Browsing by Author "Trofa, David P."

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    Is the impact of previous rotator cuff repair on the outcome of reverse shoulder arthroplasty clinically relevant? A systematic review of 2879 shoulders
    (Sage, 2024-08-10) Berk, Alexander N.; Rao, Allison J.; Obana, Kyle K.; Ifarraguerri, Anna M.; Trofa, David P.; Connor, Patrick M.; Schiffern, Shadley C.; Hamid, Nady; Saltzman, Bryan M.; Orthopaedic Surgery, School of Medicine
    Background: Outcomes of reverse shoulder arthroplasty (RSA) in patients with prior rotator cuff repair (RCR) remain inconsistent. The purpose of this study, therefore, was to systematically review the current outcomes literature on RSA in patients with prior RCR and to compare the results with controls without prior RCR. Methods: A systematic review of the literature was performed, and outcome studies reporting on functional and clinical outcomes were included. Results: A total of 11 studies encompassing 2879 shoulders were included. Improvements in postoperative patient-reported outcomes (PROs) from the baseline were higher in controls including the American Shoulder and Elbow Surgeons score (47.0 vs 39.5), Simple Shoulder Test (6.0 vs 4.9), Constant score (32.6 vs 26.4), and Visual Analog Scale for pain (-5.6 vs -4.9). Improvement in range of motion was greater in the control group, including external rotation (17° vs 11°), anterior elevation (56° vs 43°), and abduction (52° vs 43°). The overall complication rate (8% vs 5%) and revision rate (3% vs 1%) were higher in the RCR group. Discussion: Differences in postoperative PROs and improvement from the baseline demonstrate a trend toward lower outcomes in patients with prior RCR but may be below the minimal clinically import difference.
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    Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study
    (Springer Nature, 2025-01-15) Ifarraguerri, Anna M.; Graham, George D.; White, Alexander B.; Berk, Alexander N.; Gachigi, Kennedy K.; Siparsky, Patrick N.; Trofa, David P.; Piasecki, Dana P.; Fleischli, James E.; Saltzman, Bryan M.; Orthopaedic Surgery, School of Medicine
    Background: There are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure. Methods: All patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected. Results: The final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR -11.7; 95% CI -22.35 to -1.04; P = 0.031), KOOS symptoms score (OR -17.11; 95% CI -28.85 to -5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR -11.15; 95% CI -21.71 to -0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR -9.99; 95% CI -15.77 to -4.22; P = 0.001). Conclusions: The clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients.