Publications by authors named "Brandon T Goldenberg"

19 Publications

  • Page 1 of 1

Glenoid retroversion does not impact clinical outcomes or implant survivorship after total shoulder arthroplasty with minimal, noncorrective reaming.

JSES Int 2022 Jul 18;6(4):596-603. Epub 2022 Mar 18.

The Steadman Clinic, Vail, CO, USA.

Hypothesis: Both clinical outcomes and early rates of failure will not be associated with glenoid retroversion.

Methods: All patients who underwent an anatomic total shoulder arthroplasty with minimal, noncorrective reaming between 2006 and 2016 with minimum 2-year follow-up were reviewed. Measurements for retroversion, inclination, and posterior subluxation were obtained from magnetic resonance imaging or computerized tomography. A regression analysis was performed to assess the association between retroversion, inclination and subluxation, and their effect on patient reported outcomes (PROs). Clinical failures and complications were reported.

Results: One hundred fifty-one anatomic total shoulder arthroplasties (90% follow-up) with a mean follow-up of 4.6 years (range, 2-12 years) were assessed. The mean preoperative retroversion was 15.6° (range, 0.2-42.1), the mean posterior subluxation was 15.1% (range, -3.6 to 44.1%), and the mean glenoid inclination was 13.9° (range, -11.3 to 44.3). All median outcome scores improved significantly from pre- to post-operatively ( < .001). The median satisfaction was 10/10 (1st quartile = 7 and 3rd quartile = 10). Linear regression analysis found no significant association between retroversion and any postoperative PRO. A total of 5 (3.3%) failures occurred due to glenoid implant loosening (3 patients) and Cutibacterium acnes infection (2 patients) with no association between failure causation and increased retroversion or inclination. No correlation could be found between the Walch classification and postoperative PROs.

Conclusion: Anatomic total shoulder replacement with minimal and noncorrective glenoid reaming demonstrates reliable increases in patient satisfaction and clinical outcomes at a mean of 4.6-year follow-up in patients with up to 40° of native retroversion. Higher values of retroversion were not associated with early deterioration of clinical outcomes, revisions, or failures. Long-term studies are needed to see if survivorship and outcomes hold up over time.
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http://dx.doi.org/10.1016/j.jseint.2022.02.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264025PMC
July 2022

SLAP Repair Versus Subpectoral Biceps Tenodesis for Isolated SLAP Type 2 Lesions in Overhead Athletes Younger Than 35 Years: Comparison of Minimum 2-Year Outcomes.

Orthop J Sports Med 2022 Jun 21;10(6):23259671221105239. Epub 2022 Jun 21.

Steadman Philippon Research Institute, Vail, Colorado, USA.

Background: It remains unclear if young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type 2 lesions benefit more from SLAP repair or subpectoral biceps tenodesis.

Purpose: To evaluate clinical outcomes and return to sport in overhead athletes with symptomatic SLAP type 2 lesions who underwent either biceps tenodesis or SLAP repair.

Study Design: Cohort study; Level of evidence, 3.

Methods: A retrospective analysis of prospectively collected data was performed in patients who underwent subpectoral biceps tenodesis (n = 14) or SLAP repair (n = 24) for the treatment of isolated type 2 SLAP lesions. All patients were aged <35 years at time of surgery, participated in overhead sports, and were at least 2 years out from surgery. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numerical Evaluation (SANE) score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; and the 12-Item Short Form (SF-12) physical component score. Return to sport and patient satisfaction were documented. Clinical failures requiring revision surgery and complications were reported.

Results: Preoperative baseline scores in both the tenodesis and SLAP repair groups were similar. There were no significant differences between the groups on any postoperative outcome measure: For biceps tenodesis versus SLAP repair, the ASES score was 92.7 ± 10.4 versus 89.1 ± 16.7, the SANE score was 86.2 ± 13.7 versus 83.0 ± 24.1, the QuickDASH score was 10.0 ± 12.7 versus 9.0 ± 14.3, and SF-12 was 51.2 ± 7.5 versus 52.8 ± 7.7. No group difference in return-to-sports rate (85% vs 79%; = .640) was noted. More patients in the tenodesis group (80%) reported modifying their sporting/recreational activity postoperatively because of weakness compared with patients in the SLAP repair group (15%; = .022). One patient in each group progressed to surgery for persistent postoperative stiffness, and 1 patient in the tenodesis group had a postoperative complication related to the index surgery.

Conclusion: Both subpectoral biceps tenodesis and SLAP repair provided excellent clinical results for the treatment of isolated SLAP type 2 lesions, with a high rate of return to overhead sports and a low failure rate, in a young and high-demanding patient cohort. More patients reported modifying their sporting/recreational activity because of weakness after subpectoral tenodesis.
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http://dx.doi.org/10.1177/23259671221105239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9218463PMC
June 2022

Concomitant Glenolabral Articular Disruption (GLAD) Lesion is Not Associated With Inferior Clinical Outcomes After Arthroscopic Bankart Repair for Shoulder Instability: A Retrospective Comparative Study.

Arthrosc Sports Med Rehabil 2022 Jun 31;4(3):e1015-e1022. Epub 2022 Mar 31.

Steadman Philippon Research Institute, Vail, Colorado.

Purpose: The purpose of this study was to compare outcomes between anterior shoulder instability patients with and without glenolabral articular disruption (GLAD) lesions after undergoing arthroscopic Bankart repair and to evaluate potential risk factors for inferior outcomes and recurrent instability.

Methods: Prospectively collected data were retrospectively reviewed for patients who underwent arthroscopic Bankart repair with and without GLAD lesions at a minimum of 2 years follow-up. Consecutive patients were matched by age, sex, and number of anchors. Patient-reported outcomes (PROs) were evaluated before and after surgery, including American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, Quick Disabilities of the Arm, Shoulder and Hand, Short Form-12 score, and satisfaction. Recurrent dislocation, subjective instability, and reoperation were analyzed. Additionally, PROs were assessed on the basis of GLAD lesion characteristics.

Results: A total of 54 patients (27 GLAD, 27 control) with a mean age of 28.9 ± 11.6 years were analyzed at mean 4.5 ± 1.9 years (range, 2-9 years) follow-up. Thirty-eight (70.3%) of the participants were male. Patients in both groups experienced significant improvements in all PROs ( ≤ .006 for all measures) and reported high median satisfaction (scale 1-10: 10 vs 10,  = .290) at final follow-up. Two patients in the GLAD cohort and 1 in the control cohort underwent reoperation ( = .588). Four (14.8%) patients in each group reported recurrent dislocation ( = 1.0). Additionally, 2 (7.4%) GLAD patients and 1 (3.7%) control patient reported subjective shoulder instability after surgery ( = 1.0). No significant differences in PROs were observed based on anchor/labral advancement or treatment with microfracture, nor were significant correlations observed between GLAD lesion size and PROs ( > .05 for all).

Conclusion: Arthroscopic Bankart repair in patients with GLAD lesions resulted in significantly improved outcomes with high satisfaction, which was no different when compared with those without GLAD lesions.

Level Of Evidence: Level III, retrospective comparative study.
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http://dx.doi.org/10.1016/j.asmr.2022.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210388PMC
June 2022

Rehabilitation Following Posterior Shoulder Stabilization.

Int J Sports Phys Ther 2021 Jun 1;16(3):930-940. Epub 2021 Jun 1.

The Steadman Clinic; Steadman Philippon Research Institute.

Posterior shoulder instability has been noted in recent reports to occur at a higher prevalence than originally believed, with many cases occurring in active populations. In most cases, primary surgical treatment for posterior shoulder instability-a posterior labral repair-is indicated for those patients who have failed conservative management and demonstrate persistent functional limitations. In order to optimize surgical success and return to a prior level of function, a comprehensive and focused rehabilitation program is crucial. Currently, there is a limited amount of literature focusing on rehabilitation after surgery for posterior instability. Therefore, the purpose of this clinical commentary is to present a post-surgical rehabilitation program for patients following posterior shoulder labral repair, with recommendations based upon best medical evidence.

Level Of Evidence: 5.
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http://dx.doi.org/10.26603/001c.22501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8168996PMC
June 2021

Quantitative T2 mapping of the glenohumeral joint cartilage in asymptomatic shoulders and shoulders with increasing severity of rotator cuff pathology.

Eur J Radiol Open 2021 13;8:100329. Epub 2021 Feb 13.

Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA.

Purpose: To examine the relationship between glenohumeral cartilage T2 mapping values and rotator cuff pathology.

Method: Fifty-nine subjects (age 48.2 ± 13.5 years, 15 asymptomatic volunteers and 10 tendinosis, 13 partial-thickness tear, 8 full-thickness tear, and 13 massive tear patients) underwent glenohumeral cartilage T2 mapping. The humeral head cartilage was segmented in the sagittal and coronal planes. The glenoid cartilage was segmented in the coronal plane. Group means for each region were calculated and compared between the groups.

Results: Massive tear group T2 values were significantly higher than the asymptomatic group values for the humeral head cartilage included in the sagittal (45 ± 7 versus 32 ± 4 ms,  <  .001) and coronal (44 ± 6 versus 38 ± 1 ms,  =  0.01) plane images. Mean T2 was also significantly higher for massive than full-thickness tears (45 ± 7 versus 38 ± 5 ms,  =  0.02), massive than partial-thickness tears (45 ± 7 versus 34 ± 4 ms,  <  0.001), and massive tears than tendinosis (45 ± 7 versus 35 ± 4 ms,  =  0.001) in the sagittal-images humeral head region and significantly higher for massive tears than asymptomatic shoulders (44 ± 6 versus 38 ± 1 ms,  =  0.01) in the coronal-images humeral head region.

Conclusion: Humeral head cartilage T2 values were significantly positively correlated with rotator cuff pathology severity. Massive rotator cuff tear patients demonstrated significantly higher superior humeral head cartilage T2 mapping values relative to subjects with no/lesser degrees of rotator cuff pathology.
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http://dx.doi.org/10.1016/j.ejro.2021.100329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895706PMC
February 2021

Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability in the Athlete - Key Considerations for Rehabilitation.

Int J Sports Phys Ther 2021 Feb 1;16(1):259-269. Epub 2021 Feb 1.

Steadman Philippon Research Institute; The Steadman Clinic.

The Latarjet procedure with transfer of the coracoid process and its attached conjoint tendon is a well-established surgical technique for the treatment of anterior glenohumeral instability in patients with anteroinferior bone loss and/or high risk for recurrence. Biomechanical and clinical studies have shown excellent results and high rates of return to sports. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through each phase of rehabilitation. Return to sports rehabilitation, progressed by quantitatively measured functional goals, may improve the athlete's integration back to sports participation. Therefore, the purpose of this clinical commentary is to provide a rehabilitation protocol for the Latarjet procedure, progressing through clearly defined phases, with guidance for safe and effective return to sport. Recommended criteria are highlighted which allows the clinician to progress the patient through each phase appropriately rather than purely following timeframes from surgery. This progression ensures the patient has completed a thorough rehabilitation program that addresses ROM, strength, power, neuromuscular control and a graded return to play. Level of Evidence: 5.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872454PMC
February 2021

Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review.

Orthop Res Rev 2020 13;12:151-160. Epub 2020 Oct 13.

Steadman-Philippon Research Institute, Vail, CO 81657, USA.

Large and massive rotator cuff tears have the highest risk of retear. Common biologic modalities that can potentially reduce the retear rate and improve healing include platelet-rich plasma (PRP), scaffolds, and mesenchymal stem cells (MSCs). PRP has been studied for its role in improving rotator cuff healing and results of randomized controlled trials and meta-analyses show mixed results. Most studies in large and massivge tears show that PRP decreases the retear rate, but the connection between structural integrity and clinical outcomes is still unknown. Extracellular matrix (ECM) and synthetic scaffolds can increase healing in augmentation and bridging repair. Acellular dermal allografts have shown better healing rates and outcomes than xenografts in meta-analyses. Synthetic scaffolds augmented with bone marrow-derived stem cells have only been studied in vitro but are promising for the combination of mechanical stability and induction of a biological response. Superior capsule reconstruction is an exciting type of interposition graft reconstruction that has shown favorable early clinical outcomes for large and massive tears. Bone marrow-derived stem cells and adipose-derived stem cells improve the biomechanical characteristics of tendon repair and enhance the histological findings of the healing process in animal studies. However, evidence from human studies is lacking, especially in patients with large and massive tears. In summary, there are many biological options to augment rotator cuff repair in patients with large and massive tears. Due to mixed results and a lack of standardization in high-quality studies, we cannot recommend PRP at this time as an adjunct to rotator cuff repair. Both ECM and synthetic scaffolds, as well as SCR, can be used, especially in situations where native tendon is compromised, and additional mechanical augmentation is needed. Stem cells have been the least studied to date, so it is difficult to give recommendations for or against their use at this time.
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http://dx.doi.org/10.2147/ORR.S260657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568683PMC
October 2020

Total shoulder arthroplasty outcomes after noncorrective, concentric reaming of B2 glenoids.

JSES Int 2020 Sep 6;4(3):644-648. Epub 2020 May 6.

The Steadman Clinic, Vail, CO, USA.

Background: Total shoulder arthroplasty (TSA) is an effective procedure for the treatment of glenohumeral osteoarthritis (GHOA) delivering reliable pain relief and improved shoulder function. Abnormal glenoid morphologies are common, and biconcave glenoids are enigmas that have been associated with poor clinical outcomes and implant survivorship.

Purpose: To assess the clinical outcome scores of patients who underwent noncorrective, concentric reaming for TSA with biconcave glenoids (B2). We hypothesized that patients with B2 glenoids who underwent TSA with glenoid implantation using noncorrective, concentric reaming would have significant improvements in clinical outcome scores and high implant survivorship.

Methods: All patients who underwent anatomic TSA for GHOA with B2 glenoids, performed by a single surgeon, between July 2006 and December 2015 with minimum 2-year follow-up were reviewed. Walch classification was obtained from preoperative imaging (magnetic resonance imaging or computed tomography). Clinical outcome scores were prospectively collected and included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, 12-Item Short Form Health Survey physical component summary (PCS), and patient satisfaction. Clinical failures (revision TSA surgery or conversion to reverse TSA) and complications were reported. Paired test and bivariate correlations level of significance was set at  = .05. Survivorship analysis with implant failure as an endpoint was done using Kaplan-Meier survival curves.

Results: 51 TSA in 49 patients (9 females, 40 males) with primary GHOA with B2 glenoids were performed with a mean age of 64 (range 36-81 years) at the time of surgery. The mean retroversion was 19.1° (range 5.4°-38°), and posterior decentering was 42.0% (range 19.4%-78.5%). At final evaluation, 45/51 anatomic TSAs (88% follow-up) with a mean follow-up of 4.9 years (range 2.0-10.4 years) were assessed. All clinical outcome scores improved significantly pre- to postoperatively: ASES, 52.5 to 79.6 ( < .001); SANE, 52.4 to 74.7 ( < .001); QuickDASH, 39.2 to 19.1 ( = .001); and PCS, 40.9 to 48.9 ( = .001). Median postoperative satisfaction was 9 (range 1-10). There were 2 failures and 4 that required another surgery -subscapularis repair, lysis of adhesions, irrigation and débridement, and one to explore the status of the subscapularis for persistent pain. The implant survivorship rate was 95% at a mean follow-up of 4.9 years.

Conclusion: Anatomic total shoulder replacement with minimally noncorrective, concentric reaming in patients with B2 glenoids had significant improvement in clinical outcome scores, high patient satisfaction, and high survivorship in this cohort.
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http://dx.doi.org/10.1016/j.jseint.2020.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479043PMC
September 2020

Minimum 2-year clinical outcomes after superior capsule reconstruction compared with reverse total shoulder arthroplasty for the treatment of irreparable posterosuperior rotator cuff tears in patients younger than 70 years.

J Shoulder Elbow Surg 2020 Dec 9;29(12):2514-2522. Epub 2020 Jun 9.

Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA. Electronic address:

Background: To compare clinical outcomes following arthroscopic superior capsule reconstruction (SCR) using a dermal allograft (DA) with reverse total shoulder arthroplasty (RTSA) when used to treat irreparable posterosuperior rotator cuff tears without glenohumeral osteoarthritis (GHOA) in patients younger than 70 years.

Methods: In this case-control study, patients who underwent SCR or RTSA for the treatment of irreparable posterosuperior rotator cuff tears, who were younger than 70 years at the time of surgery, and who were at least 2 years out of surgery were included. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numerical Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores and the 12-Item Short Form Health Survey (SF-12). Return to sports and patient satisfaction along with clinical failures (recurrent pain or persistent pain or loss of function), revisions, and complications were reported.

Results: Two-year follow-up was obtained on 22/22 patients (100%) in the SCR group and 29/33 patients (88%) in the RTSA group. Group differences were significant for age (SCR mean, 57 ± 6.6 years, vs. RTSA mean, 63 ± 4.9 years; P < .001) and follow-up interval (SCR mean, 2.1 years, vs. RTSA mean, 2.9 years; P = .001). Preoperative outcome scores showed no significant differences (all P > .05) between groups. No significant differences in postoperative outcome scores were detected (P > .05) between SCR and RTSA: the mean ASES score was 82.6 ± 15.5 vs. 79.3 ± 21.4, mean SANE score was 71.4 ± 24.5 vs. 75.4 ± 23.3, mean QuickDASH score was 16.2 ± 16.9 vs. 25.3 ± 21.0, and mean SF-12 was 47.7 ± 8.8 vs. 46.9 ± 10.4. No significant differences in return-to-sport responses were noticed between groups at baseline or postoperatively (P = .585, P = .758). One SCR was revised at 1.2 years with revision SCR and 1 RTSA had the glenoid component revised day 1 postoperatively for instability. Both patient groups achieved successful clinical outcomes.

Conclusion: SCR using DA results in similar postoperative functional outcomes in a younger patient population when compared to RTSA for the treatment of irreparable posterosuperior rotator cuff tears, without GHOA, at short-term follow-up.
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http://dx.doi.org/10.1016/j.jse.2020.04.002DOI Listing
December 2020

A Systematic Review and Meta-analysis of Biceps Tenodesis Fixation Strengths: Fixation Type and Location Are Biomechanically Equivalent.

Arthroscopy 2020 12 30;36(12):3081-3091. Epub 2020 Jun 30.

The Steadman Clinic, Vail, Colorado, U.S.A; Steadman Philippon Research Institute, Vail, Colorado, U.S.A. Electronic address:

Purpose: The purpose of this meta-analysis and systematic review was to critically evaluate the biomechanical outcomes of different fixation constructs for a variety of biceps tenodesis techniques in cadaveric models based on both type of fixation and location.

Methods: A PROSPERO-registered systematic review (CCRD42018109243) of the current literature was conducted with the terms "long head of biceps" AND "tenodesis" AND "biomechanics" and numerous variations thereof in the PubMed, Embase, and Cochrane databases, yielding 1,460 abstracts. After screening by eligibility criteria, 18 full-text articles were included. The individual biomechanical factors evaluated included ultimate load to failure (in newtons), stiffness (in newtons per millimeter), and cyclic displacement (in millimeters). After reviewing the included literature, we performed a quality analysis of the studies (Quality Appraisal for Cadaveric Studies scale score) and a meta-analysis comparing raw mean differences in data between the suprapectoral and subpectoral fixation location groups, as well as between the fixation construct groups.

Results: Among the 18 included studies, 347 cadaveric specimens were evaluated for ultimate load to failure, stiffness, and cyclic displacement when comparing both location (suprapectoral vs subpectoral) and tenodesis fixation type (interference screw vs cortical button, suture anchor, or all-soft-tissue techniques). Interference screw fixation showed significantly greater mean stiffness by 8.0 N/mm (P = .013) compared with the other grouped techniques but did not show significant differences when evaluated for ultimate load to failure and cyclic displacement (P = .28 and P = .18, respectively). Additionally, no difference in construct strength was seen when comparing the fixation strength of suprapectoral versus subpectoral techniques for stiffness, ultimate load to failure, and cyclic loading (P = .47, P = .053, and P = .13, respectively).

Conclusions: In this meta-analysis, no significant biomechanical differences were found when the results were stratified by specific surgical technique (interference screw vs other tenodesis techniques) and location (suprapectoral vs subpectoral biceps tenodesis).

Clinical Relevance: As a result of this study, when biomechanically evaluating specific tenodesis constructs, the individual clinician has the liberty of choosing the fixation technique based on his or her preference and knowledge of shortcomings of each type of fixation construct.
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http://dx.doi.org/10.1016/j.arthro.2020.05.055DOI Listing
December 2020

Complications and implant survivorship following primary reverse total shoulder arthroplasty in patients younger than 65 years: a systematic review.

J Shoulder Elbow Surg 2020 Aug 12;29(8):1703-1711. Epub 2020 May 12.

Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.

Background: Concerns exist regarding the complication rates and implant survivorship of reverse total shoulder arthroplasty (RTSA) in younger patients.

Methods: A systematic review of the literature regarding the existing evidence on RTSA in patients younger than 65 years was performed using the CENTRAL (Cochrane Central Register of Controlled Trials), PubMed, and Embase databases on June 9, 2019. Articles published between 1995 and 2019 with combinations of the following keywords were identified: "reverse shoulder arthroplasty" and "65," "60," and/or "55." Complications, reoperations, and revisions were recorded. Reoperation-free survival and implant survival rates were grouped at 2, 5, and 10 years. Range of motion and clinical outcomes, along with postoperative radiographic results, were recorded.

Results: Data from 7 studies with a total of 286 shoulders were obtained for quantitative analysis. The mean patient age was 58.4 years (mean age range, 48.9-60.4 years), and the mean follow-up period was 4.7 years (mean follow-up range, 3.0-7.8 years). The overall rate of complications was 18.6%; reoperations, 14.4%; and revisions, 11.2%. The reoperation-free survival rate was 97% at 2 years, 88%-90% at 5 years, and 76% at 10 years. The implant survival rate was 99% at 2 years, 91%-98% at 5 years, and 88% at 10 years. Active abduction, forward elevation, and external rotation significantly improved from preoperatively to postoperatively. All clinical outcome measures significantly improved from preoperatively to postoperatively, with no decline seen over time. The overall rate of infrascapular notching was 22.7% at final follow-up.

Conclusion: RTSA is safe and effective in patients younger than 65 years. Complication, reoperation, and revision rates were similar to those seen in older patient cohorts, without an increase in revisions owing to aseptic loosening. Clinical outcome scores showed significant and lasting improvements.
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http://dx.doi.org/10.1016/j.jse.2020.02.004DOI Listing
August 2020

Online Resources for Rotator Cuff Repair: What are Patients Reading?

Arthrosc Sports Med Rehabil 2019 Nov 3;1(1):e85-e92. Epub 2019 Aug 3.

The Steadman Clinic, Vail, Colorado, U.S.A.

Purpose: The purpose of this study was to use a novel scoring system to evaluate the content and grade the quality of websites that patients may use to learn about rotator cuff repair.

Methods: Two search terms ("rotator cuff repair" and "rotator cuff surgery") were entered into 3 Internet search engines (Google, Yahoo, and Bing). We scored the quality of information using a novel scoring system. Website quality was further assessed by the (JAMA) benchmark criteria and Health on the Net Foundation (HON) code certification. The readability of the websites was evaluated with the Flesch-Kincaid score.

Results: We evaluated 47 websites. The average quality for all websites was 6.47 ± 5.21 (maximum 20 points). There was a large difference in scores between the top 5 websites and the remaining websites (16.30 vs 5.51, < .001). There was no difference in scores when comparing the 3 different search engines ( = .85). The mean reading level was 10.17 ± 2.24. Reading level was not significantly correlated with quality (r = 0.14,  = .36). The average JAMA benchmark criteria score for all websites was 2.34 ± 1.11 (maximum 4 points). JAMA criteria score was not significantly correlated with quality (r = 0.02,  = .91). Sites without HONcode certification had higher quality scores (8.33 ± 4.80) than sites with HONcode certification (6.18 ± 4.66), but this difference was not statistically significant ( = .15).

Conclusion: The quality of patient-level information on rotator cuff repair on the Internet is both incomplete and written at a reading level higher than current recommendations. Information quality is not significantly correlated with reading level or JAMA criteria, and does not depend on the search term used or HONcode certification.

Clinical Relevance: Patients having rotator cuff repair may seek information on the Internet; the information may require surgeon clarification.
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http://dx.doi.org/10.1016/j.asmr.2019.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120834PMC
November 2019

Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability.

Am J Sports Med 2020 03 10;48(4):939-946. Epub 2020 Feb 10.

Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA.

Background: Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC joint reconstruction using a hamstring tendon autograft is a commonly used treatment option, but midterm results are still lacking.

Purpose/hypothesis: The purpose of this study was to assess the clinical outcomes, survivorship, and return-to-sports rate after SC joint reconstruction using a hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, high rate of survivorship, and a high rate of return to sports.

Study Design: Case series; Level of evidence, 4.

Methods: All patients who underwent SC joint reconstruction with a hamstring tendon autograft for SC joint instability, with a minimum 5-year follow-up, were included. Patient-reported outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, 12-Item Short Form Health Survey (SF-12) physical component summary (PCS), and patient satisfaction. Survivorship of reconstruction was defined as no further revision surgery or clinical failure such as recurrent instability or subluxation events. Return to sports and pain were assessed using a customized questionnaire.

Results: A total of 22 shoulders that underwent SC joint reconstruction, with a mean patient age of 31.3 years (range, 15.8-57.0 years) at the time of surgery, were included. At the final evaluation, 18 shoulders, with a mean follow-up of 6.0 years (range, 5.0-7.3 years), completed a minimum 5-year follow-up. All clinical outcome scores improved significantly from preoperatively to postoperatively: ASES (50.0 to 91.0; = .005), SANE (45.9 to 86.0; = .007), QuickDASH (44.2 to 12.1; = .003), and SF-12 PCS (39.4 to 50.9; = .001). Median postoperative satisfaction was 9 (range, 7-10). The construct survivorship was 90% at 5-year follow-up. There were 2 patients with failed treatment at 82 and 336 days postoperatively because of instability or pain who underwent revision SC joint reconstruction and capsulorrhaphy. Another patient had a superficial wound infection, which was debrided once and resulted in a good clinical outcome. Of the patients who answered optional sports activity questions, 15 (17 shoulders, 77%) participated in recreational or professional sports before the injury. At final follow-up, 14 patients (16 of 17 shoulders, 94%) returned to their preinjury level of sports. The visual analog scale score for pain today ( = .004) and pain at its worst ( = .004) improved significantly from preoperatively to postoperatively.

Conclusion: SC joint reconstruction with a hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at midterm follow-up. Furthermore, 94% of this young and high-demand patient population returned to their previous level of sports. Concerns in terms of advanced postinstability arthritis were not confirmed because a significant decrease in pain was found after a minimum 5-year follow-up.
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http://dx.doi.org/10.1177/0363546519900896DOI Listing
March 2020

Arthroscopic Knotless Modified McLaughlin Procedure for Reverse Hill-Sachs Lesions.

Arthrosc Tech 2020 Jan 18;9(1):e65-e70. Epub 2019 Dec 18.

The Steadman Clinic, Vail, Colorado, U.S.A.

Posterior shoulder dislocations often are associated with an impression fracture involving the anterior humeral head known as a reverse Hill-Sachs lesion. These injuries can result in significant bone defects that require surgical management to prevent them from engaging the posterior glenoid. We present a modified arthroscopic, knotless McLaughlin procedure (tenodesis of the subscapularis tendon into the bone defect) for the treatment of small-to medium-sized, engaging Hill-Sachs lesions. The knotless fashion aims to eliminate potential problems associated with knot tying, such as knot migration, knot impingement, and chondral abrasion.
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http://dx.doi.org/10.1016/j.eats.2019.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993127PMC
January 2020

Clinical and Imaging Outcomes After Arthroscopic Superior Capsule Reconstruction With Human Dermal Allograft for Irreparable Posterosuperior Rotator Cuff Tears: A Minimum 2-Year Follow-Up.

Arthroscopy 2020 04 15;36(4):1011-1019. Epub 2020 Jan 15.

Steadman Philippon Research Institute, Vail, Colorado, U.S.A; The Steadman Clinic, Vail, Colorado, U.S.A. Electronic address:

Purpose: To report the clinical and structural outcomes for non-pseudoparalytic irreparable posterosuperior rotator cuff tears treated with superior capsule reconstruction (SCR) using dermal allograft (DA).

Methods: Patients who underwent SCR using DA with a mean thickness of 3 mm for irreparable posterosuperior rotator cuff tears and underwent surgery at least 2 years earlier were included. Outcomes were assessed prospectively by the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; patient satisfaction; and visual analog scale for pain. Structurally, acromiohumeral distances (AHDs) were assessed both preoperatively and postoperatively (standard radiographs). Graft integrity was assessed by magnetic resonance imaging. Clinical failures were reported.

Results: We included 22 patients with a mean age of 56 years (range, 41-65 years) and a mean follow-up period of 2.1 years (range, 2-3 years). The ASES score improved from 54.0 to 83.9 (P < .001); the Single Assessment Numeric Evaluation score improved from 44.9 to 71.4 (P < .001); and Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH) improved from 37.6 to 16.2 (P = .001). Of the patients, 85% achieved an improvement in the ASES score that exceeded the minimal clinically important difference (11.1 points). The median patient satisfaction rating was 8.5 (range, 1-10). The median preoperative visual analog scale score decreased from 4 to 0 (range, 0-3) postoperatively (P < .001). Complete radiographs of 19 of 22 patients (86%) were obtained at a mean of 5.2 months (range, 1.4-10 months) postoperatively and showed a significant increase in the mean AHD from 7.0 mm preoperatively to 8.3 mm postoperatively (P = .029). Postoperative magnetic resonance imaging scans were obtained in 95% of the patients (21 of 22) at a mean of 2.5 months (range, 0.3-10.2 months) postoperatively and showed graft integrity rates of 100% (21 of 21) on the tuberosity side, 76% (16 of 21) at the midsubstance, and 81% (17 of 21) on the glenoid side. No significant differences in clinical outcome scores (P > 0.930) were found in patients with intact grafts versus those with torn grafts. The number of previous shoulder surgical procedures was a negative predictor of clinical outcome. There was 1 clinical failure.

Conclusions: SCR using DA for irreparable tears improves outcomes with high satisfaction and high graft integrity at short-term follow-up. Graft integrity, although correlated with an increased AHD, had no correlation with clinical outcomes at final follow-up.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1016/j.arthro.2019.12.024DOI Listing
April 2020

Minimum 5-Year Outcomes and Return to Sports After Resection Arthroplasty for the Treatment of Sternoclavicular Osteoarthritis.

Am J Sports Med 2020 03 15;48(3):715-722. Epub 2020 Jan 15.

The Steadman Clinic, Vail, Colorado, USA.

Background: Osteoarthritis of the sternoclavicular (SC) joint is a rare condition that leads to decreased function and persistent pain, ultimately altering the function of the shoulder and keeping individuals from their desired activities. SC resection in the setting of primary and posttraumatic osteoarthritis is the most common surgical treatment for these patients, but midterm results are lacking.

Purpose/hypothesis: The purpose was to assess the clinical outcomes, pain levels, return to sports rate, and survivorship after open SC joint resection in the setting of painful primary SC joint osteoarthritis. We hypothesized that an SC joint resection of maximum 10 mm would result in a significant improvement in clinical outcomes, decreased pain levels, a high rate of return to sports, and a high survivorship.

Study Design: Case series; Level of evidence, 4.

Methods: Patients who underwent SC joint resection (maximum 10 mm) by a single surgeon between the years 2006 and 2013 with minimum 5-year follow-up were reviewed. The following clinical outcomes were collected prospectively during this time period: 12-Item Short Form Health Survey Physical Component Score (SF-12 PCS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and patient satisfaction. Return to sports and pain were assessed through use of a customized questionnaire. Survivorship of SC joint resection was defined as not requiring further surgery on the affected joint.

Results: A total of 21 SC joints were treated with resection of the medial clavicle and intra-articular disk and capsulorrhaphy for SC joint osteoarthritis in 19 patients with a mean age of 39.4 years (range, 12.5-66.7 years). At minimum 5-year follow-up, 19 SC joint resections were assessed in 16 of 19 patients (84%) with a mean follow-up of 6.7 years (range, 5.0-10.4 years). All outcome scores improved significantly from pre- to postoperative assessments: ASES (from 54 to 90.5; = .003), SANE (from 61.8 to 90.4; = .004), QuickDASH (from 43.1 to 13.8; = .004), and SF-12 PCS (from 39.8 to 51.3; = .004). Median satisfaction with surgical outcomes was 9 (range, 2-10), and pain levels improved from a score of 8 out of 10 to 3 out of 10 (scale of 0 to 10 with 0 being pain free and 10 worst possible pain). Of the 13 patients who answered the optional sports participation question, 13 (100%) patients had participated in sports before their injury. A total of 14 patients answered the question on sports participation after injury, with 12 (86%) indicating successful return to sports. Pain at its worst ( = .003) and pain with competition ( = .017) significantly decreased pre- to postoperatively. Resection survivorship at final follow-up was 84.2% at 5 years. We found that 3 patients (15%) had recurrent SC joint pain and were treated with revision surgery.

Conclusion: Open SC resection arthroplasty with capsulorrhaphy in the setting of pain for SC osteoarthritis results in significant improvement in clinical outcomes, patient satisfaction, return to sports, and pain reduction at minimum 5-year follow-up.
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http://dx.doi.org/10.1177/0363546519897892DOI Listing
March 2020

Comprehensive review of the physical exam for glenohumeral instability.

Phys Sportsmed 2020 05 13;48(2):142-150. Epub 2019 Nov 13.

The Steadman Clinic, Vail, CO, USA.

Glenohumeral instability is a common pathology of the shoulder joint, especially among young athletes. Despite advancements in technology and the widespread use of diagnostic imaging, a careful history and physical examination still remain the cornerstone of diagnosing patients with shoulder instability. Due to the involvement of many static and dynamic stabilizers, proficient physical examination can be challenging. With a systematic approach to clinical evaluation, the clinician can recognize characteristic patterns of relevant signs and symptoms and make an accurate diagnosis.
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http://dx.doi.org/10.1080/00913847.2019.1684809DOI Listing
May 2020

Posterior bony Bankart bridge technique results in reliable clinical 2-year outcomes and high return to sports rate for the treatment of posterior bony Bankart lesions.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 9;29(1):120-126. Epub 2019 Nov 9.

Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, 81657, USA.

Purpose: To introduce the arthroscopic "posterior bony Bankart bridge" repair technique, and to report clinical outcomes, patient satisfaction, recurrent instability rate, and return to sport rate.

Methods: Patients who were treated for posterior bony Bankart lesions with posterior bony Bankart bridge technique and were at least 2 years out from surgery were included. Clinical outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) Score, Single Assessment Numerical Evaluation (SANE) Score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) Score and patient satisfaction. Return to sports rate and complications were reported.

Results: Seven patients with a median age of 23.5 (range 17-43) and a median follow-up of 8 years (range 3-10) were included. Median time from injury to surgery was 15 days (range 3 days-2.2 years). Mean glenoid bone defect was 19% (range 11-31%). At final follow-up the median postoperative outcome scores were: ASES score 100 (range 92-100), SANE score 99 points (range 94-99) and QuickDASH 2.2 points (range 0-9). Median satisfaction of all patients was 10/10 (range 9-10). One patient reported subjective recurrent subluxations, which resolved under physical therapy. No patient underwent further surgery. No complications were noticed. At final follow-up, all patients (100%) reported that their sports participation levels were equal to their pre-injury levels.

Conclusion: The arthroscopic posterior bony Bankart bridge technique leads to reliable postoperative shoulder function and restores shoulder stability with high patient satisfaction and low complication rate in this small patient cohort for the treatment of posterior bony Bankart lesions. Also, no recurrent dislocation was observed at a minimum follow-up of at least 3 years, one patient continued to complain of subjective subluxations which resolved under physical therapy. All patients were able to return to their pre-injury sports level.

Level Of Evidence: Case series, Level IV.
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http://dx.doi.org/10.1007/s00167-019-05783-xDOI Listing
January 2021

Location of the Glenoid Defect in Shoulders With Recurrent Posterior Glenohumeral Instability.

Am J Sports Med 2019 11 16;47(13):3051-3056. Epub 2019 Oct 16.

The Steadman Clinic, Vail, Colorado, USA.

Background: Posterior glenoid bone deficiency is an increasingly recognized entity in the setting of recurrent posterior shoulder instability; however, little is known about the subject. Due to the paucity of literature on posterior bone loss, historical comparisons with anterior bone loss may not be fully accurate.

Purpose: To systematically describe the morphology of posterior bone defects in the setting of recurrent posterior shoulder instability based on several quantitative parameters, including the mean location, orientation, and extent of bone loss on a clockface model, as well as the angle of the defect relative to the long axis of the glenoid.

Study Design: Cross-sectional study; Level of evidence, 4.

Methods: Three-dimensional reconstructed computed tomography scans of serially collected patients with a history of recurrent posterior shoulder instability were evaluated by 3 separate reviewers. The posterior glenoid bone defect was characterized using the following measures: (1) the mean lesion location and orientation based on a clockface model with 6 o'clock denoted as inferior and 9 o'clock as directly posterior for all patients; (2) the total extent of the posterior bone defect based on the clockface; and (3) the average angle of the bone loss relative to the long axis of the glenoid.

Results: A total of 70 male patients and 1 female patient with a mean age of 29.3 years (range, 24.4-35.1 years) were included in the analysis. The mean clockface location of the posterior glenoid defect originated at 6:44 (range, 4:16-8:12) and extended to a mean of 9:28 (range, 7:02-10:38). The mean extent of the posterior glenoid defect was 2:43 (range, 1:08-4:50), which corresponds to a mean total bone loss arc of 81.5° (range, 34.2°-144.9°), nearly 1 quadrant of the glenoid. Posterior bone loss occurred in a posteroinferior direction at a mean angle of 30.7° (range, 8.0°-80.0°) relative to the long axis of the glenoid.

Conclusion: Posterior bone defects in the setting of posterior shoulder instability most commonly occur in the posteroinferior quadrant of the glenoid and extend on average from 6:44 to 9:28 (81.5° total degrees of arc) on a clockface model. Posterior bone loss occurs at a mean of 30° off the long axis of the glenoid in a posteroinferior direction, which is historically different from anterior bone loss, which occurs parallel to the long axis of the glenoid. This study serves to highlight the location and orientation of bone loss that one can expect in a patient with recurrent posterior shoulder instability, although additional work is needed to assess why this develops.
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http://dx.doi.org/10.1177/0363546519876282DOI Listing
November 2019
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