Shoulder Instability-Return to Sports After Injury (SIRSI) Scale Shows That Lack of Psychological Readiness Predicts Outcomes and Recurrence Following Surgical Stabilization.

PURPOSE: This study aimed to evaluate the predictive ability of psychological readiness to return to sports on clinical outcomes and recurrences in athletes who return to sports following shoulder instability surgery. METHODS: A retrospective analysis was performed of patients who underwent shoulder instability surgery between September 2020 and October 2021 (arthroscopic Bankart repair or Latarjet procedure) with a minimum follow-up of 2 years. Patients were grouped according to the achievement of psychological readiness to return to play using the SIRSI scale (≥ 55 points) measured at 6 months following surgery. Recurrences were measured and functional outcomes were evaluated by the Visual Analogue Scale (VAS), Rowe, and Athletic Shoulder Outcome Scoring System (ASOSS). The minimal clinically important difference (MCID) for the VAS and Rowe scores was calculated using the distribution-based method of ½ standard deviation of the delta (difference between postoperative and preoperative scores). The patient acceptable symptomatic state (PASS) for the VAS scale was set at 2.5 based on previous literature. To evaluate the predictive ability of SIRSI a regression model analysis and a receiver operating characteristic (ROC) curve were used. RESULTS: A total of 108 who achieved psychological readiness (PSR) and 41 who did not (NPSR) met the study criteria. PSR achieved significantly higher percentages of MCID and PASS thresholds for VAS than NPSR (MCID: 68.5% vs 48.7%, p=0.026; PASS: 92.5% vs 58.5%, p<0.001). However, there were no differences in the percentage of patients achieving MCID for the Rowe score between groups (98.1% vs 100%, p=0.999). The only strongest independent predictor of postoperative outcomes was being psychologically ready to return to sports. The SIRSI scale had an excellent predictive ability for recurrences (area under curve 0.745, 95% CI 0.5-0.8). Of those who sustained a recurrence, 20% were not psychologically ready compared to 4.3% who were (p= 0.002). A power analysis was not conducted for this study. CONCLUSION: The SIRSI scale is associated with postoperative clinical outcomes and recurrences in patients who returned to sports following shoulder instability surgery. Patients who were not psychologically ready following shoulder instability surgery had worse clinical outcomes with fewer patients achieving clinically significant outcomes (PASS and MCID) for pain, and a higher risk of recurrence. LEVEL OF EVIDENCE: Level IV, Retrospective cohort study.

Subacromial injection of Platelet Rich Plasma Provides Greater Improvement in Pain and Functional Outcomes Compared to Corticosteroids at 1 Year Follow- Up.

BACKGROUND: Studies evaluating the results of platelet-rich plasma (PRP) for the treatment of rotator cuff tendinopathy (RCT) have demonstrated conflicting results and have been confounded by small patient samples, the absence of a control group, the combined analysis of isolated tendinopathies and rotator cuff tears, insufficient reporting of PRP preparations, The purpose of this study was to perform a randomized controlled trial comparing platelet-rich plasma (PRP) with standard corticosteroid (CS) injections in providing pain relief and improved function in patients with rotator cuff tendinopathy. METHODS: This was a double-blind RCT at a single center. We evaluated patients between 18 and 50 years old who had both a clinical and magnetic resonance (MRI) diagnosis of supraspinatus tendinopathy refractory to conservative treatment. A total of 50 patients received PRP treatment, whereas 50 patients received a corticosteroid, as a control group. Patients completed patient-reported outcome assessments at baseline and at 1, 3, 6 and 12 months after injection. The primary outcome was improvement in the VAS score for pain. Secondary outcomes included changes in ASES score, SANE score and the Pittsburgh Sleep Quality Index (PSQI). Treatment failure was defined as persistent pain at 3 months which required a subsequent injection. RESULTS: The mean age was 27.7 (±7.4). All the patients completed 12 months clinical follow-up. At 12 months, patients in the PRP group showed a significantly greater improvement in the VAS than patients in the CS group 1.68(0.6) vs 2.3(1.0) (p<0.001). As well, at 12 months follow-up, the 3 scores evaluated were significantly higher in patients treated with PRP than in patients treated with CS ASES 89.8 (6.3) vs 78.0 (8.6) (p<.001); SANE 89.2 (6.3) vs 80.5 (9.6) (p< .001) and PSQI 2.72 (0.6) vs 4.02 (1.7) (p< .001) The overall failure rate, was significantly higher in the CS group (30%) than in the PRP group (12%) (p<0.01) CONCLUSION: One subacromial PRP injection in patients with rotator cuff tendinopathy showed significantly superior and sustained pain-relieving and functional improvements compared with one corticosteroid subacromial injection assessed by 4 patient-reported outcome scales at 12 months of follow-up. Moreover, the overall failure rate, was significantly higher in the CS group than in the PRP group.

Do postoperative outcomes vary between midshaft clavicle fractures of 2, 3, or more than 3 fragments?

OBJECTIVE: This study aims to assess differences in clinical and surgical outcomes associated with the surgical treatment of midshaft clavicle fractures of different complexities based on fragment number. Additionally, the investigation seeks to present the outcomes of a series of patients who underwent surgery at our institution. MATERIALS AND METHODS: A retrospective analysis was conducted on the medical records of patients aged over 18 who underwent midshaft clavicle fracture surgery at our center from November 2009 to May 2021. Patients were categorized based on the number of fracture fragments into groups of two, three, or more than three fragments. Consolidation, implant removal, complications, surgical duration, and functional outcomes (assessed through VAS, ASES, and Constant-Murley scale) were evaluated for each specific group and for the overall cohort. RESULTS: In total, 260 patients were analyzed. There were no significant differences in any of the parameters between the three groups except for surgical time, which was shorter in simple fractures than in those with more than three fragments (68.2 min vs. 75.3 min; p = 0.01). Pseudoarthrosis rate was 2.69%, implant removal rate was 9.61%, and 4.23% of patients presented with complications other than the previous ones. Functional results were excellent, with averages of 97.3 (72.7-100) for the ASES score, 97.5 (75-100) for the Constant score, and 0.6 (0-8) on the VAS. CONCLUSION: According to our results, there were no differences in postoperative results between simple and multifragmentary midshaft clavicle fractures. Patients across all groups reported satisfactory results.

Clinical Significance Thresholds in Primary and Revision Latarjet Procedures With Comparable Outcome Achievements.

BACKGROUND: Given the variability across populations and settings, defining the MCID and the PASS for the Rowe and ASOSS scores and patients undergoing primary and revision Latarjet it is essential to have accurate benchmarks relevant to these groups when interpreting clinical results. PURPOSE: To determine the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds for the visual analog scale (VAS) for pain during sports, Athletic Shoulder Outcome Scoring System (ASOSS), and Rowe scores after primary and revision Latarjet procedures for treatment of shoulder instability. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Between January 2018 and January 2020, a retrospective review of 149 patients undergoing primary Latarjet (n = 82) and revision Latarjet (n = 67) to treat shoulder instability was performed in a single institution. Patient-reported outcome measures were collected preoperatively and 1 year postoperatively. The delta was defined as the change between the pre- and postoperative scores. Distribution-based and anchored-based approaches were used to estimate the MCID and the PASS, respectively. The optimal cutoff point and the percentage of patients achieving those thresholds were also calculated. RESULTS: The distribution-based MCIDs after primary Latarjet were 1.1, 7.5, and 9.6 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the MCID thresholds were 93.9%, 98.7%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds after primary Latarjet were ≤1, ≥90, and ≥85 for the VAS, Rowe, and ASOSS scores, respectively. The percentages of patients who achieved PASS thresholds were 82.9%, 89%, and 86.5% for the VAS, Rowe, and ASOSS scores, respectively. The distribution-based MCIDs after revision Latarjet were 0.6, 6.2, and 3.4 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved MCID thresholds were 89.3%, 100%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds were ≤3, ≥87, and ≥86 after revision Latarjet for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the PASS thresholds were 88%, 88%, and 91% for the VAS, Rowe, and ASOSS, respectively. CONCLUSION: This study identified useful values for the MCID and PASS thresholds in VAS, Rowe, and ASOSS scores after primary and revision Latarjet procedures for treating shoulder instability. Most patients achieved MCID and PASS benchmarks, indicating successful primary and revision Latarjet procedure outcomes. These metrics can serve as valuable parameters when analyzing parameters in future studies and have the potential to enhance patient care by optimizing treatment strategies and surgical decision making.

Leukocyte-Poor Platelet-Rich Plasma as an Adjuvant to Arthroscopic Rotator Cuff Repair Reduces the Retear Rate But Does Not Improve Functional Outcomes: A Double-Blind Randomized Controlled Trial.

BACKGROUND: Whether the use of PRP as an adjuvant of rotator cuff repairs leads to improved tendon healing and better functional outcomes remains unclear in clinical evidence. PURPOSE: The main purpose of this study was to assess whether the use of leukocyte-poor platelet-rich plasma (LP-PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) decreases the rate of retears compared with a control group. The secondary objective was to analyze whether LP-PRP improves patient-reported outcomes. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: This was a double-blind randomized controlled trial at a single center. A consecutive series of 96 patients with rotator cuff tears <3 cm were enrolled and randomly allocated to the control group (double-row suture-bridge ARCR alone [n = 48]) and the PRP group (double-row suture-bridge repair, followed by 1 LP-PRP injection during surgery [n = 48]). The visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Pittsburgh Sleep Quality Index (PSQI) were administered preoperatively and at 6- and 12-month follow-up. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity at 6-month follow-up. Both patients and assessors were blinded to the intervention received during surgery. RESULTS: The mean patient age was 56.1 ± 2.98 years. Of the 96 patients, 90 had MRI performed at 6 months after surgery (94% radiological follow-up). The retear rate in the PRP group was 15.2% (7/46 [95% CI, 6%-28%]), which was lower than that in the control group of 34.1% (15/44 [95% CI, 20%-49%]) (P = .037). Therefore, the risk ratio of ruptures in patients exposed to LP-PRP was 0.44 (95% CI, 0.2-0.9; P = .037). Overall, the ASES, VAS, SANE, and PSQI scores showed a statistical improvement after surgery (P < .001). There were no significant differences in functional scores between the groups. Most of the patients exceeded the minimal clinically important difference for the ASES, SANE, and VAS without significant differences between the groups. CONCLUSION: In patients with rotator cuff tears <3 cm undergoing double-row suture-bridge repair, a 5-mL dose of LP-PRP injected at the tendon-bone interface significantly reduced the retear rate. However, the use of LP-PRP in terms of postoperative pain and patient-reported outcomes failed to show clinically meaningful effects. REGISTRATION: NCT04703998 (ClinicalTrials.gov identifier).

Unicortical versus bicortical plate fixation for midshaft clavicular fractures.

BACKGROUND: The aim of this study was to compare the functional and radiological outcomes of unicortical vs bicortical fixation in patients with midshaft clavicular fractures who were treated using pre-contoured locking plates. METHODS: We performed a prospective multicenter study of 45 individuals who underwent open reduction and internal fixation of midshaft clavicular fractures with precontoured locking plates between March 2017 and December 2019. Twenty-five patients were treated with bicortical screws and 20 patients with unicortical screws. Functional outcomes were assessed at 6 months and 12 months after surgery using the Constant score, the 11-item version of the Disabilities of Arm, Shoulder and Hand (Quick- DASH) score and the Single Assessment Numeric Evaluation (SANE) score. Pain was evaluated using a visual analog scale (VAS). The rate of return to work and sports was also recorded. Radiologic evaluation was obtained in the immediate postoperative day, monthly until fracture consolidation, at 6 months and 12 months. All intraoperative and postoperative complications were documented. RESULTS: At both 6 and 12 months, the follow-up rates were 100%, and the mean age was 28.5 years (range, 20 to 45 years). The mean postoperative Constant score, Quick DASH, and SANE score at 12 months were 93.5 (±6), 2.3 (±3), and 92% (±7), respectively. There were no significant differences in the functional scores between the groups neither at 6 months nor at 12 months. Of the 30 active workers, 97% were able to return to their previous working routine and from the 25 patients who practiced sports before the injury,92% returned to sports all at the same level. All the fractures healed in both groups. There were 6 complications (13%). CONCLUSION: In young, active patients with displaced midshaft clavicular fractures, both unicortical and bicortical locked plates achieved 100% bone consolidation, with excellent functional outcomes and a low rate of complications without significant differences between the groups. Therefore, locked plates with unicortical fixation could be a very good alternative for the management of young patients with midshaft clavicular fractures, potentially avoiding severe neurovascular complications. LEVEL OF EVIDENCE: Prospective comparative (Level II).

Latarjet modificada sin reparación capsular en jugadores de rugby con inestabilidad anterior recurrente y déficit óseo glenoideo significativo. resultados con un seguimiento mínimo de 5 años / Modified latarjet procedure without capsular repair in rugby players with recurrent anterior shoulder instability and a significant glenoid bone loss

Introducción: el manejo óptimo de la inestabilidad anterior recurrente con déficit óseo glenoideo significativo en deportistas de colisión continúa siendo un desafío. Objetivo: El objetivo del siguiente estudio fue analizar el retorno al deporte, los resultados clínicos y las recurrencias en jugadores de rugby con inestabilidad anterior recurrente y déficit óseos glenoideos significativos, con la técnica de Latarjet modificada sin reparación capsular. Materiales y Métodos: Un total de 31 jugadores de rugby con inestabilidad anterior recurrente y déficit óseo significativo, fueron operados con la técnica de Latarjet modificada sin reparación capsular en nuestra institución, entre junio del 2008 y junio del 2012. El rango de movilidad, el score de Rowe, la escala visual análoga EVA y el score de ASOSS (Athletic Shoulder Outcome Scoring System) fueron utilizados para la evaluación funcional. También se evaluaron el retorno al deporte y las recurrencias. Todos los pacientes fueron evaluados imagenológicamente en el postoperatorio con tomografía computarizada. Resultados: No hubo ninguna recurrencia de luxaciones o subluxaciones. No encontramos diferencias significativas entre el rango de movilidad pre y postoperatorio. El score de Rowe, la escala visual análoga y el ASOSS mejoraron significativamente luego de la cirugía (P <.01). Veintisiete pacientes (90%) volvieron a jugar al rugby, todos al mismo nivel que tenían previo a la lesión. El intervalo medio entre la cirugía y la vuelta a la competencia fue de 5.6 meses. El injerto oseo consolidó en 27 pacientes (90%). Al final del seguimiento 5 hombros (16%) tenían artrosis leve (estadio 1). Conclusión: En jugadores de rugby con inestabilidad anterior recurrente y defectos óseos significativos en la glena, la cirugía de Latarjet modificada sin reparación capsular produce excelentes resultados funcionales a mediano plazo. La mayoría de los deportistas retornó al rugby al mismo nivel que tenía previo a la cirugía sin...

Background: the optimal management of recurrent anterior shoulder instability with signi cant glenoid bone loss in collision athletes continues to be a challenge. Purpose: The purpose of this study was to analyze the time to return to sport, clinical outcomes, and recurrences of the modi ed Latarjet procedure without capsular repair in rugby players with recurrent anterior shoulder instability and a signi cant glenoid bone loss. Methods: A total of 31 consecutive rugby players were treated for recurrent anterior shoulder instability and a signi cant glenoid bone loss at our institution between June 2008 and June 2012. Range of Motion (ROM), the Rowe score, the visual analog scale (VAS) and the Athletic Shoulder Outcome Scoring System (ASOSS) were utilized to assess functional outcomes. Return to sports and recurrence rate were also evaluated. All patients were evaluated in the postoperative period with computed tomography. Results: No recurrence of either dislocation or subluxation occurred. No signi cant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe score, visual analogue scale and ASSOS score showed statistical improvement after operation (P <.01). Twenty seven patients (90%) returned to playing rugby after the procedure; all at the same level they had previous to the surgery. The mean interval between surgery and return to competition was 5.6 months. The bone block healed in 27 cases (90%). At nal follow-up, 5 shoulders (16%) had mild glenohumeral arthritis (stage 1). Conclusion: In rugby players with recurrent anterior shoulder instability and a signi cant glenoid bone loss, the modi ed Latarjet procedure without capsular repair produced excellent functional outcomes with most athletes returning to playing rugby at the same level they had previous to the surgery without...