10 results on '"Jean-David Werthel"'
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2. Anterolateral Acromioplasty Reduces Gliding Resistance Between the Supraspinatus Tendon and the Coracoacromial Arch in a Cadaveric Model
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Lukas Ernstbrunner, M.D., Ph.D., Jean-David Werthel, M.D., Ph.D., Tobias Götschi, M.E., Alex W. Hooke, M.A., and Chunfeng Zhao, M.D.
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Sports medicine ,RC1200-1245 - Abstract
Purpose: To investigate the gliding resistance dynamics between the supraspinatus (SSP) tendon and the coracoacromial arch, both before and after subacromial decompression (anterolateral acromioplasty) and acromion resection (acromionectomy). Methods: Using 4 fresh-frozen cadaveric shoulders, acromion shapes were classified (2 type I and 2 type III according to Bigliani). Subacromial bursa and coracoacromial ligament maintenance replicated physiologic sliding conditions. Gliding resistance was measured during glenohumeral abduction (0° to 60°) in internal rotation (IR) and external rotation (ER). Peak gliding resistance between the SSP tendon and the coracoacromial arch was determined and compared between intact, anterolateral acromioplasty, and acromionectomy. Results: Peak SSP gliding resistance during abduction in an intact shoulder was significantly higher in IR than in ER (4.1 vs 2.1 N, P < .001). The mean peak SSP gliding resistance during 0° to 60° glenohumeral abduction in IR in the intact condition was significantly higher compared with the subacromial decompression condition (4.1 vs 2.8 N, P = .021) and with the acromionectomy condition (4.1 vs 0.9 N, P < .001). During 0° to 60° glenohumeral abduction in ER, mean peak SSP gliding resistance in the intact condition was not significantly different compared with the subacromial decompression condition (2.1 vs 2.0 N, P = .999). The 2 specimens with a hooked (i.e. type III) acromion showed significantly higher mean peak SSP gliding resistance during glenohumeral abduction in IR and ER when compared with the 2 specimens with a flat (i.e. type I) acromion (IR: 5.8 vs 3.0 N, P = .006; ER: 2.8 vs 1.4 N, P = .001). Conclusions: In this cadaveric study, peak gliding resistance between the SSP tendon and the coracoacromial arch during combined abduction and IR was significantly reduced after anterolateral acromioplasty and was significantly higher in specimens with a hooked acromion. Clinical Relevance: The clinical benefit of subacromial decompression remains unclear. This study suggests that anterolateral acromioplasty might reduce supraspinatus gliding resistance in those with a hooked acromion and in the typical “impingement” position.
- Published
- 2024
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3. Anterior glenoid bone reconstruction and anterior latissimus transfer for failed Latarjet associated with irreparable subscapularis tear
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Jean-David Werthel, MD, PhD, Robin Lévêque, MD, and Bassem T. Elhassan, MD
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Failed Latarjet ,Latissimus dorsi transfer ,Eden-Hybinette ,Anterior shoulder instability ,Irreparable subscapularis ,Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Background: Management of combined persistent anterior glenoid bone deficiency with irreparable subscapularis tear can be very complicated and challenging especially if associated with arthritis. The objective of this study was to report the outcome of combined reconstruction of the anterior glenoid with bone autograft or allograft with additional anterior latissimus transfer to reconstruct irreparable subscapularis tear with or without humeral head replacement. Methods: Nineteen patients (average age 29 years old) who underwent open anterior glenoid bone reconstruction with iliac crest bone autograft or ostechondral bone allograft (distal tibia or glenoid allograft), with anterior latissimus transfer to reconstruct irreparable subscapularis tear with or without humeral head replacement were included in this study. Outcome measures included preoperative and postoperative pain score, visual analog scale, Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, and Constant Score. Results: Out of the 19 patients, 5 patients underwent humeral resurfacing arthroplasty. Anterior glenoid bone reconstruction was performed with iliac crest bone autograft in 8 patients, glenoid osteochondral allograft in 7 patients, and tibial plafond in 4 patients. At mean 31-month follow-up of (13-63 months), 15 patients (79%) considered their shoulder stable and were able to return to their work and 14 (74%) patients returned to their sport activity. Redislocation had occurred in 1 of the 18 shoulders (5%), subluxation had occurred in 3 patients (16%) of the shoulders and apprehension was reported for 4 patients, 21% of the operated shoulders. All outcome measures showed significant improvement compared to before surgery. No intraoperative or immediate postoperative complications were observed. Four patients (21%) had to be revised to reverse shoulder arthroplasty. Conclusion: The combination of anterior latissimus transfer, anterior glenoid bone grafting with or without humeral head resurfacing is an effective salvage surgical reconstruction that can stabilize shoulders in the setting of recurrent anterior instability after a failed Latarjet with an irreparable subscapularis tear. This could be a potential alternative reconstruction option that might be offered to patients with this difficult problem. Long-term outcome is needed to better evaluate the validity of this technique.
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- 2023
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4. Feasibility of lower trapezius and rhomboid minor transfer for irreparable subscapularis tears: an anatomic cadaveric study
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Marco Cartaya, MD, Pablo Canales, MD, Jean-David Werthel, MD, Jean Michel Hovsepian, MD, and Philippe Valenti, MD
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Lower trapezius ,Rhomboid minor ,Subscapular ,Tear ,Irreparable ,Transfer ,Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Background: Previously reported outcomes after tendon transfers to reconstruct the subscapularis are unpredictable and often unsatisfactory, especially in the presence of anterior humeral head subluxation. We studied the anatomic feasibility of the lower trapezius and the rhomboid minor transfer to reconstruct irreparable tendon tears of the subscapularis. The aim of this study was to determine the feasibility of lower trapezius and rhomboid minor transfer to reconstruct irreparable subscapularis tendon tears. Materials and methods: We measured the tendons dimensions, muscles excursions, distances to pedicles, and dissection needed to complete a successful lower trapezius and/or rhomboid minor transfer to the subscapularis footprint in 10 cadaveric shoulders. The transferred muscles were detached distally, augmented with a semitendinosus and gracilis autograft, and passed anteriorly between the scapula and the subscapularis remnant through a small serratus window to reach the lesser tuberosity. The risk of pedicle compression was subjectively assessed in all cases. Results: The trapezius and rhomboid tendons were asymmetric with an average length of 37.6 mm and 21.7 mm, an average width of 63 mm and 33.4 mm, respectively. The mean distances from each distal insertion to the lesser tuberosity were 109 mm for the trapezius and 144 mm for the rhomboid. Mean distances from tendon to pedicle were 57.9 mm and 33.1 mm, respectively. The mean size of the necessary serratus window was 49.4 mm, which was measured at maximal excursion achieved at maximal external rotation 90° representing two digitations. All of the tendon transfers were feasible, and the risk of pedicle compression was 20% for the trapezius and 10% for the rhomboid. Superior migration of the transfer was observed during passive external rotation if the insertion point was too high. Conclusions: Transfer of the lower trapezius and rhomboid minor to the lesser tuberosity to reconstruct an irreparable subscapularis tear is feasible without extensive dissection and with a low risk of nerve compression. We recommend not to transfer the rhomboid minor routinely, owing to the risk of tendon luxation after external rotation of the shoulder.
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- 2021
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5. Arthroscopic Trillat Coracoid Transfer Procedure Using a Cortical Button for Chronic Anterior Shoulder Instability
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Philippe Valenti, M.D., Charbel Maroun, M.D., Bradley Schoch, M.D., Santiago Ordoñez Arango, M.D., and Jean-David Werthel, M.D.
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Orthopedic surgery ,RD701-811 - Abstract
The Trillat procedure has been proposed to treat chronic anterior shoulder instability by performing a closing wedge osteotomy of the coracoid process fixed with a coracoscapular screw above the subscapularis. The goal of this osteotomy is to distalize and medialize the coracoid tip to place the conjoint tendon in front of the glenohumeral joint. This in turn distalizes and reinforces the subscapularis in abduction and allows the conjoint tendon to act as a sling and push the humeral head posteriorly. It is commonly accepted to perform this surgery for patients with chronic shoulder anterior instability associated with massive irreparable rotator cuff tear (to preserve and retension the residual subscapularis muscle) or in patients with anterior instability and hyperlaxity. We present a less invasive arthroscopic technique for this procedure. This arthroscopic technique allows assessment and treatment of associated lesions and allows for intraoperative assessment of the subscapularis after the coracoid process is moved to prevent subcoracoid impingement and loss of external rotation.
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- 2019
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6. Arthroscopic Latarjet Procedure Combined With Bankart Repair: A Technique Using 2 Cortical Buttons and Specific Glenoid and Coracoid Guides
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Philippe Valenti, M.D., Charbel Maroun, M.D., Eric Wagner, M.D., and Jean-David Werthel, M.D.
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Orthopedic surgery ,RD701-811 - Abstract
The arthroscopic Latarjet procedure is challenging because it can be difficult to place 2 screws parallel to the glenoid surface and a medial portal (dangerous for the brachial plexus) is mandatory. In addition, precise positioning of the coracoid bone block flush with the joint line and in a subequatorial position as recommended is troublesome without the use of a guiding system because of the arthroscopic lens distortion. To improve the reproducibility of the arthroscopic Latarjet procedure and to minimize the risk of nerve complications, we developed a guiding system to optimize the positioning of the coracoid bone block and 2 cortical buttons to facilitate its fixation. Four portals are used: a posterior standard portal and 3 anterior portals, all lateral to the conjoint tendon. The anterior rim of the glenoid and the coracoid process are prepared. Two holes are drilled in the glenoid and in the coracoid process with 2 specific guides. The subscapularis is then split, and 2 cortical buttons are passed from posterior to anterior through the tunnels with a shuttle relay. The coracoid process undergoes osteotomy and is guided through the split in the subscapularis to the anteroinferior rim of the glenoid by pulling on the cortical buttons.
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- 2018
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7. Arthroscopic-Assisted Pectoralis Minor Transfer for Irreparable Tears of the Upper Two-thirds of the Subscapularis Tendon: Surgical Technique
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Marco Cartaya, M.D., Jean-David Werthel, M.D., and Philippe Valenti, M.D.
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Open transfer of the pectoralis minor through a deltopectoral approach has been described to treat irreparable tears of the upper two-thirds of the subscapularis. We present a less invasive arthroscopic-assisted technique for this transfer. Atraumatic dissection of the pectoralis minor and harvesting of the tendon with a bone chip from the coracoid process allow strong fixation with a double-button device on the lesser tuberosity. This arthroscopic technique allows assessment and treatment of associated intra- or extra-articular lesions and represents a promising option for the management of irreparable tears of the subscapularis.
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- 2017
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8. Effect of prior rotator cuff repair on clinical outcomes following reverse shoulder arthroplasty
- Author
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Taku Hatta, Jean-David Werthel, Eric R. Wagner, Lukas Ernstbrunner, Scott P. Steinmann, Eiji Itoi, Robert H. Cofield, and John W. Sperling
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Sports medicine ,RC1200-1245 - Published
- 2016
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9. Liste des auteurs
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Emmanuel Baulot, Laurent Baverel, Julien Berhouet, Pascal Boileau, Nicolas Bonnevialle, Mikael Chelli, Philippe Clavert, Philippe Collin, Philippe Collotte, Stéphane Corvec, Lieven de Wilde, Marlen Egger, Alain Farron, Luc Favard, Matthieu Ferrand, Pierre-Henri Flurin, S. Gain, David Gallinet, Marc-Olivier Gauci, Jean-François Gonzalez, Anthony HERVÉ, Adrien Jacquot, Thierry Joudet, Alexandre Lädermann, Christophe Lévigne, Pierre Mansat, Matthieu Mazaleyrat, Timon Meynard, Cécile Nérot, Lionel Neyton, Lisa Peduzzi, François Sirveaux, Clément Spiry, Jacques Teissier, Philippe Teissier, Alexandre Terrier, Hervé Thomazeau, A. Tronchot, Philippe Valenti, René Verdonk, Lotte Verstuyft, Gilles Walch, and Jean-David Werthel
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- 2020
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10. Long-term results of latissimus dorsi transfer for internal rotation contracture of the shoulder in patients with obstetric brachial plexus injury
- Author
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Jean-David Werthel, Bassem T. Elhassan, and Eric R. Wagner
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030222 orthopedics ,medicine.medical_specialty ,Activities of daily living ,Trochanter ,business.industry ,education ,Internal rotation ,030229 sport sciences ,Long term results ,Sacrum ,medicine.disease ,Article ,Surgery ,body regions ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Brachial plexus injury ,Medicine ,Orthopedics and Sports Medicine ,Contracture ,medicine.symptom ,business - Abstract
Background This study evaluated the long-term outcome of patients with obstetric brachial plexus injury who underwent transfer of the latissimus/teres major tendon to restore shoulder external rotation and determined whether loss of internal rotation would affect their quality of life. Methods All patients with a history of obstetric brachial plexus injury who underwent latissimus dorsi transfer for internal rotation contracture were included. Results from 3 clinic visits (preoperative, and short-term and long-term postoperatively) were recorded. Quality of life was evaluated with a questionnaire. Internal rotation impairment was evaluated using the Activities of Daily Living which require active Internal Rotation scoring system. Results The study included 45 patients. At a mean 5 months postoperatively, shoulder motion was significantly improved in abduction and external rotation. This was associated with a significant loss of active internal rotation. These results deteriorated over time (at a mean 7.64 years postoperatively), especially in internal rotation (from being able to reach the sacrum to only being able to reach the trochanter) and in external rotation with the arm abducted. This decrease in function led 10 patients (22%) to undergo revision surgery. The mean score on the activities of daily living which require active internal rotation (ADLIR) at the last follow-up was 53. Conclusion Although the short-tem results of latissimus dorsi transfer and subscapularis release are encouraging, these gains deteriorated over a longitudinal follow-up period. Abduction is maintained over the long-term, but external rotation deteriorates. Internal rotation deteriorated over a long-term longitudinal follow-up, leading to functional impairment.
- Published
- 2018
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