Cyst formation and bony ingrowth inside coil-type open-architecture anchors used for arthroscopic remplissage: a volumetric computed tomographic study of 50 anchors.

BACKGROUND: The use of anchors in the proximal humerus during arthroscopic surgery can cause localized bone loss due to osteolysis and cyst formation. The purpose of this study was to use computed tomography (CT) to evaluate the incidence of implant-related bone loss and cyst formation after implantation of polyetheretherketone (PEEK) coil-type open-architecture anchors during remplissage for the management of Hill-Sachs defects (HSDs) in patients with shoulder instability. METHODS: This was a single-cohort, observational study with a minimum of 12 months of follow-up. Subjects undergoing arthroscopic instability surgery with HSD requiring remplissage were included. The volume of the bone defects and the degree of bony ingrowth into the anchor were measured on CT images. RESULTS: Thirty-one participants (28 males, 3 females; mean age 29.4 years, standard deviation [SD] 10.6) in whom 50 anchors (4.5-mm Healicoil PEEK double-loaded anchors) were used were evaluated with a CT performed at a mean of 14.1 (SD 3.74) months after surgery. Full bony ingrowth inside the anchor was found in 15 anchors (30%, range 17.8%-44.5%); clear ossification with a thin lucent rim was found in 10 anchors (20%, range 10.0%-33.7%); discontinuous ossification was found in 8 anchors (16%, range 7.2%-29.1%); and no ossification was observed inside 17 anchors (34%, range 21.2%-48.7%). Regarding bone defect size, no bone defect was identified in 15 anchors (30%, 95% CI 17.9%-44.6%), a partial bone defect was found in 17 anchors (34%, 95% CI 21.2%-48.7%), hole enlargement was found in 17 anchors (34%, 95% CI 21.2%-48.7%), and 1 anchor caused a cyst larger than twice the size of the hole made for anchor insertion (2%, 95% CI 0.1%-8.6%). At the 1-year evaluation, none of the participants presented recurrence or residual apprehension. CONCLUSION: The use of PEEK coil-type open-architecture anchors for remplissage during instability surgery caused large cystic lesions in less than 10% of anchors. There was full bony ingrowth in one-third of anchors, and partial cancellous bone ingrowth occurred in another third of anchors.

Force and Torque Characterization in the Actuation of a Walking-Assistance, Cable-Driven Exosuit.

Soft exosuits stand out when it comes to the development of walking-assistance devices thanks to both their higher degree of wearability, lower weight, and price compared to the bulkier equivalent rigid exoskeletons. In cable-driven exosuits, the acting force is driven by cables from the actuation system to the anchor points; thus, the user's movement is not restricted by a rigid structure. In this paper, a 3D inverse dynamics model is proposed and integrated with a model for a cable-driven actuation to predict the required motor torque and traction force in cables for a walking-assistance exosuit during gait. Joint torques are to be shared between the user and the exosuit for different design configurations, focusing on both hip and ankle assistance. The model is expected to guide the design of the exosuit regarding aspects such as the location of the anchor points, the cable system design, and the actuation units. An inverse dynamics analysis is performed using gait kinematic data from a public dataset to predict the cable forces and position of the exosuit during gait. The obtained joint reactions and cable forces are compared with those in the literature, and prove the model to be accurate and ready to be implemented in an exosuit control scheme. The results obtained in this study are similar to those found in the literature regarding the walking study itself as well as the forces under which cables operate during gait and the cable position cycle.

Assessment of isolated glenohumeral range of motion in patients with adhesive capsulitis can help predict failure of conservative treatment: a pilot study.

PURPOSE: To prospectively evaluate a cohort of patients with adhesive capsulitis and identify predictors of failure of conservative treatment in the first 2 months of therapy. METHODS: This was a single-cohort, prospective observational study that included 20 participants (13 females/7 males; median age of 51.8 years [interquartile range: 8.65]) with primary adhesive capsulitis managed conservatively and evaluated clinically every month for at least 2 years of follow-up (29 [5] months). The evaluation included stage of the disease, treatment applied, radiological findings, pain levels and range of motion (active and passive ROM in the four planes and isolated glenohumeral passive ROM in abduction [GH-ABD], external rotation [GH-ER] and internal rotation). The main outcome assessed was failure of conservative treatment defined as the need for surgery and persistent pain or CMS below 70 points at the 1-year follow-up. RESULTS: Seven patients (7/20, 35%) were considered to have failed conservative treatment because they required arthroscopic capsular release 5.2 (2.1) months after the initial diagnosis. Of all the clinical and epidemiological variables, absence of improvement during the first 2 months in isolated glenohumeral ROM abduction and external rotation predicted failure of conservative treatment: improvement in GH-ABD (10° or more) occurred in 10/13 patients in the conservative treatment group and in 1/7 patients in the surgery group (p = 0.017). Improvement in GH-ER (10° or more) occurred in 9/13 patients in the conservative treatment group and in 0/7 patients in the surgery group (p = 0.005). CONCLUSIONS: Precise assessment of isolated glenohumeral ROM in patients with adhesive capsulitis can help identify patients in which conservative treatment might fail. In this study, patients who did not experience early improvements in isolated glenohumeral ROM often required surgery. LEVEL OF EVIDENCE: III (Prospective cohort study).

Instrumentación vertebral y flegmasía cerúlea dolens / Vertebral instrumentation and Phlegmasia cerulea dolens

La flegmasía cerúlea dolens es un estado muy infrecuente, secundario a trombosis venosa profunda, de origen multietiológico, que afecta usualmente a las extremidades inferiores. Se presenta con dolor en miembro inferior y edema rápidamente progresivo que puede comprometer la perfusión de la extremidad, pudiendo llevar a gangrena, amputación e incluso a la muerte. Se presenta un caso de flegmasía extremadamente raro secundario a trombosis venosa profunda masiva del eje iliofemoral izquierdo provocado por un hematoma crónico compresivo de origen traumático por cizallamiento del tornillo de S1 en una paciente intervenida hacia 3 meses de hernia discal lumbar mediante artrodesis e instrumentación vertebral L5-S1. Este artículo muestra la necesidad de realizar un escrupuloso escrutinio de los tornillos tanto intra como postoperatoriamente cuando nos encontramos cerca de los grandes vasos

Phlegmasia cerulea dolens is a very infrequent condition secondary to a deep venous thrombosis of multietiological origin usually affecting the lower extremities. It presents with pain and edema in the lower limb rapidly progressive that can compromise the perfusion of the limb, being able to cause gangrene, amputation and even death. We present an extremely rare case of a phlegmasia secondary to a massive deep venous tombosis of the left iliofemoral axis caused by chronic compressive hematoma of a traumatic origin due to a S1 screw shearing in a patient operated three months ago of a lumbar herniated disc through a L5-S1 fussion. This article shows the need to perform a scrupulously scrutinize of the screws both intra and postoperatively when we are close to the great vessels

Vertebral instrumentation and Phlegmasia cerulea dolens. / Instrumentación vertebral y flegmasía cerúlea dolens.

Phlegmasia cerulea dolens is a very infrequent condition secondary to a deep venous thrombosis of multietiological origin usually affecting the lower extremities. It presents with pain and edema in the lower limb rapidly progressive that can compromise the perfusion of the limb, being able to cause gangrene, amputation and even death. We present an extremely rare case of a phlegmasia secondary to a massive deep venous tombosis of the left iliofemoral axis caused by chronic compressive hematoma of a traumatic origin due to a S1 screw shearing in a patient operated three months ago of a lumbar herniated disc through a L5-S1 fussion. This article shows the need to perform a scrupulously scrutinize of the screws both intra and postoperatively when we are close to the great vessels.

The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results.

PURPOSE: To evaluate the 2-year results of an absorbable subacromial spacer in patients with irreparable posterosuperior rotator cuff tears. METHODS: Prospective longitudinal study of a consecutive case series of 16 subjects with irreparable tears of the posterosuperior rotator cuff in which the InSpace® subacromial spacer was arthroscopically implanted. A full clinical evaluation that included the Constant test, Simple Shoulder Test (SST) and the QuickDash questionnaire was performed preoperatively and at 12 and 24 months follow-up. The primary outcome for assessing the success of the procedure was a variable composed of a clinically relevant variation of the Constant (established in an improvement greater than 10 points) and the absence of surgical reintervention. RESULTS: Fifteen subjects (11 women/4 men, median age = 69.4 years [interquartile range 7.50], range 60-80 years) completed the 2-year of follow-up. According to the main evaluation criteria, only 6 patients (40%) had a successful outcome. Five subjects required reconversion to a reverse shoulder arthroplasty (at a median of 9.8 months postoperatively) due to absence of clinical improvement or worsening of symptoms. Of the ten remaining subjects, only 6 had improvements greater than 10 points in the Constant score. Despite of this, these 10 subjects had, on average, some improvement in the Constant test (preoperative Constant: median 35.0 [27.0-52.5] vs Constant at 24 months: 53.5 [55.0-84.0], significant differences p = 0.02), in the SST (3.0 [2.0-4.0] vs 6.0 [3.25-7.75], p = 0.039) and in the QuickDASH test (37.0 [33.25-40.0] vs 27.5 [20.5-32.75], p = 0.012). CONCLUSIONS: The outcomes of the implantation of the subacromial biodegradable spacer at 2-year follow-up are not satisfactory. In this small case series only 40% of patients seem to clearly benefit from surgery. One in three required revision to a reverse shoulder arthroplasty. The described technique does not seem a reasonable alternative for the management of the majority of patients with irreparable ruptures of the rotator cuff. The indications of this device should be more clearly defined. LEVEL OF EVIDENCE: IV.

Enfoque epidemiológico sobre los factores de riesgo biomecánico por instalaciones mecánicas en edificios / Epidemiological approach about biomechanical risk factors for mechanical installations in buildings

El objetivo de este estudio es definir las causas biomecánicas de los trastornos músculo-esqueléticos de instalaciones mecánicas en edificios con el fin de conseguir objetivos como la validación y la información de precisión para el beneficio de las prevenciones de accidentes, y proporcionar información para los tratamientos de los trastornos músculo-esqueléticos. Por estos medios, esta investigación analiza los trastornos, lesiones y daños músculo-esqueléticos aplicando métodos epidemiológicos descriptivos y analíticos. La estrategia consiste en los siguientes pasos: 1) Análisis de los accidentes de trabajo como método descriptivo. 2) Las preguntas de la entrevista marco como un método descriptivo, con el fin de obtener la recopilación de datos sobre los equipos de trabajo. 3) Informes en la literatura científica como método analítico con la influencias de la revisión de análisis clínico epidemiológico. 4) Estudio de caso-control, como método de análisis para los casos atípicos.

The aim of this study is to define biomechanical causes of musculo-skeletal disorders for mechanical installations in buildings in order to pursue goals such as the validation and precision information for the benefit in accident preventions, and provide information for the musculoskeletal disorders treatments. By these means, this research analyzes the musculoskeletal disorders, injuries, and damages by applying descriptive and analytical epidemiological methods. The strategy consists in the following steps: 1) Analysis of occupational accidents as descriptive method. 2) The framework interview questions as a descriptive method in order to obtain data collection about work teams. 3) Reports in the scientific literature as analytical method with the influences of epidemiological clinical analysis review 4) Case-control study as analytical method for the untypical cases.