Normative values for internal and external glenohumeral rotation strength in rugby players: A systematic review with meta-analysis.

This systematic review aims to provide normative values for internal and external glenohumeral rotation strength in rugby players. From the inception to March 2021, the search strategy was (strength OR torque) AND shoulder AND rugby using PubMed, Scopus, Web of Science, and SPORTDiscus databases, with no language restrictions. This systematic review includes 15 articles involving 573 rugby players and presenting internal or external glenohumeral rotation strength values. Two main methods are used to assess glenohumeral rotation strength in rugby players: isokinetic and isometric methods; in the isometric method, the upper arm is abducted at either 0° or 90°. Owing to differences in isokinetic procedures and a lack of studies assessing isometric strength when the upper arm is in a neutral position, normative internal or external glenohumeral rotation strength values are only provided for isometric contractions when the upper arm is abducted at 90° based on 311 shoulders of 163 male rugby union players, with 2.04 ± 0.15 N.kg-1 and 2.11 ± 0.13 N.kg-1 for internal and external glenohumeral rotation strength, respectively. These findings may help strength and conditioning coaches and physical therapists, provide objective evidence when deciding whether or not rugby union players should return to sport.

[Chronic posttraumatic shoulder instability]. / Chronische posttraumatische Schulterinstabilität.

Chronic posttraumatic shoulder instability is characterized by trauma-associated, recurrent dislocations. Surgical treatment is indicated in most cases but it remains controversial how risk factors should be weighted to decide between arthroscopic Bankart repair (ABR), Latarjet or alternative procedures. Known risk factors for recurrence are patient age, hyperlaxity, sports profile and bone loss. Surgical techniques are discussed in detail. The ABR leads to high patient satisfaction and return to sports; however, in association with risk factors, recurrent dislocations are seen even several years later. Latarjet or bone block procedures lead to high patient satisfaction, sustainable stability as a revision procedure, but can also be primarily indicated for chronic instability depending on risk factors. Early complications are more frequent but of a minor nature in most cases. All techniques are known for a serious learning curve. If performed well, they do not seem to increase the risk of arthritis, which is most affected by the number of lifetime dislocations and higher energy trauma.

Is anterior glenoid bone block position reliably assessed by standard radiography? A cadaver study.

BACKGROUND: Standard radiography with an antero-posterior view and Bernageau's glenoid profile view is the method most widely reported in the literature to assess coracoid bone block position and fusion. OBJECTIVE: The aim of this cadaver study was to determine whether the antero-posterior and Bernageau's radiographs provide a reliable and reproducible evaluation of the position of a coracoid bone block and its fixation screws. METHOD: An isolated scapula showing no evidence of osteoarthritis or other abnormalities was used. The coracoid process was transferred to the anterior glenoid rim. Fixation was with two slightly diverging malleolar screws, chosen of different sizes for ease of identification. Computed tomography (CT) was performed as the reference imaging technique. The standard radiographs were then obtained, using fluoroscopy to accurately position the scapula for the antero-posterior and Bernageau's views. This position was defined as 0°, and radiographs were taken at angles of 5°, 10°, and 15° in all three planes. All radiographs were taken during a single session to ensure that the distance separating the tube from the scapula remained unchanged. The images were exported to OsiriX for analysis. We measured the angles formed by the screws and the glenoid surface, as well as bone block position and overhang. Finally, we used 1-mm thick disks to evaluate bone-to-bone contact. RESULTS: No correlations were found between values by CT and by standard radiography (both views) for the screw angles or overhang. A space≤1mm between the neck of the scapula and the bone block was not visible on the standard radiographs in any of the positions. CONCLUSION: Standard radiography does not provide an accurate analysis of bone block position or bone-to-bone contact. CT is needed to assess bone block and screw position and bone-to-bone contact. LEVEL OF EVIDENCE: Level III.

Functional outcomes after open versus arthroscopic Latarjet procedure: A prospective comparative study.

INTRODUCTION: The Latarjet procedure provides effective stabilization of chronically unstable shoulders. Since this procedure is mainly performed in a young athletic population, the functional impact is significant. Published data does not shed light on the time needed to recover work-related or sports-related function. Performing this procedure arthroscopically may improve functional recovery. This led us to carry out a prospective, multicenter study to compare the functional recovery after arthroscopic versus open Latarjet procedure. MATERIAL AND METHODS: Between June and November 2014, 184 patients were included in a prospective multicenter study: 85 in the open group and 99 in the arthroscopy group. The patients were evaluated preoperatively with the WOSI score. The early postoperative pain was evaluated on D3, D7 and D30. The WOSI score was determined postoperatively at 1, 3, 6 and 12 months of follow-up. RESULTS: The functional scores of the shoulder in both cohorts were identical overall preoperatively. In the immediate postoperative period, the arthroscopy group had statistically lower pain levels on D3 and D7. The postoperative WOSI was improved in both groups at 3 months, then continued to improve until it reached a plateau at 1 year. The WOSI score was better in the arthroscopy group at 3 months, but better in the open group at 6 months. CONCLUSION: This study found that a Latarjet procedure performed arthroscopically generates less immediately postoperative pain than when it is performed as an open procedure. The Latarjet procedure (whether open or arthroscopic) improves shoulder function, with normal function returning after 1 year.

Occupational outcome after surgery in patients with a rotator cuff tear due to a work-related injury or occupational disease. A series of 262 cases.

UNLABELLED: The goals of this study were to establish the occupational outcome after surgery in patients with a rotator cuff tear from a work-related injury (WRI) or occupational disease (OD) and determine which factors and conditions affected return to work. HYPOTHESIS: return to work was possible for this type of patient. This questionnaire-based study comprised 262 shoulders in 254 patients with a WRI/OD who had surgery performed on their shoulder between 2000 and 2005. The average age was 50.5 ± 6.4 years. The following variables were analysed: employment status (private sector, self-employed, government employee), type of work (non-manual, manual, heavy manual labour), nature of tendon injury and surgical technique (open, mini-open and arthroscopy). Return to work occurred in 59.5% of the cases. Factors that prevented return to work (40.4% of the cases) included retirement (14.1%), an unrelated medical condition (10.3%), and the outcome of the operated shoulder (16.0%). Age had an impact on return to work (P<5 × 10(-4)). The type of work and nature of tendon injury did not affect return to work, but did affect time away from work. Employment status and surgical technique had an effect on return to work, but not on time away from work. Age was a decisive factor for return to work. Retirement seemed to be the most common choice starting at 55 years of age. Arthroscopy seemed to have reduced the impact of the WRI on the results, particularly on the time away from work. A preoperative evaluation of the patient's probability of returning to work should be done based on occupational and injury features. There may be a longer delay in returning to work for certain profiles of work (manual labour) and tendon injury. Patient management can be improved by knowing the factors and conditions that influence return to work. LEVEL OF EVIDENCE: Level IV - Retrospective study.

Hemiarthroplasty versus total shoulder prosthesis: results of cemented glenoid components.

In this retrospective study, we compared the results of 705 total shoulder arthroplasties (TSAs) with 469 hemiarthroplasties (HSAs), all having been performed with the Aequalis shoulder prosthesis. Each group, both TSA and HSA, was comparable by age (mean, 63.9 years) and sex (853 men and 321 women). Each group had comparable dominance and preoperative Constant scores (mean, 29 points). The length of follow-up averaged 43 months (range, 24-110 months) in both groups. The postoperative functional outcome and subjective assessment demonstrated the superiority of TSA over HSA independent of age or rotator cuff status (Constant score, 65.7 vs 56.3 points). The analysis of the radiographs showed a disturbing 68% of cases with radiolucent lines developing around the glenoid component and their subsequent progression with time. We saw an adverse effect on functional outcome by the presence of these radiolucent lines. This review would suggest that TSA is superior to HSA in most cases with chronic pathologic entities. HSA remains a satisfactory solution in specific cases. In the future, we need to optimize the designs of the glenoid implant and develop a better implantation technique to avoid the problems associated with glenoid replacement.

[Results of revision surgery for glenoid loosening: a multicentric series of 37 shoulder prosthesis]. / Résultats des reprises pour descellement glénoïdien. A propos d'une série multicentrique de 37 prothèses d'épaule.

PURPOSE OF THE STUDY: The purpose of this study was to assess outcome after revision total shoulder arthroplasty as a function of therapeutic options. MATERIAL AND METHODS: Revision total shoulder arthroplasty procedures were performed in three French centers specialized in shoulder surgery. Mean follow-up was 28.5 Months (range 12-69). Constant's score was determined preoperatively and at last follow-up. Nineteen reimplantations of a cemented glenoid, twelve "glenoplasties" without reimplantation and five inverted prosthesis implantations were performed. Arthroplastic resection was performed in one patient with infection. RESULTS: The function score improved in all patients. Reimplantation of a cemented glenoid led to significant improvement in function at last follow-up. For patients without reimplantation, bone graft reconstruction of the bone loss led to better results than simple removal of the loosened implant. For patients with cuff tears, use of an inverted prosthesis led to improved clinical scores, particularly for pain. Two patients experienced repeated loosening of cemented glenoids and one patient developed infection requiring a second revision. DISCUSSION: Different therapeutic options can be proposed for patients with glenoid loosening. Simply removing the implant is effective in relieving pain but has a modest effect on motion. This type of procedure should be reserved for frail patients requiring an intervention with limited goals. The remaining amount of glenoid bone stock is the key to functional outcome after surgical repair. Glenoid reimplantation can be attempted if only a moderate amount of bone has been lost. Unlike cortical grafts, pure cancellous grafts do not allow reliable reconstruction. After grafting, reimplantation of the glenoid implant can be achieved in a two-stage procedure. Screwed glenoid implants allow fixing the graft in a single operation in better conditions than cemented implants. Inverted prostheses offer a therapeutic solution worth developing for patients with rotator cuff tears and glenoid loosening.