Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries.

National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery. There appears to be a large difference in registered parameters and outcome measurement per country. First we investigated whether existing registries have sufficient common datasets to enable pooling of data.

Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?

Background: Contrast leakage after arthrography is common. We sought to investigate if immobilization could prevent it.

Purpose: The purpose of this study was to determine the effects on contrast extravasation and image quality produced by strict immobilization of the shoulder between arthrography puncture and subsequent MR imaging.

How reliable are imaging protocols in the diagnosis of subscapularis tears?

The purpose of the study is to evaluate the accuracy of detecting subscapularis tendon tears on different imaging modalities in comparison with surgical findings. In addition, the accuracy of long head of biceps tendon pathology in assisting the diagnosis of a subscapularis tear was evaluated. Retrospectively, 336 patients who underwent surgery in the UZ Brussel for rotator cuff pathology and had pre-operative imaging at the hospital were included.

Determining On-/Off-track Lesions in Glenohumeral Dislocation Using Multiplanar Reconstruction Computed Tomography Is Easier and More Reproducible Than Using 3-dimensional Computed Tomography.

Background: The glenoid track is a useful tool to predict engagement and therefore the risk of recurrence of dislocation in the presence of Hill-Sachs and/or bony Bankart lesions. To assess the glenoid track preoperatively, only methods using 3-dimensional reconstruction (3DR) have been described, but these lack a standardized, reliable, and easy description.

Purpose/hypothesis: The purpose was to evaluate a new method for determining the glenoid track using computed tomography (CT) scan with multiplanar reconstruction (MPR) in comparison with using 3DR images.

Do patients with minor shoulder instability have a different outcome from those with recurrent anteroinferior instability?

Purpose: Minor or anterosuperior shoulder instability (MSI) is a relatively new concept with other characteristics than recurrent anteroinferior instability (TUBS). MSI includes patients without history of dislocation, with non-specific clinical symptoms and signs but with indications of laxity of (SGHL)/MGHL with isolated injury of (SGHL)/MGHL seen during arthroscopy. TUBS patients typically present with recurrent anteroinferior instability with at least labral injury of the anterior band of the IGHL.

Outcome at 3 to 5 years of a treatment algorithm for rotator cuff tears in an elderly population.

The purpose of this study is to evaluate the results of a conservative approach of rotator cuff tears in an elderly population at 3 to 5 years of follow-up. Prospective comparative study. All patients started with a program of exercises of at least 1 to 3 months.

Treatment of severe glenoid deficiencies in reverse shoulder arthroplasty: the Glenius Glenoid Reconstruction System experience.

Background: The treatment of glenoid bone deficiencies in primary or revision total shoulder arthroplasty is challenging. This retrospective study evaluated the short-term clinical and radiologic results of a new custom-made patient-specific glenoid implant.

Methods: We treated 10 patients with severe glenoid deficiencies with the Glenius Glenoid Reconstruction System (Materialise NV, Leuven, Belgium).

Health care utilization after hospitalization following a road traffic accident.

In recent years, there has been an increasing interest in measuring and modeling health care utilization. However, only limited research has been performed in the field of health care utilization following road traffic accidents. This article aims to measure the incremental health care utilization after hospital discharge after a road traffic accident and explore the association between socio-demographic and injury-related variables and health care utilization.

Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder.

Objective: The coracoglenoid ligament (CGL) forms part of the anterosuperior capsuloligamentous complex of the shoulder. Although it has received attention in the anatomical literature, it has not been investigated on imaging. The purpose of this study is to determine the percentage value and the interobserver agreement of identification and classification of the CGL on MR and MR arthrography (MRA) imaging.

What can the Radiologist do to Help the Surgeon Manage Shoulder Instability?

Imaging of the shoulder forms an important adjunct in clinical decision making in patients with shoulder instability. The typical lesions related with classic anterior and anteroinferior shoulder dislocation are an anteroinferior labral avulsion with or without bony fragment of bone loss - a (bony) Bankart lesion - and a posterolateral humeral head impaction fracture - the Hill-Sachs lesions. These are relatively straightforward to identify on imaging, although normal variants of the inferior labrum and variants of labral damage may cause confusion.

Glenohumeral translation in ABER position during muscle activity in patients treated with Latarjet procedure: an in vivo MRI study.

Purpose: The Latarjet procedure is frequently performed when treating traumatic anteroinferior shoulder instability. This procedure is supposed to have a triple effect: osseous, muscular and ligamentous. The main stabilizing mechanism in cadaver studies on fresh-frozen shoulders seems to be the sling effect produced by the subscapularis and the conjoint tendon.

Advanced imaging of the glenohumeral ligaments.

The glenohumeral ligaments (GHLs) are the most important passive stabilizers of the shoulder joint. Recognition of acute and chronic glenohumeral ligamentous lesions is very important in the preoperative work-up of shoulder instability and trauma. This article describes and depicts the normal anatomy of the GHLs and their appearance during arthroscopy and on MR and computed tomography arthrography (CTA).

Does the presence of glenoid bone loss influence coracoid bone graft osteolysis after the Latarjet procedure? A computed tomography scan study in 2 groups of patients with and without glenoid bone loss.

Background: Coracoid bone graft osteolysis and fibrous union are the principal causes of failure in patients treated with the Latarjet procedure. This study aims to investigate the hypothesis that coracoid bone graft osteolysis is more pronounced in cases without glenoid bone loss, which may be due to a diminished mechanotransduction effect at the bone healing site.

Methods: We prospectively followed up 34 patients, treated with a mini-plate Latarjet procedure, divided into 2 groups (group A patients had glenoid bone loss >15% and group B patients had no glenoid bone loss).

Arthroscopy of the sternoclavicular joint: an anatomic evaluation of structures at risk.

Introduction: Recently, arthroscopy of the sternoclavicular joint (SCJ) has been described in clinical setting. The aim of this study is to examine the accessibility and safety of the SCJ by arthroscopy in a cadaveric model.

Materials And Methods: An inferolateral and superomedial portal to the SCJ was created in 20 cadaveric specimens.

Determination of a reference system for the three-dimensional study of the glenohumeral relationship.

Objective: Knowledge of the normal and pathological three-dimensional glenohumeral relationship is imperative when planning and performing a total shoulder arthroplasty. There is, however, no consensus on which references should be used when studying this relationship. The purpose of the present study was to define the most suitable glenoid plane with normally distributed parameters, narrowest variability, and best reproducibility.

Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography.

We studied the assessment of proximal biceps tendon lesions including degeneration, tendon luxation, and partial and complete tendon tears with 3T MR arthrography and CT arthrography. Thirty-six patients who underwent both studies, as well as arthroscopy were included in the study. The images were randomized and blinded and independently reviewed by two musculoskeletal radiologists.

Anterosuperior labral tear without biceps anchor involvement: a subtle isolated cause of a painful shoulder.

Purpose: The purposes of this study were to determine common clinical symptoms related to an anterosuperior labral tear without biceps anchor involvement and to establish the outcome of arthroscopic management of this injury.

Methods: In our database of arthroscopic procedures we identified 23 patients with an isolated anterosuperior labral tear. The mean age at the time of surgery was 38.

Magnetic resonance arthrography of glenohumeral lesions: anatomy and arthroscopically confirmed pathology.

Interpretation of magnetic resonance (MR) arthrography images of the glenohumeral ligaments is made difficult by anatomical variations and by the lack of descriptions of signs of pathology of the ligaments. In this review, we describe the normal and pathologic appearance of the glenohumeral ligaments of the shoulder. These ligaments play an important role in stabilization of the shoulder.

Locked patellar dislocation: a case report.

Introduction: Acute patellar dislocation is a relatively common problem. The most common dislocation is laterally in the coronal plane. Sometimes spontaneous reduction occurs, but if not, closed reduction can easily be done.

Consequences of a Perthes-Bankart lesion in twenty cadaver shoulders.

This study investigated whether an anteroinferior capsulolabral lesion is sufficient to allow the humeral head to dislocate and whether a limited inferior approach for creating the lesions influenced the results compared with an all-arthroscopic approach. Four ligamentous zones of the glenohumeral capsule were sequentially detached from the glenoid neck and labrum in 20 cadaver shoulders through an inferior approach. Before and after each resection step, inferior stability was tested using a sulcus test and anterior stability using a drawer test and an apprehension maneuver.

Arthroscopic glenohumeral folds and microscopic glenohumeral ligaments: the fasciculus obliquus is the missing link.

This study tested the hypotheses that the folds in the inferior glenohumeral capsule appear at the borders and crossings of the underlying capsular ligaments and that embalming may result in misinterpretation of these folds as ligaments. The inferior capsular structures in 80 unembalmed cadaver shoulders were compared with 24 embalmed shoulders. During arthroscopy and dissection, an anteroinferior fold was more prominently seen in internal rotation and was almost obliterated in external rotation.

Variations in the superior capsuloligamentous complex and description of a new ligament.

Although the rotator cuff interval and the adjacent ligaments are gaining interest because of their importance for glenohumeral instability and adhesive capsulitis, there seems to be some confusion about their anatomy. This study reinvestigates the superior capsular structures in 110 cadaveric shoulders by a combination of arthroscopy, dissection, histology, and functional analysis. The structure of the superior capsule was found to be more complex than suspected until now.