Journal of Shoulder and Elbow Surgery最新文献

{"title":"Evolution of Reverse Shoulder Arthroplasty: Two Decades of Evidence from the Journal of Shoulder and Elbow Surgery.","authors":"Tarishi Parmar, Imad Ashkar, Viraj Deshpande, Niashi Parmar, Mohammad Daher, Liam Kane, Andrew Jeong, Peter Boufadel, Adam Khan, Brian Hill, John G Horneff, Eric Black, Joseph A Abboud","doi":"10.1016/j.jse.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.008","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (rTSA) has evolved from a salvage procedure to a widely adopted reconstructive solution. This study performed a descriptive bibliometric and content-trend analysis of rTSA publications in the Journal of Shoulder and Elbow Surgery (JSES) from 2004-2025.</p><p><strong>Methods: </strong>A systematic review identified 506 clinical rTSA studies published in JSES between 2004 and 2025. Extracted variables included publication year, level of evidence, authorship, institution, geographic origin, research topic, demographics, indications, complications, and implant characteristics. Temporal trends were tested using Mann-Kendall trend test and segmented regression; the relationship between implant design representation and complication reporting was evaluated with Spearman rank correlation.</p><p><strong>Results: </strong>Annual publications increased significantly (BH-adjusted P < .001), peaking at 51 studies in 2023. Mean level of evidence improved (BH-adjusted P < .001), from 4.0 (2006) to 2.86 (2023). Early authorship centered on foundational surgeons (Frankle, Boileau, Walch) and European institutions, later diffusing globally. Mean age rose modestly, though this did not remain significant after correction for multiple comparisons (BH-adjusted P = .077), stabilizing near 70-72 years after 2012. Research focus shifted from complications/technique toward outcomes after 2013, then toward instrumentation, rehabilitation, and cost. Osteoarthritis indications increased (BH-adjusted P = .005) while revision surgery declined (BH-adjusted P = .002). Implant design shifted from medialized to lateralized/non-Grammont configurations (both BH-adjusted P < .001). No individual complication subtype showed a significant temporal trend.</p><p><strong>Conclusion: </strong>RTSA publication trends in JSES reflect the field's evolution from complication-focused study to evidence-driven refinement. Implant design, evidence level, and indications changed significantly, alongside, but not statistically linked to, complication reporting, informing future shoulder reconstruction research directions.</p><p><strong>Level of evidence: </strong>Literature Review, Bibliometric Analysis.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of a Customized 3D-printed Arthrodesis Prosthesis for Reconstruction of Segmental Defects following Tumor Resection in the Proximal Humerus.","authors":"Xiao J Zhu, Jia M Lin, Guo H Song, Jin C Lu, Huai Y Xu, Tao Zhang, Qing L Tang, Jin Wang","doi":"10.1016/j.jse.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.009","url":null,"abstract":"<p><strong>Background: </strong>Currently, shoulder joint function remains poor and the incidence of complications is high after proximal humerus tumor resection. A consensus has not yet been reached on the reconstruction method. Our study investigates whether the use of a customized 3D-printed arthrodesis prostheses can improve shoulder joint function and reduce complications.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of consecutive patients with malignant tumors who underwent Malawer type I proximal humeral resection and customized 3D-printed arthrodesis prosthesis reconstruction at our institution from September 2021 to October 2023. We used the Enneking staging system to stage our patients. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and the American Shoulder and Elbow Surgeons (ASES) score. Shoulder range of motion (ROM) was also measured. The demographic data, surgical parameters, functional outcomes and complications were analyzed in this study.</p><p><strong>Results: </strong>The cohort comprised of 30 patients. The mean age of the patients was 20.1 years (11-57 years) and the mean follow-up duration was 37.7 months (24-49 months). The average resection length of the humerus was 15.5 cm (10-23.5 cm). Among the patients, 28 were classified as Enneking stage IIB, while 2 were classified as stage III. The average MSTS score was 84% and ASES 85%. The average shoulder abduction was 81°, and forward flexion was 82°. The complications included 4 cases of delayed wound healing, 1 case of prosthetic loosening and 2 cases of plate exposure. 4 cases of lung metastasis and 1 case with metastases in both lung and bone occurred during the follow-up period. Six patients (20.0%) experienced soft-tissue failure. Total deltoidectomy was significantly associated with soft-tissue failure in bivariate analysis (P=0.009). There was no case of local recurrence. Radiographic fusion was achieved in 100% of cases at the 12-month follow-up period.</p><p><strong>Conclusion: </strong>For Malawer type I resection of the proximal humerus, shoulder arthrodesis using a customized 3D-printed arthrodesis prosthesis can significantly improve upper limb function. However, total deltoidectomy was associated with an increased risk of soft-tissue complications.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The medial collapse sign is associated with cubitus varus after pediatric supracondylar humeral fracture fixation: a retrospective cohort study.","authors":"Shogo Ikeda, Seiji Okada, Ryoya Shiode","doi":"10.1016/j.jse.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.010","url":null,"abstract":"<p><strong>Background: </strong>Cubitus varus deformity is a common complication following pediatric supracondylar humeral fractures and rarely remodels spontaneously. However, surgeons lack a reliable intraoperative radiographic sign that directly reflects inadequate medial column reduction. This study aimed to evaluate whether the medial collapse sign (MCS) on immediate postoperative anteroposterior radiographs is associated with postoperative cubitus varus.</p><p><strong>Methods: </strong>A retrospective cohort study included pediatric patients who underwent surgical treatment for supracondylar humeral fractures consecutively between January 2016 and March 2024. Fifty-two patients treated with reduction and cross pinning and followed for at least 6 months were included. Patients were categorized according to the presence or absence of cubitus varus at final follow-up (n = 20 and n = 32, respectively), which was radiographically defined as a side-to-side carrying-angle difference ≥5° on standing anteroposterior radiographs. Univariable and multivariable analyses were performed using Firth's penalized logistic regression.</p><p><strong>Results: </strong>Presence of the MCS was strongly associated with cubitus varus (OR 155.4, 95% CI 24.8-1965.5; Holm-adjusted P < .001). MCS remained associated after adjustment for medial cortical comminution (OR 47.5, 95% CI 6.6-590.4, Holm-adjusted P < .001). The large effect size should be interpreted cautiously because of the limited sample size. Sensitivity and specificity were 90.0% and 96.9%, respectively. Interobserver reliability was almost perfect (κ = 0.919).</p><p><strong>Conclusion: </strong>The medial collapse sign is strongly associated with postoperative cubitus varus and may reflect inadequate medial column reduction. Recognition of the same medial cortical morphology on intraoperative fluoroscopy may prompt reassessment of alignment and reduction.</p><p><strong>Level of evidence: </strong>Level III, Retrospective cohort comparison, prognosis study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Modeling of Clinically Apparent Shoulder Periprosthetic Joint Infection (PJI).","authors":"Jason E Hsu, Eric T Ricchetti, Robert Tashjian, Surena Namdari, Andrew P Collins, Catherine Fedorka, H Mike Kim, Chong Zhang, Angela P Presson, Anastasia J Whiston","doi":"10.1016/j.jse.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.004","url":null,"abstract":"<p><strong>Introduction: </strong>The first International Consensus Meeting (ICM) definition of shoulder periprosthetic joint infection (PJI) introduced a tiered framework of PJI categories based on weighting of minor criteria for those cases not having major criteria of Definite infection. The selection of minor criteria and weightings was based on expert opinion and limited available evidence. The purpose of this study was to use prospective, multicenter data to develop a predictive model for clinically apparent shoulder PJI to inform a more evidence-based understanding of minor criteria and PJI categories.</p><p><strong>Methods: </strong>Prospective data were collected on 861 consecutive revision shoulder arthroplasty cases within the American Shoulder and Elbow Surgeons (ASES) Revision Shoulder Arthroplasty and PJI Multicenter Research Group. Presence of a sinus tract communicating with the prosthesis and intra-articular purulence were identified as pathognomonic indicators of infection (major criteria) and used as the primary outcome for multivariable analysis. Logistic regression modeling was performed, with model specification guided by information criteria. Variable selection emphasized optimal model fit while balancing complexity, focusing on: (1) markers of host inflammatory response, (2) universally available and commonly utilized diagnostic tests, (3) minimizing the total number of variables, and (4) preserving model usability despite missing data.</p><p><strong>Results: </strong>Among 861 cases, 97 shoulders (11%) met the outcome of interest (sinus tract or intra-articular purulence). The final model incorporated seven variables spanning clinical findings, laboratory values, imaging, intraoperative assessment, and microbiology. These variables were erythema, unexpected wound drainage, elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), radiographic humeral osteolysis, synovial neutrophils ≥70% or positive frozen section (≥5 polymorphonuclear cells in ≥5 high-powered fields), intraoperative humeral loosening, and ≥2 positive cultures with the same organism. The apparent concordance statistic in the development cohort was 0.90 (95% CI 0.87-0.94). A nomogram was subsequently developed to estimate the probability of PJI, defined by the presence of a sinus tract or intra-articular purulence.</p><p><strong>Conclusion: </strong>Using prospective, multicenter data, this study proposes a seven-factor nomogram to estimate the probability of clinically apparent shoulder PJI. The model showed strong apparent discrimination for clinically apparent infection in the development cohort. External validation will be necessary to confirm performance, and consensus will be required to establish weighting and diagnostic thresholds for tiers of non-definite shoulder PJI.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171441","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":"Differences in valgus and internal-rotation instability after sequential distal ulnar collateral ligament release: a cadaveric study using Thiel-embalmed cadavers.","authors":"Kanta Matsuzawa, Mutsuaki Edama, Kodai Sakamoto, Masaki Akeda, Jun Sakata, Noboru Sato","doi":"10.1016/j.jse.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.002","url":null,"abstract":"<p><strong>Background: </strong>Distal ulnar collateral ligament (UCL) tears in overhead athletes have poorer outcomes with conservative treatment than proximal tears, potentially because of limited vascularity and altered ulnohumeral alignment. Previous in vivo studies have demonstrated excessive internal rotation malalignment in distal UCL tears. Nonetheless, it remains unclear whether distal tears produce greater internal rotation instability compared with valgus instability. This cadaveric study aimed to quantify valgus and internal rotation instabilities after sequential distal UCL tears using ultrasonography in Thiel-embalmed cadavers.</p><p><strong>Methods: </strong>Twelve elbows from six Thiel-embalmed cadavers were evaluated. A distal UCL tear model was created by sequentially releasing the distal footprint of the anterior bundle: intact, 5 mm release (partial tear), and approximately 10 mm release (complete tear). Valgus instability was assessed by measuring the medial joint space (MJS) with the elbow at 90° flexion under a 1 kg valgus load. Internal rotation instability was quantified by measuring the posteromedial joint space (PMJS) with the forearm maximally pronated under the same load. Three images per condition were obtained, and mean values were analyzed. The rate of change in MJS and PMJS was calculated by dividing the MJS or PMJS value (mm) under each UCL-release condition by the corresponding value in the intact condition. The resulting rate of change was unitless. Conditions were compared using one-way analysis of variance with Bonferroni correction, paired t-tests with P values adjusted using the Holm method were used to compare the rates of change between MJS and PMJS.</p><p><strong>Results: </strong>MJS and PMJS increased significantly from intact to partial and complete tears (all P < .01), with effect sizes >0.8. PMJS showed a significantly greater rate of change than MJS in both partial tears (1.46 ± 0.17 vs 1.29 ± 0.19; P = .018) and complete tears (1.94 ± 0.33 vs 1.65 ± 0.21; P = .018).</p><p><strong>Conclusion: </strong>Distal UCL tears increased both valgus and internal rotation instability; however, internal rotation instability increased more. Therefore, functional factors, particularly increased internal rotation instability, may contribute to the characteristic internal rotation malalignment and poor prognosis of distal UCL tears.</p><p><strong>Level of evidence: </strong>Basic Science Study, Biomechanics.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148979","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":"Effects of Early Rehabilitation on Shoulder Joint Stiffness and Functional Recovery Following Arthroscopic Rotator Cuff Repair.","authors":"Shengyun Shou, Lijiang He, Peng Liu, Jia Zhi, Li Xu","doi":"10.1016/j.jse.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.003","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between rehabilitation initiation timing and shoulder stiffness and functional recovery after arthroscopic rotator cuff repair (ARCR).</p><p><strong>Methods: </strong>Patients who underwent ARCR between January 2019 and January 2023 were retrospectively identified. Based on documented rehabilitation initiation time, patients were classified post hoc into early (n = 64) or delayed rehabilitation groups (n = 71). The primary outcome was shoulder stiffness at 3 months. Secondary outcomes included Constant and American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale (VAS) pain scores, and passive forward flexion. Inverse probability of treatment weighting (IPTW) was used for sensitivity analysis. Subgroup analyses assessed whether the observed association varied by patient characteristics.</p><p><strong>Results: </strong>Among 135 patients, early rehabilitation was associated with less shoulder stiffness at 3 months and more favorable outcomes during follow-up, including higher Constant and ASES scores, lower VAS pain scores, and greater passive forward flexion. Linear mixed-effects models demonstrated significant improvements over time in all outcomes, although the overall group-by-time interactions were not statistically significant. The estimated between-group difference in passive forward flexion was greatest at 3 months. IPTW analysis generally supported the primary findings.</p><p><strong>Conclusion: </strong>Early rehabilitation was associated with less shoulder stiffness and earlier recovery of shoulder function and passive forward flexion after ARCR. These observational findings do not establish causality. Randomized trials with systematic monitoring of repair integrity and adverse events are needed to determine the effectiveness and safety of early rehabilitation.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148997","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":"Radial Head Arthroplasty for Radial Head Fracture Is Associated with a Lower Rate of Reoperation Than Open Reduction Internal Fixation: A Population-Based Cohort Study.","authors":"Patrick J Carroll, Nicholas Chang, Priscila Pequeno, Diane Nam, J Michael Paterson, Ujash Sheth","doi":"10.1016/j.jse.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.006","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to (1) describe the longitudinal trends and epidemiology in surgical management of radial head fractures and (2) compare the rate of reoperation of open reduction internal fixation (ORIF) to radial head arthroplasty (RHA) in Ontario, Canada.</p><p><strong>Methods: </strong>All patients aged 16 years and older who sustained a radial head fracture between April 1, 2002 and March 31, 2020 were identified using linked provincial health administrative databases from ICES. Patients undergoing ORIF, RHA or radial head excision for a radial head fracture were followed for subsequent reoperation. An unadjusted competing risk survival analysis was performed to tally the cumulative incidence of all-cause revision procedures. Logistic regression models were constructed to identify the patient-, provider- and fracture-related factors associated with reoperation following ORIF and RHA.</p><p><strong>Results: </strong>A total of 3159 patients underwent surgical management of a radial head fracture during the study period. The majority of patients were female (55.9%). The mean age of patients who underwent ORIF, RHA and excision was 43.9, 51.1, 52.6 years, respectively. The mean (SD) follow-up times were 8.9 (+/- 5.0), 8.4 (+/- 5.0) and 11.0 (+/-5.0) years, respectively. In total, 7.7%, 3.8% and 0.8% experienced reoperation during study follow-up, respectively. At 10 years, the cumulative incidence function (CIF) for ORIF, RHA and excision was 15.8% (95% CI 13.9%-17.7%), 10.4% (95% CI 8.7%-12.3%) and 6.5% (95% CI 4.1%-9.5%), respectively. Gray's test demonstrated a statistically significant difference between groups favouring RHA over ORIF (P < 0.0001). The most frequently performed secondary procedure was removal of hardware (32%). The odds of reoperation among those younger than 40 years of age who had an ORIF increased when surgery was performed overnight (between midnight and 7AM) (P = 0.0008).</p><p><strong>Conclusion: </strong>Radial head arthroplasty was associated with a lower rate of reoperation than ORIF following radial head fractures, irrespective of patient age. Among patients younger than 40 years, overnight ORIF was associated with an increased rate of reoperation. Long-term studies are needed to evaluate the durability of these findings, particularly in younger patients.</p><p><strong>Level of evidence: </strong>Level III, Retrospective Cohort Comparison using Large Database, Treatment Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Complications of Elbow Arthrodesis.","authors":"Sean C Clark, Elsa F Diaw, Micah J Nieboer, Mark E Morrey, Joaquin Sanchez-Sotelo","doi":"10.1016/j.jse.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.005","url":null,"abstract":"<p><strong>Background: </strong>Arthrodesis of the elbow is a rarely performed procedure sometimes considered when no other reliable surgical solutions exist. Most published reports are limited to single case reports or very small series. The purpose of this study was to evaluate the outcomes and complications of patients who underwent elbow arthrodesis and to determine whether this is a worthwhile salvage procedure for elbows not amendable to surgical reconstruction or arthroplasty.</p><p><strong>Methods: </strong>Between 2000 and 2024, a retrospective review was performed of 13 elbows (13 patients) that underwent elbow arthrodesis at a single tertiary academic institution. There were 11 males and 2 females with a mean age of 42 years at the time of arthrodesis. Most arthrodeses (92%) were performed for posttraumatic arthritis. Electronic medical records were reviewed to collect demographic and clinical data, details of the surgical procedure, clinical outcomes and complications. Additionally, patients were contacted at the time of this study to collect Visual Analogue Scale (VAS) for pain, Single Numeric Assessment Evaluation (SANE), Mayo Elbow Performance Score (MEPS), subjective satisfaction, and any additional reoperations or complications. Postoperative radiographs were evaluated to determine union and identify possible radiographic complications. The arthrodesis angle was also measured on lateral postoperative radiographs.</p><p><strong>Results: </strong>The mean follow-up of this study was 7 years. The mean postoperative arthrodesis angle was in 75 degrees of flexion. Patient outcomes could be obtained at most recent follow up for 9 of 13 patients. At most recent follow-up, average VAS scores for pain were 2 at rest and 4 with activity. The mean MEPS and SANE were 49 and 46. The overall satisfaction score was 8/10 and 57% of patients reported to be better or much better than before surgery. Complications, including nonunion or periprosthetic fracture, occurred in 6 (46%) elbows, 5 (39%) of which led to revision surgery.</p><p><strong>Conclusion: </strong>Elbow arthrodesis demonstrated reasonable pain relief and subjective satisfaction for patients with severe destruction of the elbow joint despite poor functional outcomes. The combined rate of nonunion or postoperative fracture was greater than 40%. Elbow arthrodesis is a salvage procedure that should be only considered when no other reconstructive or arthroplasty options exist.</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":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Pseudoparesis Is Not Associated With Inferior Outcomes After Anterior Latissimus Dorsi and Teres Major Transfer for Irreparable Anterosuperior Rotator Cuff Tears: A Propensity Score-Matched Analysis.","authors":"Chang Hee Baek, Jung Gon Kim, Bo Taek Kim, Chaemoon Lim, Seung Jin Kim","doi":"10.1016/j.jse.2026.09.020","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.020","url":null,"abstract":"<p><strong>Background: </strong>The prognostic relevance of preoperative pseudoparesis after combined anterior latissimus dorsi and teres major transfer (aLDTM) for irreparable anterosuperior rotator cuff tears (IASRCTs) has not been examined in a matched comparison. We hypothesized that, after propensity score matching, final outcomes would not differ significantly between groups.</p><p><strong>Methods: </strong>This retrospective comparative cohort study reviewed patients undergoing aLDTM for IASRCT between April 2015 and January 2024. Pseudoparesis was defined a priori as active forward elevation ≥45° and <90° with preserved passive elevation after local anesthetic injection and without neurologic deficit (n=57); active forward elevation ≥90° defined the comparator group (n=183). True pseudoparalysis (<45°) and advanced arthropathy (Hamada grade >2) were excluded. One-to-one propensity score matching on age, sex, body mass index, diabetes, hypertension, previous cuff repair, acromiohumeral distance (AHD), Hamada grade, intraoperative reparable infraspinatus tear, and fatty infiltration of the four rotator cuff muscles produced 57 pairs (all absolute standardized mean differences <0.10). Outcomes included clinical scores (VAS, ADLIR, Constant, UCLA, ASES), range of motion, strength, subscapularis-specific tests, and tendon integrity on 2-year postoperative MRI. Mean follow-up was 57.0 ± 20.0 months.</p><p><strong>Results: </strong>Both groups improved in clinical scores, forward elevation, abduction, internal rotation, and most strength measures (all adjusted P < .001); external rotation range of motion did not change significantly. Final clinical scores, range of motion, and strength showed no significant between-group differences (all adjusted P ≥ .569). The pseudoparesis group showed larger gains in forward elevation (69° ± 26° vs 35° ± 28°, adjusted P < .001) and abduction (48° ± 29° vs 29° ± 27°, adjusted P = .007). Subscapularis-specific tests and AHD did not differ between groups. Retear on 2-year postoperative MRI occurred in 3/57 (5.3%) and 4/57 (7.0%) (adjusted P = 1.000).</p><p><strong>Conclusion: </strong>In this propensity score-matched analysis, the pseudoparesis group had lower baseline elevation by definition, whereas final clinical, range-of-motion, strength, and structural outcomes did not differ between groups after aLDTM for IASRCT. These findings should not be extrapolated to true pseudoparalysis or advanced arthropathy.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148806","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":"Occult Infection Risk with Stem Retention in Revision Anatomic to Reverse Shoulder Arthroplasty.","authors":"Devika A Shenoy, Katelyn E Parsons, Alyssa Henriquez, Eoghan T Hurley, Justin Leal, Mariano E Menendez, Jay M Levin, Tally E Lassiter, Jonathan F Dickens, Christopher S Klifto, Michael A Moverman","doi":"10.1016/j.jse.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.jse.2026.10.007","url":null,"abstract":"<p><strong>Introduction: </strong>In revising failed anatomic shoulder arthroplasty (aTSA) with a convertible humeral component to reverse shoulder arthroplasty (rTSA), surgeons must decide whether to retain or exchange the humeral stem. While retention is less morbid, it may risk missing occult infection in certain cases. The purpose of this study was to describe the risk of occult infection, microbiological findings, and clinical outcomes among patients undergoing conversion of aTSA to rTSA with stem retention using a convertible humeral component.</p><p><strong>Methods: </strong>A single institution retrospective case series of patients undergoing conversion from aTSA to rTSA between 12/1/2013 and 7/1/2025 with minimum >1 year follow up was performed. All patients had a convertible humeral stem in which the stem was retained during the procedure. Patients with a clear preoperative diagnosis of infection (pus noted intra-operatively or a sinus tract) were excluded. Variables of interest included 2025 preoperative ICM score, complications, reoperations, postoperative infections, and patient-reported outcomes (VAS, SANE, ASES).</p><p><strong>Results: </strong>A total of 65 patients met inclusion criteria. The mean preoperative ICM score was 0.43±1.17, with all patients classified in the \"Unlikely\" PJI risk tier (<10 points). Intraoperative cultures were identified in 14% of the cases, 89% of which were Cutibacterium acnes. Overall, 6 patients (9%) received postoperative oral or IV antibiotics. However, only 2 patients (3.1%) underwent reoperation for infection, neither of which were found to have positive intra-operative cultures at the time of their index revision. Unplanned re-operations occurred in 12 (18.5%) of the cohort. Preoperative ICM scores were not associated with reoperation for infection (p=0.5). At a mean clinical follow up of 34 months, the mean SANE and ASES scores were 60.6± 29.6 and 61.1± 27.4, respectively.</p><p><strong>Conclusion: </strong>Among patients with low preoperative concern for infection, retaining a well-fixed humeral stem in revision aTSA to rTSA results in a low rate of PJI. Despite all revisions being characterized as \"unlikely\" based on the ICM criteria, approximately 1 in 7 patients were found to have unexpected positive intraoperative cultures. While this did not appear to affect postoperative infection rates, high vigilance for infection, even in cases with low preoperative concern, should be considered.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148558","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}