JSES International最新文献

{"title":"Muscle strength measurements reflecting the extent of complete subscapularis tears: reliability in patients with rotator cuff tears","authors":"Wataru Sahara MD, PhD ,&nbsp;Keishi Takagi PT ,&nbsp;Shuhei Tada PT ,&nbsp;Daichi Yamada PT ,&nbsp;Hiroki Kiya PT ,&nbsp;Hiroto Hanai MD, PhD ,&nbsp;Shoji Konda PhD ,&nbsp;Seiji Okada MD, PhD","doi":"10.1016/j.jseint.2024.08.201","DOIUrl":"10.1016/j.jseint.2024.08.201","url":null,"abstract":"<div><h3>Background</h3><div>While several clinical tests for diagnosing subscapularis (SSC) tears have been reported, no quantitative method reflecting tear size has been established. This study investigated muscle strength measurements that best reflect the extent of SSC tears and clarified their reliability.</div></div><div><h3>Methods</h3><div>We analyzed 107 patients (111 shoulders) who underwent arthroscopic surgery for rotator cuff tears, assessing preoperative and postoperative muscle strength. Isometric internal rotation strength was measured by using a handheld dynamometer using three techniques: the belly-press, Napoleon, and bear-hug techniques. The correlation between the extent of complete SSC tears and preoperative strength for each technique was assessed using Spearman’s rank correlation coefficient. Intrarater reliability was assessed using the intraclass correlation coefficient (ICC) (1, 3), minimal detectable change (MDC), and MDC% based on three preoperative measurements on the operated side. Test-retest reliability was evaluated using these parameters from measurements on the nonoperated side preoperatively and at 6- and 12-month postoperative intervals.</div></div><div><h3>Results</h3><div>The correlation coefficient between the extent of SSC tears and the strength of each muscle was approximately −0.45 for all techniques, indicating a weak negative correlation. The intrarater reliability for all techniques showed ICC (1, 3) &gt;0.95, MDC &lt;10 N, and MDC% of approximately 10%. The Napoleon technique demonstrated the highest test-retest reliability, with ICC (3, 1) of 0.87, MDC of 17 N, and MDC% of 21%.</div></div><div><h3>Conclusion</h3><div>The Napoleon technique provided more stable muscle exertion than the other methods. The results may aid in determining whether postoperative muscle strength recovery falls within the range of measurement error.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 109-115"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081001","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":"A single-surgeon experience with the internal joint stabilizer of the elbow across 56 cases","authors":"John J. Heifner MD ,&nbsp;Gagan Grewal MD ,&nbsp;Christopher J. Castagno MD ,&nbsp;Gil Gontre MD","doi":"10.1016/j.jseint.2024.08.204","DOIUrl":"10.1016/j.jseint.2024.08.204","url":null,"abstract":"<div><h3>Background</h3><div>Recurrent instability continues to plague outcomes of elbow trauma. Adjuvant stabilization—whether internal or external—is intended to acutely stabilize the elbow and off-load the repair construct(s) during early mobilization. Our objective was to report clinical outcomes for a single-surgeon consecutive series using the internal joint stabilizer (IJS) of the elbow. Furthermore, we intend to describe technical points that have been gleaned from the experience which may provide guidance.</div></div><div><h3>Methods</h3><div>A retrospective follow-up was performed for cases of elbow instability treated with the IJS (Skeletal Dynamics, Miami, Florida, USA) from 2016-2023 with a minimum requirement of 6 months of follow-up. Clinical outcomes and complications including recurrent instability were compiled.</div></div><div><h3>Results</h3><div>Of 87 potential cases, 56 met the inclusion criteria. Simple dislocations (30%) and terrible triad injury (21%) were the most common injury patterns. The mean Mayo Elbow Performance Score was 81 and the mean Disabilities of the Arm, Shoulder, and Hand score was 22.5. Recurrent instability occurred in 5.3% of cases. The mean time to removal was 21.1 weeks.</div></div><div><h3>Discussion</h3><div>Our utilization of the IJS of the elbow has evolved from simple dislocations to complex instability cases. Results demonstrated satisfactory clinical outcomes with low rates of recurrent instability and revision. The ability for early mobilization was a critical determinant for using an IJS in these cases. This advantage carried particular importance in cases that presented subacutely following an extended course of immobilization. Our protocol for removal timing is applied on a case-by-case basis and involves identification of sufficient rehabilitation and clinical stability.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 244-249"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081125","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":"Association of neighborhood level socioeconomic status and patient reported clinical improvement following total shoulder arthroplasty","authors":"Caleb Morgan MD ,&nbsp;Amanda Firoved MOT, OTR ,&nbsp;Patrick J. Denard MD ,&nbsp;Justin W. Griffin MD","doi":"10.1016/j.jseint.2024.08.205","DOIUrl":"10.1016/j.jseint.2024.08.205","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies have demonstrated higher preoperative pain and decreased patient-reported outcomes (PROs) following total shoulder arthroplasty (TSA) in individuals with lower socioeconomic status (SES). The goal of this study was to investigate the rate of clinical improvement following TSA in individuals with differing SES.</div></div><div><h3>Methods</h3><div>Individuals included in this study underwent anatomic or reverse TSA by 2 surgeons between May 2018 and January 2021. Patients were split into 3 SES groups (low, moderate, and high) based on neighborhood SES level as determined by Area Deprivation Index. PROs were collected preoperatively and at 9 weeks, 26 weeks, 1 year, and 2 years postoperatively. Shoulder-specific PROs included the American Shoulder and Elbows Surgeons shoulder score, 10-point visual analog scale for pain, single-assessment numeric evaluation, and Western Ontario Osteoarthritis of the Shoulder Index. The Veterans Rand 12-Item health survey was used to measure overall well-being. We used a mixed-design analysis of variance to determine the interaction of time and improvement in PROs following surgery followed by 1-way mixed-design analysis of variance with post-hoc analysis.</div></div><div><h3>Results</h3><div>One hundred seventy individuals (low SES n = 34, moderate n = 90, high n = 46) met the inclusion criteria and were included in this study. There were no significant differences between groups for body mass index or age at time of surgery. All groups significantly improved from baseline scores on all PROs (<em>P</em> &lt; .001) with the majority of improvement being achieved within the first year after surgery. There were no significant differences in rate of clinical improvement on PROs among the groups when compared to their respective preoperative scores. Significant differences were discovered when comparing groups independent of time with the low- and moderate-SES groups scoring significantly lower on American Shoulder and Elbows Surgeons shoulder score when compared to the high-SES group (<em>P</em> &lt; .01) and the low-SES group reporting significantly higher visual analog scale pain when compared to the high-SES group (<em>P</em> = .034).</div></div><div><h3>Conclusion</h3><div>Individuals with lower SES at the neighborhood level report higher pain and decreased shoulder function both preoperatively and postoperatively following TSA; however, the rate of clinical improvement following surgery in this group is comparable to individuals with higher SES when compared to baseline scores. All groups demonstrated significant improvement following surgery, suggesting TSA remains a successful operation regardless of SES.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 175-180"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081221","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":"The clinical impact of glenoid concavity and version on anterior shoulder stability","authors":"Sebastian Oenning MD ,&nbsp;Clara de Castillo ,&nbsp;Elena Jacob MD ,&nbsp;Arne Riegel MD ,&nbsp;Philipp A. Michel MD ,&nbsp;Jens Wermers MSc ,&nbsp;Michael J. Raschke MD ,&nbsp;J. Christoph Katthagen MD","doi":"10.1016/j.jseint.2024.09.029","DOIUrl":"10.1016/j.jseint.2024.09.029","url":null,"abstract":"<div><h3>Background</h3><div>In recent biomechanical studies, the importance of glenoid concavity and version for anterior shoulder stability has been highlighted. With this study, we aimed to assess their clinical relevance as stabilizing factors. We hypothesized that low glenoid concavity and low retroversion are associated with anterior glenohumeral instability.</div></div><div><h3>Methods</h3><div>In this single-center, retrospective case-control study, computed tomography scans of n = 34 patients following acute anteroinferior glenohumeral dislocation between 2015 and 2021 were included. Patients with glenoid fractures and pre-existing glenohumeral pathologies were excluded. In the control group, n = 68 polytrauma patients referred to our level-I-trauma center were included, who showed neither acute nor chronic glenohumeral pathologies. Both groups were matched age- and gender-specifically in a 2:1 ratio. Glenoid concavity was measured according to the bony shoulder stability ratio (BSSR) in anterior-posterior (AP) and superior-inferior (SI) direction. Version was measured by the glenoid vault method.</div></div><div><h3>Results</h3><div>The instability cohort presented with a lower BSSR (SI) compared to the control group (49.8% vs. 56.9%, <em>P</em> = .001). The BSSR (AP) did not differ significantly (30.2% vs. 33.7%, <em>P</em> = .163). A higher retroversion was seen in the instability cohort (−13.1° vs. −11.4°; <em>P</em> = .041). Subgroup analyses showed higher BSSR (SI) in ≥60-year-old patients compared to ≤30-year-old patients. BSSR (AP) and glenoid version did neither differ age- nor gender-specifically.</div></div><div><h3>Conclusion</h3><div>Glenoid concavity is a relevant factor for anterior shoulder stability in the clinical setting. In contrast to recent biomechanical studies, glenoid version appears to have only limited clinical impact on anterior stability. Regarding the individual treatment of anterior glenohumeral instability, glenoid concavity should be focused on as an essential bony stabilizing factor.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 62-69"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081291","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":"The efficacy of conservative management of micro-traumatic posterior shoulder instability","authors":"Lyn Watson Prof DocBAppSci(Physio) GradDip ,&nbsp;Simon Balster BPhty(Hon), BSc (Hon) ,&nbsp;Sarah Warby PhDB Physio (Hon) ,&nbsp;Ross Lenssen BHSc(Physiotherapy) ,&nbsp;Gregory Hoy MBBS, FRACS, FAOrthA, FACSP ,&nbsp;Shane Barwood MBBS, FRACS ,&nbsp;Jacqui French BPhysio ,&nbsp;Bonnie Kerr BHth ScMSports Physio ,&nbsp;Sam Lawrence DPT, BAppSc, PGCert ,&nbsp;Charlotte Ganderton PhDB Physio (Hon) ,&nbsp;Katherine Davis BHuman Movt (ExSci), MPhysio ,&nbsp;Tania Pizzari PhDB Physio (Hon)","doi":"10.1016/j.jseint.2024.09.016","DOIUrl":"10.1016/j.jseint.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><div>Microtraumatic posterior shoulder instability (PSI) is characterized by symptomatic posterior translation of the glenohumeral joint. A common etiology is a gradual overload of glenohumeral joint structures. The recommend initial treatment for microtraumatic PSI is rehabilitation; however, the evidence to support this recommendation is limited. The aim of this study is to investigate the patient- reported outcome measures and return to sport success of participants with microtraumatic PSI who participate in a posterior instability rehabilitation program.</div></div><div><h3>Methods</h3><div>In the single-group study design, 24 shoulders in 22 sporting participants (17 male, 5 females; mean age, 21.1 years, standard deviation 10.1 years) diagnosed with microtraumatic PSI undertook the Watson Posterior Instability Program (WIP-p) over 24 weeks. Outcome measures included the Melbourne Instability Shoulder Score and Western Ontario Shoulder Instability Index at baseline, 6, 12, and 24 weeks. Failure of conservative management and time to return to sport was measured. Treatment effects were determined using linear mixed models, with 95% confidence intervals. Significance was set at 0.05.</div></div><div><h3>Results</h3><div>After 24 weeks of the WIP-p, participants had significant improvements at 12 (effect size or standardized mean difference (SMD): 1.1, <em>P</em> &lt; .001) and 24 weeks (SMD: 1.8, <em>P</em> &lt; .001) on the Western Ontario Shoulder Instability Index and significant improvements at 6 (SMD; 0.74, <em>P</em> = .036), 12 (SMD: 0.41, <em>P</em> = .007) and 24 weeks (SMD: 1.7, <em>P</em> &lt; .001) on the Melbourne Instability Shoulder Score. For return to sport, 20 of the 22 (90.1%) participants returned to full activity at the 24-week time point, while two went on to have reconstructive surgery.</div></div><div><h3>Discussion and Conclusion</h3><div>The WIP-p resulted in a high level of return to sport and significantly improved functional outcomes in patients with microtraumatic PSI. A small proportion of sporting participations with microtraumatic PSI may fail conservative rehabilitation and require surgical consideration.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 46-55"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081294","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":"What activities do patients hope to perform following anatomic total shoulder arthroplasty but are unable to? Looking beyond patient-reported outcome measures","authors":"Alexander E. White MD ,&nbsp;Nicolas Pascual-Leone MD ,&nbsp;Anthony Finocchiaro BS ,&nbsp;Christopher M. Brusalis MD ,&nbsp;David M. Dines MD ,&nbsp;Joshua S. Dines MD ,&nbsp;Andreas Kontaxis PhD ,&nbsp;Samuel A. Taylor MD ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Michael C. Fu MD, MHS","doi":"10.1016/j.jseint.2024.09.007","DOIUrl":"10.1016/j.jseint.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing anatomic total shoulder arthroplasty (aTSA) routinely achieve significant improvements in common patient-reported outcome measures (PROMs). While these structured PROMs produce reliable and standardized data for surgeons, individual patient desires and expectations related to postoperative activities may not be completely captured in standard PROMs. The purpose of the present study was to identify specific activities, sports, and/or hobbies that patients wish they could perform but are unable to following aTSA at a minimum of 2 years postoperatively.</div></div><div><h3>Methods</h3><div>Patients who underwent primary aTSA, with a primary diagnosis of glenohumeral osteoarthritis between February 1, 2016 and January 1, 2021, were identified using an institutional clinical registry. A survey was sent to patients at a minimum of 2 years postoperatively, which included a free-text-response section in addition to 8 selection-based questions assessing patients’ ability to perform various activities.</div></div><div><h3>Results</h3><div>The survey was sent to 601 patients and 395 responded (65.7% response rate). The mean age at the time of the surgery for responders was 65.75 ± 8.8 years. There was no significant difference in age (<em>P</em> = .095), sex (<em>P</em> = .691), race (<em>P</em> = .090), or ethnicity (<em>P</em> = .054) between responders and nonresponders. The majority of patients had no difficulty managing toileting (93.7%), driving a car (92.4%), washing their hair (91.9%), and putting on a seatbelt (90.7%). Of the 395 total responders, 131 (33.2%) patients reported at least one desired activity that they could not perform. Of these 131 patients, weightlifting (14.5%), throwing a ball (12.9%), playing tennis (11.4%), carrying/holding groceries (11.4%), and performing pushups/planks (11.4%) were most commonly reported.</div></div><div><h3>Conclusion</h3><div>Following aTSA, patients are able to perform the majority of activities of daily living without difficulty. A subset of patients desire but are unable to participate in several sports and hobbies following aTSA—most commonly, weightlifting, tennis, throwing a ball, and swimming. These limitations present opportunities for further improvements in postoperative outcomes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 188-193"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081339","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":"The influence of scapular orientation on the medial scapula corpus angle in snapping scapula syndrome","authors":"Brittany Percin BS, MS4 ,&nbsp;Joseph Featherall MD ,&nbsp;Robert Z. Tashjian MD ,&nbsp;Peter N. Chalmers MD ,&nbsp;Christopher D. Joyce MD ,&nbsp;Alexander J. Mortensen MD ,&nbsp;Heath B. Henninger PhD","doi":"10.1016/j.jseint.2024.08.179","DOIUrl":"10.1016/j.jseint.2024.08.179","url":null,"abstract":"<div><h3>Background</h3><div>Snapping scapula syndrome (SSS) can result in crepitus and painful scapulae during motion and may be treated with bursectomy and/or superomedial angle resection. The medial scapula corpus angle (MSCA) measures blade curvature on a transverse plane below the suprascapular fossa and may indicate SSS, yet a large overlapping range in MSCA exists between patients with and without SSS. This study quantified the effects of 3-dimensional scapula orientation in the imaging field, and the resulting variability in scapula type and MSCA.</div></div><div><h3>Methods</h3><div>Computed tomography scans from 10 healthy controls (non-SSS) and 8 SSS patients were used to create 3-dimensional scapula models. The scapula type and MSCA were measured on a controlled reference imaging plane, and ones translated and rotated below the supraspinatus fossa to create 19 planes simulating variations due to scapulothoracic orientation. Planes translated and rotated above the reference plane also generated 13 modified MSCA planes to test areas modified during surgical resection. Statistical analyses compared the scapula type and MSCA between the reference and alternate planes within groups.</div></div><div><h3>Results</h3><div>Scapula type commonly changed and the MSCA varied up to 104° within a subject depending on the imaging plane, regardless of location below or above the reference plane. Numerous statistical differences were detected in MSCA between the reference plane and those translated and rotated below that plane in both non-SSS and SSS groups. Planes translated above the reference plane showed consistent statistical differences in MSCA to the reference plane, but only in the SSS group.</div></div><div><h3>Discussion</h3><div>Although scapula type and MSCA were previously shown to differentiate patients, the effect of viewing perspective was not considered. Differences in scapula orientation relative to the imaging plane dramatically varied the scapula type and MSCA, far exceeding differences between groups described previously. Herein, scapula type and MSCA often differed in planes translated above the reference plane, suggesting that scapular abnormalities contributing to SSS are largely at or close to the superomedial angle.</div></div><div><h3>Conclusion</h3><div>The MSCA as defined previously likely lacks the sensitivity and specificity to reliably be used as a clinical diagnostic tool for SSS. The blade showed consistent differences when translated above the reference plane; however, it was still highly variable. Sensitivity and specificity of planes above the reference plane should be investigated further as they may provide reliable differentiation of non-SSS and SSS patients.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 70-78"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081297","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":"Definitional differences in “outpatient” surgery can influence study outcomes related to total shoulder arthroplasty","authors":"Junho Song MD,&nbsp;Jennifer Yu BS,&nbsp;Avanish Yendluri BS,&nbsp;William A. Ranson MD,&nbsp;Nikan K. Namiri MD,&nbsp;John J. Corvi MD,&nbsp;David E. Kantrowitz MD,&nbsp;Thomas Boucher MD,&nbsp;Leesa M. Galatz MD,&nbsp;Paul J. Cagle MD,&nbsp;Bradford O. Parsons MD,&nbsp;Robert L. Parisien MD","doi":"10.1016/j.jseint.2024.08.191","DOIUrl":"10.1016/j.jseint.2024.08.191","url":null,"abstract":"<div><h3>Background</h3><div>Numerous studies have investigated the outcomes of outpatient total shoulder arthroplasty (TSA). However, some patients originally planned for outpatient surgery may unexpectedly require inpatient hospital stay, which can obscure the distinction of “outpatient” and “inpatient” cases. Ultimately, this inconsistent classification of “outpatient” surgery may influence study results. The objectives of this study were (1) to characterize the differences in definition of “outpatient” surgery (hospital-defined outpatient [HDO] vs. same-day discharge [SDD]), and (2) to study the effect of different definitions on 30-day outcomes following TSA.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TSA between 2011 and 2021. HDO cases were identified based on the National Surgical Quality Improvement Program inpatient or outpatient variable, and SDD cases were identified based on length of stay = 0. Demographic and clinical characteristics were compared between HDO and SDD cohorts. Propensity score was utilized to match each HDO and SDD case with one inpatient case without replacement. Two distinct sets of multivariate analyses, using Poisson regressions with robust error variance, were performed to calculate the risks of readmission, reoperation, morbidity, and complications for HDO and SDD.</div></div><div><h3>Results</h3><div>A total of 30,458 patients met the inclusion criteria, including 6711 HDO and 4490 SDD cases. 3501 out of the 6711 (52.2%) HDO patients required at least one night of inpatient hospital stay (length of stay &gt;0). Between 2011 and 2021, the annual incidence of HDO TSA rose from 4.1% to 61.6% of all TSA cases, and the incidence of SDD TSA increased from 2.0% to 34.1% of all TSA cases. Compared to SDD, HDO was associated with female sex, higher body mass index, functional dependence, diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension, American Society of Anesthesiologists ≥3, longer operation time, and nonhome discharge. After controlling for potential confounders, inpatient TSA was associated with increased risk of 30-day readmission and reoperation compared with HDO cases, while morbidity and individual complication rates were similar. However, compared with SDD patients, inpatient TSA was associated with higher rates of readmission, reoperation, morbidity, pneumonia, pulmonary embolism, myocardial infarction, and deep venous thrombosis.</div></div><div><h3>Conclusion</h3><div>Definitional differences in “outpatient” surgery can lead to significantly different study outcomes related to TSA. Future investigations on this topic should maintain consistency in the definition of “outpatient” surgery. Accurate data on the risk factors for adverse events after TSA are critical for appropriate patient selection and improving surgical outcomes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 163-168"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081299","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":"Latissimus dorsi transfer or lower trapezius transfer: a treatment algorithm for irreparable posterosuperior rotator cuff tears muscles transfers in posterosuperior rotator cuff tears","authors":"Michael Kimmeyer MD ,&nbsp;Tilman Hees MD ,&nbsp;Laurens Allaart MD ,&nbsp;Rémi Nerot MD ,&nbsp;Arno Macken MD ,&nbsp;Geert-Alexander Buijze MD, PhD, FEBHS ,&nbsp;Laurent Lafosse MD ,&nbsp;Thibault Lafosse MD","doi":"10.1016/j.jseint.2024.08.184","DOIUrl":"10.1016/j.jseint.2024.08.184","url":null,"abstract":"<div><h3>Background</h3><div>Tendon transfers of the latissimus dorsi transfer (LDT) or the lower trapezius transfer (LTT) are treatment options for irreparable posterosuperior irreparable rotator cuff tears (PSIRCT). There is still no consensus on which type of tendon transfer is superior in the treatment of PSIRCT. Due to the differences in the anatomy and biomechanics, we hypothesize that there are different clinical situations in which either LDT or LTT should be preferred. The aim of this study was to evaluate the clinical and radiological outcomes of LDT and LTT in patients with PSIRCT to establish a clinical algorithm for the treatment decision.</div></div><div><h3>Materials and methods</h3><div>This is a retrospective, single-center observational study. Included were patients who underwent arthroscopically assisted LDT (aaLDT) or arthroscopically assisted LTT (aaLTT) for PSIRCT. In all patients, range of motion (ROM), external rotation strength, visual analog scale of pain and subjective shoulder value were determined pre- and postoperatively. Constant–Murley score was evaluated at the final follow-up. The complication rate, failure of the tendon transfer, and revision rate were analyzed.</div></div><div><h3>Results</h3><div>In total, 29 aaLDT (age 64 years, median follow-up time 45 months) and 8 aaLTT (age 54 years, median follow-up time 34 months) were included. Active ROM, visual analog scale and subjective shoulder value was significantly improved in both cohorts. At follow-up, the median Constant–Murley score was 73 (aaLDT) and 77 (aaLTT), respectively. The failure rate, including revision surgery, was 14% (aaLDT) and 13% (aaLTT), respectively. Low functional findings preoperatively were correlated to a lower functional outcome at follow-up in both groups. Painful loss of anterior elevation and loss of external rotation had no significant impact on functional outcomes in aaLDT.</div></div><div><h3>Conclusion</h3><div>Following the treatment algorithm based on the clinical examination, clinical outcome parameters, active ROM and pain could be significantly improved. A good preoperative function was associated with a good clinical outcome in both transfers. A low failure and revision rate supports the good decision-making of the algorithm presented.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 79-85"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081460","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":"What happens to patients in the long term when we do not repair their cuff tears? Ten-year rotator cuff quality of life index (RC-QOL) outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears","authors":"Richard S. Boorman MD, MSc, FRCSC ,&nbsp;Kristie D. More MSc ,&nbsp;Sarah L. Koles MD, MSc, FRCPC","doi":"10.1016/j.jseint.2024.11.018","DOIUrl":"10.1016/j.jseint.2024.11.018","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to examine long-term, greater-than-ten-year outcomes of patients with full-thickness rotator cuff tears treated nonoperatively.</div></div><div><h3>Methods</h3><div>Patients with a chronic, full-thickness rotator cuff tear (demonstrated on imaging) who were referred by their physician for shoulder surgery were enrolled in this prospective study between October 2008 and September 2010. Patients then participated in a comprehensive nonoperative treatment program. After the three-month program, patients were defined as “successful” or “failed.” “Successful” patients were essentially asymptomatic and did not require surgery. “Failed” patients were symptomatic and consented to surgical repair. All patients were followed-up at 1 year, two years, and five years using a validated, disease-specific rotator cuff quality of life score (the RC-QOL) and whether or not they eventually underwent surgery during these time intervals. All of the patients who participated at the five-year follow-up were contacted for this study between 10 and 12 years (mean 11.4 years) after treatment.</div></div><div><h3>Results</h3><div>Original results from this study showed that 75% of patients were treated successfully with the nonoperative program, while 25% failed and needed surgery. These numbers were maintained at the two-year follow-up and five-year follow-up (previously reported). At greater than ten years, 88 patients were contacted for follow-up. Only two patients crossed-over from “success” at 5 years to “failed” at 10 years. The nonoperative “success” group had a mean RC-QOL score of 80 (SD = 18) at the previously reported two-year follow-up and 82 (SD = 16) at five-year follow-up. Forty-one patients provided follow-up RC-QOL data at a mean of 11.4 years. The mean RC-QOL scores of the successfully treated nonoperative group were actually higher than those who required surgery during the course of the study (success group mean 86, SD = 12; “failed”/surgery group mean 78, SD = 24), although this was not statistically different (<em>P</em> = .27). Two patients had crossed over from the successful group to undergo surgery between 5 and 11 years (one had an acute traumatic injury and the other reported aggravation with activity).</div></div><div><h3>Conclusion</h3><div>Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some may argue that nonoperative treatment delays inevitable surgical repair, this long-term study shows that patients can do very well over time.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 268-273"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081344","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}