Orthopedic resident’s learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes

Abstract Background Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. Methods A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. Results Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. Conclusion Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

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The learning curve following adoption of a novel short-stem prosthesis in total hip arthroplasty: implications on short-term patient outcomes

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-018-2355-z ◽

2018 ◽

Vol 29 (4) ◽

pp. 819-825 ◽

Cited By ~ 1

Author(s):

Jorge A. Padilla ◽

Afshin A. Anoushiravani ◽

James E. Feng ◽

Ran Schwarzkopf ◽

James Slover ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Learning Curve ◽

Patient Outcomes ◽

Hip Arthroplasty ◽

Short Stem ◽

Short Term ◽

Total Hip

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Clinical and Radiographic Outcomes With Assessment of the Learning Curve in Arthroscopically Assisted Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Rotator Cuff Tears

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2017.06.015 ◽

2017 ◽

Vol 33 (12) ◽

pp. 2144-2151 ◽

Cited By ~ 11

Author(s):

Kotaro Yamakado

Keyword(s):

Rotator Cuff ◽

Learning Curve ◽

Latissimus Dorsi ◽

Tendon Transfer ◽

Rotator Cuff Tears ◽

Radiographic Outcomes ◽

Arthroscopically Assisted

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USEFULNESS OF GASTRIC SUBMUCOSAL DISSECTION DEPTH TO EVALUATE SKILL ACQUIREMENT IN SHORT TERM TRAINING COURSES IN ESD: AN EXPERIMENTAL STUDY

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-58 ◽

2018 ◽

Vol 55 (3) ◽

pp. 221-229 ◽

Cited By ~ 1

Author(s):

Kendi YAMAZAKI ◽

Eduardo Guimarães Hourneaux de MOURA ◽

Mariana Matera VERAS ◽

Luiz Henrique MESTIERI ◽

Paulo SAKAI

Keyword(s):

Experimental Study ◽

Adverse Events ◽

Learning Curve ◽

Intraoperative Complications ◽

Gastric Body ◽

Short Term ◽

Roc Curve Analysis ◽

The Third ◽

Submucosal Dissection ◽

Training Courses

ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, with high rates of adverse events and technical difficulties. To overcome that problem, many training centers published the importance of animal models for skill acquirement in ESD. However, no study has used the submucosal dissection depth (DSUB) as a parameter to evaluate the learning curve in ESD, which might be a relevant factor since an optimal resection plane is important to achieve a curative resection and avoid intraoperative complications. OBJECTIVE: This study aimed to assess ESD skill acquirement after short-term training sessions by evaluating the submucosal dissection depth (DSUB) and the association with adverse events. METHODS: This experimental study included 25 experienced endoscopists in therapeuthic procedures (>5years) and 75 specimens resected by ESD (three resections / endoscopist). Learning parameters (resection time, size, en bloc resection rate, bleeding, perforation and submucosal dissection depth) were prospectively evaluated. The percentages of DSUB of all specimens resected were calculated. RESULTS: All specimens were resected from the gastric body (n=75). The mean size of the resected specimens was 23.97±7.2 mm. The number of adverse events, including bleeding, perforation, and death, were 17 (22.67%), 3 (4%), and 0 cases, respectively. The average mean time by the third dissection decreased from 28.44±9.73 to 18.72±8.81 min (P<0.001). The proportion of DSUB in the bleeding and non-bleeding group were respectively 37.97%±21.13% and 68.66%±23.99%, indicating a significant association between DSUB and bleeding incidence (P<0.001). The ROC curve analysis indicated a cut-off point of 61% (sensitivity, 64%; specificity, 94%) of submucosal dissection depth associated with bleeding. Therefore, when ESD was performed at a depth of >61% of the submucosal layer, the risk for bleeding during the procedure decreased (PPV, 0.97; 95% CI, 0.85-0.99). CONCLUSION: Improvement in the learning curve in ESD and a better cognitive ability were seen by the third dissection in these short term training courses. And a significant association between DSUB and the risk of bleeding.

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Short-term and long-term outcomes of robotic, laparoscopic and open radical gastrectomy in gastric cancer: A single-center retrospective study

10.21203/rs.2.15339/v1 ◽

2019 ◽

Author(s):

Weifan Zhang ◽

Xinhui Zhao ◽

Zhao Liu ◽

Hui Dang ◽

Lei Meng ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Learning Curve ◽

Operation Time ◽

Open Gastrectomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Estimated Blood Loss

Abstract Background: Few studies on the comparison among robotic, laparoscopic, and open gastrectomy had been reported in gastric cancer . The goal of this study was to evaluate the advantages of robotic-assisted gastrectomy (RAG) by comparing with laparoscopic-assisted gastrectomy(LAG) and open gastrectomy (OG). Methods: 147 gastric cancer patients who underwent gastrectomy were enrolled and retrospectively analyzed between January 2017 and July 2019. Short-term outcomes such as operation time, intraoperative estimated blood loss(EBL),number of retrieved lymph nodes, postoperative recovery, learning curve, and long-term outcome such as overall survival(OS) was compared among RAG, LAG and OG groups. Results: RAG group included 47 patients, 44 in the LAG, and 61 in the OG. Basic information such as gender, age, BMI, ASA degree were similar among three groups, and there were no statistically significances in pathological TNM staging, tumor resection extent, resection margin, methods of reconstruction( P ＞0.05). The cumulative sum(CUSUM) method showed that learning curve of RAG reached stability after 17 cases . For short-term outcomes, the RAG group had the shortest EBL( P =0.033), the shortest time to first flatus( P ＜0.001), shortest time to first intake liquid diet ( P =0.004),shortest postoperative hospital stay ( P =0.023)and the largest number of retrieved lymph nodes( P =0.044),the longest operation time( P ＜0.001), the most expensive treatment cost( P ＜0.001),however, there were no significant differences in postoperative drainage, postoperative white blood cell(WBC)count and early complications among three group( P ＞0.05). In addition to long-term outcome, similar OS was observed in three groups. Conclusion: Compared with LAG and OG, RAG has certain advantages in short-term outcomes and is a safe and reliable surgical method. But still need further prospective, multi-center research to confirm this.

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Rotator Interval Lesion and Damaged Subscapularis Tendon Repair in a High School Baseball Player

Case Reports in Orthopedics ◽

10.1155/2015/890721 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Tomoyuki Muto ◽

Hiroki Ninomiya ◽

Hiroaki Inui ◽

Masahiko Komai ◽

Katsuya Nobuhara

Keyword(s):

Tendon Repair ◽

Limited Range ◽

High Signal ◽

Subscapularis Tendon ◽

Rotator Interval ◽

Glenohumeral Ligaments ◽

Limited Range Of Motion ◽

Arthroscopic Examination ◽

Magnetic Resonance Imaging Mri ◽

One Year

In 2013, a 16-year-old baseball pitcher visited Nobuhara Hospital complaining of shoulder pain and limited range of motion in his throwing shoulder. High signal intensity in the rotator interval (RI) area (ball sign), injured subscapularis tendon, and damage to both the superior and middle glenohumeral ligaments were identified using magnetic resonance imaging (MRI). Repair of the RI lesion and partially damaged subscapularis tendon was performed in this pitcher. During surgery, an opened RI and dropping of the subscapularis tendon were observed. The RI was closed in a 90° externally rotated and abducted position. To reconfirm the exact repaired state of the patient, arthroscopic examination was performed from behind. However, suture points were not visible in the >30° externally rotated position, which indicates that the RI could not be correctly repaired with the arthroscopic procedure. One year after surgery, the patient obtained full function of the shoulder and returned to play at a national convention. Surgical repair of the RI lesion should be performed in exactly the correct position of the upper extremity.

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