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The use of anchors in the proximal humerus during arthroscopic surgery can cause localized bone loss due to osteolysis and cyst formation. The purpose of this study was to use computed tomography (CT) to evaluate the incidence of implant-related bone loss and cyst formation after implantation of polyetheretherketone (PEEK) coil-type open-architecture anchors during remplissage for the management of Hill-Sachs defects (HSDs) in patients with shoulder instability.This was a single-cohort, observational study with a minimum of 12 months of follow-up. Subjects undergoing arthroscopic instability surgery with HSD requiring remplissage were included. The volume of the bone defects and the degree of bony ingrowth into the anchor were measured on CT images.Thirty-one participants (28 males, 3 females; mean age 29.4 years, standard deviation [SD] 10.6) in whom 50 anchors (4.5-mm Healicoil PEEK double-loaded anchors) were used were evaluated with a CT performed at a mean of 14.1 (SD 3.74) months after surgery. Full bony ingrowth inside the anchor was found in 15 anchors (30%, range 17.8%-44.5%); clear ossification with a thin lucent rim was found in 10 anchors (20%, range 10.0%-33.7%); discontinuous ossification was found in 8 anchors (16%, range 7.2%-29.1%); and no ossification was observed inside 17 anchors (34%, range 21.2%-48.7%). Regarding bone defect size, no bone defect was identified in 15 anchors (30%, 95% CI 17.9%-44.6%), a partial bone defect was found in 17 anchors (34%, 95% CI 21.2%-48.7%), hole enlargement was found in 17 anchors (34%, 95% CI 21.2%-48.7%), and 1 anchor caused a cyst larger than twice the size of the hole made for anchor insertion (2%, 95% CI 0.1%-8.6%). At the 1-year evaluation, none of the participants presented recurrence or residual apprehension.The use of PEEK coil-type open-architecture anchors for remplissage during instability surgery caused large cystic lesions in less than 10% of anchors. There was full bony ingrowth in one-third of anchors, and partial cancellous bone ingrowth occurred in another third of anchors.

To evaluate with computed tomography (CT) the incidence of implant-related osteolysis after implantation of two types of all-suture anchors during remplissage for the management of Hill-Sachs lesions in shoulder instability. Single-cohort, observational study with a minimum of 12 months follow-up. Twenty-five participants (19 males and 6 females; mean age 37.4 years [SD: 11.6]) with Hill-Sachs lesions requiring remplissage were evaluated with a CT performed a mean of 14.1 [3.74] months after surgery. Fifty-five all-suture anchors (19 2.3 mm Iconix and 36 1.7 mm Suturefix) were used. The volume of the bone defects was measured in the CT. Every anchor was classified into one of four groups: (1) no bone defect. (2) Partial bone defect (bone defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (bone defect larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (bone defect larger twice the drill volume). No bone defect was identified in only two anchors (3.6%, 95% CI 0.4–12.5%). A partial bone defect was found in eight anchors (14.5%, 95% CI 6.5–26.7%). In 35 anchors (63.6%, 95% CI 49.6–76.2%), there was enlargement of the bone defect that was smaller than 200% the size of the drill used. Ten anchors caused bone defects larger than twice the size of the drill used (18.2%, 95% CI 9.1–30.9%). The defect size was a mean of 89 mm3 (SD: 49 mm3, minimum 0 mm3, maximum 230 mm3). When using all-suture anchors in arthroscopic remplissage during instability surgery, relevant bone osteolytic defects are common at 1-year-follow-up. Cystic defects larger than twice the volume of the resected bone during implantation develop in one in six anchors and significant tunnel widening will develop in another three out of five anchors. This bone loss effectively increases the size and depth of the Hill-Sachs lesions but does not seem to affect short-term clinical outcomes. Level IV.

To evaluate with computed tomography (CT) the incidence of anchor-related osteolysis after implantation of two types of all-suture anchors for the management of labral lesions in shoulder instability. Single-cohort, observational study with 12-month follow-up. Thirty-three participants (27 males/6 females; age 38.3 years [SD 11.3]) with anterior labral lesions in which 143 all-suture anchors (71 Iconix 1.4 mm and 72 Suturefix 1.7 mm) were implanted were evaluated with a CT performed a mean of 15.4 [3.85] months after surgery. The volume of the bone defects was measured in the CT. Every anchor was classified into one of four groups: (1) no bone defect. (2) Partial bone defect (defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (defects larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (defects larger than twice the drill volume). No bone defect was identified in 16 anchors (11.2%, [95% CI 6.5–17.5%]). A partial bone defect was found in 84 anchors (58.7% [50.2–66.9%]). Tunnel enlargement was found in 43 anchors (30.11% [22.6–37.6%]). No anchor caused cystic lesions (0% [0–2.5%]). The defect volume was a mean of 27.8 mm3 (SD 18.4 mm3, minimum 0 mm3, maximum 94 mm3). Neither the position in the glenoid nor the type of implant used had a significant effect in the type or size of the defects. When using all-suture anchors in the glenoid during instability surgery, relevant bone osteolytic defects are rare at 1-year follow-up. Most anchor insertion tunnels will fill completely (11%) or partially (59%) with bone. Tunnel enlargement will develop in 30% of anchors. No cystic defects larger than 0.125 cm3 were observed. There is a low risk that all-suture anchors cause significant osteolytic bone defects in the glenoid. These implants can be used safely. Level of evidence IV

Constraints and limits to adaptation are critical to understanding the extent to which human and natural systems can successfully adapt to climate change. We conduct a systematic review of 1,682 academic studies on human adaptation responses to identify patterns in constraints and limits to adaptation for different regions, sectors, hazards, adaptation response types, and actors. Using definitions of constraints and limits provided by the Intergovernmental Panel on Climate Change (IPCC), we find that most literature identifies constraints to adaptation but that there is limited literature focused on limits to adaptation. Central and South America and Small Islands generally report greater constraints and both hard and soft limits to adaptation. Technological, infrastructural, and ecosystem-based adaptation suggest more evidence of constraints and hard limits than other types of responses. Individuals and households face economic and socio-cultural constraints which also inhibit behavioral adaptation responses and may lead to limits. Finance, governance, institutional, and policy constraints are most prevalent globally. These findings provide early signposts for boundaries of human adaptation and are of high relevance for guiding proactive adaptation financing and governance from local to global scales.

Extreme heat events impact people and ecosystems across the globe, and they are becoming more frequent and intense in a warming climate. Responses to heat span sectors and geographic boundaries. Prior research has documented technologies or options that can be deployed to manage extreme heat and examples of how individuals, communities, governments, and other stakeholder groups are adapting to heat. However, a comprehensive understanding of the current state of implemented heat adaptations—where, why, how, and to what extent they are occurring—has not been established. Here, we combine data from the Global Adaptation Mapping Initiative with a heat-specific systematic review to analyze the global extent and diversity of documented heat adaptation actions (n = 301 peer-reviewed articles). Data from 98 countries suggest that documented heat adaptations fundamentally differ by geographic region and national income. In high-income, developed countries, heat is overwhelmingly treated as a health issue, particularly in urban areas. However, in low and middle income, developing countries, heat adaptations focus on agricultural and livelihood-based impacts, primarily considering heat as a compound hazard with drought and other hydrological hazards. 63% of the heat-adaptation articles feature individuals or communities autonomously adapting, highlighting how responses to date have largely consisted of coping strategies. The current global status of responses to intensifying extreme heat, largely autonomous and incremental yet widespread, establishes a foundation for informed decision making as heat impacts around the world continue to increase.

Purpose To evaluate the intra and interobserver reproducibility of a new goniometric method for evaluating the isolated passive range of motion of the glenohumeral joint in an outpatient setting. Methods This is a prospective observational study on healthy subjects. The Glenohumeral ROM Assessment with Scapular Pinch (GRASP) method is a new method for assessing the isolated range of motion (ROM) of the glenohumeral joint (GH) by a single examiner with a clinical goniometer. It measures the isolated glenohumeral passive abduction (GH-AB), passive external rotation (GH-ER) and internal rotation (GH-IR) with the arm at 45º of abduction. These three GH ROM parameters were measured in both shoulders of 30 healthy volunteers (15 males/15 females, mean age:41.6[SD = 10.3] years). The full shoulder passive abduction, passive external rotation and internal rotation 45º of abduction were measured by the same examiners with a goniometer for comparison. One examiner made two evaluations and a second examiner made a third one. The primary outcome was the intra- and interobserver reproducibility of the measurements assessed with intraclass correlation coefficients (ICC) and the Bland–Altman plot. Results The intra-observer ICC for isolated glenohumeral ROM were: 0.84 ± 0.07 for GH-ABD, 0.63 ± 0.09 for GH-ER, and 0.61 ± 0.14 for GH-IR. The inter-observer ICC for isolated glenohumeral ROM were: 0.86 ± 0.06 for GH-ABD, 0.68 ± 0.12 for GH-ER, and 0.62 ± 0.14 for GH-IR. These results were similar to those obtained for full shoulder ROM assessment with a goniometer. Conclusion The GRASP method is reproducible for quick assessment of isolated glenohumeral ROM. Level of evidence III

Purpose To prospectively evaluate a cohort of patients with adhesive capsulitis and identify predictors of failure of conservative treatment in the first 2 months of therapy. Methods This was a single-cohort, prospective observational study that included 20 participants (13 females/7 males; median age of 51.8 years [interquartile range: 8.65]) with primary adhesive capsulitis managed conservatively and evaluated clinically every month for at least 2 years of follow-up (29 [5] months). The evaluation included stage of the disease, treatment applied, radiological findings, pain levels and range of motion (active and passive ROM in the four planes and isolated glenohumeral passive ROM in abduction [GH-ABD], external rotation [GH-ER] and internal rotation). The main outcome assessed was failure of conservative treatment defined as the need for surgery and persistent pain or CMS below 70 points at the 1-year follow-up. Results Seven patients (7/20, 35%) were considered to have failed conservative treatment because they required arthroscopic capsular release 5.2 (2.1) months after the initial diagnosis. Of all the clinical and epidemiological variables, absence of improvement during the first 2 months in isolated glenohumeral ROM abduction and external rotation predicted failure of conservative treatment: improvement in GH-ABD (10° or more) occurred in 10/13 patients in the conservative treatment group and in 1/7 patients in the surgery group (p = 0.017). Improvement in GH-ER (10° or more) occurred in 9/13 patients in the conservative treatment group and in 0/7 patients in the surgery group (p = 0.005). Conclusions Precise assessment of isolated glenohumeral ROM in patients with adhesive capsulitis can help identify patients in which conservative treatment might fail. In this study, patients who did not experience early improvements in isolated glenohumeral ROM often required surgery. Level of evidence III (Prospective cohort study).

We present the first systematic, global stocktake of the academic literature on human adaptation. We screen 48,316 documents and identify 1,682 articles that present empirical research documenting human efforts to reduce risk from climate change and associated hazards. Coding and synthesizing this literature highlights that the overall extent of adaptation across global regions and sectors is low. Adaptations are largely local and incremental rather than transformative. Behavioural adjustments by individuals and households are more prevalent than any other type of response, largely motivated by drought and precipitation variability. Local governments and civil society are engaging in risk reduction across all sectors and regions, particularly in response to flooding. Urban technological and infrastructural adaptations to flood risk are prevalent in Europe, while shifts in farming practices dominate reporting from Africa and Asia. Despite increasing evidence of adaptation responses, evidence that these responses are reducing risks (observed and projected) remains limited.

Assessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses. Determining progress in adaptation to climate change is challenging, yet critical as climate change impacts increase. A stocktake of the scientific literature on implemented adaptation now shows that adaptation is mostly fragmented and incremental, with evidence lacking for its impact on reducing risk.

The present work describes a taxonomic trait able to determine sex in pandalid shrimps of the genus Plesionika and an indicator of functional maturity in females. This structure is described as formed by two teeth with abundant setae present in all males of the nine Plesionika species examined. This morphological trait has been ignored across the taxonomy in pandalids. Thoracic teeth were located on the 7th thoracic sternite. Each species presents a characteristic trait of this structure, although P. williamsi has a particular pair of thoracic teeth compared with their congeners. This structure could be used as a tool in the systematics of this genus. Sex determination through thoracic teeth shall represent a faster alternative to the classical appendix masculina sexing method. Functional maturity of females is linked to the fading of immature thoracic teeth. The observation of living specimens in tanks has allowed for the finding that males of P. narval and P. edwardsii actively seek (search for) females and use their third pair of multi-articulate legs to locate the teeth of the thoracic region, which implicates these structures in the activity of “pure searchers” to locate mature females. Thoracic teeth open a new window to different fields of research, such as taxonomy, systematics, and sexual behaviour, and are a tool to determine the first maturity of the Plesionika species.

Background:There is a low incidence of posterior instability which is present in only 2% to 10% of all unstable shoulders. The posterior instable shoulder includes different manifestations like fixed dislocation, recurrent subluxation or dislocation.Methods:Research and online content related to posterior instability is reviewed. Natural history, clinical evaluation and imaging are described.Results:An awareness of the disorder, together with a thoughtful evaluation, beginning with the clinical history, usually leads to proper diagnosis. An appropriate physical exam, taking in account hyperlaxity and specific tests for posterior instability should be done.Conclusion:Posterior shoulder instability is an uncommon condition and is challenging to diagnose. There is not a single injury that is responsible for all cases of recurrent shoulder dislocation or subluxation, and the presence of soft tissue lesions or bone alterations should be evaluated, with the use of adequate simple radiology and multiplanar imaging.

To synthesise the evidence on the prevalence of associated intraarticular lesions in subjects with acute acromioclavicular joint (ACJ) dislocations. A search in two electronic databases (PUMBMED and EMBASE) was performed from 1985 to 2019. Two independent reviewers selected studies that complied with the following inclusion criteria: (1) the study included data on surgically treated ACJ dislocation grade III–V in the Rockwood classification, (2) the ACJ injuries were acute (the surgery was performed less than 6 weeks after injury), (3) an arthroscopic evaluation of the glenohumeral joint was performed during surgery. The quality of the studies included was assessed using the tool of the Joanna Briggs Institute. A total of 47 studies with acute ACJ injuries met the initial inclusion criteria. Of these, 21 studies (9 retrospective case series, 9 prospective case series and 3 retrospective cohort studies) presented data on associated intraarticular lesions amenable for use in the meta-analysis. The meta-analysed studies included a total of 860 subjects with acute ACJ dislocations with a male/female ratio of 6.5 and a mean age of 32 years. The meta-analysis showed a prevalence of associated intraarticular lesions in subjects with acute ACJ of 19.9% (95% confidence interval [CI] 14.0–26.4%; 21 studies, 860 analysed participants; P = 0.000; I2: 74.5% random-effects model; low risk of bias). One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. The case for a customary arthroscopic evaluation of the joint, even when an open procedure is performed to deal with the ACJ dislocation, is strong. Level of evidence IV Trial registry Systematic review registration number: PROSPERO CRD42018090609.

Small-scale fisheries (SSFs), which provide an important source of livelihood for many coastal communities, are at risk from climate change. Benthic organisms are likely to be particularly affected by the impacts of climate change due to their low spatial mobility, which limits their capacity for adaptation. Therefore, SSFs that target sedentary resources (“S-fisheries”) will potentially be among the most impacted types of fishery. The pathways of such impacts can be studied in an integrated approach by means of social- ecological vulnerability assessment. The stalked barnacle (Pollicipes pollicipes) fishery, one of the most important S-fisheries in Galicia (NW Spain), represents a complex social- ecological system rooted within the culture of the region. Along Galician coast, this benthic resource is co-managed by the territorial use rights in fisheries (TURFs) scheme. The vulnerability assessment involves ranking TURF systems according to the exposure of the resource to climate hazards, the sensitivity of dependent people and the capacity of the system to adapt to the impacts. After analyzing 26 stalked barnacle TURFs (79% of all Galician TURFs), we identified the most vulnerable zones (Muxía and O Pindo), as indicated by high levels of ecological vulnerability and social sensitivity and low adaptive capacity. We discuss different ways of increasing the adaptive capacity of TURFs based on local knowledge and literature reviews. Vulnerability assessment represents a powerful tool that can be used to help policy-makers develop adaptation strategies needed at different time scales, ultimately contributing towards better informed, sustainable and efficient fisheries management. Xunta de Galicia Ref. ED431C 2017/64 Ministerio de Economía, Industria y Competitividad | Ref. PCIN-2016-063 Ministerio de Ciencia, Innovación y Universidades I Ref. FPU2016-04258

To synthesise the evidence on the prevalence of associated intraarticular lesions in subjects with acute acromioclavicular joint (ACJ) dislocations.A search in two electronic databases (PUMBMED and EMBASE) was performed from 1985 to 2019. Two independent reviewers selected studies that complied with the following inclusion criteria: (1) the study included data on surgically treated ACJ dislocation grade III-V in the Rockwood classification, (2) the ACJ injuries were acute (the surgery was performed less than 6 weeks after injury), (3) an arthroscopic evaluation of the glenohumeral joint was performed during surgery. The quality of the studies included was assessed using the tool of the Joanna Briggs Institute.A total of 47 studies with acute ACJ injuries met the initial inclusion criteria. Of these, 21 studies (9 retrospective case series, 9 prospective case series and 3 retrospective cohort studies) presented data on associated intraarticular lesions amenable for use in the meta-analysis. The meta-analysed studies included a total of 860 subjects with acute ACJ dislocations with a male/female ratio of 6.5 and a mean age of 32 years. The meta-analysis showed a prevalence of associated intraarticular lesions in subjects with acute ACJ of 19.9% (95% confidence interval [CI] 14.0-26.4%; 21 studies, 860 analysed participants; P = 0.000; IOne in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. The case for a customary arthroscopic evaluation of the joint, even when an open procedure is performed to deal with the ACJ dislocation, is strong. Level of evidence IV Trial registry Systematic review registration number: PROSPERO CRD42018090609.

Ovarian maturity, egg development and brood size were analysed for three isolated populations (Madeira, the Canary Islands and Cape Verde Islands) of Plesionika edwardsii (Decapoda, Pandalidae) in the eastern Atlantic. Multiple colour patterns were observed at the same ovarian maturity stage, which was verified histologically, invalidating the extensive use of ovarian colour as a maturity stage criterion. The physiological size at sexual maturity, based on the maturity of the ovaries, was higher in Madeira (carapace length of 19.73 mm) and decreased to the Cape Verdes (16.39 mm). Synchronic ovarian maturation was observed during the embryo incubation process, and ovigerous females bearing embryos at the final stage of development were found throughout the year. Females are multiple spawners during the reproductive season, after which the reproductive process ends and a rest period begins. The absence of females larger than the size at sexual maturity with ovaries in Stage 1, the incubation of embr...

This work documents the introduction of non-native fish species to the Canary Islands (central-eastern Atlantic) through oil rigs. Methodological approaches have included surveys by underwater visual censuses around and under oil platforms and along the docking area of rigs at the Port of Las Palmas. Eleven non-native fish species were registered. Paranthias furcifer, Abudefduf hoefleri, Acanthurus bahianus, Acanthurus chirurgus, and Acanthurus coeruleus are first recorded from the Canaries herein. Other three species could not be identified, although they have never been observed in the Canaries. Cephalopholis taeniops, Abudefduf saxatilis, and Acanthurus monroviae had been previously recorded. Native areas of these species coincide with the areas of origin and the scale of oil rigs with destination the Port of Las Palmas. The absence of native species in the censuses at rigs and their presence at rigs docking area, together with the observation of non-native species after the departure of platforms, reject the possibility that these non-native species were already present in the area introduced by another vector. C. taeniops, A. hoefleri, A. saxatilis, A. chirurgus, A. coeruleus and A. monroviae are clearly seafarer species. A. bahianus seems to be a potential seafarer species. P. furcifer is a castaway species. For the moment, the number of individuals of the non-native species in marine ecosystems of the Canaries seems to be low, and more investigation is needed for controlling these translocations.

Patterns in the life-history traits of the pandalid shrimp Plesionika edwardsii are studied for the first time in three isolated Atlantic populations (Madeira, Canaries and Cape Verde Islands) to gain an understanding of their latitudinal variations. The maximum carapace size of the populations studied, as well as the maximum weight, showed clear latitudinal patterns. The patterns observed may be a consequence of the temperature experienced by shrimps during development, 1.37 ° C higher in the Canaries and 5.96 ° C higher in the Cape Verde Islands than in Madeira. These temperature differences among populations may have induced phenotypic plasticity because the observed final body size decreased as the temperature increased. A latitudinal north-south pattern was also observed in the maximum size of ovigerous females, with larger sizes found in the Madeira area and lower sizes observed in the Cape Verde Islands. A similar pattern was observed in the brood size and maximum egg size. Females of P. edwardsii produced smaller eggs in the Cape Verde Islands than did those at the higher latitude in Madeira. P. edwardsii was larger at sexual maturity in Madeira than in the Cape Verde Islands. The relative size at sexual maturity is not affected by latitude or environmental factors and is the same in the three areas studied, varying slightly between 0.568 and 0.585. P. edwardsii had a long reproductive season with ovigerous females observed all year round, although latitudinal variations were observed. Seasonally, there were more ovigerous females in spring and summer in Madeira and from winter to summer in the Cape Verde Islands. P. edwardsii showed a latitudinal pattern in size, with asymptotic size and growth rate showing a latitudinal compensation gradient as a result of an increased growth performance in the Madeira population compared to that of the Cape Verde Islands.

To evaluate the efficacy of the Instability Severity Index Score (ISIS) in predicting an increased recurrence risk after an arthroscopic Bankart repair. Retrospective review of a cohort of patients operated in three different centres. The inclusion criteria (recurrent anterior instability [dislocation or subluxation] with or without hyperlaxity, arthroscopic Bankart repair) and the exclusion criteria (concomitant rotator cuff lesion, acute first-time dislocation, surgery after a previous anterior stabilization, surgery for an unstable shoulder without true dislocation or subluxation; multidirectional instability) were those used in the study that defined the ISIS score. The medical records and a telephone interview were used to identify the six variables that define the ISIS and identify recurrences. One hundred and sixty-three shoulders met the inclusion and exclusion criteria. Of these, 140 subjects (22 females/118 males; mean age 35.5 ± 7.9) with 142 (89.0%) shoulders were available for follow-up after 5.3 (1.1) (range 3.1–7.4) years. There were 20 recurrences (14.1%). The mean (SD) preoperative ISIS was 1.8 (1.6) in the patients without recurrence and 1.8 (1.9) in the patients with recurrence (n.s.). In the 117 subjects with ISIS between 0 and 3 the recurrence rate was 12.8%; in the 25 with ISIS 4 to 6 the rate was 20% (n.s.). For subjects with anterior shoulder instability in which an arthroscopic Bankart repair is being considered, the use of the ISIS, when the values obtained are ≤ 6 was not useful to predict an increased recurrence risk in the midterm in this retrospectively evaluated case series. The efficacy of the ISIS score in defining a group of subjects with a preoperative increased risk of recurrence after an arthroscopic Bankart instability repair is limited in lower risk populations (with ISIS scores ≤ 6). Retrospective case series, Level IV.

To evaluate the 2-year results of an absorbable subacromial spacer in patients with irreparable posterosuperior rotator cuff tears. Prospective longitudinal study of a consecutive case series of 16 subjects with irreparable tears of the posterosuperior rotator cuff in which the InSpace® subacromial spacer was arthroscopically implanted. A full clinical evaluation that included the Constant test, Simple Shoulder Test (SST) and the QuickDash questionnaire was performed preoperatively and at 12 and 24 months follow-up. The primary outcome for assessing the success of the procedure was a variable composed of a clinically relevant variation of the Constant (established in an improvement greater than 10 points) and the absence of surgical reintervention. Fifteen subjects (11 women/4 men, median age = 69.4 years [interquartile range 7.50], range 60–80 years) completed the 2-year of follow-up. According to the main evaluation criteria, only 6 patients (40%) had a successful outcome. Five subjects required reconversion to a reverse shoulder arthroplasty (at a median of 9.8 months postoperatively) due to absence of clinical improvement or worsening of symptoms. Of the ten remaining subjects, only 6 had improvements greater than 10 points in the Constant score. Despite of this, these 10 subjects had, on average, some improvement in the Constant test (preoperative Constant: median 35.0 [27.0–52.5] vs Constant at 24 months: 53.5 [55.0–84.0], significant differences p = 0.02), in the SST (3.0 [2.0–4.0] vs 6.0 [3.25–7.75], p = 0.039) and in the QuickDASH test (37.0 [33.25–40.0] vs 27.5 [20.5–32.75], p = 0.012). The outcomes of the implantation of the subacromial biodegradable spacer at 2-year follow-up are not satisfactory. In this small case series only 40% of patients seem to clearly benefit from surgery. One in three required revision to a reverse shoulder arthroplasty. The described technique does not seem a reasonable alternative for the management of the majority of patients with irreparable ruptures of the rotator cuff. The indications of this device should be more clearly defined. IV.

ResumenLa situación anatómica de la articulación acromioclavicular nos permite realizar una evaluación mediante la observación y la palpación más sencilla que en la articulación glenohumeral. Sin embargo, el dolor proveniente de la misma puede irradiar a diferentes zonas del hombro, del brazo y del cuello y solaparse con otras afecciones. Por ello, es importante conocer las diferentes maniobras exploratorias, así como estar familiarizado con la interpretación de las pruebas de imagen.En este artículo se revisan de forma sistemática los test más utilizados en la exploración de la articulación acromioclavicular, valorando sensibilidad, especificidad y valores predictivos, así como la forma correcta de realizarlos. Además, se analizan las peculiaridades radiológicas de dicha articulación y las utilidades de las diferentes proyecciones y técnicas en el diagnóstico de enfermedad acromioclavicular.AbstractThe subcutaneous location of the acromioclavicular joint allows the clinician to evaluate deformities directly and palpate the joint. This is more complicated in the glenohumeral joint. However, pain arising from the joint can irradiate to different areas of the shoulder, arm and neck, and can be misleading. Thus, it is important to be familiar with the spectrum of physical examination tests, specific radiological projections and MRI findings in order to reach an accurate diagnosis.The aim of this article is to systematically describe the most commonly used physical examination tests for acromioclavicular pathology, including sensitivity, specificity, and predictive values for all of them. Secondly, to analyse the radiological particularities of this joint and to establish the usefulness of the specific projections and imaging techniques.

ResumenObjetivoDeterminar si la asociación de un procedimiento de remplissage en los pacientes con defectos humerales grandes a los que se les realiza una reparación artroscópica de Bankart por inestabilidad glenohumeral anterior disminuye la tasa de recurrencia de la inestabilidad.MétodosEstudio retrospectivo de cohortes emparejadas de un grupo de sujetos evaluado prospectivamente con un seguimiento mínimo de 4años. Se identificaron sujetos con defectos humerales de Hill-Sachs grandes (>25% de la cabeza humeral, n=42). Se seleccionaron aquellos en los que se había realizado un remplissage (n=14) y se emparejaron con sujetos con similares características y lesiones humerales (n=21). Se analizaron la tasa de recurrencia, el rango de movilidad y la evolución de las escalas de Rowe, Constant y el test simple de hombro (SST).ResultadosNo hubo diferencias en las características epidemiológicas de las 2 cohortes (edad, sexo, lado, número de luxaciones previas o hiperlaxitud). Tras un seguimiento mínimo de 4 años (media=5,4años [desviación estándar=1,24años]) en el grupo remplissage un paciente (7,1%) presentó una recurrencia, y en el grupo control 4 pacientes (19%) presentaron una recurrencia y un paciente refería sensación de inestabilidad (24% presentaban inestabilidad; diferencias no significativas, p=0,41). En ambos grupos hubo mejoras significativas en la escala de Rowe, Constant y SST (p0,05).ConclusionesEl procedimiento de remplissage no afecta al resultado funcional de los pacientes ni a su rango de movilidad. La tasa de inestabilidad residual fue del 7% en el grupo remplissage y del 24% en el grupo control.Nivel de evidenciaIIb.Relevancia clínicaLa técnica de remplissage es un procedimiento seguro que puede tener un efecto en la tasa de recurrencia en los pacientes con inestabilidad anteroinferior de hombro y lesiones humerales de Hill-Sachs grandes.AbstractObjectiveTo determine whether a remplissage procedure in patients with large defects of the humeral head compared to those who undergo arthroscopic Bankart repair for anterior glenohumeral instability decreases the rate of recurrence of instability.MethodsA retrospective matched cohort study of a group of subjects prospectively evaluated with a minimum follow-up of 4years. Subjects with large humeral Hill-Sachs defects (>25% of the humeral head, n=42) were included. Those in which a remplissage had be performed (n=14) and matched subjects with similar characteristics and humeral lesions (n=21) were selected. The following parameters were evaluated: recurrence rate, range of motion, Rowe score, Constant score, and Simple Shoulder Test score (SST).ResultsThere were no differences in the characteristics of the two cohorts (age, sex, side, number of previous dislocations or hypermobility). After a minimum follow-up of 4 years (mean=5.4 years [SD=1.24 years]) one patient (7.1%) in the remplissage group had a recurrence and 4 patients (19%) in the control group, and one patient had a recurrence of instability (24% showed instability; no significant difference, P=.41). In both groups there were significant improvements in the Rowe, Constant, and SST scores (P.05).ConclusionA remplissage procedure does not affect patient functional outcome or the range of motion. The residual instability rate was 7% in the remplissage group and 24% in the control group.Evidence levelIIb.Clinical relevanceThe remplissage technique is a safe procedure that might have an effect on the rate of recurrence in patients with anterior shoulder instability and large Hill-Sachs humeral lesions.

ResumenPese a que las lesiones acromioclaviculares grado iii son muy frecuentes, el tratamiento adecuado sigue estando en debate debido a la falta de consenso sobre el manejo más adecuado. El propósito de este artículo es defender que, en función de la evidencia científica existente, el tratamiento conservador puede ser considerado como la opción más adecuada, dados sus buenos resultados y su baja tasa de complicaciones.AbstractDespite being a common injury, the treatment of grade iii acromioclavicular joint dislocation remains subject to debate, because there is a lack of consensus regarding its optimal management. The purpose of this article is to defend, based on the existing scientific evidence, the conservative treatment as the most adequate option due to the good results obtained and the low complication rate.