Outpatient vs. inpatient total shoulder arthroplasty: complication rates, clinical outcomes, and eligibility parameters.

Background: Improvements in total shoulder arthroplasty (TSA), fast-track surgery, multimodal anesthesia, and rehabilitation protocols have opened up the possibility of outpatient care that is now routinely practiced at our European institution. The first objective of this study was to define the TSA outpatient population and to verify that outpatient management of TSA does not increase the risk of complications. The second objective was to determine patient eligibility parameters and the third was to compare functional outcomes and identify influencing factors. Methods: The study included 165 patients who had primary TSA (106 outpatient and 59 inpatient procedures). The operative technique was the same for both groups. Demographics, complications, readmissions, and revisions were collected. American Society of Anesthesiologists, Constant, American Shoulder and Elbow Surgeons, University of California Los Angeles shoulder, and Shoulder Pain and Disability Index scores were obtained preoperatively and at 1.5, 6, and 12 months postoperatively. Satisfaction and visual analog scale pain scores also were documented. Statistical analysis was completed using multivariate linear regression. Results: Outpatients were significantly younger and had lower American Society of Anesthesiologists scores than inpatients. The rates of complications, readmissions, and reoperations were not significantly different between groups. Outpatient surgery was not an independent risk factor for complications. At 1.5 months, better outcomes were noted in the outpatient group for all scores, and these reached statistical significance. Distance to home, dominant side, operative time, and blood loss were not associated with functional results. Multivariate analysis demonstrated that outpatient care was significantly associated with improved scores at 1.5 months and did not affect functional outcomes at 6 and 12 months. Conclusion: This study reports the results of routine outpatient TSA within a European healthcare system. TSA performed in an outpatient setting was not an independent risk factor for complications and seemed to be an independent factor in improving early functional results.

Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores.

PURPOSE: Systematic reviews report return to play (RTP) within 5.8 months (range, 3-8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. METHODS: The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. RESULTS: A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). CONCLUSIONS: By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. LEVEL OF EVIDENCE: IV.

Does the critical shoulder angle decrease after anterior acromioplasty?

INTRODUCTION: No clinical studies to date have analyzed the critical shoulder angle (CSA) following anterior acromioplasty. Our study's main objective was to measure the change in the CSA after acromioplasty. MATERIALS AND METHODS: Ninety patients were included in this retrospective series. The CSA and the type of acromion were evaluated before and after surgery. RESULTS: The average CSA for patients before surgery was 35.9° (± 3.7, 26.2, 44.2) and 33° after the acromioplasty (± 3.5, 24.8, 41.4). The decrease was significant and 2.9° on average (± 2.2, - 2.2, 11.9, p = 0.000). Preoperatively, 58% of patients had a CSA ≥ 35° (n = 52) and 24% postoperatively (n = 22, p = 0.000). CONCLUSIONS: Standardized anterior acromioplasty allows for a significant decrease in the CSA without lateral resection of the acromion. This study confirms the tight link between the CSA and the anterior acromion as well as the interest of this angle to quantify acromioplasty whether anterior or lateral. LEVEL OF EVIDENCE: Level IV, Case Series, Retrospective design.

Multimodality imaging of subacromial impingement syndrome.

Subacromial impingement syndrome results from irritation of the tendons of the rotator cuff muscles in the subacromial space and may manifest as a range of pathologies. However, subacromial impingement is a dynamic condition for which imaging reveals predisposing factors but no pathognomonic indicators. Also, the usual imaging features of subacromial impingement may be seen in symptomatic and asymptomatic patients. Therefore, imaging is able to detect tears and describe the risk factors of impingement but cannot confirm subacromial impingement. Radiographs allow assessment of the morphology of the acromion and its lateral extension by means of the acromial index and the critical shoulder angle, which may increase in cases of subacromial impingement. Ultrasound is necessary to evaluate a tendon tear and is the only tool that provides dynamic information, which is essential to assessing dynamic conditions. Magnetic resonance imaging (MRI) allows the assessment of associated intraarticular abnormalities, joint effusion, and bone marrow edema. The objective of this article is to provide an overview of the pathophysiology and clinical manifestations of subacromial impingement and discuss recent advances in the imaging of subacromial impingement and the role of radiography, ultrasound, and MRI in differentiating normal from pathologic findings.

Is systematic long-term sonographic follow-up after arthroscopic rotator cuff repair useful in asymptomatic patients?

OBJECTIVE: To establish whether ultrasonographic (US) appearance is correlated to functional outcome in asymptomatic patients 12 months after rotator cuff repair. MATERIAL AND METHODS: 26 asymptomatic patients at twelve months after arthroscopic cuff repair and 26 controls were retrospectively included. A clinical score (Constant's Shoulder Score, CSS) was compared with a US score (the modified Sugaya Score, mSS). The minimal thickness of the anterior and posterior parts of the cuff was also measured. RESULTS: CSS improved significantly from preoperatively to postoperatively (mean increased from 41 to 82.6, p<.001). Correlation between the postoperative CSS and the minimal thickness of the cuff at its anterior and posterior part (p=0.55 and p=0.13) was not significant. There was also no significant correlation between the postoperative CSS and mSS (p=0.34). CONCLUSION: The sonographic appearance of the cuff repair is not correlated to the functional outcome at 12 months after arthroscopic surgery in asymptomatic patients.

Evaluation of an air spinning process to produce tailored biosynthetic nanofibre scaffolds.

We optimised the working parameters of an innovative air spinning device to produce nanofibrous polymer scaffolds for tissue engineering applications. Scanning electron microscopy was performed on the fibre scaffolds which were then used to identify various scaffold morphologies based on the ratio of surface occupied by the polymer fibres on that covered by the entire polymer scaffold assembly. Scaffolds were then produced with the spinning experimental parameters, resulting in 90% of fibres in the overall polymer construct, and were subsequently used to perform a multiple linear regression analysis to highlight the relationship between nanofibre diameter and the air spinning parameters. Polymer solution concentration was deemed as the most significant parameter to control fibre diameter during the spinning process, despite interactions between experimental parameters. Based on these findings, viscosity measurements were performed to clarify the effect of the polymer solution property on scaffold morphology.

Bioinformatic analysis of ESTs collected by Sanger and pyrosequencing methods for a keystone forest tree species: oak.

BACKGROUND: The Fagaceae family comprises about 1,000 woody species worldwide. About half belong to the Quercus family. These oaks are often a source of raw material for biomass wood and fiber. Pedunculate and sessile oaks, are among the most important deciduous forest tree species in Europe. Despite their ecological and economical importance, very few genomic resources have yet been generated for these species. Here, we describe the development of an EST catalogue that will support ecosystem genomics studies, where geneticists, ecophysiologists, molecular biologists and ecologists join their efforts for understanding, monitoring and predicting functional genetic diversity. RESULTS: We generated 145,827 sequence reads from 20 cDNA libraries using the Sanger method. Unexploitable chromatograms and quality checking lead us to eliminate 19,941 sequences. Finally a total of 125,925 ESTs were retained from 111,361 cDNA clones. Pyrosequencing was also conducted for 14 libraries, generating 1,948,579 reads, from which 370,566 sequences (19.0%) were eliminated, resulting in 1,578,192 sequences. Following clustering and assembly using TGICL pipeline, 1,704,117 EST sequences collapsed into 69,154 tentative contigs and 153,517 singletons, providing 222,671 non-redundant sequences (including alternative transcripts). We also assembled the sequences using MIRA and PartiGene software and compared the three unigene sets. Gene ontology annotation was then assigned to 29,303 unigene elements. Blast search against the SWISS-PROT database revealed putative homologs for 32,810 (14.7%) unigene elements, but more extensive search with Pfam, Refseq_protein, Refseq_RNA and eight gene indices revealed homology for 67.4% of them. The EST catalogue was examined for putative homologs of candidate genes involved in bud phenology, cuticle formation, phenylpropanoids biosynthesis and cell wall formation. Our results suggest a good coverage of genes involved in these traits. Comparative orthologous sequences (COS) with other plant gene models were identified and allow to unravel the oak paleo-history. Simple sequence repeats (SSRs) and single nucleotide polymorphisms (SNPs) were searched, resulting in 52,834 SSRs and 36,411 SNPs. All of these are available through the Oak Contig Browser http://genotoul-contigbrowser.toulouse.inra.fr:9092/Quercus_robur/index.html. CONCLUSIONS: This genomic resource provides a unique tool to discover genes of interest, study the oak transcriptome, and develop new markers to investigate functional diversity in natural populations.