Roberto Yukio Ikemoto

Correlation of coracoid thickness and glenoid width: an anatomic morphometric analysis.

Background: The coracoid has been widely used as a graft to reconstruct anterior glenoid bone defects, as described by the Latarjet and Bristow procedures, with successful results. Nevertheless, at the present, there are no studies correlating the size of the coracoid graft and its relation to the glenoid. Purpose: To assess the mediolateral (M-L) and anteroposterior (A-P) thickness of the coracoid process as well as the widest anterior-to-posterior glenoid distance (glenoid width) and to analyze the correlation between these measurements, while comparing these with the A-P coracoid process thickness. Study Design: Descriptive laboratory study. Methods: Sixty-one unpaired, adult human cadaveric scapulae were evaluated. Three examiners performed 3 independent measurements of the largest M-L thickness of the coracoid process and also the widest anterior-to-posterior distance of the glenoid. The A-P coracoid process thickness was also measured to compare for correlations with M-L coracoid thickness. Results: The glenoid width was 26.38 ± 2.69 mm (range, 20.03-32.35 mm), and the M-L coracoid thickness was 14.51 ± 1.90 mm (range, 9.60-19.31 mm). Calculating the ratio between the M-L thickness of the coracoid and glenoid width, we observed that the coracoid represented 43% to 70% of the glenoid width (54% on average). The A-P coracoid process thickness was 8.37 ± 0.93 mm (range, 6.61-9.76 mm), representing 31% of the glenoid width on average. Conclusion: A strong positive and statistically significant relationship between the coracoid process M-L thickness and the anterior-to-posterior glenoid width exists; the coracoid represents, on average, 54% of the glenoid width. Clinical Relevance: Most cases of glenoid bone loss in recurrent shoulder dislocation can be reconstructed with the coracoid process to re-establish its anatomy.

Avaliação da retroversão da cabeça do úmero em jogadores de handebol

OBJECTIVES: To evaluate the humeral head retroversion of handball players and its relationship to shoulders range of motion. MATERIALS AND METHODS: Seventeen professional players were evaluated by physical examination and X-ray images to determine the humeral head retroversion and its relationship to the range of motion. A control group was also submitted to the same evaluations. RESULTS: The difference between the average of the humeral head retroversion of the dominant and non dominant shoulders was 3.06°. The mean value for this angle between the athletes who had started training as early as 10 years old was 36.29°, compared to those who had started later in life, which was 26.6° (p<0.05). The average of the external rotation of the players whose retroversion angle was bigger than 30° was 112.27°, and for those whose angle was smaller or equal to 30°, it was 95.10° (p<0.05). CONCLUSION: There was a significant difference in the retroversion angle when comparing dominant and non-dominant shoulders. The athletes who started to play before the age of 10 presented, statistically, an increased retroversion. There is a statistical relationship between retroversion increase and shoulders external rotation gain.

Does the presence of proximal humerus growth plate changes in young baseball pitchers happen only in symptomatic athletes? An x ray evaluation of 21 young baseball pitchers

Objective To evaluate the presence of x ray changes in the proximal humerus growth plate of 21 young pitchers. Design Case series. Setting This study was conducted at the Orthopaedic and Traumatology Department of the ABC College of Medicine, Santo Andre, São Paulo, Brazil, tertiary institution. Patients 21 male adolescent baseball pitchers, with a mean age of 14.5 years and selected from the Brazilian National Team, were studied. Interventions The patients underwent x ray examinations of the shoulders. Main outcome measurements The x rays of the pitchers’ shoulders were studied to determine any changes in the proximal humeral growth plate and correlate them with clinical findings. Results Fourteen athletes (66%) had radiographic changes in the humerus growth plate but only 5 (36%) had pain complaints. Nine of these 14 cases (64%) whom the observers found radiographic changes did not complain of pain. It was also observed that there was a correlation in only 11 cases between clinical and radiographic evaluations. Conclusion Radiographic changes in the proximal humerus growth plate were found in 66% of the cases, but 64% were asymptomatic. These changes indicate possible evolution, in the future, to a greater degree of retroversion in pitchers’ dominant shoulders.

Reparação artroscópica de lesões pequenas e médias do tendão do músculo supraespinal: avaliação dos resultados clínico-funcionais após dois anos de seguimento

OBJECTIVE: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. METHODS: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136o, lateral rotation of 58o and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. RESULTS: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156o with an average gain of 20o, and the average final lateral rotation was 57o with an average gain of 9o. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. CONCLUSIONS: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

Resultados da cirurgia de latarjet no tratamento da instabilidade anterior traumática do ombro associada à erosão óssea da cavidade glenoidal - seguimento mínimo de um ano

OBJECTIVE: Evaluate the results from the Latarjet procedure in patients with anterior recurrent dislocation of the shoulder who present bone loss of the glenoid cavity greater than 25%. METHODS: Twenty six male patients underwent the Latarjet procedure, The bone loss was evaluated by means of radiography using the Bernageau view and by means of CAT scan. The patients were evaluated with regard to range of motion, using the Rowe and UCLA scales, before and after the operation, and by radiographs to assess the presence of arthrosis, position and consolidation of the graft and positioning of the screws. Statistical analysis was used to assess whether there was any relationship between the number of episodes of dislocation and the presence of arthrosis, , and any relationship between arthrosis and limitations on lateral rotation. Differences in range of motion between the operated and unaffected sides and in the UCLA and Rowe scale. RESULTS: The means for elevation and lateral rotation were statistically poorer on the operated side. The UCLA and Rowe scale showed that there was a statistically significant improvement in the clinical-functional results (P < 0.001 for both). There was a relationship between the number of episodes of dislocation and the presence of arthrosis, We also did not observe any correlation between limitations on lateral rotation and arthrosis. CONCLUSION: The Latarjet procedure is an efficient method for cases of severe erosion of the glenoid margin.

The Technique to Calculate Glenoid Bone Loss With the Bernageau Profile View: Is it Possible?

As glenoid bone erosion has been related to high rates of recurrence after traditional Bankart repair, the necessity to diagnose existing bone loss is fundamental to avoiding the recurrence of shoulder dislocation. There are many techniques described in the literature explaining how to calculate glenoid bone loss; however, there are only few articles, which shows the usefulness of the x-rays for that purpose. Moreover, just one of these papers described the reliability of a specific x-ray view to measure the percentage of a glenoid bony defect, comparing it with the computed tomography scan and known glenoid osteotomy. The aim of this study was to describe a reliable and reproducible technique for calculating glenoid bone loss using the Bernageau x-ray profile view and to show the results of a earlier study in which we calculated the distance between the posterior and anterior glenoid rim on the Bernageau profile view and compared this measurement between the right and the left shoulders. This technique is cheaper than the computed tomography scan and is easier to perform.

Estudo da resistência do tendão do supra-espinal com pontos simples, duplos e Mason Allen

OBJECTIVE: The purpose of this study was to compare the rotator cuff tendon resistance at the interface tendon-suture using three different sorts of stitches (simple, mattress and modified Mason-Allen). METHODS: To do this, 30 rotator cuffs were totally dissected from 15 specimens, which were 45 years old on average. The tests were done using a Kratos® 500/2000 machine and the statistical analyses applied were the Student t-test, ANOVA test, Multiple Bonferroni Comparison, and Pearsons correlation coefficients; all the analyses used a significance level of 5%. RESULTS: No significant difference was observed regarding the age, sample sizes and tendon displacement. The tendon resistance was 127.50 N on average when Simple stitches were used, 163.95 N when Double stitches were used and 198.45 N when the Modified Mason-Allen Knot was used. CONCLUSION: Although the tendon resistance at the interface tendon-suture was higher using the Modified Mason-Allen stitches than it was when using the Double and Simple Knots, there was no difference in tendon resistance when using the Modified Mason-Allen and Double stitches. On the other hand, we found that tendon resistance was higher when using Modified Mason-Allen stitches as compared to tendon resistance when using Simple stitches.

Tenotomia com ou sem tenodese da cabeça longa do bíceps no reparo artroscópico do manguito rotador

OBJECTIVE: To compare the functional results among patients un dergoing tenotomy with or without tenodesis of the long head of the biceps associated with arthroscopic repair of rotator cuff in juries, with a minimum two-year follow-up. METHOD: This was a retrospective non-randomized trial with evidence level III, in which the medical files of 77 patients with lesions of the long head of the biceps were reviewed and clinically reassessed. Among these, 55 patients underwent tenotomy without tenodesis and 22 underwent tenotomy with tenodesis, with outpatient follow-up for at least two years. The age, dominant side, operated side, lesion size using the Gartsman classification, pre and postoperative range of mo tion, presence or absence of the Popeye sign, pain in the bicipital groove and assessments using the University of California at Los Angeles (UCLA) score and the elbow strength index. RESULTS: The mean UCLA score of the sample went from 16.92 (range: 8 to 25) to 31.45 (range: 13 to 35) (p < 0.001). Comparison of the pre and postoperative UCLA scores in the two groups showed that the dif ference in the group with tenotomy and tenodesis was 15.95 and in the group with tenotomy alone, 14.62 (p = 0.023). However, there was no statistical significance in comparing the groups regarding pain in the bicipital groove, Popeye sign or elbow strength index. CONCLUSION: This study showed that the difference in UCLA scores was statistically significant. The group with tenotomy and tenodesis of the long head of the biceps presented better functional results.

Estudo comparativo, prospectivo e randomizado entre dois métodos de anestesia para cirurgia do ombro

aBstRaCt Objective: To evaluate the efficacy of suprascapular nerve block in combination with the infusion of anesthetic into the sub-acromial space compared to an interscalene block. Methods: Forty-five patients with small or medium isolated supraspinatus tendon lesions who underwent arthroscopic repair were pro-spectively evaluated and randomly assigned to three groups of 15, each with a different combination of anesthetic methods. The efficacy of post-surgical analgesia was measured using the visual analogue scale for pain, and analgesic, anti-inflam-matory, and opioid drug consumption. Inhalation anesthetic consumption during surgery was compared among the groups. Results: Statistical analysis found no significant differences among the groups regarding anesthetic consumption during surgery or postoperative analgesic efficacy during the first 48 hours. Conclusion: Suprascapular nerve block with infusion anesthetic into the subacromial space is an excellent alternative to interscalene block, particularly in hospitals where a nerve stimulator device is unavailable.

Mensuração da erosão da borda anterior da glenoide através do exame radiográfico: uma forma simples de realizar a incidência de Bernageau

OBJECTIVE: To analyze whether the Bernageau view is adequate for studying the anterior glenoid rim and determining the distance between the posterior and anterior glenoid rim. METHODS: Fifty patients (31 males) with a mean age of 34 years were evaluated by positioning their arm at 160o forward flexion and body at 70o with the X-Ray chassis, while positioning the X-ray tube at 30o craniocaudal, centered on the scapula spine. Three of the authors measured the distance between the posterior and anterior glenoid rim three times. The variability and reproducibility of this distance were studied. Three shoulder surgeons performed a subjective evaluation by answering whether it was possible to evaluate the anterior glenoid rim in the view studied. RESULTS: The average distance was 24.48 mm ±0.332 mm (left) and 24.82 mm ±0.316 mm (right). The Anderson-Darling test showed that this distance had a normal distribution and Pearsons correlation showed significant reproducibility (P<0.01). The first observer found that 67% of the X-Rays images were suitable for evaluating the anterior glenoid rim. The second found that 81% were suitable and the third 78%. The Kappa coefficient test showed that the second and third observers had substantial agreement of opinion. CONCLUSION: The Bernageau view provided a suitable X-Ray for studying the anterior glenoid rim and for assessing erosion after comparison with the unaffected side.