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Mirghaderi P, Azarboo A, Ghaseminejad-Raeini A, Eshraghi N, Vahedi H, Namdari S. Shoulder Arthroplasty After Previous Nonarthroplasty Surgery: A Systematic Review and Meta-Analysis of Clinical Outcomes and Complications. JBJS Rev 2024; 12:01874474-202403000-00012. [PMID: 38507516 DOI: 10.2106/jbjs.rvw.23.00239] [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: 03/22/2024]
Abstract
BACKGROUND Many patients who undergo shoulder arthroplasty (SA) have had at least 1 nonarthroplasty shoulder surgery before the surgery. There is conflicting evidence regarding the effects of previous shoulder surgery on the outcome of SA. A systematic review was conducted to compare functional outcomes and complications between SA patients with and without prior non-SA surgery on the ipsilateral shoulder. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE/PubMed, Embase, Scopus, and Web of Science comprehensively from inception to January 2023. Based on 9,279 records reviewed, 26 comparative studies were included in the meta-analysis consisting of 5,431 shoulders with prior nonarthroplasty procedures (cases) and 55,144 shoulders without previous surgery (controls). Variables such as functional scores, complications, and range of motion were compared between cases and controls using Review Manager Software. In addition, subgroup analysis was conducted based on prior surgery type (rotator cuff repair [RCR], open reduction and internal fixation [ORIF], soft tissue repairs, and not specified) and type of SA (hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty [RTSA]). The results were presented as odds ratios (ORs) or standardized mean differences (SMDs). RESULTS Except for a higher rate of periprosthetic joint infection (PJI) in patients who had undergone previous arthroscopic surgery (OR, 2.58; 95% confidence interval [CI], 1.66-4.01; p < 0.01), a higher rate of complications was only observed in patients with previous ORIF. These complications included aseptic loosening (OR, 3.43; 95% CI, 2.14-5.50; p < 0.01), shoulder dislocation (OR, 2.25; 95% CI, 1.05-4.84; p = 0.04), overall complication (OR, 3.95; 95% CI, 2.38-6.55; p < 0.01), and revision (OR, 2.52; 95% CI, 1.28-4.97; p = 0.01). Patients with a history of previous surgery demonstrated inferior functional outcomes in comparison with the control group, including American Shoulder and Elbow Surgeons (SMD, -0.39; 95% CI, -0.51 to -0.27; p < 0.01; I2 = 36%), Constant-Murley score (SMD, -0.34; 95% CI, -0.44 to -0.24; p < 0.01; I2 = 0%), abduction (SMD, -0.26; 95% CI, -0.45 to -0.08; p = 0.01; I2 = 54%), and flexion (SMD, -0.33; 95% CI, -0.46 to -0.21; p < 0.01; I2 = 40%). Subgroup analysis by previous type of surgery was not possible regarding functional outcomes. CONCLUSION Patients who have had prior fracture surgery are at a higher risk of complications, reoperations, and revisions after SA than controls. The normal shoulder anatomy may be disrupted by prior surgery, which makes arthroplasty technically challenging, particularly when it comes to soft tissue balance. On the other hand, RCR before SA did not negatively affect clinical outcomes after RTSA and did not have a higher rate of overall complications (except PJI). LEVEL OF EVIDENCE Level III (Treatment Studies). See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peyman Mirghaderi
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Azarboo
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nasim Eshraghi
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Vahedi
- West Virginia University Medicine, Morgantown, West Virginia
| | - Surena Namdari
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Wang W, Liu X, Li Q, Liu R. Mechanisms of shoulder dislocation explained in the "hand as foot teaching philosophy". Asian J Surg 2024; 47:1604-1605. [PMID: 38143175 DOI: 10.1016/j.asjsur.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE To continuously absorb new teaching concepts and try new teaching methods in the process of clinical practice teaching for medical students to improve the teaching effect. METHODS In the process of clinical practice teaching of orthopedic, the teaching concept of "hand and foot" was adopted. RESULTS In the process of clinical practice teaching for medical students, the "hand as foot teaching philosophy" was used to explain the abstract anatomical structures, which greatly stimulated students' interest in classroom learning and achieved good teaching effects. CONCLUSION The "hand as foot teaching philosophy" is a new teaching concept, which is worth exploring and applying in clinical practice, so as to continuously optimize and improve the theoretical system and better serve for teaching.
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Affiliation(s)
- Wenying Wang
- Inner Mongolia Medical University, Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Huhehot North Street, Inner Mongolia, 010050, China
| | - Xiaowei Liu
- Inner Mongolia Medical University, Department of Nursing, The Affiliated People's Hospital of Inner Mongolia Medical University, Huhehot North Street, Inner Mongolia, 010050, China.
| | - Qiang Li
- Inner Mongolia Medical University, Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Huhehot North Street, Inner Mongolia, 010050, China
| | - Rui Liu
- Inner Mongolia Medical University, Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Huhehot North Street, Inner Mongolia, 010050, China
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Smith M, Solomon DJ. Editorial Commentary: Two-Thirds Glenoid Height Technique Used to Generate a "Perfect Circle" Improves Reliability in Measuring Shoulder Glenoid Bone Loss. Arthroscopy 2024; 40:672-673. [PMID: 38219113 DOI: 10.1016/j.arthro.2023.07.044] [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: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 01/15/2024]
Abstract
When determining surgical options for shoulder stabilization, patient age, lifestyle, and sport activities help inform which procedure to select. Additionally, there is a need for solidifying the accuracy and effectiveness of measuring glenoid bone loss, which can be the critical factor in choosing a soft tissue or bony augmentation procedure. Makovicka et al. found that using two-thirds of the glenoid height to generate a perfect-circle, rather than a "best-fit" circle improved reliability of MRI-based bone loss measurement. Two-thirds height technique employs a more objective measure of glenoid height, producing a perfect circle used to subsequently estimate glenoid bone loss, which is consistently reproducible, and can be performed in most clinical settings. This was supported by the improved intra-class correlation coefficient from the two-thirds height perfect circle over the "best-fit" circle measurement observed in this study.
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Etoh T, Yamamoto N, Kawakami J, Kamimura M, Chiba D, Mori Y, Hashimoto K, Aizawa T, Itoi E. How much force is acting on the shoulder joint to create a Hill-Sachs Lesion or reverse Hill-Sachs Lesion? J Orthop Sci 2023; 28:1252-1257. [PMID: 36280491 DOI: 10.1016/j.jos.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND It has not been clarified yet how much force is acting on the shoulder joint to create Hill-Sachs/reverse Hill-Sachs lesions which are commonly observed in patients with anterior or posterior shoulder instability. The purpose of this study was to determine the magnitude of force to create these bony lesions using cadaveric shoulders. METHODS Fourteen fresh-frozen cadaveric shoulders were used. Compression tests were performed using the universal testing machine. The specimens were randomly divided into two groups. In group A, the posterior humeral head (the bare area and articular cartilage) was first compressed against the anterior glenoid rim to simulate a Hill-Sachs lesion, followed by the anterior humeral head being compressed against the posterior glenoid rim. In group B, the same procedure was repeated in the reverse order. X-ray microcomputed tomography (microCT) was also performed. RESULTS The maximum compression force to create a Hill-Sachs lesion was 771 ± 214 N (mean ± SD) on the articular cartilage of the posterior humeral head, which was significantly greater than the force of 447 ± 215 N to create it on the bare area (P = 0.0086). Regarding the reverse Hill-Sachs lesions, the maximum compression force was 840 ± 198 N when it was created on the articular cartilage of the anterior humeral head, which was significantly greater than the force of 471 ± 100 N when it was created at the footprint of the subscapularis tendon (P = 0.0238). MicroCT showed multiple breakage of the trabecular bone. CONCLUSION A force to create a Hill-Sachs lesion or a reverse Hill-Sachs lesion was significantly greater when it was created on the humeral articular cartilage than at the non-cartilage area. Also, the force to create a reverse Hill-Sachs lesion was significantly greater than the one to create a Hill-Sachs lesion.
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Affiliation(s)
- Toshimitsu Etoh
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masayuki Kamimura
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
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Cain EL, Parker D. Open Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Injuries. Clin Sports Med 2023; 42:589-598. [PMID: 37716723 DOI: 10.1016/j.csm.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Open reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments results in excellent reduction of severely displaced AC dislocations, most commonly Grades III and V. Anatomic CC reconstruction through clavicular bone tunnels can prevent vertical instability, whereas the addition of an acromial limb of the graft can increase horizontal stability. Autograft tendon is preferred in the young athletic group of collision sports participants, although allograft has had acceptable results. Accessory fixation may be placed to protect the graft during healing, or for severe instability, especially for athletes involved in contact sports.
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Affiliation(s)
- E Lyle Cain
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA.
| | - David Parker
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA
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Zhang J, Li M, Yang Y, Liu W, Meng X, Fei W, Wang J. Bibliometric and visualized analysis of arthroscopic treatment of acromioclavicular joint injury. J Orthop Surg Res 2023; 18:728. [PMID: 37752567 PMCID: PMC10523771 DOI: 10.1186/s13018-023-04193-7] [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: 07/05/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Since arthroscopy was discovered to treat acromioclavicular joint injury, people have had great interest and attention to this beautiful and minimally invasive operation, and related research has been increasing worldwide. At present, there is no bibliometric and visualized analysis in this field. The purpose of this study is to explore the research hotspots and trends of arthroscopic treatment of acromioclavicular joint injury through bibliometric and visualized analysis and look forward to the future development direction of clinical practice. METHODS The publications on arthroscopic treatment of acromioclavicular joint injury diseases from its establishment to April 2023 were obtained from the Web of Science (WOS) Core Collection database. CiteSpace, VOSviewer, Scimago graphica and Origin were used for bibliometric and visualized analysis. RESULTS This study included a total of 330 publications. The number of publications tends to increase every year. The USA has the most significant number of publications and citations. Imhoff AB is the most relevant scholar with the largest number of publications in this field, and the scholar with the highest citation and average citations is Mazzocca AD. Tech Univ Munich, Rush University and Charite are the three institutions with the greatest contribution. Tech Univ Munich, Rush University and Charite are the three institutions with the greatest contribution. In addition, "Arthroscopy-the Journal of Arthroscopic and Related Surgery" and "American Journal of Sports Medicine" are the institutions with the most significant number of publications and average citations, respectively. The most common keywords are "acromioclavicular joint dislocation," "arthroscopic resection," "arthroscopic reconstruction" and "coracoclavicular ligament." CONCLUSION The number of publications shows a steady upward trend as a whole. However, there is still a lack of cooperation among countries, institutions and scholars around the world, so various countries, institutions and scholars need to strengthen academic exchanges and expand the field of cooperation, so as to promote further research and development in related fields. However, minimally invasive methods such as arthroscopy are still the hotspots and frontiers in the treatment of acromioclavicular joint injury in the future.
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Affiliation(s)
- Jian Zhang
- Department of Orthopedics, Medical College, Yangzhou University, Yangzhou, China
| | - Mingjun Li
- Department of Orthopedics, Northern Jiangsu People's Hospital, Dalian Medical University, Dalian, China
| | - Yuxia Yang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Dalian Medical University, Dalian, China
| | - Wenkang Liu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiangji Meng
- Department of Orthopedics, Northern Jiangsu People's Hospital, Dalian Medical University, Dalian, China
| | - Wenyong Fei
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.
| | - Jingcheng Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.
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Duffett RW, Duralde XA, Marcus RE. CORR Synthesis: What Is the Most Effective Treatment for Rockwood Type III Acromioclavicular Joint Dislocations? Clin Orthop Relat Res 2023; 481:1008-1013. [PMID: 36728233 PMCID: PMC10097529 DOI: 10.1097/corr.0000000000002545] [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: 09/02/2022] [Accepted: 12/08/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Ross W. Duffett
- Department of Orthopaedic Surgery, Case Western University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Randall E. Marcus
- Department of Orthopaedic Surgery, Case Western University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Olsen BS. [Not Available]. Ugeskr Laeger 2023; 185:V205131. [PMID: 36896608] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Bo Sanderhoff Olsen
- Sektionen for Skulder- og Albuekirurgi, Afdeling for Led- og Knoglekirurgi, Herlev/Gentofte Hospital
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Goetti P, Achkar J, Sandman E, Balg F, Rouleau DM. Phone Administration of the Western Ontario Shoulder Instability Index Is More Reliable Than Administration via Email. Clin Orthop Relat Res 2023; 481:84-93. [PMID: 35943525 PMCID: PMC9750603 DOI: 10.1097/corr.0000000000002320] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Western Ontario Shoulder Instability (WOSI) questionnaire is a 21-item questionnaire to evaluate quality of life in patients with shoulder instability. Completing the questionnaire is time-consuming because each item is evaluated on a visual analog scale. Telephone or email versions of the score are appealing alternatives to administering it during the standard in-person patient visit; however, their validity and reliability remain unknown. QUESTIONS/PURPOSES (1) Does the numerical scale (NS) version of the WOSI correlate with the original WOSI and Quick-DASH? (2) Do telephone and email administration of the NS-WOSI have good reliability and consistency? (3) Compared with the original WOSI form, does the NS form lead to faster completion for patients and quicker data extraction for researchers? METHODS Between 2014 and 2019, 50 patients with a documented history of shoulder dislocation with persistent symptomatic shoulder instability, whether anterior, posterior, or multidirectional; patients scheduled for surgery; and patients with traumatic or nontraumatic injuries were prospectively recruited from the outpatient clinic of two university hospitals acting as Level 1 trauma centers and sports traumatology tertiary referral centers. The median (IQR) age was 28 years (24 to 36), and 80% (40 of 50) were men. Most (52% [26 of 50]) patients had two to five lifetime shoulder dislocations. Validity of the NS-WOSI was assessed using the Pearson correlation coefficient during an in-person visit; the original WOSI questionnaire (or its previously validated French-language version), NS-WOSI, and Quick-DASH questionnaires were administered in a random order. After a minimum 7-day interval, 78% (39 of 50) of patients completed the phone interview, and 74% (37 of 50) of patients completed the email version of the NS-WOSI score to evaluate NS-WOSI's reliability using the intraclass correlation coefficient (ICC), which was interpreted as poor (< 0.5), moderate (0.50-0.75), strong (0.75-0.90), and very strong (> 0.90). The standard error of measurement (SEM) was used to evaluate variability around the true score, with a low value indicating a high reliability. The 95% minimal detectable change (MDC 95% ) was calculated to evaluate the minimal change in score that was not related to measurement errors. Lastly, the Cronbach alpha was used to assess internal consistency (intercorrelation strength), where a value > 0.70 was considered good. The time needed for the patient to complete the various versions and for researchers to extract data was recorded. RESULTS The NS-WOSI score was very strongly correlated with the original WOSI score (r = 0.96 [95% confidence interval (CI) 0.93 to 0.98]; p < 0.001). Although telephone-acquired and email-acquired data for the NS-WOSI questionnaires were correlated with the NS-WOSI (telephone r = 0.91 [95% CI 0.83 to 0.95]; p < 0.001; email r = 0.84 [95% CI 0.71 to 0.91]; p < 0.001), the ICC was higher for telephone interviews (0.92 [95% CI 0.86 to 0.96] versus email 0.80 [95% CI 0.64 to 0.89]), indicating that although both had good reliability, the phone interview was more suitable. The phone interview was also preferable to email regarding SEM (3% [52 of 2100 points] versus 6% [132 of 2100 points]) and the MDC 95% (7% [144 of 2100 points] versus 17% [366 of 2100 points]). The 95% CI of the MDC acquired by email was superior to the reported minimum clinically important difference for the original WOSI (7% [152 of 2100 points]), meaning that an error of measurement could wrongly be interpreted as a clinically significant change in score. Internal consistency was deemed good, with a Cronbach alpha of 0.96 (95% CI 0.92 to 98) and 0.89 (95% CI 0.79 to 0.94) for NS-WOSI telephone and email, respectively. The time to complete the NS-WOSI was reduced compared with the original WOSI (221 ± 153 seconds versus 266 ± 146 seconds, mean difference -45 seconds [95% CI -72 to -12]; p = 0.009). Lastly, data extraction was faster (62 ± 15 seconds versus 209 ± 52 seconds, mean difference -147 seconds [95% CI -164 to -130]; p < 0.001) with the NS-WOSI than with the original WOSI. CONCLUSION The NS-WOSI in person, by telephone, or by email is a valid, reliable, and timesaving alternative to the original WOSI questionnaire. However, the reliability of data acquisition by telephone interviews was superior to that of email. CLINICAL RELEVANCE Given that there were no important differences in performance for the NS-WOSI, regardless of whether it was administered in person or by phone, we suggest that physicians use both interchangeably based on patient convenience. However, we do not recommend using the email version, especially for research purposes, since it was not as reliable when compared with in-person administration. The responsiveness of the modified NS-WOSI, as well as factors influencing response rates to phone interview, are questions that remain to be explored.
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Affiliation(s)
- Patrick Goetti
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jacquelina Achkar
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emilie Sandman
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- CIUSSS (Centre Intégré Universitaire de Santé et des Servives Sociaux) du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Frédéric Balg
- Centre Intégré Universitaire de Santé et des Servives Sociaux CIUSSS-de-l’Estrie-Centre Hospitalier Universitaire Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dominique M. Rouleau
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- CIUSSS (Centre Intégré Universitaire de Santé et des Servives Sociaux) du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
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Koh JL. CORR Insights®: Phone Administration of the Western Ontario Shoulder Instability Index Is More Reliable Than Administration via Email. Clin Orthop Relat Res 2023; 481:94-96. [PMID: 36018751 PMCID: PMC9750689 DOI: 10.1097/corr.0000000000002384] [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: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Jason L Koh
- Clinical Professor, NorthShore University Health System, Northshore Evanston Hospital, Evanston, IL, USA
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Raniga S, Arenas-Miquelez A, Bokor D. What Is the Most Reliable Method of Measuring Glenoid Bone Loss in Anterior Glenohumeral Instability? Response. Am J Sports Med 2022; 50:NP58-NP59. [PMID: 36318101 DOI: 10.1177/03635465221121606] [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: 11/05/2022]
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Tennent TD, Pearse Y, Arnander M. What Is the Most Reliable Method of Measuring Glenoid Bone Loss in Anterior Glenohumeral Instability? Letter to the Editor. Am J Sports Med 2022; 50:NP57-NP58. [PMID: 36318100 DOI: 10.1177/03635465221121605] [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: 11/06/2022]
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Akar B. The correlation between acromial osteolysis and acromion types in the treatment of acromioclavicular joint dislocation with hook plate. Medicine (Baltimore) 2022; 101:e31632. [PMID: 36316844 PMCID: PMC9622696 DOI: 10.1097/md.0000000000031632] [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: 11/16/2022] Open
Abstract
This study aimed to radiologically evaluate the effect of hook plates used in the treatment of acromioclavicular joint (ACJ) dislocations on the development of subacromial osteolysis (SAO) according to acromion types. A total of 43 patients with mean age of 38.5 (19-77) years who were diagnosed with AC dislocation and applied neutral clavicular hook plate between 2013 and 2020 were retrospectively evaluated. Acromion types were determined by measuring acromion slope angle on lateral shoulder radiography and 3-dimensional (D)-CT of the patients. Presence of SAO was classified according to the severity of erosion in the subacromial region (grade I: minimal osteolysis, grade II: subacromial erosion <2 mm, grade III: subacromial erosion >2 mm, grade IV: cut-through of the acromion) on postoperative 3D - CT and correlation with acromion types was analyzed. Incidence of SAO was significantly higher among type 1 acromion compared to type 2 and type 3 acromion (P = .003). While osteolysis was observed in 21 patients, no osteolysis was observed in 22 patients. Osteolysis occurred in all patients with type 1 acromion, 7 patients with type 2 acromion, and 5 patients with type 3 acromion. Since the hook tip in the sagittal plane passes posterior to the center of the acromion and the concavity of the subacromial surface is inadequate in the type 1 acromion, we believe that the increased pressure applied by the hook tip on the subacromial cartilage increases the risk of SAO. We predict that the use of hook plates with an angle of 15-20 degrees, similar to the patient's AC angle, rather than neutral hook plate, will reduce the risk of osteolysis in patients with type 1 acromion.
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Affiliation(s)
- Bedrettin Akar
- Sakarya Yenikent State Hospital, Deparmant of Orthopedics and Traumatology, Sakarya, Turkey
- * Correspondence: Bedrettin Akar, Sakarya Yenikent State Hospital, Deparmant of Orthopedics and Traumatology, Sakarya, Turkey (e-mail: )
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Hems T. Re. Jordan R, Wade RG, McCauley G, Oxley S, Bains R, Bourke G. Functional deficits as a result of brachial plexus injury in anterior shoulder dislocation. J Hand Surg Eur. 2021, 46: 725-30. J Hand Surg Eur Vol 2022; 47:876-877. [PMID: 35473425 DOI: 10.1177/17531934221090462] [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: 02/03/2023]
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Iino T, Tsujii M, Wakabayashi T, Setoguchi Y, Hasegawa M, Sudo A. Expression and distribution pattern of aggrecanases and miR-140s in the thickened synovia of shoulder joints in rotator cuff tears: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29583. [PMID: 35960057 PMCID: PMC9371533 DOI: 10.1097/md.0000000000029583] [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: 01/04/2023] Open
Abstract
The rotator cuff (RC) is frequently torn at the enthesis composed of fibrocartilage. We aimed to histopathologically evaluate lining layers and assess the distribution of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)4, ADAMTS5, and microRNA (miR)-140s in the synovia of patients with RC tears. We recruited 51 patients who underwent arthroscopic surgical treatment for full-thickness rotator cuff tears, including 26 patients with < 3 cm tear size (group N) and 25 patients with ≥ 3 cm tear size (group W). Biopsied synovia were analyzed using histological and immunohistological techniques for the presence ADAMTS4 and ADAMTS5. The layers of the synovial lining were morphologically classified into 3 grades according to the synovitis score and staining levels of ADAMTSs. The glenohumeral synovia from 8 patients with recurrent shoulder dislocation (group C) were used as controls. Furthermore, in situ hybridization was performed to evaluate the presence of miR-140s in patients with massive tears and recurrent shoulder dislocation. The staining levels were evaluated and analyzed based on comparison between patient groups and correlation between ADAMTS5 and miR-140s. Histological analysis revealed significant differences between groups W and C. ADAMTS5 and ADAMTS4 were strongly expressed in the synovial lining of patients in group W, and this expression was significantly higher than that in groups C and N. In addition, expression of ADAMTS5 was inversely correlated with that of miR-140-3p. This study showed that synovia from group W had a significantly higher rate of severely thickened areas with strong expression of both aggrecanases. Furthermore, the area with weak expression of miR-140-3p showed strong ADAMTS5 expression.
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Affiliation(s)
- Takahiro Iino
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Masaya Tsujii
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
- Department of Orthopaedic Surgery, Nagai Hospital, Tsu, Japan
- *Correspondence: Masaya Tsujii, 2-174 Edobashi, Tsu city, 514-8507, Japan (e-mail: )
| | - Toru Wakabayashi
- Department of Orthopaedic Surgery, Toyohashi Orthopaedic Surgery Ezaki Hospital, Toyohashi, Japan
| | | | - Masahiro Hasegawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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Cismasiu B, Rodrigues S, Oliveira G, Rodrigues C. Potential vascular damage by posterior dislocation of sternoclavicular joint. Port J Card Thorac Vasc Surg 2022; 29:87. [PMID: 35780422 DOI: 10.48729/pjctvs.248] [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] [Received: 04/03/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
A 34-year-old man was admitted for surgical treatment following traumatic posterior sternoclavicular joint dislocation and anterior mediastinum hematoma with compression of brachiocephalic vein (A, B). Intra-operative positioning consid- ered access for possible sternotomy and control of upper vena cava territory in case of bleeding from venous confluent (C). Patient was submitted to open reduction of sternoclavicular joint through an oblique supraclavicular incision (D), fixation with high strength orthopedic suture (E), mediastinal drainage and closure with absorbable suture (F).
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Affiliation(s)
- Brigitta Cismasiu
- Department of General Surgery, Hospital Garcia de Orta, Almada, Portugal
| | - Susana Rodrigues
- Department of Orthopedic Surgery, Hospital Garcia de Orta, Almada, Portugal
| | - Gabriel Oliveira
- Department of General Surgery, Hospital Garcia de Orta, Almada, Portugal
| | - Cristina Rodrigues
- Department of Thoracic Surgery, Hospital Garcia de Orta, Almada, Portugal; Department of Thoracic Surgery, Hospital Pulido Valente, Lisboa, Portugal
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Makihara K, Takegami Y, Tokutake K, Yamauchi K, Hiramatsu Y, Matsuura Y, Imagama S. Risk factors for fracture-related infection after open reduction and internal fixation of proximal humerus fractures: A multicenter retrospective study of 496 fractures (TRON group study). Injury 2022; 53:2573-2578. [PMID: 35641333 DOI: 10.1016/j.injury.2022.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION One of the complications of the surgical therapy for proximal humerus fractures is fracture-related infection (FRI). This multicenter study aimed to investigate the incidence of FRI and clarify the risk factors associated with FRI in patients receiving open reduction and internal fixation for proximal humerus fracture. MATERIAL AND METHODS Among 684 patients diagnosed as having proximal humerus fracture and who were treated by surgical therapy in 13 institutions (named TRON group) from 2015 through 2020, 496 patients (men, n = 134, women, n = 362; mean [SD] age, 68.5 [14.5] years; mean [SD] body mass index [BMI], 23.0 [4.4] kg/m2) were included as subjects. Excluded were 188 patients due to less than 12 month's follow-up, patients who underwent osteosynthesis using neither plate nor nail and those with open fracture. We extracted the following as risk factors of FRI: sex, BMI, smoking status, diabetes, glenohumeral fracture dislocation, fracture classification, approach, implant, waiting period, type of anesthesia, operative time and blood loss during surgery. We conducted logistic regression analysis to investigate the risk factors of FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. RESULT FRI occurred after surgery for proximal humerus fracture in 9 of the 496 patients (1.8%). The causative organism was methicillin-susceptible Staphylococcus aureus in 4 patients, Pseudomonas aeruginosa in one patient and Enterococcus faecalis in one patient. In the other 3 patients, causative organisms were not detected. The univariate analysis showed significant differences for present of glenohumeral fracture dislocation (p = 0.004). Logistic regression analysis showed glenohumeral fracture dislocation to be the significant explanatory factor for FRI (odds ratio 12.3, p = 0.0375). CONCLUSION This study revealed an infection rate following open reduction and internal fixation of proximal humerus fracture of 1.8% (9 patients) and that Staphylococcus was the most frequent causative organism. Glenohumeral fracture dislocation is a significant risk for postoperative FRI.
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Affiliation(s)
- Koichiro Makihara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Yamauchi
- Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yutaka Hiramatsu
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yui Matsuura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Cerciello S, Corona K, Morris BJ, Proietti L, Mercurio M, Cattaneo S, Milano G. Hybrid coracoclavicular and acromioclavicular reconstruction in chronic acromioclavicular joint dislocations yields good functional and radiographic results. Knee Surg Sports Traumatol Arthrosc 2022; 30:2084-2091. [PMID: 34841469 DOI: 10.1007/s00167-021-06790-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone. The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations. METHODS Twenty-two patients surgically treated for chronic AC joint dislocations (grade 3 to 5) were retrospectively reviewed. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6 months postop and at final follow-up. The same surgical technique consisting in a primary fixation with a suspensory system, coracoclavicular ligaments reconstruction with a double loop of autologous gracilis and acromioclavicular ligaments reconstruction with autologous coracoacromial ligament was performed in all cases. RESULTS Twenty-two shoulders in 22 patients (19 males and 3 females) were evaluated with a mean age of 34.4 ± 9 years at the time of surgery. The mean interval between the injury and surgery was 53.4 ± 36.7 days. The mean duration of postoperative follow-up was 49.9 ± 11.8 months. According to the Rockwood classification, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4 ± 7.6 and 64.6 ± 7.2, respectively. They improved to 91.8 ± 2.3 (p = 0.0001) and 95.2 ± 3.1 (p = 0.0001), respectively at final FU. The mean preoperative CCD was 22.4 ± 3.2 mm while the mean CCD ratio was 2.1 ± 0.1. At final FU, the mean CCD was 11.9 ± 1.4 mm (p = 0.002) and the mean CCD ratio was 1.1 ± 0.1 (p = 0.009). No recurrence of instability was observed. One patient developed a local infection and four patients referred some shoulder discomfort. Heterotopic ossifications were observed in three patients. CONCLUSIONS The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Simone Cerciello
- A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
- Marrelli Hospital, Crotone, Italy
- Casa Di Cura Villa Betania, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Brent Joseph Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, KY, USA
| | | | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Stefano Cattaneo
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Mastrantonakis K, Daskalogiannakis E, Ktistakis I, Siligardou M, Chronakis I, Kalinterakis G. Closed shoulder reduction by glenohumeral joint distraction. A technical note. Eur J Orthop Surg Traumatol 2022; 33:1427-1429. [PMID: 35157144 DOI: 10.1007/s00590-022-03222-1] [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] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
We describe a shoulder reduction technique by direct distraction at the glenohumeral joint in supine position. The technique can be performed by one or two providers and has an easy learning curve, and the use of anesthesia is not mandatory. It is anatomically based and combines traction-counter-traction technique along with scapula manipulation.
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Affiliation(s)
- K Mastrantonakis
- Department of Trauma and Orthopedics, General Hospital of Rethymnon, 74100, Rethymnon, Greece
| | - E Daskalogiannakis
- Department of Trauma and Orthopedics, General Hospital of Rethymnon, 74100, Rethymnon, Greece
| | - I Ktistakis
- Department of Trauma and Orthopedics, General Hospital of Rethymnon, 74100, Rethymnon, Greece
| | - M Siligardou
- Department of Trauma and Orthopedics, General Hospital of Rethymnon, 74100, Rethymnon, Greece
| | - I Chronakis
- Department of Anesthesia, General Hospital of Rethymnon, 74100, Rethymnon, Greece
| | - G Kalinterakis
- Department of Trauma and Orthopedics, General Hospital of Rethymnon, 74100, Rethymnon, Greece.
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Abstract
INTRODUCTION Although the coracoid process seems to play an important anatomical role, there are few reports concerning fracture nonunion of the coracoid process (CN) and its disorders. Therefore, there is no widely accepted standard for the treatment of CN. MATERIALS AND METHODS PubMed and Scopus were searched using "scapular fracture" and "coracoid fracture" as search terms. The inclusion criteria were English full-text articles concerning coracoid fracture, and articles that described patient characteristics and presented appropriate images. The exclusion criteria were descriptive cases, and cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using Ogawa's functional classification, with Eyres' anatomical classification used as a supplement when necessary. RESULTS Twenty-nine patients (26 men, 3 women) with 30 CN were identified. Nine CN had a predisposing factor such as seizure disorder and renal osteodystrophy. The fracture types were 12 Ogawa type I and 18 type II. Concurrent shoulder girdle injuries at the time of initial trauma/accident were varied. There were six cases of double disruption and two of triple disruption of the superior shoulder suspensory complex (SSSC), all of which had Ogawa type I fracture. Only six CN were isolated. The most frequent cause of CN was oversight by the previous physician (n = 11), followed by conservative treatment (n = 7). Although 12 patients with 13 CN had symptoms attributable to CN, most of these symptoms were insignificant. Although the acromioclavicular dislocation or CN persisted in eight patients, these residual abnormalities did not significantly affect the outcomes. CONCLUSIONS Physicians treating CN should recognize that CN itself is frequently asymptomatic, and a satisfactory outcome is achieved solely by treating the concurrent injuries, even if CN remains. When CN is suspected to produce symptoms, the physician must then determine the mechanism by which the symptoms are produced, and select a treatment strategy. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, 2-23-16 Higashi-Ueno, Taito-ku, Tokyo, 110-8645, Japan.
| | - Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsushi Yoshida
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako, Saitama, 351-0102, Japan
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23
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Sunde P. Anterior shoulder dislocation – examination and treatment. Tidsskr Nor Laegeforen 2021; 141:21-0663. [PMID: 34641657 DOI: 10.4045/tidsskr.21.0663] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lami D, Fauvet N, Ollivier M, Argenson JN, Grillo JC. A hybrid open-arthroscopic latarjet coracoid bone-block technique using "HyLa" instrumentation. Orthop Traumatol Surg Res 2021; 107:102978. [PMID: 34098147 DOI: 10.1016/j.otsr.2021.102978] [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: 05/19/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 02/03/2023]
Abstract
Latarjet coracoid bone-block is a gold-standard procedure for anteroinferior instability of the shoulder. Nowadays, it can be performed as open surgery or entirely under arthroscopy. The pure arthroscopic technique has the advantage of allowing concomitant intra-articular surgery, but involves a long learning curve. Here we present a hybrid concept using dedicated instrumentation comprising a specific guide with or without arthroscopic step, and notably ensuring the safety and reproducibility of the procedure, whatever the modality. This technique offers an alternative to arthroscopic coracoid bone block, performing the more complex steps as open surgery without major change to Latarjet's original technique, so as to enable concomitant intra-articular surgery if needed while getting around some of the limitations of the purely arthroscopic procedure.
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Affiliation(s)
- Damien Lami
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France
| | - Nicolas Fauvet
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France.
| | - Matthieu Ollivier
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France
| | - Jean-Noël Argenson
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France
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Nourissat G, Housset V, Lehanneur M, Bastard C. Editorial Commentary: A Functional Capsule, Not the Type of Bone Graft, Determines Outcome After Shoulder Stabilization in Cases of Anterior Glenoid Bone Deficiency. Arthroscopy 2021; 37:2409-2411. [PMID: 34353552 DOI: 10.1016/j.arthro.2021.05.054] [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: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
Many clinical results of surgical treatment of recurrent anterior shoulder instability confirm the importance of anterior bone grafting of the glenoid defect. Some studies even propose to perform a graft, even when there is no bony defect. Short- and middle-term studies report comparable results between bone grafting and Latarjet procedure. But one of the main questions that still remains is the quality and efficiency of the capsule. If Latarjet is the gold standard in anterior shoulder stabilization with very good results at very long follow-up, it is probably because the capsule is replaced by the conjoint tendon. Because Latarjet is a difficult surgery and has some complexes and/or challenging complications and because it is a nonanatomic procedure, there is a true place for anterior bone grafting. This anterior grafting under arthroscopy provides excellent results, but it is mandatory to be sure that the shoulder capsule is working. Clinical, functional, and imaging studies of this capsule need to be performed for a better understanding of the unstable shoulder function and treatment.
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Verloop WRG, Haarman CJW, van Vliet RO, de Koning JL, Rietman JS. A newly designed shoulder orthosis for patients with glenohumeral subluxation: a clinical evaluation study. Prosthet Orthot Int 2021; 45:322-327. [PMID: 34269756 DOI: 10.1097/pxr.0000000000000026] [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: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Shoulder complaints from glenohumeral subluxation are a common problem and limit patients during daily activities. OBJECTIVE To assess the clinical pros and cons and usability of a newly developed shoulder orthosis (Roessingh Omo Support [ROS]) in patients with chronic shoulder complaints. STUDY DESIGN Retrospective cross-sectional study. METHODS All patients older than 18 years who received the ROS were invited. Medical information was collected from medical records. Two questionnaires were sent to the patient: The "Shoulder Rating Questionnaire" (SRQ, max 100 points) for evaluation before and during use and a custom orthosis usability questionnaire. RESULTS In total, 28 patients (34 orthoses) participated in the study. Neuralgic amyotrophy was the most common diagnosis (64.3%). The SRQ showed a significant positive change of 8.9 points (from 35.0 [SD 12.6] to 43.9 [SD 14.3]). The most described goal was pain reduction (76.5%). 47.1% of the patients achieved their goal(s), and 71.4% were still using the orthosis. The mean satisfaction rate was 7.1 (SD 1.4). CONCLUSION The use of the ROS shows a significant functional improvement (SRQ), a decrease of pain, and a high degree of satisfaction, although the individual experiences of the patients are highly variable. Some modifications to the design to improve comfort may be needed.
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Affiliation(s)
| | - Claudia J W Haarman
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | | | | | - Johan S Rietman
- Roessingh Centre for Rehabilitation, Enschede, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
- Roessingh Research and Development, Enschede, the Netherlands
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Yancey JR, Szczepanik M. Acromioclavicular Joint Dislocation: Surgical vs. Conservative Interventions. Am Fam Physician 2021; 104:28-29. [PMID: 34264594] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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28
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Dai F, Yang JS, Zhang Q, Chen JR, Xiang M. [Reliability of three dimensional CT measurement of glenoid track in patients with recurrent anterior dislocation of shoulder]. Zhongguo Gu Shang 2021; 34:492-496. [PMID: 34180164 DOI: 10.12200/j.issn.1003-0034.2021.06.002] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the reliability and repeatability of three-dimensional (3D)-CT measurement of glenoid track. METHODS Glenoid and Hill-Sachs bone defects in 60 patients with recurrent anterior dislocation of the unilateral shoulder were evaluated by 3D-CT and analyzed by three independent observers(shoulder orthopedists) according to the Di Giacomo method. These injuries were classified to formulate a surgical protocol. All the patients were repeatedly measured 1 week later. Intraclass correlation coefficient (ICC) and coefficient of variation (COV) were used for reliability analysis. RESULTS Interobserver reliability was "very good" for both measurements of glenoid diameter and glenoid bone defects, and "good" for measurements of Hill-Sachs interval. Interobserver agreement was high on the assessment of the extent of the glenoid defect, and poor on track/off track assessment of the Hill-Sachs lesion. Intraobserver reliability for measurements of glenoid diameter, glenoid defect, and Hill-Sachs interval was "very good". The COV was 4.1% for glenoid diameter, 4.4% for glenoid defect, and 21.1% for Hill-Sachs interval. CONCLUSION The reliability and reproducibility of 3D-CT measurements of glenoid bone defects are good, but the assessment of humeral head bone defects shows large variability with poor reliability.
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Affiliation(s)
- Fei Dai
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu 610041, Sichuan, China
| | - Jin-Song Yang
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu 610041, Sichuan, China
| | - Qing Zhang
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu 610041, Sichuan, China
| | - Jun-Rong Chen
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu 610041, Sichuan, China
| | - Ming Xiang
- Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu 610041, Sichuan, China
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Owusu-Akyaw KA. Editorial Commentary: Arthroscopic Surgery Is Not Minor Surgery: Shared Decision Requires Comprehensive Informed Consent. Arthroscopy 2021; 37:1755-1756. [PMID: 34090563 DOI: 10.1016/j.arthro.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023]
Abstract
Arthroscopic surgery of the shoulder has revolutionized the way we address intra-articular and tendinous injuries about the joint. Nevertheless, despite the apparent minimally invasive nature of our trade, there remain potential long-term consequences to every operation. This is especially true if future arthroplasty is indicated, as the risk of prosthetic joint infection is increased in patients having a previous procedure. True partnership with our patients necessitates that they have a clear understanding of the full implications of any surgery, no matter how small it may seem. True informed consent necessitates that our patients understand not only the immediate implications of the current operation but the potential effects on a future operation. This can only be accomplished by effective and honest communication about the full scope of the risk undertaken when an arthroscopic surgery is performed.
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30
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Liau GZQ, Phua SKA, Li T, Yap KY, Teo RWL, Manohara R. Concomitant fracture of the coracoid process following acromioclavicular joint dislocation. Ann Acad Med Singap 2021; 50:438-440. [PMID: 34100522 DOI: 10.47102/annals-acadmedsg.2020328] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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31
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Lópiz Y, Checa P, García-Fernández C, Martín Albarrán S, López de Ramón R, Marco F. Complications after open Latarjet procedure: influence of arm positioning on musculocutaneous and axillary nerve function. Eur J Orthop Surg Traumatol 2021; 32:243-248. [PMID: 33786663 DOI: 10.1007/s00590-021-02960-y] [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] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alterations in the anatomical relationships of the musculocutaneous (MCN) and axillary nerves and the influence of arm positioning on these relationships after a Latarjet procedure have been demonstrated in the cadaver, but there are no studies in the literature that establish if there is any neurophysiological repercussion. METHODS We retrospectively identified 24 patients with a primary or revision open Latarjet procedure. A prospective clinical (Constant-Murley, Rowe and Walch-Duplay and active range of motion), radiographic (with CT), and electrodiagnostic evaluation was made at the most recent follow-up. RESULTS Nonunion occurred in four patients (22%); there were, as well, one case of partial coracoid reabsorption (5%) and two (11%) with mild glenohumeral osteoarthritis. In the anatomical position, we found no alterations in the musculocutaneous nerve and two cases (11%) in the axillary nerve slight motor unit loss. In the risk position, 11 cases (61%) had neurophysiological involvement (36% had neurophysiological changes in the musculocutaneous nerve and 64% in the axillary nerve). No differences between patients with or without neurophysiologic changes were found: Constant 87/83; Rowe 89/90; Walch-Duplay 84/78; Forward elevation 175º/170º, abduction 165°/175°; external rotation 48°/45°. CONCLUSION The rate of clinical electromyographic changes in the axillary and MCN in the abducted and externally rotated arm position (risk dislocation position) is higher than in neutral position. Nonunion of the coracoid process must play a role in these neurophysiological changes. Although in the medium-term they don't have clinical impact, further randomized prospective studies with a larger sample size are necessary to determine their true repercussion. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yaiza Lópiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain
- Surgery Department, Complutense University, Madrid, Spain
| | - Pablo Checa
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain.
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain
| | | | - Rafael López de Ramón
- Department of Traumatology and Orthopaedic Surgery, Ourense's Universitary Hospital Complex, Ourense, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain
- Surgery Department, Complutense University, Madrid, Spain
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Wermers J, Schliemann B, Raschke MJ, Michel PA, Heilmann LF, Dyrna F, Sußiek J, Frank A, Katthagen JC. Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect. Knee Surg Sports Traumatol Arthrosc 2021; 29:2631-2639. [PMID: 33839898 PMCID: PMC8298230 DOI: 10.1007/s00167-021-06562-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. The aim of this study was to evaluate whether glenoid concavity allows a more precise assessment of glenohumeral stability than the defect size alone. METHODS The stability ratio (SR) is a biomechanical estimate of glenohumeral stability. It is defined as the maximum dislocating force the joint can resist related to a medial compression force. This ratio was determined for 17 human cadaveric glenoids in a robotic test setup depending on osteochondral concavity and anterior defect size. Bony defects were created gradually, and a 3D measuring arm was used for morphometric measurements. The influence of defect size and concavity on the SR was examined using linear models. In addition, the morphometrical-based bony shoulder stability ratio (BSSR) was evaluated to prove its suitability for estimation of glenohumeral stability independent of defect size. RESULTS Glenoid concavity is a significant predictor for the SR, while the defect size provides minor informative value. The linear model featured a high goodness of fit with a determination coefficient of R2 = 0.98, indicating that 98% of the SR is predictable by concavity and defect size. The low mean squared error (MSE) of 4.2% proved a precise estimation of the SR. Defect size as an exclusive predictor in the linear model reduced R2 to 0.9 and increased the MSE to 25.7%. Furthermore, the loss of SR with increasing defect size was shown to be significantly dependent on the initial concavity. The BSSR as a single predictor for glenohumeral stability led to highest precision with MSE = 3.4%. CONCLUSION Glenoid concavity is a crucial factor for the SR. Independent of the defect size, the computable BSSR is a precise biomechanical estimate of the measured SR. The inclusion of glenoid concavity has the potential to influence clinical decision-making for an improved and personalised treatment of glenohumeral instability with anterior glenoid bone loss.
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Affiliation(s)
- Jens Wermers
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
| | - Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Philipp A Michel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Lukas F Heilmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Julia Sußiek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Andre Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - J Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
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Porcellini G, Cecere AB, Giorgini A, Micheloni GM, Tarallo L. The GLAD Lesion: are the definition, diagnosis and treatment up to date? A Systematic Review. Acta Biomed 2020; 91:e2020020. [PMID: 33559615 PMCID: PMC7944697 DOI: 10.23750/abm.v91i14-s.10987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although GLAD lesions are quite common, only sporadic case reports describe surgical techniques and clinical outcomes. Even if cartilage defects can result from various pathogenic mechanisms, the resulting defect has some similarities with GLAD, and its management can be a starting point to treat both types of lesion. Aim of the present study is to find a commonly accepted definition for GLAD lesions in order to understand its pathogenesis, diagnosis and possible treatments. METHODS A search of PubMed (MEDLINE) database has been performed in June 2020 to identify relevant articles including a combination of the following search terms: "GlenoLabral Articular Disruption" OR "GLAD" AND "shoulder" AND "cartilage, articular". RESULTS Abstract evaluation included 31 articles in the full-text review. Various studies showed that the performance of MR arthrography in the detection of glenohumeral cartilage lesions, including GLAD lesions, was moderate. Different therapeutic solutions have been described. Arthroscopic debridement of the lesion and reattachment of the labrum have been often used. In case of large articular defects, the labrum could be advanced in the cartilage defect to cover it. In case of cartilage flap with reparable margins, this could be reattached with different suture constructs. Neglected GLAD lesions following a chronic trauma or shoulder instability have not been described in literature. CONCLUSIONS The definition of GLAD injury has changed over the time. Many authors associate this lesion with shoulder instability, with trauma in abduction and extra rotation, while Neviaser's original definition described stable shoulders following a trauma in adduction.
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Affiliation(s)
- Giuseppe Porcellini
- 1 Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Antonio Benedetto Cecere
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Naples, Italy.
| | - Andrea Giorgini
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | | | - Luigi Tarallo
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
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Kearney RS, Dhanjal G, Parsons N, Ellard D, Parsons H, Haque A, Karasouli E, Mason J, Nwankwo H, Brown J, Liew Z, Drew S, Modi C, Bush H, Torgerson D, Underwood M. Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial. BMJ Open 2020; 10:e040623. [PMID: 33444204 PMCID: PMC7678365 DOI: 10.1136/bmjopen-2020-040623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION First-time traumatic anterior shoulder dislocation (TASD) is predominantly managed non-operatively. People sustaining TASD have ongoing pain, disability and future risk of redislocation. There are no published randomised controlled trials (RCTs) comparing different non-operative rehabilitation strategies to ascertain the optimum clinically effective approach after TASD. METHODS AND ANALYSIS In this multicentre adaptive RCT, with internal pilot, adults with a radiologically confirmed first time TASD treated non-surgically will be screened at a minimum of 30 sites. People with neurovascular complications, bilateral dislocations or are unable to attend physiotherapy will be excluded.Randomisation will be on a 1:1 treatment allocation, stratified by age, hand dominance and site. Participants will receive a single session of advice; or a single session of advice plus offer of further physiotherapy (maximum 4 months). The primary analysis will be the difference in Oxford Shoulder Instability Score at 6 months. A sample size of a minimum of 478 participants will allow us to show a four point difference with 90% power.An embedded qualitative study will explore the participants' experiences of the trial interventions. ETHICS, REGISTRATION AND DISSEMINATION Funded by NIHR HTA (16/167/56), 1 June 2018; National Research Ethic Committee approved (18/WA/0236), 26 July 2018. First site opened 5 November 2018 and final results will be updated on trial registries and submitted to a peer-reviewed journal and will inform rehabilitation strategies after a TASD. Study Within A Trial (SWAT) funded by MRC (MR/R013748/1), 1 May 2019; registered on the MRC-HTMR All-Ireland Hub (reference number SWAT 121). TRIAL REGISTRATION NUMBER ISRCTN63184243. (Trial stage: Pre-results).
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Affiliation(s)
| | - Gurmit Dhanjal
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Aminul Haque
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Henry Nwankwo
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | - ZiHeng Liew
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Drew
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chetan Modi
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Howard Bush
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Grigorev I, Lazko F, Prizov A, Kanaev A, Lazko M. [A COMPARISON OF RESULTS BETWEEN HOOK PLATE AND TIGHTROPE FOR ACUTE ACROMIOCLAVICULAR JOINT DISLOCATION]. Georgian Med News 2020:39-44. [PMID: 33270575] [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: 06/12/2023]
Abstract
Purpose the study - despite of this fact that there are different surgical techniques to treat acromioclavicular dislocation and also the surgery remains controversial, the purpose of our study is to compare the results of surgery treatment to acromioclavicular joint dislocation on the condition of surgical method: Hook Plate versus TightRope. Between 2015 and 2019, 30 patients were with acute Rockwood type III-VI acromioclavicular dislocation at the age of 23-54. Patients were divided into 2 groups according to the surgical methods (Hook plate: n=15; TightRope: n=15)to compare the functional outcome after using either Hook plate and TightRope stabilization. Patients were evaluated using Constant Score and radiography. Comparing the functional results, were observed some differences between the two groups. According to Constant Score the results were: Hook plate - 78.5, TightRope - 81.4. 14 patients in the hook plate group were reoperated to remove the device, except 1 patient who refused to be reoperated. There was insignificant difference between both groups regarding severity pain. The majority of tightrope group (70%) regained their normal functional activities, whereas only 40% of the hook plate patients did (р<0.001)/ About half (50%) of the tightrope group in comparison with 30% of hook plate group had active forward flexion more than 150° (р<0.01). Both groups showed no significant differences regarding degree of muscle strength, patients' satisfaction, and total outcome. Both operative methods are effective techniques and could be recommended to treat an acute acromioclavicular joint dislocation. Between the two groups are no significant differences. However, TightRope fixation provides a low rate of failure and complications and avoids the need for second surgery to remove the implant.
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Affiliation(s)
- I Grigorev
- Moscow City Clinical Hospital named after V.M. Buyanov; Peoples' Friendship University of Russia, Moscow, Russia
| | - F Lazko
- Moscow City Clinical Hospital named after V.M. Buyanov; Peoples' Friendship University of Russia, Moscow, Russia
| | - A Prizov
- Moscow City Clinical Hospital named after V.M. Buyanov; Peoples' Friendship University of Russia, Moscow, Russia
| | - A Kanaev
- Moscow City Clinical Hospital named after V.M. Buyanov; Peoples' Friendship University of Russia, Moscow, Russia
| | - M Lazko
- Moscow City Clinical Hospital named after V.M. Buyanov; Peoples' Friendship University of Russia, Moscow, Russia
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Provencher CMT, Midtgaard KS. Editorial Commentary: Evidence to Support Surgical Intervention for First-Time Shoulder Instability: Stabilize Them Early! Arthroscopy 2020; 36:2533-2536. [PMID: 32891253 DOI: 10.1016/j.arthro.2020.07.034] [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: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
Historically, a primary anterior instability event has been treated nonoperatively. In the literature, a multitude of outcome scores and definitions for recurrence of instability complicates the interpretation and synthesis of evidence-based recommendations. However, there is an emerging body of high-quality evidence that early surgical stabilization yields better overall outcomes. A wait-and-see approach would be acceptable if it was without detrimental effects, but there is a cost to recurrence of instability events, such as more extensive soft-tissue, cartilage, and bony lesions. Young age, male sex, and contact sport participation have been identified as risk factors for recurrence of anterior shoulder instability, and today, these patients are routinely recommended surgical treatment. It is also paramount to identify concomitant injury following the primary anterior instability event. The sensitivity, specificity, and reliability of radiographs is suboptimal, and the threshold to obtain advanced imaging such as computed tomography or magnetic resonance imaging with 3-dimensional reconstructions should be low. Taking into account the low non-recurrence complication rate following arthroscopic stabilization, early surgical intervention should be considered following the first instability event.
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Affiliation(s)
- Capt Matthew T Provencher
- The Steadman Philippon Research Institute (K.S.M.); Oslo University Hospital (K.S.M.); Norwegian Armed Forces Joint Medical Services (K.S.M.)
| | - Kaare S Midtgaard
- The Steadman Philippon Research Institute (K.S.M.); Oslo University Hospital (K.S.M.); Norwegian Armed Forces Joint Medical Services (K.S.M.)
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37
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
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38
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Fuchs L, Saleh S, Oron A, Kosashvilli Y. [Neglected shoulder dislocation due to COVID-19 pandemic]. Harefuah 2020; 159:528. [PMID: 32720774] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Lee Fuchs
- Orthopedic Department, Kaplan Medical Center
| | - Shadi Saleh
- Orthopedic Department, Kaplan Medical Center
| | - Amir Oron
- Orthopedic Department, Kaplan Medical Center
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Hohmann E. Editorial Commentary: Coracoclavicular Ligament Reconstruction. Double Up It Is? Arthroscopy 2020; 36:1271-1272. [PMID: 32370889 DOI: 10.1016/j.arthro.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 02/02/2023]
Abstract
More than 100 surgical techniques have been described for the reconstruction of the coracoclavicular ligament complex. None of the techniques appears superior, but double-button fixation for acute high-grade acromioclavicular dislocations has become an attractive option. The clinical outcomes are good to excellent, and the return to physical activity and sport is above 90%. However, complications such as loss of reduction and tunnel widening have been described and can reach up to 80%. The load to failure of the native coracoclavicular complex is more than 600 N, and any surgical technique must surpass this figure. Single-button and loop techniques do not always sufficiently stabilize the acromioclavicular joint. Even double- and triple-button techniques may not restore vertical and horizontal stability of the acromioclavicular joint to its native normal state. Double-button technique restores both scapula and clavicular rotation closest to the native state, but still has lower stiffness and results in higher superior-inferior translation, which could cause ongoing vertical instability.
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Barber FA, Howard MS. Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score-Will This Decrease Latarjet Abuse? Arthroscopy 2020; 36:68-70. [PMID: 31864599 DOI: 10.1016/j.arthro.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/04/2019] [Indexed: 02/02/2023]
Abstract
Open treatment of anterior shoulder instability using a coracoid transfer, such as the Latarjet procedure, is associated with low recurrence rates but with significant complications such as nerve injury, arthrosis, and graft osteolysis. However, an arthroscopic Bankart procedure, although less invasive and with a low complication rate, has the possibility of a higher recurrent instability rate. Scoring systems such as the Instability Severity Index Score, created to select patients for an arthroscopic Bankart procedure or coracoid transfer, have varying levels of success. Often, the scoring system selects a relatively high percentage of patients for the coracoid transfer, possibly undermining its widespread adoption. The relation between glenoid and humeral bone loss has produced the concept of "on-track" and "off-track," which impacts recurrent instability rates. Merging the on-track and off-track concept with the new Glenoid Track Instability Management Score may produce an algorithm that more accurately assesses the need for the Latarjet procedure or arthroscopic stabilization.
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Solomon DJ. Editorial Commentary: Should We Worry About Progressive Glenoid Bone Loss After Arthroscopic Bankart Repair? Arthroscopy 2020; 36:54-55. [PMID: 31864595 DOI: 10.1016/j.arthro.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
One of the key factors in shoulder stabilization surgery is how much glenoid bone loss is present. Too much glenoid bone loss, or the combination of glenoid bone loss combined with a humeral side Hill-Sachs deformity, can lead to an "off-track" lesion and significantly greater risk of recurrence. If the potential surgical solution for instability leads to greater glenoid bone loss, we could create more problems for our patients.
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43
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Mahnke A, Biber R. [ Shoulder dislocation after bicycle accident]. MMW Fortschr Med 2019; 161:50-51. [PMID: 31828630 DOI: 10.1007/s15006-019-1237-6] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Alexander Mahnke
- Kliniken Dr. Erler gGmbH - Klinik für Unfallchirurgie, Kontumazgarten 4-18, D-90429, Nürnberg, Deutschland.
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Kawakami J, Yamamoto N, Hatta T, Shinagawa K, Itoi E. In Which Arm Position Is a Hill-Sachs Lesion Created? Response. Am J Sports Med 2019; 47:NP74-NP75. [PMID: 31675268 DOI: 10.1177/0363546519878140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Rivas-Ruiz R, Hernández-Salinas LE. [Comment to the article «Frecuency of diagnosis of bone lesions in cases of anterior glenohumeral dislocation»]. Acta Ortop Mex 2019; 33:424-425. [PMID: 32767889] [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: 06/11/2023]
Abstract
No Abstract available.
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Affiliation(s)
- R Rivas-Ruiz
- Centro de Adiestramiento en Investigación Clínica, Coordinación de Investigación en Salud. Instituto Mexicano del Seguro Social (IMSS). México
| | - L E Hernández-Salinas
- Servicio de Urgencias, Unidad Médica de Alta Especialidad (UMAE) «Dr. Victorio de la Fuente Narváez». Ciudad de México. México
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46
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Gong F, Yu B, Zeng Q, Xia G. In Which Arm Position Is a Hill-Sachs Lesion Created? Letter to the Editor. Am J Sports Med 2019; 47:NP74. [PMID: 31675269 DOI: 10.1177/0363546519878142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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47
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Hu YC, Gao F, Chen LS, Huang C, Liu H, Li YL, Piao CD. [Iatrogenic injury caused by manual reduction of anterior dislocation of shoulder and humeral head compression: a case report]. Zhongguo Gu Shang 2019; 32:866-868. [PMID: 31615187 DOI: 10.3969/j.issn.1003-0034.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | | | | | | | - Cheng-Dong Piao
- Department of the Second Hospital of Jilin University, Changchun 130041, Jilin, China;
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Gaytán-Fernández S, Blanco-Ochoa LC, Barragán-Hervella RG, Montiel-Jarquín AJ, Sánchez-Durán MA, García-Galicia A. [Acromioclavicular dislocation management with use of Tight Rope luxation acromioclavicular con Tight Rope]. Acta Ortop Mex 2019; 33:314-318. [PMID: 32253854] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The acromioclavicular joint, important part of the shoulder complex is formed by clavicular lateral end and acromial medial border, with high index of injury in different grades, associated to physical activity and work accidents, most commonly in active young adults. OBJECTIVE To analyze functional outcomes in patients with acromioclavicular dislocation with use of tight rope in one year. Material and methods: Descriptive, prospective, longitudinal, unicentric study, from March 2015 and July 2016 in post-operated patients with diagnosis of acromioclavicular dislocation grade III in Hospital de Traumatología y Ortopedia de Puebla. Patients aged 18 to 45 years were included, active workers, with evolution time 7 days. RESULTS 17 patients with diagnosis of acromioclavicular dislocation, fourteen (82.4%) male and 3 (17.6%) female. Average age: 29.5 (19 to 44 years) ± 7.475 years; lesion occurred 9 (52.9%) patients in right shoulder and 8 (47.1%) in left side. Average time of the injury: 2.88 (1-7) ± 2,147 days. Average inability granted: 42.06 days. CONCLUSIONS The open reduction technique and dynamic stabilization of the joint with Tight Rope offers short hospital stay, short time of inability and rapid reintegration to work activity, at 1 year of evolution.
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Affiliation(s)
- S Gaytán-Fernández
- Unidad Médica de Alta Especialidad (UMAE), Hospital de Traumatología y Ortopedia de Puebla del Instituto Mexicano del Seguro Social (IMSS). Puebla, México
| | - L C Blanco-Ochoa
- Unidad Médica de Alta Especialidad (UMAE), Hospital de Traumatología y Ortopedia de Puebla del Instituto Mexicano del Seguro Social (IMSS). Puebla, México
| | - R G Barragán-Hervella
- Unidad Médica de Alta Especialidad (UMAE), Hospital de Traumatología y Ortopedia de Puebla del Instituto Mexicano del Seguro Social (IMSS). Puebla, México
| | - A J Montiel-Jarquín
- Unidad Médica de Alta Especialidad (UMAE), Hospital de Especialidades de Puebla. Instituto Mexicano del Seguro Social (IMSS). Puebla, México
| | - M A Sánchez-Durán
- Unidad Médica de Alta Especialidad (UMAE), Hospital de Traumatología y Ortopedia de Puebla del Instituto Mexicano del Seguro Social (IMSS). Puebla, México
| | - A García-Galicia
- Unidad Médica de Alta Especialidad (UMAE), Hospital de Traumatología y Ortopedia de Puebla del Instituto Mexicano del Seguro Social (IMSS). Puebla, México
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49
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López-Muñoz R. [Posterior instability of the shoulder]. Acta Ortop Mex 2019; 33:337-345. [PMID: 32253859] [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: 06/11/2023]
Abstract
No Abstract available.
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Affiliation(s)
- R López-Muñoz
- Clínica de Mérida, Mérida Yucatán. México
- Escuela de Ciencias de la Salud y Medicina de la Universidad Marista de Mérida. Yucatán, México
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Nakagawa S. Editorial Commentary: Is Arthroscopic Bankart Repair Using Suture Anchors on the Glenoid Appropriate Treatment for Traumatic Anterior Shoulder Instability? Arthroscopy 2019; 35:2509-2511. [PMID: 31395193 DOI: 10.1016/j.arthro.2019.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 02/02/2023]
Abstract
Fracture of the anterior glenoid rim along the sites of suture anchor insertion is not rare after arthroscopic Bankart repair for traumatic anterior shoulder instability. In addition to the influence of the number, type, and size of the suture anchors, placing multiple anchors in a linear arrangement might impose excessive stress on the surrounding bone, leading to critical loss of osseous integrity and glenoid fracture. Although highly active young male collision or contact athletes are most at risk, such fractures sometimes occur after relatively minor trauma at a long interval after surgery, suggesting persistent impairment of bone quality. In patients with postoperative recurrence of instability, detailed examination using computed tomography is recommended.
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