TY  - JOUR
A1  - Streck, Laura Elisa
A1  - Gaal, Chiara
A1  - Forster, Johannes
A1  - Konrads, Christian
A1  - Hertzberg-Boelch, Sebastian Philipp von
A1  - Rueckl, Kilian
T1  - Defining a synovial fluid white blood cell count threshold to predict periprosthetic infection after shoulder arthroplasty
JF  - Journal of Clinical Medicine
N2  - Background: The diagnosis of periprosthetic shoulder infection (PSI) requires a thorough diagnostic workup. Synovial fluid aspiration has been proven to be a reliable tool in the diagnosis of joint infections of the lower extremity, but shoulder specific data is limited. This study defines a threshold for synovial fluid white blood cell count (WBC) and assesses the reliability of microbiological cultures. Methods: Retrospective study of preoperative and intraoperative fluid aspiration of 31 patients who underwent a revision of a shoulder arthroplasty (15 with PSI defined by IDSA criteria, 16 without infection). The threshold for WBC was calculated by ROC/AUC analysis. Results: WBC was significantly higher in patients with PSI than in other patients. A threshold of 2800 leucocytes/mm\(^3\) showed a sensitivity of 87% and a specificity of 88% (AUROC 0.92). Microbiological cultures showed a sensitivity of 76% and a specificity of 100%. Conclusions: A threshold of 2800 leucocytes/mm\(^3\) in synovial fluid can be recommended to predict PSI. Microbiological culture has an excellent specificity and allows for targeted antibiotic therapy. Joint aspiration presents an important pillar to diagnose PSI.
KW  - upper extremity
KW  - joint infection
KW  - joint aspiration
KW  - leucocyte count
KW  - cutibacteria
KW  - ICM
KW  - MSIS
KW  - IDSA
KW  - WBC
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252275
SN  - 2077-0383
VL  - 11
IS  - 1
ER  - 
TY  - JOUR
A1  - Reichel, Thomas
A1  - Herz, Stefan
A1  - el Tabbakh, Mohammed
A1  - Bley, Thorsten Alexander
A1  - Plumhoff, Piet
A1  - Rueckl, Kilian
T1  - Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear
JF  - JSES International
N2  - Background

Diagnosis of subscapularis (SSC) tendon lesions on magnetic resonance imaging (MRI) can be challenging. A small coracohumeral distance (CHD) has been associated with SSC tears. This study was designed to define a specific threshold value for CHD to predict SSC tears on axial MRI scans.

Methods

This retrospective study included 172 shoulders of 168 patients who underwent arthroscopic surgery for rotator cuff tear or glenohumeral instability. Diagnostic arthroscopy confirmed an SSC tear in 62 cases (36.0%, test group a), rotator cuff tear tears other than SSC in 71 cases (41.3%, control group b) and glenohumeral instability without any rotator cuff tear in 39 cases (22.7%, zero-sample group c). All patients had a preoperative MRI of the shoulder (1.5T or 3T). Minimum CHD was measured on axial fat-suppressed proton density-, T2-, or T1-weigthed sequences. Receiver operating characteristics analysis was used to determine the threshold value for CHD, and sensitivity and specificity were calculated.

Results

CHD measurement had a good interobserver reliability (Intraclass correlation coefficient 0.799). Mean CHD was highly significantly (P < .001) less for test group a (mean 7.3 mm, standard deviation ± 2.2) compared with control group b (mean 11.1 mm, standard deviation ± 2.3) or zero-sample group c (mean 13.6 mm, standard deviation ± 2.9). A threshold value of CHD <9.5 mm had a sensitivity of 83.6% and a specificity of 83.9% to predict SSC tears.

Conclusion

A CHD <9.5 mm on MRI is predictive of SSC lesions and a valuable tool to diagnose SSC tears.
KW  - subscapularis tear
KW  - coracohumeral distance
KW  - rotator cuff tear
KW  - coracohumeral impingement
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259118
VL  - 5
IS  - 3
ER  -