RESUMO
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.
Assuntos
Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Dor de Ombro , Estudos Retrospectivos , Resultado do Tratamento , Artroscopia , Articulação do Ombro/cirurgia , Tendões/cirurgia , Amplitude de Movimento ArticularRESUMO
Abstract Objective To provide a current overview of the Bristow-Latarjet surgery in Brazil. Materials and MethodsThis cross-sectional study was based on an electronic questionnaire with 26 items, which was sent to active members of the Brazilian Society of Shoulder and Elbow Surgery (Sociedade Brasileira de Cirurgia do Ombro e Cotovelo, SBCOC, in Portuguese). The questionnaire addressed training, surgical technique, complications, and postoperative management. Results We sent the questionnaire to 845 specialists from April 20 to May 12, 2021, and 310 of them answered i in full. During their specialization, most specialists participated in up to ten Bristow-Latarjet procedures. The most frequent complication was graft fracture, while the most common technical difficulty was screw positioning. In total, 50.6% and 73.9% reported having experienced intraoperative and postoperative complications respectively; 57.1% declared performing subscapularis suture; 99.7% indicated postoperative immobilization; and 61.9% considered graft consolidation fundamental. Conclusion Most specialists participated in up to ten Bristow-Latarjet procedures during the specialization, but 13.5% of them graduated without participating in the surgery. The most frequent complication was graft fracture. The most common technical difficulty was screw positioning. Most participants prefer postoperative immobilization since they believe graft consolidation is essential to resume the practiced of sports. The highest complication rate occurred with specialists who have obtained their titles 11 to 15 years ago. In Brazil, the Southeast region is the largest producer of specialists and has the highest concentration of these professionals.
Resumo Objetivo Traçar um panorama atual da cirurgia de Bristow-Latarjet no Brasil. Materiais e Métodos Estudo transversal no qual um questionário eletrônico com 26 perguntas sobre aspectos de formação, técnica cirúrgica, complicações e manejo pós-cirúrgico foi enviado a membros ativos da Sociedade Brasileira de Cirurgia do Ombro e Cotovelo (SBCOC). Resultados Entre 20 de abril e 12 de maio de 2021, o questionário foi enviado a 845 especialistas, e obteve-se 310 respostas completas. Durante a especialização, a maior parte dos especialistas participou de até dez procedimentos de Bristow-Latarjet. A complicação mais frequente foi a fratura do enxerto, e a dificuldade técnica, o posicionamento dos parafusos. Ao todo, 50,6% já tiveram complicações no intraoperatório; 73,9% já tiveram complicações no pós-operatório; 57,1% fazem a sutura do subescapular; 99,7% indicam a imobilização no pós-operatório; e 61,9% consideram a consolidação do enxerto fundamental. Conclusão A maior parte dos especialistas participou de até dez procedimentos de Bristow-Latarjet durante a especialização, mas 13,5% se formaram sem ter participado de nenhuma cirurgia. A complicação mais frequente foi a fratura do enxerto. A dificuldade técnica mais frequente foi o posicionamento dos parafusos. Imobilização no pós-operatório é a preferência da maioria dos participantes, que consideram fundamental a consolidação do enxerto para o retorno ao esporte. O maior número de complicações ocorreu com especialistas que obtiveram o título de 11 a 15 anos atrás. A região Sudeste é a maior formadora de especialistas e onde está concentrada a maior parte deles.
Assuntos
Humanos , Complicações Pós-Operatórias , Luxação do Ombro/terapia , Articulação do Ombro/cirurgia , Brasil , Metanálise como Assunto , Instabilidade Articular/cirurgiaRESUMO
Los defectos glenoideos en una prótesis primaria o de revisión son un reto para el cirujano ortopedista; la toma adecuada de decisiones y la planificación preoperatoria son dos herramientas fundamentales para que el acto quirúrgico presente los mejores resultados. Existen diversos métodos de imágenes para determinar el tipo de defecto que la glena pueda presentar, ya sea aumento de la retroversión o, peor aún, una glena anteversa acompañada de una subluxación o luxación como tal. Se presenta a continuación un caso de un paciente masculino, de cuarenta y siete años, con artrosis glenohumeral Hamada tipo IV, lesión de manguito rotador Patte tipo 3, con marcada limitación funcional y hallazgos imagenológicos de alteración de su estructura ósea a nivel de glena y cabeza humeral, con dos años de evolución. Se propone como tratamiento una prótesis reversa de hombro con uso de aloinjerto estructural de pilón tibial. Se expone el caso con seguimiento a seis meses de rangos de movilidad y escala de dolor
Glenoid defects in a primary or revision prosthesis are a challenge for an orthopedic surgeon. Appropriate decision-making and preoperative planning are two fundamental tools for the surgical act to present the best results. There are various imaging methods to determine the type of defect that the glenoid may present, whether it is increased retroversion or, worse still, an anteverted glenoid accompanied by a subluxation or dislocation as such.The following is a case of a 47-year-old male patient with Hamada type IV glenohumeral osteoarthritis, Patte type 3 rotator cuff injury, with marked functional limitation and imaging achievements of alterations in his bone structure at the level of the glenoid and humeral head, with two years of evolution. A reverse shoulder prosthesis with the use of a structural allograft of the distal tibia is proposed as treatment, and the case is presented with a 6-month follow-up of ranges of motion and pain scale
Assuntos
Pessoa de Meia-Idade , Osteoartrite , Articulação do Ombro/cirurgia , Artropatia de Ruptura do Manguito Rotador , Artroplastia do OmbroRESUMO
Introducción: El objetivo de este estudio es reportar los resultados funcionales, el retorno al deporte, la tasa de consolidación y las complicaciones en deportistas jóvenes con una cirugía de Latarjet previa fallida, tratados con injerto autólogo de cresta ilíaca.Materiales y métodos: entre el 2017 y el 2020, se operaron en nuestra institución doce pacientes con inestabilidad glenohumeral recurrente luego de una estabilización previa fallida con cirugía de Latarjet, con injerto autólogo de cresta ilíaca como cirugía de revisión. La evaluación funcional se realizó con el score de Rowe, la escala visual análoga (EVA) y el score de ASOSS. Evaluamos el porcentaje de retorno al deporte, el nivel alcanzado y el tiempo que tardaron los deportistas en volver a competir. La consolidación ósea y la posición adecuada del injerto se analizó en todos los casos con radiografías de hombro frente y perfil y tomografía axial computada con reconstrucción 3D. Se registraron las complicaciones y las revisiones.Resultados: el seguimiento promedio fue de 42.6 meses (rango 24 a 92 meses). El score de Rowe, la EVA y el ASOSS mejoraron significativamente luego de la cirugía (p <0.1). Nueve pacientes retornaron al deporte, ocho de ellos al mismo nivel. El injerto óseo consolidó en todos los pacientes. No hubo recurrencias. No se reportaron complicaciones.Conclusión: el injerto autólogo de cresta ilíaca es una opción válida para el tratamiento de deportistas con inestabilidad glenohumeral recurrente luego de una estabilización previa fallida con cirugía de Latarjet. Nivel de Evidencia: IV
Introduction: The purpose of this study was to report the functional results, return to sport, consolidation rate and complications in young athletes with a previous failed Latarjet surgery, treated with an autologous iliac crest graft.Materials and methods: between 2017 and 2020, twelve patients with recurrent glenohumeral instability were operated on at our institution after previous failed stabilization with Latarjet surgery with autologous iliac crest graft as revision surgery. Functional evaluation was performed with the Rowe score, the VAS, and the ASOSS score. We evaluated the percentage of return to sport, the level reached, and the time it took the athletes to compete again. Bone consolidation and the adequate position of the graft were evaluated in all cases with front and profile X-rays of the shoulder and computed tomography with 3D reconstruction. Complications and revisions were recorded.Results: the average follow-up was 42.6 months (range 24 to 92 months). The Rowe score, visual analog scale, and ASOSS were significantly improved after surgery (p <0.1). Nine patients returned to sport, eight of them at the same level. The bone graft consolidated in all patients. There were no recurrences. No complications were reported.Conclusion: autologous iliac crest grafting is a valid option for the treatment of athletes with recurrent glenohumeral instability after previous failed stabilization with a Latarjet procedure. Level of Evidence: IV
Assuntos
Adulto , Reoperação , Luxação do Ombro , Articulação do Ombro/cirurgia , Amplitude de Movimento Articular , Transplante Ósseo , Ílio/transplanteRESUMO
Abstract Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.
Resumo Objetivo Avaliar se o paralelismo dos parafusos com a glenoide na cirurgia de Latarjet interfere no posicionamento do enxerto e verificar a reprodutibilidade de um método de mensuração da posição dos parafusos. Métodos Estudo retrospectivo, multicêntrico, de pacientes com instabilidade anterior do ombro submetidos à cirurgia de Latarjet modificada e no mínimo 1 ano de seguimento pós-operatório. Dois médicos radiologistas analisaram as imagens tomográficas pós-operatórias, adquiridas em um banco de dados, para avaliação do posicionamento dos parafusos e das complicações radiográficas. Resultados Foram avaliados 34 pacientes, com idades entre 21 e 60 anos, sendo que um deles tinha acometimento bilateral dos ombros, totalizando 35 ombros avaliados. A avaliação tomográfica dos ângulos de inclinação dos parafusos não apresentou diferença entre os observadores. Houve concordância intra e interobservador para avaliação dos seguintes parâmetros cirúrgicos: posição do enxerto, presença ou não de complicações radiográficas. Conclusão A técnica descrita para mensuração do paralelismo dos parafusos na cirurgia de Latarjet apresentou uma concordância intra e inter observador muito boa e excelente, respectivamente. O paralelismo do parafuso com a glenoide é recomendado; no entanto, não é condição obrigatória e única para se evitar as complicações radiográficas.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Parafusos Ósseos , Tomografia Computadorizada por Raios XRESUMO
Abstract Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.
Assuntos
Humanos , Articulação do Ombro/cirurgia , Isquemia do Cordão Espinal/complicações , Artroscopia/efeitos adversos , Ombro/cirurgia , Posicionamento do Paciente/efeitos adversos , Complicações Intraoperatórias/etiologia , Isquemia/complicaçõesRESUMO
OBJECTIVE@#To investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear (IMRCT).@*METHODS@#A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022. Among them, there were 11 males and 13 females with an average age of 56.2 years (range, 42-68 years). There were 12 cases of falling injuries, 3 cases of traction injuries, and the other 9 cases had no obvious causes. The disease duration ranged from 1 to 25 months (median, 6 months). The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases, and Goutallier grade 1 in 3 cases, grade 2 in 20 cases, and grade 3 in 1 case. All patients were treated with arthroscopic superior fulcrum reconstruction. Visual analogue scale (VAS) score, Constant-Murley score, the University of California at Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score were recorded before operation and at 1, 3, 6, and 12 months after operation.@*RESULTS@#The operations were all successfully completed. The incisions healed by first intention and no related complications occurred. All patients were followed up 12-33 months (mean, 24.6 months). The VAS, Constant-Murley, UCLA, and ASES scores at different time points after operation were superior to those before operation ( P<0.05). All of the above indicators further improved with time. Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months ( P>0.05), the differences between the other time points were significant ( P<0.05). At 12 months after operation, according to UCLA scoring standard, shoulder joint function was rated as excellent in 4 cases, good in 19 cases, and poor in 1 case, with an excellent and good rate of 96.0%. MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed.@*CONCLUSION@#The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain, improve the shoulder range of motion, and restore good shoulder function.
Assuntos
Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Artroscopia , Articulação do Ombro/cirurgia , Amplitude de Movimento ArticularRESUMO
OBJECTIVE@#To explore clinical effect of arthroscopy-assisted rotator cuff tendon transfer in treating irreparable rotator cuff tears (IRCT).@*METHODS@#From May 2015 to May 2018, 23 patients with unrepairable rotator cuff tears were treated with arthroscopy-assisted rotator cuff tendon transfer, and 21 patients were followed up finally, including 8 males and 13 females, aged from 48 to 82 years old with an average of(64.3±9.1) years old;the courses of disease ranged from 6 to 36 months with an average of (14.0±6.4) months. American Rotator and Elbow Surgeons Score(ASES) and Constant-Murley score were used to evaluate clinical efficacy before surgery and at the latest follow-up.@*RESULTS@#All 21 patients were followed up for 36 to 54 months with an average of (39.4±4.4) months. Axillary incision of 1 patient was redness, swelling and exudation after surgery, which healed after 3 weeks of dressing change, and exudate culture was negative. At the latest follow-up, MRI showed partial tearing of the metastatic tendon in 2 patients, but pain and movement of the affected shoulder were still better than before surgery. ASES increased from preoperative (41.0±9.6) scores to the latest follow-up (75.6±14.0) scores, and had statistical difference (t=10.50, P<0.01). Constant-Murley score increased from (49.8±7.1) scores before operation to (67.5±11.6) scores at the latest follow-up (t=11.27, P<0.01).@*CONCLUSION@#Arthroscopic assisted latissimus dorsalis tendon transposition restores physiological and anatomical structure of glenohumeral joint by reconstructing balance of horizontal and vertical couples of shoulder joint, thus achieving the stability of the shoulder joint, relieving shoulder pain and improving shoulder joint function.
Assuntos
Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Lesões do Manguito Rotador/cirurgia , Músculos Superficiais do Dorso , Manguito Rotador , Resultado do Tratamento , Articulação do Ombro/cirurgia , Transferência Tendinosa , Artroscopia , Amplitude de Movimento Articular/fisiologiaRESUMO
OBJECTIVE@#To evaluate the clinical outcomes of reverse total shoulder arthroplasty as a revision procedure for the failed fixation of proximal humeral fractures in the elderly patients.@*METHODS@#A retrospective analysis was performed on 8 patients with failed internal fixation of proximal humeral fractures from May 2014 to March 2020, including 3 males and 5 females, aged from 65 to 75 years old. All 8 patients underwent reverse total shoulder arthroplasty, and the mean time between initial fixation and reverse total shoulder arthroplasty ranged from 8 to 16 months. Range of motion(ROM), University of California at Los Angeles(UCLA) shoulder score, visual analogue scale (VAS), self-rating anxiety scale(SAS), and Constant-Murley score of shoulder function were assessed pre-operatively and at the last follow-up. Complications relating to the surgery were recorded.@*RESULTS@#All 8 patients successfully followed up. The mean follow-up after reverse total shoulder arhroplasty ranged from 16 to 28 months. The range of motion (forward flexion, external rotation, abduction and internal rotation) of the affected shoulder was significantly improved after surgery, and the post-operative VAS, SAS and UCLA scores were also significantly improved. For the Constant-Murley score of shoulder joint function, the total scores and the subscores of pain, daily activities, range of motion and strength test at the last follow-up were all significantly improved. Scapular glenoid notch was observed in patient, which was evaluated as grade 1 on imaging. All the other patients did not develop specific or non-specific complications.@*CONCLUSION@#Reverse total shoulder arhroplasty is an appropriate treatment as a revision surgery for failed fixation of proximal humeral fractures. It has shown satisfactory clinical outcomes, accelerating the rehabilitation of shoulder function and improving the quality of life.
Assuntos
Masculino , Feminino , Humanos , Idoso , Ombro/cirurgia , Artroplastia do Ombro/métodos , Estudos Retrospectivos , Resultado do Tratamento , Qualidade de Vida , Articulação do Ombro/cirurgia , Fraturas do Ombro/cirurgia , Úmero/cirurgia , Amplitude de Movimento ArticularRESUMO
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.
Assuntos
Humanos , Adulto , Articulação do Ombro/cirurgia , Artroscopia/métodos , Traumatismos dos Tendões/cirurgia , Lesões do Ombro/cirurgia , Tenodese/métodosRESUMO
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.
Assuntos
Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Lesões do Manguito Rotador/cirurgia , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento , Artroscopia/métodos , Amplitude de Movimento ArticularRESUMO
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.
Assuntos
Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Manguito Rotador/cirurgia , Tendões , Ruptura/cirurgia , Articulação do Ombro/cirurgia , Artroscopia/métodos , Amplitude de Movimento ArticularRESUMO
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.
Assuntos
Humanos , Lesões do Manguito Rotador/cirurgia , Estudos Prospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento , Artroscopia/métodos , Suturas , Amplitude de Movimento Articular , Imageamento por Ressonância MagnéticaRESUMO
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.
Assuntos
Humanos , Articulação do Ombro/cirurgia , Luxação do Ombro/cirurgia , Ombro , Instabilidade Articular/cirurgia , Escápula , Luxações Articulares , Recidiva , Artroscopia/métodosRESUMO
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.
Assuntos
Humanos , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Fenômenos Biomecânicos , Instabilidade Articular/cirurgia , Reabsorção Óssea , Artroscopia/métodosRESUMO
OBJECTIVE@#To review the research progress of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation, and provide a guide for further research on bone graft resorption.@*METHODS@#The relevant literature in recent years was extensively reviewed. The pathogenesis, classification, risk factors, clinical function impact, and management of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation were summarized.@*RESULTS@#Bone graft resorption is the common complication after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation. Stress shielding and poor blood supply may contribute to the occurrence of bone graft resorption. The absence of significant preoperative glenoid bone loss, open procedure, earlier graft healing may to be the risk factors for bone graft resorption. Various assessment methods and classification systems are used to evaluate the region and severity of bone graft resorption. Partial resorption may be considered as a natural glenoid remodeling process after the surgery, but severe and complete resorption is proved to be one of the reasons for failed procedures and there is no effective measure to prevent it, except for accepting revision surgery.@*CONCLUSION@#The pathogenesis, risk factors, clinical function impact of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation has not been fully elucidated and there is a lack of effective management strategies, so further clinical and basic researches are needed.
Assuntos
Humanos , Articulação do Ombro/cirurgia , Luxação do Ombro/cirurgia , Instabilidade Articular/cirurgia , Reabsorção Óssea/patologia , Transplante Ósseo , RecidivaRESUMO
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.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Adulto Jovem , Luxação do Ombro/cirurgia , Transplante Ósseo/métodos , Artroscopia/métodos , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Escápula/cirurgia , RecidivaRESUMO
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.
Assuntos
Humanos , Animais , Artroscopia/métodos , Escorpiões , Estudos Retrospectivos , Resultado do Tratamento , Luxação do Ombro/cirurgia , Suturas , Equidae , Articulação do Ombro/cirurgia , Instabilidade Articular/cirurgia , Âncoras de Sutura , Recidiva , Amplitude de Movimento ArticularRESUMO
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.
Assuntos
Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Luxação do Ombro/cirurgia , Estudos Retrospectivos , Instabilidade Articular/etiologia , Artroscopia/métodos , Articulação do Ombro/cirurgia , RecidivaRESUMO
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.