ABSTRACTS e13

preoperative ASES score was 58(SD+18.8). There wasa significant correlation in the ASES score with the SANE(rho¼ 0.474; p<.001), SF-12 PCS (rho¼ 0.385; p<.001) &SF-12 MCS (rho¼ 0.27; p <.001) scores (p<.001) but notwith age at surgery. Preoperatively, women had lower ASESscores than men (55 vs 61) (p¼.003). The 184 patients withpartial thickness tears had higher ASES-Functional compo-nent scores(29vs26) than the229patientswith full thicknesstears (p¼.011). Irreparable cuff tears had lower ASES-Function component scores (18 vs 28) when compared tothose that had repairable tears (p¼.007). Patients with post-erosuperior (supra & infraspinatus) tears had higher ASES-Function component scores (28 vs 24) when compared withthose with partial tears or tendonopathy (p¼.003) . Patientsthat had adhesions had lower ASES-Function componentscores of 19 vs 27 (p¼.001).Conclusion: This study shows that most surgical factorsanalyzed had significant correlations with the ASES-Functional component but not with the ASES-Paincomponent of the ASES score. Individual tendon tearswere not significantly associated with the total ASES scoreor ASES-Pain component but many cuff tendon variableswere significantly associated with the ASES-Functionalcomponent. We also found that women who presentedwith rotator cuff pathology had lower function. Theseresults will help surgeons understand differing disabilitiesin patients who present with rotator cuff disorders.

The Radiologic Results of Ultrasonography-AssistedOne-time Needling in Calcific Tendinitis Patients(SS-26) JAE CHUL YOO, M.D., PRESENTING AUTHOR

MIN SOO SHON, M.D.KYOUNG HWAN KOH, M.D.TAE KANG LIM, M.D.YOUNG EUN PARK, M.D.SEUNG WON LEE, M.D.

Introduction: The purpose of this study was two-fold,first to report the early radiologic result of the calcificmaterial after one-time ultrasonography-assisted (US-A)needling in calcific tendinitis patients and second, toidentify the demographic and radiologic factors that induceradiographic disappearance by this one-time needling.Methods: For a 3-year period, 126 consecutive patients(137 shoulders) with symptomatic calcific tendinitis weretreated by one-time US-A needling. Diagnostic US was firstperformed to rule out any other shoulder pathologies. Afterlocalizing the calcific material, 18-gauge needle was intro-duced for needling procedure including aspiration andmultiple puncture. Afterwards all patients received sub-acromial corticosteroid injection. Patients were followed upat 4 weeks after the procedure. Radiologic assessments werecompared to pre-needling radiographs on size, density, andmorphology of the calcific deposits (by French ArthroscopicSociety classification). The demographic data and radio-graphic features were compared between change in calci-fication group (including complete disappearance) versusno-change group.Results: There were 33 male and 104 female patientswith the mean age of 54.6 years. The morphology of the

calcific deposits were 91 type A and 46 type B and meansize was 14.0�6.24 mm before the procedure. At 4 weeksafter the index procedure, the radiologic unchangedgroup was 32 and changed group was 105 cases (31reduction of size, 47 lower density, 21 scant remainder,and 6 complete disappearance). Between two groups nodifference was seen for the demographic data and sizebefore the procedure. However, group FAS classificationtwo groups before the procedure was significantlydifferent (p<0.001): while the radiologic change grouphad 59 type A and 46 type B, all of the unchanged grouphad type A.Conclusion: Only with one-time needling, radiologicchanges in size and/or density were seen in 76.6% of thecalcific tendinitis patients at 4 weeks after the indexprocedure. However, complete or nearly complete disap-pearance of the calcification was seen in only 19.7%. TheFAS classification before the procedure was the only factorcorrelated with radiographic disappearance after one-timeUS assisted needling.

The Effect of Immobilization without PassiveExercise after Rotator Cuff Repair (SS-27)JAE CHUL YOO, M.D., PRESENTING AUTHOR

KYOUNG HWAN KOH, M.D.SEUNG WON LEE, M.D.MIN SOO SHON, M.D.YOUNG EUN PARK, M.D.TAE KANG LIM, M.D.

Introduction: While animal studies showed better heal-ing in longer duration of immobilization without passivemotion after rotator cuff (RC) repair, there were rareclinical studies to support. The purpose of this study was tosee clinical results of immobilization in rotator cuff repairand to see if there was any difference between duration ofimmobilization.Methods: One-hundred patients who underwent arthros-copic single-row repair for medium-to-large RC tear wereprospectively randomized to 4 or 8 weeks of immobilization.During the immobilization period after the surgery, anypassive or active range-of-motion exercise includingpendulum exercise was not allowed. According to theIntention-to-treat protocol and full analysis set, a total of 88patients were evaluated after exclusion of 12 patients whodid not have any clinical visit after 6 months post-operatively. Range-of-motion (ROM), Pain Visual AnalogueScale (PVAS), American Shoulder and Elbow Surgeon’s(ASES) score, Constant score, patient’s satisfaction, and re-tear rate were compared between 4-weeks (4W) and 8-weeks (8W) group. All enrolled patients were contacted bytelephone to investigate the clinical outcome measurementswith PVAS, ASES score, and satisfaction.Results: The real duration of immobilizationwas 4.1weeksin 4W and 7.2 weeks in 8W group. All the preoperativevariables including demographic data, ROM, clinical scores,and MRI features were comparable between two groups.There were 9 cases (10%) of full-thickness retear and 88%of patients rated their results as excellent or good. Therewere 7 delaminated partial re-tears and 5 full-thickness

e14 ABSTRACTS

re-tears in 4W group, and 7 delaminated partial re-tear and4 full-thickness re-tear in 8W group without statisticaldifference on postoperative MRI (p¼0.839). At 6 monthsand final follow-up, both groups showed no differences inROM, PVAS, ASES score, Constant score, and patientsatisfaction. On the final survey for all 98 patients inter-viewedby telephoneatmean35months, PVAS,ASES score,and patient’s satisfaction showed no difference as well.Conclusion: Immobilization without motion exerciseafter arthroscopic rotator cuff repair would result in 10%of failure to heal and good clinical results without increaseof stiffness despite of single-row repair for medium-to-large tear. However, immobilization more than 4 weeksseemed have no effects on the healing and ROM.

Cost-effectiveness of Rotator Cuff Repair (SS-28)LAURENCE D. HIGGINS, M.D., PRESENTING AUTHOR

ARVIND VON KEUDELL, M.D.NITIN JAIN, M.D., M.S.PH.JON J. P. WARNER, M.D.

Introduction: Approximately 270,000 rotator cuff repairsare performed per annum. However, there is scarce dataregarding the cost-effectiveness of rotator cuff repairs. Weassessed cost effectiveness of rotator cuff surgeryaccounting for complications and re-tear rates.Methods: We developed a cost-effectiveness analysismodel to examine the impact of the different health util-ities according to complication probabilities and associatedcosts. The model input parameters were derived frompublished literature and included a mean failure, infection,nerve injury and stiffness rate. A minimum of two-yearfollow-up studies were used to derive health utility scoresthat were calculated using the SF36. Average life expec-tancies were applied to generate cost-effectiveness ratios.Overall hospital costs were retrieved from literature andcost for physical therapy, physician appointments, andadditional procedures for revision or for complicationswere estimated. We performed sensitivity analyses toaccount for possible uncertainty in parameter estimates.We considered athroscopic and mini-open rotator cuffrepairs.Results: The mean gain of quality adjusted life-year(QALY) after rotator cuff surgery was 1.71 for anuncomplicated rotator cuff repair. Complications notrequiring further surgery yielded a QALY gain of 1.46. Thecalculated lifetime gain in QALY after a revision rotatorcuff surgery was 1.22. This yielded a cost-effectivenessratio of $9125.84/QALY for an uncomplicated cuff repair.In revision rotator cuff surgery due to a complication ora re-tear the ratio increased to $17,402.60 and $56,098.64/QALY, respectively. Sensitivity analysis demonstrated therobustness of the model.Conclusion: Rotator cuff surgery is cost-effective at theindex operation. This is the case even when complicationsoccur that do not require revision surgery. However ifa revision surgery has to be performed, rotator cuff repairis not cost-effective if a threshold of $50,000 per QALYgained is used as the benchmark.

Intra-Articular Cortisone Injection Has LimitedClinical Benefit for Non-Operative Treatment ofFemoral Acetabular Impingement with LabralPathology (SS-29) BRUCE A. LEVY, M.D., PRESENTING AUTHOR

TIMOTHY GRIFFITH, M.D.AARON KRYCH, M.D.JOSHUA HUDGENS, M.D.RAFAEL SIERRA, M.D.

Introduction: Intra-articular cortisone injection of the hipis commonly performed both as a confirmatory diagnostictest and also as a therapeutic treatment modality in patientswith femoral acetabular impingement (FAI). However, toour knowledge, there is no published data documentingthe clinical benefit of these injections in patients with FAI.Therefore, the purpose of our study is to assess the efficacyof intra-articular cortisone injection in patients with FAIand associated labral tear prior to hip arthroscopy. Wehypothesize that intra-articular cortisone injection does notprovide significant therapeutic benefit for the non-opera-tive treatment of FAI with associated labral tear.Methods: The records of patients undergoing hiparthroscopy for FAI at our institution between January2008 and October 2012 who agreed to participate inresearch were reviewed. A cohort of patients was identi-fied that underwent a pre-operative ultrasound orfluoroscopic guided intra-articular cortisone injection.Inclusion criteria were a diagnosis of FAI with labral tear,Tonnis grade 0 or 1, and minimum 50% pain relief duringthe anesthetic phase of the intra-articular injection.Exclusion criteria were patients with concomitant osteo-arthritis as defined as Tonnis grade 2 or 3. Numerical ratingscale (NRS) pain scores were prospectively recorded pre-injection, immediately post-injection, and at 14 dayfollow-up. An absolute change of 2 points on the NRSscore at 14 days was considered the minimal amount ofclinically significant pain relief. The type of steroid usedwas documented.Results: 35 patients met our inclusion criteria andincluded 29 females (83%) and 6 males (17%) witha mean age of 34.4 � 12.9 years. 7 patients had Tonnisgrade 0 (20%) and 28 had Tonnis grade 1 (80%).Patients received anesthetic combined with methyl-prednisolone (21 patients), triamcinolone (12 patients),or betamethasone (2 patients) during the intra-articularinjection. Median pre-injection NRS score was 6 (range2-10). Median immediate post-injection NRS score was2 (range 0-6). Median 14 day post-injection NRS scorewas 4 (range 0-10). Median absolute change in NRSscore at 14 days was 0 (range 0-8) with 23 patientsreporting no change (66%) and 11 patients (31%)reporting a change of � 2 points. There was nosignificant difference in pain reduction between thedifferent steroid preparations.Conclusion: In patients with symptomatic FAI and asso-ciated labral pathology, our data indicates that intra-articular cortisone injection has limited clinical benefit intwo-thirds of patients as a therapeutic non-operativetreatment modality.