Clinics in Shoulder and Elbow最新文献

The Latarjet procedure is a surgical procedure that can effectively restore glenohumeral stability, especially in patients with anterior shoulder instability and glenoid bone loss. Many studies have shown comparable clinical outcomes between patients undergoing the arthroscopic Latarjet procedure and those undergoing traditional open methods or other glenohumeral joint stabilization procedures. However, the arthroscopic Latarjet procedure is a challenging technique due to the unfamiliar portal placements, proximity of neurovascular structures, and serious postoperative complications. The arthroscopic Latarjet procedure has not yet been widely applied, and a clear understanding of the anatomical structure and the precise methods is required prior to operation performance. Satisfactory clinical outcomes can be achieved by thorough preoperative planning and proper implant fixation methods.

Irreparable massive rotator cuff tears can significantly impact daily life; and these types of tears can be difficult to repair completely, especially in younger patients who are more active and have higher functional requirements. Since its introduction by Mihata and the colleagues, superior capsular reconstruction (SCR) has gained popularity in the treatment of irreparable massive rotator cuff tears and has shown promising short-term results. A variety of studies have focused on the clinical and biomechanical outcomes of this procedure. This article reviews the biomechanics, indications for the surgical procedure, graft options, surgical technique, and rehabilitation from SCR.

Background: Our purpose was to evaluate a custom reverse total shoulder arthroplasty glenoid baseplate for severe glenoid deficiency, emphasizing the challenges with this approach, including short-term clinical and radiographic outcomes and complications.

Methods: This was a single-institution, retrospective series of 29 patients between January 2017 and December 2022 for whom a custom glenoid component was created for extensive glenoid bone loss. Patients were evaluated preoperatively and at intervals for up to 5 years. All received preoperative physical examinations, plain radiographs, and computed tomography (CT). Intra- and postoperative complications are reported.

Results: Of 29 patients, delays resulted in only undergoing surgery, and in three of those, the implant did not match the glenoid. For those three, the time from CT scan to implantation averaged 7.6 months (range, 6.1-10.7 months), compared with 5.5 months (range, 2-8.6 months) for those whose implants fit. In patients with at least 2-year follow-up (n=9), no failures occurred. Significant improvements were observed in all patient-reported outcome measures in those nine patients (American Shoulder and Elbow Score, P<0.01; Simple Shoulder Test, P=0.02; Single Assessment Numeric Evaluation, P<0.01; Western Ontario Osteoarthritis of the Shoulder Index, P<0.01). Range of motion improved for forward flexion and abduction (P=0.03 for both) and internal rotation up the back (P=0.02). Pain and satisfaction also improved (P<0.01 for both).

Conclusions: Prolonged time (>6 months) from CT scan to device implantation resulted in bone loss that rendered the implants unusable. Satisfactory short-term radiographic and clinical follow-up can be achieved with a well-fitting device. Level of evidence: III.

Background: Many patients use online resources to educate themselves on surgical procedures and make well-informed healthcare decisions. The aim of our study was to evaluate the quality and readability of online resources exploring shoulder arthroplasty.

Methods: An internet search pertaining to shoulder arthroplasty (partial, anatomic, and reverse) was conducted using the three most popular online search engines. The top 25 results generated from each term in each search engine were included. Webpages were excluded if they were duplicates, advertised by search engines, subpages of other pages, required payments or subscription, or were irrelevant to our scope. Webpages were classified into different source categories. Quality of information was assessed by HONcode certification, Journal of the American Medical Association (JAMA) criteria, and DISCERN benchmark criteria. Webpage readability was assessed using the Flesch reading ease score (FRES).

Results: Our final dataset included 125 web pages. Academic sources were the most common with 45 web pages (36.0%) followed by physician/private practice with 39 web pages (31.2%). The mean JAMA and DISCERN scores for all web pages were 1.96±1.31 and 51.4±10.7, respectively. The total mean FRES score was 44.0±11.0. Only nine web pages (7.2%) were HONcode certified. Websites specified for healthcare professionals had the highest JAMA and DISCERN scores with means of 2.92±0.90 and 57.96±8.91, respectively (P<0.001). HONcode-certified webpages had higher quality and readability scores than other web pages.

Conclusions: Web-based patient resources for shoulder arthroplasty information did not show high-quality scores and easy readability. When presenting medical information, sources should maintain a balance between readability and quality and should seek HONcode certification as it helps establish the reliability and accessibility of the presented information. Level of evidence: IV.

Rotator cuff tear is a common shoulder injury that compromises both function and quality of life. Despite the prevalence of the injury and advancements in repair techniques, a significant percentage of these repairs fail. This review aims to explore the multifactorial reasons behind this failure, including the degenerative nature of the rotator cuff tendon, inherent and extrinsic factors, and the role of hypoxia in tissue degeneration. Additionally, it elucidates potential strategies for improving healing outcomes.

Background: A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR.

Methods: We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance.

Results: The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, -8.51 points; 95% confidence interval [CI], -32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, -2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data.

Conclusions: Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR. Level of evidence: I.

Background: Silicone radial head prostheses (SRHP) are considered obsolete due to reports of frequent failure and destructive silicone-induced synovitis. Considering the good outcomes of modern non-radial silicone joint implants, the extent of scientific evidence for this negative view is unclear. The aim of this research was to systematically analyze the clinical evidence on complications and outcomes of SRHP and how SRHP compare to both non-SRHP and silicone prostheses of other joints.

Methods: A systematic literature review was conducted through the Cochrane, PubMed, and Embase databases.

Results: Eight cohort studies were included, consisting of 142 patients and follow-up periods ranging from 23 months to 8 years. Average patient satisfaction was 86%, range of 71%-100%, and 58 complications were seen, but no cases of synovitis. These outcomes were in line with non-SRHP. Four case series with 11 cases of synovitis were found, all due to implant fractures years to decades after implantation. Six systematic reviews of currently used non-radial silicone joint implants showed excellent outcomes with low complication rates.

Conclusions: Since SRHP have satisfactory clinical results and an acceptable complication rate when selecting a patient group in suitable condition for surgical indications, it is considered that SRHP can still be chosen as a potential surgical treatment method in current clinical practice.

Background: Knowledge of the base rate of signal changes consistent with distal biceps tendinopathy on magnetic resonance imaging (MRI) has the potential to influence strategies for diagnosis and treatment of people that present with elbow pain. The aim of this study is to measure the prevalence of distal biceps tendon signal changes on MRIs of the elbow by indication for imaging.

Methods: MRI data for 1,306 elbows were retrospectively reviewed for mention of signal change in distal biceps tendon. The reports were sorted by indication.

Results: Signal changes consistent with distal biceps tendinopathy were noted in 197 of 1,306 (15%) patients, including 34% of patients with biceps pain, 14% of patients with unspecified pain, and 8% of patients with a specific non-biceps indication. Distal biceps tendon changes noted on radiology reports were associated with older age, male sex, and radiologists with musculoskeletal fellowship training.

Conclusions: The finding that distal biceps MRI signal changes consistent with tendinopathy are common even in asymptomatic elbows reduces the probability that symptoms correlate with pathology on imaging. The accumulation of signal changes with age, also independent of symptoms, suggests that tendon pathology persists after symptoms resolve, that some degree of distal biceps tendinopathy is common in a human lifetime, and that tendinopathy may often be accommodated without seeking care. Level of evidence: IV.

Background: Distal biceps tendon repairs are commonly performed using open techniques. A minimally invasive distal biceps tendon repair technique using a speculum and hooded endoscope was developed to improve visualization, reduce soft-tissue dissection, and minimize complications. This paper describes the technique and reports the outcomes of 75 minimally invasive distal biceps tendon repairs.

Methods: The operation reports and outcomes of 75 patients who underwent distal biceps tendon repair using this technique between 2011 and 2021 were retrospectively reviewed.

Results: Median time to follow-up was 12 months (interquartile range [IQR], 6-56 months). Primary outcomes were function as measured by the Disabilities of Arm, Shoulder and Hand Score (DASH) questionnaire, and rate of complications. Median DASH score was 1.7 of 100 (IQR, 0-6.8). There were 2 of 75 (2.7%) re-ruptures of the distal tendon. There were no cases of vascular injury, proximal radius fracture, or posterior interosseous nerve, median, or ulnar nerve palsy.

Conclusions: In this series, minimally invasive distal biceps repair was safe and effective with a low rate of major complications. Recovery of function, as indicated by low DASH scores, was satisfactory, and inconvenience during recovery was minimized. Level of evidence: IV.