Faculty Bibliography

This article explores the current reasons why orthopedic surgeons might consider the adoption of an electronic medical record system in their practices today. The costs and benefits as well as the barriers to implementation are discussed.

PURPOSE: This study was undertaken to compare the results of mini-open rotator cuff repair with outcomes attained with hand-tied knots and suture welds. METHODS: A total of 50 consecutive patients treated by a single surgeon with mini-open cuff repair and suture welding were retrospectively evaluated and compared with 55 consecutive patients treated with mini-open cuff repair and hand-tied knots. The groups were similar in terms of age, sex, hand dominance, and preoperative duration of symptoms. All procedures were performed in a hospital outpatient surgery center with patients in a lateral decubitus position under general anesthetic. Glenohumeral arthroscopy and arthroscopic acromioplasty were performed in all cases. Rotator cuff tears were repaired through enlargement of the lateral portal. All patients were evaluated before and after surgery with the University of California Los Angeles (UCLA) Shoulder Scale. RESULTS: In all, 47 of 50 patients treated with suture weld were available for evaluation, with an average follow-up of 26 months. Preoperative UCLA scores averaged 12.5, and postoperative scores averaged 29.6. Of 55 patients treated with hand-tied knots, 40 were available, with an average follow-up of 28 months. Preoperative UCLA scores averaged 13.2, and postoperative scores averaged 31.5. CONCLUSIONS: No statistical difference in postoperative UCLA scores was noted between the 2 groups (P = .297). LEVEL OF EVIDENCE: Level III, retrospective comparative study.

This study was undertaken to review the results of an arthroscopic posterior capsular shift procedure. Twenty consecutive shoulders in 19 patients were treated with an arthroscopic posterior capsular shift for symptomatic posterior shoulder instability. Patients underwent the procedure if they exhibited a posterior Bankart lesion or had complaints of posterior instability and evidence of increased posterior joint laxity on physical examination and examination under anesthesia. Twelve of the 20 patients were injured during athletic activity. All surgeries were performed in an outpatient setting. Twelve of the 20 patients had posterior Bankart lesions and 10 had anterior Hill-Sachs lesions. The procedure entails releasing the posterior labroligamentous structures from the posterior glenoid and freshening the glenoid neck with a bur. A suture punch is used to place multiple absorbable monofilament stitches in the ligament complex. The stitches are brought through a supraclavicular portal and tied over the clavicle or scapular spine. All 20 shoulders were evaluated at an average of 31 months postoperatively with a minimum follow-up of 24 months. Based on the outcome scale described by Tibone and Bradley, the average postoperative score was 83 out of a possible 100, with 15 excellent, 2 good, 1 fair, and 3 poor results. There were two recurrent dislocations and three subluxations for an overall recurrence rate of 25%. All the recurrences occurred in patients with posterior Bankart lesions and four of the five had a voluntary component to their instability. There were no neurovascular complications or infections. Arthroscopic evaluation facilitated the diagnosis of posterior instability with the visualization of intra-articular pathology that is difficult to identify during open procedures. Although the majority of patients were able to return to vigorous activities, a recurrence rate of 25% is disturbing and consistent with recurrence rates for open procedures.

Nineteen consecutive shoulders in 19 patients were treated for multidirectional shoulder instability with an arthroscopic capsular shift. Indications for the procedure included complaints of pain, instability, or both that was unresponsive to a prescribed exercise program that stressed rotator cuff and scapular stabilizer strengthening. All patients had evidence of increased joint laxity on physical examination; 17 had a 2+ or greater sulcus test and 2 had 3+ laxity both anteriorly and posteriorly. Fourteen of the 19 patients were injured during athletic activity. All surgeries were performed in an outpatient setting. All the patients were evaluated at an average of 34 months postoperatively with a minimum follow-up of 25 months. Based on the outcome scale described by Tibone and Bradley, the average postoperative score was 91 out of a possible 100 with 13 excellent, 5 good, and 1 fair result. All but 1 of the athletes returned to their previous level of performance but none were elite throwers. One patient had recurrent anterior subluxations treated with a repeat arthroscopic capsular shift and was rated as good. The patient rated as fair had no improvement in her pain after surgery. One patient complained of a painful supraclavicular suture that resolved spontaneously. There were no neurovascular complications or infections. Visualization of intra-articular pathology was enhanced with the arthroscope and aided in the diagnosis of multidirectional instability. The described technique proved safe and effective in treating multidirectional instability and enabling athletes to return to their previous level of function.

Recent anatomic and arthroscopic studies have increased knowledge of the pathology of traumatic anterior shoulder instability. Advances in arthroscopy have made reconstruction of the shoulder using this technique seem increasingly attractive. The authors review the rationale and technique of arthroscopic reconstruction with multiple sutures.