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New Trends in Shoulder Surgery from Biomechanics to the Operating Room

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 43576

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Special Issue Editors

Dr. Edoardo Franceschetti

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Guest Editor

Policlinico Campus Bio Medico, Rome, Italy
Interests: shoulder; acromionclavicular joint; shoulder kinematics; shoulder arthroplasty; reverse arthroplasty
Special Issues, Collections and Topics in MDPI journals

Prof. Francesco Franceschi

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Guest Editor

Policlinico Campus Bio Medico, Rome, Italy

Prof. Giovanni Di Giacomo

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Guest Editor

Concordia Hospital for Special Surgery, Rome, Italy

Special Issue Information

Dear Colleagues,

In the last two decades, we have witnessed a change in our understanding of shoulder diseases and in their treatment. Thanks to biomechanical studies, we now understand that the shoulder is a key junction in a kinetic chain that starts from the lower limb and ends in the hand. The use of new materials has enabled us to change the approach we use to tackle certain pathologies, allowing us to develop techniques that increasingly align with anatomy and enabling non-anatomical surgeries to be left to the area of revision. The degenerative pathology has seen the development of well over 30 different models of reverse prostheses based on a variety of biomechanical characteristics. The management of shoulder instability and rotator cuff lesions has significantly evolved in the last few decades due to the transition from open to arthroscopic techniques allowing for management of pathological entities that were previously untreatable. Moreover, the approach to shoulder pathology has increasingly become multidisciplinary. The actors are no longer limited to surgeons but also include anesthesiologists, radiologists, and rehabilitators.

Dr. Edoardo Franceschetti
Prof. Francesco Franceschi
Prof. Giovanni Di Giacomo
Guest Editors

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Keywords

shoulder
acromionclavicular joint
shoulder kinematics
shoulder arthroplasty
reverse arthroplasty
long head of biceps pathology.

Published Papers (14 papers)

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Editorial

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3 pages, 163 KiB

Open AccessEditorial

New Trends in Shoulder Surgery from Biomechanics to the Operating Room

by Edoardo Franceschetti, Edoardo Giovannetti de Sanctis, Giovanni Di Giacomo and Francesco Franceschi

J. Clin. Med. 2021, 10(11), 2498; https://doi.org/10.3390/jcm10112498 - 5 Jun 2021

Viewed by 1495

Abstract

After a rigorous peer review process, twelve papers were accepted and published [...] Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

Research

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11 pages, 5654 KiB

Open AccessArticle

Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis?

by Alexandre Lädermann, Hugo Bothorel, Philippe Collin, Bassem Elhassan, Luc Favard, Nazira Bernal, Patric Raiss and George S. Athwal

J. Clin. Med. 2021, 10(6), 1196; https://doi.org/10.3390/jcm10061196 - 12 Mar 2021

Cited by 3 | Viewed by 2236

Abstract

Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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9 pages, 4325 KiB

Open AccessArticle

Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study

by Giuseppe Pascarella, Alessandro Strumia, Fabio Costa, Stefano Rizzo, Romualdo Del Buono, Luigi Maria Remore, Federica Bruno and Felice Eugenio Agrò

J. Clin. Med. 2021, 10(4), 781; https://doi.org/10.3390/jcm10040781 - 16 Feb 2021

Cited by 15 | Viewed by 2563

Abstract

Nerve injury is a feared complication of peripheral nerve blockade. The aim of this study was to test the effectiveness of a triple monitoring (TM), i.e., a combination of ultrasound (US), nerve stimulation (NS) and opening injection pressure (OIP) during interscalene brachial plexus block (IBPB) for surgery of the shoulder. Sixty patients undergoing IBPB for shoulder arthroscopy received TM. BSmart^®, an inline injection device connected to a 10 mL syringe, was used to detect OIP during IBPB. Nerve stimulation was set to 0.5 mA to rule out any motor response, and if OIP was below 15 PSI, 10 mL of local anaesthetic was injected under US guidance between the C5 and C6 roots. The main outcome was the ability of TM to detect a needle–nerve contact. Other outcomes including the duration of IBPB; pain during injection; postoperative neurologic dysfunction. Triple monitoring revealed needle–nerve contact in 33 patients (55%). In 18 patients, NS evoked motor responses despite first control with US; in a further 15 patients, BSmart^® detected an OIP higher than 15 PSI, despite the absence of motor response to NS. Mean duration of IBPB was 67.2 ± 5.3 seconds; neither pain during injection nor postoperative neurologic dysfunctions were detected. Clinical follow up excluded the presence of postoperative neuropathies. Triple monitoring showed to be a useful and feasible tool while performing IBPB for arthroscopic shoulder surgery. Future studies will be needed to confirm our findings. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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10 pages, 1614 KiB

Open AccessArticle

The Loop Tenodesis Procedure—From Biomechanics to First Clinical Results

by Moritz Riedl, Agnes Mayr, Stefan Greiner, Christian Pfeifer, Isabella Weiss, Lina Forchhammer, Volker Alt and Maximilian Kerschbaum

J. Clin. Med. 2021, 10(3), 432; https://doi.org/10.3390/jcm10030432 - 23 Jan 2021

Cited by 3 | Viewed by 2157

Abstract

(1) Introduction: Several surgical therapy options for the treatment of pathologies of the long biceps tendon (LHB) have been established. However, tenotomy, as well as established tenodesis techniques, has disadvantages, such as cosmetic deformities, functional impairments and residual shoulder pain. This study presents the first clinical and structural results of the recently introduced loop tenodesis procedure for the LHB, developed to overcome these issues. (2) Methods: 37 patients (11 women, 26 men, mean age 52 years), who underwent loop tenodesis of the LHB were examined six months after surgery. For the clinical evaluation the Constant score, as well as the LHB score, were used, complemented by elbow flexion and supination strength measurements. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove. (3) Results: Both, the overall Constant score as well as the LHB score showed significant improvements six months postoperatively, as compared to the preoperative value. Fourteen patients (38%) presented an examiner-dependent upper arm deformity, although only five patients (13%) reported subjective cosmetic deformities. Both, flexion and supination strength were preserved compared to the preoperative level. In 35 patients (95%), the tenodesis in the bicipital groove was proofed sonographically. (4) Conclusion: The loop tenodesis of the LHB provides good-to-excellent overall clinical results after a short-term follow-up of six month. The incidence of cosmetic deformities was inferior compared to conventional therapy options (tenotomy and anchor tenodesis). Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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10 pages, 3450 KiB

Open AccessArticle

Scapulothoracic Alignment Alterations in Patients with Walch Type B Osteoarthritis: An In Vivo Dynamic Analysis and Prospective Comparative Study

by Alexandre Lädermann, George S. Athwal, Hugo Bothorel, Philippe Collin, Adrien Mazzolari, Patric Raiss and Caecilia Charbonnier

J. Clin. Med. 2021, 10(1), 66; https://doi.org/10.3390/jcm10010066 - 27 Dec 2020

Cited by 2 | Viewed by 3053

Abstract

Background: Kinematic changes of the scapulothoracic joint may influence the relative position of the glenoid fossa and, consequently, the glenohumeral joint. As the alignment of the scapula relative to the thorax differs between individuals, such variability may be another factor in the development of posterior head subluxation. The purpose of this study was to compare scapulothoracic alignment in pathologic type B shoulders with contralateral healthy shoulders. Methods: Seven adult volunteers with unilateral type B glenohumeral osteoarthritis (OA) underwent bilateral computed tomography (CT) scans of the shoulders and arms. A patient-specific, three-dimensional measurement technique that coupled medical imaging (i.e., CT) and optical motion capture was used. Results: The scapulothoracic distance at the trigonum was 75 ± 15 mm for pathologic shoulders and 78 ± 11 mm for healthy shoulders (p = 0.583), while at the inferior angle, it was 102 ± 18 mm for pathologic shoulders and 108 ± 12 mm for healthy shoulders (p = 0.466). Conclusion: Scapula positioning at a resting position did not differ between pathologic and healthy shoulders. However, pathologic shoulders tended to be limited in maximal glenohumeral motion and exhibited greater anterior tilt of the scapula in internal rotation at 90 degrees, which may be adaptive to the restricted glenohumeral motion. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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12 pages, 1081 KiB

Open AccessArticle

Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees

by Edoardo Franceschetti, Edoardo Giovannetti de Sanctis, Alessio Palumbo, Riccardo Ranieri, Paola Casti, Arianna Mencattini, Nicola Maffulli and Francesco Franceschi

J. Clin. Med. 2020, 9(12), 3950; https://doi.org/10.3390/jcm9123950 - 5 Dec 2020

Cited by 6 | Viewed by 3377

Abstract

Background: A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes. Methods: Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size. Results: 289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher (p = 0.007 and p = 0.004) and lower (p = 0.029 and p = 0.028) in Group A, both in the Small-and Medium-size subgroups. No complications were outlined. The mediolateral width of the acromion was reduced, according to the preoperatively calculated measure. Conclusion: Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°–35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions. Level of evidence: II. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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12 pages, 575 KiB

Open AccessArticle

Revision Arthroscopic Bankart Repair: A Systematic Review of Clinical Outcomes

by Chang-Jin Yon, Chul-Hyun Cho and Du-Han Kim

J. Clin. Med. 2020, 9(11), 3418; https://doi.org/10.3390/jcm9113418 - 25 Oct 2020

Cited by 9 | Viewed by 2540

Abstract

Although the frequency of arthroscopic revision surgery is increasing in patients with recurrent dislocation after a primary shoulder stabilization, the literature describing arthroscopic revision Bankart repair has been limited. Preferred reporting items for systematic meta-analyses guidelines were followed by utilizing PubMed, EMBASE, Scopus, and Cochrane Library databases. Keywords included shoulder dislocation, anterior shoulder instability, revision surgery, stabilization, and arthroscopic Bankart repair. Quality assessments were performed with criteria from the methodological index for nonrandomized studies (MINORS). A total of 14 articles were included in this analysis. The mean MINORS score was 12.43. A total of 339 shoulders (337 patients) were included (281 males and 56 females). The mean follow-up period was 36.7 months. Primary surgeries were as follows: arthroscopic procedures (n = 172, 50.7%), open procedure (n = 87, 25.7%), and unknown (n = 80, 23.6%). The mean rate of recurrent instability after revision arthroscopic Bankart repair was 15.3% (n = 52), and an additional re-revision procedure was needed in 6.5% of cases (n = 22). Overall, there were 18.0% (n = 61) of complications reported. This systematic review suggests that arthroscopic revision Bankart repair can lead to an improvement in functional outcomes and reasonable patient satisfaction with proper patient selection. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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10 pages, 1180 KiB

Open AccessArticle

Onlay Uncemented Lateralized Reverse Shoulder Arthroplasty for Fracture Sequelae Type 1 with Valgus/Varus Malunion: Deltoid Lengthening and Outcomes

by Alfonso Maria Romano, Adriano Braile, Pasquale Casillo, Guglielmo Nastrucci, Massimiliano Susanna, Angelo Di Giunta and Francesco Ascione

J. Clin. Med. 2020, 9(10), 3190; https://doi.org/10.3390/jcm9103190 - 1 Oct 2020

Cited by 10 | Viewed by 2647

Abstract

The successful treatment of proximal humeral fractures remains challenging for shoulder surgeons, and failure rates are high, regardless of initial treatment. This study aimed to analyze the clinical and radiographic midterm results of onlay lateralized cementless stem reverse shoulder arthroplasty (RSA) in patients with valgus/varus malunion proximal humerus fracture sequelae without metaphyseal osteotomy. We retrospectively studied 35 cases with the diagnosis of fracture sequelae of the proximal part of the humerus with valgus/varus malunion. The mean duration of follow-up was 4.6 years (range, 2 to 7 years), and the mean time between fracture and arthroplasty was 6 years (1 to 32 years). Seventeen patients (48.6%) had initially been treated nonoperatively. The Constant score (CS), active range of motion, and radiographs of the affected shoulders, as well as the acromion to greater tuberosity (AGT) distance and deltoid length (DL), were analyzed before surgery and at their latest follow-up. A total of thirty-three patients (94.3%) rated their outcome as very good or good. Mean CS, forward flexion, and external rotation improved significantly (p < 0.0001), as did internal rotation and pain (p < 0.05). AGT distance significantly increased postoperatively from 14.7 to 43.3 mm, as did DL from 143 to 170 mm (p < 0.05). There was no correlation between the outcomes and valgus/varus deformity, previous surgeries, or AGT distance/DL. A total of four complications occurred (11.4%): two dislocations were detected (5.7%) and successfully revised with a longer cemented stem. Onlay lateralized uncemented stem RSA improves clinical outcomes and decreases complications when treating valgus/varus malunion fracture sequelae, avoiding intraoperative technical challenges, such as tuberosities osteotomy conscious of bone loss and proper deltoid tensioning. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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10 pages, 921 KiB

Open AccessArticle

Clinical and Radiologic Outcomes of Combined Use of Biocomposite and PEEK Suture Anchors during Arthroscopic Rotator Cuff Repair: A Prospective Observational Study

by Jae-Hoo Lee and Yong-Beom Lee

J. Clin. Med. 2020, 9(8), 2545; https://doi.org/10.3390/jcm9082545 - 6 Aug 2020

Cited by 6 | Viewed by 3521

Abstract

The aim of the current study was to evaluate the functional and radiologic outcomes of biocompatible non-absorbable PEEK (polyetheretherketone) and biocomposite (poly-L-lactic acid/poly(lactic-co-glycolic acid) 70% + β-tricalcium phosphate) anchors, especially in terms of perianchor cyst formation during the first six months postoperatively. We prospectively analysed 29 patients who underwent arthroscopic rotator cuff repair between March and May 2019. Both PEEK and biocomposite suture anchors were used as lateral anchors in one body. Clinical outcomes were assessed using the shoulder range of motion (ROM), visual analogue scale (VAS) for pain and satisfactory score, American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST). All these were obtained in patients preoperatively at 3 and 6 months after surgery. The imaging evaluation included perianchor cyst formation, anchor absorption, repaired cuff integrity, and retear pattern. All functional outcomes significantly improved over time. The biocomposite anchor had a statistically significant tendency to form higher grades of fluid collection at 3 months after surgery. However, the perianchor cyst reduced by the sixth postoperative month. Six months postoperatively, the functional outcomes were improved after rotator cuff repair and similar degrees of perianchor cyst formation were observed, regardless of the suture anchor material used. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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14 pages, 3609 KiB

Open AccessArticle

The Infinity-Lock System for Chronic Grade III AC Joint Dislocation: A Novel Technique, Rehabilitation Protocol and Short Term Results

by Alfonso Maria Romano, Pasquale Casillo, Monica De Simone, Guglielmo Nastrucci, Donatella Risorto, Massimiliano Susanna, Angelo Di Giunta and Francesco Ascione

J. Clin. Med. 2020, 9(8), 2519; https://doi.org/10.3390/jcm9082519 - 5 Aug 2020

Cited by 4 | Viewed by 4082

Abstract

Background: the choice of treatment of chronic grade III acromioclavicular (AC) joint dislocation is controversial. Several surgical techniques have been described in the literature, responding differently to nonoperative treatment. The aim of this study is to describe a modified technique of stabilizing an AC joint dislocation with the new Infinity-Lock Button System, in order to demonstrate that it is effective in optimizing outcomes and decreasing complications. Methods: this is a retrospective study of 15 patients who underwent surgical stabilization of the AC joint dislocation between 2018 and 2019, through modified surgical technique using the Infinity-Lock Button System. Active range of motion (ROM), Specific Acromio Clavicular Score (SACS) and Constant Score (CS) were evaluated preoperatively and postoperatively at last 18 months follow up. Patients rated their outcomes as very good, good, satisfactory, or unsatisfactory. Results: a total of twelve patients rated their outcome as very good and three as good; no patients were dissatisfied with surgery. The mean Constant Score increased from 38 points preoperatively to 95 postoperatively, the average SACS score decreased from 52 points preoperatively to 10 postoperatively, both significantly. No complications were detected. Conclusion: the described technique is effective for treatment of chronic grade III AC joint dislocation, resulting in elevated satisfaction ratings and predictable outcomes. Nevertheless, further longer term follow-up studies are required. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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Review

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Open AccessReview

Clinical Outcomes and Joint Stability after Lateralized Reverse Total Shoulder Arthroplasty with and without Subscapularis Repair: A Meta-Analysis

by Katia Corona, Simone Cerciello, Gianluca Ciolli, Lorenzo Proietti, Riccardo D'Ambrosi, Adriano Braile, Giuseppe Toro, Alfonso Maria Romano and Francesco Ascione

J. Clin. Med. 2021, 10(14), 3014; https://doi.org/10.3390/jcm10143014 - 6 Jul 2021

Cited by 13 | Viewed by 1901

Abstract

Introduction: Subscapularis tendon repair in reverse total shoulder arthroplasty represents a potentially modifiable risk factor for dislocation, and its role continues to be debated. The purpose of the present meta-analysis was to compare the outcomes of the primary lateralized RSAs with and without subscapularis repair in terms of range of motion, clinical outcomes, dislocations, and complications rate. Materials and Methods: A systematic literature search in MEDLINE (Pubmed), Embase, and the Cochrane Central Register of Controlled Trials database was carried up to December 2020. A data extraction form was developed to collect select data from the included studies. The methodological quality was assessed using a Methodological Index for Nonrandomized Studies (MINORS) score. Statistical analysis was performed with Review Manager (Version 5.4, The Cochrane Collaboration). Results: A total of four comparative studies involving 978 patients were included. In the pooled analysis, the reinsertion of the subscapularis yielded better functional outcomes in terms of the constant (P < 0.00001) and ASES (P = 0.002) scores. The forward elevation, external rotation at 0°, internal rotation, and dislocation rates were comparable between the two groups (P = n.s.), while statistically increased abduction was observed in those patients who did not have their subscapularis repaired (P < 0.00001). Conclusion: The results of the present findings suggest that it seems reasonable to reinsert the subscapularis whenever it is present, in good tissue conditions, and with no evidence of fatty degeneration of its muscle belly. Level of evidence: Level III meta-analysis Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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15 pages, 1749 KiB

Open AccessFeature PaperReview

The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review

by Edoardo Giovannetti de Sanctis, Edoardo Franceschetti, Ferdinando De Dona, Alessio Palumbo, Michele Paciotti and Francesco Franceschi

J. Clin. Med. 2021, 10(1), 51; https://doi.org/10.3390/jcm10010051 - 25 Dec 2020

Cited by 22 | Viewed by 5158

Abstract

(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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14 pages, 3982 KiB

Open AccessReview

An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment

by Alfonso Maria Romano, Tiziana Ascione, Pasquale Casillo, Guglielmo Nastrucci, Massimiliano Susanna, Angelo Di Giunta and Francesco Ascione

J. Clin. Med. 2020, 9(11), 3683; https://doi.org/10.3390/jcm9113683 - 16 Nov 2020

Cited by 5 | Viewed by 2102

Abstract

Periprosthetic joint infections of the shoulder (PJIS) are the major cause for revision within the first two post-operative years, and are challenging both to diagnose and treat. Success depends on early identification of microorganisms, appropriate surgical procedures and efficient antibiotic administration. The peculiar microbiology of the shoulder may render the criteria for hip/knee PJI management inappropriate. In addition, later cases with clinically subtle signs often present diagnostic challenges. In recent years, specific issues of PJIS have been managed through the use of new instruments, such as MicroDTTect in pathogen detection and Bioactive Glass and tantalum cones in humeral bone loss. In the literature to date, no reports have been found that discuss the application in shoulder revisions and infections. The early identification of the microorganisms that cause infection may help improve both treatment strategies and the efficacy of therapy. MicroDTTect proved to be more efficient than swab collection for bacterial identification in orthopedic surgery, thus reducing analysis costs. The increasing number of shoulder arthroplasties is associated with an increase in the number of revisions. In cases of massive metaphyseal humeral bone loss, several techniques have been described; no reports have been reported regarding tantalum in humeral bone loss management. In some cases the tantalum cones required adaptation for femoral diaphysis in the augmentation of the humerus metaphysis and bone loss management improvement. Obtaining stable osseointegration of prosthetic implants is one of the greatest issues in orthopedic surgery, and even more crucial in revisions. Bioactive glasses demonstrated good regenerative and osseointegration properties, and an excellent candidate as a bone graft, scaffold and antibiotics deliverer. The Bioactive glasses were used to increase prosthesis-bone interface stability and fill bone defects in PJIS revision surgeries, contributing to the prevention of re-infection. Longer-term follow-up will be necessary to determine if construction durability is improved in the long term. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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15 pages, 2377 KiB

Open AccessReview

Suprascapular Neuropathy around the Shoulder: A Current Concept Review

by Federico Bozzi, Sergi Alabau-Rodriguez, Sergi Barrera-Ochoa, Atesch Ateschrang, Anna J. Schreiner, Juan Carlos Monllau and Simone Perelli

J. Clin. Med. 2020, 9(8), 2331; https://doi.org/10.3390/jcm9082331 - 22 Jul 2020

Cited by 7 | Viewed by 5363

Abstract

Suprascapular neuropathy is an uncommon but increasingly recognized cause of shoulder pain and dysfunction due to nerve entrapment. The aim of this review is to summarize some important aspects of this shoulder pathology. An extensive research was performed on PubMed and Clinical Key. The goal was to collect all the anatomical, biomechanical and clinical studies to conduct an extensive overview of the issue. Attention was focused on researching the state of art of the diagnosis and treatment. A total of 59 studies were found suitable and included. This condition is more frequently diagnosed in over-head athletes or patients with massive rotator cuff tears. Diagnosis may be complex, whereas its treatment is safe, and it has a great success rate. Prompt diagnosis is crucial as chronic conditions have worse outcomes compared to acute lesions. Proper instrumental evaluation and imaging are essential. Dynamic compression must initially be treated non-operatively. If there is no improvement, surgical release should be considered. On the other hand, soft tissue lesions may first be treated non-operatively. However, surgical treatment by arthroscopic means is advisable when possible as it represents the gold standard therapy. Other concomitant shoulder lesions must be recognized and treated accordingly. Full article

(This article belongs to the Special Issue New Trends in Shoulder Surgery from Biomechanics to the Operating Room)

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