Giovanni Di Giacomo

Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients

BACKGROUND The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability in certain patients. However, progression of the transferred coracoid bone graft to osteolysis has been reported in the literature. We propose that the coracoid bone graft osteolysis could be one of the causes of failure of the Latarjet procedure. MATERIALS AND METHODS A computed tomography scan analysis was done of 26 patients prospectively followed-up after the Latarjet procedure to determine the location and the amount of the coracoid graft osteolysis. RESULTS The most relevant osteolysis was represented by the superficial part of the proximal coracoid, whereas the distal region of the coracoid bone graft, especially in the deep portion, was the least involved in osteolysis and had the best bone healing. DISCUSSION To our knowledge, this is the first study to quantify and localize coracoid osteolysis after Latarjet procedure for anteroinferior shoulder instability using CT scan analysis. CONCLUSION Our study suggests that the bone-block effect from the Latarjet procedure may not be the principal effect in its treatment of anteroinferior shoulder instability in patients without significant bony defects.

Management of Disorders of the Rotator Cuff: Proceedings of the ISAKOS Upper Extremity Committee Consensus Meeting

The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committees (UECs) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff- and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single- versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented.

Postoperative analgesia for arthroscopic shoulder surgery: a prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy.

Background and objectives The aim of the present study was to compare the new combination of intraarticular + subacromial injection, with intraarticular, subacromial injection and interscalenic brachial plexus block as postoperative analgesia in shoulder arthroscopy. Methods One hundred and twenty patients scheduled for shoulder arthroscopy were enrolled and randomly assigned to one of five groups: intraarticular, subacromial, interscalenic brachial plexus block (IBPB), intraarticular + subacromial (intraarticular + subacromial) injection or a control group. All patients received standardized general anaesthesia and all the injections were given with the same dose and volume of local anaesthetic. The number of boluses (fentanyl 1 μg kg−1) delivered by a patient-controlled analgesia pump applied at the end of the surgery and the visual analogue pain score (VAPS) at 0, 2, 4, 6, 12, 18 and 24 h after the intervention were recorded. A patient satisfaction score was also assessed at 24 h. Results Mean bolus consumption, compared with control group, was significantly less in all groups (P < 0.01). Intraarticular + subacromial group utilized fewer boluses compared with subacromial group and significantly lower boluses than intraarticular group (P < 0.01), but IBPB group utilized significantly fewer boluses than intraarticular + subacromial group. Patients in IBPB, intraarticular + subacromial and subacromial groups showed VAPSs that were significantly better than that of the control group at all time points (P < 0.01). The VAPS in intraarticular + subacromial group was statistically comparable with those in IBPB and subacromial groups at each time interval. IBPB and intraarticular + subacromial groups showed comparable patient satisfaction scores. Conclusion These results confirm the analgesic efficacy of IBPB for shoulder surgery. Nonetheless, the combination of intraarticular and subacromial infiltration, studied for the first time, appears to be a clinically valid alternative with no clinical meaningful adverse effects.

Atlas of functional shoulder anatomy

Scapulothoracic Joint.- Acromioclavicular Joint and Scapular Ligaments.- Glenohumeral Joint (Muscle-Tendon).- Glenohumeral Capsule.- Neuromuscular Control and Proprioception of the Shoulder.

Coracoid bone graft osteolysis after Latarjet procedure: A comparison study between two screws standard technique vs mini-plate fixation

Aims: One of the reason for Latarjet procedure failure may be coracoid graft osteolysis. In this study, we aimed to understand if a better compression between the coracoid process and the glenoid, using a mini-plate fixation during the Latarjet procedure, could reduce the amount of coracoid graft osteolysis. Materials and Methods: A computed tomography scan analysis of 26 prospectively followed-up patients was conducted after modified Latarjet procedure using mini-plate fixation technique to determine both the location and the amount of coracoid graft osteolysis in them. We then compared our current results with results from that of our previous study without using mini-plate fixation to determine if there is any statistical significant difference in terms of corcacoid bone graft osteolysis between the two surgical techniques. Results: The most relevant osteolysis was represented by the superficial part of the proximal coracoid, whereas the deep part of the proximal coracoid graft is least involved in osteolysis and has best bone healing. The current study showed a significant difference only for the deep part of the distal coracoid with our previous study (P < 0.01). Discussion: To our knowledge, there are no studies in literature that show the causes of coracoid bone graft osteolysis after Latarjet procedure. Conclusion: Our study suggests that there is a significant difference only for the deep part of the distal coracoid in terms of osteolysis. At clinical examination, this difference did not correspond with any clinical findings. Level of Evidence: Level 4. Clinical Relevance: Prospective case series, Treatment study.

Shoulder instability: State of the Art

The mobility of the glenohumeral joint in multiple anatomic planes is not without consequence as recurrent instability is common, particularly among young, active individuals. Throughout midranges of shoulder motion, stability is conferred primarily by the compression-cavity effect of the rotator cuff as muscular contractions maintain the humeral head centred in the glenoid cavity. At extremes of shoulder motion (flexion and abduction), derangements of capsule-ligamentous complex, glenoid and glenoid labrum drive a pathophysiological cascade that manifests clinically as recurrent anterior, unidirectional instability. In the setting of bone loss <25% of the inferior glenoid diameter, arthroscopic Bankart repair using proper technique yields reliable clinical results. Additionally, much is now known about the extent to which attritional glenoid bone loss, related commonly to repeated dislocation events, affects the predicted success of certain treatment approaches. The preponderance of existing literature supports performing a bone grafting procedure for cases in which the osseous defect comprises >25% of the glenoid width, with the Latarjet procedure being favoured among recent authors. A growing body of evidence has elucidated the consequence of humeral head defects (the Hill-Sachs lesion) as a predictor of recurrent instability. Thus, the concept of ‘bipolar bone loss’ has emerged as a critical concept in the surgical treatment of recurrent shoulder instability. Surgeons should adopt a treatment paradigm that focuses on the relationship between both osseous defects—glenoid and humeral head—and incorporates a surgical tactic to appropriately address each lesion.

Normal and Pathological Anatomy of the Shoulder

No wonder you activities are, reading will be always needed. It is not only to fulfil the duties that you need to finish in deadline time. Reading will encourage your mind and thoughts. Of course, reading will greatly develop your experiences about everything. Reading normal and pathological anatomy of the shoulder is also a way as one of the collective books that gives many advantages. The advantages are not only for you, but for the other peoples with those meaningful benefits.

Functional Anatomy of the Latissimus Dorsi

Transfer of the latissimus dorsi and/or teres major to the humeral head is an important tool in the treatment of massive irreparable rotator cuff tears. For an optimal length of transfer without undue tension, the tendon and muscle belly need to be released from insertion to the scapular border. However, the proximity of neurovascular structures may make a transfer hazardous if not taken into consideration during dissection. This chapter will give an overview of the structural and functional anatomy of the normal latissimus dorsi and teres major with its neurovascular supply, as well as the functional anatomy related to the transferred tendon.

Open Coracoid Transfer: Indications, Technique, and Results

Transfer of the coracoid process to the anterior aspect of the glenoid was devised and described independently in three different centers, leading to different eponyms.

Traumatic Anteroinferior Instability

Treatment of patients with glenohumeral joint instability is a complex process and involves a complete understanding of the functions and role of both the static and dynamic stabilizers of the glenohumeral joint. Additionally, a thorough knowledge of the surgical concepts and procedures outlined throughout this fine text to address the compromised anatomical structures in the patient with glenohumeral instability is of critical importance as well. The purpose of this chapter is to review the rehabilitative concepts and protocol for the treatment of the patient following arthroscopic Bankart reconstruction.