Arthroscopic Circumferential Labral Repair for Patients With Multidirectional Instability: A Comparative Outcome Study.

BACKGROUND: Circumferential tears of the glenohumeral labrum are an uncommon injury, comprising 2.4% of all labral lesions. Currently, the clinical outcomes of arthroscopic circumferential labral repair for patients with instability and combined anterior, posterior, and superior labral tears are not well-known. HYPOTHESIS: Patients treated with arthroscopic circumferential shoulder labral repairs will have inferior clinical outcomes and higher failure rates compared with patients who have isolated arthroscopic anterior labral repairs. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective cohort study was performed to identify patients aged 18 years and older who underwent circumferential arthroscopic stabilization for recurrent instability as compared with an age-matched control group of arthroscopic primary anterior labral repairs. Age at surgery, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score, Simple Shoulder Test (SST) score, 12-Item Short Form Health Survey (SF-12) score (mental and physical), and overall patient satisfaction with surgery were assessed for each group. RESULTS: A total of 35 consecutive patients (36 shoulders) who underwent an arthroscopic 360° circumferential labral repair were compared with a matched group of 31 patients who underwent an isolated arthroscopic anterior labral repair. The mean follow-up period was 34.3 and 56.8 months, respectively. No significant difference was found between the 2 groups for overall satisfaction with the surgery or recurrent instability. At the time of the follow-up survey, 22% of the patients experienced pain and 25% of the patients experienced instability in the circumferential repair group, whereas 15% of the patients experienced some level of pain and 30% of patients experienced a subjective sense of subtle instability in the isolated repair group. The ASES scores were 87.3 in the combined labral repair group and 93.3 in the isolated anterior group (P = .35), SST scores were 10.7 and 11.3 (P = .70), SF-12 mental scores were 54.6 and 56.8 (P = .80), SF-12 physical scores were 53.2 and 54.2 (P = .98), and age at time of the surgery was 26.7 and 24.6 years (P = .33), respectively. There was no difference between the 2 groups in pre- and postoperative range of motion (P > .05). CONCLUSION: There was no difference in shoulder stability and function in patients after 360° combined labral repairs versus anterior labral repair alone. With proper patient selection, patients can expect similar outcomes despite the more extensive surgical procedure and complex postoperative rehabilitation protocol for circumferential repairs.

Return to Play Following Ulnar Collateral Ligament Reconstruction.

Ulnar collateral ligament injury in the overhead athlete typically presents as activity-related pain with loss of velocity and control. Treatment options range from nonoperative rehabilitation to ligament reconstruction. Surgical reconstruction is frequently required to allow the athlete to return to competition and many surgical techniques have been described. The rehabilitation process to return back to overhead athletics, in particular pitching, is prolonged and requires progression through multiple phases. Despite this, surgical treatment has been shown by multiple investigators to be successful at returning athletes to their previous level of competition.

Comprehensive Look at Blood Transfusion Utilization in Total Joint Arthroplasty at a Single Academic Medical Center under a Single Surgeon.

The utilization of autologous and allogeneic transfusions in total joint arthroplasties was to characterize patients who may benefit from giving preoperative blood donations. We conducted a retrospective chart review of 525 patients to document preoperative hematocrit, estimated blood loss, length of stay, transfusions, and medical comorbidities. Results of our review showed that total hip arthroplasty revision (THA-R) had the highest prevalence of transfusions (60%) followed by total hip arthroplasty (THA, 53%), total knee arthroplasty-revision (TKA-R, 33%), and total knee arthroplasty (TKA, 23%). There was significant waste of autologous donations: 92% of TKA patients, 64% of THA, and 33% of THA-R patients wasted on average 1.527, 1.321, and 1.5 autologous units, respectively. Pre-operative hematocrit was the strongest predictor of future transfusion need across all procedures, and primary THA had additional predictors in age and gender.