Scapular notching is a common problem following reverse shoulder arthroplasty (RSA). This is due to impingement between the humeral polyethylene cup and scapular neck in adduction and external rotation. Various glenoid component strategies have been described to combat scapular notching and enhance impingement-free range of motion (ROM). There is limited data available detailing optimal glenosphere position in RSA with an onlay configuration. The purpose of this study was to determine which glenosphere configurations would maximise impingement free ROM using an onlay RSA prosthesis.

A three-dimensional (3D) computed tomography (CT) scan of a shoulder with Walch A1, Favard E0 glenoid morphology was segmented using validated software. An onlay RSA prosthesis was implanted and a computer model simulated external rotation and adduction motion of the virtual RSA prosthesis. Four glenosphere parameters were tested; diameter (36mm, 41mm), lateralization (0mm, 3mm, 6mm), inferior tilt (neutral, 5 degrees, 10 degrees), and inferior eccentric positioning (0.5mm, 1.5mm. 2.5mm, 3.5mm, 4.5mm). Eighty-four combinations were simulated. For each simulation, the humeral neck-shaft angle was 147 degrees and retroversion was 30 degrees.

The largest increase in impingement-free range of motion resulted from increasing inferior eccentric positioning, gaining 15.0 degrees for external rotation and 18.8 degrees for adduction. Glenosphere lateralization increased external rotation motion by 13. 6 degrees and adduction by 4.3 degrees. Implanting larger diameter glenospheres increased external rotation and adduction by 9.4 and 10.1 degrees respectively. Glenosphere tilt had a negligible effect on impingement-free ROM.

Maximizing inferior glenosphere eccentricity, lateralizing the glenosphere, and implanting larger glenosphere diameters improves impingement-free range of motion, in particular external rotation, of an onlay RSA prosthesis. Surgeons’ awareness of these trends can help optimize glenoid component position to maximise impingement-free ROM for RSA. Further studies are required to validate these findings in the context of scapulothoracic motion and soft tissue constraints.

Most previous studies investigating autograft options (quadriceps, hamstring, bone-patella-tendon-bone) in primary anterior cruciate ligament (ACL) reconstruction are confounded by concomitant knee injuries. This study aims to investigate the differences in patient reported outcome measures and revision rates for quadriceps tendon in comparison with hamstring tendon and bone-patella-tendon-bone autografts. We use a cohort of patients who have had primary ACL reconstruction without concomitant knee injuries.

All patients from the New Zealand ACL Registry who underwent a primary arthroscopic ACL reconstruction with minimum 2 year follow-up were considered for the study. Patients who had associated ipsilateral knee injuries, previous knee surgery, or open procedures were excluded. The primary outcome was Knee Injury and Osteoarthritis Outcome Score (KOOS) and MARX scores at 2 years post-surgery. Secondary outcomes were all-cause revision and time to revision with a total follow-up period of 8 years (time since inception of the registry).

2581 patients were included in the study; 1917 hamstring tendon, 557 bone-patella-tendon-bone, and 107 quadriceps tendon. At 2 years, no significant difference in MARX scores were found between the three groups (2y mean score; 7.36 hamstring, 7.85 bone-patella-tendon-bone, 8.05 quadriceps, P = 0.195). Further, no significant difference in KOOS scores were found between the three groups; with the exception of hamstring performing better than bone-patella-tendon-bone in the KOOS sports and recreation sub-score (2y mean score; 79.2 hamstring, 73.9 bone-patella-tendon-bone, P < 0.001). Similar revision rates were reported between all autograft groups (mean revision rate per 100 component years; 1.05 hamstring, 0.80 bone-patella-tendon-bone, 1.68 quadriceps, P = 0.083). Autograft revision rates were independent of age and gender variables.

Quadriceps tendon is a comparable autograft choice to the status quo for primary ACL reconstruction without concomitant knee injury. Further research is required to quantify the long-term outcomes for quadriceps tendon use.

Background: Computer Assisted Orthopaedic Surgery continues to evolve. Electromagnetic Computer Navigation has recently emerged as a new modality of CAOS that promises increased accuracy, as well as increased portability and practicality. However, there are very few studies examining this new technique and comparing it to conventional TKJR.

Methods: We carried out a prospective randomised study comparing the conventional jig-based technique of TKJR versus EM navigation (Medtronic). We examined parameters such as surgical time, blood loss, days in hospital post operatively, and complication rate. Further, we assessed the accuracy of the two techniques with the CT Scan “Perth Protocol”. Parameters measured included femoral component flexion, extension, alignment and rotation, tibial alignment, posterior slope and femorotibial mismatch.

Results: Mean Oxford Knee Score was 47.5; the mean age was 70 (67–74). 43% were female and 57% male. Half were navigated and half conventional. The mean Hb change in 48 hours, as a reflection of blood loss was 14.5% for the conventional group and 14.25% for the navigated group. Mean Surgical Time for the conventional group was 90 minutes and the navigated was 120 minutes. The average stay in hospital for both groups was 5 days after the operation. The measurements according to the Perth Protocol suggested increased accuracy in femoral alignment, posterior slope, and reduced femorotibial mismatch. Femoral rotation was not significantly different and femoral flexion extension was not significantly different. The only major complication occurred in the navigated group with a dislocated knee in a patient afflicted with multiple sclerosis.

Summary: These preliminary results suggest that EM navigation is a safe and accurate technique. It has the additional advantage of portability and increased user friendliness compared to other navigation methods. When compared to conventional jig-based techniques, it is more accurate, increases surgical time by an average 30 minutes, there is no significant difference in blood loss at 48 hours, patient’s stay in hospital is not prolonged and the rate of complications does not exceed that of conventional surgery.

Electromagnetic Navigation is in its infancy, and the authors feel that surgical time and accuracy will improve with more frequent use and the development of increasingly more sophisticated software packages. Our study continues.