Psychological risk factors for the occurrence of frozen shoulder after rotator cuff repair.

INTRODUCTION: Frozen shoulder is a dreaded complication after rotator cuff repair. HYPOTHESIS: There are psychological determinants for this complication. MATERIALS AND METHODS: We prospectively included 77 consecutive patients who underwent arthroscopic rotator cuff repair between May 2018 and April 2019. Along with a functional evaluation, we determined the Constant score, anxiety and depression levels based on the HADS, and kinesiophobia based on the Tampa Scale preoperatively and 6months after the surgery. RESULTS: At the 6-month follow-up, 8 patients had been diagnosed with frozen shoulder (group A), 65 patients had satisfactory joint range of motion (group B) and 4 were lost to follow-up. In the frozen shoulder group, the preoperative anxiety rate was significantly higher than in group B (50% versus 17%, p=0.04). Furthermore, there were significantly more women (p=0.028) and more patients with an occupational disease in group A (75% versus 18%, p=0.027). At 6months postoperative, the Constant score was 55 in the group with a frozen shoulder versus 72 in group B (p=0.004). Neither depression nor kinesiophobia were risk factors for the development of frozen shoulder after rotator cuff repair. CONCLUSION: Preoperative anxiety, the female sex and occupational disease are all risk factors for the occurrence of frozen shoulder after rotator cuff repair. Knowing these predisposing factors will help us better manage at-risk patients. LEVEL OF EVIDENCE: III, prospective study.

Open Trillat Procedure for Recurrent Anterior Instability of the Shoulder in Elderly Patients.

Among the many different procedures available in the treatment of shoulder instability, the Trillat procedure remains indicated in case of recurrent shoulder instability in elderly patient with an irreparable cuff tear or in case of hyperlaxity. Despite the constantly increasing number of arthroscopic assisted techniques, the open procedure remains a simple, reliable and fast surgical procedure with a shorter learning curve than the arthroscopic techniques. It consists in a partial osteotomy of the anterior cortical of the coracoid process which is then tilted and fixed with a screw into the anterior part of the scapula downwards and medially to obtain a re-centering effect due to the conjoint tendon on the humeral head when rotational movement are applied. This article aims to present a stepwise approach for the open surgical technique.

The "Sandwich Tenodesis": An Arthroscopic Technic for Combined Soft-Tissue and Bony Fixation of the Long Head of the Biceps.

Pathology of the long head of the biceps can contribute to substantial shoulder pain. After nonoperative treatment has failed, either open or arthroscopic tenotomy or tenodesis can be recommended depending on age, occupation, function, and cosmetic preference. While classic tenodesis techniques rely on tendon-to-bone fixation, multiple studies have shown superior healing results for fixation between similar types of tissue, such as tendon-to-tendon. In this technique, we present the "sandwich technique," performed entirely arthroscopically. A single 4-strand anchor with bioabsorbable screw is used to provide 2 types of fixation. Two strands are first used to lasso-loop the long head of the biceps to the bicipital groove, providing bone-to-tendon fixation. The other strands are then used to anchor rotator interval tissue to the tendon, providing a similar tissue or tendon-to-tendon patch augmentation.

Type-II superlattices base visible/extended short-wavelength infrared photodetectors with a bandstructure-engineered photo-generated carrier extractor.

Visible/extended short-wavelength infrared photodetectors with a bandstructure-engineered photo-generated carrier extractor based on type-II InAs/AlSb/GaSb superlattices have been demonstrated. The photodetectors are designed to have a 100% cut-off wavelength of ~2.4 µm at 300K, with sensitivity down to visible wavelengths. The photodetectors exhibit room-temperature (300K) peak responsivity of 0.6 A/W at ~1.7 µm, corresponding to a quantum efficiency of 43% at zero bias under front-side illumination, without any anti-reflection coating where the visible cut-on wavelength of the devices is <0.5 µm. With a dark current density of 5.3 × 10-4 A/cm2 under -20 mV applied bias at 300K, the photodetectors exhibit a specific detectivity of 4.72 × 1010 cm·Hz1/2/W. At 150K, the photodetectors exhibit a dark current density of 1.8 × 10-10 A/cm2 and a quantum efficiency of 40%, resulting in a detectivity of 5.56 × 1013 cm·Hz1/2/W.

Bioabsorbable screws, whatever the composition, can result in symptomatic intra-osseous tibial tunnel cysts after ACL reconstruction.

PURPOSE: To describe the clinical results of patients who underwent surgical treatment for a intra-osseous tibial tunnel cyst on a bioabsorbable interference screw following anterior cruciate ligament reconstruction (ACL). METHODS: This retrospective study included all patients who underwent surgery between 2004 and 2016 for an intra-osseous tibial tunnel cyst on bioabsorbable interference screw following ACL reconstruction. The diagnosis was suggested clinically by pretibial pain at the incision site, sometimes associated with a palpable subcutaneous nodule and then confirmed on MRI. The first stage of surgery included exploratory arthroscopy followed by open excision/curettage of the cyst and then the tunnel was filled. The main criterion for outcome was a clinically normal knee (no pain, 0-120 range of motion, stable, with no effusion) at 6 months of follow-up. RESULTS: This series included 53 patients, mean age 35.3 ± 9.9 years old w ith a mean 4.6 ± 3.1 years (between 3.1 months and 19 years) of follow-up after ligament reconstruction. The tibial screw was completely absorbed in 9/53 (17%) of patients, and fragmented in 22/53 (41.5%). At the 6-month follow-up, 42/53 (79.2%) patients had a normal knee, 11/53 (20.8%) persistent pain in the cyst area, 52/53 (98.1%) normal range of motion and 53 (100%) a stable knee. A recurrent cyst developed at 2 years of follow-up in one patient. CONCLUSION: Complete absorption of a bioabsorbable interference screw is long, increasing the risk of developing intra-osseous tibial cysts during this period. The development of new materials with improved absorption properties is needed. LEVEL OF EVIDENCE: IV-Retrospective study.

nBn extended short-wavelength infrared focal plane array.

An extended short-wavelength nBn InAs/GaSb/AlSb type-II superlattice-based infrared focal plane array imager was demonstrated. A newly developed InAs0.10Sb0.90/GaSb superlattice design was used as the large-bandgap electron barrier in this photodetector. The large band gap electron-barrier design in this nBn photodetector architecture leads to the device having lower dark current densities. A new bi-layer etch-stop scheme using a combination of InAs0.91Sb0.09 bulk and AlAs0.1Sb0.9/GaSb superlattice layers was introduced to allow complete substrate removal and a shorter wavelength cut-on. Test pixels exhibit 100% cutoff wavelengths of ∼2.30 and ∼2.48 µm at 150 and 300 K, respectively. The devices achieve saturated quantum efficiency values of 59.7% and 63.8% at 150 and 300 K, respectively, under backside illumination and without any antireflection coating. At 150 K, photodetectors exhibit dark current density of 8.75×10-8 A/cm2 under -400 mV applied bias, providing specific detectivity of 2.82×1012 cm·Hz1/2/W at 1.78 µm. At 300 K, the dark current density reaches 4.75×10-2 A/cm2 under -200 mV bias, providing a specific detectivity of 8.55×109 cm·Hz1/2/W 1.78 µm.

A Distally Based Sartorius Muscle Flap for a Gustilo Grade-III Open Fracture of the Lateral Femoral Condyle and the Head of the Fibula with a Complex Soft-Tissue Defect: A Case Report and Review of the Literature.

CASE: We present a case of lower-limb trauma associated with an extensive soft-tissue defect around the knee joint, which led to the exposure of bone and the metalwork that was used for the management of the associated fractures. Coverage was performed with a distally based sartorius muscle flap in a single-stage procedure, allowing good recovery with a nice aesthetic and functional outcome at the 1-year follow-up. Additionally, we discuss alternative options for the coverage of severe soft-tissue defects based on the clinical context. CONCLUSION: A distally based sartorius muscle flap may be a suitable alternative for coverage of complex soft-tissue defects around the knee joint.

Type-II superlattice-based extended short-wavelength infrared focal plane array with an AlAsSb/GaSb superlattice etch-stop layer to allow near-visible light detection.

A versatile infrared imager capable of imaging the near-visible to the extended short-wavelength infrared (e-SWIR) is demonstrated using e-SWIR InAs/GaSb/AlSb type-II superlattice-based photodiodes. A bi-layer etch-stop scheme consisting of bulk InAs0.91Sb0.09 and AlAs0.1Sb0.9/GaSb superlattice layers is introduced for substrate removal from the hybridized back-side illuminated photodetectors. The implementation of this new technique on an e-SWIR focal plane array results in a significant enhancement in the external quantum efficiency (QE) in the 1.8-0.8 µm spectral region, while maintaining a high QE at wavelengths longer than 1.8 µm. Test pixels exhibit 100% cutoff wavelengths of ∼2.1 and ∼2.25 µm at 150 and 300 K, respectively. They achieve saturated QE values of 56% and 68% at 150 and 300 K, respectively, under back-side illumination and without any anti-reflection coating. At 150 K, the photodetectors (27 µm×27 µm area) exhibit a dark current density of 4.7×10-7 A/cm2 under a -50 mV applied bias providing a specific detectivity of 1.77×1012 cm·Hz1/2/W. At 300 K, the dark current density reaches 6.6×10-2 A/cm2 under -50 mV bias, providing a specific detectivity of 5.17×109 cm·Hz1/2/W.

Dark current reduction in microjunction-based double electron barrier type-II InAs/InAsSb superlattice long-wavelength infrared photodetectors.

Microjunction InAs/InAs1-xSbx type-II superlattice-based long-wavelength infrared photodetectors with reduced dark current density were demonstrated. A double electron barrier design was employed to reduce both bulk and surface dark currents. The photodetectors exhibited low surface leakage after passivation with SiO2, allowing the use of very small size features without degradation of the dark current. Fabricating microjunction photodetectors (25 × 25 µm2 diodes with 10 × 10 µm2 microjunctions) in combination with the double electron barrier design results in a dark current density of 6.3 × 10-6 A/cm2 at 77 K. The device has an 8 µm cut-off wavelength at 77 K and exhibits a quantum efficiency of 31% for a 2 µm-thick absorption region, which results in a specific detectivity value of 1.2 × 1012 cm·Hz1/2/W.

Bias-selectable nBn dual-band long-/very long-wavelength infrared photodetectors based on InAs/InAs1-xSbx/AlAs1-xSbx type-II superlattices.

Type-II superlattices (T2SLs) are a class of artificial semiconductors that have demonstrated themselves as a viable candidate to compete with the state-of-the-art mercury-cadmium-telluride material system in the field of infrared detection and imaging. Within type-II superlattices, InAs/InAs1-xSbx T2SLs have been shown to have a significantly longer minority carrier lifetime. However, demonstration of high-performance dual-band photodetectors based on InAs/InAs1-xSbx T2SLs in the long and very long wavelength infrared (LWIR & VLWIR) regimes remains challenging. We report the demonstration of high-performance bias-selectable dual-band long-wavelength infrared photodetectors based on new InAs/InAs1-xSbx/AlAs1-xSbx type-II superlattice design. Our design uses two different bandgap absorption regions separated by an electron barrier that blocks the transport of majority carriers to reduce the dark current density of the device. As the applied bias is varied, the device exhibits well-defined cut-off wavelengths of either ∼8.7 or ∼12.5 µm at 77 K. This bias-selectable dual-band photodetector is compact, with no moving parts, and will open new opportunities for multi-spectral LWIR and VLWIR imaging and detection.

Demonstration of type-II superlattice MWIR minority carrier unipolar imager for high operation temperature application.

An InAs/GaSb type-II superlattice-based mid-wavelength infrared (MWIR) 320×256 unipolar focal plane array (FPA) using pMp architecture exhibited excellent infrared image from 81 to 150 K and ∼98% operability, which illustrated the possibility for high operation temperature application. At 150 K and -50 mV operation bias, the 27 µm pixels exhibited dark current density to be 1.2×10(-5) A/cm(2), with 50% cutoff wavelength of 4.9 µm, quantum efficiency of 67% at peak responsivity (4.6 µm), and specific detectivity of 1.2×10(12) Jones. At 90 K and below, the 27 µm pixels exhibited system limited dark current density, which is below 1×10(-9) A/cm(2), and specific detectivity of 1.5×10(14) Jones. From 81 to 100 K, the FPA showed ∼11 mK NEDT by using F/2.3 optics and a 9.69 ms integration time.