E. Rhett Hobgood

Comparison of Partial Versus Complete Arthroscopic Repair of Massive Rotator Cuff Tears

Background: Complete repair of massive rotator cuff tears can be limited by tendon retraction and poor tissue quality. When a complete repair cannot be accomplished, a significant partial repair may be possible. Hypothesis: A partial repair will yield comparable outcomes to complete repair of massive rotator cuff tears in this specific patient population. Study Design: Cohort study; Level of evidence, 3. Methods: All consecutive arthroscopic rotator cuff repairs done at the authors’ institution over a 2-year period were identified. A retrospective chart review was performed. Inclusion criteria required that each patient have a massive rotator cuff tear (30 cm2 or greater). Patients were categorized as either partial or complete repair. The University of California, Los Angeles (UCLA) shoulder scores were used to measure patient outcomes at an average follow-up of 24 months (10-40 months). Results: Of 1128 consecutive arthroscopic rotator cuff repairs, 97 (9%) patients were noted intraoperatively to have massive tears measuring 30 cm2 or greater. Complete repair was achieved in 52 patients, whereas partial repair was possible in 45 patients. Eleven patients were lost to follow-up. The 41 remaining patients with only partial repair achieved a postoperative mean UCLA score of 29.49, and the 45 patients with complete repair achieved a mean UCLA score of 29.64, yielding significant improvement in both the partial repair group (P = .0001) and the complete repair group (P = .0001) compared with preoperative UCLA scores. However, no statistically significant differences in postoperative outcomes were noted when the 2 groups were compared with one another (P = .89). Conclusion: Partial repair of massive rotator cuff tears yielded outcomes comparable with complete repair of massive tears.

Clinical results of revision shoulder arthroplasty using the reverse prosthesis

BACKGROUND Success of revision shoulder arthroplasty using an unconstrained prosthesis depends on an intact rotator cuff and satisfactory bone quantity. However, the reverse shoulder arthroplasty can stabilize a glenohumeral joint even in patients with rotator cuff deficiency and bone deficits, resulting in improved outcomes. MATERIALS AND METHODS Thirty shoulders in 28 patients with a failed arthroplasty were investigated consecutively between 2005 and 2008. All shoulders had significant rotator cuff deficiency without glenoid bone loss. Revision arthroplasty using the reverse prosthesis was performed with a minimum of 2 years of follow-up. Concomitant glenoid reconstructions with tricortical iliac crest bone grafting were necessary in 12 shoulders. RESULTS The average adjusted Constant score improved from 24% to 65% and the American Shoulder and Elbow Surgeons (ASES) score improved from 55 to 72 (P < .0001). Average active forward flexion increased from 42° to 106° (P < .0001). The average ASES pain score improved from 6.6 to 1.6 (P < .0001). The overall complication rate was 50%, and 7 patients (23%) required reoperation. Overall, 24 of 30 shoulders (80%) were very satisfied or satisfied. CONCLUSION Reverse shoulder arthroplasty can be an efficacious salvage procedure in the management of failed arthroplasty due to rotator cuff-related instability or bone defects, or both. Structural bone grafting on the glenoid side is successful at managing large defects, producing similar or better clinical outcomes compared with patients without bone loss. Although the operation is associated with a considerable complication rate, 80% of patients were satisfied with the results of the procedure, and 29 of 30 shoulders had a stable prosthesis.

Acute Dislocations of the Adult Elbow

Despite the highly constrained nature of the elbow joint, dislocation is not uncommon. Uncomplicated (simple) dislocations are those that occur without fracture and usually can be managed successfully with closed reduction and early motion. Precise attention, however, should be given to the stability of the elbow immediately after reduction. Instability can persist in full extension and require modification in forearm rotation and limitation of full extension to maintain stability. Soft tissue injury can be severe, at times requiring surgical repair to maintain stability.

Surface Replacement Arthroplasty of the Humeral Head in Young, Active Patients Midterm Results

Background: The treatment of glenohumeral arthritis in young, active patients remains controversial. Standard total shoulder arthroplasty in this patient group has not obtained the same satisfaction rate as in older patients. One surgical option that has emerged is humeral resurfacing. Hypothesis: Humeral head surface replacement arthroplasty (SRA) would provide satisfactory clinical outcomes in active patients, allowing them to maintain their normal lifestyle without activity restrictions. Study Design: Case series; Level of evidence, 4. Methods: From 2004 to 2007, all consecutive surface replacement arthroplasties of the humerus performed at the authors’ institution were identified and retrospectively reviewed, and 118 patients who underwent SRA during this time were identified. This study included patients younger than 60 years who wished to maintain an active lifestyle; 52 of the 118 patients met the inclusion criteria. University of California at Los Angeles (UCLA) shoulder scores and subjective shoulder value (SSV) scores were used to measure clinical outcomes at an average follow-up of 6 years (range, 4-8 years). Of the 52 patients meeting the inclusion criteria, 48 were contacted and examined for the study, with 4 patients lost to follow-up. Results: The mean postoperative UCLA score was 28.03, with 1 patient requiring revision because of pain and glenoid wear. The mean SSV was 92% (range, 0%-100%), with 3 patients restricting their activity because of the shoulder. Forty-seven of the 48 contacted patients stated that, given the option, they would have the same surgery again. One patient required revision surgery because of pain. Conclusion: Surface replacement arthroplasty provided reasonable results in patients younger than 60 years with high activity demands with a low rate of revision at midterm follow-up.

OCD/Chondral Injuries of the Elbow

Osteochondritis dissecans (OCD) of the elbow is a localized osteochondral lesion most commonly found in the capitellum. The defect often progresses through different stages and can involve the joint surface to varying degrees. This spectrum ranges from softening and fibrillation of the cartilaginous surface to a larger osteochondral fragment that can displace from its subchondral bed. Diagnosis can be made on plain radiographs or MRI which better visualizes these features. Numerous studies have evaluated these characteristics and have attempted to define each of their roles in order to assist the practitioner in deciding between a stable and unstable fragment. The stability of the lesion can have implications regarding its treatment. Nonoperative treatment has a role in the management of OCD in the elbow. Surgical treatment strategies include both open and arthroscopic means and include debridement, microfracture or drilling, fixing of the lesion, and osteochondral grafting.

Early Arthroscopic Contracture Release for Postoperative Shoulder Stiffness (SS-05)

Introduction Severe postoperative stiffness following shoulder surgery is a common problem that usually resolves. However, some cases are very resistant to normal measures, and controversy exists regarding management of these patients. The present study was carried out in an effort to determine the effectiveness of early arthroscopic intervention for severe postoperative shoulder stiffness occurring in patients with previously normal shoulder range of motion. Methods From January 2004 to January 2008, all patients who underwent arthroscopic contracture release secondary to postoperative shoulder stiffness with previously normal shoulder motion were identified. Inclusion criteria included all patients who developed postoperative forward flexion of less than 100° and passive external rotation of less than 20°, and were ultimately treated with arthroscopic contracture release. All patients undergoing this procedure had failed a minimum of 3 months of postoperative treatment measures prior to arthroscopic release. Medical records were reviewed, and all patients were evaluated preoperatively and postoperatively. Results A total of 30 consecutive patients were identified with the initial procedure being a rotator cuff repair in 23 patients, subacromial decompression in 5 patients and SLAP repair with decompression in 2 patients. Surgical intervention was carried out after an average of 4 months (3-6 months) of postoperative treatment. Closed manipulation and arthroscopic contracture release were performed in all patients. After an average follow-up of 43 months (16-79 months), range of motion in all planes was improved in all patients. Most notable were passive external rotation improvement from a mean of 5° (-10° to 20°) to 60° (45° to 80°) (p Conclusion This study demonstrates that early arthroscopic contracture release is a safe and effective method for treating severe postoperative shoulder stiffness unresponsive to postoperative measures and is helpful in restoring shoulder motion and function.