Clinics in Shoulder and Elbow最新文献

{"title":"Clinical and radiological comparisons of posterior labral tears with and without posterior glenohumeral instability.","authors":"Ji-Hyun Seo, Sang-Jin Shin","doi":"10.5397/cise.2026.00360","DOIUrl":"https://doi.org/10.5397/cise.2026.00360","url":null,"abstract":"<p><strong>Background: </strong>We compare clinical and radiological characteristics and evaluate surgical outcomes of posterior labral tears based on the presence of glenohumeral instability.</p><p><strong>Methods: </strong>Patients who were unresponsive to conservative treatment and underwent arthroscopic posterior labral repair were reviewed retrospectively. Patients were divided into two groups: those with glenohumeral instability (group 1) and those without (group 2). Demographic, radiological, physical examination, and intraoperative data were collected. Clinical outcomes were assessed at a minimum 2-year follow-up using the visual analog scale for pain, American Shoulder and Elbow Surgeons, and Rowe scores.</p><p><strong>Results: </strong>The study included a total of 85 patients (40 in group 1 and 45 in group 2) with a mean follow-up duration of 31.8±12.2 months. Patients in group 2 were older (31.4±1.0 years old, P<0.001), had longer symptom durations (30.1±5.6 months, P=0.002), and included fewer histories of trauma (16 patients, P=0.009). Competitive sports were more common in group 1 (9 patients, P=0.005), whereas weightlifting exercises were more common in group 2 (24 patients, P=0.047). Magnetic resonance imaging (MRI) underestimated incomplete posterior labral tears more frequently in group 2 than in group 1 (P=0.033). The incidence of arthroscopically detected tears among MRI-occult tears was higher in group 2 (10 patients) than in group 1 (2 patients, P=0.029). Statistically significant improvements in shoulder function were observed postoperatively in both groups.</p><p><strong>Conclusions: </strong>Clinical and magnetic resonance findings of posterior labral tears without glenohumeral instability differ from those with instability. Surgical treatment achieved satisfactory clinical outcomes regardless of the presence of instability. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228948","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":"Preoperative predictors of graft retear following arthroscopic superior capsule reconstruction with long head of biceps tendon autograft: a pilot retrospective case-control study.","authors":"Nam Sy Ho, Thanh Kien Lam, Anh Ha Nam Tang, Nhan Nghi Thanh Le, Dung Huu Tran","doi":"10.5397/cise.2026.00773","DOIUrl":"https://doi.org/10.5397/cise.2026.00773","url":null,"abstract":"<p><strong>Background: </strong>Superior capsule reconstruction (SCR) using the long head of the biceps tendon (LHBT) is a joint-preserving option for large-to-massive rotator cuff tears, but predictors of graft retear remain incompletely characterized. We aimed to identify preoperative clinical and imaging predictors of retear after arthroscopic LHBT-SCR.</p><p><strong>Methods: </strong>A retrospective pilot case-control study was conducted at two tertiary orthopedic centers. Cases had confirmed graft retear (Sugaya type IV-V on postoperative magnetic resonance imaging); controls had an intact graft and were sampled at an approximate 2:1 ratio. Forty patients were included and followed for a median of 24 months (range, 12-26 months). Preoperative variables included age, sex, tear dimensions, Hamada grade, Goutallier grade, and functional scores (Constant-Murley, American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA]). A forced-entry multivariable logistic model with three predictors was fitted; thresholds were derived using the Youden index.</p><p><strong>Results: </strong>Fourteen cases and 26 controls were identified. Preoperative Constant-Murley (median, 23.1 vs. 35.1; P=0.014), ASES (25.8 vs. 35.0; P=0.020), and UCLA (9.0 vs. 11.0; P=0.021) scores were lower in the retear group. Tear morphology did not differ between groups. The multivariable model (ASES, Goutallier grade, forward elevation; complete-case n=38) achieved an apparent area under the curve (AUC) of 0.811 (bootstrap optimism-corrected AUC, 0.754). Despite structural failure, both groups achieved equivalent functional recovery, with all patients exceeding their minimal clinically important differences.</p><p><strong>Conclusions: </strong>Preoperative functional impairment was the primary correlate of graft retear after LHBT-SCR. Prospective validation in a larger case-control study (target n=132) is warranted. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228856","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":"Clinical and radiological outcomes of primary semi-constrained total elbow arthroplasty at 10-year mean follow-up.","authors":"Kyu-Hak Jung, Min Hyeok Choi, Jun Yong Choi, Suk Woong Kang","doi":"10.5397/cise.2026.00325","DOIUrl":"https://doi.org/10.5397/cise.2026.00325","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the long-term clinical and radiological outcomes in patients undergoing semi-constrained total elbow arthroplasty (TEA). Postoperative complications and implant survival rates were also investigated.</p><p><strong>Methods: </strong>Of 68 patients who underwent primary semi-constrained TEA, data from 62 with a minimum follow-up of 5 years were analyzed. The mean follow-up duration was 117.1 months (range, 60-246 months). Forty-one patients had posttraumatic conditions, 11 had rheumatoid arthritis, and 10 had osteoarthritis. Clinical outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and Oxford Elbow Score (OES), whereas radiological outcomes were analyzed using radiolucent lines and bushing wear. Kaplan-Meier survival analysis was used to determine the implant survival rate.</p><p><strong>Results: </strong>At the final follow-up, the MEPS and OES were 88.2 (range, 55-100) and 31.6 (range, 22-42), respectively. Radiolucency of type 3 or 4 was observed on the humeral side in four patients and on the ulnar side in three patients. Grade 1 and 2 bushing wear was present in seven and three patients, respectively. The total complication rate was 25.8% (16/62), and the reoperation rate was 17.7% (11/62). Four patients underwent reoperation for periprosthetic infection after previous open reduction and internal fixation for acute fractures. In addition, three patients underwent hinge system change for hinge dissociation, four sustained periprosthetic fractures, one underwent revision TEA for gross loosening, and one underwent open repair for triceps rupture. Kaplan-Meier survival analysis revealed that the 5-, 10-, and 15-year survival rates of the implants were 100%, 92.8%, and 77.5%, respectively.</p><p><strong>Conclusions: </strong>Clinical and radiological outcomes of primary semi-constrained TEA were reasonably good at a mean 10-year follow-up. Type 3 or 4 radiolucency was observed in seven patients and complete bushing wear in three patients, while the 10-year implant survival rate was 92.8%. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228911","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":"Deep learning assessment of visualization in rotator cuff repair: a secondary analysis of a randomized controlled trial comparing epinephrine irrigation and intravenous tranexamic acid.","authors":"Son Quang Tran, Minh Cong Bui, Thun Itthipanichpong, Danaithep Limskul, Thanathep Tanpowpong, Napatpong Thamrongskulsiri","doi":"10.5397/cise.2026.00395","DOIUrl":"https://doi.org/10.5397/cise.2026.00395","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare intraoperative visualization between diluted epinephrine (EPN) irrigation and preoperative intravenous tranexamic acid (TXA) during the glenohumeral and subacromial phases of rotator cuff repair.</p><p><strong>Methods: </strong>Eighty-two patients with rotator cuff tears were prospectively randomized (1:1) to receive either 0.33 mg/L EPN irrigation without TXA (EPN group) or preoperative intravenous TXA (15 mg/kg) without EPN irrigation (TXA group). Visual clarity was evaluated using a pretrained deep learning model with a 3-point grading scale across three stages: intra-articular assessment, subacromial debridement, and rotator cuff repair. Irrigation pump pressure was recorded at each stage. Hypotensive bradycardic events (HBEs) and postoperative adverse events were monitored.</p><p><strong>Results: </strong>Overall visual clarity was significantly greater in the EPN group than in the TXA group (mean difference [MD], 0.07; 95% CI, 0.03-0.10; P<0.001). Visualization was superior with EPN during subacromial debridement (MD, 0.08; 95% CI, 0.03-0.13; P=0.001) and rotator cuff repair (MD, 0.03; 95% CI, 0.004-0.06; P=0.02). The EPN group required lower pump pressures and fewer increases in pressure. No significant differences in HBEs or adverse events were observed.</p><p><strong>Conclusions: </strong>Diluted EPN irrigation improved intraoperative visualization compared with TXA, particularly during the subacromial phases, without increasing perioperative risk. Deep learning provided objective support for its clinical use. Level of evidence: II.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228933","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":"Outcomes and retear rates after subacromial and glenohumeral injection of a chitosan-based thermosensitive anti-adhesive agent during arthroscopic rotator cuff repair: a propensity score-matched analysis.","authors":"Hyungsuk Kim, Younsung Jung, Hyun Seok Song","doi":"10.5397/cise.2025.01382","DOIUrl":"10.5397/cise.2025.01382","url":null,"abstract":"<p><strong>Background: </strong>A variety of agents are used during rotator cuff repair (RCR) to establish biophysical barriers against adhesion formation, including sodium hyaluronate and poloxamer. The aim of this study was to determine the role played by injection location and analyze the effects on shoulder function after cuff repair.</p><p><strong>Methods: </strong>We retrospectively reviewed data from 187 consecutive patients with rotator cuff tears who were treated with a thermosensitive medical chitosan-based anti-adhesive agent. The 45 patients in the glenohumeral joint (GH) group were matched 1:1 with patients in the subacromial space (SA) group based on propensity scores. Clinical outcomes and range of motion (ROM) were evaluated using a visual analog scale (VAS) score for pain and functional assessments conducted preoperatively, 6 months postoperatively, and at the final follow-up (minimum 12 months).</p><p><strong>Results: </strong>After excluding patients without 1 year of postoperative follow-up, 28 patients in each group were chosen for this study. The preoperative VAS score for pain, functional scores, and ROM did not differ significantly between the groups. At the final visit, the VAS score for pain was statistically significantly lower in the SA group (1.04±0.69 for GH group vs. 0.78±1.21 for SA group, P=0.038), but the difference did not meet the criteria for the minimal clinically important difference (MCID). Furthermore, none of the functional scores or ROMs differed significantly between the groups at the final visit. There were two retears in the GH group (7.1%) and three retears in the SA group (10.7%).</p><p><strong>Conclusions: </strong>Neither ROM nor the retear rate differed between glenohumeral and subacromial injection of a thermosensitive medical chitosan-based anti-adhesive agent after RCR. Although the SA group had a slightly lower VAS score for pain at the last follow-up, the difference did not reach the MCID criteria. Overall, the injection site did not appear to alter postoperative ROM recovery. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"316-326"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934124","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":"Bioinductive collagen scaffolds for partial- and full-thickness rotator cuff repair: a systematic review.","authors":"Vaishnav Raghavan Satheesh Kumar, Vinayak Venugopal, Devdatta Neogi, Joyanti Ghosh","doi":"10.5397/cise.2025.01326","DOIUrl":"10.5397/cise.2025.01326","url":null,"abstract":"<p><strong>Background: </strong>Partial-thickness rotator cuff tears (PTRCTs) are a common and challenging cause of shoulder pain and dysfunction. Bioinductive collagen scaffolds (BCS) have emerged as a biologic adjunct intended to mimic the extracellular matrix and promote tendon regeneration. The aim of this systematic review was to evaluate the reported clinical outcomes, imaging-based structural findings, safety, and follow-up outcomes of BCS in adults treated for partial-thickness and selected full-thickness rotator cuff tears.</p><p><strong>Methods: </strong>A systematic search of Medline, ScienceDirect, and Google Scholar was performed for English-language studies published up to March 2024. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in PROSPERO. Eligible studies included adults with PTRCTs or selected full-thickness tears treated with BCS, either as an isolated intervention or as augmentation during repair. Extracted outcomes included patient-reported outcomes, imaging-based tendon healing, adverse events, and follow-up duration. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklist.</p><p><strong>Results: </strong>Of 161 records identified, four studies involving 315 participants met the inclusion criteria: one retrospective case series, one prospective single-arm study, one prospective follow-up study, and one prospective multicenter registry study. Included studies reported postoperative improvements in functional outcomes, including American Shoulder and Elbow Surgeons, Constant-Murley, and University of California, Los Angeles scores, with pain reduction. Magnetic resonance imaging and ultrasound findings suggested increased tendon thickness and favorable structural healing, with reported healing rates up to 96% within 12-24 months. No major adverse events, foreign-body reactions, or implant-related complications were reported. Heterogeneity precluded meta-analysis.</p><p><strong>Conclusions: </strong>BCS may improve pain, function, and structural outcomes in selected rotator cuff tears; however, evidence remains limited, heterogeneous, and predominantly non-randomized.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 3","pages":"416-424"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931465","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":"Artificial intelligence for postoperative plain radiographic assessment after reverse total shoulder arthroplasty: current evidence, clinical readiness, and limitations.","authors":"Seok Won Chung, Sung-Jin Park, Yu Sung Yoon, Dong-Hyun Kim, Chul-Hyun Cho, Jun-Young Kim, Jong Pil Yoon","doi":"10.5397/cise.2026.00661","DOIUrl":"10.5397/cise.2026.00661","url":null,"abstract":"<p><p>Postoperative radiographic follow-up after reverse total shoulder arthroplasty (RTSA) plays an essential role in the early detection of implant-related complications and longitudinal risk stratification. However, interpretation of plain radiographs remains limited by interobserver variability and low sensitivity to subtle or progressive mechanical changes. This review was intended to survey the current evidence regarding artificial intelligence (AI) applications for postoperative plain radiograph-based assessment after RTSA, with a focus on clinical readiness, validated performance, and existing limitations. A narrative review was conducted with a specific focus on AI studies relating to shoulder arthroplasty and postoperative plain radiographic analysis. Applications outside shoulder arthroplasty or those based primarily on computed tomography were excluded. Among AI applications in RTSA imaging, implant identification and automated measurement of glenosphere orientation demonstrated the highest level of clinical readiness, with reproducible accuracy reported in multiple studies. In contrast, AI-based detection of scapular notching progression, component loosening, baseplate migration, and acromial or scapular spine stress reactions remains exploratory, with limited shoulder-specific validation. Across these domains, the principal barrier to clinical translation is not algorithmic capability but the lack of high-quality, longitudinally annotated RTSA radiographic datasets. Current AI applications in postoperative RTSA radiographs primarily serve to augment existing radiographic assessment, rather than replace established clinical interpretation. While select tasks are approaching clinical usability, broader adoption will require shoulder-specific longitudinal data, validated outcome-linked thresholds, and integration into routine clinical workflows.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 3","pages":"425-436"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931411","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":"The unresolved question of optimal distalization and lateralization in reverse total shoulder arthroplasty.","authors":"Hyungsuk Kim, Hyun Seok Song","doi":"10.5397/cise.2026.00724","DOIUrl":"10.5397/cise.2026.00724","url":null,"abstract":"","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 3","pages":"309-310"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931422","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":"Measurements of distalization and lateralization do not correlate with patient reported outcome measures following reverse shoulder arthroplasty.","authors":"Sofia Griff, Noah E DiNapoli, James A Rhead, Garrett S Bullock, Brian R Waterman, Nicholas A Trasolini, Benjamin R Graves, Alan W Reynolds","doi":"10.5397/cise.2025.01508","DOIUrl":"10.5397/cise.2025.01508","url":null,"abstract":"<p><strong>Background: </strong>The optimization of implant positioning in reverse shoulder arthroplasty produces evolving and conflicting data. The distalization-lateralization index (DLI) has been introduced as a measurement that combines both lateralization and distalization. This study aimed to determine whether legacy and novel measurements correlate with patient reported outcomes.</p><p><strong>Methods: </strong>Patients who underwent primary reverse shoulder arthroplasty at a single institution between 2016 and 2022 and had a minimum of 2 years of follow-up were screened by retrospective chart review. Radiographs were used to measure the lateralization shoulder angle, distalization shoulder angle, acromiohumeral interval (AHI), acromiohumeral offset (AHO), and glenohumeral offset (GHO). DLI and ΔDLI were calculated from the ΔAHI and ΔAHO. A linear regression analysis was performed to identify correlations between any measurements and the postoperative American Shoulder and Elbow Surgeons (ASES) score.</p><p><strong>Results: </strong>Data were analyzed from 140 patients with an average age of 71 years and average follow-up of 3.3 years. AHO had an adjusted mean difference of -0.29 mm (P=0.009) between high and low ASES score groups. There was a weak, but statistically significant association between the ASES score and the DLI (r=0.181, P=0.032) in the simple linear regression, but no association was found in the multivariable linear regression, β=0.46 (95% CI, -0.04 to 0.95; P=0.072).</p><p><strong>Conclusions: </strong>Increased DLI was found to be weakly associated with higher ASES scores in the univariate analysis, but not after controlling for other variables. Although the correlation was not statistically significant, both the DLI and GHO were associated with higher ASES scores in the multivariate analysis, warranting further study with larger patient cohorts. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"334-342"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158302","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":"Inverse relationship between the critical shoulder angle and rotator cuff insertional footprints: an anatomical study.","authors":"Sebastian Wegmann, Maximilian Weber, Tamara Babasiz, Jan Hockmann, Lars Peter Müller, Maximilian Lenz","doi":"10.5397/cise.2026.00073","DOIUrl":"10.5397/cise.2026.00073","url":null,"abstract":"<p><strong>Background: </strong>Degenerative shoulder disorders impose a significant clinical and economic burden. The critical shoulder angle (CSA) has been established as a predictor of rotator cuff tears and glenohumeral osteoarthritis, but the anatomical basis underlying those relationships remains incompletely characterized. This study investigates whether the CSA correlates with the size of the rotator cuff muscle insertional footprints.</p><p><strong>Methods: </strong>An anatomical study was performed on 28 shoulders from 14 formalin-fixed cadavers (mean age, 77.15 years; standard deviation, 9.94). Radiographs in the Grashey view were used to measure the CSA. The insertional footprints of the supraspinatus (SSP), infraspinatus (ISP), teres minor (TM), and subscapularis (SSC) were dissected and measured. A correlation analysis was conducted to assess relationships.</p><p><strong>Results: </strong>A moderate inverse correlation was found between the CSA and the footprint size of all examined muscles: ISP (r=-0.52, P<0.01), TM (r=-0.60, P<0.001), SSP (r=-0.51, P<0.01), and SSC (r=-0.42, P<0.05). Large CSA values were associated with small insertional areas.</p><p><strong>Conclusions: </strong>This study suggests that a large CSA is associated with significantly smaller-than-average insertional footprints. These findings provide an anatomical basis for biomechanical models that could help to refine risk assessment and preventive strategies for shoulder pathology. Level of evidence: Anatomical study.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"327-333"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333341","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}