Publications by authors named "Philippe Collin"

76 Publications

Clinical and Radiological Results of Hemiarthroplasty and Total Shoulder Arthroplasty for Primary Avascular Necrosis of the Humeral Head in Patients Less Than 60 Years Old.

J Clin Med 2021 Jul 12;10(14). Epub 2021 Jul 12.

Institut Locomoteur de l'Ouest, CHP St Grégoire, 35760 Saint Grégoire, France.

Background: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) have shown good clinical outcomes in primary avascular necrosis of the humeral head (PANHH) both in short and long terms. The purpose of this study was to assess the complications, the clinical and radiological outcomes of shoulder arthroplasty in young patients with PANHH.

Methods: One hundred and twenty-seven patients aged under 60 years old and suffering from PANHH were operated with arthroplasty. Patients were assessed clinically and radiographically before surgery with a minimum of 2 years of follow up (FU).

Results: HA was performed on 108 patients (85%). Two patients were revised for painful glenoid wear after 2 and 4 years. TSA was performed on 19 patients (15%). Five TSA had to be revised for glenoid loosening ( = 4) or instability ( = 1). Revision rate was 26% with TSA and 2% with HA. There were no significant differences between HA and TSA in terms of clinical outcomes.

Conclusions: With a mean FU of 8 years, HA and TSA improved clinical outcomes of patients with PANHH. HA revisions for painful glenoid wear were rare (2%). The revision rate was excessively high with TSA (26%).
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http://dx.doi.org/10.3390/jcm10143081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305425PMC
July 2021

Relationship between postoperative integrity of subscapularis tendon and functional outcome in reverse shoulder arthroplasty.

J Shoulder Elbow Surg 2021 Jun 30. Epub 2021 Jun 30.

Department of Orthopaedic Surgery, Prisma Health-Upstate, Greenville, SC, USA.

Hypothesis And Background: The role of the subscapularis in reverse shoulder arthroplasty (RSA) remains controversial. Studies have shown that subscapularis repair has no significant influence on the functional outcomes of patients. However, few studies have assessed the postoperative integrity of the subscapularis tendon after RSA. The aims of this study were to investigate the postoperative healing of the subscapularis after RSA via ultrasound and to evaluate the relationship between tendon integrity and functional outcomes. We hypothesized that subjects with a healed subscapularis after RSA would have higher Constant scores and better internal rotation (IR) than those without a healed subscapularis.

Methods: This was a retrospective review of all patients who underwent primary RSA with subscapularis tenotomy repair performed by a single surgeon with a minimum 2-year follow-up period. The inclusion criteria were (1) primary RSA and (2) complete intraoperative repair of the subscapularis tenotomy if the tendon was amenable to repair. The total Constant score and active and passive range of motion were measured preoperatively and at every postoperative visit. IR was further subcategorized into 3 functional types (type I, buttock or sacrum; type II, lumbar region; and type III, T12 or higher). The integrity of the subscapularis on ultrasound at 2 years was reported using the Sugaya classification. The correlation between subscapularis integrity and functional outcomes including functional IR was evaluated.

Results: A total of 86 patients (mean age, 73 ± 7.4 years; age range, 50-89 years) were evaluated. The mean postoperative Constant score for all patients significantly improved from 38 points to 72 points (P < .001) at last follow-up (mean, 3.3 years). There was significant improvement in all Constant score functional subscales and in terms of range of motion. The rate of sonographic healing of the subscapularis was 52.6%. There was no difference in Constant scores between "intact" and "failed" tendon repairs; however, intact tendons demonstrated significantly better IR with no difference in external rotation (P < .01).

Conclusion: The healing rate of the subscapularis following RSA was only 52.6%. IR function in patients with an intact subscapularis at 2 years after RSA was significantly better than in patients with failed or absent tendon repairs. Primary repair of reparable subscapularis tendons during RSA should be strongly considered.
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http://dx.doi.org/10.1016/j.jse.2021.05.024DOI Listing
June 2021

Evaluation of the subscapularis split created with passive rotation during arthroscopic dynamic anterior stabilization (DAS): A cadaveric study.

Orthop Traumatol Surg Res 2021 Sep 15;107(5):102934. Epub 2021 Apr 15.

Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Faculty of Medicine, University of Geneva, Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

Introduction: The purpose of the present study was to analyze the ability to create a subscapularis split by passive rotation of the arm during dynamic anterior stabilization (DAS) and to analyze the new geometry of the long head of the biceps LHB.

Hypothesis: The hypothesis was that this passive simple technique can create subscapularis split without additional dissection giving rise to new position of LHB with a new stabilization function.

Material And Methods: A technique of subscapularis split using the LHB was used in 12 fresh-frozen human cadaveric shoulders. A subscapularis split was created by passive rotation of the arm after the LHB is shuttled into the joint during DAS. The length of the subscapularis split, post-DAS position and length of the LHB, and the angulation of the LHB relative to bicipital groove were measured after DAS and if this new geometry can give a new dynamic effect on subscapularis muscle.

Results: The mean length of the subscapular split after maximal rotation was 20.4±6.0mm (range: 10-32mm). The mean elongation of the LHB was 0.6±1.4mm (range: -1 to +3mm). The final angle of the LHB relative to the bicipital groove was 45±5 degrees (range: 41 to 55 degrees).

Discussion: There is no need to create a distinct split prior to DAS. Additionally, DAS maintains the length-tension relationship of the LHB. The post-procedure medial angulation of the LHB relative to the bicipital groove may provide a lowering of the subscapularis, helping explain the anterior reinforcement of this technique.

Level Of Evidence: Basic science study, cadaver study.
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http://dx.doi.org/10.1016/j.otsr.2021.102934DOI Listing
September 2021

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

J Clin Med 2021 Mar 12;10(6). Epub 2021 Mar 12.

Roth McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON N6A 4L6, Canada.

Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients.

Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population.

Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia ( = 4, 2.6%), macrosomia >4 kg ( = 5, 3.2%), breech delivery ( = 6, 3.9%), fetal distress ( = 8, 5.2%), maternal diabetes ( = 2, 1.3%), clavicular fracture ( = 2, 1.3%), and forceps delivery ( = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates.

Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
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http://dx.doi.org/10.3390/jcm10061196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999215PMC
March 2021

Poor results after pyrocarbon interpositional shoulder arthroplasty.

J Shoulder Elbow Surg 2021 Mar 4. Epub 2021 Mar 4.

Institut Locomoteur de l'Ouest, CHP St Grégoire, St Grégoire, France. Electronic address:

Background: This study aimed to describe the clinical outcomes and complications of 10 cases of pyrocarbon interposition shoulder arthroplasty (PISA).

Methods: The clinical and radiographic records of 10 patients who underwent PISA using the InSpyre shoulder prosthesis (Tornier-Wright) between July 2012 and March 2017 were reviewed. The mean age at surgery was 55 years. Surgical indications included patients aged <60 years with Walch type B glenoid glenohumeral osteoarthritis (n = 7), avascular necrosis (AVN) of the humeral head (n = 1), or secondary severe glenohumeral osteoarthritis with axillary nerve dysfunction (n = 2). Outcomes of interest were postoperative complications and need for revision surgery, preoperative and postoperative patient-reported outcomes (Constant score [CS] and Subjective Shoulder Value [SSV]), and range of motion. The radiographic characteristics of the implants were evaluated.

Results: Among the 10 patients, 5 underwent revision to reverse shoulder arthroplasty during the study period owing to poor clinical outcomes based on the CS and SSV. All 5 revised patients had Walch type B glenoid morphology at the time of the index procedure. The mean time to revision surgery in this subset of patients was 60 months. The remaining 5 patients who did not undergo any revision procedure had significant improvement in mean CS and SSV from 30-65 points and 32%-87%, respectively, but at a shorter duration of follow-up of 35 months.

Conclusion: High clinical failure rate and poor results at mean 5-year follow-up were found in younger PISA patients with baseline Walch B glenohumeral osteoarthritis. We would caution against use of PISA in this challenging patient population. PISA yielded more favorable short-term outcomes in patients with humeral-sided deformity or severe secondary glenohumeral osteoarthritis with axillary nerve dysfunction; however, longevity of the implant in this population remains unclear.
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http://dx.doi.org/10.1016/j.jse.2021.01.032DOI Listing
March 2021

Comparing patient-reported outcome measures and physical examination for internal rotation in patients undergoing reverse shoulder arthroplasty: does surgery alter patients' perception of function?

J Shoulder Elbow Surg 2021 Jul 16;30(7S):S100-S108. Epub 2021 Feb 16.

Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA. Electronic address:

Background: The purpose of this study was to evaluate how patients treated with reverse shoulder arthroplasty (RSA) achieve internal rotation (IR) using video assessment and to compare this to patient-reported outcome measures (PROMs).

Methods: We reviewed 215 preoperative and 657 postoperative videos (3-78 months) for 215 patients who underwent primary RSA, performing IR using the modified vertebral level method. Their functional motion pattern was then grouped into 3 types: type I, could not reach behind their back; type II, able to reach to at least waist level, with assistance; and type III, able to reach to a minimum of waist level in an uninterrupted fashion. Patients completed functional questions (put on a coat, wash back, tuck in a shirt, and manage toileting) and a diagram of perceived IR. Patients' functional motion types were compared to PROM answers. Pre- and postoperative scores were also compared to assess the effect of surgery on patients' perception of IR function.

Results: Patients undergoing RSA will achieve IR in 3 distinct motion patterns. Analysis of self-reported IR indicated statistically significant difference between the 3 functional types of IR (P < .001). Patient-perceived IR was not significantly different between the 3 studied IR functional types (P = .076) in the analysis of preoperative measures but was significantly different in the postoperative setting (P < .001).

Conclusion: Patients attempt IR in 3 distinct functional motion patterns. The improvement of IR after RSA is measured better by patient questionnaires than by physical examination.
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http://dx.doi.org/10.1016/j.jse.2021.01.020DOI Listing
July 2021

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

J Clin Med 2020 Dec 27;10(1). Epub 2020 Dec 27.

Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland.

Background: Kinematic changes of the scapulothoracic joint may influence the relative position of the glenoid fossa and, consequently, the glenohumeral joint. As the alignment of the scapula relative to the thorax differs between individuals, such variability may be another factor in the development of posterior head subluxation. The purpose of this study was to compare scapulothoracic alignment in pathologic type B shoulders with contralateral healthy shoulders.

Methods: Seven adult volunteers with unilateral type B glenohumeral osteoarthritis (OA) underwent bilateral computed tomography (CT) scans of the shoulders and arms. A patient-specific, three-dimensional measurement technique that coupled medical imaging (i.e., CT) and optical motion capture was used.

Results: The scapulothoracic distance at the trigonum was 75 ± 15 mm for pathologic shoulders and 78 ± 11 mm for healthy shoulders ( = 0.583), while at the inferior angle, it was 102 ± 18 mm for pathologic shoulders and 108 ± 12 mm for healthy shoulders ( = 0.466).

Conclusion: Scapula positioning at a resting position did not differ between pathologic and healthy shoulders. However, pathologic shoulders tended to be limited in maximal glenohumeral motion and exhibited greater anterior tilt of the scapula in internal rotation at 90 degrees, which may be adaptive to the restricted glenohumeral motion.
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http://dx.doi.org/10.3390/jcm10010066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794942PMC
December 2020

Want a better h-index? - All you need to know about copyright and open access.

Orthop Traumatol Surg Res 2020 Dec 24;106(8):1475-1480. Epub 2020 Oct 24.

Orthopaedic Surgery Department, hôpital de La Tour, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Orthopedics and Trauma Service, University Hospitals of Geneva, rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland. Electronic address:

Introduction: Physicians, whether in the public or private sector, are increasingly bound to "publish or perish". Although researchers have become aware of certain ethical concerns relating to the concept of authorship, clinicians still tend to neglect issues of copyright. The present study aims: 1) to explain to orthopedic surgeons what exactly is protected by copyright in a scientific article; 2) to assess the legal implications of publishing contracts; and 3) to specify the means of publication that best boost the author's h-index.

Material And Methods: The study was based on intellectual property legislation and jurisprudence and the underlying principles. The European and American medical and legal literature was analyzed.

Results: It is vital to understand the basic principles of copyright and the legal implications of publishing contracts. A scientific article is protected by copyright as soon as it has been written. This confers both moral and property rights. "Moral" rights protect the person of the author and are inalienable; unlike property rights, they cannot be transferred. Publishing contracts can only concern property and other derivative rights. Most scientific articles are published in open access via Creative Commons (CC) licenses. The greater the freedom of use provided for in the CC license, the more easily other authors can use the article, adding to it or altering it. As all CC licenses include an attribution clause, authors publishing under a relatively unrestrictive CC license increase the chances of boosting their h-index.

Conclusion: Forewarned is forearmed. Mastering the means of publication enables authors to make the most of their publications in boosting their h-index, and also to contribute to the new Open Science paradigm: abandoning some intellectual property in favor of innovation and knowledge sharing rather than clinging to data protection.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.otsr.2020.05.015DOI Listing
December 2020

Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty-A Multicenter Study.

J Clin Med 2020 Oct 20;9(10). Epub 2020 Oct 20.

OCM (Orthopädische Chirurgie München), Steinerstrasse 6, 81369 Munich, Germany.

Background: The radiological phenomenon of subsidence following the implantation of uncemented short-stem reverse prostheses (USSP) has not yet been described. The purpose of this study was to describe the rate and potential risk factors for subsidence. We hypothesized that subsidence may be a frequent finding and that a subsidence of >5 mm (mm) is associated with an inferior clinical outcome.

Methods: A total of 139 patients with an average age of 73 ± 9 years were included. The clinical and radiological outcome was evaluated at a minimum follow-up (FU) of 12 months.

Results: No humeral component loosening was present at a mean FU of 18 (range, 12-51) months. Mean Constant Score (CS) and Subjective Shoulder Value (SSV) improved significantly from 34.3 ± 18.0 points and 37.0 ± 19.5% preoperatively to 72.2 ± 13.4 points and 80.3 ± 16.5% at final FU ( < 0.001). The average subsidence of the USSP was 1.4 ± 3.7 mm. Subsidence of >5 mm was present in 15 patients (11%). No association between a subsidence >5 mm and CS or SSV was found ( = 0.456, = 0.527). However, a subsidence of >5 mm resulted in lower strength at final FU ( = 0.022). Complications occurred in six cases (4.2%), and the revision rate was 3.5% (five cases).

Conclusions: Although subsidence of USSP is a frequent radiographic finding it is not associated with loosening of the component or a decrease in the clinical outcome at short term FU.

Level Of Evidence: Level 4, retrospective study.
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http://dx.doi.org/10.3390/jcm9103362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590048PMC
October 2020

A Reproducible Technique for Creation of the Subscapularis Split During Dynamic Anterior Stabilization for Shoulder Instability.

Arthrosc Tech 2020 Sep 2;9(9):e1433-e1438. Epub 2020 Sep 2.

Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin.

The subscapularis split is a required difficult step of several instability procedures. We propose creating a subscapularis split using the shuttled long head of the biceps by simple passive external rotation of the arm during dynamic anterior stabilization. This technique simplifies one of the technically demanding steps of dynamic anterior stabilization, making the split quicker and more reproducible.
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http://dx.doi.org/10.1016/j.eats.2020.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528756PMC
September 2020

Shoulder biomechanics in normal and selected pathological conditions.

EFORT Open Rev 2020 Aug 10;5(8):508-518. Epub 2020 Sep 10.

Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.

The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers.Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions.Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing. Cite this article: 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006.
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http://dx.doi.org/10.1302/2058-5241.5.200006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484714PMC
August 2020

Prospective study of tendon healing and functional gain after arthroscopic repair of isolated supraspinatus tear.

Orthop Traumatol Surg Res 2020 Dec 15;106(8S):S201-S206. Epub 2020 Sep 15.

15, rue Ampère, 92500 Rueil Malmaison, France.

Introduction: In case of failure of non-operative treatment of isolated supraspinatus tear, tendon surgery can improve shoulder function and alleviate pain. The present study hypothesis was that isolated supraspinatus repair shows good healing, with improved clinical results.

Materials And Methods: A prospective multicentre study followed up 199 patients (mean age, 57 years) for one year. Inclusion criteria comprised: isolated full-thickness supraspinatus tear, retraction grade<3, with the same double-row arthroscopic technique. Clinical assessment used Constant score at 6 weeks and 3, 6 and 12 months. Ultrasound control checked tendon repair quality on the Sugaya criteria, types I-II-III being considered as healed.

Results: At one year, mean Constant score had increased by 26 points (p<0.001). Healing rate was 94% (n=187): Sugaya type I, 46% (n=92); type II, 41% (n=81); type III, 7% (n=14). Mean Constant score was significantly higher in case of healing: 81 vs. 70 points (p=0.002). Constant score progression was identical in both healing groups throughout follow-up. Univariate analysis showed no correlation between epidemiological or tear-related factors and tendon healing.

Conclusion: Arthroscopic repair of isolated small supraspinatus tear provided 94% healing. Clinical results were better when healing was achieved.

Level Of Evidence: I, prospective cohort study.
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http://dx.doi.org/10.1016/j.otsr.2020.08.007DOI Listing
December 2020

Benefits of distal clavicle resection during rotator cuff repair: Prospective randomized single-blind study.

Orthop Traumatol Surg Res 2020 Dec 14;106(8S):S207-S211. Epub 2020 Sep 14.

15, rue Ampère, 92500 Rueil Malmaison, France.

Introduction: Rotator cuff tears often occur in combination with acromioclavicular (AC) arthropathy. But it can be difficult to separate pain caused by the rotator cuff tear from pain caused by the AC joint, despite clinical and other examinations. Distal clavicle resection (DCR) is increasingly being done at the same time as arthroscopic rotator cuff repair. The aim of this study was to compare the functional outcomes 1 year after arthroscopic rotator cuff repair between patients who simultaneously undergo DCR and patients who do not. The primary hypothesis was that DCR improves the clinical outcomes.

Material And Methods: This was a prospective, multicenter, randomized, single-blind study of 200 patients who underwent isolated supraspinatus repair using the same technique. The patients were randomized into two groups: 97 patients who also underwent DCR and 103 patients who did not. The patients were followed until 1 year postoperative according to a standardized radiological and clinical review protocol.

Results: At 1 year postoperative, all the clinical outcomes were worse in the DCR group, although only external rotation with elbow at side (53° vs. 59°, p=0.04) and the SSV (86.5 vs. 90.1, p=0.04) were statistically different. Overall shoulder pain was higher in the DCR group during the first 3 months postoperative (p=0.04). At 1 year, the DCR group had more residual pain; this pain was mainly located on the superior side of the shoulder (p=0.03), especially when more than 11 mm was resected (p=0.01). More of the shoulders in the DCR group had failures in rotator cuff healing based on ultrasonography (p=0.5).

Conclusion: Our hypothesis was not confirmed. We do not recommend doing routine DCR with arthroscopic rotator cuff repair.

Level Of Evidence: I, prospective randomized simple blind study.
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http://dx.doi.org/10.1016/j.otsr.2020.08.006DOI Listing
December 2020

Increased T2 signal intensity in the distal clavicle does not justify acromioclavicular resection arthroplasty during rotator cuff repair.

Orthop Traumatol Surg Res 2020 12 14;106(8S):S217-S222. Epub 2020 Sep 14.

15, rue Ampère, 92500 Rueil Malmaison, France.

Introduction: Acromioclavicular (AC) arthropathy can contribute to shoulder pain; it can be treated surgically by distal clavicle resection (DCR). The aim of this study was to determine whether increased T2 signal intensity in the clavicle on MRI is an argument in favour of AC resection arthroplasty by DCR during rotator cuff repair.

Methods: The MRI images from 107 shoulders in 107 patients were analysed. We looked for statistical relationships and correlations between shoulders with T2 hyperintensity (HI+) and those without (HI-) before surgery and then in shoulders with T2 hyperintensity (HI+) that underwent AC resection arthroplasty (AC+) and those who did not (AC-).

Results: On MRI, T2 hyperintensity in the AC joint was correlated with sex (more often found in men) and radiological signs of AC arthropathy. There was no statistical correlation before surgery, particularly with AC pain, or after surgery, with outcomes in shoulders undergoing DCR.

Conclusion: When repairing rotator cuff tears, the presence of T2 hyperintensity on MRI in the distal clavicle is not a predictor of better clinical outcomes after AC resection arthroplasty is done. The AC pain may be related to the rotator cuff tear instead.

Level Of Evidence: II, prospective randomised study.
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http://dx.doi.org/10.1016/j.otsr.2020.08.010DOI Listing
December 2020

Is conventional radiography still relevant for evaluating the acromioclavicular joint?

Orthop Traumatol Surg Res 2020 Dec 9;106(8S):S213-S216. Epub 2020 Sep 9.

15, rue Ampère, 92500 Rueil Malmaison, France.

Introduction: Conventional radiography using an anteroposterior view of the acromioclavicular (AC) joint is the gold standard for evaluating arthritic degeneration.

Objective: Based on a standardised AP view of the AC joint, the objective of this study was to determine whether this radiographic view is reliable and reproducible for evaluating the AC joint space.

Methods: A cadaver scapula-clavicle unit, free of osteoarthritis, was used for this study. The scapula was positioned in a stand; and then with fluoroscopy guidance, a strict AP view of the AC joint was taken. Starting from this "0" position, a radiograph was taken by varying the angle by 5°, 10°, and 15° in every plane in space. All radiographs were taken during a single session to ensure the distance between the X-ray tube and scapula did not change. The images were then exported to OsiriX for processing; the superior and inferior AC distance and the joint area were measured.

Results: There was no reproducibility in the AC joint measurements as a function of the incidence angle relative to a strict AP view.

Conclusion: Conventional radiography using an AP view of the AC joint cannot be used to do a fine analysis of arthritic degeneration of this joint. It is likely that only CT scan or MRI is sufficient to analyse osteoarthritis in this joint.

Level Of Evidence: IV, basic science study.
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http://dx.doi.org/10.1016/j.otsr.2020.08.008DOI Listing
December 2020

Single Assessment Numeric Evaluation for instability as an alternative to the Rowe score.

J Shoulder Elbow Surg 2021 May 29;30(5):1167-1173. Epub 2020 Aug 29.

Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Background: Several functional outcome scores have been proposed for the evaluation of shoulder instability. Most are multiple-item questionnaires, which can be time-consuming and difficult for patients to understand, as well as leading to lack of compliance. The Single Assessment Numeric Evaluation (SANE) score is a single question that has recently gained widespread acceptance based on its simplicity and correlation with more complex scoring systems. The purpose of this study was to assess the correlation of a new modified version of the SANE score, the SANE-instability score, with the Rowe score after treatment for shoulder instability.

Materials And Methods: We prospectively evaluated a consecutive series of 253 patients (268 shoulders) treated surgically or nonoperatively for shoulder instability between November 2017 and November 2019, for whom the Rowe and SANE-instability scores were collected before treatment and/or after treatment. The SANE-instability score was assessed with the following question: "What is the overall percent value of your shoulder if a completely stable shoulder represents 100%?" Correlations were tested using the Pearson coefficient (r) and interpreted as very high (r = 0.90-1.00), high (r = 0.70-0.89), moderate (r = 0.50-0.69), low (r = 0.30-0.49), or negligible (r = 0.00-0.29). Subgroup analyses were also performed to observe correlation variations according to follow-up length (before treatment and at 6, 12, 26, 52, and 104 weeks after treatment), patient age (<20, 20-29, 30-39, or ≥40 years), and type of treatment (nonoperative or surgical).

Results: The overall correlation between the SANE-instability and Rowe scores was high (r = 0.85, P < .001). Subgroup analyses revealed that the correlation between the 2 scores was high before treatment (r = 0.74); moderate at 6 and 12 weeks after treatment (r = 0.66 and r = 0.57, respectively); and then high at 26, 52, and 104 weeks after treatment (r = 0.75, r = 0.75, and r = 0.78, respectively) (P < .001). The correlation was high across all types of treatment (r = 0.76-0.85), high for patients aged ≥ 20 years (r = 0.80-0.86), and very high for patients aged < 20 years (r = 0.93) (P < .001).

Conclusion: This study demonstrated a significant correlation between the SANE-instability and Rowe scores before and after treatment, as well as across all patient age groups and treatments. Owing to its high simplicity, the SANE-instability score could be used as an alternative to the Rowe score for patient follow-up at various time points.
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http://dx.doi.org/10.1016/j.jse.2020.08.013DOI Listing
May 2021

Postoperative rotator cuff integrity: can we consider type 3 Sugaya classification as retear?

J Shoulder Elbow Surg 2021 Jan 9;30(1):97-103. Epub 2020 Jun 9.

CHP Saint-Grégoire, Saint-Grégoire, France.

Background: Sugaya classification is a widely accepted classification system that is used to analyze postoperative rotator cuff tendon integrity. However, there are inconsistencies in the literature as to whether type 3 Sugaya should be considered as a retear or healed tendon.

Purpose: We aimed to show that type 3 Sugaya is not a retear by comparing the long-term supraspinatus and infraspinatus muscle degeneration and the functional outcomes of type 3 with those of type 4 and 5 Sugaya. We hypothesized that the clinical course of type 3 Sugaya would be different from type 4 or 5 Sugaya.

Method: The study was a retrospective multicenter review of all the rotator cuff repair done in 2003-2004. We included all the patients who had undergone supraspinatus repair with 10-year follow-up (magnetic resonance imaging done with full functional assessment). Data collection included pre- and postoperative supraspinatus and infraspinatus fatty infiltration, supraspinatus muscle atrophy, and Constant score with a separate analysis of its Strength subsection. Supraspinatus tendon integrity at 10-year follow-up was determined according to Sugaya classification. The patients were divided into 2 groups: type 3 Sugaya and type 4 and 5 Sugaya. Statistical comparison was done between the groups.

Results: There was no significant difference in the preoperative fatty infiltration of the supraspinatus and infraspinatus, supraspinatus muscle atrophy, and Constant score between the 2 groups. However, type 3 Sugaya patients had significantly better scores in the preoperative Strength subsection. Postoperatively, type 3 Sugaya patients showed significantly lesser fatty infiltration of the supraspinatus and infraspinatus, lesser supraspinatus muscle atrophy, and higher Constant score compared with type 4 and 5 Sugaya (P < .001).

Conclusion: Patients with type 3 Sugaya supraspinatus tendon exhibited lesser muscle degeneration in the supraspinatus and infraspinatus and performed better in functional assessment compared with type 4 and 5 Sugaya patients. We inferred that type 3 Sugaya should not be considered as a retear.
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http://dx.doi.org/10.1016/j.jse.2020.05.002DOI Listing
January 2021

Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests.

Knee Surg Sports Traumatol Arthrosc 2021 Jul 28;29(7):2118-2133. Epub 2020 Jul 28.

Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France.

Purpose: Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears.

Methods: The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor.

Results: The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins-Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67-0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01-0.98), for the drop arm sign.

Conclusions: The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1007/s00167-020-06136-9DOI Listing
July 2021

Early and delayed acromioclavicular joint reconstruction provide equivalent outcomes.

J Shoulder Elbow Surg 2021 Mar 7;30(3):635-640. Epub 2020 Jul 7.

Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.

Background: Some comparative studies have reported improved outcomes for early compared with delayed reconstruction for high-grade acromioclavicular (AC) joint dislocations. However, most are based on older techniques and did not specifically involve reconstruction of both the coracoclavicular (CC) and AC joint ligaments. The purpose of this study was to compare functional outcomes of early vs. delayed surgical intervention of AC joint dislocations managed with combined CC and AC ligament reconstruction.

Methods: A retrospective comparative study was performed of 53 patients who underwent early (<2 weeks after injury) or delayed (≥2 weeks after injury) open stabilization for AC joint dislocation. All patients were managed with the same surgical technique of combined CC reconstruction and stabilization of the AC joint, except for the addition of a gracilis allograft for biologic CC reconstruction in delayed intervention. Outcome was determined at a minimum follow-up of 12 months, using the Acromioclavicular Joint Instability (ACJI) score, Taft score, Subjective Shoulder Value (SSV), visual analog scale (VAS) for pain, and overall satisfaction (0-10). Multivariable regression analyses were performed to test associations of ACJI and Taft scores with 5 independent variables (early vs. delayed surgery, age, sex, manual worker, and Rockwood type).

Results: The cohort comprised 47 men (89%) and 6 women (11%) aged 40.1 ± 11.2 years (range, 22-63 years). The early group (n = 31) underwent surgery 1.1 ± 0.5 weeks after injury, whereas the delayed group (n = 22) underwent surgery 84.3 ± 99.1 weeks after injury. There were no significant differences in ACJI scores (87 ± 14 vs. 89 ± 14, P = .267), Taft scores (10.1 ± 1.3 vs. 10.7 ± 1.3, P = .084), pain on VAS (0.3 ± 0.7 vs. 0.6 ± 1.1, P = .541), SSV (95 ± 7 vs. 93 ± 9, P = .427), or overall satisfaction (9.6 ± 0.9 vs. 9.4 ± 1.1, P = .491). Multivariable analyses revealed no associations between any of the independent variables and ACJI or Taft score.

Conclusions: Early and delayed surgical interventions of high-grade AC joint dislocation provide equivalent clinical scores when combined CC and AC joint fixation is used for stabilization. Rapid surgical intervention for high-grade AC joint dislocation may not be necessary, as most patients can still benefit from surgery at a later stage.
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http://dx.doi.org/10.1016/j.jse.2020.06.026DOI Listing
March 2021

Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties?

Orthop Traumatol Surg Res 2020 04 11;106(2):241-246. Epub 2020 Feb 11.

Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France.

Background: Shorter humeral stems were developed to improve bone preservation, vascularity and osteointegration in reverse total shoulder arthroplasty (RSA). While some studies examined the relationship between canal filling and radiographic changes, none evaluated the association between stem alignment and canal fill ratio (CFR).

Hypothesis: The hypothesis was that stem misalignment after RSA would be associated with lower CFR.

Patients And Methods: The authors retrospectively reviewed immediate postoperative radiographs of 157 patients, comprising 56 men (36%), who underwent RSA with a short uncemented stem with neck shaft angle (NSA) default of 145°. The parameters included postoperative NSA and metaphyseal CFR, both measured with excellent inter-observer agreement. Uni- and multivariable linear regressions were performed to determine associations between postoperative NSA and 5 variables (CFR, gender, age, BMI, and surgical approach).

Results: Postoperative NSA was 149°±8°, exceeding 5° of varus in 15 shoulders (9%) and 5° of valgus in 60 shoulders (38%), and CFR was 58%±8%. CFR was lower in shoulders with varus stem alignment (54%±6%) than shoulders with neutral stem alignment (59%±8%, p=0.033). Multivariable regression revealed that postoperative NSA increased with age (beta: 0.20; p=0.008), was higher for shoulders operated with the subscapularis- and deltoid-sparing approach (beta: 3.82; p=0.040) but lower for men (beta: -4.14; p=0.002).

Conclusions: Stem misalignment exceeded 5° in 47% of the shoulders. Women, older age, and subscapularis- and deltoid-sparing approach are associated with greater risks of valgus stem positioning, while lower CFR seems to be associated with greater risks of varus stem positioning.

Level Of Evidence: IV; case series.
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http://dx.doi.org/10.1016/j.otsr.2019.12.010DOI Listing
April 2020

Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty.

Int Orthop 2020 03 3;44(3):519-530. Epub 2020 Jan 3.

Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France.

Purpose: To determine how different combinations of humeral stem and glenosphere designs for reverse shoulder arthroplasty (RSA) influence range of motion (ROM) and muscle elongation.

Methods: A computed tomography scan of a non-pathologic shoulder was used to simulate all shoulder motions, and thereby compare the ROM and rotator cuff muscle lengths of the native shoulder versus 30 combinations of humeral components (1 inlay straight stem with 155° inclination and five onlay curved stems with 135°, 145° or 155° inclinations, using concentric, medialized or lateralized trays) and glenospheres (standard, large, lateralized, inferior eccentric and bony increased-offset (BIO-RSA)).

Results: Only five of the 30 combinations restored ≥ 50% of the native ROM in all directions: the 145° onlay stem (concentric tray) combined with lateralized or inferior eccentric glenospheres and the 145° stem (lateralized tray) combined with either a large, lateralized or inferior eccentric glenosphere. Lengthening of the supraspinatus and infraspinatus, observed for all configurations, was greatest using onlay stems (7-30%) and BIO-RSA glenospheres (13-31%). Subscapularis lengthening was observed for onlay stems combined with BIO-RSA glenospheres (5-9%), while excessive subscapularis shortening was observed for the inlay stem combined with all glenospheres except the BIO-RSA design (> 15%).

Conclusions: The authors suggest implanting 145° onlay stems, with concentric or lateralized trays, together with lateralized or inferior eccentric glenospheres.
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http://dx.doi.org/10.1007/s00264-019-04463-2DOI Listing
March 2020

Clinical and structural outcome 20 years after repair of massive rotator cuff tears.

J Shoulder Elbow Surg 2020 Mar 6;29(3):521-526. Epub 2019 Oct 6.

Universitätsklinik Balgrist, Zürich, Switzerland.

Background: Short- and mid-term outcomes after massive cuff tear repair are well reported, but there is no documentation of the clinical and structural outcomes at 20 years of follow-up. The hypothesis of the present study was that at 20 years, deterioration of the shoulder would have occurred and led to a substantial number of reoperations.

Methods: The authors retrospectively recalled all 127 patients operated for massive rotator cuff tears in 1994 at 6 different centers. At the 20-year follow-up, 26 patients died and 35 were lost to follow-up. Thirteen (10.2%) had been reoperated. This left 53 patients for personal clinical assessment. Forty-nine consented to standardized radiographic evaluation for assessment of osteoarthritis, 36 patients underwent magnetic resonance imaging, allowing assessment of tendon healing, atrophy, and fatty infiltration (FI) of the cuff muscles.

Results: The final Constant-Murley score (CS) was 68 ± 17.7 (range, 8-91) vs. 44 ± 15.3 (range, 13-74) preoperatively (P < .05). The final Subjective Shoulder Value (SSV) was 73% ± 23% (range, 0-100). Retears (Sugaya IV and V) were found in 17 cases (47%). Nine patients (17%) had cuff tear arthropathy (Hamada stage 4). The CS and SSV for the shoulders with FI stages III or IV were significantly inferior (53 ± 19 points and 65% ± 14% respectively) than for those with FI stages 0-II (respectively, 71.6 ± 6 points and 73% ± 4%) (P < .05).

Conclusions: Twenty years after surgical repair of massive rotator cuff tears, the functional scores remain satisfactory, and the rate of revision is low.
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http://dx.doi.org/10.1016/j.jse.2019.07.031DOI Listing
March 2020

Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty.

Bone Joint Res 2019 Aug 3;8(8):378-386. Epub 2019 Sep 3.

University of Geneva, Geneva, Switzerland; Medical Research Department, Artanim Foundation, Geneva, Switzerland.

Objectives: To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies.

Methods: 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction.

Results: CSA did not seem to influence ROM in any of the models, but greater lateralization achieved greater ROM for all movements in all configurations. Internal and external rotation at 90° of abduction were impossible in most configurations, except in models with a CSA of 25°.

Conclusion: Postoperative ROM following RSA depends on multiple patient and surgical factors. This study, based on computer simulation, suggests that CSA has no influence on ROM after RSA, while lateralization increases ROM in all configurations. Furthermore, increasing subacromial space is important to grant sufficient rotation at 90° of abduction. In summary, increased lateralization of the COR and increased subacromial space improve ROM in all CSA configurations.: A. Lädermann, E. Tay, P. Collin, S. Piotton, C-H Chiu, A. Michelet, C. Charbonnier. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. 2019;8:378-386. DOI: 10.1302/2046-3758.88.BJR-2018-0293.R1.
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http://dx.doi.org/10.1302/2046-3758.88.BJR-2018-0293.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719532PMC
August 2019

Mid-term results of reverse shoulder arthroplasty for glenohumeral osteoarthritis with posterior glenoid deficiency and humeral subluxation.

J Shoulder Elbow Surg 2019 Oct 9;28(10):2023-2030. Epub 2019 Aug 9.

Service de Chirurgie Orthopédique et Traumatologique, CHU Hôpital Pasteur 2, Nice, France.

Background: Results of anatomic shoulder arthroplasty for glenohumeral osteoarthritis with severe glenoid retroversion are unpredictable with a high rate of glenoid loosening. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, with good early results. We sought to confirm this at longer follow-up (minimum 5 years). The study hypothesis was that early results would endure over time.

Methods: We retrospectively reviewed all RSAs performed in 7 centers from 1998 to 2010. The inclusion criteria were primary glenohumeral osteoarthritis with B1, B2, B3, or C glenoid. Forty-nine shoulders in 45 patients fulfilled the criteria. Bone grafting was performed in 16 cases. Clinical outcomes were evaluated with the Constant score (CS) and shoulder range of motion.

Results: The mean total CS increased from 30 preoperatively to 68 points (P < .001) with significant improvements in all the subsections of the CS and range of motion. Scapular notching was observed in 20 shoulders (43%), grade 1 in 5 (11%), grade 2 in 7 (15%), grade 3 in 5 (11%), and grade 4 in 3 (6%). The glenoid bone graft healed in all the shoulders. Partial inferior lysis of the bone graft was present in 8 cases (50%). Scapular notching and glenoid bone graft resorption had no influence on the CS (P = .147 and P = .798).

Conclusion: RSA for the treatment of primary glenohumeral osteoarthritis in patients with posterior glenoid deficiency and humeral subluxation without rotator cuff insufficiency resulted in excellent clinical outcomes at a minimum of 5 years of follow-up.
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http://dx.doi.org/10.1016/j.jse.2019.03.002DOI Listing
October 2019

"Tomydesis" might be a reliable technique for lesions of the long head of the biceps tendon associated with rotator cuff tears: a minimum 6-month prospective clinical follow-up study.

Eur J Orthop Surg Traumatol 2020 Jan 5;30(1):83-87. Epub 2019 Aug 5.

Service d'Orthopédie 1C, Centre Hospitalier Universitaire de Tours, Avenue de la République, 37044, Tours, France.

Purpose: To compare the clinical outcomes of self-locking T-tenotomy called "tomydesis" to three different techniques of tenodesis for lesions of the long head of the biceps tendon (LHBT) associated with rotator cuff tears.

Hypothesis: Tomydesis could provide similar clinical outcomes than the other LHBT tenodesis techniques.

Methods: This prospective multicentre study included 77 patients who underwent rotator cuff repair concomitant with one of four surgical techniques on the LHBT. All patients had a minimum of 6-month follow-up post-operatively. Outcomes were evaluated based on the Constant score, SSV, pain on visual analogue scale, biceps-specific pain and Popeye deformity on photographs.

Results: There was no difference for the pain at the biceps muscle belly (p = 0.58), the bicipital groove (p = 0.69) and during resisted supination (p = 0.53), as well as for muscle cramps (p = 0.09), VAS for pain (p = 0.12) and Popeye deformity (p = 0.18). There was more pain in resisted flexion in the tomydesis group (p = 0.032), and significantly better Constant scores and SSV (< 0.001) in the patients who underwent the double lasso loop technique, but non-repairable cuff tears were most frequent in the tomydesis group.

Conclusions: Tomydesis might be a reliable alternative that combines advantages of tenodesis and tenotomy. It should be considered in cases of rotator cuff tears, whose repair and healing are the key for good functional outcomes.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s00590-019-02525-0DOI Listing
January 2020

Clinical and radiological outcomes of osteoarthritis twenty years after rotator cuff repair.

Orthop Traumatol Surg Res 2019 09 14;105(5):813-818. Epub 2019 Jun 14.

Clinique Privé Saint-Grégoire 6, boulevard de la Boutière, 35768 Saint-Grégoire, France.

Purpose: Outcomes of open or arthroscopic rotator cuff repairs are well reported in the literature. The purpose of the study was to evaluate the prevalence and clinical impact of osteoarthritis 20 years following rotator cuff repair. The hypothesis was that, at long follow-up, most shoulders would have developed gleno-humeral osteoarthritis.

Methods: The authors retrospectively recalled all 322 patients, operated for rotator cuff tears in 1994 at 6 different centres, for clinical and radiographic assessment. At 20 years of follow-up, 24 were re-operated (5 arthroplasty) and 53.4% were lost to follow-up. This left 126 patients, had been clinically assessed, had Magnetic Resonance Images (MRI) that allowed anatomic assessment of tendon healing (Sugaya), fatty infiltration (Goutallier), and X rays in order to analyse arthritis without head migration (Samilson) and with head migration (Hamada and Fukuda). Only patients with complete data were selected.

Results: Mean aged was 52.3 years (25.3-68.6) at index operation. The Constant score was 45.3±19.6 preoperatively to 67.4±18.7 points at 20 years. The SSV was 73.5±21 postoperatively. The rate of osteoarthritis was 29%. Osteoarthritis was associated with a significant inferior Constant score compared to the non-arthritic group (61 versus 71 points, p=0.02), mainly due to a significant lower strength (5.4 versus 8.7 points, p=0.007). Massive rotator cuff tears were significantly associated with a higher rate of osteoarthritis. Only 4,8% patients after cuff repear needed a reverse shoulder arthroplasty. Significantly less osteoarthritis was observed when the rotator cuff repair remained intact. Suprasupinatus retear had a significant influence on fatty infiltration of the infrasupinatus muscle and on the progression towards osteoarthritis.

Conclusion: Twenty years after open rotator cuff repair, the rate of osteoarthritis was 29%. Massive rotator cuff tears were significantly associated with a higher rate of osteoarthritis. Less osteoarthritis was observed when suprasupinatus healed.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.otsr.2019.02.013DOI Listing
September 2019

Mid- to long-term follow-up of shoulder arthroplasty for primary glenohumeral osteoarthritis in patients aged 60 or under.

J Shoulder Elbow Surg 2019 Sep 13;28(9):1666-1673. Epub 2019 Jun 13.

Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.

Background: Shoulder arthroplasty in young patients with primary glenohumeral osteoarthritis is an area of continued controversy.

Methods: A retrospective multicenter study was performed for all patients aged 60 years or less undergoing either hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis with a minimum of 24-month follow-up. Clinical and functional outcomes, complications, and need for revision surgery were analyzed. Survivorship analysis using revision arthroplasty as an endpoint was determined.

Results: A total of 202 patients with a mean age of 55.3 years (range, 36-60 years) underwent TSA with a mean follow-up of 9 years (range, 2-24.7 years). Revision arthroplasty was performed in 33 (16.3%) shoulders, with glenoid failure associated with the revision in 29 shoulders (88%). TSA survivorship analysis demonstrated 95% free of revision at 5 years, 83% at 10 years, and 60% at 20-year follow-up. A total of 31 patients with a mean age of 52.5 years (range, 38-60 years) underwent HA with a mean follow-up of 8.7 years (range, 2-21.4 years). Revision arthroplasty was performed in 5 (16.1%) shoulders, with glenoid erosion as the cause for revision in 4 shoulders (80%). HA survivorship analysis demonstrated 84% free from revision at 5 years and 79% at the final follow-up. TSA resulted in a significantly better range of motion, pain, subjective shoulder value, and Constant score compared with HA.

Conclusion: In young patients with primary glenohumeral osteoarthritis, TSA resulted in significantly better functional and subjective outcomes with no significant difference in longitudinal survivorship compared with patients treated with HA.
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http://dx.doi.org/10.1016/j.jse.2019.03.006DOI Listing
September 2019

Dynamic Anterior Shoulder Stabilization With the Long Head of the Biceps Tendon: A Biomechanical Study.

Am J Sports Med 2019 05 9;47(6):1441-1450. Epub 2019 Apr 9.

Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.

Background: The concept of dynamic anterior shoulder stabilization (DAS) combines a Bankart repair with the additional sling effect of the long head of the biceps (LHB) tendon to treat anterior glenohumeral instability. This surgical technique was created to close the gap between the indications for isolated Bankart repair and those requiring bone transfer techniques.

Purpose: To biomechanically investigate the stabilizing effects of the DAS technique in comparison with the standard Bankart repair in different defect models.

Study Design: Controlled laboratory study.

Methods: Twenty-four fresh-frozen cadaveric shoulders (mean ± SD age, 60.1 ± 8.6 years) were mounted in a 6 degrees of freedom shoulder testing system. With cross-sectional area ratios, the rotator cuff muscles and LHB tendon were loaded with 40 N and 10 N, respectively. Anterior and inferior glenohumeral translation was tested in 60° of abduction and 60° of external rotation (ABER position) while forces of 20 N, 30 N, and 40 N were applied to the scapula in the posterior direction. Total translation and relative translation in relation to the native starting position were measured with a 3-dimensional digitizer. Maximal external rotation and internal rotation after application of 1.5-N·m torque to the humerus were measured. All specimens went through 4 conditions (intact, defect, isolated Bankart repair, DAS) and were randomized to 1 of 3 defect groups (isolated Bankart lesion, 10% anterior glenoid defect, 20% anterior glenoid defect). The DAS was performed by transferring the LHB tendon through a subscapularis split to the anterior glenoid margin, where it was fixed with an interference screw.

Results: Both surgical techniques resulted in decreased anterior glenohumeral translation in comparison with the defect conditions in all defect groups. As compared with isolated Bankart repair, DAS showed significantly less relative anterior translation in 10% glenoid defects at translation forces of 20 N (0.3 ± 1.7 mm vs 2.2 ± 1.8 mm, P = .005) and 30 N (2.6 ± 3.4 mm vs 5.3 ± 4.2 mm, P = .044) and in 20% glenoid defects at all translation forces (20 N: -3.2 ± 4.7 mm vs 0.8 ± 4.1 mm, P = .024; 30 N: -0.9 ± 5.3 mm vs 4.0 ± 5.2 mm, P = .005; 40 N: 2.1 ± 6.6 mm vs 6.0 ± 5.7 mm, P = .035). However, in 20% defects, DAS led to a relevant posterior and inferior shift of the humeral head in the ABER position and to a relevant increase in inferior glenohumeral translation. Both surgical techniques did not limit the rotational range of motion.

Conclusion: In the context of minor glenoid bone defects, the DAS technique demonstrates less relative anterior translation as compared with an isolated Bankart repair at time zero.

Clinical Relevance: The new DAS technique seems capable of closing the gap between the indications for isolated Bankart repair and bone transfer techniques.
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http://dx.doi.org/10.1177/0363546519833990DOI Listing
May 2019

Postoperative Mobilization After Superior Rotator Cuff Repair: Sling Versus No Sling: A Randomized Prospective Study.

J Bone Joint Surg Am 2019 Mar;101(6):494-503

Division of Orthopaedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland.

Background: Patients are commonly advised to wear a sling for 4 to 6 weeks after rotator cuff repair despite negative effects of early immobilization and benefits of motion rehabilitation. The aim of this study was to compare clinical and radiographic outcomes up to 6 months following rotator cuff repair with and without postoperative sling immobilization.

Methods: We randomized 80 patients scheduled for arthroscopic repair of a small or medium superior rotator cuff tear into sling and no-sling groups (40 patients each). Passive mobilization was performed in both groups during the first 4 postoperative weeks, and this was followed by progressive active mobilization. Patients were evaluated clinically at 10 days and 1.5, 3, and 6 months and using ultrasound at 6 months. Univariable and multivariable analyses were performed to determine if postoperative scores were associated with sex, age at surgery, immobilization, arm dominance, a biceps procedure, resection of the distal part of the clavicle, or preoperative scores.

Results: The sling and no-sling groups had similar preoperative patient characteristics, function, and adjuvant procedures. At 10 days, there was no difference in pain between the 2 groups (mean pain score [and standard deviation], 5.2 ± 2.3 versus 5.2 ± 1.9, p = 0.996). In comparison with the sling group, the no-sling group showed greater mean external rotation (23.5° ± 15.6° versus 15.3° ± 14.6°, p = 0.017) and active elevation (110.9° ± 31.9° versus 97.0° ± 25.0°, p = 0.038) at 1.5 months as well as better mean active elevation (139.0° ± 24.7° versus 125.8° ± 24.4°, p = 0.015) and internal rotation (T12 or above in 50% versus 28%, p = 0.011) at 3 months. Ultrasound evaluation revealed no significant differences at 6 months in tendon thickness anteriorly (p = 0.472) or posteriorly (p = 0.639), bursitis (p = 1.000), echogenicity (p = 0.422), or repair integrity (p = 0.902). Multivariable analyses confirmed that the mean American Shoulder and Elbow Surgeons (ASES) score increased with patient age (beta, 0.60; p = 0.009), the Single Assessment Numeric Evaluation (SANE) decreased with sling immobilization (beta, -6.33; p = 0.014), and pain increased with sling immobilization (beta, 0.77; p = 0.022).

Conclusions: No immobilization after rotator cuff repair is associated with better early mobility and functional scores in comparison with sling immobilization. Postoperative immobilization with a sling may therefore not be required for patients treated for a small or medium tendon tear.

Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.18.00773DOI Listing
March 2019

Subscapularis in Reverse Total Shoulder Arthroplasty.

J Shoulder Elb Arthroplast 2019 7;3:2471549219834192. Epub 2019 Mar 7.

Department of Orthopaedic Surgery and Traumatology, University of Bern, Bern, Switzerland.

The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly popular, but many biomechanical aspects are poorly understood. Particularly, the role and function of the subscapularis following RSA are unclear. Several clinical and biomechanical studies have analyzed its role in range of motion and stability. There is some evidence that the subscapularis is beneficial for stability but may reduce range of motion. This review provides an overview of the current literature, which suggests that the subscapularis may have a more important role in RSA than originally thought.
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http://dx.doi.org/10.1177/2471549219834192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282168PMC
March 2019
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