Journal of Shoulder and Elbow Surgery最新文献

{"title":"Intra-articular Corticosteroid Injection versus Suprascapular Nerve Block for Adhesive Capsulitis: A Systematic Review and Meta-analysis of Level I Randomized Controlled Trials.","authors":"Jonathan D Harley, Confidence Njoku Austin, Alicia K Harrison, Bryan M Saltzman, Allison J Rao","doi":"10.1016/j.jse.2025.05.037","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.037","url":null,"abstract":"<p><strong>Background: </strong>Intra-articular corticosteroid injection and suprascapular nerve block are both options for nonoperative management of adhesive capsulitis. While numerous studies support the benefits of steroid injections, the use of suprascapular nerve blocks is less established. Published randomized trials comparing steroid injections and suprascapular nerve blocks for managing adhesive capsulitis have reported mixed results.</p><p><strong>Purpose: </strong>To synthesize the results of published level I studies to compare outcomes for patients with adhesive capsulitis following intra-articular corticosteroid injection or suprascapular nerve block.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 1.</p><p><strong>Methods: </strong>The study was performed according to the preferred reporting items for systematic reviews and meta-analysis. Three databases were searched for randomized controlled trials comparing an intra-articular steroid injection to a suprascapular nerve block in patients with adhesive capsulitis. Trials were excluded if either group received another procedure or included patients with concomitant ipsilateral shoulder pathology. Outcomes were patient-reported pain intensity and shoulder function, range of motion, and time to symptom resolution. Meta-analysis was performed for pain, shoulder function, and range of motion using random-effects models.</p><p><strong>Results: </strong>Eight studies with a total of 452 patients were included. Pain was assessed using the shoulder pain and disability index (SPADI) pain subscale and the visual analog scale (VAS). Functional outcomes were assessed using the SPADI and Constant-Murley Score. Range of motion assessments included active and passive movements in abduction, forward flexion, external rotation, and internal rotation. Random-effects comparisons at baseline, 3-4 weeks, 6-7 weeks, and 12 weeks were performed for pain and SPADI scores, and at baseline and 12 weeks for active abduction. Suprascapular nerve blocks were superior to steroid injections for pain at 3-4 weeks (standardized mean difference [SMD]: 0.63, 95% CI: 0.06-1.19, p = 0.03), 6-7 weeks (SMD: 0.49, 95% CI: 0.01-0.96, p = 0.046), and 12 weeks post-intervention (SMD: 1.68, 95% CI: 0.30-3.06, p = 0.017). Nerve blocks were superior to steroid injections in reducing SPADI scores at 12 weeks post-intervention (MD = 8.94, 95% CI: 1.44-16.44 p = 0.020). Nerve blocks were superior to steroid injections for active abduction at 12 weeks post-intervention (MD = 14.44°, 95% CI: 11.05°-17.83°, p < 0.001). Heterogeneity was considerable for all meta-analyses. There were no other significant differences between groups at any time point.</p><p><strong>Conclusions: </strong>In patients with adhesive capsulitis, suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Comparison of 2.4 mm LCP Radial Head Plate and Tripod Fixation in Mason Type III Radial Head Fractures: A Human Cadaveric Study.","authors":"Moritz Kraus, Luke van Rossenberg, Ivan Zderic, Tatjana Pastor, Boyko Gueorguiev, R Geoff Richards, Hans-Christoph Pape, Klaus Burkhart, Torsten Pastor","doi":"10.1016/j.jse.2025.05.039","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.039","url":null,"abstract":"<p><strong>Background: </strong>Proximal radius fractures, particularly Mason Type III, represent a challenge in elbow surgery due to their complexity and impact on joint function. Using the conventional radial neck plate is a reliable treatment option, however, it can cause soft tissue irritation and restricted range of motion. A novel tripod fixation approach, using three crossed screws, should minimize such complications and preserve range of motion. This study aims to compare the biomechanical competence of conventional radial neck plating using a LCP Radial Head Neck Plate 2.4 mm (DePuy Synthes, West Chester, PA, USA) versus tripod fixation in a Mason Type III fracture model.</p><p><strong>Methods: </strong>Sixteen paired human cadaveric radii underwent a standardized osteotomy to simulate a transverse neck fracture with an additional 50:50 head split component and split into two groups - Group 1 fixed with a conventional radial neck plate with two additional canulated headless compression screws (HCS) and Group 2 stabilized with tripod fixation (three cruciated 40 mm HCS) and two additional HCS. Biomechanical tests assessed stiffness in anteroposterior and mediolateral bending, axial compression, pronation, and supination.</p><p><strong>Results: </strong>No significant differences were found in stiffness across the comparisons: mediolateral bending: tripod:195±132 N/mm, plate: 91±47 N/mm (p = 0.067), anteroposterior bending: plate: 168±105 N/mm tripod: 145±108 N/mm (p = 0.670), axial compression: plate: 643±337 N/mm vs. tripod: 642±188 N/mm (p = 0.998), pronation: plate 0.15±0.10 Nm/°, tripod: 0.23±0.23 Nm/° (p = 0.336), and supination: plate: 0.17 Nm/°, Tripod: 0.25±0.21 Nm/° (p = 0.351). Cycles to failure under axial compression were recorded with the plate group showing 4,078±3,173 cycles and the tripod group 4,763±5,288 cycles, p ≥ 0.4. Load to failure was noted at 586±222 N for the plate and 789±337 N for the tripod, p ≥ 0.4.</p><p><strong>Conclusion: </strong>From a biomechanical perspective the tripod technique with two additional HCS showed comparable performance compared to plate fixation with two additional HCS in transverse radial neck fractures with an additional head split component. With potentially less soft tissue irritation and necessary secondary hardware removal the tripod technique seems to be a valid alternative to conventionally used plate osteosynthesis techniques. However, further randomized clinical trials are needed to fully evaluate its clinical value.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term survival of Acumed Anatomical Radial Head implant for Mason Type III-IV fractures: a 15-year follow-up.","authors":"Luigi Tarallo, Andrea Celli, Laura Benedetti, Matilde Delvecchio, Grazia Ciacca, Giuseppe Porcellini, Fabio Catani","doi":"10.1016/j.jse.2025.05.038","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.038","url":null,"abstract":"<p><strong>Introduction: </strong>Radial head fractures account for 1.7% to 5.4% of all skeletal fractures and approximately one-third of elbow fractures. These injuries are often associated with other concurrent injuries, such as fractures of the coronoid, ligamentous injuries of the elbow, or trauma to other regions of the upper limb. Intra-articular fractures, especially Mason type III and IV, often require anatomical reduction to restore the articular surface, but such procedures can yield suboptimal results, highlighting the role of radial head implants in complex cases.</p><p><strong>Materials and methods: </strong>This retrospective study evaluated patients treated with Acumed Anatomical Radial Head implant from 2008 to 2023, specifically those with Mason type III and IV fractures. A total of 149 patients were included, with an average follow-up of 7 years.</p><p><strong>Discussion: </strong>Clinical outcomes, assessed using the Mayo Elbow Performance Score (MEPS), showed an average score of 90, with an average range of motion of 130° in flexion and 78° in pronation and supination. Implant survival at 15 years exceeded 95%, confirming the long-term effectiveness of anatomical radial head implants. The most common complications included: heterotopic ossification with reduced joint mobility (35%), postoperative stiffness with functional limitations (9.4%), and implant loosening (4.7%).</p><p><strong>Conclusions: </strong>Radial head implants offer a reliable treatment for complex Mason type III and IV fractures, with good functional and survival outcomes and a low incidence of complications. However, careful implant sizing is crucial to avoid complications such as premature loosening, joint stiffness and pain.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Posterior Interosseous Nerve Injury during a Distal Biceps Tendon Repair, an Anatomic Study Comparing EDC and ECU Muscle Splitting Approaches.","authors":"Justin T Badon, Brian K Foster, Jeffrey S Chen, Bethany G Ricci, A Michael Luciani, Joseph F Styron, Christopher C Schmidt","doi":"10.1016/j.jse.2025.05.041","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.041","url":null,"abstract":"<p><strong>Background: </strong>Dorsal forearm approaches are commonly used to repair both partial and complete distal biceps tendon tears. Either the extensor digitorum communis (EDC) or extensor carpi ulnaris (ECU) and the supinator muscles are longitudinally split to expose the radial tuberosity (RT). Despite the known risk of posterior interosseous nerve (PIN) injury, there is little information on the safety of each approach. The purpose of this study was to define the location of the PIN relative to the radial tuberosity (RT) through both EDC and ECU muscle splitting approaches. Additionally, we aimed to find a reliable method to preoperatively locate the PIN, by using a novel line from the olecranon-to-radial styloid (ORS).</p><p><strong>Methods: </strong>EDC and ECU muscle splitting approaches were performed on 20 cadaveric specimens, and RT-to-PIN lengths were measured in forearm supination, neutral, and pronation. Additional measurements were made from the olecranon to the point of PIN intersection along the ORS line and to the RT. After RT-to-PIN measurements, the coronal dissection plane for each approach was replicated with strings, and the EDC muscle was reflected to determine if the PIN or its branches crossed either approach lines.</p><p><strong>Results: </strong>The ECU, versus EDC, approach resulted in longer mean distances between the RT and PIN (≥11mm; p<0.001). In both approaches, the PIN was farthest from the RT in pronation and closest in supination (p<0.001). The minimal distance from RT-to-PIN when using an ECU muscle splitting approach with the forearm in pronation was 21mm. The PIN crossed the midline of the radial shaft and approach line with an EDC approach; whereas only the ECU motor branch transversed the radial shaft and approach line in an ECU approach. The PIN intersected the ORS line at 35% of its total length. The RT was located 61±5mm from the tip of the olecranon.</p><p><strong>Conclusion: </strong>The ECU, versus EDC, muscle splitting approach is less likely to endanger the PIN and/or its branches because the RT-to-PIN length was ≥11mm longer in all three forearm positions (p<0.001). Additionally, the PIN crossed the midline of the radial shaft and its approach line using an EDC approach, while only the ECU motor branch transversed the radial shaft and its approach line with an ECU approach. The PIN was located ≥21mm distal to the RT using an ECU muscle splitting approach in forearm pronation. The ORS line and olecranon are useful landmarks to locate the PIN and RT, respectively.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision rates between obese and non-obese total shoulder arthroplasty patients: An Australian registry data study.","authors":"James Randolph Onggo, Richard Jamieson, Peiyao Du, David R J Gill, Kemble Wang","doi":"10.1016/j.jse.2025.05.036","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.036","url":null,"abstract":"<p><strong>Background: </strong>Obesity is an epidemic more apparent in many developed countries, like Australia. The effect upon total shoulder replacement (TSR) is not clear, with different studies reporting varying conclusions. This registry-based study offers a large-scale analysis of the effects of obesity on the risk of revision in anatomic TSR (aTSR) and reverse TSR (rTSR) for various indications.</p><p><strong>Methods: </strong>This is an observational cohort analysis of data from a national arthroplasty registry. Primary aTSR for osteoarthritis, and primary rTSR for cuff arthropathy or fracture performed between January 2015 and December 2022 in Australia were included. Procedures were stratified by body mass index (BMI) groups and the cumulative percentage of revision (CPR) was compared between groups. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models.</p><p><strong>Results: </strong>There were 9,549 primary aTSR for osteoarthritis, 13,920 primary rTSR for cuff arthropathy and 4685 primary rTSR for fractures. In rTSR indicated for fracture, obese class III had an increased all-cause revision risk compared to normal BMI patients (HR=1.87, 95%CI: 1.13-3.10, p=0.014) throughout the entire follow-up period. In contrast, all-cause revision rates for aTSR for osteoarthritis and rTSR for rotator cuff arthropathy across BMI categories were not significantly different. There was an increased risk of revision for instability/dislocation in BMI class III compared to normal BMI patients after rTSR for fracture (HR=2.84, 95%CI: 1.43-5.63, p=0.002). Obese class 1 and obese class 2 patients receiving aTSR for osteoarthritis had a higher rate of revision for cuff insufficiency compared to normal BMI patients (Entire period HR=2.30, 95%CI: 1.17-4.55, p=0.016 and Entire period HR=2.10, 95%CI: 1.00-4.40, p=0.049, respectively).</p><p><strong>Conclusion: </strong>Obesity has an increased risk of all-cause revisions and revision for instability/dislocation in patients receiving rTSR indicated for fractures. BMI was not associated with an increased risk of revision in primary aTSR indicated for osteoarthritis, nor for primary rTSR indicated for rotator cuff arthropathy. We recommend BMI class III patients undergoing rTSR for fracture to be counselled on their complication risks during the informed consenting process.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison using Large Database; Prognosis Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sponsoring Societies","authors":"","doi":"10.1016/S1058-2746(25)00456-2","DOIUrl":"10.1016/S1058-2746(25)00456-2","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 8","pages":"Page A9"},"PeriodicalIF":2.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633868","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 Greenhouse technique provides lower re-tear rate and similar outcomes in rotator cuff repair: a prospective randomized controlled trail.","authors":"Guang Yang, Renjie Chen, Shangzhe Li, Hailong Zhang, Meng Zhou, Yi Lu","doi":"10.1016/j.jse.2025.05.030","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.030","url":null,"abstract":"<p><strong>Background: </strong>It is still an important issue to reduce the rate of retear after arthroscopic rotator cuff repair (ARCR). a new ARCR technique named \"Greenhouse technique\" combined with microfracture was proposed to enhance the rotator cuff healing. The purpose of this study was to compare the clinical outcomes and retear rate of Greenhouse technique (GH) with traditional single row repair (SR) in full-thickness rotator cuff tear (FT-RCT) patients in the early term follow-up. We hypothesized that the Greenhouse technique would provide lower retear rate and similar clinical outcomes in ARCR.</p><p><strong>Methods: </strong>From December, 2020 to March, 2021, 114 FT-RCT patients who received ARCR were randomized into 2 groups, Greenhouse group (56 patients) vs. SR group (58 patients). Functional outcomes including ASES, Constant-Murley, UCLA, SST, VAS for pain, range of motion (ROM) including forward elevation (FE), external rotation (ER) and internal rotation (IR) were evaluated preoperatively, 24 months postoperatively and compared between two groups. Tendon integrity was evaluated by MRI preoperatively and 2 years postoperatively. Bone tunnel healing was evaluated by CT at 3, 6 months postoperatively. Sugaya classification was used to evaluate tendon retear and compared between two groups. The percentage of patients reaching the minimal clinically important difference (MCID), patient acceptable symptoms state (PASS), substantial clinical benefit (SCB) based on ASES were also compared between two groups.</p><p><strong>Results: </strong>All functional outcomes and ROM improved significantly compared with preoperative index in both groups (all P <.001) at 24 months follow-up. However, there were no significant differences between 2 groups at final follow-up. Overall, 116 patients (85.7%) exceeded the MCID, 114 patients (73.3%) achieved the PASS, and 98 patients (85.0%) achieved SCB without significant differences between the 2 groups. The overall retear rate after ARCR in the GH group was 5.4% and 19.0% in the SR group separately, GH group had significantly lower retear rate than that in SR group(p=0.027). Bone tunnel in 49 patients (90.7%) disappeared in 3 months postoperatively.</p><p><strong>Conclusion: </strong>Both GH and SR groups achieved significant improvement after ARCR. Comparing with SR group, Greenhouse technique group provided lower retear rate and similar clinical outcomes in the early term follow-up.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627516","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":"Stress Shielding of the Univers Revers System in Reverse Shoulder Arthroplasty is Minimal and Does Not Progress Substantially From Short- to Mid-Term Follow-up.","authors":"Roya Khorram, Samer Al-Humadi, Kevin Kohut, Evan Lederman, Brian C Werner","doi":"10.1016/j.jse.2025.05.032","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.032","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to compare short- to mid-term signs of stress shielding with an inlay press-fit reverse shoulder arthroplasty (rTSA) humeral component.</p><p><strong>Methods: </strong>A retrospective review was conducted on primary rTSAs with minimum 5-year follow-up that were implanted with a press-fit 135° inlay humeral component (Univers Revers and Revers Apex; Arthrex, Inc.; Naples, FL) designed to achieve metaphyseal fixation. Patient-reported outcomes (PROs), and range of motion (ROM) collected preoperatively and compared to 2 and 5 years postoperative. Radiographic signs of stress shielding, including cortical thinning, radiolucent lines, calcar osteolysis, and greater tuberosity (GT) resorption, were assessed and compared between 2 and 5 years postoperatively.</p><p><strong>Results: </strong>One hundred and thirteen patients with a mean age of 68 ± 6.6 years at the time of surgery met the study criteria. There were no differences in ROM or PROs between the 2- and 5-year postoperative time points (P >0.05). Partial calcar osteolysis was observed in 15% of patients at 2 years and 24% at 5 years, with no statistical difference (P = 0.093) between the time points. No cases of complete calcar osteolysis were observed at either time point. Partial GT resorption was observed in 5.4% of cases at 2 years, which increased to 9.8% at 5 years (P = 0.207). There was no case of complete GT resorption at either time point. Bony adaptive changes were classified as low in 91% of cases at final follow-up and no stems were considered as \"at risk for loosening\".</p><p><strong>Conclusion: </strong>Stress shielding appears to be minimal at mid-term follow-up after press-fit fixation of the Univers Revers, a 135° rTSA humeral component designed for metaphyseal fixation. Partial proximal bony resorption was uncommon at short-term follow-up and may progress slightly at mid-term follow-up, but complete resorption was not observed. Furthermore, ROM and PROs reached at short-term follow-up are maintained at mid-term follow-up, suggesting the impact of these bony changes is not clinically important.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; Treatment Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627515","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 Stratification of 2-Year Revision Risk Following Reverse Total Shoulder Arthroplasty: A Retrospective, Multicenter Analysis.","authors":"Philip M Parel, Agustin Ameigeiras, Eric Cui, Jackson W Durbin, Andrew Fealy, Rachel A Ranson, Sabrina Gill, Amil R Agarwal, Uma Srikumaran, Zachary R Zimmer","doi":"10.1016/j.jse.2025.05.035","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.035","url":null,"abstract":"<p><strong>Introduction: </strong>Reverse total shoulder arthroplasty (RTSA) is a valuable surgical modality for treating various shoulder pathologies including rotator cuff tear arthropathy, proximal humerus fracture, and glenohumeral osteoarthritis. As the incidence of this surgery increases, so does the burden associated with adverse complications, including revisions. Age has been recognized as an independent risk factor for revision; however, current literature lacks data-driven thresholds to guide surgical-decision making. Identifying such thresholds and understanding their varying indications for revision can help surgeons risk stratify, better educate patients, and create interventions to minimize these complications. Therefore, the aim of this study was to identify data-driven age thresholds that predict significant differences in 2-year revision rates following RTSA.</p><p><strong>Methods: </strong>A retrospective cohort analysis of patients undergoing RTSA from 2010 to 2022 was conducted using the PearlDiver national administrative claims database. Stratum specific likelihood ratio (SSLR) analysis was conducted to determine data-driven age cut-offs associated with varying risks of revision surgery within 2-years following RTSA. To control for confounders, multivariable regression analysis was conducted to confirm the association of the identified data-driven cutoffs with 2-year all-cause revision rates.</p><p><strong>Results: </strong>In total, 54,719 patients undergoing RTSA were included in this study. SSLR analysis identified four data-driven age cutoffs associated with varying risks of revision: 40-60 years, and 61-67 years, 68-77 years, and 78+ years at the time of surgery. As age increased, the incidence of all-cause revision decreased within each age stratum: 2.52% in the Age 40-60 cohort, 1.64% in the Age 61-67 cohort, 1.14% in the Age 68-77 cohort, and 0.49% in the Age 78+ cohort. Relative to the Age 78+ cohort, the odds of 2-year all-cause revision was significantly higher and sequentially increased as the age cohort decreased: Age 68-77 (OR: 2.31), Age 61-67 (OR: 3.29), Age 40-60 cohort (OR: 4.92) (P<0.001 for all).</p><p><strong>Conclusion: </strong>This study not only demonstrates the clear association between patient age and 2-year revision following RTSA, but also successfully identified four unique data-driven age cutoffs which stratified the risk of early all-cause revision following RTSA: age 40-60, age 61-67, age 68-77, and age 78+. Surgeons should not only consider patient age as a significant risk factor for revision, but should also consider these age cutoffs when discussing the potential risks and benefits of RTSA. Patients younger than 60 years, in particular, should be informed of the higher likelihood of early revision surgery.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison using Large Database; Prognosis Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620962","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":"Unsatisfactory radiographic findings do not correlate with functional impairment in patients with coronal shear fractures of the distal humerus treated with internal fixation: a long-term retrospective study according to Dubberley's classification.","authors":"Luis Palacios-Díaz, Alejandra Gómez Foulatier, Riccardo Raganato, Alfonso Vaquero-Picado, Raúl Barco, Samuel Antuña","doi":"10.1016/j.jse.2025.05.033","DOIUrl":"https://doi.org/10.1016/j.jse.2025.05.033","url":null,"abstract":"<p><strong>Aim of the study: </strong>Coronal shear fractures of the distal humerus are uncommon elbow fractures involving the capitellum and trochlea. Dubberley's classification is the most commonly used, and open reduction with internal fixation is the standard of care. This study aims to evaluate the long-term functional and radiographic findings of coronal articular shear fractures of the distal humerus treated with internal fixation and to determine the incidence of clinical complications according to Dubberley´s classification and to correlate radiographic and functional outcomes.</p><p><strong>Materials and methods: </strong>A surgical database of the Upper Limb Unit at our institution was retrospectively reviewed to select patients with fractures of the capitellum and trochlea treated with internal fixation. Clinical assessment at the last visit included bilateral evaluation of the range of motion, pain, and stability, Visual Analogic Scale (VAS) for pain and satisfaction, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score, and Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. Simple radiographs were performed at the last visit. All complications reflected in the medical record and the need for reintervention were specifically searched and collected.</p><p><strong>Results: </strong>Thirty-two patients (23 females) with a mean age of 62.1 years and a median follow-up of 68.5 months were retrospectively reviewed. Fifteen were classified as Dubberley type 1 (46.9%), 9 as type 2 (28.1%), and 8 as type 3 (25.0%), while 19 (59.4%) presented Dubberley type B fractures. Median flexion was 130^o, extension 30^o, flexion-extension range 100^o, pronation 90^o, and supination 90^o, VAS for pain 0, VAS for satisfaction 10, MEPS 95, Oxford 47, and DASH 4.16. Eighteen patients (56.3%) experienced at least one postoperative complication, with 12 (37.5%) requiring a revision surgery. Thirteen patients (40.6%) had at least one unsatisfactory radiographic finding (most frequently a condylar osteonecrosis) but no differences were found in the functional outcomes compared to patients who did not present them, except for the loss of 10 degrees of flexion (p=0.037). Patients with type B fractures had lower flexion (7.5^o, p=0.045) and extension (10^o, p=0.033) and a higher proportion of unsatisfactory radiographic findings (8.3% type A vs. 82.4% type B, p=0.00), with no differences in the other variables analyzed CONCLUSIONS: Our study confirms the utility of the Dubberley classification in describing the fracture and selecting the surgical approach. Despite a high proportion of unsatisfactory radiographic findings, they were well tolerated with no correlation with functional impairment.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; Treatment Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621026","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}