Does the amount of noise generated differ between manual and robotic TJA?

Background: The purpose of this study was to evaluate whether noise that is generated during manual and robotic-assisted total joint arthroplasty (TJA) differs and if that noise exceeds the Occupational Safety Health Administration (OSHA) action limits.

Methods: Personal dosimeters were used to record the decibel (dB) level during manual and robotic-assisted total hip and knee arthroplasty (THA/TKA). The primary surgeon wore the dosimeter on their person.

A Histological Analysis of the Superior Capsule of the Glenohumeral Joint and the Supraspinatus Tendon.

Background: Complete understanding of rotator cuff pathology relies on a comprehensive knowledge of the anatomic relationships between the supraspinatus tendon (ST) and the superior capsule (SC) of the glenohumeral joint. However, the native anatomy of these structures across the glenohumeral joint and at their attachment sites remains incompletely understood.

Purpose: To (1) determine the histological anatomy and absolute and relative thicknesses of the SC compared with the ST across the glenohumeral joint at the anterior, midpoint, and posterior portions of the ST; (2) quantify the percentage of the humeral footprint occupied by the SC versus the ST; and (3) measure the width of the SC insertion on the glenoid.

Medial elbow torque during baseball hitting: considerations for return to play.

Background: Injuries to the ulnar collateral ligament are increasing among baseball players at all levels. Little is known about the loads experienced by the medial elbow during baseball hitting. The purpose of this study was to describe the stress experienced by the medial elbow of the trail arm during baseball hitting.

Tramadol-based multimodal pain protocols after arthroscopic rotator cuff repair are similarly effective as oxycodone-based protocols with fewer morphine milligram equivalents prescribed and lower risk of refills.

Background: Tramadol is a synthetic opioid prescribed to control postoperative pain while mitigating the harmful effects of stronger opioids, such as oxycodone. However, it is unknown whether tramadol can serve as an adequate substitute for oxycodone following shoulder surgery. Therefore, the primary purpose of this study was to compare early postoperative pain scores and prescribed narcotic between patients receiving tramadol and oxycodone after arthroscopic rotator cuff repair (ARCR).

Short-term outcomes of anatomic total shoulder arthroplasty with biceps augmentation of subscapularis peel repair.

Background: Augmenting subscapularis peel repairs with the long head of the biceps tendon (LHBT) may provide increased strength to the repaired construct. We aimed to report on the early outcomes of anatomic total shoulder arthroplasty (aTSA) in patients whose subscapularis peel repairs were augmented with LHBT autografts.

Methods: All patients who underwent aTSA with augmentation of subscapularis peel repair using LHBT were reviewed.

A Dynamic, Self-Tensioning Suture Contracts in Saline to Counteract Changes in Loop Length From Cyclic Loading.

Purpose: To compare the biomechanical performance of a suture with proposed dynamic self-tensioning properties with that of commonly used high-tensile sutures by evaluating suture loop length changes, responses to cyclic loading, and failure testing with intermittent saline soaks.

Methods: Six knots each of 4 different sutures were studied: 3 high-tensile sutures (ORTHOCORD, FiberWire, and ETHIBOND), and a dynamically self-tensioning suture (DYNACORD). After we measured loop length, knots were soaked in 37°C saline for 24 hours.

Publicly Available Anatomic Total Shoulder Arthroplasty Rehabilitation Protocols Show High Variability and Frequent Divergence from the 2020 ASSET Recommendations.

Background: In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA).

Purpose: The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines.

Methods: This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA.

When Do Patients Achieve PROMIS Milestones After Rotator Cuff Repair?

Background: Given the variability of the questions asked, the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT) Version 2.0 item bank aids in the evaluation of rotator cuff repair (RCR) rehabilitation by determining when recovery milestones are possible based on the quality of patient responses at certain time points.

Purpose: To assess the time point at which patients with RCR were able to achieve specific functional milestones, determined as positive responses to the 5 most frequently asked items on the PROMIS UE CAT Version 2.

Patient-reported outcomes measurement information system depression psychometrically underperforms compared to legacy measures and is poorly associated with postoperative functional outcomes in shoulder arthroplasty patients.

Background: The purpose of this study was to investigate the associations between each mental health patient-reported outcome measure with postoperative functional outcomes following shoulder arthroplasty, and to compare psychometric properties of patient-reported outcomes measurement information system depression to the legacy (VR-12 Mental) patient-reported outcome measure.

Methods: Patients who underwent primary shoulder arthroplasty from July 2018 to February 2019 were retrospectively reviewed. Patient-reported outcomes measurement information system depression and VR-12 Mental were administered preoperatively; American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation were administered at 6-month and 1-year postoperatively.

PROMIS physical function and pain perform poorly psychometrically in patients undergoing medial patellofemoral ligament reconstruction.

Purpose: The purpose of this study was to assess the validity, floor and ceiling effects, and dimensionality of PROMIS Physical Function (PF) and Pain compared to legacy patient reported outcome (PRO) measures in patients undergoing medial patellofemoral ligament (MPFL) reconstruction.

Methods: Patients who underwent MPFL reconstruction between 2018 to 2020 were retrospectively reviewed. Preoperatively, patients completed the IKDC, VR-12, Kujala, SF-12, KOOS JR, PROMIS PF and Pain surveys.

Costs of shoulder and elbow procedures are significantly reduced in ambulatory surgery centers compared to hospital outpatient departments.

Background: Recent literature has shown the advantages of outpatient surgery for many shoulder and elbow procedures, including cost savings with equivalent safety in appropriately selected patients. Two common settings for outpatient surgeries are ambulatory surgery centers (ASCs), which function as independent financial and administrative entities, or hospital outpatient departments (HOPDs), which are owned and operated by hospital systems. The purpose of this study was to compare shoulder and elbow surgery costs between ASCs and HOPDs.

Management of Glenoid Bone Loss in Primary Reverse Total Shoulder Arthroplasty.

Purpose Of Review: Glenoid bone loss presents distinct challenges in reverse total shoulder arthroplasty (rTSA) which, if unaddressed, can cause complications including poor outcomes and early implant failure. The purpose of this review is to discuss the etiology, evaluation, and management strategies of glenoid bone loss in primary rTSA.

Recent Findings: Three-dimensional computed tomography (3D CT) imaging and preoperative planning software have revolutionized the understanding of complex glenoid deformity and wear patterns from bone loss.

Internet search analytics for shoulder arthroplasty: what questions are patients asking?

Background: Common questions about shoulder arthroplasty (SA) searched online by patients and the quality of this content are unknown. The purpose of this study is to uncover questions SA patients search online and determine types and quality of webpages encountered.

Methods: The "People also ask" section of Google Search was queried to return 900 questions and associated webpages for general, anatomic, and reverse SA.

Ulnar Collateral Ligament Reconstruction with Hamstring Autograft.

Background: Ulnar collateral ligament (UCL) reconstructions have become increasingly common, particularly in youth overhead throwing athletes. These injuries are most commonly due to overuse and repetitive trauma on the inner elbow. Throwers with a deficient UCL often report decreased pitching speeds in addition to elbow pain and instability.

Subacromial Balloon Spacer: Indications, Rationale, and Technique.

Unlabelled: Irreparable rotator cuff tears are those that cannot be restored back to their native footprint or those in which any repair will "almost certainly" lead to a structural failure as a result of poor tissue quality, degeneration, or retraction. The InSpace subacromial balloon spacer (Stryker) was developed as a temporary spacer to restore anatomic relationships between the glenoid, humerus, and acromion to improve function and reduce pain associated with this challenging pathology.

Description: First, a diagnostic arthroscopy is performed.

Management of Periprosthetic Bone Cysts After Total Ankle Arthroplasty.

Modern improvements in total ankle arthroplasty (TAA) have increased the performance of this procedure for treatment of end-stage ankle arthritis. A common finding after TAA is the formation of periprosthetic bone cysts, which can be clinically silent or result in TAA failure. The exact cause of periprosthetic bones cysts has not been established, but major theories are related to osteolysis secondary to implant wear, micromotion, and stress shielding.

Recovery from open osteocapsular débridement for primary elbow osteoarthritis is rapid and does not depend on preoperative motion.

Background And Hypothesis: Osteocapsular débridement is a surgical treatment for functionally limiting primary elbow osteoarthritis (PEOA). We hypothesized that postoperative improvement in range of motion (ROM) following elbow osteocapsular débridement could be grouped into predictable patterns. We also hypothesized that significant improvements in ROM frequently take place for up to 6 months after surgery.

Travel distance does not affect outcomes after total shoulder arthroplasty.

Background: The purpose of this investigation was to determine the effect of travel distance on achieving the minimal clinically important difference (MCID) on all three commonly used patient-reported outcome measures (PROMs) for the shoulder more than 1 year following total shoulder arthroplasty (TSA).

Methods: Patients undergoing reverse or anatomic TSA at a high-volume tertiary referral center between September 2016 and August 2018 were retrospectively reviewed. Patients were divided into 2 groups: driving distance of >50 miles from the location of surgery (referral group) and driving distance of <50 miles (local group).

Lesser Tuberosity Osteotomy Combined with Anteroinferior Capsulectomy for Anatomic Shoulder Arthroplasty.

Adequate subscapularis tendon mobilization and glenoid exposure are critical to a successful anatomic total shoulder arthroplasty. A lesser tuberosity osteotomy allows for direct bone-to-bone healing while maintaining the strong tendon-to-bone attachment of the subscapularis tendon insertion. Excision of the typically thickened and contracted anteroinferior capsule in osteoarthritic shoulders can help mobilize the subscapularis, theoretically allowing for optimal soft-tissue balance, decreased tension on the subscapularis repair, improved glenoid exposure, and anatomic repair.

Initial Impact of the COVID-19 Pandemic on a US Orthopaedic Foot and Ankle Clinic.

Background: In the United States, the COVID-19 pandemic led to a nationwide quarantine that forced individuals to adjust their daily activities, potentially impacting the burden of foot and ankle disease. The purpose of this study was to compare diagnoses made in an orthopaedic foot and ankle clinic during the shelter-in-place period of the COVID-19 pandemic to diagnoses made during the same months of the previous year.

Methods: A retrospective review of new patients presenting to the clinics of 4 fellowship-trained orthopaedic foot and ankle surgeons in a major United States city was performed.

Humeral Head Resurfacing for Isolated Primary Humeral Osteoarthritis With a Large Chondral Defect.

Primary, isolated humeral head arthritis or focal chondral defects are uncommon and difficult to diagnose preoperatively. While these lesions have traditionally been treated with total shoulder arthroplasty, shoulder hemiarthroplasty is a viable option for patients with isolated humeral head disease and minimal degenerative changes in the glenoid. This approach can be performed in a minimally invasive fashion, which preserves bone stock and native biomechanics, and can be beneficial if conversion to total shoulder arthroplasty is required in the future and avoids risk of glenoid loosening or failure in younger and more active individuals.

Mid-Flexion Instability After Total Knee Arthroplasty: Diagnosis, Implant Design, and Outcomes.

Mid-flexion instability (MFI) in total knee arthroplasty refers to a distinct clinical entity where the knee is stable at full extension and 90° of flexion, but unstable somewhere between these 2 points. The presentation of MFI is often vague, and studies defining objective clinical or intraoperative measurements are limited. In this review, we aim to properly define the condition, describe diagnostic criteria and risk factors contributing to MFI, review current implant design, and present outcomes of revision surgery performed for MFI.

Time to Achieving Clinically Significant Outcomes After Meniscal Allograft Transplantation.

Purpose: To determine the time to achieving minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for commonly administered patient-reported outcome (PRO) measures and risk factors affecting achievement of clinically significant outcomes in patients undergoing meniscal allograft transplantation (MAT).

Methods: A prospectively maintained MAT registry was retrospectively reviewed from April 2014 to May 2019. Patients who underwent revision MAT or did not complete preoperative PROs or one post operative time point were excluded.

The fifty most cited publications in shoulder arthroplasty research.

Introduction: Frequency of citation provides one quantitative metric of the impact that an article has on a given field. The purpose of this study was to evaluate characteristics of the 50 most cited publications on shoulder arthroplasty.

Methods: The Web of Science database was used to determine the 50 most frequently cited shoulder arthroplasty articles.