Do partial glenohumeral degenerative changes in patients undergoing arthroscopic rotator cuff repair influence clinical outcomes?

Background The prognostic factors for patients with full-thickness rotator cuff tears (RCTs) include tear size, muscle atrophy and fatty infiltration. However, the influence of early coexisting degenerative changes on RCT outcomes is unappreciated. The purpose of this study was to calculate the impact that pre-existing partial glenohumeral cartilaginous changes have on patients undergoing arthroscopic RCT repair. Methods A study of 54 patients undergoing arthroscopic RCT repair was undertaken. The presence of co-existing patches of glenohumeral degenerative cartilaginous changes and RCT size was recorded at surgery. Pre- and postoperative outcomes were assessed using traditional (Oxford Shoulder Score [OSS], 5-level EuroQol-5D [EQ-5D-5L] questionnaire and EuroQol visual analog scale [EQ-VAS]) and patient-centric re-formatted prisms. Outcomes were assessed as an entire dataset, and sub-group analysis was performed according to the grade of co-existing arthritis and tear size. Results Significant improvements (p<0.05) in clinical outcomes were recognized when assessed using either the traditional or reformatted prisms (average % improvements in OSS, EQ-5D-5L and EQ-VAS were 47%, 33% and 43%, respectively; average improvements in pain, function, and psychological well-being were 48%, 33% and, 29%, respectively). Positive gain was noted in all sub-groups of arthritic grading and tear size. Conclusions Good clinical outcomes can be achieved following RCT repair even in the presence of local partial degenerative cartilage changes and advancing tear size. These benefits are patient-centered but require RCT repairability

Scapular spine stress fractures:To fix or not to fix, our experience in a patient with bilateral fractures and review of the literature

We report a case of bilateral scapular spine stress fracture, treated conservatively on one side and operatively on the other side. Besides, we performed a literature review to establish management options. A 61-year-old right-handed gentleman came to our clinic with acute on chronic deterioration of shoulder pain and loss of arm function. Clinical assessment and investigations revealed long-standing bilateral rotator cuff tear and scapular spine stress fractures. The fracture on the right side united with conservative management for 2 months. However, his left side remained symptomatic with pain, abnormal mobility and no radiological evidence of union. The fracture progressed to union after fixation and bone grafting. At the final follow-up at 2 years, the patient was asymptomatic with regards to the fractures with Oxford Shoulder Score (OSS)-30 and Disabilities of the Arm, Shoulder and Hand (DASH)-30.8. Fracture union either by conservative or operative treatment is associated with good functional outcome and is supported by our review

An analysis of acromioclavicular joint morphology as a factor for shoulder impingement syndrome

BACKGROUND: The present study aimed to determine whether acromioclavicular (AC) joint morphology was a factor in the development of symptomatic impingement necessitating AC joint excision. METHODS: We performed a prospective cohort study on all patients undergoing AC joint excision for symptomatic joint pain unresponsive to conservative treatment between 2009 and 2011. This involved 106 consecutive patients (57 women, 49 men, average age 54 years, age range 33 to 76 years). Prior to surgery, radiographic classification of the AC joint was performed producing three main groups: oblique, flat or curved. Pre- and postoperative assessment was performed using the Oxford Shoulder Score and the Disabilities of the Arm, Shoulder and Hand questionnaire. RESULTS: A significantly (p < 0.05) higher frequency of oblique AC joint morphology was seen in the AC joint excision study population compared to the normal population. Postoperative outcome demonstrated no significant difference (P > 0.05) between any of the three AC joint morphologies. CONCLUSIONS: The present study demonstrates a significant association between the oblique AC joint morphology and those patients who develop AC joint pain requiring surgery. Outcomes of surgery were independent of joint morphology, gender or age, with all patient subgroups demonstrating significant improvement by the end of the study

Robotic surgery in trauma and orthopaedics:A systematic review

The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics.Cite this article: Bone Joint J 2015; 97-B:292–9.</jats:p

Hierarchical Gold Flower with Sharp Tips from Controlled Galvanic Replacement Reaction for High Surface Enhanced Raman Scattering Activity

Highly branched Au flowers (AuFs) with sharp tips have been synthesized in high yield by controlling the kinetics of nanocrystal growth via galvanic replacement reaction. Controlled galvanic replacement takes place on appropriately chosen commercially available polystyrene bead supported Cu nanoparticles with HAuCl₄. Such a reaction is thermodynamically driven through the exploitation of a Cu­(II)/Cu(0) redox couple during nanocrystal formation. The hierarchical morphology of the resulting naked Au flowers (AuFs) depends on the galvanic exchange rate, which increases with increasing HAuCl₄ concentration but over a specific concentration range. The formation of AuF is carefully studied, and a spontaneous assembly mechanism is proposed. The time-course experimental results show that the influence of electrostatic field force (EFF) of the charged resin beads is held responsible for prickly tipped AuF formation. Then the fabrication of AuF morphology becomes a large-scale free-standing synthetic protocol for a chemically stable substrate for surface-enhanced Raman scattering (SERS) studies down to the single molecular level. The SERS results guarantee that the as-prepared naked AuF is an excellent and stable SERS substrate. The prickly tips of the gold bearing enhanced field with a large number of embedded “hot spots” hidden within the oriented petals and absence of surfactant or capping agent invites a probe molecule to show the enhancement even for a concentration of 4-mercaptopyridine (4-MPy) down to 10^–12 mol dm^–3. The electric field distribution around the hot spot has been estimated from 3D-FDTD simulation studies. The selective enhancements of SER bands of the 4-MPy molecule have been unveiled from the view of Herzberg–Teller (HT) charge transfer (CT) mechanism