The influence of preoperative external rotation weakness or stiffness on reverse total shoulder arthroplasty.

BACKGROUND: Some reverse total shoulder arthroplasty (rTSA) patients may have limited preoperative external rotation (ER) because of stiffness or weakness. Currently it is not known if this affects their clinical outcome or if their ER will improve after surgery. METHODS: A multicenter shoulder arthroplasty database was queried to analyze patients undergoing a primary rTSA using a single prosthesis design featuring a medial glenoid-lateral humerus. Their pre- and postoperative range of motion was evaluated in addition to 5 outcome measures. Patients with limited preoperative ER due to weakness or stiffness were compared to patients with normal preoperative range of motion. The following questions were asked: (1) Does a preoperative ER deficit impact the postoperative outcome? (2) Do patients with preoperative ER deficits due to stiffness or weakness regain ER after rTSA? and (3) Does a preoperative ER lag sign predict a poor outcome? RESULTS: 608 patients were included in this study. Active external rotation (preoperative/postoperative) was as follows for the 3 patient groups: Normal patients (45°/44°), Stiff (-4°/30°), and Weak (16°/32°). Weak patients had a preoperative ER lag of 30°, which improved by 16° after surgery. The clinical outcome scores for all 3 groups improved after rTSA. Stiff patients had significantly greater improvement than Weak and Normal patients. Outcome scores were equivalent for Normal and Stiff patients. Weak patients tended to have slightly lower outcome scores. CONCLUSIONS: Patients with limited preoperative ER can obtain a good clinical result with rTSA using a medial glenoid-lateral humerus prosthesis, ER range of motion can improve after rTSA, and stiff patients have a particularly good prognosis for recovery.

The anatomic coracoclavicular ligament reconstruction: surgical technique and indications.

The anatomic coracoclavicular ligament reconstruction (ACCR) is a surgical procedure to address acriomioclavicular joint instability. The coracoclavicular ligaments are reconstructed using a semitendinosus allograft passed beneath the coracoid and through bone tunnels in the clavicle. The graft is secured with interference screw fixation, and the acromioclavicular joint is retained. Here we describe the authors' surgical technique, indications, and rehabilitation protocol. Also, a preliminary case series of seventeen patients is presented. Patients demonstrated significant improvement in pain levels and function. The mean ASES score increased from 52 preoperatively to 92. The Constant Murley rose from 66.6 to 94.7. There were three failures in this series, and two required revision surgery.

Anteromedialization of the tibial tubercle for patellofemoral arthritis in patients > 50 years.

This is a retrospective study of one surgeon's experience performing anteromedialization of the tibial tubercle for the treatment of isolated patellofemoral arthritis in active older patients. Patients were included if they were > 50 years at the time of the surgery and had a minimum follow-up of 2 years. Outerbridge classifications were documented by arthroscopy, and patellofemoral alignment was evaluated clinically and radiographically. Lysholm and Fern pain scores were obtained via mailed questionnaire or phone survey. A total of 22 anteromedialization procedures were performed on 17 patients who met the inclusion criteria; 82% of patients completed the followup survey. Mean age was 55 years. Mean follow-up was 77 months. Mean postoperative Lysholm score was 83. Based on Lysholm scores, there were 12 good to excellent, 6 fair, and 1 poor outcomes. Anteromedialization of the tibial tubercle is a definitive treatment option for isolated patellofemoral arthritis in active older patients.

Medial hamstring tendon regeneration following harvest for anterior cruciate ligament reconstruction: fact, myth, and clinical implication.

It has been demonstrated that the medial hamstring tendons regenerate in the majority of patients following their harvest for anterior cruciate ligament reconstruction. The anatomy and morphology of these regenerated tendons have been radiographically and surgically documented. The neotendons originate within the appropriate muscle belly but display an altered insertion anatomy. Their histological composition is largely tendinous but has regions that resemble scar tissue. Concordantly, an animal model indicates that the neotendon has decreased mechanical strength, which has implications for tendon re-harvest. The regenerated tendons do restore a muscle tendon complex that is able to generate force; however, strength testing indicates that the function of the hamstring muscles is altered by harvest and regeneration. The most significant strength deficits are present in deep knee flexion and internal rotation of the tibia, whereas the peak torque of knee flexion is minimally affected. Additional harvest of the gracilis tendon results in greater deficits. The current literature indicates that hamstring tendon regeneration does indeed occur, but with structural and functional alterations.