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BACKGROUND: The relationship between abnormalities of the ulnar collateral ligament (UCL) on magnetic resonance imaging (MRI) and elbow symptoms in baseball players remains unclear. PURPOSE/HYPOTHESIS: This study aimed to compare findings of the UCL on microscopic MRI between asymptomatic and symptomatic elbows in baseball players. We hypothesized that the MRI grade of UCL injuries would exhibit no correlation with medial elbow symptoms in baseball players. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The study participants were skeletally mature baseball players who underwent high-resolution microscopic MRI of the medial elbow including for medical checkups. Elbows with previous surgical treatment or traumatic UCL injuries were excluded. The patients were divided into symptomatic and asymptomatic groups. The UCL appearance on microscopic MRI was categorized into 4 grades and compared between the groups. Abnormal findings in the medial elbow including bony fragments at the medial epicondyle, osteophytes or bony fragments in the sublime tubercle, and bone marrow edema (BME) in the sublime tubercle were also evaluated. RESULTS: A total of 426 baseball players (426 elbows) with a mean age of 20 years (range, 14-41 years) were included. The asymptomatic and symptomatic groups included 158 and 268 elbows, respectively. In the asymptomatic group, based on MRI grading of the UCL, 46 (29%) elbows were rated as grade I, 64 (41%) as grade II, 40 (25%) as grade III, and 8 (5%) as grade IV. In the symptomatic group, 75 (28%) elbows were rated as grade I, 118 (44%) as grade II, 61 (23%) as grade III, and 14 (5%) as grade IV. There was no significant difference in the MRI grades between the groups (P = .9). BME in the sublime tubercle was more frequently seen in the symptomatic group than in the asymptomatic group (P < .001). CONCLUSION: There was no difference in MRI grades of the UCL between symptomatic and asymptomatic elbows in baseball players; approximately 30% of elbows demonstrated high-grade UCL injuries in both groups. BME in the sublime tubercle was more frequently seen in symptomatic elbows than in asymptomatic elbows. BME in the sublime tubercle was a better indicator of symptoms than was MRI grading of the UCL.
Subject(s)
Baseball , Collateral Ligament, Ulnar , Elbow Injuries , Magnetic Resonance Imaging , Humans , Baseball/injuries , Collateral Ligament, Ulnar/injuries , Collateral Ligament, Ulnar/diagnostic imaging , Cross-Sectional Studies , Adolescent , Young Adult , Adult , Male , Elbow Joint/diagnostic imaging , Athletic Injuries/diagnostic imagingABSTRACT
We report two cases of proximal humeral epiphysiolysis in elite gymnasts. Both patients presented with shoulder pain during weight-bearing movements. The patient in case 1, treated with extracorporeal shock wave therapy (ESWT), exhibited rapid bone repair and pain relief, allowing an early return to competition. In the case 2 patient, humeral shortening was identified. Handstand-position radiography revealed compensatory scapular movements, negating the need for surgical intervention. These findings highlight ESWT's potential in promoting bone repair and the utility of handstand-position radiography in assessing humeral length. Both methods provide innovative treatment approaches for proximal humeral epiphysiolysis in gymnasts.
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Background: The flexor pronator muscles (FPMs) have been thought as a dynamic stabilizer to protect the ulnar collateral ligament (UCL) from valgus stress during throwing motion. Thus, evaluation of the FPMs is important for preventing UCL injuries. Shear wave ultrasound elastography (SWE) is an imaging modality that quantifies tissue elasticity. The purpose of this study was to measure the tissue elasticities of healthy FPMs using SWE. Methods: We investigated 22 healthy men (mean age, 29 ± 6 years). The elasticities of the FPMs, including the pronator teres (PT), flexor digitorum superficialis (FDS), and flexor carpi ulnaris (FCU), were measured using SWE for each arm under two conditions: at rest (unloaded) and under valgus stress (loaded). The values obtained under different loading conditions were compared between both elbows. Results: The mean SWE values of the PT, FDS, and FCU for the dominant elbows were 22.4 ± 3.6, 22.8 ± 2.9, and 22.3 ± 3.4 kPa, respectively. The corresponding mean SWE values for the nondominant elbows were 24.2 ± 4.6, 23.1 ± 3.5, and 23.4 ± 3.5 kPa, respectively. The mean SWE values of the PT, FDS, and FCU at rest (unloaded) were 23.3 ± 4.2, 22.9 ± 3.2, and 22.9 ± 3.5 kPa, respectively. The corresponding mean SWE values under valgus stress (loaded) were 35.0 ± 6.2, 34.7 ± 5.3, and 31.9 ± 4.8 kPa, respectively. Conclusion: This noninvasive evaluation of the stiffness of the FPMs may provide clinically relevant data for the prevention of UCL injuries.
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BACKGROUND: In patients with traumatic posterior shoulder instability, little is known about the precise location and size of the reverse Hill-Sachs lesion. METHODS: Forty-nine shoulders of 47 patients with traumatic posterior instability were included in this study based on the following inclusion criteria: (1) a primary or recurrent traumatic posterior shoulder dislocation and (2) the initial event being caused by trauma. Patients were excluded if they had (1) no history of trauma, (2) prior shoulder surgery, (3) no computed tomographic (CT) examination, or (4) were seizure cases. Three-dimensional images of the humerus reconstructed from CT images were reviewed using an image analysis software. The location and size of the reverse Hill-Sachs lesion were measured and described on a clock face on the humeral head. RESULTS: The reverse Hill-Sachs lesion was observed in 25 of 49 shoulders (51%). The reverse Hill-Sachs lesions were located between 1:37 and 2:48. The depth of the reverse Hill-Sachs lesion (mean ± standard deviation) was 5.8 ± 2.2 mm. The extent of the reverse Hill-Sachs lesion was 35° ± 12°. The average orientation of the reverse Hill-Sachs lesion, represented by an angle measured from the 12 o'clock position, was 64° ± 12° and pointing toward 2:09 on a clock face. The mean length and width of reverse Hill-Sachs lesions were 9.7 ± 4.7 mm and 11.1 ± 3.6 mm, respectively. CONCLUSION: The reverse Hill-Sachs lesion was a semicircular compression fracture located on the anteromedial aspect of the humeral head. Compared with shoulders with anterior shoulder instability, the humeral defect was smaller and located more inferiorly in shoulders with posterior instability.
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PURPOSE: To investigate and compare the pathologies and clinical outcomes of patients with traumatic anterior shoulder instability who underwent arthroscopic stabilization at 40 years or older between shoulders with initial dislocation before age 40 years and at 40 years or after. METHODS: Shoulders that underwent arthroscopic stabilization for recurrent traumatic anterior shoulder instability at 40 years or older with a minimum of 2-year follow-up were included. The subjects were divided into 2 groups according to age at initial dislocation after propensity score matching to reduce potential bias: younger than 40 years (group 1) and 40 years or older (group 2). Radiographic findings, pathologies, clinical outcomes, and complications were compared between the groups. RESULTS: Group 1 included 56 shoulders in 56 patients (26 men and 30 women) with a mean age of 51 years (range, 40-77 years). Group 2 included 28 shoulders in 28 patients (13 men and 15 women) with a mean age of 51 years (range, 40-77 years). Glenoid bone loss was greater in group 1 than in group 2 (P = .004). Rotator cuff tears were more frequently observed in group 2 than in group 1 (P < .001). Both groups showed significant improvement in the West Ontario Shoulder Instability Index score (P < .001 for each) and flexion (P < .001 for each). The recurrence rate was 4% in group 1 and 7% in group 2. CONCLUSIONS: Rotator cuff tears are significantly more frequent in recurrent shoulder instability patients with initial dislocation at age 40 or older. Arthroscopic stabilization yielded a low recurrence rate and favorable outcomes with a good return-to-sport rate in patients 40 years or older. LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic trial.
Subject(s)
Arthroscopy , Joint Instability , Recurrence , Rotator Cuff Injuries , Shoulder Dislocation , Humans , Middle Aged , Male , Female , Adult , Joint Instability/surgery , Joint Instability/etiology , Shoulder Dislocation/surgery , Rotator Cuff Injuries/surgery , Aged , Age Factors , Retrospective Studies , Shoulder Joint/surgery , Treatment OutcomeABSTRACT
Background: There remain arguments regarding whether fatty degeneration of the rotator cuff muscles improves following rotator cuff repair. The purpose of this study was to prospectively investigate changes in fatty degeneration of the rotator cuff muscles, quantitatively measured on magnetic resonance imaging (MRI) with use of transverse relaxation time (T2) mapping techniques, and to assess the relationship between these changes and clinical outcomes. Methods: Patients were included if they were scheduled for arthroscopic rotator cuff repair using the suture-bridge technique between June 2014 and December 2015, underwent preoperative MRI including the T2 mapping sequence, and consented to participate in the study. Exclusion criteria consisted of trauma within 2 months before preoperative MRI, isolated subscapularis tears, patch augmentation, neuromuscular disease, and a follow-up duration of <2 years. MRI scans were acquired preoperatively and at 2 years postoperatively, and T2 values of the supraspinatus and infraspinatus muscles were measured, with smaller T2 values indicating less fat content. Shoulders were evaluated on the basis of active range of motion (ROM), Constant and University of California Los Angeles Shoulder Rating Scale scores, shoulder external rotation strength with the arm at the side, and rotator cuff integrity on postoperative MRI. Results: A total of 103 patients (103 shoulders) with a mean age of 65 ± 9 years (range, 42 to 83 years) were included, of whom 52 were male and 51 were female. There were 13 partial, 18 small, 35 medium, 33 large, and 4 massive tears. Concomitant subscapularis tears were observed in 35 shoulders. Overall, ROM, clinical scores, and external rotation strength significantly improved postoperatively. Retears were found in 27 shoulders (26%). External rotation strength significantly improved postoperatively only in shoulders without a retear. Among shoulders without a retear, the postoperative T2 values of the supraspinatus and infraspinatus were significantly smaller than the preoperative values (p < 0.001 for both); however, no improvement was seen in shoulders with a retear. Conclusions: Shoulders with successful repair demonstrated significantly smaller T2 values postoperatively as well as significantly improved external rotation strength. Fatty degeneration of the cuff muscles can be reversed, at least in part, and muscle strength improves in shoulders with successful repair. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Background: Reverse total shoulder arthroplasty (RSA) has been approved since 2014 in Japan, and the number of RSA cases has been accumulating. However, only short-to medium-term outcomes have been reported, with a small number of case series, because of its short history in Japan. This study aimed to evaluate complications after RSA in hospitals affiliated with our institute, with comparison to those in other countries. Methods: A multicenter retrospective study was performed at 6 hospitals. In total, 615 shoulders (mean age: 75.7 ± 6.2 years; mean follow-up: 45.2 ± 19.6 months) with at least 24 months of follow-up were included in this study. The active range of motion was assessed pre-and postoperatively. The 5-year survival rate was evaluated for reoperation for any reason in 137 shoulders with at least 5 years of follow-up using Kaplan-Meier analysis. Postoperative complications were evaluated, including dislocation; prosthesis failure; deep infection; periprosthetic, acromial, scapular spine, and clavicle fractures; neurological disorders; and reoperation. Furthermore, imaging assessments, including scapular notching, prosthesis aseptic loosening, and heterotopic ossification were evaluated on postoperative radiography at the final follow-up. Results: All range of motion parameters were significantly improved postoperatively (P < .001). The 5-year survival rate was 93.4% (95% confidence interval: 87.8%-96.5%) for reoperation. Complications occurred in 256 shoulders (42.0%), with reoperation in 45 (7.3%), acromial fracture in 24 (3.9%), neurological disorders in 17 (2.8%), deep infection in 16 (2.6%), periprosthetic fracture in 11 (1.8%), dislocation in 9 (1.5%), prosthesis failure in 9 (1.5%), clavicle fracture in 4 (0.7%), and scapular spine fracture in 2 (0.3%). Regarding imaging assessments, scapular notching was observed in 145 shoulders (23.6%), heterotopic ossification in 80 (13.0%), and prosthesis loosening in 13 (2.1%). Conclusion: This is the first large case series to investigate the complications after RSA in Japan, and the overall frequency of complications after RSA was similar to that in other countries.
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BACKGROUND: No consensus has been reached on the return to sports or physical work after shoulder arthroplasty due to a shortage of literature. The purpose of this study was to investigate return to sports or physical work after anatomical total shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (RSA), as well as the clinical and radiographic outcomes. METHODS: The inclusion criteria were as follows: 1) aTSA or RSA between 2012 and 2017, and 2) patients who preoperatively participated in sports or physical work. The exclusion criteria were as follows: 1) revision arthroplasty, 2) fracture/dislocation, 3) fracture sequelae, 4) postinfection, and 5) <2-year follow-up. Sports and physical work were classified as low-, medium-, or high-load activities. Range of motion, Constant score, sport or work return, and radiographic findings were evaluated and compared between aTSA and RSA groups. RESULTS: The subjects who met the criteria were 90 shoulders in 86 patients. The aTSA group consisted of 30 shoulders (10 men and 20 women) with a mean age of 71 ± 8 years (range, 56-85). The RSA group consisted of 60 shoulders (39 men and 21 women) with a mean age of 72 ± 6 years (range, 56-83). Active range of motion significantly improved after surgery in all directions in the aTSA group but only in flexion and external rotation in the RSA group. Postoperative external and internal rotations, as well as postoperative Constant scores and satisfaction, were significantly better in the aTSA than in the RSA group. In the aTSA group, the return rate was 93%, and the complete return rate was 70%. In the RSA group, the return rate was 83%, and the complete return rate was 30%. The complete return rate was significantly higher in the aTSA than in the RSA group. Only one aTSA shoulder showed loosening of the glenoid implant, and 8 RSA shoulders demonstrated low-grade scapular notching. CONCLUSION: The return to sports or physical work rates after aTSA and RSA were high; however, the complete return rates were significantly higher in the aTSA group than in the RSA group. No radiographic failures were identified except for one asymptomatic glenoid loosening with a midterm follow-up.
Subject(s)
Arthroplasty, Replacement, Shoulder , Shoulder Joint , Male , Humans , Female , Middle Aged , Aged , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Treatment Outcome , Return to Sport , Scapula/surgery , Range of Motion, Articular , Retrospective StudiesABSTRACT
BACKGROUND: Previous studies have postulated that graft thickness and graft healing may be important factors for optimizing clinical outcomes of superior capsule reconstruction (SCR) for patients with irreparable rotator cuff tears (RCTs). However, the relationship between postoperative graft integrity and clinical outcomes after SCR remains unclear. We aimed to assess the relationship between postoperative graft integrity, including graft thickness and size of graft tear, and clinical outcomes after SCR in patients with irreparable RCTs. METHODS: This retrospective multicenter study included 188 patients (86 women, 102 men; mean age, 69.2 years; range, 49-87 years) with irreparable RCTs who underwent arthroscopic SCR using fascia lata autografts. Using magnetic resonance imaging, the graft integrity was evaluated postoperatively at or after 1 year and was classified, according to Hasegawa's classification, into 4 categories: type I-II, intact graft of sufficient thickness; type III, thinned graft without discontinuity; type IV, presence of a minor discontinuity; and type V, presence of a major discontinuity. We compared (1) baseline characteristics, (2) visual analog scale (VAS) for pain, (3) American Shoulder and Elbow Surgeons (ASES) score, (4) active shoulder range of motion, and (5) acromiohumeral distance (AHD) among 4 groups based on postoperative graft integrity. RESULTS: Magnetic resonance imaging scans revealed 152 shoulders (80.9%) with type I-II graft, 13 (6.9%) with type III graft, 13 (6.9%) with type IV graft, and 10 (5.3%) with type V graft. VAS and ASES scores significantly improved after SCR in all graft types (P < .0001 to P = .02). However, shoulders with type V grafts had significantly inferior postoperative VAS and ASES scores compared to those with type I-II grafts (P = .001 and P < .0001, respectively). Shoulders without graft tears (types I-II and III) showed significant improvements in shoulder elevation and internal rotation after SCR (P < .0001 to P = .02). In contrast, shoulders with large graft tears (type V) showed no significant improvement in shoulder range of motion. Postoperative acromiohumeral distance significantly increased only in shoulders with type I-II grafts (P < .0001). CONCLUSION: Postoperative graft thickness and size of graft tear affected clinical and radiographic outcomes after SCR using a fascia lata autograft. Patients with large graft tears had significantly inferior postoperative clinical scores compared to those with intact grafts of sufficient thickness, although arthroscopic SCR provided pain relief even in patients with graft tears. Shoulders with intact grafts of sufficient thickness restored glenohumeral stability and showed better clinical outcomes than those with graft thinning or tears.
Subject(s)
Lacerations , Rotator Cuff Injuries , Shoulder Joint , Male , Female , Humans , Aged , Rotator Cuff Injuries/diagnostic imaging , Rotator Cuff Injuries/surgery , Autografts , Fascia Lata/transplantation , Treatment Outcome , Shoulder Joint/surgery , Rupture , Retrospective Studies , Range of Motion, Articular , Arthroscopy/methodsABSTRACT
Purpose: To retrospectively investigate the mid-term outcomes after arthroscopic repair of isolated subscapularis tears with a relatively large number of patients and to compare them by tear size. Methods: Medical records were reviewed for patients who underwent arthroscopic rotator cuff repair between 2010 and 2017 at our institute. The inclusion criterion was isolated subscapularis tears that underwent arthroscopic rotator cuff repair. The exclusion criteria were (1) previous rotator cuff surgery, (2) lack of imaging studies or clinical evaluation data, (3) neuromuscular diseases, and (4) <2-year follow-up. Range of motion, American Shoulder and Elbow Society score, and bear-hug or belly-press test were assessed pre- and postoperatively. Repair integrity was evaluated with magnetic resonance imaging at postoperative1 year. The clinical and imaging study outcomes were compared between smaller (Lafosse types 1-3) and larger (types 4 and 5) tears. Results: The subjects included 38 males and 8 females with a mean age of 59 years (range, 25-77 years). The mean follow-up was 36 months (range, 24-96 months). There were 13 type 1, 10 type 2, 12 type 3, 6 type 4, and 5 type 5 shoulders. Postoperative American Shoulder and Elbow Society scores were significantly better in smaller tears than larger tears: 93 ± 8 and 75 ± 14, respectively (P = .003). Smaller tears showed better postoperative internal rotation than larger tears (P = .004). Significant decrease of positive bear-hug or belly-press test was observed in smaller tears (preoperative, 25; postoperative, 11; P < .001), but there was no significant improvement in larger tears (preoperative, 11; postoperative, 9). The retear rate was significantly greater in larger tears (64%) than smaller tears (6%, P < .001). Conclusions: The clinical and structural outcomes after arthroscopic repair of isolated subscapularis tears were better in smaller tears than larger tears with a mid-term follow-up. Larger tears showed high retear rates with poorer improvement in active range of internal rotation and subscapularis strength. Level of Evidence: Level III, retrospective, comparative study.
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Background: Boileau et al have reported on the unstable, painful shoulder (UPS), which was defined as painful shoulders without any recognized anteroinferior subluxations or dislocations that were associated with roll-over lesions (ie, instability lesions) on imaging or at arthroscopy. However, they included various pathologies, probably due to the ambiguity in their definitions of UPS. We redefined UPS as follows: (1) shoulder pain during daily or sports activities, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft-tissue or bony lesions, such as Bankart or humeral avulsion of glenohumeral ligament lesion, confirmed by arthroscopy. The purpose of this study was to retrospectively investigate pathologies of UPS based on our definitions. We also aimed to assess the outcomes after arthroscopic soft-tissue stabilization for UPS. Methods: We reviewed patients who were retrospectively diagnosed as UPS based on our definition and underwent arthroscopic stabilization between January 2007 and September 2018. Patients' demographics, physical and radiographic findings, intraoperative findings, clinical outcomes (Rowe scores, Subjective Shoulder Value [SSV], and the visual analog scale [VAS] for pain), and return to play sport (RTPS) were investigated. Results: This study included 91 shoulders in 91 patients with a mean age of 23 years (range, 15-51). The mean follow-up was 37 months (range, 24-156). Eighty-seven patients were involved in sports activities: collision/contact, 55 patients (60%); overhead, 26 patients (29%). The pain was reproduced during the anterior apprehension test in 86 shoulders (95%). Normal type (49%) predominated in glenoid morphology followed by fragment (bony Bankart) type (37%). Most fragment-type lesions were seen in collision/contact athletes. Intraoperative findings demonstrated that Bankart lesions were found in all patients and Hill-Sachs lesions only in 42%. Magnetic resonance arthrography in the abducted and externally rotated positions showed a Bankart lesion in 76 shoulders (84%). Rowe score, SSV, and pain VAS significantly improved postoperatively (P < .001 for each). Forty-two of 70 athletes (60 %) with > 2-year follow-up returned to the sport at a complete or near-preinjury level. Six (9%) athletes experienced reinjury. Conclusion: All shoulders that were diagnosed as UPS with our definition had a Bankart lesion. There seemed to be two different types of pathologies: Bankart lesions in lax shoulders and bony Bankart lesions in collision/contact athletes. The pain experienced during the anterior apprehension test may be useful for the diagnosis of UPS. Arthroscopic soft-tissue stabilization yielded good clinical outcomes with a high RTPS rate, but the reinjury rate was relatively high.
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Background: Teres minor atrophy can be seen in shoulders both with and without a rotator cuff tear, even among the young population. The purpose of this study was to retrospectively investigate the incidence of teres minor atrophy in young and middle-aged patients with or without a rotator cuff tear. Methods: Patient records were reviewed to identify 10-39-year-old patients (Group Y) and 60-69-year-old patients (Group O) who underwent MRI because of shoulder disorders. The exclusion criteria were as follows: (1) prior surgeries, (2) neurological disorders in the cervical spines or shoulder girdle, (3) global atrophy of all four cuff muscles without a rotator cuff tear, (4) acute trauma, and (5) poor image quality due to artifacts. An experienced shoulder surgeon evaluated teres minor atrophy on T1-weighted oblique sagittal images. Statistical analysis was performed using the chi-square test for comparison of Groups Y and O. Results: Group Y consisted of 528 shoulders in 520 patients, including 406 males and 114 females with a mean age of 26 years. Group O consisted of 884 shoulders in 837 patients, including 394 males and 443 females with a mean age of 65 years. Rotator cuff tears were seen in 33 shoulders (6.3 %) in Group Y, and 411 shoulders (46.5%) in Group O. Teres minor atrophy was more present in Group O (59 shoulders [6.7%]) than Group Y (11 shoulders [2.1%], P < .001). Among shoulders with teres minor atrophy, the incidence of intact cuff tended to be higher in Group Y than O (7 shoulders [64%] and 21 shoulders [36%], P = .08). However, the ratio of the intact cuff to the number of patients in each group was not significantly different (Group Y, 7 of 528 [1.3%]; Group O, 21 of 884 [2.3%]). Teres minor muscle atrophy tended to be more common in athletes than nonathletes in Group Y, although the difference was not significant (P = .057). Conclusion: The incidence of teres minor atrophy was significantly higher in middle-aged patients than young patients. Middle-aged patients with teres minor atrophy were more associated with rotator cuff tears. The common cause of teres minor atrophy may be rotator cuff tears. Teres minor atrophy in young patients might be associated with sports-related factors such as infraspinatus hypertrophy or axillary nerve injury.
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BACKGROUND: Recently, to treat the long head of the biceps tendon lesions in addition to rotator cuff repair has been recommended. However, the differences in clinical outcomes between biceps tenotomy and tenodesis for middle-aged and elderly females remains unclear. The purpose of this study was to compare the outcomes of biceps tenotomy and soft-tissue tenodesis that were performed concurrently with arthroscopic rotator cuff repair in ≥60-year-old females. METHODS: Female shoulders that underwent arthroscopic rotator cuff repair in our institute in 2016 were retrospectively reviewed. This study included 66 shoulders with concurrent biceps tenotomy or soft-tissue tenodesis: tenotomy group, 41 shoulders; soft-tissue tenodesis group, 25 shoulders. Clinical scores, biceps pain (visual analogue scale, VAS), Popeye deformity, and biceps strength (%contralateral side) were compared between the two groups. RESULTS: The mean age was significantly higher in the tenotomy group than the soft-tissue tenodesis group (72 ± 4 and 68 ± 6 years, respectively; P = 0.002). There were no significant differences in post-operative JOA and UCLA scores between the groups. VAS for biceps pain was significantly higher at postoperative 6 months in the tenotomy group than the soft-tissue tenodesis group (2.9 ± 2.5 and 1.7 ± 1.6, respectively, P = 0.03), though there were no significant differences at postoperative 3, 12, and ≥24 months. Subjective evaluation of Popeye deformity was not significantly different between the groups. Postoperative biceps strength was significantly lower in the tenotomy group than the soft-tissue tenodesis group (89.9% and 102.8%, respectively, P = 0.02). CONCLUSIONS: Both biceps tenotomy and soft-tissue tenodesis concurrent with rotator cuff repair in ≥60-year-old female patients resulted in good outcomes. Shoulders with soft-tissue tenodesis demonstrated earlier improvement in postoperative biceps pain and better postoperative biceps strength than those with tenotomy. There were no differences in objective and subjective Popeye deformity between tenotomy and soft-tissue tenodesis. The LHB procedures, tenotomy or tenodesis, can be selected depending on surgeons' preference.
Subject(s)
Rotator Cuff Injuries , Tendon Injuries , Tenodesis , Aged , Arthroscopy/methods , Female , Humans , Middle Aged , Pain/surgery , Retrospective Studies , Rotator Cuff/surgery , Rotator Cuff Injuries/surgery , Tendon Injuries/surgery , Tenodesis/methods , TenotomyABSTRACT
PURPOSE: We assessed hypertrophy of preserved long head of the biceps tendon (LHBT) and vascularity in the bicipital groove after arthroscopic rotator cuff repair in ≤55-year-old patients and compared postoperative pain between shoulders with or without vascularity in the bicipital groove. METHODS: Patients who underwent arthroscopic rotator cuff repair between 2015 and 2017 were reviewed. Inclusion criteria were arthroscopic rotator cuff repair and ≤55 years old. Exclusion criteria were a history of contralateral rotator cuff repair, revision surgery, partial repair or superior capsular reconstruction, shoulder dislocation or fracture, torn LHBT at surgery, LHBT tenodesis, retears, <1-year follow-up, and incomplete follow-up data. Cross-sectional area (CSA) of the LHBT and vascularity in the bicipital groove were examined preoperatively and 1 year after surgery using ultrasonography. Shoulder pain at postoperative 1 year was assessed using the pain subscore of the University of California at Los Angeles scale. The data were compared between shoulders with negative and positive vascularity. RESULTS: Fifty-seven shoulders were included in this study. There was no side-to-side difference in preoperative CSA. No difference was found between preoperative and postoperative CSA in the affected shoulders. Postoperative vascularity was identified in 28 (49%) shoulders. Mean pain score was significantly higher in the negative vascularity group than the positive vascularity group (9 and 8, respectively; P = .002). CONCLUSIONS: The preserved LHBT did not show hypertrophy 1 year after arthroscopic repair of medium-sized or smaller posterosuperior rotator cuff tear in ≤55-year-old patients. However, 49% of the shoulders postoperatively demonstrated lower-grade vascularity in the bicipital groove. Healthy LHBT can be preserved in ≤55-year-old patients with posterosuperior medium-sized or smaller rotator cuff tears. LEVEL OF EVIDENCE: III, retrospective comparative prognostic trial.
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BACKGROUND: Recently, magnetic resonance imaging (MRI) classification of medial ulnar collateral ligament (UCL) tears has been introduced, but little is known about the relationship between MRI grading and medial joint laxity. It has been reported that microscopy coils could make it possible to achieve high-resolution images of upper extremities with a superior diagnostic ability to conventional MRI. However, there is no report that has compared the diagnostic reliability between microscopic and conventional MRI. The purpose of this study was to assess the relationship between MRI findings and medial joint laxity evaluated with stress ultrasound (US). Secondary objective was to compare the reliabilities of UCL evaluation between microscopic and conventional MRI. METHODS: One-hundred thirty baseball players who underwent MRI of the elbow for the diagnosis of UCL injury using both conventional and microscopy MRI were included in this study. They also underwent stress US for assessment of medial joint laxity against valgus stress. Our MRI grading system for UCL injuries was compared to medial joint laxity evaluated with stress US. The intrarater and interrater reliabilities of our grading system were assessed with both microscopic and conventional MRI. RESULTS: Our grading system was related to valgus stability, especially with microscopic MRI. The reliabilities were fair when combined with microscopic MRI, which exhibited better intrarater and interrater reliabilities than conventional MRI. CONCLUSION: High-resolution microscopic MRI may contribute to the accurate diagnosis of UCL injuries.
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BACKGROUND: Various factors may be related to outcomes of reverse shoulder arthroplasty (RSA) including patient and surgical factors. Differences in shoulder kinematics might be associated with poor function after RSA; however, kinematic differences between shoulders with good or poor elevation have not been elucidated. The purpose of this study was to compare RSA kinematics between shoulders with good or poor elevation. METHODS: The study included 28 shoulders with a minimum 6-month follow-up after RSA using Grammont-type prostheses. Subjects comprised 17 men and 11 women with the mean age of 75 years (range, 63-91). Subjects underwent fluoroscopy during active scapular plane abduction. Computed tomography of their shoulders was performed to create 3-dimensional scapular implant models. Using model-image registration techniques, poses of 3-dimensional implant models were iteratively adjusted to match their silhouettes with the silhouettes in the fluoroscopic images, and 3-dimensional kinematics of implants were computed. Kinematics and glenosphere orientation were compared between shoulders with good (>90 degree) or poor (<90 degree) scapular plane abduction. RESULTS: Nineteen and 9 shoulders were assigned to the good- and poor-elevation groups, respectively. There were no significant differences between the groups in age, sex, height, weight, preoperative range of motion, or Constant score, but body mass index in the poor elevation shoulders was significantly larger than that in the good elevation shoulders. There were no significant differences in glenosphere (upward/downward rotation, anterior/posterior tilt, internal/external rotation) or glenohumeral (internal/external rotation, abduction/adduction) kinematics between the good and poor elevation shoulders. Scapulohumeral rhythm was significantly higher in the good elevation shoulders than the poor elevation shoulders (P = .04). Glenosphere superior tilt was 2.3° ± 4.2° in the good-elevation group and 8.1° ± 8.9° in the poor-elevation group, and the difference was statistically significant (P = .03). DISCUSSION: Shoulders with good elevation after RSA demonstrated better scapulohumeral rhythm than those with poor elevation, though there were no significant differences in glenosphere and glenohumeral kinematics. It may be important for better elevation to achieve good glenohumeral motion in shoulders with RSA. Glenosphere orientations may affect postoperative shoulder function.
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BACKGROUND: Degenerative greater tuberosity (GT) changes are often associated with rotator cuff tears. However, little is known about the impact of GT morphology on surgical outcomes. The aim of this study was to examine the relationship between clinical and radiological outcomes, after rotator cuff repair, and GT morphology. METHODS: We retrospectively investigated shoulders that underwent arthroscopic repair of nontraumatic full-thickness supra-/infraspinatus tears. The exclusion criteria were a lack of either radiographs or magnetic resonance images, revision surgery, partial repair, complications such as infection or dislocation, and follow-up < 2 years. GT morphology on radiographs was classified into 5 groups: normal, sclerosis, bone spur, roughness, and femoralization. The acromiohumeral interval (AHI) was measured on anteroposterior radiographs. Fatty degeneration of the cuff muscles was evaluated using the global fatty degeneration index (GFDI). Postoperative cuff integrity was classified using Sugaya's classification at 2 years after surgery. Clinical outcomes were assessed preoperatively and at postoperative 2 years with the Japanese Orthopaedic Association score and the University of California, Los Angeles shoulder rating scale. RESULTS: The study included 220 shoulders in 212 patients (104 men and 108 women), with a mean age of 66 years (range 43-85). The mean follow-up period was 28 months (range, 24-60 months). Seven shoulders (3.2%) were classified as normal, 65 (29.5%) as sclerosis, 55 (25.0%) as bone spur, 78 (34.5%) as roughness, and 15 (6.8%) as femoralization. The preoperative AHI, in the roughness and femoralization groups, was significantly smaller than that in the sclerosis (P < .01) and bone spur groups (P < .001). The roughness and femoralization groups had a greater number of large tears (P = .006). In the roughness and femoralization groups, mean GFDI was significantly higher than that in the sclerosis group (P < .001 for both). Repaired cuff integrity was not different between all groups, respectively. Both Japanese Orthopaedic Association and University of California, Los Angeles scores improved postoperatively from 73.3 to 95.6 points and 18.2 to 34.0 points (P < .001 for both), respectively, and there were no significant differences between all groups, respectively. CONCLUSION: Roughness or femoralization of the GT was related to larger tears, with smaller AHI and higher GFDI. Repaired cuff integrity and clinical outcomes in shoulders with roughness or femoralization of the GT were not inferior to shoulders with the other types of GT morphologies in this study. Arthroscopic repair can be indicated for shoulders with advanced changes of the GT, if fatty degeneration of the cuff muscles is not severe.
ABSTRACT
BACKGROUND: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. PURPOSE: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. RESULTS: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). CONCLUSION: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.
Subject(s)
Joint Instability , Shoulder Dislocation , Shoulder Joint , Adolescent , Adult , Arthroscopy , Athletes , Humans , Joint Instability/surgery , Recurrence , Retrospective Studies , Shoulder , Shoulder Joint/surgery , Young AdultABSTRACT
BACKGROUND: Scapular notching is a frequently observed complication after reverse shoulder arthroplasty. Impingement of the humeral plastic insert against the scapular neck is believed to be the cause of notching. There have been no in vivo studies that analyzed the positional relationship between the scapular neck and humeral insert. The purpose of this study was to measure the distance between the scapular neck and insert in shoulders with Grammont-type prostheses during active external rotation at the side. METHODS: Eighteen shoulders with Grammont-type prostheses were enrolled in this study. There were 13 males and 5 females, and the mean age at surgery was 74 years (range, 63-91). Fluoroscopic images were recorded during active external rotation at the side from maximum internal to external rotation at an average of 14 months (range, 7-24) after surgery. Implant kinematics were determined with three-dimensional models of the implants and fluoroscopic images using model-image registration techniques. Based on the implant kinematics, the closest distance between the scapular neck and insert was computed at each 5° increment of glenohumeral internal/external rotation. RESULTS: Mean glenohumeral abduction during rotation was 17°-22°. The mean distance between the neck and insert was approximately 1 mm throughout the activity. The separation distance tended to narrow with arm external rotation, but the change was not significant. INTERPRETATION: The small distance between the scapular neck and insert in early post-operative reverse shoulder arthroplasty patients may be associated with the high incidence of scapular notching in Grammont-type prostheses.
Subject(s)
Artificial Limbs , Shoulder Joint , Female , Humans , Male , Polyethylene , Range of Motion, Articular , Scapula/diagnostic imaging , Scapula/surgery , Shoulder , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgeryABSTRACT
BACKGROUND: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial. PURPOSE/HYPOTHESIS: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years' follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined. RESULTS: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: -17° to 0°; group 2: -18° to -6°; P < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up (P = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement. CONCLUSION: No differences were observed in clinical and radiographic outcomes between patients undergoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years' follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.