Publications by authors named "Jean-David Werthel"
Article Synopsis
- A study compared the clinical outcomes of lateralized reverse shoulder arthroplasty (RSA) and RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative external rotation (ER).
- The analysis showed that lateralized RSA alone led to better postoperative ER and Constant scores while having fewer complications compared to RSA with LDT.
- Both procedures are effective for restoring ER, but lateralized RSA is preferred due to its lower risk of nerve injuries and dislocations, although LDT may still be suitable for select patients with severe ER loss.
Article Synopsis
- Patients undergoing total shoulder arthroplasty (aTSA and rTSA) often face challenges in regaining overhead range of motion (ROM) after surgery, especially if they had stiff shoulders before the operation.
- The study hypothesized that patients with stiff shoulders (passive external rotation ≤0°) would recover more slowly in ROM after surgery, compared to those with non-stiff shoulders (passive external rotation >0°).
- Results showed that non-stiff aTSA and rTSA patients regained various motion types faster than their stiff counterparts, although non-stiff rTSA patients took longer to regain internal rotation compared to stiff rTSA patients.
Background: Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint.
Purpose: To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS.
Study Design: Cohort study; Level of evidence, 2.
Case: A patient presented with complete coracoclavicular ligament ossification after an unnoticed acromioclavicular joint Rockwood Type IV dislocation. He had full passive range of motion in the glenohumeral joint but was disabled by a loss of both active (80°) and passive (90°) abduction due to insufficient passive scapulo-thoracic motion. He was treated with an arthroscopic osteotomy of the coracoclavicular ligament ossification.
View Article and Find Full Text PDFBackground: The role of tendon transfer and ideal insertion sites to improve axial rotation in reverse total shoulder arthroplasty (RTSA) is debated. We systematically reviewed the available biomechanical evidence to elucidate the ideal tendon transfer and insertion sites for restoration of external and internal rotation in the setting of RTSA and the influence of implant lateralization.
Patients And Methods: We queried the PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify biomechanical studies examining the application of tendon transfer to augment shoulder external or internal rotation range of motion in the setting of concomitant RTSA.
Background: Knowledge of premorbid glenoid parameters at the time of shoulder arthroplasty, such as inclination, version, joint line position, height, and width, can assist with implant selection, implant positioning, metal augment sizing, and/or bone graft dimensions. The objective of this study was to validate a scapular statistical shape model (SSM) in predicting patient-specific glenoid morphology in scapulae with clinically relevant glenoid erosion patterns.
Methods: Computed tomography scans of 30 healthy scapulae were obtained and used as the control group.
Introduction: Similar to the management of periprosthetic joint infections of the lower limb, one-stage revision in total shoulder arthroplasty (TSA) infections is an option that has been highlighted in scientific publications since the early 2010s. However, there are only a few studies which validate this treatment and determine its scope of application in relation to two-stage treatment.
Hypothesis: Single-stage revision for infected TSA is a reliable treatment allowing good infection control and satisfactory functional results.
Article Synopsis
- The study focuses on reverse shoulder arthroplasty (RSA) combined with latissimus dorsi transfer (LDT) to enhance external rotation, highlighting the significance of the tendon insertion site for optimal results.
- It reviews 16 studies involving 264 patients, detailing various humeral insertion sites used for LDT and comparing clinical outcomes, including range of motion and Constant scores.
- The findings show that the majority of insertion sites were at the greater tuberosity, with no significant differences in outcomes based on insertion location or whether LDT was performed alone or with teres major transfer, while common complications included dislocation and infection.
Background: The etiology of humeral posterior subluxation remains unknown, and it has been hypothesized that horizontal muscle imbalance could cause this condition. The objective of this study was to compare the ratio of anterior-to-posterior rotator cuff and deltoid muscle volume as a function of humeral subluxation and glenoid morphology when analyzed as a continuous variable in arthritic shoulders.
Methods: In total, 333 computed tomography scans of shoulders (273 arthritic shoulders and 60 healthy controls) were included in this study and were segmented automatically.
Purpose: To investigate the gliding resistance dynamics between the supraspinatus (SSP) tendon and the coracoacromial arch, both before and after subacromial decompression (anterolateral acromioplasty) and acromion resection (acromionectomy).
Methods: Using 4 fresh-frozen cadaveric shoulders, acromion shapes were classified (2 type I and 2 type III according to Bigliani). Subacromial bursa and coracoacromial ligament maintenance replicated physiologic sliding conditions.
Purpose: Several descriptions of the anatomy of the pectoralis major (PM) have been published. However, the precise description of its distal humeral insertion, which is involved in traumatic tears, remains controversial. The distal tendon is classically described as being made of two layers, one anterior (ALPM) and one posterior (PLPM), which regroup at their distal edge.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to investigate the potential link between muscle imbalances and humeral posterior subluxation in arthritic shoulders by comparing the volumes of rotator cuff muscles and deltoids in patients with different glenoid types.
- A total of 333 CT scans were analyzed to measure muscle volume ratios, but no significant differences or correlations were found between muscle ratios and glenoid morphology/humeral subluxation in the arthritic shoulder group.
- However, a notable finding was that the AP ratio for type A glenoids was higher compared to type B and C glenoids, highlighting some moderate correlations between these muscle ratios and glenoid positioning across both health statuses.
In the original publication [...
View Article and Find Full Text PDFArticle Synopsis
- - The study aimed to evaluate how the design of reverse shoulder arthroplasty (RSA), specifically medio-lateral offset and subscapularis repair, affects external and internal rotation after the surgery.
- - In a meta-analysis of 32 studies involving over 2,200 surgeries, it was found that globally lateralized implants led to significantly better postoperative external rotation compared to medialized implants.
- - The results indicated that both lateralized implants with subscapularis repair and medialized implants without repair had better outcomes in external rotation than medialized implants with subscapularis repair alone.
Purpose: Periprosthetic fractures around a stemless implant often involve lesser and greater tuberosities with a well-fixed implant in the metaphysis. This exposes the surgeon to unique questions and challenges as no surgical option (open reduction and internal fixation or revision to a stem) appears satisfactory to address them. Purpose of this study was to evaluate the clinical outcomes after non-operative management of periprosthetic fractures after stemless shoulder arthroplasty.
View Article and Find Full Text PDFBackground: Total shoulder arthroplasty (TSA) aims to reconstruct the premorbid anatomy of a pathologic shoulder. A healthy contralateral shoulder could be useful as a template in planning TSA. The symmetry between the left and right shoulders in healthy patients remains to be proved.
View Article and Find Full Text PDFPurpose: To compare clinical outcomes and complication rates of full arthroscopic latissimus dorsi tendon transfer (LDTT) vs. arthroscopically assisted LDTT, for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs) in shoulders that had failed rotator cuff repair (RCR).
Methods: We evaluated a continuous series of 191 patients who underwent LDTT over 4 consecutive years.
Case: A 19-year-old female patient with a history of shoulder trauma 6 years ago presented with dynamic horizontal instability of the acromioclavicular joint (ACJ). She was treated with open ACJ reconstruction using gracilis allograft and showed a satisfactory clinical result at 1-year follow-up.
Conclusion: Dynamic pure horizontal instability of the ACJ is a rare entity with only 6 cases reported in the literature.
Background: Sugaya et al described a classification system to assess postoperative rotator cuff tendon healing. Although Sugaya I and II tendons can be considered as healed and Sugaya type IV and V can be considered as retorn, the exact status of Sugaya III tendons remains unclear. The objective of this study was to evaluate the impact of Sugaya III tendons on postoperative functional scores in a population of patients undergoing revision rotator cuff repair.
View Article and Find Full Text PDFHypothesis: Rotator cuff repair remains associated with high retear rates, which range from 13% to 79%. The objective of this study was to evaluate the long-term clinical and structural results after revision rotator cuff repair at a minimum 10-year follow-up.
Methods: We retrospectively studied the records of all patients who underwent revision rotator cuff repair in 3 different institutions between July 2001 and December 2007 with a minimum 10-year follow-up.
Background: The purpose of this study was to evaluate the relationship between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty (RSA) with stratification based on measurement method and implant design.
Methods: This systematic review was performed using PRISMA-P guidelines. PubMed/Medline, Cochrane Trials, and Embase were queried for articles evaluating the relationship between humeral lengthening and clinical outcomes inclusive of range of motion (ROM), strength, outcome scores, and pertinent complications (acromial and scapular spine fractures, nerve injury) after RSA.
Article Synopsis
- Latissimus dorsi transfer (LDT) aims to improve motion, particularly external rotation (ER) and forward elevation (FE), in patients undergoing reverse shoulder arthroplasty (RSA) with combined motion loss, and this review summarizes evidence on its outcomes and complications.
- A systematic review of 19 studies involving 258 RSAs showed significant improvements in ER and FE post-surgery, with mean ER changing from -12° to 25° and FE from 72° to 141°.
- Complication rates were found to be 14.1%, including tendon tears and nerve-related issues, and no significant differences in outcomes were found between different implant designs or when a teres major transfer (TMT) was
Purpose: We sought to define the risk of persistent shoulder dysfunction after anatomic total shoulder arthroplasty (aTSA) beyond the early postoperative period and identify risk factors for persistent poor performance.
Methods: We retrospectively identified 144 primary aTSAs performed for primary osteoarthritis with early poor performance and 2-year minimum follow-up. Early poor performance was defined as a postoperative ASES score below the 20th percentile at 3- or 6-months (62 and 72 points, respectively).
Background: Latissimus dorsi tendon transfer (LDTT) is increasingly performed with arthroscopic assistance, requiring an open axillary incision, which could increase risks of infection, hematoma, and lymphoedema. Technological advancements now enable LDTT to be fully arthroscopic, but its benefits and safety have not yet been confirmed.
Purpose: To compare the clinical outcomes and complication rates of arthroscopic-assisted versus full-arthroscopic LDTT for irreparable posterosuperior massive rotator cuff tears in shoulders with no surgical antecedents.