Purpose

There is minimal information on outcome of glenohumeral debridement for treatment of shoulder osteoarthritis (OA). The purpose of this study was to examine the outcome of this procedure with or without acromioplasty /resection of clavicle in subjective perception of disability and functional range of motion and strength at one year following surgery.

Purpose: The purposes of this study were to examine factors that influenced the decision to repair a SLAP Type II lesion and to examine the difference between patients with and without a SLAP repair.

Method: Prospectively collected data of patients who had a SLAP Type II lesion were reviewed. Patients who had a repair were compared with those who did not have a clinical indication for repair. Disability outcome measures collected pre and 2 years post-operatively were the American Shoulder and Elbow Surgeons (ASES) and the Constant-Murley scores (CMS). Paired and independent t-tests and logistic regression were performed.

Results: One hundred and six patients (83 males, 23 females), mean age=50 (SD=14, range 18–81), with a SLAP Type II lesion were identified. Eleven patients (10%) had isolated SLAP pathology for which they received a repair. The remaining 95 (90%) patients had concurrent pathologies related to rotator cuff, instability, osteoarthritis, and other pathologies. Repair of the SLAP lesion was felt to be clinically indicated in 43(45%) of patients with combined lesions. Factors that influenced the decision to repair the SLAP lesion were age, nature of the associated pathology, the presence of a large or massive full thickness rotator cuff tear, anterior instability, and a partial biceps tear greater than 50% that required a tenodesis. Significant improvement was observed in the ASES and CMS scores (p < 0.0001) whether or not a SLAP repair was performed.

Conclusion: This study indicates that age and presence of certain associated pathologies influence the need for SLAP Type II repair. A statistically significant improvement in strength and disability level is observed in patients with SLAP Type II lesions associated with concomitant pathology, despite not having the SLAP lesion repaired. The indications for SLAP Type II repair in the presence of other pathologies are discussed.

Purpose: The purpose of this matched cohort study was to examine the clinical outcome of biceps tendon debridement at two years following surgery.

Method: The study group included patients who had undergone debridement of a tear of less than or equal to 50% of the biceps tendon. The control group did not have biceps pathology and was chosen from the same pool of data and was matched with the study group by sex, age and type of associated pathology. Standardized pre and post operative data on history and clinical examination of all patients had been collected prospectively. The outcome measures were the American Shoulder and Elbow Surgeons (ASES) assessment form, the relative Constant-Murley score (CMS), and the Western Ontario Rotator Cuff (WORC) Index. Paired and independent T-tests were performed.

Results: Review of data identified 122 patients (16 females, 45 males in each group). The mean age was 59 (SD: 11) and 57 (SD: 12) for the study and control groups respectively. Fifty six percent of the subjects in each group (34/61) had impingement or partial thickness rotator cuff tears treated with a decompression (acromioplasty/ decompression). Twenty two patients (36%) had rotator cuff repair, and 5 (8%) had a SLAP repair. A statistically significant improvement was observed in the scores of WORC, ASES and CMS (p< 0.0001) in both groups. The magnitude of change, based on the effect size showed a large change in both groups. There was no statistically significant difference in pre and post-operative scores or recovery between groups.

Conclusion: Low grade tears of the biceps tendon do not appear to produce more disability prior to surgical treatment and are effectively treated with biceps debridement in addition to surgical treatment of associated pathologies.

Purpose: This prospective, randomized double-blinded clinical trial compared cemented fixation of the humeral component to uncemented/tissue-in-growth fixation in total shoulder arthroplasty for primary osteoarthritis of the shoulder.

Method: All patients presenting with primary osteoarthritis of the shoulder requiring replacement were screened for eligibility. Patients were randomized in the operating room after glenoid preparation to the cemented or uncemented group by a computer-generated, stratified randomization procedure. Outcome measures included disease specific QOL assessment (WOOS), SF-12, ASES, MACTAR, radiographic evaluation of component fixation, operative time, complications and revision surgery. Patients were assessed by a blinded evaluator in post-operative intervals of 2 and 6 weeks, and 3, 6, 12, 18, and 24 months. The primary endpoint was the WOOS score at 2 years.

Results: One hundred and sixty-one patients were consented and randomized for the study. There were 80 patients in the cemented and 81 patients in the uncemented group. At baseline, the groups were alike with regards to demographics and baseline evaluations. The WOOS scores at post-operative intervals of 12, 18 and 24 months showed a significant difference (p=0.009, 0.001, 0.028 respectively) in favour of the cemented group. The cemented group also had better strength (3 m p=0.038, 12 m p= 0.036, 18 m p=0.051, 24 m p=0.053) and forward flexion (6m p=0.031, 12 m p=0.04). As expected, the operative time was significantly less for the uncemented group (C = 2.26h +/−.63; U = 1.69h +/− 1.9, p= 0.03).

Conclusion: These findings provide the first evidence that cemented fixation of the humeral head provides better quality of life, strength and ROM than uncemented fixation. This was a Tier 1 Project of the JOINTs Canada group.

Purpose: There is controversial information on recovery of patients with compensable injuries. The purpose of this matched case-control study was to examine the impact of an active compensation claim following a work-related shoulder injury on reporting disability as measured by subjective and objective outcomes at 1 year post-operatively.

Method: Data of 506 consecutive patients who had undergone a decompression or rotator cuff repair were reviewed. One hundred and fourteen patients were on compensation related to their shoulder problems. Patients were matched with a historical control group (patients without a compensation claim) based on age (4 age groups: < 40, 40–49, 50–59, 60–70), sex, and pathology (full-thickness tear vs. no tear). Outcome measures used were a disease-specific outcome, the Western Ontario Rotator Cuff Index (WORC) and two shoulder specific instruments, the American Shoulder and Elbow Score (ASES) and the Constant Murley (CM) score. Paired and independent t-tests and an analysis of covariance were performed.

Results: Data of the 214 patients (72 males and 35 females in each group) was used for analysis (mean age 48, SD: 10, range 20–69). Out of 107 patients in each group, 42 patients (58%) had undergone a full-thickness repair and 65 (61%) had surgeries related to impingement syndrome. Paired and independent t-tests showed that both groups improved significantly regardless of their claim status. However, the compensation group had a significantly lower level of improvement than the non-compensation group. An analysis of covariance which adjusted for pre-operative differences in disability scores showed that an active claim was indeed a strong predictor of follow up scores.

Conclusion: This is the first study that has used a matched case-control design to control for potential confounding factors in injured worker population. Our results indicate that although patients with work-related injuries demonstrate a lower level of recovery, they still benefit from surgery.