Clinics in Shoulder and Elbow最新文献

{"title":"The use of radiofrequency ablation for the treatment of lateral epicondylitis: a systematic review of the literature.","authors":"Mohammed Ali, M K Chandrashekhar, Kapil Kumar, Richard Jeavons","doi":"10.5397/cise.2026.00416","DOIUrl":"10.5397/cise.2026.00416","url":null,"abstract":"<p><strong>Background: </strong>Lateral epicondylitis (LE) is a degenerative overuse angio-fibroblastic dysplasia caused by eccentric overload at the origin of the extensor carpi radialis brevis tendon. This systematic review aimed to evaluate the effectiveness of radiofrequency ablation for managing LE.</p><p><strong>Methods: </strong>This systematic review was registered with PROSPERO under the ID CRD420251165456. A comprehensive literature search was conducted in the NHS Knowledge and Library Hub and PubMed. Eleven studies met the inclusion criteria, including fair-to-good-quality case series and four randomized controlled trials (RCTs) with low risk of bias. Risk of bias was assessed using validated tools appropriate to each study design, and results were synthesized using various statistical methods.</p><p><strong>Results: </strong>Three hundred and eleven elbows were treated with radiofrequency (RF) ablation. The majority have improved pain following these procedures, and no serious adverse events were reported. Overall, the evidence suggests that RF is a viable minimally invasive alternative for chronic LE, yielding significant pain relief and functional improvement with quick recovery and low risk. In comparative trials, its outcomes are on par with those of open or arthroscopic surgery, while offering shorter operative time and potentially a quicker return to work/activities.</p><p><strong>Conclusions: </strong>RF represents a reasonable surgical alternative for patients who fail conservative therapy, particularly those seeking rapid recovery. However, claims of definitive superiority over other surgical techniques are not supported by available evidence. Future research should include sham-controlled or active-comparator RCTs with standardized outcome measures and long-term follow-up (≥2 years).</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 3","pages":"390-402"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931471","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":"Coracoid process morphometry in Asians: a systematic review of computed tomography-based studies.","authors":"Brandon Lim, Gennie Lim, Junren Zhang","doi":"10.5397/cise.2026.00549","DOIUrl":"10.5397/cise.2026.00549","url":null,"abstract":"<p><strong>Background: </strong>Accurately measuring the coracoid process is essential to coracoid transfer procedures. This systematic review synthesizes computed tomography (CT)-based studies of coracoid morphometry in Asians, summarises measurement parameters, and establishes pooled-mean dimensional estimates.</p><p><strong>Methods: </strong>CT-based studies reporting coracoid morphometry in Asians were identified. Pooled estimates were calculated from study-level sample sizes, means, and standard deviations using a combined-group variance approach. Study quality was assessed using the Anatomical Quality Assurance checklist.</p><p><strong>Results: </strong>Fourteen studies comprising 1,581 coracoid processes were included. The pooled mean age was 46.38±14.62 years (9 studies). The pooled mean measurements were: total coracoid length 39.82±3.17 mm (5 studies); tip to flexion point distance 23.31±3.50 mm (3 studies); tip to coracoclavicular ligament distance 22.66±2.99 mm (2 studies); thickness halfway between the tip and base 11.28±1.39 mm (3 studies); and thickness 1 cm from the tip 10.03±0.95 mm (3 studies). In females, the pooled mean measurements were total length 38.79±3.95 mm (5 studies); tip to flexion point distance 19.98±1.91 mm (2 studies); thickness halfway between the tip and base 10.58±1.08 mm (3 studies); and thickness 1 cm from the tip 9.52±0.83 mm (2 studies).</p><p><strong>Conclusions: </strong>Although heterogeneity in anatomical definitions limits cross-study comparability, pooled coracoid dimensions in Asian females suggest that they approach previously proposed fracture-risk thresholds. Well-designed studies using standardised morphometric definitions and measurement protocols are needed to further evaluate this finding.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 3","pages":"403-415"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931491","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":"Clinical outcomes of arthroscopic stabilization procedures in patients with shoulder dislocation combined with posttraumatic adhesive capsulitis.","authors":"Ji-Hyun Seo, Sang-Jin Shin","doi":"10.5397/cise.2025.01424","DOIUrl":"10.5397/cise.2025.01424","url":null,"abstract":"<p><strong>Background: </strong>This study was conducted to analyze clinical outcomes after arthroscopic stabilization procedures in patients with shoulder instability and posttraumatic adhesive capsulitis.</p><p><strong>Methods: </strong>Patients who underwent arthroscopic Bankart repair between 2019 and 2022 with limitation of forward flexion <120°, external rotation <30°, and internal rotation below L3 were included. Demographic data, arthroscopic findings, visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were evaluated.</p><p><strong>Results: </strong>Nineteen (4.3%) of 442 patients were included in the study with a mean follow-up of 33.7±2.8 months. The mean age was 32.8±1.9 years, with a mean time of 6.6±1.8 months from the last episode of instability. At final follow-up, 17 of 19 patients (89.5%) recovered full ranges of motion. Forward flexion improved from 112.2°±9.4° to 170.8°±2.1° (P<0.001), internal rotation from 2.3±0.4 to 7.2±0.8 (P=0.001), and external rotation from 23.2°±1.3° to 61.6°±2.8° (P=0.019). The mean VAS score decreased from 3.5±0.5 to 0.4±0.2 (P<0.001). The ASES score improved from 71.7±2.4 to 92.7±2.2 (P<0.001), and the Rowe score increased from 71.5±3.2 to 97.4±1.0 (P<0.001). No complications or revision surgeries occurred.</p><p><strong>Conclusions: </strong>Arthroscopic stabilization provided satisfactory functional recovery and range of motion in patients with anterior instability and posttraumatic adhesive capsulitis. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"349-355"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563213","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":"Preoperative hyperglycemia within 24 hours of surgery is associated with adverse outcomes after rotator cuff repair.","authors":"Yoli Meydan, Kenny Ling, Bryan Chen, James Gallagher, Edward Wang","doi":"10.5397/cise.2026.00101","DOIUrl":"10.5397/cise.2026.00101","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff repair (RCR) is a common orthopedic procedure that relies on proper tendon healing for good outcomes. While hyperglycemia is known to worsen outcomes in other surgeries, its effects on RCR remain underexplored. We investigated whether preoperative hyperglycemia is associated with increased complication rates following RCR using a large, multi-institutional database.</p><p><strong>Methods: </strong>Using the TriNetX Research Network, we identified patients who underwent primary RCR between May 2005 and May 2024. Patients were divided into two cohorts based on preoperative glucose within 24 hours of surgery: hyperglycemia (≥180 mg/dL) and normoglycemia (70-179 mg/dL). Patients without a recorded glucose value, or with hypoglycemia, prior shoulder fracture, prior RCR, or shoulder arthroplasty were excluded. Propensity score-matched cohorts were balanced for demographics, comorbidities, diabetes status, hemoglobin A1c (HbA1c), glucose-lowering medications, and surgical factors. Complications were assessed at 90 days and 1 year. P-values were adjusted using Benjamini-Hochberg false discovery rate correction.</p><p><strong>Results: </strong>The final matched cohorts comprised 5,839 patients per group. At 90 days, hyperglycemia was associated with significantly higher rates of sepsis, acute kidney injury, myocardial infarction, postoperative infection, and pain. At 1 year, hyperglycemic patients had higher rates of stress fracture and frozen shoulder. No differences were observed in revision surgery, shoulder replacement, or hardware removal between groups. Findings were largely consistent in a sensitivity analysis restricting the normoglycemic group to 70-139 mg/dL.</p><p><strong>Conclusions: </strong>Preoperative hyperglycemia is associated with higher short- and long-term complication rates following RCR. Elevated preoperative glucose appears to be an important factor influencing both systemic and musculoskeletal outcomes after RCR. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"356-367"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563152","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":"Preservation of the long head of the biceps tendon is a viable option in rotator cuff repair: a retrospective comparative study using Biceps Inflammation Section Integrity classification.","authors":"Stefano Gumina, Matteo Cantore, Marco Rionero, Alessandro Calistri, Vittorio Candela","doi":"10.5397/cise.2025.01319","DOIUrl":"10.5397/cise.2025.01319","url":null,"abstract":"<p><strong>Background: </strong>The long head of the biceps tendon (LHBT) is a major contributor to shoulder pain in patients with rotator cuff tears (RCT), which is why tenotomy or tenodesis is commonly performed during RCT surgical repair. However, recent evidence highlights the importance of preserving the LHBT due to its potential role as an augmentative structure and stabilizer. Currently, no clear consensus or objective criteria exist to guide decisions about whether the LHBT should be sacrificed or preserved during rotator cuff repair. In this study, we compare clinical outcomes among patients with similar degrees of LHBT degeneration who were treated either with tenotomy (±tenodesis) or with debridement and radiofrequency ablation.</p><p><strong>Methods: </strong>We performed a retrospective comparative study. Group I was composed of 75 patients (mean age, 64.90±4.60; female, 46; male, 29) with large RCTs who underwent arthroscopic cuff repair associated with LHBT debridement and radiofrequency ablation for a Biceps Inflammation Section Integrity (BISI) score <5. Group II was composed of 86 patients (mean age, 65.70±3.58; female, 48; male, 38) with large RCTs who underwent arthroscopic cuff repair associated with LHBT tenotomy/tenodesis for a BISI score <5. All RC repairs were performed using a single-row technique with titanium anchors. Clinical outcomes were evaluated 1 year postoperatively using the Constant-Murley Score, the visual analog scale (VAS) for pain, and patient satisfaction surveys. Group comparisons were conducted using standard tests for continuous and categorical variables.</p><p><strong>Results: </strong>At the 1-year follow-up, the mean Constant scores were 76 in the preservation group and 78 in the tenotomy group, with no statistically significant difference (P=0.16). Both groups reported low pain levels (mean VAS, 2). Similar strength deficits and partial limitations in shoulder rotations were observed in both groups. Patient satisfaction rates were 79% vs 81%, respectively.</p><p><strong>Conclusions: </strong>Routine sacrifice of the LHBT during rotator cuff repair may not be necessary for mild to moderate degeneration (BISI <5). Biceps preservation may help maintain shoulder biomechanics and offer advantages for future revision surgeries. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"311-315"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664631","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":"Hemophilia increases risk of bleeding and thromboembolism after total shoulder arthroplasty.","authors":"Kelan L Queenan, Tarek Haj Shehadeh, Andrew H Kim, Nathan S Lanham, Gary F Updegrove","doi":"10.5397/cise.2026.00108","DOIUrl":"10.5397/cise.2026.00108","url":null,"abstract":"<p><strong>Background: </strong>Hemophilia, including hemophilia A, hemophilia B, and related coagulation disorders, poses unique perioperative challenges in total shoulder arthroplasty (TSA). Factor replacement and postoperative immobilization may paradoxically increase thromboembolic risk, yet the literature defining venous thromboembolism (VTE) and other complications in this population is limited. We aimed to characterize 90-day postoperative outcomes among patients with hemophilia undergoing TSA.</p><p><strong>Methods: </strong>A multicenter electronic health record database (TriNetX Global) was retrospectively analyzed to identify patients undergoing TSA between December 2005 and December 2025. Patients with hemophilia were compared to propensity-matched controls based on relevant comorbidities. Primary outcomes included 90-day rates of readmission, periprosthetic joint infection (PJI), revision surgery, bleeding complications, and VTE. Secondary outcomes included deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, pneumonia, acute kidney injury (AKI), and urinary tract infection (UTI). Odds ratios with 95% CIs were calculated. P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Compared with matched controls, patients with hemophilia had significantly higher rates of readmission and revision surgery. They also demonstrated increased risk of bleeding complications and thromboembolic events, including DVT, PE, VTE, and stroke. Higher rates of postoperative medical complications, including pneumonia, AKI, and UTI, as well as greater postoperative opioid prescription utilization were observed. Rates of PJI did not differ between groups.</p><p><strong>Conclusions: </strong>Patients with hemophilia are at significantly increased risk of thromboembolic complications and revision surgery following TSA. Prospective studies evaluating preoperative optimization and management of modifiable VTE risk factors are warranted. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"374-380"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631826","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 posterior ulna medial approach to the elbow: a cadaveric anatomical study of exposure of the coronoid and posteromedial collateral ligament.","authors":"Feras Qawasmi, Mustafa Yassin, Adam C Watts","doi":"10.5397/cise.2025.01375","DOIUrl":"10.5397/cise.2025.01375","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to describe the posterior ulna medial approach (PUMA) that permits exposure and repair of the anteromedial coronoid facet and posterior bundle of the medial collateral ligament (pMCL) in posteromedial rotatory instability (PMRI). Varus PMRI of the elbow disrupts key stabilizers, the anteromedial coronoid facet, the lateral ligament complex, and the posterior band of the medial collateral ligament, often requiring surgical stabilization. Although the pMCL is pivotal for stability, a reproducible posterior approach allowing for its direct repair has not been well described.</p><p><strong>Methods: </strong>Six freshly unfrozen upper limbs were dissected using the PUMA. We assessed the exposure, involvement with the ulnar nerve, and feasibility of pMCL repair. Surgeons completed online pre- and post-cadaveric questionnaires assessing the approach's utility.</p><p><strong>Results: </strong>The PUMA consistently exposed the pMCL without detaching the primary origin of the flexor pronator, violating the anterior MCL, or requiring transposition of the ulnar nerve. It enabled simulated repair of the pMCL and, when required, the medial collateral ligament, and fixation of the anteromedial coronoid. Neurovascular structures remained protected throughout the procedure.</p><p><strong>Conclusions: </strong>The PUMA offers anatomical access to the pMCL and adjacent medial elbow structures in a cadaveric setting, demonstrating feasibility for repair in selected PMRI patterns. Level of evidence: Anatomical study.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 3","pages":"343-348"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931488","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 effects of coronoid fracture fixation on functional outcomes and complication rates following terrible triad injuries of the elbow.","authors":"Tamara Babasiz, Jan Philipp Hockmann, Marc Weber, Nadine Ott, Tim Leschinger, Lars Peter Müller, Valentin Rausch","doi":"10.5397/cise.2026.00199","DOIUrl":"10.5397/cise.2026.00199","url":null,"abstract":"<p><strong>Background: </strong>Management of the coronoid fracture in terrible triad injuries (TTI) of the elbow remains controversial. We compared outcomes of TTI patients with versus without coronoid fixation.</p><p><strong>Methods: </strong>We retrospectively analyzed 105 TTI patients; 59 patients with no fixation (group 1) and 46 patients with coronoid fixation (group 2). Complications, revisions, range of motion (ROM) and functional scores (Mayo Elbow Performance Score [MEPS], Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Subjective Elbow Score [SES]) were assessed. Stratified analyses using t-tests and Fisher's exact tests with Cohen's d were performed according to O'Driscoll (OD) subtype (type 1 tip, type 2 anteromedial facet, and type 3 basal).</p><p><strong>Results: </strong>Baseline OD distribution differed substantially between groups 1 and 2 (type 1: 79.7% vs. 34.8%, respectively; type 2: 18.6% vs. 58.7%, respectively; P<0.001). Follow-up timing was comparable between the two groups (first, 4.4 vs. 4.1 months; final, 3.0 vs. 2.8 years). In the whole cohort, group 2 patients showed greater flexion (P=0.030), pronation and supination (both P<0.001), and better MEPS (P=0.032), QuickDASH (P=0.027) and SES (P=0.044) than group 1 patients. Stiffness (22.0% vs. 2.2%, P=0.003) and revision surgery rates (30.5% vs. 10.9%, P=0.018) were significantly higher in group 1 than in group 2. Within OD type 2, fixation was associated with significantly greater flexion (P=0.001), pronation (P=0.005), and supination (P<0.001), and lower rates of nonunion (9% vs. 50%, P=0.046) and posttraumatic osteoarthritis (5% vs. 50%, P=0.025) than non-fixation.</p><p><strong>Conclusions: </strong>OD type 2 fractures repaired with coronoid fixation showed greater ROM and lower complication rates than these types of fractures repaired without coronoid fixation. Within OD type 1, coronoid fixation did not show any significant benefits compared to no fixation. Level of evidence: III, retrospective cohort study.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 3","pages":"381-389"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931397","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":"Cerebral oxygenation in the beach chair position: a randomized comparison of 30° and surgeon-selected low-angle positioning during shoulder surgery.","authors":"Jeandre Deon Kotze, Petrus Hendrik Naude, Luis Montoya-Pelaez, Mikail Amod, Stephen Roche","doi":"10.5397/cise.2026.00178","DOIUrl":"10.5397/cise.2026.00178","url":null,"abstract":"<p><strong>Background: </strong>The beach chair position (BCP) is widely used for shoulder surgery but has been associated with rare yet devastating neurological complications, possibly related to cerebral hypoperfusion. This study compared cerebral perfusion in patients undergoing shoulder surgery in the conventional BCP versus a fixed 30° inclination.</p><p><strong>Methods: </strong>In this prospective, randomized comparison, adults undergoing elective shoulder surgery in BCP under combined regional and general anesthesia were allocated to a control group (CG; surgeon's preferred angle) or study group (SG; fixed 30° angle). Regional cerebral oxygen saturation (rSO₂) was continuously monitored using near-infrared spectroscopy. Cerebral desaturation events (CDEs) were defined as a ≥20% reduction from baseline. Mean arterial pressure (MAP), rSO₂, CDEs and interventions were recorded.</p><p><strong>Results: </strong>Forty-five patients were included (CG: n=22, SG: n=23). The mean inclination angle in the CG was 38.7° (30°-55°). Baseline characteristics were comparable between groups. CDEs occurred in three patients (7%) overall: two patients (9%) in the CG and one patient (4%) in the SG (P=0.61). Absolute rSO₂ values <55% were observed in 38% of patients, with no significant between-group difference (P>0.99). Vasopressor intervention for MAP reduction was required in 69% of patients (72% vs 65%, P=0.57). All procedures were completed without the need for repositioning. No clinically evident neurological complications occurred.</p><p><strong>Conclusions: </strong>Shoulder surgery performed in BCP at lower inclination angles, including 30°, is feasible and associated with a low incidence of CDEs when guided by intraoperative cerebral oximetry. Routine use of lower inclination angles and cerebral oximetry may reduce the risk of ischemic neurological injury in American Society of Anesthesiologists I-III patients undergoing shoulder surgery in BCP. Level of evidence: I.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"368-373"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563146","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":"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":"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>For 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. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"183-190"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677094","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}