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.
1
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.”2
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.3
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.
4
from the Steadman Philippon Research Institute in Vail, Colorado, present “Outcomes After Open Revision Repair of Massive Rotator Cuff Tears With Biologic Patch Augmentation.” Commentary5
is provided by Steve Snyder from Van Nuys, CA, a leader in the introduction of rotator cuff tear biologic augmentation.6
, 7
, 8
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”
9
; and (2) “Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.”10
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.11
Higgins is well published in the arena of orthopaedic value assessment.12
, - Kaplan R.S.
- Witkowski M.
- Abbott M.
- et al.
Using time-driven activity-based costing to identify value improvement opportunities in healthcare.
J Healthc Manag. 2014; 59: 399-412
- Black E.M.
- Higgins L.D.
- Warner J.J.
Value-based shoulder surgery: Practicing outcomes-driven, cost-conscious care.
J Shoulder Elbow Surg. 2013; 22: 1000-1009
13
, 14
, 15
, 16
, 17
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.
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from El Paso, Texas, and Boston, Massachusetts, with commentary by Associate Editor Nikhil Verma,19
whose editorial acumen is impressive and who is well published on the topic of shoulder instability including glenoid reconstruction using bone grafts.20
, 21
, 22
, 23
, 24
, 25
, 26
, 27
, 28
, 29
, 30
, 31
, 32
, 33
, 34
Lastly, we note “Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review” by Longo et al.
35
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,
1
, 36
, 37
, 38
, 39
to massive cuff tear,4
, 10
, 40
, 41
, 42
, 43
, 44
, 45
, 46
and from revision shoulder stabilization,9
, 47
, 48
, 49
, 50
, 51
, 52
, 53
, 54
, 55
to glenoid reconstruction in populations at high risk for shoulder instability,18
, 47
, 51
and the subtle HAGL.25
, 35
, 56
, 57
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.
References
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- 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.Arthrosopy. 2016; 32: 1750-1751
- Outcomes after open revision repair of massive rotator cuff tears with biologic patch augmentation.Arthroscopy. 2016; 32: 1752-1760
- 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.Arthroscopy. 2016; 32: 1761-1763
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- Comparison of glenohumeral contact pressures and contact areas after posterior glenoid reconstruction with an iliac crest bone graft or distal tibial osteochondral allograft.Am J Sports Med. 2014; 42: 2574-2582
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- Editorial Commentary: Using a 70° Arthroscope to Evaluate the Biceps Tendon and Rule Out Bicipital Tunnel Disease Is Better Than Using a 30° Arthroscope… but Still InadequateArthroscopyVol. 32Issue 9
- PreviewIn a well-constructed study using both cadaveric and in vivo models, Sheean et al. found that use of a 70° arthroscope significantly improves visualization of the long head of the biceps tendon and zone 1 of the bicipital tunnel compared with a standard 30° arthroscope during shoulder arthroscopy. Enthusiasm for the added visualization afforded by the 70° arthroscope, however, should be tempered by the fact that zone 2 of the bicipital tunnel and the biceps tendon within remain hidden from view along with any pathology it harbors.
- Full-Text
- Preview
- Editorial Commentary: Glenoid Bone Reconstruction for Recurrent Shoulder Instability—Risk or Benefit?ArthroscopyVol. 32Issue 9
- PreviewBone reconstruction for management of glenohumeral instability to reduce postoperative recurrence rates is increasingly emphasized in our literature. Unfortunately, significant complication rates are associated with these procedures, particularly in the United States where training in bony glenoid reconstruction may be limited. The alternative of early intervention, specifically surgical treatment of first-time shoulder dislocation, could result in glenoid bone preservation and overall improvement in the results of soft-tissue stabilization procedures.
- Full-Text
- Preview
- Editorial Commentary: Cost-Effectiveness of Orthopaedic Procedures: “A Nickel Ain't Worth a Dime Anymore” – Yogi BerraArthroscopyVol. 32Issue 9
- PreviewAlthough cost-effectiveness research has assumed a critical role in decision making in medicine, it, by definition, must be derived from solid, germane, reproducible data. The absence of such high-quality data tends to induce compromises in analysis that may degrade a scientific article's seemingly intuitive message.
- Full-Text
- Preview
- Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff TearsArthroscopyVol. 32Issue 9
- A 70° Arthroscope Significantly Improves Visualization of the Bicipital Groove in the Lateral Decubitus PositionArthroscopyVol. 32Issue 9
- Editorial Commentary: 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 AllograftArthroscopyVol. 32Issue 9
- PreviewAcellular human dermal matrix allografts are now being used to augment and sometimes replace severely damaged rotator cuff tissue. I have been interested in this important aspect of orthopaedics for 15 years and am pleased to have the opportunity to share my personal reflections of some of the highlights in science and the literature that helped get to the point now where we can expect greater than 80% healing even in these difficult cases of revision after massive failed cuff repair. The field of tissue engineering will certainly be a critical part of our rotator cuff surgical future.
- Full-Text
- Preview
- Outcomes After Open Revision Repair of Massive Rotator Cuff Tears With Biologic Patch AugmentationArthroscopyVol. 32Issue 9
- Short-Term Outcomes of Glenoid Bone Block Augmentation for Complex Anterior Shoulder Instability in a High-Risk PopulationArthroscopyVol. 32Issue 9
- Humeral Avulsion of the Glenohumeral Ligaments: A Systematic ReviewArthroscopyVol. 32Issue 9
- Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness ModelArthroscopyVol. 32Issue 9