JSES International最新文献

{"title":"The role of a multidisciplinary approach to opioid reduction for patients with operatively treated upper extremity fractures","authors":"Jack H. Drake MD, Nathan D. Poli MD, Grant R. Keith MD, Gabrielle R. Kuhn MD, Samuel J. Mosiman MS, Paul S. Whiting MD","doi":"10.1016/j.jseint.2026.101685","DOIUrl":"10.1016/j.jseint.2026.101685","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to determine whether a multimodal program for opioid reduction in upper extremity fracture patients decreased (1) inpatient opioid consumption during post-operative days (PODs) 1-4 and (2) outpatient opioid prescription volume.</div></div><div><h3>Methods</h3><div>We conducted a retrospective comparative study of patients with isolated upper extremity fractures admitted to the inpatient orthopedic unit at an academic level 1 trauma center in 2018 and 2020 (pre- and post-program implementation). We calculated total inpatient opioid consumption (measured in morphine milligram equivalents [MMEs]) during POD 1-4 and from opioid prescriptions within 90 days postdischarge. Patients with multiple concurrent fractures, preinjury opioid use, or less than 90-day follow-up were excluded. Descriptive statistics in the form of frequencies (%) and means (standard deviation) were calculated. Linear mixed modeling with repeated measures revealing <em>P</em> values of .05 or lower was considered statistically significant. Multiple concurrent fractures were defined as bilateral upper extremity injuries, ipsilateral fractures involving separate regions (eg, hand and shoulder), or combined radius and ulna fractures. This modeling was used to evaluate independent predictors of opioid use, including age, American Society of Anesthesiologists class, fracture type, and gabapentin use.</div></div><div><h3>Results</h3><div>A total of 128 patients with an operatively treated upper extremity fracture were identified (76 in 2018, 52 in 2020). No differences were seen in patient demographics. Pre-operative peripheral nerve block use was similar between groups (<em>P</em> = .570). Gabapentin was used in a significantly higher proportion of patients in 2020 than it was in 2018 (34% vs. 18.3%, <em>P</em> = .050). Inpatient opioid consumption significantly decreased from 2018 to 2020 (<em>P</em> = .003), most notably on POD 1 and 2, with age and American Society of Anesthesiologists class being significant predictors of opioid use (<em>P</em> = .0012 and <em>P</em> = .0315, respectively). Mean MMEs on POD 1 were 68.21 in 2018 vs. 50.32 in 2020, whereas mean MMEs on POD 2 were 46.76 in 2018 vs. 12.15 in 2020. Forty-six point zero five percentage of patients in 2018 were taking opioids on POD 2 vs. 26.92% in 2020 (<em>P</em> = .029). Pain scores on POD 1-4 showed no differences (<em>P</em> ≥ .4875). 90-day postdischarge opioid prescriptions decreased in 2020, though not significantly. Fracture location and concomitant gabapentin use were significant predictors of outpatient opioid use (<em>P</em> = .001 and <em>P</em> = .013, respectively.)</div></div><div><h3>Conclusion</h3><div>A multidisciplinary approach is effective for reducing inpatient opioid consumption in operatively treated upper extremity fracture patients, with the greatest reduction seen on POD 1 and 2. Increases in gabapentin prescriptions following protocol impl","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 3","pages":"Article 101685"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147802831","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":"Promoting hematoma-like tissue formation in arthroscopic rotator cuff repair: impact of a bioinductive collagen implant","authors":"Hideki Kinjo MD ,&nbsp;Naoki Suenaga MD, PhD ,&nbsp;Naomi Oizumi MD, PhD ,&nbsp;Jun Kawamata MD ,&nbsp;Kotaro Nishida MD, PhD","doi":"10.1016/j.jseint.2026.101699","DOIUrl":"10.1016/j.jseint.2026.101699","url":null,"abstract":"<div><h3>Background</h3><div>Hematomas, rich in platelet-derived growth factors, are vital in tendon–bone healing. Reportedly, larger hematoma-like tissue (HLT) surrounding the repaired tissue at 6-8 weeks after rotator cuff repair on T2-weighted magnetic resonance imaging effectively predicts structural outcomes (Sugaya classification type 1) at 6 months post-operatively. Recent studies explored the use of a reconstituted type I bovine collagen bioinductive implant derived from the bovine Achilles tendon to improve healing rates and tissue thickness, leading to favorable clinical outcomes. Therefore, we aimed to evaluate whether using this collagen implant to cover the lateral side of the sutured rotator cuff enhances the HLT size, formation, and maintenance at 6-8 weeks post-operatively.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we analyzed patients who underwent arthroscopic rotator cuff repair using the surface-holding method. Fifty-eight patients were treated without implants (H group), while 58 received bioinductive collagen implants (REGENETEN; Smith &amp; Nephew, Andover, MA, USA) (R group). Magnetic resonance imaging was performed at 1 week and 6-8 weeks post-operatively to evaluate HLT thickness, classified as grades 1 (no HLT), 2 (HLT not exceeding the line connecting the cuff surface and the lateral edge of the greater tuberosity), or 3 (HLT exceeding the line). Retears at 6-8 weeks post-operatively were also assessed.</div></div><div><h3>Results</h3><div>At 1 week post-operatively, 55.2% of the H group and 60.3% of the R group were classified as grade 3, with no significant difference (<em>P</em> = .71). At 6-8 weeks, 22.4% and 63.8% of the H and R groups, respectively, were classified as grade 3 (<em>P</em> &lt; .05). Moreover, 40.6% and 77.1% of the H and R groups, respectively, maintained grade 3 from week 1 to 6-8 weeks post-operatively (<em>P</em> &lt; .05). In addition, in the H group, no case changed from grade 1 or 2 to grade 3, whereas 37.5% of cases in the R group changed from grade 1 to grade 3 and 50% changed from grade 2 to grade 3. Furthermore, the R group had fewer cases in which the HLT became thinner, disappeared, or experienced a retear compared to the H group (<em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>Implanting a reconstituted type I bovine collagen bioinductive implant in arthroscopic rotator cuff repair using the surface-holding method helps to preserve and enhance HLT thickness, with a higher proportion of patients achieving grade 3 HLT at 6-8 weeks post-operatively. These findings suggest the potential of collagen implants to improve tendon–bone healing and structural outcomes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 3","pages":"Article 101699"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147802832","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":"Operative treatment is associated with improved 3-year survival after periprosthetic humerus fracture","authors":"Alyssa R. Henriquez BS,&nbsp;Bryan Crook MD,&nbsp;Lindsey V. Ruderman BA,&nbsp;Aaron Therien BS,&nbsp;Eoghan T. Hurley MB, MCh, PhD,&nbsp;Christopher Klifto MD,&nbsp;Oke Anakwenze MD MBA,&nbsp;Michael A. Moverman MD","doi":"10.1016/j.jseint.2026.101688","DOIUrl":"10.1016/j.jseint.2026.101688","url":null,"abstract":"<div><h3>Background</h3><div>This study examines the survival implications of operative versus nonoperative management of periprosthetic humerus fractures in a large, single-center cohort.</div></div><div><h3>Methods</h3><div>Patients at a single tertiary care center with periprosthetic humerus fractures about a shoulder prosthesis between January 2013 and March 2024 were retrospectively identified. Patients were stratified according to operative versus nonoperative treatment. The primary outcome was all-cause mortality. Survival was compared using Kaplan–Meier curves and log-rank tests. Prespecified time horizons were 90 days, 1 year, 2 years, and 3 years.</div></div><div><h3>Results</h3><div>Ninety patients with periprosthetic fractures were identified (23 nonoperative, 67 operative). There were 13 total deaths (8/23 [35%] nonoperative, 5/67 [7.5%] operative). Baseline characteristics were largely similar aside from a higher body mass index in the operative group (32 vs. 29 kg/m², <em>P</em> = .046). Age (nonoperative: 74 vs. operative: 71 years, <em>P</em> = .30), sex (<em>P</em> = .40), hand dominance (<em>P &gt;</em> .9), race (<em>P =</em> .07), smoking (<em>P =</em> .40), comorbidity burden (Elixhauser weighted and count <em>P</em> = .20 and <em>P</em> = .60, respectively), and Charlson distribution (<em>P</em> = .20) were all similar between groups. On Kaplan–Meier analysis, early mortality was rare: 90-day survival was 95.7% in the nonoperative group versus 100.0% in the operative group (<em>P</em> = .09). Survival differences widened over time, becoming significant at 3 years after the injury: 1 year (nonoperative: 95.7%; operative: 98.5%; <em>P</em> = .42), 2 years (nonoperative: 90%, operative: 98.5%; <em>P</em> = .09), and 3 years (nonoperative: 72.2%; operative: 96.5%; <em>P</em> = .004).</div></div><div><h3>Conclusions</h3><div>Surgical fixation of periprosthetic humerus fractures is associated with lower mortality that becomes apparent in a delayed fashion and grows over time. By 3 years after the injury, the mortality difference approached 25% between operatively and nonoperatively treated patients. These findings should be validated in larger, multicenter studies.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 3","pages":"Article 101688"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147802210","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":"Osteochondral autograft transfer for capitellar osteochondritis dissecans in high-level adolescent athletes","authors":"Aditi S. Desai BS ,&nbsp;Jeffery D. Hassebrock MD ,&nbsp;Grant O. Killian BS ,&nbsp;Andrew T. Mathias BS ,&nbsp;David R. Diduch MD ,&nbsp;A. Bobby Chhabra MD","doi":"10.1016/j.jseint.2026.101680","DOIUrl":"10.1016/j.jseint.2026.101680","url":null,"abstract":"<div><h3>Background</h3><div>Osteochondritis dissecans (OCD) of the capitellum is a condition that predominantly affects high-performing adolescent athletes engaged in repetitive overhead motion and can lead to pain and mechanical symptoms that can interfere with the ability to perform in sports. Optimal surgical management of large OCD lesions remains inadequately studied. Prior studies have shown good short-term outcomes with the use of osteochondral autograft transfer (OAT). This study's primary objective is to evaluate the long-term outcomes of adolescent athletes undergoing OAT procedures for capitellar OCD.</div></div><div><h3>Methods</h3><div>We retrospectively identified 28 patients with large (≥1 cm²) unstable capitellar OCD lesions who underwent OATs from the ipsilateral knee. The average age at the time of surgery was 14.95 years (range, 11-22 years). Time to return to play, post-operative and final level of play, Disabilities of the Arm, Shoulder and Hand (DASH) and Sport-Specific DASH questionnaires, pre-operative and post-operative elbow range of motion, post-operative elbow Single Assessment Numeric Evaluation score, and radiographic outcomes were collected and analyzed. Twenty patients were available for evaluation at an average of 62.4 months of follow-up (range 6 to 164.5 months). Chart review was conducted for the remaining patients.</div></div><div><h3>Results</h3><div>The average return to play timeline was 6.28 months (range, 3-13 months). The return to sport rate was 95%. Eighty percent of pitchers returned to pitching, all throwing by an average of 4 months. The average overall DASH score was 3.79 (95% confidence interval [CI]: 1.83–5.75), and the average Sport Specific DASH score was 7.11 (95% CI: 0.45–14.78). Elbow range of motion significantly improved, with improvement in flexion from a pre-operative average of 130.3° to 140.9° post-operatively (<em>P</em> &lt; .001) and improvement in extension from a pre-operative average of 16.1° to 2.3° post-operatively (<em>P</em> &lt; .001). Average post-operative elbow Single Assessment Numeric Evaluation scores collected from 12/20 patients were 85.8 (range, 60-100). Osseous integration of the graft site was complete in 24 of the patients by the 12-week post-operative visit.</div></div><div><h3>Conclusion</h3><div>Treatment of large, unstable OCD lesions of the capitellum in adolescent athletes is safe, allows for a high rate of return to sport, and has good clinical outcomes with long-term follow-up.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 3","pages":"Article 101680"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147802830","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":"Variability in preoperative planning software for shoulder arthroplasty","authors":"Ana R. Senra MD ,&nbsp;Diogo Tomaz MD ,&nbsp;Diogo S. Gomes MD ,&nbsp;Nuno S. Gomes MD ,&nbsp;Nuno Sevivas PhD ,&nbsp;Francisco Serdoura MD ,&nbsp;André Pinho PhD ,&nbsp;Alberto Vieira MD ,&nbsp;Nuno Neves PhD ,&nbsp;Carlos M. Dias PhD ,&nbsp;Daniela Linhares PhD ,&nbsp;Maria J. Leite PhD ,&nbsp;Manuel R. Silva PhD","doi":"10.1016/j.jseint.2026.101698","DOIUrl":"10.1016/j.jseint.2026.101698","url":null,"abstract":"<div><h3>Background</h3><div>Three-dimensional preoperative planning is increasingly used in shoulder arthroplasty to optimize implant selection and component positioning. Planning platforms rely on either automated best-fit sphere algorithms or manual landmark-based methods to characterize glenoid morphology, potentially introducing variability. This study aimed to compare 5 commercially available planning platforms and to determine whether differences in analytical algorithms explain intersoftware variability.</div></div><div><h3>Methods</h3><div>Thirty-three patients were included. Preoperative computed tomography scans were analyzed using Blueprint system (Stryker, Kalamazoo, MI, USA), Equinoxe Planning App (Exactech, Gainesville, FL, USA), Signature ONE Surgical Planning System (Zimmer Biomet, Warsaw, IN, USA), MyShoulder system (Medacta, Castel San Pietro, Switzerland), and LimaCorporate Pre-Op Planning Software (LimaCorporate/Enovis, San Daniele del Friuli, Udine, Italy). Glenoid version, inclination, and humeral head subluxation were assessed. Data analysis included a group evaluation for each variable and pairwise comparisons between software. A comparative analysis between automated and manual assessment methods was performed.</div></div><div><h3>Results</h3><div>Significant differences were found between platforms for version (<em>P</em> &lt; .001), inclination (<em>P</em> = .015), and subluxation (<em>P</em> = .032). Agreement was high for subluxation (intraclass correlation coefficient [ICC] = 0.826), moderate to high for version (ICC = 0.749), and low for inclination (ICC = 0.267). Pairwise agreement ranged from 45.5 to 97% for version (highest between Blueprint and LimaCorporate), 30.3–90.9% for inclination, and 60.6–75.8% for subluxation (lowest between Blueprint and LimaCorporate).</div></div><div><h3>Conclusion</h3><div>Significant variability exists between preoperative planning software, particularly for inclination. Automated software demonstrated the highest concordance for version but the lowest concordance for subluxation. These results suggest that, even with similar analytical algorithms, uniformity between software is lacking, potentially impacting surgical planning. Methodological standardization is essential to improve reliability and reproducibility of shoulder arthroplasty planning. Surgeons should consider this variability when planning shoulder arthroplasty and interpreting studies with different planning platforms.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 3","pages":"Article 101698"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147802209","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":"Long-term results of surgical management of high-energy scapula fractures at a major trauma center","authors":"Shoib Mahmood MBBS, FRCS (Tr& Orth),&nbsp;Georgios Mamarelis MD, FRCSEd(Tr & Orth), PGCert, Med Ed, MSc,&nbsp;Mochamed Hachem MD, MRCS, FEBOT,&nbsp;Adel Tavakkolizadeh MB, BS, MSC, FRCS (Orth),&nbsp;Karthik Karuppaiah FRCS (T&O),&nbsp;Toby Colegate-Stone MA (Oxon), MBBS, MRCS, MSc (Orth), FRCS (Tr & Orth)","doi":"10.1016/j.jseint.2026.101682","DOIUrl":"10.1016/j.jseint.2026.101682","url":null,"abstract":"<div><h3>Background</h3><div>Scapular fractures are rare injuries typically resulting from high-energy trauma and often occur in polytrauma patients. Historically managed nonoperatively, recent trends in surgical intervention have evolved, particularly in major trauma centers (MTCs) where expertise and case volume have increased. However, there remains limited literature on the surgical management and long-term outcomes of these injuries.</div></div><div><h3>Methods</h3><div>This retrospective cohort study reviewed all patients who underwent surgical fixation for scapular fractures over a 10-year period at a single UK MTC. Patient demographics, injury mechanism, fracture classification (using the Swedish Fracture Registry topographical system), surgical approach, and outcomes were analyzed. Outcomes included objective measures (union, complications, return to work/sport) and patient-reported outcome measures (Oxford Shoulder Score, disability of the arm, shoulder, and hand, American Shoulder and Elbow Surgeons score, EuroQol 5-Dimension questionnaire, and EuroQol Visual Analogue Scale). Statistical analysis included chi-squared and Mann-Whitney-Wilcoxon tests.</div></div><div><h3>Results</h3><div>Forty-five patients (36 males; mean age 46 years) were included. The majority (64%) sustained injuries from road traffic accidents, with 49% classified as having severe or profound injuries (injure severity score &gt;15). Displaced intra-articular fractures represented the most common fracture subtype (53%). At a mean follow-up of 78 months, 56% of patients completed patient-reported outcome measures. Mean scores were Oxford Shoulder Score: 40.1, disability of the arm, shoulder, and hand: 15.3, American Shoulder and Elbow Surgeons score: 82.7, EuroQol 5-Dimension questionnaire: 0.54, and EuroQol Visual Analogue Scale: 82.1. Intra-articular fractures were associated with the highest complication and reoperation rates, primarily due to post-traumatic glenohumeral capsulitis and early arthrosis. The overall complication rate was 35.7%, reducing to 15.6% when excluding capsulitis. No 30-day mortality was observed. Return to work and sport occurred at a mean of 147 and 185 days, respectively.</div></div><div><h3>Conclusion</h3><div>Surgical management of high-energy scapular fractures in a high-volume MTC setting can achieve good long-term clinical outcomes. Intra-articular fracture patterns carry a higher risk of complications and may require further intervention. This study provides the longest reported follow-up of scapula fracture surgery to date and highlights the importance of specialist surgical experience, structured classification, and long-term patient support.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 3","pages":"Article 101682"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147802829","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":"Letter regarding \"Grit is not associated with opioid consumption patterns in patients that undergo arthroscopic rotator cuff repair\".","authors":"Tirayut Veerasatian, Schawanya K Rattanapitoon, Nav La, Nathkapach K Rattanapitoon","doi":"10.1016/j.jseint.2026.101619","DOIUrl":"https://doi.org/10.1016/j.jseint.2026.101619","url":null,"abstract":"","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"101619"},"PeriodicalIF":0.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783187","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":"Do patients trust the tech? Exploring perception, confidence, and knowledge of innovations in shoulder arthroplasty","authors":"Aghdas Movassaghi BS ,&nbsp;Elizabeth W. Chan BS ,&nbsp;Justin T. Childers MS ,&nbsp;Benjamin T. Lack BS ,&nbsp;Garrett R. Jackson MD ,&nbsp;Clyde Fomunung MD ,&nbsp;Roya Osswald ,&nbsp;Vani J. Sabesan MD","doi":"10.1016/j.jseint.2025.101415","DOIUrl":"10.1016/j.jseint.2025.101415","url":null,"abstract":"<div><h3>Background</h3><div>As surgical technologies, such as three-dimensional preoperative planning, computer navigation, and augmented reality, become increasingly utilized in shoulder arthroplasty, questions remain about their value from the patient's perspective. While education and patient interest have driven demand and technology adoption in hip and knee arthroplasty, their role in shoulder procedures remains unclear. This study aimed to evaluate patient perceptions of innovative technologies in shoulder arthroplasty and assess whether preoperative education influences confidence, satisfaction, and expectations.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 87 patients scheduled to undergo shoulder arthroplasty at a single institution completed a preoperative survey assessing demographics, baseline familiarity with surgical technologies, and perceptions of surgeon use of innovative tools prior to seeing their provider. Following this, patients then viewed a standardized educational video on the role of technology in shoulder arthroplasty. Postvideo responses measured changes in confidence, satisfaction, and outcome expectations. Statistical analysis included paired t-tests and analysis of variance to evaluate prepost changes and demographic associations.</div></div><div><h3>Results</h3><div>Over half of patients (56.3%) were unfamiliar with innovative technologies at baseline, yet 60.9% reported increased confidence in surgeons using it. Most patients (66.7%) preferred the use of advanced planning technologies, though only 41.5% would choose a low-volume surgeon using these tools over a high-volume surgeon using conventional techniques. Improvements in confidence were significantly correlated with higher education and income levels (r = 0.31, <em>P</em> = .003). After viewing an educational video, patient confidence in their surgeon increased (<em>P</em> = .03), and expectations for improved outcomes (<em>P</em> &lt; .001), fewer complications (<em>P</em> &lt; .001), less pain (<em>P</em> &lt; .001), and faster recovery (<em>P</em> &lt; .001) significantly rose. Despite favorable perceptions, 62.1% of patients were unwilling to pay more, travel further, or wait longer to receive care involving innovative technologies.</div></div><div><h3>Conclusion</h3><div>Targeted preoperative education on surgical technology may improve patient confidence, strengthen perceptions of surgeon competency, and elevate expectations of care. While enthusiasm for advanced tools was observed following education, broader adoption may still be influenced by cost and accessibility. These findings support the role of brief, technology-focused education in enhancing the overall patient experience in shoulder arthroplasty.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101415"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941283","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":"Bot vs. doc—who is better at reading proximal humerus fracture x-rays?","authors":"Kyle K. Obana MD,&nbsp;Mark Ren MD,&nbsp;Andrew J. Luzzi MD,&nbsp;Matthew R. LeVasseur MD,&nbsp;Hasani W. Swindell MD,&nbsp;William N. Levine MD","doi":"10.1016/j.jseint.2025.101426","DOIUrl":"10.1016/j.jseint.2025.101426","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence is becoming increasingly utilized as a source of convenient, efficient, and cost-effective information. Considering the potential utility of ChatGPT as an adjuvant in clinical decision making, the current study evaluates (1) the accuracy of ChatGPT-5 at evaluating shoulder x-rays containing either normal or proximal humerus fracture (PHFx) diagnoses and (2) interrater reliability between ChatGPT and orthopedic surgeons at different levels of training.</div></div><div><h3>Methods</h3><div>The Stanford University Musculoskeletal Radiographs publicly accessible dataset was utilized, and 70 x-rays (35 PHFx, 35 normal) were analyzed after inclusion and exclusion criteria were applied. X-rays were reviewed independently by an orthopedic surgery junior resident, senior resident, shoulder/elbow fellow, and shoulder/elbow fellowship-trained attending. X-rays for each patient were uploaded to ChatGPT-5 and questions were asked using a response-based algorithm.</div></div><div><h3>Results</h3><div>ChatGPT-5 demonstrated a sensitivity of 61.8%, specificity of 74.3%, and an overall accuracy of 67.1% for PHFx x-rays. ChatGPT incorrectly diagnosed 25.7% of normal x-rays with a fracture or dislocation. ChatGPT incorrectly diagnosed 23.5% of isolated PHFx x-rays as normal, 8.8% with an isolated glenohumeral dislocation without fracture, and 5.7% with a PHFx dislocation. Inter-rater reliability for ChatGPT was slight for displaced parts and poor for fractured part, Neer parts, and located glenohumeral joint. Junior and senior residents had moderate to substantial agreement with the attending reads (fractured part, displaced parts, Neer parts), while the fellow had substantial to almost perfect agreement.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that ChatGPT-5 is highly inaccurate at identifying PHFx on shoulder x-rays, characterizing the fracture patterns, and providing accurate interpretations of shoulder x-rays. Over-reliance on generative artificial intelligence to guide clinical decisions risks harm to the patients and should be approached with limited credence.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101426"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078875","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 structural outcomes of arthroscopic rotator cuff repair augmented with biceps-based partial superior capsular reconstruction and distal tenotomy at two-year follow-up","authors":"Chang Hee Baek MD ,&nbsp;Bo Taek Kim MD ,&nbsp;Gustavo A. Gil Noriega MD ,&nbsp;Jung Gon Kim MD ,&nbsp;Chaemoon Lim MD ,&nbsp;Paulo José Llinás Hernández MD","doi":"10.1016/j.jseint.2025.101433","DOIUrl":"10.1016/j.jseint.2025.101433","url":null,"abstract":"<div><h3>Background</h3><div>Repair of medium to large rotator cuff tears (RCTs) presents ongoing challenges, as the procedure may result in tendon retear and inadequate healing. Partial superior capsular reconstruction (pSCR) using the long head of the biceps tendon (LHBT) has emerged as a biomechanically robust and biologically advantageous technique for augmenting rotator cuff repairs. This study aims to evaluate the clinical and structural outcomes of arthroscopic rotator cuff repair augmented with pSCR using the LHBT combined with distal tenotomy in patients with medium to large reparable RCTs at two years postoperatively.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on patients who underwent arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy between January 2014 and June 2017. Surgical indications were reparable supraspinatus tears, with or without infraspinatus involvement, accompanied by tendon retraction, high-grade fatty infiltration, and an intact or less than 50% partial tear of the LHBT. Exclusion criteria included prior shoulder surgery, shoulder infection, irreparable subscapularis tear, or incomplete follow-up. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and range of motion, while structural integrity was evaluated via ultrasonography at the 2-year follow-up.</div></div><div><h3>Results</h3><div>After excluding 10 patients, 45 patients (mean age: 67.2 ± 6.3 years) were included in the analysis. The VAS score improved significantly from 6.1 ± 1.3 to 1.7 ± 1.1, and the ASES score increased from 31.0 ± 7.9 to 77.2 ± 7.7 (both <em>P</em> &lt; .001). Forward elevation improved from 95° to 156°, abduction from 78° to 142°, and external rotation from 33° to 50° (all <em>P</em> &lt; .001). All patients met the minimal clinically important difference for both VAS and ASES scores. Ultrasonography at the 2-year follow-up demonstrated complete healing of the repair with the pSCR construct in 86.7% of patients, partial healing in 6.6%, and complete retear in 6.6%. No patients reported postoperative anterior shoulder pain. Subgroup analysis showed comparable outcomes between single-row repair with pSCR for medium-sized RCTs and double-row repair with pSCR for large-sized RCTs.</div></div><div><h3>Conclusion</h3><div>Arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy resulted in significant improvements in pain and range of motion at the 2-year follow-up in patients with medium to large reparable RCTs. A high healing rate was observed with the pSCR construct, and no significant complications were reported.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101433"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079045","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}