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Shoulder Problems Motivate Innovative Solutions

      Abstract

      Shoulder arthroscopic and related surgeons may require expertise in use of the 70° arthroscope, biologic patch augmentation, repair of massive rotator cuff tears, the Latarjet procedure and related glenoid bone augmentation, and reverse total shoulder arthroplasty.
      In your September 2016 issue of Arthroscopy, in addition to captivating hip and knee and ankle content, we find fascinating a compendium of shoulder articles. The shoulder content seems particularly notable this month for a number of reasons: distinguished authors, complex pathology, innovative arthroscopic and related surgical solutions, and increasingly important and valued comparative cost analyses.
      In addition, several Editorial Commentaries serve to highlight these high impact shoulder topics and enhance the value for readers. The Commentary program has matured to include, as described below, experts writing on a subject in their “wheelhouse” as a way to advance the academic conversation. We encourage readers to join the conversation by please submitting additional comments as Letters to the Editor. More conversation adds depth and understanding to important topics.
      We lead with “A 70° Arthroscope Significantly Improves Visualization of the Bicipital Groove in the Lateral Decubitus Position” by Sheean et al.
      • Sheean A.J.
      • Hartzler R.U.
      • Denard P.J.
      • Ladermann A.
      • Hanypsiak B.T.
      • Burkhart S.S.
      A 70° arthroscope significantly improves visualization of the bicipital groove in the lateral decubitus position.
      from San Antonio, Texas, Portland, Oregon, Naples, Florida, and Meyrin, Switzerland. This is a fine follow-up to a classic 2010 article from the Hospital for Special Surgery in New York, “Use of the 70° Arthroscope for Improved Visualization With Common Arthroscopic Procedures.”
      • Bedi A.
      • Dines J.
      • Dines D.M.
      • et al.
      Use of the 70° arthroscope for improved visualization with common arthroscopic procedures.
      In addition, this month's study touting the 70° arthroscope is supplemented by an insightful Editorial Commentary by Sam Taylor, also from the Hospital for Special Surgery.
      • Taylor S.A.
      Using a 70° arthroscope to evaluate the biceps tendon and rule out bicipital tunnel disease is better than using a 30° arthroscope… but still inadequate.
      This article demonstrated that we may need to use alternative viewing methods to ensure that we see all of the pathology in a shoulder, especially in the biceps tendon.
      Next, Millett et al.
      • Petri M.
      • Warth R.J.
      • Horan M.P.
      • Greenspoon J.A.
      • Millett P.J.
      Outcomes after open revision repair of massive rotator cuff tears with biologic patch augmentation.
      from the Steadman Philippon Research Institute in Vail, Colorado, present “Outcomes After Open Revision Repair of Massive Rotator Cuff Tears With Biologic Patch Augmentation.” Commentary
      • Snyder S.J.
      Reflections from a mature arthroscopic shoulder surgeon on the history and current benefits of augmentation for the revision of a massive rotator cuff tear using acellular human dermal matrix allograft.
      is provided by Steve Snyder from Van Nuys, CA, a leader in the introduction of rotator cuff tear biologic augmentation.
      • Barber F.A.
      • Hrnack S.A.
      • Snyder S.J.
      • Hapa O.
      Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation.
      • Wong I.
      • Burns J.
      • Snyder S.
      Arthroscopic graft jacket repair of rotator cuff tears.
      • Snyder S.J.
      • Arnoczky S.P.
      • Bond J.L.
      • Dopirak R.
      Histologic evaluation of a biopsy specimen obtained 3 months after rotator cuff augmentation with GraftJacket Matrix.
      Snyder's astute commentary puts this month's article by the Vail group in clear perspective, and it clearly indicates why Snyder has been revered as an educator for as long as we can remember.
      Two interesting studies from the Rush group (Makhni et al.) evaluate comparative cost-effectiveness for 2 uber-complex shoulder problems: (1) “Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model”
      • Makhni E.C.
      • Lamba N.
      • Swart E.
      • et al.
      Revision arthroscopic repair versus Latarjet procedure in patients with recurrent instability following initial repair attempt: A cost-effectiveness model.
      ; and (2) “Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.”
      • Makhni E.C.
      • Swart E.
      • Steinhaus M.E.
      • et al.
      Costeffectiveness of reverse total shoulder arthroplasty versus arthroscopic rotator cuff repair for symptomatic large and massive rotator cuff tears.
      Cost-effectiveness analysis is a relatively new field of study in arthroscopic and related surgery, and critical analysis is required to allow future authors to improve their methods. Thus, for commentary we turn to Larry Higgins from Boston, who pulls no punches in his critical analysis.
      • Higgins L.D.
      Cost-effectiveness of orthopaedic procedures: “A nickel ain’t worth a dime anymore” – Yogi Berra.
      Higgins is well published in the arena of orthopaedic value assessment.
      • Kaplan R.S.
      • Witkowski M.
      • Abbott M.
      • et al.
      Using time-driven activity-based costing to identify value improvement opportunities in healthcare.
      • Black E.M.
      • Higgins L.D.
      • Warner J.J.
      Value-based shoulder surgery: Practicing outcomes-driven, cost-conscious care.
      • Jain N.B.
      • Kuye I.
      • Higgins L.D.
      • Warner J.J.
      Surgeon volume is associated with cost and variation in surgical treatment of proximal humeral fractures.
      • Freedman J.
      • Guller U.
      • Benjamin D.K.
      • et al.
      National trends in health care utilization and racial and socioeconomic disparities in pediatric pyogenic arthritis.
      • Jain N.B.
      • Pietrobon R.
      • Guller U.
      • Ahluwalia A.S.
      • Higgins L.D.
      Influence of provider volume on length of stay, operating room time, and discharge status for rotator cuff repair.
      • Jain N.
      • Pietrobon R.
      • Guller U.
      • Shankar A.
      • Ahluwalia A.S.
      • Higgins L.D.
      Effect of provider volume on resource utilization for surgical procedures of the knee.
      • Green L.B.
      • Pietrobon R.
      • Paxton E.
      • Higgins L.D.
      • Fithian D.
      Sources of variation in readmission rates, length of stay, and operative time associated with rotator cuff surgery.
      We note the original scientific article “Short-Term Outcomes of Glenoid Bone Block Augmentation for Complex Anterior Shoulder Instability in a High-Risk Population” by Waterman et al.
      • Waterman B.R.
      • Chandler P.J.
      • Teague E.
      • Provencher M.T.
      • Tokish J.M.
      • Pallis M.P.
      Short-term outcomes of glenoid bone block augmentation for complex anterior shoulder instability in a high-risk population.
      from El Paso, Texas, and Boston, Massachusetts, with commentary by Associate Editor Nikhil Verma,
      • Verma N.N.
      Glenoid bone reconstruction for recurrent shoulder instability—risk or benefit?.
      whose editorial acumen is impressive and who is well published on the topic of shoulder instability including glenoid reconstruction using bone grafts.
      • Frank R.M.
      • Taylor D.
      • Verma N.N.
      • Romeo A.A.
      • Mologne T.S.
      • Provencher M.T.
      The rotator interval of the shoulder: Implications in the treatment of shoulder instability.
      • Shin J.J.
      • Mascarenhas R.
      • Patel A.V.
      • et al.
      Clinical outcomes following revision anterior shoulder arthroscopic capsulolabral stabilization.
      • Bhatia S.
      • Saigal A.
      • Frank R.M.
      • et al.
      Glenoid diameter is an inaccurate method for percent glenoid bone loss quantification: analysis and techniques for improved accuracy.
      • Chalmers P.N.
      • Mascarenhas R.
      • Leroux T.
      • et al.
      Do arthroscopic and open stabilization techniques restore equivalent stability to the shoulder in the setting of anterior glenohumeral instability? A systematic review of overlapping meta-analyses.
      • Erickson B.J.
      • Bhatia S.
      • Biswas D.
      • Verma N.N.
      Acute infection with propionibacterium acnes after a Latarjet coracoid transfer procedure: A case report.
      • Forsythe B.
      • Frank R.M.
      • Ahmed M.
      • et al.
      Identification and treatment of existing copathology in anterior shoulder instability repair.
      • Frank R.M.
      • Shin J.
      • Saccomanno M.F.
      • et al.
      Comparison of glenohumeral contact pressures and contact areas after posterior glenoid reconstruction with an iliac crest bone graft or distal tibial osteochondral allograft.
      • Sayegh E.T.
      • Mascarenhas R.
      • Chalmers P.N.
      • Cole B.J.
      • Verma N.N.
      • Romeo A.A.
      Allograft reconstruction for glenoid bone loss in glenohumeral instability: A systematic review.
      • Frank R.M.
      • Mall N.A.
      • Gupta D.
      • et al.
      Inferior suture anchor placement during arthroscopic Bankart repair: Influence of portal placement and curved drill guide.
      • Gupta A.K.
      • McCormick F.M.
      • Abrams G.D.
      • et al.
      Arthroscopic bony Bankart fixation using a modified Sugaya technique.
      • Strauss E.J.
      • Salata M.J.
      • Sershon R.A.
      • et al.
      Role of the superior labrum after biceps tenodesis in glenohumeral stability.
      • Harris J.D.
      • Gupta A.K.
      • Mall N.A.
      • et al.
      Long-term outcomes after Bankart shoulder stabilization.
      • Bhatia S.
      • Ghodadra N.S.
      • Romeo A.A.
      • et al.
      The importance of the recognition and treatment of glenoid bone loss in an athletic population.
      • Nho S.J.
      • Frank R.M.
      • Van Thiel G.S.
      • et al.
      A biomechanical analysis of shoulder stabilization: Posteroinferior glenohumeral capsular plication.
      • Ghodadra N.
      • Gupta A.
      • Romeo A.A.
      • et al.
      Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting.
      Lastly, we note “Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review” by Longo et al.
      • Longo U.G.
      • Rizzello G.
      • Ciuffreda M.
      • et al.
      Humeral avulsion of the glenohumeral ligaments: A systematic review.
      from Rome. Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon, but not rare, cause of shoulder instability, and as the orthopaedic adage goes, we may not have seen a HAGL, but it has seen us.
      Taken in sum, it is clear that shoulder arthroscopic and related surgery has evolved to a point where the most difficult clinical challenges are under investigation, from visualization of the bicipital groove,
      • Sheean A.J.
      • Hartzler R.U.
      • Denard P.J.
      • Ladermann A.
      • Hanypsiak B.T.
      • Burkhart S.S.
      A 70° arthroscope significantly improves visualization of the bicipital groove in the lateral decubitus position.
      • Taylor S.A.
      • Khair M.M.
      • Gulotta L.V.
      • et al.
      Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.
      • Brady P.C.
      • Narbona P.
      • Adams C.R.
      • et al.
      Arthroscopic proximal biceps tenodesis at the articular margin: Evaluation of outcomes, complications, and revision rate.
      • Gilmer B.B.
      • DeMers A.M.
      • Guerrero D.
      • Reid III, J.B.
      • Lubowitz J.H.
      • Guttmann D.
      Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis.
      • Festa A.
      • Allert J.
      • Issa K.
      • Tasto J.P.
      • Myer J.J.
      Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy.
      to massive cuff tear,
      • Petri M.
      • Warth R.J.
      • Horan M.P.
      • Greenspoon J.A.
      • Millett P.J.
      Outcomes after open revision repair of massive rotator cuff tears with biologic patch augmentation.
      • Makhni E.C.
      • Swart E.
      • Steinhaus M.E.
      • et al.
      Costeffectiveness of reverse total shoulder arthroplasty versus arthroscopic rotator cuff repair for symptomatic large and massive rotator cuff tears.
      • Weber S.
      Arthroscopic partial rotator cuff repair in the management of massive rotator cuff tears: long-term follow-up.
      • Lubowitz J.H.
      Editorial commentary: How do we tell patients their rotator cuff tear is massive?.
      • Kim S.-J.
      • Lee I.-S.
      • Kim S.-H.
      • Lee W.-Y.
      • Chun Y.-M.
      Arthroscopic partial repair of irreparable large to massive rotator cuff tears.
      • Lädermann A.
      • Denard P.J.
      • Burkhart S.S.
      Midterm outcome of arthroscopic revision repair of massive and nonmassive rotator cuff tears.
      • Henry P.
      • Wasserstein D.
      • Park S.
      • et al.
      Arthroscopic repair for chronic massive rotator cuff tears: A systematic review.
      • Park J.-Y.
      • Lhee S.-H.
      • Oh K.-S.
      • Moon S.G.
      • Hwang J.-T.
      Clinical and ultrasonographic outcomes of arthroscopic suture bridge repair for massive rotator cuff tear.
      • Charousset C.
      • Zaoui A.
      • Bellaïche L.
      • Piterman M.
      Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears?.
      and from revision shoulder stabilization,
      • Makhni E.C.
      • Lamba N.
      • Swart E.
      • et al.
      Revision arthroscopic repair versus Latarjet procedure in patients with recurrent instability following initial repair attempt: A cost-effectiveness model.
      • Blackman A.J.
      • Krych A.J.
      • Kuzma S.A.
      • Chow R.M.
      • Camp C.
      • Dahm D.L.
      Results of revision anterior shoulder stabilization surgery in adolescent athletes.
      • Abouali J.A.K.
      • Hatzantoni K.
      • Holtby R.
      • Veillette C.
      • Theodoropoulos J.
      Revision arthroscopic Bankart repair.
      • Friedman L.G.M.
      • Griesser M.J.
      • Miniaci A.A.
      • Jones M.H.
      Recurrent instability after revision anterior shoulder stabilization surgery.
      • Dewing C.B.
      • Horan M.P.
      • Millett P.J.
      Two-year outcomes of open shoulder anterior capsular reconstruction for instability from severe capsular deficiency.
      • Waterman B.R.
      • Burns T.C.
      • McCriskin B.
      • Kilcoyne K.
      • Cameron K.L.
      • Owens B.D.
      Outcomes after Bankart repair in a military population: Predictors for surgical revision and long-term disability.
      • Zhang A.L.
      • Montgomery S.R.
      • Ngo S.S.
      • Hame S.L.
      • Wang J.C.
      • Gamradt S.C.
      Arthroscopic versus open shoulder stabilization: Current practice patterns in the United States.
      • Tjoumakaris F.P.
      • Bradley J.P.
      The rationale for an arthroscopic approach to shoulder stabilization.
      • Shah A.S.
      • Karadsheh M.S.
      • Sekiya J.K.
      Failure of operative treatment for glenohumeral instability: Etiology and management.
      • Kim S.-J.
      • Kim S.-H.
      • Park B.-K.
      • Chun Y.-M.
      Arthroscopic stabilization for recurrent shoulder instability with moderate glenoid bone defect in patients with moderate to low functional demand.
      to glenoid reconstruction in populations at high risk for shoulder instability,
      • Waterman B.R.
      • Chandler P.J.
      • Teague E.
      • Provencher M.T.
      • Tokish J.M.
      • Pallis M.P.
      Short-term outcomes of glenoid bone block augmentation for complex anterior shoulder instability in a high-risk population.
      • Blackman A.J.
      • Krych A.J.
      • Kuzma S.A.
      • Chow R.M.
      • Camp C.
      • Dahm D.L.
      Results of revision anterior shoulder stabilization surgery in adolescent athletes.
      • Waterman B.R.
      • Burns T.C.
      • McCriskin B.
      • Kilcoyne K.
      • Cameron K.L.
      • Owens B.D.
      Outcomes after Bankart repair in a military population: Predictors for surgical revision and long-term disability.
      and the subtle HAGL.
      • Forsythe B.
      • Frank R.M.
      • Ahmed M.
      • et al.
      Identification and treatment of existing copathology in anterior shoulder instability repair.
      • Longo U.G.
      • Rizzello G.
      • Ciuffreda M.
      • et al.
      Humeral avulsion of the glenohumeral ligaments: A systematic review.
      • Provencher M.
      • McCormick F.
      • Gaston T.
      • LeClere L.
      • Solomon D.
      • Dewing C.
      A prospective outcome evaluation of humeral avulsions of the glenohumeral ligament (HAGL) tears in an active population.
      • Southgate D.F.
      • Bokor D.J.
      • Longo U.G.
      • Wallace A.L.
      • Bull A.M.
      The effect of humeral avulsion of the glenohumeral ligaments and humeral repair site on joint laxity: A biomechanical study.
      And Editorial Commentaries expand the scientific conversation.
      Shoulder arthroscopic and related surgeons may require expertise in use of the 70° arthroscope, biologic patch augmentation, repair of massive rotator cuff tears, the Latarjet procedure and related glenoid bone augmentation, and reverse total shoulder arthroplasty. Although there are many fine journals that must not be ignored, in the interest of patients, we hope surgeons treating complex shoulder pathology read Arthroscopy.

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