Remplissage james wilson
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The document discusses the surgical technique of remplissage, which involves filling in a bony defect (Hill-Sachs lesion) on the humeral head that commonly results from shoulder dislocations. Remplissage is performed after a Bankart repair by freshening the Hill-Sachs lesion and capsule before securing the tissue to restore stability. Studies have found that remplissage provides improved outcomes over other procedures with low complication and recurrence rates and no loss of range of motion. However, patient factors like the degree of glenoid bone loss must be considered when determining if remplissage is an appropriate additional procedure.
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This document discusses various methods for assessing bone loss in the glenoid and humeral head in shoulder instability. It finds that while CT may be the most reliable method, there is no consensus on measurement techniques and what constitutes a clinically significant lesion. Methods like MRI and arthroscopy have not been sufficiently validated. Plain radiography is not accurate enough for pre-operative planning. The glenoid track and engagement formulas attempt to combine glenoid and humeral head measurements but also have limitations and have not been fully validated. Overall, the document concludes there is still uncertainty around accurately assessing and defining the critical amount of bone loss that increases recurrence risk in shoulder instability.
Acromion - Os-acromiale Fractures and Insufficiency
1) Os acromiale occurs when the acromion fails to fully fuse during development, leaving separate ossification centers. It has a reported incidence of 1.4-30% and is often asymptomatic.
2) Treatment options for symptomatic os acromiale include non-operative measures like physiotherapy, injections, or surgical excision or fixation of the fragments. Arthroscopic excision aims to preserve deltoid attachment with good reported outcomes.
3) Acromial fractures can occur from direct trauma or overuse. Indications for surgical fixation include symptomatic nonunion, impingement, or displacement over 1cm. Posterior plating techniques are commonly used.
Revisions of failed Latarjet surgery 2015
This study reviewed outcomes of revision procedures for failed Latarjet surgery in 16 patients over 5 years. The most common direction of recurrent instability was anterior (11 cases). Common causes of failure included coracoid non-union (7 cases) and capsular laxity (8 cases). Revision procedures included Eden-Hybinette (5 cases), arthroscopic stabilization (8 cases), and remplissage (1 case). Complications occurred in 4 revisions. Most patients (12/16) and professionals (9/11) returned to their pre-injury level of sport following revision. Capsular laxity and posterior lesions were implicated in recurrent multi-directional and posterior instability cases.
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There is no “gold standard” technique for the surgical stabilization of Acromioclavicular joint (ACJ) disruptions and each of the described techniques has a failure rate. The management of failed ACJ stabilizations is a difficult problem and salvage procedures may often be constrained by the original procedure and the resultant anatomy. Reliable anatomical and biomechanically robust revision procedures for failed ACJ stabilization are therefore required. We describe a technique for revision stabilization of the ACJ that utilises a synthetic ligament in combination with augmentation from the coracoacromial ligament and biceps short head aponeurosis (‘biceps flip’ procedure).
Rotator cuff the future 2015
The document discusses potential future directions for rotator cuff repair surgery. It describes 4 possibilities - 1) biological repairs that enhance healing using growth factors, 2) augmentation devices to reinforce repairs, 3) gene therapy and nano-surgery approaches for prevention and treatment, and 4) algorithms to better determine who needs surgery versus non-operative treatment based on age, genetics, and other factors. The future may include enhanced sutures that promote angiogenesis, balloon devices to support tissue, gene therapies administered through self-monitoring techniques, and remotely-controlled nano-instruments.
Assessment of the unstable shoulder
This document discusses the assessment of unstable shoulders, including classification, biomechanics, anatomy, and physical examination tests. It provides details on classifying structural and non-structural instability, the static and dynamic biomechanical stabilizers of the shoulder, and the anatomy of bony structures. The document also reviews physical examination tests for assessing anterior, posterior, and inferior instability, providing the sensitivity and specificity of each test.
Rotator cuff Repair in Rugby 2015 funk
1) Arthroscopic rotator cuff repair was performed on 11 elite rugby players with significant rotator cuff injuries.
2) The tears ranged in size from small (<1cm) to massive (>5cm), with a mean size of 1.8cm. Post-operative ultrasound scans showed the repairs to be intact in all 9 cases that were checked.
3) All players but one returned to play at the same level, with the mean time to return to full match play being 4.8 months. The study concludes that rotator cuff tears are not uncommon in rugby players and arthroscopic repair can enable players to return to play.
SCJ instability athletes 2017
Sternoclavicular joint (SCJ) injuries are uncommon. A minority of patients with anterior dislocation progress to chronic instability associated with pain and a limitation of activities, and thus surgery should be considered. The technique is safe and effective for reconstructing chronic anterior SCJ dislocations. The all anterior approach for reconstruction of the SCJ reduces the risk to the structures posterior to the medial clavicle, manubrium sterni or first rib.
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The document traces the origins and development of shoulder arthroplasty implants from the late 19th century to modern designs. It discusses early pioneers like Jules Pean and Charles Neer who developed hemiarthroplasty and total shoulder replacement designs. Key advances included the introduction of modular components, inverted shoulder designs by Grammont to address rotator cuff deficiency, and trabecular metal and augmented glenoids to improve fixation and stability. The document outlines the progression from monoblock to anatomically designed implants to current reverse, anatomic, and resurfacing options to best address different clinical presentations.
Kienbocks disease kiran kumar naikoti
Mr. Kiran Kumar Naikoti's document describes Kienbock's disease, an idiopathic osteonecrosis of the lunate bone that commonly affects men aged 20-40. The disease is progressive and results from bone necrosis leading to fractures, sclerosis, and collapse of the lunate bone. This in turn causes decreased carpal height, proximal capitate migration, carpal instability, and degenerative wrist changes. The etiology is multifactorial and may involve trauma, anatomical factors like negative ulnar variance, vascular causes like single vessel lunate supply, and systemic diseases. Stages of the disease are described based on radiological findings from normal to severe lunate collapse. Treatment options discussed include
Addressing bone loss in shoulder instability lennard funk
This document discusses approaches to measuring and treating bone loss in the glenoid and humeral head that can contribute to shoulder instability. It addresses how to measure glenoid and Hill-Sachs lesions using various imaging modalities and arthroscopy. It presents studies examining the amount of glenoid and humeral head bone loss that significantly increases instability risk. The document also introduces the "glenoid track" and "Funky Pizza method" to assess if a Hill-Sachs lesion is engaging or non-engaging. It concludes with an overview of treatment approaches based on the size of glenoid and Hill-Sachs defects.
Understanding shoulder instability
This document discusses shoulder instability, including traumatic and atraumatic causes. It presents three case studies to demonstrate different types of instability: 1) a rugby player with recurrent anterior dislocations requiring surgical repair for bony lesions; 2) a drama student with recurrent posterior subluxations and normal imaging, indicating a motor control issue; and 3) a gymnast with multidirectional instability and hyperlaxity who may benefit from capsular plication. The document outlines the Stanmore classification system for shoulder instability (Polar types I-III) and factors to consider in surgical versus rehabilitation management depending on the specific instability pattern.
Shoulder instability current concepts mike walton
The document discusses shoulder instability, beginning with how humans evolved the ability to throw through modifications to the shoulder including a lengthened clavicle and increased external rotation of the glenohumeral joint. It then notes that the glenohumeral joint is inherently unstable, and anterior dislocation is the most common type, usually occurring with combined external rotation and abduction. Assessment of instability involves understanding the mechanism of injury, performing apprehension tests, and obtaining imaging like MR arthrogram. Bone loss and engaging Hill-Sachs lesions are predictors of failure following surgery.
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Young male patients are at greatest risk for low-grade infections following arthroscopic and open non-arthroplasty shoulder surgery. Propionibacterium acnes was the most prevalent organism. Patients presented with classical post-operative frozen shoulder symptoms, resistant to usual treatments. 80% of patients with negative cultures improved with empirical treatment.
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Remplissage james wilson
- 1. “I have a simple philosophy: Fill what’s empty. Empty what’s full. Scratch where it itches.” Alice Roosevelt Longworth Remplissage James Wilson ST8 Trainee T&O Upper Limb Fellow Wrightington Hospital
- 2. • Remplissage - • filling • filling in • filling out • padding • charging Definition
- 3. • Humeral head defects commonly associated with dislocation • Hill-Sachs lesion = impression fracture postero superior (>80%) • Large defect reduces rotational arc length • Engagement leads to recurrent dislocation Background Hill HA Sachs MD . The grooved defect of the humeral head. A frequently unrecognized complication of dislocations of the shoulder joint. Radiology. 1940;35:690-700.
- 4. • Published by Purchase et.al as a Technical Note in Arthroscopy • Posterior portal for initial assessment • Antero-Superior portal then used for viewing • Hill-Sachs and capsule freshened • Bankart repair prepared Description
- 5. 7
- 8. • September 2014 - Systematic review in Arthroscopy • Looked at studies reporting outcomes for: • Remplissage • Weber osteotomy • Allograft reconstruction • Arthroplasty What is the evidence
- 9. • Remplissage 29.5 months • Weber osteotomy 108 months • Allograft reconstruction 61.3 months • Arthroplasty 51.4 months Follow up
- 10. • Remplissage 0.9% 2/212 • Weber osteotomy 29% 53/184 • Allograft reconstruction 74% 17/23 • Arthroplasty 19% 20/104 Complications
- 11. Outcomes Constant Rowe score for instability ASES Remplissage 94.6 (3) 89.4 (9) 89.1 (5) Weber Osteotomy 79 (1) Allograft 76.2 (3) Arthroplasty 58.2 (4) 71.4 (1) 65.8 (2)
- 12. • Dislocation or subluxation • Remplissage 6.3% 21/333 • Weber osteotomy 5.6% • Allograft reconstruction 0% • Arthroplasty 14% Recurrence of instability
- 14. • Remplissage did not significantly affect ROM • Studies comparing Bankart to Bankart plus remplissage - no significant difference. Range of motion
- 15. • Franceschi • Comparative study • Historical controls • Different surgeons • However, groups well matched for age and pathology • Average D/R index 30% • Good scores, no recurrence and good ROM in the R&B group More detail
- 16. • Cohort study designed to compare ROM for the two groups • Dissimilar groups: • ISIS 5 or 6 vs ISIS < 5 • Outcomes similar • ROM no difference • One recurrence per group Nourissat et al
- 18. • Stephen Burkhart • If D/R index >15% (about 4mm) high rate of recurrent instability • Minimal glenoid bone loss (<25%) • Where arthroscopic stabilisation planned but increased stability wanted • Not for inverted pear glenoids • Do the Bankart first Other opinions
- 19. Follow up