{"title":"Outcomes following fixation of distal clavicle fractures utilizing arthroscopically assisted coracoclavicular ligament stabilization with a suspensory endobutton and cerclage tape","authors":"","doi":"10.1016/j.xrrt.2024.02.003","DOIUrl":"10.1016/j.xrrt.2024.02.003","url":null,"abstract":"<div><h3>Background</h3><p>Distal one-third clavicle fractures are frequently unstable and often require surgical fixation due to high rates of nonunion. Many common methods of fixation have high rates of union but are associated with hardware discomfort and need for secondary surgery. The purpose of this study was to evaluate the outcomes of a fixation technique involving arthroscopically assisted open reduction internal fixation of unstable distal clavicle fractures via a coracoclavicular (CC) suspensory endobutton and cerclage tape.</p></div><div><h3>Methods</h3><p>This was a retrospective case series evaluating patients who underwent fixation of unstable distal clavicle fractures via arthroscopically assisted CC stabilization by a single fellowship-trained shoulder and elbow surgeon between 2020 and 2022. Demographic and injury-related data were collected via chart review. Preoperative and postoperative radiographs were reviewed to evaluate for signs of radiographic union. Primary outcome measures included fracture union, complications, and need for additional procedures. Patients were also contacted via telephone to obtain American Shoulder and Elbow Surgeons scores.</p></div><div><h3>Results</h3><p>Six patients were eligible for inclusion in this study with a mean age of 52.8 ± 14.0 and a mean follow-up of 2.0 years (range 1.6-2.7 years). Mean American Shoulder and Elbow Surgeons scores were 86.2 ± 21.8 (range 52-100). There were no postoperative complications, signs of symptomatic hardware, or need for secondary surgery at the final follow-up among this cohort of patients. All patients had achieved and maintained full radiographic union at a mean radiographic follow-up of 5.5 months (range 2.0-12.9 months).</p></div><div><h3>Conclusion</h3><p>Arthroscopically assisted CC stabilization of distal clavicle fractures demonstrated high union rates while limiting complications or need for secondary hardware removal. Further analysis on a larger scale is recommended to determine long-term outcomes and direct comparison to other surgical techniques.</p></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 3","pages":"Pages 393-397"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666639124000324/pdfft?md5=c9da9f9ccbc66a1368bdfd665a491623&pid=1-s2.0-S2666639124000324-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Untwining the intertwined: a comprehensive review on differentiating pathologies of the shoulder and spine","authors":"","doi":"10.1016/j.xrrt.2024.02.007","DOIUrl":"10.1016/j.xrrt.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>The anatomic interplay and overlap between the cervical spine and the shoulder constitutes a challenge for shoulder and spine surgeons, as symptoms of spine and shoulder pathologies are often similar and may lead to entity misdiagnosis.</p></div><div><h3>Methods</h3><p>PubMed, Cochrane, and Google Scholar (page 1-20) searches were updated to October 2023 in search of the qualified papers. Boolean Operators were used with a combination of the keywords “spine” OR “neck” And “Shoulder”. Furthermore, reference lists from papers were also searched to find literature.</p></div><div><h3>Results</h3><p>It is of pivotal importance to conduct comprehensive preoperative clinical investigation to appropriately evaluate and assess the source of the pathology and the leading causes behind it. Certain markers can help guide surgeons towards etiologies, and these include areas of pain and physical exam findings with the arm squeeze test having the highest sensitivity and specificity for diagnosing cervical radiculopathy. As for the shoulder, despite its low sensitivity, the Yergason test had the highest specificity for diagnosing subacromial impingement. Local anesthetic injection can help as well in the diagnostic approach. Moreover, the interplay between these anatomic locations is not solely related to preoperative diagnosis. Studies have shown that previous surgery for cervical spine pathology may negatively affect the outcomes of shoulder procedures like arthroplasties.</p></div><div><h3>Conclusion</h3><p>Shoulder and spine surgeons should be wary and vigilant of accurately diagnosing the etiology of the presenting symptoms to ensure proper management and optimize prognosis.</p></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 3","pages":"Pages 385-392"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666639124000361/pdfft?md5=4a0b59dbddc878f648fcdeba4de97f5f&pid=1-s2.0-S2666639124000361-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The effect of number of knots per throw, knot technique, and suture type on strength properties of suspensory fixation button surgical procedures","authors":"","doi":"10.1016/j.xrrt.2024.05.006","DOIUrl":"10.1016/j.xrrt.2024.05.006","url":null,"abstract":"<div><h3>Background</h3><p>Previous studies of the cortical suspensory button (CSB) implant have analyzed fixation strength as a function of suture type and surgical technique, but knot configuration remains an area of interest. This study investigates 4-strand knot configurations in CSB suspensory fixation, specifically comparing the use of 2 separate knots with a single knot. We hypothesize that using 2 knots on the distal side of the CSB with #2 suture will yield the strongest and stiffest suspensory fixation.</p></div><div><h3>Methods</h3><p>Two types of knot configurations were compared: a single knot with all 4 suture strands versus 2 independent knots with 2 suture strands each (1 knot from inner strands and 1 knot from outer strands). They were tested using #2 or 2-0 suture, and at distal (on top of the button) or proximal (underneath the button) knot positions. Mechanical testing on the Instron measured ultimate failure load, elongation at failure, and stiffness. Statistical analyses (Shapiro-Wilk, unpaired Student’s <em>t</em>-tests, and Chi-square tests) assessed differences in strength, stiffness, elongation, and failure mode between knot configurations within each CSB construct combination.</p></div><div><h3>Results</h3><p>With #2 suture, 2 knots across the CSB resulted in higher load to failure compared to 1 knot in both proximal (467.00 N vs. 554.66 N, <em>P</em> = .026) and distal (395.18 N vs. 526.51 N, <em>P</em> < .001) locations. Furthermore, 2 knots provided higher stiffness than 1 knot in both proximal (53.24 N/mm vs. 67.89 N/mm, <em>P</em> < .001) and distal (47.08 N/mm vs. 56.73 N/mm, <em>P</em> = .041) knot locations. However, using 2-0 suture showed no significant differences in failure load and stiffness regardless of knot location.</p></div><div><h3>Conclusion</h3><p>Using #2 suture and tying 2 independent knots across the CSB increased load to failure and stiffness compared to using only 1 knot regardless of knot position. Thus, if using #2 suture, it is recommended to tie 2 knots to enhance construct strength. However, with 2-0 suture, the number of knots did not impact construct strength. Therefore, if using 2-0 suture, 1 knot can be used to save time. Knot position did not significantly affect the strength or stiffness of the CSB construct, emphasizing the importance of considering knot prominence and surgical approach for determining knot location.</p></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 3","pages":"Pages 424-430"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666639124000816/pdfft?md5=5406db80531838d6ecec199b6dc1b146&pid=1-s2.0-S2666639124000816-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141278949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Distal clavicle autograft for large glenoid defects during revision reverse total shoulder arthroplasty","authors":"","doi":"10.1016/j.xrrt.2024.03.002","DOIUrl":"10.1016/j.xrrt.2024.03.002","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 3","pages":"Pages 449-456"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666639124000427/pdfft?md5=87cb6606eb10f0b987a628908df24b7f&pid=1-s2.0-S2666639124000427-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Relation between spine alignment and scapular position by plain radiograph examination","authors":"","doi":"10.1016/j.xrrt.2024.02.009","DOIUrl":"10.1016/j.xrrt.2024.02.009","url":null,"abstract":"<div><h3>Background</h3><p>Both scapular dynamics and static scapular position are important in the treatment of shoulder dysfunction. This study aimed to create an index that can evaluate scapular position on plain radiographs and evaluate the relation between scapular position and posture accurately.</p></div><div><h3>Methods</h3><p>Using four fresh frozen cadavers, we developed a glenoid angle grade based on the degree of overlap between the shadow of the coracoid inflection point and the upper edge of the scapula on frontal plain radiographs: grade 1, no overlap; grade 2, overlaps by less than half of the shadow; grade 3, overlaps by more than half. We then performed a retrospective cohort study that included 329 shoulders of 329 patients who underwent spine surgery. Spine alignment parameters (SPAPs), including cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured on standing lateral plain radiographs. Glenoid anterior tilt (GAT) and glenoid anteversion angle (GAVA) were calculated on frontal radiographs and three-dimensional computed tomography scans. Correlations between SPAPs and each angle were investigated, and independent influencing factors were sought in multivariate analysis. Individual factors, GAT, GAVA, and SPAPs were compared among the grades.</p></div><div><h3>Results</h3><p>SPAPs associated with GAT were sagittal vertical axis (R = 0.14, <em>P</em> = .011), TK (R = 0.12, <em>P</em> = .026), and LL (R = −0.11, <em>P</em> = .046). Multivariate analysis identified TK and LL as independent influencing factors (TK, <em>P</em> = .001; LL, <em>P</em> = .008). SPAPs associated with GAVA were CL (R = 0.17, <em>P</em> = .002), TK (R = 0.29, <em>P</em> < .001), and LL (R = 0.25, <em>P</em> < .001). Multivariate analysis identified CL, TK, and LL as independent influencing factors (CL, <em>P</em> = .01; TK, <em>P</em> = .03; LL, <em>P</em> = .03). There were 183, 127, and 19 cases categorized as grades 1, 2, and 3. GAT (grade 1, 24.0 ± 7.8; 2, 32.4 ± 7.0; 3, 41.0 ± 7.8), GAVA (1, 29.3 ± 7.6; 2, 33.7 ± 9.5; 3, 31.5 ± 8.3), and TK (1, 30.6 ± 13.6; 2, 35.1 ± 14.2; 3, 43.1 ± 20.4) differed significantly according to grade.</p></div><div><h3>Conclusion</h3><p>We identified factors that influence scapular position and demonstrated that scapular position can be estimated by a grading system using plain radiographs.</p></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 3","pages":"Pages 398-405"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666639124000385/pdfft?md5=e5e8a7c24d95dfbbdf4b743ba69990e3&pid=1-s2.0-S2666639124000385-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel L. Honig MD, Ankur Khanna BS, Sherrea Jones PhD, Katherine E. Mallett MD, Jonathan D. Barlow MD
{"title":"Superior locking plate with braided PDS coracoclavicular fixation for the unstable distal clavicle fracture: a technical trick and case series","authors":"Rachel L. Honig MD, Ankur Khanna BS, Sherrea Jones PhD, Katherine E. Mallett MD, Jonathan D. Barlow MD","doi":"10.1016/j.xrrt.2024.07.001","DOIUrl":"10.1016/j.xrrt.2024.07.001","url":null,"abstract":"<div><div>The ideal method of operative fixation for unstable distal clavicle fractures remains controversial, with particular emphasis on the need to restore the normal coracoclavicular distance. Our preferred method of fixation includes open reduction and internal fixation with a distal clavicle locking plate in combination with a polydioxanone suture wrapped around the plate and coracoid to restore the coracoclavicular distance and offload the bony repair. The purpose of this study is to report clinical, radiographic, and functional outcomes in patients with unstable distal clavicle fractures treated with this method of fixation.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 737-742"},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gregorio Secci MD , Philipp Schippers MD , Manon Biégun MD , Mark Mouchantaf MD , Pascal Boileau MD, PhD
{"title":"The Trillat procedure: a systematic review of complications and outcome","authors":"Gregorio Secci MD , Philipp Schippers MD , Manon Biégun MD , Mark Mouchantaf MD , Pascal Boileau MD, PhD","doi":"10.1016/j.xrrt.2024.06.011","DOIUrl":"10.1016/j.xrrt.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><div>The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability. It consists of an inferior closed-wedge osteoclasy of the coracoid process. Nowadays, it is used to treat selected cases of shoulder instability. This systematic review aims to provide an overview of clinical and functional outcomes, recurrence rate, and complications of the Trillat procedure for recurrent anterior shoulder instability.</div></div><div><h3>Methods</h3><div>A systematic review of the literature regarding the Trillat procedure for recurrent anterior shoulder instability was carried out on Medline, through PubMed, and Embase. The English and French literature published before the 4<sup>th</sup> of November 2023 was analyzed. The data regarding demographics, outcome, recurrency, and complications were reported.</div></div><div><h3>Results</h3><div>From 38 articles with the primary search, seven manuscripts were enrolled. A total of 419 patients and 443 shoulders were analyzed, with a mean age of 35.46 (range 25-61) years. The mean follow-up was 65.01 (range 24.8-132) months postoperative. The pooled data showed 91.2% of subjective satisfaction, weighted mean postoperative Rowe score of 86.25 points, Walch–Duplay of 84.6 points, and a Constant–Murley Score of 84.82 points. The recurrence rate was 10.28% for all the articles involved and 8.51% for the articles proposing the procedure for selected case of anterior instability, with low-grade glenoid bone loss. The most common complications were a loss of external rotation and the development of osteoarthritis.</div></div><div><h3>Conclusion</h3><div>The Trillat procedure for recurrent anterior shoulder instability showed promising results, especially in selected cases, such as low-grade glenoid bone loss, with massive irreparable cuff tears or hyperlaxity.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 694-702"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noah Kim BS , Kenny Ling MD , Katherine Wang BA , David E. Komatsu PhD , Edward D. Wang MD
{"title":"Low preoperative hematocrit adversely affects short-term outcomes after arthroscopic rotator cuff repair","authors":"Noah Kim BS , Kenny Ling MD , Katherine Wang BA , David E. Komatsu PhD , Edward D. Wang MD","doi":"10.1016/j.xrrt.2024.06.007","DOIUrl":"10.1016/j.xrrt.2024.06.007","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to investigate preoperative anemia as a risk factor for postoperative complications after arthroscopic rotator cuff repair (ARCR).</div></div><div><h3>Methods</h3><div>Adult patients who underwent ARCR from 2015-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were grouped according to the following preoperative hematocrit levels: normal (male >39%, female >36%), mild anemia (male 33%-39%, female 33%-36%), and moderate to severe anemia (male and female ≤33%). Multivariable logistic regression analyses were performed to identify significant differences in 30-day postoperative complication rates.</div></div><div><h3>Results</h3><div>Of the 21,836 patients identified, 19,726 (90.3%) patients had normal preoperative hematocrit, 1731 (7.9%) were mildly anemic, and 379 (1.7%) were moderate to severely anemic. After adjusting for significantly associated demographics and comorbidities, mild anemia was a significant predictor of any complication (odds ratio [OR] 1.436, <em>P</em> = .007), cardiac complications (OR 4.891, <em>P</em> = .002) sepsis-related complications (OR 4.760, <em>P</em> = .004), readmission (OR 1.585, <em>P</em> = .014), and nonhome discharge (OR 1.839, <em>P</em> = .006). Moderate to severe anemia was a significant predictor of any complication (OR 2.471, <em>P</em> < .001), readmission (OR 3.002, <em>P</em> < .001), and nonhome discharge (OR 3.211, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>Preoperative anemia is a significant risk factor for postoperative complications within 30 days of ARCR.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 768-773"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Genevieve M. Fraipont BA, Ryan S. Beyer BS, Michelle H. McGarry MS, Thay Q. Lee PhD
{"title":"Acromioclavicular joint biomechanics: a systematic review","authors":"Genevieve M. Fraipont BA, Ryan S. Beyer BS, Michelle H. McGarry MS, Thay Q. Lee PhD","doi":"10.1016/j.xrrt.2024.06.009","DOIUrl":"10.1016/j.xrrt.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this systematic review was to investigate the available literature on the biomechanical characteristics of the acromioclavicular (AC) joint to identify trends in translational parameters and contributions of the various ligamentous structures supporting the joint.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in the Web of Science, Scopus, and PubMed databases until October 2023 to identify articles reporting on the biomechanical characteristics of the AC joint. Non cadaveric or projects involving reconstruction were excluded. Consistent parameters evaluated were anterior, posterior, superior, and inferior translation. The data were extracted from the included articles and summarized.</div></div><div><h3>Results</h3><div>11 biomechanical papers were reviewed from six different countries — United States (n = 6), France (n = 1), Austria (n = 1), Thailand (n = 1), United Kingdom (n = 1), and Japan (n = 1). The total number of specimens included across the reviewed papers was 141. All 11 papers reported the data on an intact model (coracoclavicular and AC ligaments intact). Seven papers assessed the translational results of the AC sectioned condition, finding a greater increase in anterior-posterior (AP) laxity relative to SI. 3 papers evaluated coracoclavicular ligament sectioning, finding increased superior-inferior laxity relative to AP. Only one study involved ligament sectioning isolating the anterior-inferior bundle of the AC joint.</div></div><div><h3>Conclusion</h3><div>This review highlights the key AP and superior-inferior constraints of both the intact and ligament sectioned AC joint. The inconsistency of AC joint testing parameters and the lack of thorough translation studies indicate a necessity for increased attention in the overall assessment of shoulder stability to close the gap in the foundational biomechanical research.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"4 4","pages":"Pages 668-675"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}