Reverse Shoulder Arthroplasty: Evaluation of the Clinical and Functional Outcomes per Etiology.

Objective The present study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty to treat several conditions. Methods Retrospective, longitudinal study analyzing the Constant and University of California at Los Angeles (UCLA) scores and range of motion of patients undergoing reverse shoulder arthroplasty. Results In total, 28 patients were analyzed, with a mean age of 75.6 years old. The mean duration of follow-up was 45 months. Overall, there was a significant variation ( p < 0.0001) between the preoperative (10.2 points) and the postoperative UCLA scores (29.6 points), corresponding to a relative increase of approximately 200%. In addition, the mean Constant score was 67.8, and the complication rate was 17.8%. As for functional outcomes per etiology, fracture sequelae cases presented the best mean elevation (165°), Constant score (79 points), postoperative UCLA score (32.5 points), and absolute delta UCLA score increase (22 points), but with no statistical significance. However, cases operated for fracture sequelae showed significantly higher elevation ( p = 0.027) and Constant score ( p = 0.047) compared to rotator cuff arthropathy cases. In addition, the lowest mean postoperative Constant and UCLA scores were observed for the following etiologies: primary arthrosis, acute fracture, and arthroplasty revision. Conclusion Reverse shoulder arthroplasty showed satisfactory functional outcomes and may be a treatment option not only for rotator cuff arthropathy but for several other conditions.

Reverse Shoulder Arthroplasty: Evaluation of the Clinical and Functional Outcomes per Etiology / Artroplastia reversa de ombro: Avaliação dos resultados clínicos e funcionais de acordo com a etiologia

Abstract Objective The present study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty to treat several conditions. Methods Retrospective, longitudinal study analyzing the Constant and University of California at Los Angeles (UCLA) scores and range of motion of patients undergoing reverse shoulder arthroplasty. Results In total, 28 patients were analyzed, with a mean age of 75.6 years old. The mean duration of follow-up was 45 months. Overall, there was a significant variation (p< 0.0001) between the preoperative (10.2 points) and the postoperative UCLA scores (29.6 points), corresponding to a relative increase of approximately 200%. In addition, the mean Constant score was 67.8, and the complication rate was 17.8%. As for functional outcomes per etiology, fracture sequelae cases presented the best mean elevation (165°), Constant score (79 points), postoperative UCLA score (32.5 points), and absolute delta UCLA score increase (22 points), but with no statistical significance. However, cases operated for fracture sequelae showed significantly higher elevation (p= 0.027) and Constant score (p= 0.047) compared to rotator cuff arthropathy cases. In addition, the lowest mean postoperative Constant and UCLA scores were observed for the following etiologies: primary arthrosis, acute fracture, and arthroplasty revision. Conclusion Reverse shoulder arthroplasty showed satisfactory functional outcomes and may be a treatment option not only for rotator cuff arthropathy but for several other conditions.

Resumo Objetivo Avaliar os resultados clínicos da artroplastia reversa do ombro no tratamento de suas diversas indicações. Métodos Estudo longitudinal retrospectivo que analisou os resultados dos escores Constant, UCLA e amplitudes de movimentos dos pacientes submetidos à artroplastia reversa do ombro. Resultados Foram analisados 28 pacientes, a média de idade foi de 75.6 anos, com seguimento médio de 45 meses. No geral, obtivemos uma variação significativa (p< 0,0001) entre o escore UCLA pré-operatório (10,2 pontos) e o escore UCLA pós-operatório (29,6 pontos), o que corresponde a um aumento relativo de aproximadamente 200%. Além disso, obtivemos pontuação média do escore Constant de 67,8 e uma taxa de complicações de 17,8%. Quanto aos resultados funcionais segundo as indicações, os casos de sequela de fratura apresentaram as melhores médias de elevação (165°), escore Constant (79 pontos), escore UCLA pós-operatório (32,5 pontos) e aumento absoluto na variação do escore UCLA (22 pontos), sem significância estatística. Porém, identificou-se que os casos operados por sequela de fratura apresentaram elevação (p= 0,027) e pontuação no escore Constant (p= 0,047) significativamente maiores em relação aos casos de artropatia do manguito rotador. Além disso, observamos que as menores médias dos escores Constant e UCLA pós-operatórios foram obtidos nas seguintes etiologias: artrose primária, fratura aguda e revisão de artroplastia. Conclusão A artroplastia reversa de ombro apresentou resultados funcionais satisfatórios, podendo ser uma opção de tratamento não somente nos casos de artropatia do manguito rotador, mas também em várias outras patologias.

Arthroscopic Treatment of Rotator Cuff Rupture in Patients Under 55 years Old versus Patients Older than 65 Years Old.

Objective To evaluate patients submitted to arthroscopic repair of the rotator cuff (RC) comparing the results of muscle, functional strength, and pain obtained in 2 distinct groups: patients < 55 years old (G55) and patients > 65 years old (G65). Methods Data collection was performed with 63 participants (29 < 55 years old and 34 > 65 years old), in 2 moments, analyzing: A) demographic, surgical and RC lesion characteristics; B) functional variables, muscle strength, and pain. Results Higher levels of anterior elevation force, lateral, and medial rotation of the operated shoulder were observed in group G55. However, when the difference between these forces of the operated shoulder and of the contralateral shoulder was evaluated, there was no significant difference between the groups. The other variables of function and pain were similar ( p > 0.05). There was also no difference between the groups in the University of California at Los Angeles Shoulder Rating Scale (UCLA) ( p = 0.56) and Constant-Murley Score ( p = 0.99) scores. Conclusion Arthroscopic repair of the RC in older, active, selected patients may achieve functional improvement and quality of life similar to that performed in younger patients.

Arthroscopic Treatment of Rotator Cuff Rupture in Patients Under 55 years Old versus Patients Older than 65 Years Old / Comparação do tratamento artroscópico de ruptura do manguito rotador em pacientes com menos de 55 anos versus pacientes com mais de 65 anos

Abstract Objective To evaluate patients submitted to arthroscopic repair of the rotator cuff (RC) comparing the results of muscle, functional strength, and pain obtained in 2 distinct groups: patients < 55 years old (G55) and patients > 65 years old (G65). Methods Data collection was performed with 63 participants (29 < 55 years old and 34 > 65 years old), in 2 moments, analyzing: A) demographic, surgical and RC lesion characteristics; B) functional variables, muscle strength, and pain. Results Higher levels of anterior elevation force, lateral, and medial rotation of the operated shoulder were observed in group G55. However, when the difference between these forces of the operated shoulder and of the contralateral shoulder was evaluated, there was no significant difference between the groups. The other variables of function and pain were similar (p> 0.05). There was also no difference between the groups in the University of California at Los Angeles Shoulder Rating Scale (UCLA) (p= 0.56) and Constant-Murley Score (p= 0.99) scores. Conclusion Arthroscopic repair of the RC in older, active, selected patients may achieve functional improvement and quality of life similar to that performed in younger patients.

Resumo Objetivo Avaliar os pacientes submetidos a reparo artroscópico do manguito rotador (MR) comparando os resultados de força muscular, funcionais e de dor obtidos em 2 grupos distintos: de pacientes < 55 anos (G55) e em pacientes > 65 anos (G65). Métodos A coleta de dados foi realizada com 63 participantes (29 pacientes < 55 anos e 34 > 65 anos), em 2 momentos, analisando: A) características demográficas, cirúrgicas e das lesões de MR; B) variáveis funcionais, força muscular e dor. Resultados Foram observados maiores níveis de na força de elevação anterior, rotação lateral e rotação medial do ombro operado no grupo G55. Porém, quando avaliada a diferença entre estas forças do ombro operado e do ombro contralateral, não se observou diferença significativa entre os grupos. As demais variáveis de função e dor foram similares (p> 0,05). Também não houve diferença entre os grupos nos escores University of California, Los Angeles (UCLA, na sigla em inglês) (p= 0,56) e Constant (p= 0,99). Conclusão O reparo artroscópico do MR em pacientes mais velhos, ativos e selecionados pode obter melhora funcional e de qualidade de vida similar ao realizado em pacientes mais jovens.

Arthroscopic Repair of Rotator Cuff Injury: An Analysis of Function, Muscular Strength and Pain Between Single Row and Double Row Techniques.

Objective To evaluate the patients submitted to arthroscopic repair of the rotator cuff (RC), comparing the functional results, muscle strength, and pain obtained after single row (SR) and double row (DR) techniques. Methods Data were collected at the postoperative follow-up (minimum of 12 months) of 128 patients submitted to arthroscopic RC repair from 2011 to 2018. The clinical-functional variables were collected through the clinical examination, and the demographic, surgical and injury variables of the RC were collected from the electronic medical records. The results were compared between the SR and DR groups. Results The DR group showed higher anterior elevation strength when compared with the SR group (SF: 4.72 ± 2.73 kg versus DR: 5.90 ± 2.73 kg; p = 0.017). The other variables of muscle strength, Constant-Murley Score, University of California at Los Angeles Shoulder Rating Scale (UCLA), and pain, were similar. Performing the stratification by size, in the analysis of small and medium injuries, no differences were found between the groups. However, in the analysis of large and extensive injuries, patients submitted to DR presented superiority of both muscle lifting strength (SF: 3.98 ± 2.24 kg versus DR: 6.39 ± 2.73 kg) and Constant score (SF: 81 ± 10 versus DR: 88 ± 7). Conclusion The use of the DR technique in arthroscopic RC repair allowed higher levels of muscle strength for anterior shoulder elevation when compared with the SF technique. Data stratification in large and extensive injuries showed superiority of anterior shoulder elevation muscle strength and of the Constant score in patients submitted to DR.

Arthroscopic Repair of Rotator Cuff Injury: An Analysis of Function, Muscular Strength and Pain Between Single Row and Double Row Techniques / Reparo artroscópico da lesão de manguito rotador: Uma análise da função, força muscular e dor entre técnicas de fileira simples e fileira dupla

Abstract Objective To evaluate the patients submitted to arthroscopic repair of the rotator cuff (RC), comparing the functional results, muscle strength, and pain obtained after single row (SR) and double row (DR) techniques. Methods Data were collected at the postoperative follow-up (minimum of 12 months) of 128 patients submitted to arthroscopic RC repair from 2011 to 2018. The clinical-functional variables were collected through the clinical examination, and the demographic, surgical and injury variables of the RC were collected from the electronic medical records. The results were compared between the SR and DR groups. Results The DR group showed higher anterior elevation strength when compared with the SR group (SF: 4.72 ± 2.73 kg versus DR: 5.90 ± 2.73 kg; p = 0.017). The other variables of muscle strength, Constant-Murley Score, University of California at Los Angeles Shoulder Rating Scale (UCLA), and pain, were similar. Performing the stratification by size, in the analysis of small and medium injuries, no differences were found between the groups. However, in the analysis of large and extensive injuries, patients submitted to DR presented superiority of both muscle lifting strength (SF: 3.98 ± 2.24 kg versus DR: 6.39 ± 2.73 kg) and Constant score (SF: 81 ± 10 versus DR: 88 ± 7). Conclusion The use of the DR technique in arthroscopic RC repair allowed higher levels of muscle strength for anterior shoulder elevation when compared with the SF technique. Data stratification in large and extensive injuries showed superiority of anterior shoulder elevation muscle strength and of the Constant score in patients submitted to DR.

Resumo Objetivo Avaliar os pacientes submetidos ao reparo artroscópico do manguito rotador (MR), comparando-se os resultados funcionais, força muscular e dor obtidos após as técnicas de fileira simples (FS) e de fileira dupla (FD). Métodos Foram coletados os dados do seguimento pós-operatório (mínimo de 12 meses) de 128 pacientes submetidos ao reparo artroscópico do MR durante o período de 2011 a 2018. As variáveis clínico-funcionais foram coletadas por meio do exame clínico, e as variáveis demográficas, cirúrgicas e das lesões do MR a partir dos prontuários eletrônicos. Os resultados foram comparados entre os grupos FS e FD. Resultados O grupo FD demonstrou força de elevação anterior maior quando comparado ao grupo FS (FS: 4,72 ± 2,73 kg versus FD:5,90 ± 2,73 kg; p = 0,017). As demais variáveis de força muscular, Constant-Murley Score, University of California at Los Angeles Shoulder Rating Scale (UCLA, na sigla em inglês) e dor foram similares. Realizando-se a estratificação por tamanho, na análise das lesões pequenas e médias, não foram encontradas diferenças entre os grupos. Porém, na análise das lesões grandes e extensas, os pacientes submetidos à FD apresentaram superioridade tanto na força muscular de elevação (FS: 3,98 ± 2,24 kg versus FD: 6,39 ± 2,73 kg) quanto no escore Constant (FS: 81 ± 10 versus FD: 88 ± 7). Conclusão A utilização da técnica de FD no reparo artroscópico do MR possibilitou maiores níveis de força muscular para elevação anterior do ombro quando comparada à técnica de FS. A estratificação dos dados em lesões grandes e extensas evidenciou superioridade da força muscular de elevação anterior do ombro e do escore Constant nos pacientes submetidos à FD.

Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft.

Objective Clinical and functional evaluation of the surgical treatment for chronic injury of the distal biceps brachii applying a surgical technique with grafting of the distal triceps brachii tendon. Methods A study based on a review of the medical records and clinical evaluation of the patients submitted to surgical treatment for chronic injury to the distal insertion of the biceps brachii between February 2015 and February 2017. In a 12-month-minimum postoperative follow-up, 7 patients were evaluated regarding the range of motion of the operated and non-operated elbows, flexion, upper-limb extension and supination with a digital dynamometer, the hook test, the satisfaction index, and the Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS) intruments. Results During the postoperative functional evaluation, no patient reported dissatisfaction with the esthetic outcome of the incisions, and all of them were satisfied/very satisfied with the range of motion and strength of the operated limb. No neurovascular complications, surgical site infection or tendon rupture were observed. On the MEPS and DASH scales, all patients scored 100 and 0 respectively. The mean flexion was of 133.5° on the operated side, versus 139.2° on the non-operated side. The mean extension was of 5° on the operated side versus 0° on the non-operated side. The supination was of 86.5° versus 90°, and the pronation, 80° versus 80°, when comparing the operated and non-operated sides respectively. The mean flexion, extension and supination corresponded respectively to 92.5%, 96.4% and 86.8% of those of the non-operated limb. Conclusion Recosntruction of the distal biceps brachii with triceps grafting seems to be an effective and safe option for the treatment of chronic distal biceps injuries.

Postoperative Comparative Evaluation of Patients Undergoing Surgical Treatment for Acute Versus Chronic Acromioclavicular Dislocations.

Objectives The present study evaluates and compares the surgical treatment of acute and chronic acromioclavicular dislocations (ACDs) to define the most effective therapeutic plan. Methods A retrospective study consisting of 30 patients submitted to the surgical treatment of types III and V ACDs between 2011 and 2018; the subjects were separated according to a temporal classification in acute (< 3 weeks; subgroup I) and chronic (> 3 weeks; subgroup II) subgroups. All patients underwent a postsurgical evaluation with a standardized protocol containing epidemiological, functional, and radiological data. Results Subgroup I presented a visual analog scale (VAS) score of 1.10, a Constant-Murley score of 92.3, and a University of California at Los Angeles (UCLA) Shoulder Rating score of 33.5. The coracoclavicular (CC) distance was of 11.0 mm, and the average increase in CC space was lower than 8.9% compared to the contralateral shoulder. In subgroup II, the VAS score was of 1.11, the Constant-Murley score was of 94.2, and the UCLA score was of 32.4. The CC distance was of 13.8 mm, with a 22.9% increase in CC space compared to the contralateral side. Conclusion Although there was no significant difference between the evaluated items, subgroup I tended to present a lower CC distance ( p = 0.098) and a lower percentage increase in CC distance ( p = 0.095) compared to subgroup II. Thus, the surgical treatment must be performed within three weeks after the trauma to try to avoid such trend. If the acute treatment is not possible, the modified Weaver Dunn technique has good clinical and functional outcomes.

Postoperative Comparative Evaluation of Patients Undergoing Surgical Treatment for Acute Versus Chronic Acromioclavicular Dislocations / Avaliação pós-operatória comparativa dos pacientes submetidos ao tratamento cirúrgico das luxações acromioclaviculares aguda versus crônica

Abstract Objectives The present study evaluates and compares the surgical treatment of acute and chronic acromioclavicular dislocations (ACDs) to define the most effective therapeutic plan. Methods A retrospective study consisting of 30 patients submitted to the surgical treatment of types III and V ACDs between 2011 and 2018; the subjects were separated according to a temporal classification in acute (< 3 weeks; subgroup I) and chronic (> 3 weeks; subgroup II) subgroups. All patients underwent a postsurgical evaluation with a standardized protocol containing epidemiological, functional, and radiological data. Results Subgroup I presented a visual analog scale (VAS) score of 1.10, a Constant-Murley score of 92.3, and a University of California at Los Angeles (UCLA) Shoulder Rating score of 33.5. The coracoclavicular (CC) distance was of 11.0 mm, and the average increase in CC space was lower than 8.9% compared to the contralateral shoulder. In subgroup II, the VAS score was of 1.11, the Constant-Murley score was of 94.2, and the UCLA score was of 32.4. The CC distance was of 13.8 mm, with a 22.9% increase in CC space compared to the contralateral side. Conclusion Although there was no significant difference between the evaluated items, subgroup I tended to present a lower CC distance (p = 0.098) and a lower percentage increase in CC distance (p = 0.095) compared to subgroup II. Thus, the surgical treatment must be performed within three weeks after the trauma to try to avoid such trend. If the acute treatment is not possible, the modified Weaver Dunn technique has good clinical and functional outcomes.

Resumo Objetivos Avaliar e comparar os resultados do tratamento cirúrgico das luxações acromioclaviculares (LACs) aguda e crônica, definindo o plano terapêutico mais eficaz. Métodos Estudo retrospectivo realizado com 30 pacientes operados entre 2011 e 2018 para LAC tipos III e V, separados de acordo com a classificação temporal em subgrupo agudo (< 3 semanas; subgrupo I) e subgrupo crônico (> 3 semanas; subgrupo II). Todos os pacientes foram submetidos a avaliação pós-cirúrgica com protocolo padronizado composto por dados epidemiológicos, funcionais e radiográficos. Resultados No subgrupo I, a pontuação na escala visual analógica (EVA) foi de 1,10, o escore de Constant-Murley foi de 92,3, e o escore da University of California at Los Angeles (UCLA) foi de 33,5. A distância coracoclavicular (CC) foi de 11,0 mm, e o aumento do espaço CC foi em média menor do que 8,9% em relação ao ombro contralateral. No subgrupo II, a EVA foi de 1,11, o escore de Constant-Murley foi de 94,2, e o da UCLA, 32,4. A distância CC foi de 13,8 mm, sendo o aumento do espaço CC de 22,9% em relação ao contralateral. Conclusão Apesar de não ter havido diferença significativa entre os quesitos avaliados, houve uma tendência de o subgrupo agudo apresentar distância CC (p = 0,098) e percentual de aumento da distância CC (p = 0,095) menor do que o subgrupo crônico. Assim, é interessante que o tratamento cirúrgico seja realizado nas primeiras três semanas após o trauma, para tentar evitar essa tendência. Nos casos em que não for possível realizar o tratamento na fase aguda, a técnica de Weaver Dunn modificada apresenta bons resultados clínicos e funcionais.

Postoperative Evaluation of Patients Submitted to Arthroscopic Repair of Anterior Shoulder Instability.

Objective To clinically evaluate the results of patients undergoing arthroscopic surgical treatment of anterior shoulder instability. Methods A retrospective study of 94 patients. With a minimum follow-up of 24 months, we sought to correlate the characteristics of the patients and the surgery, such as age, gender, type of injury (traumatic or atraumatic) and the patient's position during surgery (lateral decubitus and beach chair) with the results obtained, the recurrence rate, the lateral rotation loss, the residual pain, and the functional scores of Carter-Rowe, University of California at Los Angeles (UCLA), and Constant-Murley. Results We observed a recurrent dislocation rate of 11.7%, lateral rotation loss in 37.23% of the patients, and some degree of residual pain in 51.6% of them. We obtained a mean Carter Rowe score of 85.37, representing 86% of good/excellent results. In the UCLA score, we obtained 88% of good/excellent results, similar to those obtained in the Constant-Murley score (86%). Conclusion The arthroscopic treatment of the anterior instability of the shoulder presents satisfactory results and low index of important complications, being the method of choice for most patients.

Postoperative Evaluation of Patients Submitted to Arthroscopic Repair of Anterior Shoulder Instability / Avaliação pós-operatória de pacientes submetidos a reparo artroscópico de instabilidade anterior do ombro

Abstract Objective To clinically evaluate the results of patients undergoing arthroscopic surgical treatment of anterior shoulder instability. Methods A retrospective study of 94 patients. With a minimum follow-up of 24 months, we sought to correlate the characteristics of the patients and the surgery, such as age, gender, type of injury (traumatic or atraumatic) and the patient's position during surgery (lateral decubitus and beach chair) with the results obtained, the recurrence rate, the lateral rotation loss, the residual pain, and the functional scores of Carter-Rowe, University of California at Los Angeles (UCLA), and Constant-Murley. Results We observed a recurrent dislocation rate of 11.7%, lateral rotation loss in 37.23% of the patients, and some degree of residual pain in 51.6% of them. We obtained a mean Carter Rowe score of 85.37, representing 86% of good/excellent results. In the UCLA score, we obtained 88% of good/excellent results, similar to those obtained in the Constant-Murley score (86%). Conclusion The arthroscopic treatment of the anterior instability of the shoulder presents satisfactory results and low index of important complications, being the method of choice for most patients.

Resumo Objetivo Avaliar clinicamente os resultados de pacientes submetidos a tratamento cirúrgico artroscópico de instabilidade anterior do ombro. Métodos Estudo retrospectivo de 94 pacientes. Com seguimento mínimo de 24 meses, buscamos correlacionar as características dos pacientes e da cirurgia, como idade, gênero, tipo de lesão (traumática ou atraumática) e posição do paciente na cirurgia (decúbito lateral e cadeira de praia) com os resultados obtidos, avaliando o índice de recidivas de luxação, a perda de rotação lateral, a dor residual, e os escores funcionais de Carter-Rowe, da University of California at Los Angeles (UCLA) e de Constant-Murley. Resultados Observamos uma taxa de recidiva de luxação de 11,7%, perda de rotação lateral em 37,23% dos pacientes, e algum grau de dor residual em 51,6%. Obtivemos uma pontuação média no escore de Carter Rowe de 85,37, representando 86% de resultados bons/excelentes. No escore da UCLA, obtivemos 88% de resultados bons/excelentes, índice semelhante aos encontrados no escore de Constant-Murley (86%). Conclusão O tratamento artroscópico da instabilidade anterior do ombro apresenta resultados satisfatórios e baixo índice de complicações importantes, podendo ser o método de escolha para a maioria dos pacientes.

Tratamento da luxaçäo acrômio-clavicular grau III / Treatment of third degree acromio-clavicular dislocations

Doze casos de luxaçäo acrômio-clavicular grau III foram operados e avaliados. O seguimento médio foi de 14,8 meses. Foi empregada a técnica de Neviaser com alguns acréscimos. O procedimento, tecnicamente simples, consiste na reduçäo e fixaçäo da articulaçäo, reparaçäo dos ligamentos lesados e transposiçäo do ligamento córaco-acromial para acrômio-clavicular. Foi utilizado para casos agudos, subagudos e crônicos. Produziu bons resultados e näo apresentou complicaçöes. Os pacientes operados retornaram rapidamente ao trabalho e à pratica de esportes, sem dor residual, com boa mobilidade do membro, sem deformidade e satisfeitos com o tratamento