Bilateral suprascapular notches are asymmetrically shaped in a third of the Asian population.

PURPOSE: The side-to-side differences within an individual's suprascapular notch (SSN) and the clinical characteristics of an ossified superior transverse scapular ligament are unclear. Therefore, the morphological asymmetry of the SSN was investigated, and the factors associated with the ossification of the superior transverse scapular ligament were analyzed. METHODS: Two hundred and seventy-six computed tomography images were retrospectively analyzed, which included those of both scapulae of Asian patients (mean age, 62.1 ± 19.1 years; males, 197) with high-energy injuries or respiratory diseases. Variations in the SSN were classified into six types based on Rengachary's classification using reconstructed three-dimensional computed tomography. The group with a type VI SSN (completely ossified superior transverse scapular ligament) in at least one scapula was compared with the other group for age, sex, and chronic comorbidities. RESULTS: Among 276 patients, 95 (34.4%) had asymmetric SSNs and 15 (5.4%) had type VI SSNs. There were no significant differences in age, sex, or comorbidities between both the groups. However, on comparing age groups, the prevalence of type VI SSN was higher in patients aged > 70 years than in those aged < 70 years. Fifteen patients had type VI SSNs, which were unilateral in 10 patients. CONCLUSION: Asymmetric SSNs were observed in a third of the Asian patients. There were variations in SSNs between individuals and also within an individual. In the cases with suprascapular nerve paralysis, the difference in SSN morphology compared to a healthy side should be considered. LEVEL OF EVIDENCE: III.

Is the canal flare index a reliable means of estimation of canal shape? Measurement of proximal femoral geometry by use of 3D models of the femur.

BACKGROUND: The canal flare index (CFI; the ratio of the diameter of the femoral canal at the isthmus in the anteroposterior (A-P) view to the diameter of the medullary canal 20 mm above the lesser trochanter) is often used as a canal characteristic. Clinically, however, CFI measurements are sometimes untrustworthy because of femoral rotation and, especially, greater anteversion among Japanese patients. Our objectives were to analyze femoral geometry, by use of 3D CAD models, to evaluate the effects of rotational error, and to seek an index less affected by rotation. METHODS: Computed axial tomography (CAT) scan data from 60 femurs were used. By use of CAD software, 3D femoral models were created. The outside of the femur and the inside canal width 20 mm (P20) and 10 mm proximal (P10), and 10 mm (D10), 20 mm (D20), 30 mm (D30), and 40 mm (D40) distal from the center of the lesser trochanter, and at the isthmus were measured for different angles of femoral rotation. CFI, FFI (femoral flare index; the ratio of the extra-cortical diameters at the same levels as for the CFI), and other canal ratios (P20/D10, P20/D20, P20/D30, and P20/D40) were then calculated and the effect of rotational errors was investigated. RESULTS: Mean CFI, FFI, P20/D10, P20/D20, P20/D30, and P20/D40 were 4.29, 2.08, 2.05, 2.49, 2.85, and 3.09 in the position without rotational error. CFI was not related to anteversion but had a negative correlation with isthmus canal width (only). In contrast FFI was almost constant at approximately 2.1 for different anteversion and age. With regard to the effect of rotational error, CFI changed by 1.31, FFI by 0.40, P20/D10 by 0.41, P20/D20 by 0.40, P20/D30 by 0.59, and P20/D40 by 0.80 for a variety of rotational angles. CONCLUSIONS: Outside femoral shape was little different for any person; as a result, FFI was almost constant. In contrast, CFI was revealed to be affected by canal width at the isthmus only. With regard to the effect of rotation, P20/D20 was much less affected by rotation than CFI; it could, therefore, be an appropriate index for expressing proximal canal shape.

Risk of Cephalic Vein Injury During the Creation of an Anterior Portal in Shoulder Arthroscopy.

Background: There is a risk of cephalic vein injury during shoulder arthroscopy. However, limited data regarding its anatomic course are available. Purpose: To analyze the positional relationship and factors affecting the distance between the coracoid tip and cephalic veins. Study design: Case series; Level of evidence, 4. Methods: A total of 80 contrast-enhanced computed tomography images from 80 patients (mean age, 49.6 ± 20.3 years; 61 men) were retrospectively analyzed. The distance between the center of the coracoid tip and the vertical line through the cephalic vein was measured in the axial (D1) and sagittal (D2) planes. The distance between 1 cm lateral to the center of the coracoid tip and the vertical line through the cephalic vein was measured in the sagittal plane (D3). Each distance was compared according to patient sex and laterality. Associations between each distance and the patient's age, height, weight, and body mass index were investigated. Results: The mean D1 was 18.4 ± 7.3 mm in 59 patients. The mean D2 was 23.4 ± 11.6 mm, and it was within 10 mm in 10 patients (12.5%). The mean D3 was 33.7 ± 12.2 mm. There was no significant difference in D1, D2, and D3 according to patient sex or laterality. A positive correlation was observed only between D3 and patient height (r = 0.320; P = .034). Conclusion: The cephalic vein was found to travel a mean of 23.4 mm distal and 33.7 mm distal to 1 cm lateral to the coracoid tip. Therefore, Care should be taken to avoid cephalic vein injury when creating an anterior inferior portal or 5-o'clock portal around these areas.

Hip Arthroscopic Synovectomy and Labral Repair in a Patient With Rheumatoid Arthritis With a 2-Year Follow-up.

The arthroscopic surgical procedures reported previously for a rheumatic hip joint have been primarily performed as diagnostic procedures. Only a few studies have reported the success of arthroscopic surgery in hip joint preservation. We encountered a special case in which joint remodeling was seen in a patient with rheumatoid arthritis treated with biological drugs after hip arthroscopic synovectomy and labral repair. We report the case of a 39-year-old woman with rheumatism, which was controlled with tocilizumab, prednisolone, and tacrolimus. The hip joint showed Larsen grade 3 destruction, and the Harris Hip Score was 55 points. Because of the patient's strong desire to undergo a hip preservation operation, we performed hip arthroscopic synovectomy and repair of a longitudinal labral tear. After 2.5 years, the joint space had undergone rebuilding with improvement to Larsen grade 2, and the Harris Hip Score had improved to 78 points; the patient was able to return to work with the use of 1 crutch. It is possible to perform hip arthroscopic surgery for rheumatoid arthritis with a hip preservation operation with biological drugs.