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Giraudon T, Morvan Y, Walch A, Walch G, Werthel JD. Premorbid glenoid anatomy reconstruction from contralateral shoulder 3-dimensional measurements: a computed tomography scan analysis of 260 shoulders. J Shoulder Elbow Surg 2024; 33:792-797. [PMID: 37852431 DOI: 10.1016/j.jse.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) aims to reconstruct the premorbid anatomy of a pathologic shoulder. A healthy contralateral shoulder could be useful as a template in planning TSA. The symmetry between the left and right shoulders in healthy patients remains to be proved. The purpose of this study was to compare the 3-dimensional anatomy of the glenoid between sides in a healthy population. METHODS A multinational computed tomography scan database was retrospectively reviewed for all healthy bilateral shoulders in patients aged between 18 and 50 years. One hundred thirty pairs of healthy shoulder computed tomography scans were analyzed, and glenoid version, inclination, width, and height, as well as glenoid lateral offset and scapula lateral offset, were measured. All anatomic measures were computed with Blueprint, validated 3-dimensional planning software. The intraclass correlation coefficient was determined for each measure between left and right shoulders. The minimal detectable change (MDC) was calculated using the following formula: MDC=2×1.96×Standarderrorofmeasurement. RESULTS The comparison between 130 pairs of healthy scapulae showed statistically significant differences in absolute values between right and left glenoid version (-5.3° vs. -4.6°, P < .01), inclination (8.4° vs. 9.3°, P < .01), and width (25.6 mm vs. 25.4 mm, P < .01), as well as scapula offset (105.8 mm vs. 106.2 mm, P < .01). Glenoid height was comparable between right and left shoulders (33.3 mm vs. 33.3 mm, P = .9). The differences between the means were always inferior to the MDC regarding glenoid version, inclination, height, and width, as well as scapula offset. Very strong intraclass correlation coefficients between the left and right shoulders were found for all evaluated paired measures. CONCLUSION Healthy contralateral scapulae are highly reliable to predict inclination, height, width, and scapula offset and are reliable to predict version of a given scapula. Paired right and left scapulae were not statistically symmetrical regarding mean glenoid version, inclination, and width, as well as scapula offset. Nevertheless, the reported differences were not higher than the MDC for this cohort, confirming that healthy contralateral shoulders can be a useful template in TSA preoperative planning.
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Affiliation(s)
| | | | - Arnaud Walch
- Hôpital Pierre Zobda-Quitman, Fort-de-France, France
| | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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Verweij LPE, Dobbe JGG, Kerkhoffs GMMJ, Streekstra GJ, van den Bekerom MPJ, Blankevoort L, van Deurzen DFP. Minimal but potentially clinically relevant anteroinferior position of the humeral head following traumatic anterior shoulder dislocations: A 3D-CT analysis. J Orthop Res 2024. [PMID: 38465730 DOI: 10.1002/jor.25831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
In unstable shoulders, excessive anteroinferior position of the humeral head relative to the glenoid can lead to a dislocation. Measuring humeral head position could therefore be valuable in quantifying shoulder laxity. The aim of this study was to measure (1) position of the humeral head relative to the glenoid and (2) joint space thickness during passive motion in unstable shoulders caused by traumatic anterior dislocations and in contralateral uninjured shoulders. A prospective cross-sectional CT-study was performed in patients with unilateral anterior shoulder instability. Patients underwent CT scanning of both injured and uninjured side in supine position (0° abduction and 0° external rotation) and in 60°, 90°, and 120° of abduction with 90° of external rotation without an external load. Subsequently, 3D virtual models were created of the humerus and the scapula to create a glenoid coordinate system to identify poster-anterior, inferior-superior, and lateral-medial position of the humeral head relative to the glenoid. Joint space thickness was defined as the average distance between the subchondral bone surfaces of the humeral head and glenoid. Fifteen consecutive patients were included. In supine position, the humeral head was positioned more anteriorly (p = 0.004), inferiorly (p = 0.019), and laterally (p = 0.021) in the injured compared to the uninjured shoulder. No differences were observed in any of the other positions. A joint-space thickness map, showing the bone-to-bone distances, identified the Hill-Sachs lesion footprint on the glenoid surface in external rotation and abduction, but no differences on average joint space thickness were observed in any position.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
| | - Johannes G G Dobbe
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
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Dalmas Y, Thélu CE, Laumonerie P, Mathieu E, Robert S, Mansat P, Bonnevialle N. The arthroscopic double-button Latarjet does not modify the static posterior translation of the humeral head. Orthop Traumatol Surg Res 2024; 110:103662. [PMID: 37460084 DOI: 10.1016/j.otsr.2023.103662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The Latarjet procedure treats anterior instability of the shoulder and is based on a triple anterior lock, where the conjoint tendon straps the lower third of the subscapularis muscle. Excessive posterior translation of the humeral head is a known risk factor for shoulder osteoarthritis. No in vivo study has investigated the effect of the bone block on the posterior static translation of the humeral epiphysis. The purpose of this study was to evaluate the effect of the bone block on the static posterior translation of the humeral head. The hypothesis was that this procedure increased this translation. MATERIALS AND METHODS This retrospective study included patients treated arthroscopically for anterior shoulder instability by a double-button Latarjet. An independent examiner analyzed the CT scans preoperatively, at 15 days, and at least 6 months postoperatively according to a standardized protocol. The analysis focused on the position of the bone block in the axial and coronal planes relative to the glenoid. The posterior translation was automatically calculated using the Blueprint© planning software. RESULTS Thirty-five patients were included with a mean age of 25 years (16-43), according to a 4M/1F sex ratio. The graft was perfectly flush to the subchondral bone in 63% (n=22) of cases and subequatorial in 91% (n=32). Preoperative posterior humeral translation was 52%. The mean immediate postoperative posterior humeral translation was 56%, and 57% at more than 6 months. The change in mean posterior humeral translation between preoperative/6 months was +0.94% [-20%; +12%] (p=0.29) and immediate postoperative/6 months +0.34% [-18%; +15%] (p=0.84). Gender, hypermobility and the axial position of the bone block did not influence the change in posterior humeral translation. The equatorial position of the bone block appeared to increase posterior humeral translation by +10%±5.2% [-0.427; 20.823] (p=0.07). CONCLUSION This work refutes our initial hypothesis. The change in static posterior humeral translation after arthroscopic Latarjet bone block remains stable at more than 6 months of follow-up. This procedure does not alter the anatomical position of the humeral head in relation to the glenoid. On the other hand, a more cranial positioning of the bone block could have an influence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoann Dalmas
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France.
| | - Charles-Edouard Thélu
- Clinique du sport et de chirurgie orthopédique, 199, rue de la Rianderie, 59700 Marcq-en-Barœul, France
| | - Pierre Laumonerie
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Emilie Mathieu
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Suzanne Robert
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Pierre Mansat
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
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Werthel JD, Dufrenot M, Schoch BS, Walch A, Morvan Y, Urvoy M, Walch G, Gauci MO. Are glenoid retroversion, humeral subluxation, and Walch classification associated with a muscle imbalance? J Shoulder Elbow Surg 2024:S1058-2746(24)00028-4. [PMID: 38242526 DOI: 10.1016/j.jse.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The etiology of humeral posterior subluxation remains unknown, and it has been hypothesized that horizontal muscle imbalance could cause this condition. The objective of this study was to compare the ratio of anterior-to-posterior rotator cuff and deltoid muscle volume as a function of humeral subluxation and glenoid morphology when analyzed as a continuous variable in arthritic shoulders. METHODS In total, 333 computed tomography scans of shoulders (273 arthritic shoulders and 60 healthy controls) were included in this study and were segmented automatically. For each muscle, the volume of muscle fibers without intramuscular fat was measured. The ratio between the volume of the subscapularis and the volume of the infraspinatus plus teres minor (AP ratio) and the ratio between the anterior and posterior deltoids (APdeltoid) were calculated. Statistical analyses were performed to determine whether a correlation could be found between these ratios and glenoid version, humeral subluxation, and/or glenoid type per the Walch classification. RESULTS Within the arthritic cohort, no statistically significant difference in the AP ratio was found between type A glenoids (1.09 ± 0.22) and type B glenoids (1.03 ± 0.16, P = .09), type D glenoids (1.12 ± 0.27, P = .77), or type C glenoids (1.10 ± 0.19, P > .999). No correlation was found between the AP ratio and glenoid version (ρ = -0.0360, P = .55) or humeral subluxation (ρ = 0.076, P = .21). The APdeltoid ratio of type A glenoids (0.48 ± 0.15) was significantly greater than that of type B glenoids (0.35 ± 0.16, P < .01) and type C glenoids (0.21 ± 0.10, P < .01) but was not significantly different from that of type D glenoids (0.64 ± 0.34, P > .999). When evaluating both healthy control and arthritic shoulders, moderate correlations were found between the APdeltoid ratio and both glenoid version (ρ = 0.55, P < .01) and humeral subluxation (ρ = -0.61, P < .01). CONCLUSION This in vitro study supports the use of software for fully automated 3-dimensional reconstruction of the 4 rotator cuff muscles and the deltoid. Compared with previous 2-dimensional computed tomography scan studies, our study did not find any correlation between the anteroposterior muscle volume ratio and glenoid parameters in arthritic shoulders. However, once deformity occurred, the observed APdeltoid ratio was lower with type B and C glenoids. These findings suggest that rotator cuff muscle imbalance may not be the precipitating etiology for the posterior humeral subluxation and secondary posterior glenoid erosion characteristic of Walch type B glenoids.
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Affiliation(s)
| | | | | | | | | | | | - Gilles Walch
- Ramsay Générale de Santé, Centre Orthopédique Santy, Jean Mermoz Private Hospital, Lyon, France
| | - Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport - Centre Hospitalier Universitaire (IULS-CHU) de Nice, Nice, France
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Niu Z, Shen X, Li M, Fan M, Zuo J, Liu T. Comparison of Glenohumeral Bone Morphology Between Patients With Versus Without Anterior Shoulder Instability. Orthop J Sports Med 2023; 11:23259671231217971. [PMID: 38145224 PMCID: PMC10748947 DOI: 10.1177/23259671231217971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background The stability of the glenohumeral joint is associated with anatomic characteristics including bony structures and soft tissues. Purpose To compare the differences in specific bony glenohumeral geometries between shoulders with anterior shoulder instability (ASI), unaffected contralateral shoulders, and healthy control shoulders. Study Design Cross-sectional study; Level of evidence, 3. Methods Shoulder computed tomography (CT) scans of 36 patients with ASI and 36 matched healthy controls were retrieved and 3-dimensionally reconstructed. We measured the glenoid radius of curvature (GROC) in the anterior-posterior (AP) and superior-inferior directions, humeral head radius of curvature (HROC) in the AP direction, conformity index, glenoid height, glenoid width, glenoid index, stability angle, glenoid version, and glenoid depth. The differences between the groups were statistically calculated. CT scans of the unaffected contralateral shoulders from 21 of the ASI patients were also collected to identify the consistency of the bony structures in bilateral shoulders. Results Patients with ASI had greater GROC in the AP direction (P < .001), HROC in the AP direction (P = .002), glenoid height (P = .005), and glenoid index (P < .001) and smaller conformity index (P < .001), glenoid width (P = .002), stability angle (P < .001), and glenoid depth (P < .001). In addition, the glenoid of the ASI patients was more anteverted compared with that of controls (P = .001). There was no statistical difference in half the measurements between the bilateral shoulder joints in patients with ASI. Conclusion In this study, glenohumeral geometric differences were found between ASI patients and healthy control participants. Glenoid curvature and conformity index, based on bilateral comparisons of affected and contralateral shoulders, appear inherent and may predict ASI risk.
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Affiliation(s)
- Zhixin Niu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
- Department of Orthopedics, Jiaozuo People's Hospital, Jiaozuo, Henan Province, China
| | - Xianyue Shen
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Menglong Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Mingrui Fan
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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Tang X, Zhang J, Zhang J, He Y. Correlation between the morphological features of the biceps groove and injuries to the biceps pulley and the long head tendon of the biceps. BMC Musculoskelet Disord 2023; 24:377. [PMID: 37173699 PMCID: PMC10176717 DOI: 10.1186/s12891-023-06497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The morphometric features of the biceps groove were measured to investigate their correlation with the injury of the pulley and the long head of the biceps tendon (LHBT). METHODS A total of 126 patients undergoing arthroscopic rotator cuff repair surgery had their morphological features of bicipital groove evaluated on a 3D reconstruction model of the humeral head. The groove width, groove depth, opening angle, medial wall angle, and inclination angle of the bicipital groove were measured for each patient. During the surgery, the type of injury to the biceps pulley and the degree of long head of biceps tendon injury were assessed. The correlations of these injury assessments with bicipital groove measurements were analyzed. RESULTS The average groove width was(12.3 ± 2.1) mm. The average groove depth was(4.9 ± 1.4) mm. The average groove inclination angle was 26.3° ± 8.1°. The average opening angle was 89.8° ± 18.4°. The average medial groove wall angle was 40.6° ± 7.9°.Sixty six patients had injury of the biceps pulley structure, and their Martetschläger classifications were as follows: type I injury in 12 patients, type II injury in 18 patients, and type III injury in 36 patients. The Lafosse grades of Lesions of LHBT were as follows: 72 cases were grade 0 injury, 30 cases were grade I injury, and 24 cases were grade II injury. We found no significant correlation between the opening width, depth, inclination angle, opening angle, and medial wall angle of the morphological features of bicipital groove and injuries of the pulley and the LHBT. The correlation between pulley structure injury and lesions of LHBT was statistically significant. CONCLUSION Lesions of LHBT show strong correlation with pulley injuries.This study does not find a correlation between the injury of the pulley or the LHBT and bicipital groove morphology.
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Affiliation(s)
- Xiaoye Tang
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China
| | - Jialu Zhang
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China
| | - Jiechao Zhang
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China
| | - Yong He
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China.
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Zhang B, Guan H, Ye Z, Zhang Y. Study on geometry and morphology of proximal humerus in Northern Chinese population based on 3-D CT. J Orthop Surg Res 2023; 18:47. [PMID: 36647099 PMCID: PMC9843902 DOI: 10.1186/s13018-023-03504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study investigated the characteristics of humeral geometric and morphological parameters in northern Chinese population by three-dimensional measurements, and compared whether there were differences in humeral morphology among populations from different geographical regions. METHODS Computed tomography scans of 80 humerus were obtained, reconstructed and measured. Differences in humeral morphological parameters between genders and sides were compared. Correlation analysis was used to explore possible correlations among the parameters. The differences in humeral geometric morphometric parameters between Western and East Asian populations were compared according to pool results of present and previous studies. RESULTS The average (and standard deviation) of humeral head radius curvature, arc angle, diameter, and thickness was 151.79 ± 6.69°, 23.36 ± 2.08 mm, 44.83 ± 3.92 mm and 17.55 ± 1.84 mm in coronal humeral head plane, and 152.05 ± 8.82°, 21.81 ± 1.88 mm, 41.77 ± 3.44 mm and 16.52 ± 1.92 mm in transversal humeral head plane. The average of the humeral head medial offset and posterior offset was 7.34 ± 2.47 mm and 0.08 ± 1.72 mm. Humeral head inclination angle, arc angle and radius curvature of humeral neck-shaft averaged 137.69 ± 4.92°, 34.7 ± 5.29° and 55.76 ± 13.43 mm. Superior, inferior, anterior, posterior concave angle of humeral anatomical neck averaged 150.41 ± 10.91°, 146.55 ± 10.12°, 146.43 ± 13.53° and 149.33 ± 14.07°. The average of height of the greater tuberosity, height of the lesser tuberosity, depth, concave angle and volume of the intertubercular groove was 14.19 ± 1.7 mm, 8.9 ± 1.54 mm, 0.92 ± 0.31 mm3, 31.28 ± 9.61 mm, 4.98 ± 1.19 mm and 89.35 ± 17.62°. The upper angle of the greater tuberosity averaged 161.04 ± 7.84°, the upper angle of the greater tuberosity was 165.94 ± 3.6°. Differences in parameters of proximal humerus between genders and sides were found. There was no correlation between parameters of proximal humerus and age. Correlations were found among humeral morphological parameters. East Asian populations differed in proximal humeral morphology from Western populations. CONCLUSIONS This study will provide references for diagnosing and classifying shoulder disease, designing prosthesis and instrument, enhancing surgical precision and guiding patient recovery.
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Affiliation(s)
- Boyu Zhang
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, China ,grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Haitao Guan
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, China ,grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Zhipeng Ye
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, China ,grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Yingze Zhang
- The School of Medicine, Nankai University, Tianjin, China. .,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China. .,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Chinese Academy of Engineering, Beijing, People's Republic of China.
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Gauci MO. Patient-specific guides in orthopedic surgery. Orthop Traumatol Surg Res 2022; 108:103154. [PMID: 34838754 DOI: 10.1016/j.otsr.2021.103154] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/10/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
The interest of patient-specific guides (PSGs) lies in reliable intraoperative achievement of preoperative planning goals. They are a form of instrumentation optimizing intraoperative precision and thus improving the safety and reproducibility of surgical procedures. Clinical superiority, however, has not been demonstrated. The various steps from design to implementation leave room for error, which needs to be known and controlled by the surgeon who is responsible for final outcome. Instituting large-scale patient-specific surgery requires management systems for guides and innovative implants which cannot be a simple extension of current practices. We shall approach the present state of knowledge regarding PSGs via 5 questions: (1) What is a PSG? Single-use instrumentation produced after preoperative planning, aiming exclusively to optimize procedural exactness. (2) How to use and assess PSGs in orthopedic surgery? Strict rules of use must be adhered to. Any deviation from the predefined objective is, necessarily, an error that must be identified as such. (3) Do PSGs provide greater surgical exactness? The contribution of PSGs varies greatly between procedures. Exactness is enhanced in the spine, in osteotomies around the knee and in bone-tumor surgery. In the shoulder, their contribution is seen only in complex cases. Data are sparse for hip replacement, and controversial for knee replacement. (4) What are the expected benefits of PSGs? As well as improving exactness, PSGs allow a lower radiation dose and shorter operating time. They also enable junior surgeons to train in techniques otherwise reserved to hyperspecialists. (5) How to include PSGs in everyday practice? As well as their potential clinical interest, PSGs involve deep changes in organization, equipment provision and economic model. LEVEL OF EVIDENCE: V; expert opinion.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UCA), Hôpital Pasteur II, 30, voie Romaine, 06000 Nice, France.
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Sanchez-Sotelo J. Current Concepts in Humeral Component Design for Anatomic and Reverse Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10215151. [PMID: 34768670 PMCID: PMC8584456 DOI: 10.3390/jcm10215151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
The history of humeral component design has evolved from prostheses with relatively long stems and limited anatomic head options to a contemporary platform with short stems and stemless implants with shared instrumentation and the ability to provide optimal shoulder reconstruction for both anatomic and reverse configurations. Contemporary humeral components aim to preserve the bone, but they are potentially subject to malalignment. Modern components are expected to favorably load the humerus and minimize adverse bone reactions. Although there will likely continue to be further refinements in humeral component design, the next frontiers in primary shoulder arthroplasty will revolve around designing an optimal plan, including adequate soft tissue tension and providing computer-assisted tools for the accurate execution of the preoperative plan in the operating room.
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Goetti P, Denard PJ, Collin P, Ibrahim M, Mazzolari A, Lädermann A. Biomechanics of anatomic and reverse shoulder arthroplasty. EFORT Open Rev 2021; 6:918-931. [PMID: 34760291 PMCID: PMC8559568 DOI: 10.1302/2058-5241.6.210014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.
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Affiliation(s)
- Patrick Goetti
- Division of Orthopaedics and Trauma Surgery, Centre Hospitalier |Universitaire Vaudois, Lausanne, Switzerland
| | - Patrick J. Denard
- Denard Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, United States
| | - Philippe Collin
- Collin Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Mohamed Ibrahim, Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Gauci MO, Athwal GS, Sanchez-Sotelo J, Chaoui J, Urvoy M, Boileau P, Walch G. Identification of threshold pathoanatomic metrics in primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2021; 30:2270-2282. [PMID: 33813011 DOI: 10.1016/j.jse.2021.03.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND An assessment of the pathoanatomic parameters of the arthritic glenohumeral joint (GHJ) has the potential to identify discriminating metrics to differentiate glenoid types in shoulders with primary glenohumeral osteoarthritis (PGHOA). The aim was to identify the morphometric differences and threshold values between glenoid types including normal and arthritic glenoids with the various types in the Walch classification. We hypothesized that there would be clear morphometric discriminators between the various glenoid types and that specific numeric threshold values would allow identification of each glenoid type. METHODS The computed tomography scans of 707 shoulders were analyzed: 585 obtained from shoulders with PGHOA and 122 from shoulders without glenohumeral pathology. Glenoid morphology was classified according to the Walch classification. All computed tomography scans were imported in a dedicated automatic 3D-software program that referenced measurements to the scapular body plane. Glenoid and humeral modeling was performed using the best-fit sphere method, and the root-mean-square error was calculated. The direction and orientation of the glenoid and humerus described glenohumeral relationships. RESULTS Among shoulders with PGHOA, 90% of the glenoids and 85% of the humeral heads were directed posteriorly in reference to the scapular body plane. Several discriminatory pathoanatomic parameters were identified: GHJ narrowing < 3 mm was a discriminatory metric for type A glenoids. Posterior humeral subluxation > 70% discriminated type B1 from normal GHJs. The root-mean-square error was a discriminatory metric to distinguish type B2 from type A, type B3, and normal GHJs. Type B3 glenoids differed from type A2 by greater retroversion (>13°) and subluxation (>71%). The type C glenoid retroversion inferior limit was 21°, whereas normal glenoids never presented with retroversion > 16°. CONCLUSION Pathoanatomic metrics with the identified threshold values can be used to discriminate glenoid types in shoulders with PGHOA.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
| | | | | | | | | | - Pascal Boileau
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Gilles Walch
- Hôpital Privé Jean Mermoz-Generale De Santé (GDS) Ramsay, Lyon, France
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Simulation in shoulder arthroplasty education using three-dimensional planning software: the role of guidelines and predicted range of motion. INTERNATIONAL ORTHOPAEDICS 2021; 45:2653-2661. [PMID: 34383105 DOI: 10.1007/s00264-021-05155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
AIM To demonstrate how reverse shoulder arthroplasty (RSA) planning software could be used to improve how the trainees position glenoid and humeral implants and obtain optimal simulated range of motion (ROM). METHODS We selected four groups of five various level participants: medical student (MS), junior resident (JR), senior resident (SR), and shoulder expert (SE). Thereafter, the 20 participants planned five cases of arthritic shoulders for a RSA on a validated planning software following three phases: (1) no guidelines and no ROM feedback, (2) guidelines but no ROM feedback, and (3) guidelines and ROM feedback. We evaluated the final simulated impingement-free ROM, the choice of the implant (baseplate size, graft, glenosphere), and the glenoid implant positioning. RESULTS MS planning were significantly improved by the ROM feedback only. JR took the best advantage of both guidelines and ROM in final results. SR planning were less performant than SE into phase 1 regarding flexion, external rotation, and adduction (respectively - 10°, p = 0.03; - 11°, p = 0.003; and - 3°, p = 0,03), but reached similar results into phase 3 (respectively - 2°, p = 0.329; - 4°, p = 0.44; - 2°, p = 0.319). For MS, JR, and SR, we observed a systematic improvement in the agreement over the study course. The glenoid diameter remained highly variable even for SE. Comparing glenoid implant position to SE, the distance error decreased with advancing phases. CONCLUSION Planning software can be used as a simulation training tool to improve implant positioning in shoulder arthroplasty procedures.
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Fitzgerald EM, Kavanagh RG, O'Connor OJ, Morrissey DI. Determining the accurate placement of a posterior portal in shoulder arthroscopy with the use of computerized tomography images. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:236-241. [PMID: 37588964 PMCID: PMC10426646 DOI: 10.1016/j.xrrt.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Portal placement is an important factor in performing a successful shoulder arthroscopy. Recent cadaveric studies have found variance in the anatomy of the glenohumeral joint. Our aim was to determine if computerized tomography (CT) images could be used to map the trajectory of the posterior portal objectively and then measure the distance between this trajectory and palpable landmarks to apply this knowledge to clinical practice. Methods Two-dimensional multiplanar reformatted CT images were generated using OsiriX (Pixmeo, Switzerland) from CT images performed in a tertiary hospital over a 1-month period. The center of the glenoid was identified and a trajectory through it radiologically mapped. Horizontal and lateral measurements were taken from this trajectory to both the posterolateral edge of the acromion and tip of the coracoid. Results Following application of inclusion and exclusion criteria, 226 shoulders were analyzed. Fifty scans were selected at random and re-reviewed by the primary examiner to assess intra-rater reliability which showed strong correlation and no significant differences between first and second measurements (P < .01, r > 0.6). The mean distance from acromion to portal trajectory was 1.39 cm inferiorly (95% confidence interval [CI] 1.31-1.48, standard deviation [SD] 0.65 cm) and 1.44 cm medially (95% CI 1.35-1.53, SD 0.71 cm). The mean distance from the coracoid to the trajectory was 1.71 cm inferiorly (95% CI 1.64-1.78, SD 0.55 cm) and 1.26 cm medially (95% CI 1-2-1.31, SD 0.45 cm). Paired t-test analysis between right and left shoulders within the same subject, where these data were available (n = 81), showed no significant difference (P > .05) between sides. Subset analysis was also performed between males and females, but only showed a significant difference between the vertical distance from the coracoid process to the center of the glenohumeral joint. This distance was shorter in females compared to males (1.56 cm in females compared to 1.84 cm in males, P < .001). Conclusions Knowledge of shoulder anatomy is vital to the placement of arthroscopic portals, yet research on this topic has been based primarily on surface anatomy, small sample sized cadaveric studies or expert opinion alone. Our study shows that posterior portal placement in shoulder arthroscopy can be measured objectively using CT scanning.
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Affiliation(s)
- Eilis M. Fitzgerald
- Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Owen J. O'Connor
- Senior Lecturer and Consultant Radiologist, Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - David I. Morrissey
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland
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