Safety and exposure area in three different posteromedial surgical approaches for the treatment of ankle fractures. A cadaveric study

INTRODUCTION

This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches.

METHODS

Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB RESULTS: There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches CONCLUSION: The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.

An online training and feedback module enhances the musculoskeletal examination performance of medical interns

BACKGROUND

Pathologies of the locomotor system are frequent and can cause disability and impact the quality of life of the people affected. In recent years, online training and feedback have emerged as learning tools in many fields of medicine.

OBJECTIVE

This study aims to evaluate medical interns' musculoskeletal examination performance after completing an online training and feedback module.

METHODS

This study employed a quasi-experimental design. Medical interns were invited to complete a 4-week musculoskeletal physical examination training and feedback module via an e-learning platform. The course included written and audiovisual content pertaining to medical history, physical examination, and specific tests for the diagnosis of the most common knee, spine, shoulder, ankle, and foot conditions. Before and after completing the module, their ability to perform the physical examination was evaluated using an objective structured clinical examination (OSCE) with simulated patients that took place face-to-face. A control group of experts was assessed using the OSCE, and their performance was compared to that of the interns before and after the training. At the end of the module feedback on the OSCE was provided to participants through the platform asynchronously and two evaluation questions about the user experience were conducted at the end of the study.

RESULTS

A total of 35 subjects were assessed using the OSCE, including 29 interns and 6 experts. At the beginning of the training module, the group of interns obtained an average score of 50.6 ± 15.1. At the end of the module, 18 interns retook the OSCE, and their performance increased significantly to an average of 76.6 ± 12.8 (p < 0.01). Prior to the training, the experts performed significantly better than the interns (71.2 vs. 50.6; p = 0.01). After the interns received the training and feedback, there were no significant differences between the two groups (71.2 vs. 76.6; p = 0.43). Two evaluation questions were conducted at the end of the study, revealing that 93% of the participants affirm that the training module will be useful in their clinical practice, and 100% of the participants would recommend the training module to a colleague.

CONCLUSION

The online training and feedback module enhances the musculoskeletal examination performance of medical interns.

Design of Microbial Consortia Based on Arbuscular Mycorrhizal Fungi, Yeasts, and Bacteria to Improve the Biochemical, Nutritional, and Physiological Status of Strawberry Plants Growing under Water Deficits

Drought affects several plant physiological characteristics such as photosynthesis, carbon metabolism, and chlorophyll content, causing hormonal and nutritional imbalances and reducing nutrient uptake and transport, which inhibit growth and development. The use of bioinoculants based on plant growth-promoting microorganisms such as plant growth-promoting rhizobacteria (PGPR), yeasts, and arbuscular mycorrhizal fungi (AMF) has been proposed as an alternative to help plants tolerate drought. However, most studies have been based on the use of a single type of microorganism, while consortia studies have been scarcely performed. Therefore, the aim of this study was to evaluate different combinations of three PGPR, three AMF, and three yeasts with plant growth-promoting attributes to improve the biochemical, nutritional, and physiological behavior of strawberry plants growing under severe drought. The results showed that the growth and physiological attributes of the non-inoculated plants were significantly reduced by drought. In contrast, plants inoculated with the association of the fungus Claroideoglomus claroideum, the yeast Naganishia albida, and the rhizobacterium Burkholderia caledonica showed a stronger improvement in tolerance to drought. High biomass, relative water content, fruit number, photosynthetic rate, transpiration, stomatal conductance, quantum yield of photosystem II, N concentration, P concentration, K concentration, antioxidant activities, and chlorophyll contents were significantly improved in inoculated plants by up to 16.6%, 12.4%, 81.2%, 80%, 79.4%, 71.0%, 17.8%, 8.3%, 6.6%, 57.3%, 41%, and 22.5%, respectively, compared to stressed non-inoculated plants. Moreover, decreased malondialdehyde levels by up to 32% were registered. Our results demonstrate the feasibility of maximizing the effects of inoculation with beneficial rhizosphere microorganisms based on the prospect of more efficient combinations among different microbial groups, which is of interest to develop bioinoculants oriented to increase the growth of specific plant species in a global scenario of increasing drought stress.

Use of electromyographic biofeedback in rehabilitation following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

BACKGROUND

Rehabilitation following anterior cruciate ligament (ACL) reconstruction surgery is essential to regain functionality and return to previous activity level. Electromyographic biofeedback may be an effective intervention for rehabilitation of patients following ACL surgery.

OBJECTIVE

To synthesize the available evidence on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

PubMed, EMBASE, CENTRAL and Epistemonikos were searched.

ELIGIBILITY CRITERIA

Randomized clinical trials with patients undergoing ACL reconstruction surgery comparing biofeedback with a standard rehabilitation control group.

DATA EXTRACTION AND DATA SYNTHESIS

Two authors selected articles and performed data extraction. The analysed outcomes were strength, function, pain, knee extension and balance. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. Results were combined through random-effects meta-analysis, reporting mean differences.

RESULTS

Eight articles were included in the qualitative analysis, and four articles were included in the quantitative analysis. The interventions lasted between 4 and 12 weeks. Three studies evaluated the effect of biofeedback on quadriceps strength; of these, two studies showed a significant difference in favour of the biofeedback group. In addition, biofeedback was found to improve knee extension [standardized mean difference - 1.3, 95% confidence interval (CI) - 1.74 to -0.86] and balance (one study). There was no significant difference in Lysholm score (mean difference -6.21, 95% CI -17.51 to 5.08; I2 =59%) or pain between the biofeedback group and the control group.

CONCLUSION

Electromyographic biofeedback in knee rehabilitation could be useful following ACL reconstruction surgery.

KEY MESSAGES

SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42020193768).

Post-operative complications affect survival in surgically treated metastatic spinal cord compression

PURPOSE

The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients.

METHODS

Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan-Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups.

RESULTS

Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174-365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence.

CONCLUSION

In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.

Der p 23 sensitization in patients with house dust mite respiratory allergy

Summary

Background. The sensitization profile of patients allergic to house dust mites (HDM) and its molecular diagnosis may determine treatment and evolution of the disease. The present study investigates the prevalence of Der p 23 sensitization and its relation to asthma in a population of HDM-allergic patients. Methods. We conducted a cross-sectional study of 891 patients with HDM allergy with symptoms of rhinitis and 52.1% of them with asthma. Total and specific IgE (sIgE) was measured against Dermatophagoides pteronyssinus and its molecular components and the storage mite Lepidoglyphus destructor using ImmunoCAP. Prevalence of sensitization and levels of sIgE were analyzed according to asthma diagnosis and asthma severity. Results. Der p 23 was the predominant allergen in this population (83.7%), but IgE levels were lower than those of sIgE to Der p 1 and Der p 2. A good correlation was found between sIgE to Der p 23 and the other allergens. A total of 8.2% patients were monosensitized to Der p 23. Asthma was more frequent in patients with positive sIgE against Der p 23 than in patients without this sensitization (p = 0.027). A tendency to increase both total IgE and sIgE was observed in relation to the severity of asthma from intermittent mild asthma to persistent moderate asthma, but a substantial decrease in total IgE and sIgE was detected in more severe asthmatics. Conclusions. Der p 23 might be a prevalent allergen in regions with high rates of HDM exposure and its presence could increase the risk of asthma.

Role of Lateral Ankle Ligaments in Vertical Stability of the Fibula: A Cadaveric Model

BACKGROUND

In unstable ankle fractures, the role of the deltoid and syndesmosis ligaments has been widely studied. However, it is uncertain what the importance of the lateral ankle ligament complex (LALC) is in the vertical stability of the fibula. Given its anatomical position, it should prevent the proximal translation of the fibula. This study aims to evaluate the role of the LALC in stabilizing the fibula in the vertical plane.

METHODS

Eleven below-knee cadaveric specimens were used in this study. Proximal traction of the fibula was performed by applying 50 N in the intact state and after sequential transection of the syndesmotic ligaments, anterior talofibular ligament (ATFL), and the calcaneofibular ligament (CFL). At each stage, the proximal displacement of the fibula was measured. One-way repeated measures analysis of variance with post hoc Bonferroni correction was carried out to determine any significant differences between the groups. A P value <.05 was considered statistically significant.

RESULTS

The vertical displacement of the fibula in the intact state, and after sequential transection of syndesmotic ligaments, ATFL, and CFL was 1.96 ± 1.19 mm, 3.96 ± 1.33 mm, 5.9 ± 1.73 mm, and 10.22 ± 2.76 mm, respectively. There was no significant difference in the proximal displacement of the fibula between the intact and the syndesmotic ligaments groups (P < .05). However, when the syndesmotic ligaments were transected in conjunction with ATFL ± CFL, a significant difference was observed compared to the intact state (P < .001).

CONCLUSION

The complete disruption of syndesmotic ligaments did not significantly increase the proximal displacement of the fibula. However, when the ATFL ± CFL were additionally disrupted, there was a significant increase in the vertical translation of the fibula.

CLINICAL RELEVANCE

To our knowledge, this is the first study describing that LALC plays a paramount role in the vertical stability of the fibula. Concomitant syndesmosis and LALC should be suspected in an axially unstable fibular fracture with a significant proximal displacement.

Biochemical, Catabolic, and PGP Activity of Microbial Communities and Bacterial Strains from the Root Zone of Baccharis linearis in a Mediterranean Mine Tailing

The management of mine tailings (MT) is commonly workload heavy, intrusive, and expensive. Phytostabilization offers a promising approach for MT management; however, it poses challenges due to the unfavorable physicochemical properties of these wastes. Nevertheless, native microorganisms capable of supporting plant growth and development could enhance the efficacy of phytostabilization. This study assesses the biological activity of microbial communities from the root zone of Baccharis linearis, which is naturally present in MT, in order to evaluate their biotechnological potential for phytostabilization. The root zone and bulk samples were collected from B. linearis plants located within a MT in the Mediterranean zone of Chile. Enzyme activities related to the cycling of C, N, and P were assessed. The community-level physiological profile was evaluated using the MicroRespTM system. Bacterial plant growth-promoting (PGP) traits and colony forming units (CFU) were evaluated through qualitative and microbiological methods, respectively. CFU, enzyme activities, and CLPP were higher in the root zone compared with the bulk samples. Five bacterial strains from the root zone exhibited PGP traits such as P solubilization and N acquisition, among others. The presence of microbial communities in the root zone of B. linearis with PGP traits suggests their potential to enhance the ecological management of MT through phytostabilization programs.

[Clinical experience of using brentuximab-vedotin as therapy in relapsed/refractory Hodgkin's lymphoma at Hospital Guillermo Grant Benavente, Concepción, Chile]

INTRODUCTION

Hodgkin's lymphoma is a B-cell neoplasm with a good prognosis but a poor response to chemotherapy in refractory or relapsed cases. Brentuximab-vedotin is an anti-CD30 monoclonal antibody approved for use in these cases. This study aims to describe the clinical experience of patients treated with brentuximab-vedotin through expanded access modality.

MATERIALS AND METHODS

A retrospective study on clinical information of patients diagnosed with refractory or relapsed Hodgkin's lymphoma treated with brentuximab-vedotin at the Regional Hospital of Concepción in the period 2015-2021.

RESULTS

7 patients were identified, 5/7 male, with a median age of 35 years (21-50). Five cases were mixed cellularity, and two were nodular sclerosis. Four were in stage II, 1/7 in stage III, and 3/7 in stage IV. The median number of previous treatment lines was 4 (3-5), and the relapse was post-transplantation in two cases. In 6/7 cases, brentuximab-vedotin was used as induction, and in one case, it was used as post-autologous bone marrow transplant maintenance. The administration was outpatient via a peripheral route with a median dose of 150 mg and ten cycles. In one case, dose adjustment was required due to toxicity. Three out of 6 patients achieved complete remission and underwent autologous stem cell transplantation.

CONCLUSION

brentuximab-vedotin is an outpatient medication with low toxicity that can optimize the treatment of patients with relapsed-refractory Hodgkin's lymphoma.

Combination of BET Inhibition with Radiation Induces Anti-Tumor Immune Response in Pre-Clinical Models of ER-Positive Breast Cancer

PURPOSE/OBJECTIVE(S)

Despite advances in multidisciplinary care, the risk of late recurrence in Estrogen Receptor-positive (ER+) breast cancer (BC) patients following standard-of-care treatment ranges from 20-52% at 20 years. While immune checkpoint inhibitors (CPI), have shown enormous potential in inducing long term remission in some cases, patients with ER+ BC show poor response to these agents. The objective of this study is to develop effective radiation therapy (RT)-based combination regimens that induce anti-tumor immunity against immunologically cold ER+ breast tumors.

BACKGROUND

We have previously shown that pharmacological inhibition of bromodomain and extraterminal domain (BET) family of epigenetic regulator proteins overcomes both endocrine therapy resistance and radiation resistance in pre-clinical models of ER+ BC by reversing pathological reprogramming of transcriptional and DNA repair pathways, respectively. In this study, we explore the potential of RT+BET inhibition combination to elicit anti-tumor immunity against ER+ BC.

MATERIALS/METHODS

A unique ER+ BC model, MXT+, was used to generate tumors in female, BDF1 mice. PD-L1 expression following RT or RT+OTX015 (a BET inhibitor) was assessed by Western blot analysis. Comet assay was used to assess the degree of unrepaired DNA damage following treatment with RT alone, OTX015 alone and RT+OTX015. Multiplex IHC was used to assess changes in tumor microenvironment after various treatments. Tumor growth characteristics were established following treatment with vehicle, RT alone (8 Gy x 3), OTX015 alone (100 mg/kg x 3 days) and RT+OTX015.

RESULTS

Using murine ER+ BC model, MXT+, we show that RT is a potent inducer of PD-L1 expression. Combination of RT+OTX015 completely ablated RT-mediated PD-L1 induction at the transcription level. OTX015 also accentuated RT-induced DNA damage through inhibition of NHEJ pathway, resulting in increased micronuclei formation (which activate cGAS/STING pathway, a critical bridge between innate and adaptive immunity). Combination of OTX015 with RT also caused a statistically significant (on unpaired t test) increase tumor infiltrating lymphocytes. In in vivo therapeutic studies, combination of OTX015 with RT (8 Gy x 3) resulted in extraordinary synergy and caused complete inhibition of long-term tumor growth. Treatment with RT alone (8 Gy x 3) or OTX015 alone (on 3 consecutive days) only caused modest inhibition of tumor growth. ANOVA with Dunnett's test was used to adjust for multiple comparisons and showed statistically significant difference in tumor growth between OTX015+RT arm and OTX alone as well as OTX015+RT arm and RT alone.

CONCLUSION

Patients with ER+ BC face high risk of late recurrence after definitive treatment and show poor response to immune CPIs. We show that combination of BET inhibition with RT induces anti-tumor immunity and completely prevents tumor growth. Clinical validation of this regimen is warranted to prevent late recurrences in ER+ BC patients.

[Clinical features of blastic plasmacytoid dendritic neoplasm in Chile: report of 10 cases]

BACKGROUND

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare malignant tumor with a dismal prognosis, with isolated case reports in Chile. The BPDCN can present skin and bone marrow compromise, and its diagnosis is frequently confused with other pathologies. This study aimed to evaluate the clinical and immunophenotypical features of BPDCN in the Chilean population.

METHODS

We performed a retrospective study from 2013 to 2021 in clinical records of 2 public Chilean referral hospitals, including ten patients, 80% male, with a median age of 66 years (15-81).

RESULTS

The most frequent initial referral diagnoses were T-cell lymphoma (4/10) and acute myeloblastic leukemia (3/10). Seven patients presented skin and bone marrow involvement; we found a lower frequency of adenopathies (5/10), splenomegaly (2/10), and hepatomegaly (2/10). The complete blood count revealed anemia and leukopenia, with blasts in 5/10. Nine patients received induction therapy. CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) was indicated in 8/10 cases with remission in 5/8, and 1 patient received HyerCVAD (cyclophosphamide, vincristine, doxorubicin and dexamethasone, methotrexate, cytarabine) and an allogeneic bone marrow transplant. The median survival was 10 months (95% CI 4.2-15.8 months) with 9/10 deaths. Relapse in the central nervous system was documented in 2 cases.

CONCLUSIONS

Our study found that BPDCN, a rare pathology in the Chilean population, shows a similar clinical presentation compared to previous studies. It is susceptible to respond to initial systemic and intrathecal chemotherapy.

Oncological monitoring after transanal total mesorectal excision (TaTME) for rectal neoplasia

BACKGROUND

The surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME).

METHODS

This was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up ≥ 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed.

RESULTS

One hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%.

CONCLUSIONS

TaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.

Stability of Phenolic Compounds, Antioxidant Activity and Color Parameters in Colored-Flesh Potato Chips

Potato (Solanum tuberosum) chips are the most consumed snacks worldwide today. Colored potato chips prepared from potato cultivars with red and purple flesh are a novel alternative to traditional potato chips because of their higher phenolic compound content, such as anthocyanins and hydroxycinnamic acid derivatives (HCADs), which might make these chips healthier compared with traditional chips. There is little information on the stability of these compounds. In this study, the nutritional value of these chips was evaluated by determining phenolic profiles, antioxidant activity and color parameters with liquid chromatography diode array and mass spectrometry detection (HPLC-DAD-ESI-MS/MS) and spectrophotometric methods during storage for four months. Five anthocyanins and three HCADs were detected, with the latter compounds being the most abundant, with concentrations on average between the first (97.82 mg kg-1) and the last (31.44 mg kg-1) week of storage. Similar trends were observed in antioxidant activity and stability, with the CUPRAC method showing the highest response among all the methods employed. The color indices were stable throughout the storage time. Based on these results, colored-flesh potato chips are an optimal alternative for consumption because of their high retention of phenolic compounds and antioxidant activity during storage, providing potential benefits to human health.

Flow cytometry-detected changes in megaloblastic anemia secondary to cobalamin deficiency

Introduction

Megaloblastic anemias secondary to Vitamin B12 deficiency are a group of pathologies produced by defective nuclear DNA synthesis.

Objective

To describe the maturation alterations found in hematopoietic precursors of the bone marrow in a series of patients with megaloblastic anemia.

Methods

Were included patients attended at the Regional Hospital of Concepción with bone marrow samples sent for the study of cytopenia by flow cytometry whose final diagnosis was megaloblastic anemia. The immunophenotype was performed with CD45, CD34, CD117, HLA-DR, markers of neutrophil (CD13, CD11b, CD10, CD16) and/or erythroblast (CD105, CD71, CD36) maturation.

Results

From the flow cytometry laboratory database, 8 patients with megaloblastic anemia were identified, and myelodysplastic syndromes (n=9) and normal or reactive bone marrow (n=10) were used as controls. 44% were men, with a median age of 58 years. Megaloblastic anemia was associated with a higher proportion of size and complexity of erythroid and myeloid progenitors compared to lymphocytes compared to controls. The total percentage of erythroblasts and the proportion of CD34+ myeloid cells associated with erythroid lineage was higher in megaloblastic anemia, associated with a maturation arrest in the CD105+ precursor stage (69% vs 19% and 23%, p<0.001). The heterogeneity of CD36 and CD71 in megaloblastic anemia was similar to myelodysplastic syndromes.

Conclusions

Megaloblastic anemia produces a heterogeneous involvement of hematopoiesis, characterized by a greater size and cellular complexity of precursors of the neutrophil and erythroid series and a maturation arrest of the erythroblasts.

The Reliability of Acromioclavicular Joint Dislocation Classification Systems: A Comparison Between the Rockwood and Kraus Classifications

Background

The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries.

Purpose

To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (κ) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap.

Results

The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (κ = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (κ = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the κ values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (κ = 0.78 [95% CI, 0.72-0.81]) and Kraus (κ = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (κ = 0.65 [95% CI, 0.61-0.67]) and Kraus (κ = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations.

Conclusion

The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.

The Reverse Shoulder Arthroplasty Angle in MRI: Impact of the Articular Cartilage in the Estimated Inclination of the Inferior Glenoid

Purpose

To describe the reverse shoulder arthroplasty angle (RSA angle) in magnetic resonance imaging (MRI) and compare the angle formed using bony landmarks (Bony RSA angle or B-RSA angle) with another angle formed using the cartilage margin as reference (Cartilage RSA angle or C-RSA angle).

Methods

Adult patients with a shoulder MRI obtained in our hospital between July 2020 and July 2021 were included. The C-RSA angle and B-RSA angle were measured. All images were independently assessed by 4 evaluators. Intraclass correlation coefficient (ICC) was determined for the B-RSA and C-RSA to evaluate interobserver agreement.

Results

A total of 61 patients were included with a median age of 59 years (17-77). C-RSA angle was significantly higher than B-RSA (25.4° ± 0.7 vs 19.5° ± 0.7, respectively) with a P-value <.001. The overall agreement was considered “good” for C-RSA (ICC = 0.74 [95% CI 0.61-0.83]) and “excellent” for B-RSA angle (ICC = 0.76 [95% CI 0.65-0.85]).

Conclusions

C-RSA angle is significantly higher than B-RSA angle. In cases without significant glenoid wear neglecting to account for the remaining articular cartilage at the inferior glenoid margin may result in superior inclination of standard surgical guides.