Area Measurement Percentile of 3-Dimensional Computed Tomography Has the Highest Interobserver Reliability When Measuring Anterior Glenoid Bone Loss.

PURPOSE: To determine the accuracy of glenoid bone loss measurement and the difference between 3 methods of measurement, as well as the measurements application to previously published studies. METHODS: A list of patients with anterior bony glenoid defects was created through a search of electronic medical records. Three surgeons reviewed each patient's advanced imaging (computed tomography [CT], 3-dimensional [3D] CT, or magnetic resonance imaging), and glenoid bone loss was measured by 3 different methods: (1) linear measurement percentile (LMP), (2) area measurement percentile (AMP), and (3) circle-line method (CLM). The intraclass correlation coefficients between reviewers and mathematical differences between measurement techniques were calculated. RESULTS: The images of 125 patients with anterior glenoid bone loss were measured. For all imaging studies, the intraclass correlation coefficient was greatest with the AMP (0.738) and CT with 3D reconstruction (0.735). Within the entire sample, average bone loss measured 21.3% (range, 5.6%-43.5%) by the LMP method, 15.7% (range, 1.6%-42.2%) by the CLM, and 16.5% (range, 2.3%-40.3%) by the AMP method. On average, the difference between the LMP and AMP methods was 4.8%. When the AMP and LMP methods were compared, the greatest difference in measurement was 5.9%, and this occurred at an LMP of 19.1%, which was an AMP of 13.2%. CONCLUSIONS: When measuring anterior glenoid bone loss, CT with 3D reconstruction and the AMP method have the greatest interobserver reliability. Furthermore, the greatest difference between the LMP and AMP methods occurs at an LMP between 18.3% and 20.0% and an AMP between 12.4% and 14.2%, with the difference ranging from 5.7% to 5.9%. CLINICAL RELEVANCE: When measuring anterior glenoid bone loss, evaluation of CT with 3D reconstruction is more reliable than magnetic resonance imaging evaluation. Furthermore, the AMP method has the greatest interobserver reliability when compared with the LMP method and CLM.

Systematic review on the incidence, operative treatments, and outcomes of deltoid ruptures.

Background: A deltoid rupture can result in significant losses of shoulder function, and in the setting of a rotator cuff tear, the deltoid serves as the sole abductor of the shoulder. Deltoid ruptures can be secondary to trauma, a consequence of massive rotator cuff tears, or a result of postoperative complications. There is a paucity of literature on the management of deltoid ruptures. In this systematic review, we aim to report on the incidence of deltoid ruptures, the surgical treatment options, and the outcomes following operative treatment. Methods: A literature search was conducted on February 1, 2023 on MEDLINE and Google Scholar. Titles and abstracts were screened and the full text versions of articles that met criteria were reviewed. Criteria for inclusion included peer-reviewed studies evaluating the outcomes following surgical treatment of deltoid ruptures (direct repair, mobilization, reconstruction, and pedicled pectoralis transfer, with or without a reverse total shoulder arthroplasty). Secondary outcomes included incidence and causes of deltoid ruptures. Results: A total of 101 studies were retrieved. After review and additional studies identified from reference lists, a total of 14 studies were included in the review. The incidence of deltoid ruptures ranged from 0.3% to 7%, and large, full-thickness rotator cuff tears were found to be a significant risk factor. Surgical treatment options for deltoid ruptures include direct repair, rotationplasty, and pedicelled muscle-tendon transfers; and when indicated, these procedures can be paired with a reverse total shoulder replacement. Postoperatively, the operative extremity should be immobilized in the position of least tension (forward flexion and abduction, 30°-70°) for 4-8 weeks. Most patients in this systematic review who underwent surgical treatment of their deltoid rupture had significant improvements in pain and mean postoperative forward elevation and abduction above 90°. Discussion: The current available literature demonstrates that direct deltoid repair, rotationplasty, or reconstruction (muscle tendon transfer) with or without a concomitant reverse total shoulder arthroplasty can be an acceptable treatment option in patients with deltoid defects and massive rotator cuff tear. The average shoulder flexion and abduction increased postoperatively with improvements in pain.

An epidemiological study of martial arts injuries in patients presenting to US emergency rooms.

INTRODUCTION: With the advent of mixed martial arts (MMA) growing in popularity, there has been a described increase in its participation. The term MMA generally describes the hybridization of combat disciplines including but not limited to: karate, judo, jiu-jitsu, wrestling, taekwondo, boxing, kickboxing, and Muay Thai. With increased participation in MMA and martial arts, differing physical demands are placed on participants. Due to the physical nature of combat sports, there are injuries associated with participation. The purpose of this study is to report the incidence and characteristics of injuries seen from various martial art disciplines presenting to United States Emergency Rooms in order to educate participants and providers alike about risks assumed with participating in martial arts. METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried for martial arts-related injuries from 2009 to 2019. Cases were examined and data including patient age and gender, injury type and location, hospital disposition, and type of martial arts practiced were extracted. RESULTS: A total of 8,400 injuries were recorded, leading to a national estimate of 310,143 martial-arts related injuries over the 11 year period of 2009-2019 (95 % CI 239,063-381,223). The most common types of injuries were strains/sprains (n = 2664, 31.7 %), fractures (n = 1,575, 18.8 %), and contusions/abrasions (n = 1,698, 20.2 %). There were 260 dislocations, with shoulder dislocations being most common (n = 96, 36.9 %). Lower extremities were affected more frequently than upper extremities (n = 3566, 42.5 % versus n = 3026, 36.0 %), with the knee being the single most common location of injury (n = 811, 9.7 %). Males more commonly sustained fractures (19.7 % versus 17.4 %, p = 0.03) and dislocations (3.5 % versus 2.4 %, p = 0.01) when compared to females. Ankle injuries were more common in females than males (10.4 % versus 6.0 %, p < 0.001). Only 2.2 % of patients required admission to the hospital. Risk factors for admission included patients >35 years of age and male sex. CONCLUSION: Martial arts injuries are a significant source of musculoskeletal injuries among patients presenting to US emergency rooms. Lower extremity injuries are seen most frequently, with patients rarely requiring hospital admission. Using this information, both providers and participants may be better equipped to make educated decisions on injury prevention and treatment.

There is No Difference in Return to Duty Following the Latarjet With Subscapularis Split Versus Tenotomy Technique in the Military Population.

Purpose: To evaluate the return to duty rates between subscapularis split versus subscapularis tenotomy approach to the Latarjet procedure in an active-duty military population. Methods: A total of 46 patients were identified. Thirty-six (87.8%) were able to be contacted and included in the study. Operative technique, time to return to duty, and postoperative range of motion were collected. Patients were contacted telephonically to collect information on recurrent dislocation and time to pass first physical fitness test postoperatively. The primary outcome was time to return to full-duty status designated by passing a Physical Fitness Test. Secondary outcomes were redislocations and final range of motion. Results: In total, 36 of 41 (87.8%) patients were able to be contacted. There was no difference in return to duty rates designated by completion of first Physical Fitness Test for both groups (P = .23). In the subscapularis split group, 22 of 23 patients returned to full-duty at an average of 8.0 months versus the tenotomy group, with 12 of 13 patients returned to full-duty at an average of 8.7 months. There was also no difference with re-dislocation incidence for both groups of 0.08 (P = .45). Both groups had one patient each who was unable to return to full duty. There were no differences in postoperative forward flexion and external rotation, but abduction was 9° higher in the split compared to the tenotomy group (P = .03). Conclusions: In the military patient with anterior glenohumeral instability, the Latarjet using the subscapularis split and subscapularis tenotomy approach demonstrate similar return to duty rates and similar duration to pass a standardized fitness assessment. There was no clinically significant difference in postoperative range of motion. Both approaches produce similar results clinically; and should be chosen based on surgeon preference. Level of Evidence: III, retrospective cohort study.

Correlation of stress radiographs to injuries associated with lateral ankle instability.

BACKGROUND: Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability. AIM: To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability. METHODS: A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed. These manual radiographic stress views were then correlated with magnetic resonance imaging and operative findings. RESULTS: A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology (P = 0.008 for tendonitis and P = 0.020 for peroneal tendon tears). A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability (P = 0.043). CONCLUSION: Although valuable in the clinical evaluation of ankle instability, stress radiographs are not an independent predictor of conditions associated with ankle instability.

Anatomic Pectoralis Major Repair With Intramedullary Anchor Fixation.

Although previously described as a rare injury, pectoralis major tendon rupture has shown increased reports in recent years. This injury can be managed conservatively; however, given the propensity for young, physically active male individuals, surgical repair is often preferred. Definitive surgical repair can be performed through various techniques such as bone trough, transosseous fixation, suture anchor, and cortical button techniques. This technique guide describes surgical repair through intramedullary anchor fixation with a unique pull-through method using taped suture to secure the tendon repair to its anatomic footprint. We believe this method is biomechanically advantageous, reduces bone loss that may lead to postoperative fractures, and re-creates the anatomic footprint of the torn tendon.