LiteratureLiteraturehttp://www.shouldersurgery.info/literature/2012-04-15T09:18:24ZSquarespaceAnatomical and Functional Results After Arthroscopic Hill-Sachs Remplissagehttp://www.shouldersurgery.info/literature/anatomical-and-functional-results-after-arthroscopic-hill-sa.htmlBibhas Roy2012-04-15T09:14:45Z2012-04-15T09:14:45Z
Pascal Boileau, MD; Kieran O'Shea, MD; Pablo Vargas, MD; Miguel Pinedo, MD; Jason Old, FRCSC; Matthias Zumstein, MD
The Journal of Bone & Joint Surgery.  2012; 94:618-626  doi:10.2106/JBJS.K.00101

Background: 

Large osseous defects of the posterosuperior aspect of the humeral head can engage the glenoid rim and cause recurrent instability after arthroscopic Bankart repair for glenohumeral dislocation. Filling of the humeral head defect with the posterior aspect of the capsule and the infraspinatus tendon (i.e., Hill-Sachs remplissage) has recently been proposed as an additional arthroscopic procedure. Our hypothesis is that the capsulotenodesis heals in the humeral bone defect without a severe adverse effect on shoulder mobility, allowing return to preinjury sports activity.

Methods: 

Of 459 patients operated on for recurrent traumatic anterior shoulder instability, forty-seven (10.2%) underwent arthroscopic Bankart repair combined with Hill-Sachs remplissage with use of suture anchors. All had a large Hill-Sachs lesion (Calandra grade III), engaging over the glenoid rim, without substantial glenoid bone loss. Nine patients had had prior unsuccessful surgery to address glenohumeral instability (three Bankart and six Bristow-Latarjet procedures). The average age at the time of surgery (and standard deviation) was 29 ± 5.4 years. Postoperatively, comparative shoulder motion was precisely measured with use of digital photographic images. Capsulotenodesis healing was assessed on a computed tomography (CT) arthrogram (n = 38) or magnetic resonance image (MRI) (n = 4). The mean duration of follow-up was twenty-four months.

Results: 

Healing of the posterior aspect of the capsule and the infraspinatus tendon into the humeral defect was observed in all forty-two patients who underwent postoperative imaging, and thirty-one (74%) had a remplissage of ≥75%. Compared with the normal (contralateral) side, the mean deficit in external rotation was 8° ± 7° with the arm at the side of the trunk and 9° ± 7° in abduction at the time of the last follow-up. Of forty-one patients involved in sports, thirty-seven (90%) were able to return postoperatively and twenty-eight (68%) returned to the same level of sports, including those involving overhead activities. Ninety-eight percent (forty-six) of the forty-seven patients had a stable shoulder at the time of the last follow-up.

Conclusions: 

Arthroscopic Hill-Sachs remplissage, performed in combination with a Bankart repair, is a potential solution for patients with a large engaging humeral head bone defect but no substantial glenoid bone loss. The posterior capsulotenodesis heals predictably in the humeral defect. The slight restriction in external rotation (approximately 10°) does not significantly affect return to sports, including those involving overhead activities. The procedure, which may also be useful for revision of previous failed glenohumeral instability surgery, is not indicated for patients with glenoid bone deficiency.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Source: Anatomical and Functional Results After Arthroscopic Hill-Sachs Remplissage (http://jbjs.org/article.aspx?articleid=1064899)

]]>Outcomes of arthroscopic rotator cuff repairs in obese patientshttp://www.shouldersurgery.info/literature/outcomes-of-arthroscopic-rotator-cuff-repairs-in-obese-patie.htmlBibhas Roy2011-09-14T18:04:52Z2011-09-14T18:04:52Z

William J. Warrender, BS, Ouida L. Brown, MD, Joseph A. Abboud,

Journal of Shoulder and Elbow Surgery
Volume 20, Issue 6 , Pages 961-967, September 2011

Hypothesis

Rotator cuff tears are common orthopedic injuries and their arthroscopic treatment can be technically challenging. This study evaluated the outcomes of arthroscopic rotator cuff repairs in obese patients. We hypothesized that there would be a direct correlation between worse outcomes of arthroscopic rotator cuff repairs and increasing body mass index (BMI).

Materials and methods

A retrospective review of patients undergoing arthroscopic rotator cuff repair by one orthopedic surgeon between 2005 and 2008 was performed. The study included 149 rotator cuff repairs. Recorded data included age, sex, BMI, size of rotator cuff tear on magnetic resonance imaging and intraoperatively, number of anchors used for repair, functional outcomes (American Shoulder and Elbow Surgeons and University of Pennsylvania scores), surgery time, total time for anesthesia, positioning, and hospital stay. Tears were classified by size. Strict inclusion and exclusion criteria were used. Surgical procedures were performed with general anesthesia, interscalene block, beach chair positioning, and a standardized operative technique. Patients followed a standard postoperative rehabilitation protocol.

Results

Mean patient age was 66 years. Mean follow-up was 16.3 months. Tears were classified as high grade partial (12%), small (23%), medium (29%), large (22%), and massive (14%). Patients were classified as normal weight (38%), overweight (23%), obese (20%), and morbidly obese (19%). A statistically significant correlation was found between obesity and worse functional outcomes, longer operative times, and longer length of hospital stay.

Discussion

This study reports new data concerning the association of BMI and early clinical outcome after arthroscopic rotator cuff repair surgery. Even though the obese group had greater limiations and lower rates of satisfaction at final follow-up than their non-obese counterparts, they still reported significant improvements from the surgery.

Conclusion

Obesity has a negative impact on the operative time of arthroscopic rotator cuff repairs, length of hospitalization, and functional outcomes.

Source: Outcomes of arthroscopic rotator cuff repairs in obese patients (http://dx.doi.org/10.1016/j.jse.2010.11.006)

]]>Charles Sumner Neer II 10 November 1917–28 February 2011http://www.shouldersurgery.info/literature/charles-sumner-neer-ii-10-november-191728-february-2011.htmlBibhas Roy2011-05-29T18:12:51Z2011-05-29T18:12:51Z

Volume 20, Issue 4, Page 517 (June 2011), Journal of Shoulder and Elbow Surgery

Louis U. Bigliani, MD

Charles Sumner Neer II (Fig. 1), son of pioneer Oklahoma Territory surgeon Charles S. Neer and Pearl Brooke Neer, was born and raised in Vinita, Oklahoma. A graduate of Dartmouth College and the University of Pennsylvania Medical School, his residency training years were interrupted by military service in World War II as an orthopaedic surgeon. He served in 3 theaters as a Captain in the Army. Following the war he returned to Columbia-Presbyterian Medical Center in New York to complete his training and join the Orthopaedic Service of the Presbyterian Hospital and faculty of the College of Physicians & Surgeons of Columbia University. He eventually became Chief of both the Fracture Service and the Adult Reconstructive Service. It was a relationship that endured for 50 years. Until his passing, Dr. Neer continued as Emeritus Consultant in Orthopaedic Surgery and Emeritus Professor & Special Lecturer in Clinical Orthopaedic Surgery.

Throughout his brilliant career he was a highly-valued member of his profession receiving many honors both nationally and internationally, especially for his contributions in shoulder surgery and reconstruction. He served as a representative on the American Board of Orthopaedic Surgery, a position for which he earned the Board’s Distinguished Service Award. Dr. Neer was Founding President of the American Shoulder & Elbow Surgeons, Founding Chairman of the Board of Trustees of the Journal of Shoulder and Elbow Surgery, and founding Chairman of the International Board of Shoulder and Elbow Surgery.

Dr. Neer was a creative and innovative surgeon and developed surgical techniques and prostheses that advanced the art of shoulder surgery. A Neer prosthesis is on permanent display at the Smithsonian Institute. He was a prolific writer authoring many definitive articles on topics including displaced humeral fractures, subacromial impingement, multidirectional instability, and shoulder arthroplasty. His articles were characterized by thoughtful insight, attention to detail, and intellectual honesty. The British Journal of Bone and Joint Surgery recently searched the Orthopaedic literature from 1945 to 2008 for the top 100 quoted articles. Dr. Neer had 5 articles in the top 100 – more than anyone else, a remarkable achievement. In 1990, he published his classic textbook “Shoulder Reconstruction”.

Dr. Neer was also a committed educator and mentor. He created the first shoulder and elbow service and fellowship. He trained numerous fellows and welcomed visitors from around the world to his service. He trained and fostered many of the leaders of shoulder surgery in the world. He also lectured extensively throughout the world on many aspects of shoulder surgery. Dr. Neer will be remembered for his outstanding contributions that advanced the art and science of orthopaedics and shoulder surgery.

Source: Charles Sumner Neer II 10 November 1917–28 February 2011 (http://www.jshoulderelbow.org/article/S1058-2746%2811%2900111-X/fulltext)

]]>Loss of visual acuity due to central serous retinopathy after steroid injection into the shoulder bursahttp://www.shouldersurgery.info/literature/loss-of-visual-acuity-due-to-central-serous-retinopathy-afte.htmlBibhas Roy2011-05-29T17:59:22Z2011-05-29T17:59:22Z

Al-Amin Kassam,  William White,  Roland H. Ling,  Jeff B. Kitson,

Volume 20, Issue 4, Pages e5-e6 (June 2011)

Steroid injections are commonly given in both the hospital and primary care setting for shoulder pain. We present a case report of a patient undergoing an ultrasound-guided subacromial bursal injection of steroid that coincided with a sudden loss of visual acuity caused by central serous retinopathy.

Central serous retinopathy is an idiopathic condition with recognized associations with exogenous steroids, such as nasal sprays, skin preparations, and long-term oral steroids. Little is known about the acute presentation after a single injection of steroid.

It is important for health care professionals to be aware of this link between a single steroid injection and central serous retinopathy because of the high number of steroid injections undertaken yearly in hospital and primary care settings.

Source: Loss of visual acuity due to central serous retinopathy after steroid injection into the shoulder bursa (http://www.jshoulderelbow.org/article/S1058-2746%2811%2900020-6/fulltext)

]]>Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranonhttp://www.shouldersurgery.info/literature/results-of-open-reduction-and-plate-osteosynthesis-in-commin.htmlBibhas Roy2011-05-07T21:16:04Z2011-05-07T21:16:04Z

Ramazan Erden Erturer, MD, Cem Sever, MD, Mehmet Mesut Sonmez, MD, Ismail Bulent Ozcelik, MD Senol Akman, MD, Irfan Ozturk, MD

Hypothesis

Using radiologic and clinical results, we studied the outcome of patients who underwent open reduction and plate osteosynthesis for comminuted olecranon fractures.

Materials and methods

We retrospectively studied 18 patients (5 women [27.8%] and 13 men [72.2%]; mean age, 41 years [range, 19-67 years]) with comminuted fractures of the olecranon who underwent locking-plate osteosynthesis after open reduction between March 2005 and August 2009. According to the Mayo classification, 11 cases were classified as type IIB (61.11%) and 7 cases were classified as type IIIB (38.88%). In 7 cases, additional injuries were present in the olecranon area. We evaluated results with respect to clinical and radiologic findings. The mean follow-up duration was 22.6 months (range, 7-42 months).

Results

Complete union was achieved in all cases. Mean union time was 4.4 months (range, 4-6 months). According to the Morrey scale, 4 cases were considered very good; 8, good; 5, fair; and 1, poor. The mean QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score was 17 (range, 0-75). There were no statistically significant differences between the Mayo type IIB and type IIIB cases in terms of elbow range of motion, QuickDASH score, and Morrey score. On long-term follow-up, elbow stiffness developed in 1 patient, who underwent surgical release with simultaneous removal of the hardware. The cases with fair and poor scores were cases with open fractures and additional elbow injuries.

Conclusions

Locking-plate osteosynthesis is an effective and safe treatment option for comminuted olecranon fractures, allowing early joint motion and yielding satisfactory radiologic and clinical results. In cases with concomitant injuries, the risk of limited elbow motion is high.

Source: Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon (http://www.jshoulderelbow.org/article/S1058-2746%2810%2900527-6/abstract)

]]>Expanding the frontiers of shoulder arthroscopyhttp://www.shouldersurgery.info/literature/expanding-the-frontiers-of-shoulder-arthroscopy.htmlBibhas Roy2011-03-29T09:32:37Z2011-03-29T09:32:37ZStephen S. Burkhart, MD

 

This report is the 2010 Lipmann Kessel Lecture, presented at the 11th International Congress on Shoulder and Elbow Surgery, Edinburgh, Scotland, September 8, 2010.

 

The article is published in the JSES here

Source: Expanding the frontiers of shoulder arthroscopy (http://www.jshoulderelbow.org/article/PIIS1058274610004453/abstract?rss=yes)

]]>Unplanned overnight admissions in day-case arthroscopic shoulder surgeryhttp://www.shouldersurgery.info/literature/unplanned-overnight-admissions-in-day-case-arthroscopic-shou.htmlBibhas Roy2011-03-23T17:50:34Z2011-03-23T17:50:34ZJ. Sultan   , K.Z. Marflow,  B. Roy;  The Surgeon, Article in Press

 

The majority of arthroscopic shoulder procedures can be safely performed as day-case surgery. However, despite better pain control and preoperative assessment; some patients end with unplanned overnight admission. The aim of this study was to investigate the reasons behind unplanned admissions of patients undergoing day-case arthroscopic shoulder surgery.

A retrospective review of 242 consecutive cases of arthroscopic shoulder surgery performed by the senior author over a period of two years (2007–2008) was carried out. Twenty cases were planned admissions and were therefore excluded. 222 cases were included, of which 40 (18%) were unplanned overnight admissions.

Documented causes for overnight stay included abnormal post-operative observations, pain and wound ooze. The age of patients who stayed overnight was significantly higher (p = 0.006). The difference in ASA grade between both groups was less marked but still statistically significant (p = 0.031). More complex procedures, such as rotator cuff repair, were more likely to result in unplanned overnight admission (p < 0.001). The experience of the anaesthetist and administration of interscalene nerve block were not significantly different between the two groups. However, patients anesthetised by less experienced anaesthetists were less likely to receive an interscalene nerve block (p = 0.016).

In conclusion; higher patient age, higher ASA grade and more complex arthroscopic procedures are significant risk factors for unplanned overnight admissions in day-case arthroscopic shoulder surgery.

 

Source: Unplanned overnight admissions in day-case arthroscopic shoulder surgery (http://dx.doi.org/10.1016/j.surge.2010.11.033)

]]>Platelet-rich plasma in upper limb conditionshttp://www.shouldersurgery.info/literature/platelet-rich-plasma-in-upper-limb-conditions.htmlBibhas Roy2011-01-30T13:23:44Z2011-01-30T13:23:44ZJoost C. Peerbooms, Taco Gosens, Shoulder & Elbow Volume 3, Issue 1, pages 8–12, January 2011

Platelet-rich plasma (PRP) is an autologous platelet concentrate. It has been used since 1990 in dental and facial reconstructive surgery and its application in other areas is increasing rapidly as a result of the presumably positive effects on bone, muscle and tendon regeneration as well as wound healing. Recently, we have learned more about growth factors that play an important role in the healing process. In vitro studies show that growth factors released by platelets have a positive effect on the healing of soft tissue. Despite the presence of minimal clinical evidence, the application of PRP for upper limb conditions has increased. The medical industry promotes the application of PRP significantly. Several randomized studies are currently implemented, although we have to be careful with the use of PRP for upper limb conditions until ‘higher level’ research is published.

Source: Platelet-rich plasma in upper limb conditions (http://onlinelibrary.wiley.com/doi/10.1111/j.1758-5740.2010.00098.x/abstract)

]]>Complications of total elbow replacement: A systematic reviewhttp://www.shouldersurgery.info/literature/complications-of-total-elbow-replacement-a-systematic-review.htmlBibhas Roy2011-01-18T21:39:19Z2011-01-18T21:39:19ZIlya Voloshin, David W. Schippert, Sanjeev Kakar, Elizabeth Krall Kaye, Bernard F. Morrey

Journal of Shoulder and Elbow Surgery - January 2011 (Vol. 20, Issue 1, Pages 158-168, DOI: 10.1016/j.jse.2010.08.026)

 

Total elbow arthroplasty (TEA) is becoming an increasingly popular reconstructive procedure. Improved surgical techniques, newer implant designs, and improving clinical results have each contributed to the rise in prevalence of this surgical intervention.The most common indication remains rheumatoid arthritis (RA). However, with the advent of semi-constrained prostheses, the indications have expanded to include post-traumatic sequelae such as instability and arthritis, as well as acute comminuted distal humerus fractures in the elderly.

The rate of complications following TEA, ranging from 20% to 45%, is higher than in other large joint replacements.

Source: Complications of total elbow replacement: A systematic review (http://www.jshoulderelbow.org/article/S1058-2746%2810%2900383-6/fulltext)

]]>Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trialshttp://www.shouldersurgery.info/literature/efficacy-and-safety-of-corticosteroid-injections-and-other-i.htmlBibhas Roy2010-10-22T18:27:00Z2010-10-22T18:27:00Z