Does preoperative glenoid bony defect determine final coracoid graft positioning in arthroscopic Latarjet?

Background: It has been demonstrated that the accurate positioning of the graft is key to restoring shoulder stability and preventing future arthrosis development. Preoperative anteroinferior glenoid bone loss is frequently encountered when performing a Latarjet, and it has not been determined yet if the amount of bony defect can influence graft positioning. The aim of the study was to determine if a preoperative glenoid bony defect has an influence on the final coracoid graft position in the arthroscopic Latarjet procedure. Methods: Fifty-five patients who underwent the arthroscopic Latarjet procedure were included, with a minimum follow-up of 2 years. There were 51 men (92.7%). Mean age was 29.1 (SD 7.63). Western Ontario Shoulder Instability Index, Rowe, and Single Assessment Numeric Evaluation scores were fulfilled. All measurements were performed by a musculoskeletal radiologist based on a multiplanar bidimensional CT scan. Dimensions of the glenoid, glenoid defect, and glenoid track were calculated. Position of the graft was evaluated in the axial (distance to glenoid surface, angulation of the graft and screws) and sagittal planes (percentage of the coracoid graft below the equator) as described by Kany et al and Barth et al respectively. Results: There was a glenoid defect in 41 patients (74.5 %). Mean width of the defect was 4.32 mm (SD 3.08) which represented 15.3% of the native glenoid surface (SD 10.8). 78.2% of the patients were offtrack preoperatively, and 11.9% remained offtrack postoperatively. The final glenoid diameter with the graft was 32.1 mm (SD 4.34). Mean distance from the graft to the glenoid at 50% height was 1.1 mm (SD 2.19 mm) and at 25% height was 1.31 mm (SD 2.05). Mean angulation of the superior and inferior screws were 26.9° (SD 8.2°) and 27.1° (SD 7.35°), respectively. In 81.8% of the cases, the graft was deemed to be flush with the glenoid. The percentage of the coracoid graft under the equator of the glenoid was 71.2 % (SD 21.8). There was not a statistically significant difference in screw angulation or graft positioning in the axial plane when comparing patients who had a glenoid defect with those who did not, or depending on the size (P > .05). Percentage of graft below the equator was, however, lower in patients without bony defect (P = .04). Conclusion: This study showed that accurate position of the coracoid graft is achieved in the presence of a glenoid bony defect. In the cases of intact glenoid, the height of the graft should be carefully evaluated.

Reliability and Diagnostic Accuracy of Radiography for the Diagnosis of Calcium Pyrophosphate Deposition: Performance of the Novel Definitions Developed by an International Multidisciplinary Working Group.

OBJECTIVE: To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD). METHODS: Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologists twice assessed radiographic images for presence or absence of CPPD in menisci, hyaline cartilage, tendons, joint capsule, or synovial membrane, using the new definitions. In case of disagreement, a consensus decision was made and considered for the assessment of diagnostic performance. Histologic examination of postsurgical specimens under compensated polarized light microscopy was the reference standard. Prevalence-adjusted bias-adjusted kappa values were used to assess reliability, and diagnostic performance statistics were calculated. RESULTS: Sixty-seven patients were enrolled for the reliability study. The interobserver reliability was substantial in most of the assessed structures when considering all 4 readers (κ range 0.59-0.90), substantial to almost perfect among radiologists (κ range 0.70-0.91), and moderate to almost perfect among rheumatologists (κ range 0.46-0.88). The intraobserver reliability was substantial to almost perfect for all the observers (κ range 0.70-1). Fifty-one patients were included in the accuracy study. Radiography demonstrated an overall specificity of 92% for CPPD, but sensitivity remained low for all sites and for the overall diagnosis (54%). CONCLUSION: The new radiographic definitions of CPPD are highly specific against the gold standard of histologic diagnosis. When the described radiographic findings are present, these definitions allow for a definitive diagnosis of CPPD, rather than other calcium-containing crystal depositions; however, a negative radiographic finding does not exclude the diagnosis.

Stabilization for acute distal radioulnar instability: A novel surgical technique.

INTRODUCTION: Instability of the distal radioulnar joint (DRUJ) commonly results from traumatic disruption of the distal radioulnar ligaments of the triangular fibrocartilage complex (TFCC). Treatment of this rupture typically requires immobilization of the wrist and elbow for a period of 6 to 8 weeks. This study evaluated the hypothesis that treatment of DRUJ instability with dynamic stabilization would allow early mobilization of both the radiocarpal and distal radioulnar joints by the first postoperative week without compromising restoration of TFCC integrity. MATERIALS AND METHODS: Between September 2017 and January 2019, a retrospective study was conducted on 22 patients presenting with DRUJ instability confirmed by intraoperative Ballottement testing. Once instability was confirmed, dynamic surgical stabilization was performed, followed by one week of short cast immobilization. Arthrographic computed tomography (CT) of each patients' affected wrist was performed 4 months later to evaluate TFCC integrity. The recovery of patients was monitored at 1, 3, 6, and 12 months after surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Ballottement test, and evaluation of radioulnar join range of motion (ROM), pain, and complications. RESULTS: All patients were followed postoperatively for a mean of 13.5 months. After 1 month, all patients exhibited satisfactory range of motion and DRUJ stability. By 3 months, Ballottement tests were negative in 21 of 22 patients, with instability persisting in only 1 patient. At 4 months, CT arthrography contrast leakage (indicative of a TFCC tear) was observed in 5 of 20 patients. Upon reexamination a mean of 10.5 months later, the TFCC tears of these patients had healed in 2 cases (with foveal tears), while no difference in contrast leakage was observed for the other 3 cases (with horizontal or central tears). Revision surgery for implant related complications was performed in 2 cases. CONCLUSION: Acute DRUJ instability treated with dynamic stabilization led to satisfactory clinical outcomes in terms of range of motion, pain relief and joint stability, allowing DRUJ movement from the first postoperative week. This technique represents a simple, reproducible and minimally invasive procedure with a low rate of implant related complications.