Shoulder Stabilization Technique Using the Medial Glenohumeral Ligament in Patients With the Buford Complex.

The Buford complex is an anatomic variation defined as the association of a cordlike middle glenohumeral ligament (MGHL) and an absent anterosuperior labrum. It can be challenging to properly identify on preoperative imaging and remains mostly an arthroscopic finding. It may, however, lead to problematic situations when encountered during an arthroscopic soft-tissue stabilization procedure, as the treatment of choice in such cases is a bone block. Moreover, reattaching the MGHL to the anterior border of the glenoid rim has traditionally not been recommended because it theoretically leads to severe restriction in external rotation. This technical note describes arthroscopic stabilization for anterior traumatic glenohumeral instability associated with the Buford complex. The cordlike MGHL is used to reconstruct a neo-labrum, associated with an anteroinferior glenohumeral ligament plication. Glenohumeral stabilization using the cordlike MGHL of the Buford complex may be an efficient alternative to a bone block procedure.

Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE: To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS: From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION: Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

An Unusual Case of Onlay Reverse Shoulder Arthroplasty Disassembly Due to Cement Interposition. A Case Report.

Introduction: Reverse shoulder arthroplasty (RSA) complication rates range between 1.4% and 28% depending on the nature of the indication. Even though glenosphere dissociation is the third most frequent complication after RSA, with an incidence that can rise to just over 12%, there is no evidence in the literature describing the disassembly between the humeral stem and its metaphysics. Case Report: It is reported a novel early failure type in a reversed shoulder arthroplasty of a healthy 72-year-old female patient, involving the disassembly of the metaphysis from an onlay tray system due to cement interposition in a reversed shoulder prosthesis. Conclusion: This case highlights a rare form of early failure after RSA as a result of a disassembly between the humeral stem and its metaphysis due to the presence of interposed cement. To prevent this complication, a two-step implantation procedure is recommended, which consists of cementing the stem before inserting the metaphyseal tray.

The role of bone morphology of the greater tuberosity and lateral acromion on subacromial space during scaption: a three-dimensional dynamic simulation analysis.

BACKGROUND: The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES: This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS: Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS: CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION: Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE: III.

Reconstruction of Chronic, Retracted Pectoralis Major Tendon Tear With Achilles Tendon Allograft.

Rupture of pectoralis major tendon (PMT) is an uncommon injury, but its incidence has been increasing in the past 2 decades. Although open repair of the torn tendon is the preferred choice of treatment in acute and chronic cases, this often is not possible for chronic retracted tendon injuries. While several techniques have been described for PMT reconstruction, these allografts and autografts are often smaller and less thick than the native PMT. In this study, we describe the use of the Achilles tendon allograft with unicortical suture buttons for the reconstruction of a chronic and retracted PMT. Furthermore, the advantages and disadvantages of this technique are discussed.

Does Accreditation by the Association of Zoos and Aquariums Correlate with Animal Welfare Act Compliance?

The Association of Zoos and Aquariums (AZA) promotes itself as the "gold standard" for animal welfare in zoos and aquariums; however, no objective evaluation of this claim has been performed. As the only statute providing protection to individual animals in the United States, the Animal Welfare Act (AWA) also seeks to assure animal welfare at facilities exhibiting animals to the public. In this study, the incidences of AWA noncompliant items (NCIs) at AZA-accredited facilities were evaluated and compared to non-accredited facilities licensed as exhibitors by the United States Department of Agriculture (USDA). Based on our analysis, non-accredited exhibitors had significantly more total NCIs than AZA-accredited facilities, and non-accredited facilities also had more NCIs related to improper veterinary care, animal husbandry, and record-keeping, but not with respect to personnel qualifications. Additionally, accreditation status and number of regulated species were significant predictors of the number of NCIs. This study revealed that AZA accreditation is correlated with improved compliance with the AWA and perhaps enhanced animal welfare.

[Conventional radiological markers in rotator cuff surgery]. / Marqueurs radiologiques conventionnels dans la chirurgie de la coiffe des rotateurs.

The surgical management of a degenerative or traumatic lesion of the shoulder joint is based on anatomical, clinical, and radiologic criteria. To optimize the diagnostic and therapeutic management of patients, the use of radiological imaging must be accompanied by meticulous clinical examination first. Conventional radiography is an effective complementary exam to assess the nature of shoulder joints injuries. Many conventional radiographic markers have been described, mainly for degenerative rotator cuff lesions, and are routinely used by clinicians as a screening tool. The aim of this review was to describe these different markers and define their reliability and usefulness in avoiding more expensive imaging modalities.

La prise en charge chirurgicale d'une lésion dégénérative ou traumatique de l'épaule repose sur des critères anatomiques, cliniques et radiologiques. Afin d'optimiser la prise en charge diagnostique et thérapeutique des patients, le recours à l'imagerie est essentiel et doit être accompagné d'un examen clinique méticuleux. La radiographie conventionnelle est un examen efficace de dépistage pour apporter un diagnostic de présomption. Plusieurs marqueurs radiologiques ont été décrits, surtout dans les pathologies de la coiffe des rotateurs, et sont couramment utilisés dans la pratique clinique. Le but de cet article est d'effectuer une revue critique de ces différents marqueurs et de définir leurs fiabilité et utilité clinique pour éviter de recourir à une imagerie plus coûteuse.

All-suture technique for fixation of unstable displaced distal clavicle fracture.

Background: Displaced Neer type II and V clavicle fractures are usually treated surgically in active patients. However, distal fragment fixation remains a challenge, and no consensus has been established regarding the optimal surgical treatment. Osteosuture techniques have been popularized over the last decade, and multiple different techniques have been described. The aim of this study was to describe an all-suture technique in patients with displaced type II and V clavicle fractures and report its outcome in a prospective case series. Methods: Between 2017 and 2020, 15 patients with displaced acute distal clavicle fractures were treated with an all-suture open technique performed by one shoulder specialized surgeon, with a minimum follow-up of 1 year. Osteosuture repair consisted in a coracoclavicular cerclage with 4 no6 Ethibonds and a figure-of-0 and figure-of-8 fracture cerclage with 2 no2 SutureTapes. Single assessment numerical evaluation (SANE) and adjusted Constant score were recorded at 6 months and 1 year. The radiologic union was assessed on plain radiographs. Results: At 12 months, all patients reported excellent clinical results, with a mean SANE of 98.2 [± 5.2, range 80 to 100] and a mean adjusted Constant score of 99.0 [± 1.9, range 94 to 100]. One patient developed shoulder stiffness that resolved before the final follow-up. Fractures consolidated in 93% of the cases, with union happening between 3 and 6 months [range 3 to 12 months]. One patient developed an asymptomatic malunion. Conclusion: Excellent clinical and radiological outcomes can be achieved with this minimally invasive all-suture fixation technique for displaced distal clavicle fractures, which allows for an anatomic reduction and stable fixation. This pilot study showed low complications and a high level of union after a follow-up of 1 year. Among the numerous advantages are a smaller exposure than for plate fixation, avoidance of hardware-related complications such as screw failure, coracoid fracture from drilling, or rotator cuff damage caused by hook-plates. Furthermore, it avoids a reoperation to remove symptomatic hardware.

Implication of bone morphology in degenerative rotator cuff lesions: A prospective comparative study between greater tuberosity angle and critical shoulder angle.

BACKGROUND: Degenerative rotator cuff tear is a frequent and multifactorial pathology. The role of bone morphology of the greater tuberosity and lateral acromion has been validated, and can be measured with two plain radiographic markers on true anteroposterior views: the greater tuberosity angle (GTA) and the critical shoulder angle (CSA). However, the interdependence of both markers remains unknown, as well as their relationship with the level of professional and sports activities involving the shoulder. The aim of this prospective comparative study was to describe the correlation between the GTA and CSA in patients with degenerative rotator cuff tears. HYPOTHESIS: GTA and CSA are independent factors from one another and from demographic factors, such as age, dominance, sports, or professional activities. PATIENT AND METHODS: All patients presenting to a shoulder specialized clinic were assigned to two groups. The first consisted of patients with a symptomatic degenerative rotator cuff tear visible on MRI and the control group consisted of patients with any other shoulder complaints and no history or visible imaging of any rotator cuff lesion. RESULTS: There were 51 shoulders in 49 patients in the rotator cuff tear group (RCT) and 53 shoulders in 50 patients in the control group. Patient demographics were similar in both groups. Mean GTA was 72.1°±3.7 (71.0-73.1) in the RCT group and 64.0°±3.3 (63.1-64.9) in the control group (p<0.001). Mean CSA was 36.7°±3.7 (35.7-37.8) in the RCT group, and 32.1°±3.7 (31.1-33.1) in the control group (p<0.001). A summation of GTA and CSA values over 103° increased the odds of having a rotator cuff tear by 97-fold (p<0.001). There was no correlation between GTA and CSA, nor between GTA or CSA and age, sex, tear size, or dominance. Patients with different levels of professional and sports activities did not have significantly different GTA or CSA values. CONCLUSION: GTA and CSA are independent radiologic markers that can reliably predict the presence of a degenerative rotator cuff tear. A sum of both values over 103° increases the odds of having a rotator cuff tear by 97-fold. These markers are not correlated with patient demographic or environmental factors, suggesting that the variability of the native acromion and greater tuberosity morphology may be individual risk factors for rotator cuff tear. LEVEL OF EVIDENCE: II; diagnostic study.

Association between open tibia fractures and acute compartment syndrome: A retrospective cohort study.

BACKGROUND: Studies on the association of open tibia fractures and acute compartment syndrome (ACS) show confusing results, with some papers highlighting a positive association, and others failing to do so. The aim of this study was to determine if an open tibia fracture is at increased risk of ACS occurrence, when compared to a closed fracture. HYPOTHESIS: Skin injury in the setting of an open tibia fracture does not prevent from ACS occurrence, because the energy transmitted to the limb during trauma may lead to soft tissue lesions, including skin lacerations and ACS. PATIENTS AND METHODS: In total, 711 consecutive adult patients (mean age 44.6 years; 65.8% males) sustaining 725 tibia fractures between 01.01.2005 and 31.12.2009 were included in this retrospective study. The outcome measure was ACS. The following variables were assessed: soft tissue condition, age, sex, low- vs. high-energy injury, type of fracture, associated contiguous skeletal injury. A logistic regression model was used and adjustment was performed for age and sex. RESULTS: ACS occurred in 10.4% of proximal intra-articular fractures, 10.4% of extra-articular fractures and 3.3% of distal intra-articular fractures, and in 8.7% of closed fractures, 7.8% of open Gustilo 1 fractures and 13.3% of open Gustilo 2 and 3 fractures. Open lesions were not associated with ACS when tibia fractures were considered as a whole. When stratifying by types of fractures, open Gustilo 2 and 3 lesions were associated with ACS in proximal intra-articular fractures (p=0.048). There was no association with closed or any type of open lesions for extra-articular fractures. There were not enough ACS cases among distal intra-articular fractures to draw conclusions. DISCUSSION: As ACS may occur with any type of open tibia fractures, clinicians should not be wrongly reassured by an open fracture, assuming that the wound would relieve the pressure inside the muscle compartments. There is a weak association between open Gustilo 2 and 3 lesions and ACS in proximal intra-articular fractures only. These findings are important for surgeons treating these injuries, especially by intubated, sedated or obtunded patients. LEVEL OF EVIDENCE: III; retrospective diagnostic study.

Return to sport after shoulder arthroplasty: a systematic review.

The main goal of this study was to determine the rate of return to sport (RTS) after shoulder arthroplasty.A systematic review of the literature was performed using the PRISMA guidelines. All clinical studies written in English, French or German, with a level of evidence of 1 to 4, and evaluating return to sport after shoulder arthroplasty, were included.A total of 23 studies were included with 2199 patients who underwent hemiarthroplasty (HA), anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RSA). Mean age was 68 years (range 18 to 92.6), sex ratio (male:female) was 1:1.5. The surgery was performed on the non-dominant/dominant shoulder in 1:1.8 cases. The mean follow-up was 4.2 years. The rate of RTS was 75.5% with a mean time of 7 months. It was 77.4% for TSA, 75% for RSA and 71.2% for HA (P = non-significant).RTS after shoulder arthroplasty is high, regardless the type of arthroplasty, with a trend for a higher rate after TSA. Patients who were able to maintain a sport activity preoperatively had a greater chance of RTS after arthroplasty. Failure to RTS seems to be mostly linked to the severity of the underlying condition and length of preoperative disability. Cite this article: EFORT Open Rev 2021;6:771-778. DOI: 10.1302/2058-5241.6.200147.

Engineering Purely Nonlinear Coupling between Superconducting Qubits Using a Quarton.

Strong nonlinear coupling of superconducting qubits and/or photons is a critical building block for quantum information processing. Because of the perturbative nature of the Josephson nonlinearity, linear coupling is often used in the dispersive regime to approximate nonlinear coupling. However, this dispersive coupling is weak and the underlying linear coupling mixes the local modes, which, for example, distributes unwanted self-Kerr nonlinearity to photon modes. Here, we use the quarton to yield purely nonlinear coupling between two linearly decoupled transmon qubits. The quarton's zero ϕ^{2} potential enables an ultrastrong gigahertz-level cross-Kerr coupling, which is an order of magnitude stronger compared to existing schemes, and the quarton's positive ϕ^{4} potential can cancel the negative self-Kerr nonlinearity of qubits to linearize them into resonators. This ultrastrong cross-Kerr coupling between bare modes of qubit-qubit, qubit-photon, and even photon-photon is ideal for applications such as single microwave photon detection, ultrafast two-qubit gates, and readout.

Swiss-wide multicentre evaluation and prediction of core outcomes in arthroscopic rotator cuff repair: protocol for the ARCR_Pred cohort study.

INTRODUCTION: In the field of arthroscopic rotator cuff repair (ARCR), reporting standards of published studies differ dramatically, notably concerning adverse events (AEs). In addition, prognostic studies are overall methodologically poor, based on small data sets and explore only limited numbers of influencing factors. We aim to develop prognostic models for individual ARCR patients, primarily for the patient-reported assessment of shoulder function (Oxford Shoulder Score (OSS)) and the occurrence of shoulder stiffness 6 months after surgery. We also aim to evaluate the use of a consensus core event set (CES) for AEs and validate a severity classification for these events, considering the patient's perspective. METHODS AND ANALYSIS: A cohort of 970 primary ARCR patients will be prospectively documented from several Swiss and German orthopaedic clinics up to 24 months postoperatively. Patient clinical examinations at 6 and 12 months will include shoulder range of motion and strength (Constant Score). Tendon repair integrity status will be assessed by ultrasound at 12 months. Patient-reported questionnaires at 6, 12 and 24 months will determine functional scores (subjective shoulder value, OSS), anxiety and depression scores, working status, sports activities, and quality of life (European Quality of Life 5 Dimensions 5 Level questionnaire). AEs will be documented according to a CES. Prognostic models will be developed using an internationally supported regression methodology. Multiple prognostic factors, including patient baseline demographics, psychological, socioeconomic and clinical factors, rotator cuff integrity, concomitant local findings, and (post)operative management factors, will be investigated. ETHICS AND DISSEMINATION: This project contributes to the development of personalised risk predictions for supporting the surgical decision process in ARCR. The consensus CES may become an international reference for the reporting of complications in clinical studies and registries. Ethical approval was obtained on 1 April 2020 from the lead ethics committee (EKNZ, Basel, Switzerland; ID: 2019-02076). All participants will provide informed written consent before enrolment in the study. TRIAL REGISTRATION NUMBER: NCT04321005. PROTOCOL VERSION: Version 2 (13 December 2019).

A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial.

BACKGROUND: Hematoma formation and the need for blood transfusions are commonly reported complications after shoulder arthroplasty. Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to decrease perioperative blood loss. The role of TXA is still being established in shoulder arthroplasty. MATERIALS AND METHODS: We conducted a double-blind randomized controlled trial comparing intravenous TXA vs. placebo in 60 patients undergoing primary anatomic or reverse shoulder arthroplasty. Of these patients, 29 received a placebo whereas 31 received a single dose of 2 g of intravenous TXA. Patient demographic characteristics, as well as drain tube output, blood loss, hematoma formation, transfusion requirement, length of hospital stay, and pain score, were recorded. Patients were followed up for 12 weeks to assess for complications. RESULTS: Patients who received TXA had a lower drain tube output at all time points: 41 mL vs. 133 mL at 6 hours, 75 mL vs. 179 mL at 12 hours, and 94 mL vs. 226 mL at 24 hours (P < .001 for all). They also had a higher postoperative hemoglobin (Hb) level (12.3 g/dL vs. 11.4 g/dL, P = .009), lower change in Hb level (1.7 g/dL vs. 2.3 g/dL, P = .011), lower total Hb loss (0.078 g vs. 0.103 g, P = .042), lower blood volume loss (0.55 L vs. 0.74 L, P = .021), higher postoperative hematocrit level (36.7% vs. 34.6%, P = .020), and lower hematocrit change (5.4% vs. 7.6%, P = .022). There was no significant difference in pain score or length of hospital stay, and no patients required a transfusion. CONCLUSION: A single dose of 2 g of intravenous TXA decreases blood loss and drain tube output in primary anatomic and reverse arthroplasty of the shoulder. No differences were detected in the occurrence of complications, need for transfusion, pain score, or length of hospital stay. With the mounting evidence now available, patients undergoing elective primary shoulder arthroplasty should be given intravenous TXA to decrease perioperative blood loss.

Arthroscopic treatment of a lipoma arborescens of the elbow: A case report.

INTRODUCTION: Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa. CASE'S DESCRIPTION: We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension. DIAGNOSIS: The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy. INTERVENTIONS: After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis. OUTCOME: At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores. CONCLUSION: This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.

Accuracy of arthroscopic fluid pump systems in shoulder surgery: a comparison of 3 different pump systems.

BACKGROUND: Extra-articular fluid extravasation is a known complication during shoulder arthroscopy. The risk and amount of extravasation to a large degree is dependent on the fluid pressure delivered to the surgical site. Accurate measurement, knowledge, and control of the pressure delivered is thus important to surgeons, anesthetists, and the patient. The purpose of this study was to compare the pressure measurement accuracy of 3 arthroscopic fluid pumps, with 2 of them having 2 different settings. METHODS: Twenty-five patients (n = 5 per group) undergoing shoulder arthroscopy were selected. Three different arthroscopic fluid pumps (ConMed 24K, Stryker Crossflow, Arthrex Dual Wave) were tested in 5 different operational settings (Stryker, standard and dynamic mode; ConMed, with and without TIPS; Arthrex Dual Wave). In each operation, the set pump pressures and the subsequently delivered intra-articular surgical site fluid pressures were measured by a spinal needle connected to an anesthetic standard pressure transducer attached to the anesthetic machine. Independent measures of the surgical site pressures were obtained before multiple portals were created or extravasation had occurred. Measurements were taken at the beginning of surgery. RESULTS: Measurements of the mean intra-articular pressure were found to not be significantly different from the set pressure for the ConMed 24K with TIPS (0.98 ± 0.02-fold) and Stryker Crossflow in standard mode (0.98 ± 0.02-fold). However, actual pressure was significantly greater than the set pressure for the ConMed 24K without TIPS (by 1.30 ± 0.13-fold), Stryker Crossflow in dynamic mode (by 1.82 ± 0.08-fold), and Arthrex Dual Wave (by 2.19 ± 0.06-fold). CONCLUSION: Independently measured intra-articular pressure can be more than double the set pressure for some arthroscopic pumps. Measuring intra-articular pressure can thus aid in adjusting the set pressure. This could minimize the risk of intraoperative complications.

Shoulder Motion Analysis During Codman Pendulum Exercises.

PURPOSE: To quantify shoulder motion during Codman pendulum exercises. METHODS: Shoulder kinematics were analyzed in 17 healthy volunteers using a validated biomechanical model coupling patient-specific imaging and motion capture. Participants were instructed to perform medio-lateral, antero-posterior and circular pendulum exercises. Glenohumeral (GH), scapulothoracic (ST), thoracohumeral (TH) ROM and overall exercise amplitude were calculated for each sequence. Linear regression analyses were carried out to determine association between different components of shoulder motion. RESULTS: Mean overall exercise amplitude was 40.59±11.24° (range, 25.38 to 70.25°) for medio-lateral exercises, 46.5±22.02° (range, 20.68 to 100.24°) for antero-posterior exercises, and 20.28±7.13° (range, 10.9 to 35.49°) for circular exercises. Mean GH and ST involvement remained minimal, ranging from 6.74 to 13.81°, and 1.5° to 5.12°, respectively. There was no significant correlation between overall exercise amplitude and GH (R = 0.31, p = 0.01) or ST ROM (adjusted R2 = 0.57, p < 0.001), but a moderate correlation with TH ROM (R = 0.73, p < 0.001). CONCLUSION: This study demonstrates that Codman pendulum exercises depend mainly on truncal movement and produce very little movement in the GH and ST joints. Although they may be a safe way to promote early general stretching of the upper limb, they may be of limited further use in restoring passive shoulder ROM. CLINICAL RELEVANCE: This study quantifies motion during frequently administered shoulder rehabilitation exercises and shows that they do not produce significant movement in the shoulder. Their use in restoring passive range of motion is thus questionable.

Halo Femoral Traction for 1 Week Between Staged Anterior and Posterior Fusion Surgeries for Severe Adolescent Scoliosis Is Effective and Safe.

OBJECTIVE: To report the outcomes of halo femoral traction (HFT) used for 1 week between anterior release and definitive posterior fusion in adolescents with severe rigid scoliosis. METHODS: A retrospective single-center review of 22 consecutive patients (mean age at surgery, 14.1 years; range, 10.5-18.2 years; 17 girls) with severe, rigid scoliosis treated with anterior release, followed by HFT for 7 days prior to posterior instrumented fusion. Cobb angles were measured preoperatively, 1 week after anterior release and traction, after posterior fusion, and at a minimum 2-year follow-up. Complications were recorded. RESULTS: Mean preoperative Cobb angle was 97° (range, 80°-118°), correcting to 52° with anterior release and HFT and 31° after posterior fusion. This equated to a 68% deformity correction and was maintained at final follow-up. Three traction-related complications were experienced, including 1 case of neck pain and 2 cases of brachial plexopathy that resolved with traction weight reduction. CONCLUSIONS: Three-staged deformity correction using HFT for 1 week only offers gradual correction of the spine over sufficient time to optimize deformity correction yet minimizes neurologic dysfunction.

The Value of a Modified Wiltse Approach for Deformity Correction in Neuromuscular Scoliosis.

BACKGROUND: Wiltse approaches have been shown to reduce operative blood loss and enhance recovery in lumbar spinal surgery; however, their efficacy in neuromuscular scoliosis (NMS) deformity correction has never been assessed. Thus, the purpose of this study was to compare the outcomes of deformity correction requiring pelvic fixation in NMS performed through a Wiltse approach in contrast to a standard midline approach. METHODS: This is a retrospective review of 24 consecutive children with NMS undergoing deformity correction by a single surgeon in our institution. Patient demographic data, operative time, blood loss, curve correction, length of stay, and complications were recorded. RESULTS: In 16 children, the procedure was performed through a Wiltse approach and in 8 through a midline approach. There was no significant difference in age, sex, preoperative Cobb angle, or number of levels fused. Patients who underwent a Wiltse approach had significantly less blood loss yet similar curve correction. The hospital length of stay and complication rate were not significantly different between the groups. CONCLUSIONS: A modified Wiltse approach can be safely used for NMS deformity correction. This approach achieves similar curve corrections to a traditional midline approach with less blood loss and no need for iliac screw connectors. LEVEL OF EVIDENCE: 3.

Smartphone application technique for localising magnetically controlled growth rod actuators: the Oxford Magnetic Counter App Technique (TOMCAT).

PURPOSE: The purpose of this study is to report a novel smartphone app technique to localise a magnetically controlled growing rod (MCGR) actuator, along with determining this novel technique accuracy compared to current tactile localisation techniques through an experimental study. METHODS: Five spinal surgery fellows recorded attempts localising the MCGR magnetic actuator using a novel smartphone app technique, MAGEC Wand and magnetic disc. Three attempts per technique were performed and repeated in both the average and overweight patient models. RESULTS: In total, 90 separate localisation attempts were recorded. The smartphone app produced less localisation error than both the MAGEC Wand and magnetic disc. Mean difference was - 0.71 cm (95% CI - 1.24 to - 0.18 cm p = 0.06) and - 0.58 cm (95% CI - 1.11 to - 0.04 cm p = 0.031), respectively. Mean localisation error for the smartphone app, MAGEC Wand and magnetic disc, was 0.9 cm, 1.61 cm, 1.47 cm, respectively, for both average and overweight models combined. CONCLUSIONS: This novel smartphone app localisation technique is accurate. Current MAGEC Wand and magnetic disc techniques produced more localisation error than the reported tolerance of the external remote control lengthening unit in this experiment.