Orlando Orthopaedic Center Foundation Supporting Cutting Edge Orthopaedic Research

Graph depicting lesser pain levels for all-inside ACL reconstruction at multiple time points.

Overview: The purpose of this investigation was to compare the postoperative pain and clinical effectiveness of standard full-length tibial tunnel anterior cruciate ligament (ACL) reconstruction surgery with all-inside ACL reconstruction. This multicenter study was the first published study to evaluate this least possible invasive ACL reconstruction technique.

Methods: 120 patients undergoing ACL reconstruction with tibialis allograft were randomized to the all-inside or full-tibial tunnel technique.

Results: At two-year follow-up, there were no significant differences between the techniques regarding validated clinical knee scores. However, all-inside ACL reconstruction was less painful as compared with preoperative pain levels.

Conclusions: All-inside ACL reconstruction with allograft tendon is effective and less painful than traditional full tibial tunnel ACL reconstruction.

Efficacy of Continuous Subacromial Bupivacaine Infusion for Pain Control After Arthroscopic Rotator Cuff Repair

Randy Schwartzberg, M.D., Bryan Reuss, M.D., Randy Rust, M.D.

Published in: The Journal of Shoulder and Elbow Surgery, 2013

Overview: Since arthroscopic rotator cuff repair is a common and painful outpatient surgical procedure, the efficacy of continuous bupivacaine infusion catheters placed in the subacromial space intraoperative for pain control was evaluated. It was hypothesized that patients receiving continuous subacromial bupivacaine infusions after arthroscopic rotator cuff repair will have less postoperative pain in the early postoperative period than placebo and control groups.

Table depicting no differences between the three groups in narcotic pain medicine consumption during the study period.

Methods: 88 undergoing arthroscopic rotator cuff repair were randomized in a blinded fashion into one of three groups. Group 1 received no postoperative subacromial infusion catheter. Group 2 received a subacromial infusion catheter filled with saline solution. Group 3 received a postoperative subacromial infusion catheter filled with 0.5% bupivacaine without epinephrine. Infusions were at a continuous rate for 50 hours. Postoperative pain levels were assessed with visual analog scale scores for five days and medication logs were kept.

Results: There were no differences between the groups in postoperative pain or narcotic pain medication consumption.

Conclusion: Postoperative continuous infusion subacromial bupivacaine catheters for arthroscopic rotator cuff repair provide no demonstrable benefit.

Sensitivity and Specificity of Noncontrast Magnetic Resonance Imaging Reports in the Diagnosis of Type-II Superior Labral Anterior-Posterior Lesions in the Community Setting

Keith Connolly, M.D., Randy Schwartzberg, M.D., Bryan Reuss, M.D., David Crumbie, M.D., Brad Homan, D.O.

Published in: The Journal of Bone and Joint Surgery, 2013

Overview: MRI has been suggested to have high accuracy in studies performed at academic institutions for superior labral tears (SLAP lesions). This study evaluated the accuracy of MRI for detection of SLAP lesions in the community setting.

Table depicting accuracies for SLAP lesions regarding various MRI types and training levels of radiologists.

Methods: 140 patients with arthroscopically confirmed SLAP lesions and 100 patients with arthroscopically confirmed normal superior labra were included. The transcribed radiologists’ interpretations of the respective noncontrast shoulder MRIs were compared with the operative findings.

Results: For the diagnosis of SLAP lesion, noncontrast MRI yielded a sensitivity of 38% and specificity of 94%. Musculoskeletal fellowship trained radiologists had greater sensitivity results than non-musculoskeletal radiologists.

Conclusion: Noncontrast MRI is not a reliable diagnostic tool for SLAP lesion diagnosis in the community setting.

Ongoing Research

MRI of the Asymptomatic Shoulder in Patients 45-60 Years Old

Randy Schwartzberg, M.D., Bryan Reuss, M.D., Bradd Burkhart, M.D., Matt Butterfield, M.D.

Overview: It is generally believed that labral tears seen on MRI in middle-aged patients reflect different issues than when seen in younger athletes. There is some thought that the findings of labral tears in middle-aged patients may represent a normal degenerative process. A radiologist interpreting an MRI as a labral tear may lead an orthopaedic surgeon to recommend a labral tear surgery. The purpose of this study is to evaluate MRI findings in the shoulders of asymptomatic middle-aged people.

Methods: 52 people between the ages of 45-60 with no history of shoulder pain, no prior shoulder problem and a normal shoulder physical exam underwent shoulder MRI. Two musculoskeletal radiologists who were blinded to the purposes of the study were asked to read the MRIs.  They were asked to specifically evaluate all aspects of the labrum, rotator cuff and long head biceps tendon. The radiologists are currently evaluating the MRIs.

Efficacy of Continuous Infusion Ropivacaine Interscalene Blocks Versus Placebo for Pain Control After Arthroscopic Rotator Cuff Repair

Randy Schwartzberg, M.D., Bryan Reuss, M.D., Bradd Burkhart, M.D., Amanda Hanekom, Chris Warrell, M.D., Firas Abdul, M.D.

Overview: Since arthroscopic rotator cuff repair is a common and painful outpatient surgical procedure, the efficacy of continuous ropivacaine scalene block infusion catheters for pain control is being evaluated. It was hypothesized that patients receiving continuous ropivacaine scalene block infusions after arthroscopic rotator cuff repair will have less postoperative pain during the period the catheter is in place and for several days after it is removed.

Methods: Patients undergoing arthroscopic rotator cuff repair are candidates for the study. All patients will receive a preoperative scalene block with 0.5% ropivacaine by an anesthesiologist and a continuous infusion catheter will be placed. Patients will be randomized to receive either 0.2% ropivacaine or saline in the reservoir. The infusion will last for 50 hours. Patients will document their pain visual analog scores at multiple time points each day for five days. They will also maintain a medication log. The two groups will be compared postoperative for pain and narcotic pain medication consumption.

By Corey Gehrold and Randy Schwartzberg, M.D.

Originally Published in FloridaMD Magazine, April 2014