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Helito CP, Moreira da Silva AG, Gomes Gobbi R, Pécora JR. Recovery of Full Hyperextension After Anterior Cruciate Ligament Reconstruction Is Associated With Better Functional Outcomes but Greater Anterior Cruciate Ligament-Related Laxity After a Minimum 24-Month 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] [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 To evaluate patients who had anterior cruciate ligament (ACL) reconstruction with preoperative hyperextension and compare physical examination (KT-1000 and pivot shift) and patient-reported outcome measures of patients who recovered the entire hyperextension with patients who did not. METHODS Patients aged 18 to 60 years with more than 5° of knee hyperextension who had anatomic ACL reconstruction with any graft from June 2013 to June 2021 and at least a 24-month follow-up were evaluated retrospectively. Hamstrings and patellar tendon grafts were fixed around 20° to 30° of flexion and in full extension, respectively. Patients who could recover hyperextension were compared with patients who did not. Preoperative, intraoperative, and postoperative data, including physical examination and patient-reported outcome measures, were evaluated. RESULTS Of the 225 patients 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 ± 0.7 mm [confidence interval, 8.502-8.898 mm] vs 8.3 ± 0.7 mm [confidence interval, 8.197-8.403 mm]; P = .018). Regarding the postoperative subjective variables, patients who recovered hyperextension showed improvement on all scales (International Knee Documentation Committee, Lysholm, Forgotten Joint Score, and Global Perceived Effect) evaluated compared with 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 = .0006) and the pivot shift (62.1% [grade 0] and 37.9% [grade 1] vs 79.2% [grade 0] and 20.8% [grade 1]; P = .027). CONCLUSIONS 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 patient acceptable symptom state for the International Knee Documentation Committee score. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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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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Hess-Arcelay H, Claudio-Marcano A, Torres-Lugo NJ, Deliz-Jimenez D, Acosta-Julbe J, Hernandez G, Deliz-Jimenez D, Monge G, Ramírez N, Lojo-Sojo L. Opioid-Sparing Nonsteroid Anti-inflammatory Drugs Protocol in Patients Undergoing Intramedullary Nailing of Tibial Shaft Fractures: A Randomized Control Trial. J Am Acad Orthop Surg 2024; 32:e596-e604. [PMID: 38579315 DOI: 10.5435/jaaos-d-23-01014] [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: 10/26/2023] [Accepted: 02/18/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective analgesics commonly used in fracture management. Although previously associated with delayed fracture healing, multiple studies have demonstrated their safety, with minimal risks of fracture healing. Given the current opioid crisis in the United States, alternate pain control modalities are essential to reduce opioid consumption. This study aims to determine whether the combination of oral acetaminophen and intravenous ketorolac is a viable alternative to opioid-based pain management in closed tibial shaft fractures treated with intramedullary nailing. METHODS We conducted a randomized controlled trial evaluating postoperative pain control and opioid consumption in patients with closed tibial shaft fractures who underwent intramedullary nailing. Patients were randomized into an NSAID-based pain control group (52 patients) and an opioid-based pain control group (44 patients). Visual analog scale (VAS) scores and morphine milligram equivalents (MMEs) were evaluated at 12-hour postoperative intervals during the first 48 hours after surgery. Nonunion and delayed healing rates were recorded for both groups. RESULTS A statistically significant decrease in MMEs was noted at every measured interval (12, 24, 36, and 48 hours) in the NSAID group compared with the opioid group ( P -value 0.001, 0.001, 0.040, 0.024, respectively). No significant change in visual analog scale scores was observed at 12, 36, and 48 hours between both groups ( P -value 0.215, 0.12, and 0.083, respectively). A significant decrease in VAS scores was observed at the 24-hour interval in the NSAID group compared with the opioid group ( P -value 0.041). No significant differences in union rates were observed between groups ( P -value 0.820). DISCUSSION Using an NSAID-based postoperative pain protocol led to a decrease in opioid consumption without affecting pain scores or union rates. Owing to the minimal risk of short-term NSAID use, their role in the perioperative management of tibia shaft fractures is justified, especially when they reduce opioid consumption markedly. LEVEL OF EVIDENCE Therapeutic Level I.
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Affiliation(s)
- Hans Hess-Arcelay
- From the Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR (Hess-Arcelay, Claudio-Marcano, Torres-Lugo, Deliz-Jimenez, Lojo-Sojo), the School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR (Acosta-Julbe, Deliz-Jimenez), the Department of General Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR (Hernandez), the Oncologic Hospital Dr. Isaac Gonzalez Martinez, San Juan, PR (Monge), and the Department of Orthopaedic Surgery, Mayaguëz Medical Center, Mayaguëz, PR (Ramirez)
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宋 庆, 邵 振, 崔 国. [Research progress of Chinese unique Inlay Bristow (Cuistow surgery) using suture button fixation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:641-645. [PMID: 38918181 PMCID: PMC11190678 DOI: 10.7507/1002-1892.202403134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/23/2024] [Indexed: 06/27/2024]
Abstract
Objective To explore the research progress of the coracoid transfer surgery using suture button fixation, particularly focusing on the technique known as Chinese unique Inlay Bristow (Cuistow surgery). Methods Extensive literature review was conducted to summarize and analyze the utilization of suture button fixation in the Cuistow surgery, comparing its biomechanical and clinical outcomes with those of traditional screw fixation. Results Utilizing suture button fixation in coracoid transfer surgery helps circumvent certain metal-related complications associated with traditional screw fixation. While its biomechanical stability and effectiveness have been preliminarily confirmed, debates persist regarding its graft healing rate and postoperative recurrence rate compared to traditional screw fixation. The Cuistow surgery based on the Inlay structure is a solution to improve the healing rate of graft after suture button fixation. Conclusion Suture button fixation, as a novel approach in coracoid transfer surgery, remains to have its advantages and disadvantages compared to traditional screw fixation not entirely elucidated, underscoring the need for further in-depth clinical and fundamental research. Cuistow surgery is the Chinese experience of coracoid transfer surgery, and its biomechanical stability and clinical advantages have been preliminarily confirmed.
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Affiliation(s)
- 庆法 宋
- 北京大学第三医院运动医学科 北京大学运动医学研究所 运动医学关节伤病北京市重点实验室 运动创伤治疗技术与器械教育部工程研究中心(北京 100191)Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - 振兴 邵
- 北京大学第三医院运动医学科 北京大学运动医学研究所 运动医学关节伤病北京市重点实验室 运动创伤治疗技术与器械教育部工程研究中心(北京 100191)Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - 国庆 崔
- 北京大学第三医院运动医学科 北京大学运动医学研究所 运动医学关节伤病北京市重点实验室 运动创伤治疗技术与器械教育部工程研究中心(北京 100191)Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
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Hartman TJ, Nie JW, Khosla I, Oyetayo OO, MacGregor KR, Zheng E, Anwar FN, Roca AM, Loya AC, Medakkar SS, Federico VP, Massel DH, Sayari AJ, Lopez GD, Singh K. Cervical Disk Replacement Versus Anterior Cervical Diskectomy and Fusion: Effect of Procedural Variant on Patients With a Prolonged Preoperative Duration of Symptoms From Disk Herniation. J Am Acad Orthop Surg 2024; 32:558-562. [PMID: 38696821 DOI: 10.5435/jaaos-d-23-00655] [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: 07/25/2023] [Accepted: 02/17/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Patients with a prolonged preoperative symptom duration (PSD) in the setting of cervical disk herniation (DH) may suffer inferior outcomes after surgical intervention. Comparison between anterior cervical diskectomy and fusion (ACDF) versus cervical disk arthroplasty (CDA) in this at-risk population has not yet been conducted. METHODS Patients undergoing ACDF or CDA for DH with a PSD > 180 days were selected. Six-week (6W) and final follow-up (FF) patient-reported outcome measures (PROMs) as well as magnitude of postoperative improvements (∆PROM) were compared between cohorts using multivariable linear regression. Intercohort achievement rates of minimal clinically important difference (MCID) in each PROM were compared. RESULTS Seventy-seven of 190 patients were in the CDA cohort. 6W Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) was superior in the CDA cohort. The ACDF cohort demonstrated notable improvements in the 6W Neck Disability Index (NDI), visual analog scale-neck pain (VAS-N), visual analog scale-arm pain (VAS-A), and 9-item Patient Health Questionnaire (PHQ-9). The CDA cohort demonstrated notable improvements in 6W PROMIS-PF, NDI, VAS-N, and VAS-A. FF VAS-A was better in the CDA cohort. The ACDF cohort demonstrated notable improvements in FF PROMIS-PF, NDI, VAS-N, and VAS-A. The CDA cohort demonstrated notable improvements in all FF PROMs. ∆PROM-6W in PROMIS-PF was greater in the CDA cohort. CONCLUSION Patients with prolonged PSD due to cervical DH demonstrated notable improvements in physical function, disability, pain, and mental health regardless of fusion versus arthroplasty techniques. Accounting for demographic variations, patients undergoing CDA demonstrated a greater magnitude of improvement and superior scores in physical function at the first postoperative follow-up. Rates of clinically tangible improvements in PROMs did not markedly vary by surgical procedure. Patients undergoing CDA may perceive greater early improvements to physical function compared with patients undergoing ACDF for prolonged PSD due to DH.
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Affiliation(s)
- Timothy J Hartman
- From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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卢 奕, 陆 伟. [Development and research progress of suture button fixation Latarjet procedure]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:635-640. [PMID: 38918180 PMCID: PMC11190675 DOI: 10.7507/1002-1892.202404031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
Objective To review the development and research progress of suture button fixation Latarjet procedure. Methods A comprehensive literature review was conducted to summarize the development and related modified techniques of the suture button fixation Latarjet procedure. Results Since the Latarjet procedure was first introduced by French scholar Latarjet in 1954, it has undergone three key transformations, resulting in suture button fixation Latarjet procedure, which has shown satisfactory outcomes in treatment of recurrent shoulder dislocation. However, there are still drawbacks such as the risk of impingement of the graft on surrounding tissues, and the surgical disruption of anatomical structures like the coracoclavicular ligament and the pectoralis minor muscle. The scholars have proposed several modified techniques based on the suture button fixation Latarjet procedure to further reduce complications from impingement of the graft, to lower the glenohumeral contact pressure, and to eliminate the impact of surgery on the physiological structures of the shoulder joint. The modified techniques include the arthroscopic suture button fixation Latarjet procedure using FiberTape Cerclage, reconstruction of the coracoacromial ligament during congruent-arc Latarjet procedures, and limit unique coracoid osteotomy suture button Latarjet procedure (LU-tarjet procedure). These modified techniques have also shown good clinical outcomes. Additionally, other related modified techniques for reconstruction of the glenoid, such as Chinese unique Inlay Bristow procedure (Cuistow procedure), arthroscopic glenoid bone grafting with soft fixation, and all-arthroscopic modified Eden-Hybinette procedure, have also demonstrated favorable efficacy. However, there is still a lack of long-term follow-up results for these techniques and comparative studies between them. Conclusion Suture button fixation Latarjet procedure is an effective method for the treatment of recurrent shoulder dislocation. There are various techniques, but there is no recognized gold standard, and further clinical and basic research is needed.
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Affiliation(s)
- 奕燊 卢
- 深圳大学第一附属医院(深圳市第二人民医院)运动医学科(广东深圳 518025)Department of Sports Medicine, the Second People’s Hospital of Shenzhen, the First Affiliated Hospital of Shenzhen University, Shenzhen Guangdong, 518025, P. R. China
| | - 伟 陆
- 深圳大学第一附属医院(深圳市第二人民医院)运动医学科(广东深圳 518025)Department of Sports Medicine, the Second People’s Hospital of Shenzhen, the First Affiliated Hospital of Shenzhen University, Shenzhen Guangdong, 518025, P. R. China
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Hendrickson NR, Haselhuhn JJ, Odland K, Sembrano JN, Martin CT, Jones KE, Polly DW. Sacropelvic Fixation with Porous Fusion/Fixation Screws: A Technical Note and Retrospective Review. World Neurosurg 2024; 190:172-180. [PMID: 38878891 DOI: 10.1016/j.wneu.2024.06.046] [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: 05/23/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The goal of this study was to analyze our initial experience using a novel porous fusion/fixation screw (PFFS) for pelvic fixation and determine our rate of screw malposition requiring intraoperative repositioning. METHODS We reviewed 83 consecutive patients who underwent sacropelvic fixation with PFFS at our institution from June 1, 2022 to June 30, 2023 using intraoperative computed tomography-based computer-assisted navigation via an open posterior approach. Following PFFS insertion, intraoperative computed tomography scans were obtained to assess screw positioning. Demographic data were collected, and operative reports and patient images were reviewed to determine what implants were used and if any PFFS required repositioning. RESULTS Seventy-four patients (26M:48F) were included, and 57 (77.0%) had a prior sacroiliac joint or lumbar spine surgery. A stacked screw configuration was used in 62/74 cases (83.8%). A total of 235 PFFS were used and six (2.6%) were malpositioned. Of 88 cephalic screws placed in stacked configuration, 4 were malpositioned (4.5%) and 1/123 caudal screws were malpositioned (0.8%). One of 24 sacral-alar-iliac screws placed in a stand-alone configuration was malpositioned (4.2%). Malpositions included 4 medial, 1 lateral, and 1 inferior, and all were revised intraoperatively without major sequela. CONCLUSIONS Although PFFSs are larger than traditional sacropelvic fixation screws, stacked sacral-alar-iliac instrumentation can be done safely with computer-assisted navigation. We found a low malposition rate in our initial series of patients, the majority being the cephalad screw in a stacked configuration. This isn't surprising, as these are placed after the caudal screws, which reduces the available corridor size and increases the placement difficulty.
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Affiliation(s)
- Nathan R Hendrickson
- Departments of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Jason J Haselhuhn
- Departments of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kari Odland
- Departments of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan N Sembrano
- Departments of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher T Martin
- Departments of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristen E Jones
- Departments of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA; Departments of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - David W Polly
- Departments of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA; Departments of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
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Menger MM, Herath SC, Ellmerer AE, Trulson A, Hoßfeld M, Leis A, Ollig A, Histing T, Küper MA, Audretsch CK. Different coupling mechanisms for a novel modular plate in acetabular fractures-a comparison using a laparoscopic model. Front Surg 2024; 11:1357581. [PMID: 38919977 PMCID: PMC11196767 DOI: 10.3389/fsurg.2024.1357581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Acetabular fractures are among the most challenging injuries in traumatology. The complex anatomy usually requires extensive surgical approaches baring the risk for iatrogenic damage to surrounding neurovascular structures. As a viable alternative, minimally invasive endoscopic techniques have emerged during the recent years. This paper reports on the feasibility of different coupling mechanisms for a novel suprapectineal plate especially designed for minimally invasive acetabular surgery. Methods A total number of 34 participants contributed to the present study, who differed in their arthroscopic and surgical experience. A laparoscopic model was used to compare four different coupling mechanisms by the number of failed attempts, the time required for plate fixation, the influence of surgical experience as well as the learning success for each individual coupling mechanism. Moreover, the feasibility of each mechanism was evaluated by a questionnaire. Results The results demonstrate that plates employing grooved and pressure-sliding coupling mechanisms exhibit fewer failed attempts and reduce trial times, especially in contrast to sole sliding mechanisms. Furthermore, our study revealed that proficiency in endoscopic procedures significantly influenced the outcome. Notably, the subjective evaluation of the participants show that the pressure base and pressure-slide base plate designs are the most supportive and feasible designs. Conclusions In summary, the present study evaluates for the first-time different plate and coupling designs for minimal-invasive surgery, indicating a superior feasibility for plates with a grooved and pressure-sliding mechanism.
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Affiliation(s)
- Maximilian M. Menger
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Steven C. Herath
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Andreas E. Ellmerer
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Trulson
- Department for Traumatology, Orthopedics and Surgery, BG Trauma Center, Murnau am Staffelsee, Germany
| | - Max Hoßfeld
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Artur Leis
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Annika Ollig
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Markus A. Küper
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christof K. Audretsch
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Jacob G, Lim YP, Brito CA, Parker DA. Lateral extra-articular tenodesis does not enhance ACL graft healing, however, does reduce graft tunnel widening. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38860740 DOI: 10.1002/ksa.12310] [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: 11/06/2023] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE The study hypothesized that the addition of lateral extra-articular tenodesis (LEAT) in anterior cruciate ligament reconstruction (ACLR) had a significant effect on ACL graft healing. METHODS A total of 80 patients were divided into two cohorts matched for gender, age, body mass index, time from surgery to post-operative MRI and graft diameter. Forty patients underwent ACL reconstruction alone, while 40 underwent ACLR in addition to LEAT. Patients underwent a magnetic resonance imaging scan at 12 months post-surgery; tunnel apertures were measured using multiplanar reformation, graft healing was assessed using signal-to-noise quotient (SNQ) in three regions of interest and finally graft maturity and integration were classified using the Howell and Ge scale, respectively. In addition, clinical evaluation and patient-reported outcome measures were collected. RESULTS The mean femoral tunnel widening at 12 months post-surgery was 39.8 ± 14.0% in the ACLR + LEAT group and 55.2 ± 12.7% in the ACLR alone group (p < 0.05). The mean tibial tunnel widening was 29.3 ± 12.7% in the ACLR + LEAT group and 44.4 ± 12.1% in the ACLR group (p < 0.05). The mean adjusted graft SNQ was 9.0 ± 14.9 in the ACLR + LEAT group and 9.5 ± 11.4 in the ACLR group (n.s.). CONCLUSION At 1 year post-operatively, we noted significantly less femoral and tibial tunnel widening in the ACLR + LEAT group. LEAT did not result in a statistically significant effect on graft healing. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- George Jacob
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
| | - Yoong Ping Lim
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
- Charles Darwin University, Darwin, Northern Territory, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | | | - David A Parker
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Gosselin C, Lefebvre Y, Joudet T, Godeneche A, Barth J, Garret J, Audebert S, Charousset C, Bonnevialle N. Clinical results and computed tomography analysis of intuitive shoulder arthroplasty (ISA) stemless at a minimum follow-up of 2 years. J Shoulder Elbow Surg 2024:S1058-2746(24)00402-6. [PMID: 38851524 DOI: 10.1016/j.jse.2024.04.012] [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: 01/15/2024] [Revised: 03/30/2024] [Accepted: 04/08/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The utilization of stemless anatomic total shoulder arthroplasty is on the rise. Epiphyseal fixation leads to radiological bone remodeling, which has been reported to exceed 40% in certain studies series. The aim of this study was to present the clinical and radiological outcomes of a stemless implant with asymmetric central epiphyseal fixation at an average follow-up of 31 months. MATERIALS AND METHODS This retrospective multicenter study examined prospective data of patients undergoing total anatomic arthroplasty with intuitive shoulder arthroplasty Stemless implant and followed up at least 2 years. Clinical assessment included preoperative and final follow-up measurements of active range of motion, Constant score, and Subjective Shoulder Value. Anatomical epiphyseal reconstruction and bone remodeling at the 2-year follow-up were assessed by standardized computed tomography scanner (CT scan). Statistical analysis employed unpaired Student's t-test or chi-squared test depending on the variable type, conducted using EasyMedStat software (version 3.22; www.easymedstat.com). RESULTS Fifty patients (mean age 68 years, 62% females) were enrolled, with an average follow-up of 31 months (24-44). Primary osteoarthritis (68%) with type A glenoid (78%) was the prevailing indication. The mean Constant score and Subjective Shoulder Value improved significantly from 38 ± 11 to 76 ± 11 (P < .001) and from 31% ± 16 to 88% ± 15 (P < .001) respectively at the last follow-up. Forward elevation, external rotation, and internal rotation range of motion increased by 39° ± 42, 28° ± 21 and 3,2 ± 2,5 points respectively, surpassing the Minimally Clinically Important Difference after total shoulder arthroplasty. No revisions were necessary. CT scans identified 30% osteolysis in the posterior-medial calcar region, devoid of clinical repercussions. No risk factors were associated with bone osteolysis. CONCLUSIONS At an average follow-up of 31 months, intuitive shoulder arthroplasty Stemless implant provided favorable clinical results. CT analysis revealed osteolysis-like remodeling in the posterior-medial zone of the calcar (30%), without decline in clinical outcomes and revisions. Long-term follow-up studies are mandated to evaluate whether osteolysis is associated with negative consequences.
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Affiliation(s)
- Cerise Gosselin
- CHU de Toulouse (Toulouse University Hospital), Toulouse, France
| | - Yves Lefebvre
- Institut de l'épaule de Strasbourg (Strasbourg Shoulder Institute), Strasbourg, France
| | | | - Arnaud Godeneche
- Centre Orthopédique SANTY (SANTY Orthopedic Center), Ramsay Santé, Lyon, France
| | | | | | | | - Christophe Charousset
- Institut Ostéo Articulaire (Bone and Joint Institute) Paris Courcelles, Paris, France
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Lo EY, Nazemi M, Ouseph A, Edwards AS, Weingast N, Krishnan SG. Short-Term Radiographic Outcomes of Bone Versus Metallic Augmented, Central Screw Type Baseplate in Reverse Total Shoulder Arthroplasty: Matched Case-Control Study. J Shoulder Elb Arthroplast 2024; 8:24715492241259470. [PMID: 38846321 PMCID: PMC11155345 DOI: 10.1177/24715492241259470] [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: 03/20/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
Background Although glenoid bone grafting and metallic augmented baseplates have demonstrated success in restoring the glenohumeral joint line in the recent literature, there remain no consensus guidelines defining the use of one versus the other. Methods Between 2017 and 2020, 15 primary RTSA with screw-in metallically augmented glenoid baseplates were identified and 2:1 matched by age, sex, and body mass index with primary bony-augmented glenoid baseplate patients. Patients with previous glenoid implantation or fracture were excluded. Charts, routine radiographic series (Grashey, Scapula Y, Axillary lateral), and 3-dimensional computed tomography (3D CT) scans were retrospectively reviewed. Structural patient-specific metal or bony augmentation was indicated based on preoperative glenoid morphology as identified by 3D CT. Aseptic failure was identified as hardware breakage and/or shift in glenoid baseplate component position. Results There were 45 eligible cases with mean age of 65.7 years (range 44-85 years) and 65.5 years (range 42-82 years) for the metallic-augmented and bone graft group, respectively. Correspondingly, mean follow up was 22.6 months (range 12-53 months), and 27.3 months (range 11-53 months). At latest follow up, there were no baseplate failures in the metallic augment group and 2 baseplate failures (7%) in the bone graft group at a mean of 42.5 months (range 32-53 months) postoperatively. Mean age of the bone failure group was 64.5 years (range 64-65 years). Conclusion Contemporary reversed shoulder arthroplasty glenoid baseplate designs appear to have low incidence of failure. Further analysis is necessary to determine if a critical degree of glenoid retroversion or inclination is preferable with a specific form of augmentation. Level of Evidence III; Retrospective Cohort Comparison.
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Affiliation(s)
- Eddie Y Lo
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Monia Nazemi
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- University of North Texas Health Science Center, Ft. Worth, TX, USA
| | - Alvin Ouseph
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | | | - Nancy Weingast
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Sumant G Krishnan
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
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Castroviejo C, Siegrist O, Gousopoulos L. Pseudoaneurysm of the superolateral genicular artery following ACL outside-in reconstruction. BMJ Case Rep 2024; 17:e259257. [PMID: 38839418 DOI: 10.1136/bcr-2023-259257] [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: 06/07/2024] Open
Abstract
A female underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) via an outside-in drilling technique. At 4 weeks after surgery, she presented with a pulsatile painful mass on the lateral femoral condyle. Imaging confirmed a superolateral genicular artery pseudoaneurysm. Thrombin injections were administered twice, resulting in reduced size and minimal pain. This case emphasises the rare occurrence of pseudoaneurysms post-ACLR and highlights the importance of early detection and intervention for vascular complications. Although debated, we suggest tourniquet deflation before closure to facilitate identification and management of vascular issues. This report contributes valuable insights into managing pseudoaneurysms following ACLR.
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Affiliation(s)
- Carmen Castroviejo
- Orthopaedic Surgery and Traumatology, Hopital du Valais, Martigny, Switzerland
- Orthopaedic Surgery and Traumatology, Universitätsklinik Balgrist, Zürich, Switzerland
| | - Olivier Siegrist
- Orthopaedic Surgery and Traumatology, Hopital du Valais, Martigny, Switzerland
| | - Lampros Gousopoulos
- Orthopaedic Surgery and Traumatology, Hopital du Valais, Martigny, Switzerland
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Stumpner T, Recheis S, Gruber MS, Kindermann H, Mattausch D, Bock P, Pöchgraber P, Ortmaier R, Bischofreiter M. Achilles tendon debridement, calcaneoplasty and double-row tendon footprint reconstruction improve ankle function and athletic performance in patients with insertional Achilles tendinopathy. Foot Ankle Surg 2024:S1268-7731(24)00118-8. [PMID: 38871492 DOI: 10.1016/j.fas.2024.05.014] [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: 01/18/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Insertional Achilles tendinopathy is a frequent condition among physically active individuals. Extensive intratendinous pathologies may require partial tendon detachment, debridement and reconstruction of the tendon footprint. Positive functional outcomes are reported after the procedure, but literature on postoperative sport function is limited. METHODS Pre- and postoperative sports capability and ankle function were assessed in 25 patients undergoing Achilles tendon debridement and double-row footprint reconstruction. RESULTS The mean VAS score for pain during sport decreased significantly from 7.4 (SD, 2.5) to 1.2 (SD, 2.0) postoperatively (p < 0.001). Sports ability and subjective fitness levels increased significantly from 3.6 (SD 3.0) and 3.5 (2.2) to 8.8 (2.4) and 8.8 (2.2), respectively (p < 0.001). A trend from high-impact sports to low-impact sports was observed postoperatively. The subjective surgical outcome was good or excellent in 96 %. CONCLUSION Our study shows improvement in postoperative sports ability and high patient satisfaction after insertional Achilles tendon debridement, and double-row tendon footprint reconstruction. LEVEL OF EVIDENCE Level IV - retrospective case series.
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Affiliation(s)
- Thomas Stumpner
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria.
| | - Simon Recheis
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Michael S Gruber
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Harald Kindermann
- University of Applied Sciences Upper Austria, Roseggerstraße 15, 4600 Wels, Austria
| | - Dietmar Mattausch
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Peter Bock
- Orthopoint Vienna, Mariahilfer Str. 49, 1060 Vienna, Austria
| | - Paul Pöchgraber
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Martin Bischofreiter
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria; Department of Orthopaedic and Trauma Surgery, Clinic Diakonissen Schladming, Salzburgerstraße 777, 8970 Schladming, Austria
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Korthaus A, Hansen S, Krause M, Frosch KH. [Treatment of Injuries to the Posterior Cruciate Ligament]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:316-328. [PMID: 38834079 DOI: 10.1055/a-2091-4681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Compared to the anterior cruciate ligament injury, the rupture of the posterior cruciate Ligament (PCL) is the rarer condition. A high healing potential is attributed to the PCL in the literature, which is why conservative therapy is also considered important in addition to surgical treatment 1. Posterior cruciate ligament rupture is often associated with concomitant injuries. Among other things, up to 70% of cases are associated with accompanying injuries to the posterolateral corner 2. The detection of concomitant injuries has a significant influence on the outcome, as isolated surgical PCL stabilization does not lead to satisfactory results in these cases.
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Hobbs M, Rahman HT, Raj R, Mandalaneni K, Pemminati S, Gorantla VR. Compartment Syndrome of the Lower Limb in Adults and Children and Effective Surgical Intervention and Post-surgical Therapies: A Narrative Review. Cureus 2024; 16:e63034. [PMID: 39050277 PMCID: PMC11268266 DOI: 10.7759/cureus.63034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Compartment syndrome (CS) can be defined as an acutely painful condition that occurs due to increased pressure within a compartment, resulting in reduced blood flow and oxygen to nerves and muscles within the limb. It is considered a surgical emergency, and a delayed diagnosis may result in ischemia and eventual necrosis of the limb. The majority of cases in adults are associated with high-energy trauma, more specifically, long bone fractures of the lower limb, while supracondylar fractures of the humerus are highly associated with CS in pediatric patients. CS may also develop gradually as a result of prolonged and ongoing physical activity such as running. In this narrative review, we discuss the anatomy, pathophysiology, methods of diagnosis, and effective management of CS in adults and children.
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Affiliation(s)
- Mikayla Hobbs
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Hira T Rahman
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Rhea Raj
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Kesava Mandalaneni
- Department of Neuroscience, St. George's University School of Medicine, St. George's, GRD
| | - Sudhakar Pemminati
- Department of Pharmacology, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Vasavi R Gorantla
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, USA
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Smith CD, Simpson E, Johnson B, Quilligan E, Grumet R, Parvaresh KC. Three-Dimensional Computed Tomography Reconstructions May Detect Pincer Lesions With Higher Sensitivity Than Radiographs in Patients With Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2024; 6:100918. [PMID: 39006792 PMCID: PMC11240014 DOI: 10.1016/j.asmr.2024.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/16/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To assess the diagnostic capability of radiographs (XRs) to detect pincer lesions compared with 3-dimensional (3D) computed tomography scans in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods We performed a retrospective review of all patients who underwent hip arthroscopy for FAIS between September 1, 2020, and October 2, 2022. Preoperative imaging was reviewed. Pincer lesions were defined as a lateral center-edge angle greater than 40°; a Tönnis angle greater than 0°; the presence of the ischial spine, crossover, or posterior wall sign; and the presence of overcoverage greater than 80%. Under "select criteria," patients were classified as having a pincer lesion on XRs and 3D computed tomography reconstructions (CTRs) based on the lateral center-edge angle or Tönnis angle alone, whereas "all criteria" added the presence of the crossover sign and coverage percentage. Statistical analysis was performed to determine the diagnostic accuracy of XRs compared with 3D CTRs. Results A total of 69 patients met the inclusion criteria. There were 21 male patients (30.4%) and 48 female patients (69.6%). The mean age was 33 ± 13.5 years. χ2 Analysis for select criteria found that 3D CTR was more likely than XRs to detect a pincer lesion. χ2 Analysis for all criteria found that 3D CTR was more likely than XRs to detect a pincer lesion. χ2 Analysis further showed that when using XRs, a pincer lesion was more likely to be detected under all criteria than under select criteria. Likewise, when using 3D CTR, a pincer lesion was more likely to be detected under all criteria than under select criteria. Conclusions In this study, we found that 3D CTR detected pincer lesions in patients undergoing hip arthroscopy for FAIS with significantly higher sensitivity than XRs alone. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Cory D Smith
- Hoag Orthopedic Institute, Irvine, California, U.S.A
| | - Evan Simpson
- Hoag Orthopedic Institute, Irvine, California, U.S.A
| | | | | | - Robert Grumet
- Hoag Orthopedic Institute, Irvine, California, U.S.A
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Morgan A, Moore M, Derry K, Bi A, Brown J, Youm T, Kaplan D. Surgical Treatment and Outcomes for Gluteal Tendon Tears. Curr Rev Musculoskelet Med 2024; 17:157-170. [PMID: 38619805 DOI: 10.1007/s12178-024-09896-w] [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: 03/27/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW Gluteus medius and minimus tears, or hip abductor tendon tears, are increasingly identified as a source of lateral hip pain. Once underappreciated and undertreated, they are now recognized as a cause of greater trochanteric pain syndrome and a pathology amenable to both nonoperative and operative modalities. This review summarizes relevant anatomy, clinical presentation, and treatment options for gluteus medius tears, focusing on surgical options. RECENT FINDINGS When surgical intervention is indicated, repair, reconstruction, or tendon transfer may be considered. Open and endoscopic repair techniques demonstrate similar outcomes with improvements in patient-reported outcomes and low complication and retear rates for both partial and full thickness tears. Variations in fixation construct and graft augmentations have been described, though clinical evidence remains limited to support specific techniques. Gluteus maximus transfer via open approach is a salvage option for the severely atrophied, retracted, or revision gluteus tendon; however, persistent limitations in abduction strength and gait abnormalities are common. Emerging evidence continues to evolve our understanding of surgical decision-making for gluteus tendon tears. The current literature supports either open or endoscopic repair techniques and open tendon transfer as a salvAage option. Further study is needed to determine the optimal fixation construct, the role of graft augmentation, and patient-related factors that influence postoperative outcomes.
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Affiliation(s)
- Allison Morgan
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Michael Moore
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Kendall Derry
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Andrew Bi
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Jahnya Brown
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Thomas Youm
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Daniel Kaplan
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA.
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Matsugaki T, Yamashita A, Kikuchi K, Watanabe K. Anatomical study of the modified direct posterior gluteal splitting approach for acetabular fractures. Injury 2024; 55:111519. [PMID: 38584077 DOI: 10.1016/j.injury.2024.111519] [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: 02/16/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND In this study, we investigated the area that can be addressed with an approach in which the skin incision is made directly above the dorsal column with Thiel cadaveric specimens. METHODS Six Thiel cadaveric specimens were prepared. A skin incision was made directly above the dorsal column. The accessible proximal end from the proximal part of the greater sciatic notch to the gluteal ridge and the accessible distal end of the ischium were marked with a flat chisel. A molded 8-hole reconstruction plate was placed from the base of the ischium toward the gluteal ridge and fixed with 3 screws proximally and 2 screws distally. The length of the skin incision and the distance from each reference point on the bone to the reachable markings were assessed after the muscles were removed. RESULTS Mean skin incision length was 9.3 ± 0.7 (range, 8.0-10.0) cm. In 3 of 6 cases, proximal screws were inserted through different spaces between muscle fibers. In all cases, we were able to reach at least the greater sciatic notch, the gluteal ridge at the level of superior border of the acetabulum, and the base of the ischial tuberosity. In all cases, an 8-hole plate could be placed from the gluteal ridge to the base of the ischium. There were no superior gluteal artery or sciatic nerve injuries in any of the cases. CONCLUSION We anatomically investigated the area that can be addressed with an approach in which the skin incision was made directly above the dorsal column. In all cases, we were able to access the areas needed to reduce the fracture and place the plates necessary to stabilize the fracture through a 9.3 ± 0.7 cm skin incision. This approach can be a useful minimally invasive posterior approach for acetabular fractures.
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Affiliation(s)
- Toru Matsugaki
- Department of Orthopaedic Surgery, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan.
| | - Akihiro Yamashita
- Department of Orthopaedic Surgery, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan
| | - Keishiro Kikuchi
- Department of Orthopaedic Surgery, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan
| | - Koichi Watanabe
- Devision of Gross and Clinical Anatomy, Department of Anatomy, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan
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Entezari B, Lex JR, Litowski ML, Almaslmani S, Backstein DJ, Wolfstadt JI. Total Knee Arthroplasty Periprosthetic Joint Infection With Concomitant Extensor Mechanism Disruption and Soft-Tissue Defect: The Knee Arthroplasty Terrible Triad. J Arthroplasty 2024:S0883-5403(24)00556-4. [PMID: 38830429 DOI: 10.1016/j.arth.2024.05.084] [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: 01/22/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Periprosthetic infection (PJI) with concomitant extensor mechanism disruption (EMD) and soft-tissue defect-hereinafter termed the "Terrible Triad"-is a devastating complication following total knee arthroplasty. The purpose of this study was to define the surgical and clinical outcomes following management of a cohort of patients who have the Terrible Triad. METHODS From 2000 to 2022, 127 patients underwent operative management for PJI alone, 25 for PJI with soft-tissue defects (defined as defects requiring flap reconstruction or being a factor contributing to the decision of performing above-knee amputation or arthrodesis), 14 for PJI with EMD, and 22 for the Terrible Triad. A composite outcome of infection status, range of motion, extensor lag, and ambulatory status at final follow-up was used to compare the proportion of patients in each group with a favorable overall knee outcome. Differences between groups were determined using one-way analyses of variance with post hoc Tukey's tests and Pearson's Chi-square tests or Fisher's exact tests with post hoc Bonferroni adjustments, where applicable. Odds ratios (OR) were calculated for comparison of the overall knee outcome between groups. A Kaplan-Meier survival analysis for patient mortality was performed. RESULTS The mean follow-up was 8.4 years and similar between groups (P = .064). Patients who had the Terrible Triad had a 45.5% incidence of above-knee amputation, or arthrodesis, and an 86.4% incidence of an unfavorable outcome. Compared to patients in the PJI group, patients in the PJI who had a soft-tissue defect (OR = 5.8, 95% CI [confidence interval] 2.2 to 15.7), PJI with EMD (OR = 3.7, 95%CI 1.0 to 12.9), and Terrible Triad groups (OR = 11.6, 95% CI 3.3 to 41.5) showed higher odds of an unfavorable knee outcome. CONCLUSIONS This study demonstrates that the total knee arthroplasty Terrible Triad is a dreaded diagnosis with poor outcomes. Clinicians and patients might consider early treatment with amputation or arthrodesis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Bahar Entezari
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Johnathan R Lex
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Madison L Litowski
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Saud Almaslmani
- Department of Surgery, Faculty of Medicine, Al-Qunfudhah, Umm Al-Qura University, Makkah, Saudi Arabia
| | - David J Backstein
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jesse I Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Sharareh B, Whitson AJ, Matsen FA, Hsu JE. Minimum 10-year follow-up of anatomic total shoulder arthroplasty and ream-and-run arthroplasty for primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2024; 33:1276-1284. [PMID: 37777045 DOI: 10.1016/j.jse.2023.08.028] [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: 12/19/2022] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Reports on long term outcomes and failures of shoulder arthroplasty are uncommon. The purpose of this study is to present minimum 10-year outcomes in consecutive patients undergoing ream-and-run and anatomic total shoulder arthroplasty (TSA) for primary glenohumeral arthritis. METHODS This study analyzed consecutive patients who had undergone a ream-and-run or TSA with minimum 10-year follow-up. Pain scores and Simple Shoulder Test (SST) values were obtained preoperatively and at a minimum of 10 years postoperatively via e-mail or mail-in response. Percentage of maximum possible improvement (%MPI) was also calculated. RESULTS Of 127 eligible patients, 63 (50%) responded to a 10-year survey. This included 34 patients undergoing ream-and-run arthroplasty and 29 patients undergoing TSA. The ream-and-run patients were significantly younger than the TSA patients (60 ± 7 vs. 68 ± 8, P < .001), predominantly male (97% vs. 41%, P < .001), and had a lower American Society of Anesthesiologists classification (P = .018). In the ream-and-run group, the mean pain score improved from a preoperative value of 6.5 ± 1.9 to 0.9 ± 1.3 (P < .001), and the mean SST score improved from 5.4 ± 2.4 to 10.3 ± 2.1 at 10-year follow-up (P < .001). Twenty-eight (82%) achieved an SST improvement above the minimally clinically important difference (MCID) of 2.6. Four patients (12%) underwent single-stage exchange to another hemiarthroplasty, whereas 1 (3%) required manipulation under anesthesia. In the TSA group, the pain score improved from a preoperative value of 6.6 ± 2.2 to 1.2 ± 2.3 (P < .001), and the SST score improved from 3.8 ± 2.6 to 8.9 ± 2.6 at 10-year follow-up (P < .001). Of the 29 patients who underwent a TSA, 27 (93%) achieved an SST improvement above the MCID of 1.6. No patient in the TSA group required reoperation. CONCLUSION Although the characteristics of the patients differ between the 2 groups, excellent functional results can be obtained with the ream-and-run arthroplasty and TSA for glenohumeral osteoarthritis.
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Affiliation(s)
- Behnam Sharareh
- Shoulder and Elbow Surgery, Ventura Orthopedics, Oxnard, CA, USA
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
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Huber T, Frühwirth M, Hartenbach F, Franzmair S, Ullmann D, Rath B. A novel surgical technique for revision anterior cruciate ligament reconstruction using an isolated rectus femoris tendon autograft. Arch Orthop Trauma Surg 2024; 144:2723-2730. [PMID: 38753014 DOI: 10.1007/s00402-024-05268-8] [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: 11/01/2023] [Accepted: 03/03/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Only a few anatomic studies have described an isolated rectus femoris tendon autograft for anterior cruciate ligament (ACL) reconstruction. This study aims to demonstrate a new surgical technique utilising the rectus femoris tendon for ACL reconstruction. This study hypothesises that the rectus tendon autograft will yield satisfying postoperative outcomes in terms of stability, with minimal complications at the harvest site. METHODS This retrospective study investigated the outcomes of 28 revision ACL reconstructions using a rectus tendon autograft with a mean follow-up of 41.7 (range, 24.0-64.8) months. A 3 cm longitudinal incision was used to harvest the rectus tendon with an open tendon stripper. Intraoperative collected data included the length of the tendon and thickness of a 4-fold graft. Further outcome parameters include anterior cruciate ligament stability and range of motion. Additionally, postoperative complications, especially donor site morbidity, were documented in type and frequency. RESULTS The mean tendon length measured 32.4 cm (range, 30-35 cm). After preparing a 4-fold graft, the mean diameter was 9.2 mm (range, 8.0-10 mm) at the tibial and 9.0 mm (range, 7.5-10 mm) at the femoral end. Stability evaluated by the Lachman test improved significantly from 2 (Interquartile range (IQR), 2-3) preoperatively to 0 (IQR, 0-1) postoperatively (p < .001). Rerupture of the anterior cruciate ligament graft was observed in 2 patients (7.1%). Four patients showed a persistent extension deficit of about 5 degrees postoperatively. Two of them underwent revision surgery due to a Cyclops lesion. Only one patient complained of prolonged pain at the harvest site (3.6%). CONCLUSION The 4-fold rectus tendon represents a novel autograft technique in revision ACL reconstruction. This study provides evidence of appropriate graft dimensions and satisfying postoperative outcomes regarding stability. The technique is associated with a low complication rate at the harvest site. STUDY DESIGN Case series; Level of evidence, IV.
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Affiliation(s)
- Thorsten Huber
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - Marcel Frühwirth
- Department of Trauma Surgery, Klinikum Wels-Grieskirchen, Wels, 4600, Austria.
| | - Florian Hartenbach
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - Sarah Franzmair
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - David Ullmann
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - Björn Rath
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
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Barça F, Atilla HA, Demir EB, Çevik K, Ilgın BU, Atlı OY, Yüksel S, Şibar K, Ünlü S, Duman E, Fırat A, Akdoğan M. Comparison of single and double incision leg fasciotomy in disaster settings-Experience from 2023 Türkiye earthquakes. Injury 2024; 55:111582. [PMID: 38640595 DOI: 10.1016/j.injury.2024.111582] [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: 01/16/2024] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Although there are studies comparing methods for leg fasciotomy in compartment syndrome after fractures, choice of single or double fasciotomies in disasters was not investigated. The aim of this study was to compare the efficacy of single and double incision leg fasciotomy in the setting of disaster. METHODS Patients that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were retrospectively analyzed. The cases were separated into two groups as single incision and double incision according to the method of the first fasciotomy. The number of debridements after each fasciotomy, muscle group excisions, completion time of treatment, presence of amputation, the method of closure (primary closure or graft/flap) and positive results of wound cultures were analyzed and compared between two groups. RESULTS 62 legs of 52 patients (22 females, 30 males, age 36.9 ± 11.2 years) with compartment syndrome that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were included in the study. Single-incision group included 27 legs and double incision group included 35 legs. Amputation was needed in 15 patients (%24.2), six in single incision group and nine in double incision group. (p = 0.75). Compartment excision (eight patients in single incision, nine patients in double incision groups, p = 0.81), number of debridements (median 4 in both groups, p = 0.55), wound closure time (median 17 days in single incision, 22 days in double incision groups, p = 0.52), graft or flap requirement (11 patients in single incision, 16 patients in double incision groups, p = 0.53), positive culture results (15 patients in single incision, 16 patients in double incision groups, p = 0.44) were not different statistically between two groups. CONCLUSION Single and double incision fasciotomy methods are equally effective and safe in treatment of compartment syndrome of the leg in disaster situations. To our knowledge, this is the first study comparing outcomes of single and double incision fasciotomy in disaster settings.
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Affiliation(s)
- Fatih Barça
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye.
| | - Halis Atıl Atilla
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Ekin Barış Demir
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Kadir Çevik
- Başakşehir Çam and Sakura City Hospital, Department of Hand Surgery, Istanbul, Türkiye
| | - Bünyamin Uğur Ilgın
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Osman Yağız Atlı
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Sinan Yüksel
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Kemal Şibar
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Serhan Ünlü
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Evrim Duman
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Ahmet Fırat
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
| | - Mutlu Akdoğan
- Etlik City Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
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Pettinari F, Carrozzo A, Saithna A, Ali AA, Alayane A, Barosso M, Vieira TD, Sonnery-Cottet B. Effect of Lateral Extra-Articular Procedures Combined With ACL Reconstruction on the Rate of Graft Rupture in Patients Aged Older Than 30 Years: A Matched-Pair Analysis of 1102 Patients From the SANTI Study Group. Am J Sports Med 2024; 52:1765-1772. [PMID: 38794893 DOI: 10.1177/03635465241247760] [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: 05/26/2024]
Abstract
BACKGROUND Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) reconstruction (ACLR) and lateral extra-articular procedures (LEAPs) over isolated ACLR in terms of reducing graft rupture and reoperation rates. However, most of the published studies have included young patients, and no studies have focused on patients aged >30 years. PURPOSE/HYPOTHESIS The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at midterm follow-up in patients aged >30 years. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients >30 years of age who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched at a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was performed to determine graft rupture rates, knee stability, reoperation rates, and complications. Graft survivorship was assessed using the Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model. RESULTS Two groups of 551 patients each were included in the study, and the mean follow-up was 97.19 ± 47.23 months. The overall mean age was 37.01 ± 6.24 years. The LEAP group consisted of 503 (91.3%) patients who had anterolateral ligament reconstruction and 48 (8.7%) patients who had a Lemaire procedure. Overall, 19 (1.7%) patients had graft failure: 15 (2.7%) in the no-LEAP group and 4 (0.7%) in the LEAP group (P = .0116). The risk of graft failure was significantly associated with the absence of LEAP (31 vs 12; hazard ratio, 3.309; 95% CI, 1.088-10.065; P = .0350) and age between 30 and 35 years (hazard ratio, 4.533; 95% CI, 1.484-13.841; P = .0080). A higher rate of reoperation for secondary meniscectomy was found in the no-LEAP group (5.6% vs 2.2%; P = .0031). CONCLUSION Patients aged >30 years who underwent combined ACLR and LEAP experienced a >3-fold lower risk of ACL graft failure compared with those who underwent isolated ACLR. Furthermore, the group without LEAP experienced a higher rate of secondary meniscectomy.
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Affiliation(s)
- Francesco Pettinari
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Alessandro Carrozzo
- University of Rome La Sapienza, Orthopaedics and Traumatology Rome, Lazio, Italy
| | - Adnan Saithna
- AZBSC Orthopedics, Scottsdale, Arizona, USA
- Orthopaedics Department, Arizona State University, Tempe, Arizona, USA
| | - Ahmad Abed Ali
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Ali Alayane
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Marta Barosso
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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Cox RM, Mandava N, Lazarus MD, Williams GR, Namdari S. Management of proximal humerus bone loss with allograft prosthetic composite technique in shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:1306-1312. [PMID: 37981001 DOI: 10.1016/j.jse.2023.09.038] [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: 03/30/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Proximal humerus bone loss in shoulder arthroplasty is a difficult problem with limited treatment options. It most commonly occurs in the setting of a previously failed shoulder arthroplasty; however, it is occasionally encountered in cases of primary shoulder arthroplasty. Reconstruction of the proximal humerus is essential for soft tissue tension for implant stability and maximizing function. The purpose of this study was to analyze the clinical and functional outcomes of the allograft prosthetic composite (APC) technique for the management of proximal humeral bone loss in shoulder arthroplasty. METHODS A retrospective review was performed of all patients who underwent primary or revision shoulder arthroplasty using an APC technique with a reverse shoulder arthroplasty prosthesis for the management of proximal humerus bone loss. Data collected included demographic variables, previous shoulder surgeries, indication for APC, type of allograft utilized, fixation technique, and reoperation and revision rates. Patients were contacted by phone and/or email survey to obtain the latest patient-reported functional outcome scores. RESULTS We identified 14 patients who underwent shoulder arthroplasty using the APC technique with a reverse shoulder arthroplasty prosthesis. One (7.1%) was performed as a primary arthroplasty, and 13 (92.9%) were performed as revision arthroplasties. The indications for APC were instability (21.4%), periprosthetic fracture (21.4%), periprosthetic joint infection (14.3%), humeral component loosening (14.3%), rotator cuff failure (14.3%), fracture sequelae (7.1%), and failed hemiarthroplasty (7.1%). In terms of allograft type, 10 (71.4%) were performed with proximal femur allograft and 4 (28.6%) with proximal humerus allograft. There were 6 patients (42.9%) who sustained postoperative complications, 5 patients (35.7%) had instability, and 1 (7.1%) patient had postoperative wound drainage. All patients with a complication required a revision arthroplasty. CONCLUSION The APC technique used to address proximal humerus bone loss in shoulder arthroplasty has a high complication rate with fair patient-reported functional outcome scores. Most of the postoperative complications and reoperations are related to implant instability.
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Affiliation(s)
- Ryan M Cox
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nikhil Mandava
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark D Lazarus
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerald R Williams
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
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Wang S, Sun K, Xu X, Sun J, Wang Y, Shi JG. A Novel "De-tension"-guided Anterior Decompression Strategy-Thoracic Anterior Controllable Antedisplacement Fusion (TACAF) for Multilevel Ossification of Posterior Longitudinal Ligament in Thoracic Spine: A Retrospective Study with at Least 2-Year Follow-Up. World Neurosurg 2024; 186:e639-e651. [PMID: 38608816 DOI: 10.1016/j.wneu.2024.04.022] [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: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To propose a novel surgical strategy-thoracic anterior controllable antedisplacement fusion (TACAF) to treat multilevel thoracic ossification of the posterior longitudinal ligament (mT-OPLL), and investigate its safety and efficacy. METHODS Between January 2019 and December 2021, a total of 49 patients with thoracic myelopathy due to mT-OPLL surgically treated with TACAF were retrospectively reviewed. Patients' demographic data, radiologic parameters, and surgery-related complications, modified Japanese Orthopedic Association (mJOA) and visual analog scale (VAS) scores, thoracic kyphosis (TK), kyphosis angle in fusion area (FSK), thoracic curvature, spinal cord curvature, and curvature of curved rod in surgical region, diameter, and area of the spinal cord at the most compressed level were included. RESULTS All patients acquired satisfactory recovery of neurologic function and overall complication rate was low at the final follow up. The mean mJOA of the laminectomy+TACAF and Full Lamina Preservation +TACAF groups, respectively, was 3.74 ± 2.05, 3.67 ± 1.95 before surgery, and 9.97 ± 0.83, 9.80 ± 0.68 at the final followed up, with the recovery rate of 84.26% ± 14.20%, 82.79% ± 10.35%, as to VAS Scores. The mean FSK was 34.50 ± 4.46,35.33 ± 3.44 before surgery, and was restored to 20.97 ± 5.70, 22.93 ± 6.34 at the final followed up respectively, as to mean TK (P < 0.05). Spinal cord curvature was improved from 34.12 ± 3.59, 33.93 ± 3.45 before surgery to 19.47 ± 3.53, 18.80 ± 3.17 at the final follow-up respectively, as to thoracic curvature (P < 0.05). In addition, the area and diameter of the spinal cord was also significantly improved at the final follow up (all P < 0.05). The curvature of the thoracic pulp and thoracic vertebra is closely related to the curvature of the rod. There was no statistically significant difference in the incidence of the pelvis and the slope value of the sacrum. CONCLUSIONS This strategy provides a novel solution for the treatment of mT-OPLL with favorable recovery of neurological function, the tension of spinal cord, and fewer complications.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; 910 Hospital of China Joint Logistics Support Force, Quanzhou City, Fujian Province, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jian-Gang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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Kim J, Rajan L, Gagne O, Kim JB, Lee WC. Realignment Surgery for Failed Osteochondral Autologous Transplantation in Osteochondral Lesions of the Talus Associated With Malalignment. Foot Ankle Spec 2024; 17:240-248. [PMID: 37021377 DOI: 10.1177/19386400231163030] [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: 04/07/2023]
Abstract
BACKGROUND While osteochondral autologous transplantation (OAT) offers favorable results in most patients with osteochondral lesions of the talus (OLT), some patients continue to experience persistent pain following the procedure. Information regarding the etiology of this pain and outcomes of revision surgery are limited. This study aimed to report results of revision surgery with realignment procedures in patients with failed OAT who demonstrated concomitant malalignment at the distal tibia or hindfoot. METHODS Eight patients (8 ankles), who had been experiencing persistent pain for more than 1 year following OAT, underwent realignment procedures during revision surgery. All patients underwent primary OAT for the treatment of medial OLTs. Patients were divided into 2 groups based on the main location of deformity: the supramalleolar realignment group (SRG, 5 ankles) and the hindfoot realignment group (HRG, 3 ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using 6 parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug preoperatively and postoperatively. Clinical outcomes were assessed using Foot Function Index and Visual Analogue Scale. RESULTS All patients had medial gutter narrowing or spur formation, which are early signs of ankle arthritis. The SRG had varus distal tibial alignment with a median medial distal tibial angle of 85.7 degrees (interquartile range [IQR], 3.2). The HRG had valgus hindfoot alignment and a lower medial longitudinal arch with a median hindfoot moment arm of 8.4 mm (IQR, 6.1) and a median Meary's angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592 to 0.0873 cm3 (P < .05). Clinical scores improved in all patients. CONCLUSION The current study demonstrates the effectiveness of realignment surgery in a selected patient group who experienced persistent pain and showed radiographic evidence of malalignment after primary OAT. Our study provides evidence supporting the use of realignment procedures in these cases, with results indicating improved patient-reported outcomes and spontaneous restoration of osteochondral lesions. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, New York, New York
| | - Lavan Rajan
- Hospital for Special Surgery, New York, New York
| | - Oliver Gagne
- University of British Columbia, Vancouver, BC, Canada
| | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
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Vila M, Xiberta P, Ruiz M, Bermudo R, Leivas D, Fariñas O, Vilarrodona A, Boada I. BeST-Graft viewer, a new system to improve the bone allograft-recipient matching process. Comput Biol Med 2024; 176:108553. [PMID: 38723397 DOI: 10.1016/j.compbiomed.2024.108553] [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: 12/13/2023] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Tissue establishments are responsible for processing, testing, preserving, storing, and distributing allografts from donors to be transplanted into recipients. In some situations, a matching process is required to determine the allograft that best fits the recipient. Allograft morphology is a key consideration for the matching process. The manual procedures applied to obtain these parameters make the process error-prone. MATERIAL AND METHODS A new system to manage bone allograft-recipient matching for tissue establishments is proposed. The system requires bone allografts to be digitalized and the resulting images to be stored in a DICOM file. The system provides functionalities to: (i) manage DICOM files (registered in the PACs) from both allografts and recipients; (ii) reconstruct 3D models from DICOM images; (iii) explore 3D models using 2D, 3D, and multiplanar reconstructions; (iv) take allograft and recipient measurements; and (v) visualize and interact with recipient and allograft data simultaneously. The system has been installed in the Barcelona Tissue Bank (Banc de Sang i Teixits), which has digitalized the bone allografts to test the system. RESULTS A use case with a femur is presented to test all the viewer functionalities. In addition, the recipient-allograft workflow is evaluated to show the steps of the procedure where the viewer can be used. CONCLUSIONS The bone allograft-recipient matching procedure can be optimized using software tools with functionalities to visualize, interact, and take measurements.
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Affiliation(s)
- Marius Vila
- Graphics and Imaging Laboratory, Universitat de Girona, Girona, Catalonia.
| | - Pau Xiberta
- Graphics and Imaging Laboratory, Universitat de Girona, Girona, Catalonia
| | - Marc Ruiz
- Graphics and Imaging Laboratory, Universitat de Girona, Girona, Catalonia
| | - Raquel Bermudo
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Catalonia; Vall Hebron Institute of Research (VHIR), Barcelona, Catalonia
| | - Daniel Leivas
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Catalonia
| | - Oscar Fariñas
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Catalonia; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Catalonia
| | - Anna Vilarrodona
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Catalonia; Vall Hebron Institute of Research (VHIR), Barcelona, Catalonia
| | - Imma Boada
- Graphics and Imaging Laboratory, Universitat de Girona, Girona, Catalonia
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Zhang S, Cai G, Ge Z. The Efficacy of Anterior Cruciate Ligament Reconstruction with Peroneus Longus Tendon and its Impact on Ankle Joint Function. Orthop Surg 2024; 16:1317-1326. [PMID: 38650179 PMCID: PMC11144498 DOI: 10.1111/os.14060] [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: 10/30/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Peroneus Longus Tendon (PLT), a viable anterior cruciate ligament (ACL) graft, shares similar biomechanics, making it suitable for reconstruction. Controversy exists over whether PLT transplants affects the donor ankle joint. The purpose of this study was to examine the recovery of knee joint function following arthroscopic ACL restoration using autologous PLT and its influence on the donor ankle joint. METHODS A retrospective analysis was conducted on 65 patients with ACL rupture who underwent PLT graft reconstruction in our hospital from January 2016 to December 2021. A three-dimensional gait analysis of the bilateral knee and ankle joints was performed postoperatively using an Opti_Knee three-dimensional motion measurement and analysis system-Yidong Medical Infrared Motion Gait Analyzer. Knee function scores and changes in the range of motion of the bilateral knee and ankle joints were collected. The analysis of preoperative and postoperative joint function scores, bilateral knee and ankle mobility was performed by t-tests. RESULTS One year after surgery, the patients' International Knee Documentation Committee (IKDC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOSs), and Lysholm scores were significantly improved compared to preoperative scores, with statistically significant differences (p < 0.05). There was no statistical difference in the American Orthopedic Foot and Ankle Society (AOFAS) score of the donor ankle joint before and after surgery (p > 0.05). During different gait cycles, there was no statistical difference in knee joint mobility between the affected and healthy sides (p > 0.05), but there was a statistical difference in the inversion and eversion angle of the donor ankle joint during the support phase (p < 0.05). CONCLUSION ACL reconstruction using the PLT can yield satisfactory knee joint function. However, it does affect inversion and eversion in the donor ankle joint, necessitating postoperative exercises. Similar subjective function ratings for both operated and non-operated feet, despite increased inversion-eversion motion in the operated foot, may be influenced by the subjective nature and margin of error in the AOFAS Ankle-hindfoot score, along with the relatively small variation in ankle inversion-eversion angles.
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Affiliation(s)
- Shichao Zhang
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
| | - Guoping Cai
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
| | - Zhe Ge
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
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Ahmad SS, Becker N, Grap LV, Windhagen H, Haertlé M. The Impact of Epidural Analgesia on Immobility and extended Hospital Stay After Periacetabular Osteotomy. Arch Orthop Trauma Surg 2024; 144:2519-2525. [PMID: 38713372 PMCID: PMC11211203 DOI: 10.1007/s00402-024-05331-4] [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: 12/22/2023] [Accepted: 04/14/2024] [Indexed: 05/08/2024]
Abstract
AIMS Early mobilisation after periacetabular osteotomy (PAO) represents an important goal after surgery. The purpose of this study was to determine whether the use of epidural aznalgesia (EA) is associated with prolonged immobility and an increased length of stay (LOS) after PAO surgery. METHODS From January 2022 to July 2023, the study included a cohort of 150 PAO procedures all performed by the same surgeon (SSA). Patients were categorized into two distinct groups: those who received epidural analgesia (EA) (79 PAOs) and those who did not receive EA (71 PAOs). "Ready for discharge" was defined as the ability to ascend and descend a standardized flight of stairs independently. Multivariable linear regression was used to identify additional factors influencing LOS after PAO. RESULTS Patients in the EA group were ready for discharge 5.95 ± 2.09 days after surgery which was significantly longer than in the No EA group´s average of 4.18 days ± 2.5, (p < 0.001). While the reduction in the number of patients experiencing pulmonary embolism in the No EA group did not reach statistical significance, it still demonstrated a relevant decrease from two patients within the EA group (2.53%) to 0 (0%) in the No EA group. The active engagement of the surgeon in mobilising patients led to a substantial reduction in LOS, decreasing it from 5.81 ± 2.18 days to 2.2 ± 0.77 days (p < 0.001). Multivariable analysis revealed five independent factors influencing the LOS following PAO which included absence of EA, surgeon-led mobilisation within 24 h after surgery, postoperative hemoglobin levels, BMI, and prior experience with PAO surgery on the contralateral side. CONCLUSIONS Opting against the use of EA in patients undergoing PAO is advisable, as it will result in extended postoperative immobility and the associated risks. Additionally, the active participation of the surgeon in the mobilisation process is strongly recommended.
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Affiliation(s)
- Sufian S Ahmad
- Department of Orthopaedic surgery, Hannover Medical School, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany.
| | - Nils Becker
- Department of Orthopaedic surgery, Hannover Medical School, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
| | - Laura-Vanessa Grap
- Department of Orthopaedic surgery, Hannover Medical School, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic surgery, Hannover Medical School, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
| | - Marco Haertlé
- Department of Orthopaedic surgery, Hannover Medical School, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany
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Marmor WA, Dennis ER, Buza SS, Gruber S, Propp BE, Burge AJ, Nguyen JT, Shubin Stein BE. Outcomes of Particulated Juvenile Articular Cartilage and Association With Defect Fill in Patients With Full-Thickness Patellar Chondral Lesions. Orthop J Sports Med 2024; 12:23259671241249121. [PMID: 39045351 PMCID: PMC11265243 DOI: 10.1177/23259671241249121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 07/25/2024] Open
Abstract
Background Cartilage restoration procedures for patellar cartilage defects have produced inconsistent results, and optimal management remains controversial. Particulated juvenile articular cartilage (PJAC) allograft tissue is an increasingly utilized treatment option for chondral defects, with previous studies demonstrating favorable short-term outcomes for patellar chondral defects. Purpose To identify whether there is an association between defect fill on magnetic resonance imaging (MRI) with functional outcomes in patients with full-thickness patellar cartilage lesions treated with PJAC. Study Design Case series; Level of evidence, 4. Methods A retrospective review of prospectively collected data was conducted on patients treated with PJAC for a full-thickness symptomatic patellar cartilage lesion between March 2014 and August 2019. MRI was performed for all patients at 6, 12, and 24 months postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and at 1, 2, and >2 years postoperatively. Clinical outcome scores-including the International Knee Documentation Committee (IKDC) score, the Kujala, the Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), the Knee Injury and Osteoarthritis Outcome Score-Quality of Life (KOOS-QoL), and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS)-were analyzed and evaluated for a relationship with tissue fill on MRI. Results A total of 70 knees in 65 patients (mean age, 26.6 ± 8.1 years) were identified, of which 68 knees (97%) underwent a concomitant patellar stabilization or offloading procedure. Significant improvements were observed on all postoperative PROM scores at the 1-, 2-, and >2-year follow-up except for the Pedi-FABS, which showed no significant difference from baseline. From baseline to the 2-year follow-up, the KOOS-QoL improved from 24.7 to 62.1, the IKDC improved from 41.1 to 73.5, the KOOS-PS improved from 35.6 to 15, and the Kujala improved from 52 to 86.3. Imaging demonstrated no difference in the rate of cartilage defect fill between the 3-month (66%), 6-month (72%), 1-year (74%), and ≥2-year (69%) follow-ups. No association was observed between PROM scores and the percent fill of cartilage defect on MRI at the 1- and 2-year follow-up. Conclusion PROM scores were significantly improved at the 2-year follow-up in patients who underwent PJAC for full-thickness patellar cartilage defects. On MRI, a cartilage defect fill of >66% was achieved by 3 months in most patients. In our sample, PROM scores were not significantly associated with the defect fill percentage at the short-term follow-up.
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Affiliation(s)
- William A. Marmor
- Department of Orthopedic Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth R. Dennis
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Stephanie S. Buza
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Simone Gruber
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Bennett E. Propp
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Alissa J. Burge
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Joseph T. Nguyen
- Biostatistics Core, HSS Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Beth E. Shubin Stein
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Hinz N, Baumeister D, Dehoust J, Münch M, Frosch KH, Augat P, Hartel MJ. The infraacetabular screw versus the antegrade posterior column screw in acetabulum fractures with posterior column involvement: a biomechanical comparison. Arch Orthop Trauma Surg 2024; 144:2573-2582. [PMID: 38676740 PMCID: PMC11211174 DOI: 10.1007/s00402-024-05324-3] [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: 01/07/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Traditionally, plate osteosynthesis of the anterior column combined with an antegrade posterior column screw is used for fixation of anterior column plus posterior hemitransverse (ACPHT) acetabulum fractures. Replacing the posterior column screw with an infraacetabular screw could improve the straightforwardness of acetabulum surgery, as it can be inserted using less invasive approaches, such as the AIP/Stoppa approach, which is a well-established standard approach. However, the biomechanical stability of a plate osteosynthesis combined with an infraacetabular screw instead of an antegrade posterior column screw is unknown. MATERIAL AND METHODS Two osteosynthesis constructs were compared in a synthetic hemipelvis model with an ACPHT fracture: Suprapectineal plate + antegrade posterior column screw (APCS group) vs. suprapectineal plate + infraacetabular screw (IAS group). A single-leg stance test protocol with an additional passive muscle force and a cyclic loading of 32,000 cycles with a maximum effective load of 2400 N was applied. Interfragmentary motion and rotation of the three main fracture lines were measured. RESULTS At the posterior hemitransverse fracture line, interfragmentary motion perpendicular to the fracture line (p < 0.001) and shear motion (p < 0.001) and at the high anterior column fracture line, interfragmentary motion longitudinal to the fracture line (p = 0.017) were significantly higher in the IAS group than in the APCS group. On the other hand, interfragmentary motion perpendicular (p = 0.004), longitudinal (p < 0.001) and horizontal to the fracture line (p = 0.004) and shear motion (p < 0.001) were significantly increased at the low anterior column fracture line in the APCS group compared to the IAS group. CONCLUSIONS Replacing the antegrade posterior column screw with an infraacetabular screw is not recommendable as it results in an increased interfragmentary motion, especially at the posterior hemitransverse component of an ACPHT fracture.
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Affiliation(s)
- Nico Hinz
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
| | - Dirk Baumeister
- Institute for Biomechanics, BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Matthias Münch
- Laboratory for Biomechanics, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Maximilian J Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
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Shen J, Wei Z, Wu H, Wang X, Wang S, Wang G, Luo F, Xie Z. The induced membrane technique for the management of infected segmental bone defects. Bone Joint J 2024; 106-B:613-622. [PMID: 38821512 DOI: 10.1302/0301-620x.106b6.bjj-2023-1443.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Aims The aim of the present study was to assess the outcomes of the induced membrane technique (IMT) for the management of infected segmental bone defects, and to analyze predictive factors associated with unfavourable outcomes. Methods Between May 2012 and December 2020, 203 patients with infected segmental bone defects treated with the IMT were enrolled. The digital medical records of these patients were retrospectively analyzed. Factors associated with unfavourable outcomes were identified through logistic regression analysis. Results Among the 203 enrolled patients, infection recurred in 27 patients (13.3%) after bone grafting. The union rate was 75.9% (154 patients) after second-stage surgery without additional procedures, and final union was achieved in 173 patients (85.2%) after second-stage surgery with or without additional procedures. The mean healing time was 9.3 months (3 to 37). Multivariate logistic regression analysis of 203 patients showed that the number (≥ two) of debridements (first stage) was an independent risk factor for infection recurrence and nonunion. Larger defect sizes were associated with higher odds of nonunion. After excluding 27 patients with infection recurrence, multivariate analysis of the remaining 176 patients suggested that intramedullary nail plus plate internal fixation, smoking, and an allograft-to-autograft ratio exceeding 1:3 adversely affected healing time. Conclusion The IMT is an effective method to achieve infection eradication and union in the management of infected segmental bone defects. Our study identified several risk factors associated with unfavourable outcomes. Some of these factors are modifiable, and the risk of adverse outcomes can be reduced by adopting targeted interventions or strategies. Surgeons can fully inform patients with non-modifiable risk factors preoperatively, and may even use other methods for bone defect reconstruction.
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Affiliation(s)
- Jie Shen
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
- Trauma Medical Centre, Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyuan Wei
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hongri Wu
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
- Department of Orthopaedics, Navy 905 Hospital, Navy Medical University, Shanghai, China
| | - Xiaohua Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shulin Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Guanglin Wang
- Trauma Medical Centre, Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhao Xie
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
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Polly DW, Holton KJ, Haselhuhn JJ, Soriano PBO, Jones KE, Sembrano JN, Martin CT. Does A Hinged Operating Table Facilitate Sagittal Correction in Transforaminal Lumbar Interbody Fusion With Smith-Peterson Osteotomy? A Radiographic Analysis. Clin Orthop Relat Res 2024; 482:1065-1070. [PMID: 38038970 PMCID: PMC11124653 DOI: 10.1097/corr.0000000000002910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Osteotomies allow the restoration of appropriate sagittal alignment; however, closure of osteotomies can be challenging. Typical closure involves compressing pedicle screw heads across the rods, potentially causing screw loosening and failure. Motorized hinged operating tables are often used to assist with controlled closure of osteotomies without manual compression, but there is no published research quantifying the amount of correction provided solely by changes in the table angle. QUESTION/PURPOSE What is the incremental amount of correction achieved by change in the table angle versus instrumented manipulation during osteotomy closure in transforaminal lumbar interbody fusion (TLIF) with Smith-Petersen osteotomy? METHODS Sixty-one patients undergoing Smith-Peterson osteotomy and bilateral TLIF using a motorized hinged table from October 2019 to March 2022 were prospectively enrolled. Two patients did not undergo surgery, two did not have table extension, and seven did not have data collected intraoperatively because of disruptions in research protocols owing to the coronavirus-19 pandemic. Fifty patients (24 male, 26 female) who underwent a total of 73 osteotomies were included in the final analysis. The mean ± standard deviation age was 61 ±11 years, and the mean BMI was 31 ± 6 kg/m 2 . Patients were positioned prone on the table and flexed to 10° for decompression, Smith-Petersen osteotomy, and TLIF. The table was then extended in 5° increments, and radiographs were taken until 10° of extension was achieved or the osteotomy was fully closed. Changes in segmental lordosis across the operative site for each 5° increment were measured to the nearest degree by two reviewers. Intraclass correlation coefficients for segmental lordosis measurements at each table angle change were calculated as 0.97 to 0.98, with all p values < 0.001, indicating excellent agreement. RESULTS Table change from 10° to 5° yielded a mean segmental lordosis change of 1.9° ± 1.5° (73 osteotomies), 5° to 0° yielded a change of 1.3° ± 0.9° (73 osteotomies), 0° to -5° yielded a change of 1.3° ± 1.0° (69 osteotomies), and -5° to -10° yielded a change of 1.1° ± 1.3° (61 osteotomies). Rod placement and compression yielded a mean 1.8° ± 2.0° of additional segmental lordosis. CONCLUSION Using a motorized hinged table facilitated an average of 5.6° of total segmental lordosis correction during controlled Smith-Peterson osteotomy closure without the need for cantilevering forces across spinal instrumentation. Surgeons can use this technique to reduce the compression forces needed to close osteotomies, which could eliminate a potential source of complications.Level of Evidence Level II, therapeutic study.
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Affiliation(s)
- David W. Polly
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth J. Holton
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jason J. Haselhuhn
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Kristen E. Jones
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan N. Sembrano
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Wang S, Yang Y, Han D, Guo Y, Shi J, Wang Y, Sun J. Foramen Facet Spinal Classification for Ossification of the Posterior Longitudinal Ligament on Computed Tomography: Closely Related to Clinical Efficacy. Clin Spine Surg 2024; 37:E162-E169. [PMID: 38679813 DOI: 10.1097/bsd.0000000000001574] [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: 11/24/2022] [Accepted: 12/06/2023] [Indexed: 05/01/2024]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To develop and validate computed tomography (CT)-based classification schemes to eliminate ambiguity as much as possible and evaluate the adequacy and clinical value of its classification. BACKGROUND There is no objective criteria for laminoplasty of more than one million Chinese patients with ossification of the posterior longitudinal ligament (OPLL) every year. CT imaging can accurately show the location, size, and shape of ossification, it is very important to propose a recognized simple classification of ossifications. PATIENTS AND METHODS From 2016 to 2018, 100 patients with "moderate to severe" OPLL on CT were performed according to the following criteria. This study simply classifies the grade of the ossification as 1-2-3, the zone is A-B by the foramen facet spinal canal classification, and the interexaminer reliability is 96%. A prospective series of 60 patients for laminoplasty was performed between 2018 and 2019, and this classification scheme was verified according to the new standard. All patients with size 1 were selectively excluded from consideration for surgery. The Japanese Orthopedic Association scores from both series are superior to most published results for patients with OPLL. RESULTS The first and second series reported good to excellent results of 89% and 93.3%, respectively, and 80% and 85% for 24 months. The difference in the incidence of C5 paralysis and axial pain was statistically significant among the different zones, and most of them recovered within 6 months. The most common size and location types are 2-AB, 3-AB, and 2A. The most severe type is 3-AB. CONCLUSIONS The foramen facet spinal classification of OPLL is a simple and reliable method for objectively evaluating the ossification of patients with OPLL based on CT research. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
- 910 Hospital of China Joint Logistics Support Force, Quanzhou City, Fujian Province, People's Republic of China
| | - Yong Yang
- Department of Orthopedics, General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Dan Han
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
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Wustro L, Silva JLVD, Moura BAB, Schoenberger HS, Takito D, D'Agostini JCH. Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment. Rev Bras Ortop 2024; 59:e456-e461. [PMID: 38911898 PMCID: PMC11193579 DOI: 10.1055/s-0044-1785514] [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: 08/08/2023] [Accepted: 11/06/2023] [Indexed: 06/25/2024] Open
Abstract
Objective To evaluate whether three-dimensional (3D) printing increases agreement in the classification of tibial pilon fractures. Methods Orthopedists and traumatologists reviewed radiographs, computed tomography scans with 3D reconstruction, and prototyping 3D printing, and classified the fractures based on the Rüedi-Allgöwer and Arbeitsgemeinschaft für Osteosynthesefragen (AO, Association for the Study of Internal Fixation) Foundation/Orthopedic Trauma Association (AO/OTA) classification systems. Next, data evaluation used Kappa agreement coefficients. Results The use of the 3D model did not improve agreement for tibial pilon fractures regarding the treatment proposed by the groups. Regarding the classification systems, the agreement only improved concerning the AO/OTA classification when the 3D model was used in the assessment by the foot and ankle specialists. Conclusion Although 3D printing is statistically relevant for surgeons specializing in foot and ankle, its values remain lower than optimal.
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Affiliation(s)
| | | | | | | | - Debora Takito
- Complexo Hospitalar do Trabalhador, Curitiba, PR, Brasil
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Putzeys G, Bori E, Overes T, Innocenti B. Biomechanical analysis of push-pull principle versus traditional approach in locking plates for proximal humeral fracture treatment. Arch Orthop Trauma Surg 2024; 144:2591-2601. [PMID: 38695914 DOI: 10.1007/s00402-024-05342-1] [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: 12/05/2023] [Accepted: 04/14/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Proximal humerus fractures are usually treated with locking plates, which could present recurrence, screw penetration, joint varization. The push-pull principle was introduced to prevent these risks and showed promising results; a dedicated design was then developed and this feasibility study aims to compare the biomechanical performances of such dedicated push-pull plate with the traditional locking plate using finite elements. MATERIALS AND METHODS The humerus geometry was obtained from Sawbone CT-scans; the geometries of a traditional locking plate and of the dedicated push-pull one were used. A fracture was added below the humeral head and the plates were virtually implanted. The wire pulling mechanism was simulated connecting the plate to the humeral head apex, considering two levels of tension. Three testing set-ups (axial, torsion and compression bending) were simulated. Stress distributions on bone, plate and screws were measured. RESULTS Stress distribution on the distal humerus was similar for both plates. Stress distribution on the proximal humerus was more homogeneous for the push-pull model, showing less unloaded sections (up to 78%). The different levels of tension applied to the wire returned slight differences in terms of stress values, but the comparison with the traditional approach gave similar outcomes. CONCLUSIONS More homogeneous stress distribution is found with the push-pull plate in all three testing set-ups, showing lower unloaded areas (and thus lower stress-shielding) compared to the traditional plate; the screws implemented returned to be all loaded in at least one of the set-ups, thus showing that they all contribute to plate stability.
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Affiliation(s)
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| | - Tom Overes
- IGNITE-Concepts GmbH, Basilea, Switzerland
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium.
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Shashikumar U, Saraswat A, Deshmukh K, Hussain CM, Chandra P, Tsai PC, Huang PC, Chen YH, Ke LY, Lin YC, Chawla S, Ponnusamy VK. Innovative technologies for the fabrication of 3D/4D smart hydrogels and its biomedical applications - A comprehensive review. Adv Colloid Interface Sci 2024; 328:103163. [PMID: 38749384 DOI: 10.1016/j.cis.2024.103163] [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: 09/21/2023] [Revised: 03/18/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Repairing and regenerating damaged tissues or organs, and restoring their functioning has been the ultimate aim of medical innovations. 'Reviving healthcare' blends tissue engineering with alternative techniques such as hydrogels, which have emerged as vital tools in modern medicine. Additive manufacturing (AM) is a practical manufacturing revolution that uses building strategies like molding as a viable solution for precise hydrogel manufacturing. Recent advances in this technology have led to the successful manufacturing of hydrogels with enhanced reproducibility, accuracy, precision, and ease of fabrication. Hydrogels continue to metamorphose as the vital compatible bio-ink matrix for AM. AM hydrogels have paved the way for complex 3D/4D hydrogels that can be loaded with drugs or cells. Bio-mimicking 3D cell cultures designed via hydrogel-based AM is a groundbreaking in-vivo assessment tool in biomedical trials. This brief review focuses on preparations and applications of additively manufactured hydrogels in the biomedical spectrum, such as targeted drug delivery, 3D-cell culture, numerous regenerative strategies, biosensing, bioprinting, and cancer therapies. Prevalent AM techniques like extrusion, inkjet, digital light processing, and stereo-lithography have been explored with their setup and methodology to yield functional hydrogels. The perspectives, limitations, and the possible prospects of AM hydrogels have been critically examined in this study.
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Affiliation(s)
- Uday Shashikumar
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University (KMU), Kaohsiung City 807, Taiwan
| | - Aditya Saraswat
- Department of Chemistry, Amity Institute of Applied Sciences, Amity University, Noida, UP, India
| | - Kalim Deshmukh
- New Technologies - Research Centre University of West Bohemia Univerzitní 2732/8, 30100, Plzeň, Czech Republic
| | - Chaudhery Mustansar Hussain
- Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ 07102, United States
| | - Pranjal Chandra
- Laboratory of Bio-Physio Sensors and Nanobioengineering, School of Biochemical Engineering, Indian Institute of Technology (BHU) Varanasi, Uttar Pradesh, India
| | - Pei-Chien Tsai
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University (KMU), Kaohsiung City 807, Taiwan; Department of Computational Biology, Institute of Bioinformatics, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai 602105, Tamil Nadu, India
| | - Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes (NHRI), Miaoli County 35053, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City 807, Taiwan; Department of Medical Research, China Medical University Hospital (CMUH), China Medical University (CMU), Taichung City, Taiwan
| | - Yi-Hsun Chen
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Liang-Yin Ke
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Chung Lin
- Institute of Environmental Engineering, National Sun Yat-sen University (NSYSU), Kaohsiung City 804, Taiwan; Center for Emerging Contaminants Research, National Sun Yat-sen University (NSYSU), Kaohsiung City 804, Taiwan.
| | - Shashi Chawla
- Department of Chemistry, Amity Institute of Applied Sciences, Amity University, Noida, UP, India.
| | - Vinoth Kumar Ponnusamy
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University (KMU), Kaohsiung City 807, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City 807, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Emerging Contaminants Research, National Sun Yat-sen University (NSYSU), Kaohsiung City 804, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital (KMUH), Kaohsiung City 807, Taiwan; Department of Chemistry, National Sun Yat-sen University (NSYSU), Kaohsiung City 804, Taiwan.
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143
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Patterson JT, Brown M, Hasegawa IG, Becerra JA, Duong AM, Reddy A, Gary JL. Incidence of Suboptimal Fluoroscopic Outlet Imaging of the Sacrum and Pelvic Retroversion Necessary for Optimal Views. J Orthop Trauma 2024; 38:299-305. [PMID: 38470146 DOI: 10.1097/bot.0000000000002795] [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: 10/13/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To estimate the prevalence of suboptimal fluoroscopy of sacral outlet images due to anatomic and equipment dimensions. Pelvic retroversion is hypothesized to mitigate this issue. METHODS DESIGN In silico simulations using retrospectively collected computed tomography (CT) data from human patients. SETTING Level I trauma center. PATIENT SELECTION CRITERIA Adults with OTA/AO 61 pelvic ring disruptions treated with posterior pelvic fixation between July and December 2021. OUTCOME MEASURES AND COMPARISONS C-arm tilt angles required to obtain 3 optimal fluoroscopic sacral outlet images, defined as vectors from pubic symphysis to S2 and parallel to the first and second sacral neural foramina, were calculated from sagittal CT images. A suboptimal view was defined as collision of the C-arm radiation source or image intensifier with the patient/operating table at the required tilt angle simulated using the dimensions of 5 commercial C-arm models and trigonometric calculations. Incidence of suboptimal outlet views and pelvic retroversion necessary to obtain optimal views without collision, which may be obtained by placement of a sacral bump, was determined for each view for all patients and C-arm models. RESULTS CT data from 72 adults were used. Collision between patient and C-arm would occur at the optimal tilt angle for 17% of simulations and at least 1 view in 68% of patients. Greater body mass index was associated with greater odds of suboptimal imaging (standard outlet: odds ratio [OR] 0.84, confidence interval [CI] 0.79-0.89, P < 0.001; S1: OR 0.91, CI 0.87-0.97, P = 0.002; S2: OR 0.85, CI 0.80-0.91, P < 0.001). S1 anterior sacral slope was associated with suboptimal S1 outlet views (OR 1.12, Cl 1.07-1.17, P < 0.001). S2 anterior sacral slope was associated with suboptimal standard outlet (OR 1.07, Cl 1.02-1.13, P = 0.004) and S2 outlet (OR 1.16, Cl 1.09-1.23, P < 0.001) views. Retroversion of the pelvis 15-20 degrees made optimal outlet views possible without collision in 95%-99% of all simulations, respectively. CONCLUSIONS Suboptimal outlet imaging of the sacrum is associated with greater body mass index and sacral slope at S1 and S2. Retroversion of the pelvis by 15-20 degrees with a bump under the distal sacrum may offer a low-tech solution to ensure optimal fluoroscopic imaging for percutaneous fixation of the posterior pelvic ring. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; and
| | - Michael Brown
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; and
| | - Ian G Hasegawa
- Department of Orthopaedic Surgery and Rehabilitation, Queen's Medical Center, Honolulu, HI
| | - Jacob A Becerra
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; and
| | - Andrew M Duong
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; and
| | - Akhil Reddy
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; and
| | - Joshua L Gary
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; and
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Hannon CP, Browne JA, Schwarzkopf R, Berry DJ, Abdel MP. Tips and Tricks to Save You During Revision Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00538-2. [PMID: 38823514 DOI: 10.1016/j.arth.2024.05.066] [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: 02/15/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024] Open
Abstract
The number of revision total knee arthroplasties (TKAs) performed annually continues to rise. This article is a summary of a symposium on revision TKAs presented at the 2023 American Association of Hip and Knee Surgeons annual meeting. It will provide an overview of the surgical tips and tricks for exposure and component removal, use of metaphyseal fixation and stems to manage bone loss and optimize fixation, constraint in TKA, as well as how to manage extensor mechanism disruptions with a synthetic mesh reconstruction. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - James A Browne
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Rachuene PA, Dey R, Kauta NJ, Sivarasu S, du Plessis JP, Roche S, Vrettos B. Pre-operative planning for reverse shoulder arthroplasty in low-resource centres: A modified Delphi study in South Africa. SICOT J 2024; 10:23. [PMID: 38819293 PMCID: PMC11141516 DOI: 10.1051/sicotj/2024021] [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: 04/02/2024] [Accepted: 05/04/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Pre-operative planning for reverse shoulder arthroplasty (RSA) poses challenges, particularly when dealing with glenoid bone loss. This modified Delphi study aimed to assess expert consensus on RSA planning processes and rationale, specifically targeting low-resourced institutions. Our objective was to offer pre-operative decision-making algorithms tailored for surgeons practising in resource-constrained hospitals with limited access to computed tomography (CT) scans. METHODS A working group generated statements on pre-operative imaging and glenoid of glenoid morphology and intra-operative decision-making. The study was conducted in three stages, with virtual consensus meetings in between. Stages 2 and 3 consisted only of closed questions/statements. The statements with over 70% were considered consensus achieved and those with less than 10% were considered disagreement consensus achieved. RESULTS Twelve shoulder surgeons participated, with 67% having over five years of experience in shoulder arthroplasty. In the absence of glenoid bone loss, the sole use of plain radiographs for pre-operative planning reached consensus and is recommended by these groups, while 100% advise using CT scans when bone loss is present. Most surgeons (70%) recommend using patient-specific instrumentation (PSI) in cases of structural bone loss. Most of the statements on intra-operative decision-making related to component placement and enhancing stability failed to reach consensus. CONCLUSION While consensus was achieved on most aspects of pre-operative imaging and planning, technical aspects of surgery lacked consensus. Planning for patients with structural glenoid bone loss necessitates CT scans and planning tools.
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Affiliation(s)
- Pududu Archie Rachuene
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital Cape Town South Africa
- Department of Orthopaedics, Steve Biko Academic Hospital, University of Pretoria Pretoria South Africa
| | - Roopam Dey
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital Cape Town South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town South Africa
- Biomedical Engineering Research Centre (BMERC), University of Cape Town South Africa
- Health through Physical Activity Lifestyle and Sports (HPALS), University of Cape Town South Africa
| | - Ntambue Jimmy Kauta
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital Cape Town South Africa
| | - Sudesh Sivarasu
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital Cape Town South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town South Africa
| | - Jean-Pierre du Plessis
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital Cape Town South Africa
| | - Stephen Roche
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital Cape Town South Africa
| | - Basil Vrettos
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital Cape Town South Africa
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Garaud M, Le Nail LR, Hetaimish B, Berhouet J, Samargandi R. The Gritti-Stokes Amputation: Is It Still a Reliable Technique in the 21st Century? A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:911. [PMID: 38929528 PMCID: PMC11205467 DOI: 10.3390/medicina60060911] [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: 05/10/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Lower limb amputation is a common surgical procedure performed worldwide. Many individuals require amputation due to various circumstances, with amputations occurring above or below the knee. Surgeons rely on published research to determine the most appropriate technique based on intraoperative and postoperative outcomes. The Gritti-Stokes amputation (GSA) procedure, introduced in 1857, has shown positive results in terms of primary wound healing, reduced mortality rates during and after surgery, and accelerated healing and mobility. However, due to the need for highly trained surgeons and limitations in functional and cosmetic prosthesis fitting, concerns have been raised regarding its utility. Additionally, the procedure is underutilized in cases where it could potentially yield better results. This article provides a comprehensive review of the documented benefits of GSA, suitable candidate selection, limitations, various modifications, and a comparison with traditional approaches to lower limb amputation. The review is focused on evidence published in the last 100 years.
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Affiliation(s)
- Marwan Garaud
- Service de Chirurgie Orthopédique et Traumatologique, Clinique Jeanne d’Arc, 45500 Gien, France
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France; (L.-R.L.N.); (J.B.); (R.S.)
| | - Louis-Romée Le Nail
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France; (L.-R.L.N.); (J.B.); (R.S.)
| | - Bandar Hetaimish
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia;
| | - Julien Berhouet
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France; (L.-R.L.N.); (J.B.); (R.S.)
| | - Ramy Samargandi
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France; (L.-R.L.N.); (J.B.); (R.S.)
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia;
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Gherghel R, Onu I, Iordan DA, Antohe BA, Rezus II, Alexa O, Macovei LA, Rezus E. A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation. Biomedicines 2024; 12:1164. [PMID: 38927371 PMCID: PMC11200487 DOI: 10.3390/biomedicines12061164] [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: 04/18/2024] [Revised: 04/27/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes. MATERIALS AND METHODS This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee's range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases. RESULTS Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments. CONCLUSIONS The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee.
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Affiliation(s)
- Robert Gherghel
- Department of Orthopedics and Trauma Surgery, Piatra Neamt Emergency Hospital, 700115 Piatra Neamt, Romania;
- Departments of Orthopedy and Physiotherapy, Medlife-Micromedica Clinic, 610119 Piatra Neamt, Romania
| | - Ilie Onu
- Departments of Orthopedy and Physiotherapy, Medlife-Micromedica Clinic, 610119 Piatra Neamt, Romania
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, 700454 Iasi, Romania
- Center of Physical Therapy and Rehabilitation, “Dunărea de Jos” University of Galati, 800008 Galati, Romania;
| | - Daniel Andrei Iordan
- Center of Physical Therapy and Rehabilitation, “Dunărea de Jos” University of Galati, 800008 Galati, Romania;
- Department of Individual Sports and Kinetotherapy, Faculty of Physical Education and Sport, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Bogdan Alexandru Antohe
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacau, 600115 Bacau, Romania;
| | - Ioana-Irina Rezus
- Department of Dermatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Ovidiu Alexa
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Luana Andreea Macovei
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Elena Rezus
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
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148
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Ghani T, Ahmad A, Totakhail AM, Sardar N, Ghani K, Siawash AR. A case report of primary hydatidosis of ulna and adjacent soft tissue. IDCases 2024; 37:e01994. [PMID: 38946938 PMCID: PMC11209002 DOI: 10.1016/j.idcr.2024.e01994] [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: 03/31/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
Hydatidosis, is a zoonotic disease prevalent in sheep-raising regions globally. Musculoskeletal hydatidosis is uncommon and usually remains asymptomatic over a long period. The detection of musculoskeletal hydatidosis often signifies extensive cyst spread within the bone marrow cavity, making treatment difficult with a high recurrence rate. Unlike the conventional surgical approach for visceral hydatid cysts, treating osseous hydatidosis requires a strategy akin to oncologic therapy. We report a rare case of primary hydatidosis affecting the ulna and adjacent soft tissue in a 58-year-old woman. She presented with a painless forearm mass evolving over six years, accompanied by recent onset tenderness and restricted elbow joint mobility. Imaging revealed a cystic mass in the forearm, an intra-ulnar bone lesion, and an olecranon fracture. The primary diagnosis of musculoskeletal hydatidosis was made based on clinical findings and radiological imaging. Treatment involved resection of 2/3 of the proximal ulna and pericystectomy for the soft tissue hydatid cyst. Diagnosis of musculoskeletal hydatidosis is vital for effective preoperative planning, as internal fixation often fails without eradicating the infestation. Treatment typically involves radical operation with wide excision of the affected bone and adjacent joint structures, coupled with chemotherapy. Clinicians in endemic regions should consider musculoskeletal hydatidosis in the differential diagnosis of osteolytic lesions and slow-growing cystic masses. Diagnosis relies on clinical, serological, and radiological assessments.
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Affiliation(s)
- Torgot Ghani
- Wazir Mohammad Akbar Khan Hospital, Kabul, Afghanistan
| | - Abdullah Ahmad
- Prof. Dr. Siawash Surgical Orthopaedic Hospital, Kabul, Afghanistan
| | | | | | - Kristina Ghani
- Balkh University Faculty of Medicine, Balkh, Afghanistan
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149
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Raykov G, Ivanov S, Gueorguiev B, Pastor T, Berk T, Pastor T, Zderic I. Optimizing Subtalar Arthrodesis: A Human Cadaveric Evaluation of a Novel Partially-Threaded Screw Combination in the Delta Configuration. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:844. [PMID: 38929461 PMCID: PMC11206027 DOI: 10.3390/medicina60060844] [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: 03/18/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Despite the established role of subtalar joint arthrodesis (SJA) for treatment of subtalar osteoarthritis, achieving bone union remains challenging, with up to 46% non-union rates. Adequate compression and stable fixation are crucial for successful outcomes, with internal screw fixation being the gold standard for SJA. The delta configuration, featuring highly divergent screws, offers stability, however, it can result in hardware irritation in 20-30% of patients. Solutions to solve this complication include cannulated compression screw (CCS) countersinking or cannulated compression headless screw (CCHS) application. The aim of this biomechanical study was to investigate the stability of a delta configuration for SJA utilizing either a combination of a posterior CCHS and an anterior CCS or a standard two-CCS combination. Materials and Methods: Twelve paired human cadaveric lower legs were assigned pairwise to two groups for SJA using either two CCSs (Group 1) or one posterior CCHS and one anterior CCS (Group 2). All specimens were tested under progressively increasing cyclic loading to failure, with monitoring of the talocalcaneal movements via motion tracking. Results: Initial stiffness did not differ significantly between the groups, p = 0.949. Talocalcaneal movements in terms of varus-valgus deformation and internal-external rotation were significantly bigger in Group 1 versus Group 2, p ≤ 0.026. Number of cycles until reaching 5° varus-valgus deformation was significantly higher in Group 2 versus Group 1, p = 0.029. Conclusions: A delta-configuration SJA utilizing a posterior CCHS and an anterior CCS is biomechanically superior versus a standard configuration with two CCSs. Clinically, the use of a posterior CCHS could prevent protrusion of the hardware in the heel, while an anterior CCS could facilitate less surgical time and thus less complication rates.
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Affiliation(s)
- Georgi Raykov
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Surgery, Cantonal Hospital of Uri, 6460 Altdorf, Switzerland
| | - Stoyan Ivanov
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Orthopedics and Traumatology, Saint Marina Regional Hospital, Medical University Varna, 9002 Varna, Bulgaria
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
| | - Tatjana Pastor
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3007 Bern, Switzerland
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Orthopedics, Traumatology and Reconstructive Surgery, University Hospital Aachen, 52074 Aachen, Germany
| | - Torsten Pastor
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Orthopedics and Traumatology, Luzern Regional Hospital, 6110 Wolhusen, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
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150
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Tsai CW, Chen TY, Wang JH, Young TH. Effect of Chitosan on Synovial Membrane Derived Cells and Anterior Cruciate Ligament Fibroblasts. Tissue Eng Part A 2024. [PMID: 38695112 DOI: 10.1089/ten.tea.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024] Open
Abstract
Previously, chitosan reduces the senescence-related phenotypes in human foreskin fibroblasts through the transforming growth factor beta (TGF-β) pathway, and enhances the proliferation and migration capabilities of these cells are demonstrated. In this study, we examined whether the senescence-delaying effect of chitosan could be applied to primary knee-related fibroblasts, such as human synovial membrane derived cells (SCs) and anterior cruciate ligament fibroblasts (ACLs). These two types of cells were obtained from donors who needed ACL reconstruction or knee replacement. We found that chitosan treatment effectively reduced aging-associated β-galactosidase (SA-β-gal)-positive cells, downregulated the expression of senescence-related proteins pRB and p53, and enhanced the 5-bromo-2'-deoxyuridine (BrdU) incorporation ability of SCs and ACLs. Moreover, chitosan could make SCs secret more glycosaminoglycans (GAGs) and produce type I collagen. The ability of ACLs to close the wound was also enhanced, and the TGF-β and alpha smooth muscle actin (αSMA) protein expression decreased after chitosan treatment. In summary, chitosan not only delayed the senescence but also enhanced the functions of SCs and ACLs, which is beneficial to the application of chitosan in cell expansion in vitro and cell therapy.
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Affiliation(s)
- Ching-Wen Tsai
- Department of Biomedical Engineering , National Taiwan University, Taipei, Taiwan
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu, Taiwan
| | - Tzung-Yu Chen
- Department of Biomedical Engineering , National Taiwan University, Taipei, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Horng Young
- Department of Biomedical Engineering , National Taiwan University, Taipei, Taiwan
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