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Chatterji R, Foote J, Fry M, Erwin A, Crutcher J, Kesto W. Simulated subacromial injection instruction improves accuracy and skill level: a model for musculoskeletal procedural training. BMC MEDICAL EDUCATION 2024; 24:535. [PMID: 38745152 PMCID: PMC11094937 DOI: 10.1186/s12909-024-05456-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Musculoskeletal (MSK) complaints often present initially to primary care physicians; however, physicians may lack appropriate instruction in MSK procedures. Diagnostic and therapeutic injections are useful orthopedic tools, but inaccuracy leads to unnecessary costs and inadequate treatment. The authors hypothesized that trainees afforded the opportunity to practice on a cadaver versus those receiving visual-aided instruction on subacromial injections (SAI) will demonstrate differences in accuracy and technique. METHODS During Spring of the year 2022, 24 Internal Medicine and Family Medicine residents were randomly divided into control and intervention groups to participate in this interventional randomized cadaveric study. Each group received SAI instruction via lecture and video; the intervention group practiced on cadavers under mentored guidance. Subjects underwent a simulated patient encounter culminating in injection of latex dye into a cadaveric shoulder. Participants were evaluated based on a technique rubric, and accuracy of injections was assessed via cadaver dissection. RESULTS Twenty-three of twenty-four participants had performed at least one MSK injection in practice, while only 2 (8.3%) of participants had performed more than 10 SAIs. There was no difference in technique between control 18.4 ± 3.65 and intervention 19.2 ± 2.33 (p = 0.54). Dissections revealed 3 (25.0%) of control versus 8 (66.7%) of intervention injections were within the subacromial space. Chi-Square Analysis revealed that the intervention affected the number of injections that were within the subacromial space, in the tissues bordering the subacromial space, and completely outside the subacromial space and bordering tissues (p = 0.03). The intervention group had higher self-confidence in their injection as opposed to controls (p = 0.04). Previous SAI experience did not affect accuracy (p = 0.76). CONCLUSIONS Although primary care physicians and surgeons develop experience with MSK procedures in practice, this study demonstrates a role for early integrated instruction and simulation to improve accuracy and confidence. The goal of improving accuracy in MSK procedures amongst all primary care physicians may decrease costs and avoid unnecessary referrals, diagnostic tests, and earlier than desired surgical intervention.
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Affiliation(s)
- Rishi Chatterji
- Department of Orthopedic Surgery, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA.
| | - Jake Foote
- Department of Orthopedic Surgery, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
| | - Mike Fry
- Department of Orthopedic Surgery, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
| | - Ashley Erwin
- Department of Family Medicine, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
| | - Joe Crutcher
- Simulation and Education Center Van Eslander Surgical Innovation Center, Ascension Providence Hospital - MSU, Novi, MI, USA
| | - William Kesto
- Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
- The Core Institute, Novi, MI, USA
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Aydin M, Capkin S, Surucu S, Karahasanoglu R, Yilmaz M. The effect of biceps tenotomy on superior humeral migration in arthroscopic repaired full-thickness supraspinatus tears. JSES Int 2023; 7:768-773. [PMID: 37719819 PMCID: PMC10499908 DOI: 10.1016/j.jseint.2023.05.012] [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] [Indexed: 09/19/2023] Open
Abstract
Background Lesions of the long head of the biceps (LHB) tendon are a prevalent injury that frequently coexists with rotator cuff injuries. This study aimed to assess the effect of supraspinatus (SST) repair with concurrent LHB tenotomy on superior migration of the humeral head. The acromiohumeral distance (AHD) was determined via ultrasound to evaluate the superior migration of the humeral head. Methods The study population was retrospectively recruited from patients who underwent unilateral arthroscopic repair of isolated degenerative full-thickness SST tears between January 2017 and December 2019. Patients were divided into 2 subgroups based on whether they underwent LHB tenotomies during arthroscopy. While 37 patients underwent arthroscopic single-row SST repair, the other 33 patients underwent arthroscopic single-row SST repair with LHB tenotomy. The subject group consisted of people who had undergone arthroscopic shoulder surgery. Contralateral shoulders without rotator cuff injuries were included in the control group. The AHD and SST thicknesses of patients were examined via the ultrasound in both groups and subgroups. Results The mean age in the SST repair group was 55.52 ± 4.58 years (range, 46-63 years), whereas it was 58.24 ± 3.98 (range, 52-73 years) in the SST repair + LHB tenotomy group. In the SST repair group, 57.6% of patients were female and 42.4% were male, whereas 56.8% and 43.2% were in the SST repair + LHB tenotomy group, respectively. The mean body mass index was 28.06 ± 1.31 kg/m2 (range, 25.7-31.2 kg/m2) in the SST repair group and 28.95 ± 1.79 kg/m2 in the SST repair + LHB tenotomy group. Groups were not different for sex, surgery side, dominant side, tear size, and follow-up time; however, the SST repair + LHB tenotomy group had significantly higher mean age and body mass index than the SST repaired group. The mean AHD value and SST thickness were significantly less in both the rotator cuff repair group and the rotator cuff repair + LHB tenotomy group compared to the healthy shoulder. The mean AHD value was significantly lower in the SST repaired + LHB tenotomy group than in the SST repair group (P = .02). Conclusion The AHD was narrowed in patients who underwent LHB tenotomy and radiologically demonstrated the depressor effect of the LHB tendon on the humeral head. As a secondary outcome, we demonstrated that regardless of tenotomy, AHD could not be restored in patients who underwent arthroscopic single-row SST repair.
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Affiliation(s)
- Mahmud Aydin
- Department of Orthopaedics, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Sercan Capkin
- Department of Orthopaedics, Aksaray Universty Education Research Hospital, Aksaray, Turkey
| | - Serkan Surucu
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Ridvan Karahasanoglu
- Department of Orthopaedics, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Murat Yilmaz
- Department of Orthopaedics, Haseki Training and Research Hospital, İstanbul, Turkey
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Kizilay YO, Güneş Z, Turan K, Aktekin CN, Uysal Y, Kezer M, Camurcu Y. Volumetric Analysis of Subacromial Space After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Indian J Orthop 2023; 57:967-974. [PMID: 37214362 PMCID: PMC10192490 DOI: 10.1007/s43465-023-00881-y] [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: 09/09/2021] [Accepted: 03/24/2023] [Indexed: 05/24/2023]
Abstract
Purpose Subacromial volume measurement on magnetic resonance images is relatively new. It has been shown that decreased subacromial volume increases after surgical repair of full-thickness rotator cuff tears. There is no study examining subacromial volume changes after superior capsular reconstruction (SCR). The purpose of this study was to compare subacromial volume changes on magnetic resonance images (MRI) after superior capsular reconstruction performed for primary irreparable rotator cuff tears. Methods Patients who underwent an SCR procedure between 2017 and 2019 with a minimum 2-year postoperative follow-up were included in this retrospective study. Subacromial volume was measured on MRI using software. The preoperative and postoperative acromiohumeral distance, Constant Scores, graft thickness, and Hamada grades of the patients were evaluated. Results A total of 18 patients with a mean age of 59.7 years (range: 49-74 years) underwent an SCR for massive irreparable cuff tear. The mean preoperative subacromial volume was 3.54 ± 0.39 cm3 (range 2.88-4.36 cm3), which increased to 4.46 ± 0.39 cm3 (range 3.75-5.32 cm3) postoperatively (p = < 0.001). The increase in subacromial volume and acromiohumeral distance did not correlate with Constant scores and graft thickness. We observed a significantly higher subacromial volume increase among Hamada grade 1 patients, compared to those with Hamada grade 2 (p = 0.011). Conclusions We observed that subacromial volume significantly increased after superior capsular reconstruction. However, the increase in subacromial volume did not correlate with clinical scores, acromiohumeral distance changes, or graft thickness.Level of evidence: Level III - Retrospective Cohort Study.
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Affiliation(s)
- Yusuf Onur Kizilay
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Anadolu Caddesi 40, Kagithane, 34408 Istanbul, Turkey
| | - Zafer Güneş
- Ankara, Turkey Department of Orthopedics and Traumatology, Ankara Training and Research Hospital
| | - Kayhan Turan
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
| | - Cem Nuri Aktekin
- Ankara, Turkey Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University
| | - Yunus Uysal
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Murat Kezer
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Yalkin Camurcu
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
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Yang C, Xie C, Liu H, Hua Z, An B. Mechanical mechanism of suture passer needle break in rotator cuff repair. Front Surg 2022; 9:1065666. [PMID: 36601437 PMCID: PMC9806767 DOI: 10.3389/fsurg.2022.1065666] [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: 10/10/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Suture passer needle, as one of commonly used instrument in the arthroscopic rotator cuff repair, often breaks at the notch of the needle, which originally was designed to facilitate suture with thread. Our study aimed to evaluate the suture failure rate and stitch success rate between intact suture needle and broken needle and explore the mechanism of the needle breakage and achieving better future designs. Materials and methods From 2017 to 2021, consecutive 437 shoulders (11 cases were bilateral) underwent arthroscopic repair for full-thickness rotator cuff tear at the authors' institution. The breakage of needles was recorded. Finite elements analysis and mechanical test were utilized to compare stress distribution, puncture performance, and loaded puncture performance between the broken needle and the intact needle. Results We identified 19 consecutive patients for whom the needle tip of the TruePass™ suture passer was broken in the 437 shoulder surgeries. Based on the finite element analysis of Abaqus, around the tip and the notch of the intact needle was a large stress concentration. The average puncture force required by intact needle tip and the broken tip is 61.78N and 78.23N respectively. While the intact tip with notch is easier to break than the broken tip. Conclusions The notch of the needle is a weak point in mechanics. The broken needle without the notch still has good tendon piercing and thread passing ability. The notch of needle may be not necessary, and the tip of the needle should be modified.
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Affiliation(s)
- Chunxi Yang
- Department of Bone and Joint Surgery, Department of Orthopedic, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence: Chunxi Yang Zikai Hua Bingchen An
| | - Cheng Xie
- Department of Rehabilitation Medicine, Huadong Hospital, Fudan University, Shanghai, China,The second rehabilitation Hospital of Shanghai, Shanghai, China
| | - Hui Liu
- Orthotek Laboratory ACAD, School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China
| | - Zikai Hua
- Orthotek Laboratory ACAD, School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China,Correspondence: Chunxi Yang Zikai Hua Bingchen An
| | - Bingchen An
- Department of Rehabilitation Medicine, Huadong Hospital, Fudan University, Shanghai, China,Correspondence: Chunxi Yang Zikai Hua Bingchen An
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Wang D, Zhang X, Ng KW, Rao Y, Wang C, Gharaibeh B, Lin S, Abrams G, Safran M, Cheung E, Campbell P, Weiss L, Ker DFE, Yang YP. Growth and differentiation factor-7 immobilized, mechanically strong quadrol-hexamethylene diisocyanate-methacrylic anhydride polyurethane polymer for tendon repair and regeneration. Acta Biomater 2022; 154:108-122. [PMID: 36272687 DOI: 10.1016/j.actbio.2022.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
Biological and mechanical cues are both vital for biomaterial aided tendon repair and regeneration. Here, we fabricated mechanically tendon-like (0 s UV) QHM polyurethane scaffolds (Q: Quadrol, H: Hexamethylene diisocyanate; M: Methacrylic anhydride) and immobilized them with Growth and differentiation factor-7 (GDF-7) to produce mechanically strong and tenogenic scaffolds. In this study, we assessed QHM polymer cytocompatibility, amenability to fibrin-coating, immobilization and persistence of GDF-7, and capability to support GDF-7-mediated tendon differentiation in vitro as well as in vivo in mouse subcutaneous and acute rat rotator cuff tendon resection models. Cytocompatibility studies showed that QHM facilitated cell attachment, proliferation, and viability. Fibrin-coating and GDF-7 retention studies showed that mechanically tendon-like 0 s UV QHM polymer could be immobilized with GDF-7 and retained the growth factor (GF) for at least 1-week ex vivo. In vitro differentiation studies showed that GDF-7 mediated bone marrow-derived human mesenchymal stem cell (hMSC) tendon-like differentiation on 0 s UV QHM. Subcutaneous implantation of GDF-7-immobilized, fibrin-coated, QHM polymer in mice for 2 weeks demonstrated de novo formation of tendon-like tissue while implantation of GDF-7-immobilized, fibrin-coated, QHM polymer in a rat acute rotator cuff resection injury model indicated tendon-like tissue formation in situ and the absence of heterotopic ossification. Together, our work demonstrates a promising synthetic scaffold with human tendon-like biomechanical attributes as well as immobilized tenogenic GDF-7 for tendon repair and regeneration. STATEMENT OF SIGNIFICANCE: Biological activity and mechanical robustness are key features required for tendon-promoting biomaterials. While synthetic biomaterials can be mechanically robust, they often lack bioactivity. To biologically augment synthetic biomaterials, numerous drug and GF delivery strategies exist but the large tissue space within the shoulder is constantly flushed with saline during arthroscopic surgery, hindering efficacious controlled release of therapeutic molecules. Here, we coated QHM polymer (which exhibits human tendon-to-bone-like biomechanical attributes) with fibrin for GF binding. Unlike conventional drug delivery strategies, our approach utilizes immobilized GFs as opposed to released GFs for sustained, localized tissue regeneration. Our data demonstrated that GF immobilization can be broadly applied to synthetic biomaterials for enhancing bioactivity, and GDF-7-immobilized QHM exhibit high clinical translational potential for tendon repair.
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Affiliation(s)
- Dan Wang
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromuscular Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
| | - Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Ng
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ying Rao
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chenyang Wang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Burhan Gharaibeh
- Department of Biological Sciences, University of Pittsburgh, 4249 Fifth Avenue, Pittsburgh, PA 15260, USA
| | - Sien Lin
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Geoffrey Abrams
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - Marc Safran
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - Emilie Cheung
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - Phil Campbell
- Engineering Research Accelerator, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Lee Weiss
- Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Engineering Research Accelerator, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Dai Fei Elmer Ker
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromuscular Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China.
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Department of Material Science and Engineering, Stanford University, 496 Lomita Mall, Stanford, CA 94305, USA; Department of Bioengineering, Stanford University, 443 Via Ortega, Stanford, CA 94305, USA.
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宁 梓, 施 政, 杨 光, 钟 瑞, 余 鸿, 王 扬, 王 国, 李 彦. [Evaluation methods of postoperative healing of supraspinatus tendon tear]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1172-1177. [PMID: 36111482 PMCID: PMC9626287 DOI: 10.7507/1002-1892.202206054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
Objective To summarize the evaluation methods of postoperative healing of supraspinatus tendon tear in recent years, in order to provide reference for clinic. Methods CNKI, Wanfang, PubMed, and Foreign Medical Literature Retrieval Service (FMRS) databases were used to search the literatures between 2005 and 2022. The literature related to the diagnosis and postoperative healing of supraspinatus tendon tear was included. Finally, 50 articles were reviewed. Results Supraspinatus tendon tear is a common shoulder disease. Physical examination, clinical score, and imaging examination are used to predict and evaluate the postoperative healing. Among them, physical examination and clinical score are non-invasive and the most economical methods, but their accuracy and sensitivity are lower than imaging examination, so they can only be used as auxiliary methods. The acromio-humeral distance (AHD) and upward migration index (UMI) measured by X-ray films can directly reflect the change of supraspinatus tendon thickness, but they are impossible to distinguish whether there is tear or not. Ultrasound and MRI are the main methods for the clinical diagnosis of supraspinatus tendon tear, but the commonly used MRI sequence can not accurately judge the internal healing of the tendon. Shear wave elastrography (SWE) and ultrashort-echo-time (UTE) techniques are the latest research directions in recent years, but different studies have shown opposite conclusions on the application of SWE technique. This conclusion shows that the principle of SWE technique and its relationship with tendons need to be further studied. UTE technique has good clinical effect, and the T2* value obtained by UTE technique is more accurate than that of traditional Sugaya typing, but there are still few research samples. Conclusion AHD and UMI measured by X-ray film and T2* value measured by UTE technique can be used as effective methods for evaluating the healing of supraspinatus tendon tear after repairing, and can be used as a follow-up evaluation method combined with physical examination and clinical score for patients with supraspinatus tendon tear.
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Affiliation(s)
- 梓文 宁
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 政良 施
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 光 杨
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 瑞颖 钟
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 鸿 余
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 扬 王
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 国梁 王
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 彦林 李
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
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Kocadal O, Tasdelen N, Yuksel K, Ozler T. Volumetric evaluation of the subacromial space in shoulder impingement syndrome. Orthop Traumatol Surg Res 2022; 108:103110. [PMID: 34649000 DOI: 10.1016/j.otsr.2021.103110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/06/2020] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Shoulder impingement syndrome is evaluated radiologically with two-dimensional measurement parameters. None of these measurement parameters accurately reflect the three-dimensional geometry. The purpose of this study was to evaluate the volumetric status of the subacromial space in patients with shoulder impingement syndrome and to investigate its relationship with two-dimensional parameters. HYPOTHESIS The primary hypothesis of this study is that subacromial volume is reduced in patients with impingement syndrome. The second hypothesis is that the sagittal plane morphology of the acromion reflects the subacromial volume better than the coronal plane morphology. PATIENTS AND METHODS This retrospective study consisted of a total of 52 participants: 26 patients with impingement syndrome and 26 controls. Volumetric measurements were performed with using magnetic resonance imaging. The relationship between humerus and acromion was evaluated by acromiohumeral distance. The sagittal plane morphology of the acromion was evaluated with an objective acromial angle, while the coronal plane morphology was evaluated with a lateral acromial angle. The radiological parameters between groups were compared. RESULTS The mean subacromial volume was significantly smaller in the impingement group compared to the control group (p=0.01). The subacromial volume had a negative correlation with the objective acromial angle (R=-0.46; p=0.01) The mean tendon volume was significantly higher in the impingement group (p<0.001). The mean acromiohumeral distance in the impingement group (6.8mm±1.0mm), was calculated to be significantly lower than the control group (10.1mm±1.5mm) (p<0.001). There was a positive moderate correlation between subacromial volume and acromiohumeral distance (R=0.61; p=0.01). DISCUSSION This is the first study to demonstrate a reduction in subacromial volume in patients with impingement syndrome. The sagittal plane morphology of the acromion, rather than the coronal plane, appears to be more closely related to the subacromial volume. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Onur Kocadal
- Yeditepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Neslihan Tasdelen
- Yeditepe University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Korcan Yuksel
- Bayindir Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Turhan Ozler
- Yeditepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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Nizam Siron K, Mat Lani MT, Low CL, Kow RY. Arthroscopic Subacromial Decompression in the Treatment of Shoulder Impingement Syndrome: A Prospective Study in Malaysia. Cureus 2021; 13:e19254. [PMID: 34900455 PMCID: PMC8648140 DOI: 10.7759/cureus.19254] [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] [Accepted: 11/03/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Shoulder impingement syndrome (SIS) is one of the common problems which lead to shoulder disabilities. This condition has been described as impingement to the rotator cuff by the anterior third of the acromion process and has been classified into three stages. Treatment option varies depending on the grade of the disease. Arthroscopic subacromial decompression (ASAD) has become more popular in recent years and has shown to have a good outcome. The purpose of this study is to evaluate the outcomes following ASAD in terms of the functional, clinical, and radiological parameters in treating SIS in the ageing population in Kuantan, Pahang, Malaysia. Materials and methods This was an observational study looking at the outcomes of patients with stage 2 and stage 3 (partial cuff tear) impingement syndrome who underwent ASAD in Hospital Tengku Ampuan Afzan and International Islamic University Malaysia Medical Centre from May 2018 to June 2019. The functional outcomes were evaluated using American Shoulder and Elbow Surgeons (ASES) score taken at pre-operative, six weeks, three months, and six months post-operation. Clinical outcomes were evaluated using Constant score (CS) taken at six months post-operation. Radiological outcomes were measured by comparing acromiohumeral distance pre- and post-operation on anteroposterior (AP) view radiograph of the affected shoulder. Results A total of 28 patients were selected for the study. On functional outcome, there was a significant effect of time on the ASES scoring system (p-value <0.05) from pre-operative to six months post-operation. On clinical outcome, the CS at six months showed 13 patients have excellent scores, 10 have good, and five have fair scores. There was a statistically significant difference in mean values of all categories (p-value <0.05). In terms of the radiological outcome, this study observed a significant increase in patients’ subacromial space on X-ray from the pre-operative and post-operative treatment stages. In this study, we also observed that there was no significant difference in outcomes between partial and intact rotator cuff (RC) tears at six-month post-operation. Conclusion In this study, ASAD was found to be a beneficial intervention in the treatment of patients with shoulder impingement evidenced by the significant outcomes in terms of functional, clinical, and radiological parameters.
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Affiliation(s)
- Khairul Nizam Siron
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Muhamad Taufik Mat Lani
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Chooi Leng Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
| | - Ren Yi Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
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Song HE, Oh KS, Yoon JP, Lee DR, Baek S, Chung SW. Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression. Knee Surg Sports Traumatol Arthrosc 2021; 29:3961-3970. [PMID: 34312711 DOI: 10.1007/s00167-021-06681-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre- and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors. METHODS Thirty-five patients (mean age, 62.5 ± 8.4 years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre-existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < - 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups. RESULTS Twenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037). CONCLUSION The prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Han Eui Song
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, College of Medicine, Kyungpook University, Daegu, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea.
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How to Insert Acupuncture Needles into the Subacromial Space through LI15. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2021.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
LI15 is an important acupuncture point to treat shoulder pain. There are 4 needling methods for LI15 in the textbook; 1 method requires the insertion of the needle horizontally between the acromion and the great tuberosity of the humerus with the arm lowered for supraspinatus tendonitis. This method is also applicable for all conditions of rotator cuff disease, but it has not previously been described in detail. Providing X-ray scans and describing needle direction and depth of insertion will provide evidence for needling with the arm down as an effective stimulation of the subacromial space. Firstly, for this technique, with the arm raised, a concave point is located between the front edge of the acromion and the humerus, and the lower upper arm. Secondly, the acupuncture needle is inserted slightly posteriorly towards the supraspinous fossa, in the direction of the supraspinatus tendon and to a depth of 30-40 mm.
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Turan K, Çabuk H, Köroğlu C, Öztürk Ç. Increased acromiohumeral distance in a double-row arthroscopic rotator cuff surgery compared to a single-row surgery after 12 months. J Orthop Surg Res 2021; 16:385. [PMID: 34134739 PMCID: PMC8207657 DOI: 10.1186/s13018-021-02523-1] [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: 04/28/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Arthroscopic rotator cuff surgery is an effective treatment for rotator cuff tears with the considered use of double-row repair techniques becoming popular in the last decade. We aim to compare the effects of double- and single-row arthroscopic rotator cuff repairs (ARCR) on repair integrity (RI) and acromiohumeral distance (AHD). Methods In this observational study, we retrospectively identified 98 patients with degenerative rotator cuff tear treated with arthroscopic rotator cuff repair between 2016 and 2019. We excluded 22 patients with partial-thickness tears, 15 with associated subscapularis or SLAP tears, 13 with massive tears, and 5 patients lost to follow-up; we included 43 patients who had ARCR for full-thickness cuff tear and clinical, radiologic follow-up. Of these 43 patients, 23 are grouped as double-row repair group (DRG) and 20 as single-row repair group (SRG). A minimum of 12 months after the surgery, bilateral shoulder MRIs were obtained. Contralateral shoulders without asymptomatic rotator cuff tears served as a control group (CG). The operating surgeon and two other surgeons experienced in arthroscopy blindly measured the AHD and determined the RI at the control MRIs in all groups. Functional assessments relied on UCLA and qDASH Scores. Results The mean age was 57.89 (45–78) years, and the mean follow-up time was 28,65 (21–43) months. The mean AHD of the CG was 9.7 ± 0.96 mm, the preoperative AHD of DRG was 8.62 ± 1.45 mm, and SRG was 9.71 ± 0.95 mm. The postoperative mean AHD of DRG 9.61 ± 1.83 mm and SRG was 10.21 ± 1.97 mm. AHD differences between the preoperative and postoperative groups were significant (P=0.009). The increase of the AHD in the double-row group was significantly higher than the single-row group (P=0.004). There was a high correlation between the RI and DASH scores (P=0.005). RI did not correlate with the repair method (P=0.580). Conclusion Although double-row repairs can maintain greater AHD than single-row repairs in the clinical setting, this difference did not affect functional results. Regardless of the surgical intervention, functional results are favourable if RI is achieved. Level of evidence Level III, Retrospective Cohort Study
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Affiliation(s)
- Kaya Turan
- Department of Orthopedics and Traumatology, Medicine Faculty of Istinye University, Aşık Veysel Mah. No:1 Istinye University Liv Hospital Esenyurt, İstanbul, Turkey.
| | - Haluk Çabuk
- Department of Orthopedics and Traumatology, Medicine Faculty of Istinye University, Aşık Veysel Mah. No:1 Istinye University Liv Hospital Esenyurt, İstanbul, Turkey
| | - Cenk Köroğlu
- Department of Orthopaedics and Traumatology, Tekirdag Ismail Fehmi Cumalıoglu City Hospital, Eski Cami Mah, Hastane Sk. No:1 Suleymanpasa, Tekirdağ, Turkey
| | - Çağatay Öztürk
- Department of Orthopedics and Traumatology, Medicine Faculty of Istinye University, Aşık Veysel Mah. No:1 Istinye University Liv Hospital Esenyurt, İstanbul, Turkey
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Kholinne E, Kwak JM, Sun Y, Kim H, Park D, Koh KH, Jeon IH. The relationship between rotator cuff integrity and acromiohumeral distance following open and arthroscopic rotator cuff repair. SICOT J 2021; 7:23. [PMID: 33812470 PMCID: PMC8019552 DOI: 10.1051/sicotj/2021012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/20/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Acromiohumeral distance (AHD) has become both a diagnostic and prognostic parameter related to rotator cuff pathology which is always measured in a 2-dimensional plane. The purposes of this study were (1) to evaluate the regional AHD with MRI following open and arthroscopic rotator cuff repair and, (2) to investigate its association to the rotator cuff integrity following medium to large size rotator cuff repair with open and arthroscopic manner. Methods: A retrospective review of 112 patients who were treated for full-thickness medium to large size rotator cuff tears either by open repair (open group) or arthroscopic repair (arthroscopic group) was done. All patients included in the study are those with at least 12 and 18 months for the post-operative MRI and clinical follow-up. Propensity score matching was used to select controls matched for age, sex, body mass index, tear size, and affected site. There were 56 patients in each group with a mean age of 63.3 years (range, 50 to 77 years). The post-operative functional and radiologic outcomes for both groups were compared. AHD was measured at three regions of interest (ROI) with MRI and compared pre-and post-operatively. Results: AHD was significantly greater in the open group when measured at the anterior third of the lateral acromion border compare to the arthroscopic group (p = 0.005). The re-tear rate was affected by AHD at the anterior third of the lateral border of the acromion for the arthroscopic and open group (p = 0.021, p = 0.029). The AHD measured at the anterior and middle third of lateral acromion border were significantly greater in healed compared to the re-tear rotator cuff group (p = 0.019, p = 0.022). Conclusions: Open rotator cuff repair showed greater AHD at the anterior third of the lateral border of the acromion. Regional AHD measured at anterior third of the lateral border of acromion significantly associated with rotator cuff integrity following repair. Level of evidence: propensity-matched case-control (Level II)
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Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, Trisakti University, Department of Orthopedic Surgery, St. Carolus Hospital, 11440 Jakarta, Indonesia - Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, 05505 Seoul, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, 05505 Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, 226001 Jiangsu, PR China
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, 05505 Seoul, Republic of Korea
| | - Dongjun Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, 05505 Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, 05505 Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, 05505 Seoul, Republic of Korea
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Chuang HC, Hong CK, Hsu KL, Kuan FC, Chiang CH, Chen Y, Su WR. Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears. JSES Int 2020; 5:77-82. [PMID: 33554169 PMCID: PMC7846697 DOI: 10.1016/j.jseint.2020.09.015] [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] [Indexed: 11/01/2022] Open
Abstract
Background Degenerative signs on shoulder radiographs, including spur formation and narrow acromiohumeral intervals (AHIs), have been recognized as indicative of atrophic and fat-infiltrated rotator cuff muscles. Past studies have demonstrated that patients with poor quality muscles are prone to retraction of the supraspinatus tendon and failure to repair. However, the association between radiographic signs and tendon retraction has never been elucidated in previous literature. The present study aimed to investigate the association between the degenerative signs on shoulder radiographs and the severity of supraspinatus retraction. Methods Images of 67 individuals, who had undergone an arthroscopic rotator cuff repair, were retrospectively reviewed. The greater tuberosity (GT) morphology, subacromial spur, AHI, and acromial thickness were evaluated on the radiographs, whereas the retraction of the supraspinatus tendon was assessed via an MRI in accordance with the Patte classification. Simple regression analyses between the radiographic signs and Patte stages were performed, and factors reaching statistical significance were then included in the multiple ordinal logistic regression. Statistically significant predictors from the multiple regression analysis were constructed into combinations, for which the sensitivity and specificity were calculated. Results The GT morphology (P = .004), AHI (P = .083), subacromial spur (P = .008), and age (P = .004) were associated with supraspinatus retraction in the simple regression analyses. These four parameters were incorporated into the multiple ordinal logistic regression, where the GT spur (adjusted odds ratio 8.63, 95% confidence interval 2.16-34.53, P = .002) and AHI (AOR 0.79, 95% CI 0.63-0.98, P = .032) were demonstrated to be predictive of the Patte stage of supraspinatus retraction. The acromial spur implied a higher risk of severe retraction although this finding was not statistically significant (AOR 2.89, 95% CI 0.90-9.29, P = .075). The presence of concurrent GT spur and narrow AHI was highly specific (sensitivity 27.3% / specificity 91.1%) for advanced supraspinatus retraction. Conclusion The presence of a radiographic GT spur, narrow AHI, and subacromial spur indicated advanced retraction of the supraspinatus tendon. When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Hao Chiang
- Department of Orthopaedic Surgery, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.,Musculoskeletal Reserach Center, National Cheng Kung University, Tainan, Taiwan
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