Although arthroscopic repair of posterior medial root tears has good clinical outcomes and a low rate of subsequent surgery, an elevated BMI level is associated with worse clinical outcomes and a higher rate of subsequent surgery.
Background:Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established.Hypothesis:Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease.Study Design:Cohort study; Level of evidence, 3.Methods:Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy.Results:Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up (P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes (P = .009) and patients younger than 50 years (P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up (P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up (P = .049).Conclusion:Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.
Objectives:Posterior meniscus root tears disrupt the tibial plateau attachment, leading to a loss of hoop stresses and significant increases in tibiofemoral contact forces. As a result, there is growing interest in surgical repair of these tears. The purpose of this study is to report rates of recurrent surgery and prevalence of osteoarthritis following posterior meniscus root repairs, and associated patient factors, in a North American population.Methods:Arthroscopic posterior meniscus root repair using a pullout trans-tibial suture method was performed by a single surgeon in the United States. Eligible patients d the Knee Injury and Osteoarthritis Outcome Score (KOOS) and reported any subsequent surgeries at minimum two-year follow-up. Patients were categorized as having clinical OA based on their KOOS score. When available, post-operative radiographs were evaluated for radiographic OA using the Kellgren-Lawrence classification and the OA Research Society International (OARSI) atlas. The association of factors with the incidence of clinical and radiographic OA was evaluated.Results:Follow up was collected on 28 of 32 eligible patients (87.5%) at a mean follow up of 2.46 years (range 2.05-3.76 years). At time of surgery, mean age was 44.6 years and mean BMI was 32.7. At follow-up, two patients had undergone subsequent surgery (7%). 14 patients (50.0%) met KOOS criteria for clinical OA. Among the 11 patients with available follow up radiographs, 4 (36%) met OARSI atlas criteria for knee OA. For medial posterior root tears, patients over the age of 45 with BMI over 35 were significantly more likely to develop clinical (85.7% versus 35.0%, p=0.033) and radiographic OA (80.0% versus 0.0%, p=0.015), and undergo additional surgery (40% versus 0%, p=0.036).Conclusion:Arthroscopic repair of posterior root tears in a North American population has a low rate of subsequent surgery despite developing clinical and radiographic OA. Older and heavier patients have a higher incidence of clinical and radiographic OA. Further study is needed to determine optimal treatment for root tears in these patients.
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