Search PubMed⌕ Search

Biomedical subjects

Evan L Flatow

Publications and source records attributed to Evan L Flatow.

31 records · Page 2Linked to original sources
PubMed2002

Failed surgical management of partial thickness rotator cuff tears.

Some authors have recommended that rotator cuff tears <50% of tendon thickness be debrided and those involving >50% of the tendon be treated with miniopen repair. We hypothesize that if indications for selecting between simple debridement and tendon repair were appropriate, then both groups should have comparable outcomes. Thirty-nine patients with partial rotator cuff tears met inclusion criteria and were available for retrospective analysis. Twenty-six percent of patients who underwent debridement and 12.5% of patients who had mini-open repair had unsatisfactory results according to Neer's criteria.

Adult↗
PubMedDate not supplied

Humeral head replacement versus total shoulder arthroplasty: clinical outcomes--a review.

Total shoulder replacement (TSR) has been shown to provide predictable pain relief and functional improvement in patients with glenohumeral degenerative arthritis and an intact rotator cuff. When compared with patients with humeral head replacement (HHR), those with TSR have been reported to have more stability, less pain, and increased motion. However, concerns regarding glenoid loosening and the subsequent possibility of a difficult revision with bony deficits have led many to favor HHR alone. Proponents of HHR regard the glenoid as the "weak link" in TSR and, when weighing their options, consider glenoid resurfacing to be too great a risk. The literature suggests that TSR is the best form of treatment for glenohumeral osteoarthritis, except in certain cases of insufficient glenoid bone stock and irreparable rotator cuff tears. Several recent clinical outcomes studies support this, as they have shown better results after TSR in comparison to HHR. Although the fear of radiographic glenoid component loosening is appropriate, evidence of clinical glenoid loosening is not very common. Currently, glenoid component design, in relation to its articulation with the humeral head, continues to grow and evolve as efforts are focused on changes to decrease the incidence of loosening. In addition, improved surgical techniques of cement pressurization may help to minimize glenoid loosening as well. Thus, it is reasonable to expect that the excellent results currently attainable with TSR may improve.

Arthroplasty, Replacement↗
PubMedDate not supplied

Biomechanical evaluation of a novel glenoid design in total shoulder arthroplasty.

The amount of articular curvature mismatch providing optimal performance in total shoulder arthroplasty (TSA) is unknown. The objectives of this study were to quantify glenohumeral joint mechanics before and after TSA and to compare the performance of 3 glenoid components: (1) nonconforming, (2) conforming, and (3) a novel design featuring a conforming center extending into a nonconforming periphery. Six fresh-frozen cadaveric shoulders (mean age, 43 years) were mechanically tested on a custom apparatus by use of simulated muscle forces and a coordinate-measuring machine to determine joint kinematics. B-spline models of the natural and prosthetic articular surfaces were generated, and joint contact was computed by use of a proximity criterion. During both centered ( P = .02) and eccentric ( P = .05) loading protocols, glenoid contact migrated posteriorly in conforming implants. No statistical differences in kinematics and contact were found among the nonconforming design, the new design, and the natural joint. Therefore, adding a central region of conformity does not compromise the ability of nonconforming TSA components to reduce rim loading.

Adult↗
PubMedDate not supplied

Pathomechanics of acquired shoulder instability: a basic science perspective.

Normal asymptomatic glenohumeral motion is dependent on the coordinated function of dynamic and static stabilizers. Data from both selective sectioning studies of the capsuloligamentous components and tensile testing of the inferior glenohumeral ligament have provided important insights into the in situ function of these structures. However, little is known regarding the mechanism of microdamage accumulation in acquired shoulder instability. Recent findings suggest that cyclic subfailure loading of the inferior glenohumeral ligament may induce gradual stretching of the anteroinferior capsule, compromising its capacity to restrain excessive humeral translations. Further studies elucidating the mechanism of load transmission in the capsule during physiologic arm motion, as well as data on the intrinsic healing response of the capsular ligaments, are required to more fully characterize the pathoetiology of acquired shoulder instability.

Biomechanical Phenomena↗
PubMedDate not supplied

Effectiveness of replacement arthroplasty with calcar grafting and avoidance of greater tuberosity osteotomy for the treatment of humeral surgical neck nonunions.

A retrospective review was conducted on 12 patients (mean age, 63 years) undergoing replacement arthroplasty with calcar grafting for humeral surgical neck nonunions. Patients were evaluated preoperatively for pain and range of motion and postoperatively by use of the American Shoulder and Elbow Surgeons and Constant scores. Indications included severe pain, disability, humeral head destruction, and inadequate bone stock. Nine patients were available for a mean of 69 months' follow-up. Eight underwent humeral head replacement, and one underwent total shoulder replacement. None required greater tuberosity osteotomy. Previously, open reduction-internal fixation had failed in 2 and closed reduction and percutaneous pinning had failed in 1. Calcar grafts were incorporated in 7 of 9 patients. Postoperative pain was absent in 7 and mild in 2. Mean active forward elevation improved by 64 degrees . Mean active external rotation improved by 45 degrees . Postoperatively, American Shoulder and Elbow Surgeons scores averaged 80 and Constant scores averaged 64. Replacement arthroplasty with calcar grafting is a reliable treatment option for surgical neck nonunions.

Adult↗
PubMedDate not supplied

Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study.

Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but high retear rates by ultrasound. We prospectively assessed postoperative cuff integrity and outcome after arthroscopic RCR (40 patients) and compared these results with open RCR (32 patients). Evaluation preoperatively and at 1 year included a physical examination and magnetic resonance imaging. American Shoulder and Elbow Surgeons and Constant scores improved significantly in both groups (P < .0001). Overall, 69% of repairs in the open group and 53% in the arthroscopic group were intact by magnetic resonance imaging. Of tears less than 3 cm in size, 74% in the open group and 84% in the arthroscopic group were intact. Of tears greater than 3 cm in size, 62% in the open group and 24% in the arthroscopic group were intact (P < .036). In the arthroscopic group, patients with an intact cuff had significantly greater strength of elevation (P = .01) and external rotation (P = .02). We conclude that open and arthroscopic RCRs have similar clinical outcomes. Cuff integrity is comparable for small tears, but large tears have twice the retear rate after arthroscopic repair.

Aged↗
PubMedDate not supplied

Interscalene regional anesthesia for arthroscopic shoulder surgery: a safe and effective technique.

There has been resistance to the use of interscalene regional block for arthroscopic shoulder surgery because of concerns about potential complications and failed blocks with the subsequent need for general anesthesia. The purpose of this study was to assess whether interscalene regional block is safe and effective and offers many advantages over general anesthesia for outpatient arthroscopic shoulder surgery. Through a retrospective chart review of consecutive arthroscopic shoulder surgeries over a 2.5-year time period, in a tertiary university medical center with an anesthesiology residency, 277 interscalene blocks (96%) were successful; 12 (4%) required general anesthesia because of an inadequate block. There were no seizures, pneumothoraces, cardiac events, or other major complications. There was a 1% rate of minor complications, all of which were transient sensory neuropathies that resolved within 5 weeks on average. We conclude that interscalene block can provide effective anesthesia for arthroscopic shoulder surgery.

Adolescent↗
PubMedDate not supplied

Releases of subscapularis contracture: an anatomic and clinical study.

Correction of anterior subscapularis contracture is an important step in soft-tissue balancing at the time of total shoulder replacement (TSR). An anatomic and clinical investigation was undertaken to investigate the effect of steps involved in subscapularis release. In 14 cadaveric shoulders studied, the subscapularis insertion consisted of three regions: a thick superior tubular tendon (STT), a flat middle tendon, and an inferior portion where the muscle fibers insert directly into the humerus. In 16 consecutive patients undergoing primary TSR for osteoarthritis, measurements of subscapularis length were taken after different releases. An average of 0.9 cm (confidence interval, 0.7-1.1 cm) of excursion was added after anterior capsular release, and an additional 0.7 cm (confidence interval, 0.5-0.9 cm) of excursion was obtained after STT release. Incision of the STT is an alternative means of gaining subscapularis length when balancing the soft tissues in patients with osteoarthritis undergoing TSR.

Arthroplasty, Replacement↗
PubMedDate not supplied

Attrition sign in impingement syndrome.

Extrinsic compression of the rotator cuff by the coracoacromial arch has been accepted as a major factor in the etiology of bursitis, cuff tendonitis, and rotator cuff tears. Other etiologies for rotator cuff syndrome have also been proposed in various patient populations. These include repetitive microtrauma and underlying instability with tensile overload, particularly in the younger (younger than 35) athletic population. In this evolving field, the arthroscopist must to be able to recognize arthroscopic signs of impingement syndrome. Therefore, this paper discusses evaluating rotator cuff syndromes and reviews the signs of subacromial impingement found at bursoscopy. We also offer several tips to maximize visualization during shoulder bursoscopy.

Arthroscopy↗
PubMedDate not supplied

Loss of subscapularis function after total shoulder replacement: A seldom recognized problem.

Little attention has focused on subscapularis integrity after total shoulder replacement (TSR). We have noted that several patients have loss of internal rotation and subscapularis function on follow-up, leading to our review of success in restoring subscapularis function after TSR. A retrospective review was done of the records of 41 patients after TSR performed between 1995 and 2000. Mean follow-up was 1.9 years. Terminal internal rotation was evaluated by the lift-off and belly-press examinations. Subscapularis function was assessed by the patients' ability to tuck in a shirt. The subscapularis was repaired anatomically in 9 cases and through bone tunnels in 32 patients. Abnormal results were found for 25 of 37 lift-off examinations (67.5%) and 24 of 36 belly-press examinations (66.6%). Of 25 patients with an abnormal lift-off finding, 92% reported reduced subscapularis function (Fisher exact test, P <.01). Despite meticulous attention to subscapularis repair, suboptimal return of function was found on clinical examination and assessment of activities of daily living.

Aged↗
PubMedDate not supplied

Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs.

BACKGROUND: Open rotator cuff repairs have led to excellent clinical results; however, several studies have linked postoperative structural integrity to patient outcomes. The purpose of this study is to prospectively assess postoperative cuff integrity after open rotator cuff repair and assess its relationship to clinical outcome. HYPOTHESIS: Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes. STUDY DESIGN: Prospective nonrandomized clinical outcomes study. METHODS: Forty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospective study. A standardized evaluation was performed preoperatively and postoperatively at annual intervals. All patients underwent postoperative magnetic resonance imaging at least 1 year after surgery. Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison. RESULTS: Thirty-two patients were available for evaluation. Overall, the patients experienced a significant (P < .05) improvement in their American Shoulder and Elbow Surgeons survey (40-85) and Constant (53-80) scores. The overall retear rate was 31%. Although patients with large tears preoperatively and retears postoperatively had lower overall outcomes scores, this was not significant. CONCLUSION: These data support open rotator cuff repair as an effective technique that restores excellent shoulder function. The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff. In fact, those with a retear still had a significant improvement in all clinical areas assessed, including strength.

Adult↗