Axillary artery aneurysm with distal embolization in a major league baseball pitcher.
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Adult↗
Biomedical subjects
David W Altchek
Publications and source records attributed to David W Altchek.
Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes.
BACKGROUND: Medial ulnar collateral ligament insufficiency of the elbow can be a devastating injury in the throwing athlete. Reconstruction of the medial ulnar collateral ligament was initially described by Jobe and associates; good clinical results have been described after this procedure. The authors' experience with this technique raised several concerns, and thus the "docking" procedure was developed as an alternative method for medial ulnar collateral ligament reconstruction of the elbow. The early results of the docking technique were good. The authors wish to investigate the intermediate-term clinical results of this method in a large group of athletes. HYPOTHESIS: The docking technique can return overhead-throwing athletes to sport with minimal perioperative morbidity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: During a 3-year period, 100 consecutive overhead-throwing athletes were treated with surgical reconstruction using the docking technique. The inclusion criteria were as follows: (1) a history of medial elbow pain that prevented throwing, (2) a preoperative standard noncontrast magnetic resonance image demonstrating medial ulnar collateral ligament injury, (3) clinically apparent medial ulnar collateral ligament insufficiency, and (4) an overhead-throwing athlete. At the time of surgery, all patients underwent routine arthroscopic assessment. The ulnar nerve was transposed in 22 cases. The mean follow-up was 36 months (range, 24-60 months). RESULTS: Ninety of 100 (90%) patients were able to compete at the same or a higher level than before medial ulnar collateral ligament injury for more than 12 months as noted at the follow-up interval; 7 patients were able to compete at a lower level. Only 3 patients suffered postoperative complications. CONCLUSION: The docking technique reliably returns athletes to competitive throwing with a low perioperative morbidity.
Adolescent↗
Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft.
A variety of factors contribute to the failure of primary anterior cruciate ligament (ACL) reconstruction; most commonly, it is technical error related to tunnel placement. Recently, the increasing popularity of the all-endoscopic ACL reconstruction and concern about graft impingement may have led to more posterior placement of the tibial tunnel by surgeons. Working through a tibial tunnel placed too posterior makes it more difficult to recognize the correct starting position on the femur, and more likely to start the femoral tunnel in a central 12 o'clock position. The combination of subtle posterior placement of the tibial tunnel and central placement of the femoral tunnel results in a graft that is malpositioned in both the sagittal and coronal planes--a "vertical graft." We present a novel method of ACL revision surgery applicable to a specific subset of ACL revision patients with an intact "vertical graft" and instability that is rotational more than translational. In these patients, a double-bundle revision ACL augmentation technique can be used, leaving the original graft in place. A new tibial tunnel is placed anterior to the original and a new femoral tunnel lateral to the original. Reconstruction is performed with allograft and the combined ACL construct provides robust translational and rotational stability to the tibiofemoral joint.
Anterior Cruciate Ligament↗
Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack.
PURPOSE: The objective was to clinically evaluate the treatment of type II Slap lesions repaired surgically using a bioabsorbable device. TYPE OF STUDY: Retrospective clinical follow-up study. METHODS: Forty-one patients with isolated type II SLAP lesions who were treated with arthroscopic fixation were identified. Patients were excluded for rotator cuff tears, instability, or subacromial decompression. Patients completed the L'Insalata and the American Society of Shoulder and Elbow Surgeons (ASES) questionnaires, and underwent a thorough shoulder examination at a minimum of 2 years postoperatively. RESULTS: At a mean of 3.7 years follow-up, 33 of 41 patients returned for physical examination and 6 others returned the L'Insalata questionnaire. The mean L'Insalata and ASES scores were 86.7 and 86.8, respectively; 27 patients reported their satisfaction as good to excellent but only 14 of the 29 athletes returned to their preinjury level of athletics. The average ASES scores were statistically different in patients who had their rotator cuff pierced versus those who did not (P< .05). In addition, 13 of 16 patients who experienced night pain had a cuff piercing approach. CONCLUSIONS: Despite high outcome scores, overall patient satisfaction was only 71%. In addition, up to 41% continued to experience some degree of night pain. Patients treated with a rotator cuff piercing had a significantly poorer outcome. Moreover, the patients who were athletes performed poorer on their outcomes evaluation than did their nonathletic counterparts. Whereas the outcome scores overall were high, this problem is still difficult to treat successfully. This may be because of the high demands of athletes. The data also suggest that placing portals through the rotator cuff may be associated with poorer surgical outcomes. LEVEL OF EVIDENCE: Level III.
Absorbable Implants↗
Arthroscopically assisted acromioclavicular joint reconstruction.
Arthroscopically assisted acromioclavicular joint reconstruction avoids the large incisions necessary with open reconstructions. This acromioclavicular joint reconstruction technique via the subacromial space does not violate the rotator interval or require screw removal. The patient is placed in a modified beach-chair position. The arthroscope is placed into the subacromial space, and a bursectomy is performed through a lateral subacromial portal. The coracoacromial ligament is released from the acromion with an electrocautery and an arthroscopic elevator. A nonabsorbable suture is passed through the coracoacromial ligament with a suture passer, and an arthroscopic suture grasper is used to deliver both ends of the suture out through the lateral portal. The coracoid is identified and isolated using a radiofrequency ablator placed through the anterior portal while visualizing through the lateral portal. A percutaneous shuttle device is passed through the skin superomedial to the coracoid. The shuttle is visualized entering superior to the coracoid and is passed just medial to the coracoid. Once the tip of the shuttle can be visualized in the recess inferior to the coracoid, the shuttle loop is advanced. A suture grasper is used to deliver both ends of the shuttle out through the anterior portal. A semitendinosus allograft is used to reconstruct the coracoclavicular ligament. A nonabsorbable suture is passed through both ends of the allograft. Three strands of nonabsorbable suture are braided together. The tendon and the braided suture are shuttled around the coracoid. At this point, both the braided suture and the allograft tendon enter the anterior portal, wrap around the coracoid base, and exit the anterior portal. A 3-cm incision is made over the distal clavicle. A hole is drilled through the clavicle with a 5-mm drill. A loop of 22-gauge wire is passed through the hole in the clavicle, and a looped suture is shuttled through the hole. A curved clamp is used to create a tunnel from the acromioclavicular joint, under the deltoid, to the anterior portal. The ends of the braided suture and the tendon sutures are grasped by the clamp and pulled out the acromioclavicular joint incision. The limbs of the braided suture and the tendon suture that pass medial to the coracoid are shuttled through the hole in the clavicle using the looped suture that was previously passed through the clavicle. The acromioclavicular joint is reduced by pushing down on the distal clavicle with a bone tamp while simultaneously lifting the acromion upward by superiorly loading the humerus at the elbow. Once the acromioclavicular joint is reduced or slightly over-reduced, the braided suture is tied down securely. The acromioclavicular joint should remain reduced even after the manual reduction maneuver is released. The semitendinosus allograft is tensioned around the distal end of the clavicle and sutured to itself with a nonabsorbable suture. The released coracoacromial ligament is retrieved from the clavicular incision and sutured to the distal clavicle and semitendinosus allograft. The incision is closed in standard fashion, and a sling is applied.
Acromioclavicular Joint↗
All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up.
PURPOSE: To compare the clinical outcomes of patients undergoing all-arthroscopic versus mini-open rotator cuff repair. In addition, ultrasound was used to assess the integrity of the repair. METHODS: A total of 38 patients who had undergone all-arthroscopic repair and 33 patients who had undergone mini-open repair with minimum 2-year follow-up were evaluated. All patients completed the American Shoulder and Elbow Surgeons' Scoring Survey (ASES), the Simple Shoulder Test, the L'Insalata Scoring Survey, and visual analog scales for pain. Physical examination, including strength testing and ultrasound evaluation to determine the integrity of the rotator cuff, was performed. RESULTS: No statistical difference in ASES scores was noted between patients who had all-arthroscopic repair versus mini-open repair, and 24% of all-arthroscopic repairs and 27% of mini-open repairs showed recurrent defects on ultrasound at follow-up. This difference was not statistically significant. Patients with an original tear larger than 3 cm were 7 times more likely to have a recurrent defect at follow-up. Patients with persistent defects had statistically significant deficits in strength on forward elevation and external rotation when compared with those with a normal shoulder. However, no difference was observed with regard to pain or outcome scores between patients with intact repairs and those with persistent defects. CONCLUSIONS: No difference in clinical outcomes was found between patients with rotator cuffs repaired arthroscopically and those repaired with use of a mini-open technique. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Aged↗
Elbow arthroscopy: treatment of the thrower's elbow.
The athlete's elbow has been described as one of the last frontiers in orthopaedic sports medicine. It has been considered separately from other athletic injuries because of the unique constellation of pathology that results from repetitive overhead throwing. Tremendous gains in understanding the complex interplay between the dynamic and static stabilizers of the athlete's elbow have occurred over the past decade. The desire to treat these injuries in a minimally invasive manner has driven the development of techniques and instrumentation for elbow arthroscopy, a successful and essential technique in the treatment of the thrower's elbow. Medial collateral ligament injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans of the capitellum have all been described as consequences of the overhead throwing motion. In addition, loose body formation, bony spur formation, and capsular contracture can each be present in conjunction with these conditions or as isolated entities. Not all pathology in the thrower's elbow is amenable to arthroscopic treatment; however, the clinician must be familiar with all of these conditions to form a comprehensive differential diagnosis for an athlete with elbow pain. The surgeon treating the athlete's elbow should be comfortable with both open and arthroscopic treatments. An understanding of the anatomy and biomechanics of the thrower's elbow is essential for good patient care. The preoperative evaluation should focus on a thorough history and physical examination, as well as specific diagnostic imaging modalities.
Arthroscopy↗
Magnetic resonance imaging of the elbow.
Despite being one of the more commonly injured joints in recreational and elite athletes, diagnosis of soft-tissue injuries of the elbow remains problematic. Although plain radiographs remain the initial mainstay for imaging of the elbow, the superior soft-tissue contrast and direct multiplanar capabilities of magnetic resonance (MR) imaging has afforded the ability to more accurately diagnose the site and extent of soft-tissue pathology, including tendinous injuries and trauma to the static stabilizers. In addition, the ability of MR imaging to noninvasively assess the integrity of the articular cartilage provides for more comprehensive information that was previously unavailable and has prognostic significance in the athlete.
Athletic Injuries↗
Medial collateral ligament tears in the throwing athlete.
Medial collateral ligament (MCL) injuries of the elbow in throwing athletes are part of a spectrum of valgus extension overload injuries. Clinicians should consider reconstruction of the injured MCL in those patients who are unable to return to sports activities or work after an interval of rest and rehabilitation. Surgical treatment of this disorder has continued to evolve from the original technique developed by Jobe and associates. The authors' surgical technique involves reconstruction of the MCL using a single ulnar tunnel and single humeral tunnel that is performed through a muscle-splitting approach that usually obviates the need for ulnar nerve transposition. Knowledge of the biology and biomechanics of MCL function is important in the diagnosis and treatment of MCL injuries of the elbow in the throwing athlete.
Arthroplasty↗
Chronic rotator cuff injury and repair model in sheep.
BACKGROUND: Most rotator cuff surgery is performed on chronic tears. As there is no animal model in which to examine the physiology of muscle and tendon injury and repair in this setting, we developed a chronic rotator cuff injury model in sheep. METHODS: The infraspinatus tendon was released in thirty-six female sheep. Biopsy specimens were obtained from the muscle and were analyzed for fat content. The force generated by the muscle with supramaximal stimulation was recorded intraoperatively. A control group (twelve sheep) underwent an immediate tendon repair. In the remaining twenty-four sheep, the tendon was wrapped in a dura substitute to prevent scarring and was repaired at six weeks (eight sheep) and eighteen weeks (sixteen sheep) after release. In the immediate repair group, four animals were killed at six weeks; four, at twelve weeks; and four, at twenty weeks. In the six-week delayed repair group, four animals were killed at twelve weeks and four were killed at twenty weeks after the repair. In the eighteen-week delayed repair group, eight animals were killed at twelve weeks; four, at twenty weeks; and four, at thirty weeks after the repair. Muscle biopsies and testing were repeated prior to killing of the animals. RESULTS: The average force of muscle contraction decreased 3.6 lb (1.6 kg) by six weeks after the injury and 3.9 lb (1.8 kg) by eighteen weeks after the injury. After the repair, the force of contraction in the six-week group improved by 0.8 lb (0.4 kg) at twelve weeks postoperatively and by 1.3 lb (0.6 kg) at twenty weeks postoperatively. In contrast, no improvement occurred in the eighteen-week group until thirty weeks after the repair, at which time a 0.9-lb (0.4-kg) improvement was noted. There was a twelvefold increase in intramuscular fat concentration; this lipid infiltration was partially reversed after the tendon repair. Isolated tendon samples demonstrated an increase in the modulus of elasticity after chronic detachment that partially corrected after the tendon repair in the earlier (six-week) repair group. CONCLUSIONS: We found that earlier repair of the tendon results in a more rapid recovery of both muscle function and tendon elasticity compared with a more delayed repair. We concluded that there may be a "point of no return" in rotator cuff injury after which the elasticity of the muscle-tendon unit does not return to normal.
Animals↗
The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency.
A review of patients with anterior cruciate ligament (ACL) insufficiency, symptomatic medial compartment osteoarthritis, and varus malalignment of the knee was performed. Twenty-six patients met the inclusion criteria. Twelve patients were treated with a valgus closing-wedge high tibial osteotomy (group 1). Fourteen patients were treated with a valgus closing-wedge high tibial osteotomy combined with arthroscopic ACL reconstruction (group 2). Twenty-five patients were available for follow-up at a minimum of 2 years. For group 1 patients, high tibial osteotomy alone had no effect on the Lachman test or pivot shift phenomena. For group 2 patients, combined high tibial osteotomy/ACL reconstruction resulted in a grade 1 Lachman test in 11 of 13 patients, and a negative pivot shift in 12 of 13 patients. No deficits in range of motion were noted in either group. Prior to surgery, 14 (56%) patients participated in recreational sports; 23 (92%) patients were able to participate in recreational sports at follow-up. Radiographs demonstrated osteoarthritic progression in group 1 and 2 patients (P<.05). The results of this study suggest that high tibial osteotomy alone and combined high tibial osteotomy/ACL reconstructions are effective in the surgical treatment of varus, ACL-deficient knees with symptomatic medial compartment arthritis; however, good or excellent results were more often seen after the combined procedure.
Adult↗
Negative prognostic factors in managing massive rotator cuff tears.
OBJECTIVE: To investigate the negative prognostic factors in the management of massive rotator cuff tears. DESIGN: Retrospective nonrandomized study. SETTING: Faculty Practice associated with a major orthopedic teaching hospital. PATIENTS: 108 patients who were treated for massive rotator cuff tears were evaluated for an average of 3.2 years posttreatment. There were 58 females and 50 males, with a mean age of 61.3 years. INTERVENTIONS: 40 patients underwent conservative nonsurgical management (Group 1), 32 patients underwent arthroscopic debridement (Group 2), and 36 patients underwent primary repair of the rotator cuff (Group 3). MAIN OUTCOME MEASURES: A detailed Shoulder Rating Questionnaire was filled out by patients pretreatment and minimal 2 years posttreatment. RESULTS: Overall, Group 1 had 65% excellent or good outcomes, Group 2 had 81%, and Group 3 had 86%. The subgroup of patients in Group 1 who had cortisone injections had a 75% success rate. CONCLUSIONS: Negative prognostic factors evaluated are presence of glenohumeral arthritis, decreased passive range of motion, superior migration of the humeral head, presence of atrophy, and external rotation/abduction strength less than 3. The presence of 3 or more of these negative prognostic factors are correlated with poor outcomes in the treatment of massive rotator cuff tears.
Activities of Daily Living↗
Open posterior stabilization for recurrent posterior glenohumeral instability.
Open posterior capsular shift is used for posterior glenohumeral instability that has failed nonoperative treatment. Few series have fully evaluated the outcome after open posterior stabilization. The purpose of this series was to evaluate the clinical and radiographic outcome after open posterior stabilization of the shoulder. Preoperative and intraoperative factors were analyzed with regard to their impact on results. Forty-eight consecutive shoulders were identified that had undergone primary open shoulder stabilization by use of open posterior capsular shift. Of the shoulders, 4 were lost to follow-up, resulting in a study group of 44 shoulders in 41 patients. Shoulders were evaluated at a range of 1.8 to 22.5 years after surgery by use of the L'Insalata shoulder form, Short Form-36 (SF-36), and a subjective shoulder rating in 44 shoulders. Thirty-nine shoulders were evaluated by physical examination, and thirty-seven underwent radiographic examination. A recurrence of posterior instability occurred in 8 shoulders (19%). Of the patients, 84% were satisfied with the current status of their shoulder. The mean L'Insalata score was 81.25+/-17.8 points, the mean SF-36 physical component score was 50.81+/-7.87, and the mean mental component score was 53.82+/-7.55. Significantly poorer satisfaction and outcome scores were seen in shoulders found to have a chondral defect at the time of stabilization and in patients aged greater than 37 years at the time of surgery. No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after surgery. Open posterior shoulder stabilization is a reliable procedure for treating significant posterior instability without causing arthritic changes. Patients found to have chondral damage within the shoulder and older patients were found to have less success after stabilization.
Adolescent↗
Differential patterns of muscle activation in patients with symptomatic and asymptomatic rotator cuff tears.
Patients with rotator cuff tears have varying degrees of symptom expression. Our purpose was to evaluate the differential firing patterns of the rotator cuff, deltoid, and scapular stabilizer muscle groups in normal control subjects and in patients with symptomatic and asymptomatic 2-tendon rotator cuff tears. Eighteen subjects were evaluated: six normal subjects and twelve with 2-tendon cuff tears (six asymptomatic and six symptomatic). All cuff tear patients had magnetic resonance imaging (MRI) scans documenting superoposterior tear configurations involving the supraspinatus and infraspinatus tendons; all normal subjects had an ultrasound examination confirming the absence of cuff pathology. Subjects were grouped based on shoulder examination and outcomes questionnaires. Asymptomatic patients had minimal pain (<3 on the visual analog scale and no loss of active range of motion compared with the contralateral side); symptomatic patients had pain greater than 3 on the visual analog scale and decreased range of motion compared with the contralateral side (>10 degrees of motion loss). Electromyographic activity from 12 muscles and kinematic data were collected simultaneously during 10 functional tasks. Both symptomatic and asymptomatic cuff subjects demonstrated a trend toward increased muscle activation during all tasks compared with normal subjects. During the internal rotation tasks, asymptomatic patients had significantly greater (P<.05) subscapularis activity than symptomatic patients (65% maximal voluntary contraction [MVC] vs 42% MVC). During the carrying task, asymptomatic patients demonstrated significantly less (P<.03) upper trapezius muscle activation than symptomatic patients (16% MVC vs 50% MVC). During shoulder elevation tasks, symptomatic patients had significantly greater supraspinatus (52% MVC vs 28% MVC, P<.03), infraspinatus (32% MVC vs 16% MVC, P<.05), and upper trapezius (39% MVC vs 20% MVC, P<.04) muscle activation compared with asymptomatic patients. During heavy elevation (8 lb), asymptomatic patients showed a trend toward increased activation (P<.06) of the subscapularis compared with symptomatic patients (34% MVC vs 21% MVC). Differential shoulder muscle firing patterns in patients with rotator cuff pathology may play a role in the presence or absence of symptoms. Asymptomatic subjects demonstrated increased firing of the intact subscapularis, whereas symptomatic subjects continued to rely on torn rotator cuff tendons and periscapular muscle substitution, resulting in compromised function.
Adult↗
Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy.
The purpose of this study is to define the prevalence of peripheral nerve injury associated with full-thickness tears of the rotator cuff presenting with shoulder muscle atrophy. Twenty-five patients with the diagnosis of full-thickness rotator cuff tear were included. Electrodiagnostic testing, including nerve conduction studies and needle examination, was performed on all patients. There were 7 abnormal electromyographic examinations. The most common diagnosis was upper trunk brachial plexopathy severely affecting the axillary nerve (4/7), followed by suprascapular neuropathy (2/7) and cervical radiculopathy (1/7). The prevalence of associated peripheral neuropathy was found to be 28%. Greater degrees of atrophy were significantly associated with the presence of neuropathy in these patients. Careful neurologic screening in all patients and electromyographic examination in clinically suspicious groups are recommended in patients with full-thickness cuff tears before surgical repair.
Adult↗
Mini-open rotator cuff repair using a two-row fixation technique: outcomes analysis in patients with small, moderate, and large rotator cuff tears.
Mini-open rotator cuff repair has been used successfully to treat small- and moderate-sized rotator cuff tears but not large tears (>3 cm and <5 cm). We use a 2-row fixation technique of repairing the torn cuff to the humerus. We sought to determine if this technique would produce successful results in patients with larger rotator cuff tears. The results of 75 consecutive patients who underwent arthroscopic subacromial decompression with acromioplasty and mini-open rotator cuff repair were evaluated. All patients were evaluated at a minimum 24 months postoperatively (mean, 27 months). All patients were treated with a mini-open rotator cuff repair using a 2-row fixation technique. Patients were evaluated at follow-up with a focused shoulder examination, Hospital for Special Surgery (HSS) Shoulder Questionnaire, and the University of California Los Angeles (UCLA) Shoulder Rating Scale. There were 49 male and 26 female patients, with a mean age of 54 years (range, 34-72 years). All patients failed a preoperative course of physical therapy and nonoperative management. Thirty patients were found to have a large rotator cuff tear (group I), 35 were found to have a moderate-sized tear (group II), and 10 patients had a small tear (group III) at the time of arthroscopy. There was no statistically significant difference in outcome between groups. The mean UCLA Shoulder Rating Scale for all groups was 33.6/35. Mean HSS Shoulder Questionnaire at follow-up was 91%. The mean time from surgery to full recovery was 7 months. Patient's subjective satisfaction based on their preinjury level of performance at most recent follow-up was 92.6%. Eighty-three percent (74/89) of patients returned to their preinjury activity; 93% of patients reported that they would undergo the procedure again. We believe that mini-open rotator cuff repair using a 2-row fixation technique can yield excellent results in patients with small, moderate, and large rotator cuff tears. There was no detectable difference in outcome between groups at 2-year follow-up on clinical evaluation.
Adult↗
Development of arthrosis following dislocation of the shoulder: a case-control study.
The goal of this study was to document whether an association exists between shoulder dislocation and the development of arthrosis and to quantify this association, if present. Patients with osteoarthrosis who had undergone hemi-shoulder or total shoulder arthroplasty (TSA) were studied. Patients who had undergone total knee arthroplasty for arthrosis and who had no history of shoulder symptoms served as control subjects. All patients were asked if they had ever sustained a shoulder dislocation. Ninety-one TSA patients and 282 control subjects responded. The odds ratio for developing arthrosis after a shoulder dislocation was 19.3 (P =.000006). With the 5 patients who had shoulder surgery prior to TSA excluded, the odds ratio was 10.5 (P =.003). The risk of developing severe arthrosis of the shoulder is between 10 and 20 times greater for individuals who have had a dislocation of the shoulder.
Aged↗
Patients' expectations of shoulder surgery.
Patients' preoperative expectations of shoulder surgery affect both the decision to proceed with surgery and how patients assess outcomes of surgery. Our goals were to identify patients' expectations of shoulder surgery, to develop and test a patient-derived shoulder surgery expectations survey, and to determine the prevalence of major expectations by diagnosis. An initial sample of 409 patients (mean age, 51 +/- 17 years; 58% men) with diverse shoulder diagnoses were asked open-ended questions preoperatively about their expectations of shoulder surgery. Their responses were grouped into 38 categories including the following: pain relief, increasing range of motion, improving the ability to wash and dress, returning to sports, improving the ability to interact and care for others, and for the shoulder to be back to the way it was before shoulder symptoms started. Expectations varied by demographic characteristics, diagnosis, and functional status measured by the L'Insalata Shoulder Rating Questionnaire and the Short Form 36. The most frequently cited categories were then assembled into closed-format questions to form a draft survey. A second sample of 100 patients with diverse shoulder diagnoses completed the draft survey on 2 separate occasions to establish test-retest reliability. Items retained to form the final survey were frequently cited, represented clinically relevant or potentially unrealistic expectations, and had concordance levels of 0.40 to 0.83 measured by the kappa statistic (71% had kappa >or= 0.60). The final 17-item Hospital for Special Surgery Shoulder Surgery Expectations Survey requires less than 5 minutes to complete. This patient-derived, self-administered survey has several possible uses in daily clinical practice, such as providing a way to learn about the patient's perspectives, providing the orthopaedist with a template to guide a formal discussion about realistic and unrealistic goals, and providing a prospective record that can be used jointly by the orthopaedist and patient postoperatively to assess the outcome of surgery.
Adult↗