Publications by authors named "Hiroyuki Sugaya"

75 Publications

Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears.

J Orthop Sci 2021 May 31. Epub 2021 May 31.

Tokyo Sports & Orthopaedic Clinic, 4-29-9 Kami-ikebukuro, Toshima, Tokyo, 170-0012, Japan.

Background: Recently, to treat the long head of the biceps tendon lesions in addition to rotator cuff repair has been recommended. However, the differences in clinical outcomes between biceps tenotomy and tenodesis for middle-aged and elderly females remains unclear. The purpose of this study was to compare the outcomes of biceps tenotomy and soft-tissue tenodesis that were performed concurrently with arthroscopic rotator cuff repair in ≥60-year-old females.

Methods: Female shoulders that underwent arthroscopic rotator cuff repair in our institute in 2016 were retrospectively reviewed. This study included 66 shoulders with concurrent biceps tenotomy or soft-tissue tenodesis: tenotomy group, 41 shoulders; soft-tissue tenodesis group, 25 shoulders. Clinical scores, biceps pain (visual analogue scale, VAS), Popeye deformity, and biceps strength (%contralateral side) were compared between the two groups.

Results: The mean age was significantly higher in the tenotomy group than the soft-tissue tenodesis group (72 ± 4 and 68 ± 6 years, respectively; P = 0.002). There were no significant differences in post-operative JOA and UCLA scores between the groups. VAS for biceps pain was significantly higher at postoperative 6 months in the tenotomy group than the soft-tissue tenodesis group (2.9 ± 2.5 and 1.7 ± 1.6, respectively, P = 0.03), though there were no significant differences at postoperative 3, 12, and ≥24 months. Subjective evaluation of Popeye deformity was not significantly different between the groups. Postoperative biceps strength was significantly lower in the tenotomy group than the soft-tissue tenodesis group (89.9% and 102.8%, respectively, P = 0.02).

Conclusions: Both biceps tenotomy and soft-tissue tenodesis concurrent with rotator cuff repair in ≥60-year-old female patients resulted in good outcomes. Shoulders with soft-tissue tenodesis demonstrated earlier improvement in postoperative biceps pain and better postoperative biceps strength than those with tenotomy. There were no differences in objective and subjective Popeye deformity between tenotomy and soft-tissue tenodesis. The LHB procedures, tenotomy or tenodesis, can be selected depending on surgeons' preference.
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http://dx.doi.org/10.1016/j.jos.2021.04.012DOI Listing
May 2021

Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes.

Arthrosc Sports Med Rehabil 2021 Apr 23;3(2):e289-e296. Epub 2021 Feb 23.

Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A.

Purpose: To systematically review the available literature to further describe and report the available data on SLAP repair techniques and the association with outcomes.

Methods: A systematic review of literature was performed on manuscripts describing type II SLAP repairs in athletes. Selection criteria included studies reporting exclusively type II SLAP tears without concomitant pathology, minimum 2-year postoperative follow-up, use of anchor fixation, and return to previous level of play data available. We extracted patient outcome as well as surgical construct details from each article. Average outcomes and return to play rates were calculated and substratified further by athlete type. Return to play rates were compared by repair constructs with the Student test.

Results: Initial search resulted in 107 articles. After exclusion criteria were applied, 17 articles were included in the final analysis. Overall, 84% of patients had good-to-excellent results. Of all athletes, 66% returned to previous level of play. There was significant variation in reported technique in terms of anchor number, location, material, suture type, and knotless versus knotted constructs. No significant difference was reported in outcomes in comparison of suture type (-value .96) or knotted versus knotless constructs (-value .91). Given the significant variability in reporting, no statistical analysis was felt able to be performed on anchor location and number.

Conclusions: Repair of type II SLAP tears in athletes is a difficult problem to treat with overall low return to play despite a high rate of "good" outcomes when assessed by outcome measures. Significant variability exists in surgical technique, as well as reporting of surgical technique, potentially limiting the ability to define the best or most effective technique for SLAP repair.

Level Of Evidence: IV, systematic review of level III and level IV studies.
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http://dx.doi.org/10.1016/j.asmr.2020.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128993PMC
April 2021

Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes.

Am J Sports Med 2021 05 12;49(6):1604-1611. Epub 2021 Apr 12.

Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan.

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes.

Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability.

Study Design: Case series; Level of evidence, 4.

Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated.

Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; = .002).

Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.
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http://dx.doi.org/10.1177/03635465211003091DOI Listing
May 2021

In vivo measurement of distance between scapular neck and polyethylene insert during active external rotation in shoulders with Grammont type reverse prosthesis.

Clin Biomech (Bristol, Avon) 2021 Apr 26;84:105341. Epub 2021 Mar 26.

Department of Mechanical & Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.

Background: Scapular notching is a frequently observed complication after reverse shoulder arthroplasty. Impingement of the humeral plastic insert against the scapular neck is believed to be the cause of notching. There have been no in vivo studies that analyzed the positional relationship between the scapular neck and humeral insert. The purpose of this study was to measure the distance between the scapular neck and insert in shoulders with Grammont-type prostheses during active external rotation at the side.

Methods: Eighteen shoulders with Grammont-type prostheses were enrolled in this study. There were 13 males and 5 females, and the mean age at surgery was 74 years (range, 63-91). Fluoroscopic images were recorded during active external rotation at the side from maximum internal to external rotation at an average of 14 months (range, 7-24) after surgery. Implant kinematics were determined with three-dimensional models of the implants and fluoroscopic images using model-image registration techniques. Based on the implant kinematics, the closest distance between the scapular neck and insert was computed at each 5° increment of glenohumeral internal/external rotation.

Results: Mean glenohumeral abduction during rotation was 17°-22°. The mean distance between the neck and insert was approximately 1 mm throughout the activity. The separation distance tended to narrow with arm external rotation, but the change was not significant.

Interpretation: The small distance between the scapular neck and insert in early post-operative reverse shoulder arthroplasty patients may be associated with the high incidence of scapular notching in Grammont-type prostheses.
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http://dx.doi.org/10.1016/j.clinbiomech.2021.105341DOI Listing
April 2021

Arthroscopic Iliac Bone Grafting for Traumatic Anterior Shoulder Instability with Significant Glenoid Bone Loss Yields Low Recurrence and Good Outcome at a Minimum of Five-year Follow-Up.

Arthroscopy 2021 Mar 24. Epub 2021 Mar 24.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba.

Purpose: The purpose of this study was to investigate the clinical and radiographic outcomes of arthroscopic iliac bone grafting with capsulolabral reconstruction for severe glenoid bone loss with a minimum of 5 years' follow-up.

Methods: The inclusion criterion was shoulders that underwent arthroscopic iliac bone grafting for >20%-25% glenoid defect between January 2007 and April 2014, and the exclusion criterion was <5 years' follow-up. Iliac crest bone grafts of approximately 2.0 cm length and 0.8 cm height were arthroscopically fixed to the anterior glenoid using 2 cannulated screws followed by capsulolabral repair. Rowe score, Western Ontario Shoulder Instability Index (WOSI), and passive range of motion were evaluated. Radiographic findings including the Kellgren and Lawrence osteoarthritis grade and graft integration on 3-dimensional computed tomography at the final follow-up were also evaluated.

Results: Forty-eight shoulders met the inclusion criteria, and 24 shoulders with ≥5 years' follow-up were included (1 died; 23 were lost follow-up): 22 males, 2 females; a mean age at surgery, 30 years (range, 18-52 years); a mean follow-up of 8 years (range, 5-11 years). The mean preoperative glenoid bone defect was 22% (range, 20%-28%). All shoulders had a Hill-Sachs lesion including 4 on-track lesions. One shoulder experienced traumatic redislocation at 5 years after surgery. The scores significantly improved: Rowe score, 19 ± 8 to 94 ± 8 (P < .001); WOSI, 1547 ± 241 to 439 ± 318 (P < .001). Postoperative flexion showed significant improvement from 158 ± 18 to 169 ± 11 (P = .008), whereas internal rotation deteriorated from T8 ± 3 to T10 ± 3 (P = .005). Graft integration showed remodeling in 54% and excessive absorption in 13%. Osteoarthritis grades progressed significantly (P < .001), but only grade 1 osteoarthritic changes were seen, except for 4 shoulders with grade 2 osteoarthritis.

Conclusions: Arthroscopic iliac bone grafting for traumatic anterior shoulder instability with severe glenoid bone loss yielded satisfactory outcomes with mid-term follow-up. Arthritic changes progressed in half of the shoulders; however, most shoulders only demonstrated grade 1 osteoarthritis.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2021.03.028DOI Listing
March 2021

Comparison Between Osteochondral Autograft Transplantation and Arthroscopic Fragment Resection for Large Capitellar Osteochondritis Dissecans in Adolescent Athletes: A Minimum 5 Years' Follow-up.

Am J Sports Med 2021 04 11;49(5):1145-1151. Epub 2021 Mar 11.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial.

Purpose/hypothesis: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years' follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection.

Study Design: Cohort study; Level of evidence, 3.

Methods: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined.

Results: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: -17° to 0°; group 2: -18° to -6°; < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up ( = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement.

Conclusion: No differences were observed in clinical and radiographic outcomes between patients undergoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years' follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.
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http://dx.doi.org/10.1177/0363546521994558DOI Listing
April 2021

Morphology of the Undersurface of the Anterolateral Acromion and Its Relationship to Surrounding Structures.

Orthop J Sports Med 2021 Jan 27;9(1):2325967120977485. Epub 2021 Jan 27.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

Background: A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise correlations between the morphologic features underneath the acromion and the surrounding structures including the attachment of the coracoacromial ligament (CAL) and the origin of the deltoid middle head have not yet been determined in the absence of artifacts on the bony surface caused by dissection techniques. Moreover, anatomic findings in previous studies using only older-aged cadavers or dried bones may not reflect the morphologic features of younger and healthy specimens.

Purpose: To characterize the anterolateral structures morphologically in the inferior aspect of the acromion, assess the relationships of these structures with surrounding structures without dissection artifacts on the bony surface, and verify the cadaveric data in the asymptomatic shoulders of living middle-aged patients.

Study Design: Descriptive laboratory study.

Methods: We initially analyzed the relationship between the morphology of the anterolateral structures and surrounding structures in 18 cadaveric shoulders (mean age, 81.8 years), 15 of which were subjected to macroscopic investigation of the CAL attachment and 3-dimensional micro-computed tomography investigation with radiopaque markers and 3 of which were subjected to histologic examination. We also analyzed the morphology underneath the anterolateral acromion in 24 asymptomatic shoulders of middle-aged patients (mean age, 54.8 years) to verify the cadaveric data. In both the cadaveric shoulders and the asymptomatic shoulders of live patients, the long axis, width, and height of the anterolateral prominence were measured by use of 3-dimensional CT imaging.

Results: In cadavers, the anterolateral prominence underneath the acromion corresponded to the attachment of the CAL. Histologic evaluation revealed that the CAL was continuous to the deep layer of the deltoid middle head in the lateral acromion. The study in asymptomatic shoulders of middle-aged patients revealed bony prominences similar to those observed in cadavers.

Conclusion: The anterolateral prominence, which corresponds to the attachment of the CAL below the acromion, may be a native structure below the acromion. Moreover, the CAL is continuous to the deep layer of the deltoid middle head in the lateral acromion.
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http://dx.doi.org/10.1177/2325967120977485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844461PMC
January 2021

Evaluation and Management of Glenohumeral Instability With Associated Bone Loss: An Expert Consensus Statement Using the Modified Delphi Technique.

Arthroscopy 2021 Jun 13;37(6):1719-1728. Epub 2021 Jan 13.

Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss.

Methods: A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements. Items with over 70% agreement and less than 10% disagreement achieved consensus.

Results: After a total of 3 rounds, 31 statements achieved consensus. Eighty-six percent of the experts agreed that a history of multiple dislocations and failed soft-tissue surgery should raise suspicion about the possibility of an associated bone deficit. Ninety-five percent of the experts agreed that 3-dimensional (3D) computed tomography (CT) is the most accurate diagnostic method to evaluate and quantify bone loss. Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate; however, 91% of the experts thought that an en face view of the glenoid using 3D CT provides the most accurate method. Ninety-five percent of the experts agreed that Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Ninety percent of the experts agreed that in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed and any of the available options is valid. There was no consensus among experts on how Hill-Sachs injuries should be managed or on how postoperative rehabilitation should be carried out.

Conclusions: The essential statements on which the experts reached consensus included the following: A history of multiple dislocations and failed soft-tissue surgery should make surgeons consider the possibility of an associated bone deficit. Three-dimensional CT is the most accurate diagnostic method to evaluate and quantify bone loss. Although any of the available methods to measure glenoid bone deficiency is adequate, an en face view of the glenoid using 3D CT provides the most accurate method. Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Finally, in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed.

Level Of Evidence: Level V, consensus statement.
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http://dx.doi.org/10.1016/j.arthro.2020.12.237DOI Listing
June 2021

Clinical outcomes of arthroscopic pan-capsular release with or without entire coracohumeral ligament release for patients with frozen shoulder.

JSES Int 2020 Dec 14;4(4):826-832. Epub 2020 Oct 14.

Department of Orthopaedic Surgery, Funabashi Orthopaedic Hospital, Funabashi, Japan.

Background: We aimed to retrospectively determine the effects of arthroscopic pan-capsular release with or without entire coracohumeral ligament (CHL) release and diabetes mellitus (DM) in patients with frozen shoulder (FS).

Methods: The study included 34 patients (20 male and 14 female patients) who underwent arthroscopic pan-capsular release without entire CHL release (group 1) and 26 patients (6 male and 20 female patients) who underwent entire CHL release for FS (group 2). Patients with a minimum of 12 months of follow-up were included, and range of motion (ROM) and the shoulder rating scale of the University of California at Los Angeles (UCLA) scoring system were evaluated.

Results: In group 2, external rotation and hand-behind-the-back (HBB) ROMs were significantly increased compared with group 1 at the final follow-up (external rotation, 53.1° ± 15.2° vs. 41.3° ± 20.5° [ = .044]; HBB level, T6 [interquartile range, T5-T9] vs. T11 [interquartile range, T8-L4] [ < .001]). Total UCLA scores and UCLA scores for pain (9.2 ± 1.5 vs. 10.0,  = .003), function (8.5 ± 1.4 vs. 10.0, < .001), and active forward flexion (4.6 ± 0.6 vs. 4.9 ± 0.2, < .011) were significantly greater in group 2 at the final follow-up. Patients without DM tended to have greater recovery of forward flexion and HBB ROMs and better total, pain, and function UCLA scores compared with those with DM. In group 2, there were no significant differences in ROMs and UCLA scores between the patients with DM and those without DM.

Conclusion: Arthroscopic entire CHL release is an essential treatment option for FS patients to regain ROMs and function and to reduce pain.
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http://dx.doi.org/10.1016/j.jseint.2020.08.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738570PMC
December 2020

Three-dimensional measurement of proximal radioulnar space during active forearm pronation.

J Biomech 2020 12 9;113:110120. Epub 2020 Nov 9.

Department of Mechanical & Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.

Distal biceps tendon ruptures have been reported to be associated with narrowing of the proximal radioulnar space. There have been no studies that three-dimensionally measured the distance between the bicipital tuberosity and the proximal ulna during active motion. The purpose of this study was to three-dimensionally measure the proximal radioulnar space during active forearm pronation in healthy subjects. Five healthy volunteers (10 forearms) were recruited for this study. They consisted of all males with a mean age of 37 years (range, 34-46 years). Lateral fluoroscopy of forearm rotation from maximum supination to maximum pronation was recorded for both forearms. Three-dimensional forearm kinematics were determined using model-image registration techniques with fluoroscopic images and CT-derived bone models, and the closest distance between the bicipital tuberosity and the proximal ulna was computed at each 30° increment of radial axial rotation relative to the distal humerus. The distance between the bicipital tuberosity and the proximal ulna decreased with pronation, reaching a minimum value at 90° of radial rotation (average 4.6 ± 1.3 mm), then increased with further rotation to maximum pronation (P = 0.004). The clearance between the proximal radioulnar space and the distal biceps tendon is very small (<1mm). Hypertrophy of the bicipital tuberosity or tendon can induce impingement and lead to tendon rupture.
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http://dx.doi.org/10.1016/j.jbiomech.2020.110120DOI Listing
December 2020

Superior Labral Injuries in Elite Gymnasts: Symptoms, Pathology, and Outcomes After Surgical Repair.

Orthop J Sports Med 2020 Jul 14;8(7):2325967120935001. Epub 2020 Jul 14.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: Superior labral anterior-posterior (SLAP) lesions are common among elite gymnasts and throwing athletes. Although SLAP lesions in throwers are well-described in the literature, no study has described the characteristics of SLAP lesions in gymnasts. We aimed to reveal the characteristics of SLAP lesions in gymnasts by comparing the location and extension of these lesions between gymnasts and throwers.

Hypothesis: The location and arc of SLAP lesions in gymnasts will be different from those in throwing athletes.

Study Design: Case series; Level of evidence, 4.

Methods: This study included 27 shoulders in 20 males and 3 females with a mean ± SD age of 20 ± 2.5 years (range, 16-25 years). We performed debridement alone for shoulders with a stable lesion. Anterior and/or posterior labral repair was added for unstable SLAP lesions depending on the extension and stability of the lesions. We investigated symptoms, onset, return to sport (based on patient records), and subjective shoulder values. SLAP lesions were evaluated through use of the Snyder classification. The location and arc of SLAP lesions were determined from surgical records and videos and described by use of the right shoulder clockface method. During the same period, 65 baseball players (65 shoulders; all males; mean age, 23 ± 7.0 years; range, 16-44 years) underwent arthroscopic SLAP surgery. We compared the location and arc of SLAP lesions between gymnasts and baseball players.

Results: Symptoms during gymnastics included pain (100%), apprehension (48%), or catching (11%). We found that 20 shoulders had symptom onset during gymnastics, most commonly during rings events. Type II SLAP lesions were found in 17 shoulders, type III in 2 shoulders, and type IV in 8 shoulders. The mean center of SLAP lesions was at the 11:40 clockface position in 27 gymnasts and 10:40 clockface position in 65 baseball players, and the difference was statistically significant ( < .001). The mean arc of SLAP lesions was 125° in gymnasts and 140° in baseball players, and the difference was not significant. We performed debridement in 2 shoulders (7%) and labral repair in 25 shoulders (93%). After surgery, all patients returned to gymnastics. The mean subjective shoulder value was 35 (range, 10-90) preoperatively and 76 (range, 40-100) postoperatively.

Conclusion: SLAP lesions in gymnasts were significantly located anteriorly compared with those in baseball players. All patients returned to gymnastics after arthroscopic surgery. Secure repair of SLAP lesions may be important for good surgical outcomes, because 50% of patients experienced preoperative shoulder apprehension.
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http://dx.doi.org/10.1177/2325967120935001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361489PMC
July 2020

Repair Integrity and Retear Pattern After Arthroscopic Medial Knot-Tying After Suture-Bridge Lateral Row Rotator Cuff Repair.

Am J Sports Med 2020 08 14;48(10):2510-2517. Epub 2020 Jul 14.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: Type 2 failure is a big issue after suture-bridge rotator cuff repair, which may be because of stress concentration at the medial row stitches. We have been performing medial knot-tying after suture-bridge lateral row repair to avoid the stress concentration. This study aimed to evaluate clinical and radiological outcomes after arthroscopic rotator cuff repair using this technique.

Hypothesis: This technique would yield better radiological outcomes with a reduced type 2 failure rate compared with reported outcomes after conventional suture-bridge repair.

Study Design: Case series; Level of evidence, 4.

Methods: The inclusion criteria of this study were (1) full-thickness tears, (2) primary surgery, and (3) minimum 2-year follow-up with pre- and postoperative magnetic resonance imaging (MRI). We investigated active ranges of motion (forward elevation and external rotation), as well as the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA), scores preoperatively and at the final follow-up.

Results: This study included 384 shoulders in 373 patients (205 men and 168 women) with a mean age of 65 years (range, 24-89 years) at the time of surgery. The mean follow-up was 29 months (range, 24-60 months). There were 91 small, 137 medium, 121 large, and 35 massive tears. Postoperative MRI scans demonstrated successful repair in 324 shoulders (84.4%, group S) and retear in 60 shoulders (15.6%). Among 60 retears, 40 shoulders (67%) had type 1 failure (group F1) and 20 shoulders (33%) had type 2 failure (group F2). Forward elevation and external rotation significantly improved after surgery ( < .001 for both). Postoperative JOA and UCLA scores in group F2 were significantly lower than those in the other groups.

Conclusion: The medial knot-tying after suture-bridge lateral row repair demonstrated excellent functional and radiological outcomes after surgery, with a retear rate of 15.6%. The type 2 failure showed significantly inferior functional outcomes; however, the rate of type 2 failure was less relative to previous studies using conventional suture-bridge techniques. Our technique could be a good alternative to conventional suture-bridging rotator cuff repair because it may reduce the rate of postoperative type 2 failure.
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http://dx.doi.org/10.1177/0363546520934786DOI Listing
August 2020

The Bankart repair: past, present, and future.

J Shoulder Elbow Surg 2020 Dec 2;29(12):e491-e498. Epub 2020 Jul 2.

Imperial College, London, UK.

Arthur Sidney Blundell Bankart was a London-based orthopedic surgeon who discovered the essential lesion in recurrent anterior shoulder instability in 1923. He pioneered a technique, the Bankart repair, to re-establish stability to the glenohumeral joint, without sacrificing native joint motion. In this article, the original Bankart repair is compared to the modern arthroscopic Bankart repair, accompanied by a surgical video of Blundell Bankart performing the Bankart repair in 1951, shortly before his death. Bankart's original description included an open repair with a coracoid osteotomy and subscapularis tenotomy and repair. The history of the technique, its utility in present day, and the future of the Bankart repair are discussed.
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http://dx.doi.org/10.1016/j.jse.2020.06.012DOI Listing
December 2020

Return to Sport After Arthroscopic Rotator Cuff Repair in Middle-Aged and Elderly Swimmers.

Orthop J Sports Med 2020 Jun 17;8(6):2325967120922203. Epub 2020 Jun 17.

Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

Background: No reports have been published on the clinical outcomes, including return to sport, after rotator cuff repair in middle-aged and elderly swimmers with rotator cuff tears.

Purpose: To retrospectively investigate clinical outcomes and return to sport after arthroscopic rotator cuff repair in middle-aged and elderly swimmers.

Study Design: Case series; Level of evidence, 4.

Methods: Patients who underwent arthroscopic rotator cuff repair and met the following criteria were included: (1) age older than 45 years, (2) rotator cuff tears confirmed during surgery, (3) arthroscopic suture bridge rotator cuff repair, (4) primary surgery, and (5) swam more than once a week before surgery. The exclusion criteria were as follows: (1) irreparable large and massive tears, (2) shoulder instability, (3) arthritis or rheumatic disorders, or (4) less than 2-year follow-up. We investigated functional outcomes including range of motion; the University of California, Los Angeles (UCLA) score; the American Shoulder and Elbow Surgeons (ASES) score; return to swimming; and the return rates for each style of swimming. In addition, the functional outcomes and findings of magnetic resonance imaging were compared between the group with complete return and the group with incomplete or failed return.

Results: A total of 32 shoulders in 31 middle-aged and elderly swimmers (5 males, 26 females) were included. The mean age was 65 years (range, 47-78 years), and the mean follow-up was 47 months (range, 24-86 months). Return to swimming was achieved in 31 (97%) shoulders at a mean of 8 months (range, 3-24 months), and complete return was achieved in 18 (56%) shoulders at a mean of 12 months (range, 3-24 months). The return rate was 97% for freestyle, 83% for breaststroke, 74% for backstroke, and 44% for butterfly stroke. Postoperative UCLA and ASES scores were significantly higher in the group with complete return than in the group with incomplete or failed return ( = .001 and .01, respectively). Postoperative forward elevation was significantly better in the complete return group ( = .01).

Conclusion: This study demonstrated that 97% of elderly swimmers who underwent arthroscopic rotator cuff repair could return to swimming. The complete return rate was 56%; however, the group with incomplete or failed return showed poorer active forward elevation. Freestyle had the highest complete return rate, whereas the butterfly stroke had the lowest return rate. It may be important to achieve good active forward elevation postoperatively to return to swimming.
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http://dx.doi.org/10.1177/2325967120922203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301663PMC
June 2020

Valgus stability is enhanced by flexor digitorum superficialis muscle contraction of the index and middle fingers.

J Orthop Surg Res 2020 Mar 30;15(1):121. Epub 2020 Mar 30.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

Background: Flexor digitorum superficialis (FDS) muscle provides dynamic stabilization and medial elbow support for ulnar collateral ligament (UCL). The FDS contraction significantly affects the medial joint distance (MJD) through grip contraction. However, it remains unclear whether FDS activity alone contributes to medial elbow stability, or together with the activation of the flexor digitorum profundus during grip contraction, and which finger's FDS is the main contributor to elbow stability. We investigated the resistive effects of isolated FDS contraction in individual fingers against valgus stress in the elbow joint using stress ultrasonography (US).

Methods: We investigated 17 healthy males (mean age, 27 ± 5 years). Valgus stress US was performed using the Telos device, with the elbow at 30° flexion. MJD was measured for each arm during 3 separate conditions: at rest (unloaded), under valgus load (50 N) (loaded), and under valgus load with FDS contracted in individual fingers (loaded-contracted).

Results: MJD was significantly longer when loaded (5.4 ± 0.4 mm) than unloaded (4.1 ± 0.2 mm, P = 0.007) or loaded-contracted (4.6 ± 0.3 mm, P = 0.003) for each finger. When loaded-contracted, MJD differed statistically between the index and ring fingers (P = 0.03) and between the middle and ring fingers (P = 0.04). However, the difference between the index and middle fingers was not statistically significant (P = 0.08).

Conclusions: Individual FDS contraction, particularly of the index and middle fingers, contributes most to stabilization against valgus stress. Thus, injury care programs should incorporate FDS exercises of these fingers.
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http://dx.doi.org/10.1186/s13018-020-01640-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110663PMC
March 2020

Incidence of Axillary Nerve Injury After Arthroscopic Shoulder Stabilization.

Arthroscopy 2020 06 26;36(6):1555-1564. Epub 2020 Feb 26.

Nagareyama Central Hospital, Nagareyama, Japan.

Purpose: To investigate the incidence of axillary nerve palsy after arthroscopic shoulder stabilization and to measure the distance between the nerve and capsule in shoulders with a capsular lesion.

Methods: This retrospective study included 2,027 shoulders (1,909 patients; 1,433 male and 476 female patients; mean age, 32 years [age range, 13-81 years]) subjected to arthroscopic soft-tissue stabilization for recurrent shoulder instability from 2005 to 2017. The exclusion criteria were bone grafting or transfer and preoperative axillary nerve symptoms. We retrospectively reviewed patient records and investigated the incidence and clinical features of axillary nerve palsy. We measured the closest distance between the axillary nerve and capsule on preoperative magnetic resonance images.

Results: Postoperative axillary nerve palsy occurred in 4 shoulders (0.2% of all arthroscopic stabilizations). Capsular repair was performed in 2 shoulders (1.2% of 160 capsular repairs); humeral avulsion of the glenohumeral ligament (HAGL) repair, 1 shoulder (2% of 47 HAGL repairs); and isolated Bankart repair, 1 shoulder (0.05% of 1,941 Bankart repairs). The closest distance between the nerve and capsule was 3.4 ± 3.2 mm in shoulders with capsular or HAGL lesions and less than 1 mm in the 3 shoulders with palsy. The common symptoms in axillary nerve palsy cases were shoulder discomfort, delayed recovery of range of motion, and deltoid weakness and atrophy. A definitive diagnosis was made with electromyography in all cases. Nerve injury by a suture was confirmed during revision surgery in 3 shoulders subjected to capsular or HAGL repair during the initial operation. The palsy was transient and fully recovered in 1 shoulder with isolated Bankart repair.

Conclusions: The incidence of axillary nerve palsy after arthroscopic soft-tissue shoulder stabilization was low but higher in shoulders subjected to capsular or HAGL repair. We should always consider the possibility of axillary nerve palsy in shoulders that require capsular or HAGL repair.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2020.02.016DOI Listing
June 2020

Osteointegration of a Biocomposite Suture Anchor After Arthroscopic Shoulder Labral Repair.

Arthroscopy 2019 12 14;35(12):3173-3178. Epub 2019 Nov 14.

Matsudo Orthopaedic Hospital, Matsudo, Japan.

Purpose: To evaluate osteoconductivity of a poly-L-lactide co-glycolide (PLG)-calcium sulfate (CS)-β-tricalcium phosphate (β-TCP) biocomposite suture anchor after arthroscopic shoulder labral repair.

Methods: The subjects of this study were patients who participated in a clinical trial for acquisition of marketing approval of a PLG-CS-β-TCP biocomposite anchor in Japan. They underwent arthroscopic labral repair using the anchor, and computed tomographic (CT) images of the glenoid were obtained 2 years after surgery. Osteoconductivity at the anchor sites was evaluated with the CT images using the established ossification quality score. Shoulder function scores including the Rowe score and Japanese Shoulder Society shoulder instability score were also assessed 2 years after surgery.

Results: CT images and functional scores were obtained from 37 patients, comprising 29 men and 8 women with a mean age of 29 years (range, 25-33 years) at surgery. A total of 148 anchors were implanted in the 37 shoulders. Osteoconductivity was seen in 133 of 148 anchor sites (90.0%) 2 years after implantation. No significant differences in osteoconductivity were found by anchor diameter or position. The Rowe score significantly improved from 39.9 points (95% confidence interval [CI], 33.8-45.9 points) preoperatively to 96.6 points (95% CI, 95.1-98.1 points) at 2 years postoperatively (P < .001). The Japanese Shoulder Society shoulder instability score also significantly improved, from 63.1 points (95% CI, 58.4-67.7 points) preoperatively to 96.3 points (95% CI, 94.7-97.8 points) at 2 years postoperatively (P < .001).

Conclusions: Biocomposite suture anchors made of PLG, CS, and β-TCP exhibited some osteoconductivity 2 years after arthroscopic labral repair, as well as good clinical outcomes.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2019.06.023DOI Listing
December 2019

Relationship between postoperative retear and preoperative fatty degeneration in large and massive rotator cuff tears: quantitative analysis using T2 mapping.

J Shoulder Elbow Surg 2019 Aug;28(8):1562-1567

Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.

Background: Fatty degeneration of the rotator cuff muscles is reported to be associated with retear after rotator cuff repair. The purpose of this study was to assess the relationship between retear and preoperative fatty degeneration, as quantified by T2 mapping.

Methods: This prospective cohort study included 83 large and 24 massive rotator cuff tears (average age, 67 years; range, 46-82 years). All patients preoperatively underwent T2 mapping magnetic resonance imaging, and T2 values of the supraspinatus and infraspinatus muscles were quantified. Cuff integrity was evaluated with magnetic resonance imaging 1 year postoperatively. Preoperative T2 values were compared between the retear and intact groups. The preoperative Goutallier stage, Constant score, and the shoulder score of the University of California at Los Angeles were also compared between the 2 groups.

Results: Retear was found in 32 shoulders (30%). Postoperative Constant and University of California at Los Angeles scores were significantly higher in intact shoulders than in retear shoulders (P < .001 for both). Mean preoperative T2 values of supraspinatus and infraspinatus were 77.4 ± 13.2 ms and 73.2 ± 15.3 ms in retear shoulders and 66.5 ± 11.1 ms and 58.6 ± 11.7 ms in intact shoulders, respectively; the differences were significant in both muscles (P < .001). Cutoff values for prediction of retear were 71.8 ms in supraspinatus and 63.1 ms in infraspinatus. There were no significant differences in the preoperative Goutallier stages of supraspinatus and infraspinatus between the 2 groups.

Conclusions: Retear shoulders demonstrated significantly higher preoperative T2 values than intact shoulders. T2 mapping can be a useful tool for predicting postoperative retears.
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http://dx.doi.org/10.1016/j.jse.2019.04.036DOI Listing
August 2019

Prevalence and Site of Rotator Cuff Lesions in Shoulders With Recurrent Anterior Instability in a Young Population.

Orthop J Sports Med 2019 Jun 4;7(6):2325967119849876. Epub 2019 Jun 4.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: Partial articular supraspinatus tendon avulsion (PASTA) lesions are often seen in shoulders of throwing athletes. PASTA lesions in anterior instability are also found in recurrent anterior glenohumeral instability.

Purpose: To investigate the prevalence and location of rotator cuff tears (RCTs), including PASTA lesions, in shoulders with recurrent anterior instability.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 842 shoulders in 801 patients with recurrent anterior instability (647 men, 154 women; mean age, 24 years; age range, 13-40 years) who underwent arthroscopic surgery at the age of 40 years or younger were enrolled. During surgery, the thickness and the sites of RCTs as well as patient factors associated with RCTs were examined.

Results: RCTs were found in 57 shoulders (7%) in 56 patients. There were 4 shoulders with full-thickness RCTs and 54 shoulders with PASTA lesions. All lesions but 1 involved the anterior border of the supraspinatus (SSP). Participation in high-level athletics and older age at injury were associated with RCTs.

Conclusion: The incidence of RCTs was 7% in shoulders with recurrent anterior instability at age 40 years or younger. Most RCTs were PASTA lesions that involved the anterior border of the SSP.
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http://dx.doi.org/10.1177/2325967119849876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552367PMC
June 2019

Preoperative Pain Control in Arthroscopic Rotator Cuff Repair: Does It Matter?

Clin Orthop Surg 2019 Jun 9;11(2):192-199. Epub 2019 May 9.

Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.

Background: The purpose of this study was to clarify the importance of preoperative pain control using corticosteroid injections in patients with persistent rest pain (RP) before arthroscopic rotator cuff repair (ARCR).

Methods: A total of 360 patients (374 shoulders) who underwent primary ARCR and were followed up for at least 2 years were enrolled. After one-to-one propensity score matching, 266 patients (145 men and 128 women, 273 shoulders) were included in the study. Their mean age was 65.2 ± 7.7 years (range, 42 to 88 years) at the time of surgery. The patients were divided into three groups: those who required several intra-articular or subacromial bursa corticosteroid injections preoperatively for refractory RP (group A+), those in whom RP was resolved preoperatively (group A-), and those who had no RP and did not require any injections (group B). The incidence of postoperative RP and preoperative and final follow-up American Shoulder and Elbow Surgeons (ASES) scores were compared among the three groups.

Results: The incidence of postoperative RP was significantly higher in group A+ (35/91 cases, 38.5%) than in group A- (10/91, 11.0%) and group B (7/91, 7.7%, < 0.001 for both). The preoperative ASES score was significantly lower in group A+ (33.2 ± 14.2) than in group A- (53.9 ± 11.9) and group B (62.3 ± 11.2, < 0.001 for both), and it was significantly lower in group A- than in group B ( = 0.000). The final follow-up ASES score was significantly lower in group A+ (92.1 ± 8.4) than in group A- (97.6 ± 5.4) and group B (99.0 ± 2.5, < 0.001 for both). There was no significant difference in the final follow-up ASES score between group A- and group B ( = 0.242).

Conclusions: Patients in whom preoperative RP could be resolved before surgery achieved postoperative outcomes comparable to those in patients who had no RP before surgery, whereas the outcomes in patients with refractory preoperative RP were inferior. The results suggest that preoperative pain control is important in patients undergoing ARCR.
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http://dx.doi.org/10.4055/cios.2019.11.2.192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526121PMC
June 2019

Location and thickness of delaminated rotator cuff tears: cross-sectional analysis with surgery record review.

JSES Open Access 2018 Mar 13;2(1):84-90. Epub 2018 Mar 13.

Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Background: To facilitate better treatment, we analyzed morphologic features of delamination from the viewpoint of the location of delamination and the thickness of each layer.

Materials And Methods: Of 270 shoulders that consecutively underwent arthroscopic rotator cuff repair, 210 were included. During the operation, the surgeon assessed the size of the rotator cuff tear, determined the presence and location of delamination, and compared the thickness between superficial and deep layers if delamination was present. Immediately after the operation, the surgeon wrote down the data in the record form. The authors retrospectively referred to these surgical records to investigate those items.

Results: Delamination was found in 111 of 210 shoulders. The overall preoperative Constant score did not significantly differ between the 2 groups. In terms of the location, 7.2% cases had delamination in the anterior part, 74.8% in the posterior part, and 18.0% in both parts (Fleiss κ = 0.9). The larger the rotator cuff tear, the more frequently the delamination was limited to the posterior part (trend  = .001). As for layer thickness comparison, 40.0% of the shoulders with small tears, 38.8% with medium tears, 66.0% with large tears, and 80.0% with massive tears had a thicker deep layer than superficial layer (Fleiss κ = 0.9). The larger the size of the rotator cuff tear, the more frequently the deep layer was thicker than the superficial layer (trend  = .001).

Conclusions: The larger the rotator cuff tear, the more carefully shoulder surgeons should observe and treat the posterior and deep part of delamination.
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http://dx.doi.org/10.1016/j.jses.2017.11.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334866PMC
March 2018

Three-dimensional measurement of glenoid dimensions and orientations.

J Orthop Sci 2019 Jul 20;24(4):624-630. Epub 2018 Dec 20.

Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.

Background: Asians generally have smaller stature than Europeans and Americans, and currently available implants used in reverse shoulder arthroplasty might not fit smaller bony anatomies. However, few articles have reported glenoid geometry in the Asian population. The purpose of this study was to measure the dimensions and orientations of the glenoid from three-dimensional computed tomography reconstructions of elderly Japanese subjects.

Methods: This study included 100 shoulders (50 males and 50 females with >50 years of age). The mean age was 67 ± 7 years for both sexes, and the mean height was 167 ± 7 cm for males and 154 ± 6 cm for females. Three-dimensional scapular models were created from computed tomographic images, and the glenoid height, glenoid width, glenoid version, glenoid inclination, vault depth, and vault width were measured.

Results: The mean glenoid height and width were 38.6 and 29.4 mm for males and 33.1 and 24.4 mm for females, respectively. Both retroversion and superior inclination were approximately 3° in both sexes. The glenoid vault was deeper in the posterior region with the maximum depth of 26.1 and 23.6 mm in males and females. The vault width was narrower in the anterior region with the anterior width of 2.5 mm at 15 mm medial from the glenoid face in females.

Conclusion: Glenoids of Japanese females are small compared to currently available baseplates for reverse shoulder arthroplasty. These results may be helpful to aid design in smaller baseplates that better fit the anatomic geometry of the Asian glenoid.
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http://dx.doi.org/10.1016/j.jos.2018.11.019DOI Listing
July 2019

Medial elbow anatomy: A paradigm shift for UCL injury prevention and management.

Clin Anat 2019 Apr 9;32(3):379-389. Epub 2019 Jan 9.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

To improve the management outcomes and diagnostic accuracy of the ulnar collateral ligament (UCL) injury, the anatomy of the medial side of the elbow joint is necessary to be understood in terms of the periarticular surroundings rather than the specific ligaments. The aim of this study was to anatomically clarify the medial side of the elbow joint in terms of the tendinous structures and joint capsule. We conducted a descriptive anatomical study of 23 embalmed cadaveric elbows. We macroscopically analyzed the relationship between the flexor pronator muscles (FPMs) and the joint capsule in 10 elbows, histologically analyzed in 6 elbows, and observed the bone morphology through micro computed tomography in 7 elbows. The two tendinous septa (TS) were found: between the pronator teres (PT) and flexor digitorum superficial (FDS) muscles, and between the FDS and flexor carpi ulnaris (FCU) muscles. These two TS are connected to the medial part of the brachialis tendon, deep aponeurosis of the FDS, and FCU to form the tendinous complex, which linked the humeroulnar joint and could not be histologically separated from each other. Moreover, the capsule of the humeroulnar joint under the tendinous complex had attachment on the ST of 7 mm width. The two TS, the brachialis tendon, the deep FDS and FCU aponeuroses, and the joint capsule linked the humeroulnar joint. These anatomical findings could lead to a paradigm shift in the prevention, diagnosis, and treatment of UCL injuries in baseball players. Clin. Anat. 32:379-389, 2019. © 2018 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
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http://dx.doi.org/10.1002/ca.23322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850211PMC
April 2019

Tuberculous Distal Biceps Tendon Rupture: Case Report and Review of the Literature.

Case Rep Orthop 2018 25;2018:6374784. Epub 2018 Oct 25.

Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Tuberculous distal biceps tendon rupture is a rare condition in orthopedics. Musculoskeletal tuberculosis usually presents with bursitis, synovitis, myositis, and osteomyelitis, conditions which demonstrate an excellent response to antituberculosis chemotherapy. Tendon rupture is often associated with delayed diagnosis and treatment. We report a rare manifestation of musculoskeletal tuberculosis in the distal biceps tendon with delayed diagnosis.
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http://dx.doi.org/10.1155/2018/6374784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222221PMC
October 2018

Repair Integrity and Functional Outcomes After Arthroscopic Suture Bridge Subscapularis Tendon Repair.

Arthroscopy 2018 09 2;34(9):2541-2548. Epub 2018 Aug 2.

Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.

Purpose: This retrospective study aimed to report repair integrity and clinical outcomes after arthroscopic suture bridge subscapularis (SSC) tendon repair.

Methods: The subjects included 101 shoulders subjected to arthroscopic suture bridge repair for full-thickness SSC tear with a minimum of a 2-year follow-up. There were 57 men and 44 women with a mean age of 66 years (range, 32-85 years). The mean follow-up was 30 months (range, 24-71 months). Tenotomy or tenodesis was performed for the long head of the biceps in all cases. All patients were assessed for active range of motion; belly-press and bear-hug tests; University of California, Los Angeles score; and American Shoulder and Elbow Surgeons score preoperatively and at the final follow-up. Repair integrity and fatty degeneration of the SSC muscle were evaluated with magnetic resonance imaging at a mean 14 months (range, 12-58 months) after surgery.

Results: Flexion, internal rotation, and both functional scores significantly improved after surgery. Retears were found in 5 shoulders (5%). The shoulders with a retear showed significantly inferior functional scores compared with the intact shoulders. Fatty degeneration was significantly improved in the intact group, whereas there was no significant improvement in the retear group. Both belly-press and bear-hug test scores significantly improved after surgery; however, weakness persisted in shoulders with higher grade preoperative fatty degeneration even after successful repair.

Conclusions: Arthroscopic suture bridge repair for SSC tears yielded good clinical outcomes and a very low retear rate, even for larger tears or shoulders with higher grade fatty degeneration. Fatty degeneration of the SSC muscle improved after successful repair, although internal rotation weakness persisted in shoulders with higher grade preoperative fatty degeneration. Arthroscopic suture bridge repair is a promising procedure for treating SSC tears.

Level Of Evidence: Level IV, case series study.
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http://dx.doi.org/10.1016/j.arthro.2018.03.045DOI Listing
September 2018

Scaption kinematics of reverse shoulder arthroplasty do not change after the sixth postoperative month.

Clin Biomech (Bristol, Avon) 2018 10 5;58:1-6. Epub 2018 Jul 5.

Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A, P.O. Box 116250, Gainesville, FL 32611-6250, USA.

Background: Changes over time in shoulder kinematics and function after reverse shoulder arthroplasty have not been reported. The purpose of this study was to compare shoulder kinematics and function at 6 months and 1 year after reverse shoulder arthroplasty.

Methods: Twenty patients with a mean age of 74 years (range, 63-91 years) were enrolled in this study. Fluoroscopic images during scapular plane elevation were recorded at the mean of 6 months (range, 5-8 months) and 14 months (range, 11-21 months). CT-derived glenosphere models and computer-aided design humeral implant models were matched with the silhouette of the implants in the fluoroscopic images using model-image registration techniques. Glenosphere and humeral implant kinematics during scaption were compared between the two time points. Patients were also clinically examined with active range of motion and Constant score, and postoperative improvement in shoulder function were assessed.

Results: Active flexion and Constant score improved after surgery (p < 0.001 for both), but there was no significant improvement after six months. There was no significant improvement in active external rotation at either postoperative exam. There were no significant differences in glenosphere or humeral kinematics between six months and one year.

Interpretation: There was no significant additional improvement in either shoulder kinematics during scapular plane elevation or function between the sixth and twelfth postoperative months. We can assess kinematics at six months after reverse shoulder arthroplasty to determine how the shoulder will move. Clinically, treatment in the first six postoperative months should be emphasized to achieve better surgical outcomes.
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http://dx.doi.org/10.1016/j.clinbiomech.2018.07.005DOI Listing
October 2018

Degradation of Cylindrical Poly-Lactic Co-Glycolide/Beta-Tricalcium Phosphate Biocomposite Anchors After Arthroscopic Bankart Repair: A Prospective Study.

Orthopedics 2018 May 2;41(3):e348-e353. Epub 2018 Mar 2.

The purpose of this study was to examine widening and ossification of anchor holes after arthroscopic Bankart repair with the use of cylindrical biocomposite anchors made of 70% poly-L-lactide-co-glycolide acid (PLGA) and 30% beta-tricalcium phosphate (ß-TCP). Twenty-two patients were enrolled in a clinical trial to acquire marketing approval of a PLGA/ß-TCP biocomposite suture anchor in Japan and underwent arthroscopic Bankart repairs with the anchors. Eleven of 22 patients had computed tomography scans after 2-year follow-up. Three surgeons independently evaluated width and ossification of anchor holes in 4 grades using computed tomography scans. When the evaluations disagreed, the final grade was determined based on the 3 surgeons' consensus. Seven men and 4 women were evaluated at a mean of 30 months (range, 28-32 months) after surgery, and a total of 47 anchors were implanted. Anchor holes were narrowed in 39 (83%) of 47 anchor sites and were almost or completely filled in (type 3 or 4) in 21 (45%) of 47 anchor sites. Ossification was seen in 46 (98%) of 47 anchor sites and was nearly complete or complete (type 3 or 4) in 16 (34%) of 47 anchor sites. There were no significant differences in both anchor hole width and ossification score on comparison of the anteroinferior (4- to 6-o'clock positions in the right shoulder) with other anchor sites. Cylindrical biocomposite anchors made of 70% PLGA/30% ß-TCP showed a low incidence of anchor hole widening and excellent ossification regardless of anchor site. [Orthopedics. 2018; 41(3):e348-e353.].
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http://dx.doi.org/10.3928/01477447-20180226-08DOI Listing
May 2018

Arthroscopic Fragment Resection for Capitellar Osteochondritis Dissecans in Adolescent Athletes: 5- to 12-Year Follow-up.

Orthop J Sports Med 2017 Dec 15;5(12):2325967117744537. Epub 2017 Dec 15.

Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan.

Background: Capitellar osteochondritis dissecans (OCD) in skeletally immature athletes has often been seen in baseball players and gymnasts. The choice of surgical procedure for unstable lesions in skeletally immature athletes remains controversial.

Purpose: To investigate functional outcomes and radiographic changes in the midterm to long-term postoperative period after arthroscopic (AS) resection for small to large capitellar OCD lesions in skeletally immature athletes.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 38 elbows in 38 patients (33 boys, 5 girls; mean age, 14 years [range, 13-15 years]) with skeletally immature elbows underwent AS resection for capitellar OCD. Patients were observed for at least 5 years (mean, 8 years [range, 5-12 years]). Elbows with a lesion width that did not exceed one-half of the radial head diameter were assigned to group 1 (n = 17 elbows), and larger lesions were assigned to group 2 (n = 21 elbows). Functional scores, patient satisfaction, range of motion (ROM), and osteoarthritis (OA) grades were evaluated between the groups.

Results: All patients returned to sports activity. Functional scores at the final follow-up were not significantly different between the groups. Patient satisfaction scores were significantly higher in group 1 than in group 2. There was significant improvement in flexion ROM at the final follow-up compared with preoperative values in group 1 ( = .017), and there was a significant between-group difference (group 1: 141°; group 2: 133°; = .002). Extension ROM showed significant improvement in both groups (group 1: from -8° to 3°; group 2: from -17° to -1°; < .001 for both). Group 1 tended to have better extension than group 2, but the difference was not significant. There were no elbows with severe OA in either group, but the OA grade progressed in 5 elbows (29%) in group 1 and 9 elbows (43%) in group 2, and this rate of OA progression was statistically significant between groups ( = .005).

Conclusion: Both functional outcomes and radiological findings after AS fragment resection were excellent in elbows with small lesions. Although overall outcomes were acceptable in elbows with larger lesions, flexion ROM and patient satisfaction scores were significantly inferior to those in elbows with smaller lesions.
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http://dx.doi.org/10.1177/2325967117744537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734470PMC
December 2017

Target range of motion at 3 months after arthroscopic rotator cuff repair and its effect on the final outcome.

J Orthop Surg (Hong Kong) 2017 Sep-Dec;25(3):2309499017730423

3 Department of Orthopaedic Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.

Purpose: The postoperative protocol after arthroscopic rotator cuff repair (ARCR) is still controversial. Some surgeons recommend slower rehabilitation in order to improve the integrity of the repair, while others prefer early range-of-motion (ROM) exercise to avoid postoperative stiffness. The purpose of this study was to determine target ROM (T-ROM) measurements at 3 months after ARCR that are predictive of eventual full recovery without structural failure.

Methods: The cases consisted of 374 shoulders in 360 patients who underwent primary ARCR and were followed up for at least 2 years. Forward flexion (FF) and side-lying external rotation (ER) were measured preoperatively at 3, 6, 9, 12, and 24 months after surgery, and the patients were divided into six subgroups according to the values for each type of ROM at 3 months (ROM-3M). In each subgroup, the final ROM at 24 months after surgery was compared to determine the T-ROM. The average ROMs with time and re-tear rate were then compared between the under-T-ROM and over-T-ROM groups.

Results: The only significant difference in FF was between the 120-129° and 110-119° ROM-3M groups. Therefore, the T-ROM for FF was determined to be 120°. Similarly, the T-ROM for ER was determined to be 20°. Each ROM in the over-T-ROM group was significantly better than that in the under-T-ROM group at all assessments. There was no significant difference in the re-tear rate between the groups.

Conclusion: To acquire sufficient ROM in 2 years without high re-tear rate, a target FF of 120° and ER of 20° should be achieved within 3 months after surgery.
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http://dx.doi.org/10.1177/2309499017730423DOI Listing
April 2018

Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts.

Orthop J Sports Med 2017 Mar 1;5(3):2325967117692513. Epub 2017 Mar 1.

Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.

Background: Osteochondritis dissecans (OCD) lesions are often observed in the humeral capitellum both in young baseball players and gymnasts. It is generally believed that capitellar OCD in baseball players can be seen on an anteroposterior (AP) radiograph with the elbow in 45° of flexion. However, the mechanism of injury seems to be different in baseball players and gymnasts. Repetitive valgus overload with the elbow in flexion is believed to be the cause of capitellar OCD lesions in baseball players, whereas weightbearing with the elbow in extension may be the cause of OCD in gymnasts.

Purpose: To determine the difference in capitellar OCD location between baseball players and gymnasts and to propose the optimal AP radiographic angle of the elbow for visualization of early-stage OCD lesions in adolescent gymnasts.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Subjects consisted of 95 baseball players (95 elbows) and 21 gymnasts (24 elbows) with a mean age of 13.7 years (range, 11-18 years). To localize the lesion, inclination of the affected area in the humeral capitellum against the humeral axis was investigated using sagittal computed tomography images of the elbow. The inclination angle was defined as the angle between the long axis of the humerus and the line perpendicular to a line that connected the anterior and posterior margin of the lesion. The inclination angle in each group was compared and statistically analyzed.

Results: The mean inclination angle was 57.6° ± 10.7° in baseball players and 28.0° ± 10.7° in gymnasts. Capitellar OCD lesions were located more anterior in baseball players when compared with gymnasts ( < .01).

Conclusion: Due to differences in applied stress, capitellar OCD lesions in baseball players were located more anteriorly compared with those seen in gymnasts. Therefore, although AP radiographs with the elbow in 45° of flexion are optimal for detecting OCD lesions in baseball players, radiographs with less elbow flexion or full extension are more useful in gymnasts, especially in early-stage OCD.
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http://dx.doi.org/10.1177/2325967117692513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347432PMC
March 2017