Traumatic Inferior Glenohumeral Dislocation Associated With Rotator Cuff Avulsion Fracture: Arthroscopic-Assisted Fixation: A Technical Note

Abstract Background Incidence of rotator cuff tears (RCT) following primary anterior glenohumeral dislocation in patients over 40 years is thought to be high. Current guidelines recommend specialist clinic review and advanced imaging for all patients. The aim of this study was to report the incidence of symptomatic RCT in a large cohort of patients and to assess the safety and efficacy of a physiotherapy led virtual protocol where patients were selectively investigated and treated based on symptoms. Methods 238 consecutive patients over 40 years of age with a primary anterior glenohumeral dislocation were identified between January 2015 and June 2018 (42 months). All patients were managed initially through a physiotherapy led virtual clinic with selective referral of patients with red flag symptoms to a specialist shoulder clinic. Advanced imaging (MRI or USS) was performed at the discretion of the shoulder specialist following patient assessment. The incidence of symptomatic RCT was assessed and compared between two groups (Group 1: 40-70 years, Group 2: >70 years). All surgical interventions were recorded. Patients were assessed at a mean of 22 months (range 10-54) using the Oxford shoulder score; patient satisfaction and return to pre-injury functional level. Cost analysis was performed to compare management using this protocol versus published guidelines.Results A total of 238 patients were identified with mean age of 65 years (range 40-96). 69% (n=164/238) were symptomatic and were referred to specialist clinic. The other 31% (n=74/238) were asymptomatic and were discharged to physiotherapy. Of those referred to a specialist clinic, only 46% (n=75/164) were sent for advanced imaging following clinical examination. The incidence of symptomatic RCTs was 31% (n=51/164) in this group and only 22% (n=11/51) of those underwent subsequent surgical repair of their rotator cuff. Of those patients discharged to physiotherapy, 62% (n=47/74) responded to the questionnaire with 89% fully satisfied, 85% returned to pre-injury level and mean Oxford score was 42 (33-38, SD 3.2) indicating excellent shoulder function. With all patients pooled excluding those lost to follow-up (n=27), the incidence of symptomatic RCTs was 24% (51/211). The incidence in group 1 was 16% (n=22/137) and was significantly lower than in group 2 which was 39% (n=29/74) (p<0.05). Cost analysis demonstrated 49% cost reduction using this protocol.Conclusion Incidence of symptomatic cuff tears following a primary glenohumeral dislocation in patients over 40 years was lower than previously reported. A protocol based on selective referral and investigation for symptomatic patients was cost effective and safe.

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Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-011-1373-7 ◽

2011 ◽

Vol 132 (3) ◽

pp. 335-342 ◽

Cited By ~ 7

Author(s):

Jong-Hun Ji ◽

Mohamed Shafi ◽

Jae-Jung Jeong ◽

Yeon Soo Lee ◽

Edward G. McFarland ◽

...

Keyword(s):

Rotator Cuff ◽

Articular Surface ◽

Biceps Tendon ◽

Technical Note ◽

Arthroscopic Repair ◽

High Grade ◽

Preliminary Results ◽

Partial Thickness

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Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament: technical note

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-007-0506-5 ◽

2007 ◽

Vol 128 (11) ◽

pp. 1309-1312 ◽

Cited By ~ 15

Author(s):

Jin Hwan Ahn ◽

Yong Seuk Lee ◽

Dong Hoon Lee ◽

Hae Chan Ha

Keyword(s):

Anterior Cruciate Ligament ◽

Avulsion Fracture ◽

Cruciate Ligament ◽

Technical Note ◽

Tibial Avulsion Fracture ◽

Anterior Cruciate ◽

Physeal Sparing

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Subacromial resurfacing with fascia lata autograft for irreparable cuff tears

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00359-6 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Nuno Gomes ◽

Helder Fonte ◽

Sara Santos ◽

Duarte Sousa

Keyword(s):

Rotator Cuff ◽

Low Cost ◽

The Elderly ◽

Clinical Results ◽

Technical Note ◽

Fascia Lata ◽

Rotator Cuff Tears ◽

Surgical Options ◽

Technical Simplicity ◽

The Ideal

AbstractMassive and irreparable rotator cuff tears remain a major challenge for orthopaedic surgeons and several surgical options have been accepted for different patterns of irreparable cuff tears. However, the high-cost and technical complexity of some surgeries and the inconsistent clinical results of others, leave room for the search for surgical options that can offer a good balance between technical simplicity, a lower cost and an acceptable clinical result.The rationale behind some available techniques includes lowering the humeral head, which enables a more efficient balance of the force couples around the shoulder during rehabilitation. The interpositional arthroplasty with a biodegradable balloon, the Superior Capsule Reconstruction and, more recently, subacromial resurfacing with a dermal allograft have been presented as valid options to address that purpose.This technical note presents Subacromial Resurfacing with fascia lata as an option for the treatment of irreparable rotator cuff tears in the elderly population. Its low-cost and reasonable technical demand, along with the need for further elucidation of the ideal indications and technical optimization of other available techniques may open up room for the success of this option.

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