JSES International最新文献

{"title":"The clinical course and outcomes following arthroscopic frozen shoulder 360° release","authors":"Brandon Ziegenfuss BSc(Hons), MPH ,&nbsp;Kristine Italia MD, FPOA ,&nbsp;Kathir Azhagan Stalin MBBS ,&nbsp;Sarah Whitehouse PhD ,&nbsp;Ashish Gupta MBBS, MSc, FRACS, FAOrthA ,&nbsp;Kenneth Cutbush MBBS, FRACS, FAOrthA","doi":"10.1016/j.jseint.2024.07.006","DOIUrl":"10.1016/j.jseint.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Frozen shoulder (FS) is a debilitating inflammatory condition affecting the shoulder capsule that causes significant pain and stiffness. Its etiology, pathophysiology, and treatment remain poorly understood. Although regarded as self-limiting, FS can have profound implications on the activities of daily living and usually takes 1-4 years to resolve on its own accord. In recalcitrant or severe cases where active range of motion (AROM) is extensively restricted, an arthroscopic 360° release may be performed. The aim of this study is to evaluate the clinical outcomes following the FS 360° arthroscopic release.</div></div><div><h3>Methods</h3><div>An observational prospective cohort study was conducted assessing patient-reported outcome measures (PROMs) in patients who underwent the 360° arthroscopic release between July 2013 and January 2019. Various questionnaires were used to evaluate their shoulder preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively. Relevant PROMs included the Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; American Shoulder and Elbow Surgeons score; and general measures of pain intensity (visual analog scale) and well-being (EQ-5D-3L). AROM movements included forward flexion, abduction, external rotation, internal rotation, as well as external and internal rotation at 90° of abduction.</div></div><div><h3>Results</h3><div>Fifty consented patients underwent the arthroscopic FS 360° release. The mean age was 52.1 ± 7.7 years (range 35-72), and mean body mass index was 27.1 ± 4.7 kg/m² (range 19.5-37.5). All PROMs, AROM movements, patient satisfaction, and EQ-5D-3L scores improved significantly between preoperative and 24-month time points (<em>P</em> &lt; .001). Within-participant analysis demonstrated that there was no significant difference between the pathological shoulder AROM and the contralateral (healthy) shoulder AROM (collected preoperatively) for any movement at 24 months postoperatively (all <em>P</em> &gt; .05). No complications or reoperations were reported.</div></div><div><h3>Conclusion</h3><div>The arthroscopic 360° release is an effective and safe treatment modality for severe or recalcitrant FS. Statistically and clinically significant improvements in AROM and PROMs (Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; and American Shoulder and Elbow Surgeons score) occurred shortly after the surgery and progressively improved from 2 weeks to 24 months postoperatively, with the operative shoulder achieving similar range of motion as the nonpathological contralateral shoulder at 24 months.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morrey Award 2023: radial head donor plug for capitellum osteochondral autograft transfer: a cadaveric biomechanical analysis","authors":"MAJ Bryan G. Adams MD ,&nbsp;LT Jeremy Tran MD ,&nbsp;Steven Voinier PhD ,&nbsp;MAJ Donald F. Colantonio MD ,&nbsp;LTC Michael A. Donohue MD ,&nbsp;LTC Kelly G. Kilcoyne MD ,&nbsp;LTC Joseph W. Galvin DO","doi":"10.1016/j.jseint.2024.07.007","DOIUrl":"10.1016/j.jseint.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Limitations to using the knee as donor cartilage include cartilage thickness mismatch and donor site morbidity. Using the radial head as donor autograft for capitellar lesions may allow for local graft harvest without distant donor site morbidity. The purpose of this study is to demonstrate the feasibility of performing local osteochondral autograft transfer from the nonarticular cartilaginous rim of the radial head to the capitellum. Additionally, we sought to determine the load to failure of the radial head after harvest.</div></div><div><h3>Methods</h3><div>Sixteen matched cadaveric elbows were used. A Kaplan approach was performed in half of the specimens and an extensor digitorum communis split in the other half. 6-mm and 8-mm capitellar cartilage defects were created. A donor plug was harvested from the rim of the radial head and transferred to the capitellum. In half of the specimens, the donor site was backfilled with autograft from the recipient plug. The other half was backfilled with calcium phosphate cement. The radial head was removed from the specimen and biomechanical analysis performed.</div></div><div><h3>Results</h3><div>Both surgical approaches had adequate exposure to access the lateral two-third capitellar lesions in all specimens. The medial third of the capitellum was less accessible in extensor digitorum communis split approaches (1/8) compared to the Kaplan approach (6/8; <em>P</em> = .01). The average cartilage thickness of the peripheral rim of the radial head and capitellum was 2.5 mm (range 1.8-3.2, standard deviation 0.4) and 2.2 mm (range 1.8-3, standard deviation 0.3), respectively. During the procedure, 2 of 8 radial heads fractured in the 8-mm plug group. No radial heads fractured in the 6-mm group (<em>P</em> = .47). Biomechanical testing demonstrated a mean load to failure of 1993N with no difference between groups when stratified by donor plug size or type of backfill.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that the nonarticulating peripheral cartilaginous rim of the radial head could be a local harvest site for osteochondral autograft transfer for capitellar lesions up to 8 mm in diameter. The cartilage thickness of the radial head closely approximates the capitellum. Biomechanical analysis did not demonstrate a significant difference in load to fracture when backfilling the radial head harvest site with autograft bone or calcium phosphate cement. After harvest, the radial head could withstand forces much greater than those seen across the elbow when nonweight-bearing. Further investigation is needed to determine how to mitigate the risk of iatrogenic fracture with this operation.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with subjective shoulder function preoperatively and postoperatively after arthroscopic rotator cuff repair","authors":"Yu Ito RPT, MSc ,&nbsp;Tomoya Ishida RPT, PhD ,&nbsp;Hisashi Matsumoto RPT ,&nbsp;Shota Yamaguchi RPT ,&nbsp;Hideki Ito RPT ,&nbsp;Naoki Suenaga MD, PhD ,&nbsp;Naomi Oizumi MD, PhD ,&nbsp;Chika Yoshioka MD, PhD ,&nbsp;Shintaro Yamane MD, PhD ,&nbsp;Yukiyoshi Hisada MD ,&nbsp;Tomoya Matsuhashi MD, PhD","doi":"10.1016/j.jseint.2024.07.008","DOIUrl":"10.1016/j.jseint.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Understanding factors associated with improvements in subjective shoulder function after arthroscopic rotator cuff repair (ARCR) helps clinicians identify targets for postoperative rehabilitation. The aim of this study was to investigate the factors associated with subjective shoulder function after ARCR.</div></div><div><h3>Methods</h3><div>Patients who underwent ARCR for rotator cuff tear with at least 12 months of follow-up were included. Subjective shoulder function was assessed preoperatively and at 6 and 12 months postoperatively, using the Shoulder36 (Sh36) 5 domain scores (pain, range of motion [ROM], strength, activities of daily living, and general health). Stepwise multivariable regression analysis was performed to extract the relevant factors for each Sh36 domain score using active shoulder ROM, isometric shoulder and elbow strength, pain score, demographic data, intraoperative findings, medical complications, and cuff integrity.</div></div><div><h3>Results</h3><div>A total of 104 patients met the inclusion criteria for this study. Multivariable regression analysis identified active abduction ROM as the factor associated with 5 Sh36 domain scores at preoperatively. At 6 months postoperatively, isometric external rotation strength at the body side or 90° abduction position, but not the ROM factor, was identified as a significant associated factor with 5 Sh36 domain scores. At 12 months postoperatively, pain score was the most associated factor with pain, ROM, strength, and activities of daily living domain scores of Sh36.</div></div><div><h3>Conclusion</h3><div>Factors associated with subjective shoulder function after ARCR differed between the preoperative and postoperative periods. Postoperative treatment, including rehabilitation, should be modified according to the postoperative period after ARCR.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

{"title":"Coronoid height index: a reliable and reproducible technique for quantifying coronoid bone loss in elbow instability","authors":"Olamide Oyelade BMBS ,&nbsp;Mithun A. Joshi MBBS (Hons), FRACS (Orth), FAOrthA ,&nbsp;Joideep Phadnis MBChB, FRCS (Tr & Orth), PhD","doi":"10.1016/j.jseint.2024.07.004","DOIUrl":"10.1016/j.jseint.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Coronoid fracture size is one important factor in decision-making on surgical vs. nonsurgical management. There is currently no reliable, standardized technique to measure coronoid fracture size or bone loss. Hence, decision-making remains arbitrary, and recommendations made in the literature are unreliable. The aim of the study was to develop and assess a simple, reliable computed tomography (CT)-based technique that allows measurement of apical and anteromedial facet (AMF) coronoid height and bone loss. To achieve this, we sought to understand normal coronoid height across a large patient cohort, and whether the new technique was sensitive at detecting bone loss in patients with a fracture.</div></div><div><h3>Methods</h3><div>163 CT scans were manually formatted in the plane of the proximal ulna. A best fit circle was drawn in the greater sigmoid notch on the sagittal section. The coronoid coverage height (CCH) was defined as the distance (in mm) measured at 90° from the greater sigmoid notch floor to a line between the olecranon and coronoid tips (or fracture base in fractured coronoids), bisecting the center of the circle. The coronoid height index (CHI) was calculated as a % by dividing the CCH by the diameter of the circle. The measurements were performed at the coronoid apex and the center of the AMF in 108 intact coronoids to understand normative values and 55 fractured coronoids to assess the sensitivity of the technique at detecting bone loss. Measurements were independently performed by two investigators, and interobserver reliability was assessed with weighted Cohen’s kappa (ĸ) and intraclass correlation coefficient.</div></div><div><h3>Results</h3><div>For intact coronoids, the mean CCH was 11.4 ± 1.4 mm at the apex and 11.6 ± 1.3 mm at the AMF. The mean CHI was 56.7 ± 4.9% at the apex and 41.1 ± 3.6% at the AMF. For fractured coronoids, the mean CCH and CHI were significantly lower (<em>P</em> &lt; .001) at both the apical (9.7 ± 1.4 mm, 45.8% ± 6.5%) and AMF (9.8 ± 1.6 mm, 33.9% ± 6.5%) positions, confirming that the technique was capable of detecting coronoid bone loss. While the CCH (a metric measurement) was significantly higher in men than in women (<em>P</em> &lt; .001), the CHI (a proportion) demonstrated no significant difference at both the apex (<em>P</em> = .06) and AMF (<em>P</em> = .91). Interobserver reliability was good to excellent across all parameters.</div></div><div><h3>Conclusion</h3><div>CHI is a reliable CT-based technique to assess coronoid height and bone loss that is independent of patient size and can be used for clinical and research purposes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and predictors of reporting social determinants of health in shoulder surgery","authors":"Aditya Joshi BS ,&nbsp;Haley Tornberg BS ,&nbsp;Evan Derector BS ,&nbsp;Catherine J. Fedorka MD","doi":"10.1016/j.jseint.2024.07.001","DOIUrl":"10.1016/j.jseint.2024.07.001","url":null,"abstract":"<div><h3>Background</h3><div>The role of social determinants of health (SDH) in patient outcomes, quality of life, and overall well-being has been well documented. However, the inclusion of these variables in randomized control trials (RCTs) remains limited; thus, the extent of generalizability from such trials is brought into question. The purpose of this study is to explore the rates of reporting SDH variables in RCTs focused on shoulder surgery from the past decade.</div></div><div><h3>Methods</h3><div>The PubMed database was searched for RCTs with a focus on shoulder surgery from 2013 to 2023. Duplicates, responses to the editor, biomechanical studies, and nonshoulder studies were excluded. Each article was reviewed and data pertaining to patient demographics and socioeconomic covariates. Journal of publication was recorded, and studies from the 5 most common journals were analyzed. These journals were the Journal of Shoulder and Elbow Surgery, the Journal of Bone and Joint Surgery, the American Journal of Sports Medicine (AJSM), the Bone and Joint Journal, and the Journal of the American Medical Association. Multivariate logistic regression was performed to determine the independent effect of study characteristics on the reporting rates of SDH.</div></div><div><h3>Results</h3><div>A total of 255 articles were reviewed. Of these, 93.3% and 90.2% of articles reviewed reported age and sex, respectively. Employment status was reported in 11.8% of articles. Less than 10% reported race, ethnicity, income, insurance, and housing, with even less performing formal analyses on these variables. Studies that were conducted in the United States, multicenter, had a sample size of 251+, and had a combination of public and private funding which were significantly more likely to report on race and ethnicity. Reporting employment status was significantly associated with being European-based, multicenter, sample size 251+, double-blinded, and published in AJSM. Newer studies were significantly less likely to report education. Only publication in AJSM was significant for reporting income. Study intervention and topic were not significant for any SDH reporting.</div></div><div><h3>Discussion</h3><div>These data reflect how small of a proportion of RCTs report and analyze on SDH variables. These findings reflect a need for future RCTs to accurately report SDH variables that influence outcomes, such as race, ethnicity, education, employment, income, housing status, and insurance. SDH are infrequently reported and analyzed in RCTs pertaining to shoulder surgery. Academic medical journals should incorporate guidelines to encourage studies to include such variables and enable the assessment of outcomes to apply to a broader population.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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

{"title":"Correlation between the optimal screening for prediction of referral and outcome yellow flag tool and patient-reported legacy outcome measures in patients undergoing shoulder surgery","authors":"Billy I. Kim MD,&nbsp;Kevin A. Wu BS,&nbsp;Emily J. Luo BS,&nbsp;Nicholas J. Morriss MD,&nbsp;Grant H. Cabell MD,&nbsp;Trevor A. Lentz PT, PhD, MPH,&nbsp;Brian C. Lau MD","doi":"10.1016/j.jseint.2024.06.014","DOIUrl":"10.1016/j.jseint.2024.06.014","url":null,"abstract":"<div><h3>Background</h3><p>The Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Tool is a 10-item multidimensional screening tool utilized to evaluate pain-related psychological traits in individuals with musculoskeletal pain conditions. The validity of postoperatively collected OSPRO-YF is unclear. This study sought to assess validity of the OSPRO-YF by comparing it to patient-reported outcome scores in both preoperative and postoperative settings.</p></div><div><h3>Hypothesis</h3><p>The authors hypothesized that OSPRO-YF overall score would correlate with shoulder and global function PROs at preoperative and postoperative timepoints.</p></div><div><h3>Methods</h3><p>A review of 101 patients undergoing shoulder surgery by one sports medicine orthopedic surgeon at a large academic institution was conducted. 90 and 54 patients had complete preoperative and postoperative patient-reported outcome responses. OSPRO-YF, American Shoulder and Elbow Surgeons (ASES) Evaluation Form, and Patient-Reported Outcomes Measurement Information System Computer Adaptive Test (PROMIS-CAT) were routinely administered before and after surgery at the senior author’s clinic visits. Concurrent validity of OSPRO-YF at either timepoint was assessed by comparing scores with PROs cross-sectionally using Pearson correlations and multiple comparison corrections.</p></div><div><h3>Results</h3><p>Preoperatively, higher OSPRO-YF total score was associated with greater concurrent PROMIS-CAT Pain Interference (r = 0.43; <em>P</em> &lt; .01) and Depression (r = 0.36; <em>P</em> = .05) and lower ASES (r = −0.34; <em>P</em> &lt; .01). Higher postoperative OSPRO-YF was also associated with greater concurrent PROMIS-CAT Pain Interference (r = 0.43; <em>P</em> &lt; .01) and Depression (r = 0.36; <em>P</em> &lt; .01) and lower ASES (r = −0.34; <em>P</em> = .01). ASES had strong correlation with Single Assessment Numeric Evaluation and Pain scores at both preoperative and postoperative timepoints. Single Assessment Numeric Evaluation was not significantly associated with OSPRO-YF total score or number of yellow flags at either timepoints.</p></div><div><h3>Conclusion</h3><p>The study findings support the clinical validity of the 10-item OSPRO-YF tool when administered before or after shoulder surgery. For patients exhibiting suboptimal recovery or those identified as high risk at initial screening, assessment of pain-related psychological distress postoperatively may be particularly beneficial in guiding rehabilitation.</p></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666638324001622/pdfft?md5=7e9bb5308eb4bbc72db1733021b58d23&pid=1-s2.0-S2666638324001622-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}