Journal of Shoulder and Elbow Surgery最新文献

{"title":"Corrigendum to 'Preoperative 3-dimensional computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty' [Journal of Shoulder and Elbow Surgery volume 33, issue 7 (2024) 1503-1511].","authors":"Daniel Ritter, Patrick J Denard, Patric Raiss, Coen A Wijdicks, Samuel Bachmaier","doi":"10.1016/j.jse.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.jse.2025.06.001","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692231","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":"Identifying Clinically Meaningful Changes and Predictors of Improvement for Patient-Reported Outcome Measures in Patients who Undergo Arthroscopic Arthrolysis of Post-traumatic Elbow Stiffness.","authors":"Hui Ben, Ik Jae Jung, In-Ho Jeon","doi":"10.1016/j.jse.2025.05.042","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.042","url":null,"abstract":"<p><strong>Background: </strong>Clinically meaningful outcome thresholds, including patient acceptable symptom state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB), have rarely been evaluated after arthroscopic arthrolysis for post-traumatic elbow stiffness. This study therefore aimed to determine PASS, MCID, and SCB values for the pain Visual Analog Scale (pVAS), Single Assessment Numeric Evaluation (SANE), Mayo Elbow Performance Score (MEPS), and range-of-motion difference (ROMD) after arthroscopic elbow arthrolysis.</p><p><strong>Methods: </strong>Sixty-five patients who underwent arthroscopic elbow arthrolysis were evaluated at a minimum of 1 year postoperatively using anchor-based methods for PASS and SCB, and a distribution-based method for MCID. Anchor questions were used to define clinically meaningful thresholds. Univariate and multivariate logistic regression analyses were performed to determine predictors of improvement for surgical outcomes.</p><p><strong>Results: </strong>All four measures demonstrated acceptable discriminative ability (area under the curve >0.70) for PASS and SCB. The PASS, MCID, and SCB thresholds were 2.5, 1.2, and 2.5 for pVAS; 65.0, 11.9, and 12.5 for SANE; 87.5, 9.5, and 17.5 for MEPS; and 113, 15, and 58 for ROMD. Lower preoperative scores were associated with significantly higher odds ratios (ORs) for achieving all thresholds. Longer symptom duration and the presence of ulnar nerve symptoms were associated with significantly lower ORs for achieving PASS for SANE. Younger age was significantly associated with achieving higher odds ratios (ORs) for PASS for MEPS. For ROMD, younger age, shorter symptom duration, lower BMI, and the presence of preoperative ulnar nerve symptoms were associated with significantly higher ORs for achieving PASS.</p><p><strong>Conclusion: </strong>After arthroscopic elbow arthrolysis, reliable PASS, MCID, and SCB thresholds were identified for pVAS, SANE, MEPS, and ROMD. Favorable outcomes were more likely in patients with poorer preoperative scores, younger age, lower BMI, and shorter symptom duration, while preoperative ulnar nerve symptoms were negatively associated with achieving PASS.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison; Prognosis Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668878","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":"Glenoid-sided Lateralization Decreases Scapular Notching With a 135° Humeral Component Arthrex Reverse Shoulder Arthroplasty.","authors":"Theresa Pak, Ali I Kilic, Javier Ardebol, Reuben Gobezie, Benjamin W Sears, Evan Lederman, Brian C Werner, Patrick J Denard","doi":"10.1016/j.jse.2025.05.044","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.044","url":null,"abstract":"<p><strong>Background: </strong>The incidence of scapular notching has dramatically reduced with the shift from 155° to 135° humeral inclination in reverse shoulder arthroplasty (rTSA). However, humeral inclination is not the only factor as notching persists with medialized glenospheres. The purpose of this study was to assess the effect of glenoid-sided lateralization on scapular notching with a 135° rTSA.</p><p><strong>Methods: </strong>A retrospective review was performed from a multicenter prospectively collected database to identify patients who underwent primary rTSA and had 2 year minimum follow-up. All rTSAs were performed with the Arthrex system using a 135° inlay humeral component. Varying amounts of glenoid-sided lateralization were used from 0 to 8 mm in 2 mm increments based on surgeon preference. Postoperative radiographs were evaluated for scapular notching, distalization shoulder angle (DSA), and lateralization shoulder angle (LSA). The LSA was further subdivided into humeral (HLA) and glenoid (GLA) contributions. Regression analysis was performed on component and clinical variables to assess for factors predictive of notching and the effect on clinical outcomes.</p><p><strong>Results: </strong>Overall, scapular notching was observed in 56 out of 517 shoulders (10.8%). Metallic glenoid lateralization and glenosphere overhang were protective of notching (P = .030, P = <.001; respectively). For women, 6 mm of lateralization reduced notching compared to 4 mm or less (5.3% vs. 15.6%; P = .016). For men, 8 mm of lateralization reduced notching compared to 6 mm or less but the difference did not meet statistical significance (7.6% vs. 13.6%; P = .161). Notching also was associated with decreased forward flexion by 13° (β -12.79, 95% CI: -19.63 - -5.96 P = <.001).</p><p><strong>Discussion: </strong>With a 135° inlay humerus and lateralized glenoid rTSA, scapular notching decreases with metallic lateralization of 6 mm or more. Additionally, inferior glenosphere positioning is protective of notching. Notching is associated with worse clinical outcomes and lower postoperative ROM.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison; Prognosis Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668877","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 Post-Capsulorrhaphy Arthropathy Results in Similar Clinical Outcomes Compared to Glenohumeral Osteoarthritis.","authors":"Guy Guenthner, Adam R Bowler, Evan A Glass, Jason Corban, Himmat Sahi, Calista S Stevens, Miranda McDonald-Stahl, Pamela A Chan, Declan R Diestel, Shannon Gray, Kiet Le, Jacob M Kirsch, Andrew Jawa","doi":"10.1016/j.jse.2025.05.043","DOIUrl":"10.1016/j.jse.2025.05.043","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (rTSA) is a reliable treatment option for various indications, including glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. Following either open or arthroscopic instability surgery, a certain portion of patients develop post-capsulorrhaphy arthropathy (PCA) and ultimately need shoulder replacement. While these patients often have an intact rotator cuff, alterations to the native soft tissue anatomy may compromise the success of anatomic total shoulder arthroplasty (aTSA), leading some to consider rTSA. Limited literature currently exists evaluating the outcomes of rTSA as a treatment for PCA.</p><p><strong>Methods: </strong>Patients undergoing rTSA for the treatment of GHOA or PCA were retrospectively propensity score-matched in a 2.2:1 ratio based on age, sex, and BMI, as well as preoperative American Shoulder and Elbow Surgeons (ASES) score, forward elevation, and external rotation. Preoperative clinical outcomes at a minimum 2-years consisted of the Visual Analog Scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE) score, and ASES score, as well as active forward elevation, internal rotation, and external rotation. The PCA cohort was stratified into sub-cohorts based on capsulorrhaphy technique (open or arthroscopic), all of which were soft tissue procedures. Univariate analysis was performed to compare cohort and sub-cohort demographics, clinical outcomes, and glenoid erosion patterns using the Walch classification system.</p><p><strong>Results: </strong>After matching, the GHOA and PCA cohorts consisted of 82 and 37 patients, respectively, with no significant differences in age (GHOA 68±6 years versus PCA 66±6 years; P=.082) or follow-up duration (GHOA 29±12 months versus PCA 29±11 months; P=.493). Both groups demonstrated significant improvement in all clinical outcome metrics. The arthroscopic and open PCA sub-cohorts consisted of 19 and 18 patients, respectively. No significant preoperative or postoperative clinical outcome differences were observed between any cohort or sub-cohort studied (P>.05). There was a significant difference in Walch classification distribution between the GHOA and PCA cohorts (P=.014), with the most likely cause being a difference in frequency of A1 (GHOA 25.9% versus PCA 36.3%) and B3 (GHOA 24.7% versus PCA 12.1%) glenoid wear patterns.</p><p><strong>Conclusion: </strong>This study demonstrates that rTSA is a reliable and effective treatment option for patients with PCA. Furthermore, the surgical technique of the previous soft tissue instability procedure (arthroscopic versus open) does not affect clinical outcomes after rTSA. Given the predictability of the outcomes associated with rTSA for PCA, consideration should be given for this as a treatment choice.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison; Prognosis Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668881","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":"Patient Satisfaction and Clinical Outcomes Utilizing a Patient Care Coordination Team to Support Same Day Discharge Following Shoulder Arthroplasty.","authors":"Yulia S Lee, Melissa A Wright, Anand M Murthi","doi":"10.1016/j.jse.2025.05.040","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.040","url":null,"abstract":"<p><strong>Background: </strong>A patient care coordination (PaCC) team has been shown to reduce length of hospital stay and direct costs for total hip and knee replacement patients by coordinating successful same day discharge. There is no prior literature on the impact of a PaCC team on outcomes following shoulder arthroplasty. The aim of this study was to examine factors associated with successful same day discharge utilizing a PaCC team following shoulder arthroplasty, and the relationship of successful discharge to clinical outcomes and patient satisfaction.</p><p><strong>Methods: </strong>This is a single-center retrospective study of all primary total shoulder arthroplasties performed between July 2021 and April 2023 with one of three fellowship trained shoulder and elbow surgeons. All patients were part of the PaCC program. Four subgroups were compared based on demographics, clinical outcome, and patient satisfaction: 1) successful planned same-day discharge (SS), 2) failed planned same-day discharge (SX), 3) successful planned next-day discharge (NN), and 4) failed planned next-day discharge (NX).</p><p><strong>Results: </strong>A total of 497 patients and 515 total shoulder arthroplasty cases were included for analysis. There was a higher ratio of female patients in groups anticipated to be discharged next-day or failed to be discharged same-day compared to those successfully discharged same-day (75.0% SX, 75.4% NN, 69.7% NX vs. 50.9% SS, p < 0.001). The median BMI was higher in groups that failed to be discharged on anticipated dates (29.2 [25.8, 33.9] SS vs. 34.6 [29.6, 41.4] SX, 29.6 [24.2, 35.4] NN vs. 32.1 [29.8, 35.9] NX, p = 0.002). The presence of an active mental health disorder was also higher among patients who failed to be discharged on their anticipated dates (29.6% SS vs. 31.3% SX, 39.3% NN vs. 51.5% NX, p = 0.042). Reoperation rates were highest in the group of patients that failed next-day discharge (12.1% NX vs. 3.3% NN vs. 3.1% SX vs. 1.5% SS, p = 0.009). The rate of ER visits was also significantly higher in groups that failed planned discharge (3.1% SS vs. 6.3% SX, 1.6% NN vs. 15.2% NX, p = 0.012).</p><p><strong>Conclusions: </strong>While there was an overall high rate of successful planned same-day discharge using a PaCC program, female-identifying patients, patients with a higher BMI, and patients with a mental health disorder were at higher risk of failing to discharge as planned. Identifying specific barriers to successful discharge can ensure timely and safe discharge, particularly as practices move towards outpatient shoulder arthroplasty.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; Quality Assessment/Improvement Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668880","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":"Intra-articular Corticosteroid Injection versus Suprascapular Nerve Block for Adhesive Capsulitis: A Systematic Review and Meta-analysis of Level I Randomized Controlled Trials.","authors":"Jonathan D Harley, Confidence Njoku Austin, Alicia K Harrison, Bryan M Saltzman, Allison J Rao","doi":"10.1016/j.jse.2025.05.037","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.037","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intra-articular corticosteroid injection and suprascapular nerve block are both options for nonoperative management of adhesive capsulitis. While numerous studies support the benefits of steroid injections, the use of suprascapular nerve blocks is less established. Published randomized trials comparing steroid injections and suprascapular nerve blocks for managing adhesive capsulitis have reported mixed results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To synthesize the results of published level I studies to compare outcomes for patients with adhesive capsulitis following intra-articular corticosteroid injection or suprascapular nerve block.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and meta-analysis; Level of evidence, 1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was performed according to the preferred reporting items for systematic reviews and meta-analysis. Three databases were searched for randomized controlled trials comparing an intra-articular steroid injection to a suprascapular nerve block in patients with adhesive capsulitis. Trials were excluded if either group received another procedure or included patients with concomitant ipsilateral shoulder pathology. Outcomes were patient-reported pain intensity and shoulder function, range of motion, and time to symptom resolution. Meta-analysis was performed for pain, shoulder function, and range of motion using random-effects models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight studies with a total of 452 patients were included. Pain was assessed using the shoulder pain and disability index (SPADI) pain subscale and the visual analog scale (VAS). Functional outcomes were assessed using the SPADI and Constant-Murley Score. Range of motion assessments included active and passive movements in abduction, forward flexion, external rotation, and internal rotation. Random-effects comparisons at baseline, 3-4 weeks, 6-7 weeks, and 12 weeks were performed for pain and SPADI scores, and at baseline and 12 weeks for active abduction. Suprascapular nerve blocks were superior to steroid injections for pain at 3-4 weeks (standardized mean difference [SMD]: 0.63, 95% CI: 0.06-1.19, p = 0.03), 6-7 weeks (SMD: 0.49, 95% CI: 0.01-0.96, p = 0.046), and 12 weeks post-intervention (SMD: 1.68, 95% CI: 0.30-3.06, p = 0.017). Nerve blocks were superior to steroid injections in reducing SPADI scores at 12 weeks post-intervention (MD = 8.94, 95% CI: 1.44-16.44 p = 0.020). Nerve blocks were superior to steroid injections for active abduction at 12 weeks post-intervention (MD = 14.44°, 95% CI: 11.05°-17.83°, p &lt; 0.001). Heterogeneity was considerable for all meta-analyses. There were no other significant differences between groups at any time point.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients with adhesive capsulitis, suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668879","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":"Biomechanical Comparison of 2.4 mm LCP Radial Head Plate and Tripod Fixation in Mason Type III Radial Head Fractures: A Human Cadaveric Study.","authors":"Moritz Kraus, Luke van Rossenberg, Ivan Zderic, Tatjana Pastor, Boyko Gueorguiev, R Geoff Richards, Hans-Christoph Pape, Klaus Burkhart, Torsten Pastor","doi":"10.1016/j.jse.2025.05.039","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.039","url":null,"abstract":"<p><strong>Background: </strong>Proximal radius fractures, particularly Mason Type III, represent a challenge in elbow surgery due to their complexity and impact on joint function. Using the conventional radial neck plate is a reliable treatment option, however, it can cause soft tissue irritation and restricted range of motion. A novel tripod fixation approach, using three crossed screws, should minimize such complications and preserve range of motion. This study aims to compare the biomechanical competence of conventional radial neck plating using a LCP Radial Head Neck Plate 2.4 mm (DePuy Synthes, West Chester, PA, USA) versus tripod fixation in a Mason Type III fracture model.</p><p><strong>Methods: </strong>Sixteen paired human cadaveric radii underwent a standardized osteotomy to simulate a transverse neck fracture with an additional 50:50 head split component and split into two groups - Group 1 fixed with a conventional radial neck plate with two additional canulated headless compression screws (HCS) and Group 2 stabilized with tripod fixation (three cruciated 40 mm HCS) and two additional HCS. Biomechanical tests assessed stiffness in anteroposterior and mediolateral bending, axial compression, pronation, and supination.</p><p><strong>Results: </strong>No significant differences were found in stiffness across the comparisons: mediolateral bending: tripod:195±132 N/mm, plate: 91±47 N/mm (p = 0.067), anteroposterior bending: plate: 168±105 N/mm tripod: 145±108 N/mm (p = 0.670), axial compression: plate: 643±337 N/mm vs. tripod: 642±188 N/mm (p = 0.998), pronation: plate 0.15±0.10 Nm/°, tripod: 0.23±0.23 Nm/° (p = 0.336), and supination: plate: 0.17 Nm/°, Tripod: 0.25±0.21 Nm/° (p = 0.351). Cycles to failure under axial compression were recorded with the plate group showing 4,078±3,173 cycles and the tripod group 4,763±5,288 cycles, p ≥ 0.4. Load to failure was noted at 586±222 N for the plate and 789±337 N for the tripod, p ≥ 0.4.</p><p><strong>Conclusion: </strong>From a biomechanical perspective the tripod technique with two additional HCS showed comparable performance compared to plate fixation with two additional HCS in transverse radial neck fractures with an additional head split component. With potentially less soft tissue irritation and necessary secondary hardware removal the tripod technique seems to be a valid alternative to conventionally used plate osteosynthesis techniques. However, further randomized clinical trials are needed to fully evaluate its clinical value.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660922","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":"Long-Term survival of Acumed Anatomical Radial Head implant for Mason Type III-IV fractures: a 15-year follow-up.","authors":"Luigi Tarallo, Andrea Celli, Laura Benedetti, Matilde Delvecchio, Grazia Ciacca, Giuseppe Porcellini, Fabio Catani","doi":"10.1016/j.jse.2025.05.038","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.038","url":null,"abstract":"<p><strong>Introduction: </strong>Radial head fractures account for 1.7% to 5.4% of all skeletal fractures and approximately one-third of elbow fractures. These injuries are often associated with other concurrent injuries, such as fractures of the coronoid, ligamentous injuries of the elbow, or trauma to other regions of the upper limb. Intra-articular fractures, especially Mason type III and IV, often require anatomical reduction to restore the articular surface, but such procedures can yield suboptimal results, highlighting the role of radial head implants in complex cases.</p><p><strong>Materials and methods: </strong>This retrospective study evaluated patients treated with Acumed Anatomical Radial Head implant from 2008 to 2023, specifically those with Mason type III and IV fractures. A total of 149 patients were included, with an average follow-up of 7 years.</p><p><strong>Discussion: </strong>Clinical outcomes, assessed using the Mayo Elbow Performance Score (MEPS), showed an average score of 90, with an average range of motion of 130° in flexion and 78° in pronation and supination. Implant survival at 15 years exceeded 95%, confirming the long-term effectiveness of anatomical radial head implants. The most common complications included: heterotopic ossification with reduced joint mobility (35%), postoperative stiffness with functional limitations (9.4%), and implant loosening (4.7%).</p><p><strong>Conclusions: </strong>Radial head implants offer a reliable treatment for complex Mason type III and IV fractures, with good functional and survival outcomes and a low incidence of complications. However, careful implant sizing is crucial to avoid complications such as premature loosening, joint stiffness and pain.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660923","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":"Preventing Posterior Interosseous Nerve Injury during a Distal Biceps Tendon Repair, an Anatomic Study Comparing EDC and ECU Muscle Splitting Approaches.","authors":"Justin T Badon, Brian K Foster, Jeffrey S Chen, Bethany G Ricci, A Michael Luciani, Joseph F Styron, Christopher C Schmidt","doi":"10.1016/j.jse.2025.05.041","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.041","url":null,"abstract":"<p><strong>Background: </strong>Dorsal forearm approaches are commonly used to repair both partial and complete distal biceps tendon tears. Either the extensor digitorum communis (EDC) or extensor carpi ulnaris (ECU) and the supinator muscles are longitudinally split to expose the radial tuberosity (RT). Despite the known risk of posterior interosseous nerve (PIN) injury, there is little information on the safety of each approach. The purpose of this study was to define the location of the PIN relative to the radial tuberosity (RT) through both EDC and ECU muscle splitting approaches. Additionally, we aimed to find a reliable method to preoperatively locate the PIN, by using a novel line from the olecranon-to-radial styloid (ORS).</p><p><strong>Methods: </strong>EDC and ECU muscle splitting approaches were performed on 20 cadaveric specimens, and RT-to-PIN lengths were measured in forearm supination, neutral, and pronation. Additional measurements were made from the olecranon to the point of PIN intersection along the ORS line and to the RT. After RT-to-PIN measurements, the coronal dissection plane for each approach was replicated with strings, and the EDC muscle was reflected to determine if the PIN or its branches crossed either approach lines.</p><p><strong>Results: </strong>The ECU, versus EDC, approach resulted in longer mean distances between the RT and PIN (≥11mm; p<0.001). In both approaches, the PIN was farthest from the RT in pronation and closest in supination (p<0.001). The minimal distance from RT-to-PIN when using an ECU muscle splitting approach with the forearm in pronation was 21mm. The PIN crossed the midline of the radial shaft and approach line with an EDC approach; whereas only the ECU motor branch transversed the radial shaft and approach line in an ECU approach. The PIN intersected the ORS line at 35% of its total length. The RT was located 61±5mm from the tip of the olecranon.</p><p><strong>Conclusion: </strong>The ECU, versus EDC, muscle splitting approach is less likely to endanger the PIN and/or its branches because the RT-to-PIN length was ≥11mm longer in all three forearm positions (p<0.001). Additionally, the PIN crossed the midline of the radial shaft and its approach line using an EDC approach, while only the ECU motor branch transversed the radial shaft and its approach line with an ECU approach. The PIN was located ≥21mm distal to the RT using an ECU muscle splitting approach in forearm pronation. The ORS line and olecranon are useful landmarks to locate the PIN and RT, respectively.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660924","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":"Revision rates between obese and non-obese total shoulder arthroplasty patients: An Australian registry data study.","authors":"James Randolph Onggo, Richard Jamieson, Peiyao Du, David R J Gill, Kemble Wang","doi":"10.1016/j.jse.2025.05.036","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.036","url":null,"abstract":"<p><strong>Background: </strong>Obesity is an epidemic more apparent in many developed countries, like Australia. The effect upon total shoulder replacement (TSR) is not clear, with different studies reporting varying conclusions. This registry-based study offers a large-scale analysis of the effects of obesity on the risk of revision in anatomic TSR (aTSR) and reverse TSR (rTSR) for various indications.</p><p><strong>Methods: </strong>This is an observational cohort analysis of data from a national arthroplasty registry. Primary aTSR for osteoarthritis, and primary rTSR for cuff arthropathy or fracture performed between January 2015 and December 2022 in Australia were included. Procedures were stratified by body mass index (BMI) groups and the cumulative percentage of revision (CPR) was compared between groups. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models.</p><p><strong>Results: </strong>There were 9,549 primary aTSR for osteoarthritis, 13,920 primary rTSR for cuff arthropathy and 4685 primary rTSR for fractures. In rTSR indicated for fracture, obese class III had an increased all-cause revision risk compared to normal BMI patients (HR=1.87, 95%CI: 1.13-3.10, p=0.014) throughout the entire follow-up period. In contrast, all-cause revision rates for aTSR for osteoarthritis and rTSR for rotator cuff arthropathy across BMI categories were not significantly different. There was an increased risk of revision for instability/dislocation in BMI class III compared to normal BMI patients after rTSR for fracture (HR=2.84, 95%CI: 1.43-5.63, p=0.002). Obese class 1 and obese class 2 patients receiving aTSR for osteoarthritis had a higher rate of revision for cuff insufficiency compared to normal BMI patients (Entire period HR=2.30, 95%CI: 1.17-4.55, p=0.016 and Entire period HR=2.10, 95%CI: 1.00-4.40, p=0.049, respectively).</p><p><strong>Conclusion: </strong>Obesity has an increased risk of all-cause revisions and revision for instability/dislocation in patients receiving rTSR indicated for fractures. BMI was not associated with an increased risk of revision in primary aTSR indicated for osteoarthritis, nor for primary rTSR indicated for rotator cuff arthropathy. We recommend BMI class III patients undergoing rTSR for fracture to be counselled on their complication risks during the informed consenting process.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison using Large Database; Prognosis Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651090","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}