The Relationship between Kinesiophobia and Return to Sport after Shoulder Surgery for Recurrent Anterior Instability.

Purpose To evaluate the relationship between kinesiophobia and patient's return to sport after shoulder stabilization surgery. The hypothesis was that kinesiophobia represents an independent factor correlated to the difference between preinjury and postoperative level of sport. Methods This study retrospectively evaluated 66 patients (mean age: 35.5, standard deviation [SD] = 9.9 years) and at a mean follow-up of 61.1 (SD = 37.5) months after arthroscopic Bankart's repair or open Bristow-Latarjet procedure. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK); return to the preinjury sport was assessed by the difference between baseline and postoperative degree of shoulder involvement in sport (D-DOSIS) scale. The Western Ontario Shoulder Instability index (WOSI) was used to evaluate participants' perceptions of shoulder function. Results TSK showed correlation with D-DOSIS ( ρ = 0.505, p < 0.001) and the WOSI score ( ρ = 0.589, p < 0.001). There was significant difference in TSK and WOSI scores between participants who had and had not returned to their previous level of sport participation ( p = 0.006, and 0.0001, respectively). Conclusion This study demonstrated that kinesiophobia is correlated to the return to sport after shoulder stabilization surgery. Level of Evidence Level IV, retrospective case series.

Psychometric properties of three different scales for subjective evaluation of shoulder pain and dysfunction in Italian patients after shoulder surgery for anterior instability.

BACKGROUND: The Italian versions of Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), and University of California-Los Angeles (UCLA) Shoulder Rating Scale have been validated to assess shoulder dysfunction in patients treated for neck cancer. The present study investigated the psychometric properties of the Italian versions of the SPADI, SST, and UCLA in patients after shoulder surgery for anterior instability. MATERIALS AND METHODS: The study population included 98 patients. Patients completed the Italian SPADI, SST, and UCLA, and Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Oxford Shoulder Score (OSS), and 36-Item Short Form Health Survey (SF-36). Reproducibility was assessed by asking patients to complete another UCLA, SPADI, and SST 48 hours after the first. Validity was assessed by calculating the correlation between the SPADI, SST, and UCLA and the WOSI, ASES, OSS, and the SF-36 Physical Health subscales. RESULTS: The internal consistencies of the SPADI (α = 0.97) and the SST (α = 0.87) were very high. The test-retest reliability was excellent with intraclass correlation coefficient of 0.97 for the SPADI, 0.93 for UCLA pain, 0.95 for UCLA function, and 0.97 for the SST. A significant correlation was found between the Italian SPADI, SST, and UCLA and the WOSI, the ASES and the OSS. DISCUSSION: Psychometric properties of the Italian SPADI, SST, and UCLA compared well with those reported for the original versions, supporting their use as reliable clinimetric instruments in the setting of shoulder disorders after surgery for recurrent anterior instability.

The Degree of Shoulder Involvement in Sports (DOSIS) scale is a valid and responsive instrumentation for shoulder assessment in patients after surgery for anterior instability.

PURPOSE: The purpose of this study was to evaluate validity and responsiveness of the Degree of Shoulder Involvement in Sport (DOSIS) scale. METHODS: A web-based survey was developed to test the construct validity of the DOSIS scale. Fifty-three patients with a median age of 33 years (range 17-59) were included in the study. Convergent validity was evaluated by external correlation (Spearman's rank correlation coefficient, r) of the DOSIS with the Brophy-Marx and Tegner activity scales, the Western Ontario shoulder instability index (WOSI), the Simple Shoulder Test (SST), and the Short-Form 36 (SF-36). Responsiveness was analysed by relative efficiency calculation of the DOSIS versus the Brophy-Marx and Tegner activity scales. RESULTS: The DOSIS showed strong correlation with the Brophy-Marx and Tegner activity scales, a moderate correlation with the WOSI and SST scores, and a moderate correlation with the physical functioning, role physical and role emotional subscores of the SF-36. The distribution of the DOSIS scores had no serious ceiling or floor effects. The DOSIS demonstrated lesser responsiveness when compared to the Brophy-Marx and Tegner activity scales. CONCLUSION: The DOSIS showed an adequate validity and responsiveness. The clinical relevance of this study is that the DOSIS scale can be used for sport-specific shoulder assessment in patients after surgery for anterior instability. LEVEL OF EVIDENCE: III.

Functional versus patient-reported outcome of the bicruciate and the standard condylar-stabilizing total knee arthroplasty.

INTRODUCTION: The purpose of this retrospective comparative analysis in patients undergoing primary total knee arthroplasty (TKA) was to evaluate whether different TKA implant design would influence patient-rated outcomes, functioning, and range of motion (ROM). A secondary purpose of this study was to test for relationships between the patient-rated outcomes and the passive ROM. MATERIALS AND METHODS: Thirty-one patients who had a primary bicruciate stabilized TKA performed between May 2010 and November 2012 were retrospectively reviewed and compared with a cohort of 30 patients who had condylar-stabilizing TKA during the same period. RESULTS: No significant differences were observed between the two groups with respect to preoperative demographic characteristics, ROM and radiographic knee alignment. At a mean follow-up of 37 months (SD 7), the Triathlon group had higher mean Knee Injury and Osteoarthritis Outcome Score (KOOS) score in all subscales and a higher Knee Society Score (KSS) score than the Journey group. This difference was statistically significant for the KOOS subscales of pain (p = 0.0099) and activities of daily living (ADL) (p = 0.0003), as well as the KSS score (p = 0.03846). The ROM was significantly higher in the Journey group when compared to the Triathlon group (p = 0.0013). No significant correlation was observed between the ROM and KOOS pain, QOL and ADL subscores and KSS score. CONCLUSIONS: Postoperative knee ROM and patient perception of knee function after primary TKA can be affected by the different prosthetic designs. However, functionality afforded by the bicruciate TKA is not equivalent to patient satisfaction. LEVEL OF EVIDENCE: III.

Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques. A retrospective study.

PURPOSE: the purpose of this retrospective study was to present the outcomes of three different techniques for the treatment of type III acromioclavicular joint dislocations: arthroscopic TightRope (TR), arthroscopic GraftRope (GR), and open reconstruction of the coracoclavicular (CC) ligament using the Ligament Augmentation and Reconstruction System (LARS). METHODS: eighteen patients underwent clinical and radiological evaluations after a mean follow-up time of 43 months. The following clinical outcome measures were considered: the Disability of the Arm, Shoulder and Hand outcome measure (DASH), the Nottingham Clavicle Score (NCS), and the Constant score (CS). On X-rays, the CC distance was measured. RESULTS: the median DASH score at follow-up was 12.5 in the TR group, 5 in the GR group, and 4.2 in the LARS group. The median NCS value was 88 in the TR group, 88 in the GR group, and 91 in the LARS group. The median CS was 100 in the TR group, 95 in the GR group, and 94.5 in the LARS group. The mean CC distance was 10.3 mm in the TR group, 13.8 in the GR group, and 16.6 in the LARS group. CONCLUSIONS: all three techniques proved to be reliable in providing good clinical outcomes, although none of the studied techniques demonstrated reliability in maintaining anatomical reduction after surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Translation, cross-cultural adaptation and validation of the Italian version of the Nottingham Clavicle Score (NCS).

INTRODUCTION: The Nottingham Clavicle Score (NCS) is a specific Patient Reported Outcome Measure of injuries to the clavicle, acromio-clavicular joint (ACJ) and sterno-clavicular joint. The purpose of this study was to translate the NCS into Italian and establish its cultural adaptiveness and validity. MATERIALS AND METHODS: The original version of the NCS was translated into Italian in accordance with the cross-cultural adaptation guidelines described by Guillemin. Sixty-six patients [average age 45.7 years (SD 11.3)] who had received surgical treatment for injuries of the ACJ and the clavicle were included in the study. The study population completed the NCS twice within 5 days, the Oxford Shoulder Score (OSS), the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the short-form 36 (SF-36). Statistical tests assessed the construct validity, discriminant validity, internal consistency, reliability and feasibility of the NCS. RESULTS: The translation and adaptation of the NCS for an Italian context required no major cultural adaptation. Internal consistency was high (Cronbach's α, 0.86). Test-retest reproducibility was excellent (ρ = 0.981, p < 0.00001). Administration time was 45 s (range 1 min 32 s-8 min), and all items were answered. The Italian NCS showed strong correlation with the DASH (-0.87), the OSS (-0.84) and those subscales of the SF-36 (physical functioning, role physical and bodily pain) which aim to measure similar constructs. CONCLUSIONS: The Italian NCS scale is a reliable, valid, consistent shoulder assessment form that can be used to assess the functional limitations of patients with injuries of clavicle or ACJ. LEVEL OF EVIDENCE: III.

Implantation of matrix-induced autologous chondrocyte (MACI ®) grafts using carbon dioxide insufflation arthroscopy.

PURPOSE: The purpose of this study was to determine the safety of a new arthroscopic Matrix-induced autologous chondrocyte implant (MACI) technique with carbon dioxide insufflation utilized to improve visualization during the dry phase of the scaffold implant. METHODS: Between 2004 and 2007, thirty patients were treated for symptomatic focal chondral lesions of the medial femoral condyle. All patients were monitored during surgery for gas embolism signs and symptoms and were evaluated preoperatively and at a median follow-up of 70.5 months (range 48-93 months) using the KOOS subjective evaluation score, the Lysholm function score, the Tegner activity scale for the knee, and the IKDC objective score. RESULTS: No cases of intraoperative or postoperative symptoms or signs related to gas embolism or persistent subcutaneous emphysema were registered. Each subscale of the KOOS subjective score improved from preoperative to follow-up. The median Lysholm score was 50 (range 15-66) at baseline and 87.5 (range 54-100) at follow-up (p < 0.05). The median Tegner score was 2 (range 1-4) at baseline to 5 (range 2-7) at follow-up (p < 0.05). CONCLUSIONS: No complications registered, and the satisfactory clinical results achieved in this series suggest that carbon dioxide insufflation during arthroscopic MACI is a safe and accessible option to improve visualization during the dry phase of the scaffold implant on medial femoral condyles.

All-inside meniscal repair using the FasT-Fix meniscal repair system: is still needed to avoid weight bearing? A systematic review.

The aim of this study was to review the published clinical outcomes of meniscal repair using the FasT-Fix device comparing standard rehabilitation program to an accelerated rehabilitation protocol. A review of the Medline database was performed involving searches for clinical outcomes of all-inside meniscus repair performed with the FasT-Fix device. Eight studies were identified for inclusion. On the basis of the clinical outcomes of these studies, there appears to be no notable difference between an accelerated rehabilitation regimen with full weight bearing allowed as soon as tolerated and a standard postoperative rehabilitation program. Failure rate was 13 % for patients following an accelerated rehabilitation regimen, and 10 % for standard protocol. Accelerated rehabilitation after all-inside meniscal repair using the FasT-Fix device appears to be safe, and the incidence of retears is in line with those reported for standard rehabilitation protocol.

Arthroscopic Delivery of Matrix-Induced Autologous Chondrocyte Implant: International Experience and Technique Recommendations.

OBJECTIVE: To identify consensus recommendations for the arthroscopic delivery of the matrix-induced autologous chondrocyte implant. DESIGN: An invited panel was assembled on November 20 and 21, 2009 as an international advisory board in Zurich, Switzerland, to discuss and identify best practices for the arthroscopic delivery of matrix-induced autologous chondrocyte implantation. RESULTS: Arthroscopic matrix-induced autologous chondrocyte implantation is suitable for patients 18 to 55 years of age who have symptomatic, contained chondral lesions of the knee with normal or corrected alignment and stability. This technical note describes consensus recommendations of the international advisory board for the technique of arthroscopic delivery of the matrix-induced autologous chondrocyte implant. CONCLUSIONS: Matrix-induced autologous chondrocyte implantation can be further improved by arthroscopic delivery that does not require special instrumentation. In principle, arthroscopic versus open procedures of delivery of the matrix-induced autologous chondrocyte implant are less invasive and may potentially result in less postoperative pain, less surgical site morbidity, and faster surgical recovery. Long-term studies are needed to confirm these assumptions as well as the efficacy and safety of this arthroscopic approach.

Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder.

BACKGROUND: There are several treatment modalities for calcifying tendinitis of the shoulder. If the pain becomes chronic after several months of conservative treatment, open or arthroscopic removal is usually recommended. Recently, extracorporeal shock wave therapy has shown encouraging results in treating calcific deposits. MATERIALS AND METHODS: We report a retrospective study to compare the outcome after arthroscopic extirpation (group I, 22 cases) with the effect of low extracorporeal shock wave therapy (group II, 24 cases) in patients with a chronic homogeneous calcific deposit in the supraspinatus tendon. Patients included in the study had undergone unsuccessful conservative therapy in the previous six months with no evidence of subacromial impingement of the rotator cuff independent of the calcium deposit or rupture of the rotator cuff detected by sonography or magnetic resonance imaging. AP and LL radiographies were performed for all of the patients at least one week before the treatment and 24 months after the treatment. To keep the possibility of spontaneous resorption low, the deposit had to be sharply outlined and densely structured on the radiograph (types I and II in the Gärtner classification). In group II, the patients underwent an average of three treatment sessions of extracorporeal shock waves therapy with 1,500 impulses/session of 0.10-0.13 mJ/mm(2). RESULTS: Preoperative symptoms (P = 0.09), sex (P = 0.17), operated (P = 0.11) and dominant (P = 0.33) limbs, and age (P = 0.99) of the two groups did not show a significative difference between groups. According to the University of California Los Angeles (UCLA) rating system, the mean score in group I improved from 9.36 (+/-5.2) to 30.3 (+/-7.62) points after 24 months, with 81.81% reporting good or excellent results (P < 0.001). In group II the mean score after 24 months rose from 12.38 (+/-6.5) to 28.13 (+/-9.34) points, with 70.83% reporting good or excellent results (P < 0.001). Radiologically, after two years of follow up, there was no calcific deposit in 86.35% (P < 0.001) of the patients of group I and in 58.33 % (P < 0.001) of the patients of group II. According to the UCLA scores, there was no significant difference between the groups at two years of follow-up (P = 0.38). CONCLUSIONS: We conclude that shock wave therapy is equivalent to arthroscopy, and so shock wave therapy should be preferred because of its noninvasiveness.

Arthroscopic rotator cuff repair in patients older than 60 years.

PURPOSE: The purpose of this study was to analyze results by age, tear size, and type of suture repair (margin convergence by side-to-side suture, direct tendon-to-bone repair with suture anchor, or side-to-side plus suture anchor) of arthroscopic rotator cuff repair in patients older than 60 years (average, 67.7 years). TYPE OF STUDY: Retrospective case series. METHODS: From January 1999 to January 2001, 64 patients (64 shoulders) older than 60 years had an arthroscopic rotator cuff repair performed by the same surgical team. Fifty-four patients (84.3%) were available for follow-up (average, 27 months); 54 shoulders were evaluated using the UCLA rating scale (0-35 points). Tears were categorized according to size. The pattern of tears determined the repair technique: crescent-shaped tears were repaired in a direct tendon-to-bone fashion and U-shaped tears by margin convergence with or without suture anchor. RESULTS: The mean of postoperative UCLA score improved from 10.4 (range, 8.2-20 points) to 30.5 (range, 21-35 points) (P < .0001). Sixteen patients (29.6%) had excellent results (34-35 points), 28 (51.8%) had good results (28-33 points), 10 (18.5%) had fair results (21-27 points), and none had poor results. There were no statistical differences between postoperative UCLA score and groups by age (P = .53), suture technique (P = .06), and tear size (P = .5). The correlation between technique of repair, age, and postoperative score has not shown statistical differences between margin convergence with or without suture anchor and direct tendon-to-bone repair with suture anchor in the 61- to 65-year-old patients. Patients older than 65 years achieved the best results with margin convergence by side-to-side suture. CONCLUSIONS: Arthroscopic rotator cuff repair in the elderly achieves satisfactory results in a large percentage of cases regardless of the patient's age, tear size, and type of suture repair. These results are comparable to those of traditional open repair. We believe that arthroscopic evaluation allows an accurate assessment of rotator cuff tear configuration resulting in a more precise repair. LEVEL OF EVIDENCE: Level IV, case series (no, or historical, control group).