Journal of Shoulder and Elbow Surgery最新文献

{"title":"Better Scapulohumeral Rhythm is Associated with Superior Patient-Reported Outcome Measures in Shoulders with Semi-Inlay Type Reverse Shoulder Arthroplasty.","authors":"Itaru Kawashima, Norimasa Takahashi, Keisuke Matsuki, Ryo Haraguchi, Hayato Ryoki, Kenji Kitamura, Thomas W Wright, Scott A Banks","doi":"10.1016/j.jse.2025.02.053","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.053","url":null,"abstract":"<p><strong>Background: </strong>Shoulders capable of achieving active abduction greater than 90 degrees following reverse total shoulder arthroplasty (rTSA) have been reported to exhibit better scapulohumeral rhythm (SHR) compared to those limited to less than 90 degrees of active abduction. This study aimed to calculate SHR in shoulders following semi-inlay rTSA and to investigate whether improved SHR is associated with better postoperative patient-reported outcome measures (PROMs) in shoulders achieving active abduction greater than 90 degrees.</p><p><strong>Methods: </strong>Twenty shoulders of 19 patients who underwent semi-inlay rTSA were analyzed. Each shoulder underwent computed tomography (CT) and fluoroscopy. Fluoroscopic images were acquired during scapular plane abduction. Using model-image registration techniques, the poses of 3-dimensional (3D) models were iteratively adjusted to match the silhouettes in the fluoroscopic images. SHR was defined as (ΔH-ΔS)/ΔS, where ΔH is the increment in humeral elevation angle and ΔS is the increment in scapular upward rotation angle. The mean postoperative SHR assessed from 20° to 90° of humeral abduction was used to divide the shoulders into two groups: SHR < 2 or SHR ≥ 2. American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score was evaluated preoperatively and 1 year after surgery.</p><p><strong>Results: </strong>The mean postoperative SHR was 1.7. Fourteen shoulders had SHR < 2, while six shoulders had SHR ≥ 2. There were no significant differences in demographic data, preoperative active range of motion (ROM), or preoperative ASES scores between the groups. Although no significant differences in postoperative ROM were observed, shoulders with SHR ≥ 2 had significantly higher postoperative ASES scores (94.3 ± 4.6) compared to those with SHR < 2 (82.1 ± 9.4, p = 0.007). A significant positive correlation was observed between the postoperative ASES scores and both the mean SHR (r = 0.452, P = 0.045) and the overall SHR measured from arm at side to maximum abduction (r = 0.478, P = 0.033) across all shoulders.</p><p><strong>Conclusions: </strong>Shoulders following semi-inlay rTSA with SHR ≥ 2 exhibited significantly higher postoperative ASES scores compared to those with SHR < 2. A significant positive correlation was also observed between the mean SHR and postoperative ASES scores across all shoulders, highlighting the positive impact of improved SHR on achieving superior postoperative PROMs.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804627","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 Toxicity of Chlorhexidine and Povidone-Iodine to Rotator Cuff Tendon.","authors":"Maziar Moslehyazdi, Kory B Dylan Pasko, Benjamin Bielajew, Tyler R Johnston, Jerry C Hu, Kyriacos A Athanasiou, Dean Wang","doi":"10.1016/j.jse.2025.02.054","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.054","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial wound lavages containing chlorhexidine gluconate (CHG) or povidone-iodine (PI) are commonly used for infection prophylaxis in arthroplasty surgery, including shoulder arthroplasty. However, the potential toxicity of these solutions to the surrounding native tissue, including rotator cuff tendons is not well understood. The purpose of this study was to investigate the ex vivo effects of a 1-minute 0.05% CHG exposure and a 3-minute 0.35% PI exposure on the viability and biochemical content of rotator cuff tendon explants.</p><p><strong>Methods: </strong>Infraspinatus tendons (n=6 per group) were isolated from the shoulders of Nubian goats. Tendons were submerged in 0.05% CHG in sterile water for 1 minute or 0.35% PI for 3 minutes per manufacturer guidelines, followed by phosphate-buffered saline (PBS) wash and culture in tissue medium. Control tendon specimens were bathed in PBS solution for 1 minute, followed by PBS wash and culture in tissue medium. Seven days after exposure, isolates from both the tendinous and enthesis portions were analyzed for tenocyte viability, biochemical content (collagen and glycosaminoglycan [GAG]), and matrix histology.</p><p><strong>Results: </strong>Within the tendinous portion of the tendon, CHG and PI exposure led to reduced mean tenocyte viability compared to controls (4.35% ± 4.64% viability in CHG group, P = 0.045; 14.4% ± 20.3% viability for PI group, P = 0.097; versus 35.4% ± 28.4% viability in control group). Within the enthesis, CHG and PI exposure led to smaller and non-significant decreased mean tenocyte viability compared to controls (29.5% ± 22.9%, P = 0.336 for CHG; 37.5% ± 29.4%, P = 0.327 for PI). There were no significant differences in mean collagen content/wet weight or GAG/wet weight among groups within the tendinous and enthesis isolates, nor were there any appreciable differences on histology in collagen and GAG distribution among groups.</p><p><strong>Conclusion: </strong>Brief 0.05% CHG and 0.35% PI exposures to rotator cuff tendon may lead to reduced tenocyte viability, with the tendinous portion seemingly more susceptible than the enthesis. Additionally, at these concentrations tested, CHG appears to be more toxic than PI. These findings raise concern for the potential cytotoxic effects of low-dose CHG and PI to native tendon tissue, even after brief exposures commonly used for antimicrobial prophylaxis in shoulder arthroplasty.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796917","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":"Tornier Perform Anatomic Augmented Glenoid Implants Correct Posterior Subluxation and Maintain Active Joint Reduction in Walch B2 Glenoids.","authors":"Kylie K Paliani, James C Hunter, James A Johnson, Ting-Yim Lee, George S Athwal, Emily A Lalone","doi":"10.1016/j.jse.2025.02.047","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.047","url":null,"abstract":"<p><strong>Background: </strong>The Walch type B2 glenoid is characterized by retroversion, posteroinferior erosion and posterior humeral head subluxation. A surgical management option for a B2 glenoid is an anatomic total shoulder arthroplasty (aTSA) with a posteriorly augmented all-polyethylene glenoid (PAG) implant. However, little is known about what occurs actively at the glenohumeral articulation after aTSA with a PAG. Additionally, most studies on B2 glenoids, whether pre-aTSA or post-aTSA, assess subluxation statically. Presently, it is unknown if subluxation recurs after aTSA with a PAG or if it varies dynamically throughout active motion. Therefore, the primary objective of this study was to determine if Walch type B2 patients managed with an aTSA and a PAG (Tornier Perform Anatomic Augmented Glenoid Implant) would maintain correction of subluxation when examined statically and when stressed with active motion. The secondary objective was to analyze if a patient's range of motion (good or limited), magnitude of B2, or PAG implant size (15° or 25°) affect postoperative correction of subluxation.</p><p><strong>Methods: </strong>Twenty Walch type B2 patients (mean age 68 years, range 54 to 83) underwent stemless aTSA with a 15° or 25° PAG implant and were assessed at a minimum 2-year follow-up. All patients underwent dynamic 4DCT scanning to actively track glenohumeral implant alignment and subluxation during a provocative active internal rotation motion protocol. Bone and implant 3D models of the humerus and scapula for each 4DCT scan were created using 3D Slicer. Landmarks were selected on the models to create coordinate systems that were then used in conjunction with a custom program (MATLAB) to determine subluxation preoperatively (statically), and postoperatively (dynamically).</p><p><strong>Results: </strong>Posterior humeral head subluxation was significantly corrected (p<0.001) from an average of 66% (range 51%-98%) preoperatively to 54% (range 41%-77%) postoperatively. Concentric aTSA joint alignment was maintained throughout an active internal rotation (IR) motion protocol, as subluxation percentage only varied by 1% throughout IR movement (range 54% to 55%). Neither patient IR range of motion (good or limited) nor size of PAG (15° or 25°) had a significant effect (p>0.05) on subluxation postoperatively.</p><p><strong>Conclusion: </strong>At short-term follow-up, aTSA with an all-polyethylene PAG (Tornier Perform Anatomic Augmented Glenoid Implant) was successful at restoring and maintaining glenohumeral alignment with correction of subluxation throughout a provocative active IR motion protocol. As such, recurrence of subluxation does not occur statically or actively in patients who have undergone glenoid reconstruction with correction of posteroinferior erosion with a half-wedge PAG implant. Thus, aTSA with a PAG implant is an acceptable option for patients with mild or moderate B2 glenoids.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788964","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 Insurance and Implant Coverage on Arthroscopic Shoulder Surgery Patients: A Prospective Multicenter Analysis.","authors":"Claudius D Jarrett, Raed Maali, Akin Cil, Mina Abdelshahed, Brian W Hill, Adam Z Khan, Joshua Port, David Weinstein, Melissa A Wright, Brandon D Bushnell","doi":"10.1016/j.jse.2025.02.045","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.045","url":null,"abstract":"<p><strong>Background: </strong>Advances in implant technology for arthroscopic shoulder surgery allow patients to achieve similar success rates as traditional approaches with reduced morbidity and quicker recovery. However, in the U. S. healthcare system, insurance coverage for these implants remains variable. Unlike commercial carriers, patients with governmental insurance typically do not have coverage for arthroscopic shoulder implants. How this disparity impacts the healthcare of patients with shoulder pathology remains unclear.</p><p><strong>Methods: </strong>We performed a prospective multicenter study analyzing the effects of insurance type and implant coverage on patients undergoing arthroscopic shoulder surgery. Patients were selected upon confirmation of surgery. Each case was documented for patient age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), race, and sex. Each case was then categorized based on insurance carrier (traditional Medicare, managed Medicare, commercial plans, Medicaid, workers' compensation, cash, or other governmental insurance). The timing for surgery, primary surgical indication, whether a primary or revision surgery, number of anchors used, site of service (freestanding Ambulatory Surgery Centers (ASCs) versus hospital-based operating room), and utilization of biologic or structural grafts were all then tracked.</p><p><strong>Results: </strong>A total of 326 cases from six participating states were analyzed. In comparison to ASCs, patients having surgery in hospital settings were older (56.8 vs. 52.0 years), had a higher Body Mass Index (BMI) (31.3 vs. 29.0), had higher ASA scores (2.4 vs. 1.9), and were more likely to be non-white (41.2% vs 31.5%). (p<0.05) After controlling for comorbidities, patients with Medicare Advantage (71%), Traditional Medicare (55%), and Medicaid/Cash (66%) were more likely to have their surgery in the hospital setting than patients with commercial plans (42%) (p<0.05). Hospital patients waited significantly longer before surgery in comparison to ASC patients (45.9 days vs. 34.4 days) (p<0.05). No statistically significant difference was identified between the number of anchors used and the insurance carrier (p = 0.58). A higher percentage of surgeries in the hospital (19.6%) included biologics versus those in an ASC (10.4%) (p = 0.03).</p><p><strong>Conclusion: </strong>Patients with governmental insurance plans were less likely to undergo arthroscopic shoulder surgery at an ASC than at a hospital-based facility. Patients who had their surgery at a hospital facility had a longer wait until surgery. Insurance carrier and implant coverage might influence where and when a patient receives care. Equal coverage of surgical implants for arthroscopic shoulder surgery would improve timely access and care for shoulder pathology. Legislatures should closely consider these findings when developing insurance policies.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789405","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":"No Difference in Clinical Outcomes and Return to Sport & Work with Use of Postoperative Non-Steroidal Anti-Inflammatory Medications Following Primary Arthroscopic Glenoid Labral Repair.","authors":"Zachary I Li, Nathan A Huebschmann, Sharif Garra, Jordan Eskenazi, Samantha A Rettig, Edward S Mojica, Michael J Alaia, Eric J Strauss, Laith M Jazrawi, Kirk A Campbell","doi":"10.1016/j.jse.2025.02.048","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.048","url":null,"abstract":"<p><strong>Background: </strong>To compare clinical outcomes, return to activities, and rates of revision surgery following arthroscopic glenoid labral repair in patients who were prescribed NSAIDs as part of their postoperative pain management regimen versus those who were not.</p><p><strong>Methods: </strong>Patients aged 18-55 who underwent primary arthroscopic labral repair at a single academic institution from the years 2016-2020 were retrospectively reviewed. Patients who underwent concomitant rotator cuff repair, remplissage, or did not have minimum 2-year postoperative follow-up were excluded. Patients who were prescribed postoperative NSAIDs were matched 1:1 to those who were not based on age, sex, BMI, and number of suture anchors. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons Shoulder Score (ASES), Simple Shoulder Test (SST), Single Assessment Numeric Evaluation rating (SANE), and satisfaction. Pre-injury sport and work activity information were recorded.</p><p><strong>Results: </strong>Of 269 eligible patients, 224 patients were included. Patients prescribed NSAIDs postoperatively had similar levels of pain (1.2 vs 1.0, p=0.527) and function (ASES: 90.8 vs 89.9, p=0.824; SST: 91.9 vs 90.6, p=0.646; SANE: 83.8 vs 85.3, p=0.550) compared to those who were not. Rates of revision surgery (2.7% vs 0.9%, p=0.622) and recurrent instability (5.4% vs 8.0%, p=0.594) were similar between NSAID and non-NSAID groups. Rates of return to sport (83.5% vs 77.8%, p=0.318) and return to pre-injury level (59.3% vs 61.6%, p=0.177) were similar between NSAID and non-NSAID groups. Prescription of postoperative NSAIDs was not associated with delayed return to sport (OR:1.47, 95%CI [0.68,3.18], p=0.327) or return to work (OR:0.56, 95%CI [0.14,2.28], p=0.416).</p><p><strong>Conclusions: </strong>Patients who were prescribed NSAIDs as a part of a postoperative pain management regimen following primary arthroscopic labral repair for glenohumeral instability had similar patient-reported outcomes, revision rates, and rates of return to pre-injury activities compared to those who were not prescribed NSAIDs.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788876","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 Conventional MR Method may Overestimate Off-track Hill-Sachs Lesions.","authors":"Rei Kimura, Nobuyuki Yamamoto, Atsushi Arino, Jun Kawakami, Hideaki Nagamoto, Toshimi Aizawa, Eiji Itoi","doi":"10.1016/j.jse.2025.02.046","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.046","url":null,"abstract":"<p><strong>Introduction: </strong>Three-dimensional reconstructed CT (3D-CT) images have been used to evaluate on-/off-track Hill-Sachs lesions. In the MRI method, there is no need to reconstruct images to determine the measurement position, and measurements can be easily performed using the standard axial and sagittal imaging sequences. For these reasons, recent studies have increasingly adopted MRI for measurements. The purpose of this study was to investigate whether or not the measurements using MR images were as accurate as those using 3D-CT images.</p><p><strong>Methods: </strong>This study is a retrospective case-control study. Thirty-two cases with recurrent anterior dislocation of the shoulder who underwent both MR and CT examinations preoperatively were enrolled. A multi-helical CT scanner was used for CT and a 1.5T scanner was used for MRI. In the measurement using 3D-CT images (CT method), the Hill-Sachs interval was measured in the plane passing the center of the humeral head and perpendicular to the Hill-Sachs lesion. In the MR measurement (conventional MR method), the Hill-Sachs interval was measured at the widest point using axial images. The Hill-Sachs interval was measured in the same way as CT method on MR images (modified MR method).</p><p><strong>Results: </strong>Five of 32 cases were judged as an off-track lesion in the CT method, whereas 8 and 6 cases in the conventional and modified MR methods, respectively. There were 3 mismatched cases between the CT and conventional MR methods. The Hill-Sachs lesions in these 3 cases were judged as on-track in the CT method but as off-track in the conventional MR method. In these 3 cases, the Hill-Sachs interval measured by the MR method was significantly greater than that by the CT method (p = 0.0028). There were only one mismatched cases between the CT and modified MR methods.</p><p><strong>Discussion: </strong>Our results demonstrated that the conventional MR method overestimated an off-track lesion compared to the CT method. The difference in the measurement plane between CT method and MR method was likely to cause a difference between the two methods. On the other hand, our modified MR method used the same plane as the CT method, which enabled us to evaluate off-track lesions more accurately than the conventional MR method.</p><p><strong>Conclusion: </strong>The conventional MR method may overestimate off-track lesions. In contrast, the modified MR method is expected to achieve accuracy closer to that of the CT method, making it a potentially useful measurement technique.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788889","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":"Subcutaneous lavage with a 0.05% chlorhexidine gluconate solution leads to decreased Cutibacterium acnes deep culture rate in primary total shoulder arthroplasty: A prospective, randomized controlled trial.","authors":"Hafiz F Kassam, Abhay Mathur, Patrick Saunders, Kalyn Smith, Brian Montes, Edward Quilligan, Vance Gardner","doi":"10.1016/j.jse.2025.02.043","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.043","url":null,"abstract":"<p><strong>Background: </strong>Cutibacterium acnes (C acnes) is commonly responsible for periprosthetic joint infections (PJI) after total shoulder arthroplasty (TSA). Chlorhexidine gluconate (CHG) has been shown to decrease the prevalence of C acnes when used in preoperative skin preparations. However, the bacterium is found within the dermal layer of the skin and unable to be completely eradicated with preoperative skin preparations. This study aims to determine if the use of 0.05% CHG lavage of the subcutaneous tissues decreases the incidence of positive superficial and deep C acnes cultures in primary TSA.</p><p><strong>Methods: </strong>This was a prospective, two-arm, single-surgeon, single-blinded, randomized, controlled trial. All patients scheduled for a primary anatomic or reverse TSA were screened for enrollment at a single institution. Patients were randomized to a saline irrigation or a 0.05% CHG irrigation of the exposed dermal and subcutaneous layer after incision. Five culture samples were taken during surgery. The first was taken from the skin prior to incision and followed by a baseline superficial subcutaneous culture before lavage. Following lavage, one additional superficial and two deep cultures were taken prior to bony preparation. All cultures were incubated and examined for C acnes growth for 21 days. The study was adequately powered at 85% with a Type I error rate of 0.05. An ordinal regression analysis for each culture swab site was performed to determine odds ratios, with the irrigation group (saline/CHG) serving as the independent variable.</p><p><strong>Results: </strong>126 patients were enrolled into two groups: normal saline (n=63) and CHG (n=63). The two groups did not have any significant differences in baseline demographic characteristics. The study group that underwent normal saline irrigation had more than double the risk of C acnes contamination at the deep surgical level compared with the group that had 0.05% CHG as the surgical irrigation solution (OR = 2.21, 95% CI: 1.12-4.37). Furthermore, when male patients were isolated the risk of C acnes contamination at the deep surgical level was even more pronounced (OR = 2.84, 95% CI:1.25-6.48).</p><p><strong>Conclusions: </strong>The use of a 0.05% CHG irrigation solution in the subcutaneous layer leads to a significantly decreased rate of positive deep cultures of C acnes in TSA. Furthermore, in male patients the decrease in rate of positive deep cultures is even more substantial. We recommend its use in the subcutaneous layer during primary TSA to limit the risk of deep C acnes contamination and potentially decrease the risk of PJI.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788865","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 Comparisons of Screw fixation Versus Suture Button fixation for Managing Anterior Shoulder Instability with Distal Clavicle Bone Graft.","authors":"Fa-Chuan Kuan, Kai-Lan Hsu, Fang-Hsien Lin, Chih-Kai Hong, Yueh Chen, Chien-An Shih, Wei-Ren Su","doi":"10.1016/j.jse.2025.02.044","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.044","url":null,"abstract":"<p><strong>Background: </strong>Screws and metal suture buttons are commonly used for graft fixation in glenoid reconstruction procedures. The distal clavicle has been proposed as an alternative autograft option. The aim of the present study was to compare the biomechanical characteristics of two fixation devices for securing distal clavicle graft in glenoid reconstruction surgery.</p><p><strong>Methods: </strong>Eight matched-pair, fresh-frozen human cadaveric shoulders were randomly assigned to undergo the reconstruction surgery with either screw fixation or suture button fixation. Morphometric data, including the graft dimension, glenoid surface dimension and area, amount of restoration, were obtained. After fixation, a biomechanical test was conducted in a direct-loading scenario. The construct stiffness, cyclic displacement and ultimate failure and displacement of each specimen were collected.</p><p><strong>Results: </strong>After reconstruction, the glenoid articular surface was restored to approximately 126 ± 10% of native status. Therefore, the distal clavicle graft was able to reconstruct 47 ± 9 % of the glenoid articular area. In terms of biomechanical results, the screw group exhibited significantly greater construct stiffness (165.0 ± 38.1 N/mm) than the button group (118.2 ± 33.9 N/mm, P = .027). Cyclic displacement was significantly greater in the button group (2.6 ± 1.0 mm) as compared with the screw group (0.8 ± 0.3 mm; P= .001). No significant difference in failure load and displacement were observed between the two groups.</p><p><strong>Conclusion: </strong>In a cadaveric 20-25% anterior glenoid bone loss scenario, the distal clavicle graft is sufficient in glenoid reconstruction surgery. At time zero, the screw fixation appears to offer superior construct stiffness and greater resistance to the cyclic displacement. Although these biomechanical differences may not be clinically relevant.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774701","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 Role of Preoperative Factors, Surgical Approach, Mobilization Protocol for Improved Surgical Outcomes after Open Elbow Arthrolysis in Post-traumatic Elbow Stiffness - An Ambispective Cohort Study.","authors":"Nikku Mathew Geevarughese, Srinavasa Rao Polisetty, Yogesh A Kothari, Manjula Anil Kunder, Anil K Bhat","doi":"10.1016/j.jse.2025.02.042","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.042","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic elbow stiffness decreases the range of movements (ROM) and limits functional activities of the upper limb. Post-injury therapy and splints have been used to improve the ROM. Despite this, surgical release is required in several instances. Surgical approaches to open arthrolysis vary. However, the medial approach has been less discussed. Multiple factors impact prognosis, final ROM, and functional outcomes after arthrolysis. The objectives of this study were to analyze functional outcomes following open elbow arthrolysis, outline post-injury and postoperative mobilization protocol implemented, the role of the medial approach, and identify preoperative factors contributing towards favorable functional outcomes in post-traumatic elbow stiffness treated by open elbow arthrolysis.</p><p><strong>Methods: </strong>In this single-center ambispective cohort study, we retrospectively recruited a cohort of post-traumatic elbow stiffness patients. They were placed in a structured preoperative therapy and splinting program. Those persisting with moderate to severe stiffness 3 to 6 months following the therapy underwent open elbow arthrolysis. A prospective study was done to evaluate the functional outcomes, pain, stability, and range of movements after elbow arthrolysis. The effect of the medial approach was evaluated for surgical outcomes. Clinical significance by minimal clinically important difference (MCID) and statistical significance of various preoperative factors for improved ROM and functional outcomes were evaluated.</p><p><strong>Results: </strong>94 patients with post-traumatic stiffness underwent the structured preoperative rehabilitation protocol. The severity of stiffness was downgraded with therapy in 39 patients, and the remaining 55 patients underwent open elbow arthrolysis. At a mean follow-up of 76.6±40.4 months, the mean gain in arc of motion from preop was 54°±32°, and the mean ROM at final follow-up was 88°±30° (p=0.026). An isolated medial approach was performed in 65.5%. The mean improvement in arc of motion with the isolated medial approach was 51°±28° and 45°±34° with the combined medial-lateral approach. The severity of preoperative stiffness showed statistical significance in improvement in arc of motion and postoperative Mayo Elbow Performance Score (p=0.033), while the interval from trauma to surgery was shown to be clinically significant by MCID.</p><p><strong>Conclusions: </strong>Structured preoperative rehabilitation protocol downgrades the severity of elbow stiffness. The open elbow arthrolysis significantly improves arc of motion and MEPS. The medial approach demonstrates an improved arc of motion compared to combined and posterior approaches. The severity of preoperative stiffness and interval from trauma to surgery have a significant correlation to improvement in arc of motion and MEPS.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755491","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 Effect of Wrist Flexion/Extension on Radiocapitellar Joint Kinematics During Valgus Extension of the Elbow.","authors":"Dani Rotman, Masataka Minami, Jae-Man Kwak, Jorge Rojas Lievano, James S Fitzsimmons, Shawn W O'Driscoll","doi":"10.1016/j.jse.2025.02.040","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.040","url":null,"abstract":"<p><strong>Introduction: </strong>Osteochondritis dissecans (OCD) of the capitellum is prevalent among youth baseball pitchers. Repetitive shear forces during pitching are contributing factors. During the acceleration phase of pitching, the wrist joint moves from extension to flexion. The interplay between wrist position and elbow joint biomechanics has not been thoroughly examined, particularly within the radiocapitellar joint. This study aims to elucidate how different wrist positions affect the displacement of compression forces within the radiocapitellar joint during elbow extension and examine the change in contact pressure during simulated active wrist flexion and extension.</p><p><strong>Methods: </strong>Seven fresh frozen cadaveric upper limbs were mounted in a custom testing machine and tested under simulated throwing conditions. Radial head motion was tracked using an intra-articular thin-film pressure transducer mounted on the capitellum. The contact pressure and location of the center of force (COF) in the radiocapitellar joint were measured during three wrist positions by loading the wrist flexors and extensors: flexion, neutral, and extension.</p><p><strong>Results: </strong>Wrist flexion, compared to the neutral wrist position, displaced the COF significantly medially between 60° and 30° of elbow flexion (p<0.05). Wrist extension slightly directed the COF laterally compared to the neutral wrist, but the differences were not significant. The total horizontal displacement between the COF during active wrist flexion and extension ranged from 1.6mm to 1.8mm. Mean contact pressure was significantly higher with the wrist in extension from 80° to 40° of elbow angle and significantly lower with wrist flexion only at a 90° elbow angle (p<0.05).</p><p><strong>Discussion: </strong>This study demonstrated that simulated active wrist flexion shifts the COF medially, potentially reducing the risk of lateral OCD lesions. In contrast, wrist extension increases contact pressure, explaining the higher susceptibility to loading in the lateral compartment. These findings highlight the importance of wrist dynamics in pitching mechanics and suggest that minimizing wrist extension during practice may prevent OCD development.</p><p><strong>Conclusion: </strong>Wrist positions significantly influence the biomechanical behavior of the radiocapitellar joint during elbow extension. These insights are important for developing prevention and rehabilitation strategies for throwers at risk of OCD of the capitellum.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755534","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}