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Papers by Anestis Iossifidis

Orthopaedic Proceedings, Feb 1, 2004

Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general ana... more Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general anaesthetic and its potential for use in increasing the provision of day case shoulder surgery. Patients and Methods. 104 patients undergoing shoulder surgery were audited using a questionnaire immediately postoperatively, and at 6, 12 and 48 hours. Pain scores were recorded using a visual analogue scale. Operative details including operation time, postoperative stay and complications have also been recorded. At 48 hours patients were asked about having their operation as a day case and their pain control was assessed. Results. 52 males and 52 females mean age 49 years (range 18–85) completed the questionnaire. 90 responded to a 48-hour interview. 75 arthroscopic decompressions, 15 arthroscopically assisted mini open cuff repairs, 9 open glenohumeral stabilisations and 5 open Mumford procedures were performed. Mean operation time was 47 minutes (range 25–90) and 101 patients were discharged after one (86 patients) or two (15 patients) postoperative nights. 97 patients had no pain immediately postoperatively, 76 were pain free at 6 hours and 39 were pain free at 12 hours. Mean pain scores at 6 and 12 hours were 3 and 4. 101 patients said that their pain was well controlled throughout the first 48 hours with simple oral analgesics. 83% of patients expressing an opinion on day case treatment (69 out of 83) could have been managed as day cases provided that they were adequately counseled about the procedure. 6 patients showed signs of Horner’s syndrome that resolved fully by 12 hours. No other complications related to the inter-scalene block occurred. Conclusion. This study has shown that interscalene anaesthesia is a safe procedure providing sustained and adequate pain relief. In association with oral analgesia and patient counselling it allows a high percentage of patients undergoing shoulder surgery to be discharged home on the day of surgery.

Background: Among many advances in the treatment of rotator cuff tears, arthroscopic augmentation... more Background: Among many advances in the treatment of rotator cuff tears, arthroscopic augmentation techniques with patches of various biological and synthetic graft materials have been introduced to reinforce the repair. However, structural and functional outcomes after patch augmentation vary, and reinforcing the tendon healing remains a challenge. The aim of this study was to evaluate clinical and radiologic outcomes 1 year after arthroscopic posterosuperior (PS) rotator cuff repair with bioabsorbable patch augmentation. Methods: From October 2014 to December 2017, all patients with PS rotator cuff tears undergoing arthroscopic repair with patch augmentation using a resorbable, biologically derived poly-4hydroxybutyrate patch (Biofiber; Wright, Memphis, TN, USA) were enrolled in this study. Only fullthickness PS lesions with 1 of the following tear patterns were augmented with a patch and were the subject of this study: large U-and L-shaped tear, transtendinous tear, delamination, and fraying of the bursal layer. Patients were examined preoperatively and at 1 year postoperatively with a standardized examination protocol and magnetic resonance imaging (MRI). Results: Sixteen patients were included in this study; 1 patient was lost to follow-up. One patient only underwent clinical follow-up. We detected 1 repair failure (6.7%) with dislocation of the lateral-row anchors on computed tomography scanning at 3 months postoperatively. MRI was performed in 14 patients after 1 year; in all of them, the cuff repair was intact. The Sugaya tendon integrity score was 1.7 ± 0.9. The Constant-Murley score improved from 44 to 89 points (P < .001). Muscular strength improved in the supraspinatus (from 2.6 to 4.8), infraspinatus (from 3.2 to 4.9), and subscapularis (from 4 to 4.9) (all P < .001). Overall, patient satisfaction was high (3.6 ± 0.6). Discussion: This small-sized case series is the first to prospectively assess clinical and radiologic outcomes after patch augmentation of PS rotator cuff tears using bioabsorbable poly-4-hydroxybutyrate patches. Good to excellent structural and functional outcomes were observed with a low retear rate (6.7%) and good tendon integrity on 1-year postoperative MRI, and the graft did not cause any complications. The use of bioabsorbable patches could be beneficial when unfavorable PS tear patterns are encountered in which a stable repair of the full tendon thickness at its insertion is otherwise difficult to reach.

Orthopaedic Proceedings, Sep 1, 2012

Purpose Our understanding of the spectrum of pathological lesions of the shoulder anterior capsul... more Purpose Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability. Methods We studied 122 patients, 101 male and 21 female patients with an average age of 28 (17 to 47 years old), undergoing primary arthroscopic stabilization for anterior instability between 2004 and 2008. The pathoanatomy of the anterior capsule-labral complex was documented. Based on our previous MRI arthrography experience we were able to categorize the lesions seen arthroscopically in three subgroups: the Bankart lesion, the Perthes lesion and the ALPSA (anterior periosteal sleeve avulsion). Results Arthroscopic findings confirmed the presence of the triad of essential lesion. The relative proportions of the subcategories of the essential lesion were as follows: 71 (58%) Bankart lesions, 18 (15%) Perthes lesions and 33 (27%) ALPSA lesions. Each lesion has unique characteristics, which affect treatment and prognosis. We describe the three types of labral injury and the surgical implications. Conclusion The literature on the essential anterior capsular-labral lesion has historically focused on the Bankart lesion. There are in fact three variants of the essential lesion: the triad of Bankart, ALPSA and Perthes. This study evaluates these lesions and quantifies their relative proportions in a large series. We believe that awareness of this sub classification of the essential lesion is important as it affects the management of this condition.

Injury Extra, Jul 1, 2005

Orthopaedic Proceedings, Feb 1, 2004

Aim. The purpose of this study was to assess the outcome of arthroscopic shoulder surgery by eval... more Aim. The purpose of this study was to assess the outcome of arthroscopic shoulder surgery by evaluating the pre- and postoperative shoulder function using a simple self-assessment questionnaire filled in by the patient. Patients and Methods. In this study 89 patients were studied who underwent arthroscopic subacromial decompression. Shoulder function was assessed preoperatively and at 3 to 6 months following surgery according to a self-assessment questionnaire, which was developed in our Shoulder Unit. It allows for a maximum score of hundred, with 30 points for pain, 20 for power and 50 points for work, recreation and 8 activities of daily living. Results. All patients reported improvement in shoulder function with an average total shoulder score increase from 33.4% preoperatively to 87.8% post-surgery. The pain score increased from 21% to 83%, power from 30% to 89% and activities of daily living from 42% to 90%. Detailed analysis of ADL’s showed substantial improvement in all functions. Conclusion. This study has shown that minimal invasive surgery to the shoulder in the form of arthroscopic procedure, results in satisfactory improvement of all outcome measures in the majority of the patients. Together with low morbidity and early functional recovery, shoulder arthroscopy appears to be the procedure of choice in current surgical practice. We believe that the self-assessment questionnaire represents a useful outcome measure and reflects the improvement in shoulder function as perceived by the patient.

Orthopaedic Proceedings, Jul 1, 2002

Aim: A prospective study designed to assess and evaluate the results of arthroscopic acromioclavi... more Aim: A prospective study designed to assess and evaluate the results of arthroscopic acromioclavicular joint (ACJ) minimal excision arthroplasty. Patients and Methods: Twenty-two patients with ACJ arthropathy underwent an arthroscopic limited excision of the ACJ preserving the superior ligamentous complex. The patients were assessed pre and post operatively using the Constant score. The average time from surgery to review was five months (three to nineteen months). A self assessment questionnaire was also used, evaluating outcome measures such as activities of daily living, shoulder function and patients satisfaction. Results: The mean preoperative Constant score was 28 and postoperative score was 71 with an improvement in pain from 15% to 80% and the range of motion from 37% to 84%. The preoperative self assessment score was 25.9 and postoperative score was 83 with an improvement in activities of daily living from 28% to 79%, and shoulder function from 34% to 87%.Twenty patients were very satisfied, one was moderately satisfied and one patient was dissatisfied although his shoulder function increased from 20 to 60%. Discussion: This study suggests that this technique is well accepted by the patients and results in a good improvement in shoulder function. The results are comparable with those reported in the literature concerning the standard ACJ arthroplasty. We therefore believe that a limited excision of the ACJ is adequate and a reliable alternative to conventional techniques.

The journal of bone and joint surgery, Jul 1, 1995

We were unable to determine the sizes of the particles released from brushes but a wide range is ... more We were unable to determine the sizes of the particles released from brushes but a wide range is possible. The long-term clinical effect of ‘brushdebris' will be difficult to establish, but it is known that polyethylene wear debris plays a role in the outcome ofjoint replacement. The selection of more appropriate material for brushes and the REFERENCES Anthony PP, Gie GA, Howie CR, Ling RSM. Localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties.

Orthopaedic Proceedings, May 1, 2009

The aim of this prospective study was to report the mid-term results of arthroscopic repair of fu... more The aim of this prospective study was to report the mid-term results of arthroscopic repair of full thickness rotator cuff tears. Arthroscopic cuff repair, under regional interscalene block and balanced anaesthesia, was performed in 104 shoulders (102 patients). There were 52 female and 50 male patients with a mean age of 64 years (range 41 to 79). The mean size of the cuff tear was 3cm (range 1cm to 6 cm). Patients were discharged within 24 hours and followed a specific rehabilitation protocol. An assessment was performed pre-operatively and at a mean follow-up of 7 months (range 3 to 24 months). Outcome measures included pain, activities of daily living, shoulder function and level of patient satisfaction. Satisfactory pain relief was achieved in 98 patients (94%) with significant pain relief in 87 patients (83.6 %) and good in 12 patients (11.5 %). Ninety -six patients (92.3%) reported a satisfactory improvement in activities of daily living, with significant improvement in 89 (85.6%) and good in seven (6.7%). High levels of patient satisfaction were noted in 93 patients. Seven patients were moderately satisfied and two patients were not satisfied. The mean shoulder score improved from 29 pre-op to 82 post-op, and the shoulder function score from 32 pre-op to 84 post-op. No difference in outcome was found when the subgroup of 65 patients over the age of sixty was compared to the group of 37 patients under the age of sixty. We believe that this study has shown that the arthroscopic repair of the rotator cuff can consistently achieve a satisfactory outcome. It may therefore be considered as an alternative to the traditional open techniques.

Injury Extra, Oct 1, 2005

Injury Extra, Jun 1, 2006

International Journal of Clinical Practice, Mar 8, 2006

Necrotising fasciitis is a rare, life-threatening, soft-tissue infection characterised by rapidly... more Necrotising fasciitis is a rare, life-threatening, soft-tissue infection characterised by rapidly spreading inflammation and subsequent necrosis of the muscle, fascia and surrounding tissues. We report a case of necrotising fasciitis originating from the shoulder in a 59-year-old female patient. Necrotising fasciitis of the shoulder is very rare and has a poor prognosis because of its potential to spread to the chest wall. It can occur in otherwise healthy people without any predisposing conditions and could present as muscle strain. Disproportionate pain is the hallmark of this condition. Ultrasound examination and aspiration of fluid from the involved area is a fast and efficient method of reaching the diagnosis.

European Journal of Orthopaedic Surgery and Traumatology, Jul 19, 2006

This study looked at the potential of using a combination of general anaesthesia and inter-scalen... more This study looked at the potential of using a combination of general anaesthesia and inter-scalene block (balanced anaesthesia) for providing day-case shoulder surgery services. One hundred and four patients undergoing shoulder surgery were audited using a questionnaire immediately after operation. All patients underwent shoulder surgery under a combination of general anaesthesia and inter-scalene block. The blocks were performed by a single anaesthetist experienced in the procedure. The pain scores were recorded based on visual analogue scale at 6, 12 and 48 h after operation. At 48 h overall pain control was assessed and patients were asked their opinion about having their operation done as a day-case. There were 52 males and 52 females with mean age of 49 years (range 18-85). Mean operation time was 47 min (range 25-90). Ninety-seven (93%) patients were pain free immediately after the operation. Seventy-six (73%) patients were pain free at 6 h and 39 (38%) at 12 h. Mean pain scores at 6 h was 3 and at 12 h was 4. One hundred and one patients said their pain was well controlled throughout the first 48 h by simple oral analgesics. Eighty-four (83%) patients expressed the opinion that they could have been managed as day case provided they were adequately counselled about the procedure. Six (5.7%) patients showed signs of Horner's syndrome that resolved by 12 h. No other complications related to inter-scalene block occurred. This study has shown that inter-scalene block is a safe procedure providing sustained adequate pain relief after shoulder surgery. It could allow a high percentage of patients undergoing shoulder surgery to be discharged home on the day of the surgery. Keywords Inter-scalene block AE Arthroscopy AE Shoulder AE Day-surgery Bloc anesthe´sique interscale´nique pour chirurgie de l'e´paule en hospitalisation de jour Re´sume´Cette e´tude met en e´vidence le be´ne´fice d'une anesthe´sie balance´e (association d'un bloc interscale´nique et d'une anesthe´sie ge´ne´rale) dans la chirurgie ambulatoire de l'e´paule dans un groupe de 104 patients. Dans la pe´riode post ope´ratoire, 98% des patients ont e´te´soulage´s, tandis que 83% d'entre eux ont pu sortir le jour meˆme de l'hoˆpital. Aucune complication grave n'a e´te´note´e. Les auteurs concluent que le bloc interscale´nique est une technique analge´sique suˆre qui peut permettre de re´aliser la chirurgie arthroscopique de l'e´paule en ambulatoire. Mots cle´s Bloc anesthe´sique interscale´nique AE Arthroscopie AE e´paule AE Hospitalisation de jour No financial support received from any sources.

Injury-international Journal of The Care of The Injured, 1996

A study of 55 consecutive knee arfhroscopies under local anaesthesia zms undertaken, in order to ... more A study of 55 consecutive knee arfhroscopies under local anaesthesia zms undertaken, in order to evaluate the effectiveness, patient satisfaction and acceptability of the procedure. Knee arthroscopy was performed without a thigh tourniquet under low volume (20 ml) local anaesthesia using half the recommended safe dose of anaesthetic agents, ns a single intra-nrticular injection together with skin infiltration of the nrfhroscopic portals. The diagnostic accuracy and effectiveness of the procedure was similar to that of surgery under general anaesthesia. Sixty-two lesions were diagnosed and 48 surgical procedures were successfully carried out in 53 patiertts. All but one of the questioned patients (~7 per cent) were satisfied with the procedure which caused liftle or no discomfort in 94 per cent of cases. It is concluded that knee mthroscopy under local nnaesthesia may be considered as a reliable, zuell tolerated and safe ulternative to conventional procedures.

International Journal of Orthopaedics, 2020

We present a rare case of primary synovial chondromatosis of the elbow joint as well as a review ... more We present a rare case of primary synovial chondromatosis of the elbow joint as well as a review of the literature and discuss the clinical, imaging, histological findings and clinical outcome of this condition. It is a benign condition characterized by nodular proliferation and metaplasia of the synovium. Histology findings however suggest that the condition is not solely a metaplasia as the cartilage is often very cellular and could be interpreted as a neoplastic process. This may explain in rare cases the incidence of recurrences and malignant transformation of this condition. Awareness of the atypical histology is paramount and therefore referral to a tertiary oncology centre is mandatory. An experienced pathologist is crucial for the correct diagnosis, prognosis and management of this condition.

International Journal of Orthopaedics, Oct 28, 2021

Aim: Recurrent shoulder instability results in marked disability and affects mainly a young popul... more Aim: Recurrent shoulder instability results in marked disability and affects mainly a young population. However, the gender and age-related differences in labral injuries have been underreported. The aim of our study is to evaluate the arthroscopic spectrum of anteroinferior labrum pathology in recurrent shoulder instability, and assess the gender and age-related differences. Method: This was a study of 201 consecutive patients who underwent arthroscopic shoulder stabilisation for recurrent shoulder instability. Patients were divided into two age groups. Group 1: under 35 years old, included 152 patients, mean age of 26.3 for both sex, and Group 2: over 35 years old, included 49 patients, mean age 42.2 for male and 47.6 for female patients. The gender and age-related differences of arthroscopic findings between the two age groups and overall gender differences were evaluated. Results: Female patients had significantly less antero-inferior labrum lesions (85.7% vs 96.2%, p < 0.011) and more isolated capsule-ligamentous laxity (11.9% vs 1.8%, p < 0.003), than male patients. When analysing the three subtypes of labrum injuries, female patients were found to have significantly less Bankart lesions than male patients (15.4% vs 36.5%, p < 0.037). Both male and female patients in Group 2, had significantly more ALPSA lesions (51% vs 31%, p < 0.0178), and less combined Bankart & Perthes lesions (40.8% vs 63.8%, p < 0.008), than Group 1. Conclusion: This study showed significant gender and age-related differences of anteroinferior capsule-labral complex injuries in chronic shoulder instability. We believe that increased awareness of the different pattern of injuries in female and older patients will be helpful in pre-operative planning and the implementation of the appropriate surgical management.

International Journal of Orthopaedics, Apr 28, 2021

Suprascapular nerve entrapment at the spinoglenoid notch by a ganglion cyst results in the paraly... more Suprascapular nerve entrapment at the spinoglenoid notch by a ganglion cyst results in the paralysis of the terminal motor branch of the nerve, with isolated atrophy of the infraspinatus muscle, loss of strength in external rotation, and posterior shoulder pain. Increased awareness of this nerve compression is paramount in order to avoid the stage of irreversible infraspinatus muscle wasting and long term disability. Magnetic resonance imaging scan, electromyography and nerve conduction velocity studies can confirm the diagnosis and lead to an early arthroscopic nerve decompression and favorable functional results. We present a rare case of spinoglenoid ganglion cyst compression of the distal suprascapular nerve and discuss the recent developments in anatomy, aetiology, diagnosis, and review the treatment and current trends in the management of this condition.

International Journal of Orthopaedics, Aug 28, 2021

The arthroscopic Hill-Sachs Remplissage procedure was first described in 2004 and published in 20... more The arthroscopic Hill-Sachs Remplissage procedure was first described in 2004 and published in 2008. It consists of an arthroscopic posterior capsulodesis combined with an infraspinatus tenodesis to achieve a "filling in" effect of posterior humeral head defects. The technique was put forward as a solution to high rates of Bankart repair failure, in the presence of large Hill-Sachs lesions. We describe the evolution of the technique and its outcomes and report on the evolving surgical indications over the last decade in response to new paradigm shifts. Due to a better understanding of the pathophysiology of shoulder instability, emphasis was given to both Bankart soft tissue repair and to the associated bony injuries, accounting for both glenoid and humeral head (bipolar) bone loss. We present the transition from the concept of "engaging" Hill-Sachs lesions to the concept of "on-track" / "off-track" lesions and the current role of Remplissage in shoulder instability surgery which remains paramount. We believe that in view of the critical role of bipolar bone defects in shoulder instability, preoperative magnetic resonance imaging assessment of the glenoid track of Hill-Sachs lesions is becoming increasingly important in preoperative planning. This allows the orthopaedic surgeon to detect an "off-track" lesion, select the appropriate surgical technique and improve surgical outcomes.

Orthopaedic Proceedings, Jul 1, 2008

The aim of this study was to assess the accuracy of Magnetic Resonance Arthrography (MRA) in symp... more The aim of this study was to assess the accuracy of Magnetic Resonance Arthrography (MRA) in symptomatic shoulder joint instability. Data were collected prospectively from MR Arthrograms performed in 40 consecutive patients with recurrent symptomatic instability. MR Arthrograms included views in the stress ABER position of the shoulder. Subsequently all patients underwent an arthroscopic shoulder stabilisation and the arthroscopic and MR Arthrographic findings were correlated. In case of discrepancy the films and operative findings were reviewed. There were thirty three male and seven female patients with a mean age of 28 years (range 18–40). MR Arthrography showed 37 anterior-inferior tears (22 displaced Bankart tears, 8 nondisplaced Bankart tears, 5 chronic ALPSA lesions and 2 AGL lesions) and 3 posterior lesions. There were 3 discrepancies of which 2 were cases of missed Bankart lesion on MRArthrogram and one case of reverse Perthes lesion present on MRArthrogram but not seen on arthroscopy. Despite a review of the films, the missed Bankart’s lesions were not visualised. In the present study, MR arthrography had a 95% sensitivity in detecting ligamentolabral pathology and a positive predictive value of 0.975 in diagnosing a lesion in recurrent shoulder instability. The results show that MR Arthrogram is a highly useful tool for investigating recurrent shoulder instability with very high sensitivity and positive predictive value. Of the 40 patients who underwent arthroscopy there were only 2 cases where MR Arthrography did not demonstrate an arthroscopically detected abnormality.

Orthopaedic Proceedings, Feb 1, 2004

Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general ana... more Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general anaesthetic and its potential for use in increasing the provision of day case shoulder surgery. Patients and Methods. 104 patients undergoing shoulder surgery were audited using a questionnaire immediately postoperatively, and at 6, 12 and 48 hours. Pain scores were recorded using a visual analogue scale. Operative details including operation time, postoperative stay and complications have also been recorded. At 48 hours patients were asked about having their operation as a day case and their pain control was assessed. Results. 52 males and 52 females mean age 49 years (range 18–85) completed the questionnaire. 90 responded to a 48-hour interview. 75 arthroscopic decompressions, 15 arthroscopically assisted mini open cuff repairs, 9 open glenohumeral stabilisations and 5 open Mumford procedures were performed. Mean operation time was 47 minutes (range 25–90) and 101 patients were discharged after one (86 patients) or two (15 patients) postoperative nights. 97 patients had no pain immediately postoperatively, 76 were pain free at 6 hours and 39 were pain free at 12 hours. Mean pain scores at 6 and 12 hours were 3 and 4. 101 patients said that their pain was well controlled throughout the first 48 hours with simple oral analgesics. 83% of patients expressing an opinion on day case treatment (69 out of 83) could have been managed as day cases provided that they were adequately counseled about the procedure. 6 patients showed signs of Horner’s syndrome that resolved fully by 12 hours. No other complications related to the inter-scalene block occurred. Conclusion. This study has shown that interscalene anaesthesia is a safe procedure providing sustained and adequate pain relief. In association with oral analgesia and patient counselling it allows a high percentage of patients undergoing shoulder surgery to be discharged home on the day of surgery.

Background: Among many advances in the treatment of rotator cuff tears, arthroscopic augmentation... more Background: Among many advances in the treatment of rotator cuff tears, arthroscopic augmentation techniques with patches of various biological and synthetic graft materials have been introduced to reinforce the repair. However, structural and functional outcomes after patch augmentation vary, and reinforcing the tendon healing remains a challenge. The aim of this study was to evaluate clinical and radiologic outcomes 1 year after arthroscopic posterosuperior (PS) rotator cuff repair with bioabsorbable patch augmentation. Methods: From October 2014 to December 2017, all patients with PS rotator cuff tears undergoing arthroscopic repair with patch augmentation using a resorbable, biologically derived poly-4hydroxybutyrate patch (Biofiber; Wright, Memphis, TN, USA) were enrolled in this study. Only fullthickness PS lesions with 1 of the following tear patterns were augmented with a patch and were the subject of this study: large U-and L-shaped tear, transtendinous tear, delamination, and fraying of the bursal layer. Patients were examined preoperatively and at 1 year postoperatively with a standardized examination protocol and magnetic resonance imaging (MRI). Results: Sixteen patients were included in this study; 1 patient was lost to follow-up. One patient only underwent clinical follow-up. We detected 1 repair failure (6.7%) with dislocation of the lateral-row anchors on computed tomography scanning at 3 months postoperatively. MRI was performed in 14 patients after 1 year; in all of them, the cuff repair was intact. The Sugaya tendon integrity score was 1.7 ± 0.9. The Constant-Murley score improved from 44 to 89 points (P < .001). Muscular strength improved in the supraspinatus (from 2.6 to 4.8), infraspinatus (from 3.2 to 4.9), and subscapularis (from 4 to 4.9) (all P < .001). Overall, patient satisfaction was high (3.6 ± 0.6). Discussion: This small-sized case series is the first to prospectively assess clinical and radiologic outcomes after patch augmentation of PS rotator cuff tears using bioabsorbable poly-4-hydroxybutyrate patches. Good to excellent structural and functional outcomes were observed with a low retear rate (6.7%) and good tendon integrity on 1-year postoperative MRI, and the graft did not cause any complications. The use of bioabsorbable patches could be beneficial when unfavorable PS tear patterns are encountered in which a stable repair of the full tendon thickness at its insertion is otherwise difficult to reach.

Orthopaedic Proceedings, Sep 1, 2012

Purpose Our understanding of the spectrum of pathological lesions of the shoulder anterior capsul... more Purpose Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability. Methods We studied 122 patients, 101 male and 21 female patients with an average age of 28 (17 to 47 years old), undergoing primary arthroscopic stabilization for anterior instability between 2004 and 2008. The pathoanatomy of the anterior capsule-labral complex was documented. Based on our previous MRI arthrography experience we were able to categorize the lesions seen arthroscopically in three subgroups: the Bankart lesion, the Perthes lesion and the ALPSA (anterior periosteal sleeve avulsion). Results Arthroscopic findings confirmed the presence of the triad of essential lesion. The relative proportions of the subcategories of the essential lesion were as follows: 71 (58%) Bankart lesions, 18 (15%) Perthes lesions and 33 (27%) ALPSA lesions. Each lesion has unique characteristics, which affect treatment and prognosis. We describe the three types of labral injury and the surgical implications. Conclusion The literature on the essential anterior capsular-labral lesion has historically focused on the Bankart lesion. There are in fact three variants of the essential lesion: the triad of Bankart, ALPSA and Perthes. This study evaluates these lesions and quantifies their relative proportions in a large series. We believe that awareness of this sub classification of the essential lesion is important as it affects the management of this condition.

Injury Extra, Jul 1, 2005

Orthopaedic Proceedings, Feb 1, 2004

Aim. The purpose of this study was to assess the outcome of arthroscopic shoulder surgery by eval... more Aim. The purpose of this study was to assess the outcome of arthroscopic shoulder surgery by evaluating the pre- and postoperative shoulder function using a simple self-assessment questionnaire filled in by the patient. Patients and Methods. In this study 89 patients were studied who underwent arthroscopic subacromial decompression. Shoulder function was assessed preoperatively and at 3 to 6 months following surgery according to a self-assessment questionnaire, which was developed in our Shoulder Unit. It allows for a maximum score of hundred, with 30 points for pain, 20 for power and 50 points for work, recreation and 8 activities of daily living. Results. All patients reported improvement in shoulder function with an average total shoulder score increase from 33.4% preoperatively to 87.8% post-surgery. The pain score increased from 21% to 83%, power from 30% to 89% and activities of daily living from 42% to 90%. Detailed analysis of ADL’s showed substantial improvement in all functions. Conclusion. This study has shown that minimal invasive surgery to the shoulder in the form of arthroscopic procedure, results in satisfactory improvement of all outcome measures in the majority of the patients. Together with low morbidity and early functional recovery, shoulder arthroscopy appears to be the procedure of choice in current surgical practice. We believe that the self-assessment questionnaire represents a useful outcome measure and reflects the improvement in shoulder function as perceived by the patient.

Orthopaedic Proceedings, Jul 1, 2002

Aim: A prospective study designed to assess and evaluate the results of arthroscopic acromioclavi... more Aim: A prospective study designed to assess and evaluate the results of arthroscopic acromioclavicular joint (ACJ) minimal excision arthroplasty. Patients and Methods: Twenty-two patients with ACJ arthropathy underwent an arthroscopic limited excision of the ACJ preserving the superior ligamentous complex. The patients were assessed pre and post operatively using the Constant score. The average time from surgery to review was five months (three to nineteen months). A self assessment questionnaire was also used, evaluating outcome measures such as activities of daily living, shoulder function and patients satisfaction. Results: The mean preoperative Constant score was 28 and postoperative score was 71 with an improvement in pain from 15% to 80% and the range of motion from 37% to 84%. The preoperative self assessment score was 25.9 and postoperative score was 83 with an improvement in activities of daily living from 28% to 79%, and shoulder function from 34% to 87%.Twenty patients were very satisfied, one was moderately satisfied and one patient was dissatisfied although his shoulder function increased from 20 to 60%. Discussion: This study suggests that this technique is well accepted by the patients and results in a good improvement in shoulder function. The results are comparable with those reported in the literature concerning the standard ACJ arthroplasty. We therefore believe that a limited excision of the ACJ is adequate and a reliable alternative to conventional techniques.

The journal of bone and joint surgery, Jul 1, 1995

We were unable to determine the sizes of the particles released from brushes but a wide range is ... more We were unable to determine the sizes of the particles released from brushes but a wide range is possible. The long-term clinical effect of ‘brushdebris' will be difficult to establish, but it is known that polyethylene wear debris plays a role in the outcome ofjoint replacement. The selection of more appropriate material for brushes and the REFERENCES Anthony PP, Gie GA, Howie CR, Ling RSM. Localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties.

Orthopaedic Proceedings, May 1, 2009

The aim of this prospective study was to report the mid-term results of arthroscopic repair of fu... more The aim of this prospective study was to report the mid-term results of arthroscopic repair of full thickness rotator cuff tears. Arthroscopic cuff repair, under regional interscalene block and balanced anaesthesia, was performed in 104 shoulders (102 patients). There were 52 female and 50 male patients with a mean age of 64 years (range 41 to 79). The mean size of the cuff tear was 3cm (range 1cm to 6 cm). Patients were discharged within 24 hours and followed a specific rehabilitation protocol. An assessment was performed pre-operatively and at a mean follow-up of 7 months (range 3 to 24 months). Outcome measures included pain, activities of daily living, shoulder function and level of patient satisfaction. Satisfactory pain relief was achieved in 98 patients (94%) with significant pain relief in 87 patients (83.6 %) and good in 12 patients (11.5 %). Ninety -six patients (92.3%) reported a satisfactory improvement in activities of daily living, with significant improvement in 89 (85.6%) and good in seven (6.7%). High levels of patient satisfaction were noted in 93 patients. Seven patients were moderately satisfied and two patients were not satisfied. The mean shoulder score improved from 29 pre-op to 82 post-op, and the shoulder function score from 32 pre-op to 84 post-op. No difference in outcome was found when the subgroup of 65 patients over the age of sixty was compared to the group of 37 patients under the age of sixty. We believe that this study has shown that the arthroscopic repair of the rotator cuff can consistently achieve a satisfactory outcome. It may therefore be considered as an alternative to the traditional open techniques.

Injury Extra, Oct 1, 2005

Injury Extra, Jun 1, 2006

International Journal of Clinical Practice, Mar 8, 2006

Necrotising fasciitis is a rare, life-threatening, soft-tissue infection characterised by rapidly... more Necrotising fasciitis is a rare, life-threatening, soft-tissue infection characterised by rapidly spreading inflammation and subsequent necrosis of the muscle, fascia and surrounding tissues. We report a case of necrotising fasciitis originating from the shoulder in a 59-year-old female patient. Necrotising fasciitis of the shoulder is very rare and has a poor prognosis because of its potential to spread to the chest wall. It can occur in otherwise healthy people without any predisposing conditions and could present as muscle strain. Disproportionate pain is the hallmark of this condition. Ultrasound examination and aspiration of fluid from the involved area is a fast and efficient method of reaching the diagnosis.

European Journal of Orthopaedic Surgery and Traumatology, Jul 19, 2006

This study looked at the potential of using a combination of general anaesthesia and inter-scalen... more This study looked at the potential of using a combination of general anaesthesia and inter-scalene block (balanced anaesthesia) for providing day-case shoulder surgery services. One hundred and four patients undergoing shoulder surgery were audited using a questionnaire immediately after operation. All patients underwent shoulder surgery under a combination of general anaesthesia and inter-scalene block. The blocks were performed by a single anaesthetist experienced in the procedure. The pain scores were recorded based on visual analogue scale at 6, 12 and 48 h after operation. At 48 h overall pain control was assessed and patients were asked their opinion about having their operation done as a day-case. There were 52 males and 52 females with mean age of 49 years (range 18-85). Mean operation time was 47 min (range 25-90). Ninety-seven (93%) patients were pain free immediately after the operation. Seventy-six (73%) patients were pain free at 6 h and 39 (38%) at 12 h. Mean pain scores at 6 h was 3 and at 12 h was 4. One hundred and one patients said their pain was well controlled throughout the first 48 h by simple oral analgesics. Eighty-four (83%) patients expressed the opinion that they could have been managed as day case provided they were adequately counselled about the procedure. Six (5.7%) patients showed signs of Horner's syndrome that resolved by 12 h. No other complications related to inter-scalene block occurred. This study has shown that inter-scalene block is a safe procedure providing sustained adequate pain relief after shoulder surgery. It could allow a high percentage of patients undergoing shoulder surgery to be discharged home on the day of the surgery. Keywords Inter-scalene block AE Arthroscopy AE Shoulder AE Day-surgery Bloc anesthe´sique interscale´nique pour chirurgie de l'e´paule en hospitalisation de jour Re´sume´Cette e´tude met en e´vidence le be´ne´fice d'une anesthe´sie balance´e (association d'un bloc interscale´nique et d'une anesthe´sie ge´ne´rale) dans la chirurgie ambulatoire de l'e´paule dans un groupe de 104 patients. Dans la pe´riode post ope´ratoire, 98% des patients ont e´te´soulage´s, tandis que 83% d'entre eux ont pu sortir le jour meˆme de l'hoˆpital. Aucune complication grave n'a e´te´note´e. Les auteurs concluent que le bloc interscale´nique est une technique analge´sique suˆre qui peut permettre de re´aliser la chirurgie arthroscopique de l'e´paule en ambulatoire. Mots cle´s Bloc anesthe´sique interscale´nique AE Arthroscopie AE e´paule AE Hospitalisation de jour No financial support received from any sources.

Injury-international Journal of The Care of The Injured, 1996

A study of 55 consecutive knee arfhroscopies under local anaesthesia zms undertaken, in order to ... more A study of 55 consecutive knee arfhroscopies under local anaesthesia zms undertaken, in order to evaluate the effectiveness, patient satisfaction and acceptability of the procedure. Knee arthroscopy was performed without a thigh tourniquet under low volume (20 ml) local anaesthesia using half the recommended safe dose of anaesthetic agents, ns a single intra-nrticular injection together with skin infiltration of the nrfhroscopic portals. The diagnostic accuracy and effectiveness of the procedure was similar to that of surgery under general anaesthesia. Sixty-two lesions were diagnosed and 48 surgical procedures were successfully carried out in 53 patiertts. All but one of the questioned patients (~7 per cent) were satisfied with the procedure which caused liftle or no discomfort in 94 per cent of cases. It is concluded that knee mthroscopy under local nnaesthesia may be considered as a reliable, zuell tolerated and safe ulternative to conventional procedures.

International Journal of Orthopaedics, 2020

We present a rare case of primary synovial chondromatosis of the elbow joint as well as a review ... more We present a rare case of primary synovial chondromatosis of the elbow joint as well as a review of the literature and discuss the clinical, imaging, histological findings and clinical outcome of this condition. It is a benign condition characterized by nodular proliferation and metaplasia of the synovium. Histology findings however suggest that the condition is not solely a metaplasia as the cartilage is often very cellular and could be interpreted as a neoplastic process. This may explain in rare cases the incidence of recurrences and malignant transformation of this condition. Awareness of the atypical histology is paramount and therefore referral to a tertiary oncology centre is mandatory. An experienced pathologist is crucial for the correct diagnosis, prognosis and management of this condition.

International Journal of Orthopaedics, Oct 28, 2021

Aim: Recurrent shoulder instability results in marked disability and affects mainly a young popul... more Aim: Recurrent shoulder instability results in marked disability and affects mainly a young population. However, the gender and age-related differences in labral injuries have been underreported. The aim of our study is to evaluate the arthroscopic spectrum of anteroinferior labrum pathology in recurrent shoulder instability, and assess the gender and age-related differences. Method: This was a study of 201 consecutive patients who underwent arthroscopic shoulder stabilisation for recurrent shoulder instability. Patients were divided into two age groups. Group 1: under 35 years old, included 152 patients, mean age of 26.3 for both sex, and Group 2: over 35 years old, included 49 patients, mean age 42.2 for male and 47.6 for female patients. The gender and age-related differences of arthroscopic findings between the two age groups and overall gender differences were evaluated. Results: Female patients had significantly less antero-inferior labrum lesions (85.7% vs 96.2%, p < 0.011) and more isolated capsule-ligamentous laxity (11.9% vs 1.8%, p < 0.003), than male patients. When analysing the three subtypes of labrum injuries, female patients were found to have significantly less Bankart lesions than male patients (15.4% vs 36.5%, p < 0.037). Both male and female patients in Group 2, had significantly more ALPSA lesions (51% vs 31%, p < 0.0178), and less combined Bankart & Perthes lesions (40.8% vs 63.8%, p < 0.008), than Group 1. Conclusion: This study showed significant gender and age-related differences of anteroinferior capsule-labral complex injuries in chronic shoulder instability. We believe that increased awareness of the different pattern of injuries in female and older patients will be helpful in pre-operative planning and the implementation of the appropriate surgical management.

International Journal of Orthopaedics, Apr 28, 2021

Suprascapular nerve entrapment at the spinoglenoid notch by a ganglion cyst results in the paraly... more Suprascapular nerve entrapment at the spinoglenoid notch by a ganglion cyst results in the paralysis of the terminal motor branch of the nerve, with isolated atrophy of the infraspinatus muscle, loss of strength in external rotation, and posterior shoulder pain. Increased awareness of this nerve compression is paramount in order to avoid the stage of irreversible infraspinatus muscle wasting and long term disability. Magnetic resonance imaging scan, electromyography and nerve conduction velocity studies can confirm the diagnosis and lead to an early arthroscopic nerve decompression and favorable functional results. We present a rare case of spinoglenoid ganglion cyst compression of the distal suprascapular nerve and discuss the recent developments in anatomy, aetiology, diagnosis, and review the treatment and current trends in the management of this condition.

International Journal of Orthopaedics, Aug 28, 2021

The arthroscopic Hill-Sachs Remplissage procedure was first described in 2004 and published in 20... more The arthroscopic Hill-Sachs Remplissage procedure was first described in 2004 and published in 2008. It consists of an arthroscopic posterior capsulodesis combined with an infraspinatus tenodesis to achieve a "filling in" effect of posterior humeral head defects. The technique was put forward as a solution to high rates of Bankart repair failure, in the presence of large Hill-Sachs lesions. We describe the evolution of the technique and its outcomes and report on the evolving surgical indications over the last decade in response to new paradigm shifts. Due to a better understanding of the pathophysiology of shoulder instability, emphasis was given to both Bankart soft tissue repair and to the associated bony injuries, accounting for both glenoid and humeral head (bipolar) bone loss. We present the transition from the concept of "engaging" Hill-Sachs lesions to the concept of "on-track" / "off-track" lesions and the current role of Remplissage in shoulder instability surgery which remains paramount. We believe that in view of the critical role of bipolar bone defects in shoulder instability, preoperative magnetic resonance imaging assessment of the glenoid track of Hill-Sachs lesions is becoming increasingly important in preoperative planning. This allows the orthopaedic surgeon to detect an "off-track" lesion, select the appropriate surgical technique and improve surgical outcomes.

Orthopaedic Proceedings, Jul 1, 2008

The aim of this study was to assess the accuracy of Magnetic Resonance Arthrography (MRA) in symp... more The aim of this study was to assess the accuracy of Magnetic Resonance Arthrography (MRA) in symptomatic shoulder joint instability. Data were collected prospectively from MR Arthrograms performed in 40 consecutive patients with recurrent symptomatic instability. MR Arthrograms included views in the stress ABER position of the shoulder. Subsequently all patients underwent an arthroscopic shoulder stabilisation and the arthroscopic and MR Arthrographic findings were correlated. In case of discrepancy the films and operative findings were reviewed. There were thirty three male and seven female patients with a mean age of 28 years (range 18–40). MR Arthrography showed 37 anterior-inferior tears (22 displaced Bankart tears, 8 nondisplaced Bankart tears, 5 chronic ALPSA lesions and 2 AGL lesions) and 3 posterior lesions. There were 3 discrepancies of which 2 were cases of missed Bankart lesion on MRArthrogram and one case of reverse Perthes lesion present on MRArthrogram but not seen on arthroscopy. Despite a review of the films, the missed Bankart’s lesions were not visualised. In the present study, MR arthrography had a 95% sensitivity in detecting ligamentolabral pathology and a positive predictive value of 0.975 in diagnosing a lesion in recurrent shoulder instability. The results show that MR Arthrogram is a highly useful tool for investigating recurrent shoulder instability with very high sensitivity and positive predictive value. Of the 40 patients who underwent arthroscopy there were only 2 cases where MR Arthrography did not demonstrate an arthroscopically detected abnormality.