The purpose of this paper is to evaluate the results of surgical treatment of acute acromioclavicular joint (ACJ) dislocation using coracoclavicular cerclage, coracoacromial ligament transfer to the distal third of the clavicle, and a new option for strengthening the temporary stabilization of the ACJ using a Kirschner wire between the clavicle and scapula. We evaluated 21 patients who underwent surgical treatment for ACJ dislocation. The average follow-up period was 18 months and varied from 13 to 23 months. Postoperative results, graded by the UCLA scoring system, were satisfactory in 20 patients. Using radiographic evaluation, 18 patients did not show loss of reduction. Among 21 patients who underwent surgical treatment, only 2 complications related to a new method of temporary ACJ stabilization were reported, neither of which appeared to influence the final outcome. The authors concluded that the surgical treatment of acute ACJ dislocation provides good functional and radiographic outcomes and that a new method of temporary ACJ stabilization described herein is an easy-toperform and low-cost procedure with a low complication rate.

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Objective To determine the current clinical practice in Latin America for treating midshaft clavicle fractures, including surgical and non-surgical approaches.Methods A cross-sectional study using a descriptive questionnaire. Shoulder and elbow surgeons from the Brazilian Society of Shoulder and Elbow Surgery and from the Latin American Society of Shoulder and Elbow were contacted and asked to complete a short questionnaire (SurveyMonkey®) on the management of midshaft fractures of the clavicle. Incomplete or inconsistent answers were excluded.Results The type of radiographic classification preferably used was related to description of fracture morphology, according to 41% of participants. Allman classification ranked second and was used by 24.1% of participants. As to indications for surgical treatment, only the indications with shortening and imminence of skin exposure were statistically significant. Conservative treatment was chosen in cortical contact. Regarding immobilization method, the simple sling was preferred, and treatment lasted from 4 to 6 weeks. Although the result was not statistically significant, the blocked plate was the preferred option in surgical cases.Conclusion The treatment of midshaft clavicle fractures in Latin America is in accordance with the current literature.

IntroductionRotator cuff injuries account for up to 70% of pain in the shoulder. However, there remains no consensus on the best surgical treatment for patients with rotator cuff injuries, in terms of the cost-effectiveness and cost–utility of open and arthroscopic methods for rotator cuff repair. The objective of this trial is to compare the efficacy, cost-effectiveness and cost–utility of open and arthroscopic procedures for rotator cuff repair.Methods and analysisThe trial is a two-group, parallel-design, randomised controlled trial. A total of 100 patients with symptomatic rotator cuff lesions will be allocated in either open or arthroscopic technique in a 1:1 ratio, considering smoking (yes or no), lesion size (≤3 cm or >3 cm) and diabetes (present or absent) as stratification factors. All patients will be included in the same rehabilitation programme after the intervention. The primary outcome measure will be the Constant-Murley Score and the EuroQol-5D-3L score at 48 weeks postsurgery. Secondary outcomes include cost-effectiveness, cost–utility, pain, complications and clinical analysis, using the Simple Shoulder Test, Visual Analogue Pain Scale (VAS), integrity of the repair evaluated through MRI, and complications and failures of the proposed methods. For the cost-effectiveness analysis, we will use the VAS and the Constant-Murley Score as measures of effectiveness. For the cost–utility analysis, we will use the EuroQol-5D-3L as a measure of utility in terms of incremental cost per quality-adjusted life-years.Ethics and disseminationThe study has been approved by the local research ethics committee of both institutions: Hospital Israelita Albert Einstein and Hospital Alvorada Moema/Hospital Pró-Cardíaco. The results will be published in a peer-reviewed, open access journal.Trial registration numberNCT04146987.

Background: Shoulder pain is one of the most common musculoskeletal conditions in orthopedic practice. Rotator cuff injuries account for up to 70% of pain in the shoulder girdle. However, there is still no consensus on the best surgical treatment of patients with degenerative rotator cuff injuries, considering cost-effectiveness and cost-utility analysis between the open and arthroscopic methods of rotator cuff repair. The objective of this trial is to compare the efficacy, cost-effectiveness and cost-utility of open and arthroscopic procedure for rotator cuff repair. Methods: The trial is a two-group, parallel design, randomized controlled study. A total of 100 patients with symptomatic rotator cuff lesion will be allocated to repair surgery and randomized by either open or arthroscopic technique in a 1:1 ratio, considering smoking (yes or no), lesion size (less than 3 cm or more than 3 cm) and diabetes (present or absent) as stratification factors. All patients will be included in the same rehabilitation program after the intervention. The primary outcome measure will be the Constant-Murley score at 48 weeks post-surgery. Secondary outcomes include cost-effectiveness, cost-utility, pain, complications and clinical analysis, using the EuroQol 5-D3L, the simple shoulder test (SST), Visual Analogue Pain Scale (VAS), integrity of the repair evaluated through magnetic resonance imaging, complications and failures of the proposed methods. Theses outcomes will also be measured continuously for 48 weeks after the intervention. For the cost-effectiveness analyses, we will use the VAS and the Constant-Murley Score as measures of effectiveness; for the cost-utility analyses, we will use the EuroQol- 5D-3L as a measure of utility in terms of incremental cost per quality-adjusted life-years (QALY). Discussion: There are two options of the rotator cuff repair surgery, open and arthroscopic and, both procedure present good clinical results. However, considering that the arthroscopic surgery present supposedly higher costs, is necessary to understand if these costs present a best cost-effectiveness and cost-utility for the patient.Trials registration: ClinicalTrials.gov register: NCT04146987. Registered October 31, 2019

Objective: Adhesive capsulitis is an inflammatory disease of the joint capsule, clinically manifested as pain, stiffness, and dysfunction of the shoulder. We subjectively observed an increased incidence of adhesive capsulitis, and raised the hypothesis that adhesive capsulitis was more frequent in magnetic resonance imaging examinations performed during the COVID-19 pandemic as compared with examinations prior to this period. Methods: Data from medical records and magnetic resonance imaging of the shoulder presenting typical imaging findings of adhesive capsulitis, performed in our organization from March to June 2020, were evaluated and compared with data and imaging from the same period of the previous year. To this end, an organizational business intelligence tool called "search reports" was used, searching for the term "adhesive capsulitis" in the radiological report, results were tabulated, and corresponding magnetic resonance imaging exams were analyzed. Results: Our search found a total of 240 and 1,373 cases of adhesive capsulitis in the 2020 and 2019 periods, respectively. The mean age of patients was 53.9 years in the 2020 group and 49.9 years in 2019 (p<0.001). Magnetic resonance imaging findings were positive for adhesive capsulitis in 40 out of 240 shoulders (16.7%) in the 2020 group versus 127 out of 1,373 shoulders (9.2%) in the 2019 group. This difference was statistically significant (p=0.001). Conclusion: Our study findings suggest a relative increase in the proportion of magnetic resonance imaging findings suggestive of adhesive capsulitis cases during COVID-19 pandemics based on data from our organization.

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