Outcomes of Concomitant Glenohumeral Stabilization After Arthroscopic Rotator Cuff Repair in Military Patients Younger Than 40 Years.

Background: While concomitant rotator cuff and inferior labral tears are relatively uncommon in young civilians, military populations represent a unique opportunity to study this injury pattern. Purpose: To (1) evaluate the long-term outcomes after combined arthroscopic rotator cuff and inferior labral repair in military patients <40 years and (2) compare functional outcomes with those after isolated arthroscopic rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: Military patients who underwent arthroscopic rotator cuff repair between January 2011 and December 2016 and had a minimum of 5-year follow-up data were included in this study. The patients were categorized into those who had undergone combined arthroscopic rotator cuff and inferior labral repair (RCIL cohort) and those who had isolated arthroscopic rotator cuff repair (ARCR cohort). Pre- and postoperative outcome measures-visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, Rowe Instability Score, and range of motion-were compared between the groups. Results: A total of 50 shoulders (27 in the RCIL cohort and 23 in the ARCR cohort) were assessed. The RCIL and ARCR groups were similar in terms of age (mean, 33.19 years [range, 21-39 years] vs 35.39 years [range, 26-39 years], respectively) and sex (% male, 88.46% vs 82.61%, respectively). All patients were active-duty military at the time of surgery. The mean final follow-up was at 106.93 ± 16.66 months for the RCIL group and 105.70 ± 7.52 months for the ARCR group (P = .75). There were no differences in preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all), and there were no significant group differences in any final postoperative outcome measures. At the final follow-up, 26 (96.30%) patients in the RCIL cohort and 20 (86.96%) in the ARCR cohort had returned to unrestricted active-duty military service (P = .3223). Conclusion: The study findings indicate that concomitant glenohumeral stabilization does not prevent worse outcomes after arthroscopic rotator cuff repair in this military cohort. Combined repair produced statistically and clinically significant improvements in outcome scores at the long-term follow-up, indicating that simultaneous repair of combined lesions was an appropriate treatment option in this patient population.

Concomitant Biceps Tenodesis Does Not Portend Inferior Outcomes After Anterior Glenohumeral Stabilization.

BACKGROUND: Military patients are known to suffer disproportionately high rates of glenohumeral instability as well as superior labrum anterior to posterior (SLAP) tears. Additionally, a concomitant SLAP tear is frequently observed in patients with anterior shoulder instability. Even though biceps tenodesis has been demonstrated to produce superior outcomes to SLAP repair in military patients with isolated SLAP lesions, no existing studies have reported on outcomes after simultaneous tenodesis and anterior labral repair in patients with co-existing abnormalities. PURPOSE: To evaluate outcomes after simultaneous arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair in military patients younger than 40 years. We also sought to compare these outcomes with those after repair of an isolated anterior labral tear. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study is a retrospective analysis of all military patients younger than 40 years from a single base who underwent arthroscopic anterior glenohumeral stabilization with or without concomitant biceps tenodesis between January 2010 and December 2019. Patients with glenoid bone loss of >13.5% were not eligible for inclusion. Outcome measures including the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were administered preoperatively and postoperatively, and scores were compared between groups. RESULTS: A total of 82 patients met inclusion criteria for the study. All patients were active-duty service members at the time of surgery. The mean follow-up was 87.75 ± 27.05 months in the repair + tenodesis group and 94.07 ± 28.72 months in the isolated repair group (P = .3085). Patients who underwent repair + tenodesis had significantly worse preoperative VAS pain (6.85 ± 1.86 vs 5.02 ± 2.07, respectively; P < .001), ASES (51.78 ± 11.89 vs 62.43 ± 12.35, respectively; P = .0002), and Rowe (26.75 ± 7.81 vs 37.26 ± 14.91, respectively; P = .0002) scores than patients who underwent isolated repair. Both groups experienced significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no statistically significant differences in postoperative outcome scores or range of motion between groups. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the VAS pain, SANE, ASES, and Rowe scores between groups. Overall, 37 of the 40 (92.50%) patients in the repair + tenodesis group and 40 of the 42 (95.24%) patients in the isolated repair group returned to unrestricted active-duty military service (P = .6045). In addition, 38 (95.00%) patients in the repair + tenodesis group and 40 (95.24%) patients in the isolated repair group returned to preinjury levels of sporting activity (P = .9600). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between groups (P = .9421, P = .9400, and P = .6045, respectively). CONCLUSION: The findings of this study indicate that simultaneous biceps tenodesis and labral repair was a viable treatment option for the management of concomitant SLAP and anterior labral lesions in young, active military patients younger than 40 years.

Epidemiology of shoulder dislocations presenting to United States emergency departments: An updated ten-year study.

BACKGROUND: Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability. However, there is a paucity of current data available regarding the epidemiological trends of this injury. AIM: To provide an updated, comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States. We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events. METHODS: Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021. Incidence, age, sex, and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95% confidence intervals (CI). RESULTS: In total, an estimated 773039 shoulder dislocations (CI: 640598-905481) presented to emergency rooms across the United States during the study period. The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years. Significantly more male patients sustained dislocations than female patients (537189, 69.5%, vs 235834, 30.5%, P < 0.001). With regard to associated consumer products, sports and recreation equipment were involved in the highest proportion of incidents (44.31%), followed by home structures and construction materials (21.22%), and home furnishings, fixtures, and accessories (21.21%). Regarding product sub-groups, stairs, ramps, landings, floors was cited in the greatest number of cases (131745). CONCLUSION: The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons. Male adolescents sustained the highest proportion of dislocations, with a peak incidence in age group 15-20 years, predominantly secondary to participation in sporting and recreational activities. Conversely, women experienced a relatively consistent incidence of dislocation throughout their lifespan. After age 63, the incidence rate of dislocations in females was found to surpass that observed in males.

Analysis of the Quality of Prospective Randomized Controlled Trials for Treatment of Boxer's Fractures.

BACKGROUND: This study aimed to review level I and II therapeutic studies on boxer's fractures to measure variation in quality among the highest level study designs. METHODS: We used quantitative measures of study quality to evaluate prospective randomized controlled trials (RCTs) of treatments of boxer's fractures. A search of PubMed, using terms "boxer's fracture" and "fifth metacarpal neck fracture" identified 164 articles from 1961 to 2019. From this list, we identified 6 RCTs. Two observers classified each trial according to 3 systems: the Oxford Levels of Evidence, the modified Coleman Methodology Score, and the revised Consolidated Standards of Reporting Trials (CONSORT) score. RESULTS: The 2 reviewers were consistent in their use of the Oxford Levels of Evidence (100% agreement). The differences between the average modified Coleman Methodology scores and the average CONSORT scores assigned by the 2 observers were not significant (46.2 vs 45.3 points, κ = 0) and (13.7 vs 14.3 points, κ = 0.33), respectively. Both observers rated all the studies as level I and as unsatisfactory according to the Coleman Methodology Score (100% and 100%), and less than half as unsatisfactory according to the CONSORT score (50% and 17%). Areas of deficiency included randomization, blinding, group comparability, clinical effect measurements, and allocation into treatment arms. CONCLUSION: Classifying orthopedic scientific reports according to the levels of evidence implies a degree of respect for level I and II studies that may not always be merited. Our data suggest that the quality of higher level studies, namely those involving boxer's fractures, varies and may often be unsatisfactory when critically evaluated.

Primary Arthroscopic Labral Management: Labral Repair and Complete Labral Reconstruction Both Offer Durable, Promising Results at Minimum 5-Year Follow-up.

BACKGROUND: Increased understanding of the acetabular labrum's role in hip joint biomechanics has led to a greater focus on the conservation and restoration of normal labral anatomic characteristics; however, labral repair is often not possible in the setting of severe intrasubstance damage or deficiency. PURPOSE: To compare 5-year postoperative patient-reported outcomes between hips treated with primary complete arthroscopic labral reconstruction and those treated with primary labral repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All hips that underwent primary labral repair or reconstruction by the senior surgeon between January 2015 and December 2015 were included. Hips that had undergone a previous intra-articular procedure were excluded. Visual analog scales and patient-reported outcome (PRO) instruments were completed by patients within 1 week before surgery as a baseline measurement, between 22 and 26 months postoperatively for 2-year outcomes, and between 58 and 62 months for 5-year outcomes. PRO scores collected included the modified Harris Hip Score (mHHS), the 12-Item International Hip Outcome Tool, and the visual analog scale for pain and satisfaction. Pain and satisfaction were assessed using visual analog scales. RESULTS: A total of 68 primary labral repairs and 62 primary complete labral reconstructions were included in the final analysis. Patients in the reconstruction cohort were older (38.3 vs 29.9 years; P < .001), had a higher incidence of severe labral tearing (62.90% vs 5.88%; P < .001), required a greater number of concomitant procedures (P < .001), and were more likely to have Beck grade III or IV chondral damage (12.94% vs 1.47%; P < .001). Both groups demonstrated statistically significant increases in outcome scores at minimum 5-year follow-up. Patients who underwent labral reconstruction had a significantly greater increase in mHHS from the preoperative assessment to latest follow-up compared with patients undergoing labral repair (27.43 vs 17.13; P = .04). No statistically significant differences between the 2 cohorts were found in achievement of minimal clinically important difference, Patient Acceptable Symptom State, maximum outcome improvement, and substantial clinical benefit at latest follow-up (P > .05). In total, 2 patients in the repair cohort and 3 patients in the reconstruction cohort required revision arthroscopy (P = .574). Further, 1 patient from each group converted to arthroplasty (P = .947). CONCLUSION: The results of this study suggest that primary complete labral reconstruction is a viable surgical option for hips with moderate to severe labral pathology. At minimum 5-year follow-up, labral reconstruction produced similar outcomes to labral repair despite less favorable preoperative patient characteristics in the reconstruction cohort.

Treatment trends in distal humerus fractures between ABOS part II candidates.

PURPOSE: The purpose of this study was to determine how fellowship training influences the treatment of distal humerus fractures with either total elbow arthroplasty (TEA) or open reduction internal fixation (ORIF). METHODS: The American Board of Orthopaedic Surgery (ABOS) Part II Examination Database was queried for all orthopaedic surgeons who sat for the Part II examination between the years 2003-2019. Inclusion criteria were ORIF or TEA cases, selected by individual CPT codes for each procedure, and patients of at least age 65 years who sustained acute distal humerus fractures. Analysis was performed for each type of fellowship training completed, total number of procedures performed, the type of procedure performed, patient demographics, and any complications. RESULTS: There were 149 TEAs and 1306 ORIFs performed for distal humerus fractures between the exam years of 2003-2019. The proportion of TEA to ORIF increased from 7.6% to 11.0%. Partitioned by fellowship training, Hand and Upper Extremity surgeons performed 69 (17.4%) TEAs and 328 (82.6%) ORIFs, Shoulder and Elbow surgeons performed 34 (29.6%) TEAs and 81 (70.4%) ORIFs, Sports Medicine surgeons performed 14 (5.1%) TEAs and 263 (94.6%) ORIFs, and Trauma surgeons performed 16 (4.2%) TEAs and 366 (95.8%) ORIFs. Hand and Upper Extremity surgeons treated the most distal humerus fractures (397, 27.3%), followed by Trauma surgeons (382, 26.3%). CONCLUSION: Our data suggests that fellowship training does influence the surgical decision-making process for treating distal humerus fractures in elderly populations. Hand and Upper Extremity surgeons performed the greatest number of TEA for acute distal humerus fractures, followed by Shoulder and Elbow surgeons. Conversely, trauma surgeons performed the lowest proportion of TEA to ORIF. LEVEL OF EVIDENCE: III.