Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older.

BACKGROUND: We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. METHODS: Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant-Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. RESULTS: RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). CONCLUSION: RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.

Three-dimensional analysis of the shoulder motion in patients with massive irreparable cuff tears after latissimus dorsi tendon transfer (LDT).

INTRODUCTION: Latissimus dorsi tendon transfer (LDT) is a recent method for surgical treatment of massive, irreparable posterosuperior cuff tears (MIPCT). So far, there are no studies on the quantitative motion analysis of the shoulder and latissimus dorsi (LD) muscle activation after LDT. The changes in shoulder movements after LDT can be objectively assessed by the 3-D motion analysis. These changes may not be due to an increased activity of the LD muscle as external rotator. MATERIALS AND METHODS: The shoulder kinematics of nine patients with MIPCT were recorded through a 3-D motion analysis system, before LTD (T0), and after 3 (T1) and 6 (T2) months post-LDT. Maximal shoulder flexion-extension, abduction-adduction, and horizontal abduction-adduction, and the internal and external circumduction of the shoulder joint were measured during upright standing posture. Surface EMG activity of the LD muscle was recorded during both internal rotation (IR) and external rotation (ER) tasks in three different postures. RESULTS: A significant increase of shoulder movements was observed at T2 compared with T0 for almost all motor tasks. A significant effect of LDT was also found on LD-IR/ER ratio in posture 1 at T2 compared with T0 and T1. No significant effects were found for the LD-IR/ER ratio in the other postures. CONCLUSIONS: Our study indicates that LDT is effective in shoulder motion recovery. Such improvement is not associated with a change in function of the LD muscle, which may be induced by a depression of the humeral head into the glenoid cavity instead.

Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique.

Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start.

Grammont inverted prosthesis for the treatment of cuff tear arthropathy: a 6-year follow-up study.

This study evaluated mid-term functional results of the Grammont inverted prosthesis for the treatment of shoulder osteoarthritis associated with massive cuff rupture. Twenty-eight patients with a minimum of 6 years of follow-up were evaluated. Clinical evaluation was performed on all patients preoperatively and at follow-up using the Constant score. Radiologic assessment included radiographs and magnetic resonance imaging preoperatively and radiographs at follow-up. Constant score improved from 27.4 preoperatively to 64.6 postoperatively. The inverted prosthesis is attractive and remains one of the options for treating cuff tear arthropathy. However, glenoid loosening remains a serious problem.

Rupture of the distal biceps brachii tendon: conservative treatment versus anatomic reinsertion--clinical and radiological evaluation after 2 years.

INTRODUCTION: Distal biceps tendon rupture is a relatively rare injury. It commonly occurs in the dominant extremity of middle-aged men during an excessive eccentric tension as the arm is forced from a flexed position, while it is rarely observed during sport activities. Many techniques, including non-operative and surgical option, have been described for the treatment of a ruptured distal biceps tendon, but there is still considerable controversy about the management of choice. MATERIAL AND METHODS: Nine patients affected with traumatic distal tendon ruptures of the biceps brachii were followed-up for a minimum of 24 months. Five patients underwent surgery (two-incision technique) and four patients were treated conservatively. Tendon readaptation to its origin was done by a suture metal anchor. Outcome was evaluated based on the physical examination, radiographic analysis and the SECEC elbow score. RESULTS: The SECEC elbow score results show that every single item result is in favour of surgical treatment. On measurements of motion, we found a slight flexion-extension deficit in two patients, but reduced supination in six patients and reduced pronation in four. Two patients had postoperative dysfunction of the deep branch of the radial nerve. Radiographic examination showed heterotopic bone formation on the radial tuberosity around the presumed insertion of the reattached tendon in 2 of 5 patients and ectopic ossification more proximally in the area of the biceps muscle CONCLUSION: Our findings confirm the view that anatomic repair of distal biceps tendon rupture provides consistently good results and early anatomic reconstruction can restore strength and endurance for the elbow.

Primary synovial chondromatosis of the shoulder: clinical, arthroscopic and histopathological aspects.

Primary synovial chondromatosis is an uncommon condition, and involvement of the glenohumeral joint is rare. Currently, the recommended treatment is arthroscope-assisted synovectomy and removal of the loose bodies. We report a case with the clinical findings, radiographic features, arthroscopic technique for treatment of this disease and the main histological appearance of the removed loose bodies. We believe this is an easy and safe method for management of this disorder and that the support of an experienced pathologist is necessary to avoid differential diagnostic problems with the uncommon malignant transformation.