Comparison of Structural Subscapularis Integrity After Latarjet Procedure Versus Iliac Crest Bone Graft Transfer

Background: Although clinical outcome scores are comparable after coracoid transfer procedure (Latarjet) and iliac crest bone graft transfer (ICBGT) for anterior shoulder instability with glenoid bone loss, a significant decrease in internal rotation capacity has been reported for the Latarjet procedure. Hypothesis: The subscapularis (SSC) musculotendinous integrity will be less compromised by ICBGT than by the Latarjet procedure. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed pre- and postoperative computed tomography (CT) scans at short-term follow-up of 52 patients (26 Latarjet, 26 ICBGT) previously assessed in a prospective randomized controlled trial. Measurements included the preoperative glenoid defect area and graft area protruding the glenoid rim at follow-up and tendon thickness assessed through SSC and infraspinatus (ISP) ratios. Fatty muscle infiltration was graded according to Goutallier, quantified with muscle attenuation in Hounsfield units, and additionally calculated as percentages. We measured 3 angles to describe rerouting of the SSC musculotendinous unit around the bone grafts. Results: SSC fatty muscle infiltration was 2.0% ± 2.2% in the Latarjet group versus 2.4% ± 2.2% in ICBGT (P = .546) preoperatively and showed significantly higher values in the Latarjet group at follow-up (5.3% ± 4.5% vs 2.3% ± 1.7%; P = .001). In total, 4 patients (15.4%) in the Latarjet group showed a progression from grade 0 to grade 1 at follow-up, whereas no changes in the ICBGT group were noted. The measured rerouting angle of the SSC muscle was significantly increased in the Latarjet group (11.8° ± 2.1°) compared with ICBGT (7.5° ± 1.3°; P < .001) at follow-up, with a significant positive correlation between this angle and fatty muscle infiltration (R = 0.447; P = .008). Ratios of SSC/ISP tendon thickness were 1.03 ± 0.3 in the Latarjet group versus 0.97 ± 0.3 (P = .383) in ICBGT preoperatively and showed significantly lower ratios in the Latarjet group (0.7 ± 0.3 vs 1.0 ± 0.2; P < .001) at follow-up. Conclusion: Although clinical outcome scores after anterior shoulder stabilization with a Latarjet procedure and ICBGT are comparable, this study shows that the described decline in internal rotation capacity after Latarjet procedure has a radiographic structural correlate in terms of marked thinning and rerouting of the SSC tendon as well as slight fatty degeneration of the muscle

Optical and material analysis of opacified hydrophilic intraocular lenses after explantation: a laboratory study

Background: The opacification of hydrophilic intraocular lenses (IOLs) is a very rare complication in terms of absolute numbers. We report on the analyses of opacified Euromaxx ALI313Y and ALI313 IOLs (Argonoptics, Germany) using light and scanning electron microscopy, X-ray spectroscopy and optical bench analysis. Methods: Opacified Euromaxx ALI313Y and ALI313 IOLs were explanted after patients presented with a decrease in visual acuity. The explants were sent to our laboratory and examined using light and scanning electron microscopy. The composition of the deposits was analysed using X-ray spectroscopy. The optical quality of the intraocular lens (IOL) was assessed using the OptiSpheric IOL PRO optical bench (Trioptics GmbH Wedel, Germany). Modulation transfer function (MTF) was measured at all spatial frequencies and United States Air Force (USAF) 1951 resolution target pictures were documented. Results: Macroscopically, the entire optic was opacified in all IOLs. Light and scanning electron microscopy revealed numerous fine, granular, crystalline-like deposits, which were always distributed in a line parallel to the anterior and posterior surfaces of the IOLs. X-ray spectroscopy could prove the deposits consisted of Calcium and Phosphate. Measurements in the optical bench showed deterioration of MTF values at all spatial frequencies and the USAF target pictures demonstrated a significant reduction of brightness as well as resolution with the opacified IOLs. Conclusions: The calcification of hydrophilic IOLs only occurs rarely. The exact chemical composition of the deposits can be assessed by means of X-ray spectroscopy. Optical quality analysis of the explanted Euromaxx ALI313Y and ALI313 IOLs showed significant reduction of MTF values, which was confirmed by USAF target pictures

Effect of glenoid concavity loss on shoulder stability- a case report in a professional wrestler

Background Current glenoid defect measurement techniques only quantify bone loss in terms of defect diameter or surface. However, the glenoid depth plays an important role in shoulder stabilization by means of concavity compression. Case presentation We present a case of a professional wrestler who suffered from anterior shoulder instability after sustaining a bony Bankart lesion without loss of glenoid surface area but flattening of the concavity due to medialization of the fragment. The patient’s glenoid concavity was reconstructed arthroscopically by reduction and percutaneous screw fixation of the bony fragment along with a capsulo-ligamentous shift. Changes of the glenoid concavity with according alterations in the Bony Shoulder Stability Ratio (BSSR) were analyzed on pre-op, post-op, and follow-up CT scans. Postoperative CT scans revealed a deepened concavity (3.3 mm) and improved BSSR (46.1 %) compared to pre-op scans (0.7 mm; 11.3 %). Follow-up CT scans showed a slight remodeling of the glenoid concavity (3.2 mm) with steady BSSR (44.7 %). Conclusion This case shows that the passive stabilizing effect of the glenoid can be compromised by loss of concavity despite the absence of loss of articular surface. Therefore, addressing the concavity loss and resulting reduction of the BSSR is recommended in these cases. Bony Bankart repair was successful in restoring the BSSR of the patients shoulder as determined by mathematical calculations based on CT scans

Conservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age

Purpose: Purpose of this study was to evaluate the mid- to long-term outcome after conservatively treated first-time posterior shoulder dislocations and to determine structural defects associated with failure. Methods: In this multi-centric retrospective study, 29 shoulders in 28 patients with first-time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross-sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow-up of 8.3 +/- 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed. Results: Redislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 +/- 12.5% vs. 50.6 +/- 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8 degrees +/- 7.2 degrees, vs. 93.3 degrees +/- 9.7 degrees). The adapted gamma angle was higher than 90 degrees in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV: r = 0.543, p = 0.02; ROWE: r = 0.418, p = 0.035 and WOSI: r = 0.478, p = 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI (r = - 0.59, p = 0.02) and follow-up posterior glenohumeral decentring (r = 0.68, p = 0.007). The gamma angle (r = 0.396, p = 0.039) and depth of the reverse Hill-Sachs lesion (r = 0.437, p = 0.023) correlated significantly with the grade of osteoarthritis at follow-up. Conclusion: Conservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid- and long-term follow-up especially in patients with centred joint, low gamma angle, and middle or old age

Injectable 0.19-mg fluocinolone acetonide intravitreal implant for the treatment of non-infectious uveitic macular edema

Background: A retrospective observational clinical study to evaluate the safety and effectiveness of the injectable 0.19-mg fluocinolone acetonide intravitreal implant (ILUVIEN) in the treatment of non-infectious uveitic macular edema. Results: Data are presented from eight patients (11 eyes) with non-infectious uveitic macular edema who were treated with a 0.19-mg fluocinolone acetonide implant. Nine out of 11 eyes were pseudophakic prior to implantation of fluocinolone acetonide implant, and both phakic eyes required cataract surgery during the follow-up period (the median follow-up was 19 months; range, 8–42 months). Effectiveness and safety were assessed from changes in central retinal thickness (measured using spectral domain optical coherence tomography), corrected distance visual acuity, uveitic activity, and intraocular pressure. The main outcome measures were changes in central retinal thickness, corrected distance visual acuity, uveitic activity, and intraocular pressure. In 11/11 eyes, central retinal thickness improved between months 1 and 3. The mean maximum decrease of central retinal thickness throughout the follow-up period was 168 ± 202 μm (± standard deviation). Nine out of 11 eyes showed an improvement in corrected distance visual acuity (between + 1 and + 8 lines), and 2/11 eyes lost corrected distance visual acuity (− 1 and − 3 lines, respectively). Nine out of 11 eyes presented with inactive inflammation during the follow-up period, and in 1/11 eyes, there was a relapse at month 42. Four out of 11 eyes presented with a relapse of macular edema between months 3 and 8. The mean increase in intraocular pressure was 2.1 ± 4.7 mmHg. Nine eyes were pseudophakic prior to implantation of the injectable fluocinolone acetonide intravitreal implant. Both phakic patients developed a cataract that was treated with cataract surgery in the follow-up period. Conclusions: In this small case series with long-term follow-up, treatment of non-infectious uveitic macular edema with the injectable fluocinolone acetonide implant was associated with improved central retinal thickness and corrected distance visual acuity and a manageable safety profile. The advantage of this device is the long-term drug release and the fact that it can be injected into the vitreous as a minor surgical procedure, which is in contrast to other treatment options

Verfahren zur Herstellung von Silica-haltigen Polyol-Dispersionen und deren Verwendung zur Herstellung von Polyurethanwerkstoffen

The invention relates to a method for producing polyols containing silicate, comprising the steps of (i) mixing an aqueous silica sol (K) having an average particle diameter of I to 150 nm with a content of silicic acid, calculated as SiO2, from I to 60 wt % at a pH of I to 6, relative to the content of SiO2 used, and 0.1 to 20 times the amount, relative to water, of at least one organic solvent (L) selected from the group comprising methanol, ethanol, l-propanol, 2-propanol, l-butanol, 2-butanol, 2-me­ thyl-2-propanol, l-chloro-2-propanol, cyclopentanol, cyclohexanol, l,4-dioxane, tetrahydrofuran, l-methoxy-2-propanol, l­ ethoxy-2-propanol, 2-ethoxyethanol, 2-methyl-2-propanol, 2-methoxyethanol, dimethylformamide, acetonitrile, dimethyl sulfoxi­ de, acetone, methyl ethyl ketone, and ethyl acetate, and (ii) mixing the mixture thus obtained with a polyol, (iii) at least partially distilling off the organic solvent (L) and water, (iv) mixing with at least one compound (S) comprising at least one at least mono­ alkoxylated silyl group and at least one alkyl, cycloalkyl, or aryl substituent which can contain heteroatoms, wherein said substitu­\u3cbr/\u3eent optionally comprises a group which is reactive with an alcohol, an amine, or an isocyanate at an amount of0.l to 20 µmol (S) per m2 surface of (K), wherein the steps (i), (ii), and (iv) can be performed simultaneously or consecutively in any sequence, (v)\u3cbr/\u3eoptionally adjusting the pH of the polyol containing silicate to a value of 7 to 12 by adding a strongly basic compound, wherein the step (v) can also be performed between the steps (iii) and (iv).\u3cbr/\u3

New approaches to explanting high-viscosity silicone oil in retinal surgery—polyimide cannulas vs extraction sleeves vs a luer-trocar

Abstract Background The removal of high-viscosity silicone oil in retinal surgery is time-intensive. In this laboratory and porcine eye study, we evaluated the efficiency of novel extraction techniques, namely shortened polyimide-cannulas, an extraction sleeve and an experimental luer-trocar system, for commercially available silicone oils. Methods The volume of silicone oil after a 5-min removal time was quantified. The feasibility of all studied techniques was additionally tested in vitrectomized porcine eyes. Siluron 1000, 2000, 5000 and Xtra, as well as Densiron 68 and Densiron Xtra were examined. Results Shortening the 23G-polyimide-cannula from 6 mm up to 1.5 mm led to a significantly higher mean aspirated volume (e.g., 1 ml/min to 1.7 ml/min for Siluron Xtra). The extraction sleeve and luer-trocar increased the flow threefold compared to the shortest polyimide cannulas at 23G (5.2 ml/min and 5.2 ml/min vs 1.7 ml/min for Siluron Xtra, respectively). The extraction sleeve and luer-trocar system reached a similar flow at 27G as the best performing 23G-cannula. Angulation and movement of the eye was possible with the 2 mm-cannula, no angulation was possible when using the extraction sleeve. Stability and control were not impaired with the experimental luer-trocar setup. Conclusion Shorter polyimide-cannulas and extraction sleeves increase the extraction flow but may decrease stability during surgery. The luer-trocar system facilitates rapid removal while offering great stability and control. Small 27G silicone oil removal is possible and time efficient