Journal of Shoulder and Elbow Surgery最新文献

{"title":"Adoption of Patient-Reported Outcomes Measurement Information System (PROMIS) and Trends in PROM Use in Shoulder Literature: A Systematic Review.","authors":"Matthew G Alben, Nicholas Frappa, Danil V Chernov, Dario Fucich, Swara R Kalva, Jie J Yao, Mandeep S Virk","doi":"10.1016/j.jse.2026.09.017","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.017","url":null,"abstract":"<p><strong>Background: </strong>To provide a systematic review on the current literature specific to the adoption of Patient-Reported Outcomes Measurement Information System (PROMIS) and trends in patient reported outcome measure (PROM) use in shoulder orthopedic literature.</p><p><strong>Methods: </strong>A review of all English language articles in PubMed, Web of Science, and Embase was conducted in January of 2026. All articles between 2015 and 2025 reporting on patient outcomes in shoulder specific orthopedic literature had their study characteristics extracted, including publication year, country of origin, level of evidence, journal of publication, shoulder topic, and which PROMs were reported on. Review papers or studies that were non-English, failed to include PROMs, or were not specific to shoulder literature were excluded.</p><p><strong>Results: </strong>A total of 7,416 studies were reviewed and 3,473 met the inclusion criteria. PROMIS instruments were used in 115 studies (3.3%), with utilization increasing from 0.0% in 2015 to 5.5% in 2025 (absolute increase, 5.5%; 95% CI, 3.0%-7.9%; p = 0.001). The majority of studies utilizing PROMIS were published in the Journal of Shoulder and Elbow Surgery and related journals (60.9%), rotator cuff disorders and shoulder arthroplasty were the most commonly reported topics. The most frequently reported PROMIS domains were Upper Extremity (60.0%), Pain Interference (47.8%), and Physical Function (33.9%). PROMIS instruments were used more commonly in conjunction with traditional outcome measures (69.6%), instead of as a stand-alone PROM; it was most commonly paired to the American Shoulder and Elbow Surgeon (ASES) outcome measure (60.0%). During the study period, there was no significant increase in the number of PROMs collected per study over time (β = 0.008 PROMs per year, P = 0.388, R² = 0.08). Constant score (CS), Simple Shoulder Test (SST) and ASES score were the three most commonly reported outcome scores for shoulder condition. CS and SST utilization demonstrated a significant decline (p<0.01), while the increase in ASES utilization was not significant during the study period.</p><p><strong>Conclusions: </strong>Although PROMIS enables a standardized, patient-centered assessment of orthopedic conditions, the current study demonstrates its limited adoption over the past decade as a primary outcome measure for shoulder conditions compared to traditional legacy scores.</p><p><strong>Level of evidence: </strong>Research Methodology, Systematic Review.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138991","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":"Loss to Follow-up in Randomized Controlled Trials on Elbow Pathology: A Systematic Review and Meta-Analysis.","authors":"Zehra Güven, Huub H de Klerk, Tijn Versteeg, Simone Priester-Vink, Inger N Sierevelt, Michel P J van den Bekerom","doi":"10.1016/j.jse.2026.09.019","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.019","url":null,"abstract":"<p><strong>Introduction: </strong>Loss to follow-up (LTFU) is a well-recognized source of bias in musculoskeletal research and may compromise the validity of randomized controlled trials (RCTs). Patients lost to follow-up may have different, often worse, outcomes, potentially leading to overestimation of treatment effects. Despite improved reporting guidelines, LTFU remains inconsistently reported in orthopaedic literature. This study aimed to assess the rate of LTFU in RCTs focusing on elbow pathology and to identify factors associated with LTFU.</p><p><strong>Methods: </strong>A systematic review was conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Central, and Web of Science were searched for RCTs published between January 2020 and July 2025. Studies on elbow pathology with a minimum follow-up of six months, published in English or Dutch and in Q1 or Q2 journals, were included. Data extraction included study characteristics, follow-up-related variables, and patient characteristics. The primary outcome was the LTFU rate. Descriptive statistics and forest plots were used to explore potential associations.</p><p><strong>Results: </strong>A total of 44 RCTs including 3,012 patients were analyzed. The mean LTFU rate was 12.1% (range 0-35.6%), with follow-up durations ranging from 6 months to 2 years. No associations were found between LTFU and age, gender, type of intervention, type of pathology, traumatic vs. non-traumatic pathology, follow-up duration, study location, type of hospital, funding source, or journal ranking. A higher number of follow-up moments per month was associated with lower LTFU rates. Reporting of several variables, including factors related to trial conduct, patient characteristics, and reasons for LTFU, was often incomplete.</p><p><strong>Conclusion: </strong>This systematic review found a mean LTFU rate of 12.1% in RCTs on elbow pathology, consistent with the commonly assumed 10% attrition rate. Most factors were not associated with LTFU, although more frequent follow-up was linked to fewer dropouts. Incomplete reporting remains a key limitation and should be improved to strengthen future research.</p><p><strong>Level of evidence: </strong>Level II, Systematic Review, Research Methodology.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138966","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":"Does External Rotation Deficit After Arthroscopic Labral Repair with Remplissage Affect Clinically Meaningful Outcomes ?","authors":"Cem Ismail Gungor, Ethem Burak Oklaz, Baris Akin, Furkan Aral, Asim Ahmadov, Doruk Somuncu, Mustafa Can Erdem, Ulunay Kanatli","doi":"10.1016/j.jse.2026.09.021","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.021","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that postoperative external rotation (ER) loss following arthroscopic labral repair with remplissage is affected by patient-specific and Hill-Sachs lesion related factors. More medial lesions lead to more medialized tenodesis, causing greater ER restriction. However, the role of the lesion's craniocaudal position remains unclear. Also, while ER loss is quantitatively labeled as a \"deficit,\" prevailing evidence indicates it may not result in impaired functional outcomes. However, this interpretation relies on traditional scores, and the impact of ER loss on clinically meaningful outcomes (the Minimal Clinically Important Difference [MCID], Substantial Clinical Benefit [SCB], and Patient Acceptable Symptom State [PASS]) remains underexplored. Therefore, this study aimed to evaluate the MCID, SCB, and PASS in patients who underwent labral repair with remplissage, examine how demographic and anatomical factors affect ER deficit, and analyze the relationship between ER deficit and clinically meaningful outcomes.</p><p><strong>Methods: </strong>This retrospective case series included patients who underwent arthroscopic labrum repair with remplissage for anterior shoulder instability between May 2021 and March 2024. The evaluation comprised the American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Shoulder Instability Index (WOSI), Visual Analog Scale (VAS), and ER measurements. Hill-Sachs interval (HSI) and sagittal midpoint angle (SMA) were also assessed using imaging. The proportions of patients who achieved the thresholds for the MCID, SCB, and PASS were identified based on the ASES, WOSI, and VAS. Regression analyses were performed to evaluate factors associated with ER deficit and its relationship with achievement of MCID, SCB, and PASS.</p><p><strong>Results: </strong>This study included 45 patients (age 28.2 ± 8.3 years; follow-up 30.5 ± 5.2 months). The rates of patients achieving MCID, PASS, and SCB thresholds were as follows: ASES (82%, 78%, 73%), WOSI (93%, 80%, 71%), and VAS (91%, 80%,78%). Mean ER deficit compared with the contralateral shoulder was 15.3 ± 8.4° at side and 11.4 ± 5.9° in abduction. Increased HSI, decreased SMA, and non-dominant extremity involvement were associated with greater ER_Side (p=0.042, p=0.042, p=0.042) and ER_Abduction (p=0.028, p=0.031, p=0.028) deficits; however, ER deficits did not significantly affect clinically meaningful outcomes.</p><p><strong>Conclusions: </strong>The cohort demonstrated significant improvements in PROM scores, and most patients achieved clinically meaningful outcome thresholds after arthroscopic labral repair with remplissage.Although medial and superior Hill-Sachs lesion localization and non-dominant extremity involvement were associated with greater ER loss, these deficits were not significantly associated with clinically meaningful outcomes at a minimum follow-up of two years.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128643","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 Malnutrition and Risk of Periprosthetic Joint Infection After Reverse Total Shoulder Arthroplasty: Evaluation Using the Geriatric Nutritional Risk Index.","authors":"Rei Nishiura, Katsumasa Nakazawa, Tomoya Manaka, Yoshihiro Hirakawa, Yoichi Ito, Suguru Mori, Eriki Yanagi, Taisuke Nozu, Hidetomi Terai","doi":"10.1016/j.jse.2026.09.018","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.018","url":null,"abstract":"<p><strong>Background: </strong>Poor nutritional status has been reported to adversely affect postoperative outcomes in orthopedic surgery; however, its role in reverse total shoulder arthroplasty (rTSA) has not been fully established. This study investigated whether pre-operative nutritional status, evaluated using the Geriatric Nutritional Risk Index (GNRI), was associated with postoperative complications and clinical outcomes after rTSA.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 157 patients who underwent rTSA at the institution between 2014 and 2023, with a minimum follow-up of 2 years. Patients were stratified into two groups according to GNRI values: ≥98 (normal nutrition) and <98 (malnutrition). The primary outcome was postoperative complications. Secondary outcomes included range of motion, visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, Constant Score, and achievement of the minimal clinically important difference at 2 years. Continuous and categorical variables were compared using the Student's t-, chi-square, or Fisher's exact tests; multivariate logistic regression analysis was conducted to determine independent predictors of periprosthetic joint infection.</p><p><strong>Results: </strong>Of the 157 patients, 109 (69.4%) were classified as nutritionally normal and 48 (30.6%) as malnourished. The malnutrition group was substantially older and demonstrated lower body mass index, serum albumin, and hemoglobin levels. Although the overall complication rates were comparable between groups, periprosthetic joint infection occurred more frequently in the malnutrition group (10.4% vs. 1.8%; P = 0.03). Multivariate analysis indicated that malnutrition was an independent risk factor for periprosthetic joint infection (odds ratio, 6.88; 95% confidence interval, 1.30-36.3; P = 0.02). No differences were observed between groups in range of motion, visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, Constant Score, or achievement of the minimal clinically important difference at 2 years; however, forward flexion was significantly reduced in the malnutrition group.</p><p><strong>Conclusions: </strong>Preoperative malnutrition, as defined by a Geriatric Nutritional Risk Index <98, was associated with an increased risk of periprosthetic joint infection following rTSA. Short-term clinical outcomes were similar regardless of nutritional status. These findings suggest that preoperative nutritional screening and intervention may be important for reducing periprosthetic joint infection in patients undergoing rTSA.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128786","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":"Acute Versus Chronic Essex-Lopresti Injuries: A Systematic Review of Management Strategies and Outcome Patterns.","authors":"Wahaj Khan, Alexander O'Neill, Aakash Senthil, Omar Haque, Marc Daniel Bouchard, Manraj Nijjar, Prushoth Vivekanantha, James Yan","doi":"10.1016/j.jse.2026.09.022","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.022","url":null,"abstract":"<p><strong>Background: </strong>Essex-Lopresti injury is a rare but severe forearm injury involving radial head fracture, interosseous membrane disruption, and distal radioulnar joint instability, with management and outcomes varying by injury chronicity. The purpose of this systematic review was to highlight and evaluate the outcomes of different operative treatments for acute versus chronic Essex-Lopresti injury (ELI).</p><p><strong>Methods: </strong>A comprehensive search of OVID MEDLINE, Embase, and Emcare databases was conducted in October 2025. Eligible studies were primary research articles including randomized controlled trials, cohort studies, observational studies, and case series, published after 2000 reporting operative management of ELIs with ≥ 5 patients. Two independent reviewers screened studies and extracted data. Cohorts were categorized as acute or chronic ELI, where, acute ELI was defined as <4 weeks from injury to surgery and chronic ELI as >4 weeks. Due to heterogeneity and small sample sizes, findings were synthesized narratively. Descriptive statistics summarized outcomes with pooled mean utilized where appropriate.</p><p><strong>Results: </strong>Eleven studies met inclusion criteria, four acute and nine chronic cohorts, totaling 163 patients (52 acute, 111 chronic). Surgical approaches differed between cohorts, with acute management often prioritizing early restoration of forearm stability and chronic management more frequently required reconstruction or revision procedures. The pooled estimates and ranges of common patient-reported outcome measures for acute ELI relative to chronic ELI included: Mayo Elbow Performance Score (82.0-92.0 vs 71.0-85.8), Mayo Wrist Score (81.3-90.8 vs 61.3-82.7), and Disability of the Arm, Shoulder and Hand score (12.5-20.5 vs 24.0-55.0). Chronic ELI was associated with higher rates of complications (25.3% vs 12.1%), most commonly instability or nerve injury, and reoperations (43.5% vs 25.0%), relative to acute ELI.</p><p><strong>Conclusions: </strong>Available evidence suggests variable, often suboptimal outcomes for different management strategies of both acute and chronic ELI, with notable rates of complications and reoperations. Outcomes appeared modestly better in acute cohorts than in chronic cohorts, underscoring the importance of early recognition and treatment. However, comparative evidence across surgical interventions remains low, precluding any definitive recommendation regarding an optimal treatment strategy. Significant heterogeneity across studies further limited direct comparisons, highlighting the need for higher-quality prospective studies to better characterize outcomes and techniques used to treat both acute and chronic ELI.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128406","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":"Arthroscopic anterior shoulder bone-block stabilisation using distal clavicle autograft: A case series of 41 patients.","authors":"Steven Kyriacou, Max Little, Amr Elhoseiny, Dylan Griffiths, Tobias Baring","doi":"10.1016/j.jse.2026.09.024","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.024","url":null,"abstract":"<p><strong>Background: </strong>Glenoid bone loss is a significant risk factor for recurrent shoulder instability following surgical stabilisation. Coracoid transfer (Latarjet) remains the gold standard in treating anterior shoulder instability associated with bone loss. Complication rates of up to 25% have however been reported with the Latarjet procedure. Free bone block transfer procedures may potentially avoid some of these complications by providing a more anatomical glenoid reconstruction with equivalent rates of recurrent instability to the Latarjet procedure having previously been reported. Uncertainty remains however regarding the optimal graft of choice for this procedure. We present the largest reported clinical series of performing arthroscopic anterior bone block stabilisation using distal clavicle autograft (DCA).</p><p><strong>Methods: </strong>We reviewed the data of 41 consecutive patients who underwent arthroscopic bone block anterior stabilisation using DCA between November 2020 and November 2023. All procedures were performed by one of two surgeons at two centres utilising a standardised operative technique. Indications for the procedure included failed soft tissue stabilisation, glenoid bone loss > 15% or bipolar bone loss with an engaging Hill-Sachs lesion. Pre and post-operative data collection included patient demographics, percentage glenoid bone loss, size of Hill-Sachs lesion, previous surgery, Oxford Shoulder Instability Scores (OSIS), post-operative complications and recurrent instability. Post-operative computed tomography (CT) scans were performed between 6-21 weeks following surgery.</p><p><strong>Results: </strong>85% of patients in the study were male with a mean age of 30. Mean pre-operative glenoid bone loss was 14% and thirty-seven (90%) of patients had bipolar bone loss. Fifteen patients (37%) were revision procedures for recurrent instability. 33 patients (80.5%) had OSIS recorded pre and post-operatively with the last OSIS being recorded over 24 months post-operatively in 25 patients (61.0%). The mean follow-up time was 37 months (range 3-67). The mean increase in OSIS was 20 points with the difference between pre and post-operative scores reaching statistical significance (p<0.0001). This improvement was demonstrated to be maintained in the subgroup of 25 patients with > 24 months follow-up data. 39 (95.1%) patients had a post-operative CT scan demonstrating full or partial union in 38 (92.7%) patients. Donor site morbidity was not reported by any patient. 1 patient (2.4%) had recurrent instability post-operatively during the study period.</p><p><strong>Conclusion: </strong>Our results demonstrate that DCA arthroscopic bone block anterior stabilisation is a safe and effective technique associated with good radiological and patient outcomes and low rates of recurrent instability comparable to coracoid transfer in the short-term.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128510","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-related Humeral Retrotorsion Asymmetry in Junior Tennis Players: A Cross-sectional Ultrasound Study.","authors":"Kyosuke Numaguchi, Daisuke Momma, Taro Fukushima, Masaru Munemori, Yuki Matsui, Eiji Kondo, Norimasa Iwasaki","doi":"10.1016/j.jse.2026.09.023","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.023","url":null,"abstract":"<p><strong>Background: </strong>Humeral retrotorsion normally decreases during growth through physiologic derotation. In overhead athletes, however, repetitive loading of the dominant arm may restrict this process and lead to side-to-side asymmetry in humeral retrotorsion. Although tennis involves repeated overhead loading, it remains unclear whether junior tennis players develop such asymmetry and when it first becomes evident. Therefore, the purpose of this study was to quantify bilateral humeral retrotorsion angle (HRA) using an ultrasound-assisted technique, determine the magnitude of side-to-side difference, and identify the age at which dominant-to-nondominant differences first become statistically evident using single-year age strata.</p><p><strong>Methods: </strong>In this cross-sectional, age-stratified study, 213 competitive junior tennis players (200 boys and 13 girls; mean age, 13.0 ± 2.5 years; range, 9-17 years) underwent bilateral ultrasound-assisted assessment of HRA during tournament medical check-ups in Hokkaido, Japan. HRA was measured in both shoulders using a standardized ultrasound-guided positioning technique, and side-to-side difference (ΔHRA) was calculated as dominant minus nondominant HRA. Dominant and nondominant HRA were compared overall and within each single-year age stratum using paired t tests with Holm adjustment. Pearson correlation coefficients were used to assess associations between age and HRA.</p><p><strong>Results: </strong>Overall, HRA was significantly greater in the dominant arm than in the nondominant arm (78° ± 12° vs. 70° ± 12°, P < .001), with a mean ΔHRA of 8°. In age-stratified analyses, dominant-to-nondominant differences were not significant at age 9 years but were significant from age 10 years onward, and mean ΔHRA remained approximately 10° from age 13 years onward. HRA decreased with age in both shoulders, but the decline was smaller on the dominant side (dominant r = -0.377; nondominant r = -0.577; P < .001 for both).</p><p><strong>Conclusion: </strong>Junior tennis players demonstrated greater dominant-arm HRA than nondominant-arm HRA, with side-to-side asymmetry becoming evident from age 10 years onward and remaining approximately 10° from age 13 years onward. These findings indicate that humeral retrotorsion asymmetry emerges during late childhood in tennis players and likely reflects altered physiologic derotation of the dominant humerus during growth. This osseous adaptation may help clinicians interpret shoulder rotational findings in young overhead athletes.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128501","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":"Proceedings from the 2025 International Consensus Meeting on Orthopedic Infections: the definition of Shoulder Periprosthetic Joint infection.","authors":"Surena Namdari, Benjamin Zmistowski, Jason Hsu, Robert Z Tashjian, Thema Nicholson","doi":"10.1016/j.jse.2026.09.016","DOIUrl":"10.1016/j.jse.2026.09.016","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) remains one of the greatest diagnostic and treatment challenges facing shoulder surgeons and their patients. A definition for shoulder PJI was established by the 2018 International Consensus Meeting (ICM) on Orthopedic Infections, but the selection and weighting of its minor criteria relied largely on expert opinion. The purpose of this study was to present an updated, evidence-based definition of shoulder PJI generated by the 2025 ICM Shoulder Group.</p><p><strong>Methods: </strong>The 2025 ICM Shoulder Group, an international panel of shoulder surgeons and infectious disease specialists, used a modified Delphi process informed by 86 systematic reviews and by a predictive statistical model derived from the American Shoulder and Elbow Surgeons (ASES) Multicenter Revision Arthroplasty and PJI Group dataset to reconsider the 2018 ICM definition of shoulder PJI, including its major criteria, minor criteria, and diagnostic categories.</p><p><strong>Results: </strong>The delegates voted to eliminate organism virulence from the definition and to retain gross intra-articular purulence and presence of a sinus tract as the two criteria defining Definite PJI. The Minor Criteria were revised to include erythema, unexpected wound drainage, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), elevated synovial neutrophil percentage, positive frozen section, radiographic humeral osteolysis, intraoperative humeral loosening, and positive culture, each statistically weighted using the predictive model. Non-definite PJI was categorized by summed minor criteria score as High likelihood (≥13 points), Moderate likelihood (7-12 points), Unknown (1-6 points), or No PJI (0 points). The final definition achieved unanimous delegate consensus (51 of 51 delegates; 100% agreement; super majority, strong consensus).</p><p><strong>Conclusions: </strong>The 2025 ICM definition of shoulder PJI represents an evidence-informed evolution of the 2018 definition, combining statistical modeling of prospective multicenter data with structured expert consensus. The definition is expected to continue to evolve as further shoulder-specific data become available.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117340","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":"Comparative Efficacy of Leukocyte-Rich and Leukocyte-Poor PRP for Lateral Epicondylitis on Isokinetic and Isometric Upper Limb Strength under an Identical Rehabilitation Protocol: A Randomized Controlled Trial.","authors":"Joanna Wałecka, Jakub Kaszyński, Paweł Cisowski, Piotr Kaczmarek, Przemysław Lubiatowski","doi":"10.1016/j.jse.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.009","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP) therapies are increasingly used to support upper-limb muscle recovery, but the relative effects of leukocyte-poor versus leukocyte-rich PRP (LP-PRP vs. LR-PRP) remain unclear. This study evaluated the temporal and muscle-specific effects of LP-PRP, LR-PRP, and saline injections on upper-limb strength in patients with lateral epicondylitis over 12 months.</p><p><strong>Methods: </strong>Seventy-one participants were randomized to LP-PRP, LR-PRP, or saline injections, with the contralateral limb serving as an internal control. The primary outcome was a change in peak isometric wrist extensor torque of the treated limb from baseline to 12 months. Secondary outcomes included isokinetic elbow flexor and extensor torque at 60°/s and 120°/s, isometric wrist flexor torque, hand grip strength, and interlimb comparisons. Secondary outcomes were considered exploratory and interpreted according to statistical significance, multiple-comparison-adjusted p-values, and magnitude of change relative to the predefined MCID threshold.</p><p><strong>Results: </strong>The primary outcome, peak isometric wrist extensor torque of the treated limb, improved over 12 months in all groups, including PRP and saline groups; however, between-group differences did not exceed the MCID threshold. Exploratory analyses of secondary outcomes suggested differences in the temporal pattern of recovery among selected strength measures, although most between-group differences were modest and did not remain significant after adjustment for multiple comparisons.</p><p><strong>Conclusion: </strong>Both PRP formulations were associated with improvements in peak isometric wrist extensor torque during 12 months of follow-up; however, the primary outcome did not demonstrate clinically meaningful superiority of either PRP formulation compared with saline. Exploratory secondary analyses suggested transient differences in selected strength measures, but these findings should be interpreted cautiously. PRP may serve as an adjunct to structured rehabilitation rather than a determinant of long-term strength recovery.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117715","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":"Understanding Clinical Practice Variation in Dental Prophylaxis After Total Shoulder Arthroplasty in ASES Surgeons: A Call for Shoulder-Specific Guidelines.","authors":"Alyssa A Basdavanos, Elena P Montgomery, Matthew T Muffly, Ronald A Navarro","doi":"10.1016/j.jse.2026.09.011","DOIUrl":"https://doi.org/10.1016/j.jse.2026.09.011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Periprosthetic joint infection (PJI) after total shoulder arthroplasty (TSA) is a severe complication with substantial patient and system burden. Although current total hip and knee arthroplasty guidelines generally discourage routine antibiotic prophylaxis for dental procedures, no shoulder-specific guidelines exist. In the absence of TSA-specific evidence, practice patterns may vary by surgeon experience. We hypothesized that the American Shoulder and Elbow Surgeons (ASES) members demonstrate heterogeneity in postoperative dental antibiotic prophylaxis practices after TSA and that experience managing a suspected dental-related shoulder PJI is associated with higher rates of prescribing postoperative dental antibiotic prophylaxis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An anonymous 21-item electronic survey was distributed to ASES members from August through September 2025, assessing demographics, postoperative dental antibiotic prophylaxis practices, attitudes toward applying hip and knee literature to TSA, and support for TSA-specific guidance. Categorical variables were compared using chi-square or Fisher's exact tests. Paired analyses compared preoperative and postoperative practices. Analysis of variance assessed Likert-scale responses. Significance was set at p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 224 ASES members (15.0%) responded, with 99.1% complete surveys. Overall, 69.6% reported performing 60 or more TSAs annually. Two hundred of 224 respondents (89.3%) recommended postoperative dental antibiotic prophylaxis after TSA: 177 (79.0%) recommended prophylaxis routinely for varying postoperative durations and 23 (10.3%) reserved it for high-risk patients. Twenty-four respondents (10.7%) recommended no postoperative dental prophylaxis. Surgeons were significantly more likely to recommend postoperative than preoperative prophylaxis (p &lt; 0.001). The most common regimen was a single dose (78.1%) of amoxicillin (82.3%). Fifty-two respondents (23.2%) reported having managed a suspected dental-related shoulder PJI and 27 respondents (12.1%) reported being unsure if they had a dental-related shoulder PJI. A total of 78/79 respondents reporting yes or unsure to a dental-related PJI recommended postoperative prophylaxis (98.7%), compared to respondents reporting no such experience (Fisher exact p&lt;0.001). Mean comfort applying hip and knee arthroplasty literature to TSA was 3.83 ± 0.93 (5-point scale), while support for TSA-specific guidelines was higher at 4.35 ± 0.85.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion and conclusions: &lt;/strong&gt;Most ASES respondents recommend antibiotic prophylaxis for dental procedures after TSA despite lower extremity guidance questioning routine use. Prior reported or unsure dental-related shoulder PJI experience was associated with more frequent prophylaxis use compared to those who did not have a dental-related shoulder PJI. Strong support for TSA-specific guidelines underscores the need for should","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117367","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}