To use an expected-value decision analysis to determine the optimal treatment decision between repair or a biceps tenodesis (BT) for an isolated type II Superior Labral Anterior Posterior (SLAP) ...injury.
An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. To determine outcome probabilities, a decision tree was constructed (repair vs BT) and a meta-analysis was conducted. To determine outcome utilities, we evaluated 70 patients with a chief complaint of shoulder pain with regard to age, sex, Shoulder Activity Level (SAL) and visual analog scale regarding potential outcome preferences. Statistical fold back analysis calculated optimal treatment. One-way sensitivity analysis determined the effect of changing the reinjury rate on the expected value of a biceps tenodesis.
The overall expected value for biceps tenodesis was 8.66 versus 7.19 for SLAP repair. One-way sensitivity demonstrated that biceps tenodesis was the superior choice if reinjury rates are expected to be less than 28%. Meta-analysis of 23 studies and 908 patients revealed the probability of a well outcome was significantly greater for BT (87.8%; 95% CI 74.9-94.6%, I2=0.0%) than SLAP repair (62.9%; 95% CI 55.9-69.3%, I2=65.9%; p=0.0023). Reinjury with BT was 1.5% (95% CI 0.05% to 33.8%, I2=0.0%) and repair 6.4% (95% CI 4.2%-9.6%, I2=24%) which was not statistically significantly different (p=0.411). 50 participants mean age=25.4 (SD 8.9), male = 76%; overhead athletes = 50% met inclusion criteria. Forty-six percent of participants had a SAL score of ‘high’.
Decision analysis demonstrated that biceps tenodesis is preferred over repair for an isolated type II SLAP tear based on greater expected value of BT versus repair. Meta-analysis demonstrated more frequent favorable outcomes with BT. Surgeons can use this information to tailor discussion with patients..
Background:
Biceps tenodesis has been suggested as a superior surgical technique compared with isolated labral repair for superior labral anterior-posterior (SLAP) tears in patients older than 35 ...years. The superiority of this procedure in younger patients, however, is yet to be determined.
Purpose:
To compare the outcomes of arthroscopic SLAP repair with those of arthroscopic-assisted subpectoral biceps tenodesis for type II SLAP tears in active-duty military patients younger than 35 years.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Preoperative and postoperative evaluations with a minimum 5-year follow-up including the visual analog scale (VAS), the Single Assessment Numeric Evaluation (SANE), and the American Shoulder and Elbow Surgeons (ASES) shoulder score were administered, and scores were compared between 2 groups of patients younger than 35 years. One group included 25 patients who underwent SLAP repair, and the second group included 23 patients who underwent arthroscopic-assisted subpectoral biceps tenodesis.
Results:
The preoperative patient age (P = .3639), forward flexion (P = .8214), external rotation (P = .5134), VAS pain score (P = .4487), SANE score (P = .6614), and ASES score (P = .6519) did not vary significantly between the 2 study groups. Both groups demonstrated statistically significant increases in function as measured by the ASES and SANE and decreases in pain as measured by the VAS at a minimum of 5 years postoperatively. Also at a minimum of 5 years postoperatively, patients in the tenodesis group had lower pain (1.3 vs 2.6, respectively; P = .0358) and higher SANE (84.0 vs 63.3, respectively; P = .0001) and ASES (85.7 vs 75.4, respectively; P = .0342) scores compared with those in the repair group. Failure rate was 20.0% in the repair group versus 0.0% in the tenodesis group (P = .0234).
Conclusion:
Active-duty military patients younger than 35 years with type II SLAP tears had more predictable improvement in pain, better functional outcomes, and lower failure rates after biceps tenodesis compared with SLAP repair for type II SLAP tears. Overall, the results of this study indicate that arthroscopic- assisted subpectoral biceps tenodesis is superior to arthroscopic SLAP repair for the treatment of type II SLAP tears in military patients younger than 35 years.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background:
Studies on failed superior labrum anterior-posterior (SLAP) repair are increasing. However, the number of reports on treatment options for failed SLAP repair remains quite low, and the ...clinical results vary between different study groups.
Purpose:
To describe the clinical presentation of failed SLAP repair due to knot-induced pain and evaluate the efficacy of arthroscopic knot removal.
Study Design:
Case series; Level of evidence, 4.
Methods:
The authors retrospectively reviewed records of 11 patients (mean age, 24.6 ± 8.6 years; range, 17-43 years) with stable, healed SLAP lesions with knot-induced pain after arthroscopic fixation of unstable type II SLAP lesions. All patients demonstrated a positive compression-rotation test before knot removal. The mean follow-up duration after knot removal was 48.0 ± 37.4 months (range, 24-156 months). The mean duration between primary fixation and knot removal was 21.2 ± 14.7 months (range, 8-56 months).
Results:
Sharp pain (100%) and clicking (64%) were the most common symptoms. The knot was positioned on the glenoid side in 5 patients and the labral side in 6 patients. The knots on the glenoid side had associated humeral head cartilage damage. The mean University of California at Los Angeles score significantly improved from 15.2 points to 31.7 points after knot removal (P = .003) Additionally, the mean Constant score greatly improved from a mean of 56.5 points to 89.8 points (P = .003). At a mean of 3 weeks after surgery, we observed dramatic pain relief. Six weeks after surgery, the compression-rotation test was negative in all patients.
Conclusion:
The most common symptom of knot-induced pain after SLAP repair was persistent sharp pain followed by clicking. The knot appears to be a cause of pain in failed SLAP repairs, and arthroscopic knot removal can provide dramatic pain relief and significant improvement of clinical outcomes.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
In a diesel engine, piston slap commonly occurs concurrently with fuel combustion and serves as the main source of excitation. Although combustion pressure can be measured using sensors, determining ...the slap force is difficult without conducting tests. In this study, we propose a method to identify the slap force of the piston to solve this difficult problem. The traditional VMD algorithm easily receives noise interference, which affects the value of parameter combination k, α and thus affects the extraction accuracy of the algorithm. First, we obtain the transfer function between the incentive and vibration response through percussion tests. Secondly, a variational modal decomposition method based on whale algorithm optimization is used to separate the slap response from the surface acceleration of the block. Finally, we calculated the slap force using the deconvolution method. Deconvolution is a typical inverse problem of mathematics, often prone to ill-conditioning, and the singular value decomposition and regularization method is used to overcome this flaw and improve accuracy. The proposed method provides an important means to evaluate the angular distribution of the slap force, identify the shock positions on the piston liner, and determine the peak value of the waveform which helps us analyze the vibration characteristics of the piston and optimize the structural design of the engine.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background:
Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high ...rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years.
Purpose:
To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear.
Study Design:
Systematic review.
Methods:
A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined.
Results:
After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals.
Conclusion:
BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Noise and vibration control in mechanical systems has become ever more significant for automotive industry where the comfort of the passenger compartment represents a challenging issue for car ...manufacturers. The reduction of piston slap noise is pivotal for a good design of IC engines. In this scenario, a methodology has been developed for the vibro-acoustic assessment of IC diesel engines by means of design changes in piston to cylinder bore clearance. Vibration signals have been analysed by means of advanced signal processing techniques taking advantage of cyclostationarity theory. The procedure departs from the analysis of the Continuous Wavelet Transform (CWT) in order to identify a representative frequency band of piston slap phenomenon. Such a frequency band has been exploited as the input data in the further signal processing analysis that involves the envelope analysis of the second order cyclostationary component of the signal. The second order harmonic component has been used as the benchmark parameter of piston slap noise. An experimental procedure of vibrational benchmarking is proposed and verified at different operational conditions in real IC engines actually equipped on cars. This study clearly underlines the crucial role of the transducer positioning when differences among real piston-to-cylinder clearances are considered. In particular, the proposed methodology is effective for the sensors placed on the outer cylinder wall in all the tested conditions.
•We propose a novel method for piston slap characterization.•Use of CWT for proper frequency demodulation band.•The method is assessed via real diesel engines.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background:
While a vast body of literature exists describing biceps tenodesis techniques and evaluating the biomechanical aspects of tenodesis locations or various implants, little literature ...presents useful clinical outcomes to guide surgeons in their decision to perform a particular method of tenodesis.
Purpose/Hypothesis:
To compare the clinical outcomes of open subpectoral biceps tenodesis (OSPBT) and arthroscopic suprapectoral biceps tenodesis (ASPBT). Our null hypothesis was that both methods would yield satisfactory results with regard to shoulder and biceps function, postoperative shoulder scores, pain relief, and complications.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients who underwent either ASPBT or OSPBT for isolated superior labrum or long head of the biceps lesions with a minimum follow-up of 2 years were evaluated with several validated clinical outcome measures and physical examinations including range of motion and strength.
Results:
Between 2007 and 2011, a total of 82 patients met all inclusion and exclusion criteria, which included 32 patients with ASPBT and 50 patients with OSPBT; 27 of 32 (84.4%) patients with ASPBT and 35 of 50 (70.0%) patients with OSPBT completed clinical follow-up. Overall outcomes for both procedures were satisfactory. No significant differences were noted in postoperative Constant-Murley (ASPBT: 90.7; OSPBT: 91.8; P = .755), American Shoulder and Elbow Surgeons (ASPBT: 90.1; OSPBT: 88.4; P = .735), Single Assessment Numeric Evaluation (ASPBT: 87.4; OSPBT: 86.8; P = .901), Simple Shoulder Test (ASPBT: 10.4; OSPBT: 10.6; P = .762), long head of the biceps (ASPBT: 91.6; OSPBT: 93.6; P = .481), or Veterans RAND 36-Item Health Survey (ASPBT: 81.0; OSPBT: 80.1; P = .789) scores. No significant range of motion or strength differences was noted between the procedures.
Conclusion:
Both ASPBT and OSPBT yield excellent clinical and functional results for the management of isolated superior labrum or long head of the biceps lesions. No significant differences in clinical outcomes as determined by several validated outcome measures were found between the 2 tenodesis methods, nor were any significant range of motion or strength deficits noted at a minimum 2 years postoperatively.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background:
Pain is a common presentation after glenohumeral labral injuries. However, the source of that pain is undetermined.
Purpose/Hypothesis:
We aimed to determine if there is a differential ...expression of nerve fibers around the glenoid labrum and if torn labra have increased neuronal expression compared with untorn labra (rotator cuff repair labra). We hypothesized that the superior labrum would have a higher concentration of neurofilament than would the rest of the labrum and that the concentration of neurofilament would increase at the site of a labral tear.
Study Design:
Descriptive laboratory study.
Methods:
Seven labra were sampled at the 3-, 5-, 9-, and 12-o’clock positions during total shoulder arthroplasty. Samples were also collected at the 3-, 5-, and 12-o’clock positions during rotator cuff repair (16 labra), anterior labral repair (6 labra), type II superior labral anterior to posterior (SLAP) repair (4 labra), and capsular release for idiopathic capsulitis (5 labra). Sections were immunostained with antibodies to neurofilament, a specific neuronal marker that is used to identify central and peripheral nerve fibers, and the concentration and intensity of immunostained-positive cells assessed.
Results:
The concentration of neurofilament staining was similar in the superior, anterior, posterior, and inferior glenoid labrum in untorn labra (8 neurofilament expressing cells per square millimeter; P = .3). Torn labra exhibited a 3- to 4-fold increase in neuronal expression, which was isolated to the location of the tear in SLAP (P = .09) and anterior labral tears (P = .02). The concentration of neurofilament expressing cells in torn glenoid labrum samples was comparable that in with the glenoid labrum of adhesive capsulitis samples (P = .7).
Conclusion:
This study supports the hypothesis that after a tear of the anterior or superior labrum the labrum in that region becomes populated with new nerves fibers and that these fibers may be responsible for the pain noted by patients with superior (SLAP) and/or anterior labral (Bankart) tears.
Clinical Relevance:
This study suggests that neural infiltration contributes to the pain experienced by patients with labral tears. It may help with patient education and direct future management of labral lesions.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
In the world's competitive industrial market, the development of existing manufacturing equipment’s such as industrial reheating furnaces (IRFs) increases profitability in terms of higher production, ...higher quality, and better energy efficiency. In this review, recent progress and current status in IRFs technology have been presented. A special focus has been highlighted on the recent applications and developments of zone modeling and computational fluid dynamic (CFD) simulations in IRFs, paying particular attention to the integration of slap heating processes characteristics, flow and radiative heat transfer analyses, control strategy, and optimization of the furnace. Moreover, the energy efficiency assessment in terms of efficiency models, long-term measurements, and combustion performance improvement techniques (namely, the effect of burner design and oxy-fuel enrichment) for energy saving and thermal efficiency improvement in IRFs is analyzed. Additionally, studies that investigated the use of different waste heat recovery (WHR) systems within IRFs, to evaluate the potential recovery efficiencies and suitability of the IRFs are discussed in details. The reviewed results showed that the energy apportionment model is the most widely used and regarded as an efficient prediction tool for determining the slap energy efficiency of each heating zone in the furnace. Moreover, the Oxy-fuel combustion technique achieved significant improvements in fuel consumption of the IRF, as it fulfilled high energy-saving improvements of 16 %–26.2 %, compared to the air/fuel combustion. In WHR scope, the findings demonstrated that the potential of WHR in IRFs for the steel industry is within the range of high-medium temperature, and significantly improved the furnace overall efficiency and reduced the fuel consumption required in the furnace via the use of waste heat preheaters/units, and recuperative and regenerative burners in IRFs. Noteworthy discussions, important challenges, critical conclusions, and future strategies for each aspect are also discussed as well.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ
