Does Complete Footprint Coverage Affect Outcomes After Conventional Arthroscopic Repair of Large-Sized Rotator Cuff Tears?

Background: In large-sized rotator cuff tears, tendon repair with incomplete footprint coverage is performed frequently as a way of tension-free or low-tension repair. Purpose: To compare clinical outcomes after arthroscopic repair of large-sized rotator cuff tears between patients with complete versus incomplete footprint coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Among 297 patients who underwent arthroscopic surgery for a large-sized rotator cuff tear, we selected 58 patients (<50% coverage; mean age, 63.34 ± 6.8 years; 34 men and 24 women) with incomplete footprint coverage. Using propensity score matching, another 58 patients with complete footprint coverage (mean age, 63.4 ± 8.03 years; 34 men and 24 women) were selected after 1:1 matching for age, sex, and tear size-the main demographic and prognostic factors of outcomes after rotator cuff repair. Clinical outcomes were compared on magnetic resonance imaging or ultrasonography at minimum of 6 months postoperatively, and functional outcomes were compared using range of motion and pain visual analog scale; American Shoulder and Elbow Surgeons; Constant; University of California, Los Angeles; and Simple Shoulder Test scores at a minimum of 2 years postoperatively. Results: A total of 18 patients in the incomplete footprint coverage group (31.0%) and 20 patients in the complete footprint coverage group (34.5%) showed healing failure, with no significant difference between groups (P = .843). In addition, there were no differences in functional outcomes between groups (P > .05 for all). Conclusion: Whether the rotator cuff footprint was completely covered did not affect clinical outcomes in conventional arthroscopic repair of large-sized rotator cuff tears.

A cross-sectional study of surgical glove perforation during the posterior lumbar interbody spinal fusion surgery: Its frequency, location, and risk factors.

Lumbar fusion surgery was known to pose a greater risk of surgical glove perforation. However, there has been no study on the glove perforation that can transmit the blood-borne disease to the patient and surgical staff members in the posterior lumbar interbody fusion surgery (PLIFs).We performed a cross-sectional study to investigate the glove perforation during the PLIFs. The study included 37 consecutive patients (10 males and 27 females). All used gloves of surgical staff members, which included the surgeon, assistant surgeons, bone trimmer (who performed local bone trimming and interbody cage preparation), and scrub nurse were collected and were performed to the pinhole water infusion test. The characteristics (i.e., frequency and location of perforated glove) and relative risk of glove perforation were investigated for each participant. The independent risk factors influencing glove perforation were analyzed by multiple logistic regression analysis.The overall operative perforation rate which is a percentage of detected more than one glove perforated event in all cases was 51.4%. The overall glove perforation rate which is the percentage of perforated gloves in all gloves used for surgery was 3.8%. The relative risk of glove perforation by each participant was 2.38 in the surgeon (P = .002), 1.36 in the bone trimmer (P = .04), 1.36 in the scrub nurse (P = .04), and 1.19 in assistant surgeons (P = .13). And, the volume of trimmed local bone was analyzed as an independent risk factor for glove perforation (ORs = 1.310, P = .02).The overall operative perforation rate in PLIFs is higher than 50%. The surgeon, scrub nurse and bone trimmer were observed as a significant risk factor for glove perforation. And, the volume of trimmed local bone was analyzed as independent risk factor. Since the preparation of the interbody cage is essential for successful lumbar fusion surgery, the bone trimmer must pay attention to the glove perforation during this procedure.

Deltoid muscle volume affects clinical outcome of reverse total shoulder arthroplasty in patients with cuff tear arthropathy or irreparable cuff tears.

We aimed to estimate the interrelation between preoperative deltoid muscle status by measuring the 3-dimensional deltoid muscle volume and postoperative functional outcomes after reverse total shoulder arthroplasty(RTSA). Thirty-five patients who underwent RTSA participated in this study. All patients underwent preoperative magnetic resonance imaging(MRI) as well as pre- and postoperative radiography and various functional outcome evaluations at least 1 year. The primary outcome parameter was set as age- and sex-matched Constant scores. The 3-dimensional deltoid muscle model was generated using a medical image processing software and in-house code, and the deltoid muscle volume was calculated automatically. Various clinical and radiographic factors comprising the deltoid muscle volume adjusted for body mass index(BMI) were analyzed, and their interrelation with the outcome parameters was appraised using a multivariate analysis. As a result, all practical consequences considerably improved following surgery(all p<0.01). Overall, 20 and 15 indicated a higher and a lower practical consequence than the average, respectively, which was assessed by the matched Constant scores. The deltoid muscle volume adjusted for BMI(p = 0.009), absence of a subscapularis complete tear (p = 0.040), and greater change in acromion-deltoid tuberosity distance(p = 0.013) were associated with higher matched Constant scores. Multivariate analysis indicated that the deltoid muscle volume was the single independent prognostic factor for practical consequences(p = 0.011). In conclusion, the preoperative deltoid muscle volume significantly affected the functional outcome following RTSA in patients with cuff tear arthropathy or irreparable cuff tears. Therefore, more attention should be paid to patients with severe atrophied deltoid muscle who are at a high risk for poor practical consequences subsequent to RTSA.