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Herregodts J, Herregodts S, De Vries E, De Wilde L, Van Tongel A. Demographic heterogeneity in valgus angulation of the proximal ulnar canal in relation to the flexion-extension axis. J Shoulder Elbow Surg 2023; 32:2340-2345. [PMID: 37247775 DOI: 10.1016/j.jse.2023.04.017] [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: 10/15/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The long-term outcome of total elbow arthroplasty remains unsatisfactory because of loosening and polyethylene wear, which could be caused by malpositioning of the ulnar component. When introducing an ulnar component, 2 different angles should be considered in the coronal plane: the valgus angulation of the proximal ulna in relation to the flexion-extension axis (FE-axis) and the intramedullary varus angulation in relation to the FE-axis. Currently, available TEA designs may not always be able to reconstruct the FE-axis because of the morphologic variability of the ulna. HYPOTHESIS This study aimed to determine the demographic variability of the ulna and the relation between the 2 angulations in the frontal plane based on 3-dimentional computed tomography (CT) reconstructions of the elbow joint of healthy volunteers. METHODS Computed tomography scans of 36 left elbows of healthy volunteers were obtained (20 men and 16 women). The scans were segmented and analyzed using the Mimics Research 20.0 software. A local coordinate system was created based on the FE-axis of the elbow and the ulna's longitudinal axis. The measurements were conducted using the 3-Matic Research 12.0 software. RESULTS The valgus angulation of the proximal medullary canal was on average 16° in men but 12° in women and ranged between 5° and 21°. The varus angulation of the medullary cavity could be determined at 57 mm in men and 64 mm in women from the FE-axis. This angulation was on average 10° in men and 7° in women. There was no significant correlation between this angle and the length of the ulna or the point of varus angulation. CONCLUSION This study found a wide range of valgus angulation of the proximal ulnar canal in relation to the FE-axis. The available elbow implant designs are discordant with the mean valgus angulation of the proximal ulna found in this study, and the valgus laxity of the implants does not cover the variability in the population.
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Affiliation(s)
- Jan Herregodts
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
| | - Stijn Herregodts
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Eva De Vries
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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Peeters I, Vermeulen V, Van Tongel A, Martens A, De Wilde L. Biomechanical Evaluation of a Tubular Braided Construct for Primary Deep Flexor Tendon Surgery. J Hand Surg Am 2023; 48:1057.e1-1057.e7. [PMID: 35523636 DOI: 10.1016/j.jhsa.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/04/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Immediate postoperative mobilization has been shown to avoid adhesion formation and improve range of motion after flexor tendon repair. A tubular braided construct was designed to allow for these rehabilitation protocols. METHODS In this ex vivo study, 92 ovine flexor tendons were divided randomly into 2 equal groups. After creating a transection, the tendons of the first group were repaired using a tubular braided construct. This construct, consisting of a tubular braid of polypropylene and polyethylene terephthalate fibers, exerts a grasping effect on the tendon ends. The control group received a multistrand modified Kessler repair with a looped polydioxanone suture (PDS) 4-0 suture and a Silfverskiöld epitendinous repair using an Ethilon 6-0 suture. After the repair, a static and an incremental cyclic tensile test was performed until failure. RESULTS During the static test, the tubular braid resulted in a significantly higher load at 3 mm gap formation (86.3 N ± 6.0 vs 50.1 N ± 11.6), a higher ultimate load at failure (98.3 N ± 12.7 vs 63 N ± 11.1), higher stress at ultimate load (11.8 MPa ± 1.2 vs 8.1 MPa ± 3.1), and higher stiffness (7.1 N/mm ± 2.9 vs 8.7 N/mm ± 2.2). For the cyclic tests, survival analyses for 1-, 2- and 3-mm gap formation and failure demonstrated significant differences in favor of the tubular braided construct. CONCLUSION The tubular braided construct withstands the required loads for immediate rehabilitation not only in static tests, but also during cyclic tests. This is in contrast with the control group, where sufficient strength is reached during static tests, but failures occur below the required loads during cyclic testing. CLINICAL RELEVANCE The tubular braided construct provides a larger safety margin for immediate intensive rehabilitation protocols.
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Affiliation(s)
- Ian Peeters
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium.
| | - Valérie Vermeulen
- Faculty of Veterinary Medicine, Department of Large Animal Surgery Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Alexander Van Tongel
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
| | - Ann Martens
- Faculty of Veterinary Medicine, Department of Large Animal Surgery Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Lieven De Wilde
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
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Vermeulen V, Kozma E, Delsupehe A, Cornillie P, Stock E, Van Tongel A, De Wilde L, Vereecke EE. Scapular morphology of great apes and humans: A three-dimensional computed tomography-based comparative study. J Anat 2023; 242:164-173. [PMID: 36302086 PMCID: PMC9877474 DOI: 10.1111/joa.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 02/01/2023] Open
Abstract
The primate scapula has been studied widely since its shape has been shown to correlate with how the forelimb is used in daily activities. In this study, we expand on the existing literature and use an image-based methodology that was originally developed for orthopaedic practice to quantify and compare the three-dimensional (3D) morphology of the scapula across humans and great apes. We expect that this image-based approach will allow us to identify differences between great apes and humans that can be related to differences in mobility and loading regime of the shoulder. We hypothesize that gorillas and chimpanzees will have a similar scapular morphology, geared towards stability and weight-bearing in knuckle-walking, whilst the scapular morphology of orangutans is expected to be more similar to that of humans given their high glenohumeral mobility associated with their suspensory lifestyle. We made 3D reconstructions of computed tomography scans of 69 scapulae from four hominid genera (Pongo, Gorilla, Pan and Homo). On these 3D bone meshes, the inferior glenoid plane was determined, and subsequently, a set of bony landmarks on the scapular body, coracoid, and acromion were defined. These landmarks allowed us to measure a set of functionally relevant angles which represent acromial overhang, subacromial space and coracoacromial space. The angles that were measured are: the delto-fulcral triangle (DFT), comprising the alpha, beta, and delta angle, the acromion-glenoid angle (AGA), the coracoid-glenoid centre-posterior acromial angle (CGA), the anterior tilt (TA CGA) and the posterior tilt of the CGA (PT CGA). Three observers placed the landmarks on the 3D bone meshes, allowing us to calculate the inter-observer error. The main differences in the DFT were found between humans and the great apes, with small differences between the great apes. The DFT of humans was significantly lower compared to that of the great apes, with the smallest alpha (32.7°), smallest delta (45.7°) and highest beta angle (101.6°) of all genera. The DFT of chimpanzees was significantly higher compared to that of humans (p < 0.01), with a larger alpha (37.6°) and delta angle (54.5°) and smaller beta angle (87.9°). The mean AGA of humans (59.1°) was significantly smaller (p < 0.001) than that of gorillas (68.8°). The mean CGA of humans (110.1°) was significantly higher (p < 0.001) than in orangutans (92.9°). Humans and gorillas showed mainly a posterior tilt of their coracoacromial complex whilst chimpanzees showed mainly an anterior tilt. The coracoacromial complex of the orangutans was not tilted anteriorly or posteriorly. With our image-based method, we were able to identify morphological features of the scapula that differed significantly between hominid genera. However, we did not find an overall dichotomy in scapular morphology geared towards high stability (Pan/Gorilla) or high mobility (Homo/Pongo). Further research is needed to investigate the functional implications of these differences in scapular morphology.
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Affiliation(s)
- Valérie Vermeulen
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University Hospital, Gent, Belgium.,Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Elaine Kozma
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Arne Delsupehe
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Pieter Cornillie
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopaedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Alexander Van Tongel
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University Hospital, Gent, Belgium
| | - Evie E Vereecke
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
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Verstraete O, Van Tongel A, De Wilde L, Peeters I. Acromioclavicular reconstruction techniques after acromioclavicular joint injuries: A systematic review of biomechanical studies. Clin Biomech (Bristol, Avon) 2023; 101:105847. [PMID: 36521410 DOI: 10.1016/j.clinbiomech.2022.105847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 11/19/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Residual horizontal instability after surgical treatment for acromioclavicular joint injuries is seen as a potential cause of suboptimal clinical outcomes. Biomechanical studies have demonstrated that the acromioclavicular capsule/ligaments are the primary restraints for anteroposterior translation. However, limited studies have addressed the biomechanics of a reconstruction of the acromioclavicular capsule/ligaments. The aim of this systematic review was to evaluate the biomechanical role of acromioclavicular capsule/ligament reconstruction techniques after an acromioclavicular joint injury. METHODS A search was carried out on the databases Medline and EMBASE, and was conducted according to the PRISMA guidelines. Biomechanical studies addressing horizontal and vertical displacement or joint stiffness after reconstructing the acromioclavicular capsule/ligament with or without coracoclavicular ligament reconstruction, were included. FINDINGS Nineteen studies were included in this review after screening and eligibility assessment. Five of them investigated different sole acromioclavicular capsule/ligament reconstruction techniques. In 10 studies, a sole coracoclavicular ligament reconstruction was compared to a coracoclavicular ligament reconstruction with additional acromioclavicular capsule/ligament reconstruction. The remaining 4 studies compared different acromioclavicular capsule/ligament with coracoclavicular reconstruction techniques with each other. INTERPRETATION Several testing protocols to evaluate acromioclavicular capsule/ligament reconstruction have been described and can make it difficult to compare the results of the different studies. Acromioclavicular capsule/ligament reconstruction may provide increased anteroposterior and rotational stability but an optimal reconstruction technique, which mimics all biomechanical characteristics of the native joint is not yet available.
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Affiliation(s)
- Olivier Verstraete
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Ian Peeters
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
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Tack P, Vanhaverbeke S, De Wilde L, Van Tongel A. Hyaluronic acid as an alternative treatment option for degenerative rotator cuff tears. Acta Orthop Belg 2022; 88:691-698. [PMID: 36800652 DOI: 10.52628/88.4.10794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Rotator cuff tears have a high prevalence in older people. This research examines the clinical outcome of the non-operative treatment of symptomatic degenerative rotator cuff tears with hyaluronic acid (HA) injections. 72 patients (43 females/29 males), with an average age of 66 years with symptomatic degenerative full- thickness rotator cuff tear, confirmed with arthro-CT, were treated with three intra-articular hyaluronic acid injections and followed on multiple observational moments during a 5-year follow-up using the SF- 36 (Short-Form Health Survey), DASH (Disabilities of the Arm, Shoulder, and Hand), CMS (Constant Murley Score), and OSS (Oxford Shoulder Scale. 54 patients completed the 5-year follow-up questionnaire. 77% of the patients did not require additional treatment for their shoulder pathology, and 89% were treated conservatively. Only 11% of the patients included in this study needed surgery. Between subjects, the analysis revealed a significant difference in response in the DASH (p=0.015) and CMS (p=0.033) when the subscapularis muscle was involved. Intra-articular infiltrations with hyaluronic acid improve pain and shoulder function, especially if the subscapularis muscle is not involved.
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Abstract
Background Existing kinematic studies of the shoulder girdle focus on humerothoracic movements. Isolated scapulothoracic movements are also performed during daily activities and rehabilitation but kinematic values are lacking. Methods A kinematic analysis was performed in 14 cadaveric shoulders during protraction, retraction, and shrug. An optical navigation system was used to analyze sternoclavicular, scapulothoracic, and acromioclavicular motions. Results In the sternoclavicular joint, shrug and retraction caused a posterior clavicular rotation of 5° (standard deviation [SD] 6°) and 3° (SD 2°), while protraction induced an anterior rotation of 3° (SD 2°). Shrug caused a large clavicular elevation of 25° (SD 5°). Shrug and retraction caused an increase in retraction of 17° (SD 5°) and 9° (SD 2°). Protraction induced an increase of 10° (SD 2°) toward protraction. In the scapulothoracic joint, shrug induced an increase of 3° (SD 2°) in anterior scapular tilt, and a lateral rotation of 26° (SD 4°). Retraction caused a lateral rotation of 4° (SD 3°). Protraction caused an increase of 7° (SD 2°) in the scapular protraction position, while shrug and retraction demonstrated a decrease of 9° (SD 2°) and 6° (SD 5°). In the acromioclavicular joint, posterior tilting of the scapula compared to the clavicle increased 23° (SD 6°) during shrug, while during protraction an increase of only 4° (SD 3°) was seen. During shrug, relative lateral rotation increased 13° (SD 4°). The protraction movement decreased the relative protraction position with 3° (SD 2°). Conclusion This study provided normative kinematic values of scapulothoracic movements in the shoulder girdle.
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Affiliation(s)
- Ian Peeters
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
- Corresponding author: Ian Peeters, MD, Corneel Heymanslaan 10, Ghent 9000, Belgium.
| | - Thomas Braeckevelt
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
| | - Tanneke Palmans
- Faculty of Medicine and Health Sciences, Department of Rehabilitation sciences, Ghent University, Ghent, Belgium
| | - Alexander Van Tongel
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
| | - Lieven De Wilde
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
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Peeters I, Braeckevelt T, Palmans T, De Wilde L, Van Tongel A. Differences between Coracoclavicular, Acromioclavicular, or Combined Reconstruction Techniques on the Kinematics of the Shoulder Girdle. Am J Sports Med 2022; 50:1971-1982. [PMID: 35532965 DOI: 10.1177/03635465221095231] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the coracoclavicular (CC) ligaments are classically reconstructed after acromioclavicular (AC) joint injuries, biomechanical studies over the past decade have indicated the importance of an additional reconstruction of the AC ligaments. To date, no kinematic study has investigated the kinematic differences between these reconstruction strategies. PURPOSE To evaluate the restoration of shoulder motion after an AC injury using a CC ligament, an AC ligament, or a combined reconstruction technique. STUDY DESIGN Controlled laboratory study. METHODS After creating a Rockwood grade V lesion in 14 cadaveric shoulders, the AC joint injury was treated with either a CC ligament reconstruction using a suspension device, an in situ AC ligament reconstruction using 2 coupled soft tissue anchors, or a combination of these 2 techniques. Joint motions were registered during humerothoracic elevation in the coronal plane and protraction in the intact shoulder in a Rockwood V lesion and after the 3 reconstruction strategies. An optical navigation system measured 3-dimensional rotation in the sternoclavicular and scapulothoracic joints, and both rotation and translation were analyzed in the AC joint. RESULTS In the sternoclavicular joint, the CC and combined reconstruction techniques adequately restored clavicular axial rotation, while the AC reconstruction technique showed a better correction of clavicular elevation. Scapulothoracic joint rotations were best restored by reconstructing the AC ligaments. In the AC joint, the relative tilting position and the lateral rotation of the scapula compared with the clavicle were best restored by the suspension device and combined reconstruction. The AC ligament reconstruction technique demonstrated a better restoration of the relative protracted position and resulted in a better correction of the translation of the scapula relative to the clavicle. CONCLUSION This study illustrates that there are kinematic differences between AC, CC, or combined ligament reconstruction strategies. Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state. CLINICAL RELEVANCE Humerothoracic movements after Rockwood V lesions are best restored using the CC reconstruction technique, and scapulothoracic movements are best restored using the AC ligament reconstruction technique.
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Affiliation(s)
- Ian Peeters
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Braeckevelt
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Tanneke Palmans
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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Lampaert S, Herregodts J, De Wilde L, Van Tongel A. Radial head fractures: a quantitative analysis. Acta Orthop Belg 2022; 88:380-386. [DOI: 10.52628/88.2.9007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several classification systems for radial head fractures discuss the number of fragments and their displacement, but not the exact location. This study aimed to evaluate the location of the radial head fracture fragments and the influence of the Mason type on the size of the fracture fragment. Forty-one radial head fractures (31 Mason type I and 10 type II) with an elliptical radial head were included in this retrospective study and 3D reconstructed. First, the fragments were repositioned to their original location. Next, the orientation of the scanned forearm was evaluated using the position of the longest axis relative to the proximal radio-ulnar joint, and all radial heads were rotated to the neutral rotation. The radial head was divided into 4 quadrants (anteromedial, anterolateral, posteromedial, and posterolateral). The location of the fracture line in correlation with these 4 quadrants was evaluated. All fracture fragments were located in the anteromedial quadrant. Thirty-eight (93%) were located in the anterolateral quadrant. The posterolateral quadrant was involved in 32%. At last, the average fracture fragment size was evaluated according to the Mason classification. A significant difference was found in the average fracture fragment size between Mason type I (38% of the radial head surface) and type II (48% of the radial head surface). It was concluded that there is an important involvement of the anterior quadrants of the fracture. The mean size of the fracture is significantly larger in Mason type II compared to type I.
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Peeters I, Pien N, Mignon A, Van Damme L, Dubruel P, Van Vlierberghe S, Mantovani D, Vermeulen V, Creytens D, Van Tongel A, Schauvliege S, Hermans K, De Wilde L, Martens A. Flexor tendon repair using a reinforced tubular, medicated electrospun construct. J Orthop Res 2022; 40:750-760. [PMID: 33991020 DOI: 10.1002/jor.25103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
A reinforced tubular, medicated electrospun construct was developed for deep flexor tendon repair. This construct combines mechanical strength with the release of anti-inflammatory and anti-adhesion drugs. In this study, the reinforced construct was evaluated using a rabbit model. It was compared to its components (a tubular, medicated electrospun polymer without reinforcement and a tubular braid as such) on the one hand to a modified Kessler suture as a control group. Forty New Zealand rabbits were randomly divided into two groups. Surgery was performed in the second and fourth deep flexor tendons of one hind paw of the rabbits in the two groups using four repair techniques. Biomechanical tensile testing and macroscopic and histological evaluations were performed at 3 and 8 weeks postoperatively. A two-way analysis of variance with pairwise comparisons revealed that the three experimental surgical techniques (a reinforced tubular medicated electrospun construct, tubular-medicated construct, and tubular braid as such) showed similar strength as that of a modified Kessler suture repair, which was characterized by a mean load at ultimate failure of 19.85 N (standard deviation [SD] 5.29 N) at 3 weeks and 18.15 N (SD 8.01 N) at 8 weeks. Macroscopically, a significantly different adhesion pattern was observed at the suture knots, either centrally or peripherally, depending on the technique. Histologically, a qualitative assessment showed good to excellent repair at the tendon repair site, irrespective of the applied technique. This study demonstrates that mechanical and biological repair strategies for flexor tendon repair can be successfully combined.
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Affiliation(s)
- Ian Peeters
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nele Pien
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Ghent, Belgium
- Laboratory for Biomaterials and Bioengineering, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, Quebec, Quebec, Canada
| | - Arn Mignon
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Ghent, Belgium
- KU Leuven, Smart Polymeric Biomaterials, Surface and Interface Engineered Materials, Leuven, Flanders, Belgium
| | - Lana Van Damme
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Ghent, Belgium
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Ghent, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Ghent, Belgium
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, Quebec, Quebec, Canada
| | - Valérie Vermeulen
- Faculty of Veterinary Medicine, Surgery and Anaesthesiology of Domestic Animals, Ghent University, Merelbeke, Belgium
| | - David Creytens
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn Schauvliege
- Faculty of Veterinary Medicine, Surgery and Anaesthesiology of Domestic Animals, Ghent University, Merelbeke, Belgium
| | - Katleen Hermans
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ann Martens
- Faculty of Veterinary Medicine, Surgery and Anaesthesiology of Domestic Animals, Ghent University, Merelbeke, Belgium
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Peeters I, Braeckevelt T, Herregodts S, Palmans T, De Wilde L, Van Tongel A. Kinematic Alterations in the Shoulder Complex in Rockwood V Acromioclavicular Injuries During Humerothoracic and Scapulothoracic Movements: A Whole-Cadaver Study. Am J Sports Med 2021; 49:3988-4000. [PMID: 34714699 DOI: 10.1177/03635465211053016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous cadaveric kinematic studies on acromioclavicular injuries described mainly rotational differences during humerothoracic movements. Although isolated scapulothoracic movements are also often performed during activities of daily life and can be painful after acromioclavicular injuries, they have not been extensively studied. Further, the analysis of joint translations in kinematic studies has received little attention compared with biomechanical studies. HYPOTHESIS A kinematic analysis of joint motions in the intact shoulder versus a shoulder with Rockwood V injury would demonstrate a different pattern of kinematic alterations during humerothoracic and scapulothoracic movements. STUDY DESIGN Descriptive laboratory study. METHODS A kinematic analysis was performed in 14 cadaveric shoulders during 3 humerothoracic passive movements (coronal and sagittal plane elevation and horizontal adduction) and 3 scapulothoracic passive movements (protraction, retraction, and shrug). An optical navigation system registered rotational motions in the sternoclavicular, scapulothoracic, and acromioclavicular joints in the intact and Rockwood V conditions. In the acromioclavicular joint, mediolateral, anteroposterior, and superoinferior translations were also analyzed. RESULTS In the Rockwood V condition, a significant increase in clavicular elevation in the sternoclavicular joint during both humerothoracic and scapulothoracic movements was demonstrated, whereas a significant decrease in posterior rotation of the clavicle occurred only during humerothoracic movements. In the scapulothoracic joint, the scapular position changed most significantly during protraction. In the acromioclavicular joint, the scapular tilting position was altered significantly during both humerothoracic and scapulothoracic movements, whereas the scapular rotational position changed only during coronal and sagittal plane elevation. The largest significant changes in the scapular protraction position were seen during protraction movement. Further, in the acromioclavicular joint there was a significant inferior translation of the scapula during all motions, a significant anterior translation during protraction and horizontal adduction, and a significant posterior translation during coronal plane elevation. Mediolaterally, the acromial end of the scapula slid further under the distal clavicle during protraction than during horizontal adduction. CONCLUSION Large kinematic differences were seen between the intact state and a Rockwood V lesion not only during humerothoracic movements but also during scapulothoracic movements in the cadaveric model. During humerothoracic movements, rotational differences were mainly caused by alterations in the clavicular position. In contrast, during protraction, the alterations in the scapular position were the dominant factor. CLINICAL RELEVANCE This study demonstrates that protraction induces larger kinematic alterations than horizontal adduction in acromioclavicular injuries and can therefore be included in both clinical examination and kinematic analyses to identify lesions more clearly.
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Affiliation(s)
- Ian Peeters
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Braeckevelt
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Stijn Herregodts
- Department of Electrical Energy, Metal, Mechanical Construction & Systems, Ghent University, Ghent, Belgium
| | - Tanneke Palmans
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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Van Tongel A, De Wilde L, Shimamura Y, Sijbers J, Huysmans T. Fracture patterns in midshaft clavicle fractures. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Current classifications of midshaft clavicle fractures are based on radiography. The aim of the study was to evaluate the fracture pattern of clavicle fractures using 3-dimensional computed tomography (3D CT). A retrospective analysis was performed on CT scans of 65 acute clavicle fractures. Using quantitative 3D CT reconstruction techniques, the fracture of the clavicle was virtually reduced. Based on these reconstructions, a group-based fracture heat map and small fragment heat map, and the location of the most common fracture line were determined. Also, the direction and amount of displacement were evaluated. Three fracture patterns could be distinguished. The primary fracture line in type 1 is going from posteromedial to anterolateral and located between 50% and 68% of the clavicle’s length. In type 2, a transverse fracture line is located around 55%, and in type 3, a superolateral to inferomedial line is located between 47% and 56%. Wedged fracture fragments can be seen in types 1 and 2 and are mainly situated inferiorly. The displacement is similar in all types, but the main direction of displacement is specific for the different types (posterior, anterior, inferior). We can conclude that several fracture patterns can be seen in clavicle fractures. Most fractures are located laterally at the midshaft of the clavicle. Wedged segments are mainly located inferiorly, and at the posterior part of the clavicle, no comminution is ever seen. The direction of displacement depends on the fracture pattern.
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Van Tongel A, De Wilde L, Shimamura Y, Sijbers J, Huysmans T. Fracture patterns in midshaft clavicle fractures. Acta Orthop Belg 2021; 87:501-507. [PMID: 34808725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Current classifications of midshaft clavicle fractures are based on radiography. The aim of the study was to evaluate the fracture pattern of clavicle fractures using 3-dimensional computed tomography (3D CT). A retrospective analysis was performed on CT scans of 65 acute clavicle fractures. Using quantitative 3D CT reconstruction techniques, the fracture of the clavicle was virtually reduced. Based on these reconstructions, a group-based fracture heat map and small fragment heat map, and the location of the most common fracture line were determined. Also, the direction and amount of displacement were evaluated. Three fracture patterns could be distinguished. The primary fracture line in type 1 is going from posteromedial to anterolateral and located between 50% and 68% of the clavicle's length. In type 2, a transverse fracture line is located around 55%, and in type 3, a superolateral to inferomedial line is located between 47% and 56%. Wedged fracture fragments can be seen in types 1 and 2 and are mainly situated inferiorly. The displacement is similar in all types, but the main direction of displacement is specific for the different types (posterior, anterior, inferior). We can conclude that several fracture patterns can be seen in clavicle fractures. Most fractures are located laterally at the midshaft of the clavicle. Wedged segments are mainly located inferiorly, and at the posterior part of the clavicle, no comminution is ever seen. The direction of displacement depends on the fracture pattern.
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Peeters I, Martens A, De Wilde L. The suture of transferred tendons: a biomechanical study of a tubular braid with grasping action vs. Pulvertaft suture. J Hand Surg Eur Vol 2021; 46:786-788. [PMID: 33757324 DOI: 10.1177/17531934211002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Peeters
- Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
| | - Ann Martens
- Surgery and Anaesthesiology of Domestic Animals, Ghent University, Merelbeke, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
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Verstuyft L, Vergison L, Van Tongel A, De Wilde L. Is bone grafting always necessary in revision reverse total shoulder arthroplasty with uncontained glenoid bone defects? J Shoulder Elbow Surg 2021; 30:1891-1898. [PMID: 33276161 DOI: 10.1016/j.jse.2020.10.033] [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: 05/07/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with an uncontained glenoid bone defect can still successfully undergo a reverse total shoulder arthroplasty (RTSA). Currently, there is a tendency toward reconstruction of the premorbid glenoid plane with bone grafts, which is technically demanding. We investigated whether central peg positioning in the spine pillar (CPPSP) is a more feasible alternative to the use of bone grafts. METHODS This study included 60 revisions to an RTSA with uncontained glenoid bone defects. Patients were treated with bone grafts in 29 cases and with the CPPSP technique in 31 cases. We assessed clinical results using the Constant score and assessed the complication rate. RESULTS The Constant score changed from 42 to 69 points in the CPPSP group and from 47 to 60 points in the bone graft group. This difference in the increase in the Constant score was significant (P = .031) owing to a significant difference in strength in favor of the CPPSP group. The overall complication rate was 37.7% (20 of 53 patients), with a reoperation rate of 18.9% (10 of 53). Dislocations occurred only in the CPPSP group (n = 3), and loosening of the glenoid occurred only in the bone graft group (n = 3). CONCLUSION Patients with uncontained glenoid bone defects undergoing revision to an RTSA obtain similar clinical results with the CPPSP technique compared with the use of bone grafts. The CPPSP technique is a valid alternative but results in different complications.
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Affiliation(s)
- Lotte Verstuyft
- Department of Orthopaedic Surgery and Traumatology, UZ Gent, Gent, Belgium.
| | - Laurence Vergison
- Department of Orthopaedic Surgery and Traumatology, UZ Gent, Gent, Belgium
| | | | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, UZ Gent, Gent, Belgium
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15
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Van Parys M, Alkiar O, Naidoo N, Van Tongel A, De Wilde L. Three-dimensional evaluation of scapular morphology in primary glenohumeral arthritis, rotator cuff arthropathy, and asymptomatic shoulders. J Shoulder Elbow Surg 2021; 30:1803-1810. [PMID: 33278585 DOI: 10.1016/j.jse.2020.10.027] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recently, the 3-dimensional (3D) morphology of the coracoacromial complex in nonpathologic shoulders has been described. The aim of this study was to evaluate and compare the coracoacromial complex in pathologic shoulders (glenohumeral osteoarthritis [GHOA] and cuff tear arthropathy [CTA]) and nonpathologic shoulders. METHODS A 3D computed tomography reconstruction of 205 scapulae was performed (49 with GHOA, 48 with CTA, and 108 in normal shoulders [NL]). Subsequently, the center of the glenoid circle and several points at the coracoid, acromion, and glenoid were determined. The distances between these points and the rotation of the coracoacromial complex were calculated, and the acromion-glenoid angle was measured. RESULTS The acromial overhang was significantly different between the NL (37 mm) and CTA (35 mm) groups (P = .045), as well as between the CTA and GHOA groups (33 mm) (P = .010). The acromion-glenoid angle showed a significant difference between the NL (mean, 50°) and GHOA (mean, 42°) groups (P < .001) and between the CTA (mean, 50°) and GHOA groups (P < .001). Furthermore, a significant difference was found in the acromial height, which was larger in the GHOA group (36 mm) than in the CTA group (30 mm) (P < .001) or NL group (30 mm) (P < .001). CONCLUSION This 3D morphologic study showed that the acromial part of the complex was turned more posteriorly in both pathologic groups. Furthermore, we found the coracoacromial complex to be more cranial to the glenoid center in the GHOA group. Finally, a significant difference in the lateral overhang of the coracoacromial complex was observed between the 3 groups. The NL group had a larger overhang than the CTA group, and the CTA group in turn had a larger overhang than the GHOA group.
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Affiliation(s)
- Michiel Van Parys
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
| | - Osama Alkiar
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Nerissa Naidoo
- Department of Basic Medical Sciences, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
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Jacxsens M, Dayerizadeh N, Vandenbosch D, Van Tongel A, De Wilde L. Clinical and radiographic outcomes of an all-polyethylene fluted central peg glenoid component, implanted utilizing an off-label, uncemented technique, at a minimum 5-year follow-up. J Shoulder Elbow Surg 2020; 29:2292-2298. [PMID: 32499196 DOI: 10.1016/j.jse.2020.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component loosening remains an important concern in anatomic total shoulder arthroplasty. The aim of this study was to evaluate the clinical and radiographic results of a fully uncemented all-polyethylene fluted central peg bone-ingrowth glenoid component at a minimum 5-year follow-up. METHODS Thirty-five shoulders in 31 patients (mean age, 73 years) with a mean follow-up of 100 months were retrospectively evaluated at an early and mid-term time point for Constant score (CS). Computed tomography visualized glenoid component fixation at both time points. RESULTS Mean CS improved from 40 preoperatively to 66 postoperatively at latest follow-up (P < .001). A mean CS of 74 at early follow-up remained consistent with a mean CS of 66 at latest follow-up (P = .158), with only strength demonstrating a decrease over time (P < .001). An initial osseointegration rate of 81% at early follow-up decreased to 71% at latest follow-up with 74% of the shoulders demonstrating progressive radiolucent lines, resulting in a radiographic loosening rate of 31%. Of the 35 shoulders, 4 were revised (survival rate of 88%), of which 2 due to symptomatic aseptic loosening. CONCLUSIONS Uncemented fixation of an all-polyethylene central peg bone-ingrowth glenoid was associated with satisfactory clinical and radiographic scores, and an acceptable revision rate at mid- to long-term follow-up. Despite initial bony osseointegration in the majority of cases, radiographic loosening over time remains a concern, potentially jeopardizing long-lasting fixation of this type of glenoid component when implanted in an off-label uncemented fashion.
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Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nader Dayerizadeh
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Dominiek Vandenbosch
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.
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Deschrijver M, Lamquet S, Planckaert G, Vermue H, De Wilde L, Van Tongel A. Positioning of longest axis of the radial head in neutral forearm rotation. Shoulder Elbow 2020; 12:362-367. [PMID: 33123224 PMCID: PMC7545526 DOI: 10.1177/1758573219831285] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/25/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The radial head has an ellipsoid shape so that a longest and a shortest axis can be defined. The aim of this study is to evaluate the position of the longest axis of the radial head (LARH) in relation to proximal radioulnar joint (PRUJ) and to the forearm in neutral position using 3D computed tomography (CT). MATERIALS AND METHODS 3D CT reconstructions of the distal humerus, the radius and the ulna of 27 healthy volunteers (average age 27.65 ± 9.25; 24 males, 3 females) were created. First an evaluation of the elliptic form of the radial head and the location of its longest axis was performed. Next, three planes were defined: the PRUJ plane, the forearm plane and a neutral plane. Based on the angle between the forearm plane and the neutral plane, the rotation of the scanned forearm was measured. Taking this rotation into account, the position of the LARH compared to PRUJ plane and forearm plane in neutral position is recalculated. RESULTS The shape of the radial head is determined to be non-circular based on this study population (p < .001). In neutral position, the angle between the LARH and the forearm plane is 5.28° (SD: 15.09) and between the LARH and the PRUJ is 33.46° (SD: 13.91). CONCLUSIONS The position of the LARH is found to be approximately perpendicular to the forearm plane when the forearm is in neutral position and perpendicular to the PRUJ plane when the forearm is on average in 30° of pronation.
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Affiliation(s)
| | | | | | | | | | - Alexander Van Tongel
- Alexander Van Tongel, Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
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Thukkaram M, Coryn R, Asadian M, Esbah Tabaei PS, Rigole P, Rajendhran N, Nikiforov A, Sukumaran J, Coenye T, Van Der Voort P, Du Laing G, Morent R, Van Tongel A, De Wilde L, De Baets P, Verbeken K, De Geyter N. Fabrication of Microporous Coatings on Titanium Implants with Improved Mechanical, Antibacterial, and Cell-Interactive Properties. ACS Appl Mater Interfaces 2020; 12:30155-30169. [PMID: 32530601 DOI: 10.1021/acsami.0c07234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The success of an orthopedic implant therapy depends on successful bone integration and the prevention of microbial infections. In this work, plasma electrolytic oxidation (PEO) was performed to deposit TiO2 coatings enriched with Ca, P, and Ag on titanium to improve its surface properties and antibacterial efficacy while maintaining normal biological functions and thus to enhance the performance of orthopedic implants. After PEO treatment, the surface of Ti was converted to anatase and rutile TiO2, hydroxyapatite, and calcium titanate phases. The presence of these crystalline phases was further increased with an increased Ag content in the coatings. The developed coatings also exhibited a more porous morphology with an improved surface wettability, roughness, microhardness, and frictional coefficient. In vitro antibacterial assays indicated that the Ag-doped coatings can significantly prevent the growth of both Staphylococcus aureus and Escherichia coli by releasing Ag+ ions, and the ability to prevent these bacteria was enhanced by increasing the Ag content in the coatings, resulting in a maximal 6-log reduction of E. coli and a maximal 5-log reduction of S. aureus after 24 h of incubation. Moreover, the in vitro cytocompatibility evaluation of the coatings showed that the osteoblast (MC3T3) cell integration on the PEO-based coatings was greatly improved compared to untreated Ti and no notable impact on their cytocompatibility was observed on increasing the amount of Ag in the coating. In conclusion, the coating with favorable physicochemical and mechanical properties along with controlled silver ion release can offer an excellent antibacterial performance and osteocompatibility and can thus become a prospective coating strategy to face current challenges in orthopedics.
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Affiliation(s)
- Monica Thukkaram
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Renee Coryn
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Mahtab Asadian
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Parinaz Saadat Esbah Tabaei
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Petra Rigole
- Laboratory of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent 9000, Belgium
| | - Naveenkumar Rajendhran
- Soete Laboratory, Department of Electrical Energy, Metals, Mechanical Construction and Systems (EEMMeCS), Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Anton Nikiforov
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Jacob Sukumaran
- Soete Laboratory, Department of Electrical Energy, Metals, Mechanical Construction and Systems (EEMMeCS), Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent 9000, Belgium
| | - Pascal Van Der Voort
- Centre for Ordered Materials, Organometallics and Catalysis (COMOC), Department of Chemistry, Faculty of Sciences, Ghent University, Ghent 9000, Belgium
| | - Gijs Du Laing
- Department of Green Chemistry and Technology, Faculty of Bioscience Engineering, Ghent University, Ghent 9000, Belgium
| | - Rino Morent
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Alexander Van Tongel
- Orthopedic Surgery and Traumatology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Lieven De Wilde
- Orthopedic Surgery and Traumatology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Patrick De Baets
- Soete Laboratory, Department of Electrical Energy, Metals, Mechanical Construction and Systems (EEMMeCS), Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Kim Verbeken
- Department of Materials, Textiles and Chemical Engineering, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
| | - Nathalie De Geyter
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent 9000, Belgium
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Schepens C, Vanden Bossche L, Steyaert A, De Wilde L, Cools A, Van Tongel A. A demographic study of acute injuries in basketball players. Acta Orthop Belg 2020; 86:177-184. [PMID: 33418604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. The purpose is to present an overview of the incidence of injuries and injury patterns in Flanders and to correlate them to possible intrinsic and extrinsic risk factors. All acute injuries that occurred in Flanders during 2009-2013, collected by the insurance, were analysed. The incidence and parameters such as date of birth, date of occurrence of the injury, gender and diagnosis were evaluated. Injury incidence varied from 7.40% up to 8.45%. Females and players at age 16-17, 14-15 and older than 30 are at higher risk. The ankle/foot region is most frequently injured. There is a higher risk of injury after season-and Christmas break. Age, gender and chronometry are risk factors to get injured. Sprains are the most frequent, while the nkle/foot region is the most susceptible to injury. Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. Female players and players at age 16-17, 14-15 and older than 30 are at higher risk to basketball injuries. The ankle/foot region is most frequently injured followed by lower arm and hand. There is a higher risk of injury after season-and Christmas break.
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Thukkaram M, Vaidulych M, Kylián O, Hanuš J, Rigole P, Aliakbarshirazi S, Asadian M, Nikiforov A, Van Tongel A, Biederman H, Coenye T, Du Laing G, Morent R, De Wilde L, Verbeken K, De Geyter N. Investigation of Ag/a-C:H Nanocomposite Coatings on Titanium for Orthopedic Applications. ACS Appl Mater Interfaces 2020; 12:23655-23666. [PMID: 32374146 DOI: 10.1021/acsami.9b23237] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
One of the leading causes of failure for any bone implant is implant-associated infections. The implant-bone interface is in fact the crucial site of infection where both the microorganisms and cells compete to populate the newly introduced implant surface. Most of the work dealing with this issue has focused on the design of implant coatings capable of preventing infection while ignoring cell proliferation or vice versa. The present study is therefore focused on investigating the antibacterial and biological properties of nanocomposite coatings based on an amorphous hydrocarbon (a-C:H) matrix containing silver nanoparticles (AgNPs). a-C:H coatings with varying silver concentrations were generated directly on medical grade titanium substrates using a combination of a gas aggregation source (GAS) and a plasma-enhanced chemical vapor deposition (PE-CVD) process. The obtained results revealed that the surface silver content increased from 1.3 at % to 5.3 at % by increasing the used DC magnetron current in the GAS from 200 to 500 mA. The in vitro antibacterial assays revealed that the nanocomposites with the highest number of silver content exhibited excellent antibacterial activities resulting in a 6-log reduction of Escherichia coli and a 4-log reduction of Staphylococcus aureus after 24 h of incubation. An MTT assay, fluorescence live/dead staining, and SEM microscopy observations of MC3T3 cells seeded on the uncoated and coated Ti substrates also showed that increasing the amount of AgNPs in the nanocomposites had no notable impact on their cytocompatibility, while improved cell proliferation was especially observed for the nanocomposites possessing a low amount of AgNPs. These controllable Ag/a-C:H nanocomposites on Ti substrates, which simultaneously provide an excellent antibacterial performance and good biocompatibility, could thus have promising applications in orthopedics and other biomedical implants.
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Affiliation(s)
- Monica Thukkaram
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Mykhailo Vaidulych
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Ondřej Kylián
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Jan Hanuš
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Petra Rigole
- Laboratory of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent 9000, Belgium
| | - Sheida Aliakbarshirazi
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Mahtab Asadian
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Anton Nikiforov
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Alexander Van Tongel
- Orthopaedic Surgery and Traumatology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Hynek Biederman
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent 9000, Belgium
| | - Gijs Du Laing
- Department of Green Chemistry and Technology, Faculty of Bioscience Engineering, Ghent University, Ghent 9000, Belgium
| | - Rino Morent
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Lieven De Wilde
- Orthopaedic Surgery and Traumatology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Kim Verbeken
- Department of Materials, Textiles, and Chemical Engineering, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Nathalie De Geyter
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
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De Paepe AL, Legrain V, Van der Biest L, Hollevoet N, Van Tongel A, De Wilde L, Jacobs H, Crombez G. An investigation of perceptual biases in complex regional pain syndrome. PeerJ 2020; 8:e8819. [PMID: 32274265 PMCID: PMC7130113 DOI: 10.7717/peerj.8819] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/28/2020] [Indexed: 01/31/2023] Open
Abstract
Patients with complex regional pain syndrome (CRPS) report cognitive difficulties, affecting the ability to represent, perceive and use their affected limb. Moseley, Gallace & Spence (2009) observed that CRPS patients tend to bias the perception of tactile stimulation away from the pathological limb. Interestingly, this bias was reversed when CRPS patients were asked to cross their arms, implying that this bias is embedded in a complex representation of the body that takes into account the position of body-parts. Other studies have failed to replicate this finding (Filbrich et al., 2017) or have even found a bias in the opposite direction (Sumitani et al., 2007). Moreover, perceptual biases in CRPS patients have not often been compared to these of other chronic pain patients. Chronic pain patients are often characterized by an excessive focus of attention for bodily sensations. We might therefore expect that non-CRPS pain patients would show a bias towards instead of away from their affected limb. The aim of this study was to replicate the study of Moseley, Gallace & Spence (2009) and to extend it by comparing perceptual biases in a CRPS group with two non-CRPS pain control groups (i.e., chronic unilateral wrist and shoulder pain patients). In a temporal order judgment (TOJ) task, participants reported which of two tactile stimuli, one applied to either hand at various intervals, was perceived as occurring first. TOJs were made, either with the arms in a normal (uncrossed) position, or with the arms crossed over the body midline. We found no consistent perceptual biases in either of the patient groups and in either of the conditions (crossed/uncrossed). Individual differences were large and might, at least partly, be explained by other variables, such as pain duration and temperature differences between the pathological and non-pathological hand. Additional studies need to take these variables into account by, for example, comparing biases in CRPS (and non-CRPS) patients in an acute versus a chronic pain state.
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Affiliation(s)
- Annick L. De Paepe
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Valéry Legrain
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Lien Van der Biest
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Nadine Hollevoet
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Herlinde Jacobs
- Unit of Physical Medicine, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Bulkmans K, Peeters I, De Wilde L, Van Tongel A. The relationship of the acromion to the distal clavicle in normal and symptomatic degenerated acromioclavicular joints. Arch Orthop Trauma Surg 2020; 140:465-472. [PMID: 31428850 DOI: 10.1007/s00402-019-03258-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although degenerative osteoarthritis of the acromioclavicular joint is a common finding on technical investigations, not every patient experiences pain or function loss. The difference between symptomatic and asymptomatic patients is currently not elucidated. Therefore, we want to investigate the acromioclavicular relationship in normal, asymptomatic, and symptomatic degenerated ACJ. MATERIALS AND METHODS 84 normal ACJ, 39 asymptomatic degenerated ACJ, and 30 symptomatic degenerated ACJ were 3D reconstructed. The morphological dimensions and the relationship of the acromion and distal clavicle were measured using computational software. The reproducibility of this technique was evaluated using inter- and intra-observer reliability. RESULTS The mean anteroposterior and superoinferior distance of both the clavicle and acromion was significantly larger in asymptomatic and symptomatic degenerative ACJ compared to the normal ACJ (p < 0.001). In symptomatic osteoarthritic ACJ, both the anterior and posterior borders of the acromion were significantly more anterior to the borders of the clavicle than in the normal group and asymptomatic group (p < 0.001). Subsequent ROC curve analysis resulted in a sensitivity of 86.7% and a specificity of 88.6% for anterior subluxation of the ACJ. This technique showed an excellent inter- and intra-observer reliability. CONCLUSIONS In patients with degenerative ACJ, both the distal clavicle and acromion are enlarged. In asymptomatic patients, the AC relationship is the same as in normal patients, in contrast, in patients with symptomatic degenerative ACJ, the acromion is subluxated anteriorly compared to the clavicle.
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Affiliation(s)
- Kristof Bulkmans
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - Ian Peeters
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
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Peeters I, Herregodts S, De Wilde L, Van Tongel A. Biomechanical evaluation of a new technique for acromioclavicular stabilization. Orthop Traumatol Surg Res 2020; 106:247-254. [PMID: 31983651 DOI: 10.1016/j.otsr.2019.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/25/2019] [Accepted: 11/29/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The most commonly used repair techniques to treat an acromioclavicular dislocation imply a suspension mechanism by substituting the supero-inferior oriented coracoclavicular structures with a tight rope mechanism or allograft. Recently, the importance of restoring the antero-posterior stability by addressing the acromioclavicular structures has also been demonstrated. If an in situ repair at the acromioclavicular joint itself could achieve a reposition and would be strong enough, the suspension of the CC structures might become obsolete. Possible advantages would be minimal dissection, lower risk in damaging neurovascular structures, greater stability, reduction of the surgical time and even the possibility of locoregional anesthesia. HYPOTHESIS In this biomechanical study, the feasibility of different in situ repair techniques is explored thereby testing both compression and translation characteristics. Our hypothesis is that an in situ repair technique results in an adequate repair for the AC joint. METHODS AND MATERIALS Polyurethane foam blocks will be used as a model for the acromioclavicular joint and the repair techniques will be done by using a combination of sutures and bone anchors or using a transosseous technique. Compression will be measured by means of a Tekscan pressure sensor and translation will be tested in three orthogonal directions using a tensile testing machine. Four different knot anchor configurations (nice knot, surgical knot in two different configurations, Nicky's knot) will be tested for compression. The strongest knot anchor configuration will then be compared side to side with a transosseous configuration for translation. RESULTS The nice knot in combination with bone anchors provides the strongest compression. In the side to side comparison of a nice knot anchor configuration versus a transosseous nice knot configuration, the transosseous technique shows more resistance to translation. DISCUSSION An in situ repair by a combination of the nice knot with an anchor or a transosseous nice knot configuration can theoretically be used as a repair technique for an acromioclavicular dislocation. In comparison with existing techniques, this model shows favorable results for translation. LEVEL OF EVIDENCE III, controlled laboratory study.
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Affiliation(s)
- Ian Peeters
- Department of Orthopedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium.
| | - Stijn Herregodts
- Department of Orthopedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Department of electrical energy, metal, mechanical construction & systems, Ghent University, Technologiepark 46, 9052 Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
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Spapens N, Van Tongel A, Van Montfoort D, De Wilde L. Latissimus dorsi transfer using bone block technique to restore active external rotation in reversed total shoulder arthroplasty. Acta Orthop Belg 2020; 86:166-174. [PMID: 32490789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim was to compare the outcome of a reversed shoulder arthroplasty with a latissiumus dorsi transfer without (LD-BB) or with bone block (LD+BB) in patients with rotator cuff-deficient shoulders and combined loss of active elevation and external rotation. Postoperative patients with LD+BB were not immobilized compared to 6 weeks of immobilization in patients with LD-BB. Clinical outcome was evaluated using the Constant Score, ADLER score and satisfaction rate. Also radiological follow-up of the bone-block was performed. In total 29 patients (21 LD+BB, 8 LD-BB) were evaluated. There was no significant difference between both groups at 3 months, 6 months and 1 year in clinical outcome. The radiological evaluation revealed remodellation and ingrowth of the bone block in all but one patient. We conclude that the bone block procedure is a safe technique to perform a LD transfer with good clinical outcome. It also allows early mobilisation and radiological evaluation.
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Moreels R, De Wilde L, Van Tongel A. Evolution of nonoperative treatment of atraumatic sternoclavicular dislocation. J Shoulder Elbow Surg 2019; 28:2350-2355. [PMID: 31350108 DOI: 10.1016/j.jse.2019.04.060] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Atraumatic sternoclavicular dislocation (ASCD) is an uncommon pathology that is mainly diagnosed in young adults. The aim of this study is to better describe the clinical picture of ASCD and to describe the results of a "wait-and-see" policy in these patients. METHODS All patients with ASCD who visited our department between 2011 and 2016 were retrospectively analyzed. A standardized clinical examination was used to evaluate the clinical picture. All patients were treated nonoperatively, and at latest follow-up, several parameters and standardized questionnaires (Nottingham Clavicle Score, Oxford Shoulder Score, Constant-Murley Score) were used to evaluate the outcome. RESULTS In total, 23 patients (12 male, 11 female) were evaluated. The average age at diagnosis was 18.6 years. There was a significant difference (P < .001) in angle of dislocation during forward flexion (mean = 141°) compared with abduction (mean = 101°). At latest follow-up (average 46 months, range 14-113 months; standard deviation [SD] = 27), subluxations still occurred but were less frequent and less prominent relative to presentation at initial diagnosis in 19 of 23 patients. The chance of subjective improvement increased by 27% for each year of follow-up. High outcome scores of Nottingham Clavicle Score (mean score = 80, SD = 11), Oxford Shoulder Score (mean score = 44, SD = 4), and Constant-Murley Score (mean score = 83, SD = 11) were reported. CONCLUSION In patients with ASCD, the clavicle subluxates earlier in abduction than in forward flexion. After a midterm follow-up, a "wait-and-see" policy does not resolve the subluxations. However, most patients displayed reduced frequency and severity of subluxations over their recovery period and showed excellent scores on shoulder questionnaires.
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Affiliation(s)
- Robin Moreels
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
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Karelse A, Van Tongel A, Gosens T, De Boey S, De Wilde L. Limited Value of Current Shoulder Registries in Evidence-Based Shoulder Surgery. JSES Open Access 2019. [DOI: 10.1016/j.jses.2019.10.010] [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: 11/27/2022]
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Paquet T, Van Den Broecke R, Casier S, Van Houcke J, De Wilde L, Van Tongel A. Defining the shape of the scapulothoracic gliding surface. Surg Radiol Anat 2019; 41:1369-1375. [PMID: 31616984 DOI: 10.1007/s00276-019-02342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of the study is to evaluate the difference in shape of the upper part and lower part of the Scapulothoracic Gliding Surface (STGS). METHODS 3D-CT images of the thoracic cage of 50 patients were created in MIMICS ®. Three anatomical landmarks (insertion m. serratus anterior on 5th rib; transverse process of 2th and 7th vertebra) were used as an anteroposterior cutting plane to define the STGS. The upper part of the STG was defined as rib 2-5 and the lower part as 5-8. Next, in MATLAB ®, a script was used to create the sphere with best fit for upper and lower parts of STGS. The Root-Square-Mean Error (RSME) (mm) between two closest points on the fitted sphere and the STGS of both parts were calculated to determine the goodness-of-fit. RESULTS The RSME was found to be significantly lower for the area ribs 2-5 (mean 7.85 mm, SD 1.86) compared the area of ribs 5-8 (mean 10.08 mm, SD 1.90). CONCLUSION The STGS of the upper thoracic wall (2-5) is more spherical shaped than the STGS of the lower thoracic wall (rib 5-8).
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Affiliation(s)
- Tomas Paquet
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Robin Van Den Broecke
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Stijn Casier
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Jan Van Houcke
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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Bassens D, Decock T, Van Tongel A, De Wilde L. Long-term results of the Delta Xtend reverse shoulder prosthesis. J Shoulder Elbow Surg 2019; 28:1091-1097. [PMID: 30713067 DOI: 10.1016/j.jse.2018.11.043] [Citation(s) in RCA: 15] [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: 07/29/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty has become the standard treatment for cuff tear arthropathy and complex fractures of the proximal humerus. The Delta Xtend prosthesis (DePuy Synthes, Warsaw, IN, USA) was launched in 2006 and has shown good short-term results. Longer-term results are not yet available. METHODS There were 126 primary Delta Xtend prostheses implanted in our center by 1 surgeon from October 2006 until December 2009. Of these, 38 patients died, 12 were lost to follow-up, and 2 needed early revision of the prosthesis. Follow-up of at least 8 years was available for 74 patients. At preoperative and postoperative visits, shoulder function and pain were evaluated using the age- and sex-adjusted Constant-Murley score (aCS). The satisfaction rate was evaluated on a visual analog scale (VAS). RESULTS The mean follow-up in our population was 113.1 months. The mean aCS was 44.6% (standard deviation [SD], 19.2) preoperatively. It increased significantly (P < .001) after surgery to 75.8% (SD, 12.5) at 3 months and 91.1% (SD, 11.8) at 5 years. At the latest follow-up, the mean aCS was only 79.9% (SD, 17.7), which was significantly lower (P = .002) than the aCS at 5 years postoperatively. An overall survival rate of more than 97% was seen at 8 years of follow-up. CONCLUSION This study confirms that the promising short-term results of the Delta Xtend prosthesis can be extended in the longer-term. However, further follow-up will be necessary to check whether the statistically significant decrease in the Constant-Murley score at latest follow-up, which was driven by a decrease in range of motion and power, continues or not.
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Affiliation(s)
- David Bassens
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Decock
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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Peeters I, De Wilde L, Van Tongel A. Comments on: "The Nice knot as an improvement on current knot options: A mechanical analysis" of P. Collin, E. Laubster, P.J. Denard, F.A. Akuè, A. Lädermann published in Orthop Traumatol Surg Res. 2016 May;102(3):293-6. Orthop Traumatol Surg Res 2018; 104:935. [PMID: 30076937 DOI: 10.1016/j.otsr.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Ian Peeters
- Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium.
| | - Lieven De Wilde
- Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
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Aben A, De Wilde L, Hollevoet N, Henriquez C, Vandeweerdt M, Ponnet K, Van Tongel A. Tennis elbow: associated psychological factors. J Shoulder Elbow Surg 2018; 27:387-392. [PMID: 29433642 DOI: 10.1016/j.jse.2017.11.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The etiology of tennis elbow is multifactorial. Overuse of the wrist extensors along with anatomic factors, such as flexibility problems, aging, and poor blood circulation, may play a role. This study investigated whether patients with tennis elbow have a different psychological profile compared with healthy controls. METHODS Patients with clinical signs of tennis elbow, consulting at the Ghent University Hospital between September 2015 and January 2017, were offered a paper-and-pencil questionnaire about Big Five personality traits, perfectionism, anxiety, depression, work satisfaction, and working conditions. Healthy controls in the same risk group were offered the same questionnaires. RESULTS We recruited 69 patients (35 men, 34 women) and 100 controls (44 men, 56 women). Tennis elbow patients scored significantly lower on the personality traits extraversion and agreeableness. Men, in particular, scored significantly higher on perfectionism and were more likely to develop an anxiety disorder or a depression. Concerning work, patients indicated a significantly higher workload (especially men) and a significantly lower autonomy (especially women). Female patients also indicated less contact with colleagues. However, work satisfaction was relatively high in both groups. CONCLUSION The results suggest that there is a relationship between complaints related to tennis elbow and psychological characteristics.
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Affiliation(s)
- Aurelie Aben
- Department of Orthopedics and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopedics and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Nadine Hollevoet
- Department of Orthopedics and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Carlos Henriquez
- Federal Agency for Occupational Risks, Fedris, Brussels, Belgium
| | - Marc Vandeweerdt
- Federal Agency for Occupational Risks, Fedris, Brussels, Belgium
| | - Koen Ponnet
- Department of Communication Sciences, IMEC-MICT Ghent University, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopedics and Traumatology, University Hospital Ghent, Ghent, Belgium.
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Van Tongel A, Toussaint A, Herregods S, Van Damme S, Marrannes J, De Wilde L. Anatomically based classification of medial clavicle fractures. Acta Orthop Belg 2018; 84:62-67. [PMID: 30457501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Medial clavicle fractures represent less than 5% of all clavicle injuries. The purpose of this study was to evaluate reliability of a new anatomically based (AB) classification system compared to other classification systems and to evaluate the clinical outcome of nonoperative treated fractures. 55 acute medial clavicle fractures (55 patients) were 3D reconstructed and evaluated using the Edinburgh (ED), Throckmorton (TR) and new AB classification. The AB classification classified the fracture as medial (Type 1) or lateral (Type 2) to the costoclavicular ligament and no or minimal displaced (Type A) or displaced (Type B). Next, a consecutive retrospective clinical evaluation of 38 of these patients was performed using the Oxford Shoulder and Constant Score. An anatomically based classification shows the highest inter- and intra-observer reliability. In case the fracture line originate medial to the costoclavicular ligament and is displaced the Constant and Oxford scores are significantly less.
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Jacxsens M, Karns MR, Henninger HB, Drew AJ, Van Tongel A, De Wilde L. Guidelines for humeral subluxation cutoff values: a comparative study between conventional, reoriented, and three-dimensional computed tomography scans of healthy shoulders. J Shoulder Elbow Surg 2018; 27:36-43. [PMID: 28739298 DOI: 10.1016/j.jse.2017.06.005] [Citation(s) in RCA: 17] [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: 04/04/2017] [Revised: 05/30/2017] [Accepted: 06/08/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The humeral subluxation index (HSI) is frequently assessed on computed tomography (CT) scans in conditions of the shoulder characterized by humeral displacement. An arbitrarily set HSI cutoff value of 45% for anterior subluxation and 55% for posterior subluxation has been widely accepted. We studied whether mean values and thresholds of humeral subluxation, in relation to the glenoid and scapula, were influenced by different imaging modalities. METHODS The HSIs referenced to the scapula (SHSI) and glenoid (GHSI) were compared between conventional CT scans, CT scans reoriented into the corresponding reference plane (ie, scapular plane for the SHSI and glenoid center plane for the GHSI), and 3-dimensional (3D) CT reconstructions of 120 healthy shoulders. The 95% normal range determined the cutoff values of humeral subluxation. RESULTS The SHSI thresholds for conventional, reoriented, and 3D CT scans were 33%-61%, 44%-68%, and 49%-61%, respectively. A different mean SHSI was found for each imaging modality (conventional, 47%; reoriented, 56%; 3D, 55%; P ≤ .014), with the conventional SHSI showing an underestimation in 89% of the cases. GHSI thresholds for conventional, reoriented, and 3D CT scans were 40%-61%, 44%-56%, and 46%-54%, respectively. The mean GHSI did not differ between each imaging modality (conventional, 51%; reoriented, 50%; 3D, 50%; P = .146). CONCLUSIONS The SHSI and GHSI are susceptible to different imaging modalities with consequently different cutoff values. The redefined HSI cutoff values guide physicians in the evaluation of humeral subluxation in conditions characterized by humeral displacement, depending on the available image data.
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Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Michael R Karns
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Alex J Drew
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
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Van Tongel A, De Wilde L, Huish S, Schuind F. Virtual 3D planning and patient specific surgical guides for corrective osteotomy of the clavicle : report of three cases. Acta Orthop Belg 2017; 83:297-303. [PMID: 30399994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although many clavicular malunions result in minimal functional deficit, in some symptomatic cases a corrective osteotomy might be necessary. Recently, computer-assisted surgical planning combined with patient-specific surgical guides was introduced as a powerful technology with the potential to improve the accuracy, efficiency, and consistency of corrective osteotomies, as shown for osteotomies in other anatomical regions. We describe the use of this technique in three cases of clavicular malunion.
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Jacxsens M, Van Tongel A, Henninger HB, Tashjian RZ, De Wilde L. The three-dimensional glenohumeral subluxation index in primary osteoarthritis of the shoulder. J Shoulder Elbow Surg 2017; 26:878-887. [PMID: 27914847 DOI: 10.1016/j.jse.2016.09.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/20/2016] [Accepted: 09/29/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Assessment of glenohumeral subluxation is essential in preoperative planning of total shoulder arthroplasty. The purpose of this study was to evaluate a 3-dimensional (3D) glenohumeral subluxation index (GHSI) in shoulders with primary osteoarthritis (OA) and its relationship with morbid glenoid retroversion. METHODS The 3D computed tomography reconstructions of 120 healthy shoulders and 110 shoulders with primary glenohumeral arthritis (OA group), classified according to Walch's glenoid morphology, were analyzed. The 3D GHSI was assessed by measuring posterior decentering of the humeral head in relation to the native glenoid in each subject, and its correlation to morbid glenoid version was calculated. RESULTS The reproducible 3D GHSI (intraclass correlation coefficients ≥ 0.842) showed a posterior decentering of the humeral head in the OA population and in each type of glenoid morphology (P ≤ .005). A moderate correlation was observed in the OA group (r = -0.542; P < .001), but weak linear relationships were found for different glenoid morphology types (r between 0.041 and -0.307). Type A shoulders (r = -0.375; P = .006) correlated better than type B shoulders (r = -0.217; P = .104). After shoulders were subcategorized according to a threshold for 3D subluxation, the posteriorly subluxated group increased its correlation (r = -0.438; P < .001), whereas the centered shoulders still exhibited no relationship (r = -0.192; P = .329). CONCLUSIONS Posterior humeral head decentering in relation to the native glenoid is present in each glenoid morphology type. Grouping measures according to morphology type and 3D subluxation showed at best moderate correlations between morbid version and 3D GHSI.
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Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland.
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Heath B Henninger
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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Leuridan S, Goossens Q, Pastrav L, Van Tongel A, De Wilde L, Debeer P, Denis K, Desmet W, Vander Sloten J. A nondestructive method to verify the glenosphere-baseplate assembly in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25:e156-65. [PMID: 27079218 DOI: 10.1016/j.jse.2016.01.021] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid dissociation is a rare postoperative complication in reverse shoulder arthroplasty that has severe consequences for the patient and requires revision in most cases. A mechanically compromised Morse taper is hypothesized to be the main cause of this complication, with bony impingements and soft tissue interpositioning being cited as the most important problems. Intraoperative assessment of the taper assembly is challenging. Current methods require applying considerable torque to the glenosphere or relying on radiographs. MATERIALS AND METHODS This in vitro study demonstrates how the assembly quality can be accurately determined in a nondestructive way by exploiting the implant-specific relation between screw and Morse taper characteristics by measuring the angular rotation-torque curve. RESULTS The feasibility of the method is demonstrated on 2 reverse implant models. Several data features that can statistically discriminate between optimal and suboptimal assemblies are proposed. CONCLUSION Suboptimal assemblies can be detected using the method presented, which could easily be integrated in the current surgical workflow. Clinical recommendations based on the method's rationale are also presented, allowing detection of the most severe defect cases with surgical instruments currently in use.
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Affiliation(s)
- Steven Leuridan
- Biomechanics Division, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
| | - Quentin Goossens
- Health Engineering Technology, Campus Groep T, KU Leuven, Leuven, Belgium
| | - Leonard Pastrav
- Health Engineering Technology, Campus Groep T, KU Leuven, Leuven, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Philippe Debeer
- Department of Orthopedic Surgery, Leuven University Hospitals, Pellenberg, Belgium
| | - Kathleen Denis
- Health Engineering Technology, Campus Groep T, KU Leuven, Leuven, Belgium
| | - Wim Desmet
- Production Engineering, Machine Design and Automation Division, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Division, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
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Decock M, De Wilde L, Vanden Bossche L, Steyaert A, Van Tongel A. Incidence and aetiology of acute injuries during competitive road cycling. Br J Sports Med 2016; 50:669-72. [PMID: 26968218 DOI: 10.1136/bjsports-2015-095612] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite the ever-increasing popularity of bicycle racing, the high perceived risk of acute injuries and the recent media attention, studies of acute injuries in road cyclists are rather scarce. The goal of this study is to evaluate the incidence, aetiology and patterns of acute injuries in non-professional competitive road cyclists during cycling races in Flanders. MATERIAL AND METHODS All acute injuries that occurred during competition in Flanders in 2002 and 2012, collected in the injury registry, were analysed. The incidence, injury rate, diagnosis, circumstances and level of performance were evaluated. RESULTS A total of 777 documented reports of accidents (1230 injuries) were retrieved for the years 2002 and 2012. There was no significant difference between incidence and injury rate between 2002 and 2012. There was a strong significant difference in the incidence between the different levels of performance in both seasons. Severe injuries were seen in 29.5% in 2002 and in 30.1% in 2012. The most common location of a severe injury was the hand. Collision with another rider was the most common cause of injury. CONCLUSIONS Almost 1 out of 6 non-professional competitive road cyclists had an accident during cycling races in 2002 and 2012 in Flanders and collision with other riders was the most important cause of a crash. The most common lesion was abrasion, but almost one out of three riders had a severe injury.
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Affiliation(s)
- Mathieu Decock
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Luc Vanden Bossche
- Physical and Rehabilitation Medicine, Sports Medicine Centre, Ghent University Hospital, Belgium
| | - Adelheid Steyaert
- Physical and Rehabilitation Medicine, Sports Medicine Centre, Ghent University Hospital, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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Van Tongel A, Piepers I, De Wilde L. The significance of the clavicle on shoulder girdle function. J Shoulder Elbow Surg 2015; 24:e255-9. [PMID: 25847517 DOI: 10.1016/j.jse.2015.02.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cleidocranial dysplasia (CCD) can have a congenital partial or total absence of the clavicle. The aim of this study was to evaluate the functional shoulder score in these patients. MATERIAL AND METHODS Patients with CCD who were members of a social media group were invited to take part in an Internet-based survey. The questionnaire was composed of 3 general questions, a question concerning partial or total absence of the clavicle, and 3 patient-based shoulder scores (American Shoulder and Elbow Surgeons score; shortened Disabilities of the Arm, Shoulder, and Hand score; and patient-based Constant-Murley score). RESULTS Thirty-six patients (27 women, 9 men) with a mean age of 40 years participated in the survey; 17 patients had a bilateral absence, 16 patients had a bilateral partial absence, and 3 patients had a total absence on one side and a partial absence of the clavicle on the other side. The average patient-based Constant-Murley score was 79; shortened Disabilities of the Arm, Shoulder, and Hand score, 11; and American Shoulder and Elbow Surgeons score, 93. There was no significant difference in the scores between left and right. There was no correlation between partial and total absences and the shoulder scores. CONCLUSION Patients with self-reported CCD are subjectively normal to their peers when they are evaluated with 3 common shoulder scores. There was no correlation between partial and total absences and the shoulder scores.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
| | - Iwein Piepers
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
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Jacxsens M, Van Tongel A, Willemot LB, Mueller AM, Valderrabano V, De Wilde L. Accuracy of the glenohumeral subluxation index in nonpathologic shoulders. J Shoulder Elbow Surg 2015; 24:541-6. [PMID: 25441558 DOI: 10.1016/j.jse.2014.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 06/23/2014] [Accepted: 07/28/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Correction of posterior humeral subluxation, measured by the humeral subluxation index (HSI) according to Walch, is necessary in total shoulder arthroplasty to prevent early loosening. The 3-dimensional (3D) measurement of the shoulder is becoming well accepted and common practice as it overcomes positional errors to which 2-dimensional (2D) glenohumeral measurements are prone. The first objective was to describe the HSI in a nonpathologic population with the 2D HSI according to Walch and a newly described 3D HSI method. The second objective was to compare both measuring methods with each other. METHODS In 151 nonpathologic shoulders, the 2D HSI was measured on the midaxial computed tomography scan cut of the scapula. The 3D HSI, based on the native glenoid plane, was defined as [formula in text], in which X is the projection of the center of the humeral head to the anteroposterior axis of the glenoid fossa and R is the radius of the humeral head. Both measuring methods were compared with each other. Correlation was determined. Interobserver and intraobserver reliability of the 3D HSI was measured. RESULTS The mean 3D HSI (51.5% ± 2.7%) was significantly (P < .001) more posterior than the mean 2D HSI (48.7% ± 5.2%), with a mean difference of 2.9% ± 5.6%. No correlation was found between the 2D and 3D HSI. The interobserver and intraobserver reliability was excellent. CONCLUSION The 2D HSI seems to underestimate the humeral subluxation compared with a 3D reliable equivalent.
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Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Laurent B Willemot
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Andreas M Mueller
- Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
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Van Tongel A, Karelse A, Berghs B, Van Isacker T, De Wilde L. Diagnostic value of active protraction and retraction for sternoclavicular joint pain. BMC Musculoskelet Disord 2014; 15:421. [PMID: 25496003 PMCID: PMC4295279 DOI: 10.1186/1471-2474-15-421] [Citation(s) in RCA: 3] [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: 10/28/2014] [Accepted: 12/01/2014] [Indexed: 12/20/2022] Open
Abstract
Background Sternoclavicular joint (SCJ) arthropathy is an uncommon cause of mechanical pain. The aim of this study is to evaluate the diagnostic value of two active clinical tests for localizing the sternoclavicular joint as the source of mechanical pain. Methods All patients between June 2011 and October 2013 that visited the orthopedic departments of three hospitals with atraumatic pain in the area of the SC joint were evaluated. Local swelling, pain at palpation, pain during arm elevation and two newly described tests (pain during active scapular protraction and retraction) were evaluated. CT images were evaluated. The patients were then divided into two groups according to whether they had a ≥50% decrease in pain following the SCJ injection. Sensitivity and specificity for local swelling, the four clinical tests and CT-scan were measured. Results Forty eight patients were included in this study and SC joint pain was confirmed in 44. The tests with highest sensitivity were pain on palpation, (93% sensitivity) and pain during active scapular protraction (86%). CT-scan showed a sensitivity of 84%. Local swelling showed a high specificity (100%). Conclusion Pain at the SCJ during active scapular protraction is a good clinical diagnostic tool for SC arthropathy. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-421) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
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Cools AM, De Wilde L, Van Tongel A, Ceyssens C, Ryckewaert R, Cambier DC. Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. J Shoulder Elbow Surg 2014; 23:1454-61. [PMID: 24726484 DOI: 10.1016/j.jse.2014.01.006] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [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: 10/25/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder range of motion (ROM) and strength measurements are imperative in the clinical assessment of the patient's status and progression over time. The method and type of assessment varies among clinicians and institutions. No comprehensive study to date has examined the reliability of a variety of procedures based on different testing equipment and specific patient or shoulder position. The purpose of this study was to establish absolute and relative reliability for several procedures measuring the rotational shoulder ROM and strength into internal (IR) and external (ER) rotation strength. METHODS Thirty healthy individuals (15 male, 15 female), with a mean age of 22.1 ± 1.4 years, were examined by 2 examiners who measured ROM with a goniometer and inclinometer and isometric strength with a hand-held dynamometer (HHD) in different patient and shoulder positions. Relative reliability was determined by intraclass correlation coefficients (ICC). Absolute reliability was quantified by standard error of measurement (SEM) and minimal detectable change (MDC). Systematic differences across trials or between testers, as well as differences among similar measurements under different testing circumstances, were analyzed with dependent t tests or repeated-measures analysis of variance in case of 2 or more than 2 conditions, respectively. RESULTS Reliability was good to excellent for IR and ER ROM and isometric strength measurements, regardless of patient or shoulder position or equipment used (ICC, 0.85-0.99). For some of the measurements, systematic differences were found across trials or between testers. The patient's position and the equipment used resulted in different outcome measures. CONCLUSIONS All procedures examined showed acceptable reliability for clinical use. However, patient position and equipment might influence the results.
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Affiliation(s)
- Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium.
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium
| | - Charlotte Ceyssens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium
| | - Robin Ryckewaert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium
| | - Dirk C Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium
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Van Tongel A, Valcke J, Piepers I, Verschueren T, De Wilde L. Relationship of the Medial Clavicular Head to the Manubrium in Normal and Symptomatic Degenerated Sternoclavicular Joints. J Bone Joint Surg Am 2014; 96:e109. [PMID: 24990983 DOI: 10.2106/jbjs.m.00623] [Citation(s) in RCA: 8] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clavicular prominence is common in patients with symptomatic degenerative sternoclavicular arthritis. It is unclear if this is caused by enlargement or subluxation of the clavicle. The aim of this report is to describe a reproducible measurement technique to evaluate the relationship of the medial clavicular head to the manubrium. METHODS One hundred normal sternoclavicular joints, twenty-five sternoclavicular joints with symptomatic degenerative arthritis, and twenty-five non-symptomatic sternoclavicular joints on the contralateral side were studied with three-dimensional (3D) reconstruction with use of computer modeling. The greatest width (anterior-posterior distance) and height (superior-inferior distance) of the clavicle in the sagittal plane were measured, and the positions of the anterior and superior borders of the medial clavicle and their distances to the frontal and axial planes, respectively, were evaluated. The ratio of the anterior-posterior distance to the anterior-frontal plane distance was measured to evaluate the anterior-posterior position of the clavicle and the ratio of the superior-inferior distance to the superior-axial plane distance was measured to evaluate its superoinferior position. If the ratio was not in the 95% normal range, the clavicle was defined as subluxated. The reproducibility of this technique was evaluated on the basis of the interobserver and intraobserver reliability. RESULTS This technique showed good interobserver and intraobserver reliability. The mean anterior-posterior and superior-inferior distances were significantly larger in association with symptomatic sternoclavicular arthritis than in the normal sternoclavicular joints (p < 0001). The clavicle was subluxated anteriorly in twenty-two of the twenty-five cases of symptomatic sternoclavicular arthritis, but it was not subluxated superiorly. CONCLUSIONS The medial clavicular head in patients with degenerative sternoclavicular arthritis is significantly larger than it is in the normal population, and it is usually subluxated anteriorly.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Jens Valcke
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Iwein Piepers
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Thomas Verschueren
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail address for A. Van Tongel:
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Piepers I, Boudt P, Van Tongel A, De Wilde L. Evaluation of the muscle volumes of the transverse rotator cuff force couple in nonpathologic shoulders. J Shoulder Elbow Surg 2014; 23:e158-62. [PMID: 24342371 DOI: 10.1016/j.jse.2013.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 07/09/2013] [Revised: 09/22/2013] [Accepted: 09/26/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The balance between the subscapularis muscle and the infraspinatus/teres minor muscles, often referred to as the rotator cuff transverse force couple (TFC), has been proposed to be a critical component for normal shoulder function. The relationship between the muscle volume and the power means that TFC can be evaluated with the measurement of the muscle volume of the subscapularis muscle and the infraspinatus/teres minor. The aim of this study is to evaluate an innovative computed tomography (CT)-based technique to measure the muscle volume and to evaluate if there is a significant difference between muscle volumes of both the subscapularis muscle and the infraspinatus/teres minor in nonpathologic shoulders. MATERIALS AND METHODS CT images of 27 shoulders (21 patients) with a full scapula and a proximal humeral head were evaluated. Two volume masks (subscapularis and infraspinatus/teres minor) were calculated on the basis of the assigned muscle contours on the transverse slices. The intraobserver and interobserver correlation coefficient was calculated. RESULTS The intraobserver and interobserver correlation coefficient was excellent. The correlation between the anterior and posterior part of the TFC was strong. There was no significant difference between the volume masks. CONCLUSIONS Muscle volume of the TCF can be quantified using CT images. In nonpathologic shoulders, there is no significant difference between the muscle volume of the anterior (subscapularis) and posterior part (teres minor/infraspinatus) of the TFC.
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Affiliation(s)
- Iwein Piepers
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Pieter Boudt
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
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De Wilde L, Dayerizadeh N, De Neve F, Basamania C, Van Tongel A. Fully uncemented glenoid component in total shoulder arthroplasty. J Shoulder Elbow Surg 2013; 22:e1-7. [PMID: 23619247 DOI: 10.1016/j.jse.2013.01.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 10/21/2012] [Revised: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Loosening of the glenoid component remains the most common problem in total shoulder arthroplasty. It has been described that the round-backed, all-polyethylene components with cemented peg fixation perform better biomechanically and clinically than flat-backed, metal-backed, or keeled components. However, side effects of cementing have been described. We hypothesized that cementing of a specific type of all-polyethylene glenoid component with 3 peripheral pegs and 1 central anchor peg is not necessary to obtain good clinical and radiologic results. MATERIALS AND METHODS Thirty-four shoulders (34 patients), with a mean follow-up of 28.3 months, were evaluated clinically with the Constant-Murley score and the SF-12 Health Survey score. The fixation of the glenoid component was evaluated with computed tomography scan. RESULTS The Constant-Murley score increased from 40.2 points (range, 13-73 points) preoperatively to 72 points (range, 54-93 points) postoperatively. The SF-12 Physical Component Summary score was 45, and the SF-12 Mental Component Summary score was 50. No signs of loosening were seen around the pegs or glenoid in 30 shoulders. Signs of loosening were seen around the central anchor peg and the peripheral pegs in 4 shoulders. There was no statistical difference between the clinical outcome of patients with and without signs of loosening. CONCLUSION The clinical and radiologic evaluation of an uncemented all-polyethylene glenoid is promising, with good clinical results and with no signs of loosening in 88% of the patients on computed tomography scans.
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Affiliation(s)
- Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
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Van Tongel A, Van Hoof T, Pouliart N, Debeer P, D'Herde K, De Wilde L. Arthroscopy of the sternoclavicular joint: an anatomic evaluation of structures at risk. Surg Radiol Anat 2013; 36:375-81. [PMID: 23995518 DOI: 10.1007/s00276-013-1195-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 08/19/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Recently, arthroscopy of the sternoclavicular joint (SCJ) has been described in clinical setting. The aim of this study is to examine the accessibility and safety of the SCJ by arthroscopy in a cadaveric model. MATERIALS AND METHODS An inferolateral and superomedial portal to the SCJ was created in 20 cadaveric specimens. After debridement, the specimens were dissected with a needle positioned in the portal tracts. The distance between the needles and bony landmarks, tendons and ligaments were measured. The integrity of the posterior capsule was evaluated macroscopically. In eight specimens, after anterior dissection, the needles were replaced by K-wires that perforated the posterior capsule to evaluate the distance to the neurovascular structures behind the SCJ. RESULTS Both portals were found to be safe while allowing good access to the joint. The superomedial portal went through the tendon of the sternocleidomastoideus muscle and the inferolateral portal through the pectoralis major muscle. The portals entered the capsule medial and lateral to the anterior sternoclavicular ligament. The posterior capsule was never perforated during debridement. The perforating K-wires, however, usually perforated either a major vein or artery, but were at a safe distance from the vagal nerve. CONCLUSIONS In this cadaver study, arthroscopy of the sternoclavicular joint could be used as a minimally invasive procedure allowing debridement of the joint without damaging the posterior capsule of the joint. If the capsule is inadvertently be breached, a major risk of neurovascular damage exists. We advise to have a backup of a cardiothoracic surgeon when performing this procedure.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium,
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Van Tongel A, De Wilde L. Regarding "Long-term follow-up of cases of rotator cuff tear treated conservatively". J Shoulder Elbow Surg 2013; 22:e16. [PMID: 23352475 DOI: 10.1016/j.jse.2012.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/17/2012] [Indexed: 02/01/2023]
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Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res 2011; 469:2469-75. [PMID: 21384212 PMCID: PMC3148361 DOI: 10.1007/s11999-011-1833-y] [Citation(s) in RCA: 261] [Impact Index Per Article: 20.1] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of reverse shoulder arthroplasty has considerably increased since first introduced in 1985. Despite demonstrating early improvement of function and pain, there is limited information regarding the durability and longer-term outcomes of this prosthesis. QUESTIONS/PURPOSES We determined complication rates, functional scores over time, survivorship, and whether radiographs would develop signs of loosening. PATIENTS AND METHODS We retrospectively reviewed 527 reverse shoulder arthroplasties performed in 506 patients between 1985 and 2003. Clinical and radiographic assessment was performed in 464 patients with a minimum followup of 2 years and 148 patients with a minimum followup of 5 years (mean, 7.5 years; range, 5-17 years). Cumulative survival curves were established with end points being prosthesis revision and Constant-Murley score of less than 30 points. RESULTS Eighty-nine of 489 had at least one complication for a total of 107 complications. Survivorship free of revision was 89% at 10 years with a marked break occurring at 2 and 9 years. Survivorship to a Constant-Murley score of less than 30 was 72% at 10 years with a marked break observed at 8 years. We observed progressive radiographic changes after 5 years and an increasing frequency of large notches with long-term followup. CONCLUSIONS Although the need for revision of reverse shoulder arthroplasty was relatively low at 10 years, Constant-Murley score and radiographic changes deteriorated with time. These findings are concerning regarding the longevity of the reverse shoulder arthroplasty, and therefore caution must be exercised when recommending reverse shoulder arthroplasty, especially in younger patients. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Luc Favard
- Service Orthopedie Traumatologie, 1 CHU Trousseau, 37044 Tours Cedex, France
| | | | - Cécile Nerot
- Hôpital Maison Blanche, Orthopédie, Reims, France
| | | | - Lieven De Wilde
- Kliniek voor Orthopedie, Fysische Geneeskunde en Revalidatie, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Daniel Mole
- Clinique de Traumatologie et Orthopédie, Nancy, France
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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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Van Tongel A, De Wilde L. Sternoclavicular joint injuries: a literature review. Muscles Ligaments Tendons J 2011; 1:100-105. [PMID: 23738255 PMCID: PMC3666473] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Traumatic sternoclavicular (SC) joint injuries are rare. The goal of this literature review was to evaluate the available literature on the treatment of traumatic anterior and posterior SC (fracture-) dislocations in adults and children. In adults, anterior dislocations are most commonly treated by nonoperative means. Closed reduction can be attempted but is associated with a high recurrence rate. For posterior dislocations, closed reduction is usually more successful. Children usually present with displaced physeal fractures, as true dislocations probably do not occur in a skeletally immature population. Anterior displacement can easily be reduced but it is difficult, if not impossible, to maintain the reduction. In contrast with the recommendations in adults, ORIF with the use of absorbable sutures can be indicated in these cases. No consensus exists on the recurrence of posterior displacement after closed reduction. If closed reductions fails, operative treatment is indicated, using the same technique as in anterior displacement.
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Affiliation(s)
- Alexander Van Tongel
- Corresponding author: Alexander Van Tongel, Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium, e-mail:
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De Wilde L, Defoort S, Verstraeten TRGM, Speeckaert W, Debeer P. A 3D-CT scan study of the humeral and glenoid planes in 150 normal shoulders. Surg Radiol Anat 2011; 34:743-50. [DOI: 10.1007/s00276-011-0836-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
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Middernacht B, Winnock de Grave P, Van Maele G, Favard L, Molé D, De Wilde L. What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy? J Orthop Surg Res 2011; 6:1. [PMID: 21208449 PMCID: PMC3023718 DOI: 10.1186/1749-799x-6-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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: 02/06/2010] [Accepted: 01/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluates the preoperative conventional anteroposterior radiography and clinical testing in non-operated patients with cuff tear arthropathy. It analyses the radiological findings in relation to the status of the rotator cuff and clinical status as also the clinical testing in relation to the rotator cuff quality. The aim of the study is to define the usefulness of radiography and clinical examination in cuff tear arthropathy. Methods This study analyses the preoperative radiological (AP-view, (Artro-)CT-scan or MRI-scan) and clinical characteristics (Constant-Murley-score plus active and passive mobility testing) and the peroperative findings in a cohort of 307 patients. These patients were part of a multicenter, retrospective, consecutive study of the French Orthopaedic Society (SOFCOT-2006). All patients had no surgical antecedents and were all treated with prosthetic shoulder surgery for a painful irreparable cuff tear arthropathy (reverse-(84%) or hemi-(8%) or double cup-bipolar prosthesis (8%)). Results A positive significancy could be found for the relationship between clinical testing and the rotator cuff quality; between acromiohumeral distance and posterior rotator cuff quality; between femoralization and posterior rotator cuff quality. Conclusion A conventional antero-posterior radiograph can not provide any predictive information on the clinical status of the patient. The subscapular muscle can be well tested by the press belly test and the teres minor muscle can be well tested by the hornblower' sign and by the exorotation lag signs. The upward migration index and the presence of femoralization are good indicators for the evaluation of the posterior rotator cuff. An inferior coracoid tip positioning suggests rotator cuff disease.
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Affiliation(s)
- Bart Middernacht
- Ghent University Hospital, De Pintelaan 185, Ghent B-9000, Belgium.
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