Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Mar 2021
Randomized Controlled TrialLiposomal Bupivacaine Interscalene Nerve Block in Shoulder Arthroplasty is Not Superior to Plain Bupivacaine: A Double Blinded Prospective Randomized Control Trial.
Interscalene brachial plexus blocks are a common modality used to provide adjunctive pain relief with shoulder replacement surgery. In 2018, the Federal Drug Administration approved the use of liposomal bupivacaine (LB) for such nerve blocks. We sought to evaluate whether this formulation of bupivacaine would provide superior pain relief for shoulder replacement patients over standard bupivacaine alone. Our hypotheses were that in the LB cohort the average postoperative pain score over the first 72 hours would be significantly lower, time to block cessation would be longer, total opioid consumption would be lower, and the average patient satisfaction score regarding their pain management would be higher. ⋯ When used for an interscalene block to provide adjunctive pain relief in shoulder replacement surgery, the addition of LB to plain bupivacaine provides no additional clinically important benefit to the patient's pain experience over standard bupivacaine.
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J Shoulder Elbow Surg · Mar 2021
Early and delayed acromioclavicular joint reconstruction provide equivalent outcomes.
Some comparative studies have reported improved outcomes for early compared with delayed reconstruction for high-grade acromioclavicular (AC) joint dislocations. However, most are based on older techniques and did not specifically involve reconstruction of both the coracoclavicular (CC) and AC joint ligaments. The purpose of this study was to compare functional outcomes of early vs. delayed surgical intervention of AC joint dislocations managed with combined CC and AC ligament reconstruction. ⋯ Early and delayed surgical interventions of high-grade AC joint dislocation provide equivalent clinical scores when combined CC and AC joint fixation is used for stabilization. Rapid surgical intervention for high-grade AC joint dislocation may not be necessary, as most patients can still benefit from surgery at a later stage.
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J Shoulder Elbow Surg · Mar 2021
The incidence and incubation period of false-positive culture results in shoulder surgery.
Postoperative shoulder infection is a significant complication requiring timely identification and treatment. Indolent infections such as those involving Cutibacterium acnes (formerly Propionibacterium acnes) provide a diagnostic dilemma as they present differently, without the acute symptoms associated with most postoperative bone and joint infections. Furthermore, Cacnes is thought to be a common contaminant isolated from intraoperative cultures. With no consensus algorithm, long-held cultures play a major role in guiding management decisions in potential postoperative shoulder infection. Our study sought to determine the incidence of positive culture results in both open and arthroscopic procedures in noninfected patients, as well as to clarify whether an increase in the incubation time frame leads to an increased rate of culture growth. ⋯ A relatively high false-positive culture rate occurred in both open and arthroscopic shoulder surgery. Cacnes was the most commonly identified bacterium in cultures in the open surgery group. Knowledge of one's institutional false-positive culture rate could be important in avoiding potentially inappropriate treatment. Additionally, we found that holding cultures longer than 14 days did not lead to an increased rate of false-positive culture results.
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J Shoulder Elbow Surg · Mar 2021
Arthroscopic superior capsule reconstruction with Teflon felt synthetic graft for irreparable massive rotator cuff tears: clinical and radiographic results at minimum 2-year follow-up.
Superior capsule reconstruction (SCR) was developed to improve shoulder function and relieve pain in patients with irreparable rotator cuff tears. Here, we investigated the clinical and radiographic outcomes and postoperative complications of SCR using a Teflon graft for reconstruction. ⋯ SCR using a Teflon graft-especially a 3-layer graft-significantly improved shoulder function and shoulder abduction strength, with pain relief and a low rate of postoperative complications. SCR using a Teflon graft can be a viable option for irreparable rotator cuff tears, especially when an autograft or allograft is not available.