Minimal Clinically Important Differences for Oxford, Constant, and University of California Los Angeles Shoulder Scores After Reverse Shoulder Arthroplasty to Allow Interpretation of Patient-Reported Outcome Measures and Future Statistical Power Analyses.

PURPOSE: To determine the minimal clinically important difference (MCID) for the Constant-Murley Score (CMS), University of California Los Angeles (UCLA) Shoulder Score, and Oxford Shoulder Score (OSS) after reverse shoulder arthroplasty. METHODS: Patients were prospectively followed up between January 2011 and February 2020. Inclusion criteria was that of patients who underwent reverse shoulder arthroplasty for massive irreparable cuff tear, cuff tear arthropathy, and fractures, with and without previous cuff repair, by a fellowship-trained surgeon. Patients were assessed preoperatively and at 3, 6, and 12 months' postoperatively. Functional outcome was assessed by the CMS, UCLA Shoulder Score, and OSS and the respective MCIDs were determined using simple linear regression in consonance with patient satisfaction and expectation fulfilment. RESULTS: A total of 131 patients were followed up for 12 months. The MCIDs at 3 months for CMS, UCLA Shoulder Score, and OSS were 7.2, 3.3, and 6.9, respectively. At 6 months, the MCIDs for CMS, UCLA Shoulder Score, and OSS were 6.6, 2.4, and 4.7, respectively. At 12 months, the MCIDs for CMS, UCLA Shoulder Score, and OSS were 9.3, 2.9, and 6.6, respectively. CONCLUSIONS: CMS, UCLA Shoulder Score, and OSS are valid scores to calculate MCID after reverse shoulder arthroplasty, and the MCID established in this study can be used for the interpretation of these scores to help in statistical power analysis for future studies. LEVEL OF EVIDENCE: III, retrospective cohort study.

Open Excision of Olecranon Melorheostosis to Relieve Elbow Extension Block.

We report a 34-year-old man who presented with hyperostosis of his right elbow associated with an inability to fully extend his elbow. The radiographic assessment revealed a classical dripping candle wax appearance of his proximal ulna suggestive of melorheostosis. Computed tomography was performed to identify the impingement point and aid in surgical planning. A targeted open excision biopsy via a Boyd incision was performed to excise the exophytic component that was causing the functional block. After surgery, he achieved full elbow extension and was able to return to his usual activity.

No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series.

PURPOSE: To evaluate and compare the functional outcomes after arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tears. METHODS: We conducted a retrospective analysis of patients who had undergone arthroscopic tear completion and subsequent repair of symptomatic partial-thickness rotator cuff tears in a single institution from 2010 to 2015. Range of motion (ROM) (forward flexion and abduction), the pain score as measured on the Numeric Pain Rating Scale, and outcome scores (Constant-Murley score, University of California, Los Angeles shoulder score, and Oxford Shoulder Score) were calculated preoperatively and at 1 year and 2 years postoperatively. The delta difference was calculated for each outcome parameter at the respective follow-up points as the difference from the preoperative baseline score. RESULTS: A total of 104 patients were included. All tears involved the supraspinatus tendon and did not exceed 2 cm. Of the patients, 65 had an articular-sided tear (AST) whereas 39 had a bursal-sided tear (BST). The mean age of the patients was 53.4 years in the AST group and 55.8 years in the BST group. The AST and BST groups did not differ preoperatively in terms of age, sex, and the measured outcome parameters. Postoperatively, the patients in both groups achieved statistically significant improvement in pain relief and functional outcomes at 2 years. No statistically significant difference was observed between the 2 groups in terms of the delta-difference outcomes in ROM in forward flexion (P = .781) or abduction (P = .348), pain score (P = .187), Constant-Murley score (P = .186), University of California, Los Angeles shoulder score (P = .911), and Oxford Shoulder Score (P = .186) at 2 years. CONCLUSIONS: Partial-thickness rotator cuff tears treated with arthroscopic tear completion and subsequent repair achieved good outcomes in terms of ROM, functional outcomes, and pain relief at 2 years. There was no difference in outcomes regardless of whether the location of the tear was articular sided or bursal sided. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Arthroscopic rotator cuff repair results in similar postoperative functional outcomes in patients with only rotator cuff tears and those with concomitant cervical radiculopathy.

PURPOSE: The aim of this study was to compare postoperative functional outcomes after arthroscopic rotator cuff repair in patients with only rotator cuff tears versus those with concomitant cervical radiculopathy. METHODS: A retrospective study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2012 and 2016 was conducted. Patients included in the study were divided into two groups: (1) those with rotator cuff tears only (RC only) and (2) those with concomitant cervical radiculopathy (RC + radiculopathy). Cervical radiculopathy was treated non-surgically in these patients. Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), University of California at Los Angeles Shoulder Score (UCLASS) and Visual Analog Scale (VAS) pain score were measured for each patient preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS: As compared to the RC-only group (n = 324), the RC + radiculopathy group (n = 33) had significantly poorer OSS (p = 0.001), CSS (p = 0.017) and UCLASS (p = 0.009) functional scores preoperatively. On follow-up, there were no significant differences in functional outcomes between the groups at 3, 6, 12 and 24 months postoperatively for OSS, CSS, UCLASS and VAS pain scores, with the exception of CSS which was higher in the RC-only group at 6 months (p = 0.007). The absolute change and number of patients that attained minimum clinically important difference (MCID) for OSS, CSS and UCLASS at 12- and 24-month follow-ups were also comparable between the groups. CONCLUSION: Patients with rotator cuff tears and concomitant cervical radiculopathy achieve similar postoperative functional outcomes to those with only rotator cuff tears, after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: III.

Outcomes of Arthroscopic Rotator Cuff Repair in Stiff Shoulders are Comparable to Non-Stiff Shoulders When Combined With Manipulation Under Anesthesia.

PURPOSE: The purpose of this study was to compare the outcomes of arthroscopic rotator cuff repair (ARCR) in patients with preoperative stiffness to those without. METHODS: A total of 135 patients were prospectively evaluated for 2 years after ARCR for small to medium sized rotator cuff tears at our institution. Patients were divided into stiff (<100° of passive forward flexion) and non-stiff cohorts. The stiff group underwent manipulation under anesthesia (MUA) before ARCR was performed. Outcomes were measured using visual analog scale (VAS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) recorded at the preoperative, 6- , 12-, and 24-month time points. The results of ARCR between the cohorts were then compared. RESULTS: A total of 123 out of 135 patients (91.1%) completed the follow-up (stiff n = 46, non-stiff n = 77). There were significant improvements in the mean CSS scores at 6 (mean, 59.87; P < .001) and 12 months (mean, 65.88; P = .021) in the stiff group. There were no significant differences detectable in the CSS and OSS scores between the stiff and non-stiff groups at 6, 12, and 24 months. However, the percentage of patients achieving minimal clinically important difference was significantly higher in the stiff group (97.8%) compared with the non-stiff group (75.3%; P = .001). The VAS scores, forward flexion, and strength in both groups were found to be comparable. CONCLUSIONS: The results of our study showed no significant differences in outcomes scores in patients with stiff shoulders who underwent MUA combined with ARCR compared with patients with non-stiff shoulders who underwent ARCR alone. Therefore, early surgical repair should be considered in patients with rotator cuff tears and concomitant shoulder stiffness. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Gap formation after single lateral row versus dual-row suture bridge cuff repair: An ovine biomechanical model.

BACKGROUND: The aim of this study is to compare two types of suture bridging constructs; a laterally based bridging single row (SR) construct and a classic dual row (DR) suture bridge construct. The hypothesis is that the DR construct will demonstrate superior biomechanical properties. METHODS: Six matched pairs of sheep infraspinatus tendon tears repaired with these two different types of suture bridging techniques were tested for gap formation, ultimate failure load and mode of failure. The specimens were pre-cycled for 10 cycles before they were subjected to a constant pre-load of 10N. The specimens were then subjected to cyclic loading at a speed of 8.33 mm/s. The test was stopped after every 500 cycles for a total of 3000 cycles. RESULTS: Mean gap formation after 3000 cycles was lower in the DR group (0.81 ± 0.2 mm versus 2.44 ± 0.27 mm; p = 0.002). Mean change in gap (with every 500 cycles) was also lesser for the DR group after 1500 cycles. DR repairs failed at a higher load (523.4 ± 80.4 N) compared to the SR repairs (452.3 ± 66.3 N) but this did not reach significance. All repairs failed with sutures pulling through the tendon during load to failure testing. CONCLUSIONS: Gap formation is significantly lower with a dual row suture bridge construct than a laterally based bridging single row construct. LEVEL OF EVIDENCE: Biomechanical study.

Editorial Commentary: Outcomes in Arthroscopic Rotator Cuff Repairs: Are We Treating Patients or Radiographs?

Rotator cuff tears are among the most common disorders of the shoulder girdle requiring surgical intervention, and it is no surprise that orthopaedic surgeons have searched far and wide for means to improve on rotator cuff repair outcomes. Radiological parameters such as the critical shoulder angle have recently emerged and have been associated with the presence of degenerative rotator cuff tears. However, their true impact on postoperative outcomes are still unclear. Although radiological parameters, because of their objectivity, will always remain a critical part of a surgeon's preoperative assessment, we must remember that ultimately we are treating patients and not radiographs.

Impact of Diaphyseal Cortical Thickness on Functional Outcomes After Arthroscopic Rotator Cuff Repair.

PURPOSE: To study the influence of combined cortical thickness (CCT) of the proximal humerus on arthroscopic rotator cuff tear repair outcomes. METHODS: The study included 210 patients who underwent arthroscopic repair of full-thickness supraspinatus tears. An independent reviewer measured CCT on preoperative radiographs, and patients were evaluated postoperatively at 3, 6, 12, and 24 months. Functional outcome was assessed with the Constant shoulder score (CSS), Oxford shoulder score (OSS), and University of California at Los Angeles Shoulder rating scale (UCLASS). The patients were divided based on CCT: ≥4 mm (higher CCT) and <4 mm (lower CCT). Univariate analysis and multivariate linear regressions were applied to study the effect of higher CCT on functional scores. RESULTS: At 6 months' follow-up, CSS and UCLASS were higher in the patients with higher CCT (mean ± standard deviation, 59 ± 17 vs 54 ± 14, P = .020; and 30 ± 5 vs 28 ± 5, P = .020, respectively). At 12 months' follow-up, CSS, UCLASS, and OSS were higher in the patients with higher CCT (71 ± 13 vs 65 ± 14, P = .002; 30 ± 5 vs 28 ± 5, P = .009; and 15 ± 6 vs 18 ± 7, P = .001, respectively). At 24 months' follow-up, CSS and OSS were higher in the patients with higher CCT (74 ± 11 vs 69 ± 13, P = .006; and 14 ± 4 vs 16 ± 8, P = .041, respectively). CONCLUSION: We conclude that although a higher CCT is not associated with clinically significant differences in functional outcomes, further studies examining postoperative imaging as well as perioperative optimization of bone mineral density may yield valuable results regarding the impact of CCT on cuff healing and functional outcomes. LEVEL OF EVIDENCE: III (retrospective comparative therapeutic trial).

Determination of Threshold Scores for Treatment Success After Arthroscopic Rotator Cuff Repair Using Oxford, Constant, and University of California, Los Angeles Shoulder Scores.

PURPOSE: To determine the threshold scores for the Constant-Murley score (CMS); University of California, Los Angeles (UCLA) shoulder score; and Oxford Shoulder Score (OSS) that determine treatment success after arthroscopic rotator cuff (RC) repair. METHODS: Patients who underwent unilateral arthroscopic double-row RC repair by a single surgeon between 2010 and 2015 were prospectively followed up and assessed preoperatively and at 6, 12, and 24 months postoperatively. Perceived pain was measured with a visual analog scale, and functional outcome was assessed by the CMS, UCLA score, and OSS. Treatment success was defined as simultaneous fulfillment of 3 criteria: improvement in pain, expectations for surgery met, and patient satisfied with surgery. Threshold scores were determined by receiver operating characteristic (ROC) analyses, using the various scores as predictors and the defined treatment success as the criterion. RESULTS: The study included a total of 214 patients (96 male and 118 female patients) with a mean age of 60.1 ± 10 years. Most patients showed improvement in pain (≥88%) and high satisfaction (≥93%) and expectation fulfillment (≥80%) postoperatively. Of the patients, 73% had treatment success at 6 months; 85%, at 12 months; and 80%, at 24 months. ROC analyses showed good prediction of treatment success using the CMS, UCLA score, and OSS at all 3 follow-up time points (area under the ROC curve [AUC] > 0.70), with excellent prediction using the UCLA score at 12 months and 24 months (AUC, 0.811 and 0.805, respectively) and the OSS at 12 months (AUC, 0.820). The following threshold scores were identified: CMS of 59, UCLA score of 21, and OSS of 42 at 6 months; CMS of 61, UCLA score of 26, and OSS of 43 at 12 months; and CMS of 65, UCLA score of 30, and OSS of 46 at 24 months. CONCLUSIONS: The CMS, UCLA score, and OSS have good predictive value in defining treatment success after arthroscopic RC repair. The cutoff scores are time dependent. LEVEL OF EVIDENCE: Level II, development of diagnostic criteria.

Gender-based differences in mid-term clinical outcomes and patient acceptable symptomatic state attainment after arthroscopic rotator cuff repair: Minimum 2-year follow up.

OBJECTIVE: There is paucity of literature on the impact of patients' gender on recovery and treatment success after arthroscopic rotator cuff repair. This study investigates the effect of gender on patient-reported outcomes preoperatively and postoperatively (minimum 2 years), and to determine if gender affects the attainment of patient-acceptable symptomatic state (PASS) thresholds. METHODS: 266 patients (117 males, 149 females), who underwent primary arthroscopic rotator cuff repair for atraumatic, full-thickness tears, were included. Functional outcomes and pain scores were collected preoperatively and postoperatively. Percentage of attainment of PASS for the various outcome scores was calculated and compared between males and females. RESULTS: Women had statistically significantly poorer functional outcome and pain scores preoperatively and at 1 and 2 years postoperatively (P â€‹< â€‹0.01). They also experienced less improvement in outcome scores throughout the postoperative period. Women had statistically significantly lower rates of PASS attainment at 2 years postoperatively. CONCLUSION: Women experience greater pain and poorer shoulder function compared with men preoperatively, and up to 2 years postoperatively. Women are less likely to achieve PASS thresholds postoperatively, compared to their male counterparts. STUDY DESIGN: Retrospective Cohort Study. LEVEL OF EVIDENCE: III.

Defining minimal clinically important difference, patient acceptable symptomatic state and substantial clinical benefit for the visual analog scale pain score after arthroscopic rotator cuff repair.

INTRODUCTION: Patient satisfaction after arthroscopic rotator cuff repair (RCR) is commonly assessed with patient-reported outcome measures (PROMs), and there is an increased need to establish clinical relevance within these measures. The purpose of this study was to (1) define minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) for the visual analog scale (VAS) pain score in patients undergoing arthroscopic RCR, and (2) identify preoperative predictors of achieving each of these threshold values. METHODS: Data from consecutive patients who underwent primary arthroscopic rotator cuff repair study between 2010 and 2016 were prospectively collected. Baseline data and VAS pain scores were collected preoperatively and at 1 year and 2 years postoperatively. MCID, PASS and SCB were determined using an anchor-based approach, with anchor questions assessing postoperative satisfaction and expectation fulfillment. Multivariate logistic regression analysis was also used to identify preoperative predictors for achieving MCID, PASS, and SCB. RESULTS: A total of 286 patients were included in the final analysis, with an average age of 60.2 â€‹± â€‹10.4 and the majority being female (61.2%). The values for the VAS pain score identified to represent MCID, PASS, and SCB, respectively, at 1-year postoperatively were: 5, 2, and 1. The rates of achieving clinically significant improvement based on VAS were 60.5%, 63.3%, and 57.2%, respectively. A higher preoperative VAS was predictive for achieving MCID (odds ratio [OR], 1.84; P â€‹< â€‹0.01). CONCLUSION: This study identified threshold VAS pain scores of 5, 2, and 1 for achieving MCID, PASS, and SCB, respectively, at 1-year follow-up after arthroscopic rotator cuff repair. A higher preoperative VAS pain score was also identified as a statistically significant predictor of attaining MCID after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: II.

Different types of rotator cuff tear morphology do not affect post-repair clinical outcomes in large to massive tears.

OBJECTIVES: The primary aim of this current study is to evaluate the effects of rotator cuff tear morphology on clinical outcomes in large to massive tears, using a modified version of the existing classification system, with specific focus on tear symmetry and use of margin convergence. METHODS: Patients who underwent arthroscopic repair of large to massive, full thickness rotator cuff tears were retrospectively analysed. The tear pattern was classified at the time of surgery as Type IA, Type IB, Type IIA, and Type IIB according to tear symmetry and direction of maximum tear diameter, with Type I being symmetrical and Type II being asymmetrical. Type IA (U-shaped) had greater mediolateral (ML) than anteroposterior (AP) diameter while Type IB (crescent shaped) had greater AP than ML diameter. Type IIA tears have an anterior extension towards the rotator interval while IIB tears have a posterior extension into the infraspinatus, similar to AP L-shaped tears established in the literature. Type I tears were typically repaired from medial to lateral while Type II tears were repaired diagonally. All types were repaired using double row technique, with the addition of margin convergence for Types IA and IIB, which had larger tears in the medial and lateral directions. Primary outcome measures were Oxford Shoulder Score, Constant Shoulder Score, University of California at Los Angeles Shoulder Score followed-up at 6, 12, and 24-months as well as retear rates at latest follow-up. RESULTS: In total, 109 patients were included in the study with a mean age of 65.5 â€‹± â€‹9.4. The prevalence of each tear morphologies from Type IA to IIB was 22.0 â€‹%, 34.9 â€‹%, 27.5 â€‹%, and 15.6 â€‹%, respectively. All four groups showed statistically significant improvement from pre-operative scores in all 3 outcome measures at 24 months (p â€‹< â€‹0.001 for all). No significant difference in primary outcome measures or retear rates was detected between all 4 groups. CONCLUSION: This study found that different types of cuff tear morphology, despite affecting surgical repair technique, does not influence clinical outcomes post-arthroscopic rotator cuff repair at mid-term follow-up. LEVEL OF EVIDENCE: Retrospective Cohort study, Level III.

Determining patient acceptable symptom states from patient reported outcome measures following reverse shoulder arthroplasty: Constant-murley, UCLA, Oxford Shoulder Scores.

Aims: To establish cut-off values for Patient-Acceptable Symptom States (PASS) in three Patient Reported Outcome Measures (PROMs), the Constant-Murley Score (CMS) and University of California Los Angeles (UCLA) Shoulder Score and Oxford Shoulder Score (OSS) at 3, 6, and 12-months following reverse shoulder arthroplasty (RSA). Methods: A retrospective study was conducted for individuals who were treated for massive rotator cuff tear, rotator cuff arthropathy or proximal humerus fractures with RSA from January 2011 and February 2020. This study included patients who have completed the patient reported outcome measures (PROMs) and satisfaction questions preoperatively, and at 3, 6 and 12-months after the procedure. Functional outcome were evaluated by CMS, UCLA shoulder score and OSS, with one anchoring question regarding satisfaction. PASS thresholds for each PROM were obtained with the Youden method, by using the receiver operating characteristic analysis, and secondary analysis was performed with the 80% specificity and 75th percentile method. Results: 129 patients were included. 74.2%, 83.9%, and 89.3% of patients were found to have a satisfactory symptom state at 3, 6 and 12-months postoperatively. At 3, 6 and 12-month intervals, the respective PASS thresholds were 42, 39 and 52 for CMS, 17, 21 and 26 for UCLA score and 28, 25 and 18 for OSS. Conclusions: PASS thresholds for RSA at 3, 6 and 12-months were found for CMS (42, 39, 52), UCLA (17, 21, 26) and OSS (28, 25, 18). These thresholds suggest increasing expectations with a trend towards higher functional requirements at each time point.

Pre-operative transverse tendon thickness in small and mid-sized rotator cuff tears does not affect clinical outcomes after arthroscopic repair.

INTRODUCTION: Previous studies on rotator cuff tears have examined both clinical and radiographic parameters which may influence post-operative clinical outcomes. While rotator cuff tears are frequently classified by size or depth, there is currently no literature available examining the thickness of the remnant tendon, and its impact on post-operative outcomes. We hypothesize that decreased pre-operative transverse tendon thickness will result in poorer post-operative clinical outcomes. METHODS: We prospectively recruited patients who underwent arthroscopic repair of small to medium full-thickness rotator cuff tears. These patients were followed up for a minimum of 2 years post-operatively. Basic biodata, as well as Visual Analog Scale (VAS) for pain, Constant-Murley Score (CMS), UCLA Shoulder Score (USS), and Oxford Shoulder Score (OSS) at 3 different time points (pre-operatively, 1 year post-operatively, and 2 years post-operatively) were collected. Transverse tendon thickness was measured by independent blinded radiologists on pre-operative ultrasonographic images. Wilcoxon signed-rank test was used to compare outcome scores and multivariable robust linear model was fitted to assess the effect of transverse tendon thickness on post-operative scores. RESULTS: A total of 63 patients were enrolled in this study, predominantly female (65%) and had a median age of 72 years. Pre-operatively, the median transverse cuff thickness was 5.0 â€‹mm and median tear size was 1.4 â€‹cm. The median VAS at preoperative was 7, which reduced to 0 â€‹at 2 year post-operative, indicating statistically significant improvement in pain levels (p â€‹< â€‹0.001). Statistically significant improvement in shoulder function measured by CMS, UCLA score and OSS were also seen over time (p â€‹< â€‹0.001). Robust regression analysis revealed that transverse cuff thickness had no statistically significant effect on VAS (p â€‹= â€‹0.99), CMS (p â€‹= â€‹0.84), UCLA score (p â€‹= â€‹0.22), and OSS scores (p â€‹= â€‹0.73) at 2 years postoperatively. DISCUSSION: Pre-operative transverse tendon thickness of small- to mid-sized supraspinatus tears does not influence clinical outcomes after arthroscopic repair. Differences in transverse tendon thickness may have an association with tendon healing but do not translate to an association with post-operative outcomes in terms of pain, function, and patient-reported outcome measures. LEVEL OF EVIDENCE: IV.

Latissimus dorsi and teres major transfer in reverse shoulder arthroplasty: A systematic review.

Background: This paper aims to conduct a systematic review of the current literature to evaluate the clinical outcomes of concurrent latissimus dorsi and teres major (LD/TM) tendon transfer in reverse shoulder arthroplasty (RSA), and to compare that to isolated RSA. Methods: A comprehensive search on PubMeb, Web of Science, Embase and CINAHL was performed from inception up to January 20, 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Cohort studies, case-control studies, randomized controlled trials and case series that were written in English, which involved patients who underwent RSA with LD/TM transfer were included. Quality of studies was appraised using the Cochrane Risk Of Bias In Nonrandomized Studies of Interventions tool. Systematic review of Constant-Murley Score (CMS) and range of movement (ROM) was conducted. Results: Eight studies with a total of 265 patients were included. The average mean follow-up time was 42.5 months, with a range of 6 months to 136 months. Of the studies that reported outcomes of RSA with LD/TM transfer, five reported the CMS, five reported external rotation (ER) ROM and six reported forward flexion ROM. Comparing postoperative to preoperative scores, there was an improvement above the minimal clinically important difference for CMS (mean difference (MD) range = 22.40 to 41.80), ER (MD range = 29° to 36°) and forward flexion (MD range = 50° to 75°). Three studies that compared postoperative ER between RSA with and without LD/TM reported no significant difference. Conclusion: RSA with LD/TM transfer has good clinical outcomes postoperatively, but there is insufficient comparative data to suggest that it is superior or inferior to an isolated RSA.

Raised body mass index and reduced muscle bulk reduces the incidence of Popeye's deformity post tenotomy of long head of biceps brachii.

OBJECTIVES: The development of the Popeye's deformity is a known complication of long head of the biceps tendon (LHBT) tenotomy. Incidence of developing Popeye's deformity after LHBT tenotomy ranges between 13% and 70%. While this complication is well tolerated, it can be avoided with proper patient selection. We aim to study patient and clinical factors resulting in the development of the Popeye's deformity after LHBT tenotomy so as to better identify suitable surgical candidates. METHODS: 91 patients underwent unilateral rotator cuff repairs and concomitant LHBT tenotomy between March 2013 and March 2017. Assessment of patient factors contributing to Popeye's deformity included patient demographics, and physical attributes were analyzed and correlated. Patients also completed a questionnaire regarding their overall postoperative satisfaction. Prospectively collated Visual Analog Pain Scale (VAS), Constant-Murley shoulder score (CSS), University of California, Los Angeles Shoulder Score (UCLA), and Oxford Shoulder Score (OSS) were compared at 6 and 24 months post operation between patients who developed Popeye's deformity and those who did not. RESULTS: The incidence of post-tenotomy Popeye's sign was 58.9%. Majority of patients were satisfied with their procedure, postoperative function, and cosmesis. Patients who developed Popeye's sign had a statistically significant lower body mass index (BMI) (24.9 â€‹± â€‹4.2 â€‹kg/m2 versus 27.3 â€‹± â€‹4.3 â€‹kg/m2, p â€‹= â€‹0.048) (rpb â€‹= â€‹- 0.210, p â€‹> â€‹0.05) and had a greater biceps-circumference-(in flexion)-to-wrist-circumference ratio (1.91 â€‹± â€‹0.16 versus 1.83 â€‹± â€‹0.13, p â€‹= â€‹0.012) (rpb â€‹= â€‹0.319, p â€‹< â€‹0.05) than those who did not. Nevertheless, the development of Popeye's sign did not affect clinical outcomes (VAS, CSS, UCLA, and OSS; p â€‹> â€‹0.05) at 24 months. CONCLUSIONS: The incidence of Popeye's deformity is high post LHBT tenotomy. There was a greater incidence in patients with lower BMI and greater biceps brachii muscle bulk. However, this complication is well tolerated. By better selecting our patients, we can achieve better outcomes and minimize potential complications. LEVEL OF EVIDENCE: Level-III evidence. TYPE OF STUDY: Retrospective comparative study.

Short- to medium-term outcomes and future direction of reverse shoulder arthroplasty: Current concepts.

Reverse shoulder arthroplasty is typically indicated for patients with severe shoulder osteoarthritis, rotator cuff tear arthropathy, or proximal humerus fractures that have failed to heal properly. The primary goal of reverse shoulder arthroplasty is to improve shoulder function and reduce pain, while also restoring the ability to perform daily activities. There is a growing body of evidence supporting the effectiveness of reverse shoulder arthroplasty in improving shoulder function and reducing pain in patients with severe shoulder osteoarthritis or rotator cuff tear arthropathy. Reverse shoulder arthroplasty is associated with significant improvements in shoulder function and pain reduction compared to non-surgical treatments. This paper aims to summarize current knowledge, practices and present a summary of the long-term effects of reverse shoulder arthroplasty (RSA) on patient outcomes, including how these outcomes are defined and what measures are typically used to assess them. It will also cover newer definitions of outcomes for RSA that have been developed in recent years in order to better understand the long-term effects of the procedure on patient-reported outcomes and functional ability, as well as information on revision surgery and implant survivorship, and the future of RSA (3D-navigation, patient-specific instrumentation, robotics and artificial intelligence) and its effects on outcomes.

Anatomic risk factors for arthroscopic Bankart repair failure: A case-control study comparing failure and non-failure groups in an Asian population.

Introduction: Post-arthroscopic Bankart repair failure/re-dislocation rates are influenced by several risk factors, including anatomic defects. There is limited evidence on the role of anatomic defects, especially for Hill-Sachs size in on-track lesions. This study aimed to assess glenoid bone loss, Hill-Sachs lesion and labral tear size and evaluate their contribution to post-operative instability after a primary repair. Material and methods: Across 169 patients with on-track Bankart lesions who underwent primary arthroscopic Bankart repair from 2010 to 2015, this study matched 14 failure with 14 non-failure cases based on age/gender. Patient demographics, pre-operative radiological parameters (including size of glenoid bone loss and Hill-Sachs lesion) and labral tear size were compared between the failure and non-failure groups. Result: All patients were male with a mean age of 21.01 ± 4.97. Significantly greater glenoid bone loss (p = 0.024) and labral tear size (p = 0.039) were found in the failure group. However, there was no significant difference in mean volume of Hill-Sachs lesion between the two groups (p = 0.739). Conclusion: Extensive glenoid bone loss and labral tears are risk factors for post-arthroscopic Bankart failure. However, the size of Hill-Sachs lesion is not a risk factor for failure, in a specific group of on-track Hill-Sachs lesions. Level of evidence: Retrospective Study, Level IV.

Diagnosis and treatment of avascular necrosis of the humeral head: Current concepts.

Avascular necrosis (AVN) of the humeral head is an uncommon clinical entity which can result in significant morbidity for patients. There is a paucity of literature concerning humeral head AVN, which may be due to the relatively rarity of the condition and poorly understood nature. Despite being first described decades ago, the underlying pathophysiology leading to humeral head AVN is still poorly defined. While the staging of humeral head AVN is well described, not much is known about prognosticating factors to predict the eventual course. Most of the management options are based on that of femoral head AVN, and even so, there is a paucity of good quality clinical trials in the literature. This current concepts paper describes what is known about humeral head AVN and proposes a management algorithm to guide clinicians.

Non-selective NSAIDs do not increase retear rates post-arthroscopic rotator cuff repair: A meta-analysis.

BACKGROUND: Arthroscopic rotator cuff repairs (RCRs) are known to be associated with substantial pain and post-operative pain management is critical in overall patients' outcomes. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used oral medications and can reduce opioid usage. However, controversies arise due to its postulated effect on postoperative tendon healing. As the evidence of safety and efficacy of NSAIDs remains unclear, this study aims to investigate the effect of NSAIDs on retear rates and clinical outcomes. METHODS: A systematic search of four databases (PubMed, EMBASE, Scopus, and Cochrane Library) was conducted, identifying studies that compared cohorts with post-RCR NSAIDs use versus control groups without NSAID use. Meta-analysis was conducted for retear rate as well as pain and functional outcomes (Visual Analogue Scale and American Shoulder and Elbow Surgeons Shoulder score). Subgroup analysis was conducted for retear rates to determine the overall treatment effect of including selective COX-2 inhibitors. RESULTS: Six studies were included in the meta-analysis. The total baseline cohort size was 916, with 443 (48.3%) patients in the NSAID group and 473 (51.6%) patients in the control group. There were no statistically significant differences in the baseline characteristics between the two groups. Meta-analysis between the two groups showed that there were no statistically significant differences in retear rates (p â€‹= â€‹0.70), early and late post-operative Visual Analogue Scale score (p â€‹= â€‹0.10 and p â€‹= â€‹0.10, respectively) and latest American Shoulder and Elbow Surgeons Shoulder score (p â€‹= â€‹0.31). However, subgroup analysis of retear rates revealed a statistically significant difference between the subgroup including COX-2 selective inhibitor versus non-selective COX inhibitor (p â€‹< â€‹0.01). CONCLUSION: NSAID use in post-arthroscopic RCR pain relief does not increase retear rates and can provide similar clinical outcomes compared to a non-NSAID regimen. LEVEL OF EVIDENCE: Meta-analysis, level of evidence, 4.