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Introduction: The aim of our study is to evaluate the functional and mobility outcomes in patients who have undergone arthroscopic circumferential arthrolysis of the shoulder and to find out if there are differences in the results in relation to the patient's age., Materials and Methods: This is a retrospective case series of patients with idiopathic adhesive capsulitis treated by arthroscopic 360º circumferential capsulotomy in lateral position and followed for a minimum of 2 years. Range of motion (ROM), functional outcomes using the Constant Score (CS), health-related quality of life outcomes with the EuroQol Five Dimensions tool (EQ-5D), pain using the Visual Analogue Scale (VAS)., Results: A total of 26 shoulders were included, 10 men (41.7%) and 14 women (58.3%), with 2 patients being bilateral. The mean age was 48.64 ± 7.5 years, and the mean follow-up was 50.2 months. Postoperative ROM improved significantly compared to preoperative ROM (p < 0.05). Shoulder forward flexion improved by 38.6° (95%CI 22.3-54.9, p < 0.01), abduction by 35.2° (95%CI 17.6-52.8, p < 0.01) and external rotation by 21.9° (95%CI 12.8-30.9, p < 0.01 p < 0.01). Median internal rotation improved from buttock to T12 (p < 0.01). The mean improvement in CS was 54.3 ± 24.4 points (p < 0.01). The EQ-5D and VAS scores at the end of follow-up were 0.73 ± 0.23 and 2.73 ± 2.55, respectively. There were no statistical differences between young patients and patients aged 50 years or older in ROM or functional results., Conclusions: Patient age did not affect outcomes significantly, with patients older than 50 years showing similar results to younger patients., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Arthroscopic balloon spacer arthroplasty (BSA) is a relatively recent procedure for patients with irreparable rotator cuff tears, conceived to prevent degenerative joint changes and relieve subacromial pain., Methods: This is a retrospective case series of 16 consecutive patients treated with BSA and followed up for a minimum 12 months. Besides BSA, partial tendon repair was done whenever possible. Radiographical parameters such as acromiohumeral distance and Hamada stage were measured preoperatively and postoperatively. Range of motion, functional results (Constant score; Simple Shoulder Test; American Shoulder and Elbow Surgeons score; and Disabilities of the Arm, Shoulder, and Hand score), health-related quality of life results with the EuroQol Five Dimensions tool, complications, and patient satisfaction were also analyzed., Results: The mean age was 64 ± 10.3 years, and the male/female ratio was 6/10. Partial repair was achieved in five patients (31.2%) and did not influence functional or health-related quality of life results ( P = 0.11). The mean acromiohumeral distance and Hamada stage worsened from preoperative measures (3.7 ± 2.0 mm and 2.3 ± 1.1) to final follow-up measures (3.1 ± 2.4 mm and 3.1 ± 1.3). Shoulder abduction increased by 7.8° ± 26.8° and forward flexion decreased by 25.5° ± 32.4° after surgery. The functional results at the final follow-up were Constant 49.5 ± 18.0; American Shoulder and Elbow Surgeons 60.2 ± 27.2; Simple Shoulder Test 8.5 ± 4.6; and Disabilities of the Arm, Shoulder, and Hand 32.7 ± 12.1. The mean index value for the EuroQol Five Dimensions was 0.79, and perceived quality of life was 85.6 ± 15.4 of 100 points. 62.5% of the patients (10) were satisfied with surgery. The complication rate was 13% (2), accounting for one deep infection and one balloon migration., Conclusion: Theoretical benefits of BSA for delaying superior humeral head translation and arthropathic changes could not be demonstrated in our series. Its functional results and satisfaction rates are low, but self-reported quality of life after surgery does not seem impaired. Complications do not occur frequently but require reintervention and endanger joint viability., Level of Evidence: Level IV (case series)., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

Background: Alterations in the anatomical relationships of the musculocutaneous (MCN) and axillary nerves and the influence of arm positioning on these relationships after a Latarjet procedure have been demonstrated in the cadaver, but there are no studies in the literature that establish if there is any neurophysiological repercussion., Methods: We retrospectively identified 24 patients with a primary or revision open Latarjet procedure. A prospective clinical (Constant-Murley, Rowe and Walch-Duplay and active range of motion), radiographic (with CT), and electrodiagnostic evaluation was made at the most recent follow-up., Results: Nonunion occurred in four patients (22%); there were, as well, one case of partial coracoid reabsorption (5%) and two (11%) with mild glenohumeral osteoarthritis. In the anatomical position, we found no alterations in the musculocutaneous nerve and two cases (11%) in the axillary nerve slight motor unit loss. In the risk position, 11 cases (61%) had neurophysiological involvement (36% had neurophysiological changes in the musculocutaneous nerve and 64% in the axillary nerve). No differences between patients with or without neurophysiologic changes were found: Constant 87/83; Rowe 89/90; Walch-Duplay 84/78; Forward elevation 175º/170º, abduction 165°/175°; external rotation 48°/45°., Conclusion: The rate of clinical electromyographic changes in the axillary and MCN in the abducted and externally rotated arm position (risk dislocation position) is higher than in neutral position. Nonunion of the coracoid process must play a role in these neurophysiological changes. Although in the medium-term they don't have clinical impact, further randomized prospective studies with a larger sample size are necessary to determine their true repercussion., Level of Evidence: Level IV., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Mesenchymal stem cells (MSCs) are a promising treatment of different musculoskeletal diseases including osteoarthritis and rheumatoid arthritis (RA). Results from different approaches in this treatment have been not conclusive. Aim: To analyze factors related to interactions between peripheral blood mononuclear cells (PBMCs) and MSCs and the influence of cellular activation. Materials & methods: PBMCs from RA patients and healthy controls (HC) were obtained. MSCs from bone marrow (BM-MSCs) were obtained from six donors. CD4, CD25, CD69 and CD127 expression was measured by flow cytometry. Repeated measures analysis of variance (ANOVA) models were performed using activation, co-culture with BM-MSCs and time of culture (24 h, 72 h, 6 days) as within-subject variables. Results: PBMCs activated and co-cultured with BM-MSCs showed a lower proportion of CD25 - positive and CD25high/CD127low-negative cells in both RA and HC. Additionally, a maintained expression of CD69 was also observed in RA and HC when PBMCs were activated and co-cultured with BM-MSCs. Conclusion: Both PBMC activation grade and RA disease activity influence the immunomodulatory effect of BM-MSCs on T-cell activation.

Purpose: The purpose of the study was to compare the safety and efficacy of autologous mesenchymal stem cells (MSCs) embedded in a xenogenic scaffold for repairing the supraspinatus tendon., Methods: This was a randomized, double-blind and placebo-controlled trial evaluating patients with full-thickness rotator cuff tears (Eudra-CT, 2007-007630-19). Effectiveness was evaluated using the Constant score and a visual analogue pain scale (VAS). Constant score has four domains including pain (15 possible points), activities of daily living (20 possible points), mobility (40 possible points), and strength (25 possible points). Scores range from 0 points (most disability) to 100 points (least disability). The structural integrity of the repaired tendon was assessed by magnetic resonance imaging (MRI) according to Patte and Thomazeau classification criteria. The primary study end point was an improvement in the Constant score by 20 points at one year compared to initial assessment., Results: The trial was stopped due to adverse effects observed in both groups. Only thirteen patients were included and analyzed. The Constant questionnaire showed a significant improvement in the MSC treatment group compared with the preoperative data (p = 0.0073). Secondary outcome measures were similar in both groups., Conclusions: Our study showed preliminary inconclusive clinical outcomes in the patients treated with MSCs. Adverse events revealed the need for further approaches using scaffolds of a different nature or perhaps no scaffolds, in the context of small joints., Trial Registration: Eudra-CT, 2007-007630-19 . Registered on 30 January 2008., Level of Evidence: A Level 1 of evidence treatment study.

Introduction: At present, surgical treatment of comminuted radial head fractures without associated instability continues to be controversial. When anatomical reconstruction is not possible, radial head excision is performed. However, the appearance of long-term complications with this technique, along with the development of new radial head implants situates arthroplasty as a promising surgical alternative. The purpose of the present study was to compare the mid-term functional outcomes of both techniques., Materials and Methods: A retrospective study was performed between 2002 and 2011 on 25 Mason type-III fractures, 11 patients treated with primary radial head resection and 14 who received treatment of the fracture with metal prosthesis. At the end of follow-up, patients were contacted and outcomes evaluated according to: Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand score (DASH) and strength measurement. Radiographic assessment (proximal migration of the radius, osteoarthritic changes, and signs of prosthesis loosening) was also performed., Results: The average age of the sample was 53.7 years in the resection group, and 54.4 years in the replacement group, with a mean follow-up of 60.3 and 42 months respectively. According to the MEPS scale, there were 6 excellent cases, 3 good and 2 acceptable in the resection group, and 6 excellent cases, 3 good, 3 acceptable, and 2 poor in the prosthesis group. The mean DASH score were 13.5, and 24.8 for the resection and the replacement group respectively. We found one postoperative complication in the resection group (stiffness and valgus instability) and 6 in the replacement group: 3 of joint stiffness, 1 case of prosthesis breakage, and 2 neurological injuries., Conclusions: Although this is a retrospective study, the high complication rate occurring after radial head replacement in comparison with radial head resection, as well as good functional results obtained with this last technique, leads us to recommend it for comminuted radial head fractures without associated instability., (© 2016 Elsevier Ltd. All rights reserved.)

Introduction-Objectives: To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy., Material and Method: A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D)., Results: The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P>.05); postoperative Constant score: 81.2 and 66.5%, respectively (P>.001). Forward elevation and abduction in fracture patients decreased by 39° (P=.02), and 34° (P=.057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P=.002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months., Conclusions: Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication., (Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.)

There is a need to study and validate the mechanical behavior of the bone-implant total hip prosthesis and the treatment of its complications with experimental studies due to the limitations showed by numerical methods. Epoxy resin replicas of a femur (stereolithography) and a mechanical validation were performed. We studied three cases: intact femur (Case 1); non-defective femur with non-cemented LD primary stem (Case 2); and femur with a cavitary defect, short cemented stem over an impacted allograft (Case 3). The test pieces were connected to 7 strain gauges. Three assays per piece were carried out with a vertical and oblique load (load-unload curves after a sequence between 0 and 145.9 N). We measured the k coefficient (distance from the natural state of the strains) and stability of the stem (flexion-compression by strain gauges 1, 2, 5, and 7 and transversal lengthening by strain gauges 3, 4, and 6). Results of the strain gauge analysis revealed linearity of results in all cases, and more so in load than in unload. Gauge 7 (proximal) revealed shortening in all cases. Gauges 2 and 5 provided qualitatively similar data due to a significant increase in rigidity. K coefficients were obtained with a nonsignificant difference when each of the test pieces was compared with Case 2. The results were reproducible in all 7 gauges. Observation of the load-unload curves in all the test pieces assayed shows that there are no variations in the pattern of behavior (when comparing the stability of a primary stem and a stem in the simulated reconstructed femoral defect. If these reconstructions are considered theoretically appropriate for giving primary stability to the stem--a sine qua non for the success of replacement surgery--then our study is novel.

Introduction: There is no controversy about the need for surgical treatment of the displaced surgical neck fractures of the humerus, but there are few studies comparing the results of the three preferred types of surgical treatment. To expand the knowledge needed in decision making, a patient series is reviewed using health related quality of life (HRQoL), functional and radiographic data from patients treated with percutaneous pinning, locking plates or intramedullary nails., Materials and Methods: Retrospective observational cohort study of patients who underwent internal fixation of fractures of the surgical neck of the humerus between 2004 and 2009 (mean follow-up 40.67 ± 17.93 months). Fifty patients fulfilled the inclusion criteria (mean age 70.04 ± 13.15 years). Nine had been treated by percutaneous pinning, fifteen with locking plates and twenty-six with intramedullary nails. We compared the results between the three groups of the HRQoL with the EuroQol5D questionnaire; the functional capacity of the operated and non-operated shoulder with the Constant score; and the radiographic result with plain X-rays., Results: Forty-eight patients had achieved fracture healing. The plating and nailing groups had a better fracture reduction compared with the pinning group (p <0.05). The EuroQol-5D did not discriminate between groups (mean 0.65 ± 0.26; p >0.05). The mean Constant score of the K-wire group (47.67 ± 22.42) was lower than those of the plating (82.45 ± 17.69) and nailing groups (72.72 ± 15.96) (p = 0.001), with no differences between plates and nails. There was positive correlation between the EuroQol-5D result and the Constant score (r = 0.490; p <0.005). The fractured shoulder was worse in each item of the Constant score than the non-operated one in patients treated with pins and nails. Patients treated with plates achieved similar results between operated and non-operated shoulder in three items: arm positioning, internal and external rotation. Seventeen patients (six re-operated) had some kind of complication during follow-up., Conclusion: Patients treated with pinning achieved a worse radiographic and Constant score than patients treated with plates or nails. Although we did not find differences between the plating and nailing groups, patients treated with plates got a Constant score more similar to the non-operated shoulder., (Copyright © 2012 Elsevier Ltd. All rights reserved.)