Background: This study aimed to evaluate the long-term clinical and radiological outcomes in patients undergoing semi-constrained total elbow arthroplasty (TEA). Postoperative complications and implant survival rates were also investigated. Methods: Of 68 patients who underwent primary semi-constrained TEA, data from 62 with a minimum follow-up of 5 years were analyzed. The mean follow-up duration was 117.1 months (range, 60–246 months). Forty-one patients had posttraumatic conditions, 11 had rheumatoid arthritis, and 10 had osteoarthritis. Clinical outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and Oxford Elbow Score (OES), whereas radiological outcomes were analyzed using radiolucent lines and bushing wear. Kaplan-Meier survival analysis was used to determine the implant survival rate. Results: At the final follow-up, the MEPS and OES were 88.2 (range, 55–100) and 31.6 (range, 22–42), respectively. Radiolucency of type 3 or 4 was observed on the humeral side in four patients and on the ulnar side in three patients. Grade 1 and 2 bushing wear was present in seven and three patients, respectively. The total complication rate was 25.8% (16/62), and the reoperation rate was 17.7% (11/62). Four patients underwent reoperation for periprosthetic infection after previous open reduction and internal fixation for acute fractures. In addition, three patients underwent hinge system change for hinge dissociation, four sustained periprosthetic fractures, one underwent revision TEA for gross loosening, and one underwent open repair for triceps rupture. Kaplan-Meier survival analysis revealed that the 5-, 10-, and 15-year survival rates of the implants were 100%, 92.8%, and 77.5%, respectively. Conclusions: Clinical and radiological outcomes of primary semi-constrained TEA were reasonably good at a mean 10-year follow-up. Type 3 or 4 radiolucency was observed in seven patients and complete bushing wear in three patients, while the 10-year implant survival rate was 92.8%. Level of evidence: IV.
Background: Superior capsule reconstruction (SCR) using the long head of the biceps tendon (LHBT) is a joint-preserving option for large-to-massive rotator cuff tears, but predictors of graft retear remain incompletely characterized. We aimed to identify preoperative clinical and imaging predictors of retear after arthroscopic LHBT-SCR. Methods: A retrospective pilot case-control study was conducted at two tertiary orthopedic centers. Cases had confirmed graft retear (Sugaya type IV–V on postoperative magnetic resonance imaging); controls had an intact graft and were sampled at an approximate 2:1 ratio. Forty patients were included and followed for a median of 24 months (range, 12–26 months). Preoperative variables included age, sex, tear dimensions, Hamada grade, Goutallier grade, and functional scores (Constant-Murley, American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA]). A forced-entry multivariable logistic model with three predictors was fitted; thresholds were derived using the Youden index. Results: Fourteen cases and 26 controls were identified. Preoperative Constant-Murley (median, 23.1 vs. 35.1; P=0.014), ASES (25.8 vs. 35.0; P=0.020), and UCLA (9.0 vs. 11.0; P=0.021) scores were lower in the retear group. Tear morphology did not differ between groups. The multivariable model (ASES, Goutallier grade, forward elevation; complete-case n=38) achieved an apparent area under the curve (AUC) of 0.811 (bootstrap optimism-corrected AUC, 0.754). Despite structural failure, both groups achieved equivalent functional recovery, with all patients exceeding their minimal clinically important differences. Conclusions: Preoperative functional impairment was the primary correlate of graft retear after LHBT-SCR. Prospective validation in a larger case-control study (target n=132) is warranted. Level of evidence: IV.
Background: We compare clinical and radiological characteristics and evaluate surgical outcomes of posterior labral tears based on the presence of glenohumeral instability. Methods: Patients who were unresponsive to conservative treatment and underwent arthroscopic posterior labral repair were reviewed retrospectively. Patients were divided into two groups: those with glenohumeral instability (group 1) and those without (group 2). Demographic, radiological, physical examination, and intraoperative data were collected. Clinical outcomes were assessed at a minimum 2-year follow-up using the visual analog scale for pain, American Shoulder and Elbow Surgeons, and Rowe scores. Results: The study included a total of 85 patients (40 in group 1 and 45 in group 2) with a mean follow-up duration of 31.8±12.2 months. Patients in group 2 were older (31.4±1.0 years old, P<0.001), had longer symptom durations (30.1±5.6 months, P=0.002), and included fewer histories of trauma (16 patients, P=0.009). Competitive sports were more common in group 1 (9 patients, P=0.005), whereas weightlifting exercises were more common in group 2 (24 patients, P=0.047). Magnetic resonance imaging (MRI) underestimated incomplete posterior labral tears more frequently in group 2 than in group 1 (P=0.033). The incidence of arthroscopically detected tears among MRI-occult tears was higher in group 2 (10 patients) than in group 1 (2 patients, P=0.029). Statistically significant improvements in shoulder function were observed postoperatively in both groups. Conclusions: Clinical and magnetic resonance findings of posterior labral tears without glenohumeral instability differ from those with instability. Surgical treatment achieved satisfactory clinical outcomes regardless of the presence of instability. Level of evidence: III.
Background: This study aimed to compare intraoperative visualization between diluted epinephrine (EPN) irrigation and preoperative intravenous tranexamic acid (TXA) during the glenohumeral and subacromial phases of rotator cuff repair. Methods: Eighty-two patients with rotator cuff tears were prospectively randomized (1:1) to receive either 0.33 mg/L EPN irrigation without TXA (EPN group) or preoperative intravenous TXA (15 mg/kg) without EPN irrigation (TXA group). Visual clarity was evaluated using a pretrained deep learning model with a 3-point grading scale across three stages: intra-articular assessment, subacromial debridement, and rotator cuff repair. Irrigation pump pressure was recorded at each stage. Hypotensive bradycardic events (HBEs) and postoperative adverse events were monitored. Results: Overall visual clarity was significantly greater in the EPN group than in the TXA group (mean difference [MD], 0.07; 95% CI, 0.03–0.10; P<0.001). Visualization was superior with EPN during subacromial debridement (MD, 0.08; 95% CI, 0.03–0.13; P=0.001) and rotator cuff repair (MD, 0.03; 95% CI, 0.004–0.06; P=0.02). The EPN group required lower pump pressures and fewer increases in pressure. No significant differences in HBEs or adverse events were observed. Conclusions: Diluted EPN irrigation improved intraoperative visualization compared with TXA, particularly during the subacromial phases, without increasing perioperative risk. Deep learning provided objective support for its clinical use. Level of evidence: II.
BACKGROUND:Management of the coronoid fracture in terrible triad injuries (TTI) of the elbow remains controversial. We compared outcomes of TTI patients with versus without coronoid fixation. METHODS:We retrospectively analyzed 105 TTI patients; 59 patients with no fixation (group 1) and 46 patients with coronoid fixation (group 2). Complications, revisions, range of motion (ROM) and functional scores (Mayo Elbow Performance Score [MEPS], Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Subjective Elbow Score [SES]) were assessed. Stratified analyses using t-tests and Fisher's exact tests with Cohen's d were performed according to O'Driscoll (OD) subtype (type 1 tip, type 2 anteromedial facet, and type 3 basal). RESULTS:Baseline OD distribution differed substantially between groups 1 and 2 (type 1: 79.7% vs. 34.8%, respectively; type 2: 18.6% vs. 58.7%, respectively; P<0.001). Follow-up timing was comparable between the two groups (first, 4.4 vs. 4.1 months; final, 3.0 vs. 2.8 years). In the whole cohort, group 2 patients showed greater flexion (P=0.030), pronation and supination (both P<0.001), and better MEPS (P=0.032), QuickDASH (P=0.027) and SES (P=0.044) than group 1 patients. Stiffness (22.0% vs. 2.2%, P=0.003) and revision surgery rates (30.5% vs. 10.9%, P=0.018) were significantly higher in group 1 than in group 2. Within OD type 2, fixation was associated with significantly greater flexion (P=0.001), pronation (P=0.005), and supination (P<0.001), and lower rates of nonunion (9% vs. 50%, P=0.046) and posttraumatic osteoarthritis (5% vs. 50%, P=0.025) than non-fixation. CONCLUSIONS:OD type 2 fractures repaired with coronoid fixation showed greater ROM and lower complication rates than these types of fractures repaired without coronoid fixation. Within OD type 1, coronoid fixation did not show any significant benefits compared to no fixation. Level of evidence: III, retrospective cohort study.
