RESUMO
BACKGROUND: Surgical treatment of Rockwood grade V AC joint injuries remains varied. We hypothesized that the addition of a second suspensory device between the clavicle and coracoid would yield superior biomechanical results over a single device. We also hypothesized that the addition of an internal brace across the AC joint to a suspensory device would yield superior results over the suspensory device in isolation. METHODS: A total of 24 cadaveric shoulders were dissected and randomized to four groups with four different constructs implanted: Group A: Single AC TightRope (Arthrex Inc., Naples, FL, USA) Group B: Double AC TightRope Group C: Single Knotless AC TightRope (Arthrex Inc., Naples, FL, USA) Group D: Single Knotless AC TightRope with AC InternalBrace Ligament Augmentation (Arthrex Inc., Naples, FL, USA) These were then loaded in the Robotic arm (SIMVITRO) where 250 cycles of 50N of force in the superior plane was applied. Dynamic creep, displacement, translation and stiffness were assessed. RESULTS: Testing was successfully completed for all specimens. There were no failures due to fracture or translation of the clavicle greater than 5mm from the starting position. Reduction was maintained with a mean superior displacement of 1.7 mm (± 1.4 mm). The mean peak to peak displacement, superior and posterior translation, dynamic creep and stiffness did not differ significantly between construct groups. CONCLUSION: This study did not demonstrate any significant biomechanical differences between groups in terms of displacement, translation, creep or stiffness.
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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.
Assuntos
Antifibrinolíticos , Artroplastia do Ombro , Ácido Tranexâmico , Artroplastia do Ombro/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , HumanosRESUMO
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.
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Artroscopia , Teste de Materiais , Articulação do Ombro/cirurgia , Suturas , Elasticidade , Desenho de Equipamento , Humanos , Polietilenotereftalatos , Estresse Mecânico , ViscosidadeRESUMO
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.
Assuntos
Artroscopia/efeitos adversos , Artroscopia/instrumentação , Articulação do Ombro , Líquido Sinovial/fisiologia , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/instrumentação , Artroscopia/métodos , Humanos , Pressão , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Irrigação Terapêutica/métodosRESUMO
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.
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Cavidade Glenoide/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Escápula/diagnóstico por imagem , Adulto JovemRESUMO
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.
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Lesões do Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Rotação , Adulto JovemRESUMO
BACKGROUND: Propionibacterium acnes is a recognized pathogen in postoperative shoulder infections. A recent study reported growth of P acnes in 42% of glenohumeral joints in primary shoulder arthroplasty, concluding that P acnes may cause shoulder osteoarthritis. Whether these results reflect true bacterial infection or specimen contamination is unclear. Our prospective study aimed to determine the rate of P acnes infection in arthritic shoulders using a strict specimen collection technique. METHODS: We used modified Oxford protocol to collect tissue specimens from the glenohumeral joint of 32 consecutive patients undergoing primary shoulder arthroplasty. Specimens were cultured specifically for P acnes. Diagnosis of P acnes infection required 2 or more positive cultures and histopathology compatible with infection. RESULTS: Three of 32 patients had a positive culture for P acnes. Overall, 3.125% of specimens grew P acnes without histologic evidence of infection. There were no patients with P acnes infection. The difference in culture rates between patients with idiopathic osteoarthritis and those with a predisposing cause for osteoarthritis was not significant. CONCLUSIONS: We found a low rate of positive cultures for P acnes, but no P acnes infection and no difference between types of osteoarthritis. These results do not support a cause-and-effect relationship between P acnes and osteoarthritis. The differing results from previous studies are likely explained by our strict specimen collection technique, reflecting different rates of contamination rather than infection. That P acnes contamination occurs in primary shoulder arthroplasty is concerning. Further studies are needed to assess the rates of contamination in shoulder surgery, its clinical effect, and to determine optimal antibiotic prophylaxis.
Assuntos
Propionibacterium acnes/isolamento & purificação , Articulação do Ombro/microbiologia , Idoso , Idoso de 80 Anos ou mais , Artrite/cirurgia , Artroplastia de Substituição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Articulação do Ombro/cirurgiaRESUMO
BACKGROUND: Recent studies have reported the theoretic amount of coracoid graft available for harvesting with the Latarjet procedure. Our aim was to investigate the actual dimensions of coracoid grafts harvested using a standardized technique. We also hoped to confirm previous recommendations regarding placement of the inferior glenoid drill hole to avoid lateral overhang of the graft. MATERIALS AND METHODS: Intraoperative measurements were taken after coracoid graft harvesting and preparation during the Latarjet procedure. Specifically, we measured the length of coracoid, thickness of coracoid, distance from the inferior drill hole to the lateral margin of the graft, distance between drill holes, width at the level of the superior drill hole, and width at the level of the inferior drill hole. RESULTS: Data were collected from 76 Latarjet procedures (67 men, 9 women). Patients were an average age of 28.7 years (range 16-67 years). Mean measurements were length of coracoid graft, 26.4 ± 2.9 mm; thickness, 9.3 ± 1.4 mm; distance from the edge of the inferior drill hole to the lateral margin of the graft, 5.7 ± 1.1 mm; distance between drill holes, 7.8 ± 1.9 mm; width at the level of the superior drill hole, 14.1 ± 1.8 mm; and width at the level of the inferior drill hole, 13.3 ± 1.8 mm. CONCLUSIONS: Using a standardized surgical technique that does not violate the coracoclavicular ligaments, a coracoid graft greater than 25 mm can routinely be harvested for the Latarjet procedure. The inferior glenoid drill hole should typically be placed at least 7 mm from the glenoid margin to avoid lateral overhang.
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Procedimentos Ortopédicos/métodos , Escápula/transplante , Articulação do Ombro/cirurgia , Adolescente , Adulto , Idoso , Transplante Ósseo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escápula/cirurgia , Coleta de Tecidos e Órgãos , Transplantes , Adulto JovemRESUMO
BACKGROUND: Degenerative rotator cuff tear is a frequent and multifactorial pathology. The role of bone morphology of the greater tuberosity and lateral acromion has been validated, and can be measured with two plain radiographic markers on true anteroposterior views: the greater tuberosity angle (GTA) and the critical shoulder angle (CSA). However, the interdependence of both markers remains unknown, as well as their relationship with the level of professional and sports activities involving the shoulder. The aim of this prospective comparative study was to describe the correlation between the GTA and CSA in patients with degenerative rotator cuff tears. HYPOTHESIS: GTA and CSA are independent factors from one another and from demographic factors, such as age, dominance, sports, or professional activities. PATIENT AND METHODS: All patients presenting to a shoulder specialized clinic were assigned to two groups. The first consisted of patients with a symptomatic degenerative rotator cuff tear visible on MRI and the control group consisted of patients with any other shoulder complaints and no history or visible imaging of any rotator cuff lesion. RESULTS: There were 51 shoulders in 49 patients in the rotator cuff tear group (RCT) and 53 shoulders in 50 patients in the control group. Patient demographics were similar in both groups. Mean GTA was 72.1°±3.7 (71.0-73.1) in the RCT group and 64.0°±3.3 (63.1-64.9) in the control group (p<0.001). Mean CSA was 36.7°±3.7 (35.7-37.8) in the RCT group, and 32.1°±3.7 (31.1-33.1) in the control group (p<0.001). A summation of GTA and CSA values over 103° increased the odds of having a rotator cuff tear by 97-fold (p<0.001). There was no correlation between GTA and CSA, nor between GTA or CSA and age, sex, tear size, or dominance. Patients with different levels of professional and sports activities did not have significantly different GTA or CSA values. CONCLUSION: GTA and CSA are independent radiologic markers that can reliably predict the presence of a degenerative rotator cuff tear. A sum of both values over 103° increases the odds of having a rotator cuff tear by 97-fold. These markers are not correlated with patient demographic or environmental factors, suggesting that the variability of the native acromion and greater tuberosity morphology may be individual risk factors for rotator cuff tear. LEVEL OF EVIDENCE: II; diagnostic study.
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Lesões do Manguito Rotador , Articulação do Ombro , Acrômio/diagnóstico por imagem , Humanos , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/patologia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia , Ruptura , Ombro , Articulação do Ombro/anatomia & histologiaRESUMO
PURPOSE: We assessed the clinical and radiologic results of a cemented all-polyethylene convex-back keeled glenoid component used with a third-generation prosthesis. METHODS: Between 1996 and 2003, in 4 European centers, 333 shoulder arthroplasties were performed for primary osteoarthritis by use of a cemented all-polyethylene convex-back keeled glenoid component. Kaplan-Meier survivorship analysis was performed, and clinical outcome was assessed with the Constant score, range of motion, and subjective evaluation. RESULTS: At a mean of 89.5 months' follow-up, the Constant score improved from 31.4 to 67.6 points (P < .0001). Active forward elevation improved from 94.9° to 146.6° (P < .0001) and external rotation from 9.0° to 35.3° (P < .0001). Of the patients, 93.5% were either satisfied or very satisfied. The rate of revision for glenoid loosening was 0.6%; however, the rate of radiologic glenoid loosening was 18.9%. Glenoid survival was 99.7% at 5 years and 98.3% at 10 years with endpoint defined as revision surgery for glenoid loosening and 99.7% at 5 years and 51.5% at 10 years with endpoint defined as radiologic loosening. CONCLUSIONS: We showed highly satisfactory clinical outcomes and extremely low rates of revision for glenoid loosening using a cemented convex-back keeled glenoid. There was a concerning rate of radiologic loosening, which only became apparent after 5 years, and this was associated with excessive glenoid reaming. Because radiologic changes are progressive and precede the need for revision, innovations in this field need to report radiologic and clinical results with follow-up of at least 5 to 10 years to prove any superiority.
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Prótese Articular , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Artroplastia de Substituição , Cimentação , Seguimentos , Humanos , Desenho de Prótese , ReoperaçãoRESUMO
Controversy surrounds the optimal technique for fixation of displaced fractures, although locked intramedullary nailing is emerging as a preferred technique in managing displaced proximal humerus fractures in appropriately selected patients. This technique provides stable fracture fixation allowing early postoperative mobilization critical in ensuring a pain-free shoulder with a functional range of motion. Additional advantages include the ability to insert by way of a minimally invasive approach with limited soft tissue dissection, achieve accurate anatomic reduction, provide a secure construct even in the situation of osteopenic bone or comminution, and manage fractures of the proximal humerus extending into the shaft.
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Fixação Intramedular de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas do Ombro/cirurgia , Algoritmos , Pinos Ortopédicos , Humanos , Seleção de Pacientes , Cuidados Pós-Operatórios , Próteses e Implantes , Resultado do TratamentoRESUMO
This study evaluated spatial and temporal extracellular matrix changes, induced by controlled surgical defects in the outer third of the annulus fibrosus (AF) of ovine intervertebral discs (IVDs). Thirty-two 4 year old sheep received a 4 mm deep x 10 mm wide standard annular surgical incision in the L1L2 and L3L4 IVDs (lesion group), 32 sheep were also subjected to the same surgical approach but the AF was not incised (sham-operated controls). Remodeling of the IVD matrix in the lesion and sham discs was assessed histochemically at 3, 6,12 and 26 month post operation (PO). Discs were also dissected into annular lesion site and contra-lateral AF and NP and equivalent zones in the sham sheep group, extracted with GuHCl, dialysed, freeze dried, digested with chondroitinase ABC/keratanase-I and aliquots examined for small leucine repeat proteoglycan (SLRP) core protein species by Western blotting using C-terminal antibodies to decorin, biglycan, lumican and fibromodulin and monoclonal antibody (Mab) 2B6 to unsaturated stub epitopes on chondroitin-4-sulphate generated by chondroitinase ABC. Masson Trichrome and Picrosirius red staining demonstrated re-organisation of the outermost collagenous lamellae in the incised discs 3-6 month PO. Toluidine blue staining also demonstrated a focal loss of anionic proteoglycan (PG) from the annular lesion 3-6 month PO with partial recovery of PG levels by 26 month. Specific fragments of biglycan and fibromodulin were associated with remodeling of the AF 12-26 month PO in the lesion IVDs but were absent from the NP of the lesion discs or all tissue zones in the sham animal group. Fragments of decorin were also observed in lesion zone extracts from 3 to 6 months but diminished after this. Isolation and characterization of the biglycan/fibromodulin fragments may identify them as prospective biomarkers of annular remodeling and characterization of the enzyme systems responsible for their generation may identify therapeutic target molecules.
Assuntos
Proteínas da Matriz Extracelular/metabolismo , Fibrocartilagem/fisiopatologia , Deslocamento do Disco Intervertebral/fisiopatologia , Disco Intervertebral/fisiopatologia , Proteoglicanas/metabolismo , Regeneração/fisiologia , Animais , Biglicano , Biomarcadores/análise , Biomarcadores/metabolismo , Decorina , Modelos Animais de Doenças , Matriz Extracelular/metabolismo , Feminino , Fibrocartilagem/metabolismo , Fibrocartilagem/patologia , Fibromodulina , Disco Intervertebral/metabolismo , Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/patologia , Carneiro Doméstico , Fatores de TempoRESUMO
BACKGROUND: Propionibacterium acnes is a common pathogen identified in postoperative shoulder infection. It has been shown to be present in culture specimens during primary shoulder arthroplasty; however, recent work has suggested that it is most likely to be a contaminant. Our aim was to identify the potential sources of contamination in shoulder arthroplasty. METHODS: Tissue swabs were obtained for microbiological analysis from consecutive patients undergoing primary shoulder arthroplasty. Routine surgical technique was maintained, and 5 specimens were taken from different sites: (1) the subdermal layer, (2) the tip of the surgeon's glove, (3) the inside scalpel blade (used for deeper incision), (4) the forceps, and (5) the outside scalpel blade (used for the skin incision). RESULTS: Forty patients (25 female patients and 15 male patients) were included. Thirteen (33%) of the 40 patients had at least 1 culture specimen positive for P. acnes. Two (8%) of the 25 female patients and 11 (73%) of the 15 male patients had ≥1 culture specimen positive for P. acnes. The most common site of growth of P. acnes was the subdermal layer (12 positive samples), followed by the forceps (7 positive samples), the tip of the surgeon's glove (7 positive samples), the outside scalpel blade (4 positive samples), and the inside scalpel blade (1 positive sample). There were 27 of 75 swabs that were positive on culture for P. acnes in male patients compared with 4 of 125 swabs in female patients. Male patients had 66 times (95% confidence interval, 6 to 680 times) higher odds of having a positive culture indicating subdermal colonization compared with female patients (p < 0.001). CONCLUSIONS: P. acnes is a common contaminant of the surgical field in primary shoulder arthroplasty. The subdermal layer may be the source of this contamination, and the prevalence of P. acnes in the surgical wound may be due to the surgeon's manipulation with gloves and instruments. Our findings are consistent with those regarding the increased rates of P. acnes bacterial load and intraoperative growth in male patients compared with female patients. CLINICAL RELEVANCE: P. acnes is likely to be spread throughout the surgical field from the subdermal layer via soft-tissue handling by the surgeon and instruments. Strategies need to be utilized to minimize this contact and to reduce the chance of colonization.
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Artroplastia do Ombro/efeitos adversos , Infecções por Bactérias Gram-Positivas/etiologia , Propionibacterium acnes/isolamento & purificação , Articulação do Ombro/cirurgia , Pele/microbiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Articulação do Ombro/microbiologiaRESUMO
Recurrent anterior shoulder instability is common in contact athletes and the high-energy injuries seen in this group make them more prone to bone loss. Athletes with recurrent instability and associated bone loss have high failure rates when treated with a soft tissue reconstruction procedure. Therefore it is preferred to manage recurrent instability in contact athletes with the Latarjet-Patte procedure. In this article, the authors describe their technique. They have found this procedure to be safe and effective, with very low recurrence and early return to sport. A meticulous surgical technique is important to avoid intraoperative and postoperative complications.
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Traumatismos em Atletas/cirurgia , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/métodos , Luxação do Ombro/cirurgia , Articulação do Ombro , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Cavidade Glenoide/patologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Recidiva , Luxação do Ombro/diagnóstico , Luxação do Ombro/etiologiaRESUMO
The Latarjet-Patte procedure satisfies all of the requirements for treating recurrent anterior instability in contact athletes and is therefore their preferred management in this patient group.
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Traumatismos em Atletas/cirurgia , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/métodos , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/reabilitação , Transplante Ósseo/métodos , Transplante Ósseo/reabilitação , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/reabilitação , Procedimentos Ortopédicos/reabilitação , Posicionamento do Paciente , Luxação do Ombro/etiologia , Luxação do Ombro/reabilitação , Lesões do OmbroRESUMO
Perlecan is a widely distributed, heparan sulphate proteoglycan with roles in the sequestration of FGFs, PDGF, VEGF through which it promotes cell proliferation and matrix production. Perlecan also stabilises extracellular matrices through interaction with a diverse range of matrix components. This study examined the distribution of perlecan in an ovine partial transection tendinopathy model. In normal tendon, perlecan was immunolocalised to small blood vessels in intrafascicular regions in the tendon-bone and muscle-tendon attachments and to linear arrays of oval shaped tenocytes in the tendon mid-region. Partial transection in the mid-tendon region significantly increased perlecan accumulation within the fascicles, in granulation tissue filling the transection site and in the tendon-bone and tendon-muscle attachments. The accumulation of perlecan in the transected tendon and its known roles in matrix stabilisation and cell proliferation indicate possible roles in tendon remodelling and repair. Perlecan domain-1 has been used as a growth factor delivery vehicle for FGF-2, BMP-2 and BMP-7 in regenerative medicine but has yet to be evaluated in infraspinatus tendon repair. A better understanding of perlecan's contributions to pathobiological processes in remodelling tendon may be useful in such regenerative strategies in the future.
Assuntos
Proteoglicanas de Heparan Sulfato/metabolismo , Carneiro Doméstico/metabolismo , Tendinopatia/metabolismo , Tendões/metabolismo , Animais , Proliferação de Células , Modelos Animais de Doenças , Matriz Extracelular/metabolismo , Fator 2 de Crescimento de Fibroblastos/metabolismo , Humanos , Fator de Crescimento Derivado de Plaquetas/metabolismo , Medicina Regenerativa , Manguito Rotador/irrigação sanguínea , Manguito Rotador/metabolismo , Manguito Rotador/patologia , Carneiro Doméstico/fisiologia , Tendinopatia/patologia , Tendões/irrigação sanguínea , Tendões/crescimento & desenvolvimento , Fatores de Crescimento do Endotélio Vascular/metabolismo , Cicatrização/fisiologiaRESUMO
BACKGROUND: The aim of this study was to radiographically analyze the long-term glenoid migration patterns following total shoulder arthroplasty to better understand the factors responsible for loosening. METHODS: Complete radiographic follow-up of more than five years was available for 518 total shoulder arthroplasties performed for primary glenohumeral osteoarthritis with use of an anatomically designed prosthesis with a cemented, all-polyethylene, keeled glenoid component. Radiographs were assessed for humeral head subluxation, periprosthetic radiolucent lines, and shifting of the position of the glenoid component. The type of migration of the glenoid was defined according to the direction of tilt, or as subsidence in the case of medial migration. RESULTS: Definite radiographic evidence of glenoid loosening was observed in 166 shoulders (32%) and was characterized by radiolucency of ≥2 mm over the entire bone-cement interface in thirty shoulders and by a migration of the glenoid component (shift or subsidence) in 136 shoulders. Three predominant patterns of migration of the glenoid component were observed: superior tilting in fifty-two shoulders (10%), subsidence in forty-one shoulders (7.9%), and posterior tilting in thirty-three shoulders (6.4%). Superior tilting of the glenoid was associated with three risk factors: low positioning of the glenoid component, superior tilt of the glenoid component on the immediate postoperative coronal plane radiographs, and superior subluxation of the humeral head (p < 0.05 for all). Subsidence of the glenoid component was associated with the use of reaming to optimize the seating and positioning of the glenoid component (p < 0.001). Posterior tilting of the glenoid component was associated with preoperative posterior subluxation (i.e., a Walch type-B glenoid) and with excessive reaming (p < 0.01 for both). CONCLUSIONS: The three patterns of migration observed in this study underscore the potential importance of the supporting bone beneath the glenoid component. In some shoulders, use of a keel or pegs to provide fixation of a polyethylene component in the absence of good support from subchondral bone may not be sufficient to resist compressive and eccentric forces, resulting in loosening. Preserving subchondral bone may be important for long-term longevity of the glenoid component.
Assuntos
Artroplastia de Substituição/instrumentação , Instabilidade Articular/etiologia , Prótese Articular , Osteoartrite/cirurgia , Polietileno , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição/efeitos adversos , Análise de Falha de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Radiografia , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Secondary rotator cuff dysfunction is a recognized complication following shoulder arthroplasty. We hypothesized that the rate of secondary rotator cuff dysfunction would increase with follow-up and result in less satisfactory clinical and radiographic outcomes. Our aim was to investigate the rate of secondary rotator cuff dysfunction following shoulder arthroplasty for primary osteoarthritis and identify factors associated with the dysfunction. METHODS: Between 1991 and 2003, in ten European centers, 704 total shoulder arthroplasties were performed for primary glenohumeral osteoarthritis. Complete radiographic and clinical follow-up of more than five years was available for 518 shoulders. The diagnosis of secondary rotator cuff dysfunction was made when moderate or severe superior subluxation of the prosthetic humeral head was present on radiographs. Multivariate logistic regression identified factors associated with the development of rotator cuff dysfunction. Kaplan-Meier survivorship analysis was performed, with the end point being secondary rotator cuff failure. Clinical outcome was assessed with use of the Constant score, a subjective assessment of the shoulder, and an evaluation of shoulder motion. RESULTS: At an average of 103.6 months (range, sixty to 219 months) after shoulder arthroplasty, the rate of secondary rotator cuff dysfunction was 16.8%. Survivorship free of secondary cuff dysfunction was 100% at five years, 84% at ten years, and 45% at fifteen years. Duration of follow-up (p < 0.0001), implantation of the glenoid implant with superior tilt (p < 0.001), and fatty infiltration of the infraspinatus muscle (p < 0.05) were risk factors for the development of secondary cuff dysfunction. Patients with secondary rotator cuff dysfunction had significantly worse clinical outcomes (Constant score, subjective assessment, and range of motion; p < 0.0001) and radiographic results (radiolucent line score, radiographic loosening, glenoid component migration; p < 0.0001). CONCLUSIONS: In this study, rates of secondary rotator cuff dysfunction with moderate or severe superior subluxation of the prosthetic humeral head increased with the duration of follow-up and significantly influenced the clinical and radiographic outcome of total shoulder arthroplasty performed for primary glenohumeral osteoarthritis. Preoperative fatty infiltration of the infraspinatus muscle and implantation of the glenoid component with superior tilt were prognostic factors.