Clinics in Shoulder and Elbow最新文献

{"title":"Relationship between coracoid apex position and anterior shoulder instability.","authors":"Haluk Yaka, Ali Adem, Baran Sarikaya, Mustafa Özer, Ulunay Kanatli","doi":"10.5397/cise.2025.00073","DOIUrl":"10.5397/cise.2025.00073","url":null,"abstract":"<p><strong>Background: </strong>This study investigated whether the coracoid apex position relative to the glenoid is associated with anterior shoulder instability (ASI). We hypothesized that the coracoid apex is positioned superiorly and medially in patients with ASI.</p><p><strong>Methods: </strong>This study included 72 patients who underwent surgery for ASI and 72 age- and sex-matched controls. The sagittal central glenoid- coracoid angle (scGCA) and axial central glenoid-coracoid angle (acGCA), which assess the coracoid apex position relative to the glenoid center, the glenoid version (GV), and glenoid inclination (GI) were evaluated using magnetic resonance imaging. The critical shoulder angle (CSA) was measured using true anterior-posterior radiographs.</p><p><strong>Results: </strong>The ASI group had significantly lower scGCA and GV values than the control group (scGCA: 32.0°±4.3° vs. 39.2°±7°, P=0.004; GV: 2.2°±5.4° vs. 6.4°±5.4°, P=0.033, respectively). There was no significant difference in acGCA, GI, and CSA between the groups (P=0.377, P=0.524, P=0.847, respectively). Logistic regression analysis conducted with the scGCA, acGCA, GV, GI, and CSA parameters revealed a significant association only for scGCA (P=0.039, odds ratio: 1.28).</p><p><strong>Conclusions: </strong>Lower scGCA values, which indicate a more superior position of the coracoid apex relative to the glenoid center, are associated with ASI independently of other parameters. scGCA values below 34.5°, indicating a superiorly positioned coracoid apex, showed an 85.7% sensitivity and 73.3% specificity for ASI. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"28 2","pages":"156-162"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267497","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":"Biomechanical analysis of ulnar nerve gliding and elongation: implications for nonsurgical ulnar nerve release in cubital tunnel syndrome.","authors":"Teruhisa Mihata, Masaki Akeda, Michael Künzler, Michelle H McGarry, Thay Q Lee","doi":"10.5397/cise.2024.00934","DOIUrl":"10.5397/cise.2024.00934","url":null,"abstract":"<p><strong>Background: </strong>Nonsurgical ulnar nerve release was developed for conservative treatment of cubital tunnel syndrome. Our objective in this study was to investigate the amount of ulnar nerve gliding and elongation during passive wrist, forearm, or elbow movements to determine the most effective nonsurgical ulnar nerve release technique.</p><p><strong>Methods: </strong>Seven fresh-frozen cadaveric upper limbs were tested in an elbow-testing system. Ulnar nerve gliding (mobility) and elongation (stretching) were measured around the elbow joint using a three-dimensional digitizing system. Data were compared between arm positions (elbow extension vs. 90° flexion, wrist extension vs. flexion, or forearm pronation vs. supination).</p><p><strong>Results: </strong>Passive wrist movement from flexion to extension caused the ulnar nerve to glide. The largest amount of glide during passive wrist movement was found at 90° elbow flexion and maximum forearm supination position (5.4±1.1 mm). Ulnar nerve gliding during passive forearm movement was subtle. The ulnar nerve tightened with elbow flexion. Maximum elongation of the ulnar nerve was 5.6±0.6 mm from extension to 90° flexion in the elbow.</p><p><strong>Conclusions: </strong>Ulnar nerve gliding was most severe during passive wrist movement in elbow flexion and forearm supination. This result suggests that passive wrist movement from flexion to extension with the elbow flexed and forearm supinated may be the most effective nonsurgical ulnar nerve release position to treat cubital tunnel syndrome. Attention should be paid to the elbow flexion angle during nonsurgical ulnar nerve release to not exacerbate cubital tunnel symptoms. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"137-145"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043968","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":"A technique for arthroscopic-assisted lower trapezius transfer using an Achilles tendon allograft augmented with acellular dermal matrix to treat posterior superior irreparable rotator cuff tears in the lateral decubitus position.","authors":"Chang Hee Baek, Bo Taek Kim, Jung Gon Kim, Chaemoon Lim","doi":"10.5397/cise.2024.00822","DOIUrl":"10.5397/cise.2024.00822","url":null,"abstract":"<p><p>Lower trapezius tendon transfer has emerged as an effective treatment option with promising clinical outcomes for patients with posterior superior irreparable rotator cuff tears (PSIRCTs). This technique has gained considerable attention for PSIRCTs, with various modifications proposed by different authors. In this report, we present an arthroscopic-assisted approach to lower trapezius tendon transfer in patients with PSIRCT using an Achilles tendon allograft that is reinforced with an acellular dermal matrix graft. The procedure is conducted with the patient in the lateral decubitus position.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"213-217"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050133","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":"Early complications and risk factors following reverse versus anatomic total shoulder arthroplasty for osteoarthritis: a nationwide registry study.","authors":"Suhas Rao Velichala, Brigitte A Lieu, Aadi Sharma, Matthew Smith, James Satalich, Jennifer Vanderbeck","doi":"10.5397/cise.2024.00906","DOIUrl":"10.5397/cise.2024.00906","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (RSA) is an alternative to anatomic total shoulder arthroplasty (TSA) for treating glenohumeral osteoarthritis (OA), particularly in elderly patients. This study evaluates 90-day postoperative complication rates and identifies risk factors for adverse outcomes in RSA and TSA patients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the TriNetX Research NLP Network to identify patients aged 65-90 years who underwent RSA or TSA for OA from 2006 to 2024. 1:1 propensity score matching controlled for demographics and comorbidities. Orthopedic and infectious complications were compared using multivariate logistic regression.</p><p><strong>Results: </strong>The final matched cohort included 4,117 RSA and TSA patients. RSA was associated with significantly higher odds of orthopedic complications compared to TSA. Significant risk factors for orthopedic complications in RSA included nicotine dependence (OR, 1.592; P=0.001) and hypertension (OR, 1.545; P=0.001). In TSA, risk factors included male sex (OR, 0.702; P=0.005), chronic obstructive pulmonary disease (OR, 1.650; P=0.016), and obesity (OR, 1.776; P<0.001). For infections, RSA risk factors were male sex (odds ratio [OR], 1.698; P=0.005), heart failure (OR, 2.396; P<0.001), and diabetes (OR, 1.525; P=0.039). Diabetes was the only significant risk factor in TSA (OR, 2.453; P=0.003).</p><p><strong>Conclusions: </strong>RSA carries a higher risk of orthopedic complications and infection than TSA within 90 days. Distinct risk factors for each procedure highlight the need for patient-specific risk stratification to optimize preoperative assessment and surgical decision-making. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"146-155"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049701","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":"Risk factors associated with pain while sleeping on the affected shoulder after primary reverse shoulder arthroplasty.","authors":"Brett L Heldt, Justin L Lomax, Harrison B Houston, B Gage Griswold, Kevin A Hao, Elizabeth P Barker, Anna E Bozzone, Josie A Elwell, Stephen A Parada","doi":"10.5397/cise.2024.01067","DOIUrl":"10.5397/cise.2024.01067","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to identify risk factors of pain while lying on the operative shoulder following primary reverse total shoulder arthroplasty (rTSA).</p><p><strong>Methods: </strong>Patients who underwent primary rTSA with available (1-year) follow-up data were retrospectively identified. Demographics, diagnosis, comorbidities, implant configuration, surgical information, and pain scores (including preoperative, postoperative and improvement in pain) were assessed while lying on the operated shoulder. To categorize preoperative pain while lying on the operative shoulder, cohorts were defined based on above or below the average pain level. Postoperative pain and improvement in pain were defined based on the following thresholds: patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB). The PASS was defined as the 75th percentile of pain scores in patients with high satisfaction ratings after rTSA, while MCID and SCB were calculated as the difference in average pain improvement in patients with high versus low satisfaction rates postoperatively. Univariate and multivariate logistic regression analyses were conducted.</p><p><strong>Results: </strong>A total of 4,235 patients who underwent rTSA were included. Previous shoulder surgery, tobacco use, and preoperative pain lying on the operative shoulder failed to achieve threshold values. Subscapularis repair was associated with an improved ability to achieve the thresholds.</p><p><strong>Conclusions: </strong>Tobacco use, higher preoperative pain levels, and previous shoulder surgery were negatively associated with satisfactory improvement in pain while lying on the postoperative shoulder. In contrast, subscapularis repair was associated with clinically significant improvements. Given that postoperative pain when lying on the operative side is a frequent preoperative question, understanding these influencing factors is useful when counseling patients on postoperative expectations. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"204-212"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128773","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":"A rare case of pyomyositis with intramuscular hemangioma in the upper arm.","authors":"Ji Un Kim, Hyung Jun Park, Jung Ho Park","doi":"10.5397/cise.2024.01004","DOIUrl":"10.5397/cise.2024.01004","url":null,"abstract":"<p><p>Intramuscular hemangiomas are rare in musculoskeletal pain differentials, especially in the upper extremities. We report a case of a 56-year-old male with an intramuscular hemangioma and abscess in the biceps brachii, presenting with pain, swelling, and limited elbow movement. High C-reactive protein (25.43 mg/dL) and visual analog scale score of 10 were noted. Radiograph showed 3 phleboliths. MRI revealed an enhancing lesion (2.5×2.7×9.8 cm) and abscess. We performed surgery for excision of the intramuscular hemangioma and drainage of the abscess in the biceps muscle. By 5 weeks post-surgery, all functional limitations had resolved, and no recurrence was observed at the 5-month follow-up.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"218-222"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039042","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":"Timing of surgery for terrible triad of the shoulder: a systematic review.","authors":"Nachiket Deshpande, Moustafa S Hadi, Eleanor C Smith, Ayobami L Ward, Whitney E Muhlestein, James E Carpenter, Louis T Rodgers, Yamaan S Saadeh","doi":"10.5397/cise.2024.00829","DOIUrl":"10.5397/cise.2024.00829","url":null,"abstract":"<p><p>The terrible triad of the shoulder (STT) is an injury involving anterior shoulder dislocation, rotator cuff tear, and nerve injury. The optimal timing for rotator cuff repair (RCR) remains controversial, with some favoring early intervention and others recommending delaying surgery until nerve recovery. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, exploring STT treatment and RCR timing using PubMed, Embase, and Web of Science. The inclusion criteria were studies published in English and involving human subjects. Exclusion criteria included non-English articles, review papers, cadaveric studies, and studies on unrelated conditions. Time to surgery and outcomes related to shoulder and nerve function, such as range of motion, muscle strength, and sensation were analyzed qualitatively. Of 671 articles identified, 28 met inclusion criteria. Most patients underwent surgical RCR and demonstrated excellent functional and neurologic outcomes, with many achieving 150°+ flexion, 110°+ abduction, 4+/5 strength, and resolution of nerve hypoesthesia. RCR timing ranged from 10 days to 6 months, with comparable outcomes regardless of timing. Prompt RCR in STT may be beneficial for maximizing shoulder outcomes, while coexisting nerve injuries should be managed conservatively with watchful waiting, as most recover spontaneously.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"251-262"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040212","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":"Patient-specific instrumentation in primary total shoulder arthroplasty: a meta-analysis of clinical outcomes.","authors":"Mohammad Daher, Tarishi Parmar, Peter Boufadel, Mohamad Y Fares, Wissam Khalil, John G Horneff, Joseph A Abboud, Adam Z Khan","doi":"10.5397/cise.2024.01095","DOIUrl":"10.5397/cise.2024.01095","url":null,"abstract":"<p><strong>Background: </strong>The introduction of patient-specific instrumentation (PSI) in total shoulder arthroplasty (TSA) has improved implant positioning accuracy. However, whether PSI yields additional clinical benefit compared to standard instrumentation (SI) in the setting of primary TSA (anatomic and reverse) remains unclear.</p><p><strong>Methods: </strong>PubMed, Cochrane, Embase, and Google Scholar were queried through August 2024. Inclusion criteria consisted of studies that compared PSI to SI in TSA (anatomic and reverse). Key outcomes analyzed included adverse events, patient-reported outcomes, and discrepancies between planned and achieved implant positioning.</p><p><strong>Results: </strong>Five retrospective studies, three randomized controlled trials, and one prospective study met the inclusion criteria. There was no difference in complications (odds ratio [OR], 1.00; 95% CI, 0.16 to 6.10; P=1.00), reoperation (OR, 1.35; 95% CI, 0.37 to 4.91; P=0.65), American Shoulder and Elbow Surgeons score (mean difference [MD], 1.61; 95% CI, -4.08 to 7.30; P=0.58), Constant-Murley Score (MD, 3.06; 95% CI, -3.68 to 9.81; P=0.37), version error (MD, -0.76; 95% CI, -2.51 to 0.99; P=0.40), and inclination error (MD, -2.89; 95% CI, -5.82 to 0.05; P=0.05) between the two groups.</p><p><strong>Conclusions: </strong>This study found no significant differences in patient-reported outcomes, complication rates, or implant positioning accuracy between PSI and SI in primary TSA. Future randomized controlled trials comparing these two types of instrumentation would be useful to assess whether a benefit exists for PSI in the setting of primary TSA. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"129-136"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031523","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":"Adherence rates to the minimum information for studies evaluating biologics in orthopedics guidelines for clinical studies on platelet-rich plasma for the treatment of lateral epicondylitis: a systematic review.","authors":"Davis Hedbany, Bradley A Lezak, James Butler, Nathaniel P Mercer, Sebastian Krebsbach, John G Kennedy","doi":"10.5397/cise.2024.01060","DOIUrl":"https://doi.org/10.5397/cise.2024.01060","url":null,"abstract":"<p><strong>Background: </strong>Lateral epicondylitis (LE), commonly known as tennis elbow, is a condition involving inflammation of the extensor carpi radialis brevis tendon at its attachment to the lateral epicondyle of the humerus. In recent years, platelet-rich plasma (PRP) therapy, an ortho-biologic treatment, has emerged as a promising option for the treatment of LE. Despite promising results in clinical trials, variability in PRP preparation and administration is a barrier to consistent outcomes. To address this, the Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were created in 2017 to establish a standardized approach for reporting findings in PRP-based studies. The objective of this study was to analyze and compare the rate of adherence of the MIBO guidelines in the use of PRP in treating LE.</p><p><strong>Methods: </strong>This systematic review evaluates the adherence of studies on PRP for LE to MIBO guidelines using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Adherence was determined by calculating the total percentage of checklist items that each study adequately and clearly reported from the 46-point checklist.</p><p><strong>Results: </strong>A total of 26 studies (954 patients) were included. Overall, only 52.2% of the 46-point MIBO checklist was reported per article on average with 0 articles displaying adherence rates of 100%. There was no significant difference in the mean adherence rates between studies prior to publication of the MIBO guidelines (45.2%) and after (53.7%).</p><p><strong>Conclusions: </strong>This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. There was no difference in the adherence rates in studies published before and after the creation of MIBO guidelines in 2017. Level of evidence: II.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129049","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":"Arcuate osteoplasty for brachial plexus paralysis after plate fixation of mid-clavicle fracture: a case report and literature review.","authors":"Dongju Shin, Jae Hwi Han","doi":"10.5397/cise.2024.00717","DOIUrl":"10.5397/cise.2024.00717","url":null,"abstract":"<p><p>Brachial plexus paralysis is a rare but serious complication following clavicle fractures that is often linked to neurovascular compression, with an incidence of 0.5% to 9.0%. This report presents a case of brachial plexus paralysis in a 61-year-old woman after surgical fixation of a deformed mid-clavicle fracture with a metal plate. Revision surgery was performed to address the paralysis, involving removal of the metal plate, arcuate osteoplasty to create a smooth arch beneath the clavicle, and re-fixation of the plate with adjusted superior angularity. We used this approach to relieve neurovascular compression and restore thoracic outlet space. Over a period of 1 year, significant recovery and successful fracture union were achieved. This case demonstrates that managing brachial plexus paralysis with revision surgery and osteoplasty can effectively restore both neurological function and bone healing.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051077","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}