Jordan-Young Institute

The field of orthobiologics has attempted to address the challenge of discogenic low back pain (LBP). Research in areas such as stem cells, platelet-rich plasma, and specific growth factor injections has seen limited success. The purpose of this trial was to determine the efficacy of a single intradiscal bone marrow concentrate (BMC) injection on pain and function for chronic discogenic LBP. Patients with presumed discogenic LBP participated in a prospective, double-blind, randomized, sham controlled trial of a single intradiscal BMC injection compared to a sham procedure. Pain and function were assessed at baseline, 3, 6, and 12 months by Clinical Outcome Measurement Brief Instrument (COMBI) which includes the Numeric Rating Scale (NRS). Function was also assessed by the Oswestry Disability Index (ODI). The primary outcome was based upon clinical success, defined by at least 50% pain relief from baseline to 3, 6, and 12 months. Sixty-three patients were included in the trial (45 BMC, 18 sham). There were no significant differences in the primary outcome (>50% relief in NRS) at 3 months (40% BMC group [95 %CI: 27-50%] vs 33% sham group [95 %CI: 15-56%]), 6 months (40% BMC [95 %CI: 27-50%] vs 39% sham [95 %CI: 20-61%]), or 12 months (44% BMC [95 %CI: 31-59%] vs 56% sham [95 %CI: 34-75%]). There were no significant differences in the proportion of patients achieving at least a 30% improvement on the ODI at 3 months (51% BMC group [95 %CI: 37-65%] vs 33% sham group [95 %CI: 16-56%]), 6 months (53% BMC [95 %CI: 39-67%] vs 44% sham [95 %CI: 25-65%]), or 12 months (56% BMC [95 %CI: 41-69%] vs 61% sham [95 %CI: 39-80%]). Intradiscal BMC was equivalent to a sham procedure for chronic discogenic LBP. Both groups had a high, but statistically equivalent success rate. Unfortunately, the significant limitations of this trial, including lack of quality cell analysis, limit the ability to draw conclusions on the effectiveness of intradiscal BMC.

Pathology of the long head of the biceps tendon can be treated surgically with a multitude of tenodesis techniques; however, there is a lack of consensus on which technique provides the most optimal outcomes. Commonly used methods include inlay tenodesis with a bone tunnel and interference screw construct and onlay tenodesis with anchors or unicortical buttons. Although current methods typically provide satisfactory outcomes, many surgeons believe complications and failure rates remain suboptimal across techniques. In this article, we present an arthroscopic suprapectoral biceps tenodesis technique using an anchor device that was developed to address the shortcomings of current techniques, optimize outcomes, and minimize risk.

PurposeTo investigate surgeon preferences for graft use, including biologic augmentation and superior capsular reconstruction (SCR) associated with surgical treatment of rotator cuff repair (RCR).MethodsA 26-question survey was completed by arthroscopic shoulder surgeons. Surgeon demographics were evaluated. Surgeons were queried about shoulder arthroscopic graft use and rationale then responses were analyzed based on demographics.ResultsIn total, 260 surgeons completed the survey. Fifty-one percent of surgeons reported a decrease in the volume of SCR use in the past 5 years. Less than 3% of surgeons used SCR in >90% of irreparable RCR cases, compared with 38% using SCR in <10% of irreparable cases (P < .05). Surgeons performing >100 RCR annually (42%; P < .05) and those employed in the hospital setting (44%; P < .05) reported an overall increase in the use of SCR. More international surgeons (67%) decreased their use of SCR compared with U.S. surgeons (44%; P < .05). In contrast, bioinductive graft use is generally on the rise, with 48% of surgeons reporting increased use since first use, although used in <10% of cases by 54% of surgeons. Sixty-eight percent of surgeons performing >100 RCRs annually used bioinductive grafts (P < .05). Fewer international surgeons (30%) performed biologic augmentation (P < .05). Suboptimal published outcomes (40%) and no perceived patient benefit (40%) were most cited for decreased SCR use. Surgeons reporting increased use cited improved personal patient outcomes (72%).ConclusionsArthroscopic surgeons report decrease in volume of SCR use in the past 5 years. Surgeon’s personal experience of patient outcome and suboptimal published results were the strongest factors impacting decision-making. In contrast, bioinductive graft use is increasing. However, most surgeons use these grafts in a relatively small percentage of cases.Clinical RelevanceEvaluation of scientific data, personal experience, and influences on surgical practice will give a comprehensive understanding of current RCR practices.

In an effort to preserve bone, humeral stems in reverse total shoulder arthroplasty (RTSA) have gradually decreased in length. The purpose of this study was to compare the immediate postoperative radiographic appearance of short-length with standard-length RTSA stems. Patients who underwent RTSA using a press-fit standard-length or short-length humeral implant with a consistent geometry (Univers Revers or Revers Apex) were evaluated in a multicenter retrospective review. Initial postoperative radiographs were used to assess initial alignment and filling ratios. In addition, radiographs were evaluated for early signs of stress shielding and/or loosening. Clinical outcome scores and range of motion were also evaluated. Overall, 137 short-length stems and 139 standard-length stems were analyzed. Initial radiographs demonstrated a significantly higher percentage of stems placed in neutral alignment in the short-stem group (95.6% vs 89.2%, P = 0.045). Similar metaphyseal filling ratios were seen between groups, but a significantly higher diaphyseal filling ratio was observed in the short-stem group (57% vs 34%, P < 0.001). Less calcar osteolysis (2.2% vs 12.9%; P = 0.001) and fewer overall number of radiographic changes (tuberosity resorption, lucencies, and subsidence) (0.7% vs 5.0%; P = 0.033) were seen with short stems compared with the standard-length stems. RTSA with a short-stem humeral implant demonstrates excellent radiographic outcomes, including low rates of loosening and subsidence at 1 year, with less early calcar osteolysis compared with a standard-length stem. III (Case-control).