The Evolution of Arthroscopic Rotator Cuff Repair.

Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.

Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence.

Background: Treatment of irreparable massive rotator cuff tears (MRCTs) in patients without advanced glenohumeral osteoarthritis remains a challenge. Arthroscopic superior capsule reconstruction (SCR) represents a newer method for treatment with increasing popularity and acceptance.

Purpose: To analyze the clinical evidence surrounding SCR and determine the current clinical outcomes postoperatively.

Open Versus Arthroscopic Latarjet Procedure for the Treatment of Chronic Anterior Glenohumeral Instability With Glenoid Bone Loss.

Purpose: The purpose of this study was to compare the clinical, functional, and radiographic outcomes of open versus arthroscopic Latarjet procedures.

Methods: Between December 2009 to January 2015, all patients older than 18 years of age who were treated with a Latarjet procedure for chronic osseous anterior instability by a single surgeon were included in this retrospective cohort study. Range of motion, strength, Rowe, Western Ontario Shoulder Instability Index (WOSI) scores, and pain level according to the Visual Analog Scale (VAS) were evaluated.

Operative treatment of torsional humeral shaft fractures in throwers leads to an earlier return to sport: a survey of expert shoulder and elbow surgeons.

Purpose: To determine the management of torsional humeral shaft fractures in a group of expert shoulder and elbow surgeons and analyse the rate of return to sport of these throwing athletes.

Methods: A survey was sent to all physician members of two prominent sports medicine professional associations: the American Shoulder and Elbow Surgeons and the Herodicus Society. Due to the rare nature of this injury, a historical survey of management and return to play was performed to allow analysis of trends in treatment and return to play after both non-operative and operative management.

Return to Sport After Arthroscopic Rotator Cuff Repair: Is There a Difference Between the Recreational and the Competitive Athlete?

Background: Return to sport (RTS) remains an important challenge and measure of success for athletes undergoing arthroscopic rotator cuff repair (RCR).

Purpose: To determine the rate of RTS after RCR and to analyze predictive factors associated with a lower rate of return.

Study Design: Systematic review and meta-analysis.

Gluteus medius tears of the hip: a comprehensive approach.

Greater trochanteric pain syndrome (GTPS) is a common clinical condition that can affect a wide range of patients. Historically, the condition has been associated with trochanteric bursitis. More recently, however, a growing body of literature has demonstrated gluteus medius tendinopathy and tearing is present in many cases of GTPS.

Efficacy and safety of a novel skin cleansing formulation versus chlorhexidine gluconate.

Background: This study evaluated whether a multi-ingredient surfactant colloidal silver technology was noninferior to a 4% chlorhexidine gluconate (CHG) antiseptic on immediate and persistent antimicrobial activity.

Methods: The inguinal regions of 81 healthy adults were demarcated into 4 quadrants, and 3 were used for testing each product at baseline, 10 minutes, and 6 hours postapplication. The log of the number of colony forming units was obtained using a cylinder sampling technique.

Editorial Commentary: The Downstream Effects of Limited Hip Rotation and Femoroacetabular Impingement on the Anterior Cruciate Ligament: Could a Little Hip Stretching Every Day (or Surgery) Keep the Knee Doctor Away?

Patients with radiographic evidence of femoroacetabular impingement and decreased hip internal rotation have a higher rate of anterior cruciate ligament (ACL) tears. Limited internal rotation of the hip increases strain and potentially resultant fatigue failure of the ACL. Although causation has not been proven, a better understanding of the lower extremity kinetic chain may allow improved ACL prevention strategies through measures (operative or nonoperative) to improve rotation of the hip.

Neurovascular Compression After the Latarjet Procedure.

The Latarjet procedure is an established and effective option for the treatment of recurrent anterior shoulder instability. Symptomatic compression of the vasculature around the shoulder and adjacent brachial plexus is uncommon and may be difficult to diagnose and treat. The purpose of this report is to describe a patient with neurovascular compression of the axillary artery and brachial plexus after an open Latarjet procedure.

Posterior shoulder instability following anatomic total shoulder arthroplasty: A case report and review of management.

We report a case of posterior shoulder instability following anatomic total shoulder arthroplasty (TSA). In addition, we present guidelines to aid in the management of posterior instability after TSA. A 50-year-old male underwent anatomic TSA for glenohumeral osteoarthritis.

Regenerative treatments to enhance orthopedic surgical outcome.

In orthopedic surgery there has been a never-ending quest to improve surgical outcome and the patient's experience. Progression has been marked by the refinement of surgical techniques and instruments and later by enhanced diagnostic imaging capability, specifically magnetic resonance. Over time implant optimization was achieved, along with the development of innovative minimally invasive arthroscopic technical skills to leverage new versions of classic procedures and implants to improve short-term patient morbidity and initial, mid-term, and long-term patient outcomes.

Treatment of proximal humerus fractures: comparison of shoulder and trauma surgeons.

Surgeons' disagreement about ideal treatment for proximal humerus fractures (PHFs) may reflect a difference in training. We conducted a study to compare treatment decision-making by experienced shoulder and trauma fellowship--trained surgeons. Two expert shoulder surgeons and 2 expert trauma surgeons reviewed 100 consecutive PHFs surgically treated at another institution.

Labrum and rotator cuff injuries in the throwing athlete.

The large amount of force imparted across the shoulder during the act of throwing makes the glenohumeral joint highly susceptible to injury in the athlete performing overhead throwing motions. The bony incongruity of the shoulder enables greater range of motion than any other joint in the body, but it also results in significant strain on the surrounding soft tissues during the throwing motion. Throwers can present with acute injuries, but more commonly they suffer from chronic overuse conditions resulting from repetitive overload.

A comprehensive approach to glenohumeral arthritis.

Arthritis of the glenohumeral joint is a common cause of debilitating shoulder pain, affecting up to one-third of patients older than 60 years. It is progressive in nature and characterized by irreversible destruction of the humeral head and glenoid articular surfaces. Inflammation of the surrounding soft tissues is often present and further contributes to the pain caused by the disease process.

Acromioclavicular osteoarthritis: a common cause of shoulder pain.

Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture.

Missed locked posterior shoulder dislocation with a reverse Hill-Sachs lesion and subscapularis rupture.

We report the case of a patient who sustained a missed locked posterior shoulder dislocation with a sizable anterior impression fracture and a concomitant acute rupture of the subscapularis tendon. Despite compromise of the tendon, a transfer of the lesser tuberosity into the humeral head defect along with suture anchor repair of the subscapularis was performed. Within 6 months, the patient regained near complete function of his shoulder with no episodes of instability.

Association of suprascapular neuropathy with rotator cuff tendon tears and fatty degeneration.

Background: The mutual influence of suprascapular neuropathy (SSN) and rotator cuff tendon tears on muscle pathology is unclear. Debate continues as to how retracted cuff tears can lead to SSN and whether SSN or tendon retraction causes muscle fatty degeneration.

Methods: A cohort of 87 patients suspected of having SSN was identified from a prospectively collected registry.

Results of arthroscopic labral reconstruction of the hip in elite athletes.

Background: Femoroacetabular impingement (FAI) has been well characterized as a cause of hip pain and resultant damage to the acetabular labrum. It has become increasingly clear that an intact labrum is essential for normal joint mechanics, hip stability, and preservation of the articular cartilage. Elite athletes with a hypoplastic or irreparable labrum present a difficult clinical challenge.

Decision-making in the treatment of diaphyseal clavicle fractures: is there agreement among surgeons? Results of a survey on surgeons' treatment preferences.

Background And Hypothesis: Nonoperative treatment is standard for most diaphyseal clavicle fractures, but recent studies have demonstrated improved outcomes with operative treatment of displaced fractures. The objectives of this diagnostic study were to assess agreement of orthopaedic surgeons regarding their treatment preferences for diaphyseal clavicle fractures and to compare them with recent recommendations. Interobserver and intraobserver agreement in treatment decisions were hypothesized to be only slight.

Labral injuries of the hip in rowers.

Background: Injuries of the hip in the adolescent and young adult athlete are receiving more attention with advances in the understanding of femoroacetabular impingement (FAI), labral pathology, and hip arthroscopy. Labral tears have not been well characterized in rowers.

Questions/purposes: The purposes of this study were (1) to describe the clinical presentation of labral pathology in rowers; (2) to describe the MRI and radiographic findings of labral pathology in rowers; and (3) to determine the likelihood that a rower with labral injury, treated arthroscopically, will return to sport.

Correlation between the Child Health Questionnaire and the International Knee Documentation Committee score in pediatric and adolescent patients with an anterior cruciate ligament tear.

Background: The modified International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form has recently been shown to be valid, reliable, and responsive in a pediatric and adolescent population. The correlations between the Pedi-IKDC and quality-of-life-related health measures have not been studied in depth to determine how a knee injury affects patients in this age group. The purpose of this study was to examine the association between the Pedi-IKDC score and the Child Health Questionnaire (CHQ) in a group of pediatric patients with an anterior cruciate ligament (ACL) injury.

Stability of mid-shaft clavicle fractures after plate fixation versus intramedullary repair and after hardware removal.

Purpose: Operative treatment for middle-third clavicle fractures has been increasing as recent data has demonstrated growing patient dissatisfaction and functional deficits after non-operative management. A controlled biomechanical comparison of the characteristics of locked intramedullary (IM) fixation versus superior pre-contoured plating for fracture repair and hardware removal is warranted. Therefore, the purpose of the present study was to investigate potential differences between these devices in a biomechanical model.

Normal curvature of glenoid surface can be restored when performing an inlay osteochondral allograft: an anatomic computed tomographic comparison.

Purpose: The purpose of this study was to quantitatively measure the morphology of the glenoid and to assess feasibility of using the medial tibial plateau surface as a donor for osteoarticular allograft reconstruction of the glenoid.

Methods: Using computed tomography (CT), 10 tibias and 10 scapular models from our database (5 males and 5 females in each group) were randomly selected. Commercial software (Mimics, Materialize, Inc.

Treatment of a hip capsular injury in a professional soccer player with platelet-rich plasma and bone marrow aspirate concentrate therapy.

This report presents a 27-year-old male professional soccer player who developed heterotopic ossification of his hip capsule and gluteus minimus tendon after an arthroscopic hip procedure. After removal of the heterotopic bone, the patient had a symptomatic deficiency of his hip capsule and gluteus minimus tendon. A series of orthobiologic treatments with platelet-rich plasma and bone marrow aspirate concentrate improved the patient's pain and strength as well as the morphologic appearance of the hip capsule and gluteus minimus tendon on magnetic resonance imaging.