scholarly journals Middle trapezius transfer for treatment of irreparable supraspinatus tendon tears- anatomical feasibility study

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Philipp Moroder ◽  
Doruk Akgün ◽  
Lucca Lacheta ◽  
Kathi Thiele ◽  
Marvin Minkus ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Surgical Simulation ◽  
Muscle Length ◽  
Anatomical Study ◽  
Supraspinatus Tendon ◽  
Level Of Evidence ◽  
Pathway Length ◽  
Basic Science Study ◽  
Tendon Tears ◽  
Neurovascular Structures

Abstract Purpose The purpose of this study was to investigate the anatomical feasibility of a middle trapezius transfer below the acromion for treatment of irreparable supraspinatus tendon tears. Methods This study involved 20 human cadaveric shoulders in 10 full-body specimens. One shoulder in each specimen was dissected and assessed for muscle and tendon extent, force vectors, and distance to the neurovascular structures. The opposite shoulder was used to evaluate the surgical feasibility of the middle trapezius transfer via limited skin incisions along with an assessment of range of motion and risk of neurovascular injury following transfer. Results The harvested acromial insertion of the middle trapezius tendon showed an average muscle length of 11.7 ± 3.0 cm, tendon length of 2.7 ± 0.9 cm, footprint length of 4.3 ± 0.7 cm and footprint width of 1.4 ± 0.5 cm. The average angle between the non-transferred middle trapezius transfer and the supraspinatus was 33 ± 10° in the transversal plane and 34 ± 14° in the coronal plane. The mean distance from the acromion to the neurovascular bundle was 6.3 ± 1.3 cm (minimum: 4.0 cm). During surgical simulation there was sufficient excursion of the MTT without limitation of range of motion in a retracted scapular position but not in a protracted position. No injuries to the neurovascular structures were noted. Conclusion Transfer of the acromial portion of the middle trapezius for replacement of an irreparable supraspinatus seems to be feasible in terms of size, vector, excursion, mobility and safety. However, some concern regarding sufficiency of transfer excursion remains as scapula protraction can increase the pathway length of the transfer. Level of evidence Basic Science Study/Anatomical Study

scholarly journals Restriction of Passive Glenohumeral Abduction Combined With Normal Passive External Rotation Is a Diagnostic Feature of Calcific Tendinitis

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711775290 ◽  
Author(s):  
Anna Jungwirth-Weinberger ◽  
Christian Gerber ◽  
Glenn Boyce ◽  
Thorsten Jentzsch ◽  
Simon Roner ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Salient Feature ◽  
Supraspinatus Tendon ◽  
Calcific Tendinitis ◽  
Diagnostic Feature ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Standardized Protocol

Background: Passive glenohumeral range of motion may be characteristically limited to specific shoulder pathologies. While pain associated with loss of range of passive external glenohumeral rotation is recognized as a salient feature in adhesive capsulitis, restriction of glenohumeral range of motion in calcific tendinitis of the supraspinatus tendon has never been studied. Hypothesis: On the basis of clinical observation, we hypothesized that calcific tendinitis of the supraspinatus tendon is associated with loss of passive glenohumeral abduction without loss of external rotation. Study Design: Cohort study; Level of evidence, 3. Methods: Ranges of passive glenohumeral rotation and abduction, which are measured with a standardized protocol in our institution, were retrospectively reviewed and compared for patients diagnosed with either adhesive capsulitis or calcific tendinitis of the supraspinatus tendon. A total of 57 patients met the inclusion criteria for the calcific tendinitis, and 77 met the inclusion criteria for the adhesive capsulitis group. Results: When compared with the contralateral, unaffected shoulder, glenohumeral abduction in the calcific tendinitis group was restricted by a median of 10° (interquartile range [IQR], –20° to –5°) as opposed to glenohumeral external rotation, which was not restricted at all (median, 0°; IQR, 0° to 0°). The adhesive capsulitis group showed a median restriction of glenohumeral abduction of 40° (IQR, –50° to –30°) and a median restriction of passive glenohumeral external rotation of 40° (IQR, –60° to –30°). Conclusion: Calcific tendinitis of the supraspinatus does not typically cause loss of external rotation but is frequently associated with mild isolated restriction of abduction. This finding can be used to clinically differentiate adhesive capsulitis from calcific tendinitis.

Isolated and Combined Tears of the Subscapularis Tendon

2005 ◽  
Vol 33 (12) ◽  
pp. 1831-1837 ◽  
Author(s):  
Peter C. Kreuz ◽  
Andreas Remiger ◽  
Christoph Erggelet ◽  
Stefan Hinterwimmer ◽  
Philipp Niemeyer ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Constant Score ◽  
Young Patients ◽  
Case Series ◽  
Supraspinatus Tendon ◽  
Radiographic Examination ◽  
Subscapularis Tendon ◽  
Level Of Evidence ◽  
Tear Pattern ◽  
Tendon Tears

Background Isolated and combined subscapularis tendon tears are rare and are described in the literature only in small numbers. Hypothesis The outcome of surgical intervention for isolated and combined subscapularis tendon tears may be influenced by the tear pattern of the anterior rotator cuff and the period of time between trauma and surgical procedure. Study Design Case series; Level of evidence, 4. Methods Between 1994 and 1999, 34 shoulders with isolated traumatic tears (16 shoulders) or subscapularis tendon rupture combined with a supraspinatus tendon tear were treated operatively. The average patient age was 51 years, and the mean follow-up period was 37 months. For statistical analyses, the Friedman and Mann-Whitney tests were used. Results In patients with isolated tears, the Constant score rose from an average of 43.9 to 88.7 points (P <. 01), and in patients with combined tears, it rose from an average of 40.6 to 74.7 points (P <. 01). Isolated tears improved 14 points more than combined tears (P <. 05). The delay between trauma and surgical intervention was inversely proportional to the improvement in the Constant score. The Spearman coefficient of correlation was -0.97 in isolated tears and -0.89 in combined tears. Conclusions Young patients with isolated traumatic tears of the subscapularis tendon and immediate repair have the best prognostic factors for treatment. Accuracy in the trauma history and the clinical and radiographic examination is demanded.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

2021 ◽  
pp. 036354652199967
Author(s):  
Baris Kocaoglu ◽  
Ahmet Emre Paksoy ◽  
Simone Cerciello ◽  
Matthieu Ollivier ◽  
Romain Seil ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Repair ◽  
Gluteus Medius ◽  
Arthroscopic Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Significant Difference ◽  
Hip Abductor ◽  
Tendon Tears

Background: Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). Results: Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( P = .042); however, there was no significant difference between the SR and DR groups ( P = .32) in terms of retear rates. Conclusion: Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.

scholarly journals The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zewen Shi ◽  
Lin Shi ◽  
Xianjun Chen ◽  
Jiangtao Liu ◽  
Haihao Wu ◽  
...  
Keyword(s):  
Finite Element ◽  
Range Of Motion ◽  
Facet Joint ◽  
Adjacent Segment ◽  
Finite Element Models ◽  
Level Of Evidence ◽  
Element Analysis ◽  
Flexion Extension ◽  
Biomechanical Effect ◽  
Lumbar Range Of Motion

Abstract Background The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty. Methods Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded. Results The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base. Conclusion In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base. Level of evidence Level IV

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

Soft tissue abnormalities in Wassel Type VI radial polydactyly: a detailed anatomical study

2021 ◽  
Vol 46 (4) ◽  
pp. 352-359
Author(s):  
Susumu Saito ◽  
Itaru Tsuge ◽  
Hiroki Yamanaka ◽  
Naoki Morimoto
Keyword(s):  
Soft Tissue ◽  
Three Dimensional ◽  
Anatomical Study ◽  
Metacarpophalangeal Joint ◽  
Abductor Pollicis Brevis ◽  
Level Of Evidence ◽  
Thenar Muscle ◽  
Pulley System ◽  
Radial Deviation ◽  
Tissue Abnormalities

Wassel VI radial polydactyly is associated with metacarpal adduction and radial deviation of the metacarpophalangeal joint of the ulnar duplicate. The soft tissue abnormalities responsible for these deformities were characterized using preoperative multi-planar three-dimensional ultrasound and intraoperative observation in four patients. In all patients, the abductor pollicis brevis and superficial head of the flexor pollicis brevis inserted into the radial first metacarpal, whereas the adductor pollicis and deep head of the flexor pollicis brevis inserted into the ulnar thumb. Aberrant location of the flexor pollicis longus and absence of the A1 pulley system was associated with severe radial deviation. An additional superficial thenar muscle along the ulnar metacarpal was associated with minimal metacarpal adduction. Uneven forces on the ulnar duplicate could be associated with these characteristic deformities and joint instability. Knowledge of these abnormalities allows better planning of surgery and further insight into this rare radial polydactyly configuration. Level of evidence: II

scholarly journals Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198910
Author(s):  
Tetsuya Matsuura ◽  
Yuki Takata ◽  
Toshiyuki Iwame ◽  
Jyoji Iwase ◽  
Kenji Yokoyama ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Stress Test ◽  
Daily Maximum ◽  
Test Results ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Radiographic Images ◽  
Elbow Pain ◽  
Youth Baseball ◽  
Baseball Pitchers

Background: Reducing the number of pitches thrown is regarded as the most effective way to prevent throwing injuries in youth baseball pitchers. However, few studies have compared the effectiveness of limiting the pitch count versus the limiting the number of innings pitched in terms of elbow injuries. Hypothesis: We hypothesized that, compared with inning limits, pitch count limits would lead to greater decreases in elbow pain, range of motion deficits, positive moving valgus stress test results, and the risk of capitellar osteochondritis dissecans (OCD). Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed baseball pitchers aged 8 to 12 years in 2017 and 2018. Inning and pitch count limits in games were set to a daily maximum of 7 innings in 2017 and 70 pitches in 2018. Elbow pain, range of motion, and moving valgus stress test results were evaluated. The presence of capitellar OCD was assessed on ultrasonographic and radiographic images. Results: A total of 352 pitchers in 2017 and 367 pitchers in 2018 participated. The mean pitch count per game was lower in the pitch count limit (CL) group (52.5 ± 16.0) than in the inning limit (IL) group (98.2 ± 19.5) ( P < .001). Compared with the IL group, the CL group had significantly lower rates of elbow pain (40.9% vs 31.9%, respectively; P = .01) and reduced flexion (19.0% vs 10.6%, respectively; P = .001). Multivariate analysis revealed a significant association between elbow pain and age in both the IL and the CL groups ( P < .0001 and P = .02, respectively) and between OCD and elbow pain in the CL group ( P = .04). Conclusion: A pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.

Up-regulation of Glutamate in Painful Human Supraspinatus Tendon Tears

2014 ◽  
Vol 42 (8) ◽  
pp. 1955-1962 ◽  
Author(s):  
Sarah L. Franklin ◽  
Benjamin J.F. Dean ◽  
Kim Wheway ◽  
Bridget Watkins ◽  
Muhammad K. Javaid ◽  
...  
Keyword(s):  
Supraspinatus Tendon ◽  
Tendon Tears

Simulation of complex strabismus surgical procedures on goat eyes

2021 ◽  
pp. 112067212110451
Author(s):  
Amar Pujari ◽  
Vaishali Rakheja ◽  
Sujeeth Modaboyina ◽  
Deep Das ◽  
Manasi Tripathi ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Surgical Simulation ◽  
Muscle Length ◽  
Lateral Rectus ◽  
Muscle Quality ◽  
Oblique Muscle ◽  
Inferior Rectus ◽  
Superior Rectus ◽  
Ocular Muscle ◽  
Superior Oblique

Purpose: To describe the possibility of complex strabismus surgical simulation on goat eyes. Methods: The goat eyes were procured from local slaughterhouse with retained extra ocular muscle tissues. The obtained eyes were inspected for globe integrity, muscle quality, muscle length, and the surrounding teno-conjunctival layers. The included eyes were then segregated for surgical simulation based on their insertion and orientation (as oblique or recti), and they were mounted on a mannequin head, with a fixation suture at free end to simulate the resting tension. Additionally, as per necessary, extra muscles were also transplanted along desired sites to simulate human extra ocular muscle anatomy. Results: The inferior oblique, superior oblique, and all other four recti were successfully simulated in varying proportions in more than 50 eyes. Primarily, by simulating the lateral rectus, inferior rectus, and the inferior oblique muscle, staged weakening procedures of inferior oblique were successfully practiced (Fink’s recession, Park’s recession, Elliot and Nankin procedure, total anterior positioning, and antero-nasal trans-position or Stager’s procedure). Similarly, by simulating superior rectus, inferior rectus, lateral rectus, and the medial rectus muscles, half width transposition, full width transposition, and other complex procedures were practiced (Knapp’s procedure, augmented Knapp’s, Nishida’s procedure, Faden operation, and Y splitting procedure). Furthermore, by simulating superior oblique and the superior rectus muscles, superior oblique tuck, posterior tenectomy, loop tenotomy, and Harada Ito procedures were successfully practiced. Conclusions: On goat eyes, the complex strabismus surgical procedures can be successfully simulated and practiced after re-organizing the existing muscles in different patterns.

Sign in / Sign up

Export Citation Format

Share Document