SMW Supplementum 193 - Swiss Medical Weekly

37 S SWiSS Med Wkly 2012;142(Suppl 193) · www.smw.ch Posters
Conclusions: In 87% of cases, a good or excellent functional
outcome can be anticipated following arthroscopic repair of type II
SLAP lesions with the described techniques. Variables associated with
a poor outcome include worker’s compensation cases and possibly
age over 40.
P3
Validation of a Smartphone application for shoulder
elevation
Claude Pichonnaz1 , Cyntia Duc2 , Jean-Philippe Bassin3 ,
Noémie Sauvage Pasche3 , Ali Djahangiri4 , Brigitte M. Jolles4 ,
Kamiar Aminian2 , Alain Farron4 1 2 3 4 CHUV-UNIL et HESAV; LMAM-EPFL; HESAV; CHUV-UNIL
Introduction: Angle of arm elevation is of interest for mobility and
function evaluation in shoulder pathologies. Measurement methods
applied in clinical research and practice, such as observation,
goniometry or inclinometry, display only a moderate reliability.
Embedded kinematic measurement is more reliable, but access to
technology has limited its clinical application up to now. A Smartphone
application has been developed to facilitate implementation of
kinematic measurement of arm elevation in current practice.
The results of this method have been compared to the results
of a kinematic measurement approach.
Methods: Twenty participants (11 patients with various shoulder
conditions and 9 healthy participants) were measured using
simultaneously two systems containing 3D gyroscopes and
accelerometers, an embedded Physilog system (EPFL) and a
Smartphone (Apple). A Physilog module was fixed on the distal
posterior side of the humerus and a Smartphone was attached 2.5 cm
higher. The patients performed 3 arm elevations. Arm elevation angle
with regard to gravity was computed. Statistical analysis included
between movements and between devices reproducibility (intraclass
coefficient of correlation, ICC) and 95% limits of agreement (95%
LOA).
Results: Results were comparable for patients and healthy
participants, and for one movement or mean of 3 replications. Overall
mean difference in elevation angle between Smartphone and Physilog
was -7.6° (SD ± 9.2). ICC between devices was 0.88 for mean of
3 replications and ranged for 0.76 to 0.81 for isolated movements.
Between movements ICC ranged from 0.97 to 0.99 and 0.95 to 0.99,
respectively for Smartphone and Physilog. 95% LOA between devices
for mean of 3 replication were –7.6 ± 18.1°. Between movements 95%
LOA for Smartphone was –0.3 ± 6.1°.
Conclusion: Evaluation of shoulder elevation using a Smartphone is
easy. These results show an excellent reproducibility when considering
between movements results. The relation with an embedded
measurement method is also good, but systems are not
interchangeable. Limits of agreement between movements for the
Smartphone were better than those of other methods currently used in
clinical practice. Thus, the method is promising even if further outcome
studies are necessary to fully validate the system in a routine clinical
practice. A study aiming at the validation of shoulder function and arm
elevation angle is ongoing on a larger sample size.
P4
Long-term Outcome Of Arthroscopic Massive Rotator
Cuff Repair: The Impact Of Double-row Fixation
Alexandre Lädermann1 , Patrick Denard2 , Stephen Burkhart2 1Hôpital de LaTour; 2San Antonio Orthopaedic Group
Introduction: Little information is available about the long-term
functional outcome following arthroscopic rotator cuff repair (ARCR) of
massive rotator cuff tears (RCT). A double-row repair may improve the
functional outcome of massive tears given the higher recurrence rate
associated with increased tear size. The purpose of this study was to:
1) evaluate the long-term functional outcome of ARCR of massive
RCTs, and 2) compare the functional outcome of double-row and
single-row repair of massive RCTs.
Methods: We performed a retrospective review of an 8 year period
of patients with a primary massive RCT which was treated with an
ARCR. The minimum follow-up was 5 years. Functional outcome data
was available for 126 patients at a mean of 99 months.
Results: In the overall cohort compared to preoperative status,
statistically significant improvements were observed in forward flexion
(132 degrees vs. 168 degrees; p < .001), pain (6.3 vs. 1.3; p < .001),
UCLA score (15.7 vs. 30.7; p < .001), and ASES score (41.7 vs. 85.7;
p < .001). A good or excellent functional outcome by UCLA score was
obtained in 78% of cases and was associated with a complete repair
(p = .035) and a double-row repair (p = .008). Patient satisfaction was
observed in 91.3%, return to activity in 86.5%, and overall patients
rated their shoulder as 86.6% of normal. Excluding partial repairs, the
UCLA score improved from 16.4 to 29.8 in the group I compared to
15.2 to 32.8 in group II (p = .007), and pain improved from 6.2 to 1.5 in
group I compared to 6.8 to 0.5 in group II (p = .033). At final follow-up,
patients in group I rated their shoulder as 84.4% of normal compared
to 93.5% of normal in group II (p = .006). In multivariate analysis of
complete repairs a double-row repair was 4.9 times more likely to lead
to a good or excellent UCLA functional outcome (95% CI, 1.3–18.8;
p = .021).
Conclusion: A good or excellent long-term functional outcome can
be achieved in the majority of cases with ARCR of massive RCTs.
Preoperative active external rotation past neutral and a complete
repair are associated with improved long-term functional outcome. A
double-row repair improved the functional outcome of massive RCTs.
Given the known high risk of recurrence following repair of massive
RCTs and the knowledge that functional outcome is related to
recurrence, our data suggests that when there is sufficient tendon
mobility a double-row repair should be performed for massive RCTs.
P5
Arm velocity distribution during daily activity:
objective outcome evaluation after shoulder surgery
Cyntia Duc1 , Claude Pichonnaz2 , Jean-Philippe Bassin2 ,
Alain Farron3 , Kamiar Aminian1 1Ecole Polytechnique Fédérale de Lausanne (EPFL), LMAM;
2 3 Haute Ecole de Santé Vaud (HESAV), Physiothérapie; Centre
Hospitalier Universitaire Vaudois (CHUV), Orthopédie et
Traumatologie
Introduction: Shoulder disorders imply pain and limitation in the
arm function. Assessment of arm movement in daily activity is thus
essential for the evaluation of treatment outcome. Wearable
measurement devices are useful tools to monitor movement in real-life
condition. Such systems have been used to quantify upper limb usage,
but there is a need to assess the quality of the movement. Therefore
this study aims at providing an objective evaluation of the arm velocity
in daily condition.
Methods: 21 patients with rotator cuff tear were assessed before and
after surgery (at 3, 6 and 12 months) and compared to 41 controls.
Participants completed the Constant score (CS) and were monitored
during 7h of usual activity. Inertial modules with 3D gyroscope and
accelerometer were fixed on each humerus and on the sternum,
while an embedded datalogger recorded the signals. Movements of
humerus were detected using the angular velocity of the arm and
thorax. The distribution of the mean velocities of detected movements
was compared to a reference distribution from controls, using the
Kolmogorov-Smirnov distance (KS). Relationship between KS and
CS was quantified and the probability of “healthiness of movement”,
prhealthy, was defined as the probability to be similar to the controls in
terms of KS.
Results: KS of the painful sides of patients were significantly different
from the controls at each evaluation time. In average the patients were
thus not able to move with velocities comparable to controls, even one
year after surgery. Healthy sides of patients did not present significant
difference with reference. KS was correlated to CS and explained 55%
of the CS variance. Before surgery, prhealthy showed that 15 of the 21
patients had a probability lower than 0.25 to perform as well as
controls. One year after surgery, 11 patients improved their velocity
with prhealthy higher than 0.5. Among the 10 other patients, 5 had a
CS higher than 72, which is in the range of healthy values. Although
the clinical evaluation was good, prhealthy showed an alteration of
velocity.
Conclusion: The analysis of the arm velocity measured by inertial
sensors highlights differences between painful and healthy arms.
These results are encouraging for future assessment of patients since
velocity analysis provides an objective evaluation of the upper limb
mobility in daily activity. Moreover it is complementary to the Constant
score as it detects movement alteration at a late stage of recovery.
P6
Surgical outcome of humeral shaft fractures
with proximal extension treated with long locking plate
Luciano Agnello, Kevin Moerenhout, Mélanie Stettler,
Ali Djahangiri
CHUV Lausanne
Introduction: Most humeral shaft fractures are amenable to nonoperative
treatment with satisfactory outcome. Limitations to nonoperative
treatment do exist. Due to the biomechanical consequences
of deltoid and pectoralis major muscles, humerus shaft fractures with
proximal extension are associated fracture with displacement and
nonunion. The aim of this study is to assess the outcome of humeral
shaft fractures with proximal extension treated surgically using a long
locking plate.
Material and methods: Between January 2010 and June 2011, 22
patients with displaced humeral shaft fractures with proximal extension
underwent open reduction and internal fixation. There were 14 women
and 8 men with a mean age of 73.8 years. In all cases, a long locking
Philos plate (Synthes ® ) was implanted using an enlarged deltopectoral
approach. All patients were reviewed with a clinical and
radiographic assessment until union.