Outcomes of Mini-Invasive Arthroscopic Arthrolysis Combined with Locking Screw and/or Intramedullary Nail Extraction after Osteosynthesis of the Proximal Humerus Fracture

Data on the effectiveness of arthroscopic arthrolysis and extraction of osteosynthetic material after osteosynthesis of the proximal humerus in patients with persisting problems are rare and insufficient. In this study, we performed arthroscopic arthrolysis and extraction of fixation screws, and, where protruding, extraction of the nail in 34 patients with problems persisting 12 months after osteosynthesis of the proximal humerus using an intramedullary nail. The effectiveness of the treatment was assessed using the Constant–Murley shoulder score and forward flexion difference between the treated arm and the contralateral one. A median increase of 16 points in CMS score and 30 degrees reduction in the arm forward flexion difference was recorded 12 months after the arthroscopy. The improvement was significantly higher in the patient group with intramedullary nail extraction (however, this group had worse pre-operative values and the screw was only extracted where likely to cause problems). The median time to heal was 11 weeks; no serious peri- or post-procedural complications occurred. Mini-invasive arthroscopic arthrolysis combined with extraction of osteosynthetic material proved to be a safe and effective method for treatment of patients after osteosynthesis of the proximal humerus using an intramedullary nail with persisting pain and/or mobility limitation.

Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

Objectives: To explore the indications and surgical techniques for arthroscopic lower trapezius transfer (LTT) with tendon autograft in managing massive irreparable posterosuperior rotator cuff tears (PSRCTs); to validate the feasibility, safety, and efficacy of this technique.Methods: This study retrospectively enrolled 23 patients with massive irreparable PSRCTs, admitted to and followed up by the Taizhou Hospital of Zhejiang province between July 2020 and April 2021, and treated with ipsilateral LTT and ipsilateral hamstring tendon autograft. The control group consisted of 23 patients with massive RCTs receiving conventional repair procedures within the same frame. Follow-up data at the preoperative visit, and postoperative month 3 were collected to assess the active range of motion, Constant–Murley Score (CMS),American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California, Los Angeles (UCLA)shoulder score, visual analog scale (VAS)and the post-operative MRI results, all of which could provide a comprehensive postoperative early efficacy assessment.Results: Three months follow-up visits were completed for all patients, revealing improvements in all aspects compared to the preoperative state, with no complications, such as postoperative infection of surgical sites and nerve injuries of infection and nerve injury. The distribution of active shoulder range of motion of patients and function scores with two types of operation was as follow: angles of flexion and lifting (130.00° ± 31.55° vs. 90.78° ± 19.85°), abduction (123.26° ± 30.47°vs. 85.87° ± 18.74°), external rotation at side (101.74° ± 14.74° vs. 91.74° ± 11.92°), external rotation at 90° abduction (41.52° ± 21.97° vs. 24.57° ±12.60°), VAS (0.74± 0.81 vs. 1.87 ±0.87), CMS(56.3 ± 13.01 vs. 48.30 ± 8.38), UCLA shoulder score (24.04 ± 2.88 vs.20.96 ± 3.47), ASES (72.91 ± 9.99 vs.60.74 ± 8.84). Significantly better improvements were found in the study group on month 3.19 of 23 patients in the study group and 17 of 23 patients in the control group underwent MRI on the 3 months follow up. Retear was found in only one patient who had grade 4 subscapularis tendon injury, However, revision was not performed due to postoperative pain relief and functional improvement.Conclusion: Compared to conventional repair procedures, in the early postoperative period, LTT with tendon autograft could achieve better pain relief, more rapid motor functional recovery, and higher functional scores for massive irreparable PSRCTs.

Agreement between the American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment score (ASES) and the Oxford Shoulder Score (OSS) in patients presenting with shoulder pathology: A cohort analysis of the Clinical Quality Registry for Outcomes in Shoulder and Elbow Pathology (CROSEP) registry

Background The choice of patient-reported outcome measure (PROM) used in shoulder studies varies based on clinician's preference and location. This creates difficulties when attempting to compare studies which have used different PROMs as their outcome measure. This study aims to assess the agreement between the American Shoulder and Elbow Surgeons score (ASES) and the Oxford Shoulder Score (OSS), and identify factors associated with agreement. Methods Patients with shoulder pathology were identified from a multi-cohort observational practice registry. 1050 paired ASES and OSS pre-treatment scores were prospectively collected. Linear regression was performed to assess the agreement between the PROMs. Mixed-effects analysis of variance was performed to assess the influence of factors associated with agreement. Results Regression for mean total and mean function ASES and OSS demonstrated good fit (adjusted R2 57.7%, P < 0.001; and 63.9%, P < 0.001). Mean pain subscore demonstrated a poorer fit (adjusted R2 39.4%, P < 0.001). Crosswalks to convert between mean scores were produced with reasonable precision. Veterans RAND 12-Item Health Survey score, age and diagnosis cohort influenced agreement. Conclusion Mean total and mean function ASES and OSS scores agree well with each other. This allows for a more informed comparison of studies using either PROMs as their outcome measure.

Floor and ceiling effects in the Oxford Shoulder Score

Aims The main objective of this study was to examine whether the Oxford Shoulder Score (OSS) demonstrated floor or ceiling effects when used to measure outcomes following shoulder arthroplasty in a large national cohort. Secondary objectives were to assess its pain and function subscales, and to identify independent predictors for patients achieving a postoperative ceiling score following shoulder arthroplasty. Methods Secondary database analysis of the National Joint Registry (NJR), which included 48,270 patients undergoing shoulder arthroplasty, was conducted. The primary outcome measure was the OSS. Secondary outcome measures were the OSS-Function Component Subscale and OSS-Pain Component Subscale. Floor and ceiling effects were considered to be present if > 15% of patients scored either the lowest or highest possible score. Logistic regression analysis was used to identify independent predictors for scoring the highest possible OSS score postoperatively. Results Preoperatively, 1% of patients achieved the lowest possible OSS score (0) and 0.4% of patients achieved the highest possible score (48). Postoperatively, < 1% of patients achieved the lowest score at all timepoints, but the percentage achieving the highest score at six months was 8.3%, at three years 16.9%, and at five years 17%. Male patients, those aged between 60 and 89 years, and those undergoing an anatomical total shoulder arthroplasty (ATSA) were more likely to contribute to the ceiling effect seen in the OSS questionnaire. Pain and function subscales exhibited greater ceiling effects at three years and five years when compared with the overall OSS questionnaire. Logistic regression analysis showed that sex, procedure type, and preoperative OSS score were independent predictors for scoring the highest possible OSS at years. Conclusion Based on NJR patient-reported outcome measures data, the OSS does not exhibit a ceiling effect at six months, but does at three years and five years, in part due to outcome scores of ATSA. Preoperative OSS, age, male sex, and ATSA are independent predictors of achieving a ceiling score. Cite this article: Bone Joint J 2021;103-B(11):1717–1724.

Assessment of Rotator Cuff Partial Tear Treatment with Ultrasound Guided Platelet Rich Plasma Injection

Background Rotator cuff tears are a common orthopedic problem, and often these tears are so-called partial tears of the rotator cuff. A partial tear of the rotator cuff is an area of damage or degeneration to the rotator cuff tendons, where the tear does not go all the way through the tendons Objectives The aim of the work assessment of rotator cuff partial tear treatment with ultrasound guided platelet rich plasma injection. Patients and Methods Single arm interventional study which was conducted in Ain shams university hospitals in the period between March 2020 and October 2020, 10 confirmed cases of rotator cuff partial tear diagnosed by MRI were included in this study. Their ages ranging from 25 to 70 years old. Results Our study showed statistically significant improvements in 10 patients in VAS pain score, constant shoulder score, PENN shoulder score and OXFORD shoulder score. Conclusion The ultrasound-guided PRP injection for rotator cuff partial thickness tears is a safe, cheap, and easily prepared outpatient procedure which showed competitive, promising and wellproved results. PRP has the potential to heal the muscle-tendon unit of the rotator cuff and may be a primary nonsurgical treatment modality for rotator cuff tears.

Short-term Results of a New Anatomic Stemless Shoulder Arthroplasty- A Prospective Multicentre Study

Background: Anatomic total shoulder arthroplasty (TSA) has been continuously developed and current designs include stemless or canal-sparing humeral components. In the literature stemless and canal sparing TSA showed good clinical and radiographic results, which were comparable to stemmed TSA. The aim of this study was to determine the short-term clinical and radiological outcomes of a new stemless TSA design. Methods: A prospective multicentre study including 154 total shoulder arthroplasty patients with a follow up of 12 months was performed. At the time of follow up 129 patients were available for review. The adjusted Constant Murley score [33], Oxford shoulder score, EQ-5D-5L score and radiographs were examined preoperatively, 3 and 12 months after the implantation of the new stemless TSA implant GLOBAL ICON™ (DePuy Synthes, Warsaw, IN, USA). Complications were documented.Results: Implant Kaplan-Meier survivorship was 98.7% at 12 months. From baseline to 12 months follow-up, all scores showed a progressive significant mean improvement. The mean adjusted Constant score increased from 42.3 to 96.1 points (p<0.001). The Oxford shoulder score showed an increase of 21.6 points (p<0.001). The postoperative radiographs showed no continuous radiolucent lines, subsidence, aseptic loosening or progressive radiolucency, but one osteolytic lesion was observed. Only 2 prostheses were revised. Conclusion: The new GLOBAL ICON stemless TSA showed good clinical and radiographic results at short-term follow up which were comparable to early results of other stemless TSA. Further studies with longer follow up are needed in the future.

Development and Validation of a Simplified Chinese Version and a Face-Scale Version of the Oxford Shoulder Score: A 2-Center Prospective Study

Background: There has not yet been a pictorial version of a patient-reported outcome measure for shoulder pain. Purpose: To translate the English version of the Oxford Shoulder Score (OSS) to a simplified Chinese version (SC-OSS) and to validate a new face-scale version of the OSS (FS-OSS), while investigating cross-cultural adaptation, validation, and reproducibility of both versions in patients with shoulder pain. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The translation and cross-cultural adaptation of the SC-OSS was performed using a forward-backward translation method. The FS-OSS was developed on the basis of the SC-OSS, using the Wong-Baker FACES Pain Rating Scale for reference. Participants were asked to complete the SC-OSS, FS-OSS, Simple Shoulder Test (SST), Constant-Murley score (CMS), and 36-Item Short Form Health Survey (SF-36). Validation and reproducibility were tested by calculating Cronbach α values for internal consistency as well as by intraclass correlation coefficients. Time needed to complete the scores was used to test cross-cultural adaption. Results: A total of 312 respondents participated in the research and completed all outcome measures. The internal consistency was strong, with a Cronbach α of .94 and .91 for the FS-OSS and SC-OSS, respectively. High intraclass correlation coefficient values for the FS-OSS score (0.95) and SC-OSS (0.92) were obtained, which indicated excellent test-retest reliability. The Pearson correlation coefficients of the SC-OSS and FS-OSS with the SST ( r = 0.67 and 0.65, respectively), CMS ( r = 0.62 and 0.66, respectively), and SF-36 ( r = 0.52 and 0.57, respectively) indicated good construct validity. The time needed to complete the FS-OSS was less than that needed for the SC-OSS and SST. Conclusion: The FS-OSS and SC-OSS were validated as reliable instruments for patients with shoulder pain. For Chinese patients, the face-scale version was easier to understand than the cross-cultural text version.

Clinical and Imaging evaluation of rotator cuff tendons in Elite Waterpolo player

Background: Rotator cuff structural changes are common in overhead throwing athletes, such as baseball, javelin, swimming, volleyball, by increasing the risk of shoulder pain and injury. The structural alterations in elite waterpolo players are not well known. In elite waterpolo athletes there are structural alterations of rotator cuff tendons due to overuse of the dominant shoulder compared to the non-dominant, like in other overhead disciplines, identifiable by ultrasound (US).Methods: Asymptomatic elite men waterpolo players were selected. All athletes were evaluated with standardized scales of shoulder pain and function (Oxford Shoulder Score, Constant Shoulder Score) and provided data of training, injury and shoulder pain history. Each athlete underwent clinical evaluation of shoulders followed by US of rotator cuff, biceps and bursas. Results: Twenty-three athletes met the inclusion criteria, mean age 24.2±3.3. Fourteen athletes (61%) presented higher degeneration grade at the dominant supraspinatus compared to the contralateral, always in the same area in outfield players: anterior, lateral, pre-insertional. In twenty-two (95%) the biceps tendon was damaged: Twenty athletes (87%) bilaterally, two (9%) at the only dominant limb. The site was always at the bicipital groove in its insertion on the humerus. Power Doppler (PD) evidenced neovascularization in only five (22%) players at supraspinatus: four bilaterally, one only at the non-dominant. No statistical correlation was found between tendon degeneration and age, career years.Conclusion: Outfield waterpolo players have peculiar changes in supraspinatus at preinsertional level, as seen in other overhead throwing athletes. We found changes also in biceps, bilaterally, like in shoulders of elite swimmers. We suppose that these changes are predictive of shoulder pain and injury.