Journal of Clinical Medicine

Research

9 pages, 199 KiB

Open AccessArticle

Reaching Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptomatic State for Patient-Reported Outcome Measures following Arthroscopic Rotator Cuff Repair Does Not Correlate with Patient Satisfaction

by Adam Z. Khan, Alayna K. Vaughan, Zachary S. Aman, Mark D. Lazarus, Gerald R. Williams and Surena Namdari

J. Clin. Med. 2024, 13(9), 2550; https://doi.org/10.3390/jcm13092550 - 26 Apr 2024

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Abstract

Purpose: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) serve as metrics to gauge orthopedic treatment efficacy based on anchoring questions that do not account for a patient’s satisfaction with their surgical outcome. This study evaluates [...] Read more.

Purpose: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) serve as metrics to gauge orthopedic treatment efficacy based on anchoring questions that do not account for a patient’s satisfaction with their surgical outcome. This study evaluates if reaching MCID, SCB, or PASS values for American Shoulder and Elbow Surgeons score (ASES), Single Alpha Numeric Evaluation (SANE), Simple Shoulder Test (SST), and Visual Analog Score (VAS) for pain following arthroscopic rotator cuff repair (RCR) correlates with overall patient satisfaction. Methods: This was a single-institution, retrospective study of patients who underwent RCR from 2015 to 2019. Pre-operative and 2 year postoperative ASES, SANE, SST, and VAS scores were recorded. Patients underwent a survey to assess: (1) what is your overall satisfaction with your surgical outcome? (scale 1 to 10); (2) if you could go back in time, would you undergo this operation again? (yes/no); (3) for the same condition, would you recommend this operation to a friend or family member? (yes/no). Spearman correlation coefficients were run to assess relationship between reaching MCID, SCB, or PASS and satisfaction. Results: Ninety-two patients were included. Mean preoperative ASES was 51.1 ± 16.9, SANE was 43.3 ± 20.9, SST was 5.4 ± 2.9, and VAS was 4.6 ± 2.1. Mean 2 year ASES was 83.9 ± 18.5, SANE was 81.7 ± 27.0, SST was 9.8 ± 3.2, and VAS was 1.4 ± 1.9. Mean patient satisfaction was 9.0 ± 1.9; 89 (96.7%) patients would undergo surgery again and recommend surgery. Correlation for reaching PASS for SANE and satisfaction was moderate. Correlation coefficients were very weak for all other outcome metrics. Conclusions: Reaching MCID, SCB, and PASS in ASES, SANE, SST, or VAS following RCR did not correlate with a patient’s overall satisfaction or willingness to undergo surgery again or recommend surgery. Further investigation into the statistical credibility and overall clinical value of MCID, SCB, and PASS is necessary. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

17 pages, 2807 KiB

Open AccessArticle

Outcomes of Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon in Large to Massive Rotator Cuff Tears: A Meta-Analysis and Systematic Review

by Kyun-Ho Shin, Il-Tae Jang and Seung-Beom Han

J. Clin. Med. 2024, 13(4), 1052; https://doi.org/10.3390/jcm13041052 - 12 Feb 2024

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Abstract

(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: [...] Read more.

(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: A systematic search across the MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus databases until 1 October 2023 identified studies that directly compared SCR with LHBT with conventional RCR in patients with LMRCTs and included a minimum of a 12-month follow-up period. The assessed outcome measures encompassed retear rates, functional outcomes, range of motion (ROM), and acromiohumeral interval (AHI). Risk of bias assessment was conducted via the Robins-I tool. (3) Results: In six studies with 456 cases (210 SCR using LHBT and 246 using RCR), SCR with LHBT significantly reduced retear rates (OR = 0.21; 95% CI, 0.12–0.36; p < 0.01; I² = 0%). Furthermore, SCR with LHBT showed significant improvement in range of forward flexion (SMD 0.32, 95% CI: 0.09–0.55, p < 0.01, I² = 39%) and AHI (SMD 0.61, 95% CI: 0.31–0.92, p < 0.01, I² = 0%) postoperatively. (4) Conclusion: SCR with LHBT is a safe and effective treatment for LMRCTs, reducing retear rates, maintaining greater postoperative AHI, and improving ROM compared to conventional RCR. Additional high-quality interventional studies are needed to confirm these results. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

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9 pages, 742 KiB

Open AccessArticle

Comparison of Clinical Outcomes after Platelet-Rich Plasma and Rotator Cuff Repair in High-Grade Intrasubstance Partial Rotator Cuff Tears

by Grayson Poff, Edwin Spencer, Benson Scott, Robert Sleadd and John Broyles

J. Clin. Med. 2023, 12(17), 5554; https://doi.org/10.3390/jcm12175554 - 26 Aug 2023

Viewed by 2127

Abstract

Platelet-rich plasma injections have been shown to have many useful applications in various musculoskeletal pathologies. Research on the use of PRP for intrasubstance partial-thickness rotator cuff tears is lacking, although these tears have unique properties that may increase the efficacy of platelet-rich plasma [...] Read more.

Platelet-rich plasma injections have been shown to have many useful applications in various musculoskeletal pathologies. Research on the use of PRP for intrasubstance partial-thickness rotator cuff tears is lacking, although these tears have unique properties that may increase the efficacy of platelet-rich plasma injections. Patients with MRI-confirmed high-grade intrasubstance partial-thickness rotator cuff tears, that had failed traditional non-operative treatment, were offered either surgical repair (Group 1) or a single ultrasound-guided platelet-rich plasma injection into the tear site (Group 2). Patients were followed at 2 weeks, 6 weeks, 3 months, and a minimum of 2 years post-injection with ASES scores. A total of 25 patients received platelet-rich plasma injections, compared to 20 patients who had rotator cuff repair for intrasubstance tears in the last 3 years. The mean pre-injection ASES score for the platelet-rich plasma group was 53.2 and this improved to 92.9 at a minimum 2-year follow-up. The average convalescence period following platelet-rich plasma injection was 3.3 months. The average post-operative convalescence period for arthroscopic rotator cuff repair was 4.6 months. Both surgical repair and platelet-rich plasma injection into the tear site are equally effective in the treatment of high-grade intrasubstance partial-thickness rotator cuff tears, while platelet-rich plasma provides significantly shorter recovery time. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

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Review

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11 pages, 269 KiB

Open AccessFeature PaperReview

Common Factors in Shoulder and Hip Arthroplasty Implant Failures: A Historical Review

by Reed Andrews, Josué G. Layuno-Matos and Mark A. Frankle

J. Clin. Med. 2024, 13(8), 2370; https://doi.org/10.3390/jcm13082370 - 18 Apr 2024

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Abstract

In this era of subspecialty care in orthopedics, iterations of implant design can occur in a silo which then precludes gaining knowledge from failures of implant design that may have occurred in different subspecialties. This literature review describes the history of failures in [...] Read more.

In this era of subspecialty care in orthopedics, iterations of implant design can occur in a silo which then precludes gaining knowledge from failures of implant design that may have occurred in different subspecialties. This literature review describes the history of failures in hip and shoulder arthroplasties with the purpose of identifying similar factors that led to previous implant failures. A review of the literature was performed by two reviewers assessing articles that described failed hip and shoulder arthroplasty systems over time. We identified and analyzed 53 implant failures—23 in hip arthroplasty and 30 in shoulder arthroplasty. These failures were categorized as material, mechanical, and technical. In hip arthroplasty, 48% were material, 39% mechanical, and 13% technical failures. In shoulder arthroplasty, the distribution was 10% material, 70% mechanical, and 20% technical failures. The distribution of these failures highlights similar and sometimes repeated failure mechanisms between subspecialties. This accentuates the importance of a collaborative approach to improve future arthroplasty designs. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

14 pages, 1657 KiB

Open AccessReview

Shoulder Proprioception: A Review

by Jake A. Fox, Lauren Luther, Eden Epner and Lance LeClere

J. Clin. Med. 2024, 13(7), 2077; https://doi.org/10.3390/jcm13072077 - 03 Apr 2024

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Abstract

The purpose of this review is to provide a comprehensive resource for shoulder proprioception assessment and its integration into clinical decision making as well as targeted rehabilitation protocols. Data for this review were acquired from peer-reviewed articles from computerized online databases, namely PubMed [...] Read more.

The purpose of this review is to provide a comprehensive resource for shoulder proprioception assessment and its integration into clinical decision making as well as targeted rehabilitation protocols. Data for this review were acquired from peer-reviewed articles from computerized online databases, namely PubMed and Medline, published between 1906 and 2021. The development of digital/smart phone goniometers can improve shoulder joint range of motion (ROM) measurements and demonstrate comparable measurement accuracy to the universal standard goniometer. The inclinometer offers a portable and cost-effective method for measuring shoulder joint angles and arcs of motion in the vertical plane. Two types of dynamometers, the computerized isokinetic machine and the handheld hydraulic dynamometer, are reliable tools for objective shoulder rotator cuff strength assessment. Motion analysis systems are highly advanced modalities that create three-dimensional models of motion arcs using a series of cameras and reflective beads, offering unparalleled precision in shoulder proprioception measurement; however, they require time-consuming calibration and skilled operators. Advancements in wearable devices and compact mobile technology such as iPhone applications may make three-dimensional motion analysis more affordable and practical for outpatient settings in the future. The complex interplay between proprioception and shoulder dysfunction is not fully understood; however, shoulder proprioception can likely both contribute to and be caused by shoulder pathology. In patients with rotator cuff tears, glenohumeral osteoarthritis, and shoulder instability, clinicians can track proprioception to understand a patient’s disease progression or response to treatment. Finally, rehabilitation programs targeting shoulder proprioception have shown promising initial results in restoring function and returning athletes to play. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

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12 pages, 1975 KiB

Open AccessReview

Posterior Shoulder Instability and Glenoid Bone Loss: A Review and a Free Bone Graft Technique

by Walter Ryan Smith and T. Bradley Edwards

J. Clin. Med. 2024, 13(7), 2016; https://doi.org/10.3390/jcm13072016 - 30 Mar 2024

Viewed by 456

Abstract

Posterior glenoid bone loss (pGBL) is frequently associated with posterior shoulder instability. Posterior glenohumeral instability accounts for a small percentage of shoulder pathologies, and critical bone loss in posterior instability has not been well defined in the literature. Younger patient populations who participate [...] Read more.

Posterior glenoid bone loss (pGBL) is frequently associated with posterior shoulder instability. Posterior glenohumeral instability accounts for a small percentage of shoulder pathologies, and critical bone loss in posterior instability has not been well defined in the literature. Younger patient populations who participate in activities that repetitively stress the posterior stabilizing structures of the shoulder are more prone to developing posterior shoulder instability. A variety of surgical options have been described, ranging from isolated capsulolabral repair to glenoid osteotomy. Soft-tissue repair alone may be an inadequate treatment in cases of pGBL and places patients at a high risk of recurrence. Our preferred technique for posterior glenoid reconstruction in cases of pGBL involves the transfer of a free iliac crest bone graft onto the native glenoid. The graft is contoured to fit the osseous defect and secured to provide an extension of the glenoid track. In this study, we review pGBL in the setting of posterior instability and describe our technique in detail. Further long-term studies are needed to refine the indications for glenoid bone graft procedures and quantify what constitutes a critical pGBL. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

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20 pages, 1932 KiB

Open AccessReview

Current Evidence Regarding Shoulder Instability in the Paediatric and Adolescent Population

by Aziz Rawal, Franziska Eckers, Olivia S. H. Lee, Bettina Hochreiter, Kemble K. Wang and Eugene T. Ek

J. Clin. Med. 2024, 13(3), 724; https://doi.org/10.3390/jcm13030724 - 26 Jan 2024

Viewed by 872

Abstract

Paediatric and adolescent shoulder instability is caused by a unique combination of traumatic factors, ligamentous laxity, and pattern of muscle contractility. The multifactorial nature of its aetiology makes interpretation of the literature difficult as nomenclature is also highly variable. The purpose of this [...] Read more.

Paediatric and adolescent shoulder instability is caused by a unique combination of traumatic factors, ligamentous laxity, and pattern of muscle contractility. The multifactorial nature of its aetiology makes interpretation of the literature difficult as nomenclature is also highly variable. The purpose of this review is to summarize the existing literature and shed light on the nuances of paediatric and adolescent shoulder instability. The epidemiology, clinical features, imaging, and management of all forms of paediatric shoulder instability are presented. The main findings of this review are that structural abnormalities following a dislocation are uncommon in pre-pubertal paediatric patients. Young post-pubertal adolescents are at the highest risk of failure of non-operative management in the setting of traumatic instability with structural abnormality, and early stabilisation should be considered for these patients. Remplissage and the Latarjet procedure are safe treatment options for adolescents at high risk of recurrence, but the side-effect profile should be carefully considered. Patients who suffer from instability due to generalized ligamentous laxity benefit from a structured, long-term physiotherapy regimen, with surgery in the form of arthroscopic plication as a viable last resort. Those who suffer from a predominantly muscle patterning pathology do not benefit from surgery and require focus on regaining neuromuscular control. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

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Other

Jump to: Research, Review

16 pages, 717 KiB

Open AccessSystematic Review

From Diagnosis to Decision-Making: A Systematic Review of the Management of Reverse Hill-Sachs Lesions after Posterior Shoulder Dislocations

by Vito Gaetano Rinaldi, Federico Coliva, Antongiulio Favero, Domenico Alesi, Silvio Caravelli, Stefano Zaffagnini and Giulio Maria Marcheggiani Muccioli

J. Clin. Med. 2024, 13(7), 2085; https://doi.org/10.3390/jcm13072085 - 03 Apr 2024

Viewed by 412

Abstract

(1) Background: The aim of this study is to describe all of the possible surgical procedures that intend to treat the McLaughlin lesion (or Reverse Hill-Sachs) in posterior shoulder dislocation. (2) Methods: Google Scholar, Pubmed, and Embase were used as databases [...] Read more.

(1) Background: The aim of this study is to describe all of the possible surgical procedures that intend to treat the McLaughlin lesion (or Reverse Hill-Sachs) in posterior shoulder dislocation. (2) Methods: Google Scholar, Pubmed, and Embase were used as databases in our research. Studies reporting the results of posterior shoulder dislocations surgically treated with procedures addressing the humeral lesion were evaluated. The studies reporting results after fracture—dislocation and multidirectional instability were excluded. (3) Results: A total of 16 studies were included in our review for a total of 207 shoulders with a mean age of 41.7 years that were evaluated at a mean of 62.1 months. The Modified McLaughlin procedure and the Graft procedures were the most commonly performed. No statistically significant difference was found between the two at the evaluation of the clinical score. (4) Conclusions: Our review highlights the importance of a correct diagnosis and an accurate surgical treatment choice based on the surgeon’s experience and on the patients’ characteristics. Full article

(This article belongs to the Special Issue Advances in Shoulder Surgery: Current Trends and Future Directions)

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