Radiologic midterm results of cemented and uncemented glenoid components in primary osteoarthritis of the shoulder: a matched pair analysis.

INTRODUCTION: Cemented all-polyethylene glenoid components are considered the gold standard in anatomic shoulder arthroplasty. New designs of cementless metal backed glenoid components showed promising early and midterm results. The aim of this matched-pair analysis was to compare the radiologic results of two cemented glenoid components and a cementless glenoid component in patients with primary osteoarthritis (OA). METHODS: Sixty shoulders were clinically and radiologically evaluated after a mean follow-up of 59 months. Mean patient age was 70.4 years at surgery. Based on the design of the glenoid component (keel, peg, MB), 3 groups with, respectively, 20 shoulders were formed according to the matching criteria time of follow-up, patient age and gender. RLL and osteolysis in anteroposterior and axillary X-ray images were quantified and combined in a radiologic score (R-Score). Higher scores expressed worse radiologic outcomes. Further radiological parameters such as lateral glenohumeral offset (LGHO) and subluxation index were measured according to Walch. The functional results were documented using the age and gender normalized Constant-Murley score. RESULTS: Postoperative R-Score was highest in pegged components (peg: 5.7, keel: 2.4, MB: 1.6; p < 0.001) when combining both radiographs and after separate analysis of anteroposterior radiographs. MB glenoids had the lowest R-score in axillary radiographs (peg: 2.2, keel: 1.4, MB: 0.6; MB vs. keel: p = 0.004, MB vs peg: p < 0.001). RLL were more common (p = 0.004) and severe (p = 0.005) in pegged glenoids (RLL incidence: 77.8%, RLL-score: 2.5) than in MB glenoids (RLL incidence: 30%, RLL-score 0.7) and tended (p = 0.084) to have a higher RLL-score than keeled glenoids (RLL incidence: 63.2%, RLL-score:1.4). Both the osteolysis score (keel vs. peg: p < 0.001, MB vs. peg p < 0.001) and the incidence of osteolysis (keel vs. peg: p = 0.008, MB vs peg: p = 0.003) were significant higher in pegged glenoids (peg: osteolysis score: 3.2, osteolysis incidence: 100%; keel: osteolysis score: 1.0, osteolysis incidence: 63.2%, MB: osteolysis score: 0.9, osteolysis incidence: 60%), while the osteolysis score in axillary images was lowest for MB glenoids (peg: 1.2, keel: 0.9, MB: 0.4; peg vs. MB: p = 0.009, keel vs. MB: p = 0.047). Osteolysis in the central axillary zone was least common in MB glenoids (peg: 50%, keel: 47.4%, MB: 15%; peg vs. MB p = 0.035, keel vs. MB p = 0.041). LGHO was highest in MB glenoids (peg: 54.1, keel: 54.5, MB: 57.8; p < 0.001) but did not increase radiographic loosening (r = 0.007; p = 0.958). Preoperative posterior humeral head subluxation seemed to affect incidence of RLL negatively (pre-op posterior decentered 64.3%, pre-op centered 31.9%; p = 0.201) but did not reach statistical significance. CONCLUSION: Pegged glenoid components had a concerning rate of RLL and osteolysis. MB glenoid components had a better outcome in axillary radiographs concerning RLL and osteolysis. Increased LGHO did not increase radiographic loosening. LEVEL OF EVIDENCE: Retrospective comperative treatment study Level III.

Is there a correlation between humeral osteoarthritis and glenoid morphology according to Walch?

AIMS: The aim of this study was to determine whether there is a correlation between the grade of humeral osteoarthritis (OA) and the severity of glenoid morphology according to Walch. We hypothesized that there would be a correlation. METHODS: Overal, 143 shoulders in 135 patients (73 females, 62 males) undergoing shoulder arthroplasty surgery for primary glenohumeral OA were included consecutively. Mean age was 69.3 years (47 to 85). Humeral head (HH), osteophyte length (OL), and morphology (transverse decentering of the apex, transverse, or coronal asphericity) on radiographs were correlated to the glenoid morphology according to Walch (A1, A2, B1, B2, B3), glenoid retroversion, and humeral subluxation on CT images. RESULTS: Increased humeral OL correlated with a higher grade of glenoid morphology (A1-A2-B1-B2-B3) according to Walch (r = 0.672; p < 0.0001). It also correlated with glenoid retroversion (r = 0.707; p < 0.0001), and posterior humeral subluxation (r = 0.452; p < 0.0001). A higher humeral OL (odds ratio (OR) 1.17; 95% confidence interval (CI) 1.03 to 1.32; p = 0.013), posterior humeral subluxation (OR 1.11; 95% CI 1.01 to 1.22; p = 0.031), and glenoid retroversion (OR 1.48; 95% CI 1.30 to 1.68; p < 0.001) were independent factors for a higher glenoid morphology. More specifically, a humeral OL of ≥ 13 mm was indicative of eccentric glenoid types B2 and B3 (OR 14.20; 95% CI 5.96 to 33.85). Presence of an aspherical HH in the coronal plane was suggestive of glenoid types B2 and B3 (OR 3.34; 95% CI 1.67 to 6.68). CONCLUSION: The criteria of humeral OL and HH morphology are associated with increasing glenoid retroversion, posterior humeral subluxation, and eccentric glenoid wear. Therefore, humeral radiological parameters might hint at the morphology on the glenoid side. Cite this article: Bone Jt Open 2022;3(6):463-469.

Biceps Brachii Alterations Following the Latarjet Procedure: A Prospective Multicenter Study.

PURPOSE: To prospectively investigate the postoperative forearm supination and elbow flexion strength of both upper extremities and popeye deformity in patients who underwent a mini-open Latarjet procedure for anterior shoulder instability. METHODS: Patients who underwent a mini-open Latarjet procedure at two specialized shoulder centers were prospectively evaluated preoperatively (T0) and at least 6 months (T1) after surgery. Subjects were tested for elbow flexion and forearm supination strength of both upper extremities using an isometric dynamometer and customized torque dynamometer. Clinical outcome was assessed by the Constant Score (CS), American Shoulder and Elbow Score (ASES) and Simple Shoulder test (SST). Popeye deformity was defined as a distalization of the greatest circumference of the biceps muscle belly towards the lateral epicondyle of the elbow. RESULTS: A total of 20 patients with a mean age of 27 ± 6 years were included in the study. At a mean follow-up of 10 ± 3 months, the elbow flexion strength was restored to the preoperative state (p = 0.240). Forearm supination strength significantly decreased at final follow-up, to 88 % in the surgical arm (p = 0.015) vs. 90 % in the non-surgical arm (p = 0.023). There was no statistical difference when comparing both arms concerning elbow flexion strength (p = 0.510) and forearm supination strength (p = 0.495). No significant popeye deformity was observed in both arms (p = 0.111 vs. p = 0.508). Clinical outcome scores improved significantly from 73 ± 18 to 82 ± 13 (p = 0.014) for CS and 76 ± 22 to 89 ± 12 (p = 0.008) for ASES score preoperatively to final follow-up. No difference in the SST was documented (p = 0.10). CONCLUSION: The Latarjet procedure showed to preserve elbow flexion strength and provided comparable forearm supination strength compared to the uninjured arm with reliable clinical outcome in this study population. However, a decrease of forearm supination strength in both arms was persistent at a mean of 10 months postoperatively. No popeye deformity was noted in the postoperative examinations. LEVEL OF EVIDENCE: Case series, Level III.

A classification for partial subscapularis tendon tears.

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

Prospective midterm results of a new convertible glenoid component in anatomic shoulder arthroplasty: a cohort study.

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

Survival of stemless humeral head replacement in anatomic shoulder arthroplasty: a prospective study.

BACKGROUND: The long-term results of shoulder arthroplasty using stemless humeral head components with a mean follow-up period > 10 years were not available until now. The aim of this study was to evaluate the long-term results of shoulder arthroplasty using a stemless humeral head component. METHODS: Since 2005, we have documented stemless humeral head replacement prospectively. Seventy-five patients with a mean age of 57 years at surgery (40 hemi-shoulder arthroplasties [HSAs] and 35 total shoulder arthroplasties [TSAs], 38 women and 37 men) were clinically and radiologically followed up after a mean period of 126 months (range, 105-157 months). Functional results were documented using the age- and sex-normalized Constant-Murley score (CMS) (ie, relative CMS). RESULTS: The relative CMS improved significantly (P < .0001) from 56% preoperatively to 90% postoperatively. Its subcategories of pain (8 points preoperatively vs. 12 points postoperatively, P < .0001), activities of daily living (10 points vs. 15 points, P < .0001), range of motion (20 points vs. 29 points, P < .0001), and strength (7 points vs. 11 points, P = .011) improved significantly as well. There was no significant difference in preoperative CMS vs. postoperative CMS, as well as its subcategories, between HSA (44.8 points vs. 67.1 points, P < .0001) and TSA (44.4 points vs. 68.9 points, P = .004). Clinically and radiologically, we observed no loosening of the stemless humeral head component. Stress shielding around the humeral component was not detected. Upward migration of the humeral head was observed in 17.5% of patients (21.6% with HSA and 11.5% with TSA, P = .303). No implant failure was observed on the humeral side. At follow-up, 18.3% of patients had rotator cuff deficiency (13.9% with HSA and 25% with TSA, P = .280). Overall, 9.3% of stemless shoulder arthroplasties were revised to reverse TSAs (5% of HSAs and 14.3% of TSAs, P = .097). TSA showed a trend for a higher revision rate than HSA. Secondary glenoid wear occurred in 64.3% of HSAs, and none of the HSAs were converted to TSAs. We observed an incomplete radiolucent line < 2 mm in 30.4% and glenoid loosening in 11.4% of cemented glenoid components. Kaplan-Meier analysis revealed a 10-year survivorship rate of 96.5% and an estimated 13-year survivorship rate of 90.1% for stemless humeral components. CONCLUSION: Stemless humeral head replacement showed no loosening and a significant improvement in shoulder function after a mean period of 11 years. The long-term clinical and radiologic results as well as the survivorship of anatomic shoulder arthroplasty using a stemless humeral head implant are comparable to the long-term results of standard stemmed anatomic shoulder arthroplasty.

Lesions of the biceps pulley: a prospective study and classification update.

HYPOTHESIS: The purpose of the study was to investigate which anatomic structures are affected in a series of patients with pulley lesions and whether all lesions can be classified according to the Habermeyer classification. METHODS: One hundred consecutive patients with pulley lesions were prospectively studied. During arthroscopy, lesions of the superior glenohumeral ligament (SGHL), medial coracohumeral ligament (MCHL) and/or lateral coracohumeral ligament (LCHL), adjacent rotator cuff, and biceps (long head of the biceps) were recorded. All lesions were then classified according to the Habermeyer classification. The χ2 test was used for statistical analysis. RESULTS: There were 3 lesions in group 1, 20 in group 2, 6 in group 3, and 35 in group 4 according to the Habermeyer classification. Thirty-six lesions were not classifiable because of an intact SGHL. A lateral pulley sling (LCHL) lesion was found in 95% of the patients, and a medial pulley sling (MCHL-SGHL) lesion was noted 64%. An isolated lesion of the MCHL and/or SGHL was present in 5%, and an isolated lesion of the LCHL was found in 36%. Combined medial-lateral sling lesions were correlated with complete subscapularis tears and biceps fraying. CONCLUSION: The lateral pulley sling is more often affected than the medial sling. The SGHL is not always affected, and isolated lesions of the medial sling are rare. Lesions of both slings correlated with complete subscapularis tears and fraying of the long head of the biceps. An updated classification of direct pulley lesions is proposed: type 1, lesion of the medial pulley (MCHL and/or SGHL); type 2, lesion of the lateral pulley (LCHL); and type 3, lesion of the medial and lateral pulley slings. Concomitant lesions of the indirect pulley stabilizers can be mentioned additionally according to the well-known classifications.

Short-term safety, function, and quality of life in patients treated with Univers Revers prosthesis: a multicenter 2-year follow-up case series.

BACKGROUND: The use of reverse total shoulder arthroplasty (RTSA) has dramatically increased in recent years with the advent of new prosthesis designs regularly entering the market. We define the rate of local complications during the first 2 years after RTSA with the Univers Revers prosthesis and describe the changes in radiologic outcomes, as well as function, pain, satisfaction, and quality of life. METHODS: This multicenter, prospective case series included rotator cuff tear arthropathy patients who underwent RTSA with the Univers Revers. Incidence percentages of complications and pathologic radiographic changes were documented. Mixed-model linear regression was used to examine changes in range of motion, shoulder function (Constant score, Shoulder Pain and Disability Index, Subjective Shoulder Value), and quality of life (EQ-5D-5L [European Quality of Life 5 Dimensions 5 Level] and EQ-VAS [EuroQol Visual Analog Scale]). RESULTS: Of 187 patients, 59.4% were women, and the mean age was 75.3 years (range, 56-91 years). Twenty-five percent of patients had a postoperative complication; 5 complications were severe (2.7%, 5 of 187), whereby 2 were implant related (1.1%; 95% confidence interval [CI], 0.1%-3.8%). The incidence of scapular notching was 10.6% (95% CI, 6.5%-16%). After 2 years, abduction, flexion, and abduction strength improved by 54° (95% CI, 50°-58°), 57° (95% CI, 53°-60°), and 5 kg (95% CI, 4-5 kg), respectively (P < .001), whereas external rotation at 0° (1°; 95% CI, -1° to 3°) did not improve (P = .4). The Constant score improved by 39 (95% CI, 38-41); Shoulder Pain and Disability Index, by 50 (95% CI, 47-52); and Subjective Shoulder Value, by 43 (95% CI, 41-45) (P < .001). Furthermore, the EQ-5D-5L index value improved by 0.31 (95% CI, 0.30-0.33), and the EQ-VAS score improved by 16 (95% CI, 14-18) (P < .001). CONCLUSION: Our case series showed a low complication rate with a consistent clinically relevant and statistically significant improvement across most clinical and patient-reported outcomes for the Univers Revers. Long-term safety requires further investigation.

Arthroscopically assisted acromioclavicular joint stabilization leads to significant clavicular tunnel widening in the early post-operative period.

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

Arthroscopic Coracoclavicular and Acromioclavicular Stabilization of Acute Acromioclavicular Joint Dislocation By Suspensory Fixation System.

Arthroscopic stabilization of acute acromioclavicular joint dislocations using coracoclavicular suspension techniques has become more popular, but lack of horizontal stability is a major concern that furthermore affects the final outcome. We present an arthroscopic technique to stabilize acute acromioclavicular joint dislocations in both the vertical and horizontal planes, with better results than conventional coracoclavicular suspension techniques.

Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial.

BACKGROUND: The Latarjet and iliac crest bone graft transfer (ICBGT) procedures are competing treatment options for anterior shoulder instability with glenoid bone loss. METHODS: In this bicentric prospective randomized study, 60 patients with anterior shoulder instability and glenoid bone loss were included and randomized to either an open Latarjet or open ICBGT (J-bone graft) procedure. Clinical evaluation was completed before surgery and 6, 12, and 24 months after surgery, including the Western Ontario Shoulder Instability index, Rowe score, Subjective Shoulder Value, pain level, satisfaction level, and work and sports impairment, as well as assessment of instability, range of motion, and strength. Adverse events were prospectively recorded. Radiographic evaluation included preoperative, postoperative, and follow-up computed tomography analysis. RESULTS: None of the clinical scores showed a significant difference between the 2 groups (P > .05). Strength and range of motion showed no significant differences except for diminished internal rotation capacity in the Latarjet group at every follow-up time point (P < .05). A single postoperative traumatic subluxation event occurred in 2 ICBGT patients and 1 Latarjet patient. The type and severity of other adverse events were heterogeneous. Donor-site sensory disturbances were observed in 27% of the ICBGT patients. Computed tomography scans revealed a larger glenoid augmentation effect of the ICBGTs; this, however, was attenuated at follow-up. CONCLUSION: The Latarjet and ICBGT procedures for the treatment of anterior shoulder instability with glenoid bone loss showed no difference in clinical and radiologic outcomes except for significantly worse internal rotation capacity in the Latarjet group and frequently noted donor-site sensory disturbances in the ICBGT group.

Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization.

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

Chondral defects of the glenohumeral joint: Long-term outcome after microfracturing of the shoulder.

INTRODUCTION: An increasing number of young patients are diagnosed with chondral lesions. Minimally invasive surgical techniques are important in order to delay progression of the early stages of osteoarthritis and the need for total joint replacement. MATERIALS AND METHODS: Patients (n = 32) who had received microfracturing of the shoulder were retrospectively enrolled, of whom 5 had received shoulder replacements after a mean time of 47 months. Of these patients, 23 completed the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley Scores in addition to an additional subjective questionnaire. Patients were then clinically examined and received x­ray analysis of the operated shoulder. Data from an additional 4 patients were acquired by telephone interview. RESULTS: Mean follow-up was 105 months. Of the included patients, 13/27 patients reported no pain, 12/27 patients moderate pain. Of these 12, 6/27 reported pain only at night and 3/27 only during rest. Concerning the outcome of surgery, 19/27 patients were "satisfied" or "very satisfied". There was a statistically significant increase in internal rotation, but no further differences in the range of motion pre- and postoperatively. Patients without any signs of osteoarthritis before surgery showed statistically significantly better outcomes. There was a statistically significant increase in radiological signs of osteoarthrosis in pre- versus postoperative patients. Patients with bipolar lesions showed statistically significantly poorer Subjective Shoulder Value (SSV) results. CONCLUSION: Even though microfracturing does not prevent radiographic progression, microfracture of the glenohumeral joint might be worth considering as part of a treatment regimen for younger patients who may not yet be treated with arthroplasty.

Classification of humeral head pathomorphology in primary osteoarthritis: a radiographic and in vivo photographic analysis.

BACKGROUND: The purpose of this study was to characterize the pathologic changes of the osteoarthritic humeral head. METHODS: The study included 55 patients with primary osteoarthritis who underwent anatomic shoulder arthroplasty. Several radiologic parameters (radiography, magnetic resonance imaging) were assessed. Humeral head deformity in the transverse plane and humeral cartilage erosion in the coronal plane were chosen for photographic measurements from the resected humeral heads. RESULTS: In the coronal plane, 82% of patients presented with an aspherical humeral head shape with a significantly longer caudal osteophyte. In the transverse plane, 50% of all patients showed a decentered apex. Patients with an aspherical humeral head shape in the transverse plane showed an aspherical humeral head shape in the coronal plane in 94% and a significantly longer osteophyte than patients with spherical humeral head shape, showing a 3-dimensional deformity of the humeral head during progression of primary osteoarthritis. Patients with an osteophyte length between 7 and 12 mm were associated with a glenoid type B2 in 30% and a decentered apex in the transverse plane in 38%. Patients with a humeral osteophyte longer than 13 mm were significantly more frequently associated with a type B2 glenoid (71%; P < .0001) and a decentered apex in the transverse plane in 52%. CONCLUSION: It seems that the progression of primary osteoarthritis of the glenohumeral joint is characterized by an increasing 3-dimensional deformity of the humeral head related to the glenoid morphology. We therefore propose an extended Samilson-Prieto classification with type A (spherical) and type B (aspherical) and grade I-IV osteophytes.

[Chronic acromioclavicular joint injury of Rockwood V type with concomitant chronic anterior sternoclavicular instability]. / Chronische Acromioclaviculargelenkverletzung Typ Rockwood V mit gleichzeitiger chronischer anteriorer sternoclavicularer Instabilität.

Bipolar dislocation of the clavicle is rare. In the literature, every reported bipolar dislocation of the clavicle is caused by a traumatic injury with loss of function of the affected shoulder. Currently, there is no recommendation to treat. A conservative treatment can be tried first to achieve adequate shoulder function. If this cannot be achieved, surgical treatment will be indicated. In the literature, many options for surgical treatment are described. This article presents a case of a chronic Rockwood V injury with chronic anterior sternoclavicular joint instability. The special feature of this case was the arthroscopically assisted stabilization of the acromioclavicular joint (ACJ) with the ipsilateral semitendinosus tendon graft and the open stabilization of the sternoclavicular joint (SCJ) with the ipsilateral gracilis tendon graft. A lateral fracture of the clavicle in the course of the postoperative treatment was treated with a plate osteosynthesis. At follow-up after six months, the postoperative shoulder function was restored. The ACJ and the SCJ were stable in clinical and radiographic examination. This case report shows the first surgical treatment using two tendon grafts for combined stabilization of the ACJ and SCJ.

Risk of Engagement of Bipolar Bone Defects in Posterior Shoulder Instability.

BACKGROUND: The risk of re-engagement of bipolar bone defects in posterior shoulder instability has not yet been investigated. HYPOTHESIS: Posterior glenoid defects can lead to the engagement of supposedly noncritical reverse Hill-Sachs lesions (RHSLs). STUDY DESIGN: Descriptive laboratory study. METHODS: In a retrospective multicenter study, 102 cases of posterior shoulder dislocations and resulting RHSLs were collected. Of these cases, all patients with available computed tomography (CT) scans, with a reduced shoulder joint, and without bony posterior glenoid rim defects or concomitant dislocated fractures of the humeral head were included. The gamma angle (measure of the critical size and localization of RHSLs) and the delta angle (measure of the degree of internal rotation necessary for engagement to occur) of the RHSLs were determined on standardized CT scans. Virtual posterior glenoid defects were created, and the effect of increasing defect size on the delta angle was determined. RESULTS: The mean gamma angle of the 19 patients included in this study was 94.5° (range, 69.7°-124.8°). After creation of the virtual posterior glenoid defects, a mean reduction of the delta angle by 2.3° ± 0.2° (range, 1.9°-2.9°) per millimeter defect was observed. The cumulative change in the delta angle showed a highly significant correlation with the absolute and relative size of the glenoid defect ( R = 0.982, P < .001 and R = 0.974, P < .001, respectively). CONCLUSION: Concomitant posterior glenoid defects might lead to the engagement of noncritical RHSLs. When measuring the gamma angle to identify critical RHSLs, posterior glenoid bone loss should be accounted for.

Pulley lesions in rotator cuff tears: prevalence, etiology, and concomitant pathologies.

PURPOSE: This study aimed to demonstrate the prevalence of lesions in the biceps pulley complex in a representative, consecutive series of rotator cuff tears and rotator cuff interval treatments. We also analyzed associated tear pattern of rotator cuff injuries and superior labrum anterior-posterior (SLAP) lesions. We evaluated the relationships of these lesions to traumatic genesis and the prevalence of pulley lesions in revision cases. METHODS: This retrospective study analyzed all pre- and intra-operative documentation on arthroscopic rotator cuff reconstructions and isolated pulley lesion treatments performed by a single surgeon over 2 consecutive years. According to Habermeyer et al., we classified cases into four groups, based on the presence of additional or related complete or partial rotator cuff tears, SLAP lesions, trauma, and primary or revision surgery. RESULTS: Among 382 patients with rotator cuff tears, 345 (90.3%) had an injured pulley system; 151 (43.8%) had partial tears of the rotator cuff; out of these, 106 (30.6%) were articular-sided. All of these articular-sided partial tears showed extension into the pulley complex. In 154 cases (44.6%), history of shoulder trauma was associated with the beginning of symptoms. In addition, concomitant SLAP lesions occurred in 25-62% of pulley lesions, correlating with the severity of pulley lesions. Among the 345 cases, there have been 32 (9.3%) revision cases where a pulley lesion was intra-operatively identified and addressed. CONCLUSIONS: Pulley complex lesions are present in 90.3% of surgically treated rotator cuff lesions, particularly in articular-sided injuries. In addition, we found a significant relationship between the incidence of SLAP lesions and the severity of pulley lesions. It seems reasonable to assume an important role of pulley system injuries in the pathogenesis of rotator cuff lesions.

Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results.

BACKGROUND: Several stemless shoulder implants are available on the market, but only a few studies have presented results with sufficient mid- to long-term follow-up. The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement. METHODS: This is a prospective cohort study evaluating the stemless shoulder prosthesis since 2005. Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders; 17 underwent total shoulder replacement, and 32 underwent hemiarthroplasty. Forty-three patients were clinically and radiologically monitored after a mean of 9 years (range, 90-127 months; follow-up rate, 88%). The indications for shoulder replacement were primary osteoarthritis in 7 shoulders, post-traumatic in 24, instability in 7, cuff tear arthropathy in 2, postinfectious arthritis in 1, and revision arthroplasty in 2. RESULTS: The Constant-Murley Score improved significantly from 52% to 79% (P < .0001). The active range of motion also increased significantly for flexion from 101° to 118° (P = .022), for abduction from 79° to 105° (P = .02), and for external rotation from 21° to 43° (P < .0001). Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention. No revision caused by loosening or countersinking of the humeral implant was observed. CONCLUSIONS: The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation standard shoulder arthroplasty.

Is the stemless humeral head replacement clinically and radiographically a secure equivalent to standard stem humeral head replacement in the long-term follow-up? A prospective randomized trial.

BACKGROUND: Stemless humeral head replacement represents a young generation of shoulder arthroplasty. This study evaluated the differences of this new stemless design compared with the fourth-generation standard stemmed design. METHODS: Total shoulder arthroplasty was performed in 20 patients with a stemless shoulder prosthesis (group 1) and in 20 patients with a standard stem humeral head replacement (group 2). Twenty-nine patients were examined clinically and radiographically at a minimum follow-up of 2 years and a minimum follow-up of 5 years. Functional results were assessed using the age- and gender-related Constant Score (CS). The radiographic analysis used native x-rays in 3 planes. RESULTS: The postoperative CS improved significantly in both groups, with no significant difference between the minimum of 2-year and 5-year follow-up. The difference in the CS, its subcategories, and active range of motion between the implant groups was not significant. A significant difference was observed in the radiographic analysis for the zone adjacent to the humeral calcar, with a lower bone mineral density in 41% of group 2 and in 0% in group 1. Radiolucent lines were statistically more frequent in group 2. No statistical differences were observed between the implant groups for the change of the inclination angle, the medial offset, and the lateral offset. CONCLUSION: Both implants showed consistently good functional and radiologic results without a significant difference and achieved an anatomic reconstruction of the humeral head geometry in the coronal plane.