BackgroundWith the advent of smartphones together with their downloadable applications (apps), there is increasing opportunities for doctors, including orthopaedic sports surgeons, to integrate such technology into clinical practice. However, the clinical reliability of these medical apps remains questionable. We reviewed available apps themed specifically towards Orthopaedic Sports Medicine and related conditions and assessed the level of medical professional involvement in their design and content, along with a review of these apps.MethodThe most popular smartphone app stores (Android, Apple, Blackberry, Windows, Samsung, Nokia) were searched for Orthopaedic Sports medicine themed apps, using the search terms; Orthopaedic Sports Medicine, Orthopaedics, Sports medicine, Knee Injury, Shoulder Injury, Anterior Cruciate Ligament Tear, Medial Collateral Ligament Tear, Rotator Cuff Tear, Meniscal Tear, Tennis Elbow. All English language apps related to orthopaedic sports medicine were included.ResultsA total of 76 individual Orthopaedic Sports Medicine themed apps were identified. According to app store classifications, there were 45 (59 %) medical themed apps, 28 (37 %) health and fitness themed apps, 1 (1 %) business app, 1 (1 %) reference app and 1 (1 %) sports app. Forty-nine (64 %) apps were available for download free of charge. For those that charged access, the prices ranged from £0.69 to £69.99. Only 51 % of sports medicine apps had customer satisfaction ratings and 39 % had named medical professional involvement in their development or content.ConclusionsWe found the majority of Orthopaedic Sports Medicine apps had no named medical professional involvement, raising concerns over their content and evidence-base. We recommend increased regulation of such apps to improve the accountability of app content.

This is the first study to specifically address the characteristics of apps related to spinal surgery. We found that nearly half of spinal surgery apps had no named medical professional involvement, raising concerns over app content and evidence base for their use. We recommend increased regulation of spinal surgical apps to improve the accountability of app content.

MBBS (Sing), MMed (Surg), FRCS (Glas), MCh (Orth), Liverpool FAMS (Orth) a,b Study Design. A retrospective, radiographic comparative study conducted in a single academic institution.Objective. This study aims to compare fulcrum extension with conventional extension imaging to determine maximum ''hip lordosis'' (HL), an important novel patient-specific parameter in spinal realignment surgery, as well as understand the extension capabilities of the lower lumbar spine, which together, are key contributors to whole-body balancing. Summary of Background Data. Recent literature recognizes the hip as an important contributor to whole-body lordosis beyond a compensator for spinal imbalance. Methods. Patients >45 years' old with mechanical low back pain due to degenerative spinal conditions were included and grouped based on the imaging performed-fulcrum or conventional extension. All imaging was performed using EOS under standardized instructions and visual aids. Radiographic parameters include global lumbar angle (GLA), inflexion-S1 (Inf-S1) angle, segmental lumbar angles, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), femoral alignment angle (FAA), HL and spinocoxa angle (SCA). Unpaired t test was used to compare between radiographic parameters. Results. One hundred patients (40 males and 60 females, mean age 63.0 years) underwent either fulcrum or conventional extension EOS1 imaging. Both groups had comparable baseline radiographic parameters. Fulcrum extension gave a larger mean GLA (À60.78 vs. À48.58, P ¼ 0.001), Inf-S1 angle (À58.88 vs. À48.88, P ¼ 0.003), SCA (À36.58 vs. À24.88, P < 0.001), L4/5 and L5/S1 lordosis (À20.78 vs. À17.78, P ¼ 0.041, and À22.38 vs. À17.18, P ¼ 0.018, respectively), compared to conventional extension. PI, SS, PT, FAA, and HL were similar between both extension postures. Conclusion. Fulcrum extension, compared to conventional extension, is better at generating lordosis in the lower lumbar spine, thus improving preoperative assessment of stiffness or instability of the lumbar spine. Both extension methods were equally effective at determining the patient-specific maximum HL to assess the flexibility and compensation occurring at the hip, potentially guiding surgical management of patients with degenerative spines.

Introduction Massive rotator cuff tears (MRCTs) have long posed a complex problem for both patients and surgeons. If not treated promptly, tendon retraction, fatty infiltration and muscle atrophy of the rotator cuff muscles occur. These lead to irreparable RCTs with poor functional outcomes. We describe our technique of superior capsular reconstruction (SCR) augmented with partial cuff repair and report on our short term outcomes Method Seven consecutive patients who underwent the procedure were recruited at our institution from January 2019 to December 2019. Medical records of these patients were reviewed looking at pre-operative symptoms and examination findings, imaging studies, intra-operative findings, the surgical technique employed, post-operative progress in terms of pain, affected shoulder range of movement and outcome scores. Results All patients showed complete tears of at least two tendons and were deemed irreparable intra-operatively. All patients exhibited Goutalier grade 2–4 wasting of the affected tendons on MRI and Patte grade 3 intra-operatively. At 12 months, the mean improvement shown in Constant score is 12.1 points, in University of California Los Angeles (UCLA) score is 9.4 points and in Oxford Shoulder Score is 17 points. Active forward flexion improved in all patients with a mean improvement of 40 degrees. Numerical Pain Rating Scale improved in all patients with a mean of 5.1 points. Conclusion Our case series shows good short-term outcomes can be achieved with SCR augmented with partial cuff repair. Notably, our SCR results showed encouraging results even for challenging revision rotator cuff repairs.