Gender-Based Differences In Mid-Term Clinical Outcomes And Patient Acceptable Symptomatic State Attainment After Arthroscopic Rotator Cuff Repair: Minimum 2-Year Follow Up.

OBJECTIVE: There is paucity of literature on the impact of patients' gender on recovery and treatment success after arthroscopic rotator cuff repair. This study investigates the effect of gender on patient-reported outcomes preoperatively and postoperatively (minimum 2 years), and to determine if gender affects attainment of patient acceptable symptomatic state (PASS) thresholds. METHODS: 266 patients (117 males, 149 female), who underwent primary arthroscopic rotator cuff repair for atraumatic, full-thickness tears, were included. Functional outcomes and pain scores were collected preoperatively and postoperatively. Percentage of attainment of PASS for the various outcome scores was calculated and compared between males and females. RESULTS: Women had statistically significantly poorer functional outcome and pain scores preoperatively and at 1 and 2 years postoperatively (P<0.01). They also experienced less improvement in outcome scores throughout the postoperative period. Women had statistically significantly lower rates of PASS attainment at 2 years postoperatively. CONCLUSION: Women experience greater pain and poorer shoulder function compared with men preoperatively, and up to 2 years postoperatively. Women are less likely to achieve patient acceptable symptom state thresholds postoperatively, compared to their male counterparts. STUDY DESIGN: Retrospective Cohort Study LEVEL OF EVIDENCE: III.

Different types of rotator cuff tear morphology do not affect post-repair clinical outcomes in large to massive tears.

OBJECTIVES: The primary aim of this current study is to evaluate the effects of rotator cuff tear morphology on clinical outcomes in large to massive tears, using a modified version of the existing classification system, with specific focus on tear symmetry and use of margin convergence. METHODS: Patients who underwent arthroscopic repair of large to massive, full thickness rotator cuff tears were retrospectively analysed. The tear pattern was classified at the time of surgery as Type IA, Type IB, Type IIA, and Type IIB according to tear symmetry and direction of maximum tear diameter, with Type I being symmetrical and Type II being asymmetrical. Type IA (U-shaped) had greater mediolateral (ML) than anteroposterior (AP) diameter while Type IB (crescent shaped) had greater AP than ML diameter. Type IIA tears have an anterior extension towards the rotator interval while IIB tears have a posterior extension into the infraspinatus, similar to AP L-shaped tears established in the literature. Type I tears were typically repaired from medial to lateral while Type II tears were repaired diagonally. All types were repaired using double row technique, with the addition of margin convergence for Types IA and IIB, which had larger tears in the medial and lateral directions. Primary outcome measures were Oxford Shoulder Score, Constant Shoulder Score, University of California at Los Angeles Shoulder Score followed-up at 6, 12, and 24-months as well as retear rates at latest follow-up. RESULTS: In total, 109 patients were included in the study with a mean age of 65.5 â€‹± â€‹9.4. The prevalence of each tear morphologies from Type IA to IIB was 22.0 â€‹%, 34.9 â€‹%, 27.5 â€‹%, and 15.6 â€‹%, respectively. All four groups showed statistically significant improvement from pre-operative scores in all 3 outcome measures at 24 months (p â€‹< â€‹0.001 for all). No significant difference in primary outcome measures or retear rates was detected between all 4 groups. CONCLUSION: This study found that different types of cuff tear morphology, despite affecting surgical repair technique, does not influence clinical outcomes post-arthroscopic rotator cuff repair at mid-term follow-up. LEVEL OF EVIDENCE: Retrospective Cohort study, Level III.

Comparable outcomes of reverse shoulder arthroplasty for proximal humerus fractures and for rotator cuff arthropathy in a predominantly asian population.

Background: Reverse shoulder arthroplasty (RSA) was initially developed for rotator cuff arthropathy but has been expanded to treat comminuted proximal humerus fractures. Few studies have compared RSA for traumatic and degenerative indications. We present the first report of mid-term outcomes of RSA comparing both indications in an Asian population. Methods: 113 degenerative and 20 fracture patients underwent RSA from 2010 to 2019. Patients with degenerative indications were 4:1 propensity-score matched to fractures and adjusted for age and sex. Patients were assessed for range of motion (ROM), strength, pain, Constant-Murley score (CMS), University of California Los Angeles Shoulder Score (UCLA) and Oxford shoulder score (OSS) preoperatively, at 6-months and 1-year. Patients' satisfaction, expectation fulfilment and minimal clinically important difference (MCID) were analysed. Results: Degenerative patients had better ROM, isometric strength and CMS at 6-months, although at 1-year only abduction was superior (104.8 ± 17.3° vs 86.7 ± 19.8°). No significant differences in pain, UCLA and OSS were observed. Most improvements occurred within 6 months. Similar proportions of patients were satisfied (83.3% vs 73.3%, p = 0.460) and attained MCID (85.0% vs 86.7%, p = 1.000) at 1-year. Discussion: Although initially exhibiting slower recovery, patients with proximal humerus fractures can expect similar functional recovery and satisfaction at 1-year compared to those who received RSA for degenerative indications.

The double-lasso loop technique of Biceps tenodesis has lower displacement after cyclic loading, compared to interference screw fixation: Biomechanical analysis in an ovine model.

Background: Biceps tenodesis is an effective treatment for symptomatic long head of biceps tendon pathology. Recently the arthroscopic "double lasso-loop" suture anchor (DLSA) technique was described, advantaged by reduced cost, complexity, and operative time. We aimed to compare the in vitro strength of DLSA with conventional interference screws (IS). Methods: A biomechanical analysis was conducted on 14 sheep shoulders (8 DLSA, 6 IS), consisting of a 500-cycle cyclic loading experiment of 5-70 N and ultimate failure load (UFL) test where each specimen was pulled until failure. Displacement (mm) was recorded every 100 cycles, while stiffness and UFL were observed. Results: Cyclic displacement was significantly lower with DLSA at 100 cycles, but not above. During the UFL test, IS was stiffer (27.68 ± 6.56 N/mm versus 14.10 ± 5.80 N/mm, p = .005) and had higher UFL (453.67 ± 148.55 N versus 234.22 ± 44.57 N, p = .001) than DLSA. All DLSA failures occurred with suture/anchor pull-out, while all IS constructs failed at the muscle/tendon. Discussion: Comparison of the novel DLSA technique with a traditional IS method found lower initial displacement. While our IS constructs could withstand higher UFL, peak load characteristics of DLSA were similar to previous ovine studies. Hence, the DLSA technique is a viable alternative to IS for biceps tenodesis with its purported non-biomechanical advantages.

Short- to medium-term outcomes and future direction of reverse shoulder arthroplasty: Current concepts.

Reverse shoulder arthroplasty is typically indicated for patients with severe shoulder osteoarthritis, rotator cuff tear arthropathy, or proximal humerus fractures that have failed to heal properly. The primary goal of reverse shoulder arthroplasty is to improve shoulder function and reduce pain, while also restoring the ability to perform daily activities. There is a growing body of evidence supporting the effectiveness of reverse shoulder arthroplasty in improving shoulder function and reducing pain in patients with severe shoulder osteoarthritis or rotator cuff tear arthropathy. Reverse shoulder arthroplasty is associated with significant improvements in shoulder function and pain reduction compared to non-surgical treatments. This paper aims to summarize current knowledge, practices and present a summary of the long-term effects of reverse shoulder arthroplasty (RSA) on patient outcomes, including how these outcomes are defined and what measures are typically used to assess them. It will also cover newer definitions of outcomes for RSA that have been developed in recent years in order to better understand the long-term effects of the procedure on patient-reported outcomes and functional ability, as well as information on revision surgery and implant survivorship, and the future of RSA (3D-navigation, patient-specific instrumentation, robotics and artificial intelligence) and its effects on outcomes.

The modified fascial sling technique for ulnar nerve anterior transposition: surgical techniques and results.

Background: Approaches to surgical treatment to cubital tunnel syndrome include simple decompression, decompression with medial epicondylectomy, and decompression with anterior transposition of the ulnar nerve. Transposition of the ulnar nerve involves decompression and transposition of the nerve anteriorly to a subcutaneous, intramuscular, or submuscular position. However, transposing the ulnar nerve to subcutaneous plane renders it more susceptible to external trauma. Hence, this technique article introduces the use of a modified fascial sling. Methodology: The modified fascial sling technique for anterior transposition of the ulnar nerve involves careful dissection to identify the ulnar nerve, decompression of the nerve, then transposition of the ulnar nerve anterior to the medial epicondyle. An AlloWrap (Stryker, Kalamazoo, MI, USA) is first wrapped around the ulnar nerve, followed by wrapping a fascial sling fashioned from the flexor carpi ulnaris fascia. A prospective case series for this surgical technique was conducted. Wilcoxon signed-rank test compared preoperative and postoperative qDASH-9 scores, an abbreviated questionnaire to assess functional limitations of the upper limb. Results: Five patients were included in this study, with a mean duration of follow-up of 530.4 days. The mean QuickDASH-9 functional disability score was 36.5 ± 25.1 preoperatively and 20.6 ± 12.8 postoperatively, demonstrating statistically significant improvement (P = .008). Conclusion: The modified fascial sling technique for anterior transposition of the ulnar nerve was developed to address the complications of perineural adhesions after transposition causing tethering of the ulnar nerve. At the same time, the fascial sling prevents posterior subluxation of the ulnar nerve back to its original location, thereby reducing the risk of recurrent symptoms.

Relooking at double-bundle versus single-bundle anterior cruciate ligament reconstruction: A biomechanical model to evaluate which can confer better rotatory stability.

BACKGROUND: To treat anterior cruciate ligament (ACL) injuries, double-bundle ACL reconstruction has been proposed as a more anatomical approach relative to single-bundle reconstruction. However, controversy remains over which technique is superior in addressing knee instability, particularly rotational laxity. We hypothesize that double-bundle reconstruction better restores rotational knee laxity, while both methods are similar in restoring anterior knee laxity, to intact knee levels. METHODS: A controlled laboratory study. Eight cadaveric knees were tested accordingly: (1) static anterior laxity testing under 150 N-anterior tibial loading at 20°, 60° and 90° knee flexion using a material testing machine, followed by (2) dynamic simulated pivot-shift with knee-specific loading involving iliotibial band forces, valgus and internal rotation torques, while the knee was brought from extension to 90° flexion on a 6°-of-freedom custom-designed rig. Tibiofemoral kinematics were recorded using an electromagnetic tracking system for the ACL-intact, ACL-deficient, single-bundle and double-bundle ACL-reconstructed knee conditions. FINDINGS: Double-bundle reconstruction reduced internal rotation under pivot-shift to levels not significantly different from ACL-intact conditions (P > .173), unlike single-bundle that remained significantly higher at 10-40° flexion (P < .05). For anterior laxity, there was no significant difference between double-bundle, single-bundle, and ACL-intact conditions under static testing (P > .175) or pivot-shift (P = .219). The maximum extent of knee envelope laxity was significantly reduced for double-bundle relative to single-bundle, particularly for the rotatory component (P = .012). INTERPRETATION: Double-bundle was biomechanically superior to single-bundle in addressing envelope of rotation, while both techniques restored anterior knee laxity to ACL-intact levels.

Determining the Minimal Clinically Important Difference on the Oxford Shoulder Instability Score in Patients Undergoing Arthroscopic Bankart Repair for Shoulder Instability.

BACKGROUND: The literature on minimal clinically important differences (MCIDs) for patient-reported outcome measures assessing shoulder instability is limited, with none addressing the Oxford Shoulder Instability Score (OSIS). The OSIS was developed to provide a standardized method for assessing shoulder function after surgery for shoulder instability, and previous studies have demonstrated its high reliability, low interrater variability, and ease of administration. PURPOSE: To identify the MCID for the OSIS after arthroscopic Bankart repair for recurrent shoulder instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A longitudinally maintained institutional registry was queried for patients who underwent arthroscopic Bankart repair from 2010 to 2016 for recurrent shoulder instability secondary to a Bankart lesion without significant glenoid bone loss. The OSIS was completed preoperatively and at 1 year postoperatively. Patients were categorized into "expectations met" and "expectations unmet" groups using a questionnaire evaluating expectation fulfilment. The MCID of the OSIS at 1 year was calculated using 3 anchor-based approaches and a distribution-based approach. The 3 anchor-based approaches comprised (1) simple linear regression analysis, (2) receiver operating characteristic curve analysis, and (3) calculation of mean differences in change for the OSIS between the "expectations met" and "expectations unmet" groups. RESULTS: The study cohort comprised 68 men and 11 women aged 29.9 ± 12.7 years (mean ± SD). Duration of follow-up for all patients exceeded 1 year. The MCIDs for the OSIS based on the 4 calculation approaches yielded a narrow range of values, ranging from 7.7 to 8.5 for the anchor-based methods and 8.6 for the distribution-based method. CONCLUSION: Study results indicated that patients with recurrent shoulder instability without significant bone loss who undergo primary arthroscopic Bankart repair and have at least 8.6 points of improvement on their OSIS experience a clinically significant change at 1 year postoperatively.

Comparing the Predictors of Functional Outcomes After Arthroscopic Rotator Cuff Repair Modified Frailty Index, Clinical Frailty Scale, and Charlson Comorbidity Index.

BACKGROUND: The incidence of rotator cuff tears increases with age, and operative management is usually required in patients with persistent symptoms. Although several studies have analyzed the effect of age and comorbidities on outcomes after rotator cuff repair, no study has specifically examined the consequence of frailty. PURPOSE: To determine the best frailty/comorbidity index for predicting functional outcomes after arthroscopic rotator cuff repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors conducted a retrospective cohort study of 340 consecutive patients who underwent unilateral arthroscopic rotator cuff repair at a tertiary hospital between April 2016 and April 2018. All patients had undergone arthroscopic double-row rotator cuff repair with subacromial decompression by a single fellowship-trained shoulder surgeon. Patient frailty was measured using the Modified Frailty Index (MFI), Clinical Frailty Scale (CFS), and Charlson Comorbidity Index (CCI), calculated through retrospective chart review based on case notes made just before surgery; patient age and sex were also noted preoperatively. Functional outcomes using the Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), University of California Los Angeles (UCLA) Shoulder Score, and visual analog scale for pain were measured preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS: The MFI was a consistent significant predictor in all functional outcome scores up to 24 months postoperatively (P < .05), unlike the CFS and CCI. Sex was also a significant predictor of postoperative OSS, CSS, and UCLA Shoulder Score, with male sex being associated with better functional outcomes. Patients with higher MFI scores had slower functional improvement postoperatively, but they eventually attained functional outcome scores comparable with those of their counterparts with lower MFI scores at 24 months postoperatively. CONCLUSION: The MFI was found to be a better tool for predicting postoperative function than was the CFS or CCI in patients undergoing arthroscopic rotator cuff repair. The study findings suggest that a multidimensional assessment of frailty (including both functional status and comorbidities) is important in determining functional outcomes after arthroscopic rotator cuff repair.

Septuagenarians aged 75 years and older do benefit from arthroscopic rotator cuff repair: a propensity matched-pair analysis.

BACKGROUND: Numerous studies show that patients who failed conservative management, benefit from open, mini open and arthroscopic rotator cuff repair (ARCR). However, there is a paucity of literature addressing ARCR and outcomes in patients older than the age of 75 years. The purpose of our study was to compare the outcomes of ARCR in patients older than 75 years and younger than 75 years of age. METHODS: Between January 2010 and December 2016, 397 patients underwent unilateral ARCR; of which, 23 patients were 75 years of age and older. Outcome measures recorded include the Constant Shoulder Score (CSS), University of California, Los Angeles Shoulder Score (UCLASS), Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain assessment. RESULTS: There were no statistically significant differences in VAS, CSS, and UCLASS between the two groups at all time points of follow-up (all P > .05). At 2 years after surgery, the OSS was 2 ± 5 points better in the <75 group (P = .012). However, the improvement in OSS was comparable between both groups. The improvement in VAS, CSS, and UCLASS at 2 years after surgery compared with baseline was also similar between the two groups (all P < .05). CONCLUSIONS: The improvement in VAS, CSS, and UCLASS was similar in both groups of patients. We conclude that septuagenarians with symptomatic cuff tears, who have failed conservative management, experience significant improvement in pain, and function after surgery and should not be excluded from the benefits of ARCR.

The UCLA Shoulder Score Is a Better Predictor of Treatment Success Than the Constant and Oxford Shoulder Scores After Arthroscopic Rotator Cuff Repair: A 2-Year Follow-Up Study.

PURPOSE: The aim of this study was to determine the correlation between functional outcome scores and treatment success after arthroscopic rotator cuff repair. METHODS: We conducted a retrospective cohort study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2010 and 2015. University of California at Los Angeles Shoulder Score (UCLASS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) were measured before and at 6, 12, and 24 months after surgery. Patients were divided into 2 groups at each follow-up: (1) those with successful treatment and (2) those with unsuccessful treatment. Treatment success was defined as simultaneous fulfilment of 3 criteria: clinically significant improvement in pain, expectations for surgery met, and patient satisfied with surgery. RESULTS: A total of 214 subjects met the inclusion criteria. UCLASS was a consistent significant predictor of treatment success at 6 months (odds ratio [OR] 1.192, P = .005, 95% confidence interval [CI] 1.054-1.348), 12 months (OR 1.274, P < .001, 95% CI 1.153-1.406), and 24 months (OR 1.266, P < .001, 95% CI 1.162-1.380). Lower preoperative CSS was significant in predicting treatment success at 6 months (OR 0.952, P = .001, 95% CI 0.926-0.979), while larger tear size was significant in predicting treatment success at 24 months (OR 1.773, P = .043, 95% CI 1.019-3.083). CONCLUSION: UCLASS is a better tool for predicting treatment success than CSS and OSS in patients undergoing arthroscopic rotator cuff repair, up to a minimum of 24 months' follow-up. A holistic assessment of shoulder function, taking into account both subjective and objective evaluation of function, as well as patient-reported satisfaction, is important in determining treatment success after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: III, retrospective comparative study.

Arthroscopic Management of Scapulothoracic Bursitis: Clinical Outcomes and Assessment of Novel Bony Parameters on Magnetic Resonance Imaging.

BACKGROUND: Scapulothoracic bursitis is a significant clinical condition that limits day-to-day function. Arthroscopic scapular debridement and resection have provided satisfactory outcomes; however, techniques, approaches, and recommendations remain varied. Novel bony parameters have also gained increasing interest owing to their value in preoperative planning. PURPOSE: To assess midterm clinical outcomes after the arthroscopic management of scapulothoracic bursitis and to identify and measure novel bony parameters on preoperative magnetic resonance imaging. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 8 patients underwent arthroscopic scapular debridement and bursectomy; 5 of the 8 patients underwent additional medial scapulectomy. There were 5 male (62.5%) and 3 female (37.5%) patients with a mean age of 30.1 ± 12.3 years (range, 19-58 years). Inclusion criteria for surgery were patients with symptomatic scapulothoracic bursitis for whom extensive nonoperative modalities had been utilized for at least 6 months but failed. Outcome measures included the Oxford Shoulder Score (OSS), University of California Los Angeles (UCLA) shoulder rating scale, Constant Shoulder Score (CSS), and visual analog scale (VAS) for pain. The bony parameters included scapular shape, anterior offset, costomedial angle, and medial scapular corpus angle (MSCA). RESULTS: The follow-up duration was at least 2 years for all patients (mean follow-up, 25.0 ± 4.1 months [range, 24-35 months]). The majority of patients had a concave-shaped scapula (62.5%). The mean anterior offset was 24.3 ± 3.4 mm, and the mean costomedial angle was 132.3° ± 9.6°. Half the patients had a positive MSCA, while the other half had a negative MSCA. A statistically significant improvement was observed in the OSS, UCLA, CSS, and VAS scores from preoperatively to 2-year follow-up (P < .001 for all). No complications were observed. CONCLUSION: Arthroscopic scapular debridement and resection provided satisfactory midterm clinical outcomes for the treatment of scapulothoracic bursitis.

Arthroscopic Single Lateral Row Repair Technique for Small Rotator Cuff Tears.

Small symptomatic rotator cuff tears are a common problem seen by orthopaedic surgeons. Arthroscopic repair has been shown to have favorable outcomes for these lesions. There is as yet no consensus on the ideal technique for the arthroscopic repair of small rotator cuff tears. We present a single lateral row technique for the repair of such lesions, which we believe to be reproducible and effective, that achieves good approximation of the tear while reducing the chance of suture cutouts.

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.

No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series.

PURPOSE: To evaluate and compare the functional outcomes after arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tears. METHODS: We conducted a retrospective analysis of patients who had undergone arthroscopic tear completion and subsequent repair of symptomatic partial-thickness rotator cuff tears in a single institution from 2010 to 2015. Range of motion (ROM) (forward flexion and abduction), the pain score as measured on the Numeric Pain Rating Scale, and outcome scores (Constant-Murley score, University of California, Los Angeles shoulder score, and Oxford Shoulder Score) were calculated preoperatively and at 1 year and 2 years postoperatively. The delta difference was calculated for each outcome parameter at the respective follow-up points as the difference from the preoperative baseline score. RESULTS: A total of 104 patients were included. All tears involved the supraspinatus tendon and did not exceed 2 cm. Of the patients, 65 had an articular-sided tear (AST) whereas 39 had a bursal-sided tear (BST). The mean age of the patients was 53.4 years in the AST group and 55.8 years in the BST group. The AST and BST groups did not differ preoperatively in terms of age, sex, and the measured outcome parameters. Postoperatively, the patients in both groups achieved statistically significant improvement in pain relief and functional outcomes at 2 years. No statistically significant difference was observed between the 2 groups in terms of the delta-difference outcomes in ROM in forward flexion (P = .781) or abduction (P = .348), pain score (P = .187), Constant-Murley score (P = .186), University of California, Los Angeles shoulder score (P = .911), and Oxford Shoulder Score (P = .186) at 2 years. CONCLUSIONS: Partial-thickness rotator cuff tears treated with arthroscopic tear completion and subsequent repair achieved good outcomes in terms of ROM, functional outcomes, and pain relief at 2 years. There was no difference in outcomes regardless of whether the location of the tear was articular sided or bursal sided. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Arthroscopic rotator cuff repair results in similar postoperative functional outcomes in patients with only rotator cuff tears and those with concomitant cervical radiculopathy.

PURPOSE: The aim of this study was to compare postoperative functional outcomes after arthroscopic rotator cuff repair in patients with only rotator cuff tears versus those with concomitant cervical radiculopathy. METHODS: A retrospective study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2012 and 2016 was conducted. Patients included in the study were divided into two groups: (1) those with rotator cuff tears only (RC only) and (2) those with concomitant cervical radiculopathy (RC + radiculopathy). Cervical radiculopathy was treated non-surgically in these patients. Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), University of California at Los Angeles Shoulder Score (UCLASS) and Visual Analog Scale (VAS) pain score were measured for each patient preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS: As compared to the RC-only group (n = 324), the RC + radiculopathy group (n = 33) had significantly poorer OSS (p = 0.001), CSS (p = 0.017) and UCLASS (p = 0.009) functional scores preoperatively. On follow-up, there were no significant differences in functional outcomes between the groups at 3, 6, 12 and 24 months postoperatively for OSS, CSS, UCLASS and VAS pain scores, with the exception of CSS which was higher in the RC-only group at 6 months (p = 0.007). The absolute change and number of patients that attained minimum clinically important difference (MCID) for OSS, CSS and UCLASS at 12- and 24-month follow-ups were also comparable between the groups. CONCLUSION: Patients with rotator cuff tears and concomitant cervical radiculopathy achieve similar postoperative functional outcomes to those with only rotator cuff tears, after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: III.

Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function.

Subchondroplasty is a relatively new joint preserving procedure, which involves the localized injection of calcium pyrophosphate bone substitute into the bone marrow lesion. The advent of magnetic resonance imaging (MRI) has greatly facilitated the identification of these bone marrow lesions. We investigated the clinical efficacy of subchondroplasty in the treatment of symptomatic bone marrow lesions in the knee, including knees with preexisting osteoarthritis. This study comprised of 12 patients whose knees were evaluated with standard radiographs and MRI to identify and localize the bone marrow lesions. They then underwent subchondroplasty under intraoperative radiographic guidance. Preoperative and postoperative visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Knee Injury and Arthritis Outcome Scores (KOOS) were obtained. VAS scores improved significantly from 7.5 ± 1.8 before surgery to 5.2 ± 2.7 after surgery. This further improved to 2.1 ± 2.4 at the one-year follow-up. KOOS scores improved significantly from 38.5 ± 17.0 before surgery to 73.2 ± 19.0 at the one-year follow-up. WOMAC scores improved significantly from 47.8 ± 20.5 before surgery to 14.3 ± 13.2 at the one-year follow-up. Subchondroplasty offers an effective way to treat subchondral bone marrow lesions in the arthritic knee, resulting in improvement in symptoms and early return to activity. Long-term studies are required to evaluate if these benefits can last. This is a Level II study.

Is single stage capsular release and rotator cuff repair suitable for rotator tears with concomitant stiffness?

INTRODUCTION: It is common for patients with a rotator cuff tear to present with shoulder stiffness. There is no consensus on the acceptable level of stiffness at time of rotator cuff repair.We aim to determine if patients with stiffness undergoing rotator cuff repair and concomitant capsular release have different outcome than those with no stiffness undergoing rotator cuff repair alone. We hypothesize that patients with stiffness will not have poorer outcome than patients with no stiffness. METHOD: We conducted a retrospective study of prospectively collected data for 47 patients who underwent arthroscopic rotator cuff repair under a single surgeon from 2010 to 2015. 25 patients were considered stiff (Stiff group) and 22 patients were considered to have no pre-operative stiffness (Non-stiff group).Range of motion and functional outcomes were collected preoperatively and post-operatively at two-years. RESULTS: There were no significant differences in gender distribution, age and cuff tear size between both groups. Pre-operatively, patients in the Stiff group had significantly poorer active range of motion (Forward flexion - Stiff 74.8° vs Non-stiff 100.2°, P = 0.001) and poorer function (Constant score - Stiff 23.5 vs Non-stiff 43.2, P < 0.001). Post-operatively, both groups of patients had increased range of motion, strength and reported lesser pain compared to pre-operation. There were no significant differences in post-operative outcomes between both groups. CONCLUSION: Single-stage surgery combining capsular release and rotator cuff repair is effective for patients with stiffness as they are able to achieve similar results to those without shoulder stiffness.

Dyslipidemia With Perioperative Statin Usage Is Not Associated With Poorer 24-Month Functional Outcomes After Arthroscopic Rotator Cuff Surgery.

BACKGROUND: Current literature suggests a higher rate of rotator cuff disease development in patients with dyslipidemia (DL). Moderate to high levels of DL are associated with higher rates of retear and revision surgery after arthroscopic rotator cuff repair. Statins protect against development of rotator cuff disease and mitigate the need for rotator cuff repair. PURPOSE: We aimed to investigate the influence of DL and statin use on postoperative functional outcomes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between 2010 and 2016, 266 patients underwent arthroscopic double-row rotator cuff repair for atraumatic full-thickness tears. Evaluation was conducted preoperatively and at 3, 6, 12, and 24 months postoperatively. Three functional outcome measures were used (Constant Shoulder Score [CSS], Oxford Shoulder Score [OXF], and University of California, Los Angeles, Shoulder Rating Scale [UCLASS]), as well as a visual analog scale (VAS) for pain. DL and non-DL were classified through screening of health and assessment of lipid levels within 6 months of surgery (triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein). Patients with DL were divided into statin users and nonusers. Types and dosages of statins were recorded, and intensity and equivalency charts were employed for standardization. Mann-Whitney U test and Pearson chi-square test were used for analysis. Generalized estimating equations and linear mixed models were used to examine the influence of DL and statin dosage, respectively on percentage change of postoperative outcome scores. RESULTS: Increased age was associated with a higher incidence of DL (P < .001), and 86% of the DL group was taking statins. The DL group also exhibited poorer scores preoperatively (CSS, P = .001; OXF, P = .032). No significant difference in scores was elicited between the DL and non-DL groups at 24 months. However, patients with DL experienced greater percentage improvement of CSS and OXF from preoperative baseline than did patients without DL (P = .008 and P = .034, respectively) at 24 months. There was no significant difference in 24-month functional outcomes between statin users and nonusers. No statistically significant change of CSS; OXF; UCLASS; or VAS was noted with increasing statin doses at 24 months. CONCLUSION: Patients with DL with perioperative statin usage did not have poorer 24-month functional outcomes after arthroscopic rotator cuff surgery compared with those in patients without DL.

Outcomes of Arthroscopic Rotator Cuff Repair in Stiff Shoulders are Comparable to Non-Stiff Shoulders When Combined With Manipulation Under Anesthesia.

PURPOSE: The purpose of this study was to compare the outcomes of arthroscopic rotator cuff repair (ARCR) in patients with preoperative stiffness to those without. METHODS: A total of 135 patients were prospectively evaluated for 2 years after ARCR for small to medium sized rotator cuff tears at our institution. Patients were divided into stiff (<100° of passive forward flexion) and non-stiff cohorts. The stiff group underwent manipulation under anesthesia (MUA) before ARCR was performed. Outcomes were measured using visual analog scale (VAS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) recorded at the preoperative, 6- , 12-, and 24-month time points. The results of ARCR between the cohorts were then compared. RESULTS: A total of 123 out of 135 patients (91.1%) completed the follow-up (stiff n = 46, non-stiff n = 77). There were significant improvements in the mean CSS scores at 6 (mean, 59.87; P < .001) and 12 months (mean, 65.88; P = .021) in the stiff group. There were no significant differences detectable in the CSS and OSS scores between the stiff and non-stiff groups at 6, 12, and 24 months. However, the percentage of patients achieving minimal clinically important difference was significantly higher in the stiff group (97.8%) compared with the non-stiff group (75.3%; P = .001). The VAS scores, forward flexion, and strength in both groups were found to be comparable. CONCLUSIONS: The results of our study showed no significant differences in outcomes scores in patients with stiff shoulders who underwent MUA combined with ARCR compared with patients with non-stiff shoulders who underwent ARCR alone. Therefore, early surgical repair should be considered in patients with rotator cuff tears and concomitant shoulder stiffness. LEVEL OF EVIDENCE: Level II, prospective cohort study.