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Chen X, Liang T, Yin X, Liu C, Ren J, Su S, Jiang S, Wang K. Study on Shoulder Joint Parameters and Available Supraspinatus Outlet Area Using Three-Dimensional Computed Tomography Reconstruction. Tomography 2024; 10:1331-1341. [PMID: 39330746 PMCID: PMC11435729 DOI: 10.3390/tomography10090100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Studies addressing the anatomical values of the supraspinatus outlet area (SOA) and the available supraspinatus outlet area (ASOA) are insufficient. This study focused on precisely measuring the SOA and ASOA values in a sample from the Chinese population using 3D CT (computed tomography) reconstruction. We analyzed CT imaging of 96 normal patients (59 males and 37 females) who underwent shoulder examinations in a hospital between 2011 and 2021. The SOA, ASOA, acromiohumeral distance (AHD), coracohumeral distance (CHD), coracoacromial arch radius (CAR), and humeral head radius (HHR) were estimated, and statistical correlation analyses were performed. There were significant sex differences observed in SOA (men: 957.62 ± 158.66 mm2; women: 735.87 ± 95.86 mm2) and ASOA (men: 661.35 ± 104.88 mm2; women: 511.49 ± 69.26 mm2), CHD (men: 11.22 ± 2.24 mm; women: 9.23 ± 1.35 mm), CAR (men: 37.18 ± 2.70 mm; women: 33.04 ± 3.15 mm), and HHR (men: 22.65 ± 1.44 mm; women: 20.53 ± 0.95 mm). Additionally, both SOA and ASOA showed positive and linear correlations with AHD, CHD, CAR, and HHR (R: 0.304-0.494, all p < 0.05). This study provides physiologic reference values of SOA and ASOA in the Chinese population, highlighting the sex differences and the correlations with shoulder anatomical parameters.
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Affiliation(s)
- Xi Chen
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
- Orthopedics Surgery, Hanzhong People's Hospital, Hanzhong 724200, China
| | - Tangzhao Liang
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Xiaopeng Yin
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Chang Liu
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jianhua Ren
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Shouwen Su
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Shihai Jiang
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Kun Wang
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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Sakdapanichkul C, Chantarapitak N, Kasemwong N, Suwanalai J, Wimolsate T, Jirawasinroj T, Sakolsujin T, Kongmalai P. Transcending Patient Morphometry: Acromiohumeral Interval to Glenoid Ratio as a Universal Diagnostic Tool for Massive Rotator Cuff Tears. Clin Orthop Surg 2024; 16:578-585. [PMID: 39092296 PMCID: PMC11262935 DOI: 10.4055/cios23381] [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: 11/27/2023] [Revised: 02/04/2024] [Accepted: 02/04/2024] [Indexed: 08/04/2024] Open
Abstract
Background Morphological differences among various ethnicities can significantly impact the reliability of acromiohumeral interval (AHI) measurements in diagnosing massive rotator cuff tears. This variation raises questions about the generalizability of AHI studies conducted in Western populations to the Asian population. Consequently, the primary objective of this study was to develop a novel parameter that can enhance the diagnosis of massive rotator cuff tears, irrespective of morphometric disparities between individuals of different ethnic backgrounds. Methods A 10-year retrospective analysis of shoulder arthroscopic surgery patients was conducted, categorizing them into 3 groups based on intraoperative findings: those without rotator cuff tears, those with non-massive tears, and those with massive tears. AHI-glenoid ratio (AHIGR) was measured by individuals with varying academic backgrounds, and its diagnostic performance was compared to AHI. Sensitivity, specificity, accuracy, and intra- and inter-rater reliability were evaluated. Results AHIGR exhibited significantly improved sensitivity, specificity, and accuracy as a diagnostic tool for massive rotator cuff tears, compared to AHI. A proposed cut-off point of AHIGR ≤ 0.2 yielded comparable results to AHI < 7 mm. Intra- and inter-rater reliability was excellent among different observers. Conclusions AHIGR emerges as a promising diagnostic tool for massive rotator cuff tears, offering improved sensitivity and specificity compared to AHI. Its reproducibility among diverse observers underscores its potential clinical utility. While further research with larger and more diverse patient cohorts is necessary, AHIGR offers significant potential as a reference for enhancing the assessment of massive rotator cuff tears.
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Affiliation(s)
- Chidchanok Sakdapanichkul
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
- Department of Orthopaedics, Nopparat Rajathanee Hospital, Bangkok, Thailand
| | - Napat Chantarapitak
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Nichaphat Kasemwong
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Janyavath Suwanalai
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Triwish Wimolsate
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Thunwarath Jirawasinroj
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Thitiporn Sakolsujin
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Pinkawas Kongmalai
- Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
- Department of Orthopedics, Faculty of Medicine, Kasetsart University, Bangkok, Thailand
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Pak T, Menendez ME, Gobezie R, Sears BW, Lederman E, Werner BC, Denard PJ. Rates of subacromial notching are low following reverse shoulder arthroplasty with a 135° inlay humeral component and a lateralized glenoid. JSES Int 2024; 8:522-527. [PMID: 38707585 PMCID: PMC11064686 DOI: 10.1016/j.jseint.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Lateralization in reverse shoulder arthroplasty (RSA) decreases bony impingement and improves rotational range of motion, but has been theorized to increase the risk of subacromial notching (SaN). The purpose of this study was to evaluate the presence of SaN following RSA and its relationship with lateralization with a 135° inlay humeral component. The secondary purpose was to assess the association of SaN with functional outcomes. Methods A retrospective review was performed from a multicenter prospectively collected database on patients who underwent primary RSA from 2015 to 2021. All RSAs were performed with a 135° inlay humeral component. SaN was defined as bony erosion with sclerotic margins on the undersurface of the acromion on final follow-up radiographs not present preoperatively. Postoperative implant positioning (inclination, distalization, and lateralization) were evaluated on minimum 1-year postoperative radiographs. Regression analyses were performed on implant and clinical variables to assess for risk factors. A separate analysis was performed to determine the association of SaN with clinical outcomes. Results SaN was identified in 13 out of 442 shoulders (2.9%). Age, sex, body mass index, smoking status, diabetes mellitus, arm dominance had no relationship with SaN. Neither glenoid sided lateralization nor humeral offset were associated with SaN risk. Other implant characteristics such as distalization, glenosphere size, and postoperative inclination did not influence SaN risk. The presence of SaN did not affect patient-reported outcomes (American Shoulder and Elbow Surgeons: P = .357, Visual Analog Scale: P = .210) or range of motion. Conclusion The rate of SaN is low and not associated with glenoid or humeral prosthetic lateralization when using a 135° inlay humeral component. When SaN occurs, it is not associated with functional outcomes or range of motion at short-term follow-up.
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Affiliation(s)
- Theresa Pak
- Center for Orthopedic Research and Education, Phoenix, AZ, USA
| | | | | | | | - Evan Lederman
- University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Brian C. Werner
- University of Virginia Health System, Charlottesville, VA, USA
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Kim JS, Kim SH, Kim SC, Park JH, Kim HG, Lee SM, Yoo JC. Effect of using a small baseplate on the radiological and clinical outcomes of reverse total shoulder arthroplasty in Asian patients. Bone Joint J 2023; 105-B:1189-1195. [PMID: 37909149 DOI: 10.1302/0301-620x.105b11.bjj-2023-0450.r1] [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] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes. Methods This was retrospective analysis of 50 and 33 RSAs using a standard (33.8 mm, ST group) and a small (29.5 mm, SM group) baseplate of the Equinoxe reverse shoulder system, which were undertaken between January 2017 and March 2021. Radiological evaluations included the size of the glenoid, the β-angle, the inclination of the glenoid component, inferior overhang, scapular notching, the location of the central cage in the baseplate within the vault and the mismatch in size between the glenoid and baseplate. Clinical evaluations included the range of motion (ROM) and functional scores. In subgroup analysis, comparisons were performed between those in whom the vault of the glenoid was perforated (VP group) and those in whom it was not perforated (VNP group). Results Perforation of the vault of the glenoid (p = 0.018) and size mismatch in height (p < 0.001) and width (p = 0.013) were significantly more frequent in the ST group than in the SM group. There was no significant difference in the clinical scores and ROM in the two groups, two years postoperatively (all p > 0.05). In subgroup analysis, the VP group had significantly less inferior overhang (p = 0.009), more scapular notching (p = 0.018), and more size mismatch in height (p < 0.001) and width (p = 0.025) than the VNP group. Conclusion In Asian patients with a small glenoid, using a 29.5 mm small baseplate at the time of RSA was more effective in reducing size mismatch between the glenoid and the baseplate, decreasing the incidence of perforation of the glenoid vault, and achieving optimal positioning of the baseplate compared with the use of a 33.8 mm standard baseplate. However, longer follow-up is required to assess the impact of these findings on the clinical outcomes.
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Affiliation(s)
- Jae S Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Seung H Kim
- Department of Orthopaedic Surgery, Saeroun Hospital, Seoul, South Korea
| | - Su C Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jong H Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Hyun G Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Sang M Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jae C Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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Watanabe A, Machida T, Takashima K, Hirooka T. Discovering the Forgotten Trauma Behind Chronic Shoulder Pain: The Critical Role of a Thorough Medical Interview. Cureus 2023; 15:e49173. [PMID: 38130510 PMCID: PMC10734337 DOI: 10.7759/cureus.49173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
We report a rare case of a patient experiencing pain and dysfunction attributable to bone fragments from a trauma sustained over two decades prior. A 43-year-old Japanese woman presented with persistent left shoulder pain. Initial radiographs revealed glenohumeral joint osteoarthritis, an unusual finding for her age. Her medical history included a previously overlooked traumatic dislocation of the left acromioclavicular joint over 20 years ago. Computed tomography scans later uncovered bone fragments below the coracoid process without signs of scapular or tuberosity fractures. The fragments were arthroscopically removed, resulting in significant pain relief. The patient's Shoulder Pain and Disability Index score improved from 60 to 9 at the six-month postoperative follow-up. This case underscores the importance of considering historical trauma in patients presenting with atypical shoulder pain and highlights the potential diagnostic value of revisiting a patient's medical history when unusual lesions are discovered.
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Tan MWP, Sim DS, Cher EWL, Puah KL, Lie DTT. Comparable outcomes of reverse shoulder arthroplasty for proximal humerus fractures and for rotator cuff arthropathy in a predominantly asian population. Shoulder Elbow 2023; 15:53-62. [PMID: 37974605 PMCID: PMC10649475 DOI: 10.1177/17585732221097415] [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: 08/18/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2023]
Abstract
Background Reverse shoulder arthroplasty (RSA) was initially developed for rotator cuff arthropathy but has been expanded to treat comminuted proximal humerus fractures. Few studies have compared RSA for traumatic and degenerative indications. We present the first report of mid-term outcomes of RSA comparing both indications in an Asian population. Methods 113 degenerative and 20 fracture patients underwent RSA from 2010 to 2019. Patients with degenerative indications were 4:1 propensity-score matched to fractures and adjusted for age and sex. Patients were assessed for range of motion (ROM), strength, pain, Constant-Murley score (CMS), University of California Los Angeles Shoulder Score (UCLA) and Oxford shoulder score (OSS) preoperatively, at 6-months and 1-year. Patients' satisfaction, expectation fulfilment and minimal clinically important difference (MCID) were analysed. Results Degenerative patients had better ROM, isometric strength and CMS at 6-months, although at 1-year only abduction was superior (104.8 ± 17.3° vs 86.7 ± 19.8°). No significant differences in pain, UCLA and OSS were observed. Most improvements occurred within 6 months. Similar proportions of patients were satisfied (83.3% vs 73.3%, p = 0.460) and attained MCID (85.0% vs 86.7%, p = 1.000) at 1-year. Discussion Although initially exhibiting slower recovery, patients with proximal humerus fractures can expect similar functional recovery and satisfaction at 1-year compared to those who received RSA for degenerative indications.
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Affiliation(s)
- Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - David Shaoen Sim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Eric Wei Liang Cher
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ken Lee Puah
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Jeong HJ, Kim SW, Rhee SM, Yeo JH, Heo K, Oh JH. Subacromial notching after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:1876-1885. [PMID: 37024040 DOI: 10.1016/j.jse.2023.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Scapular notching is a well-known postoperative complication of reverse total shoulder arthroplasty (RTSA). However, subacromial notching (SaN), a subacromial erosion caused by repeated abduction impingement after RTSA, has not been previously reported in a clinical setting. Therefore, this study aimed to assess the risk factors and functional outcomes of SaN after RTSA. METHODS We retrospectively reviewed the medical records of 125 patients who underwent RTSA with the same design between March 2014 and May 2017 and had at least 2 years of follow-up. SaN was defined as subacromial erosion observed at the final follow-up but not on the X-ray 3 months after surgery. Radiologic parameters representing the patient's native anatomy and degrees of lateralization and/or distalization during surgery were evaluated using preoperative and 3 months postoperative X-rays. The visual analogue scale of pain, active range of motion, and American Shoulder and Elbow Surgeons score were assessed preoperatively and at the final follow-up to evaluate the functional outcomes of SaN. RESULTS SaN occurred in 12.8% (16/125) of enrolled patients during the study period. Preoperative center of rotation-acromion distance (P = .009) and postoperative humerus lateralization offset, which evaluated the degree of lateralization after RTSA (P = .003), were risk factors for SaN. The preoperative center of rotation-acromion distance and postoperative humerus lateralization cutoff values were 14.0 mm and 19.0 mm, respectively. The visual analogue scale of pain (P = .01) and American Shoulder and Elbow Surgeons score (P = .04) at the final follow-up were significantly worse in patients with SaN. CONCLUSIONS SaN might adversely affect postoperative clinical outcomes. As SaN correlated with patients' anatomical characteristics and degree of lateralization during RTSA, the implant's degree of lateralization should be adjusted according to the patient's own anatomical characteristics.
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Affiliation(s)
- Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Woo Kim
- Department of Orthopaedic Surgery, Nalgae Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ji Hyun Yeo
- Department of Orthopaedic Surgery, Hanam S Hospital, Hanam, Republic of Korea
| | - Kang Heo
- Department of Orthopaedic Surgery, Chambaro hospital, Seoul, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Paul S, Arora M, Das L, Raja BS, Kalia RB. Average Indian Glenoid Sizes Are Smaller than All Commercially Available Glenoid Components: A Systematic Review. Indian J Orthop 2023; 57:1008-1022. [PMID: 37384007 PMCID: PMC10293529 DOI: 10.1007/s43465-023-00885-8] [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: 01/26/2022] [Accepted: 03/26/2023] [Indexed: 06/30/2023]
Abstract
Background Despite the variability in glenoid sizes geographically, most of the currently available commercial glenoid component designs are based on the glenoid parameters of the Caucasian population which may not be suitable for the Indian population due to a mismatch between the prosthesis and native anatomy. The aim of the present study is to systematically review the literature to determine the average glenoid anthropometric parameters in the Indian population. Methods A comprehensive literature search was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines in the PubMed, EMBASE, Google Scholar, and Cochrane Library databases from the date of inception to May 2021. Any observational study conducted on the Indian population measuring the glenoid diameters, glenoid index, version, inclination, or any other glenoid measurements were included in the review. Results A total of 38 studies were included in this review. The glenoid parameters were assessed on intact cadaveric scapulae in 33 studies, on 3DCT in three studies, and 2DCT in one study. The pooled average of glenoid dimensions are as the following- the superoinferior diameter or height was 34.65 mm, anteroposterior1 diameter or maximum width was 23.72 mm, anteroposterior2 diameter or maximum width of the upper part of the glenoid was 17.05 mm, the glenoid index was 67.88, and the glenoid version was 1.75-degree retroversion. Males were having a mean height of 3.65 mm and maximum width of 2.74 mm larger than the females. A subgroup analysis revealed no significant difference between different parts of India in glenoid parameters. Conclusion The glenoid dimensions in the Indian population are smaller compared to the average European and American populations. The average glenoid maximum width of the Indian population is 1.3 mm smaller than the minimum glenoid baseplate size available in reverse shoulder arthroplasty. Glenoid components specific to the Indian market need to be designed to reduce glenoid failure attributable to the above findings. Level of evidence III.
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Affiliation(s)
- Souvik Paul
- Department of Orthopaedics, AMRI Hospitals Mukundapur, Kolkata, India
| | - Manit Arora
- Fortis Hospitals Mohali, Mohali, Punjab India
| | - Lakhsmana Das
- Department of Orthopedics, All India Institute of Medical Sciences Bhatinda, Punjab, India
| | - Balgovind S. Raja
- Department of Orthopedics, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
| | - Roop Bhusan Kalia
- Department of Orthopedics, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
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Lee HH, Park SE, Ji JH, Jun HS. Mid-term comparative study between the glenoid and humerus lateralization designs for reverse total shoulder arthroplasty: which lateralization design is better? BMC Musculoskelet Disord 2023; 24:290. [PMID: 37059977 PMCID: PMC10103464 DOI: 10.1186/s12891-023-06383-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION The complications of the conventional medialized design for reverse total shoulder arthroplasty (RSA) are increased scapular notching, and decreased external rotation and deltoid wrapping. Currently, lateralization design RSA, which avoid scapular notching and improve impingement-free range of motion, is commonly used. Especially, humeral lateralization design was most commonly used and glenoid lateralization design was preferred for glenoid abnormities. We compared mid-term clinical and radiologic outcomes of glenoid and humeral lateralization RSA in an Asian population in this study. MATERIALS AND METHODS We enrolled 124 shoulders of 122 consecutive patients (mean age 73.8 ± 6.8 years) who received glenoid or humeral lateralization RSA from May, 2012 to March, 2019. We divided these patients into two groups according to RSA using either glenoid or humeral lateralization design. These different designs were introduced consecutively in Korea. The clinical and radiological results of 60 glenoid lateralization RSA (Group I, 60 patients) and 64 humeral lateralization RSA (Group II, 62 patients) were retrospectively evaluated and also were compared between the two groups. All patients were followed for mean 3 years. RESULTS The clinical and radiologic outcomes of the two groups did not differ significantly, including scapular notching (p = 0.134). However, humeral lateralization RSA showed a larger glenoid-tuberosity (GT) distance (p = 0.000) and less distalization shoulder angle (DSA) (p = 0.035). The complication rate did not differ significantly either. But, revision surgery was performed for 2 humeral loosening in the Group II. CONCLUSION The clinical and radiologic outcomes of the two groups did not differ significantly, including scapular notching at mid-term follow-up. However, humeral lateralization design showed larger GT distance and less DSA. Humeral lateralization design RSA could preserve the normal shoulder contour due to a larger GT distance (more lateralization) and provide less deltoid tension due to less DSA (less distalization of COR).
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Affiliation(s)
- Hwan-Hee Lee
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Eun Park
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Korea.
| | - Hyun-Sik Jun
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
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Oh JH, Jeong HJ, Won YS. Implant selection for successful reverse total shoulder arthroplasty. Clin Shoulder Elb 2023; 26:93-106. [PMID: 36919511 PMCID: PMC10030993 DOI: 10.5397/cise.2022.01193] [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: 08/11/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) emerged as a new concept of arthroplasty that does not restore normal anatomy but does restore function. It enables the function of the torn rotator cuff to be performed by the deltoid and shows encouraging clinical outcomes. Since its introduction, various modifications have been designed to improve the outcome of the RTSA. From the original cemented baseplate with peg or keel, a cementless baseplate was designed that could be fixed with central and peripheral screws. In addition, a modular-type glenoid component enabled easier revision options. For the humeral component, the initial design was an inlay type of long stem with cemented fixation. However, loss of bone stock from the cemented stem hindered revision surgery. Therefore, a cementless design was introduced with a firm metaphyseal fixation. Furthermore, to prevent complications such as scapular notching, the concept of lateralization emerged. Lateralization helped to maintain normal shoulder contour and better rotator cuff function for improved external/internal rotation power, but excessive lateralization yielded problems such as subacromial notching. Therefore, for patients with pseudoparalysis or with risk of subacromial notching, a medial eccentric tray option can be used for distalization and reduced lateralization of the center of rotation. In summary, it is important that surgeons understand the characteristics of each implant in the various options for RTSA. Furthermore, through preoperative evaluation of patients, surgeons can choose the implant option that will lead to the best outcomes after RTSA.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyeon Jang Jeong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo-Sun Won
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Zhang B, Guan H, Ye Z, Zhang Y. Study on geometry and morphology of proximal humerus in Northern Chinese population based on 3-D CT. J Orthop Surg Res 2023; 18:47. [PMID: 36647099 PMCID: PMC9843902 DOI: 10.1186/s13018-023-03504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study investigated the characteristics of humeral geometric and morphological parameters in northern Chinese population by three-dimensional measurements, and compared whether there were differences in humeral morphology among populations from different geographical regions. METHODS Computed tomography scans of 80 humerus were obtained, reconstructed and measured. Differences in humeral morphological parameters between genders and sides were compared. Correlation analysis was used to explore possible correlations among the parameters. The differences in humeral geometric morphometric parameters between Western and East Asian populations were compared according to pool results of present and previous studies. RESULTS The average (and standard deviation) of humeral head radius curvature, arc angle, diameter, and thickness was 151.79 ± 6.69°, 23.36 ± 2.08 mm, 44.83 ± 3.92 mm and 17.55 ± 1.84 mm in coronal humeral head plane, and 152.05 ± 8.82°, 21.81 ± 1.88 mm, 41.77 ± 3.44 mm and 16.52 ± 1.92 mm in transversal humeral head plane. The average of the humeral head medial offset and posterior offset was 7.34 ± 2.47 mm and 0.08 ± 1.72 mm. Humeral head inclination angle, arc angle and radius curvature of humeral neck-shaft averaged 137.69 ± 4.92°, 34.7 ± 5.29° and 55.76 ± 13.43 mm. Superior, inferior, anterior, posterior concave angle of humeral anatomical neck averaged 150.41 ± 10.91°, 146.55 ± 10.12°, 146.43 ± 13.53° and 149.33 ± 14.07°. The average of height of the greater tuberosity, height of the lesser tuberosity, depth, concave angle and volume of the intertubercular groove was 14.19 ± 1.7 mm, 8.9 ± 1.54 mm, 0.92 ± 0.31 mm3, 31.28 ± 9.61 mm, 4.98 ± 1.19 mm and 89.35 ± 17.62°. The upper angle of the greater tuberosity averaged 161.04 ± 7.84°, the upper angle of the greater tuberosity was 165.94 ± 3.6°. Differences in parameters of proximal humerus between genders and sides were found. There was no correlation between parameters of proximal humerus and age. Correlations were found among humeral morphological parameters. East Asian populations differed in proximal humeral morphology from Western populations. CONCLUSIONS This study will provide references for diagnosing and classifying shoulder disease, designing prosthesis and instrument, enhancing surgical precision and guiding patient recovery.
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Affiliation(s)
- Boyu Zhang
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, China ,grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Haitao Guan
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, China ,grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Zhipeng Ye
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, China ,grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Yingze Zhang
- The School of Medicine, Nankai University, Tianjin, China. .,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China. .,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Chinese Academy of Engineering, Beijing, People's Republic of China.
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12
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Matsui Y, Momma D, Suenaga N, Urita A, Yoshioka C, Oizumi N, Iwasaki N. Computed tomography revealed the correlation between radiolucency and alignment of all-polyethylene pegged glenoid component more than 10 years after total shoulder arthroplasty in the Japanese population. J Orthop Sci 2023; 28:131-137. [PMID: 34838411 DOI: 10.1016/j.jos.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/24/2021] [Accepted: 10/28/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Anatomical total shoulder arthroplasty (TSA) provides successful long-term outcomes but complications can occur after 10 years that require revision. Computed tomography (CT) is a useful tool for assessing radiolucent lines around the glenoid component of TSA; however, the merits of long-term post-TSA follow up with CT are unclear. The purpose of this study was to evaluate the long-term outcomes after TSA of Japanese population and to identify factors related to radiolucency around the glenoid component using CT. METHODS A retrospective review was conducted of TSA patients who had completed at least 10 years of clinical follow up. Radiographs and CT images of the affected shoulder obtained at the last follow up were evaluated for radiolucent lines around the stem and each peg, superior inclination and retroversion of the glenoid component, subluxation index, and critical shoulder angle (CSA). Shoulder ROM, Constant-Murley score and UCLA score were compared between the preoperative and last follow up period. RESULTS Eighteen shoulders in 16 patients met the inclusion criteria. Mean patient age was 61 years, mean follow up period was 137 months, and mean Yian CT score was 19%. CT score was significantly highest in pegs located inferiorly (p < 0.05). Mean glenoid superior inclination was 12.6°, retroversion was -0.3°, subluxation index was 46%, and CSA was 33.7°. Glenoid superior inclination was significantly lower (p = 0.007) in shoulders with possible loosening than in cases with no loosening (5.0° vs 15.6°). Mean Constant score and UCLA score improved significantly after TSA, from 25.8 to 10.7 points preoperatively to 70.1 and 28.9 points postoperatively, respectively. Mean shoulder flexion, internal rotation, and external rotation also showed improvement postoperatively. CONCLUSION TSA provides good long-term outcomes. Radiolucency was present most frequently around the inferior pegs of the glenoid component. Glenoid superior inclination may affect the formation of radiolucent lines around glenoid pegs. LEVEL OF EVIDENCE Level IV; Case Series; Treatment study.
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Affiliation(s)
- Yuki Matsui
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan.
| | | | - Atsushi Urita
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | | | | | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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13
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Suroto H, Licindo D, Wibowo PA, Gultom GRR, Aprilya D, Setiawati R, Samijo S. Morphology of Humeral Head and Glenoid in Normal Shoulder of Indonesian Population. Orthop Res Rev 2022; 14:459-469. [PMID: 36514786 PMCID: PMC9741816 DOI: 10.2147/orr.s378658] [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: 07/04/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Shoulder prostheses designed and used around the world may not fit an Asian shoulder. Normal shoulder morphology in Asian population had been reported, ie, Chinese, Indian, Japanese, and Thai populations, but no data from the Indonesian population. The aim of this study was to evaluate the three-dimensional (3D) morphology of the glenohumeral joint in the normal Indonesian population, identify its normal values, and compare them with those of other populations in the literature. Patients and Methods Images for analysis were computed tomography (CT) scans of 85 normal shoulders from 71 patients who had CT scans for another diagnosis. Morphometry of the humeral head and glenoid were measured using 3D reconstruction. Gender differences and correlations between age, height, and glenohumeral morphometry were evaluated. Indonesians' glenohumeral morphometry was compared with those of other populations in the literature. Results In the normal Indonesian population, the mean of humeral head inclination (HHI), height (HHH), diameter in sagittal plane (DS), diameter in frontal plane (DF), radius of curvature in sagittal plane (RS), and radius of curvature in frontal plane (RF) were 134.1°, 15.6mm, 39.3mm, 41.3mm, 20.4mm, and 21.4mm, respectively. The glenoid height (GH), upper width (GUW), lower width (GLW), inclination (GI), and version (GV) mean values were 34.2mm, 18.4mm, 24.5mm, 74.0mm, and 12.3mm, respectively. There was a significant difference in HHH, DS, DF, RS, RF, GH, GUW, GLW between males and females. Except for HHI and GI, glenohumeral morphometry was correlated with patient height. Age was not correlated with any glenohumeral morphometry. Conclusion In the Indonesian population, males had a larger humeral head and glenoid than females, and the size of the humeral head and glenoid was correlated to body height. Indonesians' humeral head and glenoid sizes were smaller than those of Western populations, but close to those of other Asian populations.
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Affiliation(s)
- Heri Suroto
- Department of Orthopaedic & Traumatology, Dr. Soetomo General Academic Hospital / Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Daniel Licindo
- Department of Orthopaedic & Traumatology, Dr. Soetomo General Academic Hospital / Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Pramono Ari Wibowo
- Department of Orthopaedic & Traumatology, Dr. Soetomo General Academic Hospital / Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Goklas Ridwan Ricardo Gultom
- Department of Orthopaedic & Traumatology, Dr. Soetomo General Academic Hospital / Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dina Aprilya
- Orthopaedic & Traumatology, Indonesian Association for Upper Limb and Microsurgery, Jakarta, Indonesia
| | - Rosy Setiawati
- Department of Radiology, Dr Soetomo General Academic Hospital / Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Steven Samijo
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medisch Centrum, Heerlen, Netherlands
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Leong YC, Yeoh CW, Azman MI, Juhari MS, Siti HT. Acromion Morphology of Patients with Rotator Cuff Disease in Standard AP Shoulder Radiograph in Hospital Sultanah Bahiyah and Hospital Kuala Lumpur. Malays Orthop J 2022; 16:50-54. [PMID: 36589379 PMCID: PMC9791891 DOI: 10.5704/moj.2211.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Rotator cuff pathology is commonly attributed to acromion morphology that is demonstrable in standard AP shoulder radiographs by measuring the critical shoulder angle (CSA), the lateral acromial angle (LAA), and the acromial index (AI). However, these parameters vary among races and countries. Therefore, our study aimed to get the local data on acromion morphology in patients with rotator cuff disease. Materials and methods MRI shoulder reports between January 2012 and June 2018 were reviewed. The study group consisted of 47 patients with rotator cuff injury with a partial or complete tear, and a control group of 37 patients with tendinitis or osteoarthritis and intact rotator cuffs. The CSA, LAA, and AI of both groups were measured on the anteroposterior shoulder radiograph. The risk factors for both groups and the acromion morphology were recorded. Results The CSA for the rotator cuff tear and the control group was 39.08° and 38.28°, LAA was 72.57 ° and 73.51°, and AI was 0.79 and 0.75. The acromion morphology differed in terms of gender, and only LAA was different among the different ethnic groups. There was a negative correlation between age and CSA, age and AI, LAA and CSA, LAA and AI, but a positive correlation between AI and CSA. Conclusion The CSA for rotator cuff tear patients in our population was 39.08°, LAA was 72.57°, and AI was 0.79. The acromion morphology was significantly influenced by age and gender.
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Affiliation(s)
- YC Leong
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia,Corresponding Author: Yung Chin Leong, Department of Orthopaedics, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - CW Yeoh
- Department of Orthopaedics, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
| | - MI Azman
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - MS Juhari
- Department of Orthopaedics, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
| | - HT Siti
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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15
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Zhou J, Zhong B, Qu R, Qian L, Li Z, Liu C, Xiao Z, Xu G, Liang H, Wei K, Ouyang J, Dai J. Anatomic measurement of osseous parameters of the glenoid. Sci Rep 2022; 12:13424. [PMID: 35927571 PMCID: PMC9352768 DOI: 10.1038/s41598-022-17783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/31/2022] [Indexed: 11/09/2022] Open
Abstract
The angle and position of the scapular glenoid are important in shoulder mechanics, the interpretation of diseases, and planning shoulder replacement surgery. In total shoulder replacement, understanding the bony parameters of the glenoid is also of considerable guiding significance for designing implant size and improving material adaptability. To compare glenoid parameters measured from skeletal scapula specimens with those measured by 3D modeling of CT scanning images, analyze correlations between these data, and draw conclusions to guide clinical treatment of shoulder joint injury and total shoulder joint replacement. The data of manual and CT measurements from the same Chinese dry glenoid was compared. Three-dimensional measurement data were collected from the Japanese population and compared with the Chinese population data generated in this study. There were no significant differences between manual measurement and CT measurement in the inclination angle, glenopolar angle, anteroposterior transverse diameter, upper to lower vertical diameter, and depth of the glenoid (P = 0.288, 0.524, 0.111, 0.194, and 0.055, respectively). Further, there were no significant differences between Japanese and Chinese glenoid bones in the upper and lower vertical diameters or anteroposterior transverse diameters (P > 0.05). There were no significant differences between CT and manual measurements, suggesting that the CT method may provide measurements very close to the actual specimen size. This result, however, indicated that the measurer should be careful when measuring the depth of the glenoid.
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Affiliation(s)
- Jing Zhou
- Department of Anatomy, Youjiang Medical University for Nationalities, Baishe, 533000, China
| | - Bin Zhong
- Department of Anatomy, Youjiang Medical University for Nationalities, Baishe, 533000, China
| | - Rongmei Qu
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Lei Qian
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Zeyu Li
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Chang Liu
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Zhaoming Xiao
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Guangwei Xu
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Haibin Liang
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Kuanhai Wei
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Guangdong Provincial Key Laboratory of Bone and Cartilage Regeneration Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
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Joyce CD, Patel MS, Stoll K, Singh AM, Stone MA, Horneff JG, Austin L, Lazarus MD. Fixed- vs. variable-angle humeral neck cut in anatomic total shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg 2022; 31:1674-1681. [PMID: 35537570 DOI: 10.1016/j.jse.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Variable neck-shaft angle (NSA) stemmed humeral components have been incorporated into certain implant designs to better re-create normal anatomy in total shoulder arthroplasty (TSA). The purpose of this study was to determine if premorbid glenohumeral joint anatomy is better restored with a fixed- vs. variable-NSA prosthesis. METHODS A randomized controlled trial was performed including 50 patients with osteoarthritis indicated for primary anatomic TSA. Patients were randomized preoperatively to receive either a variable- (n = 26) or fixed-NSA (n = 24) prosthesis. Humeral neck cut in the variable-NSA group matched the patient's anatomic neck, with prosthetic NSA of 127.5°, 132.5°, and 137.5° available. Fixed-NSA cuts were made with an intramedullary guide of 132.5°. Preoperative and postoperative radiographs were evaluated for specific radiographic anatomic variables: NSA, head thickness, tuberosity-to-head height, head offset, articular arc, greater tuberosity offset, and center of rotation (COR). Postoperative radiographic criteria were compared between groups. RESULTS No differences were found between groups in demographics or preoperative radiographic measures. When comparing average difference in preoperative and postoperative measurements in the fixed-NSA group, the humeral head offset from the humeral shaft axis significantly decreased by 1.4 mm (P = .046), and the COR moved superiorly (3.0 mm, P = .002) without significant medialization or lateralization. In the variable angle group, humeral head offset decreased but did not reach significance (1.2 mm, P = .091), and the COR also moved superiorly (2.9 mm, P < .001) without significant medialization or lateralization. All remaining radiographic parameters did not significantly change from pre- to postoperative imaging. In comparing the fixed- and variable-NSA groups' net change from the premorbid measurements, no significant differences were found in tuberosity-to-head height, head offset, or COR position in both the horizontal and vertical planes. CONCLUSIONS Both fixed- and variable-NSA anatomic TSA humeral components demonstrate adequate restoration of premorbid anatomy radiographically.
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Affiliation(s)
| | - Manan S Patel
- Department of Orthopedic Surgery, Cooper Health, Cherry Hill, NJ, USA
| | - Kurt Stoll
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arjun M Singh
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Michael A Stone
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John G Horneff
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Luke Austin
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark D Lazarus
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Critical shoulder angle (CSA): age and gender distribution in the general population. J Orthop Traumatol 2022; 23:10. [PMID: 35157156 PMCID: PMC8844324 DOI: 10.1186/s10195-022-00627-w] [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: 04/30/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
Anatomical parameters and pathologies that can affect the critical shoulder angle (CSA) are subjects of discussion. To date, we do not know if the CSA value changes in the different decades of life in a population characterized by the same ethnicity, nor if there are differences related to gender or side. This study hypothesizes that age and gender may affect the CSA.
Methods
Patients older than 15 years old affected by a shoulder trauma and who were discharged with a diagnosis of shoulder contusion were enrolled. A true AP view of the shoulder was obtained as well as data regarding age and gender of all participants. The CSA was measured by three authors, and interoperator reliability was assessed. Eight subcategories, according to decades of life, were considered. Finally, the studied population was divided into three subcategories according to CSA values (< 30°; 30–35°; ≥ 35°).
Results
The initial sample comprised 3587 shoulder X-rays. The interobserver reproducibility was high, with an intraclass correlation coefficient of 0.865 (95% CI 0.793–0.915).
Two thousand eight hundred seventy-three radiograms were excluded. The studied group comprised 714 patients [431 females, 283 males; mean age (SD): 47.2 (20.9) years, range: 11–93 years]. The mean CSA was 33.6° (range: 24–50°; SD: 3.9°). The mean CSA values in females and males were 33.7°and 33.5°, respectively. The mean CSA values of the right and left shoulders were 33.3° and 33.9°, respectively (p > 0.05). Linear regression analysis showed a CSA increase by 0.04° every year. The mean CSA in subjects aged between 15 and 19 years was significantly lower than all the other groups, except for patients older than 80 years.
No significant differences were found between CSA subcategories, gender, or side.
Conclusions
In the general population, the mean CSA value was 33.6°. No significant differences were found regarding the mean CSA value according to gender or side. A significant positive linear correlation between CSA and age was detected. In each decade of life, the CSA value, which is genetically determined, shows a large variability.
Level of evidence: IV.
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Kim MS, Rhee YG, Oh JH, Yoo JC, Noh KC, Shin SJ. Clinical and Radiologic Outcomes of Small Glenoid Baseplate in Reverse Total Shoulder Arthroplasty: A Prospective Multicenter Study. Clin Orthop Surg 2022; 14:119-127. [PMID: 35251549 PMCID: PMC8858908 DOI: 10.4055/cios20301] [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: 12/07/2020] [Revised: 01/20/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to evaluate the clinical and radiologic outcomes of reverse total shoulder arthroplasty (RTSA) using a small glenoid baseplate in patients with a small glenoid and to analyze the contributing factors to scapular notching. Methods A total of 71 RTSAs performed using a 25-mm baseplate were evaluated at a mean of 37.0 ± 3.3 months. Shoulder function was evaluated using American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE) for satisfaction, and active range of motion. Scapular neck angle (SNA), prosthesis-scapular neck angle (PSNA), peg glenoid rim distance (PGRD), and sphere bone overhang distance (SBOD) were measured to assess the effects on scapular notching. Results Shoulder function (ASES: 39.4 ± 13.8 preoperative vs. 76.2 ± 9.5 at last follow-up, p < 0.001), VAS for pain (6.1 ± 1.8 vs. 1.7 ± 1.4, p < 0.001), SANE for satisfaction (7.0 ± 11.8 vs. 83.4 ± 15.3, p < 0.001), and active forward flexion (115.6° ± 40.1° vs. 141.6° ± 17.2°, p < 0.001) were significantly improved. The mean diameter of the inferior glenoid circle was 26.0 ± 3.0 mm and the mean glenoid vault depth was 24.0 ± 4.5 mm. Scapular notching was found in 13 patients (18.3%) and acromial fracture in 2 patients (2.8%). There were no significant differences in preoperative SNA and PSNA at postoperative 3 years between patients with and without scapular notching (101.6° ± 10.5° and 110.8° ± 14.9° vs. 97.3° ± 13.3° and 104.9° ± 12.4°; p = 0.274 and p = 0.142, respectively). PGRD and SBOD were significantly different between patients with scapular notching and without scapular notching (24.8 ± 1.6 mm and 2.6 ± 0.5 mm vs. 21.9 ± 1.9 mm and 5.8 ± 1.9 mm; p < 0.001 and p < 0.001, respectively). Conclusions RTSA using a 25-mm baseplate in a Korean population who had relatively small glenoids demonstrated low complication rates and significantly improved clinical outcomes. Scapular notching can be prevented by proper positioning of the baseplate and glenosphere overhang using size-matched glenoid baseplates.
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Affiliation(s)
- Min-Su Kim
- Department of Orthopaedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Cheol Noh
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Takayama K, Yamada S, Kobori Y. Clinical outcomes and temporal changes in the range of motion following superior capsular reconstruction for irreparable rotator cuff tears: comparison based on the Hamada classification, presence or absence of shoulder pseudoparalysis, and status of the subscapularis tendon. J Shoulder Elbow Surg 2021; 30:e659-e675. [PMID: 33930558 DOI: 10.1016/j.jse.2021.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) has recently gained popularity as a surgical solution for patients with massive rotator cuff tears or shoulder pseudoparalysis (PPS). Good clinical outcomes have been reported after SCR; however, the factors that influence its clinical outcomes remain unclear. Therefore, in this study, we aimed to clarify the factors influencing postoperative outcomes after SCR using tensor fascia lata graft, for which we evaluated the Hamada grade, patients with or without PPS, and the status of the subscapularis tendon (SSC). METHODS In total, 54 consecutive patients with irreparable rotator cuff tears or PPS who underwent SCR between June 2014 and October 2018 were included. The enrolled patients were grouped and compared as follows: (1) Hamada grade 2 (11 patients) and Hamada grade 3 (43 patients) and (2) non-PPS (22 patients), moderate PPS (16 patients), and severe PPS (16 patients). For subanalysis, the 32 PPS patients were divided into 3 groups: intact SSC (11 patients), repairable SSC (16 patients), and irreparable SSC (5 patients). To assess shoulder function, the American Shoulder and Elbow Surgeons (ASES) score was evaluated before surgery and at 24 months postoperatively; shoulder range of motion was evaluated at 2, 3, 4, 5, 6, 8, 10, 12, and 24 months postoperatively. RESULTS No significant differences in postoperative ASES scores and shoulder range of motion were observed between the Hamada grade 2 and grade 3 groups or between the non-PPS, moderate PPS, and severe PPS groups. However, significant differences in postoperative shoulder elevation and ASES scores were observed between the intact SSC and irreparable SSC groups (P = .006) and between the repairable SSC and irreparable SSC groups (P = .003). CONCLUSIONS This study demonstrated that the status of the SSC, rather than the Hamada grade or the presence or absence of PPS, influences the clinical outcomes after SCR. Therefore, reparability or intactness of the SSC is an important factor in considering the surgical indication for SCR.
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Affiliation(s)
- Kazumasa Takayama
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Shunsuke Yamada
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yuu Kobori
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan
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Jeong HJ, Jeong MG, Kim SW, Han J, Liu B, Rhee SM, Oh JH. Optimal insertion site of glenoid baseplate in reverse total shoulder arthroplasty: anatomical simulation using three dimensional image processing software. INTERNATIONAL ORTHOPAEDICS 2021; 45:3171-3177. [PMID: 34625824 DOI: 10.1007/s00264-021-05235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Conventionally, the central structure of the baseplate is inserted through the point where the vertical and horizontal axes of the glenoid intersect (conventional insertion site (CIS)). However, there is scanty theoretical evidence that CIS has the optimal bone stock. We evaluated the optimal insertion site for the glenoid baseplate through the three-dimensional volumetric measurement of the glenoid bone stock. METHODS Pre-operative computed tomography (CT) images of 30 consecutive reverse total shoulder arthroplasty procedures were analyzed. Three-dimensional image processing software was used to reconstruct CT and volumetrically measure the glenoid bone stock according to the simulated central peg. A simulated central peg was inserted to the medial pole of the scapula from 49 points determined along with the intersect point of the vertical and horizontal axes of the glenoid CIS at 2-mm intervals. The overlapped volume between the simulated central peg and glenoid vault, representing the amount of glenoid bone stock along the passage of the central peg, was then automatically calculated. RESULTS The depth of the glenoid vault was 25.5 ± 3.0 mm (range, 19.3-31.5), and the mean overlapped volume between the simulated central peg and the glenoid vault was 623.0 ± 185.8 ml. The optimal insertion site for the bony purchase of the central peg was 2 mm inferior and posterior from the CIS (765.3 ± 157.5). CONCLUSION The optimal insertion site of the baseplate is located slightly inferiorly and posteriorly to the CIS. This anatomical information may be used as a reference to determine the optimal insertion site of the baseplate according to an implant of a surgeon's choice.
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Affiliation(s)
- Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Myeong Gon Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Sang Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Jian Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Bei Liu
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 23, Kyungheedae-ro, Seoul, Dongdaemun-gu, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
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Tankshali K, Suh DW, Ji JH, Kim CY. Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population. Clin Shoulder Elb 2021; 24:125-134. [PMID: 34488292 PMCID: PMC8423532 DOI: 10.5397/cise.2021.00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up. Methods From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with minimum 2 years follow-up were enrolled. We evaluated the clinical and radiological outcomes, and complications at the last follow-up. In addition, we divided these patients into notching and no-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients. Results Visual analogue scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles Shoulder Scale, and Simple Shoulder Test scores improved significantly from preoperative (5.00, 3.93, 1.72, 3.94) to postoperative (1.72, 78.91, 28.34, 7.66) (p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20 of 38 patients (53%). In the comparison between notching and no-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications included three metaphyseal fractures and one inferior screw malposition. Postoperative complications included ectopic ossification, scapular neck stress fracture, humeral stem relaxation, and late infection in one case each. Conclusions BIO-RSA showed improved clinical outcomes at mid-term follow-up in Asian population. However, we observed higher scapular notching compared to the previous studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.
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Affiliation(s)
- Kirtan Tankshali
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Dong-Whan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Chang-Yeon Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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Vijittrakarnrung C, Fuangfa P, Jaovisidha S, Kijkunasathian C. Correlation between full-thickness degenerative supraspinatus tear and radiographic parameters including the acromiohumeral centre edge angle and the greater tuberosity angle. BMC Musculoskelet Disord 2021; 22:607. [PMID: 34229674 PMCID: PMC8259214 DOI: 10.1186/s12891-021-04489-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many radiographic parameters associated with the extrinsic cause of supraspinatus tears have been proposed. The aim of this study was to assess the relationship between a full-thickness degenerative supraspinatus tear (FTDST) and the patient's radiographic parameters, including the acromiohumeral centre edge angle (ACEA) and the greater tuberosity angle (GTA). METHODS A retrospective study was conducted. We included 116 patients who underwent shoulder arthroscopic surgery at our institute. The case group included FTDST patients, whereas the control group also included patients without evidence of supraspinatus tears. In each patient, the ACEA and GTA values were measured and analyzed by two independent observers. Intra- and interobserver reliabilities were assessed. Multivariate regression analysis was performed. RESULTS The ACEA values were significantly increased in the FTDST group with a mean of 26.44° ± 9.83° compared with 16.81° ± 7.72° in the control group (P < 0.001). Multivariate regression analysis also showed that higher ACEA values were associated with an FTDST (odds ratio 1.16 per degree, P = 0.01). For GTA values, a statistically significant difference was found with a mean of 70.92° ± 6.64 compared with 67.84° ± 5.56 in the control group (P = 0.02). However, stepwise regression analysis did not indicate that GTA was a predictor of FTDST. CONCLUSIONS Our study demonstrated that the presence of increased ACEA values is an independent significant risk factor for the presence of FTDSTs. Consequently, GTA values may be less helpful in assessing the risk of FTDST, especially in this specific population.
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Affiliation(s)
- Chaiyanun Vijittrakarnrung
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand.
| | - Praman Fuangfa
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Chusak Kijkunasathian
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
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The study of 2-dimensional computed tomography scans of the glenoid anatomy in relation to reverse shoulder arthroplasty in the Southern Chinese population. JSES Int 2021; 5:714-721. [PMID: 34223420 PMCID: PMC8246002 DOI: 10.1016/j.jseint.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Reverse shoulder arthroplasty is becoming an increasingly common surgical procedure in Hong Kong, as well as in many other countries worldwide. The aim of this study is to describe the glenoid anatomy in the Southern Chinese population. We are interested to know whether commercially available glenoid implants are suitable for this population and whether there are any steps or precautions we can take during surgery to optimize the clinical outcome for these patients. Method A total of 244 shoulders of Southern Chinese patients were analyzed using 2-dimensional computed tomography, formatted to align along the scapular axis. The anatomic parameters analyzed included the shape, axial configuration, maximum width, maximum height, version, and presence of bone defect. Results In our study, 76.6% of glenoids were pear-shaped, 23.0% were elliptical, and only 0.4% were inverted pear in shape. Of all glenoids, 95.1% of glenoids had posterior-prominent axial configuration, whereas 4.9% had neutral axial configuration. The mean maximum glenoid height for both genders was 33.8 mm, whereas the mean maximum glenoid height was 32.2 mm for women and 36.6 mm for men. The mean maximum glenoid width for both genders was 25.8 mm, whereas the mean maximum glenoid width was 24.8 mm for women and 27.3 mm for men. The differences in measurements between genders were statistically significant. Of all glenoids, 46.3% of the glenoids were retroverted, whereas 53.7% of the glenoids were anteverted. The mean version for both genders was 0.77 degrees anteversion. The mean version was 1.16 degrees anteversion for women and 0.10 degrees anteversion for men. Of the 244 glenoids, 4 had bone defects. In our study, 39.8% of patients had mean maximum glenoid widths that were less than 25 mm, which is the smallest size available for most conventional glenoid baseplates. Conclusion A significant portion of the Southern Chinese population has glenoid widths that are smaller than the smallest commercially available glenoid baseplates. Understanding the glenoid anatomy is crucial in the case of reverse shoulder arthroplasty, as it has significant implications in implant design, operative planning, and surgical outcomes.
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Chaimongkhol T, Benjachaya S, Mahakkanukrauh P. Acromial morphology and morphometry associated with subacromial impingement syndrome. Anat Cell Biol 2020; 53:435-443. [PMID: 32963132 PMCID: PMC7769113 DOI: 10.5115/acb.20.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022] Open
Abstract
Acromion is a major associated structure of subacromial impingement syndrome, one of the most common diagnoses in chronic shoulder pain world-wide. The aims of this study are to study morphometry of acromion and to find risk group using acromial morphometry. Total samples were 392 scapulae. The samples were of both sexes, ranging from the age of 31 to 90. Acromion type and osteophytes were observed. Acromial parameters were measured. The relationships were analyzed among acromion type, acromial osteophyte, acromial parameters, age group, sex and side. Curved acromion had the highest prevalence in all age groups. Hooked acromion had the second highest prevalence since the age of 41. Hooked acromion prevalence was higher in male than in female. The highest prevalence of acromial osteophytes was on anteroinferior surface in all age group. The prevalence of acromial osteophytes on anteroinferior surface and acromial facet increased with age. In addition, acromion type was associated with only osteophytes on anteroinferior surface of acromion. Anterior one-third acromial thickness in the age of 31 to 50 was different from those of 51 to 90. There are differences between all parameters and sexes, but not side. General population with age above 50 and concerned male group with age above 40 who have chronic shoulder pain should be investigated for subacromial impingement syndrome. Surgical treatment is recommended because hooked acromion and osteophytes are mostly the root of problem.
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Affiliation(s)
| | - Sirapat Benjachaya
- Department of anatomy Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of anatomy Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
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25
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Liu HX, Xu XX, Xu DL, Hu YZ, Pan XY, Yu Z, Xu YJ. The acromion-greater tuberosity impingement index: A new radiographic measurement and its association with rotator cuff pathology. J Orthop Surg (Hong Kong) 2020; 28:2309499020913348. [PMID: 32212965 DOI: 10.1177/2309499020913348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Several radiographic parameters describe humeral head coverage by the acromion. We describe a new radiographic measurement, the acromion-greater tuberosity impingement index (ATI), and its ability to predict rotator cuff pathology. METHODS The ATI was measured with magnetic resonance imaging (MRI) and X-ray analysis in 83 patients with rotator cuff pathology and 76 patients with acute rotator cuff tears. The lateral acromial angle (LAA), acromion type, the acromion index (AI) and the critical shoulder angle (CSA) were measured to assess their correlations with the ATI. Receiver operating characteristic (ROC) curves were used to predict degenerative rotator cuff pathology. The change in the ATI after acromion surgery was evaluated in both groups. RESULTS According to the ROC curves, the ATI is a good predictor of degenerative rotator cuff pathology on both X-ray (cut-off, 0.865) and MRI (cut-off, 0.965). Patients with degenerative rotator cuff pathology had a significantly higher average ATI compared to the trauma group (p = 0.001 for X-ray and MRI). The degenerative group had a significantly lower LAA (p = 0.001) and a higher ratio of type III acromion (p = 0.035) than the trauma group. The ATI on X-ray was negatively related to the LAA and positively related to the AI, the CSA and acromion type (each p < 0.05). The ATI on MRI was negatively related to the LAA and positively related to the AI and acromion type (each p <0.05). More patients in the degenerative group than the trauma group needed acromioplasty or acromion decompression (p < 0.05). The ATI on MRI was significantly lower after acromion surgery compared to before surgery in both groups (p < 0.05). CONCLUSION The ATI is a good predictor of degenerative supraspinatus tendon tears or subacromial impingement syndrome. The ATI on MRI is more accurate and can precisely guide acromion surgery.
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Affiliation(s)
- Hai-Xiao Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Xian Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dao Liang Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yue Zheng Hu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Yun Pan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhang Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - You-Jia Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Exploring Alternative Sites for Glenoid Component Fixation Through Three-Dimensional Digitization of the Glenoid Vault: An Anatomic Analysis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00199-9. [PMID: 33278183 PMCID: PMC7714053 DOI: 10.5435/jaaosglobal-d-20-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glenoid component loosening has remained one of the most common complications for total shoulder arthroplasty. Three-dimensional modeling of the glenoid may reveal novel information regarding glenoid vault morphology, providing a foundation for implant designs that possess the potential to extend the survivorship of the prosthesis.
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Abstract
Background Precise anatomic reconstruction of the proximal humerus is essential to a favorable outcome of total shoulder arthroplasty. Because of the wide variation in the geometric features of the proximal humerus, prosthetic designs incorporating these disparities are being developed. Methods The aim of this study is to use data obtained from cadavers and computed tomographic scans to investigate the 3-dimensional morphometric parameters of the proximal humerus of South African and Swiss samples and make an interpopulation comparison. In addition, the study combines the interarticular variations between populations with the differences in sex and shoulder sides. With the aid of medical imaging techniques and engineering design tools, various geometric features were measured. Results The results obtained from these analyses revealed several differences in sex and shoulder sides. On average, the Swiss were larger in most of the measured parameters than the South Africans. The male shoulders of Swiss and South Africans were observed to significantly vary in 4 of the parameters measured. The South African male and female right shoulders varied considerably in one-fourth of the measured shoulder variables. Generally, for both populations, the left and right shoulders of the same individuals were not different in all the measured variables irrespective of sex. Conclusion The knowledge acquired in this study is expected to assist in the development of a population-specific shoulder prosthetic design and surgical planning procedures.
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Meshram P, Pawaskar A, Kekatpure A. 3D CT scan-based study of glenoid morphology in Indian population: Clinical relevance in design of reverse total shoulder arthroplasty. J Clin Orthop Trauma 2020; 11:S604-S609. [PMID: 32774036 PMCID: PMC7394810 DOI: 10.1016/j.jcot.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The knowledge of normal anatomy of glenoid in a population has relevance in terms of comparison with other regional and national population. Furthermore, it could enable clinicians to judge whether the available sizes of reverse total shoulder arthroplasty (RTSA) prosthesis could provide optimal fit for the glenoid in Indian patients. METHODS We evaluated consecutive 200 3-dimensional chest CT scans of 50 male and 50 female patients which included both shoulder joints and done for non-orthopaedic diseases at a tertiary care institute. The glenoid height, width, and version were measured using commercially available computer program. RESULTS Mean age of the patents was 38.6 ± 13.8 years (range, 19-59 years). The mean glenoid height was 33.9 ± 3.1 mm and maximum glenoid width was 24.2 ± 2.1 mm. Mean glenoid version in the study population was a retroversion of 3.47 ± 4.7°. The maximum glenoid width of 45% female and 15% male patients was less than 25 mm which is the diameter of smallest available glenoid baseplate among the commonly used RTSA systems. CONCLUSIONS The normal glenoid size of a large cohort of Indian population studied was smaller than that reported in cohorts from western countries. The glenoid width of substantial proportion of patients, especially female patients, was less than the diameter of smallest available glenoid baseplate. Clinical studies are needed in future in Indian patients undergoing RTSA to evaluate the glenoid bone-baseplate mismatch and ascertain the necessity of development of smaller size glenoid baseplate for optimal prosthesis fit in Indian patients.
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Affiliation(s)
- Prashant Meshram
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Aditya Pawaskar
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Aashay Kekatpure
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, India
- Corresponding author. Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, India, Maharashtra, 442004, India.
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Jung HJ, Nam TS, Park D, Jeon IH. Three-Dimensional Morphometric Analysis of Penetrative Depth and Size of Nonarthritic and Degenerative Arthritic Glenoids: Implications for Glenoid Replacement in Shoulder Arthroplasty. Clin Orthop Surg 2020; 12:224-231. [PMID: 32489545 PMCID: PMC7237260 DOI: 10.4055/cios19088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/25/2019] [Indexed: 11/15/2022] Open
Abstract
Background Shoulder arthroplasty is technically demanding and relies heavily on the precision of surgical techniques. Proper glenoid component sizing plays a crucial role in successful shoulder arthroplasty. We measured the size and penetrative depth of the glenoid for peg or screw fixation in nonarthritic and degenerative arthritic shoulders by using three-dimensional computed tomography to determine the reference dimensions of the glenoid in nonarthritic and degenerative arthritic shoulders. Methods From January 2010 to January 2011, data on two groups of patients were collected and reviewed. Group 1 comprised 38 patients who underwent surgical treatment due to fracture of the proximal humerus and who had no evidence of a pathological glenoid. Group 2 comprised 14 patients who underwent surgical treatment due to osteoarthritis of the glenohumeral joint. The height (maximal superoinferior diameter) of the glenoid was measured, and the width (anteroposterior [AP] diameter) of the glenoid was measured at five different levels (H1–H5). Axial images were taken at H1–H5 levels, the AP glenoid diameter of each was divided into eight areas, and division points were labeled as W1–W7. The penetrative depths between the near cortex and far cortex of the glenoid (thickness) at each point (W1–W7) were measured. Results The overall mean glenoid height was 37.67 ± 4.09 mm in nonarthritic glenoids and 39.42 ± 3.54 mm in degenerative arthritic glenoids. The nonarthritic glenoid was significantly thicker than the degenerative arthritic glenoid at the H1W3, H1W4, H1W5, H2W7, H3W1, H3W6, H3W7, H4W5, H4W6, H4W7, H5W4, H5W5, H5W6, and H5W7 points. The posteroinferior quadrant had the smallest penetrative depth in both nonarthritic and degenerative arthritic glenoids. Also, the degenerative arthritic glenoids were significantly thinner than the nonarthritic glenoids along the posterior and inferior parts of the glenoid. Conclusions The posterior and inferior parts of the degenerative arthritic glenoid appears thinner than the nonarthritic glenoid. Thus, caution has to be taken when drilling the screw hole or inserting screws into the posteroinferior parts, where the glenoid is thinner than 15 mm on average, to avoid penetration of the far cortex.
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Affiliation(s)
- Hong Jun Jung
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea
| | - Tae-Seok Nam
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea
| | - Daewon Park
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Stamiris D, Stamiris S, Papavasiliou K, Potoupnis M, Tsiridis E, Sarris I. Critical shoulder angle is intrinsically associated with the development of degenerative shoulder diseases: A systematic review. Orthop Rev (Pavia) 2020; 12:8457. [PMID: 32391136 PMCID: PMC7206364 DOI: 10.4081/or.2020.8457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/09/2020] [Indexed: 12/11/2022] Open
Abstract
Aim of this study was to investigate the potential influence of Critical Shoulder Angle (CSA) as a predisposing factor for the development of degenerative full-thickness rotator cuff tears (DRCT) or primary glenohumeral osteoarthritis (PGOA). A systematic review of the Pubmed, Scopus, Mendeley, ScienceDirect and the Cochrane Central Register of Controlled Trials online databases was performed for literature regarding CSA and its association with DRCT and PGOA. In order to evaluate solely the relationship between CSA as a predisposing factor for the development of the aforementioned degenerative shoulder diseases (DSDs), we precluded any study in which traumatic cases were not clearly excluded. Our search strategy identified 289 studies in total, nine of which were eligible for inclusion based on our pre-established criteria. Quality assessment contacted using the Newcastle Ottawa Scale for case-control studies. There were a total of 998 patients with DRCT and 285 patients with PGOA. The control groups consisted of a total of 538 patients. The mean CSA ranged from 33.9° to 41.01° for the DRCT group, from 27.3° to 29.8° for the PGOA group and from 30.2° to 37.28° for the control group. All studies reported statistically significant differences between the DRCT and PGOA groups and the respective control groups. Our study results showed that there is moderate evidence in the literature supporting an intrinsic role of CSA in the development of DSDs. Level of evidence: IV. Systematic review of diagnostic studies, Level II-IV.
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Affiliation(s)
- Dimitrios Stamiris
- Academic Orthopedic Department, Aristotle University of Thessaloniki Medical School, Thessaloniki; CORE - Center of Orthopedic Research, Center for Interdisciplinary Research and Innovation, Thessaloniki, Greece
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Hoessly M, Bouaicha S, Jentzsch T, Meyer DC. Angle of approach to the superior rotator cuff of arthroscopic instruments depends on the acromial morphology: an experimental study in 3D printed human shoulders. J Orthop Surg Res 2019; 14:435. [PMID: 31831036 PMCID: PMC6909615 DOI: 10.1186/s13018-019-1486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022] Open
Abstract
Background Portal placement is a key factor for the success of arthroscopic procedures, particularly in rotator cuff repair. We hypothesize that the acromial anatomy may strongly determine the position of the shoulder bony landmarks and limit the surgeon’s freedom to position the arthroscopic approaches in direction towards the acromion. The purpose of this study was to analyze the relation between different acromial shapes and the freedom of movement of arthroscopic instruments relative to the rotator cuff from standardized arthroscopic portals in a laboratory study on 3D shoulder models. Methods 3D models of shoulders with a broad range of different acromial shapes were printed using CT and MRI scans. Angles from the portals to defined points on the rotator cuff and the supraglenoid tubercle were measured. In conventional radiographs, the critical shoulder angle, the scapular body acromial angle, and the glenoid acromial angle were measured and compared with the measured angles to the rotator cuff. Results There was a large variation of angles of approach of instruments to the rotator cuff between the seven shoulders for each portal. From the joint line portal and the posterior edge portal, the biggest angles were measured to the posterior cuff. From the intermediate portal, the angles were largest to the intermediate rotator cuff and from the anterior portals to the anterior cuff. To the supraglenoid tubercle, best access was from anterior. For all portals, there was a big correlation between the glenoid acromial angle and the scapular body acromial angle with the angles of approach to the tendon and especially to the supraglenoid tubercle. Conclusion The access to the rotator cuff from almost every portal is influenced by the acromial shape. As hypothesized, a small (small GAA) and flat (big SBAA) acromion provide an easier approach to the rotator cuff from almost every portal. Therefore, it may severely influence the instruments maneuverability.
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Affiliation(s)
- Menduri Hoessly
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH 8008, Zurich, Switzerland.
| | - Samy Bouaicha
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH 8008, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH 8008, Zurich, Switzerland
| | - Dominik C Meyer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH 8008, Zurich, Switzerland
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Critical shoulder angle and greater tuberosity angle according to the partial thickness rotator cuff tear patterns. Orthop Traumatol Surg Res 2019; 105:1543-1548. [PMID: 31202715 DOI: 10.1016/j.otsr.2019.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/18/2019] [Accepted: 05/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Current studies suggest that radiographic markers such as the critical shoulder angle (CSA) and the greater tuberosity angle (GTA) are associated with rotator cuff tears (RCTs). However, because the analysis of CSAs and GTAs according to the partial thickness rotator cuff tear patterns is limited, the purpose of the present study was to evaluate the relationship of CSAs and GTAs with partial thickness rotator cuff tear (PTRCT) patterns. METHOD This retrospective study included 1,069 patients from 2013 to 2017. The subjects were divided into 4 groups: Group A, control group; Group B, articular-sided PTRCTs; Group C, bursal-sided PTRCTs; and Group D, full thickness rotator cuff tears (FTRCTs). RCTs were diagnosed with magnetic resonance imaging and the CSA and GTA were measured on simple radiographs. Multivariable analyses were used to clarify the potential risks for these pathologies. RESULTS The mean CSAs of articular-sided PTRCTs (34.2°±4.7°) and FTRCTs (34.7°±4.4°) were significantly larger than those of the control group (32.3°±4.3°) and the bursal-sided PTRCTs (31.5°±4.6°), (P<0.001). Multivariable analysis also showed that larger CSAs had a significantly increased risk of both articular-sided PTRCTs and FTRCTs, with odds ratios of 1.12 and 1.17 per degree, respectively. The mean GTAs of bursal-sided PTRCTs (73.2°±4.8°) and FTRCTs (72.3°±5.4°) were significantly larger than that of the control group (70.5°±5.1°) (P<0.001), although the mean GTA of articular-sided PTRCTs (71.5°±6.9°) did not show a significant difference when compared with the other groups. Multivariable analysis also showed that larger GTAs had a significantly increased risk of both bursal-sided PTRCTs and FTRCTs, with odds ratios of 1.13 and 1.07 per degree, respectively. CONCLUSION A large critical shoulder angle was associated more with articular-sided PTRCTs than bursal-sided PTRCTs. A large greater tuberosity angle was associated more with bursal-sided PTRCTs than with articular-sided PTRCTs. Both critical shoulder angle and greater tuberosity angle were positively associated with the occurrence of full thickness rotator cuff tears. LEVEL OF EVIDENCE IV, Retrospective study.
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Rosales-Rosales L, Rosales-Varo A, García-Espona M, Roda-Murillo O, Montesinos I, Hernandez-Cortés P. Anthropometrical study of the human glenoid in a normal Spanish population. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rosales-Rosales L, Rosales-Varo AP, García-Espona MA, Roda-Murillo O, Montesinos I, Hernandez-Cortés P. Anthropometrical study of the human glenoid in a normal Spanish population. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:327-335. [PMID: 31078443 DOI: 10.1016/j.recot.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 03/09/2019] [Accepted: 04/01/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the size of the glenoid in a southern Spanish population, to compare it with previous results from other populations and determine the size of the implants that are marketed for shoulder arthroplasty. MATERIAL AND METHODS Between January 2015 and December 2017, an anthropometrical study of the human glenoid was performed using computed axial tomography scans (CT) of 154 patients over 30 years old. The glenoid dimensions were analysed 3-dimensionally using 2mm interval thicknesses, determining the average height and width of the glenoid. The upper point of the glenoid geometry was determined as the supraglenoid tubercle of the ovoid glenoid surface, where the long head of the biceps tendon is thought to originate. The lower point was then positioned at the furthest point from the upper point on the glenoid contour. Anterior and posterior points were determined such that the 3-dimensional anterior-posterior distance was maximized on the plane perpendicular to the upper-lower axis. Sex differences and correlations between sides and among the respective parameters in the glenohumeral dimensions were also evaluated. RESULTS The glenoid had an average height of 28.78mm and width of 20.27mm. The values were significantly different between the men and the women, being greater in the men. The glenoid size is well correlated with the patient's size. Direct correlations exist between the glenoid height and width and the glenoid size and the patient's height. The available metaglenoids currently on the market are no bigger than 25-24mm. CONCLUSION In comparison, the southern Spanish population have a glenoid size similar to the Caucasian population, but smaller than that of the American population. The data shown could be useful to improve the design of shoulder prostheses for the southern Spanish population.
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Affiliation(s)
| | - A P Rosales-Varo
- Área de Traumatología, Hospital de Torrecárdenas, Almería, España.
| | | | - O Roda-Murillo
- Departamento de Anatomía, Facultad de Medicina, Universidad de Granada, Granada, España
| | - I Montesinos
- Departamento de Cirugía, Facultad de Medicina, Universidad de Granada, Granada, España
| | - P Hernandez-Cortés
- Universidad de Granada, Granada, España; Área de Traumatología, Hospital de Torrecárdenas, Almería, España; Área Radiodiagnóstico, Hospital de Torrecárdenas, Almería, España; Departamento de Anatomía, Facultad de Medicina, Universidad de Granada, Granada, España; Departamento de Cirugía, Facultad de Medicina, Universidad de Granada, Granada, España
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Rhee SM, Lee JD, Park YB, Yoo JC, Oh JH. Prognostic Radiological Factors Affecting Clinical Outcomes of Reverse Shoulder Arthroplasty in the Korean Population. Clin Orthop Surg 2019; 11:112-119. [PMID: 30838115 PMCID: PMC6389533 DOI: 10.4055/cios.2019.11.1.112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/14/2018] [Indexed: 01/20/2023] Open
Abstract
Background Despite the growing use of reverse shoulder arthroplasty (RSA), it is associated with relatively frequent complications and uncertain clinical outcomes. We investigated radiological factors affecting clinical outcomes of RSA in the Korean population. Methods We evaluated physical findings, radiographic findings, visual analog scale scores for pain and satisfaction, and several functional scores in 179 consecutive patients who underwent RSA at two centers between 2008 and 2014. Results In 146 included RSAs, pain and forward flexion improved with deltoid lengthening (average, 23.5 ± 9.1 mm; p = 0.039). External rotation decreased with medialization (average, 16.8 ± 6.0 mm, p = 0.025), whereas internal rotation showed no correlation with humeral retroversion. Scapular notching (n = 44, 30%) significantly decreased with greater inferior glenosphere overhang (average, 2.94 ± 3.0 mm; p = 0.001), greater prosthesis scapular neck angle (average, 104° ± 10.3°; p = 0.001), greater glenoid neck length (average, 9.8 ± 2.54 mm; p = 0.012), lower inferior baseplate tilt angle (average, 105.5° ± 9.2°; p = 0.009), and varus humeral neck-shaft angle (p = 0.046), and it did not affect ranges of motion and pain, satisfaction, and functional scores. At the final follow-up, medialization was related to improvement in pain and satisfaction, and inferior glenosphere overhang to functional scores. Conclusions Proper amount of deltoid lengthening (mean, 2.3 cm) and inferior glenosphere overhang (mean, 2.9 mm) should be chosen for the better outcomes, while the center of rotation should be individualized according to patient characteristics in the Korean population.
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Affiliation(s)
- Sung-Min Rhee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong Dong Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Bok Park
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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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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Shinagawa K, Hatta T, Yamamoto N, Kawakami J, Shiota Y, Mineta M, Itoi E. Critical shoulder angle in an East Asian population: correlation to the incidence of rotator cuff tear and glenohumeral osteoarthritis. J Shoulder Elbow Surg 2018; 27:1602-1606. [PMID: 29731396 DOI: 10.1016/j.jse.2018.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Focus has recently been on the critical shoulder angle (CSA) as a factor related to rotator cuff tear and osteoarthritis (OA) in the European population. However, whether this relationship is observed in the Asian population is unclear. METHODS The correlation between the CSAs measured on anteroposterior radiographs and the presence or absence of rotator cuff tears or OA changes was assessed in 295 patients. Rotator cuff tears were diagnosed with magnetic resonance imaging or ultrasonography. OA findings were classified using the Samilson-Prieto classification. The CSAs among the patients with rotator cuff tears, OA changes, and those without pathologies were compared. Multivariable analyses were used to clarify the potential risks for these pathologies. RESULTS The mean CSA with rotator cuff tear (33.9° ± 4.1°) was significantly greater than that without a rotator cuff tear (32.3° ± 4.5°; P = .002). Multivariable analysis also showed that a greater CSA had a significantly increased risk of rotator cuff tears, with the odds ratio of 1.08 per degree. OA findings showed no significant correlation to the CSAs. CONCLUSIONS Our study demonstrates that the CSA is greater in those with a rotator cuff tear than in those without a tear or OA changes, which may be an independent risk factor for the incidence of rotator cuff tears in the Japanese population.
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Affiliation(s)
- Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan; Department of Orthopaedic Surgery, Oshu City Mizusawa Hospital, Oshu City, Japan
| | - Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Yuki Shiota
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Mitsuyoshi Mineta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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Jeong HY, Kim HJ, Jeon YS, Rhee YG. Factors Predictive of Healing in Large Rotator Cuff Tears: Is It Possible to Predict Retear Preoperatively? Am J Sports Med 2018; 46:1693-1700. [PMID: 29595993 DOI: 10.1177/0363546518762386] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many studies have identified risk factors that cause retear after rotator cuff repair. However, it is still questionable whether retears can be predicted preoperatively. PURPOSE To determine the risk factors related to retear after arthroscopic rotator cuff repair and to evaluate whether it is possible to predict the occurrence of retear preoperatively. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This study enrolled 112 patients who underwent arthroscopic rotator cuff repair with single-row technique for a large-sized tear, defined as a tear with a mediolateral length of 3 to 5 cm. All patients underwent routine magnetic resonance imaging (MRI) at 9 months postoperatively to assess tendon integrity. The sample included 61 patients (54.5%) in the healed group and 51 (45.5%) in the retear group. RESULTS In multivariate analysis, the independent predictors of retears were supraspinatus muscle atrophy ( P < .001) and fatty infiltration of the infraspinatus ( P = .027), which could be preoperatively measured by MRI. A significant difference was found between the two groups in sex, the acromiohumeral interval, tendon tension, and preoperative or intraoperative mediolateral tear length and musculotendinous junction position in univariate analysis. However, these variables were not independent predictors in multivariate analysis. The cutoff values of occupation ratio of supraspinatus and fatty infiltration of the infraspinatus were 43% and grade 2, respectively. The occupation ratio of supraspinatus <43% and grade ≥2 fatty infiltration of the infraspinatus were the strongest predictors of retear, with an area under the curve of 0.908, sensitivity of 98.0%, and specificity of 83.6% (accuracy = 90.2%). CONCLUSION In patients with large rotator cuff tears, it was possible to predict the retear before rotator cuff repair regardless of intraoperative factors. The retear could be predicted most effectively when the occupation ratio of supraspinatus was <43% or the fatty infiltration of infraspinatus was grade ≥2. Predicting retear preoperatively may help surgeons determine proper treatment and predict the postoperative prognosis.
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Affiliation(s)
- Ho Yeon Jeong
- Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Hwan Jin Kim
- Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Yoon Sang Jeon
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Oh JH, Park MS, Rhee SM. Treatment Strategy for Irreparable Rotator Cuff Tears. Clin Orthop Surg 2018; 10:119-134. [PMID: 29854334 PMCID: PMC5964259 DOI: 10.4055/cios.2018.10.2.119] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/11/2018] [Indexed: 12/18/2022] Open
Abstract
Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older adults, which is the primary reason for shoulder surgery in the population. Some authors have reported that up to 30% of total RCTs can be classified as irreparable due to the massive tear size and severe muscle atrophy. In this review article, we provide an overview of treatment methods for irreparable massive RCTs and discuss proper surgical strategies for RCTs that require operative management.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Suk Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung Min Rhee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Impact of vertical and horizontal malrotation on measurements of anteroposterior radiographs of the scapula: need for standardized images in modern omometry. J Shoulder Elbow Surg 2018; 27:659-666. [PMID: 29329902 DOI: 10.1016/j.jse.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/28/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND An increasing number of parameters measured on anteroposterior radiographs are used for the evaluation of the bony geometry of the scapula. Inhomogeneous acquisition of images is common because of the lack of standardization in radiographic positioning. Images with malrotation around the horizontal axis of the scapula are particularly frequent. We hypothesized that malrotated images would result in large variations in measured radiographic parameters and that image standardization using qualitative and semiquantitative "omometric" criteria would decrease these variations in measurements. "Omometry" is a newly introduced umbrella term that contains all standardized measurements on plain radiographs of the shoulder, analogous to the term "coxometry," which is widely used for the radiographic assessment of the osseous pelvis and hip. METHODS In this experimental, cadaveric radiographic study, 7 dry-bone human scapula cadaveric specimens from anonymous donors were used to obtain 210 radiographs. We incrementally rotated (steps of 3°) every scapula around its horizontal and vertical axis, with a total range of 42° per each axis. Then, we measured 5 radiographic parameters on every image and observed their change with malrotation. Furthermore, we introduced 4 omometric criteria defining an appropriate (presence of ≥3 criteria) radiographic image to improve standardization of scapular image acquisition. RESULTS Overall, measured values remained stable within a narrow range of ±9° of malrotation. Beyond this range, values of all parameters significantly deviated (>±2°) from the initial value. Measurements on appropriate images were significantly less prone to deviation. Within the appropriate images, those with 4 criteria showed a higher specificity than those with 3 criteria. CONCLUSION There is significant variation in values of measured radiographic parameters on anteroposterior radiographs of the scapula with substantially malrotated images. With the use of the 4 newly introduced semiquantitative and qualitative omometric criteria, which define an appropriate image, reliability of the measured parameters can be significantly improved.
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Kawasaki T, Hasegawa Y, Kaketa T, Shiota Y, Gonda Y, Sobue S, Kobayashi H, Yamakawa J, Itoigawa Y, Kaneko K. Midterm Clinical Results in Rugby Players Treated With the Bristow Procedure. Am J Sports Med 2018; 46:656-662. [PMID: 29172635 DOI: 10.1177/0363546517740567] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although surgical shoulder stabilization by coracoid transfer is effective for collision athletes and has a low reinjury rate, no reports have described the midterm results of this procedure in specific patient cohorts of sufficient number or provided subjective assessments of these patients. PURPOSE To evaluate midterm results after treatment of shoulder instability with the Bristow procedure in a large cohort of rugby players. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included 176 shoulders of 152 competitive rugby players who underwent shoulder stabilization surgery (Bristow procedure with Bankart repair) with a mean follow-up of 4 years (minimum of 2 years) in our institute. The primary outcome measure was the difference in the presurgical and postsurgical functional Rowe score and Western Ontario Shoulder Instability index (WOSI) score and factors affecting these scores. Complication rates and associated factors were also investigated. RESULTS In total, 176 shoulders of 152 patients underwent the Bristow procedure with Bankart repair, and 93.2% of the players returned to their preinjury competition level at a mean of 6.3 months postoperatively. All Rowe and WOSI scores were significantly improved after surgery. The numbers of shoulders with functional failure as indicated by the Rowe score, WOSI score, and inability to return to the previous level of play were 28 (15.9%), 54 (30.7%), and 12 (6.8%), respectively. Multiple logistic regression analyses demonstrated that reinjury after surgery (odds ratio [OR] = 35.1) and the number of shoulder dislocations (OR = 11.2-11.4) negatively affected the competition level after return to play, while reinjury (OR = 11.1-17.8), the number of shoulder subluxations (OR = 1.1-2.9), injury in the dominant shoulder (OR = 1.2-2.2), and large bone defects (OR = 1.1-11.5) negatively affected functional scores. Reinjury after shoulder stabilization occurred in 6 of 176 shoulders (3.4%). Multiple logistic regression analysis demonstrated that reinjury after surgery occurred more frequently in players at lower versus higher grade levels of competition (OR = 21.0). Although differences were not significant, a trend was noted toward higher postoperative reinjury rates in forward players, those in the upper categories (professional and college), and those with injury in the nondominant shoulder. CONCLUSION The Bristow procedure provides good midterm outcomes for competitive collision athletes, while postsurgical reinjury, the number of preoperative dislocations and subluxations, and large bone defects negatively affect postsurgical shoulder function. This information may be useful for treatment of shoulder dislocations in collision athletes.
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Affiliation(s)
- Takayuki Kawasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshinori Hasegawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takefumi Kaketa
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Shiota
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshinori Gonda
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shogo Sobue
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Jun Yamakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | | | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Dey R, Roche S, Rosch T, Mutsvangwa T, Charilaou J, Sivarasu S. Anatomic variations in glenohumeral joint: an interpopulation study. JSES OPEN ACCESS 2018; 2:1-7. [PMID: 30675559 PMCID: PMC6334885 DOI: 10.1016/j.jses.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background This study focused on the unique aspect of investigating shoulder morphometric differences between 2 distinct populations. Methods We used 90 computed tomography images of cadaveric shoulders for this study; 45 scans belonged to the South African (SA) cohort (49.74 ± 15.4 years) and the rest were Swiss (CH; 53.8 ± 21 years). The articulating surfaces of the glenohumeral joint were extracted, and their morphometric features, such as head circular diameter, glenoid and humeral head radius of curvature, head height, and humeral height, were measured. Results The mean interpopulation difference in the circular diameter of the humerus was 2.0 mm (P = .017) and 1.86 mm (P > .05) in the anterior-posterior and superior-inferior directions, respectively. The difference in the radius of curvature between the populations was 1.17 mm (P = .037). The SA shoulders were found to be longer than the CH shoulders by 8.4 mm (P > .05). There was no significant difference in the glenoid radius of curvature. The SA shoulders had higher glenohumeral mismatch (P = .005) and lower conformity index (P = .001) in comparison to the CH shoulders. Conclusion This study presents anatomic differences between African and European glenohumeral articulating surfaces. The results suggest that the glenohumeral geometry is both gender and population specific, and future joint replacements may be designed to address these differences.
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Affiliation(s)
- Roopam Dey
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Steven Roche
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Theo Rosch
- Jakaranda Hospital, Pretoria, South Africa
| | - Tinashe Mutsvangwa
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Johan Charilaou
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Corresponding author: Sudesh Sivarasu, PhD, Department of Human Biology, UCT Medical Campus, 7.17, Anatomy Building, Anzio Road, Observatory, Cape Town 7935, South Africa. (S. Sivarasu).
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