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limitations, including the attendant risks of entering the thorax and an extended learning curve. 22 , 23 These limitations have limited widespread uptake of the technology. In 1999, Jho 24 described endoscopic transpedicular thoracic discectomy
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adequately in a less invasive fashion. What must be kept in mind is that it is a procedure with a very steep learning curve. 17 As with any surgical procedure, indications and contraindications must be abided by, planning and technique must be perfected
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structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures. Despite the high learning curve, vertical mattress sutures to repair the posterior meniscus are only possible with posterior arthroscopy. These sutures
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, though, due to lack of long-term studies, whether long-term good clinical outcomes will compensate for barriers to the widespread adoption of this technology, such as the increased radiation dose and the learning curve. This may be more evident in complex
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limitations. First of all, fracture care by arthroscopy demands a high degree of technical skill and has a prolonged and steep learning curve; it is currently reserved to a limited number of expert arthroscopists, and requires additional learning processes
The University of Western Australia, Perth, Australia
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Clinique Victor Hugo, 5 Bis rue du Dôme 75016 Paris, France
American Hospital of Paris, 55 Boulevard du Château, 92200 Neuilly-sur-Seine, France
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Shoulder, Elbow Unit, Sportsclinicnumber1, Papiermuehlestrasse 73, 3014 Bern, Switzerland
Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
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Royal Perth Hospital, Perth, Australia
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Chronic traumatic anterior shoulder instability can be defined as recurrent trauma-associated shoulder instability requiring the assessment of three anatomic lesions: a capsuloligamentous and/or labral lesion; anterior glenoid bone loss and a Hill–Sachs lesion.
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Surgical treatment is generally indicated. It remains controversial how risk factors should be evaluated to decide between a soft-tissue, free bone-block or Latarjet-type procedure.
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Patient risk factors for recurrence are age; hyperlaxity; competitive, contact and overhead sports. Trauma-related factors are soft tissue lesions and most importantly bone loss with implications for treatment.
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Different treatment options are discussed and compared for complications, return to sports parameters, short- and long-term outcomes and osteoarthritis.
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Arthroscopic Bankart and open Latarjet procedures have a serious learning curve. Osteoarthritis is associated with the number of previous dislocations as well as surgical techniques.
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Latarjet-type procedures have the lowest rate of dislocation recurrence and if performed correctly, do not seem to increase the risk of osteoarthritis.
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Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition.
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Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle.
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There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft.
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The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores.
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There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon.
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In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.
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highlights the importance of having a surgeon with sufficient hip arthroplasty experience overseeing the procedure. Clinical application Learning curve The learning curve is defined as the rate of a surgeon’s progress in gaining experience or
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conventional THA, possibly because robotic systems require registration or placement of positioning pins, as well as the learning curve for new users. The latter has not been addressed in the meta-analyses which did not consider the level of experience of the
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revision rates in the meta-analysis by Zumstein et al were 24% and 10%, respectively. 14 The impact of the learning curve on complication rates is unclear. 19 , 20 Groh et al reported an overall complication rate of 7%, and failed to show an
