Clinics in Shoulder and Elbow最新文献

{"title":"Comparison of ultrasound-guided dry needling and platelet-rich plasma injection in the management of refractory lateral epicondyle tendinopathy.","authors":"Mustafa Mert Terzi, Yusuf Kıratlıoğlu, Uğur Bezirgan, Mehmet Armangil","doi":"10.5397/cise.2025.01389","DOIUrl":"https://doi.org/10.5397/cise.2025.01389","url":null,"abstract":"<p><strong>Background: </strong>This prospective randomized study aimed to compare the clinical effectiveness of ultrasound-guided dry needling and platelet-rich plasma injections in patients with refractory lateral epicondyle tendinopathy.</p><p><strong>Methods: </strong>Fifty patients (25 in each group) diagnosed with refractory lateral epicondyle tendinopathy were randomized to receive either ultrasound-guided dry needling or platelet-rich plasma injection. Patients were evaluated before treatment and at 1, 3, and 6 months after the intervention using the visual analog scale, the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, the Patient-Rated Tennis Elbow Evaluation, and grip strength measurements. All procedures were performed under continuous ultrasound guidance.</p><p><strong>Results: </strong>Both groups showed significant improvements in pain, function, and grip strength over time. There were no significant differences in grip strength between the groups at any time point. However, patients treated with platelet-rich plasma showed superior outcomes in pain and functional scores, particularly at the 6-month follow-up. No complications were observed in any of the patients.</p><p><strong>Conclusions: </strong>Both ultrasound-guided dry needling and platelet-rich plasma injections are effective options for refractory lateral epicondyle tendinopathy. Platelet-rich plasma may offer greater clinical benefit, particularly in pain reduction and functional improvement. Further research with larger cohorts is required to establish optimal treatment protocols.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782896","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":"Potential of early American Shoulder and Elbow Surgeons score changes to predict postoperative outcomes after total shoulder arthroplasty.","authors":"Thomas Stanila, Samuel E Mircoff, Dane H Salazar, Nickolas G Garbis","doi":"10.5397/cise.2025.01270","DOIUrl":"https://doi.org/10.5397/cise.2025.01270","url":null,"abstract":"<p><strong>Background: </strong>The American Shoulder and Elbow Surgeons (ASES) score is a patient-reported outcome measure for shoulder functionality that can be collected at baseline and postoperative time points. In total shoulder arthroplasty (TSA), its temporal relationship with other recovery metrics is unknown. This study evaluates the potential of early ASES changes after TSA to predict other outcomes, particularly active forward flexion (AFF), active external rotation (AER), and VAS pain scores at final follow-up.</p><p><strong>Methods: </strong>A retrospective chart review identified patients who underwent primary TSA between 2018 and 2023. Demographics, postoperative ASES scores, visual analog scale (VAS) pain scores, AFF, AER, and complication rates (revision, readmission, and mortality rates) were recorded. Percentage changes from baseline were calculated for each outcome. Linear regression analyses controlling for age, sex, race, body mass index, and Charlson Comorbidity Index scores were used to assess associations between ASES changes at 6 weeks, 3 months, 6 months, and 1 year and subsequent outcomes.</p><p><strong>Results: </strong>In total, 394 TSA patients were investigated, with a mean follow-up of 2.9 years. Percent changes in ASES scores at 3 months (P=0.023), 6 months (P=0.001) and 1 year (P=0.006) were significantly associated with AFF improvement at 1 year. ASES changes were also associated with VAS pain scores, with 6-week ASES changes correlating with 3-month VAS improvement (P=0.039). A 1% ASES increase at each interval predicted continued 1% gains postoperatively. No significant associations were observed for AER within 2 years postoperatively or any complication rate within 1 year postoperatively.</p><p><strong>Conclusions: </strong>Early improvements in the ASES score can predict later postoperative outcomes after TSA, supporting its use as an indicator of recovery trajectory. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782906","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":"Reimbursement, efficiency, and safety in rotator cuff repair: a comparative study of arthroscopic and open approaches.","authors":"Alexander R Zhu, Eric Mao, Grace Q Chen, Ashley R Zhu, Umasuthan Srikumaran","doi":"10.5397/cise.2025.01277","DOIUrl":"https://doi.org/10.5397/cise.2025.01277","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff repair (RCR) is one of the most common orthopedic procedures in the United States. Although arthroscopic and open RCR yield similar long-term outcomes, differences in reimbursement and short-term safety are less understood. This study aimed to evaluate differences between RCR techniques in work relative value units (wRVUs), operative times, Medicare reimbursement amounts, and 30-day complication rates.</p><p><strong>Methods: </strong>To data collection, the National Surgical Quality Improvement Program database was retrospectively analyzed (2006-2023). Patients undergoing arthroscopic or open RCR were identified by Current Procedural Terminology codes and matched 1:1 via propensity score matching according to demographics and comorbidities. Outcomes included operative time, wRVUs, Medicare reimbursement amount, and 30-day postoperative complications.</p><p><strong>Results: </strong>A total of 18,988 matched patients (9,494 with arthroscopic RCR, 9,494 with open RCR) were included. Arthroscopic RCR cases had significantly longer operative times than open RCR cases (91.82±43.71 minutes vs. 80.93±41.02 minutes, P<0.001) but generated 17.7% higher wRVUs per minute (0.20±0.09 vs. 0.17±0.07, P<0.001) and 36.0% more revenue per case ($485.20±$0.00 vs. $356.77±$7.54, P<0.001). Arthroscopic RCR patients had significantly lower overall 30-day complication rates (1.1% vs. 1.5%, P=0.010), including fewer superficial (0.2% vs. 0.4%, P=0.023) and deep surgical site infections (0.0% vs. 0.2%, P=0.004).</p><p><strong>Conclusions: </strong>Arthroscopic RCR is associated with lower short-term complication rates than open RCR, despite requiring longer operative times and more resources. This clinical trade-off suggests that the additional operative demands of arthroscopic surgery are justified by the associated improvements in patient safety, highlighting the value of reduced complications as a key advantage of the arthroscopic approach.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677094","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":"Re-revision rate after anatomic-to-anatomic revision of total shoulder arthroplasty: a descriptive study of the Dutch national registry.","authors":"M Azad Naryapraği, Dries Boulidam, Anneke Spekenbrink-Spooren, Geert A Buijze, Oscar Dorrestijn, Michel P J van den Bekerom, Arno A Macken","doi":"10.5397/cise.2025.01312","DOIUrl":"https://doi.org/10.5397/cise.2025.01312","url":null,"abstract":"<p><strong>Background: </strong>Anatomical total shoulder arthroplasty (aTSA) is typically reserved for end-stage glenohumeral arthritis with an intact rotator cuff and adequate glenoid bone stock. With the exponential increase in total shoulder arthroplasty surgeries, complications and the need for re-revision surgery have also increased. Typically, aTSA is revised to a reversed prosthesis, but in some cases the anatomic configuration is maintained. Revision surgery is associated with a higher risk of complications and re-revisions than primary surgery. However, the literature on re-revision surgery after aTSA is sparse.</p><p><strong>Methods: </strong>An observational cohort study was conducted using data from the Dutch National Registry. We report re-revision rates and reasons and analyze the implant survival of revised aTSA (anatomic-to-anatomic revision). Due to the small sample size, this study is strictly descriptive and is not suitable for identifying risk factors or predicting survival.</p><p><strong>Results: </strong>Overall, 5,547 primary aTSAs were registered between 2014 and 2023, and the 58 patients who underwent revision surgery with the implant remaining in an anatomic configuration were included in this study. Re-revision surgery was performed in 10 patients (17%). The most common indications for re-revision surgery were glenoid component loosening (n=4) and rotator cuff rupture (n=4). Implant survival at 3 years after the first revision was 80%. All re-revisions occurred within 3 years after revision surgery.</p><p><strong>Conclusions: </strong>We report a 3-year implant survival of 80% after an anatomic-to-anatomic revision of aTSA. Failure causes and the number of re-revision surgeries in aTSA indicate a high risk of early failure and provide a warning for surgeons considering the retention of an anatomic configuration.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677154","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":"Statcast-based evaluation of postoperative performance in Major League Baseball position players following ulnar collateral ligament surgery: a retrospective case-control study.","authors":"Benjamin W King, Evan P Bailey, Jesse Seilern Und Aspang, Kyle Hammond, Richard M Danilkowicz","doi":"10.5397/cise.2025.01361","DOIUrl":"https://doi.org/10.5397/cise.2025.01361","url":null,"abstract":"<p><strong>Background: </strong>This study used Statcast-derived metrics to evaluate return to play (RTP) and performance outcomes in Major League Baseball (MLB) position players following ulnar collateral ligament (UCL) surgery.</p><p><strong>Methods: </strong>MLB position players undergoing UCL surgery between 2017 and 2024 were identified using the Tommy John List. A 1:1 age-matched control group of uninjured MLB position players was used for performance comparisons. Performance data from the two seasons before surgery and the two seasons following RTP were collected. The data included usage, offensive performance, batted ball metrics, and defensive performance.</p><p><strong>Results: </strong>Twenty-five MLB position players were confirmed to have undergone UCL surgery (UCL reconstruction=18; UCL repair=7). Twenty-one players (84%) returned to MLB competition with a mean time to RTP of 9.4±3.8 months. Players who underwent UCL repair returned significantly faster than those who underwent reconstruction (7.3±1.6 vs. 10.4±4.2 months, P=0.049). No statistically significant differences were observed between pre- and post-surgery performance across any metric for the full cohort. However, catchers demonstrated statistically significant improvements in average exit velocity and hard-hit percentage compared to both preoperative performance (exit velocity: P=0.04; hard-hit percentage: P=0.03) and matched controls (exit velocity: P=0.05; hard-hit percentage: P=0.04).</p><p><strong>Conclusions: </strong>MLB position players return to competition at a high rate following UCL surgery. Among those who return, Statcast-derived offensive and defensive metrics demonstrate that postoperative changes in performance are minimal and statistically insignificant. Interestingly, catchers demonstrated paradoxical improvements in both postoperative average exit velocity and hard-hit percentage. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469565","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":"Impact of routine upright clavicle radiographs on clavicle fracture management.","authors":"Joshua Ungar, Andrew Burcke, Saksham Pruthi, Sahand Fallahi, Beau Chandler, Andrew Schlager, Thomas Revak","doi":"10.5397/cise.2025.01109","DOIUrl":"10.5397/cise.2025.01109","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine whether increased vertical displacement on upright clavicle radiographs (UCR) compared with supine clavicle radiographs (SCR) influenced the decision to operate.</p><p><strong>Methods: </strong>Adult patients with clavicle fractures identified on initial SCR or computed tomography scans during primary evaluation at a level 1 trauma center from July 2021 to November 2023 were included. The patients also underwent UCR. Exclusion criteria were patients with chronic or pathologic fractures, inadequate imaging, or incomplete documentation. Increases in vertical displacement from SCR to UCR were measured, and we recorded how often these increases on UCR prompted surgical management.</p><p><strong>Results: </strong>Overall, 160 patients (average age 47.0 years; 70% male) met the inclusion criteria. Most of the study population was managed nonoperatively (90%), with only 16 patients (10%) managed surgically. Only two of the 160 patients (1.3%) underwent surgical intervention based primarily on increased vertical displacement on UCR. With an average change of 4.5 mm (95% CI, 3.5-6.6 mm) between SCR and UCR for patients managed nonoperatively, and 5.1 mm (95% CI, 2.7-7.5 mm) for those managed operatively. There was no significant difference in management based on UCR (P=0.71). Subgroup analysis, stratifying patients by either ≥1 cm or <1 cm of displacement, found there was still no statistically significant change in SCR and UCR (P=0.44).</p><p><strong>Conclusions: </strong>Inpatient UCR rarely alters the management of clavicle fractures at our institution, indicating that its use is best reserved for case-by-case consideration. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"52-59"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior versus anteroinferior plating for displaced midshaft clavicle fractures: a systematic review and meta-analysis of union, function, and complications.","authors":"Justin Le, Faisal Al Taie, Tien Lam, Benjamin Hershfeld, Adam D Bitterman, Randy M Cohn","doi":"10.5397/cise.2025.01179","DOIUrl":"10.5397/cise.2025.01179","url":null,"abstract":"<p><strong>Background: </strong>Fixation of clavicular shaft fractures carries risks of nonunion, infection, and functional loss. Although superior and anteroinferior plating have widely been studied, the optimal approach remains debated. Previous literature has relied on indirect comparisons and been limited by early study cutoffs, high heterogeneity, and omission of key outcomes. This meta-analysis directly compared union, function, and complications between superior and anteroinferior plating.</p><p><strong>Methods: </strong>This review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Eligible studies included randomized trials or prospective/retrospective cohort studies of adults. Outcomes of interest included the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; and complications (plate removal, infection, nonunion). Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions or Cochrane Risk of Bias 2.0 tool, and certainty of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Analyses were performed in Review Manager 5.4 (Cochrane).</p><p><strong>Results: </strong>Twelve studies (n=980) were included. Constant-Murley scores did not differ significantly (mean difference [MD]=-1.19; 95% CI, -3.18 to 0.81; P=0.24). Beginning at 2 years, DASH scores showed no difference (MD=1.62; 95% CI, -0.46 to 3.70; P=0.13). Times-tounion (MD=0.41; 95% CI, -0.60 to 1.43; P=0.42) and rates of nonunion (odds ratio [OR]=2.42; 95% CI, 0.59-9.94; P=0.22) were comparable. Plate removal (OR=1.16; 95% CI, 0.82-1.65; P=0.41) and infection (OR=0.81; 95% CI, 0.32-2.06; P=0.66) also showed no significant differences. Heterogeneity was minimal (I2=0).</p><p><strong>Conclusions: </strong>Superior and anteroinferior plating of midshaft clavicle fractures provide comparable union rates, functional outcomes, and complication rates. Selection of the surgical approach should depend on fracture morphology, surgeon preference, and patient-specific factors. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 1","pages":"60-72"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence of cardiac implantable electronic devices is associated with increased risk of perioperative complications following shoulder arthroplasty.","authors":"Tarishi Parmar, Akin A Adio, Peter Boufadel, Favian Su, Mohammad Daher, Joseph A Abboud","doi":"10.5397/cise.2025.01333","DOIUrl":"10.5397/cise.2025.01333","url":null,"abstract":"<p><strong>Background: </strong>Patients with cardiac implantable electronic devices (CIEDs) increasingly present for elective orthopedic procedures. In this study we evaluate peri-operative complications associated with CIED presence using a large multicenter database.</p><p><strong>Methods: </strong>Retrospective cohort analysis was performed using the TriNetX database. Adults undergoing primary total shoulder arthroplasty (TSA) between 2005 and 2025 were identified and stratified by CIED status. Four propensity score-matched (1:1) analyses were conducted: all TSA patients with versus without CIEDs, (2) patients with cardiac disease with CIED versus without CIEDs, and patients with recent device implantation (<6 months before TSA) versus patients with remote device implantation (>6 months before TSA). Matching balanced demographic factors and comorbidities. Outcomes included 90-day and 2-year complications. Relative risks, 95% CIs, and P-values were calculated using chi-square and t-tests; significance was set at P<0.05.</p><p><strong>Results: </strong>After matching, 6,931 patients were included per cohort. CIED presence was associated with significantly higher 90-day rates of cardiac, renal, infectious, and neurologic complications, as well as increased mortality, readmissions, and emergency department visits. These associations persisted after controlling for underlying cardiac disease. Patients undergoing TSA within 6 months of device implantation experienced higher rates of complications. Revision rates were not significantly different between groups, and mechanical outcome associations were variable.</p><p><strong>Conclusions: </strong>CIED presence was associated with increased systemic complications following TSA, particularly when surgery occurred within 6 months of device implantation. Mechanical outcome differences were less consistent. These findings indicate the necessity of multidisciplinary perioperative planning, thoughtful surgical timing, and prospective studies to better define underlying risk pathways. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 1","pages":"96-104"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parsonage-Turner syndrome: current perspectives on etiology, diagnosis, and management.","authors":"Mohamad Y Fares, Akshay Khanna, Ryan Stadler, Jack Mao, Peter Boufadel, Evangeline F Kobayashi, Joseph A Abboud","doi":"10.5397/cise.2025.00885","DOIUrl":"10.5397/cise.2025.00885","url":null,"abstract":"<p><p>Parsonage-Turner syndrome (PTS) is an underdiagnosed condition that presents with debilitating symptoms in affected patients, with reported incidence rates varying between 1.64 and 3 per 100,000 individuals. Clinical presentation often includes acute shoulder pain associated with neurological deficits that do not follow a regular diagnostic pattern. The cause of this disease is not fully understood, but it is generally triggered by an upper respiratory infection a few weeks prior to presentation. Other associated risk factors include genetic predisposition, vaccines, and surgical intervention. Diagnosis often relies on clinical investigation, holistic physical exam, and appropriate diagnostic studies. Treatment is often conservative, in the form of physical rehabilitation and pain management to avoid muscular atrophy. The condition generally resolves over time, with a recovery rate of 65% at 10 months and a favorable prognosis for most cases. However, recurrences are noted, especially in patients with a genetic predisposition to the condition (75% in the hereditary form vs. 26% in the general form). Future research should explore the pathophysiological processes behind this disease to extrapolate strategies that can achieve an earlier diagnosis and more effective treatment.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 1","pages":"161-169"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant subscapularis tendon repair in reverse total shoulder arthroplasty and assessment of superior migration of reattachment: a cadaveric biomechanical study.","authors":"Yong Bok Park, Su Cheol Kim, Michelle H McGarry, Thay Q Lee, Jae Chul Yoo","doi":"10.5397/cise.2025.00675","DOIUrl":"10.5397/cise.2025.00675","url":null,"abstract":"<p><strong>Background: </strong>Concomitant repair of the subscapularis (SSC) tendon in reverse total shoulder arthroplasty (RTSA) with a lateralized design remains controversial. The present study aimed to evaluate the effect of SSC repair (repair at native insertion, repair at superiorly migrated position, and no repair) on the glenohumeral arc of motion following RTSA in a cadaveric biomechanical setting.</p><p><strong>Methods: </strong>RTSA was performed on eight cadaveric shoulders under six testing conditions as follows: unrepaired SSC/intact teres minor (TM); intact SSC/intact TM; superiorly repaired SSC/intact TM; unrepaired SSC/deficient TM; intact SSC/deficient TM; and superiorly repaired SSC/deficient TM. Increasing load (2.5-N increments) was applied to the middle deltoid (anterior, posterior; 10 N each, middle; 10- 20 N). The resulting abduction and rotation positions were measured.</p><p><strong>Results: </strong>Unrepaired SSC demonstrated greater abduction and reduced internal rotation (IR), whereas SSC repair increased IR, particularly in TM-deficient models. Superiorly repaired SSC had higher glenohumeral abduction and IR than original SSC repair. SSC repair caused excessive IR in the TM deficiency seen with massive rotator cuff tears.</p><p><strong>Conclusions: </strong>Concomitant SSC repair in lateralized RTSA decreased glenohumeral abduction and increased IR. Concomitant SSC repair at the original and superiorly migrated footprints should be carefully considered following lateralized RTSA. Level of evidence: V.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"10-19"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}