1,720,988 research outputs found
Editorial Commentary: Acromioplasty Does Not Improve Clinical Outcome of Arthroscopic Rotator Cuff Repair: The Game Is Over!
No full textAcromioplasty is a well-known, simple, and reproducible surgical technique that is used in isolation or in combination with other arthroscopic procedures. The clinical value of acromioplasty combined with arthroscopic rotator cuff repair has been largely investigated. Main theoretical benefits lie in the opportunity to improve the visualization, decrease abrasive wear with prominent acromial morphology, and release natural growth factors. On the other hand, acromioplasty and release of the coracoacromial ligament may weaken the insertion of the deltoid muscle, induce scar formation in the subacromial space, theoretically limiting shoulder mobility, and increase risk of anterior-superior humeral escape, especially in patients with large to massive rotator cuff tears. Clinical studies report conflicting results. My results show no differences in clinical outcomes in rotator cuff repairs with or without subacromial decompression, regardless of the acromial morphology. At the same time, I do believe that confirmatory studies are always necessary, especially if the aim is to disprove the usefulness of a common practice
Arthroscopic Superior Capsule Reconstruction With Doubled Autologous Semitendinosus Tendon Graft
Full text linkMassive and irreparable rotator cuff tears remain a difficult condition to treat. Fatty infiltration of the muscles and excessive retraction of the tendons predispose to high failure rates of arthroscopic repair techniques. In recent years, studies on the superior capsule have shown that it plays a key role in reducing superior humeral head translation and restoring balance to the force couples required for dynamic shoulder function. Superior capsule reconstruction has become common in clinical practice. Several techniques with different types of grafts have been described, such as fascia lata autograft, dermal allograft patch, and long head of the biceps tendon autograft. More recently, an open technique with semitendinosus tendon autograft has been proposed. Our aim is to describe an all-arthroscopic technique for superior capsule reconstruction using a doubled semitendinosus tendon autograft in a box-shaped configuration. We believe that the technique can combine the advantages of other techniques, such as graft availability, low harvest-site morbidity, limited cost, and mechanical strength
The Musculoskeletal Tumor Society Scoring system is a valid subjective and objective tool to evaluate outcomes of surgical treatment of patients affected by upper and lower extremity tumors
Full text linkPurpose: The main purpose of the present study was to evaluate if there is a difference between objective or subjective administration of the MSTS score in a cohort of patients affected by musculoskeletal oncological diseases. Materials and methods: All patients who underwent surgery for bone or soft tissue localization of neoplastic disease in lower or upper limb from June 2015 to June 2020 were considered eligible. In order to administer the score as a PROM, the MSTS was first translated and cross-culturally adapted in Italian. During follow up visits, all patients filled out Italian versions of SF36, TESS and MSTS. Psychometric properties of the Italian version of MSTS were analyzed. Correlation between objective and self-administered MSTS score was assessed through Pearson's coefficient. Results: A finale sample of 110 patients were included: 59 affected by lower extremity involvement and 51 affected by upper extremity involvement. The Italian version of the MSTS score showed good psychometric properties for both lower and upper extremity. The correlation between self-administered and hetero-administered version of the questionnaire was as high as r = 0.97 for lower extremities and r = 0.96 for upper extremities. Conclusions: The Italian version of the MSTS is a valid tool to evaluate outcomes of surgical treatment of patients affected by extremities tumors and it can be used as a subjective tool for both lower and upper extremity
The effect of autologous conditioned plasma on the treatment of focal chondral defects of the knee. An experimental study
No full textNo differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review
Full text linkPurpose: To conduct a scoping review to clarify the management of acromioclavicular joint osteoarthritis, as well as to identify any existing gaps in the current knowledge. Methods: Studies were identified by electronic databases (Ovid, Pubmed) from their inception up to April 2nd, 2020. All studies reporting functional outcomes after conservative or surgical treatment of acromioclavicular joint osteoarthritis, either primary or secondary to trauma or distal clavicle osteolysis, were included. Following data were extracted: authors, year of publication, study design (prospective or retrospective), LOE, number of shoulders treated conservatively or surgically, patients’ age, OA classification, type of conservative treatment, surgical approach, surgical technique, functional outcomes, complications, revisions, and length of follow-up. Descriptive statistics was used. Quality appraisal was assessed through the Cochrane risk of bias tool for LOE I/II studies, while the MINORS checklist was used for LOE III/IV studies. Results: Nineteen studies were included for a total of 861 shoulders. Mean age of participants was 48.5 ± 7.4 years. Mean follow-up was 43.8 ± 29.9 months. Four studies reported functional results after conservative treatment, whereas 15 studies were focused on surgical management. No studies directly compared conservative and surgical treatment. Seven studies reported a surgical approach after failure of previous conservative treatment. All studies reported functional improvement and pain relief. Complication rate was low. Overall methodological quality of included studies was very low. Conclusion: Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. However, available data did not allow to establish the superiority of one technique over another. Level of evidence: Level IV
Augmented Repair of Large to Massive Delaminated Rotator Cuff Tears With Autologous Long Head of the Biceps Tendon Graft: The Arthroscopic “Cuff-Plus” Technique
Full text linkAn anatomic and tension-free repair is the goal of arthroscopic rotator cuff repair. However, this purpose is not always achievable in large and massive tears, and sometimes, even when intraoperative results seem acceptable, clinical and radiologic outcomes can be disappointing shortly afterward. Superior capsule reconstruction has been claimed as a valid and viable joint-preserving option for treating irreparable rotator cuff tears. However, the role of the superior capsule in repairable cuff tears has also been questioned. The aim of this article is to present the so-called arthroscopic cuff-plus technique. This technique consists of superior capsule reconstruction using the proximal part of the long head of the biceps tendon associated with a tension-free repair of the rotator cuff tendons in large to massive delaminated tears
Sulcus Angle, Trochlear Depth, and Dejour's Classification Can Be Reliably Applied To Evaluate Trochlear Dysplasia: A Systematic Review of Radiological Measurements
No full textPurpose: To summarize data on the reliability of available imaging criteria for the assessment of trochlear dysplasia and to assess the methodological quality of the included studies. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Search was performed using major electronic databases from their inception to September 2021. All studies enrolling patients of any age who underwent a radiological exam to rule out features related to trochlear dysplasia were included. After the identification of available imaging criteria, reliability studies were analyzed. Descriptive statistics were used to summarize findings. Methodological quality was assessed using the Quality Appraisal of Reliability studies checklist. Results: A total of 2391 articles were identified, and 33 articles comprising 3036 patients with a mean age of 28.6 years were included. Thirty different measurements were extracted. Magnetic resonance imaging (MRI) was the most used imaging modalities (21 studies), followed by computed tomography (10 studies), conventional radiology (8 studies) and ultrasonography (US) (1 study). Sulcus angle, trochlear depth, and Dejour's classification were the most explored measurements. Overall, sulcus angle can be reliably assessed on radiography, CT and MRI, whereas trochlear depth can be reliably measured only with CT and MRI. Reliability of Dejour's classification ranged from poor or fair to very good for all imaging modalities. Methodological quality of included studies varied from 2 to 9 positive items out of 11 possible. Twenty-four studies (72.7%) were considered at high risk of bias. Conclusion: Trochlear dysplasia can be reliably evaluated at least with 3 measurements: sulcus angle, trochlear depth and Dejour's classification. Methodological quality assessment showed high risk of bias in most included studies. Level of evidence: Level III, systematic review of Level II-III studies
Integrated Protocol for Multidimensional In Vivo Assessment of Glenohumeral Joint Function during Dynamic Tasks
No full textThe shoulder is widely considered as a complex system characterized by peculiar biomechanics and involving different joints, including glenohumeral one. Indeed, the inherent shoulder structure allows for high mobility, but at the same time - in case of injuries, traumatic events, or pathologies - the overall structure is easily exposed to articular and periarticular problems. Scientific literature presents several procedures devoted to the functional evaluation of shoulder complex, including - above all - movement analysis and assessment of muscular contribution. In the last years, ultrasonography has been also proposed to quantitatively assess anterior humeral head displacement, which represents an important metrics for shoulder dislocation. The aim of this study was to present a non-invasive multidimensional testing procedure aiming at assessing the function of the shoulder complex, specifically focusing on the glenohumeral joint. The proposed setting included the integration of marker-based optoelectronic stereophotogrammetric system, surface electromyography, and ultrasonography, so as to allow an instrumental evaluation able to provide information about overall kinematics, muscular activations and synergies, and joint tissues constraining behaviour in terms of humeral head displacement. In this feasibility analysis the subjects were asked to execute two specific dynamic tasks, which overall covered glenohumeral joint movements. From this feasibility study, the proposed protocol allowed indeed to have information about the overall joint kinematics in terms of flexion/extension, abduction/adduction, and intra/extra-rotation, the corresponding muscular activations and, above all, the possibility of tracking the humeral head displacement. All the available information record may enhance the possibility to identify altered patterns in shoulder biomechanics. This multidimensional approach may be used to help clinicians characterizing the glenohumeral joint during defined motor tasks and thus designing tailored rehabilitative interventions for the shoulder joint complex
Analysis of agreement between computed tomography measurements of glenoid bone defect with and without comparison with the contralateral shoulder
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