scholarly journals Management of Failed Proximal Biceps Surgery: Clinical Outcomes after Revision to Subpectoral Biceps Tenodesis

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
David Savin ◽  
Brian Robert Waterman ◽  
Catherine Richardson ◽  
Shelby Sumner ◽  
Anthony A. Romeo
Keyword(s):  
Chronic Pain ◽  
Rotator Cuff ◽  
Revision Surgery ◽  
Functional Outcomes ◽  
Statistical Significance ◽  
Functional Score ◽  
Biceps Tenodesis ◽  
Patient Reported ◽  
Subpectoral Biceps Tenodesis

Objectives: The preferred technique for management of biceps-superior labral pathology is often debated, and rates of revision and persistence pain vary widely accordingly to surgical technique and patient demographics. The purpose of this study was to evaluate the clinical and functional outcomes of patients undergoing revision subpectoral biceps tenodesis after failed primary tenodesis or tenotomy. Methods: A retrospective review was completed to identify of all patients undergoing revision biceps tenodesis by the senior surgeon with minimum 24-month follow-up. Demographic variables including age, sex, insurance status, and tobacco use were recorded, Patient reported outcomes including the functional score, Single Assessment Mumeric Evaluation (SANE) rating, Visual Analog Scale (VAS) pain scale, Simple Shoulder Test (SST), and American Shoulder and Elbow Score (ASES) were obtained, and range of motion (ROM), strength, and complications were quantified. Results: In total, 36 patients with revision biceps tenodesis were identified, with a mean age of 46 ± 12 years and mean follow up of 60 ± 29 months. The indication for revision surgery was failure of index suprapectoral biceps tenodesis (56%), subpectoral biceps tenodesis (36%), and failure of tenotomy (8%). Concomitant procedures including rotator cuff repair and capsular release were performed in 25% and 8% of index surgeries respectively. There was a significant improvement in VAS score (P <0.001), SST (P<0.009), functional score (P<0.001) and forward elevation (P<0.001). Postoperative shoulder strength (P = 0.082), SANE (P = 0.074), abduction (P = 0.096) and external rotation (P =0.8) improved, but failed to achieve statistical significance. were not significantly improved following revision surgery. There was no difference in post-operative outcome measures between surgical indication, concomitant procedures and sex. 86% of patients reported high satisfaction and stated they would have this revision surgery again. Overall complication rate was 33% with the majority of these being either acute or chronic pain, with 8% of patients requiring additional surgeries to manage stiffness, chronic pain or rotator cuff deficiency. Conclusion: The current study demonstrates high patient satisfaction (86%) and significant improvement in functional outcomes with revision biceps tenodesis after previous failed tenodesis or tenotomy. Revision biceps tenodesis using a mini-open, subpectoral technique may be an effective strategy to address failed prior surgery, although the potential for persistent pain must be emphasized.

scholarly journals Management of Failed Proximal Biceps Surgery: Clinical Outcomes After Revision to Subpectoral Biceps Tenodesis

2019 ◽  
Vol 48 (2) ◽  
pp. 460-465 ◽  
Author(s):  
David D. Savin ◽  
Brian R. Waterman ◽  
Shelby Sumner ◽  
Catherine Richardson ◽  
John Newgren ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Revision Surgery ◽  
Complication Rate ◽  
Functional Outcomes ◽  
Persistent Pain ◽  
Functional Score ◽  
Biceps Tenodesis ◽  
Patient Reported ◽  
Subpectoral Biceps Tenodesis

Background: The preferred surgical technique to manage biceps–superior labral pathology is often debated, and rates of revision and persistence of pain vary widely according to surgical technique and patient characteristics. Purpose: To evaluate the clinical and functional outcomes of patients undergoing revision subpectoral tenodesis after failed primary tenodesis or tenotomy of the long head of the biceps. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing revision biceps management by the senior surgeon between 2006 and 2016 and with a minimum 24-month follow-up were retrospectively identified. Patients being treated with concomitant rotator cuff repair or capsular release were excluded. Patient characteristic variables were recorded. Patient-reported outcomes including the functional score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons were obtained, and range of motion, strength, and complications were quantified. Results: In total, 25 patients with revision biceps tenodesis were identified at a mean follow-up of 76.5 ± 31.5 months. The average age was 44.4 ± 14.3 years, and the surgical indications included failure of index suprapectoral biceps tenodesis (56%), subpectoral biceps tenodesis (36%), and patient dissatisfaction after tenotomy (8%). There was a significant improvement in the VAS score ( P < .001), SANE ( P = .001), SST ( P = .035), functional score ( P < .001), and forward elevation ( P = .028), whereas postoperative strength ( P = .440), abduction ( P = .100), and external rotation ( P = .745) improvement failed to achieve statistical significance after revision surgery. There was no difference in postoperative outcome measures between modes of failures, concomitant procedures, and sex. Twenty-two (88%) patients reported high satisfaction and stated they would have this revision surgery again. The overall complication rate was 48%, with half of these reporting pain of >3 on a scale of 10 and 4% of patients requiring additional surgeries. Conclusion: The current study demonstrates high patient satisfaction (88%) and significant improvement in functional outcomes with revision biceps tenodesis, a mini-open subpectoral technique, after previous failed tenodesis or tenotomy. Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. Patients should be counseled on the high complication rate (48%), with persistent pain being the most common complaint.

scholarly journals Open Subpectoral Biceps Tenodesis versus Arthroscopic Repair for SLAP Tears in Patients under 30 (224)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0033
Author(s):  
Christopher Colasanti ◽  
Eoghan Hurley ◽  
Nathan Lorentz ◽  
Kirk Campbell ◽  
Michael Alaia ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Arthroscopic Repair ◽  
Biceps Tenodesis ◽  
Total Rate ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean ◽  
Slap Tear ◽  
Subpectoral Biceps Tenodesis

Objectives: The purpose of this study is to compare the outcomes of mini-open subpectoral biceps tenodesis (BT) to arthroscopic repair (AR) for SLAP tears in patients under 30. Methods: A retrospective review of patients who underwent either isolated BT or AR for the diagnosis of a SLAP tear was performed. Patients with a follow-up duration of <24 months were excluded. The American Shoulder & Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS), Subjective Shoulder Value (SSV), patient satisfaction, willingness to undergo surgery again, revisions, and return to work/sport were evaluated. A p value of <0.05 was considered to be statistically significant. Results: Our study included 103 patients in total; 29 patients were treated with BT, and 74 were treated with AR. The mean age was 24.8 years, 79.4% were male, and the mean follow-up duration was 60 months. At final follow up, there was no difference between treatment groups in any of the functional outcome measures assessed (p > 0.05). Overall, there was no significant difference in the total rate of RTP (BT: 76.3%, AR: 85%; p = 0.53), timing of RTP (BT: 8.8 months, AR: 9.4 months; p = 0.61), and total rate of RTP among overhead athletes (BT: 84.2%, AR: 83.3%; p = 1). However, there was a significantly lower rate of revision surgery with BT (0%) as compared to AR (14.1%; p = 0.03). Conclusions: In patients under the age of 30 with isolated SLAP tear pathology, BT is a reliable alternative to AR, with a low rate of revision surgery, and excellent patient reported outcomes.

Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair

2021 ◽  
pp. 036354652110154
Author(s):  
Adam M. Johannsen ◽  
Justin W. Arner ◽  
Bryant P. Elrick ◽  
Philip-C. Nolte ◽  
Dylan R. Rakowski ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Revision Surgery ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Long Term Results ◽  
Double Row ◽  
Kaplan Meier ◽  
Patient Reported ◽  
Cuff Repair

Background: Modern rotator cuff repair techniques demonstrate favorable early and midterm outcomes, but long-term results have yet to be reported. Purpose: To determine 10-year outcomes and survivorship after arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair. Study Design: Case series; Level of evidence 4. Methods: The primary TOE rotator cuff repair procedure was performed using either a knotted suture bridge or knotless tape bridge technique on a series of patients with 1 to 3 tendon full-thickness rotator cuff tears involving the supraspinatus. Only patients who were 10 years postsurgery were included. Patient-reported outcomes were collected pre- and postoperatively, including American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey (SF-12), Single Assessment Numeric Evaluation (SANE), shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and satisfaction. Kaplan-Meier survivorship analysis was performed. Failure was defined as progression to revision surgery. Results: A total of 91 shoulders (56 men, 31 women) were included between October 2005 and December 2009. Mean follow-up was 11.5 years (range, 10.0-14.1 years). Of 91 shoulders, 5 (5.5%) failed and required revision surgery. Patient-reported outcomes for patients who survived were known for 80% (69/86). Outcomes scores at final follow-up were as follows: ASES, 93.1 ± 10.8; SANE, 87.5 ± 14.2; QuickDASH, 11.1 ± 13.5; and SF-12 physical component summary (PCS), 49.2 ± 10.1. There were statistically significant declines in ASES, SANE, and SF-12 PCS from the 5-year to 10-year follow-up, but none of these changes met the minimally clinically important difference threshold. Median satisfaction at final follow-up was 10 (range, 3-10). From this cohort, Kaplan-Meier survivorship demonstrated a 94.4% survival rate at a minimum of 10 years. Conclusion: Arthroscopic TOE rotator cuff repair demonstrates high patient satisfaction and low revision rates at a mean follow-up of 11.5 years. This information may be directly utilized in surgical decision making and preoperative patient counseling regarding the longevity of modern double-row rotator cuff repair.

Clinical Outcomes after Subpectoral Biceps Tenodesis with an Interference Screw

2008 ◽  
Vol 36 (10) ◽  
pp. 1922-1929 ◽  
Author(s):  
Augustus D. Mazzocca ◽  
Mark P. Cote ◽  
Cristina L. Arciero ◽  
Anthony A. Romeo ◽  
Robert A. Arciero
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcome ◽  
Physical Examination ◽  
Outcome Measures ◽  
Interference Screw ◽  
Biceps Tenodesis ◽  
Rotator Cuff Lesion ◽  
The Mean ◽  
Subpectoral Biceps Tenodesis

Background Subpectoral biceps tenodesis with an interference screw has been shown to be an effective procedure from both an anatomic and biomechanical perspective. There have been no clinical outcome data on this procedure to date. Hypothesis Subpectoral biceps tenodesis is an effective procedure in eliminating biceps tendinosis symptoms. Study Design Case series; Level of evidence, 4. Methods Patients who underwent subpectoral biceps tenodesis with a minimum follow-up of 1 year were evaluated using a battery of clinical outcome measures, biceps apex difference, and pain scores. A diagnosis of biceps tendinosis was made using a specific diagnostic protocol coupled with observation of biceps tendon fraying and increased erythema on dry arthroscopy. Results Between November 2002 and August 2005, 50 patients underwent subpectoral biceps tenodesis. Complete follow-up examinations were performed in 41 of 50 (82%). There were 16 women and 25 men (mean age, 50 years). Follow-up averaged 29 months (range, 12–49 months). The mean scores were 86, Rowe; 81, American Shoulder and Elbow Surgeons (ASES); 9, Simple Shoulder Test (SST); 87, Constant Murley; and 84, Single Assessment Numeric Evaluation (SANE). There was 1 failure as demonstrated by pull-out of the tendon from the bone tunnel resulting in a “Popeye” deformity on physical examination. The mean value for biceps apex distance was 0.15 cm, with 35 of 41 patients demonstrating no difference on physical examination. Twenty-three of 41 patients had complete preoperative and postoperative examinations. All clinical outcome measures demonstrated a statistically significant improvement at follow-up when compared with the preoperative scores. Thirty-one patients had identified lesions of the rotator cuff at time of arthroscopy. The mean ASES score in patients without rotator cuff lesion (89.2 ± 10.3) was significantly greater than the mean ASES for those with rotator cuff lesion (78.0 ± 21.0) ( P = .0324). The mean SST score in patients without rotator cuff lesion (10.6 ± 1.5) was significantly greater than the mean ASES score for those with rotator cuff lesion (8.8 ± 2.7) ( P = .0132). Conclusion Subpectoral biceps tenodesis with an interference screw is a viable treatment option for patients with symptomatic biceps tendinosis. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion had less favorable outcomes.

Age-Associated Pathology and Functional Outcomes After Hip Arthroscopy in Female Patients: Analysis With 2-Year Follow-up

2020 ◽  
Vol 48 (13) ◽  
pp. 3265-3271
Author(s):  
David A. Bloom ◽  
Jordan W. Fried ◽  
Andrew S. Bi ◽  
Daniel J. Kaplan ◽  
Nainisha Chintalapudi ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Functional Outcomes ◽  
Statistical Significance ◽  
Female Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Background: Previous research has demonstrated a statistically significant relationship between hip arthroscopy outcomes and age. Purpose: To investigate the link, if any, between hip arthroscopy outcomes and intraoperative pathology as well as with patient age and sex. Study Design: Cohort study; Level of evidence, 3. Methods: Of 272 female patients aged ≥14 years undergoing primary hip arthroscopy for femoroacetabular impingement between August 2010 and September 2017, and with 2-year patient-reported outcome scores, a total of 194 (71.3%) were included for final analysis. These patients were separated into 3 age-based cohorts: <30 years (n = 44), 30 to 45 years (n = 74), and >45 years (n = 76). Their data were then analyzed and compared with respect to patient characteristic information, intraoperative pathology, and functional outcome scores for statistical significance, which was set at P < .05. Results: When an analysis of variance was conducted for the 3 age groups at 2-year follow-up, there was a statistically significant difference for modified Hip Harris Score ( P = .0003; <30 years, 88.26 ± 13.1 [mean ± SD]; 30-45 years, 82.68 ± 18.0; >45 years, 75.03 ± 19.5). The results of an analysis of variance comparing 2-year Non-arthritic Hip Score were also statistically significant ( P = .0002; <30 years, 89.9 ± 13.7; 30-45 years, 85.8 ± 15.8; >45 years, 78.1 ± 17.2). Results of logistic regression demonstrated that the odds of a cam-type lesion decreased by 0.971 for every additional year in age among female patients. The odds of achieving the patient-acceptable symptomatic state decreased by a factor of 0.96 for each additional year in age ( P < .0004). Conclusion: Surgical treatment of femoroacetabular impingement in females led to improved functional outcomes at 2 years of follow-up, although older female patients did worse after hip arthroscopy as compared with their younger counterparts. There may be an age-dependent decrease in incidence of cam-type lesions in female patients.

scholarly journals Proximal Biceps Tenodesis Incorporated into Supraspinatus Repair: A Case Series and Technical Description

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097535
Author(s):  
Joshua M. Veenstra ◽  
Andrew G. Geeslin ◽  
Christopher W. Uggen
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Case Series ◽  
Supraspinatus Tendon ◽  
Biceps Tenodesis ◽  
Arm Pain ◽  
Patient Reported ◽  
Tendon Pathology

Background: Biceps tendon pathology is commonly associated with rotator cuff tears. A multitude of different biceps tenodesis techniques have been studied, with limited clinical data on arthroscopic biceps tenodesis techniques incorporated into rotator cuff repairs. Purpose: To evaluate the outcomes of an arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing surgical treatment of supraspinatus tendon tears with concomitant biceps tendon pathology were prospectively enrolled from 2014 to 2015. A total of 32 patients underwent combined biceps tenodesis and rotator cuff repair; of these, 19 patients were evaluated for a mean of 2.0 years. The primary outcome measures were the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; patient self-report and physician assessment sections), visual analog scale (VAS) pain score, responses to specific biceps-related assessments, and biceps specific physical exam findings. Results: Patient-reported ASES scores improved from 45.9 preoperatively to 91.6 at the 2-year follow-up ( P < .001). Pain VAS scores improved from 5.2 preoperatively to 0.7 at the 2-year follow-up ( P < .001). Preoperatively, 18 patients had a positive Speed test; all were negative at 5 months postoperatively, and 21 patients had bicipital groove tenderness preoperatively, which resolved in all 21 patients at 5 months postoperatively. At the 2-year follow-up, 2 patients had cramping arm pain and 4 patients noticed a change in arm contour. There were no reoperations. No complications occurred in the study group. Conclusion: Arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair was a safe and reliable option for biceps pathology with a concomitant rotator cuff tear.

scholarly journals Clinical Outcomes of an All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Mitchell B. Meghpara ◽  
William Schulz ◽  
Rafael A. Buerba ◽  
Elan J. Golan ◽  
Dharmesh Vyas
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Case Series ◽  
Biceps Tenodesis ◽  
Surgical Morbidity ◽  
Double Row ◽  
Repeat Operation ◽  
Patient Reported ◽  
Cuff Repair

Background: Pathology of the long head of the biceps tendon frequently occurs concomitantly with rotator cuff tears, necessitating a surgical treatment, often in the form of a tenodesis procedure. Many techniques for a tenodesis exist; however, they often require additional implants or a separate incision. Purpose: To report an average of 2-year outcomes of an all-arthroscopic biceps tenodesis employing the stay sutures from the anterolateral anchor during concomitant double-row rotator cuff repair (RCR). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed for all patients who underwent an all-arthroscopic biceps tenodesis during concomitant double-row RCR by the senior author between January 2014 and May 2018. Patients were included if they underwent this procedure and had baseline preoperative patient-reported outcomes (PROs) with a minimum of 1 year of postoperative PROs for the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) for pain score. Additionally, patient data, surgical history, postoperative complications, and satisfaction were reported. Results: Fifteen patients were eligible for the study. There were 12 (80%) men and 3 (20%) women with a mean age of 50.0 years (range, 35-64 years). The mean follow-up time was 25.2 months (range, 13-63 months). Six of 15 (40%) patients also had an arthroscopic subscapularis repair performed. ASES shoulder scores improved from 37.1 preoperatively to 94.1 postoperatively ( P < .001), and VAS scores improved from 6.4 preoperatively to 0.5 postoperatively ( P < .001). One patient who underwent concomitant subscapularis repair reported continued anterior groove pain. No patients experienced biceps cramping, developed a deformity, or required a repeat operation at the final follow-up. Overall, 93.3% of the patients reported being highly satisfied with their surgery. Conclusion: This study presents the clinical results of an all-arthroscopic technique for concomitant double-row RCR and biceps tenodesis, which resulted in high rates of patient satisfaction and significant improvement in reported shoulder outcome and pain scores. Additionally, this technique offers the potential benefits of avoiding a secondary incision, which may decrease surgical morbidity while also decreasing cost by eliminating the need for an extra, tenodesis-specific implant.

Predictive Modeling to Determine Functional Outcomes After Arthroscopic Rotator Cuff Repair

2020 ◽  
Vol 48 (7) ◽  
pp. 1559-1567
Author(s):  
Salvatore Frangiamore ◽  
Grant J. Dornan ◽  
Marilee P. Horan ◽  
Sandeep Mannava ◽  
Erik M. Fritz ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rotator Cuff ◽  
Patient Selection ◽  
Functional Outcomes ◽  
Patient Reported Outcomes ◽  
Female Sex ◽  
Patient Reported ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Arthroscopic rotator cuff repair (ARCR) is one of the most commonly performed orthopaedic surgical procedures; however, patient-reported outcomes have varied greatly in the literature. Purpose: To identify preoperative factors that affect outcomes and to develop prognostic tools for predicting functional outcomes in future ARCR cases. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were included who underwent ARCR for repairable full-thickness rotator cuff tears with at least 2 years of follow-up. Twelve predictors were entered as candidate predictors in each model: age, sex, workers’ compensation (WC) status, previous cuff repair, tear size, tear shape, multiple-tendon involvement, tendon stump length, Goutallier classification, critical shoulder angle, length of follow-up, and baseline subjective outcomes score. Postoperative American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand), and patient satisfaction were each modeled through proportional odds ordinal logistic regression. Model results were presented with marginal covariate effect plots and predictive nomograms. Results: Overall, 552 shoulders fit inclusion criteria. The mean age at surgery was 60.2 years (range, 23-81 years). Twenty-five (4.5%) shoulders underwent revision cuff repair or reverse arthroplasty at a mean 1.9 years (range, 0.1-7.9 years) postoperatively. Overall, 509 shoulders were eligible for follow-up, and minimum 2-year postoperative patient-reported outcomes were obtained for 449 (88.2%) at a mean 4.8 years (range, 2-11 years). The ASES score demonstrated significant improvement from pre- to postoperative median (interquartile range): 58 (44.9-71.6) to 98.3 (89.9-100; P < .001). Women demonstrated significantly higher 2-year reoperation rates than men (5.8% vs 1.6%; odds ratio, 2.8 [95% CI, 0.73-9.6]; P = .023). Independently significant predictors for lower postoperative ASES scores included previous ARCR ( P < .001), female sex ( P < .001), and a WC claim ( P < .001). Significant predictors for worse QuickDASH scores included WC claim ( P < .001), female sex ( P < .001), previous ARCR ( P = .007), and ≥7 years of follow-up time. Significant predictors for lower SF-12 PCS scores included WC claim ( P < .001), female sex ( P = .001), and lower baseline SF-12 PCS. Last, significant independent predictors of patient satisfaction included previous ARCR ( P = .004), WC claim ( P = .011), female sex ( P = .041), and age ( P = .041). Conclusion: Excellent clinical outcomes and low failure rates were obtained after ARCR by using careful patient selection and modern surgical techniques for ARCR. Female sex, WC claim, and previous ARCR were significant predictors of poorer outcomes in at least 3 patient-reported outcome models. Prognostic nomograms were developed to aid in future patient selection, clinical decision making, and patient education.

scholarly journals The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery

2021 ◽  
Vol 10 (4) ◽  
pp. 599
Author(s):  
Jan Zabrzyński ◽  
Gazi Huri ◽  
Maciej Gagat ◽  
Łukasz Łapaj ◽  
Alper Yataganbaba ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Shoulder Arthroscopy ◽  
Smoking Status ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Rotator Cuff Tears ◽  
Shoulder Injuries ◽  
The Impact

The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker’s group and 84.06 and 30.93 in the non-smoker’s group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers’ group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.

scholarly journals Utility of a Mobile Clinical Decision Support Application in Patients Undergoing Spinal Cord Stimulation.

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shervin Rahimpour ◽  
Sarah E Hodges ◽  
Luis A Antezana ◽  
Abena A Ansah-Yeboah ◽  
Rajeev Dharmapurikar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Decision Support ◽  
Patient Reported Outcomes ◽  
Clinical Decision ◽  
Software Platform ◽  
Clinical Specialist ◽  
Mobile Software ◽  
Patient Reported

Abstract INTRODUCTION Novel technologies to support real-time patient education, engagement and scalable outcomes monitoring to make clinically meaningful decisions are needed. The ManageMySurgery (MMS) Spinal Cord Stimulation (SCS) module is a mobile clinical decision support application that provides: (1) a mobile, patient-centered engagement tool for delivering pre-, peri- and postoperative SCS information; (2) scalable patient-reported outcomes collection; (3) a HIPAA-compliant 2-way messaging platform with a Clinical Specialist Educator for real-time support and goal setting. METHODS Prospective data was collected using the MMS mobile smartphone application in patients undergoing Medtronic SCS trial and permanent implant procedures. E-consent was obtained through the HIPAA compliant, mobile software platform. All data was de-identified, aggregated and analyzed. RESULTS A total of 20 patients (15-trial SCS and 5 permanent SCS patients) agreed to participate and logged onto the mobile software platform. For trial SCS patients, 100% of those that participated experienced >50% pain relief as documented in their patient-reported outcomes. Furthermore, patients found various features of the software platform helpful for navigating different aspects of their SCS procedure, with 81% finding MMS helpful in preparing for their SCS procedure, 88% finding MMS helpful in recovering from their SCS procedure and 94% in communicating with their Clinical Specialist Educator. In addition, 95% of patients would recommend MMS to a friend or family member. CONCLUSION The MMS platform appears to have utility both during the SCS Trial and Permanent procedures. In patients with chronic pain, novel patient engagement and follow-up tools such as MMS may be a good option for keeping patients engaged with the therapy and ensuring patients stay on track during their procedural journey. Randomized, controlled trials with extended follow-up are in progress and needed to further evaluate the utility of MMS in patients with chronic pain undergoing SCS.

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