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BACKGROUND: The role of the critical shoulder angle (CSA) as a risk factor for rotator cuff tear (RCT) remains controversial. Studies on the association between the CSA and RCT show considerable differences in design, and this could be responsible for the variation in study results. PURPOSE: To (1) describe the reliability of CSA measurement and (2) evaluate the results of the studies reporting the association between the CSA and RCT using meta-analytical techniques to explore potential sources of variation of study results. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 4. METHODS: MEDLINE, EMBASE, and CINAHL electronic databases were searched through June 30, 2019. Case-control and cross-sectional studies reporting the association of the CSA and RCT were selected. The weighted mean difference in the CSA was estimated using a random-effects model. Prediction interval was computed to better express uncertainties in the effect estimate. Metaregression and subgroup analyses were performed to explore potential sources of heterogeneity. RESULTS: A total of 14 studies, including 1154 cases and 1271 controls, were identified. Of these studies, 79% (11/14) assessed the reliability of the CSA measurement, demonstrating an excellent intraobserver (range, 0.91-0.99) and interobserver (range, 0.87-0.99) reliability. Compared with controls, cases with RCT showed larger measurements of the CSA (3.3° [95% CI, 2.3°- 4.4°]). However, there was a high heterogeneity (I2 = 93%), and the 95% prediction interval (-0.4° to 7.1°) included no difference in the CSA. Results of the metaregression analysis showed a significant association of several methodological aspects with the heterogeneity. The difference in the CSA tended to be larger when only full-thickness tears were included, when no specific defined criterion for assessing radiographic viewing perspective was used, in studies with smaller sample sizes, and in studies at higher risk of bias. CONCLUSION: While the CSA can be reliably measured, the difference in the CSA between cases and controls varied from very large to modest or almost no difference. Several determinants of heterogeneity were determined. Owing to this heterogeneity, it is difficult to gain an insight into the strength and exact nature of the association between the CSA and RCT with the current evidence.
Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Estudos de Casos e Controles , Humanos , Radiografia , Lesões do Manguito Rotador/diagnóstico por imagem , OmbroRESUMO
A 55-year-old woman presented to our service with chronic pain in her right shoulder with no history of trauma. Shoulder x-ray and CT scan revealed an enchondroma of the proximal humerus with no associated fracture. The MRI also showed a complete rupture of the supraspinatus and infraspinatus tendons. An arthroscopic transosseous rotator cuff repair without anchors was performed. At 12 months of follow-up, the patient had recovered functionality and the enchondromatous lesion remained stable. Anchorless transosseous arthroscopic repair of a rotator cuff tear may represent a good surgical option for patients whose bone quality makes anchor placement inappropriate, such as in the presence of a benign bone tumor such as enchondroma. Level III of evidence: Level IV; case report.
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Osborne-Cotterill lesion is an osteochondral fracture located in the posterolateral margin of the humeral capitellum, which may be associated with a defect of the radial head after an elbow dislocation. This lesion causes instability by affecting the lateral ulnar collateral ligament over its capitellar insertion, which is associated with a residual capsular laxity, thereby leading to poor coverage of the radial head, and hence resulting in frequent dislocations. We present a 54-year-old patient, a physician who underwent trauma of the left elbow after falling from a bike and suffered a posterior dislocation fracture of the elbow. The patient subsequently presented episodes of instability, and additional work-up studies diagnosed the occurrence of Osborne-Cotterill lesion. An open reduction and internal fixation of the bony lesion was performed, with reinsertion of the lateral ligamentous complex. Three months after surgery, the patient was asymptomatic, having a flexion of 130º and extension of 0º, and resumed his daily activities without any limitation. Currently, the patient remains asymptomatic 2 years after the procedure. Elbow instability includes a large spectrum of pathological conditions that affect the biomechanics of the joint. The Osborne-Cotterill lesion is one among these conditions. It is a pathology that is often forgotten and easily overlooked. Undoubtedly, this lesion requires surgical intervention.
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Introducción: La artritis séptica (AS) se define como la infección del espacio articular que afecta cualquier articulación, es más frecuente en niños menores de 5 años y su principal causa es la diseminación hematógena. El diagnóstico etiológico es difícil en niños, logrando aislamiento en menos de la mitad de los casos. Se evaluó el rendimiento diagnóstico de la botella de hemocultivo (BHC) como medio alternativo para la siembra del líquido sinovial comparado con los medios convencionales (MC). Metodología: Estudio de cohorte prospectivo realizado en centro de tercer nivel de 2011-2016, niños de 0 a 12 años con diagnóstico clínico de artritis séptica y disponibilidad de las dos muestras tomadas en cirugía. Resultados: Ingresaron 60 pacientes, masculinos 56%, mediana de edad 48 meses y tiempo de síntomas 58 horas (48-192); 33,3% con antecedente de trauma; 30% recibieron antibióticos previos. Articulaciones afectadas: cadera 44%, rodilla 28% y tobillo 18%. En 39 pacientes (65%) se tomaron hemocultivos; de estos 19 (49%) fueron positivos, todos para S. aureus. Se obtuvo confirmación en líquido sinovial por cualquier método en 27 pacientes (45%), positivos en ambos 21,6%, en MC 13,3% y en BHC 10%, los microorganismos más frecuentes SAMS 21,6%, SAMR 8,3%, S. pyogenes 3,3%, SEMR 3,3%, S. pneumoniae 1,6%, N. meningitidis 1,6%, no se aisló K. kingae. El tratamiento antibiótico más utilizado fueron los betalactamicos, mediana de estancia 18(12-25,5) días, mortalidad del 3,3%. Conclusión: Las BHC son un complemento al medio sólido convencional y aumentaron la confirmación etiológica de artritis séptica del 35% al 45%.
Introduction: Septic arthritis (SA) is defined as the infection of any joint space; it is more common in children under 5 years and its main cause is hematogenous dissemination. The etiological diagnosis is difficult in children, achieving isolation in less than half of the cases. The diagnostic performance of the blood culture bottle (BCB) was evaluated as an alternative medium for seeding synovial fluid compared to conventional media (CM). Methods: A prospective cohort survey was conducted in a third-level center from 2011-2016, in children aged 0 to 12 years with a clinical diagnosis of septic arthritis and availability of the two samples taken in surgery. Results: 60 patients were admitted, being 56% male, with a median age of 48 months and symptom time of 58 hours (48-192); 33.3% had a history of trauma; 30% received previous antibiotics. Affected joints: hip (44%), knee (28%), and ankle (18%). Blood cultures were taken in 39 patients (65%); of these, 19 (49%) were positive, all for S. aureus. Confirmation in synovial fluid was obtained by any method in 27 subjects (45%), positive in both: 21.6%, 13.3% in CM, and 10% in BCB. The most frequent microorganisms were: MSSA (21.6%), MRSA (8.3%), S. pyogenes (3.3%), MRSE (3.3%), S. pneumoniae (1.6%), N. meningitidis (1.6%). K. kingae was not isolated. The most commonly used antibiotic treatment was beta-lactams. The median of stay was 18 days (12-25.5), with a mortality of 3.3%. Conclusion: BCB are a complement to the conventional solid medium and increased the etiological confirmation of septic arthritis from 35 to 45%.