Journal of Clinical Medicine

Research

12 pages, 2278 KiB

Open AccessArticle

Arthroscopically Assisted Coracoclavicular (CC) Stabilization Using a Suture Button Device for Lateral Clavicle Fractures with CC Ligament Injury

by Yoshimasa Saigo, Daichi Morikawa, Yoshiaki Itoigawa, Hirohisa Uehara, Takayuki Kawasaki, Takefumi Kaketa, Kenta Shibuya, Hironori Tsurukami, Fumitoshi Hatae, Yasutaka Yoshimura, Kazuki Yoshida and Muneaki Ishijima

J. Clin. Med. 2024, 13(6), 1773; https://doi.org/10.3390/jcm13061773 - 20 Mar 2024

Viewed by 442

Abstract

Background: Lateral clavicle fractures represent approximately 10–15% of all clavicle fractures. However, controversy exists regarding the optimal surgical treatment because of instability associated with the coracoclavicular (CC) ligament injury and a small lateral fragment. The purpose of this study was to evaluate the [...] Read more.

Background: Lateral clavicle fractures represent approximately 10–15% of all clavicle fractures. However, controversy exists regarding the optimal surgical treatment because of instability associated with the coracoclavicular (CC) ligament injury and a small lateral fragment. The purpose of this study was to evaluate the radiological and clinical outcomes of arthroscopically assisted CC stabilization using a suture button device for lateral clavicle fractures accompanied by CC ligament injury. Methods: A retrospective observational study involved six patients with modified Neer type IIB fractures, which were treated with the technique and followed for 12 months. Postoperative range of motion (ROM) and X-rays were evaluated every 3 months. Shoulder functional scores (University of California Los Angeles score, Japanese Orthopedics Association score) and visual analog scale (VAS) scores for pain (at rest, at night, and during motion) and for satisfaction were analyzed 12 months after surgery. Results: Early phase ROM recovery and excellent outcomes were achieved. All patients achieved bone union. Slight superior clavicle displacement and bone hole dilation occurred with no critical complications. Conclusions: Arthroscopically assisted CC stabilization with a suture button device for unstable lateral clavicle fractures can produce satisfactory radiological and clinical results. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

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13 pages, 2121 KiB

Open AccessArticle

Adduction Manipulation of the Glenohumeral Joint versus Physiotherapy for Atraumatic Rotator Cuff Tears: A Randomized Controlled Trial

by Hiroshi Karasuno, Junichiro Hamada, Yuichiro Yano, Hiroaki Tsutsui, Yoshihiro Hagiwara, Kazuhiro Endo and Takashi Saito

J. Clin. Med. 2023, 12(12), 4167; https://doi.org/10.3390/jcm12124167 - 20 Jun 2023

Viewed by 1208

Abstract

Background: Atraumatic rotator cuff tears (ARCTs) are frequently concomitant with adduction restriction of the glenohumeral joint (GHJ). Adduction manipulation (AM) removes the restriction and relieves pain. The present study aimed to investigate the clinical efficacy of AM versus physiotherapy (PT) in ARCTs. Methods: [...] Read more.

Background: Atraumatic rotator cuff tears (ARCTs) are frequently concomitant with adduction restriction of the glenohumeral joint (GHJ). Adduction manipulation (AM) removes the restriction and relieves pain. The present study aimed to investigate the clinical efficacy of AM versus physiotherapy (PT) in ARCTs. Methods: Eighty-eight patients with adduction restriction were allocated to the AM and PT groups (n = 44 per group). The glenohumeral adduction angle (GAA) was calculated using X-rays at the first and last follow-up appointments. We recorded pain severity (visual analog scale, VAS), flexion, abduction, external rotation (ER), internal rotation (IR), and American Shoulder and Elbow Society (ASES) and Constant scores at baseline and at 1-, 3-, 6-, and 12- month follow-ups. Results: Forty-three patients (23 males, average age 71.3 years) in the AM group and 41 (16 males, average age 70.7 years) in the PT group were consequently analyzed. At the 1-month follow-up, VAS, shoulder motion except ER, ASES and Constant scores were much better in the AM group than in the PT group, whereas those in the PT group improved gradually up to 12 months. At the final follow-up, flexion, abduction, and Constant score were significantly better in the AM group than in the PT group. The GAA at the initial and final examinations was −21.6° and −3.2°, respectively, in the AM group, and −21.1° and −14.4°, respectively, in the PT group. Conclusions: The AM procedure, which had better clinical efficacy than PT, is recommended as the first conservative treatment option for ARCTs. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

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17 pages, 6349 KiB

Open AccessArticle

Three-Dimensional Measurement of Proximal Humerus Fractures Displacement: A Computerized Analysis

by Thomas Ripoll, Mikaël Chelli, Tyler Johnston, Jean Chaoui, Marc-Olivier Gauci, Heloïse Vasseur, Sergii Poltaretskyi and Pascal Boileau

J. Clin. Med. 2023, 12(12), 4085; https://doi.org/10.3390/jcm12124085 - 16 Jun 2023

Viewed by 1787

Abstract

Neer’s classification for proximal humerus fractures (PHFs) uses 10 mm and 45° thresholds to distinguish displaced fragments. While this system was originally developed referencing 2D X-rays, fracture displacements occur in three dimensions. Our work aimed to develop a standardized and reliable computerized method [...] Read more.

Neer’s classification for proximal humerus fractures (PHFs) uses 10 mm and 45° thresholds to distinguish displaced fragments. While this system was originally developed referencing 2D X-rays, fracture displacements occur in three dimensions. Our work aimed to develop a standardized and reliable computerized method for measuring PHF 3D spatial displacements. CT scans of 77 PHFs were analyzed. A statistical shape model (SSM) was used to generate the pre-fracture humerus. This predicted proximal humerus was then used as a “layer” to manually reduce fragments to their native positions and quantify translation and rotation in three dimensions. 3D computerized measurements could be calculated for 96% of fractures and revealed that 47% of PHFs were displaced according to Neer’s criteria. Valgus and varus head rotations in the coronal plane were present in 39% and 45% of cases; these were greater than 45° in 8% of cases and were always associated with axial and sagittal rotations. When compared to 3D measurements, 2D methods underestimated the displacement of tuberosity fragments and did not accurately assess rotational displacements. The use of 3D measurements of fracture displacement is feasible with a computerized method and may help further refine PHF analysis and surgical planning. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

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11 pages, 5158 KiB

Open AccessArticle

Lesser Tuberosity Osteotomy Healing in Stemmed and Stemless Anatomic Shoulder Arthroplasty Is Higher with a Tensionable Construct and Affected by Body Mass Index and Tobacco Use

by Cameron Phillips, Ignacio Pasqualini, Hugo Barros, Mariano E. Menendez, Jeffrey L. Horinek, Javier Ardebol and Patrick J. Denard

J. Clin. Med. 2023, 12(3), 834; https://doi.org/10.3390/jcm12030834 - 20 Jan 2023

Viewed by 1158

Abstract

Background: This study compared the healing rates of lesser tuberosity osteotomy (LTO) for anatomic total shoulder arthroplasty (TSA), repaired with either standard knot tying or a tensionable construct. Second, we evaluated LTO healing in stemmed and stemless prostheses and identified the patient characteristics [...] Read more.

Background: This study compared the healing rates of lesser tuberosity osteotomy (LTO) for anatomic total shoulder arthroplasty (TSA), repaired with either standard knot tying or a tensionable construct. Second, we evaluated LTO healing in stemmed and stemless prostheses and identified the patient characteristics associated with healing. Methods: An analysis of consecutive primary TSAs approached with an LTO performed by a single surgeon between 2016 and 2020 was conducted. In the first two years of the study period, the LTOs were repaired with four #2 polyblend sutures passed through drill tunnels and around a short press-fit stem, followed by manual knot tying. Subsequently, a tensionable construct with suture tapes (TCB) was universally adopted. The radiographic appearance of the LTO was evaluated at a minimum of six months postoperatively. Results: A total of 340 patients met the study criteria, including 168 with manual knot tying, 84 TCB repairs with a stemmed implant, and 88 TCB repairs with a stemless implant. There was no difference in the baseline demographics between the groups. The LTO healing rate of the manual knot tying group (85%) was lower than that of the stemmed (95%) and stemless (98%) TCB groups (p < 0.001). When directly comparing the LTO healing between the stemmed and stemless TCB groups, the differences were not significant (p = 0.44). Across all constructs, the body mass index (BMI) was higher in the displaced nonunion group (p = 0.04), with a failure rate of 9.4% for a BMI between 30 and 40, 12.5% for a BMI between 40 and 50, and 28.6% for a BMI > 50. The rate of tobacco use was higher in the displaced nonunion group (p = 0.037). Conclusion: A tensionable construct improves LTO healing compared to manual knot tying, irrespective of the implant type. In addition to the surgical technique, the patient factors that influence tuberosity healing include a greater BMI and tobacco use. Level of evidence: Level III, retrospective comparative study. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

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11 pages, 262 KiB

Open AccessArticle

Sex Is Associated with the Success or Failure of Manipulation Alone for Joint Stiffness Associated with Rotator Cuff Repair

by Kohei Yamaura, Yutaka Mifune, Atsuyuki Inui, Hanako Nishimoto, Shintaro Mukohara, Tomoya Yoshikawa, Issei Shinohara, Tatsuo Kato, Takahiro Furukawa, Yuichi Hoshino, Takehiko Matsushita and Ryosuke Kuroda

J. Clin. Med. 2022, 11(23), 7192; https://doi.org/10.3390/jcm11237192 - 03 Dec 2022

Cited by 1 | Viewed by 1310

Abstract

Purpose: One-stage arthroscopic rotator cuff repair with manipulation has been recently performed for rotator cuff tears with shoulder stiffness, whereas some patients require capsular release due to severe stiffness that is difficult to treat with manipulation. The purpose of this study was to [...] Read more.

Purpose: One-stage arthroscopic rotator cuff repair with manipulation has been recently performed for rotator cuff tears with shoulder stiffness, whereas some patients require capsular release due to severe stiffness that is difficult to treat with manipulation. The purpose of this study was to analyze patient backgrounds and related factors of success or failure of manipulation alone for the treatment of shoulder stiffness associated with rotator cuff tears. Methods: This study included 64 patients with rotator cuff tears and shoulder stiffness who underwent arthroscopic rotator cuff repair with manipulation alone or with manipulation and capsular release of the glenohumeral joint at our institution between January 2015 and September 2019. The patients were divided into two groups: those whose shoulder stiffness could be improved by manipulation alone (Manipulation group) and those whose stiffness could not be improved by manipulation alone and required capsular release (Capsular release addition group). Analysis was performed between the two groups regarding patient backgrounds and related factors, including rotator cuff tear morphology and range of motions pre- and postoperatively. Results: Exactly 45 patients and 19 patients were included in Manipulation group and Capsular release addition group, respectively. A comparison between the two groups showed that patient age (p = 0.0040), sex (p = 0.0005), and injury due to trauma (p = 0.0018) were significantly related to the success or failure of manipulation alone. Multivariate logistic regression analysis on these three factors showed that sex (odds ratio, 5.5; p = 0.048) was significantly associated with the success or failure of manipulation alone. In both groups, the passive ROM of all patients improved at the last postoperative follow-up compared to their pre-operative values (p < 0.001), except for internal rotation in the Capsular release addition group (p = 0.49). Conclusion: Young male patients who have shoulder stiffness associated with rotator cuff tears should be considered for arthroscopic capsular release rather than manipulation. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

9 pages, 255 KiB

Open AccessArticle

Predictive Factors for Failure of Intraarticular Injection in Management of Adhesive Capsulitis of the Shoulder

by Stefan J. Hanish, Mathew L. Resnick, Hyunmin M. Kim and Matthew J. Smith

J. Clin. Med. 2022, 11(20), 6212; https://doi.org/10.3390/jcm11206212 - 21 Oct 2022

Cited by 2 | Viewed by 1444

Abstract

Intraarticular (IA) corticosteroid injections have been demonstrated to be an effective management for adhesive capsulitis in both the short- and mid-term. Yet, certain patients fail to improve both subjectively and clinically. This study aims to identify predictive factors for treatment failure of IA [...] Read more.

Intraarticular (IA) corticosteroid injections have been demonstrated to be an effective management for adhesive capsulitis in both the short- and mid-term. Yet, certain patients fail to improve both subjectively and clinically. This study aims to identify predictive factors for treatment failure of IA injections in management of adhesive capsulitis. A retrospective review found 533 patients undergoing IA corticosteroid or IA NSAID injection for adhesive capsulitis between June 2015 and May 2020 at a single healthcare institution. Patient demographics characteristics, comorbidities, pain scores, and range of motion were compared. Treatment failure was defined as need for subsequent IA injection within 6 months or progression to surgical management within 12 months. 152 patients (28.52%) experienced treatment failure of IA corticosteroid injection. Pre-injection pain scores were greater for those who experienced treatment failure (5.40 vs. 4.21, p < 0.05). Post-injection pain scores were greater for those who experienced treatment failure (3.77 vs. 2.17, p < 0.01). Reduced post-injection external rotation in abduction also predicted treatment failure (56.88° vs. 70.22°, p < 0.01). IA corticosteroid injections are associated with increased rates of failure and progression to surgical management when patients present with increased pain levels as well as with less improvement in pain levels and ROM following injection. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

Review

Jump to: Research, Other

12 pages, 263 KiB

Open AccessReview

Current Concepts in Management of Acromioclavicular Joint Injury

by Carter M. Lindborg, Richard D. Smith, Alec M. Reihl, Blake M. Bacevich, Mark Cote, Evan O’Donnell, Augustus D. Mazzocca and Ian Hutchinson

J. Clin. Med. 2024, 13(5), 1413; https://doi.org/10.3390/jcm13051413 - 29 Feb 2024

Viewed by 779

Abstract

Background: The management of acromioclavicular joint injuries requires a thorough understanding of the anatomy and biomechanics of the joint, as well as knowledge of the pertinent physical exam findings and classification to determine an appropriate treatment approach, whether operative or nonoperative. In [...] Read more.

Background: The management of acromioclavicular joint injuries requires a thorough understanding of the anatomy and biomechanics of the joint, as well as knowledge of the pertinent physical exam findings and classification to determine an appropriate treatment approach, whether operative or nonoperative. In this article, we present a narrative review of the current state of understanding surrounding these issues. Although there are a large number of options for operative intervention, we additionally present our experience with anatomic coracoclavicular ligament reconstruction (ACCR) with imbrication of the deltoid fascia. Methods: A retrospective review of prospectively collected data on a total of 45 patients who had undergone ACCR between 2003 and 2016 were collected. Results: We found that improvements were seen in American Shoulder and Elbow Surgeons Score (ASES) (53 ± 19 to 81 ± 23), Simple Shoulder Test (SST) (6 ± 3 to 12 ± 13), Constant–Murley (CM) (60 ± 18 to 92 ± 8), and Rowe (67 ± 14 to 89 ± 11) and the mean post-operative SANE score was 86 ± 17. Conclusions: ACCR has the advantage of addressing both horizontal and vertical stability with good outcomes. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

Other

Jump to: Research, Review

12 pages, 3338 KiB

Open AccessSystematic Review

Biceps Tenodesis Better Improves the Shoulder Function Compared with Tenotomy for Long Head of the Biceps Tendon Lesions: A Meta-Analysis of Randomised Controlled Trials

by Chunsen Zhang, Guang Yang, Tao Li, Long Pang, Yinghao Li, Lei Yao, Ran Li and Xin Tang

J. Clin. Med. 2023, 12(5), 1754; https://doi.org/10.3390/jcm12051754 - 22 Feb 2023

Cited by 1 | Viewed by 1071

Abstract

Purpose: Surgical options for long head of the biceps tendon (LHBT) lesions include tenotomy and tenodesis. This study aims to determine the optimal surgical strategy for LHBT lesions with updated evidence from randomised controlled trials (RCTs). Methods: Literature was retrieved from PubMed, Cochrane [...] Read more.

Purpose: Surgical options for long head of the biceps tendon (LHBT) lesions include tenotomy and tenodesis. This study aims to determine the optimal surgical strategy for LHBT lesions with updated evidence from randomised controlled trials (RCTs). Methods: Literature was retrieved from PubMed, Cochrane Library, Embase and Web of Science on 12 January 2022. Randomised controlled trials (RCTs) comparing the clinical outcomes of tenotomy and tenodesis were pooled in the meta-analyses. Results: Ten RCTs with 787 cases met the inclusion criteria, and were included in the meta-analysis. Constant scores (MD, −1.24; p = 0.001), improvement of Constant scores (MD, −1.54; p = 0.04), Simple Shoulder Test (SST) scores (MD, −0.73; p = 0.03) and improvement of SST (p < 0.05) were significantly better in patients with tenodesis. Tenotomy was associated with higher rates of Popeye deformity (OR, 3.34; p < 0.001) and cramping pain (OR, 3.36; p = 0.008]. No significant differences were noticed between tenotomy and tenodesis regarding pain (p = 0.59), American Shoulder and Elbow Surgeons (ASES) score (p = 0.42) and its improvement (p = 0.91), elbow flexion strength (p = 0.38), forearm supination strength (p = 0.68) and range of motion of shoulder external rotation (p = 0.62). Subgroup analyses showed higher Constant scores in all tenodesis types and significantly larger improvement of Constant scores regarding intracuff tenodesis (MD, −5.87; p = 0.001). Conclusions: According to the analyses of RCTs, tenodesis better improves shoulder function in terms of Constant scores and SST scores, and reduces the risk of Popeye deformity and cramping bicipital pain. Intracuff tenodesis might offer the best shoulder function as measured with Constant scores. However, tenotomy and tenodesis provide similar satisfactory results for pain relief, ASES score, biceps strength and shoulder range of motion. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)

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