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Carofino BC. Letter to the Editor regarding Kleim et al: "pyrocarbon hemiprostheses show little glenoid erosion and good clinical function at 5.5 years of follow-up". J Shoulder Elbow Surg 2024; 33:e459-e460. [PMID: 38692403 DOI: 10.1016/j.jse.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/05/2024] [Indexed: 05/03/2024]
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Hiyama A, Sakai D, Katoh H, Sato M, Watanabe M. Impact of Osteoporosis on Short-Term Surgical Outcomes in Lumbar Degenerative Disease Patients Undergoing Lateral Lumbar Interbody Fusion: A Retrospective Analysis. World Neurosurg 2024; 188:e424-e433. [PMID: 38802060 DOI: 10.1016/j.wneu.2024.05.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE This retrospective study assesses the influence of osteoporosis on the short-term clinical outcomes of lateral lumbar interbody fusion (LLIF) surgery in patients with lumbar degenerative diseases (LDDs), focusing on complications, pain intensity, and quality of life (QOL) improvements. The primary aim of this study is to investigate the impact of osteoporosis on the short-term clinical outcomes following LLIF surgery in LDD patients, with a particular focus on the incidence of cage subsidence (CS) and overall patient well-being postoperatively. METHODS A retrospective review was conducted on 73 patients who underwent LLIF for LDD. Patients were categorized into 2 groups based on osteoporosis status determined by dual-energy X-ray absorptiometry scans: those with osteoporosis (n = 20) and those without osteoporosis (n = 53). Data collection included demographics, surgical details, complications, magnetic resonance imaging analysis, pain intensity, and QOL (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire). RESULTS The groups had no significant differences regarding operative time, estimated blood loss, and hospital stay duration. However, the incidence of CS was 40% in patients with osteoporosis, compared to 17% in nonosteoporotic patients. Despite this, significant improvements in spinal canal dimensions were observed in both groups. Both groups experienced significant reductions in pain intensity, with notable improvements in functional outcomes assessed by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, indicating the overall effectiveness of LLIF in enhancing patient well-being and functionality, irrespective of osteoporosis status. CONCLUSIONS Osteoporosis increases the risk of CS in LLIF surgery for LDD patients but does not affect short-term pain relief and QOL improvements.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Pacchiarotti G, Todesca A, Coppola M, Gumina S. Robotic-assisted patellofemoral arthroplasty provides excellent implant survivorship and high patient satisfaction at mid-term follow-up. INTERNATIONAL ORTHOPAEDICS 2024; 48:2055-2063. [PMID: 38819666 PMCID: PMC11246259 DOI: 10.1007/s00264-024-06224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Robotic adoption in knee surgery has yielded several benefits, but its application in patellofemoral arthroplasty (PFA) remains barely reported. The purpose of this study was to determine implant survival, patient satisfaction, and functional outcomes after robotic-assisted PFA at an intermediate follow-up. METHODS This prospective analysis targeted 18 knees of 16 consecutive patients who underwent robot-aided PFA with three-year minimum follow-up (range, 3 to 6 years). Each patient was evaluated collecting pre-operative and post-operative medical record data, including range of motion, radiographic images, and multiple scores, such as VAS, APKS, and OKS. RESULTS At surgery, the mean age was 55.4 years ± 14.4 (range, 32 to 78 years), and the mean BMI was 26.8 kg/m² ±5.2 (range, 20 to 36). Etiologies of patellofemoral osteoarthritis included idiopathic degeneration (28%), post-traumatic (33%), and dysplasia (39%). Pre-implantation scores were VAS 7.9 ± 1.4, AKPS 34.6 ± 23.3, and OKS 17.3 ± 10.3. One implant was revised with primary total knee arthroplasty for osteoarthritis progression. Clinical and radiographic follow-up showed no signs of loosening or infection. The maximum flexion reached an average of 131.1°±10.5° (range, 110° to 145°), accompanied by significantly improved score results (P-value < 0.01): VAS 1.1 ± 1.4, AKPS 90.2 ± 8.6, and OKS 46.3 ± 1.8. CONCLUSIONS At 3 years after robotic assisted patellofemoral arthroplasty, excellent implant survival and patient satisfaction rates can be expected along with significantly improved functional and pain control outcomes. Although the limitations imposed by the restricted cohort, these findings indicate that robotic assistance in PFA is both safe and effective at intermediate follow-up.
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Affiliation(s)
- Giacomo Pacchiarotti
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Rome, Italy.
| | | | - Michele Coppola
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Stefano Gumina
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Rome, Italy
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Tong Y, Udupa JK, McDonough JM, Wu C, Xie L, Rajapakse CS, Gogel S, Sarkar S, Mayer OH, Anari JB, Torigian DA, Cahill PJ. Characterizing Lung Parenchymal Aeration via Standardized Signal Intensity from Free-breathing 4D Dynamic MRI in Phantoms, Healthy Children, and Pediatric Patients with Thoracic Insufficiency Syndrome. Radiol Cardiothorac Imaging 2024; 6:e230262. [PMID: 39051878 DOI: 10.1148/ryct.230262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Purpose To investigate free-breathing thoracic bright-blood four-dimensional (4D) dynamic MRI (dMRI) to characterize aeration of parenchymal lung tissue in healthy children and patients with thoracic insufficiency syndrome (TIS). Materials and Methods All dMR images in patients with TIS were collected from July 2009 to June 2017. Standardized signal intensity (sSI) was investigated, first using a lung aeration phantom to establish feasibility and sensitivity and then in a retrospective research study of 40 healthy children (16 male, 24 female; mean age, 9.6 years ± 2.1 [SD]), 20 patients with TIS before and after surgery (11 male, nine female; mean age, 6.2 years ± 4.2), and another 10 healthy children who underwent repeated dMRI examinations (seven male, three female; mean age, 9 years ± 3.6). Individual lungs in 4D dMR images were segmented, and sSI was assessed for each lung at end expiration (EE), at end inspiration (EI), preoperatively, postoperatively, in comparison to normal lungs, and in repeated scans. Results Air content changes of approximately 6% were detectable in phantoms via sSI. sSI within phantoms significantly correlated with air occupation (Pearson correlation coefficient = -0.96 [P < .001]). For healthy children, right lung sSI was significantly lower than that of left lung sSI (at EE: 41 ± 6 vs 47 ± 6 and at EI: 39 ± 6 vs 43 ± 7, respectively; P < .001), lung sSI at EI was significantly lower than that at EE (P < .001), and left lung sSI at EE linearly decreased with age (r = -0.82). Lung sSI at EE and EI decreased after surgery for patients (although not statistically significantly, with P values of sSI before surgery vs sSI after surgery, left and right lung separately, in the range of 0.13-0.51). sSI varied within 1.6%-4.7% between repeated scans. Conclusion This study demonstrates the feasibility of detecting change in sSI in phantoms via bright-blood dMRI when air occupancy changes. The observed reduction in average lung sSI after surgery in pediatric patients with TIS may indicate postoperative improvement in parenchymal aeration. Keywords: MR Imaging, Thorax, Lung, Pediatrics, Thoracic Surgery, Lung Parenchymal Aeration, Free-breathing Dynamic MRI, MRI Intensity Standardization, Thoracic Insufficiency Syndrome Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Yubing Tong
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Jayaram K Udupa
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Joseph M McDonough
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Caiyun Wu
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Lipeng Xie
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Chamith S Rajapakse
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Samantha Gogel
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Sulagna Sarkar
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Oscar H Mayer
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Jason B Anari
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Drew A Torigian
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Patrick J Cahill
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
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Gauci MO, Glevarec L, Bronsard N, Cointat C, Pelletier Y, Boileau P, Gonzalez JF. Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:1771-1780. [PMID: 38281677 DOI: 10.1016/j.jse.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND We aim to predict a clinical difference in the postoperative range of motion (RoM) between 2 reverse shoulder arthroplasty (RSA) stem designs (Inlay-155° and Onlay-145°) using preoperative planning software. We hypothesized that preoperative 3D planning could anticipate the differences in postoperative clinical RoM between 2 humeral stem designs and by keeping the same glenoid implant. METHODS Thirty-seven patients (14 men and 23 women, 76 ± 7 years) underwent a BIO-RSA (bony increased offset-RSA) with the use of preoperative planning and an intraoperative 3-dimensional-printed patient-specific guide for glenoid component implantation between January 2014 and September 2019 with a minimum follow-up of 2 years. Two types of humeral implants were used: Inlay with a 155° inclination (Inlay-155°) and Onlay with a 145°inclination (Onlay-145°). Glenoid implants remained unchanged. The postoperative RSA angle (inclination of the area in which the glenoid component of the RSA is implanted) and the lateralization shoulder angle were measured to confirm the good positioning of the glenoid implant and the global lateralization on postoperative X-rays. A correlation between simulated and clinical RoM was studied. Simulated and last follow-up active forward flexion (AFE), abduction, and external rotation (ER) were compared between the 2 types of implants. RESULTS No significant difference in RSA and lateralization shoulder angle was found between planned and postoperative radiological implants' position. Clinical RoM at the last follow-up was always significantly different from simulated preoperative RoM. A low-to-moderate but significant correlation existed for AFE, abduction, and ER (r = 0.45, r = 0.47, and r = 0.57, respectively; P < .01). AFE and abduction were systematically underestimated (126° ± 16° and 95° ± 13° simulated vs. 150° ± 24° and 114° ± 13° postoperatively; P < .001), whereas ER was systematically overestimated (50° ± 19° simulated vs. 36° ± 19° postoperatively; P < .001). Simulated abduction and ER highlighted a significant difference between Inlay-155° and Onlay-145° (12° ± 2°, P = .01, and 23° ± 3°, P < .001), and this was also retrieved clinically at the last follow-up (23° ± 2°, P = .02, and 22° ± 2°, P < .001). CONCLUSIONS This study is the first to evaluate the clinical relevance of predicted RoM for RSA preoperative planning. Motion that involves the scapulothoracic joint (AFE and abduction) is underestimated, while ER is overestimated. However, preoperative planning provides clinically relevant RoM prediction with a significant correlation between both and brings reliable data when comparing 2 different types of humeral implants (Inlay-155° and Onlay-145°) for abduction and ER. Thus, RoM simulation is a valuable tool to optimize implant selection and choose RSA implants to reach the optimal RoM.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France.
| | - Laure Glevarec
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France
| | - Caroline Cointat
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Yann Pelletier
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France
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Güdü BO, Aydın AL, Mercan NE, Dilbaz S, Çırak M, Öktenoğlu T, Özer AF. Anatomical Parameters of Percutaneous, Minimally Invasive, Direct Intralaminar Pars Screw Fixation of Spondylolysis. World Neurosurg 2024; 188:e567-e572. [PMID: 38825312 DOI: 10.1016/j.wneu.2024.05.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To investigate the anatomical parameters of the ideal screw trajectory for percutaneous intralaminar screw fixation of a pars defect in lumbar spondylolysis using computed tomography scans. METHODS Using advanced radiological software, the ideal intralaminar screw trajectory was determined. The anatomical parameters of this trajectory were analyzed using a total of 80 single-level lumbar tomography scans in patients with spondylolysis at the lumbar 4 vertebrae and lumbar 5 vertebrae levels. The ideal intralaminar screw trajectory started from the inferolateral edge of the lamina and was between the intralaminar region, pars defect, and defective pars neck and pedicle. Along this trajectory, the skin-lamina distance, intralaminar screw length, isthmic lamina length and width, defective pars neck width, lateral entry distance of the screw to the center of the spinous process, and sagittal and coronal screw application angles were analyzed. RESULTS When comparing the lumbar 4 vertebrae and lumbar 5 vertebrae parameters, the mean skin-to-lamina distances were 11-9 cm (P = 0.000), intralaminar screw lengths 3.5-3.6 cm (P = 0.067), isthmic lamina lengths 2-2 cm (P = 0.698), mid-lamina widths 1-1 cm (P = 0.941), defective pars neck widths 1-1 cm (P = 0.674), screw lateral entry distances according to the spinous process 1-1.5 cm (P = 0.000), sagittal screw angles 45°-45° (P = 0.870), and coronal screw angles 10°-20° (P = 0.000), respectively. There were no differences based on age and gender (P < 0.05). CONCLUSIONS Percutaneous intralaminar rigid screw fixation of a pars defect in spondylolysis provides minimally invasive, low-profile instrumentation. In spondylolysis, a screw length of 3-4 cm and a screw diameter of 4-5 mm may be sufficient for pars fixation with intralaminar screws.
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Affiliation(s)
- Burhan Oral Güdü
- Department of Neurosurgery, Medipol University Sefakoy Hospital, Istanbul, Turkey.
| | - Ahmet Levent Aydın
- Department of Neurosurgery, Medicana Healthy Group Hospital, Istanbul, Turkey
| | - Necip Engin Mercan
- Department of Neurosurgery, Avrasya Healthy Group Hospital, Istanbul, Turkey
| | - Suna Dilbaz
- Department of Neurosurgery, Kanuni Sultan Suuleyman Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Musa Çırak
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Department of Neurosurgery, Koc University School of Medicine, American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Ali Fahir Özer
- Department of Neurosurgery, Koc University School of Medicine, American Hospital, Neurosurgery Department, Istanbul, Turkey
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van Laarhoven CMCA, Donners SJA, van Laarhoven CJHCM, Teunissen J, Bieckmann L, Schuurman AH, van der Heijden BEPA. Results of Pyrocarbon Disc Interposition Compared to Trapeziectomy with Ligament Reconstruction and Tendon Interposition. Plast Reconstr Surg 2024; 154:296e-305e. [PMID: 37678813 PMCID: PMC11262737 DOI: 10.1097/prs.0000000000011038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND To compare pyrocarbon disc interposition arthroplasty (PDI) with trapeziectomy plus ligament reconstruction tendon interposition (LRTI), the authors assessed whether PDI resulted in a higher pinch strength, and compared grip strength, range of motion (ROM), patient-reported outcomes, satisfaction, and complications between the approaches. METHODS Because of scarcity of preoperative hand measurements, the authors performed a descriptional cross-sectional cohort study of patients operated on between 2006 and 2014, with a minimum of 5 years of follow-up. Patients were treated with PDI or LRTI. The authors determined key pinch strength as the primary outcome, followed by tip and tripod pinch, grip strength, palmar abduction and opposition, Michigan Hand Outcomes Questionnaire (MHQ) and Patient-Reported Hand and Wrist Evaluation (PRWHE) scores, satisfaction level, and complications. Propensity score matching was used to match the study groups on demographic variables. A ratio of 2:1 was used, resulting in inclusion of 62 (of 154) PDI and 31 (of 31) LRTI thumbs. RESULTS Patients in the PDI group showed stronger key and tip pinch strength than did patients in the LRTI group ( P = 0.027 and P = 0.036, respectively). Tripod pinch, grip strength, and ROM were equal between the groups. MHQ and PRWHE were comparable, with higher satisfaction levels in the PDI group. Eight patients with PDI were converted to LRTI because of pain. CONCLUSIONS This study confirmed the hypothesis that key and tip pinch strength is stronger after PDI compared with LRTI for first carpometacarpal joint osteoarthritis. Both techniques have comparable outcomes considering patient-reported outcome (MHQ and PRWHE), ROM, and complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Cecile M. C. A. van Laarhoven
- From the University Medical Center Utrecht, Utrecht University
- Erasmus Medical Center, Erasmus University
- Jeroen Bosch Hospital
| | | | | | | | - Luc Bieckmann
- From the University Medical Center Utrecht, Utrecht University
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Wagner RK, Emmelot MP, van Trikt C, Visser CE, Peters EJG, Janssen SJ, Kloen P. Characteristics and Outcomes of Occult Infections in Presumed Aseptic Nonunions: A Retrospective Cohort Study. J Orthop Trauma 2024; 38:452-458. [PMID: 39007663 PMCID: PMC11219069 DOI: 10.1097/bot.0000000000002822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES To determine (1) the rate of positive cultures in presumed aseptic nonunions, (2) the rate and microbial spectrum of positive cultures that represented occult infection, and (3) rates of nonunion healing. METHODS DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS SELECTION CRITERIA Adult patients with a presumed aseptic nonunion treated with single-stage revision between 2002 and 2022. OUTCOME MEASURES AND COMPARISONS The rate of positive cultures compared for 2 protocols: old: 1-2 samples cultured 7 days versus new: 5 samples cultured 14 days. The rate of positive cultures meeting occult infection criteria with the new protocol (≥2 samples with phenotypically indistinguishable microorganisms, or ≥1 sample with a high virulent microorganism). Nonunion healing rates between protocols and between groups based on culture results with the new protocol. RESULTS One hundred seventy-nine patients were included. The rate of positive cultures was 14% (n = 15/105) with the old protocol and 51% (n = 38/74) with the new protocol (P < 0.001). With the new protocol, the rate of positive cultures meeting occult infection criteria was 19% (n = 14/74), and coagulase-negative staphylococci (48%) and Cutibacterium acnes (38%) were the most common microorganisms. Nonunion healing rates after the primary revision did not differ between protocols (old: 82% vs. new: 86%, P = 0.41) and groups based on culture result (sterile: 86% vs. occultly infected: 93%, P = 0.66). The final overall nonunion healing rate was 97%. CONCLUSIONS Occult infections were identified in 1 in 5 presumed aseptic nonunions using a standardized protocol with 5 intraoperative samples cultured 14 days and were predominantly caused by slow growing, gram-positive microorganisms. The local spectrum and antimicrobial sensitivity of occult infections should be considered when developing empiric antimicrobial protocols. Patients with presumed aseptic nonunions can expect high healing rates, regardless of the culture result. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Robert Kaspar Wagner
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, MA
| | - Mees P Emmelot
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Clinton van Trikt
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Caroline E Visser
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC Location University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Edgar J G Peters
- Amsterdam UMC location Vrije Universiteit Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands; and
- Amsterdam Infection & Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Stein J Janssen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Peter Kloen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
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Pearson Z, Hung V, Agarwal A, Stehlik K, Harris A, Ahiarakwe U, Best MJ. Does Reusable Instrumentation for Four-Anchor Rotator Cuff Repair Offer Decreased Waste Disposal Costs and Lower Waste-Related Carbon Emissions? J Am Acad Orthop Surg 2024; 32:705-711. [PMID: 38861714 DOI: 10.5435/jaaos-d-23-00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/29/2023] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Orthopaedic surgery is culpable, in part, for the excessive carbon emissions in health care partly due to the utilization of disposable instrumentation in most procedures, such as rotator cuff repair (RCR). To address growing concerns about hospital waste, some have considered replacing disposable instrumentation with reusable instrumentation. The purpose of this study was to estimate the cost and carbon footprint of waste disposal of RCR kits that use disposable instrumentation compared with reusable instrumentation. METHODS The mass of the necessary materials and their packaging to complete a four-anchor RCR from four medical device companies that use disposable instrumentation and one that uses reusable instrumentation were recorded. Using the cost of medical waste disposal at our institution ($0.14 per kilogram) and reported values from the literature for carbon emissions produced from the low-temperature incineration of noninfectious waste (249 kgCO 2 e/t) and infectious waste (569 kgCO 2 e/t), we estimated the waste management cost and carbon footprint of waste disposal produced per RCR kit. RESULTS The disposable systems of four commercial medical device companies had 783%, 570%, 1,051%, and 478%, respectively, greater mass and waste costs when compared with the reusable system. The cost of waste disposal for the reusable instrumentation system costs on average $0.14 less than the disposable instrumentation systems. The estimated contribution to the overall carbon footprint produced from the disposal of a RCR kit that uses reusable instrumentation was on average 0.37 kg CO2e less than the disposable instrumentation systems. CONCLUSION According to our analysis, reusable instrumentation in four-anchor RCR leads to decreased waste and waste disposal costs and lower carbon emissions from waste disposal. Additional research should be done to assess the net benefit reusable systems may have on hospitals and the effect this may have on a long-term decrease in carbon footprint. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Zachary Pearson
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Pearson, Agarwal, Harris, Ahiarakwe, and Best), and the Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI (Hung, and Stehlik)
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10
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Liu H, Wang X, Song X, Han B, Li C, Du F, Zhang H. A multiview deep learning-based prediction pipeline augmented with confident learning can improve performance in determining knee arthroplasty candidates. Knee Surg Sports Traumatol Arthrosc 2024; 32:2107-2119. [PMID: 38713857 DOI: 10.1002/ksa.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE Preoperative prudent patient selection plays a crucial role in knee osteoarthritis management but faces challenges in appropriate referrals such as total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and nonoperative intervention. Deep learning (DL) techniques can build prediction models for treatment decision-making. The aim is to develop and evaluate a knee arthroplasty prediction pipeline using three-view X-rays to determine the suitable candidates for TKA, UKA or are not arthroplasty candidates. METHODS A study was conducted using three-view (anterior-posterior, lateral and patellar) X-rays and surgical data of patients undergoing TKA, UKA or nonarthroplasty interventions from sites A and B. Data from site A were used to derive and validate models. Data from site B were used as external test set. A DL pipeline combining YOLOv3 and ResNet-18 with confident learning (CL) was developed. Multiview Convolutional Neural Network, EfficientNet-b4, ResNet-101 and the proposed model without CL were also trained and tested. The models were evaluated using metrics such as area under the receiver operating characteristic curve (AUC), accuracy, precision, specificity, sensitivity and F1 score. RESULTS The data set comprised a total of 1779 knees. Of which 1645 knees were from site A as a derivation set and an internal validation cohort. The external validation cohort consisted of 134 knees. The internal validation cohort demonstrated superior performance for the proposed model augmented with CL, achieving an AUC of 0.94 and an accuracy of 85.9%. External validation further confirmed the model's generalisation, with an AUC of 0.93 and an accuracy of 82.1%. Comparative analysis with other neural network models showed the proposed model's superiority. CONCLUSIONS The proposed DL pipeline, integrating YOLOv3, ResNet-18 and CL, provides accurate predictions for knee arthroplasty candidates based on three-view X-rays. This prediction model could be useful in performing decision making for the type of arthroplasty procedure in an automated fashion. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Hongzhi Liu
- Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoyao Wang
- Department of Industrial & Manufacturing Systems Engineering, School of Mechanical Engineering & Automation, Beihang University, Beijing, China
| | - Xinqiu Song
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bing Han
- Department of Orthopaedics, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Chuiqing Li
- Department of Orthopaedics, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Fuzhou Du
- Department of Industrial & Manufacturing Systems Engineering, School of Mechanical Engineering & Automation, Beihang University, Beijing, China
| | - Hongmei Zhang
- Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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11
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Gao AY, Whitrock JN, Goodman MD, Nathwani JN, Janowak CF. The Next Generation: Surgeon Learning Curve in a Mature Operative Rib Management Program. J Surg Res 2024; 301:461-467. [PMID: 39033597 DOI: 10.1016/j.jss.2024.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/28/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Prior work has demonstrated utility in using operative time to measure surgeon learning for surgical stabilization of rib fractures (SSRF); however, no studies have used operative time to evaluate the benefit of proctoring in subsequent generations of surgeons. We sought to evaluate whether there is a difference in learning between an original series (TOS) of self-taught surgeons versus the next generation (TNG) of proctored surgeons using cumulative summation (CUSUM) analysis. We hypothesized that TNG would have a comparatively accelerated learning curve. METHODS A single-center retrospective review of all SSRF at a level 1 trauma center was performed. Data were collected from the beginning of an operative chest injury program to include at least 2 y of TNG experience. Operative time was used to determine success and misstep based on prior methods. Learning curves using CUSUM analysis were calculated based on an anticipated success rate of 90% and compared between TOS and TNG groups. RESULTS Over 7 y, 163 patients with a median Injury Severity Score of 24 underwent SSRF. Median operative time was 165 min with a 0.5 plate-to-fracture ratio. All three TOS surgeons experienced a positive slope indicative of early missteps for their first 15-20 cases. By contrast, all three TNG surgeons demonstrated a series of early successes resulting in negative CUSUM slopes which coincided with a period of proctoring. By the end of TNG series, the composite cumulative score was less than half of the TOS surgeon' scores. CONCLUSIONS Operative time continues to be a useful surrogate for observing SSRF learning curves. In a mature institutional program, proctored novice surgeons appear to have an accelerated learning curve compared to novice surgeons developing a new operative rib program.
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Affiliation(s)
- Angela Y Gao
- University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Jenna N Whitrock
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Michael D Goodman
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Jay N Nathwani
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Christopher F Janowak
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio.
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12
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Poutoglidou F, Yousaf S. Takedown of Ankle Arthrodesis and Conversion to Total Ankle Arthroplasty: A Systematic Review. J Foot Ankle Surg 2024:S1067-2516(24)00149-2. [PMID: 39033845 DOI: 10.1053/j.jfas.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/07/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Management of the nonunited or painful ankle arthrodesis remains a difficult challenge. The aim of this systematic review was to investigate the clinical outcomes and complications of conversion of an ankle fusion to a Total Ankle Replacement (TAR). The PRISMA statement guidelines were followed. A literature search was performed in Pubmed, Science Direct and Cochrane Central Register of Controlled Trails (CENTRAL) from their inception up to October 10th, 2023. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tool and the Methodological Index for Non-Randomized Studies (MINORS). Seven studies with 220 patients (223 ankles) with a mean follow-up of 64.9 months were included. Takedown of an ankle fusion and conversion to a TAR led to a significant improvement in all functional and clinical scores and with an acceptable range of motion. Most common complications were malleolar fractures (12.8%) and arthrofibrosis (5.6%). The revision rate was 8% and four cases resulted in a below-knee amputation. Cases with an insufficient fibula had a good outcome when a fibular reconstruction was performed. In conclusion, takedown of an ankle fusion and conversion to a TAR has satisfactory clinical outcomes and with a limited number of complications. Future well-designed studies are needed to validate the results of the present study.
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Affiliation(s)
- Freideriki Poutoglidou
- Trauma & Orthopaedics, Epsom and St Helier University Hospitals NHS Trust/SWLEOC Epsom, Surrey, United Kingdom, KT18 7EG.
| | - Sohail Yousaf
- Trauma & Orthopaedics, Epsom and St Helier University Hospitals NHS Trust/SWLEOC Epsom, Surrey, United Kingdom, KT18 7EG
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13
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Padgett AM, Kothari E, Conklin MJ. Two-stage corrective operation for the treatment of pes cavovarus in patients with spina bifida. World J Orthop 2024; 15:618-626. [DOI: 10.5312/wjo.v15.i7.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/26/2024] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Pes cavovarus has an estimated incidence of 8%-17% in patients with spina bifida (SB). The majority of the current literature on surgical treatment of cavovarus feet in children and adolescents includes a variety of diagnoses. There are currently no case series describing a treatment algorithm for deformity correction in this specific patient population. The authors of this study present the results of a retrospective case series performed to assess the radiographic outcomes of two-stage corrective surgery in patients with SB.
AIM To assess the radiographic outcomes of a staged operation consisting of radical plantar release followed by osteotomy for pes cavovarus in patients with SB.
METHODS Retrospective chart review was performed on patients with SB with a diagnosis of pes cavovarus at a freestanding children’s hospital who underwent surgical correction of the deformity. Patients were excluded for lack of two-stage corrective operation, nonambulatory status, lack of at least six months follow-up, and age > 18 years at the time of surgery. This resulted in a cohort of 19 patients. Radiographic analysis was performed on 11 feet that had a complete series of preoperative and postoperative weightbearing X-rays. Preoperative and postoperative radiographic outcome measurements were compared using a two-sample t-test.
RESULTS Significant changes between the preoperative and postoperative measurements were seen in Meary’s angle, the anteroposterior talo-first metatarsal (AP TMT1) angle, and the talonavicular coverage. Mean values of Meary’s angle were 17.9 ± 13.1 preoperatively and 4.7 ± 10.3 postoperatively (P = 0.016). Mean AP TMT1 angle was 20.6 ± 15.1 preoperatively and 9.3 ± 5.5 postoperatively (P = 0.011). Mean talonavicular coverage values were -10.3 ± 9.6 preoperatively and -3.8 ± 10.1 postoperatively (P = 0.025).
CONCLUSION The two-stage corrective procedure demonstrated efficacy in correcting cavovarus deformity in patients with SB. Providers should strongly consider employing the staged surgical algorithm presented in this manuscript for management of these patients.
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Affiliation(s)
- Anthony Mack Padgett
- Department of Orthopedics, Indiana University, Indianapolis, IN 46202, United States
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Ezan Kothari
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Michael J Conklin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
- Department of Orthopedic Surgery, Children’s of Alabama, Birmingham, AL 35233, United States
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14
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Guo Z, Guo Y, Wang Y, Bi Y, Deng Y, Cao Y, Huang M. Finite element analysis of the treatment of a minimally invasive approach combined with a novel anatomical locking plate for scapular body fractures. J Orthop Surg Res 2024; 19:410. [PMID: 39014468 PMCID: PMC11253453 DOI: 10.1186/s13018-024-04905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The minimally invasive approach for the treatment of displaced scapular neck or body fractures has the advantages of less trauma and minimal muscle dissection. In clinical practice, the minimally invasive approach combined with an anatomical locking plate has been used to treat scapular body fractures. In addition, we have made minor modifications to the minimally invasive approach. However, the biomechanical study about the approach combined with an anatomical locking plate in treating scapular body fractures was limited. METHODS Finite element analysis (FEA) was used to conduct the biomechanical comparison between the anatomical locking plate (AP model) and reconstructive plate (RP model) in the treatment of scapular body fractures through the modified minimally invasive approach. A healthy male volunteer with no history of scapula or systemic diseases was recruited. High-resolution computed tomography images of his right scapula were obtained. Two scapula models were constructed and analyzed by the software of Mimics 21.0, Geomagic Wrap 2021, SolidWorks 2021, and ANSYS Workbench 2022, respectively. RESULTS Through static structural analysis, in terms of equivalent von Mises stress, equivalent elastic strain, and total deformation, the AP model exhibited superior safety characteristics, enhanced flexibility, and anticipated stability compared with the RP model. This was evidenced by lower maximum stress, lower maximum strain and displacement. CONCLUSION The minimally invasive approach combined with an anatomical locking plate for scapular body fractures had better biomechanical stability. The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures.
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Affiliation(s)
- Zhanpeng Guo
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yue Guo
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yansong Wang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yunlong Bi
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yu Deng
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yang Cao
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Mina Huang
- School of Nursing, Jinzhou Medical University, Jinzhou, China.
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Jiang JH, Zhao CM, Zhang J, Xu RM, Chen L. Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement. World J Clin Cases 2024; 12:4108-4120. [PMID: 39015896 PMCID: PMC11235545 DOI: 10.12998/wjcc.v12.i20.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/24/2024] [Accepted: 05/31/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The pedicle screw technique is widely employed for vertebral body fixation in the treatment of spinal disorders. However, traditional screw placement methods require the dissection of paraspinal muscles and the insertion of pedicle screws at specific transverse section angles (TSA). Larger TSA angles require more force to pull the muscle tissue, which can increase the risk of surgical trauma and ischemic injury to the lumbar muscles. AIM To study the feasibility of zero-degree TSA vertical pedicle screw technique in the lumbosacral segment. METHODS Finite element models of vertebral bodies and pedicle screw-rod systems were established for the L4-S1 spinal segments. A standard axial load of 500 N and a rotational torque of 10 N/m were applied. Simulated screw pull-out experiment was conducted to observe pedicle screw resistance to pull-out, maximum stress, load-displacement ratio, maximum stress in vertebral bodies, load-displacement ratio in vertebral bodies, and the stress distribution in pedicle screws and vertebral bodies. Differences between the 0-degree and 17-degree TSA were compared. RESULTS At 0-degree TSA, the screw pull-out force decreased by 11.35% compared to that at 17-degree TSA (P < 0.05). At 0-degree and 17-degree TSA, the stress range in the screw-rod system was 335.1-657.5 MPa and 242.8-648.5 MPa, separately, which were below the fracture threshold for the screw-rod system (924 MPa). At 0-degree and 17-degree TSA, the stress range in the vertebral bodies was 68.45-78.91 MPa and 39.08-72.73 MPa, separately, which were below the typical bone yield stress range for vertebral bodies (110-125 MPa). At 0-degree TSA, the load-displacement ratio for the vertebral bodies and pedicle screws was slightly lower compared to that at 17-degree TSA, indicating slightly lower stability (P < 0.05). CONCLUSION The safety and stability of 0-degree TSA are slightly lower, but the risks of screw-rod system fracture, vertebral body fracture, and rupture are within acceptable limits.
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Affiliation(s)
- Ji-Hong Jiang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Chang-Ming Zhao
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Jun Zhang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Rong-Ming Xu
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lei Chen
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
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Yetter TR, Halvorson RT, Wong SE, Harris JD, Allahabadi S. Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09911-0. [PMID: 39009901 DOI: 10.1007/s12178-024-09911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW To evaluate the current evidence and literature on treatment options for proximal hamstring injuries. RECENT FINDINGS Patients with 3-tendon complete tears with greater than 2 cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.
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Ripoll T, Attas J, Fairag R, Lopez M, Gonzalez JF, Badet R, Micicoi G. Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion. Orthop Traumatol Surg Res 2024:103939. [PMID: 39019691 DOI: 10.1016/j.otsr.2024.103939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture's proximity to the popliteal vascular-nervous elements. Badet's open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosynthesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Thomas Ripoll
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Joseph Attas
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Rayan Fairag
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Michael Lopez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Jean-François Gonzalez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Roger Badet
- Osteo-articular Fleming Center, Bourgoin-Jallieu, France
| | - Grégoire Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France.
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Page BJ, Sheridan GA, Greenstein MD, Reif TJ, Fragomen AT, Rozbruch SR. Percutaneous removal of hardware after orthopedic surgery: Is it safe? and What are patients saying? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04038-x. [PMID: 38981919 DOI: 10.1007/s00590-024-04038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES To analyze our patient's complication profile and rate after removal of hardware (ROH) surgery, and survey our patients to ask their overall status and improvement in symptomatology post-operatively. DESIGN Retrospective chart review and survey. SETTING Academic, tertiary referral center. PATIENTS/PARTICIPANTS 173 patients with 314 pieces of hardware. Seventy-six patients (43.9%) responded to our survey. INTERVENTION ROH surgery. MAIN OUTCOME MEASUREMENTS Patient demographics and complications were recorded. All patients were sent a brief 3-question survey which asked: (1) Why did you get your hardware removed? (2) How did your overall status change after ROH? (3) How did the ROH affect your stiffness, pain, swelling, and mobility? RESULTS There were 10 complications (5.5%): 5 infections, 2 with unresolved pain, 1 hematoma, 1 chronic regional pain syndrome exacerbation, and 1 recurrent deformity. All infections were treated with oral antibiotics and improved. All other complications resolved with treatment except for the patient who developed recurrent deformity. Patients underwent ROH surgery because their doctor suggested it (76.3%) and to improve mobility (39.5%). 86.9% reported their overall status improved after ROH. They improved regarding stiffness (73.7%), pain (73.6%), swelling (61.8%), and mobility (76.3%). Similar results were seen among different implants removed. CONCLUSIONS The majority of patients who underwent percutaneous ROH were satisfied. They reported improvement in stiffness, pain, swelling and mobility (greatest improvement). The complication rate was low (5.5%). ROH can be a meaningful operation to patients allowing them to improve their quality of life with a low complication rate. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Brian Joseph Page
- Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian - Weill Cornell Medical Center, New York, NY, USA.
| | - Gerard A Sheridan
- Department of Orthopaedic Surgery, University Hospital Galway, Galway, Ireland
| | | | - Taylor J Reif
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Austin T Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
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McChesney GR, Al Farii H, Singleterry S, Lewis VO, Moon BS, Satcher RL, Bird JE, Lin PP. Can Periprosthetic Joint Infection of Tumor Prostheses Be Controlled With Debridement, Antibiotics, and Implant Retention? Clin Orthop Relat Res 2024:00003086-990000000-01672. [PMID: 38991232 DOI: 10.1097/corr.0000000000003184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Two-stage revision for periprosthetic joint infection (PJI) in patients who have undergone segmental replacement of the distal femur or proximal tibia after tumor resection can be associated with considerable morbidity, pain, and risk of complications because the procedure often results in removal of long, well-fixed stems from the diaphysis. A less-aggressive surgical approach, such as debridement, antibiotics, and implant retention (DAIR), may be attractive to patients and surgeons because of less morbidity, but the likelihood of eradicating infection in comparison to the traditional two-stage revision is not well established for oncology patients. Furthermore, the relative risk of subsequent amputation for DAIR versus two-stage revision has not been defined for this population. QUESTIONS/PURPOSES (1) How does DAIR compare with two-stage revision in terms of infection control for patients with distal femoral or proximal tibial segmental modular endoprostheses? (2) Is DAIR as an initial procedure associated with an increased risk of amputation compared with two-stage revision for infection? METHODS From the longitudinally maintained orthopaedic oncology surgical database at our institution, we identified 69 patients who had been treated for a clinical diagnosis of PJI at the knee between 1993 and 2015. We excluded 32% (22) of patients who did not meet at least one of the major criteria of the Musculoskeletal Infection Society (MSIS) for PJI, 3% (2) of patients who underwent immediate amputation, 3% (2) of patients who had a follow-up time of < 24 months, and 7% (5) of patients who did not have a primary tumor of the distal femur or proximal tibia. The study consisted of 38 patients, of whom eight underwent two-stage revision, 26 underwent DAIR, and four underwent extended DAIR (removal of all segmental components but with retention of stems and components fixed in bone) for their initial surgical procedure. To be considered free of infection, patients had to meet MSIS standards, including no positive cultures, drainage, or surgical debridement for a minimum of 2 years from the last operation. Factors associated with time-dependent risk of infection relapse, clearance, amputation, and patient survival were analyzed using Kaplan-Meier survivorship curves and the log-rank test to compare factors. Association of demographic and treatment factors was assessed using chi-square and Fisher exact tests. RESULTS Continuous infection-free survival at 5 years was 16% (95% CI 2% to 29%) for patients undergoing DAIR compared with 75% (95% CI 45% to 100%) for patients undergoing two-stage revision (p = 0.006). The median (range) number of total surgical procedures was 3 per patient (1 to 10) for DAIR and 2 (2 to 5) for two-stage revision. Twenty-nine percent (11 of 38) of patients eventually underwent amputation. Survival without amputation was 69% (95% CI 51% to 86%) for DAIR compared with 88% (95% CI 65% to 100%) for two-stage revision at 5 years (p = 0.34). The cumulative proportion of patients achieving infection-free status (> 2 years continuously after last treatment) and limb preservation was 58% (95% CI 36% to 80%) for patients initially treated with DAIR versus 87% (95% CI 65% to 100%) for patients first treated with two-stage revision (p = 0.001). CONCLUSION Infection control was better with two-stage revision than DAIR. The chance of eventual clearance of infection with limb preservation was better when two-stage revision was chosen as the initial treatment. However, the loss to follow-up in the two-stage revision group would likely make the true proportion of infection control lower than our estimate. Our experience would suggest that the process of infection eradication is a complex and difficult one. Most patients undergo multiple operations. Nearly one-third of patients eventually underwent amputation, and this was a serious risk for both groups. While we cannot strongly recommend one approach over the other based on our data, we would still consider the use of DAIR in patients who present with acute short duration of symptoms (< 3 weeks), no radiographic signs of erosion around fixed implants, and organisms other than Staphylococcus aureus. We would advocate the extended DAIR procedure with removal of all segmental or modular components, and we would caution patients that there is a high likelihood of needing further surgery. A prospective trial with strict adherence to indications may be needed to evaluate the relative merits of an extended DAIR procedure versus a two-stage revision. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Grant R McChesney
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Humaid Al Farii
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sydney Singleterry
- Neuropsychiatric Institute, Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan S Moon
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert L Satcher
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Justin E Bird
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
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20
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Qu YP, Jin W, Huang B, Shen J. Combination of manual lymphatic drainage and Kinesio taping for treating pigmented villonodular synovitis: A case report. World J Clin Cases 2024; 12:3971-3977. [PMID: 38994276 PMCID: PMC11235440 DOI: 10.12998/wjcc.v12.i19.3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder that affects the synovial joints, bursae, and tendon sheaths. To date, few studies have reported on the treatment of postoperative pain and edema in patients with PVNS. Herein, we present the case of a woman who developed pain and edema in the left lower limb 1 wk after synovectomy and arthroscopic partial meniscectomy and was unable to walk due to limited flexion and extension of the left knee. CASE SUMMARY A 32-year-old woman underwent synovectomy and arthroscopic partial meniscectomy successively and was treated with a combination of manual lymphatic drainage (MLD) and kinesio taping (KT) in our hospital to alleviate postoperative pain and edema. The following parameters were assessed at 2 wk post-treatment and 1 wk post-discharge follow up: suprapatellar circumference, infrapatellar circumference, visual analog scale score, knee range of motion, pittsburgh sleep quality index score, hamilton anxiety rating scale (HAMA) score, and hamilton depression rating scale (HAMD) score. After treatment, the postoperative pain and edema in the patient's left knee were effectively relieved, resulting in improved sleep quality and remarkably attenuated HAMA and HAMD scores. CONCLUSION Combined MLD and KT may be an effective approach for relieving postoperative pain and edema in patients with PVNS.
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Affiliation(s)
- Yan-Ping Qu
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
| | - Wei Jin
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
| | - Ben Huang
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
| | - Jie Shen
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
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21
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Fischer M, Nonnenmacher L, Zimmerer A, Reichert JC, Möller A, Hofer A, Matziolis G, Wassilew GI. The role of different acetabular morphologies on patient-reported outcomes following periacetabular osteotomy in borderline hip dysplasia. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05432-0. [PMID: 38967778 DOI: 10.1007/s00402-024-05432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The treatment option for borderline hip dysplasia (BHD) includes hip arthroscopy and periacetabular osteotomy (PAO). To the present day the controversial discussion remains, which intervention to prefer. Literature reports supporting an educated choice are scare, based on small patient cohorts and do not address the variability of acetabular morphology. Consequently, we intended to report PAO outcomes, from patients diagnosed with BHD, dependent on acetabular morphology, in a large patient cohort and aimed to define risk factors for poor clinical results and patient satisfaction. MATERIALS AND METHODS A prospective monocentre study was conducted. Patients enrolled underwent PAO for symptomatic BHD (LCEA, 18°-25°). A total of 107 hips were included with 94 complete data sets were available for evaluation with a minimum follow-up of 1 year and a mean follow-up of 2.3 years. The mean age was 31 ± 8.2 years, and 81.3% were female. As the primary outcome measure, we utilized the modified Harris hip score (mHHS) with minimal clinically important change (MCID) of eight to define clinical failure. Results were compared after a comprehensive radiographic assessment distinguishing between lateral deficient vs. anterior/posterolateral deficient acetabular and stable vs. unstable hip joints. RESULTS Overall, clinical success was achieved in 91.5% of patients and the mHHS improved significantly (52 vs. 84.7, p < 0.001). Eight hips failed to achieve the MCID and four had radiographic signs of overcorrection. Comparing variable joint morphologies, the rate of clinical success was higher in patients with an anterior/posterolateral deficient acetabular covarage compared to lateral deficient acetabular (95.2% vs. 90.4%). tThe highest rate of clinical failure was recorded in unstable hip joints (85.7% vs. 92.5% in stable hips). CONCLUSIONS This study demonstrates that PAO is an effective means to treat symptomatic BHD with variable acetabular morphologies, achieving a clinical success in 91.5% of all patients. To maintain a high level of safety and patient satisfaction technical accuracy appears crucial.
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Affiliation(s)
- Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Diakonieklinikum Stuttgart, Department of Orthopaedic and Trauma Surgery, Orthopädische Klinik Paulinenhilfe, Stuttgart, Germany
| | - Johannes C Reichert
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Möller
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andre Hofer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Georg Matziolis
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Eisenberg, Germany
| | - Georgi I Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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22
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Pintore A, Astone A, Vecchio G, Asparago G, Calabrò G, Migliorini F, Maffulli N. Percutaneous transverse pinning for metacarpal fractures: a clinical trial. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05422-2. [PMID: 38965077 DOI: 10.1007/s00402-024-05422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. METHODS Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05. RESULTS The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. CONCLUSION Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Andrea Pintore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Alberto Astone
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giampiero Calabrò
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Nicola Maffulli
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke On Trent, England, UK.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, England, E1 4DG, UK.
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy.
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23
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Groisser BN, Thakur A, Hillstrom HJ, Adhiyaman A, Zucker C, Du J, Cunningham M, Hresko MT, Haddas R, Blanco J, Potter HG, Mintz DN, Breighner RE, Heyer JH, Widmann RF. Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms. J Robot Surg 2024; 18:278. [PMID: 38960985 PMCID: PMC11222209 DOI: 10.1007/s11701-024-02001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024]
Abstract
Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans. Three cadaveric specimens were utilized. Screw placement planning on preoperative CT was performed according to standard clinical practice. Two experienced surgeons performed bilateral T2-L4 instrumentation using robotic-assisted navigation. Postoperative CT scans of the instrumented levels were obtained. Automated segmentation and computer vision techniques were employed to align each preoperative vertebra with its postoperative counterpart and then compare screw positions along all three axes. Registration accuracy was assessed by preoperatively embedding spherical markers (tantalum beads) to measure discrepancies in landmark alignment. Eighty-eight pedicle screws were placed in 3 cadavers' spines. Automated registrations between pre- and postoperative CT achieved sub-voxel accuracy. For the screw tip and tail, the mean three-dimensional errors were 1.67 mm and 1.78 mm, respectively. Mean angular deviation of screw axes from plan was 1.58°. For screw mid-pedicular accuracy, mean absolute error in the medial-lateral and superior-inferior directions were 0.75 mm and 0.60 mm, respectively. This study introduces automated algorithms for determining accuracy and precision of planned pedicle screws. Our accuracy outcomes are comparable or superior to recent robotic-assisted in vivo and cadaver studies. This computerized workflow establishes a standardized protocol for assessing pedicle screw placement accuracy and precision and provides detailed 3D translational and angular accuracy and precision for baseline comparison.
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Affiliation(s)
- Benjamin N Groisser
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ankush Thakur
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Howard J Hillstrom
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Akshitha Adhiyaman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Colson Zucker
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jerry Du
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthew Cunningham
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Ram Haddas
- University of Rochester Medical Center, Rochester, NY, USA
| | - John Blanco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Hollis G Potter
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Douglas N Mintz
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ryan E Breighner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jessica H Heyer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Roger F Widmann
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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24
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Corban J, Shah S, Ramappa AJ. Current Evidence Based Recommendations on Rehabilitation following Arthroscopic Shoulder Surgery: Rotator Cuff, Instability, Superior Labral Pathology, and Adhesive Capsulitis. Curr Rev Musculoskelet Med 2024; 17:247-257. [PMID: 38668940 PMCID: PMC11156828 DOI: 10.1007/s12178-024-09899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis. RECENT FINDINGS For small and medium sized rotator cuff tears, early motion protocols do not seem to affect healing or retear rates, however there is no difference with regards to long term functional outcomes when compared to standard motion protocols. For larger tears (> 3 cm), early active motion may be associated with impaired tendon integrity. Early range of motion following arthroscopic Bankart repair has not been shown to increase rate of recurrence, however the data on return to sport requires more granularity to effectively guide care. Further research needs to be done to compare rehab protocols following SLAP repair and arthroscopic capsular release. Rehabilitation protocols following rotator cuff surgery and anterior shoulder stabilization have garnered the most research interest. However, there is still a need for larger higher-level studies examining the long-term effects of different rehab protocols. Regarding the arthroscopic management of other types of shoulder instability, SLAP tears and adhesive capsulitis, there is paucity of high-quality evidence. This knowledge gap likely underpins the variability in different rehab protocols seen in clinical practice, highlighting the need for more research.
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Affiliation(s)
| | - Sarav Shah
- New England Baptist Hospital, Boston, MA, USA
| | - Arun J Ramappa
- New England Baptist Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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25
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Quinn M, Lemme N, Morrissey P, Fadale P, Owens BD. An Update on Emerging Techniques and Considerations in Revision Anterior Cruciate Ligament Reconstruction. JBJS Rev 2024; 12:01874474-202407000-00007. [PMID: 39018384 DOI: 10.2106/jbjs.rvw.24.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
» The rate of primary anterior cruciate ligament reconstruction (ACLR) failure in at-risk populations remains unacceptably high and necessitates thorough evaluation of native alignment and concomitant injuries.» Posterior tibial slope of >12° is a substantial risk factor of ACLR failure and should be corrected through anterior closing wedge osteotomy.» Varus malalignment of >5° exacerbates stress on the ACL graft, increases ACLR failure risks, and should be considered for correction through high tibial osteotomy at the time of revision ACLR.» Injuries to the anterolateral ligamentous complex are prevalent in ACL ruptures, and high-risk patients have shown benefit from anterolateral ligament reconstruction or lateral extra-articular tenodesis in the revision setting.» Addressing posterolateral corner, collateral ligament, and meniscal injuries, during revision ACLR, is vital to mitigate increased graft forces and optimize knee stability and functional outcomes.
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Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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26
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Nguyen K, Cooperman S, Ng A. Osteochondral Injuries of the Talus. Clin Podiatr Med Surg 2024; 41:437-450. [PMID: 38789163 DOI: 10.1016/j.cpm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is composed primarily of hyaline cartilage, the regenerative capacity of these injuries is limited. Therefore, several open and arthroscopic techniques have been described to treat osteochondral injuries of the talus and underlying bone marrow lesions. Throughout this review, these treatment options are discussed along with their indications and currently reported outcomes. A commentary on the authors' preferences among these techniques is also provided.
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Affiliation(s)
- Kevin Nguyen
- Advanced Orthopedic & Sports Medicine Specialists, Denver, CO, USA; Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA.
| | - Steven Cooperman
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA; HCA Presbyterian Saint Lukes, Denver, CO, USA
| | - Alan Ng
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA
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27
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Herman ZJ, Keeling LE, Fox MA, Dadoo S, Musahl V. The Role of Osteotomy in Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:383-398. [PMID: 38811117 DOI: 10.1016/j.csm.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Coronal and sagittal plane knee malalignments have been shown to increase the forces on anterior cruciate ligament (ACL) grafts after ACL reconstruction (ACLR). Studies have shown the benefit of high tibial osteotomy to address coronal and sagittal imbalance in revision ACLR. The purpose of this article is to further describe the use of osteotomy by reviewing preoperative planning, indications, techniques, and outcomes of high tibial opening and closing wedge as well as anterior tibial closing wedge osteotomies in the setting of ACLR.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Laura E Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Michael A Fox
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
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28
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Bryson XM, Pham NS, Hollyer I, Hu S, Rinsky LA, Vorhies JS. 3D CT modeling demonstrates the anatomic feasibility of S1AI screw trajectory for spinopelvic fixation in neuromuscular scoliosis. Spine Deform 2024; 12:933-939. [PMID: 38733488 DOI: 10.1007/s43390-024-00840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/07/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE In patients with neuromuscular scoliosis undergoing posterior spinal fusion, the S2 alar iliac (S2AI) screw trajectory is a safe and effective method of lumbopelvic fixation but can lead to implant prominence. Here we use 3D CT modeling to demonstrate the anatomic feasibility of the S1 alar iliac screw (S1AI) compared to the S2AI trajectory in patients with neuromuscular scoliosis. METHODS This retrospective study used CT scans of 14 patients with spinal deformity to create 3D spinal reconstructions and model the insertional anatomy, max length, screw diameter, and potential for implant prominence between 28 S2AI and 28 S1AI screw trajectories. RESULTS Patients had a mean age of 14.42 (range 8-21), coronal cobb angle of 85° (range 54-141), and pelvic obliquity of 28° (range 4-51). The maximum length and diameter of both screw trajectories were similar. S1AI screws were, on average, 6.3 ± 5 mm less prominent than S2AI screws relative to the iliac crests. S2AI screws were feasible in all patients, while in two patients, posterior elements of the lumbar spine would interfere with S1AI screw insertion. CONCLUSION In this cohort of patients with neuromuscular scoliosis, we demonstrate that the S1AI trajectory offers comparable screw length and diameter to an S2AI screw with less implant prominence. An S1AI screw, however, may not be feasible in some patients due to interference from the posterior elements of the lumbar spine.
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Affiliation(s)
- Xochitl M Bryson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Nicole S Pham
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Ian Hollyer
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Serena Hu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Lawrence A Rinsky
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - John S Vorhies
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA.
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29
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Kwak DS, Woo I, Lee JM, Hong E, Park CH. The effects of medial soft tissue release for varus deformity during medial open wedge supramalleolar osteotomy: a cadaveric study. Biomed Eng Lett 2024; 14:747-754. [PMID: 38946821 PMCID: PMC11208347 DOI: 10.1007/s13534-024-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 07/02/2024] Open
Abstract
This study was performed to investigate the effects of fibular osteotomy and release of medial soft tissues including posterior tibial tendon (PTT), and deep deltoid ligaments, which act as medial stabilizing structures in medial open wedge SMO. Twelve fresh frozen human legs were obtained and disarticulated below the knee. Experiments were conducted in four steps. First, medial open wedge tibial osteotomy was performed. Second, fibular osteotomy was performed in an inferomedial direction at the same level as the tibial osteotomy. Third, the deep deltoid ligament was released from tibial attachments. Forth, total tenotomy of the PTT was performed behind the medial malleolus. After finishing each step, contact area and peak and mean pressures were measured in the tibiotalar and talofibular joints. Fibular osteotomy after medial open wedge SMO significantly decreased mean pressure in the tibiotalar joint, mean and peak pressures in the talofibular joint. Medial soft tissue release resulted in a remarkable lateral shift and decreased tibiotalar joint loading. However, no remarkable change was observed in the tibiotalar joint during releasing medial soft tissues. The overall peak pressure distribution tended to shift more laterally compared to the value of normal alignment. In conclusion, concomitant fibular osteotomy and release of the deltoid ligament and PTT provide a useful means of minimizing tibiotalar joint stress. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-024-00370-7.
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Affiliation(s)
- Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591 Republic of Korea
| | - Inha Woo
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jung-Min Lee
- Industry-Academic Cooperation Foundation, Keimyung University, Daegu, 42601 Republic of Korea
| | - Eunah Hong
- Arthrex Korea, 20th fl. Parnas Tower 521, Teheran-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415 Republic of Korea
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Lo YS, Shi BL, Lin ETE, Yeh CW, Tsai CH, Chen HT, Zhu ZZ, Qiu Y. Assessing Neurological Complications in Thoracic Three-Column Osteotomy: A Clinical Application of a Novel MRI-Based Classification Approach. Spine (Phila Pa 1976) 2024; 49:950-955. [PMID: 38221840 DOI: 10.1097/brs.0000000000004924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE To investigate the occurrence of neurological complications in patients undergoing thoracic three-column osteotomy (3CO) utilizing an magnetic resonance imaging (MRI)-based classification that assesses spinal cord shape and the presence of cerebrospinal fluid at the curve apex and evaluate its prognostic capacity for postoperative neurological deficits. SUMMARY OF BACKGROUND DATA Recent advancements in correction techniques have improved outcomes for severe spinal deformity patients undergoing 3CO. A novel MRI-based spinal cord classification system was introduced, but its validation and association with postoperative complications remain unexplored. MATERIALS AND METHODS Between September 2012 and September 2018, a retrospective analysis was conducted on 158 adult patients with spinal deformities undergoing 3CO. Radiographic parameters were measured. T2-weighted axial MRI was used to describe spinal cord morphology at the apex. Intraoperative neurophysiological monitoring alerts were recorded, and preoperative and postoperative neurological functions were assessed using the Frankel score. Categorical data were compared using the χ 2 or the Fisher exact test. The paired t test was utilized to assess the mean difference between preoperative and postoperative measurements, while the one-way analysis of variance and independent t test were used for comparative analyses among the different spinal cord types. RESULTS Patients were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles of the main curve ( P <0.001). This disparity persisted both postoperatively and during follow-up ( P <0.05). Intraoperative neurophysiological monitoring alerts were triggered in 32 patients (20.3%), with a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 morphologies ( P <0.001). New neurological deficits were observed in 15 patients (9.5%), with 1, 3, and 11 cases in type 1, 2, and 3 morphologies, respectively. CONCLUSIONS Patients with type 3 morphology exhibited greater spinal deformity severity, a higher likelihood of preoperative neurological deficits, and an elevated risk of postoperative neurological complications. This underscores the utility of the classification as a tool for predicting postoperative neurological complications in patients undergoing thoracic 3CO. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Yuan-Shun Lo
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan
| | - Ben-Long Shi
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Erh-Ti Ernest Lin
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chen-Wei Yeh
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ze-Zhang Zhu
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Yong Qiu
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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Li Y, Liu H, Guo Y, Chen S, Canavese F, Liu Y, Li J, Xu H, Xia H. Factors influencing outcomes of pelvic osteotomy for residual acetabular dysplasia following closed reduction in patients with developmental dysplasia of the hip. J Pediatr Orthop B 2024; 33:340-347. [PMID: 37610089 DOI: 10.1097/bpb.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
To investigate the factors influencing outcome of pelvic osteotomy (PO) for residual acetabular dysplasia (RAD) following closed reduction (CR) in patients with developmental dysplasia of the hip (DDH). We retrospectively reviewed 91 patients (95 hips) with DDH who underwent PO for RAD. Tönnis grade, Acetabular index, Center Edge Angle, Reimer's Index (RI), and avascular necrosis of the femoral head (AVN) were assessed. Hips were divided into satisfactory (Severin I/II) and unsatisfactory group (Severin III/IV). Finally, 87 hips (91.5%) had satisfactory and 8 (8.5%) unsatisfactory outcomes. The RI before PO was significantly higher in unsatisfactory (49.6 ± 9%) than in satisfactory group (30.6%±11.8%). All patients without AVN had satisfactory outcome, while it was 78.9% of patients with AVN. Logistic regression analysis showed that higher AVN grade and RI before PO were risk factors for unsatisfactory outcome. Satisfactory outcome was obtained in all hips with RI < 33% before PO, while it was 79.5% if RI > 33% before PO (79.5%). There was no difference in the satisfactory rate between patients undergoing open reduction (66.7%) and those not undergoing (83.3%). The rate of satisfactory outcome in patients undergoing femoral osteotomy (63.6%) was lower than those without it (100%). In patients with RAD following CR, good outcome can be expected after PO alone. AVN and preoperative RI > 33% are risk factors for poor outcome. Additional open reduction and femoral osteotomy do not significantly improve outcome of PO in patients with preoperative RI > 33%.
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Affiliation(s)
- YiQiang Li
- The First Affiliated Hospital of Jinan University, Jinan University
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - Hang Liu
- Department of Pediatric Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing
| | - YueMing Guo
- Department of Pediatric Orthopaedics, FoShan Hospital of Traditional Chinese Medicine, Foshan
| | - ShunYou Chen
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, Xiamen University, Fuzhou, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
- Department of Pediatric Orthopedics, Jeanne de Flandre Hospital, Lille University Center, Lille, France
| | - YanHan Liu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - JingChun Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - HongWen Xu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - HuiMin Xia
- The First Affiliated Hospital of Jinan University, Jinan University
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
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Abd-Elsayed A, Matta AY, Nitz JN, Henjum LJ, Shiferaw BT, May R, Fiala KJ. Efficacy of Cooled-Radiofrequency Ablation of the Genicular Nerve as Treatment for Chronic Knee Pain: A Retrospective Study. Adv Ther 2024; 41:2859-2867. [PMID: 38802633 DOI: 10.1007/s12325-024-02892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Chronic pain is one of the leading causes of reduced quality of life in the USA, with knee pain commonly reported. Multiple therapeutic modalities are traditionally utilized for pain management; however, some patients may have pain refractory to these techniques. Cooled radiofrequency ablation (c-RFA) of the geniculate nerve is a growing and promising therapy offering a potentially long-term solution to chronic knee pain. METHODS This study assessed the efficacy, average duration of relief, and potential adverse events using a retrospective chart review of 406 procedures. A two-tailed paired t test was used to assess the statistical significance between pre-RFA vs. post-RFA visual analog scale (VAS) pain scores self-reported by patients. An analysis of variance (ANOVA) test was used to evaluate for statistical differences in pre-RFA pain scores and post-RFA pain scores among the categories of age, sex, body mass index (BMI), and diagnosis group. RESULTS The mean percent in pain improvement calculated was 65.5% with an average duration of relief of 7.20 months. The average pre-RFA pain score on the VAS was 6.26 out of 10 and 2.59 out of 10 post-RFA. The ANOVA post-RFA pain scores demonstrated statistically significant differences among the categories of age and sex. A total of 54 adverse events were reported, including worsening pain, numbness, paresthesia, and knee swelling. CONCLUSION The study demonstrated that c-RFA can potentially be utilized as an alternative safe therapy for chronic knee pain, providing pain relief with a relatively prolonged duration. Inherent challenges of retrospective studies remain a part of the limitations of this study.
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Affiliation(s)
- Alaa Abd-Elsayed
- Madison School of Medicine and Public Health, Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin, Madison, USA.
| | - Andrew Y Matta
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - James N Nitz
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Lukas J Henjum
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Barnabas T Shiferaw
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Raven May
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Kenneth J Fiala
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
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Odri GA, Yatim C, Yoon DJY, Bouche PA, Severyns M, Bizot P. Extra-articular hip resection with maintenance of pelvic continuity in malignant tumours of the proximal femur with articular invasion. Hip Int 2024; 34:537-545. [PMID: 38716792 DOI: 10.1177/11207000241249135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection. TECHNIQUE We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease. CONCLUSIONS Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.
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Affiliation(s)
- Guillaume-Anthony Odri
- Orthopaedics and Traumatology, CHU Lariboisière, Paris, France
- Inserm U1132 BIOSCAR, Université Paris Cité, Paris, France
| | - Cédric Yatim
- Orthopaedics and Traumatology, CHU Lariboisière, Paris, France
| | | | | | - Mathieu Severyns
- Orthopaedic Surgery, CHU de Martinique, Fort-de-France, Martinique
| | - Pascal Bizot
- Orthopaedics and Traumatology, CHU Lariboisière, Paris, France
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Odland K, Chanbour H, Zuckerman SL, Polly DW. Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2751-2762. [PMID: 38619634 DOI: 10.1007/s00586-024-08241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Despite modern fixation techniques, spinopelvic fixation failure (SPFF) after adult spinal deformity (ASD) surgery ranges from 4.5 to 38.0%, with approximately 50% requiring reoperation. Compared to other well-studied complications after ASD surgery, less is known about the incidence and predictors of SPFF. AIMS/OBJECTIVES Given the high rates of SPFF and reoperation needed to treat it, the purpose of this systematic review and meta-analysis was to report the incidence and failure mechanisms of SPF after ASD surgery. MATERIALS/METHODS The literature search was executed across four databases: Medline via PubMed and Ovid, SPORTDiscus via EBSCO, Cochrane Library via Wiley, and Scopus. Study inclusion criteria were patients undergoing ASD surgery with spinopelvic instrumentation, report rates of SPFF and type of failure mechanism, patients over 18 years of age, minimum 1-year follow-up, and cohort or case-control studies. From each study, we collected general demographic information (age, gender, and body mass index), primary/revision, type of ASD, and mode of failure (screw loosening, rod breakage, pseudarthrosis, screw failure, SI joint pain, screw protrusion, set plug dislodgment, and sacral fracture) and recorded the overall rate of SPF as well as failure rate for each type. For the assessment of failure rate, we required a minimum of 12 months follow-up with radiographic assessment. RESULTS Of 206 studies queried, 14 met inclusion criteria comprising 3570 ASD patients who underwent ASD surgery with pelvic instrumentation (mean age 65.5 ± 3.6 years). The mean SPFF rate was 22.1% (range 3-41%). Stratification for type of failure resulted in a mean SPFF rate of 23.3% for the pseudarthrosis group; 16.5% for the rod fracture group; 13.5% for the iliac screw loosening group; 7.3% for the SIJ pain group; 6.1% for the iliac screw group; 3.6% for the set plug dislodgement group; 1.1% for the sacral fracture group; and 1% for the iliac screw prominence group. CONCLUSION The aggregate rate of SPFF after ASD surgery is 22.1%. The most common mechanisms of failure were pseudarthrosis, rod fracture, and iliac screw loosening. Studies of SPFF remain heterogeneous, and a consistent definition of what constitutes SPFF is needed. This study may enable surgeons to provide patient specific constructs with pelvic fixation constructs to minimize this risk of failure.
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Affiliation(s)
- Kari Odland
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
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Getgood AMJ. Avoiding Graft Failure: Lessons Learned from the Stability Trial. Clin Sports Med 2024; 43:367-381. [PMID: 38811116 DOI: 10.1016/j.csm.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The Stability Study was a multicenter, pragmatic, parallel groups, randomized clinical trial comparing hamstring tendon autograft anterior cruciate ligament reconstruction with or without the addition of lateral extra-articular tenodesis in young patients at high risk of graft failure. Having recruited 618 patients with a 5% loss to follow up, we were able to demonstrate a clinically and statistically significant reduction in clinical failure and graft rupture at 2 years postoperative. No differences in patient-reported outcomes (PROs) were demonstrated between groups; however, patients who experienced an adverse event had significantly worse PROs than those who did not.
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Affiliation(s)
- Alan M J Getgood
- Western University, Fowler Kennedy Sport Medicine Clinic, 3M Centre, London, Ontario N6A 3K7, Canada.
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von Pfeil DJF, Tan D, Adams R, Glassman M. Outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning. Vet Surg 2024; 53:904-917. [PMID: 38741348 DOI: 10.1111/vsu.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/07/2024] [Accepted: 03/23/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To report the outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning (FGNMP). STUDY DESIGN Retrospective case series. ANIMALS A total of 15 client owned dogs and two cats with 57 metabone fractures. METHODS Description of FGNMP and reporting of the following data: signalment, pre- and postoperative radiographs, intramedullary pin diameter used, anesthesia, surgery and coaptation times, duration to normal weightbearing and bone union, postoperative care and complications. RESULTS Median surgery time was 54 min (range: 26-99), median duration of coaptation was 14 days (range: 1-5 weeks), median time to normal weightbearing was 16 days (range: 2-45) and median time to bone union was 6 weeks (range: 4-12). All cases had at least 12 months of post-surgical follow-up with a median follow-up of 18 months (range: 12-70). No major complications occurred. Mild radiographic changes associated with subchondral bone sclerosis were noted on follow-up radiographs in 13/57 fractures. All cases returned to normal gait and full (15) or acceptable (2) function. CONCLUSION In this study, FGNMP was an effective and safe technique for metabone fracture repair, requiring only short-term external coaptation in most patients. Time to bone union and return to normal function compared favorably to previously reported techniques. CLINICAL RELEVANCE Fluoroscopically guided normograde metabone pinning provides an alternative technique for treatment of metabone fractures.
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Affiliation(s)
| | - Desmond Tan
- Sirius Veterinary Orthopedic Center, Omaha, Nebraska, USA
| | | | - Mathieu Glassman
- Friendship Surgical Specialists of the Friendship Hospital for Animals, Washington, District of Columbia, USA
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Romandini I, Grassi A, Andrea Lucidi G, Filardo G, Zaffagnini S. 10-Year Survival and Clinical Improvement of Meniscal Allograft Transplantation in Early to Moderate Knee Osteoarthritis. Am J Sports Med 2024; 52:1997-2007. [PMID: 38857030 PMCID: PMC11264561 DOI: 10.1177/03635465241253849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/22/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Meniscal allograft transplantation (MAT) is a viable option for patients experiencing unicompartmental knee pain after total or subtotal meniscectomy. Nonetheless, caution is recommended when suggesting this procedure in the presence of knee osteoarthritis (OA) because of the higher risk of poor survival and outcomes. PURPOSE/HYPOTHESIS The purpose was to document the long-term survival of MAT performed as a salvage procedure in patients with knee OA. The hypothesis was that MAT would significantly reduce pain and increase the function of the affected joint at a long-term follow-up compared with the preoperative condition, with a low number of failures and knee replacement surgeries. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 47 patients (37 men and 10 women) with symptomatic knee OA (Kellgren-Lawrence grades 2 or 3) treated with MAT were evaluated at baseline, 5 years, and a minimum 10-year final follow-up (11.1 ± 1 years) using the Lysholm score, the visual analog scale for pain, the Knee injury and Osteoarthritis Outcome Score subscales, and the Tegner score. A total of 44 patients had undergone previous surgeries. Patient satisfaction, revision surgeries, and failures were also recorded. RESULTS A statistically significant improvement was observed in all clinical scores from the baseline assessment to the final follow-up. The Lysholm score improved significantly from 46.4 ± 17.2 at the preoperative assessment to 77.7 ± 20.4 at the intermediate follow-up (P < .001), with a significant decrease at the final follow-up (71 ± 23.3; P = .018). A similar trend was reported for the visual analog scale scale for pain, Knee injury and Osteoarthritis Outcome Score, and Tegner score, with no complete recovery to the previous sports activity level. A total of 33 patients required concurrent procedures, such as anterior cruciate ligament reconstructions, osteotomies, and cartilage procedures. Five patients underwent reoperation and were considered surgical failures, while 15 patients presented a clinical condition of <65 of the Lysholm score and were considered clinical failures. Among these, 4 patients were considered both surgical and clinical failures. CONCLUSION MAT surgery has proven to be a valid option for improving pain and function even in OA joints (Kellgren-Lawrence grades 2 or 3), yielding satisfactory results despite a worsening clinical outcome in the long-term follow-up. Therefore, based on the data from this study, orthopaedic surgeons may consider recommending MAT as a salvage procedure even in knees affected by early to moderate OA, while advising patients that the need for combined interventions could potentially reduce graft survival.
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Affiliation(s)
- Iacopo Romandini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Hoellwarth JS, Tetsworth K, Al Muderis M. Single-Stage Press-Fit Osseointegration of the Radius and Ulna for Rehabilitation After Trans-Forearm Amputation. JBJS Essent Surg Tech 2024; 14:e23.00015. [PMID: 38988477 PMCID: PMC11233105 DOI: 10.2106/jbjs.st.23.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background Upper limb (UL) amputation is disabling. ULs are necessary for many domains of life1, and few effective motor and sensory replacements are accessible2. Approximately 41,000 people in the United States have UL amputation proximal to the fingers3, two-thirds of (all) traumatic amputations are UL4, and 80% of UL amputations are performed for trauma-related etiologies5. Socket prosthesis (SP) abandonment remains high because of the lack of sensation, limited prosthesis control, perceived weight, and difficulty comfortably wearing the SP6. Transcutaneous osseointegration7,8 surgically inserts a bone-anchored implant, passed through a transcutaneous portal to attach a terminal device, improving amputee rehabilitation by reducing perceived weight, conferring osseoperception9, and increasing wear time10. Without the socket, all residual skin and musculature remain available for transcutaneous myoelectrodes. The present article describes single-stage radius and ulna press-fit osseointegration (PFOI) after trans-forearm amputation. Description This technique resembles a lower-extremity PFOI11,12. Importantly, at-risk nerves and vessels are different, and implant impaction must be gentler as a result. The surgery is indicated for patients who are dissatisfied with SP rehabilitation or declining alternative rehabilitative options, and who are motivated and enabled to procure, train with, and utilize a forearm prosthesis. An engaged prosthetist is critical. Surgical steps are exposure, bone-end and canal preparation, first implant insertion (in the operative video shown, in the radius), purse-string muscle closure, confirmation that radius-ulna motion remains, performing the prior steps for the other bone (in the video, the ulna), and closure (including potential nerve reconstruction, soft-tissue contouring, and portal creation). Although the patient in the operative video did not require nerve procedures to address pain or to create targets for transcutaneous myoelectrodes, targeted muscle reinnervation or a regenerative peripheral nerve interface procedure could be performed following exposure. Alternatives Alternatives include socket modification, bone lengthening and/or soft-tissue contouring13, Krukenberg-type reconstructions14, or accepting the situation. An alternative implant is a screw-type osseointegration implant. Our preference for press-fit implants is based on considerations such as our practice's 12-year history of >1,000 PFOI surgeries; that the screw-type implant requires sufficient cortical thickness for the threads15, which is compromised in some patients; the lower cost per implant; that the procedure is performed in 1 instead of 2 surgical episodes15,16; and the documented suitability of press-fit implants for patients with challenging anatomy or comorbidities17-19. Rationale PFOI can be provided for amputees having difficulty with socket wear. PFOI usually provides superior prosthesis stability, which can confer better prosthesis control versus nonoperative and other operative options in patients expressing dissatisfaction for reasons such as those mentioned above, or for poor fit, compromised energy transfer, skin pinching, compression, and abrasions. For patients who want myoelectric control of their prosthesis but who are unable because the optimal myoelectric location is obstructed by the socket, osseointegration may provide access for the electrodes by eliminating the socket. Expected Outcomes Only 3 trans-forearm osseointegration20-22 publications totaling 10 limbs could be identified, limiting the ability to determine generalizable outcomes. Osseointegrated prostheses, being skeletally anchored, feel lighter to patients than SPs, which should confer better outcomes. In 1 patient, multiple implant fractures and infection prompted additional surgeries. Periprosthetic bone fractures and non-infectious loosening have not been documented for UL osseointegration. Important Tips Osseointegration eliminates the socket, relieving socket-based pain. However, neurogenic pain relief requires specific nerve procedures.Osseointegration provides a prosthesis connection. Nerve- or muscle-based prosthesis control requires separate, potentially integrated planning.Osseointegrated prostheses confer osseoperception (i.e., mechanical force transmission), not "normal" skin-mediated afferent sensation (i.e., light touch, temperature, pain) or native proprioception.Prostheses must be individualized to the patient's elbow flexion and radioulnar rotation. An attentive prosthetist must be ensured preoperatively.Achieving the demonstrated outcomes requires more therapy and retraining than walking with an osseointegrated lower-extremity prosthesis. Patients must expect at least several months of spending multiple hours daily engaging in self-directed rehabilitation.Prosthesis utilization decision aids23 may minimize non-beneficial surgeries. Acronyms and Abbreviations UL = upper limbSP = socket prosthesisPFOI = press-fit osseointegrationperi-pros fx = periprosthetic fractureMRI = magnetic resonance imagingCT = computed tomography.
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Affiliation(s)
- Jason S. Hoellwarth
- Osseointegration Limb Replacement Center, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Munjed Al Muderis
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
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Polly D, Mundis G, Eastlack R, Leveque JC, Elder BD, Martin C, Kent R, Snowden R, Kim HJ, Sembrano J, Herzog J, Lieberman I, Matheus V, Buchholz A, Franke J, Lee R, Shaffrey C. Randomized Trial of Augmented Pelvic Fixation in Patients Undergoing Thoracolumbar Fusion for Adult Spine Deformity: Initial Results from a Multicenter Randomized Trial. World Neurosurg 2024; 187:e15-e27. [PMID: 38310950 DOI: 10.1016/j.wneu.2024.01.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND The optimal configuration for spinopelvic fixation during multilevel spine fusion surgery for adult spine deformity remains unclear. Postoperative sacroiliac (SI) joint pain, S2AI screw loosening and implant breakage could be related to continued motion of the SI joint with use of only a single point of fixation across the SI joint. METHODS Prospective, international, multicenter randomized controlled trial of 222 patients with adult spine deformity scheduled for multilevel (4 or more levels) spine fusion surgery with pelvic fixation. Subjects were randomized to sacroalar (S2) iliac (S2AI) screws alone for pelvic fixation or S2AI + triangular titanium implants placed cephalad to S2AI screws. Quad rod techniques were not allowed or used. Baseline spinal deformity measures were read by an independent radiologist. Site-reported perioperative adverse events were reviewed by a clinical events committee. Quality of life questionnaires and other clinical outcomes are in process with planned 2-year follow-up. RESULTS One hundred thirteen participants were assigned to S2AI and 109 to S2AI + titanium triangular implants (TTI). 35/222 (16%) of all subjects had a history of SI joint pain or were diagnosed with SI joint pain during preoperative workup. Three-month follow-up was available in all but 4 subjects. TTI placement was successful in 106 of 109 (98%) subjects assigned to TTI. In 2 cases, TTI could not be placed due to anatomical considerations. Three TTI ventral iliac breaches were observed, all of which were managed non-surgically. One TTI subject had a transverse sacral fracture and 1 TTI subject had malposition of the implant requiring removal. CONCLUSIONS SI joint pain is common in patients with adult spinal deformity who are candidates for multilevel spine fusion surgery. Concurrent placement of TTI parallel to S2AI screws during multilevel spine fusion surgery is feasible and safe. Further follow-up will help to determine the clinical value of this approach to augment pelvic fixation.
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Affiliation(s)
- David Polly
- University of Minnesota, Minneapolis, Minnesota, USA.
| | - Greg Mundis
- San Diego Spine Foundation, San Diego, California, USA
| | | | | | | | | | - Roland Kent
- Axis Spine Center, Coeur D'Alene, Idaho, USA
| | - Ryan Snowden
- Tennessee Orthopaedics Associates, Nashville, Tennessee, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | | | - Robert Lee
- Royal National Orthopaedic Hospital, Stanmore, UK
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Reutersberg B, Wolk S, Knappich C, Busch A. [Ischemia-related compartment syndromes in vascular surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:513-519. [PMID: 38634918 DOI: 10.1007/s00104-024-02080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
Even after the endovascular revolution, acute compartment syndrome (CS) remains an important and frequently present differential diagnosis after many operations. Based on a qualitative review this article gives an overview of the most frequent forms of CS as well as some less frequent entities that require attention in the routine clinical practice. Additionally, the pathophysiology, diagnostics and treatment as well as current research topics for CS, especially concerning the lower leg, are dealt with in detail. In summary, nothing has essentially changed ever since the first description of CS in that the clinical estimation remains the gold standard. The detection and the adequate treatment especially of abdominal CS and CS of the lower leg remain a key competence of vascular surgeons.
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Affiliation(s)
| | - Steffen Wolk
- Bereich Gefäßchirurgie, Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Medizinische Fakultät Carl Gustav Carus und Universitätsklinikum, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Christoph Knappich
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Münchner Aorten Centrum (MAC), Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Albert Busch
- Bereich Gefäßchirurgie, Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Medizinische Fakultät Carl Gustav Carus und Universitätsklinikum, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Shaty W. Dega Osteotomy for the Treatment of Developmental Dysplasia of the Hip, a Clinical Evaluation and an Anatomic Study based on X-ray and CT Scan. Orthop Rev (Pavia) 2024; 16:120304. [PMID: 38957743 PMCID: PMC11218868 DOI: 10.52965/001c.120304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
Background Dega osteotomy is becoming more widely used for the treatment of developmental dysplasia of the hip (DDH). Objective A thorough description of this procedure is needed as many of the technical aspects are not fully defined. Moreover, more follow-up series are also needed to evaluate its outcomes. Methods In this study, we gave a detailed anatomic description for this procedure and also presented our experience as a retrospective radiographic and case-note study. We examined the clinical and radiographic records of 44 patients (48 hips) with varying degrees of DDH. Results The average age of the patients was 2 months and 7 months while the average follow up period was 41 months. Clinical and radiographic assessment including CT with 3D reconstruction to examine the anatomic characteristics of the osteotomy were undertaken. We found that concentric reduction was achieved in 93.7% with excellent clinical and radiographic outcomes. Only 3 cases needed revision of the Dega osteotomy. The re-operation rate was 12.5%. CT scan revealed that the arcuate line was crossed by the osteotomy in the majority of cases. In 20.7% of cases, a bone cut that was intended to be a Dega osteotomy was found to have been inadvertently implemented as another osteotomy variant. However, this bore no significant effect on the outcome. Conclusion We found that a well-implemented Dega osteotomy is a reliable tool to cope with the acetabular changes in DDH.
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Affiliation(s)
- Wahby Shaty
- Department of Surgery, College of Medicine University of Thi Qar, Iraq
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Wang D, Gu S, Shen H, Li T, Yin E, Wang X, Gao W, Liao Y. The therapeutic value of vacuum external fixation in polytrauma patients with multiple ribs fracture. Postgrad Med J 2024; 100:496-503. [PMID: 38366645 DOI: 10.1093/postmj/qgae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Multiple displaced rib fractures often result in a poor prognosis. Open reduction and internal fixation has been shown to provide benefits for patients with displaced rib fractures and flail chest. Nevertheless, for patients who are unwilling or unsuitable for surgery, the therapeutic options are limited. We developed a novel plastic vacuum device for rib fractures external stabilization. This study aims to compare the therapeutic efficacy of this device against a traditional chest strap in polytrauma patients with multiple rib fractures. METHODS A retrospective investigation was conducted on polytrauma patients with multiple rib fractures admitted to our trauma center between March 2020 and March 2023. Patients were categorized into two groups: vacuum external fixation and chest strap. Comparative analysis was conducted on baseline parameters, injury characteristics, and clinical outcomes between the two groups. RESULTS In this study, 54 patients were included, with 28 receiving chest strap and 26 undergoing vacuum external fixation. Results showed that, at 3 days and 7 days postintervention, the vacuum external fixation group had significantly lower visual analog scale scores during deep breathing and coughing (P < .05). Vacuum external fixation also reduced pleural drainage duration and volume, as well as lowered the risk of pneumonia and other complications (P < .05). Furthermore, the vacuum external fixation group demonstrated notable improvements in vital capacity, tidal volume, blood-gas test results, and a shorter hospital length of stay. CONCLUSIONS According to the study findings, vacuum external fixation appears to offer benefits to patients with multiple rib fractures, potentially reducing the risk of complications and improving overall clinical outcomes.
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Affiliation(s)
- Dongfang Wang
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Shuaipeng Gu
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Huaqing Shen
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Tonghan Li
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Enzhi Yin
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Xiang Wang
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Wei Gao
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Yiliu Liao
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
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Peez C, Hägerich LM, Ruhl F, Klimek M, Briese T, Glasbrenner J, Deichsel A, Raschke MJ, Kittl C, Herbst E. Collateral ligament strain is linearly related to coronal lower limb alignment: A biomechanical study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38932622 DOI: 10.1002/ksa.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/07/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to analyse the influence of coronal lower limb alignment on collateral ligament strain. METHODS Twelve fresh-frozen human cadaveric knees were used. Long-leg standing radiographs were obtained to assess lower limb alignment. Specimens were axially loaded in a custom-made kinematics rig with 200 and 400 N, and dynamic varus/valgus angulation was simulated in 0°, 30°, and 60° of knee flexion. The changes in varus/valgus angulation and strain within different fibre regions of the collateral ligaments were captured using a three-dimensional optical measuring system to examine the axis-dependent strain behaviour of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) at intervals of 2°. RESULTS The LCL and sMCL were exposed to the highest strain values at full extension (p < 0.001). Regardless of flexion angle and extent of axial loading, the ligament strain showed a strong and linear association with varus (all Pearson's r ≥ 0.98; p < 0.001) and valgus angulation (all Pearson's r ≥ -0.97; p < 0.01). At full extension and 400 N of axial loading, the anterior and posterior LCL fibres exceeded 4% ligament strain at 3.9° and 4.0° of varus, while the sMCL showed corresponding strain values of more than 4% at a valgus angle of 6.8°, 5.4° and 4.9° for its anterior, middle and posterior fibres, respectively. CONCLUSION The strain within the native LCL and sMCL was linearly related to coronal lower limb alignment. Strain levels associated with potential ultrastructural damages to the ligaments of more than 4% were observed at 4° of varus and about 5° of valgus malalignment, respectively. When reconstructing the collateral ligaments, an additional realigning osteotomy should be considered in cases of chronic instability with a coronal malalignment exceeding 4°-5° to protect the graft and potentially reduce failures. LEVEL OF EVIDENCE There is no level of evidence as this study was an experimental laboratory study.
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Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Luise Maria Hägerich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Felix Ruhl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Helito CP, da Silva AGM, Gobbi RG, Pécora JR. Recovery of Full Hyperextension after ACL Reconstruction Is Associated with Better Functional Outcomes but Greater ACL-Related Laxity after a minimum of 24 months follow up. Arthroscopy 2024:S0749-8063(24)00450-X. [PMID: 38944322 DOI: 10.1016/j.arthro.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE Evaluate patients submitted to anterior cruciate ligament (ACL) reconstruction with preoperative hyperextension and compare physical examination (KT-1000 and pivot shift) and patient reported outcomes measures of patients who recovered the entire hyperextension with patients who did not. METHODS Patients aged 18 to 60 years with more than 5 degrees of knee hyperextension submitted to anatomical ACL reconstruction with any graft from June 2013 to June 2021 and at least 24 months of follow-up were evaluated retrospectively. Hamstrings and patellar tendon grafts were fixed around 20 to 30 degrees of flexion and in full extension, respectively. Patients who could recover hyperextension were compared with patients who did not. Pre-operative, intra-operative and post-operative data, including physical examination and patient reported outcomes measures, was evaluated. RESULTS A total of 225 patients were evaluated, 48 (21.3%) did not recover hyperextension, and 177 recovered full range of motion. Patients who did not recover hyperextension had a larger graft diameter (8.7 ± 0.7mm (confidence interval 8.502-8.898) vs. 8.3 ± 0.7mm (confidence interval 8.197-8.403); p = 0.018). Regarding the postoperative subjective variables, patients who recovered hyperextension showed improvement on all scales (IKDC, Lysholm, FJS, and GPE) evaluated compared to patients who did not recover the range of motion. Patients who recovered hyperextension also showed more laxity on physical examination, measured by the KT-1000 (1.8 ± 0.8 vs. 1.1 ± 1.0; p= 0.0006) and the pivot-shift (Grade 0 - 62.1%;Grade 1 - 37.9% vs. Grade 0 - 79.2%;Grade 1 - 20.8%; p=0.027). CONCLUSION Patients with knee hyperextension who regained range of motion after ACL reconstruction have worse knee laxity than patients who regained full extension but not hyperextension. However, patients who recover full range of motion showed higher scores on subjective function scales, including a greater number of patients who achieved PASS IKDC.
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Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Hospital Sírio Libanês, São Paulo, SP, Brazil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; HCor Hospital do Coração, São Paulo, SP, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Fisher ND, Solasz S, Martel D, Chang G, Egol KA. Quadriceps muscle quality and quantity following tibial plateau fracture repair. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04002-9. [PMID: 38922405 DOI: 10.1007/s00590-024-04002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/13/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To investigate the qualitative and quantitative changes seen in quadriceps muscles [QM] following tibial plateau fracture and surgery. METHODS A consecutive series of patients with an isolated tibial plateau fracture presenting to a single academic center were enrolled and prospectively followed. Bilateral knee MRIs were performed preoperatively and 3 and 12 months postoperatively to assess quantity and quality of the quadriceps muscles. All patients underwent tibial plateau operative repair and were made non-weight-bearing for 10 weeks postoperatively then advanced to weight-bearing as tolerated. Functional status assessed via the short musculoskeletal functional assessment (SMFA); knee range of motion [ROM]; vastus medialis oblique [VMO] and vastus lateralis [VL] muscle quantity (axial width, cross sectional area [CSA] and volume) on injured and contralateral limb; VMO, sartorius, semi-membranous and biceps femoris [BF] muscle quality (fat and water content, and proton density fat fraction). All muscle quantitative and qualitative measurements were compared across all time points. RESULTS Ten patients were included in the final analysis, 6 males and 4 females, with average age of 43.62 ± 16.3 years. While the VMO and VL axial width and CSA were significantly decreased at 3 months preoperatively, this was not statistically significant. There was no significant difference between any QM quantitative measurements at any time points. There was no difference in fat content, water content or PDFF at any time point for the VMO, sartorius, semi-membranous and BF muscles. Regression analysis also showed no association between 12-month SMFA scores and knee ROM with VMO/VL CSA at 1 year. CONCLUSIONS QM quantity and quality do not significantly change at 3 months and 1 year postoperatively following tibial plateau fracture surgery. LEVEL OF EVIDENCE Prognostic Level II.
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Affiliation(s)
- Nina D Fisher
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| | - Sara Solasz
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| | - Dimitri Martel
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| | - Gregory Chang
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| | - Kenneth A Egol
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA.
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McCormick KL, Mastroianni MA, Kolodychuk NL, Herndon CL, Shah RP, Cooper HJ, Sarpong NO. Complications and Survivorship After Aseptic Revision Total Hip Arthroplasty: Is There a Difference by Surgical Approach? J Arthroplasty 2024:S0883-5403(24)00651-X. [PMID: 38936438 DOI: 10.1016/j.arth.2024.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) has traditionally been performed through the posterolateral approach (PA). Anterior approaches (AA) for rTHA are increasingly being utilized. The purpose of this study was to compare complications and survivorship from re-revision and reoperation after aseptic rTHA performed using an AA versus a PA. METHODS We retrospectively reviewed patients who underwent aseptic rTHA either through an AA (direct anterior approach [DAA], anterior-based muscle sparing [ABMS]) or PA from January 2017 to December 2021. There were 116 patients who underwent AA-rTHA (DAA 50, ABMS 66) or PA-rTHA (n = 105). Patient demographics, complications, and postoperative outcomes were collected. RESULTS The most common indication in both groups was aseptic loosening (n = 26, 22.4% AA, n = 28, 26.7% PA). Acetabular revision alone was most common in the AA group (n = 33, 28.4%), while both components were most commonly revised in the PA groups (n = 47, 44.8%). In all the AA-rTHA group, the index total hip arthroplasty was performed through a PA in 51% of patients, while the PA-rTHA group had the index procedure performed via AA in 4.8%. There was no statistically significant difference in re-revision rate between the DAA, ABMS, or PA groups (9.55 versus 5.3% versus 11.4%, respectively, P = .11). The most common overall reason for re-revision was persistent instability, with no difference in incidence of postoperative hip dislocation (n = 4, 6.8% DAA, n = 3, 5.3%, n = 10, 9.5% PA; P = .31). CONCLUSIONS This study demonstrates no difference in complication or re-revision survivorship after aseptic rTHA performed through a DAA, ABMS approach, or PA, nor between anterior or posterior-based approaches. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Michael A Mastroianni
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nicholas L Kolodychuk
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Khabyeh-Hasbani N, Hoffman AF, Meisel E, Behbahani M, Koehler SM. Glenohumeral Dysplasia Following Brachial Plexus Birth Injuries: A Review. Neurosurgery 2024:00006123-990000000-01238. [PMID: 38916346 DOI: 10.1227/neu.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/01/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the high morbidity associated with glenohumeral dysplasia (GHD) in children with brachial plexus birth injuries, the progression of this condition often remains unnoticed, even after correcting for the underlying brachial plexus birth injuries. GHD, driven by a multifactorial process involving disruptions in both direct and indirect neural regulation of bony and muscular structures, can lead to intermittent or permanent shoulder mobility imbalances, significantly impacting the quality of life of those affected. Recent research efforts are increasingly directed toward identifying the root causes, managing the deformity, and determining effective treatment options for correcting GHD. METHODS A comprehensive search strategy was used by the authors to identify relevant literature relating to the progression, pathoanatomy, clinical presentation, and management of GHD following brachial plexus birth injuries across various search engines, such as PubMed, Scopus, and Embase. Considering the topic's interdisciplinary nature, articles were retrieved from both neurosurgical and orthopaedic journals to enrich the review. RESULTS Given the challenges in managing patients with brachial plexus birth injuries, a multidisciplinary care team consisting of certified occupational hand therapists, neurosurgeons, plastic surgeons, and orthopedic surgeons, specializing in brachial plexus injuries should be advocated for. The aim of this collaborative effort is to correct brachial plexus birth injuries and prevent the persistence of GHD. CONCLUSION As research continues to focus on understanding the complexities of this condition, the aim of this review article is to summarize the current literature on the course of brachial plexus birth injury and the development of GHD. By doing so, we hope to provide neurosurgeons with the necessary knowledge and essential tools needed to identify and effectively treat GHD during management of brachial plexus birth injuries.
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Affiliation(s)
| | - Alexandra F Hoffman
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Erin Meisel
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mandana Behbahani
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Steven M Koehler
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
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Hernández Mateo JM, Flores Gallardo J, Riquelme García O, García Martín A, Igualada Blázquez C, Solans López MC, Muñoz Núñez L, Esparragoza Cabrera LA. Deformity correction from the convexity of the curve in neuromuscular scoliosis. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:224-231. [PMID: 38974489 PMCID: PMC11224787 DOI: 10.21037/jss-23-128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/23/2024] [Indexed: 07/09/2024]
Abstract
Background "Convex Pedicle Screw Technique" reduces the theoretical risk of neurovascular injury. Our aim is to evaluate the efficacy of this technique in patients with neuromuscular scoliosis (NMS). Methods Retrospective study of 12 patients who underwent a Convex Pedicle Screw Technique and were diagnosed with NMS. Patients who had undergone previous spinal surgery were excluded. The minimum follow-up required was 24 months. Demographic data, intraoperative data, neurovascular complications and neurophysiological events requiring implant repositioning, as well as pre- and postoperative radiological variables were collected. Results Twelve patients diagnosed with NMS underwent surgery. The median operative time was 217 minutes. Mean blood loss was 3.8±1.1 g/dL hemoglobin (Hb). The median postoperative stay was 8.8±4 days. A reduction of the Cobb angle in primary curve of 49.1% (from 52.8°±18° to 26.5°±12.6°; P<0.001) and in secondary curve of 25.2% (from 27.8°±18.9° to 18.3°±13.3°; P=0.10) was achieved. Coronal balance improved by 69.4% (7.5±46.2 vs. 2.3±20.9 mm; P=0.72) and sagittal balance by 75% (from -14.1±71.8 vs. -3.5±48.6 mm; P=0.50). There were no neurovascular complications. There were no intraoperative neurophysiological events requiring implant repositioning, nor during reduction maneuvers. No infections were reported. Conclusions The correction of the deformity from convexity in NMS achieves similar results to other techniques, and a very low complication rate.
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Affiliation(s)
- José María Hernández Mateo
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Jaime Flores Gallardo
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Oscar Riquelme García
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
- Department of Spine Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Azucena García Martín
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
- Department of Spine Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Cristina Igualada Blázquez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
- Department of Spine Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - María Coro Solans López
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
- Department of Spine Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Laura Muñoz Núñez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
- Department of Spine Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Luis Alejandro Esparragoza Cabrera
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
- Department of Spine Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
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Su J, Jin H, Chen S, Sun X, Gao S, Huang Z, Yang S, Deng Z. Anterior shoulder dislocation: A bibliometric analysis in the past two decades (2003-2022). Heliyon 2024; 10:e32488. [PMID: 38961893 PMCID: PMC11219497 DOI: 10.1016/j.heliyon.2024.e32488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/19/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Background Anterior shoulder dislocation is the most common type of shoulder dislocation and is easy to develop into recurrent type, causing economic burden to society. This study uses the bibliometric method to analyze the global research status, hotspots and trends of anterior shoulder dislocation, aiming to promote the exploration of anterior shoulder dislocation. Methods The literature on anterior shoulder dislocation in the past two decades were retrieved and downloaded from the Web of Science Core Collection (WOSCC) database. CiteSpace, VOSviewer and bibliometrix package of R software were used to conduct scientific bibliometric analysis of the literature. Finally, some statistical graphics were performed in Graphpad Prism. Results A total of 3914 publications related to anterior shoulder dislocation from 2003 to 2022 were retrieved and screened from the WOSCC database. The ranking of the analysis results showed that Provencher MT was the author with the highest frequency of occurrence. Rush University was the most notable contributor. The American Journal of Sports Medicine was the most comprehensive journal. The United States was the most prominent country. Keywords related to surgical treatment were more significant than others. Conclusion In the past two decades, the research output on anterior shoulder dislocation have been increasing year by year. The focus has gradually shifted to surgical treatment. Surgical treatment may continue to be the research hotspots in this field in the future.
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Affiliation(s)
- Jingyue Su
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, 530001, China
| | - Hongfu Jin
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Siyu Chen
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, 530001, China
| | - Xuying Sun
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Shanshan Gao
- Department of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, 800045, CO, USA
| | - Zhengxiang Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Shengwu Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Zhenhan Deng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, 530001, China
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Fradet J, Lopes R. Endoscopic calcaneal SpeedBridge technique: Decreased postoperative complication rate in insertional achilles tendinopathy. Orthop Traumatol Surg Res 2024:103916. [PMID: 38885739 DOI: 10.1016/j.otsr.2024.103916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 06/20/2024]
Abstract
BACKGROUND An endoscopic calcaneal SpeedBridge technique was described recently. The primary objective of this study was to report the postoperative complications seen with calcaneal SpeedBridge repair. The secondary objective was to report short- and medium-term functional outcomes. HYPOTHESIS Postoperative complications are less common with endoscopic vs. open SpeedBridge suturing. MATERIAL AND METHODS The endoscopic SpeedBridge technique was used in 9 patients who had insertional Achilles tendinopathy refractory to conservative management. The patients were evaluated at least 24 months after the procedure. Infectious and wound-healing complications were recorded. Visual analogue scale (VAS) scores for pain and patient satisfaction, shoeing difficulties, the European Foot and Ankle Society (EFAS) score, and the Victorian Institute of Sport Assessment-Achilles (VISA-A) score were assessed. RESULTS During the mean follow-up of 25.3 months, no complications were recorded. The EFAS and VISA-A scores were 37/40 and 91/100, respectively. The mean VAS scores for pain and satisfaction were 1.7/10 and 9.3/10, respectively. No patients reported shoeing difficulties. CONCLUSION Endoscopic calcaneal SpeedBridge suturing is associated with a lower complication rate compared to the open variant. Clinical outcomes are highly satisfactory in the short and middle terms. LEVEL OF EVIDENCE IV; retrospective observational cohort study.
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Affiliation(s)
- Juliette Fradet
- Pied cheville Nantes Atlantique, Santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France; Polyclinique de Poitiers (ELSAN), 1, rue de la Providence, 86000 Poitiers, France.
| | - Ronny Lopes
- Clinique Brétéché, 3, rue de la Béraudière, BP 54613, 44046 Nantes cedex 1, France; Centre orthopédique Santy, unité cheville pied, 359, avenue Jean Jaurès, 69007 Lyon, France
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