Shoulder & Elbow
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Residency Program in Orthopedics and Traumatology, University of Milan,
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Purpose
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No literature consensus was found about the best treatment of acute Rockwood type III acromioclavicular joint (ACJ) dislocation. In particular, the advantages and disadvantages between conservative treatment and surgery are not sufficiently quantified in the current literature.
Methods
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A systematic literature search was conducted using PubMed, Web of Science and Embase in March 2024. We selected studies comparing surgical and conservative treatment in acute Rockwood III ACJ dislocations. The two treatment methods were compared in terms of Constant score; Disabilities of the Arm, Shoulder, and Hand (DASH); American Shoulder and Elbow Surgeons (ASES) score; Acromioclavicular Joint Instability Score (ACJIS); subjective shoulder value (SSV); radiographical findings; reported complications; and return to sports activity. The risk of bias and quality of evidence were assessed using Cochrane guidelines.
Results
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A total of 1844 articles were evaluated, and ten were included in the study for a total of 397 patients. The results of the meta-analysis showed no significant differences between the two groups in terms of Constant score (P = 0.31), DASH (P = 0.52), ASES (P = 0.66) and SSV (P = 0.21), while it highlighted a statistically significant difference in terms of ACJIS (P = 0.00) and acromioclavicular (P = 0.00) and coracoclavicular distance (P = 0.00).
Conclusion
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The results showed no significant differences in terms of patient-reported or objective functional outcomes between the two treatment groups. Nonetheless, it highlights a difference in terms of radiographical outcomes and type of complications. While surgical intervention is able to improve joint reduction, it adds the risk for surgical complications.
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Purpose
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To evaluate the clinical and biomechanical evidence for the addition of acromioclavicular (AC) ligament repair and reconstruction in the surgical management of high-grade AC joint (ACJ) dislocation.
Methods
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This is a systematic review of biomechanical and clinical studies that describe AC reconstructive or reparative techniques. The search ranged from 1946 to 2024 and included OVID, MEDLINE, PubMed, CINAHL, Embase, Google Scholar and the Cochrane Library databases. Clinical and biomechanical outcomes were evaluated.
Results
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Thirty-two eligible studies were identified. Of these, four biomechanical studies focused on the ACJ exclusively. Twenty-eight other studies (15 clinical and 13 biomechanical) were identified involving reconstruction of the ACJ in addition to the treatment of the coracoclavicular (CC) ligaments. There was clinical evidence of improved outcomes with ACJ repair and reconstruction, although comparison was difficult. In comparative studies, ACJ-specific Taft and acromioclavicular joint instability scores were improved in patients with ACJ reconstruction. Constant score and subjective shoulder value also increased, although this was observed in studies lacking a control group. The biomechanical studies provide evidence of increased translational and rotational stability with ACJ repair and reconstruction, but the optimal technique has not been identified.
Conclusion
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ACJ repair and reconstruction, in addition to CC repair, results in improved biomechanical and functional outcomes and should be considered when treating high-grade ACJ injuries. There is insufficient evidence in the literature to be able to recommend a specific technique to treat ACJ injuries.
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Sport Traumatology and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Science, Poznań, Poland
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Conventional repair of rotator cuff tears bears a variable but significant risk of incomplete healing.
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Biological therapies that accompany surgical rotator cuff repair include platelet-rich plasma, stem cells of different origins, and biological scaffolds.
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Biological therapies facilitate the regeneration of the correct microarchitecture of the tendon attachment to the bone and reduce failures after surgical rotator cuff repair.
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Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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Purpose
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The purpose of the present scoping review is to identify sources of heterogeneity in reporting domains that have the potential to improve surgical decision-making in reverse shoulder arthroplasty associated with glenoid bone grafting.
Methods
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A scoping review was conducted according to the JBI and PRISMA ScR guidelines. Articles covering glenoid bone grafting at the time of reverse shoulder replacement, published between 2012 and 2022 in MEDLINE, Scopus, Epistemonikos, Web of Science, and Cochrane Database of Systematic Reviews, were searched. Reporting of core outcome measures, as well as prosthesis-related variables, rehabilitation protocols, radiographic evaluation methods, and bone graft incorporation assessments, were collected.
Results
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For the final analysis, a total of 14 articles were considered. There were 649 operated shoulders with a mean patient age of 72 years, ranging from 48 to 85 years. Analysis of preoperative ranges of motion and patient-reported outcome measures revealed increased heterogeneity in patient selection between studies. Reporting of implant-related parameters was the most inconsistent. Rehabilitation protocols were scarcely reported. Assessment of graft incorporation and radiographic evaluation of choice revealed that there is no consistent method or measurement and the clinical relevance of radiolucent lines at the graft-glenoid bone interface is unclear.
Conclusion
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Addressing implant-related reporting gaps has the highest potential to improve surgical decision-making and provide orthopedic surgeons with a more comprehensive understanding of published results on glenoid bone grafting at the time of primary reverse shoulder arthroplasty.
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School of Surgery, University of Western Australia, Perth, Australia
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The Trillat procedure, initially described by Albert Trillat, is historically one of the first techniques for addressing recurrent anterior shoulder instability, incorporating fascinating biomechanical mechanisms.
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After lowering, medializing, and fixing the coracoid process to the glenoid neck, the subcoracoid space is reduced, the subscapularis lowered, and its line of pull changed, accentuating the function of the subscapularis as a humeral head depressor centering the glenohumeral joint. Furthermore, the conjoint tendon creates a ‘seatbelt’ effect, preventing anteroinferior humeral head dislocation.
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Even though contemporary preferences lean towards arthroscopic Bankart repair with optional remplissage, bone augmentation, and the Latarjet procedure, enduring surgical indications remain valid for the Trillat procedure, which offers joint preservation and superior outcomes in two distinct scenarios: (i) older patients with massive irreparable cuff tears and anterior recurrent instability with an intact subscapularis tendon regardless of the extent of glenoid bone loss; (ii) younger patients with instability associated shoulder joint capsule hyperlaxity without concomitant injuries (glenoid bone loss, large Hill–Sachs lesion).
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Complications associated with the Trillat procedure include recurrent anterior instability, potential overtightening of the coracoid, leading to pain and a significant reduction in range of motion, risk of subcoracoid impingement, and restriction of external rotation by up to 10°, a limitation that is generally well-tolerated.
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The Trillat procedure may be an effective alternative technique for specific indications and should remain part of the surgical armamentarium for addressing anterior shoulder instability.
Dworska Hospital, Kraków, Poland
Hospital in Proszowice, Poland
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Rotator cuff tears (RCT) and instability are the most common surgically treated shoulder pathologies.
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The concept of augmentation using the long head of the biceps tendon (LHBT) autograft was created to improve the results of surgical treatment of these pathologies, especially in cases of chronic and massive injuries.
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The popularity of using the LHBT for augmentation is evidenced by the significant number of publications on this topic published in the last 3 years; however, only one systematic review has been published regarding only LHBT augmentation for massive RCTs.
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Several studies comparing partial repair with partial repair and additional LHBT augmentation for RCT showed superior clinical outcomes and lower re-tear rates when LHBT augmentation was performed.
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There is a rising popularity of using LHBT as an autograft to perform superior capsule reconstruction (SCR) in case of irreparable rotator cuff tears.
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In recent years, shoulder stabilization by arthroscopic Bankart repair with biceps augmentation has been promoted with very promising short-term results.
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The evidence provided by studies appears to be sufficient to recommend the use of LHBT for augmentation whenever necessary; however, larger studies with long-term follow-up are needed.
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Accurate component placement in shoulder arthroplasty is crucial for avoiding complications, achieving superior biomechanical performance and optimizing functional outcomes.
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Shoulder and elbow surgeons have explored various methods to improve surgical understanding and precise execution including preoperative planning with 3D computed tomography (CT), patient-specific instrumentation (PSI), intraoperative navigation, and mixed reality (MR).
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3D preoperative planning facilitated by CT scans and advanced software, enhances surgical precision, influences decision-making for implant types and approaches, reduces errors in guide pin placement, and contributes to cost-effectiveness.
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Navigation demonstrates benefits in reducing malpositioning, optimizing baseplate stability, improving humeral cut, and potentially conserving bone stock, although challenges such as varied operating times and costs warrant further investigation.
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The personalized patient care and enhanced operational efficiency associated with PSI are not only attractive for achieving desired component positions but also hold promise for improved outcomes in complex cases involving glenoid bone loss.
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Augmented reality (AR) and virtual reality (VR) technologies play a pivotal role in reshaping shoulder arthroplasty. They offer benefits in preoperative planning, intraoperative guidance, and interactive surgery. Studies demonstrate their effectiveness in AR-guided guidewire placement, providing real-time surgical advice during reverse total shoulder arthroplasty (RTSA). Additionally, these technologies show promise in orthopedic training, delivering superior realism and accelerating learning compared to conventional methods.
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Posterior shoulder instability (PSI) is less common than anterior shoulder instability, accounting for 2–12% of total shoulder instability cases.
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However, a much higher frequency of PSI has been recently indicated, suggesting that PSI accounts for up to 24% of all young and active patients who are surgically treated for shoulder instability.
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This differentiation might be explained due to the frequent misinterpretation of vague symptoms, as PSI does not necessarily present as a recurrent posterior instability event, but often also as mere shoulder pain during exertion, limited range of motion, or even as yet asymptomatic concomitant finding.
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In order to optimize current treatment, it is crucial to identify the various clinical presentations and often unspecific symptoms of PSI, ascertain the causal instability mechanism, and accurately diagnose the subgroup of PSI.
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This review should guide the reader to correctly identify PSI, providing diagnostic criteria and treatment strategies.
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Despite the common occurrence of radial head fractures, there is still a lack of consensus on which radial head fractures should be treated surgically.
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The radial head is an important secondary stabilizer in almost all directions. An insufficient radial head can lead to increased instability in varus–valgus and posterolateral rotatory directions, especially in a ligament-deficient elbow.
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The decision to perform surgery is often not dictated by the fracture pattern alone but also by the presence of associated injury. Comminution of the radial head and complete loss of cortical contact of at least one fracture fragment are associated with a high occurrence of associated injuries.
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Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. Displacement (>2 mm) of fragments in radial head fractures without a mechanical block to pronation/supination is not a clear indication for surgery.
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Mechanical block to pronation/supination and comminution of the fracture are indications for surgery.
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The following paper reviews the current literature and provides state-of-the-art guidance on which radial head fractures should be treated surgically.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Reverse total shoulder arthroplasty (rTSA) has been demonstrated to be an effective intervention for various shoulder disorders. The number of rTSA-related studies performed has increased annually over the past three decades.
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The Journal of Shoulder and Elbow Surgery had the highest number of publications and citations in the rTSA-related research domain and is therefore considered to be the most influential journal in this field.
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The USA published the most publications and established a high degree of cooperation with many countries worldwide. The University of Florida, the Hospital for Special Surgery, and Rush University, Mayo Clinic were representative and active institutions in this field.
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It is anticipated that advancements in prosthesis design, specifically with regards to lateralized design concepts, expanding indications for rTSA, a trend toward younger patient populations, and the management of postoperative complications will emerge as research hotspots in the following years.
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The most valuable publications, influential journals, major researchers, and leading countries were analyzed. The findings of our study will help researchers gain insights into current research hotspots and frontiers and shape their research focus in the field of rTSA.
