Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Dec 2019
The fragility of findings of randomized controlled trials in shoulder and elbow surgery.
Considered the gold standard of study designs, randomized controlled trials' (RCTs) results shape clinical practice, effect policy, and influence reimbursement. The fragility index (FI) can be used to quantitate the relative robustness of RCT results, with higher scores indicating more stout results. Unfortunately, most RCTs in surgery have fragile results. The aim of this study was to report on the FI in addition to a qualitative assessment of recent RCTs within the field of shoulder and elbow surgery. ⋯ The median FI reported in the recent shoulder/elbow literature is 4; however, a high proportion of included RCTs display significant methodological concerns. The FI is a useful adjunct to analyze RCT results, but careful analysis of trial methods should be employed in each circumstance before drawing conclusions.
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J Shoulder Elbow Surg · Dec 2019
Performance and return to sport following rotator cuff surgery in professional baseball players.
While many injuries to the rotator cuff in professional baseball players can be managed nonoperatively, recovery fails to occur with nonoperative treatment in some players and surgery on the rotator cuff is performed in an attempt to return to sport (RTS). ⋯ Rotator cuff débridement is significantly more common than repair in professional baseball players, with 86% of all rotator cuff surgical procedures reported as débridement. RTS rates following débridement and repair are disappointing, at 50.8% and 33.3%, respectively. For players who do return, performance declines after surgery.
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J Shoulder Elbow Surg · Nov 2019
Development of a clinical risk calculator for prolonged opioid use after shoulder surgery.
Understanding risk factors associated with prolonged opioid use to help mitigate abuse and develop presurgical screening programs to identify at-risk patients is paramount. The purpose of this study was to develop and validate a clinical risk assessment tool to preoperatively predict prolonged opioid use after shoulder surgery. ⋯ We present a preoperative predictive calculator to help identify at-risk patients and quantify their risk of prolonged opioid use after shoulder surgery. This is a valuable clinical decision-making tool to identify patients benefitting from referral to pain management specialists and to possibly reduce the risk of opioid abuse and addiction.
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J Shoulder Elbow Surg · Oct 2019
Randomized Controlled Trial Comparative StudyA 3-arm randomized clinical trial comparing interscalene blockade techniques with local infiltration analgesia for total shoulder arthroplasty.
The ideal analgesic modality for total shoulder arthroplasty (TSA) remains controversial. We hypothesized that a multimodal analgesic pathway incorporating continuous interscalene blockade (ISB) provides better analgesic efficacy than both single-injection ISB and local infiltration analgesia. ⋯ Continuous ISB provides superior analgesia compared with single-injection ISB and local infiltration analgesia in the first 24 hours after TSA.
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J Shoulder Elbow Surg · Oct 2019
Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review.
To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability. ⋯ On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results.