Pub Date : 2024-07-20DOI: 10.1016/j.xrrt.2024.06.009
Genevieve M. Fraipont BA, Ryan S. Beyer BS, Michelle H. McGarry MS, Thay Q. Lee PhD
Background
The aim of this systematic review was to investigate the available literature on the biomechanical characteristics of the acromioclavicular (AC) joint to identify trends in translational parameters and contributions of the various ligamentous structures supporting the joint.
Methods
A comprehensive literature search was conducted in the Web of Science, Scopus, and PubMed databases until October 2023 to identify articles reporting on the biomechanical characteristics of the AC joint. Non cadaveric or projects involving reconstruction were excluded. Consistent parameters evaluated were anterior, posterior, superior, and inferior translation. The data were extracted from the included articles and summarized.
Results
11 biomechanical papers were reviewed from six different countries — United States (n = 6), France (n = 1), Austria (n = 1), Thailand (n = 1), United Kingdom (n = 1), and Japan (n = 1). The total number of specimens included across the reviewed papers was 141. All 11 papers reported the data on an intact model (coracoclavicular and AC ligaments intact). Seven papers assessed the translational results of the AC sectioned condition, finding a greater increase in anterior-posterior (AP) laxity relative to SI. 3 papers evaluated coracoclavicular ligament sectioning, finding increased superior-inferior laxity relative to AP. Only one study involved ligament sectioning isolating the anterior-inferior bundle of the AC joint.
Conclusion
This review highlights the key AP and superior-inferior constraints of both the intact and ligament sectioned AC joint. The inconsistency of AC joint testing parameters and the lack of thorough translation studies indicate a necessity for increased attention in the overall assessment of shoulder stability to close the gap in the foundational biomechanical research.
{"title":"Acromioclavicular joint biomechanics: a systematic review","authors":"Genevieve M. Fraipont BA, Ryan S. Beyer BS, Michelle H. McGarry MS, Thay Q. Lee PhD","doi":"10.1016/j.xrrt.2024.06.009","DOIUrl":"10.1016/j.xrrt.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this systematic review was to investigate the available literature on the biomechanical characteristics of the acromioclavicular (AC) joint to identify trends in translational parameters and contributions of the various ligamentous structures supporting the joint.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in the Web of Science, Scopus, and PubMed databases until October 2023 to identify articles reporting on the biomechanical characteristics of the AC joint. Non cadaveric or projects involving reconstruction were excluded. Consistent parameters evaluated were anterior, posterior, superior, and inferior translation. The data were extracted from the included articles and summarized.</div></div><div><h3>Results</h3><div>11 biomechanical papers were reviewed from six different countries — United States (n = 6), France (n = 1), Austria (n = 1), Thailand (n = 1), United Kingdom (n = 1), and Japan (n = 1). The total number of specimens included across the reviewed papers was 141. All 11 papers reported the data on an intact model (coracoclavicular and AC ligaments intact). Seven papers assessed the translational results of the AC sectioned condition, finding a greater increase in anterior-posterior (AP) laxity relative to SI. 3 papers evaluated coracoclavicular ligament sectioning, finding increased superior-inferior laxity relative to AP. Only one study involved ligament sectioning isolating the anterior-inferior bundle of the AC joint.</div></div><div><h3>Conclusion</h3><div>This review highlights the key AP and superior-inferior constraints of both the intact and ligament sectioned AC joint. The inconsistency of AC joint testing parameters and the lack of thorough translation studies indicate a necessity for increased attention in the overall assessment of shoulder stability to close the gap in the foundational biomechanical research.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 668-675"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1016/j.xrrt.2024.06.010
Rajpal S. Narulla MBBS, MS , Xiaolong Chen MD, PhD , Ashish D. Diwan MBBS, MS(Ortho), DipNB, MNAMS, FRACS, FAOrthA, PhD , Geoffrey C.S. Smith MBBS, MS, FAOrthA, PhD
Background
The shoulder microbiome is an emerging field in orthopedic research. Large synovial joints which were typically considered to be sterile now have strong evidence demonstrating the presence of native organisms colonizing the joint. Many of the conditions that surgeons see and treat in the shoulder, including osteoarthritis, rotator cuff tears, and adhesive capsulitis, have unclear etiology. The shoulder microbiome is a potential source of pathology in dysbiosis states, or source of protection against pathology in normobiosis states. The purpose of this review is to characterize the published research detailing the microbiome of the native shoulder joint.
Methods
We conducted a systematic review and meta-analysis of data searches on Medline, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS. The following search terms were used with various permutations; shoulder, skin, microbiome, infection, colonization, commensal, microbiota, flora. The terms ‘shoulder’ and ‘shoulder AND skin’ were combined with the other 6 terms for a total of 12 searches per database. Two independent reviewers conducted the review with a third reviewer available to resolve differences of interpretation. Studies were eligible if they were human studies of patients undergoing shoulder surgery (or surgical preparation therapy) with a shoulder that had not previously been operated on, where microbial samples were reported. Studies were excluded if they were systematic reviews and meta-analyses, animal studies, cadaveric studies, studies of patients under the age of 18 and studies including postoperative shoulders.
Results
The search methodology yielded 47 eligible studies for analysis, with a total of 3283 patients. Native shoulder sampling yielded positive organisms in 50.8% of all samples (95% confidence interval [CI] = 41.8%-59.8%, I2 = 97.9%, P = .000). The predominate organism reported was C. acnes, with 29% of studies specific for C. acnes, and a total of 52 other organisms detected in the native shoulder. Skin preparation solutions reduced the skin colonization rate of 55.7% (95% CI = 32.7%-78.6%, I2 = 98.2%, P = .000) to 43.5% (95% CI = 29.5%-57.5%, I2 = 98.2%, P = .000). Despite the high rates of colonization detected under sterile conditions, of 42 studies and 3083 patients reporting postoperative outcomes, the infection rate was 1.8% (95% CI = 0.5%-3.2%, I2 = 0.0%, P = .612).
Conclusion
There is strong evidence to support the existence of a native shoulder microbiome. Further research is required to characterize this microbiome and correlate it to disease and health states.
背景肩部微生物组是骨科研究的一个新兴领域。大滑膜关节通常被认为是无菌的，但现在有确凿证据表明关节内存在原生生物。外科医生接诊和治疗的许多肩部疾病，包括骨关节炎、肩袖撕裂和粘连性关节囊炎，病因都不清楚。在菌群失调状态下，肩部微生物组是潜在的病理源，而在正常生物状态下，肩部微生物组则是防止病理发生的保护源。本综述的目的是对已发表的有关肩关节微生物组的研究进行描述。方法我们在 Medline、Embase、Cochrane Central Register of Controlled Trials 和 SCOPUS 上进行了系统性综述和荟萃分析。我们使用了以下不同排列组合的检索词：肩关节、皮肤、微生物组、感染、定植、共生、微生物群、菌群。肩部 "和 "肩部和皮肤 "与其他 6 个词结合在一起，每个数据库共进行了 12 次搜索。两位独立审稿人负责审稿，第三位审稿人负责解决解释上的分歧。如果研究对象是接受肩部手术（或手术准备治疗）的患者，且之前未接受过肩部手术，并报告了微生物样本，则符合条件。不包括系统综述和荟萃分析、动物研究、尸体研究、18 岁以下患者研究以及包括术后肩部的研究。在所有样本中，50.8% 的原生肩部样本检出阳性微生物（95% 置信区间 [CI] = 41.8%-59.8%, I2 = 97.9%, P = .000）。报告的主要微生物是痤疮丙酸杆菌，29%的研究对痤疮丙酸杆菌有特异性，在原生肩部共检测到 52 种其他微生物。皮肤制备溶液将皮肤定植率从 55.7% (95% CI = 32.7%-78.6%, I2 = 98.2%, P = .000) 降至 43.5% (95% CI = 29.5%-57.5%, I2 = 98.2%, P = .000)。尽管在无菌条件下检测到的定植率很高，但在 42 项研究和 3083 名报告术后结果的患者中，感染率为 1.8% (95% CI = 0.5%-3.2%, I2 = 0.0%, P = .612)。需要进一步的研究来确定这种微生物群的特征，并将其与疾病和健康状态联系起来。
{"title":"The shoulder microbiome: a systematic review and meta analysis","authors":"Rajpal S. Narulla MBBS, MS , Xiaolong Chen MD, PhD , Ashish D. Diwan MBBS, MS(Ortho), DipNB, MNAMS, FRACS, FAOrthA, PhD , Geoffrey C.S. Smith MBBS, MS, FAOrthA, PhD","doi":"10.1016/j.xrrt.2024.06.010","DOIUrl":"10.1016/j.xrrt.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>The shoulder microbiome is an emerging field in orthopedic research. Large synovial joints which were typically considered to be sterile now have strong evidence demonstrating the presence of native organisms colonizing the joint. Many of the conditions that surgeons see and treat in the shoulder, including osteoarthritis, rotator cuff tears, and adhesive capsulitis, have unclear etiology. The shoulder microbiome is a potential source of pathology in dysbiosis states, or source of protection against pathology in normobiosis states. The purpose of this review is to characterize the published research detailing the microbiome of the native shoulder joint.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of data searches on Medline, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS. The following search terms were used with various permutations; shoulder, skin, microbiome, infection, colonization, commensal, microbiota, flora. The terms ‘shoulder’ and ‘shoulder AND skin’ were combined with the other 6 terms for a total of 12 searches per database. Two independent reviewers conducted the review with a third reviewer available to resolve differences of interpretation. Studies were eligible if they were human studies of patients undergoing shoulder surgery (or surgical preparation therapy) with a shoulder that had not previously been operated on, where microbial samples were reported. Studies were excluded if they were systematic reviews and meta-analyses, animal studies, cadaveric studies, studies of patients under the age of 18 and studies including postoperative shoulders.</div></div><div><h3>Results</h3><div>The search methodology yielded 47 eligible studies for analysis, with a total of 3283 patients. Native shoulder sampling yielded positive organisms in 50.8% of all samples (95% confidence interval [CI] = 41.8%-59.8%, <em>I</em><sup><em>2</em></sup> = 97.9%, <em>P</em> = .000). The predominate organism reported was <em>C. acnes</em>, with 29% of studies specific for <em>C. acnes</em>, and a total of 52 other organisms detected in the native shoulder. Skin preparation solutions reduced the skin colonization rate of 55.7% (95% CI = 32.7%-78.6%, <em>I</em><sup><em>2</em></sup> = 98.2%, <em>P</em> = .000) to 43.5% (95% CI = 29.5%-57.5%, <em>I</em><sup><em>2</em></sup> = 98.2%, <em>P</em> = .000). Despite the high rates of colonization detected under sterile conditions, of 42 studies and 3083 patients reporting postoperative outcomes, the infection rate was 1.8% (95% CI = 0.5%-3.2%, <em>I</em><sup><em>2</em></sup> = 0.0%, <em>P</em> = .612).</div></div><div><h3>Conclusion</h3><div>There is strong evidence to support the existence of a native shoulder microbiome. Further research is required to characterize this microbiome and correlate it to disease and health states.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 684-693"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1016/j.xrrt.2024.06.008
Parker L. Brush MD , Delano Trenchfield BS , Nicholas B. Pohl MS , Taylor L. Swan BS , Adrian Santana BS , Christopher M. Jones MD , Surena Namdari MD , Pedro K. Beredjiklian MD , Daniel Fletcher MD
Background
Distal triceps tendon ruptures are an uncommon injury with several reported repair techniques. Outcomes research between the repair techniques is complicated by the rarity of the injury as most published materials are based on small sample sizes and specific surgical techniques. This study compared surgical complications, reoperations, and range of motion between all suture transosseous tunnel only (TT), suture anchor only (SA), and transosseous tunnel plus suture anchor (TTSA) repair techniques.
Methods
We retrospectively identified patients who underwent a distal triceps repair at our tertiary-care institution from 2011 to 2021. The electronic medical record was reviewed for patient demographics, triceps rupture characteristics, repair technique, and postoperative complications.
Results
This study includes 199 patients who underwent a repair by TT (82), SA (69), or TTSA (48) techniques. No differences were identified between groups with regards to demographics and medical comorbidities. Patients treated by SA technique were more likely to have a loss of elbow extension (SA: 14 [26.4%], TT: 6 [8.57%], TTSA: 4 [10.0%], P = .014) postoperatively with an average loss of 9° for the patients in all groups. However, no differences were identified between the groups with regards to postoperative complications (TT: 15.9%, SA: 17.4%, TTSA: 18.8%, P = .911), including triceps rerupture (TT: 6.10%, SA: 4.35%, TTSA: 12.5%, P = .260), and reoperation (TT: 11.0%, SA: 11.6%, TTSA: 14.6%, P = .822) rates.
Conclusion
Regardless of repair technique, distal triceps tendon repair surgery has a relatively high complication and reoperation rate. However, given the similarities between the various methods of repair, surgeons can be confident in repairing this type of injury by whichever modality they deem appropriate.
{"title":"A comparison of distal triceps tendon repair outcomes by surgical technique","authors":"Parker L. Brush MD , Delano Trenchfield BS , Nicholas B. Pohl MS , Taylor L. Swan BS , Adrian Santana BS , Christopher M. Jones MD , Surena Namdari MD , Pedro K. Beredjiklian MD , Daniel Fletcher MD","doi":"10.1016/j.xrrt.2024.06.008","DOIUrl":"10.1016/j.xrrt.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Distal triceps tendon ruptures are an uncommon injury with several reported repair techniques. Outcomes research between the repair techniques is complicated by the rarity of the injury as most published materials are based on small sample sizes and specific surgical techniques. This study compared surgical complications, reoperations, and range of motion between all suture transosseous tunnel only (TT), suture anchor only (SA), and transosseous tunnel plus suture anchor (TTSA) repair techniques.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients who underwent a distal triceps repair at our tertiary-care institution from 2011 to 2021. The electronic medical record was reviewed for patient demographics, triceps rupture characteristics, repair technique, and postoperative complications.</div></div><div><h3>Results</h3><div>This study includes 199 patients who underwent a repair by TT (82), SA (69), or TTSA (48) techniques. No differences were identified between groups with regards to demographics and medical comorbidities. Patients treated by SA technique were more likely to have a loss of elbow extension (SA: 14 [26.4%], TT: 6 [8.57%], TTSA: 4 [10.0%], <em>P</em> = .014) postoperatively with an average loss of 9° for the patients in all groups. However, no differences were identified between the groups with regards to postoperative complications (TT: 15.9%, SA: 17.4%, TTSA: 18.8%, <em>P</em> = .911), including triceps rerupture (TT: 6.10%, SA: 4.35%, TTSA: 12.5%, <em>P</em> = .260), and reoperation (TT: 11.0%, SA: 11.6%, TTSA: 14.6%, <em>P</em> = .822) rates.</div></div><div><h3>Conclusion</h3><div>Regardless of repair technique, distal triceps tendon repair surgery has a relatively high complication and reoperation rate. However, given the similarities between the various methods of repair, surgeons can be confident in repairing this type of injury by whichever modality they deem appropriate.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 790-796"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-26DOI: 10.1016/j.xrrt.2024.06.004
John J. Heifner MD , Gustavo E. Lacau MD , Austin T. Vegas DO , Annabella Miki , Deana M. Mercer MD , Jorge L. Orbay MD
{"title":"The supinator approach to the lateral elbow: a technique description and literature review","authors":"John J. Heifner MD , Gustavo E. Lacau MD , Austin T. Vegas DO , Annabella Miki , Deana M. Mercer MD , Jorge L. Orbay MD","doi":"10.1016/j.xrrt.2024.06.004","DOIUrl":"10.1016/j.xrrt.2024.06.004","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 750-756"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-22DOI: 10.1016/j.xrrt.2024.06.003
William E. Harkin MD, John P. Scanaliato MD, Benjamin Kerzner MD, Tyler Williams BS, Sydney Garelick BS, Gregory P. Nicholson MD, Grant E. Garrigues MD
{"title":"Axillary nerve decompression: case report and arthroscopic surgical technique","authors":"William E. Harkin MD, John P. Scanaliato MD, Benjamin Kerzner MD, Tyler Williams BS, Sydney Garelick BS, Gregory P. Nicholson MD, Grant E. Garrigues MD","doi":"10.1016/j.xrrt.2024.06.003","DOIUrl":"10.1016/j.xrrt.2024.06.003","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 839-842"},"PeriodicalIF":0.0,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-18DOI: 10.1016/j.xrrt.2024.06.001
Erica Lante MD , Geoffroi Lallemand MD
{"title":"Simultaneous bilateral reverse total shoulder arthroplasty for bilateral seizure-induced posterior shoulder fracture-dislocation complicated by severe postoperative anemia and hemorrhagic shock: a case report","authors":"Erica Lante MD , Geoffroi Lallemand MD","doi":"10.1016/j.xrrt.2024.06.001","DOIUrl":"10.1016/j.xrrt.2024.06.001","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 817-823"},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-17DOI: 10.1016/j.xrrt.2024.05.012
Udit Dave BS , Jayanth Mosalakanti BS , Pavan Guduri BA , Mia Rumps MS , Mary K. Mulcahey MD
Hypothesis and Background
A potential complication of distal biceps repair is heterotopic ossification (HO), which impacts both limb function and overall patient outcomes. Common HO prophylaxis methods include nonsteroidal anti-inflammatory drugs or localized radiation therapy. The purpose of this systematic review was to determine an effective means of providing HO prophylaxis following distal biceps repair.
Methods
A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched for studies published after 1998: PubMed, Embase, and Cochrane Library. Studies were included if they compared patients who were placed on HO prophylaxis following distal biceps repair compared to those that were not placed on HO prophylaxis, were prospective randomized controlled trials or retrospective case-control studies, and evaluated HO prophylaxis regimens. Studies that were not written in English, analyzed animals or cadavers, and did not directly evaluate patients undergoing distal biceps repair, did not study HO rophylaxis, or had alternative study designs were excluded.
Results
The initial search identified 134 studies, 4 of which met the inclusion criteria and were included in the study. Each of these 4 (100%) studies evaluated indomethacin, and 1 (25%) study evaluated both indomethacin and meloxicam. The included studies evaluated HO prophylaxis in the setting of both one- and two-incision distal biceps repairs. Overall, 2 of the 4 (50%) studies supported the use of indomethacin as HO prophylaxis, 1 of 4 (25%) did not support the use of indomethacin for HO prophylaxis, and 1 of 4 (25%) studies reported that indomethacin and meloxicam are similarly effective HO prophylaxis drugs. None of the studies meeting the inclusion criteria analyzed radiation therapy as a potential method for HO prophylaxis.
Discussion and Conclusion
Indomethacin is commonly used as a prophylactic measure for HO following distal biceps repair; however, based on the results of this study, it is not necessary to use this routinely due to its limited efficacy in preventing HO and potential risks (eg, gastrointestinal upset, bleeding) associated with the medication. Future randomized studies should evaluate the use of other nonsteroidal anti-inflammatory drugs (eg, meloxicam) for HO prophylaxis in addition to not using any HO prophylaxis following either one- or two-incision distal biceps repairs.
假设与背景 二头肌远端修复术的潜在并发症是异位骨化（HO），它会影响肢体功能和患者的整体预后。常见的异位骨化预防方法包括非甾体抗炎药或局部放射治疗。本系统性综述旨在确定在二头肌远端修复术后提供 HO 预防的有效方法。方法根据系统性综述和荟萃分析首选报告项目 (PRISMA) 指南对文献进行了系统性综述。检索了以下数据库中 1998 年后发表的研究：PubMed、Embase 和 Cochrane Library。纳入的研究必须是对二头肌远端修复术后接受 HO 预防治疗的患者与未接受 HO 预防治疗的患者进行比较的研究、前瞻性随机对照试验或回顾性病例对照研究，以及对 HO 预防治疗方案进行评估的研究。非英语撰写、分析动物或尸体、未直接评估接受二头肌远端修复术的患者、未研究HO预防方案或采用其他研究设计的研究均被排除在外。结果初步检索发现了134项研究，其中4项符合纳入标准并被纳入研究。这 4 项研究（100%）均评估了吲哚美辛，1 项研究（25%）同时评估了吲哚美辛和美洛昔康。纳入的研究评估了单切口和双切口肱二头肌远端修复时的 HO 预防措施。总体而言，4 项研究中有 2 项（50%）支持使用吲哚美辛作为 HO 预防药物，4 项研究中有 1 项（25%）不支持使用吲哚美辛作为 HO 预防药物，4 项研究中有 1 项（25%）报告称吲哚美辛和美洛昔康是效果相似的 HO 预防药物。讨论与结论吲哚美辛通常被用作二头肌远端修复术后HO的预防措施；然而，根据本研究的结果，由于其预防HO的疗效有限，且存在与该药物相关的潜在风险（如胃肠道不适、出血），因此没有必要常规使用该药物。未来的随机研究应该评估在单切口或双切口股二头肌远端修复术后，除了不使用任何HO预防药物外，使用其他非甾体抗炎药（如美洛昔康）预防HO的情况。
{"title":"Heterotopic ossification (HO) prophylaxis after distal biceps repair","authors":"Udit Dave BS , Jayanth Mosalakanti BS , Pavan Guduri BA , Mia Rumps MS , Mary K. Mulcahey MD","doi":"10.1016/j.xrrt.2024.05.012","DOIUrl":"10.1016/j.xrrt.2024.05.012","url":null,"abstract":"<div><h3>Hypothesis and Background</h3><div>A potential complication of distal biceps repair is heterotopic ossification (HO), which impacts both limb function and overall patient outcomes. Common HO prophylaxis methods include nonsteroidal anti-inflammatory drugs or localized radiation therapy. The purpose of this systematic review was to determine an effective means of providing HO prophylaxis following distal biceps repair.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched for studies published after 1998: PubMed, Embase, and Cochrane Library. Studies were included if they compared patients who were placed on HO prophylaxis following distal biceps repair compared to those that were not placed on HO prophylaxis, were prospective randomized controlled trials or retrospective case-control studies, and evaluated HO prophylaxis regimens. Studies that were not written in English, analyzed animals or cadavers, and did not directly evaluate patients undergoing distal biceps repair, did not study HO rophylaxis, or had alternative study designs were excluded.</div></div><div><h3>Results</h3><div>The initial search identified 134 studies, 4 of which met the inclusion criteria and were included in the study. Each of these 4 (100%) studies evaluated indomethacin, and 1 (25%) study evaluated both indomethacin and meloxicam. The included studies evaluated HO prophylaxis in the setting of both one- and two-incision distal biceps repairs. Overall, 2 of the 4 (50%) studies supported the use of indomethacin as HO prophylaxis, 1 of 4 (25%) did not support the use of indomethacin for HO prophylaxis, and 1 of 4 (25%) studies reported that indomethacin and meloxicam are similarly effective HO prophylaxis drugs. None of the studies meeting the inclusion criteria analyzed radiation therapy as a potential method for HO prophylaxis.</div></div><div><h3>Discussion and Conclusion</h3><div>Indomethacin is commonly used as a prophylactic measure for HO following distal biceps repair; however, based on the results of this study, it is not necessary to use this routinely due to its limited efficacy in preventing HO and potential risks (eg, gastrointestinal upset, bleeding) associated with the medication. Future randomized studies should evaluate the use of other nonsteroidal anti-inflammatory drugs (eg, meloxicam) for HO prophylaxis in addition to not using any HO prophylaxis following either one- or two-incision distal biceps repairs.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 715-719"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-16DOI: 10.1016/j.xrrt.2024.05.011
Revision total elbow arthroplasty (rTEA) is a technically challenging procedure that is associated with high rates of surgical complications. Cement removal remains an important and difficult component of rTEA. Particularly in the case of prosthetic joint infection following TEA, failure to remove all of the cement from the index procedure results in higher rates of recurrent or persistent infection. Options for cement removal include the use of nonpowered instruments, powered instruments, ultrasonic devices, arthroscopic-assisted techniques, bone episiotomies, and cortical windows. Carefully assessing the risks and benefits of each of these techniques can provide aid in both improving surgical efficiency and potentially reducing surgical morbidity during these complex procedures. The purpose of this narrative review was to explore technical aspects of cement removal for well-fixed implants during rTEA.
{"title":"Techniques for removal of well-fixed implants and cement in revision total elbow arthroplasty","authors":"","doi":"10.1016/j.xrrt.2024.05.011","DOIUrl":"10.1016/j.xrrt.2024.05.011","url":null,"abstract":"<div><div>Revision total elbow arthroplasty (rTEA) is a technically challenging procedure that is associated with high rates of surgical complications. Cement removal remains an important and difficult component of rTEA. Particularly in the case of prosthetic joint infection following TEA, failure to remove all of the cement from the index procedure results in higher rates of recurrent or persistent infection. Options for cement removal include the use of nonpowered instruments, powered instruments, ultrasonic devices, arthroscopic-assisted techniques, bone episiotomies, and cortical windows. Carefully assessing the risks and benefits of each of these techniques can provide aid in both improving surgical efficiency and potentially reducing surgical morbidity during these complex procedures. The purpose of this narrative review was to explore technical aspects of cement removal for well-fixed implants during rTEA.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 720-726"},"PeriodicalIF":0.0,"publicationDate":"2024-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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