Retrospective analysis and comparison of total internal disability preservation technique and standardized reconstruction technique / 中国骨伤

OBJECTIVE@#To investigate the efficacy and clinical results of total internal protection technique in anterior cruciate ligament reconstruction.@*METHODS@#A total of 56 patients undergoing anterior cruciate ligament reconstruction treated from January 2018 to December 2019 were selected. According to the different surgical methods, they were divided into total internal reconstruction group and standard bone tunnel group. There were 21 patients in the total internal reconstruction group, including 15 males and 6 females, aged from 20 to 48 with an average of (35.6±6.7) years old, and 35 patients in the standard tibial tunnel group, including 26 males and 9 females, aged 22 to 51 years old with an average of (33.7±9.6) years old. Preoperative examination of Lachman test was positive, magnetic resonance indicated anterior cruciate ligament rupture. There were no significant differences between the two groups in age, sex, body mass index, time from injury to ACL reconstruction, combined meniscus injury and operation method, operation time, ligament diameter, ligament length and other general information. Postoperative evaluation included operation duration, length and diameter of transplanted tendon after braid. International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score and perioperative complications 2 years after surgery.@*RESULTS@#Both groups were followed up, ranging from 24 to 30 months with an average of (26.9±3.4) months. Postoperative incision healing was good, and no failure or joint infection occurred at the last follow-up. There was no statistically significant difference between the two groups in IKDC score, Lysholm score and Tegner score before, 1 year and 2 years after surgery. However, IKDC score, Lysholm score and Tegner score at 1 year and 2 years after surgery.@*CONCLUSION@#The same postoperative function and stability of knee joint can be obtained by both the residual whole technique and the standardized reconstruction technique. In the residual whole group, only the semitendinosus muscle is taken, and the femoral thin muscle is retained, with greater tibial bone mass preserved, which is safe and effective in clinical practice.

Progress on study of factors influencing the prognosis and complications of surgery for discoid meniscus injury in children / 中国骨伤

The discoid meniscus is a common congenital meniscal malformation that is prevalent mainly in Asians and often occurs in the lateral discoid meniscus. Patients with asymptomatic discoid meniscus are usually treated by conservative methods such as observation and injury avoidance, while patients with symptoms and tears need to be treated surgically. Arthroscopic saucerization combined with partial meniscectomy and meniscus repair is the most common surgical approach., and early to mid-term reports are good. The prognostic factors are the patient's age at surgery、follow-up time and type of surgery. Some patients experience complications such as prolonged postoperative knee pain, early osteoarthritis, retears and Osteochondritis dissecans. The incidence of prolonged postoperative knee pain was higher and the incidence of Osteochondritis dissecans was the lowest. Retears of the lateral meniscus is the main reason for reoperation.

Short-term effectiveness of arthroscopic repair via modified subacromial viewing portal in treatment of Lafosse Ⅰ subscapularis tendon tears / 中国修复重建外科杂志

OBJECTIVE@#To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears.@*METHODS@#A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up.@*RESULTS@#All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%).@*CONCLUSION@#Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.

Tibial Eminence Avulsion in a Tibial Plateau Fracture - Our Approach: A Clinical Case / Avulsão da eminência tibial em uma fratura do platô tibial - Nossa abordagem: Um caso clínico

Abstract A middle-aged female patient with a tibial plateau fracture combined with an avulsion of the tibial eminence was treated with a combination of medial plate fixation for the plateau and an arthroscopic aided nonabsorbable suture of the eminence. Our technique for tibial eminence avulsion fractures has no interference with tibial plateau osteosynthesis materials and has proven, once again, to have good results in the treatment of combined and complex injuries of the knee.

Resumo Uma paciente de meia-idade com fratura do platô tibial e avulsão da eminência tibial foi tratada com uma combinação de fixação do platô com placa medial e sutura da eminência com fio não absorvível auxiliada por artroscopia. Nossa técnica para fraturas com avulsão da eminência tibial não interfere nos materiais de osteossíntese do platô tibial e, mais uma vez, teve bons resultados no tratamento de lesões combinadas e complexas do joelho.

Retorno al deporte recreativo luego de la reparación artroscópica del manguito rotador / Return to sports after arthroscopic rotator cuff repair in recreational athletes

Objetivo: Evaluar el retorno al deporte recreativo luego de una reparación artroscópica del manguito rotador. materiales y métodos: Se realizó un análisis retrospectivo de atletas recreativos sometidos a una reparación artroscópica del manguito rotador entre agosto de 2019 y diciembre de 2020 (seguimiento mínimo 1 año). Se los dividió en dos grupos: alta y baja demanda del hombro. El resultado principal evaluado fue el retorno al deporte y los resultados secundarios fueron: tiempo de retorno, nivel alcanzado, escala analógica visual pre y posoperatoria para dolor; escalas ASES y Constant. Se calcularon la diferencia mínima clínicamente importante y el beneficio clínico sustancial. Se registraron las complicaciones. Resultados: Se incluyó a 102 pacientes (media de edad 58.7 años). Setenta practicaban un deporte de alta demanda para el hombro. La media de seguimiento fue de 18 meses. El 82,3% volvió al deporte; 63, al mismo nivel. La mediana hasta el regreso fue de 6 meses. El 91% de los deportistas con baja demanda para el hombro y el 79% con alta demanda retornaron al deporte. Los puntajes de las escalas mejoraron a los 6 y 12 meses. El 98% y el 100% alcanzaron la diferencia mínima clínicamente importante y el beneficio clínico sustancial para las escalas ASES y Constant, respectivamente. Ocho tenían dolor persistente. Cinco fueron sometidos a una cirugía de revisión. Conclusión: La reparación artroscópica del manguito rotador en deportistas recreativos logró muy buenos resultados funcionales con una alta tasa de retorno deportivo al mismo nivel y un 7,8% de complicaciones. Nivel de Evidencia: IV

Objective: To assess return to sports in recreational athletes after arthroscopic rotator cuff repair (ARCR). Materials and methods: Retrospective single-site study of recreational athletes who were operated onbetween August 2019 and December 2020 for ARCR, with a minimum follow-up of one year. Patients were divided into 2 groups based on their shoulder demand: high or low. The primary endpoint was return to sports. Secondary criteria included time to return, level achieved, pre and postoperative VAS for pain, and ASES and Constant scores. The minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated. Complications were recorded.Results:A total of 102 patients (mean age: 58.7 years) were included. Seventy patients practiced a sport with high shoulder involvement. The mean follow-up was 18 months. 82.3% of patients returned to recreational sports, with 63 participating at the same level. The median time to return was six months. Return to sports was 91% in the low-shoulder demand group versus 79% in the high-shoulder demand group. VAS, Constant and ASES scores improved after six and twelve months. For the ASES and Constant scores, 98 and 100% of patients met the MCID and SCB, respectively. A total of eight patients reported persistent pain. Five patients required revision surgery. Conclusion: Most recreational athletes who undergo ARCR are able to resume their previous level of activity. Most athletes achieved significant clinical improvement with a low rate of complications (7.8%). Level of Evidence: IV

Asistencia artroscópica y fijación interna percutánea en fracturas de Maisonneuve. Evaluación por imágenes de los resultados / Arthroscopy and percutaneous internal fixation in Maisonneuve fractures. Imaging evaluation

Introducción: La fractura de Maisonneuve es una lesión caracterizada por la fractura subcapital del peroné asociada a una lesión capsuloligamentaria de tobillo. Su tratamiento supone la restauración de la anatomía ósea y capsuloligamentaria normal para restablecer las fuerzas de contacto tibioastragalinas fisiológicas. Esta calidad de reducción puede ser difícil de alcanzar, sobre todo, con técnicas percutáneas. Objetivo: Evaluar mediante imágenes la calidad de la reducción de fracturas de Maisonneuve reducidas en forma cerrada (bajo visualización directa artroscópica) y fijadas por vía percutánea. Materiales y Métodos: Se analizaron radiografías e imágenes de tomografía computarizada preoperatorias y posoperatorias, comparativas de los tobillos operado y sano. Resultados: Se evaluaron 13 fracturas. Los parámetros radiográficos posoperatorios (espacio claro medial, solapamiento tibioperoneo distal, espacio claro tibioperoneo) no registraron diferencias, excepto por el intervalo tibioperoneo anterior que aumentó en un caso. La medición tomográfica posoperatoria del solapamiento tibioperoneo distal y el intervalo tibioperoneo anterior reveló que todas las reducciones eran satisfactorias. Dos pacientes tenían valores alterados en la sindesmosis tibioperonea distal con diferencia >2 mm respecto del tobillo sano. Conclusión: Recomendamos la asistencia artroscópica para el manejo de la fractura de Maisonneuve como herramienta de control intraoperatorio para una fijación percutánea más segura. Nivel de Evidencia: IV

Introduction: Maisonneuve fracture (MF) is an injury characterized by the subcapital fracture of the fibula associated with a capsuloligamentous injury of the ankle. Treatment involves the restoration of normal bone and capsuloligamentous anatomy in order to reestablish physiological tibiotalar contact forces. This quality of reduction can be difficult to achieve, especially with percutaneous techniques. Objective: To evaluate the quality of reduction in Maisonneuve fractures reduced in a closed manner (under direct arthroscopic visualization) and fixed percutaneously. Materials and Methods: We analyzed comparative preoperative and postoperative radiographs and CT scans of the operated and healthy ankles. Results: 13 fractures were evaluated. Radiographic parameters of postoperative procedures (medial clear space, distal tibiofibular overlap, tibiofibular clear space) did not register differences except for the anterior tibiofibular space, which had increased in 1 case. Postoperative tomographic measurements of tibiofibular clear space and anterior tibiofibular space showed 100% satisfactory reductions. Two patients presented altered distal tibiofibular overlap values with a difference greater than 2 mm compared to the healthy ankle. Conclusion: We recommend arthroscopy for the management of MF as an intraoperative control tool for safer percutaneous fixation. Level of Evidence: IV

Construct Validity and Experience of Using a Low-cost Arthroscopic Shoulder Surgery Simulator / Validação de constructo e experiência de uso de um simulador de artroscopia de ombro de baixo custo

Abstract Objective To validate the low-cost model for arthroscopy training and analyze the acceptance and usefulness of the developed simulator in medical teaching and training. Method Ten medical students, ten third-year orthopedic residents, and ten shoulder surgeons performed predetermined tasks on a shoulder simulator twice. The parameters used were time to complete the tasks, number of looks at the hands, GOALS score (Global Operative Assessment of Laparoscopic Skills) and comparison between groups and within groups. An adapted Likert scale was applied addressing the individuals' impressions about the simulator and its applicability. Results In the intergroup comparison, the shoulder surgeons had better scores and times than the other groups. When the tasks were repeated, the group of surgeons had a 59% improvement in time (p < 0.05), as did the group of medical students. In the GOALS score, shoulder surgeons had consistently better scores than the other groups. And when we evaluated the evolution from the first to the second test, the group of surgeons and the group of academics had a statistically significant improvement (p < 0.05). In terms of lookdowns, there was a decrease in all groups. There was consensus that the simulator is useful in training. Conclusion The simulator developed allowed the differentiation between individuals with different levels of training in arthroscopic surgery. It was accepted by 100% of the participants as a useful tool in arthroscopic shoulder surgical training.

Resumo Objetivo Validar o modelo de baixo custo para treinamento em artroscopia e analisar a aceitação e utilidade do simulador desenvolvido no ensino e treinamento médico. Método Dez acadêmicos do curso de medicina, dez residentes do terceiro ano em ortopedia e dez cirurgiões de ombro realizaram tarefas pré determinadas em um simulador de ombro duas vezes. Os parâmetros utilizados foram o tempo para completar as tarefas, quantidade de olhares para as mãos, escore de GOALS (Global Operative Assessment of Laparoscopic Skills) e comparados entre os grupos e intragrupos. Uma escala de Likert adaptada foi aplicada abordando as impressões dos indivíduos acerca do simulador e de sua aplicabilidade. Resultados Na comparação intergrupos, os cirurgiões de ombro tiveram melhores escores e tempos que os demais grupos. Quando as tarefas foram repetidas, o grupo de cirurgiões, teve uma melhora de 59% no tempo (p < 0,05), assim como no grupo de acadêmicos. No escore de GOALS os cirurgiões de ombro apresentaram escores consistentemente melhores que os demais grupos. E quando avaliamos a evolução do primeiro para o segundo teste, o grupo de cirurgiões e o grupo de acadêmicos tiveram melhora estatisticamente significante (p < 0,05). No quesito de lookdowns houve diminuição em todos os grupos. Houve consenso em que o simulador é útil no treinamento. Conclusão O simulador desenvolvido permitiu a diferenciação entre indivíduos com diferentes níveis de treinamento em cirurgia artroscópica. Foi aceito por 100% dos participantes como uma ferramenta útil no treinamento cirúrgico artroscópico do ombro.

Manejo das disfunções temporomandibulares. Parte II: tratamento cirúrgico / Management of temporomandibular joint disorders. Part II: surgical treatment

Objetivo: Apresentar as modalidades de tratamentos cirúrgicas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTMs). Revisão da literatura: As DTMs são muito frequentes e são responsáveis ​​por dor e desconforto em um número importante de pacientes. A avaliação e o diagnóstico são as chaves para determinar um plano de manejo adequado dessas doenças. Embora o tratamento conservador seja bem-sucedido na maioria dos pacientes, os tratamentos cirúrgicos podem ser a única opção para aqueles que não respondem ao tratamento conservador ou para casos com indicação cirúrgica inicial como, por exemplo, algumas neoplasias articulares. Dentre as alternativas cirúrgicas, podemos citar a artrocentese, artroscopia, reposicionamento do disco articular por cirurgia aberta, discectomia e tratamentos cirúrgicos para hipermobilidade e anquilose da articulação temporomandibular. Considerações finais: A seleção adequada dos casos é requisito obrigatório para uma intervenção cirúrgica bem-sucedida, a fim de alcançar o resultado desejado do tratamento, como alívio dos sintomas e melhora da função.

Aim: To present the most commonly used surgical treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: TMD is very common and is responsible for pain and dysfunction in a significant number of patients. Assessment and diagnosis are key to determining a management plan for these diseases. Although conservative treatment is successful in most patients, surgical treatments may be the only option for those who do not respond to conservative treatment or for some cases with an initial surgical indication, such as some joint neoplasms. Surgical alternatives include arthrocentesis, arthroscopy, repositioning of the articular disc by open surgery, discectomy and surgical treatments for temporomandibular joint hypermobility and ankylosis. Conclusions: Proper case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired treatment outcome, such as symptom relief and improved function.

Uso de plataforma de adaptação para smartphone na artroscopia da articulação temporomandibular / Use of an adapted smartphone platform for Temporomandibular Joint Arthroscopy

Disfunção Temporomandibular é um termo utilizado para indicar alterações e doenças das articulações temporomandibulares (ATM) e estruturas anexas responsáveis por sua função. Prevalente na população geral, seus sintomas causam desconforto e limitação da função mandibular, repercutindo diretamente na qualidade de vida de seus portadores. Dentre as alterações que compõem este grupo de doenças, destacam-se os desarranjos internos da ATM, para os quais o tratamento cirúrgico pode estar indicado. A Artroscopia da ATM, procedimento diagnóstico e terapêutico caracterizado pela introdução de óticas de pequeno calibre nos compartimentos articulares vem ganhando espaço e indicação como primeira opção terapêutica devido aos seus bons resultados e mínima invasividade. No entanto, sua dificuldade técnica, alto custo, necessidade de instrumentais específicos e sistema de videocirurgia ainda são fatores limitadores para a indicação desta pelos profissionais atuantes. Nosso objetivo foi validar, por meio de um estudo com simuladores realísticos validados e 10 examinadores qualificados de diferentes níveis de atuação, o uso de plataforma de adaptação de ótica para smartphone em artroscopia da ATM, afim de qualificar a resolução das imagens obtidas e grau de ergonomia durante seu uso por meio de classificação em três scores. Como resultados, obtivemos em geral, para qualidade da imagem 77,5% de nota máxima e 22,5% nota intermediaria e para ergonomia 62,5% de nota máxima e 37,5% de nota intermediaria. Concluímos que a plataforma é viável para a indicação de artroscopia de ATM em nível I e possível de ser utilizada em nível II.

Progress in arthroscopic surgery for injury of superior labrum anterior posterior of shoulder joint / 中国骨伤

Superior labrum anterior posterior (SLAP) injury is a major challenge for orthopedic surgeons, due to the poor healing ability of the injured labrum. Although arthroscopic surgery is the gold standard for the treatment of SLAP injury, there are still disputes about the adaptation of different surgical techniques, the choice of anchors during operation, knotted or knotless anchors, and fixation methods. The authors believe that arthroscopic repair of SLAP lesions is effective for young patients with intact glenoid labrum(<35 years old) or with extensive activity, where single and knotless anchor is preferred. For the older patients(≥35 years old) with degeneration and wear of glenoid labrum, biceps tenodesis is more preferable, and interference screw fixation technique is recommended. As for patients with failed SLAP repair, biceps tenodesis can achieve a high success rate as a revision surgery. By review of the relevant literature in recent years, this paper summarizes the adaptation of different surgical methods of arthroscopic treatment of SLAP injury, intraoperative anchoring techniques, fixation methods and other improved surgical techniques.

Arthroscopic fixation of chronic bicruciate tibial avulsion fractures: A case report / 中华创伤杂志(英文版)

A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear. Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely. Over the last decades, many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures, but arthroscopic treatment in a late presenting patient has not been reported in the literature. This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament. Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury. At one year of follow-up, the patient had demonstrated full knee range of motion and stable knee with no complaints, and achieved excellent clinical outcomes. Radiographs showed union of both fractures, and the patient had resumed high-impact exercises.

Long-term effectiveness of arthroscopic partial repair for massive irreparable rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives.@*METHODS@#A retrospective analysis was conducted on the clinical data of 24 patients (25 sides) with massive irreparable rotator cuff tears who met the inclusion criteria between May 2006 and September 2014. Among them, there were 17 males (18 sides) and 7 females (7 sides) with an age range of 43-67 years (mean, 55.0 years). There were 23 cases of unilateral injury and 1 case of bilateral injuries. All patients were treated with the arthroscopic partial repair. The active range of motion of forward elevation and abduction, external rotation, and internal rotation, as well as the muscle strength for forward flexion and external rotation, were recorded before operation, at the first postoperative follow-up, and at last follow-up. The American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, and Constant score were used to evaluate shoulder joint function. And the visual analogue scale (VAS) score was used to evaluate shoulder joint pain. MRI examination was performed. The signal-to-noise quotient (SNQ) was measured above the anchor point near the footprint area (m area) and above the glenoid (g area) in the oblique coronal T2 fat suppression sequence. The atrophy of the supraspinatus muscle was evaluated using the tangent sign. The global fatty degeneration index (GFDI) was measured to assess fat infiltration in the supraspinatus muscle, infraspinatus muscle, teres minor muscle, upper and lower parts of the subscapularis muscle. The mean GFDI (GFDI-5) of 5 muscles was calculated.@*RESULTS@#The incisions healed by first intention. All patients were followed up with the first follow-up time of 1.0-1.7 years (mean, 1.3 years) and the last follow-up time of 7-11 years (mean, 8.4 years). At last follow-up, the range of motion and muscle strength of forward elevation and abduction, ASES score, Constant score, UCLA score, and VAS score of the patients significantly improved when compared with those before operation ( P<0.05). Compared with the first follow-up, except for a significant increase in ASES score ( P<0.05), there was no significant difference in the other indicators ( P>0.05). Compared with those before operation, the degree of supraspinatus muscle infiltration worsened at last follow-up ( P<0.05), GFDI-5 increased significantly ( P<0.05), and there was significant difference in the tangent sign ( P<0.05); while there was no significant difference in the infiltration degree of infraspinatus muscle, teres minor muscle, and subscapularis muscle, upper and lower parts of the subscapularis muscle ( P>0.05). Compared with the first follow-up, the SNQm and SNQg decreased significantly at last follow-up ( P<0.05). At the first and last follow-up, there was no correlation between the SNQm and SNQg and the ASES score, Constant score, UCLA score, and VAS score of the shoulder ( P>0.05).@*CONCLUSION@#Arthroscopic partial repair is effective in treating massive irreparable rotator cuff tear and significantly improves long-term shoulder joint function. For patients with severe preoperative fat infiltration involving a large number of tendons and poor quality of repairable tendons, it is suggested to consider other treatment methods.

Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT).@*METHODS@#The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared.@*RESULTS@#All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation ( P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation ( P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group ( P<0.05). There was no significant difference in other baseline data between the two groups ( P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group ( P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups ( P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B ( P>0.05).@*CONCLUSION@#Tendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.

Effectiveness of arthroscopic "hybrid" suture for delaminated rotator cuff tear: A prospective randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of "hybrid" suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture.@*METHODS@#Fifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups ( n=28) using a random number method. The patients in trial group underwent arthroscopic "hybrid" suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups ( P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al.@*RESULTS@#Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups ( P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation ( P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group ( P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) ( P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group ( P<0.05).@*CONCLUSION@#Compared with en masse suture, arthroscopic "hybrid" suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.

Research progress of the diagnosis and treatment of anterior shoulder instability / 中国修复重建外科杂志

The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.

Research progress in biomechanics of Bristow-Latarjet procedure for anterior shoulder dislocation / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of the biomechanical study of the Bristow-Latarjet procedure for anterior shoulder dislocation.@*METHODS@#The related biomechanical literature of Bristow-Latarjet procedure for anterior shoulder dislocation was extensively reviewed and summarized.@*RESULTS@#The current literature suggests that when performing Bristow-Latarjet procedure, care should be taken to fix the bone block edge flush with the glenoid in the sagittal plane in the direction where the rupture of the joint capsule occurs. If traditional screw fixation is used, a double-cortical screw fixation should be applied, while details such as screw material have less influence on the biomechanical characteristics. Cortical button fixation is slightly inferior to screws in terms of biomechanical performance. The most frequent site of postoperative bone resorption is the proximal-medial part of the bone block, and the cause of bone resorption at this site may be related to the stress shielding caused by the screw.@*CONCLUSION@#There is no detailed standardized guidance for bone block fixation. The optimal clinical treatment plan for different degrees of injury, the factors influencing postoperative bone healing and remodeling, and the postoperative osteoarticular surface pressure still need to be further clarified by high-quality biomechanical studies.

Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects.@*METHODS@#Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation.@*RESULTS@#All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation ( P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation ( P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months.@*CONCLUSION@#Arthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.

Clinical application of Fastpass Scorpion suture passer for arthroscopic Bankart repair / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness and advantages of using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair compared with traditional arthroscopic suture shuttle.@*METHODS@#The clinical data of 41 patients with Bankart lesion, who met the selection criteria and were admitted between August 2019 and October 2021, was retrospectively analyzed. Under arthroscopy, the inferior capsulolabral complex was stitched with Fastpass Scorpion suture passer in 27 patients (FS group) and with arthroscopic suture shuttle in 14 patients (ASS group). There was no significant difference between the two groups ( P>0.05) in gender, age, injured side, frequency of shoulder dislocation, time from first dislocation to operation, and preoperative Rowe score of shoulder. Taking successful suture and pull-tightening as the criteria for completion of repair, the number of patients that were repaired at 5∶00 to 6∶00 (<6:00) and 6∶00 to 7∶00 positions of the glenoid in the two groups was compared. The operation time, and the difference of Rowe shoulder score betwee pre- and post-operation, the occurrence of shoulder joint dislocation, the results of apprehension test, and the constituent ratio of recovery to the pre-injury movement level between the two groups at 1 year after operation.@*RESULTS@#Both groups completed the repair at 5∶00 to 6∶00 (<6∶00), and the constituent ratio of patients completed at 6∶00 to 7∶00 was significantly greater in the FS group than in the ASS group ( P<0.05). The operation time was significantly shorter in the FS group than in the ASS group ( P<0.05). All incisions in the two groups healed by first intention. All patients were followed up 12-36 months (mean, 19.1 months). No anchor displacement or neurovascular injury occurred during follow-up. Rowe score of shoulder in the two groups significantly improved at 1 year after operation than preoperative scores ( P<0.05), and there was no significant difference in the difference of Rowe shoulder score between pre- and post-operation between the two groups ( P>0.05). At 1 year after operation, no re-dislocation occurred, and there was no significant difference in the apprehension test and the constituent ratio of recovery to the pre-injury movement level between the two groups ( P>0.05).@*CONCLUSION@#Compared with the arthroscopic suture shuttle, using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair is more convenient, saves operation time, and has good effectiveness.

Mid-term effectiveness of arthroscopic Bankart repair in treatment of recurrent anterior shoulder dislocation / 中国修复重建外科杂志

OBJECTIVE@#To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation.@*METHODS@#The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded.@*RESULTS@#All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation ( P<0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients' satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level.@*CONCLUSION@#Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.

Modified Latarjet splitting subscapularis muscle under arthroscopy: an anatomical study based on axillary nerve, glenoid, and subscapularis muscle / 中国修复重建外科杂志

OBJECTIVE@#To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting.@*METHODS@#A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively.@*RESULTS@#In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane.@*CONCLUSION@#In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.