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Yang C, Yang AZ, Xu S, Yew A, Lie DTT. Determining patient acceptable symptom states from patient reported outcome measures following reverse shoulder arthroplasty: Constant-murley, UCLA, Oxford Shoulder Scores. J Orthop 2024; 54:143-147. [PMID: 38576728 PMCID: PMC10987672 DOI: 10.1016/j.jor.2024.03.022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
Aims To establish cut-off values for Patient-Acceptable Symptom States (PASS) in three Patient Reported Outcome Measures (PROMs), the Constant-Murley Score (CMS) and University of California Los Angeles (UCLA) Shoulder Score and Oxford Shoulder Score (OSS) at 3, 6, and 12-months following reverse shoulder arthroplasty (RSA). Methods A retrospective study was conducted for individuals who were treated for massive rotator cuff tear, rotator cuff arthropathy or proximal humerus fractures with RSA from January 2011 and February 2020. This study included patients who have completed the patient reported outcome measures (PROMs) and satisfaction questions preoperatively, and at 3, 6 and 12-months after the procedure. Functional outcome were evaluated by CMS, UCLA shoulder score and OSS, with one anchoring question regarding satisfaction. PASS thresholds for each PROM were obtained with the Youden method, by using the receiver operating characteristic analysis, and secondary analysis was performed with the 80% specificity and 75th percentile method. Results 129 patients were included. 74.2%, 83.9%, and 89.3% of patients were found to have a satisfactory symptom state at 3, 6 and 12-months postoperatively. At 3, 6 and 12-month intervals, the respective PASS thresholds were 42, 39 and 52 for CMS, 17, 21 and 26 for UCLA score and 28, 25 and 18 for OSS. Conclusions PASS thresholds for RSA at 3, 6 and 12-months were found for CMS (42, 39, 52), UCLA (17, 21, 26) and OSS (28, 25, 18). These thresholds suggest increasing expectations with a trend towards higher functional requirements at each time point.
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Affiliation(s)
- Cassie Yang
- Singapore General Hospital, Department of Orthopaedic Surgery, Outram Road, Singapore, 169608
| | - Allan Zhou Yang
- Singapore General Hospital, Department of Orthopaedic Surgery, Outram Road, Singapore, 169608
| | - Sheng Xu
- Singapore General Hospital, Department of Orthopaedic Surgery, Outram Road, Singapore, 169608
| | - Andy Yew
- Singapore General Hospital, Division of Musculoskeletal Sciences, Outram Road, Singapore, 169608
| | - Denny Tijauw Tjoen Lie
- Singapore General Hospital, Department of Orthopaedic Surgery, Outram Road, Singapore, 169608
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Foo WYX, Sheng JM, Yew KSA, Chou SM, Lie DTT. Abduction causes increased strain gradient compared to forward flexion: Evidence from a cadaver model of simultaneous strain study of the rotator cuff tendons. Clin Biomech (Bristol, Avon) 2023; 110:106115. [PMID: 37797369 DOI: 10.1016/j.clinbiomech.2023.106115] [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: 04/23/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Various strain studies of the supraspinatus have been done in isolation. Given that rotator cuff muscles function as a group, it may be physiologically representative to measure strain behaviour with the glenohumeral joint intact. Here, we explored a novel method in measuring simultaneous strain behaviour of the rotator cuff tendons and investigated the effect of full-thickness anterior tear of the supraspinatus on the infraspinatus and subscapularis tendons. METHODS Nine cadaveric shoulders were evaluated on a customized rig. Using linear differential variable transducers to measure strain, each shoulder was subjected to up to 60° of elevation in the coronal, scapular, and sagittal planes. We also assessed 30° of external rotation and up to 60° of internal rotation of the humerus. Full-thickness anterior tear of the supraspinatus was then made before re-assessing strain patterns in the scapular plane. FINDINGS Strain measurements of the intact tendons revealed a significant strain gradient between the articular and bursal sides of the supraspinatus during increasing degrees of elevation in the coronal and scapular planes. Full thickness anterior tear of the supraspinatus is localised to the tendon and does not affect the surrounding cuff musculature, with a potential shielding effect of the infraspinatus during early glenohumeral abduction. INTERPRETATION Significant strain gradient exists between the articular and bursal sides of the supraspinatus during abduction but not during forward flexion in an intact glenohumeral joint. Rehabilitation exercises for anterior supraspinatus tears can be appropriately targeted on the remaining intact rotator cuff musculature.
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Affiliation(s)
- Wayne Yong Xiang Foo
- MOH Holding Private Limited, 1 Maritime Square, #11-25, Singapore 099253, Singapore.
| | - Jia-Min Sheng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
| | - Khye Soon Andy Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865, Singapore
| | - Siaw Meng Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865, Singapore
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Lim WSR, Yew AKS, Lie H, Chou SM, Lie DTT. Rotator cuff repair with an interposition polypropylene mesh: A biomechanical ovine study. World J Orthop 2023; 14:319-327. [PMID: 37304195 PMCID: PMC10251272 DOI: 10.5312/wjo.v14.i5.319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair. We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs. We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.
AIM To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.
METHODS A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear. We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair. In seven specimens, the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens. Five specimens with an intact tendon were tested. The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.
RESULTS The mean gap formation after 3000 cycles was 1.67 mm in the continuous group, and 4.16 mm in the mattress group (P = 0.001). The mean ultimate failure load was significantly higher at 549.2 N in the continuous group, 426.4 N in the mattress group and 370 N in the intact group (P = 0.003).
CONCLUSION The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.
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Affiliation(s)
- Winston Shang Rong Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Hannah Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Siaw Meng Chou
- College of Engineering, Nanyang Technical University, Singapore 797101, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
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Zhou A, Xu S, Yew KSA, Lie DTT. Minimal Clinically Important Differences for Oxford, Constant, and University of California Los Angeles Shoulder Scores After Reverse Shoulder Arthroplasty to Allow Interpretation of Patient-Reported Outcome Measures and Future Statistical Power Analyses. Arthroscopy 2022; 39:1405-1414. [PMID: 36592696 DOI: 10.1016/j.arthro.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the minimal clinically important difference (MCID) for the Constant-Murley Score (CMS), University of California Los Angeles (UCLA) Shoulder Score, and Oxford Shoulder Score (OSS) after reverse shoulder arthroplasty. METHODS Patients were prospectively followed up between January 2011 and February 2020. Inclusion criteria was that of patients who underwent reverse shoulder arthroplasty for massive irreparable cuff tear, cuff tear arthropathy, and fractures, with and without previous cuff repair, by a fellowship-trained surgeon. Patients were assessed preoperatively and at 3, 6, and 12 months' postoperatively. Functional outcome was assessed by the CMS, UCLA Shoulder Score, and OSS and the respective MCIDs were determined using simple linear regression in consonance with patient satisfaction and expectation fulfilment. RESULTS A total of 131 patients were followed up for 12 months. The MCIDs at 3 months for CMS, UCLA Shoulder Score, and OSS were 7.2, 3.3, and 6.9, respectively. At 6 months, the MCIDs for CMS, UCLA Shoulder Score, and OSS were 6.6, 2.4, and 4.7, respectively. At 12 months, the MCIDs for CMS, UCLA Shoulder Score, and OSS were 9.3, 2.9, and 6.6, respectively. CONCLUSIONS CMS, UCLA Shoulder Score, and OSS are valid scores to calculate MCID after reverse shoulder arthroplasty, and the MCID established in this study can be used for the interpretation of these scores to help in statistical power analysis for future studies. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Allan Zhou
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
| | - Sheng Xu
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Foo WYX, Chou ACC, Lie HM, Lie DTT. Computer-assisted navigation in ACL reconstruction improves anatomic tunnel placement with similar clinical outcomes. Knee 2022; 38:132-140. [PMID: 36058120 DOI: 10.1016/j.knee.2022.08.006] [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: 08/12/2021] [Revised: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND While the use of navigation systems in anterior cruciate ligament (ACL) reconstruction theoretically improves tunnel placement accuracy and clinical outcomes, the existing literature remains inconclusive. We aimed to evaluate the potential benefits of navigated ACL reconstruction on tunnel placement and clinical outcomes. METHODS In this retrospective study, we evaluated a cohort of patients who underwent conventional or navigated (OrthoPilot system) primary ACL reconstruction at our institution from June 2004 to October 2009. Anteroposterior and lateral radiographic knee assessments were evaluated to assess postoperative tunnel positioning. Clinical outcomes, including the International Knee Documentation Committee classification, Lysholm score, and Tegner score, were evaluated preoperatively and 1-year postoperatively. Radiographic and clinical outcomes were compared and analysed using independent 2-sample t-tests and Chi-square tests. RESULTS Sixty patients met the inclusion criteria and were included for analysis, comprising of 26 navigated and 34 conventional reconstructions. Postoperative radiographs showed no differences in tibial tunnel position between both groups, but a significantly smaller deviation from the recommended position in the navigated group (navigated: 5.96 %; conventional: 7.92 %; p = 0.008). Femoral tunnel placements in the navigated group were significantly more perpendicularly away from the Blumensaat line (navigated: 38.90 %; conventional: 31.94 %; p = 0.001), with a greater deviation from recommended position (navigated: 11.00 %; conventional: 6.94 %; p = 0.009). There were no differences in 1-year postoperative clinical outcomes (p > 0.05). CONCLUSION Navigated ACL reconstruction resulted in a more anatomic femoral tunnel placement and similar clinical outcomes as conventional reconstruction. Further research should be conducted to clarify the potential biomechanical and clinical impacts of navigated ACL reconstruction.
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Affiliation(s)
| | - Andrew Chia Chen Chou
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865, Singapore
| | - Hannah Marian Lie
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore 308232, Singapore
| | - Denny Tijauw Tjoen Lie
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865, Singapore
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Zeng GJ, Foong FS, Lie DTT. Knee subchondroplasty for management of subchondral bone cysts: a novel treatment method. Singapore Med J 2021; 62:492-496. [DOI: 10.11622/smedj.2021145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Knee subchondroplasty (SCP) is one of the most novel minimally invasive methods for treating bone marrow lesions. The literature suggests that it is safe, with few complications and good outcomes. However, no studies have documented its usage for managing large subchondral bone cysts. This article outlines a case report and details the pearls and pitfalls of SCP in treating large subchondral bone cysts. Our patient underwent arthroscopic debridement with medial femoral condyle SCP. Mild posterior extravasation of synthetic bone substitute was observed on Postoperative Day 1, which was immediately rectified on revision arthroscopy. Gradual escalation of weight bearing and good pain relief were subsequently achieved, and the patient has remained complication-free after two years. No further extravasation were observed on repeat radiography. SCP is a feasible temporising measure that may help to delay the need for bone allograft or immediate knee arthroplasty in younger patients while retaining function and delaying loss of productivity.
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Chou ACC, Kang BJ, Tan AJ, Tjoen Lie DT. Arthroscopic repair is sufficient for treating recurrent shoulder instability in patients with bipolar bone defects and minor glenoid bone loss. J Orthop 2021; 24:5-8. [PMID: 33679020 DOI: 10.1016/j.jor.2021.02.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Andrew Chia Chen Chou
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | | | - Aaron Junjie Tan
- Duke-National University of Singapore Medical School, Singapore
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
- Duke-National University of Singapore Medical School, Singapore
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Hang G, Yew AKS, Chou SM, Wong YR, Tay SC, Lie DTT. Biomechanical comparison of vertical suture techniques for repairing radial meniscus tear. J Exp Orthop 2020; 7:77. [PMID: 33025241 PMCID: PMC7538523 DOI: 10.1186/s40634-020-00296-w] [Citation(s) in RCA: 2] [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: 06/16/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose The aim of this study was to (1) develop suture techniques in repairing radial meniscal tear; (2) to compare the biomechanical properties of the proposed repair techniques with the conventional double horizontal technique. Methods Thirty-six fresh-frozen porcine medial menisci were randomly assigned into four groups and a complete tear was made at the midline of each meniscus. The menisci were subsequently repaired using four different repair techniques: double vertical (DV), double vertical cross (DVX), hybrid composing one vertical and one horizontal stitch, and conventional double horizontal (DH) suture technique with suturing parallel to the tibia plateau. The conventional double horizontal group was the control. The repaired menisci were subjected to cyclic loading followed by the load to failure testing. Gap formation and strength were measured, stiffness was calculated, and mode of failure was recorded. Results Group differences in gap formation were not statistically significant at 100 cycles (p = .42), 300 cycles (p = .68), and 500 cycles (p = .70). A trend was found toward higher load to failure in DVX (276.8 N, p < .001), DV (241.5 N, p < .001), and Hybrid (237.6 N, p < .001) compared with DH (148.5 N). Stiffness was also higher in DVX (60.7 N/mm, p < .001), DV (55.3 N/mm, p < .01), and Hybrid (52.1 N/mm, p < .01), than DH group (30.5 N/mm). Tissue failure was the only failure mode observed in all specimens. Conclusion Our two proposed vertical suture techniques, as well as the double vertical technique, had superior biomechanical properties than the conventional technique as demonstrated by higher stiffness and higher strength.
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Affiliation(s)
- Guanqi Hang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore.
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Siaw Meng Chou
- School of Mechanical & Aerospace Engineering, College of Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore
| | - Yoke Rung Wong
- Department of Hand Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Shian Chao Tay
- Department of Hand Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
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Ang BFH, Chen JY, Yeo W, Lie DTT, Chang PCC. Arthroscopic undersurface rotator cuff repair versus conventional arthroscopic double-row rotator cuff repair - Comparable results at 2-year follow-up. J Orthop Surg (Hong Kong) 2019; 26:2309499018757573. [PMID: 29455632 DOI: 10.1177/2309499018757573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/16/2022] Open
Abstract
AIM The aim of our study is to compare the improvement in clinical outcomes after conventional arthroscopic double-row rotator cuff repair and arthroscopic undersurface rotator cuff repair. METHOD A consecutive series of 120 patients who underwent arthroscopic rotator cuff repair was analysed. Sixty-one patients underwent conventional double-row rotator cuff repair and 59 patients underwent undersurface rotator cuff repair. Several clinical outcomes, including numerical pain rating scale (NPRS), constant shoulder score (CSS), Oxford shoulder score (OSS) and University of California Los Angeles shoulder score (UCLASS), were prospectively recorded by a trained healthcare professional preoperatively and at 3, 6, 12 and 24 months after surgery. RESULT Comparing both groups, there were no differences in age, gender and preoperative NPRS, CSS, OSS and UCLASS. However, the tear size was 0.7 ± 0.2 (95% confidence interval (CI) 0.3-1.1) cm larger in the conventional group ( p = 0.002). There was no difference in the improvement of NPRS, CSS, OSS and UCLASS at all time points of follow-up, that is, at 3, 6, 12 and 24 months after surgery. The duration of operation was shorter by 35 ± 3 (95% CI 28-42) min in the undersurface group ( p < 0.001). CONCLUSION Both arthroscopic undersurface rotator cuff repair and conventional arthroscopic double-row rotator cuff repair showed marked improvements in clinical scores when compared preoperatively, and there was no difference in improvements between both groups. Arthroscopic undersurface rotator cuff repair is a faster technique compared to the conventional arthroscopic double-row rotator cuff repair.
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Affiliation(s)
- Benjamin Fu Hong Ang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Puah KL, Yew AKS, Chou SM, Lie DTT. Comparison of a simplified skin pointer device compared with a skeletal marker for knee rotation laxity: A cadaveric study using a rotation-meter. World J Orthop 2018; 9:85-91. [PMID: 29984195 PMCID: PMC6033708 DOI: 10.5312/wjo.v9.i6.85] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/16/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the measurements of knee rotation laxity by non-invasive skin pointer with a knee rotation jig in cadaveric knees against a skeletally mounted marker.
METHODS Six pairs of cadaveric legs were mounted on a knee rotation jig. One Kirscher wire was driven into the tibial tubercle as a bone marker and a skin pointer was attached. Rotational forces of 3, 6 and 9 nm applied at 0°, 30°, 45°, 60° and 90° of knee flexion were analysed using the Pearson correlation coefficient and paired t-test.
RESULTS Total rotation recorded with the skin pointer significantly correlated with the bone marker at 3 nm at 0° (skin pointer 23.9 ± 26.0° vs bone marker 16.3 ± 17.3°, r = 0.92; P = 0.0), 30° (41.7 ± 15.5° vs 33.1 ± 14.7°, r = 0.63; P = 0.037), 45° (49.0 ± 17.0° vs 40.3 ± 11.2°, r = 0.81; P = 0.002), 60° (45.7 ± 17.5° vs 34.7 ± 9.5°, r = 0.86; P = 0.001) and 90° (29.2 ± 10.9° vs 21.2 ± 6.8°, r = 0.69; P = 0.019) of knee flexion and 6 nm at 0° (51.1 ± 37.7° vs 38.6 ± 30.1°, r = 0.90; P = 0.0), 30° (64.6 ± 21.6° vs 54.3 ± 15.1°, r = 0.73; P = 0.011), 45° (67.7 ± 20.6° vs 55.5 ± 9.5°, r = 0.65; P = 0.029), 60° (62.9 ± 22.4° vs 45.8 ± 13.1°, r = 0.65; P = 0.031) and 90° (43.6 ± 17.6° vs 31.0 ± 6.3°, r = 0.62; P = 0.043) of knee flexion and at 9 nm at 0° (69.7 ± 40.0° vs 55.6 ± 30.6°, r = 0.86; P = 0.001) and 60° (74.5 ± 27.6° vs 57.1 ± 11.5°, r = 0.77; P = 0.006). No statistically significant correlation with 9 nm at 30° (79.2 ± 25.1° vs 66.9 ± 15.4°, r = 0.59; P = 0.055), 45° (80.7 ± 24.7° vs 65.5 ± 11.2°, r = 0.51; P = 0.11) and 90° (54.7 ± 21.1° vs 39.4 ± 8.2°, r = 0.55; P = 0.079). We recognize that 9 nm of torque may be not tolerated in vivo due to pain. Knee rotation was at its maximum at 45° of knee flexion and increased with increasing torque.
CONCLUSION The skin pointer and knee rotation jig can be a reliable and simple means of quantifying knee rotational laxity with future clinical application.
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Affiliation(s)
- Ken Lee Puah
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore General Hospital, Singapore 169608, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore General Hospital, Singapore 169608, Singapore
| | - Siaw Meng Chou
- School of Mechanical and Aerospace Engineering, College of Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore General Hospital, Singapore 169608, Singapore
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Gardner AW, Toh MZ, Yew KSA, Lie DTT, Chou SM. Cannulated versus non-cannulated cancellous screw fixation for femoral neck fractures: a synthetic bone biomechanical study. J Orthop Surg (Hong Kong) 2015; 23:41-6. [PMID: 25920642 DOI: 10.1177/230949901502300110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare the compressive strength of cannulated versus non-cannulated cancellous screws for undisplaced femoral neck fractures in synthetic bones. METHODS 18 synthetic proximal femurs simulating an AO B1 valgus impacted femoral neck fracture in osteoporotic bone were used. The fracture angles were between 55º and 63º (Pauwels grade 2). Fixation was made using 6.5-mm non-cannulated screws (n=6), 6.5-mm cannulated screws (n=6), or 7.3-mm cannulated screws (n=6). A custom-built jig was designed to guide the insertion of the screws in an identical triangular configuration. Screws were tightened by a single operator using a torque-measuring screwdriver. The femoral head was subjected to progressive axial loading at 5 mm/min. The load to failure and displacement were recorded. RESULTS The 3 groups did not differ significantly except that the load to failure was higher in the construct with 6.5-mm non-cannulated screws than that with 6.5-mm cannulated screws (1222 N vs 1008 N, p=0.003). CONCLUSION The compressive strength of a synthetic bone hip fracture model fixed with non-cannulated screws was higher than that of cannulated screws of the same diameter.
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Affiliation(s)
- A W Gardner
- Department of Orthopaedic Surgery, Jurong Health Services, Alexandra Hospital, Singapore
| | - M Z Toh
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - K S A Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - D T T Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - S M Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
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Manoharan V, Sheng JM, Chou SM, Yew AKS, Tan SH, Lie DTT. A Normative Anatomic Study of the Glenohumeral Joint and Rotator Cuff Tendons. Proceedings of Singapore Healthcare 2014. [DOI: 10.1177/201010581402300305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The purpose of this study is to determine normative values relating to the glenohumeral joint and rotator cuff tendons namely length, width, thickness and footprint of supraspinatus (SS), infraspinatus (IS), teres minor ™ and subscapularis (SC) from 19 specimens. Methods: Rotator cuff tendons and humerus dimensions were measured directly using a digital vernier calliper. In addition, moduli values of rotator cuff tendons were obtained from tensile tests on twelve cadaveric shoulders. The tendon footprints were delineated onto a tracing paper and their dimensions were calculated using digitiser software. The glenoid dimensions were obtained from marking its outline onto a tracing paper and the cavity dimensions from wax moulds. The results were tabulated and statistical analyses, including Student's t-test and ANOVA, were performed. Conclusion: The normative anatomic values obtained can be used in finite element modeling, computer simulation, design of implants and surgery.
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Affiliation(s)
- Vivek Manoharan
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Jia-Min Sheng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Siaw Meng Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Soon Huat Tan
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
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Lie DTT, Gloria N, Amis AA, Lee BPH, Yeo SJ, Chou SM. Patellar resection during total knee arthroplasty: effect on bone strain and fracture risk. Knee Surg Sports Traumatol Arthrosc 2005; 13:203-8. [PMID: 15127185 DOI: 10.1007/s00167-004-0508-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 08/18/2003] [Accepted: 12/13/2003] [Indexed: 12/31/2022]
Abstract
Patellae in small knees, or after severe patellar erosion, may be vulnerable to fracture after resection during arthroplasty. The patellar remnant may be thin, while the polyethylene component has a standard thickness. Anterior patellar bone strain was measured in cadaver knees loaded via the quadriceps, from 0 to 90 degrees flexion, with the patella intact, and after resections to 16, 13 and 11 mm thick and replacement by an 8-mm-thick polyethylene component. Strain increased significantly with knee flexion with constant 500 N quadriceps tension. Resection caused significant changes from intact values in knee flexion and extension and no significant effect at 30 degrees flexion. In flexion, bending caused the anterior surface to become more convex, with high tensile bone strains. In extension, resection caused negative anterior strains, representing bending in the opposite direction, with large tensile strains on the cut posterior surface. For normal activities, such as rising from a chair (1.8 kN quadriceps tension) the patella appears safe against fracture with a minimal resection to 16 mm thick. An eroded patella resected to 11 mm thickness may be at risk of fracture with that loading.
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Affiliation(s)
- D T T Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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