Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jul 2020
Increased opioid use following rotator cuff repair associated with prior opioid use and surgeon prescription patterns.
Prescription opioids are standard of care for postoperative pain management after musculoskeletal surgery, but there is no guideline or consensus on best practices. Variability in the intensity of opioids prescribed for postoperative recovery has been documented, but it is unclear whether this variability is clinically motivated or associated with provider practice patterns, or how this variation is associated with patient outcomes. This study described variation in the intensity of opioids prescribed for patients undergoing rotator cuff repair (RCR) and examined associations with provider prescribing patterns and patients' long-term opioid use outcomes. ⋯ The intensity of opioids received by patients for postoperative pain appears to be partially determined by the prescribing habits of their providers. Greater intensity of opioids received is, in turn, associated with greater odds of patterns of chronic opioid use after surgery. More comprehensive, patient-centered guidance on opioid prescribing is needed to help surgeons provide optimal postoperative pain management plans, balancing needs for short-term symptom relief and risks for long-term outcomes.
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J Shoulder Elbow Surg · Jul 2020
Cortical suture button fixation vs. bicortical screw fixation in the Latarjet procedure: a biomechanical comparison.
The Latarjet procedure traditionally has been performed with 2 screws in an open manner. Recently, cortical suture button fixation for coracoid transfer has been used in hopes of mitigating complications seen with screw placement. The aim of this study was to evaluate a cortical suture button and technique currently available in the United States compared with screw fixation in the Latarjet procedure in a cadaveric model. ⋯ At time zero, the cortical button fixation and technique did not resist direct loads to the graft as much as traditional screw fixation, although bony damage to the surrounding anatomy was more extensive in screw fixation than button fixation. In the event of unanticipated loading, this could place a patient at higher risk of graft migration, which could lead to unintended early outcomes. These results support the need for implants and techniques specifically tailored to the Latarjet procedure and should bring into question the adoption of a cortical button and technique not specific to the procedure.
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J Shoulder Elbow Surg · Jun 2020
Multicenter StudyCan low-profile double-plate osteosynthesis for olecranon fractures reduce implant removal? A retrospective multicenter study.
Because of poor soft-tissue coverage at the proximal ulna and prominent posteriorly positioned implants, hardware removal remains the most common reason for revision surgery of olecranon fractures that were operatively treated using plate osteosynthesis. We hypothesized that low-profile double-plate osteosynthesis would reduce the number of soft tissue-related hardware removals compared with single posterior plating whereas the functional results would be comparable. ⋯ Low-profile double-plate osteosynthesis for treating olecranon fractures resulted in good clinical outcomes. However, the rate of hardware removal was not significantly reduced, and the functional results were comparable to those of common single-posterior plate osteosynthesis.
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J Shoulder Elbow Surg · Jun 2020
Relationship between the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing and legacy instruments in patients undergoing isolated biceps tenodesis.
The purpose of this study was to correlate the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) domains with commonly used legacy patient-reported outcome measures (PROMs) preoperatively in a population of patients presenting to a tertiary care orthopedic center for biceps and labral pathology. ⋯ The PIF CAT was comparable to the ASES score, the current gold standard. Compared with legacy measures, both the UE CAT and PIF CAT are less burdensome and have few floor or ceiling effects. The PIF CAT may be a viable alternative to describe the physical and psychosocial impact of pain in biceps tenodesis patients.
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J Shoulder Elbow Surg · Jun 2020
Changes in medial elbow elasticity and joint space gapping during maximal gripping: reliability and validity in evaluation of the medial elbow joint using ultrasound elastography.
Medial elbow injuries are common in baseball pitchers. This study investigated the reliability of medial elbow elastography measurement and the characteristics of the medial elbow stabilizers. ⋯ Elastography measurements of the UCL and FPM have almost perfect reliability. Gripping reduces medial elbow joint space gapping compared with rest. For both tissues, gripping reduces their elasticity compared with rest. The elasticity of the UCL is less than that of the FPM both at rest and during gripping.