Shoulder Latarjet Surgery Shows Wide Variation in Reported Indications, Techniques, Perioperative Treatment, and Definition of Outcomes, Complications, and Failure: A Systematic Review.

PURPOSE: To systematically review and compare the surgical indications, technique, perioperative treatment, outcomes measures, and how recurrence of instability was reported and defined after coracoid transfer procedures. METHODS: A systematic review of the literature examining open coracoid transfer outcomes was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Cochrane registry, MEDLINE, and EMBASE databases from 2010 to 2020. Inclusion criteria included open coracoid transfer techniques, including the Bristow or Latarjet technique, full text availability, human studies, and English language. RESULTS: A screen of 1,096 coracoid transfer studies yielded 72 studies, which met inclusion criteria with a total of 4,312 shoulders. One study was a randomized controlled trial, but the majority of them were retrospective. Of those, 65 studies reported on postoperative outcome scores, complication rates, revision rate, and recurrence rates. Forty-three reported on range of motion results. Thirty studies reported on primary coracoid transfer only, 7 on revision only, and 30 on both primary and revision, with 5 not reporting. Average follow-up was 26.9 months (range: 1-316.8 months). Indications for coracoid transfer, technique, perioperative care, complications, and how failure was reported varied greatly among studies. CONCLUSIONS: Latarjet and coracoid transfer surgery varies greatly in its indications, technique, and postoperative care. Further, there is great variation in reporting of complications, as well as recurrence and failure and how it is defined. Although coracoid transfer is a successful treatment with a long history, greater consistency regarding these factors is essential for appropriate patient education and surgeon knowledge. LEVEL OF EVIDENCE: Level IV, systematic review of Level I-IV studies.

Rotator cuff tendinopathy: magnitude of incapability is associated with greater symptoms of depression rather than pathology severity.

BACKGROUND: Population-based studies have established that rotator cuff tendinopathy develops in most persons during their lifetimes, it is often accommodated, and there is limited correspondence between symptom intensity and pathology severity. To test the relationship between effective accommodation and mental health on its continuum, we studied the relative association of magnitude of capability with symptoms of anxiety or depression compared with quantifications of rotator cuff pathology such as defect size, degree of retraction, and muscle atrophy among patients presenting for specialty care. METHODS: We analyzed a retrospective cohort of 71 adults seeking specialty care for symptoms of rotator cuff tendinopathy who underwent a recent magnetic resonance imaging scan of the shoulder and completed the following questionnaires: Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health questionnaire (a measure of symptom intensity and magnitude of capability, consisting of mental and physical health subscores), Generalized Anxiety Disorder questionnaire (measuring symptoms of anxiety), and Patient Health Questionnaire (measuring symptoms of depression). Two independent reviewers measured the sagittal length of the rotator cuff defect and tendon retraction in millimeters on magnetic resonance imaging scans (excellent reliability) and rated rotator cuff muscle atrophy and fatty infiltration (more limited reliability), and we used the average measurement or rating for each patient. Multivariable statistical models were used to identify factors associated with the PROMIS Global Health score and mental and physical health subscores. RESULTS: Accounting for potential confounding in multivariable analysis, lower PROMIS Global Health total scores and physical health subscale scores were independently associated with greater symptoms of depression but not with measures of pathology. Lower PROMIS mental health subscale scores were independently associated with greater symptoms of anxiety and greater muscle atrophy. CONCLUSIONS: The observation that magnitude of incapability among patients seeking care for symptoms of rotator cuff pathology is associated with symptoms of depression but not with measures of the severity of the rotator cuff pathology suggests that treatment strategies for patients who seek care for symptoms of rotator cuff tendinopathy may be incomplete if they do not anticipate and address mental health.

Patients With Posterior Cruciate Ligament Injuries Obtain Information Regarding Diagnosis, Management, and Recovery from Low-Quality Online Resources.

OBJECTIVES: This study investigates the most common online patient questions pertaining to posterior cruciate ligament (PCL) injuries and the quality of the websites providing information. METHODS: Four PCL search queries were entered into the Google Web Search. Questions under the 'People also ask' tab were expanded in order and 100 results for each query were included (400 total). Questions were categorized based on Rothwell's Classification of Questions (Fact, Policy, Value). Websites were categorized by source (Academic, Commercial, Government, Medical Practice, Single Surgeon Personal, Social Media). Website quality was evaluated based on the Journal of the American Medical Association (JAMA) Benchmark Criteria. Pearson's chi-squared was used to assess categorical data. Cohen's kappa was used to assess inter-rater reliability. RESULTS: Most questions fell into the Rothwell Fact category (54.3%). The most common question topics were Diagnosis/Evaluation (18.0%), Indications/Management (15.5%), and Timeline of Recovery (15.3%). The least common question topics were Technical Details of Procedure (1.5%), Cost (0.5%), and Longevity (0.5%). The most common websites were Medical Practice (31.8%) and Commercial (24.3%), while the least common were Government (8.5%) and Social Media (1.5%). The average JAMA score for websites was 1.49 ± 1.36. Government websites had the highest JAMA score (3.00 ± 1.26) and constituted 42.5% of all websites with a score of 4/4. Comparatively, Single Surgeon Personal websites had the lowest JAMA score (0.76 ± 0.87, range [0-2]). PubMed articles constituted 70.6% (24/34) of Government websites, 70.8% (17/24) had a JAMA score of 4 and 20.8% (5/24) had a score of 3. CONCLUSION: Patients search the internet for information regarding diagnosis, treatment, and recovery of PCL injuries and are less interested in the details of the procedure, cost, and longevity of treatment. The low JAMA score reflects the heterogenous quality and transparency of online information. Physicians can use this information to help guide patient expectations pre- and post-operatively.

Patient Preferences for Graft Selection in Anterior Cruciate Ligament Reconstruction.

Background: Selecting an appropriate graft for anterior cruciate ligament (ACL) reconstruction requires consideration of a patient's preferences, goals, age, and physical demands alongside the risks and benefits of each graft choice. Purpose: To determine the most popular ACL reconstruction grafts among patients and the most important factors influencing their decisions. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients undergoing ACL reconstruction between October 2022 and April 2023 completed a survey either before (nonconsult group) or after (consult group) speaking with their surgeon, who provided an evidence-based description of the pros and cons of an allograft and the following autografts: bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT). Patient characteristics, graft choice, information influencing their graft choice, and surgeon recommendation were collected and compared between the groups. Results: Among the 100 included patients, 59.0% were male, and the mean age was 28.3 ± 10.4 years. The most popular grafts were the BPTB (56.0%), followed by the QT (29.0%), HT (8.0%), and allograft (7.0%). No significant difference was observed in the graft selection between the consult group (n = 60; BPTB, 46.7%; QT, 38.3%; HT, 8.3%; allograft, 6.7%) and nonconsult group (n = 40; BPTB, 70.0%; QT, 15.0%; HT, 7.5%; allograft, 7.5%) (P = .0757). In the consult group, 81.7% of patients selected the graft recommended to them by their surgeon. The top 2 graft selection reasons were usage in professional athletes and failure rates, while the top 2 ACL surgery concerns were returning to their desired level of athletics and graft failure risk. Among the 93 patients who researched their ACL graft options before their visit, the most popular information source was some form of media (72.0% [67/93]). Conclusion: The study findings underscore the importance of patient preference and surgeon recommendation in a patient's graft selection and highlight the need to be cognizant of the information sources available to patients when researching their graft options.

MRI findings of acromioclavicular joint osteoarthritis are the norm after age 40.

BACKGROUND: Acromioclavicular joint (AC) arthritis (A) is a common incidental finding on shoulder imaging. An improved knowledge of the age- and sex-specific prevalence (or base rate) of incidental ACA can inform diagnosis and treatment strategies for shoulder pain. HYPOTHESIS: There is no relationship between age or gender and the presence or severity of MRI findings consistent with osteoarthritis of the acromioclavicular joint. METHODS: We rated ACA on 475 MRIs from a database of patients who had MRIs for non-AC indications. The cohort consisted of 51% men, 49% women and had an average age of 55. Bivariate analyses were used for analysis of age and sex-specific prevalence. RESULTS: The prevalence of findings consistent with ACA on MRI for non-AC indications was 83%. The prevalence increased from 75% between ages 40 and 50 to 100% after age 70. Logistic regression demonstrated an association between age and ACA (Odds Ratio 2.89; 95% confidence interval [CI]=2.30 to 3.63; p=0.001). No difference was seen by sex (Chi-Square, 0.16; p=0.67). There was a positive correlation between age and ACA severity (Spearman's rho=0.43; p=0.000010). DISCUSSION: The observation that MRI evidence of ACA is the norm (75%) after age 40 and is universal with human aging (100% after age 70), makes it very difficult to discern ACA as a cause of shoulder symptoms. Given the near universal prevalence of radiological ACA, imaging cannot be used as a reference standard for diagnosis of symptomatic ACA based on symptoms and signs. LEVEL OF EVIDENCE: Not applicable.

Treatment of proximal tibial buckle fractures: removable knee immobilizer versus long leg cast.

The purpose of this study was to compare outcomes and management of patients with buckle fractures of the proximal tibia treated with either a knee immobilizer or a long leg cast (LLC). A retrospective review was performed of pediatric patients with a buckle fracture of the proximal tibia over a 5-year period. Two cohorts were included, those treated with a LLC versus a removable knee immobilizer. Data collected included immobilization type, fracture laterality, length of immobilization, number of clinic visits, fracture displacement, and complications. Differences in complications and management between the cohorts were evaluated. In total, 224 patients met inclusion criteria (58% female, mean age 3.1 years ± 1.7 years). Of these patients, 187 patients (83.5%) were treated with a LLC. No patients in either group were found to have interval fracture displacement during treatment. Seven patients (3.1%) demonstrated skin complications, all in the LLC cohort. Mean length of immobilization was shorter for those treated in a knee immobilizer at 25.9 days versus 27.9 days for the LLC cohort (P = 0.024). Total number of clinic visits was also less at 2.2 (SD ±â€…0.4 days) for the knee immobilizer and 2.6 (SD ±â€…0.7 days) for the LLC (P = 0.001) cohorts. Pediatric patients with proximal tibial buckle fractures can be safely managed with a knee immobilizer. This treatment method is associated with a shorter duration of immobilization and fewer clinic visits without incidence of fracture displacement. In addition, knee immobilizers can lessen skin issues associated with cast immobilization and cast-related office visits. This is a Level III evidence, retrospective comparative study.

Ulna Fractures After Elbow Arthrodesis: A Report of 3 Cases.

CASE: Two surgeons performed 3 elbow arthrodesis at 90° elbow flexion secured with a plate and screws. All 3 patients experienced fracture at the most distal aspect of the posterior plate, consistent with a stress riser in this location. CONCLUSION: The risk of fracture is likely related to vulnerability of the arm with no elbow flexion and may not be ameliorated by changes in operative technique or bone quality. Ulna fracture can be anticipated after elbow arthrodesis and might further limit enthusiasm for elbow arthrodesis.