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Pearson ZC, Agarwal AR, Garcia A, Mikula J, Rupp MC, Best MJ, Srikumaran U. Evaluating the Effect of Rotator Cuff Repair With Concomitant Distal Claviculectomy on 2 and 4 Year Reoperation Rates. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202407000-00008. [PMID: 38996217 PMCID: PMC11239165 DOI: 10.5435/jaaosglobal-d-24-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND The current literature has differing views on the efficacy of concomitant distal claviculectomy (DC) during rotator cuff repair (RCR) in preventing revision surgery. Our aim was to investigate the revision surgery rate between RCR with DC and RCR without DC. METHODS A retrospective cohort analysis was conducted using a national claims database. Patients undergoing open or arthroscopic primary RCR with or without concomitant DC were identified. The primary outcome was 4-year revision surgery rates. Univariate analysis was conducted using chi-square or Student t tests. Multivariable analysis was conducted using logistic regression, and an adjusted number needed to harm was calculated. RESULTS A total of 131,232 patients met inclusion criteria. After logistic regression, patients undergoing RCR with DC had higher odds of requiring a subsequent DC procedure [OR; 95% CI; P-value (1.49; 1.35-1.64; P < 0.001)] but lower odds of any revision surgery (0.87; 0.80-0.91; P < 0.001) within 4 years than those who underwent RCR without DC. CONCLUSION Although associated with a lower rate of overall revision surgeries within 2 and 4 years of RCR, those who underwent RCR with DC were 85% more likely at 2 years and 49% more likely at 4 years to undergo revision surgery of the distal clavicle than those without concomitant DC.
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Affiliation(s)
- Zachary C Pearson
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Pearson, Dr. Agarwal, Dr. Mikula, Dr. Best, and Dr. Srikumaran), and the Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Mr. Garcia and Dr. Rupp)
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Wiener JM, Sanghvi PA, Smith KA, Moyal A, Piper MM, Calcei JG. Distal Clavicular Resection Worsens Outcomes in Rotator Cuff Repair: A National Database Study. J Shoulder Elb Arthroplast 2024; 8:24715492241249374. [PMID: 38756691 PMCID: PMC11097623 DOI: 10.1177/24715492241249374] [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] [Received: 12/26/2023] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Distal clavicular resection (DCR) is a procedure used to alleviate acromioclavicular joint (ACJ) pain, often done alongside rotator cuff repair (RCR). This investigation explored the relationships between DCR and RCR, outcomes of DCR during RCR, and complication rates of DCR. Methods This retrospective study used electronic medical record data from the TriNetX database. Cohorts were subdivided based on the timeline of DCR in comparison to RCR, as well as comparing RCR with DCR against RCR without DCR. Results In total 46 534 patients underwent RCR with 14.8% (6898) of these patients also undergoing DCR. And 72.8% (5021) had DCR during RCR, and 10.7% (740) had DCR after RCR. Less than 5% (<10) of patients with preexisting ACJ pain required DCR 3 years postoperatively, and 0.002% (78) patients without ACJ pain developed ACJ pain within 3 years. Less that 20 patients underwent DCR within 3 years of being diagnosed with ACJ pain. Patients who had RCR with DCR were more likely to have chronic pain postoperatively (P < .0001). Conclusion Patients undergoing RCR do not require subsequent DCR. Performing DCR does not offer significant benefit when compared to performing isolated RCR without DCR in patients with preexisting ACJ pain, but increases risk for ACJ instability and chronic pain.
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Affiliation(s)
- Joshua M Wiener
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Parshva A Sanghvi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kira A Smith
- University Hospitals Cleveland Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Andrew Moyal
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Cleveland Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Molly M Piper
- University Hospitals Cleveland Department of Orthopedic Surgery, Cleveland, OH, USA
| | - Jacob G Calcei
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Cleveland Department of Orthopedic Surgery, Cleveland, OH, USA
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Matsusaka Y, Werner RA, Serfling SE, Buck AK, Kosmala A, Sasaki T, Weich A, Higuchi T. Evaluating the Patterns of FAPI Uptake in the Shoulder Joint: a Preliminary Study Comparing with FDG Uptake in Oncological Studies. Mol Imaging Biol 2024; 26:294-300. [PMID: 38177615 DOI: 10.1007/s11307-023-01893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Fibroblast activation protein inhibitor (FAPI) targeting PET has been introduced as a novel molecular imaging modality for visualizing cancer-associated fibroblasts. There have also been reports suggesting incidental findings of localized accumulation in the shoulder joints. However, further characterization in a larger patient cohort is still lacking. METHODS 77 consecutive patients (28 females; mean age, 63.1 ± 11.6) who underwent Ga-68 FAPI-04 PET/CT for diagnosis of solid tumors were included. The incidence and localization of tracer uptake in shoulder joints were investigated and compared with available F-18 FDG scans serving as reference. RESULTS Ga-68 FAPI-04 uptake was evaluated in 77 patients (154 shoulder joints), of whom 54 subjects (108 shoulder joints) also had available F-18 FDG scans for head-to-head comparison. On FAPI-targeted imaging, 67/154 shoulders (43.5%) demonstrated increased radiotracer accumulation in target lesions, which were distributed as follows: acromioclavicular (AC) joints in 25/67 (37.3%), followed by glenohumeral and subacromial (GH + SA) joints in 23/67 (34.3%), or both (AC and GH + SA joints) in the remaining 19/67 (28.4%). Ga-68 FAPI-04 correlated with quantified F-18 FDG uptake (r = 0.69, p < 0.0001). Relative to the latter radiotracer, however, in-vivo FAP expression in the shoulders was significantly increased (Ga-68 FAPI-04, 4.7 ± 3.2 vs F-18 FDG, 3.6 ± 1.3, p < 0.001). CONCLUSION Our study revealed focal accumulation of Ga-68 FAPI-04 in the shoulders, particularly in the AC joints, with higher uptake compared to the inflammatory-directed PET radiotracer F-18 FDG in oncological studies. As a result, further trials are warranted to investigate the potential of FAPI-directed molecular imaging in identifying chronic remodeling in shoulder joints. This could have implications for initiating anti-FAP targeted photodynamic therapy based on PET signal strength.
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Affiliation(s)
- Yohji Matsusaka
- Department of Nuclear Medicine and Comprehensive Heart Failure Center (CHFC), Molecular Imaging of the Heart, University Hospital of Würzburg, Oberdürrbacher Str. 6, ZIM House A4, 97080, Würzburg, Germany
| | - Rudolf A Werner
- Department of Nuclear Medicine and Comprehensive Heart Failure Center (CHFC), Molecular Imaging of the Heart, University Hospital of Würzburg, Oberdürrbacher Str. 6, ZIM House A4, 97080, Würzburg, Germany
- Division of Nuclear Medicine and Molecular Imaging, The Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sebastian E Serfling
- Department of Nuclear Medicine and Comprehensive Heart Failure Center (CHFC), Molecular Imaging of the Heart, University Hospital of Würzburg, Oberdürrbacher Str. 6, ZIM House A4, 97080, Würzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine and Comprehensive Heart Failure Center (CHFC), Molecular Imaging of the Heart, University Hospital of Würzburg, Oberdürrbacher Str. 6, ZIM House A4, 97080, Würzburg, Germany
| | - Aleksander Kosmala
- Department of Nuclear Medicine and Comprehensive Heart Failure Center (CHFC), Molecular Imaging of the Heart, University Hospital of Würzburg, Oberdürrbacher Str. 6, ZIM House A4, 97080, Würzburg, Germany
| | - Takanori Sasaki
- Department of Nuclear Medicine and Comprehensive Heart Failure Center (CHFC), Molecular Imaging of the Heart, University Hospital of Würzburg, Oberdürrbacher Str. 6, ZIM House A4, 97080, Würzburg, Germany
- Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Alexander Weich
- Internal Medicine II and ENETS CoE NET-Zentrum Würzburg, Gastroenterology, University Hospital Würzburg, Würzburg, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine and Comprehensive Heart Failure Center (CHFC), Molecular Imaging of the Heart, University Hospital of Würzburg, Oberdürrbacher Str. 6, ZIM House A4, 97080, Würzburg, Germany.
- Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
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Kilinc O, Ertem K, Ergen E, Aslanturk O. What are the Factors that Impact the Outcomes of Arthroscopic Rotator Cuff Repair? Niger J Clin Pract 2024; 27:483-488. [PMID: 38679771 DOI: 10.4103/njcp.njcp_706_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The cuff is a complex structure with many factors affecting it. How much it is affected after repair is still being investigated. AIM The aim of this study was to analyze the functional results of individuals who received arthroscopic rotator cuff repair and assess the various factors that could impact these outcomes. METHODS The study included 57 patients with a mean age of 58.8 years (range: 39-71) who underwent arthroscopic rotator cuff repair between 2013 and 2020, with a minimum of 6 months after the operation. Functional and clinical outcomes of the patients were evaluated using preoperative and postoperative scores (QDASH, ASES, and VAS). The study also analyzed how demographic factors, type and duration of the tear, comorbidities such as diabetes mellitus (DM) and hypertension (HT), and other pathologies may have affected the patients' scores. RESULTS The effect of the operation on the scores in rotator cuff tears was highly significant (P < 0.05). Age, gender, tear size, fatty degeneration, anchor configuration, comorbidities, and additional procedures presented variable values on postoperative scores, but were not statistically significant. The effect of DM and HT on VAS scores was statistically significant (P < 0.05). CONCLUSION The results of rotator cuff repair appear to be influenced by several factors, including the sex of the patient, type and duration of tear, comorbidities, and surgical procedures used. Although these factors had an effect on the scores, they were not statistically significant.
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Affiliation(s)
- O Kilinc
- Department of Orthopaedics and Traumatology, Mersin City Education and Research Hospital, Mersin, Turkey
| | - K Ertem
- Department of Orthopedics and Traumatology, Inonu University Medicine Faculty, Malatya, Turkey
| | - E Ergen
- Department of Orthopedics and Traumatology, Inonu University Medicine Faculty, Malatya, Turkey
| | - O Aslanturk
- Department of Orthopedics and Traumatology, Inonu University Medicine Faculty, Malatya, Turkey
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Wang J, Jia HB, Li HM, Jiang HQ, Zhao JG. Intramedullary Nailing Versus Open Reduction and Plate Fixation for Lateral Malleolar Fractures: A Meta-Analysis. J Foot Ankle Surg 2024; 63:275-280. [PMID: 38052379 DOI: 10.1053/j.jfas.2023.11.016] [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] [Received: 07/26/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
The fixation for lateral malleolar fracture in ankle fractures is still controversial. The purpose of this meta-analysis is to compare clinical and radiological outcomes between intramedullary nail (IMN) and plate for lateral malleolar fractures in ankle fractures. The PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) from databases inception to June 2023. Data on outcomes were extracted and the methodological quality of the included studies were assessed. A meta-analysis was performed using RevMan 5.3 software when the data extracted from included studies could be synthesized. Seven RCTs were included. The methodological quality of the included studies was moderate to high. The meta-analysis results showed that the infection rate of the IMN group was significantly lower than that of the plate group (RR = 0.38; 95%CI 0.18-0.82; p = .01). There were no significant differences between the 2 groups in Olerud and Molander Ankle Score (OMAS), union rate, radiological outcomes, nerve injury rate, reoperation rate, loss of reduction, and total complication rate. Our present meta-analysis demonstrated that the IMN might be a better method for the fixation of lateral malleolar fracture in ankle fracture, as the infection rate was significantly lower than a plate.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Hao-Bo Jia
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Hao-Min Li
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | | | - Jia-Guo Zhao
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Kanakamedala AC, Shankar DS, Gambhir N, Boylan MR, Boin M, Alben MG, Virk MS, Kwon YW. Concomitant open distal clavicle excision is associated with greater improvement in range of motion without increased risk of acromial stress fracture after reverse total shoulder arthroplasty: a retrospective cohort study. Clin Shoulder Elb 2023; 26:357-365. [PMID: 37957885 DOI: 10.5397/cise.2023.00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA). METHODS A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups. RESULTS Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up. CONCLUSIONS Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. Level of evidence: III.
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Affiliation(s)
- Ajay C Kanakamedala
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Neil Gambhir
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Matthew R Boylan
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Michael Boin
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Matthew G Alben
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Mandeep S Virk
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Young W Kwon
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
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Cirigliano G, Kriechling P, Wieser K, Camenzind RS. Reversed total shoulder arthroplasty after acromioclavicular joint resection yields equivalent clinical results compared to a matched control group. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3547-3553. [PMID: 37222850 DOI: 10.1007/s00590-023-03576-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Reverse total shoulder arthroplasty (RTSA) is a well-establish procedure with increasing incidence. Depending on the medical history, many patients undergo multiple soft-tissue procedures before RTSA. The role of acromioclavicular pathology as well as the consequences of a distal clavicle resection (DCR) before RTSA has not been evaluated yet. MATERIAL AND METHODS A retrospective single-center review was performed on all patients undergoing primary RTSA with or without DCR with a minimum follow-up of 2 years. We compared patient-reported outcome measures (Constant score (CS), subjective shoulder values (SSV), and range of motion (ROM)) with a matched control group. The control group consisted of patients treated with a RTSA without DCR and matching was performed for age, sex, operating side, American Society of Anesthesiologists (ASA), body mass index (BMI), and indication. Surgical time and complication rate were recorded. RESULTS Thirty-nine patients with a mean follow-up of 63 months (SD 33) were enrolled in the study group. Mean age was 67 years (SD 7) with 44% male patients for both groups. The mean relative CS improved from 43% (SD 17) to 73% (SD 20) in the study group, and from 43% (18) to 73% (22) in the control group. The SSV improved from 29% (SD 17) to 63% (SD 29) in the study group, and from 28% (SD 16) to 69% (SD 26) in the control group (both n.s.). The postoperative ROM did not significantly differ between the two groups. Five patients in the study group and six in the control group had reoperations. CONCLUSION Patients who received a DCR before RTSA showed equivalent clinical outcomes compared to a match-control group with RTSA only. Surgical time was not different, and no complication related to the open DCR was observed in the study group. Therefore, we conclude that a prior DCR does not influence the postoperative outcome after RTSA. LEVEL OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Gabriele Cirigliano
- Department of Orthopedics, University of Zurich, BalgristUniversityHospital, Forchstrasse 340, Zurich, Switzerland
| | - Philipp Kriechling
- Department of Orthopedics, University of Zurich, BalgristUniversityHospital, Forchstrasse 340, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, University of Zurich, BalgristUniversityHospital, Forchstrasse 340, Zurich, Switzerland
| | - Roland Stefan Camenzind
- Department of Orthopedics, University of Zurich, BalgristUniversityHospital, Forchstrasse 340, Zurich, Switzerland.
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Lucerne, Switzerland.
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Barth J, Garret J, Nover L, van Rooij F, Clavert P. Insufficient evidence to confirm benefit of adjuvant distal clavicle resection during rotator cuff repair: a systematic review and meta-analysis. EFORT Open Rev 2023; 8:615-625. [PMID: 37526249 PMCID: PMC10441254 DOI: 10.1530/eor-22-0101] [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: 08/02/2023] Open
Abstract
The aim of this study is to determine whether adjuvant Distal Clavicle Resection (DCR) improves outcomes of Rotator Cuff Repair (RCR) in terms of ROM, clinical scores as well as reducing complications and/or reoperations. This systematic review conforms to the PRISMA guidelines. Studies were included if they compared outcomes of RCR with and without adjuvant DCR and reported on postoperative ROM, clinical scores, complications, and/or reoperations. Seven studies that comprised 1572 shoulders which underwent RCR at a follow-up ranged 8-54 months: 398 with adjuvant DCR and 1174 without DCR. No significant differences were found between patients that had DCR versus those that did not have DCR, in terms of postoperative clinical scores (ASES, Constant, pVAS), postoperative ROM (AFE, external and internal rotation), retear rate and reoperation rate. There were no significant differences in ROM, clinical scores, or rates of retears and reoperations between patients that underwent RCR with or without adjuvant DCR. There is insufficient evidence to support routine DCR during RCR; the incidence of new or residual acromioclavicular joint (ACJ) pain after RCR with adjuvant DCR is higher than following isolated RCR, which could in fact induce iatrogenic morbidity and therefore does not justify the additional surgery time and costs of routine adjuvant DCR.
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Affiliation(s)
- Johannes Barth
- Clinique des Cèdres, 21 Avenue Albert Londres, 38130 Échirolles, France
| | - Jerôme Garret
- Clinique du parc, 155, Boulevard Stalingrad, Lyon, France
| | - Luca Nover
- ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland
| | | | - Philippe Clavert
- Service de Chirurgie du Membre Supérieur, Haut Pierre 2, CHRU Strasbourg, avenue Molière, Strasbourg, France
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Ostermann RC, Eigenschink M, Heuberer PR, Siegert P, Muellbacher W, Anderl L, Schrott B, Laky B, Pauzenberger L, Anderl W. Bony Regrowth and New Spur Formation as Possible Causes of Failed Distal Clavicle Excision-Mid-Term Outcomes after Revision Surgery in a Matched-Pair Analysis. J Pers Med 2023; 13:1221. [PMID: 37623471 PMCID: PMC10455436 DOI: 10.3390/jpm13081221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Despite high rates of successful outcomes after open and arthroscopic distal clavicle excision (DCE) for symptomatic acromioclavicular joint (ACJ) degeneration, some patients present with persistent symptoms and disabilities after surgical intervention. This study aims to compare radiological, functional, and subjective outcomes of open revision surgery after failed arthroscopic DCE to primary successful arthroscopic DCE. METHODS In this retrospective case-control study, 10 patients who underwent open DCE revision were age- and gender-matched with 10 patients who did not require revision surgery after DCE. Radiographic evaluation included presence of acromioclavicular spurs and acromioclavicular joint distance. Functional and subjective outcomes were assessed using the CS, SSV, SST, VAS for pain, patient's satisfaction, ASES and quick DASH score. RESULTS At the latest postoperative follow-up (case: 57.3 ± 19.2 months; control: 63.5 ± 16.3 months), spur formation was detected in twice as many cases in the revision group, while acromioclavicular distance showed no significant difference. However, a significant bony regrowth was noticed in the revision group between revision surgery and latest follow-up, with a decrease of the acromioclavicular distance from 9.2 ± 1.6 mm to 5.9 ± 4.6 mm (p = 0.026) and a development of new spur formations in 30% of cases. There were no significant differences in overall CS between the revision and control group (p = 0.174) at final follow-up, but the control group scored significantly higher in the CS subgroups pain (p = 0.012) and internal rotation (p = 0.016). Mean SSV was significantly lower in the revision (65.5 ± 22.3%) compared to the control group (85.9 ± 16.4%; p = 0.031). CONCLUSIONS Bony regrowth at the distal clavicle presenting as postoperative AC-distance narrowing and new spur formation was observed more distinctly in the revision group. Despite a slight increase in postoperative outcomes after revision surgery, subjective satisfaction and recalcitrant pain remain a concern. LEVEL OF EVIDENCE Therapeutic Level III, retrospective case-control study.
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Affiliation(s)
- Roman C. Ostermann
- Orthopedic Department, Vienna International Shoulder and Joint Clinic, 1030 Vienna, Austria
- 2nd Orthopedic Department, Hospital of the Sacred Heart of Jesus, Baumgasse 20A, 1030 Vienna, Austria
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), 1030 Vienna, Austria; (M.E.)
| | - Martin Eigenschink
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), 1030 Vienna, Austria; (M.E.)
- AUVA Traumacenter Vienna, Meidling, 1030 Vienna, Austria
| | - Philipp R. Heuberer
- Orthopedic Department, Vienna International Shoulder and Joint Clinic, 1030 Vienna, Austria
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), 1030 Vienna, Austria; (M.E.)
| | - Paul Siegert
- 1st Orthopaedic Department, Orthopaedic Hospital Speising, 1030 Vienna, Austria
| | - Willi Muellbacher
- 2nd Orthopedic Department, Hospital of the Sacred Heart of Jesus, Baumgasse 20A, 1030 Vienna, Austria
| | - Lisa Anderl
- TUM School of Medicine, Technical University of Munich, 80333 München, Germany
| | - Beate Schrott
- Center of Clinical Research (CCR), University Clinic of Dentistry, Medical University of Vienna, 1030 Vienna, Austria
| | - Brenda Laky
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), 1030 Vienna, Austria; (M.E.)
- Center of Clinical Research (CCR), University Clinic of Dentistry, Medical University of Vienna, 1030 Vienna, Austria
| | - Leo Pauzenberger
- 2nd Orthopedic Department, Hospital of the Sacred Heart of Jesus, Baumgasse 20A, 1030 Vienna, Austria
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), 1030 Vienna, Austria; (M.E.)
| | - Werner Anderl
- Orthopedic Department, Vienna International Shoulder and Joint Clinic, 1030 Vienna, Austria
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), 1030 Vienna, Austria; (M.E.)
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Bismuth Y, Beckers J, van Rooij F, Saffarini M, Godenèche A. Outcomes of Secondary Arthroscopic Distal Clavicle Resection for Shoulders With Symptomatic Acromioclavicular Joint Arthropathy After Isolated Rotator Cuff Repair With Complete Tendon Healing. Orthop J Sports Med 2023; 11:23259671231163143. [PMID: 37056455 PMCID: PMC10087646 DOI: 10.1177/23259671231163143] [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] [Indexed: 04/15/2023] Open
Abstract
Background Recent meta-analyses have advised against distal clavicle resection (DCR) as an adjuvant procedure during rotator cuff repair (RCR), whether performed routinely or in shoulders diagnosed with symptomatic acromioclavicular joint (ACJ) arthropathy. However, the efficacy of DCR as a secondary procedure in patients with persistent pain attributed to symptomatic ACJ arthropathy remains unknown. Purpose To evaluate outcomes of secondary DCR in patients with failed nonoperative treatment of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing. Study Design Case series; Level of evidence, 4. Methods Between 2008 and 2018, the senior surgeon performed isolated RCR in 1935 patients, of which 23 (1.2%) presented with ACJ pain and discomfort at ≥12 months after the index RCR, despite complete healing of repaired tendons. Those 23 patients underwent secondary DCR, as ACJ arthropathy was confirmed clinically and radiographically. Clinical assessment before DCR included the Subjective Shoulder Value (SSV) and pain at rest. Clinical assessment at >12 months after DCR included the SSV, pain at rest, Constant-Murley score, range of motion, and satisfaction. Pre- and post-DCR SSV and pain scores were compared. Results Of the initial cohort, 5 patients did not consent to the use of their data, leaving 18 patients aged 53.3 ± 7.6 years (mean ± SD; range, 39-68 years) for outcome assessment. At a mean follow-up of 7.0 ± 3.1 years after DCR, the SSV significantly improved from 58.7 ± 17.2 to 76.1 ± 20.2 (P < .001), and the pain at rest significantly decreased from 4.7 ± 1.5 to 2.8 ± 1.9 (P < .001). At final follow-up, the Constant-Murley score was 70.2 ± 21.0. Of 18 patients, 15 had none or mild residual pain (0-2; 83%), while 3 had substantial residual pain (5 or 6; 17%). Only 1 of the 3 patients with substantial residual pain had a poor SSV score (20 points) and was against opting for DCR in retrospect. No patient had infections or gross ACJ instability after DCR. Conclusion Secondary DCR for cases of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing reduced pain in 83% of patients, and 94% were satisfied and would undergo secondary DCR again.
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Affiliation(s)
- Yaniv Bismuth
- Hôpital Privé Jean Mermoz, Centre
Orthopédique Santy, Ramsay Santé, Lyon, France
| | - Joris Beckers
- Hôpital Privé Jean Mermoz, Centre
Orthopédique Santy, Ramsay Santé, Lyon, France
| | - Floris van Rooij
- ReSurg SA, Nyon, Switzerland
- Floris van Rooij, MSc,
ReSurg SA, Rue Saint-Jean 22, 1260 Nyon, Switzerland (
)
| | | | - Arnaud Godenèche
- Hôpital Privé Jean Mermoz, Centre
Orthopédique Santy, Ramsay Santé, Lyon, France
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11
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Malavolta EA, Assunção JH, Andrade-Silva FB, Gracitelli MEC, Kiyomoto HD, Ferreira Neto AA. Prognostic Factors for Clinical Outcomes After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2023; 11:23259671231160738. [PMID: 37065182 PMCID: PMC10102950 DOI: 10.1177/23259671231160738] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/17/2023] [Indexed: 04/18/2023] Open
Abstract
Background Limited knowledge exists regarding prognostic factors after rotator cuff repair. Purpose To identify pre- and perioperative predictors for functional outcomes after arthroscopic rotator cuff repair. Study Design Case-control study; Level of evidence, 3. Methods This study included patients who underwent arthroscopic rotator cuff repair between January 2013 and April 2019 and who had preoperative magnetic resonance imaging scans. The procedures were performed by 4 shoulder surgeons at a single institution. Excluded were patients who had previous surgeries, those who underwent open surgery, and those without 12- and 24-month follow-up clinical data. Patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES] Standardized Shoulder Assessment Form and University of California, Los Angeles [UCLA] Shoulder Rating Scale scores) were assessed preoperatively and at 6, 12, and 24 months postoperatively. Using multiple linear regression analysis, the authors evaluated the influence of 29 variables relating to patient, lesion, and procedure characteristics on postoperative outcomes, with the 24-month ASES score as the dependent variable. Results The study sample consisted of 474 patients (500 shoulders). The median ASES score increased from 41.6 preoperatively to 88.3 at 24 months (P < .001), and the median UCLA score increased from 14 preoperatively to 32 in the same period (P < .001). The following variables were found to be independent predictors for higher 24-month postoperative ASES score: male sex, absence of rheumatologic disease, older age, lower degree of supraspinatus muscle fatty degeneration, acromioplasty, and a higher preoperative ASES score. Conclusion The prognostic factors for better clinical results at 24 months after arthroscopic rotator cuff repair were male sex, absence of rheumatologic disease, older age, lower degree of fatty degeneration of the supraspinatus muscle, concomitant acromioplasty, and higher preoperative ASES score.
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Affiliation(s)
- Eduardo Angeli Malavolta
- Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- HCor–Hospital do Coração, São Paulo,
Brazil
- Eduardo Angeli Malavolta,
MD, PhD, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de
São Paulo, Rua Dr. Ovídio Pires de Campos 333 3rd Floor, Cerqueira Cesar São
Paulo/SP, Brazil 05403-010 (
)
| | - Jorge Henrique Assunção
- Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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12
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Wang J, Jia HB, Zhao JG, Wang J, Zeng XT. Plate versus screws fixation for the posterior malleolar fragment in trimalleolar ankle fractures. Injury 2023; 54:761-767. [PMID: 36336477 DOI: 10.1016/j.injury.2022.10.032] [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] [Received: 05/23/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The fixation methods of posterior malleolar fracture (PMF) in trimalleolar ankle fractures is still controversial. We aim to compare clinical and radiological outcomes between plate fixation and screws fixation for PMF in trimalleolar ankle fractures. METHODS Literature search was performed through PubMed, EMBASE, Cochrane Library and CNKI database from databases inception to May 2022 to identify randomized controlled trial (RCT) and comparative clinical study in English or Chinese. A meta-analysis was performed using RevMan 5.1 software, and systematic review was performed when the data extracted from included studies could not be synthesized. RESULTS Two RCTs and six cohort studies were included. The meta-analysis results showed that articular step-off or gap in plate fixation was superior to antero-posterior screws fixation (RR = 0.28; 95%CI: 0.11, 0.76; P = 0.01). there were no significant differences in American Orthopaedic Foot & Ankle Society scores (MD = -0.19; 95%CI: -2.43, 2.05; P = 0.87), arthritis (RR = 1.67; 95%CI: 0.61, 4.55; P = 0.32), infection and total complication (RR = 1.42; 95%CI: 0.89, 2.25; P = 0.14). CONCLUSION Plate fixation might have better articular step-off or gap, compared with "A to P" screws fixation for the posterior malleolus in trimalleolar ankle fractures. Screw fixation could achieve shorter surgical time than plate fixation. However, no significant differences were found in AOFAS scores, arthritis, infection, sural nerve injury and total complication during the comparisons.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
| | - Hao-Bo Jia
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
| | - Jia-Guo Zhao
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
| | - Jia Wang
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
| | - Xian-Tie Zeng
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China.
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13
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Davies MR, Kucirek N, Motamedi D, Ma CB, Feeley BT, Lansdown D. Relationship Between Preoperative Shoulder Osteoarthritis Severity Score and Postoperative PROMIS-UE Score After Rotator Cuff Repair. Orthop J Sports Med 2023; 11:23259671221143801. [PMID: 36636030 PMCID: PMC9829989 DOI: 10.1177/23259671221143801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023] Open
Abstract
Background Mild to moderate glenohumeral joint osteoarthritis is a common finding among patients who are evaluated for rotator cuff tears. However, the impact of preoperative shoulder joint degeneration on patient-reported outcomes after rotator cuff repair (RCR) is not well-established. Purpose To apply the magnetic resonance imaging (MRI)-based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between preoperative shoulder pathology present on MRI and postoperative Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE) scores. Study Design Case-control study; Level of evidence, 3. Methods Seventy-one MRI scans corresponding to 71 patients were analyzed by 2 independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each subscore. Spearman correlations were calculated between averaged SOAS scores, patient characteristics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as P < .05 for univariate analyses and < .0125 for multivariate analyses using the Bonferroni correction. Results The mean PROMIS-UE score of this cohort was 51.5 ± 7.4, while the mean total SOAS score was 21.5 ± 8.4. There was a negative correlation between total SOAS score and postoperative PROMIS-UE score (r = -0.24; P = .040). Both cartilage wear (r = -0.33; P = .0045) and acromioclavicular joint degeneration (r = -0.24; P = .048) individually demonstrated negative correlations with PROMIS-UE score. When a multivariate linear regression with Bonferroni correction was applied to the significant variables identified in univariate analysis along with patient characteristics, none were independently correlated with PROMIS-UE score. Conclusion In this cohort of patients undergoing RCR, increasing preoperative total SOAS score was predictive of lower postoperative PROMIS-UE scores. SOAS subscores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and acromioclavicular joint degeneration. The cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient factors in multivariate analysis.
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Affiliation(s)
- Michael R. Davies
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Natalie Kucirek
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Daria Motamedi
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA.,Drew Lansdown, MD, Department of Orthopaedic Surgery, University
of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA
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14
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Rossano A, Manohar N, Veenendaal WJ, van den Bekerom MP, Ring D, Fatehi A. Prevalence of acromioclavicular joint osteoarthritis in people not seeking care: A systematic review. J Orthop 2022; 32:85-91. [DOI: 10.1016/j.jor.2022.05.009] [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: 02/13/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
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15
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Yiannakopoulos CK, Vlastos I, Theotokatos G, Galanis N. Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:2090-2095. [PMID: 32556365 DOI: 10.1007/s00167-020-06098-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/10/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the significance of untreated primary acromioclavicular joint (ACJ) osteoarthritis, encountered during arthroscopic rotator cuff repair (RCR), as a cause of persistent symptomatology and need for revision surgery. METHODS In a cohort of 811 consecutive patients older than 55 years who underwent RCR, the effect of primary ACJ osteoarthritis presence was prospectively examined. A total of 497 patients with mild/moderate and severe ACJ osteoarthritis based on preoperative MRI evaluation were allocated to Group A (n = 185, symptomatic ACJ) and Group B (n = 312, asymptomatic ACJ). Distal clavicle excision was not performed regardless of the presence of pain. The minimum follow-up was 28 months (28-46). The visual analogue scale (VAS) pain scores were assessed for ACJ pain on palpation, the cross body adduction test, the Constant-Murley, and the American Shoulder and Elbow Surgeons (ASES). RESULTS The overall loss to follow-up rate was 3.82% (19 patients: 11 in Group A and eight in Group B). The mean ASES score at the latest follow-up was 91.16 ± 9.3 and 92.37 ± 10.44 in Groups A and B, respectively, and the mean Constant-Murley score was 96.36 ± 5.7 and 95.76 ± 4.6 in Groups A and B, respectively. There was no statistical significance between regarding both scores. Localised ACJ pain on palpation and pain on cross body adduction were diminished in both the symptomatic and asymptomatic group. There were five cases (1%: two in Group A and three in Group B) with persistent ACJ pain who had failed the conservative treatment, and ACJ excision was necessary to alleviate the symptoms. All revision operations were uncomplicated with symptom resolution. CONCLUSION Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. Routine distal clavicle excision is not absolutely necessary, even in patients with symptomatic ACJ osteoarthritis. LEVEL OF EVIDENCE II, Prospective cohort study.
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Affiliation(s)
- Christos K Yiannakopoulos
- Metropolitan General Hospital, Athens, Greece. .,School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.
| | - Iakovos Vlastos
- Metropolitan General Hospital, Athens, Greece.,School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Theotokatos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikiforos Galanis
- Orthopaedic Department, Medical School, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
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16
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No differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2194-2201. [PMID: 33386878 DOI: 10.1007/s00167-020-06377-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To conduct a scoping review to clarify the management of acromioclavicular joint osteoarthritis, as well as to identify any existing gaps in the current knowledge. METHODS Studies were identified by electronic databases (Ovid, Pubmed) from their inception up to April 2nd, 2020. All studies reporting functional outcomes after conservative or surgical treatment of acromioclavicular joint osteoarthritis, either primary or secondary to trauma or distal clavicle osteolysis, were included. Following data were extracted: authors, year of publication, study design (prospective or retrospective), LOE, number of shoulders treated conservatively or surgically, patients' age, OA classification, type of conservative treatment, surgical approach, surgical technique, functional outcomes, complications, revisions, and length of follow-up. Descriptive statistics was used. Quality appraisal was assessed through the Cochrane risk of bias tool for LOE I/II studies, while the MINORS checklist was used for LOE III/IV studies. RESULTS Nineteen studies were included for a total of 861 shoulders. Mean age of participants was 48.5 ± 7.4 years. Mean follow-up was 43.8 ± 29.9 months. Four studies reported functional results after conservative treatment, whereas 15 studies were focused on surgical management. No studies directly compared conservative and surgical treatment. Seven studies reported a surgical approach after failure of previous conservative treatment. All studies reported functional improvement and pain relief. Complication rate was low. Overall methodological quality of included studies was very low. CONCLUSION Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. However, available data did not allow to establish the superiority of one technique over another. LEVEL OF EVIDENCE Level IV.
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17
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Reddy AK, Anderson JM, Gray HM, Fishbeck K, Vassar M. Clinical Trial Registry Use in Orthopaedic Surgery Systematic Reviews. J Bone Joint Surg Am 2021; 103:e41. [PMID: 33983151 DOI: 10.2106/jbjs.20.01743] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Results from systematic reviews and meta-analyses, which have the highest level of evidence (Level I), often drive clinical decision-making and health policy. Often, unpublished trial data are omitted from systematic reviews, raising concerns about the extent of the reliability and validity of results that have been drawn from systematic reviews. We aimed to determine the extent to which systematic review authors include searches of clinical trial registries for unpublished data when conducting systematic reviews in orthopaedic surgery. METHODS Systematic reviews and/or meta-analyses were gathered from the top 5 orthopaedic surgery journals based on the h5-index from Google Scholar Metrics. Systematic reviews that had been published in the Cochrane Database of Systematic Reviews, which requires the inclusion of a clinical trial registry search, served as controls. For the primary outcome, each systematic review from the top 5 orthopaedic journals was screened to determine whether the authors of each study searched for unpublished data in clinical trial registries. We then compared the rate of registry searches with those in the control group. For the secondary analysis, a search of ClinicalTrials.gov was performed for unpublished trial data for 100 randomized systematic reviews. RESULTS All 38 of the Cochrane systematic reviews (100%) included clinical trial registry searches, while the top 5 orthopaedic journals had only 31 of 480 studies (6.5%) that looked at clinical trial registries. The secondary analysis yielded 59 of 100 systematic review articles (59.0%) that could have included unpublished clinical trial data from ≥1 studies to their sample. CONCLUSIONS Systematic reviews that have been published in the top orthopaedic surgery journals seldom included a search for unpublished clinical trial data. CLINICAL RELEVANCE The exclusion of clinical trial registry searches potentially contributes to publication bias within the orthopaedic literature. Moving forward, systematic review authors should include clinical trial registry searches for unpublished clinical trial data to provide the most accurate representation of the available evidence for systematic reviews and meta-analyses.
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Affiliation(s)
- Arjun K Reddy
- Office of Medical Student Research (A.K.R., J.M.A., H.M.G., and M.V.) and Department of Psychiatry and Behavioral Sciences (M.V.), Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - J Michael Anderson
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Harrison M Gray
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Keith Fishbeck
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Matt Vassar
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
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18
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Morris JH, Malik AT, Hatef S, Neviaser AS, Bishop JY, Cvetanovich GL. Cost of Arthroscopic Rotator Cuff Repairs Is Primarily Driven by Procedure-Level Factors: A Single-Institution Analysis of an Ambulatory Surgery Center. Arthroscopy 2021; 37:1075-1083. [PMID: 33242633 DOI: 10.1016/j.arthro.2020.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify intraoperative drivers of cost associated with arthroscopic rotator cuff repairs (RCRs) through analysis of an institutional database. METHODS This was a single-institution retrospective review of arthroscopic RCRs performed at an ambulatory surgical center between November 2016 and July 2019. Patient-level factors analyzed included age, sex, insurance type (private, Medicare, Medicaid, self-pay, and other government), American Society of Anesthesiologists grade (I, II, III, and missing), and Charlson comorbidity index (0, 1, 2, and ≥3). Procedure-level factors included use of biologics (decellularized dermal allograft or bioinductive healing implant), anesthesia type (regional block, monitored anesthesia care, or general), number of anchors and sutures, additional procedures (biceps tenodesis, distal clavicle resection, subacromial decompression), and operative time. Multivariate linear regression analysis was used to identify factors significantly associated with higher or lower charges. RESULTS A total of 712 arthroscopic RCRs were included. The risk-adjusted operative charges were $19,728 (95% confidence interval $16,543 to $22,913). The above factors predicted nearly 65% of the variability in operative charges. The only patient-level factor significantly associated with lower charges was female sex (- $1,339; P = .002). Procedure-level factors significantly associated with higher charges were use of biologics (+ $17,791; P < .001), concurrent open biceps tenodesis (+ $4,027; P < .001), distal clavicle resection (+ $2,266; P = .039), use of regional block (+ $1,256; P = .004), number of anchors (+ $2,245/anchor; P < .001), and increasing operative time ($26/min). Other factors had no significant association. CONCLUSIONS Procedural factors are the most significant drivers of operative cost in arthroscopic RCRs, such as quantity and type of implants; additional procedures such as biceps tenodesis and distal clavicle resection; and perioperative conditions such as type of anesthesia and total operating room time. Overall, patient-level factors were not shown to correlate well with operative costs, other than lower charges with female sex. LEVEL OF EVIDENCE IV, economic study.
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Affiliation(s)
- Jesse H Morris
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Azeem T Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Sarah Hatef
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Andrew S Neviaser
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A..
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Tang J, Zhao J. Arthroscopic Distal Clavicle Resection Through the Supraspinatus Fossa Portal. Arthrosc Tech 2020; 9:e2057-e2061. [PMID: 33381419 PMCID: PMC7768306 DOI: 10.1016/j.eats.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 02/03/2023] Open
Abstract
Disorders of the acromioclavicular (AC) joint quite often necessitate distal clavicle resection (DCR). Arthroscopic DCR is favored because of it is mini-invasive and convenient to treat concomitant intraarticular or subacromial lesions. In previous reports, arthroscopic DCR was performed through the anterior portal with the patient in beach chair position. However, when the patient is in the lateral decubitus position, it is inconvenient to perform DCR through the anterior portal. Thus, we introduce a special DCR technique through the supraspinatus fossa (SSF) portal. The critical point of this technique is viewing the acromioclavicular joint through the routine posterior portal, creating the SSF portal at the anterior edge of the scapular spine and the same medial-to-lateral level to the AC joint, and enough removal of the posterior edge of the distal clavicle. We believe the introduction of this technique will provide a special technical option when DCR is needed.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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20
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Métais P, Gallinet D, Labattut L, Godenèche A, Barth J, Collin P, Bonnevialle N, Garret J, Clavert P. Increased T2 signal intensity in the distal clavicle does not justify acromioclavicular resection arthroplasty during rotator cuff repair. Orthop Traumatol Surg Res 2020; 106:S217-S222. [PMID: 32943381 DOI: 10.1016/j.otsr.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Acromioclavicular (AC) arthropathy can contribute to shoulder pain; it can be treated surgically by distal clavicle resection (DCR). The aim of this study was to determine whether increased T2 signal intensity in the clavicle on MRI is an argument in favour of AC resection arthroplasty by DCR during rotator cuff repair. METHODS The MRI images from 107 shoulders in 107 patients were analysed. We looked for statistical relationships and correlations between shoulders with T2 hyperintensity (HI+) and those without (HI-) before surgery and then in shoulders with T2 hyperintensity (HI+) that underwent AC resection arthroplasty (AC+) and those who did not (AC-). RESULTS On MRI, T2 hyperintensity in the AC joint was correlated with sex (more often found in men) and radiological signs of AC arthropathy. There was no statistical correlation before surgery, particularly with AC pain, or after surgery, with outcomes in shoulders undergoing DCR. CONCLUSION When repairing rotator cuff tears, the presence of T2 hyperintensity on MRI in the distal clavicle is not a predictor of better clinical outcomes after AC resection arthroplasty is done. The AC pain may be related to the rotator cuff tear instead. LEVEL OF EVIDENCE II, prospective randomised study.
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Affiliation(s)
- Pierre Métais
- Hôpital privé La Châtaigneraie, ELSAN, 63110 Beaumont, France.
| | - David Gallinet
- Centre épaule-main, 16, rue Madeleine Brès, 25000 Besançon, France
| | - Ludovic Labattut
- Service de chirurgie orthopédique, CHU de Dijon, 14, rue PaulGaffarel, 21000 Dijon, France
| | - Arnaud Godenèche
- Ramsay Santé, hôpital privé Jean Mermoz, centre orthopédique Santy, 69008 Lyon, France
| | - Johannes Barth
- Centre ostéo-articulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France
| | | | - Nicolas Bonnevialle
- Service de chirurgie orthopédique, CHU de Toulouse, place Baylac, 31059 Toulouse, France
| | - Jérôme Garret
- Clinique du Parc, 155, boulevard Stalingrad, 69006 Lyon, France
| | - Philippe Clavert
- Service de chirurgie de l'épaule et du coude, Hautepierre 2, CHRU de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Gallinet D, Barth J, Labattut L, Collin P, Metais P, Bonnevialle N, Godeneche A, Garret J, Clavert P. Benefits of distal clavicle resection during rotator cuff repair: Prospective randomized single-blind study. Orthop Traumatol Surg Res 2020; 106:S207-S211. [PMID: 32943383 DOI: 10.1016/j.otsr.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Rotator cuff tears often occur in combination with acromioclavicular (AC) arthropathy. But it can be difficult to separate pain caused by the rotator cuff tear from pain caused by the AC joint, despite clinical and other examinations. Distal clavicle resection (DCR) is increasingly being done at the same time as arthroscopic rotator cuff repair. The aim of this study was to compare the functional outcomes 1 year after arthroscopic rotator cuff repair between patients who simultaneously undergo DCR and patients who do not. The primary hypothesis was that DCR improves the clinical outcomes. MATERIAL AND METHODS This was a prospective, multicenter, randomized, single-blind study of 200 patients who underwent isolated supraspinatus repair using the same technique. The patients were randomized into two groups: 97 patients who also underwent DCR and 103 patients who did not. The patients were followed until 1 year postoperative according to a standardized radiological and clinical review protocol. RESULTS At 1 year postoperative, all the clinical outcomes were worse in the DCR group, although only external rotation with elbow at side (53° vs. 59°, p=0.04) and the SSV (86.5 vs. 90.1, p=0.04) were statistically different. Overall shoulder pain was higher in the DCR group during the first 3 months postoperative (p=0.04). At 1 year, the DCR group had more residual pain; this pain was mainly located on the superior side of the shoulder (p=0.03), especially when more than 11 mm was resected (p=0.01). More of the shoulders in the DCR group had failures in rotator cuff healing based on ultrasonography (p=0.5). CONCLUSION Our hypothesis was not confirmed. We do not recommend doing routine DCR with arthroscopic rotator cuff repair. LEVEL OF EVIDENCE I, prospective randomized simple blind study.
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Affiliation(s)
- David Gallinet
- Centre Épaule Main Besançon, 16, rue Madeleine Brès, 25000 Besançon, France.
| | - Johannes Barth
- Centre ostéoarticulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Echirolles, France
| | - Ludovic Labattut
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital François Mitterrand CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - Philippe Collin
- Institut locomoteur de l'ouest, 7, boulevard de la Boutière, 35760 Saint Grégoire, France
| | - Pierre Metais
- Elsan Hôpital privé la Châtaigneraie, 63110 Beaumont, France
| | - Nicolas Bonnevialle
- Hôpital Pierre Paul Riquet, CHRU de Toulouse, place Baylac, 31059 Toulouse, France
| | - Arnaud Godeneche
- Centre Orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France
| | - Jérôme Garret
- Clinique du Parc, 155, boulevard Stalingrad, 69006 Lyon, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, Hautepierre 2, CHRU Strasbourg, avenue Molière, 67200 Strasbourg, France
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Wang J, Li H, Jia H, Ma X. Intramedullary versus extramedullary fixation in the treatment of subtrochanteric femur fractures: A comprehensive systematic review and meta-analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:639-646. [PMID: 33423999 DOI: 10.5152/j.aott.2020.19216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This meta-analysis aimed to compare the clinical outcomes of intramedullary fixation with the extramedullary fixation in the surgical management of subtrochanteric fractures by analyzing relevant randomized controlled trials (RCTs) and retrospective cohort studies (RCSs). METHODS The PubMed, Embase, Cochrane Library, Wanfang database, and Chinese National Knowledge Infrastructure (CNKI) were searched from their inception till June 29, 2020. Two reviewers extracted the data, including operation time, intraoperative blood loss, fluoroscopy time, length of stay, union time, nonunion rate, infection rate, implant failure rate, reoperation rate, Harris hip score, and mortality rate. The Cochrane risk-of-bias tool and the Newcastle-Ottawa quality assessment scale were used to evaluate the methodological quality of RCTs and RCSs, respectively. Statistical heterogeneity was quantitatively evaluated with the I2 statistic. RESULTS There were no significant differences in operation time, intraoperative blood loss, average length of stay in hospital, infection rate, implant failure rate, Harris hip scores, and mortality rate. Intramedullary nail could achieve shorter union time (MD=-1.77, 95% CI -3.40~-0.14, p=0.03), lower nonunion rate (RR=0.36, 95%CI 0.14~0.97, p=0.04), and reoperation rate (RR=0.46, 95% CI 0.24~0.89, p=0.02) than extramedullary fixations. The subgroup analysis indicated that intramedullary nail was superior than extramedullary fixations in operation time, reoperation rate, and Harris hip scores in the ≥60-year subgroup. However, the intraoperative blood loss in intramedullary nail group was significantly higher than that of extramedullary fixation group in the <60-year subgroup. CONCLUSION The results of this study have revealed that intramedullary fixation can confer shorter union time, lower nonunion, and reoperation rates compared with extramedullary fixations. Therefore, intramedullary fixation should be considered as the first selection for the treatment of patients with subtrochanteric fractures. LEVEL OF EVIDENCE Level II, Therapeutic study.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Haomin Li
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Haobo Jia
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xinlong Ma
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
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CORR Insights®: Does Distal Clavicle Resection Decrease Pain or Improve Shoulder Function in Patients With Acromioclavicular Joint Arthritis and Rotator Cuff Tears? A Meta-analysis. Clin Orthop Relat Res 2018; 476:2415-2417. [PMID: 30179961 PMCID: PMC6259888 DOI: 10.1097/corr.0000000000000441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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