Surgical Options and Clinical Outcomes Following a Failed Latarjet Procedure: A Systematic Review.

BACKGROUND: A failed prior Latarjet procedure can be a challenging situation for both patients and surgeons. The purpose of this study was to report on the techniques and outcomes of patients undergoing revision surgery for the treatment of recurrent anterior shoulder instability after a failed Latarjet procedure. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies which reported on surgical techniques for a failed Latarjet procedure with reporting of clinical outcomes. The search terms used were: Latarjet failed. Patients were evaluated based on revision method, patient-reported outcome measures (PROMs), reoperation rates, recurrent instability, overall satisfaction, and return to sports and work. RESULTS: Thirteen studies (all Level IV evidence) met inclusion criteria, including a total of 293 shoulders with a mean age of 28.3 years (range, 16-55 years) at the time of surgery. The mean follow-up time was 50.4 months (range, 14.0-208.0 months) and males accounted for 78.6% of all patients. Revision procedures included open and arthroscopic Eden-Hybinette, distal tibial allograft, iliac crest autograft, osteochondral glenoid allograft, and Bankart repair and/or capsular plication. These may all be viable techniques for revision surgery for a failed Latarjet procedure. All revision procedures showed improvements in PROMs including the VAS (Visual analogue scale), Constant score, subjective shoulder value (SSV), Walch-Duplay, and Rowe scores. Return to sports ranged from 46.1% to 94%. Recurrent instability rates ranged from 0% to 43.8%. Reoperation rates ranged from 0% to 31.3%. Overall satisfaction following a revision procedure ranged from 80% to 100%. CONCLUSION: A failed Latarjet procedure can be treated with various revision procedures such as open and arthroscopic Eden-Hybinette, distal tibial allograft, iliac crest autograft, osteochondral glenoid allograft, and Bankart repair and/or capsular plication. Overall, surgical management of the failed Latarjet results in improvements in PROMs, pain, return to sports, and decreased recurrent instability with a moderate complication rate.

Rotator Cuff Repair With or Without Acromioplasty: A Systematic Review of Randomized Controlled Trials With Outcomes Based on Acromial Type.

BACKGROUND: It is unclear whether the use of concomitant acromioplasty during rotator cuff repair (RCR) improves clinical outcomes and whether the outcomes are affected by acromial type. PURPOSE: To perform a systematic review of randomized controlled trials comparing clinical outcomes of RCR with and without acromioplasty, with a subanalysis of outcomes based on acromial type. STUDY DESIGN: Systematic review; Level of evidence, 2. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between RCR with versus without acromioplasty. A subanalysis was performed on the studies that provided outcomes based on acromial type. The search phrase used was rotator cuff repair (acromioplasty OR subacromial decompression) randomized. Patients were evaluated based on retear rate, reoperation rate, and patient-reported outcomes (PROs). RESULTS: Application of inclusion criteria yielded 5 studies (2 studies were level 1, and 3 studies were level 2) including a total of 409 patients, with 211 patients undergoing RCR alone (group A) and 198 patients undergoing RCR with acromioplasty (group B). The mean patient age was 58.5 and 58.3 years in groups A and B, respectively. The mean follow-up time was 52.9 months, and the overall percentage of male patients was 54.1%. The rotator cuff tear size was 20.7 mm and 19.8 mm for groups A and B, respectively. No significant differences were found between groups for any of the PROs at final follow-up. Overall retear rates did not significantly differ between groups based on acromial type. Between 2 studies that measured reoperation rate, a significantly higher reoperation rate was found for the nonacromioplasty group (15%) versus the acromioplasty group (4.1%) (P = .031). One of these studies found that 5 of 9 patients (56%) with a type III acromion in the nonacromioplasty group underwent reoperation compared with 0 of 4 patients with a type III acromion in the acromioplasty group. CONCLUSION: There is some evidence that acromioplasty during RCR reduces the risk for later reoperation. This may be particularly true for patients with type III acromions, although further studies with larger sample sizes are needed to corroborate these data.

Screw Fixation for the Latarjet Procedure May Reduce Risk of Recurrent Instability but Increases Reoperation Rate Compared to Suture-Button Fixation: A Systematic Review.

PURPOSE: To perform a systematic review to compare clinical outcomes, complications, and reoperation rates of patients undergoing the Latarjet procedure with screw vs suture-button fixation. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies directly comparing screw vs suture-button fixation for the Latarjet procedure. The search terms used were shoulder screw suture button. Patients were evaluated based on reoperation rate, complication rate, recurrent instability, radiologic outcomes, and patient-reported outcomes. Graft and screw position were assessed via computed tomography. RESULTS: Seven studies (1 Level II, 6 Level III) met inclusion criteria, with 845 patients undergoing the Latarjet procedure with screw fixation (screw group) and 279 patients with suture-button fixation (suture-button group). Mean patient age ranged from 21.2 to 29.6 years. Mean follow-up time ranged from 6.0 to 40.8 months. The recurrent instability rate ranged from 0% to 2.5% in the screw group and 0% to 8.3% in the suture-button group. The reoperation rate ranged from 0% to 7.7% in the screw group compared to 0% to 1.9% in the suture-button group. One study reported significantly lower visual analog scale pain scores in the suture-button group compared with the screw group (1.5 vs 1.2, P = .003). No other studies reported significant differences in any patient-reported outcomes. There was no significant difference in horizontal or vertical graft position, graft union rate, or complication rate between groups in any study. CONCLUSIONS: The Latarjet procedure with screw fixation may result in a lower risk of recurrent instability compared to suture-button fixation, although screw fixation may also have a higher reoperation rate due to hardware-related complications. LEVEL OF EVIDENCE: Level III, systematic review of Level II to III studies.

How do physician demographics, training, social media usage, online presence, and wait times influence online physician review scores for spine surgeons?

OBJECTIVEThe purpose of this study was to assess the impact of certain demographics, social media usage, and physician review website variables for spine surgeons across Healthgrades.com (Healthgrades), Vitals.com (Vitals), and Google.com (Google).METHODSThrough a directory of registered North American Spine Society (NASS) physicians, we identified spine surgeons practicing in Texas (107 neurosurgery trained, 192 orthopedic trained). Three physician rating websites (Healthgrades, Vitals, Google) were accessed to obtain surgeon demographics, training history, practice setting, number of ratings/reviews, and overall score (January 2, 2018-January 16, 2018). Using only the first 10 search results from Google.com, we then identified whether the surgeon had a website presence or an accessible social media account on Facebook, Twitter, and/or Instagram.RESULTSPhysicians with either a personal or institutional website had a higher overall rating on Healthgrades compared to those who did not have a website (p < 0.01). Nearly all spine surgeons had a personal or institutional website (90.3%), and at least 1 accessible social media account was recorded for 43.5% of the spine surgeons in our study cohort (39.5% Facebook, 10.4% Twitter, 2.7% Instagram). Social media presence was not significantly associated with overall ratings across all 3 sites, but it did significantly correlate with more comments on Healthgrades. In multivariable analysis, increasing surgeon age was significantly associated with a lower overall rating across all 3 review sites (p < 0.05). Neurosurgeons had higher overall ratings on Vitals (p = 0.04). Longer wait times were significantly associated with a lower overall rating on Healthgrades (p < 0.0001). Overall ratings from all 3 websites correlated significantly with each other, indicating agreement between physician ratings across different platforms.CONCLUSIONSLonger wait times, increasing physician age, and the absence of a website are indicative of lower online review scores for spine surgeons. Neurosurgery training correlated with a higher overall review score on Vitals. Having an accessible social media account does not appear to influence scores, but it is correlated with increased patient feedback on Healthgrades. Identification of ways to optimize patients' perception of care are important in the future of performance-based medicine.

Analysis of Internet Review Site Comments for Spine Surgeons: How Office Staff, Physician Likeability, and Patient Outcome Are Associated With Online Evaluations.

STUDY DESIGN: Observational study. OBJECTIVE: To evaluate how online patient comments will affect website ratings for spine surgeons. SUMMARY OF BACKGROUND DATA: With the ever-growing utilization of physician review websites, healthcare consumers are assuming more control over whom they choose for care. We evaluated patient feedback and satisfaction scores of spine surgeons using comments from three leading physician rating websites: Healthgrades.com, Vitals.com, Google.com. This is the largest review of online comments and the largest review of spine surgeon comments. METHODS: From the North American Spine Society (NASS) membership directory, 210 spine surgeons practicing in Florida (133 orthopedic trained; 77 neurosurgery trained) with online comments available for review were identified, yielding 4701 patient comments. These were categorized according to subject: (1) surgeon competence, (2) surgeon likeability/character, (3) office staff, ease of scheduling, office environment. Type 1 and 2 comments were surgeon-dependent factors whereas type 3 comments were surgeon-independent factors. Patient comments also reported a score (1-5), 5 being the most favorable and 1 being the least favorable. RESULTS: There were 1214 (25.8%) comments from Healthgrades, 2839 (60.4%) from Vitals, and 648 (13.8%) from Google. 89.9% (4225) of comments pertained to surgeon outcomes and likeability (comment type 1 and 2), compared with 10.1% (476) surgeon-independent comments (comment type 3) (P < 0.0001). There was a significantly higher number of favorable ratings associated with surgeon-dependent comments (types 1 and 2) compared with surgeon-independent comments (type 3). Surgeon-independent comments were associated with significantly lower scores compared with comments regarding surgeon-dependent factors on all review sites. CONCLUSION: Spine surgeons are more likely to receive favorable reviews for factors pertaining to outcomes, likeability/character, and negative reviews based on ancillary staff interactions, billing, and office environment. Surgeons should continue to take an active role in modifying factors patients perceive as negative, even if not directly related to the physician. LEVEL OF EVIDENCE: 3.

How social media, training, and demographics influence online reviews across three leading review websites for spine surgeons.

BACKGROUND CONTEXT: The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website. PURPOSE: This study aimed to evaluate patient satisfaction scores for spine surgeons in Florida using leading physician ratings websites. STUDY DESIGN: A retrospective study was carried out. SAMPLE POPULATION: The sample comprised spine surgeons with a review on Healthgrades.com (HG), Vitals.com (V), or Google.com (G) online rating websites as of August 17, 2017. OUTCOME MEASURES: Number of ratings, number of comments, overall rating, patient-reported wait times, physician website presence, and physician SM presence were the outcome measures. METHODS: Using the directory of registered North American Spine Society physicians, we identified all spine surgeons practicing in Florida (137 orthopedic trained; 78 neurosurgery trained). Surgeon demographics and ratings data were collected from three physician rating websites (HG, V, G) from July 19, 2017 to August 17, 2017. Using only the first 10 search results from Google.com we then identified if the surgeon had accounts on Facebook (FB), Twitter (TW), or Instagram (IG). RESULTS: Nearly every surgeon in this cohort had either an institutional or personal website (98.1%), and 38.6% had at least one SM outlet of our three reviewed. Both personal and institutional website presence significantly correlated with higher G scores. Spine surgeons with a searchable account on FB, TW, or IG made up 35.4%, 10.2%, and 0.5% of the cohort, respectively. Surgeons with an SM presence had a significantly higher number of ratings and comments on HG, V, and G, but not overall scores. In multivariable analysis, only V showed a significant inverse correlation between overall score and age, private institution, and orthopedic surgery training. Wait times >30 minutes were significantly associated with worse overall scores across all three review sites. Overall ratings between HG, V, and G all had significantly positive correlations on Pearson correlation analysis. CONCLUSION: Social media presence correlates with patient communication in the form of number of ratings and comments, yet does not impact overall scores, suggesting social media may influence patient feedback. Longer wait times are indicative of lower scores across all three platforms. Overall ratings from all three websites correlate significantly with each other, indicating agreement between physician ratings across different platforms. Understanding the factors that optimize a patient's overall experience with a physician is an important and emerging outcome measure for the future of patient-centered health care.