Browsing by Author "Claro, R"
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- Comparative clinical and radiologic evaluation between patients undergoing standard reversed shoulder arthroplasty or bony increased offsetPublication . Amorim-Barbosa, T; Ribau, A; Fonte, H; Barros, LH; Claro, RBackground: Modifications of the medialized design of Grammont-type reverse shoulder arthroplasty (RSA) using a bony increased offset (BIO-RSA) has shown better clinical results and fewer complications. The aim of this study is to compare the clinical results, complications, and radiological outcomes between patients undergoing standard RSA and BIO-RSA. Methods: A retrospective review was performed of 42 RSA procedures (22 standard RSA and 20 BIO-RSA). With a minimum of 1 year of follow-up, range of motion (ROM), Constant shoulder score (CSS), visual analog scale (VAS), and subjective shoulder score (SSS) were compared. Radiographs and computed tomography (CT) scan were examined for scapular notching, glenoid and humeral fixation, and graft healing. Results: At a mean follow-up of 27.6 months (range, 12-48 months), a significant difference was found for active-internal rotation (P=0.038) and for passive-external rotation (P=0.013), with better results in BIO-RSA. No other differences were found in ROM, CSS (P=0.884), VAS score, and SSS. Graft healing and viability were verified in all patients with CT scan (n=34). The notching rate was 28% in the standard RSA group and 33% in the BIO-RSA group, but the standard RSA had more severe notching (grade 2) than BIO-RSA (P=0.039). No other significative differences were found in glenoid and humeral fixation. Conclusions: Bone-graft lateralization is associated with better internal and external rotation and with less severe scapular notching compared to the standard RSA. Integration of the bone graft occurs effectively, with no relevant changes observed on radiographic evaluation.
- Isolated fracture of the coracoid’s process base 9-years after a Latarjet procedure: A novel case reportPublication . Rocha Carvalho, D; Claro, RAbstract: Coracoid fractures (CF) are relatively uncommon injuries and in most cases are associated with other concomitant lesions to the superior shoulder suspensory complex (SSSC). As far to the authors’ knowledge, there are no reports of an isolated acute fracture of the base of the coracoid process, years after Latarjet procedure. The authors present the case of a 51-year-old male and non-professional cyclist, with a history of left shoulder Latarjet procedure 9-years ago, sustained a high energy trauma to the left anterior shoulder. Imaging studies revealed a non-displaced fracture to the base of the reminiscent of the coracoid’s process, without other associated injuries to the SSSC or to the coracoid’s graft. A conservative treatment was approached. 1-year after CF, the patient is asymptomatic with CT scan confirming healing of the fracture in an adequate position. Despite very rare, fracture of the reminiscent of coracoid process should always be ruled out after a direct high energy trauma to the anterior shoulder, in patients with previous Latarjet procedure.
- Superior capsular reconstruction: current evidence and limitsPublication . Claro, R; Fonte, HThe treatment of rotator cuff tears (RCTs) has evolved. Nonsurgical treatment is adequate for many patients; however, for those for whom surgical treatment is indicated, rotator cuff repair provides reliable pain relief and good functional results. However, massive and irreparable RCTs are a significant challenge for both patients and surgeons. Superior capsular reconstruction (SCR) has become increasingly popular in recent years. It works by passively restoring the superior restriction of the humeral head, thus restoring the pair of forces and improving the kinematics of the glenohumeral joint. Early clinical results using fascia lata (FL) autograft were promising in terms of pain relief and function. The procedure has evolved, and some authors have suggested that FL autografts could be replaced by other methods. However, surgical techniques for SCR are highly variable, and patient indications remain undefined. There are concerns that the available scientific evidence does not support the popularity of the procedure. This review aimed to critically evaluate the biomechanics, indications, procedural considerations, and clinical outcomes associated with the SCR procedure.