Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 64
Filtrar
Mais filtros

Base de dados
Tipo de documento
Intervalo de ano de publicação
1.
Arch Orthop Trauma Surg ; 143(4): 1877-1886, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35220484

RESUMO

PURPOSE: Iatrogenic instability of the acromioclavicular joint (ACJ) following distal clavicle excision (DCE) represents an infrequent pathology. Revision surgery to restore ACJ stability and alleviate concomitant pain is challenging due to altered anatomic relationships. The purpose of this study was to evaluate the used salvage techniques and postoperative functional and radiological outcomes in retrospectively identify patients with a painful ACJ following DCE. We hypothesized that iatrogenic instability leads to ongoing impairment of shoulder function despite secondary surgical stabilization. METHODS: 9 patients with a painful ACJ after DCE (6 men, 3 women, 43.3 ± 9.4 years) were followed up at a minimum of 36 months after revision surgery. Besides range of motion (ROM), strength and function were evaluated with validated evaluation tools including the Constant score and the DASH score (Disability of the Arm, Shoulder and Hand questionnaire), specific AC Score (SACS), Nottingham Clavicle Score (NCS), Taft score and Acromioclavicular Joint Instability Score (AJI). Additionally, postoperative X-rays were compared to the unaffected side, measuring the coracoclavicular (CC) and acromioclavicular (AC) distance. RESULTS: At follow-up survey (55.8 ± 18.8 months) all patients but one demonstrated clinical ACJ stability after arthroscopically assisted anatomical ACJ reconstruction with an autologous hamstring graft. Reconstruction techniques were dependent on the direction of instability. The functional results demonstrated moderate shoulder and ACJ scores with a Constant Score of 77.3 ± 15.4, DASH-score of 51.2 ± 23.4, SACS 32.6 ± 23.8, NCS 77.8 ± 14.2, AJI 75 ± 14.7 points and Taft Score 7.6 ± 3.4 points. All patients stated they would undergo the revision surgery again. Mean postoperative CC-distance (8.3 ± 2.8 mm) did not differ significantly from the contralateral side (8.5 ± 1.6 mm) (p > 0,05). However, the mean AC distance was significantly greater with 16.5 ± 5.8 mm compared to the contralateral side (3.5 ± 1.9 mm) (p = 0.012). CONCLUSION: Symptomatic iatrogenic ACJ instability following DCE is rare. Arthroscopically assisted revision surgery with an autologous hamstring graft improved ACJ stability in eight out of nine cases (88.9%). However, the functional scores showed ongoing impairment of shoulder function and a relatively high overall complication rate (33.3%). Therefore, this study underlines the importance of precise preoperative indication and planning and, especially, the preservation of ACJ stability when performing AC joint resection procedures. LEVEL OF EVIDENCE: Case series, LEVEL IV.


Assuntos
Articulação Acromioclavicular , Instabilidade Articular , Masculino , Humanos , Feminino , Ombro , Articulação Acromioclavicular/cirurgia , Estudos Retrospectivos , Artroscopia/efeitos adversos , Artroscopia/métodos , Resultado do Tratamento , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Artralgia , Dor , Doença Iatrogênica
2.
Knee Surg Sports Traumatol Arthrosc ; 29(1): 275-283, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32285157

RESUMO

PURPOSE: The aim of the study was to analyze partial subscapularis tendon (SSC) tears and provide a descriptive classification. METHODS: The retrospective study included 50 patients with arthroscopically confirmed partial SSC tears. Internal rotation (IR) force measurements and IR ROM have been made and compared to the healthy contralateral side. Then the footprint of the SSC was routinely investigated by arthroscopy with standardized measurement of the bony footprint lesion. The partial tears were classified according to the mediolateral and craniocaudal extension of the rupture in the transverse and coronal plane, respectively. RESULTS: Partial SSC tears could be classified into split lesions (type 1, n = 11) and 3 further groups depending on the mediolateral peeled-off length of the bony footprint (type 2: < 10 mm, n = 20; type 3: 10-15 mm, n = 10; type 4: > 15 mm, n = 9). Type 2-4 could be further divided depending on the craniocaudal peeled-off length of the bony footprint (group A: < 10 mm, group B: 10-15 mm, group C: > 15 mm). Significantly decreased IR strength was shown for types 2-4 (p < 0.05) but not for split lesions as compared to healthy side. Types 1-4 showed significant decreased active IR ROM and all except type 3 (n.s.) which showed decreased passive IR ROM compared to the healthy side (p < 0.05). CONCLUSION: We present a novel classification for partial SSC tears for a more detailed and reproducible description. This can help to improve the current knowledge about the appropriate treatment. It could be shown that partial tears of the subscapularis can have an impact on IR strength and motion. LEVEL OF EVIDENCE: III.


Assuntos
Lesões do Manguito Rotador/classificação , Adulto , Idoso , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rotação , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/fisiopatologia , Ruptura/classificação , Ruptura/fisiopatologia
3.
Knee Surg Sports Traumatol Arthrosc ; 29(7): 2289-2296, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32740876

RESUMO

PURPOSE: The purpose of this study was to evaluate whether the presence of an off-track Hill-Sachs lesion has an impact on the recurrence rate after nonoperative management of first-time anterior shoulder dislocations. METHODS: A retrospective cohort study was planned with a follow-up via questionnaire after a minimum of 24 months. Fifty four patients were included in the study (mean age: 29.5 years; 16 female, 38 male). All of these patients opted for primary nonoperative management after first-time traumatic anterior shoulder dislocation, in some cases even against the clinician's advice. The glenoid track and the Hill-Sachs interval were evaluated in the MRI scans. The clinical outcome was evaluated via a shoulder-specific questionnaire, ASES-Score and Constant Score. Further, patients were asked to report on recurrent dislocation (yes/no), time to recurrent dislocation, pain, feeling of instability and satisfaction with nonoperative management. RESULTS: In 7 (13%) patients, an off-track Hill-Sachs lesion was present, while in 36 (67%) the lesion was on-track and 11 (20%) did not have a structural Hill-Sachs lesion at all. In total, 31 (57%) patients suffered recurrent dislocations. In the off-track group, all shoulders dislocated again (100%), while 21 (58%) in the on-track group and 3 (27%) in the no structural Hill--Sachs lesion group had a recurrent dislocation, p = 0.008. The mean age in the group with a recurrence was 23.7 ± 10.1 years, while those patients without recurrent dislocation were 37.4 ± 13.1 years old, p < 0.01. The risk for recurrence in patients under 30 years of age was higher than in those older than 30 years (OR = 12.66, p < 0.001). There were no significant differences between patients with on- and off-track lesions regarding patients' sex, height, weight and time to reduction and glenoid diameter. Off-track patients were younger than on-track patients (24.9 ± 7.3 years vs. 29.6 ± 13.6 years). However, this difference was not statistically significant. CONCLUSION: The presence of an off-track Hill-Sachs lesion leads to significantly higher recurrence rates compared to on-track or no structural Hill--Sachs lesions in patients with nonoperative management and should be considered when choosing the right treatment option. Therefore, surgical intervention should be considered in patients with off-track Hill-Sachs lesions. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões de Bankart/epidemiologia , Lesões de Bankart/terapia , Luxação do Ombro/terapia , Adolescente , Adulto , Lesões de Bankart/cirurgia , Criança , Suscetibilidade a Doenças , Feminino , Seguimentos , Humanos , Instabilidade Articular/epidemiologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Escápula/diagnóstico por imagem , Ombro/diagnóstico por imagem , Ombro/patologia , Luxação do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Inquéritos e Questionários , Adulto Jovem
4.
Knee Surg Sports Traumatol Arthrosc ; 29(7): 2325-2332, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32980887

RESUMO

PURPOSE: To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. METHODS: A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. RESULTS: A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar CONCLUSION: A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. LEVEL OF EVIDENCE: Level V.


Assuntos
Articulação Acromioclavicular/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Algoritmos , Consenso , Técnica Delphi , Humanos , Ligamentos Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Cuidados Pós-Operatórios , Radiografia/métodos , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia , Inquéritos e Questionários
5.
Arch Orthop Trauma Surg ; 141(5): 717-724, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32328719

RESUMO

PURPOSE: The purpose of our study was to evaluate the clinical and radiological results of a new anatomic convertible cementless glenoid component. METHODS: Forty-eight patients with a mean age of 67.3 years were clinically and radiologically followed-up with a mean of 49 months. Indications for glenoid replacement were A2 glenoid wear in 21.7%, B1 glenoid wear in 28.3%, B2 glenoid wear in 28.3%, B3 glenoid wear in 13%, D glenoid wear in 2.2%, and glenoid component loosening in 6.5%. RESULTS: The Constant-Murley score improved significantly (p < 0.0001) from 50% pre-OP to 103% post-OP. Patients with a B3 glenoid type according to Walch achieved a significant (p = 0.044) lower Constant-Murley Sscore post-OP compared to patients with a B1 glenoid type (88% vs 106%). The mean subluxation index changed significantly (p < 0.0001) from 0.54 pre-OP to 0.46 post-OP. At the metal-back bone interface an incomplete radiolucent line < 1 mm was observed in two cases (4.2%) and an incomplete radiolucent line < 2 mm was observed in another two cases (4.2%). PE dissociation occurred in two cases. No glenoid loosening was observed. The implant related revision rate was 4.2% (2 cases). All components (n = 612.5%) requiring conversion to reverse were converted without any further complications or loosening. CONCLUSION: Good functional results can be achieved in cases with a B1 and a B2 glenoid after anatomic shoulder arthroplasty using the described metal back glenoid. A conversion from an anatomic to a reverse glenoid component were possible in all cases without any further complications. Conversion of the anatomic glenoid component to a reverse system alleviates revision surgery.


Assuntos
Artroplastia do Ombro , Articulação do Ombro/cirurgia , Prótese de Ombro , Idoso , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/instrumentação , Humanos , Estudos Prospectivos , Prótese de Ombro/efeitos adversos , Resultado do Tratamento
6.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 3797-3802, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30900030

RESUMO

PURPOSE: Arthroscopic-assisted stabilization surgery for acute acromioclavicular joint (ACJ) disruption shows excellent and reliable clinical outcomes. However, characteristic complications such as fracture of the clavicle and coracoid have been reported to occur during the early post-operative period. The main goal of this study was to highlight the occurrence of fractures as a late post-operative complication. The secondary goals were to describe possible fracture morphologies and treatment outcomes. METHOD: Patient records from a single surgery centre were searched for all patients presenting with late fracture complication following arthroscopically assisted acromioclavicular stabilization. Medical reports including the operative notes and pre- and post-operative X-rays were reviewed. A telephone interview was conducted with each patient to access the American Shoulder and Elbow Surgeons shoulder score. RESULTS: A total of four patients presented with late fracture complication following arthroscopic-assisted ACJ stabilization surgery. All patients were males and presented following trauma at a median duration of 19.5 months after the index surgery. Fracture morphology differed between patients; the treatment was conservative in three patients, while one patient underwent osteosynthesis. CONCLUSION: Traumatic peri-implant fractures can occur, even 2 years after arthroscopically assisted ACJ reconstruction. This needs to be considered when planning for surgical intervention in acute ACJ disruption, especially in a high-risk population. LEVEL OF EVIDENCE: Therapeutic study, Level IV.


Assuntos
Articulação Acromioclavicular/cirurgia , Artroscopia , Clavícula/lesões , Processo Coracoide/lesões , Instabilidade Articular/cirurgia , Fraturas Periprotéticas/terapia , Adulto , Idoso , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Processo Coracoide/diagnóstico por imagem , Feminino , Fixação Interna de Fraturas , Humanos , Imobilização , Masculino , Complicações Pós-Operatórias , Radiografia
7.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 3821-3826, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410526

RESUMO

PURPOSE: Arthroscopically assisted acromioclavicular joint (ACJ) stabilization techniques use bone tunnels in the clavicle and coracoid process. The tunnel size has been shown to have an impact on the fracture risk of clavicle and coracoid. The aim of the present study was to radiographically evaluate the alterations of the clavicular tunnel size in the early post-operative period. It was hypothesized that there would be a significant increase of tunnel size. METHODS: Twenty consecutive patients with acute high-grade ACJ (Rockwood type IV-V) injury underwent arthroscopic-assisted ACJ stabilization. The median age of the patients was 40 (26-66) years. For all patients, a single tunnel button-tape construct was used along with an additional ACJ tape cerclage. Radiologic measurements were undertaken on standardized Zanca films at two separate time points, immediate post-operative examination (IPO) and at late post-operative examination (> 4 months; LPO). The LPO radiographs were taken at a median follow-up period of 4.5 (3-6) months. Clavicular tunnel width (CT) and coracoclavicular distance (CCD) were measured using digital calipers by two independent examiners and the results are presented as median, range, and percentage. RESULTS: The median CCD increased significantly from 9.5 (8-13) mm at IPO to 12 (7-20) mm at LPO (p < 0.05). Median tunnel size showed significant difference from 3 (3-4) mm at IPO to 5 (4-7) mm at LPO (p < 0.05). Despite a significant increase of 2 mm (66.6%) of the initial tunnel size, there was no correlation between tunnel widening and loss of reduction. CONCLUSION: Arthroscopic ACJ stabilization with the use of bone tunnels led to a significant increase of clavicular tunnel size in the early post-operative period. This phenomenon carries a higher fracture risk, especially in high-impact athletes, which needs to be considered preoperatively. LEVEL OF EVIDENCE: IV.


Assuntos
Articulação Acromioclavicular/cirurgia , Artroscopia , Clavícula/diagnóstico por imagem , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/lesões , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Radiografia , Adulto Jovem
8.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 3844-3855, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31624902

RESUMO

PURPOSE: Treatment of failed primary reconstruction of the unstable acromioclavicular (AC) joint remains challenging for orthopaedic surgeons. When approaching revision cases, the reason for failure has to be precisely identified. The purpose of this manuscript was to perform a critical review of the literature regarding treatment options for failed AC joint stabilization techniques and to provide a treatment algorithm for salvage procedures. METHODS: A thorough search included electronic databases for articles published up to April 15th, 2019. Inclusion criteria were set as (1) studies that reported on clinical outcomes following surgical or conservative treatment of AC joint dislocation; (2) studies reporting on failure or complications of primary treatment; (3) chronic instabilities caused by delayed or secondary treatment as well as (4) revision and salvage procedures. RESULTS: The search strategy identified a total of 3269 citations. The final dataset comprised 84 studies published between 1954 and 2019. A total of 5605 patients (9.63% females) were involved with a mean age of 34.5 years. Overall, complication rates varied between 5 and 88.9% in patients with AC joint instability. CONCLUSION: In the current literature, evidence for treatment of revision AC joint instability is still lacking, however, surgical treatment continues to evolve. The importance of failure analysis and clinically relevant algorithms were highlighted in this review. Adequately restoring native joint biomechanics is needed for ensuring an optimal healing environment that will translate into patient satisfaction and long-term stability. LEVEL OF EVIDENCE: V.


Assuntos
Articulação Acromioclavicular/cirurgia , Instabilidade Articular/cirurgia , Reoperação , Fenômenos Biomecânicos , Humanos , Procedimentos Ortopédicos , Terapia de Salvação , Falha de Tratamento
9.
Knee Surg Sports Traumatol Arthrosc ; 27(10): 3222-3229, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30725122

RESUMO

PURPOSE: Glenoid bone integrity is crucial for shoulder stability. The purpose of this study was to investigate a non-invasive method for quantifying bone loss regarding reliability and accuracy to detect glenoid bone deficiency in standard two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) measurements at different time points. It was hypothesized that the diameter of the circle used would significantly differ between raters, rendering this method inaccurate and not allowing for an exact estimation of glenoid defect size. METHODS: Fifty-two shoulder CTs from 26 patients (26 2D-CTs; 26 3D-CTs) with anterior glenoid bone defects were evaluated by 6 raters at time 0 (T0) and at least 3 weeks after (T1) to assess the glenoid bone defect using the ratio method ("best fit circle"). Inter- and intra-rater differences concerning circle dimensions (circle diameter), measured width of bone loss and calculated percentage of bone loss (length-width-ratio) were compared in 2D- versus 3D-CT scans. The intraclass coefficient (ICC) was used to determine the inter- and intra-rater agreement. RESULTS: The mean circle diameter difference in 2D-CT was 2.0 ± 1.9 mm versus 1.8 ± 1.5 mm in 3D-CT, respectively (p < 0.01). Mean width of bone loss in 2D-CT was 1.9 ± 1.7 mm compared to 1.7 ± 1.5 mm in 3D-CT, respectively (p < 0.01). The mean difference of bone loss percentage was 5.1 ± 4.8% in 2D-CT and 4.8 ± 4.5% in 3D-CT (p < 0.01). No significant differences concerning circle diameter, bone loss width and bone loss percentage were detected comparing T0 and T1. Circle diameter, bone loss width and bone loss percentage measurements in 3D-CT were significantly smaller compared to 2D-CT at T0 and T1 (p < 0.01). Agreement (ICC) was fair to good for all indicators of circle diameter (range 0.76-0.83), bone loss width (range 0.76-0.86) and percentage of bone loss (range 0.85-0.91). Overall, 3D-CT showed superior agreement compared to 2D-CT. CONCLUSION: The ratio method varies in all glenoid parameters and is not valid for consistently quantifying glenoid bone defects even in 3D computed tomography. This must be taken into consideration when determining proper surgical treatment. The degree of glenoid bone loss alone should not be used to decide for or against a bony procedure. Rather, it is more important to define a defect size as "critical" and to also take other patient-specific factors into consideration so that the best treatment option can be undertaken. Application of the "best fitting circle" is a source of error when using the ratio method; therefore, care should be taken when measuring the circle diameter. LEVEL OF EVIDENCE: III.


Assuntos
Cavidade Glenoide/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Orthopade ; 48(9): 795-808, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31432200

RESUMO

Primary osteoarthritis of the shoulder represents a destructive joint disease with associated synovitis, which in the first line seems to be genetically determined. Clinically, patients suffer from shoulder pain with progressive impairment of both active and passive range of motion. The diagnostics include a clinical examination, imaging by native radiography and magnetic resonance imaging (MRI) for assessment of the rotator cuff. Current classification systems consider the formation of humeral osteophytes, glenoid morphology and loss of humeral sphericity. Non-surgical measures include, apart from topical and oral analgesics, injection of corticosteroids and hyaluronic acid supported by physiotherapeutic measures. After failure of non-surgical therapeutic measures, arthroscopic joint-preserving arthroplasty in terms of the comprehensive arthroscopic management (CAM) procedure can be performed in young patients with early stage osteoarthritis, whereas in advanced stages endoprosthetic joint replacement is indicated.


Assuntos
Osteoartrite/diagnóstico , Articulação do Ombro , Artroplastia de Substituição , Humanos , Osteoartrite/terapia , Amplitude de Movimento Articular , Ombro , Resultado do Tratamento
11.
Unfallchirurg ; 122(12): 941-943, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31529137

RESUMO

The operative treatment of stiff shoulder using arthroscopically assisted arthrolysis is indicated in patients with persistent, symptomatic and therapy-resistant movement restrictions. Patients should be informed about relevant risks, supervised rehabilitation and possible recurrences. The surgical procedure provides a precise and controlled semicircular capsulotomy and is followed by an intensive rehabilitation program in order to minimize the risk of recurrences.


Assuntos
Anestesia , Artropatias , Manipulação Ortopédica , Artroscopia , Humanos , Artropatias/terapia , Amplitude de Movimento Articular , Ombro , Articulação do Ombro , Resultado do Tratamento
12.
BMC Musculoskelet Disord ; 19(1): 432, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30509244

RESUMO

BACKGROUND: Elbow dislocation represents a common injury, especially in the younger population. If treated surgically, the reattached tendons require a high amount of primary stability to allow for an early rehabilitation to avoid postoperative stiffness. The purpose of this study was to assess the biomechanical properties of a single and a double row technique for reattachment of the common extensor and common flexor muscles origin. We hypothesized that the double row technique would provide greater stability in terms of pullout forces than the single row technique. METHODS: Twelve cadaveric specimens were randomized into two groups of fixation methods for the common extensor tendon or the common flexor tendon at the elbow (1): a single row technique using two knotted 3.0 mm suture anchors, and (2) a double row technique using an additional knotless 3.5 mm anchor. The repairs were cyclically loaded over 500 cycles at 1 Hz from 10 N to a maximum of 100 N (extensors) or 150 N (flexors), and then pulled to failure. Stiffness and maximum load at failure and mode of failure were recorded and calculated. RESULTS: No significant differences in stiffness were observed between the two techniques for both the extensor and flexor reattachment (P = 0.701 and P = 0.306, respectively). The mean maximum load at failure indicated that the double row construct was significantly stronger than the single row construct. This was found to be true for both the extensor and flexor reattachment (213.6; SD 78.7 N versus 384.1; SD 105.6 N, P = 0.010 and 203.7; SD 65.8 N versus 318.0; SD 64.6 N, P = 0.013, respectively). CONCLUSIONS: The double row technique provides significant greater stability to the reattached common flexor or extensor origin to the medial or lateral epicondyle. Thus, it should be considered in the development of improved repair techniques for stabilizers of the elbow. STUDY DESIGN: Controlled laboratory study.


Assuntos
Lesões no Cotovelo , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/métodos , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Fenômenos Biomecânicos , Cadáver , Articulação do Cotovelo/fisiologia , Articulação do Cotovelo/cirurgia , Humanos , Luxações Articulares/fisiopatologia , Instabilidade Articular/fisiopatologia , Âncoras de Sutura , Traumatismos dos Tendões/fisiopatologia , Tendões/fisiologia , Resistência à Tração
13.
BMC Musculoskelet Disord ; 18(1): 173, 2017 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-28441943

RESUMO

BACKGROUND: Humeral head fractures requiring surgical intervention are severe injuries, which might affect the return to sports and daily activities. We hypothesize that athletic patients will be constrained regarding their sporting activities after surgically treated humeral head fractures. Despite a long rehabilitation program physical activities will change and an avoidance of overhead activities will be noticed. METHODS: Case series with 65 Patients, with a minimum follow-up of 24 months participated in this study. All patients were treated using a locking plate fixation. Their sporting activity was investigated at the time of the injury and re-investigated after an average of 3.83 years. The questionnaire setup included the evaluation of shoulder function, sporting activities, intensity, sport level and frequency evaluation. Level of evidence IV. RESULTS: At the time of injury 61 Patients (94%) were engaged in recreational sporting activities. The number of sporting activities declined from 26 to 23 at the follow-up examination. There was also a decline in sports frequency and duration of sports activities. CONCLUSION: The majority of patients remains active in their recreational sporting activity at a comparable duration and frequency both pre- and postoperatively. Nevertheless, shoulder centered sport activities including golf, water skiing and martial arts declined or were given up.


Assuntos
Placas Ósseas/tendências , Fixação Interna de Fraturas/tendências , Fraturas do Úmero/cirurgia , Cabeça do Úmero/lesões , Cabeça do Úmero/cirurgia , Volta ao Esporte/tendências , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Humanos , Fraturas do Úmero/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
BMC Musculoskelet Disord ; 18(1): 506, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29191201

RESUMO

BACKGROUND: Fractures of the humeral greater tuberosity (GT) are a frequent injury progressively treated with arthroscopic suture anchor repair. Yet, no biomechanical study has been performed comparing fixation strength of arthroscopic single- (SR) vs. double row (DR) fixation. METHODS: Standardized fractures of the greater tuberosity were created in 12 fresh frozen proximal humeri. After random assignation to the SR or DR group the fixed humeri were tested applying cyclic loading to the supraspinatus and infraspinatus tendon. Load to failure and fragment displacement were assessed by means of an electrodynamic material testing machine using an optical tracking system. RESULTS: Load to failure values were higher in the DR group (649 N; ±176) than in the SR group (490 N; ±145) however without statistical significance (p = .12). In greater tuberosity displacement of 3-5 mm surgical treatment is recommended. The fixing constructs in this study did not reach displacement landmarks of 3 or 5 mm before construct failure as shown in previous studies. Thus the applied traction force (N) at 1 mm displacement was analyzed. In the SR group the load at 1 mm displacement was 277 N; ±46 compared to 260 N; ±62 in the DR group (p = .65). CONCLUSION: The results suggest that both techniques are viable options for refixation of greater tuberosity fractures. LEVEL OF EVIDENCE: Laboratory study.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Âncoras de Sutura , Técnicas de Sutura/instrumentação , Tendões/fisiologia , Idoso , Fenômenos Biomecânicos , Cadáver , Fixação Interna de Fraturas/instrumentação , Humanos , Úmero/lesões , Úmero/cirurgia , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Distribuição Aleatória , Suporte de Carga
15.
Knee Surg Sports Traumatol Arthrosc ; 25(7): 2182-2188, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26704795

RESUMO

PURPOSE: Isolated lesions of the caudal portion of the subscapularis (SSC) tendon are rare and have not been subject of major attention in the literature yet. However, these lesions can lead to tremendous impairment of shoulder function. The purpose of the present study was to raise clinician's awareness for these "hidden lesions" and to present the crucial steps for diagnosis and management. METHODS: Five patients (three men, two women; mean age 40) with traumatic isolated caudal SSC lesion were enrolled in the present study. After clinical and radiological examination, all patients underwent diagnostic arthroscopy and open inferior SSC repair. The results of the clinical and radiological examination were documented along with the intraoperative findings. Post-operative pain level and shoulder function were assessed. RESULTS: In all patients the SSC lesion could be detected clinically. In two patients the caudal SSC tear was diagnosed delayed after initial conservative treatment. Preoperatively, all patients showed restricted active movement of the shoulder with positive clinical tests for the SSC. All SSC lesions could be detected on MR images and identified arthroscopically. After a mean follow-up of 12 months, all clinical SSC tests were negative, and the patients have almost regained preinjury shoulder function. The mean post-operative pain score (VAS) was 1 (range 0-1), and the mean ASES score was 93.3 (range 91.6-95). CONCLUSION: Arthroscopic visualization of the SSC tendon is incomplete rendering caudal SSC tears difficult to detect and easy to overlook. Clinicians' awareness of this pathology along with accurate clinical and radiological examination leads to the correct diagnosis. Open caudal SSC repair provides pain relief and reliable shoulder function after short-term follow-up. LEVEL OF EVIDENCE: IV.


Assuntos
Manguito Rotador/cirurgia , Ruptura/cirurgia , Articulação do Ombro/cirurgia , Artroscopia/métodos , Humanos , Dor Pós-Operatória , Radiografia , Articulação do Ombro/fisiopatologia , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgia
16.
J Shoulder Elbow Surg ; 26(2): 253-257, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27720560

RESUMO

BACKGROUND: A variety of measurements can be used to assess radiographic osteoarthritic changes of the shoulder. This study aimed to analyze the correlation between the radiographic humeral-sided Samilson and Prieto classification system and 3 different radiographic classifications describing the changes of the glenoid in the coronal plane. METHODS: The study material included standardized radiographs of 50 patients with idiopathic osteoarthritis before anatomic shoulder replacement. On the basis of radiographic measurements, the cases were evaluated using the Samilson and Prieto grading system, angle ß, inclination type, and critical shoulder angle by 2 independent observers. RESULTS: Classification measurements showed an excellent agreement between observers. Our results showed that the humeral-sided Samilson and Prieto grading system had a statistically significant good correlation with angle ß (observer 1, r = 0.74; observer 2, r = 0.77; P < .05) and a statistically significant excellent correlation with the inclination type of the glenoid (observer 1, r = 0.86; observer 2, r = 0.8; P < .05). A poor correlation to the critical shoulder angle was observed (r = -0.14, r = 0.03; P > .05). CONCLUSIONS: The grade of humeral-sided osteoarthritis according to Samilson and Prieto correlates with the glenoid-sided osteoarthritic changes of the glenoid in the coronal plane described by the angle ß and by the inclination type of the glenoid. Higher glenoid-sided inclination is associated with higher grade of osteoarthritis in primary shoulder osteoarthritis.


Assuntos
Cavidade Glenoide/diagnóstico por imagem , Cabeça do Úmero/diagnóstico por imagem , Osteoartrite/cirurgia , Articulação do Ombro/diagnóstico por imagem , Idoso , Artroplastia do Ombro/métodos , Estudos Transversais , Feminino , Cavidade Glenoide/fisiopatologia , Humanos , Cabeça do Úmero/fisiopatologia , Masculino , Osteoartrite/diagnóstico por imagem , Radiografia , Articulação do Ombro/fisiopatologia
17.
BMC Musculoskelet Disord ; 17(1): 376, 2016 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-27577859

RESUMO

BACKGROUND: The latest generation of shoulder arthroplasty includes canal-sparing respectively stemless designs that have been developed to allow restoration of the glenohumeral center of rotation independently from the shaft, and to avoid stem-related complications. The stemless prosthesis design has also recently been introduced for use in reverse arthroplasty systems. METHODS: We systematically reviewed the literature for studies of currently available canal-sparing respectively stemless shoulder arthroplasty systems. From the identified series, we recorded the indications, outcome measures, and humeral-sided complications. RESULTS: We identified 11 studies of canal-sparing respectively stemless anatomic shoulder arthroplasty implants, published between 2010 and 2016. These studies included 929 cases, and had a mean follow-up of 26 months (range, 6 to 72 months). The rates of humeral component-related complications ranged between 0 and 7.9 %. The studies reported only a few isolated cases of complications of the humeral component. Some arthroplasty systems are associated with radiological changes, but without any clinical relevance. CONCLUSIONS: All of the published studies of canal-sparing respectively stemless shoulder arthroplasty reported promising clinical and radiological outcomes in short to midterm follow-up. Long-term studies are needed to demonstrate the long-term value of these kind of implants.


Assuntos
Artroplastia de Substituição/instrumentação , Prótese Articular , Osteoartrite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Articulação do Ombro/cirurgia , Artroplastia de Substituição/efeitos adversos , Artroplastia de Substituição/métodos , Humanos , Úmero , Radiografia , Articulação do Ombro/diagnóstico por imagem , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 17: 1, 2016 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-26728594

RESUMO

BACKGROUND: In addition to Bankart repair engaging Hill-Sachs defects in glenohumeral instability have been treated successfully with remplissage procedure. The purpose of this study was to compare three remplissage techniques regarding (I) ability of preventing Hill-Sachs defect from engaging, (II) influence on glenohumeral rotational torque, and (III) resulting tendon coverage over the Hill-Sachs defect. METHODS: Standardized engaging Hill-Sachs defects and Bankart lesions were created in n = 7 fresh frozen human shoulder specimens. Besides Bankart repair three remplissage techniques (T) with double anchor position in the valley of the defect zone were studied: T1, knots tied over anchors; T2, knots tied between anchors (double-pulley); T3, knotless anchors with a suture tape. A parallel position-orientation and force-moment controlled navigated roboticsystem was used to compare prevention of Hill-Sachs defect engagement and torque [Nm]. Pressure sensitive film was used to study area of infraspinatus tendon coverage over Hill-Sachs defect [%]. RESULTS: All remplissage techniques prevented engagement of the Hill-Sachs defect without showing any construct failures. Regarding humeral torque there were significant impairments observed between intact conditions and the three investigated repair techniques in 60° abduction and ≥30° external rotation (p < .04). There was no significant difference in torque between intervention groups (n.s.). With a mean coverage of 26.8 % over the defect zone the knotless suture tape technique (T3) significantly improved area of soft tissue coverage compared to the other techniques (p = .03). CONCLUSION: All remplissage techniques prevented engagement of the Hill Sachs defect. With high abduction and external rotation ≥30° all techniques showed significant higher humeral torque compared to the intact specimens, while there was not one technique superior over the others. The suture tape technique conferred the largest and most effective area of tendon coverage over the Hill-Sachs defect zone. Long-term success of the remplissage procedure can possibly be enhanced by increasing the interface area of tendon coverage over the Hill-Sachs defect. Clinical studies will be necessary to proof potential benefits for clinical outcome.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Articulação do Ombro/fisiologia , Articulação do Ombro/cirurgia , Tendões/fisiologia , Tendões/cirurgia , Fenômenos Biomecânicos/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/instrumentação , Luxação do Ombro/patologia , Luxação do Ombro/cirurgia , Articulação do Ombro/patologia , Tendões/patologia
19.
Arthroscopy ; 32(6): 982-7, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26935572

RESUMO

PURPOSE: To biomechanically compare the stability of the coracoid process after an anatomic double-tunnel technique using two 4-mm drill holes or a single-tunnel technique using one 4-mm or one 2.4-mm drill hole. METHODS: For biomechanical testing, 18 fresh-frozen cadaveric scapulae were used and randomly assigned to one of the following groups: two 4-mm drill holes (group 1), one 4-mm drill hole (group 2), or one 2.4-mm drill hole (group 3). After standardized coracoid drilling, load was applied to the conjoined tendons at a rate of 120 mm/min and ultimate failure load, along with the failure mode, was recorded. RESULTS: There was no significant difference between groups regarding load to failure. Mean load to failure in group 1 was 392 N; group 2, 459 N; and group 3, 506 N. The corresponding P values were .55, .74, and .20 for group 1 versus group 2, group 2 versus group 3, and group 1 versus group 3, respectively. However, the failure mode for the group with one 4-mm drill hole and the group with two 4-mm drill holes was coracoid fracture, whereas the group with one 2.4-mm drill hole showed 5 tears of the conjoined tendons and only 1 coracoid fracture (P = .015). CONCLUSIONS: Although there was no significant difference regarding load-to-failure testing between groups, the failure mechanism analysis showed that one 2.4-mm drill hole led to less destabilization of the coracoid than one or two 4-mm drill holes. CLINICAL RELEVANCE: Techniques with small, 2.4-mm drill holes might decrease the risk of severe iatrogenic fracture complications.


Assuntos
Articulação Acromioclavicular/cirurgia , Artroscopia/métodos , Processo Coracoide/lesões , Fraturas Ósseas/prevenção & controle , Idoso , Artroscopia/efeitos adversos , Fenômenos Biomecânicos , Cadáver , Feminino , Fraturas Ósseas/etiologia , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Dispositivos de Fixação Ortopédica
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA