Osteology, Volume 2, Issue 3 (September 2022) – 4 articles

Shoulder instability is described as a functional deficiency caused by excessive mobility of the humeral head over the glenoid. Various Glenohumeral Instability (GI) types have been described, but the traumatic anteroinferior form is the most frequent. The differences between engaging and non-engaging Hill–Sachs lesions (HSLs) are linked to bone loss assessment. On the contrary, the novel difference between “on-track” and “off-track” lesions is strictly related to surgical techniques. The specific involvement of glenoid and humerus bone defects in recurrent GI was poorly assessed in the literature before the glenoid-track concept (GT). Magnetic Resonance Imaging (MRI) and Arthro-MRI have been widely used to identify and characterize lesions to the ligamentous structures. However, only new technologies (3 Tesla MRI) accurately detect HSLs. On the contrary, Computed Tomography (CT) has been adopted to quantify glenoid bone deficit. The GT concept is a valuable tool for evaluating anterior shoulder instability in patients. Shoulders out of alignment may require more than just an arthroscopic Bankart, and a remplissage or bone transfer may be necessary. Specifically, isolated Bankart repair should be considered in patients with recurrent instability and an on-track lesion with less than 25% glenoid bone loss. In off-track lesions and less than 25% glenoid bone loss, remplissage should be used. Bone transplant surgery is required for patients with a glenoid bone defect of more than 25%. This narrative review aims to report the most updated findings on “on-track” and “off-track” lesions in GI. Full article

(1) Background: This systematic review summarizes the available studies investigating when it is safe for most patients to return to driving and when to modify for individual patients following elective foot and ankle procedures. (2) Methods: A systematic review of the literature was performed using three different electronic databases to identify English-language studies from 1999 to present that investigate the return to driving after right-sided elective foot and ankle procedures. (3) Results: A total of eight studies met inclusion criteria. All the studies investigated brake reaction time (BRT) as measured by a driving simulator as their primary outcome. Patients undergoing right ankle or subtalar arthroscopy should wait 2 weeks to drive, after total ankle arthroplasty or corrective hallux valgus surgery patients should wait 6 weeks, and the appropriate time to return to driving after ankle arthrodesis is still uncertain. Additionally, various clinical factors can be used to predict who may still be unfit to drive past the usual length of time. (4) Conclusions: The recommendations from these reviewed studies can guide physicians when counseling their patients on when they can expect to safely return to driving after a specific elective foot and ankle procedure. However, these recommendations should be tailored to the patient specifically based upon how they are doing clinically. Full article

Calcific shoulder tendinopathy (CT) is a common condition involving the central part or insertion of the rotator cuff tendons (RC) or the subacromial-subdeltoid bursa (SASD). The calcific deposits consist of poorly crystallized calcium hydroxyapatite but the mechanism of their formation still remains unclear. CT can be divided into three distinct stages, as reported by Uthhoff et al. Clinically, this condition varies with the extent of the calcification and the phase of the condition. In particular, the disorder is asymptomatic or may cause mild discomfort during the deposition of calcium, while it becomes acutely painful during the resorptive phase. US-PICT (ultrasound-guided percutaneous irrigation of calcific tendinopathy) is indicated in the acute phase (resorptive phase) of CT with significant pain relief and a very low rate of minor complications. The aim of this manuscript is to define the rationale of the ultrasound-guided percutaneous irrigation of calcific tendinopathy, correlating it with the sequence of biochemical processes that lead to the hydrolysis of hydroxyapatite. Furthermore, we will explain the reasons why we prefer using the three-needle technique for the dissolution of calcifications. Full article