Mixed reality applications in upper extremity surgery: the future is now.

Mixed reality refers to the integration of virtual reality into the real-world environment. This digital content can be interacted with in real time. The emergence of mixed reality technology has been made possible by the introduction of head-mounted displays, which are being utilized across multiple surgical specialties.

Initial clinical experience with a predictive clinical decision support tool for anatomic and reverse total shoulder arthroplasty.

Purpose: Clinical decision support tools (CDSTs) are software that generate patient-specific assessments that can be used to better inform healthcare provider decision making. Machine learning (ML)-based CDSTs have recently been developed for anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty to facilitate more data-driven, evidence-based decision making. Using this shoulder CDST as an example, this external validation study provides an overview of how ML-based algorithms are developed and discusses the limitations of these tools.

Arthroscopic Superior Capsular Reconstruction Using Hamstring Allograft.

Superior capsular reconstruction (SCR) has become an acceptable treatment option for patients with chronic shoulder pain in the setting of an irreparable rotator cuff tear. Several different techniques have been described with varying graft options. In this Technical Note, we introduce a technique for arthroscopic SCR using hamstring allograft tendon.

Two-year outcomes with a bioinductive collagen implant used in augmentation of arthroscopic repair of full-thickness rotator cuff tears: final results of a prospective multicenter study.

Background: Full-thickness rotator cuff tears (FTRCTs) represent a common shoulder injury that, if untreated, can progress in size, become increasingly painful, and inhibit function. These lesions are often surgically repaired, with double-row arthroscopic repair often preferred for larger tears. Biological augmentation technologies have been developed to improve rates of postoperative radiographic retear and enhance patient-reported outcomes after surgical FTRCT repair.

Full-Thickness Rotator Cuff Tears Can Be Safely Treated With a Resorbable Bioinductive Bovine Collagen Implant: One-Year Results of a Prospective, Multicenter Registry.

Purpose: The purpose of this study was to prospectively collect safety and efficacy data in a large group of patients undergoing arthroscopic repair of full-thickness rotator cuff tears augmented with a resorbable bioinductive bovine collagen implant designed to promote healing.

Methods: Seventeen centers across the United States enrolled patients in an institutional review board-approved registry to collect outcomes data on the implant. Patients undergoing surgical management of full-thickness rotator cuff tears augmented with the implant were enrolled.

Treatment of Partial-Thickness Rotator Cuff Tears With a Resorbable Bioinductive Bovine Collagen Implant: 1-Year Results From a Prospective Multicenter Registry.

Background: Surgical treatment of partial-thickness rotator cuff tears remains challenging and controversial, with several traditional options including debridement with acromioplasty, transtendon or in situ repair, and take-down and repair. A resorbable bioinductive bovine collagen implant has shown promise as an alternative treatment option for partial-thickness tears.

Purpose: Data from a registry were analyzed to further establish that the implant contributes to improved patient-reported outcome (PRO) scores across a large number of patients treated for partial-thickness rotator cuff tears.

Retear rates and clinical outcomes at 1 year after repair of full-thickness rotator cuff tears augmented with a bioinductive collagen implant: a prospective multicenter study.

Background: Biologic technologies can potentially augment existing arthroscopic rotator cuff repair to improve retear rates and postoperative outcomes. The purpose of this study was to evaluate healing rates and clinical outcomes of full-thickness rotator cuff repairs augmented with a bioinductive bovine collagen implant.

Methods: In this prospective multicenter study, investigators enrolled 115 patients (mean age, 60.

Arthroscopically Assisted Acute Acromioclavicular Joint Reconstruction Using the Infinity-Lock Button System.

Acromioclavicular (AC) joint injuries are the most common shoulder injuries in the athletic population. The literature is rife with various surgical techniques and implants as well as opinion on proper timing of surgical options. Patient outcomes are generally similar across fixation method.

Arthroscopically Assisted Acromioclavicular Joint Reconstruction Using the Infinity-Lock Button System With Allograft Augmentation.

Acromioclavicular (AC) joint injuries are extremely common in the athletic population. Although most low-grade injuries can be managed nonoperatively, high-grade injuries often require reconstruction of the AC joint. Various reconstructive options have been described with varying risks and benefits to each.

The Role of Arthroscopy in Painful Shoulder Arthroplasty: Is Revision Always Necessary?

Purpose: To determine whether arthroscopy is an effective means to diagnose and treat postoperative pain in anatomic total shoulder arthroplasty (TSA) and reverse TSA patients.

Methods: A 2-year retrospective chart review of patients with a painful shoulder arthroplasty was performed. Patients included in the study had a painful shoulder after previous shoulder arthroplasty without gross signs of infection, severely elevated laboratory markers, implant loosening, or glenoid arthrosis after hemiarthroplasty.

Bony Ingrowth of Coil-Type Open-Architecture Anchors Compared With Screw-Type PEEK Anchors for the Medial Row in Rotator Cuff Repair: A Randomized Controlled Trial.

Purpose: To evaluate outcomes of screw-type and coil-type open-architecture suture anchors with respect to bony ingrowth, release of biological markers, and patient-reported outcome measures when used in rotator cuff repair (RCR).

Methods: Forty patients undergoing arthroscopic RCR for full-thickness rotator cuff tears were enrolled and prospectively randomized to receive a screw-type (19 patients) or coil-type (21 patients) suture anchor for the medial row during repair. All repairs used a transosseous-equivalent configuration with footprint anchors laterally.

Patient-Reported Outcomes After Use of a Bioabsorbable Collagen Implant to Treat Partial and Full-Thickness Rotator Cuff Tears.

Purpose: To collect outcomes data on patients treated with a bioinductive collagen implant designed to induce rotator cuff healing in partial- and full-thickness cuff tears and to assess the safety and efficacy of the device.

Methods: Fifteen surgeons in 15 centers in the United States enrolled patients between April 2016 and August 2017 and collected standardized outcomes data. Patients 21 years of age and older, able to read and speak English, and with partial- or full-thickness tears of the rotator cuff documented by magnetic resonance imaging were included in the study.

Arthroscopic Repair of Rare Transtendinous Rotator Cuff Tear: Utilizing Established Portals and a Posterior Superior Accessory Portal.

There is a high incidence of rotator cuff injuries in the adult population, and there are well-described techniques for the most common types. Full-thickness transtendon rotator cuff tears are an uncommon injury, and there is limited literature on the appropriate treatment. These rare injuries are important to recognize due to the risk of repair failure using traditional techniques.

Lesser Tuberosity Avulsion Fracture Repair Using Knotless Arthroscopic Fixation.

Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation.

All Knot-less Arthroscopic Superior Capsular Reconstruction.

Irreparable rotator cuff tears are a complicated problem, and current treatment options include nonoperative rehabilitation, debridement with or without a biceps tenotomy, tuberoplasty, partial rotator cuff repair, patch augmentation, biodegradable spacers, tendon transfer, and reverse shoulder arthroplasty. Arthroscopic superior capsular reconstruction is a more recent technique that is gaining popularity for use in irreparable rotator cuff tears. However, this surgery can be technically complicated.

Shoulder Instability: An American Perspective.

The recognition and management of glenohumeral instability has become an increasingly important aspect of orthopaedic care. Substantial controversy exists with regard to the indications for soft-tissue stabilization versus bony augmentation in patients with glenohumeral instability, particularly among surgeons in the United States and Europe. Although bone loss procedures are frequently performed in the United States and abroad, surgical techniques and indications for bone loss procedures are different.

Glenohumeral osteoarthritis: frequency of underlying diagnoses and the role of arm dominance-a retrospective analysis in a community-based musculoskeletal practice.

Patients with shoulder pain are commonly seen in adult primary care, and are typically referred to musculoskeletal specialists when their symptoms are persistent. Rotator cuff disorders (RCD) most commonly underlie non-traumatic shoulder pain in adults, and glenohumeral osteoarthritis (GHOA) has been considered to be relatively uncommon (Nakagawa et al., J Shoulder Elb Surg 8:580-584, 1999).

An All-Arthroscopic, Length-Tensioned Suprapectoral Biceps Tenodesis Technique.

Biceps tenodesis remains a popular choice for treating anterior shoulder pain in the setting of primary biceps tendinitis or biceps pain due to concomitant glenohumeral joint pathology. A variety of surgical approaches and fixation construct options are available for biceps tenodesis. The advantages of an all-arthroscopic biceps tenodesis include anatomic maintenance of the length-tension relation with strength preservation and improved cosmetic results.

Arthroscopic Triple Labral Repair in an Adolescent.

Traumatic glenohumeral dislocations often result in significant injury to the anterior-inferior labrum, most commonly leading to recurrent anterior instability. While in skeletally immature patients, shoulder trauma more commonly results in fracture versus a true dislocation, shoulder instability does occur and can be difficult to manage in the setting of open physes. In any event, the goal of treatment is to reduce the risk of recurrence and allow full participation in activities, including sports.

Surgical Exposures of the Shoulder.

Surgical repair, reduction, fixation, and reconstruction for glenohumeral trauma, instability, and degenerative joint disease often require an open surgical exposure. Open shoulder surgery is challenging because the deltoid and rotator cuff musculature envelop the joint, and in most approaches, exposure is limited by the proximity and importance of the axillary nerve. An understanding of the importance of the deltoid and the rotator cuff for glenohumeral function has led to a progression of innovative, advanced, and less invasive approaches to the shoulder.

Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique.

Surgical management of acromioclavicular (AC) joint separations remains challenging, especially in the revision setting. Most commonly, Rockwood type I and II injuries are managed nonoperatively whereas type IV, V, and VI injuries are managed with surgery. Type III separations are more controversial, with evidence supporting both nonoperative and operative treatment options.

Traumatic subscapularis tendon tear in an adolescent american football player.

Isolated traumatic subscapularis tendon tears are uncommon at any age. In adolescent patients, this type of injury is even more infrequent and usually presents as a bony avulsion of the lesser tuberosity. This report reviews a case of an adolescent American football player sustaining a posterior impact to an abducted, extended arm that resulted in an isolated subscapularis tendon tear.

All-arthroscopic patch augmentation of a massive rotator cuff tear: surgical technique.

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated.