IntroductionManagement of the subscapularis during shoulder arthroplasty is controversial. The purpose of this study was to compare the biomechanical performance of subscapularis peel (SP) and lesser tuberosity osteotomy (LTO) in a cadaveric model.MethodsThe subscapularis and proximal humerus were dissected from all soft tissues in 21 fresh-frozen human cadaveric shoulders and randomized to undergo SP, LTO, or standard subscapularis tenotomy (ST, control). For SP and LTO, six #5 sutures were passed through eyelets in the implant (on lateral border and through drill holes in bicipital groove [2] and under trunion [4]). Double-row repair was performed using two lateral row transosseous sutures and four medial row sutures through the tendon (SP) or osseotendinous junction (LTO). Biomechanical properties and mode of failure were tested.ResultsThere were no significant differences in elongation amplitude, cyclic elongation, or maximum load to failure between the three groups (P > 0.05). Mean stiffness was significantly higher in LTO (P = 0.009 vs. SP and ST). In the ST group, 7/7 specimens failed at the tendon-suture interface. For SP, 4/7 failed at the tendon-suture interface, one at the suture-bone interface, one fractured around the implant stem, and one at the knots. For LTO, 3/7 failed at the tendon-suture interface, two at the suture-bone interface and two fractured around the implant stem.ConclusionsIn this cadaveric model, subscapularis repair via ST, SP, and LTO techniques was biomechanically equivalent. Additional studies are needed to confirm these findings and determine the influence of biologic healing on healing rates and clinical outcomes.Level of evidenceN/a, biomechanical laboratory study
The purpose of this study was to evaluate the short-term clinical and radiographic outcomes of humeral hemiarthroplasty and concentric glenoid reaming (“ream and run” procedure) and to compare the outcomes with those of total shoulder arthroplasty (TSA) for glenohumeral arthritis. Patients with glenohumeral arthritis who underwent the ream and run procedure with a minimum follow-up of 2 years were retrospectively reviewed. The primary outcome was revision to TSA. Secondary outcome measures included functional outcome scores, range of motion, and radiographic assessment. The outcome measures were compared with those of age- and sex-matched control patients who underwent anatomic TSA during the study period. One patient in the ream and run group required revision to TSA 14 months after the surgery because of excessive shoulder pain. There were significant improvements in the postoperative outcome scores and range of motion and external rotation in the ream and run group. Postoperative radiographs showed concentric glenoids without posterior subluxation in all except 1 shoulder. The outcome measures in the ream and run group were similar to those in the TSA control group except for active forward elevation and external rotation. The ream and run procedure provides improved pain relief and shoulder function at short-term follow-up for patients with shoulder arthritis. [
Orthopedics
. 2018; 41(6):e854–e860.]
Avascular necrosis (AVN) of the humeral head is a rare, yet detrimental complication. Left untreated, humeral head AVN frequently progresses to subchondral fracturing and articular collapse. Cases of late-stage humeral head AVN commonly require invasive procedures including humeral head resurfacing, hemiarthroplasty, and total shoulder arthroplasty (TSA) to improve clinical outcomes. However, in cases of early-stage AVN, core decompression of the humeral head is a viable and efficacious short-term treatment option for patients with pre-collapse AVN of the humeral head to improve clinical outcomes and prevent disease progression. Several techniques have been described, however, a percutaneous, arthroscopic-assisted technique may allow for accurate staging and concomitant treatment of intraarticular pathology during surgery, although further long-term clinical studies are necessary to assess its overall outcomes compared with standard techniques. Biologic adjunctive treatments, including synthetic bone grafting, autologous mesenchymal stem cell/bone marrow grafts, and bone allografts are viable options for reducing the progression of AVN to further collapse in the short term, although long-term follow-up with sufficient study power is lacking in current clinical studies. Further long-term outcome studies are required to determine the longevity of core decompression as a conservative measure for early-stage AVN of the humeral head.
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