-
Journal of Shoulder and Elbow Surgery Jun 2024Navigated augmented reality (AR) through a head-mounted display (HMD) has led to accurate glenoid component placement in reverse shoulder arthroplasty (RSA) in an...
Navigated augmented reality through a head-mounted display leads to low deviation between planned, intra- and post-operative parameters during glenoid component placement of reverse shoulder arthroplasty: a proof-of-concept case series.
BACKGROUND
Navigated augmented reality (AR) through a head-mounted display (HMD) has led to accurate glenoid component placement in reverse shoulder arthroplasty (RSA) in an in-vitro setting. The purpose of this study is to evaluate the deviation between planned, intra-, and postoperative inclination, retroversion, entry point and depth of the glenoid component placement during RSA, assisted by navigated AR through a HMD, in a surgical setting.
METHODS
A prospective, multicenter study was conducted. All consecutive patients undergoing RSA in two institutions, between August 2021 and January 2023, were considered potentially eligible for inclusion in the study. Inclusion criteria were: age >18 years, surgery assisted by AR through a HMD, and postoperative computed tomography (CT) scans at six weeks. All participants agreed to participate in the study and an informed consent was provided in all cases. Preoperative CT scans were undertaken for all cases and used for three-dimensional (3D) planning. Intra-operatively, glenoid preparation and component placement were assisted by a navigated AR system through a HMD in all patients. Intraoperative parameters were recorded by the system. A postoperative CT scan was undertaken at 6 weeks, and 3D reconstruction was used for obtaining postoperative parameters. The deviation between planned, intra-, and postoperative inclination, retroversion, entry point, and depth of the glenoid component placement was calculated. Outliers were defined as >5° for inclination and retroversion and >5 mm for entry point.
RESULTS
17 patients (9 females, 12 right shoulders) with a mean age of 72.8±9.1 years old (range, 47.0 to 82.0) met inclusion criteria. The mean deviation between intra- and postoperative measurements was 1.5°±1.0° (range, 0.0° to 3.0°) for inclination, 2.8°±1.5° (range, 1.0° to 4.5°) for retroversion, 1.8±1.0 mm (range, 0.7mm to 3.0mm) for entry point, and 1.9±1.9 mm (range, 0.0mm to 4.5mm) for depth. The mean deviation between planned and postoperative values was 2.5°±3.2° (range, 0.0° to 11.0°) for inclination, 3.4°±4.6° (range, 0.0° to 18.0°) for retroversion, 2.0±2.5 mm (range, 0.0° to 9.7°) for entry point, and 1.3±1.6 mm (range, 1.3mm to 4.5mm) for depth. There were no outliers between intra- and postoperative values and there were three outliers between planned and postoperative values. The mean time (minutes:seconds) for the tracker unit placement and the scapula registration was 03:02 (range, 01:48 to 04:26) and 08:16 (range, 02:09 to 17:58), respectively.
CONCLUSION
The use of a navigated AR system through a HMD in RSA led to low deviations between planned, intra-operative and postoperative parameters for glenoid component placement.
PubMed: 38942222
DOI: 10.1016/j.jse.2024.05.006 -
Arthroscopy : the Journal of... Jun 2024The aim of this study was to present the short-term outcomes of arthroscopic in-situ biceps tenodesis combined with partial rotator cuff repair in patients with massive...
PURPOSE
The aim of this study was to present the short-term outcomes of arthroscopic in-situ biceps tenodesis combined with partial rotator cuff repair in patients with massive irreparable rotator cuff tears (MIRCT) and minimal arthritis.
METHODS
A retrospective review was conducted utilizing prospectively maintained institutional databases to identify patients who had undergone a partial rotator cuff repair with in-situ biceps tenodesis between March 2017 to December 2022. Patients were included if they (1) were diagnosed pre- or intra-operatively with MIRCT, and (2) had complete pre-operative and minimum 1-year post-operative patient-reported outcome measures.
RESULTS
Thirty-nine patients met the eligibility criteria and were included for analysis. The mean age of the study participants was 65 ± 7 years (range: 46 - 76) with 76.9% (n = 30) being male. The average follow-up was 21 ± 12 months (range: 12 - 58). Patients experienced significant improvement in visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES) score, and subjective assessment numeric evaluation (SANE) score (p < 0.001 for all comparisons). The pre- to post-operative improvement was 3.1 ± 2.3 for VAS, 27.5 ± 20.6 for ASES, and 31.3 ± 24.8 for SANE. Postoperatively, the average scores for VAS, ASES, and SANE were 1.3 ± 1.5, 79.5 ± 17.0, and 69.6 ± 20.1, respectively. Twenty-six patients (66.7%) achieved the minimal clinically important difference (MCID) for VAS, thirty-three patients (84.6%) achieved the MCID for ASES, and thirty patients (76.9%) achieved the MCID for SANE..
CONCLUSIONS
Partial rotator cuff repair with in-situ biceps tenodesis is an effective treatment for MIRCT, leading to significant improvements in patient-reported outcome and range of motion measures compared to preoperative conditions.
PubMed: 38942098
DOI: 10.1016/j.arthro.2024.06.018 -
Arthroscopy : the Journal of... Jun 2024The objective of the current study was to analyze if the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional... (Review)
Review
PURPOSE
The objective of the current study was to analyze if the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional knot-tying Bankart repair.
METHODS
Comprehensive literature search was done in Pubmed, Scopus, Embase, and Cochrane databases in May 2023. Studies comparing the clinical outcome of Bankart repair using knotless and knot-tying techniques were included in the study. In vitro, animal, and level 4 and 5 studies were excluded. The risk of bias of randomized controlled trials (RCT) was calculated according to the RoB 2 tool, and for non-randomized studies, MINORS criteria were used. Statistical analysis was done using RevMan software.
RESULTS
A total of nine studies, including two RCT and seven non-randomized comparative studies involving 720 patients, were included in the systematic review. The ROWE score ranged 81.7 to 94.3 in the knot-tying and 86 to 96.3 in the knotless group. VAS scores at final follow-up ranged between 0.1 to 1.7 in the knot-tying and 0.7 to 2.5 in the knotless group. The rate of redislocation, subluxation, and revision surgery in the knot-tying group ranged from 0 to 14.7%, 16.7 to 29.7%, and 1.6 to 17.6%, respectively, while that in the knotless group ranged from 2.4 to 23.8%, 7.4 to 22.2%, and 2.4 to 19%, respectively. The mean external rotation was 54 to 65 degrees in the knot-tying and 61 to 99 in the knotless group. The mean forward-flexion was 164 to 172 in the knot-tying and 165 to 174 in the knotless group. Our subjective synthesis doesn't reveal any difference in the outcome between the two groups.
CONCLUSION
The available literature does not demonstrate a clear difference in functional outcomes, residual pain, and rate of complications like redislocation, subluxation and revision surgery between Bankart repair performed with knotted and knotless anchors.
PubMed: 38942097
DOI: 10.1016/j.arthro.2024.05.036 -
Arthroscopy : the Journal of... Jun 2024Arthroscopic remplissage has been suggested as a means to decrease recurrent instability in arthroscopic Bankart repair surgery involving patients with significant...
Indications for Augmenting Arthroscopic Bankart Procedure with Remplissage in Patients with Non-engaging Hill-Sachs Lesions Must Be Individualized Based on Surgeon and Patient.
Arthroscopic remplissage has been suggested as a means to decrease recurrent instability in arthroscopic Bankart repair surgery involving patients with significant Hill-Sachs lesions. Remplissage fills the H-S lesion to prevent glenohumeral "engagement" and recurrent instability. Remplissage is not generally indicated in patients with smaller, non-engaging Hill-Sachs lesions. However, a recent review suggests that by expanding the indications to non-engaging H-S lesions, recurrence of shoulder instability may be lower in patients having arthroscopic Bankart repair. Further, the review suggests that patients having Bankart plus remplissage did not lose shoulder external rotation range-of-motion. A concern, in addition to follow-up that likely results in underestimation of recurrence, is that anatomically, remplissage should decrease external rotation, and manual measurement of ER could reflect compensatory scapulothoracic motion. This is a particular problem for throwing athletes.
PubMed: 38942096
DOI: 10.1016/j.arthro.2024.06.029 -
Spine Jun 2024A retrospective study.
STUDY DESIGN
A retrospective study.
OBJECTIVE
To identify independent risk factors and construct a prediction model for lumbar curve correction (LCC) after selective thoracic fusion (STF) in patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA
STF has been widely applied in Lenke 1 and 2 AIS patients. However, LCC after STF is still controversial.
METHODS
128 patients undergoing STF with at least 2 years follow-up were included. Cases were divided into high-LCC group and low-LCC group according to a rounded-up median of 65%. 49 variables were taken into account. Logistic regression was applied to identify independent predictive factors. Prediction model was established by backward stepwise regression, and its evaluation was implemented on R.
RESULTS
Five parameters showed independent predictive value for low LCC: Right shoulder higher before surgery [right shoulder higher vs. balanced: odds ratio (OR)=0.244, P=0.014], postoperative Cobb angle of lumbar curve (LC) (OR=1.415, P=0.001, cut-off value=11°), lowest instrumented vertebra (LIV) distal to end vertebra (no vs. yes: OR=4.587, P=0.013), postoperative LIV tilt (OR=0.686, P=0.010, cut-off value=6.85°) and postoperative LIV+1 tilt (OR=1.522, P=0.005, cut-off value=6.25°). The prediction model included six variables: lumbar modifier, preoperative shoulder balance, postoperative Cobb angle of LC, LIV position, postoperative LIV tilt and postoperative LIV+1 tilt. Model evaluation demonstrated satisfactory capability and stability [area under curve=0.890, 10-fold cross-validation accuracy=0.782].
CONCLUSION
Preoperative shoulder balance, Cobb angle of LC, LIV position, postoperative LIV and LIV+1 tilt could be used to prognosticate LCC after STF. A model with solid prediction ability was established, which could further our understanding of LCC and assist in making clinical decisions.
PubMed: 38940221
DOI: 10.1097/BRS.0000000000005078 -
Pain Management 2024Conventionally, peripheral nerve stimulation (PNS) for treatment of chronic pain has involved a two-stage process: a short-term (e.g., 7 days) trial and, if significant... (Review)
Review
Conventionally, peripheral nerve stimulation (PNS) for treatment of chronic pain has involved a two-stage process: a short-term (e.g., 7 days) trial and, if significant pain relief is achieved, a permanent PNS system is implanted. A percutaneous PNS treatment is now available where a coiled lead may be implanted for up to 60 days with the goal of producing sustained relief. In the present review, published prospective trials using percutaneous PNS treatment were identified and synthesized. The collected evidence indicates that percutaneous PNS treatment for up to 60 days provides durable clinically significant improvements in pain and pain interference. Similar efficacy across diverse targets and etiologies supports the broad applicability for use within the chronic pain population using this nonopioid technology.
Topics: Humans; Chronic Pain; Transcutaneous Electric Nerve Stimulation; Pain Management; Peripheral Nerves; Prospective Studies; Treatment Outcome
PubMed: 38939963
DOI: 10.1080/17581869.2024.2352398 -
Cureus May 2024Ganglion cysts represent a small group of lesions that can arise from almost any joint in the body. Demonstrating a predilection for the joints in the hand and wrist,...
Ganglion cysts represent a small group of lesions that can arise from almost any joint in the body. Demonstrating a predilection for the joints in the hand and wrist, ganglion cysts in the glenohumeral joint are extremely rare. Due to the vivid array of masses that can be found in the axillary fossa, forming a free-from-error work-up to the correct diagnosis can be quite confounding. In this paper, we present a case of a paralabral cyst of the shoulder joint, located in the axilla. With there being only eight other such cases published in clinical literature, we believe this case report to be of unique importance in gaining further insight into the genesis and treatment of this pathology.
PubMed: 38939263
DOI: 10.7759/cureus.61200 -
Journal of Medical Imaging (Bellingham,... May 2024We present a method that combines compressed sensing with parallel imaging that takes advantage of the structure of the sparsifying transformation.
PURPOSE
We present a method that combines compressed sensing with parallel imaging that takes advantage of the structure of the sparsifying transformation.
APPROACH
Previous work has combined compressed sensing with parallel imaging using model-based reconstruction but without taking advantage of the structured sparsity. Blurry images for each coil are reconstructed from the fully sampled center region. The optimization problem of compressed sensing is modified to take these blurry images into account, and it is solved to estimate the missing details.
RESULTS
Using data of brain, ankle, and shoulder anatomies, the combination of compressed sensing with structured sparsity and parallel imaging reconstructs an image with a lower relative error than does sparse SENSE or L1 ESPIRiT, which do not use structured sparsity.
CONCLUSIONS
Taking advantage of structured sparsity improves the image quality for a given amount of data as long as a fully sampled region centered on the zero frequency of the appropriate size is acquired.
PubMed: 38938501
DOI: 10.1117/1.JMI.11.3.033504 -
Anatomical Record (Hoboken, N.J. : 2007) Jun 2024Humboldt's woolly monkey (Lagothrix lagortricha) is a ceboid primate that more frequently engages in plantigrade quadrupedalism (~89%) but is, like most other members of...
Humboldt's woolly monkey (Lagothrix lagortricha) is a ceboid primate that more frequently engages in plantigrade quadrupedalism (~89%) but is, like most other members of the subfamily Atelinae, capable of suspensory postures and "tail assisted" brachiation. That taxon's decreased reliance on suspension is reflected in the skeletal anatomy of the upper limb which is less derived relative to more frequently suspensory atelines (Ateles, Brachyteles) but is in many ways (i.e., phalangeal curvature, enlarged joint surfaces, elongated diaphyses) intermediate between highly suspensory and quadrupedal anthropoids. Although it has been suggested that muscle may have morphogenetic primacy with respect to bone this has not been explicitly tested. The present study employs analyses of Lagothrix upper limb muscle fiber length, relative physiological cross-sectional area and relative muscle mass to test whether muscular adaptations for suspensory postures and locomotion in Lagothrix precede adaptive refinements in the skeletal tissues or appear more gradually in conjunction with related skeletal adaptations. Results demonstrate that Lagothrix upper limb musculature is most like committed quadrupeds but that limited aspects of the relative distribution of segmental muscle mass may approach suspensory hylobatids consistent with only a limited adaptive response in musculature prior to bone. Results specific to the shoulder were inconclusive owing to under-representation of quadrupedal shoulder musculature and future work should be focused more specifically on the adaptive and functional morphology of the muscular anatomy and microstructure of the scapulothoracic joint complex.
PubMed: 38938152
DOI: 10.1002/ar.25514 -
Trials Jun 2024Hemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic...
Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial.
BACKGROUND
Hemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem.
METHODS
This study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score.
DISCUSSION
Ultrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function.
TRIAL REGISTRATION
Chinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722 .
Topics: Humans; Shoulder Pain; Ultrasonography, Interventional; Stroke; Botulinum Toxins, Type A; Randomized Controlled Trials as Topic; Injections, Intra-Articular; Treatment Outcome; Pain Measurement; Shoulder Joint; Time Factors; Hemiplegia; Recovery of Function; Range of Motion, Articular; China; Neuromuscular Agents; Double-Blind Method; Biomechanical Phenomena
PubMed: 38937804
DOI: 10.1186/s13063-024-08258-8