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Zampeli F, Marín Fermín T, Hagert E, Arnaiz J, Andersson JK. Reverse or Ulnar-Sided, Greater Arc Perilunate Injury: Case Report and Systematic Review of Literature. Hand (N Y) 2023:15589447231211605. [PMID: 37964486 DOI: 10.1177/15589447231211605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Perilunate injuries of carpal bones are uncommon, high-energy injuries that necessitate early diagnosis and appropriate management to prevent progressive carpal instability and posttraumatic osteoarthritis. A much more uncommon mechanism that starts from the lunotriquetral ligament and proceeds radially in an opposite direction than the classic mechanism may cause a reverse or ulnar-sided perilunate dislocation (PLD). The purposes were: (1) to present an uncommon case of greater arc reverse (ulnar-sided) perilunate fracture-dislocation (REPLFD); and (2) to conduct a systematic review (SR) to evaluate the current evidence on reverse perilunate injuries (REPLIs). METHODS A novel pattern of injury of REPLFD with fractures of the ulnar styloid, triquetrum, and capitate is presented. A SR was conducted with primary outcome measures of the type of injury (pathoanatomy of lesions) and pathomechanics. Secondary outcome measures were choice of surgery and outcome on follow-up. RESULTS The Murad's tool and modified Coleman Methodology Score revealed poor methodological quality of the available literature on REPLI. Evidence is lacking in the mechanism of injury and treatment of REPLI, especially regarding REPLFD. CONCLUSIONS The SR revealed poor methodological quality of the available literature and exposes that not all PLDs can be explained by the current existing pathomechanical injury classifications. However, following the management principles of perilunate injuries, REPLI tends to have good functional results with no major complications. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Frantzeska Zampeli
- KAT Attica General Hospital, Kifissia, Greece
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Elisabet Hagert
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Karolinska Institutet, Stockholm, Sweden
| | - Javier Arnaiz
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- University of Cantabria, Torrelavega, Spain
| | - Jonny K Andersson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- HandCenter Gothenburg, Mölndal, Sweden
- University of Gothenburg, Sweden
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Fermín TM, Zampeli F, Hagert E. The Lateral-W Construct: An Anatomical Variant of the Dorsal Wrist Ligaments. J Wrist Surg 2023; 12:474-476. [PMID: 37841349 PMCID: PMC10569824 DOI: 10.1055/s-0042-1758706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022]
Abstract
Background The dorsal intercarpal ligament (DIC) is an elegant dorsal stabilizer of the proximal carpal row, including the scaphoid's proximal pole and scapholunate joint. Along with the dorsal radiocarpal (DRC) ligament, it acts as a dorsal radioscaphoid stabilizer, with dynamism due to its ability to modify its length up to threefold by changing the angles between its V-shaped bundle morphology. The DIC ligament consistently originates from the dorsal tubercle of the triquetrum on the ulnar side. It spans transversely, attaching to the dorsal groove of the scaphoid (97-100%), lunate (75-90%), and proximal rim of the trapezium (12.5-50%), and overlapping the lunotriquetral interosseous ligament and the scapholunate interosseous ligament. Together with the DRC, Viegas et al (Viegas SF, Yamaguchi S, Boyd NL, Patterson RM. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg Am 1999;24(3):456-468) proposed that this ligament complex should be called the "lateral-V construct." Anatomical Variant The authors present a unique type C variant of the DIC ligament, showing a distinct thick bundle directed at the dorsal aspect of the second metacarpal base that thus creates a "lateral-W construct." This dorsal triquetro-metacarpal 2 (dTqMC2) ligament acts as restraint to the body of the capitate and will provide enhanced stability of the dorsal midcarpal joint by limiting dorsal translation of the capitate in relation to the lunate. Clinical Relevance Our finding may contribute to the increasing knowledge of the dorsal ligament complex and its role in dorsal midcarpal instability, as well as surgical repair techniques.
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Affiliation(s)
- Theodorakys Marín Fermín
- Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Doha, Qatar
| | - Frantzeska Zampeli
- Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Doha, Qatar
- Department of Hand-Upper Limb-Microsurgery, General Hospital of Attica “KAT,” Kifisia, Athens, Greece
| | - Elisabet Hagert
- Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Doha, Qatar
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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Piskopakis A, Totlis T, Achlatis V, Zampeli F, Georgoulis JD, Hantes M, Piskopakis N, Vekris M. Manual and Device-Assisted Hamstring Autograft Tensioning Yield Similar Outcomes following ACL Reconstruction. J Clin Med 2023; 12:4623. [PMID: 37510738 PMCID: PMC10380746 DOI: 10.3390/jcm12144623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The optimal initial graft tension during ACL reconstruction is still a matter of debate. Manual tension is commonly applied to the graft during tibial fixation. However, this has been associated with a greater graft failure rate than that associated with device-assisted tensioning. This study aims to compare the clinical outcomes between the application of manual tension and the use of the ConMed Linvatec SE™ Graft Tensioning System during graft fixation while performing anatomic single-bundle ACL reconstruction. METHODS A prospective comparative study was conducted between September 2015 and May 2017. Sixty-four patients (mean age 29.3 years, range 14-45) with isolated ACL injuries (and who would be subjected to ACL reconstruction with a quadruple hamstring tendon graft) were divided into two groups. In Group A (n = 29), common tension was applied manually to both grafts. In Group B (n = 35), specific tension was applied to the grafts with the use of a tensioner device (ConMed Linvatec SE™ (Stress Equalization) Graft Tensioning System). A total of 60 N was applied to the semitendinosus, and 40 N was applied to the gracilis. Clinical outcomes were assessed at 6, 12, and 24 months. RESULTS There were no significant differences between the baseline demographic and clinical data among the patients of the two groups (all p > 0.05). The patients were followed up for a minimum of 24 months (mean ± SD). There were no significant differences in the side-to-side anterior knee laxity, the IKDC, the Lysholm Knee, and the Tegner Activity Scale scores for up to 24 months after operation. The pivot shift test was negative in all cases, and no graft failure was reported at a 2-year follow-up. CONCLUSION No significant differences were found with respect to postoperative anterior knee laxity, clinical outcomes, activity level, and patient satisfaction between the application of manual tension and the use of the graft-tensioning system during tibial fixation while performing anatomic single-bundle ACL reconstruction with a quadruple hamstring tendon graft. Further high-quality clinical studies are required to elucidate whether device-assisted tension is superior to manual tension.
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Affiliation(s)
- Andreas Piskopakis
- Department of Orthopaedics and Traumatology, KAT General Hospital, 14561 Kifissia, Greece; (A.P.); (F.Z.); md. (N.P.)
- Department of Orthopaedics and Sports Injuries, Medical Center of Athens, 15125 Marousi, Greece
| | - Trifon Totlis
- Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke’s Hospital, 55236 Thessaloniki, Greece
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Vlasios Achlatis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Frantzeska Zampeli
- Department of Orthopaedics and Traumatology, KAT General Hospital, 14561 Kifissia, Greece; (A.P.); (F.Z.); md. (N.P.)
| | - Jim Dimitris Georgoulis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece;
| | - Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, 41334 Larissa, Greece;
| | - Nikolaos Piskopakis
- Department of Orthopaedics and Traumatology, KAT General Hospital, 14561 Kifissia, Greece; (A.P.); (F.Z.); md. (N.P.)
- Department of Orthopaedics and Sports Injuries, Medical Center of Athens, 15125 Marousi, Greece
| | - Marios Vekris
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 45110 Ioannina, Greece;
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Zampeli F, Kazum E, Fadhel BW, Gomez AJ, Valenti P. Medialized rotator cuff repair for retracted, massive, postero superior tears: Clinical and radiological outcomes. Orthop Traumatol Surg Res 2023; 109:103296. [PMID: 35537680 DOI: 10.1016/j.otsr.2022.103296] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/08/2022] [Accepted: 03/03/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The footprint medialization allows a tension free repair in severely retracted rotator cuff tears (RCT), thereby de-creasing the rate of retear. The purpose of the study was to evaluate the clinical and radiological results in a cohort of chronic RCT treated with medialized repair. Secondary purpose was to analyze the impact of medialization length on shoulder function and tendon healing. HYPOTHESIS It was hypothesized that the medialization length would have an impact on clinical and radiological outcome. MATERIAL AND METHODS A consecutive series of thirty patients that underwent arthroscopic repair of a massive posterosuperior RCT at a single institution were retrospectively studied at mean follow-up 18.4months (SD 15.3; range 9-58). The medialization of the medial footprint was measured intraoperatively. Preoperative and postoperative examination included active range of motion, abduction strength, pain assessment, and functional scores. The postoperative rotator cuff integrity was evaluated according to the Sugaya's classification. Types IV-V were categorized as absence of healing. RESULTS At final follow-up the clinical outcomes were significantly improved in all patients (p≤0.001) with the exception of external rotation that displayed no significant improvement (p=0.05). In group 1 (n=8) medialization length was≤10mm (mean 8, SD 1.9) and in group 2 (n=14)>10mm (mean 12.6, SD 1.7). There were no significant differences regarding preoperative and postoperative clinical outcomes (p>0.05) between two groups. Group 2 demonstrated moderate correlation between length of medialization and Sugaya stage of tendon healing (r=0.53, p=0.049). Absence of healing was noted in 4/22 patients, 1/8 in group 1 and 3/14 in group 2. DISCUSSION Medialized repair is an effective technique for treating chronic, massive and retracted posterosuperior RCT. A medialization of the footprint less than or equal to 10mm is recommended, as it was associated with good clinical and radiological results. The rate of tendon healing decreases when medialization exceeds 10mm. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frantzeska Zampeli
- Paris shoulder unit, Clinique Bizet, Paris, France; Hand-Upper Limb-Microsurgery Department, KAT Attica General Hospital, Kifissia, Greece.
| | - Efi Kazum
- Paris shoulder unit, Clinique Bizet, Paris, France; Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kazum E, Martinez-Catalan N, Caruso G, Schofield BA, Nidtahar I, Zampeli F, Valenti P. Reverse shoulder arthroplasty with isolated latissimus dorsi or combined with teres major transfer for lack of external rotation: a comparative study. Int Orthop 2022; 46:2273-2281. [PMID: 35922519 DOI: 10.1007/s00264-022-05530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The objective of this study was to evaluate the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) associated with two techniques: L'Episcopo procedure (combined teres major and latissimus dorsi transfer) and modified L'Episcopo procedure (isolated latissimus dorsi transfer). METHODS A retrospective review of 36 RSAs (mean age 69.8 years; SD 8.9) associated with either L'Episcopo procedure (Group 1, 21 cases) or modified L'Episcopo procedure (Group 2, 15 cases) was performed between 2007 and 2020. Clinical outcome measures consisted of range of motion (ROM), SSV, VAS, and Constant-Murley scores. These scores were compared between the two groups. Radiographs were assessed for transfer site bony lesions. RESULTS With a mean follow-up of 40.8 months (6-98; SD 28.8), no significant differences were revealed in the clinical outcomes: Constant score, SSV, VAS, ROM. The entire study group demonstrated a significant improvement in post-operative functional outcome scores and ROM parameters compared to their pre-operative state, IR measures being the only exception (p = 0.26). Radiographs demonstrated transfer site bony lesions in 60% of the patients (18/30). Three complications (8.3%) were noted in the study. CONCLUSION At the short-term follow-up, RSA combined with either latissimus dorsi (LD) transfer in isolation or in association with teres major proved to be equally effective in restoring external rotation in the settings of an irreparable postero-superior cuff tear treated with RSA. Although the LD transfer group displayed a tendency towards superior ROM, this was not supported statistically. Post-operative radiographs confirmed the presence of bony lesions at the transfer fixation sites in both groups of patients (52% vs. 72%).
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Affiliation(s)
- Efi Kazum
- Tel Aviv Sourasky Medical Center, Division of Orthopaedic Surgery, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv, Israel.
| | | | - Giovanni Caruso
- Shoulder Unit, Koelliker Hospital, Corso Galileo Ferraris, 247/255, 10134, Turin, Italy
| | | | - Imen Nidtahar
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
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Valenti P, Zampeli F, Caruso G, Nidtahar I, Martinez-Catalan N, Kazum E. Proximal humeral bone defect in reverse shoulder arthroplasty combined with latissimus-dorsi transfer is not related with a poor outcome. Orthop Traumatol Surg Res 2022; 108:103263. [PMID: 35248792 DOI: 10.1016/j.otsr.2022.103263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RSA) associated with modified L'Episcopo (isolated LD) or L'Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with postero-superior massive cuff tear and teres minor deficiency. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome. MATERIAL AND METHODS A retrospective review of 24 RSAs (mean age 68.71 years, range 52-83) associated with modified L'Episcopo procedure (9) and L'Episcopo procedure (15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. In addition, signs of stem loosening were assessed. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores. RESULTS With a mean follow-up of 44.71 months (12-97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3%) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 74% of cementless stems. Radiolucent lines were detected in one cemented stem (p=0.046). GT resorption (p=0.147), condensations lines (p=0.449) and spot weld (p=0.342), appeared exclusively in non-cemented stem. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group 2, 16 patients) and without bony lesions (Group 1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34). CONCLUSION At short-term follow-up, RSA combined with L'Episcopo or modified l'Episcopo procedure resulted in high incidence (67%) of lateral proximal humerus lesions. Radiolucent lines were noted in cemented stems whereas, signs of stress shielding and GT resorption appeared in non-cemented stems. Yet, no case of humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of cemented straight standard-length humeral stems should be positively considered in RSA associated with LD\TM tendon transfer. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Giovanni Caruso
- Shoulder Unit, Koelliker Hospital, Corso Galileo Ferraris 247/255, 10134 Turin, Italy
| | - Imen Nidtahar
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Natalia Martinez-Catalan
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France; Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv, Israel.
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Fandridis EΜ, Zampeli F, Dimakopoulos P. Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption. Arthrosc Tech 2022; 11:e937-e946. [PMID: 35646578 PMCID: PMC9134684 DOI: 10.1016/j.eats.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/14/2022] [Indexed: 02/03/2023] Open
Abstract
The surgical management of acute high-grade acromioclavicular (AC) joint (ACJ) injuries has evolved during the last decades. Numerous surgical techniques exist and recently arthroscopically assisted or all endoscopic techniques have gained popularity due to certain advantages. The goals of the new anatomic coracoclavicular ligament reconstruction techniques are to achieve anatomic reduction of the ACJ to allow and facilitate primary healing of AC and coracoclavicular (CC) ligaments, and also to minimize the risk of associated complications. We regularly use the open repair with double-loop sutures for the acute ACJ disruption, as described by Dimakopoulos et al. at 2006. In this surgical technique article, we present the arthroscopically assisted technique for the double-loop suture repair.
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Affiliation(s)
- Emmanouil Μ. Fandridis
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT(E.M.F., F.Z.); and Athens, Greece(P.D.)
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT(E.M.F., F.Z.); and Athens, Greece(P.D.).,Address correspondence to Frantzeska Zampeli, M.D., Ph.D., KAT General Hospital, Nikis 2, Kifisia, Postal code 145 61, Greece.
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Fandridis E, Koutserimpas C, Raptis K, Antonopoulos D, Zampeli F, Gakidis I. Anterior dislocation of sternoclavicular joint: A novel surgical technique. Injury 2022; 53:1562-1567. [PMID: 34740440 DOI: 10.1016/j.injury.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. The objective of the present study is to present a novel suture technique for treatment of anterior SCJ traumatic dislocation and to report clinical outcomes from a small case series undergoing this procedure. PATIENTS AND METHODS Patients presenting with traumatic anterior SCJ disruption in our institution were eligible to participate. Surgical technique consisted of two bone tunnels drilled in vertical direction from the anterior to the posterior cortex of the manubrium. Analogous to the sternal side of the clavicle, two vertical bone tunnels were drilled from the anterior cortex towards the posterior cortex. A non-absorbable suture was passed though the four holes in a parallel configuration. Then, by pulling the free suture edges the posterior translation of the clavicle was performed. Two additional drill holes, the first in manubrium and the second in clavicle were performed from the anterior cortex to the posterior between the previous bone tunnels. A non-absorbable suture was placed in a simple configuration in order to stabilize the SCJ in the superior-inferior direction. The final follow up was 28.2 months. The mean QuickDASH was used for functional assessment. RESULTS Seven patients (6 males and 1 female) with average age of 34,8 years were included in the present study. Two patients suffered from concomitant medial clavicle fracture. At final follow-up (none of the patients had experienced any symptoms of instability of SCJ, no side-to-side difference was observed, while the Mean QuickDASH score was 4.85. CONCLUSION The reported technique for SCJ reconstruction in traumatic anterior SCJ dislocations with two sutures has theoretical advantages, since it stabilizes the SCJ in the antero-posterior, as well as the supero- inferior direction. Outcomes from this small case series are favorable. However, more research is desirable to compare different techniques and to conclude to the optimal surgical treatment.
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Affiliation(s)
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece.
| | - Konstantinos Raptis
- Hand-Upper Limb & Microsurgery Department, Hospital "KAT", Athens, Greece; Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
| | | | - Frantzeska Zampeli
- Hand-Upper Limb & Microsurgery Department, Hospital "KAT", Athens, Greece
| | - Ioannis Gakidis
- Department of Thoracic Surgery, Hospital "KAT", Athens, Greece
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Zampeli F, Pappas E, Velonakis G, Roumpelakis IM, Poulou LS, Papagiannis GI, Kelekis AD, Mastrokalos DS. Development of new cartilage lesions after ACL reconstruction is associated with abnormal knee rotation. Knee Surg Sports Traumatol Arthrosc 2022; 30:842-851. [PMID: 33528592 DOI: 10.1007/s00167-020-06387-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to examine the association between the development of articular cartilage pathology and knee rotation after single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Seventeen patients that underwent single-bundle ACL reconstruction and did not have any cartilage lesions at the time of surgery based on the Outerbridge classification or meniscal injury that required meniscectomy > 20% were examined by MRI and in the biomechanics laboratory at a 6-year minimum follow-up. Cartilage lesions that occurred after reconstruction were graded on MRI according to a modified Noyes scale. For cartilage evaluation, the lateral and medial femoral condyles were divided into 9 segments each (lateral, central, and medial third and each third was divided into anterior, central, and posterior segment). Tibial rotation during a pivoting task was measured with optoelectronic motion analysis system and side-to-side differences of tibial rotation between the reconstructed and contralateral intact knees were calculated. The association between the total modified Noyes scale score (outcome variable) and side-to-side differences of tibial rotation after controlling for meniscectomy and meniscal repair was investigated with hierarchical regression models. RESULTS Side-to-side difference of tibial rotation was associated with total modified Noyes scale score (p = 0.015, β = 0.667, adjusted R2 = 42.1%). All patients developed new cartilage lesions in MRI located mainly at the central region of the lateral femoral condyle and less frequently in the central and anterior regions of the medial femoral condyle. CONCLUSION Abnormally increased tibial rotation that persists after ACL-R is significantly associated with the development of new articular cartilage lesions at mean 8.4 years after reconstruction which were located mainly at the central region of the LFC and secondarily in the central and anterior regions of the MFC (more superficial lesions). These findings suggest that there is emerging evidence that abnormal rotational kinematics is a potential risk factor for the pathogenesis and onset of posttraumatic articular cartilage degeneration after ACLR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- F Zampeli
- 1st Department of Orthopaedics, ATTIKO University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece.
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Pappas
- Discipline of Physiotherapy - Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - G Velonakis
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - I M Roumpelakis
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - L S Poulou
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - G I Papagiannis
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A D Kelekis
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - D S Mastrokalos
- 1st Department of Orthopaedics, ATTIKO University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Martinez-Catalan N, Kazum E, Zampeli F, Cartaya M, Cerlier A, Valenti P. Long-term outcomes of arthroscopic Bankart repair and Hill-Sachs remplissage for bipolar bone defects. Eur J Orthop Surg Traumatol 2022; 33:947-953. [PMID: 35226166 DOI: 10.1007/s00590-022-03237-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate long-term results after arthroscopic Bankart repair and Hill-Sachs remplissage (BHSR) in bipolar bone defects with less than 20% of glenoid bone loss (GBL) and to analyse risk factors for recurrent dislocation. METHODS From 2009-2012, 43 patients with recurrent anterior shoulder instability were treated with BHSR. Inclusion criteria were GBL < 20% and minimum of 4-yearfollow-up. There were 35 males and 8 females with a mean age of 29 years (range 16-53). The mean ISIS score was 3.6 (range 2-6). Patients were evaluated for recurrence, range of motion and functional outcomes (Walch-Duplay and Rowe score). Post-operative MRI was performed at least 6 months after surgery to evaluate infraspinatus capsulotenodesis healing. Glenoid track was assessed retrospectively from pre-operative computed tomography. Mean follow-up was 7.3 years (range 4-11). RESULTS At the last follow-up, good to excellent outcomes were reported in 86% of patients. Average post-operative Walch-Duplay was 87.9 (range 75-100) and ROWE 93.7 (range 70-100). Infraspinatus capsulotenodesis healing was achieved in 86%. The rate of recurrence and revision surgery was 9.3% and 13.9%, respectively. Recurrence was associated with higher ISIS score (p = 0.0191) and lower age at surgery (p = 0.0227). Four (9.3%) Hill-Sachs lesions were considered off-track. The presence of off-track Hill-Sachs was associated with higher risk of recurrence (p < 0.00001). CONCLUSION Arthroscopic BHSR improves shoulder instability in the setting of bipolar bone defects with less than 20% of GBL. Patient-related factors and pre-operative glenoid track should be taken into consideration to reduce the risk of recurrence.
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Affiliation(s)
- Natalia Martinez-Catalan
- Paris Shoulder Unit, Institut de La Main Clinique Bizet, 21 bis rue Georges Bizet, 75116, Paris, France. .,Hospital Fundación Jiménez Diaz, Avenida de los Reyes Católicos 2, 28040, Madrid, Spain.
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Marco Cartaya
- Shoulder Surgery, Hospital del Trabajador de Santiago, Ramón Carnicer 185, Providencia, Región Metropolitana, Chile
| | - Alexandre Cerlier
- CMCO Centre Méditerranéen De Chirurgie Orthopédique, 189 ter Av. François Mitterrand, 13170, Les Pennes-Mirabeau, France
| | - Philippe Valenti
- Paris Shoulder Unit, Institut de La Main Clinique Bizet, 21 bis rue Georges Bizet, 75116, Paris, France
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Martetschläger F, Zampeli F, Tauber M, Habermeyer P, Leibe M. A classification for partial subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:275-283. [PMID: 32285157 PMCID: PMC7862509 DOI: 10.1007/s00167-020-05989-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to analyze partial subscapularis tendon (SSC) tears and provide a descriptive classification. METHODS The retrospective study included 50 patients with arthroscopically confirmed partial SSC tears. Internal rotation (IR) force measurements and IR ROM have been made and compared to the healthy contralateral side. Then the footprint of the SSC was routinely investigated by arthroscopy with standardized measurement of the bony footprint lesion. The partial tears were classified according to the mediolateral and craniocaudal extension of the rupture in the transverse and coronal plane, respectively. RESULTS Partial SSC tears could be classified into split lesions (type 1, n = 11) and 3 further groups depending on the mediolateral peeled-off length of the bony footprint (type 2: < 10 mm, n = 20; type 3: 10-15 mm, n = 10; type 4: > 15 mm, n = 9). Type 2-4 could be further divided depending on the craniocaudal peeled-off length of the bony footprint (group A: < 10 mm, group B: 10-15 mm, group C: > 15 mm). Significantly decreased IR strength was shown for types 2-4 (p < 0.05) but not for split lesions as compared to healthy side. Types 1-4 showed significant decreased active IR ROM and all except type 3 (n.s.) which showed decreased passive IR ROM compared to the healthy side (p < 0.05). CONCLUSION We present a novel classification for partial SSC tears for a more detailed and reproducible description. This can help to improve the current knowledge about the appropriate treatment. It could be shown that partial tears of the subscapularis can have an impact on IR strength and motion. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frank Martetschläger
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany.
- Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Frantzeska Zampeli
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
| | - Markus Leibe
- Helios Clinic Munich West, Department of Orthopedic Sports Medicine, Trauma Surgery and Hand Surgery, Munich, Germany
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12
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Fandridis E, Zampeli F. Superior Capsular Reconstruction With Double Bundle of Long Head Biceps Tendon Autograft: The "Box" Technique. Arthrosc Tech 2020; 9:e1747-e1757. [PMID: 33294336 PMCID: PMC7695594 DOI: 10.1016/j.eats.2020.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/20/2020] [Indexed: 02/03/2023] Open
Abstract
The superior capsular reconstruction (SCR) is an arthroscopic surgical technique recently introduced as an effective solution to restore the defect of superior articular capsule in massive rotator cuff tears that cannot be repaired anatomically. The SCR retains static stability and inhibits the proximal humeral migration, thereby optimizing the force couples about the shoulder. In this surgical technique paper, we present our technique of SCR using a double bundle construct of long head of biceps tendon, called the "box" technique. It is always combined with partial rotator cuff repair.
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Affiliation(s)
| | - Frantzeska Zampeli
- Address correspondence to Frantzeska Zampeli, M.D., Ph.D., General Hospital, Nikis 2, Kifisia, 145 61, Greece.
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13
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Valenti P, Zampeli F, Ciais G, Kany J, Katz D. The initial treatment of complex proximal humerus fracture affects the outcome of revision with reverse shoulder arthroplasty. Int Orthop 2020; 44:1331-1340. [PMID: 32451653 DOI: 10.1007/s00264-020-04612-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study is to report the results of reverse shoulder arthroplasty (RSA) after three types of initial treatment performed for complex proximal humeral fracture (PHF): conservative, reduction and internal fixation (RIF), or hemiarthroplasty. METHODS This is a retrospective study of 63 patients separated into three groups with a minimum follow-up of two years. Group I included 25 patients with an initial conservative fracture treatment, group II included 25 patients treated by RIF, and group III included 13 patients initially treated by hemiarthroplasty. Patients were assessed using the absolute Constant-Murley score, functional parameters, complications rate, and radiological follow-up. RESULTS One patient died and five were lost to follow-up. All functional outcomes improved significantly post-operatively for the three groups (p < 0.005). The mean Constant-Murley score increased from 13.7 to 54.1 (group I); 16.6 to 48.5 (group II); and 22.6 to 48.2 (group III) (p < 0.001). The gain of Constant-Murley and SST scores was better for group I (p = 0.049 and 0.028, respectively), while post-operative pain was better in group III (p = 0.033). The complication rate was 38% in group III, 30% in group II, and 14.3% in group I. CONCLUSIONS Reverse shoulder arthroplasty represents a good surgical option in complex proximal humeral fracture sequelae. Whatever the initial treatment, function and motion of the shoulder are improved. The final result is better if the initial treatment was conservative. The group initially treated with hemiarthroplasty had the most complications.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Institut de la Main, Clinique Bizet, 21 rue Georges Bizet, 75116, Paris, France.
| | - Frantzeska Zampeli
- Paris Shoulder Unit, Institut de la Main, Clinique Bizet, 21 rue Georges Bizet, 75116, Paris, France
| | | | - Jean Kany
- Clinique de l'Union, Toulouse, France
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14
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Abstract
Hypothesis The purpose of the study was to investigate which anatomic structures are affected in a series of patients with pulley lesions and whether all lesions can be classified according to the Habermeyer classification. Methods One hundred consecutive patients with pulley lesions were prospectively studied. During arthroscopy, lesions of the superior glenohumeral ligament (SGHL), medial coracohumeral ligament (MCHL) and/or lateral coracohumeral ligament (LCHL), adjacent rotator cuff, and biceps (long head of the biceps) were recorded. All lesions were then classified according to the Habermeyer classification. The χ2 test was used for statistical analysis. Results There were 3 lesions in group 1, 20 in group 2, 6 in group 3, and 35 in group 4 according to the Habermeyer classification. Thirty-six lesions were not classifiable because of an intact SGHL. A lateral pulley sling (LCHL) lesion was found in 95% of the patients, and a medial pulley sling (MCHL-SGHL) lesion was noted 64%. An isolated lesion of the MCHL and/or SGHL was present in 5%, and an isolated lesion of the LCHL was found in 36%. Combined medial-lateral sling lesions were correlated with complete subscapularis tears and biceps fraying. Conclusion The lateral pulley sling is more often affected than the medial sling. The SGHL is not always affected, and isolated lesions of the medial sling are rare. Lesions of both slings correlated with complete subscapularis tears and fraying of the long head of the biceps. An updated classification of direct pulley lesions is proposed: type 1, lesion of the medial pulley (MCHL and/or SGHL); type 2, lesion of the lateral pulley (LCHL); and type 3, lesion of the medial and lateral pulley slings. Concomitant lesions of the indirect pulley stabilizers can be mentioned additionally according to the well-known classifications.
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Affiliation(s)
- Frank Martetschläger
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany.,Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Frantzeska Zampeli
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany.,Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
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Savvidou OD, Zampeli F, Antoniadou T, Van Beeck A, Papagelopoulos PJ. Pioneer Female Orthopedic Surgeons as Role Models. Orthopedics 2020; 43:e8-e14. [PMID: 31693748 DOI: 10.3928/01477447-20191031-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/04/2019] [Indexed: 02/03/2023]
Abstract
Maud Forrester-Brown in the United Kingdom (1921), Marika Daniilidou in Greece (1932), Ruth Jackson in the United States (1932), Loris Figgins in Australia (1957), and Evalina Burger in South Africa (1993) all chose to specialize in orthopedics. Although there are dynamic female leaders in orthopedic surgery, the field continues to present obstacles to women. Role models, mentors, and exposure to the field have been lacking for women. Although improvements have occurred in the past few decades, further changes are necessary to attract, develop, and retain qualified female candidates. [Orthopedics. 2020; 43(1):e8-e14.].
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Zampeli F, Fandridis E, Spyridonos S. Olecranon Fracture Dislocation With Disrupted Ulnohumeral and Proximal Radioulnar Joint. Necessity for Lesser Sigmoid Notch Fractures to be Included in the Current Classification Systems. JSES Open Access 2019. [DOI: 10.1016/j.jses.2019.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Papagiannis GI, Triantafyllou AI, Roumpelakis IM, Zampeli F, Garyfallia Eleni P, Koulouvaris P, Papadopoulos EC, Papagelopoulos PJ, Babis GC. Methodology of surface electromyography in gait analysis: review of the literature. J Med Eng Technol 2019; 43:59-65. [PMID: 31074312 DOI: 10.1080/03091902.2019.1609610] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Gait analysis is a significant diagnostic procedure for the clinicians who manage musculoskeletal disorders. Surface electromyography (sEMG) combined with kinematic and kinetic data is a useful tool for decision making of the appropriate method needed to treat such patients. sEMG has been used for decades to evaluate neuromuscular responses during a range of activities and develop rehabilitation protocols. The sEMG methodology followed by researchers assessed the issues of noise control, wave frequency, cross talk, low signal reception, muscle co-contraction, electrode placement protocol and procedure as well as EMG signal timing, intensity and normalisation so as to collect accurate, adequate and meaningful data. Further research should be done to provide more information related to the muscle activity recorded by sEMG and the force produced by the corresponding muscle during gait analysis.
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Affiliation(s)
- Georgios I Papagiannis
- a 1st Department of Orthopaedic Surgery, Medical School , Orthopaedic Research and Education Center "P.N.Soukakos", Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens , Greece.,b Physioloft Physical Therapy Center , Athens , Greece
| | - Athanasios I Triantafyllou
- a 1st Department of Orthopaedic Surgery, Medical School , Orthopaedic Research and Education Center "P.N.Soukakos", Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens , Greece.,b Physioloft Physical Therapy Center , Athens , Greece
| | - Ilias M Roumpelakis
- a 1st Department of Orthopaedic Surgery, Medical School , Orthopaedic Research and Education Center "P.N.Soukakos", Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens , Greece.,b Physioloft Physical Therapy Center , Athens , Greece
| | - Frantzeska Zampeli
- a 1st Department of Orthopaedic Surgery, Medical School , Orthopaedic Research and Education Center "P.N.Soukakos", Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Panayiotis Koulouvaris
- a 1st Department of Orthopaedic Surgery, Medical School , Orthopaedic Research and Education Center "P.N.Soukakos", Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Elias C Papadopoulos
- c 2nd Department of Orthopaedic Surgery, Medical School , Konstantopouleio General Hospital, Nea Ionia, National and Kapodistrian University of Athens , Athens , Greece
| | - Panayiotis J Papagelopoulos
- a 1st Department of Orthopaedic Surgery, Medical School , Orthopaedic Research and Education Center "P.N.Soukakos", Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - George C Babis
- c 2nd Department of Orthopaedic Surgery, Medical School , Konstantopouleio General Hospital, Nea Ionia, National and Kapodistrian University of Athens , Athens , Greece
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Savvidou OD, Zampeli F, Georgopoulos G, Dimopoulos L, Antoniadou T, Papanastassiou I, Papagelopoulos PJ. Total Scapulectomy and Shoulder Reconstruction Using a Scapular Prosthesis and Constrained Reverse Shoulder Arthroplasty. Orthopedics 2018; 41:e888-e893. [PMID: 30371919 DOI: 10.3928/01477447-20181023-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Malignant tumors of the scapula are rare, and limb salvage surgery after tumor resection is challenging. The authors present a series of 6 patients who were treated by total scapulectomy and reconstruction with a custom-made scapular prosthesis and a constrained reverse shoulder arthroplasty. Postoperative oncologic and functional outcomes were assessed. The mean follow-up was 37 months (range, 9-84 months). Clear surgical margins were achieved in all patients. At the last follow-up, 4 patients showed no evidence of disease and 2 had died of systemic metastatic disease. Although shoulder function was limited, all shoulders were painless and stable and the patients retained satisfactory hand, wrist, and elbow function. [Orthopedics. 2018; 41(6):e888-e893.].
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Savvidou OD, Zampeli F, Koutsouradis P, Chloros GD, Kaspiris A, Sourmelis S, Papagelopoulos PJ. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev 2018; 3:558-567. [PMID: 30662764 PMCID: PMC6335604 DOI: 10.1302/2058-5241.3.180009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Treatment of distal humerus fractures is demanding. Surgery is the optimal treatment and preoperative planning is based on fracture type and degree of comminution. Fixation with two precontoured anatomical locking plates at 90o:90o orthogonal or 180o parallel is the optimal treatment. The main goal of surgical treatment is to obtain stable fixation to allow immediate postoperative elbow mobilization and prevent joint stiffness. Despite evolution of plates and surgical techniques, complications such as mechanical failure, ulnar neuropathy, stiffness, heterotopic ossification, nonunion, malunion, infection, and complications from olecranon osteotomy are quite common. Distal humerus fractures still present a significant technical challenge and need meticulous technique and experience to achieve optimal results.
Cite this article: EFORT Open Rev 2018;3:558-567. DOI: 10.1302/2058-5241.3.180009
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Affiliation(s)
- Olga D Savvidou
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Frantzeska Zampeli
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | - George D Chloros
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Aggelos Kaspiris
- Department of Trauma and Orthopaedics, Thriasio General Hospital-NHS, Athens, Greece
| | - Savas Sourmelis
- First Department of Orthopaedics, Hygeia Hospital, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
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Zampeli F, Terzidis I, Espregueira-Mendes J, Georgoulis JD, Bernard M, Pappas E, Georgoulis AD. Restoring tibiofemoral alignment during ACL reconstruction results in better knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2018; 26:1367-1374. [PMID: 29067474 DOI: 10.1007/s00167-017-4742-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/02/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) reconstruction (ACLR) aims to restore normal knee joint function, stability and biomechanics and in the long term avoid joint degeneration. The purpose of this study is to present the anatomic single bundle (SB) ACLR that emphasizes intraoperative correction of tibiofemoral subluxation that occurs after ACL injury. It was hypothesized that this technique leads to optimal outcomes and better restoration of pathological tibiofemoral joint movement that results from ACL deficiency (ACLD). METHODS Thirteen men with unilateral ACLD were prospectively evaluated before and at a mean follow-up of 14.9 (SD = 1.8) months after anatomic SB ACLR with bone patellar tendon bone autograft. The anatomic ACLR replicated the native ACL attachment site anatomy and graft orientation. Emphasis was placed on intraoperative correction of tibiofemoral subluxation by reducing anterior tibial translation (ATT) and internal tibial rotation. Function was measured with IKDC, Lysholm and the Tegner activity scale, ATT was measured with the KT-1000 arthrometer and tibial rotation (TR) kinematics were measured with 3Dmotion analysis during a high-demand pivoting task. RESULTS The results showed significantly higher TR of the ACL-deficient knee when compared to the intact knee prior to surgery (12.2° ± 3.7° and 10.7° ± 2.6° respectively, P = 0.014). Postoperatively, the ACLR knee showed significantly lower TR as compared to the ACL-deficient knee (9.6°±3.1°, P = 0.001) but no difference as compared to the control knee (n.s.). All functional scores were significantly improved and ATT was restored within normal values (P < 0.001). CONCLUSIONS Intraoperative correction of tibiofemoral subluxation that results after ACL injury is an important step during anatomic SB ACLR. The intraoperative correction of tibiofemoral subluxation along with the replication of native ACL anatomy results in restoration of rotational kinematics of ACLD patients to normal levels that are comparable to the control knee. These results indicate that the reestablishment of tibiofemoral alignment during ACLR may be an important step that facilitates normal knee kinematics postoperatively. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Frantzeska Zampeli
- 1st Department of Orthopaedics, ATTIKON University General Hospital, Haidari, Greece. .,Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece.
| | - Ioannis Terzidis
- The-MIS, Center of Orthopaedic Surgery, Sports Medicine and Rehabilitation, St Luke's Hospital, Thessaloniki, Greece
| | - João Espregueira-Mendes
- Orthopaedics Department of Minho University, Minho, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal
| | - Jim-Dimitris Georgoulis
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Manfred Bernard
- Departement of Orthopaedic Surgery, Klinik Sanssouci, Helene-Lange, Potsdam, Germany
| | - Evangelos Pappas
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece.,Discipline of Physiotherapy-Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Anastasios D Georgoulis
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
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Giotis D, Paschos NK, Zampeli F, Pappas E, Mitsionis G, Georgoulis AD. Bracing can partially limit tibial rotation during stressful activities after anterior crucial ligament reconstruction with a hamstring graft. Orthop Traumatol Surg Res 2016; 102:601-6. [PMID: 27234872 DOI: 10.1016/j.otsr.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/26/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hamstring graft has substantial differences with BPTB graft regarding initial mechanical strength, healing sequence, and vascularization, which may imply that a different approach during rehabilitation period is required. The purpose of this study was to investigate the influence of knee bracing on tibial rotation in ACL-reconstructed patients with a hamstring autograft during high loading activities. The hypothesis was that there would be a decrease in tibial rotation in the ACL-reconstructed braced knee as compared to the unbraced knee. METHODS Twenty male patients having undergone unilateral ACL reconstruction with a semitendinosus/gracilis autograft were assessed. Kinematic data were collected with an eight-camera optoelectronic system during two stressful tasks: (1) descending from a stair and subsequent pivoting; and (2) landing from a platform and subsequent pivoting. In each patient, three different experimental conditions were evaluated: (A) wearing a prophylactic brace (braced condition); (B) wearing a patellofemoral brace (sleeved condition); (C) without brace (unbraced condition). The intact knee without brace served as a control. RESULTS Tibial rotation was significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (P≤0.01 for both tasks). Presence of a brace or sleeve resulted in lower tibial rotation than in the unbraced condition (p=0.003 for descending/pivot and P=0.0004 for landing/pivot). The braced condition resulted in lower rotation than the sleeved condition for descending/pivoting (P=0.031) while no differences were found for landing/pivoting (P=0.230). CONCLUSION Knee bracing limited the excessive tibial rotation during pivoting under high loading activities in ACL-reconstructed knees with a hamstring graft. This partial restoration of normal kinematics may have a potential beneficial effect in patients recovering from ACL reconstruction with a hamstring autograft. LEVEL OF EVIDENCE Level III, case-control therapeutic study.
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Affiliation(s)
- D Giotis
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
| | - N K Paschos
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece; Department of biomedical engineering, university of California, One Shields Avenue, Davis, 95616, CA, USA.
| | - F Zampeli
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
| | - E Pappas
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece; Discipline of physiotherapy, faculty of health sciences, university of Sydney, Sydney, NSW, Australia; Department of physical therapy, Long Island university, Brooklyn campus, Brooklyn, New York, USA
| | - G Mitsionis
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
| | - A D Georgoulis
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
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Georgoulis AD, Ristanis S, Moraiti CO, Paschos N, Zampeli F, Xergia S, Georgiou S, Patras K, Vasiliadis HS, Mitsionis G. ACL injury and reconstruction: Clinical related in vivo biomechanics. Orthop Traumatol Surg Res 2010. [PMID: 21036116 DOI: 10.1016/j.otsr.2010.09.004)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Several researchers including our group have shown that knee joint biomechanics are impaired after anterior cruciate ligament (ACL) injury, in terms of kinematics and neuromuscular control. Current ACL reconstruction techniques do not seem to fully restore these adaptations. Our research has demonstrated that after ACL reconstruction, excessive tibial rotation is still present in high-demanding activities that involve both anterior and rotational loading of the knee. These findings seem to persist regardless of the autograft selection for the ACL reconstruction. Our results also suggest an impairment of neuromuscular control after ACL reconstruction, although muscle strength may have been reinstated. These abnormal biomechanical patterns may lead to loading of cartilage areas, which are not commonly loaded in the healthy knee and longitudinally can lead to osteoarthritis. Muscle imbalance can also influence patients' optimal sports performance exposing them to increased possibility of knee re-injury. In this review, our recommendations point towards further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.
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Affiliation(s)
- A D Georgoulis
- Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopaedic Surgery, University of Ioannina, Georgiou Papandreou 2, PO Box 1042, Ioannina 45110, Greece.
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Georgoulis AD, Ristanis S, Moraiti CO, Paschos N, Zampeli F, Xergia S, Georgiou S, Patras K, Vasiliadis HS, Mitsionis G. ACL injury and reconstruction: Clinical related in vivo biomechanics. Orthop Traumatol Surg Res 2010; 96:S119-28. [PMID: 21036116 DOI: 10.1016/j.otsr.2010.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several researchers including our group have shown that knee joint biomechanics are impaired after anterior cruciate ligament (ACL) injury, in terms of kinematics and neuromuscular control. Current ACL reconstruction techniques do not seem to fully restore these adaptations. Our research has demonstrated that after ACL reconstruction, excessive tibial rotation is still present in high-demanding activities that involve both anterior and rotational loading of the knee. These findings seem to persist regardless of the autograft selection for the ACL reconstruction. Our results also suggest an impairment of neuromuscular control after ACL reconstruction, although muscle strength may have been reinstated. These abnormal biomechanical patterns may lead to loading of cartilage areas, which are not commonly loaded in the healthy knee and longitudinally can lead to osteoarthritis. Muscle imbalance can also influence patients' optimal sports performance exposing them to increased possibility of knee re-injury. In this review, our recommendations point towards further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.
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Affiliation(s)
- A D Georgoulis
- Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopaedic Surgery, University of Ioannina, Georgiou Papandreou 2, PO Box 1042, Ioannina 45110, Greece.
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