Open Latarjet-Patte Procedure for Anterior Shoulder Stabilization: Critical Steps and Pearls for the Walch Technique

Background: Latarjet is a term used for different techniques and modifications to expose the glenoid and to transfer and fix the coracoid. The procedure is intricate and technically demanding. Outcomes and complications are heterogeneous in the literature. A master technique, the Walch technique, has been practiced for decades, with outstanding long-term results and patient satisfaction. Indications: Documented anterior dislocations with evidence for emergency reduction, with or without hyperlaxity and confirmation of a traumatic capsuloligamentous lesion. Contraindications include voluntary dislocations and multidirectional instability without these criteria. The Instability Severity Index Score can guide decision making on whether Bankart surgery is sufficient. Large Hill-Sachs lesions may be an indication for additional remplissage. Technique Description: Three key maneuvers and 6 surgical stages need to be mastered for consistent results. Key maneuvers include: (1) arm positioning for all stages, (2) retractor placement, and (3) safe conjoint tendon releases. Six key stages include: (1) coracoid exposure and initial release; (2) osteotomy and subsequent release; (3) bone preparation; (4) subscapularis split and arthrotomy; (5) 360° scapula neck exposure; and (6) cornerstone drill hole positioning, fixation, and simple capsuloplasty. Specific arm positioning facilitates coracoid exposure, releases, subscapularis split, arthrotomy, and retractor insertion, as well as capsular repair. A 360° anterior scapula neck exposure is crucial to drill the inferior cornerstone hole (2.5 for 4.0 partially threaded cancellous screw) 7 mm medial to the articular surface with mandatory direction parallel to the articular surface. The bone block can be dialed to the exact position, preventing lateral overhang. The capsule is closed to the coracoacromial ligament stump in 45° of external rotation. Results: A series of >80 cases with minimum 1-year follow-up (range: 1-5 years) demonstrated excellent results. Outcomes were good to excellent (small saphenous vein >80% in 95% of cases; Constant score >90% and Rowe score > 90%) in keeping with the Walch results (>1000 cases). The complication rate was low: 1 early coracoid fracture (1.3%), no dislocation and neurological complications, no new arthritis or progression, and good coracoid position without lateral overhang. Conclusion: The Walch technique, although technically demanding, provides excellent, consistently reproducible results once the 3 key surgical maneuvers and 6 stages of the procedure are mastered.

Download Full-text

Long-Term Results of Conservative Treatment of Osteomyelitis Spine

Journal of New Medical Technologies ◽

10.12737/5912 ◽

2014 ◽

Vol 21 (3) ◽

pp. 108-112 ◽

Cited By ~ 1

Author(s):

Веретельникова ◽

I. Veretelnikova ◽

Носков ◽

V. Noskov ◽

Стариков ◽

...

Keyword(s):

Conservative Treatment ◽

Degenerative Disc Disease ◽

Neurological Complications ◽

Long Term Results ◽

Bone Block ◽

Life Questionnaire ◽

Disc Disease ◽

Degenerative Disc ◽

Treatment Indications

The purpose of this study was to analyze long-term results of conservative treatment of patients with osteomyelitis of the spine. The authors examined 135 patients with osteomyelitis of the spine. Conservative treatment was made in 67 (50%) patients, other patients was carried out surgical treatment. Indications for treatment included: early diagnosis of the disease, the absence of sig-nificant lesions destruction of vertebral bodies, neurological complications, the presence of comorbidity and organ failure. The complex conservative treatment consisted of: antibacterial and detoxification therapies, orthopedic immobilization, immune-corrective and tonic medicines. In the preoperative and long-term period (time from 1 year to 15 years after surgery) the clinical, paraclinical, radiation methods and classification developed by Frankel H.L.et al (1969) were used for evaluation of neurological disorders. Long-term results included assessment of pain on VAS and quality of life questionnaire developed by Oswestry and SF-36. For statistical analysis of the material was used the software package Statistica 6.1 (license agreement BXXR006B092218FAN11). Long-term clinical, laboratory and x-ray methods didn’t shown recurrence of the disease. In 16 patients with neurological complications after treatment, regression of neurological symptoms was revealed. Pains in the spine, associated with symptoms of degenerative disc disease without neurological deficit, were established in some patients. At most patients the presence of spontaneous fibrous or bone block is marked at the level of former inflammatory process with symptoms of degenerative disc disease in the lower divisions. All patients returned to their previous jobs in terms from 6 to 12 months after the treatment. Thus, the authors concluded that conservative treatment of the patients with osteomyelitis of the spine is defensible, harmless and effective method in particular indicated cases.

Download Full-text

Characteristics of Effective and Safe Methods of Treatment for Fresh Fracture-Dislocations of the Proximal Humerus

Orthopedics Research and Traumatology - Open Journal ◽

10.17140/ortoj-5-117 ◽

2020 ◽

Vol 5 (1) ◽

pp. 3-8

Author(s):

Pavel Kogan ◽

◽

Dmitrii Chugaev ◽

Leonid Solomin ◽

◽

...

Keyword(s):

Proximal Humerus ◽

Articular Surface ◽

Constant Score ◽

Fracture Dislocation ◽

Long Term Results ◽

Average Score ◽

Surgical Interventions ◽

Factors Affecting ◽

Results Of Treatment ◽

Fracture Dislocations

Aim The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics. Patients and Methods This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis. Results Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed. Conclusion The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.

Download Full-text

GIRD syndrome in male handball and volleyball players: Is the decrease of total range of motion the turning point to pathology?

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-191767 ◽

2021 ◽

pp. 1-8

Author(s):

Jonas Schmalzl ◽

Helen Walter ◽

Wolfram Rothfischer ◽

Sören Blaich ◽

Christian Gerhardt ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

Turning Point ◽

External Rotation ◽

Constant Score ◽

High Rate ◽

Overhead Athletes ◽

Glenohumeral Internal Rotation Deficit ◽

Total Range ◽

Volleyball Players

BACKGROUND: Adaptations in glenohumeral range of motion may affect overhead athletes and lead to shoulder pathologies. OBJECTIVE: The purpose of this study was to evaluate glenohumeral internal rotation deficit (GIRD) and postero-superior impingement among male handball and volleyball players and the relationship between these pathologies and training level (amateur vs. professional), position (attack vs. no attack), experience (> 5 years vs. < 5 years) and sports. METHODS: Sixty-seven handball players and 67 volleyball players with a mean age of 25 [± 5] years were included. The range of motion including external and internal rotation in 90∘ abduction of the dominant and non-dominant shoulder was measured of each examined athlete. Visual analogue scale, disabilities of the shoulder and hand score, constant score and subjective shoulder value were recorded. The athletes were examined for postero-superior impingement and abduction force was measured with an isokinetic dynamometer. RESULTS: Internal rotation was significantly lower and external rotation was significantly greater in the dominant arm for both sports. 72% presented with GIRD. GIRD was more prevalent in athletes active for > 5 years (odds ratio (OR) 3), in those training > 3 times per week (OR 1.4) and in handball players (OR 2.7). 24% presented with postero-superior impingement. Players active for > 5 years (OR 1.22), professionals (OR 1.14), volleyball players (OR 1.19), offensive players (OR 2.2) and athletes with GIRD > 10∘ (OR 1.5) showed a higher prevalence of postero-superior impingement. CONCLUSION: GIRD is a common phenomenon in handball and volleyball players. Offensive players are frequently suffering from postero-superior impingement. GIRD > 10∘ leads in nearly 75% of the athletes to a decrease of total range of motion and a high rate of postero-superior impingement. Thus, a decreased range of motion seems to be the turning point from adaptation to pathology. Therefore, regular controls of range of motion and countermeasures by means of stretching the posterior shoulder joint should be integrated in the training content.

Download Full-text

Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699250 ◽

2008 ◽

Vol 41 (02) ◽

pp. 110-115

Author(s):

Mukund Jagannathan ◽

Maksud Devale ◽

Prashantha Kesari ◽

Siddharth Karanth

Keyword(s):

Temporomandibular Joint ◽

Articular Surface ◽

Superficial Temporal Artery ◽

Mouth Opening ◽

Temporal Artery ◽

Long Term Results ◽

Success Rates ◽

Tmj Ankylosis ◽

Potential Applicability ◽

Bony Segment

ABSTRACT Context: Surgery for the release of temporomandibular joint (TMJ) ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw. Aims: We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint. Settings and Design: There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA), which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint. Materials and Methods: Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid. Results: The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained. Conclusions: The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.

Download Full-text

Total Articular Knee Replacement Using Polyurethane

The Journal of Knee Surgery ◽

10.1055/s-0039-1677816 ◽

2019 ◽

Vol 33 (03) ◽

pp. 242-246

Author(s):

James W. Pritchett

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Articular Surface ◽

Long Term Results ◽

Material Loss ◽

Alternative Material ◽

Tibial Insert ◽

Total Knee ◽

Wear Simulator

AbstractThis study reviewed the early use of polyurethane for total knee resurfacing, the long-term results of polycarbonate urethane (PCU) for total knee replacement and conducted wear simulator testing of PCU. In 1959 and 1960, 10 patients underwent total articular polyurethane knee replacement (polyethylene was not available). The polyurethane was placed on the articular surface of the femur with metal surfaces on the tibia and patella. In 1996 and 1997, four patients received a newer PCU tibial insert in revision procedures; all had well-fixed prostheses, but no revision polyethylene implants were available. In addition, this study evaluated six new PCU tibial inserts in a 10-million cycle (Mc) wear simulator. All 10 of the early knees performed well clinically and 2 knees were functional for more than 30 years. Of the four more recent patients, all knees remain functional at more than 20 years' follow-up with no signs of wear or osteolysis. Wear simulator testing found mean material loss of 14.2 mg/Mc which equates to a volumetric wear of 11.9 mg/Mc, similar to the wear of conventional polyethylene. Polyurethane performs well as conventional polyethylene but not better than current cross-linked polyethylene tibial inserts. Its large wear particles (mean, 11 µm) and biocompatibility are less likely to cause an inflammatory response leading to pain and bone loss. Newer, superior polyurethanes can again be considered a candidate material for the tibial insert of a total knee replacement. A larger study may be able to validate polyurethane as an alternative material for joint replacement.

Download Full-text

Glenoid loosening and migration in reverse shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b4.bjj-2018-1275.r1 ◽

2019 ◽

Vol 101-B (4) ◽

pp. 461-469 ◽

Cited By ~ 6

Author(s):

A. Lädermann ◽

A. J. Schwitzguebel ◽

T. B. Edwards ◽

A. Godeneche ◽

L. Favard ◽

...

Keyword(s):

Conservative Treatment ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Multivariable Analysis ◽

Range Of Movement ◽

Original Cohort ◽

Glenoid Loosening

Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.

Download Full-text

Arthroscopic Coracoclavicular Ligament Reconstruction Using a Synthetic Polycaprolactone-Based Polyurethane Urea Tendon Graft: A Report of 5 Cases

Surgical Innovation ◽

10.1177/1553350618756150 ◽

2018 ◽

Vol 25 (3) ◽

pp. 224-229 ◽

Cited By ~ 1

Author(s):

Juha O. Ranne ◽

Terho U. Kainonen ◽

Lasse L. Lempainen ◽

Jussi A. Kosola ◽

Sami A. Kajander ◽

...

Keyword(s):

Cross Sections ◽

Ligament Reconstruction ◽

Constant Score ◽

Practical Method ◽

Drill Hole ◽

Tendon Graft ◽

Simple Shoulder Test ◽

Coracoclavicular Ligament Reconstruction ◽

The Mean

Background. Several techniques have been introduced to treat acromioclavicular (AC) separation using the semitendinosus tendon as a graft for coracoclavicular (CC) ligament reconstruction. However, the tendon may have been used previously or the patient may not want it harvested. Hence, synthetic tendon transfers have become increasingly popular. Methods. Five patients with chronic AC separations were treated. A synthetic polyurethane urea tendon graft (Artelon Tissue Reinforcement [ATR]) was chosen for its ability to partially transform into connective tissue. The patient follow-up period lasted 45 to 60 months. Results. The mean preoperative Constant Score increased from 64.8 to 100 postoperatively. The mean preoperative Simple Shoulder Test increased from 7.2 to 12 postoperatively. The mean postoperative increase of the CC distance was 1.5 mm. The mean expansion of the clavicular drill hole from the original was 2.1 mm. According to the postoperative magnetic resonance imaging, the grafts had healed well and the cross-sections of the grafts were up to 10.5 mm between the coracoid and the clavicle. Discussion. The synthetic ATR tendon strip was a practical method for reconstructing a torn CC ligament complex. The ATR graft appears promising for future CC ligament reconstructions.

Download Full-text

Early clinical results of minimally invasive coracoclavicular ligament reconstruction can be maintained at a minimum of five years’ follow-up

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2020-0114.r1 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 918-924

Author(s):

Steffen B. Rosslenbroich ◽

Katharina Heimann ◽

Jan Christoph Katthagen ◽

Clemens Koesters ◽

Oliver Riesenbeck ◽

...

Keyword(s):

Minimally Invasive ◽

Constant Score ◽

Clinical Results ◽

Long Term Results ◽

Short Term ◽

Ac Joint ◽

Ac Joint Dislocation ◽

Significant Difference

Aims There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive AC joint reconstruction (MINAR) and compare it to corresponding short-term data. Methods We assessed patients with a follow-up of at least five years after minimally invasive flip-button repair for high-grade AC joint dislocation. The clinical outcome was evaluated using the Constant score and a questionnaire. Ultrasound determined the coracoclavicular (CC) distance. Results of the current follow-up were compared to the short-term results of the same cohort. Results A total of 50 patients (three females, 47 males) were successfully followed up for a minimum of five years. The mean follow-up was 7.7 years (63 months to 132 months). The overall Constant score was 94.4 points (54 to 100) versus 97.7 points (83 to 100) for the contralateral side showing a significant difference for the operated shoulder (p = 0.013) The mean difference in the CC distance between the operated and the contralateral shoulder was 3.7 mm (0.2 to 7.8; p = 0.010). In total, 16% (n = 8) of patients showed recurrent instability. All these cases were performed within the first 16 months after introduction of this technique. A total of 84% (n = 42) of the patients were able to return to their previous occupations and sport activities. Comparison of short-term and long-term results revealed no significant difference for the Constant Score (p = 0.348) and the CC distance (p = 0.974). Conclusion The clinical outcome of MINAR is good to excellent after long-term follow-up and no significant differences were found compared to short-term results. We therefore suggest this is a reliable technique for surgical treatment of high-grade AC joint dislocation. Cite this article: Bone Joint J 2020;102-B(7):918–924.

Download Full-text

Syndesmotic Instability After Total Ankle Replacement

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00103 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0010

Author(s):

Roxa Ruiz ◽

Lukas Zwicky ◽

Beat Hintermann

Keyword(s):

Ankle Joint ◽

Tibial Component ◽

External Rotation ◽

Articular Surface ◽

Cyst Formation ◽

Total Ankle Replacement ◽

Hindfoot Alignment ◽

Additional Degree ◽

Component Design ◽

Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) evolved over the last decades and has been shown to be an effective concept in the treatment of ankle osteoarthritis (OA). In three-component designs, the second interface between polyethylene insert (PI) and tibial component allows the PI to find its position according the individual physiological properties. This was believed to decrease shear forces within the ankle joint. However, it is not clarified to which extent such an additional degree of freedom may overload the ligamentous structures of the ankle joint over time. This may in particular be the case for the syndesmotic ligaments. Therefore, the purpose of this study was to analyze all ankles after TAR that showed a symptomatic overload of the syndesmotic ligaments and to determine the potential consequences. Methods: Between 2003 and 2017, 31 ankles (females, 17; males 14; mean age 60 [40-79] years) were treated with a tibio-fibular fusion for a symptomatic instability of the syndesmosis. The indication for TAR was posttraumatic OA in 27 (87%), primary OA in 3 (10%), and hemochromatosis in one ankle (3%). The 31 ankles included 23 primary TAR (74%), 6 revision TAR (19%), and two take-down of a fusion and conversion to TAR (7%). Criteria for fusion were the presence of at least two of the followings: (1) tenderness over the syndesmosis, (2) pain while compressing the fibula against the tibia (squeeze test), (3) pain while rotating the foot externally (external rotation test), (4) widening of the syndesmosis on an anteroposterior view. Alignment of TAR (tibial articular surface [TAS] angle) and hindfoot alignment were measured on standard radiographs. Intraoperatively, the syndesmotic instability was confirmed before fusion. The wear of PI was documented. Results: After a mean of 63 (range, 4 – 152) months after TAR, all patients evidenced pain at the level of the syndesmosis of at least 3 months. 25 ankles (81%; 24 after posttraumatic OA) showed a widening of the syndesmotic space and 22 ankles (71%) of the medial clear space with lateral translation of the talus. The PI was seen to overlap the tibial component in 15 ankles (48%). Nine ankles (29%) evidenced cyst formation, and eight ankles (26%) showed a decrease in height of the PI; whereas, in 3 ankles (10%) a fracture of the PI was found. A valgus misalignment of the heel was found in 25 ankles (81%), a valgus TAS in 16 (52%) and a varus TAS in 11 ankles (36%). Conclusion: A syndesmotic instability after a three-component TAR apparently occurred mostly after posttraumatic OA, in particular if the heel was left in valgus. If the talus starts to move lateralward, the PI seems to be at risk for increased wear and finally mechanical failure (Figure 1). Therefore, a valgus misaligned heel should always be corrected during TAR implantation. If there is any sign of syndesmotic instability, a fusion should be considered. Further studies must proof whether in cases with a syndesmotic instability the use of a two-component design will be superior, as it stabilizes the talus in the coronal plane.

Download Full-text

Simultaneous, Bilateral Acute Subscapularis Ruptures and Their Arthroscopic Management

Case Reports in Orthopedics ◽

10.1155/2019/7964351 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Andrew M. Schwartz ◽

Jacob M. Wilson ◽

Kyle Hammond

Keyword(s):

External Rotation ◽

Primary Repair ◽

Constant Score ◽

Tendon Repair ◽

Functional Independence ◽

Young Person ◽

Successful Outcome ◽

Subscapularis Tendon ◽

Shoulder Injuries ◽

Early Therapy

We present the first known case of bilateral, acute ruptures of the subscapularis tendons following a bicycle accident in a 43-year-old male. He underwent right shoulder arthroscopic, anatomic subscapularis tendon repair two weeks postinjury, with the left side staged for surgical treatment six weeks after the index procedure. Postoperatively, the patient remained in a sling for 6 weeks before advancing with therapy protocols. The interval between arthroscopic treatments allowed for independence with activities of daily living and focused, early therapy for each shoulder. This approach yielded a right-sided constant score of 89 and subjective shoulder value of 90%; the left side was 87 and 90%, respectively, at 33 months postoperatively. The patient’s only postoperative complaint was slightly diminished external rotation, a near-universal limitation after unilateral repair. This represents a successful outcome that balances functional independence, concentrated rehabilitation, and adherence to safe indications for primary repair. While bilateral traumatic shoulder injuries in a young person is a rare clinical entity, early and staged treatment can lead to good patient outcomes.

Download Full-text