Apprehension Test Research Articles

MPFL Reconstruction in Skeletally Immature Patients: Comparison Between Anatomic and Non-Anatomic Femoral Fixation—Systematic Review

Background: MPFL reconstruction in children with open physis may be challenging, as a major concern during the surgery is to preserve the distal femoral physis. The purpose of this study was to compare the complication rate and the patient-reported outcomes in skeletally immature patients who underwent MPFL reconstruction using an anatomic (A) or non- anatomic (NA) surgical technique. Methods: For this systematic review, the authors adhered to the PRISMA guidelines. The literature search was conducted from inception to 31 May 2024. Three databases were used: Pubmed, Scopus and Cochrane library. We included skeletally immature patients who underwent MPFL reconstruction for chronic or recurrent patellar instability. The included studies should describe the surgical technique, report clinical outcomes and complications. Patients with closed physis, prior ipsilateral knee surgery, concomitant surgical procedures except for lateral retinacular release, multiligament knee injury, congenital or acute patellofemoral instability, hyperlaxity or less than 12 months follow up were excluded. Risk of bias was assessed using ROBINS-I, MINORS and MCMS scores. Results: Data from 304 procedures were collected, of which 208 were performed using an anatomic technique and 96 using a non-anatomic technique. Patient age at the time of surgery ranged from 8 to 17 years. The follow-up time ranged between 12 and 116.4 months. Postoperative Kujala (−0.73, p = 0.55) and Tegner (−0.70, p = 0.80) scores were better in the anatomic group compared to the non-anatomic one. Higher rates of recurrent instability (OR 0.91; 95%CI 0.44–1.86, p = 0.85), redislocation (OR 1.21; 95%CI 0.42–3.51, p = 0.8), subluxation (OR 0.73; 95%CI 0.29–1.83, p = 0.62), a positive apprehension test (OR 0.92; 95%CI 0.27–3.13, p = 0.89), stiffness (decreased ROM) (OR 1.63; 95%CI 0.33–1.72, p = 0.54) and reoperation (OR 1.16; 95%CI 0.35–3.80, p = 0.8) were reported in papers using the anatomic technique. Conclusions: The findings of this systematic review reveal that there is no significant difference between anatomic and non-anatomic MPFL reconstruction techniques in terms of patient-reported outcomes and complications. Thus, the choice of surgical technique might be left up to surgeon’s preference. Further high-quality, pediatric-oriented studies with long-term follow–up are needed to better guide clinical decision-making.

Glenohumeral joint kinematics during apprehension-relocation test in patients with anterior shoulder instability and glenoid bone loss.

This study aimed to quantify the shoulder kinematics during an apprehension-relocation test in patients with anterior shoulder instability (ASI) and glenoid bone loss using the radiostereometric analysis (RSA) method. Kinematics were compared with the patient's contralateral healthy shoulder. A total of 20 patients with ASI and > 10% glenoid bone loss and a healthy contralateral shoulder were included. RSA imaging of the patient's shoulders was performed during a repeated apprehension-relocation test. Bone volume models were generated from CT scans, marked with anatomical coordinate systems, and aligned with the digitally reconstructed bone projections on the RSA images. The glenohumeral joint (GHJ) kinematics were evaluated in the anteroposterior and superoinferior direction of: the humeral head centre location relative to the glenoid centre; and the humeral head contact point location on the glenoid. During the apprehension test, the centre of the humeral head was 1.0 mm (95% CI 0.0 to 2.0) more inferior on the glenoid for the ASI shoulder compared with the healthy shoulder. Furthermore, the contact point of the ASI shoulder was 1.4 mm (95% CI 0.3 to 2.5) more anterior and 2.0 mm (95% CI 0.8 to 3.1) more inferior on the glenoid compared with the healthy shoulder. The contact point of the ASI shoulder was 1.2 mm (95% CI 0.2 to 2.6) more anterior during the apprehension test compared to the relocation test. The humeral head centre was located more inferior, and the GHJ contact point was located both more anterior and inferior during the apprehension test for the ASI shoulders than the healthy shoulders. Furthermore, the contact point displacement between the apprehension and relocation test revealed increased joint laxity for the ASI shoulder than the healthy shoulders. These results contribute to existing knowledge that ASI shoulders with glenoid bone loss may also suffer from inferior shoulder instability.

Outcomes of Arthroscopic Cortical-Button Latarjet Procedure with Minimum Five Year Follow-Up

IntroductionThe surgical treatment of anterior shoulder instability with arthroscopic cortical-button Latarjet procedure has been the subject of very few medium and long-term studies. The aim of this study was to analyze the clinical and radiological results of arthroscopic cortical-button Latarjet procedure with minimum 5 years follow-up. MethodThis is a monocentric retrospective study including 40 patients who have undergone shoulder stabilization with primary arthroscopic cortical-button Latarjet procedure and been reviewed with minimum 5 years follow-up. The average age at the time of surgery was 26.6 years (16 – 59; ± 10) and 92.5% were sporty individuals. The average ISI score was 6 points (2- 9; ± 1,6). The clinical evaluation involved active range of motion measurement, apprehension test, Rowe and Walch-Duplay scores, SSV and Net Promoter Score. Radiologically, evolution of the bone graft and degenerative arthritis of the shoulder joint were analyzed at the last follow-up. ResultsAt an average follow-up of 71 months (60 – 97; ± 12), 3 patients (7.5%) experienced recurrence as a dislocation or subluxation, which was responsible for revision in 1 case. Moreover, apprehension persisted in 6 (16%) patients. There were no significant restrictions in recovery of active ranges of motion, including external rotation. Return to sports was effective in 94.6% of cases. The average Rowe and Walch-Duplay scores were 87 points (15 - 100; ± 20) and 88 points (15 - 100; ± 19) respectively. SSV was 91% (10 – 100; ± 16) and NET Promoter Score was 9.3 points (5 – 10; ± 1,3). Radiologically, degenerative arthritis occurred in 18.7% of patients, mainly asymptomatic stage 1 (9.4%). Bone healing was acquired in 72% of cases and partial lysis of the bone block in 41%. ConclusionAt an average follow-up of 6 years, arthroscopic cortical-button Latarjet procedure effective, enabling return to sport in 95% of cases. Onset of asymptomatic arthritis seems similar to conventional techniques but justifies a more long-term follow-up.

Chronic shoulder instability using the Latarjet technique: About 20 cases

This retrospective study included 20 patients operated on in the Traumatology and Orthopedics Surgery Department (A) of the HASSAN II University Hospital in Fez, treated with a LATARJET · between January 2016 and December 2023, a 5-year period · In our series, the mean age at surgery was 27 years. · Male predominance was evident, with a traumatic context found in 90% of cases. · The apprehension test was positive in 65% of cases. · Our patients underwent a systematic standard preoperative radiological work-up. · We opted for the LATARJET technique · Elbow-to-body immobilization for 21 days post-operatively. · They were followed up in consultation with a 5-year follow-up. The results of our series are very satisfactory according to the ROWE score: · -85% of patients complained of no pain. Stability was perfect in 18 cases (90%). · -Unrestricted mobility was restored in 80% of cases. · -Only one case of recurrence (5%) · One patient with postoperative osteoarthritis, corresponding to 5%. In all, we had 85% good and excellent results, versus 15% fair and poor results. The results of this study are similar to those found in the literature, confirming that the LATARJET technique is the most reliable in the treatment of anterior shoulder instability, with good functional results and the fewest complications.

EHLERS–DANLOS SYNDROME — A CASE OF MULTIDIRECTIONAL SHOULDER INSTABILITY REHABILITATION

Introduction: Ehlers–Danlos Syndrome (EDS) is a hereditary and heterogeneous syndrome that affects conjunctive tissue, due to collagen production compromise. Hypermobile EDS (hEDS) is the most common subtype of this syndrome and can cause shoulder joint instability, which can lead to chronic pain and significant functional impairment. Methods: A case report of a patient with hEDS followed in our local health unit was made. The authors describe their clinical insight regarding the case, as well as the rehabilitation program the patient was submitted to. Results: Female patient, 32 years old. Functionally autonomous in every daily living activity. Clinically diagnosed with hEDS in 2013, after reporting bilateral shoulder instability. The patient presented herself in a Physical and Rehabilitation Medicine consultation, 6 months after being submitted to the third surgical intervention of the right shoulder. She presented an overall limited range of motion, decreased muscle strength and positive apprehension and drawer tests. An extensive rehabilitation program was prescribed, focusing on joint mobilization, dynamic stabilizers strengthening and proprioceptive training. After 12 weeks, the patient presented reduced shoulder pain and a better functional status. Conclusion: hEDS compromises the integrity of the static and dynamic stabilizers of the shoulder. Clinical management of these cases involves a multidisciplinary approach with early and adequate rehabilitation care treatments.

Arthroscopic medial patellofemoral ligament reconstruction with polyethylene suture combined with medial retinaculum plication for the treatment of acute patellar dislocation in young and middle-aged patients with a follow-up of at least 2 years

PurposeThe purpose of this study was to propose a surgical technique for arthroscopic medial patellofemoral ligament (MPFL) reconstruction with polyethylene suture combined with medial retinaculum plication and to evaluate the efficacy of this surgical technique in the treatment of acute patellar dislocation.MethodsClinical data of patients with acute patellar dislocations treated with arthroscopic MPFL reconstruction with polyethylene tape (FiberTape) combined with medial support band compression were analyzed retrospectively from January 2018 to January 2021. The mean age of the patients was 25.15 ± 4.66 years; the mean follow-up time was 27.5 (24–36) months. Clinical evaluation consisted of apprehension test results, patellar extrapolation test results, Lysholm score, Kujala score, and IKDC score, the Patellar lateral shift distance and patellar tilt angle (PTA) measured by CT scan.ResultsAll patients had no recurrent patellar dislocation or subluxation after surgery, and the apprehension test was negative. In all patients, the Kujala score (36.0 ± 9.9 vs. 98.2 ± 3.1), the IKDC score (48.6 ± 7.0 vs. 90.6 ± 4.4) and the Lysholm score (32.8 ± 10.4 vs. 96.7 ± 3.1) had improved at the 24-month follow up (P < 0.05). In addition, PTA was significantly lower at the 12-month follow-up and 24-giving-month follow-up compared to the preoperative period (P < 0.05, Table 2). The patellar lateral shift distance decreased from 14.94 ± 6.11 mm preoperatively to 3.00 ± 1.40 mm (12-month follow up) and 3.26 ± 1.37 mm (24-month follow up), respectively.ConclusionArthroscopic MPFL reconstruction with polyethylene suture combined with medial retinaculum plication is a safe and reliable surgical technique for the treatment of acute patellar dislocation in young and middle-aged patients.Level of EvidenceLevel III, Therapeutic Study.

Большая пятерка личностных черт как модератор взаимосвязи между языковой тревожностью и креативной личностью

&lt;p&gt;Foreign language anxiety has received significant attention since many learners experience psychological barriers when learning a language. At the same time, numerous teaching methods aim to create a more efficient approach to language learning. Current research seeks to determine the influence of creative personality and the Big Five Personality Traits (BFPT) on Foreign Language Classroom Anxiety (FLCA). The respondents (N=452) aged between 16 and 45 (M=23,41, SD=7,22) received the Creative Personality Scale by Renzulli, the Ten Item Personality Inventory by Gosling, Rentfrow and Swann, and the Foreign Language Classroom Anxiety Scale by Horwitz evaluating test anxiety, communication apprehension, and fear of negative evaluation. We hypothesize that creative personality predicts FLCA components and the BFPT moderates the relationship between creative personality and FLCA. We found that creative personality significantly predicted FLCA We also found that agreeableness has a moderating effect on the relationship between creative personality and communication apprehension and creative personality and test anxiety, respectively. Based on the findings, we suggested that teachers should pay more attention to the learners&amp;rsquo; individual differences. First, it is essential to implement creativity-nurturing methods of teaching more consciously. Second, online or offline teaching methods could decrease communication apprehension depending on the learners&amp;rsquo; agreeableness.&lt;/p&gt;

Early-term effectiveness of Latarjet procedure by coracoid osteotomy with preserving coracoacromial ligament for recurrent anterior shoulder dislocation

To evaluate the early-term effectiveness of Latarjet procedure with double EndoButtons fixation for recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament. Between January 2021 and June 2023, 19 patients with recurrent anterior shoulder dislocations were treated by arthroscopic Latarjet procedure with double EndoButtons fixation, all of which underwent coracoid osteotomy with preserving the coracoacromial ligament. There were 11 males and 8 females, with an average age of 23.3 years (range, 17-32 years). Shoulder dislocations ranged from 3 to 11 times, with an average of 6.4 times. The disease duration ranged from 3 to 35 months, with an average of 12.9 months. All apprehension tests were positive. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 13%-26%, with an average of 19.8%. After operation, the shoulder range of motion was examined, including flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery (ASES) score, and Rowe score. Imaging examinations were taken to observe the position and shaping of coracoid. All incisions healed by first intention and no nerve or vessel injury occurred. All patients were followed up 9-24 months (mean, 14.5 months). There was no recurrence of shoulder dislocation and the apprehension tests were negative during follow-up. There was no significant difference in the shoulder range of motion (flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation) between preoperation and at last follow-up ( P>0.05). The Walch-Duplay score, ASES score, and Rowe score significantly improved when compared with those before operation ( P<0.05). Postoperative imaging showed that coracoid graft was at the same level with the glenoid in all cases; the center of coracoid graft was located between 3 to 5 o'clock. During follow-up, there was no glenohumeral joint degeneration, the acromiaohumeral distance was not reduced when compared with preoperation, and the coracoid bone gradually formed concentric circles with the humeral head. The Latarjet procedure with double EndoButtons fixation can effectively treat recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament, and the early-term effectiveness is satisfactory.

Medial patellofemoral ligament reconstruction with an extensor hallucis longus allograft: a retrospective study of 45 cases.

Reconstruction of the Medial Patellofemoral Ligament (MPFL) has become the procedure of choice in patients with patellar instability. The type of graft used for reconstruction is controversial. The purpose of this study was to analyze and describe the clinical and radiological results achieved with a MPFL reconstruction performed using an extensor hallucis longus allograft. This work is a retrospective study of 41 patients (45 knees) who underwent MPFL reconstruction using an extensor hallucis longus allograft. The patellar apprehension test, Kujala scale, and EQ-5D European quality of life scale were evaluated preoperatively and postoperatively at 24 months. Complications, recurrence rate, time to return to sports, and satisfaction with the procedure were also assessed. Statistically significant differences were observed between pre- and postoperative variables on the Kujala scale (p < .001) and the EQ-5D (p < .001). The isolated MPFL presented an increase on the Kujala scale of 41.9 ± 13.4, in contrast to the reconstruction with tibial tubercle osteotomy with an increase of 29.4 ± 16.6 (p = 0.031). MPFL reconstruction with an extensor hallucis longus allograft is a suitable alternative in patients with patellofemoral instability because it offers clinically and radiologically satisfactory results. MPFL reconstruction combined with a tibial tubercle osteotomy can offer inferior functional outcomes to the isolated reconstruction.

Estimation of Atraumatic Hip Microinstability Among Long Distance Truck Drivers in Western Maharashtra : A Cross-Sectional Study

Introduction: Hip micro-instability is an upcoming concern and is gaining acceptance as an important contributing factor for hip joint dysfunction among adults and is a major risk factor for the development of early osteoarthritis. Around 20-25% of people at the age of 50 suffer hip pain and knee pain because of chronic wear and tear of joint articular cartilage. is typically described as painful extra-physiologic hip movements, either alone or in combination with symptoms of unstable hip joints. Truck drivers travel long routes for an extensive duration of time with their hips in an ergonomically compromised position. Occupational stress can cause pain which is an effect of vibrational forces and postural stress. Investigation suggests that hip musculoskeletal pain as a whole is one of the main causes of hip micro-instability. Hence, it is important to evaluate the presence of hip micro-instability among long-distance truck drivers. Methods: A cross-sectional study was conducted from 4 May 2023 in a rural tertiary care hospital in Karad for about 6 months. Wherein a total of 103 long-distance truck drivers were randomly selected based on the inclusion criteria which included truck drivers by occupation within the age group of 35-45 years, working for more than 12 hours in a day and for 5 days/week with no history of trauma. They were assessed by using the Anterior Apprehension Test, Prone Apprehension Test, and AB-HEER test. The data was then analyzed using statistical procedures, and the results were obtained. Results: The present study shows that over 12% of participants showed positive results for hip micro-instability. A significant positive correlation was observed between the number of years of driving in relation to pain (P value &lt; 0.0001). On assessment, there was an increase in flexion, adduction, and internal rotation ranges which hence revealed anterior hip micro-instability (P value = 0.0121) as compared to extension, abduction and external rotation ranges which revealed posterior instability. Conclusion: The study concluded that over 12% of participants showed positive results for hip micro-instability. Also, anterior hip micro-instability was more as compared to posterior hip micro-instability amongst the truck drivers due to capsular relaxation which was affected due to prolonged hours of poor ergonomics. This study also showed the existence of micro-instability despite the presence or absence of ligamentous laxity.

Longer peripheral-track lesions are associated with instability after arthroscopic Bankart repair

BackgroundThe Glenoid track concept has enabled the categorization of Hill-Sachs lesions (HSLs) into on-track lesions and off-track lesions. Furthermore, among the on-track lesions, further categorization has been established based on the distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track, into peripheral-track lesions and central-track lesions. Recent studies on peripheral-track lesions and central-track lesions within the glenoid track have shown inconsistencies in failure rates, which deserves further investigation. MethodsA retrospective cohort comparison of patients who underwent arthroscopic Bankart repair between 2015 and 2020 was performed. 102 patients with peripheral-track HSLs were included. The patients were divided into two groups based on the results of the postoperative apprehension test: the apprehension positive group (n=30), and the apprehension negative group (n=72). Using preoperative computed tomography and an image reconstruction program, three-dimensional images were segmented to calculate the length, width, depth, and distance of the HSLs. A multivariate logistic regression was used to determine the risk factors of recurrence, for which odds ratio (OR) and 95% confidence interval (CI) were provided. ResultsA multivariate logistic regression analysis revealed that the length of the peripheral-track HSLs was a significant independent predictor of failure in this study. (OR 1.380; 95% CI 1.170–1.627; P<0.001). The receiver operating characteristics curve demonstrated a predictive power (area under the curve = 0.841) and a threshold value of 14.2 mm. ConclusionLength was the only risk factor for the recurrent instability of peripheral-track HSLs after ABR. In the context of surgical decision-making, utilizing the glenoid track concept, medical practitioners may need to evaluate instability by considering the length as a continuous factor, while differentiating between peripheral-track and central-track classifications.

Knotless Bioabsorbable Anchors Placed on the Glenoid Face for Arthroscopic Bankart Repair

Background: Quantitative analysis of the glenoid face knotless-type anchor placement for arthroscopic Bankart repair has not been reported. Purpose: To evaluate the clinical and radiologic outcomes after arthroscopic Bankart repair using knotless bioabsorbable anchors depending on the anchor location. Study design: Case series, Level of evidence, 4. Methods: A total of 124 patients (113 men and 11 women; age, 25.6 ± 7.5 years; follow-up time, 46.5 ± 18.2 months [range, 6.2-75.5 months]) who underwent arthroscopic Bankart repair with the bioabsorbable knotless anchor between 2017 and 2021 were included in this study. Among them, 118 patients were observed for >2 years (mean, 48.2 ± 16.8 months [range, 24-75.5 months]) and were analyzed for final clinical and radiologic outcomes. Using postoperative 6-month magnetic resonance imaging, remnant glenoid (%) and labral height were measured. Shoulder range of motion (ROM), radiographic osteoarthritic change, dislocation, apprehension test, and return to sports were recorded. Three groups were established based on the remnant glenoid, which represented the percentage of the exposed glenoid anteroposterior diameter to the original diameter using the best-fit circle method—group A: lower quartile; group B: interquartile; and group C: upper quartile—and variables were analyzed. Results: Overall, the remnant glenoid was 57% ± 6.4% (range, 41.5%-75%) after the surgery. Osteoarthritic change, dislocations, and positive apprehension tests were observed in 5 (4.2%), 4 (3.4%), and 12 (10.2%) patients, respectively. A total of 34 (28.8%) and 64 (54.2%) patients could return to sports without and with restrictions, respectively. Comparing groups A, B, and C, postoperative labral height (7 ± 1, 7 ± 2, and 7 ± 1 mm; P = .623), final osteoarthritic change (1, 4, and 0; P = .440), positive apprehension tests (5, 5, and 2; P = .387), and return to sports (complete/restricted/unable, 6/18/5, 19/29/11, 9/17/4; P = .769) were not different. All ROM were similar across the groups (all P > .054), except for external rotation (ER) at postoperative 6 months (41.3°± 12.8°; 50.2°± 18.5°; and 49.8°± 15.2°; P = .050). However, ER after 1 year was similar across the groups (all P > .544). In further analysis, patients with positive apprehension tests had lower labral height compared with others (5 [4-6] mm and 7 [6-8] mm; P < .001). Conclusion: In arthroscopic Bankart repair, the placement of knotless bioabsorbable anchors on the glenoid face, combined with the remplissage procedure or rotator interval closure, resulted in a low recurrence rate and moderate return to sports. However, most patients had some restrictions in returning to sports. Moreover, this technique was not associated with postoperative arthritis and shoulder stiffness, including ER deficit, which was not affected by the position of the anchor on the glenoid face for a minimum 2-year follow-up.

Outcome of Modified Open Latarjet Operation in the Treatment of the Recurrent Anterior Shoulder Dislocation: A Cohort Study

Introduction: Shoulder instability is defined as a symptomatic translation of the humeral head about the glenoid fossa during active shoulder motion. Anteroinferior glenoid bone loss or labrum avulsion is most often a consistent finding in recurrent dislocation. The modified open Latarjet procedure is one of the most effective methods of treatment for patients with recurrent shoulder instability with glenoid bone loss. Aim: To determine the functional outcome of the congruent arc modification of the open Latarjet procedure. Materials and Methods: This prospective cohort study was conducted at a tertiary healthcare centre in Bhopal, Madhya Pradesh, India between January 2018 and December 2020. A total of 25 patients with recurrent anterior shoulder dislocation underwent treatment using the modified open Latarjet procedure. Two patients were lost to follow-up, resulting in the evaluation of 23 patients. All patients underwent a 3D Computed Tomography (CT) scan to document glenoid bone loss. The intensity of pain, activity level, strength of abduction, and Range of Motion (ROM) were assessed to calculate the Constant Shoulder Score for pre- and postoperative evaluation of functional outcomes. Follow-ups were conducted at 3 months, 6 months, 1 year, and 2 years after surgery. The data was analysed using the Wilcoxon’s signed-rank test, and Spearman’s correlation coefficient was used to identify associations between various variables. Results: A total of 23 male patients aged between 18 and 63 years were included. The average age of patients was 30.35±11.27 years. Preoperatively, only 3 patients (13.04%) had good to excellent Constant Shoulder Scores. However, no statistically significant variation in Constant Score was observed three months after surgery. Six months post-surgery, 17 patients (73.92%) showed good to excellent scores. Nearly one year after surgery, 21 patients (91.3%) had good to excellent outcomes. At the final follow-up, 22 patients (95.65%) demonstrated good to excellent outcomes. A statistically significant improvement in good to excellent scores was noted six months postoperatively (p-value &lt;0.001). A total of 20 patients (86.96%) achieved full ROM, with only 3 patients (13.04%) reporting mild to moderate limitations in shoulder ROM. None of the patients experienced redislocation, and the apprehension test was positive in only one patient. Conclusion: The modified open Latarjet procedure is a reliable method for providing stability and Self confidence to patients with recurrent shoulder instability and glenoid bone loss.

The validity and reliability of writing attitude scale for EFL learners in the Indonesian context

Having a positive attitude in writing is very important since the positive attitude will make the students approach writing in a good way and will enable them to finish the writing task well. Thus, an appropriate instrument to measure the writing attitude is needed. Yet, scarce research is dedicated to investigating the validity and reliability of the writing attitude scale. This research is intended to investigate the validity and reliability of the writing attitude scale adapted from Podsen (1997) which was originally developed from the Daly-Miller Writing Apprehension Test (Daly Miler, 1975b). The design of this study was an observational, non-experimental study with a cross-sectional design, in which the researchers focused on analyzing Podsen’s (1997) Writing Attitude Scale (WAS). The population of the study was 96 students who took the Essay Writing course in the English Department, at a public university in East Java. The data were in the form of numbers on an ordinal scale. The researchers used the Content Validity Ratio (CVR) to analyze the validity and Cronbach alpha to check the inter-item correlation coefficient in SPSS 25. The result of the study shows that the CVR analysis was 1, and all items in the questionnaire were valid (p=.000≤.000) as shown in the Pearson product-moment analysis. Secondly, the internal consistency of Podsen’s (1997) Writing Attitude Scale was high (r.877). This implies that the instrument is applicable because it possesses validity and is highly reliable in measuring students’ writing attitudes.

At long-term follow-up many first-time male traumatic shoulder dislocators remain symptomatic.

To assess the status at 13 to 17 years follow-up of a cohort of young male traumatic shoulder dislocators. Prospective cohort study. A prospective study of first-time young male traumatic shoulder dislocators, began in 2004. Subjects were evaluated by the apprehension test after completing rehabilitation 6 to 9 weeks post dislocation. Between March 2021 and July 2022, a telephone questionnaire was administered to ascertain their current shoulder status. Subjects were questioned about avoidance of activities of daily living and sport, participation in sports, current instability, and self-assessed shoulder function by the SANE score. 50/53 (94.3%) of the study subjects, mean age 20.4 years, completed a mean follow-up of 181.8 ± 12 months. The non-redislocation survival was 13% for those with a positive apprehension test and 49% for those with a negative test (p = 0.007). SANE scores were 64.3 ± 23.7 for those with a positive apprehension test and 83.7 ± 19.7 for those with a negative test (p = 0.001). In the year before the follow-up, 33.3% of those treated conservatively and 42.9% treated surgically experienced subluxation (p = 0.5). Fifty-seven percent of those who were treated conservatively and 56% of those who underwent surgery avoided some ADL or sports because of their shoulder. For young male first time traumatic shoulder dislocators a positive apprehension test after rehabilitation is associated with a high risk for reoccurrence and poorer long-term results. Most subjects were still dealing with shoulder symptoms at long-term follow-up.

Clinical application of Fastpass Scorpion suture passer for arthroscopic Bankart repair

To explore the effectiveness and advantages of using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair compared with traditional arthroscopic suture shuttle. The clinical data of 41 patients with Bankart lesion, who met the selection criteria and were admitted between August 2019 and October 2021, was retrospectively analyzed. Under arthroscopy, the inferior capsulolabral complex was stitched with Fastpass Scorpion suture passer in 27 patients (FS group) and with arthroscopic suture shuttle in 14 patients (ASS group). There was no significant difference between the two groups ( P>0.05) in gender, age, injured side, frequency of shoulder dislocation, time from first dislocation to operation, and preoperative Rowe score of shoulder. Taking successful suture and pull-tightening as the criteria for completion of repair, the number of patients that were repaired at 5∶00 to 6∶00 (<6:00) and 6∶00 to 7∶00 positions of the glenoid in the two groups was compared. The operation time, and the difference of Rowe shoulder score betwee pre- and post-operation, the occurrence of shoulder joint dislocation, the results of apprehension test, and the constituent ratio of recovery to the pre-injury movement level between the two groups at 1 year after operation. Both groups completed the repair at 5∶00 to 6∶00 (<6∶00), and the constituent ratio of patients completed at 6∶00 to 7∶00 was significantly greater in the FS group than in the ASS group ( P<0.05). The operation time was significantly shorter in the FS group than in the ASS group ( P<0.05). All incisions in the two groups healed by first intention. All patients were followed up 12-36 months (mean, 19.1 months). No anchor displacement or neurovascular injury occurred during follow-up. Rowe score of shoulder in the two groups significantly improved at 1 year after operation than preoperative scores ( P<0.05), and there was no significant difference in the difference of Rowe shoulder score between pre- and post-operation between the two groups ( P>0.05). At 1 year after operation, no re-dislocation occurred, and there was no significant difference in the apprehension test and the constituent ratio of recovery to the pre-injury movement level between the two groups ( P>0.05). Compared with the arthroscopic suture shuttle, using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair is more convenient, saves operation time, and has good effectiveness.

Glenoid rim morphology in young athletes with unstable painful shoulders: primarily painful vs. frankly unstable

To investigate the characteristics of glenoid rim morphology in young athletes (<40 yr) with unstable painful shoulder. This was a retrospective case series. The inclusion criteria were as follows: (1) shoulder pain during sports activity, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft tissue or bony lesions confirmed on imaging examinations (computed tomography and magnetic resonance imaging). The above-mentioned painful cohort was then compared (in a 2:1 ratio) to a match-paired control group of patients with similar demographics but with frank anterior glenohumeral instability as defined by imaging and physical findings. The pain (not apprehension) was reproduced during the anterior apprehension test in supine position and relieved by relocation test in all patients. Glenoid rim morphology, bone union in shoulders with a fragment-type glenoid, glenoid defect size, bone fragment size, medial displacement of bone fragments (MDBF), and medial distance of erosion (MDE) were compared between painful shoulders and unstable shoulders. There were 79 painful shoulders and 165 unstable shoulders. The glenoid rim morphology was normal in 33 shoulders, erosion-type in 15 shoulders, and fragment-type in 31 shoulders among painful shoulders, whereas the respective shoulders were 19, 33, and 113 among unstable shoulders (P<.001). Bone union was complete in 15 shoulders, partial in 14 shoulders, and nonunion in 2 shoulders among painful shoulders, whereas the respective shoulders were 43, 31, and 39 among unstable shoulders (P=.001). The mean glenoid defect size was 6.0±7.2% and 12.7±7.4%, respectively (P<.001), and the mean bone fragment size was 5.8±6.4% and 5.4±4.6%, respectively, (P=.591). The mean MDBF was 1.4±1.5 mm and 3.0±2.2 mm, respectively (P<.001), and the mean MDE was 2.3±1.2 mm and 5.2±2.4 mm, respectively (P<.001). In shoulders with a smaller glenoid defect (<13.5%), the prevalence of shoulders with MDBF (<2 mm) and shoulders with MDE (<2 mm) was more frequent in painful shoulders. On the other hand, in shoulders with a larger glenoid defect (≥13.5%), erosion-type glenoid, nonunion in fragment-type glenoid and bone fragment smaller than 7.5% was not recognized in painful shoulders. Shoulders with MDBF (<2 mm) were significantly more frequent in painful shoulders (P=.009). In painful shoulders normal or erosion-type glenoid was predominant, and glenoid defect size was significantly smaller than unstable shoulders. On the other hand, a large bone fragment (≥7.5%) remained and united completely or partially in all shoulders with a larger glenoid defect (≥13.5%). Bone union was obtained within 2 mm from the articular surface in most of them.

Do We Need A Bone Block Procedure in Recurrent Anterior Shoulder Instability?: A Case Report

Background: Recurrent Anterior Shoulder Instability (RASI) is usually preceded by trauma. The incidence recurrence rate is high in trauma Induced RASI, especially in younger patients. The right diagnosis and management must be ruled out immediately for a better outcome. Case Report: The 28-year-old man complained of right shoulder instability for the past eight years, which worsened in the last year. The patient had a history of trauma. Anterior apprehension and relocation test for the right shoulder showed a positive result. Radiologic imaging showed bony bankart loss (27%) and an on-track hillsach lesion of the humeral head. The Instability Severity Index Score (ISIS) is 7 points. Based on these results, an open surgery bone block-Latarjet procedure was done. The surgery was successfully performed, and there was no sign of recurrent instability and pain after one year.Discussion: The number of recurrent shoulder dislocations is over 75%. Bone loss found in the patient will increase the chance of RASI. No block procedure effectively prevented future recurrence from the bone stop effect, which increases the glenoid cavity, stretching effect, and tensioning effect that prevents excessive humeral translation.Conclusion: In the case of RASI, treatment decisions need to be based on the patient's exact condition. Bone block-Latarjet procedure is indicated in patients with bony bankart loss &gt;25%, on track hillsach lesion, and &gt;6 ISIS. In this research, the patient showed improved functional and clinical outcomes after eight years of chronic shoulder instability.

Valeur prédictive du test d’hyperabduction de Gagey pour identifier les lésions du ligament glénohuméral inférieur

IntroductionClinical tests that can identify inferior glenohumeral ligament (IGHL) complex injuries are indispensable for the diagnosis of shoulder instability. Gagey's hyperabduction test has been developed to diagnose IGHL hyperlaxity, however, it is unclear whether the test is able to accurately diagnose an IGHL lesion. The aim of this study was to (1) determine the diagnostic performance of the Gagey test in identifying an IGHL lesion and (2) determine if a positive Gagey test is more predictive for an anterior or posterior IGHL lesion thanks to the heatmapping of the lesions. It was hypothesized that a Gagey test can accurately predict IGHL lesions, but would not be able to distinguish between anterior and inferior IGHL lesions. MethodsA retrospective diagnostic accuracy study was conducted including all consecutive patients who underwent glenoid labral repair between January 2005 and September 2021 with a documented Gagey test prior to surgery. Using arthroscopic findings as a reference standard, the diagnostic performance characteristics of the Gagey test for each type of IGHL lesion (anterior, posterior and combined) were calculated and labral heatmapping was used to depict its localisation. ResultsA total of 167 patients were included, with a mean age of 29±10 years. The sensitivity, specificity and accuracy of the Gagey test on determining an IGHL lesion were 46%, 38% and 46%, respectively. The positive and negative predictive values were 88% and 7%, respectively. Heatmapping of the labral lesions demonstrated that a positive Gagey test was most predictive of anterior IGHL and axillary pouch tears and non-predictive of posterior IGHL lesions. DiscussionThe Gagey test demonstrated a low sensitivity and specificity to identify an IGHL lesion and therefore the hypothesis could not be confirmed. However, the Gagey test has a high positive predictive value to diagnose anterior IGHL lesions. Further prospective research with a more evenly distribution of lesions is needed to investigate the clinical value of the Gagey test to identify these lesions. Based on this data, the Gagey test seems especially important to support the results of other clinical tests such as the apprehension, relocation and surprise tests. Level of evidenceIII, retrospective case-control study.

The supine moving apprehension test-Reliability and validity among healthy individuals and patients with anterior shoulder instability.

Performance-based tests for patients with anterior shoulder dislocation are lacking. This study determined the reliability and validity of the supine moving apprehension test designed to assess the ability to control anterior instability loads. Thirty-six participants were recruited (18 healthy individuals, and 18 patients following anterior shoulder dislocation). Healthy participants performed the supine moving apprehension test on 2 separate occasions to determine test-retest reliability. Patients completed the supine moving apprehension test and the Western Ontario Shoulder Instability index before and 6 months after surgical stabilization of their shoulder. The presence of anterior apprehension was also documented post-operatively. The supine moving apprehension test demonstrated good test-retest reliability (intraclass correlation coefficient = 0.74-0.84). Patients performed 18-30 repetitions less than healthy individuals during the supine moving apprehension test (P < 0.01). A strong correlation was found between supine moving apprehension test scores and Western Ontario Shoulder Instability post-operatively (r = -0.74, P ≤ 0.01). Supine moving apprehension test scores significantly improved among patients following surgery (P < 0.01). Patients with a negative apprehension test post-operatively performed the supine moving apprehension test significantly better than patients with a positive apprehension test (P < 0.01). The supine moving apprehension test is reliable and valid among patients with anterior shoulder dislocation and may serve to assess patients' ability to control shoulder anterior instability loads.