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Atoun E, Oulianski M, Bachar-Avnieli I, Artamonov A, Gilat R, Lubovsky O, Rosinsky PJ. Subacromial Balloon Spacer for Irreparable Rotator Cuff Tear Treatment Shows Improved Pain and Strength at 5-Year Follow-Up. Arthroscopy 2024; 40:543-550. [PMID: 37586666 DOI: 10.1016/j.arthro.2023.07.058] [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: 01/26/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To report on minimum 5-year outcomes following subacromial balloon spacer implantation (SBSI), in terms of survivorship, pain reduction, functional outcomes, complications, and reoperations. METHODS Data were prospectively collected and retrospectively analyzed for consecutive patients undergoing SBSI between April 1, 2012, and June 30, 2016. Patients completed preoperative and postoperative follow-up for minimum 5 years on the following patient-reported outcomes (PROs): Constant-Murley Score (CMS), visual analog scale for pain (VAS), strength, and patient satisfaction. Reoperations and complications were recorded. Minimal detectable change (MDC) was calculated and the proportion of patients achieving MDC for CMS and VAS were calculated. RESULTS During the study period, SBSI was performed in 36 patients. Three patients were deceased within 5 years. Of the remaining 33 patients, follow-up was available on 29 patients (80.6%). Mean age at the time of operation was 72.7 ± 4.5 years, and 69% of the patients were males. Mean follow-up time was 72.5 months. Significant improvements from preoperative to last follow-up were demonstrated in CMS (36.08 vs. 63.88; P < .001), VAS (6.72 vs. 1.68; P < .001), and strength (3.8 vs 5.87 kg; P < .001). These improvements were demonstrated at 3 weeks, 6 months, 12 months, 24 months, and 60 months. Mean patient satisfaction at last follow-up was 8.72. The MDC for both CMS and VAS was achieved by 75.9% (22/29) of patients. Four patients underwent conversion to a reverse total shoulder arthroplasty (RTSA). Complications included one patient with balloon dislocation and one patient with a secondary infection due to urinary tract infection. CONCLUSIONS Pain reduction and functional improvements are sustained at minimum 5 years after SBSI in patients with irreparable rotator cuff tears. The 5-year conversion rate to an RTSA was 13.79%. LEVEL OF EVIDENCE Level IV, retrospective case-series.
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Affiliation(s)
- Ehud Atoun
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Maria Oulianski
- Orthopedic Department, Kaplan Medical Center, Rechovot, Israel
| | - Ira Bachar-Avnieli
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | | | - Ron Gilat
- Orthopedic Department, Shamir Medical Center, Rishon Lezion, Israel
| | - Omri Lubovsky
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Philip J Rosinsky
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel; Ben-Gurion University, Beer-Sheva, Israel.
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Panagopoulos G, Picca G, Adamczyk A, Leonidou A, Consigliere P, Sforza G, Atoun E, Rath E, Levy O. The "purse string" technique for anterior glenohumeral instability: long-term results 7-13-year follow-up. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03426-5. [PMID: 36350404 DOI: 10.1007/s00590-022-03426-5] [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] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST. METHODS The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7-13-year follow-up). RESULTS Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch-Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment. CONCLUSION The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport. LEVEL OF EVIDENCE Level IV; Case series; Treatment study.
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Affiliation(s)
- Georgios Panagopoulos
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK.
| | - Girolamo Picca
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Aleksandra Adamczyk
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Paolo Consigliere
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
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Panagopoulos GN, Pugliese M, Leonidou A, Butt F, Jaibaji M, Megaloikonomos PD, Consigliere P, Sforza G, Atoun E, Levy O. Acute versus delayed reverse total shoulder arthroplasty for proximal humeral fractures: a consecutive cohort study. J Shoulder Elbow Surg 2022; 31:276-285. [PMID: 34400290 DOI: 10.1016/j.jse.2021.07.003] [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: 01/17/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of displaced proximal humeral fractures (PHFs) remains controversial. Open reduction-internal fixation (ORIF) can be challenging, especially in elderly patients with poor bone quality, whereas hemiarthroplasty has had unpredictable outcomes. Conservative treatment may result in severe fracture sequelae with poor outcomes, requiring late reverse total shoulder arthroplasty (RTSA) in many cases. The past few years have seen a shift toward the use of RTSA for the treatment of PHFs. The aim of this study was to compare the outcomes of RTSA between patients with acute fractures and patients who underwent delayed RTSA for fracture sequelae. Our hypothesis was that the outcomes of RTSA for acute PHFs would be better than those of delayed RTSA for fracture sequelae. METHODS We followed up 36 patients with a mean age of 79.1 years who underwent primary RTSA for acute PHFs and 56 patients with a mean age of 72.1 years who underwent RTSA in delayed fashion for fracture sequelae, including failed ORIF. The minimum follow-up period was 24 months. The mean follow-up period was 39.3 months in the acute RTSA group and 56.6 months in the delayed RTSA group. Demographic data, radiographs, and surgery data were prospectively collected and analyzed. At final follow-up, range of motion and radiographic analysis findings, as well as the Subjective Shoulder Value (SSV) and Constant score (CS), were recorded. RESULTS The clinical results favored the group undergoing acute RTSA for acute PHFs, with a mean SSV of 8.3 of 10 and adjusted CS of 88.9% compared with a mean SSV of 8.0 of 10 and adjusted CS of 77.6% in the group undergoing late RTSA for fracture sequelae-but without statistically significant differences between the groups. Although the acute RTSA group showed slightly better range-of-motion values, no statistically significant differences were found between the groups. No intraoperative complications occurred. The time from injury to the regaining of good pain-free function was significantly shorter in the acute RTSA group. CONCLUSION Although there were no statistically significant differences in outcomes between early RTSA for acute PHFs and late RTSA for fracture sequelae, the time from injury to the regaining of good pain-free function was significantly shorter in the acute RTSA group. Therefore, we advocate early RTSA for acute PHFs in elderly patients to provide a quicker recovery and an early return to good predictable outcomes with a much shorter period of pain and discomfort. In cases of failed conservative treatment, malunion, or failed ORIF, salvage RTSA has the potential to provide a good outcome.
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Affiliation(s)
| | - Mattia Pugliese
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Faisal Butt
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Monketh Jaibaji
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | | | | | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK; Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Lee J, Consigliere P, Fawzy E, Mariani L, Witney-Lagen C, Natera L, Buch B, Atoun E, Sforza G, Amar E, Levy O. Accelerated rehabilitation following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e545-e557. [PMID: 33418090 DOI: 10.1016/j.jse.2020.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/15/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postoperative rehabilitation is considered essential and indeed routine practice following rTSA. However, the optimal approach to postoperative rehabilitation is unknown, based on protocols for anatomic TSA, and published literature is sparse, as is the quantity and quality of research evidence. The aim of this study is to outline the accelerated rehabilitation protocol (with immediate activity and no immobilization at all) following reverse total shoulder arthroplasty (rTSA) and assess its safety and effectiveness compared to the more conservative rehabilitation protocols of immobilization in a sling for 6 weeks and for 3 weeks. MATERIALS AND METHODS Between July 2005 and October 2017, a total of 357 consecutive rTSA in 320 patients underwent a primary rTSA and were included in the study. Patients were divided into 3 groups depending on rehabilitation protocol (6 and 3 weeks' postoperative immobilization, respectively, for groups 1 and 2, and no immobilization for group 3). Patients were assessed preoperatively and reviewed at 3 weeks, 3, 6, and 12 months, and yearly thereafter postoperatively. Constant score (CS), Subjective Shoulder Value (SSV), patient satisfaction, and pain scores were used at each appointment and patients assessed both clinically and radiographically. RESULTS Mean age at surgery was 76 years (range 40-93). At 1-year follow-up, the CS improved from 16.6 (adjusted 23.9) to 63.2 (adjusted 91.5) in group 1 (n = 114), from 21.5 (adjusted 30.7) to 67.7 (adjusted 98.4) in group 2 (n = 125), and from 22.6 (adjusted 31.3) to 66.6 (adjusted 94.9) in group 3 (n = 118). Pain score improved from 3.1/15 preoperatively to 12.5/15 postoperatively in group 1, from 3.5/15 to 13/15 in group 2, and from 3.7/15 to 12.5/15 in group 3. SSV improved to 8.5/10, 8.6/10, and 8.1/10 for groups 1, 2, and 3, respectively. Mean range of motion (ROM) improved to 142° elevation and 131° abduction in group 1, 153° elevation and 144° abduction in group 2, and 149° elevation and 146° abduction in group 3. No statistically significance differences were observed in CS, SSV, patient satisfaction, pain, and ROM between the 3 groups. Less postoperative complications were observed in group 3 (No immobilization). CONCLUSION Accelerated rehabilitation regime post rTSA without immobilization is safe and lead to reliable good clinical results and quick return to function. This study confirms noninferiority of the accelerated rehabilitation regime with fewer postoperative complications related to falls. Accelerated rehabilitation regime post rTSA have further psychological and emotional advantage to the patient, with earlier return to normal function and regaining independence. We recommend the accelerated rehabilitation regime without immobilization following rTSA.
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Affiliation(s)
- Jonathan Lee
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Paolo Consigliere
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Ernest Fawzy
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Laura Mariani
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | | | - Luis Natera
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK; Hospital General de Granollers, Avinguda Francesc Ribas s/n, Granollers, Barcelona, Spain; Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Berta Buch
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, Granollers, Barcelona, Spain; Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Giuseppe Sforza
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Levy
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK; Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Atoun E, Horneff JG, Levy O, Stanwood W, Verma N, Abboud JA. Needle-Based Arthroscopic Transosseous Rotator Cuff Repair: A Short-Term Outcomes Analysis. Cureus 2021; 13:e13595. [PMID: 33815995 PMCID: PMC8007122 DOI: 10.7759/cureus.13595] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Given the limitations of anchor-based rotator cuff repair, surgeons have considered and investigated the use of an arthroscopic transosseous repair technique using only sutures to repair tendon tissue. Returning full circle to the gold standard of transosseous repair, but with the modern adaptation of arthroscopy, advocates of arthroscopic transosseous rotator cuff repair believe that many of the risks associated with suture anchors can be avoided. The purpose of this study was to examine the capabilities of a novel needle-based arthroscopic transosseous tunneling device (OmniCuff™ arthroscopic transosseous device, MinInvasive Ltd., Magal, Israel) and evaluate the short-term clinical outcomes and patient satisfaction of patients treated with this technique. Materials and methods This study was a prospective, single-arm, multi-center study performed on patients from January 2014 to March 2015. During the study period, thirty-two patients underwent arthroscopic transosseous rotator cuff repair using the OmniCuff™ arthroscopic transosseous device. Results The average age of patients was 58.2 years (range, 44 to 80 years). The sizes of the tears were as follows: seven small, 18 medium, four large, and three massive. The average number of tunnels used per repair was 1.9 with the following breakdown: six one-tunnel repairs, 22 two-tunnel repairs, and four three-tunnel repairs. The mean American Shoulder and Elbow Surgeon (ASES) score improved from 45.1 to 87.7, the mean Simple Shoulder Test (SST) score improved from 42.6 to 92. Overall patient satisfaction was high with an average Likert scale of 4.6. Conclusion Our study demonstrated significantly improved outcomes for patients undergoing arthroscopic transosseous rotator cuff repair using the needle based Omnicuff device. Patients were overall very satisfied with the outcome of their surgery and their ASES and SST scores demonstrated this appropriately.
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Affiliation(s)
- Ehud Atoun
- Orthopaedics, Barzilai Medical Center, Ashkelon, ISR
| | - John G Horneff
- Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, USA
| | - Ofer Levy
- Shoulder and Elbow Surgery, Reading Shoulder Unit, Royal Berkshire Hospital, Reading, GBR
| | | | - Nikhil Verma
- Orthopaedics, Midwest Orthopaedics at Rush University, Chicago, USA
| | - Joseph A Abboud
- Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, USA
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Beer Y, Gilat R, Ner EB, Shohat N, Atoun E, Lindner D, Agar G. Impact of Body Mass Index on the Accuracy of Physical Examination and MRI of the Shoulder. Orthop J Sports Med 2021; 9:2325967120985643. [PMID: 33709009 PMCID: PMC7907545 DOI: 10.1177/2325967120985643] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The physical examination of overweight patients can require specific adaptations. Orthopaedic literature on the impact of body mass index (BMI) on the physical examination of the shoulder is virtually nonexistent. PURPOSE To assess whether BMI affects the sensitivity and specificity of common shoulder tests, using arthroscopy as a gold standard. We also examined the effects of BMI on the sensitivity and specificity of magnetic resonance imaging (MRI) of the shoulder for reference. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS We analyzed the data of 116 consecutive patients who underwent shoulder arthroscopy for the treatment of rotator cuff tears, Bankart lesions, and superior labral anterior-posterior (SLAP) lesions. Preoperative BMI, physical examination of the shoulder findings, and MRI findings were extracted. Contingency tables and receiver operating characteristic curves were used to evaluate the sensitivity and specificity of provocative tests of the shoulder and MRI as well as their relationship to BMI. RESULTS The sensitivity and specificity of the Jobe supraspinatus test were 77.8% and 72.7% in patients with BMI ≤25, 82.6% and 70.6% in those with 25 < BMI ≤ 30, and 81.3% and 55.6% in those with BMI >30, respectively (P < .001). The apprehension and relocation tests demonstrated higher sensitivity and specificity for the overweight patients (25 < BMI ≤ 30) compared with the other BMI groups, with a sensitivity and specificity of 83.3% and 100% for the apprehension test and a sensitivity and specificity of 75% and 100% for the relocation test, respectively. The O'Brien, Speed, and Ebinger tests for SLAP tears had low accuracy and did not yield statistically significant results. MRI interpretation was found to be influenced by BMI in obese patients, especially when SLAP lesions were assessed. CONCLUSION Counterintuitively, tests for shoulder instability had greater specificity in overweight patients and should be encouraged, particularly in obese patients, in whom the specificity of shoulder MRI for the detection of a Bankart lesion is lower. The Jobe test was more sensitive but less specific in overweight patients. These findings may assist care providers in improving the interpretation of the shoulder examination of overweight patients and consequently lead to better treatment-related decisions.
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Affiliation(s)
- Yiftah Beer
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Ron Gilat
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Eran Beit Ner
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Noam Shohat
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Dror Lindner
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Agar
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
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Leonidou A, Virani S, Panagopoulos G, Sforza G, Atoun E, Consigliere P, Levy O. Minimally invasive fixation with modified palm tree technique for proximal humerus fractures: Outcomes in a series of 132 patients. J Clin Orthop Trauma 2021; 17:11-17. [PMID: 33717967 PMCID: PMC7920127 DOI: 10.1016/j.jcot.2021.01.010] [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: 11/20/2020] [Revised: 01/03/2021] [Accepted: 01/21/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Various surgical techniques and implants are available for surgical treatment of significantly displaced proximal humerus fractures. We describe a minimally invasive technique using 3 curved wires, inserted in a retrograde fashion into the humeral head. These are aimed to diverge within the humeral head to provide three separate 3-point fixations to achieve good stability. We present the results of proximal humerus fractures managed with the modified palm tree technique. METHODS A retrospective analysis of data collected prospectively including demographics, radiographs, clinical outcomes, complications and revision surgery for patients treated with the palm tree technique was performed. RESULTS Between 1998 and 2017, 132 patients underwent fixation with this technique. Average age was 61.8 years. Fifty-Eight fractures were 2 part, 46 were three part and 28 were four part. Average follow up was 26 months. In three to four part fractures, a bone graft substitute block was used behind the humeral head fragment for structural support. There were 11 early revisions (8.3%). In 7 cases the fixation failed early and was revised to other implants like angular & locking plates (4), hemiarthroplasties (2) and reverse arthroplasty (1). In 4 cases the construct was revised to achieve better positioning of the wires. From the 125 remaining patients, 120 achieved union(96.8%). There were 3 painless fibrous non-unions and 2 painful non-unions requiring revision. The mean final Constant score was 75.5 and subjective shoulder value was 7.8/10. Nine patients (6.8%) developed avascular necrosis of the humeral head of which three patients were revised later to an arthroplasty. CONCLUSION This technique is a simple, minimally invasive technique which can be used for two, three and four part fractures with good functional outcomes and high union rates. No metalwork remains in the proximal humerus should another procedure like arthroplasty be required in case of avascular necrosis of the humeral head or fracture sequela.
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Ferrando A, Natera L, Buch B, Consigliere P, Bruguera J, Sforza G, Atoun E, Levy O. Software simulations of changing offsets and thus soft tissue tension when revising anatomic to reverse total shoulder arthroplasty in convertible platform systems. Eur J Orthop Surg Traumatol 2020; 31:611-619. [PMID: 33090267 DOI: 10.1007/s00590-020-02812-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Revision shoulder arthroplasty may involve the need to remove a well-fixed humeral stem. To avoid this, convertible platform systems have been introduced. The biomechanics of reverse total shoulder arthroplasty (rTSA) differs from anatomic shoulder arthroplasty (aTSA). The different humeral osteotomy and soft tissue tension may jeopardize the optimal results of the converted rTSA. The aim was to evaluate the radiographic parameters of soft tissue distraction when converting an aTSA to rTSA in a platform system and assess the capability of conversion without "over-stuffing" the shoulder in the "best-case scenario". METHODS Radiographic analysis of soft tissue distraction parameters: difference in acromio-humeral distance, difference in lateral humeral offset and difference in latero-inferior displacement were evaluated in aTSA and in the converted rTSA in six different implants. Image analysing software was used on 10 non-deformed osteoarthritic shoulder X-rays to simulate conversion. RESULTS The greatest increase in arm length was found for Tornier Ascend Flex (26.8 ± 3.6 mm) while the smallest increase was observed with Lima SMR (19.3 ± 4 mm). The humerus remained most lateralized with the Zimmer Anatomical/Inverse ( - 1.4 ± 2.9 mm) while Lima SMR ( - 15.8 ± 2.7 mm) was more medialized. The greatest increase in latero-inferior distance was found in the onlay systems. A group analysis of onlay rTSA showed an increase of 46% in arm length (p < 0.0001), 83% larger humeral offset (p < 0.0001) and 144% increase in latero-inferior distraction (p < 0.0001) when compared to inlay rTSA. CONCLUSION The conversion of aTSA to rTSA using a convertible platform system may lead to significant increase in radiographic parameters corresponding to soft tissue tension. This may alter the biomechanics, restrict the convertibility or jeopardize the optimal clinical outcome of rTSA even in the best-case scenario.
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Affiliation(s)
- Albert Ferrando
- Traumatology and Orthopaedic Surgery Department, Hospital Universitari Sant Joan de Reus, Avinguda del Doctor Josep Laporte 2, 43204, Tarragona, Reus, Spain
| | - Luis Natera
- Hospital General de Granollers, Avinguda Francesc Ribas S/N, 08402, Granollers, Spain.
- Hospital Asepeyo Sant Cugat, Av. Alcalde Barnils, 54, 60, 08174, Barcelona, Spain.
| | - Berta Buch
- Hospital General de Granollers, Avinguda Francesc Ribas S/N, 08402, Granollers, Spain
- Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Paolo Consigliere
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, RG1 6UZ, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, RG1 6UZ, UK
- Hospital San Juan de Dios Pamplona, Sreet Beloso Alto 3, 31006, Pamplona (Navarra), Spain
| | - Giuseppe Sforza
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, RG1 6UZ, UK
| | - Ehud Atoun
- Faculty of Health Sciences, Barzilai Medical Center Campus, Ben-Gurion University, Ashkelon, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, RG1 6UZ, UK
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Walecka J, Lubiatowski P, Consigliere P, Atoun E, Levy O. Shoulder proprioception following reverse total shoulder arthroplasty. Int Orthop 2020; 44:2691-2699. [PMID: 32803357 PMCID: PMC7679309 DOI: 10.1007/s00264-020-04756-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
Abstract
Joint replacement affects the proprioception, as shown in knees, elbows, and shoulder studies. AIM The aim was to evaluate shoulder joint position sense (JPS) following reverse total shoulder arthroplasty (rTSA) for patients with cuff arthropathy. METHODS Twenty-nine patients that underwent unilateral rTSA (19 females, 10 males) and 31 healthy volunteers evaluated for JPS of shoulder using a dedicated high accuracy electronic goniometer. Error of active reproduction of joint position (EARJP) was assessed at the following reference positions: 30°, 60°, 90°, and 120° for forward flexion and abduction and 15°, 30°, and 45° for internal and external rotation in rTSA, contralateral non-operated, and control shoulders. RESULTS Results of EPRJP for rTSA, contralateral, and control (respectively) are as follows:Forward flexion: 30° = (8.0 ± 5.7, 9.8 ± 6.1, and 4.9 ± 3.0), 60° = (5.0 ± 2.8, 5.9 ± 2.7, and 5.1 ± 3.2), 90° = (3.1 ± 1.6, 5.5 ± 2.6, and 3.2 ± 1.4), and 120° = (3.4 ± 2.1, 5.6 ± 4.0, and 3.5 ± 1.7)Abduction: 30° = (5.2 ± 2.5, 9.1 ± 6.1, and 4.6 ± 2.3), 60° = (5.2 ± 3.6, 6.6 ± 4.1, and 5.3 ± 3.1), 90° = (3.8 ± 2.0; 7.4 ± 5.5, and 4.1 ± 1.9), and 120° = (5.3 ± 2.9, 7.7 ± 5.3, and 4.2 ± 1.9)Internal rotation: 15° = (4.3 ± 3.1, 6.2 ± 4.4, and 2.8 ± 1.2), 30° = (3.2 ± 1.9, 4.5 ± 2.3, and 3.3 ± 1.4), and 45° = (3.5 ± 2.0, 4.1 ± 1.8, and 2.8 ± 1.0)External rotation: 15° = (3.0 ± 1.7, 4.2 ± 2.2, and 3.6 ± 1.4) and 30° = (3.1 ± 1.5, 3.8 ± 2.6, and 3.4 ± 1.6)The results showed significantly better JPS (lower EPRJP) in shoulders following rTSA and normal control shoulders comparing with the patient's contralateral shoulder. The explanation can be that rTSA improves joint kinematics and stability, which allows better muscular performance and proprioception feedback. CONCLUSION Shoulders following rTSA show JPS superior to non-operated contralateral shoulders and comparable with healthy population shoulders. It seems that rTSA restores shoulder proprioception.
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Affiliation(s)
- Joanna Walecka
- Sport Trauma and Biomechancis Unit, Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, ul Gorecka 30, 60-201, Poznan, Polska.
- Rehasport Clinic, ul. Górecka 30, 60-201, Poznań, Poland.
| | - Przemysław Lubiatowski
- Sport Trauma and Biomechancis Unit, Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, ul Gorecka 30, 60-201, Poznan, Polska
- Rehasport Clinic, ul. Górecka 30, 60-201, Poznań, Poland
| | - Paolo Consigliere
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
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Consigliere P, Tsvieli O, Polyzois I, Atoun E, Sforza G, Bruguera J, Levy O. Manipulation Under Anaesthetic for Frozen Shoulder Using Codman’s Paradox - Safe and Early Return of Function. JSES Open Access 2019. [DOI: 10.1016/j.jses.2019.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Consigliere P, Atoun E, Sforza G, Bruguera J, Levy O. Uncemented Reverse Total Shoulder Arthroplasty for Acute Four-part Proximal Humerus Fractures. JSES Open Access 2019. [DOI: 10.1016/j.jses.2019.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Consigliere P, Witney-Lagen C, Leonidou A, Atoun E, Panagopoulos G, Sforza G, Levy O. Reverse Total Shoulder Arthroplasty in Patients With Parkinson’s Disease. JSES Open Access 2019. [DOI: 10.1016/j.jses.2019.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Witney-Lagen C, Mazis G, Bruguera J, Atoun E, Sforza G, Levy O. Do elderly patients gain as much benefit from arthroscopic rotator cuff repair as their younger peers? J Shoulder Elbow Surg 2019; 28:1056-1065. [PMID: 30704915 DOI: 10.1016/j.jse.2018.10.010] [Citation(s) in RCA: 10] [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: 06/12/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was conducted to ascertain whether patients aged older than 75 years achieve outcomes after arthroscopic rotator cuff repair comparable to younger patients. METHODS Arthroscopic cuff repair was performed in 60 shoulders of 59 patients aged older than 75 years. A control group of 60 younger patients, matched for sex, tear size, and American Society of Anesthesiology Functional Classification grade were included. Surgery occurred from 2006 to 2016. Prospective outcomes were the Constant score (CS), Subjective Shoulder Value, pain, satisfaction, and operative complications. Mean follow-up was 29 months. RESULTS The elderly group was a mean age of 78 years compared with 59 years for controls. Tear sizes were 25 massive, 20 large, 12 medium, and 3 small. The CS improved by 25.1 points in elderly patients compared with 23.7 points for controls (P = .742). Pain improved by 7.5 of 15 in elderly patients vs. 6.2 of 15 in controls (P = .055). Fifty-five of 59 older patients were satisfied compared with 52 of 60 controls (P = .378). The overall complication rate did not differ between the groups (P = .509). Both groups had 1 infection and 1 stiffness. An acromioclavicular joint cyst developed in 1 younger patient, and a traumatic retear occurred in 1 patient. Subsequent reverse total shoulder arthroplasty was performed in 4 elderly patients at a mean of 28 months after cuff repair. Massive tears had higher risk for subsequent reverse total shoulder arthroplasty (P = .026). CONCLUSION Elderly patients benefit as much from arthroscopic rotator cuff repair as their younger counterparts. Similar improvements in CS, Subjective Shoulder Value, pain, and satisfaction occurred for both elderly and control patients. Arthroscopic repair was safe and effective in both groups. Even elderly patients with massive tears showed clinically significant improvements. Arthroscopic rotator cuff repair should be considered as a valuable treatment irrespective of age.
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Affiliation(s)
- Caroline Witney-Lagen
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Georgios Mazis
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
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14
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Levy O, Panagopoulos GN, Leonidou A, Atoun E. Stemless reverse shoulder arthroplasty: indications, technique and European experience. Ann Joint 2018. [DOI: 10.21037/aoj.2018.12.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Debi R, Slamowicz E, Cohen O, Elbaz A, Lubovsky O, Lakstein D, Tan Z, Atoun E. Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches. BMC Musculoskelet Disord 2018; 19:188. [PMID: 29879934 PMCID: PMC5992835 DOI: 10.1186/s12891-018-2097-4] [Citation(s) in RCA: 12] [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: 11/24/2017] [Accepted: 05/17/2018] [Indexed: 02/08/2023] Open
Abstract
Background Total hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches. Methods The study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches. Results For the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094). Conclusion Our study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.
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Affiliation(s)
- Ronen Debi
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Evyatar Slamowicz
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Ornit Cohen
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Avi Elbaz
- AposTherapy Research Group, Herzelyia, Israel
| | - Omri Lubovsky
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel
| | - Dror Lakstein
- Department of Orthopaedic Surgery, Wolfson Medical Center , Holon, Israel
| | - Zachary Tan
- Department of Orthopaedic Surgery, Wolfson Medical Center , Holon, Israel
| | - Ehud Atoun
- Department of Orthopedic Surgery, Barzilai Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel. .,Affiliated to the Ben-Gurion University of the Negev, Beer sheva, Israel.
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16
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Atoun E, Gilat R, van Tongel A, Pradhan R, Cohen O, Rath E, Levy O. Intraobserver and interobserver reliability of the Copeland-Levy classification for arthroscopic evaluation of subacromial impingement. J Shoulder Elbow Surg 2017; 26:2167-2172. [PMID: 28919000 DOI: 10.1016/j.jse.2017.07.018] [Citation(s) in RCA: 5] [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] [Received: 02/28/2017] [Revised: 07/08/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Defining a simple and reliable classification for acromial and bursal impingement lesions is necessary to standardize terminology, to improve communication, and to allow better evaluation of the proper treatment of impingement lesions and rotator cuff tears. The purpose of this study was to assess orthopedic surgeons' intraobserver and interobserver reliability of the Copeland-Levy classification. METHODS Six fellowship-trained orthopedic surgeons reviewed shoulder arthroscopy videos of 69 consecutive patients who underwent shoulder arthroscopy for rotator cuff tear repair or subacromial decompression. The surgeons were asked to classify impingement lesions according to the Copeland-Levy classification. One month afterward, the surgeons were requested to repeat the evaluation of the same impingement lesions. Intraobserver reliability was calculated using Cohen's weighted κ. Interobserver reliability was calculated using Kendall's W. RESULTS Overall intraobserver reliability for acromial and bursal lesions was κ = 0.86 (95% confidence interval, 0.82-0.9) and κ = 0.97 (95% confidence interval, 0.95-0.98), respectively. Interobserver reliability for acromial and bursal lesions was W = 0.87 and W = 0.92, respectively. CONCLUSION Intraobserver and interobserver reliability of the Copeland-Levy classification among senior orthopedic surgeons is excellent. Hence, we suggest the Copeland-Levy classification be used to standardize terminology of the subacromial impingement lesion.
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Affiliation(s)
- Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel.
| | - Ron Gilat
- Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Be'er Ya'akov, Israel
| | - Alexander van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Riten Pradhan
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ornit Cohen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ehud Rath
- Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
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17
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Natera L, Consigliere P, Witney-Lagen C, Brugera J, Sforza G, Atoun E, Levy O. The "Parachute" Technique: A Simple and Effective Single-Row Procedure to Achieve an Increased Contact Area Between the Cuff-Tendon and Its Footprint. Arthrosc Tech 2017; 6:e1903-e1909. [PMID: 29416977 PMCID: PMC5797836 DOI: 10.1016/j.eats.2017.07.010] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/11/2017] [Indexed: 02/03/2023] Open
Abstract
Many techniques of arthroscopic rotator cuff repair have been described. No significant differences in clinical outcomes or rerupture rates have been observed when comparing single-row with double-row methods. Not all single- and double-row repairs are the same. The details of the technique used are crucial. It has been shown that the suture-tendon interface is the weakest point of the reconstruction. Therefore, the biomechanical properties of rotator cuff repairs might be influenced more by the suture configuration than by the number of anchors or by the number of rows involved. Techniques that secure less amount of tendon over a smaller area of the healing zone might be expected to have higher failure rates. The way the sutures of the "parachute technique" are configured represents a quadruple mattress that increases the contact and pressure between the tendon and its footprint and increases the primary load to failure of the repair. We present a simple and effective single-row technique that involves the biomechanical and biological advantages related to the increased contact area and pressure between the cuff and its footprint.
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Affiliation(s)
- Luis Natera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, United Kingdom
| | - Paolo Consigliere
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, United Kingdom
| | - Caroline Witney-Lagen
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, United Kingdom
| | - Juan Brugera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, United Kingdom.,Hospital San Juan de Dios Pamplona, Pamplona (Navarra), Spain
| | - Giuseppe Sforza
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, United Kingdom
| | - Ehud Atoun
- Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, United Kingdom
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18
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Lakstein D, Atoun E, Wissotzky O, Tan Z. Does restoration of leg length and femoral offset play a role in functional outcome one year after hip hemiarthroplasty? Injury 2017; 48:1589-1593. [PMID: 28477993 DOI: 10.1016/j.injury.2017.04.054] [Citation(s) in RCA: 9] [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: 02/20/2017] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the correlation between specific joint biomechanical parameters and 1year functional outcome scores in elderly patients receiving hemiarthroplasty in the setting of intracapsular hip fractures. METHODS This is a retrospective, institutional registry based study. 168 hip hemarthroplasties were captured from October 2013 to June 2015. Patients were excluded based on contralateral hip surgery, perioperative complications or inadequate radiographs. 84 patients were alive at one year follow up. We compared mobility and pain scores to radiographically determined variations of leg lengths and femoral offset. We also compared the performance of fellowship trained arthroplasty surgeons to their non-fellowship trained counterparts. RESULTS The operated leg was a mean of 1.12±6.8mm longer than the contralateral. leg length discrepancy (LLD) was less than 10mm in 72 patients. Mean difference in offset between limbs was 0.25±3.3mm. The difference was within 5mm in 79 patients (94%). We found no statistically significant correlation between mobility or pain scores and variations in leg length or offset. We found significantly better performance of the arthroplasty surgeons in restoring leg length but no difference in offset reconstruction or functional benefit for the patient. CONCLUSIONS Our study was unable to demonstrate a significant relationship between leg length or femoral offset restoration and the patient's ultimate functional recovery. Arthroplasty surgeons performed better in restoring leg length, but no associated functional advantage was seen.
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Affiliation(s)
- Dror Lakstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Orthopedic Department, E. Wolfson Medical Center, Holon, POB 58100, Israel.
| | - Ehud Atoun
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel; Faculty of Medicine, Ben-gurion University, Beer-Sheva, Israel
| | - Orit Wissotzky
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zachary Tan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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19
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Debi R, Mor A, Elbaz A, Segal G, Lubovsky O, Kahn G, Peskin B, Beer Y, Atoun E. Correlation between gait analysis and clinical questionnaires in patients with spontaneous osteonecrosis of the knee. Clin Biomech (Bristol, Avon) 2017; 44:90-93. [PMID: 28364675 DOI: 10.1016/j.clinbiomech.2017.03.008] [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: 05/05/2016] [Revised: 03/05/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spontaneous osteonecrosis of the knee is usually verified by magnetic resonance imaging accompanied by clinical questionnaires to assess the level of pain and functional limitation. There is a lack however, in an objective functional test that will reflect the functional severity of spontaneous osteonecrosis of the knee. The purpose of the current study was to examine the correlation between spatiotemporal gait parameters and clinical questionnaires in patients with spontaneous osteonecrosis of the knee. METHODS 28 patients (16 females and 12 males) were included in the analysis. Patients had unilateral spontaneous osteonecrosis of the knee of the medial femoral condyle confirmed by magnetic resonance imaging. All patients performed a computerized spatiotemporal gait analysis and completed the Western Ontario and McMaster University Osteoarthritis Index and the Short-Form 36. Relationships between selected spatiotemporal gait measures and self-assessment questionnaires were assessed by Spearman non-parametric correlations. FINDINGS Significant correlations were found between selected spatiotemporal gait parameters and clinical questionnaires (r ranged between 0.28 and 0.79). Single limb support was the gait measure with the strongest correlation to pain (r=0.58), function (r=0.56) and quality of life. INTERPRETATION Spatiotemporal gait assessment for patients with spontaneous osteonecrosis of the knee correlates with the patient's level of pain and functional limitation there by adding objective information regarding the functional condition of these patients.
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Affiliation(s)
- Ronen Debi
- Department of Orthopedic Surgery, Barzliay Medical Center, Ashkelon, Israel
| | - Amit Mor
- AposTherapy Research Group, Herzliya, Israel.
| | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel
| | - Ganit Segal
- AposTherapy Research Group, Herzliya, Israel
| | - Omri Lubovsky
- Department of Orthopedic Surgery, Barzliay Medical Center, Ashkelon, Israel
| | - Gadi Kahn
- Department of Orthopedic Surgery, Barzliay Medical Center, Ashkelon, Israel
| | - Bezalel Peskin
- Department of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yiftah Beer
- Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ehud Atoun
- Department of Orthopedic Surgery, Barzliay Medical Center, Ashkelon, Israel
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20
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Levy O, Walecka J, Arealis G, Tsvieli O, Della Rotonda G, Abraham R, Polyzois I, Jurkowski Z, Atoun E. Bilateral reverse total shoulder arthroplasty-functional outcome and activities of daily living. J Shoulder Elbow Surg 2017; 26:e85-e96. [PMID: 27856265 DOI: 10.1016/j.jse.2016.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 01/03/2016] [Revised: 08/07/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years, providing good shoulder elevation, yet less predictable rotations. Good rotations are crucial for performance of activities of daily living (ADLs), including personal hygiene. Concerns remain regarding bilateral rTSA over lack of rotations bilaterally and resultant difficulties with ADLs. This study examined the outcome of patients with bilateral rTSA in restoration of function and ADLs. METHODS Data were prospectively collected for 19 patients (15 women, 4 men; 38 shoulders), with a mean age of 74.5 years, who underwent staged bilateral rTSA between 2007 and 2013. Mean follow-up was 48.4 months (range, 24-75 months). Patients were evaluated clinically using the Constant score, patient's satisfaction, Subjective Shoulder Value, and the Activities of Daily Living External and Internal Rotations (ADLEIR) score. Video clips were also recorded for documentation at all visits. RESULTS Mean duration between staged operations was 18.2 months (range, 3-46 months). The Constant score improved from 18.7 to 65.1 points (age- and sex-adjusted, 100.2). Elevation improved from 57.5° to 143°, internal rotation (IR) from 9° to 81° (30 shoulders could reach above the sacroiliac joint), and external rotation (ER) from 20° to 32° (35 shoulders had >20° ER in adduction, 31 shoulders had full ER in elevation). The Subjective Shoulder Value improved from 2.1 of 10 to 9.2 of 10. Mean ADLEIR score was 33 of 36 (P < .001 for all). Most patients resumed their leisure and sport activities (gardening, golf, swimming, bowling). CONCLUSION Bilateral rTSA results in marked and predictable improvement in all movements, pain relief, and functional outcomes, with high patient satisfaction and high ADLEIR score. All patients were able to perform perineal hygiene after their rTSA. Most patients had no limitation in ADLs and their leisure activities.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
| | - Joanna Walecka
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - George Arealis
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Oren Tsvieli
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Giuseppe Della Rotonda
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ioannis Polyzois
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Zac Jurkowski
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
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21
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Atoun E, Mor A, Segal G, Debi R, Grinberg D, Benedict Y, Rozen N, Beer Y, Elbaz A. A non-invasive, home-based biomechanical therapy for patients with spontaneous osteonecrosis of the knee. J Orthop Surg Res 2016; 11:139. [PMID: 27842560 PMCID: PMC5109820 DOI: 10.1186/s13018-016-0472-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the current study was to examine the effect of a non-invasive, home-based biomechanical treatment program for patients with spontaneous osteonecrosis of the knee (SONK). METHODS Seventeen patients with SONK, confirmed by MRI, participated in this retrospective analysis. Patients underwent a spatiotemporal gait analysis and completed the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Short-Form-36 (SF-36). Following an initial assessment, patients commenced the biomechanical treatment (AposTherapy). All patients were reassessed after 3 and 6 months of treatment. RESULTS A significant reduction in pain and improvement in function was seen after 3 months of therapy with additional improvement after 6 months of therapy. Pain was reduced by 53% and functional limitation reduced by 43%. Furthermore, a significant improvement was also found in the SF-36 subscales, including the summary of physical and mental scores. Significant improvements were found in most of the gait parameters including a 41% increase in gait velocity and a 22% increase in step length. Patients also demonstrated improvement in limb symmetry, especially by increasing the single limb support of the involved limb. CONCLUSIONS Applying this therapy allowed patients to be active, while walking more symmetrically and with less pain. With time, the natural course of the disease alongside the activity of the patients with the unique biomechanical device led to a significant reduction in pain and improved gait patterns. Therefore, we believe AposTherapy should be considered as a treatment option for patients with SONK. TRIAL REGISTRATION Assaf Harofeh Medical Center Institutional Helsinki Committee Registry, 141/08; ClinicalTrials.gov NCT00767780 .
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Affiliation(s)
- Ehud Atoun
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Amit Mor
- AposTherapy Research Group, 1 Abba Even Blvd., 46733, Herzliya, Israel.
| | - Ganit Segal
- AposTherapy Research Group, 1 Abba Even Blvd., 46733, Herzliya, Israel
| | - Ronen Debi
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Dan Grinberg
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Yeshaiau Benedict
- Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Nimrod Rozen
- Department of Orthopedic Surgery, HaEmek Medical Center, Afula, Israel
| | - Yiftah Beer
- Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Avi Elbaz
- AposTherapy Research Group, 1 Abba Even Blvd., 46733, Herzliya, Israel
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Haim A, Segal G, Elbaz A, Mor A, Agar G, Bar-Ziv Y, Beer Y, Morag G, Debi R, Atoun E. The outcome of a novel biomechanical therapy for patients suffering from anterior knee pain. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.145] [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: 10/20/2022]
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Levy O, Narvani A, Hous N, Abraham R, Relwani J, Pradhan R, Bruguera J, Sforza G, Atoun E. Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study. J Shoulder Elbow Surg 2016; 25:1362-70. [PMID: 26923308 DOI: 10.1016/j.jse.2015.12.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 07/18/2015] [Revised: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder prostheses are increasingly used in recent years for treatment of glenohumeral arthropathy with deficient rotator cuff. Bone preservation is becoming a major goal in shoulder replacement surgery. Metaphyseal humeral components without a stem were developed to minimize bone resection and preserve bone. This study evaluated the clinical and radiologic outcomes at 2 to 7 years using a novel short metaphyseal reverse total shoulder arthroplasty (rTSA) prosthesis without a diaphyseal stem. METHODS Between 2005 and 2010, 102 consecutive patients underwent rTSA with this implant, and 98 (20 men, 78 women) were available for follow-up. Mean age was 74.4 years (range, 38-93 years). Indications were cuff tear arthropathy, 65; fracture sequelae, 12; rheumatoid arthritis, 13; failed rotator cuff repair, 3; cuff deficiency with loosening of anatomic prosthesis, 3; and acute trauma, 2; with 17 of these as revisions. RESULTS Patients' satisfaction (Subjective Shoulder Value) improved from 8 of 100 to 85 of 100. The Constant score improved from 14 to 59 (age- and sex-adjusted, 86; P < .0001). Range of motion improved from 47° to 129° in elevation, 10° to 51° in external rotation, and 21° to 65° in internal rotation. Radiographic analysis showed no lucencies, subsidence, or stress shielding around the humeral or glenoid components. Glenoid notching was found in 21 patients (18 grade 1-2; 3 grade 3). CONCLUSIONS The short metaphyseal rTSA design without a diaphyseal stem shows encouraging short- to midterm results, with excellent pain relief and shoulder function, restoration of good active range of motion, and high patient satisfaction scores. The design of this implant seems to result in improved rotational movements, low incidence of glenoid notching, and no implant loosening, subsidence, or stress shielding.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
| | - Ali Narvani
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Nir Hous
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Jai Relwani
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Riten Pradhan
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
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Lakstein D, Bachar I, Debi R, Lubovsky O, Cohen O, Tan Z, Atoun E. Radiographic templating of total hip arthroplasty for femoral neck fractures. Int Orthop 2016; 41:831-836. [PMID: 27271723 DOI: 10.1007/s00264-016-3235-y] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. METHODS We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. RESULTS The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. CONCLUSION The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.
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Affiliation(s)
- Dror Lakstein
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ira Bachar
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ronen Debi
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Omri Lubovsky
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ornit Cohen
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Zachary Tan
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel.
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25
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Cisneros LGN, Atoun E, Abraham R, Tsvieli O, Bruguera J, Levy O. Revision shoulder arthroplasty: does the stem really matter? J Shoulder Elbow Surg 2016; 25:747-55. [PMID: 26821560 DOI: 10.1016/j.jse.2015.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 03/07/2015] [Revised: 10/07/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of a failed shoulder arthroplasty represents a complex and difficult problem for the treating surgeon, with potential difficulties and complications that are related to the need to remove a well-fixed stem. The aim of this study is to compare the intraoperative complications, postoperative complications, and outcome of revisions from stemmed arthroplasties (STAs) with those from surface replacement arthroplasties (SRAs). METHODS From 2005 to 2012, 40 consecutive revision shoulder arthroplasties were performed at our institute: 17 from STAs and 23 from SRAs. Perioperative events, operation time, blood loss, intraoperative fractures, and use of structural allograft were recorded. Clinical and radiologic outcomes were analyzed. RESULTS Operation time, need for humeral osteotomy, need for structural allograft, and number of intraoperative fractures were significantly higher in the STA group. Blood loss, drop in hemoglobin level, need for blood transfusion, and hospitalization time were also higher in the STA group, but these differences were not statistically significant. Reoperation was performed in 3 patients in the SRA group. A significant clinical improvement was observed in both groups. The Constant score was higher in the SRA group. CONCLUSION Revision of STAs is a more demanding procedure. The postoperative complication rate was slightly higher in the SRA group. The group with revision of SRAs showed slightly better clinical and radiographic results, but there was no statistically significant difference between the groups.
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Affiliation(s)
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Oren Tsvieli
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
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Natera L, Bruguera J, Atoun E, Levy O. Revision shoulder arthroplasty from resurfacing to non-cemented short-stem reverse prosthesis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:175-83. [PMID: 26949138 DOI: 10.1016/j.recot.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/25/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the surgical parameters and the clinical and radiological outcomes of revisions of resurfacing shoulder arthroplasty to non-cemented short-stem reverse total shoulder arthroplasty. MATERIAL AND METHODS A total of 23 revisions from resurfacing shoulder arthroplasty to reverse total shoulder arthroplasty were performed. The mean age was 70.3±11.95 years. The patients included 82.6% (19/23) revised for cuff failure; 13.04% (3/23) cuff failure and aseptic loosening, and 4.35% (1/23) peri-prosthetic fracture. The need for humeral osteotomy or structural allograft, operation length, blood loss, blood transfusions and intraoperative fractures were recorded. Minimum follow-up 25 months. RESULTS No humeral osteotomy or humeral structural allograft was required, and 2/23 (8.69%) required allograft for glenoid reconstruction. The mean operation time was 113.35±21.30minutes. Intra-operative blood loss was 374±245.09 mls. Blood transfusion was required in one case. Intra-operative fracture occurred in 1 case. The Constant score improved from 17.32 to 59.78 (age/sex adjusted, 84). Overall satisfaction improved from 1.37 to 8.04. The range of motion increased 79.57° in forward elevation; 72.88° in abduction; 38.06° in internal rotation; and 13.57° in external rotation. There was no evidence of radiolucency, subsidence, or bone resorption. CONCLUSION Revisions of resurfacing implants to non-cemented short-stem reverse prosthesis show good clinical and radiological outcomes, with minimal intra-operative complexities. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- L Natera
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Hospital General de Catalunya, Sant Cugat del Vallés, Barcelona, España.
| | - J Bruguera
- Unidad de Hombro y Extremidad Superior, COT, Hospital San Juan de Dios, Pamplona, Navarra, España; Reading Shoulder Unit, Orthopaedics Department, Berkshire Independent Hospital, Reading, Berkshire, Reino Unido
| | - E Atoun
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - O Levy
- Reading Shoulder Unit, Orthopaedics Department, Berkshire Independent Hospital, Reading, Berkshire, Reino Unido; Reading Shoulder Unit, Orthopaedics Department, Royal Berkshire Hospital, Reading, Berkshire, Reino Unido
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27
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Debi R, Lubovsky O, Cohen O, Bachar I, M Debbi E, Atoun E. Anteversion of the Acetabular Cup Determined by
Digital Radiographic Software as Compared to CT-Based
Measurement. ACTA ACUST UNITED AC 2016. [DOI: 10.17554/j.issn.2311-5106.2016.03.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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28
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Lubovsky O, Mor A, Segal G, Atoun E, Debi R, Beer Y, Agar G, Norman D, Peled E, Elbaz A. A novel self-care biomechanical treatment for obese patients with knee osteoarthritis. Int J Rheum Dis 2015. [PMID: 26218248 DOI: 10.1111/1756-185x.12694] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine the effect of a novel biomechanical, home-based, gait training device on gait patterns of obese individuals with knee OA. METHODS This was a retrospective analysis of 105 (32 males, 73 females) obese (body mass index > 30 kg/m2 ) subjects with knee OA who completed a 12-month program using a biomechanical gait training device and performing specified exercises. They underwent a computerized gait test to characterize spatiotemporal parameters, and completed the Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and Short Form-36 (SF-36) Health Survey. They were then fitted with biomechanical gait training devices and began a home-based exercise program. Gait patterns and clinical symptoms were assessed after 3 and 12 months of therapy. RESULTS Each gait parameter improved significantly at 3 months and more so at 12 months (P = 0.03 overall). Gait velocity increased by 11.8% and by 16.1%, respectively. Single limb support of the more symptomatic knee increased by 2.5% and by 3.6%, respectively. There was a significant reduction in pain, stiffness and functional limitation at 3 months (P < 0.001 for each) that further improved at 12 months. Pain decreased by 34.7% and by 45.7%, respectively. Functional limitation decreased by 35.0% and by 44.7%, respectively. Both the Physical and Mental Scales of the SF-36 increased significantly (P < 0.001) at 3 months and more so following 12 months. CONCLUSIONS Obese subjects with knee OA who complied with a home-based exercise program using a biomechanical gait training device demonstrated a significant improvement in gait patterns and clinical symptoms after 3 months, followed by an additional improvement after 12 months.
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Affiliation(s)
- Omri Lubovsky
- Department of Orthopedic Surgery, Barzilay Medical Center, Ashkelon, Israel
| | - Amit Mor
- AposTherapy Research Group, Herzliya, Israel
| | - Ganit Segal
- AposTherapy Research Group, Herzliya, Israel
| | - Ehud Atoun
- Department of Orthopedic Surgery, Barzilay Medical Center, Ashkelon, Israel
| | - Ronen Debi
- Department of Orthopedic Surgery, Barzilay Medical Center, Ashkelon, Israel
| | - Yiftah Beer
- Department of Orthopedic Surgery, Assaf HaRofeh Medical Center, Zerifin, Israel
| | - Gabriel Agar
- Department of Orthopedic Surgery, Assaf HaRofeh Medical Center, Zerifin, Israel
| | - Doron Norman
- Department of Orthopedic Surgery, Rambam Medical Center, Haifa, Israel
| | - Eli Peled
- Department of Orthopedic Surgery, Rambam Medical Center, Haifa, Israel
| | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel
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Amar E, Warschawski Y, Sampson TG, Atoun E, Steinberg EL, Rath E. Capsular closure does not affect development of heterotopic ossification after hip arthroscopy. Arthroscopy 2015; 31:225-30. [PMID: 25442652 DOI: 10.1016/j.arthro.2014.08.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 02/04/2014] [Revised: 08/12/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the role of capsular closure after hip arthroscopy in reduction of the incidence of heterotopic ossification (HO). METHODS One hundred (50 study group, 50 control group) consecutive hip arthroscopy procedures with radiographic follow-up of more than 9 weeks were included in the study. The study group consisted of 50 patients in whom capsular closure with 2 No. 1 polydioxanone (PDS) sutures was performed, and a control group consisted of 50 patients in whom the capsule remained open after capsulotomy. HO was assessed by radiographs using the Brooker classification. Statistical analysis of the data was carried out with the χ-square or Fisher exact test and Student t test, when appropriate, at a significance level of .05. RESULTS Thirty-six (36%) patients had radiographic evidence of postoperative HO (14 patients in the capsular closure group). No significant difference was found regarding sex, side of operation, age, or HO rate between the study and the control groups (P = .778, P = .123, P = .744, and P = .144, respectively). Furthermore, no significant difference was found in the rate of HO with potential clinical significance (Brooker classification > I) between the control and study groups (P = .764). CONCLUSIONS Capsular closure did not seem to alter the rate of HO when compared with a control group of patients in whom the capsulotomy was not repaired. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Eyal Amar
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Yaniv Warschawski
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Thomas G Sampson
- Department of Hip Arthroscopy, Post Street Orthopaedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ehud Atoun
- Barzilai Medical Center Campus, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
| | - Ely L Steinberg
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Lakstein D, Naser M, Adar E, Atoun E, Edelman A, Hendel D. Partial lateral patellar facetectomy as an alternative to lateral release in Total Knee Arthroplasty (TKA). J Arthroplasty 2014; 29:2146-9. [PMID: 25064018 DOI: 10.1016/j.arth.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/10/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 02/01/2023] Open
Abstract
This study presents the selective use of partial patellar lateral facetectomy for maltracking during primary TKA, as an alternative to lateral release. Twenty three partial facetectomies were performed out of 191 TKAs (12%). Balanced tracking was achieved in 22 knees. At follow-up 2 patients had persistent anterior knee pain. Mean Knee Society score (KSS) was 94 and mean functional KSS was 86. Mean patellar score was 28. Patellar tilt angles were within 2 degrees in all but one knee. Patellar translation was within 2 mm in all cases. No complications were recorded. A control group of 46 matched patients had similar functional and radiographic results. If tracking is not satisfactory at the conclusion of TKA, our method of choice would be partial lateral facetectomy.
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Affiliation(s)
- Dror Lakstein
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Naser
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Eliyahu Adar
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Center, Ashkelon, Israel; Faculty of Medicine, Ben-Gurion University, Beer-Sheva, Israel
| | | | - David Hendel
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Tsvieli O, Atoun E, Amar E, Levy O, Rath E. Arthroscopic bankart repair: accessory posterior portal with slotted cannula for lowest capsulolabral access. Arthrosc Tech 2014; 3:e403-8. [PMID: 25126512 PMCID: PMC4129978 DOI: 10.1016/j.eats.2014.02.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023] Open
Abstract
We present a novel technique for safe establishment of the accessory posterior portal using a slotted cannula. Arthroscopic Bankart repair is a common procedure. A variety of arthroscopic techniques have been described in the literature, commonly using the posterior portal for visualization and the anterior portal with a working cannula. The accessory posterior portal enables elegant access to the lower part of the capsulolabral junction, a firmer grasp and mobilization of the tissue, quick and easy tool exchange using a slotted cannula, and clearer suture placement because of the flat, direct working angle. The skin incision is made small without the need for an arthroscopic cannula, and the portal location is in a relatively safe zone. The use of the accessory posterior portal along with a slotted cannula shortens the duration of the operative procedure and improves safety and performance.
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Affiliation(s)
- Oren Tsvieli
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, England,Address correspondence to Oren Tsvieli, M.D., Reading Shoulder Unit, Royal Berkshire Hospital, London Rd, Reading RG1 5AN, England.
| | - Ehud Atoun
- Barzilai Medical Center, Ashkelon, Israel
| | - Eyal Amar
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, England,Centre for Sports Medicine and Human Performance, School of Sport and Education, Brunel University, London, England
| | - Ehud Rath
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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32
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Atoun E, Van Tongel A, Hous N, Narvani A, Relwani J, Abraham R, Levy O. Reverse shoulder arthroplasty with a short metaphyseal humeral stem. Int Orthop 2014; 38:1213-8. [PMID: 24705690 DOI: 10.1007/s00264-014-2328-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Reverse shoulder prostheses have been gaining popularity in recent years. A short metaphyseal stem design will allow bone stock preservation and minimize stem related complications. We examined the clinical and radiographic short-term outcome of a short metaphyseal stem reverse shoulder arthroplasty. METHODS Thirty-one patients, with a mean follow-up of 36 months (24-52), were evaluated clinically with the Constant-Murley score, patient satisfaction and pain relief scores. The fixation of the glenoid and humeral components, subsidence and notching were evaluated on radiographs. The indications were cuff tear arthropathy (22), fracture sequelae (five) and rheumatoid arthritis (four). RESULTS The average Constant score improved from 12.7 (range two to 31) pre-operatively to 56.2 (range 17-86) postoperatively. It rose from 13.5 to 58.3 in patients with Cuff arthropathy, from 15.8 to 62.0 in revision arthroplasty, from 10.2 to 47.4 in those with fracture sequelae, and from 11.5 to 55.3 in patients with rheumatoid arthritis. The overall mean patient satisfaction score improved from 2.4/10 to 8.5/10 and mean pain score improved from 0.8/15 to 12.5/15. We found an overall improvement in active forward flexion from 46.8 to 128.5° and from 41.6 to 116.5° in abduction. No humeral loosening or subsidence was observed. Two cases of grade 1-2 glenoid notching were reported. Overall there were three intra-operative fractures that did not affect the operation and healed without affecting the good results. There were five late traumatic periprosthetic fractures, only one of them required a revision surgery to a stemmed implant and the rest healed without surgery. There were two early dislocations that had to be revised. CONCLUSIONS The clinical and radiographic evaluation of a bone preserving metaphyseal humeral component in reverse shoulder arthroplasty is promising, with good clinical results, no signs of loosening or subsidence.
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Affiliation(s)
- Ehud Atoun
- Orthopaedic Department, Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel,
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Atoun E, Bano AA, Tongel AV, Narvani A, Sforza G, Levy O. Acromioclavicular joint acceleration-deceleration injury as a cause of persistent shoulder pain: Outcome after arthroscopic resection. Indian J Orthop 2014; 48:193-6. [PMID: 24741142 PMCID: PMC3977376 DOI: 10.4103/0019-5413.128764] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder pain in general and acromioclavicular joint (ACJ) pain specifically is common after acceleration-deceleration injury following road traffic accident (RTA). The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these cases. MATERIALS AND METHODS Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29-46 years). All presented with normal X-rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI). Arthroscopic ACJ excision arthroplasty was performed in all patients. RESULTS At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10. CONCLUSION Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration-deceleration injury.
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Affiliation(s)
- Ehud Atoun
- Department of Orthopaedic, Barzilai Medical Center, Ashkelon, Ben-Gurion University of the Negev, Beer Sheva, Israel,Address for correspondence: Dr. Ehud Atoun, Department of Orthopaedic, Barzilai Medical Center, Ashkelon, Israel. E-mail:
| | - Artan-Athanasios Bano
- The Reading Shoulder Unit, Department of Orthopedics, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
| | - Alexander Van Tongel
- The Reading Shoulder Unit, Department of Orthopedics, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
| | - Ali Narvani
- The Reading Shoulder Unit, Department of Orthopedics, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
| | - Giuseppe Sforza
- The Reading Shoulder Unit, Department of Orthopedics, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
| | - Ofer Levy
- The Reading Shoulder Unit, Department of Orthopedics, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
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Van Tongel A, Begum R, Atoun E, Levy O. Breast Lump as an Unusual Manifestation of Massive Rotator Cuff Tear. Shoulder Elbow 2014; 6:44-6. [PMID: 27582909 PMCID: PMC4986657 DOI: 10.1111/sae.12045] [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: 06/20/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Abstract
Acromioclavicular joint cysts have been reported in association with extensive rotator cuff tears. However, cysts related to rotator cuff pathology can aslo form in other areas. In this case report, we describe the presentation of a large breast cyst associated with rotator cuff arthropathy mimicking a rapidly enlarging breast tumor.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium,
Correspondence: Alexander Van Tongel, Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. Tel.: +32 93321020. Fax: +32 93324975. E-mail:
| | - Ruzi Begum
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
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Levy O, Haddo O, Massoud S, Mullett H, Atoun E. A patient-derived Constant-Murley score is comparable to a clinician-derived score. Clin Orthop Relat Res 2014; 472:294-303. [PMID: 23982405 PMCID: PMC3889436 DOI: 10.1007/s11999-013-3249-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 04/15/2013] [Accepted: 08/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although there are many advantages to patient-based assessment for musculoskeletal conditions, one common problem is that many of these assessments are perceived to be subjective. To overcome this limitation for patient-based shoulder evaluation, we developed a modified Constant-Murley score that allows patients to complete subjective and objective sections of the score. QUESTIONS/PURPOSES The purpose of our study was to assess the reliability of the new patient-based Constant-Murley score questionnaire by comparing composite scores and subscores obtained with those obtained using the standard physician-based Constant-Murley questionnaire in the same group of patients. METHODS Between August and October 2000, all patients having shoulder surgery in our institute were invited to participate in this study; 58 of 61 (95%) opted to do so and completed the patient-based questionnaire at preoperative and postoperative assessments. The clinician-based Constant-Murley score was performed by a clinician who was blinded to the corresponding patient-based questionnaire. Patients underwent various procedures ranging from manipulation under anesthesia and arthroscopic procedures to reverse shoulder arthroplasty. RESULTS The mean patient-based and the clinician-based Constant-Murley scores were 47 (SD = 19.5; range, 4-90; N = 108) and 48 (SD = 19.9; range, 4-90; N = 108) points respectively. The mean difference was -1.3 (SD = 3; range, -11 to 8; N = 108) points. The new patient-based Constant-Murley score questionnaire reproduced the patient-based method and had substantial to almost perfect agreement with it for the composite score and various subgroups. CONCLUSIONS These results suggest that a patient-based questionnaire can be used interchangeably with or in place of a clinician-based Constant-Murley score. These results apply to subjective and objective items of the Constant-Murley score.
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Affiliation(s)
- Ofer Levy
- />Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Omar Haddo
- />Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Samir Massoud
- />Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Hannan Mullett
- />Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ehud Atoun
- />Barzilai Medical Center Campus, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
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Haim A, Segal G, Elbaz A, Mor A, Agar G, Bar-Ziv Y, Beer Y, Morag G, Debi R, Atoun E. The outcome of a novel biomechanical therapy for patients suffering from anterior knee pain. Knee 2013; 20:595-9. [PMID: 23273535 DOI: 10.1016/j.knee.2012.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 05/30/2012] [Revised: 10/24/2012] [Accepted: 11/28/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was devised to examine the effect of a novel biomechanical therapy for patients suffering from anterior knee pain (AKP). METHODS A retrospective analysis of 48 patients suffering from AKP was performed. Patients underwent a gait evaluation, using an electronic walkway mat, and completed the SF-36 health survey and the WOMAC questionnaire at baseline and after 3 and 6months of therapy. A special biomechanical device was individually calibrated for each patient. AposTherapy is a functional, non-invasive rehabilitation therapy consisting of a biomechanical foot-worn device that is used during activities of daily living. Repeated measures analyses were performed to compare gait parameters and self-evaluation questionnaires between baseline, 3months and 6months. RESULTS Walking velocity significantly increased by 5.7cm/s, cadence increased by 1.6 steps/minute, and stride length increased by 3.4cm in relation to pretreatment testing (p<0.001 for all). End-point evaluation revealed additional improvement of these parameters; however these did not significantly differ from that of mid-treatment. Pain decreased by 36.6% and 49.2% following 13 and 26 weeks of treatment, respectively (P<0.01) and function improved by 25.2% and 41.7% following 13 and 26 weeks of treatment, respectively (P=0.01). CONCLUSIONS Based on the current study's results it may be concluded that this therapy might have a positive effect for patients with AKP.
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Affiliation(s)
- Amir Haim
- Department of Orthopedic Surgery, Sourasky Medical Center, Tel-Aviv, Israel.
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Affiliation(s)
- E Atoun
- Royal Berkshire NHS Foundation Trust, UK
| | - R Pradhan
- Royal Berkshire NHS Foundation Trust, UK
| | - O levy
- Royal Berkshire NHS Foundation Trust, UK
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Affiliation(s)
- E Atoun
- Royal Berkshire NHS Foundation Trust, UK
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Rath E, Alkrinawi N, Levy O, Debbi R, Amar E, Atoun E. Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment. J Shoulder Elbow Surg 2013; 22:e8-e11. [PMID: 23639834 DOI: 10.1016/j.jse.2013.01.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 06/24/2012] [Revised: 01/11/2013] [Accepted: 01/30/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally displaced (<3 mm) and non-displaced fractures of the proximal humerus are a common source of disability; nevertheless, there is no agreement on the recommended rehabilitation program in these patients. The purpose of this study was to evaluate the outcome of this group of patients and describe the rehabilitation protocol we have used for the treatment of this injury. METHODS We retrospectively analyzed the records of patients diagnosed with minimally displaced (<3 mm) fractures of the greater tuberosity who were admitted to our institute between June 2007 and May 2008. Patients were treated with a three-phase protocol. In the first phase, patients were immobilized in a sling for 3 weeks. In the second phase, pendular and active assisted exercises were begun 3 to 6 weeks after the injury. In the third phase, active exercises were commenced starting 6 weeks after injury. RESULTS Sixty-nine patients matched our inclusion and exclusion criteria. At an average follow-up of 31 months (range, 26-41 months), the average Constant score improved from 40 points (range, 33-58 points) to 95 points (range, 75-100 points). Average satisfaction score improved from 4.2 of 10 (range, 2-6) to 9.5 of 10 (range, 7-10). The reported average duration of pain and decreased range of motion from the time of injury was 8.1 months (range, 1-24 months). CONCLUSIONS When the diagnosis of a minimally displaced fracture of the proximal humerus is made, the patient can be reassured that a favorable outcome is anticipated with a staged rehabilitation protocol. Nevertheless, clinicians and patients should be aware that full recovery from the injury may take an average of 8 months.
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Affiliation(s)
- Ehud Rath
- Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel.
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Van Tongel A, Atoun E, Narvani A, Sforza G, Copeland S, Levy O. Medium to long-term outcome of thoracoscapular arthrodesis with screw fixation for facioscapulohumeral muscular dystrophy. J Bone Joint Surg Am 2013; 95:1404-8. [PMID: 23925745 DOI: 10.2106/jbjs.l.01097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder girdle muscle weakness is the most constant feature of facioscapulohumeral muscular dystrophy and leads to scapular winging. Mechanical fixation of the scapula to the thoracic wall provides a stable fulcrum on which the deltoid muscle can exert its action on the humerus. The aim of this study was to evaluate the medium to long-term outcome of thoracoscapular arthrodesis with screw fixation (the modified Howard-Copeland technique). METHODS All patients with facioscapulohumeral dystrophy who underwent thoracoscapular arthrodesis with screw fixation and bone-grafting from July 1997 to July 2010 were retrospectively reviewed. Preoperative and postoperative clinical assessment included active shoulder elevation, the Constant score, a patient satisfaction score, and cosmetic satisfaction. Union was determined both clinically and radiographically. RESULTS Thoracoscapular arthrodesis was performed in thirty-five shoulders in twenty-four patients; eleven patients underwent bilateral procedures. The principal study group consisted of thirty-two shoulders in twenty-one patients with a minimum follow-up of twenty-four months (mean, eighty-eight months; range, twenty-four to 174 months). The mean Constant score increased from 30 (range, 17 to 41) preoperatively to 61 (range, 30 to 90) postoperatively. The mean satisfaction score increased from 1 (range, 0 to 4) to 8.4 (range, 4 to 10). Early complications consisted of one pneumothorax, one superficial wound infection, and four early failures, two of which were associated with noncompliance with the postoperative regimen. Late complications consisted of one posttraumatic fracture resulting in loosening and one painful nonunion; both were treated successfully with revision. CONCLUSIONS Thoracoscapular arthrodesis with screw fixation prevented scapular winging and improved short-term and long-term shoulder function in patients with facioscapulohumeral dystrophy. LEVEL OF EVIDENCE Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander Van Tongel
- Reading Shoulder Unit, Royal Berkshire Hospital, London Road, Reading, Berkshire RG1 5AN, UK
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Atoun E, Funk L, Copland SA, Even T, Levy O, Rath E. The effect of shoulder manipulation on rotator cuff integrity. Acta Orthop Belg 2013; 79:255-259. [PMID: 23926725] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of shoulder manipulation in the treatment of frozen shoulder remains controversial. Humeral fractures and neurological damage are the risks associated with the procedure. A concern of causing a rotator cuff tear exists but the incidence of iatrogenic rotator cuff tears is not reported. The purpose of this study was to assess the effect of shoulder manipulation for frozen shoulder on the integrity of the rotator cuff. In a prospective study, 32 consecutive patients (33 shoulders) with the diagnosis of frozen shoulder underwent manipulation of the shoulder under anaesthesia (MUA), 18 female and 15 males with mean age at manipulation of 503 years (range: 42-63). The average duration of symptoms before treatment was 6.2 months (range: 2-18 months). The patients were examined prior to the manipulation and at follow-up for combined shoulder range of motion, external and internal rotation and strength. All patients had an ultrasound assessment of the rotator cuff before and at 3 weeks after manipulation of the shoulder. Mean time between manipulation and last follow-up was 133 weeks. None of the patients had ultrasound findings of a rotator cuff tear, prior to the manipulation. In all patients the rotator cuff remained undamaged on ultrasound examination at 3 weeks after the procedure. The mean improvement in motion was 81.2 degrees (from 933 degrees pre-op to 174.5 degrees at last follow-up) for forward flexion; 102.6 degrees (from 68.8 degrees pre-op to 171.4 degrees at last follow-up) for abduction, 49.4 degrees (from 8.8 degrees pre-op to 58.2 degrees at last follow-up) for external rotation and 3.5 levels of internal rotation (range: 2 to 5 levels). These gains in motion were all highly significant (p < 0.0001). No fractures, dislocations or nerve palsies were observed. In this study, manipulation of the shoulder has not been associated with rotator cuff tears. If done properly the procedure appeared to be safe and to result in a marked improvement of range of movement and function.
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Affiliation(s)
- Ehud Atoun
- Royal Berkshire Hospital, Reading, Berkshire, United Kingdom.
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Narvani AA, Atoun E, Van Tongel A, Sforza G, Levy O. The "anchor shape" technique for long head of the biceps tenotomy to avoid the popeye deformity. Arthrosc Tech 2013; 2:e167-70. [PMID: 23875145 PMCID: PMC3716228 DOI: 10.1016/j.eats.2013.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 09/24/2012] [Accepted: 01/15/2013] [Indexed: 02/03/2023] Open
Abstract
Surgical options for symptomatic pathologies of the long head of the biceps (LHB) include tenotomy and tenodesis. Tenotomy is surgically simple and quick, does not require immobilization, and avoids implant complications. However, it is associated with residual "Popeye" muscle deformity and biceps muscle cramps. Tenodesis avoids Popeye deformity, but it is technically a more difficult operation with a longer rehabilitation period and possible implant complications. The purpose of this report is to describe a novel technique for LHB tenotomy that avoids the Popeye muscle deformity. Before releasing the LHB from its anchor over the superior labrum, this technique consists of making an oblique incision, involving 50% of the tendon, distal to its attachment at the superior labrum. A second standard complete tenotomy incision is made about 1.5 cm medial to the oblique incision. The remaining stump of the LHB at the tendon-labrum junction is resected. The first incision, an oblique incomplete incision, allows the remnant of the LHB to open up and form an "anchor shape" that anchors the LHB at the articular entrance of the bicipital groove, thus decreasing the risk of Popeye deformity.
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Affiliation(s)
| | | | | | | | - Ofer Levy
- Address correspondence to Ofer Levy, M.D., M.Ch.(Orth), F.R.C.S, Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, England.
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Levy O, Iyer S, Atoun E, Peter N, Hous N, Cash D, Musa F, Narvani AA. Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis? J Shoulder Elbow Surg 2013; 22:505-11. [PMID: 22981447 DOI: 10.1016/j.jse.2012.07.007] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [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: 01/03/2012] [Revised: 07/08/2012] [Accepted: 07/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Propionibacterium acnes is a common pathogen in infections after shoulder surgery. Recent reports found positive P acnes cultures in a high percentage of patients who had revision shoulder arthroplasty for "aseptic loosening" without any overt signs of infection. Isolation of P acnes is difficult, and by use of conventional microbiological protocols of 48-hour incubation, a considerable proportion of patients with possible P acnes infection may remain unidentified. We recently noted P acnes in shoulder joint cultures in patients undergoing primary shoulder replacement for glenohumeral arthropathy without any signs of infection. METHODS We collected aspirates and biopsy specimens from 55 consecutive patients with arthritic shoulders undergoing primary joint replacement and examined them for the presence of P acnes. Special measures were taken to ensure that the specimens were carefully taken from within the joint to reduce the risk of contamination to minimal. RESULTS In 23 of 55 consecutive patients (41.8%) undergoing primary shoulder joint replacement, P acnes was found in the joint fluid and tissues taken before the insertion of the implants. All these patients were treated early postoperatively with pathogen-directed specific dual oral antibiotic treatment for 4 weeks. In none have any signs of infection developed. DISCUSSION AND CONCLUSION This finding of a high incidence of P acnes in joints before arthroplasty may suggest a role of P acnes in the pathogenesis of glenohumeral arthropathy. In addition, it raises the question of whether development of painful joint replacement later on and presumed aseptic loosening do, in fact, comprise an unrecognized low-grade infection that has been present since before the index operation.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, England.
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Van Tongel A, Atoun E, Narvani A, Sforza G, Levy O. The 'hand squeeze' test for posterior 'muscle patterning instability' of the shoulder. Acta Orthop Belg 2013; 79:31-35. [PMID: 23547512] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Muscular patterning can be a contributor of positional posterior shoulder instability. Failure to recognize this pattern may lead to unnecessary surgical treatment with high failure rate. We analyzed the results of a new simple clinical test (hand squeeze test). The test is regarded positive, if during squeezing with the contralateral hand and elevation of the involved arm, in pronation, no posterior shoulder dislocation occurs. The test is regarded negative if posterior dislocation does occur regardless of the "hand squeeze". The patients with positive test were treated conservatively. Ten patients (12 shoulders) were treated between July 2006 and July 2010. The 'hand squeeze' test was positive in 8 patients (10 shoulders) and negative in 2 patients (2 shoulders). Both patients with a negative sign had structural lesions in the glenohumeral joint confirmed on arthro-MRI and were treated operatively.
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Atoun E, Debbi R, Lubovsky O, Weiler A, Debbi E, Rath E. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release. Arthrosc Tech 2013; 2:e41-3. [PMID: 23802093 PMCID: PMC3691777 DOI: 10.1016/j.eats.2012.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 05/21/2012] [Accepted: 10/23/2012] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space.
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Affiliation(s)
- Ehud Atoun
- Orthopaedic Department, Barzilai Medical Center, Ashkelon, Israel,Ben-Gurion University of the Negev, Be'er Sheva, Israel,Address correspondence to Ehud Atoun, M.D., Orthopaedic Department, Barzilai Medical Center, 2 Hahistadrout St, Ashkelon 78278, Israel.
| | - Ronen Debbi
- Orthopaedic Department, Barzilai Medical Center, Ashkelon, Israel,Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Omri Lubovsky
- Orthopaedic Department, Barzilai Medical Center, Ashkelon, Israel,Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Andreas Weiler
- Arthroscopy Service, Charité, Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany
| | - Eytan Debbi
- Orthopaedic Department, Barzilai Medical Center, Ashkelon, Israel
| | - Ehud Rath
- Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel
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Atoun E, van Tongel A, Narvani A, Rath E, Sforza G, Levy O. Arthroscopically assisted internal fixation of the symptomatic unstable os acromiale with absorbable screws. J Shoulder Elbow Surg 2012; 21:1740-5. [PMID: 22521390 DOI: 10.1016/j.jse.2011.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 08/29/2011] [Revised: 12/10/2011] [Accepted: 12/19/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Symptomatic meso- type os acromiale is a common pathology with inconsistent outcomes of treatment with various surgical techniques. We report the outcome of a new technique for arthroscopic fusion of symptomatic os acromiale with absorbable screws. MATERIALS AND METHODS The study included 8 shoulders in 8 patients with symptomatic meso- type os acromiale who were treated with the use of a new technique for arthroscopic fusion with absorbable screws. The mean age was 54 years (range, 38-67 years), and the mean time from onset of symptoms to surgery was 18 months (range, 9-25 months). No patients reported a specific traumatic event before the onset of symptoms, and all noted the insidious onset of pain with no precipitating event. RESULTS The average length of follow-up was 22 months (range, 12-36 month). The average Constant score improved from 49 points (range, 35-57 points) to 81 points (range, 75-86 points). The average satisfaction score improved from 4.5 of 10 (range, 2-6) to 8.5 of 10 (range 7-9). All patients made a good clinical recovery at 3 to 6 months after surgery. At the last follow-up, full radiographic union was observed in 6 patients, partial union in 1 patient, and persistent radiologic nonunion in 1 patient. Anterior bulging of the absorbable screws was noted in 2 patients, and the screws were trimmed 6 months after the first procedure. CONCLUSIONS We have found that this new arthroscopic technique of fixation of os acromiale with absorbable screws provides promising clinical, cosmetic, and radiologic results with high patient satisfaction.
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Affiliation(s)
- Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
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Hughes A, Even T, Narvani AA, Atoun E, Van Tongel A, Sforza G, Levy O. Pattern and time phase of shoulder function and power recovery after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2012; 21:1299-303. [PMID: 22154313 DOI: 10.1016/j.jse.2011.08.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/17/2011] [Revised: 08/21/2011] [Accepted: 08/28/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND It has been our observation that early during rehabilitation after rotator cuff repair, patients may take a step back before improving. The purpose of this study is to investigate the pattern and time phase of changes in Constant score and strength recovery after arthroscopic rotator cuff repair. MATERIALS AND METHODS Forty-five patients undergoing arthroscopic rotator cuff repair were prospectively enrolled in this study. Patients underwent scoring preoperatively with the Constant score. All were followed up at 3 months and 6 months after surgery. The Constant score and strength at 3 months were compared with those at the 6-month mark. RESULTS The mean Constant score improved from 46.4 points (SD, 17.3) preoperatively to 51.8 points (SD, 13.5) 3 months postoperatively (P = .0777). At 6 months postoperatively, the mean Constant score was 69.0 points (SD, 11.1), a significant increase from both the preoperative (P < .0001) and 3-month (P < .0001) results. The mean preoperative strength result of 4.5 kg (SD, 3.2) decreased significantly to 3.3 kg (SD, 1.8) at 3 months postoperatively (P = .0154) before improving to 5.8 kg (SD, 2.6) at 6 months postoperatively. The improvement in strength at 6 months was significant compared with both the preoperative (P = .0070) and 3-month (P < .0001) results. CONCLUSIONS Although there is highly significant improvement in overall function (Constant score) and strength 6 months postoperatively, patients appear to take a step back before improving, in fact with a drop in strength at 3 months. This may cause concern in patients and may require assurance that time and effort with physiotherapy will improve function and symptoms.
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Affiliation(s)
- Adrian Hughes
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
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Van Tongel A, Levy O, Atoun E, De Wilde L. Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res 2011; 469:2389-90; author reply 2391-2. [PMID: 21660597 PMCID: PMC3126946 DOI: 10.1007/s11999-011-1926-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, RG1 6AN UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, RG1 6AN UK
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
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