Short-term complications of the Latarjet procedure: a systematic review
PURPOSE/OBJECTIVE:The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures and to meta-analyze the studies comparing the 2 approaches. METHODS:PubMed was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures. A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following the open or arthroscopic Latarjet were included. Meta-analysis was performed for comparative studies using Review Manager, version 5.3. A P value of <.05 was considered statistically significant. RESULTS:Overall, 89 studies (Level of Evidence [LOE] I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (P = .81). CONCLUSION/CONCLUSIONS:Our study established that the overall complication rate following the Latarjet procedure was 6%-7%, with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.
No difference in 90-day complication rate following open versus arthroscopic Latarjet procedure
The purpose of this study was to compare the 90-day complication rate between the open and arthroscopic Latarjet procedure. A retrospective review of patients who underwent an open or arthroscopic Latarjet procedure at NYU Langone Health between 2012 and 2019 was performed. The complications, readmissions, and reoperations within 90 days were assessed. Outcomes were compared between the two approaches, and a p value ofâ€‰<â€‰0.05 was considered to be statistically significant. The study included 150 patients (open: 110; arthroscopic: 40), with no patients lost to follow-up within the first 90Â days. Both cohorts were similar in terms of patient demographics. No intra-operative complications were observed in either group. Overall, there were 4 post-operative complications with the open approach and 2 with the arthroscopic approach (3.6% and 5.0%, respectively; n.s.) during the study period. Three patients required a readmission within the 90-day period; one patient in both groups required a revision Latarjet for graft fracture, and one patient in the open Latarjet required irrigation and debridement for deep infection (n.s.). With the open approach, there were 2 (2.3%) wound complications, 1 graft complication, and 1 (1.1%) nerve injury. With the arthroscopic approach, there was 1 (2.8%) wound complication and 1 (2.8%) hardware complication. The safety, and 90-day complication and readmission profile of arthroscopic Latarjet is similar to open Latarjet procedure. LEVEL OF EVIDENCE: Level III.
Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications
BACKGROUND:The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity. PURPOSE:To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation. STUDY DESIGN:Descriptive laboratory study. METHODS:Axial, non-fat suppressed, T1-weighted MRI scans of the elbow were obtained in positions of maximal supination, neutral, and maximal pronation in 13 skeletally mature individuals. Distances were measured from the PIN to (1) the simulated path of an entering guidewire (GWE-PIN) and (2) the cortical starting point of the guidewire on the bicipital tuberosity (CSP-PIN) achievable from the single-incision approach. To radiographically define the location of the nerve relative to constant landmarks, measurements were also made from the PIN to (3) the prominent-most point on the bicipital tuberosity (BTP-PIN) and (4) a perpendicular plane trajectory from the bicipital tuberosity exiting the opposing radial cortex (PPT-PIN). All measurements were subsequently compared between positions of pronation, neutral, and supination. In supination only, BTP-PIN and PPT-PIN measurements were made and compared at 3 sequential axial levels to evaluate the longitudinal course of the nerve relative to the bicipital tuberosity. RESULTS:< .001). CONCLUSION:This MRI study supports existing evidence that supination protects the PIN from the entering guidewire instrumentation during anterior, single-incision biceps tendon repair using cortical button fixation. The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. CLINICAL RELEVANCE:When a safe technique is used, PIN injuries during anterior repair are likely the result of aberrant retractor placement, and we recommend against the use of retractors deep to the radial neck. Guidewire placement as close as possible to the anatomic footprint of the biceps tendon is safe from the anterior approach. MRI evaluation confirms that ulnar and proximal guidewire trajectory is the safest technique when using single-incision bicortical suspensory button fixation.
Institutional Reductions in Opioid Prescribing Following Hip Arthroscopy Do Not Change Patient Satisfaction Scores
Purpose/UNASSIGNED:To investigate what effect decreased opioid prescribing following hip arthroscopy had on Press-Ganey satisfaction survey scores. Methods/UNASSIGNED:A retrospective review of prospectively collected data was conducted on patients who underwent primary hip arthroscopy for femoroacetabular impingement between October 2014 and October 2019. Inclusion criteria consisted of complete Press-Ganey survey information, no history of trauma, fracture, connective tissue disease, developmental hip dysplasia, autoimmune disease, or previous hip arthroscopy. Groups were separated based on date of surgery relative to implementation of an institutional opioid reduction policy that occurred in October 2018. Prescriptions were converted to milligram morphine equivalents (MME) for direct comparison between different opioids. Results/UNASSIGNED:> .05). Conclusions/UNASSIGNED:A reduction in opioids prescribed after a hip arthroscopy is not associated with any statistically significant difference in patient satisfaction with pain management, as measured by the Press-Ganey survey. Level of Evidence/UNASSIGNED:Level III, retrospective comparative study.
Arthroscopic Latarjet Procedure: Indications, Techniques, and Outcomes
Â»:The proposed advantages of the arthroscopic approach in the Latarjet procedure for shoulder dislocation include improved visualization for accurate positioning of the coracoid graft, the ability to address any associated intra-articular pathologies, and the diminished potential for the formation of postoperative scar tissue and stiffness associated with an open procedure. Â»:Young age, the presence of glenoid and/or humeral bone loss, a history of dislocation, a history of failed arthroscopic stabilization surgery, and an active lifestyle are all associated with recurrent dislocation and are relative indications for an osseous augmentation procedure. Â»:Both the open and arthroscopic Latarjet procedures result in substantial improvements in patient function, with comparable rates of recurrent instability and complication profiles.
Decreased Hip Labral Width Measured via Preoperative MRI is Associated with Inferior Outcomes for Arthroscopic Labral Repair for Femoroacetabular Impingement
PURPOSE/OBJECTIVE:To determine the association between labral width as measured on preoperative MRI with hip-specific validated patient self-reported outcomes at a minimum of 2 years follow-up. METHODS:An IRB-approved retrospective review of prospectively gathered hip arthroscopy patients from 2010 to 2017 was performed. Inclusion criteria was defined as patients >18 years old with radiographic evidence of femoroacetabular impingement who underwent a primary labral repair and had a minimum of 2 years clinical follow-up. Exclusion criteria was defined as inadequate preoperative imaging, prior hip surgery, Tonnis grade â‰¥2 or lateral central edge angle <25 degrees. An a-priori power analysis was performed. MRI measurements of labral width were conducted by two blinded, musculoskeletal fellowship-trained radiologists at standardized "clockface" locations using a previously validated technique. Outcomes were assessed using the Harris Hip Score (HHS), Modified HHS (mHSS), and NonArthritic Hip Score (NAHS). For mHHS, a minimal clinically important difference (MCID) and Patient Acceptable Symptomatic State (PASS) of 8 and 74 were used, respectively. Patients were divided into groups by labral width of < (hypoplastic) and â‰¥ 1 standard deviation below the mean. Statistical analysis was performed using linear and polynomial regression, Mann-Whitney U, chi-square, Fischer exact, and interclass-correlation coefficients (ICC) testing. RESULTS:=0.26, p<0.001). CONCLUSION/CONCLUSIONS:Hip labral width < 1 standard deviation below the mean measured via preoperative MRI was associated with significantly worse functional outcomes following arthroscopic labral repair and treatment of FAI. The negative relationship between labral width and outcomes may be non-linear.
MRI of superior capsular reconstruction graft and associated short-term clinical outcomes in patients with massive irreparable rotator cuff tears
OBJECTIVE:To assess MRI appearance of the dermal allograft and its correlation with clinical outcome following superior capsular reconstruction (SCR). MATERIALS AND METHODS/METHODS:This is a retrospective study of patients who underwent SCR between 2015 and 2018. Patients with postoperative MRI and clinical follow-up were included. Exclusion criteria were preoperative shoulder instability, advanced glenohumeral arthritis, and lack of postoperative MRI or clinical follow-up. Radiographs and MRIs were evaluated for graft integrity and position, acromiohumeral interval, superior subluxation distance (SSD), and glenohumeral cartilage loss. Correlation between imaging and clinical outcome measures were assessed. RESULTS:24 shoulders (23 patients) met the inclusion criteria at a mean clinical and MRI follow-up of 9.1Â months. There were 12 intact grafts (50%) and 12 torn grafts (50%), most commonly at the glenoid attachment (8/12). Patients with graft tear had greater SSD (mean 10.5Â Â±Â 6.1Â mm) than those without tear (mean 6.1Â Â±Â 3.8Â mm) (pÂ =Â 0.028). SSDÂ >Â 7.9Â mm had a 79% sensitivity and 91% specificity for graft tear. The intact grafts were more commonly covering the superior humeral head (91.7%) compared with the torn grafts (41.7%) (pÂ =Â 0.027). There was improvement of clinical outcome measures including American Shoulder and Elbow Surgeons score (pÂ =Â 0.005) and forward elevation (pÂ =Â 0.021) although there was no correlation between clinical outcome and integrity of the graft. CONCLUSION/CONCLUSIONS:SCR results in significant short-term clinical improvement even in the presence of graft tear on postoperative MRIs on current study. Gap between graft and the anchors, non-superior position of the graft, and humeral head superior subluxation can be associated with tear.
Collagen-Based Bioinductive Implant for Treatment of Partial Thickness Rotator Cuff Tears
INTRODUCTION/BACKGROUND:Partial thicknessrotator cuff tears(PTRCT) have low healing potential and tend to progress over time if not addressed surgically. There is a relative paucity of literature discussing optimal treatment for symptomatic PTRCT as compared to full thicknessrotator cuff tears. The available data supports a treatment course of debridement with or without acromioplasty for symptomatic patients with tears less than 50% in thickness combined with the use of repair (conversion to full thickness or transtendinous) for symptomatic patients with tears greater than 50% in thickness. The aim of this study was to evaluate functional and radiographic outcomes following surgical implantation of a collagen-based bioinductive implant for PTRCT. METHODS:Patients with PTRCT who underwent implantation of a collagen-based bioinductive implant over the bursal surface of the rotator cuff were identified. Patients who had an implant placed to augment a standard full thickness repair were excluded from analysis. We administered questionnaires to patients with a minimum of 6 months since surgery and collected patient data including demographics, preoperative and postoperative American Shoulder and Elbow Society (ASES) scores, preoperative and postoperative visual analog scale (VAS) pain scores, complications, and satisfaction level. Magnetic resonance imaging (MRI) was obtained as needed, at 6 months, or at 12 months postoperatively, and tendon thickness was measured on coronal views. RESULTS:Thirty patients were identified who met the inclusion and exclusion criteria. Twenty-four patients (80% response rate) were available for follow-up; 19 were male and five were female. Mean age and body mass index were 54.5 Â± 11.6 years and 28.6 Â± 5.9 kg/m2 , respectively. Mean tear thickness as measured intraoperatively was 56.6%. There were 16 (66.7%) articular-sided, five (20.8%) bursal-sided, and three (12.5%) intrasubstance tears. Mean survey follow-up time was 19.1 months. Mean ASES scores increased significantly from 45.6 preoperatively to 68.1 postoperatively (p = 0.001). Mean VAS pain scores decreased significantly from 8.3 preoperatively to 3.8 postoperatively (p < 0.001). Mean patient satisfaction level was 7.5. Ten patients had both a preoperative and postoperative MRI available for comparison. Tendon thickness at the tear site increased significantly from 5.7 mm preoperatively to 6.5 mm at mean 9.9 months follow-up (p = 0.007). There were no implant-related complications. One patient suffered a traumatic re-tear 4 months postoperatively. CONCLUSION/CONCLUSIONS:Highly porous collagen-based bioinductive implants are safe and effective forreducing pain and improving shoulderfunction in patientswith PTRCT of approximately 50%, with radiographic evidence of new tissue formation. Randomized controlled trials are needed to assess efficacy relative to debridement and standard repair techniques.
Recall Bias in Retrospective Assessment of Preoperative Patient-Reported American Shoulder and Elbow Surgeons Scores in Arthroscopic Rotator Cuff Repair Surgery
BACKGROUND/UNASSIGNED:The gold-standard method for collecting patient-reported outcomes (PROs) is the prospective assessment of preoperative to postoperative change. However, this method is not always feasible because of unforeseen cases or emergencies, logistical and infrastructure barriers, and cost issues. In such cases, a retrospective approach serves as a potential alternative, but there are conflicting conclusions regarding the reliability of the recalled preoperative PROs after orthopaedic procedures. PURPOSE/UNASSIGNED:To assess the agreement between prospectively and retrospectively collected PROs for a common, low-risk procedure. STUDY DESIGN/UNASSIGNED:Cohort study (Diagnosis); Level of evidence, 3. METHODS/UNASSIGNED:Patients who underwent arthroscopic rotator cuff repair between May 2012 and September 2017 at the study institution were identified. All of the patients completed the American Shoulder and Elbow Surgeons (ASES) Standard Shoulder Assessment Form preoperatively at their preassessment appointment. Patients were then contacted in the postoperative period and asked to recall their preoperative condition while completing another ASES form. RESULTS/UNASSIGNED:= .068). Greater age at the time of recall, a shorter symptomatic period before surgery, and less severe preoperative shoulder dysfunction were associated with a greater difference between preoperative ASES and recall ASES. CONCLUSION/UNASSIGNED:Retrospectively reported PROs are subject to significant recall bias. Recalled PROs were almost always lower than their prospectively recorded counterparts. Recalled PROs are more likely to be accurate when reported by younger patients, those with a longer duration of symptoms, and those with more severe preoperative conditions.
Tibial Slope and Anterior Cruciate Ligament Reconstruction Outcomes