Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Relationship between the Hounsfield Unit value of the greater trochanter and the risk of greater trochanteric fractures in anterolateral muscle-sparing minimally invasive total hip arthroplasty","authors":"Ryuichiro Okuda ,&nbsp;Tomonori Tetsunaga ,&nbsp;Kazuki Yamada ,&nbsp;Tomoko Tetsunaga ,&nbsp;Tomohiro Inoue ,&nbsp;Yasutaka Masada ,&nbsp;Tetsuya Yamamoto ,&nbsp;Shin Matsumoto ,&nbsp;Yuki Okazaki ,&nbsp;Toshifumi Ozaki","doi":"10.1016/j.otsr.2026.104642","DOIUrl":"10.1016/j.otsr.2026.104642","url":null,"abstract":"<div><h3>Background</h3><div>No previous studies have investigated the association between the risk of greater trochanteric fractures and the Hounsfield Unit (HU) of the greater trochanter in muscle-sparing minimally invasive total hip arthroplasty (MIS-THA). This study aimed to investigate the risk factors for greater trochanteric fractures in anterolateral MIS-THA.</div></div><div><h3>Hypothesis</h3><div>Lower HU values of the greater trochanter are associated with a higher risk of intraoperative and early postoperative greater trochanteric fractures.</div></div><div><h3>Patients and methods</h3><div>This single-center retrospective observational study included 223 patients (257 hips) who underwent primary THA for osteoarthritis or osteonecrosis between January 2010 and August 2024 using a minimally invasive anterolateral approach in the lateral position. All surgeries were performed by four surgeons. Preoperative CT was used to reconstruct coronal sections including the femoral head center and proximal femoral axis, and cancellous HU values of the greater trochanter were measured. Postoperative CT (1 week) with metal artifact reduction was routinely performed; fractures were defined as cortical fracture lines on 3D-reconstructed CT and assessed by two independent orthopedic surgeons. Patients were divided into two groups according to the presence or absence of fractures.</div></div><div><h3>Results</h3><div>The incidence of greater trochanteric fractures was 6.6% (17/257 hips). Twelve of these fractures (70.6%) were recognized intraoperatively or immediately postoperatively. Full hydroxyapatite (HA)-coated stems were associated with an increased fracture risk compared with other designs (relative risk [RR], 2.68; 95% CI, 1.07–6.68). Age, sex, BMI, ASA physical status, and diagnosis were not significantly associated with fractures. Multivariate analysis identified lower HU values (odds ratio [OR], 0.973; <em>p</em> &lt; 0.0001) and full HA-coated stems (OR, 13.3; <em>p</em> = 0.04) as independent predictors. Receiver operating characteristic (ROC) analysis determined an optimal cut-off of 72.0 HU (sensitivity, 0.941; specificity, 0.742), with a value ≤72.0 HU demonstrating high predictive power (RR, 36.7; <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Preoperative measurement of HU values in the greater trochanter is a useful screening tool for identifying patients at increased risk of fractures in anterolateral MIS-THA. While an HU value of ≤ 72.0 necessitates careful intraoperative management and increased vigilance, it should be interpreted as an indicator of risk rather than a definitive predictor of fracture due to its moderate specificity.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104642"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis and rectal injuries in patients with pelvic fractures at a level 1 trauma center: a retrospective cohort study","authors":"Lasse Rehné Jensen ,&nbsp;Emma Possfelt-Møller ,&nbsp;Dennis Zetner ,&nbsp;Cecilie Mørck Offersen ,&nbsp;Caroline Ewertsen ,&nbsp;Allan Evald Nielsen ,&nbsp;Upender Martin Singh ,&nbsp;Lars Bo Svendsen ,&nbsp;Luit Penninga","doi":"10.1016/j.otsr.2026.104632","DOIUrl":"10.1016/j.otsr.2026.104632","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is a cause of delayed morbidity and mortality after pelvic fracture surgery. Rectal injuries, although rare, may be underdiagnosed and contribute to infectious complications. Recent studies on this topic are scarce and often lack radiologic correlation. This study aimed to address the following questions: (1) What is the incidence of sepsis in surgically treated pelvic and/or acetabular fractures? (2) Which clinical and injury-related factors are associated with sepsis? (3) Are rectal injuries underdiagnosed? and (4) Do radiologic perirectal abnormalities correlate with sepsis?</div></div><div><h3>Hypothesis</h3><div>We hypothesized that sepsis is associated with identifiable clinical risk factors and that radiologic signs of rectal injury are underrecognized contributors to sepsis.</div></div><div><h3>Patients and methods</h3><div>In this retrospective cohort study, we included 1059 patients who underwent pelvic or acetabular fracture surgery at a Level 1 Trauma Center between 2009 and 2020. Clinical data and CT imaging were reviewed. Patients were stratified by sepsis status. Sepsis was defined according to the Sepsis-3 criteria. The primary outcome was occurrence of sepsis; secondary outcomes included ICU stay, length of hospitalization, and 90-day mortality. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for sepsis.</div></div><div><h3>Results</h3><div>Sepsis occurred in 71 patients (7%). In multivariate analysis, an Injury Severity Score ≥20 (OR 2.88, 95% CI 1.36–6.07), emergency laparotomy (OR 6.70, 95% CI 2.84–15.78), heart disease (OR 4.80, 95% CI 1.82–12.69), and liver disease (OR 3.67, 95% CI 1.11–12.08) were independently associated with sepsis. Rectal injury was diagnosed in 1 patient (0.1%), while perirectal CT abnormalities were observed in 107/766 (14%) patients. Sepsis was associated with longer ICU stays, longer hospitalization, and increased 90-day mortality.</div></div><div><h3>Discussion</h3><div>The incidence of sepsis remains clinically significant in pelvic fracture patients and is associated with identifiable injury and patient-related factors. Radiologic perirectal findings are more frequent than clinically diagnosed rectal injuries and may signal occult injury. These findings suggest a need for heightened vigilance and further investigation of subtle imaging abnormalities.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104632"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Better meniscal volume and quality reduce cartilage degeneration following autologous osteochondral transfer: A retrospective comparative study with a mean 6-year follow-up","authors":"Hyo Yeol Lee ,&nbsp;Jong-Min Kim ,&nbsp;Bum-Sik Lee ,&nbsp;Ju-Ho Song","doi":"10.1016/j.otsr.2026.104591","DOIUrl":"10.1016/j.otsr.2026.104591","url":null,"abstract":"<div><h3>Background</h3><div>Autologous osteochondral transfer (AOT) surgery yields favorable outcomes with appropriate patient selection. Although several factors influencing surgical outcomes have been identified, the effect of meniscal volume and quality on AOT outcomes remains unclear.</div></div><div><h3>Hypothesis</h3><div>Better meniscal status would be associated with reduced deterioration of cartilage repair over time following AOT.</div></div><div><h3>Materials and methods</h3><div>Patients who underwent AOT between March 2002 and March 2021 were retrospectively reviewed. Inclusion criteria were: (1) magnetic resonance imaging (MRI) at 1–2 years postoperatively for evaluation of meniscal status, and (2) follow-up MRI after at least 2 years. Meniscal lesions were addressed during surgery, and postoperative residual meniscal status was graded using a 6-point scale (0–3 for volume, 0–3 for quality). Patients were divided into better meniscus (BM) and poorer meniscus (PM) groups using a cutoff score of 2.5, derived from a time-dependent receiver operating characteristic (ROC) curve that maximized early deterioration in the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score after AOT. Follow-up intervals were categorized into early (1–2 years), short-term (2–5 years), mid-term (5–10 years), and long-term (&gt;10 years). Structural outcomes including MOCART scores, joint space width (JSW), and cartilage T2 relaxation times, and patient-reported outcome measurements (PROMs) including Lysholm score, IKDC subjective score, Tegner activity scale, and visual analog scale (VAS) for pain were compared.</div></div><div><h3>Results</h3><div>A total of 35 patients were finally included in the study, with a mean follow-up of 6.8 ± 5.2 years. Among them, 22 were classified into the BM group and 13 into the PM group. Significant group-by-time interaction effects were observed for MOCART scores (<em>p</em> = .048) and JSW (<em>p</em> = .03); the BM group demonstrated higher MOCART scores from the short-term follow-up (<em>p</em> = .005) and less JSW narrowing from the mid-term follow-up (<em>p</em> = .009). In contrast, no significant group differences were found in T2 relaxation times. Clinically, IKDC (53.5 ± 16.4 to 76.3 ± 11.0; <em>p</em> = .03), Lysholm (66.1 ± 18.3 to 91.7 ± 7.4; <em>p</em> = .02), and VAS pain scores (5.1 ± 2.3 to 1.8 ± 1.8; <em>p</em> = .01) significantly improved from preoperative to early postoperative follow-up and were maintained thereafter. However, no significant group differences were found.</div></div><div><h3>Conclusion</h3><div>Meniscal lesions should be properly addressed during AOT, as residual meniscal status was associated with cartilage degeneration. However, structural improvements on MRI did not translate into better clinical outcomes, as T2 relaxation times and PROMs were not correlated.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104591"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetabular fractures with transverse component: Predictors of radiological and clinical outcomes","authors":"Anaïs Bernardeau,&nbsp;Marc Magnier,&nbsp;Elias Melhem,&nbsp;Pierre-Emmanuel Moreau,&nbsp;Peter Upex,&nbsp;Mourad Zaara,&nbsp;Guillaume Riouallon","doi":"10.1016/j.otsr.2025.104579","DOIUrl":"10.1016/j.otsr.2025.104579","url":null,"abstract":"<div><h3>Background</h3><div>Acetabular fractures with a transverse component tend to result in poorer outcomes than other types. However, few studies have focused specifically on this fracture type. The aim of this study was to investigate predictive factors associated with outcomes after surgical treatment of such fractures.</div></div><div><h3>Hypothesis</h3><div>We hypothesize that the reduction was achieved in more than 50% of the cases.</div></div><div><h3>Material and methods</h3><div>We retrospectively collected data on patients with displaced transverse fractures who underwent surgery at our institution between 2007 and 2020. The mean follow-up was 18.5 months. The quality of reduction was assessed by the Saint-Joseph Acetabular Score (SJAS) on postoperative CT scan. Functional outcomes were assessed at final follow-up using the Harris Hip Score (HHS). Prognostic factors for SJAS and HHS such as demographics, fracture modifiers and characteristics of treatment were analyzed through multivariate analysis. Sixty-three patients, including 51 men (80.9%) and 12 women (19.1%), with a mean age of 36.7 years, were included.</div></div><div><h3>Results</h3><div>Twenty-one fractures achieved satisfactory reduction (33.3%). Reduction quality was significantly affected by initial displacement (p = 0.0143) and time to surgery (p = 0.0118). The functional results were excellent or good in 71.7% (45 patients) of cases according to the HHS. The functional score was significantly influenced by initial maximum step (p = 0.0186), reduction quality (p &lt; 0.0001), and late complications (p &lt; 0.0001). Late complications included 11 cases (17%) of hip osteoarthritis and 3 of avascular necrosis (5%).</div></div><div><h3>Conclusion</h3><div>Transverse fractures are challenging to treat and are associated with a poor prognosis. The quality of surgical reduction appears to be one of the most important factors in determining functional outcome, which is itself affected by initial displacement and time to surgery. Recognizing these predictive factors may help refine prognostic assessments and could inform early modifications to the surgical strategy, potentially improving long-term outcomes.</div></div><div><h3>Level of evidence</h3><div>IV; Retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104579"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inside-out repair of bucket-handle meniscal tears in young patients: Long-term effectiveness in a high-risk population","authors":"François Fauré,&nbsp;Jeanne Commeureuc,&nbsp;Robin Fauconnet,&nbsp;Antoine Josse,&nbsp;Franck Chotel","doi":"10.1016/j.otsr.2025.104301","DOIUrl":"10.1016/j.otsr.2025.104301","url":null,"abstract":"<div><h3>Objective</h3><div>Bucket-handle meniscal tears (BHMT) represent a severe tear and are challenging to preserve. This study focused on BHMT repair with mainly inside-out vertical sutures using non-absorbable materials in stable knees (no associated anterior cruciate ligament tear) in patients under 18 years old, evaluating survival rates and clinical outcomes. We hypothesized that this technique could result in a low failure rate in this presumed at-risk population.</div></div><div><h3>Methods</h3><div>This retrospective study included 31 patients (31 knees) with a mean age of 13.7 years old at time of arthroscopic meniscal repair for BHMT (19 lateral and 12 medial) between 2010 and 2019.</div></div><div><h3>Results</h3><div>After a mean follow-up of 8.25 ± 2.9 years, seven clinical healing failures (22%) were observed, with 5-year survival rates of 77.4% for all lesions, 75% for medial menisci, and 78.9% for lateral menisci. The mean recurrence interval was 26.4 ± 18.8 mo. Clinical outcomes included mean pedi-IKDC scores of 83.7 ± 12.2 mean Kujala scores of 86.7 ± 10.9, Simple Value Test subjective functional scores of 82.5 ± 13.3, and Tegner scores of 6.4 ± 2.1.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that sutured repair of bucket-handle meniscal tears in stable knees of patients under 18 years of age is associated with a relatively low failure rate, supporting the hypothesis that this technique is effective in a population traditionally considered at risk.</div></div><div><h3>Level of evidence</h3><div>IV; Retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104301"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualization of the posteromedial compartment in the knee: Comparison between a posterolateral transseptal approach with a standard anterior transnotch approach when repairing posterior lesions of the medial meniscus","authors":"Andreas Friberg ,&nbsp;Nicolas Kloek ,&nbsp;Fabrice Duparc ,&nbsp;Olivier Courage ,&nbsp;Franck Dujardin ,&nbsp;Jonathan Curado","doi":"10.1016/j.otsr.2025.104181","DOIUrl":"10.1016/j.otsr.2025.104181","url":null,"abstract":"<div><h3>Introduction</h3><div>Visualization and exposure of the medial meniscus in the posterior compartment during knee arthroscopy can be challenging. Using a posterolateral transseptal approach can help to have a better visualization to ensure a better meniscal repair in the posterior compartment.</div></div><div><h3>Hypothesis</h3><div>The posterolateral transseptal approach allows a better visualization of the posterior segment of the medial meniscus when compared to a trans notch approach.</div></div><div><h3>Material and Methods</h3><div>A controlled laboratory study using 12 human cadaveric knees were included in this arthroscopic study. The first step was to visualize the posterior medial compartment by transnotch viewing. A posteromedial portal was then created, and a meniscal suture was positioned as medial as possible under direct visualization by an all inside technique with a suture hook. Afterwards the posterolateral transseptal portal was created and a second meniscal suture was positioned as medial as possible with the same technique. Finally, by dissection, a posterior arthrotomy was performed allowing us to directly measure the length of the medial meniscus (at its meniscocapsular junction) from its posterior root to respectively the first and second suture, representing the two different approaches. The safety was evaluated by extended dissection of the neurovascular posterior structures.</div></div><div><h3>Results</h3><div>The mean paired difference between the first and second suture was 6.75 ± 2.56 mm (CI95% = 5.19; 8.31, P ≈ 0.001). No nerve or vascular lesion were observed during dissection.</div></div><div><h3>Discussion</h3><div>A transseptal viewing portal offers better exposure and visualization of the medial meniscus in the posterior compartment and can be safely performed. When repairing meniscal lesions in the posterior compartment, it is commonly advised to insert a knot at least every 5 mm. Our study has demonstrated a significant difference in distance of 6.75 mm when using a transseptal approach, which provides an argument for its utilization during posterior meniscal repair enabling the operator to better repair meniscal lesion and potentially improve the healing process.</div></div><div><h3>Level of evidence</h3><div>III; Case/Control anatomical study on cadaveric specimens.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104181"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should arthro-CT be used routinely to assess glenoid bone defects in anterior glenohumeral instability?","authors":"Pierre-Louis Coulet,&nbsp;Louis Lajoinie,&nbsp;Lisa Peduzzi,&nbsp;François Sirveaux","doi":"10.1016/j.otsr.2025.104560","DOIUrl":"10.1016/j.otsr.2025.104560","url":null,"abstract":"<div><h3>Background</h3><div>In cases of chronic anterior shoulder instability, surgical indications are guided by clinical and morphological parameters that are largely integrated into the ISIS score. The glenoid bone defect is a central decision factor. Arthro-CT represents for many the frequently used examination, but is this superiority proven for the evaluation of glenoid lesions and is its systematic use justified?</div></div><div><h3>Purpose</h3><div>Our aim was to compare the Bernageau view versus arthro-CT for the assessment of glenoid bone defects in anterior glenohumeral instability, and to integrate our results into the diagnostic approach.</div></div><div><h3>Patients and methods</h3><div>We report a retrospective study of 95 patients with chronic anterior shoulder instability, mean age 28.7 ± 11.6 years. A sample of 23 patients was selected who underwent arthro-CT of the pathological shoulder and bilateral Bernageau views. The bone defect on the Bernageau view is expressed as a percentage of the width of the healthy glenoid; on the arthro-CT it was assessed using the Sugaya method. Associated lesions (Bankart, notches, SLAP, HAGL and rotator cuff tear) were collected on the various examinations. The measurement method on the two images was validated by two examiners with high inter- and intra-observer reproducibility (ICC between 0.84 and 1). Statistical evaluation was based on non-parametric tests.</div></div><div><h3>Results</h3><div>The glenoid defect calculated on the Bernageau view was 5.90% (±7.56) compared with 5.93% (±6.59) for arthro-CT, the mean difference between the two measurements was 1.92 (±1.86). There were no statistically significant differences based on the Wilcoxon test (<em>p</em> = 0.85, CI95% [0.577; 0.911]). The Spearmann correlation coefficient between the two methods was 0.8 (CI 95% [0.577; 0.911], <em>p</em> &lt; 0.001). Associated lesions included: 44% glenoid fracture, 81% Bankart lesion, 8.3% HAGL, 73% Hill-Sachs lesions, 5% SLAP and 2.1% rotator cuff tears.</div></div><div><h3>Discussion</h3><div>Our study supports the finding that bilateral Bernageau views provide accuracy comparable to arthro-CT in quantifying glenoid defects. Arthro-CT, which is more invasive, requires more radiation and is a potential source of infectious complications, provides additional information that is only relevant in the case of SLAP and rotator cuff tears.</div><div>We therefore recommend reserving arthro-CT for the pre-therapeutic assessment of instability in specific cases: Bankart indication, patients ≥ 40 years old, or symptomatic patients of any age (functional deficits, muscle weakness, or pain during rotator cuff testing).</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104560"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotics and refinements in surgical approach: A new paradigm in total hip arthroplasty?","authors":"Pascal Kouyoumdjian ,&nbsp;Anthony Viste ,&nbsp;Fabien Billuart ,&nbsp;Matthieu Lalevee ,&nbsp;Henri Migaud","doi":"10.1016/j.otsr.2026.104723","DOIUrl":"10.1016/j.otsr.2026.104723","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104723"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does subscapularis repair affect joint loads? Effect of humeral tray thickness in Reverse Total Shoulder Arthroplasty (rTSA)","authors":"Alexandre Caubère ,&nbsp;Stella Rutigliano ,&nbsp;Samuel Bourdon ,&nbsp;John Erickson ,&nbsp;Moreno Morelli ,&nbsp;Moby Parsons ,&nbsp;Lionel Neyton ,&nbsp;Marc-Olivier Gauci","doi":"10.1016/j.otsr.2025.104413","DOIUrl":"10.1016/j.otsr.2025.104413","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate how subscapularis tendon repair influences joint loads in relation to humeral offset and arm position.</div></div><div><h3>Patients and methods</h3><div>Two fresh-frozen, whole-body cadaveric shoulders underwent a reverse total shoulder arthroplasty (rTSA) on the humeral side using an internal proprietary load-sensing system (LSS) (Goldilocks, Statera Medical, Montreal, Canada). In addition to three \"complex\" Activity Daily Life positions (\"behind the back\", \"overhead reach\", and \"across the chest\"), four standard postures (external rotation, extension, abduction, and flexion) were used to record the glenohumeral loads (Newtons) and their locations applied to the implant. The humeral system's adjustability function was used to gradually raise the thickness for each setting from 0 to 6 mm. The first part of the tests consisted of taking these measurements with the repaired subscapularis tendon. Once all the measurements had been taken, the tendon was detached, and the same measurements were repeated in the same order. Load and contact point were measured using the load centroid radial distance (|r|).</div></div><div><h3>Results</h3><div>The measurements showed good repeatability with an intra-class correlation coefficient (ICC) greater than 0.9 for all positions. Increasing the thickness of the humeral implant from 0 to 6 mm, without subscapularis, resulted in a refocusing of loads on the humeral cup for several positions, except for abduction at 60° (|r|_0mm = 1 mm VS |r|_6mm = 0.9 mm; p = 0.570), cross body (|r|_0mm = 0.7 mm VS |r|_6mm = 0.5 mm; p = 0.413) and overhead reach (|r|_0mm = 1 mm VS |r|_6mm = 0.9 mm; p = 0.284). Subscapularis repair enhances this recentering effect for all positions, with a particularly significant influence on abduction at 60°, \"behind back\" and \"overhead reach\" (|r|_6mm = 0.2 mm VS 0.9 mm, p &lt; 0.001). Subscapularis repair also significantly increased joint loads for these positions at 6 mm humeral lateralization.</div></div><div><h3>Discussion</h3><div>The findings of this biomechanical study provide substantial evidence to support the hypothesis that the subscapularis muscle plays a pivotal role in the process of refocusing joint loads in rTSA. Consequently, subscapularis repair may exert a biomechanical effect on rTSA stabilisation.</div></div><div><h3>Level of evidence</h3><div>V; Biomechanical study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104413"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term results of reverse total shoulder arthroplasty after failed rotator cuff repair","authors":"Pierre-Henri Flurin ,&nbsp;Thibault Lafosse ,&nbsp;Pascal Boileau ,&nbsp;Luc Favard ,&nbsp;Nicolas Bonnevialle ,&nbsp;Laurent Nové-Josserand","doi":"10.1016/j.otsr.2025.104575","DOIUrl":"10.1016/j.otsr.2025.104575","url":null,"abstract":"<div><h3>Background – Introduction</h3><div>Cuff repairs are associated with a relatively high risk of retear for which reverse total shoulder arthroplasty (rTSA) represents a treatment option. The objective of this study was to evaluate the mid-term results of rTSA after failed rotator cuff repair and to analyze the factors that may influence these results.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective multi-center analysis of 117 rTSA after failed cuff repair with 2 years minimum follow-up. Clinical scores (Constant, SSV and EVA pain scores) and active range of motion were pre- and postoperatively assessed.</div></div><div><h3>Results</h3><div>A total of 117 shoulders with a mean follow-up of 60 months (range 24–144) were identified with a mean age of 70 years (range 49–86). Preoperatively, according to Collin classification, the supraspinatus tear with posterior extend (type D: 34%) and with antero-posterior extend (type C: 33%) were the most frequent feature. Preoperatively, according to Hamada classification, there was no osteoarthritis in 32% of cases and proven glenohumeral osteoarthritis in 46% of cases.</div><div>Postoperatively, the mean Active Anterior Elevation improved from 89° ± 41° to 136° ± 33° (p &lt; 0.001). Postoperatively, the mean Constant’s score improved from 29 ± 12 to 61 ± 18 (p &lt; 0.001) and the mean SSV score improved from 26 ± 15 to 71 ± 21 (p &lt; 0.001).</div><div>A greater Constant score was associated with an isolated Supraspinatus tear and a lower Constant score was associated with tears involving the supraspinatus and the Infraspinatus (type D) with also a negative influence on active external rotation.</div><div>In absence of glenohumeral osteoarthritis, the mean Constant score was significatively lower. We also found a significantly lower mean Constant score and mean activity sub-score in younger patients.</div><div>A total of 14 complications (12%) and 8 revision surgeries (7%) were reported.</div></div><div><h3>Discussion/Conclusion</h3><div>Our results are consistent with recent series in the literature on similar indication of rTSA after failed cuff repair, and lower than those of primary rTSA. Association of an infraspinatus tear, absence of glenohumeral arthritis and a younger age were identified as predictive preoperative factors responsible for a lower result. These observations further encourage caution in the indication of a rTSA in the younger patients and in absence of glenohumeral osteoarthritis.</div></div><div><h3>Level of Evidence</h3><div>IV; Case series with no comparison group.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104575"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}