JSES InternationalPub Date : 2025-09-01DOI: 10.1016/j.jseint.2025.04.028
Kwabena Adu-Kwarteng MD , Alaowei Y. Amanah BS , Jay M. Levin MD, MBA , Eoghan T. Hurley MBBCh, PhD, MSc , Zachary S. Aman MD , Yaw D. Boachie-Adjei MD , Christopher S. Klifto MD , Oke Anakwenze MD, MBA
{"title":"Short-term outcomes of reverse total shoulder arthroplasty for proximal humerus fractures in patients under 70 versus patients 70 and over","authors":"Kwabena Adu-Kwarteng MD , Alaowei Y. Amanah BS , Jay M. Levin MD, MBA , Eoghan T. Hurley MBBCh, PhD, MSc , Zachary S. Aman MD , Yaw D. Boachie-Adjei MD , Christopher S. Klifto MD , Oke Anakwenze MD, MBA","doi":"10.1016/j.jseint.2025.04.028","DOIUrl":"10.1016/j.jseint.2025.04.028","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to compare the short-term outcomes of reverse total shoulder arthroplasty (rTSA) in patients with proximal humerus fractures stratified by age into young and elderly cohorts.</div></div><div><h3>Methods</h3><div>This retrospective review analyzed patients with a minimum 1-year follow-up who underwent RTSA for proximal humerus fractures, categorizing patients <70 years as young and ≥70 as elderly. The operative and postoperative courses were recorded, including discharge location, range of motion (ROM), and need for revision surgery. Patient-reported outcomes such as Single Assessment Numeric Evaluation (SANE) and Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected. A <em>P</em> value ≤.05 was statistically significant.</div></div><div><h3>Results</h3><div>The study consisted of 52 patients (<70 years, n = 22; ≥70 years, n = 30). The <70 group had a higher ROM in forward flexion (141° ± 26° vs. 123° ± 35°; <em>P</em> = .05). ROM in external rotation (34° ± 14° vs. 35° ± 22°; <em>P</em> = .86) and abduction (102° ± 29° vs. 107° ± 46°; <em>P</em> = .79) were similar between the groups. The revision rate was similar between the 2 groups, at 9.1% in the under-70 cohort and 13.3% in the 70 and over cohort (<em>P</em> = .73). Postoperative PROMIS - upper extremity scores were similar between age groups, with mean scores of 35.0 ± 5.7 for the <70 group and 35.3 ± 8.7 for the ≥70 group (<em>P</em> = .96). There was no statistically significant difference in postoperative PROMIS – Physical Function scores, with mean values of 44.8 ± 10.2 in the <70 group and 37.6 ± 9.3 in the ≥70 group (<em>P</em> = .06). In addition, there was no statistically significant difference in postoperative PROMIS – pain interference scores, with mean values of 55.2 ± 9.6 in the <70 group and 54.2 ± 7.7 in the ≥70 group (<em>P</em> = .78). Postoperative SANE scores demonstrated no significant difference between the younger and older cohorts, with mean scores of 73.7 ± 24.4 and 80.0 ± 11.4, respectively (<em>P</em> = .58).</div></div><div><h3>Conclusion</h3><div>There was no difference in short-term postoperative PROMIS – upper extremity, PROMIS – Physical Function, SANE, ROM in external rotation or abduction, pain, and revision rates between patients <70 and ≥70 undergoing RTSA. However, the <70 RTSA group had higher short-term ROM in forward flexion.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1603-1607"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108876","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}
JSES InternationalPub Date : 2025-09-01DOI: 10.1016/j.jseint.2025.04.003
Prince Shanavas Khan D'Ortho, MS Ortho , Yon-Sik Yoo MD, PhD , Ayyappan V. Nair D'Ortho, DNB Ortho , Seong-Wook Jang MS , Aebel Raju MRCS , Sreehari C K MS Ortho
{"title":"Pathomechanics of glenohumeral capsule and scapula in idiopathic frozen shoulder: a study using a three-dimensional finite element model","authors":"Prince Shanavas Khan D'Ortho, MS Ortho , Yon-Sik Yoo MD, PhD , Ayyappan V. Nair D'Ortho, DNB Ortho , Seong-Wook Jang MS , Aebel Raju MRCS , Sreehari C K MS Ortho","doi":"10.1016/j.jseint.2025.04.003","DOIUrl":"10.1016/j.jseint.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>The pathomechanics of primary frozen shoulders are not yet fully understood. There is ongoing uncertainty regarding the optimal extent of surgical release, with concerns about both over- and under-release of the joint capsule. In the frozen shoulder, different ranges of motion of the shoulder joint experience varying areas of stress, contributing to stiffness and limited movement. The ultimate goal of treatment is to restore the full range of motion while carefully addressing the specific areas of pathology. The purpose of this study was to analyze the kinematics of the glenohumeral joint capsule in a frozen shoulder and to investigate scapulothoracic motion patterns.</div></div><div><h3>Methods</h3><div>Ten patients with unilateral idiopathic frozen shoulders confirmed by a computed tomography (CT) arthrogram were enrolled in this study. All patients were scanned with additional high-resolution CT at maximum humeral abduction position. The modelling programs were used to simulate glenohumeral and scapulothoracic motion based on reconstructed CT images. The finite element models of the glenohumeral capsule were also constructed based on the CT arthrogram at 0° abduction. We evaluated the changes in scapular position between 0 to maximal humeral abduction angles and measured the degree of scapular abduction, external rotation, and posterior tilt. The tension changes and stress patterns of the capsule during various shoulder motions were also assessed.</div></div><div><h3>Results</h3><div>In maximal humeral abduction, abutment of the humeral head against the lateral acromion was found in all frozen shoulder models. The scapula showed an increment in scapular upward rotation and a decrement in posterior tilt but inconsistency in internal/external rotation in the humeral abduction position. The abduction and internal rotation behind the back position of the humerus caused an increase in the stress at the anteroinferior capsule, compared to other portions of the capsule. Meanwhile, the anterosuperior capsule showed a prominent stress in external rotation at 0° humeral abduction.</div></div><div><h3>Conclusion</h3><div>Pathomechanics of the frozen shoulder characterised by glenohumeral motion limitations should be considered complicated, as confirmed by high tension in the anteroinferior glenohumeral capsule and altered scapular motion. Selective surgical release of the anteroinferior part of the glenohumeral capsule with scapular mobilization can regain glenohumeral motion in the idiopathic frozen shoulder.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1474-1480"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109050","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}
JSES InternationalPub Date : 2025-09-01DOI: 10.1016/j.jseint.2025.02.017
William N. Levine MD, Kyle K. Obana MD, Michael A. Mastroianni MD, Dongyeon Joanna Kim MD
{"title":"Reverse total shoulder arthroplasty in younger patients","authors":"William N. Levine MD, Kyle K. Obana MD, Michael A. Mastroianni MD, Dongyeon Joanna Kim MD","doi":"10.1016/j.jseint.2025.02.017","DOIUrl":"10.1016/j.jseint.2025.02.017","url":null,"abstract":"<div><div>The utility of reverse total shoulder arthroplasty (rTSA) in younger patients has been long debated. Initial rTSA designs were highly constrained and led to increased rates of failure in the literature. This garnered concerns regarding implant longevity and the need for complex revision surgery in young and active patients. Thus, rTSA was reserved for older patients with decreased upper-extremity demand. However, recent advancements in both rTSA design and techniques have demonstrated promise for rTSA in young and active patients. Various techniques, including glenoid lateralization, humeral lateralization, and tendon transfers, aim to restore shoulder function and range of motion. Furthermore, patient-specific characteristics and comorbidities may be more valuable predictors of long-term success following rTSA compared to age, which has been arbitrarily defined in the literature.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1876-1879"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108225","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}
JSES InternationalPub Date : 2025-09-01DOI: 10.1016/j.jseint.2025.05.026
Wolbert van den Hoorn PhD , Maxence Lavaill PhD , Freek Hollman MBBS, PhD , Roberto Pareyón Valero MBBS , François Bruyer-Montéléone MEng , Kenneth Cutbush MBBS , Ashish Gupta MBBS , Graham Kerr PhD
{"title":"How do visual and smartphone camera-based shoulder ranges of motion compare?","authors":"Wolbert van den Hoorn PhD , Maxence Lavaill PhD , Freek Hollman MBBS, PhD , Roberto Pareyón Valero MBBS , François Bruyer-Montéléone MEng , Kenneth Cutbush MBBS , Ashish Gupta MBBS , Graham Kerr PhD","doi":"10.1016/j.jseint.2025.05.026","DOIUrl":"10.1016/j.jseint.2025.05.026","url":null,"abstract":"<div><h3>Background</h3><div>Objective assessment of functional shoulder range of motion (ROM) is crucial for evaluating shoulder interventions and guiding rehabilitation. The goniometer is the clinical standard, but due to practicality, visual estimation is often used despite its lower reliability. Recently, smartphone video-based assessment using two-dimensional (2D) pose estimation models has emerged as a potential objective alternative. This study aimed to compare 2D-pose–based ROM assessment with visual estimation and examine inter-observer agreement.</div></div><div><h3>Methods</h3><div>Seventeen individuals (8 females, 9 males) with normal, pain-free shoulder function were assessed for active ROM in abduction, flexion, extension, external rotation (ER) in two positions (ERI & ERII), and functional internal rotation (FIR). 2D videos from three smartphones were used to estimate shoulder ROM, while two othopedic surgeons visually estimated ROM. For each movement, participants performed six repetitions, three at maximum and three less than maximum ROM (self-selected). Mixed effects models assessed the relationship between 2D-pose–based and visual-based ROM, with visual observer as fixed factor and visual estimates × observer interaction. The coefficient of determination (R<sup>2</sup>) from these mixed effects models assessed consistency, and smallest detectable difference was used to determine agreement.</div></div><div><h3>Results</h3><div>Consistency between 2D-pose and visual estimates was excellent for abduction (R<sup>2</sup> = 0.99), flexion (R<sup>2</sup> = 0.95), and ERII (R<sup>2</sup> = 0.86), good for extension (R<sup>2</sup> = 0.69) and ERI (R<sup>2</sup> = 0.73), and fair for FIR (R<sup>2</sup> = 0.52). Smallest detectable difference values ranged from 4.4° to 7.9°. Agreement varied by movement type and observer, with significant visual estimates × observer (<em>P</em> < .003) interaction effects for abduction and flexion: both observers reported higher ROM values than 2D-pose near end-ROM (∼3-4°) with observer 2 reporting lower values than observer 1 (∼15°) at smaller ROM (<60°). 2D-pose estimates were higher (∼20°) for extension at low ROM (<45°) than visual estimates. 2D-pose estimates were lower (∼30°) for ERI at high ROM (>45°) than visual estimates. Visual observers agreed on extension, ERI, ERII, and FIR estimates but disagreed on abduction and flexion estimates.</div></div><div><h3>Conclusion</h3><div>2D-pose–based estimates of shoulder ROM were consistent with visual estimates for most movements, though discrepancies existed at specific ROM levels and between observers. The higher resolution estimates of 2D-pose suggests it could reduce observer variation, making it a promising alternative for clinical and research settings. However, further refinement is needed for movements like ERI and FIR using both methods. These findings highlight the importance of method consistency in assessing shoulder ROM and th","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1793-1802"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108572","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}
JSES InternationalPub Date : 2025-09-01DOI: 10.1016/j.jseint.2025.05.025
Nabile Himer MD , Philippe Clavert MD, PhD , Amine Mellal MD , Emmanuel Baulot MD, PhD , Stefan Bauer MD , Maxime Antoni MD
{"title":"Factors associated with humeral stem extraction difficulty in revision shoulder arthroplasty","authors":"Nabile Himer MD , Philippe Clavert MD, PhD , Amine Mellal MD , Emmanuel Baulot MD, PhD , Stefan Bauer MD , Maxime Antoni MD","doi":"10.1016/j.jseint.2025.05.025","DOIUrl":"10.1016/j.jseint.2025.05.025","url":null,"abstract":"<div><h3>Background</h3><div>Removal of the humeral stem during revision shoulder arthroplasty can be challenging and is associated with complications. The primary objective of this study was to identify risk factors for intraoperative humerus fractures or the need for a humerotomy. The secondary objective was to determine factors associated with the use of a standard or long revision stem.</div></div><div><h3>Methods</h3><div>In this retrospective monocentric study, a total of 127 consecutive shoulder arthroplasty revisions (53 men, 74 women, mean age 68 ± 11 years) were included. All included patients underwent a complete revision of the humeral component. Preoperative periprosthetic fractures were excluded. Assessed risk factors included patient-related factors, the etiology and characteristics of the primary prosthesis, time between the primary arthroplasty and revision, and the etiology of the revision. All risk factors were evaluated through a multivariate analysis with logarithmic regression.</div></div><div><h3>Results</h3><div>A humerotomy was required in 7.9% (10/127), while an iatrogenic humerus fracture occurred in 24.4% (31/127) of cases, resulting in a total of 32.3% (41/127). Factors associated with difficulties during stem extraction included chronic infection (<em>P</em> = .001), the presence of a long stem (<em>P</em> = .04), and the use of a cemented stem (<em>P</em> = .01). Age and gender were not associated. During revision, a short, standard-length, and long stem were implanted in 7.1% (9/127), 55.1% (70/127), and 37.8% (48/127), respectively. Factors associated with the use of a standard or long revision stem included increased age (<em>P</em> = .006), lower preoperative external rotation (<em>P</em> = .028), a standard (<em>P</em> < .0001) or long (<em>P</em> = .002) primary stem, a cemented primary stem (<em>P</em> = .006), a longer interval between primary arthroplasty and revision (<em>P</em> = .025), and the occurrence of a fracture or the need for a humerotomy (<em>P</em> = .016), particularly in cases of diaphyseal localization (<em>P</em> = .009).</div></div><div><h3>Conclusion</h3><div>Difficulties and complications extracting the humeral stem were encountered in 32.3% of cases in our series. Chronic infection as the cause of revision and the use of a long or cemented stem were significant associated factors.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1705-1712"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108617","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":"Short-term results of a hybrid ingrowth glenoid in anatomic total shoulder arthroplasty: a radiographic analysis for radiolucent lines and osteointegration using tomosynthesis","authors":"Kazumasa Takayama MD , Atsuhiko Ichimura , Hiromu Ito MD, PhD","doi":"10.1016/j.jseint.2025.05.003","DOIUrl":"10.1016/j.jseint.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Loosening of the glenoid component is the most common cause of implant failure in total shoulder arthroplasty. Recently, a hybrid glenoid component with polyethylene peripheral pegs and an ingrowth central peg was developed. This study aimed to evaluate radiolucent lines (RLLs) around the pegs and osteointegration around the central metal peg in the hybrid glenoid component using tomosynthesis.</div></div><div><h3>Methods</h3><div>Nineteen patients with a hybrid glenoid and 18 with a cemented all-polyethylene glenoid were included. Radiographic lucency around the glenoid components was graded (Grade 0-5). To investigate the accuracy of RLL detection on plain radiographs, tomosynthesis images and plain radiographs were compared 2 years postoperatively. The zone of spot welds (a sign of osteointegration) and RLL in the hybrid glenoids were evaluated.</div></div><div><h3>Results</h3><div>The incidence of RLL was 15.8% (Grade 1, 3/19 cases) in the hybrid glenoid component and 33.3% (Grades 1 and 3: three cases each, 6/18 cases) in the cemented all-polyethylene glenoid component; however, the difference was not statistically significant. All 19 patients achieved osteointegration around the central metal peg 8 months postoperatively, and no progression of the RLL was observed. The concordance in the detection of RLL between tomosynthesis and plain radiography was 89.4% (17/19 cases) in the hybrid glenoid group and 72.2% (13/18 cases) in the cemented all-polyethylene group. However, plain radiography tended to underestimate RLL in both groups.</div></div><div><h3>Conclusion</h3><div>The hybrid glenoid component may be a viable alternative to the cemented all-polyethylene glenoid. Tomosynthesis may be a new and effective modality for evaluating glenoid loosening.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 5","pages":"Pages 1645-1652"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108779","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}
JSES InternationalPub Date : 2025-07-01DOI: 10.1016/j.jseint.2025.02.018
Denise E. de Gruijter MD , Leanne S. Blaas MD , Kelly van Winden BSc , Rosa E. Boeschoten MSc, PhD , Susan van Dieren MSc, PhD , Michel P.J. van den Bekerom MD, PhD , Robert Jan Derksen MD, PhD, MSc
{"title":"Neuroticism is related to functional outcomes after surgically treated proximal humerus fractures","authors":"Denise E. de Gruijter MD , Leanne S. Blaas MD , Kelly van Winden BSc , Rosa E. Boeschoten MSc, PhD , Susan van Dieren MSc, PhD , Michel P.J. van den Bekerom MD, PhD , Robert Jan Derksen MD, PhD, MSc","doi":"10.1016/j.jseint.2025.02.018","DOIUrl":"10.1016/j.jseint.2025.02.018","url":null,"abstract":"<div><h3>Background</h3><div>It is known that physical factors play an important role in the outcome after a proximal humerus fracture (PHF). However, an increasing body of evidence shows that psychological factors are of importance as well. As such, it follows that the level of neuroticism in a patient might be especially important. This study aims to examine the correlation between neuroticism levels and functional outcomes following surgically treated PHFs.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort analysis. Patients with PHFs who were surgically treated from 2013 to 2023 and had a minimum 1-year follow-up were eligible. During follow-up, shoulder range of motion and functional scores (Constant Shoulder Score [CSS], Oxford Shoulder Score, and quick Disability of the Arm, Shoulder and Hand) were measured. To ascertain the level of neuroticism, the short-revised version of the Eysenck Personality Questionnaire was administered.</div></div><div><h3>Results</h3><div>In total, 65 patients were included in the study. Eighty-nine percent of included subjects were women (n = 58) and the median age was 72.3 ± 7.4 years. Seventy-four percent (n = 48) was treated with a reverse total shoulder arthroplasty and 60% (n = 39) was operated on their dominant side. The level of neuroticism is correlated with the CSS for fracture side (r = −0.28; <em>P</em> = .023), correlated with the Oxford Shoulder Score (r = −0.46; <em>P</em> < .001) and to the quick Disability of the Arm, Shoulder and Hand (r = 0.30; <em>P</em> = .017). The CSS difference score between the fracture side and the nonaffected side was not correlated with the level of neuroticism (r = 0.20; <em>P</em> = .12).</div></div><div><h3>Conclusion</h3><div>A higher level of neuroticism is related to worse functional outcomes after a surgically treated PHF.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1034-1039"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604990","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}
JSES InternationalPub Date : 2025-07-01DOI: 10.1016/j.jseint.2025.04.015
Armin Badre MD, MSc, FRCSC , Moayd Abdullah H. Awad MBBS, FRCSC , Robert Chan MD, MSc, FRCSC , Michael Lapner MD, FRCSC
{"title":"Anteromedial facet coronoid fractures: an algorithmic approach for assessment and management based on 3 dimensional computed tomography humeral subtraction","authors":"Armin Badre MD, MSc, FRCSC , Moayd Abdullah H. Awad MBBS, FRCSC , Robert Chan MD, MSc, FRCSC , Michael Lapner MD, FRCSC","doi":"10.1016/j.jseint.2025.04.015","DOIUrl":"10.1016/j.jseint.2025.04.015","url":null,"abstract":"<div><h3>Background</h3><div>Isolated coronoid fractures without concomitant radial head injury raise suspicion for an anteromedial facet (AMF) fracture as a result of a varus posteromedial rotatory instability (VPMRI) mechanism. However, not all isolated coronoid fractures involve the AMF, nor are they all the result of a VPMRI mechanism. AMF fractures as a result of a VPMRI mechanism have been reported to have specific radiographic features (medially oblique, concave, with extension to the sublime tubercle). We hypothesized that a detailed assessment of the pattern of AMF fracture utilizing three-dimensional computed tomography with digital subtraction of the humerus allows for a reliable treatment algorithm to avoid over- or under-treatment of these complex injuries.</div></div><div><h3>Methods</h3><div>This was a retrospective case series of patients with isolated coronoid fractures involving the AMF. Patients with an AMF fracture meeting radiographic features consistent with a VPMRI mechanism were managed operatively, and those with an AMF fracture that did not meet one of the radiographic features of a VPMRI mechanism were considered for nonoperative management. Our primary outcome was the appropriateness of this treatment algorithm by assessing whether any patients in the nonoperative group required later surgical intervention or developed any evidence of subluxation or degenerative changes. Secondary outcomes were elbow and forearm range of motion, functional outcome, patient-reported outcomes, and complications at the final follow-up.</div></div><div><h3>Results</h3><div>43 patients with a minimum of 6 months of follow up were reviewed. 28 patients met all radiographic features of VPMRI and underwent surgical stabilization. After an average follow up of 17 ± 14 months, they achieved an elbow arc of 130° ± 19°, forearm arc of 153° ± 13°, Mayo Elbow Performance Index of 98.4 ± 4.0, quick disabilities of the arm, shoulder, and hand of 8.3 ± 9.1, patient-rated elbow evaluation of 18.2 ± 9.1, and a single assessment numeric evaluation score of 90% ± 11%. The incidence of overall complications was 64%. 15 remaining patients did not meet at least one radiographic feature of VPMRI and all but one were managed nonoperatively. After an average follow up of 15 ± 13 months, they achieved an elbow arc of 136° ± 8°, forearm arc of 158° ± 12°, Mayo Elbow Performance Index of 99.0 ± 3.7, quick disabilities of the arm, shoulder, and hand of 6.8 ± 4.8, patient-rated elbow evaluation of 15.9 ± 6.3, and a single assessment numeric evaluation score of 93% ± 7%. Importantly, no patient developed any evidence of late instability, incongruity, or degenerative changes.</div></div><div><h3>Conclusion</h3><div>The proposed algorithm based on a detailed assessment of the pattern of AMF fracture provides a reliable decision tool for the management of these injuries. Utilizing this decision tool and appropriate nonoperative or operative intervention can lead to good-","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1418-1427"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605408","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":"Impact of prior arthroscopic rotator cuff repair on postoperative outcomes of reverse shoulder arthroplasty: a comparative analysis of muscle strength recovery and clinical results","authors":"Yoshihiro Hirakawa MD, PhD , Tomoya Manaka MD, PhD , Katsumasa Nakazawa MD, PhD , Yoichi Ito MD, PhD , So Taniguchi MD , Ayako Ogura PT , Hidetomi Terai MD, PhD","doi":"10.1016/j.jseint.2025.04.021","DOIUrl":"10.1016/j.jseint.2025.04.021","url":null,"abstract":"<div><h3>Background</h3><div>Although the postoperative outcomes of reverse total shoulder arthroplasty (rTSA) are favorable, few studies have examined the impact of previous arthroscopic rotator cuff repair (ARCR) on rTSA outcomes in detail. This study aimed to evaluate and compare the short-term outcomes of rTSA in patients without previous ARCR (control group) and those with a history of ARCR (previous ARCR group). By focusing on postoperative range of motion, clinical scores, and muscle strength over a minimum 2-year follow-up period, we sought to reveal critical insights into how previous ARCR influences recovery trajectories.</div></div><div><h3>Methods</h3><div>We analyzed all patients diagnosed with cuff tear arthropathy or massive rotator cuff tears who underwent rTSA between April 2014 and March 2021, with at least two years of follow-up. The follow-up rate was 81.4% (228/280). The exclusion criteria included revision arthroplasty, infection, previous open surgery, and additional tendon transfer. The key metrics assessed were range of motion, American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), visual analog scale score for pain, and muscle strength.</div></div><div><h3>Results</h3><div>In total, 228 patients were included: 182 (mean age: 76 years) in the control group and 46 (mean age: 75 years) in the previous ARCR group. Active elevation improved significantly from 77° to 121° in the control group and from 81° to 116° in the previous ARCR group. External rotation at the side showed no significant change in either group, whereas internal rotation worsened postoperatively in both groups. The ASES, CS, and visual analog scale scores showed significant improvements 2 years postoperatively in both groups. However, the control group had significantly higher postoperative ASES and CS scores than those in the previous ARCR group. Muscle strength significantly improved in the control group but not in the previous ARCR group.</div></div><div><h3>Conclusion</h3><div>Postoperative muscle strength improvement was not observed in patients undergoing rTSA with a history of ARCR, and their postoperative clinical outcomes were inferior to those undergoing rTSA without a history of ARCR. This deficiency in muscle strength improvement may contribute to the differences in clinical scores, a factor that surgeons need to consider.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1339-1344"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605523","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}
JSES InternationalPub Date : 2025-07-01DOI: 10.1016/j.jseint.2025.03.012
Felix Hochberger MD , Julian Hess MD , Christian Konrads MD , Tizian Heinz MD , Ella Segatz , Maximilian Rudert MD , Kilian List MD
{"title":"Short-term clinical and functional outcomes of distal biceps tendon fixation: all-suture vs. titanium anchors","authors":"Felix Hochberger MD , Julian Hess MD , Christian Konrads MD , Tizian Heinz MD , Ella Segatz , Maximilian Rudert MD , Kilian List MD","doi":"10.1016/j.jseint.2025.03.012","DOIUrl":"10.1016/j.jseint.2025.03.012","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study was to evaluate the preliminary clinical and functional outcomes of patients with distal biceps tendon ruptures undergoing surgical fixation using 2 intramedullary all-suture anchors (ASAs) and to compare these outcomes with a control group treated with 2 intramedullary titanium anchors (TAs).</div></div><div><h3>Methods</h3><div>A retrospective case series was conducted on patients who underwent distal biceps tendon fixation using either TAs (Mitek Sports Medicine, Raynham, MA, USA) or ASAs (Arthrex, Naples, FL, USA). Clinical and functional outcomes were evaluated at a mean follow-up of 24 months, using the Mayo Elbow Performance Score, Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire, and visual analog scale. Secondary assessments included isometric strength testing with the IsoForce Control Dynamometer (IsoForce, Dübendorf, Switzerland) and the identification of postoperative complications, such as heterotopic ossification (HO).</div></div><div><h3>Results</h3><div>A total of 53 patients (23 ASA, 30 TA) were included in the final analysis, with ASA patients being slightly younger (55.2 ± 9.8 years vs. 63.2 ± 7.7 years, <em>P</em> < .05) and the only group to include females (4), as the TA cohort comprised exclusively male patients. The average follow-up duration was 33.8 ± 9.3 months for the ASA group and 45.4 ± 11.1 months for the TA group. HOs were significantly more prevalent in the TA group (37.5% vs. 17.2%, <em>P</em> < .05). Functional outcomes, measured by Mayo Elbow Performance Score and QuickDASH, and strength recovery ratios were comparable across both groups, though ASA patients demonstrated higher absolute isometric strength values at specific flexion angles (<em>P</em> < .05). Both anchor systems delivered equivalent functional and clinical outcomes after 1 year postoperatively.</div></div><div><h3>Conclusion</h3><div>Both, ASAs and TAs, achieved excellent functional and clinical outcomes in distal biceps tendon fixation with low complication rates. ASA demonstrated significant fewer HOs compared to TA.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1400-1405"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605977","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}