The role of subscapularis repair following reverse shoulder arthroplasty: systematic review and meta-analysis.

PURPOSE: Inadequate subscapularis repair has been advocated as one of the contributing factors for dislocation in reverse total shoulder arthroplasty; nonetheless the need to restore the subscapularis tendon integrity is under debate. The aim of this systematic review was to answer the question: does subscapularis reattachment following reverse total shoulder arthroplasty improve joint stability, range of motion and functional scores? METHODS: The literature was systematically screened in accordance with PRISMA guidelines looking for papers evaluating clinical outcomes of reverse total shoulder arthroplasty in relation to the management of subscapularis tendon. Studies comparing clinical outcomes, complications and dislocation rate with or without subscapularis repair were included. Studies in which reverse total shoulder arthroplasty was performed for trauma or tumors were excluded. The methodology of included articles was scored with MINORS scale and the Risk of Bias was assessed adopting the ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) developed by the Cochrane Group. A meta-analysis was also performed combining the studies to increase the sample size and hence the power to obtain meaningful data. RESULTS: The database search identified 1062 records, and 6 full-text articles were finally included. A total number of 1085 reverse total shoulder arthroplasty were assessed on. Except for one study, lateralized prosthetic designs have been used. Dislocation occurred in 0.8% (5/599 patients) of the patient with repaired subscapularis and in 1.6% (8/486 patients) of the tenotomized patients, and subscapularis repair was not associated with a higher risk of dislocation (pooled Peto OR: 0.496, 95% CI: 0.163 to 1.510, p = 0.217). Qualitative assessment revealed no differences in the range of motion and clinical scores. CONCLUSION: Subscapularis repair after reverse total shoulder arthroplasty produces no clinically meaningful benefits, particularly using lateralized prosthetic designs. Subscapularis re-attachment does not improve implant stability, nor increases range of motion or clinical scores. Given these results, keeping in mind the antagonistic effect of the repaired subscapularis on external rotation, no evidence lead to suggest subscapularis reattachment following reverse total shoulder arthroplasty with lateralized prosthetic designs.

The Iron Man of the Renaissance: the contribution of Girolamo Fabrizi d'Acquapendente.

PURPOSE: To highlight the most relevant contributions of the Italian Renaissance surgeon Girolamo Fabrizi d'Acquapendente in the field of orthopaedics and traumatology. METHODS: An extensive research on the life and achievements of Girolamo Fabrizi was conducted on University Libraries as well as on electronic databases like PubMed. RESULTS: Girolamo Fabrizi d'Acquapendente is known for his embryology and physiology studies, particularly on sensory organs and blood circulation. He founded the world's first permanent anatomical theater established at the University of Padua and inaugurated in 1595. His most notable publications include surgical and definitely orthopedics works such as "De fracturis" (On fractures) and "De luxationibus" (On joint displacement). He outlined some principles of treatment that are still valid nowadays such as anatomical reduction and stabilization of the fracture, that were applied using the equipment available at that time. He described and illustrated maneuvers and instruments, such as pulleys, winches, splint, and bandages. He further depicted the famous "Oplomochlion" ("the armored man"), which is actually a collection of all of the braces used at the time to correct congenital and post-traumatic deformities. CONCLUSION: Bracing and prosthetic replacements have accompanied medical history throughout the centuries, from Ancient Egypt to the present, but it was the ingenuity of Renaissance surgeons that pushed biomedical technology to new heights: Girolamo Fabrizi d'Acquapendente was one of the most illustrious contributors to these great achievements.

Posterior cruciate ligament reconstruction in skeletally immature athletes.

Posterior cruciate ligament rupture is a rare knee ligamentous injury in skeletally immature patients with unfused growth plates. Despite being very uncommon, it still represents a significant challenge in terms of decision-making and treatment choice. The purpose of this case series was to report subject and objective outcomes (IKDC, TAS,LYSHOLM,KT2000) after PCL reconstruction in two teenage elite football players aged 15 and 16 respectively, who underwent surgical repair in July 2017 using for the femoral and tibial fixation of the PCL graft (hamstring tendons) respectively a curve cross-pin system and interferential screw. At fifteen months follow up, both athletes had returned to normal, pre-injury, competing levels with no leg discrepancy.

Modular dual mobility cups with multihole metal back in total hip arthroplasty revision: a systematic review.

Dislocation after hip revision is a frequent complication; amongst the strategies to prevent dislocation dual mobility (DM) implants are gaining popularity. We want to evaluate the reliability of non cemented DM cups with multihole metal back and chrome-cobalt liner called Modular Dual Mobility (MDM). We performed a systematic review and selected 5 studies with a total of 285 hips who underwent revision surgery with MDM implants. The mean survivorship rate of the 5 studies was 92.46% (range 90-96%). 267 prosthesis (93.6%) were still implanted at the last follow-up; the mean weighted follow up was 38.7% (range 24-48). We found 13 mechanical complications in 285 hips (4.5%). Five of them were treated conservatively; the other 8 were treated with re-revision. Nine of these complications were dislocation and recurrent instability; 2 of them were associated to metallosis and adverse local tissue reaction. There was 1 patient that had episodes of subluxation; 2 cases of impingement and 1 case of metallosis. Zero intraprosthetic dislocations (IPD) occurred in 285 hips. A 93.6% survivorship is a good result for MDM implants, considering that most of patients had important bone loss and went through multiple revisions. The rate of dislocation is very low compared to the mean rate of dislocation in revision hip surgery. In our review, fretting is a rare complication but it can lead to ALTR and metallosis. For this reason, MDM implants have to be used in selected cases at high risk of dislocation. In conclusion MDM is a great option for decreasing dislocation rate in hip revision, but a longer follow-up and a greater number of cases is needed to assess its reliability.

Concurrent femoral and tibial osteotomies versus soft tissue balance in total knee arthroplasty: A technical case report.

This case report outlines some of the challenges as well as limitations in correction of osteoarthritis of the knee in combination with extra-articular deformities,and provides a novel and straightforward surgical solution in overcoming these challenges. We describe the case of a 37-year-old male who suffered from advanced bilateral tri-compartmental knee arthritis due to untreated bloodstream-sourced osteomyelitis after birth. Radiographs and surgery confirmed extremely severe deformities. We performed two different surgical techniques in order to correct extra-articular deformities (one-stage approach of concurrent tibial and femoral osteotomy and total knee arthroplasty on one side, and soft tissue balancing with "pie-crusting technique" plus total knee arthroplasty on the other side), with description of subsequent results at 36-months follow-up.