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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_9 | Pages 9 - 9
1 Jun 2021
Greene A Verstraete M Roche C Conditt M Youderian A Parsons M Jones R Flurin P Wright T Zuckerman J
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INTRODUCTION

Determining proper joint tension in reverse total shoulder arthroplasty (rTSA) can be a challenging task for shoulder surgeons. Often, this is a subjective metric learned by feel during fellowship training with no real quantitative measures of what proper tension encompasses. Tension too high can potentially lead to scapular stress fractures and limitation of range of motion (ROM), whereas tension too low may lead to instability. New technologies that detect joint load intraoperatively create the opportunity to observe rTSA joint reaction forces in a clinical setting for the first time. The purpose of this study was to observe the differences in rTSA loads in cases that utilized two different humeral liner sizes.

METHODS

Ten different surgeons performed a total of 37 rTSA cases with the same implant system. During the procedure, each surgeon reconstructed the rTSA implants to his or her own preferred tension. A wireless load sensing humeral liner trial (VERASENSE for Equinoxe, OrthoSensor, Dania Beach, FL) was used in lieu of a traditional plastic humeral liner trial to provide real-time load data to the operating surgeon during the procedure. Two humeral liner trial sizes were offered in 38mm and 42mm curvatures and were selected each case based on surgeon preference. To ensure consistent measurements between surgeons, a standardized ROM assessment consisting of four dynamic maneuvers (maximum internal to external rotation at 0°, 45°, and 90° of abduction, and a maximum flexion/extension maneuver) and three static maneuvers (arm overhead, across the body, and behind the back) was completed in each case. Deidentified load data in lbf was collected and sorted based on which size liner was selected. Differences in means for minimum and maximum load values for the four dynamic maneuvers and differences in means for the three static maneuvers were calculated using 2-tailed unpaired t-tests.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_1 | Pages 77 - 77
1 Feb 2020
Roche C Friedman R Simovitch R Flurin P Wright T Zuckerman J Routman H
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Introduction

Acromial and scapular fractures are a rare but difficult complication with reverse total shoulder arthroplasty (rTSA), with an incidence rate reported from 1–10%. The risk factors associated with these fractures types is largely unknown. The goal of this study is to analyze the clinical outcomes, demographic and comorbidity data, and implant sizing and surgical technique information from 4125 patients who received a primary rTSA with one specific prosthesis (Equinoxe, Exactech, Inc) and were sorted based on the radiographic documentation of an acromial and/or scapula fracture (ASF) to identify factors associated with this complication.

Methods

4125 patients (2652F/1441M/32 unspecified; mean age: 72.5yrs) were treated with primary rTSA by 23 orthopaedic surgeons. Revision and fracture reverse arthroplasty cases were excluded. The radiographic presence of each fracture was documented and classified using the Levy classification method. 61 patients were identified as having ASF, 10 patients had fractures of the Type 1, 32 patients had Type 2, and 18 patients had Type 3 fractures according to Levy's classification. One fracture was not classifiable. Pre-op and post-op outcome scoring, ROM as well as demographic, comorbidity, implant, and surgical technique information were evaluated for these 61 patients and compared to the larger cohort of patients to identify any associations. A two-tailed, unpaired t-test identified differences (p<0.05).


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_1 | Pages 76 - 76
1 Feb 2020
Roche C Simovitch R Flurin P Wright T Zuckerman J Routman H
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Introduction

Machine learning is a relatively novel method to orthopaedics which can be used to evaluate complex associations and patterns in outcomes and healthcare data. The purpose of this study is to utilize 3 different supervised machine learning algorithms to evaluate outcomes from a multi-center international database of a single shoulder prosthesis to evaluate the accuracy of each model to predict post-operative outcomes of both aTSA and rTSA.

Methods

Data from a multi-center international database consisting of 6485 patients who received primary total shoulder arthroplasty using a single shoulder prosthesis (Equinoxe, Exactech, Inc) were analyzed from 19,796 patient visits in this study. Specifically, demographic, comorbidity, implant type and implant size, surgical technique, pre-operative PROMs and ROM measures, post-operative PROMs and ROM measures, pre-operative and post-operative radiographic data, and also adverse event and complication data were obtained for 2367 primary aTSA patients from 8042 visits at an average follow-up of 22 months and 4118 primary rTSA from 11,754 visits at an average follow-up of 16 months were analyzed to create a predictive model using 3 different supervised machine learning techniques: 1) linear regression, 2) random forest, and 3) XGBoost. Each of these 3 different machine learning techniques evaluated the pre-operative parameters and created a predictive model which targeted the post-operative composite score, which was a 100 point score consisting of 50% post-operative composite outcome score (calculated from 33.3% ASES + 33.3% UCLA + 33.3% Constant) and 50% post-operative composite ROM score (calculated from S curves weighted by 70% active forward flexion + 15% internal rotation score + 15% active external rotation). 3 additional predictive models were created to control for the time required for patient improvement after surgery, to do this, each primary aTSA and primary rTSA cohort was subdivided to only include patient data follow-up visits >20 months after surgery, this yielded 1317 primary aTSA patients from 2962 visits at an average follow-up of 50 months and 1593 primary rTSA from 3144 visits at an average follow-up of 42 months. Each of these 6 predictive models were trained using a random selection of 80% of each cohort, then each model predicted the outcomes of the remaining 20% of the data based upon the demographic, comorbidity, implant type and implant size, surgical technique, pre-operative PROMs and ROM measures inputs of each 20% cohort. The error of all 6 predictive models was calculated from the root mean square error (RMSE) between the actual and predicted post-op composite score. The accuracy of each model was determined by subtracting the percent difference of each RMSE value from the average composite score associated with each cohort.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_1 | Pages 136 - 136
1 Feb 2020
Greene A Parsons I Jones R Youderian A Byram I Papandrea R Cheung E Wright T Zuckerman J Flurin P
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INTRODUCTION

3D preoperative planning software for anatomic and reverse total shoulder arthroplasty (ATSA and RTSA) provides additional insight for surgeons regarding implant selection and placement. Interestingly, the advent of such software has brought previously unconsidered questions to light on the optimal way to plan a case. In this study, a survey of shoulder specialists from the American Shoulder and Elbow Society (ASES) was conducted to examine thought patterns in current glenoid implant selection and placement.

METHODS

172 ASES members completed an 18-question survey on their thought process for how they select and place a glenoid implant for both ATSA and RTSA procedures. Data was collected using a custom online Survey Monkey survey. Surgeon answers were split into three cohorts based on their responses to usage of 3D preoperative planning software: high users, seldom users, and non-users. Data was analyzed for each cohort to examine differences in thought patterns, implant selection, and implant placement.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_1 | Pages 131 - 131
1 Feb 2020
Greene A Parsons I Jones R Youderian A Byram I Papandrea R Cheung E Wright T Zuckerman J Flurin P
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INTRODUCTION

The advent of CT based 3D preoperative planning software for reverse total shoulder arthroplasty (RTSA) provides surgeons with more data than ever before to prepare for a case. Interestingly, as the usage of such software has increased, further questions have appeared over the optimal way to plan and place a glenoid implant for RTSA. In this study, a survey of shoulder specialists from the American Shoulder and Elbow Society (ASES) was conducted to examine thought patterns in current RTSA implant selection and placement.

METHODS

172 ASES members completed an 18-question survey on their thought process for how they select and place a RTSA glenoid implant. Data was collected using a custom online Survey Monkey survey. Surgeon answers were split into two cohorts based on number of arthroplasties performed per year: between 0–75 was considered low volume (LV), and between 75–200+ was considered high volume (HV). Data was analyzed for each cohort to examine differences in thought patterns, implant selection, and implant placement.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_1 | Pages 134 - 134
1 Feb 2020
Greene A Parsons I Jones R Youderian A Byram I Papandrea R Cheung E Wright T Zuckerman J Flurin P
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INTRODUCTION

3D preoperative planning software for anatomic total shoulder arthroplasty (ATSA) provides surgeons with increased ability to visualize complex joint relationships and deformities. Interestingly, the advent of such software has seemed to create less of a consensus on the optimal way to plan an ATSA rather than more. In this study, a survey of shoulder specialists from the American Shoulder and Elbow Society (ASES) was conducted to examine thought patterns in current ATSA implant selection and placement.

METHODS

172 ASES members completed an 18-question survey on their thought process for how they select and place an ATSA glenoid implant. Data was collected using a custom online Survey Monkey survey. Surgeon answers were split into two cohorts based on number of arthroplasties performed per year: between 0–75 was considered low volume (LV), and between 75–200+ was considered high volume (HV). Data was analyzed for each cohort to examine differences in thought patterns, implant selection, and implant placement.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_5 | Pages 122 - 122
1 Mar 2017
Roche C Greene A Wright T Flurin P Zuckerman J Grey S
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Introduction

The clinical impact of radiolucent glenoid lines is controversial, where the presence of a radiolucent glenoid lines has been suggested to be an indicator of clinical glenoid loosening. The goal of this database analysis is to quantify and compare the pre- and post-operative outcomes of 427 patients who received a primary aTSA with one specific prosthesis and were sorted based upon the radiographic presence of a radiolucent glenoid line at latest clinical followup.

Methods

427 patients (mean age: 67.0yrs) with an average follow-up of 49.4 months was treated with aTSA for OA by 14 fellowship trained orthopaedic surgeons. Of these 427 patients, 293 had a cemented keel glenoids (avg follow-up = 50.8 months) and 134 had a cemented pegged glenoids (avg follow-up = 48.7 months). Cemented peg and keel glenoid patients were analyzed separately and also combined into 1 cohort: 288 patients (158 female, avg: 68.7 yrs; 130 male, avg: 64.9 yrs) did not have a radiolucent glenoid line (avg follow-up = 46.9 months); whereas, 139 patients (83 female, avg: 68.5 yrs; 56 male, avg: 64.6 yrs) had a radiolucent glenoid line (avg follow-up = 54.4 months). Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; active ROM also measured. A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_5 | Pages 123 - 123
1 Mar 2017
Roche C Greene A Flurin P Wright T Zuckerman J Jones R
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Introduction

Humeral radiolucent lines after anatomic TSA (aTSA) have been well described; however, little clinical consequences have been attributed to them. The recent emergence of shorter humeral stems has demonstrated higher incidences of humeral radiolucencies than has been reported historically with standard length components. This large scale database analysis quantifies and compares the clinical outcomes of aTSAs with and without radiolucent humeral lines using one specific prosthesis to determine their impact on clinical outcomes.

Methodology

This is a multicenter, retrospective, case controlled radiographic and clinical review. Preoperative and postoperative data was analyzed from 671 aTSA patients with a minimum of 2 years followup. 538 of these 671 aTSA patients had full radiographic followup (80.2%) and were included in this study; these patients had an average followup of 45.3 months). 459 patients had noncemented humeral stems; whereas, 79 patients had cemented humeral stems. Radiographs were reviewed at latest follow up for humeral radiolucent lines based on the technique described by Gruen et al. Patients were evaluated and scored pre-operatively and at latest follow-up using the SST, UCLA, ASES, Constant, and SPADI scoring metrics; ROM was also recorded. A Student's two-tailed, unpaired t-test was used to identify differences in pre-operative, post-operative, and improvement in results, where p<0.05 denoted a significant difference.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 143 - 143
1 Feb 2017
Greene A Hamilton M Polakovic S Andrews R Jones R Parsons I Saadi P Cheung E Flurin P Wright T
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INTRODUCTION

As computer navigated surgery continues to progress to the forefront of orthopedic care, the application of a navigated total shoulder arthroplasty has yet to appear. However, the accuracy of these systems is debated, as well as the dilemma of placing an accurate tool in an inaccurate hand. Often times a system's accuracy is claimed or validated based on postoperative imaging, but the true positioning is difficult to verify. In this study, a navigation system was used to preoperatively plan, guide, and implant surrogate shoulder glenoid implants and fiducials in nine cadaveric shoulders. A novel method to validate the position of these implants and accuracy of the system was performed using pre and post operative high resolution CT scans, in conjunction with barium sulfate impregnated PEEK surrogate implants.

METHODS

Nine cadaveric shoulders were CT scanned with .5mm slice thickness, and the digital models were incorporated into a preoperative planning software. Five orthopedic shoulder specialists used this software to virtually place aTSA and rTSA glenoid components in two cadavers each (one cadaver was omitted due to incomplete implantation), positioning the components as they best deemed fit. Using a navigation system, each surgeon registered the native cadaveric bone to each respective CT. Each surgeon then used the navigation system to guide him or her through the total shoulder replacement, and implant the barium sulfate impregnated PEEK surrogate implants. Four cylindrical PEEK fiducials were also implanted in each scapula to help triangulate the position of the surrogate implants. Previous efforts were attempted with stainless steel alloy fiducials, but position and image accuracy were limited by CT artifact. BaSO4 PEEK provided the highest resolution on a postoperative CT with as little artifact as possible. All PEEK fiducials and surrogate implants were registered by probing points and planes with the navigation system to capture the digital position. A high resolution post operative CT scan of each specimen was obtained, and variance between the executed surgical plan and PEEK fiducials was calculated.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 5 - 5
1 May 2016
Roche C Stroud N Palomino P Flurin P Wright T Zuckerman J DiPaola M
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Introduction

Achieving prosthesis fixation in patients with glenoid defects can be challenging, particularly when the bony defects are large. To that end, this study quantifies the impact of 2 different sizes of large anterior glenoid defects on reverse shoulder glenoid fixation in a composite scapula model using the recently approved ASTM F 2028–14 reverse shoulder glenoid loosening test method.

Methods

This rTSA glenoid loosening test was conducted according to ASTM F 2028–14; we quantified glenoid fixation of a 38mm reverse shoulder (Equinoxe, Exactech, Inc) in composite/dual density scapulae (Pacific Research, Inc) before and after cyclic testing of 750N for 10k cycles. Anterior defects of 8.5mm (31% of glenoid width and 21% of glenoid height; n=7) and 12.5mm (46% of glenoid width and 30% of glenoid height; n=7) were milled into the composite scapula along the S/I glenoid axis with the aid of a custom jig. The baseplate fixation in scapula with anterior glenoid defects was compared to that of scapula without an anterior glenoid defect (n = 7). For the non-defect scapula, initial fixation of the glenoid baseplates were achieved using 4, 4.5×30mm diameter poly-axial locking compression screws. To simulate a worst case condition in each anterior defect scapulae, no 4.5×30mm compression screw were used anteriorly, instead fixation was achieved with only 3 screws (one superior, one inferior, and one posterior). A one-tailed unpaired student's t-test (p < 0.05) compared prosthesis displacements relative to each scapula (anterior defect vs no-anterior defect).


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 7 - 7
1 May 2016
Greene A Sajadi K Wright T Flurin P Zuckerman J Stroud N
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Introduction

Reverse Total Shoulder Arthroplasty (rTSA) is currently advised against in patient populations with movement disorders, due to potential premature failure of the implants from the use of walking assistive devices. The objective of this study is to measure the amount of displacement induced by the simulated loading of axillary crutches on a rTSA assembly in a laboratory mimicking immediate postoperative conditions.

Methods

8 reverse shoulder baseplate/glenosphere assemblies (Equinoxe, Exactech, Inc) were fixated to 15 lb/ft3 density rigid polyurethane bone substitute blocks. Displacement of the assemblies in the A/P and S/I axes was measured using digital displacement indicators by applying a physiologically relevant 357N shear load parallel to the face of the glenosphere, and a nominal 50N compressive axial load perpendicular to the glenosphere. Westerhoff et al. reported in vivo shoulder loads while ambulating with axillary crutches had a maximum resultant force of 170% times the patient's bodyweight with the arm at 45.25° of abduction1. This was recreated by applying a 1435.4N compressive load (Average bodyweight of 86.1kg*170%) to a humeral liner and reverse shoulder assembly in an Instron testing apparatus at 45.25° of abduction as shown in Figure 1. The glenosphere was rotated about the humeral component through the arc of the axillary crutch swing, from −5° of extension to 30° of flexion as shown in Figure 2 for 183,876 cycles2. The number of cycles was based on number of steps taken in a day from pedometer data reported by Tudor Locke et al. for patients with movement disorders, extrapolated out to a 6 week postoperative recovery period3. A Student's one-tailed, paired t-test was used to identify whether or not significant displacement occurred, where p<0.05 denoted a significant difference.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 6 - 6
1 May 2016
Greene A Twiss T Wright T Flurin P Zuckerman J Stroud N
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Introduction

The General Social Survey estimates that 19 million Americans shoot firearms, with 10% of this population being over the age of 65. More reverse total shoulder arthroplasty (rTSA) are seeking to return to physical activity after surgery, but the effects of shooting a firearm on the fixation of a rTSA implant are unknown. This study will seek to examine the recoil effect of a firearm on a rTSA baseplate fixation, by recording the forces absorbed by a shooter and applying these forces to a rTSA implant assembly in laboratory conditions.

Methods

A total of 5 shooters over a range of heights and bodyweights fired a single action 12 gauge shotgun with 3 ounce slugs 5 times each. An accelerometer was rigidly fixated to the barrel of the firearm to record impulse values upon firing. 8 reverse shoulder baseplate/glenosphere assemblies (Equinoxe, Exactech, Inc) were fixated to 15 lb/ft3 density rigid polyurethane bone substitute blocks for drop tower testing. Displacement was measured before and after testing using digital displacement indicators by applying a physiologically relevant 357N shear load parallel to the face of the glenosphere, and a nominal 50N compressive axial load perpendicular to the glenosphere as shown in Figure 1. Measurements were taken for the S/I axis, and the sample was rotated 90 degrees for the A/P axis. The glenosphere/baseplate assemblies were loaded in a drop tower apparatus at 0° of abduction and 90° flexion to replicate the orientation of the joint seen while shooting. The drop tower utilized a 1.079kg weight set at 8” with a rubber impulse specific materil between the weight and impactor to reproduce the highest average impulse seen in shooting. A total of 50 drops were performed, to simulate two rounds of trap shooting at 25 shots each. A Student's one-tailed, paired t-test was used to identify whether or not significant loosening occurred, where p<0.05 denoted a significant difference.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 4 - 4
1 May 2016
Roche C Flurin P Grey S Wright T Zuckerman J
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Introduction

Posterior glenoid wear is common with glenohumeral osteoarthritis. To correct posterior wear, surgeons may eccentrically ream the anterior glenoid to restore version. However, eccentric reaming undermines prosthesis support by removing unworn anterior glenoid bone, compromises cement fixation by increasing the likelihood of peg perforation, and medializes the joint line which has implications on joint stability. To conserve bone and preserve the joint line when correcting glenoid version, manufacturers have developed posterior augment glenoids for aTSA and rTSA applications. This clinical study quantifies outcomes achieved using posteriorly augmented aTSA/rTSA glenoid implants in patients with severe posterior glenoid wear at 2 years minimum follow-up.

Methods

47 patients (mean age: 68.7yrs) with 2 years minimum follow-up were treated by 5 fellowship trained orthopaedic surgeons using either 8° posteriorly augmented aTSA/rTSA glenoid components in patients with severe posterior glenoid wear. 24 aTSA patients received posteriorly augmented glenoids (65.8 yrs; 7F/17M) for OA and 23 rTSA patients received posteriorly augmented glenoids (71.8 yrs; 9F/14M) for treatment of CTA and OA. Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, forward flexion, and external rotation were also measured to quantify function. Average follow-up was 27.5 months (aTSA 29.4; rTSA 25.5). A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 7 - 7
1 May 2016
Roche C Simovitch R Flurin P Wright T Johnson D Najmabadi Y Zuckerman J
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Introduction

A better understanding of the rate of improvement associated with aTSA and rTSA is critical to establish accurate patient expectations for treatment to reduce pain and restore function; more realistic patient expectations pre-operatively may lead to greater patient satisfaction post-operatively. To this end, this study quantifies the rate of improvement in outcomes of aTSA and rTSA using 5 different scoring metrics for 1641 patients with one platform shoulder arthroplasty system.

Methods

1641 patients (mean age: 69.3yrs) were treated by 14 orthopaedic surgeons using one platform shoulder system (Exactech, Inc). 729 patients received aTSA (65.3yrs; 384F/345M) for treatment of degenerative arthritis and 912 patients received rTSA (72.5yrs; 593F/319M) for treatment of CTA/RCT/OA. Each patient was scored pre-operatively and at various follow-up intervals (3 months, 6months, annually, etc) using the SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, active forward flexion, and active/passive external rotation were also measured. 4439 total follow-up reports were analyzed (1851 and 2588 rTSA). Improvements in outcome using each metric score were calculated and normalized on a 100 point scale. The rate of improvement was analyzed using a 40 point moving filter treadline and with a 3rd order polynomial treadline over the entire range of follow-up.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 8 - 8
1 May 2016
Roche C Flurin P Crosby L Wright T Zuckerman J
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Introduction

The clinical impact of scapular notching is controversial. Some reports suggest it has no impact while others have demonstrated it does negatively impact clinical outcomes. The goal of this clinical study is to analyze the pre- and post-operative outcomes of 415 patients who received rTSA with one specific prosthesis (Equinoxe; Exactech, Inc).

Methods

415 patients (mean age: 72.2yrs) with 2 years minimum follow-up were treated with rTSA for CTA, RCT, and OA by 8 fellowship trained orthopaedic surgeons. 363 patients were deemed to not have a scapular notch by the implanting surgeon at latest follow-up (72.1 yrs; 221F/131M) whereas 52 patients were deemed to have a scapular notch at latest follow-up (73.3 yrs; 33F/19M). Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, forward flexion, and internal/external rotation were also measured to quantify function. Average follow-up was 38.1 months (No Notch: 37.2; Notch: 44.4). A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 9 - 9
1 May 2016
Roche C Flurin P Grey S Wright T Zuckerman J Jones R
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Introduction

Due to the predictability of outcomes achieved with reverse shoulder arthroplasty (rTSA), rTSA is increasingly being used in patients where glenoid fixation is compromised due to presence of glenoid wear. There are various methods to achieve glenoid fixation in patients with glenoid wear, including the use of bone grafting behind the glenoid baseplate or the use of augmented glenoid baseplates. This clinical study quantifies clinical outcomes achieved using both techniques in patients with severe glenoid wear at 2 years minimum follow-up.

Methods

80 patients (mean age: 71.6yrs) with 2 years minimum follow-up were treated by 7 fellowship trained orthopaedic surgeons using rTSA with bone graft behind the baseplate or rTSA with an augmented glenoid baseplate in patients with severe posterior glenoid wear. 39 rTSA patients (14 female, avg: 73.1 yrs; 25 male, avg: 71.5 yrs) received an augmented glenoid (cohort composed of 24 patients with an 8° posterior augment baseplate and 15 patients with a 10° superior augment baseplate) for treatment of CTA, RCT, and OA with a medially eroded scapula. 41 rTSA patients (27 female, avg: 73.0 yrs; 14 male, avg: 66.9 yrs) received glenoid bone graft (cohort composed of 5 patients with allograft and 36 patients with autograft) for treatment of CTA, RCT, and OA with a medially eroded scapula. Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, forward flexion, and internal/external rotation were also measured to quantify function. Average follow-up was 31.2 months (augment 28.3; graft 34.1). A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 353 - 353
1 Jul 2014
Hamilton M Diep P Roche C Flurin P Wright T Zuckerman J Routman H
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Summary Statement

Reverse shoulder design philosophy can impact external rotation moment arms. Lateralizing the humerus can increase the external rotator moment arms relative to normal anatomy.

Introduction

The design of reverse shoulders continues to evolve. These devices are unique in that they are not meant to reproduce the healthy anatomy. The reversal of the fulcurm in these devices impacts every muscle that surrounds the joint. This study is focused on analyzing the moment arms for the rotator cuff muscles involved in internal and external rotation for a number of reverse shoulder design philosophies.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 257 - 257
1 Jul 2008
LANDREAU P FLURIN P BOILEAU P BRASSART N CHAROUSSET C COURAGE O DAGHER E GRAVELEAU N GRÉGORY T GUILLO S KEMPF J LAFOSSE L TOUSSAINT B
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Purpose of the study: Completely arthroscopic repair of rotator cuff tears is widely considered as the standard treatment. We reviewed a multicentric retrospective series of patients.

Material and methods: This series of arthroscopic repairs of full-thickness tears of the supraspinatus and infraspinatus were assess with the Constant score together with arthroMRI or arthroscan at one year follow-up at least. Data were analyzed with SPSS10. The series included 576 patients who underwent surgery from January 2001 to June 2003. Mean age was 57.7 years, 52% males and 60% manual laborers. Mean preoperative Constant score was 46.4/100 (r13.4). The tear was limited to the supraspinatus in 69% of patients with extension to the upper third of the infraspinagus for 23.5% and to all tendons for 7.5%. The supraspinatus tear was distal in 41.7% of patients, intermediary for 44%, and retracted for 14.3%. Arthroscopic repair was performed in all cases, with locoregional anesthesia for 60.9%. Implants were resorbable for 33% and metallic for 62.1%. Acromioplasty was performed for 92.7% and capsulotomy for 14.9%.

Results: The mean subjective outcome was scored 8.89/10. The Constant score improved from 46.3±13.4 to 82.7±10.3 with 62% of patients being strictly pain free. The force score improved from 8.5±3.7 to 13.6±5.4. Outcome was excellent or very good for 94% of the shoulders at 18.5 mean follow-up. The rate of complications was 6.2% with 3.1% of patients presenting prolonged joint stiffness, 2.7% reflex dystrophy, 0.2% infection and 0.2% implant migration. The cuff was considered normal in 55.7% of the shoulders with an intratendon addition image for 19%, i.e. 74.7% non-torn cuffs. A point leakage was noted in 9.5% with pronounced leakage in 15.7%, i.e. 25.2% recurrent tears.

Discussion and conclusion: The functional outcome obtained after arthroscopic repair of rotator cuff tears is good. Arthroscopy has the advantage of a low rate of complications yet provides good clinical and anatomic results. Age is correlated with functional outcome and healing, but should not be considered as a contraindication.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 257 - 257
1 Jul 2008
FLURIN P LANDREAU P BOILEAU P BRASSART N CHAROUSSET C COURAGE O DAGHER E GRAVELEAU N GRÉGORY T GUILLO S KEMPF J LAFOSSE L TOUSSAINT B
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Purpose of the study: A statistical analysis of correlations between clinical outcome and anatomic results after arthroscopic repair of rotator cuff tears.

Material and methods: This multicentric series of rotator cuff tears was limited to the supraspinatus and infraspinatus. The statistical analysis searched for correlations between the clinical outcome (Constant score) and anatomic results (arthroscan and arthroMRI). The series included 576 patients, mean age 57.7 years, 52%μ males and 60% manual laborers. The tear was limited to the suprapsinatus in 69% of patients, with extension to the upper third of the infraspinatus in 23.5% and all tendons in 7.5%. The supraspinatus tear was distal in 41.7% of patients, intermediary in 44% and retracted in 14.3%. Fatty degeneration of the supraspinatus was noted grade 0 in 59.7%, 1 in 27.1%, 2 in 10.8% and 3 in 2.4%.

Results: The Constant score (46.3 preoperatively and 82.7 postoperatively) was strongly correlated with successful repair. The correlation was found for force, motion, and activity, but not for pain. The clinical outcome was correlated with extension, retraction, cleavage, and degeneration of the preoperative injury. The anatomic result was statistically less favorable for older, more extended, retracted, and cleaved tears or tears associated with fatty degeneration. Age was correlated with the extent of the initial tear and also with less favorable clinical and anatomic results. Work accidents were correlated with less favorable clinical outcome.

Discussion: The large number of anatomic controls with contrast injection facilitated demonstration of several statistically significant correlations. This enabled disclosure in a single series of evidence confirming earlier reports in the literature: repair of cuff tears improves the overall functional outcome for massive tears; the anatomic result depends on the size of the initial tear; pre-operative fatty degeneration is an important prognostic criteria; cuff healing is age-dependent.

Conclusion: Study of anatamoclinical correlations helps guide therapeutic decision making and enables the establishment of reliable prognostic criteria after arthroscopic repair of rotator cuff tears.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_I | Pages - 23
1 Mar 2002
Gleyze P Thomazeau H Flurin P Lafosse L Gazielly D Allard M
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Purpose of the study: The aim of this study was to evaluate the anatomical and technical limits of endoscopic rotator cuff repair. Anatomical results were also compared with functional assessment of the shoulder.

Material and methods: A multicentric serie of 87 patients presenting a full thickness rotator cuff tear repaired endoscopically was retrospectively reviewed at 25.4 months (mean) post surgery. Limits of the surgical technique were studied in correlation with functional results and anatomic radiographic evaluation (arthroscans in 93 p. 100).

Results: Anatomical repair (normal thickness and no contrast in the subacromial space on arthroscan) was achieved in 83 p. 100 of the rotator cuffs with limited damage to the frontal part of the supra spinatus tendon. This percentage fell to 57.8 p. 100 in case of posterior extension of the tear to the supra spinatus tendon and further dropped to 40.8 p. 100 in case of retraction to the apex of the humeral head. Functional outcome evaluated with the Constant score was strongly related to the radiographic cuff condition (p < 0.05). For distal and anterior tears of the supra spinatus tendon, the Constant score at revision was 89.8 points in cases with anatomic repair at revision. This score fell to 75 when the rotator cuff tear was evidenced radiographically (p < 0.0001). For tears involving the entire supra spinatus tendon repaired by arthroscopy, the functional difference at revision was 8 points on the Constant scale. Objective and subjective analysis of the surgical procedure identified significant peroperative elements predictive of clinical and anatomical outcome (difficult reduction, p < 0.05; subjective degree of solidity, p < 0.0001; anatomical aspect of the repaired cuff, p < 0.05).

Discussion: A comparison of our findings with data on equivalent lesions reported in the literature suggests that endoscopic surgery for rotator cuff tears offers both functional and anatomic results equivalent to those achieved with conventional open surgery. This assumes that the surgical procedure is carried out by surgeons experienced in shoulder arthroscopy who can precisely gauge the posterior/anterior extension of the tears and the limits of the surgical technique.