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    Arthroscopic Lysis of Adhesions for Stiffness After Surgical Management of Proximal Humerus Fractures Leads to Satisfactory Outcomes in Most Patients
    (Elsevier Inc., 2023) Ardebol J.; Zuk N.A.; Kiliç A.?.; Pak T.; Menendez M.E.; Denard P.J.
    Purpose: To report patient-reported outcomes (PROs), range of motion (ROM), and satisfaction, in patients who underwent arthroscopic lysis of adhesions for stiffness after open reduction with internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) for fracture. Methods: A retrospective review was performed to identify patients with stiffness who underwent arthroscopic lysis of adhesions following ORIF or RSA for proximal humerus fracture at a single institution between 2012 and 2021 with minimum 1-year follow-up. PROs including visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES), and Subjective Shoulder Value (SSV), as well as active ROM including forward flexion (FF), external rotation (ER), internal rotation (IR), were collected pre- and postoperatively. Attempted nonoperative treatment before arthroscopic lysis of adhesions was documented. Complications and satisfaction were also recorded. Results: A total of 21 patients met the study criteria (4 RSA, 17 ORIF), with an average age of 66.7 ± 8 years. The study sample comprised mostly of female patients (90%). The mean time from the index surgery to arthroscopy was 9 months, and mean follow-up post-lysis was 17 months. Patients with ORIF reported significant pain relief (VAS, ? –3.2) and improvement in range of motion (FF, ? 36°; ER, ? 20°; IR ? 3 spinal levels) and PROs (ASES, ? 34.7; SSV ? 44.8) (P < .01) after lysis. Patients with RSA had significant improvement in ASES (? 21.8; P = .04), SSV (? 8.8; P = .04), and FF (? 38; P = .02) but did not have significant improvement in VAS (? –2; P = .2), ER (? 0°; P = 1.0), and IR (? 1 spinal level; P = .2). Satisfaction was 100% in the RSA cohort and 82% in the ORIF cohort. No complications were observed. Conclusions: Arthroscopic lysis of adhesions for stiffness after surgical management of proximal humerus fracture leads to satisfactory outcomes in most patients. Post-ORIF, patients may achieve improvement in PROs and global ROM, whereas post-RSA, patients may achieve improvement in PROs and FF but do not necessarily improve in rotational ROM. Level of Evidence: Level IV, therapeutic case series. © 2023 The Authors
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    Clinical Outcomes and Tendon Healing After Arthroscopic Isolated Subscapularis Tendon Repair: Results at Midterm Follow-up
    (SAGE Publications Ltd, 2024) Kilic A.I.; Zuk N.A.; Ardebol J.; Pak T.; Menendez M.E.; Denard P.J.
    Background: Few studies have reported clinical outcomes and tendon healing rates after arthroscopic isolated subscapularis (SSC) repair (AISR). Purpose/Hypothesis: The primary purpose of this study was to evaluate clinical outcomes and tendon healing after AISR. It was hypothesized that AISR would result in satisfactory clinical outcomes along with a high rate of tendon healing at the midterm follow-up. The secondary purpose was to assess the influence of tear size and muscle atrophy on SSC tendon healing and patient-reported outcomes. It was hypothesized that both would be negatively correlated with healing but would have no effect on clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted on prospectively collected data for 77 patients who underwent primary AISR between 2011 and 2021 at a single institution, with a minimum 2-year postoperative follow-up for all patients. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Subjective Shoulder Value (SSV), and the visual analog scale for pain. Repair techniques and concomitant procedures were also collected. SSC tendon healing was evaluated via ultrasound at the final follow-up. Linear regression analysis was performed to determine factors affecting SSC healing. Results: The mean follow-up was 58.1 ± 3.3 months. ASES scores significantly improved from 41.5 to 81.6, and the SSV improved from 38.2 to 80.5 (P <.01 for both). Among the 40 patients (51.9%) who underwent postoperative ultrasound, 87.5% showed complete tendon healing. There were no significant differences in outcome scores between healed and unhealed tendons. Increased muscle atrophy and larger tears were correlated with failure of SSC healing (? = ?0.285 [P =.015] and ? = ?0.157 [P =.045], respectively). Conclusion: Improved clinical outcomes and an overall high rate of tendon healing were seen at the midterm follow-up after AISR. Smaller tear sizes with less muscle atrophy were correlated with improved tendon healing. However, even when the tendon incompletely healed, the procedure improved functional outcomes. © The Author(s) 2024.