Search

Purpose: The primary purpose of this study was to determine the effect of the preoperative position of the musculotendinous junction (MTJ) on rotator cuff healing after double-row arthroscopic rotator cuff repair. A secondary purpose was to evaluate how tendon length and MTJ position change when the rotator cuff heals.Methods: Preoperative and postoperative magnetic resonance imaging (MRI) scans of 42 patients undergoing arthroscopic double-row rotator cuff repair were reviewed. Patients undergoing repairs with other constructs or receiving augmented repairs (platelet-rich fibrin matrix) who had postoperative MRI scans were excluded. Preoperative MRI scans were evaluated for anteroposterior tear size, tendon retraction, tendon length, muscle quality, and MTJ position with respect to the glenoid in the coronal plane. The position of the MTJ was referenced off the glenoid face as either lateral or medial. Postoperative MRI scans were evaluated for healing, tendon length, and MTJ position.Results: Of 42 tears, 36 (86%) healed, with 27 of 31 small to medium tears (87%) and 9 of 11 large to massive tears (82%) healing. Healing occurred in 94% of tears that had a preoperative MTJ lateral to the face of the glenoid but only 56% of tears that had a preoperative MTJ medial to the glenoid face (P = .0135). The measured tendon length increased an average of 14.4 mm in patients whose tears healed compared with shortening by 6.4 mm in patients with tears that did not heal (P < .001). The MTJ lateralized an average of 6.1 mm in patients whose tears healed compared with medializing 1.9 mm in patients whose tears did not heal (P = .026). The overall follow-up period of the study was from April 2005 to September 2014 (113 months).Conclusions: The preoperative MTJ position is predictive of postoperative healing after double-row rotator cuff repair. The position of the MTJ with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing.Level Of Evidence: Level IV, retrospective review of case series; therapeutic study. [ABSTRACT FROM AUTHOR]

Background Assessment of glenohumeral subluxation is essential in preoperative planning of total shoulder arthroplasty. The purpose of this study was to evaluate a 3-dimensional (3D) glenohumeral subluxation index (GHSI) in shoulders with primary osteoarthritis (OA) and its relationship with morbid glenoid retroversion. Methods The 3D computed tomography reconstructions of 120 healthy shoulders and 110 shoulders with primary glenohumeral arthritis (OA group), classified according to Walch's glenoid morphology, were analyzed. The 3D GHSI was assessed by measuring posterior decentering of the humeral head in relation to the native glenoid in each subject, and its correlation to morbid glenoid version was calculated. Results The reproducible 3D GHSI (intraclass correlation coefficients ≥ 0.842) showed a posterior decentering of the humeral head in the OA population and in each type of glenoid morphology ( P  ≤ .005). A moderate correlation was observed in the OA group ( r  = −0.542; P  < .001), but weak linear relationships were found for different glenoid morphology types ( r between 0.041 and −0.307). Type A shoulders ( r  = −0.375; P  = .006) correlated better than type B shoulders ( r  =  −0.217; P  = .104). After shoulders were subcategorized according to a threshold for 3D subluxation, the posteriorly subluxated group increased its correlation ( r  = −0.438; P  < .001), whereas the centered shoulders still exhibited no relationship ( r  = −0.192; P  = .329). Conclusions Posterior humeral head decentering in relation to the native glenoid is present in each glenoid morphology type. Grouping measures according to morphology type and 3D subluxation showed at best moderate correlations between morbid version and 3D GHSI. [ABSTRACT FROM AUTHOR]

Background The diagnosis of infection after shoulder arthroplasty can be challenging. The current study evaluated the utility of a prerevision biopsy sample in predicting positive cultures or a final diagnosis of infection in the setting of an “at-risk” failed shoulder arthroplasty. Methods The study reviewed 77 patients with no history of infection undergoing revision shoulder arthroplasty by a single surgeon between June 2010 and July 2015. All patients with a C-reactive protein and erythrocyte sedimentation rate within normal reference ranges and no fluid on aspirate, or an abnormal value for the erythrocyte sedimentation rate or C-reactive protein, or both, and no growth on aspirate, underwent a prerevision biopsy because they were considered “at-risk” for infection. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the utility of biopsy specimens to predict positive cultures as well as a final determination of infection. Results A prerevision biopsy was performed in 17 patients with a failed arthroplasty. The sensitivity, specificity, PPV, and NPV, for a positive prerevision biopsy sample to predict a positive final culture were 0.75, 0.6, 0.82, and 0.5, respectively. The sensitivity, specificity, PPV, and NPV for an infection defined by a prerevision biopsy sample to predict an infection defined by the combined final revision and biopsy cultures were 0.9, 0.86, 0.9, and 0.86, respectively. Conclusions The ability for prerevision biopsy specimens of failed arthroplasties to predict the presence of bacteria at the time of revision surgery is high, although lower than previously reported. If biopsy results are used to define and predict a diagnosis of infection, the sensitivity, specificity, PPV, and NPV all significantly improve. [ABSTRACT FROM AUTHOR]

Background: A familial predisposition to the development of rotator cuff tearing has been previously reported. Very little information exists on the development of global tendon dysfunction in patients with rotator cuff tears. The purpose of the current study was to determine the incidence of global tendon dysfunction as well as the need for surgery for tendon dysfunction in patients with rotator cuff tears and their family members and compare them to age-matched controls. Methods: Ninety two patients with full-thickness rotator cuff tears and 92 age-matched controls with no history of shoulder dysfunction or surgery responded to several questions regarding tendon diseases in themselves as well as their family members. Individuals were queried regarding the presence of tendon diseases other than the rotator cuff, the need for surgery on these other tendinopathies, the presence of family members having tendinopathies including rotator cuff disease, and the need for family members to have surgery for these problems. Chi-square analysis was performed to compare the incidences between cases and controls (P,0.05 was considered significant). Results: The average age of patients in the rotator cuff tear group and control groups were 58.24±7.4 and 58.42±8.5 years, respectively (P=0.876). Results showed 32.3% of patients in the rotator cuff tear group reported that family members had a history of rotator cuff problems or surgery compared to only 18.3% of the controls (P=0.035), and 38.7% of patients in the rotator cuff tear group reported they had a history of other tendon problems compared to only 19.3% of individuals in the control group (P=0.005). Conclusion: Individuals with rotator cuff tears report a higher incidence of family members having rotator cuff problems or surgery as well as a higher incidence of other tendinopathies compared to controls. This data further supports a familial predilection for the development of rotator cuff tearing and generalized tendinopathies. [ABSTRACT FROM AUTHOR]

La inestabilidad compleja de codo implica la luxación de la articulación humerocubital junto a la fractura de uno o varios estabilizadores óseos del codo, incluidos la cabeza radial, el cúbito proximal, la apófisis coronoides o el húmero distal. La inestabilidad recidivante frecuentemente no se asocia a las luxaciones simples. Sin embargo, una luxación compleja inadecuadamente tratada puede ser el comienzo de una inestabilidad crónica recidivante de codo. La inestabilidad compleja es mucho más frecuente que la inestabilidad simple. Hay que valorar las fracturas de la cabeza radial, las de la coronoides y las del olécranon asociadas con la luxación, puesto que frecuentemente requieren cirugía. Se desconocen los resultados a largo plazo del tratamiento quirúrgico de las lesiones complejas del codo. Algunas series publicadas han estudiado combinaciones de diferentes patrones del lesión tratadas con diversos métodos. Sin embargo, recientemente, varios estudios prospectivos bien diseñados han valorado el tratamiento de diversos patrones diferentes de fracturas-luxaciones mediante un algoritmo terapéutico unificado. La fijación o sustitución de los elementos óseos lesionados, la reparación ligamentosa y los fijadores externos en bisagra pueden utilizarse para tratar con éxito de las inestabilidades complejas del codo. [ABSTRACT FROM AUTHOR]

Although scapular morphology contributes to glenohumeral osteoarthritis and rotator cuff disease, its role in traumatic glenohumeral instability remains unknown. We hypothesized that coracoacromial and glenoid morphology would differ between healthy subjects and patients with recurrent traumatic anterior shoulder instability. Computed tomography scans of 31 cadaveric control scapulae and 54 scapulae of patients with recurrent traumatic anterior shoulder instability and Hill-Sachs lesions were 3-dimensionally reconstructed. Statistical shape modeling identified the modes of variation between the scapulae of both groups. Corresponding measurements quantified these modes in relation to the glenoid center (linear offset measures), defined by the best-fit circle of the inferior glenoid, or the glenoid center plane (angles), which bisects the glenoid longitudinally. Distances were normalized for glenoid size. Compared with controls, the unstable coracoids were shorter (P =.004), with a more superior and medial offset of the tip (mean difference [MD], 7 and 3 mm, respectively; P <.001) and an origin closer to the 12-o'clock position (MD, 6°; P <.001). The unstable scapular spines originated closer to the 9-o'clock position (MD, 4°; P =.012), and the unstable acromions were more vertically oriented (MD, 6°; P <.001). The unstable glenoids had an increased height-width index (MD, 0.04; P =.021), had a flatter anterior-posterior radius of curvature (MD, 77 mm; P <.001), and were more anteriorly tilted (MD, 5°; P =.005). Coracoacromial and glenoid anatomy differs between individuals with and without recurrent traumatic anterior shoulder instability. This pathologic anatomy is not addressed by current soft-tissue stabilization procedures and may contribute to instability recurrence. [ABSTRACT FROM AUTHOR]