Conversion to reverse shoulder arthroplasty fifty-one years after shoulder arthrodesis: A case report.

BACKGROUND: Patients with a shoulder arthrodesis generally experience restriction in range of motion and limitations in activities of daily living. In addition, up to one-third of the patients deals with serious peri scapular pain. The conversion of a shoulder arthrodesis in a reverse shoulder arthroplasty (RSA) has been described as an effective treatment to achieve better function and decreased pain, although literature is sparse. We present the case of a conversion from a painful shoulder arthrodesis to RSA, after a 51 years interval. CASE SUMMARY: A 71-year-old male presented with severe peri scapular pain and limited function 51 years after shoulder arthrodesis. Preoperative workup showed a normal bone stock of the glenoid and an intact axillary nerve, but atrophic posterior part of the deltoid muscle. The shoulder arthrodesis was successfully converted to RSA. Twelve months postoperative the patient was very satisfied. He has no pain at rest, nor with exercise and experienced definite improvements in activities of daily living, despite his limited range of motion. CONCLUSION: Conversion from shoulder arthrodesis to a RSA can be performed safely, with a high chance of peri scapular pain relief; even after a longstanding arthrodesis.

New insights in the treatment of acromioclavicular separation.

A direct force on the superior aspect of the shoulder may cause acromioclavicular (AC) dislocation or separation. Severe dislocations can lead to chronic impairment, especially in the athlete and high-demand manual laborer. The dislocation is classified according to Rockwood. Types I and II are treated nonoperatively, while types IV, V and VI are generally treated operatively. Controversy exists regarding the optimal treatment of type III dislocations in the high-demand patient. Recent evidence suggests that these should be treated nonoperatively initially. Classic surgical techniques were associated with high complication rates, including recurrent dislocations and hardware breakage. In recent years, many new techniques have been introduced in order to improve the outcomes. Arthroscopic reconstruction or repair techniques have promising short-term results. This article aims to provide a current concepts review on the treatment of AC dislocations with emphasis on recent developments.

Validity and Reliability of the Achillometer(®): An Ankle Dorsiflexion Measurement Device.

Limited ankle dorsiflexion is closely related to important foot and ankle pathologies. Various measurement devices and methods have been examined, but these have demonstrated limited validity and reliability. The purpose of the present study was to assess the validity and intra- and interobserver reliability of the Achillometer(®). A total of 22 consecutive subjects with ankle or foot pathologies and 39 healthy participants were included. All participants were measured using the goniometer and the Achillometer(®), a portable device used to assess ankle dorsiflexion in the weightbearing position with knee in extension. The intraclass correlation coefficient, standard error of the mean, and minimal detectable change were determined. The goniometer and Achillometer(®) revealed high intraobserver reliability coefficients with an intraclass correlation coefficient of 0.88 (standard error of the mean 1.49, minimal detectable change 4.12) and 0.85 (standard error of the mean 1.57, minimal detectable change 4.34), respectively. The interobserver reliability of both measurement techniques ranged from 0.63 to 0.67. The Achillometer(®) showed a strong correlation with the goniometer for both observers. In conclusion, the Achillometer(®) is a valid measurement device to assess ankle dorsiflexion range of motion in the weightbearing position with an extended knee in a heterogeneous population. The device has good intraobserver and moderate interobserver reliability and measurement properties comparable to those of the goniometer.

Preliminary results of 97 percutaneous gastrocnemius muscular lengthening operations in neurologically healthy children with an equinus contracture.

BACKGROUND: We report a gastrocnemius lengthening in neurologically healthy children, whose gastrocnemius equinus could not be corrected non-operatively. METHODS: Fifty-five children with an equinus contracture were included in this study. Ninety-seven operations were performed in these patients. The mean age was 11.5 years [6-16] and sixty percent of the patients were male. After 12 weeks we measured dorsiflexion post-surgery and after one year all parents of patients were telephoned and asked about their satisfaction with the result of the surgical treatment. Persistence of pre-operative complaints and complications were evaluated. RESULTS: Ankle dorsiflexion significantly improved by more than 11° post-surgery compared with preoperative (p=0.01). The mean satisfaction was 8.0 [4-10] on a 10-point VAS scale. Except one complication of ankle fracture during surgery, no other clinically relevant complications were observed. At follow up 50% of the patients have no complaints, 47% reported an improvement but some persisting complaints and 3% of the patients report no improvement. CONCLUSION: Percutaneous muscular gastrocnemius lengthening can be used to correct gastrocnemius equinus in otherwise healthy children, who have not benefited from prior nonsurgical treatment.