The purpose of this study was to compare the 90‐day complication rate between the open and arthroscopic Latarjet procedure. A retrospective review of patients who underwent an open or arthroscopic Latarjet procedure at NYU Langone Health between 2012 and 2019 was performed. The complications, readmissions, and reoperations within 90 days were assessed. Outcomes were compared between the two approaches, and a p value of < 0.05 was considered to be statistically significant. The study included 150 patients (open: 110; arthroscopic: 40), with no patients lost to follow‐up within the first 90 days. Both cohorts were similar in terms of patient demographics. No intra‐operative complications were observed in either group. Overall, there were 4 post‐operative complications with the open approach and 2 with the arthroscopic approach (3.6% and 5.0%, respectively; n.s.) during the study period. Three patients required a readmission within the 90‐day period; one patient in both groups required a revision Latarjet for graft fracture, and one patient in the open Latarjet required irrigation and debridement for deep infection (n.s.). With the open approach, there were 2 (2.3%) wound complications, 1 graft complication, and 1 (1.1%) nerve injury. With the arthroscopic approach, there was 1 (2.8%) wound complication and 1 (2.8%) hardware complication. The safety, and 90‐day complication and readmission profile of arthroscopic Latarjet is similar to open Latarjet procedure. Level of evidence Level III.

Revision to RTSA significantly improved PRO scores compared to hemi- or total shoulder arthroplasty. RevSA for infection demonstrated the least improvement in outcomes.

Category: Sports; Other Introduction/Purpose: Depending upon the site of injury, Achilles tendinopathy (AT) can be either Insertional (IAT) or Non- Insertional (nIAT). AT has long been managed by conservative measures such as eccentric exercises, but now extracorporeal shock wave therapy (ESWT) has emerged as a non-invasive treatment to stimulate self-repair. However, the native biology at the insertion of the Achilles tendon and mid-substance are intrinsically different, with the mid-substance (2 to 6 cm above the insertion) being significantly less perfused. Thus, we performed a systematic review of the literature on shockwave therapy to determine if there was a difference in efficacy for patients who have undergone ESWT for IAT and nIAT. Methods: In January 2022, the MEDLINE and EMBASE databases were systematically reviewed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included randomized controlled trials, prospective and retrospective studies, published in English, with pre- and post-operative scores for at least either Visual Analogue Scale (VAS) or Victorian Institute of Sport Assessment - Achilles (VISA-A). We excluded basic science studies, systematic reviews and meta- analyses, retrospective studies, case reports, studies without pre-operative scores, studies that don't differentiate IAT and nIAT. The LoE and QoE of the included studies were evaluated using the Journal of Bone and Joint Surgery Criteria and the Modified Coleman Methodology Score, respectively. We calculated weighted mean values for age, body mass index (BMI), the number of ESWT sessions and their frequency, duration of symptoms prior to ESWT, follow-up time, as well as for each outcome score. Results: 16 studies were included in this review, six with Level I evidence, four with Level II, five with Level III, and one with Level IV. There were 505 cases of AT: 325 patients with IAT and 180 with nIAT. For the IAT cohort, the weighted mean (WM) duration of symptoms prior to treatment was 18.1 months, and WM follow-up was 8.1 months. For the nIAT cohort, the WM duration of symptoms prior to treatment was 15.0 months, and WM follow-up was 11.6 months. In terms of outcome scores, for VAS, the WM pre-operative scores were 6.89 for IAT and 7.76 for nIAT and the WM post-operative scores were 2.76 for IAT and 2.49 for nIAT. For VISA-A, the WM pre-operative scores were 49.3 for IAT and 42.8 for nIAT, and the WM post-operative scores were 75.4 for IAT and 75.7 for nIAT. Conclusion: As the mid-substance portion of the Achilles tendon has diminished blood supply compared to the insertional portion, we expected outcomes after ESWT to be inferior for the nIAT cohort. Interestingly, the VAS pain scores and VISA-A functional scores displayed similar positive results for both cohorts. We see that the virtually equivalent functional and pain outcomes mean that ESWT is stimulating cellular components of the tendon to promote healing regardless of injury location.

Category: Sports; Other Introduction/Purpose: Extracorporeal Shock Wave Therapy (ESWT) is one of the major advances in orthopedics over the last 20 years as a method for orthopedic surgeons to conservatively treat tendon pathologies such as Achilles tendinopathy (AT). Unfortunately, previous studies involve only a small number of cases, relatively short duration of symptoms, and simple measures of pain. The purpose of this study is to evaluate the impact of age, body mass index (BMI), and location of AT (Insertional (IAT) or Non-Insertional (nIAT)) on clinical outcomes and return to sport (RTS) time after ESWT. Methods: This is a retrospective cohort study that included existing clinical data from 40 patients from a single academic institution. Patients greater than 18 years of age who underwent ESWT for Achilles tendinopathy in the office setting between 8/1/2019 to 8/30/2021 were included. Clinical outcomes of patients were evaluated through the self-reported Visual Analogue Scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores for assessing pain and functional outcomes of Achilles Tendinopathy. Descriptive statistics were used to provide an overview of the patient characteristics, including sex, age, laterality of injury, BMI, duration of symptoms, RTS time, and follow-up. For these data, mean and standard deviation were calculated, and paired samples T-tests and Welch's T-tests were performed on clinical outcome scores. Results: This study included 48 patients (62 heels), with an average age of 50.8+-14.2 years, BMI of 27.3+-5.3, follow-up of 6.41+- 6.9 months, and RTP time of 5.39+-5.3 weeks. Patients with a BMI <25.0 had significantly higher post-operative VISA-A scores (p=0.007) compared to those with a BMI >25.0, and post-operative VAS scores displayed this trend without significance (p=0.07). Patients <=50 years old had significantly higher post-operative VISA-A scores (p=0.02) compared to those >50 years old, and post-operative VAS scores displayed this trend without significance (p=0.1). Pre- and post-operative VISA-A scores, and post- operative VAS scores, were not significantly different between IAT and nIAT cohorts, except for pre-operative VAS scores where nIAT was higher (p=0.03). Additionally, we found significant improvements in pre-operative to post-operative scores for VAS scores for IAT and nIAT cohorts (p<0.0001), as well for VISA-A for the IAT cohort (p=0.008), but no significant improvement in VISA for the nIAT cohort (p=0.119). Conclusion: Increased BMI and age are determinant factors that significantly adversely affect functional scores (VISA-A) in patients with AT treated with ESWT, but no significant differences were found for these risk factors in terms of pain improvement (VAS). Additionally, we found that the nIAT cohort had significantly higher pre-operative pain than IAT, and no significant improvement in VISA-A scores (though there was a trend of functional improvement). This aligns with the fact that the mid- substance of the Achilles tendon is a watershed area with relatively low vascularity compared to the insertional portion, where lower perfusion weakens the healing benefits of ESWT.