Myotendinous junction tears of the pectoralis major are occurring more frequently and discrepancies exist between intraoperative and radiographic assessments.

Background: Pectoralis major (PM) tears have been shown to occur most frequently at the tendinous humeral insertion. However, no substantial updates on tear location have been published in 20 years or are based on relatively small sample sizes. The primary purpose of this study was to evaluate PM tear location based on magnetic resonance imaging (MRI). A secondary purpose was to evaluate agreement between MRI and intraoperative assessments of tear characteristics. We hypothesized that PM tears at the myotendinous junction (MTJ) occur at a higher rate than previously reported and that intraoperative and MRI assessments would demonstrate agreement in at least 80% of cases. Materials and methods: An observational study of consecutive patients evaluated for a PM tear at a single institution between 2010 and 2022 was conducted. Patient demographics as well as MRI and intraoperative assessments of tear location, extent of tear, and muscle head involvement were collected from the electronic medical record. Agreement was calculated by comparing radiographic and intraoperative assessments per variable and reported as percentages. Data and statistical analysis were performed with SPSS software with a significance level set to P < .05. Results: A total of 102 patients were included for analysis. Mean age was 35.8 ± 10.5 years and mean body mass index was 29.4 ± 4.8 kg/m2. 60.4% of the study population had tears of the MTJ, 34.9% of the tendinous humeral insertion, and 4.7% within the muscle belly, as determined intraoperatively. Complete tears had significantly higher agreement between MRI and intraoperative assessments relative to partial tears (83.9% and 62.5%, respectively; P ≤ .01). Discussion: The majority of PM tears occurred at the MTJ. Preoperative MRI and intraoperative assessments agreed in 80% of cases, a value that was significantly higher for complete over partial tears. These findings demonstrate that tears of the MTJ are increasingly more common and support the use of MRI in preoperative planning for complete PM tears.

Depressive and Anxiety Disorders Increase Risk for Recurrent Anterior Shoulder Pain Following Arthroscopic Suprapectoral Biceps Tenodesis.

Purpose: To evaluate factors associated with postoperative anterior shoulder pain following arthroscopic suprapectoral biceps tenodesis (ABT) and to determine the clinical impact of postoperative anterior shoulder pain. Methods: A retrospective study of patients that underwent ABT between 2016 and 2020 was conducted. Groups were categorized by the presence (ASP+) or absence (ASP-) of postoperative anterior shoulder pain. Patient-reported outcomes (American Shoulder and Elbow score [ASES], visual analog scale [VAS] for pain, subjective shoulder value [SSV]), strength, range of motion, and complication rates were analyzed. Differences between continuous and categorical variables were tested with two-sample t-tests and chi-squared or Fisher's exact tests, respectively. Variables collected at different postoperative timepoints were analyzed using mixed models with post hoc comparisons when significant interactions were detected. Results: A total of 461 (47 ASP+, 414 ASP-) patients were included. A statistically significant lower mean age was observed in the ASP+ group (P < .001). A statistically significant higher prevalence of major depressive disorder (MDD) (P = .03) or any anxiety disorder (P = .002) was observed in the ASP+ group. Prescription medication with psychotropic medications (P = .01) was significantly more prevalent in the ASP+ group. No significant differences were observed in the proportion of individuals reaching the minimal clinical important difference (MCID) for ASES, VAS, or SSV between groups. Conclusions: A pre-existing diagnosis of major depressive disorder or any anxiety disorder, as well as the use of psychotropic medications was associated with postoperative anterior shoulder pain following ABT. Other factors associated with anterior shoulder pain included younger age, participation in physical therapy before surgery, and lower rate of concomitant rotator cuff repair or subacromial decompression. Although the proportion of individuals reaching MCID did not differ between groups, the presence of anterior shoulder pain after ABT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ABT in patients diagnosed with MDD or anxiety should be carefully considered, given the correlation to postoperative anterior shoulder pain and inferior outcomes. Level of Evidence: Level III, retrospective case-control study.

An Analysis of Radiographic Leg Length Discrepancy and Hip Offset in Patients at Risk of Developing Osteoarthritis.

Background: Leg length and hip offset are important principles in total hip arthroplasty (THA). Patients may endorse leg length differences (LLD) postoperatively that may be anatomical or functional. The objective of this study was to determine the normal radiographic variation in leg length and hip offset in a preosteoarthritic population without a THA. Methods: A retrospective study was completed using data from the Osteoarthritis Initiative, a prospective longitudinal study. Patients at risk of developing or with early osteoarthritis without inflammatory arthritis or prior THA were included. Measurements were made from full limb length anterior-posterior (AP) radiographs. Multiple linear regression models were employed to predict side-to-side differences in LLD, Δ femoral offset (FO), Δ abductor muscle length (AML), Δ abductor lever arm, and Δ AP pelvic offset. Results: The mean radiographic LLD was 4.6 mm, with 12 mm within 1 standard deviation. No significant differences were detected between LLD and sex, age, body mass index, or height. The median radiographic differences in FO, AML, abductor lever arm, and AP pelvic offset were 3.2 mm, 4.8 mm, 3.6 mm, and 3.3 mm, respectively. Height was predictive of Δ FO, while both height and age were predictive of Δ AML. Conclusions: Radiographic leg length variations in a population without symptomatic or radiographic osteoarthritis exist. FO and AML are dependent on patient characteristics. Preoperative radiographic LLD is not predicted by age, gender, body mass index, or height. It should be stressed that anatomic reconstruction is one of the many goals of arthroplasty and can stand in conflict with the priority and primary goals of stability and fixation, which should be prioritized.