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.

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.

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.

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

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 (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.

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.

Radial head arthroplasty is an essential element in the management of an unstable elbow when there is a fracture of the radial head that cannot be repaired. Similarly, radial head arthroplasty must be considered when the radial head is not repairable and there is evidence of an injury to the interosseous membrane. If replacement of the radial head is necessary, the surgeon must make preoperative decisions regarding the implant and surgical approach; he or she must make intraoperative decisions regarding stem size and head size, as well as which structures are repaired. Most of the available implants will help restore lateral stability, however, the surgeon must decide if he or she wants a monopolar or a bipolar implant and whether the implant should have a smooth stem, a stem with the potential for ingrowth or a stem that will be cemented. Approach to the radial head may be facilitated by avulsion of the lateral complex. If the lateral complex is intact, the surgeon may choose to work around the intact complex or perform a release followed by repair. In most elbows, stability will be restored with placement of a radial head and repair of the lateral complex. However, the surgeon must have a contingency plan for dealing with residual instability. This article will discuss the developments in prosthetic treatment of radial head fractures, surgical technique, decision making, and the essential features of the varied radial head implant designs on the market today.

Source: Radial Head Prosthesis Update (http://journals.lww.com/shoulderelbowsurgery/Fulltext/2009/03000/Radial_Head_Prosthesis_Update.6.aspx?WT.mc_id=HPxADx20100319xMP)