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Gonnachon A, Michon B, Savoye-Laurens T, Colombi R, Baulot E, Labattut L, Martz P. Subscapularis atrophy and function after arthroscopic Trillat procedure. Orthop Traumatol Surg Res 2024:103961. [PMID: 39059546 DOI: 10.1016/j.otsr.2024.103961] [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: 09/12/2023] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Several studies have reported a strength deficit in internal rotation (IR) following a Latarjet procedure, which can persist for months or even years. The arthroscopic Trillat procedure does not require splitting the subscapularis muscle, potentially making it less damaging. HYPOTHESIS The arthroscopic Trillat procedure does not cause any atrophy or strength deficit in the subscapularis muscle. METHODS This was a single center, retrospective study of patients treated between 2013 and 2021. Included were patients who had chronic anterior shoulder instability with an indication for surgical stabilization using an arthroscopic Trillat procedure and who underwent a CT scan before surgery and a second one at 6 months postoperative. The following morphological parameters were measured on all the rotator cuff muscles: cross-sectional area (CSA), thickness and fatty infiltration using the mean muscle attenuation (MMA) measurement. Isokinetic tests were done 1 year post-surgery. RESULTS One hundred seventeen patients underwent arthroscopic Trillat surgery between 2013 and 2021; 58 were included, 30 were analyzed and 17 patients underwent isokinetic testing. The CSA of the subscapularis was significantly smaller by 5.3% (17.0 vs. 16.1; p = 0.03). None of the other rotator cuff muscles had a smaller CSA. The MMA of the subscapularis increased significantly while the MMA of the external rotators decreased postoperatively. No strength deficit was found at 1 year postoperative in the internal and external rotators. DISCUSSION The arthroscopic Trillat procedure produces minor atrophy of the subscapularis muscle at 6 months, with no strength deficit at 1 year postoperative. Several studies have reported a deficit in internal rotation strength after a Latarjet procedure, ranging from 6% to 19% depending on the study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Arnaud Gonnachon
- Service d'Orthopédie, CHU F. Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000 Dijon, France.
| | - Bastien Michon
- Service d'Orthopédie, CHU F. Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000 Dijon, France
| | - Timothée Savoye-Laurens
- Service d'Orthopédie, CHU F. Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000 Dijon, France
| | - Romain Colombi
- Centre Orthopédique de Dracy-le-Fort, 2 Rue du Pressoir, 71640 Dracy-le-Fort, France
| | - Emmanuel Baulot
- Service d'Orthopédie, CHU F. Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000 Dijon, France; Unité INSERM CAPS 1093, Université de Bourgogne, Faculté des Sciences du Sport (UFR Staps), 3 allée des Stades Universitaires, BP 27877, Dijon, France
| | - Ludovic Labattut
- Service d'Orthopédie, CHU F. Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000 Dijon, France
| | - Pierre Martz
- Service d'Orthopédie, CHU F. Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000 Dijon, France; Unité INSERM CAPS 1093, Université de Bourgogne, Faculté des Sciences du Sport (UFR Staps), 3 allée des Stades Universitaires, BP 27877, Dijon, France
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Orgiu A, Boukebous B, Bouhali H, Riou P, Rousseau MA, Boyer P. Faster strength recovery and better strength ratio with arthroscopic Latarjet compared to the open technique: An observational study. Orthop Traumatol Surg Res 2024; 110:103815. [PMID: 38246492 DOI: 10.1016/j.otsr.2024.103815] [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: 07/19/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The arthroscopic bone block has shown reliability and reproducibility regarding functional scores and shoulder mobility compared to the open bone block technique. The recovery of muscle strength, especially the strength ratio external rotator/internal rotator (ER/IR), is crucial to recovering satisfactory function. This ratio should be as near to 1 as possible, meaning a good strength balance. Little is known about the difference in strength recovery between the open and arthroscopic techniques. HYPOTHESIS Arthroscopic Latarjet reduces surgical stress and improves the strength recovery and strength ratio. OBJECTIVES To compare arthroscopic and open Latarjet procedures for shoulder muscle strength and functional outcomes. MATERIAL AND METHODS It was an observational longitudinal and prospective cohort follow-up. Two groups of patients were accessible for comparison: 35 in an arthroscopy group and 38 in an open group. The main outcome was the muscle strength of shoulder muscles measured with a dynamometer and expressed in Newton (N) at day 21 (D21), D45, D90, D180, and D365 in the operated and contralateral shoulders. The measurements were made for the pectoralis major, the three deltoid fascicles, and the subscapularis. The shoulder ER/IR strength ratio was calculated. Other variables were the range of motion (ROM), the Walch-Duplay (WD), the Western Ontario Shoulder Instability score (WOSI), and the Visual Analogic Scale for pain assessment. The strength, ROM, and functional scores were compared between open and arthroscopy with linear mixed models. RESULTS The median strengths at 52 weeks were significantly higher than at 3 weeks (P<10-4): anterior deltoid (AD) 8N (Q1:7, Q3: 9) versus 4N (Q1:2, Q3: 5), lateral deltoid (LD) 9N (Q1:9, Q3: 11) versus 6N (Q1:4, Q3: 7), posterior deltoid (PD) 14N (Q1:12, Q3: 15) versus 9N (Q1:8, Q3: 10), subscapularis 10N (Q1:9, Q3: 12) versus 7N (Q1:5, Q3: 8), and pectoralis major (PM) 11N (Q1:9, Q3: 12) versus 7N (Q1:5, Q3: 10). The overall strengths were lower in the open group compared to the arthroscopy group: AD -2.1N (CI95%[-3.1--1.2], p=0.0005), LD -1.3N (CI95% [-2.4--0.15], p=0.03), PD -0.35N (CI95% [-1-0.9], p=0.52), subscapularis -2.1N (CI95% [-3.3--0.7], p=0.006), and PM -1.4N (CI95% [-2.2--0.02], p=0.03). The ER/IR ratio was stable throughout the follow-up for both the operated and contralateral shoulders (p>0.5). The overall mean ratio was 1.3 (median 1.2, Q1: 1, Q3:1.45) for the operated shoulder and 1.1 (median 1, Q1: 0.9, Q3:1.3) for the contralateral shoulder (p=0.0004). The average ER/IR ratio was 0.27 points higher in the open group (CI95% [0.1-0.46], p=0.003). The ROM was similar between the two groups, and there was no correlation between the ER/IR ratio and the ROM (p>0.5). The VAS < 3 weeks and WD > 12 weeks were significantly poorer in the open group: +0.61 (CI95% [0.03-1.16] p=0.02), and -7.3 points (CI95% [-13--0.01], p=0.05), on average, respectively. CONCLUSION The patients in the arthroscopy group had a better ER/IR strength ratio (closer to 1) and better WOSI after 12 weeks. The strength and the ROM were not correlated with each other. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Antoni Orgiu
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - Baptiste Boukebous
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France; Université Paris Cité, Équipe ECAMO, CRESS (Centre of Research in Epidemiology and Statistics), INSERM, UMR 1153, Paris, France.
| | - Haroun Bouhali
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - Pierre Riou
- Masseur kinésithérapeute, 750018 Paris, France
| | - Marc-Antoine Rousseau
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - Patrick Boyer
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Alnusif N, Lari A, AlQahtani S, Athwal GS. Strength after the arthroscopic Latarjet procedure: Are shoulder internal rotation, elbow flexion & supination strength decreased? Shoulder Elbow 2024; 16:53-58. [PMID: 38435038 PMCID: PMC10902414 DOI: 10.1177/17585732231165227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2024]
Abstract
Background The Latarjet procedure is an effective shoulder stabilizing surgery, however, the procedure results in an alteration of anatomy that may result in shoulder and elbow weakness. Thus, the purpose of this study was to assess post-operative shoulder and elbow strength after the Latarjet procedure. We hypothesized that shoulder and elbow strength are not affected after the procedure. Methods The study group consisted of patients that had undergone the arthroscopic Latarjet procedure. An isokinetic dynamometer was used to evaluate the strength of bilateral shoulder internal rotation, elbow flexion, forearm supination using peak torque (N/m), as well as grip strength (kilograms). Shoulder range of motion and the potential effects of hand dominance were further analysed. Results Nineteen patients with a mean age of 29 years and an average follow up of 47 months were included. Shoulder internal rotation strength, elbow flexion and forearm supination strength and grip strength were not significantly different when compared to the non-operative side (p > 0.13). The range of shoulder external rotation was significantly reduced (p < 0.001) on the Latarjet side. Conclusion The results from this study demonstrate no statistically significant differences in the strength of shoulder internal rotation, elbow flexion, forearm supination or grip strength despite the surgical alterations to the subscapularis and conjoint tendon.
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Affiliation(s)
- Naser Alnusif
- St Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
- Department of Orthopedic Surgery, AlRazi Orthopedic Hospital, Kuwait City, Kuwait
| | - Ali Lari
- Department of Orthopedic Surgery, AlRazi Orthopedic Hospital, Kuwait City, Kuwait
| | - Saad AlQahtani
- Department of Orthopedic Surgery, King Fahad Hospital of the University, Imam AbdulRahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - George S Athwal
- St Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
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van de Kuit A, Verweij LP, Priester-Vink S, Veeger H(D, van den Bekerom MP. Changes in Scapular Function, Shoulder Strength, and Range of Motion Occur After Latarjet Procedure. Arthrosc Sports Med Rehabil 2023; 5:100804. [PMID: 37822673 PMCID: PMC10562159 DOI: 10.1016/j.asmr.2023.100804] [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: 03/23/2023] [Accepted: 08/17/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose To evaluate the current literature on the effects of anatomic changes caused by the Latarjet procedure and to identify areas for future research. Methods English-language studies that addressed the consequences of anatomic alterations after the open Latarjet procedure were included. Articles written in languages other than English, reviews, and case reports were excluded. Titles and abstracts were screened by 2 authors. Studies that met the inclusion criteria were screened by the same authors. The following data were extracted from the included studies: authors, year of publication, journal, country of origin, aims or purpose, study population and sample size, methods, procedure, intervention type, and key findings that relate to the scoping review questions. Results Twenty-two studies were included for analysis, yielding the following findings: First, the Latarjet procedure may change the position of the scapula owing to pectoralis minor tenotomy and/or transfer of the conjoint tendon. Second, dissection of the coracoacromial ligament may result in increased superior translation of the humeral head. The impact of this increased translation on patients' function remains unclear. Third, the subscapularis split shows, overall, better internal rotation strength compared with subscapularis tenotomy. Fourth, passive external rotation may be limited after capsular repair. Fifth, despite the movement of the conjoint tendon, elbow function seems unchanged. Finally, the musculocutaneous nerve is lengthened with a changed penetration angle into the coracobrachialis muscle, but the clinical impact seems limited. Conclusions The Latarjet procedure leads to anatomic and biomechanical changes in the shoulder. Areas of future research may include better documentation of scapular movement (bilateral, as well as preoperative and postoperative) and elbow function, the effect of (degenerative) rotator cuff ruptures after the Latarjet procedure on shoulder function, and the impact of capsular closure and its contribution to the development of glenohumeral osteoarthritis. Clinical Relevance This comprehensive overview of anatomic changes after the Latarjet procedure, with its effects on shoulder and elbow function, showed gaps in the current literature. Orthopaedic shoulder surgeons and physical therapists could use our findings when providing patient information and performing future clinical research.
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Affiliation(s)
- Anouk van de Kuit
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Lukas P.E. Verweij
- Department of Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Simone Priester-Vink
- Department of Research and Epidemiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - H.E.J. (Dirkjan) Veeger
- Department of Biomechanical Engineering, Faculty 3mE, Technical University Delft, Delft, The Netherlands
| | - Michel P.J. van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije University Medical Center Amsterdam, Amsterdam, The Netherlands
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Liu W, Jiang X, Yu Z, Pang K, Wang J, Peng Y. Effects of a Graphene Heating Device on Fatigue Recovery of Biceps Brachii. Bioengineering (Basel) 2023; 10:bioengineering10030381. [PMID: 36978772 PMCID: PMC10044709 DOI: 10.3390/bioengineering10030381] [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: 02/16/2023] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Far-infrared (FIR) is considered to be an ideal method to promote fatigue recovery due to its high permeability and strong radiation. In this paper, we report a flexible and wearable graphene heating device to help fatigue recovery of human exercise by using its high FIR divergence property. This study compares two different fatigue recovery methods, graphene far-infrared heating device hot application and natural recovery, over a 20 min recovery time among the male colleges' exhaustion exercise. Experimental results show that the achieved graphene device holds excellent electro-thermal radiation conversion efficiency of 70% and normal total emissivity of 89%. Moreover, the graphene FIR therapy in our work is more energy-efficient, easy to use, and wearable than traditional fatigue recovery methods. Such an anti-fatigue strategy offers new opportunities for enlarging potential applications of graphene film in body science, athletic training recovery, and wearable devices.
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Affiliation(s)
- Wenming Liu
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China
| | - Xiaohui Jiang
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China
| | - Zhiran Yu
- The MOF Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Kai Pang
- The MOF Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Jian Wang
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China
| | - Yuxin Peng
- Department of Sports Science, Zhejiang University, Hangzhou 310058, China
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Rossi LA, Pasqualini I, Tanoira I, Ranalletta M. Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability. Open Access J Sports Med 2022; 13:35-40. [PMID: 35401017 PMCID: PMC8985826 DOI: 10.2147/oajsm.s340699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete's decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete's psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete's return to sports after shoulder instability surgery remains uncertain and unexplored.
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Affiliation(s)
- Luciano Andrés Rossi
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Pasqualini
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
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