Incidence and Risk Factors for Failure of Arthroscopic Posterior Capsulolabral Reconstruction

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repair is not well defined. It is hypothesized that athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play with risk factors including younger age, injury size, bone loss, anchor number, and anchor type. Methods: A review of 161 shoulders who underwent arthroscopic posterior capsulolabral repair using modern techniques at minimum 2 year follow up was completed. In addition to surgical data, ASES, stability, ROM, strength, and pain scores were compared pre- and post-operatively as well as return to sport. Those who required revision surgery were identified and compared to those not undergoing revision. Results: Twenty shoulders required revision surgery (12.4%) at 5.3 year follow-up. Significant risk factors included female gender (p = 0.001), dominant shoulder (p = 0.005), and concomitant rotator cuff injury (p = 0.029). Patients with 3 or fewer anchors were more likely to require revision (OR = 3.48). There was no difference after normalization to tear size and location (p > 0.05). Return to sport at the same level was significantly lower if revision surgery was required (15.4% vs. 64.3%) (p = 0.004). All patients had significant improvements in ASES, pain, ROM, and strength after the original surgery, however, those who required revision surgery had less improvement (p < 0.05). Stability improved significantly in non-revision athletes (p < 0.001), but did not in revision patients (p = 0.662). Conclusion: Athletes required revision arthroscopic posterior capsulolabral repair at an incidence of 12.4% and had poorer outcome scores and return to play with risk factors being dominant shoulder surgery, female gender, concomitant rotator cuff injury, and the use of 3 or fewer anchors. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder instability failure requiring revision has not previously been evaluated. [Table: see text]

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Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00317 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0031

Author(s):

Justin W. Arner ◽

Sachidhanand Jayakumar ◽

Dharmesh Vyas ◽

James P. Bradley

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Revision Surgery ◽

Significant Risk ◽

Return To Sport ◽

Significant Risk Factor ◽

Return To Play ◽

Bone Width ◽

Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

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Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair

The American Journal of Sports Medicine ◽

10.1177/0363546518785893 ◽

2018 ◽

Vol 46 (10) ◽

pp. 2457-2465 ◽

Cited By ~ 9

Author(s):

James P. Bradley ◽

Justin W. Arner ◽

Sachidhanand Jayakumar ◽

Dharmesh Vyas

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Range Of Motion ◽

Revision Surgery ◽

Return To Play ◽

Female Sex ◽

Bone Width ◽

Posterior Shoulder ◽

Rotator Cuff Injury

Background: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repair of the shoulder are currently not well defined. Hypothesis: Athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play when compared with those undergoing primary procedures, with risk factors including younger age, injury size, bone loss, and anchor number. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 297 shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2-year follow-up were reviewed. In addition to surgical data, the American Shoulder and Elbow Surgeons scoring system with subjective stability, range of motion, strength, and pain scores as well as return to sport were compared pre- and postoperatively between those who did and did not require revision surgery. Magnetic resonance arthrogram measurements of glenoid labral, chondral, and bone version and labral and bone width were also compared. Results: Nineteen shoulders required revision surgery (6.4%) at 8.9-year follow-up. Significant risk factors included female sex ( P = .001), dominant shoulder ( P = .005), and concomitant rotator cuff injury ( P = .029). Patients with ≤3 anchors were more likely to require revision (odds ratio = 3.48). Smaller glenoid bone width was a risk factor for requiring future revision surgery ( P < .001), but glenoid labral, chondral, and bone version and labral width were not risk factors. All patients had significant improvements in American Shoulder and Elbow Surgeons, pain, range of motion, and strength scores after the original surgery; however, those who required revision surgery had less improvement ( P < .05). Stability improved significantly for nonrevisions ( P < .001) but did not for revisions ( P = .662). In the nonrevision group, 64.3% returned to sport at the same level, which was significantly higher than the 15.4% of the revision group ( P = .004). Overall, 78.6% of the nonrevision group and 61.6% of the revision group returned to sport at some level ( P = .280). Conclusion: Athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 6.4%. Revision patients had significantly poorer outcome scores and return to play when compared with those who did not undergo revision surgery with risk factors being dominant shoulder surgery, female sex, concomitant rotator cuff injury, the use of 3 or fewer anchors, and smaller glenoid bone width. These data are essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder instability failure requiring revision has not previously been evaluated.

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Arthroscopic SLAP IIb Repair Using Knot-tying Versus Knotless Suture Anchors: Is There a Difference?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00107 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

Justin W. Arner ◽

Joseph De Groot ◽

James P. Bradley

Keyword(s):

Revision Surgery ◽

Statistical Significance ◽

Return To Play ◽

Shoulder Injuries ◽

Overhead Athletes ◽

Pain Scores ◽

Sport Type ◽

Surgical Data ◽

Small Cohort

Objectives: SLAP IIb surgical outcomes have traditionally been less predictable when compared to other shoulder injuries. Traditional knotted anchors may partially be to blame by abrading the rotator cuff leading to tearing and pain. Methods: Seventy-four athletes who underwent arthroscopic SLAP IIb repair with traditional (n=42) and knotless anchors (n=32) at minimum 2-year follow-up were evaluated. Demographic, surgical data, return to play (RTP), KJOC, ASES, stability, ROM, strength, and pain scores were compared. Results: Knotless anchors had slightly higher RTP (93.5%, 58.1% same level) vs. traditional (90.2%, 53.7% same level), but was not statistically significant. Knotless anchors were less likely to require revision surgery (9%) compared to traditional anchors (17%), but was not statistically significant. There was no difference in KJOC, ASES, stability, ROM, strength, and pain between the two anchor types (Table 1). Pain was the only variable linked to decreased RTP (p < 0.0001). Younger patients had significantly poorer KJOC (p = 0.02) and ASES scores (p = 0.02) but no difference in RTP. No difference in outcome measures or RTP was found with gender, age, overhead athletes, number of anchors, or sport type (Table 2). Average follow-up was 6.5 years. Conclusion: Knotless anchors required less revision surgery, had higher RTP, ASES, and KJOC scores; however, statistical significance was not achieved in this relatively small cohort. Further evaluation, such as case matching and assessment of a larger sample size should be done. Possible other advantages such as tensioning and surgical time may also be important when considering lower profile knotless fixation.

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The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

Psychological Medicine ◽

10.1017/s0033291721002932 ◽

2021 ◽

pp. 1-11

Author(s):

Yini Wang ◽

Xueqin Gao ◽

Zhenjuan Zhao ◽

Ling Li ◽

Guojie Liu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Significant Risk ◽

Type D Personality ◽

Adverse Outcomes ◽

Combined Effect ◽

Continuous Variables ◽

Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

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

The American Journal of Sports Medicine ◽

10.1177/03635465211015419 ◽

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.

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Infeções do Trato Urinário numa Coorte de Transplantados Renais

Acta Médica Portuguesa ◽

10.20344/amp.4959 ◽

2014 ◽

Vol 27 (3) ◽

pp. 364 ◽

Cited By ~ 2

Author(s):

Ana Bispo ◽

Milene Fernandes ◽

Cristina Toscano ◽

Teresa Marques ◽

Domingos Machado ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Hospital Admissions ◽

Female Gender ◽

Tract Infections

Introduction: Urinary tract infection is the most common infectious complication following renal transplantation and its frequency is insufficiently studied in Portugal. The aim of this study was to characterize the incidence of urinary tract infections and recurrent urinary tract infections in renal transplant recipients. Material and Methods: This was a retrospective cohort observational study, obtained from clinical files of all patients who received a renal transplant at the Hospital of Santa Cruz, from January 2004 to December 2005, with a mean follow-up period of five years or until date of graft loss, death or loss of follow-up. After a descriptive analysis of the population, we used bivariate tests to identify risk factors for urinary tract infections. Results: A total of 127 patients were included, with a 593 patients.year follow-up. We detected 53 patients (41.7%) presenting with at least one episode of urinary tract infection; 21 patients (16.5%) had recurrent urinary tract infection. Female gender was the only risk factor associated with the occurrence of urinary tract infections (p < 0.001, OR = 7.08, RR = 2.95) and recurrent urinary tract infections (p < 0.001, OR = 4.66, RR = 2.83). Escherichia coli (51.6%), Klebsiella pneumoniae (15.5%) and Enterobacter spp (9.9%) were the most frequently identified pathogens. Patients did not reveal an increased mortality or allograft loss. However, urinary tract infections were the most important cause of hospital admissions. Discussion: Female gender was the only risk factor for urinary tract infections in this population. Escherichia coli was the most frequent agent isolated. Conclusion: Despite preventive measures, urinary tract infections remain an important cause of morbidity and hospital admissions. Keywords: Urinary Tract Infections; Postoperative Complications; Risk Factors; Kidney Transplantation; Portugal.

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Use of Radiographic Criteria for Proximal Humeral Head Migration After Dislocation of the Shoulder to Identify Damage to Its Rotator Cuff

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2019-100-2-95-101 ◽

2019 ◽

Vol 100 (2) ◽

pp. 95-101

Author(s):

A. P. Stepanchenko ◽

G. V. Fedoruk ◽

A. A. Makovskiy ◽

V. E. Dubrov ◽

R. V. Zaytsev ◽

...

Keyword(s):

Rotator Cuff ◽

Correlation Analysis ◽

Humeral Head ◽

Shoulder Dislocation ◽

Older Patients ◽

Subacromial Space ◽

Rotator Cuff Injury ◽

Mri Study ◽

Mri Measurements

Objective. To assess whether radiographic criteria for proximal humeral head migration can be used as screening of damage to the rotator cuff after dislocation in patients over 45 years of age.Material and methods. The study included the results of a follow-up of 101 patients after shoulder dislocation without signs of damage to the rotator cuff before injury. Damage to the rotator cuff was assessed using MRI, followed by a correlation analysis between the results of measuring the height of the subacromial space with radiography and MRI.Results. Signs of cranial migration of the humeral head are detected statistically significantly more frequently in the group of older patients than in that of young ones (F=0.009; p<0.05). MRI study statistically significantly more often revealed signs of damage to the rotator cuff in the older patients than in the young ones (F=0.009; p<0.05). There was a high correlation between the humeral head migration index and the MRI measurements of the acromiohumeral interval (r=0.93, p<0.05).Conclusion. The acromiohumeral index, as well as MRI, can be used as a criterion for rotator cuff injury. This study has shown that the older patients have a 19-fold higher risk for damage to the rotator cuff from a dislocated shoulder (95% CI 6.93–52.11). Thus, attention should be paid to the presence of radiographic signs of rotator cuff injury in all patients after dislocation of the shoulder.

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Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

10.21203/rs.2.14819/v4 ◽

2020 ◽

Author(s):

David R. Maldonado ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Mitchell Meghpara ◽

...

Keyword(s):

Hip Arthroscopy ◽

Cartilage Damage ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Return To Play ◽

Harris Hip Score ◽

Level Of Evidence ◽

Tennis Players ◽

Patient Reported

Abstract Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players.Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS.Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved by players with a continued interest in playing. The severity of cartilage damage was shown to not influence rate of returned to sport nor PROs in this population. The data here may be useful in counseling tennis players of various levels who are considering arthroscopic treatment of a hip injury. Level of Evidence: IV

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Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0837.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 285-293 ◽

Cited By ~ 6

Author(s):

A. Nakamae ◽

N. Adachi ◽

M. Deie ◽

M. Ishikawa ◽

T. Nakasa ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Articular Cartilage ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Cartilage Damage ◽

Significant Risk ◽

Articular Cartilage Damage ◽

Anterior Cruciate

Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.

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ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ

Medical Informatics and Engineering ◽

10.11603/mie.1996-1960.2012.1.173 ◽

2012 ◽

Author(s):

І. К. Чурпій

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Pulmonary Embolism ◽

High Risk ◽

Significant Risk ◽

Female Gender ◽

Electrolyte Composition ◽

Terminal Phase ◽

Phase Flow ◽

History Of

To optimize the therapeutic tactics and improve the treatment of peritonitis on the basis of retrospective analysis there are determined the significant risk factors: female gender, age 60 – 90 years, time to hospitalization for more than 48 hours, a history of myocardial infarction, stroke, cardiac arrhythmia, biliary, fecal and fibrinous purulent exudate, the terminal phase flow, operations with resection of the intestine and postoperative complications such as pulmonary embolism, myocardial infarction, pleurisy, early intestinal obstruction. Changes in the electrolyte composition of blood and lower albumin <35 % of high risk prognostic course of peritonitis that requires immediate correction in the pre-and postoperative periods. The combination of three or more risk factors for various systems, creating a negative outlook for further treatment and the patient's life.

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