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Paper 34: Normal Shoulder Outcome Score Values in the Young, Active Adult
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ABSTRACTS
of injury was recognized in the remaining athletes involving a direct impact injury to the braced shoulder (the ‘collision shoulder’). In these athletes the clinical symptoms and signs were less specific but there was a high incidence of ‘dead arm’ at the time of injury (72%). Over 40% of the ‘elite’ athletes were included in this group. Results: The spectrum of pathology in the entire series was wide with a high incidence of associated intraarticular lesions. In those athletes with an impact type of injury without dislocation there was more extensive labral pathology with a high incidence of posterior labral tears (50%). The incidence of associated chondral lesions was similarly very high (50%) but significant bony pathology (bony Bankart) was less common than in the dislocation group (11% versus 26%). The ‘elite’ athletes had less frank dislocations but were more likely to sustain neurologic injury, posterior labral tears, SLAP lesions and cartilaginous and capsular injuries. Discussion: The incidence of all lesions in this series of collision athletes is higher than those previously published. These lesions often occurred in the absence of a frank dislocation (the ‘collision shoulder’), especially in the ‘elite’ players. It is important to anticipate additional pathology when planning definitive management in these patients, with surgery being tailored to the specific lesions found. However the collision athlete who sustains an impact type of shoulder injury without dislocation can do well following arthroscopic treatment, with a high rate of successful return to their sport, even at the ‘elite’ level. Paper 34: Normal Shoulder Outcome Score Values in the Young, Active Adult DANIEL JORDAN SOLOMON, MD, USA, PRESENTING AUTHOR MICHAEL G CLARKE, MD, USA MATTHEW THOMAS PROVENCHER, MD, USA ABSTRACT Objectives: Although numerous shoulder scores are available to assess pain, function, symptoms, and athletic activities for a variety of shoulder conditions, the majority of shoulder scores have not been tested in a normal subset of patients. The purpose of our study is to determine baseline, normative values for multiple shoulder outcomes scores in a young, active population without shoulder symptoms. Methods: A total of 206 patients were recruited to complete a battery of shoulder outcomes scores. Participants were first screened to exclude anyone with a current or prior shoulder condition, or who presented with any shoulder pain. Fourteen patients were excluded based on these criteria or failure to complete the majority of the
battery. One hundred ninety-two participants completed the Single Assessment Numeric Evaluation (SANE), modified American Shoulder and Elbow Society Score (ASES), Western Ontario Shoulder Instability Index (WOSI), Simple Shoulder Test (SST), and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. The mean age was 28.79 (range, 17 to 50, SD 7.4 years), and there were 148 males (77%), 38 females (20%), and 6 undeclared (3%). Results: A total of 59 participants (31%) scored no deficiencies on all of the outcomes instruments (a score of zero, or 100% function). The majority of participants (133 or 69%) demonstrated some level of abnormal shoulder score. The mean scores for all participants were SANE⫽ 97.7 (⫹/⫺ 5.2), ASES⫽98.9 (⫹/⫺ 3.3), WOSI ⫽ 82.7 of 2100 (⫹/⫺ 153.5), SST ⫽ 11.79 (⫹/⫺ 0.60), and DASH ⫽ 1.85 (⫹/⫺ 5.99). The relative scores from a perfect result in descending order were the WOSI (3.9%), the SANE (2.3%), the DASH (1.8%), the SST (1.7%) and the ASES (1.1%). Conclusions: Our results demonstrate, even in a completely asymptomatic population, that the best possible shoulder score may not be equivalent to a perfect score on the outcomes scale. Clinicians and researchers should be aware that normal outcomes scores in a young population may be in the 96 to 98% range of a perfect score. These numbers may be used by future researchers and surgeons to accurately assess outcomes in a young, active adult population. Key Words: outcomes scores; shoulder pain; correlation
Paper 35: Rotator Cuff Repair: Suture Spanning Anatomic Footprint Restoration Technique is Superior to Standard Dual-Row Repair STEVEN W. MEIER, MD, USA ABSTRACT Introduction: In rotator cuff surgery, dual-row suture anchor fixation is gaining popularity because of its ability to create a broad, anatomic healing surface as well as a high strength and rigid repair. Many concerns exist with this new technique, however, because it may prolong surgical time and increase the cost of the procedure. There are also questions as to whether as crowding the tuberosity with multiple implants and formation of many prominent knots may be problematic. Furthermore, the possibility of overtensioning the myotendinous unit is of utmost concern. The purpose of this study was to describe a modified anatomic repair technique that addresses these issues.
ABSTRACTS
of injury was recognized in the remaining athletes involving a direct impact injury to the braced shoulder (the ‘collision shoulder’). In these athletes the clinical symptoms and signs were less specific but there was a high incidence of ‘dead arm’ at the time of injury (72%). Over 40% of the ‘elite’ athletes were included in this group. Results: The spectrum of pathology in the entire series was wide with a high incidence of associated intraarticular lesions. In those athletes with an impact type of injury without dislocation there was more extensive labral pathology with a high incidence of posterior labral tears (50%). The incidence of associated chondral lesions was similarly very high (50%) but significant bony pathology (bony Bankart) was less common than in the dislocation group (11% versus 26%). The ‘elite’ athletes had less frank dislocations but were more likely to sustain neurologic injury, posterior labral tears, SLAP lesions and cartilaginous and capsular injuries. Discussion: The incidence of all lesions in this series of collision athletes is higher than those previously published. These lesions often occurred in the absence of a frank dislocation (the ‘collision shoulder’), especially in the ‘elite’ players. It is important to anticipate additional pathology when planning definitive management in these patients, with surgery being tailored to the specific lesions found. However the collision athlete who sustains an impact type of shoulder injury without dislocation can do well following arthroscopic treatment, with a high rate of successful return to their sport, even at the ‘elite’ level. Paper 34: Normal Shoulder Outcome Score Values in the Young, Active Adult DANIEL JORDAN SOLOMON, MD, USA, PRESENTING AUTHOR MICHAEL G CLARKE, MD, USA MATTHEW THOMAS PROVENCHER, MD, USA ABSTRACT Objectives: Although numerous shoulder scores are available to assess pain, function, symptoms, and athletic activities for a variety of shoulder conditions, the majority of shoulder scores have not been tested in a normal subset of patients. The purpose of our study is to determine baseline, normative values for multiple shoulder outcomes scores in a young, active population without shoulder symptoms. Methods: A total of 206 patients were recruited to complete a battery of shoulder outcomes scores. Participants were first screened to exclude anyone with a current or prior shoulder condition, or who presented with any shoulder pain. Fourteen patients were excluded based on these criteria or failure to complete the majority of the
battery. One hundred ninety-two participants completed the Single Assessment Numeric Evaluation (SANE), modified American Shoulder and Elbow Society Score (ASES), Western Ontario Shoulder Instability Index (WOSI), Simple Shoulder Test (SST), and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. The mean age was 28.79 (range, 17 to 50, SD 7.4 years), and there were 148 males (77%), 38 females (20%), and 6 undeclared (3%). Results: A total of 59 participants (31%) scored no deficiencies on all of the outcomes instruments (a score of zero, or 100% function). The majority of participants (133 or 69%) demonstrated some level of abnormal shoulder score. The mean scores for all participants were SANE⫽ 97.7 (⫹/⫺ 5.2), ASES⫽98.9 (⫹/⫺ 3.3), WOSI ⫽ 82.7 of 2100 (⫹/⫺ 153.5), SST ⫽ 11.79 (⫹/⫺ 0.60), and DASH ⫽ 1.85 (⫹/⫺ 5.99). The relative scores from a perfect result in descending order were the WOSI (3.9%), the SANE (2.3%), the DASH (1.8%), the SST (1.7%) and the ASES (1.1%). Conclusions: Our results demonstrate, even in a completely asymptomatic population, that the best possible shoulder score may not be equivalent to a perfect score on the outcomes scale. Clinicians and researchers should be aware that normal outcomes scores in a young population may be in the 96 to 98% range of a perfect score. These numbers may be used by future researchers and surgeons to accurately assess outcomes in a young, active adult population. Key Words: outcomes scores; shoulder pain; correlation
Paper 35: Rotator Cuff Repair: Suture Spanning Anatomic Footprint Restoration Technique is Superior to Standard Dual-Row Repair STEVEN W. MEIER, MD, USA ABSTRACT Introduction: In rotator cuff surgery, dual-row suture anchor fixation is gaining popularity because of its ability to create a broad, anatomic healing surface as well as a high strength and rigid repair. Many concerns exist with this new technique, however, because it may prolong surgical time and increase the cost of the procedure. There are also questions as to whether as crowding the tuberosity with multiple implants and formation of many prominent knots may be problematic. Furthermore, the possibility of overtensioning the myotendinous unit is of utmost concern. The purpose of this study was to describe a modified anatomic repair technique that addresses these issues.