1
|
Min KS. Response to Sahu et al: A type II error likely exists due to the low sample size. J Shoulder Elbow Surg 2024:S1058-2746(24)00485-3. [PMID: 39038696 DOI: 10.1016/j.jse.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
| |
Collapse
|
2
|
Green CK, Scanaliato JP, Sandler AB, Patrick CM, Dunn JC, Parnes N. Outcomes of Concomitant Glenohumeral Stabilization After Arthroscopic Rotator Cuff Repair in Military Patients Younger Than 40 Years. Orthop J Sports Med 2024; 12:23259671231218970. [PMID: 38435718 PMCID: PMC10906051 DOI: 10.1177/23259671231218970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 03/05/2024] Open
Abstract
Background While concomitant rotator cuff and inferior labral tears are relatively uncommon in young civilians, military populations represent a unique opportunity to study this injury pattern. Purpose To (1) evaluate the long-term outcomes after combined arthroscopic rotator cuff and inferior labral repair in military patients <40 years and (2) compare functional outcomes with those after isolated arthroscopic rotator cuff repair. Study Design Cohort study; Level of evidence, 3. Methods Military patients who underwent arthroscopic rotator cuff repair between January 2011 and December 2016 and had a minimum of 5-year follow-up data were included in this study. The patients were categorized into those who had undergone combined arthroscopic rotator cuff and inferior labral repair (RCIL cohort) and those who had isolated arthroscopic rotator cuff repair (ARCR cohort). Pre- and postoperative outcome measures-visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, Rowe Instability Score, and range of motion-were compared between the groups. Results A total of 50 shoulders (27 in the RCIL cohort and 23 in the ARCR cohort) were assessed. The RCIL and ARCR groups were similar in terms of age (mean, 33.19 years [range, 21-39 years] vs 35.39 years [range, 26-39 years], respectively) and sex (% male, 88.46% vs 82.61%, respectively). All patients were active-duty military at the time of surgery. The mean final follow-up was at 106.93 ± 16.66 months for the RCIL group and 105.70 ± 7.52 months for the ARCR group (P = .75). There were no differences in preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all), and there were no significant group differences in any final postoperative outcome measures. At the final follow-up, 26 (96.30%) patients in the RCIL cohort and 20 (86.96%) in the ARCR cohort had returned to unrestricted active-duty military service (P = .3223). Conclusion The study findings indicate that concomitant glenohumeral stabilization does not prevent worse outcomes after arthroscopic rotator cuff repair in this military cohort. Combined repair produced statistically and clinically significant improvements in outcome scores at the long-term follow-up, indicating that simultaneous repair of combined lesions was an appropriate treatment option in this patient population.
Collapse
Affiliation(s)
- Clare K Green
- The George Washington University, School of Medicine and Health Services, Washington, District of Columbia, USA
| | - John P Scanaliato
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois, USA
| | - Alexis B Sandler
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery, El Paso, Texas, USA
| | - Cole M Patrick
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery, El Paso, Texas, USA
| | - John C Dunn
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital/Claxton-Hepburn Medical Center, Department of Orthopaedic Surgery, Carthage, New York, USA
| |
Collapse
|
3
|
Long B, Bridwell RE, Gottlieb M. Analgesic Techniques for Managing Orthopedic Injuries: A Review for the Emergency Clinician. J Emerg Med 2024; 66:211-220. [PMID: 38278679 DOI: 10.1016/j.jemermed.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/11/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Orthopedic injuries are commonly managed in the emergency department (ED) setting. Fractures and dislocations may require reduction for proper management. There are a variety of analgesic and sedative strategies to provide patient comfort during reduction. OBJECTIVE This narrative review evaluates hematoma block, intra-articular injection, intravenous regional analgesia (IVRA) (also known as the Bier block), and periosteal block for orthopedic analgesia in the ED setting. DISCUSSION Analgesia is an essential component of management of orthopedic injuries, particularly when reduction is necessary. Options in the ED setting include hematoma blocks, intra-articular injections, IVRA, and periosteal blocks, which provide adequate analgesia without procedural sedation or opioid administration. When used in isolation, these analgesic techniques decrease complications from sedation and the need for other medications, such as opioids, while decreasing ED length of stay. Emergency clinicians can also use these techniques as analgesic adjuncts. However, training in these techniques is recommended prior to routine use, particularly with IVRA. CONCLUSIONS Knowledge of analgesic techniques for orthopedic procedures can assist clinicians in optimizing patient care.
Collapse
Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
4
|
Green CK, Scanaliato JP, Sandler AB, Patrick CM, Dunn JC, Parnes N. Concomitant Biceps Tenodesis Does Not Portend Inferior Outcomes After Anterior Glenohumeral Stabilization. Am J Sports Med 2023; 51:3851-3857. [PMID: 37975490 DOI: 10.1177/03635465231209731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Military patients are known to suffer disproportionately high rates of glenohumeral instability as well as superior labrum anterior to posterior (SLAP) tears. Additionally, a concomitant SLAP tear is frequently observed in patients with anterior shoulder instability. Even though biceps tenodesis has been demonstrated to produce superior outcomes to SLAP repair in military patients with isolated SLAP lesions, no existing studies have reported on outcomes after simultaneous tenodesis and anterior labral repair in patients with co-existing abnormalities. PURPOSE To evaluate outcomes after simultaneous arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair in military patients younger than 40 years. We also sought to compare these outcomes with those after repair of an isolated anterior labral tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study is a retrospective analysis of all military patients younger than 40 years from a single base who underwent arthroscopic anterior glenohumeral stabilization with or without concomitant biceps tenodesis between January 2010 and December 2019. Patients with glenoid bone loss of >13.5% were not eligible for inclusion. Outcome measures including the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were administered preoperatively and postoperatively, and scores were compared between groups. RESULTS A total of 82 patients met inclusion criteria for the study. All patients were active-duty service members at the time of surgery. The mean follow-up was 87.75 ± 27.05 months in the repair + tenodesis group and 94.07 ± 28.72 months in the isolated repair group (P = .3085). Patients who underwent repair + tenodesis had significantly worse preoperative VAS pain (6.85 ± 1.86 vs 5.02 ± 2.07, respectively; P < .001), ASES (51.78 ± 11.89 vs 62.43 ± 12.35, respectively; P = .0002), and Rowe (26.75 ± 7.81 vs 37.26 ± 14.91, respectively; P = .0002) scores than patients who underwent isolated repair. Both groups experienced significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no statistically significant differences in postoperative outcome scores or range of motion between groups. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the VAS pain, SANE, ASES, and Rowe scores between groups. Overall, 37 of the 40 (92.50%) patients in the repair + tenodesis group and 40 of the 42 (95.24%) patients in the isolated repair group returned to unrestricted active-duty military service (P = .6045). In addition, 38 (95.00%) patients in the repair + tenodesis group and 40 (95.24%) patients in the isolated repair group returned to preinjury levels of sporting activity (P = .9600). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between groups (P = .9421, P = .9400, and P = .6045, respectively). CONCLUSION The findings of this study indicate that simultaneous biceps tenodesis and labral repair was a viable treatment option for the management of concomitant SLAP and anterior labral lesions in young, active military patients younger than 40 years.
Collapse
Affiliation(s)
- Clare K Green
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - John P Scanaliato
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Alexis B Sandler
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Cole M Patrick
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John C Dunn
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
5
|
Bond EC, Florance J, Dickens JF, Taylor DC. Review of Burkhart and DeBeer's (2000) article on traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repair: Where have we taken the concept of glenoid bone loss in 2023? J ISAKOS 2023; 8:467-473. [PMID: 37673126 DOI: 10.1016/j.jisako.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
This classic discusses the original publication by Burkhart and DeBeer "Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repair" published in 2000 in Arthroscopy. At that time, the authors sought to understand the reasons behind the failure of arthroscopic soft tissue repair. Based on their findings, the authors introduced the concept of the inverted pear glenoid and engaging Hill-Sachs lesion which is now part of the orthopedic lexicon. The importance of bony pathologic changes in anterior glenohumeral instability has become so apparent, that it now forms the basis of clinical understanding and underpins treatment algorithms. Since this publication over 20 years ago, the idea of glenohumeral bone loss has been extensively explored and refined. There is no doubt of the importance of structural bone loss yet there is still uncertainty as to the best management of those with subcritical bone loss. The purpose of revisiting this classic article is to look at where we are in understanding recurrent instability and bony deficiency while appreciating how far we have come. This review begins with a detailed summary of the classic article along with a historic perspective. Next, we look at the current evidence as it pertains to the classic article and how modern technology and innovation has advanced our ability to assess and quantify glenohumeral bone loss. We finish with expert commentary on the topic from two current surgeons with a research interest in shoulder instability to offer an insight into how modern surgeons view and address this issue. One of the original authors also reflects on the topic. The findings of this classic study changed the way we think about shoulder instability and opened the doors to an exciting body of research that is still growing today. Future research offers an opportunity for high quality evidence to guide management in the group of patients with subcritical bone loss and we eagerly await the results.
Collapse
Affiliation(s)
- Elizabeth C Bond
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathon Florance
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathan F Dickens
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Dean C Taylor
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| |
Collapse
|
6
|
Green CK, Scanaliato JP, Turner RC, Sandler AB, Dunn JC, Parnes N. Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients. Orthop J Sports Med 2023; 11:23259671231181906. [PMID: 37435424 PMCID: PMC10331190 DOI: 10.1177/23259671231181906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background US military servicemembers experience higher rates of posterior and combined-type instability as compared with their nonmilitary peers. Purpose (1) To determine the prevalence of glenoid bone loss (GBL) in young, active-duty military patients with combined-type shoulder instability who underwent operative shoulder stabilization; (2) to evaluate whether GBL is associated with differences in postoperative outcomes; and (3) to identify factors associated with larger defects. Study Design Case series; Level of evidence, 4. Methods This study included active-duty military patients who underwent primary surgical shoulder stabilization for combined anterior and posterior capsulolabral tears between January 2012 and December 2018. Preoperative magnetic resonance arthrograms were used to calculate anterior, posterior, and total GBL using the "perfect circle" technique. We recorded patient characteristics, revisions, complications, return to duty, range of motion, and scores on multiple outcome measures (visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Rowe). GBL prevalence was compared by time to surgery, glenoid version, history of trauma, and number of anchors used for labral repair. Outcome scores, return to active duty, and revision procedures were compared by degree of anterior or posterior GBL: <13.5% (mild) versus ≥13.5% (subcritical). Results GBL was noted in 28 (77.8%) of the 36 patients. Nineteen (52.8%) patients had anterior GBL, 18 (50.0%) had posterior, and 9 (25.0%) had combined. Four (11.1%) patients had subcritical anterior or posterior GBL. Increased posterior GBL was associated with history of trauma (P = .041), time to surgery >12 months (P = .024), and glenoid retroversion ≥9° (P = .010); increased total GBL was associated with longer time to surgery (P = .023) and labral repair requiring >4 anchors (P = .012); and increased anterior GBL was associated with labral repair requiring >4 anchors (P = .011). There were statistically significant improvements on all outcome measures, with no changes in range of motion postoperatively. No significant difference on any outcome score was observed between patients with mild and subcritical GBL. Conclusion In our analysis, 78% of patients had appreciable GBL, suggesting that GBL is highly prevalent in this patient population. Longer time to surgery, traumatic cause, significant glenoid retroversion, and large labral tears were identified as risk factors for increased GBL.
Collapse
Affiliation(s)
- Clare K. Green
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert C. Turner
- Department of Orthopaedic Surgery, Fort Drum, Fort Drum, New York, USA
| | - Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
7
|
Green CK, Scanaliato JP, Sandler AB, Jones EW, Dunn JC, Parnes N. Diagnosis of Posterior and Combined-Type Shoulder Instability: A 10-Year Cross-sectional Study From a Single Military Base. Orthop J Sports Med 2023; 11:23259671231168878. [PMID: 37435422 PMCID: PMC10331199 DOI: 10.1177/23259671231168878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background Large variations exist in the reported frequency and etiology of posterior and combined shoulder instability in the active-duty military population. Purpose To compare imaging and clinical examination findings as well as reoperation rates between active-duty military patients who underwent surgery for anterior, posterior, and combined-type shoulder instability. Study Design Cross-sectional study; Level of evidence, 3. Methods A retrospective review was conducted on patients treated surgically for shoulder instability from a single military base from January 2010 to December 2019. Each case was characterized as isolated anterior, isolated posterior, or combined, according to arthroscopic findings. Information was collected on patient characteristics, history of trauma, time to surgery, associated pathological findings, and survivorship at a minimum 2-year follow-up. Results Overall, 416 patients (n = 394 men; n = 22 women), with a mean age of 29.1 years, underwent primary shoulder stabilization surgery during the study period. There were 158 patients (38%) with isolated anterior instability, 139 (33%) with isolated posterior instability, and 119 (29%) with combined instability. A history of trauma was more prevalent with isolated anterior instability (129 [81.7%]) than with either isolated posterior (95 [68.4%]) or combined instability (73 [61.3%]) (P = .047 and P = .001, respectively). Patients with anterior instability were significantly more likely to be diagnosed on the preoperative physical examination when compared with patients with posterior instability (93% vs 79.1%; P < .001) or combined instability (93% vs 75.6%; P < .001) and were also more likely to have a discrete labral tear detected on a preoperative magnetic resonance arthrogram than patients with posterior instability (82.9% vs 63.3%; P < .001). There was no significant difference in the rate of medical discharge or recurrent instability requiring reoperation between groups. Conclusion The study findings indicated that young, active-duty military patients are at increased risk for isolated posterior and combined-type shoulder instability, with posterior and combined instability collectively accounting for over 60% of instability cases in this cohort. Orthopaedic surgeons should be aware of instability when evaluating and treating young, active-duty military patients with shoulder pain, even in the absence of diagnostic physical examinations or imaging findings.
Collapse
Affiliation(s)
- Clare K. Green
- The George Washington University, Washington, District of Columbia, USA
| | - John P. Scanaliato
- William Beaumont Army Medical Center, El Paso, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B. Sandler
- William Beaumont Army Medical Center, El Paso, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Ethan W. Jones
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - John C. Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
8
|
Green CK, Scanaliato JP, Sandler AB, Czajkowski H, Rolf RH, Dunn JC, Parnes N. Midterm Outcomes Following Combined Biceps Tenodesis and Anterior Labral Repair in Active Duty Military Patients Younger than 35 Years. Am J Sports Med 2023:3635465231169238. [PMID: 37196664 DOI: 10.1177/03635465231169238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Superior labrum anterior-posterior (SLAP) lesions and anterior instability are common causes of shoulder pain and dysfunction among active-duty members of the United States military. However, little data have been published regarding the surgical management of type V SLAP lesions. PURPOSE To compare the outcomes of arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair with those of arthroscopic SLAP repair (defined as contiguous repair spanning from the superior labrum to the anteroinferior labrum) for type V SLAP tears in active-duty military patients younger than 35 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All consecutive patients from January 2010 to December 2015 who underwent arthroscopic SLAP repair or combined biceps tenodesis and anterior labral repair for a type V SLAP lesion with a minimum 5-year follow-up were identified. The decision to perform type V SLAP repair versus combined biceps tenodesis and anterior labral repair was based on the condition of the long head of the biceps tendon (LHBT). Labral repair was performed in patients who had a type V SLAP tear with an otherwise clinically and anatomically healthy LHBT. Combined tenodesis and repair was performed in patients with evidence of LHBT abnormalities. Outcomes including the visual analog scale (VAS) score, the Single Assessment Numeric Evaluation (SANE) score, the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were collected preoperatively and postoperatively, and scores were compared between the groups. RESULTS A total of 84 patients met the inclusion criteria for the study. All patients were active-duty service members at the time of surgery. A total of 44 patients underwent arthroscopic type V SLAP repair, and 40 patients underwent anterior labral repair with biceps tenodesis. The mean follow-up was 102.59 ± 20.98 months in the repair group and 94.50 ± 27.11 months in the tenodesis group (P = .1281). There were no significant differences in preoperative range of motion or outcome scores between the groups. Both groups experienced statistically significant improvements in outcome scores postoperatively (P < .0001 for all); however, compared with the repair group, the tenodesis group reported significantly better postoperative VAS (2.52 ± 2.36 vs 1.50 ± 1.91, respectively; P = .0328), SANE (86.82 ± 11.00 vs 93.43 ± 8.81, respectively; P = .0034), and ASES (83.32 ± 15.31 vs 89.90 ± 13.31, respectively; P = .0394) scores. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the SANE and ASES between the groups. Overall, 34 patients in each group returned to preinjury levels of work (77.3% vs 85.0%, respectively; P = .3677), and 32 patients (72.7%) in the repair group and 33 patients (82.5%) in the tenodesis group returned to preinjury levels of sporting activity (P = .2850). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between the groups (P = .0923, P = .1602, and P = .2919, respectively). CONCLUSION Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions. The results of this study suggest that biceps tenodesis combined with anterior labral repair produces comparable outcomes to arthroscopic type V SLAP repair in active-duty military patients younger than 35 years.
Collapse
Affiliation(s)
- Clare K Green
- The George Washington University, Washington, District of Columbia, USA
| | - John P Scanaliato
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B Sandler
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Hunter Czajkowski
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - Robert H Rolf
- Beacon Orthopaedics & Sports Medicine, Cincinnati, Ohio, USA
- TriHealth, Cincinnati, Ohio, USA
| | - John C Dunn
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
9
|
Green CK, Scanaliato JP, Sandler AB, Dunn JC, Covillon E, Parnes N. Simultaneous Arthroscopic Glenohumeral Stabilization and Glenoid Microfracture in Young, Active-Duty Military Patients: Outcomes at 5-Year Follow-up. Orthop J Sports Med 2023; 11:23259671221146170. [PMID: 36756169 PMCID: PMC9900666 DOI: 10.1177/23259671221146170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
Background Glenohumeral instability represents a common cause of shoulder pain and disability among active-duty members of the military and is associated with the development of glenoid osteochondral defects. Purpose To report clinical outcomes and survivorship after combined microfracture of isolated chondral lesions of the glenoid and labral repair among young, active-duty military patients and to compare outcomes with those of patients who underwent isolated shoulder stabilization. Study Design Cohort study; Level of evidence, 3. Methods Included were 31 active-duty military patients aged <40 years who underwent simultaneous microfracture of chondral lesions of the glenoid and labral repair for shoulder instability between January 2011 and January 2017 (microfracture group) and 209 patients without chondral defects who underwent shoulder stabilization during the same time period (instability group). Preoperative and 5-year postoperative outcomes (range of motion [ROM], visual analog scale [VAS] for pain, Single Assessment Numeric Evaluation [SANE] score, American Shoulder and Elbow Surgeons [ASES] shoulder score, and Rowe instability score) were compared within and between groups, and separate subgroup analyses were performed to determine whether variant of instability and dominant-shoulder involvement were associated with worse outcomes. Results The mean follow-up was significantly longer for the microfracture group versus the instability group (95.58 ± 23.12 vs 83.38 ± 25.93 months; P = .014). Age and sex distributions were similar between groups. In both groups, there was significant pre- to postoperative improvement on all outcomes scores (P = .0001 for all). When compared with the instability cohort, microfracture patients had significantly worse postoperative VAS pain (2.65 ± 1.78 vs 1.55 ± 1.92; P = .003), SANE (79.13 ± 14.43 vs 91.23 ± 13.20; P < .0001), and ASES (79.90 ± 13.87 vs 89.03 ± 14.28; P = .001) scores, as well as decreased ROM in forward flexion (151.29° ± 11.76° vs 155.48° ± 10.3°; P = .039) and external rotation (63.65° ± 8.34° vs 65.17° ± 0.64°; P = .010). At latest follow-up, 58% of microfracture patients had returned to active-duty military service compared with 93.78% of isolated instability patients (P < .0001). Conclusion Combined microfracture and arthroscopic labral repair produced modest, albeit statistically significant, improvements in patient-reported outcome measures and may be a reasonable treatment option for patients with chondral lesions who are not candidates for arthroplasty. However, microfracture patients had significantly worse outcomes than patients who underwent stabilization without concomitant chondral defects.
Collapse
Affiliation(s)
- Clare K. Green
- George Washington University School of Medicine, Washington DC,
USA.,Clare K. Green, BS, George Washington University School of
Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052, USA
()
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical
Center, El Paso, Texas, USA.,Department of Orthopaedic Surgery, Texas Tech University Health
Sciences Center, El Paso, Texas, USA
| | - Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical
Center, El Paso, Texas, USA.,Department of Orthopaedic Surgery, Texas Tech University Health
Sciences Center, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical
Center, El Paso, Texas, USA.,Department of Orthopaedic Surgery, Texas Tech University Health
Sciences Center, El Paso, Texas, USA
| | - Emma Covillon
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage,
New York, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage,
New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
10
|
Scanaliato JP, Sandler AB, Baird MD, Dunn JC, Uhlinger J, Parnes N. Glenoid microfracture in active-duty military patients: minimum 5-year follow-up demonstrates 75% survival. JSES Int 2022; 7:86-92. [PMID: 36820416 PMCID: PMC9937841 DOI: 10.1016/j.jseint.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background To present midterm patient-reported outcomes and survivorship data of active-duty military patients undergoing microfracture for full-thickness cartilage defects of the glenoid. Methods All consecutive patients from January 2013 through December 2016 who underwent glenoid microfracture for full-thickness cartilage injuries with complete outcome scores were identified. Twenty patients met the final inclusion criteria for the study, and all were active-duty military at the time of surgery. A separate subgroup analysis was performed to determine if dominant-shoulder involvement portends worse outcomes. Results The mean follow-up was 81.45 ± 19.43 months (range, 60-108). Of the 20 patients, 5 required a secondary surgical procedure within 5 years of their index procedure, with an average time to failure of 45.6 ± 13.15 months. For the 15 patients who did not fail, there was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (57.20 vs. 88.27, P < .0001) and Single Assessment Numeric Evaluation (45.00 vs. 86.33, P < .0001). Mean pain decreased significantly as measured by the pain visual analog scale (5.40 vs. 1.37, P < .0001). Range of motion in forward elevation, external rotation, and internal rotation did not change significantly postoperatively (P = .4528, .4810, and .1919, respectively). Concomitant procedures did not predict changes in pain, American Shoulder and Elbow Surgeons, or Single Assessment Numeric Evaluation scores. A majority of patients (13/20, 65%) were able to remain on unrestricted military active-duty service, but 7 (35%) underwent medical discharge, including the 5 patients who had experienced treatment failure, plus 2 additional patients. Conclusion Glenoid microfracture can result in pain relief and symptomatic improvement for a select group of active-duty military patients, with 75% survivorship at 5 years. Approximately one in three (35%) patients, however, were unable to remain on active-duty military service.
Collapse
Affiliation(s)
- John P. Scanaliato
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, TX, USA
- Corresponding author: John P Scanaliato, MD, William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 18511 Highlander Medics Street, Fort Bliss, TX 79918, USA.
| | - Alexis B. Sandler
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, TX, USA
| | - Michael D. Baird
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, MD, USA
| | - John C. Dunn
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, TX, USA
| | - Jason Uhlinger
- Carthage Area Hospital, Department of Orthopaedic Surgery, Carthage, NY, USA
| | - Nata Parnes
- Carthage Area Hospital, Department of Orthopaedic Surgery, Carthage, NY, USA
- Claxton-Hepburn Medical Center, Department of Orthopaedic Surgery, Ogdensburg, NY, USA
| |
Collapse
|
11
|
Scanaliato JP, Childs BR, Dunn JC, Czajkowski H, Parnes N. Arthroscopic Posterior Labral Repair in Active-Duty Military Patients: A Reliable Solution for an At-Risk Population, Regardless of Anchor Type. Am J Sports Med 2022; 50:3036-3044. [PMID: 35983962 DOI: 10.1177/03635465221111568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Active-duty servicemembers are a population at risk for the development of posterior shoulder instability. While short-term outcomes after arthroscopic posterior labral repair for posterior shoulder instability are promising, there is a paucity of longer term follow-up data for this procedure. PURPOSES The primary purpose was to report midterm outcomes after arthroscopic posterior labral repair in active-duty military patients for posterior shoulder instability without bone loss. The secondary purpose was to determine if outcomes varied between anchor types used. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Preoperative and postoperative outcomes, with a minimum 3-year follow-up, for a visual analog scale for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) score, and the Rowe score were collected and analyzed. A separate subgroup analysis was performed comparing the outcomes of patients who underwent repair with biocomposite anchors versus those who underwent repair with all-suture anchors. RESULTS A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months met the inclusion criteria and were available for analysis. As a whole, the cohort demonstrated statistically and clinically significant improvements in outcome scores at final follow-up. Preoperative and postoperative range of motion did not vary significantly. While the difference in final outcome scores between the 2 anchor types did not reach statistical significance, a statistically significantly larger proportion of patients who underwent repair with all-suture anchors versus those who underwent repair with biocomposite anchors met the Patient Acceptable Symptom State for the SANE (97.14% vs 78.95%, respectively; P = .0180) and the ASES score (88.57% vs 68.42%, respectively; P = .0171). The proportion of patients who achieved the substantial clinical benefit or surpassed the minimal clinically important difference, however, did not vary by anchor type. Overall, 70 patients (95.89%) remained on active duty and were able to return to preinjury work and recreational activity levels. There were 3 patients (4.11%) who had recurrent posterior instability. CONCLUSION This population of active-duty servicemembers undergoing posterior labral repair for posterior labral instability without bone loss demonstrated a statistically and clinically significant improvement in midterm outcomes, a low recurrence rate, and a rate of return to active duty of 95.89%, regardless of the anchor type used.
Collapse
Affiliation(s)
| | | | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
12
|
Biceps Tenodesis Combined With Arthroscopic Posterior Labral Repair for Type VIII SLAP Lesions in Active-Duty Military Patients Yields Excellent Return to Military Duty. Arthroscopy 2022; 38:2620-2627. [PMID: 35367303 DOI: 10.1016/j.arthro.2022.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To report short-term outcomes following biceps tenodesis combined with arthroscopic posterior labral repair of type VIII SLAP lesions in active-duty military patients. METHODS All consecutive patients from January 2012 through December 2018 who underwent biceps tenodesis combined with arthroscopic posterior labral repair of type VIII SLAP tears performed by the senior surgeon with complete outcome scores and minimum 2.5 years follow-up were identified. Exclusion criteria included concomitant glenoid microfracture, rotator cuff repair, or other capsulolabral repair. Outcome measures were completed by patients within 7 days before surgery and at latest follow-up. Biceps tenodesis performed was a mini-open, through a subpectoral approach, using a double-loaded 2.9mm suture-anchor. RESULTS Thirty-two patients met the inclusion criteria for the study. All patients were active-duty military at time of surgery. Average follow-up was 73.53 ± 22.37 months. Thirty-one patients achieved the minimal clinically important difference, 30 of 32 reached the substantial clinical benefit, and 31 of 32 met the patient acceptable symptomatic state, as defined for the American Shoulder and Elbow Surgeons Shoulder Score. Similarly, 30 of 32 patients reached the minimal clinically important difference, 29 of 32 achieved the substantial clinical benefit, and 32 of 32 met the patient acceptable symptomatic state for the Single Assessment Numeric Evaluation. There were no significant changes in forward flexion, external rotation, or internal rotation between pre- and postoperative measurements. Three patients reported postoperative complications and 1 patient progressed to further surgery. Thirty (93.75%) patients remained on active-duty military service and were able to return to preinjury levels of activity. CONCLUSIONS Active-duty military patients with type VIII SLAP tears had statistically and clinically significant increases in outcome scores, marked improvement in pain, and high rates of return to unrestricted active-duty following mini-open subpectoral biceps tenodesis combined with posterior labral repair. LEVEL OF EVIDENCE IV, retrospective case series.
Collapse
|
13
|
Scanaliato JP, Eckhoff MD, Dunn JC, Czajkowski H, Fink WA, Parnes N. Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40 Years. Am J Sports Med 2022; 50:2753-2760. [PMID: 35862618 DOI: 10.1177/03635465221107371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair is an effective procedure through which to decrease pain and increase strength, with favorable long-term outcomes demonstrated in older patient populations with full-thickness rotator cuff tears. The long-term outcomes after this procedure in younger, higher-demand patients, however, is not as clearly defined. PURPOSE To report on the long-term outcomes after arthroscopic rotator cuff repair of traumatic full-thickness rotator cuff tears in active duty military patients under the age of 40 years at the time of surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS Preoperative, midterm, and final evaluations were collected, including scores on the visual analog scale for pain, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons shoulder form. A total of 42 patients were screened for inclusion: 3 underwent additional surgical procedures on the operative shoulder and 2 were lost to follow-up, leaving 37 patients with mean follow-up of 104.51 months available for analysis. A subgroup analysis was performed comparing outcomes between patients with Southern California Orthopaedic Institute grade 1 or 2 tears and those with grade 3 or 4 tears. RESULTS At final follow-up, pain per the visual analog scale decreased to 1.16 from 8.03 (P < .0001); the Single Assessment Numeric Evaluation score increased to 87.32 from 48.24 (P < .0001); and the American Shoulder and Elbow Surgeons score increased to 88.68 from 41.00 (P < .0001). There was no statistically significant difference in outcome scores or range of motion between midterm and final follow-up. Improvement in outcome scores and range of motion at final follow-up did not vary between patients with small and large tears. Of 42 patients, 37 (88.1%) were able to return to full unrestricted active duty and sporting activity, while 5 (11.9%) were medically separated from the military. CONCLUSION Active duty military patients under the age of 40 years with traumatic full-thickness rotator cuff tears had statistically and clinically significant increases in outcome scores and decreases in pain after arthroscopic rotator cuff repair at long-term follow-up.
Collapse
Affiliation(s)
| | | | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Walter A Fink
- Carson Tahoe Health Administration, Carson City, Nevada, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
14
|
Swan ER, Lynch TB, Sheean AJ, Schmitz MR, Dickens JF, Patzkowski JC. High Incidence of Combined and Posterior Labral Tears in Military Patients With Operative Shoulder Instability. Am J Sports Med 2022; 50:1529-1533. [PMID: 35315289 DOI: 10.1177/03635465221078609] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior shoulder instability is the pattern most commonly reported in the civilian population, but military servicemembers may represent a unique population. At 1.7 per 1000 person-years, servicemembers not only have a higher incidence of instability events compared with civilians (reported rate of 0.2-0.8), but the distribution of labral tears in the military may differ significantly as well. HYPOTHESIS The incidence of combined and posterior labral tears in the military population will be greater than numbers previously reported. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The Wounded, Ill, and Injured Registry, a Department of Defense patient reported outcomes data collection platform that includes all military branches, was queried retrospectively for all patients who had undergone a primary arthroscopic or open shoulder stabilization procedure (Current Procedural Terminology codes 29806, 23455, 23462) between October 2016 and January 2019. Demographic information was obtained through intake forms completed by patients at the time of enrollment into the Military Orthopaedics Tracking Injuries and Outcomes Network. Tear location was determined arthroscopically and labeled as anterior, inferior, posterior, superior, or any combination thereof. Chi-square analysis was used to compare the percentage of patients with isolated anterior, isolated posterior, isolated inferior, or combined labral tears in the current study cohort with those in a previously reported cohort of patients with operative shoulder instability at a single military treatment facility. RESULTS A total of 311 patients were included who had undergone primary shoulder stabilization during the study period. Of these patients, 94 (30.2%) had isolated anterior tears, 76 (24.4%) had isolated posterior tears, and 136 (43.7%) had combined tears. We observed a higher percentage of combined tears in our data set than in a data set from a single military treatment facility (χ2(2) = 48.2; P < .00001). Chi-square analysis demonstrated that significantly more female patients had an isolated anterior labral tear (51.2%) compared with male patients (27.1%; χ2(2) = 9.4; P = .009). CONCLUSION The incidence of combined and posterior labral tears in the military population is greater than numbers previously reported in both military and civilian populations.
Collapse
Affiliation(s)
- Erin R Swan
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Thomas B Lynch
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Jon F Dickens
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | |
Collapse
|
15
|
Green CK, Scanaliato JP, Fares AB, Czajkowski H, Dunn JC, Parnes N. Midterm Outcomes After Arthroscopic Repair of Type VIII SLAP Lesions in Active Duty Military Patients Younger Than 35 Years. Orthop J Sports Med 2022; 10:23259671221095908. [PMID: 35601738 PMCID: PMC9118435 DOI: 10.1177/23259671221095908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Superior labrum from anterior to posterior (SLAP) lesions represent a significant cause of shoulder pain and disability among active duty members of the US military. However, few data exist regarding the surgical management of type VIII SLAP lesions. Hypothesis We hypothesized that arthroscopic repair would decrease pain and increase function at the midterm follow-up and allow for a high rate of maintenance of active duty status. Study Design Case series; Level of evidence, 4. Methods Consecutive active duty military patients were identified from January 2011 through June 2015 who underwent arthroscopic repair of type VIII SLAP lesions performed by a single surgeon. Patients were excluded if they underwent glenoid microfracture, other capsulolabral repair, or rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up: pain visual analog scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, and Rowe instability score. Results A total of 30 patients met the inclusion criteria for the study. The mean ± SD follow-up was 96.60 ± 10.91 months. At final follow-up, the mean visual analog scale score improved from 8.17 ± 1.6 to 1.63 ± 1.90 (P < .0001), the Single Assessment Numeric Evaluation score from 41.65 ± 16.78 to 87.63 ± 13.02 (P < .0001), the American Shoulder and Elbow Surgeons score from 36.47 ± 10.26 to 88.07 ± 13.94 (P < .0001), and the Rowe score from 35.33 ± 6.56 to 90.00 ± 14.68 (P < .0001). Three patients reported postoperative complications, and 1 progressed to further surgery. Overall, 90% of patients remained on active duty military service and were able to return to preinjury levels of work and recreational activity. The failure rate, defined as persistent instability or activity-limiting pain, was 10%. Conclusion The results of this study demonstrated favorable outcomes for the majority of patients after arthroscopic repair of type VIII SLAP lesions at midterm follow-up, supporting repair as a viable treatment option for type VIII SLAP tears in this patient population.
Collapse
Affiliation(s)
- Clare K. Green
- School of Medicine, The George Washington University, Washington, DC, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B. Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Hunter Czajkowski
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
16
|
Scanaliato JP, Dunn JC, Fitzpatrick KV, Czajkowski H, Parnes N. Double-Pulley Remplissage in Active-Duty Military Population With Off-Track Anterior Shoulder Instability Results in Improved Outcomes and Low Recurrence at Minimum 4-Year Follow-Up. Arthroscopy 2022; 38:743-749. [PMID: 34530108 DOI: 10.1016/j.arthro.2021.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/03/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report mid-term outcomes of active-duty patients with anterior shoulder instability following our technique for double-pulley remplissage (DPR) with concomitant anterior labral repair. METHODS All consecutive patients from 1/2010 through 12/2016 that underwent DPR by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation following a traumatic event, and had subsequent instability recalcitrant to conservative management. Patients were excluded if they were lost to follow-up (3) of if they underwent stabilization procedures other than DPR (148). Outcome measures were completed by patients within 1 week prior to surgery and at latest follow-up. Twenty-four patients met the inclusion criteria for the study, and all were active-duty military at the time of surgery. RESULTS 20/24 (83.3%) patients met the patient acceptable symptomatic state (PASS), while 21/24 (87.5%) achieved substantial clinical benefit (SCB) and 22/24 (91.7%) exceeded the minimal clinically important difference (MCID) for their operative shoulder, as determined by the American Shoulder and Elbow Surgeons (ASES) Score. 21/24 (87.5%) patients met the PASS, while 19/24 (79.2%) achieved SCB and 20/24 (83.3%) exceeded the MCID for their operative shoulder, as determined by the single assessment numeric evaluation (SANE). In addition, 23/24 (95.8%) patients exceeded the MCID for their operative shoulder, as determined by the Rowe Instability score. Preoperative and postoperative range of motion did not vary significantly. All patients had decreased pain postoperatively (P < .0001); 22/24 (91.67%) of patients remained on active-duty status. Failure rate, defined as recurrent subluxation or dislocation, was 4.2%. CONCLUSIONS Mid-term outcomes in this population of active-duty patients undergoing DPR for shoulder instability without glenoid bone loss demonstrate a statistically and clinically significant improvement in patient-reported outcomes, a significant decrease of pain and an overall return to active-duty rate of 91.67%. LEVEL OF EVIDENCE IV, therapeutic case series.
Collapse
Affiliation(s)
- John P Scanaliato
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A..
| | - John C Dunn
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A
| | - Kelly V Fitzpatrick
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, U.S.A.; Claxton-Hepburn Medical Center, Ogdensburg, New York
| |
Collapse
|
17
|
Scanaliato JP, Dunn JC, Fares AB, Czajkowski H, Parnes N. Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study. Am J Sports Med 2022; 50:334-340. [PMID: 34898288 DOI: 10.1177/03635465211061602] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a high prevalence of combined shoulder instability in military patients. Short-term outcomes after 270° labral repair are promising; however, there is a paucity of longer term outcome data in this high-demand group of patients. PURPOSE To report the midterm outcomes of active-duty military patients treated with 270° labral repair for combined shoulder instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS All consecutive patients between January 2011 and January 2019 who underwent 270° labral repair by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation after a traumatic event and had magnetic resonance imaging and intraoperative findings consistent with combined-type instability. A total of 52 patients met the inclusion criteria for the study, and all were active-duty servicemembers at the time of surgery. RESULTS The mean follow-up was 78.21 months (range, 24-117 months). There was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (from 44.92 to 89.31; P < .0001), Single Assessment Numeric Evaluation score (from 52.32 to 93.17; P < .0001), and Rowe instability score (from 46.63 to 91.35; P < .0001) from preoperatively to postoperatively. Mean pain decreased significantly as measured by the visual analog scale for pain (from 8.04 to 1.44; P < .0001). Range of motion in forward flexion (from 155.29° to 155.96°; P = .6793), external rotation (from 67.50° to 65.29°; P = .0623), and internal rotation (from T9.58 to T9.56; P = .9650) did not change significantly postoperatively. Outcomes did not differ significantly for patients who underwent surgery on their dominant shoulder versus those who underwent surgery on their nondominant shoulder, nor did outcomes vary with the type of anchor utilized (biocomposite vs all-suture). The overall rate of return to active duty was 92.31%. CONCLUSION Midterm outcomes in this population of active-duty patients undergoing 270° labral repair for combined shoulder instability demonstrated a statistically and clinically significant improvement in patient-reported outcome scores, a significant decrease in pain, and an overall rate of return to active duty of 92.31%.
Collapse
Affiliation(s)
| | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B Fares
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| |
Collapse
|
18
|
Gould HP. CORR Insights®: The Incidence of Posterior and Combined AP Shoulder Instability Treatment with Surgical Stabilization Is Higher in an Active Military Population than in the General Population: Findings from the US Naval Academy. Clin Orthop Relat Res 2021; 479:709-711. [PMID: 33177478 PMCID: PMC8083915 DOI: 10.1097/corr.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Heath P Gould
- H. P. Gould, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
19
|
Wolfley CN, DeFoor MT, Antosh IJ, Parada SA. Treatment of a Combined Pectoralis Major Tear, Anterior Labral Tear, and Humeral Avulsion of the Glenohumeral Ligament (HAGL) in an Active Duty Soldier. Mil Med 2021; 187:e530-e534. [PMID: 33523231 DOI: 10.1093/milmed/usaa422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/26/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022] Open
Abstract
Anterior glenohumeral instability is an increasingly common injury among young military servicemen. First-time dislocations occurring in combination with anterior labral tears and humeral avulsion of glenohumeral ligament lesions, although rare, significantly contribute to further shoulder dysfunction with recurrent instability and pain. Tears of the pectoralis major are also a type of injury more common in the military population, with operative management resulting in decreased strength. We present a unique case of a young, active duty male that sustains an anterior shoulder dislocation with a concomitant pectoralis major tendon rupture while bench press weight lifting in preparation for the Army Special Forces selection. To the best of our knowledge, this is the first case presented in the literature describing management of a simultaneous anterior shoulder dislocation, humeral avulsion of glenohumeral ligament lesion, and pectoralis major tendon rupture treated with a single operation. After aggressive rehabilitation, the patient was able to successfully pass Special Forces selection and has near full function of the operative shoulder with remarkable satisfaction scores.
Collapse
Affiliation(s)
- Cortney N Wolfley
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, 30905, USA
| | - Mikalyn T DeFoor
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA
| | - Ivan J Antosh
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, 30905, USA
| | - Stephen A Parada
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA
| |
Collapse
|