No abstract

No abstract

Background Functionally irreparable rotator cuff tears (FIRCTs) present an ongoing challenge to the orthopedic surgeon. The aim of this systematic review was to critically compare the outcomes of three latissimus dorsi tendon transfer (LDT) techniques and two superior capsular reconstruction (SCR) techniques in treatment of FIRCTs. Methods A systematic review of studies evaluating the outcome of FIRCT treatment was performed via a search of four databases in April 2020. Each included study was reviewed in duplicate by two reviewers for evaluation of methodological quality. The treatments analyzed were arthroscopic LDT (aLDT), open LDT Gerber technique (oLDTG), open LDT L'Episcopo technique (oLDTL), SCR with allograft (SCR-Allo), and SCR with autograft (SCR-TFL). Demographics, range of motion, patient-reported outcome measures, radiographic acromiohumeral distance (AHD), treatment failures, and revisions were recorded. Results Forty-six studies (1287 shoulders) met criteria for inclusion. Twenty-three studies involved open latissimus transfer, with 445 shoulders undergoing oLDTG with mean follow-up of 63.2 months and 60 patients undergoing oLDTL with mean follow-up of 51.8 months. Ten studies (n = 369, F/U 29.2mo) reported on aLDT. Seven studies (n = 253, F/U 16.9mo) concerned SCR-Allo, and six studies (n = 160, F/U 32.mo) reported on SCR-TFL. Range of motion and subjective outcome scores improved in all techniques with no differences across treatments. Both SCR methods provided greater improvement in AHD than open LDT methods (p < 0.01). The re-tear rates were lower in both oLDT groups compared to the SCR groups (p = 0.03). Clinical failure rates were higher in the SCR-Allo and oLDTG groups, while overall treatment failures were lowest in oLDTL compared to all four other groups. Conclusion SCR techniques were associated with improved short-term radiographic acromiohumeral distance, while the open LDT techniques had lower tendon re-tear and treatment failure rates. All techniques resulted in improved clinical outcomes and pain relief compared to preoperative levels with no differences across techniques. Level of evidence IV Systematic review of case series and cohort studies.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Background: Loss to clinic follow-up is common among orthopaedic trauma survivors. The purpose of this study was to develop a prediction tool to identify patients at risk for orthopaedic trauma clinic follow-up non-adherence.Methods: Comprehensive social determinants of health (SDOH) assessment surveys were administered to adult patients (age ≥18) who were hospitalized with orthopaedic trauma injuries at an urban Level 1 trauma center. Clinic follow-up adherence within the 90-day post-operative period was examined using adherence fractions ([number of attended follow-up visits]/[number of attended follow-up visits + number of missed visits]). Adherence fractions ≥0.75 were considered to be “High” and £0.75 considered to be “Low”. Demographic and SDOH factors, including the Distressed Communities Index (DCI), were analyzed for their association with clinic follow-up adherence. A risk prediction tool for follow up non-adherence was developed using a multivariable logistic regression model.Results: 294 patients were included for final analysis. Higher community distress, more severe injury, lack of private insurance, lower education levels, no primary care physician, financial and relationship instability, and lack of transportation were significantly associated with low clinic follow up adherence (p<0.05, Table 2 and 3). Low clinic adherence (£0.75) was also significantly associated with presentation to the emergency department within the 90-day post-operative period (p<0.01). The final risk prediction model included 5 covariates: “Distressed” or “At Risk” DCI levels, lack of private insurance, high school or lower education, no primary care physician, and male gender (n=210, AUROC=0.65, 95% CI = 0.57-0.72). The maximum possible risk score was 8. The mean score for patients with low clinic adherence was 4.0±1.6 and 3.1±1.75 for those with high adherence (p<0.01).Discussion: Coordinated care of patients in the aftermath of trauma is imperative to improve healthcare quality and patient outcomes. This study suggests that post-trauma clinic adherence may be predicted at the time of hospital discharge based on a combination of five demographic and SDOH risk factors. We offer a predictive tool for such behavior, which we visualize as a valuable component in a social work discharge plan. Future studies should assess interventions for patients at high risk for follow up non-adherence.