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Cross RE, de Klerk HH, Hilgersom NF, Bhashyam AR, van den Bekerom MPJ. Does Literature on Elbow Arthroscopy Put Complications Into Perspective? Arthroscopy 2024; 40:1386-1388. [PMID: 38342284 DOI: 10.1016/j.arthro.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Affiliation(s)
| | - Huub H de Klerk
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Nick F Hilgersom
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abhiram R Bhashyam
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Verweij LPE, Dobbe JGG, Kerkhoffs GMMJ, Streekstra GJ, van den Bekerom MPJ, Blankevoort L, van Deurzen DFP. Minimal but potentially clinically relevant anteroinferior position of the humeral head following traumatic anterior shoulder dislocations: A 3D-CT analysis. J Orthop Res 2024. [PMID: 38465730 DOI: 10.1002/jor.25831] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
In unstable shoulders, excessive anteroinferior position of the humeral head relative to the glenoid can lead to a dislocation. Measuring humeral head position could therefore be valuable in quantifying shoulder laxity. The aim of this study was to measure (1) position of the humeral head relative to the glenoid and (2) joint space thickness during passive motion in unstable shoulders caused by traumatic anterior dislocations and in contralateral uninjured shoulders. A prospective cross-sectional CT-study was performed in patients with unilateral anterior shoulder instability. Patients underwent CT scanning of both injured and uninjured side in supine position (0° abduction and 0° external rotation) and in 60°, 90°, and 120° of abduction with 90° of external rotation without an external load. Subsequently, 3D virtual models were created of the humerus and the scapula to create a glenoid coordinate system to identify poster-anterior, inferior-superior, and lateral-medial position of the humeral head relative to the glenoid. Joint space thickness was defined as the average distance between the subchondral bone surfaces of the humeral head and glenoid. Fifteen consecutive patients were included. In supine position, the humeral head was positioned more anteriorly (p = 0.004), inferiorly (p = 0.019), and laterally (p = 0.021) in the injured compared to the uninjured shoulder. No differences were observed in any of the other positions. A joint-space thickness map, showing the bone-to-bone distances, identified the Hill-Sachs lesion footprint on the glenoid surface in external rotation and abduction, but no differences on average joint space thickness were observed in any position.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
| | - Johannes G G Dobbe
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
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Verweij LPE, Yamamoto N, Arino A, Kawakami J, Kerkhoffs GMMJ, van Deurzen DFP, van den Bekerom MPJ, Aizawa T. Statistical shape models that predict native glenoid width based on glenoid height are inaccurate in their current form: A cross-sectional study. J Shoulder Elbow Surg 2024:S1058-2746(24)00158-7. [PMID: 38467182 DOI: 10.1016/j.jse.2024.01.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The extent of measurement errors of statistical shape models that predict native glenoid width based on glenoid height to subsequently determine the amount of anterior glenoid bone loss is unclear. Therefore, the aim of this study was to (1) create a statistical shape model based on glenoid height and width measured on 3D-CT and determine the accuracy through measurement errors and (2) determine measurement errors of existing 3D-CT statistical shape models. MATERIALS AND METHODS A retrospective cross-sectional study included all consecutive patients that underwent CT-imaging before undergoing primary surgical treatment of traumatic anterior shoulder dislocation between 2007 and 2022 at the Tohoku University Hospital and affiliated hospitals. Patients were included when instability was unilateral and CT scans of both the injured and contralateral uninjured shoulder were available. 3D segmentations were created and glenoid height and width of the injured and contralateral uninjured side (gold standard) were measured. Accuracy was determined through measurement errors, which were defined as a percentage error deviation from native glenoid width (contralateral uninjured glenoid), calculated as measurement error = ((estimated glenoid width with a statistical shape model - native glenoid width) / native glenoid width) x 100%. A linear regression analysis was performed to create a statistical shape model based on glenoid height according to the formula native glenoid width = a * glenoid height + b. RESULTS The diagnosis and procedure codes identified 105 patients, of which 69 (66%) were eligible for inclusion. Glenoid height demonstrated a very strong correlation (r= 0.80) with native glenoid width. The linear regression formula based on this cohort was native glenoid width = 0.75 * glenoid height - 0.61 and demonstrated an absolute average measurement error of 5 ± 4%. The formulas by Giles et al, Chen et al and Rayes et al demonstrated absolute average measurement errors of 10 ± 7%, 6 ± 5% and 9 ± 6%, respectively CONCLUSION: Statistical shape models that estimate native glenoid width based on glenoid height demonstrate unacceptable measurement errors, despite a high correlation. Therefore, great caution is advised when using these models to determine glenoid bone loss percentage. To minimize errors caused by morphological differences, preference goes to methods that use the contralateral side as reference.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan; Amsterdam UMC, location AMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands.
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Atsushi Arino
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, location AMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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van Iersel TP, Verweij LPE, van den Bekerom MPJ. Can We Conclude That the Arthroscopic Bankart Repair and Open Latarjet Procedure Show Similar Rates of Return to Play and How Should This Conclusion Be Interpreted? Arthroscopy 2024; 40:655-657. [PMID: 38206249 DOI: 10.1016/j.arthro.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/27/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Theodore P van Iersel
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands; Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Lukas P E Verweij
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands; Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands; Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Duijn RGA, Meijering D, Vegter RJK, Albers F, Boerboom AL, Eygendaal D, van den Bekerom MPJ, Stevens M, Schelhaas R, Lamoth CJC, Murgia A. Elbow joint loads during simulated activities of daily living: implications for formulating recommendations after total elbow arthroplasty. J Shoulder Elbow Surg 2024; 33:145-155. [PMID: 37689102 DOI: 10.1016/j.jse.2023.07.042] [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: 05/22/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Overloading of the elbow joint prosthesis following total elbow arthroplasty can lead to implant failure. Joint moments during daily activities are not well contextualized for a prosthesis's failure limits, and the effect of the current postoperative instruction on elbow joint loading is unclear. This study investigates the difference in elbow joint moments between simulated daily tasks and between flexion-extension, pronation-supination, and varus-valgus movement directions. Additionally, the effect of the current postoperative instruction on elbow joint load is examined. METHODS Nine healthy participants (age 45.8 ± 17 years, 3 males) performed 8 tasks; driving a car, opening a door, rising from a chair, lifting, sliding, combing hair, drinking, emptying cup, without and with the instruction "not lifting more than 1 kg." Upper limb kinematics and hand contact forces were measured. Elbow joint angles and net moments were analyzed using inverse dynamic analysis, where the net moments are estimated from movement data and external forces. RESULTS Peak elbow joint moments differed significantly between tasks (P < .01) and movement directions (P < .01). The most and least demanding tasks were, rising from a chair (13.4 Nm extension, 5.0 Nm supination, and 15.2 Nm valgus) and sliding (4.3 Nm flexion, 1.7 Nm supination, and 2.6 Nm varus). Net moments were significantly reduced after instruction only in the chair task (P < .01). CONCLUSION This study analyzed elbow joint moments in different directions during daily tasks. The outcomes question whether postoperative instruction can lead to decreasing elbow loads. Future research might focus on reducing elbow loads in the flexion-extension and varus-valgus directions.
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Affiliation(s)
- Roos G A Duijn
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Daniëlle Meijering
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Friederike Albers
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG Hospital, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reslin Schelhaas
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Claudine J C Lamoth
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alessio Murgia
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Pott CMJM, de Klerk HH, Priester-Vink S, Eygendaal D, van den Bekerom MPJ. Treatment Outcomes of Simple Elbow Dislocations: A Systematic Review of 1,081 Cases. JBJS Rev 2024; 12:01874474-202401000-00001. [PMID: 38181107 DOI: 10.2106/jbjs.rvw.23.00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND The treatment of simple elbow dislocations (SEDs) has become more functional last decade with a tendency to shorter immobilization of the elbow, whereas simultaneously, surgical stabilization has been promoted by some authors. The primary aim of this study was to systematically review the literature and analyze the outcomes and complications of different treatment options for acute and persistent SEDs, including operative and nonoperative treatments with varying immobilization periods. METHODS A literature search was performed based on the online medical databases MEDLINE, Embase, and the Cochrane databases. Articles presenting patients with a SED were eligible for inclusion. When an SED persists for >3 weeks, it is categorized as persistent. Various outcome measures were assessed, including the range of motion (ROM), patient-reported outcome measures, and complication rates. To get insight into the severity of complications, all complications were categorized as minor or major. The Methodological Index for Nonrandomized Studies was used to assess the methodological quality of nonrandomized studies. The risk of bias in the randomized studies was assessed with the Cochrane risk-of-bias tool. RESULTS A total of 37 articles were included with 1,081 dislocated elbows (1,078 patients). A fair quality of evidence was seen for the nonrandomized studies and a low risk of bias for the randomized study. Nonoperative treatment was administered to 710 elbows, with 244 elbows treated with early mobilization, 239 with 1- to 3-week immobilization, and 163 with ≥3-week immobilization. These groups showed a ROM flexion-extension arc (ROM F/E) of 137, 129, and 131°, respectively. Surgical treatment as open reduction and ligament repair or reconstruction was performed in 228 elbows and showed a ROM F/E of 128°. All persistent SEDs were treated surgically and showed a ROM F/E of 90°. CONCLUSION The early mobilization treatment showed the most consistent satisfactory outcomes in the literature compared with the other treatment options. Nevertheless, there remains ambiguity regarding which patients would benefit more from surgery than nonoperative treatment. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charlotte M J M Pott
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
| | - Huub H de Klerk
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, University Medical Center Groningen (UMCG) and Groningen University, Groningen, the Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Spek RWA, Spekenbrink-Spooren A, Vanhommerig JW, Jonkman N, Doornberg JN, Jaarsma RL, Jutte PC, van der Veen HC, van Noort A, van den Bekerom MPJ. Primary reverse total shoulder arthroplasty for fractures requires more revisions than for degenerative conditions 1 year after surgery: an analysis from the Dutch Arthroplasty Register. J Shoulder Elbow Surg 2023; 32:2508-2518. [PMID: 37327989 DOI: 10.1016/j.jse.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although reverse total shoulder arthroplasty (RTSA) is considered a viable treatment strategy for proximal humeral fractures, there is an ongoing discussion of how its revision rate compares with indications performed in the elective setting. First, this study evaluated whether RTSA for fractures conveyed a higher revision rate than RTSA for degenerative conditions (osteoarthritis, rotator cuff arthropathy, rotator cuff tear, or rheumatoid arthritis). Second, this study assessed whether there was a difference in patient-reported outcomes between these 2 groups following primary replacement. Finally, the results of conventional stem designs were compared with those of fracture-specific designs within the fracture group. MATERIALS AND METHODS This was a retrospective comparative cohort study with registry data from the Netherlands, generated prospectively between 2014 and 2020. Patients (aged ≥ 18 years) were included if they underwent primary RTSA for a fracture (<4 weeks after trauma), osteoarthritis, rotator cuff arthropathy, rotator cuff tear, or rheumatoid arthritis, with follow-up until first revision, death, or the end of the study period. The primary outcome was the revision rate. The secondary outcomes were the Oxford Shoulder Score, EuroQol 5 Dimensions (EQ-5D) score, numerical rating scale score (pain at rest and during activity), recommendation score, and scores assessing change in daily functioning and change in pain. RESULTS This study included 8753 patients in the degenerative condition group (mean age, 74.3 ± 7.2 years) and 2104 patients in the fracture group (mean age, 74.3 ± 7.8 years). RTSA performed for fractures showed an early steep decline in survivorship: Adjusted for time, age, sex, and arthroplasty brand, the revision risk after 1 year was significantly higher in these patients than in those with degenerative conditions (hazard ratio [HR], 2.50; 95% confidence interval, 1.66-3.77). Over time, the HR steadily decreased, with an HR of 0.98 at year 6. Apart from the recommendation score (which was slightly better within the fracture group), there were no clinically relevant differences in the patient-reported outcome measures after 12 months. Patients who received conventional stems (n = 1137) did not have a higher likelihood of undergoing a revision procedure than those who received fracture-specific stems (n = 675) (HR, 1.70; 95% confidence interval, 0.91-3.17). CONCLUSION Patients undergoing primary RTSA for fractures have a substantially higher likelihood of undergoing revision within the first year following the procedure than patients with degenerative conditions preoperatively. Although RTSA is regarded as a reliable and safe treatment option for fractures, surgeons should inform patients accordingly and incorporate this information in decision making when opting for head replacement surgery. There were no differences in patient-reported outcomes between the 2 groups and no differences in revision rates between conventional and fracture-specific stem designs.
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Affiliation(s)
- Reinier W A Spek
- Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia; Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
| | | | | | - Nini Jonkman
- Department of Epidemiology, OLVG, Amsterdam, The Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands; Shoulder and Elbow Expertise Center, Amsterdam, The Netherlands; Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Verweij LPE, Sierevelt IN, van der Woude HJ, Hekman KMC, Veeger HEJD, van den Bekerom MPJ. Surgical Intervention Following a First Traumatic Anterior Shoulder Dislocation Is Worthy of Consideration. Arthroscopy 2023; 39:2577-2586. [PMID: 37597706 DOI: 10.1016/j.arthro.2023.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
Up to 60% of patients experience recurrence after a first traumatic anterior shoulder dislocation (FTASD), which is often defined as having experienced either dislocation or subluxation. Thus surgical intervention after FTASD is worthy of consideration and is guided by the number of patients who need to receive surgical intervention to prevent 1 redislocation (i.e., number needed to treat), (subjective) health benefit, complication risk, and costs. Operative intervention through arthroscopic stabilization can be successful in reducing recurrence risk in FTASD, as has been shown in multiple randomized controlled trials. Nevertheless, there is a large "gray area" for the indication of arthroscopic stabilization, and it is therefore heavily debated which patients should receive operative treatment. Previous trials showed widely varying redislocation rates in both the intervention and control group, meta-analysis shows 2% to 19% after operative and 20% to 75% after nonoperative treatment, and redislocation rates may not correlate with patient-reported outcomes. The literature is quite heterogeneous, and a major confounder is time to follow-up. Furthermore, there is insufficient standardization of reporting of outcomes and no consensus on definition of risk factors. As a result, surgery is a reasonable intervention for FTASD patients, but in which patients it best prevents redislocation requires additional refinement.
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Affiliation(s)
- Lukas P E Verweij
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
| | - Inger N Sierevelt
- Xpert Clinics, Department of Orthopedic Surgery, Amsterdam, the Netherlands; Spaarnegasthuis Academy, Orthopedic Department, Hoofddorp, the Netherlands
| | - Henk-Jan van der Woude
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Radiology, OLVG, Amsterdam, the Netherlands
| | - Karin M C Hekman
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder Center IBC Amstelland, Amstelveen, the Netherlands
| | - H E J DirkJan Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Orthopedic Surgery, Medical Center Jan van Goyen, Amsterdam, the Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Broekman MM, Ring D, van den Bekerom MPJ. Resolution of Sleep Disturbance and Improved Functional Outcomes After Rotator Cuff Repair: Letter to the Editor. Am J Sports Med 2023; 51:NP64. [PMID: 38031744 DOI: 10.1177/03635465231202517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
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Verweij LPE, Sierevelt IN, Baden DN, Derksen RJ, van der Woude HJ, Hekman KMC, van den Bekerom MPJ. A modified Delphi study to identify which items should be evaluated in shoulder instability research: a first step in developing a core outcome set. JSES Int 2023; 7:2304-2310. [PMID: 37969539 PMCID: PMC10638565 DOI: 10.1016/j.jseint.2023.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The aim of this study was to identify items that healthcare providers and/or patients consider important to include in a questionnaire for clinical trials and cohort studies in shoulder instability research. This could serve as a basis to develop a core outcome set for shoulder instability research. Methods Healthcare providers and patients were included in a panel for a modified Delphi consensus study. The study consisted of three rounds, comprising (1) identifying items, (2) rating the importance of the items, and (3) rating the importance again after seeing a summary of the results of round two. Importance was rated on a 9-point Likert scale. Consensus was defined as ≥ 80% of the panel giving a score of 7 or higher. Results In total, 44 healthcare providers and 30 patients completed all three rounds. Round one identified 54 items. After round three, the panel reached a consensus on 11 items that should be included in a questionnaire, comprising re-dislocation (99%), instable feeling of the shoulder (96%), limitations during sport (93%), patient satisfaction with the shoulder (93%), fear/anxiety for re-dislocation (91%), range of motion (88%), return to old level of functioning (85%), performing daily activities (85%), return to sport (82%), return to work (82%), and trusting the shoulder (81%). Conclusion Healthcare providers and patients reached a consensus on 11 items that should be included in a questionnaire for shoulder instability research. These items can facilitate design and development of future clinical trials and form the basis for the development of a core outcome set.
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Affiliation(s)
- Lukas P E Verweij
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Xpert Clinics, Department of Orthopedic Surgery, Amsterdam, The Netherlands
- Spaarnegasthuis Academy, Orthopedic Department, Hoofddorp, The Netherlands
| | - David N Baden
- Emergency Department, Diakonessenhuis, Utrecht, The Netherlands
| | - Robert Jan Derksen
- Department of Trauma Surgery, Zaandam Medical Center, Zaandam, The Netherlands
| | - Henk-Jan van der Woude
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Radiology, OLVG, Amsterdam, The Netherlands
| | - Karin M C Hekman
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, The Netherlands
- Shoulder Center IBC Amstelland, Amstelveen, The Netherlands
- Department of Orthopedic Surgery, Medical Center Jan van Goyen, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Medical Center Jan van Goyen, Amsterdam, The Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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de Klerk HH, Verweij LPE, Sierevelt IN, Priester-Vink S, Hilgersom NFJ, Eygendaal D, van den Bekerom MPJ. Wide Range in Complication Rates Following Elbow Arthroscopy in Adult and Pediatric Patients: A Systematic Review. Arthroscopy 2023; 39:2363-2387. [PMID: 37146664 DOI: 10.1016/j.arthro.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To perform a systematic review of complications associated with elbow arthroscopy in adults and children. METHODS A literature search was performed in the PubMed, EMBASE, and Cochrane databases. Studies reporting complications or reoperations after elbow arthroscopy with at least 5 patients were included. Based on the Nelson classification, the severity of complications was categorized as minor or major. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized clinical trials, and nonrandomized trials were assessed using the Methodological Items for Non-randomized Studies (MINORS) tool. RESULT A total of 114 articles were included with 18,892 arthroscopies (16,815 patients). A low risk of bias was seen for the randomized studies and a fair quality for the nonrandomized studies. Complication rates ranged from 0% to 71% (median 3%; 95% confidence interval [CI], 2.8%-3.3%), and reoperation rates from 0% to 59% (median 2%; 95% CI, 1.8%-2.2%). A total of 906 complications were observed, with transient nerve palsies (31%) as the most frequent complication. According to Nelson classification, 735 (81%) complications were minor and 171 (19%) major. Forty-nine studies reported complications in adults and 10 studies in children, showing a complication rate ranging from 0% to 27% (median 0%; 95% CI, 0%-0.4%) and 0% to 57% (median 1%; 95% CI, 0.4%-3.5%), respectively. A total of 125 complications were observed in adults, with transient nerve palsies (23%) as the most frequent complication, and 33 in children, with loose bodies after surgery (45%) as the most frequent complication. CONCLUSIONS Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy. Higher complication rates are observed after more complex surgery. The incidence and type of complications can aid surgeons in patient counseling and refining surgical techniques to further reduce the complication rates. LEVEL OF EVIDENCE Level IV; systematic review of Level I-IV studies.
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Affiliation(s)
- Huub H de Klerk
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, University Medical Center Groningen (UMCG) and Groningen University, Groningen, the Netherlands.
| | - Lukas P E Verweij
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Inger N Sierevelt
- Specialized Centre for Orthopedic Research and Education (SCORE), Xpert Clinics, Orthopedic Department, Amsterdam, the Netherlands; Department of Orthopaedics, Spaarne Gasthuis Academie, Hoofddorp, the Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, the Netherlands
| | - Nick F J Hilgersom
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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Macken AA, Macken LC, Oosterhoff JHF, Boileau P, Athwal GS, Doornberg JN, Lafosse L, Lafosse T, van den Bekerom MPJ, Buijze GA. Developing a machine learning algorithm to predict the probability of aseptic loosening of the glenoid component after anatomical total shoulder arthroplasty: protocol for a retrospective, multicentre study. BMJ Open 2023; 13:e074700. [PMID: 37852772 PMCID: PMC10603397 DOI: 10.1136/bmjopen-2023-074700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Despite technological advancements in recent years, glenoid component loosening remains a common complication after anatomical total shoulder arthroplasty (ATSA) and is one of the main causes of revision surgery. Increasing emphasis is placed on the prevention of glenoid component failure. Previous studies have successfully predicted range of motion, patient-reported outcomes and short-term complications after ATSA using machine learning methods, but an accurate predictive model for (glenoid component) revision is currently lacking. This study aims to use a large international database to accurately predict aseptic loosening of the glenoid component after ATSA using machine learning algorithms. METHODS AND ANALYSIS For this multicentre, retrospective study, individual patient data will be compiled from previously published studies reporting revision of ATSA. A systematic literature search will be performed in Medline (PubMed) identifying all studies reporting outcomes of ATSA. Authors will be contacted and invited to participate in the Machine Learning Consortium by sharing their anonymised databases. All databases reporting revisions after ATSA will be included, and individual patients with a follow-up less than 2 years or a fracture as the indication for ATSA will be excluded. First, features (predictive variables) will be identified using a random forest feature selection. The resulting features from the compiled database will be used to train various machine learning algorithms (stochastic gradient boosting, random forest, support vector machine, neural network and elastic-net penalised logistic regression). The developed and validated algorithms will be evaluated across discrimination (c-statistic), calibration, the Brier score and the decision curve analysis. The best-performing algorithm will be used to create an open-access online prediction tool. ETHICS AND DISSEMINATION Data will be collected adhering to the WHO regulation on data sharing. An Institutional Review Board review is not applicable. The study results will be published in a peer-reviewed journal.
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Affiliation(s)
- Arno Alexander Macken
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
| | - Loïc C Macken
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacobien H F Oosterhoff
- Department of Engineering Systems and Services, Delft University of Technology, Delft, The Netherlands
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Locomoteur & Sport, Centre Hospitalier Universitaire de Nice, Nice, France
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Job N Doornberg
- Orthopaedic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
| | - Thibault Lafosse
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
| | - Michel P J van den Bekerom
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Geert Alexander Buijze
- Alps Surgery Institute, Clinique Generale Annecy, Annecy, France
- Department of Orthopedic Surgery, Hôpital Lapeyronie, Montpellier, France
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Macken AA, Haagmans-Suman A, Spekenbrink-Spooren A, van Noort A, van den Bekerom MPJ, Eygendaal D, Buijze GA. Corrigenda. Bone Joint J 2023; 105-B:1131. [PMID: 37777196 DOI: 10.1302/0301-620x.105b10.bjj-2023-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
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Macken AA, Haagmans-Suman A, van Spekenbrink-Spooren A, van Noort A, van den Bekerom MPJ, Eygendaal D, Buijze GA. Anterosuperior versus deltopectoral approach for primary reverse total shoulder arthroplasty. Bone Joint J 2023; 105-B:1000-1006. [PMID: 37652454 DOI: 10.1302/0301-620x.105b9.bjj-2023-0238.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims The current evidence comparing the two most common approaches for reverse total shoulder arthroplasty (rTSA), the deltopectoral and anterosuperior approach, is limited. This study aims to compare the rate of loosening, instability, and implant survival between the two approaches for rTSA using data from the Dutch National Arthroplasty Registry with a minimum follow-up of five years. Methods All patients in the registry who underwent a primary rTSA between January 2014 and December 2016 using an anterosuperior or deltopectoral approach were included, with a minimum follow-up of five years. Cox and logistic regression models were used to assess the association between the approach and the implant survival, instability, and glenoid loosening, independent of confounders. Results In total, 3,902 rTSAs were included. A deltopectoral approach was used in 54% (2,099/3,902) and an anterosuperior approach in 46% (1,803/3,902). Overall, the mean age in the cohort was 75 years (50 to 96) and the most common indication for rTSA was cuff tear arthropathy (35%; n = 1,375), followed by osteoarthritis (29%; n = 1,126), acute fracture (13%; n = 517), post-traumatic sequelae (10%; n = 398), and an irreparable cuff rupture (5%; n = 199). The two high-volume centres performed the anterosuperior approach more often compared to the medium- and low-volume centres (p < 0.001). Of the 3,902 rTSAs, 187 were revised (5%), resulting in a five-year survival of 95.4% (95% confidence interval 94.7 to 96.0; 3,137 at risk). The most common reason for revision was a periprosthetic joint infection (35%; n = 65), followed by instability (25%; n = 46) and loosening (25%; n = 46). After correcting for relevant confounders, the revision rate for glenoid loosening, instability, and the overall implant survival did not differ significantly between the two approaches (p = 0.494, p = 0.826, and p = 0.101, respectively). Conclusion The surgical approach used for rTSA did not influence the overall implant survival or the revision rate for instability or glenoid loosening.
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Affiliation(s)
- Arno A Macken
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France
| | | | | | - Arthur van Noort
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Michel P J van den Bekerom
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Geert A Buijze
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands
- Department of Orthopaedic Surgery, Montpellier University Medical Center, Lapeyronie Hospital, University of Montpellier, Montpellier, France
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Allaart LJH, Lech J, Macken AA, Kling A, Lafosse L, Lafosse T, van den Bekerom MPJ, Buijze GA. Biomodulating healing after arthroscopic rotator cuff repair: the protocol of a randomised proof of concept trial (BIOHACK). BMJ Open 2023; 13:e071078. [PMID: 37586862 PMCID: PMC10432644 DOI: 10.1136/bmjopen-2022-071078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE/INTRODUCTION Over the last decades, there has been increasing interest in biological stimulation or bioaugmentation after rotator cuff repair. So far, there is no consensus on the appropriate composition of biologicals or which patients would benefit most, and moreover, these biologicals are often expensive. However, there are other, non-pharmacological strategies that are also believed to achieve biological stimulation. This randomised controlled trial evaluates the possible cumulative effect of pragmatic application of cryobiomodulation, photobiomodulation and electrobiomodulation-collectively called biomodulation-on the bone-to-tendon healing process after rotator cuff repair. METHODS In this randomised, controlled proof of concept study, 146 patients undergoing arthroscopic repair of a full thickness posterosuperior or anterosuperior rotator cuff tear will be 1:1 randomly assigned to either a control group or to the additional biomodulation protocol group. The adjuvant biomodulation protocol consists of seven self-applicable therapies and will be administered during the first 6 weeks after surgery. Primary outcome will be healing of the rotator cuff as evaluated by the Sugaya classification on MRI at 1-year postoperatively. ETHICS AND DISSEMINATION This study has been accepted by the National Ethical Review Board CPP Sud-Est IV in France and has been registered at Clinicaltrials.gov. The results of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04618484.
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Affiliation(s)
- Laurens Jan Houterman Allaart
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - James Lech
- Radiology, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Department of Physics and Astronomy, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arno Alexander Macken
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Agathe Kling
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
| | - Laurent Lafosse
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
| | - Thibault Lafosse
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
| | - Michel P J van den Bekerom
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Geert Alexander Buijze
- Division of Orthopaedics and Trauma Surgery, Clinique Générale Annecy, Annecy, France
- Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Montpellier University Medical Center, Lapeyronie Hospital, University of Montpellier, Montpellier, France
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Welvaars K, Oosterhoff JHF, van den Bekerom MPJ, Doornberg JN, van Haarst EP. Implications of resampling data to address the class imbalance problem (IRCIP): an evaluation of impact on performance between classification algorithms in medical data. JAMIA Open 2023; 6:ooad033. [PMID: 37266187 PMCID: PMC10232287 DOI: 10.1093/jamiaopen/ooad033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
Objective When correcting for the "class imbalance" problem in medical data, the effects of resampling applied on classifier algorithms remain unclear. We examined the effect on performance over several combinations of classifiers and resampling ratios. Materials and Methods Multiple classification algorithms were trained on 7 resampled datasets: no correction, random undersampling, 4 ratios of Synthetic Minority Oversampling Technique (SMOTE), and random oversampling with the Adaptive Synthetic algorithm (ADASYN). Performance was evaluated in Area Under the Curve (AUC), precision, recall, Brier score, and calibration metrics. A case study on prediction modeling for 30-day unplanned readmissions in previously admitted Urology patients was presented. Results For most algorithms, using resampled data showed a significant increase in AUC and precision, ranging from 0.74 (CI: 0.69-0.79) to 0.93 (CI: 0.92-0.94), and 0.35 (CI: 0.12-0.58) to 0.86 (CI: 0.81-0.92) respectively. All classification algorithms showed significant increases in recall, and significant decreases in Brier score with distorted calibration overestimating positives. Discussion Imbalance correction resulted in an overall improved performance, yet poorly calibrated models. There can still be clinical utility due to a strong discriminating performance, specifically when predicting only low and high risk cases is clinically more relevant. Conclusion Resampling data resulted in increased performances in classification algorithms, yet produced an overestimation of positive predictions. Based on the findings from our case study, a thoughtful predefinition of the clinical prediction task may guide the use of resampling techniques in future studies aiming to improve clinical decision support tools.
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Affiliation(s)
- Koen Welvaars
- Corresponding Author: Koen Welvaars, MSc, Data Science Team, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands;
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Welvaars K, van den Bekerom MPJ, Doornberg JN, van Haarst EP. Evaluating machine learning algorithms to Predict 30-day Unplanned REadmission (PURE) in Urology patients. BMC Med Inform Decis Mak 2023; 23:108. [PMID: 37312177 DOI: 10.1186/s12911-023-02200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/18/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Unplanned hospital readmissions are serious medical adverse events, stressful to patients, and expensive for hospitals. This study aims to develop a probability calculator to predict unplanned readmissions (PURE) within 30-days after discharge from the department of Urology, and evaluate the respective diagnostic performance characteristics of the PURE probability calculator developed with machine learning (ML) algorithms comparing regression versus classification algorithms. METHODS Eight ML models (i.e. logistic regression, LASSO regression, RIDGE regression, decision tree, bagged trees, boosted trees, XGBoost trees, RandomForest) were trained on 5.323 unique patients with 52 different features, and evaluated on diagnostic performance of PURE within 30 days of discharge from the department of Urology. RESULTS Our main findings were that performances from classification to regression algorithms had good AUC scores (0.62-0.82), and classification algorithms showed a stronger overall performance as compared to models trained with regression algorithms. Tuning the best model, XGBoost, resulted in an accuracy of 0.83, sensitivity of 0.86, specificity of 0.57, AUC of 0.81, PPV of 0.95, and a NPV of 0.31. CONCLUSIONS Classification models showed stronger performance than regression models with reliable prediction for patients with high probability of readmission, and should be considered as first choice. The tuned XGBoost model shows performance that indicates safe clinical appliance for discharge management in order to prevent an unplanned readmission at the department of Urology.
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Affiliation(s)
- Koen Welvaars
- Data Science Team, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands.
- Department of Orthopaedic Surgery, UMCG, Groningen, Netherlands.
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, OLVG, Amsterdam, Netherlands
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, UMCG, Groningen, Netherlands
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Verweij LPE, Doornberg JN, van den Bekerom MPJ. Early Treatment of Shoulder Pathology May Be Necessary, but Let Us First Improve Patient Risk Stratification to Prevent Overtreatment. Arthroscopy 2023; 39:1123-1125. [PMID: 37019526 DOI: 10.1016/j.arthro.2023.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/28/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Lukas P E Verweij
- Academic Medical Center, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise, Amsterdam, The Netherlands
| | - Job N Doornberg
- University Medical Center, Groningen, Department of Orthopaedic & Trauma Surgery, the Netherlands; Flinders University, Department of Orthopaedic Trauma, Adelaide, Australia
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow Unit, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Verweij LPE, van Iersel TP, van Deurzen DFP, van den Bekerom MPJ, Floor S. "Nearly off-track lesions" or a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track does not seem to be accurate in predicting recurrence after an arthroscopic Bankart repair in a military population: a case-control study. J Shoulder Elbow Surg 2023; 32:e145-e152. [PMID: 36368476 DOI: 10.1016/j.jse.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND On-track lesions with a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track (nearly off-track) may predispose recurrence after arthroscopic Bankart repair (ABR) in the general population. The aim of this study was to determine if a shorter distance between the medial edge of the Hill-Sachs lesion and the medial edge of the glenoid track could accurately predict recurrence after an ABR in a high-demand military population. It was hypothesized that a shorter distance would not accurately predict recurrence. MATERIALS AND METHODS A retrospective monocenter case-control study was performed at the Dutch Central Military Hospital. Patients with an on-track Hill-Sachs lesion who underwent a primary ABR between 2014 and 2019 with a minimal follow-up of 2 years and a preoperative magnetic resonance imaging (MRI) assessment received a questionnaire. The primary outcome was recurrence, defined as a complete dislocation or subluxation. Glenoid bone loss was assessed using a linear-based method on MRI. The distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track was defined as the distance to dislocation (DTD). A receiver operating characteristic curve was created to determine the predictive value of the DTD for recurrence. Logistic regression was used to determine preoperative risk factors that predispose recurrence. Covariates were selected based on univariable analysis and included gender, body mass index, age at surgery and first dislocation, laterality, smoking habits, overhead shoulder activity during work, preoperative dislocations, sports type and level, bony or labral lesions on MRI, and DTD. RESULTS In total, 80 patients with an average follow-up of 4.8 ± 1.9 years completed the questionnaire and were included in the analyses. Seventeen patients (21%) experienced recurrence at the final follow-up. No difference in DTD was observed among patients who experienced recurrence (9 ± 4 mm) compared with patients who did not (9 ± 5 mm; P = .81). The receiver operating characteristic curve demonstrated no predictive power of DTD for recurrence (area under the curve = 0.49). Smoking at the time of surgery (odds ratio: 3.9; confidence interval: 1.2-12.7; P = .02) and overhead shoulder movement during work (odds ratio: 9.3; confidence interval: 1.1-78.0; P = .04) were associated with recurrence according to the logistic regression analysis. CONCLUSION A shorter DTD demonstrated no accuracy in predicting recurrence in a military population. Smoking at the time of surgery and overhead shoulder activity during work were associated with recurrence; however, these analyses were underpowered to draw valid conclusions.
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Affiliation(s)
- Lukas P E Verweij
- Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
| | - Theodore P van Iersel
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sebastiaan Floor
- Department of Orthopedic Surgery, Central Military Hospital, Utrecht, the Netherlands
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Broekman MM, Verstift DE, Doornberg JN, van den Bekerom MPJ. Treatment of acromioclavicular dislocations with a concomitant coracoid fracture: a systematic review of 37 patients. JSES Int 2023; 7:225-229. [PMID: 36911766 PMCID: PMC9998878 DOI: 10.1016/j.jseint.2022.12.014] [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] [Indexed: 12/30/2022] Open
Abstract
Background Acromioclavicular (AC) dislocations with a concomitant fracture of the coracoid process (CP) are rare and there is ambiguity on treatment options. This systematic review was performed to address the clinically relevant question: what are the shoulder functions, union rates, and expected time until return to daily life in patients with a dislocation of the AC joint with a concomitant CP fracture after (1) nonsurgical treatment, (2) sole fixation of the AC joint, and (3) fixation of both the AC joint and the coracoid process? Methods Studies were identified by conducting an online. Thirty records met the inclusion criteria and were suitable for data extraction. Results A total of 37 shoulders from 37 patients were included. Surgical treatment was provided to 22 out of 37 patients, and 15 patients had nonsurgical treatment. Out of the surgically treated patients, 12 patients were treated with a fixation of both the AC joint and the CP, 9 patients with a sole fixation of the AC joint, and 1 patient with a sole fixation of the CP. Conclusion Existing literature does not indicate that one treatment option is superior, and more data are needed to guide evidence-based decisions on this rare injury.
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Affiliation(s)
- Melle M Broekman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Austin at Texas, Austin, TX, USA.,Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, The Netherlands
| | - Daniel E Verstift
- Department of Orthopaedic Surgery, Shoulder and elbow unit, OLVG, Amsterdam, The Netherlands
| | - Job N Doornberg
- Department of Orthopedic Trauma Surgery, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Michel P J van den Bekerom
- Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Shoulder and elbow unit, OLVG, Amsterdam, The Netherlands
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21
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de Groot C, Verstift DE, Heisen J, van Deurzen DFP, van den Bekerom MPJ. Management of Acromioclavicular Injuries - Current Concepts. Orthop Res Rev 2023; 15:1-12. [PMID: 36814992 PMCID: PMC9940602 DOI: 10.2147/orr.s340531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Treatment of a patient with acromioclavicular joint (ACJ) injury remains challenging for orthopedic surgeons. To date, there is debate over the optimal management of ACJ injuries. This review provides an overview of assessment, treatment, and future perspectives for the treatment of and research into ACJ. Material and Methods A scoping literature review was performed. The search was built including the following terms: acromioclavicular joint injuries or dislocation, and pathophysiology, etiology, anatomy, treatment, and trauma mechanism. The papers with evidence levels 1-3 were included in the current narrative review. Results A total of 2242 potential relevant studies were identified in the searches. After removal of duplicates, 432 studies were screened on their titles and abstracts, resulting in 35 studies being included in the review, based on the eligibility criteria. Conclusion The management of acute and chronic ACJ injuries is not clarified in the current literature. However, there is currently insufficient high-level evidence for the overall treatment options for ACJ injuries. If surgical intervention is decided upon in consultation with the patient, the complications may not outweigh the benefits. The multitude of existing techniques is indicative of the uncertainty surrounding this issue, and no gold standard has yet been established for treatment methods. An ideal classification would include not only vertical and horizontal instability, but also the severity of kinematic alterations of the shoulder complex. This indicates the need for a new and improved diagnostic tool for the classification of ACJ injuries.
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Affiliation(s)
- Charlotte de Groot
- Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands,Correspondence: Charlotte de Groot, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, P.O. Box 95500, Amsterdam, 1090 HM, the Netherlands, Email
| | - Daniel E Verstift
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | | | - Derek F P van Deurzen
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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22
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Allaart LJH, Spanning SV, Lafosse L, Lafosse T, Ladermann A, Athwal GS, Hendrickx LAM, Doornberg JN, van den Bekerom MPJ, Buijze GA. Developing a machine learning algorithm to predict probability of retear and functional outcomes in patients undergoing rotator cuff repair surgery: protocol for a retrospective, multicentre study. BMJ Open 2023; 13:e063673. [PMID: 36764713 PMCID: PMC9923257 DOI: 10.1136/bmjopen-2022-063673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION The effectiveness of rotator cuff tear repair surgery is influenced by multiple patient-related, pathology-centred and technical factors, which is thought to contribute to the reported retear rates between 17% and 94%. Adequate patient selection is thought to be essential in reaching satisfactory results. However, no clear consensus has been reached on which factors are most predictive of successful surgery. A clinical decision tool that encompassed all aspects is still to be made. Artificial intelligence (AI) and machine learning algorithms use complex self-learning models that can be used to make patient-specific decision-making tools. The aim of this study is to develop and train an algorithm that can be used as an online available clinical prediction tool, to predict the risk of retear in patients undergoing rotator cuff repair. METHODS AND ANALYSIS This is a retrospective, multicentre, cohort study using pooled individual patient data from multiple studies of patients who have undergone rotator cuff repair and were evaluated by advanced imaging for healing at a minimum of 6 months after surgery. This study consists of two parts. Part one: collecting all potential factors that might influence retear risks from retrospective multicentre data, aiming to include more than 1000 patients worldwide. Part two: combining all influencing factors into a model that can clinically be used as a prediction tool using machine learning. ETHICS AND DISSEMINATION For safe multicentre data exchange and analysis, our Machine Learning Consortium adheres to the WHO regulation 'Policy on Use and Sharing of Data Collected by WHO in Member States Outside the Context of Public Health Emergencies'. The study results will be disseminated through publication in a peer-reviewed journal. Institutional Review Board approval does not apply to the current study protocol.
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Affiliation(s)
- Laurens J H Allaart
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sanne van Spanning
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Laurent Lafosse
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
| | - Thibault Lafosse
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
| | - Alexandre Ladermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hopital Prive SA, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Laurent A M Hendrickx
- Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
- Orthopaedic and Trauma Surgery, Flinders University, Adelaide, South Australia, Australia
| | - Job N Doornberg
- Orthopaedic and Trauma Surgery, Flinders University, Adelaide, South Australia, Australia
- Orthopaedic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Geert Alexander Buijze
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
- Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
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23
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Uittenbogaard SJ, van Es LJM, den Haan C, van Deurzen DFP, van den Bekerom MPJ. Outcomes, Union Rate, and Complications After Operative and Nonoperative Treatments of Neer Type II Distal Clavicle Fractures: A Systematic Review and Meta-analysis of 2284 Patients. Am J Sports Med 2023; 51:534-544. [PMID: 34779668 DOI: 10.1177/03635465211053336] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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 As nonoperative treatment of Neer type II distal clavicle fractures is associated with nonunion rates up to 33%, operative treatment is frequently advocated. However, evidence is lacking regarding which operative treatment to perform and whether this is superior to nonoperative treatment in terms of functional outcome and complication rate. PURPOSE (1) To evaluate which surgical technique in the treatment of Neer type II distal clavicle fractures is optimal with regard to patient-reported outcomes and union and complication rates. (2) To review nonoperatively treated patients. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature and meta-analysis were performed on January 27, 2021, in PubMed, Embase, CENTRAL, CINAHL/EBSCO, Web of Science/Clarivate Analytics, and SPORTDiscus/EBSCO. The search included all studies regarding nonoperative and operative treatment of Neer type II distal clavicle fractures with a minimum of 20 patients and follow-up of 12 months. The primary and secondary outcomes were patient-reported outcome measures at 12 months and union, complication, and revision rates. RESULTS A total of 59 articles were included involving 2284 patients. Coracoclavicular fixation, hook plate, transacromial pins, alternative plate, tension band wire/K-wire, a combination of surgical techniques, and a nonoperative group were described. Hook plates showed lower Constant-Murley scores as compared with coracoclavicular fixation (standard mean difference, -0.77; 95% CI, -1.26 to -0.28; P = .002). However, no significant difference was seen when the hook plate was compared with the locking plate and tension band wire/K-wire groups, and no significant difference in union rate was seen among all operative treatment groups. Operatively treated patients had significantly higher union rates than patients treated nonoperatively (standard mean difference: 0.05; 95% CI, 0.01 to 0.37; P = .004). CONCLUSION Patients treated with hook plates showed significantly lower Constant-Murley scores and higher complication and revision rates as compared with those treated with coracoclavicular fixation, without differences in union rate. Higher Constant-Murley scores were seen in those patients with supplemental coracoclavicular fixation when using locking. Nonoperatively treated patients showed good functional outcome despite the 31% nonunion rate, although future studies are necessary to substantiate this conclusion. When using a locking plate, additional craniocaudal fixation showed significant better functional outcome.
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Affiliation(s)
- Sophie J Uittenbogaard
- Department of Orthopaedic Surgery, Shoulder Elbow Expertise Centre, OLVG Hospital, Amsterdam, the Netherlands
| | - Laurian J M van Es
- Department of Orthopaedic Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands
| | - Chantal den Haan
- Medical Library, Department of Research and Epidemiology, OLVG Hospital, Amsterdam, the Netherlands
| | - Derek F P van Deurzen
- Department of Orthopaedic Surgery, Shoulder Elbow Expertise Centre, OLVG Hospital, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Shoulder Elbow Expertise Centre, OLVG Hospital, Amsterdam, the Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, the Netherlands
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24
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de Klerk HH, Oosterhoff JHF, Schoolmeesters B, Nieboer P, Eygendaal D, Jaarsma RL, IJpma FFA, van den Bekerom MPJ, Doornberg JN. Recognition of the pattern of complex fractures of the elbow using 3D-printed models. Bone Joint J 2023; 105-B:56-63. [PMID: 36587260 DOI: 10.1302/0301-620x.105b1.bjj-2022-0415.r2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS This study aimed to answer the following questions: do 3D-printed models lead to a more accurate recognition of the pattern of complex fractures of the elbow?; do 3D-printed models lead to a more reliable recognition of the pattern of these injuries?; and do junior surgeons benefit more from 3D-printed models than senior surgeons? METHODS A total of 15 orthopaedic trauma surgeons (seven juniors, eight seniors) evaluated 20 complex elbow fractures for their overall pattern (i.e. varus posterior medial rotational injury, terrible triad injury, radial head fracture with posterolateral dislocation, anterior (trans-)olecranon fracture-dislocation, posterior (trans-)olecranon fracture-dislocation) and their specific characteristics. First, fractures were assessed based on radiographs and 2D and 3D CT scans; and in a subsequent round, one month later, with additional 3D-printed models. Diagnostic accuracy (acc) and inter-surgeon reliability (κ) were determined for each assessment. RESULTS Accuracy significantly improved with 3D-printed models for the whole group on pattern recognition (acc2D/3D = 0.62 vs acc3Dprint= 0.69; Δacc = 0.07 (95% confidence interval (CI) 0.00 to 0.14); p = 0.025). A significant improvement was also seen in reliability for pattern recognition with the additional 3D-printed models (κ2D/3D = 0.41 (moderate) vs κ3Dprint = 0.59 (moderate); Δκ = 0.18 (95% CI 0.14 to 0.22); p ≤ 0.001). Accuracy was comparable between junior and senior surgeons with the 3D-printed model (accjunior = 0.70 vs accsenior = 0.68; Δacc = -0.02 (95% CI -0.17 to 0.13); p = 0.904). Reliability was also comparable between junior and senior surgeons without the 3D-printed model (κjunior = 0.39 (fair) vs κsenior = 0.43 (moderate); Δκ = 0.03 (95% CI -0.03 to 0.10); p = 0.318). However, junior surgeons showed greater improvement regarding reliability than seniors with 3D-printed models (κjunior = 0.65 (substantial) vs κsenior = 0.54 (moderate); Δκ = 0.11 (95% CI 0.04 to 0.18); p = 0.002). CONCLUSION The use of 3D-printed models significantly improved the accuracy and reliability of recognizing the pattern of complex fractures of the elbow. However, the current long printing time and non-reusable materials could limit the usefulness of 3D-printed models in clinical practice. They could be suitable as a reusable tool for teaching residents.Cite this article: Bone Joint J 2023;105-B(1):56-63.
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Affiliation(s)
- Huub H de Klerk
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia.,Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, University Medical Centre Groningen (UMCG) and Groningen University, Groningen, the Netherlands
| | - Jacobien H F Oosterhoff
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia.,Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Duivendrecht, the Netherlands
| | - Bram Schoolmeesters
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia.,Department of Orthopaedic Surgery, University Medical Centre Groningen (UMCG) and Groningen University, Groningen, the Netherlands
| | - Patrick Nieboer
- Department of Orthopaedic Surgery, University Medical Centre Groningen (UMCG) and Groningen University, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Frank F A IJpma
- Department of Orthopaedic Surgery, University Medical Centre Groningen (UMCG) and Groningen University, Groningen, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, University Medical Centre Groningen (UMCG) and Groningen University, Groningen, the Netherlands.,Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Duivendrecht, the Netherlands
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25
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Alkaduhimi H, Willigenburg NW, Wessel RN, Wolterbeek N, Veen EJD, Koorevaar RCT, Willems WJ, Nelissen EM, Sonneveld H, Flikweert PE, Pasma JH, Visser CPJ, Meier ME, van den Borne MPJ, Dijkstra AJ, Kraal T, van Noort A, Alta TDW, Gałek-Aldridge MS, Floor S, van den Bekerom MPJ, Eygendaal D. Ninety-day complication rate based on 532 Latarjet procedures in Dutch hospitals with different operation volumes. J Shoulder Elbow Surg 2022; 32:1207-1213. [PMID: 36586507 DOI: 10.1016/j.jse.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/31/2022] [Accepted: 11/13/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND In this study, we aimed to provide insight into the 90-day complication rates following the Latarjet procedure. Data from 2015 were collected from multiple hospitals in the Netherlands, with different volumes of Latarjet procedures. Our second aim was to examine which patient and surgical factors were associated with complications. METHODS We conducted a retrospective chart review of 13 hospitals between 2015 and 2022. Data regarding complications within 90 days of Latarjet procedures were extracted. The effect of sex, age, body mass index (BMI), smoking, previous shoulder operations, fixation material, hospital volume, screw size, and operation time on the complication rate was assessed by multivariable logistic regression analysis. RESULTS Of the 532 included patients, 58 (10.9%) had complications. The most common complications were material failure (n = 19, 3.6%) and nerve injury (n = 13, 2.4%). The risk of complications was lower for male patients than for female patients (odds ratio, 0.40; 95% confidence interval, 0.21-0.77; P = .006). Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time were not associated with complications. CONCLUSION The 90-day complication rate after the Latarjet procedure was 10.9% and was higher in female patients than in male patients. Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time did not affect complication rates. We advise setting up a national registry to prevent under-reporting of complications.
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Affiliation(s)
| | | | - Ronald N Wessel
- Department of Orthopedic Surgery, St Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopedic Surgery, St Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Egbert J D Veen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rinco C T Koorevaar
- Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands
| | - W Jaap Willems
- Department of Orthopaedic Surgery, DC Clinics, Amsterdam, The Netherlands
| | - Eelco M Nelissen
- Department Orthopaedic Surgery, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | - Heleen Sonneveld
- Department of Orthopaedic Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Petra E Flikweert
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - Jantsje H Pasma
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - Cornelis P J Visser
- Department of Orthopaedic Surgery, Alrijne Hospital, Leiden, The Netherlands
| | - Maartje E Meier
- Department of Orthopaedic Surgery, Alrijne Hospital, Leiden, The Netherlands
| | | | - Arien J Dijkstra
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - Tim Kraal
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, the Netherlands
| | - Tjarco D W Alta
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - Sebastiaan Floor
- Department of Orthopaedic Surgery, Central Military Hospital, Utrecht, The Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Denise Eygendaal
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, the Netherlands
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26
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Rutgers C, Verweij LPE, Schuit AA, Sierevelt IN, Jamaludin FS, van der Woude HJ, van den Bekerom MPJ. High resorption rates following glenoid augmentation procedures do not seem to lead to higher recurrence rates or worse clinical outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07267-x. [PMID: 36515733 DOI: 10.1007/s00167-022-07267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Bone augmentation techniques show a relatively high complication rate, which might be due to graft non-union and resorption. It is unclear which augmentation techniques demonstrate the highest amount of non-union and resorption and whether this leads to worse clinical or functional outcomes. Therefore, the aim of this review was (i) to compare non-union and resorption rates between surgical approaches, procedures, graft types, donor sites and fixation methods regarding clinical and functional outcomes and (ii) determine whether high non-union or resorption rates lead to less favorable clinical or functional outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements were followed. PubMed, EMBASE (Ovid) and Cochrane Library were searched on December 15th 2021 for studies examining bone graft non-union or resorption using radiograph or CT following glenoid augmentation to treat anterior shoulder dislocation. RESULTS The search resulted in 103 inclusions, comprising 5,128 glenoid augmentations. When comparing pooled proportions of bony union, graft fracture rate, hardware failure rate, recurrence rate, return to sports and Rowe score, most results were similar between approaches, procedures, graft types, donor sites and fixation methods. High resorption rates were seen for allograft augmentation (74.3; 95% CI: 39.8-92.7) compared to autograft augmentation (15.5; 95% CI 10.1-23.2), but this was not associated with higher recurrence rates or worse clinical outcomes. Meta-analyses (8 studies; 494 patients) demonstrated no difference in incomplete and complete non-union rates between arthroscopic and open procedures; however, both analyses showed substantial heterogeneity. Higher partial resorption rates were observed on CT (48.0; 95% CI 43.3-52.7) compared to radiograph (14.1; 95% CI 10.9-18.1). Three studies comprising 267 shoulders demonstrated a higher rate of non-union and recurrence in smokers, whereas one study comprising 38 shoulders did not. CONCLUSION Non-union and resorption rates were similar among procedures, grafts and fixation methods. Higher resorption rates were observed in allografts, but this was not associated with higher recurrence rates or worse clinical outcomes. Pooling data demonstrated substantial heterogeneity and definitions varied among studies, warranting more standardized measuring. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cain Rutgers
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. .,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, The Netherlands.
| | - Lukas P E Verweij
- Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Musculoskeletal Health Program, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Jan Tooropstraat 164, Amsterdam, The Netherlands
| | - Alexander A Schuit
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, Laarderhoogtweg 12, Amsterdam, The Netherlands.,Orthopedic Department, Spaarnegasthuis Academy, Spaarnepoort 1, Hoofddorp, The Netherlands
| | - Faridi S Jamaludin
- Amsterdam UMC, Location AMC, Research Support, Medical Library AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk-Jan van der Woude
- Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Oosterpark 9, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Jan Tooropstraat 164, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, The Netherlands
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27
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van Spanning SH, Verweij LPE, Allaart LJH, Hendrickx LAM, Doornberg JN, Athwal GS, Lafosse T, Lafosse L, van den Bekerom MPJ, Buijze GA. Development and training of a machine learning algorithm to identify patients at risk for recurrence following an arthroscopic Bankart repair (CLEARER): protocol for a retrospective, multicentre, cohort study. BMJ Open 2022; 12:e055346. [PMID: 36508223 PMCID: PMC9462090 DOI: 10.1136/bmjopen-2021-055346] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Shoulder instability is a common injury, with a reported incidence of 23.9 per 100 000 person-years. There is still an ongoing debate on the most effective treatment strategy. Non-operative treatment has recurrence rates of up to 60%, whereas operative treatments such as the Bankart repair and bone block procedures show lower recurrence rates (16% and 2%, respectively) but higher complication rates (<2% and up to 30%, respectively). Methods to determine risk of recurrence have been developed; however, patient-specific decision-making tools are still lacking. Artificial intelligence and machine learning algorithms use self-learning complex models that can be used to make patient-specific decision-making tools. The aim of the current study is to develop and train a machine learning algorithm to create a prediction model to be used in clinical practice-as an online prediction tool-to estimate recurrence rates following a Bankart repair. METHODS AND ANALYSIS This is a multicentre retrospective cohort study. Patients with traumatic anterior shoulder dislocations that were treated with an arthroscopic Bankart repair without remplissage will be included. This study includes two parts. Part 1, collecting all potential factors influencing the recurrence rate following an arthroscopic Bankart repair in patients using multicentre data, aiming to include data from >1000 patients worldwide. Part 2, the multicentre data will be re-evaluated (and where applicable complemented) using machine learning algorithms to predict outcomes. Recurrence will be the primary outcome measure. ETHICS AND DISSEMINATION For safe multicentre data exchange and analysis, our Machine Learning Consortium adhered to the WHO regulation 'Policy on Use and Sharing of Data Collected by WHO in Member States Outside the Context of Public Health Emergencies'. The study results will be disseminated through publication in a peer-reviewed journal. No Institutional Review Board is required for this study.
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Affiliation(s)
- Sanne H van Spanning
- Orthopaedic Surgery, OLVG, Amsterdam, Noord-Holland, The Netherlands
- Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Alps Surgery Institute, Annecy, France
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lukas P E Verweij
- Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, Netherlands
| | - Laurens J H Allaart
- Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Alps Surgery Institute, Annecy, France
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laurent A M Hendrickx
- Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Job N Doornberg
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Thibault Lafosse
- Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Alps Surgery Institute, Annecy, France
| | - Laurent Lafosse
- Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Alps Surgery Institute, Annecy, France
| | - Michel P J van den Bekerom
- Orthopaedic Surgery, OLVG, Amsterdam, Noord-Holland, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Geert Alexander Buijze
- Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Alps Surgery Institute, Annecy, France
- Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Department of Orthopaedic Surgery, Montpellier University Medical Center, Montpellier, Languedoc-Roussillon, France
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van Iersel TP, van Spanning SH, Verweij LPE, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up. J Shoulder Elbow Surg 2022; 31:1982-1991. [PMID: 35430365 DOI: 10.1016/j.jse.2022.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is uncertainty with regard to the optimal revision procedure after failed labral repair for anterior shoulder instability. An overview of outcomes of these procedures with quantitative analysis is not available in literature. The aim of this review is (1) to compare recurrence rates after revision labral repair (RLR) and revision bony reconstruction (RBR), both following failed labral repair. In addition, (2) recurrence rates after RBR following failed labral repair and primary bony reconstruction (PBR) are compared to determine if a previous failed labral repair influences the outcomes of the bony reconstruction. METHODS Randomized controlled trials and cohort studies with a minimum follow-up of 2 years and reporting recurrence rates of (1) RBR following failed labral repair and PBR and/or (2) RLR following failed labral repair and RBR following failed labral repair were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, and Web of Science/Clarivate Analytics. RESULTS Thirteen studies met the inclusion criteria and comprised 1319 shoulders. Meta-analyses showed that RBR has a significantly higher recurrence rate than PBR (risk ratio [RR] 0.51, P < .008) but found no significant difference in the recurrence rates for RLR and RBR (RR 1.40, P < .49). Also, no significant differences were found between PBR and RBR in return to sport (RR 1.07, P < .41), revision surgery (RR 0.8, P < .44), and complications (RR 0.84, P < .53). Lastly, no significant differences between RLR and RBR for revision surgery (RR 3.33, P < .19) were found. CONCLUSION The findings of this meta-analyses show that (1) RBR does not demonstrate a significant difference in recurrence rates compared with RLR and that (2) RBR has a significantly higher recurrence rate than PBR.
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Affiliation(s)
- Theodore P van Iersel
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
| | - Sanne H van Spanning
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Lukas P E Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | | | - Derek F P van Deurzen
- Trauma Unit & Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Spek RWA, Hoogervorst LA, Elias MEC, Jaarsma RL, Veeger DHEJ, Doornberg JN, Jutte PC, van den Bekerom MPJ. Management of displaced humeral surgical neck fractures in daily clinical practice: hanging does not re-align the fracture. Arch Orthop Trauma Surg 2022; 143:3119-3128. [PMID: 35840714 DOI: 10.1007/s00402-022-04545-8] [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: 02/11/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION It is unclear if the collar and cuff treatment improve alignment in displaced surgical neck fractures of the proximal humerus. Therefore, this study evaluated if the neckshaft angle and extent of displacement would improve between trauma and onset of radiographically visible callus in non-operatively treated surgical neck fractures (Boileau type A, B, C). MATERIALS AND METHODS A consecutive series of patients (≥ 18 years old) were retrospectively evaluated from a level 1 trauma center in Australia (inclusion period: 2016-2020) and a level 2 trauma center in the Netherlands (inclusion period: 2004 to 2018). Patients were included if they sustained a Boileau-type fracture and underwent initial non-operative treatment. The first radiograph had to be obtained within 24 h after the initial injury and the follow-up radiograph(s) 1 week after trauma and before the start of radiographically visible callus. On each radiograph, the maximal medial gap (MMG), maximal lateral gap (MLG), and neck-shaft angle (NSA) were measured. Linear mixed modelling was performed to evaluate if these measurements would improve over time. RESULTS Sixty-seven patients were included: 25 type A, 11 type B, and 31 type C fractures. The mean age (range) was 68 years (24-93), and the mean number (range) of follow-up radiographs per patient was 1 (1-4). Linear mixed modelling on both MMG and MLG revealed no improvement during follow-up among the three groups. Mean NSA of type A fractures improved significantly from 161° at trauma to 152° at last follow-up (p-value = 0.004). CONCLUSIONS Apart from humeral head angulation improvement in type A, there is no increase nor reduction in displacement among the three fracture patterns. Therefore, it is advised that surgical decision-making should be performed immediately after trauma. LEVEL OF CLINICAL EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Reinier W A Spek
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Flinders Dr, Bedford Park, Adelaide, 5042, Australia. .,Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands. .,Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
| | - Lotje A Hoogervorst
- Department of Orthopaedic Surgery, Department of Biomedical Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Ruurd L Jaarsma
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Flinders Dr, Bedford Park, Adelaide, 5042, Australia
| | - DirkJan H E J Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - Michel P J van den Bekerom
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Caekebeke P, Meglic U, van den Bekerom MPJ, van Riet R. Evaluation of clinical tests for partial distal biceps tendon ruptures and tendinitis. J Shoulder Elbow Surg 2022; 31:532-536. [PMID: 34774776 DOI: 10.1016/j.jse.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The clinical diagnosis of partial distal biceps tendon ruptures or tendinosis can be challenging. Three clinical tests have been described to aid in an accurate and timely diagnosis: biceps provocation test, tilt sign, and resisted hook test. However, not much is known about the sensitivity, specificity, and inter-rater reliability as the available evaluations are based on small groups or are case based. Furthermore, these tests have not been compared together in the same patient group. METHODS Two dedicated elbow surgeons each included 20 consecutive patients in whom distal biceps tendon pathology was suspected. Patients with a complete distal biceps tendon tear were excluded. As a control, the same number of consecutive patients with various elbow pathologies other than distal biceps tendon problems was included. All 3 tests were performed both in control patients and in patients with suspected biceps tendon pathology. Magnetic resonance imaging (MRI) in the flexion-abduction-supination view and/or surgical exploration was performed in both groups. The findings of the clinical tests were determined before the results of MRI and other technical investigations were analyzed. The values of sensitivity, specificity, and accuracy were calculated. RESULTS The combined sensitivity, specificity, and accuracy values for the biceps provocation test were 95%, 97%, and 96%, respectively. For the resisted hook test, the combined values were 78%, 76%, and 77%, respectively. The combined values for the tilt sign were 58%, 55%, and 56%, respectively. When the biceps provocation test and the resisted hook test were combined in a parallel testing setup, the sensitivity increased to 98% whereas the specificity was 73%. The sensitivity and specificity of the biceps provocation test and the tilt sign in a parallel testing setup were 97% and 53%, respectively. Finally, the sensitivity and specificity of the tilt sign and the resisted hook test in a parallel testing setup were 90% and 41%, respectively. CONCLUSIONS The biceps provocation test yielded higher accuracy than the resisted hook test and the tilt sign. When the biceps provocation test and the resisted hook test were combined, the sensitivity increased to 98%. We advise integration of these tests in daily practice to minimize delays in the diagnosis of partial distal biceps tendon ruptures, distal biceps tendon bursitis, or tendinosis. MRI in the flexion-abduction-supination view is still advised to distinguish between a partial biceps tendon rupture and tendinosis or bursitis at the distal biceps tendon insertion as this may influence further treatment.
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Affiliation(s)
- Pieter Caekebeke
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - Uros Meglic
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roger van Riet
- Department of Orthopedic Surgery, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium; Orthopaedic Specialists, Harley Street Specialist Hospital, London, UK
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Rutgers C, Verweij LPE, Priester-Vink S, van Deurzen DFP, Maas M, van den Bekerom MPJ. Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2130-2140. [PMID: 34988633 PMCID: PMC9165262 DOI: 10.1007/s00167-021-06847-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. METHODS PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. RESULTS The proportion of Hill-Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill-Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01). CONCLUSION Higher proportions of Hill-Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill-Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cain Rutgers
- Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
| | - Lukas. P. E. Verweij
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands
| | - Derek F. P. van Deurzen
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Mario Maas
- Division of Musculoskeletal Radiology, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Spek RWA, Schoolmeesters BJA, Oosterhoff JHF, Doornberg JN, van den Bekerom MPJ, Jaarsma RL, Eygendaal D, IJpma F. 3D-printed Handheld Models Do Not Improve Recognition of Specific Characteristics and Patterns of Three-part and Four-part Proximal Humerus Fractures. Clin Orthop Relat Res 2022; 480:150-159. [PMID: 34427569 PMCID: PMC8673959 DOI: 10.1097/corr.0000000000001921] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reliably recognizing the overall pattern and specific characteristics of proximal humerus fractures may aid in surgical decision-making. With conventional onscreen imaging modalities, there is considerable and undesired interobserver variability, even when observers receive training in the application of the classification systems used. It is unclear whether three-dimensional (3D) models, which now can be fabricated with desktop printers at relatively little cost, can decrease interobserver variability in fracture classification. QUESTIONS/PURPOSES Do 3D-printed handheld models of proximal humerus fractures improve agreement among residents and attending surgeons regarding (1) specific fracture characteristics and (2) patterns according to the Neer and Hertel classification systems? METHODS Plain radiographs, as well as two-dimensional (2D) and 3D CT images, were collected from 20 patients (aged 18 years or older) who sustained a three-part or four-part proximal humerus fracture treated at a Level I trauma center between 2015 and 2019. The included images were chosen to comprise images from patients whose fractures were considered as difficult-to-classify, displaced fractures. Consequently, the images were assessed for eight fracture characteristics and categorized according to the Neer and Hertel classifications by four orthopaedic residents and four attending orthopaedic surgeons during two separate sessions. In the first session, the assessment was performed with conventional onscreen imaging (radiographs and 2D and 3D CT images). In the second session, 3D-printed handheld models were used for assessment, while onscreen imaging was also available. Although proximal humerus classifications such as the Neer classification have, in the past, been shown to have low interobserver reliability, we theorized that by receiving direct tactile and visual feedback from 3D-printed handheld fracture models, clinicians would be able to recognize the complex 3D aspects of classification systems reliably. Interobserver agreement was determined with the multirater Fleiss kappa and scored according to the categorical rating by Landis and Koch. To determine whether there was a difference between the two sessions, we calculated the delta (difference in the) kappa value with 95% confidence intervals and a two-tailed p value. Post hoc power analysis revealed that with the current sample size, a delta kappa value of 0.40 could be detected with 80% power at alpha = 0.05. RESULTS Using 3D-printed models in addition to conventional imaging did not improve interobserver agreement of the following fracture characteristics: more than 2 mm medial hinge displacement, more than 8 mm metaphyseal extension, surgical neck fracture, anatomic neck fracture, displacement of the humeral head, more than 10 mm lesser tuberosity displacement, and more than 10 mm greater tuberosity displacement. Agreement regarding the presence of a humeral head-splitting fracture was improved but only to a level that was insufficient for clinical or scientific use (fair to substantial, delta kappa = 0.33 [95% CI 0.02 to 0.64]). Assessing 3D-printed handheld models adjunct to onscreen conventional imaging did not improve the interobserver agreement for pattern recognition according to Neer (delta kappa = 0.02 [95% CI -0.11 to 0.07]) and Hertel (delta kappa = 0.01 [95% CI -0.11 to 0.08]). There were no differences between residents and attending surgeons in terms of whether 3D models helped them classify the fractures, but there were few differences to identify fracture characteristics. However, none of the identified differences improved to almost perfect agreement (kappa value above 0.80), so even those few differences are unlikely to be clinically useful. CONCLUSION Using 3D-printed handheld fracture models in addition to conventional onscreen imaging of three-part and four-part proximal humerus fractures does not improve agreement among residents and attending surgeons on specific fracture characteristics and patterns. Therefore, we do not recommend that clinicians expend the time and costs needed to create these models if the goal is to classify or describe patients' fracture characteristics or pattern, since doing so is unlikely to improve clinicians' abilities to select treatment or estimate prognosis. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Reinier W. A. Spek
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Bram J. A. Schoolmeesters
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Jacobien H. F. Oosterhoff
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Amsterdam University Medical Center, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
| | - Michel P. J. van den Bekerom
- Shoulder and Elbow Expertise Centre, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Ruurd L. Jaarsma
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, Amphia Hospital, Breda, the Netherlands
| | - Frank IJpma
- Department of Trauma Surgery, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
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van der Vossen AH, van der Woude HJ, Hindori VG, Wolbink G, van den Bekerom MPJ, van Deurzen DFP. [Swelling at the sternoclavicular joint]. Ned Tijdschr Geneeskd 2021; 165:D5665. [PMID: 34854595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A visible mass around the sternoclavicular (SC) joint may be explained by a wide variety of diagnoses, each with its own diagnostic pathway and treatment options. Here we report three cases: a 56-year-old male with an anterior luxation of the right SC joint, a 59-year-old male with osteomyelitis of the left SC joint and a 78-year-old male with a painless swelling to the right medial clavicle, interpreted as sterno-costo-clavicular hyperostosis (SCCH) as part of his SAPHO syndrome. An atraumatic swelling of the SC joint is most often caused by osteoarthritis, characterized by a slowly progressing solid swelling. Acute swelling with concurrent redness and fever justifies an intra-articular- or bone aspiration, possibly CT guided, in combination with laboratory blood tests to differentiate between an infectious or rheumatologic cause. Since there are also multiple rare diseases that present specifically around the SC joint, a multidisciplinary review often proves helpful.
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Sanders FRK, Birnie MF, Dingemans SA, van den Bekerom MPJ, Parkkinen M, van Veen RN, Goslings JC, Schepers T. Functional outcome of routine versus on-demand removal of the syndesmotic screw: a multicentre randomized controlled trial. Bone Joint J 2021; 103-B:1709-1716. [PMID: 34719269 PMCID: PMC8528163 DOI: 10.1302/0301-620x.103b11.bjj-2021-0348.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aims The aim of this study was to investigate whether on-demand removal (ODR) is noninferior to routine removal (RR) of syndesmotic screws regarding functional outcome. Methods Adult patients (aged above 17 years) with traumatic syndesmotic injury, surgically treated within 14 days of trauma using one or two syndesmotic screws, were eligible (n = 490) for inclusion in this randomized controlled noninferiority trial. A total of 197 patients were randomized for either ODR (retaining the syndesmotic screw unless there were complaints warranting removal) or RR (screw removed at eight to 12 weeks after syndesmotic fixation), of whom 152 completed the study. The primary outcome was functional outcome at 12 months after screw placement, measured by the Olerud-Molander Ankle Score (OMAS). Results There were 152 patients included in final analysis (RR = 73; ODR = 79). Of these, 59.2% were male (n = 90), and the mean age was 46.9 years (SD 14.6). Median OMAS at 12 months after syndesmotic fixation was 85 (interquartile range (IQR) 60 to 95) for RR and 80 (IQR 65 to 100) for ODR. The noninferiority test indicated that the observed effect size was significantly within the equivalent bounds of -10 and 10 scale points (p < 0.001) for both the intention-to-treat and per-protocol, meaning that ODR was not inferior to RR. There were significantly more complications in the RR group (12/73) than in the ODR group (1/79) (p = 0.007). Conclusion ODR of the syndesmotic screw is not inferior to routine removal when it comes to functional outcome. Combined with the high complication rate of screw removal, this offers a strong argument to adopt on demand removal as standard practice of care after syndesmotic screw fixation. Cite this article: Bone Joint J 2021;103-B(11):1709–1716.
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Affiliation(s)
- Fay R K Sanders
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Merel F Birnie
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Siem A Dingemans
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Markus Parkkinen
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Meijering D, Welsink CL, Boerboom AL, Bulstra SK, Vegter RJK, Stevens M, Eygendaal D, van den Bekerom MPJ. Triceps Insufficiency After Total Elbow Arthroplasty: A Systematic Review. JBJS Rev 2021; 9:01874474-202107000-00008. [PMID: 34270508 DOI: 10.2106/jbjs.rvw.20.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The incidence of triceps insufficiency after total elbow arthroplasty (TEA) varies in the literature, and a consensus on treatment strategy is lacking. We review the incidence, the risk factors, the clinical presentation, and the diagnosis and treatment of triceps insufficiency after TEA. Based on this information, we have formulated recommendations for clinical practice. METHODS We performed a systematic review of the literature from January 2003 to April 2020 to identify studies that investigated triceps function following TEA by searching the PubMed, Cochrane, and Embase databases. Eligible studies (1) reported on triceps function following primary or revision TEA for every indication, regardless of technique (e.g., bone grafts), (2) included ≥6 adult patients, (3) had the full-text article available, and (4) had a minimum follow-up of 1 year. RESULTS Eighty studies with a total of 4,825 TEAs were included. The quality was low in 15 studies, moderate in 64 studies, and high in 1 study. The mean incidence of triceps insufficiency was 4.5%. The rates were highest in patients after revision TEA (22%), in those with posttraumatic arthritis as an indication for surgery (10.2%), and after a triceps-reflecting approach (4.9%). Most studies used the Medical Research Council scale to score triceps function, although cutoff points and the definition of triceps insufficiency differed among studies. Surgical treatment showed favorable results with anconeus tendon transfer and Achilles allograft repair when compared with direct repair. CONCLUSIONS The incidence of triceps insufficiency varies greatly, probably due to a lack of consensus on the definition of the term. Therefore, we recommend the guidelines for clinical practice that are presented in this article. These guidelines assist clinicians in providing the best possible treatment strategy for their patients and help researchers optimize their future study designs in order to compare outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniëlle Meijering
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Chantal L Welsink
- Department of Orthopedic Surgery, Isala Klinieken, Zwolle, the Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Hoogervorst LA, Spek RWA, van den Bekerom MPJ. Comments to: "Outcomes of surgical fixation of greater tuberosity fractures: A systematic review" by S.R. Huntley, E.J. Lehtonen, J.X. Robin, A.M. Arguello, D.M. Rouleau, E.W. Brabston, B.A. Ponce, A.M. Momaya published in Orth Traumatol Surg Res. 2020;106(6):1119-1126. Orthop Traumatol Surg Res 2021; 107:102919. [PMID: 33836281 DOI: 10.1016/j.otsr.2021.102919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/02/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Lotje A Hoogervorst
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 Leiden, The Netherlands.
| | - Reinier W A Spek
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Michel P J van den Bekerom
- Shoulder and Elbow Expertise Centre, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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van Deurzen DFP, Auw Yang KG, Onstenk R, Raven EEJ, van den Borne MPJ, Hoelen MA, Wessel RN, Willigenburg NW, Klaassen AD, van den Bekerom MPJ. Long Head of Biceps Tenotomy Is Not Inferior to Suprapectoral Tenodesis in Arthroscopic Repair of Nontraumatic Rotator Cuff Tears: A Multicenter, Non-inferiority, Randomized, Controlled Clinical Trial. Arthroscopy 2021; 37:1767-1776.e1. [PMID: 33556551 DOI: 10.1016/j.arthro.2021.01.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if long head of the biceps (LHB) tenotomy is not inferior to suprapectoral LHB tenodesis when performed in conjunction with arthroscopic repair of small- to medium-sized nontraumatic rotator cuff tears. METHODS This multicenter, randomized, non-inferiority trial recruited 100 participants older than 50 years who had a supraspinatus and/or infraspinatus tear sagittally smaller than 3 cm and arthroscopically confirmed LHB pathology. During arthroscopic rotator cuff repair, we randomized 48 patients to undergo suprapectoral LHB tenodesis and 52 patients to undergo LHB tenotomy. Data were collected preoperatively and at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome was non-inferiority of the Constant-Murley score (CMS) at 1-year follow-up. Secondary outcomes included the Dutch Oxford Shoulder Score; Disabilities of the Arm, Shoulder and Hand questionnaire; Popeye deformity; elbow flexion strength index; arm cramping pain; and quality of life (EQ-5D score). The integrity of the rotator cuff repair was assessed with magnetic resonance imaging. Differences between intervention groups were analyzed by mixed modeling. RESULTS The mean CMS in the LHB tenotomy group improved from 44 (95% confidence interval [CI], 39-48) to 73 (95% CI, 68-79). In patients with LHB tenodesis, the mean CMS improved from 42 (95% CI, 37-48) to 78 (95% CI, 74-82). The difference between groups at 1-year follow-up was 4.8 (97.5% CI, -∞ to 11.4), with a P value for non-inferiority of .06. The secondary outcomes also improved over time, with no remarkable differences between groups. A Popeye deformity occurred in 33% of tenodesis patients and 47% of tenotomy patients (P = .17). Tenotomy was performed with a shorter operative time (73 minutes vs 82 minutes, P = .03). Magnetic resonance imaging showed a recurrent rotator cuff tear in 20% of all cases. CONCLUSIONS Although statistically "inconclusive" regarding non-inferiority of the CMS at 1-year follow-up, any observed differences between patients with LHB tenotomy and those with LHB tenodesis in all outcome scores were small. LEVEL OF EVIDENCE Level I, randomized controlled trial and treatment study.
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Affiliation(s)
- Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands.
| | - Kiem G Auw Yang
- Department of Orthopedic Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Ron Onstenk
- Department of Orthopedic Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - Eric E J Raven
- Department of Orthopedic Surgery, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | | | - Max A Hoelen
- Department of Orthopedic Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Ronald N Wessel
- Department of Orthopedic Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Nienke W Willigenburg
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Amanda D Klaassen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands
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Alkaduhimi H, Saarig A, Amajjar I, van der Linde JA, van Wier MF, Willigenburg NW, van den Bekerom MPJ. Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging. Clin Shoulder Elb 2021; 24:98-105. [PMID: 34078018 PMCID: PMC8181846 DOI: 10.5397/cise.2021.00115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our aim is to determine the interobserver reliability for surgeons to detect Hill-Sachs lesions on magnetic resonance imaging (MRI), the certainty of judgement, and the effects of surgeon characteristics on agreement. METHODS Twenty-nine patients with Hill-Sachs lesions or other lesions with a similar appearance on MRIs were presented to 20 surgeons without any patient characteristics. The surgeons answered questions on the presence of Hill-Sachs lesions and the certainty of diagnosis. Interobserver agreement was assessed using the Fleiss' kappa (κ) and percentage of agreement. Agreement between surgeons was compared using a technique similar to the pairwise t-test for means, based on large-sample linear approximation of Fleiss' kappa, with Bonferroni correction. RESULTS The agreement between surgeons in detecting Hill-Sachs lesions on MRI was fair (69% agreement; κ, 0.304; p<0.001). In 84% of the cases, surgeons were certain or highly certain about the presence of a Hill-Sachs lesion. CONCLUSIONS Although surgeons reported high levels of certainty for their ability to detect Hill-Sachs lesions, there was only a fair amount of agreement between surgeons in detecting Hill-Sachs lesions on MRI. This indicates that clear criteria for defining Hill-Sachs lesions are lacking, which hampers accurate diagnosis and can compromise treatment.
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Affiliation(s)
- Hassanin Alkaduhimi
- Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Amsterdam, Netherlands
| | - Aïmane Saarig
- Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Amsterdam, Netherlands
| | - Ihsan Amajjar
- Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Amsterdam, Netherlands
| | - Just A van der Linde
- Department of Orthopedic Surgery and Traumatology, Reinier Haga Orthopedisch Centrum, Zoetermeer, Netherlands
| | - Marieke F van Wier
- Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Amsterdam, Netherlands
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van der Vis J, Janssen SJ, Bleys RLAW, Eygendaal D, van den Bekerom MPJ. Distal biceps tendon injection. Clin Shoulder Elb 2021; 24:93-97. [PMID: 34078017 PMCID: PMC8181841 DOI: 10.5397/cise.2021.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon. Methods Seven upper limb specialists, two general orthopedic specialists, and three orthopedic surgical residents manually injected a cadaver elbow with acrylic dye using an anterior and a lateral infiltration approach. After infiltration the cadaveric elbows were dissected to determine the location of the acrylic dye. Results In total, 79% of the injections were localized near the biceps tendon. Of these injections, 20% were localized on the radius near the bicipitoradial bursa. In total, 53% of the performed infiltrations were injected by anterior and 47% by lateral approaches. Of the injections near the distal biceps (79%), 47% were injected by an anterior and 53% by a lateral approach. Of the injections on the radius (20%), 33% were injected by anterior and 67% by lateral approach. Of the inaccurate injections (21%), 75% were injected anterior and 25% lateral. Conclusions Manual infiltration without ultrasound guidance for distal biceps pathology lacks accuracy. We therefore recommend ultrasound guidance for more accurate infiltration.
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Affiliation(s)
| | - Stein J Janssen
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Department of Orthopedic Surgery, Amphia Ziekenhuis, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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40
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Meijering D, Boerboom AL, Gerritsma CLE, The B, van den Bekerom MPJ, van der Pluijm M, Vegter RJK, Bulstra SK, Eygendaal D, Stevens M. Prospective cohort study comparing a triceps-sparing and triceps-detaching approach in total elbow arthroplasty: a protocol. BMJ Open 2021; 11:e046098. [PMID: 33952551 PMCID: PMC8103376 DOI: 10.1136/bmjopen-2020-046098] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New surgical approaches have been developed to optimise elbow function after total elbow arthroplasty (TEA). Currently, there is no consensus on the best surgical approach. This study aims to investigate the functional outcomes, prosthetic component position and complication rates after a triceps-sparing and a triceps-detaching approach in TEA. METHODS AND ANALYSIS A multicentre prospective comparative cohort study will be conducted. All patients with an indication for primary TEA will enrol in either the triceps-sparing or the triceps-detaching cohort. Primary outcome measure is elbow function, specified as fixed flexion deformity. Secondary outcome parameters are self-reported and objectively measured physical functioning, including triceps force, prosthetic component position in standard radiographs and complications. DISCUSSION The successful completion of this study will clarify which surgical approach yields better functional outcomes, better prosthetic component position and lower complication rates in patients with a TEA. ETHICS AND DISSEMINATION The Medical Ethics Review Board of University Medical Center Groningen reviewed the study and concluded that it is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO), therefore WMO approval is not needed (METc2019/544). TRIAL REGISTRATION NUMBER NTR NL8488.
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Affiliation(s)
- Danielle Meijering
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bertram The
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco van der Pluijm
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Orthopedic Surgery, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
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van Deurzen DFP, Garssen FL, Wessel RN, Kerkhoffs GMMJ, van den Bekerom MPJ, van Wier MF. The Popeye sign: a doctor's and not a patient's problem. J Shoulder Elbow Surg 2021; 30:969-976. [PMID: 33290851 DOI: 10.1016/j.jse.2020.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Popeye sign is a frequently reported finding following long head of the biceps (LHB) surgery and may be more often detected by doctors than by patients. This study investigates agreement between patients and doctors regarding the presence of a Popeye sign following LHB surgery. METHOD This interobserver study investigates agreement between patients and consulting physicians with regard to assessment of a Popeye sign in patients following LHB surgery. Furthermore, this was compared with assessments by non-consulting physicians (observers) using digital photographs of the operated arm, taken both preoperatively and postoperatively. Data about gender, age, and body mass index (BMI) were collected to investigate their role in doctor's reporting of a Popeye sign. Patient's dissatisfaction with a Popeye sign in the operated arm was evaluated as well. RESULTS Ninety-seven patients (mean age 61 ± 6.0 years, 62% male) underwent LHB surgery. A Popeye sign was reported by 2 patients (2%) as opposed to 32 cases (40%) by consulting physicians, of which only 1 case was in agreement. Krippendorff's alpha (Kalpha) for agreement between observers for preoperative photographs was 0.074 (95% CI -0.277, 0.382) and 0.495 (95% CI 0.317, 0.659) for postoperative cases. Kalpha between observers and consulting physicians for pre- and postoperative cases were 0.033 (95% CI -970, 0.642) and 0.499 (95% CI 0.265, 0.699), respectively. Phi coefficient analysis showed a moderate, statistically significant correlation between male sex and Popeye sign identification. Rank-biserial calculation revealed negligible correlation between BMI and age with regard to detecting a Popeye sign by both consulting physicians and observers. Dissatisfaction about swelling in the upper arm was reported in 1 case, though in a location that did not correspond to the location of a Popeye sign. CONCLUSION The Popeye sign is more often identified by doctors than by patients after undergoing LHB surgery. BMI and age are not related to the detection of a Popeye sign, but sex is moderately correlated. Together with the low percentage of dissatisfaction of patients with this swelling, this signifies that a Popeye sign seems to be a doctor's rather than a patient's problem.
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Affiliation(s)
- Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands.
| | - Frans L Garssen
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Ronald N Wessel
- Department of Orthopedic Surgery, St Antonius ziekenhuis, Utrecht, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Academic Center of Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands; International Olympic Committee (IOC) Research Centre of Excellence, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Marieke F van Wier
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands
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Alkaduhimi H, Connelly JW, van Deurzen DFP, Eygendaal D, van den Bekerom MPJ. High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e951-e966. [PMID: 34195665 PMCID: PMC8220632 DOI: 10.1016/j.asmr.2021.02.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To determine the definitions for recurrence used in the literature, assess the consensus in using these definitions, and determine the impact of these definitions on recurrence rates. Methods A literature search was performed in PubMed and EMBASE including studies from 2000 to 2020 reporting on recurrence rates after anterior arthroscopic shoulder instability surgery. Dislocation, apprehension, subluxation and recurrence rates were compared. Results Ninety-one studies were included. In 68% of the eligible studies, recurrence rates are not well defined. Thirty (33%) studies did not report on dislocations, 45 (49%) did not report on subluxations, and 58 (64%) did not report on apprehension. Seventeen different definitions for recurrence of instability, 4 definitions of dislocations, and 8 definitions of subluxation were used. Conclusion Recurrence rates are poorly specified and likely underreported in the literature, hampering comparison with results of other studies. This highlights the need for a consensus on definition of recurrence across shoulder instability studies. We recommend not using the definition recurrence of instability anymore. We endorse defining dislocations as a radiographically confirmed dislocation or a dislocation that is manually reduced, subluxations as the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation, and a positive apprehension sign as fear of imminent dislocation when placing the arm in abduction and external rotation during physical examination. Reporting on the events resulting in a dislocation or subluxation aids in making an estimation of the severity of instability. Level of Evidence Level IV, systematic review.
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Affiliation(s)
| | - James W Connelly
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | | | - Denise Eygendaal
- Orthopaedic Department, Amphia Ziekenhuis, Breda, the Netherlands.,Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Amsterdam, the Netherlands.,Amsterdam University Medical Centres, Amsterdam, the Netherlands
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Dietvorst M, Reijman M, van Zutven R, van den Bekerom MPJ, Meuffels DE, Somford MP, Janssen RPA. Current State of Care for Pediatric ACL Ruptures in the Netherlands: A Survey. J Knee Surg 2021; 34:520-525. [PMID: 31550739 DOI: 10.1055/s-0039-1697626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The management of anterior cruciate ligament (ACL) injuries in the skeletally immature patient is an area of controversy. The purpose of this survey is to inventory the current state of care for pediatric ACL injuries in the Netherlands. This survey was conveyed by e-mail among all members of the Dutch Arthroscopy Society (Nederlandse Vereniging van Arthroscopie [NVA]) and promoted on the Web site of the NVA. It was developed by the scientific committee of the NVA by a consensus meeting discussing relevant topics in pediatric ACL injuries. All members of the NVA received the survey (n = 540). A total of 158 (29%) members responded to the survey, of which 143 were completed. A total of 126 responses were analyzed after exclusion. The main finding of this survey is that 78% of the respondents tend to treat children with open physes nonoperatively, while 65% tend to treat children with closed physes operatively. The most frequently performed procedure is the transphyseal reconstruction. Many considerations were involved in choosing operative treatment. The postoperative follow-up period varies from less than 1 year (24%) until fully grown (27%). In conclusion, this survey shows that the current state of care for pediatric ACL injuries is variable and a matter of debate in the Netherlands. Although the response rate seems low, this survey provides an overview of the opinions of specialized orthopaedic surgeons in the Netherlands. The results of this survey led to the development of the national registry for pediatric ACL in the Netherlands. The level of evidence for this study is V.
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Affiliation(s)
- Martijn Dietvorst
- Department of Orthopaedic Surgery, Máxima Medical Center, Eindhoven, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rein van Zutven
- Department of Orthopaedic Surgery, Máxima Medical Center, Eindhoven, the Netherlands
| | | | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Matthijs P Somford
- Department of Orthopaedic Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Rob P A Janssen
- Department of Orthopaedic Surgery, Máxima Medical Center, Eindhoven, the Netherlands.,Department of Value-Based Health Care, Fontys University of Applied Sciences, Eindhoven, the Netherlands.,Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
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Verstift DE, Kilsdonk ID, van Wier MF, Haverlag R, van den Bekerom MPJ. Long-term Outcome After Nonoperative Treatment for Rockwood I and II Acromioclavicular Joint Injuries. Am J Sports Med 2021; 49:757-763. [PMID: 33439041 DOI: 10.1177/0363546520981993] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rockwood I and II acromioclavicular joint injuries are generally treated nonoperatively. The long-term outcome is considered to be good but has not yet been properly investigated. PURPOSE To assess the long-term outcome after nonoperative therapy for Rockwood I and II acromioclavicular joint injuries regarding functional and radiologic outcome. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Eligible patients visited the emergency department between January 2003 and December 2015 and were ≥16 years old at the time of presentation. The main study parameters were the Constant score, the Disabilities of the Arm, Shoulder and Hand score, and the Simple Shoulder Test. The Constant score was measured in the injured and contralateral shoulders. Radiologic outcomes in both shoulders included joint displacement, joint space, degenerative changes, osteolysis of the distal clavicle, and ossification of the ligaments. RESULTS A total of 75 patients were included for follow-up. After a median follow-up of 85 months (interquartile range [IQR], 68.0-100.0), the mean Constant score in the injured shoulder for the total sample was 88.6 (SD, 12.7) as compared with 93.3 (SD, 8.7) in the contralateral shoulder, with a significant difference of 4.7 points between shoulders. The median Disabilities of the Arm, Shoulder and Hand score was 4.2 (IQR, 0.0-10.8), and the median Simple Shoulder Test was 100 (IQR, 91.7-100.0). The median patient satisfaction for the injured shoulder was 83 (IQR, 70.0-95.0). Regarding radiologic outcomes, for the injured shoulder versus the contralateral shoulder, patients had similar rates of degeneration (44% vs 46%) but more frequent osteolysis of the distal clavicle (31% vs 0%), ossification of the ligaments (29% vs 7%), and deformity of the distal clavicle (19% vs 0%). CONCLUSION Despite the frequent occurrence of radiographic changes, long-term functional outcome after Rockwood I and II acromioclavicular joint injuries is good, with only clinically nonrelevant functional differences between the injured and contralateral shoulders.
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Mellema JJ, Janssen S, Schouten T, Haverkamp D, van den Bekerom MPJ, Ring D, Doornberg JN. Intramedullary nailing versus sliding hip screw for A1 and A2 trochanteric hip fractures. Bone Joint J 2021; 103-B:775-781. [PMID: 33591214 DOI: 10.1302/0301-620x.103b.bjj-2020-1490.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Indexed: 11/05/2022]
Abstract
AIMS This study evaluated variation in the surgical treatment of stable (A1) and unstable (A2) trochanteric hip fractures among an international group of orthopaedic surgeons, and determined the influence of patient, fracture, and surgeon characteristics on choice of implant (intramedullary nailing (IMN) versus sliding hip screw (SHS)). METHODS A total of 128 orthopaedic surgeons in the Science of Variation Group evaluated radiographs of 30 patients with Type A1 and A2 trochanteric hip fractures and indicated their preferred treatment: IMN or SHS. The management of Type A3 (reverse obliquity) trochanteric fractures was not evaluated. Agreement between surgeons was calculated using multirater kappa. Multivariate logistic regression models were used to assess whether patient, fracture, and surgeon characteristics were independently associated with choice of implant. RESULTS The overall agreement between surgeons on implant choice was fair (kappa = 0.27 (95% confidence interval (CI) 0.25 to 0.28)). Factors associated with preference for IMN included USA compared to Europe or the UK (Europe odds ratio (OR) 0.56 (95% CI 0.47 to 0.67); UK OR 0.16 (95% CI 0.12 to 0.22); p < 0.001); exposure to IMN only during training compared to surgeons that were exposed to both (only IMN during training OR 2.6 (95% CI 2.0 to 3.4); p < 0.001); and A2 compared to A1 fractures (Type A2 OR 10 (95% CI 8.4 to 12); p < 0.001). CONCLUSION In an international cohort of orthopaedic surgeons, there was a large variation in implant preference for patients with A1 and A2 trochanteric fractures. This is due to surgeon bias (country of practice and aspects of training). The observation that surgeons favoured the more expensive implant (IMN) in the absence of convincing evidence of its superiority suggests that surgeon de-biasing strategies may be a useful focus for optimizing patient outcomes and promoting value-based healthcare. Cite this article: Bone Joint J 2021;103-B(4):775-781.
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Affiliation(s)
- Jos J Mellema
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Stein Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tundi Schouten
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | | | | | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Job N Doornberg
- Department of Orthopaedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands
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Abstract
Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another.
Cite this article: EFORT Open Rev 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067
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Affiliation(s)
| | | | - Inger N Sierevelt
- Spaarne Gasthuis, Hoofddorp, The Netherlands.,Xpert Orthopedics, Amsterdam, The Netherlands
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Verweij LPE, van Spanning SH, Grillo A, Kerkhoffs GMMJ, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders. Knee Surg Sports Traumatol Arthrosc 2021; 29:4004-4014. [PMID: 34420117 PMCID: PMC8595227 DOI: 10.1007/s00167-021-06704-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Determining the risk of recurrent instability following an arthroscopic Bankart repair can be challenging, as numerous risk factors have been identified that might predispose recurrent instability. However, an overview with quantitative analysis of all available risk factors is lacking. Therefore, the aim of this systematic review is to identify risk factors that are associated with recurrence following an arthroscopic Bankart repair. METHODS Relevant studies were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, CINAHL/Ebsco, and Web of Science/Clarivate Analytics from inception up to November 12th 2020. Studies evaluating risk factors for recurrence following an arthroscopic Bankart repair with a minimal follow-up of 2 years were included. RESULTS Twenty-nine studies met the inclusion criteria and comprised a total of 4582 shoulders (4578 patients). Meta-analyses were feasible for 22 risk factors and demonstrated that age ≤ 20 years (RR = 2.02; P < 0.00001), age ≤ 30 years (RR = 2.62; P = 0.005), participation in competitive sports (RR = 2.40; P = 0.02), Hill-Sachs lesion (RR = 1.77; P = 0.0005), off-track Hill-Sachs lesion (RR = 3.24; P = 0.002), glenoid bone loss (RR = 2.38; P = 0.0001), ALPSA lesion (RR = 1.90; P = 0.03), > 1 preoperative dislocations (RR = 2.02; P = 0.03), > 6 months surgical delay (RR = 2.86; P < 0.0001), ISIS > 3 (RR = 3.28; P = 0.0007) and ISIS > 6 (RR = 4.88; P < 0.00001) were risk factors for recurrence. Male gender, an affected dominant arm, hyperlaxity, participation in contact and/or overhead sports, glenoid fracture, SLAP lesion with/without repair, rotator cuff tear, > 5 preoperative dislocations and using ≤ 2 anchors could not be confirmed as risk factors. In addition, no difference was observed between the age groups ≤ 20 and 21-30 years. CONCLUSION Meta-analyses demonstrated that age ≤ 20 years, age ≤ 30 years, participation in competitive sports, Hill-Sachs lesion, off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, > 1 preoperative dislocations, > 6 months surgical delay from first-time dislocation to surgery, ISIS > 3 and ISIS > 6 were risk factors for recurrence following an arthroscopic Bankart repair. These factors can assist clinicians in giving a proper advice regarding treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lukas P. E. Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | - Sanne H. van Spanning
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Adriano Grillo
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | | | | | - Michel P. J. van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands ,Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Hendrickx LAM, Hilgersom NFJ, Alkaduhimi H, Doornberg JN, van den Bekerom MPJ. Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients. Arch Orthop Trauma Surg 2021; 141:561-568. [PMID: 32285189 PMCID: PMC7966639 DOI: 10.1007/s00402-020-03446-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Humeral shaft fractures are often associated with radial nerve palsy (RNP) (8-16%). The primary aim of this systematic review was to assess the incidence of primary and secondary RNP in closed humeral shaft fractures. The secondary aim was to compare the recovery rate of primary RNP and the incidence of secondary RNP between operative and non-operative treatment. METHODS A systematic literature search was performed in 'Trip Database', 'Embase' and 'PubMed' to identify original studies reporting on RNP in closed humeral shaft fractures. The Coleman Methodology Score was used to grade the quality of the studies. The incidence and recovery of RNP, fracture characteristics and treatment characteristics were extracted. Chi-square and Fisher exact tests were used to compare operative versus non-operative treatment. RESULTS Forty studies reporting on 1758 patients with closed humeral shaft fractures were included. The incidence of primary RNP was 10%. There was no difference in the recovery rate of primary RNP when comparing operative treatment with radial nerve exploration (98%) versus non-operative treatment (91%) (p = 0.29). The incidence of secondary RNP after operative and non-operative treatment was 4% and 0.4%, respectively (p < 0.01). INTERPRETATION One-in-ten patients with a closed humeral shaft fracture has an associated primary RNP, of which > 90% recovers without the need of (re-)intervention. No beneficial effect of early exploration on the recovery of primary RNP could be demonstrated when comparing patients managed non-operatively with those explored early. Patients managed operatively for closed humeral shaft fractures have a higher risk of developing secondary RNP. LEVEL OF EVIDENCE Level IV; Systematic Review.
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Affiliation(s)
- Laurent A. M. Hendrickx
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, 5042 Australia
| | - Nick F. J. Hilgersom
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, 1091 Amsterdam, The Netherlands
| | - Hassanin Alkaduhimi
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, 1091 Amsterdam, The Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, 5042 Australia
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Verweij LPE, Pruijssen EC, Kerkhoffs GMMJ, Blankevoort L, Sierevelt IN, van Deurzen DFP, van den Bekerom MPJ. Treatment type may influence degree of post-dislocation shoulder osteoarthritis: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2312-2324. [PMID: 32936334 PMCID: PMC8225537 DOI: 10.1007/s00167-020-06263-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Age at primary dislocation, recurrence, and glenoid bone loss are associated with development of osteoarthritis (OA). However, an overview of OA following traumatic anterior shoulder instability is lacking and it is unclear to what degree type of surgery is associated with development of OA in comparison to non-operative treatment. The aim of this study was to determine the degree of OA at long-term follow-up after non-operative and operative treatments for patients with anterior shoulder instability. Surgery is indicated when patients experience recurrence and this is associated with OA; therefore, it was hypothesized that shoulders show a higher proportion or degree of OA following operative treatment compared to non-operative treatment. METHODS A literature search was performed in the PubMed/Medline, EMBASE, and Cochrane databases. Articles reporting the degree of OA that was assessed with the Samilson-Prieto or Buscayret OA classification method after non-operative and operative treatment for anterior shoulder instability with a minimum of 5 years follow-up were included. RESULTS Thirty-six articles met the eligibility criteria of which 1 reported the degree of OA for non-operative treatment and 35 reported the degree of OA for 9 different operative procedures. A total of 1832 patients (1854 shoulders) were included. OA proportions of non-operative and operative treatments are similar at any point of follow-up. The Latarjet procedure showed a lower degree of OA compared to non-operative treatment and the other operative procedures, except for the Bristow procedure and Rockwood capsular shift. The meta-analyses showed comparable development of OA over time among the treatment options. An increase in OA proportion was observed when comparing the injured to the contralateral shoulder. However, a difference between the operative subgroups was observed in neither analysis. CONCLUSION Non-operative and operative treatments show similar OA proportions at any point of follow-up. The hypothesis that shoulders showed a higher proportion or degree of OA following operative treatment compared to non-operative treatment is not supported by the data. Operative treatment according to the Latarjet procedure results in a lower degree of OA compared to other treatments, including non-operative treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Erik C Pruijssen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Specialized Center of Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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de Klerk HH, Welsink CL, Spaans AJ, Verweij LPE, van den Bekerom MPJ. Arthroscopic and open debridement in primary elbow osteoarthritis: a systematic review and meta-analysis. EFORT Open Rev 2020; 5:874-882. [PMID: 33425376 PMCID: PMC7784140 DOI: 10.1302/2058-5241.5.190095] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Primary osteoarthritis (OA) of the elbow can cause disabling symptoms of pain, locking, stiffness, and a limitation in the range of motion. There is no consensus regarding the role of open and arthroscopic debridement in the treatment of symptomatic primary elbow OA. The aim of this study is to systematically review the outcome of surgical debridement. A preoperative/postoperative comparison will be made between the two surgical procedures. All studies reporting on debridement as treatment for primary elbow OA with a minimum of one-year follow-up were included. Outcome parameters were functional results, complications, and performance scores. Data were extracted from 21 articles. The arthroscopic group consisted of 286 elbows with a weighted mean follow-up of 40 ± 17 months (range, 16–75). The open group consisted of 300 elbows with a weighted mean follow-up of 55 ± 20 months (range, 19–85). Both procedures showed improvement in Mayo Elbow Performance Score (MEPS), range of motion (ROM) flexion-extension, and ROM pronation-supination. Only in ROM flexion was a statistically significant difference in improvement seen between the groups in favour of the open group. The arthroscopic group showed improvement in pain visual analogue scale (VAS) scores. Nothing could be stated about pain VAS scores in the open group due to a lack of data. In the arthroscopic group 18 complications (6%) were described, in the open group 29 complications (12%). Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate.
Cite this article: EFORT Open Rev 2020;5:874-882. DOI: 10.1302/2058-5241.5.190095
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Affiliation(s)
- Huub H de Klerk
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Anne J Spaans
- Department of Orthopaedic Surgery, St Maartenskliniek, Nijmegen/Boxmeer, The Netherlands
| | - Lukas P E Verweij
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences (AMS), Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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