Publications by authors named "Patrick Denard"
Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus.
Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.
Hypothesis And Background: Reverse shoulder arthroplasty (RSA) exhibits favorable outcomes in managing rotator cuff arthropathy, primary glenohumeral arthritis, and complex proximal humeral fractures. Despite its success and reliability, certain patients experience persistent pain and stiffness. The clinical utility of therapeutic arthroscopy in RSA patients remains an area for investigation.
View Article and Find Full Text PDFComparison of Clinical Outcomes Between Arthroscopic Rotator Cuff Repair and Reverse Total Shoulder Arthroplasty in Patients With Massive Rotator Cuff Tears and High-Grade Fatty Atrophy Without Glenohumeral Osteoarthritis.
Orthop J Sports Med
December 2024
Background: Despite the effectiveness of reverse total shoulder arthroplasty (RSA) and arthroscopic rotator cuff repair (ARCR) for treating massive rotator cuff tears (MRCTs), controversies remain in patients without glenohumeral osteoarthritis (GHOA).
Purpose: To compare clinical outcomes of ARCR or RSA in patients with MRCT with high-grade fatty atrophy without GHOA.
Study Design: Cohort study; Level of evidence, 3.
Background: Lateralization has been previously studied for reverse shoulder arthroplasty, but there is little clinical research investigating the independent effect of medialization or lateralization of the joint line, nor global medialization or lateralization for anatomic total shoulder arthroplasty (TSA). The goal of this study was to assess the impact of lateralization on clinical outcomes after anatomic TSA.
Methods: A retrospective review of a multi-institutional registry was performed.
Article Synopsis
- The study aimed to analyze how scapulothoracic orientation affects simulated range of motion (ROM) in reverse total shoulder arthroplasty (rTSA), expecting notable differences between adjusted and unadjusted values.
- Using CT scans from ten shoulder patients, six surgeons independently planned rTSA with software that adjusted for scapular orientation, comparing various movement planes.
- Results showed significant differences in all movement planes with adjustments leading to lower ROM values, particularly in external rotation, extension, and internal rotation, indicating the importance of posture in preoperative planning for rTSA.
Article Synopsis
- The long head of the biceps tendon is often affected in patients with massive rotator cuff tears (MRCTs), which make up about one third of all rotator cuff injuries.
- Treatment approaches for this issue include options like tenotomy, tenodesis, and innovative techniques like augmentation and superior capsular reconstruction.
- There is still no consensus or established guidelines on how to effectively manage biceps tendon problems alongside MRCTs.
Determining the Patient Acceptable Symptom State (PASS) for Shoulder Strength After Subscapularis Arthroscopic Repair and Evaluating the Preoperative Predictors for PASS Achievement.
Orthop J Sports Med
October 2024
Article Synopsis
- The study investigates what patients consider acceptable strength after undergoing arthroscopic rotator cuff repair (ARCR) for tears involving the subscapularis muscle, focusing on the Patient Acceptable Symptom State (PASS) values for strength metrics.
- A total of 278 patients were analyzed over a mean follow-up period of 72.8 months, revealing specific PASS values for both Constant strength and internal rotation (IR) strength based on gender.
- Findings indicate that older age, fatty infiltration of tendons, and unsuccessful healing of the subscapularis negatively impact the likelihood of achieving satisfactory strength post-surgery.
Article Synopsis
- The study evaluates a new technique for preparing an autograft patch from the long head of the biceps to aid in repairing rotator cuff injuries.
- It involved analyzing tissue samples from patients who underwent biceps tenodesis, comparing compressed and non-compressed samples for signs of tenocyte damage.
- Results indicate that the compression process did not significantly harm the tenocyte morphology, suggesting it is a safe method for enhancing rotator cuff repairs.
Article Synopsis
- The AAOS guidelines indicate that early and delayed rehabilitation after arthroscopic rotator cuff repairs have similar healing outcomes, supported by "strong" evidence.
- A study analyzed randomized controlled trials (RCTs) with non-significant tendon re-tear rates to calculate the reverse fragility index (RFI) and reverse fragility quotient (RFQ), revealing that these studies are statistically weak.
- The findings suggest that the evidence supporting the equivalency of both rehabilitation strategies is fragile, as small changes in patient outcomes can significantly affect results; thus, RFI should be routinely reported in clinical guidelines.
Article Synopsis
- Reverse shoulder arthroplasty is used to treat conditions like cuff tear arthropathy and irreparable rotator cuff tears, and advances in design allow for improved correction of glenoid retroversion and inclination with augmented baseplates.
- The study involved analyzing CT scans from 21 patients and comparing the effects of standard and augmented baseplates when adjusting the glenoid inclination to neutral, with surgeons virtually placing both types to ensure consistency.
- Results showed that while the area of baseplate contact was similar between both types, patients with augmented baseplates experienced significantly less bone loss during surgery (619 mm vs. 1102 mm reamed), indicating a potential advantage of the augmented design.
Article Synopsis
- The study aimed to analyze the minimal clinically important difference (MCID) and patient-acceptable satisfactory state (PASS) values for patient-reported outcomes following shoulder instability surgeries (Bankart, Latarjet, and Remplissage).
- A systematic review was performed on studies published from 1985 to 2023, focusing on how MCID and PASS values were derived and their usage frequency in the literature.
- Out of 174 records screened, 8 studies were included, revealing that MCID was commonly reported, while PASS was less frequently mentioned, with the American Shoulder and Elbow Surgeons score being the most researched outcome measure.
Article Synopsis
- Reduced bone density is identified as a risk factor for complications in reverse shoulder arthroplasty (RSA), prompting the need for effective methods to quantify bone quality using preoperative CT scans.
- The study involved three main steps: developing a patient-specific calibration method with cadaveric CT scans, applying this method to a cohort of 345 RSA patients, and utilizing machine learning for better analysis and classification of bone density data.
- Results showed that the patient-specific calibration method significantly improved accuracy for measuring bone densities, effectively classified patients into high and low-density groups, and provided better predictions using machine learning techniques compared to traditional methods.
Background: Several studies have reported proximal bone resorption in stemless and press-fit short-stem humeral implants for anatomic total shoulder arthroplasty. The purpose of this biomechanical study was to evaluate implant and cortical bone micromotion of a cortical rim-supported stemless implant compared to a press-fit short stem implant during cyclic loading and static compression testing.
Methods: Thirty cadaveric humeri were assigned to 3 groups based on a previously performed density analysis, adopting the metaphyseal and epiphyseal and inferior supporting bone densities for multivariate analyses.
Article Synopsis
- A study compared the short-term clinical and radiologic outcomes of two types of reverse shoulder arthroplasty implants: bone increased offset RSA (BIO-RSA) and metal increased offset RSA (MIO-RSA).
- Both implant designs resulted in comparable improvements in shoulder function and range of motion, with no significant differences in postoperative scapular notching.
- Notable differences were found in lateralization and distalization angles between the two groups, but overall, both designs showed similar short-term effectiveness in patients.
Article Synopsis
- The study aimed to assess how well experienced reviewers can differentiate between AI-generated and original research abstracts in shoulder and elbow surgery, alongside evaluating an AI detection tool's performance.
- Out of 50 abstracts evaluated by eight peer reviewers, only 62% of AI-generated ones were correctly identified; however, 38% of original abstracts were mistakenly classified as AI-generated.
- Reviewers found unrealistic data helped identify AI-created abstracts, while misclassifications of original work often resulted from similarities in writing style.
Article Synopsis
- The study aimed to compare the effectiveness of supervised physical therapy (PT) versus home-based exercise programs for patients after arthroscopic repair of massive rotator cuff tears over various follow-up periods (3, 6, 12 months, and longer).
- It involved a retrospective analysis of 99 patients who had chosen their rehabilitation approach; patient-reported outcomes, range of motion, and recovery metrics were collected and analyzed.
- Results showed no significant differences in recovery outcomes, complications, or overall satisfaction between the two groups, indicating both rehabilitation methods can be effective post-surgery.
Background: Previous research has emphasized the effect of prognostic factors on arthroscopic rotator cuff repair (ARCR) success, but a specific focus on subscapularis (SSC) tendon repair healing is lacking.
Purpose: To identify prognostic factors for SSC healing after ARCR and develop the Subscapularis Healing Index (SSC-HI) by incorporating these factors.
Study Design: Case-control study; Level of evidence, 3.
Article Synopsis
- The study investigates how the healing of the subscapularis tendon affects the restoration of internal rotation behind the back (IR1) in patients who have undergone reverse shoulder arthroplasty (RSA), along with other influencing factors like anterior scapular tilt and passive internal rotation at abduction (IR2).
- A total of 77 patients were reviewed, and over three years, it was found that successful healing of the subscapularis tendon was linked to significantly better IR1 outcomes, with a 85% success rate compared to 53% in unhealed cases.
- Multivariate analysis indicated that better functional IR1 is independently associated with subscapularis healing, increased anterior tilt of the scapula
Article Synopsis
- * A retrospective review of patient data from 2015 to 2021 showed that SaN was present in only 2.9% of cases, with no significant correlations found between patient characteristics or implant positioning and the occurrence of SaN.
- * Importantly, the study concluded that the presence of SaN did not negatively affect patients' functional outcomes or range of motion in the short-term post-surgery.
Background: A proposed etiology of anterior shoulder pain and limited internal rotation after reverse shoulder arthroplasty (RSA) is impingement of the humeral component on the coracoid or conjoint tendon. The primary goal of this study was to investigate radiographic surrogates for potential coracoid or conjoint tendon impingement and their relationship to postoperative pain and internal rotation after RSA.
Methods: A retrospective review of a clinical registry was performed to identify patients with (1) primary RSA, (2) minimum 2-year clinical follow-up, and (3) satisfactory postoperative axillary lateral radiographs.
Article Synopsis
- The study aimed to determine the Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptomatic State (PASS) for patient-reported outcomes in individuals who underwent arthroscopic isolated subscapularis repair (AISR).
- A retrospective analysis was done on data from 77 patients with an average follow-up of 58.1 months, assessing outcomes using VAS pain score, ASES score, and Subjective Shoulder Value (SSV).
- Results showed specific MCID values for VAS pain, ASES, and SSV, while PASS values were also identified, though no significant correlations were found between certain patient characteristics and the achievement of these thresholds.
Article Synopsis
- The study focuses on the relationship between post-surgery range of motion (ROM) recovery and tendon healing after arthroscopic rotator cuff repair (ARCR), finding that early loss of ROM may indicate poor healing outcomes.
- A total of 1207 cases were analyzed, revealing an overall healing rate of 86.7%, with older patients showing lower healing rates.
- Results indicated that patients whose repairs healed experienced greater increases in ROM at various follow-up points, highlighting the importance of measuring passive anterior elevation early in recovery as a predictor of healing success.
Background: Optimal glenosphere positioning in a lateralized reverse shoulder arthroplasty (RSA) to maximize functional outcomes has yet to be clearly defined. Center of rotation (COR) measurements have largely relied on anteroposterior radiographs, which allow assessment of lateralization and inferior position, but ignore scapular Y radiographs, which may provide an assessment of the posterior and inferior position relative to the acromion. The purpose of this study was to evaluate the COR in the sagittal plane and assess the effect of glenosphere positioning with functional outcomes using a 135° inlay stem with a lateralized glenoid.
View Article and Find Full Text PDFArticle Synopsis
- Treating massive rotator cuff tears is complex, with options ranging from arthroscopic repair to reverse shoulder surgery.
- Arthroscopic repair can still be viable even in advanced cases, and the risk of needing follow-up surgery after reverse shoulder surgery is high.
- An individualized treatment plan should take into account the patient's X-rays, functional needs, and personal goals, with younger patients and those seeking pain relief likely benefiting from arthroscopic methods.
Reverse shoulder arthroplasty for massive rotator cuff tears without glenohumeral arthritis can improve clinical outcomes despite history of prior rotator cuff repair: A systematic review.
J ISAKOS
June 2024
Article Synopsis
- - Reverse shoulder arthroplasty (RSA) is a surgical option for addressing massive irreparable rotator cuff tears (MIRCT) in patients without arthritis, but it's unclear how previous rotator cuff repairs (RCR) impact results.
- - A systematic review analyzed data from seven studies, comparing 343 patients who underwent primary RSA with 95 patients who had prior RCR, focusing on functional outcomes and complications.
- - While functional outcomes and range of motion were similar between groups, those with prior RCR showed a greater potential for improvement but also faced a significantly higher risk of complications and the need for revisions post-surgery.