No abstract

Level II, prognostic study.

Introduction: As the indications for reverse shoulder arthroplasty (RSA) expand beyond traditional cuff tear arthropathy, the role of RSA in elderly patients with glenohumeral arthritis and an intact rotator cuff remains unclear. Methods: This retrospective cohort study included 135 patients who underwent RSA or total shoulder arthroplasty (TSA) at a single tertiary orthopedic center between 2005 and 2015 and were 70 years of age or older at the time of surgery. All patients had preoperative advanced imaging confirming an intact rotator cuff but active forward elevation less than 90°. Complications, reoperations, and patient survival were recorded from the medical record. Patient-reported outcomes (Pain visual analog scale, Satisfaction Score, American Shoulder and Elbow Surgeons [ASES], and Western Ontario Osteoarthritis of the Shoulder [WOOS]) and patient-reported range of motion were collected at a minimum of 2 years after procedure. Results: There was no significant difference in complication rate or revision surgery rate between patients undergoing TSA and RSA (complications 13.7% versus 12.1%, P = 0.810; reoperations 6.9% vs 3.0%, P = 0.418). There were no differences in patient-reported outcome measures between the two groups. Mean pain visual analog scale scores were low in both groups (0.72, SD 1.93 for TSA and 0.31, SD 0.72 for RSA). Satisfaction scores were high (86.1, SD 23.3 for TSA and 91.8, SD 9.0 for RSA, P = 0.286). Mean ASES and WOOS scores were also high in both groups (86 [SD 15.6] for TSA and 83 [SD 12.6] for RSA for ASES [P = 0.400] and 86 [SD 18.3] for TSA and 89 [SD 10.2] for RSA for WOOS [P = 0.400]). One hundred percent of subjects following RSA and 98% of subjects following TSA rated their forward elevation as full or nearly full (>135°) (P = 0.516). Discussion: Given the good clinical outcomes after both TSA and RSA, there may be an increased role for RSA in this elderly cohort to provide effective treatment of glenohumeral osteoarthritis. Level of Evidence: Level III, retrospective comparative study

"Factors affecting outcome after structural failure of repaired rotator cuff tears

Background Post-traumatic joint contracture (PTJC) in the elbow is a challenging clinical problem due to the anatomical and biomechanical complexity of the elbow joint. Methods Previously, we established an animal model to study elbow PTJC, wherein surgically induced soft tissue damage followed by six-weeks of unilateral immobilization in Long-Evans rats led to stiffened and contracted joints that exhibited features similar to the human condition. In this study following the six-weeks of immobilization, we remobilized the animal (i.e. external bandage removed and free cage activity) for an additional six-weeks; after which the limbs were evaluated mechanically and histologically. Hypothesis The objective of this study was to evaluate whether this decreased joint motion would persist following six-weeks of free mobilization. Results After free mobilization (FM), flexion-extension demonstrated decreased total range of motion (ROM) and neutral zone length, and increased ROM midpoint for injured limbs compared to control and contralateral limbs. Specifically, following FM total ROM demonstrated a significant decrease of approximately 22% and 26% compared to control and contralateral limbs for Injury I (anterior capsulotomy) and Injury II (anterior capsulotomy with lateral collateral ligament transection), respectively. Histological evaluation showed increased adhesion, fibrosis and thickness of the capsule tissue in the injured limbs after FM compared to control and contralateral limbs, which is consistent with patterns previously reported in human tissue. Conclusion Therefore, even with free mobilization, injured limbs in this model demonstrate persistent joint motion loss and histological results similar to the human condition. Future work will use this animal model to investigate the mechanisms responsible for PTJC and responses to therapeutic intervention.

No abstract

Knee dislocations are relatively uncommon but potentially catastrophic injuries. In athletes, these injuries generally result from high-energy traumatic mechanisms such as collisions in football and rugby, high-velocity falls in skiing, and falls from heights in gymnastics and extreme sports. Knee dislocations are frequently associated with coincident neurological or vascular injuries. Recognition of vascular injury is particularly challenging because vascular compromise may not be immediately associated with clinical signs of ischemia and may result from injuries without complete or evident dislocation. This article reviews the rationale behind selective angiography, adjunctive vascular testing, and the need for observation after multiligament knee trauma. An algorithm for the diagnosis of vascular injuries is presented.

Diagnostic II.