Long head of the biceps tendon versatility in reconstructive shoulder surgery: a narrative review of arthroscopic techniques and their biomechanical principles with video presentation.

The management of the long head of the biceps tendon (LHBT) during shoulder arthroscopy has been a subject of controversy for many years, with evolving discussions and trends. Despite long-standing debate, the nature of the surgical indication regarding how to treat concomitent LHBT injuries has undergone changes in recent years. It now extends beyond the timing of tenotomy to encompass considerations of alternative methods for preserving the LHBT, along with an ongoing exploration of how it can be effectively utilized in reconstructive shoulder surgery. Recent techniques describe approaches to using LHBT in a wide range of procedures, from shoulder instability to rotator cuff tears. Additionally, LHBT-based reconstructive techniques have surfaced for addressing what were formerly denoted as irreparable rotator cuff tears. While current literature provides detailed anatomical descriptions of the LHBT and many reports of novel, advanced techniques, there is still much debate regarding the decision-making process in each case. Because of the growing number of emerging techniques and the escalating debate in the subsequent paper, a decision has been made to present the current literature review concerning the potential utilization of LHBT in shoulder arthroscopy. In a dedicated video, we demonstrate the main arthroscopic techniques employed by the authors in their daily practice.

Proximal ulna morphology in various pediatric population age groups: proximal ulna dorsal angulation (PUDA) and olecranon tip-to-apex (TTA) distance.

PURPOSE: To measure proximal ulna dorsal angulation (PUDA) and olecranon tip-to-apex distance (TTA) in pediatric population to aid surgeons with data for proximal ulna fractures fixation. METHODS: Retrospective review of the hospital radiographic database. All elbow radiographs were identified and after implementing exclusion criteria, included were 95 patients aged 0-10; 53 patients aged 11-14; and 53 patients aged 15-18. PUDA was defined as the angle between lines placed on the "flat spot" of the olecranon and the dorsal edge of the ulnar shaft and TTA as the distance between the tip of the olecranon to the apex of angulation. Two evaluators performed measurements independently. RESULTS: In age group 0-10, mean PUDA was 7.53°, range 3.8-13.7, 95% CI 7.16-7.91, while mean TTA was 22.04 mm, range 8.8-50.5, 95% CI 19.92-24.17. In age group 11-14, mean PUDA was 4.99°, range 2.5-9.3, 95% CI (4.61-5.37), while mean TTA was 37.41 mm, range 16.5-66.6, 95% CI (34.91-39.90). In age group 15-18, mean PUDA was 5.18°, range 2.9-8.1, 95% CI (4.75-5.61), while mean TTA was 43.79 mm, range 24.5-79.4, 95% CI (41.38-46.19). PUDA was negatively correlated with age (r = - 0.56, p < 0.001), while TTA was positively correlated with age (r = 0.77, p < 0.001). Reliability levels of 0.81-1 or 0.61-0.80 were achieved for most of intra- and inter-rater reliabilities besides two levels of 0.41-60 and one of 0.21-0.40. CONCLUSION: The main study finding is that in most cases mean age-group values may serve as a template for proximal ulna fixation. There are some cases in which X-ray of contralateral elbow may provide surgeon with a better template. LEVEL OF EVIDENCE: II.

Arthroscopically Assisted Coraco-Clavicular Ligament Reconstruction in Treatment of Acute Displaced Distal Clavicle Fractures Provides Good to Excellent Shoulder Function Despite Low Union Rates and High Complication Rates: A Systematic Review.

PURPOSE: The aim of this systematic review was to assess the clinical outcome of arthroscopically assisted coraco-clavicular ligament (AACCL) reconstruction for treatment of displaced distal clavicle fractures in terms of union rate, complications, and shoulder function. METHODS: A review of the online databases Medline and Embase was conducted on January 1, 2021, according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications, and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS: The search strategy identified 14 studies eligible for inclusion, 12 retrospective case series and 2 nonrandomized retrospective comparative studies. All studies reported on shoulder function, union rate, and complications. The overall shoulder function was good to excellent according to Constant-Murley score, with mean scores ranging from 81.8 to 96.2 [I2 (inconsistency) = 0% (95% confidence interval [CI] = 0% to 61%)]. The mean union rate ranged from 70% to 100% [I2 = 32.6% (95% CI = 0% to 63.4%)], and the mean complication rate ranged from 0 to 28.6% [I2 = 43.4% (95% CI = 0% to 68.4%)]. The most common complications were hardware related (3.1%), wound related (2.7%), and postoperative shoulder stiffness (2.2%). CONCLUSION: This systematic review analyzed clinical studies that evaluated the outcome of AACCL reconstruction in displaced distal clavicle fractures. The overall findings of this systematic review are that the union rate can be as low as 70% with this technique and the complication rate as high as 28.6%. Overall shoulder function was good to excellent according to Constant-Murley score. As the literature surrounding this topic is heterogeneous, further comparative clinical studies are required to assess superiority compared with other traditional techniques. LEVEL OF EVIDENCE: V: systematic review of level III and IV studies.

Editorial Commentary: Adverse Events After Rotator Cuff Repair Are Not Rare: Houston, We (May) Have a Problem.

The first national medical database registry was started in Sweden in 1975, and clinical registries have gained enormous popularity. Analysis of a large database of rotator cuff repair surgeries shows that adverse events may occur in almost 1 of 5 cases, showing the use of a register as a highly beneficial source of information. However, retrospective review of prospectively collected registry data has limitations and biases as well as benefits, including inconsistent reporting and recording of data, lack of control of confounding patient variables, and loss to follow-up.

Is residual tendon a predictor of outcome following arthroscopic rotator cuff repair? A preliminary outlook at short-term follow-up.

BACKGROUND: Multiple factors including muscle atrophy, fatty infiltration, smoking, advanced patient age, and increasing tear size have been identified as risk factors for retear after rotator cuff repair. However, little is known about what effect the length of the residual rotator cuff tendon has on the success of repair and patient outcomes. METHODS: This study included 64 patients. Patients were stratified based on a residual tendon length of greater than 15 mm (group 1, residual tendon) or 15 mm or less (group 2, no residual tendon). Rotator cuff tendon integrity was then evaluated using ultrasound imaging at 6 months. Outcome measures included the Single Assessment Numeric Evaluation score, visual analog scale score, EQ5D Index score, Global Rating of Change score, and Penn Shoulder Score. RESULTS: No differences were found between groups regarding demographic data or repair configuration. Assessment of tendon healing demonstrated an increased rate of tendons that had "not healed" in group 2 (19.3% [n = 5] vs. 13.2% [n = 5]), but this difference was not statistically significant (P = .55). Functional outcome scores improved significantly from preoperatively to final follow-up in both groups and displayed no differences at 6-month follow-up. CONCLUSION: A smaller residual tendon length was not a negative predictor of clinical outcomes following arthroscopic rotator cuff repair in patients with short-term follow-up. Although there was a trend toward a decreased rate of healing in patients with smaller residual tendons, this was not significant.

The effect of subscapularis repair on dislocation rates in reverse shoulder arthroplasty: a meta-analysis and systematic review.

BACKGROUND: Reverse total shoulder arthroplasty is an effective treatment for patients with rotator cuff arthropathy; however, complication rates are relatively high (19%-50%), with implant instability and infection being particularly devastating to overall outcomes. The objective of this study was to analyze the highest level of data comparing dislocation rates and outcomes in reverse total shoulder arthroplasty with and without the subscapularis tendon repaired. METHODS: The databases MEDLINE, Embase, and CINAHL were searched using a sensitive search strategy for this meta-analysis/systematic review. Eligibility included any studies in which patients were treated with a reverse total shoulder arthroplasty in which the status of the subscapularis tendon could be determined. A data extraction form was developed to collect select data from the included studies. A meta-analysis was performed on pooled data of 5 studies comparing dislocation rates and 3 studies comparing postoperative forward elevation, rate of infection, overall complication rates, and fractures. RESULTS: Two independent researchers reviewed 1008 studies. Seven studies met inclusion criteria. A meta-analysis was performed on all level III studies, resulting in 1306 patients being analyzed. Results demonstrated lower dislocation rates in the subscapularis repair group (odds ratio, 0.19; P < .001). However, in patients without a subscapularis repair, lateralized center of rotation (COR) resulted in a significantly lower dislocation rate compared with medialized COR (odds ratio, 0.24; P < .001). CONCLUSION: The results of our meta-analysis of the available data demonstrated a decrease in dislocation risk when the subscapularis tendon was repaired in medialized and lateralized designs. When subscapularis repair is not performed, lateralized COR, regardless of humeral socket design, may reduce the dislocation rates.

Outcomes for subscapularis management techniques in shoulder arthroplasty: a systematic review.

BACKGROUND: This systematic review aims to synthesize published data for the most common subscapularis takedown and repair to compare outcomes in the setting of shoulder arthroplasty. METHODS: Searches of MEDLINE and Cochrane Library databases identified studies that reported clinical or radiologic outcomes for subscapularis management in the setting of shoulder arthroplasty. Comparisons included musculotendinous integrity, subscapularis testing and strength, shoulder range of motion, and functional outcome scores. RESULTS: The 14 included studies reported considerable variability in techniques, outcomes, and musculotendinous integrity. Lesser tuberosity osteotomy (LTO) demonstrated better healing rates (93.1%) than subscapularis peel (SP; 84.1%) and midsubstance tenotomy (ST; 75.7%), although not significantly different. A statistically significant increase in fatty infiltration was found after surgery across techniques, and range of motion and strength were similar. Mean rates of normal results for belly-press and lift-off tests were uniformly better for LTO (79.1% and 80.7%) over ST (66.7% and 65.6%), although multiple studies showed poor correlation between subscapularis functional testing and musculotendinous integrity. Mean total Constant and Western Ontario Osteoarthritis of the Shoulder Index outcome scores were slightly better for LTO (77.6, 84.2) than for SP (71.8 and 82.7). Mean American Shoulder and Elbow Surgeons scores favored the ST group (80.8) over the SP (79.1) and LTO (73) groups. CONCLUSIONS: The data suggest no significant differences exist for postoperative musculotendinous integrity or clinical outcomes among the subscapularis management techniques in shoulder arthroplasty. Subscapularis healing and integrity appear to favor the lesser tuberosity takedown method. Additional randomized controlled comparisons with long-term follow-up are needed to more effectively compare these surgical approaches.

Clinical outcomes of suprascapular nerve decompression: a systematic review.

BACKGROUND: Suprascapular neuropathy is an uncommon clinical diagnosis. Although there have been a number of case series reporting on this pathologic process, to date there has been no systematic review of these studies. This study aimed to synthesize the literature on suprascapular neuropathy with regard to clinical outcomes. The secondary objective was to detail the diagnosis and treatment of suprascapular neuropathy and any associated complications. METHODS: A systematic review was performed to identify studies that reported the results or clinical outcomes of suprascapular nerve decompression. The searches were performed using MEDLINE through PubMed and Cochrane Database of Systematic Reviews. RESULTS: Twenty-one studies comprising 275 patients and 276 shoulders met inclusion criteria. The mean age was 41.9 years, and mean follow-up was 32.5 months. The most common symptom was deep, posterior shoulder pain (97.8%), with a mean duration of symptoms before decompression of 19.0 months; 94% of patients underwent electrodiagnostic testing before decompression, and 85% of patients had results consistent with suprascapular neuropathy. The most common outcome reported was the visual analog scale score, followed by the Constant-Murley score. The mean postoperative Constant-Murley score obtained was 89% of ideal maximum. Ninety-two percent of athletes were able to return to sport. Only 2 (0.74%) complications were reported in the included studies. CONCLUSIONS: Surgical decompression in the setting of suprascapular neuropathy leads to satisfactory outcomes as evidenced by the patient-reported outcomes and return to sport rate. Furthermore, the rate of complications appears to be low.

The advantages of a spine coil over a torso coil in magnetic resonance imaging examination of the sternoclavicular joints.

PURPOSE: There are two standard methods for an magnetic resonance imaging (MRI) examination of the sternoclavicular joints: with loop coils and the patient in the prone position, or with torso coils with the patient in a supine position. In some centres these joints are examined with the spine coil in a patient laying prone. There are no reports on the advantages of this method. Our hypothesis is that despite different MRI systems, application of a spine coil will improve examination quality. MATERIAL AND METHODS: Twenty-one healthy volunteers (10 female, 11 male, mean age 25 years) were randomised into three groups and scanned using three different MRI scanners (1.5T: Siemens Avanto, Philips Ingenia, 3.0T: Philips Achieva). Each volunteer was examined twice: using a standard protocol with a torso coil and with a spine coil, in prone position. The two groups were compared with regard to the intensity of motion artefacts using the χ2 test, and to the signal-to-noise ratio with the Wilcoxon signed-rank test. RESULTS: Application of a spine coil resulted in a significant decrease in the number of motion artefacts in all three planes (axial: p = 0.0004; sagittal: p < 0.0001; coronal: p = 0.0054). Moreover, the signal-to-noise ratio was significantly increased with the application of a spine coil (28.6 ± 8.6 vs. 18.5 ± 7.3, respectively; p = 0.0002). CONCLUSIONS: Application of a spine coil with the patient in a prone position is suitable for MRI evaluation of the sternoclavicular joints. It allows a higher signal-to-noise ratio and a lower intensity of motion artefacts to be obtained compared to a torso coil.

Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults.

BACKGROUND: The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcomes between RSA and nonoperative treatment groups. METHODS: A retrospective review was performed on all 3- and 4-part proximal humeral fractures treated with either RSA or nonoperative treatment with minimum 1-year follow-up. All patients in the nonoperative cohort were offered RSA but declined. Objective patient data were obtained from medical records. Patient-reported outcomes including visual analog scale score, Single Assessment Numeric Evaluation score, Penn Shoulder Score, American Shoulder and Elbow Surgeons score, resiliency score, and Veterans Rand-12 scores were obtained at follow-up. Statistical analysis was performed by use of the Student t test for continuous variables and χ2 analysis for nonparametric data. RESULTS: We analyzed 19 nonoperative and 20 RSA patients with a mean follow-up period greater than 2 years (29 months in nonoperative group and 53 months in RSA group). There were no differences in range of motion between groups (forward elevation, 120° vs 119° [P = .87]; external rotation, 23° vs 31° [P = .06]). No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes. Among patients receiving RSA, there was no difference in outcomes in those undergoing surgery less than 30 days after injury versus those receiving delayed RSA. CONCLUSIONS: This study suggests that there are minimal benefits of RSA over nonoperative treatment for 3- and 4-part proximal humeral fractures in older adults.

Clinical evaluation of the shape of the suprascapular notch--an ultrasonographic and computed tomography comparative study: Application to shoulder pain syndromes.

The most common site of suprascapular nerve compression and injury is the suprascapular notch. The aim of this study was to assess the sensitivity and specificity of sonography in determining the type of suprascapular notch (SSN). Thirty randomized patients (60 upper extremities) underwent USG examination of the shoulder area. The results were further compared with three-dimensional reconstructions of the scapulae obtained through CT examination to place the SSNs within a fivefold classification. For identification of type I, the sensitivity was 73.3% and the specificity 97.8%. For identification of type III, the values was 96.9% and 85.7%, respectively. Type II was not found in USG examination. Discrimination between type IV and V was not possible. The mean distance between the line connecting the edges of the SSN and the skin was 38 mm in right-handed patients and 34 mm in ambidextrous subjects. Ultrasonographic examination of the SSN is characterized by high specificity for type I, and high sensitivity for type III SSN. Discrimination between type IV and V of the SSN is not recommended based on sonographic evaluation.

Do gene expression changes in articular cartilage proteases of the synovial membrane correlate with expression changes of the same genes in systemic blood cells?

PURPOSE: The aim of our study was to find whether an injury of the knee joint tissues increases gene expression of selected hyaline cartilage degenerating enzymes such as matrix metaloproteinases (MMP) and aggreacaneses (Agg). METHODS: A total of 138 patients (81 female, 57 male) were admitted for knee arthroscopy with a mean age of 38.8 years. Full blood samples were collected preoperatively and synovium samples intraoperatively. Joint tissue lesions such as menisci, anterior cruciate ligament (ACL) and hyaline cartilage were estimated. Real time PCR with spectrophotometric analysis was performed. RESULTS: An ACL lesion was found in 56 patients, medial menisci (MM) in 65, and lateral menisci (LM) in five. Chondral lesions were estimated according to Outerbridge's grading system. In laboratory tests correlation between ACL tear and gene expression was seen except TIMP1 in serum (p < 0.05). In MM lesions MMP9, Agg2 elevation in serum was observed. LM lesions erased MMP13, MMP14 in serum and MMP8 in synovium. Chondral lesions revealed that many genes had higher expression in patients without hyaline degeneration. All of the gene expressions correlated between serum and synovium. CONCLUSION: An ACL lesion provokes elevation in expression of proteases genes, while the influence of other lesions remains elusive. Gene expression in synovium correlates with peripheral blood.

[Osteoarthritis: etiology, risk factors, molecular mechanisms]. / Osteoartroza: etiologia, czynniki ryzyka, mechanizmy molekularne.

Osteoarthritis is an incurable joint disease manifesting itself with gradually progressing degenerative changes, leading to premature motor disability. These changes mainly occur owing to an imbalance between the processes of degeneration and regeneration of articular cartilage structures. Until now many risk factors favoring the development of degenerative joint disease have been identified. These include age, weight, previously sustained traumas to joints, sports, sex and genetic predisposition. The latest scientific reports confirm that the pathogenesis of changes in osteoarthritic joints is complex and occurs on many levels. Enzymes belonging to the metalloproteinases family are mainly responsible for the degeneration of articular cartilage. Their activity is regulated by numerous pro-inflammatory cytokines, transcription factors and miRNA. A thorough analysis of all processes occurring in the afflicted joints needs to be carried out before effective therapeutic strategies can be developed.

The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction.

CONTEXT: Anterior cruciate ligament (ACL) injuries greatly impact patients in terms of future performance, reduced physical activity and athletic participation, and overall economic burden. Decades of research have investigated how to improve ACL reconstruction (ACLR) outcomes. Recently, there has been growing interest to understand the effects of psychosocial factors on patient outcomes. STUDY DESIGN: Clinical review. EVIDENCE ACQUISITION: A search of the PubMed database was performed in March 2023. Articles were reviewed by at least 2 authors to determine relevance. We highlighted publications of the past 5 years while incorporating previous pertinent studies. LEVEL OF EVIDENCE: Level 5. RESULTS: There is no standardization of psychosocial factors regarding ACLR. As such, there is a lack of consensus regarding which psychosocial measures to use and when. There is a need for clarification of the complex relationship between psychosocial factors and physical function. Despite this, psychosocial factors have the potential to help predict patients who are more likely to return to sport: (1) desire/motivation to return; (2) lower levels of kinesiophobia; (3) higher levels of self-efficacy, confidence, and subjective knee function; (4) risk acceptance; and (5) social support. However, there are no standardized interventions to improve psychosocial factors after ACLR. CONCLUSION: Psychosocial factors affect outcomes after ACLR. However, the interplay between psychosocial factors and physical function is complex. There is emerging evidence that testing and interventions may improve ACLR outcomes. There is a lack of standardized interventions to determine or improve psychosocial factors after ACLR. Further research is needed to identify psychosocial factors and to develop standardized interventions for clinicians to implement to improve clinical outcomes.

Remplissage May Decrease the Redislocation Rate After Arthroscopic Bankart Repair in Patients With an Engaging Hill-Sachs Defect: A Systematic Review and Meta-analysis of Studies With Minimal 2-Year Follow-up.

BACKGROUND: The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage. PURPOSE: To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL. STUDY DESIGN: Meta-analysis; Level of evidence, 3. METHODS: PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms "remplissage" and "shoulder instability" according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up. RESULTS: From 802 articles found during the initial search, 7 studies with a total of 837 patients-558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)-were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; P < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; P < .001) and decreased external rotation in adduction (MD, -1.43°; 95% CI, -2.40° to -0.46°; P = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, -1.48 to 6.54; P = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, -61.60; 95% CI, -148.03 to 24.82; P = .162) scores that were comparable with those of the BR group. CONCLUSION: Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients' external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair.

The effect of tranexamic acid and epinephrine on visual clarity during arthroscopic shoulder surgery: A meta-analysis of RCTs.

INTRODUCTION: Visual clarity in arthroscopic rotator cuff repair is essential to reduce the operative time and for efficiency of repair. Tranexamic acid (TXA) in open shoulder surgery has been shown to reduce blood loss but its use in shoulder arthroscopy for rotator cuff repair for improved clarity is not understood. The purpose of this SR is to determine the effect of TXA and epinephrine on visual clarity in shoulder arthroscopy for rotator cuff repair. HYPOTHESIS: We hypothesise that visual clarity should improve in those that have TXA compared to those who do not receive TXA. METHODS: A review of the online databases MEDLINE and Embase was conducted on 8th October 2022 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Randomised clinical trials reporting visual clarity and/or, operative time, volume of irrigation fluid used and mean arterial pressure were included. The studies were appraised using the CONSORT tool. RESULTS: Seven studies met eligible criteria, all of which were double-blinded RCTs. Five studies reported no difference in visual clarity between TXA vs. saline, while two reported a significant improvement with TXA. Pooling of data showed that visual clarity was significantly better in the TXA group vs. saline, on a standardised 10-point Likert scale (mean difference 0.73 points, p=0.03). However, the use of epinephrine was reported in two studies and its administration offered significantly better visual clarity than TXA (mean difference 0.9 points, p=0.02). There was no significant difference with TXA use in MAP (mean difference 1.2mmHg, p=0.14), operative time (mean difference 6.8minutes, p=0.11), irrigation volume used (mean difference 0.2L, p=0.88), or postoperative pain (mean difference 3.89 on a 0-100 VAS, p=0.34). CONCLUSION: The use of TXA in shoulder arthroscopy has shown to have significantly improved visual clarity in comparison to saline irrigation alone. This may not necessarily result in a significant clinical difference and may not translate to significantly less operative time or postoperative pain score. Furthermore, epinephrine use alone offers significantly better clarity than TXA. There may not be an added benefit to give both, but this area requires further research. LEVEL OF EVIDENCE: II; systematic review.

Is the Synovium the First Responder to Posttraumatic Knee Joint Stress? The Molecular Pathogenesis of Traumatic Cartilage Degeneration.

OBJECTIVE: The aim of this study was to evaluate if a similar catabolic and inflammatory gene pattern exists between the synovium, hyaline cartilage, and blood of patients with the knee joint tissues and if one precedes the other. DESIGN: A total of fifty-eight patients (34 females and 24 males) with a mean age of 44.7 years (range, 18-75) underwent elective knee arthroscopy due to previously diagnosed pathology. Full blood samples were collected preoperatively from synovium and cartilage samples intraoperatively. Real time PCR with spectrophotometric analysis was performed. Following genes taking part in ECM (extracellular matrix) remodeling were selected for analysis: MMP-1, MMP-2, MMP-8, MMP-9, MMP-13, MMP-14, ADAMTS-4 (Agg1) and ADAMTS-5 (Agg2) proteases, TIMP-1, and TIMP-2 - their inhibitors - and IL-1 and TNF-α cytokines. RESULTS: Analysis revealed a strong and significant correlation between gene expression in synovial and systemic blood cells (p <0.05 for all studied genes) with ADAMTS-4, ADAMTS-5, IL-1, TNF-α and TIMP-2 expression most positively correlated with an R>0.8 for each. An analysis between chondrocytes and systemic blood gene expression shown no significant correlation for all genes. Bivariate correlation of International Cartilage Repair Society grading and genes expression revealed significant associations with synovial MMP-1, MMP-2, MMP-8, MMP-9, IL-1, TNF-α and TIMP-2. CONCLUSION: We suggest that the synovial tissue is the first responder for knee joint stress factors in correlation with the response of blood cells. The chondrocyte's genetic response must be further investigated to elucidate the genetic program of synovial joints, as an organ, during OA development and progression.

Time of Return to Work (RTW) May Not Correlate with Patient-Reported Outcomes Measurements (PROM) at Minimum One Year Post Arthroscopic Bankart Repair.

It is widely recognized that work serves a dual role by not only ensuring financial independence but also functioning as a vital source of psychosocial well-being and contributing significantly to the attribution of meaning in life. The cost of work disability can be a multifactorial problem for both employers and workers; thus the inability to return to work (RTW) may have a destructive effect on mental health and confidence. Shoulder surgery is one of the conditions that inevitably impacts patients' ability to work. As current data focus on restoring range of motion, strength, and the patients' activity, to this day the data about RTW post shoulder surgery remain limited. The purpose of this study was to evaluate the return-to-work time of patients treated with an arthroscopic Bankart repair and to evaluate if patient-reported outcomes (PROM) correlate with the incapacity to work after an arthroscopic Bankart repair. We performed a retrospective review by conducting a questionnaire with patients more than 12 months after surgery and we identified 31 patients who met the criteria for the study and were able to contact 17 of them. In this paper we demonstrated that on average among groups working physically and at the office we may expect patients who underwent arthroscopic Bankart repair to return to work within 7 weeks from the surgery, with office workers tending to return significantly faster with an average of 2.5 weeks (p = 0.0239).

Variability in the Processing of Fresh Osteochondral Allografts.

The indications for fresh osteochondral allograft continue to increase. As a result, variations in graft processing and preservation methods have emerged. An understanding of these techniques is important when evaluating the optimal protocol for processing fresh osteochondral allografts prior to surgical implantation. The aim of this study is to review the literature and understand various tissue processing protocols of four leading tissue banks in the United States. Donor procurement, serological and microbiological testing, and storage procedures were compared among companies of interest. Similarities between the major tissue banks include donor screening, aseptic processing, and testing for microorganisms. Variability exists between these companies with relation to choice of storage media, antibiotic usage, storage temperature, and graft expiration dates. Potential exists for increased chondrocyte viability and lengthened time-to-expiration of the graft through a protocol of delicate tissue handling, proper choice of storage medium, adding hormones and growth factors like insulin growth factor-1 (IGF-1) to serum-free nutrient media, and storing these grafts closer to physiologic temperatures.

Arthroscopy Association of Canada Position Statement on Opioid Prescription After Arthroscopic Surgery.

Background: Despite the ongoing opioid epidemic, most patients are still prescribed a significant number of opioid medications for pain management after arthroscopic surgery. There is a need for consensus among orthopaedic surgeons and solutions to aid providers in analgesic strategies that reduce the use of opioid pain medications. Purpose: This position statement was developed with a comprehensive systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to synthesize the best available evidence for managing acute postoperative pain after arthroscopic surgery. Study Design: Position statement. Methods: The Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were searched from inception until August 10, 2022. Keywords included arthroscopy, opioids, analgesia, and pain, and associated variations. We included exclusively RCTs on adult patients to gather the best available evidence for managing acute postoperative pain after arthroscopic surgery. Patient characteristics, pain, and opioid data were extracted, data were analyzed, and trial bias was evaluated. Results: A total of 21 RCTs were identified related to the prescription of opioid-sparing pain medication after arthroscopic surgery. The following recommendations regarding noninvasive, postoperative pain management strategies were made: (1) multimodal oral nonopioid analgesic regimens-including at least 1 of acetaminophen-a nonsteroidal anti-inflammatory drug-can significantly reduce opioid consumption with no change in pain scores; (2) cryotherapy is likely to help with pain management, although the evidence on the optimal method of application (continuous-flow vs ice pack application) is unclear; (3) and (4) limited RCT evidence supports the efficacy of transcutaneous electrical nerve stimulation and relaxation exercises in reducing opioid consumption after arthroscopy; and (5) limited RCT evidence exists against the efficacy of transdermal lidocaine patches in reducing opioid consumption. Conclusion: A range of nonopioid strategies exist that can reduce postarthroscopic procedural opioid consumption with equivalent vocal pain outcomes. Optimal strategies include multimodal analgesia with education and restricted/reduced opioid prescription.