Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

{"title":"Single-Stage Triple Procedure Bilateral Hip Open Reduction, Acetabuloplasty, and Femoral Shortening for Late Diagnosed Patients With Developmental Dysplasia of the Hip.","authors":"Fahad A Alshayhan, Raheef Alatassi, Abdullah H Alomar, Mahdi Alqarni, Khalid Bakarman, Fahad Alhuzaimi, Mofarreh Khabiah, Khadijah Alghanmy, Abdulrhman Hassan, Abdulmonem Alsiddiky","doi":"10.5435/JAAOSGlobal-D-25-00031","DOIUrl":"10.5435/JAAOSGlobal-D-25-00031","url":null,"abstract":"<p><strong>Background: </strong>Developmental dysplasia of the hip is a challenging pediatric condition requiring timely and effective surgical management. This study evaluates the clinical and radiographic outcomes of a simultaneous bilateral single-stage triple procedure, which integrates open reduction, acetabuloplasty, and femoral shortening osteotomy. This approach offers a potential alternative to standard staged procedures by reducing treatment time and cumulative anesthesia exposure.</p><p><strong>Methods: </strong>This retrospective study included 54 patients who underwent a standardized simultaneous bilateral single-stage procedure at two tertiary centers. The average age at the time of surgery is 3 ± 1.5 years. Clinical and radiographic outcomes were assessed, with follow-up extending to an average of 3 years.</p><p><strong>Results and conclusion: </strong>In our study of 54 patients (108 hips), significant improvements were noted after surgery with a mean reduction in the acetabular index of 27° ± 7° for the right hip and 26° ± 6° for the left hip (P = 0.0001). The Severin classification indicated 83% excellent, 13% good, and 4% poor outcomes. Redislocation occurred in 6% of hips, with no significant differences in osteonecrosis, lateral subluxation, or redislocation based on sex or age (P > 0.05). All patients achieved good-to-full range of motion by the final follow-up.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664069","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":"The Carbon Footprint of In-person Versus Virtual Orthopaedic Care.","authors":"Emily B Parker, Cameron C Young, Eric M Bluman, Jeremy T Smith","doi":"10.5435/JAAOSGlobal-D-25-00195","DOIUrl":"10.5435/JAAOSGlobal-D-25-00195","url":null,"abstract":"<p><strong>Background: </strong>Climate change is a global health emergency, with substantial carbon emissions coming from health care. This study compares the carbon footprint of in-person versus virtual orthopaedic care at a large, urban, academic healthcare system.</p><p><strong>Methods: </strong>Data were abstracted from the billing and claims database for orthopaedic clinic visits from 2018 to 2023 at a large, urban, academic medical center and its suburban satellite clinics. Carbon footprint per in-person visit was determined by combining emissions from supplies, facility energy use, and patient travel. The reduction in emissions of virtual visits was calculated compared with if all visits occurred in person.</p><p><strong>Results: </strong>Overall, 508,394 orthopaedic clinic visits (94.3% in-person, 5.7% virtual) were recorded. The average in-person visit resulted in 7.12 vs. 0.026 kg CO2e for the average virtual visit. Actual carbon emissions were estimated to be 3,411,206 kg CO2e compared with 3,714,565 kg if all visits occurred in person (8.2% reduction). Most emissions (99.8%) were attributed to patient travel, with 0.2% coming from supplies and <0.1% from facility energy use. The peak of the COVID-19 pandemic in 2020 saw the greatest reduction in carbon emissions at 19.5%, with emissions increasing each year thereafter (8.3% reduction in 2023).</p><p><strong>Conclusion: </strong>The carbon footprint of clinic-based orthopaedic care is large and can be reduced by transitioning from in person to virtual care. Although virtual orthopaedic care has limitations, the environmental benefits are clear. Further research into virtual outpatient orthopaedic care should consider environmental impacts in addition to safety, effectiveness, and patient satisfaction.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664070","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":"Digitally Designed Bone; A 3D-patient-specific Allograft Shelf for Severe Adolescent Hip Dysplasia: From Digital Design to Clinical Reality-A Conceptual Case Report.","authors":"Erik M van Bussel, Jafar Nasrabadi, Joëll Magré, Vahid Arbabi, Koen Willemsen, Bart J Kaptein, Bjorn P Meij, Marianna A Tryfonidou, Bart C H van der Wal, Harrie H Weinans, Ralph J B Sakkers","doi":"10.5435/JAAOSGlobal-D-24-00382","DOIUrl":"10.5435/JAAOSGlobal-D-24-00382","url":null,"abstract":"<p><strong>Background: </strong>Adolescents with severe dysplasia of the hip regularly undergo a periacetabular osteotomy to prevent pain and early osteoarthritis. Unfortunately, this procedure is not suited for severe dysplasia with a non-congruent-deformed hip joint. The optimal treatment might be a tailor-made biologic optimization of femoral coverage with a shape matching the aberrant anatomy. This study introduces a novel approach using a patient-specific allograft shelf augmentation based on personalized 3D kinematic planning.</p><p><strong>Methods: </strong>A 17-year-old patient with severe right-sided hip dysplasia underwent 3D CT analysis showing a lateral center-edge angle of -7° and a craniocaudal femoral head coverage of 50%. Using digital augmentation techniques and kinematic simulations, the femoral coverage was optimized while respecting the range of motion. An allograft cortical shelf of a distal femur with a matching surface and curvature as digitally designed was found in the bone bank and implanted at the acetabular rim using patient-specific molds.</p><p><strong>Results: </strong>After uncomplicated implantation of the patient-specific allograft shelf, the lateral center-edge angle and femoral head coverage increased to 18° and 77% while preserving range of motion. A CT scan at 9-month follow-up showed incorporation of the allograft in the native bone with sustained coverage of the weight-bearing area of the patient-specific allograft shelf.</p><p><strong>Conclusion: </strong>An acetabular augmentation shelf was digitally designed and implanted using a matching allograft donor in a case of severe hip dysplasia. The excellent and predictable functional and radiologic outcomes suggest that patient-specific allograft bone shelves could be a serious option for adolescents with severe hip dysplasia.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Relevant Integrated Radiologic and Surgical Classification Scheme for Giant Cell Tumors of Bones.","authors":"Yu-Cherng Chang, Juan Pretell-Mazzini, H Thomas Temple, Roxana Soler, Julian Purrinos, Andrew E Rosenberg, Emily Jonczak, Ty K Subhawong","doi":"10.5435/JAAOSGlobal-D-24-00321","DOIUrl":"10.5435/JAAOSGlobal-D-24-00321","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional classification systems for giant cell tumors (GCTs) lack robust correlation with management and clinical outcomes. We propose a new radiologic classification system based on surgically relevant features to address this shortcoming.</p><p><strong>Methods: </strong>This IRB-approved single-institution retrospective study involved 35 extremity GCTs from 2013 to 2023 with preoperative radiographs and cross-sectional imaging (MRI and/or CT). An experienced musculoskeletal (MSK) radiologist and orthopaedic oncologist independently assessed tumors according to the Campanacci or new grading system, defined on 1 to 3 scale: (1) intraosseous contained tumor, (2) intraosseous noncontained tumor with extraosseous implant accessible through single incision, and (3) intraosseous noncontained tumor with an extraosseous soft tissue implant nonaccessible from single incision alone. Interrater agreement was determined through the intraclass correlation coefficient. The two-way Friedman test with rater and grading system as factors was used to compare system grading similarity.</p><p><strong>Results: </strong>Thirty patients underwent curettage, five underwent resection; 10 experienced local recurrence. Intraclass correlation coefficients between raters for the Campanacci and novel grading systems were 0.83 and 0.79, respectively. However, compared with the novel system, Campanacci grades were significantly higher by an average of 0.34 ± 0.68 and 0.46 ± 0.70 for the first and second raters, respectively (P = 0.003). None of the patients who underwent resection experienced local recurrence, but in patients who underwent curettage, recurrence rates were higher in Campanacci versus novel grade 1 tumors (29% vs. 17%).</p><p><strong>Discussion: </strong>The novel GCT grading system demonstrates excellent interrater agreement, and classified more nonrecurrent curetted tumors as low grade, suggesting improved predictive performance compared with the Campanacci classification.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664066","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":"Decrease in Pediatric Anterior Cruciate Ligament Injury-related Care Disparities for Medicaid Patients From 2015 to 2020.","authors":"Lucas Y Kim, Corinna C Franklin, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-25-00194","DOIUrl":"10.5435/JAAOSGlobal-D-25-00194","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cruciate ligament (ACL) injuries are relatively common in the pediatric population, and ACL reconstruction (ACLR) followed by postoperative physical therapy (PT) is frequently considered to decrease the risk of additional knee injury and improve functional outcomes. Disparities across insurance groups in ACL surgical rates and PT utilization have been previously reported, but there is limited analysis from national databases, and even less about disparity trends over time.</p><p><strong>Methods: </strong>The 2015 to 2020 M157 PearlDiver database was queried for patients younger than 18 years diagnosed with ACL injury with commercial or Medicaid insurance. Factors abstracted included year, insurance plan, ACLR or not, and PT utilization and number of visits. The incidence of ACLR and PT visits were compared across insurance groups by year.</p><p><strong>Results: </strong>In total, 61,333 ACL injuries were identified for which ACLR was done for 21,083 (34.4%). The incidence of reconstruction was higher for those with commercial than Medicaid (35.0% vs. 30.7%, P < 0.001). Over the years of the study, this gap decreased from 7.7% in 2015 (P < 0.001) to 0.7% in 2020 (P = 0.714). For postoperative patients, those with commercial insurance had more PT sessions (26.45 vs. 22.53, P < 0.001). This gap decreased from 6.48 sessions in 2015 (P < 0.001) to 4.07 sessions in 2020 (P = 0.002). For nonsurgical patients, those with commercial insurance were more likely to receive PT (43.3% vs. 39.8%, P < 0.001) and to receive more sessions (18.76 vs. 14.35, P < 0.001). The gap in PT incidence deceased from 9.7% in 2015 (P < 0.001) to 2.4% in 2020 (P = 0.200).</p><p><strong>Conclusion: </strong>Medicaid pediatric patients with ACL injuries were markedly less likely to undergo reconstruction and received less PT than commercial insurance patients, but these differences decreased/disappeared over the years studied. It is reassuring to see these insurance-related disparities decreasing over time, and continued access efforts are needed.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601854","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":"Practice Patterns of Adult Reconstruction Fellowship-Trained Surgeons: Current Trends and Evolution of Training From 1986 to 2022.","authors":"Shujaa T Khan, Daniel D Li, Jacob Moore, Nickelas Huffman, Viktor Krebs, Nicolas S Piuzzi, Matthew E Deren","doi":"10.5435/JAAOSGlobal-D-25-00175","DOIUrl":"10.5435/JAAOSGlobal-D-25-00175","url":null,"abstract":"<p><strong>Introduction: </strong>Total joint arthroplasty (TJA) is evolving with new technologies and techniques introduced in fellowship training, but the effect on surgeons' future practices remains unclear. We assessed current practice patterns and influential factors among fellowship-trained arthroplasty surgeons.</p><p><strong>Methods: </strong>An electronic survey was sent to all currently practicing surgeons (n = 90) who had completed a high-volume adult reconstruction fellowship at a single tertiary academic center from 1986 to 2022. The survey consisted of 73 questions regarding surgeon and practice characteristics for primary and revision total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty. Data were tabulated and analyzed in REDCap software.</p><p><strong>Results: </strong>The survey was completed by 53 surgeons (59%): 46% had been in practice for 0 to 5 years, 32% for 6 to 10 years, and 21% for 11 to 20 years. Overall, 81% performed at least 100 THAs, and 77% performed at least 150 TKAs annually. Revision TJA constituted 0% to 20% of surgical practice for 70% of surgeons, whereas 30% performed revision TJA in 21% to 40% of cases. The most common approach for THA was direct anterior (28/53, 53%), followed by posterior (22/53, 42%). Fellowship experience was the most influential factor on the choice of THA approach (57%), as well as on the choice of THA (64%) and TKA (57%) implants. Among surgeons with access to robots, 52% did not perform any robotic THAs, whereas 27% performed more than 80% of their THAs robotically. By contrast, 64% of surgeons performed more than 80% of their primary TKAs robotically, and only 13% did no robotic TKAs despite having access to a robot.</p><p><strong>Conclusion: </strong>Fellowship experience was the primary factor influencing approach and implant choices in both THA and TKA, highlighting its notable effect on shaping trainees' future practices. Therefore, fellowship programs should offer exposure to diverse technologies and techniques to enable informed decision making.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601857","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":"Accuracy of the Automated Range of Motion Observer and Reporter Software for Fully Automated Joint Measurement From Patient Videos.","authors":"Sundeep Chakladar, Christopher J Dy, David M Brogan","doi":"10.5435/JAAOSGlobal-D-25-00088","DOIUrl":"10.5435/JAAOSGlobal-D-25-00088","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate assessment of joint range of motion (ROM) is essential for diagnosing and managing upper extremity injuries. Universal goniometers are the most used tools for measuring ROM, but they require skilled observers and are limited by interobserver variability. An automated system for measuring joint range of motion from patient videos could facilitate standardized reporting of outcomes after reconstructive surgery.</p><p><strong>Methods: </strong>An Automated Range of Motion Observer and Reporter (ARMOR) software was developed as an autonomous, video-based ROM measurement tool leveraging OpenCV pose estimation. ARMOR was used to assess upper extremity range of motion and was validated against photography-based (photogoniometry) and manual goniometry in a cohort of brachial plexus surgery patients.</p><p><strong>Results: </strong>The correlation coefficients comparing ARMOR to manual goniometry were above 0.90 for all motion tasks, except for elbow flexion. For shoulder flexion, the mean difference between ARMOR and manual goniometry was more than 14° smaller than the difference for photogoniometry. Mean differences for shoulder abduction were similar between ARMOR and photogoniometry.</p><p><strong>Conclusion: </strong>ARMOR's accuracy in assessing shoulder ROM, independence from human observer bias, and telemedicine compatibility makes it a promising solution for consistent and accessible ROM assessment. The autonomous nature of the software enhances the data collection workflow for clinical researchers while eliminating interrater variability.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601780","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":"Nonspecific Knee Synovitis Caused by Foreign Bodies Undetectable on Imaging Studies: Four Cases and Literature Review.","authors":"Addy S Brandstetter, Ron Qual, Amit Benady, Nadav Graif, Moshe Yaniv, Roy Gigi","doi":"10.5435/JAAOSGlobal-D-25-00058","DOIUrl":"10.5435/JAAOSGlobal-D-25-00058","url":null,"abstract":"<p><p>Diagnosing and managing acute knee monoarthritis in children presents a complex challenge, and when an etiology is not clear, it might be the result of an occult presence of a radiolucent foreign body. We report on four instances of acute monoarticular knee arthritis in pediatric patients. Despite employing standard imaging techniques, patient history, and laboratory tests, no foreign bodies (FBs) were initially identified. However, arthroscopy conducted in all cases, unveiled FBs that might have otherwise gone unnoticed and led to proper treatment of the problem. Despite their rarity, a unique challenge arises in this population due to the deceptive presentation of symptoms. The often-inconspicuous nature of the injury, combined with negative radiographs and nonspecific soft-tissue inflammation, on MRI frequently leads to delayed diagnosis and treatment. Our study and broader literature highlight the limitations of standard imaging in detecting FBs, especially in children. In cases of persistent or recurring knee pain, a high index of suspicion for undetected FBs and prompt arthroscopic evaluation are paramount for achieving optimal outcomes in children with otherwise unexplained monoarticular knee arthritis.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601855","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":"Orthopaedic Research Year Fellowships: Enhancing Medical Student Productivity and Hands‑On Experience.","authors":"Madison Balagtas, Jakub Gocal, Shreya M Saraf, Mary K Mulcahey","doi":"10.5435/JAAOSGlobal-D-25-00176","DOIUrl":"10.5435/JAAOSGlobal-D-25-00176","url":null,"abstract":"<p><strong>Introduction: </strong>Orthopaedic surgery was the fifth most competitive specialty in the 2024 Match cycle as measured by the percentage of positions filled overall (915 of 916 [99.9%]). With the United States Medical Licensing Examination Step 1 examination now pass/fail, research experience and publications have become increasingly important for applicants. This study explores key aspects of orthopaedic surgery research fellowships for medical students including the average number of publications and presentations, additional learning opportunities, and total number of fellows who matched into an orthopaedic surgery residency after their research year.</p><p><strong>Methods: </strong>Research year fellowships were identified through an online search using publicly available information and the search terms \"Orthopaedic Research Fellowship\" and \"Orthopaedic Research Gap Year\" in May 2024. If available, information from individual program websites was used. Programs were contacted to provide the number of publications, presentations, and clinical opportunities offered by the program and the number of previous research fellows matched.</p><p><strong>Results: </strong>In total, 130 orthopaedic research year fellowship programs were identified. Information was collected for 80 programs through survey response or publicly available information. The average number of fellowship-related publications was 11.7 (range 2 to 30) and presentations was 11.86 (range 1 to 60). In addition, 68 programs offered additional opportunities including clinical and operating room exposure, educational experiences, and mentorship. The total number of research fellows from each program who matched into orthopaedic surgery ranged from 0 to 30.</p><p><strong>Conclusion: </strong>This study found that orthopaedic research fellowships offer medical students an average of 11.7 publications and 11.86 presentations, along with notable clinical exposure. This study offers insights into key characteristics of research fellowships for students evaluating programs, while also highlighting the need for future research to determine which applicants benefit most and how the role of these fellowships is changing in light of the pass/fail United States Medical Licensing Examination Step 1 examination.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601856","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":"Open Modified Gallie Procedure for Chronic Anterior Shoulder Instability.","authors":"Hassan Choudhry, Trent Davis, Sean Porter, Liam Ortega, Samuel G Eaddy, Logan M Druessel, Jason Levine","doi":"10.5435/JAAOSGlobal-D-24-00286","DOIUrl":"10.5435/JAAOSGlobal-D-24-00286","url":null,"abstract":"<p><p>A 65-year-old female patient with capsular insufficiency was treated with open modified Gallie anatomic reconstruction using a tibialis anterior allograft and inferior capsular shift. The patient was previously diagnosed with adhesive capsulitis but suffered from multiple dislocations and persistent pain with both subjective and physical examination findings of instability after manipulation. Diagnosis of capsular insufficiency secondary to humeral avulsion of the glenohumeral ligaments was made with magnetic resonance imaging with arthrography demonstrating contrast extravasation from the axillary pouch. After confirmatory diagnostic arthroscopy, the deltopectoral approach with subscapularis sparing technique subsequently was used to reconstruct the anterior capsule. A tibialis anterior graft was inserted into bone tunnels in the glenoid and anchored to the humerus. Anchors were inserted into the glenoid for inferior capsule shift of the torn inferior glenohumeral ligament. The patient experienced immediate resolution of instability and relief of pain on follow-up. Functional outcomes at 12 months were satisfactory with only a mild reduction in function with overhead activities and internal rotation. It is proposed that open reconstruction of the anterior capsule with inferior capsular shift is the procedure of choice for patients with recurrent anterior shoulder dislocations because of capsular insufficiency with humeral avulsion of the glenohumeral ligaments lesions.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 7","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585215","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}