Browsing by Author "Badman, Brian L."

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    Rotator Cuff Repair Augmented With Interpositional Nanofiber Scaffold
    (Elsevier, 2022-12-21) Beleckas, Casey M.; Bishai, Shariff K.; Badman, Brian L.; Orthopaedic Surgery, School of Medicine
    Despite advances in arthroscopic rotator cuff repair, failure rates up to 94% have been reported in the literature for large tears, with rates as high as 36% for small and medium tears. One strategy for improving outcomes is augmentation with a patch, which has typically been incorporated onto the bursal portion of the repaired tendon and been made up of either dermal or bovine collagen tissue. The Rotium wick (Atreon Orthopedics, Columbus, OH)-an interpositional augmentation-is a nanofiber scaffold that is meant to be sandwiched between the rotator cuff and humerus at the bone-tendon interface and is currently the only implant approved by the US Food and Drug Administration to be used in this manner. The scaffold works to improve the cellular organization of the basement membrane during tendon healing at the enthesis and, in a recent sheep study, has been shown to better replicate the natural Sharpey-like fibers similar to the native tendon and increase the strength of the repair more rapidly. The purpose of this Technical Note is to describe the means for use of an interpositional nanofiber scaffold for arthroscopic rotator cuff repair.
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    Short-Term Clinical Outcomes and Comparison of Ultrasound Versus Magnetic Resonance Imaging of Superior Capsular Reconstruction
    (Elsevier, 2020-04-16) Badman, Brian L.; Baessler, Aaron M.; Moor, Molly; Orthopaedic Surgery, School of Medicine
    Purpose To evaluate the short-term outcomes of 10 patients with irreparable massive rotator cuff tears treated with arthroscopic superior capsular reconstruction (SCR) using dermal allograft. Methods Between 2016 and 2018, patients with symptomatic irreparable rotator cuff tears were prospectively enrolled for treatment with arthroscopic SCR. Investigational review board approval was achieved. All patients were treated by a single fellowship-trained shoulder surgeon. Minimum follow-up was 1 year. Range of motion and functional outcome according to visual analog scale pain, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores were assessed preoperatively and at routine follow-up intervals. Magnetic resonance imaging (MRI) and ultrasound were obtained at a minimum of 1 year to assess graft integrity and to correlate clinical outcomes. Results Ten patients with a mean age of 58.6 years had a minimum follow-up of 1 year. In all patients, preoperatively to postoperatively, mean forward flexion improved from 141° to 173° (P = .018), mean visual analog scale pain score decreased from 6.5 to 1 (P = .004), and mean American Shoulder and Elbow Surgeons score improved from 43 to 87 (P = .005). At 1 year, ultrasound evaluation identified graft failure in 1 patient (10%), whereas MRI diagnosed graft failure in 7 patients (70%). Of the 7 failures diagnosed by MRI, 4 failed at the level of the glenoid, 2 failed mid-graft, and 1 failed at the humerus. Conclusions Although clinical outcomes are statistically improved following arthroscopic SCR using a dermal allograft, the early high failure rates of the graft raise concerns about the long-term outcomes of the procedure. Furthermore, the use of ultrasound alone to validate an intact graft should be used with caution, as failures can occur at the glenoid and can be missed without MRI correlation. Level of Evidence Level IV, Therapeutic case series
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    Trends in outpatient shoulder arthroplasty during the COVID-19 (coronavirus disease 2019) era: increased proportion of outpatient cases with decrease in 90-day readmissions
    (Elsevier, 2022) Seetharam, Abhijit; Ghosh, Priyanka; Prado, Ruben; Badman, Brian L.; Orthopaedic Surgery, School of Medicine
    Background: The COVID-19 (coronavirus disease 2019) pandemic has placed an increased burden on health care resources, with hospitals around the globe canceling or reducing most elective surgical cases during the initial period of the pandemic. Simultaneously, there has been an increased interest in performing outpatient total joint arthroplasty in an efficient manner while maintaining patient safety. The purpose of this study was to investigate trends in total shoulder arthroplasty (TSA) during the COVID-19 era with respect to outpatient surgery and postoperative complications. Methods: We conducted a retrospective chart review of all primary anatomic and reverse TSAs performed at our health institution over a 3-year period (January 2018 to January 2021). All cases performed prior to March 2020 were considered the "pre-COVID-19 era" cohort. All cases performed in March 2020 or later comprised the "COVID-19 era" cohort. Patient demographic characteristics and medical comorbidities were also collected to appropriately match patients from the 2 cohorts. Outcomes measured included type of patient encounter (outpatient vs. inpatient), total length of stay, and 90-day complications. Results: A total of 567 TSAs met the inclusion criteria, consisting of 270 shoulder arthroplasty cases performed during the COVID-19 era and 297 cases performed during the pre-COVID-19 era. There were no significant differences in body mass index, American Society of Anesthesiologists score, smoking status, or distribution of pertinent medical comorbidities between the 2 examined cohorts. During the COVID-19 era, 31.8% of shoulder arthroplasties were performed in an outpatient setting. This was significantly higher than the percentage in the pre-COVID-19 era, with only 4.5% of cases performed in an outpatient setting (P < .0001). The average length of stay was significantly reduced in the COVID-19 era cohort (0.81 days vs. 1.45 days, P < .0001). There was a significant decrease in 90-day readmissions during the COVID-19 era. No significant difference in 90-day emergency department visits, 90-day venous thromboembolism events, or 90-day postoperative infections was observed between the 2 cohorts. Conclusion: We found a significant increase in the number of outpatient shoulder arthroplasty cases being performed at our health institution during the COVID-19 era, likely owing to a multitude of factors including improved perioperative patient management and increased hospital burden from the COVID-19 pandemic. This increase in outpatient cases was associated with a significant reduction in average hospital length of stay and a significant decrease in 90-day readmissions compared with the pre-COVID-19 era. The study data suggest that outpatient TSA can be performed in a safe and efficient manner in the appropriate patient cohort.
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    Trends in Outpatient Shoulder Arthroplasty during the COVID-19 era: Increased Proportion of Outpatient Cases with Decrease in 90-day Readmissions
    (Elsevier, 2022-01) Seetharam, Abhijit; Ghosh, Priyanka; Prado, Ruben; Badman, Brian L.; Orthopaedic Surgery, School of Medicine
    Background The COVID-19 pandemic has placed increased burden on healthcare resources, with hospitals around the globe cancelling or reducing most elective surgical cases during the initial period of the pandemic. Simultaneously, there has been an increased interest in performing outpatient total joint arthroplasty in an efficient manner while maintaining patient safety. The purpose of this study is to investigate trends in total shoulder arthroplasty during the COVID-19 era with respect to outpatient surgery and postoperative complications. Methods After approval from our Institution Review Board (IRB), a retrospective chart review was performed of all primary anatomic and reverse total shoulder arthroplasties at our health institution over a 3 year period (January 2018 – January 2021). All cases done prior to March 2020 were considered the “pre-COVID era” cohort. All cases after March 2020 were in the “COVID-19 era” cohort. Patient demographic and medical comorbidities were also collected to appropriately match patients from the two cohorts. Outcomes measured included patient encounter (outpatient versus inpatient), total length of stay, and 90 day complications. Results A total of 567 total shoulder arthroplasties met the inclusion criteria. There were 270 shoulder arthroplasty cases during the COVID-19 era, and 297 cases during the examined pre-COVID era. There were no significant differences in BMI, ASA score, smoking status, or distribution of pertinent medical comorbidities between the two examined cohorts. During the COVID-19 era, 31.8% of shoulder arthroplasties were performed in the outpatient setting. This was significantly higher than in the pre-COVID era, with only 4.5% of cases done in an outpatient setting (p < 0.0001). Average length of stay was significantly reduced in the COVID-19 era cohort (0.81 versus 1.45 days, p<0.0001). There was a significant decrease in 90-day readmissions during the COVID-19 era. 90 day ER visits, 90 day VTE, or 90 day postoperative infection were not significantly different between the two cohorts. Conclusion We found a significant increase in the number of outpatient shoulder arthroplasty cases being done at our health institution during the COVID-19 era, likely due to a multitude of factors including improved perioperative patient management and increased hospital burden from the COVID-19 pandemic. This increase in outpatient cases was associated with a significant reduction in average hospital length of stay and decrease in 90 day readmissions compared to the pre-COVID era. The data suggest that outpatient total shoulder arthroplasty can be performed in a safe and efficient manner in the appropriate patient cohort.
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    Use of a Nanofiber Resorbable Scaffold During Rotator Cuff Repair: Surgical Technique and Results After Repair of Small- to Medium-Sized Tears
    (Sage, 2022-05-13) Seetharam, Abhijit; Abad, Joel; Baessler, Aaron; Badman, Brian L.; Orthopaedic Surgery, School of Medicine
    Background: The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of cuff repair with scaffold devices has been reported to improve healing after cuff repair. Purpose/hypothesis: To describe the surgical technique of using an interpositional nanofiber scaffold during rotator cuff repair and report on a retrospective series of patients regarding functional outcomes and postoperative healing on magnetic resonance imaging (MRI). We hypothesized that augmentation of cuff repair with an interpositional scaffold would result in a high rate of tendon healing and excellent functional outcomes. Study design: Case series; Level of evidence, 4. Methods: A total of 33 patients underwent arthroscopic rotator cuff repair augmented with a nanofiber, bioresorbable polymer patch secured as an inlay between the tendon and underlying bone. Patients were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) shoulder score, and active range of motion (ROM) measurements. Postoperative MRI was used to evaluate repair status. Results: At a minimum follow-up of 6 months, the patients showed significant improvement on SST and ASES scores (P < .0001 for both). ROM in forward flexion, abduction, internal rotation, and external rotation significantly improved at 6 months postoperatively (P < .05 for all). MRI at an average of 11 months postoperatively showed healing in 91% of patients; one patient had a recurrent tear with transtendon failure, and another patient had retear at the insertional site. The patch was not visible on postoperative imaging, suggesting complete resorption in all patients. No adverse events were associated with the patch. Conclusion: Our results demonstrate the preliminary safety and efficacy of a novel, bioresorbable synthetic scaffold for rotator cuff repair. The use of the scaffold resulted in a 91% tendon healing rate and significant improvements in functional and patient-reported outcome measures. The results are promising for improving the current unacceptably high rate of rotator cuff repair failure.