Effect of bone loss in anterior shoulder instability

Anterior shoulder instability with bone loss can be a difficult problem to treat. It usually involves a component of either glenoid deficiency or a Hill-Sachs lesion. Recent data shows that soft tissue procedures alone are typically not adequate to provide stability to the shoulder. As such, numerous surgical procedures have been described to directly address these bony deficits. For glenoid defects, coracoid transfer and iliac crest bone block procedures are popular and effective. For humeral head defects, both remplissage and osteochondral allografts have decreased the rates of recurrent instability. Our review provides an overview of current literature addressing these treatment options and others for addressing bone loss complicating anterior glenohumeral instability

Long Head of Biceps Tendon Management: a Survey of the American Shoulder and Elbow Surgeons

© 2017, Hospital for Special Surgery. Background:: Management of symptomatic long head of biceps tendon (LHBT) pathology remains a source of debate. Questions/Purposes:: The purpose of this study was to identify consensus trends for the treatment of LHBT pathology among specialists. Methods:: A survey was distributed to members of the American Shoulder and Elbow Society (ASES), consisting of three sections—demographics, case scenarios, and general LHBT pathology management. Cases presented common clinical scenarios, and surgeons reported their management preferences. Consensus responses were defined as \u3e 50% of participants giving a single response. Results:: One hundred and forty-two of 417 (34%) surgeons completed surveys. Forty-seven percent of questions reached a consensus answer. Biceps tenodesis was the overwhelmingly preferred technique in cases demonstrating LHBT pathology, as compared to tenotomy. No consensus, however, was reached regarding a specific surgical technique for biceps tenodesis. The two most popular techniques were arthroscopic tenodesis to bone and open subpectoral biceps tenodesis. Fellowship-trained arthroscopic surgeons and surgeons with a largely arthroscopic practice were more likely to perform tenodesis arthroscopically. Conclusion:: ASES members favored biceps tenodesis over tenotomy for surgical management of LHBT pathology, without consensus regarding a specific surgical technique

Revision Total Shoulder Arthroplasty is Associated with Increased Thirty-Day Postoperative Complications and Wound Infections Relative to Primary Total Shoulder Arthroplasty

© 2017, Hospital for Special Surgery. Background: With an increasing volume of primary total shoulder arthroplasties (TSA), the number of revision TSA cases is expected to increase as well. However, the postoperative medical morbidity of revision TSA has not been clearly described. Questions/Purposes: The purpose of this study was to determine the rate of postoperative complications following revision TSA, relative to primary TSA. In addition, we sought to identify independent predictors of complications, as well as to compare operative time and postoperative length of stay between primary and revision TSA. Methods: Patients who underwent primary/revision TSA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Differences in complications, readmission rates, operative time, length of stay, and predictors of complications were evaluated using bivariate and multivariate analyses. Results: A total of 10,371 primary TSA (95.4%) and 496 revision TSA cases (4.6%) were identified. The overall complication rate was 6.5% in primary and 10.7% in revision TSA patients (p \u3c 0.001). Multivariate analysis identified an increased risk of any complication (odds ratio 1.73, p \u3c 0.001), major complication (2.08, p = 0.001), and wound infection (3.45, p = 0.001) in revision TSA patients, relative to primary cases. Operative time was increased in revision cases (mean ± standard deviation, 125 ± 62.5), relative to primary (115 ± 47.7, p \u3c 0.001). Age \u3e 75, female sex, history of diabetes or chronic obstructive pulmonary disease, and American Society of Anesthesiologists classification ≥ 3 were associated with increased risk of any complication. Smoking history was the only significant predictor of wound infection. Conclusion: Revision TSA, in comparison to primary, poses an increased risk of postoperative complications, particularly wound infections. A history of smoking was an independent predictor of wound infections

Platelet-rich plasma and other cellular strategies in orthopedic surgery

The use of biologics in the treatment of musculoskeletal disease has become increasingly more common as research studies continue to provide further elucidation of their mechanisms in healing. Platelet-rich plasma, patches, growth factors, and stem cells are among the many biologics under active investigation and have varying levels of success in augmenting surgical or nonoperative interventions. However, the limitations of these treatments exist, and clear guidelines for their indications and application have yet to be established. Well-designed clinical trials will help determine the appropriate future use of biologics to ensure consistent outcomes

Arthroscopic subscapularis bankart technique as a salvage procedure for failed anterior shoulder stabilization

BACKGROUND: Shoulder instability is a relatively common problem. Even with contemporary surgical techniques, instability can recur following both open and arthroscopic fixation. Surgical management of capsular insufficiency in anterior shoulder stabilization represents a significant challenge, particularly in young, active patients. There are a limited number of surgical treatment options. The Laterjet technique can present with a number of intraoperative challenges and postoperative complication.; DESCRIPTION OF TECHNIQUE: We report an arthroscopic subscapularis tenodesis technique as a salvage procedure for challenging glenohumeral instability cases. Sutures are passed through the subscapularis tendon and capsule before they are tied as one in the subdeltoid psace. The rotator interval is closed with superior and medial advancement of anterior and inferior tissue. This technical note carefully describes this procedure with useful technical tips, illustrations, and diagrams.; PATIENTS AND METHODS: Two clinical cases are described involving patients with recurrent instability following failed surgery who were successfully managed with this procedure.; RESULTS: Both cases described resulted in improved shoulder stability, range of motion, and function following management with this surgical technique. This arthroscopic subscapularis tenodesis procedure is proposed as a useful alternative repair technique for cases of recurrent instability after failed surgery with isolated capsular insufficiency.; CONCLUSION: It is believed that this arthroscopic subscapularis tenodesis technique can potentially provide similar outcomes to open bone block stabilization procedures, while reducing the risks associated with those procedures

Can ion mobility mass spectrometry and density functional theory help elucidate protonation sites in 'small' molecules?

Ion mobility spectrometry-mass spectrometry (IMS-MS) offers an opportunity to combine measurements and/or calculations of the collision cross-sections and subsequent mass spectra with computational modelling in order to derive the three-dimensional structure of ions. IMS-MS has previously been reported to separate two components for the compound norfloxacin, explained by protonation on two different sites, enabling the separation of protonated isomers (protomers) using ion mobility with distinguishable tandem mass spectrometric (MS/MS) data. This study reveals further insights into the specific example of norfloxacin and wider implications for ion mobility mass spectrometry

Patterns of strain and the determination of the safe arc of motion after subscapularis repair—A biomechanical study

This study characterizes the strain patterns and safe arcs for passive range of motion (ROM) in the superior and inferior subscapularis tendon in seven cadaveric shoulders, mounted for controlled ROM, after deltopectoral approach to the glenohumeral joint, including tenotomy of the subscapularis tendon 1 cm medial to its insertion on the lesser tuberosity. The tenotomy was repaired with end‐to‐end suture in neutral rotation. Strain patterns were measured during passive ROM in external rotation (ER), ER with 30° abduction (ER+30), abduction, and forward flexion in the scapular plane (SP) before and after surgery. Percentages were calculated from 35 trials corresponding to five trials of each motion across seven specimens. With ER of 0−30°, 89% of trials of superior subscapularis tendon and 100% of trials of inferior subscapularis tendon achieved strains >3%, with very similar patterns noted in ER+30. In abduction of 0−90°, 5.8% of trials of superior and 85.3% of trials of inferior tendon achieved >3% strain. With passive ROM in SP, 26.5% of trials reached 3% strain in superior tendon compared to 100% in inferior tendon. Strain patterns in abduction and SP differed significantly (p < 0.001). Selective tenotomy and repair of the superior subscapularis tendon with open reparative or reconstructive shoulder procedures, when feasible, may be favorable for protected early passive ROM and rehabilitation postoperatively. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:518–524, 2016.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137457/1/jor23045-sup-0002-SuppData-S2.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137457/2/jor23045.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137457/3/jor23045_am.pd

Creative Reverse Engineering – from remote sensuality to haptic metrology

Our ongoing experimentation in close-range Photogrammetry has overcome common challenges to generate accurate, high-resolution 3D models using a single DSLR camera and innovative approaches and computer-coded devices. More recent investigations across disciplines sought to bridge the gap between traditional creative skills and modes of visualisation, and what can be made possible through digital means. Working as artists and designers alongside museums and historians, we have developed new photogrammetry equipment and approaches to help overcome the complex fluid geometry, shadowy occlusions and delicate lamina edges of challenging monochromatic garments. The resulting 3D models have allowed the rapid extraction of faithful seams and surfaces direct from the processed ‘mesh’ and into CAD modelling environments for the production of new designs, patterns and production tooling. Current collaborations seek to apply these developments to the capture, visualisation and reverse engineering of iconic garments and museum artefacts, alongside the 'remote sensing' of traditional pattern cutters whose eyes, minds and hands are the equivalent of the digital approaches explored in our paper. The second phase sought to unpick some of the familiar structures of object- and asset creation in and for Virtual and Augmented Reality. Experimenting with equipment, methods and processing techniques allowed us to explore the potential of 3D visualisations and readily available tools within Virtual and Augmented Reality for garment design and other forms of object-based creative ideation, sketching and prototyping. In the next stages of our ongoing research we explored a more haptic form of CAD-enabled modelling and metrology, aiming to bring these approaches within the reach of a wider range of creative users: enabling artists, designers and makers to move more seamlessly between digital tools and virtual environments, and actual things in real time and space

Building better Sex Robots: Lessons from Feminist Pornography

How should we react to the development of sexbot technology? Taking their cue from anti-porn feminism, several academic critics lament the development of sexbot technology, arguing that it objectifies and subordinates women, is likely to promote misogynistic attitudes toward sex, and may need to be banned or restricted. In this chapter I argue for an alternative response. Taking my cue from the sex positive ‘feminist porn’ movement, I argue that the best response to the development of ‘bad’ sexbots is to make better ones. This will require changes to the content, process and context of sexbot development. Doing so will acknowledge the valuable role that technology can play in human sexuality, and allow us to challenge gendered norms and assumptions about male and female sexual desire. This will not be a panacea to the social problems that could arise from sexbot development, but it offers a more realistic and hopeful vision for the future of this technology in a pluralistic and progressive society