Session 17: Sport and Shoulder/Elbow
17. November
12:45 - 13:45
Lokale: 102-105
Chair: Anne Kathrine B Sørensen and Stig Brorson
142. Open knotless suture-staples procedure for partial, low-grade gluteus medius tendon repair - a promising novel technique
Patrick Korsgaard, Jeppe Lange, Bent Lund, Marie Bagger Bohn
All authors are employed at Department of Orthopaedics, Horsens Regional hospital.
Background: In 2018 an endoscopic “suture staples” technique for
partial thickness hip abductor tendon (HAT) repair
was reported by Domb et al.1 We have adopted the
technique, but perform surgery as an open
procedure. The technique is potentially beneficial in
selected cases of HAT, due to the minute iatrogenic
soft tissue injury.
Aim: To report 1-year follow-up on our first cases of an
open “suture staples” procedure.
Materials and Methods: From our database on HAT repairs (n>120), we
extracted cases with a “suture staples”
procedure, who had a minimum of 1-year follow-
up.
Patients were selected for this procedure, if
presenting with Lateral Hip Pain and had HAT
pathology on MRI, but no bony changes at the
anterior footprint and with an intact gluteus
minimus tendon. During surgery the tendon
complex had to appear intact, but display “wave
sign”. In all other cases a standardized
detachment of the tendon complex was
performed. Bursectomy was not performed, but
the bursa was divided to access the tendon
complex.
Oxford Hip Score (OHS), Numeric Rating Scale
(NRS), The Euro-Qol Visual Analogue Scale
(EQ-VAS) and Copenhagen Hip and groin
outcome score (HAGOS) were filled out before
surgery at baseline and 12 months post-surgery.
Global Rating of change score (GROC) were
collected at 12 months. Data are presented as
median with 25-75% interquartile range. All
patients gave consent to participate in this study.
Results: 6 patients (5 females), age 55 years (49-58), Body
Mass Index 28 (22-29), had reached a 1-year follow-
up. The duration of surgery was 31 minutes (27-36).
At 1-year 6 of 6 (100%) reported success on
GROC. OHS improved from 20 (17-24) to 43 (40-45)
(p=0.03). HAGOS improved statistically significant in
all sub-scales. Pain during activity decreased on
NRS from 9 (8-10) to 1 (0-2) (p=0.03). EQ-VAS went
from 55 (50-60) to 95 (90-99) (p=0.03). All index hips
tested stronger at 12 months follow up.
Interpretation / Conclusion: We present a novel surgical procedure for minor
HAT pathologies with excellent 1-year results. Due
to the technical simplicity of the procedure, our novel
technique appears of value in selected HAT cases.
More research into this procedure is warranted.
138. Shoulder instability following recurrent traumatic anterior dislocations measured with radiostereometry during apprehension-relocation test.
Josephine Olsen Kipp1,3, Emil Toft Petersen1,2, Thomas Falstie-Jensen2, Johanne Frost Teilmann1, Anna Zejden4, Rikke Jellesen Åberg4, Maiken Stilling1,2,3, Theis Muncholm Thillemann2,3
1 AutoRSA Research Group, Orthopaedic Research Unit, Aarhus
University Hospital
2 Department of Orthopedic Surgery, Aarhus University Hospital
3 Department of Clinical Medicine, Aarhus University
4 Department of Radiology Aarhus University Hospital
Background: Anterior shoulder instability (ASI) is
characterized by recurrent dislocations of
the glenohumeral joint (GHJ) and may
induce glenoid bone defects. Apprehension-
relocation test is the preferred clinical test to
evaluate shoulder instability. To our
knowledge, the GHJ kinematics during
apprehension-relocation test has not
previously been studied in patients with ASI.
Aim: The aim of this study was to examine the
GHJ kinematics during an apprehension-
relocation test in patients with ASI
scheduled for a Latarjet procedure with
radiostereometry (RSA).
Materials and Methods: Twenty patients (16 males, mean age 31
years (21-40)) with severe ASI and glenoid
bone loss scheduled for the Latarjet
procedure on one side, and a healthy
shoulder on the contralateral side, were
included at Aarhus University Hospital.
Three consecutive static RSA recordings
were performed bilaterally on the patient's
shoulders during 1) relaxation (abducted
and externally rotated), 2) apprehension
test, and 3) relocation test. Double
examination was performed to examine the
repeatability of the tests. Bone models from
CT scans were aligned on the RSA
recordings. Anatomical coordinate systems
were applied to describe the GHJ
kinematics.
Results: Preliminary results for the first eight patients
showed that for the unstable shoulder, the
mean anterior humeral head translation
during apprehension was 0.31 mm
(SD=0.88) compared to the relaxed
position. For the contralateral healthy
shoulder, the humeral head translated 2.11
mm (SD=1.08), which was significantly
more than the unstable shoulder. No
statistically significant difference was found
between the healthy and the anterior
unstable shoulder for the relocation test. For
the double examinations, no significant
differences were found in any of the
positions.
Interpretation / Conclusion: RSA is a feasible method to assess GHJ
kinematics. Anterior translation is lower in
ASI compared to the patient’s healthy
shoulder during apprehension test, which
may be explained by patient’s increased
muscle guard during apprehension due to
smaller glenoid size and translation distance
to dislocation.
139. Evaluation of glenohumeral joint kinematics following a simulated bony Bankart lesion. A dynamic radiosteometric cadaver study.
Josephine Olsen Kipp1,3, Emil Toft Petersen1,2, Theis Muncolm Thillemann2,3, Thomas Falstie-Jensen2, Lindgren Lars4, Maiken Stilling1,2,3
1 AutoRSA Research Group, Orthopaedic Research Unit, Aarhus
University Hospital
2 Department of Orthopedic Surgery, Aarhus University Hospital
3 Department of Clinical Medicine, Aarhus University
4 Department of Radiology, Aarhus University Hospital
Background: During anterior shoulder dislocation, the
anterior rim of the glenoid may be damaged
with a combined labral and bone lesion
(bony Bankart lesion). This leads to a
reduced contact surface in the
glenohumeral joint (GHJ) and may result in
anterior shoulder instability. Instability
symptoms typically occur during active
abduction and external rotation. Dynamic
evaluation of GHJ kinematics during motion
has not previously been described.
Aim: The aim of this study was to establish an
experimental setup to measure the GHJ
translation before and after a 15% anterior
glenoid bone lesion using dynamic
radiostereometric analysis (dRSA).
Materials and Methods: Nine human donor arms were fixed in a
motorized fixture allowing a controlled 90
degrees external rotation of the GHJ
positioned at 60 degrees of abduction.
Dynamic radiostereometry recordings were
performed before and after inducing a bony
Bankart lesion (15% of the glenoid width).
All shoulders were tested before and after
bony Bankart lesion and both stages with
and without a 10N anterior directed load.
Bone models from computed tomography
scans were aligned on the dynamic
radiostereometry recordings and anatomic
coordinate systems were applied to
describe GHJ kinematics during motion.
Results: Without loading, the maximal anterior-
posterior translation range of the humeral
head increased with a mean of 0.56 mm
(SD=1.68) after the bony Bankart lesion.
With a 10N anterior directed load, the
maximal anterior-posterior translation range
increased by a mean of 1.32 mm (SD=1.53)
after the bony Bankart lesion compared to
the native joint.
After the bony Bankart lesion, the humeral
head position was 0.62 mm (SD = 1.04)
more inferior for the unloaded joint. With a
10N anterior load, the humeral head
position was 1.18 mm (SD = 1.16) more
inferior for the loaded joint, as compared
with the intact glenoid.
Interpretation / Conclusion: After 15 % bony Bankart lesion the humeral
head translated anteriorly and inferiorly
compared to the intact glenoid during active
rotation in 60 degrees abduction. However,
the 10N anterior directed load was not
sufficient to demonstrate statistical
significance of the pathomechanics.
140. Ultrasonographic findings in patients with isolated unilateral subacromial pain syndrome and intact rotator cuff tendons.
Adam Witten1, Mikkel Bek Clausen2, Kristian Thorborg1, Per Hölmich1, Kristoffer Weisskirchner Barfod1,
1. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of
Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre,
Denmark;
2. Department of Midwifery, Physiotherapy, Occupational Therapy and
Psychomotor Therapy, Faculty of Health, University College Copenhagen,
Copenhagen, Denmark
Background: The aetiology of subacromial pain syndrome
(SAPS) remains enigmatic. It is theorized that
the supraspinatus tendon (SUPRA) and the
subacromial bursa (BURSA) are the primary
pain-generating structures. SUPRA and BURSA
are generally considered to be thickened in
patients with SAPS, but this assumption lacks
validation. Some consider mechanical
impingement of the subacromial structures to be
the primary cause of pain, others do not. There
is a trend to abandon the term impingement,
though it has never been investigated if it can
be visually observed.
Aim: To measure SUPRA, BURSA and
acromiohumeral distance (AHD), and assess
the presence of mechanical impingement in
patients with SAPS, and compare it to their
asymptomatic side.
Materials and Methods: Patients were recruited from the outpatient
clinic, Hvidovre Hospital, using validated criteria
for SAPS. Patients with contralateral shoulder
pain, acromioclavicular osteoarthrosis, rotator
cuff tears, biceps tendon or labral pathology, or
calcified tendinitis were excluded. Validated
ultrasonographical measurements methods
were used. Thickness (mm) of SUPRA and
BURSA were measured perpendicular to the
tendon longitudinal axis, 2 cm from the lateral
border of the SUPRA footprint, with the shoulder
in slight internal rotation. AHD (mm) was
measured as the shortest distance from the
anterolateral acromion to humerus with the
shoulder in neutral position. Impingement was
defined as visual bulging (Yes/No) of BURSA in
active shoulder abduction.
Results: We examined 56 patients with unilateral SAPS
from 01.09.21 to 31.12.22. We found
significantly more cases of ultrasonographic
impingement in painful shoulders compared to
the pain-free (45 vs 18, Chi-Square p = 0.04).
Mean measurements of painful and pain-free
shoulders did not differ: SUPRA 5.4 vs 5.5 mm;
BURSA 1.9 vs 1.9 mm; AHD 11.1 vs 11.0 mm.
Interpretation / Conclusion: In this cohort of patients with isolated unilateral
SAPS, we found more cases of
ultrasonographic impingement in painful
shoulders compared to the pain-free, but no
significant differences in SUPRA, BURSA or
AHD between painful and pain-free shoulders.
These findings question the dogma of thickened
subacromial structures being the primary
aetiological explanation.
141. TITLE Patients with subacromial pain syndrome often present with varying combinations of concomitant shoulder pathology. A cross-sectional study in a secondary care setting.
Adam Witten1, Mikkel Bek Clausen2, Kristian Thorborg1, Per Hölmich1, Kristoffer Weisskirchner Barfod1
1. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of
Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre,
Denmark; 2. Department of Midwifery, Physiotherapy, Occupational Therapy and
Psychomotor Therapy, Faculty of Health, University College Copenhagen,
Copenhagen, Denmark
Background: Subacromial pain syndrome (SAPS) lacks
recognized diagnostic criteria. This could lead to
variations in concomitant shoulder pathology
across patient populations. It is possible that the
presence of concomitant pathology can explain
why some patients do not benefit from a typical
non-surgical approach, or from surgery aimed at
SAPS. It is not known how often SAPS is seen
in combination with concomitant pathology or in
which pattern. Knowledge of this could be
valuable to stratify treatment and in the design
and interpretation of future studies.
Aim: To investigate how often, and in which pattern,
SAPS is seen with associated concomitant
shoulder pathology.
Materials and Methods: Patients with insidious onset of shoulder pain,
referred to the outpatient clinic, Hvidovre
Hospital, were eligible for inclusion. Patients
were systematically screened for SAPS using
validated criteria and for 7 predefined
concomitant pathologies. We used 18
standardized physical examination tests
performed by experienced orthopedic
specialists and radiographs, ultrasound and/or
MR when indicated. Patients with frozen
shoulder, cervical pathology, glenohumeral
osteoarthritis (OA) or previous
fractures/surgery/radiotherapy in the shoulder
girdle, were excluded.
Results: We identified and examined 741 patients, with
insidious onset of shoulder pain, from 01.09.21
to 31.12.22. 408 (55%) were diagnosed with
SAPS. 160 (39%) had at least one type of
concomitant pathology (acromioclavicular OA 76
(48%), full-thickness rotator cuff tears 60 (38%),
biceps tendon pathology 54 (34%), labral
pathology 17 (11%), minor shoulder instability:
14 (9%), calcified tendinitis: 6 (4%). A
combination of concomitant pathology, with two
or more different types, were seen in 53 (33%)
patients. In total, 18 different combinations of
concomitant pathology were seen.
Interpretation / Conclusion: Patients with SAPS constitute an etiological
heterogenic group, presenting with many
different patterns of concomitant shoulder
pathology. The clinical importance of individual
concomitant pathologies remains uncertain, but
the high prevalence underpins the need for a
systematic and transparent approach in future
studies to ensure qualified interpretation and
comparison of studies.
143. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: A systematic review and meta-analysis of randomized controlled trials
Troels Kjeldsen1,2,3, Katrine Jessen Hvidt1, Marie Bagger Bohn4, Bjarne Mygind-Klavsen1, Martin Lind1,2, Adam Ivan Semciw5,6, Inger Mechlenburg1,2,7
1 Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus,
Denmark, 2 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,
3 The Research Unit PROgrez, Department of Physiotherapy and Occupational
Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark, 4 H-HiP, Department of
Orthopaedic Surgery, Horsens Regional Hospital, Denmark, 5 Department of
Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University,
Australia, 6 Department of Allied Health, Northern Health, Australia, 7 Department
of Public Health, Aarhus University, Aarhus, Denmark.
Background: Greater trochanteric pain syndrome (GTPS)
is a regional pain syndrome involving
pathology of several potential anatomical
structures. It is believed that the primary
causes of GTPS are tendinosis or tears of the
hip abductors, and a shift in focus of GTPS
treatment to address these structures has
previously been proposed. However, no
review has performed meta-analyses focused
specifically on exercise compared with a
control condition or other conservative
treatments across multiple clinical outcomes
in this condition.
Aim: To estimate the effectiveness of exercise at end
of treatment and at long-term follow-up
compared with a control condition or other
conservative treatment in patients with GTPS.
Materials and Methods: Randomized controlled trials comparing exercise
interventions for patients with GTPS with a
control condition; corticosteroid injection; shock
wave therapy; or other types of exercise
programs were included. Risk of bias was
assessed using the Cochrane ROB2 tool. Meta-
analyses were performed using a random-effects
model. The certainty of the evidence was rated
by the GRADE approach.
Results: Meta-analyses showed that in the long term,
exercise reduces hip pain and disease severity
while improving patient-reported physical
function and global rating of change compared
with a control condition. Compared with
corticosteroid injection, exercise improves long-
term global rating of change. No serious adverse
events from exercise therapy were reported.
Interpretation / Conclusion: The current evidence supports the
implementation of exercise as first-line treatment
in patients with GTPS. Compared with
corticosteroid injection, exercise is superior in
increasing the likelihood that patients experience
meaningful global improvement.
144. Ten years’ experience with a local allograft bank - optimizing the treatment for 552 patients.
Helia Azkia1, Lene Holm Harritshøj2, Connie Nielsen2, Niels Agerlin3, Mette Gotlieb Jensen4, Pia Charlotte Andersen1, Michael Rindom Krogsgaard1
1. Department of Orthopedic Surgery, Bispebjerg and Frederiksberg University
Hospital, Copenhagen, Denmark,
2. Department of Clinical Immunology, (Rigshospitalet), Copenhagen University
Hospital,
3. Department of Neurosurgery, (Rigshospitalet), Copenhagen University Hospital,
4. Transplantation coordinator, (Rigshospitalet), Copenhagen University Hospital
Background: In 2011 the Danish National Board of Health
(DNBH) centralized treatment of multi-
ligament injury and revision ligament surgery
of the knee, meniscus transplantation, and
advanced cartilage procedures to few
departments with the purpose to increase
experience and quality of these challenging
procedures. This increased the need for
allogeneic connective tissue (grafts). It is
possible to obtain grafts from tissue banks in
other countries, but from an ethical point of
view Denmark should be self-providing, and
there are differences in how grafts are
obtained and preserved, which might affect
tissue quality. Therefore, a local tissue bank
was established in 2014.
Aim: To report experience from this tissue bank.
Materials and Methods: Various logistic models were explored. It was
decided to connect allograft donation to the
organ donor program. The age limit for
donors is 50 years for tendons, 40 for
menisci, and 30 for hyaline cartilage. After
permission from relatives is obtained the
transplantation coordinator contacts the
orthopedic team (two surgeons and two
nurses), and after organ donation the
musculoskeletal tissue is removed. The
tissue is handled and stored by dept. of
clinical immunology. The donor is tested for
contagious disease and the grafts are
cultured for contamination. After negative
results, the grafts are released for use.
Results: Since June 2014 there has been 31
donations, resulting in 1160 grafts. 40 grafts
had a positive bacteria culture and were
discarded. Until April 2023, 552 recipients
have been treated by use of these allografts:
175 knee multi-ligament reconstructions
(Rs), 226 revision ligament Rs, 44 meniscal
transplantations (Ts), 18 fresh cartilage Ts, 3
tibial plateau+meniscal Ts, 2 ulnar Rs, 5 AC
joint, 9 SC joint and 1 PTF joint
stabilizations, 4 quadriceps Rs, 9 labral Rs
(hip) 2 pectoralis major tendon Rs, 1 revision
ankle stabilization, 45 one ligament Rs
(knee). There are no recorded
transplantation related complications. During
the period it was necessary in addition to buy
245 grafts from tissue banks in Belgium.
Interpretation / Conclusion: Through the established donation program it has
been possible to offer optimal treatment for
several highly specialized musculoskeletal
conditions.