1
|
Kim S, Deivert KT, Goodeill T, Firoved AB, Morgan CN, Worcester KS, Kim W, Bonner KF. Concomitant Biceps Tenodesis Does Not Compromise Arthroscopic Rotator Cuff Repair Outcomes. Arthroscopy 2024:S0749-8063(24)00170-1. [PMID: 38479637 DOI: 10.1016/j.arthro.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To compare outcomes of patients who underwent rotator cuff repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR. METHODS Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff arthropathy, calcific tendinitis, adhesive capsulitis requiring a capsular release, or advanced osteoarthritis of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe tenosynovitis, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed. RESULTS There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, P = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, P = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, P = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years' postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm2 vs 2.80 ± 0.32 cm2, P = .001) than the isolated RCR group. CONCLUSIONS This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears. LEVEL OF EVIDENCE Level III, retrospective case study.
Collapse
Affiliation(s)
- Samuel Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A..
| | - Kyle T Deivert
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | | | - Amanda B Firoved
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - Caleb N Morgan
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Katherine S Worcester
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - William Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin F Bonner
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.; Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| |
Collapse
|
2
|
Lavoie-Gagne O, Nukala V, Berkson EM, Asnis P, Price MD, Oh LS, Tanaka MJ. Hemoglobin A1c Levels >6.6% Are Associated With Higher Postoperative Complications After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100843. [PMID: 38283906 PMCID: PMC10819401 DOI: 10.1016/j.asmr.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/09/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To investigate the relation between hemoglobin A1c (HbA1c) levels and postoperative complications after primary anterior cruciate ligament reconstruction (ACLR). Methods A retrospective review was performed of consecutive patients with an isolated anterior cruciate ligament tear, preoperative diagnosis of diabetes, and documented HbA1c within 90 days of primary ACLR between 2000 and 2019. Data collected included demographic and surgical characteristics, 90-day medical complications, and subsequent surgeries on the ipsilateral knee. A receiver operating curve was constructed for each HbA1c level in relation to postoperative complications and the optimal cutoff identified via Youden's J statistic. Multivariable logistic regression was performed to assess the relation between postoperative complications and age, sex, graft type, diabetes subtype, and HbA1c. Results Nineteen patients (7 females, 12 males) fulfilled inclusion criteria with preoperative HbA1c ranging from 5.5 to 10. Complications included septic knee (n = 1) and cyclops lesions requiring arthroscopic lysis (n = 3). Patients with HbA1c of 6.7% or higher were 25 times more likely to experience any postoperative complication (P = .04) and 16 times more likely to require lysis of adhesions (P = .08). On multivariable regression, HbA1c remained significantly associated with any complication (P = .005) and developing arthrofibrosis (P = .02) independent of age, sex, graft type, and diabetes subtype. Conclusions Diabetic patients undergoing primary ACLR with a preoperative HbA1c of 6.7% or higher were 25 times more likely to require repeat surgical intervention for a postoperative complication. These complications included arthrofibrosis and infection. Strict glycemic control may help minimize the risk of postoperative complications after ACLR. Level of Evidence Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Ophelie Lavoie-Gagne
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Varun Nukala
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eric M. Berkson
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Peter Asnis
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mark D. Price
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Luke S. Oh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Miho J. Tanaka
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
3
|
Liu SH, Ling K, Loyst RA, Al-Humadi S, Komatsu DE, Wang ED. Preoperative thrombocytopenia and thrombocytosis predict complications after arthroscopic rotator cuff repair. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:48-52. [PMID: 38323198 PMCID: PMC10840563 DOI: 10.1016/j.xrrt.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background The purpose of this study was to investigate the association between preoperative platelet count and 30-day postoperative complications following arthroscopic rotator cuff repair (aRCR). Methods The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent aRCR between 2015 and 2021. The study population was divided into 5 groups based on preoperative platelet count: normal (200-450k, reference cohort), low-normal (150-200k), mild thrombocytopenia (100-150k), moderate-to-severe thrombocytopenia (<100k), and thrombocytosis (>450k). Thirty-day postoperative complications following aRCR were collected. Multivariate logistic regression analysis was conducted to investigate the relationship between preoperative platelet counts and postoperative complications. Results 24,779 patients were included in this study: 18,697 (75.5%) in the normal group, 4730 (19.1%) in the low-normal group, 1012 (4.1%) in the mild thrombocytopenia group, 171 (0.7%) in the moderate-to-severe thrombocytopenia group, and 169 (0.7%) in the thrombocytosis group. Low-normal platelets were an independent predictor of urinary tract infection (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.12-3.77; P = .020). Mild thrombocytopenia was not an independent predictor of any complications. Moderate-to-severe thrombocytopenia was an independent predictor of sepsis (OR 9.39, 95% CI 1.48-59.47; P = .017), pneumonia (OR 6.62, 95% CI 1.32-33.24; P = .022), and nonhome discharge (OR 3.34, 95% CI 1.20-9.25; P = .021). Thrombocytosis was an independent predictor of urinary tract infection (OR 4.91, 95% CI 1.16-20.78; P = .030). Conclusion Abnormal preoperative platelet counts, both low and high, were independent risk factors for 30-day postoperative complications following aRCR.
Collapse
Affiliation(s)
- Steven H. Liu
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Rachel A. Loyst
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Samer Al-Humadi
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
4
|
Martinel V, Zipoli B. The Zipknot Technique: A Modified Tension Band Repair Technique for Isolated Supraspinatus Tears. Arthrosc Tech 2024; 13:102820. [PMID: 38312869 PMCID: PMC10837841 DOI: 10.1016/j.eats.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/27/2023] [Indexed: 02/06/2024] Open
Abstract
Tension band repair frequently is used for small rotator cuff tears. This Technical Note describes a variation using a single knotless suture anchor but with a specific lark's head knot technique to pass the sutures through the tendon that improves bone-tendon contact and tendon healing while preventing a dog-ear deformity.
Collapse
Affiliation(s)
- Vincent Martinel
- Groupe Orthopédie Ormeau Pyrénées, ELSAN - Polyclinique de l'Ormeau, Tarbes, France
| | - Bruno Zipoli
- Service orthopédie et traumatologie, centre hospitalier de Dax, Dax, France
| |
Collapse
|
5
|
Liu SH, Patel V, Loyst RA, Lung B, Cohen D, Kashanchi K, Komatsu DE, Wang ED. Preoperative Risk Stratification in Arthroscopic Rotator Cuff Repair: Aspartate Aminotransferase-to-Platelet Ratio Index as an Estimate of Liver Dysfunction. Cureus 2023; 15:e41980. [PMID: 37593301 PMCID: PMC10427769 DOI: 10.7759/cureus.41980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) is a cost-effective and noninvasive measure of liver function, an alternative to the gold standard liver biopsy which is resource-intensive and invasive. This study investigates the association between various degrees of liver dysfunction based on APRI and 30-day postoperative complications following arthroscopic rotator cuff repair (aRCR). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent aRCR between 2015 and 2021. The study population was divided into four groups based on preoperative APRI: normal/reference (APRI ≤ 0.5), mild fibrosis (0.5 < APRI ≤ 0.7), significant fibrosis (0.7 < APRI ≤ 1), and cirrhosis (APRI > 1). Multivariate logistic regression analysis was conducted to investigate the connection between preoperative APRI and postoperative complications. RESULTS Compared to normal liver function, mild fibrosis was significantly associated with male gender, lower BMI, American Society of Anesthesiologists (ASA) classification ≥ 3, and comorbid diabetes, hypertension, chronic obstructive pulmonary disease, and bleeding disorders. Significant fibrosis was significantly associated with male gender, greater BMI, ASA classification ≥ 3, and comorbid diabetes, hypertension, and bleeding disorders. Cirrhosis was significantly associated with younger age, ASA classification ≥ 3, smokers, and comorbid diabetes and bleeding disorders. Compared to normal liver function, fibrosis was not associated with complications, significant fibrosis was associated with myocardial infarction, and cirrhosis was associated with major complications, sepsis, non-home discharge, and mortality. However, mild fibrosis, significant fibrosis, and cirrhosis were independently associated with any adverse 30-day postoperative complications following aRCR. CONCLUSION Among those with predicted liver damage based on preoperative APRI, 30-day postoperative complications following aRCR were not found to be independently associated with preoperative mild fibrosis, significant fibrosis, or cirrhosis. Our results suggest that APRI predictive of liver dysfunction may be a weaker deterrent to undergoing aRCR compared to other orthopedic surgeries.
Collapse
Affiliation(s)
- Steven H Liu
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Vaidehi Patel
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Rachel A Loyst
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Brandon Lung
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, USA
| | - Dorian Cohen
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Kevin Kashanchi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - David E Komatsu
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| | - Edward D Wang
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA
| |
Collapse
|
6
|
Hwang A, Zhang L, Ramirez G, Maloney M, Voloshin I, Thirukumaran C. Black Race, Hispanic Ethnicity, and Medicaid Insurance Are Associated With Lower Rates of Rotator Cuff Repair in New York State. Arthroscopy 2022; 38:3001-3010.e2. [PMID: 35817374 DOI: 10.1016/j.arthro.2022.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the use of operative rotator cuff repair for rotator cuff pathology in New York State and analyze the racial, ethnic, and income-based disparities in receiving rotator cuff repair. METHODS A retrospective review of the Statewide Planning and Research Cooperative System Database of New York State was conducted to include patients with a new diagnosis of rotator cuff tear between July 1, 2017, and June 30, 2019, with at least 6 months of follow-up. Bivariate analysis using χ2 tests and multivariable logistic regression models were used to determine racial, ethnic, and income-based disparities in the use of surgical treatment with rotator cuff repair. RESULTS A total of 87,660 patients were included in the study. Of these, 36,422 patients (41.5%) underwent surgical treatment with rotator cuff repair. Multivariable analysis showed that Black race (adjusted odds ratio [aOR] 0.78; 95% confidence interval [CI] 0.69-0.87; P < .001), Hispanic/Latino ethnicity (aOR 0.91; 95% CI 0.85-0.97); P = .004), and Medicaid (aOR 0.75; 95% CI 0.70-0.80; P < .001), or other government insurance (aOR 0.82; 95% CI 0.78-0.86; P < .001) were independently associated with lower rates of rotator cuff repair. Male sex (aOR 1.18; 95% CI 1.14-1.22; P < .001), Asian race (aOR 1.27; 95% CI 1.00-1.62; P = .048), workers' compensation insurance (aOR 1.12; 95% CI 1.07-1.18; P < .001), and greater home ZIP code income quartile (aOR 1.19; 95% CI 1.09-1.30; P < .001) were independently associated with greater rates of operative management. Although race was an independent covariate affecting rate of rotator cuff repair, the effects of race were altered when accounting for the other covariates, suggesting that race alone does not account for the differences in rate of surgery for rotator cuff pathology. CONCLUSIONS In this analysis of all adult patients presenting with rotator cuff tears to New York hospital systems from 2017 to 2019, we identified significant racial, ethnic, and socioeconomic disparities in the likelihood of rotator cuff repair surgery for patients with rotator cuff tears. These include lower rates of rotator cuff repair for those Black, Hispanic, and low-income populations as represented by Medicaid insurance and low home ZIP code income quartile. CLINICAL RELEVANCE This study reports disparities in the use of rotator cuff repair for individuals with rotator cuff pathology.
Collapse
Affiliation(s)
- Alan Hwang
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A..
| | - Linda Zhang
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Gabriel Ramirez
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Michael Maloney
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Ilya Voloshin
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Caroline Thirukumaran
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| |
Collapse
|