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Papers by Jason Old
The American Journal of Sports Medicine
Background: The biceps tendon is a known source of shoulder pain. Few high-level studies have att... more Background: The biceps tendon is a known source of shoulder pain. Few high-level studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. Purpose: To compare patient-reported and objective clinical results between tenotomy and tenodesis for the treatment of lesions of the long head of the biceps brachii. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients aged ≥18 years undergoing arthroscopic surgery with intraoperative confirmation of a lesion of the long head of the biceps tendon were randomized. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score, while secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, elbow and shoulder strength, operative time, complications, and the incidence of...
Orthopaedic Journal of Sports Medicine
Objectives: The purpose of this prospective randomized, double blinded controlled trial was to co... more Objectives: The purpose of this prospective randomized, double blinded controlled trial was to compare patient-reported outcomes and clinical results between arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in patients with anterior shoulder instability with a Hill-Sachs lesion. Failure to recognize and address large Hill Sach’s defects during arthroscopic stabilization surgery for glenohumeral instability is known to lead to high rates of recurrence. Arthroscopic remplissage has evolved in recent years as a reproducible technique with a proposed benefit of decreased dislocations. However, there are no high level clinical studies to conclusively support its efficacy in reducing redislocations. Methods: One hundred and four patients, aged 14 years and older, with a confirmed Hill Sach’s lesion on ultrasound, CT or MRI, were randomized intraoperatively after confirming an engaging Hill Sach’s lesion to either undergo arthroscopic infraspinatus rempli...
Journal of Shoulder and Elbow Surgery
To compare the long-term effectiveness of care delivered by a clinical nurse specialist (CNS) wit... more To compare the long-term effectiveness of care delivered by a clinical nurse specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations. Background. The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care, such as multidisciplinary team care, are lacking. Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND-36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures. No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up, except that visits to nurse specialists were more frequent and home help was less frequent in the CNS group. A comparison of clinical outcomes among the three groups and a comparison between the nurse specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly (P < 0.05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study. Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Clinical Journal of Sport Medicine
Case Reports in Orthopedics
Acromioclavicular cysts are an uncommon manifestation secondary to a massive rotator cuff tear an... more Acromioclavicular cysts are an uncommon manifestation secondary to a massive rotator cuff tear and/or a degenerative osteoarthritic AC joint. We present a case of an 80-year-old female with a symptomatic acromioclavicular cyst that extended intramuscularly into the trapezius. She did not complain of symptoms associated with a massive rotator cuff tear; however, the cyst has been increasing in size and she was interested in having it removed. Intraoperatively, the mass extended into the trapezius muscle and was removed en bloc after dissecting it down to the stalk. A distal clavicle excision was then performed using an oscillating saw. After the cyst was excised, it was incised revealing thick mucoid content. The patient did well postoperatively at the three-month follow-up without signs of recurrence. To our knowledge, this is the first case of AC joint cyst with intramuscular extension that was managed operatively.
Journal of Orthopaedic Surgery
Surgical management of a young patient with a stable but painful acromioclavicular (AC) joint but... more Surgical management of a young patient with a stable but painful acromioclavicular (AC) joint but normal imagining is a challenging problem. A standard arthroscopic excision of distal clavicle seems too aggressive. An alternative procedure is arthroscopic debridement of the joint, particularly the often torn meniscus, and chondroplasty. This study demonstrates in younger patients the medium-term result of arthroscopic debridement of a painful AC joint. Methods: Fifty-three young adult patients with a stable but painful AC joint, and virtually normal magnetic resonance imaging (MRI) scan, had arthroscopic debridement of the AC joint. Follow-up was with questionnaire and American Shoulder and Elbow Surgeons Shoulder Score (ASES). Results: Mean age was 29 years (18-39), 41 male, 31 dominant arm. Twenty-two patients demonstrated additional shoulder pathology. Two patients had a later distal clavicle excision. Five patients had later surgery to other areas of the shoulder but had an asymptomatic AC joint. Thirty-eight patients completed the ASES questionnaire at mean 44 months (24-86) post-operation. The mean ASES score was 82.8 (52-100). There was no association between ASES score and AC joint disease severity found at operation (p ¼ 0.25). Seven patients had ongoing shoulder symptoms, although none were severe enough to warrant any treatment. Conclusion: In this young group of patients with arthroscopic AC joint debridement, most had good relief of the AC joint related symptoms. This is a worthwhile procedure in the young patient, with quick recovery, and does not preclude further AC joint surgery later.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Purpose Dexamethasone prolongs the duration of interscalene block, but the benefits of higher dos... more Purpose Dexamethasone prolongs the duration of interscalene block, but the benefits of higher doses and perineural vs intravenous administration remain unclear. Methods This factorial design, double-blinded trial randomized 280 adult patients undergoing ambulatory arthroscopic shoulder surgery at a single centre in a 1:1:1:1 ratio. Patients received ultrasound-guided interscalene block with 30 mL 0.5% bupivacaine and 4
Annals of Joint
Traumatic anterior shoulder dislocations are a common problem. There is a high rate of recurrent ... more Traumatic anterior shoulder dislocations are a common problem. There is a high rate of recurrent instability, especially in patients <30 years of age that are involved in high level sports. The purpose of this review is to discuss the natural history after a first-time shoulder dislocation and provide a brief overview of management options. Initial nonoperative management consists of immobilization in internal rotation for 1-3 weeks. The current evidence does not support immobilization in external rotation or for longer periods of time. For those patients who are at a high risk of recurrent instability, the evidence suggests that early surgical repair to address the pathology can be undertaken. This has shown to be clinically and fiscally effective while improving patient outcomes.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
World journal of orthopedics, Jan 18, 2017
Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedi... more Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most c...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2016
Arthroscopy Techniques, 2016
The recent literature shows that imaging modalities, physical examination tests, and glenohumeral... more The recent literature shows that imaging modalities, physical examination tests, and glenohumeral arthroscopy all have low sensitivities and specificities with respect to the diagnosis of the long head of biceps tendon pathology. Biceps tenoscopy is a strategy that aims to reduce the rate of missed diagnoses by improving visualization of the extra-articular part of the tendon. This is an area of predilection of pathology that is not adequately visualized with conventional arthroscopic techniques. This technical note presents the surgical technique for biceps tenoscopy.
Shoulder & elbow, 2015
The aim of this retrospective case series study was to assess the outcomes of patients with recur... more The aim of this retrospective case series study was to assess the outcomes of patients with recurrent anterior shoulder instability with antero-inferior glenoid bone loss treated with a specific open stabilization technique using intra-substance coracoid bone-grafting and Bankart repair. Over a 4-year period, 34 shoulders in all male patients of mean age 21 years were stabilized with this technique. Pre- and postoperative function, motion and stability were assessed as part of Rowe stability scoring, and American Shoulder and Elbow Surgeons (ASES) and Oxford Instability were recorded, with at least 2 years of follow-up in all patients. Union of the graft was determined by post-operative computed tomography (CT) of the affected shoulder. For all cases, two redislocations (5.9%) and two subluxations occurred when continuing high-risk sport after 2 years. Post-operative scores [median, mean (SD): Rowe 77.5, 77.2 (19.5); ASES 94.2, 92 (7.7); Oxford 43, 41.2 (6)]. CT scans on 28 shoulder...
Techniques in Shoulder & Elbow Surgery, 2016
Current Orthopaedic Practice, 2016
Journal of Bone Joint Surgery British Volume, Nov 1, 2011
Journal of Bone Joint Surgery British Volume, Nov 1, 2011
The American Journal of Sports Medicine
Background: The biceps tendon is a known source of shoulder pain. Few high-level studies have att... more Background: The biceps tendon is a known source of shoulder pain. Few high-level studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. Purpose: To compare patient-reported and objective clinical results between tenotomy and tenodesis for the treatment of lesions of the long head of the biceps brachii. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients aged ≥18 years undergoing arthroscopic surgery with intraoperative confirmation of a lesion of the long head of the biceps tendon were randomized. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score, while secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, elbow and shoulder strength, operative time, complications, and the incidence of...
Orthopaedic Journal of Sports Medicine
Objectives: The purpose of this prospective randomized, double blinded controlled trial was to co... more Objectives: The purpose of this prospective randomized, double blinded controlled trial was to compare patient-reported outcomes and clinical results between arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in patients with anterior shoulder instability with a Hill-Sachs lesion. Failure to recognize and address large Hill Sach’s defects during arthroscopic stabilization surgery for glenohumeral instability is known to lead to high rates of recurrence. Arthroscopic remplissage has evolved in recent years as a reproducible technique with a proposed benefit of decreased dislocations. However, there are no high level clinical studies to conclusively support its efficacy in reducing redislocations. Methods: One hundred and four patients, aged 14 years and older, with a confirmed Hill Sach’s lesion on ultrasound, CT or MRI, were randomized intraoperatively after confirming an engaging Hill Sach’s lesion to either undergo arthroscopic infraspinatus rempli...
Journal of Shoulder and Elbow Surgery
To compare the long-term effectiveness of care delivered by a clinical nurse specialist (CNS) wit... more To compare the long-term effectiveness of care delivered by a clinical nurse specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations. Background. The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care, such as multidisciplinary team care, are lacking. Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND-36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures. No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up, except that visits to nurse specialists were more frequent and home help was less frequent in the CNS group. A comparison of clinical outcomes among the three groups and a comparison between the nurse specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly (P &amp;amp;amp;amp;amp;lt; 0.05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study. Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Clinical Journal of Sport Medicine
Case Reports in Orthopedics
Acromioclavicular cysts are an uncommon manifestation secondary to a massive rotator cuff tear an... more Acromioclavicular cysts are an uncommon manifestation secondary to a massive rotator cuff tear and/or a degenerative osteoarthritic AC joint. We present a case of an 80-year-old female with a symptomatic acromioclavicular cyst that extended intramuscularly into the trapezius. She did not complain of symptoms associated with a massive rotator cuff tear; however, the cyst has been increasing in size and she was interested in having it removed. Intraoperatively, the mass extended into the trapezius muscle and was removed en bloc after dissecting it down to the stalk. A distal clavicle excision was then performed using an oscillating saw. After the cyst was excised, it was incised revealing thick mucoid content. The patient did well postoperatively at the three-month follow-up without signs of recurrence. To our knowledge, this is the first case of AC joint cyst with intramuscular extension that was managed operatively.
Journal of Orthopaedic Surgery
Surgical management of a young patient with a stable but painful acromioclavicular (AC) joint but... more Surgical management of a young patient with a stable but painful acromioclavicular (AC) joint but normal imagining is a challenging problem. A standard arthroscopic excision of distal clavicle seems too aggressive. An alternative procedure is arthroscopic debridement of the joint, particularly the often torn meniscus, and chondroplasty. This study demonstrates in younger patients the medium-term result of arthroscopic debridement of a painful AC joint. Methods: Fifty-three young adult patients with a stable but painful AC joint, and virtually normal magnetic resonance imaging (MRI) scan, had arthroscopic debridement of the AC joint. Follow-up was with questionnaire and American Shoulder and Elbow Surgeons Shoulder Score (ASES). Results: Mean age was 29 years (18-39), 41 male, 31 dominant arm. Twenty-two patients demonstrated additional shoulder pathology. Two patients had a later distal clavicle excision. Five patients had later surgery to other areas of the shoulder but had an asymptomatic AC joint. Thirty-eight patients completed the ASES questionnaire at mean 44 months (24-86) post-operation. The mean ASES score was 82.8 (52-100). There was no association between ASES score and AC joint disease severity found at operation (p ¼ 0.25). Seven patients had ongoing shoulder symptoms, although none were severe enough to warrant any treatment. Conclusion: In this young group of patients with arthroscopic AC joint debridement, most had good relief of the AC joint related symptoms. This is a worthwhile procedure in the young patient, with quick recovery, and does not preclude further AC joint surgery later.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Purpose Dexamethasone prolongs the duration of interscalene block, but the benefits of higher dos... more Purpose Dexamethasone prolongs the duration of interscalene block, but the benefits of higher doses and perineural vs intravenous administration remain unclear. Methods This factorial design, double-blinded trial randomized 280 adult patients undergoing ambulatory arthroscopic shoulder surgery at a single centre in a 1:1:1:1 ratio. Patients received ultrasound-guided interscalene block with 30 mL 0.5% bupivacaine and 4
Annals of Joint
Traumatic anterior shoulder dislocations are a common problem. There is a high rate of recurrent ... more Traumatic anterior shoulder dislocations are a common problem. There is a high rate of recurrent instability, especially in patients <30 years of age that are involved in high level sports. The purpose of this review is to discuss the natural history after a first-time shoulder dislocation and provide a brief overview of management options. Initial nonoperative management consists of immobilization in internal rotation for 1-3 weeks. The current evidence does not support immobilization in external rotation or for longer periods of time. For those patients who are at a high risk of recurrent instability, the evidence suggests that early surgical repair to address the pathology can be undertaken. This has shown to be clinically and fiscally effective while improving patient outcomes.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
World journal of orthopedics, Jan 18, 2017
Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedi... more Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most c...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2016
Arthroscopy Techniques, 2016
The recent literature shows that imaging modalities, physical examination tests, and glenohumeral... more The recent literature shows that imaging modalities, physical examination tests, and glenohumeral arthroscopy all have low sensitivities and specificities with respect to the diagnosis of the long head of biceps tendon pathology. Biceps tenoscopy is a strategy that aims to reduce the rate of missed diagnoses by improving visualization of the extra-articular part of the tendon. This is an area of predilection of pathology that is not adequately visualized with conventional arthroscopic techniques. This technical note presents the surgical technique for biceps tenoscopy.
Shoulder & elbow, 2015
The aim of this retrospective case series study was to assess the outcomes of patients with recur... more The aim of this retrospective case series study was to assess the outcomes of patients with recurrent anterior shoulder instability with antero-inferior glenoid bone loss treated with a specific open stabilization technique using intra-substance coracoid bone-grafting and Bankart repair. Over a 4-year period, 34 shoulders in all male patients of mean age 21 years were stabilized with this technique. Pre- and postoperative function, motion and stability were assessed as part of Rowe stability scoring, and American Shoulder and Elbow Surgeons (ASES) and Oxford Instability were recorded, with at least 2 years of follow-up in all patients. Union of the graft was determined by post-operative computed tomography (CT) of the affected shoulder. For all cases, two redislocations (5.9%) and two subluxations occurred when continuing high-risk sport after 2 years. Post-operative scores [median, mean (SD): Rowe 77.5, 77.2 (19.5); ASES 94.2, 92 (7.7); Oxford 43, 41.2 (6)]. CT scans on 28 shoulder...
Techniques in Shoulder & Elbow Surgery, 2016
Current Orthopaedic Practice, 2016
Journal of Bone Joint Surgery British Volume, Nov 1, 2011
Journal of Bone Joint Surgery British Volume, Nov 1, 2011