What is the optimal surgical intervention for patients with frozen shoulder and a concomitant partial-thickness rotator cuff tear?

BACKGROUND: Patients with recalcitrant frozen shoulder traditionally undergo arthroscopic capsular release. Some patients may have a concomitant partial-thickness rotator cuff tear (PTT). There is limited evidence if these PTT require repair at the same setting. We aim to compare if patients undergoing concomitant rotator cuff repair do better than patients undergoing capsular release alone. Secondarily, we aim to determine if outcomes after arthroscopic capsular release differ for patients with and without PTT. METHODS: A retrospective review of patients with frozen shoulders undergoing arthroscopic capsular release between 2012 and 2016 was performed. Patients with partial-thickness tears and patients without rotator cuff tears were included. Clinical outcomes were collected preoperatively and at 3, 6, 12 months after operation. RESULTS: There were 33 patients with PTT-15 underwent capsular release without repair (CR group), whereas 18 underwent capsular release with rotator cuff repair (RCR group). A total of 62 control patients without rotator cuff tears (No Tear) underwent arthroscopic capsular release only. For patients with PTT, there were no significant differences in preoperative demographics and function between the CR and RCR group. The CR group had significantly worse preoperative pain. At 1-year follow-up, the RCR group had significantly better internal rotation, lesser pain, and better function than the CR group. For patients undergoing capsular release only, the No Tear group had better internal rotation, lesser pain, and better function at 1 year compared with the CR group. CONCLUSION: Patients with a stiff, frozen shoulder and concomitant PTT do benefit from arthroscopic rotator cuff repair with capsular release. The benefit is evident at 1-year follow-up.

Arthroscopic procedures could delay the need for a subsequent knee arthroplasty in older patients with end-stage osteoarthritis.

BACKGROUND/OBJECTIVE: Arthroscopic surgery in knee osteoarthritis is controversial with many studies refuting its efficacy in recent literature. This study aims to evaluate the mean duration to knee arthroplasty, and the effect of microfracture on the need for subsequent knee arthroplasty in patients above the age of 55 undergoing arthroscopic procedures for osteoarthritis. METHODS: One hundred and nine consecutive patients with diagnosed osteoarthritis who underwent arthroscopic surgery performed from January 2000 to December 2012 on patients aged 55 years and above by a single surgeon were reviewed retrospectively. Demographic data, age at operation, comorbidities, perioperative details and information of subsequent total knee arthroplasty were collected and analysed. RESULTS: There were 38 males and 71 females in our study group. The group was predominantly Chinese (51.38%), with hypertension and hyperlipidaemia being the most common comorbidities, each affecting 57.8% of our study cohort. All patients had a preoperative radiograph and a magnetic resonance imaging confirming the diagnosis of osteoarthritis associated with meniscal tears. Fifty-eight knees underwent microfracture along with arthroscopic meniscectomy. The mean follow-up duration was 127.5 months (10.5 years, range: 67-212 months). Twenty three patients (20.91%) underwent knee arthroplasties subsequently, with the mean duration to arthroplasty being 65.0 months (5.5 years, range: 7-166 months). The odds ratio of avoiding knee arthroplasty with microfracture was 1.03 (95% CI = 0.410-2.581). CONCLUSION: Arthroscopic procedures could possibly delay the need for subsequent knee arthroplasty for approximately 65 months in older patients with osteoarthritis. However, microfracture does not affect the duration between therapeutic arthroscopy and subsequent arthroplasty. Our long-term retrospective study provides an additional step in the understanding of the impact of arthroscopic procedures and a prospective case-control study would be an ideal follow-up to fully justify the application of arthroscopic procedures to delay knee arthroplasty.

Risk factors of lateral epicondylitis: A meta-analysis.

INTRODUCTION: Lateral Epicondylitis is commonly associated with numerous anatomical and mechanical risk factors. Thus far, there have been no reviews synthesising the risk factors of lateral epicondylitis. We hence aimed to perform a meta-analysis of factors associated with lateral epicondylitis. METHODOLOGY: We searched MEDLINE, Scopus and Web of Science for 1032 articles. Eventually, based on our exclusion criteria, we had 33 articles remaining for our systematic review. 15 of these articles were used for our meta-analysis. Data was analysed using Mantel-Haenszel statistics and random effect models where appropriate. RESULTS: Females had a 1.29 times higher odds of sustaining lateral epicondylitis (OR Males: Females = 0.77, 95% CI = 0.67-0.89, Z = 3.52, I2 = 33%, p < 0.001). The odds of an individual with a current or past tobacco smoking history sustaining lateral epicondylitis was 1.49 times that of an individual with no tobacco smoking history (95% CI = 1.18-1.87, Z = 3.40, I2 = 0%, p < 0.001). There was no statistical difference in sustaining lateral epicondylitis when comparing individuals with a current tobacco smoking history to individuals with a past or no tobacco smoking history (OR = 1.18, 95% CI = 0.91-1.51, Z = 1.26, I2 = 0%, p = 0.21). Neither was there a statistical difference in sustaining lateral epicondylitis when comparing individuals with a BM ≥ 25 to those with a BMI<25 (OR = 1.12, 95% CI = 0.69-1.83, Z = 0.46, I2 = 62%, p = 0.65). CONCLUSION: Female gender and a positive and past smoking history were associated with lateral epicondylitis. Further studies should focus on identifying other associations with lateral epicondylitis and the pathophysiological explanation of such associations.

Outcome following total knee arthroplasty in obese versus non-obese Asian patients.

PURPOSE: To compare the outcome following total knee arthroplasty (TKA) in obese and non-obese Asian patients. METHODS: 27 obese patients were compared with 27 non-obese controls matched for age, gender, diagnosis (osteoarthritis), prosthesis, preoperative Knee Society knee and function scores, preoperative Oxford Knee Score, and follow-up duration. All TKAs were performed by a single surgeon. Patients were assessed at 6 months and 2 years for the range of motion, Knee Society knee and function scores, Oxford Knee Score, and Short Form-36 Health Survey (SF-36). RESULTS: The obese and non-obese groups did not differ significantly in pre- and post-operative variables: range of motion, Knee Society knee and function scores, Oxford Knee Score, and SF-36 score. Using revision as an end-point, implant survival was 100%. There were no intra- or post-operative complications in either group. CONCLUSION: Obese and non-obese Asian patients achieved a comparable outcome following TKA.

Radiographic grading of the patellofemoral joint is more accurate in skyline compared to lateral views.

BACKGROUND: The patellofemoral joint is perhaps the most commonly involved compartment in knee osteoarthritis (OA). Radiographic studies are routinely ordered and are seen as the first-line investigations for patellofemoral osteoarthritis (PFOA). The Kellgren-Lawrence (K&L) grading scale is often used to quantify the severity of radiographic OA. In this study, we aim to determine the correlation of the K&L grading scale on both the skyline and lateral views with arthroscopic visualization of articular cartilage damage. METHODS: All patients with clinical and radiographic features of PFOA who underwent knee arthroscopy by a single surgeon from 2006 to 2010 in our institution were reviewed. The study group consisted of 66 patients with PFOA. All patients had skyline and lateral radiographs of the knee taken before surgery. All patients had arthroscopic evidence of PFOA. Blinded investigators graded the radiographs according to the K&L grading scale. At arthroscopy, the patellofemoral joint was graded according to the Outerbridge classification. Correlation and statistical analysis of the radiographic and arthroscopic grade was carried out. RESULTS: The general trend shows that the higher the radiographic K&L grading, the greater the severity of articular cartilage degeneration on arthroscopy. However, an increasing K&L grade accounts for only 39.7% and 28.4% of the variation of severity of arthroscopically-determined articular cartilage degeneration on skyline and lateral views respectively. Interestingly, on both views, better correlation with arthroscopic findings was seen in early (K&L grades 1 and 2) PFOA. Skyline views were superior to lateral views in terms of specificity, PPV, NPV and accuracy in predicting early OA. CONCLUSIONS: Skyline radiographs are more accurate than lateral radiographs in prediction of severity of PFOA.

Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus.

Arthroscopic treatment of osteochondritis dissecans (OCD) of the talus has resulted in outcomes as good as, or better than, those after arthrotomy. We noted a lack of prospective studies investigating the outcomes of arthroscopic treatment. As such, we conducted a prospective study investigating the functional outcomes, pain scores, patient satisfaction, and expectation scores of patients undergoing arthroscopic treatment of OCD of the talus, hypothesizing that these patients would have good outcomes and satisfaction. A total of 61 patients underwent arthroscopic chondroplasty, removal of loose bodies, and microfracture for OCD of the talus and completed ≥1 year of follow-up. We evaluated patients pre- and postoperatively at 6 and 12 months using the Ankle-Hindfoot score, visual analog scale for pain, and Medical Outcomes Study short-form 36 questionnaires. We also evaluated the patients' expectations and satisfaction. The mean Ankle-Hindfoot score improved significantly from 53.0 ± 14.3 points preoperatively to 77.8 ± 19.1 at 6 months and 83.1 ± 18.3 at 12 months after arthroscopic treatment (p < .001). The overall scores at the final follow-up visit were excellent for 30 (49%), good for 6 (10%), fair for 18 (30%), and poor for 7 (11%). The patients also experienced significant improvement in the visual analog scale score and physical component score of the short-form 36 questionnaire (p < .001). Of the 61 patients, 67% had their expectations fulfilled and 74% were satisfied with their surgery at 12 months of follow-up. Arthroscopic treatment of OCD of the talus continues to be a successful procedure to alleviate pain and loss of function. It is also associated with improvements to quality of life and good patient satisfaction.

Correlation between radiographic and arthroscopic findings in Asian osteoarthritic knees.

PURPOSE: To evaluate the correlation between radiographic and arthroscopic findings for severity of knee osteoarthritis (OA) in 119 Asians. METHODS: Medical records of 52 men and 67 women aged 33 to 70 (mean, 51) years who had complaints of chronic mechanical knee pain for >3 months and were arthroscopically diagnosed with articular cartilage degeneration of the knee were reviewed. The severity of knee OA was classified using the Kellgren-Lawrence (K&L) scale and the modified Outerbridge classification. The highest grade in any compartment of the knee was used to represent the severity of OA. The correlation between the radiographic and arthroscopic findings for severity of knee OA was evaluated. RESULTS: 17 of the 119 patients with no radiographic evidence of OA (K&L grade 0) had articular cartilage degeneration arthroscopically (mean grade, 1.14). In general, higher K&L grades correlated with more severe articular cartilage degeneration. The Pearson correlation coefficient was 0.32, indicating that the association between the radiographic and arthroscopic findings for severity of knee OA was weak. CONCLUSION: The K&L scale correlated poorly with arthroscopic findings of articular cartilage degeneration in an Asian population with knee OA.