Journal of Shoulder and Elbow Surgery最新文献

{"title":"Outcomes After Arthroscopic Assisted Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears.","authors":"Brent A Geers, Jacob Archutowski, Clarence Cabatu, Jacob Best, Michael Ayad, David Donnelly, Jalen Warren, Paul J Favorito, David Kummerfeld, Shariff K Bishai","doi":"10.1016/j.jse.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.018","url":null,"abstract":"<p><strong>Background: </strong>The preferred surgical management for massive irreparable posterosuperior rotator cuff tears remains undecided. Treatment options include primary partial repair with allograft augmentation, balloon spacer, tendon transfers, and reverse total shoulder arthroplasty (rTSA). For younger and more active patients where rTSA is not preferred, tendon transfers may be an appropriate option. This study evaluates the outcomes of patients who underwent an arthroscopic assisted lower trapezius tendon transfer (AaLTT) for irreparable posterosuperior rotator cuff tears.</p><p><strong>Methods: </strong>A total of 54 patients, 42 males and 12 females, with an average age of 59 (range 36 - 76 years) were evaluated. All patients were treated with an AaLTT as treatment for a massive irreparable posterosuperior rotator cuff tear and had a minimum follow-up of 12 months. Pre- and postoperative American Shoulder and Elbow Surgeon (ASES) scores, Visual Analog Scale (VAS), and range of motion (ROM) were compared to evaluate improvement in ROM and function after the procedure.</p><p><strong>Results: </strong>At a minimum follow-up of 12 months, patients demonstrated significant improvement in forward flexion (average 20º, p-value < 0.0001) and external rotation ROM (average 10º, P value < .0001). A preoperative external rotation lag sign was reversed in 36/38 (94.7%) patients. There were significant improvements in postoperative ROM and patient reported outcome measurement scores (ASES and VAS) with median improvement of 53-points for the ASES score and median improvement of 4-points on the VAS scale. There is no literature describing the Minimal clinically important difference (MCID) for VAS and ASES change following aLTT. However, our values do exceed the MCID cited in prior reports for arthroscopic rotator cuff repair of 27.13 and 2.37 for ASES and VAS respectively.</p><p><strong>Conclusion: </strong>This study demonstrates that arthroscopic assisted lower trapezius tendon transfers with allograft augmentation for irreparable rotator cuff tears provides patients with significant improvement in range of motion, specifically forward flexion and external rotation, as well as patient reported outcome measures. Future studies should focus on follow-up beyond 12 months as well as creating standardization of surgical technique in order to improve procedure adoption.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; Treatment Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse Shoulder Arthroplasty for Acute Trauma vs Trauma Sequalae following failed conservative management: A cohort study using data from the National Joint Registry and Hospital Episode Statistics for England.","authors":"Olivia O'Malley, Andrew Davies, Amar Rangan, Sanjeeve Sabharwal, Peter Reilly","doi":"10.1016/j.jse.2025.05.016","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.016","url":null,"abstract":"<p><strong>Introduction: </strong>While the majority of proximal humerus fractures (PHFs) can be managed conservatively, for some, particularly complex 3- or 4-part fractures, management is controversial. The decision-making process can be challenging, especially in older patients when considering whether secondary surgery for failed non operative management comes with more risk than acute surgical treatment. There is limited evidence in the literature that compares the outcomes of patients having an acute reverse shoulder arthroplasty (rTSA) for trauma against those having an rTSA for trauma sequalae following failed previous conservative management. This study aims to use the National Joint Registry (NJR) and Hospital Episode Statistics (HES) for England to compare outcomes of rTSA for acute trauma against those of rTSA for trauma sequalae following failed conservative management.</p><p><strong>Methods: </strong>NJR data from April 2012 to March 2022 was linked to HES. All patients undergoing an rTSA for acute or trauma sequalae were included. Primary outcome was revision. Secondary outcomes were non revision re-operation, mortality, medical complications within 30 & 90 days of primary procedure and length of stay.</p><p><strong>Results: </strong>In the propensity matched cohorts, there were 2488 patients in the acute trauma group and 1267 patients in the trauma sequalae group. rTSA for trauma sequalae had a higher cumulative revision rate at 1,3,5,7 and 10 years and statistically significant increased risk in overall revision (HR of 2.44 (1.68-3.55 p<0.001) in comparison to acute trauma rTSA. There was no statistical difference in incidence of non-revision re-operation (p=0.17). At one year the mortality rate was 4.11% (3.38-5.00) for acute trauma and 3.07% (2.23-4.23) for trauma sequalae and this was not statistically different (HR 0.74 (0.51-1.09) p=0.13). In the acute trauma group, there was a statistically significant increase in medical complications at 30 & 90 days post procedure as well as length of stay (p<0.001).</p><p><strong>Conclusion: </strong>Based on this national joint registry analysis, patients are twice as likely to require a revision surgery if they undergo rTSA after conservative management has failed, compared to those who receive the procedure immediately following a proximal humerus fracture. While this may inform decision making and the consent process, given some of the limitations around registry analysis, the findings underline the importance of well-designed prospective trials in establishing the optimal timing of surgery.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison using Large Database; Treatment Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of implant placement after pre-operative planning using Blueprint Software in inlay and onlay reverse total shoulder arthroplasty systems: A cadaver study.","authors":"Brittany Percin, Jared L Zitnay, Robert Z Tashjian, Gilles Walch, Peter N Chalmers, Christopher D Joyce, Heath B Henninger","doi":"10.1016/j.jse.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.019","url":null,"abstract":"<p><strong>Background: </strong>Accurate implant placement is desirable in reverse total shoulder arthroplasty (rTSA). Prior studies have focused on the accuracy of patient-specific glenoid implant placement, with little data on humeral preparation. This study quantified both glenoid and humerus implant placement, with specific focus on differences between inlay and onlay humeral implant systems.</p><p><strong>Methods: </strong>Twenty cadaver shoulders were preoperatively planned in Blueprint Software. After the rTSA was placed, computed tomography (CT) scans were obtained and 3-dimensional models of the bones and implants were created. Errors were assessed for factors like glenoid guide pin location, reaming depth, inclination, and version, and humeral implant height, inclination, and version, by comparing the models from planned and performed surgeries.</p><p><strong>Results: </strong>Glenoid guide pin placement was accurate, with error of mean±SD 1.6±0.7 mm. While glenoid reaming depth appeared accurate (0.9±1.4 mm), variability between specimens ranged from -2.5 mm of over-reaming to 4.8 mm of under-reaming. Consequent glenoid inclination and version showed small mean error in inlay and onlay systems (1.4±3.9° and -1.4±4.2°, respectively) but large ranges among specimens (15.8° and 20.0°, respectively). Likewise, humeral implant height relative to the bone had small mean error (0.5±3.4 and -0.8±1.1 mm, respectively). The inlay height variation was nearly 3x that of the onlay (11.8 and 3.6 mm, respectively). Error in effective humeral inclination was again small (0.9±3.3° and -1.8±3.7°, respectively), with large overall variation (11.4° and 12.4°, respectively). Humeral implant version was the most error-prone, where specimen-specific variation ranged nearly 40° between the plan and procedure. The glenoid or humeral preparation error did not differ between the inlay and onlay systems for any metric (p≥0.059).</p><p><strong>Conclusion: </strong>This study quantified the error in placing glenoid and humeral implants relative to a preoperative plan for both humeral inlay and onlay systems. With the exception of humeral implant version, the mean placement error was generally small. In contrast, specimen-specific implant placement had large errors, even when the average appeared acceptable. Device manufacturers should evaluate the ability of their preoperative planning softwares (like Blueprint) and instrumentation to control these variables in practice, especially humeral implant version, and specifically account for anatomic humeral torsion as it likely has a substantial impact on humeral implant placement. These procedure-to-procedure variations have biomechanical implications that could affect shoulder function and complications and negatively impact outcomes of patient-specific rTSA if left unchecked.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellar Tendon Autografts Outperform Fascia Lata in Superior Capsular Reconstruction: A Comparative Histopathological and Biomechanical Study.","authors":"Muhammed Uslu, Erdinc Genc, Ergun Bozdag, Fatih Yamak, Mehmet Kapicioglu, Serdar Yuksel, Kerem Bilsel","doi":"10.1016/j.jse.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.015","url":null,"abstract":"<p><strong>Background: </strong>In the treatment of irreversible rotator cuff (RC) tears, surgeons reconstruct the superior capsule of the shoulder using tensor fascia lata (TFL) or various allografts to halt progressive joint degeneration. This study evaluated the healing characteristics of patellar tendon (PT) autograft versus TFL autograft in superior capsule reconstruction (SCR), examining both biomechanical and histological aspects.</p><p><strong>Methods: </strong>A total of 28 shoulders from 14 rabbits were used in this experimental study. Retracted tear models involving complete resection of both the supraspinatus and subscapularis tendons were created in all surgical groups. After an 8-week retraction period, superior capsular reconstruction (SCR) was performed using standardized techniques: fascia lata (FL) autografts were implanted in the right shoulders and patellar tendon (PT) autografts in the left shoulders, while the control group received no intervention. All grafts were fixed identically with bone tunnels and prolene sutures at the glenoid superiorly and the greater tuberosity laterally. Rabbits were observed for 8 weeks postoperatively. Outcome measures included biomechanical testing (load-to-failure) and histopathological analysis (tendon maturation scoring, collagen type I-III ratio, and CD31 immunoreactivity).</p><p><strong>Results: </strong>Post hoc pairwise analysis revealed that the load-to-failure values were significantly lower in FL group compared to control group (P<0.01), suggesting that FL group could not maintain biomechanical stability and tendon-bone integration. No significant difference was found between PT and control groups(P>0.05). Cellularity, vascularity, collagen continuity, and tidemark development showed no significant differences between the PT and control groups (P>0.05), while these parameters were significantly reduced in the FL group (P<0.05). FL group's mean total modified Watkins score was much lower than that of the control group (P=0.01) whilst the PT group nearly equaled the control group. Tendons of PT groups had significantly higher immunoreactivity for collagen type I and type III and CD31 compared to the control group (P=0.019, P=0.015 and P=0.014, respectively).</p><p><strong>Conclusions: </strong>In this rabbit model, PT autografts showed superior biomechanical strength, vascularity, and collagen remodeling compared to FL autografts in SCR, suggesting improved graft integration. Further studies, including cadaver-based research and clinical trials, are required to validate these findings and establish the clinical relevance of graft choice for SC in humans.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chewing Tobacco Use is Associated with Increased Perioperative Complications after Arthroscopic Rotator Cuff Repair.","authors":"Michael E Khnanisho, Alejandro M Holle, Sailesh V Tummala, Joseph C Brinkman, Steven J Hattrup, John M Tokish","doi":"10.1016/j.jse.2025.05.017","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.017","url":null,"abstract":"<p><strong>Introduction: </strong>Arthroscopic rotator cuff repair (RCR) is a common and effective treatment used to treat rotator cuff tears. Cigarette smoking is a known modifiable risk factor for poor outcomes following RCR. However, the relationship between chewing tobacco and outcomes following RCR have not been established in the literature. The purpose of this study was to assess the incidence of perioperative/postoperative complications and reoperation rate among patients who use chewing tobacco and undergo RCR.</p><p><strong>Methods: </strong>A comparative study was conducted using a large national insurance database. Patients who underwent RCR with at least 2 years of follow-up data were included. Smokeless tobacco and cigarette users were identified by patients who had the International Classification of Disease (ICD) code ICD-10-D-F17220 and ICD-10-D-F17210, respectively. Smokeless tobacco users and cigarette smokers were matched to non-user controls based on demographic variables and comorbidities. Smokeless tobacco users were also matched to cigarette smokers. There were no differences in age, sex, and Elixhauser Comorbidity Index between groups. Postoperative complications within 90 days and reoperations within 2 years were compared between groups. A Bonferroni correction was applied and a p<0.006 was used as the cutoff for statistical significance.</p><p><strong>Results: </strong>Within 90 days after RCR, chewing tobacco users had an increased risk of surgical site infection (0.8% vs 0.3%; Odds Ratio (OR): 3.75), venous thromboembolism (VTE) (1.3% vs 0.4%; OR: 4.09), pneumonia (2.7% vs 0.7%; OR: 4.76), acute kidney injury (AKI) (2.9% vs 0.7%; OR 6.84), myocardial infarction (1.1% vs 0.2%; OR: 6.68), and emergency department utilization (19.3% vs 8.3%; OR: 3.11) compared to non-user controls. When compared to cigarette smokers, chewing tobacco users had an increased risk of infection (0.9% vs 0.3%; OR: 3.25), VTE (1.5% vs 0.7%; OR: 3.08), pneumonia (2.9% vs 1.2%; OR: 2.97), AKI (3.3 vs 0.9%; OR 4.76), myocardial infarction (1.0% vs 0.4%; OR: 2.75), and emergency department utilization (20.2% vs 14.9%; OR: 1.97) within 90 days. Chewing tobacco use was not associated with an increased risk of receiving an ipsilateral total shoulder arthroplasty compared to non-user controls within 2 years. There were no significant differences in subsequent reoperations between chewing tobacco users and cigarette smokers within 2 years.</p><p><strong>Conclusion: </strong>Chewing tobacco use is associated with increased risk of medical complications and emergency department utilization following an RCR compared to non-user controls and cigarette users. This study demonstrates the importance of preoperative screening for chewing tobacco in patients undergoing RCR.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of Anterior Shoulder Instability Treatment with ALPSA Lesion Comparing Arthroscopic Bankart Repair With or Without Remplissage.","authors":"Carlos Verdu, Lorena Moril, Andres Lapeña, Manuel Ruiz, Alejandro Pagan, Alejandro Lizaur","doi":"10.1016/j.jse.2025.05.014","DOIUrl":"10.1016/j.jse.2025.05.014","url":null,"abstract":"<p><strong>Introduction: </strong>The complexity of the anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion is linked to an increased frequency of shoulder dislocations and a higher failure rate after surgical treatment.</p><p><strong>Objective: </strong>The purpose of this study was to determine whether arthroscopic treatment combining Bankart repair with a remplissage procedure reduces recurrence rates and improves functional outcomes compared to isolated Bankart repair.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted on patients treated between 2009 and 2014 at our hospital for traumatic anterior shoulder instability with ALPSA lesions and subcritical bone loss. Epidemiological data, recurrence of instability, range of motion, and functional outcomes were evaluated using Rowe, Walch-Duplay, and Western Ontario Shoulder Instability Index (WOSI) scales.</p><p><strong>Results: </strong>A total of 65 patients were included in the study (30 treated with isolated Bankart repair and 35 with a combination of Bankart and remplissage technique). At a minimum 5-year follow-up period, there were no statistically significant differences in recurrence rates between the group treated with the combined technique (5.7%) and those treated with Bankart repair alone (16.7%) (P=0.234). Patients treated with the combination of both procedures had better results on functional evaluation scales: Rowe (89.2 vs. 74.5; P=0.009), Walch-Duplay (90 vs. 81.5; P=0.016), and WOSI (89.8% vs. 76.3%; P=0.007).</p><p><strong>Conclusions: </strong>Arthroscopic Bankart repair with remplissage augmentation did not result in a statistically significant difference in recurrence rates for the treatment of ALPSA lesions with subcritical bone defects. Additionally, remplissage significantly improved functional outcomes compared to isolated Bankart repair.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding \"Is the \"Sling Effect\" of the Conjoint Tendon in Latarjet Procedures Real? A Systematic Review and Descriptive Synthesis of Controlled Laboratory and Comparative Clinical Studies\".","authors":"Harry Constantin, Luis José María Suarez Jimenez, Quentin Rialet, Pascal Boileau","doi":"10.1016/j.jse.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.011","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Resident Involvement Impact Postoperative Outcomes After Surgical Treatment of Proximal Humerus Fractures?","authors":"Alexander R Zhu, Eve R Glenn, Emily M O'Connell, Eric Mao, Seyedeh Zahra Mousavi, Umasuthan Srikumaran","doi":"10.1016/j.jse.2025.05.013","DOIUrl":"10.1016/j.jse.2025.05.013","url":null,"abstract":"<p><strong>Background: </strong>Proximal humerus fractures (PHFs) are a prevalent orthopedic injury and often require surgical intervention. These surgeries frequently involve resident participation as part of their training, but the impact of this involvement on surgical outcomes remains unclear. This study evaluates the effect of resident participation on perioperative complications and mortality in PHF surgeries.</p><p><strong>Methods: </strong>The National Surgical Quality Improvement Program (NSQIP) database was retrospectively analyzed from 2006 to 2012. Data was extracted from inpatient records of patients with a PHF who received open reduction internal fixation (ORIF), hemiarthroplasty (HA), or total shoulder arthroplasty (TSA). Multivariate logistic and linear regression models, controlling for demographics and comorbidities identified through univariate analysis, were performed to examine the effect of resident involvement on each outcome. Complication rates between non-resident and resident cases were also stratified by post-graduate year level of training and analyzed via ANOVA. Because of multiple statistical comparisons, a Bonferroni correction was used for univariate and multivariate analyses, with statistical significance was set at P < 0.0011.</p><p><strong>Results: </strong>Among the 2,277 analyzed cases, multivariate analysis revealed that resident involvement was associated with increased postoperative complications, including minor complications. Furthermore, the involvement of a senior resident or fellow was significantly associated with increased minor complications compared with cases involving the attending surgeon alone.</p><p><strong>Discussion: </strong>While resident involvement is vital for developing surgical skills, this study's findings suggest it is associated with increased postoperative complications in PHF surgeries, particularly minor complications. This association highlights the need for further research to understand the factors contributing to the observed differences in postoperative outcomes.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Constantin et al. regarding: \"Is The \"Sling Effect\" of the Conjoint Tendon in Latarjet Procedures Real? A Systematic Review and Descriptive Synthesis of Controlled Laboratory and Comparative Clinical Studies\".","authors":"Kevin A Hao, Xinning Li, Kevin W Farmer, Ryan P Roach, Bradley S Schoch, Joseph J King, Keegan M Hones","doi":"10.1016/j.jse.2025.05.012","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.012","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scapula anatomy influences simulated impingement free range of motion in reverse shoulder arthroplasty.","authors":"Stefan Greiner, Patrick J Denard, Nick Metcalfe, Siddhant Thakur, David Knopf, Shoulder Arthroplasty Research Committee ShARC, Brian C Werner","doi":"10.1016/j.jse.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.008","url":null,"abstract":"<p><strong>Introduction: </strong>Impingement-free range of motion (ROM) after reverse shoulder arthroplasty (rTSA) may depend on implant position and scapula anatomic parameters. The critical shoulder angle (CSA) is influenced by a combination of scapula parameters. The aim of this study was to evaluate whether the CSA has an influence on impingement-free ROM after rTSA in a virtual simulation using a Statistical Shape Model (SSM).</p><p><strong>Materials and methods: </strong>100 scapulae chosen from a database of 10,000 scapulae were used to generate a Statistical Shape Model (SSM). Modes corresponding to anatomical characteristics (size, CSA etc.) were defined. Five CSA-models were obtained including a mean and two standard deviations (SD) (CSA 32°(-2 SD), CSA 30°(-1 SD), CSA 27°(mean), CSA 25°(+1 SD) and CSA 23°(+2 SD). A 39mm glenosphere was virtually implanted in each model. The humeral side was kept consistent with the simulation of a 135° neck-shaft-angle (NSA) component (Univers Revers, Arthrex Inc., Naples, FL, USA). Glenoid positioning parameters included: 1) lateral offset (0-10mm in 2mm increments), 2) inferior offset (0, 2d.5, 5, 7.5mm) and 3) posterior offset (0, 2.5, 5mm). External rotation (ER) at 0 and 60° of abduction and internal rotation (IR) at 60° of abduction were then analyzed for the different positioning parameters (inferior-, posterior- and lateral offset) and the combination of 0mm inferior and 2.5 posterior offset and lateralization from 0-10mm, 2.5mm inferior and 0mm of posterior offset and lateralization (0-10mm) and the combination of 2.5mm inferior and 2.5mm posterior offset and lateralization (0-10mm).</p><p><strong>Results: </strong>Lower CSA models showed higher ER 0° values (e.g., 435% increase from CSA 32° to CSA 23° at 0mm lateral, inferior and posterior offset), while models with greater CSAs showed higher IR 60° values (e.g., 505% increase from CSA SD 23° to CSA SD 32° at 0mm lateral, inferior and posterior offset). By lateralizing, ROM increased in all CSA models (e.g., 884% increase from 0mm to 10mm lateralization for CSA 32° for ER 0°). Posterior positioning of 2.5 and 5mm improved ER not IR. Maximal IR at 60° was achieved with no posterior, 2.5mm of inferior offset and lateralization between 2-6mm according to the evaluated CSA.</p><p><strong>Conclusion: </strong>Specific CSA ranges require particular implant positioning strategies to optimize impingement-free ROM in rTSA. To achieve the maximal ROM combination of IR and ER in this simulation, 2.5mm of inferior offset with no posterior offset and lateralization of 4mm for CSA≥30° and 6mm for CSA SD≤25° was required.</p><p><strong>Level of evidence: </strong>Basic Science Study; Computer Modeling.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}