Publications by authors named "Paolo Paladini"

61 Publications

Locked anterior glenohumeral dislocation: is it always recommendable a conservative treatment?

Musculoskelet Surg 2021 Mar 8. Epub 2021 Mar 8.

Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia Policlinico Di ModenaVia del Pozzo 71, 41124, Modena, Italy.

Purpose: Chronic anterior shoulder dislocation represents a rare condition, and there is still lack of consensus in its treatment. Purpose of this study is to evaluate the clinical and radiological outcome of painful locked dislocation underwent shoulder replacement, with a minimum follow-up of two years. Second endpoint is to assess the glenoid bone graft, harvested from the humeral head.

Methods: Eight patients underwent shoulder replacement for locked anterior shoulder dislocation. Four patients with a mean age of 23 y.o. were treated with Pyrocarbon-hemiarthroplasty and four patients with a mean age of 76 y.o. were treated with reverse shoulder arthroplasty. Glenoid single stage reconstruction was performed with a bone autograft harvested from the resected humeral head. Patients were observed for a clinical and radiological follow-up for a minimum period of 2 years; ASES and Constant score were assessed.

Results: Pain and ROM improvement was reported in all the patients. In one case, postoperative recurrent RSA instability was found. Glenoid reconstruction was performed in seven cases, showing a good integration and no reabsorption issues in all but one cases. ASES and Constant-Murley functional outcomes were rated as excellent by 1 patient with pyrocarbon HA and 1 patient with RSA, good by 3 patients with RSA and 2 patients with HA, fair by 1 patient with HA and poor by one patient with RSA.

Conclusion: The treatment of locked anterior glenohumeral dislocation still represents a challenge in symptomatic patients. Shoulder replacement showed good results in young and older patients, with HA and RSA, respectively. Autograft from the humeral head is reliable for glenoid defect, even in ream and run procedure. Locked dislocation lasting more than one year, surgery is debatable for higher risk of a poor outcome and recurrent instability.
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http://dx.doi.org/10.1007/s12306-021-00702-1DOI Listing
March 2021

Shoulder arthroplasty to address the sequelae of anterior instability arthropathy and stabilization procedures: systematic review and meta-analysis.

Arch Orthop Trauma Surg 2020 Dec 5;140(12):1891-1900. Epub 2020 Mar 5.

Centro di chirurgia della spalla e del gomito, Ospedale Civile Cervesi, Cattolica, Italy.

Purpose: Chronic anterior glenohumeral joint instability is a common situation and can lead to progressive cartilage deterioration and ultimately instability arthopathy. Progressive cartilage deterioration can occur despite conservative or surgical treatment and the sequelae of these conditions are often addressed with total shoulder arthroplasty. Aims of the present study were to analyze the available literature to describe the technical aspects of this particular operation and to report outcomes and complication rates. The hypothesis was that shoulder arthropalsty in the sequelae of instability had lower outcomes and higher complication rates than arthroplasties for primary arthritis.

Methods: A systematic review of the literature was performed, in accordance with the PRISMA guidelines. PubMed, Ovid, Cochrane Reviews, and Google Scholar were comprehensively searched using a combination of the following keywords: shoulder arthroplasty, reverse shoulder arthroplasty, dislocation arthropathy, capsulorrhaphy arthropathy and stabilization procedures.

Results: Thirteen studies with 365 patients met inclusion criteria. Since 13 patients were lost to follow-up, 352 were reviewed at an average follow-up of 53.4 months. The average Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scores improved from 35.6 and 35.7 to 72.7 and 77, respectively. The overall complication rate was 25.7% and the reoperation rate was 18.5%. Radiographs at follow-up revealed radiolucent lines on the humerus in 12.4% of cases and radiolucent lines or notching on the glenoid side in 22.7% of cases. The average Methodological Index for Non-randomized Studies Score (MINORS) was 12.9 for non-comparative studies and 21.3 for comparative studies.

Conclusion: Shoulder arthroplasty to address the sequelae of instability arthropathy and stabilization procedures can be a challenging procedure as a consequence of the distorted anatomy and severe glenohumeral joint pathology. Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis; however, the difference is not statistically significant. When reverse shoulder arthroplasties (RSA) were considered as a subgroup and compared to anatomic shoulder replacements (total shoulders and hemiarthroplasties), they showed a lower revision rate.
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http://dx.doi.org/10.1007/s00402-020-03400-yDOI Listing
December 2020

Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older.

Int Orthop 2020 06 4;44(6):1131-1141. Epub 2020 Mar 4.

Orthopaedic and Trauma Unit, University of Modena and Reggio Emilia, Modena, Italy.

Background: We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older.

Methods: Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant-Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded.

Results: RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001).

Conclusion: RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.
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http://dx.doi.org/10.1007/s00264-020-04501-4DOI Listing
June 2020

A new plate design to treat displaced 3-4 parts proximal humeral fractures in comparison to the most tested and used plate: clinical and radiographic study.

Med Glas (Zenica) 2019 Aug 1;16(2). Epub 2019 Aug 1.

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.

Aim Proximal humeral fractures are common and most complex patterns currently represent a challenge for surgeons. Difficulties in obtaining good anatomical reduction (particularly of great tuberosity) often lead to unsatisfactory results; choices often fall onto prosthesis implantation against fixation options. The aim of this study was to compare a new design of proximal humeral plate with the most used plates in the treatment of these injures by analysing outcomes and complications. Methods Two hundred patients with proximal 3 or 4 parts humeral fracture were enrolled (Neer 3-4). First group treated with PGR Plate composed of 98 patients. Second group treated with Philos Plate composed of 102 patients. Evaluation criteria were Non-Union Scoring System, duration of surgery, complications, objective quality of life and elbow function (Constant Shoulder Score), subjective quality of life and elbow function (Oxford Shoulder Score), post-op radiographs, centrum collum diaphyseal angle. Evaluation endpoint was 12 months. Results There was no statistically significant difference between the groups with regard to the selected evaluation parameters. Achievement of good shoulder range of motion and ability to perform normal daily living activities was obtained in both groups. The PGR had a positive impact on treatment results of varuspattern of proximal humeral fractures. Conclusions The PGR allowed good clinical and radiographic results in the treatment of proximal humeral fractures, comparable to those obtained with Philos. Also, PGR had the advantage to aid and keep the anatomical reduction of patterns of fracture involving the greater tuberosity.
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http://dx.doi.org/10.17392/1033-19DOI Listing
August 2019

Irreparable rotator cuff tears: challenges and solutions.

Orthop Res Rev 2018 5;10:93-103. Epub 2018 Dec 5.

Shoulder and Elbow Unit, "D. Cervesi" Hospital, AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy,

Irreparable rotator cuff tears are common conditions seen by shoulder surgeons, characterized by a torn and retracted tendon associated with muscle atrophy and impaired mobility. Direct fixation of the torn tendon is not possible due to the retracted tendon and lack of healing potential which result in poor outcome. Several treatment options are viable but correct indication is mandatory for a good result, pain improvement, and restoration of shoulder function. Patient can be treated either with a conservative program or surgically when necessary, by different available modalities like arthroscopic debridement, partial reconstruction, subacromial spacer, tendon transfer, and shoulder replacement with reverse prosthesis. The aim of this study was to review literature to give an overview of the available possible solutions, with indications and expected outcomes.
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http://dx.doi.org/10.2147/ORR.S151259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376460PMC
December 2018

Assessment of anatomical and reverse total shoulder arthroplasty with the scapula-weighted Constant-Murley score.

Int Orthop 2019 03 10;43(3):659-667. Epub 2018 Aug 10.

Orthopaedic and Trauma Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Aim Of The Study: To evaluate total (TSA) and reverse total shoulder arthroplasty (RTSA) using the Constant-Murley score (CMS) and the scapula-weighted (SW) CMS, an integrated outcome measure that takes into account the compensatory movements of the scapula.

Methods: Twenty-five consecutive patients, 12 with TSA and 13 with RTSA, underwent kinematic analysis before and after shoulder replacement. Measurements included flexion (FLEX) and abduction (ABD) for the humerus and Protraction-Retraction (PR-RE), Medio-Lateral rotation (ME-LA), and Posterior-Anterior tilting (P-A) for the scapula. They were recorded at baseline (T0) and at six (T1) and 12 months (T2). Reference data were obtained from 31 control shoulders.

Results: At T1, differences in CMS and SW-CMS were not significant in either group, whereas values at T2 were significantly lower in RTSA patients (p = 0.310 and p = 0.327, respectively). In TSA shoulders, the compensatory scapular movements in FLEX were all reduced from T0 to T2, whereas P-A was increased in ABD. In RTSA patients, the compensatory scapular movements in FLEX showed a general reduction at T1, with an increase in P-A at T2, whereas in ABD, all increased at T1 and decreased at T2 except for P-A, which did not decrease.

Discussion: The SW-CMS showed that the physiological scapulothoracic motion was not restored in TSA and RTSA patients; it may be used as a reference for the gradual progression of deltoid and scapular muscle rehabilitation.

Conclusions: The worse CMS and SW-CMS scores found in RTSA patients at six months may be due to the biomechanics of the reverse prosthesis and to the weakness of deltoid and periscapular muscles.
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http://dx.doi.org/10.1007/s00264-018-4088-3DOI Listing
March 2019

Comparison of shoulder replacement to treat osteoarthritis secondary to instability surgery and primary osteoarthritis: a retrospective controlled study of patient outcomes.

Int Orthop 2018 09 12;42(9):2147-2157. Epub 2018 May 12.

Orthopaedic and Trauma Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Purpose: We hypothesized that osteoarthritis developing after instability surgery is radiographically similar to primary arthritis and that arthroplasty provides comparable outcomes in patients with these two types of osteoarthritis.

Methods: Patients with osteoarthritis due to instability surgery (group I) and with primary osteoarthritis (group II) were included. Mean follow-up was 52.6 and 41.6 months, respectively. Hemiarthroplasties (HA) were 32% in group I and 27% in group II; total shoulder arthroplasties (TSA) were 68 and 73% respectively. Outcome measures included active shoulder mobility (anterior elevation [AAE], lateral elevation [ALE], external rotation [ER], and internal rotation [IR]), pain, Constant-Murley score, and Simple Shoulder Test. Pre-operative and post-operative radiographs were taken. Glenoid arthritis was assessed by computed tomography.

Results: Participants were 19 in the group I (mean age 44.5 years, 12 males, 7 females) and 30 in the group II (mean age 48.2 years, 28 males, 12 females). Both patient groups had pre-operative concentric arthritis. Group II had higher rates of A2 and B1 glenoids (p = 0.003). A longer interval from stabilization to replacement was associated with lower post-operative IR (p = 0.017) and ALE (p = 0.035). Post-operative ER and IR were higher in group I (p < 0.001 and p = 0.001, respectively). In group I, AFE and ALE were higher in HA than TSA patients (both p = 0.009). The CS and SST score increased significantly in both groups (both p < 0.001). Group II showed significantly greater humeral radiolucency (p = 0.025) and a higher rate of TSA revision to reverse prostheses compared with group I.

Conclusions: Shoulder replacement provides similar clinical and radiographic outcomes in arthritis secondary to instability surgery and in primary osteoarthritis. Posterior glenoid wear is more common in primary osteoarthritis.
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http://dx.doi.org/10.1007/s00264-018-3969-9DOI Listing
September 2018

Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up.

J Shoulder Elbow Surg 2018 Apr 28;27(4):701-710. Epub 2017 Dec 28.

Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Rimini, Italy.

Background: There are few investigations comparing lateralized and medialized reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy. This study assessed the outcomes of 2 RTSA designs.

Methods: Sixty-eight consecutive cuff tear arthropathy patients (74 shoulders) with a follow-up of at least 24 months received a Grammont or an onlay curved short-stem humeral component, with or without glenoid lateralization; a cementless humeral stem was implanted in >90%. Clinical outcome measures included active range of motion (anterior and lateral elevation, external and internal rotation), pain, and the Constant-Murley score. Radiologic outcomes included radiolucency, condensation lines, cortical thinning, spot weld, loosening and subsidence, and tuberosity resorption for the humeral component and radiolucency, scapular notching, formation of scapular bone spurs, ossifications, and loosening for the glenoid component.

Results: Both prostheses provided significant differences between preoperative and postoperative scores and showed a similar complication rate. Scapular fractures were found only in the patients who received the curved short-stem implant. Glenoid bone grafting did not significantly affect clinical scores. Both implants provided similar postoperative shoulder mobility, even though the lateralized curved stem was associated with higher delta scores for external rotation (P = .002) and lower rates of scapular notching (P = .0003), glenoid radiolucency (P = .016), and humeral bone remodeling (P = .004 and P = .030 for cortical thinning and spot weld, respectively).

Conclusions: Medialized and short-stem lateralized RTSA implants provided similar midterm clinical outcomes and range of motion. The curved short stem was associated with higher delta scores for external rotation and a lower rate of radiographic risk factors.
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http://dx.doi.org/10.1016/j.jse.2017.10.016DOI Listing
April 2018

Revision of failed shoulder hemiarthroplasty to reverse total arthroplasty: analysis of 157 revision implants.

J Shoulder Elbow Surg 2018 Jan 24;27(1):75-81. Epub 2017 Jul 24.

Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy.

Background: There remains a paucity of studies examining the conversion of failed hemiarthroplasty (HA) to reverse total shoulder arthroplasty (RTSA). Therefore, the purpose of this study was to examine a large series of revision HA to RTSA.

Methods: A population of 157 patients who underwent conversion of a failed HA to a revision RTSA from 2006 through 2014 were included. The mean follow-up was 49 months (range, 24-121 months). The indications for revision surgery included instability with rotator cuff insufficiency (n = 127) and glenoid wear (n = 30); instability and glenoid wear were associated in 38 cases. Eight patients with infection underwent 2-stage reimplantation.

Results: Patients experienced significant improvements in their preoperative to postoperative pain and shoulder range of motion (P < .0001), with median American Shoulder and Elbow Surgeons and Simple Shoulder Test scores of 60 and 6 points, respectively. There were 11 (7%) repeated revision surgeries, secondary to glenoid component loosening (n = 3), instability (n = 3), humeral component disassembly (n = 2), humeral stem loosening (n = 1), and infection (n = 2). Implant survivorship was 95.5% at 2 years and 93.3% at 5 years. There were 4 reoperations including axillary nerve neurolysis (n = 2), heterotopic ossification removal (n = 1), and hardware removal for rupture of the metal cerclage for an acromial fracture (n = 1). At final follow-up, there were 5 "at-risk" glenoid components.

Conclusion: Patients experience satisfactory pain relief and recovery of reasonable shoulder function after revision RTSA from a failed HA. There was a relatively low revision rate, with glenoid loosening and instability being the most common causes.
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http://dx.doi.org/10.1016/j.jse.2017.06.038DOI Listing
January 2018

Arthroscopic Debridement Versus Platelet-Rich Plasma Injection: A Prospective, Randomized, Comparative Study of Chronic Lateral Epicondylitis With a Nearly 2-Year Follow-Up.

Arthroscopy 2017 Jul 19;33(7):1320-1329. Epub 2017 Apr 19.

Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy.

Purpose: The purpose of this prospective, randomized study was to compare the efficacy of autologous platelet-rich plasma (PRP) injections and arthroscopic lateral release in treating chronic lateral epicondylitis (LE).

Methods: Patients who had a clinical diagnosis of LE confirmed by ultrasound (US) were included in this study. A total of 101 patients received arthroscopic release (n = 50) or US-guided PRP injections (n = 51). Outcomes were assessed using a visual analog scale for pain, the Patient-Rated Tennis Elbow Evaluation (PRTEE), and a calibrated hand dynamometer for grip strength.

Results: Both patient groups experienced significant improvement in all measures. Between-group comparisons showed a significantly higher value in the PRP group only for grip strength at week 8 (P = .0073); all other significant differences were in favor of arthroscopy: overall pain (P = .0021), night pain (P = .0013), and PRTEE score (P = .0013) at week 104 and grip strength at weeks 24, 52, and 104 (all P < .0001). Consumption of rescue pain medication was not significantly different between the groups.

Conclusions: The present findings suggest that (1) PRP injections and arthroscopic extensor carpi radialis brevis release are both effective in the short and medium term; (2) PRP patients experienced a significant worsening of pain at 2 years; (3) arthroscopic release ensured better long-term outcomes in terms of pain relief and grip strength recovery; and (4) both procedures were safe and well accepted by patients. LEVEL OF EVIDENCE: Level II, prospective comparative study.
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http://dx.doi.org/10.1016/j.arthro.2017.02.009DOI Listing
July 2017

Metallosis in shoulder arthroplasty: an integrative review of literature.

Musculoskelet Surg 2016 Dec 30;100(Suppl 1):3-11. Epub 2016 Nov 30.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Via L.V. Beethoven 46, 47841, Cattolica, RN, Italy.

Shoulder arthroplasty has gained popularity as an efficient means of achieving pain relief and improved function in a variety of complex shoulder disorders. Despite promising reports, given the increasing number of shoulder arthroplasty procedures, various causes that may contribute to failure of a well-functioning arthroplasty are being increasingly recognized. One such disastrous condition is metallosis, a subject which has not been much talked off with reference to shoulder arthroplasty. This article besides reviewing the existing literature intends to discuss the possible causes that contribute to metallosis and devise a protocol for its timely diagnosis and management.
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http://dx.doi.org/10.1007/s12306-016-0408-1DOI Listing
December 2016

Total shoulder replacement using a bone ingrowth central peg polyethylene glenoid component: a prospective clinical and computed tomography study with short- to mid-term follow-up.

Int Orthop 2016 Nov 10;40(11):2355-2363. Epub 2016 Aug 10.

Shoulder and Elbow Unit, D. Cervesi Hospital, Via L.V. Beethoven 5, Cattolica (RN), 47841, Italy.

Aim Of The Study: To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene glenoid component (APGC).

Methods: Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3 years (range, 45-75), were implanted with the novel component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at two months and at a mean follow-up of 31 months (range, 24-39). Early and late follow-up CT scans were available for 21/30 shoulders.

Results: Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p < 0.001). CMS rose from 30 to 80.5 points and SST from 2.5 to 11 (both p < 0.0001). None of the glenoid components migrated. Progressive radiolucency was seen in 28/30 shoulders. There was a strong correlation between greater bone ingrowth (median Arnold score: 7) and lower radiolucency score (median Yian score: 2) at the last follow-up (p < 0.001). Osteolysis around the central peg was seen in two shoulders. There was no correlation between clinical scores and CT findings (p >0.05).

Discussion: The partially cemented glenoid component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth.

Conclusions: The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene glenoids.
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http://dx.doi.org/10.1007/s00264-016-3255-7DOI Listing
November 2016

Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures.

Int Orthop 2017 Jan 25;41(1):141-148. Epub 2016 Apr 25.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Via L.V Beethoven 5, 47841, Cattolica, Rimini, Italy.

Purpose: The aim of this study was to assess the effectiveness of reverse total shoulder arthroplasty (RTSA) with an all-polyethylene glenosphere in patients with failed hemiarthroplasty (HH) or the sequelae of proximal humeral fractures.

Methods: Thirty-six patients were assessed at a mean follow-up of 36 months using clinical scores and recording shoulder range of movement (ROM).

Results: Active anterior elevation (p < 0.001), lateral elevation (p < 0.001) and internal rotation (p < 0.0001) improved significantly, whereas improvement in external rotation was not significant. The mean Constant score rose significantly from 8.5 ± 7.6 to 40.7 ± 15.7 (p < 0.001) and the Simple Shoulder Test score from 0.42 ± 0.85 to 5.5 ± 2.6 (p < 0.001). Pain improved significantly from 8.7 ± 0.9 to 2.3 ± 1.2 (p < 0.001). Implant radiographic survivorship was 84.6 %. Scapular notching was detected in 7/36 patients (17.5 %). There were five complications: one (stiffness) among patients with fracture sequelae and four among those with failed HH (instability, n = 2; humeral component disassembly, n = 1; pain, n = 1). The two groups did not exhibit significant differences in pain, clinical scores or ROM.

Discussion: RTSA with an all-polyethylene glenosphere may have the potential to reduce the risk of biological notching due to polyethylene osteolysis. Further long-term studies are required to assess its efficacy.

Conclusions: The good clinical performance and reasonable rate of notching of the polyethylene glenosphere support its use in primary and revision shoulder arthroplasty.

Level Of Evidence: Level 4, retrospective therapeutic case series.
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http://dx.doi.org/10.1007/s00264-016-3188-1DOI Listing
January 2017

Intra-articular glenohumeral injections of HYADD®4-G for the treatment of painful shoulder osteoarthritis: a prospective multicenter, open-label trial.

Joints 2015 Jul-Sep;3(3):116-21. Epub 2016 Jan 28.

Unit of Orthopaedics, Istituto Clinico Humanitas, Rozzano (MI), Italy.

Purpose: numerous experimental and clinical studies in osteoarthritis (OA) have demonstrated that intra-articular (IA) administration of hyaluronic acid can improve the altered rheological properties of the synovial fluid and exert protective and reparative effects on the joint structure. The objective of this study was to evaluate the safety and performance of HYADD®4-G (Hymovis®) in patients with glenohumeral joint OA.

Methods: forty-one patients with shoulder pain and limited shoulder function resulting from concentric glenohumeral joint OA were enrolled in a multicenter clinical trial. Patients received two HYADD®4-G injections administered one week apart. The main outcome measure was improvement in shoulder pain on movement at six months as assessed through a 100-mm visual analog scale (VAS), range of motion (ROM) values, and Constant-Murley Shoulder Outcome Score (CS).

Results: two IA injections of HYADD®4-G (Hymovis®) significantly decreased pain and improved shoulder function for up to six months from the first injection. The VAS score decreased (from 66.1 mm to 37.7 mm at six months) and improvements were recorded in the total CS and in the ROM values ( rotation decreased from a mean value of 54.2° at baseline to 63.2° at six months and internal rotation from a mean value of 44.0° at baseline to 45.7° at 26 weeks). No serious adverse events occurred.

Conclusions: the study results demonstrated that two IA injections of HYADD®4-G (Hymovis®) may be a safe and effective treatment option for shoulder pain associated with glenohumeral OA and that the effects of the injections are still present for up to six months after the treatment.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.11138/jts/2015.3.3.116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732777PMC
February 2016

Latarjet procedure: is the coracoid enough to restore the glenoid surface?

Int Orthop 2016 Aug 5;40(8):1675-1681. Epub 2016 Jan 5.

Unit of Shoulder and Elbow Surgery-D. Cervesi Hospital, Via L.V. Beethoven 46, Cattolica, RN, Italy.

Purpose: The aim of this study was to establish whether anterior glenoid bone loss in patients with large glenoid rim defects can be restored with a coracoid graft (Latarjet procedure).

Methods: A total of 143 consecutive patients with chronic anterior shoulder instability and glenoid bone deficiency were treated in 2013. A pre-operative computed tomography (CT) scan using the PICO method was obtained to estimate anterior glenoid rim erosion. The 23 patients with anterior glenoid deficiency exceeding 20 % were included in the study. A post-operative CT scan was obtained to establish whether coracoid transfer had fully restored the glenoid surface.

Results: Mean bone loss was 26 ± 3.9 % of the glenoid surface (range 20-34 %) compared with the contralateral glenoid. Mean coracoid dimensions were 26.3 ± 2.9 mm × 7.6 ± 0.65 mm. The graft successfully restored the glenoid surface in all patients (mean filling, 102.4 ± 0.8 %).

Discussion: The Latarjet procedure is a valuable approach to treat patients with chronic shoulder instability and glenoid deficiency.

Conclusion: Coracoid transfer restored the glenoid surface even in patients with large defects. The Eden-Hybinette technique seems to be more appropriate for revision surgery and for patients with a failed Latarjet procedure.
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http://dx.doi.org/10.1007/s00264-015-3093-zDOI Listing
August 2016

Anterior Glenoid Rim Fracture Following Use of Resorbable Devices for Glenohumeral Stabilization.

Orthop J Sports Med 2015 Jun 8;3(6):2325967115586559. Epub 2015 Jun 8.

UO Chirurgia della Spalla e Gomito, Ospedale Cervesi Di Cattolica, Cattolica, Italy.

Background: Resorbable anchors are widely used in arthroscopic stabilization of the shoulder as a means of soft tissue fixation to bone. Their function is to ensure repair stability until they are replaced by host tissue. Complications include inflammatory soft tissue reactions, cyst formation, screw fragmentation in the joint, osteolytic reactions, and enhanced glenoid rim susceptibility to fracture.

Purpose: To evaluate resorption of biodegradable screws and determine whether they induce formation of areas with poor bone strength that may lead to glenoid rim fracture even with minor trauma.

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

Methods: This study evaluated 12 patients with anterior shoulder instability who had undergone arthroscopic stabilization with the Bankart technique and various resorbable anchors and subsequently experienced redislocation. The maximum interval between arthroscopic stabilization and the new dislocation was 52 months (mean, 22.16 months; range, 12-52 months). The mean patient age was 31.6 years (range, 17-61 years). The persistence or resorption of anchor holes; the number, area, and volume of osteolytic lesions; and glenoid erosion/fracture were assessed using computed tomography scans taken after redislocation occurred.

Results: Complete screw resorption was never documented. Osteolytic lesions were found at all sites (mean diameter, 5.64 mm; mean depth, 8.09 mm; mean area, 0.342 cm(2); mean volume, 0.345 cm(3)), and all exceeded anchor size. Anterior glenoid rim fracture was seen in 9 patients, even without high-energy traumas (75% of all recurrences).

Conclusion: Arthroscopic stabilization with resorbable devices is a highly reliable procedure that is, however, not devoid of complications. In all 12 patients, none of the different implanted anchors had degraded completely, even in patients with longer follow-up, and all induced formation of osteolytic areas. Such reaction may lead to anterior glenoid rim fracture according to the literature and as found in 75% of the study patients with local osteolysis (9/12). Reducing anchor number and/or size may reduce the risk of osteolytic areas and anterior glenoid rim fracture.
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http://dx.doi.org/10.1177/2325967115586559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622364PMC
June 2015

The Constant score and the assessment of scapula dyskinesis: Proposal and assessment of an integrated outcome measure.

J Electromyogr Kinesiol 2016 Aug 6;29:81-9. Epub 2015 Jul 6.

Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, Italy.

The Constant-Murley score (CMS) is a popular measure of shoulder function. However, its ability to monitor the evolution of patients during rehabilitation after rotator-cuff repair is controversial. Moreover, CMS does not account for possible alterations in the scapulo-humeral coordination (SHC, scapula dyskinesis), which are apparent in variety of shoulder pathologies. To address these issues, a new formulation of CMS was firstly proposed, which rates the "affected-to-controlateral side difference in SHC" of a patient with respect to reference values of asymptomatic controls (Scapula-Weighted CMS). Then, 32 patients (53±9year-old) were evaluated with CMS and SW-CMS at 45, 70, 90-day and >6-month after rotator-cuff repair, to test three hypotheses: (1) CMS and SW-CMS are largely responsive to change; (2) accounting (SW-CMS) or not (CMS) for scapula dyskinesis leads to statistically different scores and SW-CMS cannot be predicted from CMS without clinically relevant differences; (3) 90% of patients recover a side-to-side SHC similar to asymptomatic controls at 90days. Results supported hypotheses 1 and 2. On the contrary (hypothesis 3), only 10% of patients recovered for SHC alterations at 90days, and 50% at follow-up. These findings support the use of SW-CMS and the importance of treating scapula dyskinesis after rotator-cuff repair.
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http://dx.doi.org/10.1016/j.jelekin.2015.06.011DOI Listing
August 2016

Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment.

J Orthop Traumatol 2016 Mar 12;17(1):7-14. Epub 2015 Jul 12.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy.

Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff.
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http://dx.doi.org/10.1007/s10195-015-0367-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805635PMC
March 2016

Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale.

Muscles Ligaments Tendons J 2014 Oct-Dec;4(4):425-32. Epub 2015 Feb 5.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica - AUSl della Romagna Ambito Territoriale di Rimini, Italy.

Background: treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient's pain and disability, surgery should be considered.

Methods: different surgical techniques are available and the choice of the most appropriate procedure depends on the presenting symptoms, age of the patient, functional demand, medical comorbidities, joint stability and presence of arthritic changes. The transposition of the surrounding muscles to replace the rotator cuff function represents a viable option in the treatment of younger patients without glenohumeral osteoarthritis and with severe functional limitation.

Purpose: aim of this study is to give an overview of the currently available evidence regarding tendon transfer procedures for irreparable rotator cuff tears.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327351PMC
March 2015

Complications of calcific tendinitis of the shoulder: a concise review.

J Orthop Traumatol 2015 Sep 20;16(3):175-83. Epub 2015 Feb 20.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, AUSL della Romagna Ambito Territoriale di Rimini, Rimini, Italy,

Unlabelled: Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient.

Level Of Evidence: 5.
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http://dx.doi.org/10.1007/s10195-015-0339-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559544PMC
September 2015

Early anchor displacement after arthroscopic rotator cuff repair.

Int Orthop 2015 May 10;39(5):915-20. Epub 2015 Feb 10.

Department of Orthopaedics, Semmelweis University, Karolina út 27, 1113, Budapest, Hungary,

Purpose: Arthroscopic rotator cuff repair is a success and became the mainstream method of reconstruction in recent years. Due to the technical development in shoulder surgery, novel suture anchors and high-strength sutures are widely used providing convincing fixation, however anchor pullout still remains a problem. The aim of our study was to observe early anchor movement on a large patient cohort, and identify clinical, biological and technical variables that can lead to this complication.

Methods: A total of 5,327 patients who had arthroscopic rotator cuff reconstruction for full thickness tear were included in the study. Radiographs taken immediately after surgery were observed and occurrent anchor displacement was recorded. Patient-specific, tendon-specific, bone-specific and implant-specific variables were studied. Any possible relationship between these factors and anchor displacement was investigated.

Results: Early anchor movement occurred in six cases (0.1%). The involvement of two or more tendons, retraction of the tendon by more than 2 cm and the use of four anchors was associated with higher incidence of anchor displacement, however the difference was not significant.

Conclusions: Based on our study, anchor pullout occurring immediately after surgery is a relatively rare complication. Instead of timing the radiologic examination directly after the procedure, assessment of the anchors' position four to six weeks after surgery should be considered.
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http://dx.doi.org/10.1007/s00264-015-2690-1DOI Listing
May 2015

Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies.

Eur J Orthop Surg Traumatol 2015 Aug 1;25(6):975-85. Epub 2015 Feb 1.

Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, AUSL della Romagna Ambito Territoriale di Rimini, Cattolica, Italy,

Multidirectional instability (MDI) of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Its pathoanatomy is complex and characterized by a redundant capsule, resulting in increased glenohumeral joint volume. The fact that several further factors may contribute to symptom onset complicates the diagnosis and hampers the identification of a therapeutic approach suitable for all cases. There is general agreement that the initial treatment should be conservative and that surgery should be reserved for patients who have not responded to an ad hoc rehabilitation program. We review the biomechanics, clinical presentation, and treatment strategies of shoulder MDI.
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http://dx.doi.org/10.1007/s00590-015-1606-5DOI Listing
August 2015

Outcomes of arthroscopic Hill-Sachs remplissage and anterior Bankart repair: a retrospective controlled study including ultrasound evaluation of posterior capsulotenodesis and infraspinatus strength assessment.

Am J Sports Med 2015 Feb 11;43(2):407-14. Epub 2014 Dec 11.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy.

Background: Hill-Sachs lesions are compression fractures that result from shoulder dislocation. They involve "engaging" the humeral head on the anterior glenoid rim when the arm is abducted and externally rotated. The defect grows as the number of dislocations increases.

Hypothesis: Arthroscopic remplissage and anterior Bankart repair do not significantly affect infraspinatus strength while ensuring healing of the capsulotenodesis.

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

Methods: Sixty-one patients with traumatic anterior shoulder instability treated by arthroscopic Bankart repair and Hill-Sachs remplissage at least 24 months previously were compared with a control group of 40 healthy participants. Preoperative imaging included magnetic resonance imaging for Bankart lesion identification and computed tomography to quantify the humeral head defect. Active range of motion and clinical scores (Walch-Duplay, Constant-Murley, and Rowe) were assessed. External rotation (ER) and internal rotation (IR) were measured with arm at the side (ER1 and IR1) and abducted at 90° (ER2 and IR2). Infraspinatus strength was assessed with the scapula free (infraspinatus strength test [IST]) and retracted (infraspinatus scapula retraction test [ISRT]). Infraspinatus tenodesis and posterior capsulodesis healing were evaluated by ultrasound (US).

Results: The follow-up median was 39.5 months (range, 24-56 months). One patient experienced a recurrence of instability at 34 months. In the remplissage patients, ER1 was significantly lower in the affected compared with the unaffected shoulder (P < .001). Mean IST and ISRT strength values did not show differences between sides. The mean Constant-Murley score rose from 62.9 ± 7.1 to 90 ± 5.2 (P < .0001). The Walch-Duplay and Rowe scores were excellent in 23 (78.6%), good in 6 (17.8%), and poor in 1 patient (both scores). The remplissage group had significantly lower ER1 (P < .001), ER2 (P < .001), and IR2 (P < .01) values compared with the control group. Differences in IST and ISRT between the groups were not significant. Capsulotenodesis healing and filling of the Hill-Sachs defect were confirmed by dynamic US in all subjects.

Conclusion: Arthroscopic remplissage is a reliable approach to Hill-Sachs lesions. The ER and IR restriction does not significantly affect quality of life. Infraspinatus strength recovery is satisfactory even compared with healthy subjects. Ultrasound examination allows accurate evaluation of capsulotenodesis healing.
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http://dx.doi.org/10.1177/0363546514559706DOI Listing
February 2015

Arthroscopically assisted shoulder arthrodesis: is it an effective technique?

Arthroscopy 2014 Dec 29;30(12):1550-6. Epub 2014 Aug 29.

Unit of Shoulder Surgery, D. Cervesi Hospital, Cattolica, Italy.

Purpose: The purpose of this study was to compare clinical and radiographic outcomes of open and mini-open arthroscopic arthrodesis.

Methods: Twelve patients underwent arthroscopically assisted glenohumeral arthrodesis over a 5-year period; none were lost to follow-up. Surgery was performed with the patient in the lateral decubitus position, with the arm positioned in 30° each of flexion, internal rotation, and abduction. The articular cartilage was arthroscopically removed from the humerus and glenoid, creating flat opposing surfaces. One to 2 Kirschner wires were inserted percutaneously through the deltoid and across the glenohumeral joint in the center of the articulation; screws were then inserted arthroscopically. The glenohumeral joint was accessed through a mini-open posterior approach beneath the deltoid and was then reassessed before cannulated screws were tightened completely to compress the joint. Two dynamic compression plates were applied to the posterior glenohumeral joint to neutralize rotatory forces. Each patient was immobilized for 6 weeks. Follow-up radiographic imaging was performed at 2, 6, 12, and 24 months after surgery. These patients were then compared with a similar group who underwent a classic open approach. Success of arthrodesis was determined by bone growth across the glenohumeral joint as visualized on axillary radiographs.

Results: At 2-year follow-up, complete fusion was achieved in 12 (100%) arthroscopically treated patients, with 2 patients (17%) having early bone grafting (within 6 weeks) through a percutaneous approach. Four patients in the classic open approach group ("open group") required additional grafting. Two patients in the group undergoing arthroscopic surgery ("arthroscopic group") had solid fusion but persisting infection from previously failed operations. Comparison of the 2 groups showed no difference in patient satisfaction or infection rates (2 in each group, all of whom had active infection at the time of the index surgery). One patient in the open group sustained a humeral shaft fracture 5 years after arthrodesis, which required additional surgery. No patient who underwent an arthroscopic procedure required additional surgery other than the 2 early bone grafts.

Conclusions: Arthroscopically assisted mini-open glenohumeral arthrodesis provides results that are at least equal to those of open arthrodesis, with a much less invasive approach. Success and complication rates are the same as for the completely open procedure.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2014.06.026DOI Listing
December 2014

Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review.

J Orthop Traumatol 2015 Mar 15;16(1):67-73. Epub 2014 Jul 15.

Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, AUSL della Romagna, Ambito Territoriale di Rimini, L.V Beethowen 5, 47841, Cattolica, RN, Italy,

Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed.
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http://dx.doi.org/10.1007/s10195-014-0309-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348528PMC
March 2015

Venous thromboembolism in patients undergoing shoulder surgery: findings from the RECOS Registry.

Thromb Res 2014 Aug 15;134(2):273-7. Epub 2014 May 15.

Unit of Shoulder Surgery - D. Cervesi Hospital - Cattolica,(RN), Italy.

Background: Limited informations are available about venous thromboembolic (VTE) complications and thromboprophylaxis use after shoulder surgery. The primary end-point of the study was to determine the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90days after shoulder surgery. Risk factors for VTE and thromboprophylaxis practices were also studied.

Methods: RECOS is a prospective multicenter registry of consecutive patients undergoing shoulder surgery recruited in nine hospitals in Italy. Cumulative rates of VTE were estimated according to the Kaplan-Meier method; a Cox regression model was used to calculate adjusted hazard ratio (HR) and 95% confidence interval (CI) for some variables that were identified as risk factors for VTE.

Results: From June 2009 to June 2011 1366 patients (males 54.4%; mean age 55,65±15.3years) were enrolled. The surgical procedures were: arthroscopy (71.9%), hemiarthroplasty (17.2%) total replacement (8.9%), fixation for proximal humeral fracture (2%). After 90days, the incidence of symptomatic VTE was 0.66% (95CI% 0.2-1.12). Mean age was significantly higher in patient with than in patients without VTE (67,1+/3.49years vs 55,6+/-0,42years, respectively; p=0.024). Duration of surgery>60minutes (HR:10.99; 95CI% 1.26-95.89; p=0.030) was found as independent risk factor for VTE, while cancer, medical disease, venous insufficiency and previous VTE were not. Pharmacological thromboprophylaxis was prescribed in 33.5% (n=457) of the patients, in 95.8% of whom for a duration >10days.

Conclusions: The risk of symptomatic VTE in patients undergoing shoulder surgery is low. The potential need for thromboprophylaxis should be based on a case by case evaluation.
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http://dx.doi.org/10.1016/j.thromres.2014.05.014DOI Listing
August 2014

Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years.

Eur J Orthop Surg Traumatol 2015 Jan 10;25(1):91-8. Epub 2014 Apr 10.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica - AUSL della Romagna, Via L. V. Beethoven 46, Cattolica, Italy,

Background: Pectoralis major (PM) tendon rupture is an uncommon injury whose incidence has risen in recent decades mainly as a result of the increasing number of sports-practising individuals. This study evaluates clinical and ultrasound (US) outcomes after surgical repair of acute and chronic PM tendon rupture.

Materials And Methods: Twelve men with PM tendon rupture (9 right and 3 left shoulders) were enrolled. Mean age was 34.6 years, and mean follow-up was 60 months (range 12-108). Rupture was diagnosed by magnetic resonance imaging. Eight patients underwent direct tendon repair (acute group) and 4 had allograft reconstruction (chronic group). Pain, range of motion, strength recovery and return to sports were assessed. Postoperative X-ray and US scans were obtained in all patients. Final outcomes were graded as excellent, good, fair or poor. Isometric strength in adduction/abduction, flexion, internal rotation (IR) and external rotation was recorded.

Results: There were 9 excellent and 3 good outcomes. A comparative strength assessment failed to show significant differences in any plane. Mean strength was not significantly different between affected and unaffected arm. Slight but significantly lower strength in IR with the arm adducted (p = 0.0306) was found in chronic patients. On US, all PM tendons appeared to be anatomically intact and continuous with the humerus.

Discussion: Prompt surgical repair ensures satisfactory outcomes in patients with complete PM rupture; however, delayed allograft repair provides good results with only slight strength impairment. Fresh insights are provided on the role of US in evaluating PM anatomy and tendon attachment to bone.
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http://dx.doi.org/10.1007/s00590-014-1451-yDOI Listing
January 2015

Computed tomography quantification of bone density adjacent to cemented pegged polyethylene glenoid components in shoulder arthroplasty.

Eur J Orthop Surg Traumatol 2014 Jul 26;24(5):753-61. Epub 2013 Nov 26.

Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, L.V Beethoven 1, 47841, Cattolica, RN, Italy,

Background: Cemented polyethylene devices are the prostheses implanted more frequently, but there is no agreement on the optimal glenoid component design. In this study, bone mineral density (BMD) adjacent to cemented all-polyethylene glenoid components was assessed to gain insights into the characteristics of glenoid bone as a potential risk factor implicated in the failure of shoulder arthroplasty.

Patients And Methods: Twenty-two subjects were examined at an average follow-up of 31 months using the Constant-Murley score (CS) and multi-detector computed tomography. BMD was measured in 5 regions of interest (ROIs) at the sites where radiolucent lines are usually detected. BMD differences among the ROIs were tested. The relationship between BMD and a number of variables (CS subscores, age, gender, follow-up duration) was explored.

Results: There was a significant increase in CS scores (p<0.05). Significantly different BMD (p=0.0039) was found in the 5 ROIs, especially between ROIs 2 and 5 (p=0.016, Bonferroni's test) and between ROIs 3 and 5 (p=0.005, Bonferroni's test). BMD was lower in ROI 1 than ROI 3 and in ROI 2 than ROI 4, but the difference was not significant.

Discussion: The heterogeneous BMD distribution may be related to: (1) an interindividual variability in glenoid BMD; (2) the fixation technique; or (3) the different bone response to eccentric loading of the prosthetic head on the glenoid component.

Conclusions: BMD analysis may contribute to extent our knowledge on glenoid component loosening and encourage further techniques of glenoid fixation.
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http://dx.doi.org/10.1007/s00590-013-1368-xDOI Listing
July 2014

Snapping scapula syndrome: current concepts review in conservative and surgical treatment.

Muscles Ligaments Tendons J 2013 Apr 9;3(2):80-90. Epub 2013 Jul 9.

Unit of Shoulder and Elbow Surgery, Biomechanics laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica, Italy.

The snapping scapula, also called "washboard syndrome" is a controversial condition attributed to bony and soft tissue abnormalities. The syndrome was understimated for long time and often associated only with specific osseous abnormalities. The nodal point in the overview of the syndrome is that crepitus associated with symptomatic bursitis may be physiologic and is not uncommon a clinical presentation without any form of crepitus or craquement. In the current rewiew we analyzed the current concepts in the conservative and surgical management of snapping scapula syndrome, preceded by a description of scapular anatomy, pathophysiology of scapulothoracic articulation and clinical features of snapping scapula.
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http://dx.doi.org/10.11138/mltj/2013.3.2.080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711706PMC
April 2013