Journal of Shoulder and Elbow Surgery最新文献

{"title":"Development and Validation of the Shoulder Arthroplasty Risk of Non-Home Discharge (SHORD) Score: A Risk Stratification Model for Non-Home Discharge Following Primary Total Shoulder Arthroplasty.","authors":"Rohan A Phadke, Samer G Salman, Sameer R Khawaja, Benjamin Fiedler, Abbas Rana, Zaamin B Hussain, Grant E Garrigues, T Bradley Edwards","doi":"10.1016/j.jse.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.017","url":null,"abstract":"<p><strong>Background: </strong>Non-home discharge (NHD) after total shoulder arthroplasty (TSA) increases cost, complications, and readmission, yet most existing risk tools depend on postoperative data or are not built to directly estimate the risk of this outcome. We developed and validated the Shoulder Arthroplasty Risk of Non-home Discharge (SHORD) Score, a purely preoperative bedside tool.</p><p><strong>Methods: </strong>We carried out a retrospective prognostic model development and validation study of 29,382 patients undergoing primary TSA in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP, 2016 to 2021). Patients were split into a derivation (two-thirds) and a held-out validation (one-third) cohort. Preoperative candidate predictors were screened by univariate logistic regression, assessed for collinearity, and entered into multivariable logistic regression; independent predictors were converted to integer points to form the SHORD Score. Discrimination (area under the receiver operating characteristic curve [AUROC]), calibration, and classification were assessed in validation and compared with the 5-item modified frailty index (mFI-5), American Society of Anesthesiologists (ASA) class, age, the Risk Analysis Index (RAI), and the NSQIP morbidity probability using the DeLong test. Sensitivity analyses addressed acute proximal humerus fracture, baseline non-home residence, missing albumin, and dyspnea.</p><p><strong>Results: </strong>NHD occurred in 2,057 patients (7.0%). 16 independent predictors formed the score, the strongest being age 85 years or older, transfer from acute care, ASA class 4, dependent functional status, and preoperative non-home residence. In validation, the SHORD Score achieved an AUROC of 0.816 (95% confidence interval 0.802 to 0.830) with excellent calibration (calibration slope 0.96; Brier score 0.057). It significantly outperformed every comparator (all DeLong P < .001) and produced a marked gradient exceeding 20-fold, from 0.4% in the lowest risk group to 20.3% in the highest. Discrimination was similar across subgroups and sensitivity analyses, including after excluding the 5.7% of patients with acute proximal humerus fracture (AUROC 0.811).</p><p><strong>Conclusion: </strong>The SHORD Score is an internally validated, preoperative tool whose score is associated with non-home discharge after shoulder arthroplasty and uses only admission-day variables, which may support early discharge planning and resource allocation. External and prospective validation are warranted.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229170","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":"Prevalence and Severity of Spin in Systematic Reviews and Meta-Analyses Evaluating Treatment for Shoulder Instability.","authors":"Daman P Dhunna, Abigail Cook, Kenneth T Nguyen, Kevin A Wu, Eric Mai, Christopher Warburton, Ishan Oza, Jaxon S Boley, Jason Fink, Avanish Yendluri, Robert L Parisien","doi":"10.1016/j.jse.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.020","url":null,"abstract":"<p><strong>Background: </strong>Shoulder instability is a common and clinically significant condition, particularly among young and active populations, and represents a frequent indication for both nonoperative and operative intervention. As the volume of clinical research and comparative surgical literature continues to grow, systematic reviews and meta-analyses are increasingly relied upon to guide treatment selection, patient counseling, and return-to-sport expectations. In this setting, biased reporting within evidence syntheses may meaningfully influence clinical decision-making. The purpose of this study was to evaluate the prevalence and types of reporting bias (spin) in systematic reviews and meta-analyses addressing shoulder instability and to determine whether spin is associated with methodological rigor.</p><p><strong>Methods: </strong>This systematic review was prospectively registered with PROSPERO (CRD420261399489). Following PRISMA guidelines, PubMed, Scopus, and Embase were searched for systematic reviews and meta-analyses focused on shoulder instability in December 2025. Eligible studies were evaluated for 15 predefined types of spin using the Yavchitz taxonomy, and methodological quality was assessed using AMSTAR 2. Study characteristics included PRISMA adherence, protocol preregistration, level of evidence, publication year, and journal impact factor. Associations between spin and study characteristics were analyzed using Chi-square, Mann-Whitney U, Kruskal-Wallis, and Spearman rank correlation tests.</p><p><strong>Results: </strong>A total of 126 studies were included. Spin was identified in 86 studies (68.3%), most commonly involving misleading reporting (55.6%) and misleading interpretation (38.1%). Most studies were rated as critically low confidence on AMSTAR 2 (73.0%). The presence and burden of spin were significantly associated with lower numerical AMSTAR 2 scores (p < 0.01). Level of evidence was associated with spin burden but not spin presence. Journal impact factor and year of publication were not associated with spin.</p><p><strong>Conclusion: </strong>Reporting spin is highly prevalent in systematic reviews and meta-analyses addressing shoulder instability and is strongly associated with lower methodological quality. Given the high prevalence of shoulder instability and the reliance on evidence syntheses to inform treatment decisions, patient counseling, and expectations regarding recurrence and return to sport, biased reporting may contribute to misinterpretation of treatment effectiveness and inappropriate clinical conclusions. These findings underscore the need for greater methodological rigor, transparency, and critical appraisal of evidence syntheses to support informed, evidence-based care for patients with shoulder instability.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229261","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":"Variation of the definition of \"survival\" in reverse total shoulder arthroplasty: a systematic review.","authors":"Henry Maxwell Fox, Eve R Glenn, James H Padley, Branden Lee, Jacob White, Uma Srikumaran, Edward G McFarland","doi":"10.1016/j.jse.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.016","url":null,"abstract":"<p><strong>Background: </strong>Although studies have been published on long-term outcomes of reverse total shoulder arthroplasty (rTSA), various definitions of \"survival\" and \"revision\" are used, making comparisons of the findings difficult. Arthroplasty registries also vary in their definitions of these terms. The goal of this systematic review was to determine how variation in definitions of these terms affects the reported long-term results of rTSA.</p><p><strong>Methods: </strong>We systematically searched the PubMed and Embase databases to identify studies reporting ≥10-year follow-up after primary rTSA. Nine studies (493 shoulders) met our selection criteria. The included clinical studies were predominantly Level IV retrospective cohort studies. Definitions of survival and revision were extracted from these studies. Previously published lists of national or regional arthroplasty registries were used to identify publicly available registry reports. When available, 10-year survival data for primary rTSA were extracted from these reports. Of the 11 registries reviewed, 3 had substantive 10-year survival data and definitions and were included in our analysis. Using standardized definitions of survival, we calculated pooled 10-year survival rates from the included studies and compared them with those from the arthroplasty registries. We defined entire-construct survival as the percentage of shoulders in which neither the metal components (humeral stem and/or glenoid baseplate) nor the polyethylene component had been revised. Similarly, we assessed 10-year survival of the metal components (no revision of metal components, but shoulder underwent polyethylene exchange/revision). Using these definitions, we recalculated survival rates for both entire-construct survival and metal component survival.</p><p><strong>Results: </strong>Definitions of survival varied among clinical studies. The weighted average 10-year survival rates were 82.7% for the entire rTSA construct (polyethylene, humerus, and glenoid components), and 89.5% for the metal components only. The rate of isolated polyethylene liner exchange was 7%. Registry-reported 10-year survival rates for the entire construct were consistently higher (approximately 94%-95%) than the weighted averages from the included clinical studies.</p><p><strong>Conclusion: </strong>With standardized definitions, 10-year revision-free survival was 82.7% for the entire construct and 89.5% when isolated polyethylene liner exchange was excluded. Considerable inconsistency in the definition of long-term survival across clinical series and arthroplasty registries limits direct comparison and supports standardized reporting of survival endpoints.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229269","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":"Myocardial Infarction Within 6 Months before Total Shoulder Arthroplasty is Strongly Associated with Postoperative Complications.","authors":"Romir P Parmar, Vickrambir S Sahni, Alejandro M Holle, Michael H Amini, Michael McKee, Evan Lederman, Midhat Patel","doi":"10.1016/j.jse.2026.10.018","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.018","url":null,"abstract":"<p><strong>Background: </strong>As total shoulder arthroplasty (TSA) is increasing in volume, limited data exist regarding how recent myocardial infarction (MI) influences postoperative outcomes. This study aimed to evaluate the impact of MI timing, type, treatment, and anatomical location on rates of postoperative cardiac, medical, and surgical complications following TSA.</p><p><strong>Methods: </strong>A national insurance database, PearlDiver, was queried to identify patients with a history of MI within two years prior to TSA. These patients were propensity-matched 1:4 to controls without prior MI based on demographics and comorbidities. The MI cohort was stratified by timing (0-6 months, 6-12 months, 12-18 months, 18-24 months), and subgroup analyses were performed by MI type (Type 1 vs. Type 2), ST-Segment Elevation Myocardial Infarction (STEMI) vs Non-ST-Elevation Myocardial Infarction (NSTEMI) classification, percutaneous coronary intervention (PCI), guideline-directed medical therapy (GDMT), and infarct location.</p><p><strong>Results: </strong>A history of MI within 2 years preceding TSA had a strong association with higher odds of postoperative MI (OR 5.67; 95% CI, 3.86-8.32). The strongest association was observed when MI occurred within 6 months of TSA (OR 9.95; 95% CI, 6.50-15.24). Type 1 MI was strongly associated with postoperative MI, particularly within 6 months (OR 10.86; 95% CI, 6.96-16.95). Type 2 MI within 6 months was strongly associated with postoperative MI (OR 10.69; 95% CI, 2.50-45.63), DVT (OR 9.81; 95% CI, 2.30-41.79), and PJI (OR 5.24; 95% CI, 1.60-17.18). Both STEMI (OR = 6.17) and NSTEMI (OR = 5.77) were strongly associated with postoperative MI. Anterior MI was strongly associated with postoperative MI (OR 7.22; 95% CI, 3.36-15.49), whereas inferior MI was strongly associated with 90-day mortality (OR 6.46; 95% CI, 1.85-22.60).</p><p><strong>Conclusion: </strong>MI within 2 years and specifically 6 months of TSA was associated with higher odds of postoperative complications. MI timing, subtype, treatment, and location should be carefully weighed when considering TSA in this high-risk population.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229249","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":"Postoperative Complications Following Shoulder Stabilization for Primary Versus Recurrent Anterior Shoulder Dislocation: A National Database Study.","authors":"Andrew K Chow, Sashrik Sribhashyam, Suhas Rao Velichala, Matthew S Smith, Benjamin P Cassidy, Jennifer Vanderbeck, Jonathan F Dickens, James Satalich","doi":"10.1016/j.jse.2026.10.015","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.015","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anterior shoulder dislocation (ASD) is the most common joint dislocation in young patients with recurrence rates of nearly 90%. Multiple dislocations can cause progressive structural damage and bone loss, increasing the risk of instability. This study compares recurrence and postoperative complications following ASD between patients with a primary versus recurrent ASD. We hypothesized that surgical stabilization following recurrent ASD would be associated with an increased risk of subsequent instability and a higher complication burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective query was conducted using the TriNetX database (January 1, 2015 to January 1, 2025) in accordance with STROBE/RECORD guidelines. Patients aged 18 years or older undergoing surgical repair for primary or recurrent ASD were identified. Propensity score matching was applied in a 1:1 ratio and estimated using logistic regression. Postoperative outcomes were evaluated at 3 and 6 months with Benjamini-Hochberg false discovery rate correction (q=0.05) applied to cohort comparisons. Multivariate logistic regression analysis was performed to assess independent risk factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Pre-match cohorts included 2,312 patients who underwent surgical repair for primary ASD compared to 7,594 patients in the recurrent ASD cohort; propensity score matching yielded 2,302 patients per group (mean age: 29.7±14.5 years vs. 28.8±13.6 years, respectively). Following Benjamini-Hochberg false discovery rate correction, recurrent ASD patients experienced significantly higher rates of subsequent dislocation (3-month: 21.4% vs. 1.3%, RD=-20.1%; 6-month: 23.5% vs. 1.7%, RD=-21.8%; both p&lt;0.0001) and shoulder instability (3-month: 44.0% vs. 21.8%, RD=-22.2%; 6-month: 47.8% vs. 24.0%, RD=-23.8%; both p&lt;0.0001). At 6-months, reoperation rates differed between cohorts on unadjusted analysis (2.0% vs. 1.1%, RD=-0.9%, p=0.0159), but the difference did not retain significance following Benjamini-Hochberg FDR correction (q=0.089). No significant differences were observed in shoulder stiffness, rotator cuff tears, shoulder impingement, or shoulder pain. Logistic regression analysis demonstrated that elevated BMI significantly increased odds of postoperative shoulder instability at 3 and 6 months (p=0.022-0.038) in both the primary and recurrent ASD groups. Epilepsy or recurrent seizures were significantly associated with postoperative instability across both time points in primary and recurrent repair groups (p&lt;0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients undergoing surgical repair for recurrent ASD experienced significantly higher short-term rates of recurrent instability compared to those treated for primary ASD. Elevated BMI and seizure disorders were identified as independent risk factors associated with postoperative instability. These findings should be interpreted as associative and hypothesis-generating. Prospective cohort studies inco","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229228","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":"Is Global Scapular Morphology, and Particularly Posterior Acromial Morphology, Symmetrical in a Healthy Cohort?","authors":"Jean-David Werthel, Julien Ogor, Jules Le Brigand, Yannick Morvan, Christian Gerber","doi":"10.1016/j.jse.2026.10.019","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Certain scapular morphologies, particularly those involving the posterior acromion, have recently been associated with posterior instability and primary glenohumeral osteoarthritis. In particular, a shorter, higher, and flatter posterior acromion appears to represent an at-risk phenotype. These extreme morphologies are uncommon, and their prevalence appears to decrease in older healthy cohorts. However, bilateral symmetry of overall scapular morphology in healthy individuals remains poorly understood. The aim of this study was to assess scapular morphologic symmetry in subjects without detectable structural abnormality on bilateral CT and determine whether it varied with age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A total of 304 patients (608 shoulders) were included and divided into 2 age groups: &lt;60 years (204 patients, 408 shoulders) and ≥60 years (100 patients, 200 shoulders). For each subject, a reference shoulder was defined as the shoulder showing the lowest cumulative standardized absolute deviation from previously established older reference means across 15 morphologic parameters. The contralateral shoulder was then compared with the reference shoulder. Bilateral symmetry was analyzed in the overall cohort and after age stratification. Morphologic differences between age groups were then assessed. Additional analyses were performed to determine whether asymmetry was concentrated in the most morphologically extreme subjects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the overall cohort, 8 measurements showed significant asymmetry between the reference shoulder and the contralateral shoulder. After age stratification, 9 measurements were significantly asymmetric in subjects &lt;60 years, whereas no significant asymmetry was observed in subjects ≥60 years. However, the mean magnitude of these side-to-side differences in the younger cohort was generally small. Extreme-value analysis showed a significant reduction in 6 parameters in the older cohort. When differences between age groups, bilateral asymmetry, and extreme-value analyses were integrated, posterior acromial coverage was the only parameter that fulfilled all 3 criteria. Additional subgroup analyses showed that morphologically extreme younger subjects were not more asymmetric than the remaining younger subjects, but instead frequently exhibited bilateral morphologic deviation in the same direction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Overall bilateral scapular morphology appears largely symmetrical in subjects without detectable structural abnormality on CT. Although statistically significant side-to-side differences were observed in younger subjects, their mean magnitude was generally small whereas significant asymmetry was absent in subjects ≥60 years. Importantly, morphologically extreme younger subjects were not more asymmetric than the remaining younger subjects but instead showed bilateral deviation from the older reference morphology. These findin","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225168","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":"Preoperative subacromial autologous conditioned plasma (ACP) injections and histological and immunohistochemical findings in degenerative supraspinatus tendon tears - results of a prospective comparative cohort study.","authors":"Andreas W Werner, Carolin Linke, Veit Krenn, Philip Linke","doi":"10.1016/j.jse.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.011","url":null,"abstract":"<p><strong>Background: </strong>Degenerative supraspinatus tendon quality is a key determinant of healing after rotator cuff repair, and advanced histological degeneration has been associated with increased retear rates. While platelet-rich plasma (PRP) has been extensively studied as an intraoperative adjunct, the potential role of preoperative biological tissue conditioning using platelet-rich plasma remains poorly defined.</p><p><strong>Hypothesis/purpose: </strong>The purpose of this study was to evaluate the association of preoperative subacromial PRP injections (autologous conditioned plasma, ACP®, Arthrex, Naples, Fl.) with histological and immunohistochemical characteristics of degenerative supraspinatus tendons at the time of rotator cuff repair. It was hypothesized that preoperative ACP treatment would be associated with lower Bonar and degeneration scores compared with untreated controls.</p><p><strong>Methods: </strong>A prospective comparative cohort study was performed including patients undergoing arthroscopic repair of isolated, degenerative full-thickness supraspinatus tendon tears. The intervention group received three preoperative subacromial ACP injections (two in one patient) within 3 to 4 weeks before surgery, with the final injection administered no more than 1 week preoperatively. A control group of patients who declined ACP did not receive biological preconditioning. Intraoperatively, tendon biopsies were harvested from the lateral edge of the supraspinatus tendon. The Bonar score and a semiquantitative degeneration score were the co-primary endpoints. Ki-67, CD31 and CD45/LCA immunostaining were exploratory endpoints.</p><p><strong>Results: </strong>Fifty-four patients were included (ACP group, n = 24, control group, n = 30). The ACP group had lower Bonar scores (6.5 ± 2.0 vs 8.2 ± 1.3, mean difference -1.7, 95% CI -2.7 to -0.7, adjusted P = .044) and lower degeneration scores (1.7 ± 0.8 vs 2.2 ± 0.6, mean difference -0.5, 95% CI -0.9 to -0.1, adjusted P = .044) than controls. CD31 immunostaining was higher in the ACP group, but this difference was not significant after correction for multiple testing (adjusted P = .100). Ki-67, CD45/LCA, reparative changes and the proportion of necrotic tissue did not differ between groups.</p><p><strong>Conclusion: </strong>Preoperative subacromial ACP injections were associated with lower Bonar and degeneration scores in degenerative supraspinatus tendons at the time of rotator cuff repair. The differences were small, the difference in Bonar score was below the predefined minimal clinically important difference, and the clinical relevance of these findings is unclear.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208034","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":"Evolution of Reverse Shoulder Arthroplasty: Two Decades of Evidence from the Journal of Shoulder and Elbow Surgery.","authors":"Tarishi Parmar, Imad Ashkar, Viraj Deshpande, Niashi Parmar, Mohammad Daher, Liam Kane, Andrew Jeong, Peter Boufadel, Adam Khan, Brian Hill, John G Horneff, Eric Black, Joseph A Abboud","doi":"10.1016/j.jse.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.008","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (rTSA) has evolved from a salvage procedure to a widely adopted reconstructive solution. This study performed a descriptive bibliometric and content-trend analysis of rTSA publications in the Journal of Shoulder and Elbow Surgery (JSES) from 2004-2025.</p><p><strong>Methods: </strong>A systematic review identified 506 clinical rTSA studies published in JSES between 2004 and 2025. Extracted variables included publication year, level of evidence, authorship, institution, geographic origin, research topic, demographics, indications, complications, and implant characteristics. Temporal trends were tested using Mann-Kendall trend test and segmented regression; the relationship between implant design representation and complication reporting was evaluated with Spearman rank correlation.</p><p><strong>Results: </strong>Annual publications increased significantly (BH-adjusted P < .001), peaking at 51 studies in 2023. Mean level of evidence improved (BH-adjusted P < .001), from 4.0 (2006) to 2.86 (2023). Early authorship centered on foundational surgeons (Frankle, Boileau, Walch) and European institutions, later diffusing globally. Mean age rose modestly, though this did not remain significant after correction for multiple comparisons (BH-adjusted P = .077), stabilizing near 70-72 years after 2012. Research focus shifted from complications/technique toward outcomes after 2013, then toward instrumentation, rehabilitation, and cost. Osteoarthritis indications increased (BH-adjusted P = .005) while revision surgery declined (BH-adjusted P = .002). Implant design shifted from medialized to lateralized/non-Grammont configurations (both BH-adjusted P < .001). No individual complication subtype showed a significant temporal trend.</p><p><strong>Conclusion: </strong>RTSA publication trends in JSES reflect the field's evolution from complication-focused study to evidence-driven refinement. Implant design, evidence level, and indications changed significantly, alongside, but not statistically linked to, complication reporting, informing future shoulder reconstruction research directions.</p><p><strong>Level of evidence: </strong>Literature Review, Bibliometric Analysis.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208023","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":"Clinical Outcomes of a Customized 3D-printed Arthrodesis Prosthesis for Reconstruction of Segmental Defects following Tumor Resection in the Proximal Humerus.","authors":"Xiao J Zhu, Jia M Lin, Guo H Song, Jin C Lu, Huai Y Xu, Tao Zhang, Qing L Tang, Jin Wang","doi":"10.1016/j.jse.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.009","url":null,"abstract":"<p><strong>Background: </strong>Currently, shoulder joint function remains poor and the incidence of complications is high after proximal humerus tumor resection. A consensus has not yet been reached on the reconstruction method. Our study investigates whether the use of a customized 3D-printed arthrodesis prostheses can improve shoulder joint function and reduce complications.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of consecutive patients with malignant tumors who underwent Malawer type I proximal humeral resection and customized 3D-printed arthrodesis prosthesis reconstruction at our institution from September 2021 to October 2023. We used the Enneking staging system to stage our patients. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and the American Shoulder and Elbow Surgeons (ASES) score. Shoulder range of motion (ROM) was also measured. The demographic data, surgical parameters, functional outcomes and complications were analyzed in this study.</p><p><strong>Results: </strong>The cohort comprised of 30 patients. The mean age of the patients was 20.1 years (11-57 years) and the mean follow-up duration was 37.7 months (24-49 months). The average resection length of the humerus was 15.5 cm (10-23.5 cm). Among the patients, 28 were classified as Enneking stage IIB, while 2 were classified as stage III. The average MSTS score was 84% and ASES 85%. The average shoulder abduction was 81°, and forward flexion was 82°. The complications included 4 cases of delayed wound healing, 1 case of prosthetic loosening and 2 cases of plate exposure. 4 cases of lung metastasis and 1 case with metastases in both lung and bone occurred during the follow-up period. Six patients (20.0%) experienced soft-tissue failure. Total deltoidectomy was significantly associated with soft-tissue failure in bivariate analysis (P=0.009). There was no case of local recurrence. Radiographic fusion was achieved in 100% of cases at the 12-month follow-up period.</p><p><strong>Conclusion: </strong>For Malawer type I resection of the proximal humerus, shoulder arthrodesis using a customized 3D-printed arthrodesis prosthesis can significantly improve upper limb function. However, total deltoidectomy was associated with an increased risk of soft-tissue complications.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207970","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":"The medial collapse sign is associated with cubitus varus after pediatric supracondylar humeral fracture fixation: a retrospective cohort study.","authors":"Shogo Ikeda, Seiji Okada, Ryoya Shiode","doi":"10.1016/j.jse.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.010","url":null,"abstract":"<p><strong>Background: </strong>Cubitus varus deformity is a common complication following pediatric supracondylar humeral fractures and rarely remodels spontaneously. However, surgeons lack a reliable intraoperative radiographic sign that directly reflects inadequate medial column reduction. This study aimed to evaluate whether the medial collapse sign (MCS) on immediate postoperative anteroposterior radiographs is associated with postoperative cubitus varus.</p><p><strong>Methods: </strong>A retrospective cohort study included pediatric patients who underwent surgical treatment for supracondylar humeral fractures consecutively between January 2016 and March 2024. Fifty-two patients treated with reduction and cross pinning and followed for at least 6 months were included. Patients were categorized according to the presence or absence of cubitus varus at final follow-up (n = 20 and n = 32, respectively), which was radiographically defined as a side-to-side carrying-angle difference ≥5° on standing anteroposterior radiographs. Univariable and multivariable analyses were performed using Firth's penalized logistic regression.</p><p><strong>Results: </strong>Presence of the MCS was strongly associated with cubitus varus (OR 155.4, 95% CI 24.8-1965.5; Holm-adjusted P < .001). MCS remained associated after adjustment for medial cortical comminution (OR 47.5, 95% CI 6.6-590.4, Holm-adjusted P < .001). The large effect size should be interpreted cautiously because of the limited sample size. Sensitivity and specificity were 90.0% and 96.9%, respectively. Interobserver reliability was almost perfect (κ = 0.919).</p><p><strong>Conclusion: </strong>The medial collapse sign is strongly associated with postoperative cubitus varus and may reflect inadequate medial column reduction. Recognition of the same medial cortical morphology on intraoperative fluoroscopy may prompt reassessment of alignment and reduction.</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":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208081","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}