Journal of Shoulder and Elbow Surgery最新文献

{"title":"Preoperative Planning and Inferior Glenosphere Overhang Increases the Odds of Achieving High Internal Rotation After Univers Reverse Total Shoulder Arthroplasty.","authors":"Matthew B Noble, Justin W Griffin, Benjamin W Sears, Reuben Gobezie, Evan Lederman, Brian C Werner, Patrick J Denard","doi":"10.1016/j.jse.2025.01.018","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.018","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in surgical technique and implant design, internal rotation (IR) after reverse total shoulder arthroplasty (rTSA) continues to be relatively unpredictable. The purpose of this study was to compare patient characteristics, utilization of three-dimensional computed tomography (3D CT) based preoperative planning, and postoperative implant position between patients with high or low IR after rTSA.</p><p><strong>Methods: </strong>A retrospective review was performed of a multicenter prospectively collected database on patients who underwent primary rTSA (Univers Revers; Arthrex, Inc., Naples, FL, USA) from 2016-2021 with minimum 2-year follow-up. Patients were selected for a comparative analysis who either achieved high IR (T12 or better) or low IR (below the hip) postoperatively. Baseline demographics and postoperative radiographs were evaluated for association with IR. Implant position was assessed on radiographs for lateralization shoulder angle (LSA), distalization shoulder angle (DSA), inferior glenosphere overhang, and coracoid to glenosphere distance. Regression analyses were performed on component and clinical variables to assess for factors predictive of high vs low IR.</p><p><strong>Results: </strong>A total of 344 rTSAs were eligible, of which 98 patients met criteria for the high IR group, and 50 met criteria for the low IR group. Decreased body mass index (BMI) (OR 1.14, 95% CI 1.01-1.30, p=0.044), high preoperative IR (OR 1.30, 95% CI 1.02-1.66, p=0.034), and surgery on the dominant arm (OR 5.38 95% CI 1.31-22.1, p=0.019) correlated with an increased odds of high IR. The use of 3D CT-based preoperative planning was associated with having high IR (OR 9.69, 95% CI 1.83-51.3, p=0.008). Radiographically, increased DSA (OR 1.09, 95% CI 1.02-1.16, p=0.012) and increased inferior glenoid overhang (OR 1.39, 95% CI 1.07-1.80, p=0.013) were associated with a greater chance of being in the high IR group.</p><p><strong>Conclusion: </strong>While specific baseline patient characteristics influence the ability to obtain high IR after rTSA including increased preoperative IR, decreased BMI, and surgery on the dominant arm, there are several factors within the surgeon's control. The use of 3D CT-based preoperative planning greatly increases the odds of obtaining increased postoperative IR. More precisely, mindful implant positioning including inferior glenosphere overhang and slight distalization increased postoperative IR. Therefore, the use of 3D CT-based preoperative planning may be considered in order to carefully and consciously position the glenosphere to slightly increase distalization and inferior overhang in order to optimize IR. However, further evaluation with regard to 3D planned position and postoperative outcomes are required.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450820","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 characteristics are more important than preoperative radiographic factors in predicting the risk of acromial stress fracture following reverse total shoulder arthroplasty.","authors":"Matthew B Noble, Lisa A Galasso, Brian C Werner, Patrick J Denard","doi":"10.1016/j.jse.2025.01.022","DOIUrl":"10.1016/j.jse.2025.01.022","url":null,"abstract":"<p><strong>Background: </strong>Acromial stress fractures (ASFs) after reverse total shoulder arthroplasty (rTSA) can have a devastating effect on a patient's overall function, causing decreased range of motion and patient satisfaction. The purpose of this study was to evaluate preoperative patient demographics and radiographic findings associated with risk for ASF after rTSA.</p><p><strong>Methods: </strong>A retrospective review was performed on patients who underwent primary rTSA by a single surgeon between December 2011 and December 2022. Inclusion criteria were primary rTSA with minimum 6-month postoperative radiographs. Preoperative demographics, comorbidities, and radiographic factors (acromial thickness, critical shoulder angle, humeral cortical thickness, and acromiohumeral distance) were reviewed. Postoperative radiographs were all evaluated for the presence of ASF and classified according to the Levy classification. Univariate analyses followed by logistic regression analyses were performed to evaluate for significant risk factors. A Bonferroni correction was then performed.</p><p><strong>Results: </strong>A total of 757 rTSAs were included and 58 (7.7%) ASFs identified. ASFs were identified at a median of 14 weeks postoperatively. Across the entire cohort, including both male and female patients, multiple factors including lower body mass index, inflammatory arthritis, and decreased acromial thickness were identified as initially being correlated with ASF. Among females, the presence of inflammatory arthritis, the use of preoperative osteoporosis medications, humeral cortical thickness, and acromial thickness were initially identified as increasing the risk of ASF. For males, surgery on the dominant arm and lower body mass index were initially identified as increasing the risk of ASF. After a Bonferroni correction was completed and the P value representing significance was set at P < .0025, only the presence of inflammatory arthritis in females was found to be statistically significant (odds ratio: 4.87, 95% confidence interval: 2.16-10.96, P < .001).</p><p><strong>Conclusion: </strong>This study points to multiple preoperative patient characteristics that showed initial correlation with an increased risk of ASF and demonstrates the importance of future study. After the statistical significance was revised and set at P < .0025, females with inflammatory arthritis are associated with increased risk of ASF after rTSA. These findings suggest that overall patient health and fragility may be more predictive of ASF rather than preoperative radiographic characteristics that were studied. We propose that further study of other factors, such as implant position, patient nutrition, and postoperative rehabilitation parameters, be performed to determine their impact on ASF risk.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442551","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":"Short-term outcomes of anatomic total shoulder arthroplasty with nonaugmented glenoid component for Walch B2 and B3 glenoid morphology.","authors":"Charles J Cogan, Midhat Patel, Jonathan Guevara, Sambit Sahoo, Bong Jae Jun, Chao Zhang, Cathy Shemo, Andrew Baker, Andrew Qi, Vahid Entezari, Joseph P Iannotti, Jason C Ho, Eric T Ricchetti","doi":"10.1016/j.jse.2025.01.023","DOIUrl":"10.1016/j.jse.2025.01.023","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of posterior glenoid bone loss in glenohumeral osteoarthritis with anatomic total shoulder arthroplasty (aTSA) remains unknown, as the degree of bone loss and retroversion can vary across a wide spectrum in glenoids with Walch B2 and B3 morphology. The objectives of the current study were to evaluate the clinical and radiographic outcomes of utilizing standard, all-polyethylene, nonaugmented anchor-peg glenoid (APG) components in aTSA for patients with mild to moderate B2 or B3 morphology.</p><p><strong>Methods: </strong>Between January 2010 and September 2019, we identified 79 shoulders with mild to moderate B2 or B3 glenoid morphology that underwent aTSA with use of a nonaugmented APG glenoid component and minimum 2 years clinical and radiographic follow-up. In each case, the surgeon had access to an augmented glenoid component but chose to use a standard component based upon the presence of mild to moderate deformity, defined as the ability to template components within 10° of premorbid glenoid vault retroversion and within 3 mm of premorbid glenoid vault joint line based on preoperative 3-dimensional computed tomography planning. The Penn Shoulder Score (PSS), glenoid anchor-peg osteolysis (APO) (grade 1 vs. 2 and 3), and humeral head subluxation (HHS) were the main outcomes of interest.</p><p><strong>Results: </strong>The cohort included 63/79 (80%) B2 glenoids and 17/79 (21%) B3 glenoids. Median patient age at surgery was 64.2 years [interquartile range {IQR} 59.6; 68.5]; median preoperative retroversion was 13.0° [IQR 9.8; 15.4]; and median preoperative joint line medialization was 1.4 mm [IQR 0.4; 2.4]. Median follow-up duration was 4.3 years [IQR 2.5; 6.8]; The PSS and HHS were improved amongst all patients postoperatively (P < .0001), with a median PSS at latest follow-up of 96.0 [IQR 88.5; 99.0] and posterior HHS present in 11.8% at final follow-up. There were 4 complications in the cohort (5.0%), one of which required reoperation due to persistent posterior HHS. Postoperative grade 1 APO was present on latest radiographs in 8/79 (10.1%) cases. Walch classification, preoperative glenoid version, inclination, and joint line medialization as measured on 3-dimensional computed tomography were not significantly associated with PSS or APO at final follow-up. Higher PSS at final follow-up was associated with better shoulder range of motion. APO at final follow-up was not associated with lower PSS.</p><p><strong>Discussion: </strong>The use of nonaugmented polyethylene APG components in patients undergoing aTSA with mild to moderate B2 and B3 glenoids results in significant improvements in clinical and radiographic outcomes with low complication and reoperation rates at short-term follow-up. Further follow-up of this cohort is needed to better understand the implications of glenoid component APO on loosening patterns and failure rates in the long-term.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442589","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":"Which is More Important for Achieving Superior Stability in a Massive Rotator Cuff Tear?: The Spacer effect (static) versus Concavity compression (dynamic): A Biomechanical Cadaveric Study.","authors":"Yoon Sang Jeon, Sang Hyun Ko, Yoon Cheol Nam, Gi Cheol Bae, Dong Jin Ryu, Yeop Na, Dong Seok Kang, Sungwook Jung, Aaron Hui, Michelle H McGarry, Thay Q Lee","doi":"10.1016/j.jse.2024.12.051","DOIUrl":"https://doi.org/10.1016/j.jse.2024.12.051","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the biomechanical effect of subacromial spacer (physically depressing the humeral head) and magnets (concavity compression restoration) in massive rotator cuff tear (MRCT). We assessed the influence on superior stability by employing the subacromial spacer (the spacer effect) and magnets (concavity compression effect) separately or in combination in MRCT.</p><p><strong>Methods: </strong>A customized shoulder testing system tested seven fresh-frozen cadaveric shoulders. The prosthesis implantation was performed prior to all experimental conditions. Each specimen underwent the following conditions: (1) intact rotator cuff without magnets, (2) MRCT without magnets; (3) MRCT with magnets, (4) MRCT with a spacer, (5) MRCT with magnets and a spacer. For each condition, superior migration and subacromial contact pressure were measured at 0°, 30°, and 60° abduction angles.</p><p><strong>Results: </strong>Condition 2 resulted in a significant increase in both superior migration and subacromial contact pressure compared to condition 1. Condition 3 exhibited no significant differences in both parameters compared to condition 2 (p > 0.05). In condition 4, both parameters significantly decreased (p < 0.05), and in condition 5, levels were restored to those of the intact condition with no significant difference. Neither parameter between conditions 4 and 5 differed significantly (p > 0.05).</p><p><strong>Conclusion: </strong>The combination of the static (spacer) and dynamic (concavity compression) effect demonstrated restoration of superior migration and subacromial contact pressure after MRCT to levels comparable to the intact condition. However, the subacromial spacer alone also showed positive results, and the influence of concavity compression was minimal. To achieve superior stability in MRCT, the static role (spacer) as superior restraint is more critical for rotator cuff function than the dynamic role (concavity compression).</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434196","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":"Evaluating Postoperative Outcomes of Arthroscopic Rotator Interval Release after Rotator Cuff Repair: A Randomized Prospective Trial.","authors":"Amir M Boubekri, Michael Scheidt, Hassan Farooq, Andrew Chen, Stanley Liu, Thomas Stanila, Krishin Shivdasani, Dane Salazar, Nickolas Garbis","doi":"10.1016/j.jse.2024.12.050","DOIUrl":"10.1016/j.jse.2024.12.050","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous rotator interval release is not classically performed during arthroscopic rotator cuff repair (RCR). However, concurrent rotator interval release has been anecdotally reported to facilitate less propensity for postoperative shoulder stiffness. The purpose of our investigation was to compare outcomes of pain and stiffness among patients who underwent arthroscopic rotator cuff repair with and without concomitant rotator interval release.</p><p><strong>Methods: </strong>A single-blinded, randomized controlled trial was conducted between September 2018 and April 2021. Outcomes including Visual Analog Scale (VAS), narcotic usage, American Shoulder and Elbow Surgeons (ASES) Shoulder Score, active forward flexion (aFF), and active external rotation (aER) range of motion measurements were collected at 4-6 weeks, 3 months, 6 months, and at most recent follow-up postoperatively.</p><p><strong>Results: </strong>83 patients were prospectively enrolled and randomized into RCR with rotator interval versus without interval release. Postoperative temporal association between VAS score, ASES score, and average narcotic pain tablet use did not depend on group assignment (P = 0.990, P = 0.760, and P = 0.700, respectively). Similarly, the association between time point and aFF and aER range of motion did not depend on group assignment (P = 0.300 and P = 0.630, respectively).</p><p><strong>Conclusion: </strong>Arthroscopic rotator interval release during rotator cuff repair showed no statistically significant difference in short-term or long-term postoperative pain or range of motion outcomes compared to control.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426514","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":"Short-Term Functional, Imaging, and Electrodiagnostic Outcomes of Arthroscopic-Assisted Lower Trapezius Transfer.","authors":"Adrik Da Silva, Michael A Moverman, Megan K Mills, Daniel M Cushman, Luke A Myhre, Mitchell J Yelton, Christopher D Joyce, Peter N Chalmers, Robert Z Tashjian","doi":"10.1016/j.jse.2024.12.045","DOIUrl":"https://doi.org/10.1016/j.jse.2024.12.045","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the short-term functional outcomes, structural healing and neuromuscular activity after arthroscopic assisted lower trapezius transfer for irreparable posterior superior rotator cuff tears.</p><p><strong>Methods: </strong>All patients who underwent arthroscopic assisted lower trapezius tendon transfer for an irreparable posterior superior rotator cuff tear between 2017-2021 by two surgeons with a minimum of 2 year follow-up were identified. Functional outcome scores (American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain), range of motion, shoulder strength, magnetic resonance imaging (MRI) to assess transfer healing and needle electromyographic (EMG) examination to assess lower trapezius muscle activity were performed at a minimum of two-years postoperatively. Contralateral nonoperative lower trapezius muscle activity was assessed by EMG. Grafts were defined as completely healed if anatomic graft healing occurred, partial healing if some graft was healed to the proximal humerus and unhealed if no graft was attached to the proximal humerus on postoperative MRI.</p><p><strong>Results: </strong>Twenty-four eligible patients (25 shoulders) were identified through chart review. Mean age and follow-up were 54.9±9.5 and 2.9±1.7 years, respectively. Overall, 72% (18/25) clinical follow-up was obtained. All functional outcomes including ASES (preoperative, 48.8±19.6; postoperative, 80.9±15.4; p<0.001), VAS pain (4.9±2.3; 1.4±1.5; p<0.001), and active forward flexion (110°±53.2; 141.7±40.4°; p=0.024) statistically significantly improved. Twelve shoulders (48%) presented for EMG follow-up. All twelve patients demonstrated EMG activity of the lower trapezius in forward elevation, external rotation at the side, and external rotation at 90° of abduction, which was symmetric to the contralateral shoulder. Fifteen shoulders (60%) were available for MRI follow-up. Thirteen (87%) patients demonstrated complete or partial healing of the allograft to the greater tuberosity, while 2 (13%) demonstrated a complete tear of the graft.</p><p><strong>Conclusions: </strong>Arthroscopic assisted lower trapezius transfer demonstrates improved functional outcomes two-years postoperatively. Complete re-tear of the transfer is relatively uncommon (13%). The lower trapezius fired in phase in forward flexion, external rotation at the side, and external rotation in 90° of abduction in all patients that underwent EMG testing, which was consistent with the firing pattern of the contralateral normal lower trapezius muscle. These results may support the theory that active function of the muscle transfer itself, as opposed to a tenodesis effect, is a potential mechanism by which this procedure improves shoulder function as it consistently fires in phase.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426518","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":"Are the dominant-nondominant functional differences at 4.5 months after open Latarjet procedure better predictors for successful return to sport at 1 year postoperatively than the operated-nonoperated differences?","authors":"Isabelle Rogowski, Laurent Nové-Josserand, Arnaud Godenèche, Philippe Collotte, Gabriel Franger, Florent Borel, Grégory Vigne, Thais Dutra Vieira, Yoann Blache, Lionel Neyton","doi":"10.1016/j.jse.2024.12.046","DOIUrl":"10.1016/j.jse.2024.12.046","url":null,"abstract":"<p><strong>Background: </strong>There is no evidence on which functional levels have to be recovered to return to the preinjury sport at the preinjury level, that is, successful RTS, after an open Latarjet procedure. Therefore, this study aimed to identify whether RTS criteria assessed at 4.5 months postoperatively predict successful RTS at 1 year after the open Latarjet procedure.</p><p><strong>Methods: </strong>All patients who underwent an open Latarjet procedure between August 2018 and July 2021 were eligible. At 4.5 months postoperatively, patients completed the Shoulder Instability-Return to Sport after Injury questionnaire and performed unilaterally with each side maximal isometric strength in glenohumeral internal and external rotation, Upper-Quarter Y Balance Test, Unilateral Seated Shot-Put Test, and modified Closed Kinetic Chain Upper Extremity Stability Test. They answered RTS inquiry at 12 months postoperatively. Logistic regressions were applied to assess the ability of parameters based on operated-nonoperated or dominant-nondominant ratios to predict successful RTS.</p><p><strong>Results: </strong>Among 126 eligible patients, 110 answered the RTS inquiry; 21 patients were excluded, 49 were included in the successful RTS group, and 40 in the unsuccessful RTS group. No parameters based on the operated-nonoperated ratios were prognostic factors for successful RTS. Despite a low precision of the model (area under the receiver operating characteristic curve = 0.64), dominant-nondominant ratios in internal rotation strength (odds ratio [OR] = 0.98, P = .02), balance between external and internal rotation strength at the operated shoulder (OR = 1.03, P = .02), and muscular endurance ability (OR = 1.03, P = .04) were found to be prognostic factors for successful RTS.</p><p><strong>Conclusion: </strong>The findings challenge the ability of criteria expressing operated shoulder functions with reference to those of the contralateral one in predicting a successful RTS. They suggest that when assessed 4.5 months postoperatively, the balance of function between dominant and nondominant shoulders in reference to those of healthy athletes would be better predictors of returning to preinjury sport at the preinjury level. This study highlights that clinicians and sport supervisors may place particular care on the recovery of dominant-nondominant balance in maximal internal rotation strength and in upper extremities strength endurance to enhance the likelihood of returning to sport successfully for their athletes who underwent anterior shoulder stabilization surgery by an open Latarjet procedure.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426512","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 Sequentially Increased Polyethylene Constraint on Impingement in Reverse Shoulder Arthroplasty: A Biomechanical Investigation.","authors":"Cole T Fleet, Patrick Carroll, James A Johnson, George S Athwal","doi":"10.1016/j.jse.2024.12.049","DOIUrl":"https://doi.org/10.1016/j.jse.2024.12.049","url":null,"abstract":"<p><strong>Background: </strong>The constraint of the polyethylene liner in reverse total shoulder arthroplasty (rTSA) can affect glenohumeral joint stability. However, its influence on glenohumeral range of motion (ROM) remains unclear. Therefore, it was the objective of this study to determine the effect of sequentially increasing polyethylene liner constraint on impingement-free ROM following rTSA. Additionally, these sequentially increasing constraint designs were evaluated with various humeral neck shaft angles (NSAs), glenosphere diameters, and a new variable termed the polyethylene rim width.</p><p><strong>Methods: </strong>Twenty upper extremity cadavers were computed tomography scanned and manually segmented to developed three-dimensional models of the scapula and humerus. Each model was then virtually implanted with a generic rTSA implant. Nine different polyethylene constraint ratios (defined as the ratio between the polyethylene depth and polyethylene radius; with values ranging from 0.35-0.75 in 0.05 increments) were assessed, along with three NSAs (135°, 145°, and 155°), three glenosphere diameters (36mm, 39mm, and 42mm), and four polyethylene rim widths (1mm, 2mm, 3mm, and 4mm). This resulted in 108 different polyethylene designs and 324 different rTSA designs. All virtually implanted bone models were imported as rigid bodies into a custom motion software, in which six standard motions (abduction, adduction, forward elevation, extension, internal rotation, and external rotation) were conducted, followed by the assessment of global circumduction ROM. Impingement during each motion was automatically detected. The maximum impingement-free ROM for each implant configuration and motion pathway were then quantified and statistically assessed.</p><p><strong>Results: </strong>Polyethylene constraint, polyethylene rim width, NSA, and glenosphere diameter were all found to significantly affect impingement-free ROM for all motions simulated (P<0.001). Increases in polyethylene constraint and rim width were found to significantly reduce impingement-free ROM (P<0.001). A 135° NSA with a 42mm glenosphere combination were found to maximize ROM during extension, adduction, internal rotation, external rotation, and global circumduction motion, while a 155° NSA with a 36mm glenosphere combination resulted in optimized abduction and forward elevation ROM.</p><p><strong>Discussion: </strong>Increases in polyethylene constraint were found to significantly reduce impingement-free ROM for all motions evaluated. However, polyethylene constraint had the greatest impact on glenohumeral extension, adduction, internal rotation, external rotation, and global circumduction. Polyethylene rim width was also found to significantly affect impingement-free ROM for all motions. Further study is needed to determine the optimal value of polyethylene liner constraint in rTSA due to its impact on rTSA biomechanics, joint stability and ROM.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426532","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 Statistical Fragility of Treatments for Adhesive Capsulitis: A Systematic Review of Randomized Controlled Trials.","authors":"Auston R Locke, Niklas H Koehne, Matthew D Ramey, Jackson L Oxner, Avanish Yendluri, Michael N Megafu, John J Corvi, Nikan K Namiri, John D Kelly, Robert L Parisien","doi":"10.1016/j.jse.2024.12.047","DOIUrl":"https://doi.org/10.1016/j.jse.2024.12.047","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trials (RCTs) have assessed a range of treatments for shoulder adhesive capsulitis (AC), with conflicting results over the most clinically beneficial options. This study used the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to evaluate statistical fragility of the outcomes reported in RCTs assessing the efficacy of shoulder AC treatments.</p><p><strong>Methods: </strong>PubMed and Embase were systematically searched for RCTs from January 1, 2004, to May 1, 2024 that assessed shoulder AC treatments. We quantified FI and rFI, which represent the amount of outcome event reversals necessary to change statistical significance for significant and non-significant findings, respectively. Subanalyses were performed for outcomes relating to clinical efficacy, patient satisfaction, pain, and adverse events. The FQ was determined by dividing the FI by the study sample size.</p><p><strong>Results: </strong>Of 468 articles screened, there were a total of 38 RCTs analyzed that yielded 67 outcomes of interest. Across the 67 outcomes, the median FI was 3 (IQR [Interquartile Range] 2-6) and the median FQ was 0.075 (IQR 0.034-0.100). The 17 statistically significant outcomes had a median FI of 2 (IQR 1-4) and a median FQ of 0.050 (IQR 0.018-0.091). The remaining 50 outcomes were statistically nonsignificant, with a median FI of 4 (IQR 2-6) and a median FQ of 0.079 (IQR 0.037-0.102). Notably, in 40.3% of all outcomes, loss-to-follow-up was greater or equal to the outcome's respective FI or rFI. The most fragile outcomes were related to patient satisfaction (FI 2) and adverse events (FI 2.5).</p><p><strong>Conclusion: </strong>The outcomes of interest regarding treatments for adhesive capsulitis from RCTs are statistically fragile, most notably significant outcomes and those pertaining to patient satisfaction. RCT results surrounding adhesive capsulitis treatments remain inconclusive; thus, combining p-values with both FI and FQ metrics may improve the interpretation of clinical findings regarding treatment modalities for adhesive capsulitis. Future clinical RCTs may reduce outcome fragility by improving follow-up rates and increasing patient sample sizes.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426537","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":"Surgical treatment of sternoclavicular joint osteoarthritis: a systematic review.","authors":"Anna H N Rasmussen, Michael R Krogsgaard","doi":"10.1016/j.jse.2024.12.044","DOIUrl":"10.1016/j.jse.2024.12.044","url":null,"abstract":"<p><strong>Background: </strong>Sternoclavicular joint (SCJ) osteoarthritis is rarely treated surgically, and the available published manuscripts are limited to small patient series. The aims of this systematic review were to identify the surgical treatment options for osteoarthritis of the SCJ, describe the quality of the available literature, analyze the outcome and complications, and compare open vs. arthroscopic surgery.</p><p><strong>Methods: </strong>Literature was searched in PubMed, MEDLINE, and Embase. Single case reports and studies that did not include surgical management were excluded. Data of interest included study year, sample size, diagnosis, sex, age, demographics, clinical data, type of surgical management, follow-up periods, outcomes, and complications related to the surgical treatment.</p><p><strong>Results: </strong>Eight articles on series of patients met the inclusion criteria and included 107 patients. Mean patient age was 48.2 years (range: 17-72). 68% of patients were females and 32% males. The most commonly described treatment option was arthroscopic resection of the medial clavicle end (56%). Revision surgery was performed in 3 cases: 2 following trauma and 1 for persistent pain. The mean follow-up period was 45.4 months (range: 28-80). Scores from patient-reported outcome measures (Rockwood, Constant, and Disabilities of the Arm, Shoulder, and Hand questionnaires) and visual analog scale pain scores all improved significantly from preoperatively to postoperatively. Four studies with 32 patients reported the overall subjective patient outcome with 84% reaching excellent or good. There were no randomized controlled trials and no comparative cohorts. Arthroscopic surgery was only reported by 1 center, and this may induce risk of bias. It was not possible to compare outcomes following open and arthroscopic surgery.</p><p><strong>Conclusion: </strong>Based on this systematic review, surgical treatment of SCJ osteoarthritis is a safe procedure which offers good pain reduction and a high rate of satisfaction. It is not possible from literature to conclude whether open or arthroscopic surgery is preferable.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426530","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}