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The clinical course and outcomes following arthroscopic frozen shoulder 360° release 关节镜下冰冻肩360°松解术的临床过程和结果

Q2 Medicine

JSES International

Pub Date : 2024-07-24 DOI: 10.1016/j.jseint.2024.07.006

Brandon Ziegenfuss BSc(Hons), MPH , Kristine Italia MD, FPOA , Kathir Azhagan Stalin MBBS , Sarah Whitehouse PhD , Ashish Gupta MBBS, MSc, FRACS, FAOrthA , Kenneth Cutbush MBBS, FRACS, FAOrthA

Background

Frozen shoulder (FS) is a debilitating inflammatory condition affecting the shoulder capsule that causes significant pain and stiffness. Its etiology, pathophysiology, and treatment remain poorly understood. Although regarded as self-limiting, FS can have profound implications on the activities of daily living and usually takes 1-4 years to resolve on its own accord. In recalcitrant or severe cases where active range of motion (AROM) is extensively restricted, an arthroscopic 360° release may be performed. The aim of this study is to evaluate the clinical outcomes following the FS 360° arthroscopic release.

Methods

An observational prospective cohort study was conducted assessing patient-reported outcome measures (PROMs) in patients who underwent the 360° arthroscopic release between July 2013 and January 2019. Various questionnaires were used to evaluate their shoulder preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively. Relevant PROMs included the Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; American Shoulder and Elbow Surgeons score; and general measures of pain intensity (visual analog scale) and well-being (EQ-5D-3L). AROM movements included forward flexion, abduction, external rotation, internal rotation, as well as external and internal rotation at 90° of abduction.

Results

Fifty consented patients underwent the arthroscopic FS 360° release. The mean age was 52.1 ± 7.7 years (range 35-72), and mean body mass index was 27.1 ± 4.7 kg/m² (range 19.5-37.5). All PROMs, AROM movements, patient satisfaction, and EQ-5D-3L scores improved significantly between preoperative and 24-month time points (P < .001). Within-participant analysis demonstrated that there was no significant difference between the pathological shoulder AROM and the contralateral (healthy) shoulder AROM (collected preoperatively) for any movement at 24 months postoperatively (all P > .05). No complications or reoperations were reported.

Conclusion

The arthroscopic 360° release is an effective and safe treatment modality for severe or recalcitrant FS. Statistically and clinically significant improvements in AROM and PROMs (Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; and American Shoulder and Elbow Surgeons score) occurred shortly after the surgery and progressively improved from 2 weeks to 24 months postoperatively, with the operative shoulder achieving similar range of motion as the nonpathological contralateral shoulder at 24 months.

背景肩周炎（FS）是一种影响肩关节囊的衰弱性炎症，会引起明显的疼痛和僵硬。人们对其病因、病理生理学和治疗方法仍然知之甚少。尽管肩周炎被认为具有自限性，但它会对日常生活产生深远影响，通常需要 1-4 年的时间才能自行缓解。对于顽固性或严重的病例，如果主动活动范围（AROM）受到广泛限制，可进行关节镜下360°松解术。本研究旨在评估FS 360°关节镜松解术后的临床疗效。方法对2013年7月至2019年1月期间接受360°关节镜松解术的患者进行观察性前瞻性队列研究，评估患者报告的疗效指标（PROMs）。研究人员使用各种问卷对患者的肩关节进行术前评估，以及术后2周、6周、3个月、6个月、12个月和24个月的评估。相关的 PROM 包括牛津肩关节评分；西安大略省肩关节不稳定性指数；手臂、肩部和手部残疾；Constant-Murley 评分；美国肩肘外科医生评分；以及疼痛强度（视觉模拟量表）和幸福感（EQ-5D-3L）的一般测量。AROM运动包括前屈、外展、外旋、内旋以及外展90°时的外旋和内旋。平均年龄为（52.1±7.7）岁（35-72岁），平均体重指数为（27.1±4.7）kg/m2（19.5-37.5）。所有 PROMs、AROM 运动、患者满意度和 EQ-5D-3L 评分在术前和 24 个月的时间点之间均有显著改善（P < .001）。参与者内部分析表明，术后24个月时，病变肩部AROM与对侧（健康）肩部AROM（术前收集）在任何运动方面均无明显差异（P均为0.05）。结论关节镜下360°松解术是治疗严重或顽固FS的一种有效而安全的方法。术后不久，AROM和PROM（牛津肩关节评分；西安大略省肩关节不稳定性指数；手臂、肩部和手部残疾；Constant-Murley评分；美国肩肘外科医生评分）就有了统计学和临床意义上的明显改善，术后2周至24个月内逐步改善，24个月时，手术肩关节的活动范围与非病理对侧肩关节相似。

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引用次数: 0

Morrey Award 2023: radial head donor plug for capitellum osteochondral autograft transfer: a cadaveric biomechanical analysis 莫雷奖 2023：用于帽状腱膜骨软骨自体移植物移植的桡骨头捐献塞：尸体生物力学分析

Q2 Medicine

JSES International

Pub Date : 2024-07-24 DOI: 10.1016/j.jseint.2024.07.007

MAJ Bryan G. Adams MD , LT Jeremy Tran MD , Steven Voinier PhD , MAJ Donald F. Colantonio MD , LTC Michael A. Donohue MD , LTC Kelly G. Kilcoyne MD , LTC Joseph W. Galvin DO

Background

Limitations to using the knee as donor cartilage include cartilage thickness mismatch and donor site morbidity. Using the radial head as donor autograft for capitellar lesions may allow for local graft harvest without distant donor site morbidity. The purpose of this study is to demonstrate the feasibility of performing local osteochondral autograft transfer from the nonarticular cartilaginous rim of the radial head to the capitellum. Additionally, we sought to determine the load to failure of the radial head after harvest.

Methods

Sixteen matched cadaveric elbows were used. A Kaplan approach was performed in half of the specimens and an extensor digitorum communis split in the other half. 6-mm and 8-mm capitellar cartilage defects were created. A donor plug was harvested from the rim of the radial head and transferred to the capitellum. In half of the specimens, the donor site was backfilled with autograft from the recipient plug. The other half was backfilled with calcium phosphate cement. The radial head was removed from the specimen and biomechanical analysis performed.

Results

Both surgical approaches had adequate exposure to access the lateral two-third capitellar lesions in all specimens. The medial third of the capitellum was less accessible in extensor digitorum communis split approaches (1/8) compared to the Kaplan approach (6/8; P = .01). The average cartilage thickness of the peripheral rim of the radial head and capitellum was 2.5 mm (range 1.8-3.2, standard deviation 0.4) and 2.2 mm (range 1.8-3, standard deviation 0.3), respectively. During the procedure, 2 of 8 radial heads fractured in the 8-mm plug group. No radial heads fractured in the 6-mm group (P = .47). Biomechanical testing demonstrated a mean load to failure of 1993N with no difference between groups when stratified by donor plug size or type of backfill.

Conclusion

This study demonstrates that the nonarticulating peripheral cartilaginous rim of the radial head could be a local harvest site for osteochondral autograft transfer for capitellar lesions up to 8 mm in diameter. The cartilage thickness of the radial head closely approximates the capitellum. Biomechanical analysis did not demonstrate a significant difference in load to fracture when backfilling the radial head harvest site with autograft bone or calcium phosphate cement. After harvest, the radial head could withstand forces much greater than those seen across the elbow when nonweight-bearing. Further investigation is needed to determine how to mitigate the risk of iatrogenic fracture with this operation.

背景使用膝关节作为供体软骨的局限性包括软骨厚度不匹配和供体部位发病率。使用桡骨头作为帽状腱膜病变的供体自体移植物可实现局部移植物采集，而不会造成远处供体部位发病。本研究的目的是证明从桡骨头非关节软骨边缘向帽状腱膜进行局部骨软骨自体移植物移植的可行性。此外，我们还试图确定采集后桡骨头的失效负荷。一半标本采用卡普兰法，另一半标本采用伸拇法。创建了 6 毫米和 8 毫米的髌骨软骨缺损。从桡骨头边缘采集供体塞，然后转移到岬部。在一半的标本中，供体部位用受体塞的自体移植物回填。另一半用磷酸钙水泥回填。从标本中取出桡骨头，并进行生物力学分析。结果在所有标本中，两种手术方法都能充分暴露于帽状腱外侧三分之二的病变部位。与Kaplan方法（6/8；P = .01）相比，伸拇肌分叉法（1/8）更难触及岬的内侧三分之一。桡骨头和瓣周缘的平均软骨厚度分别为2.5毫米（范围1.8-3.2，标准差0.4）和2.2毫米（范围1.8-3，标准差0.3）。在手术过程中，8 毫米塞子组的 8 个桡骨头中有 2 个发生骨折。而 6 毫米组没有桡骨头骨折（P = 0.47）。生物力学测试表明，失败时的平均载荷为1993N，根据供体塞大小或回填类型进行分层后，组间无差异。桡骨头的软骨厚度与帽状腱膜非常接近。生物力学分析表明，用自体骨或磷酸钙骨水泥回填桡骨头采集部位时，骨折载荷没有明显差异。取骨后，桡骨头可承受的力量远大于肘部非负重时的力量。要确定如何通过这种手术降低先天性骨折的风险，还需要进一步的研究。

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引用次数: 0

Factors associated with subjective shoulder function preoperatively and postoperatively after arthroscopic rotator cuff repair 关节镜下肩袖修复术前后肩关节主观功能的相关因素

Q2 Medicine

JSES International

Pub Date : 2024-07-23 DOI: 10.1016/j.jseint.2024.07.008

Yu Ito RPT, MSc , Tomoya Ishida RPT, PhD , Hisashi Matsumoto RPT , Shota Yamaguchi RPT , Hideki Ito RPT , Naoki Suenaga MD, PhD , Naomi Oizumi MD, PhD , Chika Yoshioka MD, PhD , Shintaro Yamane MD, PhD , Yukiyoshi Hisada MD , Tomoya Matsuhashi MD, PhD

Background

Understanding factors associated with improvements in subjective shoulder function after arthroscopic rotator cuff repair (ARCR) helps clinicians identify targets for postoperative rehabilitation. The aim of this study was to investigate the factors associated with subjective shoulder function after ARCR.

Methods

Patients who underwent ARCR for rotator cuff tear with at least 12 months of follow-up were included. Subjective shoulder function was assessed preoperatively and at 6 and 12 months postoperatively, using the Shoulder36 (Sh36) 5 domain scores (pain, range of motion [ROM], strength, activities of daily living, and general health). Stepwise multivariable regression analysis was performed to extract the relevant factors for each Sh36 domain score using active shoulder ROM, isometric shoulder and elbow strength, pain score, demographic data, intraoperative findings, medical complications, and cuff integrity.

Results

A total of 104 patients met the inclusion criteria for this study. Multivariable regression analysis identified active abduction ROM as the factor associated with 5 Sh36 domain scores at preoperatively. At 6 months postoperatively, isometric external rotation strength at the body side or 90° abduction position, but not the ROM factor, was identified as a significant associated factor with 5 Sh36 domain scores. At 12 months postoperatively, pain score was the most associated factor with pain, ROM, strength, and activities of daily living domain scores of Sh36.

Conclusion

Factors associated with subjective shoulder function after ARCR differed between the preoperative and postoperative periods. Postoperative treatment, including rehabilitation, should be modified according to the postoperative period after ARCR.

背景了解关节镜下肩袖修复术（ARCR）后肩关节主观功能改善的相关因素有助于临床医生确定术后康复的目标。本研究旨在调查与 ARCR 术后肩关节主观功能相关的因素。方法纳入因肩袖撕裂接受 ARCR 术且随访至少 12 个月的患者。采用Shoulder36（Sh36）5个领域（疼痛、活动范围[ROM]、力量、日常生活活动和一般健康）的评分对术前、术后6个月和12个月的主观肩关节功能进行评估。通过对肩关节活动度、等长肩关节和肘关节力量、疼痛评分、人口统计学数据、术中检查结果、医疗并发症和肩袖完整性进行逐步多变量回归分析，以提取 Sh36 各领域评分的相关因素。多变量回归分析发现，术前主动外展 ROM 是与 Sh36 的 5 个领域评分相关的因素。术后 6 个月时，体侧或外展 90° 位置的等长外旋力量（而非 ROM 因素）被确定为与 5 个 Sh36 领域评分显著相关的因素。术后12个月时，疼痛评分是与Sh36的疼痛、ROM、力量和日常生活活动领域评分最相关的因素。术后治疗（包括康复治疗）应根据 ARCR 术后情况进行调整。

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引用次数: 0

Can Patient-Reported Outcomes Measurement Information System estimate high-impact chronic pain after total shoulder arthroplasty? 患者报告结果测量信息系统（PROMIS）能否估算出全肩关节置换术后的高影响慢性疼痛？

Q2 Medicine

JSES International

Pub Date : 2024-07-22 DOI: 10.1016/j.jseint.2024.07.005

Katherine S. Norman PT, DPT, MS , M. Alan Brookhart PhD , Oke Anakwenze MD, MBA , Michael P. Bolognesi MD , Maggie E. Horn DPT, MPH, PhD , Adam P. Goode PT, DPT, PhD , Steven Z. George PT, PhD

Background

Identification of high-impact chronic pain (HICP) among patients receiving total shoulder arthroplasty (TSA) may allow for the design and implementation of tailored pain interventions to address the negative impact on postoperative outcomes and quality of life. This analysis sought to determine if Patient-Reported Outcome Measurement Information System (PROMIS) measures could be used to estimate HICP status following TSA.

Methods

This was a secondary analysis of a cohort of patients (n = 227) who received a TSA at a single, academic medical center, of whom 25 (11.5%) met HICP status postoperatively. Generalized linear models estimated HICP from each PROMIS measure of physical function, pain interference, sleep disturbance, anxiety, and dyspnea individually, then in a combined model. Area under the curve (AUC) was calculated using receiver operator characteristic curves to assess accuracy of each PROMIS measure to estimate HICP status for patients receiving TSA.

Results

Bivariate generalized linear models and mean difference analyses revealed individuals with HICP had worse PROMIS scores in every included domain (all P values < .01). Only pain interference (AUC = 0.964) and physical function (AUC = 0.907) PROMIS measures met criteria (AUC > 0.850) to accurately predict HICP. A pain interference score ≥58.3 and/or a physical function score ≤41.2 could be used to estimate HICP from PROMIS measures in this cohort.

Conclusion

Two PROMIS measures commonly administered in orthopedic surgery settings, physical function and pain interference, can be used to estimate HICP for patients receiving TSA. Further application and evaluation of these cutoff scores can be used to assist in refining assessment of outcomes for patients receiving TSA.

背景在接受全肩关节置换术（TSA）的患者中识别高影响慢性疼痛（HICP）可能有助于设计和实施有针对性的疼痛干预措施，以解决其对术后效果和生活质量的负面影响。本分析旨在确定患者报告结果测量信息系统（PROMIS）的测量结果是否可用于估计TSA术后的HICP状况。方法这是对在一家学术医疗中心接受TSA的一组患者（n = 227）进行的二次分析，其中25人（11.5%）术后达到了HICP状况。广义线性模型分别从身体功能、疼痛干扰、睡眠障碍、焦虑和呼吸困难的每项 PROMIS 指标中估算出 HICP，然后在综合模型中进行估算。使用接收器操作者特征曲线计算曲线下面积（AUC），以评估 PROMIS 各项指标在估计接受 TSA 患者的 HICP 状态方面的准确性。只有疼痛干扰（AUC = 0.964）和身体功能（AUC = 0.907）PROMIS 测量符合准确预测 HICP 的标准（AUC > 0.850）。在该队列中，疼痛干扰评分≥58.3和/或身体功能评分≤41.2可用于根据PROMIS测量值估算HICP。结论骨科手术中常用的两种PROMIS测量值（身体功能和疼痛干扰）可用于估算接受TSA患者的HICP。对这些截断分数的进一步应用和评估有助于完善对接受 TSA 患者的疗效评估。

{"title":"Can Patient-Reported Outcomes Measurement Information System estimate high-impact chronic pain after total shoulder arthroplasty?","authors":"Katherine S. Norman PT, DPT, MS , M. Alan Brookhart PhD , Oke Anakwenze MD, MBA , Michael P. Bolognesi MD , Maggie E. Horn DPT, MPH, PhD , Adam P. Goode PT, DPT, PhD , Steven Z. George PT, PhD","doi":"10.1016/j.jseint.2024.07.005","DOIUrl":"10.1016/j.jseint.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Identification of high-impact chronic pain (HICP) among patients receiving total shoulder arthroplasty (TSA) may allow for the design and implementation of tailored pain interventions to address the negative impact on postoperative outcomes and quality of life. This analysis sought to determine if Patient-Reported Outcome Measurement Information System (PROMIS) measures could be used to estimate HICP status following TSA.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of a cohort of patients (n = 227) who received a TSA at a single, academic medical center, of whom 25 (11.5%) met HICP status postoperatively. Generalized linear models estimated HICP from each PROMIS measure of physical function, pain interference, sleep disturbance, anxiety, and dyspnea individually, then in a combined model. Area under the curve (AUC) was calculated using receiver operator characteristic curves to assess accuracy of each PROMIS measure to estimate HICP status for patients receiving TSA.</div></div><div><h3>Results</h3><div>Bivariate generalized linear models and mean difference analyses revealed individuals with HICP had worse PROMIS scores in every included domain (all <em>P</em> values < .01). Only pain interference (AUC = 0.964) and physical function (AUC = 0.907) PROMIS measures met criteria (AUC > 0.850) to accurately predict HICP. A pain interference score ≥58.3 and/or a physical function score ≤41.2 could be used to estimate HICP from PROMIS measures in this cohort.</div></div><div><h3>Conclusion</h3><div>Two PROMIS measures commonly administered in orthopedic surgery settings, physical function and pain interference, can be used to estimate HICP for patients receiving TSA. Further application and evaluation of these cutoff scores can be used to assist in refining assessment of outcomes for patients receiving TSA.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coronoid height index: a reliable and reproducible technique for quantifying coronoid bone loss in elbow instability 冠状骨高度指数：量化肘关节不稳症患者蝶骨损失的可靠且可重复的技术

Q2 Medicine

JSES International

Pub Date : 2024-07-20 DOI: 10.1016/j.jseint.2024.07.004

Olamide Oyelade BMBS , Mithun A. Joshi MBBS (Hons), FRACS (Orth), FAOrthA , Joideep Phadnis MBChB, FRCS (Tr & Orth), PhD

Background

Coronoid fracture size is one important factor in decision-making on surgical vs. nonsurgical management. There is currently no reliable, standardized technique to measure coronoid fracture size or bone loss. Hence, decision-making remains arbitrary, and recommendations made in the literature are unreliable. The aim of the study was to develop and assess a simple, reliable computed tomography (CT)-based technique that allows measurement of apical and anteromedial facet (AMF) coronoid height and bone loss. To achieve this, we sought to understand normal coronoid height across a large patient cohort, and whether the new technique was sensitive at detecting bone loss in patients with a fracture.

Methods

163 CT scans were manually formatted in the plane of the proximal ulna. A best fit circle was drawn in the greater sigmoid notch on the sagittal section. The coronoid coverage height (CCH) was defined as the distance (in mm) measured at 90° from the greater sigmoid notch floor to a line between the olecranon and coronoid tips (or fracture base in fractured coronoids), bisecting the center of the circle. The coronoid height index (CHI) was calculated as a % by dividing the CCH by the diameter of the circle. The measurements were performed at the coronoid apex and the center of the AMF in 108 intact coronoids to understand normative values and 55 fractured coronoids to assess the sensitivity of the technique at detecting bone loss. Measurements were independently performed by two investigators, and interobserver reliability was assessed with weighted Cohen’s kappa (ĸ) and intraclass correlation coefficient.

Results

For intact coronoids, the mean CCH was 11.4 ± 1.4 mm at the apex and 11.6 ± 1.3 mm at the AMF. The mean CHI was 56.7 ± 4.9% at the apex and 41.1 ± 3.6% at the AMF. For fractured coronoids, the mean CCH and CHI were significantly lower (P < .001) at both the apical (9.7 ± 1.4 mm, 45.8% ± 6.5%) and AMF (9.8 ± 1.6 mm, 33.9% ± 6.5%) positions, confirming that the technique was capable of detecting coronoid bone loss. While the CCH (a metric measurement) was significantly higher in men than in women (P < .001), the CHI (a proportion) demonstrated no significant difference at both the apex (P = .06) and AMF (P = .91). Interobserver reliability was good to excellent across all parameters.

Conclusion

CHI is a reliable CT-based technique to assess coronoid height and bone loss that is independent of patient size and can be used for clinical and research purposes.

背景冠状突骨折的大小是决定手术与非手术治疗的一个重要因素。目前还没有一种可靠的标准化技术来测量冠状面骨折的大小或骨量损失。因此，决策仍然具有随意性，文献中的建议也不可靠。本研究旨在开发和评估一种简单、可靠的基于计算机断层扫描（CT）的技术，该技术可测量冠状面顶端和前内侧面（AMF）的高度和骨质流失情况。为此，我们试图了解大量患者群体的正常冠状面高度，以及新技术在检测骨折患者骨质流失方面是否灵敏。在矢状切面上的大乙状切迹处画一个最佳拟合圆。冠状面覆盖高度（CCH）被定义为从大乙状切迹底面到肩胛骨和冠状面尖端（或冠状面骨折时的骨折基底）之间的直线，以90°的角度测量到的距离（单位：毫米），与圆的中心成二等分。冠状面高度指数（CHI）的计算公式为：CCH 除以圆的直径。测量在 108 个完整冠状体的冠状顶和 AMF 中心进行，以了解标准值，并在 55 个骨折冠状体进行，以评估该技术检测骨质流失的灵敏度。测量由两名研究人员独立完成，并使用加权科恩卡帕（ĸ）和类内相关系数评估观察者之间的可靠性。结果对于完整的冠状体，顶点的平均 CCH 为 11.4 ± 1.4 毫米，AMF 为 11.6 ± 1.3 毫米。顶点的平均 CHI 为 56.7 ± 4.9%，AMF 为 41.1 ± 3.6%。对于骨折的冠状骨，顶点（9.7 ± 1.4 mm，45.8% ± 6.5%）和AMF（9.8 ± 1.6 mm，33.9% ± 6.5%）位置的平均CCH和CHI均显著较低（P < .001），证实该技术能够检测冠状骨缺损。虽然男性的 CCH（度量值）明显高于女性（P <.001），但 CHI（比例值）在顶点（P = .06）和 AMF（P = .91）没有明显差异。结论CHI是一种可靠的基于CT的冠状面高度和骨质流失评估技术，与患者体型无关，可用于临床和研究目的。

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引用次数: 0

Trends and predictors of reporting social determinants of health in shoulder surgery 肩部手术中报告健康社会决定因素的趋势和预测因素

Q2 Medicine

JSES International

Pub Date : 2024-07-18 DOI: 10.1016/j.jseint.2024.07.001

Aditya Joshi BS , Haley Tornberg BS , Evan Derector BS , Catherine J. Fedorka MD

Background

The role of social determinants of health (SDH) in patient outcomes, quality of life, and overall well-being has been well documented. However, the inclusion of these variables in randomized control trials (RCTs) remains limited; thus, the extent of generalizability from such trials is brought into question. The purpose of this study is to explore the rates of reporting SDH variables in RCTs focused on shoulder surgery from the past decade.

Methods

The PubMed database was searched for RCTs with a focus on shoulder surgery from 2013 to 2023. Duplicates, responses to the editor, biomechanical studies, and nonshoulder studies were excluded. Each article was reviewed and data pertaining to patient demographics and socioeconomic covariates. Journal of publication was recorded, and studies from the 5 most common journals were analyzed. These journals were the Journal of Shoulder and Elbow Surgery, the Journal of Bone and Joint Surgery, the American Journal of Sports Medicine (AJSM), the Bone and Joint Journal, and the Journal of the American Medical Association. Multivariate logistic regression was performed to determine the independent effect of study characteristics on the reporting rates of SDH.

Results

A total of 255 articles were reviewed. Of these, 93.3% and 90.2% of articles reviewed reported age and sex, respectively. Employment status was reported in 11.8% of articles. Less than 10% reported race, ethnicity, income, insurance, and housing, with even less performing formal analyses on these variables. Studies that were conducted in the United States, multicenter, had a sample size of 251+, and had a combination of public and private funding which were significantly more likely to report on race and ethnicity. Reporting employment status was significantly associated with being European-based, multicenter, sample size 251+, double-blinded, and published in AJSM. Newer studies were significantly less likely to report education. Only publication in AJSM was significant for reporting income. Study intervention and topic were not significant for any SDH reporting.

Discussion

These data reflect how small of a proportion of RCTs report and analyze on SDH variables. These findings reflect a need for future RCTs to accurately report SDH variables that influence outcomes, such as race, ethnicity, education, employment, income, housing status, and insurance. SDH are infrequently reported and analyzed in RCTs pertaining to shoulder surgery. Academic medical journals should incorporate guidelines to encourage studies to include such variables and enable the assessment of outcomes to apply to a broader population.

背景健康的社会决定因素（Social determinants of Health，SDH）在患者预后、生活质量和整体福祉方面的作用已被充分证明。然而，将这些变量纳入随机对照试验（RCT）的情况仍然有限；因此，此类试验的可推广性受到质疑。本研究旨在探讨过去十年间以肩部手术为重点的 RCT 中 SDH 变量的报告率。方法在 PubMed 数据库中搜索 2013 年至 2023 年间以肩部手术为重点的 RCT。排除了重复文章、给编辑的回复、生物力学研究和非肩部研究。对每篇文章进行审查，并收集与患者人口统计学和社会经济协变量相关的数据。对发表期刊进行记录，并对 5 种最常见期刊上的研究进行分析。这些期刊包括《肩肘外科杂志》、《骨与关节外科杂志》、《美国运动医学杂志》（AJSM）、《骨与关节杂志》和《美国医学会杂志》。为了确定研究特征对 SDH 报告率的独立影响，我们进行了多变量逻辑回归。其中，分别有 93.3% 和 90.2% 的文章报告了年龄和性别。11.8%的文章报告了就业状况。只有不到 10%的文章报告了种族、民族、收入、保险和住房情况，而对这些变量进行正式分析的文章则更少。在美国进行的、多中心的、样本量超过 251 个的、有公共和私人资金支持的研究更有可能报告种族和民族情况。报告就业状况与是否在欧洲进行、是否为多中心、样本量是否超过 251 个、是否为双盲、是否在 AJSM 上发表等因素密切相关。较新的研究报告教育程度的可能性明显较低。只有在 AJSM 上发表的研究才与报告收入有显著关系。这些数据反映了报告和分析 SDH 变量的 RCT 所占比例很小。这些发现表明，未来的 RCT 需要准确报告影响结果的 SDH 变量，如种族、民族、教育、就业、收入、住房状况和保险。在有关肩部手术的 RCT 中，很少报告和分析 SDH。医学学术期刊应纳入相关指南，鼓励研究纳入此类变量，使结果评估适用于更广泛的人群。

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引用次数: 0

Complete elbow ankylosis secondary to heterotopic ossification: operative management leads to fair to excellent long-term outcomes 继发于异位骨化的完全性肘关节强直：手术治疗可获得尚可至卓越的长期疗效

Q2 Medicine

JSES International

Pub Date : 2024-07-15 DOI: 10.1016/j.jseint.2024.06.019

Krishin Shivdasani MD MPH , Michael Scheidt MD , Stanley Liu BS , Amir Boubekri MD , Andrew Chen MD , Nickolas Garbis MD , Dane Salazar MD MBA

Background

Heterotopic ossification in the elbow, often caused by trauma or neurogenic factors, can lead to limited range of motion and physical impairment, while severe cases may result in debilitating loss of function. Complete bony ankylosis of the elbow, though rare, presents challenges in treatment due to complex anatomy and high recurrence rates, with limited literature on management and outcomes. This study retrospectively investigates cases of elbow ankylosis secondary to heterotopic ossification, assessing long-term functional outcomes following operative intervention and standardized rehabilitation.

Methods

A retrospective case series was performed on patients who underwent surgical excision of heterotopic ossification of the elbow at our institution. Outcomes of interest were intraoperative flexion-extension arc, flexion-extension arc at the final long-term postoperative follow-up, visual analog scale pain scores at long-term follow-up, and Mayo Elbow Performance scores at long-term follow-up. The Wilcoxon signed-rank test was performed to identify a statistically significant difference between arc of motion achieved intraoperatively and the arc of motion maintained at the final long-term postoperative follow-up.

Results

Between September 1999 and July 2021, 107 patients underwent operative resection for heterotopic ossification around the elbow, with 13 patients (16 elbows) exhibiting complete ankylosis at time of surgery. Patients were followed up for a minimum of 2 years. Long-term outcomes demonstrated an average visual analog scale pain score of 1.4 +/− 1.7, and an average Mayo Elbow Performance score of 85.9 +/−12.8, with 75% of cases maintaining at least 100 degrees of flexion-extension arc at the final long-term postoperative follow-up. On average, the flexion-extension arc of motion at the final follow-up was preserved at 95% of intraoperative levels. Patients did have an average residual flexion contracture of 18 +/− 9 degrees at the final follow-up.

Conclusion

Surgical excision for complete elbow ankylosis secondary to heterotopic ossification presents challenges due to potential complications. Our study shows favorable long-term outcomes in pain scores, range of motion, and Mayo Elbow Performance scores. Despite reported complications in the literature, our series exhibited no adverse events, supporting operative excision as a standard treatment with overall fair to excellent outcomes. Further research, particularly involving multicenter, randomized, prospective studies, is warranted to refine protocols and understand predictors for improved outcomes in this patient population.

背景肘部异位骨化通常由外伤或神经源性因素引起，可导致活动范围受限和肢体功能障碍，严重病例可导致功能丧失。肘部完全性骨性强直虽然罕见，但由于解剖结构复杂、复发率高，治疗面临挑战，有关治疗和结果的文献有限。本研究回顾性地调查了继发于异位骨化的肘关节强直病例，评估了手术干预和标准化康复治疗后的长期功能预后。方法对在本院接受肘关节异位骨化手术切除的患者进行回顾性病例系列研究。研究结果包括术中屈伸弧度、术后长期随访时的屈伸弧度、长期随访时的视觉模拟量表疼痛评分以及长期随访时的梅奥肘关节功能评分。结果1999年9月至2021年7月，107名患者接受了肘部异位骨化手术切除，其中13名患者（16个肘部）在手术时表现出完全强直。患者接受了至少两年的随访。长期结果显示，平均视觉模拟量表疼痛评分为1.4 +/- 1.7，平均梅奥肘关节表现评分为85.9 +/-12.8，75%的病例在术后长期随访中至少保持了100度的屈伸弧度。最后随访时，屈伸运动弧度平均保持在术中水平的95%。结论由于潜在的并发症，手术切除继发于异位骨化的完全性肘关节强直是一项挑战。我们的研究显示，在疼痛评分、活动范围和梅奥肘关节功能评分方面，长期疗效良好。尽管有文献报道了并发症，但我们的系列研究未显示任何不良事件，支持将手术切除作为一种标准治疗方法，总体疗效尚可至优秀。我们有必要开展进一步的研究，尤其是涉及多中心、随机、前瞻性研究的研究，以完善治疗方案，并了解此类患者改善疗效的预测因素。

{"title":"Complete elbow ankylosis secondary to heterotopic ossification: operative management leads to fair to excellent long-term outcomes","authors":"Krishin Shivdasani MD MPH , Michael Scheidt MD , Stanley Liu BS , Amir Boubekri MD , Andrew Chen MD , Nickolas Garbis MD , Dane Salazar MD MBA","doi":"10.1016/j.jseint.2024.06.019","DOIUrl":"10.1016/j.jseint.2024.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Heterotopic ossification in the elbow, often caused by trauma or neurogenic factors, can lead to limited range of motion and physical impairment, while severe cases may result in debilitating loss of function. Complete bony ankylosis of the elbow, though rare, presents challenges in treatment due to complex anatomy and high recurrence rates, with limited literature on management and outcomes. This study retrospectively investigates cases of elbow ankylosis secondary to heterotopic ossification, assessing long-term functional outcomes following operative intervention and standardized rehabilitation.</div></div><div><h3>Methods</h3><div>A retrospective case series was performed on patients who underwent surgical excision of heterotopic ossification of the elbow at our institution. Outcomes of interest were intraoperative flexion-extension arc, flexion-extension arc at the final long-term postoperative follow-up, visual analog scale pain scores at long-term follow-up, and Mayo Elbow Performance scores at long-term follow-up. The Wilcoxon signed-rank test was performed to identify a statistically significant difference between arc of motion achieved intraoperatively and the arc of motion maintained at the final long-term postoperative follow-up.</div></div><div><h3>Results</h3><div>Between September 1999 and July 2021, 107 patients underwent operative resection for heterotopic ossification around the elbow, with 13 patients (16 elbows) exhibiting complete ankylosis at time of surgery. Patients were followed up for a minimum of 2 years. Long-term outcomes demonstrated an average visual analog scale pain score of 1.4 +/− 1.7, and an average Mayo Elbow Performance score of 85.9 +/−12.8, with 75% of cases maintaining at least 100 degrees of flexion-extension arc at the final long-term postoperative follow-up. On average, the flexion-extension arc of motion at the final follow-up was preserved at 95% of intraoperative levels. Patients did have an average residual flexion contracture of 18 +/− 9 degrees at the final follow-up.</div></div><div><h3>Conclusion</h3><div>Surgical excision for complete elbow ankylosis secondary to heterotopic ossification presents challenges due to potential complications. Our study shows favorable long-term outcomes in pain scores, range of motion, and Mayo Elbow Performance scores. Despite reported complications in the literature, our series exhibited no adverse events, supporting operative excision as a standard treatment with overall fair to excellent outcomes. Further research, particularly involving multicenter, randomized, prospective studies, is warranted to refine protocols and understand predictors for improved outcomes in this patient population.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative Doppler flowmetry evaluation of humeral head perfusion after proximal humerus fracture 肱骨近端骨折后肱骨头灌注的术中多普勒血流测量评估

Q2 Medicine

JSES International

Pub Date : 2024-07-08 DOI: 10.1016/j.jseint.2024.06.012

Doruk Akgün MD , Alp Paksoy MD , Jan-Philipp Imiolczyk MD , Soraya Bahlawane , Henry Gebauer MD , Rony-Orijit Dey Hazra MD , Ulrich Stöckle MD , Karl Friedrich Braun MD , Philipp Moroder MD

Background

Understanding vascularity and assessing the risk of post-traumatic avascular necrosis are crucial for predicting outcomes and identifying optimal treatment options in proximal humerus fractures (PHFs). Until now, Hertel et al have been the only researchers to evaluate the intraoperative perfusion of the humeral head after fracture using Doppler flowmetry in a central single drill hole within the head. This pilot study aims to standardize the evaluation of intraoperative perfusion measurements in different areas of the humeral head in patients with PHF.

Methods

In this prospective pilot study, intraoperative semiquantitative Doppler perfusion measurements were conducted during plate osteosynthesis for PHF treatment in our institution between July 2021 and May 2022. The fracture morphology was classified radiologically according to Resch's criteria. Quality of reduction was determined postoperatively to be either anatomical, minor malreduced, or major malreduced according to Peters et al in conventional and computed tomography examinations. Medial hinge integrity and medial metaphyseal extension were assessed radiographically according to Hertel et al. Intraoperatively, after drilling screw holes through the plate, a Doppler probe was inserted through all nine drill holes on the humeral head and at least one on the humeral shaft to successively measure the presence of a pulse to indicate if perfusion is present.

Results

A total of ten patients (mean age 59 years, range, 36–83) with a humeral head fracture (2 × 2GL, 3 × 3G, 2 × 4G, 2 × 4GL, 1 × 5aG according to Resch) were included. Nine of the ten patients showed a pulse signal on the humeral shaft. Overall, pulse-synchronous perfusion was detected using Doppler sonography in at least one hole in the humeral head of all patients. In patients with an intact medial hinge (N = 6), pulse-synchronous perfusion could be measured in almost twice as many humeral head holes on average (5.7 vs. 3.0 drill holes) compared to patients with a dislocated medial hinge (N = 4). In patients with metaphyseal extension (N = 3), pulse-synchronous perfusion was measured in an average of 6.7 humeral head holes compared to 3.7 holes in patients without metaphyseal extension (N = 7).

Conclusion

Semiquantitative, intraoperative Doppler flowmetry offers a noninvasive and rapid assessment of humeral perfusion which allows an understanding of humeral head perfusion, when used in a standardized fashion to measure flow in different areas of the humeral head.

背景了解肱骨近端骨折（PHF）的血管情况和评估创伤后血管坏死的风险对于预测预后和确定最佳治疗方案至关重要。迄今为止，Hertel 等人是唯一使用多普勒血流测量仪在肱骨头中央单孔内评估骨折后肱骨头术中灌注情况的研究人员。本试验性研究旨在对 PHF 患者肱骨头不同区域的术中灌注测量进行标准化评估。方法在这项前瞻性试验性研究中，我院于 2021 年 7 月至 2022 年 5 月期间在钢板骨合成术治疗 PHF 时进行了术中半定量多普勒灌注测量。根据 Resch 标准对骨折形态进行放射学分类。术后根据彼得斯等人的常规和计算机断层扫描检查结果，确定骨折的复位质量为解剖复位、轻度复位不良或重度复位不良。术中，在钢板上钻出螺钉孔后，将多普勒探针插入肱骨头的所有九个钻孔和肱骨轴上的至少一个钻孔，连续测量是否出现脉搏，以显示是否存在灌注。结果共纳入十名肱骨头骨折患者（平均年龄 59 岁，范围 36-83）（根据 Resch 标准，2 × 2GL、3 × 3G、2 × 4G、2 × 4GL、1 × 5aG）。十名患者中有九名在肱骨轴上显示出脉冲信号。总体而言，所有患者的肱骨头至少有一个孔可以通过多普勒超声检测到脉冲同步灌注。在内侧铰链完好的患者中（N = 6），与内侧铰链脱位的患者（N = 4）相比，在肱骨头钻孔中测量到的脉冲同步灌注平均几乎是后者的两倍（5.7 个钻孔对 3.0 个钻孔）。结论术中多普勒血流测量仪可对肱骨灌注进行无创、快速的评估，通过标准化方式测量肱骨头不同区域的血流，可了解肱骨头灌注情况。

{"title":"Intraoperative Doppler flowmetry evaluation of humeral head perfusion after proximal humerus fracture","authors":"Doruk Akgün MD , Alp Paksoy MD , Jan-Philipp Imiolczyk MD , Soraya Bahlawane , Henry Gebauer MD , Rony-Orijit Dey Hazra MD , Ulrich Stöckle MD , Karl Friedrich Braun MD , Philipp Moroder MD","doi":"10.1016/j.jseint.2024.06.012","DOIUrl":"10.1016/j.jseint.2024.06.012","url":null,"abstract":"<div><h3>Background</h3><p>Understanding vascularity and assessing the risk of post-traumatic avascular necrosis are crucial for predicting outcomes and identifying optimal treatment options in proximal humerus fractures (PHFs). Until now, Hertel et al have been the only researchers to evaluate the intraoperative perfusion of the humeral head after fracture using Doppler flowmetry in a central single drill hole within the head. This pilot study aims to standardize the evaluation of intraoperative perfusion measurements in different areas of the humeral head in patients with PHF.</p></div><div><h3>Methods</h3><p>In this prospective pilot study, intraoperative semiquantitative Doppler perfusion measurements were conducted during plate osteosynthesis for PHF treatment in our institution between July 2021 and May 2022. The fracture morphology was classified radiologically according to Resch's criteria. Quality of reduction was determined postoperatively to be either anatomical, minor malreduced, or major malreduced according to Peters et al in conventional and computed tomography examinations. Medial hinge integrity and medial metaphyseal extension were assessed radiographically according to Hertel et al. Intraoperatively, after drilling screw holes through the plate, a Doppler probe was inserted through all nine drill holes on the humeral head and at least one on the humeral shaft to successively measure the presence of a pulse to indicate if perfusion is present.</p></div><div><h3>Results</h3><p>A total of ten patients (mean age 59 years, range, 36–83) with a humeral head fracture (2 × 2GL, 3 × 3G, 2 × 4G, 2 × 4GL, 1 × 5aG according to Resch) were included. Nine of the ten patients showed a pulse signal on the humeral shaft. Overall, pulse-synchronous perfusion was detected using Doppler sonography in at least one hole in the humeral head of all patients. In patients with an intact medial hinge (N = 6), pulse-synchronous perfusion could be measured in almost twice as many humeral head holes on average (5.7 vs. 3.0 drill holes) compared to patients with a dislocated medial hinge (N = 4). In patients with metaphyseal extension (N = 3), pulse-synchronous perfusion was measured in an average of 6.7 humeral head holes compared to 3.7 holes in patients without metaphyseal extension (N = 7).</p></div><div><h3>Conclusion</h3><p>Semiquantitative, intraoperative Doppler flowmetry offers a noninvasive and rapid assessment of humeral perfusion which allows an understanding of humeral head perfusion, when used in a standardized fashion to measure flow in different areas of the humeral head.</p></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666638324001609/pdfft?md5=642ef0464d31df3feb300ab7482b1b82&pid=1-s2.0-S2666638324001609-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141698862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fixation failure and early loss of reduction with the use of suture anchors for surgical repair of acromioclavicular joint dislocation: a case series 使用缝合锚手术修复肱锁关节脱位时的固定失败和早期复位损失：病例系列

Q2 Medicine

JSES International

Pub Date : 2024-07-08 DOI: 10.1016/j.jseint.2024.06.011

Erel Ben-Ari MD, Dashaun A. Ragland BS, Andrew J. Cecora BS, Mandeep S. Virk MD

Background

Suture anchors have been used in surgical repair of acromioclavicular joint (ACJ) dislocation. While some reports indicate favorable results, others emphasize less promising outcomes. This case series reports our experience with suture anchors for surgical treatment of ACJ dislocation.

Methods

Clinical and radiographic outcomes in three patients treated operatively for ACJ dislocations were reviewed. In all patients, two suture anchors were inserted in the coracoid (unicortical) and #5 nonabsorbable suture from the suture anchor was shuttled through drill holes in the clavicle and tied over two button devices. The coracoclavicular ligaments were reconstructed using a figure of eight semitendinosus allograft around the coracoid and clavicle. Postoperatively, sling immobilization was used for 6 weeks, and physical therapy was initiated at 6 weeks with contact activity allowed at 6 months.

Results

Three male patients underwent treatment for Rockwood type 3 (chronic; n = 1) and type 5 (n = 2) ACJ dislocations. Loss of reduction was noted within 6 weeks postoperatively. Two patients exhibited failure due to complete suture anchor pullout and the third patient had partial pull out of one of the anchors. Additionally, the third patient also suffered a coracoid fracture adjacent to the anchor’s placement after sustaining direct trauma to his shoulder, one-year postoperatively.

Conclusion

In our case series, we found a high rate of fixation failure and early loss of reduction with the use of suture anchors for the treatment of ACJ dislocation. These findings should be taken into consideration when selecting an appropriate implant for fixation of ACJ dislocation.

背景缝合锚已被用于肩锁关节（ACJ）脱位的手术修复。虽然一些报告显示了良好的效果，但另一些报告则强调了不太乐观的结果。本系列病例报告了我们使用缝合锚手术治疗肩锁关节脱位的经验。方法回顾了三位接受手术治疗的肩锁关节脱位患者的临床和影像学结果。在所有患者中，在冠状骨（单皮质）上插入两个缝合锚，缝合锚上的 5 号非吸收缝线通过锁骨上的钻孔穿梭并绑在两个纽扣装置上。使用围绕肩胛骨和锁骨的 "八 "字形半腱肌异体移植物重建了肩锁韧带。术后使用吊带固定 6 周，6 周后开始物理治疗，6 个月后可进行接触性活动。结果三位男性患者接受了 Rockwood 3 型（慢性；n = 1）和 5 型（n = 2）交锁关节脱位治疗。术后 6 周内发现复位丧失。两名患者因缝合锚完全脱出而导致治疗失败，第三名患者的其中一个缝合锚部分脱出。结论在我们的病例系列中，我们发现使用缝合锚治疗 ACJ 脱位的固定失败率很高，而且早期失去了复位能力。在选择合适的植入物固定前十字韧带脱位时，应考虑到这些发现。

{"title":"Fixation failure and early loss of reduction with the use of suture anchors for surgical repair of acromioclavicular joint dislocation: a case series","authors":"Erel Ben-Ari MD, Dashaun A. Ragland BS, Andrew J. Cecora BS, Mandeep S. Virk MD","doi":"10.1016/j.jseint.2024.06.011","DOIUrl":"10.1016/j.jseint.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><p>Suture anchors have been used in surgical repair of acromioclavicular joint (ACJ) dislocation. While some reports indicate favorable results, others emphasize less promising outcomes. This case series reports our experience with suture anchors for surgical treatment of ACJ dislocation.</p></div><div><h3>Methods</h3><p>Clinical and radiographic outcomes in three patients treated operatively for ACJ dislocations were reviewed. In all patients, two suture anchors were inserted in the coracoid (unicortical) and #5 nonabsorbable suture from the suture anchor was shuttled through drill holes in the clavicle and tied over two button devices. The coracoclavicular ligaments were reconstructed using a figure of eight semitendinosus allograft around the coracoid and clavicle. Postoperatively, sling immobilization was used for 6 weeks, and physical therapy was initiated at 6 weeks with contact activity allowed at 6 months.</p></div><div><h3>Results</h3><p>Three male patients underwent treatment for Rockwood type 3 (chronic; n = 1) and type 5 (n = 2) ACJ dislocations. Loss of reduction was noted within 6 weeks postoperatively. Two patients exhibited failure due to complete suture anchor pullout and the third patient had partial pull out of one of the anchors. Additionally, the third patient also suffered a coracoid fracture adjacent to the anchor’s placement after sustaining direct trauma to his shoulder, one-year postoperatively.</p></div><div><h3>Conclusion</h3><p>In our case series, we found a high rate of fixation failure and early loss of reduction with the use of suture anchors for the treatment of ACJ dislocation. These findings should be taken into consideration when selecting an appropriate implant for fixation of ACJ dislocation.</p></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666638324001592/pdfft?md5=672383b29294f41eb32e3f8e8c5642bc&pid=1-s2.0-S2666638324001592-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correlation between the optimal screening for prediction of referral and outcome yellow flag tool and patient-reported legacy outcome measures in patients undergoing shoulder surgery 肩部手术患者转诊预测和结果黄旗工具的最佳筛查与患者报告的遗留结果测量之间的相关性

Q2 Medicine

JSES International

Pub Date : 2024-07-08 DOI: 10.1016/j.jseint.2024.06.014

Billy I. Kim MD, Kevin A. Wu BS, Emily J. Luo BS, Nicholas J. Morriss MD, Grant H. Cabell MD, Trevor A. Lentz PT, PhD, MPH, Brian C. Lau MD

Background

The Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Tool is a 10-item multidimensional screening tool utilized to evaluate pain-related psychological traits in individuals with musculoskeletal pain conditions. The validity of postoperatively collected OSPRO-YF is unclear. This study sought to assess validity of the OSPRO-YF by comparing it to patient-reported outcome scores in both preoperative and postoperative settings.

Hypothesis

The authors hypothesized that OSPRO-YF overall score would correlate with shoulder and global function PROs at preoperative and postoperative timepoints.

Methods

A review of 101 patients undergoing shoulder surgery by one sports medicine orthopedic surgeon at a large academic institution was conducted. 90 and 54 patients had complete preoperative and postoperative patient-reported outcome responses. OSPRO-YF, American Shoulder and Elbow Surgeons (ASES) Evaluation Form, and Patient-Reported Outcomes Measurement Information System Computer Adaptive Test (PROMIS-CAT) were routinely administered before and after surgery at the senior author’s clinic visits. Concurrent validity of OSPRO-YF at either timepoint was assessed by comparing scores with PROs cross-sectionally using Pearson correlations and multiple comparison corrections.

Results

Preoperatively, higher OSPRO-YF total score was associated with greater concurrent PROMIS-CAT Pain Interference (r = 0.43; P < .01) and Depression (r = 0.36; P = .05) and lower ASES (r = −0.34; P < .01). Higher postoperative OSPRO-YF was also associated with greater concurrent PROMIS-CAT Pain Interference (r = 0.43; P < .01) and Depression (r = 0.36; P < .01) and lower ASES (r = −0.34; P = .01). ASES had strong correlation with Single Assessment Numeric Evaluation and Pain scores at both preoperative and postoperative timepoints. Single Assessment Numeric Evaluation was not significantly associated with OSPRO-YF total score or number of yellow flags at either timepoints.

Conclusion

The study findings support the clinical validity of the 10-item OSPRO-YF tool when administered before or after shoulder surgery. For patients exhibiting suboptimal recovery or those identified as high risk at initial screening, assessment of pain-related psychological distress postoperatively may be particularly beneficial in guiding rehabilitation.

背景转诊和结果黄旗预测最佳筛查（OSPRO-YF）工具是一种 10 个项目的多维筛查工具，用于评估肌肉骨骼疼痛患者与疼痛相关的心理特征。术后收集的 OSPRO-YF 的有效性尚不明确。本研究试图将 OSPRO-YF 与术前和术后患者报告的结果评分进行比较，以评估 OSPRO-YF 的有效性。作者假设 OSPRO-YF 总分与术前和术后时间点的肩关节和整体功能 PROs 相关。分别有 90 名和 54 名患者拥有完整的术前和术后患者报告结果。OSPRO-YF、美国肩肘外科医生（ASES）评估表和患者报告结果测量信息系统计算机适应性测试（PROMIS-CAT）在手术前后由资深作者出诊时进行常规管理。结果术前，较高的 OSPRO-YF 总分与较高的 PROMIS-CAT 疼痛干扰（r = 0.43; P < .01）和抑郁（r = 0.36; P = .05）以及较低的 ASES（r = -0.34; P < .01）相关。术后 OSPRO-YF 越高，同时 PROMIS-CAT 疼痛干扰（r = 0.43; P <.01）和抑郁（r = 0.36; P <.01）越大，ASES 越低（r = -0.34; P = .01）。在术前和术后的时间点上，ASES 与单次数值评估和疼痛评分都有很强的相关性。结论：研究结果表明，在肩关节手术前后使用 10 项 OSPRO-YF 工具具有临床有效性。对于恢复不理想的患者或初筛时被确定为高风险的患者，术后疼痛相关心理困扰的评估可能对指导康复特别有益。

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