Terahertz Néel spin-orbit torques drive nonlinear magnon dynamics in antiferromagnetic Mn2Au.

Antiferromagnets have large potential for ultrafast coherent switching of magnetic order with minimum heat dissipation. In materials such as Mn2Au and CuMnAs, electric rather than magnetic fields may control antiferromagnetic order by Néel spin-orbit torques (NSOTs). However, these torques have not yet been observed on ultrafast time scales. Here, we excite Mn2Au thin films with phase-locked single-cycle terahertz electromagnetic pulses and monitor the spin response with femtosecond magneto-optic probes. We observe signals whose symmetry, dynamics, terahertz-field scaling and dependence on sample structure are fully consistent with a uniform in-plane antiferromagnetic magnon driven by field-like terahertz NSOTs with a torkance of (150 ± 50) cm2 A-1 s-1. At incident terahertz electric fields above 500 kV cm-1, we find pronounced nonlinear dynamics with massive Néel-vector deflections by as much as 30°. Our data are in excellent agreement with a micromagnetic model. It indicates that fully coherent Néel-vector switching by 90° within 1 ps is within close reach.

Current-driven writing process in antiferromagnetic Mn2Au for memory applications.

Current pulse driven Néel vector rotation in metallic antiferromagnets is one of the most promising concepts in antiferromagnetic spintronics. We show microscopically that the Néel vector of epitaxial thin films of the prototypical compound Mn2Au can be reoriented reversibly in the complete area of cross shaped device structures using single current pulses. The resulting domain pattern with aligned staggered magnetization is long term stable enabling memory applications. We achieve this switching with low heating of ≈20 K, which is promising regarding fast and efficient devices without the need for thermal activation. Current polarity dependent reversible domain wall motion demonstrates a Néel spin-orbit torque acting on the domain walls.

Knotless Arthroscopic Glenoid Labral Stabilization for a 270° Tear With Concurrent Remplissage in the Lateral Decubitus Position.

Labral tears resulting in 270° near-circumferential pathology predispose patients to recurrent instability and are technically challenging to repair. Furthermore, when such lesions are associated with Hill-Sachs lesions, recurrent instability risk is significantly increased and can result in substantially lower clinical outcomes. When determining a surgical treatment algorithm for shoulder stabilization, it is important to consider both humeral- and glenoid-sided pathology because subtle defects can have significant influence on recurrence and patient reported outcomes. In this Technical Note and accompanying video, we discuss our surgical technique for knotless arthroscopic stabilization for a 270° labral tear with concurrent remplissage in the setting of recurrent shoulder instability.

Effect of Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Augmentation on the Rate of Revision Rotator Cuff Repair.

Background: The application of orthobiologics at the time of arthroscopic rotator cuff repair (RCR) has received an increasing amount of clinical interest despite a relative scarcity of human clinical studies on their efficacy. Purpose: To utilize a national administrative database to determine the association of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) applied at the time of RCR with revision surgery rates. Study Design: Cohort study; Level of evidence, 3. Methods: The Mariner data set from the PearlDiver patient records repository was utilized to identify patients undergoing RCR using Current Procedural Terminology (CPT) code 29827. Patients receiving BMAC or PRP at the time of RCR were then identified using CPT coding. For comparison purposes, a matched cohort was created consisting of patients who underwent RCR without biologic augmentation in a 5:1 fashion for each biologic separately. Cases were matched according to age, sex, tobacco use, biceps tenodesis, distal clavicle excision, and subacromial decompression. All groups were then queried for revision RCR or conversion to reverse shoulder arthroplasty. Revision rates were compared utilizing a multivariate binomial logistic regression analysis. Adjusted odds ratios (ORs) and 95% CIs were calculated. Results: A total of 760 patients who underwent biologic augmentation during RCR were identified, including 646 patients in the PRP group and 114 patients in the BMAC group. They were compared with 3800 matched controls without documented biologic application at the time of surgery. Compared with matched controls, patients who received BMAC at the time of surgery experienced a significantly lower incidence of revision surgery at 2 years (OR, 0.36; 95% CI, 0.15-0.82; P = .015). There was no significant difference in revision rates between PRP and matched controls (OR, 0.87; 95% CI, 0.62-1.23; P = .183). Conclusion: The application of BMAC at the time of RCR was associated with a significant decrease in the incidence of revision surgery. There was no apparent effect of PRP on the incidence of revision surgery after primary RCR. Higher-level clinical studies considering surgical factors are needed to more clearly define the role of biologic adjuvants in RCR.

Direct observation of antiferromagnetic parity violation in the electronic structure of Mn2Au.

Using momentum microscopy with sub-µm spatial resolution, allowing momentum resolved photoemission on individual antiferromagnetic domains, we observe an asymmetry in the electronic band structure,E(k)≠E(-k), in Mn2Au. This broken band structure parity originates from the combined time and parity symmetry,PT, of the antiferromagnetic order of the Mn moments, in connection with spin-orbit coupling. The spin-orbit interaction couples the broken parity to the Néel order parameter direction. We demonstrate a novel tool to image the Néel vector direction,N, by combining spatially resolved momentum microscopy withab-initiocalculations that correlate the broken parity with the vectorN.

COVID-19 Prevalence in UNIVI Group Nursing Homes and Multilevel Geriatric Hospitals: Epidemiological Study of Immunological Status with Rapid Serological Tests for Diagnostic Guidance and Follow Up.

BACKGROUND/OBJECTIVES: To date, data are lacking on the proportion of residents, and employees who have actually been exposed to SARS-Cov-2 in nursing homes and geriatric healthcare institutions, as well as the evolution of their serological status and the recurrence of Covid-19. The primary objective was to determine the prevalence of COVID-19 using NG Biotech rapid serological tests among caregivers and residents. The secondary objectives were to determine: prevalence according to RT PCR tests or clinical diagnosis; the risk factors (autonomy, arterial hypertension, diabetes mellitus) and clinical presentation (e.g. respiratory, abdominal or cutaneous symptoms, asthenia, fever) among residents; the risk factors (age, sex, profession, family situation) among caregivers; the evolution of the serological status at 1, 3 and 6 months using NG Biotech rapid serological tests; the symptomatic recurrence of Covid 19 at 1, 3 and 6 months. DESIGN: Multicentric prospective observational. SETTING: Study location: 27 nursing homes and 3 multilevel geriatric hospitals belonging to the UNIVI Group in France. PARTICIPANTS: 1334 professionals: 692 among multilevel geriatric hospitals (mean age: 43.6+/-11.8; 441 (82.4%) female) and 642 among nursing homes (mean age: 43.5+/-12.4; 685 (85.9%) female), and 1145 residents (mean age: 89+/-7.5; 898 (78.7%) female). MEASUREMENTS: Prevalence using NG Biotech rapid serological tests, medical diagnosis, RT-PCR tests.Risk factors among residents using the medical file and among caregivers using questionnaires.Clinical presentation in residents using the medical file. RESULTS: The prevalence using NG Biotech rapid serological test in residents was 14.4 % (168 of 1142 available diagnostics), the global prevalence (positive RT-PCR or positive serological test) was 22.7% (203 of 895 available diagnostics). The prevalence using NG Biotech rapid serological test in professionals was 12.8% (164 of 1315 available diagnostics), the global prevalence (positive RT-PCR test or positive serological test) was 23.8% (222 of 933 available diagnostics). The risk factors among residents were: living in an Alzheimer unit, and being a contact case. Being independent for activities of daily living was protective. The risk factor among caregivers was being a contact case. Another risk factor was the job; nurse assistants, nurses, and physicians were the most exposed. Residents had atypical clinical presentations including frequent geriatric syndromes (falls, delirium). 68.3% (71 of 104) of the initially positive residents still had a positive rapid serological test at 1 month follow up and 74 % (54 of 73) at 3 months follow up. 77.9% (88 of 113) of the initially positive employees still had a positive rapid serological test at 1 month follow up. Symptomatic reinfection was exceptional in caregivers or in residents during follow up. CONCLUSION: COVID 19 prevalence among caregivers and residents in nursing homes and geriatric health Institutions is underestimated when using only one method for diagnosis. Geriatric syndromes such as falls and delirium in residents should trigger further investigations on a COVID-19 cause. Immunity was persistent in ¾ of caregivers and residents during the 3 months follow up. The high prevalence of COVID 19 in geriatric institutions pleads in favor of the French vaccination policy, initially targeting as a priority the most vulnerable and dependent people, followed by staff members in healthcare institutions and nursing homes. More studies on the persistence of immunity and the perspective of Covid 19 mutations will help determine the long-term vaccine booster policy.

[Seroprevalence, risk factors and clinical presentation after the first wave of COVID-19 in nursing homes of the UNIVI group: The SEROCOVID study]. / Séroprévalence, facteurs de risque et présentation clinique après la première vague COVID-19 dans les EHPAD du groupe UNIVI : étude SEROCOVID.

INTRODUCTION: The pandemic caused by SARS-COV-2 infection spread rapidly during the "first wave" through France between March and May 2020. It was responsible for high mortality in subjects with comorbidities and the elderly who lived in nursing homes. In May 2020, 75% of the deaths occurred in people over 75 years old in nursing homes. It is difficult to estimate accurately the prevalence of COVID-19 infection during this period because only 50% of the diagnoses in nursing homes were made by RT-PCR. During this period, the diagnosis was mainly based on the clinical symptoms. POPULATION AND METHODS: We carried out a prospective study among residents of the 27 EHPADs in the UNIVI group (SEROCOVID study) between August 31 and October 16, 2020 using rapid ELISA serotests carried out by pricking the fingertip. We looked for the seroprevalence by the use of rapid serotests as well as the overall prevalence by cumulating the positive results of the RT-PCR when done and of the rapid serotest. The secondary objectives were the study of risk factors for infection by multivariate analysis as well as the description of the symptoms that led to the diagnosis. RESULTS: In total, 1145 residents were included aged on average 89±7.5 years old (female 78.7%). The time between the COVID-19 disease and the rapid inclusion serotest was on average 5±1.7 months. The prevalence estimated by the three diagnostic evaluation methods (medical diagnosis, RT-PCR or by rapid serotest ELISA) is about 14%, underestimated compared to the overall prevalence at 22.7%. The study of risk factors in multivariate analysis shows that the most dependent residents, living in a protected unit due to behavioral disorders or whose close contact with a person with COVID-19 had significantly higher rates of infection. Finally, the symptoms most frequently observed in residents differed from those in younger subjects with geriatric characteristics, such as the higher frequency of digestive symptoms and geriatric syndromes. Fever has only been observed in one third of cases in the elderly. Smell and taste disorders were seldom described. CONCLUSION: Our study provides an estimate of the overall prevalence as well as the mean seroprevalence of COVID-19 in EHPAD residents five months after the diagnosis of COVID-19 disease. The difference between the two estimates is probably explained by the frailty and decreased immunity of the nursing home residents. Therefore, it would need to be reactivated by vaccination of all residents, even those already infected with SARS-COV-2. These elements corroborate the governmental strategy of vaccination deployed in all residents of EHPAD regardless of their previous contact with the virus.

Readout of an antiferromagnetic spintronics system by strong exchange coupling of Mn2Au and Permalloy.

In antiferromagnetic spintronics, the read-out of the staggered magnetization or Néel vector is the key obstacle to harnessing the ultra-fast dynamics and stability of antiferromagnets for novel devices. Here, we demonstrate strong exchange coupling of Mn2Au, a unique metallic antiferromagnet that exhibits Néel spin-orbit torques, with thin ferromagnetic Permalloy layers. This allows us to benefit from the well-established read-out methods of ferromagnets, while the essential advantages of antiferromagnetic spintronics are only slightly diminished. We show one-to-one imprinting of the antiferromagnetic on the ferromagnetic domain pattern. Conversely, alignment of the Permalloy magnetization reorients the Mn2Au Néel vector, an effect, which can be restricted to large magnetic fields by tuning the ferromagnetic layer thickness. To understand the origin of the strong coupling, we carry out high resolution electron microscopy imaging and we find that our growth yields an interface with a well-defined morphology that leads to the strong exchange coupling.

The risk of early infection following intra-articular corticosteroid injection following shoulder arthroplasty.

BACKGROUND: There is little literature examining the association of corticosteroid injections into shoulders with a pre-existing arthroplasty. The aim of the current study was to determine the risk of early infection following intra-articular corticosteroid injection into a pre-existing shoulder arthroplasty. METHODS: The PearlDiver database was retrospectively reviewed to identify patients with a pre-existing shoulder arthroplasty from 2007 to 2017. Patients with an ipsilateral shoulder corticosteroid injection in the postoperative period were identified. A control group of patients without an injection was matched 4:1 by age, gender, and postoperative timepoint. Periprosthetic infection within six months after the injection was then assessed and compared using a logistic regression analysis. RESULTS: Nine hundred and fifty-eight patients were identified who underwent a postoperative corticosteroid injection into a pre-existing shoulder arthroplasty and compared to 3832 control patients. After controlling for demographics, comorbidities, and procedure type, the rate of infection in patients who received a postoperative corticosteroid injection (1.77%) was significantly higher than control patients who did not receive an injection (0.91%) (OR 1.98 (95% CI 1.31-2.98), p = 0.0253). CONCLUSIONS: There is a significant association between intra-articular shoulder corticosteroid injections in patients with pre-existing shoulder arthroplasties and prosthetic joint infection compared to matched controls without postoperative injections. STUDY DESIGN: Level III, retrospective cohort study.

Trends and impact of three-dimensional preoperative imaging for anatomic total shoulder arthroplasty.

BACKGROUND: The goals of this study were to determine the incidence in the United States of preoperative three-dimensional imaging prior to anatomic total shoulder arthroplasty for osteoarthritis and to determine if preoperative imaging is associated with decreased complication rates. METHODS: Using a Medicare insurance database, we identified all patients who underwent computed tomography (n = 9380) and/or magnetic resonance imaging (n = 15,653) prior to anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis from 2005 to 2014. The incidence of imaging over time was analyzed and complication rates compared between patients with imaging to matched controls. RESULTS: The incidence of preoperative three-dimensional imaging significantly increased over time, with computed tomography increasing more than magnetic resonance imaging. Compared to controls, patients with preoperative computed tomography imaging had significantly lower revision rates at two years (odds ratio 0.72 (0.64-0.82), p = 0.008). There were no other significant differences in the other complications studied. CONCLUSIONS: The use of preoperative three-dimensional imaging for anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis has increased dramatically, with the use of computed tomography increasing the most. Patients who underwent preoperative computed tomography imaging experienced lower revision rates at two years postoperatively compared to matched controls without such imaging. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

The Relationship of Staged, Bilateral Arthroscopic Primary Rotator Cuff Repair Timing and Postoperative Complications.

BACKGROUND: Although previous studies have reported acceptable clinical outcomes after simultaneous, single-stage bilateral and staged bilateral rotator cuff repair (RCR), few studies have been adequately powered to compare postoperative complication rates at various time intervals between procedures. PURPOSE: To examine the relationship between the timing of bilateral arthroscopic RCR and complications. STUDY DESIGN: Descriptive epidemiology study. METHODS: Patients from the Medicare data set within the PearlDiver database who underwent bilateral RCR between 2005 and 2014 were identified. These patients were then stratified by time between surgeries into cohorts: (1) single stage, (2) <3 months, (3) 3 to 6 months, (4) 6 to 9 months, (5) 9 months to 1 year, and (6) 1 to 2 years. Surgical and medical complications of these cohorts were compared with those of a control cohort of patients who underwent bilateral RCR >2 years apart using a regression analysis. RESULTS: A total of 11,079 patients who underwent bilateral RCR were identified. Patients who underwent single-stage bilateral arthroscopic RCR experienced higher rates of revision RCR (odds ratio [OR], 2.1; P < .0001), reverse total shoulder arthroplasty (RTSA) (OR, 2.47; P < .0001), and postoperative infection (OR, 2.18; P = .007) in addition to higher rates of venous thromboembolism (VTE) (OR, 1.78; P = .031) and emergency department visits (OR, 1.51; P = .002) compared with the control group. Patients who underwent bilateral RCR with a <3-month interval had higher rates of revision surgery (OR, 1.56; P = .003), RTSA (OR, 1.89; P = .002), and lysis of adhesions (OR, 2.31; P < .0001) in addition to increased rates of VTE (OR, 1.92; P = .015) and emergency department visits (OR, 1.62; P < .0001) compared with the control group. There were no differences in any surgical or medical complications when surgeries were staged by ≥3 months compared with controls. CONCLUSION: Patients with Medicare undergoing single-stage and staged bilateral RCR who had the second repair within 3 months had significantly higher rates of multiple medical and surgical complications compared with patients waiting >2 years between procedures.

Vitamin D deficiency and total shoulder arthroplasty complications.

INTRODUCTION: The primary objective of this study was to examine the relationship between vitamin D deficiency and implant-related and medical complications following total shoulder arthroplasty. METHODS: Using the PearlDiver database, patients who underwent total shoulder arthroplasty from 2005 to 2016 with vitamin D deficiency were identified. These were compared to a 3:1 control group matched by age, sex, and presence of a concomitant osteoporosis diagnosis. Primary outcome measures were implant-related complications (loosening, periprosthetic fracture, periprosthetic joint infection, and revision total shoulder arthroplasty) in addition to medical complications within 90 days of surgery. A multivariable logistic regression analysis was utilized to control for patient demographics and comorbidities. RESULTS: One thousand and six hundred and seventy-four patients with vitamin D deficiency were identified and compared to 5022 controls. There was a significantly higher rate of revision total shoulder arthroplasty in the vitamin D deficient patients compared to controls (2.3% versus 0.8%, odds ratio 3.3, p < 0.0001). After controlling for confounding variables, there were no significant differences in any of the remaining implant-related or medical complications with the exception of higher rates of urinary tract infections in patients with vitamin D deficiency. CONCLUSIONS: Vitamin D deficiency is associated with a higher rate of all-cause revision total shoulder arthroplasty but not medical complications compared to controls.Level of evidence: Level III case control study.

Transtibial Anterior Cruciate Ligament Reconstruction: Tips for a Successful Anatomic Reconstruction.

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopaedic sports procedures. Two main techniques are used for accomplishing an ACL reconstruction: transtibial and anteromedial portal techniques. The transtibial technique has been criticized for its inability to create an anatomic femoral tunnel given the intrinsic constraint of the tibial tunnel during drilling. However, technical modifications of the transtibial technique can result in anatomic tunnel entrance positioning and a properly oriented graft. This Technical Note presents our technique for anatomic transtibial ACL reconstruction.

Patient-Related Risk Factors for Contralateral Anterior Cruciate Ligament (ACL) Tear After ACL Reconstruction: An Analysis of 3707 Primary ACL Reconstructions.

BACKGROUND: Return to play after anterior cruciate ligament (ACL) reconstruction can increase risk for both ipsilateral graft rupture and contralateral ACL rupture. The risk for injury of the contralateral knee after ACL reconstruction could be nearly double that of ipsilateral graft rupture. QUESTIONS/PURPOSES: We sought to identify independent, patient-related risk factors for contralateral ACL rupture following primary ACL reconstruction. METHODS: A national database was queried for patients who underwent primary ACL reconstruction from 2007 to 2015 with a minimum of 2 years of post-operative follow-up (n = 12,044). Patients who underwent subsequent primary ACL reconstruction on the contralateral extremity were then identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for contralateral ACL rupture, including demographic and comorbidity variables. Adjusted odds ratios and 95% confidence intervals were calculated for each risk factor. RESULTS: Of the 3707 patients who had a minimum of 2 years of database activity and comprised the study group, 204 (5.5%) experienced a contralateral ACL rupture requiring reconstruction. Independent risk factors for contralateral ACL rupture included age less than 20 years, female gender, tobacco use, and depression. Obesity, morbid obesity, type 1 diabetes, type 2 diabetes, and a history of anxiety were not significant predictors of contralateral injury. CONCLUSION: We were able to adequately power an analysis to identify several significant patient-related risk factors for contralateral ACL rupture after primary ACL reconstruction, including younger age, female gender, tobacco use, and depression. This information can be used to counsel patients on the risk of injury to the contralateral knee.

Certificate-of-Need Programs Are Associated with a Reduced Incidence, Expenditure, and Rate of Complications with Respect to Knee Arthroscopy in the Medicare Population.

BACKGROUND: To curb costs at the state level, improve care quality, and promote access to care, certificate-of-need (CON) laws were established in many states in 1974. It is not known how CON regulations have affected the provision of knee arthroscopy, one of the most common orthopedic procedures performed in the USA. QUESTIONS/PURPOSES: We sought to characterize the effects of CON regulations on knee arthroscopy in the national Medicare population by examining trends in procedure volumes, comparing trends in procedure charges, evaluating distribution of procedure volumes between high-, mid-, and low-volume facilities, and comparing adverse event and complication rates after knee arthroscopy between states with and without CON regulations. METHODS: States with CON regulations covering both inpatient and outpatient operating rooms formed the study group (n = 25 states) and were compared with states without CON laws or laws that did not cover operating rooms during the study period (n = 20 states). The 100% Medicare Standard Analytical Files from 2005 through 2014 were used to compare knee arthroscopy procedure volumes, charges, reimbursements, distribution of procedures based on facility volumes and adverse events between the two groups. RESULTS: The rate of decrease in the incidence of knee arthroscopy was significantly greater in CON states than that in non-CON states. CON states also had significantly lower charges at all time points, and overall, compared with non-CON states. There were significantly more high- and mid-volume facilities in CON states than in non-CON states, and there were significantly more low-volume facilities in non-CON states than in CON states. Finally, there were significantly higher rates of emergency room visits within 30 days and infection within 6 months in non-CON states than in CON states. CONCLUSIONS: CON regulations appear to have achieved several of their intended goals for knee arthroscopy. Further research is needed to determine if CON regulations affect the quality and sustainability of care provided to patients undergoing knee arthroscopy.

Néel Vector Induced Manipulation of Valence States in the Collinear Antiferromagnet Mn2Au.

The coupling of real and momentum space is utilized to tailor electronic properties of the collinear metallic antiferromagnet Mn2Au by aligning the real space Néel vector indicating the direction of the staggered magnetization. Pulsed magnetic fields of 60 T were used to orient the sublattice magnetizations of capped epitaxial Mn2Au(001) thin films perpendicular to the applied field direction by a spin-flop transition. The electronic structure and its corresponding changes were investigated by angular-resolved photoemission spectroscopy with photon energies in the vacuum-ultraviolet, soft, and hard X-ray range. The results reveal an energetic rearrangement of conduction electrons propagating perpendicular to the Néel vector. They confirm previous predictions on the origin of the Néel spin-orbit torque and anisotropic magnetoresistance in Mn2Au and reflect the combined antiferromagnetic and spin-orbit interaction in this compound leading to inversion symmetry breaking.

Arthroscopic Superior Capsular Reconstruction with Dermal Allograft for the Treatment of a Massive Irreparable Rotator Cuff Tear.

A massive, irreparable rotator cuff tear represents a challenging treatment scenario with respect to surgical intervention. Traditionally, surgical options have included reverse total shoulder arthroplasty, hemiarthroplasty, or rotator cuff repair; however, these techniques may not necessarily restore proper anatomy to the superior capsule, a structure implicated in the maintenance of subacromial contact pressures and the prevention of superior glenohumeral translation. Indications for arthroscopic superior capsular reconstruction include massive, irreparable supraspinatus and/or infraspinatus tears and failure of conservative treatment beyond subjective pain thresholds and dysfunction tolerability. Adequate latissimus dorsi, pectoralis major, and deltoid function helps to ensure the appropriate level of shoulder stability and the ability to complete the necessary rehabilitation protocol. The current surgical guide details the clinical evaluation, surgical technique, and rehabilitation protocol for patients undergoing arthroscopic superior capsular reconstruction for a massive, irreparable rotator cuff tear involving the subscapularis, supraspinatus, and infraspinatus. The procedure is performed arthroscopically with the patient in a beach-chair position, starting first with anterior and lateral portal placement for comprehensive diagnostic shoulder arthroscopy assessing rotator cuff damage. Single-row suture repair of the subscapularis and infraspinatus is performed, followed by concomitant subacromial bursectomy, decompression, and coracoplasty to aid in visualization, avoid graft abrasion, and provide access to marrow elements. Suture anchor placement, allograft fixation, and appropriate suture management are highlighted, as well as rehabilitation timelines, complications, and clinical pearls.

Editorial Commentary: Go Ahead and Repair My Rotator Cuff. I Dare You.

A national database in the United States was used to identify increasing age, male sex, smoking, obesity, hyperlipidemia, and vitamin D deficiency as significant independent patient-specific risk factors for rotator cuff repair failure requiring revision repair. Understanding risks for repair failure can help counsel patients, inform treatment strategies, and consider treatment alternatives for patients with symptomatic rotator cuff tears.

Salvage reverse total shoulder arthroplasty for failed anatomic total shoulder arthroplasty: a cohort analysis.

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed anatomic total shoulder arthroplasty (TSA) is increasing in incidence. The purpose of this study was to analyze the results of RTSA as a revision salvage procedure for failed TSA and identify factors that influenced those outcomes. METHODS: All anatomic TSAs that were revised to RTSAs in adult patients, under the care of 2 senior surgeons at a single academic center from 2006 to 2018, were queried and reviewed. Cases in which hemiarthroplasty or RTSA was revised to RTSA were excluded. Electronic medical records and survey databases were reviewed for each subject. Demographic and surgical details were reviewed and analyzed with descriptive statistics. Preoperative and postoperative range of motion (ROM) including active forward elevation and active external rotation were evaluated. Patient-reported outcome surveys including the American Shoulder and Elbow Surgeons survey, Single Assessment Numeric Evaluation, and visual analog scale for pain were collected and analyzed. Improvement in ROM and outcome survey measures was assessed with 2-sample t tests. Complication and reoperation rates were analyzed with descriptive statistics. RESULTS: A total of 75 patients (32 men and 43 women) were available for analysis at a mean of 22.3 months. The subjects were aged 60.3 ± 11.3 years at the time of TSA and 64.6 ± 9.7 years at the time of RTSA. The average period between TSA and RTSA was 4.3 years. The 3 most common indications for revision RTSA were painful arthroplasty (n = 62, 82.7%), rotator cuff failure (n = 56, 74.7%), and unstable arthroplasty (n = 25, 33.3%), but the majority of patients had multiple indications for surgery (n = 69, 92%). Significant improvements were found in all outcome measures from the time of failed TSA diagnosis to most recent follow-up after salvage RTSA with the exception of active external rotation: American Shoulder and Elbow Surgeons score, 39 ± 15 preoperatively vs. 62 ± 25 postoperatively; Single Assessment Numeric Evaluation, 27 ± 23 vs. 60 ± 30; visual analog scale pain score, 5 ± 2 vs. 3 ± 3; and active forward elevation, 79° ± 41° vs. 128° ± 33°. Major complications occurred in 21 patients (28.4%) after salvage RTSA, and 9 (12%) underwent reoperation. CONCLUSIONS: RTSA for failed TSA can improve pain, function, and quality-of-life measures in patients with various TSA failure etiologies. However, postoperative ROM and patient-reported outcomes do not reach the values seen in the primary RTSA population.