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  • 1
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    A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions
    Springer Science and Business Media LLC ; 2023
    In:  Knee Surgery, Sports Traumatology, Arthroscopy Vol. 31, No. 8 ( 2023-08), p. 3221-3229
    Details
    In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer Science and Business Media LLC, Vol. 31, No. 8 ( 2023-08), p. 3221-3229
    Abstract: To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries. Methods A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged. Results Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group. The intra-class correlation coefficient of measurements was 0.843–0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p   〈  0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p   〈  0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p  = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p   〈  0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04–15.2). Conclusion A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of  〉  95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair. Level of evidence Level III.
    Type of Medium: Online Resource
    ISSN: 0942-2056 , 1433-7347
    URL: Article
    DOI: 10.1007/s00167-023-07350-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 2
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    Excellent clinical and radiological outcomes after both open flake refixation and autologous chondrocyte implantation following acute patella dislocation and concomitant flake fractures
    Springer Science and Business Media LLC ; 2022
    In:  Knee Surgery, Sports Traumatology, Arthroscopy Vol. 30, No. 10 ( 2022-10), p. 3334-3342
    Details
    In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer Science and Business Media LLC, Vol. 30, No. 10 ( 2022-10), p. 3334-3342
    Abstract: To investigate clinical and magnetic resonance (MR) imaging results of patients undergoing patella stabilization with either open flake refixation (oFR) or autologous chondrocyte implantation (ACI) and concomitant soft tissue patella stabilization after sustaining primary, acute patella dislocation with confirmed chondral and/or osteochondral flake fractures. It was hypothesized that refixation will lead to better results than ACI at mid-term follow-up. Methods A retrospective chart review was conducted to identify all patients undergoing oFR or ACI after sustaining (osteo-)chondral flake fractures and concomitant soft tissue patella stabilization following primary, acute patella dislocation between 01/2012 and 09/2018 at the author’s institution. Patients were excluded if they were aged  〈  14 years or  〉  30 and had previous knee surgeries at the index knee. Clinical outcomes were assessed using the Tegner activity score, Kujala score, subjective IKDC score, and the KOOS score at a minimum follow-up of 24 months postoperatively. MR images were assessed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 knee score. Thirty patients were included in the study, with 16 patients assorted to the oFR group and 14 patients to the ACI group (Follow-up 81%). Results Demographic data did not show significant group differences (oFR: 6 females, 10 males; age 26.9 ± 5.6 years, FU: 57 months (27–97 months); ACI: 9 females, 5 males; age 25.5 ± 4.9 years, FU: 51 months (29–91 months); n.s.). Defect location was similar in both groups (oFR: 12 × patella/4 × lateral femoral condyle; ACI: 12/2; n.s.). Both groups showed excellent clinical outcomes, with no statistically significant difference between both the groups (oFR group vs. ACI group: Tegner: 5.1 ± 1.8 vs. 5.1 ± 1.4; Kujala: 86.1 ± 12.6 vs. 84.9 ± 9.1; IKDC: 83.8 ± 15.0 vs. 83.6 ± 11.3; KOOS: 83.3 ± 14.0 vs. 83.6 ± 12.0; n.s.). One patient in each group suffered a patella re-dislocation and needed revision surgery. The MOCART 2.0 score showed good results for the oFR group (68.2 ± 11.1) and the ACI group (61.1 ± 16.9) while no significant differences were noted between both the groups. The inter-rater reliability was excellent (0.847). Conclusion Open refixation of (osteo-)chondral fragments in patients after sustaining acute patella dislocation with (osteo)-chondral flake fractures led to good clinical and radiological results at a minimum follow of 24 months, showing that it is a good surgical option in the treatment algorithm. However, if open refixation is not possible, ACI may be an excellent fallback option in these younger patients with equally good clinical and radiological outcomes, but requiring a second minimally invasive surgery. Level of evidence III.
    Type of Medium: Online Resource
    ISSN: 0942-2056 , 1433-7347
    URL: Article
    DOI: 10.1007/s00167-022-06899-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 3
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    Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptomatic State following Patellofemoral Inlay Arthroplasty for Visual Analog Scale Pain, Western Ontario and McMaster Universities Arthritis Index, and Lysholm Scores
    Elsevier BV ; 2023
    In:  The Journal of Arthroplasty ( 2023-6)
    Details
    In: The Journal of Arthroplasty, Elsevier BV, ( 2023-6)
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2023.05.084
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2041553-9
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  • 4
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    The 50 most cited studies on posterior tibial slope in joint preserving knee surgery
    Springer Science and Business Media LLC ; 2022
    In:  Journal of Experimental Orthopaedics Vol. 9, No. 1 ( 2022-12-12)
    Details
    In: Journal of Experimental Orthopaedics, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2022-12-12)
    Abstract: To determine the 50 most cited studies on posterior tibial slope (PTS) in joint preserving knee surgery and assess their level of evidence, objective study quality scores as well as to examine whether the study quality correlated with the citation count and citation density in the top 50 list. Methods A literature search on Web of Science was performed to determine the 50 most cited studies on the topic of PTS in joint preserving knee surgery between 1990 and 2022. The studies were evaluated for their bibliographic parameters, level of evidence rating (LOE), citation counts, the Modified Coleman Methodological Score (MCMS), the Methodological Index for Non-Randomized Studies (MINORS), and the Radiologic Methodology and Quality Scale (MQCSRE). Results Of the top 50 list, 16 studies were published in the American Journal of Sports Medicine. A total of 23 studies were produced in the United States (46%). Of 10 different study types, case control studies ( n  = 16, 32%) and cadaveric studies ( n  = 10, 20%) were most common. 15 studies (30%) were purely radiological studies. 6 studies were level II (12%), 23 level III (46%), 15 level IV (30%), and 6 level V studies (12%), respectively. The number of citations ranged from 42 to 447 (mean 105.6 ± 79.2 citations) and showed a mean citation density of 10.3 ± 5.2, composed of the decades 1994 – 2000 (8.3 ± 4.1), 2001 – 2010 (11.1 ± 5.9), 2011 – 2019 (10.1 ± 5.1). Mean quality scores were 55.9 ± 13.0 for MCMS ( n = 18), 14.5 ± 3.2 for MINORS ( n  = 18) and 18.1 ± 3.7 for MQCSRE ( n  = 20), respectively. High citation counts did not correlate with higher study quality scores ( p   〉  0.05). Radiological studies were not significantly cited more often than non-radiological studies (mean 116.9 ± 88.3 vs. 100.8 ± 75.8 citations; p   〉  0.05). Conclusion In joint preserving knee surgery, the 50 most cited studies on PTS did not represent a ranking of the highest methodological quality scores. Citation counts and citation density over the past three decades did not significantly differ, even though the number of articles in the presented list multiplied over the same period. This list can serve as a reference tool for orthopedic surgeons aiming to review PTS literature.
    Type of Medium: Online Resource
    ISSN: 2197-1153
    URL: Article
    DOI: 10.1186/s40634-022-00557-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2780021-0
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  • 5
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    Physiological Tensioning During Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears May Be Important for Improvement in Shoulder Kinematics
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 9 ( 2023-07), p. 2422-2430
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 9 ( 2023-07), p. 2422-2430
    Abstract: Lower trapezius transfer (LTT) has been proposed for restoring the anteroposterior muscular force couple in the setting of an irreparable posterosuperior rotator cuff tear (PSRCT). Adequate graft tensioning during surgery may be a factor critical for sufficient restoration of shoulder kinematics and functional improvement. Purpose/Hypothesis: The purpose was to evaluate the effect of tensioning during LTT on glenohumeral kinematics using a dynamic shoulder model. It was hypothesized that LTT, while maintaining physiological tension on the lower trapezius muscle, would improve glenohumeral kinematics more effectively than undertensioned or overtensioned LTT. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a validated shoulder simulator. Glenohumeral abduction angle, superior migration of the humeral head, and cumulative deltoid force were compared across 5 conditions: (1) native, (2) irreparable PSRCT, (3) LTT with a 12-N load (undertensioned), (4) LTT with a 24-N load (physiologically tensioned according to the cross-sectional area ratio of the lower trapezius muscle), and (5) LTT with a 36-N load (overtensioned). Glenohumeral abduction angle and superior migration of the humeral head were measured using 3-dimensional motion tracking. Cumulative deltoid force was recorded in real time throughout dynamic abduction motion by load cells connected to actuators. Results: Physiologically tensioned (Δ13.1°), undertensioned (Δ7.3°), and overtensioned (Δ9.9°) LTT each significantly increased the glenohumeral abduction angle compared with the irreparable PSRCT ( P 〈 .001 for all). Physiologically tensioned LTT achieved a significantly greater glenohumeral abduction angle than undertensioned LTT (Δ5.9°; P 〈 .001) or overtensioned LTT (Δ3.2°; P = .038). Superior migration of the humeral head was significantly decreased with LTT compared with the PSRCT, regardless of tensioning. Physiologically tensioned LTT resulted in significantly less superior migration of the humeral head compared with undertensioned LTT (Δ5.3 mm; P = .004). A significant decrease in cumulative deltoid force was only observed with physiologically tensioned LTT compared with the PSRCT (Δ–19.2 N; P = .044). However, compared with the native state, LTT did not completely restore glenohumeral kinematics, regardless of tensioning. Conclusion: LTT was most effective in improving glenohumeral kinematics after an irreparable PSRCT when maintaining physiological tension on the lower trapezius muscle at time zero. However, LTT did not completely restore native glenohumeral kinematics, regardless of tensioning. Clinical Relevance: Tensioning during LTT for an irreparable PSRCT may be important to sufficiently improve glenohumeral kinematics and may be an intraoperatively modifiable key variable to ensure postoperative functional success.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465231179693
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 6
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    The Bony Morphology Of The Bicipital Sulcus Influences The Development And Type Of Pulley Lesions
    Elsevier BV ; 2022
    In:  Journal of Shoulder and Elbow Surgery Vol. 31, No. 3 ( 2022-03), p. e164-
    Details
    In: Journal of Shoulder and Elbow Surgery, Elsevier BV, Vol. 31, No. 3 ( 2022-03), p. e164-
    Type of Medium: Online Resource
    ISSN: 1058-2746
    URL: Article
    DOI: 10.1016/j.jse.2022.01.090
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2046901-9
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  • 7
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    Augmenting Suture Tape Used in Rotator Cuff Surgery With Magnesium Increases in Vitro Cellular Adhesion of Human Subacromial Bursal Tissue
    Elsevier BV ; 2021
    In:  Arthroscopy, Sports Medicine, and Rehabilitation Vol. 3, No. 6 ( 2021-12), p. e1975-e1980
    Details
    In: Arthroscopy, Sports Medicine, and Rehabilitation, Elsevier BV, Vol. 3, No. 6 ( 2021-12), p. e1975-e1980
    Type of Medium: Online Resource
    ISSN: 2666-061X
    URL: Article
    DOI: 10.1016/j.asmr.2021.09.020
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 3003188-6
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  • 8
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    Contact Mechanics of Elliptical and Spherical Head Implants during Axial Rotation in Anatomic Total Shoulder Arthroplasty: A Biomechanical Comparison
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 15 ( 2023-07-26), p. 4918-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 15 ( 2023-07-26), p. 4918-
    Abstract: Background: Elliptical humeral head implants have been proposed to result in more anatomic kinematics following total shoulder arthroplasty (aTSA). The purpose of this study was to compare glenohumeral contact mechanics during axial rotation using spherical and elliptical humeral head implants in the setting of aTSA. Methods: Seven fresh-frozen cadaveric shoulders were utilized for biomechanical testing in neutral (NR), internal (IR), and external (ER) rotation at various levels of abduction (0°, 15°, 30°, 45°, 60°) with lines of pull along each of the rotator cuff muscles. Each specimen underwent the following three conditions: (1) native, and TSA using (2) an elliptical and (3) spherical humeral head implant. Glenohumeral contact mechanics, including contact pressure (CP; kPa), peak contact pressure (PCP; kPa), and contact area (CA; mm2), were measured in neutral rotation as well as external and internal rotation using a pressure mapping sensor. Results: Elliptical head implants showed a significantly lower PCP in ER compared to spherical implants at 0° (Δ−712.0 kPa; p = 0.034), 15° (Δ−894.9 kPa; p = 0.004), 30° (Δ−897.7 kPa; p = 0.004), and 45° (Δ−796.9 kPa; p = 0.010) of abduction, while no significant difference was observed in ER at 60° of abduction or at all angles in NR and IR. Both implant designs had similar CA in NR, ER, and IR at all tested angles of abduction (p 〉 0.05, respectively). Conclusions: In the setting of aTSA, elliptical heads showed significantly lower PCP during ER at 0° to 45° of abduction, when compared to spherical head implants. However, in NR and IR, PCP was similar between implant designs. Both designs showed similar CA during NR, ER, and IR at all abduction angles. Level of Evidence: basic science; controlled laboratory study.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12154918
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
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  • 9
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    Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits
    Springer Science and Business Media LLC ; 2022
    In:  Knee Surgery, Sports Traumatology, Arthroscopy Vol. 30, No. 6 ( 2022-06), p. 2060-2066
    Details
    In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer Science and Business Media LLC, Vol. 30, No. 6 ( 2022-06), p. 2060-2066
    Abstract: To determine the sensorimotor and clinical function of patients with confirmed successful outcome after either undergoing acromioclavicular joint (ACJ) stabilization, Bankart repair (BR), or rotator cuff repair (RC), and to compare these measures to the contralateral, healthy side without history of previous injuries or surgeries of the upper extremity. It was hypothesized that patients of each interventional group would have inferior sensorimotor function of the shoulder joint compared to the contralateral, healthy side, while presenting with successful clinical and functional outcomes. Methods Three intervention groups including ten patients who had confirmed successful clinical and functional outcomes after either undergoing ACJ stabilization, BR, or RC were evaluated postoperatively at an average follow-up of 31.7 ± 11.6 months. Additionally, a healthy control group (CG) of ten patients was included. Clinical outcomes were assessed using the Constant–Murley (CM) and American Shoulder and Elbow Surgeons (ASES) Score. Pain was evaluated using the visual analogue scale (VAS). Sensorimotor function was assessed by determining the center of pressure (COP) of the shoulder joint in a one-handed support task in supine position on a validated pressure plate. Results Each interventional group demonstrated excellent clinical outcome scores including the CM Score (ACJ 83.3 ± 11.8; BR 89.0 ± 10.3; RC 81.4 ± 8.8), ASES Score (ACJ 95.5 ± 7.0; BR 92.5 ± 9.6; RC 96.5 ± 5.2), and VAS (ACJ 0.5 ± 0.9; BR 0.5 ± 0.8; RC 0.5 ± 0.8). Overall, the CG showed no significant side-to-side difference in COP, whereas the ACJ-group and the BR-group demonstrated significantly increased COP compared to the healthy side (ACJ 103 cm vs. 98 cm, p  = 0.049; BR: 116 cm vs. 102 cm, p  = 0.006). The RC-group revealed no significant side-to-side difference (120 cm vs. 108 cm, n.s.). Conclusion Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. This may indicate that specific postoperative training and rehabilitation protocols should be established for patients who underwent surgery of the upper extremity. These results underline that sensorimotor training should be an important component of postoperative rehabilitation and physiotherapeutic activities to improve postoperative function and joint control. Level of evidence IV.
    Type of Medium: Online Resource
    ISSN: 0942-2056 , 1433-7347
    URL: Article
    DOI: 10.1007/s00167-021-06751-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1473170-8
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  • 10
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    Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system
    Springer Science and Business Media LLC ; 2022
    In:  Knee Surgery, Sports Traumatology, Arthroscopy Vol. 30, No. 11 ( 2022-11), p. 3842-3850
    Details
    In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer Science and Business Media LLC, Vol. 30, No. 11 ( 2022-11), p. 3842-3850
    Abstract: To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. Materials and methods Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19–56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior–posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. Results Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8–19.0) to 14.5 ± 3.3 mm (8.7–20.6 mm) ( p   〈  0.001) while the D/A ratio increased from 0.4 ± 0.3 (− 0.4–0.9) to 0.6 ± 0.3 (1.1–0.1) ( p  = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction ( 〉  6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p  = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction ( p  = 0.027; relative risk 3.4; odds ratio 11.67). Conclusions Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. Level of evidence IV.
    Type of Medium: Online Resource
    ISSN: 0942-2056 , 1433-7347
    URL: Article
    DOI: 10.1007/s00167-022-06978-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1473170-8
    SSG: 31
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