Glenoid failure remains the most common mode of total shoulder arthroplasty failures. Porous tantalum metal (Trabecular Metal™, Zimmer) have grown in popularity in hip and knee arthroplasty. First-generation porous tantalum metal-backed glenoid components demonstrated metal debris, resulted in failure, and were revised to second-generation glenoid implants. Evidence for second-generation porous tantalum metal implants in shoulder arthroplasty is sparse.1–4 The purpose of this study was to assess clinical and radiographic outcomes in a series of patients with second-generation porous tantalum glenoid components at a minimum two-years postoperative.

We retrospectively reviewed the clinical and radiographic outcomes of patients who received a second-generation porous tantalum glenoid component anatomic shoulder arthroplasty between May 2009 and December 2017 with minimum 24 months follow-up. The shoulder arthroplasties were performed by one of two senior fellowship-trained surgeons. We collected postoperative clinical outcome indicators: EQ5D visual analog scale (VAS), Western Ontario Osteoarthritis of the Shoulder (WOOS) Index, American Shoulder and Elbow Surgeons (ASES) Score, and Constant Score (CS). Radiographic review was performed by an independent fellowship-trained surgeon. The Endrizzi metal debris grading system1 was utilized to grade metal debris. We computed descriptive statistics and compared outcome scores between groups via the non-parametric Wilcoxon rank-sum test, with group-wise comparisons defined by: metal debris and humeral head migration (secondary analyses).

Thirty-five patients [23 male (65.7%) and 12 female (34.3%)] with 40 shoulder replacements participated in the study. Forty of 61 shoulders (65.6%) had an average of 64 ± 20.3 months follow-up (range 31 to 95). Average BMI was 27.5 ± 4.4 kg/m2 (range 19.5 to 39.1). The average postoperative EQ5D VAS at final follow-up was 74.6 ± 22.5, WOOS Index 87.9 ± 16.6, ASES Score 88.3 ± 10.9, and CS 80.4 ± 13. At final follow-up, 18 of 40 shoulders (45%) had metal debris [15 of 40 (37.5%) Endrizzi grade 1 and three of 40 (7.5%) Endrizzi grade 2], and 22 of 40 shoulders (55%) did not show evidence of metal debris. There was one non-revision reoperation (open subscapularis exploration), one shoulder with anterosuperior escape, three shoulders with glenoid radiolucencies indicative of possible glenoid loosening, and nine shoulders with superior migration of the humeral head (>2mm migration at final follow-up compared to immediate postoperative). When comparing postoperative scores between patients with vs without metal debris, we found no statistically significant difference in the EQ5D VAS, WOOS Index, ASES Score and CS. On further analyses, when comparing superior migration of the humeral head and postoperative outcomes scores, we found no statistically significant difference.

We report the longest published follow-up with clinical and radiographic outcomes of second-generation porous tantalum glenoid anatomic shoulder arthroplasties. In this series of patients, 45% of total shoulder arthroplasties with a second-generation porous tantalum glenoid implant had radiographic evidence of metal debris. This metal debris was not statistically associated with poorer postoperative outcomes. Further investigation and ongoing follow-up are warranted.

Purpose

Electrothermal arthroscopic capsulorrhaphy (ETAC) was a technology introduced for orthopaedic surgery without good scientific clinical evidence supporting its use. This multicentre randomized clinical trial provides the scientific clinical evidence comparing ETAC to Open Inferior Capsular Shift (ICS), by measuring disease-specific quality of life at 2-years post-operatively, in patients with shoulder instability due to capsular redundancy.

Purpose

This prospective, expertise-based randomized clinical trial compares arthroscopic to open shoulder stabilization by measuring the disease-specific quality of life outcome in patients with traumatic unidirectional anterior shoulder instability, and determining the incidence of recurrent instability at 2-years post-operatively.

This meta-analysis supports the conclusion that in patients with recurrent traumatic anterior shoulder instability, an open repair has a more favorable outcome with respect to recurrence and return to activity when compared to arthroscopic repair. More evidence from randomized clinical trials is required to either refute or substantiate this conclusion.

The purpose of this study was to evaluate the outcomes between arthroscopic and open repair for recurrent traumatic anterior shoulder instability.

The search involved clinical studies of all languages in the Medline database up to October 31, 2001. The following key words were used:

anterior shoulder instability;

All abstracts were reviewed and articles were included if there was a direct comparison between arthroscopic and open repair for traumatic recurrent anterior shoulder instability. These articles were manually assessed and cross-referenced for additional abstracts. The final group of articles were independently critically appraised and data on recurrent instability and return to activity (RTA) was extracted.

Recurrent instability was defined as patient report of one or more subluxations and/or dislocations. RTA was not consistently defined in these articles and was based upon the available information.

584,

From these searches, sixteen articles were determined eligible for the meta-analysis including two foreign and two unpublished manuscripts. Ten studies were included in the final analysis: one RCT, two pseudo-experimental designs, four prospective cohorts, and three retrospective studies.

Pooled Mantel-Haenszel Odds Ratio for recurrent instability and RTA were 2.22 (p=0.002, 95%CI 1.36,3.65) and 2.85 (p=0.004, 95%CI 1.40,5.78) respectively, in favor of the open repair.

Based upon this meta-analysis open repair has a more favorable outcome with respect to recurrence and RTA.

The standard of reference by which many imaging studies and clinical tests are often measured is arthroscopy. However, the inter-rater reliability of a surgeon’s arthroscopic diagnosis a relatively unexplored area of investigation. The purpose of the study was to determine the inter-rater reliability among a group of experienced orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in a real-time diagnostic shoulder arthroscopy using a videotape model. Given the conditions of this study, the agreement among experienced shoulder surgeons was structure dependent ranging from poor to very good and was influenced by the prevalence of pathology.

To determine the inter-rater reliability among a group of experienced orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in a real-time diagnostic shoulder arthroscopy using a videotape model.

In this patient population, the agreement among experienced shoulder surgeons was structure dependent ranging from poor to very good and was influenced by the prevalence of pathology.

For educational, research and legal reasons, it is important to objectively demonstrate that intra-operative findings can be reproduced. To date, this is a relatively unexplored area of investigation within shoulder arthroscopy.

The video-review surgeon median overall agreements were as follows: anterior labrum=90%, inferior labrum=45%, superior labrum=60%, posterior labrum=65%, superior glenohumeral ligament(GHL)=50%, middleGHL=50%, anterior-inferiorGHL=25%, glenoid surface=35%, detection of Hill Sachs lesion=85%, biceps tendon=70%, supraspinatus tendon=85%, infraspinatus tendon=70%, subscapularis tendon=80%.

Twenty patients (nineteen males, one female) diagnosed with recurrent anterior shoulder instability with an average age of 27.9 years (15–44years) consented to participate. One experienced surgeon performed a standardized diagnostic shoulder arthroscopy following a modified Snyder 15-point protocol. All surgeries were videotaped. The operative protocol, clarity of videotape information and data collection forms were pre-tested to ensure accuracy. The patients’ clinical information, x-rays and videotaped arthroscopy were sent to six experienced shoulder surgeons. The surgeons reviewed the clinical information, assessed the intra-articular structures shown on the videotape and recorded their diagnoses on a standardized data collection form. The primary outcome was the median overall percent agreement for the video-review surgeons. This was calculated for each structure evaluated.

This randomized clinical trial utilizing the validated rotator cuff disease specific quality of life outcome measure (RC-QOL) and adequate power demonstrates no difference in outcome for full thickness rotator cuff tears comparing open to mini-open surgical techniques.

The purpose of the study was to compare standard open rotator cuff repair versus mini-open rotator cuff repair by measuring the disease specific quality of life in patients with rotator cuff injury.

This randomized clinical trial utilizing a validated disease specific outcome measure and adequate power demonstrates no difference in outcome for full thickness rotator cuff tears comparing open to mini-open surgical techniques.

The miniopen approach utilizing an arthroscoic acromioplasty provides no additional beneifit to the patient undergoing a rotator cuff repair.

The mean one year RC-QOL score for the open and mini-open groups were 85.3 (SD = 15.6) and 87.4 (SD = 12.0) out of a maximum of one hundred, respectively. This difference was not statistically significant (p = 0.572).

Seventy-two patients (forty-eight males/twenty-four females) with an average age of 56.4 years (thirty-three to eighty-two years) consented to participate in the study. Inclusion criteria involved: unremitting pain, failed conservative treatment of at least three months, weakness of rotator cuff, and positive diagnostic imaging indicating a full-thickness rotator cuff tear. Massive rotator cuff tears were excluded.

Prior to surgery, patients were randomized to either open or mini-open rotator cuff repair. Patients were assessed and outcomes were collected at three, six and twelve months after surgery. Primary Outcome Measure: Patient quality of life was quantified using the validated disease specific, reliable and responsive Rotator Cuff Quality of Life Questionnaire (RC-QOL) measured on a one hundred point visual analogue scale format. Secondary Outcomes: Range of motion, strength, American Shoulder and Elbow Surgeons Score, and the Shoulder Rating Questionnaire.

This investigation was performed to determine whether MRI would provide any additional diagnostic information to the clinical evaluation and diagnostic arthroscopy of the shoulder. The study was performed in patients with shoulder impingement syndrome booked for an arthroscopic subacromial decompression. Although there was significant discordance between the MRI and arthroscopic findings, the MRI did not change the diagnosis or treatment plan in a clinically important way.

To determine whether the radiologist’s MRI report provided to an arthroscopist upon completion of a standard diagnostic shoulder arthroscopy would result in changes to the initial arthroscopic findings.

Despite high percentage of discordance between MRI and arthroscopy, the MRI information modified the initial arthroscopic diagnosis in a much smaller percentage of cases. In only one patient, did the change in diagnostic information have an impact on the planned treatment.

MRI adds minimal clinically important information to diagnostic shoulder athroscopy in patients with impingement syndrome.

The percentage discordance between MRI and arthroscopy for each structure of interest was calculated along with the percentage change in diagnosis based upon the arthroscopic re-evaluation and the consequence of the change.

Supraspinatus 55.2% discordance(n=32/58), 18.8% change in diagnosis(n=6/32), in 1 patient a change in the planned operation occurred from subacromial decompression to mini-open rotator cuff repair. Infra-spinatus 44.8% discordance(n=26/58), 3.8% change in diagnosis(n=1/26), and no consequence to planned treatment. Subscapularis 37.9% discordance(n=22/58), no change in diagnosis. Biceps tendon 62.3% discordance(n=33/53; five patients not adequately visualized on MRI), no change in diagnosis.

Fifty-eight patients presenting with shoulder impingement syndrome underwent a standardized MRI prior to planned arthroscopic subacromial decompression. A standard diagnostic arthroscopy was performed. The anatomic and pathologic findings were documented intra-operatively by an independent observer. The arthroscopist was initially blinded to the MRI information. MRI results were then revealed to the surgeon. An arthroscopic re-evaluation was performed to resolve discrepancies between MRI and arthroscopy.

Introduction and Aims: The authors have previously reported the comparison between MRI and arthroscopic diagnosis in a blinded prospective study in patients with shoulder impingement syndrome. The purpose of this investigation was to determine whether the radiologist’s MRI report provided to an arthroscopist upon completion of a standard diagnostic shoulder arthroscopy would result in changes to the initial arthroscopic findings.

Method: Fifty-eight patients presenting with clinical signs and symptoms of shoulder impingement syndrome underwent an MRI one week prior to planned arthroscopic subacromial decompression. MRI scans were obtained following a standardised protocol. Images were read by one musculoskeletal radiologist. A standard diagnostic arthroscopy was performed. The anatomic and pathologic findings were documented intra-operatively by an independent observer. The arthroscopist was initially blinded to the MRI information until completion of the standard diagnostic arthroscopy. MRI results were then revealed to the surgeon. An arthroscopic re-evaluation was performed to resolve any discrepancies between MRI and the initial arthroscopic findings.

Results: The percentage discordance between MRI and initial arthroscopic findings for each structure of interest was calculated along with the percentage change in diagnosis based upon the arthroscopic re-evaluation and the consequence of the change.

Supraspinatus 55.2% discordance (n=32/58), 18.8% change in diagnosis (n=6/32), in one patient a change in the planned operation occurred from subacromial decompression to mini-open rotator cuff repair. Infra-spinatus 44.8% discordance (n=26/58), 3.8% change in diagnosis (n=1/26), and no consequence to planned treatment. Subscapularis 37.9% discordance (n=22/58), no change in diagnosis. Biceps tendon 62.3% discordance (n=33/53; five patients not adequately visualised on MRI), no change in diagnosis. Acromion type 50% discordance (n=26/52; five patients did not have a sub-acromial bursocopy and in one patient the acromion was not well visualised), 7.7% change in diagnosis (n=2/26) with no consequence to planned treatment. Acromioclavicular joint 22.5% discordance (n=9/40; in 18 patients the AC joint was not entered), 11.1% change in diagnosis (n=1/9) with no consequence to planned treatment.

Conclusion: Despite high percentage of discordance between MRI and arthroscopy, the MRI information modified the initial arthroscopic diagnosis in a much smaller percentage of cases. In only one patient, did the change in diagnostic information have an impact on the planned treatment.