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Shoulder & Elbow Apr 2023There is limited evidence examining glenoid osteotomy as a treatment for posterior shoulder instability. (Review)
Review
BACKGROUND
There is limited evidence examining glenoid osteotomy as a treatment for posterior shoulder instability.
METHODS
A search of Medline, Embase, PubMed and Cochrane Central Register of Controlled Trials was conducted from the date of origin to 28th November 2019. Nine out of 3,408 retrieved studies met the inclusion criteria and quality was assessed using the Methodological Index for Non-randomized Studies tool.
RESULTS
In 356 shoulders, the main indication for osteotomy was excessive glenoid retroversion (greater than or equal to approximately -10°). The mean preoperative glenoid version was -15° (range, -35° to -5°). Post-operatively, the mean glenoid version was -6° (range, -28° to 13°) and an average correction of 10° (range, -1° to 30°) was observed. Range of motion increased significantly in most studies and all standardized outcome scores (Rowe, Constant-Murley, Oxford instability, Japan Shoulder Society Shoulder Instability Scoring and mean shoulder value) improved significantly with high rates of patient satisfaction (85%). A high complication rate (34%, = 120) was reported post-surgery, with frequent cases of persistent instability (20%, = 68) and fractures (e.g., glenoid neck and acromion) (4%, = 12). However, the revision rate was low (0.6%, = 2).
CONCLUSION
Glenoid osteotomy is an appropriate treatment for posterior shoulder instability secondary to excessive glenoid retroversion. However, the high rate of persistent instability should be considered when making treatment decisions. Systematic review; Level 4.
PubMed: 37035619
DOI: 10.1177/17585732211056053 -
Journal of Clinical Medicine Jan 2022Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments.... (Review)
Review
BACKGROUND
Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments. The purpose of this study was to review factors associated with increased acromial and scapular spine strain after RTSA from a biomechanical standpoint.
METHODS
A systematic review of the literature was conducted based on PRISMA guidelines. PubMed, Embase, OVID Medline, and CENTRAL databases were searched and strict inclusion and exclusion criteria were applied. Each article was assessed using the modified Downs and Black checklist to appraise the quality of included studies. Study selection, extraction of data, and assessment of methodological quality were carried out independently by two of the authors. Only biomechanical studies were considered.
RESULTS
Six biomechanical studies evaluated factors associated with increased acromial and scapular spine strain and stress. Significant increases in acromial and scapular spine strain were found with increasing lateralization of the glenosphere in four of the included studies. In two studies, glenosphere inferiorization consistently reduced acromial strain. The results concerning humeral lateralization were variable between four studies. Humeral component neck-shaft angle had no significant effect on acromial strain as analysed in one study. One study showed that scapular spine strain was significantly increased with a more posteriorly oriented acromion (55° vs. 43°; < 0.001). Another study showed that the transection of the coracoacromial ligament increased scapular spine strain in all abduction angles ( < 0.05).
CONCLUSIONS
Glenoid lateralization was consistently associated with increased acromial and scapular spine strain, whereas inferiorization of the glenosphere reduced strain in the biomechanical studies analysed in this systematic review. Humeral-sided lateralization may increase or decrease acromial or scapular spine strain. Independent of different design parameters, the transection of the coracoacromial ligament resulted in significantly increased strains and scapular spine strains were also increased when the acromion was more posteriorly oriented. The results found in this systematic review of biomechanical in-silico and in-vitro studies may help in the surgical planning of RTSA to mitigate complications associated with acromion and scapular spine fracture.
PubMed: 35054057
DOI: 10.3390/jcm11020361 -
The American Journal of Sports Medicine Feb 2020Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries...
BACKGROUND
Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes.
PURPOSE
To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint.
STUDY DESIGN
Systematic review.
METHODS
The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded.
RESULTS
Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases.
CONCLUSION
No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization.
Topics: Acromioclavicular Joint; Humans; Joint Instability; Ligaments, Articular; Radiography; Sutures
PubMed: 31013137
DOI: 10.1177/0363546519831013 -
Shoulder & Elbow Oct 2022Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing... (Review)
Review
BACKGROUND
Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening.
METHODS
This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures).
RESULTS
The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%.
CONCLUSION
This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.
PubMed: 36199509
DOI: 10.1177/17585732211019390 -
JSES Reviews, Reports, and Techniques Feb 2021Chronic shoulder dislocation has been treated by either anatomic shoulder arthroplasty (ASA) or reverse shoulder arthroplasty (RSA) with encouraging results. Although... (Review)
Review
Instability, complications, and functional outcomes after reverse shoulder arthroplasty and anatomic shoulder arthroplasty for chronic neglected shoulder dislocation: a systematic review.
BACKGROUND
Chronic shoulder dislocation has been treated by either anatomic shoulder arthroplasty (ASA) or reverse shoulder arthroplasty (RSA) with encouraging results. Although good results have been reported after both the procedures, several complications such as instability and glenoid failures have also been highlighted. The aim of this study was to aggregate the results that have been reported with the use of ASA or RSA in chronic shoulder dislocation and analyze the instability rates, complication rates, and functional outcomes.
METHODS
A comprehensive search was performed in May 2020 using PubMed, EMBASE, and Cochrane Library databases. Studies that reported on the outcomes after either ASA or RSA for chronic anterior dislocation (CAD) or chronic posterior dislocation (CPD) were included in the systematic review. Methodologic quality was assessed using the Methodological Index for Nonrandomized Studies appraisal tool for observational studies.
RESULTS
We aggregated 13 studies that included data on 128 patients with CAD and 51 patients with CPD. The combined weighted postoperative instability rate in the CAD group was significantly higher after ASA than after RSA ( = .04). There was no significant difference in the combined weighted instability rate between ASA in the CAD group and ASA in the CPD group ( = .37). The complications of RSA in CAD included glenoid base plate loosening, humeral shaft fractures, late infection, acromion fractures, and instability. The complications of the ASA in CAD and CPD included glenoid loosening and erosions, severe pain necessitating revision, severe superior migration of the head, redislocation with rupture of the cuff tendons, bone graft migration, instability, and 2 cases of neuropathies (median nerve and axillary nerve) that eventually resolved.
CONCLUSION
Postoperative instability was significantly more common after ASA than after RSA for chronic shoulder dislocations, but both RSA and ASA had a high complication rate in CAD. Shoulder arthroplasty improved the range of motion, functional outcomes, and pain in patients with chronic shoulder dislocation.
PubMed: 37588630
DOI: 10.1016/j.xrrt.2020.11.001 -
Journal of Orthopaedic Surgery and... Jan 2022Rotator cuff tears are one of the most common shoulder injuries in the older population. This study aimed to determine whether acromioplasty reliably decreases the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Rotator cuff tears are one of the most common shoulder injuries in the older population. This study aimed to determine whether acromioplasty reliably decreases the critical shoulder angle (CSA) and describe any associated complications.
METHODS
A systematic literature review was performed according to PRISMA guidelines using PubMed, EMBASE, Web of Science, and Cochrane Library Database. Two reviewers independently screened the titles and abstracts using prespecified criteria. Studies where the acromioplasty was performed as a surgical procedure were included. Patient characteristics and degree of CSA reduction were collected from each individual study. All statistical analyses were performed using Review Manager (RevMan) 5.4.1 software. A random-effects model was used for meta-analysis.
RESULTS
A total of 9 studies involving 1236 patients were included in the meta-analysis. The age of patients ranged from 23 to 82 years. The follow-up period ranged from 12 to 30 months. Of the 9 studies, 8 (88.9%) were retrospective, 1 (11.1%) was prospective, 5 were comparative, and 4 were case series. The mean CSA was significantly reduced from 36.1° ± 4.6° to 33.7° ± 4.2 (p < 0.05). The meta-analysis showed an overall best estimate of the mean difference in pre- and postoperative CSA equal to 2.63° (95% confidence interval: 2.15, 3.11] (p < 0.00001).
CONCLUSIONS
Acromioplasty can significantly reduce CSA, notably in cases of high preoperative CSA. In addition, the effect of lateral acromioplasty on the CSA was more significant compared to anterolateral acromioplasty. Acromioplasty was not associated with complications during the short-term follow-up.
Topics: Acromion; Adult; Aged; Aged, 80 and over; Arthroscopy; Female; Humans; Male; Middle Aged; Rotator Cuff Injuries; Shoulder; Shoulder Joint; Young Adult
PubMed: 35033137
DOI: 10.1186/s13018-022-02927-7 -
Arthroscopy : the Journal of... Dec 2019To scope the scientific literature and analyze the influence of bony risk factors for degenerative full-thickness primary rotator cuff tear. (Meta-Analysis)
Meta-Analysis
PURPOSE
To scope the scientific literature and analyze the influence of bony risk factors for degenerative full-thickness primary rotator cuff tear.
METHODS
A systematic review of databases PubMed, Scopus, EMBASE, and Cochrane Library was performed up to June 30, 2018. Meta-analysis was performed with mean difference (MD) or risk ratio for degenerative full-thickness rotator cuff injury, and when there were ≥3 studies for the considered potential risk factor. Methodologic quality was assessed using the Newcastle-Ottawa scale.
RESULTS
We analyzed 34 studies comprising 5,916 shoulders (3,369 shoulders with rotator cuff tear and 2,546 controls) and identified 19 potential risk factors for degenerative full-thickness rotator cuff tears. There was moderate evidence that a higher critical shoulder angle (MD = 4.41, 95% confidence interval [CI] 3.43 to 5.39), higher acromion index (MD = 0.06, 95% CI 0.04 to 0.09), and lower lateral acromion angles (MD = -7.11, 95% CI -8.32 to -5.90) were associated with degenerative full-thickness rotator cuff tears compared with controls. Moderate evidence showed that a type III acromion significantly increases the risk for full-thickness degenerative rotator cuff tear (risk ratio = 2.26, 95% CI 1.38 to 3.70).
CONCLUSION
There is moderate evidence that larger critical shoulder angle, higher acromion index, lower lateral acromion angles, and a type III acromion are significantly associated with degenerative full-thickness rotator cuff tears. Other potential risk factors identified showed insufficient evidence.
LEVEL OF EVIDENCE
Level IV, systematic review of level II to IV studies.
Topics: Acromion; Humans; Risk; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint
PubMed: 31785763
DOI: 10.1016/j.arthro.2019.07.005 -
Cureus Apr 2022The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization... (Review)
Review
The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. The review protocol was submitted with PROSPERO (ID: 319251). PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. Data were depicted by self-generated images. The initial search identified 174 articles. After applying the inclusion and exclusion criteria, 57 articles were shortlisted. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Twelve deltoid IMI sites and techniques were identified. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); mid-deltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The authors received no specific funding for this study except for the journal publication charges.
PubMed: 35592188
DOI: 10.7759/cureus.24172 -
Journal of Shoulder and Elbow Surgery Feb 2020The literature is unclear as to the optimal surgical management of a symptomatic os acromiale that has failed nonoperative treatment. Surgical options include excision,...
BACKGROUND
The literature is unclear as to the optimal surgical management of a symptomatic os acromiale that has failed nonoperative treatment. Surgical options include excision, acromioplasty, and open reduction and internal fixation. The purpose of this study is to summarize the described methods and compare their reported outcomes with the goal to provide direction on how to surgically manage os acromiale.
METHODS
We performed a systematic review of the current medical literature. Fifteen studies met all the inclusion criteria. Two hundred eleven total subjects (220 shoulders) underwent surgical treatment for a symptomatic os acromiale. There were 140 men and 71 women with a mean age of 49.6 ± 9.1 years. The mean follow-up duration was 40 ± 11.6 months. Surgical techniques used in the included studies were excision, acromioplasty, and open reduction with internal fixation. Concurrent surgical procedures performed were also included.
RESULTS
Meso-os acromiale was the most common type (167 cases, 94.4%). The most common surgical technique was internal fixation (135 cases, 60.8%), with screw fixation being the majority (76 cases, 56.3%). Excision (65 cases, 29.3%) was the second most used technique. The most common concurrent surgical procedure performed was rotator cuff repair (125 cases, 56.3%), followed by distal clavicle excision (31 cases, 14%).
CONCLUSIONS
All surgical techniques employed resulted in improvement in postsurgical clinical outcomes without any technique demonstrating superior results. Operative management of a symptomatic os acromiale that has failed initial nonoperative treatment leads to decreased symptoms and improvement in clinical outcomes.
Topics: Acromion; Arthroplasty; Fracture Fixation, Internal; Humans; Open Fracture Reduction; Treatment Failure
PubMed: 31474323
DOI: 10.1016/j.jse.2019.05.047 -
Arthroscopy : the Journal of... Feb 2022To determine whether posterior glenoid bone block augmentation performed for the treatment of recurrent posterior shoulder instability succeeds in restoring stability... (Review)
Review
PURPOSE
To determine whether posterior glenoid bone block augmentation performed for the treatment of recurrent posterior shoulder instability succeeds in restoring stability and is associated with rates of complications or clinical failures comparable to other glenoid bone augmentation procedures.
METHODS
A comprehensive search of PubMed, MEDLINE, and EMBASE databases was performed. Level of evidence studies I to IV pertaining to posterior bone block augmentation reporting on outcomes or complications were included. The search was carried out in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines.
RESULTS
Screening of titles, abstracts, and manuscripts with application of inclusion and exclusion criteria yielded 17 full-text articles reporting on 269 shoulders undergoing bone block augmentation. Surgical technique varied between studies with regard to graft type (iliac crest, 13 studies; scapular spine, 2; acromion, 1; distal tibia allograft, 1), graft positioning (medial to 1.5 cm lateral to glenoid surface, equatorial to subequatorial), and open versus arthroscopic technique (open, 10 studies; arthroscopic, 4; both, 3). Four of the 8 studies with pre- and postoperative patient-reported outcomes (PROs) showed significant improvements in these outcomes at final follow-up. The postoperative outcomes ranged from 60 to 90 for Rowe scores (n = 7 studies) and 79 to 90 for Walch-Duplay scores (n = 7 studies). Complications were commonly encountered, with high rates of recurrent instability (0% to 73%) and revision procedures (0% to 67%) across different studies.
CONCLUSION
Posterior bone block augmentation for recurrent posterior shoulder instability does not reliably yield substantial improvements in PROs, and complications are frequently observed. The substantial heterogeneity across studies and the small number of patients precludes any substantive judgements as to the superiority of one surgical technique over another.
LEVEL OF EVIDENCE
IV, systematic review of level III and IV studies.
Topics: Arthroscopy; Humans; Joint Instability; Scapula; Shoulder; Shoulder Dislocation; Shoulder Joint
PubMed: 34332053
DOI: 10.1016/j.arthro.2021.07.018