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Background: Opioid-related morbidity and mortality are major public health concerns, and the risk of long-term opioid use after shoulder arthroscopy is not well defined., Hypothesis: Substance abuse disorders, pain disorders, and psychiatric conditions increase the risk for prolonged opioid use., Study Design: Case-control study, Level of evidence, 3., Methods: Insurance claims data from the Truven Health MarketScan Research Databases was used to identify patients who underwent shoulder arthroscopy between January 1, 2010, and March 31, 2015. Opioid-naïve patients were included. New prolonged opioid use was defined as continued opioid use between 91 and 180 days after the index procedure. The authors used a multivariable logistic regression model to identify patient factors associated with the risk of new prolonged opioid use., Results: In this cohort of 104,154 opioid-naïve adult patients, 8686 (8.3%) developed new prolonged opioid use as defined in this study. A total of 31,768 (30.5%) filled an opioid prescription in the 30 days before surgery. Patients who had limited debridement had the highest prolonged use rate (9.0%), followed by rotator cuff repair (8.5%), anterior labrum lesion repair (8.5%), and extensive debridement (8.2%). Patient characteristics associated with the highest odds ratios (ORs) of prolonged opioid use included those who had a total opioid dose during the perioperative period that was ≥743 oral morphine equivalents (ie, at least 149 tablets of 5-mg hydrocodone) (OR, 2.0; 95% CI, 1.9-2.1), followed by patients with a suicide and self-harm disorder (OR, 2.0; 95% CI, 1.1-3.4), a history of alcohol dependence or abuse (OR, 1.6; 95% CI, 1.3-1.9), a mood disorder (OR, 1.3; 95% CI, 1.2-1.4), an opioid prescription filled in the 30 days before surgery (OR, 1.3; 95% CI, 1.2-1.4), female sex (OR, 1.3; 95% CI, 1.2-1.3), an anxiety disorder (OR, 1.2; 95% CI, 1.1-1.3), and a history of a pain diagnosis (OR, 1.2; 95% CI, 1.1-1.2)., Conclusion: The risk of prolonged opioid use after arthroscopic shoulder procedures is 8.3%, and it is higher among women and among those with greater opioid use in the early postoperative period, mental health conditions, substance dependence and abuse, and preexisting pain disorders. Patients at high risk warrant close surveillance after surgery for early recognition and management.

Purpose: To examine orthopaedic surgery case logs for arthroscopy case volume during residency training and to evaluate trends in case volume and variability over time., Methods: Publicly available Accreditation Council for Graduate Medical Education surgical case logs from 2007 to 2013 for orthopaedic surgery residency were assessed for variability and case volume trends in shoulder, elbow, wrist, hip, knee, and ankle arthroscopy. The national average number of procedures performed in each arthroscopy category reported was directly compared from 2009 to 2013. The 10th and 90th percentile arthroscopy case volume was compared between 2007 and 2013 for shoulder and knee arthroscopy procedures. Subsequently, the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2007 was compared with the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2013., Results: From 2007 to 2013, shoulder arthroscopy procedures performed per resident increased by 43.1% (P = .0001); elbow arthroscopy procedures increased by 28.0% (P = .00612); wrist arthroscopy procedures increased by 8.6% (P = .05); hip arthroscopy procedures, which were first reported in 2012, increased by 588.9%; knee arthroscopy procedures increased by 8.5% (P = .0435); ankle arthroscopy increased by 27.6% (P = .00149). The difference in knee and shoulder arthroscopy volume between residents in the 10th and 90th percentile in 2007 and residents in the 10th and 90th percentile in 2013 was not significant (P > .05). There was a 3.66-fold difference in knee arthroscopy volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 3.36-fold in 2013 (P = .70). There was a 5.86-fold difference in shoulder arthroscopy case volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 4.96-fold in 2013 (P = .29)., Conclusions: The volume of arthroscopy cases performed by graduating orthopaedic surgery residents has significantly increased over time. There continues to be substantial variability in knee and shoulder arthroscopy case volume between residents in the 10th and 90th percentile., Clinical Relevance: Variability in residency training is notable and may affect knowledge, skill, and practice patterns of surgeons., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the safety and accuracy of a transhumeral portal to arthroscopically access and prepare the glenohumeral articular surface without subscapularis transection or glenohumeral dislocation., Methods: In 10 fresh-frozen cadaveric shoulders, we used a transhumeral portal and an anterior mini-open rotator interval exposure to arthroscopically prepare the humeral and glenoid articular surfaces. To evaluate our technique, we measured the distance from the portal to the branches of the axillary nerve and the biceps groove on the humeral extra-articular surface, the angle of trajectory of the portal through the humerus, and the accuracy of targeting the center-center of the humeral and glenoid surfaces., Results: The transhumeral portal allows perpendicular access to the humeral and glenoid articular surfaces without damage to the subscapularis, supraspinatus, or axillary nerve. The transhumeral portal courses an average of 20.7 ± 15.0 mm from the closest terminal branch of the anterior branch of the axillary nerve, enters the humerus 8.8 ± 2.7 mm lateral to the biceps groove, and traverses the humerus at an angle of 46.0° ± 4.3° relative to the humeral intramedullary axis. Arthroscopic guidance resulted in an average distance of 8.1 ± 5.6 mm from the humeral center and 3.9 ± 1.0 mm from the glenoid center., Conclusions: Creating an arthroscopic transhumeral portal allows perpendicular access to the humeral and glenoid articular surfaces without injury to the axillary nerve, subscapularis transection, or dislocation of the glenohumeral joint. However, this transhumeral portal did traverse within 5 mm of a terminal branch of the anterior branch of the axillary nerve in 20% of our specimens., Clinical Relevance: These findings describe an arthroscopic transhumeral portal that achieves perpendicular access to the glenohumeral joint surfaces without transection of the subscapularis or dislocation of the glenohumeral joint. This transhumeral portal may assist in articular cartilage repair and resurfacing of the glenohumeral joint., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Several studies have demonstrated that patients have significant impairments in understanding their injury and appropriate course of management in orthopedic surgery. The purpose of this investigation is to determine if patients are able to obtain a fundamental understanding of the requisite care associated with hip arthroscopy. Any patient who elected to have hip arthroscopy was prospectively recruited to participate in the study. All patients were told they would be asked to complete a questionnaire about their surgery and post-operative instructions. The answers to each question of the questionnaire they would receive at the first post-operative visit were verbally given to each patient during the pre-operative visit. They were also given a post-operative instruction sheet on the day of surgery that contained answers to the questionnaire. At the first post-operative visit, all patients were then asked to complete a multiple-choice questionnaire prior to seeing the surgeon. A total of 56 patients (14 males, 42 females) were enrolled. All patients reported they had read the post-operative instruction sheet. The average number of correct answers was 6.5 ± 0.6 (95% CI 6 − 7) out of 11 questions (59% correct response rate ±18% [95% CI 52 − 66%]). Although we made significant pre-operative oral and written efforts to help patients achieve an elementary level of health literacy regarding their forthcoming hip arthroscopy, many patients did not achieve satisfactory comprehension. Even with instruction and information given verbally and physically (via post-operative instruction sheet) patients did not obtain satisfactory comprehension of their surgical procedure. New ways (through video, simplified cartoons or verbal explanations) must be considered in educating patients concerning surgical procedures to increase comprehension and health literacy. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to identify patient characteristics that increase risk for unplanned readmission within 30 days of an initial hospital stay after outpatient rotator cuff repair (RCR). Methods: A retrospective cohort study was performed utilizing the National Surgical Quality Improvement Program (ACS NSQIP) datasets from 2012 to 2015. Patients were preliminarily included in the study based on the presence of a primary Common Procedural Terminology code for RCR (23410, 23412, 23420, and 29827). Only non-emergent, outpatient, and elective procedures performed on patients with American Society of Anesthesiologists (ASA) ≤4 were considered. The primary outcome variables were 30-day unplanned readmission after outpatient surgery. Secondary analyses were implemented to establish reason and timing of readmission. Results: A total of 18,061 cases were reviewed, and 199 (1%) patients experienced 30-day unplanned readmission. Age ≥80 (OR = 2.13, p = 0.0276), COPD (OR = 1.75, p = 0.0354), hypertension requiring medication (OR = 1.67, p = 0.0027), dialysis (OR = 13.46, p < 0.0001) and an ASA classification of 3 (OR = 2.78, p = 0.0143) or ASA 4 (OR = 6.15, p = 0.0012) were identified as major prognosticators for readmission. Female sex was associated with lower odds of readmission (OR = 0.54, p = 0.0001). The most common complications associated with readmission were cardiovascular (29%), infection (19%), and respiratory (17%). Conclusions: The rate of 30-day unplanned inpatient readmission following outpatient RCR using the NSQIP data was found to be 1%, with advanced age and preexisting medical comorbidities contributing to the highest odds of readmission. Cardiovascular, infectious, and respiratory complications contributed to the majority of readmissions. The ability to identify patients with these risk factors will be of utility in optimizing outcomes and cost-effectiveness of RCR. Level of evidence: Level III [ABSTRACT FROM AUTHOR]

There are several treatment options for recurrent shoulder instability. The Latarjet addresses bone loss via coracoid transfer, and creates a "sling effect" on the humeral head with the conjoint tendon. It does however carry a high potential risk of complications including graft resorption, hardware failure, and neurologic injury. It is hypothesized that the long head of the biceps can function similarly, without the donor site morbidity of a coracoid transfer. We present a case of recurrent instability and musculocutaneous nerve palsy following primary arthroscopic stabilization three years prior, and treatment via long head of the biceps stabilization. [ABSTRACT FROM AUTHOR]

Ochronotic arthropathy occurs in patients with alkaptonuria, manifesting first in the intervertebral discs of the lumbar spine, with subsequent degeneration most often observed in the knee, hip, and shoulder joints. Efforts at treatment are targeted at minimizing the damaging effects of the underlying metabolic disorder on the articular cartilage. Vitamin E and N-acetyl cysteine are potential therapies because of their scavenging of free radicals and consequent limitation of oxidative damage to joint tissue. Arthroscopy has been found to be an effective diagnostic tool in cases of suspected ochronosis. Arthroplasty performed in patients with ochronotic arthropathy suggests that the procedure is effective in the alleviation of joint pain and the improvement of mobility. Perioperative management of these patients may require more careful consideration pertinent to the associated comorbidities of this disorder. [ABSTRACT FROM AUTHOR]

Objective: To evaluate patients' ability to return to preinjury activity level after arthroscopically assisted triangular fibrocartilage complex (TFCC) repair. Data Sources: The PubMed electronic library was systematically searched from inception to August 2021 for any eligible articles using a combination of the phrases "TFCC," "return to sport," "return to work," and "athlete." Results: Studies that evaluated patients who had undergone arthroscopic repair of isolated TFCC injury and reported objective or patient-reported outcome measures were included. Fifteen studies representing 478 patients fulfilled the inclusion criteria. An average of 84% of patients were able to fully return to their previous work or sport activities. Most studies reported that range of motion (ROM) and grip strength (GS) both returned to >90% of the contralateral side, and every study that evaluated pain levels found a significant reduction in pain postoperatively. Mayo Modified Wrist Score was reported as excellent or good in 83% of patients, and the average Disabilities of the Arm, Shoulder, and Hand score was 13.8 postoperatively. Conclusion: Patients were able to return to their previous work or sport activities at a high rate after TFCC repair, even those participating in more strenuous activities. Measurable functional outcomes of ROM and GS were also reliably restored to near preinjury levels. Patient-reported outcomes of pain and disability were similarly improved after TFCC repair. Current literature has established the long-term success of TFCC repair but is lacking in evaluation of the time points at which patients can expect functional status to be restored. [ABSTRACT FROM AUTHOR]