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Birgin E, Heibel M, Téoule P, Reißfelder C, Rahbari NN. Robotic sectionectomy versus robotic hemihepatectomy for anatomic liver resection: a comparative analysis of perioperative outcomes. J Robot Surg 2024; 18:197. [PMID: 38703346 DOI: 10.1007/s11701-023-01751-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/18/2023] [Indexed: 05/06/2024]
Abstract
Sectionectomy is a parenchma-sparing alternative to (extended) right or left hemihepatectomy. However, the effectiveness and safety of robotic sectionectomy (RS) versus robotic (extended) hemihepatectomy (RH) for the treatment of liver tumors remains unclear. We reviewed our prospective database for consecutive patients who had undergone robotic hepatectomies between March 2021 and July 2023 and included all patients with RS and RH. Demographic data, perioperative outcomes and long-term outcomes were analyzed and compared between both groups. Thirty patients met our inclusion criteria, of whom 16 patients underwent RS as opposed to 14 patients who underwent RH. Baseline characteristics were comparable between the study groups. The duration of Pringle maneuver was significantly longer in the RS group, while the remaining operative details were comparable. There were no significant differences in posthepatectomy outcomes between the study groups. All patients had negative resection margins. RS is a safe and effective parenchyma-sparing treatment modality.
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Affiliation(s)
- Emrullah Birgin
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Marie Heibel
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Patrick Téoule
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany.
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Turnbull G, Blacklock C, Akhtar A, Dunstan E, Ballantyne JA. Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03901-1. [PMID: 38565783 DOI: 10.1007/s00590-024-03901-1] [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] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre. PATIENTS AND METHODS Between 2000 and 2002, 94 consecutive THAs were performed using the 170 mm Lubinus SP II anatomical femoral stem in our institution. Patient demographics, operative details and clinical outcomes were collected prospectively in an arthroplasty database. Patient records and national radiographic archives were reviewed finally at a mean of 21.5 years (SD 0.7) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture. RESULTS Mean patient age at surgery was 65.8 years (SD 12.5, 34-88 years). There were 48 women (51%). Osteoarthritis was the operative indication in 88 patients (94%). Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (95% confidence interval [CI], 98.0-99.3%) at 10 years and 96.7% (94.5-98.9%) at 21 years. The 20-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line > 2 mm) and no stems required revision. Patient demographics did not appear to influence risk of revision (p > 0.05). There were 2 revisions in total (2 for acetabular loosening with original stems retained). There were no PPFs identified at mean 21.5 year follow-up and 5 dislocations (5%). CONCLUSIONS The Lubinus SP II 170 mm stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA.
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Affiliation(s)
- G Turnbull
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK.
- The Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Rd, Edinburgh, EH16 4SA, Scotland, UK.
| | - C Blacklock
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
| | - A Akhtar
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
| | - E Dunstan
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
| | - J A Ballantyne
- National Treatment Centre Fife Orthopaedics, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, Scotland, UK
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Mahmood F, Rae F, Rae S, Ewen A, Holloway N, Clarke J. Mid-term results of an anatomic total knee replacement design. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05246-0. [PMID: 38512460 DOI: 10.1007/s00402-024-05246-0] [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: 08/30/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION A significant proportion of patients remain dissatisfied following total knee arthroplasty (TKA) surgery. Reasons for this are unclear. Contemporary implants seek to mirror innate anatomy. Such innovations are necessarily subject to scrutiny to validate their use. The Zimmer-Biomet Persona® Personalized Knee system is such an anatomic TKA. This work seeks to establish medium term survival data and patient reported outcomes for this implant. METHODS This was a cohort study of prospectively collected data on all patients undergoing Persona TKA at our institution. Patients were managed using a standardised protocol for intra- and post-operative care. Survivorship data were collected using our National Joint Registry and corroborated with local data. Range of motion, Oxford Knee Score (OKS) and patient satisfaction were recorded at six weeks and one year post-operatively. Hip-knee-ankle radiographs were used to record pre- and post-operative alignment. RESULTS Data were collected for 749 knees in 679 patients. Overall survivorship was 99.0% at a mean 5.35 years, with seven patients undergoing revision surgery during the study period. Significant improvements in the OKS (mean 20.7 points) and range of motion were observed (mean 104.6° at one year). 94.9% of patients were satisfied at one year. Mean correction was to a mechanical femoro-tibial angle of 0.8° varus. CONCLUSIONS We demonstrate excellent medium term survival of the Persona TKA in this large cohort, coupled with improvements in patient reported outcomes, range of motion and patient satisfaction at one year which compare favourably to other implants.
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Affiliation(s)
- Fahd Mahmood
- Department of Orthopaedics, Golden Jubilee University National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK.
| | - Fraser Rae
- Department of Orthopaedics, Golden Jubilee University National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
| | - Sophie Rae
- Department of Orthopaedics, Golden Jubilee University National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
| | - Alistair Ewen
- Department of Orthopaedics, Golden Jubilee University National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
| | - Nicholas Holloway
- Department of Orthopaedics, Golden Jubilee University National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
| | - Jon Clarke
- Department of Orthopaedics, Golden Jubilee University National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
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Duran A, Cortuk O, Eroglu S. Round Autoprosthesis: Use of Adipodermaglandular Flap in T Scar Mastopexy. Aesthetic Plast Surg 2024:10.1007/s00266-024-03909-2. [PMID: 38438763 DOI: 10.1007/s00266-024-03909-2] [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: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE This study focuses on the use of round or anatomically shaped breast autoprosthesis with different volumes prepared from the central and lower poles of the breast. The technical details and surgical outcomes for patients with varying degrees of breast ptosis are discussed. MATERIAL AND METHOD This study involved 42 patients who underwent the Wise-pattern superior pedicle mastopexy procedure using the adipodermaglandular island flap technique. The research spanned from December 2017 to August 2022. The study participants had not previously undergone breast surgery, did not desire breast implants, and exhibited grade 2 and 3 breast ptosis according to the Regnault Classification. Age and preoperative breast measurements of the patients were recorded for subsequent analysis. Measurements, such as the distance from the nipple-areolar complex to the inframammary fold and the distance from the suprasternal notch to the nipple-areolar complex, were taken both before the surgery and one year after. A systematic process was followed to identify acute and subacute complications during the postoperative follow-up period. RESULTS This study involved 42 patients with a mean age of 33.9 years (range: 23-49 years). These procedures were conducted between December 2017 and August 2022. The average SN-N distance before surgery measured 26.7 cm (range: 24-33 cm). One year after surgery, the average SN-N distance was 23.1 cm (range: 21.3-24.8 cm). The follow-up duration for the examined cases ranged from 12 to 18 months on average. Among the observed cases, delayed wound healing was noted in one instance, venous insufficiency of the nipple in another, and fat necrosis in a third case. The overall complication rate in the group was determined to be 7.1%. CONCLUSION In our study, the detachment of dermal connections at the level of the inframammary fold (IMF) and the smooth advancement of the flap in the form of an "island flap" made a contribution to upper pole fullness. Furthermore, we hypothesize that the fusion of the medial and lateral ends of the flap will enhance tissue integration during the healing process, promoting compatibility between the autoprosthesis tissue and breast tissue. Regarding the rates of complications described, classic mastopexy techniques have exhibited similar rates in our findings. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Alpay Duran
- Department of Plastic, Reconstructive and Aesthetic Surgery, Private Practice, Bagdat Street N:322/8 Kadikoy, Istanbul, Turkey.
| | - Oguz Cortuk
- Department of Plastic, Reconstructive and Aesthetic Surgery, Private Practice, Bagdat Street N:322/8 Kadikoy, Istanbul, Turkey
| | - Sinem Eroglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, School of Medicine, Altınbas University, Istanbul, Turkey
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Pikoulis E, Papaconstantinou D, Pikouli A, Pararas N, Buettner S, Wang J, Stasinos G, Belias M, Dellaportas D, Pozios I, Antoniou E, Beyer K, Kreis ME, Pawlik TM, Margonis GA. Is Precision Surgery Applicable to Colorectal Liver Metastases? A Systematic Review and Meta-analysis of Studies that Investigate the Association of Surgical Technique with Outcomes in the Context of Distinct Tumor Biology. Ann Surg Oncol 2024; 31:1823-1832. [PMID: 38155339 DOI: 10.1245/s10434-023-14774-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Although some data suggest that patients with mutRAS colorectal liver metastases (CRLM) may benefit from anatomic hepatectomy, this topic remains controversial. We performed a systematic review and meta-analysis to determine whether RAS mutation status was associated with prognosis relative to surgical technique [anatomic resection (AR) vs. nonanatomic resection (NAR)] among patients with CRLM. PATIENTS AND METHODS A systematic review and meta-analysis of studies were performed to investigate the association of AR versus NAR with overall and liver-specific disease-free survival (DFS and liver-specific DFS, respectively) in the context of RAS mutation status. RESULTS Overall, 2018 patients (831 mutRAS vs. 1187 wtRAS) were included from five eligible studies. AR was associated with a 40% improvement in liver-specific DFS [hazard ratio (HR) = 0.6, 95% confidence interval (CI) 0.44-0.81, p = 0.01] and a 28% improvement in overall DFS (HR = 0.72, 95% CI 0.54-0.95, p = 0.02) among patients with mutRAS tumors; in contrast, AR was not associated with any improvement in liver-specific DFS or overall DFS among wtRAS patients. These differences may have been mediated by the 40% decreased incidence in R1 resection among patients with mutRAS tumors who underwent AR versus NAR [relative risk (RR): 0.6, 95% CI 0.40-0.91, p = 0.02]. In contrast, the probability of an R1 resection was not decreased among wtRAS patients who underwent AR versus NAR (RR: 0.93, 95% CI 0.69-1.25, p = 0.62). CONCLUSIONS The data suggest that precision surgery may be relevant to CRLM. Specifically, rather than a parenchymal sparing dogma for all patients, AR may have a role in individuals with mutRAS tumors.
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Affiliation(s)
- Emmanouil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Papaconstantinou
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anastasia Pikouli
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Stefan Buettner
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jane Wang
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Michail Belias
- Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dionysios Dellaportas
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Pozios
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Efstathios Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katharina Beyer
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Martin E Kreis
- Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
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Shields DW, A’Court J, Rashid MS, Monga P. Clinical outcome of wedged glenoid reconstruction in anatomic total shoulder arthroplasty for osteoarthritic retroverted glenoid: a minimum 2-year follow-up. JSES Int 2024; 8:343-348. [PMID: 38464446 PMCID: PMC10920140 DOI: 10.1016/j.jseint.2023.11.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background Glenoid retroversion and humeral head subluxation is a progressive disorder due to abnormal force coupling and increased contact force. In situ placement of anatomic total shoulder arthroplasty (TSA) components in this scenario results in edge loading, progressive subluxation, and early failure. Wedged glenoid components have been demonstrated to improve glenohumeral alignment, but have not been correlated with mid-term clinical outcomes. Methods Patients undergoing TSA using a wedged all-polyethylene glenoid component for retroverted glenoid deformity were identified from a prospectively maintained database. Preoperative planning computed tomography was routinely performed and compared to postoperative correction on radiographic evaluation. Evidence of loosening was correlated to prospectively collect clinical outcome using patient-reported outcome measures. A matched group of neutrally aligned glenohumeral joints undergoing anatomic TSA was used to compare improvement in clinical outcomes. Results Over a 5-year period, 17 patients with mean age 60 (range 43-81, standard deviation 10.5) were identified with a mean preoperative neoglenoid retroversion of 16.7° (standard deviation 4.5). At a mean follow-up of 43.8 months (range 27-60), no revision surgeries were undertaken. Improvement in the Oxford Shoulder Score was 18 points (P < .0001). The mean improvement was compared to a matched control group demonstrating a comparable magnitude of improvement of 20.4 points. Conclusion Wedged polyethylene components for Walch B2-type glenoids in TSA yield acceptable correction of the joint line, excellent clinical outcomes, and survivorship is maintained in the short term. The clinical and radiological outcome demonstrated similar improvement to that seen in A type deformities.
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Affiliation(s)
| | - Jamie A’Court
- Wrightington Upper Limb Unit, Wrightington Hospital, Wigan, Lancashire, UK
| | - Mustafa S. Rashid
- University of Calgary, Alberta Health Services, Calgary, Alberta, Canada
| | - Puneet Monga
- Wrightington Upper Limb Unit, Wrightington Hospital, Wigan, Lancashire, UK
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Birgin E, Abdelhadi S, Seyfried S, Rasbach E, Rahbari M, Téoule P, Reißfelder C, Rahbari NN. Robotic or laparoscopic repeat hepatectomy after open hepatectomy: a cohort study. Surg Endosc 2024; 38:1296-1305. [PMID: 38102396 DOI: 10.1007/s00464-023-10645-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Repeat hepatectomies are technically complex procedures. The evidence of robotic or laparoscopic (= minimally invasive) repeat hepatectomies (MIRH) after previous open hepatectomy is poor. Therefore, we compared postoperative outcomes of MIRH vs open repeat hepatectomies (ORH) in patients with liver tumors after previous open liver resections. METHODS Consecutive patients who underwent repeat hepatectomies after open liver resections were identified from a prospective database between April 2018 and May 2023. Postoperative complications were graded in line with the Clavien-Dindo classification. We stratified patients by intention to treat into MIRH or ORH and compared outcomes. Logistic regression analysis was performed to define variables associated with the utilization of a minimally invasive approach. RESULTS Among 46 patients included, 20 (43%) underwent MIRH and 26 (57%) ORH. Twenty-seven patients had advanced or expert repeat hepatectomies (59%) according to the IWATE criteria. Baseline characteristics were comparable between the study groups. The use of a minimally invasive approach was not dependent on preoperative or intraoperative variables. All patients had negative resection margins on final histology. MIRH was associated with less blood loss (450 ml, IQR (interquartile range): 200-600 vs 600 ml, IQR: 400-1500 ml, P = 0.032), and shorter length of stay (5 days, IQR: 4-7 vs 7 days, IQR: 5-9 days, P = 0.041). Postoperative complications were similar between the groups (P = 0.298). CONCLUSIONS MIRH is feasible after previous open hepatectomy and a safe alternative approach to ORH. (German Clinical Trials Register ID: DRKS00032183).
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Affiliation(s)
- Emrullah Birgin
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Schaima Abdelhadi
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Steffen Seyfried
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Erik Rasbach
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mohammad Rahbari
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Patrick Téoule
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany.
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Zee MJM, Pijpker PAJ, Kraeima J, Viddeleer AR, Diercks RL. Patient specific instrumentation in ACL reconstruction: a proof-of-concept cadaver experiment assessing drilling accuracy when using 3D printed guides. Arch Orthop Trauma Surg 2024; 144:289-296. [PMID: 37773534 PMCID: PMC10774211 DOI: 10.1007/s00402-023-05072-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Accurate positioning of the femoral tunnel in ACL reconstruction is of the utmost importance to reduce the risk of graft failure. Limited visibility during arthroscopy and a wide anatomical variance attribute to femoral tunnel malposition using conventional surgical techniques. The purpose of this study was to determine whether a patient specific 3D printed surgical guide allows for in vitro femoral tunnel positioning within 2 mm of the planned tunnel position. MATERIALS AND METHODS A patient specific guide for femoral tunnel positioning in ACL reconstruction was created for four human cadaveric knee specimens based on routine clinical MRI data. Fitting properties were judged by two orthopedic surgeons. MRI scanning was performed both pre- and post-procedure. The planned tunnel endpoint was compared to the actual drilled femoral tunnel. RESULTS This patient specific 3D printed guide showed a mean deviation of 5.0 mm from the center of the planned femoral ACL origin. CONCLUSION In search to improve accuracy and consistency of femoral tunnel positioning in ACL reconstruction, the use of a patient specific 3D printed surgical guide is a viable option to explore further. The results are comparable to those of conventional techniques; however, further design improvements are necessary to improve accuracy and enhance reproducibility.
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Affiliation(s)
- Mark J M Zee
- Department of Orthopedic Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands.
| | - Peter A J Pijpker
- 3D Lab, Department of Orthopedic Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Alain R Viddeleer
- Medical Imaging Center, Department of Radiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Ronald L Diercks
- Department of Orthopedic Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
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Daher M, Fares MY, Koa J, Singh J, Abboud J. Bilateral reverse shoulder arthroplasty versus bilateral anatomic shoulder arthroplasty: a meta-analysis and systematic review. Clin Shoulder Elb 2023:cise.2023.00332. [PMID: 38147874 DOI: 10.5397/cise.2023.00332] [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: 05/01/2023] [Accepted: 06/13/2023] [Indexed: 12/28/2023] Open
Abstract
As the population is aging and indications are expanding, shoulder arthroplasty is becoming more frequent, especially bilateral staged replacement. However, surgeons are hesitant to use bilateral reverse prostheses due to potential limitations on activities of daily living. This meta-analysis was conducted to compare bilateral anatomic to bilateral reverse shoulder implants. PubMed, Cochrane, and Google Scholar (pages 1-20) were searched until April 2023. The clinical outcomes consisted of postoperative functional scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], Physical Component Score [PCS], Mental Component Score, and Simple Shoulder Test), pain, and range of motion (external rotation and forward elevation). Three studies were included in this meta-analysis. Bilateral anatomic implants had better postoperative functional outcomes and range of motion, but no significant difference was seen in postoperative pain when compared to the reverse prosthesis. Better ASES score, SANE score, and PCS as well as better external rotation and forward elevation were seen in the bilateral anatomic shoulder replacement group, but no significant difference in pain levels was seen between the two groups. These results may be explained by the lower baseline seen in the reverse prosthesis group, which may be due to an older population and different indications. Nevertheless, more randomized controlled studies are needed to confirm these findings.
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Affiliation(s)
- Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Jaspal Singh
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Joseph Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Thomas Jefferson Medical Center, Philadelphia, PA, USA
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10
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Schick S, Elphingstone J, Murali S, Carter K, Davis W, McGwin G, Evely T, Ponce B, Momaya A, Brabston E. The incidence of shoulder arthroplasty infection presents a substantial economic burden in the United States: a predictive model. JSES Int 2023; 7:636-641. [PMID: 37426907 PMCID: PMC10328787 DOI: 10.1016/j.jseint.2023.03.013] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Periprosthetic joint infections (PJIs) are a major cause of morbidity after shoulder arthroplasty. Prior national database studies have estimated the trends of shoulder PJI up to 2012.21 Since 2012, the landscape of shoulder arthroplasty has changed drastically with the expanding popularity of reverse total shoulder arthroplasty. The dramatic growth in primary shoulder arthroplasties is likely paralleled with an increase of PJI case volume. The purpose of this study is to quantify the rise in shoulder PJIs and the economic stress they currently place on the American healthcare system as well as the toll they will incur over the coming decade. Methods The Nationwide Inpatient Sample database was queried for primary and revision anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty from 2011-2018. Multivariate regression was used to predict cases and charges through the year 2030 adjusted to 2021 purchasing power parity. Results From 2011 to 2018, PJI was found to be 1.1% shoulder arthroplasties, from 0.8% (2011) to 1.4% (2018). Anatomic total shoulder arthroplasty experienced the greatest proportion of infections at 2.0%, followed by hemiarthroplasty at 1.0% and reverse total shoulder arthroplasty at 0.3%. Total hospital charges grew 324%, from $44.8 million (2011) to $190.3 million (2018). Our regression model projects 176% growth in cases and 141% growth in annual charges by 2030. Conclusion This study demonstrates the large economic burden that shoulder PJIs pose on the American healthcare system, which is predicted to reach nearly $500 million in charges annually by 2030. Understanding trends in procedure volume and hospital charges will be critical in evaluating strategies to reduce shoulder PJIs.
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Affiliation(s)
- Samuel Schick
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Elphingstone
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sudarsan Murali
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Carter
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Davis
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Thomas Evely
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Amit Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene Brabston
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Bergholtz SE, Kurnot SR, DeJonckheere M, Hawley ST, Owens SR, Lapedis CJ. A Mixed-Methods Study of Clinicians' Attitudes Toward Pathology Explanation Clinics. Am J Clin Pathol 2023; 159:437-447. [PMID: 36821476 DOI: 10.1093/ajcp/aqac175] [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: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES To characterize the attitudes of treating clinicians toward pathology explanation clinics (PECs). METHODS Clinicians from a tertiary care academic medical center were asked, "How interested would you be in having your patient meet with a pathologist to discuss their pathology report and see their tissue under the microscope?" Clinicians ranked their interest, then expanded on concerns and benefits in a semistructured interview. Audio recordings of interviews were transcribed and analyzed using a qualitative thematic approach. RESULTS A total of 35 clinicians were interviewed, with 83% reporting some level of interest in PECs. Clinicians felt that highly educated and motivated patients were most likely to benefit from a PEC. Clinicians recognized that PECs could improve understanding and emotional processing but that the patient's information needs must be balanced with the potential for cognitive overload and emotional distress. When integrating the pathologist into the care team, clinicians worried about the pathologist's communication skills, care fragmentation, and increased clinician workload. If performed well, clinicians felt PECs had the potential to increase clinician efficacy and improve quality of care. CONCLUSIONS Overall, clinicians are interested in PECs when they fulfill a patient's information needs and are optimally performed.
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Affiliation(s)
| | | | | | - Sarah T Hawley
- Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, US
| | | | - Cathryn J Lapedis
- Departments of Pathology.,Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, US
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12
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Fox MA, Engler ID, Zsidai BT, Hughes JD, Musahl V. Anatomic anterior cruciate ligament reconstruction: Freddie Fu's paradigm. J ISAKOS 2023; 8:15-22. [PMID: 35988888 DOI: 10.1016/j.jisako.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/04/2022] [Revised: 05/26/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022]
Abstract
Anterior cruciate ligament (ACL) reconstruction techniques have evolved over the past four decades. There is evidence that non-anatomic reconstruction techniques, such as traditional transtibial drilling, fail to recreate the native anatomy of the ACL, which can lead to increased rotatory knee instability, revision risk, and post-traumatic osteoarthritis. Anatomic ACL reconstruction has emerged as the gold standard, with the goal of restoring the patient's native anatomy and knee kinematics. This review will summarise the relevant anatomy, modern anatomic ACL reconstruction techniques, and literature supporting anatomic ACL reconstruction as the new paradigm. LEVEL OF EVIDENCE: Level V, review article.
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Affiliation(s)
- Michael A Fox
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Ian D Engler
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Balint T Zsidai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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13
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Imiolczyk JP, Krukenberg A, Mansat P, Bartsch S, McBirnie J, Gotterbarm T, Wiedemann E, Soderi S, Scheibel M. Midterm results of stemless impaction shoulder arthroplasty for primary osteoarthritis: a prospective, multicenter study. JSES Int 2022; 7:1-9. [PMID: 36820431 PMCID: PMC9937825 DOI: 10.1016/j.jseint.2022.09.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Stemless shoulder arthroplasty using 4 open-fin press-fit anchors has been showing promising short-term clinical and radiographic results for patients' primary osteoarthritis. This prospective, multicenter study presents 5-year postoperative clinical and radiological outcomes of a stemless shoulder arthroplasty for primary osteoarthritis. Methods Between November 2012 and December 2015, 100 patients were treated for primary osteoarthritis with the Sidus stem-free shoulder system at 7 European centers. Clinical assessment included the Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, Subjective Shoulder Value, and range of motion. True anteroposterior, axial and lateral radiographs were reviewed for osteolysis, glenoid and humerus loosening, heterotopic ossification, radiolucent lines, component migration and humeral bone resorption. In addition to a Kaplan-Meier survival analysis, a comparative analysis between total shoulder arthroplasty and hemiarthroplasty was performed. Results Seventy-one patients (36 females) with a mean age of 63.8 years (range: 47-79 years) were available for the 5-year clinical and radiographic follow-up (range: 52-79 months). There was a significant increase (P < .0001) in all outcome scores compared to baseline values. Patients with total shoulder arthroplasty (n = 48) achieved significantly better functional outcome than patients with shoulder hemiarthroplasty (n = 23) with regard to the absolute and relative Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, and Subjective Shoulder Value as well as greater abduction strength and range of motion in forward elevation and external rotation (P ≤ .004). There were no cases of osteolysis or humeral loosening. There were some cases of heterotopic ossification (1.4%), radiolucency around the humerus (1.4%) or glenoid (25%), glenoid migration (2.1%), inferior osteophytes (1.4%) or humerus bone resorption (9.9%). The 5-year survival was 94%. Conclusion Patients treated with the Sidus stem-free shoulder system for primary osteoarthritis continue to achieve good clinical and radiographic results without any signs of aseptic humeral implant loosening at 5 years postsurgery.
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Affiliation(s)
| | - Anna Krukenberg
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany
| | - Pierre Mansat
- Centre Hospitalier Universitaire Toulouse, Hôpital Purpan, Toulouse, France
| | | | - Julie McBirnie
- Department of Orthopaedics, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Austria
| | | | - Stefano Soderi
- Orthopedic Clinic, Department of NeuroMuscoloSkeletal and Sense Organs, Azienda Ospedaliero Universitaria Careggi, Centro Traumatologico Ortopedico, Florence, Italy
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany,Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland,Corresponding author: Markus Scheibel, MD, Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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14
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Wu J, Liu H, Xu C. The optimal procedure for lateral column lengthening calcaneal osteotomy according to anatomical patterns of the subtalar joint: an anatomical study in the Chinese population. BMC Musculoskelet Disord 2022; 23:751. [PMID: 35927661 PMCID: PMC9354284 DOI: 10.1186/s12891-022-05715-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Lateral column lengthening calcaneal osteotomy is a powerful procedure for correcting forefoot abduction in flatfoot deformity. However, it involves the risk of damaging articular facets of the subtalar joint. The optimal method to avoid violating the subtalar joint during lateral column lengthening remained controversial in published reports, implying that the subtalar joint might present anatomical variations among different nationalities. Therefore, the objective of this study was to perform an anatomical study by targeting the healthy Chinese population for the purpose of identifying the optimal procedure for lateral column lengthening calcaneal osteotomy according to anatomical patterns of the subtalar joint. Methods A total of 72 ft from 70 fresh frozen cadavers were obtained from the Department of Anatomy of Central South University. For each foot, soft tissues were surgically removed from the bones, and the calcaneus was completely separated from other bones to recognize the anatomical features of the calcaneus. The distance between the calcaneocuboid joint and the articular facet of the subtalar joint was measured by digital calipers for further analysis. Results Out of the 72 ft, 36.1% had separated anterior and middle facets in the calcaneus, and 63.8% had partly or completely fused anterior and middle facets. In the calcanei with discrete facets, the mean distance from the calcaneocuboid joint to the proximal margin of the anterior facet was 12.75 ± 2.10 mm, and the mean width of the separation between the anterior and middle facets was 2.43 ± 1.41 mm. In the calcanei with partly or completely fused anterior and middle facets, the mean width of the narrowest part of the tarsal sinus was 5.81 ± 0.62 mm and 6.25 ± 0.35 mm, respectively. Conclusions The anatomy of the subtalar joint presents significant individual variations in the Chinese population. Calcanei with partly or completely fused anterior and middle facets were observed in nearly two thirds of individuals. Since the modified Evans procedure might potentially incur damage to the subtalar joint facets, the Hintermann procedure or other modified extra-articular lateral column lengthening procedures may be more applicable to the Chinese population.
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Affiliation(s)
- Jiajun Wu
- Department of Orthopaedics Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Hua Liu
- Department of Orthopaedics Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Can Xu
- Department of Orthopaedics Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China.
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15
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Hughes JD, Gibbs CM, Almast A, Atte A, Sansone M, Karlsson J, Musahl V. More anatomic tunnel placement for anterior cruciate ligament reconstruction by surgeons with high volume compared to low volume. Knee Surg Sports Traumatol Arthrosc 2022; 30:2014-2019. [PMID: 35092445 DOI: 10.1007/s00167-022-06875-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Correct placement of the femoral and tibial tunnels in the anatomic footprint during anterior cruciate ligament reconstruction (ACLR) is paramount for restoring rotatory knee stability. Recent studies have looked at surgeon volume and its outcomes on procedures such as total knee arthroplasty and infection rates, but only few studies have specifically examined tunnel placement after ACLR based on surgeon volume. The purpose of this study was to compare the placement of femoral and tibial tunnels during ACLR between high-volume and low-volume surgeons. It was hypothesized that high-volume surgeons would have more anatomic tunnel placement compared with low-volume surgeons. METHODS A retrospective review of all ACLR performed between 2015 and 2019 at an integrated health care system consisting of both academic and community hospitals with 68 orthopaedic surgeons was conducted. Surgeon volume was categorized as less than 35 ACLR per year (low volume) and 35 or more ACLR per year (high volume). Femoral tunnel placement for each patient was determined using an exact strict lateral radiograph (less than 6 mm of offset between the posterior halves of the medial and lateral condyles) taken after the primary ACLR using the quadrant method. The centre of the femoral tunnel was measured in relation to the posterior-anterior (PA) and proximal-distal (PD) dimensions (normal centre of anatomic footprint: PA 25% and PD 29%). Tibial tunnel placement for each patient was determined on the same lateral radiographs by measuring the mid-sagittal tibial diameter and the centre of the tibial attachment area of the ACL from the anterior tibial margin (normal centre of anatomic footprint: 43%). Each lateral radiograph was reviewed by one of two blinded reviewers. RESULTS A total of 4500 patients were reviewed, of which 645 patients met all the inclusion/exclusion criteria and were included in the final analysis. There were 228 patients in the low-volume group and 417 patients in the high-volume group. Low-volume surgeons performed a mean of 5 ACLRs per year, whereas surgeons in the high-volume group performed a mean of 40 ACLRs per year. In the PA dimension, the low-volume group had significantly more anterior femoral tunnel placement compared with the high-volume group (32 ± 10% vs 28 ± 9%, p < 0.01). In the PD dimension, the low-volume group had statistically significant more proximal femoral tunnel placement compared to the high-volume group (32 ± 9% vs 35 ± 9%, p < 0.01). For the tibial tunnel, the low-volume group had significantly more posterior tibial tunnel placement compared with the high-volume group (41 ± 10% vs 38 ± 7%, p < 0.01). CONCLUSION Low-volume surgeons placed their femoral tunnels significantly more anterior and proximal (high) during ACLR, and placed their tibial tunnels significantly more posterior, compared with high-volume surgeons. Prior research has indicated that anatomic placement of the femoral and tibial tunnels during ACLR leads to improved rotatory knee stability. The findings of this study demonstrate the importance of surgical volume and experience during ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christopher M Gibbs
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA
| | - Anmol Almast
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Akere Atte
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA
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16
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Cherches MF, Halvorson R, Lalchandani G, Kandemir U, Lattanza LL, Lee N. Anatomic Radial Head Arthroplasty: The Importance of Implant Angle. J Hand Surg Am 2022; 47:534-539. [PMID: 35397935 DOI: 10.1016/j.jhsa.2022.02.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Multifragmentary radial head and neck fractures not amenable to open reduction and internal fixation are usually treated with radial head arthroplasty (RHA). Although the optimal implant design is still subject to debate, anatomic designs are common. We hypothesized that positioning of the implant leading to increased radial stem angle (RSA) (angle of the RHA stem with respect to the proximal radius shaft, RSA) in anatomic RHA designs will contribute to failures. The aim of this study was to characterize the risk of RHA failure with respect to the stem angle in anatomic RHA design. METHODS A retrospective review of patients who underwent anatomic RHA for acute fractures between 2006 and 2019 at 2 academic centers was conducted. Initial postoperative elbow radiographs were reviewed to measure RSA on the anterior-posterior and lateral views. Radiolucency, stress shielding, and radiocapitellar arthritis were also evaluated. Implant failure was defined as prosthesis removal or revision. RESULTS Implant failure was associated with significantly larger lateral RSA than that in intact implants. Increasing stem shaft angle on a lateral radiograph was associated with decreased implant survival. Radiolucency, stress shielding, and radiocapitellar arthritis were similar between the 2 groups. CONCLUSIONS Anatomic radial head implants are commonly used; however, the importance of prosthesis positioning, specifically that of the stem within the proximal radius, remains understudied. Higher RSA is associated with the risk of implant failure and need for revision. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Matthew F Cherches
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
| | - Ryan Halvorson
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Gopal Lalchandani
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Utku Kandemir
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | | | - Nicolas Lee
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
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17
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Byrne KJ, Hughes JD, Gibbs C, Vaswani R, Meredith SJ, Popchak A, Lesniak BP, Karlsson J, Irrgang JJ, Musahl V. Non- anatomic tunnel position increases the risk of revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1388-95. [PMID: 33983487 DOI: 10.1007/s00167-021-06607-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/05/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) graft failure is a complication that may require revision ACL reconstruction (ACL-R). Non-anatomic placement of the femoral tunnel is thought to be a frequent cause of graft failure; however, there is a lack of evidence to support this belief. The purpose of this study was to determine if non-anatomic femoral tunnel placement is associated with increased risk of revision ACL-R. METHODS After screening all 315 consecutive patients who underwent primary single-bundle ACL-R by a single senior orthopedic surgeon between January 2012 and January 2017, 58 patients were found to have both strict lateral radiographs and a minimum of 24 months follow-up without revision. From a group of 456 consecutive revision ACL-R, patients were screened for strictly lateral radiographs and 59 patients were included in the revision group. Femoral tunnel placement for each patient was determined using a strict lateral radiograph taken after the primary ACL-R using the quadrant method. The center of the femoral tunnel was measured in both the posterior-anterior (PA) and proximal-distal (PD) dimensions and represented as a percentage of the total distance (normal center of anatomic footprint: PA 25% and PD 29%). RESULTS In the PA dimension, the revision group had significantly more anterior femoral tunnel placement compared with the primary group (38% ± 11% vs. 28% ± 6%, p < 0.01). Among patients who underwent revision; those with non-traumatic chronic failure had statistically significant more anterior femoral tunnel placement than those who experienced traumatic failure (41% ± 13% vs. 35% ± 8%, p < 0.03). In the PD dimension, the revision group had significantly more proximal femoral tunnel placement compared with the primary group (30% ± 9% vs 38% ± 9%, p < 0.01). CONCLUSION In this retrospective study of 58 patients with successful primary ACL-R compared with 59 patients with failed ACL-R, anterior and proximal (high) femoral tunnels for ACL-R were shown to be independent risk factors for ACL revision surgery. As revision ACL-R is associated with patient- and economic burden, particular attention should be given to achieving an individualized, anatomic primary ACL-R. Surgeons may reduce the risk of revision ACL-R by placing the center of the femoral tunnel within the anatomic ACL footprint. LEVEL OF EVIDENCE Level III.
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18
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Judkins BL, Hao KA, Wright TW, Jones BK, Boezaart AP, Tighe P, Vasilopoulos T, Horodyski M, King JJ. Early reduction in postoperative pain is associated with improved long-term function after shoulder arthroplasty: a retrospective case series. Eur J Orthop Surg Traumatol 2022; 33:1023-1030. [PMID: 35286469 DOI: 10.1007/s00590-022-03242-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Mixed modalities are frequently utilized in total shoulder arthroplasty (TSA) to control pain, improve patient satisfaction, reduce narcotics use and facilitate earlier discharge. We investigate the relationship between early postoperative pain control and long-term functional outcomes after shoulder arthroplasty. METHODS A retrospective review identified 294 patients (314 shoulders) who underwent anatomic or reverse TSA and received a continuous cervical paravertebral nerve block perioperatively. Opioid and non-opioid analgesics were also available to the patients in an "as needed" capacity to augment perioperative pain control. In addition to demographic and surgical characteristics, the impact on functional outcomes of relative pain (i.e., a patient's subjective pain relative to the entire cohort), pain gradient (i.e., the slope of a patient's subjective pain), and opioid consumption during the first 24 h postoperatively were assessed. Shoulder function was assessed using validated outcome measures collected at 2 year follow-up. Outcomes were measured using American Shoulder and Elbow Surgeons questionnaire (ASES), Shoulder Pain and Disability Index (SPADI), SPADI-130, Raw and Normalized Constant Score, SST-12 and UCLA score. RESULTS Patients younger than 65, females, reverse TSA, revisions, and preoperative opioid users had worse functional outcomes. On univariate analysis, increased pain perioperatively (> 50% percentile relative pain) was associated with decreased function at 2 years when analyzed with all seven outcome scores (P < .001 for all), reaching minimal clinically important difference (MCID) using the Constant Score. On multivariate analysis, increased pain in the first 24 h postoperatively (assessed on a continuous scale) was independently associated with worse ASES, SPADI, and SPADI-130 scores. Intraoperative ketamine administration and opioid consumption in the 24 h postoperative period did not influence long-term shoulder function. CONCLUSION Patients reporting reduced pain after TSA demonstrated improved shoulder function with the Constant score at 2 years postoperatively in both univariate and multivariate analysis. Larger-scale investigation may be warranted to see if this is true for other functional outcome measures. LEVEL OF EVIDENCE III, treatment study.
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Affiliation(s)
- Benjamin L Judkins
- Department of Orthopedic Surgery, Prisma Health - Upstate, Greenville, SC, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Braden K Jones
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Andre P Boezaart
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA.,Lumina Health Pain Medicine Collaborative, Surrey, UK
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | | | - MaryBeth Horodyski
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
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19
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Montanhesi PK, Coelho G, Curcio SAF, Poffo R. Three-Dimensional Printing in Minimally Invasive Cardiac Surgery: Optimizing Surgical Planning and Education with Life-Like Models. Braz J Cardiovasc Surg 2022; 37:110-117. [PMID: 35274522 PMCID: PMC8973130 DOI: 10.21470/1678-9741-2020-0409] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Over recent years, the surgical community has demonstrated a growing interest in imaging advancements that enable more detailed and accurate preoperative diagnoses. Alongside with traditional imaging methods, three-dimensional (3-D) printing emerged as an attractive tool to complement pathology assessment and surgical planning. Minimally invasive cardiac surgery, with its wide range of challenging procedures and innovative techniques, represents an ideal territory for testing its precision, efficacy, and clinical impact. This review summarizes the available literature on 3-D printing usefulness in minimally invasive cardiac surgery, illustrated with images from a selected surgical case. As data collected demonstrates, life-like models may be a valuable adjunct tool in surgical learning, preoperative planning, and simulation, potentially adding safety to the procedure and contributing to better outcomes.
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Affiliation(s)
| | - Giselle Coelho
- Hospital Infantil Sabará, São Paulo, São Paulo, Brazil.,EDUCSIM Institute, São Paulo, São Paulo, Brazil
| | | | - Robinson Poffo
- 1Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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20
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Miller TI, Flanagan MR, Lowry KP, Kilgore MR. Error Reduction and Diagnostic Concordance in Breast Pathology. Surg Pathol Clin 2022; 15:1-13. [PMID: 35236626 DOI: 10.1016/j.path.2021.11.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Errors in anatomic pathology can result in patients receiving inappropriate treatment and poor patient outcomes. Policies and procedures are necessary to decrease error and improve diagnostic concordance. Breast pathology may be more prone to diagnostic errors than other surgical pathology subspecialties due to inherit borderline diagnostic categories such as atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Mandatory secondary review of internal and outside referral cases before treatment is effective in reducing diagnostic errors and improving concordance. Assessment of error through amendment/addendum tracking, implementing an incident reporting system, and multidisciplinary tumor boards can establish procedures to prevent future error.
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Affiliation(s)
- Timothy Isaac Miller
- Department of Laboratory Medicine and Pathology, University of Washington, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357100, Seattle, WA 98195, USA.
| | - Meghan R Flanagan
- Department of Surgery, University of Washington, 1100 Fairview Avenue, M4-B874, Seattle, WA 98109, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG-215, Seattle, WA 98109, USA
| | - Mark R Kilgore
- Department of Laboratory Medicine and Pathology, University of Washington, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357100, Seattle, WA 98195, USA
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Dukan R, Rouillon O, Masmejean EH. Can you maintain a competitive golf swing after total shoulder arthroplasty? Eur J Orthop Surg Traumatol 2022; 33:795-801. [PMID: 35113220 DOI: 10.1007/s00590-022-03213-2] [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] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Return to sports after joint arthroplasty is mainly evaluated for lower limbs procedures. When a return to a specific sport is mentioned, no technical approach nor level consideration are specified. We suggested that patients who undergo total shoulder arthroplasty will be able to maintain playing golf at same high level. METHODS We performed a retrospective study on active golf players who have undergone shoulder arthroplasty. Inclusion criteria were: (1) over 50 years old (2) handicap < 54 (3) playing golf before the procedure (4) minimum follow-up of 1 year. Patients were divided into two groups: ASA group and RSA Group. A clinical assessment was performed using the following scores: Constant, ASES and QuickDash. RESULTS Sixty-one patients were retrospectively included in the cohort. Mean age was 69.1 years old. Mean follow-up was 79 months. Preoperative golf frequency and handicap were similar between the two groups. Surgery resulted in significant pain relief in both groups. No difference was shown between the two groups in clinical assessment. Satisfaction rate was 95%. Return to golf time was done progressively from the twentieth week for putting until the twenty-seventh week for playing on the course. Handicap analysis did not show any difference between the level before surgery and the current level in ASA group (23.7 vs. 22.9,p = 0.33) and RSA group (24.2 vs. 23.3,p = 0.63). CONCLUSION Our study suggested that both patients with ASA or RSA can maintain an active lifestyle with moderate to high frequencies of participation after surgery, particularly in golf. Surgeons can reassure their patients about their recovery and show confidence with regard to their ability to return to a similar golf practice also after RSA. Prospective study with larger cohort is required to confirm the results. LEVEL OF EVIDENCE Level IV, cases study.
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Affiliation(s)
- Ruben Dukan
- Hand, Upper Limb & Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), 20 rue Leblanc, 75015, Paris, France.
| | - Olivier Rouillon
- Federation Francaise de Golf, 68 Rue Anatole France, 92300, Levallois-Perret, France.,Racing 92 Rugby, 11 Avenue Paul Langevin, 92350, Le Plessis-Robinson, France
| | - Emmanuel H Masmejean
- Hand, Upper Limb & Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), 20 rue Leblanc, 75015, Paris, France.,Medical School, University of Paris, 12 rue de l'Ecole de Médecine, 75006, Paris, France.,Research Unit-Clinique Blomet, 136 bis rue Blomet, 75015, Paris, France
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Turnbull GS, Marshall C, Nicholson JA, MacDonald DJ, Clement ND, Breusch SJ. The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years. Arch Orthop Trauma Surg 2022; 142:2361-70. [PMID: 34304278 DOI: 10.1007/s00402-021-03992-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/09/2021] [Indexed: 10/29/2022]
Abstract
INTRODUCTION The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. PATIENTS AND METHODS Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3-17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen's zones RESULTS: Mean patient age at surgery was 68.0 years (SD 10.9, 31-93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%-100%) and at 15 years was 97.5% (94.6%-100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%-100%) at 10 years and 95.9% (92.4%-99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7-11.3) follow-up, mean OHS was 39 (SD 10.3, range 7-48) and 94% of patients reported being very satisfied or satisfied with their THA. CONCLUSIONS The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.
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Smoak JB, Kluczynski MA, DiPaola M, Zuckerman JD. Chronic glenohumeral dislocations treated with arthroplasty: a systematic review. JSES Rev Rep Tech 2021; 1:335-343. [PMID: 37588708 PMCID: PMC10426476 DOI: 10.1016/j.xrrt.2021.06.001] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The aim of this systematic review was to summarize the clinical outcomes and associated predictors of outcomes for chronic glenohumeral dislocations treated with arthroplasty. Methods A systematic literature search was performed with Embase, PubMed, CENTRAL, BIOSIS, and CINAHL databases from the inception of these databases through January 1, 2021 to identify all articles that examined outcomes or predictors of outcomes of arthroplasty in patients with chronic glenohumeral dislocations. Studies that examined outcomes for patients with a chronic glenohumeral dislocation (≥3 weeks) treated with hemiarthroplasty, anatomic total shoulder arthroplasty, or reverse total shoulder arthroplasty were included. Those with acute or subacute dislocations (<3 weeks), fracture dislocations, and those treated with joint preserving treatment modalities were excluded. Results We identified 195 articles; of which, 22 (201 patients/205 shoulders) met our inclusion criteria. A total of 14 studies reported outcomes of hemiarthroplasty, 10 studies reported outcomes of anatomic total shoulder arthroplasty, and 9 studies reported outcomes of reverse total shoulder arthroplasty. All studies documented clinical improvement after arthroplasty. Among 16 studies that measured range of motion, all 16 studies demonstrated improvement in range of motion postoperatively. Thirty-one reoperations (15%) were performed across all studies. Conclusion We found improved clinical outcomes after arthroplasty for the treatment of chronic glenohumeral fewer dislocations at a long-term follow-up. Some evidence suggests that reverse total shoulder arthroplasty may have superior outcomes and less complications compared with hemiarthroplasty and anatomic total shoulder arthroplasty. There is insufficient evidence regarding the potential influence that duration of dislocation, direction of dislocation, addition of concomitant procedures, or humeral component retroversion have on outcomes.
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Affiliation(s)
- Jason B. Smoak
- School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Matthew DiPaola
- School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Di Martino A, Castagnini F, Stefanini N, Bordini B, Geraci G, Pilla F, Traina F, Faldini C. Survival rates and reasons for revision of different stem designs in total hip arthroplasty for developmental dysplasia: a regional registry study. J Orthop Traumatol 2021; 22:29. [PMID: 34275012 PMCID: PMC8286209 DOI: 10.1186/s10195-021-00590-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/06/2020] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) in dysplastic hips is challenging, and each specific implant used in this context has been associated with specific complications. A registry study was performed to query survival rates, hazard ratios, and reasons for revision of different stem designs in THAs after developmental dysplasia of the hip. MATERIALS AND METHODS A regional arthroplasty registry was inquired about cementless THAs performed for hip dysplasia from 2000 to 2017. Patients were stratified according to stem design in tapered (TAP; wedge and rectangular), anatomic (ANAT), and conical (CON), and divided on the basis of modularity (modular, M; nonmodular, NM). In total, 2039 TAP stems (548 M and 1491 NM), 1435 ANAT (1072 M and 363 NM), and 2287 CON (1020 M and 1267 NM) implants were included. Survival rates and reasons for revisions were compared. RESULTS The groups were homogeneous for demographics, but not fully comparable in terms of implant features. NM-CON stems showed the highest risk of failure (significant) and a high risk for cup aseptic loosening (2.5%). The adjusted risk ratio showed that NM-CON was more prone to failure (HR versus NM-ANAT: 3.30; 95%CI 1.64-7.87; p = 0.0003). Revision rates for dislocations and stem aseptic loosening did not differ between cohorts. CONCLUSIONS NM-CON stems showed the highest risk of failure, especially high rates of cup aseptic loosening. NM-CON implants were not more prone to dislocations and stem aseptic loosening. Clinical comparative studies are required to investigate the causes of NM-CON failures, which may be due to abnormal acetabular morphology or imperfect restoration of the proximal biomechanics.
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Affiliation(s)
- Alberto Di Martino
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
- grid.6292.f0000 0004 1757 1758Dipartimento di Scienze Biomediche e Neuromotorie - DIBINEM, University of Bologna, Bologna, Italy
| | - Francesco Castagnini
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia E Chirurgia Protesica E Dei Reimpianti Di Anca E Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - Niccolò Stefanini
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - Barbara Bordini
- grid.419038.70000 0001 2154 6641Laboratorio Di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy
| | - Giuseppe Geraci
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - Federico Pilla
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - Francesco Traina
- grid.6292.f0000 0004 1757 1758Dipartimento di Scienze Biomediche e Neuromotorie - DIBINEM, University of Bologna, Bologna, Italy
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia E Chirurgia Protesica E Dei Reimpianti Di Anca E Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - Cesare Faldini
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
- grid.6292.f0000 0004 1757 1758Dipartimento di Scienze Biomediche e Neuromotorie - DIBINEM, University of Bologna, Bologna, Italy
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EJNISMAN LEANDRO, HELITO CAMILOPARTEZANI, CAMARGO ANDRÉFERRARIDEFRANÇA, ROCHA BRUNOARAGÃO, BAPTISTA ANDRÉMATHIAS, CAMARGO OLAVOPIRESDE. THREE-DIMENSIONAL PRINTING IN ORTHOPEDICS: WHERE WE STAND AND WHERE WE ARE HEADING. Acta Ortop Bras 2021; 29:223-227. [PMID: 34566483 PMCID: PMC8443020 DOI: 10.1590/1413-785220212904245927] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Three-dimensional printing is a technology in expansion in the medical field. It also presents many applications in orthopedics. Our review article aims to describe 3D printing, types of 3D printers, and its use in the orthopedic field. 3D models can be created using tomography scans. Those models can then be manipulated, even simulating surgeries. It is possible to print biomodels, which will help us understand deformities and plan surgeries. Orthopedic surgeons must be updated in these disruptive technologies that may help their daily practice. Level of Evidence V, Expert opinion.
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Affiliation(s)
- LEANDRO EJNISMAN
- Universidade de São Paulo, Brazil; Hospital Israelita Albert Einstein, Brazil
| | | | | | - BRUNO ARAGÃO ROCHA
- Hospital Sírio Libanês, Brazil; Universidade de São Paulo, Brazil; Grupo Fleury, Brazil
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Weatherby PJ, Efejuku TA, Somerson JS. Complications After Anatomic Shoulder Arthroplasty: Revisiting Leading Causes of Failure. Orthop Clin North Am 2021; 52:269-77. [PMID: 34053572 DOI: 10.1016/j.ocl.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
For practicing shoulder arthroplasty surgeons, it is advisable to consider a breadth of data sources concerning complications and outcomes. Although published series from high-volume centers are the primary source of data, these results may not be generalizable to a wide range of practice settings. National or health system-specific registry and medical device databases are useful adjuncts to assess the changing complication profile of shoulder arthroplasty, as well as to understand the complications specific to certain implants or implant types. To reduce the risk of postoperative complications, surgeons must have a clear understanding of the most common modes of failure.
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Lobo-Escolar L, Abellán-Miralles C, Escolà-Benet A. Outcomes of press-fit radial head arthroplasty following complex radial head fractures. Orthop Traumatol Surg Res 2021; 107:102645. [PMID: 32768276 DOI: 10.1016/j.otsr.2020.03.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/26/2018] [Revised: 01/24/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Press-fit radial head arthroplasty (RHA) is increasingly popular in treating complex radial head fractures. This study assessed the outcome of RHA, including the outcome following re-operation, and explored potentially influencing factors. HYPOTHESIS Complex radial head fractures treated with press-fit radial head prosthesis would have a favourable outcome. MATERIAL AND METHODS Data on all consecutive patients treated with anatomic press-fit RHA from February 2002 to February 2015 were analysed. Post-surgery clinical and X-rays assessments included a post-discharge evaluation of function. Standardised methods implemented include the assessment of range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and subjective satisfaction scales. RESULTS Forty-five patients were recruited and 71% were classified in Mason IV and 62.2% had the "terrible triad". Re-operation was performed in 26.7% and prosthesis removal in 15.6%. Mean follow-up was 140.8 months (95% CI 117.7-164) and prosthesis survival was 69.5% at 24 months. Mean MEPS before re-operations was 86.3±15.9. Pain and/or instability were the most common reasons for re-operation, and re-operations were significantly more frequent in patients having one or more "associated injuries" (p=0.05), but not the terrible triad; and in patients with radiological "loosening" signs (p<0.01). Subjective scores were relatively good in most patients, although the functionality perceived in the re-operation with implant removal group was rather low. DISCUSSION Several studies of complex radial head fractures treated with press-fit radial head prosthesis have also shown favourable results, but the patients in such studies generally had less severe lesions. Moreover, differently from previous reports, this study with a long follow-up has included a younger population with high functionality requirements. Pain and/or instability, as observed in several previous reports, were the most common reasons for re-operation, but contrary to the expectation, the terrible triad was not associated with unfavourable outcome. CONCLUSION Treatment of complex fractures with press-fit radial head prosthesis, including re-operation with implant removal yields satisfactory results. Most scores of functional and subjective outcome improved following the re-intervention and most patients returned to their usual occupation. LEVEL OF EVIDENCE Level IV; case series; treatment study.
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Affiliation(s)
- Luis Lobo-Escolar
- Department of Orthopaedics & Traumatology Surgery, Hospital Asepeyo Sant Cugat, Sant Cugat, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain.
| | - César Abellán-Miralles
- Department of Orthopaedics & Traumatology Surgery, Hospital Asepeyo Sant Cugat, Sant Cugat, Barcelona, Spain
| | - Anna Escolà-Benet
- Department of Orthopaedics & Traumatology Surgery, Hospital Universitario General de Cataluña, Sant Cugat, Barcelona, Spain
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Ahearn N, Gooden B, Salmon L, Martina K, Lyons M. Conforming patellar button design improves outcome of total knee arthroplasty. Knee 2021; 29:399-404. [PMID: 33711674 DOI: 10.1016/j.knee.2021.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 01/05/2021] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellar resurfacing is commonly performed during total knee arthroplasty (TKA), and the patellar button design can vary within a TKA implant. Implant design is known to affect patella kinematics, contact mechanics, and ultimately the outcome of TKA. The aim of this study was to compare the patient-reported outcomes of TKA with either a conforming (CP) or medialized dome (MD) patellar component. METHODS The study was a prospective cohort study of 100 TKAs performed between December 2015 and August 2017. We compared a consecutive series of 50 TKA subjects with a CP, with the previous 50 TKA subjects with an MD patella. The primary outcome measure was difference in Knee Injury and Osteoarthritis Score (KOOS) at 12 months. Other patient-reported outcome measures included EQ5D as a general health measure, and patient satisfaction. RESULTS There was no significant difference in baseline characteristics, KOOS, or EQ5D between the two groups. At 12 months, the CP Group had a higher mean KOOS function score (87 vs. 80, P = 0.04), and greater patient satisfaction (98% vs. 82% satisfied, P = 0.009) compared with the MD group. The CP Group had significantly lower frequency of pain with level walking, less difficulty with stairs, and lower mean EQ5D mobility at 12 months compared with the MD group. CONCLUSIONS TKA performed using a conforming patella has superior results over a medialized dome patellar component for KOOS function, patient satisfaction, walking pain, stair performance, and mobility at 12 months postoperatively. The differences observed with the change in patellar design may be unique to this prosthesis.
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McEwen PJC, McArthur M, Brereton SG, O'Callaghan WB, Wilkinson MPR. Flexion deformity and laxity as a function of knee position at the time of tensioning of rigid anatomic hamstring ACL grafts. Asia Pac J Sports Med Arthrosc Rehabil Technol 2020; 22:67-73. [PMID: 33204647 DOI: 10.1016/j.asmart.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022]
Abstract
Background Anatomic ACL grafts routinely display the anisometric length-tension behaviour seen in the native ligament with maximum length in full knee extension. Recent improvements in hamstring graft preparation and fixation have improved graft rigidity to the point where total graft lengthening after implantation may be less than 1 mm. Despite this it remains common practice to fix these grafts in a knee flexed position. Methods Nineteen participants underwent all-inside ACL reconstruction with optimally preconditioned 4 strand semitendinosus grafts using bi-cortical adjustable suspensory loop fixation. Using a computer navigation system, baseline measures of anisometricity, extension range, and tibial rotation were made. The graft was tensioned and provisionally fixed with the knee flexed 5° beyond its anisometric point and extension range recorded. The graft was then definitively fixed with the knee fully extended and extension range and tibial rotation recorded again. Anterior laxity measurements were made pre-operatively and postoperatively using a manual arthrometer and compared to those from the contralateral limb. Results Fixing the graft with the knee flexed produced a mean FD of 10.9° (p < 0.0001) and fixing in extension restored full extension (p = 0.661). Fixing in extension restored anterior laxity at 30° (p = 0.224) and at 90° (p = 0.668). There were very strong correlations between post-operative and control extension range (r = 0.931, p < 0.0001) and anterior laxity and 30° (r = 0.830, p < 0.0001) measures. Constraint of tibial internal rotation increased by 2.9° during the pivot-shift (p < 0.001) and increased with pivot shift grade (r = 0.474, p = 0.040). Conclusion Fixing rigid anatomic hamstring grafts in a knee flexed position routinely produces a flexion deformity. Tensioning and fixing grafts with the knee fully extended restores full extension and anterior laxity at 30° and 90°. Rotational constraint is significantly improved and correlates with the pivot-shift grade. Clinical relevance Rigid anatomic grafts should be tensioned and fixed with the knee fully extended.
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Tank S, Dutt S, Sehrawat R, Kumar V, Sabat D. 3D CT evaluation of femoral and tibial tunnels in anatomic double bundle anterior cruciate ligament reconstruction. J Clin Orthop Trauma 2021; 15:22-6. [PMID: 33680823 DOI: 10.1016/j.jcot.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An anatomical double bundle ACL reconstruction replicates the anatomy of native ACL as the tunnels are made to simulate the anatomy of ACL with AM and PL bundle foot prints. The goal of anatomic ACL reconstruction is to tailor the procedure to each patient's anatomic, biomechanical and functional demands to provide the best possible outcome. The shift from single bundle to double bundle technique and also from transtibial to transportal method has been to provide near anatomic tunnel positions. PURPOSE To determine the position of femoral and tibial tunnels prepared by double bundle ACL reconstruction using three dimensional Computed tomography. STUDY DESIGN A prospective case series involving forty patients with ACL tear who underwent transportal double bundle ACL reconstruction. METHOD Computed tomography scans were performed on forty knees that had undergone double bundle anterior cruciate ligament reconstruction. Three-dimensional computed tomography reconstruction models of the knee joint were prepared and aligned into an anatomical coordinate axis system for femur and tibia respectively. Tibial tunnel centres were measured in the anterior-to-posterior and medial-to-lateral directions on the top view of tibial plateau and femoral tunnel centres were measured in posterior to anterior and proximal-to-distal directions with anatomic coordinate axis method. These measurements were compared with published reference data. RESULTS Analysing the Femoral tunnel, the mean posterior-to-anterior distances for anteromedial and posterolateral tunnel centre position were 46.8% ± 7.4% and 34.5% ± 5.0% of the posterior-to-anterior height of the medial wall and the mean proximal-to-distal distances for the anteromedial and posterolateral tunnel centre position were 24.1% ± 7.1% and 61.6% ± 4.8%. On the tibial side, the mean anterior-to-posterior distances for the anteromedial and posterolateral tunnel centre position were 28.8% ± 4.3% and 46.2% ± 3.6% of the anterior-to posterior depth of the tibia measured from the anterior border and the mean medial-to-lateral distances for the anteromedial and posterolateral tunnel centre position were 46.5% ± 2.9% and 50.6% ± 2.8% of the medial-to-lateral width of the tibia measured from the medial border. There is high Inter-observer and Intra-observer reliability (Intra-class correlation coefficient). DISCUSSION AND CONCLUSION Femoral AM tunnel was positioned significantly anterior and nearly proximal whereas the femoral PL tunnel was positioned significantly anterior and nearly distal with respect to the anatomic site. Location of tibial AM tunnel was nearly posterior and nearly medial whereas the location of tibial PL tunnel was very similar to the anatomic site Evaluation of location of tunnels through the anatomic co-ordinate axes method on 3D CT models is a reliable and reproducible method. This method would help the surgeons to aim for anatomic placement of the tunnels. It also shows that there is scope for improvement of femoral tunnel in double bundle ACL reconstruction through transportal technique.
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Joechle K, Vreeland TJ, Vega EA, Okuno M, Newhook TE, Panettieri E, Chun YS, Tzeng CD, Aloia TA, Lee JE, Vauthey JN. Anatomic Resection Is Not Required for Colorectal Liver Metastases with RAS Mutation. J Gastrointest Surg 2020; 24:1033-9. [PMID: 32162236 DOI: 10.1007/s11605-019-04299-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/03/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Non-anatomic resection (NAR) has emerged as a safe and effective technique for resection of colorectal liver metastases (CRLM). More recently, RAS mutation has been identified as an important indicator of aggressive disease, which may require anatomic resection (AR). In this retrospective study, we compared the long-term outcomes of AR versus NAR in CRLM patients with and without RAS mutations. METHODS Patients with known RAS mutation status who underwent AR or NAR for CRLM between 2006 and 2016 were included. Differences in baseline characteristics were adjusted using 1:1 propensity score matching, including the most important factors that contributed to the decision to use the resection technique. Overall survival (OS), recurrence-free survival (RFS), and liver-specific recurrence-free survival (L-RFS) were compared between cohorts. RESULTS Among 622 total patients, 338 (54%) underwent AR and 284 (46%) NAR. There was no difference in OS or L-RFS between the AR and NAR groups, regardless of mutation status. There was increased RFS in the RAS WT patients with NAR (P = 0.034), but no difference in RFS in the whole cohort or RAS mutant group. After propensity score matching, 360 patients were analyzed, and no differences in OS, RFS, or L-RFS rates were seen between any groups. There was also no difference in margin recurrence. CONCLUSIONS Similar outcomes can be achieved with both AR and NAR, regardless of RAS mutation status. These data do not support a universal requirement for AR in RAS mutant CRLM when not necessary to achieve an R0 resection.
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Bhandari M, Fobi MAL, Buchwald JN; Bariatric Metabolic Surgery Standardization (BMSS) Working Group:. Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement. Obes Surg 2019; 29:309-45. [PMID: 31297742 DOI: 10.1007/s11695-019-04032-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Rothrauff BB, Jorge A, de Sa D, Kay J, Fu FH, Musahl V. Anatomic ACL reconstruction reduces risk of post-traumatic osteoarthritis: a systematic review with minimum 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2020; 28:1072-1084. [PMID: 31471726 DOI: 10.1007/s00167-019-05665-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 05/14/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To systematically review the literature for radiographic prevalence of osteoarthritis (OA) at a minimum of 10 years following anterior cruciate ligament (ACL) reconstruction (ACLR) with anatomic vs. non-anatomic techniques. It was hypothesized that the incidence of OA at long-term follow-up would be lower following anatomic compared to non-anatomic ACLR. METHODS A systematic review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Library, for studies reporting OA prevalence by radiographic classification scales at a minimum of 10 years following ACLR with autograft. Studies were categorized as anatomic if they met or exceeded a score of 8 according the Anatomic ACL Reconstruction Scoring Checklist (AARSC), while those with a score less than 8 were categorized as non-anatomic/non-specified. Secondary outcomes included graft failure and measures of knee stability (KT-1000, Pivot Shift) and functional outcomes [Lysholm, Tegner, subjective and objective International Knee Documentation Committee (IKDC) scores]. OA prevalence on all radiographic scales was recorded and adapted to a normalized scale. RESULTS Twenty-six studies were included, of which 5 achieved a score of 8 on the AARSC. Using a normalized OA classification scale, 87 of 375 patients (23.2%) had diagnosed OA at a mean follow-up of 15.3 years after anatomic ACLR and 744 of 1696 patients (43.9%) had OA at mean follow-up of 15.9 years after non-anatomic/non-specified ACLR. The AARSC scores were 9.2 ± 1.3 for anatomic ACLR and 5.1 ± 1.1 for non-anatomic/non-specified ACLR. Secondary outcomes were relatively similar between techniques but inconsistently reported. CONCLUSIONS This study showed that anatomic ACLR, defined as an AARSC score ≥ 8, was associated with lower OA prevalence at long-term follow-up. Additional studies reporting long-term outcomes following anatomic ACLR are needed, as high-level studies of anatomic ACLR are lacking. The AARSC is a valuable resource in performing and evaluating anatomic ACLR. Anatomic ACLR, as defined by the AARSC, may reduce the long-term risk of post-traumatic OA following ACL injury to a greater extent than non-anatomic ACLR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Benjamin B Rothrauff
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Ahmed Jorge
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Darren de Sa
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA.
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Mao Y, Marshall B, Price T, Linde M, Smolinski P, Fu FH, van Eck CF. Notchplasty alters knee biomechanics after anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:614-621. [PMID: 31690993 DOI: 10.1007/s00167-019-05766-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/15/2019] [Accepted: 10/21/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE The aims of this study were (1) to study the biomechanics of single-bundle anatomic ACL reconstructed knees with and without notchplasty using a robotic testing system and (2) to determine if there would be a difference between performing a small or large notchplasty. METHODS Fifteen fresh-frozen specimens were used in this study. The ACL reconstruction (ACL-R) was performed using an anatomic single-bundle technique with the 8 mm soft tissue graft fixed at 30° with suspensory fixation on the femoral side and a screw and washer on the tibial side. The notchplasty was then created with a burr. The following knee states were compared: (1) ACL-R, (2) ACL-R with a small (3 mm) notchplasty, and (3) ACL-R with a large (6 mm) notchplasty. Four loading conditions were applied: (1) an anterior drawer with an 89 N anterior tibial load, (2) simulated pivot-shift loading, (3) a 5 Nm internal rotational moment, and (4) a 5 Nm external rotational moment. RESULTS Under anterior tibial loading, anterior tibial translation increased, and graft force decreased significantly after ACL-R + 3 mm notchplasty and ACLR + 6 mm notchplasty compared to ACL-R alone at FE, 15° and 30° of knee flexion. There were no changes in either anterior tibial translation or graft force under simulated pivot-shift loading, internal rotational moment, or external rotational moment. CONCLUSION When added to anatomic ACL reconstruction, notchplasty increased anterior tibial translation and decreased graft forces during low knee flexion angles. There was no difference between a small and large notchplasty. The findings of this study are clinically relevant as the purpose of anatomic ACL reconstruction is to restore normal knee laxity, and while notchplasty may be helpful in avoiding graft impingement and improving visualization, removing even 3 mm of bone leads to biomechanical changes.
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Affiliation(s)
- Yongtao Mao
- Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Freddie Fu Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Brandon Marshall
- Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, USA
| | - Taylor Price
- Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, USA
| | - Monica Linde
- Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, USA
| | - Patrick Smolinski
- Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, USA
| | - Freddie H Fu
- Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Freddie Fu Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Carola F van Eck
- Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, USA. .,Department of Orthopaedic Surgery, University of Pittsburgh, Freddie Fu Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.
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Friedman RJ, Cheung E, Grey SG, Flurin PH, Wright TW, Zuckerman JD, Roche CP. Clinical and radiographic comparison of a hybrid cage glenoid to a cemented polyethylene glenoid in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:2308-2316. [PMID: 31324502 DOI: 10.1016/j.jse.2019.04.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 02/19/2019] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study reports the clinical and radiographic outcomes of a hybrid cage glenoid compared with an age-matched, sex-matched, and follow-up-matched cohort of cemented all-polyethylene peg glenoids in patients undergoing anatomic total shoulder arthroplasty with 2 years' minimum follow-up. MATERIALS AND METHODS We reviewed 632 primary anatomic total shoulder arthroplasty patients from an international multi-institutional database; 316 patients received hybrid cage glenoids and were matched for age, sex, and follow-up with 316 patients with cemented all-polyethylene peg glenoids. Each cohort received the same humeral component. Scoring was performed in all patients preoperatively and at latest follow-up using 5 outcome scoring metrics and 4 active range-of-motion measurements. A Student 2-tailed unpaired t test identified differences in outcomes; P < .05 denoted a significant difference. RESULTS Cage glenoid patients had significantly lower rates of radiolucent glenoid lines (9.0% vs. 37.6%, P < .0001) and radiolucent humeral lines (3.0% vs. 9.1%, P = .0088) than all-polyethylene peg glenoid patients. In the cage glenoid cohort, 4 cases of aseptic glenoid loosening (1.3%) and 4 cases of articular surface dissociation (1.3%) occurred. In the all-polyethylene peg cohort, 12 cases of aseptic loosening (3.8%) occurred. Cage glenoid patients had a significantly lower revision rate than all-polyethylene peg glenoid patients (2.5% vs. 6.9%, P = .0088). CONCLUSION At 50 months' mean follow-up, cage glenoids demonstrated equally good clinical outcomes to all-polyethylene peg glenoids. Cage glenoids had significantly fewer radiolucent lines around both the glenoid and humeral components and a lower revision rate. Longer-term follow-up is required to confirm these promising short-term results.
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Affiliation(s)
- Richard J Friedman
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Sean G Grey
- Orthopaedic & Spine Center of the Rockies, Fort Collins, CO, USA
| | | | - Thomas W Wright
- Department of Orthopaedics & Sports Medicine, University of Florida, Gainesville, FL, USA
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Duan AQ, Feng K, Liu JX, Que F, Xu ZS, Xiong AS. Elevated gibberellin altered morphology, anatomical structure, and transcriptional regulatory networks of hormones in celery leaves. Protoplasma 2019; 256:1507-1517. [PMID: 31168667 DOI: 10.1007/s00709-019-01396-w] [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: 01/11/2019] [Accepted: 05/24/2019] [Indexed: 06/09/2023]
Abstract
Gibberellins (GAs), as one of the important hormones in regulating the growth and development of higher plants, can significantly promote cell elongation and expansion. Celery is a widely grown leafy vegetable crop with rich nutritional value. However, the effect of gibberellins on celery leaves is unclear. In this paper, the celery variety "Jinnan Shiqin" plants were treated with gibberellic acid (GA3) and paclobutrazol (PBZ, a gibberellin inhibitor). Our results showed that GA3 treatment promoted the growth of celery leaves and caused lignification of celery leaf tissue. In addition, the transcript levels of genes associated with gibberellins, auxin, cytokinins, ethylene, jasmonic acid, abscisic acid, and brassinolide were altered in response to increased or decreased exogenous gibberellins or inhibitor. GA3 may regulate celery growth by interacting with other hormones through crosstalk mechanisms. This study provided a reference for further study of the regulation mechanism of gibberellins metabolism, and exerted effects on understanding the role of gibberellins in the growth and development of celery.
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Affiliation(s)
- Ao-Qi Duan
- State Key Laboratory of Crop Genetics and Germplasm Enhancement, Ministry of Agriculture and Rural Affairs Key Laboratory of Biology and Germplasm Enhancement of Horticultural Crops in East China, College of Horticulture, Nanjing Agricultural University, Nanjing, 210095, China
| | - Kai Feng
- State Key Laboratory of Crop Genetics and Germplasm Enhancement, Ministry of Agriculture and Rural Affairs Key Laboratory of Biology and Germplasm Enhancement of Horticultural Crops in East China, College of Horticulture, Nanjing Agricultural University, Nanjing, 210095, China
| | - Jie-Xia Liu
- State Key Laboratory of Crop Genetics and Germplasm Enhancement, Ministry of Agriculture and Rural Affairs Key Laboratory of Biology and Germplasm Enhancement of Horticultural Crops in East China, College of Horticulture, Nanjing Agricultural University, Nanjing, 210095, China
| | - Feng Que
- State Key Laboratory of Crop Genetics and Germplasm Enhancement, Ministry of Agriculture and Rural Affairs Key Laboratory of Biology and Germplasm Enhancement of Horticultural Crops in East China, College of Horticulture, Nanjing Agricultural University, Nanjing, 210095, China
| | - Zhi-Sheng Xu
- State Key Laboratory of Crop Genetics and Germplasm Enhancement, Ministry of Agriculture and Rural Affairs Key Laboratory of Biology and Germplasm Enhancement of Horticultural Crops in East China, College of Horticulture, Nanjing Agricultural University, Nanjing, 210095, China
| | - Ai-Sheng Xiong
- State Key Laboratory of Crop Genetics and Germplasm Enhancement, Ministry of Agriculture and Rural Affairs Key Laboratory of Biology and Germplasm Enhancement of Horticultural Crops in East China, College of Horticulture, Nanjing Agricultural University, Nanjing, 210095, China.
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Michels NR, Vanhomwegen E. An educational study to investigate the efficacy of three training methods for infiltration techniques on self-efficacy and skills of trainees in general practice. BMC Fam Pract 2019; 20:133. [PMID: 31521131 PMCID: PMC6744665 DOI: 10.1186/s12875-019-1023-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/03/2019] [Indexed: 11/13/2022]
Abstract
Background Research shows that few general practitioners perform intra- and periarticular infiltrations. Lack of good training strategies to teach these skills would be an important reason for this observation. In this study, we investigated and compared three different training strategies for infiltrations of the glenohumeral joint, subacromial space, lateral epicondyle, carpal tunnel and knee joint. Methods Trainees in general practice were randomized into three teaching groups: a theoretical lecture (n = 18), or a theoretical lecture with training on anatomical models (n = 19) or with a training on cadavers (n = 11). The study period was 3 months. Before and after the training, the self-efficacy (questionnaire) and skills (Objective Structured Clinical Examination or OSCE, test on anatomical models) were evaluated. The self-efficacy was assessed again 3 months later. A Kruskal-Wallis test was used to compare the results before versus after training and between groups (p < 0.05). Results All three training strategies had a significantly positive effect on the self-efficacy concerning knowledge and skills. This benefit remained 3 months after training. However, some participants still felt uncomfortable to perform infiltrations. Best scores for self-efficacy concerning skills and best scores on the OSCE were observed after training on cadavers, followed by training on anatomical models. Conclusions Based on this study we suggest the combination of a theoretical lecture with a training on cadavers to teach infiltration techniques. To achieve an optimal long-term effect, additional refresher trainings may be necessary.
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Affiliation(s)
- Nele R Michels
- Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium.
| | - Els Vanhomwegen
- Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium
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Welborn BT, Butler RB, Dumas BP, Mock L, Messerschmidt CA, Friedman RJ. Patient reported outcome measures of bilateral reverse total shoulder arthroplasty compared to bilateral anatomic total shoulder arthroplasty. J Orthop 2019; 17:83-86. [PMID: 31879480 DOI: 10.1016/j.jor.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/06/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to compare patient reported functional outcomes following bilateral aTSA vs rTSA. A retrospective review was conducted on twenty-six pateints who underwent staged bilateral aTSA or rTSA, with a minimum of 2 years follow up. Thirteen patients were included in each group, and patient assessed functional outcomes were measured using the PENN Score, ASES, SST, and SF-12. No statistically significant differences were found between the two groups for all functional outcome scores, patient satisfaction, or SF-12. These findings suggest that patients undergoing bilateral rTSA can expect functional outcomes similar to those obtained after bilateral aTSA. None of the authors involved in the work nor any of the author's institutions at any time received payment or services from a third party for any aspect of the submitted work and have no conflicts of interest to disclose.
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Affiliation(s)
| | - R Bryan Butler
- Medical University of South Carolina, Charleston, SC, USA
| | - Bonnie P Dumas
- Medical University of South Carolina, Charleston, SC, USA
| | - Lisa Mock
- Medical University of South Carolina Department of Orthopaedics, Charleston, SC, USA
| | | | - Richard J Friedman
- Shoulder and Elbow Surgery, Medical University of South Carolina, Charleston, SC, USA
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Chan AY, Urgun K, Tran DK, Kyong T, Hsu FPK, Vadera S. Cerebral Peduncle Volume and Motor Function Following Adult Hemispherectomy. World Neurosurg 2019; 126:156-159. [PMID: 30877000 DOI: 10.1016/j.wneu.2019.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemispherectomy is a successful and well-described treatment option for pediatric patients with hemispheric ictal onset, but adult outcomes have been far less studied. We describe the outcomes in adult patients with medically refractory epilepsy and hemispheric disease and the relationship to cerebral peduncle volume. CASE DESCRIPTIONS We retrospectively reviewed adult hemispherectomy patients at our institution from 2015 to 2018. Patient data including demographic information, pathologic changes, seizure-free outcomes, and ipsilateral (i.e., surgical side) and contralateral (i.e., functional side) cerebral peduncle volume data were collected. We identified 4 adult patients who underwent hemispherectomy. The mean age at surgery was roughly 25 years. All patients were categorized as Engel I or II, and motor scores at last follow-up were unchanged. The mean volume for contralateral and ipsilateral cerebral peduncle means were 1.42 and 0.78 cm3, respectively (P = 0.01). CONCLUSIONS These findings suggest that smaller ipsilateral cerebral peduncle size could potentially be associated with unchanged postoperative hemiparesis. We hypothesize that smaller ipsilateral peduncle size could have represented corticospinal tract reorganization in childhood, implying that the removed brain matter was mostly noncontributory to contralateral motor function.
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Affiliation(s)
- Alvin Y Chan
- Comprehensive Epilepsy Center, University of California, Irvine, Orange, California, USA.
| | - Kamran Urgun
- Comprehensive Epilepsy Center, University of California, Irvine, Orange, California, USA
| | - Diem Kieu Tran
- Comprehensive Epilepsy Center, University of California, Irvine, Orange, California, USA
| | - Thomas Kyong
- Comprehensive Epilepsy Center, University of California, Irvine, Orange, California, USA
| | - Frank P K Hsu
- Comprehensive Epilepsy Center, University of California, Irvine, Orange, California, USA
| | - Sumeet Vadera
- Comprehensive Epilepsy Center, University of California, Irvine, Orange, California, USA
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Sollaccio DR, Navo P, Ghiassi A, Orr CM, Patel BA, Lewton KL. Evaluation of Articular Surface Similarity of Hemi-Hamate Grafts and Proximal Middle Phalanx Morphology: A 3D Geometric Morphometric Approach. J Hand Surg Am 2019; 44:121-128. [PMID: 30017649 DOI: 10.1016/j.jhsa.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/14/2017] [Accepted: 05/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Hemi-hamate arthroplasty has been described as a viable treatment option for unstable proximal interphalangeal joint fracture-dislocations. The procedure uses a dorsal distal hamate osteochondral graft to recreate the injured volar middle phalanx (MP) proximal base. The purpose of this study was to evaluate the similarity in shape of these articular surfaces using quantitative 3-dimensional methods. METHODS Three-dimensional virtual renderings were created from laser scans of the articular surfaces of the dorsal distal hamate and the volar MP bases of the index, middle, ring, and little fingers from cadaveric hands of 25 individuals. Three-dimensional landmarks were obtained from the articular surfaces of each bone and subjected to established geometric morphometric analytical approaches to quantify shape. For each individual, bone shapes were evaluated for covariation using 2-block partial least-squares and principal component analyses. RESULTS No statistically significant covariation was found between the dorsal distal hamate and volar MP bases of the middle, ring, or little digits. Whereas the volar MP bases demonstrated relative morphologic uniformity among the 4 digits both within and between individuals, the dorsal distal hamates exhibited notable variation in articular surface morphology. CONCLUSIONS Despite the early to midterm clinical success of hemi-hamate arthroplasty, there is no statistically significant, uniform similarity in shape between the articular surfaces of the dorsal distal hamate and the volar MP base. In addition, there is wide variation in the articular morphology of the hamate among individuals. CLINICAL RELEVANCE The lack of uniform similarity in shape between the dorsal distal hamate and the volar MP base may result in unpredictable outcomes in HHA. It is recommended that the variation in hamate morphology be considered while reconstructing the injured volar MP base in the procedure.
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Affiliation(s)
- David R Sollaccio
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Paul Navo
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Caley M Orr
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO; Department of Anthropology, University of Colorado Denver, Denver, CO
| | - Biren A Patel
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA
| | - Kristi L Lewton
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA
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Sowa B, Bochenek M, Braun S, Kretzer JP, Zeifang F, Bruckner T, Walch G, Raiss P. The subchondral bone layer and glenoid implant design are relevant for primary stability in glenoid arthroplasty. Arch Orthop Trauma Surg 2018; 138:1487-1494. [PMID: 29974217 DOI: 10.1007/s00402-018-2990-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical studies suggest that reaming of the subchondral bone layer to achieve good implant seating is a risk factor for glenoid loosening. This study aims to evaluate (1) the importance of the subchondral bone layer and (2) the influence of the design of the glenoid component. METHODS Different techniques for preparation of an A1 glenoid were compared: (1) preserving the subchondral bone layer; (2) removal of the subchondral bone layer; (3) implantation of a glenoid component that does not adapt to the native anatomy. Artificial glenoid bones (n = 5 each) were used with a highly standardized preparation and implantation protocol. Biomechanical testing was performed during simulated physiological shoulder motion. Using a high-resolution optical system, the micromotions between implant and bone were measured up to 10,000 motion cycles. RESULTS At the 10,000 cycle measuring point, significantly more micromotions were found in the subchondral layer removed group than in the subchondral layer preserved group (p = 0.0427). The number of micromotions in the nonadapted group was significantly higher than in the subchondral layer preserved group (p = 0.0003) or the subchondral layer removed group (p = 0.0207). CONCLUSION Conservative reaming proved important to diminish the micromotions of the glenoid component. Implantation of a glenoid component that matches with the bony underlying glenoid can help to preserve the subchondral bone layer without sacrificing proper implant seating.
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Affiliation(s)
- Boris Sowa
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Martin Bochenek
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Steffen Braun
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Felix Zeifang
- Ethianum Clinic Heidelberg, Voßstraße 6, 69115, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz -GDS Ramsay, 24, Avenue Paul Santy, 69008, Lyon, France
| | - Patric Raiss
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.,OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
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Wu AM, Li XL, Tian HJ, Zhang K, Zhao CQ, Sheng SR, Lin Y, Ni WF, Wang XY, Zhao J. Optimal medial transforaminal lumbar interbody fusion approach with five extensive options: A simulated study on three-dimensional digital reconstructed images. J Orthop Translat 2018; 15:1-8. [PMID: 30128289 PMCID: PMC6098232 DOI: 10.1016/j.jot.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 04/27/2018] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 10/31/2022] Open
Abstract
Objective The objective of this study is to use 3D digital lumbar models to investigate and simulate the optimal posterior operative approach for safe decompression and insertion of an interbody cage. Methods Thirty lumbar spine (L3-S1) computed tomography data are collected for 3D reconstruction. We cut medial half part of the superior facet and define the distance between the margin of the operative side of the spinous process and the medial margin of the cut superior facet as "medial distance (MD)". Then, we cut the total superior facet and define the distance between the margin of the operative side of the spinous process and the lateral side of the junction of the pedicle and the vertebral body as "extend distance (ED)". The feasible insertion of the current standard width size (10 mm and 12 mm) interbody cages was assessed by the two aforementioned MD and ED approaches. Besides the ED, we also simulate four other extensive options of lateral upper, lateral lower, vertical upper and lower and transmedian contralateral decompression on 3D digital lumbar model. Results The MD increased from 13.48 ± 1.28 mm at L3/4 to 18.05 ± 1.43 mm at L5/S1, and the ED increased from 16.64 ± 1.34 mm at L3/4 to 21.12 ± 1.62 mm at L5/S1. To insert a 10-mm-wide cage, 16.7% (left) and 13.3% (right) of MD for L3/4 is not enough, 60.0% (left) and 46.7% (right) of MD for L3/4 is subsafe, 13.3% (left) and 16.7% (right) of MD for L4/5 is subsafe and all others are safe. To insert a 12-mm-wide cage, 76.7% (left) and 60.0% (right) of MD for L3/4 is not enough, 20.0% (left) and 30.0% (right) of MD for L3/4 is subsafe, 13.3%% (left) and 16.7% (right) of MD for L4/5 is not enough, 63.3% (left) and 56.7% (right) of MD for L4/5 is subsafe and 6.7% (left) and 10.0% (right) of MD for L5/S1 is subsafe, whereas 33.3%% (left) and 30.0% (right) of ED for L3/4 is subsafe, 3.3% (left) and 3.3% (right) of ED for L4/5 is subsafe and all others are safe. Besides the ED, on 3D models, four other extensive options could be simulated too and may need to be performed for different special individuals. Conclusion Our 3D digital image study provides a feasible optimal medial transforaminal lumbar interbody fusion approach with five extensive options on lower lumbar region. It can provide safe lumbar decompression and interbody fusion in most population. In addition, surgeons can choose the different extensive options for special individual conditions. The translational potential of this article Transforminal lumbar interbody fusion is very common used for lumbar degenerative diseases. The optimal medial transforminal lumbar interbody fusion with five options provide a safe and precise approach for surgeons in treatment of lumbar degenerative diseases.
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Affiliation(s)
- Ai-Min Wu
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China.,Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Xun-Lin Li
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Hai-Jun Tian
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Kai Zhang
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Chang-Qing Zhao
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Sun-Ren Sheng
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Yan Lin
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Wen-Fei Ni
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Jie Zhao
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
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Dimitriou I, Katsourakis A, Nikolaidou E, Noussios G. The Main Anatomical Variations of the Pancreatic Duct System: Review of the Literature and Its Importance in Surgical Practice. J Clin Med Res 2018; 10:370-375. [PMID: 29581798 PMCID: PMC5862083 DOI: 10.14740/jocmr3344w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/15/2018] [Indexed: 02/07/2023] Open
Abstract
Anatomical variations or anomalies of the pancreatic ducts are important in the planning and performance of endoscopic retrograde cholangiopancreatography (ERCP) and surgical procedures of the pancreas. Normal pancreatic duct anatomy occurs in approximately 94.3% of cases, and multiple variations have been described for the remaining 5.7%. The purpose of this study was to review the literature on the pancreatic duct anatomy and to underline its importance in daily invasive endoscopic and surgical practice. Two main databases were searched for suitable articles published from 2000 to 2017, and results concerning more than 8,200 patients were included in the review. The most common anatomical variation was that of pancreas divisum, which appeared in approximately 4.5% of cases.
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Affiliation(s)
- Ioannis Dimitriou
- Department of Anatomy in the Department of Physical Education and Sports Science (Serres), Aristotle University of Thessaloniki, Thessaloniki, Greece.,Laboratory of Anatomy in the Department of Physical Education and Sports Science (Serres), Aristotele University of Thessaloniki, Thessaloniki, Greece
| | | | - Eirini Nikolaidou
- Department of Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | - George Noussios
- Laboratory of Anatomy in the Department of Physical Education and Sports Science (Serres), Aristotele University of Thessaloniki, Thessaloniki, Greece
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Abstract
Background Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Anatomic ACL reconstruction attempts to closely reproduce the patient's individual anatomic characteristics with the aim of restoring knee kinematics, in order to improve patient short and long-term outcomes. We designed an arthroscopic, patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel. Methods The guide design was based on MRI scan of the subject's uninjured contralateral knee, identifying the femoral footprint and its anatomical position relative to the borders of the femoral articular cartilage. Image processing software was used to create a 3D computer aided design which was subsequently exported to a 3D-printing service. Results Transparent acrylic based photopolymer, PA220 plastic and 316L stainless steel patient-specific ACL femoral tunnel guides were created; the models produced were accurate with no statistical difference in size and positioning of the center of the ACL femoral footprint guide to MRI (p=0.344, p=0.189, p=0.233 respectively). The guides aim to provide accurate marking of the starting point of the femoral tunnel in arthroscopic ACL reconstruction. Conclusion This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction.
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Affiliation(s)
- Iain Rankin
- Aberdeen Royal Infirmary - Trauma and Orthopaedic Surgery, Foresterhill Aberdeen AB25 2ZN, United Kingdom of Great Britain and Northern Ireland
| | - Haroon Rehman
- Aberdeen Royal Infirmary - Trauma and Orthopaedic Surgery, Foresterhill Aberdeen AB25 2ZN, United Kingdom of Great Britain and Northern Ireland
| | - Mark Frame
- University Hospital Southampton NHS Foundation Trust Ringgold standard institution - Trauma and Orthopaedic Surgery Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
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Achtnich A, Ranuccio F, Willinger L, Pogorzelski J, Imhoff AB, Braun S, Herbst E. High incidence of partially anatomic tunnel placement in primary single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:462-467. [PMID: 28439635 DOI: 10.1007/s00167-017-4555-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/14/2016] [Accepted: 04/19/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate tunnel position and width in failed primary single-bundle (SB) anterior cruciate ligament (ACL) reconstructions. It was hypothesized that both femoral and tibial bone tunnels are frequently malplaced in terms of a partially anatomic position in the setting of failed SB ACL reconstruction. METHODS Patients with recurrent instability following isolated SB ACL reconstruction using hamstring tendon autografts, undergoing revision ACL surgery, were retrospectively included. Further inclusion criteria were age >18 years and availability of preoperative computed tomography (CT) scans and radiographs of the affected knee. Patients with multiligamentous instabilities as well as incomplete or poor radiographs were excluded. Tunnel position was evaluated according to the method described by Harner et al. and Stäubli and Rauschning. Tunnel width was determined on CT scans perpendicular to the bone tunnel axis at three different heights of each bone tunnel. RESULTS Eighty-two patients met the inclusion criteria and were considered for radiological analysis. Femoral tunnels were graded as anatomic in 60% (49 of 82) of all cases. In the remaining 40% (33/82), 27% of the tunnels were placed partially anatomic and 13% were graded as non-anatomic. Tibial tunnel placement was found to be anatomic in 54% (44/82) of all cases, partially anatomic in 45% and non-anatomic in 1% of the cases. No statistically significant difference between anatomic or partially anatomic tunnel position and tunnel diameter, neither for the femoral nor for the tibial side, was observed (n.s.). CONCLUSION The present study demonstrates that there is a high incidence of partially anatomic placed tunnels in failed SB ACL reconstruction. Tunnel width was not associated with tunnel position. Clinically, partially anatomic bone tunnels frequently require a staged procedure with bone grafting and subsequent ACL revision surgery. Thus, surgeons should carefully analyse tunnel position and width preoperatively to properly plan ACL revision surgery.
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Affiliation(s)
- Andrea Achtnich
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Francesco Ranuccio
- Department of Orthopaedic and Trauma Surgery, Policlinico San Pietro, Ponte St. Pietro, Italy
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Reichel LM, MacCormick LM, Dugarte AJ, Rizkala AR, Graves SC, Cole PA. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX. Injury 2018; 49:309-314. [PMID: 29277392 DOI: 10.1016/j.injury.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 08/04/2017] [Revised: 12/03/2017] [Accepted: 12/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Anterior external fixation for pelvic ring fractures has shown to effectively improve stability and reduce mortality. However, these fixators can be associated with substantial morbidity such as pin tract infection, premature loss of fixation, and decreased quality of life in patients. Recently, two new methods of subcutaneous anterior pelvic internal fixation have been developed; the INFIX and the Pelvic Bridge. These methods have the purported advantages of lower wound complications, less surgical site pain, and improved quality of life. We sought to investigate the measured distances to critical anatomic structures, as well as the qualitative and topographic differences notable during implantation of both devices in the same cadaveric specimen. MATERIALS AND METHODS The Pelvic Bridge and INFIX were implanted in eleven fresh cadavers. Distances were then measured to: the superficial inguinal ring, round ligament, spermatic cord, lateral femoral cutaneous nerve (LFCN), femoral nerve, femoral artery, and femoral vein. Observations regarding implantation and topography were also recorded. RESULTS The INFIX had greater measured distances from all structures except for the LFCN, in which its proximity placed this structure at risk. Neither device appears to put other critical structures at risk in the supine position. Significant implantation and topographic differences exist between the devices. The INFIX application lacked "safety margins" concerning the LFCN in 10/11 (90.9%) specimens, while Pelvic Bridge placement lacked "safety margins" with regard to the right superficial ring (1/11, 9%) and the right spermatic cord (1/11, 9%). CONCLUSIONS Both the Pelvic Bridge and INFIX lie at safe distances from most critical pelvic structures in the supine position, though INFIX application places the LFCN at risk.
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Affiliation(s)
- Lee M Reichel
- Dell Medical School, University Of Texas, Surgery and Perioperative Care, United States
| | - Lauren M MacCormick
- University of Minnesota, Department of Orthopedic Surgery, Regions Hospital, United States
| | - Anthony J Dugarte
- University of Minnesota, Department of Orthopedic Surgery, Regions Hospital, United States
| | - Amir R Rizkala
- Stony Brook School of Medicine, Department of Physical Medicine and Rehabilitation, United States
| | - Sara C Graves
- Central Vermont Orthopaedics and Sports Medicine, University of Vermont health network, United States
| | - Peter A Cole
- University of Minnesota, Department of Orthopedic Surgery, Regions Hospital, United States.
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Hamrin Senorski E, Alentorn-Geli E, Musahl V, Fu F, Krupic F, Desai N, Westin O, Samuelsson K. Increased odds of patient-reported success at 2 years after anterior cruciate ligament reconstruction in patients without cartilage lesions: a cohort study from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc 2018; 26:1086-1095. [PMID: 28593387 PMCID: PMC5876276 DOI: 10.1007/s00167-017-4592-9] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/31/2017] [Indexed: 12/04/2022]
Abstract
PURPOSE To investigate whether the surgical technique of single-bundle anterior cruciate ligament (ACL) reconstruction, the visualization of anatomic surgical factors and the presence or absence of concomitant injuries at primary ACL reconstruction are able to predict patient-reported success and failure. The hypothesis of this study was that anatomic single-bundle surgical procedures would be predictive of patient-reported success. METHODS This cohort study was based on data from the Swedish National Knee Ligament Register during the period of 1 January 2005 through 31 December 2014. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendons were included. Details on surgical technique were collected using an online questionnaire comprising essential anatomic anterior cruciate ligament reconstruction scoring checklist items, defined as the utilization of accessory medial portal drilling, anatomic tunnel placement, the visualization of insertion sites and pertinent landmarks. A univariate logistic regression model adjusted for age and gender was used to determine predictors of patient-reported success and failure, i.e. 20th and 80th percentile, respectively, in the Knee injury and Osteoarthritis Outcome Score (KOOS), 2 years after ACL reconstruction. RESULTS In the 6889 included patients, the surgical technique used for single-bundle ACL reconstruction did not predict the predefined patient-reported success or patient-reported failure in the KOOS4. Patient-reported success was predicted by the absence of concomitant injury to the meniscus (OR = 0.81 [95% CI, 0.72-0.92], p = 0.001) and articular cartilage (OR = 0.70 [95% CI, 0.61-0.81], p < 0.001). Patient-reported failure was predicted by the presence of a concomitant injury to the articular cartilage (OR = 1.27 [95% CI, 1.11-1.44], p < 0.001). CONCLUSION Surgical techniques used in primary single-bundle ACL reconstruction did not predict the KOOS 2 years after the reconstruction. However, the absence of concomitant injuries at index surgery predicted patient-reported success in the KOOS. The results provide further evidence that concomitant injuries at ACL reconstruction affect subjective knee function and a detailed knowledge of the treatment of these concomitant injuries is needed. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Eric Hamrin Senorski
- 0000 0000 9919 9582grid.8761.8Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eduard Alentorn-Geli
- Fundación García-Cugat, Barcelona, Spain ,Artroscopia GC, SL, Barcelona, Spain ,Mutualidad Catalana de Futbolistas – Delegación Cataluña, Federación Española de Fútbol, Barcelona, Spain ,0000 0004 0459 167Xgrid.66875.3aDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Volker Musahl
- 0000 0004 1936 9000grid.21925.3dDepartment of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - Freddie Fu
- 0000 0004 1936 9000grid.21925.3dDepartment of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - Ferid Krupic
- 0000 0000 9919 9582grid.8761.8Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, 431 80 Mölndal, Gothenburg, Sweden
| | - Neel Desai
- 0000 0000 9919 9582grid.8761.8Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, 431 80 Mölndal, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Olof Westin
- 0000 0000 9919 9582grid.8761.8Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, 431 80 Mölndal, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, 431 80, Mölndal, Gothenburg, Sweden. .,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden.
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Tashiro Y, Okazaki K, Murakami K, Matsubara H, Osaki K, Iwamoto Y, Nakashima Y. Anterolateral rotatory instability in vivo correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft. World J Orthop 2017; 8:913-921. [PMID: 29312850 PMCID: PMC5745434 DOI: 10.5312/wjo.v8.i12.913] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/23/2017] [Accepted: 10/29/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) autografts, and to clarify the influence of tunnel positions on the knee stability.
METHODS Single-bundle ACL reconstruction with BTB autograft was performed on 50 patients with a mean age of 28 years using the trans-tibial (TT) (n = 20) and trans-portal (TP) (n = 30) techniques. Femoral and tibial tunnel positions were identified from the high-resolution 3D-CT bone models two weeks after surgery. Anterolateral rotatory translation was examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging (MRI) 1.0-1.5 years after surgery, by measuring anterior tibial translation at the medial and lateral compartments on its sagittal images. Anterior-posterior stability was evaluated with a Kneelax3 arthrometer.
RESULTS A total of 40 patients (80%) were finally followed up. Femoral tunnel positions were shallower (P < 0.01) and higher (P < 0.001), and tibial tunnel positions were more posterior (P < 0.05) in the TT group compared with the TP group. Anterolateral rotatory translations in reconstructed knees were significantly correlated with the shallow femoral tunnel positions (R = 0.42, P < 0.01), and the rotatory translations were greater in the TT group (3.2 ± 1.6 mm) than in the TP group (2.0 ± 1.8 mm) (P < 0.05). Side-to-side differences of Kneelax3 arthrometer were 1.5 ± 1.3 mm in the TT, and 1.7 ± 1.6 mm in the TP group (N.S.). Lysholm scores, KOOS subscales and re-injury rate showed no difference between the two groups.
CONCLUSION Anterolateral rotatory instability significantly correlated shallow femoral tunnel positions after ACL reconstruction using BTB autografts. Clinical outcomes, rotatory and anterior-posterior stability were overall satisfactory in both techniques, but the TT technique located femoral tunnels in shallower and higher positions, and tibial tunnels in more posterior positions than the TP technique, thus increased the anterolateral rotation. Anatomic ACL reconstruction with BTB autografts may restore knee function and stability.
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Affiliation(s)
- Yasutaka Tashiro
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, United States
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka 812-8582, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka 812-8582, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka 812-8582, Japan
| | - Hirokazu Matsubara
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka 812-8582, Japan
| | - Kanji Osaki
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka 812-8582, Japan
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Bayoumi AB, Efe IE, Berk S, Kasper EM, Toktas ZO, Konya D. Posterior Rigid Instrumentation of C7: Surgical Considerations and Biomechanics at the Cervicothoracic Junction. A Review of the Literature. World Neurosurg 2017; 111:216-226. [PMID: 29253696 DOI: 10.1016/j.wneu.2017.12.026] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The cervicothoracic junction is a challenging anatomic transition in spine surgery. It is commonly affected by different types of diseases that may significantly impair stability in this region. The seventh cervical vertebra (C7) is an atypical cervical vertebra with unique anatomic features compared to subaxial cervical spine (C3 to C6). C7 has relatively broader laminae, larger pedicles, smaller lateral masses, and a long nonbifid spinous process. These features allow a variety of surgical methods for performing posterior rigid instrumentation in the form of different types of screws, such as lateral mass screws, pedicle screws, transfacet screws, and intralaminar screws. Many biomechanical studies on cadavers have evaluated and compared different types of implants at C7. METHODS We reviewed PubMed/Medline by using specific combinations of keywords to summarize previously published articles that examined C7 posterior rigid instrumentation thoroughly in an experimental fashion on patients or cadavers with additional descriptive radiologic parameters for evaluation of the optimum surgical technique for each type. RESULTS A total of 44 articles were reported, including 22 articles that discussed anatomic considerations (entry points, sagittal and axial trajectories, and features of screws) and another 22 articles that discussed the relevant biomechanical testing at this transitional region if C7 was directly involved in terms of receiving posterior rigid implants. CONCLUSIONS C7 can accommodate different types of screws, which can provide additional benefits and risks based on availability of bony purchase, awareness of surgical technique, biomechanics, and anatomic considerations.
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Affiliation(s)
- Ahmed B Bayoumi
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey.
| | - Ibrahim E Efe
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey; Department of Neurosurgery, Charite-University Medicine Berlin, Berlin, Germany
| | - Selim Berk
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Zafer Orkun Toktas
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey
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Ohori T, Mae T, Shino K, Tachibana Y, Sugamoto K, Yoshikawa H, Nakata K. Morphological changes in tibial tunnels after anatomic anterior cruciate ligament reconstruction with hamstring tendon graft. J Exp Orthop 2017; 4:30. [PMID: 28916912 PMCID: PMC5602815 DOI: 10.1186/s40634-017-0104-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 06/29/2017] [Accepted: 09/04/2017] [Indexed: 02/05/2023] Open
Abstract
Background Three-dimensional (3D) reconstructed computed tomography (CT) is crucial for the reliable and accurate evaluation of tunnel enlargement after anterior cruciate ligament (ACL) reconstruction. The purposes of this study were to evaluate the tibial tunnel enlargement at the tunnel aperture and inside the tunnel and to clarify the morphological change at the tunnel footprint 1 year after the anatomic triple-bundle (ATB) ACL reconstruction using 3D CT models. Methods Eighteen patients with unilateral ACL rupture were evaluated. The ATB ACL reconstruction with a semitendinosus tendon autograft was performed. 3D computer models of the tibia and the three tibial tunnels were reconstructed from CT data obtained 3 weeks and 1 year after surgery. The cross-sectional areas (CSAs) of the two anterior and the one posterior tunnels were measured at the tunnel aperture and 5 and 10 mm distal from the aperture and compared between the two periods. The locations of the center and the anterior, posterior, medial, and lateral edges of each tunnel footprint were also measured and compared between the two periods. Results The CSA of the posterior tunnel was significantly enlarged at the aperture by 40.4%, whereas that of the anterior tunnels did not change significantly, although the enlargement rate was 6.1%. On the other hand, the CSA was significantly reduced at 10 mm distal from the aperture in the anterior tunnels. The enlargement rate in the posterior tunnel was significantly greater than that in the anterior tunnels at the aperture. The center of the posterior tunnel footprint significantly shifted postero-laterally. The anterior and posterior edges of the posterior tunnel footprint demonstrated a significant posterior shift, while the lateral edge significantly shifted laterally. There was no significant shift of the center or all the edges of the anterior tunnels footprint. Conclusions The posterior tibial tunnel was significantly enlarged at the aperture by 40% with the morphological change in the postero-lateral direction reflected by the ACL fiber orientation 1 year after the ATB ACL reconstruction. The proper tibial tunnel location in the ACL reconstruction should be determined considering the tunnel enlargement in postero-lateral direction after surgery.
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Affiliation(s)
- Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Yuta Tachibana
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
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