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Anterior glenohumeral instability:Current review with technical pearls and pitfalls of arthroscopic soft-tissue stabilization

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World Journal of Orthopedics 2021年第1期12卷 1-13页

作者： John M Apostolakos joshua Wright-Chisem Lawrence V Gulotta samuel A Taylor joshua s dines Department of sports Medicine and shoulder surgery Hospital for Special SurgeryNew YorkNY 10021United States

The glenohumeral joint(GHJ)allows for a wide range of motion,but is also particularly vulnerable to episodes of *** GHJ instability is especially frequent among young,athletic populations during contact sporting *** first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation,however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate *** of the optimal treatment strategy should be made on a case-by-case basis while weighing both patient specific factors and injury patterns(i.e.,bone loss).The purpose of this review is to describe the relevant anatomical stabilizers of the GHJ,risk factors for recurrent instability including bony lesions,indications for arthroscopic vs open surgical management,clinical history and physical examination techniques,imaging modalities,and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohumeral instability.

关键词： Arthroscopic soft-tissue Anterior instability Glenohumeral Functional anatomy Recurrent instability

Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction

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World Journal of Orthopedics 2016年第11期7卷 709-717页

作者： Hao-Hua Wu Max Liu joshua s dines John D Kelly Grant H Garcia Perelman school of Medicine University of Pennsylvania Jordan Medical Education Center stanford school of Medicine Hospital for special surger Department of Orthopaedic surgery University of Pennsylvania

While most patients with an anterior cruciate ligament(ACL) injury indicate satisfaction with surgical intervention, a significant proportion still do not return to pre-injury level of function or sport. Psychiatric comorbidities, such as depression, have recently been associated with poor clinical outcomes after ACL reconstruction(ACLR). To date, no article has yet examined how depression affects ACLR outcomes and how potential screening and intervention for psychological distress may affect postoperative activity level. The purpose of this review is to delineate potential relationships between depression and ACLR outcome, discuss clinical implications and identify future directions for research.

关键词： Depression Preoperative evaluation Anxiety Anterior cruciate ligament reconstruction Patient reported outcome Orthopedic surgery

Understanding the medial ulnar collateral ligament of the elbow: Review of native ligament anatomy and function

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World Journal of Orthopedics 2018年第6期9卷 78-84页

作者： joshua R Labott William R Aibinder joshua s dines Christopher L Camp Mayo Clinic school of Medicine Mayo Clinic Department of Orthopedic surgery Mayo Clinic sports Medicine and shoulder service Hospital of Special Surgery Department of Orthopedic surgery and sports Medicine Mayo Clinic

The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament(MUCL)], posterior(PB), and transverse ligament, is commonly injured in overhead throwing athletes. Attenuation or rupture of the ligament results in valgus instability with variable clinical presentations. The AB or MUCL is the strongest component of the ligamentous complex and the primary restraint to valgus stress. It is also composed of two separate bands(anterior and posterior) that provide reciprocal function with the anterior band tight in extension, and the posterior band tight in flexion. In individuals who fail co-mprehensive non-operative treatment, surgical repair or reconstruction of the MUCL is commonly required to restore elbow function and stability. A comprehensive understanding of the anatomy and biomechanical properties of the MUCL is imperative to optimize reconstructive efforts, and to enhance clinical and radiographic outcomes. Our understanding of the native anatomy and biomechanics of the MUCL has evolved over time. The precise locations of the origin and insertion footprint centers guide surgeons in proper graft placement with relation to bony anatomic landmarks. In recent studies, the ulnar insertion of the MUCL is described as larger than previously thought, with the center of the footprint at varying distances relative to the ulnar ridge, joint line, or sublime tubercle. The purpose of this review is to consolidate and summarize the existing literature regarding the native anatomy, biomechanical, and clinical significance of the entire medial ulnar collateral ligament complex, including the MUCL(AB), PB, and transverse ligament.

关键词： Elbow Anterior bundle Medial ulnar collateral ligament Native anatomy Biomechanics Valgus stability

Evaluation and treatment of internal impingement of the shoulder in overhead athletes

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World Journal of Orthopedics 2016年第12期7卷 776-784页

作者： Keith T Corpus Christopher L Camp David M dines David W Altchek joshua s dines shoulder and sports Medicine service Hospital for Special Surgery

One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulderpain resulting from internal impingement. "Internal impingement" is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial,involving physiologic shoulder remodeling,posterior capsular contracture,and scapular dyskinesis. Throwers with internal impingement may complain of shoulder stiffness or the need for a prolonged warm-up,decline in performance,or posterior shoulder pain. On physical examination,patients will demonstrate limited internal rotation and posterior shoulder pain with a posterior impingement test. Common imaging findings include the classic "Bennett lesion" on radiographs,as well as articular-sided partial rotator cuff tears and concomitant sLAP lesions. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule. Operative management is variable depending on the exact pathology,but largely consists of rotator cuff debridement. Outcomes of operative treatment have been mixed,therefore intense non-operative treatment should remain the focus of treatment.

关键词： Internal impingement Overhead athlete Partial rotator cuff tear scapular dyskinesis Posterior capsular contracture sLAP tear

Treatment of the ulnar nerve for overhead throwing athletes undergoing ulnar collateral ligament reconstruction

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World Journal of Orthopedics 2016年第10期7卷 650-656页

作者： Matthew s Conti Christopher L Camp Neal s Elattrache David W Altchek joshua s dines Department of Orthopaedic surgery Hospital for Special Surgery shoulder and sports Medicine service Hospital for Special Surgery Kerlan-Jobe Orthopaedic Clinic

Ulnar nerve(UN) injuries are a common complaint amongst overhead athletes. The UN is strained during periods of extreme valgus stress at the elbow, especially in the late-cocking and early acceleration phases of throwing. Although early ulnar collateral ligament(UCL) reconstruction techniques frequently included routine submuscular UN transposition, this is becoming less common with more modern techniques. We review the recent literature on the sites of UN compression, techniques to evaluate the UN nerve, and treatment of UN pathology in the overhead athlete. We also discuss our preferred techniques for selective decompression and anterior transposition of the UN when indicated. More recent studies support the use of UN transpositions only when there are specific preoperative symptoms. Athletes with isolated ulnar neuropathy are increasingly being treated with subcutaneous anterior transposition of the nerve rather than submuscular transposition. When ulnar neuropathy occurs with UCL insufficiency, adoption of the muscle-splitting approach for UCL reconstructions, as well as using a subcutaneous UN transposition have led to fewer postoperative complications and improved outcomes. Prudent handling of the UN in addition to appropriate surgical technique can lead to a high percentage of athletes who return to competitive sports following surgery for ulnar neuropathy.

关键词： Ulnar nerve Neuropathy Ulnar collateral ligament reconstruction Management Athletes

Bile acid metabolism and signaling in health and disease:molecular mechanisms and therapeutic targets

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signal Transduction and Targeted Therapy 2024年第5期9卷 2014-2064页

作者： joshua s.Fleishman sunil Kumar Department of Pharmaceutical sciences College of Pharmacy and Health SciencesSt.John’s UniversityQueensNYUSA

Bile acids,once considered mere dietary surfactants,now emerge as critical modulators of macronutrient(lipid,carbohydrate,protein)metabolism and the systemic pro-inflammatory/anti-inflammatory *** acid metabolism and signaling pathways play a crucial role in protecting against,or if aberrant,inducing cardiometabolic,inflammatory,and neoplastic conditions,strongly influencing health and *** curative treatment exists for any bile acid influenced disease,while the most promising and well-developed bile acid therapeutic was recently rejected by the ***,we provide a bottom-up approach on bile acids,mechanistically explaining their biochemistry,physiology,and pharmacology at canonical and non-canonical *** this mechanistic model of bile acids,we explain how abnormal bile acid physiology drives disease pathogenesis,emphasizing how ceramide synthesis may serve as a unifying pathogenic feature for cardiometabolic *** provide an in-depth summary on pre-existing bile acid receptor modulators,explain their shortcomings,and propose solutions for how they may be ***,we rationalize novel targets for further translational drug discovery and provide future *** than dismissing bile acid therapeutics due to recent setbacks,we believe that there is immense clinical potential and a high likelihood for the future success of bile acid therapeutics.

关键词： metabolism rejected shortcomings

Return to sports after shoulder arthroplasty

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World Journal of Orthopedics 2016年第9期7卷 519-526页

作者： Christine C Johnson Daniel J Johnson Joseph N Liu joshua s dines David M dines Lawrence V Gulotta Grant H Garcia Department of sports Medicine and shoulder surgery Hospital for Special Surgery the school of Medicine Vanderbilt University School of Medicine

Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty(TsA), reverse total shoulder arthroplasty(RTsA), and hemiarthroplasty(HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TsA, RTsA, and shoulder ***, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TsA(75%-100%) are slightly higher than those reported for HA(67%-76%) and RTsA(75%-85%). Patients undergoing TsA, RTsA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TsA has been associated with higher rates of return to sports than RTsA and HA,although this may reflect differences in patient population or surgical indication.

关键词： Total shoulder arthroplasty Reverse total shoulder arthroplasty shoulder replacement Return to sport Hemiarthroplasty

Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes?

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World Journal of Orthopedics 2016年第4期7卷 229-243页

作者： Lauren H Redler Ryan M Degen Lucas s McDonald David W Altchek joshua s dines sports Medicine and shoulder service Hospital for Special Surgery

Injury to the ulnar collateral ligament(UCL) most commonly occurs in the overhead throwing athlete. Knowledge surrounding UCL injury pathomechanics continues to improve, leading to better preventative treatment strategies and rehabilitation programs. Conservative treatment strategies for partial injuries, improved operative techniques for reconstruction in complete tears, adjunctive treatments, as well as structured sport specific rehabilitation programs including resistive exercises for the entire upper extremity kinetic chain are all important factors in allowing for a return to throwing in competitive environments. In this review, we explore each of these factors and provide recommendations based on the available literature to improve outcomes in UCL injuries in athletes.

关键词： Elbow Ulnar collateral ligament Valgus instability Tommy John surgery Rehabilitation Overhead athlete Improved outcomes

骨科教程不易修复性肩袖破裂：如何做和何时做；医生的困惑

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骨科动态 2007年第1期3卷 58-64页

作者： DAVID M. dines DANIEL P. MOYNIHAN joshua s. dines PETER MCCANN 钱不凡（译） An Instructional Course Lecture American Academy of Orthopaedic Surgeons 上海市伤骨科研究所 200025

不易修复性肩袖破裂虽不常见，但是一种不能用常规方法修复的大型明确定位的病损。Rockwood及其他学者认为．根据其破裂的尺寸及回缩程度的特点采用常规游离及软组织松解的方法不能一期把它们的支点重新安放到结节上。Goutallier等根据C... 详细信息

不易修复性肩袖破裂虽不常见，但是一种不能用常规方法修复的大型明确定位的病损。Rockwood及其他学者认为．根据其破裂的尺寸及回缩程度的特点采用常规游离及软组织松解的方法不能一期把它们的支点重新安放到结节上。Goutallier等根据CT显示的肌肉萎缩及脂肪浸润程度，对肩袖破裂进行分类。这种破裂因常合并盂肱关节炎，而使其治疗更为复杂。

关键词：肩袖破裂修复性骨科教程医生软组织松解盂肱关节炎浸润程度肌肉萎缩