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Neidlein C, Watrinet J, Pätzold R, Berthold DP, Prall WC, Böcker W, Holzapfel BM, Fürmetz J, Bormann M. Patient-Reported Outcomes following Tibial Plateau Fractures: Mid- to Short-Term Implications for Knee Function and Activity Level. J Clin Med 2024; 13:2327. [PMID: 38673600 DOI: 10.3390/jcm13082327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Patients with complex proximal tibial plateau fractures (TPFs) tend to overestimate the prognosis of their injury, potentially due to factors such as a limited understanding, optimism, and the influence of the pain intensity. Understanding the reasons behind this misperception is crucial for healthcare providers to effectively communicate with patients and establish realistic expectations for treatment outcomes. The purpose of this study was to analyze the outcomes of TPFs, with a particular focus on patient-reported outcome measures concerning functional recovery, pain levels, and overall satisfaction with treatment. The authors aim to provide valuable insights into the realistic expectations and potential limitations that patients may encounter during their recovery journey. Methods: In this retrospective single-center study, all surgically treated TPFs between January 2014 and December 2019 with a minimum follow-up of 12 months were included. Several patient-reported outcome measures were obtained, including the International Knee documentation Committee Score (IKDC), Lyholm score, Tegner score, and visual analog scale (VAS) for pain. Fractures were classified according to Schatzker, and then subgrouped into simple (Schatzker I-III) and complex (Schatzker IV-VI) fractures. Results: A total of 54 patients (mean age 51.1 ± 11.9 years, 59.3% female) with a mean follow-up time of 3.9 years were included. Schatzker II fractures were present in 48% (n = 26) of the cases, with Schatzker III in 6% (n = 3), Schatzker IV fractures in 6% (n = 3), and Schatker VI fractures in 41% (n = 22) of the cases. All outcome scores showed a significant improvement between the first year after surgery and the last follow-up (mean: 3.9 years). Simple fractures showed significantly lower patient-reported outcomes when compared to the preinjury state; however, good to excellent results were observed. Patient-reported outcomes of complex fractures showed no significant changes in the study period with good to excellent results. When it comes to the Lysholm score, there were no significant differences in the outcome between simple and complex fractures. Furthermore, there was a return-to-sports rate of 100%, with high rates of changing sporting activity in 25% (simple fractures) and 45% in complex fractures. Conclusions: The data from this study showed that both simple and complex tibial plateau fractures show favorable outcomes at the midterm follow-up, and that injury severity does not correlate with worse results. While patients may tend to overestimate the recovery speed, this research highlights the importance of long-term follow-up, demonstrating a substantial improvement between one year post-surgery and the final evaluation. Return-to-sports rates were high, with adjustments needed for certain activities. However, patients should recognize the need to shift to lower-impact sports and the lengthy recovery process.
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Affiliation(s)
- Claas Neidlein
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany
| | - Julius Watrinet
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Robert Pätzold
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Daniel P Berthold
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany
| | - Wolf Christian Prall
- Devision of Knee, Hip, Shoulder and Elbow Surgery, Schoen Clinic Munich, Harlachinger Straße 51, 81547 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany
| | - Julian Fürmetz
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Markus Bormann
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany
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Berthold DP, Bormann M. Psychological Resilience Promotes Positive Outcomes After Surgery. Arthroscopy 2024:S0749-8063(24)00272-X. [PMID: 38615799 DOI: 10.1016/j.arthro.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
The significance of psychological factors in orthopaedic surgery has long been underestimated. High psychological resilience plays a significant role in achieving a positive postoperative outcome in terms of mental health, pain, and functional outcomes. This underscores the need for a more holistic approach to patient care, one that considers not only the physical aspects of treatment but also the emotional and psychological well-being of patients. This may involve implementing strategies to enhance resilience, providing support resources for coping with the challenges of surgery and recovery, and fostering open communication between patients and healthcare providers. Patients who feel supported and empowered throughout their surgical journey are likely to experience improved overall satisfaction with their care. Patient emotional well-being is integral to achieving optimal recovery.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
| | - Markus Bormann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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Berthold DP, Polzer H, Baumbach SF. Letter Regarding: CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review. Foot Ankle Int 2024; 45:419-420. [PMID: 38651665 DOI: 10.1177/10711007241230321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
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Sachinis NP, Yiannakopoulos CK, Berthold DP, Franz A, Beitzel K. Can we accelerate rehabilitation following reverse shoulder arthroplasty? A systematic review. Shoulder Elbow 2024; 16:214-227. [PMID: 38655406 PMCID: PMC11034463 DOI: 10.1177/17585732221144007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/13/2022] [Accepted: 11/19/2022] [Indexed: 04/26/2024]
Abstract
Background There is no consensus concerning the rehabilitation protocol following reverse shoulder arthroplasty. Several patients are expecting to be able to use their arms for sports or recreation shortly after their operation. Methods This review was designed as an intervention systematic review with narrative analysis. Authors searched English literature in PubMed and Embase databases from 1/1/1989 until July 2022. Controlled studies comparing rehabilitation protocols for patients undergoing reverse shoulder arthroplasty were included. Data quality was examined with the Cochrane risk of a bias assessment tool for randomized trials, the Methodological Index for Non-Randomized studies (MINORS) tool, as well as the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. Results Three studies were finally analyzed. At 3 months post-op, forward flexion was found to be significantly higher in the early rehabilitation group (140.5, 95% confidence intervals (CIs): 135.10-145.89; the delayed rehabilitation group mean was 131.24, 95% CI: 125.73-136.74; p = 0.019). Twelve months post-op, no significant difference in any clinical or patient-reported outcome was shown. More complications were reported in the 6 weeks-delayed rehabilitation group. Discussion Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. The lack of strong evidence warrants the need for future controlled studies; subsequently, postoperative rehabilitation should be individualized.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, “Georgios Papanikolaou” Hospital, Thessaloniki, Greece
| | - Christos K Yiannakopoulos
- IASO Hospital, Athens, Greece
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
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Rupp MC, Hochberger F, Berthold DP, Muench LN, Imhoff AB, Siebenlist S, Willinger L. Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee. Orthop J Sports Med 2024; 12:23259671241232397. [PMID: 38455152 PMCID: PMC10919139 DOI: 10.1177/23259671241232397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/09/2024] Open
Abstract
Background Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for impingement of the femoral condyles. Purpose To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle. Study Design Cohort study; Level of evidence, 3. Methods Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD). Results With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006). Conclusion LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.
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Affiliation(s)
| | - Felix Hochberger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Daniel P. Berthold
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU Munich), Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | | | - Lukas Willinger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
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Berthold DP, Rupp MC, Obopilwe E, Siebenlist S, Elhassan BT, Mazzocca AD, Muench LN. Anterior Latissimus Dorsi Transfer for Irreparable Subscapularis Tears Improves Shoulder Kinematics in a Dynamic Biomechanical Cadaveric Shoulder Model. Am J Sports Med 2024; 52:624-630. [PMID: 38294257 PMCID: PMC10905977 DOI: 10.1177/03635465231223514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/08/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND In young patients with irreparable subscapularis deficiency (SSC-D) and absence of severe osteoarthritis, anterior latissimus dorsi transfer (aLDT) has been proposed as a treatment option to restore the anteroposterior muscular force couple to regain sufficient shoulder function. However, evidence regarding the biomechanical effect of an aLDT on glenohumeral kinematics remains sparse. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the effects of an aLDT on range of glenohumeral abduction motion, superior migration of the humeral head (SM), and cumulative deltoid force (cDF) in a simulated SSC-D model using a dynamic shoulder model. It was hypothesized that an aLDT would restore native shoulder kinematics by reestablishing the insufficient anteroposterior force couple. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric shoulders were tested using a validated shoulder simulator. Glenohumeral abduction angle (gAA), SM, and cDF were compared across 3 conditions: (1) native, (2) SSC-D, and (3) aLDT. gAA and SM were measured using 3-dimensional motion tracking, while cDF was recorded in real time during dynamic abduction motion by load cells connected to actuators. RESULTS The SSC-D significantly decreased gAA (Δ-9.8°; 95% CI, -14.1° to -5.5°; P < .001) and showed a significant increase in SM (Δ2.0 mm; 95% CI, 0.9 to 3.1 mm; P = .003), while cDF was similar (Δ7.8 N; 95% CI, -9.2 to 24.7 N; P = .586) when compared with the native state. Performing an aLDT resulted in a significantly increased gAA (Δ3.8°; 95% CI, 1.8° to 5.7°; P < .001), while cDF (Δ-36.1 N; 95% CI, -48.7 to -23.7 N; P < .001) was significantly reduced compared with the SSC-D. For the aLDT, no anterior subluxation was observed. However, the aLDT was not able to restore native gAA (Δ-6.1°; 95% CI, -8.9° to -3.2°; P < .001). CONCLUSION In this cadaveric study, performing an aLDT for an irreparable subscapularis insufficiency restored the anteroposterior force couple and prevented superior and anterior humeral head migration, thus improving glenohumeral kinematics. Furthermore, compensatory deltoid forces were reduced by performing an aLDT. CLINICAL RELEVANCE Given the favorable effect of the aLDT on shoulder kinematics in this dynamic shoulder model, performing an aLDT may be considered as a treatment option in patients with irreparable SSC-D.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | | | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Bassem T. Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
- Department of Trauma Surgery, Armed Klinikum München Süd, Munich, Germany
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7
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Muench LN, Berthold DP, Rupp MC, Dorsey CG, Hawthorne B, Trudeau MT, Wolf JD, Wellington I, Mazzocca AD. Long-Term Functional Outcomes and Athletic Ability in Shoulder Sports After Anatomic Coracoclavicular Ligament Reconstruction for Chronic Type 3 and 5 Acromioclavicular Joint Injuries. Orthop J Sports Med 2024; 12:23259671241227224. [PMID: 38313753 PMCID: PMC10836141 DOI: 10.1177/23259671241227224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 02/06/2024] Open
Abstract
Background Promising short- and midterm outcomes have been seen after anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint (ACJ) injuries. Purpose/Hypothesis To evaluate long-term outcomes and shoulder-related athletic ability in patients after ACCR for chronic type 3 and 5 ACJ injuries. It was hypothesized that these patients would maintain significant functional improvement and sufficient shoulder-sport ability at a long-term follow-up. Study Design Case series; Level of evidence, 4. Methods Included were 19 patients (mean age, 45.9 ± 11.2 years) who underwent ACCR for type 3 or 5 ACJ injuries between January 2003 and August 2014. Functional outcome measures included the American Shoulder and Elbow Surgeons (ASES), Rowe, Constant-Murley, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores as well as the visual analog scale (VAS) for pain, which were collected preoperatively and at the final follow-up. Postoperative shoulder-dependent athletic ability was assessed using the Athletic Shoulder Outcome Scoring System (ASOSS). Shoulder activity level was evaluated using the Shoulder Activity Scale (SAS), while the Subjective Patient Outcome for Return to Sports (SPORTS) score was collected to assess the patients' ability to return to their preinjury sporting activity. Results The mean follow-up time was 10.1 ± 3.8 years (range, 6.1-18.8 years). Patients achieved significant pre- to postoperative improvements on the ASES (from 54.2 ± 22.6 to 83.5 ± 23.1), Rowe (from 66.6 ± 18.1 to 85.3 ± 19), Constant-Murley (from 64.6 ± 20.9 to 80.2 ± 22.7), SST (from 7.2 ± 3.4 to 10.5 ± 2.7), SANE (from 30.1 ± 23.2 to 83.6 ± 26.3), and VAS pain scores (from 4.7 ± 2.7 to 1.8 ± 2.8) (P < .001 for all), with no significant differences between type 3 and 5 injuries. At the final follow-up, patients achieved an ASOSS of 80.6 ± 32, SAS level of 11.6 ± 5.1, and SPORTS score of 7.3 ± 4.1, with no significant differences between type 3 and 5 injuries. Four patients (21.1%) had postoperative complications. Conclusion Patients undergoing ACCR using free tendon allografts for chronic type 3 and 5 ACJ injuries maintained significant improvements in functional outcomes at the long-term follow-up and achieved favorable postoperative shoulder-sport ability, activity, and return to preinjury sports participation.
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Affiliation(s)
- Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Germany
| | - Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | | | - Caitlin G. Dorsey
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Benjamin Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Maxwell T. Trudeau
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - John D. Wolf
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Ian Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Augustus D. Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, Massachusetts, USA
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Berthold DP, Muench LN, Kadantsev P, Siebenlist S, Scheiderer B, Mazzocca AD, Calvo E, Imhoff AB, Beitzel K, Hinz M. The importance of a structured failure analysis in revision acromioclavicular joint surgery: A multi-rater agreement on the causes of stabilization failure from the ISAKOS shoulder committee. J ISAKOS 2023; 8:425-429. [PMID: 37562575 DOI: 10.1016/j.jisako.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Acromioclavicular joint (ACJ) stabilizations are associated with a high overall failure rate with 9.5% of these patients requiring subsequent revision surgery. Consequently, understanding the specific cause of primary ACJ stabilization failure is paramount to improving surgical decision-making in this challenging patient cohort. PURPOSE To (1) identify risk factors and mechanisms for failure following primary arthroscopically-assisted ACJ stabilization to highlight the importance of conducting a detailed failure analysis and to (2) establish revision strategies based on real-life cases of primary failed ACJ stabilization. STUDY DESIGN Level of evidence IV. METHODS A survey was shared internationally among members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) shoulder committee. The survey contained failure analysis of 11 real-life cases of failed primary arthroscopically-assisted ACJ stabilization. For each case, a thorough patient history, standardized radiographs, and CT scans were provided. Participants were asked to give their opinion on bone tunnel placement, cause of failure (biological, technical, traumatic, or combined), the stabilization technique used, as well as give a recommendation for revision. RESULTS Seventeen members of the ISAKOS shoulder committee completed the survey. Biological failure was considered the most common cause of failure (47.1%), followed by technical (35.3%) and traumatic (17.6%) failure. The majority deemed two modifiable factors (i.e., patient's profession and sport) as well as non-modifiable factors (i.e., patient's age and time from trauma to initial surgery) to be risk factors for failure. In 10 of 11 cases, the correct fixation device was used in the primary setting (90.9%; 52.8-82.4% agreement); however, in eight of those cases, the technique was not performed correctly (80.0%; 58.8-100% agreement). In 8 of all 11 cases, the majority recommended an arthroscopically assisted technique with graft augmentation for revision (52.9-58.8% agreement). CONCLUSION Biological failure and technical failure are the most common reason for failure in primary ACJ stabilization followed by traumatic failure. Besides, biological failure can be triggered by technical errors such as clavicular or coracoidal tunnel misplacement. Consequently, a detailed failure analysis including preoperative CT should be conducted on the causes of primary ACJ failure, and, if possible, an arthroscopically-assisted technique with graft augmentation should be prioritized in revision ACJ surgery. CLINICAL RELEVANCE ACJ stabilizations are associated with a high overall failure rate - potentially due to biological and technical properties. When encountering failed arthroscopically-assisted ACJ stabilization, a detailed failure analysis should be conducted on the causes of primary ACJ failure. Furthermore, an arthroscopically-assisted revision stabilization is feasible in most cases.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, 80336 Munich, Germany; Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany.
| | - Lukas N Muench
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Pavel Kadantsev
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Augustus D Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Knut Beitzel
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany; Department of Shoulder Surgery, ATOS Clinic, 50858 Cologne, Germany
| | - Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
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9
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Rupp MC, Khan ZA, Dasari SP, Berthold DP, Siebenlist S, Imhoff AB, Chahla J, Pogorzelski J. Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptomatic State following Patellofemoral Inlay Arthroplasty for Visual Analog Scale Pain, Western Ontario and McMaster Universities Arthritis Index, and Lysholm Scores. J Arthroplasty 2023; 38:2580-2586. [PMID: 37286052 DOI: 10.1016/j.arth.2023.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The purposes of the study were to define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after patello-femoral inlay arthroplasty (PFA) and to identify factors predictive for the achievement of clinically important outcomes (CIOs). METHODS A total of 99 patients who underwent PFA between 2009 and 2019 and had a minimum of 2-year postoperative follow-up were enrolled in this retrospective monocentric study. Included patients had a mean age of 44 years (range, 21 to 79). The MCID and PASS were calculated using an anchor-based approach for the visual analog scale (VAS) pain, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lysholm patient-reported outcome measures. Factors associated with CIO achievement were determined using multivariable logistic regression analyses. RESULTS The established MCID thresholds for clinical improvement were -2.46 for the VAS pain score, -8.5 for the WOMAC score, and + 25.4 for the Lysholm score. Postoperative scores corresponding to the PASS were <2.55 for the VAS pain score, <14.6 for the WOMAC score, and >52.5 points for the Lysholm score. Preoperative patellar instability and concomitant medial patello-femoral ligament reconstruction were independent positive predictors of reaching both MCID and PASS. Additionally, inferior baseline scores and age were predictive of achieving MCID, whereas superior baseline scores and body mass index were predictive of achieving PASS. CONCLUSION This study determined the thresholds of MCID and PASS for the VAS pain, WOMAC, and Lysholm scores following PFA implantation at 2-year follow-up. The study demonstrated a predictive role of patient age, body mass index, preoperative patient-reported outcome measure scores, preoperative patellar instability, and concomitant medial patello-femoral ligament reconstruction in the achievement of CIOs. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Zeeshan A Khan
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Suhas P Dasari
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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10
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Muench LN, Tamburini L, Kriscenski D, Berthold DP, Rupp MC, Cote MP, McCarthy MB, Mazzocca AD. The effect of augmenting suture material with magnesium and platelet-rich plasma on the in vitro adhesion and proliferation potential of subacromial bursa-derived progenitor cells. JSES Int 2023; 7:2367-2372. [PMID: 37969491 PMCID: PMC10638578 DOI: 10.1016/j.jseint.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Connective tissue subacromial bursa-derived progenitor cells (SBDCs) have been suggested as a potent biologic augment to promote healing of the repaired rotator cuff tendon. Maximizing the amount of retained progenitor cells at the tendon repair site is essential for ensuring an optimal healing environment, warranting a search for proadhesive and proliferative adjuvants. The purpose was to evaluate the effect of magnesium (Mg), platelet-rich plasma (PRP), and a combination of both adjuvants on the in vitro cellular adhesion and proliferation potential of SBDCs on suture material commonly used in rotator cuff surgery. Methods SBDCs were isolated from subacromial bursa samples harvested during rotator cuff repair and cultured in growth media. Commercially available collagen-coated nonabsorbable flat-braided suture was cut into 1-inch pieces, placed into 48-well culture dishes, and sterilized under ultraviolet light. Either a one-time dose of 5 mM sterile Mg, 0.2 mL of PRP, or a combination of both adjuvants was added, while a group without treatment served as a negative control. Cellular proliferation and adhesion assays on suture material were performed for each treatment condition. Results Augmenting the suture with Mg resulted in a significantly increased cellular adhesion (total number of attached cells) of SBDCs compared to PRP alone (31,527 ± 19,884 vs. 13,619 ± 8808; P < .001), no treatment (31,527 ± 19,884 vs. 21,643 ± 8194; P = .016), and combination of both adjuvants (31,527 ± 19,884 vs. 17,121 ± 11,935; P < .001). Further, augmentation with Mg achieved a significant increase in cellular proliferation (absorbance) of SBDCs on suture material when compared to the PRP (0.516 ± 0.207 vs. 0.424 ± 0.131; P = .001) and no treatment (0.516 ± 0.207 vs. 0.383 ± 0.094; P < .001) group. The combination of Mg and PRP showed a significantly higher proliferation potential compared to PRP alone (0.512 ± 0.194 vs. 0.424 ± 0.131; P = .001) and no treatment (0.512 ± 0.194 vs. 0.383 ± 0.094; P < .001). There were no significant differences in the remaining intergroup comparisons (P > .05, respectively). Conclusion Augmenting suture material with Mg resulted in a significantly increased cellular adhesion of SBDCs compared to untreated suture material, as well as augmentation with PRP alone or a combination of both adjuvants. Further, Mg with or without PRP augmentation achieved a significant increase in the cellular proliferation of SBDCs on suture material compared to untreated sutures and augmentation with PRP alone. Application of Mg may be a clinically feasible approach to optimizing the use of SBDCs as a biological augment in rotator cuff repair, while combined augmentation with PRP may harness the full potential for optimized tissue recovery due to the high concentration of PRP-derived growth factors.
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Affiliation(s)
- Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Lisa Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Danielle Kriscenski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | | | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Augustus D. Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA, USA
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11
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Bormann M, Bitschi D, Neidlein C, Berthold DP, Jörgens M, Pätzold R, Watrinet J, Böcker W, Holzapfel BM, Fürmetz J. Mismatch between Clinical-Functional and Radiological Outcome in Tibial Plateau Fractures: A Retrospective Study. J Clin Med 2023; 12:5583. [PMID: 37685650 PMCID: PMC10488212 DOI: 10.3390/jcm12175583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The evaluation of tibial plateau fractures (TPF) encompasses the assessment of clinical-functional and radiological parameters. In this study, the authors aimed to investigate the potential correlation between these parameters by utilizing both the clinical-functional and the modified radiological Rasmussen score. METHODS In this retrospective monocentric study conducted at a level-I trauma center, patients who underwent surgery between January 2014 and December 2019 due to a TPF were included. The clinical-functional Rasmussen score prior to the injury, at 1-year postoperatively, and during the last follow-up (minimum 18 months) was assessed using a standardized questionnaire. Additionally, the modified radiological Rasmussen score was determined at the 1-year postoperative mark using conventional radiographs in two planes. RESULTS A total of 50 patients were included in this study, comprising 40% (n = 20) men, and 60% (n = 30) women, with an average age of 47 ± 11.8 years (range 26-73 years old). Among them, 52% (n = 26) had simple fractures (classified according to Schatzker I-III), while 48% (n = 24; according to Schatzker IV-VI) had complex fractures. The mean follow-up was 3.9 ± 1.6 years (range 1.6-7.5 years). The functional Rasmussen score assessed before the injury and at follow-up showed an "excellent" average result. However, there was a significant difference in the values of complex fractures compared to before the injury. One year postoperatively, both the clinical-functional score and the modified radiological score demonstrated a "good" average result. The "excellent" category was more frequently observed in the functional score, while the "fair" category was more common in the radiological score. There was no agreement between the categories in both scores in 66% of the cases. CONCLUSIONS The data from this retrospective study demonstrated that patients with TPF are able to achieve a nearly equivalent functional level in the medium-term after a prolonged recovery period, comparable to their pre-injury state. However, it is important to note that the correlation between clinical-functional and radiological parameters is limited. Consequently, in order to create prospective outcome scores, it becomes crucial to objectively assess the multifaceted nature of TPF injuries in more detail, both clinically and radiologically.
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Affiliation(s)
- Markus Bormann
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - David Bitschi
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Claas Neidlein
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Daniel P. Berthold
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Maximilian Jörgens
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Robert Pätzold
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau, Germany
| | - Julius Watrinet
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau, Germany
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Julian Fürmetz
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau, Germany
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12
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Bormann M, Neidlein C, Neidlein N, Ehrl D, Jörgens M, Berthold DP, Böcker W, Holzapfel BM, Fürmetz J. High Prevalence of Persistent Measurable Postoperative Knee Joint Laxity in Patients with Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation (ORIF). J Clin Med 2023; 12:5580. [PMID: 37685647 PMCID: PMC10488731 DOI: 10.3390/jcm12175580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The development of post-traumatic osteoarthrosis after tibial plateau fracture (TPF) is multifactorial and can only be partially influenced by surgical treatment. There is no standardized method for assessing pre- and postoperative knee joint laxity. Data on the incidence of postoperative laxity after TPF are limited. The purpose of this study was to quantify postoperative laxity of the knee joint after TPF. Fifty-four patients (mean age 51 ± 11.9 years) were included in this study. There was a significant increase in anterior-posterior translation in 78.0% and internal rotation in 78.9% in the injured knee when compared to the healthy knee. Simple fractures showed no significant difference in laxity compared to complex fractures. When preoperative ligament damage and/or meniscal lesions were present and surgically treated by refixation and/or bracing, patients showed higher instability when compared to patients without preoperative ligament and/or meniscal damage. Patients with surgically treated TPF demonstrate measurable knee joint laxity at a minimum of 1 year postoperatively. Fracture types have no influence on postoperative laxity. This emphasizes the importance of recognizing TPF as a multifaceted injury involving both complex fractures and damage to multiple ligaments and soft tissue structures, which may require further surgical intervention after osteosynthesis.
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Affiliation(s)
- Markus Bormann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Claas Neidlein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Niels Neidlein
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dennis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, LMU Munich, 81377 Munich, Germany
| | - Maximilian Jörgens
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Julian Fürmetz
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau am Staffelsee, Germany
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13
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Muench LN, Slater M, Archambault S, Berthold DP, Rupp MC, Obopilwe E, Cote MP, Mazzocca AD. Contact Mechanics of Elliptical and Spherical Head Implants during Axial Rotation in Anatomic Total Shoulder Arthroplasty: A Biomechanical Comparison. J Clin Med 2023; 12:4918. [PMID: 37568320 PMCID: PMC10420122 DOI: 10.3390/jcm12154918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Elliptical humeral head implants have been proposed to result in more anatomic kinematics following total shoulder arthroplasty (aTSA). The purpose of this study was to compare glenohumeral contact mechanics during axial rotation using spherical and elliptical humeral head implants in the setting of aTSA. METHODS Seven fresh-frozen cadaveric shoulders were utilized for biomechanical testing in neutral (NR), internal (IR), and external (ER) rotation at various levels of abduction (0°, 15°, 30°, 45°, 60°) with lines of pull along each of the rotator cuff muscles. Each specimen underwent the following three conditions: (1) native, and TSA using (2) an elliptical and (3) spherical humeral head implant. Glenohumeral contact mechanics, including contact pressure (CP; kPa), peak contact pressure (PCP; kPa), and contact area (CA; mm2), were measured in neutral rotation as well as external and internal rotation using a pressure mapping sensor. RESULTS Elliptical head implants showed a significantly lower PCP in ER compared to spherical implants at 0° (Δ-712.0 kPa; p = 0.034), 15° (Δ-894.9 kPa; p = 0.004), 30° (Δ-897.7 kPa; p = 0.004), and 45° (Δ-796.9 kPa; p = 0.010) of abduction, while no significant difference was observed in ER at 60° of abduction or at all angles in NR and IR. Both implant designs had similar CA in NR, ER, and IR at all tested angles of abduction (p > 0.05, respectively). CONCLUSIONS In the setting of aTSA, elliptical heads showed significantly lower PCP during ER at 0° to 45° of abduction, when compared to spherical head implants. However, in NR and IR, PCP was similar between implant designs. Both designs showed similar CA during NR, ER, and IR at all abduction angles. LEVEL OF EVIDENCE basic science; controlled laboratory study.
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Affiliation(s)
- Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, 81675 Munich, Germany
| | - Maria Slater
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA (M.P.C.)
| | - Simon Archambault
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA (M.P.C.)
| | - Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, 82152 Munich, Germany
| | - Marco-Christopher Rupp
- Department of Sports Orthopaedics, Technical University of Munich, 81675 Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA (M.P.C.)
| | - Mark P. Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA (M.P.C.)
| | - Augustus D. Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA 02115, USA
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14
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Muench LN, Rupp MC, Obopilwe E, Mehl J, Scheiderer B, Siebenlist S, Elhassan BT, Mazzocca AD, Berthold DP. Physiological Tensioning During Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears May Be Important for Improvement in Shoulder Kinematics. Am J Sports Med 2023; 51:2422-2430. [PMID: 37318086 PMCID: PMC10353027 DOI: 10.1177/03635465231179693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/28/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Lower trapezius transfer (LTT) has been proposed for restoring the anteroposterior muscular force couple in the setting of an irreparable posterosuperior rotator cuff tear (PSRCT). Adequate graft tensioning during surgery may be a factor critical for sufficient restoration of shoulder kinematics and functional improvement. PURPOSE/HYPOTHESIS The purpose was to evaluate the effect of tensioning during LTT on glenohumeral kinematics using a dynamic shoulder model. It was hypothesized that LTT, while maintaining physiological tension on the lower trapezius muscle, would improve glenohumeral kinematics more effectively than undertensioned or overtensioned LTT. STUDY DESIGN Controlled laboratory study. METHODS A total of 10 fresh-frozen cadaveric shoulders were tested using a validated shoulder simulator. Glenohumeral abduction angle, superior migration of the humeral head, and cumulative deltoid force were compared across 5 conditions: (1) native, (2) irreparable PSRCT, (3) LTT with a 12-N load (undertensioned), (4) LTT with a 24-N load (physiologically tensioned according to the cross-sectional area ratio of the lower trapezius muscle), and (5) LTT with a 36-N load (overtensioned). Glenohumeral abduction angle and superior migration of the humeral head were measured using 3-dimensional motion tracking. Cumulative deltoid force was recorded in real time throughout dynamic abduction motion by load cells connected to actuators. RESULTS Physiologically tensioned (Δ13.1°), undertensioned (Δ7.3°), and overtensioned (Δ9.9°) LTT each significantly increased the glenohumeral abduction angle compared with the irreparable PSRCT (P < .001 for all). Physiologically tensioned LTT achieved a significantly greater glenohumeral abduction angle than undertensioned LTT (Δ5.9°; P < .001) or overtensioned LTT (Δ3.2°; P = .038). Superior migration of the humeral head was significantly decreased with LTT compared with the PSRCT, regardless of tensioning. Physiologically tensioned LTT resulted in significantly less superior migration of the humeral head compared with undertensioned LTT (Δ5.3 mm; P = .004). A significant decrease in cumulative deltoid force was only observed with physiologically tensioned LTT compared with the PSRCT (Δ-19.2 N; P = .044). However, compared with the native state, LTT did not completely restore glenohumeral kinematics, regardless of tensioning. CONCLUSION LTT was most effective in improving glenohumeral kinematics after an irreparable PSRCT when maintaining physiological tension on the lower trapezius muscle at time zero. However, LTT did not completely restore native glenohumeral kinematics, regardless of tensioning. CLINICAL RELEVANCE Tensioning during LTT for an irreparable PSRCT may be important to sufficiently improve glenohumeral kinematics and may be an intraoperatively modifiable key variable to ensure postoperative functional success.
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Affiliation(s)
- Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
- Department of Orthopedics & Sports Medicine, University of Connecticut, Farmington, Connecticut, USA
| | | | - Elifho Obopilwe
- Department of Orthopedics & Sports Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Julian Mehl
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Bassem T. Elhassan
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Augustus D. Mazzocca
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel P. Berthold
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
- Department of Orthopedics & Sports Medicine, University of Connecticut, Farmington, Connecticut, USA
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15
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Geyer S, Achtnich AE, Voss A, Berthold DP, Lutz PM, Imhoff AB, Martetschläger F. Iatrogenic instability of the acromioclavicular joint leads to ongoing impairment of shoulder function even following secondary surgical stabilization. Arch Orthop Trauma Surg 2023; 143:1877-1886. [PMID: 35220484 PMCID: PMC10030407 DOI: 10.1007/s00402-022-04387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 02/05/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Iatrogenic instability of the acromioclavicular joint (ACJ) following distal clavicle excision (DCE) represents an infrequent pathology. Revision surgery to restore ACJ stability and alleviate concomitant pain is challenging due to altered anatomic relationships. The purpose of this study was to evaluate the used salvage techniques and postoperative functional and radiological outcomes in retrospectively identify patients with a painful ACJ following DCE. We hypothesized that iatrogenic instability leads to ongoing impairment of shoulder function despite secondary surgical stabilization. METHODS 9 patients with a painful ACJ after DCE (6 men, 3 women, 43.3 ± 9.4 years) were followed up at a minimum of 36 months after revision surgery. Besides range of motion (ROM), strength and function were evaluated with validated evaluation tools including the Constant score and the DASH score (Disability of the Arm, Shoulder and Hand questionnaire), specific AC Score (SACS), Nottingham Clavicle Score (NCS), Taft score and Acromioclavicular Joint Instability Score (AJI). Additionally, postoperative X-rays were compared to the unaffected side, measuring the coracoclavicular (CC) and acromioclavicular (AC) distance. RESULTS At follow-up survey (55.8 ± 18.8 months) all patients but one demonstrated clinical ACJ stability after arthroscopically assisted anatomical ACJ reconstruction with an autologous hamstring graft. Reconstruction techniques were dependent on the direction of instability. The functional results demonstrated moderate shoulder and ACJ scores with a Constant Score of 77.3 ± 15.4, DASH-score of 51.2 ± 23.4, SACS 32.6 ± 23.8, NCS 77.8 ± 14.2, AJI 75 ± 14.7 points and Taft Score 7.6 ± 3.4 points. All patients stated they would undergo the revision surgery again. Mean postoperative CC-distance (8.3 ± 2.8 mm) did not differ significantly from the contralateral side (8.5 ± 1.6 mm) (p > 0,05). However, the mean AC distance was significantly greater with 16.5 ± 5.8 mm compared to the contralateral side (3.5 ± 1.9 mm) (p = 0.012). CONCLUSION Symptomatic iatrogenic ACJ instability following DCE is rare. Arthroscopically assisted revision surgery with an autologous hamstring graft improved ACJ stability in eight out of nine cases (88.9%). However, the functional scores showed ongoing impairment of shoulder function and a relatively high overall complication rate (33.3%). Therefore, this study underlines the importance of precise preoperative indication and planning and, especially, the preservation of ACJ stability when performing AC joint resection procedures. LEVEL OF EVIDENCE Case series, LEVEL IV.
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Affiliation(s)
- Stephanie Geyer
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andrea E Achtnich
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas Voss
- Department of Trauma Surgery, University Medical Center, Regensburg, Germany
- Sporthopaedicum, Regensburg, Germany
| | - Daniel P Berthold
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Patricia M Lutz
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Frank Martetschläger
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany.
- Deutsches Schulterzentrum, ATOS Klinik München, Effnerstr. 38, 81925, Munich, Germany.
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16
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Geyer S, Siebler J, Eggers F, Münch LN, Berthold DP, Imhoff AB, Siebenlist S, Scheiderer B. Influence of sportive activity on functional and radiographic outcomes following reverse total shoulder arthroplasty: a comparative study. Arch Orthop Trauma Surg 2023; 143:1809-1816. [PMID: 35092467 PMCID: PMC10030429 DOI: 10.1007/s00402-022-04344-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of the present study was to compare the functional and radiographic outcomes following reverse total shoulder arthroplasty (RTSA) in a senior athletic and non-athletic population. MATERIAL AND METHODS In this retrospective cohort study, patients who underwent RTSA between 06/2013 and 04/2018 at a single institution were included. Minimum follow-up was 2 years. A standardized questionnaire was utilized for assessment of patients' pre- and postoperative physical fitness and sportive activity. Patients who resumed at least one sport were assigned to the athletic group, while patients who ceased participating in sports were assigned to the non-athletic group. Postoperative clinical outcome measures included the Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and visual analog scale (VAS) for pain. Active shoulder range of motion (ROM) and abduction strength were assessed. Radiographic evaluation was based on a standardized core set of parameters for radiographic monitoring of patients following shoulder arthroplasty. RESULTS Sixty-one of 71 patients (85.9%; mean age: 72.1 ± 6.6 years) were available for clinical and radiographic follow-up at a mean of 47.1 ± 18.1 months. Thirty-four patients (55.7%) were assigned to the athletic group and 27 patients (44.3%) to the non-athletic group. The athletic group demonstrated significantly better results for CS (P = 0.002), ASES score (P = 0.001), SST (P = 0.001), VAS (P = 0.022), active external rotation (P = 0.045) and abduction strength (P = 0.016) compared to the non-athletic group. The overall rate of return to sport was 78.0% at an average of 5.3 ± 3.6 months postoperatively. Incomplete radiolucent lines (RLL) around the humeral component were found significantly more frequently in the athletic group compared to the non-athletic group (P = 0.019), whereas the occurrence of complete RLLs around the implant components was similar (P = 0.382). Scapular notching was observed in 18 patients (52.9%) of the athletic group and 12 patients (44.9%) of the non-athletic group (P = 0.51). The overall rate for revision surgery was 8.2%, while postoperative complications were encountered in 3.3% of cases. CONCLUSION At mid-term follow-up, the athletic population demonstrated significantly better clinical results following RTSA without a higher rate of implant loosening and scapular notching when compared to non-athletic patients. However, incomplete radiolucency around the humeral component was observed significantly more often in the athletic group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jakob Siebler
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felipe Eggers
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas N Münch
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Muench LN, Murphey M, Oei B, Kia C, Obopilwe E, Cote MP, Mazzocca AD, Berthold DP. Elliptical and spherical heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty. BMC Musculoskelet Disord 2023; 24:171. [PMID: 36882825 PMCID: PMC9990317 DOI: 10.1186/s12891-023-06273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Elliptical shape humeral head prostheses have been recently proposed to reflect a more anatomic shoulder replacement. However, its effect on obligate glenohumeral translation during axial rotation compared to a standard spherical head is still not well understood. The purpose of the study was to compare obligate humeral translation during axial rotation using spherical and elliptical shaped humeral head prostheses. It was hypothesized that the spherical head design would show significantly more obligate translation when compared to the elliptical design. METHODS Six fresh-frozen cadaveric shoulders were utilized for biomechanical testing of internal (IR) and external (ER) rotation at various levels of abduction (0°, 30°, 45°, 60°) with lines of pull along each of the rotator cuff muscles. Each specimen underwent the following three conditions: (1) native; total shoulder arthroplasty (TSA) using (2) an elliptical and (3) spherical humeral head implant. Obligate translation during IR and ER was quantified using a 3-dimensional digitizer. The radius of curvature of the superoinferior and anteroposterior dimensions of the implants was calculated across each condition. RESULTS Posterior and inferior translation as well as compound motion of spherical and elliptical heads during ER was similar at all abduction angles (P > 0.05, respectively). Compared to the native humeral head, both implants demonstrated significantly decreased posterior translation at 45° (elliptical: P = 0.003; spherical: P = 0.004) and 60° of abduction (elliptical: P < 0.001; spherical: P < 0.001). During internal rotation at 0° abduction, the spherical head showed significantly more compound motion (P = 0.042) compared to the elliptical head. The spherical implant also demonstrated increased anterior translation and compound motion during internal rotation at 60° abduction (P < 0.001) compared to the resting state. This difference was not significant for the native or elliptical head design at this angle (P > 0.05). CONCLUSION In the setting of TSA, elliptical and spherical head implants showed similar obligate translation and overall compound motion during axial rotation. A gained understanding of the consequences of implant head shape in TSA may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes. LEVEL OF EVIDENCE Controlled Laboratory Study.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Matthew Murphey
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Bridget Oei
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Augustus D Mazzocca
- Massachusetts General Brigham, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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Muench LN, Dyrna F, Otto A, Wellington I, Obopilwe E, Scheiderer B, Imhoff AB, Beitzel K, Mazzocca AD, Berthold DP. Superior Capsular Reconstruction Partially Restores Native Glenohumeral Joint Loads In A Dynamic Biomechanical Shoulder Model. Arthroscopy 2023:S0749-8063(23)00199-8. [PMID: 36868531 DOI: 10.1016/j.arthro.2023.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To evaluate the effect of an irreparable posterosuperior rotator cuff tear (PSRCT) on glenohumeral joint loads and to quantify improvement following superior capsular reconstruction (SCR) using an acellular dermal allograft. METHODS Ten fresh-frozen cadaveric shoulders were tested using a validated dynamic shoulder simulator. A pressure mapping sensor was placed between the humeral head and glenoid surface. Each specimen underwent the following conditions: (1) native, (2) irreparable PSRCT, (3) SCR using a 3mm-thick acellular dermal allograft. Glenohumeral abduction angle (gAA) and superior humeral head migration (SM) were measured using 3D motion tracking software. Cumulative deltoid force (cDF) and glenohumeral contact mechanics, including contact area (gCA) and contact pressure (gCP), were assessed at rest,15°,30°,45°, and maximum angle of glenohumeral abduction. RESULTS The PSRCT resulted in a significant decrease of gAA along with an increase in SM, cDF, and gCP (P<.001, respectively). SCR did not restore native gAA (P<.001), however, SM was significantly reduced (P<.001). Further, SCR significantly reduced deltoid forces at 30° (P=.007) and 45° of abduction (P=.007) when compared to the PSRCT. SCR did not restore native cDF at 30°(P=.015), 45°(P<.001), and maximum angle (P<.001) of glenohumeral abduction. Compared to the PSRCT, SCR resulted in a significant decrease of gCP at 15°(P=.008), 30°(P=.002), and 45°(P=.006). However, SCR did not completely restore native gCP at 45° (P=.038) and maximum abduction angle (P=.014). CONCLUSION In this dynamic shoulder model, SCR only partially restored native glenohumeral joint loads. However, SCR significantly decreased glenohumeral contact pressure, cumulative deltoid forces, and superior migration, while increasing abduction motion, when compared to the posterosuperior rotator cuff tear. CLINICAL RELEVANCE These observations raise concerns regarding the true joint preserving potential of SCR for an irreparable posterosuperior rotator cuff tear, along with its ability to delay progression of cuff tear arthropathy and eventual conversion to reverse shoulder arthroplasty.
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Affiliation(s)
- Lukas N Muench
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| | | | - Alexander Otto
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Ian Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Germany
| | - Knut Beitzel
- Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
| | - Augustus D Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel P Berthold
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Berthold DP. Editorial Commentary: Shoulder Superior Capsular Reconstruction Remains to Be Proven Superior to Partial Repair of the Rotator Cuff for Active Patients With Irreparable Tears and Without Osteoarthritis. Arthroscopy 2023; 39:716-718. [PMID: 36740294 DOI: 10.1016/j.arthro.2022.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 02/07/2023]
Abstract
The management of irreparable rotator cuff tears in active patients without severe osteoarthritis is challenging. Retracted tears of the superior cuff result in devastating glenohumeral kinematics and decreased shoulder function. Surgical solutions such as superior capsular reconstruction (SCR) or tendon transfers may improve shoulder function. Regarding SCR, the superior capsule has been described as a static stabilizer allowing for the centering of the humeral head. However, some bases for SCR are based on biomechanical studies that should be regarded as time zero, absent healing, and generally oversimplified as ball-and-socket research rather than replicating complex functional shoulder kinematics. SCR may be waning in popularity. SCR using autograft may, or may not, prove effective in the long run. For now, it remains to be seen whether SCR is superior to partial repair of the rotator cuff.
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Muench LN, Kia C, Murphey M, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD, Berthold DP. Elliptical heads result in increased glenohumeral translation along with micro-motion of the glenoid component during axial rotation in total shoulder arthroplasty. Arch Orthop Trauma Surg 2023; 143:177-187. [PMID: 34216260 PMCID: PMC9886581 DOI: 10.1007/s00402-021-04018-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Elliptical-shaped humeral head prostheses have recently been proposed to reflect a more anatomic shoulder replacement. However, its subsequent effect on micro-motion of the glenoid component is still not understood. MATERIALS AND METHODS Six fresh-frozen, cadaveric shoulders (mean age: 62.7 ± 9.2 years) were used for the study. Each specimen underwent total shoulder arthroplasty using an anatomic stemless implant. At 15°, 30°, 45° and 60° of glenohumeral abduction, 50° of internal and external rotations in the axial plane were alternatingly applied to the humerus with both an elliptical and spherical humeral head design. Glenohumeral translation was assessed by means of a 3-dimensional digitizer. Micro-motion of the glenoid component was evaluated using four high-resolution differential variable reluctance transducer strain gauges, placed at the anterior, posterior, superior, and inferior aspect of the glenoid component. RESULTS The elliptical head design showed significantly more micro-motion in total and at the superior aspect of glenoid component during external rotation at 15° (total: P = 0.004; superior: P = 0.004) and 30° (total: P = 0.045; superior: P = 0.033) of abduction when compared to the spherical design. However, during internal rotation, elliptical and spherical heads showed similar amounts of micro-motion at the glenoid component at all tested abduction angles. When looking at glenohumeral translation, elliptical and spherical heads showed similar anteroposterior and superoinferior translation as well as compound motion during external rotation at all tested abduction angles. During internal rotation, the elliptical design resulted in significantly more anteroposterior translation and compound motion at all abduction angles when compared to the spherical design (P < 0.05). CONCLUSION In the setting of total shoulder arthroplasty, the elliptical head design demonstrated greater glenohumeral translation and micro-motion at the glenoid component during axial rotation when compared to the spherical design, potentially increasing the risk for glenoid loosening in the long term. LEVEL OF EVIDENCE Controlled Laboratory Study.
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Affiliation(s)
- Lukas N. Muench
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Matthew Murphey
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Mark P. Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Daniel P. Berthold
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Vieider RP, Berthold DP, Runer A, Winkler PW, Schulz P, Rupp MC, Siebenlist S, Muench LN. The 50 most cited studies on posterior tibial slope in joint preserving knee surgery. J Exp Orthop 2022; 9:119. [PMID: 36508044 PMCID: PMC9743935 DOI: 10.1186/s40634-022-00557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine the 50 most cited studies on posterior tibial slope (PTS) in joint preserving knee surgery and assess their level of evidence, objective study quality scores as well as to examine whether the study quality correlated with the citation count and citation density in the top 50 list. METHODS A literature search on Web of Science was performed to determine the 50 most cited studies on the topic of PTS in joint preserving knee surgery between 1990 and 2022. The studies were evaluated for their bibliographic parameters, level of evidence rating (LOE), citation counts, the Modified Coleman Methodological Score (MCMS), the Methodological Index for Non-Randomized Studies (MINORS), and the Radiologic Methodology and Quality Scale (MQCSRE). RESULTS Of the top 50 list, 16 studies were published in the American Journal of Sports Medicine. A total of 23 studies were produced in the United States (46%). Of 10 different study types, case control studies (n = 16, 32%) and cadaveric studies (n = 10, 20%) were most common. 15 studies (30%) were purely radiological studies. 6 studies were level II (12%), 23 level III (46%), 15 level IV (30%), and 6 level V studies (12%), respectively. The number of citations ranged from 42 to 447 (mean 105.6 ± 79.2 citations) and showed a mean citation density of 10.3 ± 5.2, composed of the decades 1994 - 2000 (8.3 ± 4.1), 2001 - 2010 (11.1 ± 5.9), 2011 - 2019 (10.1 ± 5.1). Mean quality scores were 55.9 ± 13.0 for MCMS (n = 18), 14.5 ± 3.2 for MINORS (n = 18) and 18.1 ± 3.7 for MQCSRE (n = 20), respectively. High citation counts did not correlate with higher study quality scores (p > 0.05). Radiological studies were not significantly cited more often than non-radiological studies (mean 116.9 ± 88.3 vs. 100.8 ± 75.8 citations; p > 0.05). CONCLUSION In joint preserving knee surgery, the 50 most cited studies on PTS did not represent a ranking of the highest methodological quality scores. Citation counts and citation density over the past three decades did not significantly differ, even though the number of articles in the presented list multiplied over the same period. This list can serve as a reference tool for orthopedic surgeons aiming to review PTS literature.
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Affiliation(s)
- Romed P. Vieider
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,grid.22937.3d0000 0000 9259 8492Medical University of Vienna, Spitalgasse 23, Vienna, Austria
| | - Daniel P. Berthold
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Armin Runer
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp W. Winkler
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,grid.473675.4Department of Orthopaedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria
| | - Phillip Schulz
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco-Christopher Rupp
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lukas N. Muench
- grid.5252.00000 0004 1936 973XDepartment of Sports Orthopaedics, Klinikum Rechts Der Isar, Technichal University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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22
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Berthold DP, Muench LN, Dyrna F, Mazzocca AD, Garvin P, Voss A, Scheiderer B, Siebenlist S, Imhoff AB, Beitzel K. Current concepts in acromioclavicular joint (AC) instability - a proposed treatment algorithm for acute and chronic AC-joint surgery. BMC Musculoskelet Disord 2022; 23:1078. [PMID: 36494652 PMCID: PMC9733089 DOI: 10.1186/s12891-022-05935-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century. MAIN BODY Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability. CONCLUSION Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.
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Affiliation(s)
- Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,grid.411095.80000 0004 0477 2585Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery University Hospital Münster, Munich, Germany
| | - Augustus D. Mazzocca
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Patrick Garvin
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Andreas Voss
- grid.7727.50000 0001 2190 5763Department of Trauma Surgery, University Regensburg, Regensburg, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Knut Beitzel
- Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
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Lutz PM, Geyer S, Winkler PW, Irger M, Berthold DP, Feucht MJ, Imhoff AB, Forkel P. Reliable ligamentous stability and high return-to-sport rates after arthroscopic reduction and internal fixation of tibial eminence fractures. Arch Orthop Trauma Surg 2022; 142:3623-3631. [PMID: 34009463 PMCID: PMC9596592 DOI: 10.1007/s00402-021-03961-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To investigate functional and clinical outcomes, and physical activity after arthroscopic suture fixation of tibial eminence fractures with regard to postoperative stability, range of motion (ROM), complications, and return to sports. METHODS Patients undergoing arthroscopic reduction and internal fixation (ARIF) of tibial eminence fractures using a suture fixation technique were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using KT-1000 arthrometer measurements, clinical examination, outcome scores (Lysholm score, Tegner Activity Scale), and a questionnaire about sport activities. RESULTS A total of 23 patients (44% male, 57% female) with a mean age of 25 ± 15 years were included. Mean follow-up was 57 ± 25 months. KT-1000 arthrometer measurements of anterior tibial translation revealed a mean side-to-side difference of 0.9 ± 1.0 mm. Clinical examination showed 100% normal or nearly normal anterior translation of the tibia. Two patients (9%) received an ACL reconstruction due to traumatic ACL re-instability and were, therefore, considered as failures. An extension deficit concerning hyperextension occurred in 29% of patients postoperatively. Further postoperative complications occurred in 14% of patients and included postoperative stiffness with ROM limitations and secondary dislocation of a fragment. Mean postoperative Lysholm score was 89 ± 14. Comparing pre- and postoperative values, no significant change of the Tegner Activity Scale was observed. All patients (failures excluded) returned to high impact sports activities after ARIF. CONCLUSION Excellent reliable ligamentous stability and high rates of return to high impact sports can be expected after ARIF using a suture fixation technique for type II-IV tibial eminence fractures. Complications, such as limitations in ROM, commonly occur in up to 30% after ARIF. Therefore, regular follow-up examinations remain important in this usually young patient cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp W Winkler
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Markus Irger
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Muench LN, Berthold DP, Kia C, Obopilwe E, Cote MP, Imhoff AB, Scheiderer B, Elhassan BT, Beitzel K, Mazzocca AD. Biomechanical comparison of lower trapezius and latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears using a dynamic shoulder model. J Shoulder Elbow Surg 2022; 31:2392-2401. [PMID: 35671930 DOI: 10.1016/j.jse.2022.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the setting of irreparable posterosuperior rotator cuff tears (PSRCTs), lower trapezius transfer (LTT) may be anatomically better positioned for restoring the muscular force couple compared with latissimus dorsi transfer (LDT). The purpose of the study was to evaluate the effect of LTT and LDT on glenohumeral kinematics using a dynamic shoulder model. METHODS Ten fresh-frozen cadaveric shoulders (mean age: 56.5 ± 17.2 years) were tested using a dynamic shoulder simulator. The maximum abduction angle (MAA), superior humeral head migration (SHM), and cumulative deltoid forces (CDFs) were compared across 4 conditions: (1) native; (2) irreparable PSRCT; (3) LTT using an Achilles tendon allograft; and (4) LDT. MAA and SHM were measured using 3-dimensional motion tracking. CDF was recorded in real time throughout the dynamic abduction motion by load cells connected to actuators. RESULTS Compared to the native state, the PSRCT resulted in a significant decrease (Δ-24.1°; P < .001) in MAA, with a subsequent significant increase after LTT (Δ13.1°; P < .001) and LDT (Δ8.9°; P < .001). LTT achieved a significantly greater MAA than LDT (Δ4.2°; P = .004). Regarding SHM, both LTT (Δ-9.4 mm; P < .001) and LDT (Δ-5.0 mm; P = .008) demonstrated a significant decrease compared with the PSRCT state. LTT also achieved significantly less SHM compared with the LDT (Δ-4.4 mm; P = .011). Further, only the LTT resulted in a significant decrease in CDF compared with the PSRCT state (Δ-21.3 N; P = .048), whereas LTT and LDT showed similar CDF (Δ-11.3 N; P = .346). However, no technique was able to restore the MAA, SHM, and CDF of the native shoulder (P < .001, respectively). CONCLUSION LTT and LDT both achieved a significant increase in MAA along with significantly less SHM compared with the PSRCT state. Although LTT required significantly less compensatory deltoid forces compared with the PSRCT state, this was not observed for the LDT. Further, the LTT prevented loss of abduction motion and SHM more sufficiently. In the challenging treatment of irreparable PSRCTs, LTT may restore native glenohumeral kinematics more sufficiently, potentially leading to improved postoperative functional outcomes.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Berthold DP, Achtnich A, Mehl J. Anterolaterale Instabilität – Grenzgebiete der Indikation. Arthroskopie 2022. [DOI: 10.1007/s00142-022-00565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berthold DP, Muench LN, Rupp MC, Siebenlist S, Cote MP, Mazzocca AD, Quindlen K. Head-Mounted Display Virtual Reality Is Effective in Orthopaedic Training: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1843-e1849. [PMID: 36312724 PMCID: PMC9596866 DOI: 10.1016/j.asmr.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To conduct a systematic review to determine the efficacy of head-mounted display (HMD) virtual reality (VR) in orthopaedic surgical training. Methods A thorough search was conducted on PubMed for articles published between January 2000 and August 2020. Studies were included if they (1) concerned orthopaedic surgery, (2) dealt with an HMD VR device, (3) the technology was being used for training purposes, and (4) was a randomized control trial (RCT). Results Eight articles met the inclusion criteria. Analysis of the 8 RCTs reveals 6 of the 8 demonstrating HMD VR to be a superior training method to traditional-based training modules. However, in the remaining 2 articles, authors found no significant difference between the VR group and controls, but showed at least equivalent ability to train novice surgeons. Conclusions RCTs show promising evidence that HMD VR is an efficacious tool in surgical training for orthopaedic procedures, with most randomized clinical trials showing improvement in novice students/surgeons compared with controls. Clinical Relevance As VR technology advances, so must the research directed at determining the efficacy of such technologies at educating our novice surgeons. RCTs are already demonstrating the role HMD VR can play in the education of novice orthopaedic surgeons.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
- Address correspondence to Daniel P. Berthold, M.D., Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Lukas N. Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Storrs, Connecticut, U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Kevin Quindlen
- Department of Orthopaedic Surgery, University of Connecticut, Storrs, Connecticut, U.S.A
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Cusano A, Kanski G, Uyeki C, Adams K, Cote MP, Muench LN, Connors JP, Garvin P, Messina JC, Berthold DP, Kissenberth MJ, Mazzocca AD. Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction. J Shoulder Elbow Surg 2022; 31:1426-1435. [PMID: 35122950 DOI: 10.1016/j.jse.2021.12.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) can be used for massive irreparable rotator cuff tears in the absence of significant degenerative changes; however, those who fail an SCR may require reverse shoulder arthroplasty (RSA). The effect of a previously performed SCR on outcomes following RSA remains unknown. METHODS Subjects who underwent RSA from May 2015 to January 2021 at 2 separate institutions were retrospectively identified through prospectively collected databases. Patients who underwent RSA after failed SCR were matched to those who underwent RSA after failed rotator cuff repair (RCR) based on the number of previous ipsilateral shoulder procedures (n = 1, 2, ≥3) and secondarily by age within 5 years. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Western Ontario Osteoarthritis of the Shoulder index (WOOS) scores were compared between groups. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds were calculated to determine clinically relevant differences between groups. RESULTS Forty-five patients were included (32 RSA following RCR, 13 following SCR). There were more smokers (P = .001) and worker's compensation cases (P = .034) in the SCR group. The RCR cohort was older (P = .007) and had a greater incidence of mental health (P > .999) and somatic disorders (P = .698), although these did not reach statistical significance. The mean follow-up for the RCR and SCR groups were 24.2 ± 23.3 and 20.4 ± 14.9 months following RSA, respectively (P = .913). The time from index RCR or SCR to RSA were 94.4 ± 22.2 and 89.2 ± 5.3 months, respectively (P = .003). Pre- and postoperative range of motion were similar between groups, as was the overall change in forward flexion (P = .879), abduction (P = .971), and external rotation (P = .968) following RSA. The RCR group had lower postoperative VAS pain (P = .009), higher SANE (P = .015), higher ASES (P = .008), and higher WOOS (P = .018) scores. The percentage achieving the MCID (P = .676) and SCB (P > .999) were similar; however, 56.7% of the RCR group met the SANE PASS threshold compared with 0.0% in the SCR group (P = .005). There were no differences in postoperative complications (P = .698) or revision rates (P = .308) following RSA between cohorts. CONCLUSION When matched for number of previous procedures to the ipsilateral extremity and age, patients who underwent RSA following failed SCR had worse clinical outcome scores than their RSA following failed RCR counterparts. No patient in the SCR group met the SANE PASS threshold, whereas more than half of the RCR group did.
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Affiliation(s)
- Antonio Cusano
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| | - Gregory Kanski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Colin Uyeki
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Kyle Adams
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - John Patrick Connors
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Patrick Garvin
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - James C Messina
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Berthold DP, Muench LN, Imhoff AB, Lacheta L. Stabilisierung des Akromioklavikulargelenks. Arthroskopie 2022. [DOI: 10.1007/s00142-022-00546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Muench LN, Berthold DP, Otto A, Dyrna F, Bell R, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD, Beitzel K. Increased Glenohumeral Joint Loads Due to a Supraspinatus Tear Can Be Reversed With Rotator Cuff Repair: A Biomechanical Investigation. Arthroscopy 2022; 38:1422-1432. [PMID: 34801659 DOI: 10.1016/j.arthro.2021.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of an isolated full-thickness supraspinatus (SSP) tear on glenohumeral kinematics and contact mechanics, as well as to quantify improvement following rotator cuff repair (RCR). METHODS Ten fresh-frozen cadaveric shoulders (mean age: 63.1 ± 4.6 years) were tested using a dynamic shoulder simulator. A pressure-mapping sensor was placed between the humeral head and the glenoid. Each specimen underwent the following three conditions: 1) native, 2) isolated full-thickness SSP tear, and 3) RCR. Maximum abduction angle (MAA) and superior humeral head migration (SHM) were measured using 3D motion tracking software. Cumulative deltoid force (CDF) and glenohumeral contact mechanics, including contact area (GCA) and contact pressure (GCP), were assessed at the resting position, as well as at 15°, 30°, 45°, and 60° of glenohumeral abduction. RESULTS Compared to native, the SSP tear resulted in a significant decrease in MAA (Δ-8.3°; P < .001) along with a SHM of 6.4 ± 3.8 mm, while significantly increasing CDF (Δ20.5 N; P = .008), GCP (Δ63.1 kPa; P < .001), and peak GCP (Δ278.6 kPa; P < .001), as well as decreasing GCA (Δ-45.8 mm2; P < .001) at each degree of abduction. RCR reduced SHM to 1.2 ± 2.5 mm, while restoring native MAA, CDF (Δ1.8 N), GCA (Δ4.5 mm2), GCP (Δ-4.5 kPa) and peak GCP (Δ19.9 kPa) at each degree of abduction (P > .999, respectively). CONCLUSION In a dynamic biomechanical cadaveric model, increased glenohumeral joint loads due to a full-thickness SSP tear can be reversed with RCR. More specifically, RCR restored native glenohumeral contact area and contact pressure, while preventing superior humeral head migration and decreasing compensatory deltoid forces. CLINICAL RELEVANCE These time 0 observations indicate that undergoing rotator cuff repair may prevent the development of degenerative changes by significantly reducing glenohumeral joint loads and ensuring sufficiently stable joint kinematics.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Alexander Otto
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University of Augsburg, Augsburg, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery, University of Münster, Münster, Germany
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany
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Berthold DP, Ravenscroft M, Bell R, Obopilwe E, Cote MP, Kane Z, Morgan BW, Mühlenfeld N, Mazzocca AD, Muench LN. Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft for Massive, Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Investigation. Arthroscopy 2022; 38:297-306.e2. [PMID: 34329702 DOI: 10.1016/j.arthro.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of bursal acromial reconstruction (BAR) using an acellular dermal allograft on glenohumeral joint kinematics including maximum abduction angle, glenohumeral superior translation, cumulative deltoid force, and subacromial contact pressure. METHODS In this dynamic biomechanical cadaveric shoulder study, 8 fresh-frozen cadaveric shoulders (age 53.4 ± 14.2 years, mean ± standard deviation) were tested using a dynamic shoulder testing system. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP) were compared across 3 conditions: (1) intact shoulder; (2) massive retracted irreparable posterosuperior rotator cuff tear (psRCT) according to Patte III; and (3) BAR. Additionally, humeral head containment was measured using contact pressure. RESULTS Compared with the simulated psRCT, BAR significantly increased mean MAA and significantly decreased ghST (P < .001, respectively) and cDF (P = .017) Additionally, BAR was found to significantly decrease sCP compared with psRCT (P = .024). CONCLUSION In a dynamic biomechanical cadaveric shoulder simulator, resurfacing the undersurface of the acromion using the BAR technique leads to significantly improved ghST, MAA, cDF, and sCP compared with the irreparable rotator cuff tear. CLINICAL RELEVANCE With the BAR technique, native humeral containment may be restored, which can potentially delay progressive subacromial and glenoidal abrasive wear and improve overall shoulder function. As such, the proposed BAR technique can be considered as a technically feasible and potentially cost- and timesaving procedure, as no bone anchors are needed, glenoidal or humeral side graft ruptures can be avoided, and postoperative rehabilitation can be started immediately. However, future clinical studies are needed.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
| | | | | | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Zenon Kane
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | | | - Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Orthoteam Centre, Manchester, UK
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Hinz M, Kleim BD, Berthold DP, Geyer S, Lambert C, Imhoff AB, Mehl J. Injury Patterns, Risk Factors, and Return to Sport in Brazilian Jiu Jitsu: A Cross-sectional Survey of 1140 Athletes. Orthop J Sports Med 2022; 9:23259671211062568. [PMID: 34988235 PMCID: PMC8721390 DOI: 10.1177/23259671211062568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Brazilian jiu jitsu (BJJ) is a growing martial art that focuses on grappling techniques. Purpose To quantify the 3-year incidence of BJJ-related injuries and detect common injury patterns as well as risk factors among those practicing BJJ. It was hypothesized that there would be a high incidence of injuries, they would be caused by submissions in sparring situations, and they would occur predominantly at the extremities. Study Design Descriptive epidemiology study. Methods Active BJJ athletes were invited to take an English-language online survey developed by orthopaedic surgeons together with BJJ athletes and a sports scientist. Data were recorded regarding athlete demographics, sporting activity level, injuries within the past 3 years that caused at least a 2-week time loss, injury mechanisms, and return to sport. Results Overall, 1140 responses were received from 62 different countries; 88.9% of all athletes were male, and 63.9% were regular competitors. Within the investigated cohort, 1052 injuries were recorded in 784 athletes, for an injury incidence of 308 per 1000 athletes per year. The lower extremity (45.7%) and upper extremity (30.2%) were predominant sites of injury, with injuries to the knee (27.1%) being the most common. The most frequent knee injuries were meniscal injuries (n = 65), anterior cruciate ligament (ACL) tears (n = 36), and medial collateral ligament injuries (n = 36). ACL tears were especially associated with long time frames for return to sport. Most injuries occurred during sparring (77.6%) and were caused by submissions (29.7%) and takedowns (26.4%). Competing regularly (P = .003), older age (P < .001), and higher belt rank (P = .003) were significant risk factors for injury. Conclusion Injury incidence was high among BJJ athletes surveyed, with 2 out of 3 athletes reporting at least 1 injury within a 3-year period that caused a 2-week absence from training. Most injuries occurred during sparring, and we believe that a high potential for injury reduction lies in drawing awareness to common injury patterns and sites in athletes.
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Affiliation(s)
- Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christophe Lambert
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Muench LN, Wolf M, Kia C, Berthold DP, Cote MP, Fischler A, Arciero RA, Edgar C. A reduced concentration femoral nerve block is effective for perioperative pain control following ACL reconstruction: a retrospective review. Arch Orthop Trauma Surg 2022; 142:2271-2277. [PMID: 34673999 PMCID: PMC9381487 DOI: 10.1007/s00402-021-04221-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Femoral nerve block (FNB) is a routinely used regional analgesic technique for anterior cruciate ligament (ACL) reconstruction. One method to balance the analgesic effect and functional impairment of FNBs may be to control the concentration of local anesthetics utilized for the block. MATERIALS AND METHODS Retrospective chart review was performed on 390 consecutive patients who underwent ACL reconstruction between June 2014 and May 2017. Patients were divided into those who received a standard (0.5%-bupivacaine) or low (0.1-0.125%-bupivacaine) concentration single-shot FNB performed with ultrasound guidance. Maximum postoperative VAS, Post-Anaesthesia Care Unit (PACU) time prior to discharge, need for additional 'rescue' block, and intravenous postoperative narcotic requirements were recorded. RESULTS A total of 268 patients (28.4 ± 11.9 years) were included for final analysis, with 72 patients in the low-concentration FNB group and 196 patients receiving the standard concentration. There were no differences in the maximum postoperative VAS between the low (6.4 ± 2.5) and standard (5.7 ± 2.9) concentration groups (P = 0.08). Similarly, the time from PACU arrival to discharge was not different between groups (P = 0.64). A sciatic rescue block was needed in 22% of patients with standard-dose FNB compared to 30% of patients receiving the low-concentration FNB (P = 0.20). Patients with a hamstring autograft harvest were more likely to undergo a postoperative sciatic rescue block compared to a bone-patellar tendon autograft (P = 0.005), regardless of preoperative block concentration. Quadriceps activation was preserved with low-concentration blocks. CONCLUSIONS Using 1/5th to 1/4th the standard local anesthetic concentration for preoperative femoral nerve block in ACL reconstruction did not significantly differ in peri-operative outcomes, PACU time, need for rescue blockade, or additional immediate opioid requirements. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lukas N. Muench
- grid.208078.50000000419370394Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Megan Wolf
- grid.208078.50000000419370394Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Cameron Kia
- grid.208078.50000000419370394Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Daniel P. Berthold
- grid.208078.50000000419370394Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mark P. Cote
- grid.208078.50000000419370394Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Adam Fischler
- grid.208078.50000000419370394Department of Anesthesiology, UConn Health, Farmington, CT USA
| | - Robert A. Arciero
- grid.208078.50000000419370394Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Cory Edgar
- grid.208078.50000000419370394Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
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Muench LN, Berthold DP, Archambault S, Slater M, Mehl J, Obopilwe E, Cote MP, Arciero RA, Chahla J, Lee Pace J. Anterior cruciate ligament (ACL) repair using cortical or anchor fixation with suture tape augmentation vs ACL reconstruction: A comparative biomechanical analysis. Knee 2022; 34:76-88. [PMID: 34875498 DOI: 10.1016/j.knee.2021.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose was to compare knee kinematics in a cadaveric model of anterior cruciate ligament (ACL) repair using an adjustable-loop femoral cortical suspensory (AL-CSF) or independent bundle suture anchor fixation (IB-SAF) with suture tape augmentation to a bone-patellar tendon-bone (BPTB) ACL reconstruction. METHODS Twenty-seven cadaveric knees were randomly assigned to one of three surgical techniques: (1) ACL repair using the AL-CSF technique with suture tape augmentation, (2) ACL repair using the IB-SAF technique with suture tape augmentation, (3) ACL reconstruction using a BPTB autograft. Each specimen underwent three conditions according to the state of the ACL (native, proximal transection, repair/reconstruction) with each condition tested at four different angles of knee flexion (0°, 30°, 60°, 90°). Anterior tibial translation (ATT) and internal tibial rotation (ITR) were evaluated using 3-dimensional motion tracking software. RESULTS ACL transection resulted in a significant increase in ATT and ITR when compared to the native state (P < 0.001, respectively). ACL repair with the AL-CSF or IB-SAF technique as well as BPTB reconstruction restored native ATT and ITR at all tested angles of knee flexion, while showing significantly less ATT at 0°, 30°, 60°, and 90° as well as significantly less ITR at 30°, 60°, and 90° of knee flexion when compared to the ACL-deficient state. There were no significant differences in ATT and ITR between the three techniques utilized. CONCLUSION ACL repair using the AL-CSF or IB-SAF technique with suture tape augmentation as well as BPTB ACL reconstruction each restored native anteroposterior and rotational laxity, without significant differences in knee kinematics between the three techniques utilized. LEVEL OF EVIDENCE Controlled Laboratory Study.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Daniel P Berthold
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Simon Archambault
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Maria Slater
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Julian Mehl
- Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Mark P Cote
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Robert A Arciero
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Jorge Chahla
- Department of Orthopedics, Rush University, Chicago, IL 60612, United States
| | - J Lee Pace
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Elite Sports Medicine @ Connecticut Children's Medical Center, Farmington, CT 06032, United States.
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Rupp MC, Kadantsev PM, Siebenlist S, Hinz M, Feucht MJ, Pogorzelski J, Scheiderer B, Imhoff AB, Muench LN, Berthold DP. Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system. Knee Surg Sports Traumatol Arthrosc 2022; 30:3842-3850. [PMID: 35451639 PMCID: PMC9568474 DOI: 10.1007/s00167-022-06978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. MATERIALS AND METHODS Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19-56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior-posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. RESULTS Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8-19.0) to 14.5 ± 3.3 mm (8.7-20.6 mm) (p < 0.001) while the D/A ratio increased from 0.4 ± 0.3 (- 0.4-0.9) to 0.6 ± 0.3 (1.1-0.1) (p = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction (p = 0.027; relative risk 3.4; odds ratio 11.67). CONCLUSIONS Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Pavel M. Kadantsev
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russian Federation ,grid.77642.300000 0004 0645 517XPeoples Friendship University of Russia, Moscow, Russian Federation
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany ,grid.5963.9Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Berthold DP, Willinger L, LeVasseur MR, Marrero DE, Bell R, Muench LN, Zenon K, Imhoff AB, Herbst E, Cote MP, Arciero RA, Edgar CM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury: Response. Am J Sports Med 2022; 50:NP3-NP5. [PMID: 34984957 DOI: 10.1177/03635465211049388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ehmann YJ, Berthold DP, Reuter S, Beitzel K, Köhler R, Stöcker F, Muench LN, Pogorzelski J, Rupp MC, Braun S, Imhoff AB, Buchmann S. Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits. Knee Surg Sports Traumatol Arthrosc 2022; 30:2060-2066. [PMID: 34741625 PMCID: PMC9165257 DOI: 10.1007/s00167-021-06751-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the sensorimotor and clinical function of patients with confirmed successful outcome after either undergoing acromioclavicular joint (ACJ) stabilization, Bankart repair (BR), or rotator cuff repair (RC), and to compare these measures to the contralateral, healthy side without history of previous injuries or surgeries of the upper extremity. It was hypothesized that patients of each interventional group would have inferior sensorimotor function of the shoulder joint compared to the contralateral, healthy side, while presenting with successful clinical and functional outcomes. METHODS Three intervention groups including ten patients who had confirmed successful clinical and functional outcomes after either undergoing ACJ stabilization, BR, or RC were evaluated postoperatively at an average follow-up of 31.7 ± 11.6 months. Additionally, a healthy control group (CG) of ten patients was included. Clinical outcomes were assessed using the Constant-Murley (CM) and American Shoulder and Elbow Surgeons (ASES) Score. Pain was evaluated using the visual analogue scale (VAS). Sensorimotor function was assessed by determining the center of pressure (COP) of the shoulder joint in a one-handed support task in supine position on a validated pressure plate. RESULTS Each interventional group demonstrated excellent clinical outcome scores including the CM Score (ACJ 83.3 ± 11.8; BR 89.0 ± 10.3; RC 81.4 ± 8.8), ASES Score (ACJ 95.5 ± 7.0; BR 92.5 ± 9.6; RC 96.5 ± 5.2), and VAS (ACJ 0.5 ± 0.9; BR 0.5 ± 0.8; RC 0.5 ± 0.8). Overall, the CG showed no significant side-to-side difference in COP, whereas the ACJ-group and the BR-group demonstrated significantly increased COP compared to the healthy side (ACJ 103 cm vs. 98 cm, p = 0.049; BR: 116 cm vs. 102 cm, p = 0.006). The RC-group revealed no significant side-to-side difference (120 cm vs. 108 cm, n.s.). CONCLUSION Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. This may indicate that specific postoperative training and rehabilitation protocols should be established for patients who underwent surgery of the upper extremity. These results underline that sensorimotor training should be an important component of postoperative rehabilitation and physiotherapeutic activities to improve postoperative function and joint control. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yannick J Ehmann
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sven Reuter
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- SRH University for Applied Health Sciences, Stuttgart, Germany
| | - Knut Beitzel
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Atos Orthoparc Klinik, Cologne, Germany
| | - Robin Köhler
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Fabian Stöcker
- Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sepp Braun
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Gelenkpunkt, Sport and Joint Surgery Innsbruck, Innsbruck, Austria
- OSMI - Research Unit for Orthopaedic Sports Medicine and Injury Prevention, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stefan Buchmann
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- OFZ Weilheim, Weilheim, Germany
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Berthold DP, LeVasseur MR, Muench LN, Mancini MR, Uyeki CL, Lee J, Beitzel K, Imhoff AB, Arciero RA, Scheiderer B, Siebenlist S, Mazzocca AD. Minimum 10-Year Clinical Outcomes After Arthroscopic 270° Labral Repair in Traumatic Shoulder Instability Involving Anterior, Inferior, and Posterior Labral Injury. Am J Sports Med 2021; 49:3937-3944. [PMID: 34723684 PMCID: PMC8649457 DOI: 10.1177/03635465211053632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current literature reports highly satisfactory short- and midterm clinical outcomes in patients with arthroscopic 270° labral tear repairs. However, data remain limited on long-term clinical outcomes and complication and redislocation rates in patients with traumatic shoulder instability involving anterior, inferior, and posterior labral injury. PURPOSE To investigate, at a minimum follow-up of 10 years, the clinical outcomes, complications, and recurrent instability in patients with 270° labral tears involving the anterior, inferior, and posterior labrum treated with arthroscopic stabilization using suture anchors. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective outcomes study was completed for all patients with a minimum 10-year follow-up who underwent arthroscopic 270° labral tear repairs with suture anchors by a single surgeon. Outcome measures included pre- and postoperative Rowe score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test, visual analog scale for pain, and Single Assessment Numeric Evaluation (SANE). Western Ontario Shoulder Instability Index (WOSI) scores were collected postoperatively. Complication data were collected, including continued instability, subluxation or dislocation events, and revision surgery. Failure was defined as any cause of revision surgery. RESULTS In total, 21 patients (mean ± SD age, 27.1 ± 9.6 years) with 270° labral repairs were contacted at a minimum 10-year follow-up. All outcome measures showed statistically significant improvements as compared with those preoperatively: Rowe (53.9 ± 11.4 to 88.7 ± 8.9; P = .005), ASES (72.9 ± 18.4 to 91.8 ± 10.8; P = .004), Simple Shoulder Test (8.7 ± 2.4 to 11.2 ± 1.0; P = .013), visual analog scale (2.5 ± 2.6 to 0.5 ± 1.1; P = .037), and SANE (24.0 ± 15.2 to 91.5 ± 8.3; P = .043). The mean postoperative WOSI score at minimum follow-up was 256.3 ± 220.6. Three patients had postoperative complications, including a traumatic subluxation, continued instability, and a traumatic dislocation, 2 of which required revision surgery (14.2% failure rate). CONCLUSION Arthroscopic repairs of 270° labral tears involving the anterior, inferior, and posterior labrum have highly satisfactory clinical outcomes at 10 years, with complication and redislocation rates similar to those reported at 2 years. This suggests that repairs of extensile labral tears are effective in restoring and maintaining mechanical stability of the glenohumeral joint in the long term.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA,Department of Orthopaedic Sports
Medicine, Technical University of Munich, Munich, Germany,Daniel P. Berthold, MD,
Department of Orthopaedic Sports Medicine, Technical University of Munich,
Ismaninger Str 22, 81675 Munich, Germany (
)
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA
| | - Lukas N. Muench
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA,Department of Orthopaedic Sports
Medicine, Technical University of Munich, Munich, Germany
| | - Michael R. Mancini
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA
| | - Colin L. Uyeki
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA
| | - Julianna Lee
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA
| | - Knut Beitzel
- Arthroscopy and Orthopedic
Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports
Medicine, Technical University of Munich, Munich, Germany
| | - Robert A. Arciero
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA
| | - Bastian Scheiderer
- Department of Orthopaedic Sports
Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports
Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery,
University of Connecticut, Mansfield, Connecticut, USA
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Muench LN, Kriscenski D, Tamburini L, Berthold DP, Rupp MC, Mancini MR, Cote MP, McCarthy MB, Mazzocca AD. Augmenting Suture Tape Used in Rotator Cuff Surgery With Magnesium Increases in Vitro Cellular Adhesion of Human Subacromial Bursal Tissue. Arthrosc Sports Med Rehabil 2021; 3:e1975-e1980. [PMID: 34977656 PMCID: PMC8689267 DOI: 10.1016/j.asmr.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lukas N. Muench
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
- Address correspondence to Lukas N. Muench, M.D., Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Danielle Kriscenski
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Lisa Tamburini
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Daniel P. Berthold
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
| | | | - Michael R. Mancini
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Mark P. Cote
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
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Morikawa D, LeVasseur MR, Luczak SB, Mancini MR, Bellas N, McCarthy MBR, Cote MP, Berthold DP, Muench LN, Mazzocca AD. Decreased Colony-Forming Ability of Subacromial Bursa-Derived Cells During Revision Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e1047-e1054. [PMID: 34430884 PMCID: PMC8365201 DOI: 10.1016/j.asmr.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To compare the cellular viability and differentiation potential of subacromial bursa-derived cells (SBDCs) located over the rotator cuff muscle and tendon of patients undergoing primary versus revision arthroscopic rotator cuff repair (ARCR). Methods Subacromial bursa was harvested from 18 primary (57.1 ± 4.6 years) and 12 revision ARCRs (57.3 ± 6.7 years). Bursa was collected from 2 sites (over rotator cuff tendon and muscle), digested with collagenase, and grown in culture. The number of nucleated cells, colony-forming units (CFUs), differentiation potential, and mesenchymal stem cell surface markers were compared in primary and revision cases. Results There was no difference in the number of nucleated cells between primary and revision ARCR harvested from the subacromial bursa overlying the tendon (3019.3 ± 1420.6 cells/mg and 3541.7 ± 2244.2 cells/mg, respectively; P = .912) or muscle (2753.5 ± 1547.1 cells/mg and 2989.0 ± 2231.4 cells/mg, respectively; P = .777). There was no difference in the number of CFUs between primary and revision ARCR over the rotator cuff tendon (81.5 ± 49.5 CFUs and 53.0 ± 36.9 CFUs, respectively; P = .138), but there were significantly fewer CFUs over the muscle in revision cases (28.1 ± 22.7 CFUs) compared with primary cases (55.7 ± 34.5 CFUs) (P = .031). SBDCs from revision ARCR expressed characteristic mesenchymal stem cell surface epitopes and had multidifferentiation potentials for chondrogenesis, osteogenesis, and adipogenesis. Conclusions SBDCs harvested over the rotator cuff muscle demonstrated significantly decreased colony-forming abilities in revision arthroscopic rotator cuff repairs compared with primary repairs. However, the subacromial bursa retains its pluripotent differentiation potential for chondrogenic, osteogenic, and adipogenic lineages in the revision setting. Clinical Relevance The subacromial bursa may play a role in the healing response of the repaired rotator cuff. This capacity is not necessarily diminished in the revision setting and may be harnessed as an orthobiologic.
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Affiliation(s)
- Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - S Brandon Luczak
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Nicholas Bellas
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth R McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
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Muench LN, Uyeki CL, Mancini MR, Berthold DP, McCarthy MB, Mazzocca AD. Arthroscopic Rotator Cuff Repair Augmented with Autologous Subacromial Bursa Tissue, Concentrated Bone Marrow Aspirate, Platelet-Rich Plasma, Platelet-Poor Plasma, and Bovine Thrombin. Arthrosc Tech 2021; 10:e2053-e2059. [PMID: 34504743 PMCID: PMC8417132 DOI: 10.1016/j.eats.2021.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED As recurrent rotator cuff tears following repair remain a significant problem, improving healing potential using biologic adjuvants, including concentrated bone marrow aspirate (cBMA), platelet-rich plasma (PRP), or subacromial bursa tissue (SBT), has become increasingly popular in recent years. In an attempt to combine the benefits of these various biologic adjuvants and maximize the healing potential of the repaired tendon, an arthroscopic rotator cuff repair technique biologically augmented with autologous SBT, cBMA, PRP, platelet-poor plasma (PPP), and bovine thrombin has been developed. The created clot is used as a biologic scaffold for sufficient delivery, and it is stabilized using bovine thrombin in order to ensure maximum stability and retainment of the applied biologic augments at the repair site. CLASSIFICATIONS I: shoulder; II: rotator cuff.
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Affiliation(s)
- Lukas N. Muench
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A.,Address correspondence to Lukas N. Muench, M.D., Dept. of Orthopaedic Sports Medicine, Technical University of Munich, Germany.
| | - Colin L. Uyeki
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
| | - Daniel P. Berthold
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
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Muench LN, Berthold DP, Kia C, Otto A, Cote MP, McCarthy MB, Mazzocca AD, Mehl J. Nucleated Cell Count Has Negligible Predictive Value for the Number of Colony-Forming Units for Connective Tissue Progenitor Cells (Stem Cells) in Bone Marrow Aspirate Harvested From the Proximal Humerus During Arthroscopic Rotator Cuff Repair. Arthroscopy 2021; 37:2043-2052. [PMID: 33581306 DOI: 10.1016/j.arthro.2021.01.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate whether nucleated cell count (NCC) could serve as an approximation for the number of colony-forming units (CFUs) in concentrated bone marrow aspirate (cBMA) obtained from the proximal humerus. METHODS Bone marrow aspirate (BMA) was harvested from the proximal humerus in 96 patients (mean age 56.2 ± 7.0 years) during arthroscopic rotator cuff repair. Following concentration of the aspirate, nucleated cells of each sample were counted. The total number of CFUs was evaluated under the microscope at their first appearance, usually after 5 to 10 days in culture. Fluorescence-activated cell sorting analysis and assays for osteogenic, adipogenic, and chondrogenic differentiation were performed. Linear regression was assessed to predict the number of CFUs by using NCC. Age, sex, and body mass index (BMI) were evaluated as independent variables. RESULTS The average volume of the obtained BMA was 86.7 ± 35.2 mL. The cBMA contained a mean of 26.3 ± 6.8 × 106 nucleated cells per mL, which yielded a mean of 1421.7 ± 802.7 CFUs in cell culture. There were no significant differences in NCC or number of CFUs when sex, volume of BMA, age, or BMI was examined independently (P >.05, respectively). Linear regression found that NCC was of limited predictive value for the total number of CFUs being yielded after cell culture (r2 = 0.28 with a root mean square error of 679.4). CONCLUSION NCC was of negligible predictive value for the total number of CFUs for connective tissue progenitor cells in BMA harvested from the proximal humerus during arthroscopic rotator cuff repair. CLINICAL RELEVANCE NCC is often used to assess the quality of cBMA samples for biological augmentation during surgery. The limited predictive value of this measurement tool is of clinical importance, because effectiveness of BMA applications has been suggested to depend on the concentration of progenitor cells within the sample.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Alexander Otto
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Julian Mehl
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
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Berthold DP, Bell R, Muench LN, Jimenez AE, Cote MP, Obopilwe E, Edgar CM. A new approach to superior capsular reconstruction with hamstring allograft for irreparable posterosuperior rotator cuff tears: a dynamic biomechanical evaluation. J Shoulder Elbow Surg 2021; 30:S38-S47. [PMID: 33892119 DOI: 10.1016/j.jse.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) treatment of massive, symptomatic, irreparable rotator cuff tears (RCTs) has become a more recently used procedure. However, there is a lack of consensus surrounding optimal graft choice for the SCR technique, and current dermal grafts have increased cost and are technically challenging because of a need for multiple implants. The purpose of this study was to biomechanically investigate a biological lower-cost alternative as a support for the superior capsule reconstruction concept: an isolated semitendinosus tendon (STT) allograft and a combination graft with the long head of the biceps tendon (LHBT) in an established massive posterosuperior RCT cadaver model. METHODS Ten fresh-frozen cadaveric shoulders (53.3 ± 12.4 years: range: 26-65) were tested on an established dynamic shoulder simulator using dynamic muscle loading. Cumulative deltoid forces, maximum abduction angle, and superior humeral head translation were compared across 4 testing conditions: (1) intact state, (2) massively retracted (Patte III), irreparable posterosuperior RCT, (3) SCR repair using an STT allograft, and (4) SCR repair using a combined STT-LHBT repair. RESULTS Intact shoulders required a mean deltoid force of 154.2 ± 20.41 N to achieve maximum glenohumeral abduction (55.3° ± 2.3°). Compared with native shoulders, the maximum abduction angle decreased following a massively retracted posterosuperior RCT by 52% (28.3° ± 8.4°; P < .001), whereas the cumulative deltoid forces increased by 48% (205.3 ± 40.9 N; P = .001). The STT repair and the STT-LHBT repair improved shoulder function compared with the tear state, with a mean maximum abduction angle of 30.6° ± 9.0° and 31.8° ± 7.7° and a mean deltoid force of 205.3 ± 40.9 N and 201.0 ± 34.0 N, respectively, but this was not statistically significant (P > .05). The STT-LHBT repair significantly improved the range of motion with respect to the tear state (P = .04). CONCLUSIONS In a dynamic shoulder simulator model, both the STT and the STT-LHBT repair techniques improved glenohumeral joint kinematics in an amount similar to previously reported "traditional" SCR techniques for treatment of an irreparable posterosuperior RCT.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andrew E Jimenez
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Cory M Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
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Berthold DP, Willinger L, LeVasseur MR, Marrero DE, Bell R, Muench LN, Kane Z, Imhoff AB, Herbst E, Cote MP, Arciero RA, Edgar CM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury. Am J Sports Med 2021; 49:2117-2124. [PMID: 34086492 PMCID: PMC8246408 DOI: 10.1177/03635465211015682] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the Kaplan fiber complex (KFC) are not routinely assessed for in the anterior cruciate ligament (ACL)-deficient knee during preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI scans may help surgeons to individualize treatment and improve outcomes, as well as to reduce failure rates. PURPOSE To retrospectively determine the rate of initially overlooked KFC injuries on routine MRI in knees with isolated primary ACL deficiency. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent isolated ACL reconstruction between August 2013 and December 2019 were identified. No patient had had Kaplan fiber (KF) injury identified on the initial reading of the MRI scan or at the time of surgery. Preoperative knee MRI scans (minimum 1.5 T) were reviewed and injuries to the proximal and distal KFs were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (the lateral joint line and the lateral femoral epicondyle) were measured. Additional radiological findings, including bleeding, lateral femoral notch sign, and bone marrow edema (BME), were identified to detect correlations with KFC injury. RESULTS The intact KFC could reliably be identified by all 3 reviewers (85.9% agreement; Kappa, 0.716). Also, 53% to 56% of the patients with initially diagnosed isolated ACL ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8%, and 43.3% by the first, second, and third reviewers, respectively) than injuries to the proximal KFs (35.6%, 47.1%, and 45.2% by the first, second, and third reviewers, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries (P = .023). Additionally, there was a positive correlation between distal KF injuries and lateral tibial plateau BME (P = .035), but no associations were found with the lateral femoral notch sign or other patterns of BME, including pivot-shift BME. CONCLUSION KF integrity and injury can be reliably detected on routine knee MRI scans. Also, 53% to 56% of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as ACL injuries diagnosed by current routine MRI examination protocols may come with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL graft failure or reoperation rates, significant improvements in preoperative diagnostic imaging are required to determine the exact injury pattern and to assist in surgical decision making.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany,Daniel P. Berthold, MD, Ismaninger Str. 22, 81675 Munich, Germany ()
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Daniel E. Marrero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lukas N. Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Zenon Kane
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery University Hospital, Münster, Germany
| | - Mark P. Cote
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Robert A. Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Cory M. Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Muench LN, Berthold DP, Uyeki C, Kia C, Cote MP, Imhoff AB, Beitzel K, Corona K, Mazzocca AD, Cerciello S. Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries. Knee Surg Sports Traumatol Arthrosc 2021; 29:2264-2271. [PMID: 32710143 DOI: 10.1007/s00167-020-06159-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/14/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare the clinical outcomes of patients who underwent successful nonoperative treatment for type III-V acromioclavicular joint (ACJ) injuries to those who eventually required conversion to anatomic coracoclavicular ligament reconstruction (ACCR) at a minimum 5-year follow-up. METHODS Patients with primary, chronic type III-V ACJ injuries who either underwent successful conservative treatment or conversion to ACCR after failing a trail of conservative management between 2003 and 2014 with a minimum 5-year follow-up were included in the study. Clinical outcome measures comprised the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) score, collected preoperatively and at final visit for the ACCR group. Outcome scores for patients with successful conservative treatment were only collected at final visit. A Self- Assessment Numeric Evaluation (SANE) score was obtained at terminal follow-up for both groups. RESULTS Twenty-two patients (mean age: 40.1 ± 15.6 years) with successful nonoperative treatment and twenty-one patients (mean age: 43.6 ± 12.0 years) who required conversion to ACCR were included in the study. At final follow-up, patients with successful non-operative treatment achieved similar ASES (93.0±12.0NonOP vs. 86.1±16.8ACCR), SST (11.2±1.4NonOP vs. 10.7±2.0ACCR) and SANE scores (80.9±19.7NonOPvs. 90.5±14.7ACCR) compared to those who were converted to ACCR. Additionally, patients who underwent conversion to ACCR showed significant improvement in ASES (49.8±18.1pre vs. 86.1±16.8post; Δ36.3±19.7) and SST scores (6.5±3.2prevs. 10.7±2.0post; Δ4.2±4.0) from pre- to postoperative. CONCLUSION At a minimum 5-year follow-up, patients with successful non-operative treatment for type III-V ACJ injuries achieved similar clinical outcomes compared to those who were converted to ACCR. In patients with chronic severe ACJ dislocation a trial of conservative treatment may be attempted, astime from injuryto eventual conversion to ACCR had no significant influence on postoperative clinical outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Colin Uyeki
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
- Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany
| | - Katia Corona
- Department of Medicine, Health Sciences Vincenzo Tiberio. University of Molise, Campobasso, Italy.
| | | | - Simone Cerciello
- Casa di Cura Villa Betania, Rome, Italy
- Marrelli Hospital, Crotone, Italy
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Berthold DP, Muench LN, Elhassan BT. How the Biomechanical Complexity of Tendon Transfers in Shoulder Surgery is Still Robbing us of Sleep in 2021. Arthroscopy 2021; 37:2026-2028. [PMID: 34225995 DOI: 10.1016/j.arthro.2021.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Mühlenfeld N, Steendahl IB, Berthold DP, Meyer T, Hauser T, Wagner N, Sander AL, Marzi I, Kaltenbach B, Yel I, Vogl T, Eichler K. Assessment of muscle volume using magnetic resonance imaging (MRI) in football players after hamstring injuries. Eur J Sport Sci 2021; 22:1436-1444. [PMID: 34110980 DOI: 10.1080/17461391.2021.1942226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Muscle injuries of the hamstrings are among the most frequent in football and a main cause for significant time away from training and competition. The purpose of this study was to prospectively evaluate the loss of muscle volume in recreational football players three and six weeks after initial trauma. We hypothesized that significant muscle volume loss occurs within 6 weeks after the initial injury event. Twenty recreational football players (mean-age=25 ± 4years; mean-height=181 ± 8cm; mean-weight=81 ± 10kg) with type3a (minor partial muscle tear) and type3b (moderate partial muscle tear) injuries were included. Muscle volume was determined using established methods for the hamstrings and the quadriceps femoris muscle within 3 days and after 3 and 6 weeks following the initial injury. The injured hamstrings lost 6.5% (mean=64 cm3(95%CI=31-98 cm3), p<0.001), the healthy hamstrings lost 2.1% (mean=21 cm3(3-44 cm3),p=0.096) of muscle volume after six weeks. The quadriceps in the injured leg lost 3.8% (mean=78 cm3(51-104 cm3), p<0.001) and 4.5% (83 cm3 (45-121 cm3), p<0.001) in the healthy leg. Muscle volume loss inversely correlated with activity levels in the healthy leg for the quadriceps (r=0.96 (0.90-0.98); R2=0.92; p<0.001) and the hamstrings (r=0.72 (0.40-0.88); R2=0.51; p<0.001), as well as the quadriceps in the injured leg (r=0.70 (0.37-0.87); R2=0.49; p<0.001), but not the injured hamstrings. Muscle volume ratio of hamstrings to quadriceps in the control limb was 0.52 ± 0.06 and 0.53 ± 0.06 in the injured leg. The rehabilitation period of six weeks did not have a relevant negative or a positive effect on ratios. Significant muscle volume loss in the upper thigh occurs in recreational soccer players within three, and within six weeks after a hamstring injury and lies between 2% and 7%.Highlights This study found that significant muscle volume loss occurs within six weeks after sustaining hamstring muscle group injuries.Additionally, most of the non-professional football players in the present study demonstrated low hamstring-to-quadriceps volume ratios in both the injured, as well as the heathy leg. Low hamstring-to-quadriceps volume ratios may provide an opportunity to focus on muscle hypertrophy strategies to help reduce the risk for muscle imbalances and thus future injury.After three weeks of resting, reduced training activity, compared to the training activity before the injury, seems to be sufficient to preserve 99% of the remaining muscle volume in the quadriceps and as well as the healthy hamstrings. The number of training-minutes correlates statistically significant inversely with the muscle volume lost in a rehabilitation period.
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Affiliation(s)
- Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ida Bo Steendahl
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany.,Deutscher Fußball-Bund (DFB), Frankfurt, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany
| | | | - Nils Wagner
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anna-Lena Sander
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Benjamin Kaltenbach
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
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Berthold DP, Muench LN, Cusano A, Uyeki CL, Slater M, Tamburini LM, Geyer S, Cote MP, Arciero RA, Mazzocca AD. Clinical and Functional Outcomes After Operative and Nonoperative Treatment of Distal Biceps Brachii Tendon Ruptures in a Consecutive Case Series. Orthop J Sports Med 2021; 9:2325967120984841. [PMID: 34179199 PMCID: PMC8193667 DOI: 10.1177/2325967120984841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with ruptures of the distal biceps brachii tendon (DBBT) have traditionally been treated via surgical repair, despite limited patient data on nonoperative management. Purpose/Hypothesis: To determine the clinical and functional outcomes for patients with partial and complete DBBT injuries treated nonoperatively or surgically through an anatomic single-incision technique. We hypothesized that there would be no difference in outcomes in patients treated with nonoperative or operative management. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review identified all patients with a partial or complete DBBT injury sustained between 2003 and 2017. Surgically treated patients underwent DBBT repair using an anatomic single-incision technique. Nonoperative management consisted of formal physical therapy. The following clinical outcome measures were included for analysis: American Shoulder and Elbow Surgeons (ASES) score; the Disabilities of the Arm, Shoulder and Hand (DASH) upper extremity patient questionnaire; the Single Assessment Numeric Evaluation (SANE) score; and the 36-Item Short Form Health Survey. Results: A total of 60 patients (mean ± SD age, 47.8 ± 11.5 years; range, 18-70 years) sustained DBBT ruptures (38 complete and 22 partial) during the study period. Of patients with complete DBBT, 34 were treated operatively and 4 nonoperatively; of those with partial DBBT, 11 were treated operatively and 11 nonoperatively. At a mean follow-up of 5.4 ± 4.0 years (range, 0.5-16.6 years), patients with complete DBBT ruptures achieved overall similar improvements with respect to mean ASES pain, ASES function, SANE, and DASH scores, regardless of whether they were treated operatively or nonoperatively. Subjective satisfaction and functional scores were comparable between the groups. Similarly, at a mean follow-up of 4.1 ± 3.8 years (range, 0.5-11.3 years), patients with partial DBBT injuries had improved mean ASES pain, ASES function, SANE, and DASH scores, regardless of operative or nonoperative treatment. Subjective satisfaction and functional scores were comparable between these groups. For those treated surgically, 5 patients (11.1%) sustained a surgical postoperative complication. Conclusion: In our case series, patients were able to achieve satisfactory outcomes regardless of whether they were treated nonoperatively or with an anatomic single-incision approach for complete or partial DBBT ruptures.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Antonio Cusano
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Colin L Uyeki
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Maria Slater
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lisa M Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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LeVasseur MR, R Mancini M, Berthold DP, Cusano A, McCann GP, Cote MP, Gomlinski G, Mazzocca AD. Acromioclavicular Joint Injuries: Effective Rehabilitation. Open Access J Sports Med 2021; 12:73-85. [PMID: 34093044 PMCID: PMC8169819 DOI: 10.2147/oajsm.s244283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/08/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose To perform a review of the literature focusing on rehabilitation protocols in patients with acromioclavicular (AC) joint injuries treated operatively and nonoperatively and to provide an updated rehabilitation treatment algorithm. Methods Studies were identified by searching the MEDLINE database from 01/1995 to 09/2020. Included studies contained detailed rehabilitation protocols with physiologic rationale for AC joint injuries. Biomechanical studies, technique articles, radiographic studies, systematic reviews, case studies, editorials, and studies that compared nonoperative versus operative treatment without focus on rehabilitation were excluded. Following identification of the literature, an updated treatment algorithm was created. Results The search strategy yielded 1742 studies, of which 1654 studies were excluded based on title, 60 on the abstract, and 25 on the full manuscript. One study was manually identified using article reference lists, yielding four publications presenting detailed rehabilitation protocols based on physiologic rationale. No randomized controlled trials or comparative studies were identified or cited as a basis for these rehabilitation protocols. Conclusion Few detailed rehabilitation protocols in patients with AC joint injuries have been published. These protocols are limited by their standardization, arbitrary timelines, and provide minimal assessment of individual patient characteristics. The quality of patient care can be improved with more practical guidelines that are goal-oriented and allow for critical thinking among clinicians to address individual patient needs. Three common barriers preventing successful rehabilitation were identified and addressed: Pain, Apprehension, and (anterior chest wall) Stiffness to regain Scapular control, effectively termed "PASS" for AC joint rehabilitation. Clinical Relevance Rehabilitation protocols for AC joint injuries should be less formulaic and instead allow for critical thinking and effective communication among clinicians and therapists to address individual patient needs.
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Affiliation(s)
- Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Antonio Cusano
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Grace P McCann
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Gregg Gomlinski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Berthold DP, Muench LN, Herbst E, Mayr F, Chadayammuri V, Imhoff AB, Feucht MJ. High prevalence of a deep lateral femoral notch sign in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:1018-1024. [PMID: 32440714 DOI: 10.1007/s00167-020-06071-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the prevalence of a deep lateral femoral notch sign (LFNS) in magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus (PLRT). METHODS A retrospective chart review was conducted to identify all patients undergoing ACL reconstruction between 2016 and 2018. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: isolated ACL tear (ACL-Group), ACL tear with concomitant lateral meniscus tear not involving the posterolateral root (Meniscus-Group), and ACL tear with concomitant PLRT (PLRT-Group). Incidence and depth of a LFNS on preoperative MRI was compared between the three cohorts. RESULTS 115 patients (mean age: 29.5 ± 11.3 years) were included in the study, with 58 patients (50.4%) assorted to the ACL-Group, 24 patients (20.9%) to the Meniscus-Group, and 33 patients (28.7%) to the PLRT-Group. The prevalence of a LFNS was significantly higher in the PLRT-Group (39.4%), when compared to the ACL- (5.2%) or Meniscus-Groups (25.0%; p < 0.001, respectively). Additionally, logistic regression analysis demonstrated that patients with PLRT were 5.3 times more likely to have a LFNS as compared to those without a lateral root tear (p < 0.001). CONCLUSION In patients with ACL tears, the presence of a LFNS on preoperative MRI may be predictive for a PLRT. As the LFNS occurs in almost 40% of the patients with combined ACL tears and PLRT, the LFNS may be a useful secondary diagnostic finding in early MRI diagnostic. Identifying PLRT on MRI is clinically relevant, as it prevents misdiagnosis and facilitates surgical decision-making, thus avoiding subsequent delayed treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Felix Mayr
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Vivek Chadayammuri
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Muench LN, Tamburini L, Kriscenski D, Landry A, Berthold DP, Kia C, Cote MP, McCarthy MB, Mazzocca AD. The Effect of Insulin and Insulin-like Growth Factor 1 (IGF-1) on Cellular Proliferation and Migration of Human Subacromial Bursa Tissue. Arthrosc Sports Med Rehabil 2021; 3:e781-e789. [PMID: 34195645 PMCID: PMC8220627 DOI: 10.1016/j.asmr.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/25/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose To evaluate the effect of a one-time dose of insulin or insulin-like growth factor 1 (IGF-1) on cellular proliferation and migration of subacromial bursa tissue (SBT) over time. Methods SBT was harvested from over the rotator cuff tendon in 4 consecutive patients undergoing primary arthroscopic rotator cuff repair. SBT was cultured for 3 weeks in complete media until reaching confluence. The culture dishes were stored in a humidified, low oxygen tension (5% CO2) incubator at 37°C. SBT of each patient underwent treatment with a one-time dose of insulin or IGF-1, whereas nontreated SBT served as a negative control. Cellular proliferation and migration were evaluated after 24, 48, 72, and 96 hours of incubation. SBT-derived cells migrated in the detection field were visualized using fluorescent microscopy. Results Cellular proliferation at 24, 48, 72, and 96 hours was 1.40 ± 0.27, 1.00 ± 0.20, 1.47 ± 0.31, and 1.68 ± 0.28 for IGF-1; 1.44 ± 0.24, 1.15 ± 0.27, 1.60 ± 0.36, and 1.61 ± 0.32 for insulin; and 1.51 ± 0.35, 1.29 ± 0.33, 1.53 ± 0.35, and 1.57 ± 0.38 for nontreated SBT. Untreated SBT demonstrated a significantly greater proliferation when compared with IGF-1 and insulin within the first 48 hours, although this effect was found to subside by 96 hours. Cellular migration at 24, 48, 72, and 96 hours was 575.7 ± 45.0, 641.6 ± 77.7, 728.3 ± 122.9, and 752.3 ± 114.5 for IGF-1; 528.4 ± 31.3, 592.5 ± 69.8, 664.2 ± 115.2, and 695.6 ± 148.2 for insulin; and 524.4 ± 41.9, 564.4 ± 49.8, 653.2 ± 81.5, and 685.7 ± 115.5 for nontreated SBT. Insulin showed no difference in migration at each timepoint compared to nontreated SBT (P > .05, respectively). Conclusions Insulin and IGF-1 initially inhibit cellular proliferation of human SBT, although this effect was found to subside by 96 hours. Further, neither insulin nor IGF-1 changed the slope of cellular migration over time. However, each treatment group demonstrated a significant increase in cellular proliferation and migration. Clinical Relevance In the setting of biologic augmentation of rotator cuff repair, the compatibility and synergistic effect of insulin on human SBT is highly limited.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lisa Tamburini
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Danielle Kriscenski
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Arthur Landry
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
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