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.
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.
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.
The glenoid labrum acts as a bumper, deepening glenoid concavity and amplifying the concavity-compression mechanism, and serves as the scapular attachment for glenohumeral ligaments. The role of the ...posterosuperior labrum in anteroinferior glenohumeral stability, and the role of the anterior labrum in posterior stability has been debated. The purpose of this study was to quantify the contribution of anteroinferior and posterosuperior labral tears to loss of glenohumeral stability in multiple directions.
Fourteen fresh-frozen cadaveric shoulders were tested on a custom stability ratio measurement apparatus. The peak force that was required to translate the humeral head in anterior, anteroinferior, posterior, and posteroinferior directions was measured under 5 conditions: intact labrum (n = 14), anteroinferior labral tear (n = 7), posterosuperior labral tear (n = 7), combined labral tear (n = 14), and no labrum (n = 14). The stability ratio was defined as the peak translational force divided by the compressive force. Within force-translation curves, we defined the suction cup effect as the force required to release the negative pressure created by an intact labrum.
The suction cup effect was usually present with the intact labrum and always disappeared after removal of the labrum for anterior (100% vs. 0%) and posterior (86% vs. 0%) translations (P < .001). After creation of an anteroinferior labral tear, the stability ratio for posterior direction decreased (P < .001) and the suction cup effect disappeared (P < .001). After creation of a posterosuperior labral tear, stability ratios in the anterior and anteroinferior directions decreased (P ≤ .006) and the suction cup effect disappeared (P ≤ .015). The stability ratio for anterior and anteroinferior testing was more diminished by posterosuperior labral tears than anteroinferior labral tears, and the stability ratio for posterior testing was more diminished by anteroinferior labral tears than posterosuperior labral tears.
Anteroinferior labral tears decreased posterior stability and posterosuperior labral tears decreased anterior and anteroinferior stability, largely because of loss of the suction cup effect.
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.
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.
This paper proposes a new method for encryption of RGB color images by combining two encryption approaches: the spatial approach and the transformation approach. The proposed method uses the 3D ...fractional modified Henon map (3D FrMHM) and the discrete fractional Krawtchouk moments (FrDKM). We have also proposed a new hybrid optimization algorithm (H-SSAOA) to optimize the parameters of the proposed Henon map and the parameters of the Krawtchouk fractional moments. This algorithm is based on the hybridization of two metaheuristic algorithms: the "Salp Swarm Algorithm" (SSA) and the "Arithmetic Optimization Algorithm" (AOA). The simulation results reveal the optimization efficiency of the proposed hybrid algorithm H-SSAOA compared to other meta-heuristic algorithms and the efficiency of the suggested encryption method for encrypting RGB color images in terms of sensitivity to the security key and resistance to different attacks.
Glenoid superior biceps-labral pathology diagnosis, treatment, and outcomes are an evolving area of shoulder surgery. Historically, described as superior labrum anterior posterior (SLAP) tears, these ...lesions were identified as a source of pain in throwing athletes. Diagnosis and treatments applied to these SLAP lesions resulted in less than optimal outcomes in some patients and a prevailing sense of confusion. The purpose of this paper is to perform a reappraisal of the anatomy, examination, imaging, and diagnosis by the American Shoulder and Elbow Surgeons/SLAP biceps study group. We sought to capture emerging concepts and suggest a more unified approach to evaluation and identify specific needs for future research.
To compare lesion prevalence and treatment outcomes in patients with primary and recurrent anterior shoulder instability.
Patients who were admitted to the institution with a diagnosis of anterior ...shoulder instability and who underwent arthroscopic surgery between July 2006 and February 2020 were retrospectively evaluated. Minimum follow-up duration of the patients was 24 months. The recorded data and Magnetic Resonance Imaging (MRI) of the patients were examined. Patients over 40 years of age, with a history of shoulder region fracture, inflammatory arthritis, a history of epilepsy, multi-directional instability, non-traumatic dislocation, and off-track lesions were excluded from the study. Shoulder lesions were documented and patient outcome evaluation was made with the Oxford Shoulder Score (OSS) and Visual Analog Scale (VAS).
A total of 340 patients were included in the study. The mean age of patients was 25.6 (±6.49). Recurrent instability group had significantly higher rate of Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesions compared to primary instability group (40.6% vs 24.6% respectively) (p=0.033). 25 patients (43.9%) had Superior Labrum Anterior and Posterior (SLAP) lesions in primary instability group and 81 patients (28.6%) had SLAP lesions in recurrent instability group (p=0.035). OSS increased for both primary (from 35 (16-44) to 46 (36-48)) (p=0.001) and recurrent instability groups (from 33 (6-45) to 47 (19-48)) (p=0.001). There was no significant difference between the groups regarding postoperative VAS and Oxford scores (p>0.05).
Successful results were obtained in patients younger than 40 years old with both primary and recurrent anterior shoulder instability after arthroscopic treatment. ALPSA lesion prevalence was higher while SLAP lesion prevalence was lower regarding the patients with recurrent instability. Postoperative OSS was comparable between the patient groups however failure rate was higher in the recurrent instability patients.
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