Radiographic Analysis of Glenoid Size and Shape After Arthroscopic Coracoid Autograft Versus Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability

Background: The Latarjet procedure for autograft transposition of the coracoid to the anterior rim of the glenoid remains the most common procedure for reconstruction of the glenoid after shoulder instability. The anatomic glenoid reconstruction using distal tibial allograft has gained popularity and is suggested to better match the normal glenoid size and shape. However, concerns about decreased healing and increased resorption arise when an allograft bone is used. Purpose: To use radiological findings to evaluate the arthroscopic reconstruction of the glenoid with respect to the size, shape, healing, and resorption of coracoid autograft versus distal tibial allograft. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of 48 consecutive patients who had an arthroscopic bony reconstruction of the glenoid (12 coracoid autograft, 36 distal tibial allograft), diagnosed anterior shoulder instability, and computed tomography (CT)–confirmed glenoid bone loss more than 20%. Coracoid autograft was performed only when tibial allograft was not accessible from a bone bank. Two fellowship-trained musculoskeletal radiologists reviewed pre- and postoperative CT scans at a minimum follow-up of 6 months for the following: graft position, glenoid concavity, cross-sectional area, width, version, total area, osseous union, and graft resorption. Clinical outcome was noted in terms of instability, subluxation, and dislocation at a minimum follow-up of 2 years. Simple logistic regression, 2-tailed independent-sample t tests, paired t tests, and Fisher exact tests were performed. Results: Graft union was seen in 9 of the 12 patients (75%) who had coracoid autograft and 34 of the 36 patients (94%) who had tibial allograft (odds ratio, 5.66; 95% CI, 0.81-39.20; P = .08). The odds ratio comparing allograft to coracoid for overall resorption was 7.00 (95% CI, 1.65-29.66; P = .008). Graft resorption ≥50% was seen in 3 (8%) of the patients who had tibial allograft and none of the patients who had coracoid autograft. Graft resorption less than 50% was seen in the majority of patients in both groups: 27 (73%) patients with tibial allograft and 5 (42%) patients with coracoid autograft. No statistically significant difference was found between the 2 procedures regarding anteroposterior diameter of graft ( P = .81) or graft cross-sectional area ( P = .93). However, a significant difference was observed in step formation between the 2 procedures ( P < .001). Two patients experienced subluxations in the coracoid group (16%) as well as 2 patients in the tibial allograft group (6%) with a P value of .25. Conclusion: Arthroscopic anatomic glenoid reconstruction via distal tibial allograft showed similar bony union but higher resorption compared with coracoid autograft. Even so, no statistically significant difference was found between the 2 procedures regarding final graft surface area, the size of grafts, and the anteroposterior dimensions of the reconstructed glenoids. These short-term results suggest that distal tibial allografts can be used as an alternative to coracoid autograft in the recreation of glenoid bony morphologic features.

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Radiographic Analysis of Glenoid Morphology after Arthroscopic Latarjet vs Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00094 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0009 ◽

Cited By ~ 1

Author(s):

Ivan H. Wong ◽

JP King ◽

Gordon Boyd ◽

Michael Mitchell ◽

Catherine M. Coady

Keyword(s):

Shoulder Instability ◽

Distal Tibia ◽

Cross Sectional Area ◽

Anterior Shoulder Instability ◽

Sectional Area ◽

Common Procedure ◽

Cross Sectional ◽

Significant Difference ◽

Glenoid Reconstruction ◽

Graft Resorption

Objectives: The Latarjet procedure for autograft transposition of coracoid to the anterior rim of the glenoid remains the most common procedure for reconstruction of the glenoid after shoulder instability. The anatomic glenoid reconstruction using distal tibial allograft has gained popularity and is suggested to better match the normal glenoid size and shape. However, there is concern for decreased healing and increased resorption using an allograft bone. The purpose of this study was to evaluate the arthroscopic reconstruction of the glenoid with respect to the size, shape, healing, and resorption of autograft coracoid vs allograft distal tibia. Methods: A retrospective review of 50 consecutive patients who had an arthroscopic boney reconstruction of the glenoid (13 coracoid; 37 distal tibial), diagnosed with anterior shoulder instability, and CT confirmed glenoid bone loss >20%. Pre-and post-operative CT scans were reviewed by two fellowship trained musculoskeletal radiologists for: graft position, glenoid concavity, cross sectional area, width, version, total area, osseous union, and graft resorption. Results: Graft nonunion was seen in 3 (23.07%) of the coracoid patients, and in 2 (5.4%) of the tibial allograft patients (OR 5.25; 95% CI: 0.768-35.89). Odds ratios comparing allograft to coracoid for overall resorption was 5.00 (CI: 1.276-19.597). Graft resorption greater than 50% was seen in 3 (8.11%) of the allografts and was absent within the coracoid patients. Graft resorption lesser than 50% was greater in both groups with 27 (72.97%) allograft and 6 (46.15%) coracoid patients. However, no statistically significant difference was found between the two procedures regarding AP diameter of graft (p=0.818) or graft cross sectional area (p=0.797). Conclusion: Arthroscopic anatomic glenoid reconstruction using distal tibial allograft showed greater boney union but higher resorption compared to coracoid autograft. Even so, there was no statistically significant difference between the two procedures regarding final graft surface area and size of grafts. These short-term results suggest distal tibial allograft as an alternative to coracoid autograft in the recreation of glenoid boney morphology.

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Posterior dynamic stabilization in the treatment of degenerative lumbar stenosis: validity of its rationale

Journal of Neurosurgery Spine ◽

10.3171/2012.9.spine12392 ◽

2013 ◽

Vol 18 (1) ◽

pp. 24-31 ◽

Cited By ~ 9

Author(s):

Kee-Yong Ha ◽

Jun-Yeong Seo ◽

Soon-Eok Kwon ◽

Il-Nam Son ◽

Ki-Won Kim ◽

...

Keyword(s):

Ct Images ◽

Cross Sectional Area ◽

Disc Height ◽

Lumbar Stenosis ◽

Sectional Area ◽

Cross Sectional ◽

Significant Difference ◽

Posterior Dynamic Stabilization ◽

The Mean

Object The authors undertook this study to investigate the validity of the rationale for posterior dynamic stabilization using the Device for Intervertebral Assisted Motion (DIAM) in the treatment of degenerative lumbar stenosis. Methods A cohort of 31 patients who underwent single-level decompression and DIAM placement for degenerative lumbar stenosis were followed up for at least 2 years and data pertaining to their cases were analyzed prospectively. Of these patients, 7 had retrolisthesis. Preoperative and postoperative plain lumbar radiographs obtained in all patients and CT images obtained in 14 patients were analyzed. Posterior disc heights; range of motion (ROM) of proximal, distal, and implant segments; lordotic angles of implant segments; percentage of retrolisthesis; and cross-sectional area and heights of intervertebral foramina on CT sagittal images were analyzed. Clinical outcomes were evaluated using visual analog scale scores and Oswestry Disability Index scores. Results The mean values for posterior disc height before surgery, at 1 week after surgery, and at the final follow-up visits were 6.4 ± 2.0 mm, 9.7 ± 2.8 mm, and 6.8 ± 2.5 mm, respectively. The mean lordotic angles at the implant levels before surgery, at 1 week after surgery, and at the final follow-up visits were 7.1° ± 3.3°, 4.1° ± 2.7°, and 7.0° ± 3.7°, respectively. No statistically significant difference was found between the preoperative values and values from final follow-up visits for posterior disc height and lordotic angles at implant levels (p = 0.17 and p = 0.10, respectively). There was no statistically significant difference between the preoperative and final follow-up visit values for intervertebral foramen cross-sectional area and heights on CT images. The ROMs of proximal and distal segments also showed no significant decrease (p = 0.98 and p = 0.92, respectively). However, the ROMs of implant segments decreased significantly (p = 0.02). The average 31.4-month improvement for all clinical outcome measures was significant (p < 0.001). Conclusions Based on radiological findings, the DIAM failed to show validity in terms of the rationale of indirect decompression, but it did restrict motion at the instrumented level without significant change in adjacent-segment ROM. The clinical condition of the patients, however, was improved, and improvement was maintained despite progressive loss of posterior disc height after surgery.

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Guideline Values for Minimum Nasal Cross-Sectional Area in Children

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665618767107 ◽

2018 ◽

Vol 55 (8) ◽

pp. 1043-1050

Author(s):

Maija T. Laine-Alava ◽

Siiri Murtolahti ◽

Ulla K. Crouse ◽

Donald W. Warren

Keyword(s):

Cleft Lip ◽

Cross Sectional Area ◽

Adult Size ◽

Nasal Airway ◽

Sectional Area ◽

Cross Sectional ◽

Age Cohorts ◽

Guideline Values ◽

Significant Difference ◽

Research Criteria

Objective: The purpose was to determine age-specific values of the minimum cross-sectional area of the nasal airway in children without cleft lip or palate and to assess whether gender differences occur with growth in order to develop guidelines for assessment in children with clefts. Participants: All schoolchildren aged 8 to 17 years who met the research criteria were studied during rest breathing using the pressure-flow technique. The children came from a rural area of 3800 inhabitants. Consecutive age cohorts were used for comparisons. Results: Nasal cross-sectional area increased in females from 0.38 cm2 in 8-year-olds to 0.58 cm2 in 17-year-olds. There was a decrease in size at ages 10 to 11 and 14 to 15 years. In males, the area increased from 0.40 to 0.68 cm2 and decreased slightly from 9 to 10 and 14 to 15 years. The annual changes were statistically significant in females between 8 and 9 and 11 to 13 years of age, and in males from 11 to 12, 13 to 14, and 15 to 17 years of age. Across gender, the only significant difference occurred at age 16. Conclusions: Our results indicate that the increase in nasal airway size is not consistent during growth. Nasal airway size showed almost equal values for both genders in young children but was systematically larger in boys from 14 years of age on. The results refer that by 17 years of age nasal airway may not have reached adult size in males.

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Relevance of classification by size to topographical differences in bronchial smooth muscle response

Journal of Applied Physiology ◽

10.1152/jappl.1993.75.5.2013 ◽

1993 ◽

Vol 75 (5) ◽

pp. 2013-2021 ◽

Cited By ~ 9

Author(s):

P. Chitano ◽

S. B. Sigurdsson ◽

A. J. Halayko ◽

N. L. Stephens

Keyword(s):

Smooth Muscle ◽

Electrical Field Stimulation ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Muscle Response ◽

Bronchial Responsiveness ◽

Sixth Generation ◽

Significant Difference ◽

And Control

To investigate heterogeneity of airway smooth muscle response, we studied strips of large and small branches from third- to sixth-generation bronchi obtained from ragweed antigen-sensitized and control dogs. The response to electrical field stimulation and carbamylcholine chloride was greater in strips from larger branches of the same generation when expressed as "tissue stress" (force per unit cross-sectional area of the whole tissue), whereas no difference emerged with use of the more appropriate "smooth muscle stress" (force per unit cross-sectional area of the muscle tissue). The response to histamine was significantly higher in small branches than in large ones, and histamine sensitivity [mean effective concentration (EC50)] was 7.79 x 10(-6) [geometric standard error of the mean (GSEM) 1.20] and 1.49 x 10(-5) M (GSEM 1.14), respectively (P < 0.01). Strips from control and sensitized animals at each site and strips from different generations did not show any significant difference. When we clustered our preparations according to dimensions, the response to histamine was significantly higher in small bronchi than in large ones and histamine EC50 was 8.95 x 10(-6) (GSEM 1.17) and 1.57 x 10(-5) M (GSEM 1.18), respectively (P < 0.05). We conclude that evaluation of muscle response in different tissues requires appropriate normalization. Furthermore, classification into generations is inadequate to study bronchial responsiveness, inasmuch as major differences originate from airway size.

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Gender differences in upper airway compliance during NREM sleep: role of neck circumference

Journal of Applied Physiology ◽

10.1152/japplphysiol.00553.2001 ◽

2002 ◽

Vol 92 (6) ◽

pp. 2535-2541 ◽

Cited By ~ 52

Author(s):

James A. Rowley ◽

Carrie S. Sanders ◽

Brian R. Zahn ◽

M. Safwan Badr

Keyword(s):

Gender Differences ◽

Gender Difference ◽

Upper Airway ◽

Nrem Sleep ◽

Neck Circumference ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Significant Difference ◽

Upper Airway Structure

It has been proposed that the gender difference in sleep apnea prevalence is related to gender differences in upper airway structure and function. We hypothesized that men would have smaller retropalatal cross-sectional area and higher compliance during sleep compared with women. Using upper airway imaging, we measured upper airway cross-sectional area and retropalatal compliance in wakefulness and non-rapid eye movement (NREM) sleep in 15 men and 15 women without sleep-disordered breathing. Cross-sectional area at the beginning of inspiration tended to be larger in men compared with women in both wakefulness [194.5 ± 21.3 vs. 138.8 ± 12.0 (SE) mm2] and NREM sleep (111.1 ± 17.6 vs. 83.3 ± 11.9 mm2; P = 0.058). There was no significant difference, however, after correction for body surface area. Retropalatal compliance also tended to be higher in men during both wakefulness (5.9 ± 1.4 vs. 3.1 ± 1.4 mm2/cmH2O; P = 0.006) and NREM sleep (12.6 ± 2.7 vs. 4.7 ± 2.6 mm2/cmH2O; P = 0.055). However, compliance was similar in men relative to women after correction for neck circumference. We conclude that the gender difference in retropalatal compliance is more accurately attributed to differences in neck circumference between the genders.

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Superior-capsular elongation and its significance in atraumatic posteroinferior multidirectional shoulder instability in magnetic resonance arthrography

Acta Radiologica ◽

10.3109/02841850903524421 ◽

2010 ◽

Vol 51 (3) ◽

pp. 302-308 ◽

Cited By ~ 10

Author(s):

Yi-Chih Hsu ◽

Ru-Yu Pan ◽

Yen-Yu I. Shih ◽

Meei-Shyuan Lee ◽

Guo-Shu Huang

Keyword(s):

Magnetic Resonance ◽

Shoulder Instability ◽

Mr Arthrography ◽

Supraspinatus Tendon ◽

Cross Sectional Area ◽

Rotator Interval ◽

Sectional Area ◽

Cross Sectional ◽

Control Subjects ◽

Linear Distance

Background: Redundancy of the capsule has been considered to be the main pathologic condition responsible for atraumatic posteroinferior multidirectional shoulder instability; however, there is a paucity of measurements providing quantitative diagnosis. Purpose: To determine the significance of superior-capsular elongation and its relevance to atraumatic posteroinferior multidirectional shoulder instability at magnetic resonance (MR) arthrography. Material and Methods: MR arthrography was performed in 21 patients with atraumatic posteroinferior multidirectional shoulder instability and 21 patients without shoulder instability. One observer made the measurements in duplicate and was blinded to the two groups. The superior-capsular measurements (linear distance and cross-sectional area) under the supraspinatus tendon, and the rotator interval were determined on MR arthrography and evaluated for each of the two groups. Results: For the superior-capsular measurements, the linear distance under the supraspinatus tendon was significantly longer in patients with atraumatic posteroinferior multidirectional shoulder instability than in control subjects ( P<0.001). The cross-sectional area under the supraspinatus tendon, and the rotator interval were significantly increased in patients with atraumatic posteroinferior multidirectional shoulder instability compared to control subjects ( P<0.001 and P=0.01, respectively). Linear distance greater than 1.6 mm under the supraspinatus tendon had a specificity of 95% and a sensitivity of 90% for diagnosing atraumatic posteroinferior multidirectional shoulder instability. Cross-sectional area under the supraspinatus tendon greater than 0.3 cm2, or an area under the rotator interval greater than 1.4 cm2 had a specificity of more than 80% and a sensitivity of 90%. Conclusion: The superior-capsular elongation as well as its diagnostic criteria of measurements by MR arthrography revealed in the present study could serve as references for diagnosing atraumatic posteroinferior shoulder instability and offer insight into the spectrum of imaging findings corresponding to the pathologies encountered at clinical presentation.

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The Effect of ACL Reconstruction on Involved and Contralateral Limb Vastus Lateralis Morphology and Histology: A Pilot Study

The Journal of Knee Surgery ◽

10.1055/s-0039-1697899 ◽

2019 ◽

Author(s):

Eric C. Leszczynski ◽

Christopher Kuenze ◽

Brett Brazier ◽

Joseph Visker ◽

David P. Ferguson

Keyword(s):

Fiber Type ◽

Vastus Lateralis ◽

Knee Extension ◽

Cross Sectional Area ◽

Vastus Lateralis Muscle ◽

Myosin Isoforms ◽

Sectional Area ◽

Cross Sectional ◽

Contralateral Limb ◽

Significant Difference

AbstractQuadriceps muscle weakness is a commonly reported issue post anterior cruciate ligament reconstruction (ACLR), with minimal information related to skeletal muscle morphology following surgery. The purpose is to examine the morphological and functional differences in the vastus lateralis muscle from patient's ACLR and contralateral leg. Three physically active ACLR participants were recruited and secured to a dynamometer to perform maximal voluntary isometric knee extension contractions (MVIC) of the ACLR and contralateral limb. Muscle biopsies of the ACLR and contralateral vastus lateralis were performed, then sectioned, and stained for myosin isoforms to determine fiber type. Confocal images were acquired, and ImageJ software was used to determine the fiber type and cross-sectional area (CSA). There was a significant reduction in CSA of the type IIa and type IIx muscle fiber cells between healthy (IIa: 7,718 ± 1,295 µm2; IIx; 5,800 ± 601 µm2) and ACLR legs (IIa: 4,139 ± 709 µm2; IIx: 3,708 ± 618 µm2) (p < 0.05), while there was no significant difference in knee extension MVIC torque between legs (healthy limb: 2.42 ± 0.52 Nm/kg; ACLR limb: 2.05 ± 0.24 Nm/kg, p = 0.11). The reduction in the cross-sectional area of the ACLR type II fibers could impair function and increase secondary injury risk.

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Cross-sectional area of the paraspinal muscles and its association with muscle strength among fighter pilots: a 5-year follow-up

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2551-y ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 5

Author(s):

Tuomas Honkanen ◽

Matti Mäntysaari ◽

Tuomo Leino ◽

Janne Avela ◽

Liisa Kerttula ◽

...

Keyword(s):

Muscle Strength ◽

Cross Sectional Area ◽

Sectional Area ◽

Paraspinal Muscles ◽

Cross Sectional

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Prediction Models for the Erector Spinae Muscle Cross-Sectional Area

Journal of Biomechanical Engineering ◽

10.1115/1.4029984 ◽

2015 ◽

Vol 137 (7) ◽

Cited By ~ 9

Author(s):

Celal Gungor ◽

Ruoliang Tang ◽

Richard F. Sesek ◽

Kenneth Bo Foreman ◽

Sean Gallagher ◽

...

Keyword(s):

Prediction Models ◽

Absolute Error ◽

Cross Sectional Area ◽

Erector Spinae ◽

Low Back ◽

Sectional Area ◽

Cross Sectional ◽

Erector Spinae Muscle ◽

Significant Difference ◽

Mri Scans

Accurate and reliable “individualized” low back erector spinae muscle (ESM) data are of importance to estimate its force producing capacity. Knowing the force producing capacity, along with spinal loading, enhances the understanding of low back injury mechanisms. The objective of this study was to build regression models to estimate the ESM cross-sectional area (CSA). Measurements were taken from axial-oblique magnetic resonance imaging (MRI) scans of a large historical population [54 females and 53 males at L3/L4, 50 females and 44 males at L4/L5, and 41 females and 35 males at L5/S1 levels]. Results suggest that an individual's ESM CSA can be accurately estimated based on his/her gender, height, and weight. Results further show that there is no significant difference between the measured and estimated ESM CSAs, and expected absolute error is less than 15%.

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Functional outcome of arthroscopic Bankart repair for anterior shoulder instability based on suture anchor configuration

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200524 ◽

2020 ◽

Vol 6 (2) ◽

pp. 301

Author(s):

Madan Ballal ◽

Tarun Jayakumar

Keyword(s):

Functional Outcome ◽

Shoulder Instability ◽

Bankart Repair ◽

Functional Improvement ◽

Anterior Shoulder Instability ◽

Suture Anchors ◽

Arthroscopic Bankart Repair ◽

Significant Difference ◽

Functional Scores

Background: The objective of the study was to evaluate the functional outcome of arthroscopic Bankart repair for anterior shoulder instability to assess whether the number and position of suture anchors plays a role in determining the functional outcome.Methods: This was a prospective study on 32 patients operated with arthroscopic Bankart repair between December 2017 to April 2019. Pre-op and regular follow-up scores were measured at 1 month, 3 months and 6 months post-op using Rowe score and American Shoulder and Elbow Surgeons score to assess functional outcome.Results: Mean age of the study group was 24.5±6.9 years. Functional outcome as determined by Rowe score and ASES score at 6 months follow-up were found to be 90.5±7.2 and 85.9±14.1 respectively when compared to the pre-op scores of 23.2±8.2 and 47.9±5.7 respectively; all of which showed highly significant functional improvement with highly significant reduction in visual analog scale (VAS) pain score. Patients had no recurrent dislocations with mean external rotation limitation of 5o. 25 (78.1%) patients had two suture anchors inserted and 7 (21.9%) patients had multiple (>2) anchors; and when analysis was done, there was no statistically significant difference between number of suture anchors used with respect to the functional scores.Conclusions: We conclude that arthroscopic Bankart repair is a useful and successful procedure. Patient identification and selection remains the key in determining the success of repair. Meticulous surgical technique and correct positioning of suture anchors may help in reducing the number of anchors without compromising on the final functional outcome, thereby reducing the economic burden on patients.

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