Journal of Shoulder and Elbow Surgery最新文献

{"title":"The validity of sonographic posterolateral rotatory stress test for atraumatic posterolateral rotatory instability diagnosis.","authors":"Nattakorn Mahasupachai, Arnakorn Premsiri, Cholawish Chanlalit","doi":"10.1016/j.jse.2025.08.015","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.015","url":null,"abstract":"<p><strong>Background: </strong>Enthesopathy of the extensor carpi radialis brevis (ECRB), commonly known as tennis elbow, is effectively managed conservatively in most cases. However, some patients require surgery, often due to hidden concomitant conditions like atraumatic posterolateral rotatory instability (PLRI). Diagnosing atraumatic PLRI is challenging due to its subtle instability and limited sensitivity of physical examination tests and imaging modalities. This study evaluates the validity of the sonographic posterolateral rotatory stress test compared to arthroscopy, the gold standard, for diagnosing atraumatic PLRI.</p><p><strong>Methods: </strong>This single-center prospective diagnostic accuracy study included patients with persistent lateral elbow pain undergoing elbow arthroscopy between April 1, 2021, and September 30, 2024. The arthroscopic ulnohumeral (UH) gap opening sign using the posterior central portal was used as the gold standard. The sonographic posterolateral rotatory stress test was performed using dynamic ultrasonography with the same maneuver. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. The reliability of the sonographic test was assessed using intra- and inter-observer intraclass correlation coefficients (ICC).</p><p><strong>Results: </strong>A total of 42 patients were included, with 13 having a positive arthroscopic UH gap opening sign. The sonographic test demonstrated a sensitivity of 69.23%, specificity of 100%, PPV of 100%, NPV of 87.88%, and an accuracy of 90.48%. It outperformed MRI (54.76% accuracy) and physical examination tests (accuracy: 76.19% for the posterolateral drawer test and lateral pivot-shift test, 78.57% for the pivot-shift apprehension test). Significant differences in UH distance were observed between symptomatic and contralateral elbows, supporting the validity of the sonographic test. The test demonstrated perfect intra-observer reliability (ICC: 0.87-0.94) and substantial to perfect inter-observer reliability (ICC: 0.78-0.94).</p><p><strong>Conclusion: </strong>The sonographic posterolateral rotatory stress test is a highly accurate and noninvasive diagnostic tool for atraumatic PLRI. Its high specificity and ability to compare with the contralateral elbow make it a valuable preoperative assessment method, particularly in patients with recalcitrant tennis elbow. We recommend incorporating this test into clinical practice to aid surgical decision-making.</p><p><strong>Level of evidence: </strong>Level I; Prospective Cohort Design; Diagnostic Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259777","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":"An Analysis of Variability and Terminology Inconsistencies in the Amount and Type of Constraint in Polyethylene Bearing Liners Across Reverse Shoulder Arthroplasty Implant Systems.","authors":"Daniel Misioura, Shreya Chandra, Andrew Chen, Samuel E Mircoff, Nickolas G Garbis, Dane H Salazar","doi":"10.1016/j.jse.2025.08.019","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.019","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate the amount and type of constraint between different Reverse Total Shoulder Arthroplasty (rTSA) systems in order to address a current gap in uniform nomenclature and help guide surgical decision-making in rTSA.</p><p><strong>Methods: </strong>Data was collected on commercially available polyethylene liners for rTSA implant manufacturers in the United States. Constraint ratios were calculated using liner depth and glenosphere radius, and for select designs, lip heights were used. All available sizes and diameters were analyzed, and data was cross-referenced with published literature and product manuals.</p><p><strong>Results: </strong>The mean constraint ratio for standard liners was 48.74% (SD = 5.60%), with values ranging from 40% (Medacta Shoulder System) to 62% (Stryker Reunion S). Several devices fell outside one standard deviation from the mean, indicating notable inter-company variability. A one-way ANOVA confirmed significant differences among standard liner designs (p < 0.001). For retentive liners, the mean constraint ratio was 61.90% (SD = 5.24%), ranging from 47% to 71%. Again, multiple devices fell outside the expected range, and ANOVA results demonstrated significant variation across manufacturers (p < 0.001).</p><p><strong>Conclusion: </strong>Significant variability exists between implant systems when defining \"standard\" and \"retentive\" liners in rTSA with calculated constraint ratios. This inconsistency can complicate surgical decisions, especially during revisions or when switching systems, potentially leading to unintended biomechanical outcomes. We advocate for enhanced transparency and standardization by moving away from utilizing the terms \"standard\" and \"retentive\" and instead utilizing the implant's neck shaft angle and capture ratio.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259727","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":"Anatomical explanation of the screw motion of the elbow joint.","authors":"Jan Herregodts, Kate Duquesne, Mauro Van Den Haute, Eva De Vries, Stijn Herregodts, Jan Detand, Emmanuel Audenaert, Alexander Van Tongel","doi":"10.1016/j.jse.2025.08.018","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.018","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the anatomical factors contributing to the screw motion of the elbow joint during a flexion/extension movement of the elbow joint.</p><p><strong>Background: </strong>Historically, the humero-ulnar joint has been simplified to a symmetrical, mono-axial hinge joint. More recent studies suggest an asymmetrical screw motion or helical movement during the flexion movement. This subtle varus-valgus motion during flexion and extension likely has evolutionary explanations. When the arm is in a dependent position (upper arm next to the body), the valgus angle of the elbow allows the arm to relax comfortably without interference with the pelvis. However, no anatomical studies have been conducted to confirm this biomechanical hypothesis. This study aims to explore the screw motion of the elbow joint anatomically.</p><p><strong>Methods: </strong>Non-coupled statistical shape models of the humerii and ulnae were separately created using CT scans of 210 humerii (115 right, 95 left) and 156 ulnae (75 right, 81 left). The mean shape and the 95% CI of the variation of the first five shape modes were calculated and analyzed.The deepest points of the osseous trochlear grove were indicated on the five shape modes. This was performed in 3-matic by making sections of the articular humerus in different flexion angles. The mediolateral distance of each point to the sagittal plane was measured. The same procedure was performed for the greater sigmoid notch of the ulna. The geometry of the notch was investigated by determining the mediolateral shift of the notch with respect to the point of origin.</p><p><strong>Results: </strong>The mean shape model of the humeral osseous groove has a helical anatomy. The ulnar greater sigmoid ridge has a circular anatomy, without any helical anatomy, as there was no mediolateral shift of the notch in the different section planes with respect to the point of origin. The maximal valgus position of the elbow was reached in extension, while the maximal varus position was reached in deep flexion.</p><p><strong>Conclusion: </strong>This is the first anatomical study clarifying the origin of the vortical movement of the elbow due to the helical path of the distal humeral groove based on a statistical shape model of the humerus. This morphological effect should be taken into account when performing osteosynthesis or in the development of total elbow implants.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259730","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":"Impact of Cement Use and Stem Length on Clinical Outcomes in Revision Reverse Shoulder Arthroplasty: Is a Short Stem with Cementless Fixation a Viable Option?","authors":"Hyosung Lee, Joseph J King, Jonathan O Wright, Jordyn Pendarvis, Joseph Hartman, Kevin W Farmer, Aimee M Struk, Thomas W Wright","doi":"10.1016/j.jse.2025.08.013","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.013","url":null,"abstract":"<p><strong>Background: </strong>Revision reverse total shoulder arthroplasty (rTSA) is performed as a salvage procedure after failed shoulder arthroplasty. However, it presents substantial challenges compared to primary rTSA due to altered anatomy and compromised bone quality. This study aimed to compare clinical outcomes of revision rTSA based on the revision humeral stem fixation methods (cemented vs. cementless) and stem length (short vs. standard vs. long).</p><p><strong>Methods: </strong>We conducted a retrospective analysis using a prospectively maintained shoulder arthroplasty database from a single institution. All revision rTSAs performed between 2005 and 2023 with a minimum two-year follow-up were included. Patients were excluded for revision from a primary antibiotic spacer placed in the native shoulder or a history of multiple arthroplasty procedures. The final cohort consisted of 113 revision rTSAs (45 cemented vs. 68 cementless; 16 short vs. 79 standard vs. 18 long). Demographic data, surgical characteristics, outcome scores, active range of motion, complications and re-revision rates were compared across cohorts.</p><p><strong>Results: </strong>Revision rTSA showed no significant differences in active range of motion or outcome scores between the cemented and cementless humeral fixation cohorts. The short and standard stem cohorts demonstrated greater improvement in active abduction compared to the long stem cohort (34 ± 32 vs. 0 ± 18; P = .045; 37 ± 41 vs. 0 ± 18; P = .001). Similarly, they exhibited greater improvement in the Constant score (23.5 ± 17.7 vs. 3.5 ± 10.5; P = .018; 19.1 ± 19.5 vs. 3.5 ± 10.5; P = .012). Overall re-revision rates in the cemented and cementless cohorts were 7.2% and 14.9%, respectively, and humeral stem re-revision rates were 7.2% and 9.9%, respectively. (P = .204 and P = .746). Overall re-revision rates in the short, standard, and long stem cohorts were 3.7%, 13.7%, and 11.5%, respectively, and humeral stem re-revision rates were 0%, 10.3%, and 11.5%, respectively. (P = .361 and P = .199) CONCLUSION: The use of a short stem in revision rTSA demonstrated clinical outcomes comparable to other stem lengths. Complications and re-revision rates did not significantly differ by cement use or stem length.</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":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259770","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":"Impact of Reverse Total Shoulder Arthroplasty on Scapulohumeral Rhythm: A Systematic Review and Meta-Analysis.","authors":"Mitchell A Johnson, Taylor Cogsil, Alexander E White, Argen Omurzakov, Andreas Kontaxis, Samuel A Taylor, Joshua S Dines, Michael C Fu, Gabriella E Ode, David M Dines, Lawrence V Gulotta, Christopher M Brusalis","doi":"10.1016/j.jse.2025.08.010","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.010","url":null,"abstract":"<p><strong>Background: </strong>Scapulohumeral rhythm (SHR) describes the relative contributions of the humerus and scapula to total shoulder motion and is defined as the ratio of glenohumeral elevation (GH) to scapulothoracic (ST) upward rotation. The impact of reverse total shoulder arthroplasty (rTSA) on scapular kinematics and SHR has not been fully elucidated. The purpose of the present study was to perform a systematic review and meta-analysis of the literature to compare SHR among patients following rTSA and asymptomatic controls.</p><p><strong>Methods: </strong>A literature search was performed by querying PubMed, EMBASE, and the Cochrane computerized databases to identify studies that assess SHR, or the relationship of GH elevation to ST upward rotation, in patients after rTSA. Study quality was assessed using the MINORS criteria. Quantitative review was performed for studies that reported either SHR directly, or reported GH and ST rotation. Differences in scapulohumeral rhythm were compared between different ranges of humeral elevation including rest-30°, 30-60°, 60-90°, and the total arc of elevation.</p><p><strong>Results: </strong>Twenty-seven studies comprised of 464 patients who underwent rTSA were included in the final analysis for review. Among the studies included, 19 (70%) directly assessed SHR. The average SHR across all elevation ranges in the scapular plane was 1.6 (range: 0.8-2.7). The average SHR in the rest-30°, 30-60°, and 60-90° degree elevation arc ranges were 4.3 (range: 0.8-34), 2.0 (range: 0.7-4), and 1.8 (range: 0.8-3), respectively. Compared to controls, patients who underwent rTSA had greater ST upward rotation, quantified as a significantly lower SHR (1.9 vs. 3.2, p=0.0238).</p><p><strong>Conclusion: </strong>There is an increased contribution of ST rotation relative to GH motion throughout arm elevation following rTSA compared to asymptomatic shoulders. The average SHR was lowest between 60-90° of arm elevation compared to the other measured ranges of arm elevation, indicating a greater contribution of scapulothoracic rotation required at higher angles of arm elevation. Further investigations are needed to determine the clinical implications of greater scapulothoracic motion in patients following rTSA, as well as the biomechanical causes and consequences of this alteration in scapular kinematics.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114475","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 self-selection does not influence postoperative improvements in pain, function, or satisfaction in ream-and-run arthroplasty patients.","authors":"Ashley M B Suttmiller, Brice A Snyder, Bradley C Carofino","doi":"10.1016/j.jse.2025.08.006","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.006","url":null,"abstract":"<p><strong>Background: </strong>The ream-and-run arthroplasty (RnR) has shown to be a viable treatment option for young, active patients with shoulder osteoarthritis. However, there are notable concerns with the generalizability of these findings as much of the literature on the RnR is published by the originating surgeon. Additionally, a high proportion of RnR patients represented in the studies are self-selecting the procedure, which may introduce biased outcomes. Therefore, our purpose was to compare the clinical outcome improvement and satisfaction of patients who self-selected the RnR procedure as their preferred treatment method and those who did not.</p><p><strong>Methods: </strong>We used a retrospective, cross-sectional comparative study design and included patients that had undergone a RnR performed by one fellowship-trained orthopedic surgeon with a minimum of 1-year follow-up. Patients who deliberately sought out the surgeon and RnR procedure made up the self-selecting group (RnR_SS), and all other patients who underwent the RnR procedure and met inclusionary criteria were our control group (RnR_CON). Clinical improvement at the most recent follow-up visit on the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), daily and worst pain outcomes, were compared between groups. Satisfaction at their latest follow-up post-arthroplasty was also compared.</p><p><strong>Results: </strong>A total of 78 shoulders (47=RnR_SS, 31=RnR_CON) belonging to 70 patients were included. Both groups reported significant improvements at the latest follow-up compared to their preoperative condition (P < .001), and no differences were found between groups in MOI% (P > .05) or proportion of patients reaching minimal clinically important difference (MCID) on any patient-reported outcome. Groups also reported similar subjective satisfaction ratings (P > .05).</p><p><strong>Conclusions: </strong>RnR patients self-selecting the RnR arthroplasty were found to report similar pain and functional improvements, and satisfaction ratings as those who were not specifically seeking out the procedure. This finding provides evidence to support generalizability of previous RnR results as patients self-selecting the RnR likely make up a bulk of those represented in existing literature.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103017","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":"Subcoracoid impingement exacerbates pain and scapular dysfunction in full-thickness rotator cuff tears.","authors":"Yi-Hsuan Weng, Yang-Ting Chien, Chon-Kio Wong, Jing-Lan Yang, Chung-Hsun Chang, Jiu-Jenq Lin","doi":"10.1016/j.jse.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.009","url":null,"abstract":"<p><strong>Background: </strong>Subcoracoid impingement co-occurs with subacromial impingement in 19% of patients with rotator cuff tears. The influence of subcoracoid impingement in patients with full-thickness rotator cuff tear (FT-RCT) remains unknown. Therefore, it is worthwhile to investigate potential differences between FT-RCT patients with and without subcoracoid impingement.</p><p><strong>Methods: </strong>Twenty-two participants were categorized as having an FT-RCT combined with subcoracoid impingement, while 25 others were diagnosed with an FT-RCT without subcoracoid impingement. Characteristics and tear sizes were recorded using ultrasonography (USG). Humeral head migration was assessed by calculating the acromiohumeral distance using USG at 0°, 60°, and 90° of shoulder abduction. Shoulder range of motion, pain levels, and self-reported shoulder function were evaluated. Scapular kinematics (upward/downward rotation, anterior/posterior tilt, external/internal rotation) and associated muscle activities (upper trapezius, lower trapezius, serratus anterior [SA] and teres major [TM]) were recorded during arm raising and lowering using motion tracing and surface electromyography systems, respectively.</p><p><strong>Results: </strong>The FT-RCT combined with subcoracoid impingement group experienced slightly higher pain levels (1.7±0.6, 95% CI=0.5-2.9, p=0.008) and marginally more humeral head superior migration from 0°-60° shoulder abduction (0.14±0.05 cm, 95% CI=0.03-0.25 cm, p=0.017) compared to the FT-RCT without subcoracoid impingement group. Regarding scapular biomechanics, the FT-RCT combined with subcoracoid impingement group demonstrated decreased upward rotation during arm lowering (4.0±1.3°, 95% CI=1.4-6.5°, p=0.003) as well as decreased SA muscle activation during arm lowering (18.8±8.5%, 95% CI=1.7-36.0%, p=0.032) and decreased TM muscle activation during arm raising (11.4±6.0%, 95% CI=0.6-23.5%, p=0.018).</p><p><strong>Conclusion: </strong>Patients with FT-RCT combined with subcoracoid impingement report a slightly higher pain score. Greater superior humeral head migration, coupled with reduced scapular upward rotation, may exacerbate impingement and worsen symptoms. Additionally, these patients exhibit decreased recruitment of the SA and TM muscles. Despite reaching statistical significance, the magnitude of difference may limit its clinical applicability and warrants cautious interpretation.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103023","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":"Outcomes of Arthroscopic Versus Open Bankart Repair in Collision Athletes Following a First Episode of Anterior Shoulder Dislocation: A 5-Year Prospective Cohort Study.","authors":"Iván José Bitar, Christian Allende Nores, Lucas Daniel Marangoni, Damian Gabriel Bustos, Luciano Pezzutti, Lucia Belen Bitar, Juan Valentín Rivera Bacile","doi":"10.1016/j.jse.2025.08.007","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.007","url":null,"abstract":"<p><strong>Background: </strong>Isolated arthroscopic Bankart repair (IABR) and open Bankart repair with inferior capsular shift (OBICS) have not been previously compared in the context of a first episode of anterior shoulder dislocation (FEAD). This study aimed to compare the recurrence rate, functional outcomes, range of motion (ROM), and return to preinjury sport level (RTS) between IABR and OBICS in collision athletes with FEAD. We hypothesized that OBICS would yield clinical outcomes comparable to those of IABR.</p><p><strong>Methods: </strong>A prospective cohort study involving 80 collision athletes, divided into two groups of 40 patients each, was conducted. The inclusion criteria were age ≤30 years, with or without a glenoid bone defect ≤13%, and on-track Hill-Sachs lesions, all of which presented with first-time anterior shoulder dislocation. The mean follow-up was 68.9 months (range, 60-85) for the OBICS group and 70.5 months (range, 60-87) for the IABR group. The recurrence rate was considered the primary outcome, whereas the Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES) score, ROM, and RTS were secondary outcomes. All assessments were conducted at baseline, 6 months, 12 months, and a minimum of 60 months postoperatively. All outcomes were compared between the two groups.</p><p><strong>Results: </strong>The OBICS group demonstrated a significantly lower recurrence rate (2.5%) than did the IABR group (17.5%) (P = 0.031). Both groups showed significant improvements in WOSI and ASES scores from baseline to the final follow-up (P = 0.001); however, no significant differences were found between the groups at the five-year follow-up (WOSI: P = 0.38; ASES: P = 0.72). There were no significant differences in ROM within or between groups. The degree of external rotation was similar in both groups (rotation at the side: OBICS P = 0.82, IABR P = 0.91; at 90° abduction: OBICS P = 0.68, IABR P = 0.43). RTS rates were also comparable, with 80% of OBICS patients and 82.5% of IABR patients returning to their preinjury level (P = 0.69) and 17.5% (OBICS) and 15% (IABR) returning to a lower level (P = 0.47).</p><p><strong>Conclusions: </strong>Compared with IABR, OBICS resulted in a significantly lower recurrence rate. The functional scores and the ROM and RTS outcomes were comparable between the groups. We highly recommend OBICS for collision athletes with FEADs.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103036","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":"Age Influences Lesser Tuberosity Osteotomy Nonunion Following Anatomic Total Shoulder Arthroplasty.","authors":"Johnlevi S Lazaro, Ruchir Nanavati, John Pignataro, Luke S Austin, Dennis DeBernardis","doi":"10.1016/j.jse.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.003","url":null,"abstract":"<p><strong>Background: </strong>Lesser tuberosity osteotomy (LTO) is one method that can be utilized for subscapularis mobilization during anatomic total shoulder arthroplasty (aTSA) and has reported union rates of 83-97%. However, LTO nonunion remains a cause of aTSA failure, and the factors influencing LTO healing are not well understood. The goal of this study is to identify patient- and technique-specific factors affecting the incidence of LTO union following aTSA.</p><p><strong>Methods: </strong>We conducted a retrospective review of all patients who underwent aTSA with LTO between February 2019 and December 2021. Patients with at least 3 months of radiographic follow-up were included. LTO union was assessed using radiographs and classified as healed (H), nondisplaced nonunion (NN), or displaced nonunion (DN). Patients who underwent revision surgery for LTO failure prior to the 3 month time point were categorized in the displaced nonunion group. Patient demographics, surgical characteristics, and radiographic variables were analyzed to determine their influence on radiographic union.</p><p><strong>Results: </strong>Of the 449 included patients, 66.6% achieved LTO union, 26.7% were NN, and 6.7% were DN. Younger age was identified as a predictor of nonunion (OR = 0.98, p = 0.037). No significant differences in union rates were observed based on implant type or size, LTO thickness, change in the humeral head center of rotation, or any additional demographic variables. Despite a 33.4% nonunion rate, only 2.7% of patients with nonunion required revision surgery due to subscapularis-related complications.</p><p><strong>Discussion: </strong>Younger age is a positive predictor of radiographic LTO nonunion following aTSA, while additional demographic, surgical, and radiographic factors do not significantly influence union rates. Despite the reported radiographic nonunion rate, the need for revision surgery remains low.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103084","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 the Graft Position Critical for Functional Outcomes Following Arthroscopy-Assisted Lower Trapezius Tendon Transfer for Posterosuperior Irreparable Rotator Cuff Tears? A Comparison of Anterior vs. Posterior Position of Graft.","authors":"Chang Hee Baek, Bassem T Elhassan, Chaemoon Lim, Jung Gon Kim, Bo Taek Kim, Seung Jin Kim","doi":"10.1016/j.jse.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.jse.2025.08.005","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopy-assisted lower trapezius tendon transfer (aLTT) has emerged as a reasonable treatment option for posterosuperior irreparable rotator cuff tears (PSIRCTs) due to its biomechanical advantages and favorable clinical outcomes. Although there are various surgical techniques for aLTT, the optimal positioning of the graft on the humeral head footprint is unknown in aLTT. This study aimed to evaluate clinical and radiological outcomes based on the interpositional graft position of aLTT graft in PSIRCTs.</p><p><strong>Methods: </strong>Patients who underwent aLTT for PSIRCTs from 2017 to 2022 were retrospectively analyzed, with a minimum follow-up period of 2 years. Patients were classified into Anterior group (n=44) if the interpositional graft was in the anterior position (supraspinatus footprint) or Posterior group (n=68) if it was in the posterior position (infraspinatus footprint) on postoperative magnetic resonance image. Clinical outcomes were evaluated with the visual analog scale (VAS) score, patient-reported outcome measurements (PROMs), active range of motion (aROM), and aROM strength. Radiological outcomes were evaluated by the acromiohumeral distance (AHD), Hamada grade, progression of osteoarthritis (OA), and acromial wear.</p><p><strong>Result: </strong>Although both groups showed significant postoperative improvements in clinical outcomes, the postoperative forward elevation (FE, 160.2˚ ± 28.3˚ vs 150.4˚ ± 22.0˚, p = 0.037) of the Anterior group were significantly higher than that of the Posterior group. Moreover, the postoperative FE strength (27.4 ± 4.5 vs 24.4 ± 4.4, p = 0.037) of the Anterior group were significantly higher than that of the Posterior group. Postoperatively, AHD significantly increased in the Anterior group, whereas no significant change was observed in the Posterior group. The achievement of minimal clinical importance difference for AHD (68.2% vs 45.6%, p = 0.021) were significantly better in the Anterior group. Although the Posterior group demonstrated a numerically higher rate of progression of osteoarthritis and acromial wear, the difference was not statistically significant.</p><p><strong>Conclusion: </strong>aLTT showed significant postoperative clinical improvement regardless of the interpositional graft position in patients with PSIRCTs. However, attaching the interpositional graft to the supraspinatus footprint is thought to provide dynamic stability and static stability in subacromial space, leading to favorable outcomes. Therefore, unless the posterior remnant cuff is insufficient for posterior side-to-side suturing, it is recommended to place the graft as anteriorly as possible.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103093","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}