The role of bone morphology of the greater tuberosity and lateral acromion on subacromial space during scaption: a three-dimensional dynamic simulation analysis.

BACKGROUND: The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES: This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS: Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS: CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION: Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE: III.

[Conventional radiological markers in rotator cuff surgery]. / Marqueurs radiologiques conventionnels dans la chirurgie de la coiffe des rotateurs.

The surgical management of a degenerative or traumatic lesion of the shoulder joint is based on anatomical, clinical, and radiologic criteria. To optimize the diagnostic and therapeutic management of patients, the use of radiological imaging must be accompanied by meticulous clinical examination first. Conventional radiography is an effective complementary exam to assess the nature of shoulder joints injuries. Many conventional radiographic markers have been described, mainly for degenerative rotator cuff lesions, and are routinely used by clinicians as a screening tool. The aim of this review was to describe these different markers and define their reliability and usefulness in avoiding more expensive imaging modalities.

La prise en charge chirurgicale d'une lésion dégénérative ou traumatique de l'épaule repose sur des critères anatomiques, cliniques et radiologiques. Afin d'optimiser la prise en charge diagnostique et thérapeutique des patients, le recours à l'imagerie est essentiel et doit être accompagné d'un examen clinique méticuleux. La radiographie conventionnelle est un examen efficace de dépistage pour apporter un diagnostic de présomption. Plusieurs marqueurs radiologiques ont été décrits, surtout dans les pathologies de la coiffe des rotateurs, et sont couramment utilisés dans la pratique clinique. Le but de cet article est d'effectuer une revue critique de ces différents marqueurs et de définir leurs fiabilité et utilité clinique pour éviter de recourir à une imagerie plus coûteuse.

Engineering Purely Nonlinear Coupling between Superconducting Qubits Using a Quarton.

Strong nonlinear coupling of superconducting qubits and/or photons is a critical building block for quantum information processing. Because of the perturbative nature of the Josephson nonlinearity, linear coupling is often used in the dispersive regime to approximate nonlinear coupling. However, this dispersive coupling is weak and the underlying linear coupling mixes the local modes, which, for example, distributes unwanted self-Kerr nonlinearity to photon modes. Here, we use the quarton to yield purely nonlinear coupling between two linearly decoupled transmon qubits. The quarton's zero ϕ^{2} potential enables an ultrastrong gigahertz-level cross-Kerr coupling, which is an order of magnitude stronger compared to existing schemes, and the quarton's positive ϕ^{4} potential can cancel the negative self-Kerr nonlinearity of qubits to linearize them into resonators. This ultrastrong cross-Kerr coupling between bare modes of qubit-qubit, qubit-photon, and even photon-photon is ideal for applications such as single microwave photon detection, ultrafast two-qubit gates, and readout.

A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial.

BACKGROUND: Hematoma formation and the need for blood transfusions are commonly reported complications after shoulder arthroplasty. Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to decrease perioperative blood loss. The role of TXA is still being established in shoulder arthroplasty. MATERIALS AND METHODS: We conducted a double-blind randomized controlled trial comparing intravenous TXA vs. placebo in 60 patients undergoing primary anatomic or reverse shoulder arthroplasty. Of these patients, 29 received a placebo whereas 31 received a single dose of 2 g of intravenous TXA. Patient demographic characteristics, as well as drain tube output, blood loss, hematoma formation, transfusion requirement, length of hospital stay, and pain score, were recorded. Patients were followed up for 12 weeks to assess for complications. RESULTS: Patients who received TXA had a lower drain tube output at all time points: 41 mL vs. 133 mL at 6 hours, 75 mL vs. 179 mL at 12 hours, and 94 mL vs. 226 mL at 24 hours (P < .001 for all). They also had a higher postoperative hemoglobin (Hb) level (12.3 g/dL vs. 11.4 g/dL, P = .009), lower change in Hb level (1.7 g/dL vs. 2.3 g/dL, P = .011), lower total Hb loss (0.078 g vs. 0.103 g, P = .042), lower blood volume loss (0.55 L vs. 0.74 L, P = .021), higher postoperative hematocrit level (36.7% vs. 34.6%, P = .020), and lower hematocrit change (5.4% vs. 7.6%, P = .022). There was no significant difference in pain score or length of hospital stay, and no patients required a transfusion. CONCLUSION: A single dose of 2 g of intravenous TXA decreases blood loss and drain tube output in primary anatomic and reverse arthroplasty of the shoulder. No differences were detected in the occurrence of complications, need for transfusion, pain score, or length of hospital stay. With the mounting evidence now available, patients undergoing elective primary shoulder arthroplasty should be given intravenous TXA to decrease perioperative blood loss.

Smartphone application technique for localising magnetically controlled growth rod actuators: the Oxford Magnetic Counter App Technique (TOMCAT).

PURPOSE: The purpose of this study is to report a novel smartphone app technique to localise a magnetically controlled growing rod (MCGR) actuator, along with determining this novel technique accuracy compared to current tactile localisation techniques through an experimental study. METHODS: Five spinal surgery fellows recorded attempts localising the MCGR magnetic actuator using a novel smartphone app technique, MAGEC Wand and magnetic disc. Three attempts per technique were performed and repeated in both the average and overweight patient models. RESULTS: In total, 90 separate localisation attempts were recorded. The smartphone app produced less localisation error than both the MAGEC Wand and magnetic disc. Mean difference was - 0.71 cm (95% CI - 1.24 to - 0.18 cm p = 0.06) and - 0.58 cm (95% CI - 1.11 to - 0.04 cm p = 0.031), respectively. Mean localisation error for the smartphone app, MAGEC Wand and magnetic disc, was 0.9 cm, 1.61 cm, 1.47 cm, respectively, for both average and overweight models combined. CONCLUSIONS: This novel smartphone app localisation technique is accurate. Current MAGEC Wand and magnetic disc techniques produced more localisation error than the reported tolerance of the external remote control lengthening unit in this experiment.

A Biomechanical Comparison of Different Suture Materials Used for Arthroscopic Shoulder Procedures.

PURPOSE: To evaluate the viscoelastic properties of 4 commercially available cord-like sutures and 2 commercially available suture tapes when subjected to physiological loads, as well as to compare them with each other and to identify the clinically most desirable combination of suture material properties. METHODS: Six suture materials (Ethibond, FiberWire, FiberTape, Orthocord, Ultrabraid, and Ultratape) underwent creep testing (n = 7, 60 N, 10 minutes) to determine specimen stiffness, initial elongation at 60 N of load, static creep (during 10 minutes of loading), and relaxed elongation (material recovery 3 minutes after removal of load). Furthermore, cyclic testing (n = 7, 10-45 N, 0.5 Hz, 500 cycles) was carried out to determine dynamic creep, peak-to-peak displacement, and relaxed elongation. Mechanical testing was conducted on a material testing machine in 37°C phosphate-buffered saline solution. RESULTS: FiberTape showed the greatest stiffness (23.9 ± 3.2 N/mm, P < .001), the smallest amounts of static (0.38 ± 0.10 mm, P < .001) and dynamic (0.16 ± 0.09 mm, P = .003) creep, and the smallest peak-to-peak displacement (0.20 ± 0.02 mm, P < .001). FiberTape and FiberWire showed the smallest initial elongation (1.17 ± 0.17 mm and 1.63 ± 0.25 mm, respectively; P < .001). Ultrabraid showed the greatest relaxed elongation, both statically (4.73 ± 0.73 mm, P < .001) and dynamically (4.18 ± 0.83 mm, P = .002). CONCLUSIONS: FiberTape consistently displayed less creep, greater stiffness, and less extensibility than the other suture types. Ultrabraid showed the largest amount of relaxed elongation on both static and dynamic testing. CLINICAL RELEVANCE: When considering high stiffness in combination with low initial extension and low static creep to be ideal parameters to achieve optimal initial construct stability and considering low dynamic creep in combination with low peak-to-peak displacement to be ideal conditions for the repetitive loading of the construct during the healing process, tapes seem to be superior to cord-like sutures for performing rotator cuff repair.

Accuracy of arthroscopic fluid pump systems in shoulder surgery: a comparison of 3 different pump systems.

BACKGROUND: Extra-articular fluid extravasation is a known complication during shoulder arthroscopy. The risk and amount of extravasation to a large degree is dependent on the fluid pressure delivered to the surgical site. Accurate measurement, knowledge, and control of the pressure delivered is thus important to surgeons, anesthetists, and the patient. The purpose of this study was to compare the pressure measurement accuracy of 3 arthroscopic fluid pumps, with 2 of them having 2 different settings. METHODS: Twenty-five patients (n = 5 per group) undergoing shoulder arthroscopy were selected. Three different arthroscopic fluid pumps (ConMed 24K, Stryker Crossflow, Arthrex Dual Wave) were tested in 5 different operational settings (Stryker, standard and dynamic mode; ConMed, with and without TIPS; Arthrex Dual Wave). In each operation, the set pump pressures and the subsequently delivered intra-articular surgical site fluid pressures were measured by a spinal needle connected to an anesthetic standard pressure transducer attached to the anesthetic machine. Independent measures of the surgical site pressures were obtained before multiple portals were created or extravasation had occurred. Measurements were taken at the beginning of surgery. RESULTS: Measurements of the mean intra-articular pressure were found to not be significantly different from the set pressure for the ConMed 24K with TIPS (0.98 ± 0.02-fold) and Stryker Crossflow in standard mode (0.98 ± 0.02-fold). However, actual pressure was significantly greater than the set pressure for the ConMed 24K without TIPS (by 1.30 ± 0.13-fold), Stryker Crossflow in dynamic mode (by 1.82 ± 0.08-fold), and Arthrex Dual Wave (by 2.19 ± 0.06-fold). CONCLUSION: Independently measured intra-articular pressure can be more than double the set pressure for some arthroscopic pumps. Measuring intra-articular pressure can thus aid in adjusting the set pressure. This could minimize the risk of intraoperative complications.

The arthroscopic Latarjet: a multisurgeon learning curve analysis.

BACKGROUND: The open Latarjet procedure is a standard surgical treatment option for anterior shoulder instability in patients with a high risk of failure following soft tissue stabilization. The arthroscopic technique has potential advantages of minimal invasiveness, reduced postoperative stiffness, and faster rehabilitation but is regarded as technically challenging with concern over surgical risk during the learning curve. The aim of this study was to undertake a multisurgeon, large-volume learning curve analysis of the arthroscopic Latarjet procedure using continuous learning curve analysis. METHODS: Individual patient data from 12 surgeons across 5 countries were retrospectively reviewed. A total of 573 patients undergoing the arthroscopic Latarjet procedure were included. Outcome measures of learning were collected, including operative time, computed tomography (CT) bone-block positioning, complications, and patient-reported outcome measures (PROMs). A segmented linear regression modeling technique was used for learning curve analysis. RESULTS: High-volume surgeons converged to an operative time steady state after 30-50 cases. Surgeons completing fewer procedures demonstrated a constant reduction in operative time without reaching a plateau. Low-volume surgeons completing fewer than 14 operations did not demonstrate a reduction in operative time. Accuracy of bone-block positioning on postoperative CT demonstrated constant improvement without reaching a plateau after 53 cases. There was no change in PROMs or complications with increased operative volume. CONCLUSION: Specialist shoulder surgeons require 30-50 arthroscopic Latarjet procedures to attain steady-state operative efficiency, during which there is improvement in bone-block positioning. Only surgeons expecting to undertake the arthroscopic Latarjet in high volume should consider adopting this procedure.

Visual field shape and foraging ecology in diurnal raptors.

Birds, particularly raptors, are believed to forage primarily using visual cues. However, raptor foraging tactics are highly diverse - from chasing mobile prey to scavenging - which may reflect adaptations of their visual systems. To investigate this, we studied the visual field configuration of 15 species of diurnal Accipitriformes that differ in such tactics, first focusing on the binocular field and blind area by using a single-traits approach, and then exploring the shape of the binocular field with a morphometric approach. While the maximum binocular field width did not differ between species with different foraging tactics, the overall shape of their binocular fields did. In particular, raptors chasing terrestrial prey (ground predators) had a more protruding binocular field and a wider blind area above the head than did raptors chasing aerial or aquatic prey and obligate scavengers. Ground predators that forage on mammals from above have a wide but short bill - which increases ingestion rate - and a large suborbital ridge to avoid sun glare. This may explain the protruding binocular field and the wide blind area above the head. By contrast, species from the two other groups have long but narrow bills used to pluck, flake or tear food and may need large visual coverage (and reduced suborbital ridges) to increase their foraging efficiency (e.g. using large visual coverage to follow the escaping prey in three dimensions or detect conspecifics). We propose that binocular field shape is associated with bill and suborbital ridge shape and, ultimately, foraging strategies.

Comparative analysis of 2 glenoid version measurement methods in variable axial slices on 3-dimensionally reconstructed computed tomography scans.

BACKGROUND: Most glenoid version measurement methods have been validated on 3-dimensionally corrected axial computed tomography (CT) slices at the mid glenoid. Variability of the vault according to slice height and angulation has not yet been studied and is crucial for proper surgical implant positioning. The aim of this study was to analyze the variation of the glenoid vault compared with the Friedman angle according to different CT slice heights and angulations. The hypothesis was that the Friedman angle would show less variability. MATERIALS AND METHODS: Sixty shoulder CT scans were retrieved from a hospital imaging database and were reconstructed in the plane of the scapula. Seven axial slices of different heights and coronal angulations were selected, and measurements were carried out by 3 observers. RESULTS: Mid-glenoid mean version was -8.0° (±4.9°; range, -19.6° to +7.0°) and -2.1° (±4.7°; range, -13.0° to +10.3°) using the vault method and Friedman angle, respectively. For both methods, decreasing slice height or angulation did not significantly alter version. Increasing slice height or angulation significantly increased anteversion for the vault method (P < .001). Both interobserver reliability and intraobserver reliability were significantly higher using the Friedman angle. CONCLUSION: Version at the mid and lower glenoid is similar using either method. The vault method shows less reliability and more variability according to slice height or angulation. Yet, as it significantly differs from the Friedman angle, it should still be used in situations where maximum bone purchase is sought with glenoid implants. For any other situation, the Friedman angle remains the method of choice.

The greater tuberosity angle: a new predictor for rotator cuff tear.

BACKGROUND: The implication of scapular morphology in rotator cuff tears has been extensively studied. However, the role of the greater tuberosity (GT) should be of equal importance. The aim of this study was to propose a new radiographic marker, the GT angle (GTA), which measures the position of the GT in relation to the center of rotation of the humeral head. The hypothesis was that a higher angle value would be associated with a higher likelihood in detecting a rotator cuff tear. METHODS: During 1 year, patients were prospectively recruited from a single institution specialized shoulder clinic in 2 different groups. The patient group consisted of individuals with a degenerative rotator cuff tear involving at least the supraspinatus. The control group consisted of individuals with no rotator cuff pathology. Individuals in both groups with congenital, post-traumatic, or degenerative alterations of the proximal humerus were excluded. The GTA was measured on an anteroposterior shoulder x-ray image with the arm in neutral rotation by 3 observers at 2 different times. RESULTS: The study recruited 71 patients (33 patients, 38 controls). Mean GTA value was 72.5° (range, 67.6°-79.2°) in patients and 65.2° (range, 55.8°-70.5°) for controls (P <.001). A value above 70° resulted in 93-fold higher odds of detecting a rotator cuff tear (P <.001). Interobserver and intraobserver reliability were high. CONCLUSIONS: GT morphology is implicated in rotator cuff tears. The GTA is a reliable radiographic marker, with more than 70° being highly predictive in detecting such lesions.

Redefining anterior shoulder impingement: a literature review.

Many different types of impingements have been described in the shoulder. Inasmuch as the term 'shoulder impingement' usually refers to subacromial impingement, anterior impingement usually refers to subcoracoid impingement. However, there are many different subtypes of anterior impingements in the shoulder, and awareness of their existence is critical as they vary in their nature and treatment. Recent advances in biomechanical research and arthroscopic exploration of the anterior structures of the shoulder have brought new insights on the various potential impingements, warranting a revision and update of the current definitions of anterior shoulder impingement. The purpose of this article is to propose a comprehensive review and classification of all different subtypes of anterior impingement in the shoulder, including newly described entities.

[Management of a first-time dislocation in the athlete]. / Prise en charge d'un premier épisode de luxation antéro-inférieure de l'épaule chez l'athlète.

Management of a first-time dislocation in the athlete patient is challenging. This patient population has important requirements with high expectations and deadlines to meet, especially if the trauma occurs during high season. As initial management is usually conservative with immobilization followed by rehabilitation, some authors support the role of primary surgical treatment in high risk athletes. Indication for surgery and choice of surgical technique is based on an algorithm incorporating risk factors for recurrence and the presence of concomitant bony lesions on the humeral and glenoid sides. Return to sport varies from 3 to 6 months depending on the type of sport practiced.

La luxation gléno-humérale chez l'athlète présente un challenge particulier dans la prise en charge. Cette population de patients a des exigences importantes avec des échéances à respecter dans son programme, surtout si le traumatisme a lieu en pleine saison. Si la prise en charge initiale consiste en un traitement conservateur comprenant une immobilisation suivie d'une réédu-cation musculaire, certains auteurs préconisent une stabilisation chirurgicale d'emblée chez les patients à haut risque de récidive. Le choix de la chirurgie et de sa technique se fait en fonction d'un algorithme basé sur les facteurs de risque de récidive ainsi que la présence de lésions concomitantes. Le retour au sport varie de 3 à 6 mois selon le type de sport pratiqué.

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study.

BACKGROUND: The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. METHODS: All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. RESULTS: The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (<45 years), male sex, higher Schatzker grade (IV-V-VI), higher tibial widening ratio (≥1.05) and higher femoral displacement ratio (≥0.08) were significantly associated in the analysis adjusted for age and sex. CONCLUSIONS: Two parameters related to the occurrence of ACS in tibial plateau fractures were highlighted in this study: the presence of a non-contiguous tibia fracture or knee dislocation, and higher AO/OTA classification. They may be especially useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients), and should rise the suspicion level of the treating surgeon. In these cases, regular clinical examinations and/or intra-compartmental pressure measurements should be performed before and after surgery, even if acute compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

[Fractures of the distal humerus in the elderly : osteosynthesis or elbow arthoplasty ?] / Fractures de l'humérus distal chez la personne âgée : ostéosynthèse ou prothèse de coude ?

With an aging population, distal humerus fractures are becoming an emerging problem. Whereas open reduction and internal fixation has been the treatment of choice, results have not been as conclusive in elderly patients. Over two thirds of the cases in this population present with a highly comminuted articular fracture and poor bone stock, jeopardizing the quality and stability of the construct. Total elbow arthroplasty has gained popularity in the treatment of such fractures, and has shown higher results in terms of pain, function, and patient satisfaction. Nevertheless, it also has a high complication rate, such as infection, ulnar neuropathy and loosening, that should be discussed with patients before surgery. The aim of this article was thus to review the different treatment options and propose a treatment algorithm.

Face à une population vieillissante, les fractures de l'humérus distal deviennent un problème en émergence. Si l'ostéosynthèse est le traitement de choix dans ce type de fracture, les résultats ne sont pas aussi satisfaisants chez les personnes âgées qui présentent dans deux tiers des cas une fracture articulaire complexe avec un capital osseux limité, compromettant la qualité du montage. En revanche, la prothèse totale de coude a montré des meilleurs résultats en termes de douleurs, fonction et satisfaction du patient. Cependant, un taux de complications non négligeable, telles qu'infections, neuropathies ulnaires, descellements doivent être discutées avec le patient lors de l'indication opératoire. Le but de cet article est donc de mettre en perspective les différents types de traitement et de proposer un algorithme de prise en charge.

Isokinetic shoulder strength correlates with level of sports participation and functional activity after reverse total shoulder arthroplasty.

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) is increasingly being performed. Many patients may wish to return to high levels of sporting activity. This study aimed to evaluate the correlation of isokinetic shoulder strength with level of participation in sport and recreation after RTSA. METHODS: We surveyed 51 patients at a mean of 29.5 months (range, 12-60 months) after surgery. Mean age was 74.1 years. Patient-reported sporting activity was classified as low, medium, or high demand. All patients completed the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire and the Oxford Shoulder Score and underwent Biodex dynamometer testing of the RTSA evaluating isokinetic shoulder strength in flexion and extension, abduction and adduction, and internal and external rotation. RESULTS: Reported sporting activity was high demand in 35% and moderate demand in 43%. There was a large variation in shoulder isokinetic strength parameters especially for internal and external rotation. With the exception of abduction, a significant correlation was noted between strength and the level of sports participation that patients reported (P < .03). A significant correlation was also noted between strength and patient-reported outcome measures for internal rotation and arm flexion and abduction (P < .05). CONCLUSION: Most patients reported returning to moderate- or high-level sporting activity in the short term after RTSA. Isokinetic shoulder strength, especially in internal rotation and arm flexion, positively correlates with both patient-reported level of participation in sports and recreation and daily function.

King penguins can detect two odours associated with conspecifics.

Recent studies on olfaction in penguins have focused on their use of odours while foraging. It has been proposed for some seabirds that an olfactory landscape shaped by odours coming from feeding areas exists. Islands and colonies, however, may also contribute to the olfactory landscape and may act as an orienting map. To test sensitivities to a colony scent we studied whether King penguins (Aptenodytes patagonicus) could detect the smell of sand, feathers or feces by holding presentations beneath their beaks while they naturally slept on the beach. Penguins had a significantly greater response to the feathers and feces presentations than to sand. Although only a first step in exploring a broader role of olfaction in this species, our results raise the possibility of olfaction being used by King penguins in three potential ways: (1) locating the colony from the water or the shore, (2) finding the rendezvous zone within the colony where a chick or partner may be found, or (3) recognizing individuals by scent, as in Humboldt penguins (Spheniscus demersus).

Correlation Between American Shoulder and Elbow Surgeons and Single Assessment Numerical Evaluation Score After Rotator Cuff or SLAP Repair.

PURPOSE: To compare the American Shoulder and Elbow Surgeons (ASES) and the Single Assessment Numerical Evaluation (SANE) scores after rotator cuff repair, rotator cuff revision, and SLAP repair. METHODS: This study was a retrospective review of a prospectively filled database of 262 patients who underwent arthroscopic surgery for rotator cuff tears or SLAP lesions between 1999 and 2007. All patients were operated on by the same surgeon, with a minimum follow-up of 2 years. The patient database included preoperative and outcome measures, such as pain, range of motion, and notably postoperative ASES and SANE scores. Any patient with incomplete data was removed from the study. RESULTS: Three groups were identified: primary rotator cuff repair (n = 135), rotator cuff revision (n = 73), and SLAP repair (n = 54). The overall mean ASES and SANE scores after surgery were 82.7 (± 20.2) and 83.3 (± 19.6), respectively. The Pearson correlation coefficient (r) between both scores was 0.8 (P < .001), demonstrating a very good correlation. In subgroup analysis, the correlation was highest in the cuff revision group (r = 0.88; P < .001) followed by the SLAP group (r = 0.78; P < .001) and primary cuff group (r = 0.75; P < .001). CONCLUSIONS: This study shows that there is a significant correlation between postoperative SANE and ASES rating methods in rotator cuff and SLAP repairs. We recommend the SANE score as a reliable outcome indicator for iterative follow-up, which can then be combined with a more clinically informative score such as the ASES or other process-based scores for preoperative and final workup. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Gram and acridine orange staining for diagnosis of septic arthritis in different patient populations.

PURPOSE: The sensitivity of Gram staining is known to be suboptimal for the diagnosis of native joint septic arthritis. We lack information about the accuracy of Gram compared to other microscopic staining techniques for predicting infection in different patient populations. METHODS: This was a cohort study with cost evaluations at the Orthopaedic Service of Geneva University Hospitals (January 1996-October 2012). RESULTS: Among 500 episodes of arthritis (196 with immunosuppression, 227 with underlying arthroplasties and 69 with gout or other crystals in synovial fluid), Gram staining revealed pathogens in 146 episodes (146/500, 29 %) or in 146 of the 400 culture-positive episodes (37 %). Correlation between the Gram and acridine staining of the same sample was good (Spearman 0.85). Overall, the sensitivity, specificity, positive predictive value and negative predictive value of Gram stain for rapid diagnosis of septic arthritis was 0.37, 0.99, 0.99 and 0.28, respectively, compared to microbiological cultures. Quite similar values were recorded across the different patient subpopulations, in particular for sensitivity values that were 0.33 for patients with prosthetic joint infections, 0.40 for immunosuppressed patients, 0.36 for patients under antibiotic administration and 0.52 for patients with concomitant crystalline disease. CONCLUSIONS: The sensitivity of Gram or acridine orange staining for a rapid diagnosis of episodes of septic arthritis is suboptimal compared to microbiological culture, regardless of underlying conditions, immunosuppression or antibiotic therapy. The sensitivity in the presence of synovial fluid crystals is moderate. Acridine orange and Gram stains are equivalent.

Shoulder Stabilization Technique Using the Medial Glenohumeral Ligament in Patients With the Buford Complex.

The Buford complex is an anatomic variation defined as the association of a cordlike middle glenohumeral ligament (MGHL) and an absent anterosuperior labrum. It can be challenging to properly identify on preoperative imaging and remains mostly an arthroscopic finding. It may, however, lead to problematic situations when encountered during an arthroscopic soft-tissue stabilization procedure, as the treatment of choice in such cases is a bone block. Moreover, reattaching the MGHL to the anterior border of the glenoid rim has traditionally not been recommended because it theoretically leads to severe restriction in external rotation. This technical note describes arthroscopic stabilization for anterior traumatic glenohumeral instability associated with the Buford complex. The cordlike MGHL is used to reconstruct a neo-labrum, associated with an anteroinferior glenohumeral ligament plication. Glenohumeral stabilization using the cordlike MGHL of the Buford complex may be an efficient alternative to a bone block procedure.