JSES International最新文献

{"title":"Occupational and functional outcomes of arthroscopic labral repair are not affected by concomitant extra-articular shoulder procedures","authors":"Collin D.R. Hunter BS ,&nbsp;Brandon Wilde BS ,&nbsp;Adrik Da Silva BS ,&nbsp;Anish Singh BS ,&nbsp;Mitchell Kirkham BS ,&nbsp;Daniel J. Song MD ,&nbsp;Peter N. Chalmers MD ,&nbsp;Justin J. Ernat MD","doi":"10.1016/j.jseint.2025.05.017","DOIUrl":"10.1016/j.jseint.2025.05.017","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to compare return to work (RTW), patient-reported outcomes, and complications in patients who underwent arthroscopic labral repair for anterior and posterior shoulder instability with and without concomitant extra-articular procedures.</div></div><div><h3>Methods</h3><div>This is a retrospective chart review of 535 consecutive patients who received arthroscopic labral repair for unidirectional shoulder instability between 2013 and 2020. Patients aged &lt;17 years, with revision procedures, without documented dislocation/subluxation, and with multidirectional instability were excluded. Patients with the concomitant extra-articular procedures, such as biceps tenodesis (BT), rotator cuff repair (RCR), and distal clavicle excision (DCE), and those with &gt;1 of these procedures were propensity score matched with isolated labral repairs based on age, sex, body mass index, and direction of instability (anterior or posterior). Outcomes included satisfaction, RTW, subsequent surgeries, recurrent instability, Patient-reported Outcomes Measures Information System – Upper Extremity, single alphanumeric evaluation, and American Shoulder and Elbow Surgeons scores.</div></div><div><h3>Results</h3><div>A total of 67 patients who met inclusion criteria, with 55 (82%) available for minimum 2-year follow-up (mean age: 34.6 years; range 17-62 years), including 30 BT, 10 RCR, 8 DCE, and 7 combination procedures. The matched control group included 53 patients (mean age: 32.2 years). There were no differences found between the BT (n = 36) and controls, RCR (n = 10) and controls, DCE (n = 12) and controls, nor combination (n = 7) and controls, in satisfaction, subsequent ipsilateral shoulder surgery, return to work (RTW), or recurrent instability. Similarly, single alphanumeric evaluation, American Shoulder and Elbow Surgeons, and Patient-reported Outcomes Measures Information System – Upper Extremity scores were all comparable at pre- and post-operative levels between BT and controls, RCR and controls, and DCE and controls.</div></div><div><h3>Conclusion</h3><div>Concomitant extra-articular procedures, including BT, DCE, and RCR, did not affect patient satisfaction, RTW, rates subsequent surgery, or recurrent instability when compared to patients undergoing isolated arthroscopic labral repair. Surgeons and patients can have confidence in performing these procedures concomitantly if they are felt to be indicated.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1457-1461"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109047","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":"Minimum 10-year outcomes after arthroscopically assisted anatomic coracoclavicular ligament reconstruction for the treatment of type III and V acromioclavicular joint injuries","authors":"Maximilian Hinz MD ,&nbsp;Bradley M. Kruckeberg MD ,&nbsp;Marilee P. Horan MPH ,&nbsp;Amelia Drumm BA ,&nbsp;Ayham Jaber MD ,&nbsp;Christopher J. Hawryluk MBS ,&nbsp;Peter J. Millett MD, MSc","doi":"10.1016/j.jseint.2025.05.018","DOIUrl":"10.1016/j.jseint.2025.05.018","url":null,"abstract":"<div><h3>Background</h3><div>Acromioclavicular joint (ACJ) injuries can lead to severe pain and reduced shoulder function. Anatomic coracoclavicular ligament reconstruction (ACCR) using a free tendon graft has demonstrated favorable biomechanical properties and good short- to mid-term outcomes, but data on long-term outcomes are scarce. The purpose of the present study was to evaluate the long-term clinical and functional outcomes after ACCR with a focus on return to sport and revision surgery.</div></div><div><h3>Methods</h3><div>Patients who underwent ACCR using a free tendon allograft for the treatment of ACJ injuries type III or V between November 2006 and April 2011 by a single surgeon, with a minimum 10-year follow-up, were eligible for inclusion. Patient-reported outcome measures, including the American Shoulder and Elbow Surgeons score, short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, Single Assessment Numeric Evaluation, patient satisfaction (1-10 scale with “10” indicating maximum satisfaction), rates of return to sport and revision surgery were evaluated minimum 10 years postoperatively. Pain (via visual analog scale) was assessed preoperatively and at final follow-up. Patients who underwent further surgery were excluded from analysis. Survivorship was reported as two scenarios: not undergoing revision ACJ stabilization and not undergoing any further surgery.</div></div><div><h3>Results</h3><div>Fourteen patients were evaluated after 13.0 (interquartile range, 12.0-15.0) years. Four patients (28.6%) underwent further surgery (revision ACJ stabilization [n = 2], exostosis removal [n = 2]) and were excluded from further analysis. Shoulder function was excellent at follow-up (American Shoulder and Elbow Surgeons score: 100 [96.6-100], Quick Disabilities of the Arm, Shoulder and Hand: 0 [0-5.1]), Single Assessment Numeric Evaluation: 99.0 [91.5-99.0]). Pain levels decreased significantly from preoperatively to follow-up (visual analog scale for pain: 2.0 [1.0-3.0] to 0 [0-0.5], <em>P</em> = .016). Satisfaction at follow-up was high (10 [5.0-10]). Nine patients reported their postoperative sporting level, of which eight returned to sport (88.9%). Four patients (44.4%) returned equal to or above the preoperative level and 4 patients (44.4%) returned below their preoperative level. One patient reported hypersensitivity and anterior shoulder pain postoperatively but reported low pain levels at follow-up. Survivorship was 85.7% for not undergoing revision ACJ stabilization and 71.4% for not undergoing any further surgery.</div></div><div><h3>Conclusion</h3><div>ACCR using a free tendon graft for the treatment of ACJ injuries type III or V resulted in good to excellent shoulder function, low pain levels, and high patient satisfaction at long-term follow-up. The rate of revision ACJ stabilization was 14.3%.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1462-1466"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109048","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":"Biomechanical impact of repair of the posterior band of the inferior glenohumeral ligament on anterior stabilization of the shoulder with a large glenoid bone defect","authors":"Amadou Diop PhD ,&nbsp;Nathalie Maurel PhD ,&nbsp;Aurore Blancheton MD ,&nbsp;Théo Kavakelis MD ,&nbsp;Claire Bastard MD ,&nbsp;Geoffroy Nourissat PhD","doi":"10.1016/j.jseint.2025.05.030","DOIUrl":"10.1016/j.jseint.2025.05.030","url":null,"abstract":"<div><h3>Background</h3><div>Anterior glenohumeral dislocation usually results in capsuloligamentous lesions and the most common repair consists in reattachment of the anterior band of the inferior glenohumeral ligament (IGHL) to the glenoid. But it appears that reattachment of the posterior band (PB) of the IGHL to the glenoid is also important, particularly when there is an anterior glenoid bone loss. The aim of this biomechanical study was to analyze the effect of such a complementary repair of the IGHL PB compared to an isolated anterior repair, in an unstable shoulder with anterior glenoid bone defect.</div></div><div><h3>Methods</h3><div>Six fresh-frozen cadaveric shoulders were tested intact, after creating a 20% glenoid bone defect and anterior and posterior injuries of the IGHL, after anterior repair and finally after anterior and posterior repairs. Shoulders were placed at 90° of humerothoracic elevation in scapular plane and 60° of external rotation. Joint stability was analyzed by applying an anteroinferior loading and measuring three-dimensional humeral head displacements. Maximal range of external rotation was also measured.</div></div><div><h3>Results</h3><div>A lesion to the PB is needed to produce high instabilities in anteroinferior direction and a complementary repair of the PB increased the stability of the glenohumeral joint compared to an isolated anterior repair. The 2 repairs did not produce any deficit in external rotation compared to intact situation.</div></div><div><h3>Conclusion</h3><div>In the present testing conditions, repair of the PB of the IGHL increased shoulder stability when compared to isolated anterior repair, even when there was a 20% anterior glenoid bone loss.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1467-1473"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109049","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":"Incidence, management, and outcomes following elbow ulnar collateral ligament injuries in nonquarterback professional football players","authors":"Neel K. Patel MD ,&nbsp;Adeeb Hanna DO ,&nbsp;William L. Johns MD ,&nbsp;Arsh S. Dhanota MD ,&nbsp;Christopher C. Dodson MD ,&nbsp;Matthew Pepe MD","doi":"10.1016/j.jseint.2025.04.010","DOIUrl":"10.1016/j.jseint.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Ulnar collateral ligament (UCL) injuries can cause significant disability, especially in overhead throwing athletes. A majority of studies in the literature focus on the effects of UCL injuries in baseball players, but little is known about the severity and outcomes of these injuries in elite nonthrowing contact athletes. The purpose of this study was to characterize the severity of UCL injuries and describe management outcomes in nonthrowing professional football players.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted using the National Football League (NFL) Injury Surveillance System on nonquarterback players that had a UCL injury from 2015 to 2022. Player demographics, player position, severity and mechanism of injury, type of management, and time to return to play were collected. The severity of injury was classified based on laxity on clinical examination and graded on a scale of I-III. Data were analyzed to determine the number of injuries that occurred per year, per position, and per setting to determine differences in time from play that was missed based on injury severity. Statistical significance was set a <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>A total of 268 nonquarterback NFL players sustained isolated UCL injuries between 2015 and 2022, including 33.5 ± 4.2 injuries per year. Offensive and defensive linemen were the most common positions to sustain isolated UCL injuries, accounting for 56.0% (150 of 268 total injuries total) of all nonquarterback UCL injuries in the NFL. Ninety-eight percent of player with isolated UCL injuries were treated nonoperatively with only 4 players requiring surgical treatment of their injury. Seventy-three percent of injuries were grade I sprains, 16.8% were grade II sprains, and 10.1% were Grade III sprains. Seventy-two percent of athletes did not miss any time due to their isolated UCL injury. In the 28% of players that did miss time, the mean time missed was 5.4 ± 24.2 days. There was a significant difference in the time missed between grade I and grade II injuries (1.1 days vs. 12.4 days; <em>P</em> &lt; .05) and grade I and grade III injuries (1.1 days vs. 26.3 days; <em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>Isolated UCL injuries are relatively uncommon injuries in nonquarterback NFL players. The vast majority of injuries are grade I sprains and are treated nonoperatively. Grade II and grade III injuries result in significantly increased time missed compared to grade I injuries. This information can be useful when counseling players regarding prognosis and timing of return to play based on severity of injury.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1809-1812"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108574","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":"Individualized humeral tray selection in a single design of implant (comprehensive system; Zimmer Biomet, Warsaw, IN) based on clinical symptoms and anatomy enhanced clinical outcomes following reverse total shoulder arthroplasty","authors":"Seok Won Lee MD ,&nbsp;Hyeon Jang Jeong MD, PhD ,&nbsp;Young Ki Min MD ,&nbsp;Sheng Chen Han MD ,&nbsp;Jian Han MD, PhD ,&nbsp;Joo Han Oh MD, PhD","doi":"10.1016/j.jseint.2025.05.019","DOIUrl":"10.1016/j.jseint.2025.05.019","url":null,"abstract":"<div><h3>Background</h3><div>Recently, a medialized offset eccentric humeral tray was introduced to overcome the complications based on excessive humeral lateralization after reverse total shoulder arthroplasty (rTSA). However, previous literature evaluating the clinical outcomes of the eccentric tray is still not sufficient. Therefore, this study aimed to compare the functional outcomes of rTSA according to individualized humeral tray selection based on clinical symptoms and anatomical parameters. We hypothesized that rTSA with individualized tray selection would result in better clinical outcomes than the routine use of a concentric or eccentric tray regardless of clinical or radiological findings.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 182 patients who underwent rTSA with a single type of lateralized glenoid–lateralized humerus implant with adjustable tray options (Comprehensive System; Zimmer Biomet, Warsaw, IN, USA) between September 2017 and March 2022. Since the eccentric tray became available for use in December 2019, patients before (early period) and after this date (late period) were divided into four groups based on the study period and humeral tray options; Groups EE (early period, indicated for eccentric tray but not applied), EC, LE (late period, eccentric tray), and LC (late period, concentric tray). The eccentric tray was indicated to overcome pseudoparalysis, meanwhile, the concentric tray was utilized in patients with positive external rotation lag sign without pseudoparalysis. If a patient had neither pseudoparalysis nor external rotation lag sign, the eccentric tray was utilized in patients with a critical shoulder angle less than 32° or center of rotation–to–acromion distance more than 14 mm. Functional and radiological outcomes were compared between four groups. The mean follow-up duration for the overall cohort was 12.8 ± 2.0 months (range: 12-24).</div></div><div><h3>Results</h3><div>Compared to EE, LE presented greater distalization (EE vs. LE 29.0 ± 5.0 mm vs. 38.0 ± 4.0 mm, <em>P</em> &lt; .001) and less lateralization (19.0 ± 5.0 mm vs. 15.0 ± 4.0 mm, <em>P</em> = .001). Also, LE showed better postoperative forward flexion than EE (134.3° ± 14.1° vs. 144.2° ± 8.8°, <em>P</em> &lt; .001). Meanwhile, the functional and radiological outcomes of LC were not different from those of EC (all <em>P</em> &gt; .05). Notably, subacromial erosion was observed in EE alone (5.4%, 2/37).</div></div><div><h3>Conclusion</h3><div>To achieve favorable outcomes and avoid postoperative complications, the mediolateral offset of the humeral tray for lateralized rTSA should be selected based on a comprehensive consideration of clinical symptoms and anatomical characteristics of individual patients.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1683-1692"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108816","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":"Psychosocial factors associated with postoperative outcomes after arthroscopic rotator cuff repair","authors":"Kensuke Oba RPT, PhD ,&nbsp;Kohei Nishikawa RPT, BSc ,&nbsp;Naoki Oikawa ROT, PhD ,&nbsp;Yoshinari Sakaki RPT, PhD ,&nbsp;Yu Sato RPT, BSc ,&nbsp;Hiroki Watanabe RPT, BSc ,&nbsp;Satoshi Ichikawa RPT, MS ,&nbsp;Yujiro Katayama MD ,&nbsp;Hiroaki Tonami MD ,&nbsp;Kazutaka Takahashi MD ,&nbsp;Hideji Kura MD, PhD ,&nbsp;Kenji Okamura MD, PhD","doi":"10.1016/j.jseint.2025.05.031","DOIUrl":"10.1016/j.jseint.2025.05.031","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic rotator cuff repair (ARCR) is a common treatment for rotator cuff tears with postoperative outcomes being influenced by multiple factors. Patient characteristics and surgical techniques are well-documented associated with postoperative outcomes; however, the role of psychosocial factors, including pain catastrophizing, kinesiophobia, and pain self-efficacy, in influencing postoperative functional outcomes remains unclear. The present study explores whether psychosocial factors are associated with postoperative outcomes following ARCR.</div></div><div><h3>Methods</h3><div>This retrospective study included patients who underwent ARCR for full-thickness supraspinatus tears between January 2022 and May 2024. Comprehensive data were collected before and after surgery, including patient demographics, characteristics of the tendon lesion, surgical techniques, and psychosocial factors evaluated using the Tampa Scale for Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), and Pain Self-Efficacy Questionnaire. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score. Multiple linear regression analysis was conducted to evaluate the association between patient demographics, characteristics of the tendon lesion, surgical techniques, psychosocial factors, preoperative ASES scores, and the postoperative ASES scores.</div></div><div><h3>Results</h3><div>Significant improvements were observed postoperatively in ASES, TSK-11, PCS, and Pain Self-Efficacy Questionnaire scores (<em>P &lt;</em> .01, all). Multiple linear regression analysis identified male sex, absence of diabetes, repair technique, higher preoperative ASES scores, and lower TSK-11 and PCS scores as variables independently associated with higher postoperative ASES scores. The model accounted for approximately 10% of the variance in postoperative ASES scores (adjusted R² = 0.10, <em>P &lt;</em> .01).</div></div><div><h3>Conclusion</h3><div>This study suggests a potential association between psychosocial factors—such as kinesiophobia and pain catastrophizing—and functional recovery after ARCR. Although causality cannot be inferred, these associations highlight the potential clinical relevance of psychosocial factors in postoperative recovery. Poorer psychological scores, including high TSK-11 and PCS scores, were associated with lower postoperative outcomes. Further investigation is needed to explore how interventions targeting these psychosocial factors can enhance recovery and patient satisfaction.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1579-1584"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108873","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":"Artificial intelligence to automatically measure on radiographs the postoperative positions of the glenosphere and pivot point after reverse total shoulder arthroplasty","authors":"Linjun Yang PhD ,&nbsp;Elizabeth S. Kaji BA ,&nbsp;Austin F. Grove BA ,&nbsp;Rodrigo de Marinis MD ,&nbsp;Ausberto Velasquez Garcia MD ,&nbsp;Marisa N. Ulrich MD ,&nbsp;John W. Sperling Jr. ,&nbsp;Erick M. Marigi MD ,&nbsp;Joaquin Sanchez-Sotelo MD, PhD","doi":"10.1016/j.jseint.2025.04.027","DOIUrl":"10.1016/j.jseint.2025.04.027","url":null,"abstract":"<div><h3>Background</h3><div>Radiographic evaluation of the implant configuration after reverse total shoulder arthroplasty (rTSA) is a time-consuming task that is frequently subject to interobserver disagreement. Deep learning (DL) artificial intelligence algorithms have previously demonstrated high accuracy when analyzing relevant angles to determine rTSA distalization and lateralization, as well as glenoid inclination and humeral alignment. The goal of this study is to build on this existing work to automatically measure the postoperative radiographic location of the glenosphere center of rotation (GCR) and the pivot point (PP) in reference to the scapula.</div></div><div><h3>Methods</h3><div>A total of 417 primary rTSA postoperative anteroposterior radiographs were retrieved and utilized for this study. Five measurements were designed and manually performed by 3 observers: (1) the medial position and (2) the inferior position of the geometric center of rotation of the glenosphere (glenosphere center of rotation medialization [GCRm] and glenosphere center of rotation inferiorization [GCRi], respectively) relative to the most lateral aspect of the inferior acromion, as well as (3) the projection of the PP to GCR vector on the fossa line (PP projection), (4) the distance between GCR and glenoid (GCR-glenoid distance), and (5) the overall glenoid lateral offset (GLO). Subsequently, a DL algorithm was developed to automatically segment the radiograph and perform the same measurements described above. All measurements were corrected for radiographic magnification using the known glenosphere diameter for each shoulder. Intraclass Correlation Coefficients (ICCs) were calculated to assess interobserver and DL-human agreements on all measurements.</div></div><div><h3>Results</h3><div>The DL algorithm achieved an average Dice Coefficient of 0.86, indicating good segmentation accuracy. The ICCs (95% confidence interval) amongst human observers were 0.86 (0.81-0.90) for the GCRm, 0.93 (0.9-0.95) for the GCRi, 0.95 (0.92-0.96) for the PP projection, 0.85 (0.79-0.89) for GCR-glenoid distance, and 0.92 (0.88-0.95) for GLO. The ICCs between the DL-derived measurements and the average of manual measurements were 0.95 (0.92-0.96) for the GCRm, 0.90 (0.84-0.93) for the GCRi, 0.96 (0.94-0.98) for the PP projection, 0.91 (0.87-0.94) for GCR-glenoid distance, and 0.92 (0.88-0.95) for GLO. The DL algorithm automatically analyzed each testing image in 2 seconds.</div></div><div><h3>Conclusion</h3><div>The developed DL algorithm can automatically measure the location of the glenosphere geometric center of rotation and the location of the PP on postoperative radiographs obtained after primary rTSA. Agreement between DL-derived measures and those from human observers was high. This DL algorithm adds to the armamentarium of tools available for automatic assessment of final implant position on radiographs after rTSA.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1594-1602"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108875","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":"Increasing use of reverse total shoulder arthroplasty in younger adults despite higher complication rates","authors":"Cory K. Mayfield MD ,&nbsp;Julian Wier MD ,&nbsp;Kevin C. Liu MD ,&nbsp;Eric H. Lin BA ,&nbsp;Cailan L. Feingold BS ,&nbsp;Alexander E. Weber MD ,&nbsp;Seth C. Gamradt MD ,&nbsp;Joseph N. Liu MD ,&nbsp;Frank A. Petrigliano MD","doi":"10.1016/j.jseint.2025.05.020","DOIUrl":"10.1016/j.jseint.2025.05.020","url":null,"abstract":"<div><h3>Background</h3><div>The indications for reverse total shoulder arthroplasty (rTSA) continue to expand. Although there has been an increase in the use of rTSA across the United States, there are limited data to evaluate the outcomes of rTSA in younger patients. We sought to evaluate the trends of rTSA use in the United States and to evaluate medical and surgical complications in patients under 60 years of age undergoing rTSA.</div></div><div><h3>Methods</h3><div>Patients who underwent primary, elective anatomic or reverse TSAs between January 1, 2016, and December 31, 2020, were identified using the Premier Healthcare Database. Patients undergoing rTSA were divided into groups based on age &lt;60 years old. Annual trends in rTSA use in this age group were assessed. These patients were then propensity matched to patients ≥60 years old undergoing rTSA. Multivariable models were conducted to evaluate the effect of age on 90-day surgical and medical complications.</div></div><div><h3>Results</h3><div>Over the study period, there was a significant increase in the proportion of rTSAs used, with rTSA comprising 48.29% of all TSA in patients &lt;60 years old in 2016 and rising to 58.77% by 2020 (R² = 0.93). After matching, 3,087 patients &lt;60 years old and 9,261 patients ≥60 years old remained. The groups were well balanced for all covariates with a standardized mean difference of &lt;0.1. After adjusting for residual confounding, 1.53 (95% confidence interval 1.13-2.02) times greater odds of 90-day surgical complications in patients &lt;60 years old were observed, without a difference in odds of medical complications.</div></div><div><h3>Conclusion</h3><div>These results demonstrate the risks associated with younger age in rTSA and suggest that further investigation is required to optimize outcomes of younger patients undergoing rTSA as indications continue to grow.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1693-1697"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108306","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":"Hypogonadism is associated with worse outcomes in arthroscopic rotator cuff repair","authors":"Brandon M. Wilde BS ,&nbsp;Jennifer Wang MD ,&nbsp;James M. Hotaling MD ,&nbsp;Corrine Welt MD ,&nbsp;Robert Z. Tashjian MD ,&nbsp;Christopher D. Joyce MD ,&nbsp;Peter N. Chalmers MD","doi":"10.1016/j.jseint.2025.05.022","DOIUrl":"10.1016/j.jseint.2025.05.022","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this pilot study was to determine the association between systemic circulating factor abnormalities known to associate with fracture nonunion and outcomes after rotator cuff repair (RCR).</div></div><div><h3>Methods</h3><div>This was a prospective study of patients undergoing RCR. Preoperatively and at six months postoperatively, we collected patient-reported outcomes, including visual analog scale for pain scores, simple shoulder test scores, American Shoulder and Elbow Surgeons scores, and a magnetic resonance imaging scan. Preoperatively, we also collected a battery of serum hormone, vitamin, and metabolic tests, including testosterone, estradiol, thyroid-stimulating hormone, luteinizing hormone, vitamin D, calcium, alkaline phosphatase, hemoglobin A1C, and a lipid panel. In men, we collected the Androgen Deficiency in the Aging Male score and, in women, we collected the menopause rating scale, and these scores were defined as normal or abnormal based upon previously published norms.</div></div><div><h3>Results</h3><div>Of the 50 included patients, 46/50 (92%) had clinical and 41/50 (82%) had magnetic resonance imaging follow-up at six months. Forty-three percent (19/44) of included patients were hypogonadal, 32% (12/38) had hypovitaminosis D, 66% (29/44) had dyslipidemia, and 37% (17/46) were diabetic or prediabetic. One hundred percent were euthyroid, normocalcemic, and had normal alkaline phosphatase. Hypogonadism was associated with significantly worse visual analog scale for pain (2.5 ± 2.2 vs. 1.0 ± 1.1, <em>P</em> = .014), simple shoulder test (10 ± 30 vs. 11 ± 20, <em>P</em> = .037), and American Shoulder and Elbow Surgeons (74 ± 19 vs. 88 ± 11, <em>P</em> = .006) scores postoperatively. While not significant (<em>P</em> = .102), hypogonadism was associated with lower healing rates (36% vs. 63%). Hypovitaminosis D, diabetes, and dyslipidemia did not associate with clinical outcomes. Dyslipidemia was associated with significantly higher healing rates (71% vs. 31%, <em>P</em> = .036).</div></div><div><h3>Conclusion</h3><div>While almost all patients undergoing RCR suffered from systemic biologic deficiencies, only hypogonadism was associated with significant differences in patient-reported outcomes. Given that this factor is modifiable, this result supports larger studies with longer follow-up and exploration of hormone replacement therapy.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1562-1569"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108516","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":"Regional disparities in shoulder surgery related to distribution of specialists: national database analysis","authors":"Masataka Minami PhD, MD ,&nbsp;Masamitsu Kido PhD, MD ,&nbsp;Yoshikazu Kida PhD, MD ,&nbsp;Ausberto R. Velasquez Garcia MD ,&nbsp;Jesse B. O'Driscoll BSc ,&nbsp;Kenji Takahashi PhD, MD ,&nbsp;Shawn W. O'Driscoll PhD, MD","doi":"10.1016/j.jseint.2025.05.005","DOIUrl":"10.1016/j.jseint.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff tears are the most common shoulder disorders requiring surgical management. In Japan, reverse total shoulder arthroplasty was introduced in 2014, initially restricted to certified surgeons. While this system ensured that only trained specialists could perform reverse total shoulder arthroplasty, it may have limited access to surgery. This study aimed to analyze regional disparities in shoulder surgeries and their correlation with shoulder specialists using the national database.</div></div><div><h3>Methods</h3><div>A retrospective epidemiological study was conducted using the Japanese national claims database and Japanese Shoulder Society (JSS) membership records (2014-2022). Rotator cuff repair (RCR), shoulder arthroplasty volumes, and incidence in each prefecture were calculated per population. Gini coefficients assessed regional disparities, and a generalized linear mixed model evaluated the correlation between JSS membership and surgical volumes.</div></div><div><h3>Results</h3><div>RCR showed stable regional disparities (Gini coefficient remained around 0.3) over 9 years, whereas shoulder arthroplasties exhibited extreme inequality in 2014 (Gini coefficient: 0.6), improving to moderate levels (Gini coefficient: 0.3) by 2022. JSS membership distribution was moderately equitable (Gini coefficient: 0.2). Prefectures with higher JSS membership demonstrated significantly higher surgical volumes (RCR: coefficient = 0.009, <em>P</em> &lt; .001; shoulder arthroplasty: coefficient = 0.012, <em>P</em> &lt; .001).</div></div><div><h3>Discussion</h3><div>RCR exhibited moderate regional disparities, whereas shoulder arthroplasty disparities were initially extreme but stabilized as volumes increased. This trend reflects the growing accessibility of shoulder arthroplasty due to the dissemination of certified surgeons. The correlation between shoulder specialists and surgical volumes for both procedures underscores the specialization required for these surgeries.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1760-1770"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108567","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}