RESUMO
INTRODUCTION: Despite the widespread use of arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair (RCR) techniques, midterm outcome data are limited. The purpose of this article was to assess midterm clinical outcomes of patients following arthroscopic TOE RCR using either a knotless tape bridge (TB) repair or knotted suture bridge (SB) repair technique. We hypothesized that there would be significant improvements in patient-reported outcomes with TOE RCR that would be durable over time. We also hypothesized that the knotless TB technique would yield equivalent clinical results to the knotted SB technique, but that there would be differences in retear types between the two TOE techniques. METHODS: Patients included were a minimum of 5 years from an index arthroscopic double-row TOE repair using either a knotless TB or knotted SB technique for one, two, or three tendon full-thickness rotator cuff tears involving the supraspinatus tendon. Preoperative and postoperative American Shoulder and Elbow Surgeons, Short-Form 12 Physical Component Summary, Quick Disabilities of the Arm, Shoulder, and Hand, Single Assessment Numeric Evaluation, and satisfaction scores were collected. Scores were also stratified and compared based on primary and revision repair, tear location, and tear chronicity. Outcomes between techniques were contrasted, and survivorship analysis was conducted, with failure defined as progression to revision surgery. RESULTS: One-hundred ninety-two shoulders were included with a mean follow-up of 6.6 years (range, 5.0 to 11.0 years). Fifteen shoulders (7.8%) underwent revision cuff repair. All scores improved significantly for TB repair (P < 0.001). For SB repair, all scores improved, but only American Shoulder and Elbow Surgeons and Short-Form 12 Physical Component Summary scores (P < 0.05) demonstrated statistical significance. No statistically significant differences were found between the repair techniques when stratified by primary and revision repairs, tear location, or chronicity. Postoperative clinical survivorship was 96.6% and 93.6% for knotted SB repairs and 96.7% and 93.9% for knotless TB repairs at 2 and 5 years, respectively. CONCLUSION: TOE RCR results in significant clinical improvement and excellent survivorship at a minimum of 5 years of follow-up, using either knotted SB or knotless TB repair techniques in primary and revision cases and in small and large tears. Equivalent results were obtained with both TOE techniques. Patients undergoing repair with a TOE showed significant improvements in patient-reported outcomes that were durable at a minimum of 5 years postoperatively.
Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Técnicas de Sutura/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/instrumentação , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Sobrevivência , Adulto JovemRESUMO
Patient-reported outcomes are, by definition, subjective, and there is consensus that individual patient expectations have a significant effect on the postoperative outcome after shoulder arthroscopy. Most of the outcomes in orthopaedic surgery are measured either in terms of functional scores assessing only one joint or as disease or condition-specific outcomes. As such, there exists a growing interest developing better tools to measure quality-of-life outcome scores as an assessment of overall patient health and satisfaction. Recent research shows that quality-of-life outcome measures correlate with joint-specific and functional outcomes after arthroscopic Bankart repair. We also personally believe that quality-of-life scores should become a standard outcome assessment measurement in orthopaedic surgery because while we perform surgery on the joint, we take care of the whole patient.
Assuntos
Luxação do Ombro , Articulação do Ombro , Artroscopia , Seguimentos , Humanos , Motivação , Satisfação Pessoal , Qualidade de Vida , OmbroRESUMO
Clavicle fractures are among the most common fractures occurring in the general population, and the vast majority are localized in the midshaft portion of the bone. Management of midshaft clavicle fractures remains controversial. Although many can be managed nonoperatively, certain patient populations and fracture patterns, such as completely displaced and shortened fractures, are at risk of less optimal outcomes with nonoperative management; surgical intervention should be considered in such cases. The purpose of this article is to demonstrate our technique of midshaft clavicle fixation using minimally invasive intramedullary fixation.