Journal of Shoulder and Elbow Surgery最新文献

{"title":"Efficacy of conservative treatment strategies for partial distal biceps tendon ruptures: a case-control study.","authors":"Neal Jansen, Laurens Zweers, Lotte Verstuyft, Roger van Riet, Pieter Caekebeke","doi":"10.1016/j.jse.2025.04.017","DOIUrl":"10.1016/j.jse.2025.04.017","url":null,"abstract":"<p><strong>Background: </strong>Partial distal biceps tendon tears (PDBTs) are uncommon injuries that present with a range of symptoms, from mild pain to significant weakness. The optimal treatment approach for PDBTs remains debated, with a lack of consensus regarding the most effective nonoperative strategies. This study compares three nonoperative treatments: wait-and-see, physiotherapy, and injection therapy, to determine their efficacy and identify factors influencing treatment outcomes.</p><p><strong>Materials and methods: </strong>This retrospective study included 78 patients diagnosed with partial distal biceps tears from January 2017 to December 2024. Diagnosis was confirmed through clinical examination and magnetic resonance imaging. Patients were treated with one of three nonoperative strategies: a wait-and-see approach, standardized physiotherapy, or ultrasound-guided injection therapy. Functional and clinical assessments, including the Mayo Elbow Performance Score and visual analog scale for pain, were conducted at 3- and 6-months post-treatment.</p><p><strong>Results: </strong>The overall success rate for nonoperative treatment at 6 months was 47%, with no significant difference between the treatment groups (injection 50%, physiotherapy 46%, wait-and-see 46%). Injection therapy resulted in the fastest symptom relief, with most patients reporting improvement within one week. No patients progressed to complete ruptures, and those requiring surgery after treatment failure achieved full resolution. Multivariable analysis showed no significant impact of factors like inflammatory disease, diabetes, profession, smoking, grading of the tear and lesion origin (trauma vs. attrition) on treatment outcomes.</p><p><strong>Conclusion: </strong>Nonoperative treatment for PDBTs, including injection therapy, physiotherapy, and a wait-and-see approach, yields moderate success rates. Injection therapy offers the quickest relief with no detrimental effects. Surgery remains an effective option for treatment failures.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183467","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":"Period of formation of and factors associated with perianchor cysts around Healicoil and Footprint polyetheretherketone anchors following arthroscopic rotator cuff repair.","authors":"Yu Mei, Lizhong Jing, Pengfeng He, Wenjie Wu, Zegang Wang, Fengyuan Zhao, Jiahao Zhang, Dai Li, Peiqin Xu, Hui Yan","doi":"10.1016/j.jse.2025.04.012","DOIUrl":"10.1016/j.jse.2025.04.012","url":null,"abstract":"<p><strong>Background: </strong>To investigate the factors associated with the formation of perianchor cysts (PCs) around Healicoil and Footprint polyetheretherketone (PEEK) anchors following arthroscopic rotator cuff (RC) repair and assess its association with clinical shoulder function and the incidence of RC retearing.</p><p><strong>Methods: </strong>The data of patients who underwent arthroscopic RC repair with Healicoil and Footprint PEEK anchors were retrospectively analyzed. The incidence of PCs was evaluated on postoperative magnetic resonance imaging and compared across multiple follow-up points. Binary logistic regression was used to identify risk factors for PCs at 12 months postoperatively. Functional scores were evaluated preoperatively and postoperatively at a minimum of 24 months. The incidence of RC retearing was assessed 12 months postoperatively.</p><p><strong>Results: </strong>One hundred eighty-four patients were included, among whom 66 patients presented PCs at the 12-month follow-up (cyst group) and 118 did not (noncyst group). The incidence of PCs at 3, 6, and 12 months postoperatively was 16.3%, 37.5%, and 35.9%, respectively. Significant differences were observed in the incidence of PCs between 3 months and both 6 months (P < .001) and 12 months (P < .001). There were no significant differences between the incidence of PCs at 12 months and at 6 months postoperatively (P = .362). Risk factors for PCs included age ≥ 60 years (odds ratio [OR] = 1.91, 95% confidence interval [CI]: 1.04-3.52, P = .038), large and massive RC tears (OR = 2.15, 95% CI: 1.14-4.03, P = .017), and anchors located in the medial row in the greater tuberosity (OR = 3.30, 95% CI: 2.62-8.1, P < .001). Compared with the preoperative scores, significantly improved postoperative functional scores were observed for all patients (P < .001). There were no significant differences in the postoperative Constant scores (P = .165), University of California, Los Angeles scores (P = .899), or American Shoulder and Elbow Surgeons scores (P = .310) or in the incidence of RC retearing (P = .061) between the 2 groups.</p><p><strong>Conclusions: </strong>The incidence of PCs around Healicoil and Footprint PEEK anchors after RC repair tended to stabilize at 6 months postoperatively. The factors influencing the formation of PCs were related mainly to tear size, patient age, and anchor location. No association was observed between the formation of PCs and postoperative functional scores or the incidence of RC retearing.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144080","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":"Combined proximal humerus fractures are associated with greater mortality and morbidity compared with isolated fractures: a retrospective cohort study.","authors":"Daniel Shaham, Barak Haviv, Mohamed Kittani, Mustafa Yassin, Tzadok Yona, Lee Yaari","doi":"10.1016/j.jse.2025.04.013","DOIUrl":"10.1016/j.jse.2025.04.013","url":null,"abstract":"<p><strong>Background: </strong>Proximal humerus fractures (PHFs) are the third most common type of osteoporotic fracture. One-year mortality rates following PHF are between 4% and 15%. This study examines whether combined fractures involving PHFs and other osteoporotic fractures increase mortality and morbidity rates compared with isolated PHFs.</p><p><strong>Methods: </strong>This is a retrospective study on patients aged ≥45 years with PHF between January 1, 2011, and December 31, 2020, in Israel's largest health maintenance organization. Fractures were categorized as isolated PHFs or combined fractures involving the proximal humerus with a femoral, distal radial, or vertebral fracture. Patient characteristics, mortality, and morbidity were recorded. Kaplan-Meier survival curves and Cox regression models were used to assess mortality and morbidity.</p><p><strong>Results: </strong>This study included 21,647 patients, 713 in the combined fracture group and 20,934 in the isolated PHF group. The combined fracture group had significantly higher 1-year mortality (14.7% vs. 5.7%, P < .001). After adjusting for covariates, combined fractures involving the femur (hazard ratio [HR] = 1.885, P = .003) or vertebra (HR = 1.751, P = .020) were associated with higher mortality, whereas combined fractures with the radius were not. Morbidity was higher in the combined fracture group, with increased rates of pulmonary embolism (HR = 2.740, P = .012), deep vein thrombosis (HR = 4.982, P = .021), and sepsis (HR = 2.132, P = .018).</p><p><strong>Conclusion: </strong>This study showed that combined fractures with femoral or vertebral fractures are associated with significantly higher mortality and morbidity compared with isolated PHFs.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of arthroscopic Bankart repair: risk of recurrence and osteoarthritis at 11-20 years of follow-up.","authors":"Klaas Victor, Thomas Verschueren, Anne-Sophie F D Cools, Filip Verhaegen, Jan F A Somers","doi":"10.1016/j.jse.2025.04.015","DOIUrl":"10.1016/j.jse.2025.04.015","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic Bankart repair (ABR) is a commonly performed treatment for anterior shoulder instability. Risk factors for recurrence of dislocation after this procedure have been investigated previously at short- and mid-term follow-up. Recurrence of dislocation in the long term, as well as the incidence and risk factors for the development of osteoarthritis (OA) after this procedure require further investigation.</p><p><strong>Methods: </strong>In this single-institution retrospective study, patients who had received ABR for structural anterior instability of the shoulder with a history of at least 1 documented dislocation, were contacted for a clinical and radiographic reassessment at long-term follow-up. Functional outcomes were assessed by the Oxford Shoulder Instability Score, Rowe score, and subjective shoulder value. Recurrence was defined as redislocation. Postoperative range of motion and strength were systematically assessed. Standard radiographs of the operated shoulder were screened for degenerative changes and scored according to the Samilson-Prieto classification for OA.</p><p><strong>Results: </strong>Out of 59 consecutive shoulders eligible for inclusion, 49 shoulders were reassessed at a mean follow-up of 15 (standard deviation [SD] ± 2.4, range 11-20) years after the index procedure. The mean age of our cohort was 27.7 (SD ± 9.5) years. Nine shoulders (18.4%) sustained recurrence of dislocation. At the end of follow-up, the mean subjective shoulder value was 87% (SD ± 18, range 40-100), the mean Oxford Shoulder Instability score was 44.5 (SD ± 4.6, range 30-48) and the mean Rowe score 81.1 (SD ± 19.1, range 30-100). At final follow-up, 57% of shoulders had developed mild, 16% moderate and 11% severe degenerative changes. Age at index surgery (relative risk 2.96 [1.76-17.31] at ≥30 years) and the number of preoperative dislocations (relative risk 1.30 [1.07-1.59] if ≥5 preoperative dislocations) were significant risk factors for the development of OA. Recurrence of dislocation (P = .40) and duration of follow-up (P = .31) showed no significant association with OA.</p><p><strong>Conclusion: </strong>In the long term, the risk of recurrence of dislocation after ABR is low in comparison with reports on conservative treatment of anterior shoulder instability, but the incidence of OA after this procedure remains equally high. Preoperative factors significantly affect the risk of OA, rather than postoperative factors. Despite the high incidence of postoperative degenerative changes in the long term, functional outcomes remain satisfactory.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical effectiveness of lower trapezius tendon transfer with intercalary tendon-bone graft vs. the modified l'Episcopo procedure in reverse total shoulder arthroplasty with proximal humeral bone loss.","authors":"Franziska Eckers, Bettina Hochreiter, Paul Johnson, Ashen Fernando, Yichen Huang, Lukas Ernstbrunner, David C Ackland, Eugene T Ek","doi":"10.1016/j.jse.2025.04.014","DOIUrl":"10.1016/j.jse.2025.04.014","url":null,"abstract":"<p><strong>Background: </strong>In reverse total shoulder arthroplasty (rTSA), proximal humeral bone loss (PHBL) is associated with higher complication rates and inferior functional results, particularly loss of active external rotation (ER). Traditionally, adjunct tendon transfers such as the latissimus dorsi transfer or the modified l'Episcopo procedure have been employed to address this. Recently, in native shoulders, lower trapezius transfer (LTT) has gained popularity as an alternative method to restore ER. To date, almost no literature exists on its use in rTSA. The purpose of this study was to evaluate the biomechanical effectiveness of a novel, modified lower trapezius transfer with tendon-bone allograft (LTT+) that aims to reconstruct the greater tuberosity in situations of PHBL and to compare it with the modified l'Episcopo procedure. It was the hypothesis of this study that LTT+ would provide comparatively higher ER and lower adduction (ADD) moments.</p><p><strong>Methods: </strong>Ten right, cadaveric upper limbs were prepared by resecting the proximal humerus, creating moderate PHBL (4 cm). rTSA was performed, and both an LTT+ and an l'Episcopo tendon transfer were added. The specimens were mounted on a custom-built testing apparatus, and an optical motion analysis system was employed to record joint kinematics and tendon excursions. During passive rotational and abduction-ADD motion cycles, the ER and ADD moment arms were computed using the tendon-excursion method.</p><p><strong>Results: </strong>Both LTT+ and l'Episcopo are biomechanically effective in generating shoulder ER in rTSA with PHBL. LTT+ moment arms were higher; significance being reached after a minimum of 45° to 55° of ER had been achieved, depending on the angle of abduction. For pooled internal rotation (-20° to 0° rotation), low (0° to 45° rotation), and high ER (45° to 70° rotation), the mean differences of the ER moment arms were significant in all abduction positions (P < .0001 for all 3 groups). The ADD moment arms of LTT+ were significantly lower than l'Episcopo's (P < .0001), measured in neutral rotation in the scapular plant between 40° and 70° abduction. The differences were most relevant in lower degrees of abduction.</p><p><strong>Conclusion: </strong>Biomechanically, both LTT+ and the modified l'Episcopo procedure demonstrated effective shoulder ER capacity. LTT+ provided significantly higher ER moment arms in high degrees of ER, and, additionally, lower ADD moment arms, thereby potentially avoiding interference with the deltoid during abduction and elevation. These effects may strongly depend on the transfers' insertion site and technique.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143132","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":"Effect of instrument-assisted soft tissue mobilization in addition to conventional rehabilitation on pain, range of motion, and functional level in patients with arthroscopic rotator cuff repair: a randomized controlled trial.","authors":"Musa Güneş, Metehan Yana, Beril Kütükçü, Yılmaz Ergişi, Uygar Daşar","doi":"10.1016/j.jse.2025.04.010","DOIUrl":"10.1016/j.jse.2025.04.010","url":null,"abstract":"<p><strong>Background: </strong>After arthroscopic rotator cuff repair (RCR), rehabilitation focuses on pain, range of motion (ROM), and function. Instrument-assisted soft tissue mobilization (IASTM) is also widely used to improve these functions. However, its effectiveness after arthroscopic RCR is unknown. This study aimed to investigate the short-term effects of IASTM on pain, ROM, functional level, and kinesiophobia in patients following arthroscopic RCR.</p><p><strong>Methods: </strong>A randomized, controlled, double-blind study was conducted with 33 patients 4 weeks after arthroscopic RCR. Patients were randomly assigned to an IASTM group (n = 17) or a control (n = 16) group. While the control group received conventional physiotherapy, the IASTM group received IASTM 3 sessions per week for 4 weeks, in addition to conventional physiotherapy. Pain intensity (visual analog scale [VAS]), ROM, functional level (Shoulder Pain and Disability Index), and kinesiophobia (Tampa Scale for Kinesiophobia) were evaluated before and after 4 weeks of treatment.</p><p><strong>Results: </strong>The baseline characteristics of the groups were similar. After treatment, the improvement in VAS rest (mean difference [MD]: -2.6 vs. -2.1, P = .004), VAS activity (MD: -4.2 vs. -2.6, P = .009), VAS night (MD: -4.2 vs. -2.7, P = .024), and Shoulder Pain and Disability Index total (MD: -30.5 vs. -20.0, P = .004) scores was statistically greater in the IASTM group compared to the control group. After treatment, both active and passive shoulder ROM angles improved statistically significantly within groups (P < .001), with significantly greater improvements in the IASTM group than those in the control group (P < .05). Tampa Scale for Kinesiophobia scores improved significantly within groups (P < .001). However, there was no statistical difference between groups (P = .089).</p><p><strong>Conclusion: </strong>IASTM effectively improved pain, ROM, upper extremity function, and kinesiophobia in the short term after arthroscopic RCR. Therefore, adding IASTM to rehabilitation programs after arthroscopic RCR may obtain more effective results.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143834","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":"Analysis of mechanoreceptors and free nerve endings in the lateral collateral ligament of the elbow using immunofluorescence and confocal microscopy.","authors":"Rafael Patrocínio de Paula Costa, João Pedro Barreto Rocha, Marcus Vinicius Macedo Oliveira, José Atualpa Pinheiro Júnior, Maria Luzete Costa Cavalcante, Diego Ariel de Lima","doi":"10.1016/j.jse.2025.04.005","DOIUrl":"10.1016/j.jse.2025.04.005","url":null,"abstract":"<p><strong>Background: </strong>The lateral collateral ligament (LCL) of the elbow is an essential static stabilizer against varus and posterolateral rotatory forces. It is hypothesized that injury to the LCL might impair elbow proprioception, although direct evidence for this impairment remains limited and warrants further investigation. This study aimed to describe the morphology and distribution of mechanoreceptors and free nerve endings within the LCL.</p><p><strong>Methods: </strong>Twenty ligaments were obtained from 10 fresh cadavers, in compliance with local legislation. Each ligament was measured, weighed, and sectioned. Histological integrity was confirmed using hematoxylin-eosin staining on 10 μm sections, while 50 μm sections underwent immunofluorescence with protein gene product 9.5 as the primary antibody and Alexa Fluor 488 as the secondary antibody, followed by analysis with a confocal laser scanning microscope (Zeiss LMS 710).</p><p><strong>Results: </strong>The LCL was identified in 100% of dissections, with an average length of 36.2 ± 3.4 mm, width of 9.5 ± 2.24 mm, and weight of 0.8 ± 0.13 g. Hematoxylin-eosin staining revealed dense, organized collagen fibers and vascular tissue. Type I (Ruffini-like) and type IV (free nerve endings) mechanoreceptors were identified, along with unclassified nerve endings.</p><p><strong>Conclusion: </strong>These findings suggest a potential additional role for the LCL in proprioception, highlighting the possible importance of neural structures preservation. However, further clinical studies are necessary to determine the actual functional impact beyond mechanical stabilization.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129484","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":"Association between functional scores, radiological parameters, and muscle strength in shoulders with asymptomatic or symptomatic rotator cuff tears and healthy controls.","authors":"Eleonora Croci, Hanspeter Hess, Corina Nüesch, Daniel Baumgartner, Kate Gerber, Andreas Marc Müller, Annegret Mündermann","doi":"10.1016/j.jse.2025.04.004","DOIUrl":"10.1016/j.jse.2025.04.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Differences in function and morphology between shoulders with symptomatic and asymptomatic rotator cuff tears are poorly understood. This study aimed to compare functional scores, radiological parameters, muscle strength and their association in shoulders with rotator cuff disorders and healthy shoulders. We hypothesized that symptomatic shoulders would have lowest functional scores, muscle strength, and subacromial space and highest critical shoulder angles and fat fraction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Twenty-five older patients with unilateral symptomatic rotator cuff tears (45-85 years), 25 older control subjects (45-85 years), and 25 younger control subjects (20-30 years) were enrolled. Functional scores, critical shoulder angle, subacromial space, muscle volume, and fat fraction of the rotator cuff muscles, as well as isometric muscle strength measurements were assessed for both shoulders of all participants. Differences in these parameters between groups defined by magnetic resonance imaging diagnosis were analyzed using univariate analysis of variance with post-hoc tests (Bonferroni). Pearson's cross-correlations between these parameters were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final analyses included 43 healthy shoulders, 24 shoulders with rotator cuff tendinopathy, 38 shoulders with asymptomatic rotator cuff tears, and 25 shoulders with symptomatic rotator cuff tears. Twenty shoulders were excluded because of magnetic resonance imaging findings not related to the rotator cuff. Lowest functional scores were found in symptomatic rotator cuff tears (P &lt; .001). No significant differences in the critical shoulder angle or the subacromial space (P &gt; .05) were observed between shoulder types. Symptomatic rotator cuff tears had 2%-8% higher fat fractions than healthy shoulders in all rotator cuff muscles (P ≤ .021), and 3% higher fat fractions than asymptomatic rotator cuff tears in the supraspinatus muscle (P = .018). Muscle strength of symptomatic rotator cuff tears was half that of healthy shoulders (P &lt; .001). Asymptomatic rotator cuff tears were 38% stronger in external rotation than symptomatic rotator cuff tears (P = .011) and between 18% and 30% weaker in abduction and external and internal rotation than healthy shoulders (P ≤ .014). Functional scores moderately correlated with muscle strength (0.21 ≤ R ≤ 0.68) and fat fraction (-0.69 ≤ R ≤ -0.21), and muscle strength correlated with fat fraction (-0.66 ≤ R ≤ -0.51). Only very few and low correlations were found between functional scores and anatomical parameters (-0.20 ≤ R ≤ 0.37).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Functional scores appeared to reflect muscle morphology and strength but not anatomical variations. Fat fraction of the supraspinatus muscle may be able to discriminate symptomatic from asymptomatic shoulders. Considering quantitative 3-dimensional fat fraction and dynamometric muscle strength measurements in abduction and rotat","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128083","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":"Shoulder geometry after reverse total shoulder arthroplasty with a medialized glenoid and a lateralized humerus predicts subacromial notching and acromial or scapular spine fractures.","authors":"Itaru Kawashima, Joseph J King, Jonathan O Wright, Aimee M Struk, Scott A Banks, Thomas W Wright","doi":"10.1016/j.jse.2025.04.007","DOIUrl":"10.1016/j.jse.2025.04.007","url":null,"abstract":"<p><strong>Background: </strong>The primary purpose of this study was to assess whether the difference between the distance from the acromion to the glenosphere center of rotation (DA) and the distance from the greater tuberosity to the glenosphere center (DGT) influences the incidence of subacromial notching (SaN) in shoulders following reverse total shoulder arthroplasty (rTSA) with a medialized glenoid and a lateralized humerus. The secondary purpose was to evaluate whether this relationship also impacts the incidence of acromion or scapular spine fractures.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients who underwent rTSA with a medialized glenoid and a lateralized humerus between 2007 and 2021. A total of 526 shoulders were included. Preoperative and postoperative functional outcome scores were evaluated. The Grashey view on plain radiographs preoperatively, within 3 months postoperatively, and at the final follow-up were evaluated. Shoulders were classified into 2 groups: DA ≥ DGT or DA < DGT. Propensity score matching was used to ensure comparability between groups. Clinical outcomes, SaN, and acromion or scapular spine fractures were assessed.</p><p><strong>Results: </strong>After propensity score matching, 360 shoulders were analyzed (240 in the DA ≥ DGT group and 120 in the DA < DGT group). The DA ≥ DGT group exhibited a significantly lower incidence of SaN (0%) compared to the DA < DGT group (10.8%, P < .001). Additionally, the DA ≥ DGT group had a lower rate of acromion or scapular spine fractures (0.4%) compared to the DA < DGT group (5.0%, P = .006). Both groups showed significant and similar improvements in clinical outcomes postoperatively.</p><p><strong>Conclusions: </strong>Implanting components such that DA is greater than DGT in rTSA with a medialized glenoid and a lateralized humerus is associated with a lower incidence of SaN and acromion or scapular spine fractures. These findings suggest that adjusting humeral lateralization or glenosphere distalization to achieve DA ≥ DGT may reduce postoperative complications.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128734","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":"Cost-effectiveness of a preoperative 12-week smoking cessation program prior to arthroscopic rotator cuff repair.","authors":"Elyette Lugo, Victor Cardona-Perez, Miguel A Cartagena-Reyes, Amit Jain, Umasuthan Srikumaran","doi":"10.1016/j.jse.2025.04.006","DOIUrl":"10.1016/j.jse.2025.04.006","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate the cost utility of preoperative 12-week smoking cessation program (SCP) in adults undergoing arthroscopic rotator cuff repair.</p><p><strong>Methods: </strong>A decision-analysis model was developed for a hypothetical adult smoker undergoing arthroscopic rotator cuff repair. Literature review data identified event probabilities, costs, and health utilities. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Base-case analysis calculated incremental cost and effectiveness of a 12-week preoperative SCP. Probabilistic sensitivity analysis evaluated model uncertainty and calculated mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analysis identified variables with the greatest model impact.</p><p><strong>Results: </strong>The preoperative 12-week SCP was the preferred strategy in 98.4% of iterations. It demonstrated greater benefits and lower costs, with an incremental cost-effectiveness ratio below the willingness-to-pay threshold of $50,000 per QALY. The use of preoperative 12-week SCP was associated with a mean incremental net monetary benefit of $16,338 (95% confidence interval: 15,889-16,787). One-way sensitivity analyses identified QALYs associated with avoiding revision surgery due to retear as a key driver of the cost-utility outcomes.</p><p><strong>Conclusion: </strong>Use of a preoperative 12-week SCP is a cost-effective approach to reduce costs related to revision surgery and providing higher QALYs at 5 years. The use of SCPs should be strongly considered as part of patient management strategies.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128403","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}