S. Van Driessche

Les lésions histologiques des tendons des supraspinatus dans les ruptures transfixiantes de la coiffe des rotateurs

Resume Les auteurs ont essaye de savoir si les ruptures iteratives apres simple suture tendon-os des coiffes des rotateurs rompues pourraient etre expliquees par la presence, sur les moignons tendineux repares, de lesions histologiques qui, ont le sait, diminuent leur qualite mecanique. Trente-deux moignons de supraspinatus rompus, reseques sur plus d’1 cm pour eliminer les lesions tendineuses macroscopiques (tendons fins, dilaceres, clives ou indurees et blanchâtres) et pour retrouver un moignon tendineux suffisamment epais et legerement saignant ont ete etudies sur des coupes histologiques longitudinales. Tous les moignons tendineux reseques etaient histologiquement anormaux. L’etendue des lesions histologiques etait en moyenne de 4 mm inferieure a celle de la resection tendineuse. Dix-huit fois cependant tout le tendon reseque etait histologiquement anormal. Les lesions histologiques des moignons tendineux des ruptures de coiffe pourrait etre au moins en partie a l’origine des ruptures iteratives apres simple suture tendon-os. La resection des moignons tendineux macroscopiquement anormaux apparait logique mais elle expose, en dehors d’artifice technique, a des sutures sous tension elles memes generatrices de rupture iterative.

Does hip joint positioning affect maximal voluntary contraction in the gluteus maximus, gluteus medius, tensor fasciae latae and sartorius muscles?

BACKGROUND Minimally invasive total hip arthroplasty (THA) is presumed to provide functional and clinical benefits, whereas in fact the literature reveals that gait and posturographic parameters following THA do not recover values found in the general population. There is a significant disturbance of postural sway in THA patients, regardless of the surgical approach, although with some differences between approaches compared to controls: the anterior and anterolateral minimally invasive approaches seem to be more disruptive of postural parameters than the posterior approach. Electromyographic (EMG) study of the hip muscles involved in surgery [gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S)] could shed light, the relevant literature involves discordant methodologies. We developed a methodology to assess EMG activity during maximal voluntary contraction (MVC) of the GMax, GMed, TFL and sartorius muscles as a reference for normalization. A prospective study aimed to assess whether hip joint positioning and the learning curve on an MVC test affect the EMG signal during a maximal voluntary contraction. HYPOTHESIS Hip positioning and the learning curve on an MVC test affect EMG signal during MVC of GMax, GMed, TFL and S. METHODS Thirty young asymptomatic subjects participated in the study. Each performed 8 hip muscle MVCs in various joint positions recorded with surface EMG sensors. Each MVC was performed 3 times in 1 week, with the same schedule every day, controlling for activity levels in the preceding 24h. EMG activity during MVC was expressed as a ratio of EMG activity during unipedal stance. Non-parametric tests were applied. RESULTS Statistical analysis showed no difference according to hip position for abductors or flexors in assessing EMG signal during MVC over the 3 sessions. Hip abductors showed no difference between abduction in lateral decubitus with hip straight versus hip flexed: GMax (19.8±13.7 vs. 14.5±7.8, P=0.78), GMed (13.4±9.0 vs. 9.9±6.6, P=0.21) and TFL (69.5±61.7 vs. 65.9±51.3, P=0.50). Flexors showed no difference between hip flexion/abduction/lateral rotation performed in supine or sitting position: TFL (70.6±45.9 vs. 61.6±45.8, P=0.22) and S (101.1±67.9 vs. 72.6±44.6, P=0.21). The most effective tests to assess EMG signal during MVC were for the hip abductors: hip abduction performed in lateral decubitus (36.7% for GMax, 76.7% for GMed), and for hip flexors: hip flexion/abduction/lateral rotation performed in supine decubitus (50% for TFL, 76.7% for S). DISCUSSION The study hypothesis was not confirmed, since hip joint positioning and the learning curve on an MVC test did not affect EMG signal during MVC of GMax, GMed, TFL and S muscles. Therefore, a single session and one specific test is enough to assess MVC in hip abductors (abduction in lateral decubitus) and flexors (hip flexion/abduction/lateral rotation in supine position). This method could be applied to assess muscle function after THA, and particularly to compare different approaches. LEVEL OF EVIDENCE III, case-matched study.

Transsupraspinatus arthrotomy through an enlarged transacromial approach for total shoulder replacement

The authors describe a step-by-step technique for anatomic total shoulder arthroplasty using transsupraspinatus arthrotomy via the enlarged transacromial approach. This technique seems ideal to ensure adequate postoperative tensional balance of the infraspinatus and the subscapularis, which is critical for the rotator cuffs to function properly and to achieve optimal arthroplasty stability. Reviewing these different steps helps understanding each rotator cuff individual components contribution to achieve optimal arthroplasty stability.