Purpose To evaluate the clinical and radiographic outcome of a biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tear. Methods Between January 2011 and December ...2014, all shoulders with symptomatic massive irreparable rotator cuff tears treated at our institution with arthroscopic implantation of a biodegradable subacromial spacer followed for at least 1 year were included in our series. Patients with osteoarthritis ≥ grade 3 in the Hamada classification were excluded. Outcome measures included pre- and postoperative, range of motion, Constant score, acromiohumeral distance, and Hamada classification on anteroposterior and lateral radiographs. Results Thirty-nine consecutive shoulders (37 patients) met the inclusion criteria. The mean age of patients was 69.8 (53-84) years. At the last follow-up (mean 32.8 ± 12.4 months), range of motion was significantly increased for all patients in anterior elevation (from 130° to 160°, P = .02), abduction (from 100° to 160°, P = .01), and external rotation (from 30° to 45°, P = .0001). The mean Constant score was also significantly ( P < .001) improved from 44.8 (±15.2) preoperatively to 76.0 (±17.1) at the last follow-up. The mean acromiohumeral distance significantly ( P = .002) decreased from 8.2 mm (±3.4) to 6.2 mm (±3.1) at the last follow-up. The Hamada score progressed of 1 radiographic stage in 4 shoulders (15%) and progressed of 3 stages in 2 (4%), whereas the other 32 shoulders remained stable. No intra- or postoperative complications were found except for 1 patient who required a revision for spacer migration. Conclusions Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear leads to significant improvement in shoulder function at a minimum of 1 year postoperatively. Level of Evidence Level IV, therapeutic case series; treatment study.
Purpose To compare postoperative pain during the first postoperative week and the position of the coracoid bone block at the anterior aspect of the glenoid after the arthroscopic and the mini-open ...Latarjet procedure. The secondary purpose was to assess functional results and recurrence after at least 2 years of follow-up. Methods This comparative prospective study included patients who underwent a Latarjet-Bristow procedure for anterior shoulder instability in 2012. The Latarjet procedure was performed by a mini-open approach (G1) in one center and by an arthroscopic approach (G2) in the other. The main evaluation criterion was average shoulder pain during the first postoperative week assessed by the patient on a standard 10-cm visual analog scale (0-10). Secondary criteria were consumption of analgesics during the first week, the position of the coracoid bone block on radiograph and computed tomography scan at the 3-month follow-up and clinical outcomes (Western Ontario Score Index and new surgery) after at least 2 years of follow-up. Results Fifty-eight patients were included, 22 G1 and 36 G2, 13 women and 45 men, mean age 26.9 ± 7.7 years. The mean follow-up was 29.8 ± 4.4 months. There was significantly less pain in the arthroscopic Latarjet group than in the mini-open group during the first postoperative week (2.5 ± 1.4 vs 1.2 ± 1.2, P = .002) with comparable consumption of analgesics ( P > .05). The arthroscopic Latarjet procedure resulted in a more lateral coracoid bone block ( P = .04) and a better equatorial position than the mini-open technique ( P = .02). Three patients underwent revision surgery (1 recurrence 2.8%, 1 block fracture, 1 screw ablation) in the arthroscopic group, none in the mini-open group ( P = .54). At the final follow-up, the Western Ontario Score Index score was good in all patients (G1: 78.5 ± 7.5% vs G2: 82.3 ± 7%, P = .03). Conclusions This prospective comparative study showed that the arthroscopic Latarjet procedure was significantly less painful than the mini-open procedure during the first postoperative week. The clinical outcomes were comparable after at least 2 years of follow-up. Level of Evidence Level II, prospective comparative study.
Background:
It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation.
Purpose:
To compare ...the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test.
Results:
A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures.
Conclusion:
Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.
Background:
The preoperative number of dislocations has been previously proved to be a major factor influencing the results after Bankart repair with more preoperative dislocations correlated with ...higher recurrence rates and more reoperations. This could possibly be because of the lower quality of the tissue repaired during the procedure after multiple dislocations. On the other hand, the Latarjet procedure does not “repair” but rather reconstructs and augments the anterior glenoid.
Purpose/Hypothesis:
The main objective was to report the clinical outcomes of patients undergoing a Latarjet procedure after 1 dislocation versus multiple (≥2) dislocations. The hypothesis was that the preoperative number of dislocations would not influence clinical results.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients older than 18 years who had undergone a primary Latarjet procedure for shoulder instability with at least 2 years of follow-up were included. Three different techniques were used: a mini-open technique using 2 screws, an arthroscopic technique using 2 screws, and an arthroscopic technique using 2 cortical buttons. Patients were evaluated and answered a questionnaire to assess the number of episodes of dislocation before surgery, the time between the first dislocation and surgery, recurrence of the dislocation, revision surgery, the Walch-Duplay score, the Simple Shoulder Test score, and the visual analog scale (VAS) score for pain.
Results:
A total of 308 patients were included for analysis with a mean follow-up of 3.4 ± 0.8 years. Of that, 83 patients were included in the first-time dislocation group and 225 in the recurrent dislocation group. At last follow-up, the rates of recurrence and reoperation were not significantly different between groups: 4.8% in the first-time dislocation group versus 3.65% in the recurrent dislocation group and 6.1% versus 4.0%, respectively. The overall Walch-Duplay scores at last follow-up were also comparable between the 2 groups, 67.3 ± 24.85 and 71.8 ± 25.1, even though the first-time dislocation group showed a lower pain subscore (15.0 ± 8.6 vs 18.0 ± 7.5; P = .003). The VAS for pain was also significantly higher in the first-time dislocation group compared with the recurrent dislocation group (1.8 ± 2.3 vs 1.2 ± 1.7; P = .03).
Conclusion:
The number of episodes of dislocation before surgery does not affect postoperative instability rates and reoperation rates after the Latarjet procedure. However, patients with first-time dislocations had more postoperative pain compared with patients with recurrent dislocations before surgery.
Tendon formation and repair rely on specific combinations of transcription factors, growth factors, and mechanical parameters that regulate the production and spatial organization of type I collagen. ...Here, we investigated the function of the zinc finger transcription factor EGR1 in tendon formation, healing, and repair using rodent animal models and mesenchymal stem cells (MSCs). Adult tendons of Egr1-/- mice displayed a deficiency in the expression of tendon genes, including Scx, Col1a1, and Col1a2, and were mechanically weaker compared with their WT littermates. EGR1 was recruited to the Col1a1 and Col2a1 promoters in postnatal mouse tendons in vivo. Egr1 was required for the normal gene response following tendon injury in a mouse model of Achilles tendon healing. Forced Egr1 expression programmed MSCs toward the tendon lineage and promoted the formation of in vitro-engineered tendons from MSCs. The application of EGR1-producing MSCs increased the formation of tendon-like tissues in a rat model of Achilles tendon injury. We provide evidence that the ability of EGR1 to promote tendon differentiation is partially mediated by TGF-β2. This study demonstrates EGR1 involvement in adult tendon formation, healing, and repair and identifies Egr1 as a putative target in tendon repair strategies.
Abstract
With the emergence of disease modifying osteoarthritis drugs (DMOAD), imaging methods to quantitatively demonstrate their efficacy and to monitor osteoarthritis progression at the functional ...level are urgently needed. Our group showed that articular cartilage can be quantitatively assessed in nuclear medicine imaging by our radiotracer
99m
Tc-NTP 15-5 targeting cartilage proteoglycans. In this work, surgically induced DMM mice were treated with sprifermin or saline. We investigated cartilage remodelling in the mice knees by
99m
Tc-NTP 15-5 SPECT-CT imaging over 24 weeks after surgery, as wells as proteoglycan biochemical assays. OA alterations were scored by histology according to OARSI guidelines. A specific accumulation of
99m
Tc-NTP 15-5 in cartilage joints was evidenced in vivo by SPECT-CT imaging as early as 30 min post-iv injection. In DMM,
99m
Tc-NTP 15-5 accumulation in cartilage within the operated joints, relative to contralateral ones, was observed to initially increase then decrease as pathology progressed. Under sprifermin,
99m
Tc-NTP 15-5 uptake in pathological knees was significantly increased compared to controls, at 7-, 12- and 24-weeks, and consistent with proteoglycan increase measured 5 weeks post-surgery, as a sign of cartilage matrix remodelling. Our work highlights the potential of
99m
Tc-NTP 15-5 as an imaging-based companion to monitor cartilage remodelling in OA and DMOAD response.
Purpose
The purpose of this study was to compare the clinical results of the Latarjet procedure using two cortical buttons vs two screws. It was hypothesized that cortical button would result in ...similar rates of recurrent dislocations, but a lower rate of reoperation compared to screw fixation.
Methods
A retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior glenohumeral instability. Patient demographics, number of dislocations prior surgery, arm dominance, shoulder hyperlaxity, level of sport, type of sport and ISIS score were collected. Shoulders were separated into two groups based on surgical fixation (screws vs cortical button). Postoperatively, shoulders were evaluated for recurrent dislocation, revision surgery, post-operative Walch–Duplay score, and the Simple shoulder test (SST). Two hundred and thirty-six patients were included in the screw fixation group (group A) and 72 in button fixation group (group B) and were evaluated at a mean follow-up of 3.4 ± 0.8 years. Demographics of the two groups were similar with the exception of operative side hand dominance, which was more common in group B 50 (69.4%) vs 128 (54.2%),
p
= 0.02.
Results
Recurrent dislocation was significantly lower in Group A: 6 (2.5%) vs 6(8.3%) (
p
= 0.02). Reoperation was more common in group A 14 (5.9%) vs 0 (0%). At follow-up, Walch–Duplay scores and simple shoulder tests were similar in both groups.
Conclusion
Button fixation for Latarjet showed higher rates of recurrent dislocation compared to screw fixation. However, the increased stability afforded by screw fixation needs to be weighed against the increased risk of reoperation for hardware prominence.
Level of evidence
III.
Background:
An isolated arthroscopic Bankart repair carries a high mid- and long-term risk of recurring instability. Preoperative patient selection based on the Instability Severity Index Score ...should improve outcomes.
Purpose:
To report the overall long-term recurrence rate for isolated Bankart repair, investigate the predictive factors for recurrence, analyze time to recurrence, and determine a quantitative cutoff point for recurrence in terms of Instability Severity Index Score.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
This was a prospective multicenter study. Inclusion criteria were recurring anterior instability and an Instability Severity Index Score of 4 or less. Of the 125 patients included, 20 patients had a score of 0, 31 patients scored 1, 29 patients scored 2, 34 patients scored 3, and 11 patients scored 4. All centers used the same arthroscopic technique and rehabilitation protocol. Follow-up data were collected at 3, 6, 12, and 24 months and 3 and 9 years. The primary endpoint was recurrence of instability (total or partial dislocation). The statistical analysis was performed by use of the software package SAS 9.4.
Results:
We initially identified 328 patients, of whom 125 patients were prospectively included. The main reason for excluding the 202 patients was the presence of bony lesions, which carry 2 points each in the Instability Severity Index Score (humeral head notch and/or glenoid lesion visible on standard radiographs). Of the 125 eligible patients, 73% were athletes and 22.5% competitors; 16% were lost at the last follow-up. At the endpoint, 23% had experienced a recurrence after a mean interval of 35 months (range, 5.5-103 months). No statistical differences were found between patients with and without bony lesions in the overall group of 125 patients or in the subgroup with an Instability Severity Index Score of 3 or 4 points (P = .4). According to univariate analysis, the only predictive factor for recurrence was age less than 20 years at the time of surgery, with a 42% rate of recurrence in this group (P = .03). Multivariate analysis showed that the Instability Severity Index Score was the only predictive factor with a quantitative cutoff point (namely, a score of ≤2 points) that was statistically associated with a decreased long term recurrence rate (P = .02). The recurrence rate was 10% for a preoperative Instability Severity Index Score of 2 or less compared with 35.6% for a score of 3 or 4. The survival curves demonstrated no new dislocations after year 4 for patients with an Instability Severity Index Score of up to 2 points.
Conclusion:
In a preselected population, mainly without bony lesions, the Instability Severity Index Score cutoff value that provides an acceptable recurrence rate at 9 years after isolated Bankart repair is 2 out of 10.
To analyze the learning curves of 5 experienced, fellowship-trained shoulder surgeons and their respective 25 first arthroscopic Latarjet cases in regard to surgical time, graft placement, ...complication rates, and recurrent instability.
The first 25 arthroscopic Latarjet procedures of 5 surgeons were retrospectively analyzed in an international multicenter setting, and thus 125 patients were included in this study. The surgical time, intraoperative and postoperative events out of the ordinary, and graft positioning were examined.
The 125 patients consisted of 16 women (12.8%) and 109 men (87.2%). In 81.6% (n = 102), surgery was undertaken as a first-line procedure, whereas 18.4% (n = 23) were revisions. Surgical time decreased significantly from an average of 123.8 minutes (range 70 to 210) to 92.6 minutes (range 50 to 160) from the first 5 cases to the last 5 cases of each surgeon within a period of <2 years. Overall, 22 events in 21 patients requiring additional treatment were reported (17.6%). Five (4%) were unlikely to affect final outcome and did not require revision surgery. Twelve (9.6%) required revision surgery that was not trauma related yet was prone to affect outcomes. Five events were trauma-related (4%), 4 requiring revision surgery and 1 treated conservatively. Overall, 6 patients (4.8%) had recurrent shoulder instability, 3 as a result of a traumatic event. Conventional radiology showed the bone-block in ideal positioning in 93 cases (74.4%), flush with the glenoid in a true anteroposterior view. In 3 cases (2.4%), it was considered too high, 15 too low (12%), 5 too lateral (4%), and 15 too medial (12%). Some patients had combinations of the above.
This analysis shows that surgical time in arthroscopic Latarjet can be significantly reduced after only 20 cases. However, complication rates did not decrease over this time. The authors believe that the arthroscopic Latarjet is a challenging yet viable technique to treat anterior shoulder instability, achieving results equal to the open technique with advantages of the arthroscopic setting.
Level IV, retrospective cohort study.
Background:
One of the most frequent demands from patients after shoulder replacement surgery is to return to sport.
Purpose:
To determine the rate of return to sport after shoulder arthroplasty ...(total shoulder arthroplasty, reverse shoulder arthroplasty, hemiarthroplasty) in recreational athletes.
Study Design:
Meta-analysis and systematic review.
Methods:
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating return to sport after shoulder replacement surgery and on patients practicing a sport regularly, whatever the level, with all ages and sports included. The main criterion was the rate of patients who returned to a sport activity.
Results:
Nine studies were selected among the 35 identified, including a total of 613 patients (39% male and 61% female) with a mean age of 71.7 years (range, 22.6-92.6 years). All the included patients practiced sports before surgery. The most common reported sports were golf (n = 140), swimming (n = 128), and tennis (n = 54). The mean rate of return to sport was 80.7% (range, 57.1%-97.3%). All patients who returned to sport were practicing in the 3 months before surgery. No radiological data were reported in the literature. The subgroup analysis for resuming golf after shoulder arthroplasty revealed a rate of return to sport of 79.2% (95% CI, 62.9%-89.5%). In the swimming subgroup, the rate was 75.6% (95% CI, 61.3%-85.8%) and in the tennis subgroup was 63.5% (95% CI, 34.1%-85.5%). The subgroup analysis for reverse shoulder arthroplasty reported a lower rate of return to sport than for all types of shoulder arthroplasty combined: 76.5% (95% CI, 60%-87%) versus 80.7% (95% CI, 70.9%-87.8%), respectively.
Conclusion:
Most patients returned to sport after surgery, and all who returned to sport were practicing their sport in the 3 months before surgery. No radiological data were reported in the literature.
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