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Pak T, Ardebol J, Kilic AI, Sears BW, Lederman E, Werner BC, Moroder P, Denard PJ. Posteroinferior glenosphere positioning is associated with improved range of motion following reverse shoulder arthroplasty with a 135° inlay humeral component and lateralized glenoid. J Shoulder Elbow Surg 2024; 33:2171-2177. [PMID: 38537768 DOI: 10.1016/j.jse.2024.02.019] [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: 11/11/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Optimal glenosphere positioning in a lateralized reverse shoulder arthroplasty (RSA) to maximize functional outcomes has yet to be clearly defined. Center of rotation (COR) measurements have largely relied on anteroposterior radiographs, which allow assessment of lateralization and inferior position, but ignore scapular Y radiographs, which may provide an assessment of the posterior and inferior position relative to the acromion. The purpose of this study was to evaluate the COR in the sagittal plane and assess the effect of glenosphere positioning with functional outcomes using a 135° inlay stem with a lateralized glenoid. METHODS A retrospective review was performed on a prospectively maintained multicenter database on patients who underwent primary RSA from 2015 to 2021 with a 135° inlay stem. The COR was measured on minimum 2-year postoperative sagittal plain radiographs using a best-fit circle fit method. A best-fit circle was made on the glenosphere and the center was marked. From there, 4 measurements were made: (1) center to the inner cortex of the coracoid, (2) center to the inner cortex of the anterior acromion, (3) center to the inner cortex of the middle acromion, and (4) center to the inner cortex of the posterior acromion. Regression analysis was performed to evaluate any association between the position of the COR relative to bony landmarks with functional outcomes. RESULTS A total of 136 RSAs met the study criteria. There was no relation with any of the distances with outcome scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale). In regard to range of motion (ROM), each distance had an effect on at least 1 parameter. The COR to coracoid distance had the broadest association with ROM, with improvements in forward flexion (FF), external rotation (ER0), and internal rotation with the arm at 90° (IR90) (P < .001, P = .031, and P < .001, respectively). The COR to coracoid distance was also the only distance to affect the final FF and IR90. For every 1-mm increase in this distance, there was a 1.8° increase in FF and 1.5° increase in IR90 (β = 1.78, 95% confidence interval [CI] 0.85-2.72, P < .001, and β = 1.53, 95% CI 0.65-2.41, P < .001; respectively). CONCLUSION Evaluation of the COR following RSA in the sagittal plane suggests that a posteroinferior glenosphere position may improve ROM when using a 135° inlay humeral component and a lateralized glenoid.
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Affiliation(s)
- Theresa Pak
- Center for Orthopedic Research and Education, Phoenix, AZ, USA
| | | | - Ali I Kilic
- Oregon Shoulder Institute, Medford, OR, USA; Department of Orthopaedics and Traumatology, Izmir Bakircay University, Izmir, Turkey
| | | | - Evan Lederman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Brian C Werner
- University of Virginia Health System, Charlottesville, VA, USA
| | - Philipp Moroder
- Department for Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
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Gallinet D, Hubert L, Guery J, Garret J, Nérot C, Godenèche A. Intraoperative repair of functional subscapularis during RSA by deltopectoral approach could improve internal rotation but does not prevent anterior dislocation. Orthop Traumatol Surg Res 2024; 110:103869. [PMID: 38492633 DOI: 10.1016/j.otsr.2024.103869] [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: 09/01/2023] [Revised: 02/22/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION The role of the subscapularis following reverse shoulder arthroplasty (RSA) remains controversial as repair could restore adequate internal rotation and shoulder stability, but might compromise external rotation. The purpose of this multi-centre study, on a large cohort of RSAs performed using the deltopectoral approach, was to determine the effect of subscapularis preoperative status and intraoperative repair on range of motion, clinical scores and rates of complications at a minimum follow-up of 2 years. HYPOTHESIS Repair of a functional subscapularis grants better internal rotation and stability without compromising external rotation. MATERIALS AND METHODS We retrospectively reviewed records of all RSAs (n=916) performed by 14 surgeons that participated in a large national society symposium, and excluded 234 operated by the anterosuperior approach, 42 operated for rheumatoid arthritis, fractures, instability or post traumatic sequalae, and eight that had adjuvant latissimus dorsi tendon transfer (LDTT). This left 632 RSAs, in which the subscapularis was detached in 594, and repaired after detachment in 495. Patients completed pre- and postoperative Constant Score and postoperative Subjective Shoulder Value (SSV). Active forward elevation, active external rotation (ER), and active internal rotation (IR) were recorded pre- and postoperatively. Complications following RSA that required conservative treatment, reoperation without implant removal, as well as reoperation with implant removal were recorded. RESULTS Of the initial cohort of 632 shoulders, 120 (19%) were lost to follow-up, 12 (2%) died due to causes unrelated to RSA, and 26 (4%) were revised with implant removal. Of the remaining 474 shoulders, 259 (55%) had a functional repaired subscapularis (Group FR), 59 (12%) had a non-functional repaired subscapularis (Group nFR), whereas 68 (14%) had a not repaired subscapularis (Group nR). Comparison of patient demographics revealed no significant differences among the three groups. Postoperative Constant Score (p=0.031) and SSV (p=0.016) were significantly different among the three groups, but effect sizes were small and not clinically relevant. Differences in postoperative ER as well as postoperative IR were not significant among the three groups: 91 (35%) gained functional IR in Group FR, 11 (19%) in Group nFR, and 13 (19%) in Group nR. Three shoulders (1.2%) reported subjective instability and 1 (0.4%) dislocated in Group FR, but none in either Groups nFR or nR. DISCUSSION Despite statistically significant differences in Constant Score and SSV among the three groups, the clinical relevance of these differences is negligible, so repair of functional subscapularis has little or no influence on functional outcomes. During RSA by deltopectoral approach, repair of a functional subscapularis could slightly improve internal rotation in some patients but does not compromise external rotation, forward elevation or clinical scores, while repair of a non-functional subscapularis, compared to non-repair, did not improve range of motion or clinical scores. LEVEL OF EVIDENCE III; retrospective comparative.
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Affiliation(s)
- David Gallinet
- Clinique Saint-Vincent ELSAN, 40, chemin des Tilleroyes, 25000 Besançon, France; Centre épaule main Besançon, 16, rue Madeleine-Brès, 25000 Besançon, France; French Shoulder and Elbow Society (SoFEC), Paris, France
| | - Laurent Hubert
- Department of Orthopaedics and Traumatology, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; French Shoulder and Elbow Society (SoFEC), Paris, France
| | - Jacques Guery
- Polyclinique du Val de Loire ELSAN, Nevers, France; French Shoulder and Elbow Society (SoFEC), Paris, France
| | - Jérôme Garret
- Clinique du Parc ELSAN, Lyon, France; French Shoulder and Elbow Society (SoFEC), Paris, France
| | - Cécile Nérot
- Département d'orthopédie et traumatologie, CHU de Reims, Reims, France; French Shoulder and Elbow Society (SoFEC), Paris, France
| | - Arnaud Godenèche
- Centre orthopédique Santy, hôpital privé Jean-Mermoz, Ramsay santé, Lyon, France; French Shoulder and Elbow Society (SoFEC), Paris, France
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Ameziane Y, Holschen M, Engel NM, Schorn D, Witt KA, Steinbeck J. Does the subscapularis repair affect the clinical outcome after primary reverse shoulder arthroplasty? J Shoulder Elbow Surg 2024; 33:1909-1917. [PMID: 38759837 DOI: 10.1016/j.jse.2024.03.057] [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: 10/22/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Reverse shoulder arthroplasty is an established procedure for patients with rotator cuff tear arthropathy. However, the repair of the subscapularis tendon remains a controversial and frequently discussed topic. This prospective randomized study was conducted to evaluate the clinical benefit of the subscapularis repair after reverse shoulder arthroplasty. METHODS Fifty patients (36 female and 14 male) were randomized and assigned to either the "repaired" (rep) or the "not repaired" (nrep) cohort. Intraoperatively, the subscapularis tendon was reattached in the rep cohort with 4 tendon-to-tendon sutures, whereas no repair was performed in the nrep cohort. The Constant-Murley Score (CS) and the range of motion were evaluated preoperatively as well as 12 and 36 months postoperatively. The Subjective Shoulder Value and the Lift-off test were performed 36 months postoperatively. The postoperative subscapularis integrity was assessed sonographically. RESULTS Twelve months postoperatively the rep cohort presented better results in the CS (rep: 71 vs. nrep: 66, P = .037). The normalized CS was 80% in the rep cohort and 75% in the nrep cohort (P = .114). At our last follow-up after 36 months, we did not find significant differences between the rep cohort and the nrep cohort in the CS (rep: 76 vs. nrep: 75, P = .285) and normalized CS (rep: 91% vs. nrep: 91%, P = .388). Concerning internal rotation (in points), the rep cohort achieved better results than the nrep cohort (rep: 7.3 vs. nrep: 6.6, P = .040). Flexion (rep: 145° vs. nrep: 151°, P = .826), abduction (rep: 135° vs. nrep: 137°, P = .816), external rotation (rep: 34° vs. nrep: 37°, P = .817), and the Subjective Shoulder Value (rep: 81% vs. nrep: 77%, P = .398) presented no significant differences between the cohorts. The ultrasound examination after 36 months displayed an intact tendon in 70%. CONCLUSIONS Although the subscapularis repair affects the postoperative internal rotation positively, there were no differences in midterm follow-up concerning the overall results after reverse total shoulder arthroplasty. Further, the external rotation is not affected by the repair of the subscapularis tendon.
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Affiliation(s)
- Yacine Ameziane
- Orthopedic Practice Clinic, Muenster, Germany; Department for Orthopedic and Trauma Surgery, Raphaelsclinic, Muenster, Germany.
| | | | - Nina Myline Engel
- Department of Musculoskeletal Oncology, Sarcoma Center, University Hospital, Essen, Germany
| | - Dominik Schorn
- Department for Shoulder and Elbow Surgery, Paracelsius Clinic, Bremen, Germany
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Cueto RJ, Hao KA, O’Keefe DS, Mallat MA, Hones KM, Turnbull LM, Wright JO, Soberon J, Schoch BS, King JJ. Clinical outcomes of over-the-top subscapularis repair in reverse shoulder arthroplasty. JSES Int 2024; 8:866-872. [PMID: 39035640 PMCID: PMC11258842 DOI: 10.1016/j.jseint.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Biomechanical research demonstrates increased subscapularis abduction range of motion (ROM) when the tendon's upper two-thirds is repaired over-the-top of the center of rotation during reverse shoulder arthroplasty (RSA). This study compares the clinical outcomes of patients undergoing RSA with over-the-top subscapularis repair (OTTR) to patients without repair. Methods We retrospectively reviewed 97 consecutive RSAs with either OTTR of the subscapularis (N = 75) or no repair (N = 22). Repair was attempted in all patients but not performed if the subscapularis could not be brought to the over-the-top position in 20° of external rotation (ER) and 30° of abduction. Improvements in ROM were compared to the minimal clinically important difference for RSA. Results The mean follow-up was 3.8 ± 1.6 years. Demographics were similar between groups. Preoperatively, patients undergoing repair had greater ER when compared to those without repair (15 ± 16° vs. 5 ± 12°, P = .003). Postoperatively, patients undergoing repair had greater forward elevation (132 ± 21° vs. 126 ± 22°, P = .268) and abduction (114 ± 26° vs. 106 ± 23°, P = .193) with both exceeding the minimal clinically important difference (-2.9° and -1.9°, respectively); however, not statistically significant. Patients with repair were more frequently able to reach the small of their back postoperatively (65% vs. 21%, P = .006) but had less improvement in ER (13 ± 20° vs. 24 ± 20°, P = .028). Postoperative outcome scores, complications, and reoperations were similar between groups. Discussion OTTR of the subscapularis in RSA had similar ROM and outcome scores compared to no repair, but a significantly larger proportion of patients with repair achieved functional internal rotation to the small of the back. ER limitations seen after conventional repair may also apply to this novel technique, but without a corresponding detrimental effect on forward elevation or abduction.
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Affiliation(s)
- Robert J. Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A. Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Marlee A. Mallat
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan M. Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lacie M. Turnbull
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O. Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
- Department of Orthopaedic Surgery, North Florida South Georgia Veterans Health System, Gainesville, FL, USA
| | - Jose Soberon
- Department of Anesthesiology, North Florida Southern Georgia Veterans Health System, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Bradley S. Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph J. King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
- Department of Orthopaedic Surgery, North Florida South Georgia Veterans Health System, Gainesville, FL, USA
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Valenti P, Moussa MK, Kazum E, Eichinger JK, Murillo Nieto C, Caruso G. Pectoralis major tendon transfer in reverse total shoulder arthroplasty with irreparable subscapularis: surgical technique and preliminary clinical and radiological results. JSES Int 2024; 8:500-507. [PMID: 38707568 PMCID: PMC11064713 DOI: 10.1016/j.jseint.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Hypothesis/Background Addressing irreparable subscapularis in conjunction with reverse total shoulder arthroplasty (RTSA) presents challenges. RTSA without subscapularis repair leads to similar clinical results compared to those with a subscapularis repair but with less range of motion in internal rotation (IR). Optimization of IR and anterior stability after RTSA, in the setting of an irreparable subscapularis may be achieved with a pectoralis major (PM) tendon transfer. This study aims to describe a novel surgical technique involving PM transfer in RTSA for irreparable subscapularis and report the initial clinical and radiological outcomes. Methods This study included 13 patients with an average of 65.5 years (range, 52-82 years). All patients underwent a lateralized RTSA with concurrent PM transfer, associated to an irreparable subscapularis, performed by a single surgeon (PV). Preoperative and postoperative range of motion, including internal rotation 1, internal rotation 2, external rotation 1 (ER1) and forward elevation, were measured. The absolute Constant score, the age and sex-adjusted Constant Murley score, Visual Analog Scale and subjective shoulder value were evaluated by the same surgeon. Standard X-rays, preoperative magnetic resonance imaging, and computed tomography scan were performed for all patients. Results With an average follow-up of 37 months, the mean Constant score improved from 17.7 preoperatively to 61 postoperative (P < .05). Postoperative clinical outcomes significantly improved across the study group. Mean internal rotation 2 increased from 44.6° to 61.5° (P < .05), while internal rotation 1 improved from 2.6 to 5 (P < .05). The Gerber test yielded positive results for all patients, while the belly press test was negative for eleven patients. Postoperative imaging assessment of the transferred PM tendon transfer showed intact repair, a good cicatrization on the lesser tuberosity with excellent trophicity of the muscle without any fatty infiltration in all patients. Conclusion PM transfer combined with a lateralized RSTA in cases of irreparable subscapularis leads to improved shoulder range of motion, particularly in IR, increased strength and pain relief.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, Paris, France, Charleston, SC, USA
| | - Mohamad K. Moussa
- Paris Shoulder Unit, Clinique Bizet, Paris, France, Charleston, SC, USA
| | - Efi Kazum
- Paris Shoulder Unit, Clinique Bizet, Paris, France, Charleston, SC, USA
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Nové-Josserand L, Nerot C, Colotte P, Guery J, Godenèche A. Reverse shoulder arthroplasty for primary glenohumeral osteoarthritis: significantly different characteristics and outcomes in shoulders with intact vs. torn rotator cuff. J Shoulder Elbow Surg 2024; 33:850-862. [PMID: 37633591 DOI: 10.1016/j.jse.2023.07.027] [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: 04/25/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE To compare outcomes of reverse shoulder arthroplasty (RSA) for primary osteoarthritis (OA) with and without rotator cuff (RC) tears to those with secondary OA due to RC tears. METHODS We reviewed records of all patients who received RSA for primary OA or secondary OA. All patients had preoperative radiographs, computed tomographic arthrography (CTA), and/or magnetic resonance imaging (MRI) scans of their shoulders to assess their etiology, glenoid morphology, and fatty infiltration. Pre- and postoperative (at minimum follow-up of 2 years) Constant scores and range of motion were compared between patients who had RSA for primary OA with and without RC tears to those with secondary OA due to RC tears. RESULTS Of the initial cohort of 605 shoulders (583 patients), 153 were lost to follow-up (25.3%), 25 required revision with implant removal (4.1%), and 13 died of causes unrelated to the surgery (2.1%), and left a final cohort of 414 patients. Of the final cohort, 97 had primary OA with intact RC, 62 had primary OA with RC tears, and 255 had secondary OA. Postoperative Constant scores were significantly higher for primary OA with intact RC (73.8 ± 14.3), compared with both primary OA with RC tears (66.1 ± 14.6, P < .001) and secondary OA (64.1 ± 14.8, P < .001). There were no differences in pre- or postoperative scores between primary OA with RC tears and secondary OA. CONCLUSION At 2 or more years following RSA, Constant scores were significantly higher for primary OA with intact RC, compared to either primary OA with RC tears or secondary OA, whereas there were no differences in pre- or postoperative scores of shoulders that had primary OA with RC tears vs. secondary OA. The authors recommend distinguishing primary OA with intact RC from primary OA with RC tears, as the two have considerably different characteristics and prognosis following RSA.
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Affiliation(s)
- Laurent Nové-Josserand
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France; SoFEC - French Shoulder and Elbow Society, Paris, France
| | - Cecile Nerot
- SoFEC - French Shoulder and Elbow Society, Paris, France; Reims University Hospital, Reims, France
| | - Philippe Colotte
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France; SoFEC - French Shoulder and Elbow Society, Paris, France
| | - Jacques Guery
- SoFEC - French Shoulder and Elbow Society, Paris, France; Polyclinique du Val de Loire, ELSAN, Nevers, France
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Park SG, Seok HG. Towards optimal reverse total shoulder arthroplasty design: reconsidering the role of lateralized implants. Clin Shoulder Elb 2024; 27:1-2. [PMID: 38469595 PMCID: PMC10938010 DOI: 10.5397/cise.2024.00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Sam-Guk Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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Hao KA, Cueto RJ, Gharby C, Freeman D, King JJ, Wright TW, Almader-Douglas D, Schoch BS, Werthel JD. Influence of lateralized versus medialized reverse shoulder arthroplasty design on external and internal rotation: a systematic review and meta-analysis. Clin Shoulder Elb 2024; 27:59-71. [PMID: 37957880 PMCID: PMC10938020 DOI: 10.5397/cise.2023.00577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA. METHODS We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Meta-analysis was conducted using a random-effects model. RESULTS Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°-44°] vs. 27° [22°-32°], P<0.001) and postoperative improvement in ER (20° [15°-26°] vs. 10° [5°-15°], P<0.001). Lateralized implants with subscapularis repair or medialized implants without subscapularis repair had significantly greater postoperative ER and postoperative improvement in ER compared to globally medialized implants with subscapularis repair (P<0.001 for both). Mean postoperative IR was reported in 56% (n=18) of studies and achieved the minimum necessary IR in 51% of lateralized (n=325, 5 cohorts) versus 36% (n=177, 5 cohorts) of medialized implants. CONCLUSIONS Lateralized RSA produces superior axial rotation compared to medialized RSA. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater axial rotation compared to medialized RSA with subscapularis repair. Level of evidence: 2A.
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Affiliation(s)
- Kevin A. Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert J. Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christel Gharby
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - David Freeman
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J. King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W. Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Bradley S. Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jean-David Werthel
- Hopital Ambroise Pare, Orthopedic Department, Boulogne-Billancourt, France
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Macken AA, van der Poel WJ, Buijze GA, Beckers JJ, Eygendaal D, Lafosse L, Lafosse T. Reverse shoulder arthroplasty with a 155° neck-shaft angle inlay implant design without reattachment of the subscapularis tendon results in satisfactory functional internal rotation and no instability: a cohort study. J Orthop Traumatol 2024; 25:10. [PMID: 38418742 PMCID: PMC10902217 DOI: 10.1186/s10195-024-00755-5] [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: 09/05/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The aim of this study was to use the Activities of Daily Living which require Internal Rotation (ADLIR) questionnaire to assess the functional internal rotation in patients who had undergone reverse shoulder arthroplasty (RSA) without reattachment of the subscapularis (SSc) tendon at a minimum follow-up of 2 years. The secondary aim was to report the objective range of motion (ROM) and the rate of postoperative instability. MATERIALS AND METHODS All consecutive primary RSA procedures without reattachment of the SSc tendon that were performed using a Delta Xtend prosthesis (an inlay system with a 155° neck-shaft angle) between January 2015 and December 2020 were identified to ensure a minimum follow-up of 2 years. Patients were contacted and requested to fill in several questionnaires, including the ADLIR and Auto-Constant scores. RESULTS In total, 210 patients met the inclusion criteria; among those patients, 187 could be contacted and 151 completed questionnaires (response rate: 81%). The SSc tendon was fully detached without repair in all cases, and a superolateral approach was used in 130 (86%) cases. The median follow-up was 4.5 years (range: 2.0-7.6). At final follow-up, the mean ADLIR score was 88/100 (interquartile range (IQR): 81-96). The median level reached in internal rotation was the 3rd lumbar vertebra (IQR: lumbosacral region-12th thoracic vertebra). Of the 210 eligible patients, one required a revision for a dislocation within the first month after primary surgery. With regards to regression analysis with ADLIR score as the outcome, none of the factors were associated with the ADLIR score, although age and smoking approached significance (0.0677 and 0.0594, respectively). None of the explanatory variables were associated with ROM in internal rotation (p > 0.05). CONCLUSIONS This study demonstrates that satisfactory ADLIR scores and internal rotation ROM were obtained at mid-term follow-up after RSA leaving the SSc detached. Leaving the SSc detached also did not lead to high instability rates; only one out of 210 prostheses was revised for dislocation within the first month after primary surgery. LEVEL OF EVIDENCE III
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Affiliation(s)
- Arno A Macken
- Alps Surgery Institute, 4 Chemin de La Tour de Reine, Clinique Générale d'Annecy, 74000, Annecy, France.
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Wouter J van der Poel
- Alps Surgery Institute, 4 Chemin de La Tour de Reine, Clinique Générale d'Annecy, 74000, Annecy, France
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Geert A Buijze
- Alps Surgery Institute, 4 Chemin de La Tour de Reine, Clinique Générale d'Annecy, 74000, Annecy, France
- Department of Orthopaedic Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, Montpellier University Medical Center, Lapeyronie Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Joris J Beckers
- Alps Surgery Institute, 4 Chemin de La Tour de Reine, Clinique Générale d'Annecy, 74000, Annecy, France
- Department of Orthopaedics and Traumatology, AZ Sint-Jan Hospital, Mariastraat 38, 8000, Brugge, Belgium
- Department of Orthopaedics and Traumatology, AZ Sint-Lucas Hospital, Sint-Lucaslaan 29, 8310, Brugge, Belgium
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Laurent Lafosse
- Alps Surgery Institute, 4 Chemin de La Tour de Reine, Clinique Générale d'Annecy, 74000, Annecy, France
| | - Thibault Lafosse
- Alps Surgery Institute, 4 Chemin de La Tour de Reine, Clinique Générale d'Annecy, 74000, Annecy, France
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Axford DT, Potra R, Appleyard R, Tomka J, Arenas-Miquelez A, Bokor D, Ferreira L, Raniga S. Development of a Cadaveric Shoulder Motion Simulator with Open-Loop Iterative Learning for Dynamic, Multiplanar Motion: A Preliminary Study. J Clin Med 2023; 12:4596. [PMID: 37510711 PMCID: PMC10380955 DOI: 10.3390/jcm12144596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Ex vivo shoulder motion simulators are commonly used to study shoulder biomechanics but are often limited to performing simple planar motions at quasi-static speeds using control architectures that do not allow muscles to be deactivated. The purpose of this study was to develop an open-loop tendon excursion controller with iterative learning and independent muscle control to simulate complex multiplanar motion at functional speeds and allow for muscle deactivation. The simulator performed abduction/adduction, faceted circumduction, and abduction/adduction (subscapularis deactivation) using a cadaveric shoulder with an implanted reverse total shoulder prosthesis. Kinematic tracking accuracy and repeatability were assessed using maximum absolute error (MAE), root mean square error (RMSE), and average standard deviation (ASD). During abduction/adduction and faceted circumduction, the RMSE did not exceed 0.3, 0.7, and 0.8 degrees for elevation, plane of elevation, and axial rotation, respectively. During abduction/adduction, the ASD did not exceed 0.2 degrees. Abduction/adduction (subscapularis deactivation) resulted in a loss of internal rotation, which could not be restored at low elevation angles. This study presents a novel control architecture, which can accurately simulate complex glenohumeral motion. This simulator will be used as a testing platform to examine the effect of shoulder pathology, treatment, and rehabilitation on joint biomechanics during functional shoulder movements.
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Affiliation(s)
- David Timothy Axford
- Department of Mechanical and Materials Engineering, Western University, London, ON N6A 3K7, Canada
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Robert Potra
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Department of Electrical and Computer Engineering, Western University, London, ON N6A 3K7, Canada
| | - Richard Appleyard
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Janos Tomka
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Antonio Arenas-Miquelez
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Desmond Bokor
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Louis Ferreira
- Department of Mechanical and Materials Engineering, Western University, London, ON N6A 3K7, Canada
| | - Sumit Raniga
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
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Ren H, Wu L, Zhang X, Jian Z, Yi C. The effect of integrity of lesser tuberosity-medial calcar on postoperative outcome in the proximal humeral fracture. J Orthop Surg Res 2023; 18:363. [PMID: 37194053 DOI: 10.1186/s13018-023-03851-0] [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: 12/22/2022] [Accepted: 05/10/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND In proximal humeral fractures, the medial calcar is often considered an important stabilizing structure. When the medial calcar is disrupted, some patients may have accompanying humeral lesser tuberosity comminution that has not been noticed. To investigate the impacts of comminuted fragments of lesser tuberosity and calcar on postoperative stability, CT results, number of fragments, cortical integrity, and the variation of neck-shaft angle were compared in patients with proximal humeral fractures. MATERIALS AND METHODS From April 2016 to April 2021, this study included patients with senile proximal humeral fractures diagnosed by CT three-dimensional reconstruction with lesser tuberosity fractures and medial column injuries. The number of fragments in the lesser tuberosity and the continuity of medial calcar were evaluated. Postoperative stability and shoulder function were evaluated by comparing changes in neck-shaft angle and the DASH upper extremity function score from 1 week to 1 year after the operation. RESULTS A total of 131 patients were included in the study, and the results showed that the number of fragments of the lesser tuberosity was related to the integrity of the medial cortex of the humerus. That is, when there were more than two lesser tuberosity fragments, the integrity of humeral medial calcar was poor. The positive rate of the lift-off test was higher in patients with lesser tuberosity comminutions 1 year after surgery. In addition, patients with more than two lesser tuberosity fragments and continuous destruction of the medial calcar had large variations in the neck-shaft angle, high DASH scores, poor postoperative stability, and poor recovery of shoulder joint function 1 year postoperatively. CONCLUSION The number of humeral lesser tuberosity fragments and the integrity of the medial calcar were associated with the collapse of the humeral head and the decrease in shoulder joint stability after the proximal humeral fracture surgery. When the number of lesser tuberosity fragments was greater than two and the medial calcar was damaged, the proximal humeral fracture had poor postoperative stability and poor functional recovery of the shoulder joint, which required auxiliary internal fixation treatment.
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Affiliation(s)
- Hanru Ren
- Department of Orthopaedics, Pudong Medical Center, Shanghai Pudong Hospital, Fudan University, No. 2800, Gongwei Road, Shanghai, 200120, China
| | - Lianghao Wu
- Department of Orthopaedics, Pudong Medical Center, Shanghai Pudong Hospital, Fudan University, No. 2800, Gongwei Road, Shanghai, 200120, China
| | - Xu Zhang
- Department of Orthopaedics, Pudong Medical Center, Shanghai Pudong Hospital, Fudan University, No. 2800, Gongwei Road, Shanghai, 200120, China
| | - Zhen Jian
- Department of Orthopaedics, Pudong Medical Center, Shanghai Pudong Hospital, Fudan University, No. 2800, Gongwei Road, Shanghai, 200120, China
| | - Chengqing Yi
- Department of Orthopaedics, Pudong Medical Center, Shanghai Pudong Hospital, Fudan University, No. 2800, Gongwei Road, Shanghai, 200120, China.
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12
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Sulkar HJ, Aliaj K, Tashjian RZ, Chalmers PN, Foreman KB, Henninger HB. High and low performers in internal rotation after reverse total shoulder arthroplasty: a biplane fluoroscopic study. J Shoulder Elbow Surg 2023; 32:e133-e144. [PMID: 36343789 PMCID: PMC10023281 DOI: 10.1016/j.jse.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Internal rotation in adduction is often limited after reverse total shoulder arthroplasty (rTSA), but the origins of this functional deficit are unclear. Few studies have directly compared individuals who can and cannot perform internal rotation in adduction. Little data on underlying 3D humerothoracic, scapulothoracic, and glenohumeral joint relationships in these patients are available. METHODS Individuals >1-year postoperative to rTSA were imaged with biplane fluoroscopy in resting neutral and internal rotation in adduction poses. Subjects could either perform internal rotation in adduction with their hand at T12 or higher (high, N = 7), or below the hip pocket (low, N = 8). Demographics, the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and scapular notching grade were recorded. Joint orientation angles were derived from model-based markerless tracking of the scapula and humerus relative to the torso. The 3D implant models were aligned to preoperative computed tomography models to evaluate bone-implant impingement. RESULTS The Simple Shoulder Test was highest in the high group (11 ± 1 vs. 9 ± 2, P = .019). Two subjects per group had scapular notching (grades 1 and 2), and 3 high group and 4 low group subjects had impingement below the glenoid. In the neutral pose, the scapula had 7° more upward rotation in the high group (P = .100), and the low group demonstrated 9° more posterior tilt (P = .017) and 14° more glenohumeral elevation (P = .047). In the internal rotation pose, axial rotation was >45° higher in the high group (P ≤ .008) and the low group again had 11° more glenohumeral elevation (P = .058). Large rotational differences within subject groups arose from a combination of differences in the resting neutral and maximum internal rotation in adduction poses, not only the terminal arm position. CONCLUSIONS Individuals who were able to perform high internal rotation in adduction after rTSA demonstrated differences in joint orientation and anatomic biases versus patients with low internal rotation. The high rotation group had 7° more resting scapular upward rotation and used a 15°-30° change in scapular tilt to perform internal rotation in adduction versus patients in the low group. The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction. In addition, inter-patient variation in humeral torsion may contribute substantially to postoperative internal rotation differences. These data point toward modifiable implant design and placement factors, as well as foci for physical therapy to strengthen and mobilize the scapula and glenohumeral joint in response to rTSA surgery.
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Affiliation(s)
- Hema J Sulkar
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Klevis Aliaj
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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Preuss FR, Fossum BW, Peebles AM, Eble SK, Provencher MT. Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:437-441. [PMID: 37588468 PMCID: PMC10426677 DOI: 10.1016/j.xrrt.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Hypothesis/Background There is no consensus on whether to repair the subscapularis in the setting of reverse total shoulder arthroplasty (rTSA). There have been an assortment of studies showing mixed results regarding shoulder stability and postoperative strength outcomes when looking at subscapularis repair in rTSA. The purpose of this systematic review was to investigate differences in biomechanical strength outcomes of cadaveric subscapularis repair vs. no repair in rTSA.Increased force will be required to move the shoulder through normal range of motion (ROM) in cadaveric rTSA shoulders with the subscapularis repaired when compared with no subscapularis repair. Methods A comprehensive literature review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The databases used to search the keywords used for the concepts of subscapularis, reverse total shoulder arthroplasty, and muscle strength were PubMed (includes MEDLINE), Embase, Web of Science, Cochrane Reviews and Trials, and Scopus. Original, English-language cadaveric studies evaluating rTSA and subscapularis management were included, with subscapularis repair surgical techniques and strength outcomes being evaluated for each article meeting inclusion criteria. Results The search yielded 4113 articles that were screened for inclusion criteria by 4 authors. Two articles met inclusion criteria and were subsequently included in the final full-text review. A total of 11 shoulders were represented between these 2 studies. Heterogeneity of the data across the 2 studies did not allow for meta-analysis. Hansen et al found that repair of the subscapularis with rTSA significantly increased the mean joint reaction force and the force required by the posterior deltoid, total deltoid, infraspinatus, teres minor, total posterior rotator cuff, and pectoralis major muscles. Giles et al found that rotator cuff repair and glenosphere lateralization both increased total joint load. Conclusion The present review of biomechanical literature shows that repair of the subscapularis in the setting of rTSA can effectively restore shoulder strength by increasing joint reactive forces and ROM force requirements of other rotator cuff muscles and of the deltoid muscle. Available biomechanical evidence is limited, and further biomechanical studies evaluating the strength of various subscapularis repair techniques are needed to evaluate the effects of these techniques on joint reactive forces and muscle forces required for ROM.
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Affiliation(s)
- Fletcher R. Preuss
- David Geffen School of Medicine at The University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Matthew T. Provencher
- The Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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14
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Ascione F, Panni AS, Braile A, Corona K, Toro G, Capuano N, Romano AM. Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties, a systematic review: part II-problems and reinterventions. J Orthop Traumatol 2021; 22:49. [PMID: 34826010 PMCID: PMC8626544 DOI: 10.1186/s10195-021-00613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. METHODS This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (1 January 2000 to 14 April 2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar, employing several combinations of keywords: "reverse shoulder arthroplasty," "reverse shoulder prosthesis," "inverse shoulder arthroplasty," "inverse shoulder prosthesis," "problems," "complications," "results," "outcomes," "reoperation," and "revision." RESULTS Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with overall reoperation and revision rates of 1.7% and 2.6%, respectively. CONCLUSIONS Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas no humeral fractures or stem loosening were reported with short stems. Infections (1.3%) were the most common reason for component revision, followed by instability (0.8%). LEVEL OF EVIDENCE Systematic review IV.
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Affiliation(s)
- Francesco Ascione
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy. .,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.
| | - Alfredo Schiavone Panni
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Adriano Braile
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | - Giuseppe Toro
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Nicola Capuano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy
| | - Alfonso M Romano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy.,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
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