The impact of extensive loads on the cartilage of the proximal interphalangeal-(PIP) and distal interphalangeal (DIP) joints of the fingers in elite sport climbers are relatively unknown. The purpose of this study was to investigate the changes in the cartilage of the PIP and DIP joints as well as the existence of osteophytes, in fingers of elite sport climbers with a minimum of 15 years of climbing history. Thirty-one elite male sport climbers and 20 male non-climbers volunteered for the current cross-sectional observation. By means of ultrasonography, the thickness of cartilage of the PIP and DIP joints in a sagittal and frontal plane of the digits II to V of both hands, as well as the existence of osteophytes on the dorsal aspect of the phalanges were assessed. The main results were: (1) cartilage thickness revealed to be significantly greater in climbers than non-climbers,; (2) larger cartilage thickness differences were found at the DIP joints; (3) while climbers showed a substantial occurrence of osteophytes with highest relative frequencies at Dig III, in the group of non-climbers no osteophytes were observed; (4) small to moderate correlations were found between the cartilage and osteophyte thickness of climbers at the PIP and DIP joints and Dig III. In conclusion, an accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career may induce degenerative changes at the PIP and DIP joints.
Background: The Latarjet is a successful procedure but can be associated with significant complications, including failure. Iliac crest bone grafting (ICBG) is one of the salvage options for such failure. Purpose: To analyze factors associated with failure or success to restore shoulder stability with ICBG after Latarjet failure. Study Design: Case series; Level of evidence, 4. Methods: Twenty consecutive patients with recurrence of instability after a Latarjet procedure underwent revision using ICBG. Sixteen patients (80%) with a mean age of 35.0 years (range, 25-55) could be personally reexamined clinically and radiographically (including computed tomography scan) after a mean follow-up of 4.5 years (range, 2-8). Twelve patients had redislocation and 4 had recurrent subluxation after the Latarjet. Results: Salvage ICBG failed in 7 patients because of recurrent dislocations, with 5 necessitating reoperations: 2 arthrodeses, 1 reverse total shoulder arthroplasty, 1 repeat ICBG, and 1 Hill-Sachs allograft reconstruction and Bankart repair. Factors associated with ICBG failure were multidirectional instability (n = 2), subscapularis insufficiency (n = 1), uncontrolled seizures (n = 1), static inferior glenohumeral subluxation (n = 1), total graft resorption (n = 1), and voluntary dislocation attributed to schizoaffective disorder (n = 1). The initial Latarjet graft was malpositioned (too medial) in 3 of these patients. In patients without recurrent instability (n = 9), reasons for Latarjet failure were graft related: 6 graft avulsions, 2 graft resorptions, and 1 medial graft malpositioning. The mean absolute Constant score (62 to 87 points, P = .012) and relative Constant score (66% to 91%, P = .012), pain (10 to 15 points, P < .001), and Subjective Shoulder Value (31% to 85%, P = .011) in the group with a successful procedure were significantly improved over the preoperative state, and the total Western Ontario Shoulder Instability Index averaged 64% at final follow-up. Except in 1 case of major resorption, mild graft resorption or none was observed in successful procedures. Axial and sagittal graft positioning was good in all 9 patients. Conclusions: Salvage ICBG for failed Latarjet procedures failed in 7 of 16 patients. It was successful in patients with clearly graft-related factors of the initial Latarjet procedure. However, patients with unclear instability symptoms, subscapularis insufficiency, inferior subluxation, uncontrolled seizures, or psychological disorders were poor candidates for salvage ICBG, underlining the importance of careful patient selection for the initial Latarjet procedure and for salvage ICBG.
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