scholarly journals Combined and Posterior Labral Tears are More Common in a Large Military Population with Operative Shoulder Instability than Previously Reported

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Jeanne Patzkowski ◽  
Erin Swan
Keyword(s):  
Shoulder Instability ◽  
Labral Tear ◽  
Study Cohort ◽  
Treatment Facility ◽  
Military Population ◽  
Shoulder Stabilization ◽  
Chi Square ◽  
Medical Treatment Facility ◽  
Labral Tears ◽  
The Military

Objectives: Shoulder instability is endemic in military and young athletic populations. Anterior shoulder instability is the most prevalent instability in civilian populations, but the unique physical demands placed upon military service members shoulders likely result in a different injury pattern. The purpose of the current investigation was to examine the distribution of labral tears across multiple military medical centers. We hypothesized there would be a higher incidence of posterior and combined labral tears treated operatively as compared to the civilian literature. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network’s (MOTION) prospective Wounded Ill and Injured Registry (WIIR) was queried for all patients who had undergone a surgical stabilization procedure (CPT 29806, 23455, 23462) from October 2016 to January 2019. Patients with isolated superior labral repairs were excluded. Labral tear location was abstracted from intraoperative data collection forms. Chi-Square analyses (X2) compared the percentage of patients with isolated anterior, isolated posterior, isolated inferior, or combined labral tears between individuals in the current study cohort with a previously reported civilian Norway shoulder instability registry, a reported prevalence at the National Football League scouting combine, and with operative shoulder instability patients at a single military treatment facility. Chi-square analyses also compared differences in labral tear location between males and females. Statistical significance was set a priori at α ≤ 0.05. Results: Three hundred fourteen patients (n=314) were identified who had undergone primary shoulder stabilization during the study period. Three patients were excluded due to insufficient data. Of the 311 remaining patients, 41 (13%) were female, 269 (87%) were male, 1 patient did not report a gender. All 311 patients’ military status was either active duty or active reserve (301 and 10, respectively). Ninety-four patients (30.23%) had isolated anterior labral tears (21 female, 73 male), 76 patients (24.44%) had isolated posterior labral tears (7 female, 69 male), 5 patients (1.61%) had isolated inferior tears, and 136 patients (43.73%) had combined labral tears. The number of posterior and combined labral tears in our data differed from previously reported percentages in the civilian literature (9.90% and 6.93%, respectively; X2(2)=208.94, p<0.00001). We also observed a higher percentage of combined tears than was previously reported from a military institution (18.61%; X2(2)=48.20, p<0.00001). The NFL combine cohort had 31% of players with anterior, 35% of players with posterior, and 35% with combined anterior/posterior labral tears (X2(2)=9.54, p=0.0085). Significantly more females (51.22%) had an isolated anterior labral tear, as compared to males (25.65%; X2(2)=9.25, p=0.009). Conclusion: The rate of posterior and combined labral tears in a military population with shoulder instability is higher than what is reported in the civilian literature, which is in keeping with a previous study at one Army medical treatment facility, although the rate of combined tears was even higher in the current cohort than previously reported in either population. The distribution of tear location is most similar tothat of an NFL combine population, supporting the thought that the military population should be thought of and treated as a population of athletes. Labral tears in females were more consistent with the civilian literature in that they had significantly more isolated anterior tears than posterior orcombined, which significantly differed from males. Military shoulder surgeons should be prepared to address multiple labral tears at the time of shoulder stabilization and be aware of the difference in tear location in females versus males.

The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Undergoing Arthroscopic Shoulder Stabilization

2019 ◽  
Vol 47 (11) ◽  
pp. 2686-2690 ◽  
Author(s):  
Saqib Javed ◽  
Daniel Gheorghiu ◽  
Emma Torrance ◽  
Puneet Monga ◽  
Lennard Funk ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Study Design ◽  
Case Series ◽  
Labral Tear ◽  
Shoulder Stabilization ◽  
Chi Square ◽  
Level Of Evidence ◽  
Labral Tears ◽  
Combined Lesions ◽  
Chi Square Test

Background: Posterior and combined shoulder instabilities have been reported as accounting for only 2% to 5% of cases. More recently, an increased incidence of posterior capsulolabral tear has been reported. Purpose: To assess the incidence of posterior and combined labral tears in a large cohort of patients with surgically treated shoulder labral tears. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study that evaluated 442 patients who underwent an arthroscopic capsulolabral repair over a 3-year period. Patients were categorized according to the location of their labral tear and whether their injury was sustained during sporting or nonsporting activity. Proportions of labral tears between sporting and nonsporting populations were compared using the chi-square test. Results: Patients had a mean age of 25.9 years and 89.6% were male. Isolated anterior labral tears occurred in 52.9%, with posterior and combined anteroposterior labral tears accounting for 16.3% and 30.8%, respectively. The frequency of posterior and combined lesions was greater in the sporting population compared with the nonsporting population ( P = .013). Conclusion: Posterior and combined labral tears are more prevalent than previously reported, particularly in the sporting population.

scholarly journals Predictors of Large Labral Tears: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0041
Author(s):  
Kevin Cronin ◽  
Brian Wolf ◽  
Justin Magnuson ◽  
Gregory Hawk ◽  
Azimeh Sedaghat ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Demographic Data ◽  
Demographic Variables ◽  
Labral Tear ◽  
Time Of Surgery ◽  
Racquet Sports ◽  
Cell Counts ◽  
Labral Tears ◽  
Patient Reported ◽  
Labral Pathology

Objectives: Labral tears are often described by either their location (superior, anterior, or posterior) or their size, commonly defined as degrees of labral involvement from 0° to 360°. Large tears are thought to include 270° or more of the labrum, which has been reported to include 3.3% to 6.5% of those undergoing shoulder instability surgery for labral pathology. Demographic or injury characteristics of those with large labral tears (>270°) has not been defined in the literature. The purpose of this study was to identify factors predictive of a large labral tear at the time of shoulder instability surgery. Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients undergoing open or arthroscopic shoulder instability surgery for a labral tear were evaluated. Those with an isolated SLAP (superior labrum anterior to posterior) tear or a concomitant rotator cuff tear requiring repair were excluded. Demographic data, injury history, preoperative patient-reported outcome scores (PROs), imaging and intraoperative findings, and surgical procedures performed were recorded. The treating surgeon reported the size and location of labral pathology visualized at the time of surgery. Patients with greater than a 270° tear were defined as having a large labral tear. For categorical demographic variables, a chi-square test or Fisher’s Exact test was used, as appropriate based on cell counts. For continuous demographic variables, a two-sample t-test was performed. In order to build a predictive logistic regression model for large tears, the Feasible Solutions Algorithm (Lambert et al. 2018) was used to add significant interaction effects iteratively until no more significant two-way interactions could be added to the model. Results: After applying exclusion criteria, 1235 patients were available for analysis. There were 222 females (18.0%) and 1013 males (82.0%) in the cohort with an average age of 24.7 years old (12 – 66 years old). The incidence of large tears was 4.6% with the average tear size being 141.9°, or 39.4%. Males accounted for significantly more of the large tears seen in the cohort (94.7%, p = 0.01). Racquet sports (p = 0.002), swimming (p = 0.02), softball (p = 0.05), skiing (p = 0.04), and golf (p = 0.04) were all found to be predictive of large labral tears as was a higher Western Ontario Shoulder Instability (WOSI) score (p = 0.01) (Table 1). Patients with a larger body mass index (BMI) who played contact sports were also more likely to have large tears (p = 0.007). Age, race, history of dislocation, injury during sport, or previous shoulder surgery were not associated with having a larger tear. Conclusion: Patients with large labral tears are a small, but not insignificant, subset of patients undergoing shoulder instability surgery. Multiple factors were identified as being associated with large labral tears at the time of surgery including male sex, pre-operative WOSI score, and participation in certain sports including racquet sports, softball, skiing, swimming, and golf. Surgeons treating patients with these risk factors should be prepared to encounter a large labral tear at the time of surgery. Further studies will evaluate the outcomes of this patient population. [Table: see text]

scholarly journals Prescription Patterns and Risk Factors for Prolonged Opioid Dependence in Elective Anterior Cruciate Ligament Reconstruction in a Military Population

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092648
Author(s):  
Ashley B. Anderson ◽  
George C. Balazs ◽  
Daniel I. Brooks ◽  
Benjamin K. Potter ◽  
Jonathan A. Forsberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Active Duty ◽  
Study Cohort ◽  
Opioid Use ◽  
Military Population ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
The Military

Background: Limited data are available regarding excessive opioid prescribing in the perioperative period after routine orthopaedic procedures in US military personnel. Purpose: To examine the demographic profile of the patients receiving these medications and to identify potential risk factors for prolonged opioid use after anterior cruciate ligament reconstruction (ACLR) in the active duty military population. Study Design: Case-control study; Level of evidence, 3. Methods: The Military Analysis and Reporting Tool (M2) was used to search the Military Health System Data Repository (MDR) for patients undergoing ACLR from 2012 through 2015 and specifically for active duty personnel with an arthroscopically assisted ACLR (Current Procedural Terminology [CPT] code 29888). Complete opioid prescription filling history was also obtained. This study had 2 primary outcomes: (1) use of opiate analgesics more than 90 days after surgery, representing prolonged opiate prescriptions, and (2) high levels of postoperative opiate use, defined as having filled prescriptions accounting for greater than the 95th percentile of morphine equivalents for patients in the study cohort. Data were analyzed via multivariate regression analysis to identify potential associations with the primary outcomes. Results: A total of 9474 patients met the inclusion criteria. Median patient age was 27 years, and the sample included 1316 (14%) female and 8158 (86%) male patients. A total of 66 (0.7%) patients had a preoperative diagnosis for substance abuse; 2656 (28%) patients continued to receive opioid prescriptions more than 90 days after surgery, and 502 (5%) patients were in the top 95th percentile of all opioid users within the study cohort. Total preoperative morphine equivalents per day and total perioperative morphine equivalents per day were highly important risk factors for both outcomes, although other demographic factors such as race, sex, and age may play minor roles. Conclusion: We identified total preoperative morphine equivalents, total perioperative morphine equivalents, sex, and race as potential predictors of prolonged opioid use after ACLR. This information may prove useful in developing a predictive model to identify at-risk patients before surgery. This could help mitigate future misuse or abuse and improve preoperative patient counseling regarding pain management expectations.

scholarly journals The HALP – An unusual triad in shoulder instability

2020 ◽  
Vol 1 ◽  
pp. 226-229
Author(s):  
Richard S. Page ◽  
Gaurav Gupta ◽  
Saseendar Shanmugasundaram
Keyword(s):  
Shoulder Instability ◽  
English Literature ◽  
Labral Tear ◽  
Rotator Cuff Tears ◽  
Shoulder Injuries ◽  
Arthroscopic Technique ◽  
Glenohumeral Ligament ◽  
Labral Tears ◽  
Tendon Avulsion ◽  
Infraspinatus Tendon

Humeral avulsion of the glenohumeral ligament (HAGL) and posterior labral tears are less common injuries in comparison to Bankart lesion in traumatic shoulder instability. The association of rotator cuff tears with posterior capsulolabral lesions is even rarer. We present an unreported combination of HAGL with posterior labral tear and partial articular infraspinatus tendon avulsion (PAITA). This combination of shoulder injuries (HALP triad – HAGL + posterior labral tear + PAITA) has not been reported so far in English literature. The mechanism of this rare combination of injuries is discussed. The arthroscopic technique for simultaneous repair of this combination of ligament tears is presented.

scholarly journals The Influence of Laxity on Injury Severity at the Time of Anterior Shoulder Stabilization Surgery

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0037
Author(s):  
Jacqueline Baron ◽  
Kyle R. Duchman ◽  
Carolyn M. Hettrich ◽  
Shannon F. Ortiz ◽  
Natalie Glass ◽  
...  
Keyword(s):  
Bone Loss ◽  
Injury Severity ◽  
Labral Tear ◽  
Categorical Variables ◽  
Shoulder Stabilization ◽  
Chi Square ◽  
Exact Test ◽  
Standardized Protocol ◽  
Wilcoxon Rank Sum Test ◽  
Patients At Risk

Objectives: To determine whether a greater degree of translation measured under anesthesia during anterior shoulder stabilization surgery was associated with greater injury severity, more dislocations in the previous year, and a greater duration of injury. Methods: This study evaluated Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group shoulder instability participants who underwent anterior shoulder stabilization surgery between October 2012-September 2016. Surgeons measured shoulder mobility under anesthesia following a standardized protocol and graded translation as 0, 1+, 2+ or 3+. Using this measure, translation was defined as having a grade ≥2+. Labral tear length, duration of injury, and number of times dislocated in the previous year were compared between mobility groups using the Wilcoxon Rank Sum Test while categorical variables were compared between groups using the chi-square or exact test. Logistic regression was also used to model the relationship between mobility grade as an ordered variable and presence of >10% bone loss as well as HSL >20%. Age and BMI were compared between groups using t-tests. Results: A total of 679 participants (19% women) with an average age of 24.8±9.5years and BMI of 25.4±4.4 kg/m2were included in analyses. Mobility grade groups <2 had a slightly higher BMI than ≥2 (27.0±5.2 vs 25.0±4.1kg/m2, <0.01) but did not significantly differ in age (26.0±10.7 vs 24.4±9.0yrs, p=0.31) or proportion of women (14% vs 20%, p=0.12), respectively. Labral tear length (median: 126, range: 0-360°) and the proportion with >10% bone loss (5.8% vs 9.8%) did not significantly differ between groups (all p>0.05). However, there was a greater proportion of HSL >20% in the ≥2 (3.2%) vs <2 (0%, p<0.01) groups. In addition, mobility under anesthesia was associated with a larger number of dislocations reported in the previous year (p<0.01), but not a greater duration of injury (p=0.76). A greater proportion of the ≥2 (13.7%) vs <2 (4.7%) mobility groups also had a Beighton score ≥4 (p<0.01). Results were similar looking at EUA grade as an ordinal variable except that an increase in EUA grade was associated with a greater odds of >10% bone loss (OR: 1.51, 95%CI: 1.01-2.27, p=0.046). Labral tear length was significantly greater in individuals who reported at least two dislocations in the previous year (median=144, 0-360°) vs less than two (126, 0-360°, p=0.02). Conclusion: Measures of translation during EUA in patients undergoing anterior shoulder stabilization surgery demonstrated higher likelihood of HSL and increased glenoid bone loss>10% as positive predictors of translation ≥2 intra-operatively. Self-reported number of dislocations and Beighton scores≥4 were also found to be correlated with increasing translation under EUA and may serve as a reliable clinical predictor of patients at risk for recurrent instability.

scholarly journals Open Capsulorrhaphy for Recurrent Multidirectional Instability of the Shoulder

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110071
Author(s):  
Ioanna K. Bolia ◽  
Rebecca Griffith ◽  
Nickolas Fretes ◽  
Frank A. Petrigliano
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Young Female ◽  
Subscapularis Tendon ◽  
Shoulder Stabilization ◽  
Ehlers Danlos Syndrome ◽  
Physically Active ◽  
Recurrent Shoulder Instability ◽  
Multidirectional Instability

Background: The management of multidirectional instability (MDI) of the shoulder remains challenging, especially in athletes who participate in sports and may require multiple surgical procedures to achieve shoulder stabilization. Open or arthroscopic procedures can be performed to address shoulder MDI. Indications: Open capsulorrhaphy is preferred in patients with underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures. Technique Description: With the patient in the beach-chair position (45°), tissue dissection is performed to the level of subscapularis tendon via the deltopectoral approach. The subscapularis tenotomy is performed in an L-shaped fashion, and the subscapularis tendon is tagged with multiple sutures and mobilized. Careful separation of the subscapularis tendon from the underlying capsular tissue is critical. Capsulotomy is performed, consisting of a vertical limb and an inferior limb that extends to the 5 o’clock position on the humeral neck (right shoulder). After evaluating the integrity of the labrum, the capsule is shifted superiorly and laterally, and repaired using 4 to 5 suture anchors. The redundant capsule is excised, and the subscapularis tendon is repaired in a side-to-side fashion, augmented by transosseous equivalent repair using the capsular sutures. Results: Adequate shoulder stabilization was achieved following open capsulorrhaphy in a young female athlete with tissue hyperlaxity and history of a previously failed arthroscopic soft tissue stabilization surgery of the shoulder. The athlete returned to sport at 6 months postoperatively and did not experience recurrent shoulder instability episodes at midterm follow-up. Discussion/Conclusion: Based on the existing literature, 82% to 97% of patients who underwent open capsulorrhaphy for MDI had no recurrent shoulder instability episodes at midterm follow-up. One study reported 64% return-to-sport rate following open capsulorrhaphy in 15 adolescent athletes with Ehlers-Danlos syndrome, but more research is necessary to better define the indications and outcomes of this procedure in physically active patients.

scholarly journals Respiratory Viral Pathogens Among U.S. Military Personnel at a Medical Treatment Facility in Hawaii From 2014 to 2019

2021 ◽  
Author(s):  
Agnes S Montgomery ◽  
Michael B Lustik ◽  
Susan A Reichert-Scrivner ◽  
Ronald L Woodbury ◽  
Milissa U Jones ◽  
...  
Keyword(s):  
Military Personnel ◽  
Influenza A ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Signs And Symptoms ◽  
Military Operations ◽  
Military Population ◽  
Viral Pathogens ◽  
Viral Pathogen ◽  
Medical Treatment Facility

ABSTRACT Introduction Acute respiratory diseases account for a substantial number of outpatient visits and hospitalizations among U.S. military personnel, significantly affecting mission readiness and military operations. We conducted a retrospective analysis of respiratory viral pathogen (RVP) samples collected from U.S. military personnel stationed in Hawaii and tested at Tripler Army Medical Center from January 2014 to May 2019 in order to describe the etiology, distribution, and seasonality of RVP exposure in a military population. Materials and Methods Samples were analyzed by viral culture or multiplex PCR. Distribution of respiratory viruses over time was analyzed as well as subject demographic and encounter data. Presenting signs and symptoms were evaluated with each RVP. Results A total of 2,576 military personnel were tested, of which 726 (28.2%) were positive for one or more RVP. Among positive tests, the three most common viral pathogens detected were influenza A (43.0%), rhinovirus (24.5%), and parainfluenza (7.6%). Symptoms were generally mild and most frequently included cough, fever, and body aches. Conclusion Our study evaluated respiratory virus prevalence, seasonality, and association with clinical symptoms for military personnel in an urban tropical setting in Oahu, HI, over a 5-year period. We show that viral prevalence and seasonality in Hawaii are distinct from those of the CONUS. Results contribute to the broader understanding of seasonality, clinical manifestation, and demographics of RVP among active duty military personnel stationed in Hawaii.

scholarly journals Penetrating Neck Injuries Treated at a U.S. Role 3 Medical Treatment Facility in Afghanistan During Operation Resolute Support

2020 ◽  
Author(s):  
John Breeze ◽  
William G Gensheimer ◽  
Joseph J DuBose
Keyword(s):  
Medical Treatment ◽  
Emergency Room ◽  
Neck Region ◽  
Neck Injuries ◽  
Treatment Facility ◽  
Medical Treatment Facility ◽  
Trauma Registries ◽  
Neck Wound ◽  
Major Injury ◽  
High Negative Predictive Value

ABSTRACT Introduction Military trauma registries can identify broad epidemiological trends from neck wounds but cannot reliably demonstrate temporal casualty from clinical interventions or differentiate penetrating neck injuries (PNI) from those that do not breach platysma. Materials and Methods All casualties presenting with a neck wound to a Role 3 Medical Treatment Facility in Afghanistan between January 1, 2016 and September 15, 2019 were retrospectively identified using the Emergency Room database. These were matched to records from the Operating Room database, and computed tomography (CT) scans reviewed to determine damage to the neck region. Results During this period, 78 casualties presented to the Emergency Room with a neck wound. Forty-one casualties underwent surgery for a neck wound, all of whom had a CT scan. Of these, 35/41 (85%) were deep to platysma (PNI). Casualties with PNI underwent neck exploration in 71% of casualties (25/35), with 8/25 (32%) having surgical exploration at Role 2 where CT is not present. Exploration was more likely in Zones 1 and 2 (8/10, 80% and 18/22, 82%, respectively) compared to Zone 3 (2/8, 25%). Conclusion Hemodynamically unstable patients in Zones 1 and 2 generally underwent surgery before CT, confirming that the low threshold for exploration in such patients remains. Only 25% (2/8) of Zone 3 PNI were explored, with the high negative predictive value of CT angiography providing confidence that it was capable of excluding major injury in the majority of cases. No deaths from PNI that survived to treatment at Role 3 were identified, lending evidence to the current management protocols being utilized in Afghanistan.

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