Postoperative Range Of Motion Research Articles

Accuracy of Blueprint in Predicting Range of Motion One Year After Reverse Total Shoulder Arthroplasty.

/hypothesis: Blueprint 3D CT software has a functionality that predicts impingement-free range of motion with the limits of range of motion determined at which bone and/or prosthetic impingement occurs. To the best of knowledge, there is only one previously published study that assessed the ability for the Blueprint software to predict actual postoperative range of motion after reverse total shoulder arthroplasty. The hypothesis of this study was that 1) mean Blueprint predicted impingement-free range of motion will be statistically similar to the mean actual range of motion one year after reverse total shoulder arthroplasty and 2) there will be a correlation between Blueprint predicted impingement-free range of motion and the actual range of motion one year after reverse total shoulder arthroplasty. A retrospective review of patients that had Blueprint planning prior to undergoing reverse total shoulder arthroplasty from March 2017 through May 2021 was reviewed. At one-year follow-up. flexion, external rotation at the side, abduction, abduction / external rotation, abduction / internal rotation, and internal rotation behind the back were measured. The preoperatively predicted flexion, extension, abduction, external rotation, and internal rotation were recorded from the Blueprint software. Group 1 analysis examined the predicted vs actual range of motion for all 127 patients regardless if intraoperative component modifications were made. Group 2 examined the predicted vs actual range of motion of only the patients that did not have intraoperative changes that would affect the preoperative range of motion prediction (n=97). Group 3 examined the predicted vs actual range of motion of Group 2 combined with the 30 patients that had post-hoc Blueprint planning modifications to account for the changes made intraoperatively (combined sample size = 127). One-hundred-twenty-seven patients of the 141 patients (90%) were available for one year follow-up. When examining the mean of all three groups, the actual range of motion and predicted range of motion was statistically significantly different (p<0.0001) for flexion, external rotation, abduction, abduction/ external rotation, and abduction / internal rotation. In Group 1, a very weak or poor correlation was found between predicted internal rotation and actual abducted/internal rotation (r=0.19; p=0.04). For all other range of motion metrics in Groups 1, 2, and 3, there were no correlations between predicted and actual range of motion (p >.07). In its current state, preoperative Blueprint 3D CT planning software is unable to accurately predict range of motion one year after reverse total shoulder arthroplasty.

Influence de l’allongement huméral sur les résultats cliniques de l’arthroplastie inversée de l’épaule

BackgroundDeltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but may predispose patients to acromial/scapular spine fractures and neurologic injury. Clinical evidence linking patient outcomes to humeral lengthening is limited. This study assesses the relationship between humeral lengthening and clinical outcomes after RSA. MethodsA single institution review of 284 RSAs performed in 265 patients was performed. Humeral lengthening was defined as the difference in the subacromial height preoperatively to postoperatively as measured on Grashey radiographs. The subacromial height was measured as the vertical difference between the most inferolateral aspect of the acromion and the most superior aspect of the greater tuberosity. The relationship between humeral lengthening and clinical outcomes was assessed on a continuous basis. Secondarily, clinical outcomes were assessed using a dichotomous definition of humeral lengthening (≤25 vs. >25mm) based on prior clinical and biomechanical work purporting a correlation with clinical outcomes. Improvement exceeding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for ROM and outcome scores after RSA were also compared. ResultsHumeral lengthening demonstrated a nonlinear relationship with postoperative ROM, clinical outcome scores, and shoulder strength and their improvement preoperatively to postoperatively. Furthermore, there were minimal differences in ROM measures, outcome scores, and shoulder strength when stratified using the dichotomous definition of humeral lengthening. No difference in the proportion of patients exceeding the MCID or SCB when stratified by humeral lengthening ≤25 vs. >25mm was found. There was no difference in humeral lengthening in patients with versus without complications. ConclusionNo clear relationship between humeral lengthening and clinical outcomes was identified. The previously purported 25mm threshold for humeral lengthening did not predict improved patient outcomes. Outcomes after RSA are multifactorial; the relationship between humeral lengthening and outcomes is likely confounded by other patient and surgical factors. Level of evidenceIV; case series.

Comparison of direct surgical cost and outcomes for unstable elbow injuries: internal joint stabilizer versus external fixation

Unstable elbow injuries sometimes require External fixation (ExF) or an Internal Joint Stabilizer (IJS) to maintain joint reduction. No studies have compared the clinical outcomes and surgical costs of these 2 treatment modalities. The purpose of this study was to determine whether clinical outcome and surgical encounter total direct costs (SETDCs) differ between ExF and IJS for unstable elbow injuries. This retrospective study identified adult patients (aged ≥ 18 years) with unstable elbow injures treated by either an IJS or ExF between 2010 and 2019 at a single tertiary academic center. Patients postoperatively completed 3 patient-reported outcome measures (the Disability of the Arm, Shoulder, and Hand, the Mayo Elbow Performance score, and EQ-5D-DL). Postoperative range of motion was measured in all patients, and complications tallied. SETDCs were determined and compared between the 2 groups. A total of 23 patients were identified, with 12 in each group. Clinical and radiographic follow-up for the IJS group averaged 24 months and 6 months, respectively, and for the ExF group, 78 months and 5 months, respectively. The 2 groups had similar final range of motion, the Mayo Elbow Performance score, and 5Q-5D-5L scores; ExF patients had better the Disability of the Arm, Shoulder, and Hand scores. IJS patients had fewer complications and were less likely to require additional surgery. The SETDCs were similar between the 2 groups, but the relative contributors to cost differed significantly between the groups. Patients treated with an ExF or IJS had similar clinical outcomes, but complications and second surgeries were more likely in ExF patients. The overall SETDC was also similar for ExF and IJS, but relative contributions of the cost subcategories differed.

Topical administration of tranexamic acid reduces postoperative blood loss and inflammatory response in knee arthroscopic arthrolysis: a retrospective comparative study

BackgroundKnee arthroscopic arthrolysis serves as an effective treatment for knee arthrofibrosis. However, hemarthrosis is the most common complication in arthroscopic surgery, which has potential adverse effects on postoperative rehabilitation. The purpose of this study was to evaluate the effects of topical tranexamic acid (TXA) in knee arthroscopic arthrolysis.MethodsA total of 87 patients with knee arthrofibrosis who underwent arthroscopic arthrolysis from September 2019 to June 2021 were eligible for this retrospective review. Patients in the TXA group (n = 47) received topical administration of TXA (50 mL, 10 mg/mL) at the end of the surgery, and patients in the control group (n = 40) received no TXA. The postoperative drainage volumes, hematologic levels, inflammatory marker levels, knee range of motion (ROM), visual analog scale (VAS) pain scores, Lysholm knee scores and complications were compared between the two groups. The curative effect of each group was calculated according to Judet’s criteria.ResultsThe mean drainage volumes on postoperative day (POD) 1 and POD 2, and total drainage volume were significantly lower in the TXA group than in the control group (P < 0.001 for all). The TXA group had significantly lower postoperative CRP and IL-6 levels on POD 1 and POD 2, and at postoperative week (POW) 1 and POW 2 than the control group. The VAS pain scores in the TXA group were significantly lower on POD 1 and POD 2, and at POW 1 and POW 2 than those in the control group (P < 0.001 for all). Patients in the TXA group showed better postoperative ROM and Lysholm knee scores at POW 1 and POW 2. No patient had any complications such as deep venous thrombosis (DVT) or infection. The excellent and good rates of knee arthroscopic arthrolysis were comparable between the two groups at the sixth postoperative month (P = 0.536).ConclusionsTopical administration of TXA in knee arthroscopic arthrolysis can reduce postoperative blood loss and inflammatory response, alleviate early postoperative pain, increase early postoperative knee ROM, and improve early postoperative knee function without increased risks.

Open Latarjet Versus Arthroscopic Bankart Repair for the Treatment of Traumatic Anterior Shoulder Instability in High-Demand Patients With Minimal Glenoid Bone Loss.

This study compared the clinical outcomes and return to sports/work between open Latarjet and arthroscopic Bankart repair in high-demand patients with traumatic anterior shoulder instability with minimal glenoid bone loss. We prospectively recruited 30 patients and randomised them to either open Latarjet or arthroscopic Bankart. The mean duration of follow-up in our study was 13.27 months±2.70. All patients were males with a mean age at surgery of 28.6 years (range, 18-41 years). The overall mean for the Rowe score in the 30 patients increased from 33.5±14 points preoperatively to 79.6±18 points. However, there was no statistically significant difference in the postoperative ROM (range of motion) and Rowe score among the Bankart and Latarjet groups. The main finding in our study was the time to return to sports/work which was significantly lower in the Latarjet group (5.2 months) compared to the Bankart group (seven months). Open Latarjet is considered a more invasive and non-anatomical procedure, however, it is less costly with a shorter time to return to sports/work compared to the Bankart procedure, which is very crucial for high-demand patients, especially the competitive athletes targeting an early return to sports at the same pre-injury level with minimal incidence of recurrence, making the surgeon's choice very challenging.

Rise of the robots: are they coming?

The use of technology has increased over the last decade across all surgical specialties. Robotics is the ultimate tool and can accomplish accuracy and consistency for surgeons executing their preoperative plan. In orthopedic surgery, robotic-assisted knee and hip arthroplasty techniques have experienced rapid growth, and the next field of interest is, without a doubt, shoulder arthroplasty. While the survival rates extend to over 90% at 10 years of follow-up and overall satisfaction rates are very high, some report that up to 10% of the patients with a shoulder replacement remain dissatisfied with their postoperative range of motion and overall functional outcome. There have been numerous advances in implant designs and materials as well as the introduction of enhanced recovery programs, however, reported patient outcomes, and reoperation rates may not always have significantly benefited from those advances in shoulder arthroplasty over the last two decades. Lately, the digitalization of shoulder arthroplasty has drawn a lot of attention with the intent to improve the correction of joint deformities and component implantation, possibly leading to enhanced patient outcomes after shoulder arthroplasty. The potential benefits of shoulder robots are multiple. First, by converting data from imaging or intraoperative anatomy mapping, a patient-specific 3-dimensional representation of the joint may facilitate surgical planning and subsequent boundary control for the bony resections, reaming, and implant positioning. Second, the system may allow intraoperative assessment of the range of motion and joint stability. Third, research may be facilitated and encouraged by supporting case-by-case data collection. This next evolution in surgical technology aims to make shoulder replacements accurate and reproducible in both easy and challenging shoulders and usable by both low-volume and highly experienced surgeons.

Effect of humeral tray offset on clinical outcomes and computed tomography parameter in reverse total shoulder arthroplasty

BackgroundDespite the evolution of reverse total shoulder arthroplasty (RTSA), limitations in range of motion (ROM) and strength leading to limited increases in functional scores have been reported. This study was undertaken to determine the effects of humeral tray lateralization. MethodsA retrospective clinical study was performed on 35 patients who underwent RTSA with a single implant (Aequalis Ascend Flex short stem; Tornier SAS–Wright Medical Inc., Bloomington, MN, USA) and a humeral tray offset of 1.5 mm from July 2016 to November 2020 by a single surgeon. Patients were classified into two groups: an inferiorly positioned humeral tray group resulting in humeral lateralization (the inferior group [n = 22]) and a superiorly positioned humeral tray group resulting in distalization (the superior group [n = 13]). Constant-Murley score, University of California-Los Angeles shoulder scale, Simple Shoulder Test, Activity scale, American Shoulder and Elbow Surgeons shoulder score, and pain visual analog score were evaluated. ROM for forward flexion and abduction was measured. Strengths of forward flexion, internal rotation at 90° abduction, and external rotation at side (ER) were measured. Computed tomography was performed postoperatively to measure the amount of humeral lateralization. ResultsPostoperative ER power was greater in the inferior group (32.39 N ± 12.08 N) than in the superior group (23.77 N ± 10.96 N; P = .043). Postoperative abduction ROM was also greater in the inferior group (158.18° ± 18.36° vs. 128.08° ± 34.97°; P = .011), and humeral tray center to greater tubercle distance was larger in this group (54.68 mm ± 5.31 mm vs. 50.76 mm ± 3.65 mm; P = .025). ConclusionLateralization by inferior humeral tray positioning provided better results than distalization by superior humeral tray positioning in RTSA in terms of ER strength and abduction ROM. RTSA with humeral lateralization appears to result in better functional outcomes in certain conditions.

Non-use of intra-articular drain after anterior cruciate ligament reconstruction does not affect postoperative knee pain and muscle strength on early period

IntroductionThis study aimed to determine the effect of using an intra-articular drain after anterior cruciate ligament (ACL) reconstruction on early postoperative pain, range of motion (ROM), muscle strength, and complications. Materials and methodsBetween 2017 and 2020, of the 200 consecutive patients who underwent anatomical single-bundle ACL reconstruction, 128 patients underwent primary ACL reconstruction with hamstring tendons and were evaluated for postoperative pain and muscle strength at 3 months postoperatively. Sixty-eight patients who received intra-articular drain before April 2019 were classified as group D and 60 patients without an intra-articular drain after ACL reconstruction after May 2019 were classified as group N. Patient background, operative time, postoperative pain, number of additional analgesics used, presence of intra-articular hematoma, ROM at 2, 4, and 12 weeks postoperatively, extensor and flexor muscle strength at 12 weeks postoperatively, and perioperative complications were compared between the two groups. ResultsThe postoperative pain at 4 h after surgery was significantly greater in group D than in group N although no significant difference was found in the pain felt in the immediate postoperative period and at 1 day and 2 days postoperatively and in the number of additional analgesics used. No significant difference in the postoperative ROM and muscle strength was noted between the two groups. Six patients with intra-articular hematomas in group D and four patients in group N needed puncture by 2 weeks postoperatively, and no significant difference was found between the two groups. ConclusionPostoperative pain was greater at 4 h postoperatively in group D. Furthermore, the intra-articular drain did not affect muscle strength, ROM, and complications on the early postoperative period. The usefulness of intra-articular drain after ACL reconstruction was considered low. Level of EvidenceLevel IV.

Low resilience is associated with decreased patient-reported outcomes following arthroscopic rotator cuff repair

<h2>Abstract</h2><h3>Background</h3> The purpose of this study was to evaluate the relationship between preoperative resiliency and outcomes following arthroscopic rotator cuff repair (ARCR). The hypothesis was that patients with low preoperative resilience would have poorer postoperative patient reported outcomes compared to patients with high preoperative resilience following ARCR. <h3>Methods</h3> Eighty-one consecutive patients undergoing ARCR over a 1 year period at a single institution were prospectively evaluated. Baseline evaluation included a Brief Resilience Scale (BRS), range of motion, and the following patient-reported outcomes (PROs): visual analog scale pain (VAS), the American Shoulder and Elbow Surgeons (ASES), Veterans RAND 12-Item Health Survey (VR-12), and the Single Assessment Numeric Evaluation (SANE) tests. PROs and range of motion were reassessed at a minimum of 2 years postoperatively. Patients were divided based on the baseline BRS score into low-resilience (LR), normal-resilience (NR), and high-resilience (HR), and outcome scores were calculated for each group. Additionally, a regression analysis was performed to evaluate predictors of the final ASES score as a continuous variable. <h3>Results</h3> Despite similar baseline characteristics and postoperative range of motion and VAS scores, patients with LR had poorer postoperative ASES scores compared to patients with HR. The postoperative ASES score was 69 in the LR group, compared to 90 in the HR group (p =.031). Satisfaction was 78% in the LR group, compared to 100% in the HR group (p =.086). Based on regression analysis, the final ASES score increased 1.6 points for every 1-point increase in resilience. <h3>Conclusion</h3> Preoperative low resilience is associated with an over 20-point drop in postoperative ASES scores following ARCR. This difference is present despite similar baseline characteristics, suggesting the psychological contribution to postoperative outcomes is substantial.

Curve-on-curve technique does not improve tibial coverage in total knee arthroplasty in comparison to tibial tuberosity technique with use of anatomical implants: randomized controlled trial

IntroductionDuring the last years, main attention while performing total knee replacement was paid to femoral component alignment; however, there is still lack of studies concerning tibial baseplate rotational alignment, especially in terms of anatomical designs of knee prosthesis. Some recent studies proved that tibial baseplate malrotation might be a cause of knee pain and patients’ dissatisfaction. The aim of this study was to compare tibial component rotation and its coverage on the tibial plateau achieved with curve-on-curve and tibial tuberosity techniques (t-t technique) with use of anatomic knee designs with asymmetric tibial baseplate.Materials and methodsA total of 88 patients were randomly assigned in a 1:1 ratio to undergo total knee arthroplasty with use of the PERSONA PS (Zimmer Biomet) knee design with an asymmetric baseplate. The rotation of the tibial component was assessed and performed with two different techniques: curve-on-curve technique and tibial tuberosity technique. Tibial component rotation was measured on computed tomography (CT) scans using the method suggested by Benazzo et al. and designed for asymmetrical implants. For the measurement of the tibial bone coverage, the component surface area was outlined and measured on a proper CT section, then the tibial cut surface area was outlined and measured on a section just below the cement level. Pre- and post-operative range of motion was measured by another independent researcher 12 months post-operatively during follow-up visit.ResultsThere was a statistically significant difference between both groups in median value of tibial rotation angle: 7° (interquartile range (IQR) = 0–12) in curve-on-curve technique group vs 2° (IQR-1–7) in tibial tuberosity technique group, probability value (p) = 0.0041, with values above 0 meaning external rotation of the component. There was no statistically significant difference between both groups in terms of range of motion (ROM) with average values of 124.3° ± 13.0° for curve-on-curve technique and 125.6° ± 12.8° for t-t technique with p = 0.45. There was a statistically insignificant difference between both groups in terms of coverage percentage in slight favor for curve-on-curve technique (85.9 ± 4.2 vs 84.5 ± 4.8, p = 0.17).ConclusionIn this study, no difference between the groups in terms of tibial bone coverage and range of motion was proved, even though both techniques differed significantly with values of tibial rotation. Future studies should be focused on influence of specific values of tibial rotation on patient-reported outcomes and survivorship of anatomic knee implants.

Joint awareness after fixed and mobile-bearing total knee arthroplasty with minimum 12 years of follow-up: A propensity matched-pair analysis

BackgroundMany comparative articles studied mobile-bearing (MB) and fixed-bearing (FB) total knee arthroplasties (TKAs). Meta-analyses found no difference in survival or biomechanical outcome. This study aimed to compare long-term clinical results between fixed-bearing (FB) and mobile-bearing (MB) total knee arthroplasty (TKA) as well as patients’ adaptation to their artificial joints. MethodTKAs performed with the same surgical protocol divided into categories according to the insert design preferred. 70 MB design TKAs were compared with 70 FB design TKAs utilizing propensity matching for parameters; gender, age, body mass index, coronal plane deformity, range of motion (ROM) and appropriateness criteria. Forgotten Joint Score-12 (FJS-12) was used to assess patients’ ability to forget their artificial joints in daily life. ResultsPatients had a mean follow-up of 15.6 (±2.2) years. No difference was observed between groups for post-operative ROM, WOMAC, Knee Society Knee and Function Scores. The FJS-12 in the MB and FB groups were 66.1 and 72.8, respectively (P = 0.026). There was no significant difference in survival between both designs. ConclusionThis study suggests that in TKA, joint awareness is higher in MB compared to FB design. FJS-12 appears to be a sensitive measuring tool when comparing two designs and should be implemented in long-term follow-up.

Staged replacement of both hips and both knees in patients with rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) undergoing bilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) are an uncommon population, and their outcomes are also difficult to predict. The purpose of this study was to evaluate whether both bilateral cementless THA and cemented posterior-stabilized TKA (PS-TKA) can provide reliable outcomes for RA patients.MethodsWe retrospectively reviewed 30 RA patients (60 hips and 60 knees) who underwent both elective bilateral cementless THA and cemented PS-TKA, with a minimum follow-up of 2 years. Clinical, patient-reported, and radiographic data were retrospectively analyzed.ResultsThe mean follow-up was 84 months (range, 24–156). By the last follow-up, the post-operative range of motion, Harris Hip Score, Knee Society Score (KSS) clinical, KSS functional, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) hip, and WOMAC knee scores were significantly improved compared to the preoperative values. All patients achieved the ability to walk. In addition, overall satisfaction scores on a 100-point scale were 92.5 after THA and 89.6 after TKA. Only one patient underwent revision surgery due to knee joint instability, and all replaced hips and knees were radiographically stable by the assessment of the radiolucent line. The proportion of implants that did not suffer loosening or require revision surgery was 99.2% during the 84-month follow-up, based on Kaplan-Meier analysis.ConclusionsOur study suggests that bilateral cementless THA and cemented PS-TKA provides reliable mid-long-term clinical, patient-reported, and radiographic outcomes in RA patients, with high survivorship and patient satisfaction.

Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease

ObjectiveThe aim of this study was to investigate the feasibility of using the Isobar TTL system and posterolateral fusion in a two-segment hybrid fixation approach, combined with spinal decompression, for treating mild and moderate lumbar degenerative disease. Specifically, we sought to evaluate the effectiveness of this approach for managing two-segment mild and moderate lumbar degenerative disease, and to determine whether it could provide a safe and reliable alternative to traditional surgical methods.MethodsThis retrospective study included 45 consecutive patients with two-level lumbar disc herniation or spinal stenosis, 24 of whom underwent the TTL system and posterolateral fusion combined (TTL group), and 21 of whom underwent posterolateral fusion alone (Rigid group). The surgical segment, admission diagnosis, operation time, and intraoperative bleeding were recorded separately for the two groups of patients. Imaging studies included pre- and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain.ResultsAll patients completed the surgery successfully with a mean follow-up of 56.09 months. The operative time and intraoperative bleeding were lower in the TTL group than in the Rigid group (p < 0.05). All patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, and ODI scores (p < 0.05). ODI scores, the TTL group was better than the Rigid group at 1 year after surgery and at the final follow-up (p < 0.05). Postoperative surgical segment range of motion (ROM) decreased in both groups (p < 0.05). The postoperative ROM of the upper adjacent segment increased in both groups and was significantly higher in both groups at the last follow-up compared with the preoperative period (p < 0.05), and the superior adjacent segment rom of the TTL group was lower than the Rigid group (p < 0.05). The modified Pfrrmann classification of the superior adjacent segment was significantly increased in both groups at the last follow-up (p < 0.05). And in the TTL group, ROM, DH, and modified Pfrrmann grading of dynamic segment outperformed fusion segments. According to the UCLA classification, the incidence of adjacent segment degeneration (ASD) was 4.2% in the TTL group and 23.8% in the Rigid group, and the incidence of ASD was lower in the TTL group than in the Rigid group (P < 0.05).ConclusionThe Isobar TTL System was utilized in two-level lumbar hybrid surgery, resulting in no evident indications of lumbar instability being detected on X-rays captured at a minimum of 4 years after the operation, while retaining partial range of motion of the surgical segment. The general clinical efficacy is equivalent to titanium rod fusion surgery, presenting an alternative treatment for individuals with mild and moderate lumbar degenerative disease.

Unstable Middle Phalanx Base Fractures Treated With an Internal Joint Stabilizer: Preliminary Results.

Unstable fractures of the base of the middle phalanx are notorious for causing chronic loss of proximal interphalangeal (PIP) joint function, and they remain a challenge for the hand surgeon. We report on a temporary intraoperatively constructed internal joint stabilizer for unstable PIP joint injuries. Across 2 institutions, a retrospective chart review was performed for cases with acute presentation of pilon fracture or fracture-dislocation of the base of the middle phalanx which were surgically treated with an internal joint stabilizer. Information collected included time from injury to surgical intervention, time from implantation to device removal, complications, and preoperative and postoperative range of motion. Seven patients met the inclusion criteria with a mean age of 51 (range: 24-72) years and a mean follow-up of 29 (range: 11-72) months. After removal of the fixator, the mean arc of PIP joint motion was 8° to 88° (range: 0°-100°). There were no infections, no hardware loosening or failures, and no revision procedures. The current findings are comparable to the results for dynamic external fixators. An internal joint stabilizer for unstable injuries to the base of the middle phalanx provides satisfactory functional outcomes, allows early postoperative motion, and mitigates the routine complications which may arise with external fixation.

Influence of joint volume on range of motion after arthroscopic rotator cuff repair

BackgroundCapsular contracture is a well-known etiology in the primary stiff shoulder; thus capsular contracture and resultant decreased joint volume could lead to postoperative stiffness, which is a commonly reported morbidity after arthroscopic rotator cuff repair (ARCR). The purpose of this study was (1) to quantify the joint volume (total joint volume and each quadrant compartmental volume) using computed tomography arthrography (CTA) and (2) to demonstrate the relationship between joint volume and postoperative range of motion (ROM) after ARCR.Materials and methodsEighty-three patients (60 ± 5.11 years, men = 26, women = 57) who had undergone ARCR between January 2015 to December 2020 due to small to medium full-thickness tear and followed by CTA 6 months postoperatively were retrospectively reviewed. An image reconstruction program (3D Slicer, version 4.11.2 software) was used to calculate the joint volume (total joint volume and quadrant compartment joint volumes; anteroinferior, anterosuperior, posterosuperior and posteroinferior). For shoulder ROM, data including scaption (Sc), external rotation on side (ERs), external rotation at 90° (ER90), and internal rotation on back (IRb) were collected 6 months postoperatively. An evaluation of the correlation between joint volume and each shoulder motion was performed.ResultsThere were moderate correlations between the total joint volume and each motion (Sc: Pearson coefficient, 0.32, p = 0.0047; ERs: Pearson coefficient, 0.24, p = 0.0296; ER90: Pearson coefficient, 0.33, p = 0.0023; IRb: Pearson coefficient, 0.23, p = 0.0336). Among the quadrant compartments, the anteroinferior (Sc: Pearson coefficient, 0.26, p = 0.0199; ERs: Pearson coefficient, 0.23, p = 0.0336; ER90: Pearson coefficient, 0.25, p = 0.0246; IRb: Pearson coefficient, 0.26, p = 0.0168) and posterosuperior (Sc: Pearson coefficient, 0.24, p = 0.029; ER90: Pearson coefficient, 0.29, p = 0.008; IRb: Pearson coefficient, 0.22, p = 0.0491) and posteroinferior (Sc: Pearson coefficient, 0.30, p = 0.0064; ER90: Pearson coefficient, 0.29, p = 0.0072) showed moderate correlations with each shoulder motion.ConclusionTotal joint volume, anteroinferior compartment joint volume, posterosuperior compartment joint volume and posteroinferior compartment joint volume were related to postoperative ROM after ARCR. Perioperative methods to increase the joint volume, especially the anteroinferior, posterosuperior and posteroinferior parts of the capsule may prevent postoperative stiffness after ARCR.Level of EvidenceLevel III; Retrospective Case-Control Study.

Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction

PurposeThe decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aims to report the 2-year results of an initial patient cohort in terms of revision rate, PROMs and complications for Computer Aided Surgery (CAS) Navigated FA TKA.MethodsThis paper reports a single surgeon’s outcomes of 165 consecutive CAS FA TKAs. The final follow-up was 24 months. Pre-operative and post-operative patient-reported outcome measures, WOMAC and KSS, and intra-operative CAS data, including alignment, kinematic curves, and gaps, are reported. Stress kinematic curves were analysed for correlation with CAS final alignment and CAS final alignment with radiographic long-leg alignment. Pre- and post-operative CPAK and knee phenotypes were recorded. Three different types of prostheses from two manufacturers were used, and outcomes were compared. Soft tissue releases, revision and complication data are also reported.ResultsMean pre-operative WOMAC was 48.8 and 1.2 at the time of the final follow-up. KSS was 48.8 and 93.7, respectively. Pre- and post-operative range of motion was 118.6° and 120.1°, respectively. Pre-operative and final kinematic curve prediction had an accuracy of 91.8%. CAS data pre-operative stress alignment and final alignment strongly correlate in extension and flexion, r = 0.926 and 0.856, p < 0.001. No statistical outcome difference was detected between the types of prostheses. 14.5% of patients required soft tissue release, with the lateral release (50%) and posterior capsule (29%) being the most common.ConclusionCAS FA TKA in this cohort proved to be a predictable, reliable, and reproducible technique with acceptable short-term revision rates and high PROMs. FA can account for extremes in individual patient bony morphology and achieve desired gap and kinematic targets with soft tissue releases required in only 14.5% of patients.Level of evidenceIV (retrospective case series review).

Quantitatively biomechanical response analysis of posterior musculature reconstruction in cervical single-door laminoplasty

Background and objectiveThe current trend of laminoplasty is developing toward the goal of muscle preservation and minimum tissue damage. Given this, muscle-preserving techniques in cervical single-door laminoplasty have been modified with protecting the spinous processes at the sites of C2 and/or C7 muscle attachment and reconstruct the posterior musculature in recent years. To date, no study has reported the effect of preserving the posterior musculature during the reconstruction. The purpose of this study is to quantitatively evaluate the biomechanical effect of multiple modified single-door laminoplasty procedures for restoring stability and reducing response level on the cervical spine. MethodsDifferent cervical laminoplasty models were established for evaluating kinematics and response simulations based on a detailed finite element (FE) head-neck active model (HNAM), including ① C3 – C7 laminoplasty (LP_C37), ② C3 – C6 laminoplasty with C7 spinous process preservation (LP_C36), ③ C3 laminectomy hybrid decompression with C4 – C6 laminoplasty (LT_C3 + LP_C46) and ④ C3 – C7 laminoplasty with unilateral musculature preservation (LP_C37 + UMP). The laminoplasty model was validated by the global range of motion (ROM) and percentage changes relative to the intact state. The C2 – T1 ROM, axial muscle tensile force, and stress/strain levels of functional spinal units were compared among the different laminoplasty groups. The obtained effects were further analysed by comparison with a review of clinical data on cervical laminoplasty scenarios. ResultsAnalysis of the locations of concentration of muscle load showed that the C2 muscle attachment sustained more tensile loading than the C7 muscle attachment, primarily in flexion-extension (FE) and in lateral bending (LB) and axial rotation (AR), respectively. Simulated results further quantified that LP_C36 primarily produced 10% decreases in LB and AR modes relative to LP_C37. Compared with LP_C36, LT_C3 + LP_C46 resulted in approximately 30% decreases in FE motion; LP C37 + UMP also showed a similar trend. Additionally, when compared to LP_C37, LT_C3 + LP_C46 and LP C37 + UMP reduced the peak stress level at the intervertebral disc by at most 2-fold as well as the peak strain level of the facet joint capsule by 2–3-fold. All these findings were well correlated with the result of clinical studies comparing modified laminoplasty and classic laminoplasty. ConclusionsModified muscle-preserving laminoplasty is superior to classic laminoplasty due to the biomechanical effect of the posterior musculature reconstruction, with a retained postoperative ROM and loading response levels of the functional spinal units. More motion-sparing is beneficial for increasing cervical stability, which probably accelerates the recovery of postoperative neck movement and reduces the risk of the complication for eventual kyphosis and axial pain. Surgeons are encouraged to make every effort to preserve the attachment of the C2 whenever feasible in laminoplasty.

Single- and Bicolumn Limited Intercarpal Fusion: A Solution for the SLAC or SNAC Wrist.

Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union. Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35-79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed as two-column fusion, and in 12 cases as one-column fusion. The union was determined by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments (visual analog score: 0-100), range of motion (ROM), grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand score were prospectively included. Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range: 12-68). All patients but two achieved union at a mean of 9.5 weeks (range: 5-25 weeks). Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively ( p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean) (not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5 (median) before the surgery to 11 (median) after the surgery ( p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total dorsovolar/radioulnar flexions, respectively. Three patients were converted to total wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column fusion, which united. Conclusion One- and two-column fusion showed significant improvement in pain and function, with minimal impairment of the grip strength on the short- to mid-term follow-up. A union rate of 95% and an acceptable complication rate were achieved, without fusing all carpals. Level of Evidence Prospective, cohort study, level III.

Revision Arthroscopic Labral Repair Using All-Suture Anchors in Patients With Subcritical Glenoid Bone Loss After Failed Bankart Repair: Clinical Outcomes at 2-Year Follow-up.

All-suture anchors have been used for primary arthroscopic Bankart repair because of their ability to minimize initial bone loss. To evaluate the clinical efficacy of using all-suture anchors in revision arthroscopic labral repair after failed Bankart repair. Case series; Level of evidence, 4. Enrolled in this study were 28 patients who underwent revision arthroscopic labral repair with all-suture anchors after a failed primary arthroscopic Bankart repair. Revision surgery was determined for patients who had a frank redislocation history with subcritical glenoid bone loss (<15%), nonengaged Hill-Sachs lesion, or off-track lesion. Minimum 2-year postoperative outcomes were evaluated using shoulder range of motion (ROM), the Rowe score, the American Shoulder and Elbow Surgeons (ASES) score, apprehension, and the redislocation rate. Postoperative shoulder anteroposterior radiographs were assessed to evaluate arthritic changes in the glenohumeral joint. The mean patient age was 28.1 ± 6.5 years, and the mean time between primary Bankart repair and revision surgery was 5.4 ± 4.1 years. Compared with the number of suture anchors used in the primary operation, significantly more all-suture anchors were inserted in the revision surgery (3.1 ± 0.5 vs 5.8 ± 1.3, P < .001). During the mean follow-up period of 31.8 ± 10.1 months, 3 patients (10.7%) required reoperation because of traumatic redislocation and symptomatic instability. Of patients with symptoms that did not require reoperation, 2 patients (7.1%) had subjective instability with apprehension depending on the arm position. There was no significant change between preoperative and postoperative ROM. However, ASES (preoperative: 61.2 ± 13.3 to postoperative: 81.4 ± 10.4, P < .01) and Rowe (preoperative: 48.7 ± 9.3 to postoperative: 81.7 ± 13.2, P < .01) scores were significantly improved after revision surgery. Eight patients (28.6%) showed arthritic changes in the glenohumeral joint on final plain anteroposterior radiographs. Revision arthroscopic labral repair using all-suture anchors demonstrated satisfactory 2-year clinical outcomes in terms of functional improvement. Postoperative stability was obtained in 82% of patients without recurrent shoulder instability after failed arthroscopic Bankart repair.

Surgical Technique: Lateral Plate Osteosynthesis of Proximal Phalanx Fractures.

Dorsal plate fixation of proximal phalanx (PP) fractures is a conventional approach but interferes with the extensor mechanism and results in stiffness. Biomechanical studies have shown that laterally placed plates on the proximal phalanges are equally stable and rigid. This technique obviates the issue of tendon adhesion and may result in better postoperative range of motion and lower secondary procedures such as removal of implant and tenolysis. The low adoption of this technique may be related to lack of familiarity with the surgical approach. We describe our surgical technique with lateral plating of PP fractures and present our case that lateral plate osteosynthesis is an acceptable surgical fixation option for PP fractures, which extends the hand surgeon's armamentarium for more challenging and comminuted fractures.