Initial clinical experience with a predictive clinical decision support tool for anatomic and reverse total shoulder arthroplasty.

PURPOSE: Clinical decision support tools (CDSTs) are software that generate patient-specific assessments that can be used to better inform healthcare provider decision making. Machine learning (ML)-based CDSTs have recently been developed for anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty to facilitate more data-driven, evidence-based decision making. Using this shoulder CDST as an example, this external validation study provides an overview of how ML-based algorithms are developed and discusses the limitations of these tools. METHODS: An external validation for a novel CDST was conducted on 243 patients (120F/123M) who received a personalized prediction prior to surgery and had short-term clinical follow-up from 3 months to 2 years after primary aTSA (n = 43) or rTSA (n = 200). The outcome score and active range of motion predictions were compared to each patient's actual result at each timepoint, with the accuracy quantified by the mean absolute error (MAE). RESULTS: The results of this external validation demonstrate the CDST accuracy to be similar (within 10%) or better than the MAEs from the published internal validation. A few predictive models were observed to have substantially lower MAEs than the internal validation, specifically, Constant (31.6% better), active abduction (22.5% better), global shoulder function (20.0% better), active external rotation (19.0% better), and active forward elevation (16.2% better), which is encouraging; however, the sample size was small. CONCLUSION: A greater understanding of the limitations of ML-based CDSTs will facilitate more responsible use and build trust and confidence, potentially leading to greater adoption. As CDSTs evolve, we anticipate greater shared decision making between the patient and surgeon with the aim of achieving even better outcomes and greater levels of patient satisfaction.

Effects of graft rotation on initial biomechanical failure characteristics of bone-patellar tendon-bone constructs.

BACKGROUND: Graft-tunnel mismatch is a potential problem during single-incision technique for anterior cruciate ligament reconstruction with the central third of the patellar tendon. Mismatch is present when the graft is too long to fit appropriately in the tunnels that have been created. Graft rotation is one method for addressing this problem. PURPOSE: To determine the results of graft rotation up to 540 degrees on initial graft biomechanical properties and graft length. STUDY DESIGN: Controlled laboratory study. METHODS: Forty porcine bone-patellar tendon-bone constructs were divided into four groups and constructs were rotated to 0 degrees, 90 degrees, 180 degrees, and 540 degrees, respectively, for each group. Biomechanical testing to failure was performed with the constructs under tension at an elongation rate of 5 cm/sec. Lengths were measured after a 1-kg load was applied to the grafts. RESULTS: No statistical difference in ultimate failure strength was encountered between any of the groups (P = 0.915). The grafts that were twisted to 540 degrees shortened an average of 5.41 mm, which represented an average shortening of 10% of the initial tendon length. CLINICAL RELEVANCE: Graft rotation up to 540 degrees does not result in loss of initial graft strength, and may be a solution for graft-tunnel mismatch.

Results of pectoralis major transfer with fascia lata autograft augmentation for scapula winging.

Fifteen patients (9 male and 6 female) with a mean age of 32.8 years (range, 17-44 years) were examined at a mean follow-up of 64 months (range, 33-118 months) after undergoing pectoralis major transfer with a fascia lata autograft for scapular winging. Ten patients were treated as part of a worker's compensation claim. Twelve reported that they would undergo the procedure again. The mean Rowe score was 66 (range, 41-92), the mean Constant-Murley score was 74 (range, 32-95), the mean Simple Shoulder Test score was 8 of 12 positive responses, and the mean American Shoulder and Elbow Surgeons score was 63 (range, 10-87). Pain decreased in 11 patients, whereas function improved in 10 patients. According to the Rowe scoring system, the results were excellent in 2 patients, good in 5, fair in 4, and poor in 4. Better results occur in patients attaining at least 60 degrees of external rotation postoperatively. Although complete relief of pain and full function were not always achieved, most patients returned to their preoperative level of activity with minor adaptations.