Hill-Sachs Remplissage Procedure Based on Posterosuperior Capsulomuscular Anatomy.

The remplissage technique is a procedure designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterior-superior capsule in patients with engaging Hill-Sachs lesions. We describe a remplissage technique using 2 posterior working portals that respects the anatomy of the posterior-superior area of the glenohumeral joint without compromising the vascularization.

Do Articular-Sided Partial-Thickness Rotator Cuff Tears After a First-Time Traumatic Anterior Shoulder Dislocation in Young Athletes Influence the Outcome of Surgical Stabilization?

BACKGROUND: Because of the high risk for redislocations after a first-time traumatic anterior shoulder dislocation with conservative treatment, recent publications have recommended early arthroscopic intervention, especially for young athletes. Concomitant rotator cuff tendon damage may occur when the shoulder dislocates; however, its presence and influence on clinical results have not been well described in this patient category. HYPOTHESIS: In opposition to current opinion, a substantial number of articular-sided partial-thickness rotator cuff tears (APTRCTs) would be found at surgery after a first-time traumatic anterior shoulder dislocation in young athletes. However, the impact of these injuries on 2-year postoperative results would be negligible. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Sixteen male patients (mean age, 21 years [range, 16-25 years]) with a first-time traumatic anterior shoulder dislocation without bony Bankart lesions were included in this study. The indications for surgical treatment were age less than 25 years and being active in collision or contact sports at a competitive level. Arthroscopic surgery was performed at a mean 7.8 days (range, 2-14 days) after injury. Rowe and American Shoulder and Elbow Surgeons (ASES) scores as well as range of motion were evaluated at a minimum 2 years after an arthroscopic Bankart procedure, and a comparison of the clinical results between patients with and without APTRCTs was conducted. RESULTS: An anterior-inferior capsulolabral injury was found in all patients. There were no bony Bankart lesions. An APTRCT was found in 9 of the 16 patients. At 2 years after surgical treatment, there were no significant differences between the patients with and without APTRCTs in terms of the Rowe score (90.0 and 87.1, respectively; P = .69) and ASES score (94.6 and 90.4, respectively; P = .67). CONCLUSION: APTRCTs were found in the superior part of the shoulder joint after a first-time traumatic anterior shoulder dislocation in a majority of young male athletes treated with surgical stabilization. There were no significant differences found between patients with and without APTRCTs in terms of the Rowe and ASES scores at 2 years after surgical treatment.

The glenocapsular ligament and the posterosuperior part of the joint capsule of the shoulder are well vascularized.

PURPOSE: A detailed structural anatomy of the posterosuperior shoulder capsule and "glenocapsular ligament" is still rather unknown. The purpose of this study was meticulously to investigate and describe the structure and blood supply of the glenocapsular ligament on the posterosuperior shoulder joint capsule. METHOD: Sixteen fixed and twelve fresh cadaveric shoulder specimens with a mean age of 73.4 (±6.4) years were analysed. Dissection without arterial injection was performed on the 16 fixed specimens-using an alcohol-formalin-glycerol solution. Before dissection, the 12 fresh specimens received of arterial injection a 10% aqueous dispersion of latex solution. After the injection, these shoulders were also fixed in an alcohol-formalin-glycerol solution. RESULTS: The glenocapsular ligament was found in all 28 specimens. Single or double parallel-running bundles of connective tissue fibres were found to form a capsular-ligamentous structure on the posterosuperior part of the joint capsule. One part of the ligament was mediosuperior, another posterosuperior. The mediosuperior part varied in shape, and in 12 of 28 cases, it was absent. The glenocapsular ligament arose from the supraglenoid tubercle and posterior part of the collum scapulae and inserted into the semicircular humeral ligament. The posterior ascending branch of the circumflex scapular artery directly fed small branches laterally and medially to the joint capsule, supplying the glenocapsular ligament and the deep layer of the joint capsule. CONCLUSION: The glenocapsular ligament is a constant anatomical structure that consists of one or two different parts. The glenocapsular ligament and the posterosuperior part of the joint capsule appear well vascularized via the posterior ascending branch of the circumflex scapular artery. CLINICAL RELEVANCE: It is the hope of the authors that this anatomical study can help surgeons who perform open or arthroscopic surgery to the posterior part of the shoulder. Knowledge of the vascular anatomy presented in this study may be especially important when incisions are made to the posterior part of the shoulder, and should minimize the risk of complications.

Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side.

PURPOSE: Vascularity of the subacromial bursa and rotator cuff tendons is key factors in the pathogenesis of subacromial bursitis and impingement syndrome, rotator cuff tendinitis, and rotator cuff tears. The purpose of this study was to investigate and describe blood supply to the cranial and caudal parts of the subacromial bursa and the vascularity of the rotator cuff tendons on the bursal side. METHODS: Fourteen fresh cadaveric shoulders from six females and eight males with a mean age of 71.7 (±10.8) years were studied. Before dissection, an arterial injection of 10% aqueous dispersion of latex was administered. Post-injection, the shoulders were fixed in an alcohol-formalin-glycerol solution. RESULTS: The cranial and caudal bursa of all specimens was mainly supplied by the thoracoacromial, suprascapular, and anterior and posterior circumflex humeral arteries. The cranial part of the bursa was supplied anteriorly by the thoracoacromial artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third. The caudal part received arterial blood anteriorly from the anterior circumflex humeral artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third of the caudal bursa. In addition, the suprascapular artery branched at the upper surface of the coracohumeral ligament, and the subcoracoid artery branched at the under surface of the same ligament. CONCLUSION: The subacromial bursa appears well vascularized. The results of the present investigation showed that blood supply to the subacromial bursa at the caudal part and rotator cuff tendons on the bursal side was linked to the same arteries. The subcoracoid artery supplied interval rotator structures close to the caudal bursa. It is the wish of the authors that this meticulous anatomical work will help surgeons in their day-to-day clinical work, e.g. to minimize the risk of complications such as perioperative bleeding.

Rotator cuff tendon connections with the rotator cable.

PURPOSE: The literature currently contains no descriptions of the rotator cuff tendons, which also describes in relation to the presence and characteristics of the rotator cable (anatomically known as the ligamentum semicirculare humeri). The aim of the current study was to elucidate the detailed anatomy of the rotator cuff tendons in association with the rotator cable. METHODS: Anatomic dissection was performed on 21 fresh-frozen shoulder specimens with an average age of 68 years. The rotator cuff tendons were dissected from each other and from the glenohumeral joint capsule, and the superior glenohumeral, coracohumeral, coracoglenoidal and semicircular (rotator cable) ligaments were dissected. Dissection was performed layer by layer and from the bursal side to the joint. All ligaments and tendons were dissected in fine detail. RESULTS: The rotator cable was found in all specimens. It was tightly connected to the supraspinatus (SSP) tendon, which was partly covered by the infraspinatus (ISP) tendon. The posterior insertion area of the rotator cable was located in the region between the middle and inferior facets of the greater tubercle of the humerus insertion areas for the teres minor (TM), and ISP tendons were also present and fibres from the SSP extended through the rotator cable to those areas. CONCLUSION: The connection between the rotator cable and rotator cuff tendons is tight and confirms the suspension bridge theory for rotator cuff tears in most areas between the SSP tendons and rotator cable. In its posterior insertion area, the rotator cable is a connecting structure between the TM, ISP and SSP tendons. These findings might explain why some patients with relatively large rotator cuff tears can maintain seamless shoulder function.

Anatomy of the superior glenohumeral ligament.

BACKGROUND: The aim of the present study was to give a detailed, anatomical description of the superior glenohumeral ligament and its relationship with the neighbouring structures in the rotator interval. METHOD: Twenty-seven cadaveric shoulder specimens were dissected in fine detail to describe superior glenohumeral ligament and additional histologic examination was performed. RESULTS: The superior glenohumeral ligament is a constant, gross anatomic structure that was present in all of twenty-seven investigated specimens. The fibers of the superior glenohumeral ligament could be divided into two groups - the oblique and direct fibers. The direct fibers of the superior glenohumeral ligament arise from the glenoid labrum, run parallel with the tendon of the long head of the biceps brachii towards the lesser tubercle, which they also partly insert onto. The rest of the direct fibers course into the bottom of the bicipital groove and bridge over it, forming the superior part of the transverse humeral ligament. The oblique fibers arise from the supraglenoid tubercle, run over the intraarticular part of the tendon of the long head of the biceps brachii and insert below the coracohumeral ligament into the humeral semicircular ligament. CONCLUSION: Due to its anatomic composition and tight connection with the neighboring articular structures, the superior glenohumeral ligament is involved in the stabilizing mechanisms of the intraarticular part of the tendon of the long head of the biceps brachii and plays an important role in the variety of clinical disorders that occur within the rotator interval.

The spiral glenohumeral ligament: an open and arthroscopic anatomy study.

PURPOSE: The purpose of this study was to visualize arthroscopically and to describe the micro- and macroscopic anatomy of the poorly known ligament of the anterior capsule of the glenohumeral joint: the so-called ligamentum glenohumerale spirale (spiral GHL). METHODS: Twenty-two fresh shoulder joints were dissected, and the anatomy of the anterior capsular structures (the spiral GHL, the middle glenohumeral ligament [MGHL], and the anterior band as well as the axillary part of the inferior glenohumeral ligament [AIGHL and AxIGHL, respectively]) was investigated. For arthroscopic visualization, 30 prospective arthroscopic clinical cases and 19 retrospective video clips of the patients who had an arthroscopic shoulder procedure with a normal subscapularis tendon, labrum, and anterior joint capsule were evaluated. RESULTS: The spiral GHL and the AxIGHL were present in all 22 shoulder specimens. The AIGHL was not recognizable on the extra-articular side of the joint capsule. The MGHL was absent in 3 shoulder specimens (13.6%). Arthroscopically, the spiral GHL was found in 22 (44.9%), the MGHL in 43 (87.8%), and the AIGHL in 46 (93.9%) of the cases. The spiral GHL arose from the infraglenoid tubercle and the triceps tendon and inserted together with subscapularis tendon onto the lesser tubercle of the humerus. CONCLUSIONS: Our results suggest that extra-articular structure of the spiral GHL is consistently recognizable, the upper part of which can be arthroscopically identified. CLINICAL RELEVANCE: Advanced anatomic knowledge of the spiral GHL helps the clinician better understand the normal anatomy of the shoulder joint and also helps to differentiate it from pathologic findings of the patient. The biomechanical importance of the spiral GHL and its connection with shoulder pathology remains to be determined in further studies.

Expression of insulin signaling transmitters and glucose transporters at the protein level in the rat testis.

Insulin receptor substrate (IRS) proteins are key mediators in insulin signaling from the insulin receptor. It takes place through receptor-mediated tyrosine phosphorylation of IRS proteins. The aim of the present article is to demonstrate the distribution of IRS 1-3, glucose transporters 1-4 (GLUT 1-4), signal regulatory protein 1alpha (SIRP1alpha), PKB, and PI 3-kinase in the rat testis to see if signal transduction mediated by these proteins is active in testicular cells. Wistar rats were used as donors of testis tissue. Expression of these genes was studied at the protein level by using immunohistochemistry and Western blotting. IRS-1, IRS-2, GLUT 1, GLUT 2, GLUT 3, and SIRP1alpha were strongly expressed in the Sertoli cells (except GLUT 1), early spermatocytes, peritubular myoid cells, macrophage-like interstitial cells, and testicular endothelial cells in all the testes investigated by immunohistochemistry. IRS-2 was also expressed in the Leydig cells. Immunoblotting experiments demonstrated the presence of about 26-67 kDa reactive with anti- IRS-1, IRS-2, GLUT 1, GLUT 2, GLUT 3, PKB, and SIRP1alpha. The present results suggest that proteins like insulin and certain cytokines using IRS-1, IRS-2, GLUT 1, GLUT 2, GLUT 3, PKB, and SIRP1alpha in their signal transduction can have effects on the different types of testicular cells in the rat.

Experimental sepsis: characteristics of activated macrophages and apoptotic cells in the rat spleen.

Sepsis, being characterized by massive translocation of bacteria into tissues, induces the suppression of the function of both leukocytes and macrophages. The aim of the study was to count activated macrophages (AMs) and apoptotic (Ao) cells in the rat spleen during the period of experimental sepsis and to clarify the associations of these parameters with each other and with leukocyte migration and bacterial translocation into different organs. The Wistar rats were intraperitoneally inoculated with Escherichia coli (E. coli) and were sacrificed after 2, 6, 24, 48, and 120 h. Bacteria and leukocytes in tissues were specifically stained. AMs were identified by immunohistological staining and Ao cells by the TUNEL assay. The high counts of E. coli at 6 h were strongly associated with a low level of the total counts of leukocytes, accompanied by the high translocation of microbes into tissues. In the spleen, lymphocytes, macrophages, and neutrophils with pyknotic nuclei were identified. The count of AMs was highest at 24 h after the inoculation with E. coli; at the same time the Ao cell count began to rise and achieved the highest level 24 h later. Our investigation indicates that the molecular peculiarities of macrophages and their responses to the inflammation process are tissue-specific. In the spleen the activation process involving hematopoietic cells and macrophages was remarkable at the late stage of sepsis, characterized by a high count of Ao cells.

Immunohistochemical detection of glucose transporters class I subfamily in the mouse, rat and human testis.

A family of glucose transporters (GLUT) mediates the cellular uptake of glucose at the plasma membrane by facilitated diffusion. We investigated the presence of isoforms GLUT1-4 of class I subfamilies in different types of cells in the mouse, rat and human testis by indirect immunofluorescence technique. Immunocytochemical analyses demonstrated that GLUT1 was expressed in the rat testis, GLUT2 in the mouse and rat testis, GLUT3 in the mouse, rat and human testis and GLUT4 was not presented in the testis at all. A very intensive positive immunoreaction for GLUT3 was found in Sertoli cells, peritubular myoid cells, macrophage-like interstitial cells, testicular endothelial cells and early spermatocytes. GLUT3 positive cells were not found in the luminal part of Sertoli cells, spermatids or Leydig cells. The present results suggest that glucose uptake in different testicular cells is mediated by GLUT1, GLUT2 and GLUT3 and the GLUT3 was the prominent glucose transporter type in the testicular cells.

Changes of activated macrophages and apoptotic cell count in the organs of rats during experimental sepsis.

OBJECTIVE: Leukocyte migration plays an important role in inflammation. The aim of our study was to detect the activated macrophage count and to define the apoptotic cell count in the rat's liver and lungs during different stages of sepsis and to clarify whether the activity of macrophages is associated with the apoptotic cell count in the course of the septic process. MATERIAL AND METHODS: Experimental sepsis was induced by inoculating Wistar rats intraperitoneally with E. coli cells. The liver and lung tissue was obtained 2, 6, 24, 48 and 120 hours after inoculation, and blood smears to detect the leukocyte volume were prepared at the same time. Macrophage activity was studied by immunohistochemical staining, using the ABC method. Apoptotic cell count was detected with the "In Situ Cell Death Detection Kit". RESULTS: Decrease in the total count of leukocyte and lymphocyte percentage and a rise in the percentage of neutrophils in the blood were evidences of a strong inflammation process in an organism. The count of activated macrophages in the liver was high, showing the maximum level at the end of the 2(nd) h after inoculation, after which it began to fall. Apoptotic cell count rose after a decrease in macrophage activity. In the lungs both changes - a decrease in activated macrophage level and a rise in the apoptotic cell count took place later on. CONCLUSION: Our investigations indicate that a decrease in the activated macrophage level is connected with an increased rise in the apoptotic cell count in both organs depending on the stage of the disease and occurs in the liver earlier than in the lungs but the process of cell apoptosis was more intensive in the lungs.