Clinics in Shoulder and Elbow最新文献

Background: This study compared the clinical and radiological outcomes of chronic retracted rotator cuff tears where complete footprint coverage cannot be achieved, using two treatments: footprint medialization with bone marrow stimulation and conventional incomplete repair.

Methods: This retrospective study included 87 patients who underwent arthroscopic rotator cuff repair with incomplete footprint coverage. The included patients were divided into group 1 (54 patients with footprint medialization and bone marrow stimulation) and group 2 (33 patients with conventional repair). Medialization and bone marrow stimulation were performed if the tendon did not cover a footprint of ≥1 cm2. Clinical outcomes, including a visual analog scale for pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and patient satisfaction, were evaluated preoperatively and at follow-up. Radiological healing was assessed using magnetic resonance imaging or computed tomography arthrography at 6 months and ultrasound at 2 years.

Results: Both groups showed significant improvements in clinical outcomes from preoperative levels. Group 1 demonstrated better outcomes in all measures at the final follow-up than group 2. Active range of motion improved significantly in both groups, with no significant postoperative differences. At 2 years postoperatively, group 1 had a significantly lower retear rate (14.8%) than group 2 (36.4%) (P=0.020).

Conclusions: In this study, the group that underwent footprint medialization and bone marrow stimulation for chronic retracted rotator cuff tears, in which complete footprint coverage was not possible, exhibited a lower retear rate and better clinical outcomes than the group that underwent conventional incomplete repair, with a minimum follow-up period of 2 years. Level of evidence: III.

Rotator cuff repair has experience great development, transitioning from open surgical techniques to minimally invasive arthroscopic methods. This review explores its historical development, current repair techniques, biomechanical considerations, and advances in materials and biological augmentation. It also addresses strategies for managing partial-thickness and massive tears, compares single-row and double-row repairs, and highlights the importance of individualized postoperative rehabilitation. By integrating biomechanical precision with biological innovations, modern rotator cuff repair aims to improve healing rates, reduce retear risk, and optimize functional outcomes.

Background: Reverse total shoulder arthroplasty (RTSA) has become increasingly popular in recent years, and this trend is expected to continue. However, differences in outcomes of RTSA for fractures compared with other indications are poorly understood. This study aimed to identify the compare the incidences of adverse events during RTSA to treat cuff tear arthropathy (CTA) versus RTSA to treat fractures, as well as identify risk factors for any adverse event.

Methods: Patients who underwent RTSA from 2010 to 2020 in the National Surgical Quality Improvement Program database were included. Matched cohorts were created using nearest-neighbor matching. Independent sample t-tests and chi-square tests were used to determine differences between groups, and binary logistic regression was performed to determine odds ratios and 95% CIs.

Results: In total, 27,607 CTA patients (94.5%) and 1,537 fracture patients (5.3%) underwent RTSA. Adverse events occurred in 1,088 CTA patients (3.9%) and 192 fracture patients (12.4%). Incidences of adverse events, postoperative transfusions, and returns to an operating room were all significantly higher in the fracture cohort compared with CTA patients.

Conclusions: Following surgery, higher rates of adverse events were observed in the CTA patients compared with those in the fracture cohort. These findings improve our understanding of the effectiveness of an increasingly popular surgical intervention due to the use of a large database analysis to identify short-term complications and risk factors. Level of evidence: III.

Background: Accurate pathoanatomic diagnosis of the cause of shoulder pain cannot rely solely on clinical tests. Similarly, diagnosis based on imaging results alone is not reliable due to the high prevalence of asymptomatic pathology. This study aims to assess the diagnostic accuracy of clinical testing with lidocaine injection and ultrasonography as a screening method for detecting supraspinatus disorders compared with magnetic resonance imaging (MRI).

Methods: Patients with supraspinatus-related shoulder pain were collected from outpatient clinics. Clinical tests, ultrasonography, and subacromial lidocaine injections were performed, with tests repeated post-injection. The results were confirmed with MRI findings.

Results: Of 78 patients, the average age was 58±6 years, with 76.9% being normal weight females. Moderate shoulder pain was reported by 75.6% of participants, predominantly on the dominant right side (84.6%), with a significant correlation (P<0.05). The Hawkins-Kennedy test (0.73) and Neer sign (0.68) had the best sensitivity, while the drop arm test (0.93) showed the highest specificity for tendon pathology. For full-thickness tears, the Hawkins-Kennedy and empty can test (0.76) had the best sensitivity, and the drop arm test (0.82) had the best specificity. Lidocaine injection reduced sensitivity but increased specificity, with the drop arm test reaching 0.96. Supraspinatus ultrasonography was over 90% accurate compared with MRI, with a kappa value above 0.7.

Conclusions: Subacromial lidocaine injection reduces sensitivity but increases the specificity of clinical tests for supraspinatus tendon disorders. Ultrasonography can be used as a screening tool for supraspinatus tendon abnormalities. Level of evidence: IV.

Background: Mesenchymal stem cells (MSCs) have shown potential in regenerative medicine. In the present study the effects of MSC dosage and recipient sex on tendon regeneration were evaluated.

Methods: A full-thickness tendon defect (FTTD) was created on supraspinatus tendons (SSTs) of rats and cryoprotective solution (CPS) and MSCs (0.05, 0.1 and 0.5 million MSCs [M-MSC] for female groups and 1.0 M-MSC for both female and male groups) were applied. After 2 and 4 weeks, macroscopic and histological evaluations were performed.

Results: Total macroscopic scores were improved in all MSC groups compared with the CPS group, with no significant differences among the MSC groups. Furthermore, all MSC groups had lower total degenerative scores than the CPS group; however, only 0.1 M-MSC, 0.5 M-MSC, and 1 M-MSC groups showed significantly improved hyalinization compared with the CPS group at 4 weeks. Collagen organization and coherence were higher in all MSC groups than in the CPS group at both 2 and 4 weeks; however, 0.5 M-MSC and 1 M-MSC groups scored better than the 0.05 M-MSC group at 4 weeks. Heterotopic matrix analysis revealed smaller glycosaminoglycan (GAG)-rich areas in the 0.1 M-MSC, 0.5 M-MSC, and 1 M-MSC groups compared with the CPS group at 4 weeks. Overall, macroscopic and histological evaluations were not significantly different between female and male groups except for GAG-rich area.

Conclusions: The MSC dosage affected collagen and heterotopic matrix formation in a FTTD rat model; however, the efficacy of MSCs (1.0 M dose) in collagen regeneration was not affected based on the sex of the recipient. Level of evidence: I.

Background: Although functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures are satisfactory, there is a high rate of complications. This study aims to characterize the 30-day complications, readmissions, and mortality of patients with TEA for distal humerus fractures in a large registry database.

Methods: Patients who underwent TEA for a distal humerus fracture were identified from the 2015 to 2020 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Baseline demographics, clinical characteristics, and complications including deep vein thrombosis/pulmonary embolus, infection, mortality, readmissions, and reoperations were recorded. Overall, 134 patients (mean age, 73.6 years; mean body mass index, 28.9 kg/m2 ; 88.8% females) were included.

Results: The total complication rate was 21.6% (n=29). The most common complications were unplanned readmission (6.0%), postoperative transfusion (5.2%), unplanned reoperation (3.0%), wound disruption (2.2%), and urinary tract infection (1.5%). The composite infection rate was 3.7%. There were no 30-day events of mortality, sepsis, or cerebral vascular accident. Patients 80 years or older had higher but not significant rates of unplanned readmission (10.2% vs. 3.5%, P=0.116) and reoperation (6.1% vs. 1.2%, P=0.105).

Conclusions: TEA for distal humerus fracture analyzed over 5 years had high rates of 30-day postoperative complications (21.6%), with unplanned readmission, reoperation, and infection being the most common. Level of evidence: IV.

Vitamin D deficiency is highly prevalent in the general population and is associated with various chronic health conditions. In addition to its role in bone mineralization, Vitamin D has various physiological effects that may impact the pathogenesis of shoulder pathologies. Vitamin D deficiency may also affect outcomes after shoulder surgeries, such as rotator cuff repair and total shoulder arthroplasty. Vitamin D plays a role in tissue healing, bone growth, and maintenance of homeostasis in skeletal muscle cells. Vitamin D also has anti-inflammatory effects that are important to rotator cuff health. Vitamin D deficiency is highly prevalent in patients with rotator cuff tears, suggesting its role as a potential risk factor. Vitamin D deficiency has been associated with decreased preoperative shoulder strength as well as increased re-tear rates, postoperative stiffness, and the need for revision surgery in patients who underwent rotator cuff repair. Studies have also demonstrated a potential association between vitamin D deficiency and increased risk of revision after total shoulder arthroplasty. Further research is necessary to elucidate the direct role of vitamin D in the pathogenesis of rotator cuff tears and its impact on clinical outcomes after rotator cuff surgery and total shoulder arthroplasty.

Background: Iatrogenic suprascapular nerve injury secondary to posterior drilling or screw penetration is a recognized complication of bone block or coracoid process transfers for anterior glenohumeral instability. We present the first cadaveric study that assesses the safety of posteroanterior reference guides and quantifies the relationship of the suprascapular nerve to posterior glenoid fixation with suture buttons.

Methods: Anterior glenoid bone block reconstruction with suture buttons utilizing a posteroanterior reference guide was performed in 10 fresh frozen cadavers via a posterior portal. Bullets were inserted in predefined superior and inferior guide holes via percutaneous incisions to facilitate posteroanterior drilling. Looped guide wires were used to deliver suture buttons from anterior to posterior positions. The shoulder joint was disarticulated and the infraspinatus sharply elevated until the suprascapular nerve was visualized. Four independent static measures of the shortest distance from the superior drill sleeve to the lateral aspect of the suprascapular nerve were recorded.

Results: The suprascapular nerve was not compromised utilizing the posteroanterior guide and suture button fixation technique in any specimen. The mean distance from superior sleeve tunnel to the suprascapular nerve was 5.00 mm (range, 3.25-8.00 mm) in females and 6.80 mm (range, 5.50-8.75 mm) in males. The shortest distance was 3.25 mm and the longest was 8.75 mm.

Conclusions: The use of posteroanterior reference guides for suture button fixation was not associated with iatrogenic suprascapular nerve injury in the specimens examined. However, the proximity of the suprascapular nerve underscores the need for caution. Comparative analysis with anteroposterior bone block techniques is required to establish the potential benefits of this procedure. Level of evidence: V.

Background: This retrospective observational study compared outcomes of arthroscopic rotator cuff surgery using double row anchor repair (DRR) versus transosseous anchorless repair (TAR) in patients with small to large full-thickness rotator cuff tears.

Methods: A total of 42 patients underwent DRR (n=20) or TAR (n=22) between January 2022 and May 2023. Patients were matched based on age, sex, body mass index, and tear severity. Baseline demographics, including diabetes, smoking status, and Cofield classification, were compared. Functional outcomes were assessed using University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores, along with range of motion (ROM) parameters: forward flexion, extension, internal rotation, external rotation, and abduction.

Results: Baseline characteristics were similar between groups (P>0.05). TAR showed higher UCLA scores at 3 and 6 months (P<0.001) and superior ASES scores at 3 (P=0.025) and 6 months (P<0.001) compared to DRR. By 1 year, no significant differences were observed in UCLA (P=0.101), ASES (P=0.051), or ROM parameters (P>0.05).

Conclusions: Both DRR and TAR showed comparable outcomes at 1 year. However, TAR demonstrated early functional benefits at 3 and 6 months, indicating potential advantages in the initial recovery phase. Level of evidence: III.

Background: The purpose of this study is to describe anterolateral rotatory instability (ALRI) as a possible etiology of primary osteoarthritis (OA) of the elbow.

Methods: We examined 76 fresh frozen cadaveric elbows (male:female, 56:20; mean age, 81 years) for patterns of cartilage erosion that could be due to ALRI. These included erosions on the lateral trochlear ridge (LTR) lesion, crescent rim of the radial head (RC) lesion or the ventral capitellum (VC) lesion. The extent and location of the lesions were mapped by image processing of photographs of the humeral and radial articular surfaces, and the degeneration of the articular surface was graded.

Results: Ten of 76 specimens (13%) had one or more lesions consistent with ALRI. LTR lesions were most common and were seen in 10 of 10 specimens (100%), typically involving the distal 30% of the LTR. RC lesions were seen in 9 of 10 and were located on anteromedial crescent of the radial head ranging from 6 to 10 o'clock. VC lesions were seen in 8 of 10 specimens directed anteroinferiorly about 60° to the long axis of the humerus.

Conclusions: ALRI is a possible mechanism initiating primary OA of the elbow. It has a characteristic pattern of triple lesions involving the LTR, the RC, and the VC. Level of evidence: IV.