Search

A double cortical button technique for ulnar collateral ligament reconstruction (UCLR) has advantages including significant control over graft tensioning, less concern about graft length, and minimized risk of bone tunnel fracture compared with traditional UCLR techniques. This double cortical button technique was recently found to be noninferior in mechanical performance to the traditional docking technique regarding joint strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between these UCLR techniques. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return-to-sport (RTS) outcomes to baseball players who underwent UCLR with the traditional docking (docking) technique. Baseball players who underwent primary UCLR from 2011 to 2020 across 2 institutions were identified. Included patients were contacted to complete a follow-up survey evaluating reoperations, RTS, and functional outcome scores. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic score, the Conway-Jobe score, the Andrews-Timmerman elbow score, and the Single Assessment Numeric Evaluation score. Overall, 78 male baseball players (age: 18.9 ± 2.4 years) with an average follow-up of 3.1 ± 2.4 years were evaluated, with 73 of the players being baseball pitchers. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received gracilis autografts (22% vs. 58%) compared with players in the docking group (P =.001); however, all other demographic factors were similar between the groups. All players in the double button group were able to RTS in 11.1 ± 2.6 months, whereas 96% of players in the docking group were able to RTS in 13.5 ± 3.4 months (P >.05). All postoperative outcomes and patient-reported outcomes were statistically similar between the groups and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all P >.05). RTS and other postoperative outcomes may be similar between baseball players who underwent UCLR with the double button technique and the docking technique. Although future research may be necessary to strengthen clinical recommendations, these findings provide the first clinical outcomes in light of a recent cadaveric study finding similar elbow strength, joint stiffness, and graft strain compared with the docking technique. [ABSTRACT FROM AUTHOR]

Diabetic patients have a greater incidence of adhesive capsulitis (AC) and a more protracted disease course than patients with idiopathic AC. The purpose of this study was to compare gene expression differences between AC with diabetes mellitus and AC without diabetes mellitus. Shoulder capsule samples were prospectively obtained from diabetic or nondiabetic patients who presented with shoulder dysfunction and underwent arthroscopy (N = 16). Shoulder samples of AC with and without diabetes (n = 8) were compared with normal shoulder samples with and without diabetes as the control group (n = 8). Shoulder capsule samples were subjected to whole-transcriptome RNA sequencing, and differential expression was analyzed with EdgeR. Only genes with a false discovery rate < 5% were included for further functional enrichment analysis. The sample population had a mean age of 47 years (range, 24-62 years), and the mean hemoglobin A 1c level for nondiabetic and diabetic patients was 5.18% and 8.71%, respectively. RNA-sequencing analysis revealed that 66 genes were differentially expressed between diabetic patients and nondiabetic patients with AC whereas only 3 genes were differentially expressed when control patients with and without diabetes were compared. Furthermore, 286 genes were differentially expressed in idiopathic AC patients, and 61 genes were differentially expressed in diabetic AC patients. On gene clustering analysis, idiopathic AC was enriched with multiple structural and muscle-related pathways, such as muscle filament sliding, whereas diabetic AC included a greater number of hormonal and inflammatory signaling pathways, such as cellular response to corticotropin-releasing factor. Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. The new genes expressed explain the differences in the disease course and suggest new therapeutic targets that may lead to different treatment paradigms in these 2 subsets. [ABSTRACT FROM AUTHOR]

Background A variety of techniques currently exist for ulnar collateral ligament (UCL) reconstruction in symptomatic overhead athletes, all with the potential complication of fracture about the humeral or ulnar tunnels. Far cortical button fixation is a reproducible, biomechanically attractive option; however, no clinical series has been published on this technique to date. This study reports the clinical outcomes, with minimum 2-year follow-up, of a dual far cortical button suspension technique for UCL reconstruction in athletes. Methods A retrospective evaluation was performed of 23 consecutive athletes who underwent UCL reconstruction with the use of ulnar and humeral-sided far cortical button fixation with minimum 2 years of follow-up. Data were collected from electronic medical records and patient telephone calls. The primary outcome was return to sport. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand score, range of motion, and complications. Results We included 23 athletes with a mean follow-up of 47.2 months (range, 24-81 months). Autograft was used in 22 patients (16 palmaris, 6 gracilis, 1 semitendinosus, and 1 gracilis allograft). Overall, 82.6% (19 of 23) of patients returned to sport. At final follow-up, the average Disabilities of the Arm, Shoulder and Hand score was 3.8, and range of motion averaged 0° to 140°, with 87% (20 of 23) of patients achieving full motion. The visual analog scale score improved from 3.8 preoperatively to 0.2 at the final follow-up ( P  < .0001). There was 1 reconstruction failure. Conclusions The humeral and ulnar far cortical button suspension technique provides a new UCL fixation option with theoretically lower concern for tunnel fracture and with predictable return to sport and good functional outcomes. [ABSTRACT FROM AUTHOR]

Background Little is known about the time dependence of the failure rate of surgically repaired rotator cuffs. Retears are significant, as they are common and may lead to less satisfactory outcomes and additional operations. Their timing is critical foundational information for understanding failure mechanisms. However, this remains unclear. Currently, there exist a number of studies that have reported retear rates at specific time points. Combining data from these publications can reveal when cuffs retear, which will help inform expectations and guidelines for progression of activity after surgery. Methods PubMed, Medline, and Embase were searched for studies relating to rotator cuff repair. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Data were extracted from those publications that satisfied all requirements, and regression analysis was performed. Results Thirteen articles were included in the final meta-analysis. Retear rates for medium tears increased for approximately 15 months and leveled off at approximately 20%. Retear rates for large tears progressed steadily for about 12 months and approached an upper limit of approximately 40%. Retear rates for massive tears ranged from 20% to 60%, but the distribution of retear rate over time for these cuff tears is not clear from these data. Conclusion Retear rates for medium and large tears generally increase until at least 10-15 months after surgery, after which they are likely to level off. Retear rates for massive tears are variable and may follow a time course different from that of other tear sizes. Retear rates depend on size of the original tear. [ABSTRACT FROM AUTHOR]

Background Recent studies have identified Propionibacterium acnes as the causal organism in an increasing number of postoperative shoulder infections. Most reports have found a high rate of P acnes infection after open surgery, particularly shoulder arthroplasty. However, there are limited data regarding P acnes infections after shoulder arthroscopy. Materials and methods We prospectively collected data on all shoulder arthroscopies performed by the senior author from January 1, 2009, until April 1, 2013. Cultures were taken in all revision shoulder arthroscopy cases performed for pain, stiffness, or weakness. In addition, 2 cultures were taken from each of a cohort of 32 primary shoulder arthroscopy cases without concern for infection to determine the false-positive rate. Results A total of 1,591 shoulder arthroscopies were performed during this period, 68 (4.3%) of which were revision procedures performed for pain, stiffness, or weakness. A total of 20 revision arthroscopies (29.4%) had positive culture findings, and 16 (23.5%) were positive for P acnes . In the control group, 1 patient (3.2%) had P acnes growth. Conclusions The rate of P acnes infection in patients undergoing revision shoulder arthroscopy is higher than previously published and should be considered in cases characterized by refractory postoperative pain and stiffness. [ABSTRACT FROM AUTHOR]

Glenoid bone deficiency and eccentric posterior wear are difficult problems faced by shoulder arthroplasty surgeons. Numerous options and techniques exist for addressing these issues. Hemiarthroplasty with concentric glenoid reaming may be a viable alternative in motivated patients in whom glenoid component failure is a concern. Total shoulder arthroplasty has been shown to provide durable pain relief and excellent function in patients, and numerous methods and techniques can assist in addressing bone loss and eccentric wear. However, the ideal amount of version correction in cases of severe retroversion has not yet been established. Asymmetric reaming is a commonly used technique to address glenoid version, but correction of severe retroversion may compromise bone stock and component fixation. Bone grafting is a technically demanding alternative for uncontained defects and has mixed clinical results. Specialized glenoid implants with posterior augmentation have been created to assist the surgeon in correcting glenoid version without compromising bone stock, but clinical data on these implants are still pending. Custom implants or instruments based on each patient's unique glenoid anatomy may hold promise. In elderly, sedentary patients in whom bone stock and soft-tissue balance are concerns, reverse total shoulder arthroplasty may be less technically demanding while still providing satisfactory pain relief and functional improvements. [Copyright &y& Elsevier]

Background: The number of times an article has been cited has been used as a marker of its influence in a medical specialty. The purpose of this study was to determine the 50 most cited articles in shoulder surgery and their characteristics. Methods: Science Citation Index Expanded was searched for citations of articles published in any of the 61 journals in the category “Orthopedics.” Each of the journals was searched to determine the 50 most often cited articles specific to shoulder surgery. The following characteristics were determined for each article: authors, year of publication, source journal, geographic origin, article type, and level of evidence for clinical articles. Citation density (total number of citations/years since publication) was also determined. Results: The number of citations ranged from 1211 to 192. The 50 most often cited articles were published in 8 journals. The majority of the articles (42) were clinical, with the remaining representing some type of basic science research. The most common level of evidence was IV (23). The mean number of citations for methodologic articles (437 citations per article) was greater than that for non-methodologic articles (301 citations per article) (P = .034). Conclusions: Articles that introduced instruments for outcome evaluation or that introduced classification systems (methodologic) were highly cited regardless of the date of publication. The top 50 list presented provides residency and fellowship directors with a group of “classic” articles in the subspecialty of orthopedic shoulder surgery that can be included in reading curriculums for their trainees. [ABSTRACT FROM AUTHOR]

Hypothesis: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has been validated as an effective upper extremity specific outcome measure. Normative scores have not been established for young athletes. This study was conducted to establish normative DASH scores for intercollegiate athletes. We hypothesized that DASH scores in intercollegiate athletes differ from published values obtained from the general population. Materials and methods: The DASH questionnaire was administered to 321 athletes cleared for full participation in intercollegiate sports. Their scores were compared with normative values in the general population and 2 other age-matched cohorts. Results: Intercollegiate athletes had significantly better upper extremity function compared with the general population (1.37 ± 2.96 vs 10.10 ± 14.68, P < .001) and an age-matched cohort of employed adults (1.37 ± 2.96 vs 5.40 ± 7.57, P < .0001). The DASH was 0 for 65.1%. Within this cohort, men reported better upper extremity function than women (0.98 vs 1.82, P = .010). Athletes participating in overhead sports reported worse upper extremity function than nonoverhead athletes (1.81 vs 0.98, P = .042). Discussion: We report normative DASH values for a group of intercollegiate athletes and show a significant difference between the scores of these athletes and the general population. Within our cohort of competitive athletes, overhead sports and female gender are associated with significantly lower DASH scores and sports module scores. The utility of using these results are limited by a substantial ceiling effect in this population of competitive athletes. Differences within our cohort and differences between our cohort and other populations are minimized by this ceiling effect. Various upper extremity outcome measures may be similarly limited by a ceiling effect and should be examined for appropriateness before use. Conclusion: Intercollegiate athletes report significantly greater upper extremity function than the general population; however, validity of the DASH in these athletes is limited and population differences may be minimized by a substantial ceiling effect. [Copyright &y& Elsevier]

Tuberosity malpositioning commonly occurs and is associated with a decline in clinical function after prosthetic shoulder reconstruction for proximal humeral fractures. This study assesses the biomechanical effects of inferior tuberosity position on glenohumeral joint forces and humeral head position at multiple positions. Eight fresh-frozen cadaveric shoulders were tested. Hemiarthroplasty was performed with preservation of anatomic tuberosity height and with 10 mm and 20 mm of inferior tuberosity displacement. The rotator cuff, deltoid, pectoralis major, and latissimus dorsi muscles were statically loaded. Contact forces and humeral head position were recorded within a functional range of motion. Glenohumeral joint forces shifted significantly superiorly (P < .05) at 30° of abduction after both 10 mm and 20 mm of tuberosity displacement. At 60° of glenohumeral abduction, glenohumeral joint forces remained significantly altered after tuberosity displacement of 10 mm and 20 mm compared with the intact height (P < .005). This study demonstrates that, during hemiarthroplasty performed for proximal humeral fractures, malpositioning the tuberosities inferiorly results in significant superior glenohumeral joint force displacement. These findings suggest that the mechanical advantage of the shoulder abductor muscles is compromised with inferior tuberosity malpositioning and may help to explain inferior functional results seen in these patients. [Copyright &y& Elsevier]