Our primary objective was to compare healing rates in patients undergoing arthroscopic rotator cuff repair for degenerative tears, with and without bone channeling. Our secondary objectives were to compare disease-specific quality of life and patient reported outcomes as measured by the Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score and Constant score between groups.

Patients undergoing arthroscopic rotator cuff repair at three sites were randomized to receive either bone channeling augmentation or standard repair. Healing rates were determined by ultrasound at 6 and 24 months post operatively. WORC, ASES, and Constant scores were compared between groups at baseline and at 3, 6, 12 and 24 months post operatively.

One hundred sixty-eight patients were recruited and randomized between 2013 to 2018. Statistically significant improvements occurred in both groups from pre-operative to all time points in all clinical outcome scores (p < 0 .0001). Intention to treat analysis revealed no statistical differences in healing rates between the two interventions at 24 months post-operative. No differences were observed in WORC, ASES or Constant scores at any time-point.

This trial did not demonstrate superiority of intra-operative bone channeling in rotator cuff repair surgery at 24 months post-operative. Healing rates and patient-reported function and quality of life measures were similar between groups.

Purpose

Locking plate constructs for proximal humerus fractures can fail due to varus collapse, especially in the presence of osteoporosis and comminution of the medial cortex. Augmentation using a fibular allograft as an intramedullary bone peg may strengthen fixation preventing varus collapse. This study compared the ability of the augmented locking plate construct to withstand repetitive varus stresses relative to the non-augmented construct in cadaveric specimens.

Purpose: Due to its proximity to the glenohumeral joint, the suprascapular nerve may be at risk of iatrogenic nerve injury during arthroscopic labral repair. Our primary objective is to evaluate the risk of suprascapular nerve injury during standard drilling techniques utilized in arthroscopic superior labral repairs. Secondarily, we evaluated the correlation between this risk and scapular size.

Method: Forty-two cadaveric shoulders were dissected to isolate their scapulae. A surgical drill and guide was used to create suture anchor holes in 3 locations in the superior rim of the glenoids as typically done in arthroscopic superior labral repairs. The orientation of these drill holes correspond to common shoulder arthroscopic portals. The suprascapular nerve was then dissected from the suprascapular notch to the spinoglenoid notch. The presence of drill perforations through the medial cortex of the glenoid vault was recorded along with the corresponding hole depth and distance to the suprascapular nerve.

Results: Medial glenoid vault perforations occurred in 8/21(38%) cadavers with a total of 18/126(14%) perforations. The suprascapular nerve was in line of the drill path in 5/18(28%) perforations. Female specimens and smaller scapulae had a statistically higher risk of having a perforation (p< 0.05).

Conclusion: The results of this anatomic study suggest that there is a substantial risk of medial glenoid vault perforation. When a perforation does occur, the suprascapular nerve appears to be at high risk for injury especially with more posterior drill holes. The risk is significantly higher in females and in smaller scapulae.

Purpose: The purpose of this study is to compare two fixation methods for surgical neck proximal humeral fractures with medial calcar comminution:

locking plate fixation alone and

Method: Eight embalmed pairs of cadaveric specimens were utilized in this study. Dual energy X-ray absorptiometry (DXA) scans were initially performed to determine the bone density of the specimens. Surgical neck proximal humerus fractures were simulated in these specimens by creating a 1-centimeter wedge-shaped osteotomy at the level of the surgical neck to simulate medial calcar fracture comminution. Each pair of specimens had one arm randomly repaired with locking plate fixation, and the other arm repaired with locking plate fixation augmented with an intramedullary fibular autograft bone peg. The constructs were tested in bending to determine the failure loads, and initial stiffness using Digital Imaging Correlation (DIC) technology. The moment created by the rotator cuff was replicated by fixating the humeral head, and applying a point load to the distal humerus. A load was applied with a displacement rate of 4 mm/min, and was stopped approximately every 5 lbs to take a picture and record the load. This process was continued until failure of the specimens was obtained.

Results: The intramedullary bone peg autograft increased the failure load of the constructs by 1.57±0.59 times (p = 0.026). Initial stiffness of the construct was also increased 3.13±2.10 times (p = 0.0079) with use of the bone peg.

Conclusion: The stronger and stiffer construct provided by the addition of an intramedullary fibular allograft bone peg to locking plate fixation may help maintain reduction, and reduce the risk of fixation failure in surgical neck proximal humerus fractures with medial comminution.