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Introduction: The functional outcome after reverse shoulder arthroplasty (RSA) is closely linked to how much the humerus shifts because of the implants. While two-dimensional (2D) angle measurements have been used to capture this shift, it can be measured in three dimensions (3D) as the arm change position (ACP). In a previous study, the ACP was measured using 3D preoperative planning software with the passive virtual shoulder range of motion obtained after RSA. The main objective of this study was to evaluate the relationship between the ACP and the actual active shoulder range of motion measured after RSA. The hypothesis was that the ACP and the active clinical range of motion are related such that the ACP is a reliable parameter to guide the preoperative planning of an RSA. The secondary objective was to assess the relationship between 2D and 3D humeral displacement measurements. Materials and methods: This prospective observational study enrolled 12 patients who underwent RSA and had a minimum follow-up of 2 years. The active range of motion in shoulder flexion, abduction, and internal and external rotation was measured. At the same time, ACP measurements were taken from a reconstructed postoperative CT scan, in addition to the radiographic measurements of humeral lateralization and distalization angles on AP views in neutral rotation. Results: The mean humeral distalization induced by RSA was 33.3 mm (±3.8 mm). A non-statistically significant increase in shoulder flexion was observed for humeral distalization beyond 38 mm (R2 = 0.29, p = 0.07). This “threshold” effect of humeral distalization was also observed for the gains in abduction, as well as internal and external rotations, which seemed better with less than 38 mm or even 35 mm distalization. No statistical correlation was found between the 3D ACP measurements and 2D angle measurements. Conclusion: Excessive humeral distalization seems to be detrimental to joint mobility, especially shoulder flexion. Humeral lateralization and humeral anteriorization measured using the ACP seem to promote better shoulder range of motion, with no threshold effect. These findings could be evidence of tension in the soft tissues around the shoulder joint, which should be taken into consideration during preoperative planning.

Purpose Systematic reviews report return to play (RTP) within 5.8 months (range, 3–8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. Methods The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. Results A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). Conclusions By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. Level of evidence IV.

Ultrasound assessment of the long head of the biceps (LHB) is difficult. The aim of the present study was to analyze the inter- and intra-observer reproducibility of 2 ultrasound cross-sections not previously assessed: humeral head apex (image 1) and bicipital groove entrance (image 2).These ultrasound cross-sectional images allow reliable and reproducible analysis of the intra-articular LHB.A single-center prospective study was conducted. Inter-observer reproducibility was assessed between 2 radiologists in 20 healthy shoulders (asymptomatic group) and 35 painful shoulders (symptomatic group); intra-observer reproducibility was assessed for 1 observer in 10 healthy shoulders. Quantitative parameters comprised short and long axes and transverse area, and qualitative parameters comprise echogenicity and LHB position.On images 1 and 2, inter-observer agreement on the 3 quantitative parameters was good to excellent in both subject groups (p0.05), and more precise and highly reproducible for image 1. Agreement on the 2 qualitative parameters was excellent (p0.001). Intra-observer reproducibility results were non-significant on all parameters.The 2 intra-articular LHB cross-sections proved reliable and reproducible in painful and in healthy shoulders. A standardized ultrasound protocol could thus enhance the precision of LHB assessment and treatment. The difficulties of LHB measurement, often related to shoulder pathology, may, however, hinder interpretation.III, prospective intra- and inter-observer study.

Resume Introduction L’evaluation echographique de la longue portion du biceps (LPB) est difficile. Le but de cette etude etait d’analyser la reproductibilite inter et intra-observateur de deux coupes echographiques jusqu’a maintenant non evaluees : a l’apex de la tete humerale (coupe 1) et a l’entree de la gouttiere bicipitale (coupe 2). Hypothese Ces coupes echographiques seraient fiables et reproductibles pour l’analyse de la LPB dans sa portion intra-articulaire. Materiel et methodes Il s’agissait d’une etude prospective monocentrique. Une evaluation inter-observateur etait conduite par deux radiologues pour 20 epaules saines (groupe « asymptomatique ») et pour 35 epaules douloureuses (groupe « symptomatique »). Une evaluation intra-observateur etait realisee par un radiologue pour 10 epaules saines. Des mesures quantitatives : petit et grand axes, surface transversale, et des mesures qualitatives : echogenicite et position de la LPB etaient analysees. Resultats Pour les coupes 1 et 2, le niveau de concordance inter-observateur pour les 3 mesures quantitatives etait bon a excellent dans les 2 groupes de patients evalues (p Discussion Les deux niveaux de coupes intra-articulaires de la LPB sont fiables et reproductibles chez des patients avec une epaule saine ou douloureuse. L’interet d’un protocole echographique standardise pourrait permettre ainsi d’ameliorer la precision d’evaluation de la LPB ainsi que sa prise en charge. Les difficultes de mesures de la LPB, souvent associee a une situation pathologique de l’epaule peuvent cependant venir interferer l’interpretation echographique. Niveau de preuve III ; etude prospective intra et inter-observateur.

Resume Introduction En 1985, Grammont a defini le concept de la prothese inversee pour les omarthroses avec une atteinte severe de la coiffe. Cependant, cette prothese ne permet pas toujours une bonne recuperation de la mobilite en rotation interne. Objectif L’objectif de cette etude a ete de rechercher les facteurs pre- et peroperatoires correles a la recuperation d’une bonne rotation interne. Notre hypothese est que le statut restant de la coiffe et la position de la sphere sont les deux facteurs les plus discriminants. Materiel et methode Cette etude prospective a ete menee, du 2/11/2015 au 10/01/2017, chez 36 patients operes d’une prothese totale inversee. Les criteres d’inclusion etaient : les ruptures massives de coiffe avec ou sans arthrose et les omarthroses avec usure asymetrique de la glene. En preoperatoire, les elements suivants ont ete analyses : le score de Constant, le SSV, les amplitudes articulaires passives et actives. Le bilan preoperatoire comportait des radiographies standard et un scanner. En postoperatoire, les patients ont tous ete revus a 6 mois et a chaque fois les memes parametres cliniques et radiographiques ont ete collectes. Resultats En postoperatoire, l’ensemble des mobilites a ete amelioree sauf la rotation interne coude au corps (RI1) consistant a mettre la main dans le dos. L’analyse montre que l’obtention d’une RI1 a hauteur de L3 ou plus haut etait significativement correlee a un IMC plus bas (p = 0,04), une bonne RI passive preoperatoire (p = 0,056), une inclinaison glenoidienne preoperatoire moins importante et un debord glenoidien de la sphere plus important (p = 0,03). L’etat du sub-scapulaire ainsi que sa reparation n’avait pas d’influence significative. La presence d’un teres minor fonctionnel limitait significativement la RI1. Conclusion Une RI1 active satisfaisante est correlee a une bonne RI1 passive. La RI1 est meilleure chez les sujets maigres presentant une omarthrose excentree associee. Par ailleurs, la RI est amelioree s’il existe un debord inferieur d’au moins 6 mm. Niveau d’evidence IV, etude prospective non randomisee.

Resume Introduction La chirurgie du poignet rhumatoide repose sur la synovectomie articulaire associee a une stabilisation-reaxation du carpe. L’objectif de cette etude etait d’etudier les resultats obtenus par une technique conservatrice de stabilisation : le transfert tendineux du long extenseur radial du carpe (ECRL) sur l’extenseur ulnaire du carpe (ECU), et de redefinir ses indications therapeutiques. Hypothese Le transfert tendineux du long extenseur radial du carpe (ECRL) sur l’extenseur ulnaire du carpe (ECU) peut prevenir ou ralentir l’evolution des deformations du poignet rhumatoide. Materiels et methodes Il s’agissait d’une etude observationnelle retrospective. Seize poignets ont ete inclus. L’evaluation preoperatoire portait sur les criteres suivants : douleur, synovite, mobilites, hauteur du carpe, glissement ulnaire et deviation radiale du carpe, qualite des interlignes radio- et mediocarpien (Larsen). Une evaluation postoperatoire a ete conduite en consultation selon les memes criteres d’analyse. Resultats Au recul moyen de 42,5 mois, la douleur avait diminue dans 14 cas et la synovite disparue dans 10. Les gains en extension et flexion etaient respectivement de 19,7° et 5,7°. Sur le plan radiographique, on constatait une stabilite de la deviation radiale et du glissement ulnaire du carpe, mais une diminution de hauteur. L’atteinte radiographique des interlignes medio- et radiocarpiens etait stationnaire. Pour les 3 patients ayant eu un geste supplementaire d’arthrodese mediocarpienne pour atteinte preoperatoire avancee, l’interligne radiocarpien etait reste inchange. Le resultat pour ces 3 poignets etait identique a l’ensemble des cas de la serie. Discussion/Conclusion Le transfert tendineux de l’ECRL en association a la synovectomie est efficace sur la douleur et previent la destabilisation radiocarpienne. La principale indication reste le poignet avec deviation radiale et glissement ulnaire du carpe reductible. Le transfert de l’ECRL est aussi une bonne indication en association avec une arthrodese mediocarpienne dans les rares cas avec atteinte mediocarpienne predominante de Larsen > 2. Niveau de l’etude IV.

Introduction The main goal of this study was to propose a new method of surgical assistance for the implantation of a total shoulder prosthesis, with the use of augmented reality (AR). The advantage of this approach is that it supplements information, on the one hand pre-existing or disappeared due to a pathological process, such as the premorbid glenoid, and on the other hand already existing but not accessible to the surgeon during the procedure, such as the so-called “hidden” face of the scapula. Material and methods Several information preparation steps were needed. The first consisted in the three-dimensional (3D) rendering of the pathological glenoid, from a point cloud corresponding to the premorbid glenoid based on previously developed regression equations. A library of “healthy” generic glenoids was then created by hierarchical bottom-up analysis. From this database, a so-called adequate normal generic glenoid was fused and matched to the pathological glenoid reconstructed using a morphing technique. An experimental AR application was constructed. Smart glasses were used to display the prepared 3D information. Results A pathological 3D glenoid was reconstructed and used for the AR application. A complete display of the scene, reconstructed glenoid and full scapula was obtained. However, an offset from reality was observed. The main limitations were technical, related to the connected tool itself and the operating software. Discussion/Conclusion This was a feasibility study of the different steps required to apply AR, from information preparation to its visualization. A new parameter crossing experiment is needed to optimize each step of this process. Level of evidence IV, Basic science study.

RGB-Depth calibration refers to the estimation of both RGB and Depth camera parameters, as well as their relative pose. This step is critical to align streams correctly. However, in the literature there is still no general method for accurate RGB-D calibration. Recently, promising methods proposed to use spheres to perform the calibration, the centers of these objects being well distinguishable by both cameras. This paper proposes a new minimization function which constrains spheres centers positions by requiring the knowledge of sphere radius, and a previously calibrated RGB camera. We show the limits of previous approaches and their correction with the proposed method. Results demonstrate an improvement in relative pose estimation compared to the original method on the selected datasets.

Management of massive rotator cuff tears is a therapeutic challenge in patients younger than 65 years, particularly if still working. According to our hypothesis, choice of the most appropriate treatment option mainly depends on the patient's functional status and on two predictive factors: height of the subacromial space and fatty muscle infiltration. This is a retrospective, multicenter study of a series of 296 patients younger than 65 years, including 176 males and 120 females with extensive or massive cuff tear. Patients had loss of elevation or external rotation or both in 162 cases. Four types of management of massive rotator cuff tear were performed in this study: anatomical watertight repairs, palliative treatments and partial repairs, watertight repairs using flaps or cuff prostheses and reverse shoulder prostheses. At follow-up, the Constant score (65.6+/-3.4) and active elevation (147.7 degrees +/-32 degrees) had significantly improved. Active external rotation with elbow at the side, and acromiohumeral interval (AHI) were unchanged. Work-related injuries, previous surgeries and complications were correlated with a poorer Constant score. At follow-up, the anatomical repair sub-group had a significantly better Constant score than the three other treatment groups but involved patients with unchanged AHI and a low degree of fatty infiltration of the infraspinatus muscle. The reverse shoulder prostheses sub-group showed better outcomes in terms of function benefits. The presence of a long biceps was correlated with the use of a palliative treatment. In the light of the results and literature, an approach to treatment is suggested related to the functional capacity of patients, the AHI and the degree of fatty infiltration of the infraspinatus and subscapularis muscles.