Recovery after shoulder arthroscopy: Inpatient versus outpatient management.

INTRODUCTION: Shoulder arthroscopy is particularly suited to outpatient surgery, thanks to advances in anesthetic and analgesic techniques. The main goal of this study was to compare postoperative recovery after shoulder arthroscopy between outpatient and inpatient management. HYPOTHESIS: There is no difference in functional recovery between inpatient and outpatient management. MATERIALS AND METHOD: A single-center, single-operator prospective study was conducted. Both groups received patient-controlled analgesia via an interscalene catheter. The inclusion criterion was shoulder arthroscopy for rotator cuff tendinopathy. The choice between inpatient and outpatient management was left to the patient. The study endpoint was postoperative recovery assessed on QOR-15 at days 1, 2, 3, 4 and 7 and on Quick-DASH at 6 weeks. RESULTS: Forty-nine patients were included, divided into 2 groups. The outpatient (OP) and inpatient (IP) groups were comparable. Reconstructive surgery accounted for 54% of cases in OP versus 62% in IP. There was no significant difference in recovery in the first postoperative days (QOR-15) or at 6 weeks (Quick-DASH) (p>0.05). Pain on visual analog scale (VAS) was significantly greater in OP after discharge home. DISCUSSION: No significant difference in postoperative recovery was observed between groups. Nevertheless, pain management and patient information for outpatients need improving. LEVEL OF EVIDENCE: II, comparative study.

Influence of lower limb rotation on hindfoot alignment using a conventional two-dimensional radiographic technique.

BACKGROUND: Rotation is one of the variables explaining lack of reproducibility in assessing hindfoot alignment. The hypothesis for this study was that a mathematical model predicts how this modifies radiographic hindfoot alignment measurements. METHODS: A cadaveric lower limb, disjointed at knee level, was used. Sagittal and coronal planes were fixed using a custom clamp. Standard AP views were shot every five degrees and measured hindfoot alignments were compared to theoretical values obtained from a mathematical simulation. RESULTS: Hindfoot angle was 7.04° at 0° rotation and 2.11° at -90°. Intra-class and inter-investigator correlation was 0.863. The t-test showed no significant difference (p=0.73). Intra-investigator correlation was 0.957. The R2 correlation index was 0.852. CONCLUSIONS: The mathematical model accurately predicted the variations of the hindfoot angle which was maximum when the foot was aligned with the X-rays source. It then decreased when the foot rotated away, following a parabolic curve.

Influence of fixation point of latissimus dorsi tendon transfer for irreparable rotator cuff tear on glenohumeral external rotation: A cadaver study.

Latissimus dorsi tendon transfer is a surgical option for treating irreparable posterosuperior rotator cuff tears, notably when attempting to reconstruct active external rotation. We hypothesized that the positioning of the transfer's point of fixation would differ depending on the desired elbow-to-body external rotation or external rotation with the elbow abducted. MATERIAL AND METHODS: Seven shoulders from four whole frozen cadavers were used. We created two systems to install the subject in a semi-seated position to allow external rotation elbow to body and the arm abducted 90°. Traction sutures were positioned on the latissimus dorsi muscle and a massive tear of the rotator cuff was created. We tested six different transfer positions. Muscle contraction of the latissimus dorsi was stimulated using 10-N and 20-N suspended weights. RESULTS: The point of fixation of the latissimus dorsi on the humeral head had an influence on the elbow-to-body external rotation and with 90° abduction (P<0.001). The fixation point for a maximum external rotation with the elbow to the body was the anterolateral position (P<0.016). The fixation point for a maximum external rotation at 90° abduction was the position centered on the infraspinatus footprint (P<0.078). CONCLUSION: The optimal point of fixation differs depending on whether external rotation is restored at 0° or 90° abduction. LEVEL OF EVIDENCE: Fundamental study, anatomic study.