Optimal peri-operative pain management in arthroscopic rotator cuff repair remains debatable. The primary aim was to perform a meta-analysis of randomised controlled trials comparing various regional anaesthesia regimes utilised in arthroscopic rotator cuff repair. After registration (PROSPERO CRD42021286681), we conducted a systematic review and meta-analysis of randomised controlled trials found on MEDLINE, Embase, PsycINFO and the Cochrane Library databases. Titles, abstracts, and full text articles were screened by two independent reviewers. Data was collected by two authors. Risk of bias assessments included the Cochrane risk of bias tool. 24 studies that randomised between 30 - 85 patients, published from 2007 – 2021, were included in the meta-analysis,. Regional anaesthesia reduced post-op VAS scores at 24 hours (SMD 0.43, 95% CI 0.19-0.67) and 48 hours (SMD 0.51, 95% CI 0.15-0.88) compared to control. Regional anaesthesia resulted in fewer episodes of nausea and vomiting compared to control (OR 0.34, 95% CI 0.17-0.70). The addition of an axillary nerve block results in significantly improved VAS scores at <4 hours (SMD 1.11, 95% CI 0.15-2.08), <24 hours (SMD 0.81, 95% CI 0.12-1.50), and <48 hours (SMD 0.57, 95% CI 0.25-0.89) post-operatively, without increased adverse events (OR 0.66, 95% CI 0.10-4.25). This meta-analysis demonstrated better pain relief and fewer episodes of nausea/vomiting in the early post-operative period following arthroscopic rotator cuff repair when regional anaesthesia of any regime was used compared to control. The addition of axillary nerve blockade to suprascapular nerve block further improved pain relief without increasing the adverse event rate.

Introduction: In arthroscopic Latarjet procedure, the medial portal is used as a portal for the fixation of the coracoid to the glenoid. Medial portal is located three finger breadths distal and medial from the tip of the coracoid process. The purpose of this study is to establish the safety and complications when performing shoulder arthroscopic surgery with the use of medial portal. Methodology: Total of 20 cadavers were dissected via extended deltopectoral approach. Before dissection, location of medial portal was marked, and Steinman pin was inserted through the portal towards the inferior glenoid. Demographic data such as age, gender, weight and height were analyzed. Distance of neurovascular structure from pin and injury to the neurovascular structure by the pin was recorded and analyzed. Results: Forty shoulders were dissected. There were 4 (10%) injuries to the musculocutaneous nerve (MCN) caused by the pin. The mean distance of MCN from the pin was 9.81± 3.93mm. Male had increased distance of MCN and lateral cord of brachial plexus from pin compared to female (p<0.05). Increase in body mass index (BMI) was also associated with decrease distance of MCN and axillary nerve (AN) from instrument (pin) (p<0.05). Increase in BMI was also associated with increase distance of MCN and AN from coracoid process (p<0.05). Conclusion: There were 4 injuries to the MCN, although mean distance of MCN from the instrument (pin) was 9.81± 3.93mm. Hence, shoulder arthroscopic surgery that involved medial portal need to be done with extra precaution.

Introduction: Recurrent dislocation leads to early arthritis among patients, especially young individuals. In this study, we contemplate the surgical outcome of two different procedures used for recurrent dislocation.

Study Design & Methods:
This is a prospective case series study from a tertiary care public hospital from July 2012 to August 2015 who presented with recurrent anterior dislocation shoulder.

Results: The cohort included Males -32 , Females -8 with mean age 23.1+/-7.8 years . Theaverage follow up included - 63+/-12.7 years (range 49 - 102 months)
Shoulder dislocation is more prevalent in younger age group <30 years especially in males with higher body mass index . There was a positive co-relation between the period of immobilization post dislocation and further recurrences.
The recurrence rates in patients who underwent Boytchev surgery had (40.3 % ) higher and statistically significant difference as compared to the Bristow surgery (10.9 %). Mean external rotation deficit in Boytchev surgery (28+/- 2 degree) was higher than the Bristow surgery (20+/-2 degree) . Patients who underwent Bristow surgery had a less recurrent dislocation and lesser shoulder pain and better Rowe score (60 % good functional score, 10 % poor Rowe score) as compared to those who underwent Boytchev surgery(45% good functional score, , 40 % poor functional score )

Conclusions
Patients who have undergone Bristow surgery had better Rowe functional shoulder scores as compared to boytchev surgery. Predisposing factors for shoulder dislocation were improper post-dislocation immobilization. External rotation deficit was more in patients who have undergone Boytchev surgery.

Background: Long head bicep tendon (LHBT) pathologies are often managed surgically with bicep tenodesis or tenotomy. This study seeks to present patients outcomes by comparing the clinical effectiveness of these two treatments. Methods: Patients with pathological LHBT who were treated surgically between 2017 and 2021 were included in this retrospective cohort study. They were evaluated using the recognised Oxford Shoulder Score (OSS) for functionality and stability, Visual Analog Scale (VAS) for pain measurement, in addition to Single Assessment Numeric Evaluation (SANE) score for perceived improvement after 12 months too. Face-to-face follow-up also occurred to determine the range of motion and strength with the Constant Score (CS). Scores were generated within the Amplitude system. Results: A total of 63 patients (tenodesis: 45, tenotomy: 18) were included. Post-SANE score showed improvement and significant differences in both groups (tenodesis: 82, tenotomy: 67). Both groups demonstrated improvement in OSS (tenodesis: 41, tenotomy: 37), VAS (tenodesis: 21, Tenotomy: 26), and similar improvement in clinician evaluated CS. At latest follow-up, 9% (4/45) of tenodesis patients had complications which included frozen shoulder (2/45), persistent pain (1/45), and acute port-site bleeding (1/45) compared with 6% (1/18) had a Popeye deformity in tenotomy. Conclusion: Our study shows that both bicep tenodesis and tenotomy yield similar improvements. There is an increased risk of physical post-op complications with a trade-off for cosmetic deformity in tenodesis group without the need for further re-operation. However, patient-perceived improvement favours tenodesis. Therefore, tenodesis should be offered as an alternative option in younger population.

Purpose: The purpose of this study was to develop automated semantic segmentation with a deep convolutional neural network (DCNN) on 2D MRI images of rotator cuff tears to visualize 3D models of related anatomic structures.
Methods: MRI from 56 patients of rotator cuff tears (T2 Linear Coronal MRI, 3.0T, 512 mm × 512 mm, and 2.5-mm slice thickness) were collected. Segmentation mask for cuff tendon, muscle, bone and cartilage was performed by four orthopaedic shoulder surgeons, and these data were revised by one shoulder-trained surgeon with more than 20 years’ experience. We performed 2 D and 3D segmentation using nnU-Net with 2nd labels for reducing false positives. Final validation was performed in the external dataset acquired in T2 MRI (10 cases) from other institutions. The Dice Similarity Coefficient (DSC) was used to validate segmentation quality.
Results: The nnU-Net using 3D CNN with 2nd labels to reduce false positives achieved satisfactory results, even with a limited number of datasets. DSCs (mean±SD) of cuff tendon, muscle, bone, and cartilage in the internal test set were 80.7±9.7%, 85.8±8.6%, 97.8±0.6%, and 80.8±15.1%, respectively. In external validation, DSC of the tendon segmentation was 82.74±5.2%.
Conclusion: Automated segmentation using 3D CNN produced acceptable accuracy and reproducibility. This method could provide rapid, intuitive visualization that can significantly aid the diagnosis and treatment planning in patients with rotator cuff tears.

Background: The incidence of traumatic rotator cuff tear has been increasing in the last two decades. There is no consensus about the best course for management and whether early or late repair can affect the outcome. Objectives: To determine the effect of time to repair (early vs delayed) on the outcome after an acute traumatic rotator cuff tear. Study Design & Methods: Retrospective analysis of prospectively collected data on patients presenting with acute traumatic rotator cuff tear. Primary outcome was improvement in oxford shoulder score. Final follow up score was done at least one-year post-operative. The effect of mechanism of injury, tear size and pre-operative shoulder status were also considered. Patient divided into two groups early (<=6 months) and delayed (>6 months) operative groups. Results: The study had 49 patients in total (M: F 35:14). Fifteen patients had early surgery within 6 months of injury (mean age 55) and thirty-four patients had delayed surgery after 6 months (mean age 61). Tear size was classified as per Cofield Classification. The mean timing for postoperative oxford shoulder score was 14.9 months for the early group and 16.3 months for the delayed group. Both groups show significant improvement in the oxford score, early group (mean 22.53), delayed group (mean 20.97). Post op oxford scores were similar in both groups, early group (mean 40.93), delayed group (mean 40.53) with p=0.333 (chi-squared).Conclusions: There is no significant difference in the final functional outcome between early and delayed surgical repair of traumatic ARCT.

Purposes: This study aimed to 1) define treatment failure using the referred patient acceptable symptomatic state (PASS) values for PVAS, ASES, and SANE clinical scores and 2) identify the factors that lead to patient dissatisfaction after arthroscopic rotator cuff repair (ARCR).
Methods: We analyzed the arthroscopic rotator cuff surgery registry data from January 2015 to December 2016. Patients were followed for ≥2 years and categorized as dissatisfied or satisfied based on our own definition of treatment failure at 2 years postoperatively. For defining treatment failure, the referred PASS values for the PVAS, ASES, and SANE scores were used. Patients who failed to attain the PASS values were categorized into the dissatisfied group. Univariable and multivariable logistic regression analyses were performed to identify the factors affecting patient satisfaction at 2 years after rotator cuff repair.
Results: Of 117 patients, 30 (25.6%) were defined as the dissatisfied group (mean follow-up period, 37.5 months). Seventeen patients (14.5%) had confirmed re-tear on follow-up MRI. Progressed retear size featured a significantly higher risk of patient dissatisfaction (P=0.024; odds ratio, 6.430; 95% confidence interval, 1.270–32.541) in the multivariable analysis using symptom duration, sex, preoperative ASES score, preoperative tear size, retear, and progressed retear size as variables. Moreover, female sex had an increased odds for dissatisfaction (odds ratio, 4.646; 95% confidence interval, 1.590–13.578, P=0.005).
Conclusion: Two years after ARCR, most patients (74.4%) reported satisfaction with their outcomes. However, satisfaction levels can be altered by female sex or progressed retear size compared with the preoperative state.

Aim:
To evaluate the functional and clinical outcomes of primary arthroscopic anterior cruciate ligament (ACL) repair for the management of acute ACL tear.
Methodology:
This was a single surgeon prospective case series. All patients undergoing primary ACL repair from October, 2019 to December, 2021 were included in this study. A total of 35 patients underwent ACL repair in the study duration. The outcome measures included were pre-injury level of activities, pre and post op range of motion, Tegner score, International Knee Documentation Committee (IKDC), Lachman’s test, pivot shift test and single legged hopping test with minimum follow up of 2 years.
Results:
The mean age of cohort was 27±5.5 years. All of our patients achieved good range of motion at 1 month post- operatively. Lachman’s and pivot shift test were negative in all our patients and 80% of our patients had no difficulty in single legged hopping test after 12 months of surgery. The pre-op IKDC & Tegner score for the whole cohort was 35.45 and 30 which was significantly improves after 2 years to 90.56±5.6 to 95±2 with P- value <0.001.
Conclusion:
The clinical outcomes of arthroscopic primary anterior cruciate ligament repair is a good option for acute ACL tears. Our experience shows good clinical and functional outcomes with no complain of post-operative laxity and re-tear.

Objective
This study aims to compare the clinical and functional outcomes and donor site morbidity of anterior cruciate ligament reconstruction with hamstring tendon autograft and peroneus longus tendon autograft in patients with complete anterior cruciate ligament rupture.
Methods
Patients who underwent ACL reconstruction from February 2018 to July 2019 were randomly allocated into two groups (hamstring and peroneus longus). Functional scores (IKDC and Lysholm scores) and pain intensity by visual analogue score were recorded preoperatively, 3, 6months, 1, and 2 years postoperatively. Donor site morbidities were assessed with thigh circumference measurements in hamstring group and ankle scoring with the American foot and ankle score in peroneus longus group.
Results
Sixty patients (hamstring n = 30, peroneus n = 30) met the inclusion criteria. The functional scores (IKDC and Lysholm) did not show statistical difference among the two groups at two years follow-up (P- value>0.05). The means values for visual analogue score after two years in the hamstring and Peroneus longus group was 1±0.74 and 1.03± 1.06, respectively. In peroneus longus group, the mean foot and ankle score was 98.63±3.88 (range= 85-100). A significant difference was found in the hamstring group between operated and non-operated thigh circumferences with p- value <0.001.
Conclusions
Peroneus longus tendon autograft is an easily accessible tendon for ACL reconstruction and gives comparable functional outcomes as hamstring tendon with no additional donor site morbidity in our study.