Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

BACKGROUND: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. PURPOSE: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. RESULTS: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation (P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points (P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up (P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points (P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). CONCLUSION: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

Validación posoperatoria en la selección asistida por computadora de aloinjertos de fémur distal / Postoperative assessment in computer assisted selection of femur osteoarticular allograft

El objetivo de nuestro trabajo fue comparar dos grupos de pacientes tratados con trasplantes osteoarticulares del fémur distal en términos de evaluar: 1) el volumen del fémur distal del receptor y del trasplante, 2) la superficie articular de contacto del fémur distal del receptor y del trasplante, 3) el ángulo del valgo anatómico femoral del fémur distal del receptor y del trasplante. Materiales y métodos: se realizó una búsqueda retrospectiva entre 2002 y 2012 analizando a pacientes tratados con un trasplante osteoarticular de fémur distal. Se incluyó un total de 32 pacientes. Estos fueron divididos en dos grupos de acuerdo con el método de selección del trasplante: Grupo 1, conformado por 16 pacientes con trasplantes seleccionados mediante tomografía 2D y Grupo 2, 16 pacientes con trasplantes seleccionados a través de un método 3D. La evaluación fue realizada por un observador independiente y ciego para los dos grupos. Resultados: las diferencias en las pruebas de estimación de volumen y superficie articulares entre el donante y el receptor no fueron estadísticamente significativas (p>0,05). Sin embargo, la diferencia entre los ángulos de valgo del fémur receptor y el fémur donante, seleccionados por el método 2D fue significativa (p<0,05), mientras que la diferencia de estos ángulos en el método 3D no lo fue (p>0,05). Conclusión: el método de selección de un aloinjerto, mediante la utilización de un banco de huesos virtual 3D para la reconstrucción con un trasplante osteoarticular de femur distal, permite obtener una mejor alineación del miembro comparado con aquellos seleccionados solo con un método bidimensional. (AU)

The aim of our study was to compare two groups of patients treated with distal femur osteoarticular allograft in terms of: 1) the volume of the distal femur of the allograft and patient, 2) the articular surface contact, 3) the anatomical femoral valgus angle. Material and methods: a retrospective review was performed between 2002 and 2012 and all patients with an osteo-articular allograft of the distal femur were analysed. A total of 32 patients were included in the study. Patients were divided into two groups according to the selection method of the allograft: Group 1, 16 patients with allograft selected by 2D (CT) and Group 2, 16 patients selected through a 3D method. The evaluation was done by an independent and blind observer. Results: the differences in terms of volume estimation and joint surface contact between the donor allograft and patient distal femur were not statistically significant (p>0.05). However, the difference between the valgus angle showed significant differences between donor and patient femurs selected by the 2D method (p<0.05) but no difference in the group of patients selected by 3D method (p>0.05). Conclusion: the 3D method for allograft selection of the distal femur showed better results in limb alignment compared to 2D selection method. (AU)

Sarcomas de partes blandas en pacientes pediátricos: análisis de una serie de casos del subtipo no rabdomiosarcoma / Pediatric soft tissue sarcomas: analysis of non rhabdomyosarcoma group

Se evaluó una serie de 29 pacientes con diagnóstico de sarcomas de partes blandas variante no rabdomiosarcomas tratados quirúrgicamente entre2000 y 2010, y se analizó la supervivencia global y los factores que influyen en el pronóstico. La edad media fue de 11,6 años (rango de 3 meses-17 años); 16 pacientes eran de sexo masculino y el tiempo promedio de seguimiento fue de 56 meses (de 8 a 132 meses). Se documentaron 8 variedades histológicas diferentes de tumores malignos, y el sarcoma sinovial resultó ser el más frecuente (14 pacientes). La cirugía de conservación de miembro fue posible en 28 pacientes y se asoció tratamiento adyuvante en 26. La supervivencia global de la serie estudiada fue de 72% a los 5 años y, en 9 pacientes, se diagnosticó una recurrencia local. La presencia de metástasis (p < 0,0001) y la recurrencia local (p < 0,007) resultaron ser factores de pronóstico negativo para la supervivencia global.(AU)

We evaluated 29 patients with non rhabdomyosarcoma soft tissue sarcomas treated with surgery between 2000 and 2010; we analyzed overall survival and which factors affect the prognosis. The mean age was 11.6 years (range 3 months-17 years); 16 patients were males and the median follow-up was 56 months (8 to 132 months). Eight different histological malignant tumors were identified, being synovial sarcoma the most prevalent one (14 patients). Twenty-eight patients were treated with limb salvage surgery and in 26 cases, adjuvant therapy was used. Five years overall survival was 72%. Nine of the 29 patients presented a local recurrence. The presence of metastases (p <0.0001) and local recurrence (p <0.007) were negative prognostic factors for overall survival.(AU)

Sarcomas de partes blandas en pacientes pediátricos: análisis de una serie de casos del subtipo no rabdomiosarcoma / Pediatric soft tissue sarcomas: analysis of non rhabdomyosarcoma group

Se evaluó una serie de 29 pacientes con diagnóstico de sarcomas de partes blandas variante no rabdomiosarcomas tratados quirúrgicamente entre2000 y 2010, y se analizó la supervivencia global y los factores que influyen en el pronóstico. La edad media fue de 11,6 años (rango de 3 meses-17 años); 16 pacientes eran de sexo masculino y el tiempo promedio de seguimiento fue de 56 meses (de 8 a 132 meses). Se documentaron 8 variedades histológicas diferentes de tumores malignos, y el sarcoma sinovial resultó ser el más frecuente (14 pacientes). La cirugía de conservación de miembro fue posible en 28 pacientes y se asoció tratamiento adyuvante en 26. La supervivencia global de la serie estudiada fue de 72% a los 5 años y, en 9 pacientes, se diagnosticó una recurrencia local. La presencia de metástasis (p < 0,0001) y la recurrencia local (p < 0,007) resultaron ser factores de pronóstico negativo para la supervivencia global.

We evaluated 29 patients with non rhabdomyosarcoma soft tissue sarcomas treated with surgery between 2000 and 2010; we analyzed overall survival and which factors affect the prognosis. The mean age was 11.6 years (range 3 months-17 years); 16 patients were males and the median follow-up was 56 months (8 to 132 months). Eight different histological malignant tumors were identified, being synovial sarcoma the most prevalent one (14 patients). Twenty-eight patients were treated with limb salvage surgery and in 26 cases, adjuvant therapy was used. Five years overall survival was 72%. Nine of the 29 patients presented a local recurrence. The presence of metastases (p <0.0001) and local recurrence (p <0.007) were negative prognostic factors for overall survival.

[Pediatric soft tissue sarcomas: analysis of non rhabdomyosarcoma group]. / Sarcomas de partes blandas en pacientes pediátricos: análisis de una serie de casos del subtipo no rabdomiosarcoma.

We evaluated 29 patients with non rhabdomyosarcoma soft tissue sarcomas treated with surgery between 2000 and 2010; we analyzed overall survival and which factors affect the prognosis. The mean age was 11.6 years (range 3 months-17 years); 16 patients were males and the median follow-up was 56 months (8 to 132 months). Eight different histological malignant tumors were identified, being synovial sarcoma the most prevalent one (14 patients). Twenty-eight patients were treated with limb salvage surgery and in 26 cases, adjuvant therapy was used. Five years overall survival was 72%. Nine of the 29 patients presented a local recurrence. The presence of metastases (p <0.0001) and local recurrence (p <0.007) were negative prognostic factors for overall survival.

Sarcomas de partes blandas en pacientes pediátricos: análisis de una serie de casos del subtipo no rabdomiosarcoma. / [Pediatric soft tissue sarcomas: analysis of non rhabdomyosarcoma group].

We evaluated 29 patients with non rhabdomyosarcoma soft tissue sarcomas treated with surgery between 2000 and 2010; we analyzed overall survival and which factors affect the prognosis. The mean age was 11.6 years (range 3 months-17 years); 16 patients were males and the median follow-up was 56 months (8 to 132 months). Eight different histological malignant tumors were identified, being synovial sarcoma the most prevalent one (14 patients). Twenty-eight patients were treated with limb salvage surgery and in 26 cases, adjuvant therapy was used. Five years overall survival was 72

. Nine of the 29 patients presented a local recurrence. The presence of metastases (p <0.0001) and local recurrence (p <0.007) were negative prognostic factors for overall survival.

Three-dimensional virtual bone bank system workflow for structural bone allograft selection: a technical report.

Structural bone allograft has been used in bone defect reconstruction during the last fifty years with acceptable results. However, allograft selection methods were based on 2-dimensional templates using X-rays. Thanks to preoperative planning platforms, three-dimensional (3D) CT-derived bone models were used to define size and shape comparison between host and donor. The purpose of this study was to describe the workflow of this virtual technique in order to explain how to choose the best allograft using a virtual bone bank system. We measured all bones in a 3D virtual environment determining the best match. The use of a virtual bone bank system has allowed optimizing the allograft selection in a bone bank, providing more information to the surgeons before surgery. In conclusion, 3D preoperative planning in a virtual environment for allograft selection is an important and helpful tool in order to achieve a good match between host and donor.

Validity of an automatic measure protocol in distal femur for allograft selection from a three-dimensional virtual bone bank system.

Osteoarticular allograft is one possible treatment in wide surgical resections with large defects. Performing best osteoarticular allograft selection is of great relevance for optimal exploitation of the bone databank, good surgery outcome and patient's recovery. Current approaches are, however, very time consuming hindering these points in practice. We present a validation study of a software able to perform automatic bone measurements used to automatically assess the distal femur sizes across a databank. 170 distal femur surfaces were reconstructed from CT data and measured manually using a size measure protocol taking into account the transepicondyler distance (A), anterior-posterior distance in medial condyle (B) and anterior-posterior distance in lateral condyle (C). Intra- and inter-observer studies were conducted and regarded as ground truth measurements. Manual and automatic measures were compared. For the automatic measurements, the correlation coefficients between observer one and automatic method, were of 0.99 for A measure and 0.96 for B and C measures. The average time needed to perform the measurements was of 16 h for both manual measurements, and of 3 min for the automatic method. Results demonstrate the high reliability and, most importantly, high repeatability of the proposed approach, and considerable speed-up on the planning.

Spontaneous healing in complete ACL ruptures: a clinical and MRI study.

BACKGROUND: Most authors believe the ACL does not spontaneously heal after a complete rupture. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities. QUESTIONS/PURPOSES: We therefore asked whether (1) a complete ACL rupture in patients can spontaneously heal without the use of a specific rehabilitation program or bracing and (2) patients are able to return to their athletic activity after spontaneous ACL healing. PATIENTS AND METHODS: We retrospectively reviewed 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Average age at injury was 31 years (range, 23-41 years). All patients were athletically active before injury. Surgery was indicated in all patients but for various reasons postponed. We obtained International Knee Documentation Committee scores, Lysholm-Gillquist scores, and MRI. The minimum followup was 25 months (mean, 30 months; range, 25-36 months). RESULTS: At last followup, the mean Lysholm-Gillquist score was 97. According to the International Knee Documentation Committee evaluation, 10 knees were normal and four nearly normal. All knees regained end point with a negative pivot shift test; MRI at followup showed an end-to-end continuous ACL with homogeneous signal. All patients returned to their former activity level. However, after the study period, two patients had a rerupture of the ACL (2.5 years after the first lesion). CONCLUSIONS: Our observations indicate an acutely injured ACL may eventually spontaneously heal without using an extension brace, allowing return to athletic activity. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Technical aspects of core needle biopsy and fine needle aspiration in the diagnosis of bone lesions.

OBJECTIVE: Percutaneous needle biopsy is an effective and safe technique for obtaining diagnostic material from bone lesions. STUDY DESIGN: We describe the technical details of fine needle aspiration and core needle biopsy performed in our laboratory of orthopedic pathology. RESULTS: With these procedures, we obtained accurate diagnosis in 83% of 7,375 cases, sent by different orthopedic centers in our country, over a period of 21 years (1986-2007). CONCLUSION: We describe the percutaneous needle procedure (fine needle aspiration, core needle biopsy), the handling of the materials in detail, the different cytological techniques, as well as the advantages of the procedures and how to avoid its disadvantages. We believe that accurate diagnosis with bone needle biopsy mainly depends on the training of the surgical cytologist and the pathologist, who must integrate all the knowledge on the clinical data, image diagnosis, histological procedures and the experience in the histopathological interpretation of bone lesions.

Anatomic double-bundle posterior cruciate ligament reconstruction using double-double tunnel with tibial anterior and posterior fresh-frozen allograft.

Techniques for the reconstruction of knee ligaments must restore the injured knee to a satisfactory level of performance. For this, a precise anatomic reconstruction is necessary. Many arthroscopic techniques for reconstruction of the posterior cruciate ligament (PCL) have been reported to restore the normal anatomy of the intact PCL using a double-bundle reconstruction with a Y-shaped tendon graft (2 femoral tunnel and 1 tibial tunnel). However, this procedure is sometimes difficult because the graft must be tightened in different grades of flexion to obtain complete strength of both bundles. We thought that double-bundle PCL reconstruction using double-double tunnels (2 femoral and 2 tibial tunnels) would allow an anatomic reconstruction, restoring better knee biomechanics, and probably improving patient outcome.