Trans-tendon suture bridge rotator cuff repair with tenotomized pathologic biceps tendon augmentation in high-grade PASTA lesions.

PURPOSE: The purpose of this study was to evaluate whether trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation improves mid-term clinical outcomes for high-grade partial articular-sided supraspinatus tendon avulsion (PASTA) lesions or not. METHODS: A retrospective review of a consecutive series of arthroscopic trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation was conducted. Total 115 patients (44 men and 71 women) with minimum 2 years follow-up were enrolled in our study. Their mean age was 59.7 ± 7.6 (38-77) years and mean follow-up were 6.9 ± 2.5 (2 ~ 10) years. Clinical assessment and radiological outcomes using post-operative MRI were evaluated at last follow-up. RESULTS: All these tears were high-grade PASTA lesions in which mean cuff tear size (exposed footprint) was anteroposterior length 15.7 ± 6.3 mm (5-25 mm) and mediolateral width 10.1 ± 3.6 mm 6.4 mm (5-16 mm). At last follow-up, mean pain VAS, ASES, UCLA, and SST scores were improved from pre-operative values of 5, 59, 21, and 7 to post-operative values of 1, 84.4, 29.5, and 9.4, respectively (p value < 0.001). ROM such as forward flexion, abduction, and internal rotation to the back were improved from a pre-operative mean of 148° (±24), 144° (±24), L2 (Buttock-T7) to a post-operative mean of 161° (±10), 160.0° (±12), and T12 (L3-T5), respectively (p value < 0.001). Follow-up MRI showed Sugaya classification type I in 24 patients (20.9%), type II in 78 patients (67.8%), type III in 11 patients (9.6%) and type 4 in 2 patients (1.7%) were found. As complications, shoulder stiffness was found in five patients, Popeye deformity in two patients and retear in two patients. Revision surgery of the retear was performed in 2 patients. At the last follow-up, 17% (20/115 patients) reported occasional discomfort at the extremes of range of motion during a heavy work or sports activities. CONCLUSIONS: In high-grade PASTA lesions, arthroscopic trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation could be a useful treatment modality capable of preserving rotator cuff footprint, providing simultaneous biceps tenodesis, inducing better tendon healing and possibly preventing tendon buckling and residual pain of the conventional trans-tendon repair methods. These specific methods showed satisfactory outcomes and decreased residual shoulder discomfort (17%) at mid-term follow-up. LEVEL OF EVIDENCE: Level IV, Retrospective case study.

Non-fracture stem vs fracture stem of reverse total shoulder arthroplasty in complex proximal humeral fracture of asian elderly.

PURPOSE: Fracture stem of the reverse total shoulder arthroplasty (RTSA) was designed for better tuberosity bone healing for the proximal bone defect of complex proximal humeral fractures (PHF). Our purpose was to compare the clinical and radiological outcomes of patients using fracture stem vs non-fracture (conventional) stem of RTSA in complex PHF of elderly patients. METHODS: Between 2008 March and 2017 June, 48 patients who had undergone an RTSA with non-fracture or fracture stem for complex PHF with a minimum 18 months of follow-up were evaluated. Finally, total 45 patients with a mean age of 80 ± 7 years (65-92 years) were enrolled because three patients were excluded due to age related mortality. We divided them into two groups: 25 patients using non-fracture stem (non-fracture stem group) in the early period of this study, and consecutive 20 patients using fracture stem (fracture stem group) in the later period. Between two groups, we compared clinical and radiologic outcomes such as tuberosity failure, heterotopic ossification (HO), dislocation, acromion fracture, notching, loosening and periprosthetic fracture. RESULTS: In all patients, clinical outcomes were improved significantly and tuberosity failure was found in 62% (28/45). Between two groups, there were no statistically significant differences on clinical outcomes and radiologic outcomes except UCLA score. As complications, two humeral stem revision was performed due to tuberosity failure related HO and stem loosening with subsequent periprosthetic fracture in non-fracture stem group. CONCLUSIONS: Compared to non-fracture stem, fracture stem usage of RTSA in complex PHF of elderly patients has no significant different impact on clinical and radiological outcomes. However, tuberosity failure related secondary HO of non-fracture stem might be responsible for stem loosening and periprosthetic fracture in the RTSA for complex PHF of elderly patients. LEVEL OF EVIDENCE: Level IV, case series study.

Enhanced High Performance of a Metasurface Polarizer Through Numerical Analysis of the Degradation Characteristics.

This study focuses on the experimental and numerical investigations for the degradation characteristics of a metasurface polarizer. The metasurface has a stacked complementary structure that exhibits a high extinction ratio of the order of 10,000 in the near-infrared region. However, its performance has significantly degraded over time. To clarify the origin of this degradation, the effects of surface roughness and metallic loss are investigated numerically. The degradation is mainly attributed to increase in the loss. These numerical calculations also reveal that the extinction ratio is enhanced by adjusting the thicknesses of the complementary structures to different values. This study paves a way to realize a metasurface polarizer that has a low sensitivity to the time degradation and has a high extinction ratio.

High-performance metasurface polarizers with extinction ratios exceeding 12000.

High-performance ultrathin polarizers have been experimentally demonstrated employing stacked complementary (SC) metasurfaces, which were produced using nanoimprint lithography. It is experimentally determined that the metasurface polarizers composed of Ag and Au have large extinction ratios exceeding 17000 and 12000, respectively, in spite of the subwavelength thickness. It is also shown that the ultrathin polarizers of the SC structures are optimized at telecommunication wavelengths.

Selective Plasmonic Enhancement of Electric- and Magnetic-Dipole Radiations of Er Ions.

Lanthanoid series are unique in atomic elements. One reason is because they have 4f electronic states forbidding electric-dipole (ED) transitions in vacuum and another reason is because they are very useful in current-day optical technologies such as lasers and fiber-based telecommunications. Trivalent Er ions are well-known as a key atomic element supporting 1.5 µm band optical technologies and also as complex photoluminescence (PL) band deeply mixing ED and magnetic-dipole (MD) transitions. Here we show large and selective enhancement of ED and MD radiations up to 83- and 26-fold for a reference bulk state, respectively, in experiments employing plasmonic nanocavity arrays. We achieved the marked PL enhancement by use of an optimal design for electromagnetic (EM) local density of states (LDOS) and by Er-ion doping in deep subwavelength precision. We moreover clarify the quantitative contribution of ED and MD radiations to the PL band, and the magnetic Purcell effect in the PL-decay temporal measurement. This study experimentally demonstrates a new scheme of EM-LDOS engineering in plasmon-enhanced photonics, which will be a key technique to develop loss-compensated and active plasmonic devices.

The artificial control of enhanced optical processes in fluorescent molecules on high-emittance metasurfaces.

Plasmon-enhanced optical processes in molecules have been extensively but individually explored for Raman scattering, fluorescence, and infrared light absorption. In contrast to recent progress in the interfacial control of hot electrons in plasmon-semiconductor hybrid systems, plasmon-molecule hybrid systems have remained to be a conventional scheme, mainly assuming electric-field enhancement. This was because it was difficult to control the plasmon-molecule interface in a well-controlled manner. We here experimentally substantiate an obvious change in artificially enhanced optical processes of fluorescence/Raman scattering in fluorescent molecules on high-emittance plasmo-photonic metasurfaces with/without a self-assembled monolayer of sub-nm thickness. These results indicate that the enhanced optical processes were successfully selected under artificial configurations without any additional chemical treatment that modifies the molecules themselves. Although Raman-scattering efficiency is generally weak in high-fluorescence-yield molecules, it was found that Raman scattering becomes prominent around the molecular fingerprint range on the metasurfaces, being enhanced by more than 2000 fold at the maximum for reference signals. In addition, the highly and uniformly enhancing metasurfaces are able to serve as two-way functional, reproducible, and wavelength-tunable platforms to detect molecules at very low densities, being distinct from other platforms reported so far. The change in the enhanced signals suggests that energy diagrams in fluorescent molecules are changed in the configuration that includes the metal-molecule interface, meaning that plasmon-molecule hybrid systems are rich in the phenomena beyond the conventional scheme.

Overcoming metal-induced fluorescence quenching on plasmo-photonic metasurfaces coated by a self-assembled monolayer.

We have experimentally shown significant suppression of metal-induced fluorescence (FL) quenching on plasmo-photonic metasurfaces by incorporating a self-assembled monolayer (SAM) of sub-nm thickness. The FL signals of rhodamine dye molecules have been several-ten-fold enhanced by introducing the SAM, in comparison with the previous configuration contacting molecules and metal surfaces.

Heteroplasmon hybridization in stacked complementary plasmo-photonic crystals.

We constructed plasmo-photonic crystals in which efficient light-trapping, plasmonic resonances couple with photonic guided resonances of large density of states and high-quality factor. We have numerically and experimentally shown that heteroplasmon hybrid modes emerge in stacked complementary (SC) plasmo-photonic crystals. The resonant electromagnetic-field distributions evidence that the two hybrid modes originate from two different heteroplasmons, exhibiting a large energy splitting of 300 meV. We further revealed a series of plasmo-photonic modes in the SC crystals.

Ultraviolet-nanoimprinted packaged metasurface thermal emitters for infrared CO2 sensing.

Packaged dual-band metasurface thermal emitters integrated with a resistive membrane heater were manufactured by ultraviolet (UV) nanoimprint lithography followed by monolayer lift-off based on a soluble UV resist, which is mass-producible and cost-effective. The emitters were applied to infrared CO2 sensing. In this planar Au/Al2O3/Au metasurface emitter, orthogonal rectangular Au patches are arrayed alternately and exhibit nearly perfect blackbody emission at 4.26 and 3.95 µm necessary for CO2 monitoring at the electric power reduced by 31%. The results demonstrate that metasurface infrared thermal emitters are almost ready for commercialization.