The acromial index, a radiological parameter assessing the subacromial space, is vital for diagnosing conditions like rotator cuff tears and subacromial impingement syndrome as the acromial Index influences the choice of therapy. Traditionally determined via X-ray, AI is increasingly assessed using MRI due to its superior image quality. However, MRI's cost and limited availability highlight the need for alternative methods. Ultrasound offers a promising, cost-effective alternative, providing real-time imaging without radiation exposure. This study aims to compare the accuracy and reliability of ultrasound-based AI determination with MRI. This retrospective study enrolled patients with shoulder complaints who underwent both MRI and ultrasound examinations between November 2021 and October 2022. Inclusion criteria included appropriate MRI and ultrasound images of the shoulder joint. AI was measured on MRI images and a modified AI was assessed using ultrasound. Statistical analyses evaluated the accuracy and reliability of both methods, focusing on intra- and interobserver consistency. A total of 113 patients (53.2 years average age, 31.3% female) were included. The mean MRI-determined AI was 0.65 (SD 0.065), with 15.6% showing pathological AI. Ultrasound-determined modified acromial index averaged 0.74 (SD 0.122), with 33% showing pathological modified acromial index. Comparative analysis showed no significant difference between MRI and ultrasound measurements (p = 0.237). Both methods demonstrated high intra- and interobserver reliability (ICC values > 0.9). Ultrasound-assisted AI determination is a valid, reproducible, and reliable alternative to MRI. Its advantages include cost-effectiveness, accessibility, and absence of ionizing radiation, making it particularly useful in resource-limited settings.
J-sign assessment is considered a helpful clinical parameter in the treatment of lateral patellar instability (LPI). However, it is unclear whether there is a correlation between the degree of the J-sign and anatomic risk factors. The aim of this study was to investigate whether there is a correlation between the degree of the J-sign assessed by haptic-visual assessment and anatomic risk factors of LPI. J-sign grading was prospectively assessed by two experienced observers in 51 knee joints in 46 patients (male/female 19/32; age 25.1 ± 10 years; ≥ 1 patellar dislocation) according to the quadrant method of Zhang et al. Assessment was done with haptic-visual assessment, including palpation of the medial and lateral patellar facets with the thumb and index finger. The J-Sign grade was correlated with known anatomic risk factors for patellar instability, including the Caton‒Deschamps index, the Dejour type of trochlear dysplasia with additional measurements of trochlear bump height and lateral trochlear inclination angle, the tibial tuberosity–trochlear groove (TT–TG) distance, the tibial tuberosity–posterior cruciate ligament (TT–PCL) distance, the varus/valgus deformity and the total number of anatomic risk factors. There was a significant correlation between the J-sign and the Caton–Deschamps index (r1 = 0.51; p < 0.001 and r2 = 0.41; p = 0.005), the total number of anatomic risk factors (r1 = 0.34; p = 0.015 and r2 = 0.30; p = 0.032) and the trochlear bump height (r1 = 0.36; p = 0.021 and r2 = 0.35; p = 0.027) for both raters. Moreover, the results revealed a significant correlation between the J-sign grade assessed by one rater and the TT–TG distance (r1 = 0.31; p = 0.044). Haptic-visual assessment of the J-sign revealed a significant correlation with patella height, trochlear bump height, TT–TG distance and the total number of anatomic risk factors for patellar instability.
Background Glenoid version and inclination can be corrected with an augmented baseplate during reverse shoulder arthroplasty (rTSA) procedures. To achieve an optimal correction of both glenoid version and inclination, this study investigated whether the preoperative use of a 3-dimensional planning system improved the correction of glenoid anatomy in terms of glenoid version (0°) and inclination (rTSA 0°). Methods We measured preoperative and postoperative glenoid version and inclination by rTSA angle by x-ray and computed tomography scans in 50 prospective cases of rTSA with wedged baseplates. All patients underwent an rTSA due to osteoarthritis and rotator cuff insufficiency. All 50 patients underwent rTSA with the use of a hemi-wedge to correct the glenoid morphology. Twenty five patients additionally underwent a preoperative planning with the Signature ONE Planner to determine the exact rotational position of the hemi-wedge. rTSA angle was determined in preoperative and postoperative x-rays, and glenoid version was determined in preoperative and postoperative computed tomography scans at 3 different glenoid levels. The Signature ONE Planner system determined the rotation, position, and size of the hemi-wedge (10°, 20°, or 30°). A control group of 25 patients underwent hemi-wedge rTSA without preoperative planning. The position of the sphere and the sphere bone overhang distance (mm) was determined in both groups. Results In all 50 patients, the inclination was almost corrected anatomically from a preoperative rTSA angle of 16.2° ± 6.4° to 2.4° ± 3.5° postoperatively, irrespective of the use of Signature ONE Planner. In comparison, the average correction of retroversion was worse and achieved to a lower degree but the use of Signature ONE Planner significantly improved the correction of retroversion in all 3 parts of the glenoid to an almost anatomical level (P < .0001). In both groups, the sphere bone overhang distance was between 4 and 5 mm without scapular notching. Discussion and Conclusion The anatomical correction of a retroverted glenoid with a hemi-wedge baseplate can be considerably improved by the preoperative use of the Signature ONE planning system. Preoperative planning can thus help surgeons to achieve an optimal baseplate position and may thus improve the correction of the glenoid retroversion after rTSA.
PURPOSE:The main goal was to perform a modified Delphi process with the Ligament Injuries Committee of the German Knee Society (DKG) to structure and optimize the management of isolated posterior cruciate ligament (PCL) injuries. METHODS:A structured modified Delphi approach was used to develop an expert statement. Steering group formulated an initial questionnaire and distributed it to 15 experienced knee surgeons (male/female 13/2, mean age 45 ± 5 years) of the working group in Round 1. Thirty-one statements covering five thematic topics were then derived from the responses and comprehensive literature search (Medline, Scopus and Cochrane) using variations of different search terms (literature group). The statements underwent two rating cycles by the working group, using a 5-point Likert scale in Round 2 and as a binary 'agree/disagree' in the final third round. Levels of evidence were assigned to each statement using standardized A-E and GRADE grading systems based on the available data. RESULTS:High agreement (≥80%) was achieved for 24 of the 31 statements (range, 83%-100%), whereas for 7 agreement was <80% (range 63%-74%). The highest levels of agreement were reached for imaging modalities, treatment of PCL tibial avulsions, and preservation of native PCL fibres in reconstruction techniques, whereas the greatest divergence was observed regarding the role of leg axis and slope analyses and indications for corrective osteotomies, use of augmentation in reconstruction and post-operative rehabilitation protocols. The available level of evidence across studies in the literature was predominantly low to moderate. Of the 31 statements, 17 were graded as expert opinion (E, GRADE: very low), 12 as case series (C; GRADE: low), and only 2 achieved higher levels of evidence (B2, GRADE: moderate). CONCLUSION:By providing structured treatment protocols, this Delphi-based structured expert statement can support clinicians in day-to-day decision-making and ultimately improve patient care and outcomes. STUDY DESIGN:Expert survey. LEVEL OF EVIDENCE:Level V.
PURPOSE:This study aimed to evaluate whether age at the time of surgery influences patient-reported outcome measures (PROMs) in patients undergoing tailored surgical treatment for lateral patellar dislocation (LPD), including deepening trochleoplasty (TP). METHODS:This retrospective cohort study used a prospectively maintained database. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and a numerical analogue scale (0-10) for patellofemoral pain (PFP) and subjective knee joint function were used to assess patients' disease-specific quality of life before and after surgery. Preoperative cartilage status was evaluated via the semiquantitative Area Measurement and Depth & Underlying Structures (AMADEUS) scoring system. RESULTS:Twenty-nine patients (m/f 4/25) were ≥30 years of age (mean: 35.3; range: 30-51) and formed the study group (SG), and 127 patients (m/f 39/88) were <30 years of age (mean: 20.4; range: 11-29) and formed the control group (CG). The evaluation was performed at a mean of 30 ± 13.2 (SG) and 33.1 ± 13.3 months (CG) post-operatively (p = 0.27). The BPII 2.0 increased from 48.7 ± 21.4 to 85.4 ± 10.7 points (p < 0.0001) (SG) and from 44 ± 20.6 to 78.6 ± 18.4 points (p < 0.0001) (CG), without any significant difference between the groups at the final follow-up (p = 0.24). PFP and subjective knee joint function also improved significantly in both groups (p < 0.0001; p < 0.0001), without any significant difference between the groups at the final follow-up (p = 0.08; p = 0.3). In the SG and the CG, 88.2% and 89.7% of patients, respectively, achieved an MCID of 10 points calculated for the BPII 2.0 (p = 0.99), and no correlation was found for 'age' or any evaluated post-operative PROM (all p > 0.1). The AMADEUS scores were 80.1 ± 15 points (CG) and 82.1 ± 14.2 points (SG) (p = 0.57), respectively. CONCLUSION:Deepening TP, as part of a tailored surgical treatment plan for recurrent LPD, yielded satisfying results, irrespective of patient age at the time of surgery. LEVEL OF EVIDENCE:Level III.
