Clinical Outcomes and Re-Tear Rates for Partial Arthroscopic Rotator Cuff Repair With or Without Biceps Augmentation for Large-to-Massive Tears: A Systematic Review and Meta-analysis.

BACKGROUND: The recent addition of biceps tendon augmentation to partial arthroscopic rotator cuff repair (ARCR) for the treatment of large-to-massive rotator cuff tears is proposed to improve clinical outcomes and reduce re-tears. MATERIALS AND METHODS: The purpose of this systematic review and meta-analysis (5 studies) was to compare outcomes between partial ARCR with (142 patients) and without (149 patients) biceps augmentation. RESULTS: Partial ARCR with and without biceps augmentation were comparable in pain, function, and range of motion. However, biceps augmentation vs no augmentation at all during ARCR may lower re-tear rates for irreparable large-to-massive rotator cuff tears (42.9% vs 72.5%, P=.007). CONCLUSION: More research is needed to investigate this technique and guide surgical decision-making. [Orthopedics. 2024;47(5):e217-e224.].

Clinical Outcomes and Complication Rates for Noncontiguous Anterior Cervical Discectomy and Fusion, Cervical Disc Arthroplasty, and Hybrid Cervical Surgery: A Systematic Review.

OBJECTIVE: This study examined clinical outcomes associated with 3 types of noncontiguous cervical surgeries - anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and hybrid cervical surgery (HCS) - to improve surgeon decision-making. METHODS: A systematic review was performed using PubMed, CINAHL, MEDLINE, and Web of Science from database inception until June 6th, 2023. Inclusion criteria were studies that reported any type of clinical outcome, examined noncontiguous ACDF, noncontiguous CDA, and/or noncontiguous HCS. RESULTS: Ten articles out of 523 articles initially retrieved were included. Patients (n = 388) had a mean age of 52 ± 5.1 years and a mean follow up time of 33 ± 6.0 months. Overall, 119 patients underwent non-contiguous HCS, 65 underwent non-contiguous CDA, and 204 underwent non-contiguous ACDF. There appears to be no clinically meaningful difference in Neck Disability Index (NDI) score, Japanese Orthopedic Association (JOA) score, and improvement in pain based on surgery type. There was a total of 83 complications (21% of cases) with non-contiguous ACDF having a higher absolute rate of dysphagia (20%) as compared to non-contiguous HCS (6.7%) or non-contiguous CDA (6.2%). Non-contiguous ACDF had a higher absolute rate of adjacent segment degeneration (ASD) as a reported complication (6.4%) as compared to non-contiguous HCS (1.7%) and non-contiguous CDA (0.0%). CONCLUSIONS: There may be no clinically meaningful difference in many clinical outcomes for different non-contiguous surgical interventions for non-contiguous cervical degenerative disc disease (CDDD). However, complication rates, such as dysphagia and ASD, appear higher for non-contiguous ACDF as compared to non-contiguous CDA or HCS.

The Impact of Ketorolac Utilization on Outcomes for Lumbar Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: Ketorolac is one of the most potent nonsteroidal anti-inflammatory drugs commonly used in spine surgery. The purpose of this study is to examine the impact of ketorolac utilization with or without other medications on a patient's postoperative course after lumbar surgery. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed using PubMed, CINAHL, MEDLINE, and Web of Science in July 2023. Inclusion criteria were RCTs that used ketorolac for lumbar surgery. RESULTS: Thirteen RCTs were included (N = 997; mean age, 54.6 ± 7.8 years; n = 535 in the ketorolac group) in this systematic review. There was no significant difference in the 24-hour and total postoperative morphine utilization (P = 0.185 and P = 0.109, respectively), 24-hour and final postoperative pain scores (0-10 scale) (P = 0.065 and P = 0.582, respectively), and length of stay at the hospital (P = 0.990) between patients in the ketorolac group and patients in the non-ketorolac group who underwent lumbar surgery. Overall, patients had similar rates of major complications (3.7% vs. 5.4%) and minor complications (42.1% vs. 51.7%) between groups after lumbar surgery. However, patients in the ketorolac group had a significantly lower rate of nausea and/or vomiting compared with the non-ketorolac group after lumbar surgery (21.6% vs. 37.1%, respectively; P = 0.018). CONCLUSIONS: There is no significant difference in 24-hour and total postoperative morphine utilization, pain scores, or length of stay, with similar complication rates after lumbar surgery between patients receiving ketorolac and patients not receiving ketorolac via meta-analysis of RCTs.

Examining the Dimensions of the Bicipital Groove: A Human Cadaveric Study.

Introduction Understanding the mechanisms and risk factors associated with bicipital groove (BG) morphology is essential for optimizing patient outcomes. Despite interest in the topic of BG morphology, there remains a lack of clarity and consensus on the parameters of BG morphology due to significant methodological limitations in the existing research. The purpose of this study is to explore the dimensions of BG morphology with a methodology rooted in recent research findings to better understand the human anatomy, potentially underpinning various shoulder pathologies.  Methods The right shoulders of seventeen cadavers (nine male and eight female; median age of death: 88.0 years; age of death range: 66.0 - 97.0 years) were included in this cadaveric study. Dissection was done by removing the deltoid musculature and reflecting the long head of the biceps tendon to expose the BG. Measurements for BG morphology included BG width (millimeters, mm), depth (mm), and length (mm). Statistical comparisons were done between male and female measurements using the independent-samples Mann-Whitney U test due to the small sample size.  Results The median width of the BG at the narrowest point was 4.3 mm (mean: 4.7 ± 1.4 mm; range: 3.0 - 7.7 mm) with male cadavers having a significantly wider BG as compared to female cadavers (median: 5.0 mm versus 3.7 mm; p=0.006). The median depth of the BG was 5.1 mm (mean: 5.0 ± 0.7 mm; range: 3.8 - 6.3 mm) with no statistically significant difference between male and female cadavers (median: 4.8 mm versus 5.3 mm; p=0.370). The median length of the BG was 25.1 mm (mean: 25.1 ± 3.3 mm; range: 18.1 - 31.3 mm) with no statistically significant difference between male and female cadavers (median: 25.4 mm versus 23.9 mm; p=0.673). Conclusion The width of the BG at the narrowest point was significantly larger in male cadavers as compared to female cadavers in this study. However, there was no difference between male and female cadavers in terms of depth and length of the BG. This study contributes to the understanding of BG morphology by exploring the dimensions for width, depth, and length of the BG, which may contribute to biceps tendon pathology in clinical practice. Future research should focus on reducing measurement variability and exploring the possible relationship between BG morphology and biceps tendon conditions to further enhance the understanding of this complex relationship.