Arthroscopic subscapularis repair using the subscapularis interlocking (SICK)-stitch technique leads to restoration of clinical function with low complication and revision rates.

Background: The purpose of this study is to determine the mid-term outcome after arthroscopic subscapularis tendon (SCP) reconstruction using the subscapularis interlocking (SICK)-stitch technique. The hypotheses are that arthroscopically repaired SCP lesions using the SICK-stitch show a good restoration of shoulder function with low complication and failure rates. Methods: This is a retrospective monocentric study of n = 199 patients (n = 106 female) with arthroscopically treated SCP tears with the interlocking (SICK) stitch technique from July 2013 to October 2018. Inclusion criteria: minimum follow-up of 2 years. Exclusion criteria: irreparable and massive cuff tears, osteoarthritis, and fractures. The postoperative assessment consisted of the range of motion, constant score, simple shoulder test, simple shoulder value, disability of the shoulder and arm score, short form 12, and patient satisfaction. Results: Mean age was 61 years (25-83); n = 4 (2%) patients were lost to follow-up with mean follow-up time of 63.6 months (36-96). Additional supraspinatus tendon lesions (n = 147) were repaired in n = 101 cases. SCP grading (n = 69) (35% traumatic) (Fox/Romeo): n = 113 grade II, n = 71 grade III, n = 11 grade IV. A positive preoperative lift-off test (n = 132, 68%) was corrected in n = 124 (94%) of cases. Ninety seven percent of patients would undergo surgery again with a mean satisfaction score of 14.4/15. Results at final follow-up (data: mean pre; post; P value): lexion (130; 166; .001), abduction (123;159; .001), external rotation (35;82; .001), internal rotation (52; 68; .07), constant score (50; 82; .001), disability of the shoulder and arm score (40; 19; .001), simple shoulder test (5; 10; .001), and simple shoulder value (44; 83; .001) significantly improved. The mean physical health scale short form 12 was 46 (24-63) and 51 (15-66) for mental health. Age, body mass index, SCP-grading, and supraspinatus tendon repair did not significantly affect any outcome parameter. Three (1.5%) patients underwent revision surgery, of which 1 (0.5%) had an infection. Conclusion: Two years after arthroscopic SCP repair using the SICK-stitch technique, we observed excellent restoration of clinical function with low complication and revision rates. The SICK-stitch technique thus represents a good and reliable therapeutic option for the arthroscopic repair of SCP lesions.

Midterm outcomes of autologous bridging of rotator cuff tears with an autologous tendon patch (TEAR patch).

BACKGROUND: Large and massive rotator cuff tears and tears after failed surgical repair are a challenging clinical problem with different treatment options. The purpose of the study was to evaluate the midterm outcomes after rotator cuff repair (RCR) with autologous hamstring tendon graft bridging (tissue-enhanced autologous rotator cuff repair [TEAR] patch) with the hypothesis that outcomes would be reasonable and complication rates would be low. METHODS: This is a retrospective case series study of patients who underwent open RCR using a TEAR patch from June 2015 to March 2019. The exclusion criteria included evidence of cuff tear arthropathy, advanced fatty infiltration, moderate-to-severe arthropathy, and workers compensation board or litigation involved. Clinical outcome measures were Constant score; Disabilities of the Arm, Shoulder and Hand score; Simple Shoulder Test; Subjective Shoulder Value; range of motion (ROM); and manual muscle test for forward elevation, abduction, external and internal rotation, patient satisfaction, and willingness to perform the operation again. Radiographic outcome measures were magnetic resonance imaging, ultrasound, and radiographs: graft integrity and acromiohumeral distance (AHD). RESULTS: A total of 44 patients were followed (89%) for ≥2 years (45 shoulders, mean age 60.3 years [48-76 years], mean follow-up 4.3 years [2-6 years]). All clinical outcome measures (Constant score, Disabilities of the Arm, Shoulder and Hand score, Simple Shoulder Test, Subjective Shoulder Value, ROM, and manual muscle test) demonstrated significant improvement except active external and internal rotation. At 2 years of follow-up, the mean patient satisfaction was high (12.2 of 15 points), and 33 of 38 patients (73.3%) would perform the operation again. A perfect graft integration was observed in 30 (66.7%), a small gap in 7 (15.6%), a retear in 3 (7%), and a complete failure of the tendon patch in 5 (11%) patients. Graft integrity was strongly correlated with the postoperative AHD (r = 0.599, P = .001) and the gain in AHD (r = 0.599, P = .001) but not with ROM or patient-reported outcome measures or patient satisfaction. Four patients required revision surgeries (3 due to deep infection and 1 for poor function and pain). CONCLUSIONS: Midterm clinical and radiographic outcomes after RCR with graft bridging using a TEAR patch were reasonable. The procedure resulted in improved shoulder function and a high level of patient satisfaction. The revision rate is acceptable in view of the specific patient group and treatment alternatives. The described technique of the TEAR patch can be a valuable alternative to existing methods and a new autograft source for rotator cuff surgeries that need bridging of a tendon defect.

[Conversion of anatomic to reverse shoulder arthroplasty : Does it make sense?] / Konversion von anatomischer auf inverse Prothese : Macht das Sinn?

We can observe increasing numbers for the implantation of shoulder endoprostheses in developed industrial countries. This is accompanied by a certain number of revision surgeries. The conversion to reverse arthroplasty systems is by far the most common revision procedure. Depending on the primary implant and the individual situation, the surgical effort and consumption of resources can be substantial. Particularly favorable revision scenarios exist in the conversion of stemless primary implants that are part of a platform system and allow a partial exchange and easy conversion from anatomical to reverse implants.

Anterolateral Acromioplasty Does Not Change the Critical Shoulder Angle and Acromion Index in a Clinically Relevant Amount.

PURPOSE: Assessment on whether radiographic parameters of the acromion measured in radiographs change significantly after anterolateral acromioplasty. METHODS: This retrospective study included patients that underwent an arthroscopic anterolateral acromioplasty between January 2014 and September 2020. n = 435 subjects with high-quality preoperative and postoperative radiographs according to Suter-Henninger criteria were included in the final assessment. All measurements were independently performed by the first and second author in a blinded fashion using dicomPACS software: acromion index (AI), critical shoulder angle (CSA), lateral acromial angle (LAA), beta angle, acromio-humeral distance (AHD), Aoki angle, frontal supraspinatus outlet angle (FSOW), and acromion type, according to Bigliani. SPSS software was used for statistical analysis. RESULTS: The beta angle and the CSA did not significantly change after operation (alpha power 0.32 and 0.11, respectively). In a subgroup analysis of patients with a pathological CSA >35° (n = 194), the CSA changed from 38.62 (range: 35.08-47.52, SD 2.83) to 38.04 (range: 29.18-48.12, SD 3.77) postoperatively (P = .028) (Fig 8). All other parameters changed significantly after operation (AI, AHD, FSOW, and Aoki; P = .001, LAA; P = .039) (Fig. 9). The interobserver and intraobserver reliability was good to excellent in the majority of measured values. Mean patient age was 59.2 years (range: 18.1-87.1; SD 11.3), mean height was 1.73 meters (range: 1,50-1.98, SD 0.09), mean weight was 80.2 kg (range: 37.0-133.0, SD 16.68), and mean body mass index was 26.6 (range: 0.0-46.1, SD 4.73). CONCLUSION: Anterolateral acromioplasty producing a flat acromion undersurface did not result in a significant change of the CSA in the study population. Pathological preoperative CSA values of >35° were significantly reduced but not to normal values, but only by a small amount that puts the clinical relevance into question. LEVEL OF EVIDENCE: IV, diagnostic study, case series.

Analysis of revision shoulder arthroplasty in the German nationwide registry from 2014 to 2018.

BACKGROUND: The purpose of this study is to identify and analyze primary revision arthroplasties of the shoulder in the Germany Shoulder Arthroplasty Registry. The objective is to provide demographic and clinical data of the included cases and information about the revision surgery itself and to compare the findings to other registry studies and clinical studies. METHODS: All documented cases of primary revision arthroplasties of the Germany Shoulder Arthroplasty Registry in the time period 2014-2018 (n = 975) were included in the initial data analysis. Exclusion criteria were multiple revisions and data sets with a missing link of the revision arthroplasty to the data set of the primary implantation leaving n = 433 cases that were included. SPSS software (IBM SPSS Statistics for Windows, version 24.0; IBM Corp., Armonk, NY, USA) was used for statistical analyses. RESULTS: The age of patients with revised anatomic implants (66.3 years) was significantly lower than that of patients with reverse implants (77.1 years) (P = .001). Female patients with anatomic and fracture implants were significantly older than their male counterparts (70.1 vs. 60.5 years, P = .001; 74.3 vs. 62 years, P = .019) and showed a significantly higher rate of revision than their male counterparts (P = .001). The reason for revision was significantly different for anatomic and reverse implant systems (P = .001). Aseptic loosening of either the humeral or glenoid component was the most common reason for revision for anatomic implants, whereas unspecified reasons, dislocation, and loosening of the glenosphere were the most common reasons for reverse implants. The most common type of revision procedure for anatomic implants was conversion to a reverse system in about one third of the cases. Most of the revisions of reverse implants were not specified and almost equally distributed for revision at the humeral or the glenoid side. Anatomic implants showed significantly better Constant-Murley scores (26.1 points) than reverse implants (19.6 points) (P = .001) and significantly better function before revision for passive flexion (P = .002), passive abduction (P = .015), active external rotation (P = .002), and passive external rotation (P = .002). CONCLUSION: This study provides a well-documented basis to compare revision arthroplasties of the shoulder performed in Germany over the last decade as documented in the nationwide registry with other nationwide registries and with clinical studies. Especially, the detailed analysis of intraoperative and postoperative complications and the shoulder function at the time of revision offers new information in addition to the results of other registries.