An Automated Technique for the Measurement of Limb Occlusion Pressure During Blood Flow Restriction Therapy Is Equivalent to Previous Gold Standard

PURPOSE: To evaluate the efficacy of an automated pneumatic torniquet pump and its ability to automatically calculate the limb occlusion pressure (LOP), as compared with the manual Doppler ultrasound technique. METHODS: Participants presenting to a Sports Medicine clinic were evaluated for study enrollment. Participants were fitted with a pneumatic tourniquet for the upper and lower extremity. LOP measurements were taken with a Doppler ultrasound or automated SmartCuffs PRO device in a randomized order. RESULTS: Final analysis was performed on 96 limbs (48 upper extremities and 48 lower extremities). The study population had a mean age 37.1 ± 14.7 years old and a mean body mass index of 25.47 ± 3.80. The mean measured LOP pressure on the upper extremity with Doppler ultrasound was 174.0 ± 48.7 mm Hg with a range from 120 to 282 mm Hg, whereas the mean measured LOP by the automated pump was 184.0 ± 44.9 mm Hg with a range from 135 to 266 mm Hg. There was no statistically significant difference found between the Doppler LOP and the Smart Cuff upper extremity LOP (P = .29). When evaluating LOP pressure on the lower extremity the mean LOP found with the Doppler ultrasound was 195.0 ± 31.9 mm Hg with a range from 160 to 272 mm Hg, whereas the automated pump the mean LOP was 205.0 ± 27.1 mm Hg with a range from 168 to 278 mm Hg. There was no statistically significant difference found between the Doppler LOP and the automated pump lower extremity LOP (P = .09). CONCLUSIONS: No difference in the personalized LOP measurement was found when comparing an automated pump with the current gold standard of manual Doppler ultrasound. No patients companied of pain or discomfort during the LOP measurement. LEVEL OF EVIDENCE: Level II, diagnostic: prospective cohort study

Reverse shoulder arthroplasty after failed tendon transfer for irreparable posterosuperior rotator cuff tears

BACKGROUND Tendon transfers (TTs) can be successful for the management of selected posterosuperior functionally irreparable rotator cuff tears. However, when these procedures fail to provide adequate pain relief or functional improvement, reverse shoulder arthroplasty (RSA) is commonly considered the next treatment option. The effect of prior TT on RSA remains largely unknown. The purposes of this investigation were to evaluate the outcomes of RSA after previous TT performed for posterosuperior functionally irreparable rotator cuff tears and to determine the effect of various TT types on RSA. METHODS A retrospective review of 2 institutional databases identified 33 patients who underwent RSA implantation between 2006 and 2019 with a previous failed tendon transfer (FTT) of the shoulder and at least 2 years of clinical follow-up. FTTs included 21 latissimus dorsi transfers, 6 latissimus dorsi and teres major (LD-TM) transfers, and 6 lower trapezius transfers. RSAs were performed at an average of 5.5 years (range, 0.3-28 years) after FTT, with a mean follow-up period of 4.1 ± 2.0 years. Outcomes evaluated included the visual analog scale pain score, range of motion, absolute Constant-Murley score (CS) and relative CS, American Shoulder and Elbow Surgeons score, Subjective Shoulder Value, complications, and implant survivorship free of reoperation or revision. RESULTS RSA significantly improved pain and function, with improvements in the visual analog scale pain score (6.2 preoperatively vs. 2.2 at most recent follow-up, P < .001), active elevation (85° vs. 111°, P < .001), American Shoulder and Elbow Surgeons score (51 vs. 74, P = .001), absolute CS (34 vs. 48, P = .003), and relative CS (42% vs. 59%, P = .002), exceeding the minimal clinically important difference threshold. There were 7 complications (21%) across the entire cohort, with dislocation (n = 3, 9.1%) as the most common complication. Comparison across TT groups showed that LD-TM transfer had the highest complication rate (3 shoulders, 50%), followed by lower trapezius transfer (1 shoulder, 16.7%); latissimus dorsi transfer had the lowest rate (3 shoulders, 14.3%; P = .037). Survivorship free of revision or reoperation was estimated to be 90.1% at 1 year, 84.9% at 2 years, and 71.2% at 5 years, with no difference among TT groups (P = .654). CONCLUSIONS RSA can serve as a viable salvage option for FTT procedures. At mid-term follow-up, RSA led to significant improvements in pain, range of motion, and patient-reported outcomes. Patients with prior LD-TM transfers may have a higher complication rate, but no other differences were found between TT groups

Subacromial Balloon Implantation for the Treatment of Irreparable Posterosuperior Rotator Cuff Tears

Despite the development of various therapeutic options, surgical management of irreparable rotator cuff tears (IRCTs) remains controversial. Recently, implantation of a biodegradable subacromial balloon spacer (InSpace, Stryker Corporation; Kalamazoo, MI) has gained considerable interest for the treatment of certain IRCTs. The reported outcome of balloon implantation has not been consistent, likely due to differing indications and technical approaches. The purpose of this article is to present a reproducible arthroscopic technique for implantation of a subacromial balloon and to review the literature published to date, regarding the efficacy and outcomes of this procedure

Hybrid fixation in anatomic shoulder arthroplasty: surgical technique and review of the literature

Hybrid constructs have been used as a primary fixation technique in primary anatomic total shoulder arthroplasty for more than a decade. A highly porous metal central peg, metal cage, or coatings attached to the surface of cemented polyethylene glenoid component have been used with the concept of providing an additional adjunct in promoting osseointegration, preventing glenoid component loosening, and promoting longer-term success. The purpose of this article is to analyze the published results, complications, as well as rate of revision using this form of glenoid fixation. In addition, key aspects of the surgical technique that may be considered to facilitate optimal results when hybrid fixation is considered in total shoulder arthroplasty are also reviewed

Hemiarthroplasty versus total shoulder arthroplasty in B2 glenoids with an intact rotator cuff: a long-term matched cohort analysis

Background: Walch B2 glenoids present unique challenges to the shoulder arthroplasty surgeon, particularly in young, active patients who may wish to avoid the restrictions typically associated with an anatomic total shoulder arthroplasty (TSA). Long-term data are limited when comparing hemiarthroplasty (HA) and TSA for patients with an intact rotator cuff. The purpose of our study was to compare the long-term outcomes of HA vs. TSA in a matched analysis of patients with B2 glenoids, primary osteoarthritis (OA), and an intact rotator cuff. Methods: A retrospective review was performed of all patients who underwent HA or TSA between January 2000 and December 2011 at a single institution. Inclusion criteria were primary OA, Walch B2 glenoid morphology, an intact rotator cuff intraoperatively, at least 2 years of clinical follow-up, or revision within 2 years of surgery. Fifteen HAs met inclusion criteria and were matched 1:2 with 30 TSAs using age, sex, body mass index, and implant selection. Clinical outcomes including range of motion (ROM), visual analog scale (VAS) for pain, subjective shoulder value score, American Shoulder and Elbow Surgeons (ASES) score, complications, and revisions were recorded. Postoperative radiographs were reviewed to assess for stem loosening, humeral head subluxation, glenoid loosening, and glenoid erosion. Results: A total of 15 HAs and 30 TSAs met inclusion criteria at a mean follow-up of 9.3 years. The mean age at the time of surgery was 60.2 years for HA and 65.4 years for TSA (P = .08). Both cohorts had significant improvements in ROM, subjective shoulder value, and VAS pain scores (P < .001). TSA had higher postoperative ASES scores compared to HA (P = .03) and lower postoperative VAS pain scores (P = .03), although the decrease in pain from preoperatively to final follow-up was not significantly different between HA and TSA (P = .11). HAs were more likely to have posterior humeral subluxation (P < .001) and stem lucencies (P = .02). Revisions occurred in 11.1% of the cohort with no difference for HA and TSA (P = .73). Conclusions: At nearly 10 years of follow-up, HA and TSA both showed significant improvements in ROM and pain when performed for primary glenohumeral OA in B2 glenoids with intact rotator cuffs. Compared to HA, TSAs had less posterior humeral subluxation, less stem lucencies, higher ASES scores, and lower postoperative VAS pain scores. However, our study failed to demonstrate a difference in ROM, complication, or revision rates between HA and TSA

Cost analysis and complication rate comparing open, mini-open, and all arthroscopic rotator cuff repair

Hypothesis/Background: Value-based healthcare delivery models are becoming increasingly common and are driving cost effectiveness initiatives. Rotator cuff repair (RCR) is a commonly performed procedure with some variations on the specific surgical technique. The purpose of this study was to perform a comprehensive analysis of the cost, complications, and readmission rates of 3 categories of RCR techniques (open [oRCR], combined arthroscopically assisted and mini-open [CRCR], and all arthroscopic [ARCR]) at a high-volume institution. Methods: All RCR procedures performed by 2 fellowship-trained shoulder surgeons at a single institution between 2012 and 2017 were retrospectively identified. These consisted of oRCR, CRCR, and ARCR repair techniques. One surgeon performed oRCR and CRCR, and the second surgeon performed ARCR. A cost analysis was designed to include a period of 60 days preoperatively, the index surgical hospitalization, and 90 days postoperatively, including costs of any readmission or reoperation. Results: The cohort consisted of 95 oRCR, 233 CRCR, and 287 ARCR. Median standardized costs were as follows: preoperative evaluation $486.03; index surgical hospitalization oRCR$9,343.10, CRCR $10,057.20, and ARCR$10,330.60; and postoperative care $875.02. Preoperative and postoperative costs did not vary based on the type of RCR performed. However, significant differences were observed among index surgical costs (P = .0008). The highest standardized cost for hospitalization for both the CRCR group and the ARCR group was related to the cost of the operating room and the implants. The 90-day complication, reoperation, and readmission rates were 1.1$10,704.15, $11,418.25, and$11,691.65 for oRCR, CRCR (average added cost $714.10), and ARCR (added cost$987.50), respectively. The group complication, reoperation, and readmission rate were 0.5%, 0.5%, and 1.8% with no significant differences between the varying techniques, respectively. This retrospective cost analysis and complication profile may serve as a useful reference as surgeons consider engaging in bundled payment for RCR. As value based initiatives continue to progress, implant cost may serve as an actionable area for cost reduction