MUSCULOSKELETAL SURGERY最新文献

{"title":"Extensor mechanism injury/failure following spacer dislocation in periprosthetic joint infection: a case series in a single reference center.","authors":"A Mei, M Scazzarriello, D Brioschi, M Larghi, A Manzotti","doi":"10.1007/s12306-025-00907-8","DOIUrl":"10.1007/s12306-025-00907-8","url":null,"abstract":"<p><p>Antibiotic-loaded spacers are widely used in the two-stage revision protocol for managing periprosthetic joint infections (PJIs) of the knee, offering effective local antibiotic delivery while maintaining joint space and soft tissue tension. However, despite their clinical benefits, complications such as extensor mechanism rupture remain under-recognized and can severely compromise functional outcomes. This retrospective case series presents consecutive patients treated between 2014 and 2022 by a single orthopedic team at our institution. All patients were diagnosed with knee PJI and experienced extensor mechanism rupture following the implantation of either static or dynamic antibiotic-loaded spacers. The analysis highlights the multifactorial etiology of this complication, including factors such as severe bone loss, suboptimal spacer positioning or design, repeated debridements, and individual patient risks such as obesity and previous surgical history. Dynamic spacers, while allowing partial joint mobility, were associated with a higher risk of mechanical overload, whereas static spacers posed risks related to rigidity and stress transmission. Surgical management in all cases involved radical debridement, assessment of bone loss and femoral canal diameter, and careful selection of spacer type. Awareness of the potential for extensor mechanism injury should inform both surgical technique and postoperative care strategies.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"117-125"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the ulnar nerve using an adipofascial flap in elbow surgery.","authors":"A Greco, L L Marcovici, I Molayem, C Amendola, A Pagnotta","doi":"10.1007/s12306-025-00916-7","DOIUrl":"10.1007/s12306-025-00916-7","url":null,"abstract":"<p><strong>Purpose: </strong> Ulnar nerve entrapment is a common condition, with a recurrence rate after surgery reaching up to 25%. In such cases, treatment remains controversial. During elbow surgery, management of the ulnar nerve and performing neurolysis are often the initial steps, even in the absence of clear symptoms. In this study, we assessed the clinical applicability of using an adipofascial flap to cover the nerve during elbow surgery.</p><p><strong>Methods: </strong> A retrospective study of 53 patients with elbow conditions who underwent surgery between December 2020 and December 2023 was performed. All patients received an X-ray of the elbow and electromyography (ENMG). The following scores were recorded: NRS, MEPS, and McGowan, both preoperatively and at the 1-year follow-up.</p><p><strong>Results: </strong> The NRS score decreased from 7.9 ± 0.8 (range: 6-9) to 2.8 ± 1.3 (range: 0-7) at the 1-year follow-up. MEPS improved from 70.7 ± 15.9 (range: 20-100) to 96.5 ± 7.2 (range: 70-100), indicating reduced pain and improved elbow function. The McGowan scale showed improvements in 49 out of 53 cases. All patients, except one, were satisfied with the surgery, and no recurrence of ulnar nerve-related pain was observed.</p><p><strong>Conclusion: </strong> Preliminary results suggest that covering the ulnar nerve with an adipofascial flap following neurolysis and/or anterior transposition is an effective method for managing ulnar nerve entrapment. It appears to help prevent post-surgical complications and adhesions, which are the main causes of the high recurrence rates reported in the literature.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":"77-84"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical fixation reduces scapular dyskinesis and mal-union rates in midshaft clavicle fractures: a retrospective comparative analysis.","authors":"L M Oldrini, D Previtali, S Tamborini, G Filardo, C Candrian","doi":"10.1007/s12306-025-00942-5","DOIUrl":"https://doi.org/10.1007/s12306-025-00942-5","url":null,"abstract":"<p><strong>Backgrounds: </strong>Clavicle fractures are a common injury, with lesions of the middle third accounting for 80% of all clavicle fractures. The most suitable approach to address these fractures remains debated, especially at long term. The aim of this study was to compare surgical and conservative treatments of displaced midshaft clavicle fractures at long-term follow-up.</p><p><strong>Materials and methods: </strong>A total of 123 patients (≥18 years) with a displaced midshaft clavicle fracture, treated surgically with plate fixation (68 patients) or conservatively (55 patients) and evaluated at a mean follow-up 6.7±2.6 years, were included in this study. Shoulder function was evaluated with the Constant-Murley score (CMS) and disabilities of the arm, shoulder, and hand (DASH) score. Aesthetic satisfaction, scapular dyskinesia, radiological outcomes, and overall patient satisfaction were documented as well. A sub-analysis was performed to evaluate the influence of the radiological outcome on the functional outcome.</p><p><strong>Results: </strong>The mean CMS was 94.1±10.6 points in the surgical group and 88.5±16.8 points in the conservative group (p=0.03). The DASH score was 5.1±11.3 in the surgical, 6.7±13.1 in the conservative group (n.s). The incidence of scapular dyskinesis was significantly lower (p<0.001) in the surgical group. Radiological follow-up documented a lower rate of non-unions (p<0.001) and mal-unions (p<0.001) in the surgical group. Regarding patient satisfaction, there was no difference in terms of aesthetic satisfaction, while the overall satisfaction favored the surgical treatment (p=0.02). Patient with a non-union or a mal-union showed a worse outcome regarding CMS, overall and aesthetic satisfaction, and incidence of scapular dyskinesis.</p><p><strong>Conclusions: </strong>These findings support surgical fixation in patients at risk of malalignment or with high activity demands, as it significantly improves long-term function, biomechanics, and patient satisfaction compared to non-operative management.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durability of posterior column fixation through the anterior-only approach: a prospective study for assessment of reduction loss.","authors":"Mahmoud Fahmy, Mostafa Ahmed Shawky","doi":"10.1007/s12306-025-00943-4","DOIUrl":"https://doi.org/10.1007/s12306-025-00943-4","url":null,"abstract":"<p><strong>Purpose: </strong>Durability of anterior-only fixation for posterior column acetabular fractures remains debated, particularly regarding potential loss of reduction over time. This study prospectively evaluated radiographic stability and functional outcomes following fixation performed exclusively through the anterior approach.</p><p><strong>Methods: </strong>Between 2019 and 2023, forty-five consecutive patients with displaced acetabular fractures requiring posterior column fixation were enrolled. All underwent reduction and fixation via the anterior approach in the supine position. Patients with old fractures (> 3 weeks), pathological fractures, or prior hip surgery were excluded. Standardized radiological assessments measured posterior column height and displacement immediately postoperatively and at 12-month follow-up (mean 15.6 ± 1.2 months). Reduction loss was defined as ≥ 2 mm displacement. Functional recovery was evaluated using the Harris Hip Score (HHS). Complications were prospectively recorded.</p><p><strong>Results: </strong>Mean age was 49.3 years. Radiological assessment showed minimal change between immediate postoperative and final follow-up: mean posterior column height increased 0.4 mm and posterior displacement 0.7 mm. No patient demonstrated displacement ≥ 2 mm. Functional outcomes were excellent, with mean HHS of 92.7 ± 6.4. Subgroup analysis revealed slightly lower scores in cases requiring posterior column fixation with infrapectineal buttressing (mean HHS 89.4 ± 5.1 vs. 94.1 ± 4.2, p < 0.05). One deep infection occurred (2.2% complication rate), managed successfully with debridement. No reoperation for fixation failure or nonunion was required.</p><p><strong>Conclusion: </strong>Anterior-only fixation of posterior column acetabular fractures provided durable radiographic stability and excellent short-term functional outcomes at one year, with a low complication rate. While exclusion of irreducible fragments limits generalizability, these findings support the anterior intrapelvic approach as a reliable option in appropriately selected patients. Longer-term follow-up and comparative studies are warranted to determine its role relative to combined or posterior approaches.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neglected pelvic ring injuries: prospective evaluation of radiological, functional, and predictive factors for optimal reconstruction.","authors":"Mahmoud Fahmy, Mohamed Abo-Elsoud, Mostafa Ahmed Shawky","doi":"10.1007/s12306-025-00944-3","DOIUrl":"https://doi.org/10.1007/s12306-025-00944-3","url":null,"abstract":"<p><strong>Purpose: </strong>Neglected pelvic ring injuries are rare but pose significant reconstructive challenges due to chronic deformity, soft-tissue contracture, and pelvic instability. Evidence on prognostic factors and optimal fixation strategies is limited. This prospective study evaluates radiological and functional outcomes after delayed reconstruction, identifies predictors of reduction quality and complications, and compares minimally invasive INFIX versus open anterior plating.</p><p><strong>Methods: </strong>Twenty patients presenting ≥ 6 weeks post-injury with pelvic malunion or nonunion underwent individualized staged reconstruction between 2019 and 2022. Posterior stabilization was performed first, followed by anterior fixation using either open plating or INFIX. Radiological alignment was graded by Matta's criteria, and functional recovery was assessed with the Majeed Pelvic Score. Correlation and multivariable analyses identified independent predictors of outcomes.</p><p><strong>Results: </strong>At a mean follow-up of 13.2 months, bone union was achieved in 95% of cases, and anatomical or satisfactory reduction in 90%. Mean Majeed scores improved from 48.7 ± 12.4 to 82.5 ± 9.7 (p < 0.001). Multivariable analysis identified surgical delay > 12 weeks and type C morphology as independent predictors of suboptimal reduction, while minimally invasive INFIX fixation reduced wound complications, providing an evidence-based framework for decision-making. Overall complications occurred in 20% of cases, and the predictive model showed good discriminative power (AUC = 0.81).</p><p><strong>Conclusion: </strong>Delayed reconstruction of neglected pelvic fractures can achieve high union rates and meaningful functional recovery when guided by meticulous planning, staged fixation, and anatomical reduction. Reduction quality and surgical timing are key determinants of outcome, and INFIX constructs reduce wound complications. Neglected pelvic fractures are uncommon, representing fewer than 5% of all pelvic injuries; despite the small cohort, this study is among the largest prospective series reported, offering novel predictive data to inform timing, technique, and functional expectations in delayed reconstruction.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailor's bunion (bunionette): current concepts and outcomes of open versus minimally invasive surgery.","authors":"G Colò, F Fusini, D Marcolli, A Testa, M Leigheb, M F Surace","doi":"10.1007/s12306-025-00941-6","DOIUrl":"https://doi.org/10.1007/s12306-025-00941-6","url":null,"abstract":"<p><strong>Background: </strong>Bunionette deformity (BD), also referred to as Tailor's bunion, is characterized by a lateral prominence of the fifth metatarsal head, frequently associated with pain, inflammation, and shoe-related discomfort. This narrative review synthesizes current knowledge on the pathogenesis and clinical presentation of BD, while placing particular emphasis on recent developments in minimally invasive surgery (MIS) techniques compared with traditional open approaches.</p><p><strong>Methods: </strong>A narrative review of the literature was conducted using PubMed, Scopus, and Embase databases up to July 2025, focusing on the etiology, clinical presentation, and treatment strategies for BD. Both conservative and surgical approaches, including open and MIS techniques, were critically analyzed.</p><p><strong>Results: </strong>Conservative management, including footwear modification and orthoses, is recommended as first-line treatment. However, no long-term studies have demonstrated sustained symptom relief with non-operative modalities. Surgical options include exostectomy and a range of metatarsal osteotomies (distal, diaphyseal, and proximal), performed via open or MIS techniques. Complication rates in open surgery are reported as highest in proximal (22%) and diaphyseal (21%) osteotomies, followed by distal osteotomies (11%). Revision surgery is more frequent in diaphyseal osteotomies (n = 5; 2%). MIS techniques demonstrate complication rates ranging from 0% to 21.4%, with nonunion rates between 0% and 5.6%. MIS appears to reduce wound-related and hardware complications compared to open techniques; however, direct comparative studies are lacking.</p><p><strong>Conclusion: </strong>While MIS techniques demonstrate favorable complication and recovery profiles in retrospective studies, the lack of high-quality prospective trials prevents definitive conclusions. Future research should prioritize randomized comparative designs to establish clear treatment guidelines.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analytic evaluation of complications and longevity of bone-anchored prostheses in lower extremity amputees: does design matter?","authors":"Hugh Milchem, Yasmine J Khair, Maamoun Adra, Shayndhan S Sivanathan, Shreehari Suresh, Dilip K Vankayalapati, Aslam Mohamed Haroon, Christian A Than, Nadim Tarazi, Hayato Nakanishi, Peter J Smitham","doi":"10.1007/s12306-026-00946-9","DOIUrl":"https://doi.org/10.1007/s12306-026-00946-9","url":null,"abstract":"<p><p>Bone-anchored prostheses (BAPs) are an alternative option for lower-limb amputees with problematic suspended socket prostheses (SSPs). We sought to meta-analytically quantify complication burden and revision-free survival for BAPs, whilst investigating possible differences in complication rates between common screw-fit (OPRA) and press-fit (ILP/OPL) designs. A multi-database search of PubMed, EMBASE, CiNAHL, Cochrane Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus and Web of Science from inception to September 2025 was conducted. Proportions were pooled using a random-effects model. This review was registered in PROPSPERO (ID: CRD42024507070). A total of 22 studies reporting 979 patients were included. An overall complication rate of 65% (95% CI: 0.53-0.75, I² = 69%) was found. The most common complication was breakage of the abutment or dual-cone adaptor (DCA) (0.38, 95% CI: 0.19-0.62, I² = 97%), which constituted 94% of all mechanical failures (95% CI: 0.87-0.98, I² = 51%). Second was infection (0.36, 95% CI: 0.25-0.50, I² = 92%) with 72% of infections being grade I (95% CI: 0.57-0.83, I² = 72%). Estimated revision-free survival was 89% (95% CI: 0.84-0.93, I² = 0%) at five years and 77% (95% CI: 0.70-0.82, I² = 0%) at ten years. The largest difference between implant designs was for overall proportion of mechanical failure, OPRA at 68% (95% CI: 0.34-0.90, I² = 98%), ILP/OPL at 19% (0.09-0.36, I² = 85%). BAPs do carry appreciable risks for superficial infection and mechanical (abutment/DCA) breakage, with screw-fit designs appearing to have a higher mechanical failure rate. However, the revision-free survival rate overall remains acceptable up to 10 years demonstrating the viability of BAPs in lower-limb amputees.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of blood flow restriction (BFR) rehabilitation treatment in patients undergoing primary total and partial knee arthroplasty: a single-center case-control study.","authors":"Simone Giusti, Biagio Zampogna, Vittorio Alfonsi, Simona Cerulli, Rocco Papalia, Ezio Adriani","doi":"10.1007/s12306-025-00940-7","DOIUrl":"https://doi.org/10.1007/s12306-025-00940-7","url":null,"abstract":"<p><strong>Background: </strong>Blood flow restriction (BFR) therapy has emerged as a promising rehabilitation modality to enhance post-operative recovery following knee arthroplasty. This study evaluates the efficacy of BFR rehabilitation in patients undergoing primary total and partial knee arthroplasty compared to standard physiotherapy protocols.</p><p><strong>Methods: </strong>A single-center, case-control study was conducted on patients undergoing knee arthroplasty. Participants were divided into two groups: one receiving conventional physiotherapy and the other incorporating BFR rehabilitation. Outcome measures included postoperative range of motion (ROM), quadriceps strength, functional mobility (assessed via the Timed Up and Go test), and patientreported pain and satisfaction scores.</p><p><strong>Results: </strong>Patients in the BFR group demonstrated significantly greater improvements in quadriceps strength (p 0.05) and functional mobility compared to the control group. ROM and pain scores also showed favorable trends in the BFR group, indicating enhanced postoperative recovery. No significant adverse effects were reported.</p><p><strong>Conclusions: </strong>BFR rehabilitation appears to be an effective adjunct to conventional physiotherapy in enhancing functional recovery after knee arthroplasty. Further large-scale studies are warranted to validate these findings and optimize rehabilitation protocols.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee arthroplasty for spontaneous osteonecrosis of the knee: a matched analysis comparing total and unicompartmental.","authors":"Mohammad Daher, Jean Tarchichi, Joseph E Nassar, Jonathan Liu, Alan H Daniels, Mouhanad M El-Othmani","doi":"10.1007/s12306-026-00947-8","DOIUrl":"https://doi.org/10.1007/s12306-026-00947-8","url":null,"abstract":"<p><p>The surgical management of spontaneous osteonecrosis of the knee (SONK) in its advanced stages typically involves joint replacement procedures such as unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This study aims to compare the risk of complications, revisions, and costs between patients undergoing TKA and UKA for SONK. This study is a retrospective review of the PearlDiver Mariner Database. The patients with a diagnosis of SONK undergoing surgical management were divided into 2 groups: patients with TKA, and patients with UKA. The two groups were matched based on age, gender, the Charlson comorbidity index (CCI), and obesity. There was a higher rate of transfusions at 30 days (< 10 vs. 0%, p = 0.04) and 90 days (< 10 vs. 0%, p = 0.02) in the TKA group. In addition, there was a higher rate of stiffness and manipulation under anesthesia (MUA) in the TKA group at 1 year (3.2% vs. < 10, p = 0.01; and 4.1% vs. < 10, p < .001 respectively), 2 years (3.6% vs. < 10, p = 0.01; and 4.5% vs. < 10, p < .001 respectively), and 3 years (3.8% vs. < 10, p = 0.003; and 4.7% vs. < 10, p < .001 respectively). Furthermore, the TKA group had higher costs at 3 years compared to the UKA group (35,269 ± 61,459 vs. 25,141 ± 25,185, p = 0.001). This study highlights the increased risks of transfusion, stiffness, MUA, and higher costs after TKA compared to patients with UKA for SONK. Our study shows that UKA seems to be a safer and less expensive option for patients with SONK.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy in predicting 135° neck-shaft angle short-stem and glenoid components size in reverse shoulder arthroplasty with 3D preoperative planning.","authors":"Alessandro Donà, Rocco Bonfatti, Gian Mario Micheloni, Andrea Giorgini, Davide Basile, Anna Pirozzi, Giuseppe Porcellini","doi":"10.1007/s12306-025-00938-1","DOIUrl":"https://doi.org/10.1007/s12306-025-00938-1","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (RSA) is a widely used procedure for glenohumeral joint degeneration. Despite advancements in 3D preoperative planning, the concordance between planned and intraoperatively implanted components remains unclear. This study evaluates the accuracy of 3D preoperative planning in predicting humeral and glenoid components size in RSA with a 135° neck-shaft angle (NSA) short-stem.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on 84 RSA cases performed between October 2023 and September 2024 at a specialized shoulder surgery center. All cases underwent standardized preoperative imaging, including anteroposterior and axillary radiographs and a 3D CT scan-based planning protocol using BluePrint software. The planned and intraoperatively implanted humeral stems, glenoid baseplates, and glenospheres were compared. Statistical analyses were performed to assess concordance in term of size and identify factors influencing deviations from the preoperative plan.</p><p><strong>Results: </strong>The preoperative plan was fully respected in 23.1% of cases for both the humeral and glenoid components. The humeral stem size matched the preoperative plan in 28.6% of cases, with a deviation within one adjacent size in 67.9%. The glenoid baseplate size was concordant in 92.6%, while the glenosphere size matched in 60.7%. Kappa values indicated slight agreement for stem size (κ = 0.12) and moderate agreement for glenosphere size (κ = 0.54). A statistically significant correlation was observed between changes in humeral stem and glenosphere size (p < 0.05). No significant correlation was found with patient age, while sex significantly influenced stem and glenosphere size variation (p < 0.05).</p><p><strong>Conclusion: </strong>3D preoperative planning demonstrated moderate to high accuracy for glenoid component selection but lower concordance for humeral stem size. Intraoperative adjustments were mainly related to metaphyseal bone quality and soft tissue tension. Future improvements in planning software should incorporate bone mineral density and humeral osteotomy variability to enhance predictive accuracy.</p>","PeriodicalId":18875,"journal":{"name":"MUSCULOSKELETAL SURGERY","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}