Reversed total shoulder arthroplasty after acromioclavicular joint resection yields equivalent clinical results compared to a matched control group.

INTRODUCTION: Reverse total shoulder arthroplasty (RTSA) is a well-establish procedure with increasing incidence. Depending on the medical history, many patients undergo multiple soft-tissue procedures before RTSA. The role of acromioclavicular pathology as well as the consequences of a distal clavicle resection (DCR) before RTSA has not been evaluated yet. MATERIAL AND METHODS: A retrospective single-center review was performed on all patients undergoing primary RTSA with or without DCR with a minimum follow-up of 2 years. We compared patient-reported outcome measures (Constant score (CS), subjective shoulder values (SSV), and range of motion (ROM)) with a matched control group. The control group consisted of patients treated with a RTSA without DCR and matching was performed for age, sex, operating side, American Society of Anesthesiologists (ASA), body mass index (BMI), and indication. Surgical time and complication rate were recorded. RESULTS: Thirty-nine patients with a mean follow-up of 63 months (SD 33) were enrolled in the study group. Mean age was 67 years (SD 7) with 44% male patients for both groups. The mean relative CS improved from 43% (SD 17) to 73% (SD 20) in the study group, and from 43% (18) to 73% (22) in the control group. The SSV improved from 29% (SD 17) to 63% (SD 29) in the study group, and from 28% (SD 16) to 69% (SD 26) in the control group (both n.s.). The postoperative ROM did not significantly differ between the two groups. Five patients in the study group and six in the control group had reoperations. CONCLUSION: Patients who received a DCR before RTSA showed equivalent clinical outcomes compared to a match-control group with RTSA only. Surgical time was not different, and no complication related to the open DCR was observed in the study group. Therefore, we conclude that a prior DCR does not influence the postoperative outcome after RTSA. LEVEL OF EVIDENCE: Level III: Retrospective comparative study.

Correlation between preoperative clinical examination and intraoperatively found subscapularis tendon tear.

PURPOSE: Analyze the diagnostic value for subscapularis (SSC) tendon tears, their correlation between pain and strength on clinical tests, and compare them with intraoperative arthroscopic findings to prove their diagnostic value. METHODS: 110 consecutive patients undergoing arthroscopic rotator cuff repair were reviewed and allocated to isolated SSC (n = 39) and combined anterosuperior tendon tear (n = 71) groups and analyzed. Preoperative clinical testing included belly press (BPT), bear hug (BHT), lift-off (LOT), palm-up (PUT), and Jobe test (JT). All tests were performed in two categories: pain (in 4 categories: 0, 5, 10, and 15) and strength (from 0 to 5). The tendon tears were intraoperatively reviewed and classified. RESULTS: Mean age was 59 years (SD 10). The sensitivity of the BHT was 88.2% and 74.5% for BPT, while specificity was only 41.9% for BHT and 45% for BPT. Sensitivity of JT was 90.5% and 87.5% for PUT, while specificity was only 41% for JT and 28.2% for PUT. A low positive correlation for an intraoperative SSC lesion and the strength of BPT (Spearman rank correlation - 0.425; p value < 0.0001) and the strength of BHT ( - 0.362; p value = 0.001) could be found. With linear regression analysis estimated by ordinary least squares, a correlation between BPT strength and surgical grade of SSC lesion (- 0.528; 95% CI, - 0.923 to - 0.133; pvalue < 0.01) was found. CONCLUSION: The BHT showed a higher sensitivity for a SSC lesion, while the BPT had a higher correlation between preoperative testing, most notably internal rotation strength, and intraoperative surgical grade of the SSC tendon lesion. LEVEL OF EVIDENCE: Level II, Prospective cohort study for Diagnostic tests.

Acceptable Long-Term Outcomes of Arthroscopic Bone Grafting for Recurrent Posterior Shoulder Instability: Minimum Follow-Up of 5 Years.

PURPOSE: To examine the long-term clinical outcome associated with arthroscopically placed autologous iliac crest bone graft (ICBG) for recurrent posterior shoulder instability. METHODS: From January 2008 to December 2013, patients treated with posterior ICBG and a minimum follow-up of 5 years were included. Clinical outcome of patients operated with a posterior ICBG was analyzed with multiple patient-reported outcome measures included Constant (CS), American Shoulder and Elbow Surgeons (ASES), Walch-Duplay, and Rowe scores, shoulder subjective value, and pain visual analog score. Patient satisfaction was assessed by asking the patients their overall level of satisfaction at last follow-up on a 1 to 10 scale. RESULTS: In total, 18 patients (19 shoulders) were included. At a mean follow-up of 7.3 years (range, 5-10 years), patients had significant improvements in their mean CS from 63 (standard deviation [SD] 18) to 80 (SD 18; P = .005), ASES from 57 (SD 18) to 81 (SD 18; P = .003), Walch-Duplay from 34 (SD 31) to 79 (SD 22; P < .001), and Rowe score from 37 (SD 23) to 79 (SD 24; P < .001). Pain level decreased from 5.6 (SD 2.5) preoperative to 2.3 (SD 2.3; P < .001) and shoulder subjective value improved 58 (SD 20) to 76 (SD 24; P = .002). Global satisfaction with the procedure was 8.4 (SD 2.1). Clinical significance was met or exceeded by 84% for CS and 89% of the patients for ASES and 95% met or exceeded satisfaction threshold for CS. There were 7 shoulders (37%) reoperated for symptomatic screw irritation. CONCLUSIONS: This series reporting on the long-term follow-up after arthroscopic posterior ICBG for recurrent posterior shoulder instability demonstrates, despite a high number of reoperations for symptomatic screw irritation, its effectiveness with acceptable clinical outcomes and satisfied patients. LEVEL OF EVIDENCE: IV, therapeutic case series.