Subscapularis atrophy and function after arthroscopic Trillat procedure.

INTRODUCTION: Several studies have reported a strength deficit in internal rotation (IR) following a Latarjet procedure, which can persist for months or even years. The arthroscopic Trillat procedure does not require splitting the subscapularis muscle, potentially making it less damaging. HYPOTHESIS: The arthroscopic Trillat procedure does not cause any atrophy or strength deficit in the subscapularis muscle. METHODS: This was a single center, retrospective study of patients treated between 2013 and 2021. Included were patients who had chronic anterior shoulder instability with an indication for surgical stabilization using an arthroscopic Trillat procedure and who underwent a CT scan before surgery and a second one at 6 months postoperative. The following morphological parameters were measured on all the rotator cuff muscles: cross-sectional area (CSA), thickness and fatty infiltration using the mean muscle attenuation (MMA) measurement. Isokinetic tests were done 1 year post-surgery. RESULTS: One hundred seventeen patients underwent arthroscopic Trillat surgery between 2013 and 2021; 58 were included, 30 were analyzed and 17 patients underwent isokinetic testing. The CSA of the subscapularis was significantly smaller by 5.3% (17.0 vs. 16.1; p = 0.03). None of the other rotator cuff muscles had a smaller CSA. The MMA of the subscapularis increased significantly while the MMA of the external rotators decreased postoperatively. No strength deficit was found at 1 year postoperative in the internal and external rotators. DISCUSSION: The arthroscopic Trillat procedure produces minor atrophy of the subscapularis muscle at 6 months, with no strength deficit at 1 year postoperative. Several studies have reported a deficit in internal rotation strength after a Latarjet procedure, ranging from 6% to 19% depending on the study. LEVEL OF EVIDENCE: IV.

Arthroscopic Trillat technique for chronic post-traumatic anterior shoulder instability: outcomes at 2 years of follow-up.

BACKGROUND: The purpose of this study was to assess the outcomes of a new arthroscopic Trillat technique at a 2-year follow-up. Our current hypothesis was that this technique could be used for the effective treatment of chronic post-traumatic unidirectional anterior shoulder instability, and that the recurrence and complication rates, external rotation, and functional outcomes would be as good as those of the reference technique. METHODS: Between April 2012 and August 2016, all patients older than 16 years who underwent the arthroscopic Trillat technique for unidirectional chronic post-traumatic anterior shoulder instability at the Dijon University Hospital (France), after the failure of well-conducted medical and rehabilitation treatment with at least 24 months of follow-up, were included. Criteria for noninclusion were association with posterior and/or inferior instabilities, voluntary instabilities, and glenoid bone loss greater than 20%. Patients attended follow-up with their surgeon before the intervention, in the immediate postoperative period, at 6 weeks, 3 and 6 months, and then by an independent observer for the last evaluation. Patients were then examined clinically with scores such as Constant, Rowe and Walch-Duplay scores, and subjective shoulder value, for shoulder range of motion, and radiographically (anteroposterior and Lamy's lateral x-rays of the operated shoulder). RESULTS: Forty-nine patients and 52 shoulders were included, with a mean follow-up of 40 months (range, 24-71 months). The recurrence rate of instability was 3.8% (2 of 52). No conversion to arthrotomy was necessary. No intraoperative complications, postoperative neurological lesions, or sepsis were observed. The mean Constant score was 92.1 (77.5-100) points, Walch-Duplay 82.9 (40-100), Rowe 81.73 (5-100), and subjective shoulder value 86.1 (50-100) at the last follow-up. The arm at side external rotation limitation averaged 8.4° (-25° to 40°) and the external rotation with 90° arm abduction limitation 0.34° (-5° to 15°). Forty-one patients (79%) resumed their sports activity at the same level. Fifty patients (96%) were satisfied to very satisfied. One patient developed nonunion of the coracoid process and subsequently underwent a Latarjet procedure with a good outcome. CONCLUSIONS: The arthroscopic Trillat procedure offers good outcomes as a first-line treatment for chronic anterior post-traumatic glenohumeral instability. It should be excluded in cases of glenoid loss greater than 20%.

Does anterior acromioplasty reduce critical shoulder angle?

INTRODUCTION: Critical shoulder angle (CSA) is the angle between glenoid inclination and the lateral edge of the acromion. CSA>35° has been shown to be a risk factor for primary and iterative rotator cuff tendon tear. The present study aimed to assess change in CSA after anterior acromioplasty. The study hypothesis was that CSA is significantly reduced. METHOD: A single-center retrospective descriptive observational study included patients undergoing open or arthroscopic anterior acromioplasty, with strict AP pre- and post-operative radiographs. Patients with radiographs not meeting Moor's criteria were excluded. RESULTS: One hundred and forty-eight patients were included: arthroscopy, 112; open surgery, 36. Mean age was 57.8 years (range, 29-80 years). Mean preoperative CSA was 36.1±4.25° (range, 25-48.4°) and postoperative CSA 33.5±3.9° (23.8-45.2°), for a significant reduction of -2.6±2.5° (p=0.001). Surgical technique did not affect change in CSA: open surgery, -2.3±1.9° (-6.3° to -1°); arthroscopy, -2.7±2.7° (-10.5° to -5°) (p=0.06). In pathologic CSA (>35°), the mean reduction was -3.2±2.6° (-10.5°to -5°). CSA normalized below the 35° threshold in 48% of patients. DISCUSSION: Despite reduction in CSA, the 35° threshold for iterative tear is not always reached after anterior acromioplasty. Complementary strictly lateral resection is theoretically required. However, change in CSA is difficult to predict intraoperatively. CONCLUSION: Anterior acromioplasty significantly reduced CSA, independently of technique and preoperative value. LEVEL OF EVIDENCE: IV, retrospective descriptive study.

Exclusive Posterolateral Arthroscopic and Endoscopic Approaches Used in the Treatment of Lateral Epicondylitis.

Complications following arthroscopy of the elbow for the treatment of lateral epicondylitis are essentially related to the anterior arthroscopic approach. The principal aims of this study were to describe and evaluate the mixed arthroscopic and endoscopic surgical technique using posterolateral approaches exclusively. This was a retrospective study of consecutive patients operated on between 2005 and 2014 for lateral epicondylitis following more than 6 months of ineffective medical treatment. The exploration was arthroscopic via a distal posterolateral portal. The extensor carpi radialis brevis was disinserted via a proximal extra-articular posterolateral endoscopic portal. The postoperative clinical follow-up included subjective (visual analog scale, Nirschl) and objective (Mayo Clinic Elbow Performance Score) evaluations of pain, the time to return to work, the level of satisfaction, complications, and failures. Thirty-seven patients underwent the procedure, including 3 lost to follow-up. Mean±SD follow-up was 32.8±24.7 months. Mean±SD visual analog scale scores were 0.8±0.8 at rest, 2.4±1.3 during everyday activities, and 3.1±1.5 during effort. Mean±SD Mayo Clinic Elbow Evaluation Score was 10.1±1.0 of 12 and mean±SD Mayo Clinic Elbow Performance Score was 91.9±12.5 of 100. Mean±SD Nirschl score was 67.5±9.6 of 80. Mean±SD time to return to work was 2.0±2.6 months. The level of satisfaction was 94.1%. The failure rate was 2.9%, with no neurological lesions. With equivalent or even better results than those already published, this surgical procedure enables the treatment of lateral epicondylitis via posterolateral portals alone, thus avoiding the complications inherent to anterior and medial arthroscopic approaches. [Orthopedics. 2019; 42(6):e521-e527.].

Is distal locking screw necessary for intramedullary nailing in the treatment of humeral shaft fractures? A comparative cohort study.

PURPOSE: The gold standard for intramedullary nailing (IMN) in humeral shaft fracture treatment is bipolar interlocking. The aim of this study was to compare clinical and radiographic outcomes in two cohorts of patients treated with IMN with or without distal interlocking. We hypothesized that there was no significant difference between isolated proximal interlocking and bipolar interlocking in terms of consolidation and clinical results. METHODS: One hundred twenty-one acute humeral shaft fractures were retrospectively included in group WDI (without distal interlocking screw, n = 74) or in group DI (with distal interlocking screw, n = 47). One hundred six patients (87.60%) could be verified by an X-ray, and 63 (52.07%) could be examined clinically. Fracture union at 6 months was the primary outcome, and the second was the final clinical outcome for shoulder and elbow after at least 6 months of follow-up. Pain, operating time, and radiation time were also analyzed. RESULTS: The two groups were not significantly different for population, fractures, or immobilization duration. No significant difference was found for bone union (WDI 89.06% vs DI 83.33%, p = 0.51), shoulder or elbow functional outcomes, or pain. However, there were significant differences in advantage to the WDI group for operating time (WDI 63.09 ± 21.30 min vs DI 87.96 ± 30.11 min, p < 0.01) and fluoroscopy time (WDI 59.06 ± 30.30 s vs DI 100.36 ± 48.98 s, p < 0.01). CONCLUSIONS: Thus, it seems that there were no significant differences between proximal unipolar and bipolar interlocking for humeral shaft fractures in terms of consolidation and clinical outcomes. WDI avoided the additional operating time and fluoroscopy time and risks linked to DI.