Journal of Shoulder and Elbow Surgery最新文献

{"title":"Bilateral Ultrasonographic Findings in Patients with Unilateral Subacromial Pain Syndrome and Intact Rotator Cuff Tendons.","authors":"Adam Witten, Mikkel Bek Clausen, Kristian Thorborg, Per Hölmich, Kristoffer Weisskirchner Barfod","doi":"10.1016/j.jse.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.020","url":null,"abstract":"<p><strong>Background: </strong>The etiology of subacromial pain syndrome (SAPS) remains enigmatic. It is theorized that the supraspinatus tendon and the subacromial bursa are the primary pain-generating structures. The supraspinatus tendon and the subacromial bursa are considered to be thickened in patients with SAPS but this assumption lacks validation. The aim of this study was to ultrasonographically measure the subacromial structures and evaluate the presence of impingement in patients with SAPS and to compare it with their asymptomatic shoulder.</p><p><strong>Methods: </strong>Patients were recruited consecutively from an orthopedic outpatient clinic using validated criteria for SAPS. Patients with contralateral shoulder pain and patients with acromioclavicular osteoarthrosis, rotator cuff tears, calcified tendinopathy, biceps tendon or labral pathology were excluded. Validated ultrasonographical methods were used. Thickness of the supraspinatus tendon and the subacromial bursa were measured perpendicular to the tendon longitudinal axis two cm from the lateral border of the supraspinatus tendon footprint with the shoulder in slight internal rotation. Acromio-humeral distance was measured as the shortest distance from the anterolateral acromion to the humerus with the shoulder in neutral position. Ultrasonographic impingement was defined as visual bulging of the subacromial bursa during active shoulder abduction and internal rotation.</p><p><strong>Results: </strong>We examined 58 patients with unilateral SAPS and intact rotator cuff tendons. We found significantly more cases of ultrasonographic impingement in painful shoulders compared to the pain-free (45 vs 18, Chi-Square p = 0.04). There were no significant differences between affected and unaffected shoulders regarding supraspinatus tendon thickness (5.4 vs 5.5 mm), subacromial bursa thickness (1.9 vs 1.9 mm) or the acromio-humeral distance (11.1 vs 11.0 mm). The mean age of the included patients was 51 years, 64% were women, the median symptom duration was 18 months, and the dominant shoulder was affected in 71% of cases.</p><p><strong>Conclusion: </strong>In this cohort of patients with isolated unilateral SAPS, we found more cases of ultrasonographic impingement in affected shoulders compared to unaffected, but no significant differences in supraspinatus tendon thickness, subacromial bursa thickness or acromio-humeral distance. These findings question ultrasonography's ability to discriminate between shoulders with and without SAPS based on measurements of subacromial structures alone.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634050","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":"3-Week immobilization vs. no immobilization in primary reverse total shoulder arthroplasty: A randomized controlled trial.","authors":"Carlos Torrens, Claudia González-García, Marta Díez-Izquierdo, Fernando Santana","doi":"10.1016/j.jse.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus about the length of the immobilization period after receiving a Reverse Shoulder Arthroplasty (rTSA) for a cuff-deficient shoulder. The objective of this study was to determine whether patients receiving an rTSA for a cuff-deficient shoulder could be managed without any immobilization after surgery.</p><p><strong>Methods: </strong>Prospective randomized study that included a primary rTSA implanted for a cuff-deficient shoulder. Patients were randomized into group I (3-weeks immobilization) or group II (without immobilization). Pain was assessed with the VAS the day before surgery, at 24 and 48 hours after surgery, at 7 days, at 3 weeks, and at 3, 6, 12 and 24 months. The functional outcome was evaluated before surgery and at 12 and 24 months follow-up using the Constant Score. Complications were also recorded at all the points throughout.</p><p><strong>Results: </strong>A total of 64 patients were included. The mean age was 73.5 years (range, 68.5 to 79.5 years). There were 50 women and 14 men. Group 1 consisted of 32 patients and 32 were allocated to group II. There were no significant differences between the two groups in terms of age, gender and the preoperative VAS and Constant scores. No statistically significant differences were noted between the 2 groups relative to the postoperative VAS at 24 hours (p = 0.576), 48 hours (p = 0.296), 7 days (p = 0.512), 3 weeks (p = 0.114), 3 months (p = 0.823), 6 months (p = 0.623), 12 months (p = 0.388), and 24 months (p = 0.515). Neither were there any differences in the Constant Score at 12 months (p = 0.501), and at 24-months (p = 0.566). Furthermore, no complications were reported during the follow-up period in any group.</p><p><strong>Conclusions: </strong>Based on the results of this study, there is no need to immobilize the arm after receiving an rTSA for a cuff-deficient shoulder. The pain and functional outcomes are comparable to those obtained with a 3-week immobilization period.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634883","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":"Development and validation of a severity-focused score for the assessment of lateral epicondylitis using enhanced magnetic resonance imaging.","authors":"Seunghun Lee, Woo Sung Jung, Keung Yoon Kim, Kiho Jung, Chang-Hun Lee","doi":"10.1016/j.jse.2025.01.052","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.052","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI) does not sufficiently reflect the severity of lateral epicondylitis. Although some authors have reported meaningful findings on conventional MRI, it is not widely accepted that MRI is useful for evaluating lateral epicondylitis. The aim of this study is to evaluate the relationship between the lateral epicondylitis severity score (LESS) using contrast-enhanced T1-weighted MRI and patients' perceptive pain and clinical courses.</p><p><strong>Methods: </strong>This retrospective study included 80 patients diagnosed with lateral epicondylitis and who also went contrast-enhanced 3.0-T MRI. The study cohort was split into a development (n=50) and a validation cohort (n=30). The patient's pain was assessed using a visual analogue scale (VAS), and the involvement of the common extension tendon (CET) origin, radial collateral ligament (RCL), lateral ulnar collateral ligament (LUCL), and plica were evaluated using T2-weighted images. The enhancement of CET and subcutaneous tissue was scored using a novel classification in the contrast-enhanced T1-weighted MRI. LESS was calculated from MRI findings to determine the severity of lateral epicondylitis. Pearson's correlation analysis was performed to evaluate the relationship between patients' VAS scores and MRI findings. ROC curve was constructed to determine cut-off value of LESS for the surgical treatment of lateral epicondylitis.</p><p><strong>Results: </strong>The average age of the development cohort (n=50) and the validation cohort (n=30) were 49.8 (31-66) years and 52.3 (37-67) years, and the average VAS score were 7.3 (4-9) and 7.2 (5-10) respectively. In T2-weighted image evaluation, the correlation of VAS and grade of CET, RCL, LUCL, and plica were -0.03 (p=0.87), -0.03 (p=0.87), -0.14 (p=0.39), and 0.36 (p=0.02). Discordant contrast enhancement in T1-weighted images compared to nonspecific T2-weighted images was observed in 46 of 50 cases (92%). A statistically significant correlation was observed between the patients' VAS and LESS scores (r= 0.67, p<0.01). AUC was 0.76 (p<0.01) and the optimal cut-off value of LESS for the surgical treatment of lateral epicondylitis was 5.5 (sensitivity 72.7%, specificity 70.6%). When the cut-off value was used to predict surgical treatment in the validation cohort, the sensitivity was 100% and the specificity was 75%.</p><p><strong>Conclusion: </strong>Contrast-enhanced T1-weighted images provided more detail than conventional T2-weighted images in evaluation of structural or unobserved abnormalities to assess the severity of the lateral epicondylitis, and had excellent inter- and intra-observer reliability. LESS showed significant positive correlation with pain severity. If the LESS is 5.5 or more, surgical treatment of lateral epicondylitis may need to be considered.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634194","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":"Trends in Shoulder Arthroplasty Across a Large Health System Over the Past 10 Years.","authors":"Aaron M Atlas, Anthony Modica, Shawn Geffken, Jeni Sacklow, Scott Weiner, Randy M Cohn, Nicholas A Sgaglione","doi":"10.1016/j.jse.2025.02.014","DOIUrl":"10.1016/j.jse.2025.02.014","url":null,"abstract":"<p><strong>Background: </strong>The indications and techniques for shoulder arthroplasty (SA) have significantly expanded since the introduction of reverse shoulder arthroplasty (rTSA) in 1991. While national databases provide broad trends, they often lack the granularity needed for patient-specific insights. This study aims to analyze trends in anatomic total shoulder arthroplasty (aTSA), rTSA, and hemiarthroplasty (HA) within a large multihospital system over the past decade.</p><p><strong>Methods: </strong>We conducted a retrospective review of 2,542 SA cases performed from January 2014 to July 2023 across several hospitals within the Northeast United States (US). Cases were identified using specific Current Procedural Terminology (CPT) codes and were stratified by procedure type: aTSA, rTSA, and HA. Data collected included patient demographics, comorbidities, surgical characteristics, and outcomes. Statistical analyses were performed using one-way ANOVA tests with Bonferroni corrections and Pearson correlations, with significance set at p<0.05.</p><p><strong>Results: </strong>RTSA increased from 29% to 83.4% of all SA cases during the study period (p<0.001), while aTSA and HA declined to 16.4% and 0.4%, respectively (p<0.001). The mean patient age was 68.7 years, with rTSA patients becoming younger over time (from 75.5 years in 2014 to 71.4 years in 2023, p=0.008). rTSA patients had higher Charlson Comorbidity Index (CCI) scores compared to aTSA and HA (3.4 vs. 2.7 and 2.8, respectively, p<0.001). The use of stemless humeral components in aTSA rose to 26.7% by 2023 (p<0.001), and there was a significant decline in the use of cemented humeral stems for HA (p<0.001). Regional nerve blocks were used at consistently high rates, being performed in 84.5% of cases. Length of hospital stay decreased overall, with an increasing trend toward discharge by postoperative day one, particularly in rTSA and aTSA cohorts.</p><p><strong>Conclusion: </strong>Over the last decade, there has been an increase in the proportion of rTSA, which is being done increasingly in younger patients with higher ASA scores, comorbidities, and intact rotator cuffs. There has been a rise in stemless aTSA and cementless hemiarthroplasty implants. Finally, patients are increasingly going home on postoperative day one after shoulder arthroplasty, which is likely related to the high rates of regional nerve block usage.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634509","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)00126-0","DOIUrl":"10.1016/S1058-2746(25)00126-0","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 4","pages":"Page A8"},"PeriodicalIF":2.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excellent clinical and radiological mid-term outcomes of the arthroscopic \"double-inlay\" Eden-Hybinette procedure for bone defects exceeding 20%: a 5-year case series.","authors":"Aofei Gao, Qingfa Song, Guoqing Cui, Zhenxing Shao","doi":"10.1016/j.jse.2025.02.009","DOIUrl":"10.1016/j.jse.2025.02.009","url":null,"abstract":"<p><strong>Background: </strong>Eden-Hybinette procedure can maximize the restoration of the glenoid defect by harvesting a proper size of iliac bone block. We developed an arthroscopic \"double-inlay\" Eden-Hybinette procedure to achieve better bone union of the graft. The aim of this study was to evaluate the clinical and radiological mid-term outcomes of the arthroscopic \"double-inlay\" Eden-Hybinette procedure for bone defects exceeding 20%.</p><p><strong>Methods: </strong>A retrospective case series was conducted. The inclusion criterion was a bone defect exceeding 20%, especially failed Bristow-Latarjet procedure or recurrent anterior shoulder instability among patients with epilepsy. An arthroscopic \"double-inlay\" Eden-Hybinette procedure was carried out. Recurrence and apprehension, the American Shoulder and Elbow Surgeons, University of California at Los Angeles, Subjective Shoulder Value, Rowe, and visual analog scale pain scores and rate of return to sports were obtained at final follow-up. Graft position, healing, and resorption were evaluated via 3D computerized tomography scan. Moreover, postoperative complications and the incidence of osteoarthritis were recorded.</p><p><strong>Results: </strong>The study cohort included 15 patients, with a mean age of 34.9 ± 13.2 years (range, 19-59 years) and a mean follow-up duration of 5 ± 1.7 years (range, 2.0-8.0 years). No patients experienced recurrent dislocation, and the visual analog scale pain and instability scores during shoulder range of motion decreased from a mean 6.5 ± 2.3 and 9.6 ± 0.9 preoperatively to 1.9 ± 1 and 2 ± 1.7 at the last follow-up (P < .001). The Rowe, American Shoulder and Elbow Surgeons, University of California at Los Angeles, and Subjective Shoulder Value scores of the patients increased from 18.7 ± 10.6, 71.8 ± 5, 22.9 ± 3.5, and 49.3 ± 16.2 preoperatively to 90.3 ± 6.2, 90.1 ± 4.2, 30.1 ± 2.4 (P < .001) and 81.1 ± 15.7 (P = .001) postoperatively. At the final follow-up, the bone graft healing rate was 100%, and there was no severe bone resorption. All patients returned to work, and 73.3% of patients (11 of 15) returned to sports at their preinjury or higher level.</p><p><strong>Conclusions: </strong>The arthroscopic \"double-inlay\" Eden-Hybinette procedure has demonstrated reliability and efficacy, yielding excellent mid-term clinical and radiological outcomes for bone defects exceeding 20%, particularly in cases of failed Bristow-Latarjet procedures or in patients with epilepsy.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617700","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 influence of the relative deltoid moment arm on active motion in patients with massive cuff tears.","authors":"Jie J Yao, Ryan D Lopez, Michael Chang, Pranav Jain, Adam Rizk, Surena Namdari","doi":"10.1016/j.jse.2025.03.001","DOIUrl":"10.1016/j.jse.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>The underlying mechanisms for why certain patients with massive cuff tears develop pseudoparesis are unclear. A recent biomechanical study described the Shoulder Abduction Moment (SAM) index, which considers the deltoid and rotator cuff moment arms based on a patient's specific anatomy as measured on a plain XR Grashey view. The purpose of this study was to clinically evaluate the correlation of pseudoparesis with the SAM index in patients with massive cuff tears.</p><p><strong>Methods: </strong>This was a single surgeon retrospective study of 105 patients presenting with magnetic resonance imaging-diagnosed massive cuff tears. A massive cuff tear was defined as a full thickness tear of the rotator cuff involving 2 or more tendons. Pseudoparesis was defined as inability to achieve active elevation of 90° with retained passive motion beyond 90° of elevation. Thirty-six patients (34%) presented with pseudoparesis. Six radiographic measurements including the SAM index and demographics were evaluated as risk factors for pseudoparesis.</p><p><strong>Results: </strong>Univariate analysis showed no significant differences in demographics between those with and without pseudoparesis. Patients with pseudoparesis more commonly opted for surgery instead of physical therapy as their initial treatment (44% vs. 23%; P = .04). For those with pseudoparesis, the median SAM index was significantly lower (0.72 [interquartile range 0.70, 0.76] vs. 0.75 [0.74, 0.78]; P = .001). The receiver operating characteristic curves comparing radiographic measurements' ability to predict pseudoparesis demonstrated that the measurement with the highest area under the curve was the SAM index (0.69; 95% CI 0.59-0.80).</p><p><strong>Conclusions: </strong>The SAM index was found to correlate with the clinical presence of pseudoparesis in patients with massive cuff tears. This index is an indication of the relative moment arms of the deltoid and rotator cuff and may provide insight into the variable presentation of massive cuff tear patients.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617703","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":"Evaluation of new normal after shoulder arthroplasty: comparison of anatomic vs. reverse total shoulder arthroplasty.","authors":"Casey M Beleckas, Daniel F Schodlbauer, Albert D Mousad, Jonathan C Levy","doi":"10.1016/j.jse.2025.02.010","DOIUrl":"10.1016/j.jse.2025.02.010","url":null,"abstract":"<p><strong>Background: </strong>Reports of equivalent patient-reported outcomes between anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) have contributed to a continued preference of rTSA. Although many surgeons believe that the best aTSA outcome can outperform the best rTSA outcome, this has not yet been demonstrated in the literature. The purpose of this study is to investigate the outcome characteristics of aTSA and rTSA patients who perceive that their shoulder is close to normal, with the hypothesis that aTSA patients will outperform rTSA patients.</p><p><strong>Methods: </strong>A retrospective query of our institution's data repository from 2006 to 2021 identified primary anatomic and rTSA patients with minimum 2-year follow-up and who have achieved a \"new normal,\" defined as a most recent Single Assessment Numeric Evaluation score ≥95. aTSA and rTSA patients were compared based on patient-reported outcome measures, range of motion, and satisfaction. Specific patient-reported outcome measure questions representative of higher functional demands were analyzed, and a subset analysis of patients treated for osteoarthritis with an intact rotator cuff was performed.</p><p><strong>Results: </strong>The query identified 849 aTSA and 745 rTSA patients with minimum 2-year follow-up. Of these, 40% (337) of aTSA and 26% (193) of rTSA patients reached a Single Assessment Numeric Evaluation score ≥95 at most recent follow-up. aTSA significantly outperformed rTSA in total American Shoulder and Elbow Surgeons score (P < .001); ability to reach a high shelf (P < .001), lift 10 pounds (P < .001), and perform usual work and usual sport (P < .001); total Simple Shoulder Test score (P < .001); ability to lift 8 pounds and carry 20 pounds (P < .001); and range of motion including clinician measured elevation, abduction, external rotation, and internal rotation (P < .001). A subanalysis among patients treated for osteoarthritis with an intact rotator cuff produced similar results, with aTSA patients outperforming rTSA patients in many higher demand functions.</p><p><strong>Conclusion: </strong>aTSA patients have a 40% chance of perceiving their shoulder as normal. Among shoulder arthroplasty patients who perceive their shoulder as normal, aTSA patients outperform rTSA patients with better motion and greater ability to return to work, return to sport, and perform higher demand activities without difficulty.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No difference in 2-year outcomes of arthroscopic rotator cuff repair in patients with osteoporosis.","authors":"Stephen J Sierra, Adam Lutz, Samantha A Piergiovanni, Ellen Shanley, Charles A Thigpen, Michael J Kissenberth, Stephan G Pill","doi":"10.1016/j.jse.2025.02.011","DOIUrl":"10.1016/j.jse.2025.02.011","url":null,"abstract":"<p><strong>Background: </strong>Many prognostic factors associated with healing after arthroscopic rotator cuff repair have been evaluated. It has been shown from previous literature that osteoporosis is an independent risk factor for poor healing and increased need for revision surgery. To our knowledge, there has not been a study reporting patient reported outcomes (PROs) for arthroscopic rotator cuff repair in patients with osteoporosis. The purpose of this study was to compare PROs of arthroscopic rotator cuff repair (RCR) in patients with decreased bone mineral density to those with normal bone mineral density. We hypothesized that patients with decreased bone mineral density would have worse outcomes.</p><p><strong>Methods: </strong>A retrospective chart review identified patients who had arthroscopic RCR with preoperative and minimum 2-year postoperative PROs. Demographic data and rotator cuff tear size were recorded, and the PROs included American Shoulder and Elbow Surgeons (ASES), visual analog scale pain score, Single Assessment Numeric Evaluation, Veterans RAND 12-Item Health Survey (VR-12) physical component score (PCS), and VR-12 mental component score (MCS). Each patient record was queried for an osteoporosis, osteopenia, or osteoporotic fracture diagnosis within a year before or after RCR. Patients with one of these diagnoses comprised the decreased bone mineral density group; whereas, patients without these diagnoses comprised the control group. An analysis of covariance was used to compare 2-year PROs while controlling for age, sex, tear size, preop ASES, preop VR-12 MCS, preop VR-12 PCS, and Charlson Comorbidity Index. Significance was set at α = 0.05.</p><p><strong>Results: </strong>Three-hundred fifty-seven patients were included. The mean age was 59.8 ± 10.0 years, and 191 (53.5%) were male. There were 30 patients (8.4%) in the decreased bone mineral density group and 327 patients (91.6%) in the control group. One hundred eighty-two (51.0%) patients had large or massive tears, and 175 patients (49.0%) had small or medium tears. There were no baseline differences between groups based on Charlson Comorbidity Index (P = .092), VR-12 MCS mean scores (P = .924), and initial ASES mean scores (P = .183). A small baseline difference existed in VR-12 PCS mean scores (P = .032). As expected, the decreased bone mineral density group had more females (28 of 30, P < .001) and older patients (67.6 ± 7.6 years vs. 59.1 ± 10.0 years, P < .001). Analysis of covariance identified no significant difference in 2-year ASES scores between groups (P = .216).</p><p><strong>Conclusion: </strong>Despite previous literature showing the negative effect of osteoporosis on rotator cuff healing, our data showed no relationship between decreased bone mineral density and 2-year clinical outcomes following RCR. Patients with decreased bone mineral density can still achieve excellent 2-year outcomes.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617701","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 influence of age on cellular senescence in injured versus healthy muscle and its implications on rotator cuff injuries.","authors":"Kevin C Wang, Justin Lau, Steven M Garcia, Aboubacar Wague, Sankalp Sharma, Xuhui Liu, Brian T Feeley","doi":"10.1016/j.jse.2025.02.008","DOIUrl":"10.1016/j.jse.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>Advanced age increases the prevalence of rotator cuff tears and affects the success of repair surgeries. Cellular senescence is proposed as a key mechanism behind these age-related differences, likely due to contribution of the senescence-associated secretory phenotype. This state is linked to various age-related diseases, including rotator cuff injuries.</p><p><strong>Materials and methods: </strong>Rotator cuff muscle samples were obtained from young and aged patients who underwent surgery. Samples were processed for single-cell RNA sequencing to analyze cellular differences. Cells were isolated and sequenced to identify different cell populations and their gene expression profiles.</p><p><strong>Results: </strong>Six major cell populations were identified in rotator cuff muscle tissue, including fibroadipogenic progenitor cells (FAPs), satellite cells, endothelial cells, pericytes, macrophages, and T cells. Aged FAPs showed higher expression of senescence markers and genes associated with fibrosis and inflammation. Younger FAPs had higher levels of extracellular matrix remodeling genes. Specifically, ATF3-a senescence marker-was found to be elevated in aged FAPs. In silico analysis highlighted a potential role of ATF3 in regulating FAP differentiation.</p><p><strong>Conclusions: </strong>Markers of cellular senescence are significantly elevated in older human rotator cuff tissue samples compared with young rotator cuff. Of specific interest is ATF3, a gene that has been previously implicated in regulating adipogenesis, which demonstrates a trend to function in a protective capacity against the formation of fibrosis in computational analysis of our data.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587838","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}