Background The aim of this study was to assess the influence of 3-dimensional (3D) preoperative planning and patient-specific instrument (PSI) guidance of glenoid component positioning on its ...inclination in total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). Materials and methods Thirty-six shoulder arthroplasties (12 TSAs, 24 RSAs) were analyzed, of which 18 procedures (6 TSAs, 12 RSAs) were executed using preoperative 3D planning and patient-specific guides to position the central guide pin for glenoid component implantation. In 9 cases, the glenoid anatomy was severely distorted through wear or previous surgery. The inclination of the glenoid component was measured by 2 observers, using the angle between the glenoid baseplate and the floor of the supraspinatus fossa (angle β) on postoperative radiographs. Results For TSA, the average angle β was 74 ± 9 in the PSI group and 86 ± 12 in the non-PSI group; for RSA, the average angle β was 83 ± 7 in the PSI group and 90 ± 17 in the non-PSI group. Extreme angles β, which represent extreme values of glenoid component inclination, are more likely to occur in the non-PSI group than in the PSI group ( P < .001 for TSA; P = .02 for RSA). Conclusions The3D preoperative surgical planning and PSI guidance reduce variability in glenoid component inclination and avoid extreme inclination errors for TSA and RSA.
Hypothesis In total shoulder arthroplasty, the humeral component, particularly the stem, can be involved in some of the complications and technical difficulties increase in posttraumatic arthritis ...with proximal humeral malunion. To decrease the intraoperative complications related to the stem, the TESS (Biomet Inc, Warsaw, IN) humeral implant, was designed in 2004 hypothesis that we can obtain a good fixation with a stemless prothesis. This investigation reports the preliminary results of this prosthesis with more than 3 years of follow-up. Methods Between March 2004 and June 2005, 70 patients underwent 72 shoulder replacements with the TESS humeral prosthesis. Sixty-three patients were reviewed with a follow-up of more than 36 months (average, 45.2 months; range, 36-51 months). The mean preoperative Constant score was 29.6. Results Gain in active mobility was 49° for forward flexion and 20° for external rotation. The postoperative Constant score was 75. Radiographic analysis showed no radiolucencies or implant migration. Functional results are comparable with previous reports on prosthetic glenohumeral replacement. Discussion Our clinical results are similar to this with classical prosthesis. The humeral head removal facilitates the glenoid exposure and implantation. After the initial cases any specific complication was seen. Conclusions Owing to the automatic central positioning of the implant, an anatomic reconstruction was achieved. In malunions, no tuberosity osteotomy was required. At 3 years of follow-up, there is radiologic evidence of maintained implant stability. These encouraging preliminary results confirm our belief that a stemless prosthesis can be used to obtain an anatomic reconstruction of the proximal humerus. A longer-term follow-up study is needed to validate these results.
Background: Altered muscle activity in the scapular muscles is commonly believed to be a factor contributing to shoulder impingement
syndrome. However, one important measure of the muscular ...coordination in the scapular muscles, the timing of the temporal
recruitment pattern, is undetermined.
Purpose: To evaluate the timing of trapezius muscle activity in response to an unexpected arm movement in athletes with impingement
and in normal control subjects.
Study Design: Prospective cohort study.
Methods: Muscle latency times were measured in all three parts of the trapezius muscle and in the middle deltoid muscle of 39 âoverhand
athletesâ with shoulder impingement and compared with that of 30 overhand athletes with no impingement during a sudden downward
falling movement of the arm.
Results: There were significant differences in the relative muscle latency times between the impingement and the control group subjects.
Those with impingement showed a delay in muscle activation of the middle and lower trapezius muscle.
Conclusion: The results of this study indicate that overhand athletes with impingement symptoms show abnormal muscle recruitment timing
in the trapezius muscle. The findings support the theory that impingement of the shoulder may be related to delayed onset
of contraction in the middle and lower parts of the trapezius muscle.
Background Only a few articles describe the reproducibility and clinical feasibility of glenoid inclination measurements on conventional radiographs, and none of them validated their method in ...shoulder arthroplasty cases. From a clinical point of view, the angle measured between the supraspinatus fossa and the glenoid fossa line (angle β) appears to be the most interesting angle to assess glenoid inclination. This study aimed to validate the angle β in shoulder arthroplasty patients to facilitate the assessment of glenoid component inclination. Materials and methods Seventeen patients who underwent total or reverse shoulder arthroplasty were evaluated. The angle β was measured by 2 independent observers on postoperative radiographs and 3-dimensional (3D) models. The interobserver variability and accuracy of angle β were analyzed by calculating the intraclass correlation coefficient (ICC) and by generating Bland-Altman plots. Results The angle β showed a good interobserver variability (ICC = 0.971 for radiographs, ICC = 0.980 for 3D models) and a good agreement between the radiographic and 3D measurements (ICC = 0.904 for observer 1 and ICC = 0.908 for observer 2). Bland-Altman plots demonstrated that in 95% of the measurements on radiographs, the error will be <10. In the investigated population, 85% showed an error <6. Conclusion This study demonstrates that angle β can be measured on radiographs to assess glenoid component inclination in total and reverse shoulder arthroplasty, but clinicians and researchers should keep in mind that measurement errors of 10° may occur in a minority of cases.
Hypothesis The purpose of this study is to report the functional outcome of the repair of a distal biceps tendon rupture by the use of the endobutton technique. We hypothesized that the endobutton ...provides excellent strength and clinical results after repair of distal biceps tendon rupture. Materials and methods Twenty-six patients underwent repair of biceps tendon ruptures by use of an endobutton for fixation of the biceps tendon stump to the radial tuberosity. There were 20 men and three women. The mean age was 52 years (39-75). The dominant side was involved in 11 patients. A partial rupture of the biceps tendon was found in four patients. The average delay in diagnosis was 16 days, with four patients presenting at six weeks or more after trauma. Results At an average follow-up of 16 months (6-48), 23 of 26 patients were available for follow-up and were examined clinically, radiologically, and by isokinetic testing. The average postoperative Mayo Elbow Performance Score (MEPS) was 94 points. The average Visual Analogue Scale (VAS) for pain was 1.5. Patients regained an almost full range of motion. Average flexion strength recovery was 80% and corresponding recovery of supination strength was 91%. Two patients developed asymptomatic heterotopic ossification seen on standard radiographs. In three patients, the endobutton had apparently disengaged without important difference in functional outcome. In one case, the endobutton had to be removed. There were no neurological complications. Conclusion This study shows that a distal biceps tendon can be safely reattached to the radius by using the endobutton technique, yielding excellent and reproducible results. Level of evidence Level 4; Retrospective case series, no control group.
Soccer players frequently experience acute and chronic groin pain. Sportsman's hernia is a common injury in professional soccer players, that causes inguinal pain. The authors discuss their ...experience with the management of sportsman's hernia in professional soccer players competing in national and international competition in a retrospective review of prospectively collected data. Between March 2004 and December 2009, seventy-one professional soccer players were surgically treated for sportsman's hernia. Average age at surgery was 24 years, and average duration of symptoms from onset to surgical repair was 11 months. Conservative treatment improved symptoms temporarily or to some extent in 18 athletes. All athletes underwent a bilateral open hernia repair with concurrent adductor tendon release. Average follow-up was 4 years, and average time to return to competitive sport was 4 months. At final follow-up, 95% of soccer players were still active, 48 at the same level and 19 at a lower level. Four athletes had stopped their careers because of another injury (n=2) or recurrence (n=2). Sportsman's hernia is a potentially career-ending injury in professional soccer players. Conservative management is often unsuccessful. An open surgical hernia repair combined with an adductor longus tenotomy relieves the symptoms caused by a sportsman's hernia and restores activity in 95% of athletes. This study offers insight into the management of sportsman's hernia and offers a successful treatment to salvage the careers of professional soccer players.
Purpose
Despite good clinical results and low recurrence rates, post-operative complications of coracoid process transfer procedures are not well understood. This study aims to evaluate the ...underlying failure mechanism in cases requiring major open revision surgery after prior Bristow or Latarjet stabilization.
Methods
Between January 2006 and January 2017, 26 patients underwent major open revision after primary Bristow or Latarjet procedure. Clinical notes and radiographic images were retrospectively reviewed for all cases to determine underlying pathology. Choice of treatment and clinical and radiographic outcome were similarly reported for all cases.
Results
The underlying failure mechanism was associated with non-union in 42.3%, resorption in 23.1%, graft malpositioning in 15.4%, and trauma or graft fracture in 19.2% of cases. Although none of the patients reported any dislocations, mean subjective shoulder score was 60.2% and WOSI scores averaged 709.3 points at final follow-up. Radiographic signs of deteriorating degenerative arthritis were seen in 34.6%.
Conclusion
Graft non-union resulting in recurrent instability was the main indication for open revision surgery after Bristow or Latarjet procedure, followed by resorption, malpositioning, and graft fracture in this retrospective case series. Revision surgery consisted of a structural iliac crest bone graft in the majority of cases. Clinical and radiographic outcomes are predictably variable in this population of multioperated patients.
Background:
Persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) has been correlated with poor clinical outcomes and graft failure.
Hypothesis:
We ...hypothesized that a single-bundle, hamstring ACLR in combination with a lateral extra-articular tenodesis (LET) would reduce the risk of ACLR failure in young, active individuals.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
This is a multicenter, prospective, randomized clinical trial comparing a single-bundle, hamstring tendon ACLR with or without LET performed using a strip of iliotibial band. Patients 25 years or younger with an ACL-deficient knee were included and also had to meet at least 2 of the following 3 criteria: (1) grade 2 pivot shift or greater, (2) a desire to return to high-risk/pivoting sports, (3) and generalized ligamentous laxity (GLL). The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Secondary outcome measures included the P4 pain scale, Marx Activity Rating Scale, Knee injury Osteoarthritis and Outcome Score (KOOS), International Knee Documentation Committee score, and ACL Quality of Life Questionnaire. Patients were reviewed at 3, 6, 12, and 24 months postoperatively.
Results:
A total of 618 patients (297 males; 48%) with a mean age of 18.9 years (range, 14-25 years) were randomized. A total of 436 (87.9%) patients presented preoperatively with high-grade rotatory laxity (grade 2 pivot shift or greater), and 215 (42.1%) were diagnosed as having GLL. There were 18 patients lost to follow-up and 11 who withdrew (~5%). In the ACLR group, 120/298 (40%) patients sustained the primary outcome of clinical failure, compared with 72/291 (25%) in the ACLR+LET group (relative risk reduction RRR, 0.38; 95% CI, 0.21-0.52; P < .0001). A total of 45 patients experienced graft rupture, 34/298 (11%) in the ACLR group compared with 11/291 (4%) in the ACL+LET group (RRR, 0.67; 95% CI, 0.36-0.83; P < .001). The number needed to treat with LET to prevent 1 patient from graft rupture was 14.3 over the first 2 postoperative years. At 3 months, patients in the ACLR group had less pain as measured by the P4 (P = .003) and KOOS (P = .007), with KOOS pain persisting in favor of the ACLR group to 6 months (P = .02). No clinically important differences in patient-reported outcome measures were found between groups at other time points. The level of sports activity was similar between groups at 2 years after surgery, as measured by the Marx Activity Rating Scale (P = .11).
Conclusion:
The addition of LET to a single-bundle hamstring tendon autograft ACLR in young patients at high risk of failure results in a statistically significant, clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years after surgery.
Registration:
NCT02018354 (ClinicalTrials.gov identifier)
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