Faculty Bibliography

BACKGROUND:Preoperative planning software and intraoperative guidance technology is being increasingly used for managing complex glenoid deformity in anatomic and reverse total shoulder arthroplasty (aTSA; rTSA). The aim of this study is to review the intraoperative efficacy and complications of computer assisted navigation (CAN) surgery for treating glenoid deformity in TSA. METHODS:A retrospective review was performed of all the TSAs implanted using a single computer navigation shoulder system. All patients underwent preoperative planning using a CT based preoperative planning software. The starting point on the glenoid, and the final version and inclination of the central post (cage) of the glenoid component were reviewed on the intraoperative navigation guidance report and compared to these parameters on the preoperative plan for each patient. The intraoperative accuracy of CAN for the glenoid was determined by the deviation of the starting point and final position of the central cage drill in the glenoid compared to preoperative plan. Intraoperative complications and the number of times the navigation system was abandoned intraoperatively were collected. RESULTS:A total of 16,723 aTSAs and rTSAs performed worldwide with this navigation system were included in this review. 16,368 cases (98%) completed every step in the navigation procedure without abandoning use of the system intraoperatively. There was minimal deviation in the intraoperative execution of the preoperative plan with respect to version (0.6° ± 1.96°), inclination (0.2° ± 2.04°) and starting point on the glenoid face (1.90mm ± 1.2 mm). There were 9 coracoid fractures (0.05%) reported in this cohort. CONCLUSION/CONCLUSIONS:And Discussion: This study demonstrates the safety and efficacy of computer assisted navigation for glenoid implantation in TSA. Future studies should continue to focus on the impact of CAN on longevity and survival of the glenoid component and improve cost-effectiveness of this technology.

PURPOSE/OBJECTIVE:The purpose of this study was to compare the outcomes of primary rTSA utilizing glenoid bone grafting (BG rTSA) to primary rTSA utilizing augmented glenoid baseplates (Aug rTSA) with a minimum 2-year follow-up. METHODS:520 primary rTSA patients treated with 8° posterior glenoid augments (n=246), 10° superior glenoid augments (n=97), or combined 10° superior/8° posterior glenoid augments (n=177) were compared to 47 patients undergoing glenoid bone grafting for glenoid bone insufficiency. Mean follow-up of 37.0(±16) and 53.0(±27) months. Outcomes were analyzed preoperatively and at the latest follow-up using conventional statistics and stratification by minimum clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds where applicable. Radiographs were analyzed for baseplate failure and the incidence of postoperative complications and revisions were recorded. RESULTS:The glenoid Aug rTSA cohort had greater improvements in patient reported outcome measures (PROMs) and ROM when compared to the BG rTSA group at a minimum of 2-year follow-up including: simple shoulder test (SST), Constant Score, American Shoulder and Elbow Surgeons (ASES)score, University of California Los Angeles (UCLA)score, Shoulder Pain and Disability Index (SPADI)score, Shoulder Function, Shoulder Arthroplasty Smart (SAS)score, abduction, and external rotation(p<0.05). Patient satisfaction was higher in Aug rTSA group compared to BG rTSA group(p=0.006). The utilization of an augmented glenoid component instead of glenoid bone grafting resulted in approximately 50% less total intraoperative time (p<0.001), nearly 33% less intraoperative blood loss volume (p<0.001), approximately threefold less scapular notching (p<0.01) and approximately fifteenfold less adverse events requiring revision (p<0.01) when compared to BG rTSA cohort. Aside from SCB for abduction, the Aug rTSA cohort achieved higher rates of exceeding MCID and SCB for every PROM compared to BG rTSA. More specifically, 77.6% and 70.2% of the Aug rTSA achieved SCB for ASES and SPADI versus 55% and 48.6% in the BG rTSA, respectively(p=0.003 and p=0.013). CONCLUSION/CONCLUSIONS:The present midterm clinical and radiographic study demonstrates that the utilization of an augmented base plate for insufficient glenoid bone stock is superior as judged by multiple PROMs and ROM metrics when compared to bone graft augmentation at minimum 2-year follow-up. Additionally, when analyzed according to MCID and SCB thresholds, the use of augmented baseplates outperforms the use of glenoid bone grafting. Complication and revision rates also favor the use of augmented glenoid baseplates over glenoid bone grafting. Long-term clinical and radiographic follow-up is necessary to confirm that these promising mid-term results are durable.

Snapping sternoclavicular joint (SCJ) is a rare presentation in the SCJ. We present a case report detailing the presentation and treatment of unilateral snapping SCJ in a 14-year-old male patient. Clinical findings included the subluxation of the medial end of the clavicle in the anterior-posterior direction following a specific maneuver by the patient that involved repetitive external rotation with the arm in horizontal abduction. Dynamic ultrasound demonstrated an asymmetric widening of the right sternoclavicular joint in the neutral position with a pronounced subluxation in provocative positioning. At 3.5-year follow-up, he continued to remain pain-free without static deformity of the SCJ. Snapping SCJ is a benign phenomenon that does not require any intervention and is not associated with ligament laxity.

BACKGROUND:Anxiety and depression are the two most commonly diagnosed psychiatric disorders in the US. The effect of these disorders on total shoulder arthroplasty (TSA) outcomes must be appreciated. The purpose of this study was to examine the correlation between preoperative diagnosis of anxiety and depression and its association with postoperative outcomes after TSA. The secondary goals were to determine whether patients contemporaneously being treated with medicine for their mental health diagnosis fared better than a non-medicated cohort and to examine the degree to which PROMIS Mental Health (PROMIS-MH) scores correlate with patient outcomes. Our hypothesis is that a history of anxiety and/or depression will negatively impact patient outcomes after TSA. METHODS:A retrospective analysis was performed on a prospectively collected cohort at a single institution. Anatomic and reverse TSA patients (aTSA, rTSA) with either anxiety and/or depression (aTSApsych+, rTSApsych+) were identified and compared to a cohort of patients without a mental health diagnosis enrolled in an institutional registry from 2011 to 2020. Demographic characteristics, diagnoses, implant type, range of motion (ROM), adverse events (AE) and clinical outcome metric scores:PROMIS-MH, American Shoulder and Elbow Surgeons (ASES), Constant, Shoulder Arthroplasty Smart Score (SAS) were recorded. Outcomes between cohorts were analyzed using conventional statistics as well as stratification by MCID and SCB thresholds where applicable. RESULTS:218 patients (114 rTSA and 95 aTSA) had a diagnosis of either anxiety and/or depression and 378 (153 rTSA and 217 aTSA) had no history. Although both cohorts achieved MCID and SCB for postoperative ASES, the psych+ cohort resulted in lower postoperative outcomes scores (p<0.05), higher AE, and significantly lower Δ differences in all variables when compared to the psych negative cohort. There were no differences in outcome scores after rTSApsych+ or aTSApsych+ between patients being treated for anxiety/depression compared to not receiving treatment. PROMIS-MH score was positively correlated with postoperative outcomes and patient satisfaction. CONCLUSION/CONCLUSIONS:The current study demonstrates that patients with anxiety and/or depression who undergo TSA have inferior postoperative outcomes and higher rates of AE compared to a cohort without a mental health diagnosis. Additionally, patients on medications for treatment of depression and/or anxiety did not gain any significant benefit in terms of their postoperative shoulder outcomes or satisfaction rate compared to those with a diagnosis but not on medication. Additionally, we found that, independent of a patient's underlying shoulder pathology or psychiatric diagnosis, lower PROMIS-MH scores was correlated with worse postoperative outcomes.

PURPOSE/UNASSIGNED:The purposes of this study were to determine why athletes did not return to play (RTP) following operative management of superior-labrum anterior-posterior (SLAP) tears, compare these athletes to those who did RTP, and evaluate the SLAP-Return to Sport after Injury (SLAP-RSI) score to assess the psychological readiness of athletes to RTP after operative management of SLAP tears. METHODS/UNASSIGNED:A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 24-month follow-up was performed. Outcome data, including visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, patient satisfaction, and whether they would undergo the same surgery again was collected. Additionally, the rate and timing of return to work (RTW), the rate and timing of RTP, SLAP-RSI score, and VAS during sport were evaluated, with subgroup analysis among overhead and contact athletes. The SLAP-RSI is a modification of the Shoulder Instability-Return to Sport after Injury (SI-RSI) score, with a score >56 considered to be a passing score for being psychologically ready to RTP. RESULTS/UNASSIGNED: = .001) were all associated with greater likelihood of return to sports at final follow-up. CONCLUSIONS/UNASSIGNED:Following the operative management of SLAP tears, patients who are unable to RTP exhibit poor psychological readiness to return, which may be due to residual pain in overhead athletes or fear of reinjury in contact athletes. Lastly, the SLAP-RSI tool in combination with ASES proved to be useful in identifying patients' psychological and physical readiness to RTP. LEVEL OF EVIDENCE/UNASSIGNED:Level IV, prognostic case series.

PURPOSE/UNASSIGNED:To assess the preoperative and postoperative performance of the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE, version 2.0) outcome score in comparison to the American Shoulder and Elbow Surgeons (ASES) and Western Ontario Rotator Cuff Index (WORC) instruments in patients undergoing rotator cuff repair. METHODS/UNASSIGNED:) between these tools was calculated at each time point. Correlations were graded as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), or poor (<0.4). Responsiveness to change was assessed using the effect size and the standardized response mean. Floor and ceiling effects for each instrument were also assessed. RESULTS/UNASSIGNED:The PROMIS-UE instrument showed good to excellent correlation with the legacy instruments at all time points. There were variations in the measured effect sizes of the various instruments, with the PROMIS-UE instrument showing responsiveness to change at 3 and 12 months but the ASES and WORC instruments showing responsiveness at 6 weeks, 3 months, and 12 months. Both PROMIS-UE and ASES scores displayed ceiling effects at 12 months. CONCLUSIONS/UNASSIGNED:The PROMIS-UE instrument shows excellent correlation with the ASES instrument and a rotator cuff-specific outcome instrument-the WORC instrument-preoperatively and at 1 year after arthroscopic rotator cuff repair. Variations in the measured effect sizes at different postoperative time points and high ceiling effects of the PROMIS-UE instrument at the 1-year time point may limit its utility in the early postoperative phase and at long-term follow-up after rotator cuff repair. CLINICAL RELEVANCE/UNASSIGNED:The performance of the PROMIS-UE outcome measure after arthroscopic rotator cuff repair was investigated.

STUDY DESIGN/METHODS:Retrospective analysis of outcomes in cervical spine and shoulder arthroscopy patients. OBJECTIVE:The objective of this study is to assess differential improvements in health-related quality of life for cervical spine surgery compared with shoulder surgery. SUMMARY OF BACKGROUND DATA/BACKGROUND:An understanding of outcome differences between different types of orthopedic surgeries is helpful in counseling patients about expected postoperative recovery. This study compares outcomes in patients undergoing cervical spine surgery with arthroscopic shoulder surgery using computer-adaptive Patient-reported Outcome Information System scores. MATERIALS AND METHODS/METHODS:Patients undergoing cervical spine surgery (1-level or 2-level anterior cervical discectomy and fusion, cervical disc replacement) or arthroscopic shoulder surgery (rotator cuff repair±biceps tenodesis) were grouped. Patient-reported Outcome Information System scores of physical function, pain interference, and pain intensity at baseline and at 3, 6, and 12 months were compared using paired t tests. RESULTS:Cervical spine (n=127) and shoulder (n=91) groups were similar in sex (25.8% vs. 41.8% female, P=0.731) but differed in age (51.6±11.6 vs. 58.60±11.2, P<0.05), operative time (148.3±68.6 vs. 75.9±26.9 min, P<0.05), American Society of Anesthesiologists (ASAs) (2.3±0.6 vs. 2.0±0.5, P=0.001), smoking status (15.7% vs. 4.4%, P=0.008), and length of stay (1.1±1.0 vs. 0.3±0.1, P=0.000). Spine patients had worse physical function (36.9 ±12.6 vs. 49.4±8.6, P<0.05) and greater pain interference (67.0±13.6 vs. 61.7±4.8, P=0.001) at baseline. Significant improvements were seen in all domains by 3 months for both groups, except for physical function after shoulder surgery. Spine patients had greater physical function improvements at all timepoints (3.33 vs. -0.43, P=0.003; 4.81 vs. 0.08, P=0.001; 6.5 vs. -5.24, P=<0.05). Conversely, shoulder surgery patients showed better 6-month improvement in pain intensity over spine patients (-8.86 vs. -4.46, P=0.001), but this difference resolved by 12 months. CONCLUSIONS:Cervical spine patients had greater relative early improvement in physical function compared with shoulder patients, whereas pain interference and intensity did not significantly differ between the 2 groups after surgery. This will help in counseling patients about relative difference in recovery and improvement between the 2 surgery types. LEVEL OF EVIDENCE/METHODS:III.

BACKGROUND/UNASSIGNED:The purpose of this study was to identify prognostic factors that are associated with improvements in patient-reported outcomes measures (PROMs) related to upper extremity function and pain in those suffering from idiopathic adhesive capsulitis. METHODS/UNASSIGNED:value of < .05 was considered statistically significant. RESULTS/UNASSIGNED: = .002). CONCLUSION/UNASSIGNED:Patient-perceived improvements in PROMIS score during the natural history of adhesive capsulitis are likely multifactorial, with anxiety, hyperlipidemia, increased body mass index, and Hispanic heritage associated with reduced improvement in PROMIS scores.

Anterior shoulder instability has been a common shoulder problem since the earliest of human civilizations. Over the course of thousands of years, our understanding regarding shoulder instability and treatment options have evolved tremendously. Specifically, over the past several decades we have seen a gradual but substantial development in our understanding of the natural history of anterior shoulder instability with and without surgical treatment. There is increasing recognition and improved understanding of the role of bone loss in the pathophysiology of shoulder instability, with ongoing emphasis on restoring native anatomy with minimally invasive techniques. The rich history of successes and failures of past surgical procedures forms the basis of the many innovative surgical techniques currently used, including both bony and soft tissue procedures. The purpose of this review is to highlight some of the most influential and important breakthroughs in the evolution of our understanding and management of anterior shoulder instability.

BACKGROUND/UNASSIGNED:Instability is one of the leading causes of revision for reverse total shoulder arthroplasty (RTSA). Closed reduction (CR) of a dislocated RTSA is recommended by many as initial treatment with varying degrees of success. In this study, we describe polyethylene liner dissociation from the humeral tray (PDH) as a cause of failure of CR of dislocated RTSA. METHODS/UNASSIGNED:In this retrospective study, patients who underwent revision RTSA for instability were identified through our institutional database review using specific International Classification of Diseases and Current Procedural Terminology codes. Pertinent clinical information including demographics, details of instability event (early vs. late), traumatic vs. atraumatic, outcomes of CR (if performed), and intraoperative findings during revision surgery were collected and analyzed. RESULTS/UNASSIGNED:Twenty-two patients met the inclusion criteria with average follow-up of 2 years. CR was attempted in 12 (55%) patients, prior to revision surgery, and was successful in 5 (23%) patients. During the revision surgery polyethylene liner dissociation from the humeral tray (PDH) was identified in 10 patients (45%). Five of these 10 patients had failed CR and the other 5 patients did not undergo CR due to primary surgeon's preference. All patients with PDH event had onlay humeral tray RTSA system. Although not a consistent radiographic finding in our series, the presence of the metallic glenosphere in direct contact with the humeral tray on anteroposterior or axillary radiographs was diagnostic for PDH. CONCLUSION/UNASSIGNED:Dissociation of polyethylene liner from the humeral tray can be associated with an RTSA dislocation and is a contraindication for CR. A radiographic finding of the metallic humeral tray articulating directly with the glenosphere is an indication that the polyethylene liner is dissociated from the humeral tray.