Papers by Socrates Kalogrianitis
Most common current surgical treatment options for cuff tear arthropathy (CTA) are hemiarthroplas... more Most common current surgical treatment options for cuff tear arthropathy (CTA) are hemiarthroplasty and reverse total shoulder replacement. At our unit we have been using Reverse Total shoulder replacement (TSR) for CTA patients since 2001. We present our results of Reverse TSR in 64 patients (single surgeon) with a mean follow up of 2 years (Range 1 to 8 years). There were 45 males and 19 females in the study with a mean age of 70 years. Preoperative and postoperative Constant scores were collected by a team of specialist shoulder physiotherapists. Preoperatively plain radiographs were used to evaluate the severity of arthritis and bone stock availability. 90% patients showed an improvement in the Constant score post operatively. The mean improvement in Constant score was 25 points. The mean Pain Score (max 15) improved from 6.3 to 11.8; the mean ADL Score (max 20) improved from 6.8 to 12.3; the mean Range of Motion score (max 40) improved from 10.8 to 20.2; but the mean Power Scor...
Indian Journal of Orthopaedics
In this article we describe a modification of the open Latarjet technique, using sutures and cort... more In this article we describe a modification of the open Latarjet technique, using sutures and cortical buttons, for the fixation of the coracoid. The transfer of the coracoid to the anterior glenoid is a popular technique used for complex shoulder instability. The technique is proven to be effective with consistently good results but complications have been reported related to the screws used for the fixation of the coracoid. Recent studies confirm that the suture-button technique for the fixation of the coracoid is biomechanically comparable to the screw fixation. The proposed technique combines the advantages of the open approach and avoids the use of metal screws, potentially minimizing hardware-related complications.
European Journal of Orthopaedic Surgery & Traumatology
Objective The aim of this study was to compare outcomes of arthroscopic tricortical iliac crest a... more Objective The aim of this study was to compare outcomes of arthroscopic tricortical iliac crest autograft and allograft bone blocks for recurrent traumatic anterior shoulder instability in terms of bone resorption, union and recurrent instability and assess which one is a better graft choice. Patients and methods Twenty-two consecutive patients treated for recurrent traumatic anterior shoulder instability that required reconstruction with bone block were included in the study. Surgical reconstruction was carried out arthroscopically with contoured tricortical iliac crest autograft or allograft . At follow-up, patients were assessed for Oxford Shoulder Instability Score (OSIS), recurrent dislocation, apprehension testing, complications, and 3-dimensional computed tomography (CT) for resorption and union rate at a mean of 10.89 months. Results There were 10 patients in the allograft group with a median age of 27.7 years and a mean follow-up of 26.6 months. In the autograft group, there were 12 patients with a median age of 29 years and a mean follow-up of 28.7 months. The OSIS increased in both groups but was significantly higher in the autograft group (54.1 vs 48.2, p = 0.02). There were 2 failures in each group but no hardware complications. Allograft had higher resorption rate in comparison (75% in allograft vs 40% in autograft) and higher non-union rate (62.5% in allograft vs 16.5% in autograft). Conclusion This study demonstrated that both tricortical iliac crest autograft and allograft can improve shoulder instability symptoms. However, the results suggest that autograft may lead to significantly improved instability score, higher union rate and less bone resorption. Level of evidence IV, retrospective study.
We defined the immunocytochemical expression of matrix metalloproteinases (MMPs) and their tissue... more We defined the immunocytochemical expression of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in benign soft tissue neoplasms, fibromatoses, and sarcomas, together with the activity of gelatinase MMPs and TIMPs measured by zymography and reverse zymography in a subset of cases. The most strongly expressed MMP in all tumors was MMP-1, with weaker expression of MMP-10, MMP-11, and MMP-14 in most tumors. Nuclear expression of MMP-1, MMP-8, and MMP-13 was an unusual feature. TIMP-2 was expressed in all tumors, with stronger expression in fibromatoses than in sarcomas. Fibromatoses and high-grade sarcomas showed greater MMP-1 expression than other groups, and endothelial MMP-2 expression was more extensive in sarcomas. Differences in MMP and TIMP expression might be linked to the biologic behavior of soft tissue neoplasms. The activation of endothelial MMP-2 linked to widespread MMP-14 expression provides a mechanism for sarcomas to modulate their matrix and facilitate angiogenesis. The extracellular matrix (ECM) is a complex meshwork of protein and carbohydrate polymers that is secreted by, surrounds, and anchors the cells of the connective tissues. The connections between the ECM, cell-surface integrins, and cytoskeletal actin fibers support the conformational changes and migration exploited by normal, reactive, and malignant cells. 1 Management of the ECM is a specialized function of mesenchymal cells, incorporating the proliferative and migratory functions required for matrix restoration during wound repair. Modulation of the ECM is important in the development and progression of malignancy, during neoangiogenesis, and through the complex processes involved in metastasis. 2,3 High-grade soft tissue sarcomas, including malignant fibrous histiocytoma (MFH), leiomyosarcoma, and undifferentiated sarcoma, are aggressive, rapidly growing tumors accounting for 2% of deaths from malignancy. Early metastasis to the lungs is common, and 10% of patients have advanced disease at initial examination. Soft tissue sarcomas tend to be resistant to radiotherapy and current chemotherapy regimens. A relatively poor prognosis is associated with age older than 60 years, size of more than 5 cm, and high histologic grade. 4 Wide surgical resection with a clear margin is the treatment of choice for sarcomas of the extremities, irrespective of tumor phenotype, but this frequently is disabling and sometimes impossible. Improvement in survival is unlikely without advances in neoadjuvant and adjuvant therapy. Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that, collectively, are capable of degrading almost all ECM components. Substrate specificity is determined by the C-terminal domain; however, there is considerable overlap, which cautions against attributing specific degradative functions in vivo. Biological activity is regulated at the level of gene
Lancet (London, England), Jan 20, 2017
Arthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone sp... more Arthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression. We did a multicentre, randomised, pragmatic, parallel group, placebo-controlled, three-group trial at 32 hospitals in the UK with 51 surgeons. Participants were patients who had subacromial pain for at least 3 months with intact rotator cuff tendons, were eligible for arthroscopic surgery, and had previously completed a non-operative management programme that included exercise therapy and at least one steroid injection. Exclusion criteria included a full-thickness torn rotator cuff. We randomly assigned participants (1:1:1) to arthroscopic subacromial decompression, investigational arthroscopy only, or no treatment (attendance of one reassessment appointment with...
International Journal of Shoulder Surgery
Arthroscopy Techniques
Recurrent anterior shoulder instability with significant bone loss represents a surgical challeng... more Recurrent anterior shoulder instability with significant bone loss represents a surgical challenge. Anterior bone block procedures including variations of the Latarjet coracoid transfer have been used in this setting. Bone graft resorption with prominence of the metalwork is a serious concern, whereas the relative contribution of the dynamic sling effect of a Latarjet procedure is still controversial. We describe an arthroscopic technique for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. This technique allows accurate placement of the bone block; fixation with 2 knotless TightRope devices (Arthrex, Naples, FL), avoiding the use of screws; and a final labral repair.
International Journal of Shoulder Surgery
Follow-up series of the Copeland resurfacing hemiarthroplasty have reported few postoperative fra... more Follow-up series of the Copeland resurfacing hemiarthroplasty have reported few postoperative fractures around the prosthesis. We report three cases of periprosthetic fracture around a Copeland resurfacing arthroplasty. Due to prosthetic loosening and tuberosity comminution, all cases were managed with revision shoulder arthroplasty. All patients had good functional outcome and range of movement on early follow-up.
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, Jan 24, 2017
The management of displaced fractures of the distal clavicle remains controversial, particularly ... more The management of displaced fractures of the distal clavicle remains controversial, particularly in younger patients where there is no consensus as to which surgical intervention is best. Each surgical method has unique surgical complications and rates of persistent pain and post-traumatic arthritis. We report an innovative surgical technique using a plate fixation augmented with minimally invasive tension slide coracoclavicular fixation using a cortical tenodesis button (8.5 mm). A single-surgeon series, comprising of eleven cases, underwent retrospective review. A low-profile pre-contoured stainless steel plate that combines locking and non-locking options was used. Secondary fixation to the coracoid, through the plate, was achieved under fluoroscopic guidance eliminating the need for arthroscopy or exposure of the coracoid. An 8.5-mm cortical button loaded with a single FiberTape is inserted with fluoroscopic navigation, flipped under the coracoid and fixed to the plate. Patients...
Journal of Bone Joint Surgery British Volume, Mar 1, 2010
Purpose of the study: To present our experience in managing Sterno-Clavicular Joint (SCJ) problem... more Purpose of the study: To present our experience in managing Sterno-Clavicular Joint (SCJ) problems. SCJ pain is caused by a number of pathological conditions that include primary, post-infection, and post-traumatic OsteoArthritis (OA), Sterno-Costo-Clavicular Hyperotosis (SCCH) and posttraumatic instability. Methods: All cases of painful SCJ problems treated surgically by the senior author over the past 20 years have been reviewed. Results: All operations have been carried out using a “necklace” thyroid type incision. OA in which the pain becomes chronic and disabling, has been treated surgically. Medial clavicle reshaping (2), or hemiarthroplasty with a radial head prosthesis (3), sometimes combined with an interpositional arthroplasty using a GraftJacket is a new technique, developed to obliterate dead space, improve wound cosmesis, and prevent regeneration of the medial clavicle. SCCH is strongly associated with seronegative spondyloarthropathy, and can from part of the SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis), Patients with severe excruciating pain and those with restricted motion resulting from complete fusion of the clavicle and sternum may be candidates for surgical treatment. Excision of the medial end of the clavicle (1), the whole clavicle (1) and replacement hemiarthroplasty using a radial head as well as a pectoralis major flap interposition between the first rib and the clavicle (1), is a technique that has not been described previously. Instability for persistent subluxation or dislocation of the SCJ has been treated with interposition with Graft-Jacket +/− medial clavicle resection (2) or a sterno-mastoid tendon stabilisation (2). Conclusions: Previous surgical treatment of SCJ problems has been disappointing. Rockwood’s success rate with excision of the medial end of the clavicle alone has been poor (40% good only) – these newer techniques show greater promise.
Journal of pediatric orthopedics. Part B, 2007
Controversy exists regarding the role of early reduction and stabilization in the management of u... more Controversy exists regarding the role of early reduction and stabilization in the management of unstable slipped capital femoral epiphysis. It seems logical that early reduction and stabilization of an unstable slip might preserve the remaining blood supply to the epiphysis and reduce the incidence of avascular necrosis. Some studies have indeed shown lower rates of avascular necrosis following early reduction and stabilization, but others have shown the contrary. To try to resolve this disagreement, we conducted a retrospective review of slipped capital femoral epiphysis treated in Alder Hey Hospital over a 4-year period. We reviewed 117 consecutive slips in 82 children (43 boys and 39 girls, mean age 12 years), treated by internal fixation from 1998 to 2002. Mean follow-up was 18 months (range, 12-48 months). Sixteen cases (19%) were unstable at presentation. Avascular necrosis developed in eight of these, of which all but one were treated between 24 and 72 h after symptom onset. ...
This study reviews our experience with primary total elbow arthroplasty in the management of acut... more This study reviews our experience with primary total elbow arthroplasty in the management of acute distal humeral fractures by use of the iBP unlinked elbow prosthesis. We followed up 9 elbows in 9 patients (including 2 with rheumatoid arthritis), with a mean age of 73 years, for a mean of 3.5 years. Functional outcome was assessed with the Mayo Elbow Performance Score and the recently developed Liverpool Elbow Score. Clinical examination and radiologic assessment were performed by an independent surgeon. All elbows were stable at the latest follow-up examination, all patients were able to perform daily activities, and pain relief was satisfactory. The median value for the Mayo Elbow Performance Score was 95 (range, 65-100). This is the first report of the use of an unlinked prosthesis for the treatment of distal humeral fractures. Our results show that this method of treatment provides a reliable and effective way of dealing with these very difficult fractures when internal fixation is not a viable option. (
Trauma, 2014
Fracture of the proximal humerus is a common orthopaedic injury and is likely to increase in inci... more Fracture of the proximal humerus is a common orthopaedic injury and is likely to increase in incidence. This fracture type is associated with a wide variety in fracture morphology and as a direct result there are many treatment options available. It is often not clear what treatment modality should be utilised. This article reviews the current literature on proximal humerus fractures offering evidence for care pathways and management strategies from presentation to rehabilitation.
Microsurgery, 2006
Tumor involvement of the brachial plexus is uncommon. The most common intrinsic neoplasms involvi... more Tumor involvement of the brachial plexus is uncommon. The most common intrinsic neoplasms involving the brachial plexus are benign neurilemmomas and neurofibromas that are usually associated with neurofibromatosis-1 (NF-1). Solitary neurofibromas unassociated with NF-1 are very uncommon. Malignant peripheral nerve-sheath tumors (MPNST) are rare at this site, arising spontaneously or in the context of NF-1. This presentation discusses the clinical presentation, pathology, and management of these tumors, which usually occur in young adults. MPNST are intermediate or high-grade sarcomas with a high risk of local and distant spread. Approximately 50% of MPNST arise in patients with NF-1, and therefore these patients should be thoroughly investigated for any new symptoms or masses. MPNST of the brachial plexus should be treated with an adequate wide local excision, with adjuvant high-dose radiotherapy pre- or postoperatively. The role of chemotherapy in the treatment of MPNST is not clearly defined, but it may have some benefit in salvaging treatment failures.
Techniques in Shoulder & Elbow Surgery, 2011
ABSTRACT The treatment of recurrent anterior shoulder instability often involves bony augmentatio... more ABSTRACT The treatment of recurrent anterior shoulder instability often involves bony augmentation procedures. We present an all-arthroscopic Bristow-Latarjet coracoid transfer for complex anterior shoulder instability. The technique consists of 6 arthroscopic portals, and involves exposure and osteotomy of the coracoid process and transfer of the coracoid block with the attached conjoint tendon to the anterior glenoid neck where it is fixed with a single cannulated screw. Our main indications for coracoid transfer are significant glenohumeral bone loss and revision cases after failed Bankart repair. Our initial experience has been encouraging and we will continue to further develop this arthroscopic technique.
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Papers by Socrates Kalogrianitis