JSES International最新文献

{"title":"Lower socioeconomic status is not associated with worse 2-year outcomes following reverse total shoulder arthroplasty","authors":"Christopher A. Colasanti MD ,&nbsp;Utkarsh Anil MD ,&nbsp;Jay M. Levin MD, MBA ,&nbsp;Erel Ben-Ari MD ,&nbsp;Michelle S. Shen MD ,&nbsp;Joseph D. Zuckerman MD","doi":"10.1016/j.jseint.2025.04.007","DOIUrl":"10.1016/j.jseint.2025.04.007","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to evaluate the association between Area Deprivation Index (ADI) and patient outcomes following reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients who underwent an rTSA at a single institution between 2011 and 2021 with minimum 2-year follow-up. Each patient's home address was mapped to the ADI to determine the level of socioeconomic disadvantage. Patients were categorized into 5 groups based on socioeconomic status (SES): ADI group 1; the least deprived group and ADI group 5; the most deprived group. Bivariate analysis was performed to determine the association between the level of SES and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score. Multivariable regression analysis was utilized to assess the role of independent variables in achieving minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for ASES.</div></div><div><h3>Results</h3><div>A total of 551 patients, mean age: 71.1 ± 9.1 year/old and overall mean follow-up time of 42.5 ± 29.9 months. The mean ADI value of all cohorts was 49.3 ± 29.4. The mean ADI for groups 1 through 5 were 9.0 ± 4.9, 30.1 ± 7.6, 47.6 ± 4.4, 70.9 ± 6.7, and 89.9 ± 5.2. There were no differences in age, sex, body mass index, or preoperative medical comorbidities. The average preoperative ASES score across ADI subgroups was 30.6 ± 18.0. Preoperative ASES scores were lowest in both ADI group 1:26.5 ± 15.3 and ADI group 5:25.9 ± 16.7. There was no difference in preoperative range of motion (ROM) across all ADI subgroups. The average postoperative ASES score was 74.2 ± 23.7. There was a significant inverse relationship between ADI and postoperative ASES (<em>P</em> = .047). ADI group 1 had the highest postoperative ASES score of 78.6 ± 21.6 compared to 70.0 ± 24.1 in group 5. There was no difference in change preoperative to postoperative ASES scores across ADI subgroups with an average delta ASES score of 42.8 ± 26.2. Like preoperative ROM, there was no difference across ADI subgroups in terms of postoperative ROM. The average percentage of the cohort of patients across ADI subgroups that achieved MCID, SCB, and PASS for ASES was 87.6%, 68.9%, and 57.5%, respectively. There was no difference in terms of achieving MCID, SCB, or PASS for ASES across ADI subgroups.</div></div><div><h3>Conclusion</h3><div>The current study supports an inverse relationship between ADI and postoperative outcomes in patients undergoing rTSA. Additionally, our study found that a patient's ability to achieve MCID, SCB, or PASS for ASES at a minimum of 2 years after rTSA was not dependent on SES. Lastly, our study demonstrated that the risk of suffering an adverse event or undergoing a revision surgery were not associated with SES.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1886-1892"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108230","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":"Risk factors for elbow injuries in professional baseball players based on ultrasound images: a prospective cohort study of 56 players","authors":"Masahiro Ikezu MS, RPT ,&nbsp;Shintarou Kudo PhD, RPT ,&nbsp;Issei Noda PhD, RPT ,&nbsp;Takanori Kubo MD ,&nbsp;Hidetoshi Hayashi MD, PhD","doi":"10.1016/j.jseint.2025.04.029","DOIUrl":"10.1016/j.jseint.2025.04.029","url":null,"abstract":"<div><h3>Background</h3><div>Risk factors for the development of elbow injuries, focusing on the function of the flexor digitorum superficialis (FDS) and the structure of the ulnar nerve, have not been fully clarified. This study aimed to prospectively investigate the ring-down artifact (RDA) under gravity load and gravity load with FDS contraction conditions and the cross-sectional area (CSA) of the ulnar nerve and clarify the risk factors for elbow injuries in professional baseball players.</div></div><div><h3>Methods</h3><div>We enrolled 56 professional Japanese baseball players without elbow pain. The measurements were RDA under gravity load and gravity load with FDS contraction, and the CSA of the ulnar nerve at the Struthers arcade, cubital tunnel, and Osborne's ligament. We prospectively investigated the development of elbow injuries over a 1-year period. Statistical analysis was performed using Fisher's exact test, and the relative risk (RR) was calculated.</div></div><div><h3>Results</h3><div>The development of elbow injuries was associated with the following variables: the presence of RDA under gravity load (<em>P</em> &lt; .01, RR: 5.22), the presence of RDA under gravity load with FDS contraction (<em>P</em> = .02, RR: 3.26), CSA at Struthers arcade ≥10 mm² (<em>P</em> &lt; .01, RR: 6.71), CSA at cubital tunnel ≥10 mm² (<em>P</em> &lt; .01, RR: 36.56), and CSA at Osborne's ligament ≥10 mm² (<em>P</em> &lt; .01, RR: 4.57).</div></div><div><h3>Conclusion</h3><div>The RDA under gravity load, FDS contraction conditions, and increased CSA of the ulnar nerve were associated with the development of elbow injuries in professional baseball players.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1820-1824"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108307","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 of suture tension band technique for fixation of olecranon fractures: a retrospective case series","authors":"Moayd Abdullah H. Awad MBBS, FRCSC ,&nbsp;Makena Mbogori MBChB, MMed Orth, FCS ECSA ,&nbsp;Amaan Lalani BScKin ,&nbsp;Armin Badre MD, MSc, FRCSC","doi":"10.1016/j.jseint.2025.04.032","DOIUrl":"10.1016/j.jseint.2025.04.032","url":null,"abstract":"<div><h3>Background</h3><div>Tension band wiring is one of the earliest and most common techniques for the fixation of olecranon fractures with good functional outcomes. However, it is fraught with hardware-related complications, with reported reoperation rates of 33.3%-79.2%. Despite the aim of reducing hardware-related complications, low-profile precontoured plates continue to have hardware removal rates of 15%-56%. Suture tension band fixation is a novel technique for the management of select olecranon fractures with equivalent or superior biomechanical performance to tension band wiring and avoids hardware-related complications associated with tension band wiring and plate fixation. However, outcomes of this fixation technique are not yet well-reported. The goal of this study was to evaluate the clinical and radiographic outcomes of patients who underwent suture tension band fixation of select olecranon fractures.</div></div><div><h3>Methods</h3><div>This study was a retrospective case series of 25 patients with simple transverse or short oblique olecranon fractures or fractures with minimal comminution that can be converted to a simple fracture pattern who underwent suture tension band fixation. Our primary outcome was the reoperation rate for symptomatic fixation material, failure of fixation, or nonunion. Secondary outcomes were elbow and forearm range of motion, rate of union, as well as patient-reported outcome measures including the patient-rated elbow evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, and the Single Assessment Numeric Evaluation scores at the final follow-up.</div></div><div><h3>Results</h3><div>The average age of patients in our cohort was 59 ± 19 years, and 64% (n = 14) of patients were female. Our average follow-up time was 14 ± 9 months. None of the patients required reoperation for prominent or irritating suture material, failure of fixation, or nonunion. The patients achieved an average elbow arc of motion of 134° ± 9° and an average forearm arc of 156° ± 12° at the final follow-up. At the time of the final follow-up, patients reported an average patient-rated elbow evaluation of 16.6 ± 8.6, Quick Disabilities of the Arm, Shoulder, and Hand of 9.0 ± 11.2, and Single Assessment Numeric Evaluation score of 93% ± 8%. Complications included one case of postoperative infection, one asymptomatic nonunion, and one fracture through the ulnar tunnel as a result of subsequent trauma.</div></div><div><h3>Conclusion</h3><div>The suture tension band technique is a viable option for managing simple olecranon fractures or fractures with minimal comminution that can be converted to a simple fracture pattern. This technique yields excellent clinical and radiographic outcomes and avoids hardware-related complications associated with tension band wiring and plate fixation. Larger cohorts and randomized clinical trials are needed to confirm these findings.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1825-1832"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108309","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":"Evaluation of ChatGPT’s responses to frequently asked questions about shoulder arthroplasty","authors":"Fátima Fernández Dorado MD,&nbsp;Salvador Álvarez Villar MD,&nbsp;Carlos Alexi Osuna Mavare MD,&nbsp;Raquel Ruíz Díaz MD,&nbsp;Jorge Díaz Heredia MD, PhD,&nbsp;Miguel Ángel Ruiz Ibán MD, PhD","doi":"10.1016/j.jseint.2025.05.008","DOIUrl":"10.1016/j.jseint.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>Patients now have access to numerous resources about common orthopedic procedures before clinical consultations. Recently, artificial intelligence (AI)-powered chatbots have gained popularity, offering human-like, convincing responses. A prominent example is ChatGPT, an AI-based chat technology, which has seen rapid growth in acceptance. Given the increasing likelihood that patients will turn to this technology for educational information prior to undergoing surgical intervention, we aimed to determine ChatGPT’s ability to provide adequate answers to frequently asked questions about shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>After a literature review, we formulated the 10 most frequently asked questions about shoulder arthroplasty and presented them to the chatbot without follow-up questions or repetitions. The responses were analyzed by 15 independent shoulder surgeons, who evaluated each response for accuracy using an evidence-based approach. The responses were classified as “excellent response without need for clarification,” “satisfactory requiring minimal clarification,” “satisfactory requiring moderate clarification,” or “unsatisfactory requiring substantial clarification.”</div></div><div><h3>Results</h3><div>Of the responses given by the chatbot, 45.5% of the time the expert panel rated the response as “excellent,” 38.2% of the time the rating was “satisfactory requiring minimal clarification,” and only 11.8% and 4.5% of the responses were rated as “satisfactory requiring moderate clarification” and “unsatisfactory,” respectively.</div></div><div><h3>Conclusion</h3><div>ChatGPT provides reliable information to patients undergoing shoulder arthroplasty. As a complementary educational resource, AI shows potential by delivering accurate, evidence-based answers with little need for clarification and minimal bias. Despite limitations, the study underscores the promising role of AI-based platforms in healthcare.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1771-1777"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108568","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":"Trends of shoulder arthroplasty and rotator cuff repair in Japan: national database analysis","authors":"Masataka Minami MD, PhD ,&nbsp;Masamitsu Kido MD, PhD ,&nbsp;Yoshikazu Kida MD, PhD ,&nbsp;Ausberto R. Velasquez Garcia MD ,&nbsp;Kenji Takahashi MD, PhD ,&nbsp;Shawn W. O'Driscoll MD, PhD","doi":"10.1016/j.jseint.2025.05.013","DOIUrl":"10.1016/j.jseint.2025.05.013","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty was introduced to Japan in 2014, principally to treat cuff tear arthropathy and irreparable massive rotator cuff tears. Its indications have expanded significantly worldwide since then. This study aimed to analyze the annual trends in shoulder arthroplasties and rotator cuff repairs (RCRs) from 2014 to 2022 and to examine differences by sex and age group using a publicly available national database.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis using data from the National Database of Health Insurance Claims and Specific Health Checkups provided by the Ministry of Health, Labour, and Welfare in Japan. The surgical categories analyzed included shoulder arthroplasty and RCR between 2014 and 2022. The annual number of surgeries was reported according to sex and age group. Age-specific incidence was calculated per 100,000 people using age group population data. Descriptive statistics and the independent <em>t</em>-test were used for comparisons by sex and age, and linear regression analysis was applied to assess trends.</div></div><div><h3>Results</h3><div>Shoulder arthroplasties increased dramatically from 1,246 in 2014 to 5,439 in 2022. From 2014 to 2022, the number of RCRs did not decrease; in fact, they continued to increase steadily from 17,553 to 21,183, except for a dip in 2020. Shoulder arthroplasties were nearly twice as common in females, whereas RCRs were more frequent in males. Shoulder arthroplasties peaked in the 75-79 age group, with an average age of 78 years, whereas RCRs were most frequent in the 70-74 age group, averaging 67 years.</div></div><div><h3>Discussion and Conclusion</h3><div>Despite the substantial increase in shoulder arthroplasties, the number of RCRs has also slightly increased. These findings demonstrate that reverse total shoulder arthroplasty did not simply replace RCRs but complement conventional RCR in the treatment spectrum of shoulder disorders. The findings indicated that females had a higher prevalence of shoulder arthroplasty procedures, whereas males were more likely to undergo RCR. In addition, the patients who underwent shoulder arthroplasty tended to be older than those who underwent RCR. These observations may be attributed to sex-specific differences in the progression of shoulder conditions and the accessibility of various treatment approaches or possibly a difference in indications for surgery in females and males. This study demonstrated substantial increases in shoulder arthroplasties in Japan over the past decade, with notable differences in age and sex distributions compared with conventional RCR.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1781-1792"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108571","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":"Augmented vs. standard glenoid baseplate use in reverse total shoulder arthroplasty: a systematic review","authors":"Emily N. Lau MD ,&nbsp;Ryan Lin BS ,&nbsp;Abbey Glover BS ,&nbsp;Albert Lin MD","doi":"10.1016/j.jseint.2025.05.032","DOIUrl":"10.1016/j.jseint.2025.05.032","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid bone loss can be a challenging problem to address surgically in patients with glenohumeral joint arthritis and concomitant end-stage rotator cuff deficiency. Reverse total shoulder arthroplasty (rTSA) has emerged as a treatment to restore function in this patient population and has demonstrated good clinical outcomes. Addressing bone loss is essential to prevent complication such as glenoid baseplate loosening, scapular notching, and instability. Metal augmentation of glenoid baseplates has shown good clinical and functional outcomes with low complication rates. This systematic review analyzes the outcomes of patients undergoing rTSA with augmented baseplates vs. those treated with a standard glenoid baseplate. Pain, range of motion, patient reported outcomes scores, complication, and revision rates were assessed.</div></div><div><h3>Methods</h3><div>Four online literature databases (PubMed, MEDLINE, ScienceDirect, Scopus) were searched from database inception to July 1, 2024, for comparative studies evaluating outcomes between augmented and standard rTSA. Functional and clinical outcomes along with complication and revision rates were collected across studies. Frequency weighted means were used to synthesize data where appropriate.</div></div><div><h3>Results</h3><div>Five manuscripts met final criteria for inclusion encompassing 2,331patients with a mean age of 71.3 years and mean follow-up time of 38.8 months. When compared to the standard baseplate group or those treated with bone graft augmentation, the metal augmentation group had comparable improvement in frequency weight means in forward elevation, abduction, and external rotation. Similarly, frequency weighted means of improvement were comprable in the augmented group with regards to American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant scores. In studies directly comparing augmented to nonaugmented rTSA, there was a total of 167 (7.5%) reported complications: 132 (7.8%) in the standard and 35 (6.7%) in the augmented cohorts.</div></div><div><h3>Conclusion</h3><div>This systematic review demonstrates similar functional and clinical outcomes with the use of augmented glenoid baseplates to address glenoid bone loss in rTSA when compared to standard baseplates. Complications were comparable in the augmented baseplate group, with no difference in revision rates. These findings illustrate that augmented baseplates not only address bony defects but can provide good clinical and functional outcomes without the risk of increased complication in rTSA.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1723-1730"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108619","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":"Chronic nonsteroidal anti-inflammatory drug use is associated with increased risk of distal biceps tendon injury","authors":"Annika N. Hiredesai BA ,&nbsp;Sailesh V. Tummala MD ,&nbsp;Alejandro M. Holle BS ,&nbsp;Katelyn T. Koschmeder MD ,&nbsp;Eugenia Lin MD ,&nbsp;Alexander J. Hoffer MD ,&nbsp;Kostas J. Economopoulos MD","doi":"10.1016/j.jseint.2025.05.009","DOIUrl":"10.1016/j.jseint.2025.05.009","url":null,"abstract":"<div><h3>Background</h3><div>Prior basic science literature suggests chronic nonsteroidal anti-inflammatory drugs (NSAID) use may be associated with impaired tendon health. The purpose of this study was to investigate the association between chronic NSAID use and risk of distal biceps tendon injury (BTI).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted using the PearlDiver database. A sample of 500,000 chronic NSAID users were exact matched to controls for age, sex, Charlson Comorbidity Index, diabetes, and tobacco use. Multivariable logistic regression with sex-specific and age-specific subanalyses was conducted for 1- and 2-year risk of distal BTI and 2-year surgical repair rates as defined by International Classification of Disease and Current Procedural Terminology codes.</div></div><div><h3>Results</h3><div>After exact matching, 499,240 chronic NSAID users were matched with 499,240 controls. Patients with chronic NSAID use had a significantly increased risk of distal BTI at both 1-year (odds ratio: 1.51; 95% confidence interval: 1.32-1.71) and 2-year (odds ratio: 1.39; 95% confidence interval: 1.27-1.53) follow-up compared to controls. When stratified by sex, males and females with chronic NSAID use were significantly more likely to experience distal BTI compared to controls at 1- and 2-year follow-up.</div></div><div><h3>Discussion</h3><div>Chronic NSAID use was associated with increased risk of distal BTI at 1- and 2-year follow-up, including in sex-specific analysis. These findings may inform risks and expectations for providers prescribing chronic NSAIDs and merit further investigation.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1833-1839"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108220","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":"Comparing the exposure of the ulna coronoid using the anterior or medial surgical approaches: a cadaveric study","authors":"Sophia Gogos BBMED, MBBS (Hons) ,&nbsp;Rejith V. Mannambeth MS, FRCS, FRACS ,&nbsp;Samuel T. Chee MBBS (Hons), MTrauma (Orth) ,&nbsp;Ash K. Moaveni BHB, MBChB, FRACS, FAOrthA, MPH","doi":"10.1016/j.jseint.2025.05.012","DOIUrl":"10.1016/j.jseint.2025.05.012","url":null,"abstract":"<div><h3>Background</h3><div>Surgical fixation of isolated coronoid process fractures while maintaining the soft tissue integrity of the elbow joint is challenging. Several surgical approaches are described, each with their own benefits and risks. The purpose of this cadaveric study was to compare the extent of visualization and access to the coronoid process using the medial flexor carpi ulnaris (FCU)-split and anterior brachial artery and median nerve (B-M) approaches.</div></div><div><h3>Methods</h3><div>A total of 33 fresh frozen cadaveric upper limb specimens from 17 cadavers were dissected. Two surgical exposures, a FCU-split and anterior B-M interval approach, were performed on each specimen in a randomized order. The visibility of anatomical landmarks of the coronoid process was documented. Deidentified clinical images of the exposed coronoid were taken and the total surface area exposed was analyzed using SketchAndCalc Area calculator Software. The Medartis Aptus coronoid plate was used to assess the ease of screw hole access via each approach.</div></div><div><h3>Results</h3><div>The anterior B-M approach visualized a significantly greater surface area of the coronoid process compared to the medial FCU-split (35.4 mm² vs. 12.8 mm², <em>P</em> = .00). Both sex and side of limb did not independently affect the surface area of the coronoid exposed by either approach. The anteromedial facet and coronoid tip were more easily visualized using the anterior approach, with the sublime tubercle and posterior bundle of the medial collateral ligament seen best via the FCU-split. Access to screw hole labeled 1 was significantly easier using the anterior approach compared to the medial approach, with screws holes 4-10 more easily accessed through the FCU-split.</div></div><div><h3>Conclusion</h3><div>The anterior B-M approach provides significantly greater surface area exposure of the coronoid process compared to the medial FCU-split. While the anterior approach excels in visualization of the coronoid tip, the medial approach may provide easier access to multiple screw placement options.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1840-1846"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108221","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":"Cost-effectiveness of rotator cuff repair based on modern constructs, tear size, and implant cost at 1, 5, and 10 years","authors":"Lambert T. Li MD ,&nbsp;Krishna Mandalia BS ,&nbsp;Andrew R. Ames DO ,&nbsp;Stephen Le Breton BS ,&nbsp;Albert Mousad BS ,&nbsp;Katharine Ives BS ,&nbsp;Janine Molino PhD ,&nbsp;Sarav S. Shah MD","doi":"10.1016/j.jseint.2025.04.038","DOIUrl":"10.1016/j.jseint.2025.04.038","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the cost-effectiveness of arthroscopic rotator cuff repair (RCR) utilizing multiple surgical constructs sorted by tear size.</div></div><div><h3>Methods</h3><div>Real-world cost data and previously published data on both anchor failure loads and retear rates by tear size and construct were inputted into a Markov model with time-points of 1, five, and ten years. Cost-effectiveness was assessed in terms of cost per quality-adjusted life-year (QALY). Health states included intact repair, asymptomatic or symptomatic retear, revision RCR, and cuff tear arthropathy. Knotted and knotless single row (SR) and double row (DR) constructs were used.</div></div><div><h3>Results</h3><div>For small and medium-sized tears, the optimal 10-year strategy was the DR knotted Corkscrew Biocomposite/Swivelock Biocomposite, which had an incremental cost-effectiveness ratio (ICER) of $12,562/QALY and $16,678/QALY, adding 0.54 QALY and 0.51 QALY versus nonoperative management, respectively. For large tears, the optimal 10-year strategy was the DR knotless Swivelock Biocomposite, which had an ICER of $19,836/QALY and added 0.53 QALY versus nonoperative management. For massive tears, the optimal 10-year strategy was the DR knotless Healicoil PEEK/Footprint Ultra polyether ether ketone, which had an ICER of $27,748/QALY and added 0.46 QALY versus nonoperative management.</div></div><div><h3>Conclusion</h3><div>Our study uniquely used modern suture anchors and construct configurations including knotted and knotless for multiple commercially available systems and for every tear size to evaluate short- and long-term cost-effectiveness. We found that, compared to nonoperative management, operative management of cuff tears was the optimal long-term treatment modality; specifically, when considering massive RCT, the DR knotless construct was optimal. This was supported by our finding that operative management of cuff tears is increasingly cost-effective with time, given nonrepaired cuff tears are unlikely to heal and portend worse symptomatology. Our findings may help inform surgeons/payors and guide anchor and construct selection for optimization of value-based care when performing arthroscopic RCR.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1524-1531"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108506","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 insurance-mandated physical therapy does not prevent the need for shoulder arthroplasty in patients with glenohumeral osteoarthritis","authors":"Brendan M. Patterson MD, MPH ,&nbsp;Grant E. Garrigues MD ,&nbsp;Gregory N. Lervick MD ,&nbsp;Maria F. Bozoghlian MD ,&nbsp;Arden Shen BS ,&nbsp;James V. Nepola MD ,&nbsp;Jay D. Keener MD ,&nbsp;Jason E. Hsu MD","doi":"10.1016/j.jseint.2025.04.031","DOIUrl":"10.1016/j.jseint.2025.04.031","url":null,"abstract":"<div><h3>Background</h3><div>Glenohumeral osteoarthritis (GHOA) is a common cause of shoulder pathology for many patients. Nonsurgical treatment options for advanced GHOA are limited, and there are currently no high-level studies supporting the use of physical therapy (PT) to treat advanced cases of GHOA. Despite this, there has been an increasing requirement for insurance-mandated PT before shoulder arthroplasty. The purpose of this study was to investigate patients with shoulder arthritis who were denied shoulder arthroplasty by their insurance carriers based on the lack of preoperative PT. We further sought to assess health-care provider's perception regarding frequency, duration, and overall impact of the peer-to-peer (P2P) process.</div></div><div><h3>Methods</h3><div>This was a multicenter case series of patients with moderate to severe GHOA who were denied shoulder arthroplasty by their insurance carrier due to lack of preoperative PT. The cohort was followed to assess if a P2P took place and if patients were required to perform formal preoperative PT before shoulder arthroplasty. Variables collected included demographic data, insurance carrier status, preoperative range of motion, preoperative patient-reported outcome measures (PROMs), and postphysical therapy PROMs. A survey was administered to assess health-care provider's perception of the frequency, duration, and overall impact of the P2P process.</div></div><div><h3>Results</h3><div>A total of 12 patients were included for analysis. Eleven patients (92%) ultimately underwent the indicated shoulder arthroplasty, and 1 patient was undergoing mandated PT at the time of analysis. Ten of the 12 cases (75%) underwent a P2P. Six P2P appeals (60%) were unsuccessful, and 5 of those patients were required to undergo a course of preoperative PT. Two cases did not undergo a P2P process but were still required to perform PT. A total of 7 patients (58%) were required to undergo formal preoperative PT and 6 of those 7 patients (86%) ultimately underwent shoulder arthroplasty. Results from the survey show that almost half of health-care respondents spend between 40 and 60 minutes on P2P appeals.</div></div><div><h3>Conclusion</h3><div>Despite the lack of evidence to support PT for the treatment of GHOA, many patients indicated for shoulder arthroplasty are denied the surgery by their insurance due to lack of preoperative PT. Insurance-mandated preoperative PT in this cohort did not significantly improve range of motion, pain, or prevent the need for shoulder arthroplasty. Results of this study highlight a significant burden to providers and to patients who are denied a shoulder arthroplasty in the setting of moderate to advanced GHOA.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1616-1622"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108817","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}