Revision reverse shoulder arthroplasty has similar outcomes to primary reverse shoulder arthroplasty at 5 Year average follow-up.

Background: Shoulder arthroplasty is a successful procedure that provides pain relief and improvements in function and range of motion. Anatomic and reverse shoulder arthroplasty are both effective procedures, and their indications continue to expand. We look at the outcomes of revision reverse total shoulder arthroplasty and compare it to the outcomes of primary reverse and anatomic total shoulder arthroplasty. Methods: We identified patients undergoing total shoulder arthroplasty at our institution between the years of 2010 and 2020. Data was prospectively collected and retrospectively reviewed for post-operative range of motion and strength in patients with revision surgery and compared to controls. Measurements were collected preoperatively and postoperatively including range of motion and strength in the affected and unaffected shoulder. We collected patient reported outcome measures in person and via phone to identify subjective outcomes of total shoulder arthroplasty. Average final follow-up was 5.27 years. Results: Our total patient sample was split between three groups: those with primary anatomic arthroplasty those who underwent primary reverse arthroplasty, and those who were revised to a reverse shoulder arthroplasty. All three groups had significant improvements in abduction and forward elevation from their pre-operative baseline to two years follow-up. Primary reverse had a significant improvement over revision reverse in abduction at one year follow-up. For all other range of motion measurements, there was no statistically significant difference at 2 years between primary and revision reverse shoulder arthroplasty. Patient reported outcomes had a significant increase from pre-op to most recent follow-up in all three groups. Conclusion: Overall, our data suggest there is an improvement in outcomes with both primary and revision surgeries, and that results after revision reverse total shoulder arthroplasty may be comparable to primary reverse total shoulder arthroplasty.

Partial ligamentum teres tears are associated with larger acetabular labra and less damage to the labrum than complete ligamentum teres tears.

The purpose of this study was to investigate the association between ligamentum teres (LT) tears with hypertrophy of the acetabular labrum and cartilage and labral damage. Surgeries (1723) were performed from February 2010 to March 2016 with arthroscopic measurement of the labrum and assessment of the LT, labrum and acetabular cartilage. Labral width was measured in the anterosuperior (AS), anteroinferior (AI), posteroinferior (PI) and posterosuperior (PS) quadrants. Grade 2 (50-99% torn) LT tears had larger labra in all four quadrants (AS = 5.64 ± 1.97 mm; AI = 5.23 ± 1.51; PS = 5.58 ± 1.39; PI = 4.60 ± 1.13) than grade 3 (100% torn) (AS = 5.50 ± 1.94; AI 4.90 ± 1.43; PS 5.43 ± 1.32; PI 4.42 ± 1.03), grade 1 (<50% torn) (AS 5.30 ± 1.68; AI 4.96 ± 1.32; PS = 5.38 ± 1.13; PI = 4.45 ± 1.04) and no tear (AS = 5.09 ± 1.51; AI = 4.92 ± 1.24; PS = 5.24 ± 1.09; PI = 4.37 ± .93); P < 0.01 in all quadrants. Grade 3 LT tears had more damage to the labrum than grade 2, grade 1 and no tear; P < 0.001. ALAD tears were larger in grade 3 and grade 2 than grade 1 and non-torn LTs; P < 0.001. Grade 3 tears had a higher percentage of high-grade cartilage tears than grade 2 LT tears; P < 0.001. Degenerative tears had larger labra, labral tears and acetabular cartilage tears than full- and partial-thickness LT tears; P < 0.01. Patients with partial-thickness LT tears had larger labra in all four quadrants than full-thickness tears in the Percentile and Villar classifications. Full-thickness tears had more severe labral damage and higher-grade chondral damage than partial-thickness tears. Degenerative tears demonstrated the largest labra, labral tears and ALAD tears. The condition of the LT demonstrated an association with acetabular cartilage injury and should be evaluated when considering hip preservation surgery. LEVEL OF EVIDENCE: Level IV Case Series.

Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: a matched-pair controlled study with minimum 2-year follow-up.

BACKGROUND: The acetabular labrum is an important structure that plays a significant role in proper biomechanical function of the hip joint. When the labrum is significantly deficient, arthroscopic reconstruction could provide a potential solution for the nonfunctional labrum. PURPOSE: To compare the clinical outcomes of arthroscopic labral reconstruction (RECON) with those of arthroscopic segmental labral resection (RESEC) in patients with femoroacetabular impingement (FAI) of the hip. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between April 2010 and March 2011, all prospectively gathered data for patients with FAI who underwent arthroscopic acetabular labral reconstruction or segmental resection with a minimum 2-year follow-up were reviewed. Eleven cases in the RECON group were matched to 22 cases in the RESEC group according to the preoperative Non-Arthritic Hip Score (NAHS) and sex. The patient-reported outcome scores (PROs) used included the NAHS, the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS). Statistical analyses were performed to compare the change in PROs in both groups. RESULTS: There was no statistically significant difference between groups regarding the preoperative NAHS (P = .697), any of the other preoperative PROs, or demographic and radiographic data. The mean change in the NAHS was 24.8 ± 16.0 in the RECON group and 12.5 ± 16.0 in the RESEC group. The mean change in the HOS-activities of daily living (HOS-ADL) was 21.7 ± 16.5 in the RECON group and 9.5 ± 15.5 in the RESEC group. Comparison of the amount of change between groups showed greater improvement in the NAHS and HOS-ADL for the RECON group (P = .046 and .045, respectively). There was no statistically significant difference in the mean changes in the rest of the PROs, although there were trends in all in favor of the RECON group. All PROs in both groups showed a statistically significant improvement at follow-up compared with preoperative levels. CONCLUSION: Arthroscopic labral reconstruction is an effective and safe procedure that provides good short-term clinical outcomes in hips with insufficient and nonfunctional labra in the setting of FAI.

Endoscopic repair of a chronic incomplete proximal hamstring avulsion in a cheerleader.

: Injuries to the hamstring muscle are common among athletes, especially strains at the myotendinal junction that respond well to nonoperative treatment. Proximal hamstring avulsion injuries can be severely debilitating, and the role of endoscopic treatment for these injuries has not been explored. This article describes the case report of a 16-year-old girl who was diagnosed with incomplete proximal hamstring avulsion showing no improvement despite extensive nonoperative treatment. The patient was treated by endoscopic repair in the prone position using a novel technique. Her preoperative pain on the ischial tubercle and while sitting disappeared completely 3 months postoperatively.

Arthroscopic technique for treatment of femoroacetabular impingement.

With an increasing understanding of femoroacetabular impingement (FAI) and advancement of the surgical treatment in patients with FAI, various techniques have been published. Successful outcome after arthroscopic hip surgery depends on appropriately reshaping the bony architecture to allow for improved range of motion before impingement symptoms occur, with special attention to preserve the labrum and restore its function. We present our surgical technique for the arthroscopic treatment of FAI.