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Open AccessArticle

The Glenoid Track Concept: On-Track and Off-Track—A Narrative Review

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Osteology 2022, 2(3), 129-136; https://doi.org/10.3390/osteology2030015 - 19 Jul 2022

Viewed by 1403

Abstract

Shoulder instability is described as a functional deficiency caused by excessive mobility of the humeral head over the glenoid. Various Glenohumeral Instability (GI) types have been described, but the traumatic anteroinferior form is the most frequent. The differences between engaging and non-engaging Hill–Sachs [...] Read more.

Shoulder instability is described as a functional deficiency caused by excessive mobility of the humeral head over the glenoid. Various Glenohumeral Instability (GI) types have been described, but the traumatic anteroinferior form is the most frequent. The differences between engaging and non-engaging Hill–Sachs lesions (HSLs) are linked to bone loss assessment. On the contrary, the novel difference between “on-track” and “off-track” lesions is strictly related to surgical techniques. The specific involvement of glenoid and humerus bone defects in recurrent GI was poorly assessed in the literature before the glenoid-track concept (GT). Magnetic Resonance Imaging (MRI) and Arthro-MRI have been widely used to identify and characterize lesions to the ligamentous structures. However, only new technologies (3 Tesla MRI) accurately detect HSLs. On the contrary, Computed Tomography (CT) has been adopted to quantify glenoid bone deficit. The GT concept is a valuable tool for evaluating anterior shoulder instability in patients. Shoulders out of alignment may require more than just an arthroscopic Bankart, and a remplissage or bone transfer may be necessary. Specifically, isolated Bankart repair should be considered in patients with recurrent instability and an on-track lesion with less than 25% glenoid bone loss. In off-track lesions and less than 25% glenoid bone loss, remplissage should be used. Bone transplant surgery is required for patients with a glenoid bone defect of more than 25%. This narrative review aims to report the most updated findings on “on-track” and “off-track” lesions in GI. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessArticle

Multi-Level Fibrotomy for Pediatric Patients with Cerebral Palsy: A Cohort Study

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Pier Francesco Costici

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Osteology 2021, 1(3), 141-148; https://doi.org/10.3390/osteology1030015 - 16 Aug 2021

Viewed by 2266

Abstract

Muscle retraction in Cerebral Palsy (CP) often requires surgical treatment. Multilevel procedures (using open or percutaneous techniques) are commonly performed in the ambulant patient with CP. The necessity to find new surgical techniques, reduce postoperative discomfort, and accelerate the healing process and rehabilitation [...] Read more.

Muscle retraction in Cerebral Palsy (CP) often requires surgical treatment. Multilevel procedures (using open or percutaneous techniques) are commonly performed in the ambulant patient with CP. The necessity to find new surgical techniques, reduce postoperative discomfort, and accelerate the healing process and rehabilitation is mandatory for these patients. A retrospective cohort study with 189 pediatric patients with CP was performed. The multilevel gradual fibrotomy of Ulzibat was modified using an ophthalmic knife. No significant complications were reported using our technique. Opioid drugs were not necessary, and casting time was reduced at the first 24 h. A significant Range of Motion recovery was assessed post-operatory and maintained at the last follow-up. Mean days of hospitalization were 2.2. The mean follow-up was 39 months (6–64 months). The modified multilevel fibrotomy reduces postoperative pain with easier patient management, resulting in a faster discharge from the hospital. However, the retrospective nature and the lack of a control group of the present study did not allow the authors to report significant results. Further studies with longer follow-up are in progress to obtain more certain data that confirm our preliminary results. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessArticle

Comparative Evaluation of Primary Stability between Different Diameters Multi-Scale Roughness Dental Implant by Solid Rigid Polyurethane Simulation

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Margherita Tumedei

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Morena Petrini

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Alessandro Cipollina

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Mariastella Di Carmine

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Adriano Piattelli

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Antonio Cucurullo

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Giovanna Iezzi

Osteology 2021, 1(1), 62-72; https://doi.org/10.3390/osteology1010006 - 12 Mar 2021

Cited by 2 | Viewed by 2564

Abstract

Background: Implant primary stability is determined by screw characteristics and surgical procedure. The aim of the present study was to evaluate, on a polyurethane model, the insertion torque (IT), removal torque (RT), and resonance frequency analysis (RFA) of multi-scale roughness dental implants of [...] Read more.

Background: Implant primary stability is determined by screw characteristics and surgical procedure. The aim of the present study was to evaluate, on a polyurethane model, the insertion torque (IT), removal torque (RT), and resonance frequency analysis (RFA) of multi-scale roughness dental implants of different diameters. Methods: Two implant sizes were tested on two polyurethane blocks (20 pounds per cubic foot (PCF) and 30 PCF): 3.0 diameter and 13 mm length and 5.0 diameter and 13 mm length. The IT, RT, and RFA were assessed. Results: A significant difference of IT and RT was present in favor of wider implants at both polyurethane densities. No statistical difference was present between the 5.0 diameter and 3.0 diameter implants at both polyurethane densities. A statistically increased RFA was reported for 5.0 implant 30 PCF polyurethane blocks. Conclusions: Multi-scale roughness dental implants of both diameters showed high insertion torque and primary stability on polyurethane blocks, which is valuable for implant loading protocols. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessArticle

Delayed Rehabilitation Protocol after Rotator Cuff Repair

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Osteology 2021, 1(1), 29-38; https://doi.org/10.3390/osteology1010003 - 26 Dec 2020

Cited by 8 | Viewed by 3494

Abstract

Rotator cuff tears are a frequent cause of shoulder pain that often require arthroscopic repair. After surgery an intense and well-studied rehabilitation protocol is needed to obtain the complete recovery of shoulder function. Fifty patients, who sustained arthroscopic rotator cuff repair for symptomatic, [...] Read more.

Rotator cuff tears are a frequent cause of shoulder pain that often require arthroscopic repair. After surgery an intense and well-studied rehabilitation protocol is needed to obtain the complete recovery of shoulder function. Fifty patients, who sustained arthroscopic rotator cuff repair for symptomatic, atraumatic and full-thickness supraspinatus tendon tear, were involved. According to our rehabilitation protocol, during the first four postoperative weeks, the arm was supported with an abduction sling pillow, and pendulum exercises, table slide and active elbow extension and flexion were conceded. Outcome measures (Oxford shoulder score (OSS), simple shoulder test (SST), patient-reported satisfaction), shoulder function (range of motion (ROM) and muscle strength), and MRI examination were evaluated. The mean OSS score and SST score increased from 16 to 30.2 and from 5.3 to 11.4, respectively. Patient-reported satisfaction was 96%. At 12 months, patients improved ROM and muscle strength. Postoperative passive anterior elevation was 176; external rotation averaged 47; internal rotation was 90. Postoperative muscle strength during anterior elevation was 8.3 ± 2.2 kg, internal rotation 6.8 ± 3 kg, external rotation 5.5 ± 2.3 kg. Five out of seven patients with recurrent tears evaluated their results as satisfactory. They reported improvements in terms of OSS and SST mean scores despite recurrent tears; therefore, they did not undergo revision surgery. The delayed postoperative physical therapy protocol was associated with improvements in the outcome measures and shoulder function compared to the preoperatory state and rotator cuff healing demonstrated by MRI. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

Review

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Open AccessReview

The Remplissage Technique for Hill–Sachs Lesions in Competitive Athletes: A Narrative Review

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Michele Novi

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Simone Nicoletti

Osteology 2022, 2(4), 152-160; https://doi.org/10.3390/osteology2040018 - 17 Nov 2022

Viewed by 870

Abstract

Anterior shoulder instability with Bankart lesion and associated posterior humeral head injury (Hill–Sachs) is common in athletes. Several treatments have been proposed for the management of the Hill–Sachs lesion, from bone grafts or rotation osteotomies to capsulotendinous interposition, such as remplissage. This procedure [...] Read more.

Anterior shoulder instability with Bankart lesion and associated posterior humeral head injury (Hill–Sachs) is common in athletes. Several treatments have been proposed for the management of the Hill–Sachs lesion, from bone grafts or rotation osteotomies to capsulotendinous interposition, such as remplissage. This procedure has been shown to be safe and effective in increasing glenohumeral stability. However, the correct indication concerning the bone defect and its effects in terms of range of motion and function, especially in highly demanding patients, is still debated. This narrative review aims to present the current state-of-the-art of the posterior capsulotenodesis in association with Bankart repair, for treating anterior shoulder instability in competitive athletes. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessReview

Percutaneous Vertebroplasty: A Minimally Invasive Procedure for the Management of Vertebral Compression Fractures

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Rosario Francesco Grasso

Osteology 2022, 2(4), 139-151; https://doi.org/10.3390/osteology2040017 - 10 Oct 2022

Viewed by 812

Abstract

A vertebral compression fracture (VCF) is a pathological condition, which can be caused by osteoporotic degeneration or metastatic disease. It represents a socioeconomic burden on healthcare systems, due to increased pain, long-term morbidity, and disability. Vertebroplasty (VP) is an image-guided, minimally invasive, interventional [...] Read more.

A vertebral compression fracture (VCF) is a pathological condition, which can be caused by osteoporotic degeneration or metastatic disease. It represents a socioeconomic burden on healthcare systems, due to increased pain, long-term morbidity, and disability. Vertebroplasty (VP) is an image-guided, minimally invasive, interventional procedure, in which bone cement is injected via a percutaneous approach into the vertebral soma, to provide structural support and to stabilize the weakened structure. The aim of this narrative review is to describe vertebral column biomechanics, as well as indications, contraindications, and techniques to successfully perform VP for the treatment of VCFs. Methods: We performed a narrative literature review on the main online databases regarding VP, and mainly focused on patient selection, preoperative imaging, procedural steps, complications, and outcomes. Results: The most recent evidence in the literature has shown that VP provides significant and sustained clinical benefits for patients with a VCF, and it is indicated in patients with comorbidities that make prolonged bed rest dangerous, patients with fractures that fail to heal, and as palliation in patients with a painful VCF due to metastatic disease. Conclusions: VP is considered to be a safe and effective treatment option for the treatment of osteoporotic and malignant VCFs that are resistant to adequate medical therapy. Patient selection, preprocedural evaluation, and proper technique execution are the key points to obtain the best outcomes and to minimize complications. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessReview

Current Perspectives on Rotator Cuff Disease

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Barbara Juliette Mera

Osteology 2022, 2(2), 62-69; https://doi.org/10.3390/osteology2020007 - 29 Mar 2022

Cited by 1 | Viewed by 1189

Abstract

Rotator cuff (RC) disease, defined as any pathological state of the rotator cuff, is one of the most common shoulder conditions worldwide. It accounts for 70% of shoulder pain and dysfunction in adults and is the third most prevalent musculoskeletal disorder. Currently, the [...] Read more.

Rotator cuff (RC) disease, defined as any pathological state of the rotator cuff, is one of the most common shoulder conditions worldwide. It accounts for 70% of shoulder pain and dysfunction in adults and is the third most prevalent musculoskeletal disorder. Currently, the main issue with rotator cuff disease is that surgery represents the most common treatment performed. However, rotator cuff surgeries have a high failure rate positively correlated with the severity of the tear, and a high re-tear rate. This review will focus on the current research perspectives of rotator cuff repairs as well as new advances in the field. Current research is shifting its focus to target the healing and tendon repair process in an aim to decrease the failure rates. The bulk of research right now is within biologic methods based on growth factors, repair scaffolds, and stem cells that promote healing. Among this, researchers are continuously trying to improve surgical techniques. The complement of both methods should pave the way for much more effective, longer-lasting rotator cuff repairs. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

Open AccessReview

Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review

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Francesca Gargano

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Sabrina Migliorelli

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Alessandro Strumia

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Massimiliano Carassiti

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Felice Eugenio Agrò

Osteology 2022, 2(1), 52-61; https://doi.org/10.3390/osteology2010006 - 06 Mar 2022

Cited by 2 | Viewed by 2012

Abstract

Shoulder surgery has radically evolved within the last 70 years, from a marginal orthopedic sub-specialty to an area of great research and advancement; consequently, anesthetic techniques have undergone important development. In fact, a wide variety of anesthetic strategies have emerged, to provide anesthesia [...] Read more.

Shoulder surgery has radically evolved within the last 70 years, from a marginal orthopedic sub-specialty to an area of great research and advancement; consequently, anesthetic techniques have undergone important development. In fact, a wide variety of anesthetic strategies have emerged, to provide anesthesia and post-operative analgesia: general anesthesia (GA), regional anesthesia (RA), or combined GA and RA. A literature review on online databases was carried out about the different anesthetic approaches for shoulder surgery and their evolution through the years, taking in consideration papers from 1929 to 2021. A comprehensive preoperative assessment of patients undergoing shoulder surgery allows to identify and modify potential risk factors and complications of general anesthesia. Moreover, the use of ultrasound-guided regional blocks could improve the effectiveness of these techniques and bring better postoperative outcomes. Anesthetic management for shoulder surgery has progressed drastically during the last century. More studies are needed to finally standardize anesthetic techniques for specific procedure. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

Open AccessReview

Patellar Instability in Pediatric Patients: Review of the Literature

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Filippo Familiari

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Riza Mert Cetik

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Gazi Huri

Osteology 2021, 1(4), 197-208; https://doi.org/10.3390/osteology1040019 - 24 Oct 2021

Cited by 1 | Viewed by 2192

Abstract

Patellar instability is a common pathology of the knee in pediatric patients. The management of this condition can be a challenge for the orthopedic surgeon, and a comprehensive understanding of the anatomy and biomechanics of the structures around the knee is of utmost [...] Read more.

Patellar instability is a common pathology of the knee in pediatric patients. The management of this condition can be a challenge for the orthopedic surgeon, and a comprehensive understanding of the anatomy and biomechanics of the structures around the knee is of utmost importance in formulating a treatment plan. Predisposing factors can be related to: trochlear and patellar morphological abnormalities, ligamentous stabilizers, limb geometries in the axial plane, and patellar height abnormalities. Traditionally, first-time dislocators have been treated non-operatively; however, recent evidence suggests that certain factors are related to recurrent instability, and surgical treatment may be considered even after the first dislocation. It is important to keep in mind that younger children with open physes are not suitable candidates for certain surgical techniques. In this comprehensive review, we aimed to focus on the most up-to-date information on this topic and emphasize the importance of individualizing the treatment of pediatric patients. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessReview

An Overview of Achilles Tendinopathy Management

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Osteology 2021, 1(4), 175-186; https://doi.org/10.3390/osteology1040017 - 29 Sep 2021

Cited by 3 | Viewed by 4097

Abstract

Background: Persistent tendon pain and swelling related to mechanical loading are the main signs of Achilles tendinopathy (AT). This condition is one of the most common tendinopathies of the lower limb affecting mainly athletes involved in running and jumping sports. Methods: we included [...] Read more.

Background: Persistent tendon pain and swelling related to mechanical loading are the main signs of Achilles tendinopathy (AT). This condition is one of the most common tendinopathies of the lower limb affecting mainly athletes involved in running and jumping sports. Methods: we included pivotal papers retrieved from the literature (Pubmed, Google Scholar, PEDro, and Scopus) to present an overview of the management of AT, with a specific focus on conservative management. Results: An accurate and timely diagnosis of AT is necessary to set up early treatments and to manage the problem conservatively. Diagnosis is primarily based on clinical assessment; instrumental imaging may be helpful in confirming the clinical diagnosis. Conservative treatment is effective in most cases, mainly using physical exercise based on eccentric training. Other non-surgical treatments such as extracorporeal shock wave therapy, thermotherapies, and injections can be added to exercise. Surgical treatment is indicated for patients where the conservative treatments of at least six months fails. Conclusions: Conflicting results from numerous studies hamper to identify gold standard treatments asking for further well-conducted level I and II research about the management of AT. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Other

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Open AccessOpinion

Calcific Shoulder Tendinopathy (CT): Influence of the Biochemical Process of Hydrolysis of HA (Hydroxyapatite) on the Choice of Ultrasound-Guided Percutaneous Treatment (with the Three-Needle Technique)

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Stefano Galletti

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Marco Miceli

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Salvatore Massimo Stella

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Osteology 2022, 2(3), 112-120; https://doi.org/10.3390/osteology2030013 - 27 Jun 2022

Viewed by 1000

Abstract

Calcific shoulder tendinopathy (CT) is a common condition involving the central part or insertion of the rotator cuff tendons (RC) or the subacromial-subdeltoid bursa (SASD). The calcific deposits consist of poorly crystallized calcium hydroxyapatite but the mechanism of their formation still remains unclear. [...] Read more.

Calcific shoulder tendinopathy (CT) is a common condition involving the central part or insertion of the rotator cuff tendons (RC) or the subacromial-subdeltoid bursa (SASD). The calcific deposits consist of poorly crystallized calcium hydroxyapatite but the mechanism of their formation still remains unclear. CT can be divided into three distinct stages, as reported by Uthhoff et al. Clinically, this condition varies with the extent of the calcification and the phase of the condition. In particular, the disorder is asymptomatic or may cause mild discomfort during the deposition of calcium, while it becomes acutely painful during the resorptive phase. US-PICT (ultrasound-guided percutaneous irrigation of calcific tendinopathy) is indicated in the acute phase (resorptive phase) of CT with significant pain relief and a very low rate of minor complications. The aim of this manuscript is to define the rationale of the ultrasound-guided percutaneous irrigation of calcific tendinopathy, correlating it with the sequence of biochemical processes that lead to the hydrolysis of hydroxyapatite. Furthermore, we will explain the reasons why we prefer using the three-needle technique for the dissolution of calcifications. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessCase Report

Angiomatoid Fibrous Histiocytoma: Case Presentation with Review of Literature

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Osteology 2021, 1(3), 112-117; https://doi.org/10.3390/osteology1030012 - 30 Jun 2021

Viewed by 1820

Abstract

Angiomatoid fibrous histiocytoma is a rare neoplasm with an intermediate malignant potential, that mostly occurs in the subcutis and features varying proportions of epithelioid, ovoid and spindle cells in a nodular and syncytial growth pattern, with hemorrhagic pseudovascular spaces. Here, we report the [...] Read more.

Angiomatoid fibrous histiocytoma is a rare neoplasm with an intermediate malignant potential, that mostly occurs in the subcutis and features varying proportions of epithelioid, ovoid and spindle cells in a nodular and syncytial growth pattern, with hemorrhagic pseudovascular spaces. Here, we report the clinical case of a 68-year-old man who presented with AFH on the right arm; the disease relapsed a few years after surgical excision. We also conduct a brief review of the literature, focusing on the biological and genetic characteristics and the differential diagnosis from other more or less similar entities. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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Open AccessConcept Paper

The Products of Bone Resorption and Their Roles in Metabolism: Lessons from the Study of Burns

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Gordon L. Klein

Osteology 2021, 1(2), 73-79; https://doi.org/10.3390/osteology1020007 - 01 Apr 2021

Cited by 1 | Viewed by 2103

Abstract

Surprisingly little is known about the factors released from bone during resorption and the metabolic roles they play. This paper describes what we have learned about factors released from bone, mainly through the study of burn injuries, and what roles they play in [...] Read more.

Surprisingly little is known about the factors released from bone during resorption and the metabolic roles they play. This paper describes what we have learned about factors released from bone, mainly through the study of burn injuries, and what roles they play in post-burn metabolism. From these studies, we know that calcium, phosphorus, and magnesium, along with transforming growth factor (TGF)-β, are released from bone following resorption. Additionally, studies in mice from Karsenty’s laboratory have indicated that undercarboxylated osteocalcin is also released from bone during resorption. Questions arising from these observations are discussed as well as a variety of potential conditions in which release of these factors could play a significant role in the pathophysiology of the conditions. Therapeutic implications of understanding the metabolic roles of these and as yet other unidentified factors are also raised. While much remains unknown, that which has been observed provides a glimpse of the potential importance of this area of study. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

Open AccessSystematic Review

Isolated Medial Subtalar Joint Dislocation during Sports Activities: A Systematic Review of the Literature with Individual Participant Data Analysis

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Carlo Biz

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Giovanni Baldin

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Claudia Cappelletto

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Nicola Luigi Bragazzi

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Pietro Nicoletti

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Alberto Crimì

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Pietro Ruggieri

Osteology 2021, 1(1), 48-61; https://doi.org/10.3390/osteology1010005 - 05 Mar 2021

Viewed by 2928

Abstract

In athletes, one of the most common injuries is a sprained ankle. If the energy of the trauma is particularly high, this type of injury can lead to an isolated medial dislocation of the subtalar joint (STJ), a rare condition poorly described in [...] Read more.

In athletes, one of the most common injuries is a sprained ankle. If the energy of the trauma is particularly high, this type of injury can lead to an isolated medial dislocation of the subtalar joint (STJ), a rare condition poorly described in the literature. The aim of this study was to verify if a reliable conservative treatment and a specific physiotherapy rehabilitation protocol in isolated medial dislocation of the STJ in athletes is described in the literature. A systematic review of the published literature of the last 11 years was performed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using three databases: Pubmed, Scopus, and Web of Science. The keywords used were “(subtalar OR talocalcaneal) AND dislocation”. We considered only studies that included professional or amateur athletes (athletic patients). We used the American Orthopedic Foot and Ankle Society (AOFAS) scale, range of motion (ROM) of the subtalar and ankle joint, subtalar and talonavicular joint osteoarthritis, and patient feedback to evaluate their outcomes. A total of 12 studies were included in our review, with a total of 26 athletic patients. Sixteen of them had good results with the correlation between the duration of immobilisation and the outcomes. Nevertheless, due to the small number of patients included in the analysed studies on this subject in the literature, there is not yet a univocal clinical protocol to treat the isolated medial subtalar joint dislocation (STJD) warranting further research in the field. Full article

(This article belongs to the Special Issue Feature Papers in Osteology)

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