Long-term Outcomes After Open Repair of Humeral Avulsion of the Glenohumeral Ligament.

Background: There is a lack of data regarding the long-term clinical outcomes of open repair of humeral avulsion of the glenohumeral ligament (HAGL).

Purpose: To examine the long-term patient outcomes, prevalence of related shoulder lesions, and return to sports in patients who have had open HAGL repair.

Study Design: Case series; Level of evidence, 4.

Is preoperative elevated glycated hemoglobin (HbA1c) a risk factor for postoperative shoulder stiffness after posterior-superior rotator cuff repair?

Background: Postoperative shoulder stiffness (POSS) affects a large number of patients undergoing rotator cuff repair (RCR). Diabetes may increase the risk of POSS. Preoperative glycated hemoglobin (HbA1c) is a convenient measure of glucose control in this group.

Development of a Cadaveric Shoulder Motion Simulator with Open-Loop Iterative Learning for Dynamic, Multiplanar Motion: A Preliminary Study.

Ex vivo shoulder motion simulators are commonly used to study shoulder biomechanics but are often limited to performing simple planar motions at quasi-static speeds using control architectures that do not allow muscles to be deactivated. The purpose of this study was to develop an open-loop tendon excursion controller with iterative learning and independent muscle control to simulate complex multiplanar motion at functional speeds and allow for muscle deactivation. The simulator performed abduction/adduction, faceted circumduction, and abduction/adduction (subscapularis deactivation) using a cadaveric shoulder with an implanted reverse total shoulder prosthesis.

Does the osteoarthritic shoulder have altered rotator cuff vectors with increasing glenoid deformity? An in silico analysis.

Background: A transverse force couple (TFC) functional imbalance has been demonstrated in osteoarthritic shoulders by recent 3-dimensional (3D) muscle volumetric studies. Altered rotator cuff vectors may be an additional factor contributing to a muscle imbalance and the propagation of glenoid deformity.

Methods: Computed tomography images of 33 Walch type A and 60 Walch type B shoulders were evaluated.

What Is the Most Reliable Method of Measuring Glenoid Bone Loss in Anterior Glenohumeral Instability? A Cadaveric Study Comparing Different Measurement Techniques for Glenoid Bone Loss.

Background: Preoperative quantification of bone loss has a significant effect on surgical decision making and patient outcomes. Various measurement techniques for calculating glenoid bone loss have been proposed in the literature. To date, no studies have directly compared measurement techniques to determine which technique, if any, is the most reliable.

Grading the severity of the rotator cuff tendinosis on MRI: Assessment of inter-observer agreement and evaluation of a novel objective assessment tool.

Introduction: MRI is generally considered the modality of choice for the assessment of rotator cuff pathology including tendinosis. Assessment of severity is currently subjective primarily based on tendon morphology and signal intensity. Limited data are available evaluating the inter-observer agreement regarding the assessment of tendinosis severity.

Does the Walch type B shoulder have a transverse force couple imbalance? A volumetric analysis of segmented rotator cuff muscles in osteoarthritic shoulders.

Background: The etiology of the Walch type B shoulder remains unclear. We hypothesized that a scapulohumeral muscle imbalance, due to a disturbed transverse force couple (TFC) between the anterior and posterior rotator cuff muscles, may have a role in the pathogenesis of the type B morphology. The purpose of this study was to determine whether there is a TFC imbalance in the Walch type B shoulder using an imaging-based 3-dimensional (3D) volumetric and fatty infiltration assessment of segmented rotator cuff muscles.

Mapping of the Inferior Glenohumeral Ligament for Suture Pullout Strength: A Biomechanical Analysis.

Background: Suture pullout during rehabilitation may result in loss of tension in the inferior glenohumeral ligament (IGHL) and contribute to recurrent instability after capsular plication, performed with or without labral repair. To date, the suture pullout strength in the IGHL is not well-documented. This may contribute to recurrent instability.

Evaluation and Management of Glenohumeral Instability With Associated Bone Loss: An Expert Consensus Statement Using the Modified Delphi Technique.

Purpose: To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss.

Methods: A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements.

[Coagulopathy in COVID-19: pathophysiology].

On March 11, 2020, just after 2 months from the first cases of coronavirus disease 2019 (COVID-19) in China, the Director-General of the World Health Organization stated that COVID-19 has to be considered as a pandemic. Italian doctors were the first protagonists, after the Chinese ones, in the management of this disease. Clinical observations showed that, in addition to the respiratory infection, a systemic inflammatory response occurs, which leads to coagulation disorders and consequent venous thromboembolism as well as other thrombotic complications.

Rotator interval closure: inconsistent techniques and its association with anterior instability. A literature review.

The Rotator interval (RI) is an anatomic space in the anterosuperior part of the glenohumeral joint. An incompetent or lax RI has been implicated in various conditions of shoulder instability and therefore RI has been frequently touted as an area that is important in preserving stability of the shoulder. Biomechanical studies have shown that repair of RI ligamentous and capsular structures decreases glenohumeral joint laxity in various directions.

Does proximal porous coating in short-stem humeral arthroplasty reduce stress shielding?

Context: Short-stem humeral designs in shoulder arthroplasty have been introduced recently. A retrospective cohort study was conducted to determine if newer proximal porous titanium coating in humeral short stems produced clinical and radiologic improvements.

Method: Short-stem humeral implants (Tornier Ascend, Wright Medical) were used in 46 anatomical total shoulder replacements from October 2012 to December 2015.

Anchor Hole Placement for Bankart Repairs and Its Interaction With Variable Size Hill-Sachs Defects-Minimizing Risk of Glenoid Rim Fractures.

As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability after Bankart lesions of the shoulder, increases, an emerging problem has been the incidence of glenoid rim fractures through suture drill holes. Very little is known regarding the effect of the Hill-Sachs lesion on the glenoid's susceptibility to fracture and how drill hole location can further affect this. This study used finite element modeling techniques to investigate the risk of fracture of the glenoid rim in relation to variable sized Hill-Sachs defects impacting on the anterior glenoid edge with suture anchor holes placed in varying positions.

Axillary Nerve Position in Humeral Avulsions of the Glenohumeral Ligament.

Background: The axillary nerve is at risk during repair of a humeral avulsion of the glenohumeral ligament (HAGL).

Purpose: To measure the distance between the axillary nerve and the free edge of a HAGL lesion on preoperative magnetic resonance imaging (MRI) and compare these findings to the actual intraoperative distance measured during open HAGL repair.

Study Design: Case series; Level of evidence, 4.

Design, Modeling, and Evaluation of the Eddy Current Sensor Deeply Implanted in the Human Body.

Joint replacement surgeries have enabled motion for millions of people suffering from arthritis or grave injuries. However, over 10% of these surgeries are revision surgeries. We have first analyzed the data from the worldwide orthopedic registers and concluded that the micromotion of orthopedic implants is the major reason for revisions.

Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study.

Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings.

Objective: The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting.

Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: a 2-year MRI follow-up.

Background: partial-thickness rotator cuff tears frequently enlarge due to increased local strain and often progress to full-thickness tears. Studies suggest the addition of new tendinous tissue to injured cuff tendons would significantly decrease peak strain, possibly protecting against tear progression. The aim of this study was to assess the ability of a highly-porous collagen implant to induce new tissue formation and limit tear progression when placed on the bursal surface of partial-thickness cuff tears.

Influence of Field Position on Rugby League Players Requiring Shoulder Reconstruction.

A consecutive series of patients sustaining their index anterior instability while playing Rugby League and requiring shoulder reconstruction was retrospectively reviewed and evaluated. The details of their on-field position and hand dominance at time of injury, the side of injury, and mechanism of injury were collated and statistically analyzed. A total of 173 Bankart repairs were performed on 132 patients, and 102 players had one injury while 30 had 2 or more injuries.

Preliminary investigation of a biological augmentation of rotator cuff repairs using a collagen implant: a 2-year MRI follow-up.

Background: the inability to restore the normal tendon footprint and limit strains on the repair site are thought to contribute to re-tearing following rotator cuff repair. The purpose of this study was to use a collagen implant to augment rotator cuff repairs through the restoration of the native tendon footprint and the induction of new tissue to decrease overall tendon strain.

Methods: repairs of full-thickness rotator cuff lesions in 9 adult patients were augmented with a novel collagen implant placed over the bursal surface of the repair.

The influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair.

Background: The purpose of this study was to determine when cuff re-tear commonly occurs in the postoperative period and to investigate the clinical factors that might predispose to an early cuff re-tear.

Methods: All patients with rotator cuff (supraspinatus ± infraspinatus) tear that required arthroscopic repair during the period between June 1, 2010, and May 31, 2012, with completed serial ultrasound examinations at 6 weeks, 12 weeks, and 26 weeks postoperatively were included. Intraoperative findings were noted.

Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia.

Purpose: To examine the risks of shoulder arthroscopy in the beach-chair position (BCP) as opposed to the lateral decubitus position. The challenge during general anesthesia, particularly with the patient in the BCP, has been to ascertain the lower limit of blood pressure autoregulation, correctly measure mean arterial pressure, and adequately adjust parameters to maintain cerebral perfusion. There is increasing concern about the BCP and its association with intraoperative cerebral desaturation events (CDEs).

Perianchor radiolucency following PEEK suture anchor application associated with recurrent shoulder dislocation: a case report.

The authors describe a case of a 25 year old male who suffered recurrent shoulder dislocations after a symptom-free period following an initial arthroscopic shoulder stabilisation using PEEK suture anchors to repair the Bankart and SLAP lesions. The MRI and CT scans showed perianchor radiolucency around all of the previously placed PEEK suture anchors. It is believed that his recurrent shoulder instability was related to this radiological finding although the exact pathomechanism of the osteolysis is not clear.

Steady-State Serum T3 Concentrations for 48 Hours Following the Oral Administration of a Single Dose of 3,5,3'-Triiodothyronine Sulfate (T3S).

Objective: Sulfate conjugation of thyroid hormones is an alternate metabolic pathway that facilitates the biliary and urinary excretion of iodothyronines and enhances their deiodination rate, leading to the generation of inactive metabolites. A desulfating pathway reverses this process, and thyromimetic effects have been observed following the parenteral administration of 3,5,3'-triiodothyronine (T3) sulfate (T3S) in rats. The present study investigated whether T3S is absorbed after oral administration in humans and if it represents a source of T3.

A novel dynamic mechanical testing technique for reverse shoulder replacements.

In vitro mechanical testing of orthopedic implants provides information regarding their mechanical performance under simulated biomechanical conditions. Current in vitro component stability testing methods for reverse shoulder implants are based on anatomical shoulder designs, which do not capture the dynamic nature of these loads. With glenoid component loosening as one of the most prevalent modes of failure in reverse shoulder replacements, it is important to establish a testing protocol with a more realistic loading regime.