Controversy exists regarding the optimal technique for arthroscopic rotator cuff repair. No previous comparative trials have reported on the long-term follow-up of single and double row fixation in arthroscopic cuff repair. The purpose of this study was to compare the long-term functional outcomes of single-row and double-row suture techniques for repair of the rotator cuff 10-years post-operatively.

Ninety patients undergoing arthroscopic rotator cuff repair were randomized to receive either single-row or double-row repair. The primary objective was to compare the Western Ontario Rotator Cuff Index (WORC) score 10-years post-operatively. Secondary objectives included comparison of the Constant, and American Shoulder and Elbow Surgeons (ASES) scores and supraspinatus strength between groups. Out of 90 patients originally randomized, 57 returned for the long-term 10-year follow-up.

Baseline demographic data did not differ between groups. The WORC score was not significantly different between groups at long-term follow-up (p=0.13). No statistical differences were observed between groups for the Constant (p=0.51), ASES (p=0.48) scores, or strength scores (p=0.93). A significant improvement was observed between pre-operative and the final 10-year follow-up. There were no differences observed in all outcomes between two and 10-years post-operatively.

No statistically significant differences in functional or quality of life outcomes were identified between single-row and double-row fixation techniques at long-term follow-up.

When compared to magnetic resonance imaging (MRI), ultrasound (US) performed by experienced users is an inexpensive tool that has good sensitivity and specificity for diagnosing rotator cuff (RC) tears. However, many practitioners are now utilizing in-office US with little to no formal training as an adjunct to clinical evaluation in the management of RC pathology. The purpose of our study was to determine if US without formal training is effective in managing patients with a suspected RC tear.

This was a single centre prospective observational study. Five fellowship-trained surgeons each examined 50 participants referred for a suspected RC tear (n= 250). Patients were screened prior to the consultation and were included if ≥ 40 years old, had an MRI of their affected shoulder, had failed conservative treatment of at least 6 months, and had ongoing pain and disability. Patients were excluded if they had glenohumeral instability, evidence of major joint trauma, or osteonecrosis. After routine clinical exam, surgeons recorded their treatment plan (“No Surgery”, “Uncertain”, or “Surgery”). Surgeons then performed an in-office diagnostic US followed by an MRI and documented their treatment plan after each imaging study. Interrater reliability was analyzed using a kappa statistic to compare clinical to ultrasound findings and ultrasound findings to MRI, normal and abnormal categorization of biceps, supraspinatus, and subscapularis.

Following clinical assessment, the treatment plan was recorded as “No Surgery” in 90 (36%), “Uncertain” in 96 (39%) of cases, “Surgery” in 61 (25%) cases, and incomplete in 3 (2%). In-office US allowed resolution of 68 (71%) of uncertain cases with 227 (88%) of patients having a definitive treatment plan. No patients in the “No Surgery” group had a change in treatment plan. After MRI, 16 (6%) patients in the “No Surgery” crossed-over to the “Surgery” group after identification of full-thickness tears, larger than expected tears or alternate pathology (e.g., labral tear).

The combination of clinical examination and in-office US may be an effective method in the initial management of patients with suspected rotator cuff pathology. Using this method, a definitive diagnosis and treatment plan was established in 88% of patients with the remaining 12% requiring an MRI. A small percentage (6%) of patients with larger than expected full-thickness rotator cuff tears and/or alternate glenohumeral pathology (e.g., labral tear) would be missed at initial evaluation.

Musculoskeletal ultrasound (MSK-US) can have many uses for orthopaedic surgeons, such as assisting in clinical diagnosis for muscle, tendon and ligament injuries, providing direct guidance for joint injections, or assessing the adequacy of a reduction in the emergency department. However, proficiency in sonography is not a requirement for Royal College certification, and orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK-US course in an orthopaedic surgery program.

A MSK-US course for orthopaedic surgery residents was developed by an interdisciplinary team involving a paediatric orthopaedic surgeon, an emergency physician with a fellowship in point-of-care ultrasonography, and an orthopaedic surgery resident. Online videos were created to be viewed by residents prior to a half-day long practical course. The online portion covered the basics of ultrasonography, as well as the normal and abnormal appearance of musculoskeletal structures, while the practical portion applied those principles to the examination, injection, and aspiration of joints, and ultrasound-guided fracture reduction. An online survey covering the level of training of the resident and their previous use of ultrasound (total hours) was filled by the participants prior to the course. Resident's knowledge acquisition was measured with a written pre-course, same-day post-course and six-month follow-up tests. Residents were also scored on a practical shoulder examination immediately after the course and at six-month follow-up. An online survey was also sent to evaluate residents' satisfaction with different aspects of the course (NAS). Change in test scores were calculated using an ANOVA and a Wilcoxon signed-rank test.

Ten orthopaedic surgery residents underwent the MSK-US curriculum. Pre-course interest to MSK-US was moderate (65%) and prior exposure was low (1.5 hours mean total experience). MSK-US has been previously mostly observed in the emergency department and sports orthopaedic clinic. Satisfaction with the online curriculum, hands-on practice session and general quality of the course were high (8.78, 8.70 and 8.60/10 respectively). Written test scores improved significantly from 50.7 ± 17% to 84 ± 10.7% immediately after the course (p < 0 .001) and suffered no significant drop at six months (score 75 ± 8.7%, p=0.303). Average post-course practical exam score was 78.8 ± 3.1% and decreased to 66.2 ± 11.3% at six months (p=0.012). Residents significantly improved their subjective comfort level with all aspects of ultrasound use at six months (p=0.007–0.018) but did not significantly increase clinical usage frequency.

A MSK-US curriculum was successfully developed and implemented using an interdisciplinary approach. The course was rated high quality and succeeded in improving the residents' knowledge, skills, and comfort with MSK-US. This improvement was maintained at six months on the written test, but did not result in higher frequency of use by the residents.

The purpose of this study was to quantify tibial tunnel enlargement at 3-, 6- and 12-months post-anterior cruciate ligament reconstruction (ACLR), and evaluate the magnitude of tunnel widening with use of a Poly (L-lactic Acid) interference screw (PLLA (Bioscrew XtraLok, Conmed, New York)) compared to a Poly (L-lactic Acid) + tricalcium phosphate interference screw (PLLA+TCP (GENESYS Matryx screw comprised of microTCP and 96L/4D PLA, Conmed, New York)).

This was a prospective randomized controlled trial with two parallel groups. Eighty unilateral ACL-deficient participants awaiting ACLR surgery were recruited between 2013 and 2017 from the clinic of a sole fellowship trained orthopaedic surgeon. Patients had to be skeletally mature and less than 45 years old, with no concomitant knee ligament injuries requiring surgery, chondromalacia, or previous history of ipsilateral knee joint pathology, surgery or trauma to the knee.

Participants were randomized intra-operatively into either the PLLA or PLLA+TCP tibial interference screw fixation group. Study time points were pre-, 3-, 6-, and 12-months post ACLR. Participants underwent x-rays with a 25 mm calibration ball, IKDC knee assessment, and completed the ACL-Quality of Life score (ACL-QOL) at each visit.

Measurement (mm) of the most proximal and distal extents as well as the widest point of the tibial tunnel were taken using efilm (IBM Watson Health) and were standardized relative to the calibration ball. A contrast inverter was used to determine clear borders based on contrast between normal and drilled bone. In addition, a subjective evaluation of the tunnel was conducted looking for bowing of the borders of the tunnel or change in tunnel shape, categorizing the tunnel as widened or not widened.

Differences between groups at each time point were evaluated using independent t-tests corrected for multiple comparisons. Tunnel width was also compared as a percentage of actual screw size at 12-months post-operative. Categorical data were compared using Fisher's Exact Test. Forty participants were randomized to each group with mean age (SD) of 29.7 (7.6) and 29.8 (9.1), for PLLA and PLLA+TCP, respectively. There were no differences between groups in age, gender or ACL-QOL.

There were no differences found between groups at any time point in either tunnel width measurements or tunnel width as a percentage of actual screw size. The greatest difference between groups was noted in the measurement of the widest point on lateral x-ray view with a mean difference of 11%. Based on subjective evaluation of tunnel shape, three participants had visible widening in the PLLA group, and two in the PLLA+TCP group (p=NS).

No differences in tunnel widening were identified between ACL reconstruction patients using a PLLA interference screw compared to a PLLA+TCP screw for tibial fixation up to 12-months post-operative.

Recent literature has demonstrated that conventional arthroscopic techniques do not adequately visualise areas of predilection of pathology of the long head of biceps (LHB) tendon and are associated with a 30–50% rate of missed diagnoses. The aim of this study was to evaluate the safety, effectiveness and ease of performing biceps tenoscopy as a novel strategy for reducing the rate of missed diagnoses.

Five forequarter amputation cadaver specimens were studied. The pressure in the anterior compartment was measured before and after surgical evaluation. Diagnostic glenohumeral arthroscopy was performed and the biceps tendon was tagged to mark the maximum length visualised by pulling the tendon into the joint. Biceps tenoscopy was performed using 3 different techniques (1. Flexible video-endoscopy, 2. Standard arthroscopy via Neviaser portal. 3. Standard arthroscope via antero-superior portal with retrograde instrumentation). Each was assessed for safety, ease of the procedure and whether the full length of the extra-articular part of the LHB tendon could be visualised. The t-test was used to compare the length of the LHB tendon visualised at standard glenohumeral arthroscopy vs that visualised at biceps tenoscopy. An open dissection was performed after the arthroscopic procedures to evaluate for an iatrogenic injury to local structures.

Biceps tenoscopy allowed visualisation to the musculotendinous junction in all cases. The mean length of the tendon visualised was therefore significantly greater at biceps tenoscopy (104 mm) than at standard glenohumeral arthroscopy (33 mm) (mean difference 71 mm, p<0.0001). Biceps tenoscopy was safe with regards to compartment syndrome and there was no difference between pre- and post-operative pressure measurements (mean difference 0 mmHg, p=1). No iatrogenic injuries were identified at open dissection.

Biceps tenoscopy allows excellent visualisation of the entire length of the LHB tendon and therefore has the potential to reduce the rate of missed diagnoses. This study did not demonstrate any risk of iatrogenic injury to important local structures or any risk of compartment syndrome. Clinical evaluation is required to further validate this technique.

The majority of studies reporting sensitivity and specificity data for imaging modalities and physical examination tests for long head of biceps (LHB) tendon pathology use arthroscopy as the gold standard. However, there is little published data to validate this as an appropriate benchmark. The aim of this study was to determine the maximum length of the LHB tendon that can be seen at glenohumeral arthroscopy and whether it allows adequate visualisation of common sites of pathology.

Seven female cadaveric specimens were studied. Mean age was 74 years (range 44–96 years). Each specimen underwent arthroscopy in lateral decubitus (LD) and beach chair (BC) positions. The LBH-tendon was tagged with a suture placed with a spinal needle marking the intra-articular length and the maximum excursions achieved using a hook and a grasper in both LD and BC positions. T-tests were used to compare data.

The mean intra-articular and extra-articular lengths of the tendon were 23.9 mm and 82.3 mm respectively. The mean length of tendon that could be visualised by pulling it into the joint with a hook was significantly less than with a grasper (LD: hook 29.9 mm, grasper 33.9 mm, mean difference 4 mm, p=0.0032. BC: hook 32.7 mm, grasper 37.6 mm, mean difference 4.9 mm, p=0.0001). Using the BC position allowed visualisation of a significantly greater length than the LD position when using either a hook (mean difference 2.86 mm, p=0.0327) or a grasper (mean difference 3.7 mm, p=0.0077). The mean length of the extra-articular part of the tendon visualised using a hook was 6 mm in LD and 8.9 mm in BC. The maximum length of the extra-articular portion visualised using this technique was 14 mm (17%).

Pulling the tendon into the joint with a hook does not allow adequate visualisation of common distal sites of pathology in either LD or BC. Although the BC position allows a significantly greater proportion of the tendon to be visualised this represents a numerically small value and is not likely to be clinically significant. The use of a grasper also allowed greater excursion but results in iatrogenic tendon injury which precludes its use. The reported incidence of pathology in Denard zone C (distal to subscapularis) is 80% and in our study it was not possible to evaluate this zone even by using a grasper or maximum manual force to increase excursion. This is consistent with the extremely high rate of missed diagnoses reported in the literature. Surgeons should be aware that the technique of pulling the LHB-tendon into the joint is inadequate for visualising distal pathology and results in a high rate of missed diagnoses. Furthermore, efforts to achieve greater excursion by “optimum” limb positioning intra-operatively do not confer an important clinical advantage and are probably unnecessary.

Purpose

The development of skills in arthroscopic surgery is essential to the training of modern orthopedic surgeons. Few validated, objective tools exist which track improvement in arthroscopic skills. The purpose of this study was to validate an objective global assessment of arthroscopic skills employing videotape footage of diagnostic arthroscopy performed by participants of various skill levels on a cadaveric knee.

Purpose

Controversy exists regarding the optimal technique for arthroscopic rotator cuff repair. The purpose of this multicentre randomized double-blind controlled study was to compare the functional outcomes and healing rates of double-row suture techniques with single row repair.

Purpose: The development of confidence in the operating room is a major goal of surgical training. Confidence in surgery involves trusting information, intuition and experience. Confidence can also be detrimental when it impedes the ability to self-assess skills and decision-making. The measurement of confidence is difficult owing to the sequential acquisition of information and experience. The following study examines the trends in self-reported confidence in residents participating in cadaveric arthroscopic courses.

Method: In 2007 and 2008 residents participating in annual arthroscopic courses at the returned pre-course and post-course questionnaires recording previous arthroscopic exposure. Participants had access to fresh-frozen cadaver specimens and arthroscopic instruments for five hours after didactic lectures. Each participant rated perceived confidence and skill on a five-point Likert scale before and after the course. Mean confidence was compared using a student’s t-test. Data were further analysed using linear regression of pre – and post-course Likert scores.

Results: Residents showed a significant increase in self-perceived confidence in the performance of meniscal repair, anterior cruciate ligament reconstruction and labral repair and subacromial decompression directly after an arthroscopy course (p< 0.01). Regression analysis yielded a y-intercept not significantly different from zero prior to the course with a significant increase in the intercept after the course. There was no significant difference in the relationship of increasing arthroscopic experience to training noted as a result of the course.

Conclusion: Novice residents appeared to gain more self-reported confidence than experienced residents following an arthroscopic skills course. Future courses should consider the separation of novice and experienced residents to focus on improving the self-perceived confidence of experienced residents while exposing novice residents to the complexities of arthroscopic techniques. More research is needed to increase the understanding of the effects of confidence on trainees at various stages of training.

Purpose: Damage to the infrapatellar branch of the saphenous nerve and subsequent loss of sensation following graft harvest in ACL reconstruction is common. An oblique incision, rather than a vertical incision, has been shown to reduce the incidence and area of sensory loss following graft harvest [1] although the results are not universal. The purpose of this study was to determine if there was a difference in the area of infrapatellar neuritis (IFPN) and quality of life (QOL) between ACL patients that received a vertical – (VI) versus oblique-incision (OI) for hamstring tendon harvest.

Method: An interim analysis of a single-blinded randomized controlled trial (N=100) was conducted. Patients with clinical – and/or MRI-evidence of an ACL tear and no previous injury to the knee or surrounding soft tissues (including skin) were consented. Participants completed an ACL-QOL questionnaire pre-operatively, were randomized intra-operatively, and returned for follow-up at 1.5-, 6-, 12 – and 24-months to trace altered area of skin sensation and complete an ACL-QOL questionnaire. The area of altered skin sensation was quantified with ImageJ (NIH) software. The intention-to-treat principle was applied and a student’s t-test was used for statistical analysis. (p< .05).

Results: An interim analysis of 25 patients with a follow-up of 6 – to 24-mo demonstrated that the VI group (79.1 ± 15.6 cm2) had a greater affected area than the OI group (10.9 ± 3.5 cm2), no difference in ACL-QOL scores was evident.

Conclusion: Based on the difference in morbidity between the two groups, and similar results in a previous study (2), OI incision for graft harvest is recommended.

Purpose: The hypothesis of this randomized controlled trial is patients undergoing ACL reconstruction using contralateral hamstring harvest will have better quality of life and strength than using ipsilateral graft.

Method: One hundred participants were assigned to the ipsilateral (IG) or contralateral (CG) group. Primary and secondary outcomes were ACL Quality of Life (ACL-QOL) and concentric isovelocity knee flexion/extension strength measured on a dynamometer at five speeds. Data was gathered pre-surgery, and at 3, 6, 12, and 24 months post-surgery. Findings to 12 months are presented.

Results: ACL-QOL scores and knee flexion/extension strength were not significantly different between groups across time. Comparing side-to-side strength within each group, knee extension strength was consistently higher on the non-reconstructed side. In the IG, there were no side-to-side differences in knee flexion strength. In the CG, flexion on the reconstructed side was stronger than the grafted side early post surgery (3, 6 months) at 60 degrees/s, but this pattern was reversed at 90, 150, and 210 degrees/s. Post-hoc comparisons revealed hamstring/ quadriceps (H/Q) ratios were not different between limbs in the CG or for the uninvolved limb for the IG. However, at most time points and speeds, the H/Q ratio for the involved limb in the IG was higher than the uninvolved limb in the IG and either limb in the CG.

Conclusion: This study reveals that ipsilateral graft harvest may alter the H/Q ratio. It was also demonstrated that contralateral graft harvest may normalize this effect. This may have some bearing on function and re-injury risk that should be further investigated.

Purpose: Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (> 25% of glenoid diameter) We hypothesized that restoring a near-normal glenoid structure would prevent further dislocations and that osseous union would be achieved

Method: All athletes with recurrent anterior shoulder instability and a large glenoid defect who underwent open anterior shoulder stabilization and glenoid reconstruction with iliac crest allograft were prospectively followed over a three year period. Pre-operatively, a detailed history and physical exam was obtained along with radiographs, a CT scan, and magnetic resonance imaging of the affected shoulder. All patients also complete the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms pre – and post-operatively. A CT scan was again obtained 6 months post-operatively to assess osseous union of the graft, and the patient again when through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms.

Results: Nine patients (all male) were followed for an average of 16 months (4 – 36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/ relocation test and full shoulder strength at final follow-up. Eight of nine patients had achieved osseous union at six months (88.9%). ASES scores improved from 64.3 to 96.7, and SST scores improved from 66.7 to 100. Average post-operative WOSI scores were 94%.

Conclusion: The use of iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency

Purpose: This research project compared the accuracy of 3 methods of meniscal injury diagnosis that are commonly employed in a clinical orthopaedics: Clinical examination, MRI and Arthroscopic surgery.

Method: A retrospective review of charting was used to collect meniscal injury assessment data for 116 patients that had sustained an acute anterior cruciate ligament injury to one knee. Sixty-eight of the 116 patients had the presence of a meniscal lesion confirmed via surgery. Sensitivity and specificity of “hands on” clinical examination and MRI interpretation were determined using the results of arthroscopic surgery as the gold standard. Sensitivity and specificity of “hands on” clinical examination relative to MRI interpretation was also calculated. Finally, the findings of all three methods of meniscal evaluation were compared.

Results: Accuracy testing demonstrated that the sensitivity and specificity of clinical examinations (0.54 / 0.81) was comparable to levels observed for MRI (0.69 / 0.70), and when directly comparing the findings of clinical examination against MRI, that there was a high level of agreement when a meniscal lesion was not present (specificity: 0.91), but a much lower level of agreement when a meniscal lesion was suspected (sensitivity: 0.54). In general, when comparing the findings from clinical examination, MRI, and arthroscopic surgery, complete agreement among all 3 methods of evaluation occurred in only 51% of the patients.

Conclusion: Our results serve to highlight the inaccuracies associated with meniscal injury assessment when evaluating an acutely traumatized knee joint, and suggest that the incidence of secondary joint trauma following ligament injury may be under predicted.

Purpose: The increasing number of ACL reconstructions has led to the introduction of new techniques irrespective of the fact optimal tunnel angle placement has yet to be established. Improper tunnel angle placement is associated with a variety of complications including graft failure. The purpose of this retrospective study was to compare the reliability of tibial tunnel angles produced by two experienced surgeons using a free hand method or mechanical guide (HowellTM 65° Tibial Guide).

Method: Tibial tunnel angles in the coronal and sagittal planes were determined from anteroposterior and lateral radiographs, respectively, taken at 2 to 6 months postoperatively. Fifty-two sets of digital radiographs were analyzed (free hand = 28, mechanical = 24) with the knee in full extension 100 cm from the beam source. Tunnel angle measurements were calculated using NIH ImageJ software. Each angle was measured by two investigators on three separate occasions with minimum 7 days between each analysis.

Results: There was a significant difference (p< 0.05) in tibial tunnel angle placement between the mechanical guide (64.76 ± 5.88) and free hand (61.11 ± 5.04) group in the coronal plane. No significant difference in tibial tunnel placement in the sagittal plane was detected (mechanical guide =73.63 ± 7.69, free hand = 73.51 ± 6.68). Intra-rater and Inter-rater reliability for measurements in the sagittal (ICC = 0.809; 0.733) and coronal (ICC = 0.69; 0.812) plane ranged from high (> 0.75) to moderate (0.75–0.40), respectively.

Conclusion: Tibial tunnel angles in the coronal plane produced with a mechanical guide are more accurate than those drilled free hand when the intended angle of placement is 65°. The method used to measure tibial angles in this study was reliable within and between investigators. Further research will be conducted to investigate the correlation between tunnel angle placement and patient outcome measures.

Purpose: To describe the current practices and opinions of members of the Canadian Orthopaedic Association (COA) pertaining to anterior cruciate ligament (ACL) reconstruction.

Method: All orthopaedic surgeon members of the COA residing in Canada were sent an email invitation to take part in a survey via an internet-based survey manager. Expanding on a previously published survey (Marx et al., 2003), the current survey was comprised of 30 questions regarding the natural history of ACL-injured knees, surgical and post-surgical treatment choices, and success of the surgery. Clinical agreement was defined as greater than 80% agreement in choice of response option.

Results: Two hundred and eighty-three surgeons (49.3%) responded to the survey. Responses of the 143 surgeons (50.5%) who indicated they performed ACL reconstruction in the last year are presented. Clinical agreement with respect to surgical technique was demonstrated with respect to only three practices – ipsilateral graft harvest (100%), single incision approach (86.1%), and manual graft tensioning (81.6%). In terms of natural history, the only area of agreement was that hamstring and quadriceps strength affects function in ACL deficient knees (92%). Although less than the clinical agreement threshold, a majority of surgeons indicated their preference for semitendinosis-gracilis autograft (73%), transtibial versus anteromedial portal for establishment of the femoral tunnel (65 versus 29%), notch-plasty (65% only with impingement) and promotion of full weight-bearing and range of motion immediately post-surgery (72.1 and 74.8%, respectively). The most frequent surgeon-reported complications were tunnel widening (9.8%) and graft failure (4.4%). A greater proportion of high-volume surgeons used a manual tensioning device intra-operatively and permitted earlier return to sport (p< 0.05).

Conclusion: In the rapidly evolving area of ACL reconstruction, no recent survey of practices and opinions of orthopaedic surgeons has been published. The current survey is more extensive than others conducted to date and attempts to involve all practicing orthopaedic surgeons in Canada. In addition to providing information from a Canadian perspective, such an undertaking allows surgeons to evaluate their treatment decisions based on those of their colleagues, and also presents areas of dissimilarity that can be targeted for more extensive research.

Purpose: To determine whether generalized ligamentous laxity is a predisposing factor for primary traumatic anterior shoulder dislocation in young, active patients.

Method: Prospective case series with age and sex matched controls. The Hospital Del Mar Criteria was utilized to measure generalized ligamentous laxity. Fifty-seven (n=57) consecutive individuals (age< 30) sustaining a primary traumatic anterior shoulder dislocation between 2003 and 2006 were examined for hyperlaxity. The control group was comprised of seventy-two (n=72) undergraduate university students without a prior history of shoulder dislocation or anterior cruciate ligament injury.

Results: After adjusting for age and sex, the prevalence of hyperlaxity in the study group was 32.8% compared with 10.4% in the control group (p< 0.01). The prevalence of increased contralateral shoulder external rotation (> 85o) was 40.3% in the study group compared with 20.8% in the control group (p< 0.03). Among males, the prevalence of hyperlaxity was 28.3% in the study group and 5.3% in the controls (p< 0.01).

Conclusion: Although several studies have looked at the variables affecting shoulder instability, generalized ligamentous laxity (as measured by validated criteria) has not previously been identified as a predisposing factor for primary traumatic shoulder dislocation. This study demonstrates that generalized joint laxity and increased external rotation in the contralateral shoulder were found to be more common in patients who had sustained a primary shoulder dislocation. These observations may suggest a role for shoulder-specific proprioceptive and strength training protocols in hyperlax individuals participating in high-risk sports. Furthermore, the implications of hyperlaxity on the surgical management of traumatic primary shoulder instability are uncertain.

Purpose: Few studies have investigated the relationship between patients requiring rotator cuff surgery and their body mass index (BMI). The objective of this retrospective study was to evaluate the association between BMI and pre-operative pain and function in patients awaiting rotator cuff repair surgery as measured by the American Shoulder and Elbow Surgery (ASES) form and Simple Shoulder Score (SST). A second objective was to evaluate the role of several other factors in predicting patient pre-operative scores.

Method: Patients selected for this study were those who underwent arthroscopic rotator cuff repair performed by the same surgeon between 2002 and 2007. Their medical record included documentation of age, height, weight, smoking status, worker’s compensation status (WCB), and pre-operative ASES and SST scores. Correlation between BMI and ASES and SST scores was performed to determine the association between these variables. In addition, multiple stepwise regression was performed to assess the predictive value of other demographic and lifestyle factors.

Results: Fifty-four patients were included in the study (39 men, 15 women). No significant correlation was found between BMI and either ASES or SST scores. Based on multiple regression analysis, only WCB status was identified as a significant predictor of pre-operative ASES score (p=0.003) while sex, age, BMI, and smoking status were not. Patients with WCB claims had lower ASES scores than those without. Sex was found to have the strongest association with SST scores (r2 = 0.502) with men having greater SST scores than women. The model with the most significant value in predicting SST scores included sex, WCB and smoking status (r2 -= 0.640). Patients that did not fall under a WCB claim and were non-smokers had better SST scores pre-operatively.

Conclusion: BMI did not have a significant relationship to ASES and SST scores in patients awaiting rotator cuff repair surgery. A prospective study including pre- and post-surgical follow-up and a detailed analysis of the role between BMI and other demographic and lifestyle factors would be beneficial. Such a risk factor analysis may shed light on the indications for rotator cuff surgery or non-operative management, depending on the patient population.

Purpose: The diagnosis and treatment of superior labral antero posterior (SLAP) lesions is a controversial subject in shoulder pathology. The aim of this retrospective study was to evaluate the strength of association between clinical assessment (O’Brien test), standard MRI, and arthroscopic identification of a SLAP lesion.

Method: Patients who underwent isolated arthroscopic treatment of a SLAP lesion by two senior orthopaedic surgeons between 2004 and 2007 were included in this study. Pre-operatively, all had a standard MRI and the outcome of O’Brien test had been documented. Sensitivity of these measures in detecting a SLAP lesion confirmed through arthroscopy were calculated independently and combined. The relationship between O’Brien test and standard MRI are also presented.

Results: Forty-five patients were included in this study. The O’Brien test demonstrated a sensitivity of 42% (true positive) in detecting a SLAP lesion while sensitivity of the standard MRI was only 13%. The sensitivity of the O’Brien test and standard MRI when considered together was 47%, only slightly higher than the O’Brien test alone. The association between the O’Brien test and standard MRI in identifying a SLAP lesion as measured by the phi correlation coefficient was −0.19 which suggests little to no relationship (p = 0.095).

Conclusion: The current study illustrates the difficulties in accurately diagnosing a SLAP lesion pre-operatively. Previously documented sensitivity of the O’Brien test in identifying a SLAP lesion was not replicated herein. Furthermore, this study draws into question the practice of patient’s undergoing a standard MRI for SLAP lesion identification because the added value from this investigation was nominal. A standard MRI is often requested when the diagnosis is not certain or to exclude other shoulder pathology. If, however, a SLAP lesion is suspected clinically in absence of other shoulder pathology, then a diagnostic tool other than standard MRI may be more meaningful. Some literature suggests MRI arthrogram may be useful in diagnosing a SLAP lesion but access to this tool can be limited.

The purpose of this prospective randomised clinical trial is to examine the effect of acromioplasty on the outcome of arthroscopic rotator cuff repair.

Patients included individuals that were referred for assessment after six months of failed conservative management. Following informed consent patients were randomly assigned to receive arthroscopic rotator cuff repair with or without acromioplasty. The surgeon was not blinded to the type of procedure; however, the researcher who performed the follow-up evaluations and the patient was blinded to the surgical protocol. Subacromial decompression (acromioplasty) was performed with release of the coracoacromial ligament off the anterior undersurface of the acromion. The procedure for arthroscopic cuff repair without acromioplasty followed the protocol of arthroscopic cuff repair with acromioplasty, without division of the coracoacromial ligament or resection of the acromion. Both groups experienced the same post-operative rehabilitation protocol. Wound healing and active and passive range of motion were assessed and recorded at six to eight weeks post-operatively. Subsequent post-operative visits occurred at three, six, twelve, eighteen and twenty-four months and included documentation of patient range of motion, patient derived WORC scores (1) and complete ASES scores.

Preliminary results suggest, based on a one-tailed t-test, patients that receive a rotator cuff repair with acromioplasty demonstrate a statistically significant improvement (< 0.05) in Quality of Life, based on WORC and ASES scores, compared to the non-acromioplasty group. To date, three patients in the non-acromioplasty group required a revision surgery; two of these patients had a Type III acromion.

Arthroscopic rotator cuff repair with arthroscopic acromioplasty in the treatment of full thickness rotator cuff tears is recommended for patients with a Type III acromion.