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Archambault SD, Kakazu R, Jimenez AE, Polisetty T, Cusano A, Berthold DP, Muench LN, Cote M, Slater MG, Levy JC, Mazzocca AD. Variations in the Anatomic Morphology of the Scapular Spine and Implications on Fracture After Reverse Shoulder Arthroplasty. J Am Acad Orthop Surg 2024; 32:712-718. [PMID: 38739868 DOI: 10.5435/jaaos-d-22-00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/12/2023] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION This study evaluates the role of anatomic scapular morphology in acromion and scapular spine fracture (SSAF) risk after reverse shoulder arthroplasty (RSA). METHODS Twelve scapular measurements were captured based on pilot study data, including scapular width measurements at the acromion (Z1), middle of the scapular spine (Z2), and medial to the first major angulation (Z3). Measurements were applied to 3D-CT scans from patients who sustained SSAF after RSA (SSAF group) and compared with those who did not (control group). Measurements were done by four investigators, and the intraclass correlation coefficient was calculated. Regression analysis determined trends in fracture incidence. RESULTS One hundred forty-nine patients from two separate surgeons (J.L., A.M.) were matched by age and surgical indication of whom 51 sustained SSAF after reverse shoulder arthroplasty. Average ages for the SSAF and control cohorts were 78.6 and 72.1 years, respectively. Among the SSAF group, 15 were Levy type I, 26 Levy type II, and 10 Levy type 3 fractures. The intraclass correlation coefficient of Z1, Z2, and Z3 measurements was excellent (0.92, 0.92, and 0.94, respectively). Zone 1 and 3 measurements for the control group were 18.6 ± 3.7 mm and 3.2 ± 1.0 mm, respectively, compared with 22.5 ± 5.9 mm and 2.0 ± 0.70 mm in the SSAF group, respectively. The fracture group trended toward larger Z1 and smaller Z3 measurements. The average scapular spine proportion (SSP), Z1/Z3, was significantly greater in the control 6.20 ± 1.80 versus (12.60 ± 6.30; P < 0.05). Regression analysis showed a scapular spine proportion of ≤5 was associated with a fracture risk <5%, whereas an SSP of 9.2 correlated with a 50% fracture risk. DISCUSSION Patients with a thicker acromions (Z1) and thinner medial scapular spines (Z3) have increased fracture risk. Understanding anatomic scapular morphology may allow for better identification of high-risk patients preoperatively.
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Affiliation(s)
- Simon D Archambault
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Archambault, Kakazu, Cusano, and Slater), the American Hip Institute Research Foundation, Chicago, IL (Jimenez), the Holy Cross Orthopedic Institute, Fort Lauderdale, FL (Polisetty and Levy), Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany (Muench), Department of Orthopaedics and Trauma Surgery, Musculoskeletal UniversityCenter Munich (MUM), LMU University Hospital, LMU Munich (Berthold), and the Massachusetts General Hospital/Harvard Medical School, Boston, MA (Cote and Mazzocca)
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Noh KC, Lee S, Park CW, Bai H, Kim JY. Three-Dimensional Morphological Analysis of the Suprascapular Notch in Patients with Arthroscopic Rotator Cuff Repair. Clin Orthop Surg 2024; 16:586-593. [PMID: 39092301 PMCID: PMC11262953 DOI: 10.4055/cios24013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 08/04/2024] Open
Abstract
Background The morphology of the suprascapular notch (SSN) and the ossification of the superior transverse suprascapular ligament (STSL) are risk factors for injury of the suprascapular nerve (SN) during arthroscopic shoulder procedures. The purpose of the current study was to compare preoperative clinical and radiologic characteristics between patients with and without STSL ossification and to evaluate SSN morphology in patients who underwent arthroscopic rotator cuff repair using a 3-dimensional (3D) reconstructed model. Methods Patients who underwent arthroscopic rotator cuff repair and were given a computed tomography (CT) scan from March 2018 to August 2019 were included in this study. Patients were divided into 2 groups: those without STSL ossification (group I) and those with STSL ossification (group II). Tear size of the rotator cuff and fatty infiltration of rotator cuff muscles were assessed in preoperative magnetic resonance imaging. The morphology of the SSN was classified following Rengachary's classification. The transverse and vertical diameters of the SSN and the distances from anatomical landmarks to the STSL were measured. All measurements were completed using a 3D CT reconstructed scapula model. Results A total of 200 patients were included in this study. One hundred seventy-eight patients (89.0%) without STSL ossification were included in group I, and 22 patients (11.0%) with STSL ossification were included in group II. Group II showed a significantly advanced age (61.0 ± 7.4 vs. 71.0 ± 7.3 years, p < 0.001) and a shorter transverse diameter of SSN (10.7 ± 3.1 mm vs. 6.1 ± 3.7 mm, p < 0.001) than group I. In the logistic regression analysis, age was an independent prognostic factor for STSL ossification (odds ratio, 1.201; 95% confidence interval, 1.112-1.296; p < 0.001). Patients in type VI showed significantly shorter transverse diameters than other types (p < 0.001). The patient with type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than those with other types (p < 0.001). Conclusions In the 3D morphological analysis, age was the independent factor associated with STSL ossification in patients who underwent arthroscopic rotator cuff repair. Type VI showed significantly shorter transverse diameters than other types. Type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than other types.
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Affiliation(s)
- Kyu Cheol Noh
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Chang Won Park
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Haotian Bai
- Department of Orthopedic Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Jung-Youn Kim
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
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Testa EJ, Katz L, Zhang H, Chang K, Kutschke MJ, Dworkin M, Owens BD. Rotator Cuff Tears to Shoulder Instability: The Relationship Between Acromial Morphology and Shoulder Pathology. JBJS Rev 2024; 12:01874474-202401000-00004. [PMID: 38181125 DOI: 10.2106/jbjs.rvw.23.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
» The acromion is a well-studied region of the scapula that has demonstrated substantial relationships to various shoulder pathologies.» Abnormal acromial morphology is associated with rotator cuff pathology, and our understanding of this risk factor inspired acromioplasty as an adjunctive treatment for rotator cuff tears.» The acromion is linked closely to shoulder kinematics and biomechanics, as it serves as the origin for the deltoid muscle.» In degenerative shoulder disease, eccentric glenohumeral osteoarthritis has been associated with a higher, flatter acromial roof.» Increasing literature is emerging connecting morphology of the acromion with shoulder instability.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Luca Katz
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Helen Zhang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Kenny Chang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Michael J Kutschke
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Myles Dworkin
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
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Perry NPJ, Omonullaeva NK, Bacevich BM, Nascimento RJ, O'Donnell EA, Price MD, Mazzocca AD. Acromioclavicular Joint Anatomy and Biomechanics: The Significance of Posterior Rotational and Translational Stability. Clin Sports Med 2023; 42:557-571. [PMID: 37716721 DOI: 10.1016/j.csm.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
The shoulder girdle extends from the sternoclavicular joint to the scapular stabilizing muscles posteriorly. It consists of 3 joints and 2 mobile regions. The shoulder girdle is statically stabilized by the acromioclavicular and coracoclavicular capsuloligamentous structures and dynamically stabilized by the trapezius, deltoid, and deltotrapezial fascia. During humerothoracic elevation, the clavicle elevates, protracts, and rotates posteriorly through the sternoclavicular joint while the scapula tilts posteriorly and rotates upward. The purpose of this article is to review the anatomy and biomechanics of the acromioclavicular joint and the shoulder girdle.
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Affiliation(s)
- Nicholas P J Perry
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard School of Medicine, Massachusetts General Brigham, Boston, MA 02115, USA; Sports Medicine, Mass General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA.
| | - Nozimakhon K Omonullaeva
- Sports Medicine, Mass General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA; Nova Southeastern University, College of Osteopathic Medicine, 3301 College Avenue, Fort Lauderdale, FL 33314, USA
| | - Blake M Bacevich
- Sports Medicine, Mass General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Robert J Nascimento
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard School of Medicine, Massachusetts General Brigham, Boston, MA 02115, USA; Sports Medicine, Mass General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA
| | - Evan A O'Donnell
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard School of Medicine, Massachusetts General Brigham, Boston, MA 02115, USA; Sports Medicine, Mass General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA
| | - Mark D Price
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard School of Medicine, Massachusetts General Brigham, Boston, MA 02115, USA; Sports Medicine, Mass General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA
| | - Augustus D Mazzocca
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard School of Medicine, Massachusetts General Brigham, Boston, MA 02115, USA; Sports Medicine, Mass General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA
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Strnad T, Bartoníček J, Tuček M, Naňka O. Circumflex arterial sulcus of the scapula (sulcus arteriae circumflexae scapulae): its anatomy and clinical relevance. Surg Radiol Anat 2022; 44:1111-1119. [PMID: 35896729 DOI: 10.1007/s00276-022-02993-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The circumflex scapular artery (CSA) has been described in detail in the literature, but the groove, i.e., the circumflex sulcus (CFS), formed by the artery on the lateral pillar of the scapula has been completely neglected. The aim of the present study was to describe the variability and anatomy of the CFS. MATERIALS AND METHODS The study was based on the examination of 103 pairs of dry bone specimens of adult scapulae, i.e., 206 specimens, including 92 (46 pairs) male and 114 (57 pairs) female specimens. In the first step, quantitative criteria were defined for assessment of the CFS presence and type. Subsequently, statistical analysis of the obtained data was performed. RESULTS The study revealed considerable variability of the arterial groove, which was well developed in 33% (type A), shallow in 40% (type B), and absent in 27% (type C) of cases. The mean distance between CFS and the infraglenoid tubercle was 3.3 cm CI0.95 (3.1-3.3), which corresponds to the proximal third of the lateral border of the scapula. CONCLUSION The study has confirmed variability of the arterial groove (CFS) and its localization in relation to the inferior glenoid rim. The findings are clinically important, particularly in relation to the Judet approach to scapular fractures (localization of the CSA course).
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Affiliation(s)
- Tomáš Strnad
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Orthopedics, First Faculty of Medicine, Charles University and the Central Military Hospital, Prague, Czech Republic
| | - Jan Bartoníček
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Orthopedics, First Faculty of Medicine, Charles University and the Central Military Hospital, Prague, Czech Republic
| | - Michal Tuček
- Department of Orthopedics, First Faculty of Medicine, Charles University and the Central Military Hospital, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Robertson DD, Sharma GB, McMahon PJ, Karas SG. Glenoid Version Assessment When the CT Field of View Does Not Permit the Friedman Method: The Robertson Method. Orthop J Sports Med 2022; 10:23259671221083589. [PMID: 35571972 PMCID: PMC9096205 DOI: 10.1177/23259671221083589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: To improve spatial resolution, current clinical shoulder cross-sectional imaging studies reduce the field of view of the shoulder, excluding the medial scapula border and preventing glenoid version measurement according to the Friedman method. Purpose: To evaluate a method to accurately and reliably measure glenoid version on cross-sectional shoulder images when the medial scapula border is not included in the field of view, and to establish measurements equivalent to the Friedman method. Study Design: Controlled laboratory study. Methods: Sixty-five scapulae underwent computed tomography (CT) scanning with an optimal shoulder CT-positioning protocol. Glenoid version was measured on CT images of the full scapula using the Friedman method. We developed a measurement method (named the Robertson method) based on the glenoid vault version from partial scapula images, with a correction angle subtracted from the articular-surface-glenoid vault measurement. Comparison with the Friedman method defined the accuracy of the Robertson method. Three observers tested inter- and intraobserver reliability of the Robertson method. Accuracy was statistically evaluated with t tests and reliability with the intraclass correlation coefficient (ICC). Results: The statistical distribution of glenoid version was similar to published data,–0.5° ± 3° [mean ± SD]. The initial measurement using the Robertson method resulted in a more retroverted angle compared with the Friedman method, and a correction angle of 7° was then applied. After this adjustment, the difference between the 2 methods was nonsignificant (0.1° ± 4°; P > .65). Reliability of the Robertson method was excellent, as the interrater ICC was 0.77, the standard error of measurement (SEM) was 1.1° with P < .001. The intrarater ICC ranged between 0.84 and 0.92, the SEM ranged between 0.9° and 1.2° with P < .01. Conclusion: A validated glenoid version measurement method is now available for current clinical shoulder CT protocols that reliably create Friedman-equivalent values. Clinical Relevance: Friedman-equivalent values may be made from common clinical CTs of the shoulder and compared with prior and future Friedman measurements of the scapula.
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Affiliation(s)
- Douglas D. Robertson
- Author deceased
- Emory Orthopaedics and Spine Center, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Gulshan B. Sharma
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick J. McMahon
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery and Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Spero G. Karas
- Emory Orthopaedics and Spine Center, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
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Yeazell ST, Inacio J, Malige A, Dailey H, Carolan GF. Bone density and its relation to the development of acromial stress fracture following reverse total shoulder arthroplasty. Shoulder Elbow 2022; 14:135-141. [PMID: 35265178 PMCID: PMC8899318 DOI: 10.1177/1758573220949992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/14/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative acromial stress fracture is a troublesome postoperative complication after reverse shoulder arthroplasty. Our study aims to utilize routinely performed preoperative computed tomography scans to identify differences in the material properties of the acromion in patients who did and did not develop a postoperative acromial stress fracture. METHODS Treatment records and computed tomography scans for 99 reverse shoulder arthroplasties were collected. Scans were calibrated using a phantom and transferred for post-processing where the acromion, full scapula, and humeral head were isolated. The final segmented model was used to assess acromial volume and volumetric bone mineral density for each region of interest. RESULTS There was no association between age and volumetric bone mineral density in any region of interest (all R 2 ≤ 0.048, all p > 0.082). Patients who developed an acromial stress fracture were not significantly different from those who did not in terms of age, acromial volume, or acromial volumetric bone mineral density (all p > 0.559). Patients with known osteoporosis or osteopenia had slightly lower volumetric bone mineral density, but the differences were not significant (all p ≥ 0.072). CONCLUSION Postoperative acromial fractures following reverse shoulder arthroplasty cannot be predicted by computed tomography-derived volumetric bone mineral density or volume. These mechanical characteristics also do not predictably decrease with age or osteoporosis diagnosis.
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Affiliation(s)
- Shawn T Yeazell
- Department of Orthopedic Surgery, St Luke's University Health Network, Bethlehem, USA,Shawn T Yeazell, Department of Orthopedic Surgery, St Luke's University Health Network, 801 Ostrum St. PPHP2, Bethlehem, PA 18015, USA.
| | - Jordan Inacio
- Department of Mechanical Engineering and Mechanics, Lehigh University Packard Laboratory, Bethlehem, USA
| | - Ajith Malige
- Department of Orthopedic Surgery, St Luke's University Health Network, Bethlehem, USA
| | - Hannah Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University Packard Laboratory, Bethlehem, USA
| | - Gregory F Carolan
- Department of Orthopedic Surgery, St Luke's University Health Network, Bethlehem, USA
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Identification of recurring scapular fracture patterns using 3-dimensional computerized fracture mapping. J Shoulder Elbow Surg 2022; 31:571-579. [PMID: 34628033 DOI: 10.1016/j.jse.2021.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapular fracture fixation and implant selection are guided by the fracture pattern and classification, which requires accurate understanding and interpretation of the fracture lines. Three-dimensional (3D) computed tomography (CT)-based fracture pattern analysis enhances a more accurate understanding of the scapular fracture patterns. The purpose of this study was to create scapular fracture maps and identify the frequent fracture patterns using 3D reconstructed CT images. METHOD Seventy patients treated for scapular fractures, in a single hospital, were considered for this study. Their CT images were reconstructed into 3D models and the fracture fragments were virtually reduced. The reduced 3D models were first aligned on a 3D template and 2D images were captured on the anterior, posterior, and lateral views. Then each fracture image was aligned on a corresponding 2D template and the fracture lines were transferred to the template. The 3 separate views were used to accurately capture the propagation and exit of the fractures through the scapular anatomy. These fracture lines were compiled and heat maps were generated to identify the frequent fracture zones of the scapula. RESULT The observed scapular fractures propagated through multiple regions of the bone. Overall, the 3 most common exit zones in the scapula were the lateral (69%), medial (67%), and superior borders (60%). More specifically, the superior lateral border, medial base of the scapula spine, spinoglenoid notch, and mid-superior border were the most frequent zones of fracture in the scapular body. Simple intra-articular fractures (transverse or oblique type) were the most common (92%) fracture type in the glenoid region. CONCLUSION Scapular fractures reveal repeatable patterns. The zones of recurrent fracture patterns can be identified from fracture and heat maps. Graphical plots of fracture and heat maps may assist surgical planning and implant design optimization.
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Boutillon A, Salhi A, Burdin V, Borotikar B. Anatomically Parameterized Statistical Shape Model: Explaining Morphometry through Statistical Learning. IEEE Trans Biomed Eng 2022; 69:2733-2744. [PMID: 35192459 DOI: 10.1109/tbme.2022.3152833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective: Statistical shape models (SSMs) are a popular tool to conduct morphological analysis of anatomical structures which is a crucial step in clinical practices. However, shape representations through SSMs are based on shape coefficients and lack an explicit one-to-one relationship with anatomical measures of clinical relevance. While a shape coefficient embeds a combination of anatomical measures, a formalized approach to find the relationship between them remains elusive in the literature. This limits the use of SSMs to subjective evaluations in clinical practices. We propose a novel SSM controlled by anatomical parameters derived from morphometric analysis. Methods: The proposed anatomically parameterized SSM (ANATSSM) is based on learning a linear mapping between shape coefficients (latent space) and selected anatomical parameters (anatomical space). This mapping is learned from a synthetic population generated by the standard SSM. Determining the pseudo-inverse of the mapping allows us to build the ANATSSM. We further impose orthogonality constraints to the anatomical parameterization (OC-ANATSSM) to obtain independent shape variation patterns. The proposed contribution was evaluated on two skeletal databases of femoral and scapular bone shapes using clinically relevant anatomical parameters within each (five for femoral and six for scapular bone). Results: Anatomical measures of the synthetically generated shapes exhibited realistic statistics. The learned matrices corroborated well with the obtained statistical relationship, while the two SSMs achieved moderate to excellent performance in predicting anatomical parameters on unseen shapes. Conclusion: This study demonstrates the use of anatomical representation for creating anatomically parameterized SSMs and as a result, removes the limited clinical interpretability of standard SSMs. Significance: The proposed models could help analyze differences in relevant bone morphometry between populations, and be integrated in patient-specific pre-surgery planning or in-surgery assessment.
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Anatomy of the coracoid process in thais: Cadaveric study and clinical implications. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Huang Y, Robinson DL, Pitocchi J, Lee PVS, Ackland DC. Glenohumeral joint reconstruction using statistical shape modeling. Biomech Model Mechanobiol 2021; 21:249-259. [PMID: 34837584 DOI: 10.1007/s10237-021-01533-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Abstract
Evaluation of the bony anatomy of the glenohumeral joint is frequently required for surgical planning and subject-specific computational modeling and simulation. The three-dimensional geometry of bones is traditionally obtained by segmenting medical image datasets, but this can be time-consuming and may not be practical in the clinical setting. The aims of this study were twofold. Firstly, to develop and validate a statistical shape modeling approach to rapidly reconstruct the complete scapular and humeral geometries using discrete morphometric measurements that can be quickly and easily measured directly from CT, and secondly, to assess the effectiveness of statistical shape modeling in reconstruction of the entire humerus using just the landmarks in the immediate vicinity of the glenohumeral joint. The most representative shape prediction models presented in this study achieved complete scapular and humeral geometry prediction from seven or fewer morphometric measurements and yielded a mean surface root mean square (RMS) error under 2 mm. Reconstruction of the entire humerus was achieved using information of only proximal humerus bony landmarks and yielding mean surface RMS errors under 3 mm. The proposed statistical shape modeling facilitates rapid generation of 3D anatomical models of the shoulder, which may be useful in rapid development of personalized musculoskeletal models.
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Affiliation(s)
- Yichen Huang
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
| | | | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia.
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Ehrlich JH, Vendries V, Bryant TJ, Rainbow MJ, Ploeg HL, Bicknell RT. Trabecular bone density distribution in the scapula of patients undergoing reverse shoulder arthroplasty. JSES Int 2021; 6:32-39. [PMID: 35141673 PMCID: PMC8811382 DOI: 10.1016/j.jseint.2021.09.004] [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] [Indexed: 11/22/2022] Open
Abstract
Background To improve implant survival after reverse shoulder arthroplasty (RSA), surgeons need to maximize screw fixation. However, bone density variation and distribution within the scapula are not well understood as they relate to RSA. The three columns of bone in the scapula surrounding the glenoid fossa are the lateral border, the base of the coracoid process, and the spine of the scapula. In our previous study by Daalder et al on cadaveric specimens, the coracoid column was significantly less dense than the lateral border and spine. This study’s objective was to verify whether these results are consistent with computer tomography (CT) scan information from patients undergoing RSA. Methods Two-dimensional axial CT images from twelve patients were segmented, and a three-dimensional digital model of the scapula was subsequently created using Mimics 17.0 Materialise Software (Leuven, Belgium). Hounsfield unit (HU) values representing cortical bone were filtered out to determine the distributions of trabecular bone density. An analysis of variance with post hoc Bonferroni tests determined the differences in bone density between the columns of bone in the scapula. Results The coracoid superolateral (270 ± 45.6 HU) to the suprascapular notch was significantly less dense than the inferior (356 ± 63.6 HU, P = .03, ds = 1.54) and anterosuperior portion of the lateral border (353 ± 68.9 HU, P = .04, ds = 1.42) and the posterior (368 ± 70 HU, P = .007, ds = 1.65) and anterior spine (370 ± 78.9 HU, P = .006, ds = 1.54). Discussion/Conclusion The higher-density bone in the spine and lateral border compared with the coracoid region may provide better bone purchase for screws when fixing the glenoid baseplate in RSA. This is in agreement with our previous study and indicates that the previous cadaveric results are applicable to clinical CT scan data. When these studies are taken together, they provide robust evidence for clinical applications, including having surgeons aim screws for higher-density regions to increase screw fixation, which may decrease micromotion and improve implant longevity.
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Sarı A, Sasani H, Çetin MÜ, Günaydin B, Kilinç S, Yildirim I, Dinçel YM. Analysis of the coracoid morphology with multiplanar 2D CT and its effects on the graft size in the Latarjet procedure. J Orthop Surg (Hong Kong) 2021; 28:2309499020964602. [PMID: 33150837 DOI: 10.1177/2309499020964602] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In this study, we aimed to reveal the individual differences regarding the size of the coracoid and their effects on the classical and modified Latarjet procedures. METHODS Computed tomography images of 120 patients (mean age: 41.18 ± 12.01 years) without shoulder complaints or shoulder instability were evaluated retrospectively. The glenoid width, the surgical graft length, and the coracoid total length, width, and thickness were measured using the multiplanar reconstruction method on the Sectra Picture Archiving and Communications System (PACS) system. Age, gender, side, the dominant hand, and the height of the patients were recorded and the correlations between them were investigated. On the created hypothetical model, the current size of the coracoid was evaluated to determine what size of glenoid defects it could repair by employing the classical and the modified Latarjet techniques. RESULTS There was no significant difference between the right-hand-dominant group and the left-hand-dominant group in terms of coracoid measurement results (p > 0.05). Again, there was no statistically significant difference between the right and the left side regarding the coracoid size (p > 0.05). A positive correlation could be detected only between age and the coracoid width and thickness (p < 0.05). A positive correlation was also found between the glenoid width and the coracoid width and thickness in both shoulders (p < 0.001). Coracoid thickness could fill in the defects that amounted to 40% of the glenoid width, while the coracoid width could fill in for the defects that were 50% of the glenoid width in both genders. CONCLUSION Our study showed that hand dominance and side were not effective on the coracoid dimensions. In addition, it has been shown that the coracoid dimensions did not have a significant effect in the choice of Latarjet technique in terms of defect repair and that repair rates of up to 40% could be achieved in glenoid defects with both techniques.
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Affiliation(s)
- Abdulkadir Sarı
- Department of Orthopedics and Traumatology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Hadi Sasani
- Department of Radiology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Mehmet Ümit Çetin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Burak Günaydin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Seyran Kilinç
- Department of Orthopedics and Traumatology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Ilker Yildirim
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Yaşar Mahsut Dinçel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
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Yeazell ST, Malige A, Visser T, Carolan GF. The role of acromial morphometry in the development of acromial stress fracture following reverse total shoulder arthroplasty. Shoulder Elbow 2021; 13:296-302. [PMID: 34659470 PMCID: PMC8512991 DOI: 10.1177/1758573220906764] [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: 07/20/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Indications for reverse total shoulder arthroplasty are expanding, and postoperative acromial stress fractures are a troubling postoperative complication. The purpose of this study was to determine if differences in acromial morphometry were present between cohorts with and without this complication. METHODS A retrospective review of 101 reverse total shoulder arthroplasty procedures met criteria for the study. A total of eight acromial measurements on preoperative computed tomography scans were performed in axial, coronal, and sagittal views. Postoperative acromial stress fractures were confirmed by computed tomography scan on six patients and classified by fracture type. Statistical analysis was performed using a Mann-Whitney U test. RESULTS The median acromial thickness at the posterior and lateral half was significantly thinner in the fracture cohort compared to the non-fracture cohort. Fracture and non-fracture cohort measurements demonstrated a median lateral thickness of 6.8 and 8.7 mm (p = 0.010), respectively, and median posterior thickness of 7.6 and 9.5 mm (p = 0.008), respectively. There were no demographic differences between cohorts. DISCUSSION Two acromial measurements (lateral and posterior thickness) were associated with the development of postoperative acromial stress fracture following reverse total shoulder arthroplasty. These findings suggest that a thinner acromion in the lateral and posterior half is a risk factor for an acromial stress fracture following reverse total shoulder arthroplasty.
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Affiliation(s)
- Shawn T Yeazell
- Shawn T Yeazell, Department of Orthopedic
Surgery, St Luke’s University Health Network, 801 Ostrum St. PPHP2, Bethlehem,
PA 18018, USA.
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15
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Sun Z, Li H, Wang B, Yan J, Han L, Han S, Yang X, Zhao B. A guideline for screw fixation of coracoid process base fracture by 3D simulation. J Orthop Surg Res 2021; 16:58. [PMID: 33446228 PMCID: PMC7809839 DOI: 10.1186/s13018-021-02203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fractures of the base of the coracoid process are relatively rare, but an increasing number of studies have reported using screws to fix coracoid process base fractures. This study was performed to simulate the surgical procedure and obtain the ideal diameter, length, insertion point and angle of the screw from a 3-D axial perspective in Chinese patients. METHODS We randomly collected right scapula computed tomography (CT) scans from 100 adults. DICOM-formatted CT scan images were imported into Mimics software. A 3D digital model of the right scapula was established. Two virtual cylinders representing two screws were placed from the top of the coracoid process to the neck of the scapula and across the base of the coracoid process to fix the base of the coracoid process. The largest secure diameters and lengths of the virtual screws were measured. The positions of the insertion points and the directions of the screws were also examined. RESULTS The screw insertion safe zone can exhibit an irregular fusiform shape according to the reconstructed scapula model. The mean maximum diameters of the medial and lateral screws were 7.08 ± 1.19 mm and 7.34 ± 1.11 mm, respectively. The mean maximum lengths of the medial and lateral screws were 43.11 ± 6.31 mm and 48.16 ± 6.94 mm, respectively. A screw insertion corridor with a diameter of at least 4.5 mm was found in all patients. We found sex-dependent differences in the mean maximum diameters and maximum lengths of the two screws. The positions of the two insertion points were statistically different across sexes. CONCLUSIONS The study provides a valuable guideline for determining the largest secure corridor for two screws in fixing a fracture at the base of the coracoid process. For ideal screw placement, we suggest individualised preoperative 3D reconstruction simulations. Further biomechanical studies are needed to verify the function of the screws.
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Affiliation(s)
- Zhongye Sun
- Department of Orthopaedics, Liaocheng People’s Hospital, 67 Dongchang West Road, Liaocheng, 252000 Shandong China
| | - Hao Li
- Department of Orthopaedics, Liaocheng People’s Hospital, 67 Dongchang West Road, Liaocheng, 252000 Shandong China
| | - Bei Wang
- Department of Imaging, Liaocheng Infectious Disease Hospital, Liaocheng, Shandong China
| | - Jun Yan
- Department of Orthopaedics, Liaocheng People’s Hospital, 67 Dongchang West Road, Liaocheng, 252000 Shandong China
| | - Liren Han
- Department of Orthopaedics, Liaocheng People’s Hospital, 67 Dongchang West Road, Liaocheng, 252000 Shandong China
| | - Shizhang Han
- Department of Orthopaedics, Liaocheng People’s Hospital, 67 Dongchang West Road, Liaocheng, 252000 Shandong China
| | - Xiaofei Yang
- Department of Orthopaedics, Liaocheng People’s Hospital, 67 Dongchang West Road, Liaocheng, 252000 Shandong China
| | - Bei Zhao
- Department of Orthopaedics, Liaocheng People’s Hospital, 67 Dongchang West Road, Liaocheng, 252000 Shandong China
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Minuesa-Asensio A, García-Esteo F, Mérida-Velasco JR, Barrio-Asensio C, de la Cuadra-Blanco C, Murillo-González J. Basic morphological characteristics of coracoid grafts obtained by open and arthroscopic Latarjet techniques: A comparative study. Orthop Traumatol Surg Res 2020; 106:1083-1087. [PMID: 32763008 DOI: 10.1016/j.otsr.2020.04.014] [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: 11/02/2019] [Revised: 04/12/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND A knowledge of the anthropometric characteristics of the coracoid graft (CG) that can be obtained by the open and arthroscopic Latarjet techniques may be beneficial in the preoperative planning and intraoperative decision making for coracoid osteotomy and transfer. We have not found any study that compared the morphology of the CG that can be obtained from open and arthroscopic Latarjet techniques. The purpose of this study was to verify if the basic anthropometric characteristics of CGs are equivalent. HYPOTHESIS We hypothesize that the basic anthropometric characteristics of the CGs are similar. METHODS Twenty fresh-frozen human paired cadaveric shoulder specimens that had been randomly distributed in two groups of 10 specimens each were used. Two surgeons, each with experience in performing the open and arthroscopic Latarjet technique, performed these procedures in each of the respective groups (OG, open group; AG, arthroscopic group). A CT scan was performed. Using the volume rendering technique, a metric analysis of the volume, area and length of the CG were performed, evaluated and statistically analysed. RESULTS There were no significant differences in length (p=0.162) (mean length, 22.6mm for OG and 23.6mm for AG). There were significant differences in the volume (p=0.031) and area (p=0.007) of the CG, being lower in the OG (mean volume, 2.8 cm3 for OG and 3.6 cm3 for AG; mean area, 9.9 cm2 for OG and 12.8 cm2 for AG). No significant differences were observed by sex or laterality. CONCLUSION The mean lengths of the CGs that were obtained by each technique are equivalent. However, the areas and volumes of the grafts are different, being lower in the open surgery. These differences have not been an impediment to perform the technique. Our results corroborates that consolidation is more related to the preparation and placement than to the anthropometric characteristics of the CG. No significant differences were observed by sex or laterality. LEVEL OF EVIDENCE Basic Science.
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Affiliation(s)
| | | | - José Ramón Mérida-Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Carmen Barrio-Asensio
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Crótida de la Cuadra-Blanco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain.
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Strnad T, Bartoníček J, Naňka O, Tuček M. The coracoglenoid notch: anatomy and clinical significance. Surg Radiol Anat 2020; 43:11-17. [PMID: 32696246 DOI: 10.1007/s00276-020-02527-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/04/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The superior surface of the anatomical neck is presented in the classification of scapular fractures as a 2-cm-long structure, which does not correspond to reality. This issue has not yet been adequately addressed in the literature. The aim of the study was to assess the variability of a notch between the upper rim of the glenoid and the coracoid base, the so-called coracoglenoid notch (CGN), and its clinical significance. MATERIALS AND METHODS The study was based on the examination of 204 dry bone specimens of adult scapulae (92 male and 112 female). We have determined quantitative criteria for the evaluation of the CGN type, measuring the offset of anatomical neck using a digital caliper. The findings were compared with 3D CT reconstructions of fractures of the scapular anatomical neck. RESULTS Three basic types of CGN have been identified: type A-a well-developed notch in 31%, type B-a shallow notch in 53% and type C-an absent notch in 16%. No significant difference in CGN was found between the sexes, or between the right and left sides. When compared with our six cases of the anatomical neck fracture of the scapula, two patients displayed CGN type A and type B, respectively; but in four patients, it was impossible to distinguish between types A and B. CONCLUSION The study has documented a high variability of CGN. Its presentation in the classification schemes does not correspond to anatomical reality. The presence of a deep, or shallow, notch may constitute an anatomical predisposition to a fracture of the anatomical neck.
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Affiliation(s)
- Tomáš Strnad
- 1st Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic.,Department of Orthopedics, 1st Faculty of Medicine, Charles University and the Central Military Hospital, Prague, Czech Republic
| | - Jan Bartoníček
- 1st Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic.,Department of Orthopedics, 1st Faculty of Medicine, Charles University and the Central Military Hospital, Prague, Czech Republic
| | - Ondřej Naňka
- 1st Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic.
| | - Michal Tuček
- Department of Orthopedics, 1st Faculty of Medicine, Charles University and the Central Military Hospital, Prague, Czech Republic
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Aslani MA, Mirzaee F, Baradaran AF, Ziaei ME, Zafarani Z, Aslani H. Results of surgical treatment for Sprengle's deformity with vertical corrective scapular osteotomy. Ann Med Surg (Lond) 2020; 54:32-36. [PMID: 32322392 PMCID: PMC7170800 DOI: 10.1016/j.amsu.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/28/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sprengle deformity is the most common congential anomaly of shoulder complex that is the result of scapular placement in cephalad abnormal position. The purpose of this study is the evaluation of clinical and radiological results of vertical corrective scapular osteotomy and comparision of these results with previous studies. METHODS We retrospectively reviewed the results of the vertical corrective scapular osteotomy (VSO) with or without clavicular osteotomy and wake-up test in 31 consecutive patients at an average duration of follow up of 30 month (6 month-15 years). 22 patients were girls and 9 were boys. The average age of the patients was 7.3 years (3-13) at the time of surgery. We evaluated the clinical and radiological results of this method in last fallow-up. No funding was used for this study and there are no conflicts of interest. RESULTS 31 surgical procedures were performed. All osteotomies were healed. No neurovascular complication. Postoperative the mean shoulder flexion and abduction were improved 30 and 36° respectively (p < 0.001). The mean improvement of superior scapular angle (S.S.A) and inferior scapular angle (I.S.A) were 16 and 21° respectively (p < 0.001). CONCLUSION It is intuitive that more cosmetic scapular lowering with little chance of neurovascular problems can be achieved after VSO. In addition, scapular rotation can be corrected using this technique, which should be considered as one of the advantages of this technique.We believe that a properly applied VSO procedure in severe deformities is safe with predictable outcomes in the treatment of a complex deformity that provides favorable functional and cosmetic outcomes in the longer term.
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Affiliation(s)
- Mohammad Amin Aslani
- Medical student of Tehran University of Medical Sciences, Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran
| | - Fateme Mirzaee
- MSc of Orthosis & Prosthesis, university of social welfare and rehabilitation sciences, Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran
| | - Amir Farahanchi Baradaran
- Shahid Beheshti University of Medical Sciences, Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran
| | - Majid Eyvaz Ziaei
- Orthopedic Surgeon, Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran
| | - Zohreh Zafarani
- Researcher in Knee and Sport Medicine Research and Education Center, Milad hospital, Tehran, Iran
| | - Hamidreza Aslani
- Orthopedic Surgeon, Knee and Sport Medicine Research and Education Center, Milad hospital, Tehran, Iran
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Said HG, Fetih TN, Abd-Elzaher HE, Lambert SM. Radiographic parameters and a novel fluoroscopic control view for posterior screw fixation of coracoid base fractures - A cadaveric study. SICOT J 2020; 6:9. [PMID: 32369014 PMCID: PMC7199510 DOI: 10.1051/sicotj/2020008] [Citation(s) in RCA: 2] [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: 01/04/2020] [Accepted: 03/31/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Coracoid fractures have the potential to lead to inadequate shoulder function. Most coracoid base fractures occur with scapular fractures and the posterior approaches would be utilized for surgical treatment. We investigated the possibility of fixing the coracoid through the same approach without an additional anterior approach. MATERIALS AND METHODS Multi-slice CT scans of 30 shoulders were examined and the following measurements were performed by an independent specialized radiologist: posterior coracoid screw entry point measured form infraglenoid tubercle, screw trajectory in coronal plane in relation to scapular spine and lateral scapular border, screw trajectory in sagittal plane in relation to glenoid face bisector line and screw length. We used the results from the CT study to guide postero-anterior coracoid screw insertion under fluoroscopic guidance on two fresh frozen cadaveric specimens to assess the reproducibility of accurate screw placement based on these parameters. We also developed a novel fluoroscopic projection, the anteroposterior (AP) coracoid view, to guide screw placement in the para-coronal plane. RESULTS The mean distance between entry point and the infraglenoid tubercle was 10.8 mm (range: 9.2-13.9, SD 1.36). The mean screw length was 52 mm (range: 46.7-58.5, SD 3.3). The mean sagittal inclination angle between was 44.7 degrees (range: 25-59, SD 5.8). The mean angle between screw line and lateral scapular border was 47.9 degrees (range: 34-58, SD 4.3). The mean angle between screw line and scapular spine was 86.2 degrees (range: 75-95, SD 4.9). It was easy to reproduce the screw trajectory in the para-coronal plane; however, multiple attempts were needed to reach the correct angle in the parasagittal plane, requiring several C-arm corrections. CONCLUSION This study facilitates posterior fixation of coracoid process fractures and will inform the "virtual visualization" of coracoid process orientation.
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Affiliation(s)
- Hatem Galal Said
- Professor, Orthopaedics and Traumatology Department, Assiut University, 71515 Assiut, Egypt
| | - Tarek Nabil Fetih
- Assistant lecturer, Orthopaedics and Traumatology Department, Assiut University, 71515 Assiut, Egypt
| | - Hosam Elsayed Abd-Elzaher
- Assistant lecturer, Orthopaedics and Traumatology Department, Al-Azhar University, 11651 Assiut, Egypt
| | - Simon Martin Lambert
- Consultant, Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, WC1E6BT London, UK
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Suter T, Krähenbühl N, Howell CK, Zhang Y, Henninger HB. Viewing perspective malrotation influences angular measurements on lateral radiographs of the scapula. J Shoulder Elbow Surg 2020; 29:1030-1039. [PMID: 31784385 PMCID: PMC7170764 DOI: 10.1016/j.jse.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate and reliable assessment of acromial tilt (ATA) and slope (ASA) angles have been important in the clinical evaluation of degenerative and traumatic rotator cuff tears. This study analyzed the influence of radiographic viewing perspective on the ATA and ASA and developed criteria to identify true lateral (TL) view radiographs. METHODS Three-dimensional computed tomographic (CT) reconstructions of 52 scapulae without rotator cuff tears or osteoarthritis were studied. Digitally reconstructed radiographs (DRRs) were aligned to obtain a TL view. In 10 random scapulae, incremental ante- and retroversion and up- and downward rotation views were generated (10° increments, ±30°), and ATA and ASA were measured by 2 observers. Clinically applicable criteria were developed and validated to identify TL views. RESULTS The mean ATA and ASA on TL views were 33°±4° (range 23°-42°) and 22°±7° (8°-43°), respectively. Mixed effect models showed that DRRs malpositioned in 20° and 30° anteversion and downward rotation decreased the ATA (P ≤ .030). DRRs malpositioned in anteversion and >10° of up- and downward rotation demonstrated a significantly decreased ASA (P ≤ .047). Intra- and interobserver reliability was excellent for TL views (intraclass correlation coefficient ≥ 0.95) but decreased with increasing viewing angle. Anatomic landmark criteria were capable of identifying TL-view radiographs with sensitivity of 81% and specificity of 82%. CONCLUSION Both ATA and ASA were significantly affected by malposition in anteversion and downward rotation of the scapula. Reliable ASA measurement was more susceptible in up- and downward rotation than the ATA. New visual criteria can identify TL-view radiographs and should be used in future studies to ensure consistency in ATA and ASA measurement.
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Affiliation(s)
- Thomas Suter
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Switzerland,Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - C. Kalebb Howell
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Heath B. Henninger
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5736136. [PMID: 32104697 PMCID: PMC7035523 DOI: 10.1155/2020/5736136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/11/2020] [Indexed: 11/18/2022]
Abstract
Purpose In this study, our aim was to evaluate the glenoid version, height, and width measurements based on gender, side, age, height, and hand dominance in the Turkish population using computed tomography (CT) images. Methods In our study, CT images of 140 patients (62 females and 78 males; mean age: 39.6 years) who had no shoulder complaints were evaluated retrospectively. Glenoid version (GV), AP diameter (width), and SI diameter (height) on both shoulders were measured on the CT images. Correlations between patient gender, side, age, height, and hand dominance and the GV and size were evaluated. Results The right shoulder had a mean GV of −0.93 ± 7.80 degrees and the left shoulder had a GV of −0.88 ± 6.63 degrees (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder ( Conclusion Hand dominance had an effect on the glenoid version, while patient gender, age, and height had an effect on the glenoid size. The glenoid width in the Turkish population was similar to that of the European and American populations, and the glenoid height was similar to that of the Asian population. Our GV values were similar to those of the Asian population and more anteverted compared to the Western population. We believe that our findings will be useful in preoperative planning and in the production of implants for our population.
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Lin Y, Gan K, Zhang L, Wei H, Zhou X, Chen H. The Anatomical Variation of the Scapular Spine in A Chinese Population. Med Sci Monit 2019; 25:8863-8872. [PMID: 31757937 PMCID: PMC6884942 DOI: 10.12659/msm.917870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The occurrence of fractures and risks following reverse total shoulder arthroplasty (rTSA) is common due to the variation of scapular spine (SS). Therefore, the consideration of the variable osteological features of SS prior to surgery may prove to be significant for the implementation of rTSA. This study aimed to propose a classification of SS through particular and quantitative parameters. Material/Methods In total, 354 intact dry scapulae were geometrical measured and classified on account of anatomical characteristics and the shapes of SS. Results Type I SS was found, and this was the most frequency was type (27.97%). The least common type was type II. The type of SS had a direct association with bone stock and bone mineral density. Type II represented an association with a much thinner spine and restricted cortical and cancellous bone; types II and V were also associated with a crooked SS, which had a more complex morphology. Conclusions This study offered a comprehensive classification of SS in the Chinese population. On the whole, this study indicates that knowledge of the morphological variations of SS can prompt the diagnosis of scapular fractures and can promote more successful rTSA procedures, and the relative clinical trial is necessary to support it.
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Affiliation(s)
- Yimu Lin
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Kaifeng Gan
- Department of Orthopaedics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China (mainland).,Medical School of Ningbo University, Ningbo, Zhejiang, China (mainland)
| | - Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Sichuan, China (mainland).,National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Hongrui Wei
- School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Xin Zhou
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Hengshu Chen
- School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland)
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Panagiotopoulos AC, Crowther IM. Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT J 2019; 5:29. [PMID: 31430250 PMCID: PMC6701878 DOI: 10.1051/sicotj/2019029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/17/2019] [Indexed: 11/14/2022] Open
Abstract
The improper movement of the scapula during shoulder movement is termed scapular dyskinesis and is an often-forgotten cause of pain and dysfunction. The scapula is a key part of the upper limb kinematic chain and is a vital component of the glenohumeral rhythm; which is a major determinant of the efficiency and efficacy of the upper limb. We provide an overview of the complex regional anatomy of the shoulder girdle and how this allows the scapula to act as a both a dynamic and static stabilizer to the upper limb. We explore the normal biomechanics and the aetiology, epidemiology and pathological occurrences which can disrupt the normal function and lead to scapula dyskinesis. Scapula dyskinesis is a poorly understood condition and provides a challenge for the clinician in both diagnosis and management. We provide a summary of the clinical assessment which is most likely to identify the source of the pathology and guides the treatment which is largely rehabilitation of the musculature with focused and specialized physiotherapy.
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Affiliation(s)
| | - Ian Martyn Crowther
- Northumbria Specialist Emergency Care Hospital, Northumbria Way, Cramlington, Northumberland NE23 6NZ, United Kingdom
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Rohman E, Gronbeck K, Tompkins M, Mittelsteadt M, Kirkham JA, Arciero RA. Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site. Am J Sports Med 2019; 47:2469-2477. [PMID: 31310727 DOI: 10.1177/0363546519861965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current structural bone graft options used for glenoid augmentation in glenohumeral instability have known drawbacks. The scapular spine may be a possible alternative graft choice, but its dimensions and anatomy are not fully reported. HYPOTHESIS The scapular spine's harvestable graft dimensions will be similar to harvestable dimensions of the coracoid and iliac crest. STUDY DESIGN Descriptive laboratory study. METHODS The scapular spine, coracoid, and iliac crest dimensions were recorded and compared bilaterally in 50 patients with 3-dimensional computed tomography imaging. The portion of the scapular spine with the largest harvestable dimensions was quantified and its location defined. Measurements were independently taken by 2 investigators and averaged for the final result. RESULTS The scapular spine has 81.5 mm of harvestable length and a "flare" located approximately 49.6 mm lateral to the medial scapular border, where the widest harvestable cross section is located (mean harvestable dimensions: 10.9-mm height, 11.5-mm width). Mean coracoid dimensions were 24-mm length, 14.2-mm height, and 10.6-mm width. Mean iliac crest width was 14.7 mm. In sum, 96% of scapular spines, 85% of coracoids, and 100% of iliac crests exceeded minimum dimensions of 8 mm × 8 mm × 20 mm. The coronal radius of curvature of the glenoid was significantly different from the corresponding plane of all measured structures. CONCLUSION/CLINICAL RELEVANCE The scapular spine has dimensions similar to the coracoid and iliac crest in the majority of patients and is therefore appropriate for further investigation as a potential graft choice in glenohumeral instability. A harvest location 49.6 mm lateral to the medial scapular border will provide the largest cross-sectional graft while avoiding the acromial base.
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Affiliation(s)
- Eric Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle Gronbeck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopaedic Center, Bloomington, Minnesota, USA
| | - Marcus Mittelsteadt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - James A Kirkham
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert A Arciero
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
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van Trikt CH, Dobbe JGG, Donders JCE, Streekstra GJ, Kloen P. The "coracoid tunnel view": a simulation study for finding the optimal screw trajectory in coracoid base fracture fixation. Surg Radiol Anat 2019; 41:1337-1343. [PMID: 31273419 PMCID: PMC6841653 DOI: 10.1007/s00276-019-02274-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Coracoid fractures represent approximately 3-13% of all scapular fractures. Open reduction and internal fixation can be indicated for a coracoid base fracture. This procedure is challenging due to the nature of visualization of the coracoid with fluoroscopy. The aim of this study was to develop a fluoroscopic imaging protocol, which helps surgeons in finding the optimal insertion point and screw orientation for fixations of coracoid base fractures, and to assess its feasibility in a simulation study. METHODS A novel imaging protocol was defined for screw fixation of coracoid base fractures under fluoroscopic guidance. The method is based on finding the optimal view for screw insertion perpendicular to the viewing plane. In a fluoroscopy simulation environment, eight orthopaedic surgeons were invited to place a screw down the coracoid stalk through the coracoid base and into the neck of 14 cadaveric scapulae using anatomical landmarks. The surgeons placed screws before and after they received an e-learning of the optimal view. Results of the two sessions were compared and inter-rater reliability was calculated. RESULTS Screw placement was correct in 33 out of 56 (58.9%) before, and increased to 50 out of 56 (89.3%) after the coracoid tunnel view was explained to the surgeons, which was a significant improvement (p < 0.001). CONCLUSIONS Our newly developed fluoroscopic view based on simple landmarks is a useful addendum in the orthopaedic surgeon's tool box to fixate fractures of the coracoid base.
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Affiliation(s)
- C H van Trikt
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J C E Donders
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Jeong YS, Yum JK, Lee JS. Another Glenoid Measurements for Shoulder Surgery. Clin Shoulder Elb 2018; 21:179-185. [PMID: 33330174 PMCID: PMC7726404 DOI: 10.5397/cise.2018.21.4.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Background We analyzed the angle between the glenoid anterior surface and glenoid axis, the range of the glenoid apex and the location of the glenoid apex for assistance during shoulder surgery. Methods Sixty-two patients underwent a computed tomography of the shoulder with a proximal humerus fracture. In the range of the glenoid apex, the ratios of the distribution of triangles with a Constant anterior and posterior area of the glenoid were measured. The location of glenoid apex was confirmed as the percentage of the position with respect to the upper part of the glenoid with the center of the part, analyzed the angle between the glenoid anterior surface and glenoid axis was measured. Results The angle between the glenoid anterior surface and glenoid axis was 19.80° ± 3.88°. The location of the glenoid apex is 60.36% ± 9.31%, with the upper end of the glenoid as the reference. The range of the glenoid apex was 21.16% ± 4.98%. When the height of the glenoid becomes smaller, the range of the glenoid apex tends to become larger (p=0.001) and the range of the glenoid apex becomes wider (p=0.001) as the glenoid width narrows. Conclusions We believe the anatomical measurements of the glenoid will be helpful for a more accurate insertion in glenoid component. It is thought that more accurate insertion is possible if we can set other anatomical measurements using computed tomography imaging of the glenoid which can develop into the study of other anatomical measurements.
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Affiliation(s)
- Yeon-Seok Jeong
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jae-Kwang Yum
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jun-Seok Lee
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
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Casier SJ, Van den Broecke R, Van Houcke J, Audenaert E, De Wilde LF, Van Tongel A. Morphologic variations of the scapula in 3-dimensions: a statistical shape model approach. J Shoulder Elbow Surg 2018; 27:2224-2231. [PMID: 30100175 DOI: 10.1016/j.jse.2018.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Morphologic variations of the scapula and acromion have been found to be associated with shoulder pathology. This study used statistical shape modelling to quantify these variations in healthy shoulders. MATERIALS AND METHODS A statistical shape model of the scapula was created using 3-dimensional computed tomography reconstructions of 108 survey-confirmed nonpathologic shoulders of 54 patients. The mean shape and the 95% confidence interval were calculated and analyzed in the first 5 shape modes. RESULTS The first 5 shape modes consisted of consecutively sized (72% of total variation), rotation of the coracoacromial complex (5%), acromial shape and slope (4%), shape of the scapular spine (2%), and acromial overhang (2%). DISCUSSION AND CONCLUSION In healthy shoulders, a certain variation in rotation of the coracoacromial complex and in acromial shape and slope was observed. These new parameters might be correlated with shoulder pathology such as glenohumeral osteoarthritis or rotator cuff tears.
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Affiliation(s)
- Stijn J Casier
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | | | - Jan Van Houcke
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | | | - Lieven F De Wilde
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
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Knapik DM, Cumsky J, Tanenbaum JE, Voos JE, Gillespie RJ. Differences in Coracoid and Glenoid Dimensions Based on Sex, Race, and Age: Implications for Use of the Latarjet Technique in Glenoid Reconstruction. HSS J 2018; 14:238-244. [PMID: 30258327 PMCID: PMC6148576 DOI: 10.1007/s11420-018-9618-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Latarjet procedure restores shoulder stability through reconstruction of the glenoid arc. Prior investigations of glenoid and coracoid dimensions have been underpowered to detect differences based on sex and race. QUESTIONS/PURPOSES We sought to establish normative values for glenoid width and coracoid dimensions based on sex, race, and age. In addition, we assessed the restoration of glenoid dimensions using the classic and modified Latarjet techniques (classic technique: placing lateral surface of the coracoid to the glenoid; modified technique: placing inferior surface of the coracoid to the glenoid). METHODS A total of 993 cadaveric specimens (n = 1986 scapulae) from people over 18 years of age at the time of death were analyzed. Measurements of maximal glenoid width, coracoid width, thickness, and length were recorded. Statistical analysis was performed to detect differences based on sex and race, while univariable linear regression was used to determine the association of increasing age on measured dimensions. RESULTS All dimensions of specimens were significantly larger in males than in females. Caucasians possessed larger mean glenoid width, coracoid width, and coracoid length, while coracoid thickness was significantly larger in African Americans. Linear regression analysis found that increasing age was associated with increased glenoid width and coracoid dimensions. Coracoid positioning restored glenoid width in defects measuring 20% of glenoid width using both classic and modified Latarjet techniques, while defects measuring up to 25% were more accurately reproduced using the modified technique. CONCLUSION Dimensions were significantly larger in males and in Caucasians, aside from coracoid thickness. Mean dimensions increased with advancing age. Coracoid positioning using classic or modified Latarjet techniques restored glenoid width defects measuring 20% of the glenoid width, while the modified technique allowed for restoration of larger defects.
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Affiliation(s)
- Derrick M. Knapik
- University Hospitals Sports Medicine Institute, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106 USA ,School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Jameson Cumsky
- University Hospitals Sports Medicine Institute, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106 USA ,School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Joseph E. Tanenbaum
- University Hospitals Sports Medicine Institute, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106 USA ,School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - James E. Voos
- University Hospitals Sports Medicine Institute, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106 USA ,School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Robert J. Gillespie
- University Hospitals Sports Medicine Institute, 11100 Euclid Ave., Hanna House 5043, Cleveland, OH 44106 USA ,School of Medicine, Case Western Reserve University, Cleveland, OH USA
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Totlis T, Gowd AK, Bernardoni ED, Cole BJ, Verma NN, Natsis K. A simple method to directly evaluate the lateral extension of the acromion: an anatomic study of 128 cadaveric scapulae. J Shoulder Elbow Surg 2018; 27:1694-1699. [PMID: 29730136 DOI: 10.1016/j.jse.2018.02.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The lateral extension of the acromion from the glenohumeral joint is the critical variable that both the acromial index and critical shoulder angle reflect. The purpose of this study was to establish a simple and reproducible method to directly measure the lateral extension of the acromion that will be independent of patient demographic characteristics, scapular rotation, or other morphologic features of the shoulder. METHODS This study used 128 unpaired cadaveric scapulae with a mean age of 69.4 ± 11.1 years (66 right and 62 left scapulae, 65 female and 63 male cadaveric specimens). The lateral extension of the acromion was measured from the supraglenoid tubercle to the most lateral point of the acromion with a digital caliper placed perpendicular to the scapula long axis. This distance was called the "lateral offset of the acromion." RESULTS The lateral offset was 2.62 ± 0.72 cm in men and 2.69 ± 0.73 cm in women. The offset was 2.61 ± 0.66 cm in right and 2.70 ± 0.78 cm in left scapulae. The offset in the group aged 46-60 years was 2.85 ± 0.76 cm; in the group aged 61-75 years, it was 2.62 ± 0.76 cm; and in the group aged 76 years or older, it was 2.54 ± 0.60 cm. No significant difference was found between any of the groups. CONCLUSIONS This study established a simple method to directly measure the lateral extension of the acromion based on the longitudinal axis of the scapula, which eliminates bias that may exist in the acromial index and critical shoulder angle from the position of the scapula and glenoid inclination. The lateral offset was found to be independent of sex, side, or age, limiting bias in a potential future clinical application.
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Affiliation(s)
- Trifon Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anirudh K Gowd
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eamon D Bernardoni
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Trabecular bone density distribution in the scapula relevant to reverse shoulder arthroplasty. JSES OPEN ACCESS 2018; 2:174-181. [PMID: 30675591 PMCID: PMC6334872 DOI: 10.1016/j.jses.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background How trabecular bone density varies within the scapula and how this may lead to more optimal reverse shoulder arthroplasty (RSA) screw placement has not been addressed in the scientific literature. The 3 columns of trabecular bone within the scapula adjacent to the glenoid fossa, one extending through the lateral border, a second into the base of the coracoid process, and a third extending into the spine of the scapula, were hypothesized to be of relatively similar density. Methods Two-dimensional axial computed tomography (CT) images of 19 fresh frozen cadaver specimens were obtained. Digital Imaging and Communications in Medicine (DICOM; National Electrical Manufacturers Association, Rosslyn, VA, USA) image files of the CT scanned scapulae were imported into Mimics 17.0 Materialise Software (Leuven, Belgium) for segmentation and 3-dimensional digital model generation. To determine the distribution of trabecular bone density, Hounsfield unit (HU) values in the scapulae gray value files obtained from Mimics were filtered to remove any cortical bone. HU values of 650 define the corticocancellous interface in CT image data and were considered to be cortical bone. Analyses of variance with post hoc Bonferroni tests were used to determine statistical differences between the intra- and inter-regions of bone density comparisons. Results The base of the coracoid process was statistically significantly less dense than the spine and the lateral border of the scapulae examined (P < .05). Discussion/Conclusion The higher-quality bone in the spine and lateral border, compared with the coracoid regions, may provide better bone purchase for screws when fixing the glenoid baseplate in RSA.
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Can the contralateral scapula be used as a reliable template to reconstruct the eroded scapula during shoulder arthroplasty? J Shoulder Elbow Surg 2018; 27:1133-1138. [PMID: 29478943 DOI: 10.1016/j.jse.2017.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/13/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The contralateral scapula can be used as a reliable template to determine scapular offset, glenoid inclination, and version of the native scapula in view of reconstructing pathologic scapulae. METHODS Three-dimensional measurements of scapular offset, inclination, and version were performed using data from a set of 50 bilateral computed tomography scans of full scapulae to determine direct side-to-side differences. RESULTS The scapula pairs had a mean bilateral difference of 2 mm in offset, 2° in inclination, and 2° in version. Ninety percent of the scapula pairs showed an offset difference smaller than 3 mm. In 96% and 94% of the scapula pairs, the inclination difference and version difference, respectively, were smaller than 5°. The maximum bilateral difference for offset, inclination, and version was 6 mm, 6°, and 8°, respectively. DISCUSSION AND CONCLUSION The anatomic parameters of scapular offset, glenoid inclination, and version are quite symmetrical and fall into the currently technically feasible accuracy of shoulder arthroplasty implantation. The healthy scapula can be used as a template to guide the reconstruction of the glenoid during shoulder arthroplasty planning in the case of unilateral advanced arthropathy.
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Dyrna F, de Oliveira CCT, Nowak M, Voss A, Obopilwe E, Braun S, Pauzenberger L, Imhoff AB, Mazzocca AD, Beitzel K. Risk of fracture of the acromion depends on size and orientation of acromial bone tunnels when performing acromioclavicular reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:275-284. [PMID: 28986617 DOI: 10.1007/s00167-017-4728-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Current techniques for anatomic repair of the dislocated acromioclavicular (AC) joint aim on reconstruction of the AC ligaments and utilize tunnels drilled through the acromion . This improves the stability of the reconstruction but might also increase the risk of fractures at the acromion. The purpose of this study was to evaluate the fracture risk for the acromion after transacromial tunnel placement for anatomic AC joint stabilization procedure. It was hypothesized that the risk of fracture of the acromion is correlated to size and orientation of bone tunnels commonly used for anatomic AC joint reconstruction. METHODS A finite element analysis was used to simulate multiple bone tunnels and incoming force vectors (lateral vs. superior). Different tunnels were analysed, horizontal meaning an anterior-posterior orientation versus a vertical inferior-superior orientation through the acromion. Two tunnel diameters were simulated (2.4 vs. 4.5 mm). Furthermore, the tunnel length and distance between tunnels were altered. Forty-five cadaveric specimens (median age: 64 years, range 33-71 years) were utilized for data acquisition. Out of these, 30 specimens were used to evaluate basic tunnel orientations and drill diameters using a MTS 858 servohydraulic test system. RESULTS With regard to the tunnel orientation and drill hole size, the loads to failure were limited. The acromion is at higher fracture risk, with a superior to inferior directed incoming force. Position, size and direction of bone tunnels influenced the loads to failure. Horizontal tunnels with a higher diameter (4.5 mm) had the most impact on load to failure reduction. A long horizontal tunnel with a diameter of 4.5 mm reduced the load to failure with medial direction of force to 25% of the native acromion. The identical tunnel with a diameter of 2.4 mm reduced the load to failure to 61%. Both 2.4-mm horizontal tunnels with a medium and short length did not reduce the load to failure. CONCLUSION Tunnels placed at the acromion did not result in an increased risk of fracture. However, descriptive data showed a tendency for an increased fracture risk if tunnels are placed at the acromion, especially in horizontal direction with diameters of 4.5 mm. In addition, the pattern of fracture was dependent on the orientation of the bone tunnels and the size. However, the results indicate a "safe zone" for the placement of bone tunnels within the anterior half of the acromion, which does not affect the loads to failure at the acromion. Therefore, current techniques for anatomic AC joint reconstruction which utilize fixation of grafts or sutures at the acromion are safe within current ranges of tunnel placement and sizes.
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Affiliation(s)
- Felix Dyrna
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Celso Cruz Timm de Oliveira
- Department of Civil Environmental, and Biomedical Engineering, College of Engineering and Technology and Architecture, University of Hartford, West Hartford, CT, USA
| | - Michael Nowak
- Department of Civil Environmental, and Biomedical Engineering, College of Engineering and Technology and Architecture, University of Hartford, West Hartford, CT, USA
| | - Andreas Voss
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Gelenkpunkt, Sport- und Gelenchirurgie Innsbruck, Innsbruck, Austria
| | - Leo Pauzenberger
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Humphries A, Cirovic S, Shaheen AF. Shoulder Bone Geometry Affects the Active and Passive Axial Rotational Range of the Glenohumeral Joint. Am J Sports Med 2017; 45:3010-3019. [PMID: 28777666 DOI: 10.1177/0363546517716926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The range of motion of the glenohumeral joint varies substantially among individuals and is dependent on humeral position. How variation in shape of the humerus and scapula affects shoulder axial range of motion at various positions has not been established. PURPOSE To quantify variation in the shape of the glenohumeral joint and investigate whether the scapula and humerus geometries affect the axial rotational range of the glenohumeral joint. STUDY DESIGN Descriptive laboratory study. METHODS The range of active and passive internal-external rotation of the glenohumeral joint was quantified for 10 asymptomatic participants with optical motion tracking at 60º, 90º, and 120º humeral elevations in the coronal, scapular, and sagittal planes. Bone geometrical parameters were acquired from shoulder magnetic resonance image scans, and correlations between geometrical parameters and maximum internal and external rotations were investigated. Three-dimensional participant-specific models of the humerus and scapula were used to identify collisions between bones at the end of range. RESULTS Maximum internal and external rotations of the glenohumeral joint were correlated to geometric parameters and were limited by bony collisions. Generally, the active axial rotational range was greater with increased articular cartilage and glenoid curvature, while a shorter acromion resulted in greater passive range. Greater internal rotation was correlated with a greater glenoid depth and curvature in the scapular plane ( r = 0.76, P < .01, at 60° of elevation), a greater subacromial depth in the coronal plane ( r = 0.74, P < .01, at 90° of elevation), and a greater articular cartilage curvature in the sagittal plane ( r = 0.75, P < .01, at 90° of elevation). At higher humeral elevations, a greater subacromial depth and shorter acromion allowed a greater range of motion. CONCLUSION The study strongly suggests that specific bony constraints restrict the maximum internal and external rotations achieved in active and passive glenohumeral movement. CLINICAL RELEVANCE This study identifies bony constraints that limit the range of motion of the glenohumeral joint. This information can be used to predict full range of motion and set patient-specific rehabilitation targets for those recovering from shoulder disorders. It can improve positioning and choice of shoulder implants during preoperative planning by considering points of collision that could limit range of motion.
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Affiliation(s)
- Alexander Humphries
- Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, University of Surrey, Guildford, UK
| | - Srdjan Cirovic
- Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, University of Surrey, Guildford, UK
| | - Aliah F Shaheen
- Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, University of Surrey, Guildford, UK
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Simon P, Diaz M, Cusick M, Santoni B, Frankle M. 3D image-based morphometric analysis of the scapular neck length in subjects undergoing reverse shoulder arthroplasty. Clin Anat 2017; 31:43-55. [PMID: 28514491 DOI: 10.1002/ca.22911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 01/31/2023]
Abstract
Scapular notching after RSA may, in part, be related to a patient's scapular morphology. The purpose of this study was to develop a novel 3 D measurement technique to describe infraglenoid tubercle morphometry. We hypothesize that the parameters describing infraglenoid tubercle would be normally distributed and would correlate with individual's demographics and glenoid morphometry. A group of 110 subjects treated with RSA were evaluated. Scapular geometry was obtained from pre-operative CT scans. The scapular neck length was defined in anterior and posterior view as the orthogonal distance between the glenoid surface and (a) the point of most significant change of curvature on lateral pillar; (b) the most lateral portion of the infraglenoid tubercle. Scapular neck angle, maximum anatomical adduction angle, glenoid width, height and version were also measured. Scapular neck length measured in the anterior and posterior view were normally distributed with mean values of 17.6 ± 2.8 mm and 7.9 ± 2.5 mm, respectively. Scapular neck angle was on average 112.4 ± 10.6° and maximal adduction angle was 17.6 ± 2.8°. No significant associations between infraglenoid tubercle morphometric parameters, demographic, glenoid size or version were identified. Improved understanding of the patient-specific risk factors for scapular notching will help surgeons with pre-surgical planning and implant selection. Parametrization of the infraglenoid tubercle presented in this study showed normal distribution in the population unrelated to gender, side or demographics. The size of the infraglenoid tubercle is a unique trait, pre-operative evaluation of the scapular neck should be always warranted to decrease the incidence of post-operative notching. Clin. Anat. 31:43-55, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- P Simon
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, Florida.,Department of Orthopaedic and Sport Medicine, University of South Florida, Tampa, Florida
| | - M Diaz
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - M Cusick
- Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, Florida
| | - B Santoni
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, Tampa, Florida.,Department of Orthopaedic and Sport Medicine, University of South Florida, Tampa, Florida
| | - M Frankle
- Department of Orthopaedic and Sport Medicine, University of South Florida, Tampa, Florida.,Department of Shoulder and Elbow Surgery, Florida Orthopaedic Institute, Tampa, Florida
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Voss A, Dyrna F, Achtnich A, Hoberman A, Obopilwe E, Imhoff AB, Mazzocca AD, Beitzel K. Acromion morphology and bone mineral density distribution suggest favorable fixation points for anatomic acromioclavicular reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:2004-2012. [PMID: 28434036 DOI: 10.1007/s00167-017-4539-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Recent techniques for acromioclavicular (AC) joint reconstruction focus on additional AC cerclage to coracoclavicular (CC)-reconstructions. Due to the specific slim bone morphology at the acromion, there are concerns regarding these additional bone tunnels, as they may predispose to fracture and break out. The purpose of this study was to investigate anatomic properties of the acromion which may help improve surgical techniques directed at injuries to the AC joint. It was hypothesized that via measurements of thickness and density points of increased strength and support could be identified on the acromion. METHODS Eighty-five fresh frozen cadaveric shoulders were used for this study. A standardized 3D-net was developed and thicknesses of the acromion were taken from defined points using a certified caliper. To define the acromial arch, the angle and radius of curvature between the antero-lateral, the highest point of the acromial arch and the postero-lateral aspect of the acromion were measured. Additional bone mineral density (BMD) evaluation was performed on 43 specimens in an anterio-posterior and latero-medial direction using 5-mm slices with a maximum of 10 and 6 slices, respectively. RESULTS Median specimen age was 63.0 (range 36) years (55 female, and 30 male). There was no statistical significance between male (62.0, range: 35 years) and female (64.5, range 32 years) regarding age (n.s.). Thickness of acromion points of interest were ranging from 3.5 to 24.3 mm. Median radius of curvature of acromial arch for female was 48.2 (range 92.7) mm and 66.2 (range 85.6) for male (p = 0.019). The median angle for female specimens was 21.4° (range: 44.6°) and 23.3° (range 51.7°) for male (p = 0.047). The latero-medial measurements showed significant difference between the region of interest (ROI): 1 and 4, 5, 6 (p = 0.001, p = 0.001, p = 0.001), 2 and 4, 5, 6 (p = 0.007, p = 0.001, p = 0.001), 3 and 5, 6 (p = 0.001, p = 0.001), 4 and 5, 6 (p = 0.010, p = 0.001). Antero-posterior measurements showed significant difference between the ROI: 1 and 8 (p = 0.031). CONCLUSION The posterior-medial acromion close to the AC joint revealed the highest BMD with an increasing density from lateral to medial. In combination with thickness measurements this region would support additional anatomical fixation of the AC joint using bone tunnels if necessary. CLINICAL RELEVANCE To anatomically reproduce the insertions of the AC ligaments at the acromion, either bone tunnels or anchors are needed. Therefore, several techniques have been developed. This study provides the anatomical data for these techniques and confirms the reconstructive approach of techniques using anatomical points of fixation and orientation.
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Affiliation(s)
- Andreas Voss
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, 06034, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Felix Dyrna
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, 06034, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andrea Achtnich
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alex Hoberman
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, 06034, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, 06034, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, 06034, USA.
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Protective and Predisposing Morphological Factors in Suprascapular Nerve Entrapment Syndrome: A Fundamental Review Based on Recent Observations. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4659761. [PMID: 28691025 PMCID: PMC5485264 DOI: 10.1155/2017/4659761] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/23/2017] [Accepted: 05/15/2017] [Indexed: 11/17/2022]
Abstract
Suprascapular nerve entrapment syndrome (SNES) is a neuropathy caused by compression of the nerve along its course. The most common compression sites include the suprascapular notch and the spinoglenoid notch. The aim of this article was to review the anatomical factors influencing the occurrence of SNES in the light of the newest reports. Potential predisposing morphological factors include a V-shaped, narrow, or "deep" suprascapular notch; a band-shaped, bifurcated, or completely ossified superior transverse scapular ligament (STSL); particular arrangements of the suprascapular nerve and vessels at the suprascapular notch. A very recent report indicates structures at the suprascapular notch region that may protect from SNES, such as the suprascapular notch veins (SNV). The role of the anterior coracoscapular ligament (ACSL) is still not clear. While some studies indicate that it may predispose for SNES, the newest study proposes a protective function. Knowledge of these variations is essential for arthroscopic and other surgical procedures of this area in order to avoid iatrogenic injury of the suprascapular nerve or unexpected bleeding from the suprascapular vessels running alongside the STSL.
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Saha S, Vasudeva N. Morphometric Evaluation of Adult Acromion Process in North Indian Population. J Clin Diagn Res 2017; 11:AC08-AC11. [PMID: 28273959 DOI: 10.7860/jcdr/2017/21060.9312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/25/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dimensions of acromion process are important to show linkage to the shoulder girdle pathologies. Also morphometric analysis of acromion process would be helpful for surgeons while performing surgical procedures on the shoulder joint. AIM The purpose of this present study was to observe the detailed morphometric evaluation of adult acromion processes in North Indian population because different morphometric dimensions play an important role in various disorders of the shoulder, particularly sub acromial impingement syndrome. MATERIALS AND METHODS Two hundred adult dry scapulae from the osteology museum of MAMC, New Delhi, were obtained for evaluation of various measurement of acromion process. The length, width, thickness of acromion, coraco-acromial (C-A) distance and acromio-glenoid (Ac-g) distance were measured. The measurements were compared with other osteological studies performed on different population group. Data was analysed using SPSS version 12.0 and mean values with standard deviation for each dimension were presented. RESULTS The mean values of each measurement were: length: 41.007 mm; width: 21.82 mm; thickness: 6.58 mm; C-A distance: 28.34 mm and Ac-g distance: 26.21 mm. CONCLUSION It is expected that various dimensions of adult acromion process will serve as a reference base and will assist the surgeon in the approach to be used and precision of the operative technique. So, the study will provide a vital support for planning and executing acromioplasty in the treatment of impingement syndrome.
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Affiliation(s)
- Susmita Saha
- Assistant Professor, Department of Anatomy, SGT Medical College, Hospital and Research Institute , Budhera, Gurgaon, India
| | - Neelam Vasudeva
- Director Professor and Head, Department of Anatomy, Maulana Azad Medical College , New Delhi, India
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Owaydhah WH, Alobaidy MA, Alraddadi AS, Soames RW. Three-dimensional analysis of the proximal humeral and glenoid geometry using MicroScribe 3D digitizer. Surg Radiol Anat 2016; 39:767-772. [DOI: 10.1007/s00276-016-1782-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 11/12/2016] [Indexed: 12/19/2022]
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Obert L, Peyron C, Boyer E, Menu G, Loisel F, Aubry S. CT scan evaluation of glenoid bone and pectoralis major tendon: interest in shoulder prosthesis. SICOT J 2016; 2:33. [PMID: 27716461 PMCID: PMC5054739 DOI: 10.1051/sicotj/2016021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/11/2016] [Indexed: 01/08/2023] Open
Abstract
Introduction: The shoulder arthroplasty brings satisfaction to patients in terms of quality of life and indolence. However whether anatomic implant or reverse, it does not escape from the loosening of the glenoid component. Moreover, optimal implantation is required to ensure the functional outcome without shortening of the arm. The purpose of this study is obtain CT scan evaluation of the glenoid bone stock in order to optimize glenoid component implantation and obtain a reference to determine optimal humeral component placement in case of humeral proximal fracture. Materials and methods: Between 2010 and 2011 we have analyzed 200 intact shoulder’s CT. We measured maximal and minimal width in the transverse plane of the glenoid, the distance from the pectoralis major (PM) tendon to the humeral head, the greater tubercle, change of curvature and the anatomical neck. Results: Mean maximum width was 27.4 ± 3.4 mm and mean minimum width was 15.5 ± 2.8 mm. Distances between upper edge of PM tendon to: humeral head, greater tubercle, change of curvature and anatomical neck were respectively: 67.6 ± 9.98 mm, 57.8 ± 10.3 mm, 28.7 ± 9 mm, and 34.2 ± 9.7 mm. Conclusion: Our study has produced an assessment of glenoid bone stock for optimal positioning of the glenoid implant but also to obtain a reference to determine the ideal location of the humeral component in the case of proximal humerus fracture.
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Affiliation(s)
- Laurent Obert
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 25000 Besançon, France - Intervention, Innovation, Imagery, Engineering in Health (EA 4268), Medical and Pharmacology Section, IFR 133, University of Franche-Comté, 25000 Besançon, France
| | - Christelle Peyron
- Intervention, Innovation, Imagery, Engineering in Health (EA 4268), Medical and Pharmacology Section, IFR 133, University of Franche-Comté, 25000 Besançon, France - Radiology unit, Research Unit: EA 4268 I4S - IFR 133 INSERM University Hospital of Besançon, 25000 Besançon, France
| | - Etienne Boyer
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 25000 Besançon, France
| | - Gauthier Menu
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 25000 Besançon, France
| | - François Loisel
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 25000 Besançon, France - Intervention, Innovation, Imagery, Engineering in Health (EA 4268), Medical and Pharmacology Section, IFR 133, University of Franche-Comté, 25000 Besançon, France
| | - Sébastien Aubry
- Intervention, Innovation, Imagery, Engineering in Health (EA 4268), Medical and Pharmacology Section, IFR 133, University of Franche-Comté, 25000 Besançon, France - Radiology unit, Research Unit: EA 4268 I4S - IFR 133 INSERM University Hospital of Besançon, 25000 Besançon, France
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Moraiti C, Klouche S, Werthel JD, Bauer T, Hardy P. Description and reproducibility assessment of a new computerised tomography scan index to measure the glenoid orientation in relation to the anterior glenoid surface. INTERNATIONAL ORTHOPAEDICS 2016; 41:1017-1022. [PMID: 27699459 DOI: 10.1007/s00264-016-3290-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To propose and to assess the reproducibility of a new method (GO [glenoid orientation] index) for the estimation of the glenoid orientation in relation to the anterior surface of the glenoid. METHODS This is a retrospective study on computed tomography (CT) scan. The GO index was defined as the angle formed by a line perpendicular to the tangent to the anterior surface of the scapula and the glenoid line (which is defined as the line connecting the anterior and the posterior rim of the glenoid). The measurements were performed at the level of the glenoid where its diameter is the greatest. Two independent observers performed each measurement twice. The intra- and inter-observer reproducibility was evaluated by the Pearson coefficient (r) and the intra-class correlation coefficient (ρ, ICC). The correlation between GO index and glenoid version as described by Friedman was also studied. RESULTS Seventy-eight CT scans were analysed, 38 shoulders with glenohumeral arthritis and 40 healthy shoulders, 32 females/46 males, mean age 53.9 ± 22.7 years. The measures were all highly correlated (r > 0.50, p = 0.00001). The intra- and inter-observer reproducibility was good to excellent (0.71 < ρ < 0.84, p = 0.00001). GO index was 26.9 ± 6.3°, 28.4 ± 6° in the group with glenohumeral osteoarthritis and 25.5 ± 6.4° in the healthy group, p = 0.04. The glenoid version was -0.8 ± 7.9° in the group with glenohumeral osteoarthritis and -3.9 ± 6° in the healthy group, p = 0.05. No agreement was found between the glenoid version and GO index. CONCLUSIONS GO index is simple and reproducible. It could be very useful for the pre-operative planning and intra-operative positioning of the implants in total shoulder arthroplasty.
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Affiliation(s)
- Constantina Moraiti
- Ambroise Paré Hospital, 9, avenue Charles De Gaulle, 92104, Boulogne-Billancourt, France.
| | - Shahnaz Klouche
- Ambroise Paré Hospital, 9, avenue Charles De Gaulle, 92104, Boulogne-Billancourt, France
| | - Jean David Werthel
- Ambroise Paré Hospital, 9, avenue Charles De Gaulle, 92104, Boulogne-Billancourt, France
| | - Thomas Bauer
- Ambroise Paré Hospital, 9, avenue Charles De Gaulle, 92104, Boulogne-Billancourt, France
| | - Philippe Hardy
- Ambroise Paré Hospital, 9, avenue Charles De Gaulle, 92104, Boulogne-Billancourt, France
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Mayne IP, Bell SN, Wright W, Coghlan JA. Acromial and scapular spine fractures after reverse total shoulder arthroplasty. Shoulder Elbow 2016; 8:90-100. [PMID: 27583005 PMCID: PMC4950466 DOI: 10.1177/1758573216628783] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
Acromial and scapular spine fractures after reverse total shoulder arthroplasty occur predominantly as a result of bony insufficiency secondary to patient and intra-operative technical factors. The spectrum of the pathology can range from a stress reaction to an undisplaced or displaced fracture. Prompt diagnosis of these fractures requires a high suspicion in the postoperative patient with a clinical presentation of acute onset of pain along the acromion or scapular spine and/or deterioration of shoulder function. Conventional shoulder radiographs are frequently unreliable in identifying these fractures, especially if they are undisplaced. Computed tomography (CT) and/or single photon emission computed tomography/CT scans are useful imaging modalities for obtaining a definitive diagnosis. Early diagnosis and non-operative treatment of a stress reaction or undisplaced fracture is essential for preventing further displacement and potential disability. The management of displaced fractures is challenging for the orthopaedic surgeon as a result of high rates of mal-union or non-union, decreased functional outcomes, and variable results after open reduction and internal fixation. Strategies for preventing these fractures include optimizing the patient's bone health, correct glenoid baseplate screw length and position, and avoiding excessive deltoid tension. Further research is required to identify the specific patient and fracture characteristics that will benefit from conservative versus operative management.
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Affiliation(s)
- Ian P Mayne
- Department of Surgery, Melbourne Shoulder and Elbow Centre, Monash University, Melbourne, Australia,Ian Mayne, Melbourne Shoulder & Elbow Centre, 31 Normanby Street, Brighton, VIC 3186, Australia. Tel: +61 4 1018 2635.
| | - Simon N Bell
- Department of Surgery, Melbourne Shoulder and Elbow Centre, Monash University, Melbourne, Australia
| | | | - Jennifer A Coghlan
- Department of Surgery, Melbourne Shoulder and Elbow Centre, Monash University, Melbourne, Australia
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Kocsis G, Thyagarajan DS, Fairbairn KJ, Wallace WA. A new classification of glenoid bone loss to help plan the implantation of a glenoid component before revision arthroplasty of the shoulder. Bone Joint J 2016; 98-B:374-80. [PMID: 26920963 DOI: 10.1302/0301-620x.98b3.36664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aims Glenoid bone loss can be a challenging problem when revising a shoulder arthroplasty. Precise pre-operative planning based on plain radiographs or CT scans is essential. We have investigated a new radiological classification system to describe the degree of medialisation of the bony glenoid and that will indicate the amount of bone potentially available for supporting a glenoid component. It depends on the relationship between the most medial part of the articular surface of the glenoid with the base of the coracoid process and the spinoglenoid notch: it classifies the degree of bone loss into three types. It also attempts to predict the type of glenoid reconstruction that may be possible (impaction bone grafting, structural grafting or simple non-augmented arthroplasty) and gives guidance about whether a pre-operative CT scan is indicated. Patients and Methods Inter-method reliability between plain radiographs and CT scans was assessed retrospectively by three independent observers using data from 39 randomly selected patients. Inter-observer reliability and test-retest reliability was tested on the same cohort using Cohen's kappa statistics. Correlation of the type of glenoid with the Constant score and its pain component was analysed using the Kruskal-Wallis method on data from 128 patients. Anatomical studies of the scapula were reviewed to explain the findings. Results Excellent inter-method reliability, inter-observer and test-retest reliability were seen. The system did not correlate with the Constant score, but correlated well with its pain component. Take home message: Our system of classification is a helpful guide to the degree of glenoid bone loss when embarking on revision shoulder arthroplasty. Cite this article: Bone Joint J 2016;98-B:374–80.
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Affiliation(s)
- G. Kocsis
- Semmelweis University Budapest, 27
Karolina St. Budapest 1113, Hungary
| | - D. S. Thyagarajan
- Sheffield Teaching Hospitals NHS Trust, Herries
Road, Sheffield S5 7AU, UK
| | - K. J. Fairbairn
- Nottingham University Hospitals NHS Trust, Hucknall
Road, NG5 1PB, UK
| | - W. A. Wallace
- University of Nottingham, C Floor, West
Block, Queen’s Medical Centre, Nottingham NG7
2UH, UK
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Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg 2015; 24:e149-58. [PMID: 25591458 PMCID: PMC4433827 DOI: 10.1016/j.jse.2014.10.021] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate assessment of the critical shoulder angle (CSA) is important in clinical evaluation of degenerative rotator cuff tears. This study analyzed the influence of radiographic viewing perspective on the CSA, developed a classification system to identify malpositioned radiographs, and assessed the relationship between the CSA and demographic factors. METHODS Glenoid height, width, and retroversion were measured on 3-dimensional computed tomography reconstructions of 68 cadaver scapulae. A digitally reconstructed radiograph was aligned perpendicular to the scapular plane, and retroversion was corrected to obtain a true anteroposterior (AP) view. In 10 scapulae, incremental anteversion/retroversion and flexion/extension views were generated. The CSA was measured, and a clinically applicable classification system was developed to detect views with >2° change in CSA vs. true AP view. RESULTS The average CSA was 33° ± 4°. Intraobserver and interobserver reliability was high (intraclass correlation coefficient ≥ 0.81) but decreased with increasing viewing angle. Views beyond 5° anteversion, 8° retroversion, 15° flexion, and 26° extension resulted in >2° deviation of the CSA compared with the true AP view. The classification system was capable of detecting aberrant viewing perspectives with sensitivity of 95% and specificity of 53%. Correlations between glenoid size and CSA were small (R ≤ 0.3), and CSA did not vary by gender (P = .426) or side (P = .821). CONCLUSIONS The CSA was most susceptible to malposition in anteversion/retroversion. Deviations as little as 5° in anteversion resulted in a CSA >2° from true AP view. A new classification system refines the ability to collect true AP radiographs of the scapula. The CSA was unaffected by demographic factors.
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Affiliation(s)
- Thomas Suter
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Ariane Gerber Popp
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
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Outcomes are favorable in Asian patients undergoing deltoid-on open rotator cuff repair without acromioplasty. J Orthop 2015; 12:126-9. [PMID: 26236114 DOI: 10.1016/j.jor.2015.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/23/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To evaluate if rotator cuff repair without acromioplasty would result in improvement in outcomes without the risks associated with acromioplasty in Asian patients. METHODS 38 primary repairs of tears of the rotator cuff were performed through a deltoid-on approach. The Simple Shoulder Test (SST) and UCLA shoulder rating scale were measured preoperatively and at 2 years post-operatively. RESULTS There was a significant improvement in the SST 2 years post-operatively (p < 0.001). UCLA scores for pain control and function (p < 0.001) also significantly improved 2 years post-operatively. CONCLUSION Outcomes are favorable in Asians following deltoid-on open rotator cuff repair without acromioplasty. LEVEL OF EVIDENCE III.
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Chae SW, Kim SY, Lee H, Yon JR, Lee J, Han SH. Effect of baseplate size on primary glenoid stability and impingement-free range of motion in reverse shoulder arthroplasty. BMC Musculoskelet Disord 2014; 15:417. [PMID: 25488492 PMCID: PMC4295354 DOI: 10.1186/1471-2474-15-417] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Use of a baseplate with a smaller diameter in reverse shoulder arthroplasty is increasing, especially in patients with a small glenoid or glenoid wear. However, the effect of a smaller baseplate on stability of the glenoid component has not been evaluated. Thus, the purpose of this study was to determine whether a smaller baseplate (25 mm) is beneficial to the initial stability of the glenoid component compared to that with a baseplate of a commonly used size (29 mm). Methods Micromotion of glenoid components attached to 14 scapulae of fresh-frozen cadavers was measured and compared between 25- and 29-mm baseplates in biomechanical testing. Impingement-free range of motion in abduction, adduction, internal rotation, and external rotation was evaluated by using a simulated computer model constructed based on the same fresh-frozen cadavers used in biomechanical testing. Results Micromotion at the inferior third of the glenoid-glenosphere interface was higher in the 29-mm baseplate group than in the 25-mm baseplate group during both 0.7- and 1-body weight cyclic loading in biomechanical testing. Adduction deficit was smaller, and total impingement-free range of motion from abduction to adduction and rotation were greater in the 25-mm baseplate group than in the 29-mm baseplate group in the simulated computer model. Conclusions Use of a baseplate with a smaller diameter (25 mm) in reverse shoulder arthroplasty is suitable for improving the primary stability of the glenoid component. With a smaller baseplate, impingement-free range of motion is optimized in a smaller glenoid. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-417) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Soung-Yon Kim
- Department of Orthopaedic Surgery, Hallym University, Kangnam Sacred Heart Hospital, Seoul, South Korea.
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Matsumura N, Ogawa K, Kobayashi S, Oki S, Watanabe A, Ikegami H, Toyama Y. Morphologic features of humeral head and glenoid version in the normal glenohumeral joint. J Shoulder Elbow Surg 2014; 23:1724-30. [PMID: 24862249 DOI: 10.1016/j.jse.2014.02.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/11/2014] [Accepted: 02/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The morphologic features and clinical significance of version of the humeral head and glenoid remain unclear. The purpose of this study was to evaluate the normal values of humeral head version and glenoid version on computed tomography scans and to clarify their features in the normal glenohumeral joint. METHODS Images for analysis were computed tomography scans of 410 normal shoulders from healthy volunteers. Values of humeral head and glenoid version were measured. In glenoid version measurement, 3-dimensionally corrected slices were reconstructed to eliminate scapular inclination. Differences in humeral head version and glenoid version were assessed between dominant and nondominant shoulders and between men and women. Correlation analyses were also performed in the values of version between dominant and nondominant shoulders and between humeral head version and glenoid version. RESULTS The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. Both humeral head retroversion and glenoid retroversion were significantly higher on the dominant side than on the nondominant side and significantly higher in men than in women. Humeral head version and glenoid version values were well correlated with those of the contralateral shoulder. No correlation was found between humeral head version and glenoid version. CONCLUSIONS This study found differences in humeral head version and glenoid version by sex and shoulder dominance in a large sample. Both the humeral head and glenoid are thought to be more retroverted in high-demand shoulders.
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Affiliation(s)
- Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
| | - Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, Tokyo, Japan
| | | | - Satoshi Oki
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Anri Watanabe
- Department of Orthopedic Surgery, Ito Municipal Hospital, Ito, Japan
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Safety screw fixation technique in a case of coracoid base fracture with acromioclavicular dislocation and coracoid base cross-sectional size data from a computed axial tomography study. Arch Orthop Trauma Surg 2014; 134:913-8. [PMID: 24770936 DOI: 10.1007/s00402-014-1995-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Indexed: 10/25/2022]
Abstract
Coracoid base fracture accompanied by acromioclavicular joint dislocation with intact coracoclavicular ligaments is a rare injury. Generally, an open reduction with screw fixation is the first treatment choice, as it protects the important structures around the coracoid process. This report presents a new technique of screw fixation for coracoid base fracture and provides anatomic information on cross-sectional size of the coracoid base obtained by computed tomography (CT). An axial image of the coracoid base was visualized over the neck of the scapula, and a guidewire was inserted into this circle under fluoroscopic guidance. The wire was inserted easily into the neck of scapula across the coracoid base fracture with imaging in only 1 plane. In addition, 25 measurements of the coracoid base were made in 25 subjects on axial CT images. Average length of the long and short axes at the thinnest part of the coracoid base was 13.9 ± 2.0 mm (range 10.6-17.0) and 10.5 ± 2.2 mm (6.6-15.1), respectively. This new screw fixation technique and measurement data on the coracoid base may be beneficial for safety screw fixation of coracoid base fracture.
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Berhouet J, Garaud P, Favard L. Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: a cadaver study. Orthop Traumatol Surg Res 2013; 99:887-94. [PMID: 24211248 DOI: 10.1016/j.otsr.2013.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND A common disadvantage of reverse shoulder arthroplasty is limitation of the range of arm rotation. Several changes to the prosthesis design and implantation technique have been suggested to improve rotation range of motion (ROM). HYPOTHESIS Glenoid component design and degree of humeral component retroversion influence rotation ROM after reverse shoulder arthroplasty. MATERIAL AND METHODS The Aequalis Reversed™ shoulder prosthesis (Tornier Inc., Edina, MN, USA) was implanted into 40 cadaver shoulders. Eight glenoid component combinations were tested, five with the 36-mm sphere (centred seating, eccentric seating, inferior tilt, centred with a 5-mm thick lateralised spacer, and centred with a 7-mm thick lateralised spacer) and three with the 42-mm sphere (centred with no spacer or with a 7-mm or 10-mm spacer). Humeral component position was evaluated with 0°, 10°, 20°, 30°, and 40° of retroversion. External and internal rotation ROMs to posterior and anterior impingement on the scapular neck were measured with the arm in 20° of abduction. RESULTS The large glenosphere (42 mm) was associated with significantly (P<0.05) greater rotation ROMs, particularly when combined with a lateralised spacer (46° internal and 66° external rotation). Rotation ROMs were smallest with the 36-mm sphere. Greater humeral component retroversion was associated with a decrease in internal rotation and a significant increase (P<0.05) in external rotation. The best balance between rotation ROMs was obtained with the native retroversion, which was estimated at 17.5° on average in this study. DISCUSSION Our anatomic study in a large number of cadavers involved a detailed and reproducible experimental protocol. However, we did not evaluate the variability in scapular anatomy. Earlier studies of the influence of technical parameters did not take humeral component retroversion into account. In addition, no previous studies assessed rotation ROMs. CONCLUSION Rotation ROM should be improved by the use of a large-diameter glenosphere with a spacer to lateralise the centre of rotation of the gleno-humeral joint, as well as by positioning the humeral component at the patient's native retroversion value.
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Affiliation(s)
- J Berhouet
- Université François-Rabelais de Tours, Faculté de Médecine de Tours, CHRU Trousseau, Service d'orthopédie traumatologie 2A, 1C, avenue de la République, 37170 Chambray-les-Tours, France.
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Quental C, Fernandes PR, Monteiro J, Folgado J. Bone remodelling of the scapula after a total shoulder arthroplasty. Biomech Model Mechanobiol 2013; 13:827-38. [DOI: 10.1007/s10237-013-0537-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 10/11/2013] [Indexed: 12/21/2022]
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