Use of a Dry Surgical Simulator Improves Orthopaedic Residents' Competency and Technical Skills for Arthroscopic Rotator Cuff Repair.

Purpose: To evaluate whether an anatomic dry shoulder Dexter training model surgical simulator would be effective in augmenting orthopaedic residents' skills for arthroscopic rotator cuff repair. Methods: Nine residents, enrolled for this prospective study, watched a video presentation about transosseus equivalent (TOE) double-row, rotator cuff repair technique, repeating the aforementioned technique twice on the simulator. The time to complete all steps to final repair, as well as the quality of the final repair, were measured. Results: The data for repair completion time showed a statistically significant difference in the total duration time of performing the procedure, when comparing the timing in tests 1 and 2, demonstrating a reduced operative time. The qualitative data collected show an increase in the final score in 100% (9 out of 9) of the participants between the first and second tests, with an improvement in the average score of 16.4% (3.22 points with a standard deviation of 2.64). Hence, there is a statistically significant difference (P = .006) between the total scores obtained by the participants at the end of tests 1 and 2, presenting an improvement of the quality score, shifting from the first (average score 19.7) to the second (average score 22.9) test. Conclusion: The dry simulator may be a valuable device to improve arthroscopic technical skills. This improvement was observed both in the resulting reduced operative time required to carry out the surgical procedure and the increased quality score (established to evaluate the quality of the required tasks). Clinical Relevance: In order to provide as many training opportunities as possible, an arthroscopy simulator could be used to supplement clinical arthroscopy skills training for orthopaedic residents.

Latarjet procedure for anterior shoulder instability: a 24-year follow-up study.

INTRODUCTION: Different surgical techniques (open and arthroscopic) have been described for the treatment of post-traumatic recurrent anterior instability. The aim of the surgery is to restore when possible, normal shoulder anatomy by repairing the underlying pathology responsible for the instability. Sometimes other surgical techniques are indicated. The purpose of this retrospective study was to investigate the long-term clinical and radiographic results and complications of the open Latarjet procedure after a minimum follow-up of 24 years. MATERIALS AND METHODS: A retrospective study was performed for 67 patients treated with an open Latarjet procedure in a single center. Forty of these 67 patients returned for follow-up evaluation and clinical/radiological examination during the year 2018, having had a minimum of 24-year follow-up. Clinical outcomes were analyzed using two functional scores, in addition to the ROM and strength assessment. Radiographic evaluation included several views (AP views in neutral, internal and external rotation and a comparative Bernageau view) RESULTS: A total of 40 patients underwent an open Latarjet procedure. All the patients were avaible for follow-up at an average of 25.6 years. Clinically, no patient reported any episode of dislocation at the time of follow-up. The mean Rowe score and the Walch-Duplay score were 84.5 (range 45-100) and 83.5 (range 55-100), respectively. Non-union/fibrous union was reported in 12.5% of cases, partial resorption of the graft was found in 7.5% of cases, while total resorption was found in 5% of cases. Osteoarthritis was identified in 52.5% (21) of the patients. CONCLUSIONS: This long-term follow-up study demonstrated that the open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability. The Latarjet procedure provides good long-term stability although associated with a slight limitation in external rotation. LEVEL OF EVIDENCE: Level III; retrospective cohort comparison; treatment study.

Arthroscopic Transosseous Repair of Rotator Cuff Tear and Greater Tuberosity Cysts.

PURPOSE: To evaluate the short-term outcomes of rotator cuff repair in the presence of a greater tuberosity cyst (GTC) using a transosseous repair technique. METHODS: This study included patients who underwent arthroscopic rotator cuff tear repair with a transosseous technique and were evaluated clinically and by postoperative magnetic resonance imaging (MRI) after 1 year. The inclusion criteria were based on the results of preoperative MRI and were as follows: patients identified as having a repairable full-thickness rotator cuff tear associated with the presence of cystic changes at the tendon insertion site of the greater tuberosity, defined as a GTC involving the footprint area of the torn tendon (supraspinatus and/or infraspinatus tendons). RESULTS: We evaluated 25 patients. The mean preoperative and postoperative American Shoulder and Elbow Surgeons scores were 39.48 (P = .530) and 84.64 (P = .035), respectively; Constant shoulder scores, 38.96 (P < .005) and 80.28 (P = .425), respectively; and University of California-Los Angeles shoulder rating scale scores, 10.6 (P = .045) and 29.04 (P = .315), respectively. The GTC mapping system was easily adopted in all the MRI examinations independently from the quality of the images. The GTCs were mostly located in the superficial anterolateral section of the humeral head and in both the posterolateral sections (superficial and deep). CONCLUSIONS: Arthroscopic transosseous rotator cuff repair led to significant mid-term improvement and satisfactory subjective outcomes with low complication and failure rates in this study. The GTC mapping system could be useful to evaluate GTCs and to aid surgeons in the choice of the best surgical technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.