Structural and Functional Results of Subscapularis and Conjoint Tendon After Latarjet Procedure at 8-Year Average Follow-up

2021 ◽  
pp. 036354652110615
Author(s):  
Sebastien Azizi ◽  
Lukas Urbanschitz ◽  
Susanne Bensler ◽  
Christopher G. Lenz ◽  
Paul Borbas ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Bone Block ◽  
Subscapularis Tendon ◽  
Latarjet Procedure ◽  
Mri Scans ◽  
The Mean ◽  
Rotation Strength ◽  
Nonoperative Side ◽  
Conjoint Tendon

Background: The Latarjet procedure involves initial dissection through a longitudinal split of the subscapularis tendon with only a final partial closure to accommodate the transferred coracoid bone. Furthermore, by transferring the coracoid bone block to the anterior glenoid, the surgeon completely alters the resting and dynamic route of the attached conjoint tendon. The eventual structural and functional integrity of the subscapularis and conjoint tendons is currently unknown. Purpose: To examine the structural and functional integrity of the subscapularis and the conjoint tendon after the Latarjet procedure at an 8-year average follow-up. Study design: Case series; Level of evidence, 4. Methods: Twenty patients with anterior shoulder instability at a mean age of 30 years (range, 19-50 years) underwent the open Latarjet procedure. Clinical examination at the final follow-up included quantitative isometric measurement of abduction and internal rotation strength compared with the nonoperative side. Patients were assessed via radiograph examination and preoperative computed tomography. Final position and healing of the transferred coracoid bone block were evaluated using standard radiographs. At follow-up, the subscapularis and conjoint tendon were evaluated via magnetic resonance imaging (MRI) with metal artifact reduction techniques and via ultrasound. Results: Nineteen of the 20 shoulders remained stable at the final follow-up; there was 1 redislocation (5%) after 14 months. The mean Rowe score was 83 points (SD, 17.9 points), the mean Constant score was 85 points (SD, 8.1 points), and the Subjective Shoulder Value was 80% (SD, 18%). The mean abduction strength of the operative shoulder was 7.41 ± 2.06 kg compared with 8.33 ± 2.53 kg for the nonoperative side ( P = .02). The mean internal rotation strength at 0° for the operative shoulder was 8.82 ± 3.47 kg compared with 9.06 ± 3.01 kg for the nonoperative side ( P = .36). The mean internal rotation strength in the belly-press position for the operative shoulder was 8.12 ± 2.89 kg compared with 8.50 ± 3.03 kg ( P = .13). Four of 20 shoulders showed mild tendinopathic changes of the subscapularis tendon but no partial or complete tear. One patient exhibited fatty degeneration Goutallier stage 1. Conjoint tendon was in continuity in all 20 shoulders on MRI scans. Conclusion: Abduction, but not internal rotation strength, was slightly reduced after the Latarjet procedure at a mean of 8 years of follow-up. The subscapularis tendon was intact based on ultrasound examination, and the conjoint tendon was intact based on MRI scans. Subscapularis muscle girth relative to the supraspinatus muscle remained intact from preoperative measurements based on MRI scans.

The Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss

2020 ◽  
pp. 175857322094416
Author(s):  
Luciano A Rossi ◽  
Ignacio Tanoira ◽  
María G Bruchmann ◽  
Ignacio Pasqualini ◽  
Maximiliano Ranalletta
Keyword(s):  
Bone Loss ◽  
Scoring System ◽  
Functional Outcomes ◽  
Glenoid Bone Loss ◽  
Bone Block ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Competitive Athletes ◽  
The Mean

Purpose To analyze return to sports, functional outcomes, and complications following the Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss. Methods Between 2010 and 2017, 60 competitive athletes younger than 20 years old with a significant glenoid bone loss were operated with the Latarjet procedure. Return to sports, range of motion, and the Rowe and the Athletic Shoulder Outcome Scoring System score were used to assess functional outcomes. Complications and bone consolidation were also evaluated. Results The mean follow-up was 58 months and the mean age was 16.3 years. Overall, 93% were able to return to sports and 84% returned at the same level. The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after operation ( P <  .001). The total complication rate was 22% and the revision rate was 1.6%. The recurrence rate was 3.3%. The bone block healed in 93% of the cases. Conclusions In competitive athletes younger than 20 years old with a significant glenoid bone loss, the Latarjet procedure resulted in excellent functional outcomes, with most of the patients returning to sports and at the same level they had before injury with a low rate of recurrences. However, this procedure is associated with a significant rate of complications and should preferably be performed by experienced surgeons.

The Effects of Mean of Visit-to-Visit Blood Pressure on Incident Brain Vascular Lesions and Functional-Cognitive Decline

2021 ◽  
pp. 1-12
Author(s):  
Bibek Gyanwali ◽  
Celestine Xue Ting Cai ◽  
Christopher Chen ◽  
Henri Vrooman ◽  
Chuen Seng Tan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Decline ◽  
Hippocampal Volume ◽  
Intracranial Stenosis ◽  
Vascular Lesions ◽  
Linear Regression Models ◽  
Volume Functional ◽  
Mri Scans ◽  
The Mean

Background: Cerebrovascular disease (CeVD) is an underlying cause of cognitive impairment and dementia. Hypertension is a known risk factor of CeVD, but the effects of mean of visit-to-visit blood pressure (BP) on incident CeVD and functional-cognitive decline remains unclear. Objective: To determine the association between mean of visit-to-visit BP with the incidence and progression of CeVD [white matter hyperintensities (WMH), infarcts (cortical infarcts and lacunes), cerebral microbleeds (CMBs), intracranial stenosis, and hippocampal volume] as well as functional-cognitive decline over 2 years of follow-up. Methods: 373 patients from a memory-clinic underwent BP measurements at baseline, year 1, and year 2. The mean of visit-to-visit systolic BP, diastolic BP, pulse pressure, and mean arterial pressure were calculated. Baseline and year 2 MRI scans were graded for WMH, infarcts, CMBs, intracranial stenosis, and hippocampal volume. Functional-cognitive decline was assessed using locally validated protocol. Logistic and linear regression models with odds ratios, mean difference, and 95%confidence interval were constructed to analyze associations of visit-to-visit BP on CeVD incidence and progression as well as functional-cognitive decline. Results: Higher mean of visit-to-visit diastolic BP was associated with WMH progression. Higher tertiles of diastolic BP was associated with WMH progression and incident CMBs. There was no association between mean of visit-to-visit BP measures with incident cerebral infarcts, intracranial stenosis, change in hippocampal volume, and functional-cognitive decline. Conclusion: These findings suggest the possibility of hypertension-related vascular brain damage. Careful monitoring and management of BP in elderly patients is essential to reduce the incidence and progression of CeVD.

scholarly journals Salvage Arthrodesis with Femoral Head Allograft for Failed Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0032
Author(s):  
Hong S. Lee ◽  
Kiwon Young ◽  
Tae-Hoon Park ◽  
Hong Seop Lee
Keyword(s):  
Femoral Head ◽  
Subjective Assessment ◽  
Total Ankle Arthroplasty ◽  
Bone Block ◽  
Ankle Arthroplasty ◽  
Pain Scores ◽  
Walking Aids ◽  
The Mean ◽  
Final Followup

Category: Ankle Introduction/Purpose: Failed total ankle arthroplasty (TAA) often results in significant bone loss and requires salvage arthrodesis. The aim of this study was to investigate the outcomes of Salvage arthrodesis with allo-bone block for failed TAA. Methods: This study included 8 patients who underwent salvage arthrodesis with femoral head allograft for failed TAA from August 2012 to March 2018 because of loosing of TAA implant. The mean age of the patients was 71 years (range, 54-81 years), and the mean follow-up period was 32 months (range, 12 to 84 months). Allograft problem and alignment of joint were evaluated radiographically. American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and visual analogue scale (VAS) pain scores were recorded preoperatively and at the time of final followup. Functional questionnaires were used to assess the duration for which the patient could walk continuously, use of walking aids, consumption of pain medication, and the patient’s subjective assessment of the percentage of overall improvement compared with before the salvage arthrodesis. Results: The allograft was retained without collapse for a mean of 24 months (range, 12 to 36 months) in four patients. Collapse of the allograft was observed in four patients at a mean of 11 months (range, 9 to 16 months), 1 of 4 patients were conserved to retrograde intramedullary nail at postoperative 12 months because of with implant failure and nonunion. The mean AOFAS and VAS pain scores improved from 12 (range, 8 to 40) preoperatively to 63 (range, 38 to 75) postoperatively (p = 0.001) and from 7 (range, 6 to 10 to 3 (range, 2 to 8) (p = 0.001), respectively. At the final follow-up evaluation, 6 of 8 patients were able to walk continuously at least 30 minutes with walking aid. Conclusion: The successful rate of salvage arthrodesis with femoral head allograft was 75% (Six of total 8 patients). The incidence rate of allograft collapse was 50% (Four of total 8 patients).

scholarly journals Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773199 ◽  
Author(s):  
Anthony J. Dugarte ◽  
Rocklend J. Davis ◽  
T. Sean Lynch ◽  
Mark S. Schickendantz ◽  
Lutul D. Farrow
Keyword(s):  
Internal Rotation ◽  
Shoulder Pain ◽  
Older Patients ◽  
Morphological Changes ◽  
Young Female ◽  
Coracoid Process ◽  
Subscapularis Tendon ◽  
The Mean ◽  
Tendon Tears ◽  
Anterior Shoulder Pain

Background: Subcoracoid impingement has been implicated as a cause of anterior shoulder pain and subscapularis tendon tears. Purpose/Hypothesis: The purpose of this study was to evaluate the bony anatomy of the coracoid process and the subcoracoid space. We hypothesized that age-related changes that may contribute to subcoracoid impingement occur in the subcoracoid space. Study Design: Descriptive laboratory study. Methods: In total, 418 skeletal shoulder specimens were included in this study. We utilized 214 shoulders from a young cohort (25-35 years of age) and 204 shoulders from an older cohort (>55 years of age) for comparison. We evaluated several morphological characteristics of the coracoid process and the subcoracoid space: coracoid width, coracoid shape, coracoid thickness, and subcoracoid distance. Each coracoid was observed for the presence of spurring or other morphological changes. Results: The mean anteroposterior (AP) thickness of the coracoid tip was 7.9 and 9.4 mm in our young female and male cohorts, respectively, while the mean AP thickness was 8.1 and 9.7 mm in our older female and male cohorts, respectively. The coracoid tip was hooked in 31 of 108 young female shoulders compared with 55 of 102 older female shoulders, and the coracoid tip was hooked in 25 of 106 young male shoulders compared with 45 of 102 older male shoulders. The mean subcoracoid distance in neutral rotation was 14.8 and 12.5 mm in young and older female shoulders, respectively, while the mean subcoracoid distance in internal rotation in these same cohorts was 8.7 and 7.0 mm, respectively. The mean subcoracoid distance in neutral rotation was 14.8 and 13.3 mm in young and older male shoulders, respectively, while the mean subcoracoid distance in internal rotation was 8.6 and 8.1 mm in young and older male shoulders, respectively. Conclusion: The principal findings of our study demonstrate that anatomic changes implicated in subcoracoid impingement may be developmental and worsen with age. The subcoracoid space was narrower in our older cohort of shoulders. Additionally, these older shoulders also had a greater AP width and a more hooked coracoid compared with young shoulders. Clinical Relevance: Narrowing of the subcoracoid space has been shown to be implicated as a cause of anterior shoulder pain and subscapularis tendon tears. This is the first study to show that the morphological changes implicated in subcoracoid impingement become more prevalent with age. This may help to explain the increasing prevalence of subscapularis tendon tears in older patients. Furthermore, subcoracoid decompression may be seen as an option for older patients with anterior shoulder pain and subscapularis tendon tears.

Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

2020 ◽  
Vol 48 (9) ◽  
pp. 2081-2089
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Domingo Luis Muscolo ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Bone Block ◽  
Return To Sports ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean ◽  
Anterior Glenohumeral Instability

Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation ( P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points ( P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up ( P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points ( P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

scholarly journals Osseous Healing With Nonrigid Suture Fixation in the Arthroscopic Latarjet Procedure

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096448
Author(s):  
Jack W. Weick ◽  
Vivek Kalia ◽  
Emily Pacheco ◽  
Jon A. Jacobson ◽  
Michael T. Freehill
Keyword(s):  
Ct Scan ◽  
Case Series ◽  
Ct Scans ◽  
Suture Fixation ◽  
Latarjet Procedure ◽  
Average Percentage ◽  
Cortical Button ◽  
The Mean ◽  
Graft Migration

Background: The Latarjet procedure is a popular means to surgically address anterior glenohumeral joint instability. Although the Latarjet procedure is becoming increasingly common, challenges persist and include postoperative complications secondary to use of the conventional 2 bicortical fixation screws. Recently, a novel surgical technique using a guided surgical approach for graft positioning with nonrigid fixation via a suture suspensory system has been described. Purpose: To evaluate healing rates and stability of the grafts in patients who underwent this new Latarjet technique. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively gathered anonymized computed tomography (CT) data sets from a total of 107 patients who underwent nonrigid suture fixation using a cortical button fixation for anterior glenohumeral instability. Of the 107 patients, 45 had CT scans performed at 2 different time periods. The CT scans of each patient were compared by 2 fellowship-trained musculoskeletal radiologists. Data recorded included age, sex, date of scan, initial graft position on the glenoid, presence and degree of graft migration relative to the equator on follow-up scan, and percentage of osseous healing (as assessed by osseous bridging) on the follow-up scan. Descriptive statistics were calculated to evaluate the average migration and average percentage of healing at both time points. Results: Our population (n = 45) consisted of 38 men (84.4%) and 7 women (15.6%). The mean age was 27.1 ± 1.1 years. The mean time between initial CT scan (2 weeks postoperatively) and follow-up CT scan was 26 ± 2 weeks. On follow-up scan, reviewer 1 found 75.6% of patients had greater than 75% healing, and reviewer 2 found 70.2% of patients had greater than 75% healing. The center of the graft was measured at or below the equator on follow-up examination in 43 of 45 (95.6%) patients by reviewer 1 and 44 of 45 (97.8%) patients by reviewer 2. Conclusion: Based on these findings, nonrigid suture fixation using a cortical button device offers an effective alternative to traditional screw fixation for the Latarjet procedure with a high level of osseous healing and minimal graft migration.

scholarly journals Modified Arthroscopic Latarjet Procedure: Suture-Button Fixation Achieves Excellent Remodeling at 3-Year Follow-up

2019 ◽  
Vol 48 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Jian Xu ◽  
Haifeng Liu ◽  
Wei Lu ◽  
Zhenhan Deng ◽  
Weimin Zhu ◽  
...  
Keyword(s):  
Humeral Head ◽  
Case Series ◽  
Concentric Circle ◽  
Vertical Position ◽  
Latarjet Procedure ◽  
Level Of Evidence ◽  
Suture Button ◽  
The Mean ◽  
Best Fit

Background: Some studies have advocated the use of suture-button fixation during the Latarjet procedure to reduce complications associated with screw fixation. However, the sample size of these studies is relatively small, and their follow-up period is short. Purpose: To investigate the efficacy of the suture-button Latarjet procedure with at least 3 years of follow-up and remodeling of the coracoid graft. Study Design: Case series; Level of evidence, 4. Methods: A total of 152 patients who underwent the suture-button Latarjet procedure between February 2013 and February 2016 were selected, and 128 patients who met the inclusion criteria were enrolled in this study. Preoperative and postoperative clinical results were assessed. The position and healing condition of the coracoid graft and arthropathy of the glenoid and humeral head were also assessed using radiography and 3-dimensional computed tomography (CT). Results: The mean follow-up time was 40.3 ± 5.8 months. There were 102 patients included in this study. The mean visual analog scale score for pain during motion, the American Shoulder and Elbow Surgeons score, the Rowe score, and the Walch-Duplay score were improved considerably. A total of 100 grafts achieved bone union. The overall absorption rate was 12.6% ± 4.3%. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. A vertical position was achieved in 98 grafts (96% of all cases) immediately postoperatively, with the mean graft midline center at the 4 o’clock position. In the axial view, CT showed that 89 grafts were flush to the glenoid, whereas 2 and 11 grafts were fixed medially and laterally, respectively. In all cases, the bone graft and glenoid tended to extend toward each other to form concentric circles during the remodeling process. During follow-up observations, the height of the 11 grafts that were positioned laterally (ie, above the glenoid level) exhibited a wave-curved change. No arthropathy was observed in any patient. Conclusion: Patient outcomes were satisfactory after the modified arthroscopic suture-button Latarjet technique. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. The graft exhibited the phenomenon of ectatic growing when it fused with the glenoid and finally remodeled to a new concentric circle with the humeral head analogous to the original glenoid. Grafts positioned laterally did not cause arthropathy of the joints within the period of the study.

scholarly journals Clinical Results and MRI Evaluation of Patellar Osteochondral Fracture Fixation following Patellar Dislocation

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Krzysztof Małecki ◽  
Kornelia Pruchnik–Witosławska ◽  
Dominika Gwizdała ◽  
Piotr Grzelak ◽  
Paweł Flont ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Patellar Dislocation ◽  
Articular Surface ◽  
Clinical Results ◽  
Suture Technique ◽  
Osteochondral Fracture ◽  
Mri Scans ◽  
The Mean ◽  
Reconstructed Surface

Aim. The aim of the study was to analyze the clinical results and MRI scans after transpatellar osteochondral fracture fixation following patellar dislocation. Methods. Our study group comprised 17 patients with patellar dislocation followed by osteochondral fracture of the articular surface of the patella. All patients underwent surgery where the fractured osteochondral fragments of the patella were attached using the transpatellar suture technique. The mean age at the time of surgery was 14.1 years, and the mean follow-up period was 7.5 years. Results. The results of the patellar compression test and the apprehension test were negative in all patients. The mean Lysholm and Kujala scores were 89.2 and 89.6, respectively. The MRI scan revealed healing of the fixed fragment and restoration of the articular surface in all patients. In 16 cases, subchondral bone of the fixed fragment area was described as irregular: its articular cartilage was narrowed and not homogenous. Progressive degenerative changes were observed in the patellofemoral joint at follow-up in three patients. Conclusions. By fixing osteochondral fragments, the patellar articular surface can be restored. The MRI scans show that the cartilage in the reconstructed surface is narrowed after a mean 7.5-year follow-up.

scholarly journals Internal Fixation with a Locking T-Plate for Proximal Humeral Fractures in Patients Aged 65 Years and Older

2017 ◽  
Vol 20 (4) ◽  
pp. 217-221 ◽  
Author(s):  
Jae Kwang Yum ◽  
Min Kyu Seong ◽  
Chi Woon Hong
Keyword(s):  
Postoperative Complications ◽  
Internal Fixation ◽  
Internal Rotation ◽  
Proximal Humerus ◽  
External Rotation ◽  
Osteoporotic Fractures ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
The Mean

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older.METHODS: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients.RESULTS: The mean flexion was 155.0° (range, 90°?180°), the mean internal rotation was T8 (range, T6?L2), and the mean external rotation was 66.8° (range, 30°?80°). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was 131.4° at the 6-month follow-up. According to the Paavolainen method, “good” and “fair” radiographic results each accounted for 38 and 9 of the total patients, respectively.CONCLUSIONS: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.

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