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Lopez R, Singh J, Ghoraishian M, Nicholson T, Gates S, Namdari S. Anatomic factors associated with degeneration and fraying of the coracoacromial ligament. Clin Shoulder Elb 2024; 27:26-31. [PMID: 38147873 PMCID: PMC10938016 DOI: 10.5397/cise.2023.00661] [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: 07/25/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND The coracoacromial ligament (CAL) is frequently observed to be damaged during arthroscopy and it is unclear how demographic, anatomic, and radiographic factors are related to CAL degeneration in full-thickness rotator cuff tears. METHODS A prospective study was conducted of patients at a single institution undergoing shoulder arthroscopy for first-time, full-thickness rotator cuff tears. We evaluated preoperative anteroposterior radiographs to obtain critical shoulder angle, glenoid inclination, acromial index, acromiohumeral distance, lateral acromial angle, and acromial morphology. We documented CAL quality, rotator cuff tear size and pattern during arthroscopy. Multiple logistic regression was used to identify predictive factors for encountering severe CAL fraying during arthroscopy. RESULTS Shoulders had mild CAL degeneration in 58.1% of cases, whereas severe CAL degeneration was present in 41.9% of shoulders. Patients with severe CAL attrition were significantly older (62.0 years vs. 58.0 years, P=0.042). Shoulders with severe CAL attrition had large rotator cuff tears in 54.1% of cases (P<0.001), and tears involving the infraspinatus (63.2% vs. 29.6%, P=0.003). The severe degeneration group was more likely to have a larger critical shoulder angle measurement on preoperative radiographs than those in the mild attrition group (36.1°±3.6° [range, 30°-45°] vs. 34.1°±3.8° [range, 26°-45°], P=0.037). CONCLUSIONS While the clinical impact of CAL degeneration remains uncertain, increased severity of CAL degeneration is associated with older age, larger rotator cuff tear size, presence of infraspinatus tearing, and increased preoperative critical shoulder angle. Level of evidence: III.
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Affiliation(s)
- Ryan Lopez
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaspal Singh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mohammad Ghoraishian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Thema Nicholson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen Gates
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Effect of the Critical Shoulder Angle on the Efficacy of Ultrasound-Guided Steroid Injection for Subacromial Bursitis. J Pers Med 2022; 12:jpm12111879. [PMID: 36579587 PMCID: PMC9692981 DOI: 10.3390/jpm12111879] [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: 09/17/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The critical shoulder angle (CSA) is associated with impingement and rotator cuff lesions, and ultrasound-guided corticosteroid injection is effective for subacromial bursitis. However, because the efficacy of this treatment varies, this study investigated the effect of the CSA on the efficacy of corticosteroid injection in the subacromial space. Patients who received a diagnosis of subacromial bursitis after a clinical physical examination and ultrasound were enrolled prospectively from May 2019 to December 2021. Patients’ baseline variables and CSAs were assessed before intervention. Patients’ shoulder pain and disability index (SPADI), visual analog scale (VAS), and shoulder joint range of motion (ROM) scores were assessed at 2, 6, and 12 weeks after ultrasound-guided corticosteroid injection. All participants were divided into CSA > 38° and CSA ≤ 38° groups. We conducted the intragroup and intergroup comparisons of the variables and performed Pearson analysis to identify potential correlations between the CSA and outcome parameters. A total of 55 patients were enrolled in this study. Of these, 28 were included in the CSA > 38° group and 27 in the CSA ≤ 38° group. The baseline variables of the two groups did not differ. In the intragroup and intergroup comparisons, although VAS, SPADI, and ROM scores improved up to 12 weeks after intervention, no difference was identified between groups. The Pearson analysis revealed a positive correlation (r = 0.30, p = 0.024) between the CSA and VAS scores before the intervention. However, no correlation was found between the CSA and follow-up parameters. The CSA was not associated with the clinical efficacy of ultrasound-guided corticosteroid injection for subacromial bursitis.
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Fan L, Song C, Lu X, Wang T, Han J, Guo R. In situ preparation of hydroxyapatite in lamellar liquid crystals for joint lubrication and drug delivery. SOFT MATTER 2022; 18:7859-7865. [PMID: 36200686 DOI: 10.1039/d2sm01105k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Arthritis is a disease that seriously affects the quality of human life, which is partly caused by the reduction of joint lubrication performance. Thus, for the treatment of arthritis, how to improve the lubrication performance of joints is important. The lamellar liquid crystals (LLCs) systems have the potential to be used as joint lubrication due to their double-layer structure and good biocompatibility, however, the LLCs system alone could not provide a satisfactory lubrication effect. Herein, this work synthesized hydroxyapatite (HAP) in situ inside Tween 85/Tween 80/H2O LLCs to construct a biocompatible HAP/Tween 85/Tween 80/H2O LLCs (HAP/LLCs) lubrication system with both sustained drug release properties and anti-wear properties. HAP is the main component of bone with good stability and bioactivity. The LLCs have good lubricating and drug-carrying properties. The impact of HAP on the structure and lubrication properties of LLCs, the mechanism of friction, and the anti-wear reduction of HAP/LLCs were investigated. Moreover, the drug release behavior of the ibuprofen-loaded HAP/LLCs during the friction process was also studied. The results indicated that the addition of HAP could improve the lubricity performance of LLCs. The cumulative drug releasing increased with the friction frequency and was less affected by the load. The related studies provided the theoretical basis for HAP/LLCs for joint lubrication and synergistic therapy.
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Affiliation(s)
- Lei Fan
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, P. R. China.
| | - Chao Song
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, P. R. China.
| | - Ximing Lu
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, P. R. China.
| | - Tong Wang
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, P. R. China.
| | - Jie Han
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, P. R. China.
| | - Rong Guo
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002, P. R. China.
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Yıldız AE, Yaraşır Y, Huri G, Aydıngöz Ü. Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI. Orthop J Sports Med 2022; 10:23259671221109522. [PMID: 35982832 PMCID: PMC9380228 DOI: 10.1177/23259671221109522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Suboptimal positioning on Grashey view radiographs may limit the
prognosticating potential of the critical shoulder angle (CSA) for shoulder
disorders. Purpose: To investigate whether radiography optimized according to the latest research
is reliable for measuring CSA in comparison with magnetic resonance imaging
(MRI) featuring 3-dimensional (3D) zero echo time (ZTE) sequencing, which
accentuates the contrast between cortical bone and surrounding soft tissue
with high fidelity. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with shoulder pain were prospectively and consecutively enrolled.
All patients had Grashey view radiographs as well as 3.0-T MRI scans with
isotropic 3D ZTE sequencing. Acceptable positioning on the radiographs was
determined using the ratio of the transverse to longitudinal (RTL) diameter
of the lateral glenoid outline; radiographs with an RTL ≥0.25 were repeated.
Two observers independently measured the CSA on the radiographs and the
coronal oblique reformatted ZTE images, the latter including verification of
measurement points by cross-referencing against images from other planes.
Reliability of measurements between observers and modalities was analyzed
with the intraclass correlation coefficient (ICC). The paired-samples
t test was used to compare the differences between
imaging modalities. Results: Enrolled were 65 patients (35 female and 30 male; mean age, 40.2 years;
range, 25-49 years). Radiographs with optimal positioning (RTL < 0.25)
were attained after a mean of 1.6 exposures (range, 1-4); the mean RTL was
0.09 (range, 0-0.20). Interobserver agreement of CSA was excellent for
radiographs (ICC = 0.91; 95% CI, 0.84-0.94) and good for ZTE MRI scans (ICC
= 0.85; 95% CI, 0.71-0.92). Intermodality agreement of CSA between
radiographs and ZTE MRI scans was moderate (ICC = 0.66; 95% CI, 0.48-0.73).
The CSA was significantly different between an optimal radiograph (30.7° ±
4.3°) and ZTE MRI scan (31.8° ± 3.8) (P = .005). Subgroup
analysis revealed no significant differences in CSA measurement between ZTE
MRI scans and Grashey view radiographs with an RTL of <0.1
(P = .08). Conclusion: CSA measurement on ZTE MRI scans with anatomic point cross-referencing was
significantly different from that on Grashey view radiographs, even with
optimal positioning, and radiography may necessitate more than 1 exposure.
An RTL of <0.1 ensured reliability of radiographs when other standards of
sufficient x-ray exposure were met.
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Affiliation(s)
- Adalet Elçin Yıldız
- Department of Radiology, Hacettepe University School of Medicine,
Ankara, Turkey
- Adalet Elçin Yıldız, MD, Department of Radiology, Hacettepe
University School of Medicine, Sihhiye, 06230 Ankara, Turkey (
)
| | - Yasin Yaraşır
- Department of Radiology, Hacettepe University School of Medicine,
Ankara, Turkey
| | - Gazi Huri
- Department of Orthopedics and Traumatology, Hacettepe University
School of Medicine, Ankara, Turkey
| | - Üstün Aydıngöz
- Department of Radiology, Hacettepe University School of Medicine,
Ankara, Turkey
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Hsu TH, Lin CL, Wu CW, Chen YW, Vitoonpong T, Lin LC, Huang SW. Accuracy of Critical Shoulder Angle and Acromial Index for Predicting Supraspinatus Tendinopathy. Diagnostics (Basel) 2022; 12:diagnostics12020283. [PMID: 35204373 PMCID: PMC8871498 DOI: 10.3390/diagnostics12020283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Critical shoulder angle (CSA) is the angle between the superior and inferior bony margins of the glenoid and the most lateral border of the acromion. The acromial index (AI) is the distance from the glenoid plane to the acromial lateral border and is divided by the distance from the glenoid plane to the lateral aspect of the humeral head. Although both are used for predicting shoulder diseases, research on their accuracy in predicting supraspinatus tendinopathy in patients with shoulder pain is limited. Data were retrospectively collected from 308 patients with supraspinatus tendinopathy between January 2018 and December 2019. Simultaneously, we gathered the data of 300 patients with shoulder pain without supraspinatus tendinopathy, confirmed through ultrasound examination. Baseline demographic data, CSA, and AI were compared using the independent Student’s t test and Mann–Whitney U test. Categorical variables were analyzed using the chi-square test. A receiver operating characteristic curve (ROC) analysis was performed to investigate the accuracy of CSA and AI for predicting supraspinatus tendinopathy, and the optimal cut-off point was determined using the Youden index. No statistical differences were observed for age, sex, body mass index, evaluated side (dominant), diabetes mellitus, and hyperlipidemia between the groups. The supraspinatus tendinopathy group showed higher CSAs (p < 0.001) than did the non-supraspinatus tendinopathy group. For predicting supraspinatus tendinopathy, the area under the curve (AUC) of ROC curve of the CSA was 76.8%, revealing acceptable discrimination. The AUC of AI was 46.9%, revealing no discrimination. Moreover, when patients with shoulder pain had a CSA > 38.11°, the specificity and sensitivity of CSA in predicting supraspinatus tendinopathy were 71.0% and 71.8%, respectively. CSA could be considered an objective assessment tool to predict supraspinatus tendinopathy in patients with shoulder pain. AI revealed no discrimination in predicting supraspinatus tendinopathy in patients with shoulder pain.
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Affiliation(s)
- Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
| | - Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Timporn Vitoonpong
- Rehabilitation Department, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
| | - Lien-Chieh Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-222-490-088 (ext. 1602)
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Yang L, Zhao X, Zhang J, Ma S, Jiang L, Wei Q, Cai M, Zhou F. Synthesis of charged chitosan nanoparticles as functional biolubricant. Colloids Surf B Biointerfaces 2021; 206:111973. [PMID: 34303997 DOI: 10.1016/j.colsurfb.2021.111973] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/17/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022]
Abstract
Osteoarthritis has been a major disease in recent years, which is mainly related to the breakdown of the lubrication function of the cartilage sliding interface, along with the inflammation of the joint capsule. In this paper, one kind of novel biomimetic nanoparticles (NPs) lubricant, named CS-PS, is synthesized through chemically grafting hydrophilic sulfonic acid (SO3-) groups onto the surface of biocompatible and biodegradable chitosan (CS) NPs. Compared with control CS NPs, the as-synthesized CS-PS NPs exhibits excellent hydration and stability because of negatively charged surface zeta potential, along with extraordinary lubrication performance in water for realizing a super-low friction coefficient (COF) as ∼0.01 at the sliding interface of PDMS elastomer-Ti6Al4V disk. Correspondingly, the CS-PS NPs can also be used as a drug carrier for aspirin, which presents very good drug loading and release behavior in PBS (pH = 7.4). MCS cells culture experiment proves that this kind of novel lubricant is nontoxic and biocompatible, for which may be expected to use as potential articular injective material for the treatment of osteoarthritis.
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Affiliation(s)
- Lumin Yang
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Xiaoduo Zhao
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Jing Zhang
- Key Laboratory of Tibetan Medicine Research, Northwest Institute of Plateau Biology, Chinese Academy of Sciences/Qinghai Provincial Key Laboratory of Tibetan Medicine Research, Xining, 810008, China
| | - Shuanhong Ma
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.
| | - Lei Jiang
- Key Laboratory of Tibetan Medicine Research, Northwest Institute of Plateau Biology, Chinese Academy of Sciences/Qinghai Provincial Key Laboratory of Tibetan Medicine Research, Xining, 810008, China
| | - Qiangbing Wei
- Key Laboratory of Eco-Environmental-Related Polymer Materials, Ministry of Education, Key Laboratory of Polymer Materials of Gansu Province, College of Chemistry and Chemical Engineering, Northwest Normal University, Lanzhou 730070, China
| | - Meirong Cai
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Feng Zhou
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.
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Lin CL, Lin LF, Hsu TH, Lin LC, Lin CH, Huang SW. Acromioplasty reduces critical shoulder angle in patients with rotator cuff tear. PLoS One 2021; 16:e0253282. [PMID: 34191814 PMCID: PMC8245121 DOI: 10.1371/journal.pone.0253282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.
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Affiliation(s)
- Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Lien-Chieh Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan, R.O.C
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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