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PURPOSE: To determine arthroscopic Bankart repair outcomes and recurrence risk factors at a minimum 5-year follow-up. METHODS: Retrospective assessment of prospectively collected data, single-cohort study of patients who underwent arthroscopic Bankart repair with a minimum 5-year follow-up. Demographical and preoperative instability features were collected. Primary outcome was recurrent instability set as dislocation or subluxation. Secondary outcomes were revision surgery, postoperative instability degree according to Manta criteria, objective and subjective clinical and functional status, assessed by the Rowe, Western Ontario Shoulder Index (WOSI) and Subjective Shoulder Value (SSV) scores. Return to sport and postoperative sports activity at the final follow-up were also recorded. RESULTS: One-hundred and seventy-two patients, 82% men, average age at surgery 29.5 ± 9.2 years, were included. At a mean follow-up of 8.3 ± 2.6 years, recurrent instability occurred in 53 of 172 patients (30.8%). Revision surgery was required in 23/53 (43.4%) of shoulder with recurrent instability. Recurrence occurred within the first 2 years postoperative in 49% of the shoulders, whereas 51% of recurrences occurred after this period. Recurrence took place after a traumatic event in 25% and 56%, respectively. Recurrence rates were higher in patients who underwent surgery after two or more dislocations (p = 0.029). Patients younger at the time of first dislocation, younger at surgery and those with a higher preoperative degree of instability also showed significantly higher rates of recurrence (p = 0.04, p = 0.02, p = 0.03). Postoperative ROWE, WOSI and SSV scores were significantly worse in patients with recurrent instability (p < 0.001). Return-to-sports rate was also lower in patients with postoperative recurrence (p < 0.001). CONCLUSION: The arthroscopic Bankart repair was associated with a high long-term recurrence rate, and its effectiveness decreased over time. The lowest recurrence rates in arthroscopic Bankart repair were achieved in older patients with only one prior instability episode and a lower instability degree. LEVEL OF EVIDENCE: Level IV.
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PURPOSE: The aim of this study was to analyse clinical, functional and shoulder kinematics results using subacromial balloon spacer in nonreparable massive rotator cuff tears. Subacromial balloon spacer was hypothesised to improve shoulder kinematics and increases clinical and functional outcomes scores in nonreparable massive rotator cuff tears. METHODS: This is a prospective study in massive rotator cuff tears. From October 2021 to October 2022, a total of 127 shoulders suffering massive rotator cuff tears were initially evaluated. All patients were evaluated preoperatively, at 6 and 12 months. Patients' patient-reported outcome measures (PROM) subjective values using visual analogue scale (VAS) and the Spanish Western Ontario Rotator Cuff Index (WORC) version were analysed. We also evaluated objective outcomes: constant score, range of movement and kinematic shoulder analysis (isokinetic test to evaluate internal and external rotation forces). Statistical analysis was conducted using SPSS software; continuous variables were presented as means and standard deviations (SDs). RESULTS: Seventeen nonrepairable massive rotator cuff tears were finally included. Three patients required reverse shoulder arthroplasty before 6 months postoperative. After 1-year follow-up, objective and subjective (PROM) outcome scores and isokinetic measurements improved in 13 patients. Preoperative VAS improved from 6.5 ± 2.1 to 2 ± 1.9 points on average at 1-year follow-up and WORC index from 1603 ± 217.3 to 699 ± 361.6. Constant score from 42.1 ± 13.1 on average and at 1-year follow-up increased to 60.8 ± 14.7. Range of movement also improved in elevation 122.2 ± 39.3 to 166.9 ± 25.8, abduction 120.3 ± 38.6 to 134.6 ± 21.1, external rotation 30.3 ± 19.7 to 86.1 ± 13.8 and internal rotation L4-T12 on average at 1-year follow-up. Isokinetic evaluation showed functional improvement 1 year after implantation. Both internal and external rotation improved compared with their healthy shoulder. External rotation improved from 30.3° ± 19.7° preoperatively to 86.1° ± 13.8° (43.7% in the isokinetic study) and internal rotation from L4 preoperatively to L1 (49.8% in isokinetic study) on average. CONCLUSION: Among the different alternatives for irreparable rotator cuff injuries surgical treatment, subacromial balloon spacer is an effective alternative in selected patients, both in terms of clinical-functional improvement and short-term isokinetic results. LEVEL OF EVIDENCE: Level II.
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BACKGROUND: The role of arthroscopic Latarjet stabilization after failed arthroscopic Bankart repair has yet to be definitively established and merits further investigation. OBJECTIVE: To assess clinical and radiological outcomes after arthroscopic Latarjet stabilization as a revision procedure for failed Bankart repair, as well as the return to athletic activity and complication rates. METHODS: Between 2009 and 2020, patients with a previous failed arthroscopic Bankart repair who were treated with an arthroscopic Latarjet were retrospectively evaluated. Clinical outcomes at a minimum of 24 months postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome score (CS), and Single Assessment Numeric Evaluation (SANE). Dislocations, subluxations, complications, pre and postoperative level of activity and degree of osteoarthritis were also assessed. RESULTS: A total of 77 patients, mean age at revision surgery 31.2 ± 9.1 and with either one (n = 59), two (n = 13), or three (n = 4) arthroscopic previous stabilizations underwent revision surgery using arthroscopic Latarjet procedure were studied. Postoperatively, the mean ROWE and CS scores increased from 41.8 ± 16 to 90.7 ± 14.3 (p<0.001) and from 50.5 ± 13.8 to 90.5 ± 10.3 (p<0.001), respectively. WOSI decreased from 1247 ± 367.6 to 548.9 ± 363 at the final follow-up (p<0.001). After a mean follow-up of 39.6 ± 23.1 months, 64 shoulders (83.1%) were subjectively graded as good to excellent using SANE score. Grade 1, 2, and 3 osteoarthritis, according to Ogawa et al were found in 18 (23.4%), 6 (7.8%), and 3 (3.9%) shoulders, respectively. Six dislocations after revision surgery were reported (7.8%). In four failed cases an Eden-Hybinette procedure was conducted and in remaining two patients an arthroscopic extraarticular anterior capsular reinforcement was performed. Significantly decreased level of athletic activity was observed postoperatively (p= 0.01). CONCLUSIONS: Arthroscopic Latarjet for revision of failed arthroscopic Bankart repair provides satisfactory patient-reported subjective outcomes with low rate of recurrences and complications. However, decreased level of athletic activity is expected.
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BACKGROUND: To analyze the causes of failure after a Latarjet procedure and to evaluate the results of revision surgery. METHODS: Single-cohort, retrospective, observational study. Fifteen patients (13 males, mean age at revision failed Latarjet 38.9 years [range, 20-57]) with anterior glenohumeral instability who underwent a revision surgery for a failed Latarjet procedure were reviewed. Failure was defined as subluxation or dislocation. Demographic features, the reason for failure, type of lesions observed, and postoperative clinical and functional status were recorded. Functional status was assessed with the Rowe score. Subjective clinical evaluation was performed using the Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV). RESULTS: Recurrence occurred in the first year following the Latarjet procedure in 11 patients (73.3%). The causes of failure were graft avulsion in 3 cases, fracture in 1, coracoid misposition in 2 cases, graft nonunion in 1, advanced osteolysis in 4 cases, and persistence of an off-track Hill-Sachs lesion in 1. In 3 cases, no identifiable cause of failure but generalized severe hyperlaxity was found. Regarding revision surgery after the Latarjet procedure, 8 patients underwent an arthroscopic Eden-Hybinette procedure and in 3 patients the graft was repositioned. In the remaining 4 patients, an extra-articular capsular reinforcement was performed. Regarding the latter, 1 patient suffered new dislocations and required an additional revision surgery consisting of an Eden-Hybinette procedure. All patients remained stable after the revision surgery at the latest follow-up, except 2 who reported subluxations after an arthroscopic Eden-Hybinette and an extra-articular capsular reinforcement, but no additional surgical procedure was required. Functional status after revision surgery was satisfactory, with a mean Rowe score of 78 (10-100), WOSI score of 829 (225-1425), and an SSV score of 67 points (40-90). CONCLUSION: The causes of failure after a Latarjet procedure were poor bone graft due to mispositioning, avulsion, fracture or resorption, generalized hyperlaxity, and incomplete restoration of the glenoid track. Our study demonstrates that when the cause of failure is identified and addressed, stability is restored, and clinical and functional scores improved.
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PURPOSE: To compare clinical and radiological outcomes, implant survivorship at a minimum of 1-year follow-up using metaphyseal trabecular cones with or without impaction grafting in a complex revision TKA. METHODS: A retrospective comparative matched analysis was performed and 15 patients who underwent revision surgery using the combination of porous trabecular metaphyseal cone and diaphyseal impaction grafting (MC-IBG) were matched with a group of 13 patients who also underwent revision surgery using metaphyseal cone (MC) without impaction grafting. All included patients presented severe bone defect (AORI 2,3) and a rotating-hinge prosthesis were implanted. RESULTS: Both groups were comparable regarding the baseline demographic and clinical data. Patients had previously undergone a mean of 4 (range, 2-12) and 3 (range, 2-5) previous procedures in the MC-IBG and MC groups, respectively. The indications for revision were aseptic loosening in 11 (73.3%) and 11 (84.6%) patients; prosthetic joint infection in 4 (26.7%) and 2 (15.4%) in the MC-IBG and MC groups, respectively. There was no significant difference in the mean postoperative Knee Society Score between the study groups (p = 0.806). Overall, 4 patients had further revision. Two patients were revised in the MC-IBG group, one patient for aseptic loosening and the second one after 2 episodes of instability. Two patients in the MC group presented prosthetic joint infection and underwent a two-stage reimplantation. No significant difference was observed between the study groups at comparison (p = 0.92). CONCLUSION: Trabecular metal cones with diaphyseal impaction grafting provide an alternative technique in a complex revision TKA surgery with early clinical and radiographic success.
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Artroplastia do Joelho , Prótese do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Estudos Retrospectivos , Resultado do Tratamento , Desenho de Prótese , Prótese do Joelho/efeitos adversos , Reoperação , Articulação do Joelho/cirurgiaRESUMO
PURPOSE: The comprehensive arthroscopic management (CAM) procedure is a useful joint-preserving option for young or active patients with glenohumeral osteoarthritis (GHOA). Our objective was to evaluate the results and prognostic factors of the CAM procedure without direct axillary nerve release or subacromial decompression. METHODS: A retrospective observational study among patients with GHOA who underwent the CAM procedure was conducted. Neither axillary nerve neurolysis nor subacromial decompression was performed. Both primary and secondary GHOA were considered; the latter was defined as a history of shoulder pathology (mainly instability or proximal humerus fracture). The American Shoulder and Elbow Surgeons scale, Simple Shoulder Test, Visual Analogue Scale, activity level, Single Assessment Numeric Evaluation, EuroQol 5 Dimensions 3 Levels, Western Ontario Rotator Cuff Index, and active range of motion (aROM) were analysed. RESULTS: Twenty-five patients who underwent the CAM procedure met the inclusion criteria. After a mean follow-up of 42.4 ± 22.9 months, we found improvement (p < 0.001) in all postoperative values of the different scales. The procedure increased aROM overall. Patients with arthropathy due to instability showed worse results. The rate of CAM failures, defined as conversion to shoulder arthroplasty, was 12%. CONCLUSIONS: This study showed that the CAM procedure without direct axillary nerve neurolysis or subacromial decompression might be a valid alternative in active patients with advanced GHOA to improve shoulder function (aROM and scores), decrease pain, and delay arthroplasty. This technique showed good subjective functional scores, high patient satisfaction, and a low rate of complications. LEVEL OF EVIDENCE: IV.
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Osteoartrite , Articulação do Ombro , Humanos , Ombro , Osteoartrite/cirurgia , Manguito Rotador/cirurgia , Satisfação do Paciente , Articulação do Ombro/cirurgia , Estudos Retrospectivos , Descompressão , Resultado do Tratamento , Artroscopia/métodosRESUMO
Cement removal during hip or knee arthroplasty revision is challenging and not exempt of complications. Cement-on-cement procedure is among techniques developed to safe removal of cement from bone, and it could be a realistic solution. This cement-on-cement devices can provide advantages in removing bone cement during hip and knee arthroplasty septic and non-septic revision surgeries, and can be regarded as an effective and safe alternative. We present our experience using the cement-on-cement technique in 34 cases between 2010 and 2021, including revision surgeries for 20 knee and 14 hip arthroplasties. In 3 out of 34 cases the technique failed, with a success of 91%. Mean surgical time was 2.77 (SD 0.93) hours and blood transfusion was required in 23 cases. Success was achieved in every aseptic case. Of all patients, 60% were septic cases. Infection was considered to be eradicated in 70% (14/20) of patients with a septic revision. Cement-on-cement is a safe and effective alternative for cement removal during hip and knee arthroplasty revision. Level of evidence: III, retrospective case series.
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Artroplastia de Quadril , Artroplastia do Joelho , Humanos , Reoperação/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Cimentos Ósseos , Estudos Retrospectivos , Falha de PróteseRESUMO
BACKGROUND: Lateralized reverse shoulder arthroplasty (RSA) has emerged as an attempt to improve on some of the drawbacks of conventional RSA, such as glenoid notching and decrease in ROM. Although this new design is being used in clinical practice, the evidence is mostly limited to case series and has not been systematically reviewed. QUESTIONS/PURPOSES: (1) How much did patient-reported outcome measures (PROMs) and ROM improve among patients who receive a lateralized RSA implant? (2) What proportion of shoulders experience complications, revision surgery, or scapular notching? METHODS: The PubMed and EMBASE databases were searched from database inception to January 31, 2020. We included clinical studies that reported the PROMs and/or ROM of patients with insufficient rotator cuffs undergoing RSA with a lateralized implant. All other types of studies and those including patients with fractures, instability or escape, infection, rheumatologic disease, neurologic disease, or revision surgeries as an indication for RSA were excluded. PROMs and ROM were collected and are reported as mean values and ranges. Complications, revision surgery, and scapular notching are presented as proportions. The percentage of the mean change relative to the minimum clinically important difference (MCID) was calculated using the anchor-based value for each outcome. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. The initial search yielded 678 studies; 61 full-text articles were analyzed according to our eligibility criteria. After a detailed analysis, we included nine studies that evaluated 1670 patients (68% of whom [1130] were women) with a mean age of 71.8 ± 0.6 years. The mean follow-up period was 41.1 ± 5.6 months. The mean MINORS score was 12 ± 4. RESULTS: Active ROM improved for forward flexion (mean change 47° to 82°; MCID 12°), abduction (mean change 43° to 80°; MCID 7°), external rotation (mean change 8° to 39°; MCID 3°), and internal rotation (mean change -2 to 1 points). PROM scores also improved, including the American Shoulder and Elbow Surgeons score (mean change 20 to 50; MCID 20.9 points), Constant score (mean change 28 to 40; MCID 5.7 points), Simple Shoulder Test score (mean change 3 to 7; MCID 2.4 points), and VAS score (mean change -1.8 to -4.9; MCID -1.6 points). The proportion of shoulders with complications ranged from 0% (0 of 44) to 21% (30 of 140), and the proportion of shoulders with scapular notching ranged from 0% (0 of 76) to 29% (41 of 140). The proportion of patients undergoing revision ranged from 0% (0 of 44) to 13% (10 of 76) at short-term follow-up. CONCLUSION: Lateralized RSA is a reasonable alternative to medialized implants for patients with rotator cuff insufficiency because it might reduce the likelihood of scapular notching without apparently compromising PROMs or ROM. More studies are required to determine whether there is a direct correlation between the amount of lateralization and PROMs or ROM.
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Artroplastia do Ombro , Articulação do Ombro , Prótese de Ombro , Idoso , Artroplastia do Ombro/efeitos adversos , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the discriminatory ability of ultrasound in calcium pyrophosphate deposition disease (CPPD), using microscopic analysis of menisci and knee hyaline cartilage (HC) as reference standard. METHODS: Consecutive patients scheduled for knee replacement surgery, due to osteoarthritis (OA), were enrolled. Each patient underwent ultrasound examination of the menisci and HC of the knee, scoring each site for presence/absence of CPPD. Ultrasound signs of inflammation (effusion, synovial proliferation and power Doppler) were assessed semiquantitatively (0-3). The menisci and condyles, retrieved during surgery, were examined microscopically by optical light microscopy and by compensated polarised microscopy. CPPs were scored as present/absent in six different samples from the surface and from the internal part of menisci and cartilage. Ultrasound and microscopic analysis were performed by different operators, blinded to each other's findings. RESULTS: 11 researchers from seven countries participated in the study. Of 101 enrolled patients, 68 were included in the analysis. In 38 patients, the surgical specimens were insufficient. The overall diagnostic accuracy of ultrasound for CPPD was of 75%-sensitivity of 91% (range 71%-87% in single sites) and specificity of 59% (range 68%-92%). The best sensitivity and specificity were obtained by assessing in combination by ultrasound the medial meniscus and the medial condyle HC (88% and 76%, respectively). No differences were found between patients with and without CPPD regarding ultrasound signs of inflammation. CONCLUSION: Ultrasound demonstrated to be an accurate tool for discriminating CPPD. No differences were found between patents with OA alone and CPPD plus OA regarding inflammation.
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Condrocalcinose/diagnóstico por imagem , Cartilagem Hialina/diagnóstico por imagem , Menisco/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Idoso , Artroplastia do Joelho , Pirofosfato de Cálcio/análise , Feminino , Humanos , Cartilagem Hialina/patologia , Masculino , Menisco/patologia , Microscopia/métodos , Microscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Período Pré-Operatório , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss. METHODS: A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements. Items with over 70% agreement and less than 10% disagreement achieved consensus. RESULTS: After a total of 3 rounds, 31 statements achieved consensus. Eighty-six percent of the experts agreed that a history of multiple dislocations and failed soft-tissue surgery should raise suspicion about the possibility of an associated bone deficit. Ninety-five percent of the experts agreed that 3-dimensional (3D) computed tomography (CT) is the most accurate diagnostic method to evaluate and quantify bone loss. Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate; however, 91% of the experts thought that an en face view of the glenoid using 3D CT provides the most accurate method. Ninety-five percent of the experts agreed that Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Ninety percent of the experts agreed that in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed and any of the available options is valid. There was no consensus among experts on how Hill-Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. CONCLUSIONS: The essential statements on which the experts reached consensus included the following: A history of multiple dislocations and failed soft-tissue surgery should make surgeons consider the possibility of an associated bone deficit. Three-dimensional CT is the most accurate diagnostic method to evaluate and quantify bone loss. Although any of the available methods to measure glenoid bone deficiency is adequate, an en face view of the glenoid using 3D CT provides the most accurate method. Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Finally, in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed. LEVEL OF EVIDENCE: Level V, consensus statement.
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Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Consenso , Técnica Delphi , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgiaRESUMO
PURPOSE: Although fifth metacarpal neck fractures are typically treated nonsurgically, most often with closed reduction and orthosis immobilization, cast immobilization may not improve outcomes compared with buddy taping without reduction. The aim of this study was to compare functional outcomes of buddy taping versus reduction and cast immobilization in patients with fifth metacarpal neck fractures. METHODS: Adult patients with acute fifth metacarpal neck fractures with less than 70º volar angulation and without rotational deformity were randomly assigned to be treated either with buddy taping or a cast after closed reduction. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score at 9 weeks. Secondary outcomes included the DASH score at 3 weeks and 1 year, range of motion of the metacarpophalangeal joint, pain, grip strength, return to work, radiographic angulation, and complication rate. RESULTS: We recruited 72 patients between August 2016 and January 2018. After 3 weeks, the DASH score was significantly lower for patients treated with buddy taping (19.7 ± 19.7) compared with cast immobilization (44.6 ± 15.0). At 9 weeks, clinical outcomes in the buddy taping group were better in terms of range of motion and DASH score, with a mean difference of 6.3 points, which did not exceed the minimally clinically important difference. There were more complications in the cast immobilization group. Fracture angulation after reduction was followed by a loss of reduction at 3 weeks' follow-up and equivalent residual radiographic volar angulation was observed at 3 and 9 weeks after injury in both groups. Duration of time off from work was 28 days shorter with buddy taping compared with cast treatment. CONCLUSIONS: There is no benefit to reduction and orthosis immobilization of fifth metacarpal neck fractures with an initial angulation less than 70°. Use of buddy taping and early mobilization had good clinical results as well as significant improvement in time lost from work. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
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Fraturas Ósseas , Traumatismos da Mão , Ossos Metacarpais , Adulto , Moldes Cirúrgicos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/lesões , Estudos Prospectivos , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
BACKGROUND: Subscapularis function after arthroscopic Bankart repair has been widely studied. However, data regarding subscapularis performance after arthroscopic Latarjet procedures are lacking. This study aimed to evaluate subscapularis clinical and radiologic performance after arthroscopic Latarjet procedures. METHODS: We included 40 patients who underwent arthroscopic Latarjet procedure with a minimum 2-year follow-up. Clinical evaluation included Western Ontario Shoulder Instability Index and Rowe scores, specific subscapularis isokinetic study, and lift-off tests. Contralateral measurements were used for comparison. Computed tomographic evaluation included graft consolidation, muscle dimensions, and degree of fatty atrophy, calculated as the mean muscle attenuation (MMA). RESULTS: There was a decrease of 8.3% of maximum internal rotation peak torque in the operated arm (P = .02). However, there was no significant difference in the agonist-antagonist ratio: 76.9% in the operated arm and 76% in the contralateral (P = .82). Lift-off strength test demonstrated a decrease in the first year but not at final follow-up (P = .38). There was a significant decrease in lift-off distance of 23% compared to the contralateral side (P < .001). Subscapularis MMA was diminished when compared to the infraspinatus/teres minor (P < .001) at the expense of its upper part (P = .03). Hyperlaxity and number of dislocation episodes were correlated to a lower MMA (P = .046 and P = .005). CONCLUSION: Arthroscopic Latarjet procedures provide satisfactory clinical results. There seems to be a diminished subscapularis MMA depending on its superior half. Hyperlaxity and number of previous dislocations were correlated to a lower MMA. Although there was a decrease in the maximum internal rotation peak torque, we did not find any difference in the agonist-antagonist ratio or in the final lift-off strength between sides.
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Instabilidade Articular/cirurgia , Manguito Rotador/fisiopatologia , Luxação do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Adolescente , Adulto , Artroplastia/métodos , Artroscopia , Feminino , Seguimentos , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Força Muscular , Estudos Prospectivos , Rotação , Manguito Rotador/diagnóstico por imagem , Luxação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
PURPOSE: SARS-CoV-2's new scenario has forced health systems to work under extreme stress urging to perform a complete reorganization of the way our means and activities were organized. The orthopaedic and trauma units have rescheduled their activities to help SARS-CoV-2 units, but trauma patients require also treatment, and no standardized protocols have been established. METHODS: A single-centre cross-sectional study was performed in a tertiary hospital. Two different periods of time were analyzed: a two week period of time in March 2019 (pre-SARS-CoV-2) and the same period in March 2020 (SARS-CoV-2 pandemic time). Outpatient's data, emergency activity, surgical procedures, and admissions were evaluated. Surgeons' and patient's opinion was also evaluated using a survey. RESULTS: A total of ~ 16k (15,953) patients were evaluated. Scheduled clinical appointments decreased by ~ 22%. Urgent consultations and discharge from clinics also descended (~ 37% and ~ 20% respectively). Telemedicine was used in 90% of outpatient clinical evaluations. No elective surgical procedures during SARS-CoV-2 time were scheduled, and subtracting the effect of elective surgeries, there was a reduction of inpatient surgeries, from ~ 85% to ~ 59%. Patients delayed trauma assistance more than 48 hours in 13 cases (35%). Pre-operative admission for hip fractures decreased in ten hours on average. Finally, surveys stated that patients were more in favour than surgeons were to this new way to evaluate orthopaedic and trauma patients based strongly on telemedicine. CONCLUSION: Detailed protocols should be standardized for surgical departments during the pandemic. This paper offers a general view in how this virus affects an orthopaedic unit and could serve as a protocol and example for orthopaedic and trauma units. Even in the worst scenario, an orthopaedic and trauma unit could offer an effective, efficient, and quality service. SARS-CoV-2 will set up a new paradigm for health care in orthopaedics and trauma.
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Betacoronavirus , Infecções por Coronavirus , Ortopedia , Pandemias , Pneumonia Viral , COVID-19 , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Serviço Hospitalar de Emergência , Humanos , Procedimentos Ortopédicos , SARS-CoV-2 , Centros de TraumatologiaRESUMO
PURPOSE: To scope the scientific literature and analyze the influence of bony risk factors for degenerative full-thickness primary rotator cuff tear. METHODS: A systematic review of databases PubMed, Scopus, EMBASE, and Cochrane Library was performed up to June 30, 2018. Meta-analysis was performed with mean difference (MD) or risk ratio for degenerative full-thickness rotator cuff injury, and when there were ≥3 studies for the considered potential risk factor. Methodologic quality was assessed using the Newcastle-Ottawa scale. RESULTS: We analyzed 34 studies comprising 5,916 shoulders (3,369 shoulders with rotator cuff tear and 2,546 controls) and identified 19 potential risk factors for degenerative full-thickness rotator cuff tears. There was moderate evidence that a higher critical shoulder angle (MD = 4.41, 95% confidence interval [CI] 3.43 to 5.39), higher acromion index (MD = 0.06, 95% CI 0.04 to 0.09), and lower lateral acromion angles (MD = -7.11, 95% CI -8.32 to -5.90) were associated with degenerative full-thickness rotator cuff tears compared with controls. Moderate evidence showed that a type III acromion significantly increases the risk for full-thickness degenerative rotator cuff tear (risk ratio = 2.26, 95% CI 1.38 to 3.70). CONCLUSION: There is moderate evidence that larger critical shoulder angle, higher acromion index, lower lateral acromion angles, and a type III acromion are significantly associated with degenerative full-thickness rotator cuff tears. Other potential risk factors identified showed insufficient evidence. LEVEL OF EVIDENCE: Level IV, systematic review of level II to IV studies.
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Acrômio/anatomia & histologia , Lesões do Manguito Rotador/etiologia , Manguito Rotador/anatomia & histologia , Articulação do Ombro/anatomia & histologia , Humanos , RiscoRESUMO
HYPOTHESIS: Conservative treatment of isolated coronoid fractures and fracture-dislocations focused on soft-tissue healing can provide good clinical results in the majority of patients. Our aims were (1) to evaluate the outcome of a conservative treatment protocol designed for isolated coronoid fractures with or without associated elbow dislocations (ICFs) and (2) to characterize the fractures with a dedicated image analysis protocol. METHODS: Of 38 consecutive patients sustaining acute ICFs, 28 were treated nonsurgically after meeting specific inclusion criteria, prospectively followed up, and clinically evaluated at least 1 year after sustaining their injuries. All cases underwent elbow computed tomography scans with tri-plane and 3-dimensional reconstructions according to a specific protocol referenced to the proximal ulna. RESULTS: The study included 15 male and 13 female patients, with a mean follow-up period of 32 ± 14 months (range, 12-61 months). An associated dislocation was presented in 8 (29%). Mean extension and flexion were 2° ± 8° (range, -10° to 30°) and 139° ± 11° (range, 110°-155°), respectively. Mean pronation and supination were 74° ± 3° (range, 60°-75°) and 83° ± 9° (range, 40°-85°), respectively. Of the patients, 78% rated their elbow as being normal or nearly normal. The mean Mayo Elbow Performance Score was 95 ± 9 (range, 70-100). The mean Disabilities of the Arm, Shoulder and Hand score was 7 ± 13 (range, 0-57). The mean coronoid fracture height was 5.7 ± 1.2 mm (range, 3.7-7.9 mm). The mean percentage of coronoid height fractured was 33% ± 6% (range, 23%-43%). Mean fracture displacement was 2.7 ± 2 mm (range, 1-9 mm). Of the fractures, 23 (82%) were located at the anteromedial coronoid. CONCLUSION: An ICF with a perfectly reduced ulnohumeral joint, a competent sublime tubercle, and a fractured coronoid height up to 50% can be treated without surgery with excellent or good results in more than 90% of cases regardless of the location of the fracture in the coronoid or the type of soft tissue-associated disruptions.
Assuntos
Lesões no Cotovelo , Fratura-Luxação/terapia , Imobilização , Fraturas da Ulna/terapia , Adolescente , Adulto , Idoso , Moldes Cirúrgicos , Tratamento Conservador , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Fratura-Luxação/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pronação , Amplitude de Movimento Articular , Supinação , Fraturas da Ulna/diagnóstico por imagem , Adulto JovemRESUMO
AIM: To evaluate the influence of the specific procedure performed and other variables on the intensity of acute postoperative pain following outpatient shoulder arthroscopy. METHODS: One hundred patients undergoing outpatient shoulder arthroscopy under single-shot interscalene block plus general anaesthesia were prospectively studied. Acetaminophen with ibuprofen was prescribed for postoperative pain control and tramadol HCl as rescue medication. Patients scored pain intensity at 2, 6, and 24 h postoperatively. The influence of the surgical procedure, age, gender, surgery duration, and irrigation volume used on the intensity of postoperative pain was studied. RESULTS: Five patients were excluded due to ineffective block or protocol deviation. Among the 95 remaining patients, 51 underwent rotator cuff tear repair, 25 shoulder stabilisation, and 19 subacromial decompression. While there were no differences at 2 and 6 h after surgery, pain intensity was significantly higher among those undergoing rotator cuff tear repair (5.2, 1-10) at 24 h compared to stabilisation (4.1, 1-8) or subacromial decompression (5, 1-8) (p < 0.0001). No association was found between pain intensity and other variables. CONCLUSION: A higher degree of acute postoperative pain should be expected in patients undergoing arthroscopic rotator cuff tear repair compared to other arthroscopic shoulder procedures, and additional pain treatment is recommended.
Assuntos
Artroscopia/efeitos adversos , Dor Pós-Operatória/etiologia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios , Anestesia Geral , Artroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Lesões do Manguito Rotador/complicações , Dor de Ombro/tratamento farmacológicoRESUMO
PURPOSE: The aim of this study was to evaluate the clinical outcome of arthroscopic rotator cuff revision surgery in a cohort of patients and to identify prognostic factors for this procedure. METHODS: Fifty-one consecutive patients undergoing revision arthroscopic rotator cuff repair were prospectively followed over a minimum period of one year. Radiologic findings and clinical data regarding primary and revision surgery were collected. Clinical evaluation was performed pre- and post-operatively by means of Constant Score and Simple Shoulder Test. RESULTS: Median age at the time of revision surgery was 60 years (range 36-77 years). Median follow-up was 25 months (range 12-58 months). There were 17 men (33.3%) and 34 women (66.7%). The majority of the tears affected the supraspinatus tendon alone (51%) or both the supra- and infraspinatus tendons (35.3%). Significant improvements were seen in terms of active forward elevation, active external rotation, pain, Simple Shoulder Test score, Constant Score, and post-operative satisfaction-age, gender, and time to revision surgery did not show significant predictive value. A smaller tear size and pre-operative elevation greater than 90° were demonstrated to be independent prognostic factors for better outcome. However, the mean increase in Constant Score was not related to the size of the tear, range of motion, or age. CONCLUSION: The results of this study indicate that arthroscopic revision rotator cuff repair results in reliable improvement in shoulder function, pain, and satisfaction. Pre-operative active range of motion and tear size seem to determine final outcome. A similar increase in mean Constant Score can be achieved even in large tears in patients aged over 65 years. LEVEL OF EVIDENCE: IV.
Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Ruptura/cirurgia , Articulação do Ombro/cirurgia , Artroplastia , Artroscopia/métodos , Humanos , Período Pós-Operatório , Prognóstico , Amplitude de Movimento Articular , Reoperação , RotaçãoRESUMO
The Bristow and Latarjet procedures have become popular among orthopaedic surgeons thanks to the development of new instruments that allow the use of arthroscopic techniques to treat cases of glenohumeral instability with bone defects or capsular deficiency. Nonetheless, several complications have been reported after Latarjet procedures, including neurological injuries. This report describes surgical damage to the suprascapular nerve, an unusual complication. Level of evidence Expert opinion, Level V.