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Accuracy of shoulder joint injections with ultrasound guidance:Confirmed by magnetic resonance arthrography

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World Journal of Orthopedics 2022年第3期13卷 259-266页

作者： Kosuke Kuratani Makoto Tanaka Hiroto Hanai Kenji Hayashida Department of Orthopedic Surgery Japan Community Healthcare Organization Osaka HospitalOsaka 553-0003Japan Center for sports medicine Daini Osaka Police HospitalOsaka 543-8922Japan Department of orthopaedic Surgery Osaka University Graduate School of MedicineSuita 565-0871Japan Department of orthopaedic Surgery Daini Osaka Police HospitalOsaka 543-8922Japan

BACKGROUND Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used;however, they pose a risk of radiation exposure and are expensive and timeconsuming. Recently, it has been suggested that ultrasound-guided injections are accurate and cost effective procedures.AIM To evaluate the accuracy of ultrasound-guided glenohumeral injections using a posterior approach that is confirmed using magnetic resonance arthrography(MRA).METHODS The study included 179 shoulders of patients with recurrent anterior instability(150 patients;103 and 76 right and left shoulders, respectively;160 males and 19 females;average age = 20.5 years;age range: 14-63 years) who underwent MRA for preoperative diagnosis. They were injected with 12 m L lidocaine(1%) using the ultrasound-guided posterior approach and then underwent magnetic resonance imaging. Two shoulder surgeons, except for the injector, evaluated the transverse relaxation(T2)-weighted images of axial planes and classified the intraarticular condition of injected contrast into three groups based on one of the three following scenarios: no leakage, injection into the glenohumeral joint without leakage;minor leakage, practical intra-articular injection with some leakage outside the posterior rotator cuffs;and major leakage, inaccurate injection with mass leakage without any contrast into the joint. The inter-rater reliability between two assessors was also evaluated by calculating Cohen’s kappa coefficient. The learning curve was assessed regarding the inaccurate injection rate by analyzing Spearman’s rank correlation coefficient.RESULTS Of the 179 injections, 163 shoulders(91.0%) had no leakage, 10 shoulders(5.6%) had minor leakage, and six shoulders(3.4%) had major leakage. In total, 173 shoulders(96.6%) were intraarticularly injected;thus, we could detect anterior labrum and capsular pathologies. Regarding the inter-rater reliability, the kappa coefficient was 0.925, in

关键词： Shoulder injections Glenohumeral injections Ultrasound guidance Magnetic resonance arthrography

Systematic review of bone marrow stimulation for osteochondral lesion of talus-evaluation for level and quality of clinical studies

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World Journal of Orthopedics 2017年第12期8卷 956-963页

作者： Youichi Yasui Laura Ramponi Dexter Seow Eoghan T Hurley Wataru Miyamoto Yoshiharu Shimozono John G Kennedy 2~(nd) Department of orthopaedic Surgery Teikyo University School of Medicine Hospital for Special Surgery New York 2~(nd) Rizzoli orthopaedic Institute 2~(nd) Royal College of surgeons in Ireland Department of orthopaedic Surgery Teikyo University School of Medicine

AIM To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation(BMS) for osteochondral lesions of the talus(OLT). METHODS Two reviewers searched the Pub Med/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence(LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score. RESULTS This review included 22 studies. Overall, 21 of the 22(95.5%) included studies were level Ⅳ or level Ⅲ evidences. The remaining study was a level Ⅱ evidence. MQOE analysis revealed 14 of the 22(63.6%) included studies having fair quality, 7(31.8%) studies having poor quality and only 1 study having excellent quality. CONCLUSION The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.

关键词： Osteochondral lesion of talus Arthroscopy Bone marrow stimulation Systematic review

Management of proximal biceps tendon pathology

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World Journal of Orthopedics 2022年第1期13卷 36-57页

作者： Simon P Lalehzarian Avinesh Agarwalla Joseph N Liu The Chicago Medical School Rosalind Franklin University of Medicine and ScienceNorth ChicagoIL 60064United States Department of Orthopedic Surgery Westchester Medical CenterValhallaNY 10595United States USC Epstein Family Center for sports medicine Keck Medicine of USCLos AngelesCA 90033United States

The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.

关键词： Shoulder pathology Long head of the biceps tendon Biceps-labral complex Biceps tenotomy Biceps tenodesis Superior labrum anterior to posterior lesions

Who should you be following? The top 100 social media influencers in orthopaedic surgery

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World Journal of Orthopedics 2019年第9期10卷 327-338页

作者： Nathan H Varady Akash A Chandawarkar Willem A Kernkamp Itai Gans Department of orthopaedic Surgery Massachusetts General Hospital/Harvard Medical SchoolBostonMA 02114United States Department of Plastic and Reconstructive Surgery Johns Hopkins University School of MedicineBaltimoreMD 21205United States Department of orthopaedic Surgery Johns Hopkins University School of MedicineBaltimoreMD 21205United States

BACKGROUND Social media has been credited with the potential to transform medicine,and Twitter was recently named“an essential tool”for the academic surgeon.Despite this,peer-to-peer and educational influence on social media has not been studied within orthopaedic surgery.This knowledge is important to identify who is controlling the conversation about orthopaedics to the public.We hypothesized that the plurality of top influencers would be sports medicine surgeons,that social media influence would not be disconnected from academic productivity,and that some of the top social media influencers in orthopaedic surgery would not be orthopaedic surgeons.AIM To identify the top 100 social media influencers within orthopaedics,characterize who they are,and relate their social media influence to academic influence.METHODS Twitter influence scores for the topic“orthopaedics”were collected in July 2018 using Right Relevance software.The accounts with the top influence scores were linked to individual names,and the account owners were characterized with respect to specialty,subspecialty,practice setting,location,board certification,and academic Hirsch index(h-index).RESULTS Seventy-eight percent of top influencers were orthopaedic surgeons.The most common locations included California(13%),Florida(8%),New York(7%),United Kingdom(7%),Colorado(6%),and Minnesota(6%).The mean academic h-index of the top influencers(n=79)was 13.67±4.12(mean±95%CI)and median 7(range 1-89)(median reported h-index of academic orthopaedic faculty is 5 and orthopaedic chairpersons is 13).Of the 78 orthopaedic surgeons,the most common subspecialties were sports medicine(54%),hand and upper extremity(18%),and spine(8%).Most influencers worked in private practice(53%),followed by academics(17%),privademics(14%),and hospital-based(9%).All eligible orthopaedic surgeons with publicly-verifiable board certification statuses were board-certified(n=74).CONCLUSION The top orthopaedic social media influencers on Twitter were predominantly board-certified,sport

关键词： Social media Influence Impact Twitter orthopaedics Orthopedics

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study

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World Journal of Orthopedics 2021年第12期12卷 983-990页

作者： Dimitrios Kitridis Dimosthenis Alaseirlis Nikolaos Malliaropoulos Byron Chalidis Patrick McMahon Richard Debski Panagiotis Givissis orthopaedic Department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54124Greece William Harvey Research Institute Centre for Sports and ExerciseBarts and The London School of Medicine and DentistryQueen MaryUniversity of LondonLondon EC1M 6BQUnited Kingdom McMahon Orthopedics and Rehabilitation University of PittsburghPittsburghPA 15203United States Department of Bioengineering Swanson School of EngineeringUniversity of PittsburghPittsburghPA 15219United States

BACKGROUND Arthroscopic procedures are commonly performed for rotator cuff pathology.Repair of rotator cuff tears is a commonly performed procedure.The intraoperative evaluation of the tear size and pattern contributes to the choice and completion of the technique and the prognosis of the repair.AIM To compare the arthroscopic and open measurements with the real dimensions of three different patterns of simulated rotator cuff tears of known size using a plastic shoulder model.METHODS We created three sizes and patterns of simulated supraspinatus tears on a plastic shoulder model(small and large U-shaped,oval-shaped).Six orthopaedic surgeons with three levels of experience measured the dimensions of the tears arthroscopically,using a 5 mm probe,repeating the procedure three times,and then using a ruler(open technique).Arthroscopic,open and computerized measurements were compared.RESULTS A constant underestimation of specific dimensions of the tears was found when measured with an arthroscope,compared to both the open and computerized measurements(mean differences up to-7.5±5.8 mm,Psurgeons and fellows.CONCLUSION This study suggests that arthroscopic measurements of full-thickness rotator cuff tears constantly underestimate the dimensions of the tears.Development of more precise arthroscopic techniques or tools for the evaluation of the size and type of rotator cuff tears are necessary.

关键词： Shoulder Arthroscopy Simulation model Rotator cuff tear Supraspinatus tear Cuff tear size

Diabetes and its negative impact on outcomes in orthopaedic surgery

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World Journal of Orthopedics 2015年第3期6卷 331-339页

作者： Dane K Wukich Department of orthopaedic Surgery University of Pittsburgh School of Medicine UPMC Mercy Health Center

An estimated 285 million adults(aged 20-79 years)worldwide were diagnosed to have diabetes mellitus(DM)in 2010,and this number is projected to grow to 439million adults by the year 2030.orthopaedic surgeons,regardless of their subspecialty interest,will encounter patients with DM during their career since this epidemic involves both developed and emerging countries.Diabetes results in complications affecting multiple organ systems,potentially resulting in adverse outcomes afterorthopaedic surgery.The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients.Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle,upper extremity,adult reconstructive,pediatrics,spine surgery and sports medicine.Poorly controlled diabetes negatively impacts bone,soft tissue,ligament and tendon healing.It is the complications of diabetes such as neuropathy,peripheral artery disease,and end stage renal disease which contributes to adverse outcomes.Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes.orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.

关键词： Diabetes orthopaedic surgery Outcomes Complications Neuropathy

Current and future of anterior cruciate ligament reconstruction techniques

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World Journal of Meta-Analysis 2021年第5期9卷 411-437页

作者： Toshiaki Takahashi Seiji Watanabe Toshio Ito Department of sports and Health Science Ehime UniversityMatsuyama 790-8577EhimeJapan Department of Orthopedic Surgery Ehime University Graduate School of MedicineToon 791-0295EhimeJapan Department of orthopaedic Surgery Murakami Memorial HospitalSaijo 793-0030EhimeJapan

In recent years,anterior cruciate ligament(ACL)reconstruction has generally yielded favorable outcomes.However,ACL reconstruction has not provided satisfactory results in terms of the rate of returning to sports and prevention of osteoarthritis(OA)progression.In this paper,we outline current techniques for ACL reconstruction such as graft materials,double-bundle or single-bundle reconstruction,femoral tunnel drilling,all-inside technique,graft fixation,preservation of remnant,anterolateral ligament reconstruction,ACL repair,revision surgery,treatment for ACL injury with OA and problems,and discuss expected future trends.To enable many more orthopedic surgeons to achieve excellent ACL reconstruction outcomes with less invasive surgery,further studies aimed at improving surgical techniques are warranted.Further development of biological augmentation and robotic surgery technologies for ACL reconstruction is also required.

关键词： Anterior cruciate ligament reconstruction Surgical techniques Revision surgery Biological augmentation Computer-aided surgery