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ISSN 2457-0338
Acta of Shoulder and Elbow Surgery by http://asesjournal.com/ is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
ISSN 2457-0338
Dynamic Anatomy of Elbow Stability
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 30-32 | Juan Del Castillo, Rodrigo Fratelli, Mauricio Oehler, Nicolás Casales, Viviana Teske, Domingo Beltramelli
Authors: Juan Del Castillo [1], Rodrigo Fratelli [1], Mauricio Oehler [1], Nicolás Casales [1], Viviana Teske [1], Domingo Beltramelli [1].
[1] Departamento de Anatomía Facultad de Medicina UdelaR (Anatomy Department, School of Medicine, University of the Republic of Uruguay
Address of Correspondence
Dr. Juan Del Castillo,
Departamento de Anatomía Facultad de Medicina UdelaR
(Anatomy Department, School of Medicine, University of the Republic of Uruguay
Email:btorres@ceoecuador.com.
Abstract
Background: Elbow dislocation leads to varying degree of instabilities depending on the ligaments damaged and amount of damage to these ligaments. Various studies have noted role of these ligaments and present study is a dynamic cadaveric study to understand these instabilities better
Material and Methods: 10 cadaveric elbows maintained in 10% formaldehyde concentration were employed. Healthy joint upper limbs were prepared, and the elbow joint was further dissected. The different joint osseous and ligament stabilizers were sectioned by stages, and their implication on the stability of the elbow joint complex was recorded.
Results: Collateral ligaments were confirmed to be the main ligament stabilizers in the elbow. The lateral complex controls both varus and posterolateral stress. The medial collateral complex controls valgus stress, mainly thanks to its anterior bundle. The radial head plays a secondary role, controlling valgus stress once the medial collateral complex has been sectioned. Once radial head has been replaced, valgus stress stability is regained
Conclusion: The role of elbow stabilizers has been determined, and our results are consistent with those of international literature
Keywords: Elbow Instability, Cadaveric Study
References
1. O’Driscoll SW, Jupiter JB, King GJ, et al. The unstable elbow. Instr Course Lect 2001;50:89–102.
2. Crhis D. Bryce; April D. Armstrong. Anatomy and Biomechanics of the elbow. Orthop Clin N Am 39 (2008 141-154)
3. Miller Mark, Thompson S. DeLee & Drez ́s Orthopaedic Sports Medicine Principles and Practice 2015
4. Morrey B, The Elbow and its disorders, 3rd ed 2004
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Clinical and Ecographical/ultrasound Partial Results on Superior Capsular Reconstruction for Rotator Cuff Irreparable Tears
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 24-26 | Byron Torres, Paúl Terán
Authors: Byron Torres [1], Paúl Terán [1].
[1] Hospital Metropolitano de Quito Hospital Vozandes de Quito Sociedad Latinoamericana de Hombro y Codo
Address of Correspondence
Dr. Byron Torres D.
Hospital Metropolitano de Quito Hospital Vozandes de Quito
Sociedad Latinoamericana de Hombro y Codo
Email: btorres@ceoecuador.com
Abstract
Introduction: The rotator cuff irreparable tears cause pain and an important functional impairment in patients. The different strategies that we have to treat them, have given variable results and the great concern remains in how to hold the progression towards degenerative arthropathy. The superior capsular reconstruction seems to be a logical and biomechanically adequate concept with good clinical results. With this in mind, we set ourselves the objectives of carrying out this procedure assessing its replicability and perform a follow-up with ultrasound, functional scores and of patient satisfaction score.
Methods: It deals with a series of 10 cases with prospective follow-up (2 men and 8 women), who were performed the superior capsule reconstruction, by the same surgeon between January 2015 and February 2016 with an average follow-up of 6 months. All of them with irreparable rupture of the rotator cuff, not responding to conservative management. We performed shoulder arthroscopy and superior capsular reconstruction with autologous ipsilateral fascia lata graft.
Results: The DASH score was of 64 in average in the pre-surgical, and of 24 average in the post- surgical phases. The working module obtained 56 as average range in the pre-surgical and 18 as average in the post-surgical phases. The sports module obtained 56 in the average range during the pre-surgical and 22 of average in the post-surgical phases. All the 10 patients made known that they would repeat the proceeding towards the final follow-up, which in average was of 6 months. The average age of the patients was of 61.5 years, with a minimum age of 53 and the maximum of 67 years old. Graft’s width was assessed through ultrasound, in the most anterior part, intermediate part, and the most posterior part, being the narrower graft of 3mm in average and the thicker of 6.9 mm in average. The anteroposterior length was also assessed, with an average of 1.9 cm and values that ranged from 1.2 cm through 2.56 cm. Three out of 10 patients related occasional residual pain at the donor site.
Conclusions: The superior capsular reconstruction with fascia lata autograft Is a demanding but a replicable procedure that in our series had good clinical results in the medium term, and also had good to excellent results in functional and satisfaction scales. Up-to-date information suggests that long-term results are influenced by the width of the graft, but that goes beyond this follow-up. We are committed to keep track of the cases, so the thickness can be assessed further in time, and its impact in the results noted. This encourages us to continue with our cases so as to assess this data in the future and its impact on the results. Autologous grafting often generates some post-surgery discomfort, reason why maybe the heterologous grafting may be a better option, if available.
Keywords: superior capsular reconstruction, irreparable rotator cuff tear
References
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2. Lee B, Cho N, Rhee Y. Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears. Arthroscopy 2011;27:1341-1350.
3. Kim S, Lee I, Kim S. Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy 2012;28:761-768.
4. YooJ,KohK,WooK,ShonM,KooK.Clinicalandradiographicresults of partial repairs in irreparable rotator cuff tears: Preliminary report. Arthroscopy 2010;26:E3
5. Wellmann M, Lichtenberg S, da Silva G, Magosch P, Habermeyer P. Results of arthroscopic partial repair of large retracted rotator cuff tears. Arthroscopy 2013;29: 1275-1282.
6. Holtby R, Razmjou H. A prospective outcome study of patients with large and massive rotator cuff tears: Role of complete vs. partial repair. Arthroscopy 2011;27:E88-E89
7. Mori D, Funakoshi N, Yamashita F. Arthroscopic surgery of irreparable large or massive rotator cuff tears with lowgrade fatty degeneration of the infraspinatus: Patch autograft procedure versus partial repair procedure. Arthroscopy 2013;29:1911-1921.
8. Chang V, Grimberg J, Kany J, Valenti P, Duranthon L, Garret J. Early clinical results of arthroscopic latissimus dorsi transfer for irreparable cuff tears. Arthroscopy 2012;28:E14 (abstr).
9. Yamakado K. Arthroscopic assisted latissimus dorsi transfer for irreparable cuff tears. Arthroscopy 2015;31: E11-E12
10. Ishihara Y, Mihata T, Tamboli M, et al. Role of the superior shoulder capsule in passive stability of the glenohumeral joint. J Shoulder Elbow Surg. 2014;23:642-648.
11. Mihata T, Lee TQ, Watanabe C, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29:459-470.
12. Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med. 2012;40:2248-2255.
13. Mihata T, Watanabe C, Fukunishi K, Tsujimura T, Ohue M, Kinoshita M. Clinical outcomes after arthroscopic superior capsular reconstructionfor irreparable rotator cuff tear. Shoulder Joint.2010;34:451-453
14. Maximilian Petri, M.D., Joshua A. Greenspoon, B.Sc., and Peter J. Millett, M.D., M.Sc., Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears , Arthroscopy Techniques, Vol 4, No 6 (December), 2015: pp e751-e755
15. Gupta A.K., Hug K., Berkoff D.J. Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med. 2012;40:141–147
16. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ Biomechanical Effect of Thickness and Tension of Fascia Lata Graft on Glenohumeral Stability for Superior Capsule Reconstruction in Irreparable Supraspinatus Tears. Arthroscopy. 2016 Mar;32(3):418-26.
17. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical Effects of Acromioplasty on Superior Capsule Reconstruction for Irreparable Supraspinatus Tendon Tears Am J Sports Med. 2016 Jan;44(1):191-7
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Prevalence of Musculoskeletal disorders of the Shoulder in a Hospital of the City of Buenos Aires – Retrospective study
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 20-23 | Muhafara, Gastón Jorge, Cura, Adriano Javier, Tozzi Walter Ariel, Villarruel Matias, Virgilio Sacha Ali, Mariano Alfredo, Esperón Luis Francisco
Authors: Muhafara, Gastón Jorge [1], Cura, Adriano Javier [1], Tozzi Walter Ariel [1], Villarruel Matias [1], Virgilio Sacha Ali [1], Mariano Alfredo [1], Esperón Luis Francisco [1].
[1] Hospital P . Piñero, Clínica Santa Catalina, University of Buenos Aires, Fundación Favaloro.
Address of Correspondence
Dr. Muhafara,
Hospital P . Piñero, Clínica Santa Catalina, University of Buenos Aires, Fundación Favaloro.
Email: muhafara@gmail.com
Abstract
Introduction: Musculoskeletal disorders of the shoulder are recognized as the third cause of medical consultation with the health service, interfering in the activities of daily life of patients, both personally and at work. With regard to the diagnostic criteria, upon classifying the different pathologies, no universal consensus exists. In Argentina, no published data on individuals with this alteration who have received physical therapy (PT) treatment have been found. The objective of this study was to determine the prevalence and epidemiological characteristics of adult patients diagnosed with a shoulder pathology, who visited the outpatient Physical Therapy Department(PTD) of the Parmenio T. Piñero Hospital in a one-year period.
Materials and Method: Descriptive, cross-sectional, and retrospective study. A search of the database of the PTD of the Parmenio T. Piñero Hospital was carried out, selecting the PT files of patients with a shoulder pathology who had a medical consultation between June 1, 2015 and May 31, 2016.
Results: During the period covered by the study, a total of 1423 patients had medical consultations with the PTD, with a prevalence of shoulder pathologies of 10.05 % (143/1423). The average age (SD) was 52.9 ± 16.74 years of age, with 56.64 % of females (n = 81). The patients analyzed were mainly housewives, retirees, and housekeepers. The main reason of consultations was the subacromial syndrome, with 53.85 % (n = 77), followed by trauma conditions, with 21.68 % (n = 31). The discontinuance rate was 51.74 %.
Conclusion: This study enabled us to know the epidemiological characteristics of adult patients with a shoulder pathology, who visited the Outpatient PTD of the Parmenio T. Piñero Hospital in a one- year period.
Key words: Prevalence, musculoskeletal disorders, shoulder, Hospital, physical therapy
References
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7. Amérigo E y Such-Sanz A. Trastornos músculoesqueléticos del hombro en atención primaria. Estudio de prevalencia en un centro de la Agencia Valenciana de Salud. Fisioterapia. 2013;35(1):10-17. 7.Gillian AH, Mian S, Kendzerska T, French M. Measures of Adult Pain. Arthritis Care&Research. Vol. 63, No. S11, November 2011, pp S240 –S252.
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Treatment of symptomatic acromioclavicular dislocation- Our experience
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 27-29 | Ernesto Daniel Yedro, Claudia Alejandra Cáceres Saglio
Authors: Ernesto Daniel Yedro, Claudia Alejandra Cáceres Saglio.
[1] Ex fellow Servicio de Miembro superior Instituto Dupuytren (Cap. Federal.
BsAs). Ex Fellow de Artroscopia del CT8O San Isidro (BsAs) Argentina.
Traumatologo– Sanatorio Integral IOT. Ciudad de Posadas. Misiones. Argentina
[2] Servicio Miembro Superior Hospital Escuela de Agudos HEA. Traumatologa.
Sanatorio Integral IOT. Ciudad de Posadas. Misiones. Argentina
Address of Correspondence
Dr. Ernesto Daniel Yedro
Bolivar 2376 Posadas Misiones
Email: edyedro@yahoo.com.ar
Abstract
Purpose: the purpose of this study is to report the clinical and radiological results of the reduction of acromioclavicular dislocation during the healing period without the anatomical reconstruction of the CC and AC ligaments.
Materials and Methods: twelve patients were treated between 2012 and 2015 with a mean follow-up of 1.5 years. Patients were included if they had Rockwood types III, IV and V acromioclavicular dislocation and were treated during the acute period (i.e. during the first three weeks of the injury). The technique employed was arthroscopic with mini-invasive. The reduction of ACD was achieved during the healing period by using two titanium buttons connected by four highly-resistant, non-reabsorbable suture cord: one button was placed in the clavicle and the other in the coracoid.
Results: results were reported after two years of post-surgical follow-up. The measurements included the static and dynamic evaluation and the DASH outcome scoring. Static radiographic measurements of the CC distance with mean discharge was 0.93 cm compared to 2.7 cm at the initial examination (p<0.0001); and DASH outcome measure of 14 compared to a pre-surgical scoring of 52 (p>0001). The patients were satisfied or very satisfied with the cosmesis and were able to return to their previous sorts and work routine normally.
Conclusion: this study confirms that he reduction of ACD by means of double button fixation during the acute healing period, and adequate immobilization helps to the biological repair without he need of anatomical reconstruction of AC and CC ligaments. In this way the patients could restore the function of the arm and achieve the static and dynamic stability. They were also able to reinstate their work and sport previous to the injury.
Keywords: acromioclavicular dislocation, button, arthroscopy, DASH score, coracoclavicular distance.
References
1. Collins DN. Disorders of the acromioclavicular joint. In: Rockwood CA Jr, editor. The shoulder. 4th ed. Philadelphia: Elsevier Health Sciences; 2009. pp. 453–526.
2. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35(2):316–29.
3. Fukuda K, Craig EV, An KN, et al. Biomechanical Study of the ligametous systm of the acromioclavicular joint. J Bone Joint Surg Am. 1986; 68:434 – 440.
4. Verdano M, Pellegrini A, Zanelli M, Paterlini M, Ceccarelli F. Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation. Musculoskeletal Surg. 2012;96(3):213–22
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6. Jari R, Costic RS, Rodosky MW, Debski RE. Biomechanical function of surgical procedures for acromioclavicular joint dislocations Arthroscopy 2004; 20: 237 – 245.
7. Nissen CW, Chatterjee A. Type III acromioclavicular separation: Results of a recent survey on its management. Am JOrthop 2007;36:89-93.
8. Warren-Smith CD, Ward MW. Operation for acromioclavicular dislocation. A review of 29 cases treated by one method. J Bone Joint Surg Br 1987;69:715-718
9. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med. 2006; 34(7):1112-9.
10. Koukakis A, Manouras A, Apostolou CD, Lagoudianakis E, Papadima A, Triantafillou C, et al. Results using the AO hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices. 2008; 5(5):567-72
11. Hellmich A, Sievers U. Operative repair ofacromioclavicular separation via transcutaneous Kirschner wire fixation: results of follow-up examinations in 45 patients. Aktuelle Traumatol.1988; 18(3):9-13.
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20. Galpin RD; Hawkins RJ; Grainger RW. A comparative analysis of operative versus nonoperative treatment of grade III acromioclavicular separations. Clin J Sport –med. 2003; 18: 162 – 166.
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22. Pan Z, Zhang H, Sun C, Qu L, Cui Y. Arthroscopyassisted reconstruction of coracoclavicular ligament by Endobutton fixation for treatment of acromioclavicular joint dislocation. Arch Orthop Trauma Surg. 2015; 135(1):9-16. 8. Iannotti JP, Williams GR. Disorders.
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25. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008; 17(2):220-5.
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Editorial: Joint Congress between the American Shoulder and Elbow Surgeons and the Argentinean Shoulder and Elbow Association
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 1 | Daniel Moya
Authors: Daniel Moya [1].
[1] ESWT Unit, Orthopaedic Department Buenos, Aires British Hospital, Argentina
Address of Correspondence
Dr. Daniel Moya,
Castex 3293, (C1425CDC) Ciudad Autónoma de Buenos
Aires, Argentina
E-mail: drdanielmoya@yahoo.com.ar
Abstract
I am grateful for the opportunity given by Acta of Shoulder and Elbow Surgery to publish the abstracts selected for the First Joint Congress between the American Shoulder and Elbow Surgeons and the Argentinean Shoulder and Elbow Association. This meeting brought together assistants from all over South America and Spain and allowed to interact with one of the most important shoulder and elbow societies in the world.
Acta of Shoulder and Elbow Surgery covers a need and fills a very important space. The possibility of having a forum for publishing papers and scientific discussion online that is not managed by a commercial company is excellent news.
We are experiencing a changing time in relation to editorial policies. The great difficulty of accessing to publish in certain journals, gave way to the offer to accept the works by means of payment with the excuse of offering an open publication. This may be an alternative for certain researchers backed by a university or a company but in most cases in our environment that does not happen. On the other hand, academic electronic spam including invitations to attend conferences or submit manuscripts sent by predatory publishers or organizations cause great confusion.
Despite all difficulties, the interest for scientific search, to exchange information and publish is not interrupted. The production of scientific works in our countries is the result of the personal effort of the researchers in most cases.
The development of a multilateral information flow model is our responsibility. To achieve this, it is necessary to join forces and have a clear common goal. Working in this way allows the achievement of the proposed objectives. A good example of this is the organization in just over 10 years of two shoulder and elbow world congresses in Latin America, by Brazil (2007) and Argentina (2019).
In conclusion, we have a very important human potential that, in so far as it has communication tools and an accessible participation framework, will be able to make a significant contribution to our subspecialty. Acta of Shoulder and Elbow Surgery can become a fundamental link in this process.
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Treatment of Acute Acromioclavicular joint injuries using hook plate: a retrospective study
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 16-19 | Sebastian Trindade, Paola Del Re
Authors: Sebastian Trindade [1], Paola Del Re [2].
[1] Service of a upper limb of the Trinidad Mitre Clinical (CABA) and Medical Corporation Clinical (prov. Buenos Aires)
[2] Trinidad Mitre Clinical (CABA) and Medical Corporation Clinical (prov. Buenos Aires)
Address of Correspondence
Dr. Sebastian Trindade,
Manager of the service of a upper limb of the Trinidad Mitre Clinical (CABA) and Medical Corporation Clinical (prov. Buenos Aires)
Member Titular of The Argentina Association of Orthopedics and Traumatology (AAOT)
Email: trindadesebastian@gmail.com
Abstract
Introduction: Traumatic injuries of the AC joint are frequent in orthopedic practice accounting for about 9% of all shoulder injuries, the most commonly used classification is Rockwood. The purpose of this retrospective IVevidence level study is to present our experience using for the joint stabilization the hook plate described by Blazer 1976.
Material and Methods: from the period of August 2005 to March 2012 312 patients with acromio-clavicular dislocations were treated in our department, 51 were classified as III and IV type following Rockwood classification, 38 patients (11%) were treated with hook plate. The mean follow-up was 19 months, ranging from 11 to 26 months. The mean age was 36 years old (20-49). The surgery was performed at the average of 14 days from de injury.
Results: Patients were evaluated 6 and 18 months with the modified Quick-DASH, VAS and Constant Murley scales with 95% satisfaction. Discussion: In the surgical treatment, the method of fixation for the stability of the acute AC injury is a matter of debate. In clinical experience, none of them have proven to be any better than others. Based on an old principle of surgery in which different procedures of equal result should be chosen the simplest, animated by simplicity and reproducibility in the technique with low number of complications and an early rehabilitation we continue using this surgical procedure
Key words: Luxation A-C, Plate Hook. Level of Evidence: IV
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6. Schliemann B, Roblenbroich SB, Schneider KN, et al. Why does minimally invasive coracoclavicular ligament reconstruction using a flip button repair technique fail? An analysis of risk factors and complications. Knee Surg Sports TraumatolArthrosc. 2015;23(5):1419-1425.
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