Browsing by Author "Marinis Acle, Rodrigo Ignacio de"

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    A pilot multicenter randomized controlled trial comparing Bankart repair and remplissage with the Latarjet procedure in patients with subcritical bone loss (STABLE): study protocol
    (2022) Marinis Acle, Rodrigo Ignacio de; Khan, Moin; Bedi, Asheesh; Degen, Ryan; Warner, Jon; Bhandari, Mohit; Khan, Moin; Degen, Ryan; Bhandari, Mohit; Bedi, Asheesh; Warner, Jon; Madden, Kim; Barkhordari, Nazanin; Garrido Clua, Miriam; Wozny, Kelsey; Moro, Jaydeep; Denkers, Matthew; Ayeni, Olufemi R.; Litchfield, Robert; Bryant, Diane; Wanlin, Stacey; Firth, Andrew; Horst, Stephanie; Inch, Katelyn; Lapner, Peter; McIlquham, Katie; García Portabella, Montserrat; H. Núñez, Jorge; Batalla, Lledo; Massons, Josep; Henry, Patrick; Milner, Katrine; Ou, Yinmin; Kunz, Mónica; Álvares, Alicia; Moganathas, Saranjan; Chandrasegaram, Aarani; Oliogu, Etinosa; Balasuberamaniam, Phumeena; Gundi, Bárbara; Sivakumar, Nithila; Rashid, Khadija; Lewaniak, Stephanie; Fariha, Atqiya; Sri, Lavaneyaa; Alolabi, Bashar; Bolton, Carlee; Li, Xinning; Curry, Emily; Michlin, Dana; Bardana, Davide; Bicknell, Ryan; Liendo Verdugo, Rodrigo Javier; Vidal Olate, Catalina Victoria
    Introduction: Anterior dislocations, the most common type of shoulder dislocation, are often complicated by subsequent instability. With recurrent dislocations there often is attrition of the labrum and progressive loss of the anterior bony contour of the glenoid. Treatment options for this pathology involve either soft tissue repair or bony augmentation procedure. The optimal management remains unknown and current clinical practice is highly varied. Methods and analysis:The Shoulder instability Trial comparing Arthroscopic stabilization Benefits compared with Latarjet procedure Evaluation (STABLE) is an ongoing multi-centre, pilot randomized controlled trial of 82 patients who have been diagnosed with recurrent anterior shoulder instability and subcritical glenoid bone loss. Patients are randomized to either soft tissue repair (Bankart + Remplissage) or bony augmentation (Latarjet procedure). The primary outcome for this pilot is to assess trial feasibility and secondary outcomes include recurrent instability as well as functional outcomes up to two years post-operatively. Conclusions: This trial will help to identify the optimal treatment for patients with recurrent shoulder instability with a focus on determining which treatment option results in reduced risk of recurrent dislocation and improved patient outcomes. Findings from this trial will guide clinical practice and improve care for patients with shoulder instability. Ethics and dissemination: This study has ethics approval from the McMaster University/Hamilton Health Sciences Research Ethics Board (REB) (approval #4942). Successful completion will significantly impact the global management of patients with recurrent instability. This trial will develop a network of collaboration for future high-quality trials in shoulder instability.
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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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    Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears
    (2022) Meissner-Haecker, Arturo; Contreras Marambio, Julio César; Valenzuela, Alfonso; Delgado, Byron; Taglioni, Angelinni; Marinis Acle, Rodrigo Ignacio de; Calvo, Claudio; Soza, Francisco; Liendo Verdugo, Rodrigo Javier; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Atraumatic full thickness rotator cuff tears (AFTRCT) are common lesions whose incidence increases with age. Physical therapy is an effective conservative treatment in these patients with a reported success rate near 85% within 12 weeks of treatment. The critical shoulder angle (CSA) is a radiographic metric that relates the glenoid inclination with the lateral extension of the acromion in the coronal plane. A larger CSA has been associated with higher incidence of AFTRCT and a higher re-tear rate after surgical treatment. However, no study has yet described an association between a larger CSA and failure of conservatory treatment in ARCT. The main objective of this study is to determine whether there is an association between CSA and failure of physical therapy in patients with AFTRCT. Methods: We reviewed the imaging and clinical records of 48 patients (53 shoulders), 60% female, with a mean age of 63.2 years (95% CI ± 10.4 years); treated for AFTRCT who also underwent a true anteroposterior radiograph of the shoulder within a year of diagnosis of the tear. We recorded demographic (age, sex, type of work), clinical (comorbidities), and imaging data (CSA, size and location of the tear). We divided the patients into two groups according to success or failure of conservative treatment (indication for surgery), so 21 shoulders (39.6%) required surgery and were classified as failure of conservative treatment. Univariate and multivariate analysis was performed to detect predictors of failure of conservative treatment. Results: The median CSA was 35.5º with no differences between those with failure (median 35.5º, range 29º to 48.2º) and success of conservative treatment (median 35.45º, range 30.2º to 40.3º), p = 0.978. The multivariate analysis showed a younger age in patients with failure of conservative treatment (56.14 ± 9.2 vs 67.8 ± 8.4, p < 0.001) and that male gender was also associated with failure of conservative treatment (57% of men required surgery vs 28% of women, p = 0.035). Conclusions: It is still unclear if CSA does predict failure of conservative treatment. A lower age and male gender both could predicted failure of conservative treatment in AFTRCT. Further research is needed to better address this subject.
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    Increasing incidence of rotator cuff surgery : a nationwide registry study in Chile
    (2021) Vidal Olate, Catalina Victoria; Lira Salas, María Jesús; Marinis Acle, Rodrigo Ignacio de; Liendo Verdugo, Rodrigo Javier; Contreras, Julio J.
    Background: The rotator cuff surgery (RCS) incidence is rising rapidly in North America, Europe, Asia, and Australia. Despite this, multiple factors limit patients’ access to surgery. In Latin America, barriers to orthopedic surgery have been largely ignored. The purpose of this study was to calculate the rate of RCS in Chile between 2008 and 2018, investigating possible associated factors to access such as age, sex, and the health insurance. Methods: An ecological study was carried out with nationwide data obtained from the Database of Hospital Discharges of the Department of Statistics. All Chilean inhabitants aged 25 years or more were included. We used the ICD-10 codes M751, M754, and S460. The annual incidence rate of surgeries and the incidence rate for the period studied per 100,000 inhabitants were calculated. Data were analyzed stratified by age, sex, year of study, and the health insurance. Negative binomial regression was used to compare rates. Statistical analyzes were performed with Stata v.14 software. Results: 39,366 RCSs were performed, with a total rate for the period of 32.36 per 100,000 inhabitants. The annual rate of surgeries from 2008 to 2018 increased from 24.55 to 49.11 per 100,000/year. When adjusting for year, an annual increase in surgery rates of 8.19% (95% CI 6.7–9.6) and 101% growth between 2008 and 2018 (95% CI 90–109%, p < 0.001) was observed. When comparing the global rates according to the health insurance, the public system corresponds to 21.3 per 100,000 and the private system to 72 per 100,000, the latter being 3.4-times higher (95% CI 2.7–4.4; p < 0.001). Conclusion: RCS rates are increasing in Chile concordantly with previous reports of other western countries. The most important factor associated with RCS rate found was the patients’ health insurance, with higher rates observed for the private sector.
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    Increasing surgical rate of clavicle fractures and acromioclavicular dislocations in Chile: analysis over the last 15 years reveals disparities in access according to insurance type
    (Springer Nature, 2025) Vidal Olate, Catalina Victoria; Marinis Acle, Rodrigo Ignacio de; Liendo Verdugo, Rodrigo Javier; Silva Canales, Isadora Camila del Carmen; Lira Salas, María Jesús; Contreras Fernández, Julio José
    Background In recent years, an increase in surgeries to treat clavicle injuries has been reported. It has been hypothesized that the studies regarding the beneficial effect of surgery in patients with displaced clavicle fractures may have contributed to raise the surgical rates for injuries around the clavicle. To our knowledge, there is a lack of data from Latin American countries on surgical rates of clavicle-related surgeries. The aim of this study is to describe the rate of clavicle surgeries, including clavicle fracture and acromioclavicular dislocation, in the last 15 years and to analyze the possible effect of sex, age, and health insurance in those rates. Methods An observational cross-sectional study was carried out. Patients over 18 years old diagnosed with the following ICD-10 codes were selected: S420 "Clavicle fracture", S431 "Dislocation of the acromioclavicular joint", and S435 "Sprains and strains of the acromioclavicular joint". We collected information on the year of surgery, sex, age and type of insurance. The annual rate of surgeries and the rate for the period studied per 100,000 people were calculated. The rate was compared through negative binomial regression, reporting Incidence Rate Ratios (IRR) with 95% confidence interval (95% CI). Results During a 15 years period of observation, 24,570 surgeries were performed. For clavicle fractures an 8.0 × 100,000 surgical rate was observed, and a 4.7 × 100,000 rate was found for acromioclavicular dislocations. The surgical rate for clavicular injuries increased from 2.8 in 2005 to 19.1 in 2019. Rates were higher in men, and ages between 20 and 35 years. The surgical rate for clavicular injuries in the public system was 11.1 × 100,000 and 30.9 × 100,000 in the private system, which represents a difference of 2.8 times between those healthcare systems. Conclusion There has been a significant increase in clavicle and acromioclavicular dislocation surgeries in Chile, with disparities influenced by age, gender, and type of health insurance.
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    Lower Trapezius Transfer Improves Clinical Outcomes With a Rate of Complications and Reoperations Comparable to Other Surgical Alternatives in Patients with Functionally Irreparable Rotator Cuff Tears: A Systematic Review
    (2023) Marinis Acle, Rodrigo Ignacio de; Marigi, Erick; Atwan, Yousif; Velásquez García, Ausberto; Morrey, Mark E.; Sánchez Sotelo, Joaquin
    Purpose To analyze the clinical outcomes of lower trapezius transfer (LTT) for patients with functionally irreparable rotator cuff tears (FIRCT) and summarize the available literature regarding complications and reoperations. Methods After registration in the International prospective register of systematic reviews(PROSPERO [CRD42022359277]), a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Inclusion criteria were English, full-length, peer-reviewed publications with a level of evidence IV or higher reporting on clinical outcomes of LTT for FIRCT. Ovid MEDLINE(R), Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus via Elsevier databases were searched. Clinical data, complications and revisions were systematically recorded. Results Seven studies with 159 patients were identified. The mean age range was 52 – 63 years, 70.4% of the patients included were male, and the mean follow-up time ranged between 14 and 47 months. At final follow-up, LTT lead to improvements in range of motion (ROM), with reported forward elevation (FE) and external rotation (ER) mean gains of 10º – 66º and 11º – 63º, respectively. ER lag was present preoperatively in 78 patients and was reversed after LTT in all shoulders. Patient reported outcomes were improved at final follow-up, including the American Shoulder and Elbow Society score, Shoulder Subjective Value and Visual Analogue Scale. The overall complication rate was 17.6% and the most reported complication was posterior harvest site seroma/hematoma (6.3%). The most common reoperation was conversion to reverse shoulder arthroplasty (5%) with an overall reoperation rate of 7.5%. Conslusions Lower trapezius transfer improves clinical outcomes in patients with irreparable rotator cuff tears with a rate of complications and reoperations comparable to other surgical alternatives in this group of patients. Increases in FF and ER are to be expected, as well as a reversal of ER lag sign when preoperatively present. Level of Evidence Level IV, a systematic review of Level III-IV studies.
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    Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis
    (2023) Velásquez García, Ausberto; Nieboer, Micah J.; Marinis Acle, Rodrigo Ignacio de; Morrey, Mark E.; Valenti, Philippe; Sánchez-Sotelo, Joaquín
    Background: This study aims to analyze the mid- to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety.Methods: A systematic review was performed according to the PRISMA guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4-year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation.Results: Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4 to 9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% CI 21, 36; I2= 89%; P<.001); visual analog scale, with a standardized MD = 2.5 (95%CI 1.7, 3.3; P<.001; I2= 89%; P<.001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2=95% P<.001); abduction, with a MD = 38° (95% CI 20°, 56°; I2=85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2=87%; P= .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2=0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2=0%).Conclusions: Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid- to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.
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    Proximal humerus variable angle locking plate for the treatment of periprosthetic humeral fractures in a patient with previous tendon transfers: A case report
    (2023) Marinis Acle, Rodrigo Ignacio de; López Le-beuffe, Cristóbal Ernesto; Regan, Christina; Guarin, Sergio; Valenzuela, Alfonso; Kameid, Gonzalo; Liendo Verdugo, Rodrigo Javier
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    Shoulder surgery in Chile: how far we have come and our future challenges
    (Elsevier Inc., 2025) Marinis Acle, Rodrigo Ignacio de; Vidal Olate, Catalina Victoria; Correa Rivas, Ignacio Andrés; Contreras Fernández, Julio José; Kuroiwa Rivero, Aron Rriky; Calvo Palma, Claudio; Liendo Verdugo, Rodrigo Javier; Cerda, Jaime; Soza Rex, José Francisco
    Shoulder surgery in Chile has seen a remarkable development in the last 2 decades. From a handful of overseas-trained pioneers, Chilean shoulder surgeons now have a growing and robust society with more than 150 members with 8 fellowship programs and around 10 new fellowship-trained shoulder surgeons graduating every year. Academic activity has been steadily improving in both quality and quantity, aspiring to reach the standards of Europe and North America. State-of-the-art clinical practice is the standard in larger cities with considerable access issues in more remote areas of the country. In the broader picture, the country has a mixed public-private insurance system with a health budget that accounts for 9% of the gross domestic product (GDP).27 Although private insurance is accessible to only approximately 18% of the population, the elevated out-of-pocket cost of health care is a growing issue, especially for elective surgery. In this narrative review, we provide an overview of the development of shoulder surgery in Chile. We will discuss our health care system, surgical rates, and waiting lists issues and address the challenges along with opportunities for future developments. By discussing our strengths, limitations, opportunities, and threats, we aim to provide the reader with useful insights into global health care issues around shoulder surgery and exemplify potential solutions and barriers.
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    Substantial influence of psychological factors on return to sports after anterior shoulder instability surgery: a systematic review and meta-analysis
    (2023) Velásquez García, Ausberto; Iida, Naoya; Kuroiwa, Tomoyuki; Hsu, Kai-Lan; Marinis Acle, Rodrigo Ignacio de; Abdo, Glen; Ekdahl, Max
    Purpose: This systematic review and meta-analysis aimed to (1) determine the proportion of patients who underwent anterior shoulder instability surgery and did not return to sports for psychological reasons and (2) estimate differences in psychological readiness scores between patients who did and did not return to sports. Methods: The EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE and Cochrane Library databases were searched for relevant studies. The data synthesis included the proportion of patients who did not return to sports for psychological reasons and the mean differences in the psychological readiness of athletes who returned and those who did not return to sports. Non-binomial data were analysed using the inverse-variance approach and expressed as the mean difference with 95% confidence intervals. Results: The search yielded 700 records, of which 13 (1093 patients) were included. Fourteen psychological factors were identified as potential causes for not returning to sports. The rates of return to sports at any level or to the preinjury level were 79.3% and 61.9%, respectively. A total of 55.9% of the patients cited psychological factors as the primary reason for not returning to sports. The pooled estimate showed that patients who returned to sports had a significantly higher Shoulder Instability-Return to Sport After Injury score (P < 0.00001) than those who did not, with a mean difference of 30.24 (95% CI 24.95–35.53; I2 = 0%; n.s.).Conclusions: Psychological factors have a substantial impact on the rate of return to sports after anterior shoulder instability surgery. Patients who returned to sports had significantly higher psychological readiness than those who did not return to sports. Based on these results, healthcare professionals should include psychological and functional measurements when assessing athletes’ readiness to return to sports.
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    Venous Thromboembolism Following Surgical Management of Proximal Humerus Fractures: A Systematic Review
    (2023) Marigi, Erick M.; Sperling, John W.; Marinis Acle, Rodrigo Ignacio de; Gupta, Puneet; Hassett, Leslie C.; Soza Rex Jose Francisco; Sánchez-Sotelo, Joaquín
    Currently, there is limited information on the incidence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) after surgical treatment of proximal humerus fractures (PHFs). Therefore, the purpose of this systematic review is to evaluate the incidence of VTE, DVT, and PE following surgery for PHFs.