Background:Patients with type II diabetes mellitus (T2DM) undergoing rotator cuff repair (RCR) have increased postoperative risk. Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly used in T2DM, but their perioperative safety remains uncertain. This study evaluated the association between preoperative GLP-1 agonist exposure and postoperative outcomes following RCR. Methods:A retrospective cohort study using the TriNetX Research Network identified adults with T2DM undergoing RCR between 2018 and 2024. Patients were stratified by preoperative GLP-1 agonist exposure. Outcomes included 90-day medical complications, surgical complications, and healthcare utilization. Univariate and inverse propensity score-weighted binary logistic regression were performed to adjust for confounding. Results:Among 5876 patients, 233 used GLP-1 preoperatively. Unadjusted analyses revealed increased odds of postoperative respiratory complications (odds ratio (OR): 1.97, 95% confidence interval (CI): 1.32-2.86, P = 0.0006), urinary tract infection (OR: 3.85, 95% CI: 1.31-9.12, P = 0.0055), and postoperative stiffness (OR: 2.20, 95% Cl: 1.31-3.49, P = 0.0016) among GLP-1 users. After inverse propensity score-weighting, no significant differences in postoperative outcomes were observed. Discussion:Preoperative GLP-1 agonist use was not independently associated with decreased or increased risk of postoperative complications following RCR. These findings suggest perioperative continuation of GLP-1 therapy may be safe, though prospective studies are warranted.
Background:Investigating outcomes following radial extracorporeal shockwave therapy (rESWT) for patients with chronic lateral elbow tendinopathy (tennis elbow). Methods:43 patients with chronic lateral elbow tendinopathy were recruited from a single NHS Sport Medicine clinic. Participants were randomised equally within this double-blinded randomised controlled trial to receive either three sessions of 'therapeutic-dose' or 'minimal-dose' rESWT, respectively, alongside a structured and progressive home exercise programme. Participants: 63% female, 70% affecting the dominant arm, mean age 47.9 ± 8.0 years, symptom duration: 31.7 ± 25.4 months. Maximum six-month follow-up, with interim data at six weeks and three months. Results:Improvements were seen in both groups, but no between-group differences were seen with any measure at any time point, suggesting no benefit from 'therapeutic' levels of extracorporeal shockwave therapy (ESWT) above minimal dosage. Self-reported 'average' pain improved by 27% at six weeks, rising to 40% at three months, and 52% at six months, irrespective of ESWT 'dose'. Improvements were seen across different validated patient-reported outcome measures. Conclusion:This study has not shown superiority of rESWT compared to 'minimal-dose' rESWT in patients with chronic lateral elbow tendinopathy (tennis elbow), when performed alongside a structured progressive loading home exercise programme. This study does not support the use of rESWT performed at the 'maximally comfortably tolerated dose' as per manufacturer recommendations. Level of evidence:Level I - Randomised controlled trial.
Background:Proton pump inhibitors (PPIs) are commonly used perioperatively, but their effect on postoperative total shoulder arthroplasty (TSA) outcomes is unclear. The purpose of this study is to determine the effects of perioperative PPIs on surgical complications following primary TSA. Methods:A retrospective cohort study using TriNetX identified patients undergoing TSA using CPT code 23472. The exposure cohort included patients prescribed a perioperative PPI from seven days preoperatively to two days postoperatively and underwent propensity score matching 1:1 to its nearest neighbor. Surgical outcomes were studied at 3 years. Risk ratios (RRs), 95% confidence intervals (CIs), and p-values were reported. Statistical significance was set at p < 0.05. Results:At 3 years postoperatively, PPI cohort had increased rates of aseptic loosening (1.3% vs. 0.7%; RR 1.9; 95% CI 1.0, 3.6; p = 0.034), dislocation (2.3% vs. 1.3%; RR 1.7; 95% CI 1.1, 2.7; p = 0.017), and revision TSA (3.0% vs. 2.0%; RR 1.5; 95% CI 1.0, 2.2; p = 0.031), and overall complications (5.7% vs. 4.3%; RR 1.3; 95% CI 1.0, 1.7; p = 0.043) compared to matched controls. Conclusion:Perioperative PPI use was associated with increased rates of aseptic loosening, dislocation, and revision TSA through 3 years following primary TSA, suggesting PPI exposure may be an important preoperative risk factor. Level of Evidence:Level III-Retrospective cohort study.
Retear after arthroscopic rotator cuff repair remains a major concern, especially in large, chronic, retracted tears. Although anatomic footprint restoration is preferred, forced lateralization may increase repair tension, compromising fixation mechanics and tendon perfusion. This systematized narrative review synthesizes clinical, biomechanical, cadaveric, and technical evidence on repair tension, footprint coverage, medialization, margin convergence, interval slide procedures, and partial functional repair. A structured PubMed/MEDLINE search was supplemented by targeted publisher searches and citation chaining through April 2026. Evidence suggests that repair tension is measurable, reflects tear severity and imaging risk factors, and may be associated with poorer cuff integrity and reduced tendon microvascular flow. Recent Level III comparative evidence favors tension-reducing repair at 24 months, but measurement methods and thresholds do not support a universal strategy. Complete anatomic repair remains the goal when achievable under acceptable tension. In retracted tears, a tension-aware approach may support selective mobilization, margin convergence, limited medialization, or functional partial repair rather than forced high-tension repair. Medialization refers to bone-bed location, whereas functional partial repair is defined by a planned residual tendon defect. This review proposes a decision framework and provisional tension-aware categories, emphasizing individualized surgical judgment and prospective comparative studies.
Background:Coracoid-based pain is an underrecognized complication after reverse total shoulder arthroplasty (RTSA). The purpose of this study was to determine the prevalence, risk factors, and outcomes of patients with coracoid pain after RTSA. Methods:A case-control study was performed. Patients with coracoid or conjoint tendon tenderness at least 3 months after RTSA were included as cases. Controls without surgical complications and with a minimum 1-year follow-up were matched 3:1 to cases. Patient-reported outcomes were collected retrospectively. Multivariable logistic regression was used to identify risk factors for the development of coracoid pain. Results:67 patients developed coracoid-based pain at a mean time of 10.0 months (range, 3-72 months) after RTSA. The overall prevalence over a 10-year period was 1.0%. Symptoms completely resolved in 33 (49%) patients at a mean time of 4.9 months (range, 1-15 months) with non-operative treatment. On multivariate analysis, osteoporosis, a decreased subcoracoid distance, more anterior glenosphere overhang, and less calcar distalization were significant predictors of coracoid pain. Discussion:Coracoid pain is uncommon and tends to completely resolve in 49% of patients with non-operative measures. It is associated with surgeon factors that decrease the subcoracoid space and humeral arc to impingement.
Objective With the increasing incidence of operatively treated proximal humerus fractures (PHF) and the high prevalence of osteoporosis, it is becoming harder to obtain a stable reduction until the fracture heals. Osteosynthesis augmentation with bone graft (BG) is a proposed solution to this issue. Methods PubMed, Cochrane, and Google Scholar were screened up until December 2025. A sub-analysis by type of graft (biologic [Fibular allograft, femoral head allograft, iliac crest autograft] or synthetic) was performed. Results Five randomized controlled trials (RCTs) met the inclusion criteria with 175 patients in the graft-group and 175 in the control-group, and a mean follow-up of 1.6 years. The graft-group had a lower rate of complications when BG was used (odds-ratio = 0.21; p = . 001) even when sub-analyzing by type of BG. The graft group had a shorter healing time (mean difference = −3.25 weeks; p = . 02) and less pain (mean difference = −0.99; p = . 03) when a biologic graft was used with no difference between the graft-group and control-group in healing time or pain when synthetic graft was used. Conclusion Patients undergoing PHF osteosynthesis with BG had a lower rate of complications. A shorter healing time and less pain was also observed in patients receiving biologic BG with their PHF osteosynthesis. Level of evidence
Background:Reverse total shoulder arthroplasty (RTSA) is increasingly performed in younger patients, yet prior studies frequently include heterogeneous cohorts and revision cases. This systematic review evaluated outcomes of primary RTSA in patients <65 years. Methods:Embase, PubMed, and CENTRAL were queried through October 2025. Methodological quality was assessed using the Newcastle-Ottawa Scale (level III) and NIH Quality Assessment Tool for Case Series (level IV). Random-effects meta-analysis generated pooled estimates for range-of-motion (ROM), patient-reported outcome measures (PROMs), and complication/revision rates. Results:Thirteen studies (nine level III, four level IV; fair-to-good quality) were included. Weighted mean age was 55.4 years (60.9% female; follow-up 2-7.8 years). Forward flexion = 133.2° (95% CI 126-140.4); external rotation = 38.1° (95% CI 32-44.2); abduction = 118.2° (95% CI 111.2-125.2); internal rotation = 3.7 (95% CI 2.7-4.7, 0-7 scale). ASES = 69.5 (95% CI 64.7-74.4); VAS = 2.6 (95% CI 1.3-3.9); Constant-Murley = 62.9 (95% CI 60.3-65.5); SST = 7.5 (95% CI 5.9-9.1); SPADI = 38 (95% CI 33.3-42.7); UCLA = 27.9 (95% CI 26.9-28.8). Complication rate was 13% (95% CI 6%-23%) and revision rate 8% (95% CI 5%-14%), most commonly for instability. Sensitivity analyses demonstrated significant pre-to-postoperative improvements in forward flexion (+46.6°; 95% CI 34.9-58.3) and external rotation (+16.6°; 95% CI 13.6-19.5). Discussion:Primary RTSA in patients <65 years improves ROM and PROMs. Although complication/revision risk increases over time, these findings support RTSA in appropriately selected younger patients and provide benchmarks for outcome counseling.
Context:This cross-sectional study examined whether shoulder pain and muscle strength of kinetic chain components are associated with performance on the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST), Upper Quarter Y Balance Test (UQYBT), and Upper Limb Rotation Test (ULRT) in swimmers. Methods:Sixty-two competitive swimmers (aged 12-60 years; 30 with shoulder pain, 32 asymptomatic) across all competition levels were included. Isometric strength of the scapular protractors, lower trapezius, trunk flexors, Hip Stability Isometric Test (HIPSIT), and knee extensor was assessed. Participants also completed the mCKCUEST, UQYBT, and ULRT. Hierarchical multiple linear regression analyses were conducted to examine the associations between shoulder pain, kinetic chain muscle strength, and upper limb performance tests. Results:The model explained 28% of the variance in mCKCUEST performance, with shoulder pain and HIPSIT reaching statistical significance. Knee extensors and scapular protractors strength were significantly associated with the medial direction of the UQYBT, explaining 35% of the variance. Lower trapezius strength was associated with the superolateral direction (11% of variance), while knee extensor strength was associated with the inferolateral direction (37% of variance). Knee extensors and scapular protractors strength were associated with the composite score (38% of variance). For the ULRT, pain, scapular protractors, knee extensors, and trunk flexors strength showed significant associations, explaining 38% of the variance. Discussion:Shoulder pain and isometric strength of kinetic chain muscles may be associated with performance on the mCKCUEST, UQYBT, and ULRT, highlighting the relevance of kinetic chain assessment in swimmers.
Background:Reverse shoulder arthroplasty (RSA) has evolved through different humeral stem designs to optimize biomechanics and minimize complications. Although inlay and onlay configurations differ in geometry and bone preservation, their clinical outcomes often appear similar. This study aimed to compare clinical, functional, and radiographic outcomes between onlay and semi-inlay humeral stems, hypothesizing that comparable results may be achieved through distinct glenoid and humeral lateralization and distalization patterns. Methods:A retrospective analysis was conducted on 199 patients who underwent primary RSA between January 2021 and January 2024. Radiographic parameters lateralization shoulder angle (LSA), distalization shoulder angle (DSA), glenoid and humeral lateralization angles (GLA and HLA), and glenoid and humeral distalization angles (GDA and HDA) were measured on standardized anteroposterior radiographs. Clinical evaluation included Constant-Murley Score, Simple Shoulder Test, Visual Analog Scale, and range of motion. Statistical comparisons were performed using non-parametric or parametric tests according to data distribution (α = 0.05). Results:At a mean follow-up of 28 ± 8 months, 164 patients met the inclusion criteria (41 semi-inlay; 123 onlay); the groups showed no significant difference in clinical outcomes. Radiographically, semi-inlay stems demonstrated higher glenoid lateralization (GLA 53.31 ± 4.43 vs. 50.26 ± 6.92, p = 0.001) and lower humeral lateralization (HLA 34.52 ± 6.49 vs. 35.62 ± 9.11, p > 0.05), while onlay stems showed greater glenoid distalization (GDA 76.84 ± 12.03 vs. 70.01 ± 8.05, p = 0.001) and lower humeral distalization (HDA 22.04 ± 8.40 vs. 29.95 ± 6.53, p < 0.001). No significant differences were found for global LSA or DSA (p > 0.05). Scapular notching incidence was comparable in the groups. Interobserver reliability for angular measurements was excellent (κ = 0.82). Conclusion:Onlay and semi-inlay RSA designs achieved equivalent clinical outcomes through different biomechanical adaptations. Semi-inlay stems appear to compensate for their intrinsic lower humeral lateralization with increased glenoid lateralization, whereas onlay stems may balance their humeral geometry through greater glenoid distalization. These complementary strategies highlight that, rather than the selection of a specific stem design, it is the achievement of the desired lateralization and distalization obtained through different approaches that is key to successful RSA outcomes.
Background There is no clear consensus as to whether pre-operative biopsies (arthroscopic or open) should be routinely obtained to confirm absence of infection in presumed aseptic revision cases, and practice widely varies. Methods Consecutive patients over a 4-year period from a single centre undergoing a revision shoulder or elbow procedure without evidence or suspicion of infection were included. Electronic patient records were utilised to determine biopsy results, revision procedure and clinical outcome. Results Of 81 patients undergoing a revision shoulder or elbow procedure for presumed aseptic cause, 40 had biopsies taken prior to the revision procedure, with seven positive results (defined as ≥3/5 positive samples). These were treated with oral antibiotics before undergoing revision. At revision, intra-operative biopsies showed that infection had been cleared in 4/7 cases, and new infection was identified in six cases that were previously negative. Of the 41 patients who did not have pre-revision biopsies, 13 were positive at the time of definitive procedure and subsequently successfully treated with oral antibiotics. Discussion Pre-revision biopsy has a low sensitivity (54%) for identifying bacteria in presumed aseptic cases and is not necessarily a benign procedure, with potential risk of introducing infection. Pre-revision antibiotic treatment may not result in negative biopsies at the time of definitive revision.
Background Instability is a major complication after reverse total shoulder arthroplasty (rTSA). This study reports a tertiary centre experience of managing this challenging complication. Methods We retrospectively reviewed a prospectively maintained database of patients treated surgically for a dislocated rTSA between 2013 and 2023, with a minimum follow-up of 12 months. Demographics, indication for the index procedure, timing and cause of dislocation, revision procedures, and persistence of instability were recorded. Results Forty-two dislocated rTSAs were identified. The mean age was 68 years. 30 cases were primary rTSAs and 12 cases were revision rTSAs. Most dislocations occurred early, with 34 of 42 (81%) within 6 weeks. Loss of compression was the commonest mechanism of instability, present in 33 of 42 cases (78.5%). Loss of containment occurred in 12% and impingement in 9.5%. Stability was achieved in 36 of 42 shoulders (86%). Modular component exchange was the most frequent successful revision strategy, used in 20 cases (47.5%). Discussion Dislocation after rTSA most commonly reflects the loss of compression, particularly in the early postoperative period. Modular component exchange restores stability in many cases, but a substantial proportion requires more extensive revision or salvage procedures. Careful identification of the mechanism of instability is essential for guiding treatment.
Background:Hormone replacement therapy (HRT) is commonly prescribed to alleviate symptoms of menopause. Incidence of women undergoing total shoulder arthroplasty (TSA) continues to rise, yet the impact of HRT on primary TSA outcomes remains unclear. The purpose of this study is to examine the effects of HRT on postoperative complications following primary TSA. Methods:The PearlDiver Mariner database was queried for menopausal aged females undergoing primary TSA between 2010 and 2023. Patients with prior history of breast cancer, deep vein thrombosis (DVT), pulmonary embolism, or stroke were excluded. Patients prescribed HRT within 365 days preoperatively were propensity score matched 1:1 to non-users. Chi-square analysis and multivariable logistic regression were used to evaluate associations between HRT use and postoperative complications. Statistical significance was defined as p < .05. Results:HRT users had lower incidence of acute kidney injury (AKI) (p = .02) at 180 days and lower incidence of AKI (p = .03) and pneumonia (p = .04) at 365 days. HRT was found to be independently predictive of decreased rates of AKI (p = .03), UTI (p = .02), pneumonia (p = .01), and transfusion (p = .01) following TSA. Conclusion:HRT was found to be independently associated with reduced medical complications following primary TSA and was not associated with surgical complications following primary TSA. Level of evidence:Level III - Retrospective cohort study.
Aims:It is known that survival of primary total shoulder arthroplasty at 10 years is excellent; however, evidence beyond this time-point is limited. We aimed to evaluate the long-term survival of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) implants, at ≥13 years follow-up, using case series and international joint registry data. Methods:CENTRAL, Embase, and MEDLINE databases were searched for studies reporting TSA survival data at ≥13 years follow-up. National joint registries were contacted for implant data. Pooled survival at 13, 15, and 20 years was calculated for case series and registry data using a random-effects model. Results:Data from four national joint registries and seven studies were analysed. Pooled aTSA registry data showed survival of 91.50% (89.36-93.64) at 13-years and 90.82% (88.25-93.38) at 15-years. Pooled rTSA registry data showed survival of 93.19% (91.78-94.60) at 13-years and 90.74% (85.73-95.74) at 15-years. Data from case series gave pooled aTSA survival estimates of 88.69% (76.97-100.42), 90.23% (85.87-94.58) and 82.08% (70.30-93.88) at 13, 15 and 20 years, respectively. Conclusion:Our analysis suggests approximately 90% of shoulder replacements last up to 15 years without revision. Variation between individual implants highlights the need for granular implant-level data to guide patient and clinician decision making.
Introduction:Long head of the biceps (LHB) tendinopathy a common source debilitating shoulder pain. Biceps tenodesis is reserved for patients who fail conservative management, but the optimal tensioning technique remains unclear. This study compared outcomes following standard anatomic landmark-based versus patient-specific anatomic tensioning. We hypothesized that anatomic tensioning would yield decreased pain and superior patient outcomes. Methods:A single-blinded randomized control trial (RCT) was conducted at a level-1 trauma center between October 2020 and December 2022. One hundred and sixty patients (56% male) were randomized to undergo standard landmark-based (control, 81) or patient-specific anatomic tensioning techniques (intervention, 79). American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and range of motion (ROM) were compared at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year, postoperatively. Results:At final postoperative follow-up, ASES scores, VAS scores, forward flexion, external rotation were similar between cohorts (p = .604, 0.308, 0.171, and 0.726, respectively). At 6 weeks, the intervention group demonstrated higher ASES scores (mean difference, 9.1; 95 CI: [0.1, 18.0]; p = .048). Discussion:Both biceps tenodesis tensioning techniques are acceptable in the management of LHB tendinopathy. Patient-specific tensioning may provide earlier functional improvement for patients desiring accelerated rehabilitation.
Background:Stemless shoulder arthroplasty utilizes epiphysometaphyseal fixation, eliminating the need for humeral canal reaming. Extending stemless technology to reverse total shoulder arthroplasty (rTSA) introduced distinct biomechanical challenges. In the absence of diaphyseal support, concerns regarding humeral component subsidence, varus tilting, and aseptic loosening arise. In the United States, stemless rTSA remains investigational, with the Fx Easytech Reversed system currently under evaluation through an Investigational Device Exemption clinical trial. Methods:Explanted components were submitted to an independent orthopaedic laboratory for systematic, non-destructive analysis comprising high-magnification microscopy. Bony ongrowth was assessed using a non-standardized, semi-quantitative grading scale applied across four fixation surface quadrants (Q1-Q4), estimating tissue coverage from 0 (none) to 4 (75-100%). Results:Bony ongrowth was observed on all three titanium-hydroxyapatite (Ti/HA)-coated humeral anchor bases across implantation durations ranging from 39 days to 3 years and 8 months, with semi-quantitative scores of Q1: 2-4, Q2: 4, Q3: 3-4, Q4: 3. No case was revised for fixation failure. Conclusion:Ti/HA-coated stemless humeral components demonstrated osseointegration under the compressive-dominant loading environment of rTSA. Bony ongrowth was evident as early as 39 days postoperatively. Larger retrieval series and long-term follow-up are necessary to confirm the durability of stemless humeral implants. Level of evidence:Level IV, Case Report.
Background:Structural bone grafting to address glenoid bone defects in reverse shoulder arthroplasty (RSA) has become increasingly common, allowing restoration of lateralization, tilt, and version. Despite its advantages, graft-related radiographic alterations are frequently reported, while mechanical failure remains relatively uncommon. Interpretation of these findings is limited by the absence of standardized methods for postoperative graft evaluation. Methods:This systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, and Google Scholar were searched up to February 8, 2026. Studies evaluating structural glenoid bone grafting in RSA with postoperative radiographic assessment of graft incorporation or failure were included. Two reviewers independently screened studies and extracted data regarding patient characteristics, graft features, imaging modalities, radiographic criteria, and graft-related complications. Methodological quality was assessed using the Newcastle-Ottawa Scale and RoB 2 tool. Results:Nineteen studies including 962 shoulders were analyzed. Radiographic assessment was reported at the latest available follow-up, with a mean of 40 months but ranging widely across studies (7 to 152 months). Standard radiographs were the most used imaging modality, followed by CT. Radiographic evaluation criteria were heterogeneous, most frequently based on radiolucent lines, graft thickness changes, or graft lysis. Radiographic signs suggestive of graft resorption were observed in 6.3% of shoulders, whereas graft failure associated with mechanical loosening occurred in 1.9%.Scapular notching was reported in 32.8% of cases. Discussion:Postoperative graft evaluation remains highly variable across studies, relying predominantly on qualitative radiographic parameters without standardized definitions. Importantly, radiographic signs suggestive of graft resorption were observed in 6.3% of cases, whereas true mechanical failure occurred in only 1.9%, indicating that many radiographic changes may reflect biological remodeling rather than clinically significant compromise.
Background:Articular cartilage defects of the glenohumeral joint are challenging in young, active patients, where microfracture-a common first-line marrow-stimulation technique-has uncertain efficacy and long-term durability in the shoulder. This study evaluates the clinical outcomes of patients undergoing treatment with microfracture for chondral lesions of the glenohumeral joint. Methods:A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Cochrane Library were searched through January 2026. Patient-reported outcomes (PROs), reoperation rates, complications, and radiographic outcomes were assessed. Results:Eight Level IV studies comprising 171 shoulders met the inclusion criteria. Mean age was 50.4 years with a 97.5-month follow-up. Significant improvements occurred in the American Shoulder and Elbow Score (+20.3 points), Visual Analogue Scale for pain (-2.2 points), and Single Assessment Numeric Evaluation scores. Pooled reoperation rate was 20.9% (95% CI 14.2-29.7%). No procedure-related complications were reported. Two studies noted radiographic progression of osteoarthritis despite clinical improvement. Discussion:Microfracture provides consistent short- to mid-term improvements in PROs and appears safe for glenohumeral cartilage defects. However, the evidence is limited to Level IV studies, and concerns remain regarding long-term durability and progression of osteoarthritis.
Avulsion fractures of the coracoid process at the coracoclavicular ligament attachment are extremely rare and typically occur as part of a double disruption of the superior shoulder suspensory complex. No previous reports have included longitudinal imaging assessments or patient-reported outcome measures (PROMs) for this fracture pattern. We describe a 59-year-old man with a distal clavicle fracture associated with an avulsion fracture at the coracoid base involving the conoid ligament. Surgical fixation was performed using a CW plate for the clavicle and a suture anchor for the coracoid fragment. Progressive healing was observed at 3 months, and complete union was achieved by 6 months. At 12 months, the patient demonstrated excellent functional recovery with full PROMs. This case suggests that anatomical reconstruction may be a reasonable treatment option.
Purpose:This study compared clinical outcomes after arthroscopically assisted middle trapezius tendon (MTT) transfer for irreparable supraspinatus tears (ISTs) between patients with Hamada grade 1 (acromiohumeral distance (AHD) > 6 mm) and those with Hamada grade 2 (AHD ≤ 6 mm). Methods:A retrospective review was conducted of patients who underwent MTT transfer for ISTs between December 2019 and November 2023. Inclusion criteria included symptomatic tears with severe retraction, advanced fatty infiltration, and minimal glenohumeral osteoarthritis. Clinical outcomes assessed were visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant score, range of motion (ROM), and muscle strength, while radiographic evaluation included AHD and Hamada grade. Results:Of 124 eligible patients, 112 were analyzed after excluding 12 for incomplete data or loss to follow-up, including 92 with Hamada grade 1 (mean follow-up, 30.6 ± 14.8 months) and 20 with grade 2 (28.6 ± 12.3 months). Both groups showed significant improvements in VAS, ASES, constant scores, forward elevation, and abduction (all p < .001), with no significant between-group differences in pain, functional scores, ROM, or strength at final follow-up (all p > .05). Despite between-group differences in AHD and Hamada grade, AHD did not change significantly within either group. Conclusion:MTT transfer provides significant pain relief and clinical improvement in patients with ISTs, regardless of preoperative AHD. Postoperative pain, functional scores, ROM, and muscle strength were comparable between Hamada grade 1 and Hamada grade 2 patients at final follow-up. Level of Evidence:IV, retrospective case series.
