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Zhang F, Liao W, Chen X, Zhang B, Xu L, Wang X, Zhu Y, Fu Y, Xiong W, Song S, Sheng X, Gao H, Lai S, Zhang Q. Stabilizing Mechanisms in Patients Treated Using Hill-Sachs Remplissage With Bankart Repair in Abduction-External Rotation Position. Am J Sports Med 2024; 52:603-612. [PMID: 38288525 DOI: 10.1177/03635465231220373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Hill-Sachs lesion (HSL) remplissage with Bankart repair (RMBR) provides a minimally invasive solution for treating HSLs and glenoid bone defects of <25%. The infraspinatus tendon is inserted into the HSL during the remplissage process, causing the infraspinatus to shift medially, leading to an unknown effect on glenohumeral alignment during the resting abduction-external rotation (ABER) and muscle-active states. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the possible check-rein effect and muscle-active control in stabilizing the glenohumeral joint after RMBR in vivo. We hypothesized that the check-rein effect and active control would stabilize the glenohumeral joint in the ABER position in patients after RMBR. STUDY DESIGN Controlled laboratory study. METHODS We included 42 participants-22 patients in group A who met the inclusion criteria after RMBR and 20 healthy participants in group B without shoulder laxity. Three-dimensional magnetic resonance imaging was performed to analyze the alignment relationship of the glenohumeral joint with and without muscular activity. Ultrasonic shear wave elastography was used to evaluate the elastic properties of the anterior capsule covered with the anterior bands of the inferior glenohumeral ligament. RESULTS Patients who underwent RMBR demonstrated more posterior (-1.81 ± 1.19 mm vs -0.76 ± 1.25 mm; P = .008) and inferior (-1.05 ± 0.62 mm vs -0.45 ± 0.48 mm; P = .001) shifts of the humeral head rotation center and less anterior capsular elasticity (70.07 ± 22.60 kPa vs 84.01 ± 14.08 kPa; P = .023) than healthy participants in the resting ABER state. More posterior (-3.17 ± 0.84 mm vs -1.81 ± 1.19 mm; P < .001) and less-inferior (-0.34 ± 0.56 mm vs -1.05 ± 0.62 mm; P < .001) shifts of the humeral head rotation center and less anterior capsular elasticity (36.57 ± 13.89 kPa vs 70.07 ± 22.60 kPa; P < .001) were observed in the operative shoulder during muscle-active ABER than in resting ABER states. CONCLUSION The check-rein effect and muscle-active control act as stabilizing mechanisms in RMBR during the ABER position. CLINICAL RELEVANCE Stabilizing mechanisms in RMBR during the ABER position include the check-rein effect and muscle-active control.
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Affiliation(s)
- Fei Zhang
- Chinese People's Liberation Army Medical School, Beijing, China; Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Weixiong Liao
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xianghui Chen
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baoxiang Zhang
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lin Xu
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaolin Wang
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yaqiong Zhu
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yangmu Fu
- Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wentao Xiong
- Chinese People's Liberation Army Medical School, Beijing, China; Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shoulong Song
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xianhao Sheng
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huayi Gao
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shengwei Lai
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiang Zhang
- Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
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Kim S, Lee GY. Evaluation of the ulnar nerve with shear-wave elastography: a potential sonographic method for the diagnosis of ulnar neuropathy. Ultrasonography 2020; 40:349-356. [PMID: 33115185 PMCID: PMC8217804 DOI: 10.14366/usg.20101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/23/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study was designed to verify whether shear-wave elastography (SWE) can be used to differentiate ulnar neuropathy at the cubital tunnel from asymptomatic ulnar nerve or medial epicondylitis. An additional aim was to determine a cut-off value to identify patients with ulnar neuropathy. METHODS This study included 10 patients with ulnar neuropathy at the cubital tunnel as confirmed with electromyography (three women and seven men; mean age, 51.9 years), 10 patients with medial epicondylitis (nine women and one man; mean age, 56.1 years), and 37 patients with asymptomatic ulnar nerve and lateral epicondylitis (21 women and 16 men; mean age, 54.0 years). Each patient underwent SWE of the ulnar nerve at the cubital tunnel, distal upper arm, and proximal forearm. RESULTS Patients with ulnar neuropathy at the cubital tunnel exhibited significantly greater mean ulnar nerve stiffness at the cubital tunnel (66.8 kPa) than controls with medial epicondylitis (21.2 kPa, P=0.015) or lateral epicondylitis (33.9 kPa, P=0.040). No significant differences were observed between patients and controls with regard to ulnar nerve stiffness at the distal upper arm or the proximal forearm. A stiffness of 31.0 kPa provided 100% specificity, 80.0% sensitivity, 100% positive predictive value, and 83.3% negative predictive value for the differentiation between ulnar neuropathy and medial epicondylitis. CONCLUSION Cubital tunnel syndrome is associated with a stiffer ulnar nerve than lateral or medial epicondylitis. SWE seems to be a new, reliable, and simple quantitative diagnostic technique to aid in the precise diagnosis of ulnar neuropathy at the cubital tunnel.
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Affiliation(s)
- Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Guen Young Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
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