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Journal of Shoulder and Elbow Surgery Sep 2021To investigate the effect of a dermal allograft superior capsule reconstruction (SCR) on kinematics and joint pressure biomechanics immediately after simulated superior...
PURPOSE
To investigate the effect of a dermal allograft superior capsule reconstruction (SCR) on kinematics and joint pressure biomechanics immediately after simulated superior irreparable rotator cuff tear.
METHODS
This controlled laboratory study tested 8 fresh-frozen cadaveric shoulders using a custom test frame. Balanced loading configuration centered the humeral head on the glenoid, and unbalanced load created a force pulling the head toward the acromion. Experimental conditions included the intact rotator cuff, irreparable supraspinatus tear (ISST), and dermal allograft SCR. A digital sensor measured glenohumeral and subacromial contact pressure maps, and a microscribe measured the acromion-humeral distance.
RESULTS
Glenohumeral contact pressure of ISST was 175% (295 ± 44 kPa; P = .018) of the intact rotator cuff value (169 ± 10 kPa) at 0° in the balanced condition and 176% (P = .048) of intact at 30°. SCR decreased glenohumeral contact pressure to 110% (185 ± 27 kPa; P = .044) of intact at 0° and to 95% (P = .034) at 30°. Unbalanced ISST contact pressure was 146% (365 ± 23 kPa; P = .009) of intact (250 ± 24 kPa) at 0° and 122% (P = .045) at 60°. SCR decreased contact pressures to 110% (274 ± 21 kPa; P = .039) of intact at 0° and to 89% (P = .003) at 60°. ISST increased superior migration of the humeral head, decreasing the acromion-humeral distance by 3.0 ± 0.6 mm (P = .006) in the unbalanced condition at 0°. SCR increased the acromion-humeral distance to a value similar to that of the intact cuff (P = .003). SCR significantly lowered subacromial pressures in the unbalanced condition.
CONCLUSIONS
In an irreparable supraspinatus tear model, the dermal allograft SCR showed competency in stabilizing the glenohumeral joint, decreasing glenohumeral and subacromial contact pressures, and increasing the acromion-humeral distance.
Topics: Allografts; Biomechanical Phenomena; Cadaver; Humans; Humeral Head; Range of Motion, Articular; Rotator Cuff Injuries; Shoulder Joint
PubMed: 33482371
DOI: 10.1016/j.jse.2020.11.024 -
Orthopaedic Surgery Jun 2021To find out which structure is crucial for the formation of shoulder impingement syndrome with the purpose of directing surgical procedures of subacromial decompression...
Morphological Characteristics of Acromion and Acromioclavicular Joint in Patients with Shoulder Impingement Syndrome and Related Recommendations: A Three-Dimensional Analysis Based on Multiplanar Reconstruction of Computed Tomography Scans.
UNLABELLED
To find out which structure is crucial for the formation of shoulder impingement syndrome with the purpose of directing surgical procedures of subacromial decompression and discussing whether it is necessary to manage acromioclavicular joint during operation and how to do it properly.
METHODS
This was a retrospective study. Clinical data and preoperative computed tomography (CT) images were collected from patients who were diagnosed with rotator cuff tears between January 2017 and August 2019 (sample size: 46) and those who were diagnosed without rotator cuff tears between March 2018 and August 2019 (sample size: 44) in our institution, respectively. Three-dimensional models of shoulders were established by multiplanar reconstruction of CT scans and measurements were performed on these models. The parameters such as the acromial length and width, the axial tilt, and the distance from acromial margin to glenoid plane were measured in an adjusted axial plane, and the critical shoulder angle and the spatial volume under acromioclavicular joint were measured in an adjusted coronal plane. The demographic characteristics, the acromial morphology and the spatial volume under acromioclavicular joint were compared to find significant differences between the two groups. The association between the axial tilt and the distance from acromial margin to glenoid plane was evaluated by an ordinary least squares linear regression.
RESULTS
The patients with rotator cuff tears consisted of 16 males and 30 females, among which 30 right shoulders and 16 left shoulders were included. The patients without rotator cuff tears consisted of 28 males and 16 females, among which 15 right shoulders and 29 left shoulders were involved. Significant differences between the groups were found in the acromial width (3.332 cm vs 3.111 cm), the axial tilt (33.765° vs 23.829°), the critical shoulder angle (32.630° vs 30.363°), the distance from anterior 3 cm of lateral acromial margin (range, 2.476 cm-3.302 cm vs 1.993 cm-3.089 cm), and anterior 0.9 cm of medial acromial margin (range, 0.967 cm-2.369 cm vs 0.668 cm-1.993 cm) to glenoid plane, and the spatial volume under acromioclavicular joint (1.089 cm vs 1.446 cm) in the two groups. No significant differences were found in the age (60.0 years vs 58.3 years) or the acromial length (4.187 cm vs 4.184 cm). Significant association was revealed by linear regression analysis between the axial tilt and the distance from anterior two-thirds of lateral acromial margin to glenoid plane, and similar association was also found in the anterior half of medial margin.
CONCLUSION
Anterior two-thirds of lateral acromial margin, anterior half of medial acromial margin, and inferior aspect of acromioclavicular joint are crucial structures and need to be fully decompressed when treating patients with rotator cuff tears.
Topics: Acromioclavicular Joint; Acromion; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Retrospective Studies; Rotator Cuff Injuries; Shoulder Impingement Syndrome; Tomography, X-Ray Computed
PubMed: 33955185
DOI: 10.1111/os.13001 -
Orthopaedics & Traumatology, Surgery &... Apr 2022Scapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between...
PURPOSE
Scapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between critical shoulder angle (CSA) and acromion index (AI) with partial-bursal side and full thickness RCT and the size of the RCT.
HYPOTHESIS
The hypothesis was that CSA and AI would be greater in partial bursal-side RCT and full-thickness RCT patients and would increase with the size of the RCT.
METHODS
This retrospective study assessed 218 patients who had standard shoulder radiographs and magnetic resonance imaging. Patients were divided into three groups: intact rotator cuff (68), partial bursal-side RCT (34) and full-thickness RCT (116). In the second part, full-thickness RCT patients were divided into four groups according to RCT size; small (<1cm), medium (1-3cm), large (3-5cm) and massive (>5cm). AI and CSA measurements were evaluated from radiographs.
RESULTS
The mean CSA was 32.8̊ in control group, 34.3̊ in partial group and 36.9̊ in full-thickness group. The mean AI was 0.66, 0.68 and 0.72 respectively. Significant difference was found in AI and CSA between full thickness RCT and intact RC group (p<0.01), and partial RCT and full thickness RCT group (p<0.05) in paired comparisons. In full thickness RCT size groups the mean CSA was 34.2̊, 36.4̊, 39.0̊ and 40.8̊ and mean AI was 0.70, 0.71, 0.73 and 0.79 respectively. Significant difference was found between small-large, small-massive, medium-massive groups for CSA in paired comparisons and between small-massive, medium-massive groups for AI.
CONCLUSION
CSA and AI were significantly greater in full-thickness RCT patients and the size of the RCT increased with CSA and AI. The greater CSA and AI could be predictors for larger RCT.
LEVEL OF EVIDENCE
III; Cross-Sectional Design; Prognosis Study.
Topics: Acromion; Humans; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Shoulder Joint
PubMed: 34687950
DOI: 10.1016/j.otsr.2021.103122 -
Journal of Clinical Medicine Dec 2022The pathogenesis of subacromial impingement syndrome is controversially discussed. Assuming that bursal sided partial tears of the supraspinatus tendons are rather the...
The pathogenesis of subacromial impingement syndrome is controversially discussed. Assuming that bursal sided partial tears of the supraspinatus tendons are rather the result of a direct subacromial impact, the question arises whether there is a morphological risk configuration of the acromion and its spatial relation to the glenoid. Patients who underwent arthroscopic repair of either a partial articular supraspinatus tendon avulsion (PASTA) or bursal-sided supraspinatus tear (BURSA) were retrospectively allocated to two groups. Various previously described and new omometric parameters on standard anteroposterior and axial shoulder radiographs were analyzed. We hypothesized that acromial shape and its spatial relation to the glenoid may predispose to a specific partial supraspinatus tendon tear pattern. The measurements included the critical shoulder angle (CSA), the acromion index (AI), Bigliani acromial type and the new short sclerotic line, acromioclavicular offset angle (ACOA), and AC offset. The ratio length/width of acromion and the medial acromial offset were measured on axial radiographs. A total of 73 patients were allocated to either PASTA ( = 45) or BURSA ( = 28). The short sclerotic line showed a statistically significant difference between PASTA and BURSA (16.2 mm versus 13.1 mm, = 0.008). The ratio acromial width/length was statistically significant ( = 0.021), with BURSA having slightly greater acromial length (59 vs. 56 mm). The mean acromial offset was 42.9 mm for BURSA vs. 37.7 mm for PASTA ( = 0.021). ACOA and AC offset were both higher for BURSA, without reaching statistical significance. The CSA did not differ significantly between PASTA and BURSA (33.73° vs. 34.56°, = 0.062). The results revealed an association between a narrow acromial morphology, increased medial offset of the acromion in relation to the glenoid, and the presence of a short sclerotic line in the anteroposterior radiograph in bursal-sided tears of the supraspinatus tendon. Assuming that bursal-sided tears are rather the result of a direct conflict of the tendon with the undersurface of the acromion, this small subgroup of patients presenting with impingement syndrome might benefit from removing a harming acromial spur.
PubMed: 36615033
DOI: 10.3390/jcm12010233 -
The American Journal of Sports Medicine Sep 2023Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the...
BACKGROUND
Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear.
PURPOSE
To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear.
RESULTS
The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00]; = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19]; = .036) were associated with an increased risk of a rotator cuff retear.
CONCLUSION
Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.
Topics: Humans; Rotator Cuff Injuries; Cohort Studies; Radiography; Acromion; Rotator Cuff; Lacerations
PubMed: 37593843
DOI: 10.1177/03635465231187900 -
International Journal of Environmental... Dec 2021The purpose of this study was to explore the kinematical characteristics of jumping discus throwing. Eight male right-handed discus throwers who used to practice the...
The purpose of this study was to explore the kinematical characteristics of jumping discus throwing. Eight male right-handed discus throwers who used to practice the jumping throwing technique were recruited as participants. Two high-speed digital cameras with 120 Hz sampling rate were synchronized to capture the movement. The captured images were processed using a motion analysis suite, and the markers attached to joints on images were digitized manually. Based on the results, throwers should keep smaller the shoulder-hip twisting and the right anterior superior iliac spine (abbreviated: ASIS) in front of the right acromion (for right-handed throwers) from the instant the right foot lands to the instant the left foot lands, before the instant of the right foot lands; keep the discus at a depressed position; and reduce the time before discus release, particularly the time of the non-support phase and the second single-support phase. Additionally, release velocity must be improved because throwing distance is directly proportional to squared release velocity. In conclusion, the current study demonstrated comprehensive kinematical analyses, which can be used to instruct the jumping discus throwing technique with duration and angle characteristics of throwing movement for athletes by coaches with videos.
Topics: Athletes; Biomechanical Phenomena; Foot; Humans; Male; Movement; Track and Field
PubMed: 34949021
DOI: 10.3390/ijerph182413414 -
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 Orthopaedics Aug 2023Understanding demographic and MRI parameters with determinant role in rotator cuff tearing (RCT) is required to predict outcomes and select more appropriate treatment in...
PURPOSE
Understanding demographic and MRI parameters with determinant role in rotator cuff tearing (RCT) is required to predict outcomes and select more appropriate treatment in patients with non-traumatic shoulder pain. This study aimed to survey the association of rotator cuff tears with these factors.
METHODS
We performed this cross-sectional study on patients referred to Kashani Hospital with non-traumatic shoulder pain suspected of rotator cuff injuries from April 2020 to February 2021. We obtained their demographic data and MRI from electronic hospital records. After that, two radiologists reviewed MRI and recorded data. We employed the SPSS 23 software to organize the obtained results and statistical evaluations.
RESULTS
371 subjects, with the age of 48.61 ± 14.89 years, were included in our study, and 50% of them were male. The flat and down-sloping acromion and partial tearing of the supra and infraspinatus tendons were more frequent than the others. Gender could not consider as a determinant factor for the severity of tendon injuries, acromion types and variants. The relation of age to acromion morphology and the tendinopathy severity was significant. Remarkably, down-sloping acromion was higher at all the acromion shapes; however, it makes no difference in the level of supra and infraspinatus involvement. Moreover, we found that partial tearing was higher in all acromion types, except concave. This distribution was significant only for supraspinatus tears.
CONCLUSION
The clinical decision is the most important step in patients with RCT and MRI prognostic factors, which are helpful to improve the management of the cases. RCT in older patients and down-slope acromion was more severe than the others. According to the previous studies, acromion morphology (as an important determinant factor) in RCT could be influenced by age, as well.
PubMed: 37449026
DOI: 10.1016/j.jor.2023.06.012 -
The Journal of Manual & Manipulative... Aug 2021: Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head...
: Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.: Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP. The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.: The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three. In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly. Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.: The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.
Topics: Acromion; Arm; Head; Humans; Posture; Shoulder Joint
PubMed: 33250012
DOI: 10.1080/10669817.2020.1854010 -
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