Browsing by Author "Velasquez Garcia, Ausberto"

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    All-Arthroscopic Coracoacromial Ligament Transfer: The Modified Neviaser Procedure for Acromioclavicular Dislocations
    (2022) Velasquez Garcia, Ausberto; Mendez, Magdalena; Abdo, Glen
    Over the course of the years, the topic of optimizing the management of acromioclavicular joint dislocations has gained popularity, remaining a subject of debate. It has been determined that posterior horizontal instability appears to be one of the factors influencing both clinical and radiographic outcomes, postsurgical reconstructions with coracoclavicular techniques. In contrast, the acromioclavicular ligament complex (ACLC) has been experimentally demonstrated to play a crucial role in horizontal translation and rotational stability of the clavicle. Although several strategies have been established, perfect surgical timing, and its potential impact during the healing process, remain poorly defined. Furthermore, appropriate surgical techniques to restore normal acromioclavicular joint kinematics while ensuring an adequate biological environment remain unclear. Due to the existence of multiple features present in acromioclavicular joint reconstruction techniques, an ideal approach involves ACLC and coracoclavicular combination reconstruction, minimal clavicular drilling, and biological enhancement to ensure anatomical reduction and an adequate process of ligament healing. The purpose of this Technical Note is to present a modified surgical technique of the Neviaser procedure. This modified surgical technique combines an all-arthroscopic single tunnel coracoclavicular fixation with the transfer of the coracoacromial ligament to reconstruct the ACLC.
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    Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up
    (Elsevier Inc., 2025) Marinis Acle, Rodrigo Ignacio de; Sperling, John W.; Marigi, Erick M.; Velasquez Garcia, Ausberto; Wagner, Eric R.; Sanchez-Sotelo, Joaquin
    Background: Revision reverse total shoulder arthroplasty (rTSA) of a previously cemented humeral component is challenging. In hip arthroplasty, the cement-within-cement (CwC) technique has been well described as an effective option. However, for shoulder arthroplasty there remains a paucity of data investigating this technique. The purpose of this study was to determine the mid-term outcomes of patients who underwent a revision rTSA utilizing the CwC for management of the humeral component. Methods: Between 2005 and 2021, 68 revision rTSA using the CwC technique with a minimum of 2 years clinical follow-up were identified from a single institution joint registry database. Revised implants consisted of 38 (55.9%) hemiarthroplasties, 22 (32.4%) anatomic total shoulder arthroplasties, and 8 (11.8%) rTSA. A total of 12 (17.6%) shoulders required an osteotomy (corticotomy or window) to assist with extraction of the cemented stem. The mean follow-up after revision was 5.4 years (range, 2-16 years). Surgical complications, reoperations, revisions, and implant survivorship were assessed. Results: Of the 12 shoulders that required an osteotomy for component removal, 11 (91.7%) were healed. At final follow-up, the overall complication rate was 26.9%. The most common complication was fracture or fragmentation of the greater tuberosity (20.6%, n = 13) with 10 (76.9%) cases showing signs of healing at final follow-up. The overall survivorship free of revision surgery was 88.2% at 2 and 80.9% at 5 years, respectively. The most frequent causes of re-revision surgery were aseptic glenoid component loosening (n = 4) and instability (n = 4), with only 2 (2.9%) patients developing humeral component loosening (at 2 and 5 years, respectively). Male sex was associated with an increased risk of revision surgery (hazard ratio [HR], 3.52 [95% confidence interval [CI] 1.22-10.18]; P = .02) and complications (HR, 3.56 [95% CI, 1.40-9.07]; P = .008). The grade of postoperative lucent lines at the humerus (HR, 1.35 [95% CI, 1.04-1.74]; P = .02) and glenoid (HR, 1.59 [95% CI, 1.22-2.10]; P = .001) also correlated with an increased risk of re-revision surgery. Conclusion: The CwC technique is a reliable option for revising previously cemented humeral components in revision rTSA. Although a low rate of humeral component loosening was observed, higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability, which are not directly related to CwC technique but to revision surgery in general.
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    Latissimus Dorsi Transfer Combined with Subacromial Balloon Spacer for Bidirectional Rotator Cuff Deficiency
    (2022) Velasquez Garcia, Ausberto; Osorio Valdivia, Pedro; Brito, Cristian; Mendez, Magdalena
    Patients with massive, irreparable rotator cuff tears represent a challenge for treatment, particularly those with loss of external rotation and active elevation. In the cases of glenohumeral arthropathy, reverse shoulder arthroplasty combined with transfer of the latissimus dorsi and teres major tendons has improved active external rotation and overall patient outcomes. However, the reverse shoulder prosthesis could be better used as a second-line treatment in patients without arthropathy. Several joint-preserving surgical approaches have been described for irreparable cuff tears with no substantial differences in results. Although latissimus dorsi transfer has shown long-term clinical reliability and improved functional shoulder function in relatively young patients, isolated tendon transfer appears insufficient to restore range of motion in patients with a bidirectional deficit. The subacromial balloon spacer is an additional new treatment option. This surgical procedure describes an arthroscopic-assisted transfer of the latissimus dorsi tendon followed by the implantation of the subacromial balloon. This combination potentially addresses the bidirectional deficiency by restoring the shoulder external rotational coupling, improving the deltoid load, centering the humeral head, and protecting the transferred tendon from the subacromial compression stresses.
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    The Reliability of Acromioclavicular Joint Dislocation Classification Systems: A Comparison Between the Rockwood and Kraus Classifications
    (2023) Velasquez Garcia, Ausberto; Liendo, Rodrigo; Ekdahl, Max; Calvo, Cristobal; Vidal, Catalina
    Background:The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries. Purpose:To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments. Study Design:Cohort study (diagnosis); Level of evidence, 3. Methods:Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (kappa) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap. Results:The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (kappa = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (kappa = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the kappa values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (kappa = 0.78 [95% CI, 0.72-0.81]) and Kraus (kappa = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (kappa = 0.65 [95% CI, 0.61-0.67]) and Kraus (kappa = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations. Conclusion:The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.