The Subscapularis Healing Index: A New Scoring System for Predicting Subscapularis Healing After Arthroscopic Repair.

BACKGROUND: Previous research has emphasized the effect of prognostic factors on arthroscopic rotator cuff repair (ARCR) success, but a specific focus on subscapularis (SSC) tendon repair healing is lacking. PURPOSE: To identify prognostic factors for SSC healing after ARCR and develop the Subscapularis Healing Index (SSC-HI) by incorporating these factors. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: This was a retrospective study using prospectively maintained data collected from patients with isolated or combined SSC tears who underwent ARCR between 2011 and 2021 at a single institution with a minimum 2-year follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and visual analog scale (VAS) pain scale. SSC tendon healing was evaluated via ultrasound at the final follow-up. Multivariate logistic regression analysis was performed to determine the factors affecting SSC healing, and based on these factors, the SSC-HI, which ranges from 0 to 15 points, was developed using odds ratios (ORs). RESULTS: Among 1018 ARCR patients, 931 met the inclusion criteria; 279 returned voluntarily for postoperative SSC ultrasound assessment. The overall healing failure rate was 10.8% (30/279). Risk factors for healing failure included female sex (P = .008; OR, 3.119), body mass index (BMI) ≥30 (P = .053; OR, 2.323), supraspinatus fatty infiltration ≥3 (P = .033; OR, 3.211), lower SSC fatty infiltration ≥2 (P = .037; OR, 3.608), and Lafosse classification ≥3 (P = .007; OR, 3.224). A 15-point scoring system comprised the following: 3 points for female sex, 2 points for BMI ≥30, 3 points for supraspinatus fatty infiltration ≥3, 4 points for lower SSC fatty infiltration ≥2, and 3 points for Lafosse classification ≥3. Patients with ≤4 points had a 4% healing failure rate, while those with ≥9 points had a 55% rate of healing failure. Patients with a healed SSC reported significantly higher ASES (healed SSC: ΔASES, 44.7; unhealed SSC: ΔASES, 29; P < .01) and SSV (healed SSC: ΔSSV, 52.9; unhealed SSC: ΔSSV, 27.5; P < .01) and lower VAS (healed SSC: ΔVAS, -4.2; unhealed SSC: ΔVAS, -3; P < .01) scores compared with those with an unhealed SSC. CONCLUSION: The SSC-HI scoring system integrates clinical and radiological factors to predict SSC healing after surgical repair. Successful SSC healing was found to be associated with enhanced functional outcomes, underscoring the clinical relevance of SSC healing prediction in the management of these tears.

Better short-term outcomes of mini-open rotator cuff repair compared to full arthroscopic repair.

BACKGROUND: Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as miniopen and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. METHODS: A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups. RESULTS: Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317). CONCLUSIONS: Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique. Level of evidence: III.

Determining minimal clinically important difference and patient-acceptable symptom state after arthroscopic isolated subscapularis repair.

Background: Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptomatic State (PASS) have emerged as patient-based treatment assessments. However, these have not been investigated in patients undergoing arthroscopic isolated subscapularis repair (AISR). The primary purpose of this study was to determine the MCID and PASS for commonly used patient-reported outcomes in individuals who underwent AISR. The secondary purpose was to assess potential associations between preoperative and intraoperative patient characteristics and the MCID and PASS. Methods: A retrospective analysis was conducted on prospectively collected data for patients who underwent primary AISR between 2011 and 2021 at a single institution, with minimum 2-year postoperative follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) pain scale. The MCID was determined using the distribution-based method, while PASS was evaluated using area under the curve analysis. To investigate the relationship between preoperative variables and the achievement of MCID and PASS thresholds, Pearson and Spearman coefficient analyses were employed for continuous and noncontinuous variables, respectively. Results: A total of 77 patients with a mean follow-up of 58.1 months were included in the study. The calculated MCID values for VAS pain, ASES, and SSV were 1.2, 10.2, and 13.2, respectively. The PASS values for VAS pain, ASES, and SSV were 2.1, 68.8, and 68, respectively. There was no significant correlation between tear characteristics and the likelihood of achieving a MCID or PASS. Female sex, worker's compensation status, baseline VAS pain score, and baseline ASES score, exhibited weak negative correlations for achieving PASS for VAS pain and ASES. Conclusion: This study defined the MCID and PASS values for commonly used outcome measures at short-term follow-up in patients undergoing AISR. Tear characteristics do not appear to impact the ability to achieve a MCID or PASS after AISR. Female sex, worker's compensation claim, and low baseline functional scores have weak negative correlations with the achievement of PASS for VAS pain and ASES scores.

Posteroinferior glenosphere positioning is associated with improved range of motion following reverse shoulder arthroplasty with a 135° inlay humeral component and lateralized glenoid.

BACKGROUND: Optimal glenosphere positioning in a lateralized reverse shoulder arthroplasty (RSA) to maximize functional outcomes has yet to be clearly defined. Center of rotation (COR) measurements have largely relied on anteroposterior radiographs, which allow assessment of lateralization and inferior position, but ignore scapular Y radiographs, which may provide an assessment of the posterior and inferior position relative to the acromion. The purpose of this study was to evaluate the COR in the sagittal plane and assess the effect of glenosphere positioning with functional outcomes using a 135° inlay stem with a lateralized glenoid. METHODS: A retrospective review was performed on a prospectively maintained multicenter database on patients who underwent primary RSA from 2015 to 2021 with a 135° inlay stem. The COR was measured on minimum 2-year postoperative sagittal plain radiographs using a best-fit circle fit method. A best-fit circle was made on the glenosphere and the center was marked. From there, 4 measurements were made: (1) center to the inner cortex of the coracoid, (2) center to the inner cortex of the anterior acromion, (3) center to the inner cortex of the middle acromion, and (4) center to the inner cortex of the posterior acromion. Regression analysis was performed to evaluate any association between the position of the COR relative to bony landmarks with functional outcomes. RESULTS: A total of 136 RSAs met the study criteria. There was no relation with any of the distances with outcome scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale). In regard to range of motion (ROM), each distance had an effect on at least 1 parameter. The COR to coracoid distance had the broadest association with ROM, with improvements in forward flexion (FF), external rotation (ER0), and internal rotation with the arm at 90° (IR90) (P < .001, P = .031, and P < .001, respectively). The COR to coracoid distance was also the only distance to affect the final FF and IR90. For every 1-mm increase in this distance, there was a 1.8° increase in FF and 1.5° increase in IR90 (ß = 1.78, 95% confidence interval [CI] 0.85-2.72, P < .001, and ß = 1.53, 95% CI 0.65-2.41, P < .001; respectively). CONCLUSION: Evaluation of the COR following RSA in the sagittal plane suggests that a posteroinferior glenosphere position may improve ROM when using a 135° inlay humeral component and a lateralized glenoid.

The Effects of Workload Excess on Quality of Work Life in Third-Level Healthcare Workers: A Structural Equation Modeling Perspective.

Examining the workload and working conditions of healthcare workers is crucial regarding the quality of the work life of employees and the quality of services provided. This study aims to determine the effects of the perceptions of workload on the quality of work life of health personnel working in two different tertiary hospitals affiliated with the Ministry of Health and the Higher Education Institution in Türkiye with structural equation modeling. This study was conducted in two hospitals in Malatya province: Inönü University Turgut Özal Medical Center affiliated with the Higher Education Institution and Malatya Training and Research Hospital affiliated with the Ministry of Health. The mean score of the Individual Workload Perception Scale was 106.18 ± 16.5, and the mean score of the Work-related Quality of Life Scale was 66.39 ± 15.33. Total workload scores had a statistically significant positive effect on total quality of work life scores (ß1 = 0.98; p = 0.001). It was concluded that there was a statistically significant relationship between workload and quality of work life and age, unit of employment, working time in the profession, and hospital type.

Open Reduction and Plate Fixation, External Fixator, and Conservative Treatment for Intra-articular Distal Radius Fractures.

Background Distal radius fractures are common fractures. Treatment of intra-articular fractures is controversial, with treatment modalities including closed reduction and casting, open reduction and plating, and closed reduction and fixation with an external fixator. In this study, we compared the clinical and radiological outcomes of our patients treated with three different methods for intra-articular distal radius fractures. We hypothesize that open reduction and plate application are superior. Methodology Adult patients with intra-articular (AO type B and C) fractures of the distal radius and treated with closed reduction-casting, volar locking plate, and external fixator were identified. Radiologically, joint stepping at the end of treatment, radial inclination, radial height, volar tilt, and distal ulna fracture were examined. For clinical scoring, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) scores were computed. Obtained data were compared statistically between groups. Results A total of 164 patients were included in the study. Overall, the treatment modality was conservative in 61, volar with plating in 78, and external fixation in 25. The mean age of the patients was 53.7 years (range = 20-82 years). Overall, 39.6% of the patients were male and 60.4% were female. The mean follow-up period of the patients was 16.7 months (range = 12-28 months). No statistically significant difference was found between Q-DASH scores in the statistical evaluation (p > 0.05). There was a statistically significant difference between the groups in the radiological evaluation. When conservative treatment and the volar plate group were compared, the volar plate was superior in all radiological parameters (p < 0.05). Compared with conservative treatment and external fixation, only volar tilt and radial inclination angle were different. External fixation was better (p < 0.05). Radial length, volar compared to plate and external fixation tilt, and ulnar variance were better in the plate group (p < 0.05). Regarding joint stepping and radial, there was no difference in inclination between the two groups (p > 0.05). Reflex sympathetic dystrophy was seen in a total of 10 (6.1%) patients. Pin-site infection was seen in three (12%) patients in the external fixator group. Implant removal was performed in seven (9.0%) patients who developed plaque due to irritation and tenosynovitis. Early arthrosis was seen in three (4.3%) patients. Conclusions The treatment of distal radius intra-articular fractures should be evaluated and decided individually for each patient. No single method is directly superior to other methods. However, in some cases, the best results radiologically in the treatment of comminuted intra-articular fractures have been obtained in patients with volar plates.

Clinical Outcomes and Tendon Healing After Arthroscopic Isolated Subscapularis Tendon Repair: Results at Midterm Follow-up.

Background: Few studies have reported clinical outcomes and tendon healing rates after arthroscopic isolated subscapularis (SSC) repair (AISR). Purpose/Hypothesis: The primary purpose of this study was to evaluate clinical outcomes and tendon healing after AISR. It was hypothesized that AISR would result in satisfactory clinical outcomes along with a high rate of tendon healing at the midterm follow-up. The secondary purpose was to assess the influence of tear size and muscle atrophy on SSC tendon healing and patient-reported outcomes. It was hypothesized that both would be negatively correlated with healing but would have no effect on clinical outcomes . Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted on prospectively collected data for 77 patients who underwent primary AISR between 2011 and 2021 at a single institution, with a minimum 2-year postoperative follow-up for all patients. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Subjective Shoulder Value (SSV), and the visual analog scale for pain. Repair techniques and concomitant procedures were also collected. SSC tendon healing was evaluated via ultrasound at the final follow-up. Linear regression analysis was performed to determine factors affecting SSC healing. Results: The mean follow-up was 58.1 ± 3.3 months. ASES scores significantly improved from 41.5 to 81.6, and the SSV improved from 38.2 to 80.5 (P < .01 for both). Among the 40 patients (51.9%) who underwent postoperative ultrasound, 87.5% showed complete tendon healing. There were no significant differences in outcome scores between healed and unhealed tendons. Increased muscle atrophy and larger tears were correlated with failure of SSC healing (ß = -0.285 [P = .015] and ß = -0.157 [P = .045], respectively). Conclusion: Improved clinical outcomes and an overall high rate of tendon healing were seen at the midterm follow-up after AISR. Smaller tear sizes with less muscle atrophy were correlated with improved tendon healing. However, even when the tendon incompletely healed, the procedure improved functional outcomes.

Greater Socioeconomic Disadvantage as Measured by the Area Deprivation Index Is Associated With Failure of Healing Following Arthroscopic Repair of Massive Rotator Cuff Tears but Not With Clinical Outcomes.

PURPOSE: To analyze the relationship between Area Deprivation Index (ADI) and preoperative status and short-term postoperative clinical outcomes among patients who underwent arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCTs). METHODS: A retrospective review was conducted on prospectively maintained data on patients who underwent ARCR of MRCTs defined as tear size ≥5 cm or complete tear of at least 2 tendons, with a minimum 2-year follow-up and a valid home address between January 2015 and December 2018. Each patient's home address was mapped to the ADI to determine neighborhood disadvantage. This composite index is composed of 17 census-based indicators, including income, education, employment, and housing quality to quantify the level of socioeconomic deprivation. Ratings were recorded and categorized based on the sample's percentile. Patients were then divided into 2 groups: upper quartile (ie, most disadvantaged [≥75th percentile]) and lower 3 quartiles (ie, least disadvantaged [<75th percentile]). Bivariate analysis was performed to associate ADI with patient-reported outcomes (PROs) and range of motion pre- and postoperatively, as well as complications, healing rate, satisfaction, and return to work. Patients reaching or exceeding the minimal clinically important difference for visual analog scale (VAS), American Shoulder and Elbow Surgeons, Veterans Rand 12-Item questionnaire, and subjective shoulder value were recorded for both cohorts. RESULTS: Ninety-nine patients were eligible for study analysis. Preoperative PROs and range of motion were similar, except for a greater VAS for pain (6.3 vs 4.3; P < .01) and lower American Shoulder and Elbow Surgeons score (32.2 vs 45.1; P = .01) in the most disadvantaged group. Both groups showed similar postoperative PROs scores, but greater VAS improvement was seen in the upper quartile group (Δ 4.2 vs Δ 3.0; P = .04). In contrast, only the least-disadvantaged group significantly improved in internal rotation (P = .01) and forward flexion (18°; P < .01) from baseline. Although satisfaction, complications, and return to work were comparable (P > .05), failure of healing occurred more frequently in the most disadvantaged group (21% vs 6%; P = .03). CONCLUSIONS: Patients with MRCTs residing in the most disadvantaged neighborhoods as measured by the ADI have more pain and functional limitations before undergoing ARCR but demonstrate similar postoperative functional improvements to patients from other socioeconomic backgrounds. Failure of healing of MRCTs may be more common in disadvantaged groups. Furthermore, both groups reported similar rates of clinically important functional improvement. LEVEL OF EVIDENCE: Level III, retrospective cohort comparison.

Evaluation of the dynamic thiol/disulfide homeostasis in patients with chronic venous insufficiency.

OBJECTIVE: There is no study in the literature evaluating the dynamic thiol/disulfide homeostasis in patients with chronic venous insufficiency. Thus, we designed this study to evaluate the dynamic thiol/disulfide homeostasis as a novel indicator of oxidative stress in patients with chronic venous insufficiency. METHODS: This was a prospective case-control study performed at the department of cardiovascular surgery of a tertiary referral hospital in Turkey. A total of 80 (CEAP C3-C6) patients with lower extremity chronic venous insufficiency (as the study group) and 80 healthy subjects (as the control group) were enrolled to the study. The participants' basic demographic and clinical characteristics as well as serum levels of some laboratory parameters including albumin, ferroxidase, myeloperoxidase, native thiol, total thiol, disulphide, native thiol/total thiol, disulphide/native thiol, and disulphide/total thiol were determined, and then compared between the groups. RESULTS: In terms of basic demographic and clinical characteristics, both groups were statistically similar, and there were no significant differences between the groups. When the laboratory parameters were considered, serum ferroxidase and myeloperoxidase levels were detected to be significantly higher, whereas albumin, native thiol, total thiol, and disulphide levels were detected to be significantly lower in the study group than in the control group. CONCLUSIONS: Dynamic thiol/disulphide homeostasis could be considered as an indicator reflecting the oxidative stress status in patients with chronic venous insufficiency.

The Bear Hug Test Improves Sensitivity Compared With the Belly Press Test for Identifying Subscapularis Tendon Tears, but Both Tests Miss the Majority of Partial Tears.

Purpose: To investigate the performance of the bear hug (BH) and belly press (BP) tests in diagnosing tears of the subscapularis (SSC). Methods: A retrospective review was conducted on prospectively maintained data on patients who underwent arthroscopic rotator cuff repair (ARCR) of SSC tears between 2011 and 2021. A control group also was obtained of ARCRs with an intact SSC tendon. All examinations and ARCRs were performed by one high-volume shoulder surgeon. The BH test and BP test results were compared with arthroscopic findings as the gold-standard diagnostic modality. Tear type was classified based on the Lafosse classification. Sensitivity, specificity, positive and negative predictive values, false-positive and false-negative rates, and accuracy were calculated for both tests. Results: A total of 1,122 patients were included for analysis, 866 with intraoperatively confirmed SSC tears (77%) and 256 without (23%). The BH test diagnosed SSC tears with a sensitivity of 46.1% and a specificity of 83.2%, whereas the BP test diagnosed tears with a sensitivity of 23.3% and a specificity of 93.4%. Overall, both tests missed SSC tears in 42.3% (n = 475) of cases. The BH test had accuracy rates of 25.9% for SSC type I tear, 48.7% for type II tear, 65% for type III tear, and 81.7% for type IV-V tear. In contrast, the BP test had accuracy rates of 7.6% for type I tear, 14.7% for type II tear, 42% for type III tear, and 68.7% for type IV-V tear. Conclusions: The BH test had greater sensitivity than the BP test in identifying SSC tears. Both tests showed low accuracy in identifying SSC tears as tear size decreased. Combining both tests did not provide any additional benefits over using the BH test alone. Level of Evidence: Level III, diagnostic study.

Both Radiologists and Surgeons Miss a Substantial Number of Subscapularis Tears on Magnetic Resonance Imaging Examination Prior to Shoulder Arthroscopy.

Purpose: To compare radiologist and surgeon magnetic resonance imaging (MRI) interpretations of subscapularis (SSC) tears against intraoperative arthroscopic examination. Methods: We conducted a retrospective review of prospectively maintained data on patients who underwent arthroscopic rotator cuff repair with and without SSC tears between 2011 and 2022. The radiologists' assessments of SSC integrity were extracted from the MRI reports. One high-volume fellowship-trained shoulder surgeon assessed all MRI scans for the presence or absence of SSC tears. Radiologist and surgeon MRI-based assessments were compared against the diagnostic gold standard (intraoperative arthroscopic examination) and classified according to the Lafosse classification. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. Results: A total of 1,090 patients were included for analysis, 839 with intraoperatively confirmed SSC tears (77%) and 251 without such tears (23%). Radiologists diagnosed SSC tears with a sensitivity of 56.0% (470 of 839 patients) and specificity of 67.3% (169 of 251 patients) via MRI, whereas the surgeon diagnosed SSC tears with a sensitivity of 71.4% (599 of 839 patients) and specificity of 78.1% (196 of 251 patients). Overall, radiologists only correctly identified 56% of SSC tears whereas the shoulder surgeon correctly identified approximately 71.4% of tears. When considering arthroscopically confirmed tear size, that is, intact, partial, full thickness [upper border], and complete, the radiologists' diagnosis rates with MRI were 67.3%, 40.4%, 64.6%, and 78.3%, respectively, and the surgeon's diagnosis rates were 78.1%, 52.7%, 81.9%, and 97.5%, respectively. Conclusions: In a community practice, radiologists miss approximately 50% of SSC tears on MRI examination. A shoulder surgeon with the benefit of clinical examination misses 28.6% of tears on MRI. Accuracy increases as tear size increases, with radiologists detecting 40.4% of partial tears and 78.3% of complete tears and a surgeon detecting 52.7% and 97.5%, respectively. Level of Evidence: Level III, diagnostic study (nonconsecutive patients).

Patients 75 years or older with primary glenohumeral arthritis and an intact rotator cuff show similar clinical improvement after reverse or anatomic total shoulder arthroplasty.

BACKGROUND: The optimal management of primary glenohumeral arthritis (GHOA) in the elderly is an ongoing topic of debate. The purpose of this study was to compare functional outcomes and complications in patients aged 75 years or older treated with anatomic total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) for primary GHOA with an intact rotator cuff. METHODS: A retrospective study was performed on a prospectively maintained database which was queried for patients 75 years of age or older who underwent TSA or RSA for primary GHOA with an intact rotator cuff at a single institution between 2012 and 2021 with minimum 2-year follow-up. Patient-reported outcomes (PROs), including Visual Analog Scale for pain, American Shoulder and Elbow Surgeons, and Subjective Shoulder Value, as well as active range of motion including forward flexion, external rotation, internal rotation, were collected preoperatively and postoperatively. Complications, reoperations, and satisfaction were also recorded. The percentage of patients achieving clinically significant improvement was evaluated with the minimally clinical important difference, substantial clinical benefit, and patient acceptable symptomatic state for each PRO. RESULTS: One-hundred and 4 patients were available for analysis, including 67 TSA patients and 37 RSAs with a mean follow-up of 39.4 months. Preoperative baseline characteristics, PROs, and range of motion were similar between groups. RSA was more commonly performed for eccentric glenoid wear (Walch B2/B3, 62% vs. 22%; P < .001). While clinical outcomes improved comparably in both groups, the TSA cohort showed significantly greater improvement in external rotation (36° vs. 26°; P = .013). Both cohorts had low revision (3% for TSA vs. 0% for RSA) and complication (7% for TSA vs. 5% for RSA; P = .677) rates. Satisfaction was similar in both groups (93% for TSA vs. 92% for RSA; P = .900). Clinically significant improvement was comparable between groups based on the American Shoulder and Elbow Surgeons score (minimally clinical important difference, 93% for TSA vs. 100% for RSA; substantial clinical benefit, 82% vs. 95%; patient acceptable symptomatic state, 67% vs. 78%; P > .05). CONCLUSION: In this retrospective small sample size comparison study, TSA and RSA provide similar short-term clinical outcomes for patients 75 years and older with primary GHOA and an intact rotator cuff. Complication and revision rates are comparably low at short-term follow-up. Our data suggests that advanced age alone should not be used as a decision-making tool for TSA vs. RSA in the setting of primary GHOA with an intact rotator cuff.

Missed Diagnosis of a Rare Retropatellar Juxta-Articular Angioleiomyoma: A Case Report.

Angioleiomyomas are benign tumors that originate from smooth muscle cells and most commonly affect organs such as the uterus or gastrointestinal tract. This article presents a case of a rarely reported angioleiomyoma located in the retropatellar juxta-articular region of the knee. The patient is a 42-year-old female who experienced chronic anterior knee pain that led to two unsuccessful arthroscopic surgeries. Magnetic resonance imaging (MRI) revealed a well-defined lesion in the retropatellar area, prompting the decision to proceed with open surgery. The histopathological examination confirmed the diagnosis of angioleiomyoma. This case highlights the challenges in diagnosing angioleiomyomas in the knee and emphasizes the importance of comprehensive MRI evaluation for accurate diagnosis and appropriate surgical intervention. Prompt identification and excision of the soft tissue lesion can lead to the complete resolution of symptoms and effective management of this rare condition.

Optimization of the Centrifugal Spinning Parameters to Prepare Poly(butylene succinate) Nanofibers Mats for Aerosol Filter Applications.

Air pollution is becoming a serious issue because it negatively impacts the quality of life. One of the first most useful self-defense approaches against air pollution are face masks. Typically made of non-renewable petroleum-based polymers, these masks are harmful to the environment, and they are mostly disposable. Poly(butylene succinate) (PBS) is regarded as one of the most promising materials because of its exceptional processability and regulated biodegradability in a range of applications. In this regard, nanofiber-based face masks are becoming more and more popular because of their small pores, light weight, and excellent filtration capabilities. Centrifugal spinning (CS) provides an alternative method for producing nanofibers from various materials at high speeds and low costs. This current study aimed to investigate the effect of processing parameters on the resultant PBS fiber morphology. Following that, the usability of PBS nonwoven as a filter media was investigated. The effects of solution concentration, rotating speed, and needle size have been examined using a three-factorial Box-Behnken experimental design. The results revealed that PBS concentration had a substantial influence on fiber diameter, with a minimum fiber diameter of 172 nm attained under optimum production conditions compared to the anticipated values of 166 nm. It has been demonstrated that the desired function and the Box-Behnken design are useful instruments for predicting the process parameters involved in the production of PBS nanofibers. PBS filters can achieve an excellent efficiency of more than 98% with a pressure drop of 238 Pa at a flow rate of 85 L/min. The disposable PBS filter media was able to return to nature after use via hydrolysis processes. The speed and cost-effectiveness of the CS process, as well as the environmentally benign characteristics of the PBS polymer, may all contribute considerably to the development of new-age filters.

Arthroscopic Lysis of Adhesions for Stiffness After Surgical Management of Proximal Humerus Fractures Leads to Satisfactory Outcomes in Most Patients.

Purpose: To report patient-reported outcomes (PROs), range of motion (ROM), and satisfaction, in patients who underwent arthroscopic lysis of adhesions for stiffness after open reduction with internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) for fracture. Methods: A retrospective review was performed to identify patients with stiffness who underwent arthroscopic lysis of adhesions following ORIF or RSA for proximal humerus fracture at a single institution between 2012 and 2021 with minimum 1-year follow-up. PROs including visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES), and Subjective Shoulder Value (SSV), as well as active ROM including forward flexion (FF), external rotation (ER), internal rotation (IR), were collected pre- and postoperatively. Attempted nonoperative treatment before arthroscopic lysis of adhesions was documented. Complications and satisfaction were also recorded. Results: A total of 21 patients met the study criteria (4 RSA, 17 ORIF), with an average age of 66.7 ± 8 years. The study sample comprised mostly of female patients (90%). The mean time from the index surgery to arthroscopy was 9 months, and mean follow-up post-lysis was 17 months. Patients with ORIF reported significant pain relief (VAS, Δ -3.2) and improvement in range of motion (FF, Δ 36°; ER, Δ 20°; IR Δ 3 spinal levels) and PROs (ASES, Δ 34.7; SSV Δ 44.8) (P < .01) after lysis. Patients with RSA had significant improvement in ASES (Δ 21.8; P = .04), SSV (Δ 8.8; P = .04), and FF (Δ 38; P = .02) but did not have significant improvement in VAS (Δ -2; P = .2), ER (Δ 0°; P = 1.0), and IR (Δ 1 spinal level; P = .2). Satisfaction was 100% in the RSA cohort and 82% in the ORIF cohort. No complications were observed. Conclusions: Arthroscopic lysis of adhesions for stiffness after surgical management of proximal humerus fracture leads to satisfactory outcomes in most patients. Post-ORIF, patients may achieve improvement in PROs and global ROM, whereas post-RSA, patients may achieve improvement in PROs and FF but do not necessarily improve in rotational ROM. Level of Evidence: Level IV, therapeutic case series.

Production of Ultrafine PVDF Nanofiber-/Nanonet-Based Air Filters via the Electroblowing Technique by Employing PEG as a Pore-Forming Agent.

Particles with diameters smaller than 2.5 µm (PM2.5) can penetrate the respiratory system and have negative impacts on human health. Filter media with a porous surface and nanofiber/nanonet structure demonstrate superior filtration performance compared to traditional nano- and microfiber-based filters. In this study, nanostructured filters were produced using the electroblowing method from solutions containing different ratios of poly(vinylidene fluoride) (PVDF) and polyethylene glycol (PEG) polymers for the first time. By increasing the water-soluble PEG ratio in PVDF/PEG blend nanofibers and employing a water bath treatment to the produced mat afterward, a more porous fibrous structure was obtained with a lower average fiber diameter. Notably, the removal of PEG from the PVDF/PEG (3-7) sample, which had the highest PEG content, exhibited clustered nanofiber-/nanonet-like structures with average diameters of 170 and 50 nm at the points where the fibers intersect. Although this process resulted in a slight decrease in the filtration efficiency (-1.3%), the significant reduction observed in pressure drop led to a 3.2% increase in the quality factor (QF). Additionally, by exploiting the polarizability of PVDF under an electric field, the filtration efficiency of the nanostructured PVDF filters enhanced with a ratio of 3.6% after corona discharge treatment leading to a 60% improvement in the QF. As a result, the PVDF/PEG (3-7) sample presented an impressive filtration efficiency of 99.57%, a pressure drop (ΔP) of 158 Pa, and a QF of 0.0345 Pa-1.

Higher Upper Subscapularis Goutallier Grade and Coracohumeral Distance Narrowing Are Predictive of Subscapularis Tears in Patients Undergoing Arthroscopic Rotator Cuff Repair.

PURPOSE: To evaluate the relation between subscapularis (SSC) Goutallier grade or coracohumeral distance (CHD) and SSC tears, as well as the relation between these radiographic variables and long head of the biceps tendon lesions. METHODS: A retrospective analysis was conducted on prospectively maintained data on patients who underwent arthroscopic rotator cuff repair of SSC tears between 2011 and 2021 with at least 6 months of follow-up. Patients with identified subscapularis tears during arthroscopy were included. A control group was established by randomly selecting patients without SSC tears from the same study period. Goutallier grading and CHD were obtained from preoperative magnetic resonance imaging (MRI) scans. Receiver operating characteristic analysis was conducted to define optimal cutoff values for these diagnostic measures. RESULTS: The study included 735 patients with SSC tears and 249 patients in the control group. Comparing subscapularis tear and intact groups' Goutallier grades revealed significant differences in infraspinatus, upper and lower SSC, and overall SSC (P < .001). No significant difference was detected in supraspinatus Goutallier grade (P = .364). An SSC tear was observed in 58.3% (n = 265) of patients with Goutallier grade 0 of the upper SSC, 77.1% (n = 195) of patients with grade 1 changes, 98.7% (n = 155) with grade 2 changes, and 100% of grade 3 or 4 changes. Goutallier grade of the upper SSC showed a significant correlation with tear size (rs = 0.533; P < .01). CHD measurements were lower in individuals with SSC tears compared to those without tears (6.6 ± 1.7 vs 9.6 ± 1.8; P < .001). Upper SSC Goutallier grade >1 had an acceptable area under the curve (AUC) of 0.742. CHD of 7.96 mm or less had an excellent predictive AUC of 0.879. CONCLUSIONS: Higher Goutallier grade and CHD narrowing are potential associations predictive of SSC tears. Routine MRI assessment of muscle of the upper SSC and the CHD can contribute to the diagnostic accuracy of SSC tears and offer valuable information regarding the severity of such tears. LEVEL OF EVIDENCE: Level III, diagnostic study.

Secondary Rotator Cuff Insufficiency After Anatomic Total Shoulder Arthroplasty.

¼ Secondary rotator cuff insufficiency is a challenging complication after anatomic total shoulder arthroplasty.¼ Acute tears may be amenable to open or arthroscopic repair in some instances.¼ Chronic attritional tears are best managed with revision to reverse shoulder arthroplasty, especially in the elderly.¼ Increased glenoid inclination, larger critical shoulder angle, oversized humeral components, thicker glenoid components, and rotator cuff muscle fatty infiltration have all shown to contribute to tear risk.

Electrically assisted solution blow spinning of PVDF/TPU nanofibrous mats for air filtration applications.

In this study, pure polyvinylidene fluoride (PVDF), pure thermoplastic polyurethane (TPU), and PVDF/TPU blend nanofibers (1:3, 2:2, 3:1 ratios) were produced via electrically assisted solution blow spinning for air filtration applications. Scanning electron microscopy (SEM) analysis was conducted to investigate the diameters and morphology of nanofibers. The filtration performance of nanofibrous mats was examined by air filtration test with challenging with 0.26 ± 0.07 µm salt particles. Moreover, the flexibility and strength of the samples were determined via tensile tests. Results showed that pure TPU nanofibers had better mechanical properties, while pure PVDF nanofibers showed better filtration performance. However, 3PVDF/1TPU nanofibrous sample had high filtration efficiency (98.86%) close to pure PVDF (99.85%) and better flexibility (32.80% elongation) compared to pure PVDF (11.64% elongation).