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Genter J, Croci E, Oberreiter B, Eckers F, Bühler D, Gascho D, Müller AM, Mündermann A, Baumgartner D. The influence of rotator cuff tear type and weight bearing on shoulder biomechanics in an ex vivo simulator experiment. J Biomech 2024; 166:112055. [PMID: 38522362 DOI: 10.1016/j.jbiomech.2024.112055] [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: 11/03/2023] [Revised: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Glenohumeral biomechanics after rotator cuff (RC) tears have not been fully elucidated. This study aimed to investigate the muscle compensatory mechanism in weight-bearing shoulders with RC tears and asses the induced pathomechanics (i.e., glenohumeral translation, joint instability, center of force (CoF), joint reaction force). An experimental, glenohumeral simulator with muscle-mimicking cable system was used to simulate 30° scaption motion. Eight fresh-frozen shoulders were prepared and mounted in the simulator. Specimen-specific scapular anthropometry was used to test six RC tear types, with intact RC serving as the control, and three weight-bearing loads, with the non-weight-bearing condition serving as the control. Glenohumeral translation was calculated using instantaneous helical axis. CoF, muscle forces, and joint reaction forces were measured using force sensors integrated into the simulator. Linear mixed effects models (RC tear type and weight-bearing) with random effects (specimen and sex) were used to assess differences in glenohumeral biomechanics. RC tears did not change the glenohumeral translation (p > 0.05) but shifted the CoF superiorly (p ≤ 0.005). Glenohumeral translation and joint reaction forces increased with increasing weight bearing (p < 0.001). RC and deltoid muscle forces increased with the presence of RC tears (p ≤ 0.046) and increased weight bearing (p ≤ 0.042). The synergistic muscles compensated for the torn RC tendons, and the glenohumeral translation remained comparable to that for the intact RC tendons. However, in RC tears, the more superior CoF was close to where glenoid erosion occurs in RC tear patients with secondary osteoarthritis. These findings underscore the importance of early detection and precise management of RC tears.
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Affiliation(s)
- Jeremy Genter
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Birgit Oberreiter
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Franziska Eckers
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Dominik Bühler
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Andreas M Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
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Baum C, Audigé L, Stojanov T, Müller SA, Candrian C, Müller AM, Rosso C, Fankhauser L, Willscheid G, Moroder P, Akgün D, Danzinger V, Gebauer H, Imiolczyk JP, Karpinski K, Lacheta L, Minkus M, Paksoy A, Samaniego E, Thiele K, Weiss I, Suter T, Müller-Lebschi J, Mueller S, Saner M, Haag-Schumacher C, Tamborrini-Schütz G, Trong MLD, Buitrago-Tellez C, Hasler J, Riede U, Weber S, Moor B, Biner M, Fournier S, Gallusser N, Marietan D, Pawlak S, Spormann C, Hansen B, Mamisch N, Durchholz H, Bräm J, Cunningham G, Kourhani A, Ossipow S, Simao P, Lädermann A, Egli R, Erdbrink S, Flückiger R, Lombardo P, Pinworasarn T, Scacchi P, Weihs J, Zumstein M, Flury M, Berther R, Ehrmann C, Hübscher L, Schwappach D, Eid K, Bensler S, Fritz Y, Grünberger N, Kriechling P, Langthaler D, Niehaus R, Nobs R, Benninger E, de Groot Q, Doert A, Ebert S, Grimm P, Mottier F, Pisan M, Schätz J, Schwank A, Wiedenbach J, Scheibel M, Audigé L, Bellmann F, Brune D, de Jong M, Diermayr S, Endell D, Etter M, Freislederer F, Gkikopoulos N, Glanzmann M, Grobet C, Jung C, Moro F, Moroder P, Ringer R, Schätz J, Schwyzer HK, Weber B, Wehrli M, Wirth B, Nötzli M, Franz A, Oswald J, Steiger B, Ameziane Y, Child C, Spagna G, Candrian C, Del Grande F, Feltri P, Filardo G, Marbach F, Schönweger F, Jost B, Badulescu M, Lüscher S, Napieralski F, Öhrström L, Olach M, Rechsteiner J, Scheler J, Spross C, Zdravkovic V, Zumstein MA, Chlasta A, Gerber K, Hayoz A, Müller-Lebschi J, Schuster F, Wieser K, Borbas P, Bouaicha S, Camenzind R, Catanzaro S, Gerber C, Grubhofer F, Hasler A, Hochreiter B, Marcus R, Selman F, Sutter R, Wyss S, Appenzeller-Herzog C, Aghlmandi S, Ahlborn I, Baum C, Eckers F, Grezda K, Hatz S, Hunziker S, Stojanov T, Taha M, Tamborrini-Schütz G, Mueller AM. Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon. Am J Sports Med 2024; 52:441-450. [PMID: 38259113 PMCID: PMC10838469 DOI: 10.1177/03635465231219253] [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: 06/16/2023] [Accepted: 10/02/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.
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Affiliation(s)
- Cornelia Baum
- Investigation performed at University Hospital Basel, Basel and the Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Surgical Outcome Research Center, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Thomas Stojanov
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Sebastian A. Müller
- Department of Orthopaedic and Trauma Surgery, Shoulder and Elbow, Cantonal Hospital Baselland, Bruderholz, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Candrian
- Trauma and Ortho Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Andreas M. Müller
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sandra Weber
- Hôpital du Valais–Centre Hospitalier du Valais Romand, Martigny, CH
| | | | | | | | | | | | | | | | | | | | | | - Jakob Bräm
- Hirslanden Clinique la Colline, Geneva, CH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Larissa Hübscher
- Institute of Social and Preventive Medicine, University of Bern, Bern, CH
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- University Library Basel, University of Basel, Basel, CH
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Genter J, Croci E, Ewald H, Müller AM, Mündermann A, Baumgartner D. Ex vivo experimental strategies for assessing unconstrained shoulder biomechanics: A scoping review. Med Eng Phys 2023; 117:104003. [PMID: 37331756 DOI: 10.1016/j.medengphy.2023.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Biomechanical studies of the shoulder often choose an ex vivo approach, especially when investigating the active and passive contribution of individual muscles. Although various simulators of the glenohumeral joint and its muscles have been developed, to date a testing standard has not been established. The objective of this scoping review was to present an overview of methodological and experimental studies describing ex vivo simulators that assess unconstrained, muscular driven shoulder biomechanics. METHODS All studies with ex vivo or mechanical simulation experiments using an unconstrained glenohumeral joint simulator and active components mimicking the muscles were included in this scoping review. Static experiments and humeral motion imposed through an external guide, e.g., a robotic device, were excluded. RESULTS Nine different glenohumeral simulators were identified in 51 studies after the screening process. We identified four control strategies characterized by: (a) using a primary loader to determine the secondary loaders with constant force ratios; (b) using variable muscle force ratios according to electromyography; (c) calibrating the muscle path profile and control each motor according to this profile; or (d) using muscle optimization. CONCLUSION The simulators with the control strategy (b) (n = 1) or (d) (n = 2) appear most promising due to its capability to mimic physiological muscle loads.
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Affiliation(s)
- Jeremy Genter
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Andreas M Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
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Finsterwald M, Dao Trong ML, Hollo D, Müller AM, Riede U, Bouaicha S. Conservative treatment of Rockwood type III acromioclavicular joint separation: a randomized controlled trial sling vs. brace. JSES Int 2023; 7:527-531. [PMID: 37426936 PMCID: PMC10328777 DOI: 10.1016/j.jseint.2023.02.017] [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: 07/11/2023] Open
Abstract
Background Management of Rockwood III acromioclavicular joint separations is a matter of ongoing debate, with nonoperative treatment being favored in recent literature. The aim of this study is to compare clinical and radiological outcomes of nonoperative treatment with a brace, which elicits a direct reduction force to the distal clavicle, to a sling. We hypothesized the brace might yield in better acromioclavicular joint (ACJ) reduction and cosmesis. Methods In this dual center prospective randomized controlled trial, all patients sustaining an acromioclavicular joint separation Rockwood III between July 2017 and August 2020 were included. Patients with previous ipsi- or contralateral ACJ injury or surgery were excluded. Randomization occurred in the emergency department to either the sling or brace group. Patients were followed up at 1, 6, and 12 weeks. Patient-reported outcome measures included subjective shoulder value (SSV) and American Shoulder and Elbow Surgeons (ASES) score at each follow-up and Constant Score at 6 and 12 weeks. Vertical distal clavicle displacement was assessed on bilateral non-weighted panoramic anteroposterior radiographs using coracoclavicular (CC) distance to calculate the CC-index. Results Thirty-five consecutive patients were included across the 2 sites, 18 (all male) in the brace and 17 (14 male) in the sling group. Baseline characteristics did not differ significantly between groups, the average age was 40 years, and body mass index 25.5 kg/m2. Analysis revealed no statistical difference in CC-index between groups at the time of injury, 6 weeks and 12 weeks postinjury (P = .39, P = .11, and P = .21). SSV improved from 30 and 35 postinjury to 81 and 84 at 12 weeks in the sling and brace group, respectively (P = .59). ASES improved from 48 and 38 to 82 and 83, respectively (P = .84). Similarly, Constant Score improved from 64 and 67 to 82 and 81, respectively (P = .90). One patient in the brace group underwent ACJ stabilization with hamstring autograft at 4 months due to persistent pain. Conclusion This randomized controlled trial shows no statistically significant difference between the brace and sling group in clinical (SSV, ASES, Constant Score) or radiological (CC-index) outcomes after conservative treatment of Rockwood III injuries.
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Affiliation(s)
- Michael Finsterwald
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Mai Lan Dao Trong
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - David Hollo
- Department of Orthopaedic Surgery, University Hospital Basel and Bethesda Hospital, Basel, Switzerland
| | - Andreas M. Müller
- Department of Orthopaedic Surgery, University Hospital Basel and Bethesda Hospital, Basel, Switzerland
| | - Ulf Riede
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
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Genter J, Croci E, Ewald H, Müller AM, Mündermann A, Baumgartner D. Ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics: a scoping review protocol. F1000Res 2023; 11:77. [PMID: 36704048 PMCID: PMC9834666.3 DOI: 10.12688/f1000research.72856.3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Background: Shoulder biomechanics cannot be measured directly in living persons. While different glenohumeral joint simulators have been developed to investigate the role of the glenohumeral muscles in shoulder biomechanics, a standard for these simulators has not been defined. With this scoping review we want to describe available ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics. Objective: The scoping review aims at identifying methodological and/or experimental studies describing or involving ex-vivo simulators that assess unconstrained shoulder biomechanics and synthesizing their strengths and limitations. Inclusion criteria: All unconstrained glenohumeral joint simulators published in connection with ex-vivo or mechanical simulation experiments will be included. Studies on glenohumeral simulators with active components to mimic the muscles will be included. We will exclude studies where the experiment is static or the motion is induced through an external guide, e.g., a robotic device. Methods: We will perform database searching in PubMed, Embase via Elsevier and Web of Science. Two reviewers will independently assess full texts of selected abstracts. Direct backward and forward citation tracking on included articles will be conducted. We will narratively synthesize the results and derive recommendations for designing ex-vivo simulators for assessing unconstrained shoulder biomechanics.
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Affiliation(s)
- Jeremy Genter
- ZHAW School of Engineering, IMES Institute for Mechanical Systems, Winterthur, Switzerland,Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland,
| | - Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Andreas M. Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- ZHAW School of Engineering, IMES Institute for Mechanical Systems, Winterthur, Switzerland
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Genter J, Croci E, Ewald H, Müller AM, Mündermann A, Baumgartner D. Ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics: a scoping review protocol. F1000Res 2023; 11:77. [PMID: 36704048 PMCID: PMC9834666 DOI: 10.12688/f1000research.72856.1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Shoulder biomechanics cannot be measured directly in living persons. While different glenohumeral joint simulators have been developed to investigate the role of the glenohumeral muscles in shoulder biomechanics, a standard for these simulators has not been defined. With this scoping review we want to describe available ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics. Objective: The scoping review aims at identifying methodological and/or experimental studies describing or involving ex-vivo simulators that assess unconstrained shoulder biomechanics and synthesizing their strengths and limitations. Inclusion criteria: All unconstrained glenohumeral joint simulators published in connection with ex-vivo or mechanical simulation experiments will be included. Studies on glenohumeral simulators with active components to mimic the muscles will be included. We will exclude studies where the experiment is static or the motion is induced through an external guide, e.g., a robotic device. Methods: We will perform database searching in PubMed, Embase via Elsevier and Web of Science. Two reviewers will independently assess full texts of selected abstracts. Direct backward and forward citation tracking on included articles will be conducted. We will narratively synthesize the results and derive recommendations for designing ex-vivo simulators for assessing unconstrained shoulder biomechanics.
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Affiliation(s)
- Jeremy Genter
- ZHAW School of Engineering, IMES Institute for Mechanical Systems, Winterthur, Switzerland,Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland,
| | - Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Andreas M. Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- ZHAW School of Engineering, IMES Institute for Mechanical Systems, Winterthur, Switzerland
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Genter J, Croci E, Ewald H, Müller AM, Mündermann A, Baumgartner D. Ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics: a scoping review protocol. F1000Res 2023; 11:77. [PMID: 36704048 PMCID: PMC9834666.2 DOI: 10.12688/f1000research.72856.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 02/03/2023] Open
Abstract
Background: Shoulder biomechanics cannot be measured directly in living persons. While different glenohumeral joint simulators have been developed to investigate the role of the glenohumeral muscles in shoulder biomechanics, a standard for these simulators has not been defined. With this scoping review we want to describe available ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics. Objective: The scoping review aims at identifying methodological and/or experimental studies describing or involving ex-vivo simulators that assess unconstrained shoulder biomechanics and synthesizing their strengths and limitations. Inclusion criteria: All unconstrained glenohumeral joint simulators published in connection with ex-vivo or mechanical simulation experiments will be included. Studies on glenohumeral simulators with active components to mimic the muscles will be included. We will exclude studies where the experiment is static or the motion is induced through an external guide, e.g., a robotic device. Methods: We will perform database searching in PubMed, Embase via Elsevier and Web of Science. Two reviewers will independently assess full texts of selected abstracts. Direct backward and forward citation tracking on included articles will be conducted. We will narratively synthesize the results and derive recommendations for designing ex-vivo simulators for assessing unconstrained shoulder biomechanics.
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Affiliation(s)
- Jeremy Genter
- ZHAW School of Engineering, IMES Institute for Mechanical Systems, Winterthur, Switzerland,Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland,
| | - Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Andreas M. Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- ZHAW School of Engineering, IMES Institute for Mechanical Systems, Winterthur, Switzerland
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Eckers F, Müller AM, Loske S. Aktuelle Aspekte der Behandlung der Rotatorenmanschette. Arthroskopie 2022. [DOI: 10.1007/s00142-022-00574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ZusammenfassungRotatorenmanschettenrupturen gehören zu den häufigsten muskuloskeletalen Erkrankungen und können mit ausgeprägten Schmerzen und Funktionseinschränkungen einhergehen. Für ihre Entstehung ist eine Vielzahl von Faktoren relevant, u. a. die individuelle Anatomie des Akromions. Mit Hilfe der heutigen technischen Möglichkeiten wurde nun festgestellt, dass zusätzlich zu seiner lateralen Ausdehnung auch die sagittale Ausdehnung des Akromions eine Rolle zu spielen scheint. Die bildgebende Darstellung der Rotatorenmanschette (RM) hat von den technischen Fortschritten der letzten Jahrzehnte ebenfalls profitiert. Magnetresonanztomographie (MRT) und MR-Arthrographie werden heute flächendeckend eingesetzt. Letztere bietet die höchste Sensitivität für die Entdeckung selbst kleiner Partialläsionen. Neue Sequenzen und Nachbearbeitungsmöglichkeiten können als hilfreiche tools für die operative Planung eingesetzt werden. Grundsätzlich richtet sich die Behandlung der RM neben der Symptomatik nach der Rupturgenese und -morphologie sowie der erwarteten Gewebequalität des Muskel-Sehnen-Kontinuums. Auch das Gesamtprofil, die Erwartungshaltung und die Rehabilitationsmöglichkeiten des Patienten sind wichtig. Die heutigen operativen Techniken werden durch spannende Entwicklungen der Industrie mitbestimmt, die in den letzten Jahren immer bessere Fadenankersysteme, aber auch Augmentationsmaterialien auf den Markt gebracht hat. Letztere zielen nicht nur auf die mechanische Verstärkung der Sehnenrekonstruktion, sondern auch auf die Optimierung der biologischen Eigenschaften des Konstrukts ab. Hinsichtlich Fixation konnte die biomechanische Forschung zeigen, dass zweireihige oder Suture-Bridge-Fixationen einreihigen oder transossären Fixationen überlegen sind. Diese Überlegenheit im Labor spiegelt sich noch nicht klar in den klinischen Ergebnissen wider, dennoch sind die meisten Chirurgen heute auf diese Technik übergegangen. Was die postoperative Nachbehandlung angeht, stellen jüngste randomisiert-kontrollierte Untersuchungen das Konzept der postoperativen Immobilisation in Abduktion in Frage. Hier scheint das letzte Wort noch nicht gesprochen zu sein.
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Bilici M, Reinhardt J, Morgenstern M, Müller AM, Rikli D. Outcome oriented clinical research and quality measurement in fracture care. Br J Surg 2022. [DOI: 10.1093/bjs/znac187.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
The paradigm shift according to the principles of Value-Based Healthcare is receiving growing attention. In Orthopedic Trauma care, there are no defined standards to provide an incentive system to recompensate for quality instead of quantity. The definitions of quality from the patient's view have to be validated and included in the reimbursement cycle. In our Department, we now have fully standardized and structured documentation and outcome measurement workflow from the clinical point of view.
Methods
We set up a Fracture Registry with a REDCap® Database to document every patient with surgical treatment. Included are all surgically treated fractures of the extremities, excluding the hand. Furthermore pelvic, acetabular, and periprosthetic fractures, joint dislocations, and tendon ruptures. With interfaces to our Clinical Documentation Systems, the administrative effort became very efficient. The interfaces provide a possibility to identify every patient with inclusion criteria and implement reminder feedback for Surgeons. We collect PROMs with the heartbeat-Software, and document CROMs with REDCap®. We merged these data using the software ‘R’. The documentation of each patient is completed with a database for Adverse Events.
Results
Data-entry rates were less than 50% in 2018 and have reached 99.1% for 2020 and 99.5% for 2021 for surgically treated fracture patients. Until the submission of this abstract, 2382 surgical procedures have been performed at our Department on 2073 hospitalized patients. 972 patients were included in the Fracture Registry (47%). In a feasibility study, we have merged clinical data with the PROMs of patients treated for distal radius (DR) and proximal humerus (PH) fractures. The baseline values for DR of the quality-of-life questionnaire EQ5D was 0.83 (n=144), after 3months 0.9 (n=58) and 0.97 one year after treatment (n=6). Although not more than a trend, we realized the same pattern for PH-patients with an EQ5D-Baseline of 0.75 (n=63), three months values of 0.75 (n=58), and one-year results of 0.87 (n=6).
Conclusion
Collecting structured data allows combining routine clinical data with PROMs and CROMs. This information is of inestimable value to define the quality of care for Orthopedic Trauma Surgery. Our combination of Databases to collect diagnosis, subjective and objective outcome measures has been proven feasible and showed high data quality.
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Affiliation(s)
- M Bilici
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel , Basel, Switzerland
| | - J Reinhardt
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel , Basel, Switzerland
| | - M Morgenstern
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel , Basel, Switzerland
| | - A M Müller
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel , Basel, Switzerland
| | - D Rikli
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel , Basel, Switzerland
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Stojanov T, Modler L, Müller AM, Aghlmandi S, Appenzeller-Herzog C, Loucas R, Loucas M, Audigé L. Prognostic factors for the occurrence of post-operative shoulder stiffness after arthroscopic rotator cuff repair: a systematic review. BMC Musculoskelet Disord 2022; 23:99. [PMID: 35090426 PMCID: PMC8800355 DOI: 10.1186/s12891-022-05030-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Post-operative shoulder stiffness (POSS) is one of the most frequent complications after arthroscopic rotator cuff repair (ARCR). Factors specifying clinical prediction models for the occurrence of POSS should rely on the literature and expert assessment. Our objective was to map prognostic factors for the occurrence of POSS in patients after an ARCR. Methods Longitudinal studies of ARCR reporting prognostic factors for the occurrence of POSS with an endpoint of at least 6 months were included. We systematically searched Embase, Medline, and Scopus for articles published between January 1, 2014 and February 12, 2020 and screened cited and citing literature of eligible records and identified reviews. The risk of bias of included studies and the quality of evidence were assessed using the Quality in Prognosis Studies tool and an adapted Grading of Recommendations, Assessment, Development and Evaluations framework. A database was implemented to report the results of individual studies. The review was registered on PROSPERO (CRD42020199257). Results Seven cohort studies including 23 257 patients were included after screening 5013 records. POSS prevalence ranged from 0.51 to 8.75% with an endpoint ranging from 6 to 24 months. Due to scarcity of data, no meta-analysis could be performed. Overall risk of bias and quality of evidence was deemed high and low or very low, respectively. Twenty-two potential prognostic factors were identified. Increased age and male sex emerged as protective factors against POSS. Additional factors were reported but do require further analyses to determine their prognostic value. Discussion Available evidence pointed to male sex and increased age as probable protective factors against POSS after ARCR. To establish a reliable pre-specified set of factors for clinical prediction models, our review results require complementation with an expert's opinion. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05030-4.
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Audigé L, Aghlmandi S, Grobet C, Stojanov T, Müller AM, Felsch Q, Gleich J, Flury M, Scheibel M. Prediction of Shoulder Stiffness After Arthroscopic Rotator Cuff Repair. Am J Sports Med 2021; 49:3030-3039. [PMID: 34310220 DOI: 10.1177/03635465211028980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. PURPOSE/HYPOTHESIS The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model's predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. RESULTS Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. CONCLUSION A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.
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Affiliation(s)
- Laurent Audigé
- Research and Development, Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.,Department of Orthopedic Surgery and Traumatology, University Hospital of Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Cécile Grobet
- Research and Development, Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Thomas Stojanov
- Research and Development, Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland.,Department of Orthopedic Surgery and Traumatology, University Hospital of Basel, Switzerland
| | - Andreas M Müller
- Department of Orthopedic Surgery and Traumatology, University Hospital of Basel, Switzerland
| | - Quinten Felsch
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Johannes Gleich
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Matthias Flury
- Center for Orthopedics & Neurosurgery, In-Motion, Wallisellen, Switzerland
| | - Markus Scheibel
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
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Müller SA, Adolfsson L, Baum C, Müller-Gerbl M, Müller AM, Rikli D. Fluoroscopy of the Elbow: A Cadaveric Study Defining New Standard Projections to Visualize Important Anatomical Landmarks. JB JS Open Access 2021; 6:JBJSOA-D-20-00160. [PMID: 34056508 PMCID: PMC8154458 DOI: 10.2106/jbjs.oa.20.00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Despite new 3-dimensional imaging modalities, 2-dimensional fluoroscopy remains the standard intraoperative imaging modality. The elbow has complex anatomy, and defined standard fluoroscopic projections are lacking. Therefore, the aim of this study was to define standard projections of the elbow for intraoperative fluoroscopy. Methods This study consisted of 2 parts. In part I, dissected cadaveric elbows were examined under fluoroscopy, and their radiographic anatomical features were assessed, with focus on projections showing defined anatomical landmarks. In part II, projections from part I were verified on entire cadavers to simulate intraoperative imaging. Standard projections for anteroposterior (AP) and lateral views as well as oblique and axial views were recorded. Results Eight standardized projections could be defined and included 3 AP, 1 lateral, 2 oblique, and 2 axial views. By applying these specific projections, we could visualize the epicondyles, the trochlea with its medial and lateral borders, the capitellum, the olecranon, the greater sigmoid notch, the coronoid process including its anteromedial facet, the proximal radioulnar joint with the radial tuberosity, and the anterior and posterior joint lines of the distal part of the humerus. These standard projections were reliably obtained using a specific sequence. Conclusions Knowledge about radiographic anatomy and standard projections is essential for visualizing important landmarks. With the presented standard projections of the elbow, important anatomical landmarks can be clearly examined. Thus, fluoroscopic visualization of anatomical fracture reduction and correct implant placement should be facilitated. Clinical Relevance This basic science cadaveric study defines fluoroscopic standard projections of the elbow essential for visualization of anatomical landmarks during surgery.
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Affiliation(s)
- Sebastian A Müller
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Lars Adolfsson
- Department of Orthopedic Surgery, Linköping University, Linköping, Sweden
| | - Cornelia Baum
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Andreas M Müller
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Daniel Rikli
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
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Audigé L, Bucher HCC, Aghlmandi S, Stojanov T, Schwappach D, Hunziker S, Candrian C, Cunningham G, Durchholz H, Eid K, Flury M, Jost B, Lädermann A, Moor BK, Moroder P, Rosso C, Schär M, Scheibel M, Spormann C, Suter T, Wieser K, Zumstein M, Müller AM. Swiss-wide multicentre evaluation and prediction of core outcomes in arthroscopic rotator cuff repair: protocol for the ARCR_Pred cohort study. BMJ Open 2021; 11:e045702. [PMID: 33888530 PMCID: PMC8070866 DOI: 10.1136/bmjopen-2020-045702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the field of arthroscopic rotator cuff repair (ARCR), reporting standards of published studies differ dramatically, notably concerning adverse events (AEs). In addition, prognostic studies are overall methodologically poor, based on small data sets and explore only limited numbers of influencing factors. We aim to develop prognostic models for individual ARCR patients, primarily for the patient-reported assessment of shoulder function (Oxford Shoulder Score (OSS)) and the occurrence of shoulder stiffness 6 months after surgery. We also aim to evaluate the use of a consensus core event set (CES) for AEs and validate a severity classification for these events, considering the patient's perspective. METHODS AND ANALYSIS A cohort of 970 primary ARCR patients will be prospectively documented from several Swiss and German orthopaedic clinics up to 24 months postoperatively. Patient clinical examinations at 6 and 12 months will include shoulder range of motion and strength (Constant Score). Tendon repair integrity status will be assessed by ultrasound at 12 months. Patient-reported questionnaires at 6, 12 and 24 months will determine functional scores (subjective shoulder value, OSS), anxiety and depression scores, working status, sports activities, and quality of life (European Quality of Life 5 Dimensions 5 Level questionnaire). AEs will be documented according to a CES. Prognostic models will be developed using an internationally supported regression methodology. Multiple prognostic factors, including patient baseline demographics, psychological, socioeconomic and clinical factors, rotator cuff integrity, concomitant local findings, and (post)operative management factors, will be investigated. ETHICS AND DISSEMINATION This project contributes to the development of personalised risk predictions for supporting the surgical decision process in ARCR. The consensus CES may become an international reference for the reporting of complications in clinical studies and registries. Ethical approval was obtained on 1 April 2020 from the lead ethics committee (EKNZ, Basel, Switzerland; ID: 2019-02076). All participants will provide informed written consent before enrolment in the study. TRIAL REGISTRATION NUMBER NCT04321005. PROTOCOL VERSION Version 2 (13 December 2019).
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Affiliation(s)
- Laurent Audigé
- Research and Development, Schulthess Klinik, Zurich, Switzerland
- Orthopaedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Heiner C C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Thomas Stojanov
- Research and Development, Schulthess Klinik, Zurich, Switzerland
- Orthopaedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sabina Hunziker
- Medical Communication/Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christian Candrian
- Trauma and Ortho Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Gregory Cunningham
- Shoulder Center, Hirslanden Clinique La Colline, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
| | | | - Karim Eid
- Clinic for Orthopaedics and Traumatology, Baden Cantonal Hospital, Baden, Switzerland
| | - Matthias Flury
- Center for Orthopaedics and Neurosurgery, In-Motion, Wallisellen, Switzerland
| | - Bernhard Jost
- Clinic for Orthopaedic Surgery and Traumatology of the Musculoskeletal System, Cantonal Hospital of St.Gallen, St Gallen, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Beat Kaspar Moor
- Service for Orthopaedics and Traumatology of the Musculoskeletal System, Hôpital du Valais - Centre Hospitalier du Valais Romand, Martigny, Switzerland
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charitè Medicine University, Berlin, Germany
| | - Claudio Rosso
- Shoulder and Elbow Center, Arthro Medics, Basel, Switzerland
| | - Michael Schär
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charitè Medicine University, Berlin, Germany
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Christophe Spormann
- Center for Endoprosthetics and Joint Surgery, Endoclinic, Zürich, Switzerland
| | - Thomas Suter
- Orthopaedic Shoulder and Elbow, Canton Hospital Baselland, Bruderholz, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Matthias Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland
- Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Stiftung Lindenhof, Bern, Switzerland
| | - Andreas M Müller
- Orthopaedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland
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14
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Müller SA, Taha M, Müller AM. [Update on Shoulder Arthroplasty]. Ther Umsch 2020; 77:505-510. [PMID: 33272049 DOI: 10.1024/0040-5930/a001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Update on Shoulder Arthroplasty Abstract. Shoulder arthroplasty is indicated for treatment of primary osteoarthritis, cuff tear athropathy, complex proximal humerus fractures, and posttraumatic situations. The rotator cuff plays an important role. In case of an intact rotator cuff, anatomical shoulder arthroplasty is preferred. Over the past decades, the number of hemi prostheses has declined in favor of total shoulder arthroplasties. Reverse shoulder arthroplasty is used for severe and irreparable rotator cuff tears, advanced cuff tear athropathy, and increasingly for complex proximal humerus fractures. Reverse shoulder arthroplasties account for almost 80 % of all shoulder prostheses. Modern implants allow conversion from an anatomic to a reverse situation if needed. Improved understanding of the pathology, new implant designs, and preoperative 3D planning have improved the overall outcome.
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Affiliation(s)
- Sebastian A Müller
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland
| | - Mohy Taha
- Abteilung für Orthopädie und Traumatologie, Universität Basel
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Feissli S, Audigé L, Steinitz A, Müller AM, Rikli D. Treatment options for proximal humeral fractures in the older adults and their implication on personal independence. Arch Orthop Trauma Surg 2020; 140:1971-1976. [PMID: 32350602 DOI: 10.1007/s00402-020-03452-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND No consensus exists on the optimal treatment of proximal humeral fractures (PHFx). Uncertainty about surgical treatment in the older adults using locking plates (e.g., PHILOS) has emerged, due to a high number of complications. This study aimed to assess the impact of non-operative versus operative treatment of a PHFx on the level of self-dependence in our older population. METHODS We included patients aged over 65 years with some level of self-dependence, treated at our hospital between 5/2011 and 4/2013 for isolated PHFx of AO subtypes A2, A3, and B1 for which either non-operative or surgical treatment using a PHILOS plate had been applied. The patients were questioned, examined, or interviewed via phone; AO fracture patterns and treatment were documented as well as level of self-dependence, complications, constant score (CSM), subjective shoulder value (SSV), quality of life (EQ-5D), and shoulder pain and disability index (SPADI). RESULTS Patients with PHFx of AO subtypes A2, A3, or B1 that were either treated non-operative (n = 50) or operative by insertion of the PHILOS plate (n = 63) were included. Operative-treated patients were 3.3 times as likely to lose some level of independence (95% CI 0.39-28, p = 0.271). Shoulder motion, strength, and functional outcomes tended to be lower in operative-treated patients, with adjusted differences of, - 11 CMS points (95% CI - 23 to 2), - 9 SPADI points (95% CI - 18 to 0), and - 6% in SSV (95% CI - 17 to 5). Quality-of-life EQ-5D utility index was similar in both groups (mean - 0.04; 95% CI - 0.18 to 0.10). CONCLUSION In our study population, non-operatively treated older adults with an AO type A2, A3, B1 fracture of the proximal humerus tended to have a high chance to return to their premorbid level of independence, compared to patients treated with a locking plate. A change in the treatment algorithm for these PHFx may be carefully considered and further investigated in clinical practice.
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Affiliation(s)
- Sandra Feissli
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Laurent Audigé
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Research and Development Department, Schulthess Clinic, Zurich, Switzerland.,Institute of Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Amir Steinitz
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Andreas M Müller
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Daniel Rikli
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Hollo D, Kolling C, Audigé L, Moro F, Rikli D, Müller AM. Plating and cortical bone grafting of clavicular nonunions: clinical outcome and its relation to clavicular length restoration. JSES Int 2020; 4:508-514. [PMID: 32939477 PMCID: PMC7479049 DOI: 10.1016/j.jseint.2020.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The goal of this study was to evaluate whether plating and cortical bone grafting of shortened clavicular nonunions would restore clavicular length and enable bone healing. The association between the clavicular length difference (CLD) between sides and long-term functional outcome was also explored. Methods For this retrospective 2-center study, patients who underwent plate fixation with cortical bone grafting of a clavicular nonunion were assessed after ≥2 years. The CLD and bone union were assessed using radiography and navigation ultrasound. The functional outcome was determined by the Constant score, Simple Shoulder Test score, and Subjective Shoulder Value, as well as local pain (0-10 numeric rating scale). Results Between 2 and 13 years after surgery, 25 patients (mean age, 53 years; 13 female patients) were examined. The median CLD was 0 mm (range, –17 to 13 mm) on ultrasound measurements and 2 mm (range, –32 to 9 mm) on radiographs. At follow-up, the median Constant score, Simple Shoulder Test score, Subjective Shoulder Value, and pain level were 82 points (range, 38-95 points), 12 points (range, 3-12 points), 95% (range, 60%-100%), and 0 (range, 0-8), respectively. There was no correlation between the CLD and all functional outcome scores. Bone union was achieved in all patients. After plate removal, 4 refractures occurred, 3 of which required revision. Conclusions Plate fixation with cortical bone grafting of clavicular nonunions is associated with restoration of clavicular length and a high rate of bone union. There is, however, a considerable risk of refracture following plate removal. There was no association between the CLD and clinical outcome.
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Affiliation(s)
- David Hollo
- Department of Orthopedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Christoph Kolling
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland
| | - Laurent Audigé
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland
| | - Fabrizio Moro
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Daniel Rikli
- Department of Orthopedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Andreas M. Müller
- Department of Orthopedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland
- Corresponding author: Andreas M. Müller, MD, Department of Orthopedic Surgery and Traumatology, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
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Müller SA, Müller-Lebschi JA, Müller AM. Komplikationsmanagement in der operativen Versorgung der Klavikulafraktur. Arthroskopie 2020. [DOI: 10.1007/s00142-020-00341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Audigé L, Graf L, Flury M, Schneider MM, Müller AM. Functional improvement is sustained following anatomical and reverse shoulder arthroplasty for fracture sequelae: a registry-based analysis. Arch Orthop Trauma Surg 2019; 139:1561-1569. [PMID: 31236674 DOI: 10.1007/s00402-019-03224-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 03/28/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Shoulder arthroplasty for proximal humerus fracture sequelae is known to provide significant patient improvement, yet this outcome varies with time, prosthesis type, and fracture sequelae. We outline the expected course of postoperative shoulder pain and function in patients with anatomical (ASA) or reverse (RSA) shoulder arthroplasty following different fracture sequelae. MATERIALS AND METHODS Of 111 consecutive patients from our local shoulder arthroplasty registry, 32 underwent ASA for Boileau type 1 sequelae and 77 RSA patients were identified with Boileau types I, III, and IV. By 5 year post-surgery, there were 72 patients available. All patients underwent standardised ASA or RSA procedures with anatomical (Promos Standard; Lima SMR™; Arthrex Eclipse™; Univers™ II) or reverse prostheses (Promos Reverse®; Lima SMR™ Reverse; Univers Revers™; Aequalis® Reversed). Range of motion, Constant-Murley, Disability of the Arm, Shoulder and Hand (DASH), and Shoulder Pain and Disability Index (SPADI) scores were compared at 6, 12, 24, and 60 months postoperatively. We used generalised linear mixed models or random-effects ordered logistic regression to investigate postoperative changes of outcome parameters from baseline to follow-up time points for each group as well as for group comparisons. RESULTS Range of motion and clinical scores improved until 24 months postoperatively and did not deteriorate thereafter, except for internal rotation of Boileau type III and IV patients and external rotation of RSA patients with type I and IV sequelae. At all follow-ups, ASA patients with Boileau type I sequelae had significantly better internal and external rotation versus patients with RSA and/or other Boileau types (p < 0.001), while Constant, DASH, and SPADI scores were not significantly different between groups. CONCLUSION In humeral fracture sequelae, ASA and RSA lead to sustained clinical improvements. Surgeons may primarily consider implantation of ASA in type I sequelae.
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Affiliation(s)
- Laurent Audigé
- Research and Development Department, Shoulder and Elbow Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland. .,Shoulder and Elbow Surgery Department, Schulthess Klinik, Zurich, Switzerland. .,Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland.
| | - Lukas Graf
- Research and Development Department, Shoulder and Elbow Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.,Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Matthias Flury
- Shoulder and Elbow Surgery Department, Schulthess Klinik, Zurich, Switzerland.,In Motion, Centre for Orthopaedic and Neurosurgery, Wallisellen, Switzerland
| | - Marco M Schneider
- Shoulder and Elbow Surgery Department, Schulthess Klinik, Zurich, Switzerland.,University of Witten/Herdecke, Witten, Germany
| | - Andreas M Müller
- Research and Development Department, Shoulder and Elbow Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.,Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
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Müller AM, Osório CS, Silva DR, Sbruzzi G, de Tarso P, Dalcin R. Interventions to improve adherence to tuberculosis treatment: systematic review and meta-analysis. Int J Tuberc Lung Dis 2019; 22:731-740. [PMID: 29914598 DOI: 10.5588/ijtld.17.0596] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING One of the most serious problems in tuberculosis (TB) control is non-adherence to treatment. Several strategies have been developed to improve adherence and increase the cure rate. OBJECTIVE To systematically review interventions to improve adherence to anti-tuberculosis treatment. DESIGN We performed a systematic review and meta-analysis of 22 randomised clinical trials (RCTs) to ascertain whether providing directly observed treatment, short-course (DOTS), financial incentives, food incentives and/or patient education/counselling improved adherence to anti-tuberculosis treatment. The primary outcome was cure rate; secondary outcomes were default and mortality rates. Sources used were Medline (accessed via PubMed), Cochrane Central, LILACS (Literatura Latino Americana em Ciências da Saúde, Latin American and Caribbean Health Sciences Literature) and Embase from inception to October 2015. RESULTS A significant increase in cure rates, by 18% with DOTS and by 16% with patient education and counselling, was observed. In addition, the default rate decreased by 49% with DOTS, by 26% with financial incentives and by 13% with patient education and counselling. There was no statistically significant reduction in mortality rates with these interventions. CONCLUSION Use of DOTS and patient education/counselling significantly improved cure rates; DOTS, patient education/counselling and financial incentives led to a reduction in the default rate.
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Affiliation(s)
- A M Müller
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Rio Grande do Sul
| | - C S Osório
- Universidade Federal do Rio Grande do Sul (UFRGS)
| | - D R Silva
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - G Sbruzzi
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Rio Grande do Sul
| | | | - Roth Dalcin
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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20
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Doerschner M, Pekar-Lukacs A, Messerli-Odermatt O, Dommann-Scherrer C, Rütti M, Müller AM, Nair G, Kamarachev J, Kerl K, Beer M, Messerli M, Frauenknecht K, Haralambieva E, Hoetzenecker W, French LE, Guenova E. Interferon alfa-2a maintenance after salvage autologous stem cell transplantation in atypical mycosis fungoides with central nervous system involvement. Br J Dermatol 2019; 181:1296-1302. [PMID: 30565216 DOI: 10.1111/bjd.17535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/05/2023]
Abstract
Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma with unfavourable prognosis for patients with advanced stages of the disease. Refractory disease and advanced-stage disease require systemic therapy. We report on a rare case of an atypical predominantly CD8+ folliculotropic MF, a subtype of MF with poorer prognosis, in a 59-year-old woman. She was initially diagnosed with MF restricted to the skin, of T3N0M0B0/stage IIB according to the current World Health Organization-European Organisation for Research and Treatment of Cancer classification. First-line treatment with local percutaneous radiotherapy in combination with systemic interferon alfa-2a resulted in complete remission. However, 21 months later the disease progressed to T3N0M1B0/stage IVB with development of cerebral manifestation and thus very poor prognosis. Allogeneic stem cell transplantation (SCT) was not a therapeutic option due to the lack of a suitable donor. We initiated methotrexate and cytarabine chemotherapy, followed by high-dose chemotherapy with thiotepa and carmustine with autologous SCT. Despite rapid response and complete remission of the cerebral lesions, disease recurrence of the skin occurred soon after. Interestingly, readministration of interferon alfa-2a as a maintenance treatment after the salvage autologous SCT resulted in a durable complete remission during the follow-up period of currently 17 months after autologous SCT. What's already known about this topic? Mycosis fungoides is a primary cutaneous T-cell lymphoma with unfavourable prognosis for the advanced stages of the disease. A refractory course of disease requires systemic therapy. What does this study add? We report on an unusual case of a patient with mycosis fungoides with cerebral involvement, in which a durable complete remission was achieved upon autologous stem cell therapy and interferon alfa-2a maintenance therapy.
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Affiliation(s)
- M Doerschner
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - A Pekar-Lukacs
- Department of Oncology and Pathology, Lund University, Lund, Sweden
| | | | - C Dommann-Scherrer
- Institute of Pathology, Canton Hospital Winterthur, Winterthur, Switzerland
| | - M Rütti
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - A M Müller
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - G Nair
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - J Kamarachev
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - K Kerl
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M Beer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - M Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - K Frauenknecht
- Institute of Neuropathology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - E Haralambieva
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - W Hoetzenecker
- Department of Dermatology, University Hospital Linz, Linz, Austria
| | - L E French
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - E Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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21
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Haeni DL, Lafosse T, Haggerty C, Plath J, Kida Y, Sanchez-Brass M, Wolf F, Calvo E, Müller AM, Barbero A, Lafosse L. Tissue on the Transferred Coracoid Graft After Latarjet Procedure: Histological and Morphological Findings. Am J Sports Med 2019; 47:704-712. [PMID: 30716278 DOI: 10.1177/0363546518819825] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior shoulder instability is a debilitating condition that can require stabilization via a Latarjet procedure. PURPOSE The aim of this study was to characterize the histological composition of the articular-sided surface of the coracoid bone graft after Latarjet procedure. Specific features of cells isolated from the coracoid and graft tissues were assessed. STUDY DESIGN Case series; Level of evidence, 4. METHODS Tissue samples were harvested from 9 consecutive patients undergoing arthroscopic debridement and screw removal after arthroscopic or open Latarjet procedure. Tissues were processed histologically. In 2 patients, the samples were analyzed to assess specific cellular properties. RESULTS Safranin O staining indicated that glenoid tissues contained variable amounts of glycosaminoglycan (GAG) and round chondrocytic cells mainly organized in clusters. Graft tissues contained less GAG and were more cellular but were not organized in clusters and had variable morphological features. An association appeared to exist between the cartilage quality of glenoid tissues and that of the graft tissues. Cells isolated from glenoid and graft tissues exhibited similar proliferation capacity. CONCLUSION The results of our analysis show that cells located at the articular-sided surface of transferred coracoid grafts demonstrate fibrocartilaginous properties and may have the capacity for chondral proliferation. Further studies are needed to confirm this observation and future application.
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Affiliation(s)
- David L Haeni
- Orthopaedic Department, Children's Hospital, University of Basel, Basel, Switzerland
| | | | | | | | - Yoshikazu Kida
- Pioneer Peek Orthopedics, Palmer, Alaska, USA.,Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Françine Wolf
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Emilio Calvo
- Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain
| | - Andreas M Müller
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Affiliation(s)
- Parham Sendi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Andreas M Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Elie Berbari
- Division of Infectious Disease, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Bockey A, Janda A, Braun C, Mendel B, Müller AM, Stete K, Kern WV, Rieg S, Lange B. Patient satisfaction and use of health care: a cross-sectional study of asylum seekers in Freiburg. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Bockey
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - A Janda
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - C Braun
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - B Mendel
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - AM Müller
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - K Stete
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - WV Kern
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - S Rieg
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
| | - B Lange
- Universitäts Klinikum Freiburg, Freiburg im Breisgau, Germany
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24
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Affiliation(s)
- M C Herwig-Carl
- 1 Department of Ophthalmology, Division of Ophthalmic Pathology, University of Bonn, Bonn, Germany
| | - U Gembruch
- 2 Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - K Kuchelmeister
- 3 Department of Neuropathology, University of Bonn, Bonn, Germany
| | - K U Loeffler
- 1 Department of Ophthalmology, Division of Ophthalmic Pathology, University of Bonn, Bonn, Germany
| | - A M Müller
- 4 Center of Pediatric Pathology and Pathology, MVZ Venusberg, University Clinic Bonn, Bonn, Germany
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25
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Müller AM, Born M, Jung C, Flury M, Kolling C, Schwyzer HK, Audigé L. Glenosphere size in reverse shoulder arthroplasty: is larger better for external rotation and abduction strength? J Shoulder Elbow Surg 2018; 27:44-52. [PMID: 28747277 DOI: 10.1016/j.jse.2017.06.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 02/08/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The role of glenosphere size in reverse shoulder arthroplasty (RSA) may be important in prosthetic stability, joint kinematics, rotator cuff tension and excursion, scapular impingement, humeral lateralization, deltoid wrap, and the occurrence of "notching." This study compared short- and midterm clinical and radiographic outcomes for 2 different glenosphere sizes of a single RSA type with respect to implant positioning, glenoid size, and morphology. METHODS This retrospective analysis included 68 RSA procedures that were prospectively documented in a local register during a 5-year postoperative period. Two glenosphere diameter sizes of 36 mm (n = 33) and 44 mm (n = 35) were used. Standard radiographs were made preoperatively (ie, baseline) and at 6, 12, 24, and 60 months after surgery. Range of motion, strength, the Constant-Murley score, and the Shoulder Pain and Disability Index were also assessed at all follow-up visits. The effect of glenosphere size on measured outcomes was adjusted for baseline values, patient gender, and humeral head diameter. RESULTS No significant differences were found in the functional scores between treatment groups at all follow-up assessments. At the 12-month follow-up, patients with a 44-mm glenosphere had greater external rotation in adduction (mean difference, 12°; P = .001) and abduction strength (mean difference, 1.4 kg; P = .026) compared with those with the smaller implant. These differences remained at 60 months. Scapular notching was observed in 38% of all patients, without any relevant difference between the groups. CONCLUSION An increase in glenosphere diameter leads to a clinically moderate but significant increase in external rotation in adduction and abduction strength at midterm follow-up.
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Affiliation(s)
- Andreas M Müller
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Marian Born
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Christian Jung
- Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland
| | - Matthias Flury
- Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland
| | - Christoph Kolling
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland; Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland
| | | | - Laurent Audigé
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland; Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland.
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26
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Müller AM, Flury M, Alsayed HN, Audigé L. Influence of patient and diagnostic parameters on reported retear rates after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2017; 25:2089-2099. [PMID: 28255656 DOI: 10.1007/s00167-017-4481-2] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/13/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this meta-analysis was to investigate patient and diagnostic parameters influencing the reported rates of recurrent rotator cuff defects after ARCR. METHODS PubMed, EMBASE, Cochrane Library and Scopus databases were searched for clinical studies on tendon defects after ARCR. Imaging modalities, definitions, detection time points, and other known patient risk factors (patient age, tear severity, grade of fatty infiltration, repair technique) as well as reported defect rates were extracted. A meta-analysis of proportion and meta-regression analysis were used to investigate independent variables influencing reported defect rates. RESULTS Of 109 articles reviewed, the diagnostic studies used magnetic resonance imaging (MRI) only (n = 56), ultrasound (US) only (n = 28), MRI or computed tomography (CT) arthrography (CTA, n = 14) or a combination of US, MRI and CTA (n = 11) up to 57 months after ARCR. Definitions of tendon defects were highly variable, including those of partial tendon healing with insufficient thickness defined as either an acceptable outcome (n = 72) or a recurrent defect (n = 22). Reported defect rates demonstrated highly significant heterogeneity between studies and groups. Follow-up time and the evaluation of partial tendon healing were independent factors of the defect rate alongside age, tear severity and repair technique. The type of imaging did not significantly alter defect rates. CONCLUSION A number of specific factors significantly alter the rates of rotator cuff defects reported after ARCR. Standardized protocols in clinical practice are required for consistent diagnosis of recurrent defects after ARCR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas M Müller
- Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.,Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Matthias Flury
- Upper Extremities, Schulthess Clinic, Zurich, Switzerland
| | - Hasan N Alsayed
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland.,Department of Orthopaedics, Dammam University, Dammam, Saudi Arabia
| | - Laurent Audigé
- Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland. .,Upper Extremities, Schulthess Clinic, Zurich, Switzerland.
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27
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Affiliation(s)
- A M Müller
- Zentrum für Kinderpathologie und Pathologie, MVZ Venusberg, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
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Audigé L, Flury M, Müller AM, Durchholz H. Complications associated with arthroscopic rotator cuff tear repair: definition of a core event set by Delphi consensus process. J Shoulder Elbow Surg 2016; 25:1907-1917. [PMID: 27496354 DOI: 10.1016/j.jse.2016.04.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 01/07/2016] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature does not consistently report on complications associated with arthroscopic rotator cuff repair (ARCR). Valid comparison of the occurrence of complications between ARCR interventions requires standardization. This project was implemented to define a core set of negative (untoward) events associated with ARCR along with their terms and definitions, which should be systematically documented and reported in routine care and clinical research. MATERIALS AND METHODS A Delphi consensus process was applied. An international panel of experienced shoulder surgeons was nominated through professional societies and personal contacts. On the basis of a systematic review of terms and definitions, an organized list of relevant events associated with ARCR was developed and reviewed by panel members. Between each survey, all comments and suggestions were considered to revise the proposed core set, including local event groups along with definitions, specifications, and timing of occurrence. Consensus was defined as at least two-thirds agreement. RESULTS Three successive online surveys were implemented involving 84 surgeons. Consensus with over 86% agreement was reached for a core list of local events including 3 intraoperative event groups (device, osteochondral, and soft tissue) and 9 postoperative event groups (device, osteochondral, pain, rotator cuff, surgical-site infection, peripheral neurologic, vascular, superficial soft tissue, and deep soft tissue). Experts agreed on a period for documentation of each event or group of events ranging from 3 to 24 months after ARCR. CONCLUSION A structured core set of local events associated with ARCR has been developed by international consensus. Further evaluation and validation in the context of clinical studies are required.
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Affiliation(s)
- Laurent Audigé
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland; Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland.
| | - Matthias Flury
- Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland
| | - Andreas M Müller
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | | | - Holger Durchholz
- Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland
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Alahmadi N, Evdokimov SA, Kropotov YJ, Müller AM, Jäncke L. Different Resting State EEG Features in Children from Switzerland and Saudi Arabia. Front Hum Neurosci 2016; 10:559. [PMID: 27853430 PMCID: PMC5089970 DOI: 10.3389/fnhum.2016.00559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 02/26/2016] [Accepted: 10/21/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Cultural neuroscience is an emerging research field concerned with studying the influences of different cultures on brain anatomy and function. In this study, we examined whether different cultural or genetic influences might influence the resting state electroencephalogram (EEG) in young children (mean age 10 years) from Switzerland and Saudi Arabia. Methods: Resting state EEG recordings were obtained from relatively large groups of healthy children (95 healthy Swiss children and 102 Saudi Arabian children). These EEG data were analyzed using group independent components analyses (gICA) and conventional analyses of spectral data, together with estimations of the underlying intracortical sources, using LORETA software. Results: We identified many similarities, but also some substantial differences with respect to the resting state EEG data. For Swiss children, we found stronger delta band power values in mesial frontal areas and stronger power values in three out of four frequency bands in occipital areas. For Saudi Arabian children, we uncovered stronger alpha band power over the sensorimotor cortex. The additionally measured theta/beta ratio (TBR) was similar for Swiss and Saudi Arabian children. Conclusions: The different EEG resting state features identified, are discussed in the context of different cultural experiences and possible genetic influences. In addition, we emphasize the importance of using appropriate EEG databases when comparing resting state EEG features between groups.
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Affiliation(s)
- Nsreen Alahmadi
- Department of Special Education, Institute of Higher Education Studies, King Abdulaziz University Jeddah, Saudi Arabia
| | - Sergey A Evdokimov
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Sciences St. Petersburg, Russia
| | - Yury Juri Kropotov
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Sciences St. Petersburg, Russia
| | | | - Lutz Jäncke
- Department of Special Education, Institute of Higher Education Studies, King Abdulaziz UniversityJeddah, Saudi Arabia; Department of Neuropsychology, Psychological Institute, University of ZurichZurich, Switzerland
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30
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Müller AM. [Report of the child and fetal pathology working group]. Pathologe 2016; 37:240-241. [PMID: 27796498 DOI: 10.1007/s00292-016-0234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A M Müller
- Zentrum für Kinderpathologie und Pathologie, MVZ Venusberg, Universitätsklinik Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland.
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Mallmann MR, Reutter H, Müller AM, Geipel A, Berg C, Gembruch U. Der OEIS-Komplex und assoziierte Fehlbildungen in 12 pränatal diagnostizierten Fällen. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Sterilized allografts may be less resistant to collapse and prone to nonunion leading to loss of correction in open wedge osteotomies. These adverse events usually occur at early time points (i.e., < 9 months postoperatively). The goal of this study was to compare sterilized allografts to autologous grafts in respect to secondary loss of hindfoot alignment and graft incorporation after lateral calcaneal lengthening osteotomies.Fifty patients (22 F/ 28 M, age: 16-69 years) who had undergone 50 lateral calcaneal lengthening osteotomies for adult flatfoot deformity were included in this retrospective study. Cortical sterilized allografts were used in 25 patients, autologous grafts in the remaining 25. Patients' preoperative, 6 and 12 weeks, and 6 to 9 months follow-up weight-bearing radiographs of the affected foot were analyzed by 2 blinded radiologists: on each radiograph, graft incorporation, the talo-first metatarsal angle (TFMA), the talo-navicular coverage angle (TNCA), and the calcaneal pitch angle (CPA) were assessed. Loss of hindfoot alignment was defined as an increase of the TFMA or the TNCA or a decrease of the CPA, each by 5°.Inter- and intraclass correlation coefficients for TFMA, TNCA, and CPA measurements ranged from 0.93 to 0.99. At all follow-up visits, the ratio of patients with loss of hindfoot alignment and graft incorporation was not significantly different between the allograft and autograft group. However, loss of correction was associated with failure of graft incorporation.Compared with autografts, sterilized allografts do not increase the risk for loss of hindfoot alignment in lateral column lengthening of the calcaneus. With respect to mechanical resistance, allografts thus mean an equal and valid alternative without risk of donor site morbidities.
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Affiliation(s)
- Sebastian A. Müller
- Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
- Correspondence: Sebastian A. Müller, Department of Orthopedic Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland (e-mail: ); Alexej Barg, MD, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Zdzieblo D, Li X, Lin Q, Zenke M, Illich DJ, Becker M, Müller AM. Pcgf6, a polycomb group protein, regulates mesodermal lineage differentiation in murine ESCs and functions in iPS reprogramming. Stem Cells 2015; 32:3112-25. [PMID: 25187489 DOI: 10.1002/stem.1826] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 04/16/2014] [Accepted: 07/23/2014] [Indexed: 01/04/2023]
Abstract
Polycomb group (PcG) proteins comprise evolutionary conserved factors with essential functions for embryonic development and adult stem cells. PcG proteins constitute two main multiprotein polycomb repressive complexes (PRC1 and PRC2) that operate in a hierarchical manner to silence gene transcription. Functionally distinct PRC1 complexes are defined by Polycomb group RING finger protein (Pcgf) paralogs. So far, six Pcgf paralogs (Pcgf1-6) have been identified as defining components of different PCR1-type complexes. Paralog-specific functions are not well understood. Here, we show that Pcgf6 is the only Pcgf paralog with high expression in undifferentiated embryonic stem cells (ESCs). Upon differentiation Pcgf6 expression declines. Following Pcgf6 kockdown (KD) in ESCs, the expression of pluripotency genes decreased, while mesodermal- and spermatogenesis-specific genes were derepressed. Concomitantly with the elevated expression of mesodermal lineage markers, Pcgf6 KD ESCs showed increased hemangioblastic and hematopoietic activities upon differentiation suggesting a function of Pcgf6 in repressing mesodermal-specific lineage genes. Consistant with a role in pluripotency, Pcgf6 replaced Sox2 in the generation of germline-competent induced pluripotent stem (iPS) cells. Furthermore, Pcgf6 KD in mouse embryonic fibroblasts reduced the formation of ESC-like colonies in OSKM-driven reprogramming. Together, these analyses indicate that Pcgf6 is nonredundantly involved in maintaining the pluripotent nature of ESCs and it functions in iPS reprogramming.
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Affiliation(s)
- D Zdzieblo
- Institute for Medical Radiation and Cell Research (MSZ) in the Center of Experimental Molecular Medicine (ZEMM), University of Würzburg, Würzburg, Germany
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Kurz R, Bachour H, Müller A, Bartmann P, Geipel A, Berg C, Gembruch U, Born M, Müller AM, Kalff JC, Heydweiller A. Ergebnisse von Kindern mit angeborenen Lungenfehlbildungen: Bericht über ca. 7 Jahre Erfahrung in der Kinderchirurgie der Uniklinik Bonn. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Müller AM. [Report of the working group on pediatric and fetal pathology]. Pathologe 2015; 36 Suppl 2:227-8. [PMID: 26483247 DOI: 10.1007/s00292-015-0095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Audigé L, Blum R, Müller AM, Flury M, Durchholz H. Complications Following Arthroscopic Rotator Cuff Tear Repair: A Systematic Review of Terms and Definitions With Focus on Shoulder Stiffness. Orthop J Sports Med 2015; 3:2325967115587861. [PMID: 26665096 PMCID: PMC4622367 DOI: 10.1177/2325967115587861] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Valid comparison of outcomes after surgical procedures requires consensus on which instruments and parameters should be used, including the recording and evaluation of surgical complications. An international standard outlining the terminology and definitions of surgical complications in orthopaedics is lacking. Purpose This study systematically reviewed the literature for terms and definitions related to the occurrence of negative events or complications after arthroscopic rotator cuff repair (ARCR) with specific focus on shoulder stiffness. Study Design Systematic review; Level of evidence, 4. Methods PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for reviews, clinical studies, and case reports of complications associated with ARCR. Reference lists of selected articles were also screened. The terminology of complications and their definitions were extracted from all relevant original articles by a single reviewer and verified by a second reviewer. Definitions of shoulder stiffness or equivalent terms were tabulated. Results Of 654 references published after 2007 and obtained from the search, 233 full-text papers (44 reviews, 155 studies, 31 case reports, and 3 surgical technique presentations) were reviewed. Twenty-two additional references cited for a definition were checked. One report defined the term surgical complication. There were 242 different terms used to describe local events and 64 to describe nonlocal events. Furthermore, 16 definitions of terms such as frozen shoulder, shoulder stiffness, or stiff painful shoulder were identified. Diagnosis criteria for shoulder stiffness differed widely; 12 various definitions for restriction in range of motion were noted. One definition included a gradation of stiffness severity, whereas another considered the patient’s subjective assessment of motion. Conclusion The literature does not consistently report on complications after ARCR, making valid comparison of the incidence of these events among published reports impossible. Specifically, the variation in criteria used to diagnose shoulder stiffness is problematic for valid and accurate reporting of this event. A standard for reporting this event and other complications after ARCR is needed. Clinical Relevance This review serves as the basis for the development of a uniform documentation process for shoulder stiffness and the standardization of complication definitions in ARCR following international consensus.
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Affiliation(s)
- Laurent Audigé
- Research and Development, Schulthess Clinic, Zurich, Switzerland. ; Upper Extremities, Schulthess Clinic, Zurich, Switzerland. ; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Raphael Blum
- Upper Extremities, Schulthess Clinic, Zurich, Switzerland. ; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Andreas M Müller
- Upper Extremities, Schulthess Clinic, Zurich, Switzerland. ; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Matthias Flury
- Upper Extremities, Schulthess Clinic, Zurich, Switzerland
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Hübner J, Gast AS, Müller AM, Bartmann P, Gembruch U. [Stillbirths in Germany: Retrospective Analysis of 168 Cases between 2003 and 2011]. Z Geburtshilfe Neonatol 2015; 219:73-80. [PMID: 25901868 DOI: 10.1055/s-0034-1395654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The decline in the incidence of stillbirths in Germany has remained static in recent years. This study aims to analyse the current situation of data documentation and examination of stillbirths. Furthermore, possible stillbirth prevention strategies should be developed. METHODS Searches in the international peer-reviewed literature, retrospective data collection of 168 stillbirths in 8 hospitals, (in the area of Bonn) with subsequent statistical evaluation (descriptive statistics, t-test and binominal test) were undertaken. RESULTS This study shows considerable deficits in data documentation, interdisciplinary communication and postmortal examination. Only in 51.8% (87/168) of the cases was a certain or uncertain cause of death found (42.3% placental, 1.2% foetal, 3.6% chromosomal, 4.8% umbilical cord abnormalities). Severe foetal growth restriction (<5(th) percentile) was observed in 29.2%; 44.9% (22/49) of them died at the age of ≥36+0 weeks of gestation. CONCLUSION The first step to reduce the rate of stillbirths in Germany is to increase the identified causes of foetal death: Therefore, an interdisciplinary case report form was compiled to improve data collection and interdisciplinary collaboration. To standardise and complete postmortal management, an algorithm was created. The long-term aim is the development of a central data register for statistical analysis, to identify goals of research and to organise conferences with interdisciplinary reports of diagnostic findings.
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Affiliation(s)
- J Hübner
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn
| | - A-S Gast
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn
| | - A M Müller
- Zentrum für Kinderpathologie und Pathologie, MVZ Universitätsklinikum Bonn, Bonn
| | - P Bartmann
- Abteilung für Neonatologie, Universitätsklinikum Bonn, Bonn
| | - U Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn
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Doberentz E, Madea B, Müller AM. Coronal clefts in infants - rare differential diagnosis of traumatic injuries of vertebral bodies in battered children. Leg Med (Tokyo) 2014; 16:333-6. [PMID: 25082734 DOI: 10.1016/j.legalmed.2014.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/31/2014] [Revised: 05/28/2014] [Accepted: 06/27/2014] [Indexed: 11/18/2022]
Abstract
Accidental and nonaccidental spinal injuries are generally rarely seen in infants. If affected, vertebral bodies usually present compression fractures due to forced hyperflexion or hypertension. Radiographic examination of the infantile skeleton can reveal a radiolucent band running through a vertebral body. These so called vertebral clefts are mainly visualized in the lateral spinal radiograph. Usually they can be found in the 1st year of life. Radiological appearance of coronal clefts was compared to that of a traumatic vertebral compression fracture. Clefts were mostly localized in the lumbar spine and had a completely different radiological appearance comparing to a traumatic compression fracture. As coronal clefts can be seen as a result from a retarded ossification of the vertebral bodies in fetal development they are a physiological variant. Due to this different etiology they have to be distinguished from spinal signs of child abuse.
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Affiliation(s)
- E Doberentz
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany.
| | - B Madea
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany
| | - A M Müller
- Department of Pediatric Pathology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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Knoop K, Müller AM, Schmohl KA, Schwenk N, Carlsen J, Hacker M, Göke B, Wagner E, Nelson PJ, Spitzweg C. In vivo imaging of mesenchymal stem cell recruitment into the tumor stroma of hepatocellular carcinoma (HCC) using a HIF-specific sodium iodide symporter gene system. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Novakova V, Hamprecht K, Müller AM, Arellano-Galindo J, Ehlen M, Horneff G. Severe postnatal CMV colitis with an extensive colonic stenosis in a 2-month-old male immunocompetent term infant infected via breast milk. J Clin Virol 2014; 59:259-63. [PMID: 24553057 DOI: 10.1016/j.jcv.2014.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/22/2014] [Accepted: 01/26/2014] [Indexed: 11/30/2022]
Affiliation(s)
- V Novakova
- Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinic, Arnold Janssen Strasse 29, 53575 Sankt Augustin, Germany.
| | - K Hamprecht
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen, Elfriede Aulhorn Strasse 6, 72076 Tuebingen, Germany
| | - A M Müller
- Department of Paediatric Pathology, University Clinic Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - J Arellano-Galindo
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen, Elfriede Aulhorn Strasse 6, 72076 Tuebingen, Germany; Virology Laboratory, Children Hospital of México Federico Gómez, Doctor Márquez 162 Doctores, Cuauhtémoc, 06720 México City, Distrito Federal, Mexico
| | - M Ehlen
- Department of Neonatology and Paediatric Intensive Care, Centre of Paediatrics and Neonatology, Asklepios Clinic, Arnold Janssen Strasse 29, 53575 Sankt Augustin, Germany
| | - G Horneff
- Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinic, Arnold Janssen Strasse 29, 53575 Sankt Augustin, Germany
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Hermanns MI, Müller AM, Tsokos M, Kirkpatrick CJ. LPS-induced effects on angiotensin I-converting enzyme expression and shedding in human pulmonary microvascular endothelial cells. In Vitro Cell Dev Biol Anim 2013; 50:287-95. [PMID: 24165975 DOI: 10.1007/s11626-013-9707-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/10/2013] [Indexed: 12/15/2022]
Abstract
Angiotensin I-converting enzyme (kininase II, ACE, and CD143) availability is a determinant of local angiotensin and kinin concentrations and their physiological actions. Until now, it is unclear whether the decrease of pulmonary ACE activity in sepsis-described in clinical studies-is due to an enzyme compensatory downregulation (reduced ACE-mRNA expression) to shedding of ACE or endothelial damage. To address these questions, ACE distribution under septic conditions was studied in vitro by treating pulmonary microvascular endothelial cells (HPMEC) and human umbilical vein endothelial cells (HUVEC) with lipopolysaccharide from Escherichia coli (LPS). Primary isolated HUVEC and HPMEC were compared by detecting ACE activity, membrane-bound ACE, as well as shedding and mRNA production of ACE with and without LPS (1 ng/ml-1 μg/ml). ACE mRNA expression was detected by real-time PCR, and shedded ACE was measured in cell culture supernatant by ELISA. Additionally, membrane-bound protein expression was investigated by immunohistochemistry in situ. In septic ARDS, the distribution of ACE protein was significantly reduced in all lung endothelial cells (p<0.001). After stimulation with LPS, cultivated HPMEC showed more markedly than HUVEC, a concentration-dependent reduction of ACE protein expression compared to the respective untreated controls. Real-time PCR demonstrated a reduced ACE mRNA expression after LPS stimulation, predominantly in HPMEC. Specifically, in HPMEC, a concentration-dependent increase of shedded ACE was shown 24 h after LPS treatment. HPMEC cultures are an apt model for the investigation of pulmonary ACE expression in sepsis. This study suggests that reduced pulmonary microvascular endothelial ACE expression in septic ARDS is caused by two processes: (initial) increased shedding of ACE accompanied by a compensatory downregulation of ACE-mRNA and membrane-bound protein expression.
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Affiliation(s)
- M I Hermanns
- IKFE GmbH, Cell Biology, Parcusstr. 6, 55116, Mainz, Germany,
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Vavken P, Wimmer MD, Smirnov E, Quidde J, Speth B, Müller AM, Valderrabano V. [Evidence-based treatment of combined rotator cuff and SLAP lesions]. Z Orthop Unfall 2013; 151:513-9. [PMID: 24129723 DOI: 10.1055/s-0033-1350793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE In the face of improved radiological and arthroscopic techniques the diagnosis and treatment of SLAP lesions has recently gained much interest. Originally described as an (isolated) injury of the overhead athlete, it was only recently that the association of SLAP and rotator cuff defects was described in up to 40 % of cases. This study addresses the question of the evidence-based treatment of such frequent, combined lesions. METHODS Based on a systematic review of the online databases PubMed, EMBASE, CINAHL and Cochrane Library we identified clinical studies on the treatment of combined SLAP and rotator cuff lesions. Study quality was assessed using levels of evidence and a modified Jadad score. Clinical outcome was assessed through scores and range of motion assessments. RESULTS We included 7 studies of 374 patients with a mean age of 53 ± 11 years followed for 35 ± 13 months. Combined lesions have a significant negative effect on isolated rotator cuff or SLAP repair. Patients older than 45 years of age had a significantly better clinical result after biceps tenotomy than SLAP repair with concomitant rotator cuff repair. Biceps tenotomy plus rotator cuff repair showed significantly better range of motion for flexion and rotation than SLAP plus rotator cuff repair. CONCLUSION The frequent combination of SLAP and rotator cuff injury should be considered during assessment and informed consent of shoulder patients. While young patients and isolated SLAP lesions show excellent clinical results after elective repair, combined lesions should be treated with biceps tenotomy and/or debridement plus rotator cuff repair in patients older than 45 years.
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Affiliation(s)
- P Vavken
- Orthopädische Universitätsklinik Basel, Universitätsspital Basel, Schweiz
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Müller AM, Sadoghi P, Lucas R, Audige L, Delaney R, Klein M, Valderrabano V, Vavken P. Effectiveness of bracing in the treatment of nonosseous restriction of elbow mobility: a systematic review and meta-analysis of 13 studies. J Shoulder Elbow Surg 2013; 22:1146-52. [PMID: 23796383 DOI: 10.1016/j.jse.2013.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/21/2013] [Accepted: 04/01/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restriction of elbow mobility is a very frequent complaint after trauma or surgery. The objective of this study was to assess and compare the effectiveness of dynamic, static, or static-progressive bracing in patients with elbow stiffness of traumatic or postoperative origin and without evidence of ossification. For the purpose of this study, effectiveness was measured as the increase in total range of motion, as well as extension and flexion. MATERIALS AND METHODS We performed a systematic search of the keywords "elbow AND (stiffness OR stiff) AND (brace OR splint OR conservative)" in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. We included all clinical studies using dynamic or static bracing in patients with elbow stiffness. Eligible outcomes were changes in total range of motion, flexion, and extension; sustainability of results; and complications. RESULTS We included 13 eligible studies, providing data on 14 treated groups in 247 patients. The mean age of these patients was 34.5 ± 10.4 years, and female patients comprised 46% ± 12%. The mean duration from the incident to the start of brace treatment was 6.9 ± 5.1 months. The mean improvement in range of motion during the course of treatment was 38.4° ± 8.9° (95% confidence interval, 39.5°-41.8°). CONCLUSIONS The current evidence strongly supports the use of static-progressive stretching 3 times 30 minutes per day in each direction as a first line of treatment in patients with post-traumatic and postsurgical elbow stiffness. If this treatment fails or if reasons for stiffness other than soft-tissue incompliance are identified, further surgical interventions should be considered.
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Affiliation(s)
- Andreas M Müller
- Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland
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Rosso C, Müller AM, Entezari V, Dow WA, McKenzie B, Stanton SK, Li D, Cereatti A, Ramappa AJ, DeAngelis JP, Nazarian A, Della Croce U. Preliminary evaluation of a robotic apparatus for the analysis of passive glenohumeral joint kinematics. J Orthop Surg Res 2013; 8:24. [PMID: 23883431 PMCID: PMC3724692 DOI: 10.1186/1749-799x-8-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/15/2013] [Indexed: 11/12/2022] Open
Abstract
Background The shoulder has the greatest range of motion of any joint in the human body. This is due, in part, to the complex interplay between the glenohumeral (GH) joint and the scapulothoracic (ST) articulation. Currently, our ability to study shoulder kinematics is limited, because existing models isolate the GH joint and rely on manual manipulation to create motion, and have low reproducibility. Similarly, most established techniques track shoulder motion discontinuously with limited accuracy. Methods To overcome these problems, we have designed a novel system in which the shoulder girdle is studied intact, incorporating both GH and ST motions. In this system, highly reproducible trajectories are created using a robotic actuator to control the intact shoulder girdle. High-speed cameras are employed to track retroreflective bone markers continuously. Results We evaluated this automated system’s capacity to reproducibly capture GH translation in intact and pathologic shoulder conditions. A pair of shoulders (left and right) were tested during forward elevation at baseline, with a winged scapula, and after creation of a full thickness supraspinatus tear. Discussion The system detected differences in GH translations as small as 0.5 mm between different conditions. For each, three consecutive trials were performed and demonstrated high reproducibility and high precision.
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Affiliation(s)
- Claudio Rosso
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
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Vavken P, Sadoghi P, von Keudell A, Rosso C, Valderrabano V, Müller AM. Rates of radiolucency and loosening after total shoulder arthroplasty with pegged or keeled glenoid components. J Bone Joint Surg Am 2013; 95:215-21. [PMID: 23389784 DOI: 10.2106/jbjs.l.00286] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to conduct a meta-analysis and cost-effectiveness analysis of the effect of glenoid design on radiolucency, loosening, and revision after total shoulder arthroplasty. METHODS We conducted a systematic review of PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL with use of a search for the terms arthroplasty AND shoulder AND (peg OR keel). Data on study design and on the end points of radiolucency, loosening, and revision were extracted independently and in duplicate. Random-effect models were used to calculate the pooled risk ratio and risk difference. The risk difference was used to estimate the number needed to treat (the number of individuals who would have to receive a pegged component to avoid one loosening or revision). RESULTS Eight studies with a total of 1460 patients (mean age, sixty-seven years) were included. The mean study quality was 1.75 points (95% confidence interval [CI], 1.26 to 2.24) on the 3-point modified Jadad scale. There was no significant difference in the risk of any radiolucency (risk ratio, 0.42; 95% CI, 0.12 to 1.42) or in the risk of severe radiolucency (risk ratio, 0.65; 95% CI, 0.23 to 1.82) between pegged and keeled components. The pooled risk ratio for revision was 0.27 (95% CI, 0.08 to 0.88) in favor of pegged components (p = 0.028). At a cost-effectiveness threshold of $50,000 per quality-adjusted life year, pegged components can be between $2325 and $40,920 more expensive than keeled components and still be cost-effective. CONCLUSIONS Our study produced evidence that pegged glenoid components were associated with a lower revision risk compared with keeled components. However, the difference was rather small and will therefore be most meaningful to high-volume shoulder arthroplasty centers. Because of the similarity between primary and secondary costs, pegged glenoid designs were more cost-effective than keeled glenoid designs.
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Affiliation(s)
- Patrick Vavken
- Department of Orthopedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Enders 260, Boston, MA 02115, USA.
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Abstract
Approximately 1% of the world's adult population is affected by ankle osteoarthritis (OA). Therapeutic options include conservative and surgical measures. Because of substantial progress in total ankle replacement, ankle fusion is no longer the "gold standard" therapy for end-stage ankle OA. Various ankle prostheses have been designed and are currently available. This article reviews the in vitro studies addressing the biomechanics and kinematics of the replaced ankle. Furthermore, a systematic literature review was conducted to assess possible differences in clinical outcomes, including prosthesis survivorship and postoperative range of motion between mobile- and fixed-bearing total ankle prostheses.
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Affiliation(s)
- Victor Valderrabano
- Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland.
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Abstract
The ankle joint is part of a biomechanical hindfoot complex. Approximately 1% of the world's adult population is affected by ankle osteoarthritis (AO). Trauma is the primary cause of ankle OA, often resulting in varus or valgus deformities. Only 50% of patients with end-stage ankle OA have a normal hindfoot alignment. The biomechanics and morphology of the arthritic valgus ankle is reviewed in this article and therapeutic strategies, including joint preserving and nonpreserving modalities are presented. Pitfalls are discussed and the literature is reviewed regarding outcomes in patients with valgus deformity who underwent total ankle replacement.
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Affiliation(s)
- Alexej Barg
- Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland.
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Abstract
Cystic abdominal structures in first trimester fetuses are rare. In order to elucidate the clinical significance of first trimester abdominal cysts, we present three cases of the ultrasonographic detection of upper abdominal cysts in first trimester fetuses with spontaneous regression until birth. Cysts with maximum diameters of 20, 15 and 21 mm were diagnosed in the first scan at 12 + 3 weeks of gestation and two times at 13 + 0 weeks of gestation, respectively. They had echogenic walls, a longish shape and were all located in the upper part of the abdomen. Further anomalies, relevant maternal infections, the most frequent cystic fibrosis mutations and fetal chromosomal abnormalities were excluded. In all three cases follow-up scans showed similar characteristics: The relatively large intraabdominal cyst resolved during the early second trimester. A hyperdense structure of up to 24 mm close to the liver capsule was the sole prenatally detectable remnant. During the first months after birth, development of all three children was normal. Pediatric ultrasound examination reported subcapsular liver calcifications. In conclusion, these cases demonstrate that first trimester upper abdominal cysts with spontaneous resolution until birth are associated with a favorable outcome, if infections and additional anatomical or chromosomal anomalies are ruled out. Nevertheless, one should be aware that postnatal gastrointestinal complications have been described in a few cases, even if the cyst had resolved spontaneously in utero.
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Affiliation(s)
- V Holschbach
- Center for Prenatal Medicine, Caritas Krankenhaus St. Josef, Regensburg
| | - C R Lattrich
- Center for Prenatal Medicine, Caritas Krankenhaus St. Josef, Regensburg
| | - O Ortmann
- Center for Prenatal Medicine, Caritas Krankenhaus St. Josef, Regensburg
| | - A M Müller
- Department of Pediatric Pathology, University of Bonn
| | - U Germer
- Center for Prenatal Medicine, Caritas Krankenhaus St. Josef, Regensburg
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Rapp M, Rapp M, Berg C, Knoepfle G, Müller AM, Bartmann P, Müller AM. Prenatal suspicion of Kaposiform hemangioendo-thelioma in siblings: different clinical manifestation and emergency relief. Klin Padiatr 2012; 224:390-1. [PMID: 23143766 DOI: 10.1055/s-0032-1327562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Rapp
- Neurosurgery, University of Duesseldorf, Duesseldorf, Germany.
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Mehrkens A, Müller AM, Valderrabano V, Schären S, Vavken P. Tissue engineering approaches to degenerative disc disease--a meta-analysis of controlled animal trials. Osteoarthritis Cartilage 2012; 20:1316-25. [PMID: 22789805 DOI: 10.1016/j.joca.2012.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/06/2012] [Accepted: 06/15/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this systematic review was to assess cell/biomaterial treatments of degenerative disc disease in controlled animal trails. The primary endpoints were restoration of disc height and T2 signal intensity. METHOD PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews (CDSR) were searched for studies reporting on the use of tissue engineering treatments (cells/biomaterials/cells and biomaterials) for degenerative disc disease treatments in a controlled trial. Publication bias was assessed graphically using funnel plots and Egger's regression. Data were grouped by follow-up duration - early (<4 weeks), intermediate (4-12 weeks) and late (>12 weeks), and weighted mean differences (WMD) were calculated using DerSimonian-Laird Random Effect models. RESULTS Thirteen papers, published between 2004 and 2011, were included in this study. In comparison with the injured disc, all three treatments showed a positive effect in disc height, but none of the treatments restored disc height compared to the healthy disc. Overall, there seemed to be a better effect on disc height restoration for the treatment with cells and biomaterials. None of the treatments could achieve the same T2 signal intensity as the healthy disc, and compared to the injured disc, only the treatment with cells and biomaterials showed consistently better results. CONCLUSION Treatment of an injured/degenerating disc with cells, cells plus biomaterial or biomaterial alone has a potential for at least a partial regeneration of the disc. However, so far, none of the treatments is able to effectively restore the properties of a healthy disc.
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Affiliation(s)
- A Mehrkens
- Toronto Western Research Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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