Objectives: Reverse shoulder arthroplasty (RSA) is increasingly used for rotator cuff arthropathy, glenohumeral arthritis, and irreparable rotator cuff tears. Scapular notching, erosion of the inferior scapular neck from prosthetic impingement, is graded using the Nerot-Sirveaux classification. This study aimed to determine the incidence and severity of scapular notching after RSA in an Asian population, identify factors predictive of its occurrence, and evaluate its effect on functional outcomes. Age, sex, glenoid height, and implant neck-shaft angle were assessed as candidate predictors given their influence on glenosphere positioning and impingement risk. Material and Methods: This was a retrospective cohort study of all patients who underwent primary RSA at a single institution by a single surgeon between January 2011 and December 2019 (IRB-approved; consent waived). Patients with rotator cuff arthropathy, primary glenohumeral osteoarthritis, post-traumatic glenohumeral arthritis with rotator cuff tear, or humeral head avascular necrosis were included; those with fracture non-union, malunion, or revision RSA were excluded. In total, 142 shoulders in 137 patients (5 bilateral) met these criteria and were analyzed, with 1-year follow-up. Post-operative radiographs were graded for notching using the Nerot- Sirveaux system, and outcomes were compared using the Constant, UCLA, and Oxford Shoulder scores and range of motion. Results: Scapular notching occurred in 25 of 142 shoulders (17.61%; 95% CI, 11.73%-24.88%) within 1 year (Grade 1, n=14; Grade 2, n=6; Grade 3, n=4; Grade 4, n=1). Notching was not significantly associated with age, sex, glenoid height, or implant neck-shaft angle; 1-year forward flexion and abduction were similar between groups. At 2 years, shoulders without notching had significantly better median Constant ( p <0.001), UCLA ( p <0.046), and Oxford Shoulder ( p <0.001) scores than those with notching. Conclusion: Scapular notching occurred in approximately 1 in 6 shoulders after RSA in this Asian cohort. While it did not affect early range of motion, notching was associated with significantly poorer functional outcomes at 2 years, supporting strategies to minimize its occurrence.
Objectives: Revision anterior cruciate ligament reconstruction remains technically challenging, and graft selection may influence early postoperative recovery. The rectus femoris tendon has recently been proposed as an autologous graft option, particularly in patients with previous hamstring harvest. However, its impact on early neuromuscular recovery remains poorly documented. Hypothesis: Rectus femoris tendon harvest for revision anterior cruciate ligament reconstruction is not associated with increased early postoperative morbidity and may allow satisfactory early neuromuscular recovery. Material and Methods: This retrospective single-center comparative study included 50 consecutive patients who underwent anterior cruciate ligament reconstruction between August 2025 and February 2026. Twenty-five patients underwent revision anterior cruciate ligament reconstruction using a rectus femoris tendon autograft, and 25 underwent primary anterior cruciate ligament reconstruction using hamstring tendon autografts. The primary outcome was the arthrogenic muscle inhibition grade at postoperative day 21. Surface electromyography of the vastus medialis on day 21 was also assessed. Secondary outcomes included tourniquet time, postoperative pain, hematoma, knee range of motion, and complications. Results: At day 21, absence of arthrogenic muscle inhibition (grade 0) was more frequent in the rectus femuris group than in the hamstring group (28% versus 0%; p = 0.0096), whereas grade 2A inhibition was more frequent in the hamstring group (48% versus 20%; p = 0.04). The quadriceps activation ratio on surface electromyography tended to be higher in the RF group (0.65 ± 0.15 versus 0.52 ± 0.18), without reaching statistical significance ( p = 0.07). Tourniquet time was longer in the rectus femoris group (49.1 ± 10.6 min versus 29.4 ± 5.4 min; p < 0.001), with no significant between-group differences in postoperative pain, hematoma, extension deficit, or complications. Associated meniscal lesions were similarly frequent overall in both groups (60% vs 52%), although ramp lesions were significantly more frequent in the RF group (44% vs 8%; p = 0.008). Conclusion: In this exploratory comparison, rectus femoris tendon harvest in revision anterior cruciate ligament reconstruction was not associated with increased early postoperative morbidity and was associated with less arthrogenic muscle inhibition at 3 weeks, despite longer operative time. However, interpretation of these findings should remain cautious because the comparison involved non-equivalent groups, with revision procedures in the reduction femoris group and primary procedures in the hamstring group. Rectus femoris tendon harvest appears to be a safe autograft option in revision anterior cruciate ligament reconstruction, with no increase in early postoperative morbidity in this series. Level of evidence: Level III, retrospective comparative study
Objectives: Revision total knee arthroplasty (rTKA) is inherently challenging but further complicated in instances of excessive bone loss. Revision cones, particularly newly designed 3-dimensional (3D) titanium constructs, are one of the options currently available to address bony defects. This study aimed to report on the minimum one- year survivorship of a newly released rTKA cone, hypothesizing that the survivorship of the construct would be favorable. Material and Methods: A previously described cohort of 24 patients having received either femoral or tibial cones with a matching knee arthroplasty system was assessed at a minimum one-year follow-up. Data collected included the cone location (femoral or tibial), demographics including age, sex, and body mass index (BMI), reoperations, cone survivorship, and patient-reported outcomes (PROs), including the Knee Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and visual analog scale (VAS). Data was assessed using student’s t-tests, with p < 0.05 indicating statistical significance. Results: The cohort of 24 patients was 16 (66.7%) females, with a mean age of 68.4 ± 7.7 years old and a BMI of 32.1 ± 4.7. The mean follow-up was 17.5 ± 5 months (range: 12, 26). At the time of follow-up, no patients had experienced any reoperations or revisions, demonstrating 100% survivorship of the cone construct. Regarding PROs, statistically significant improvements were noted in both the KOOS JR (mean change, +12.4 points; 95% CI, 4.6–20.1; p =0.0041) and VAS (mean change, −20.6 points; 95% CI, −36.8 to −4.4; p =0.0164) at one year compared to preoperative scores. Conclusion: This study reports on the durability and feasibility of a newly designed rTKA cone, which is, to our knowledge, the longest timepoint of reporting for this particular device. Additionally, this study supports the existing body of literature on other similarly designed (3D printed titanium) constructs.
Wound dressings are an essential component to orthopedic surgical procedures as they allow for facilitation of wound healing and reduction of surgical site infections. Different dressings may be utilized, each with various compositions and subsequent risks, benefits, and costs. Allergic contact dermatitis (ACD) remains an important risk with the use of surgical dressingsrisk of surgical site infection. While ACD results from a hypersensitivity reaction to the ingredients found in wound dressings may lead to increased risks of reaction. Through a search of the current literature, this review aims to highlight the risk of ACD with the use of three notable surgical dressings including cyanoacrylate mesh, silver-based, and silk-fibroin dressings. It was observed that cyanoacrylate mesh dressings were identified to have higher risks of ACD compared to silver-based dressings and that silk-fibroin dressings were found to have no reported risk of ACD. While the risks of ACD across dressing types may differ, infection prevention, cosmesis, or overall postoperative outcomes may influence final dressing selection.
Objectives: Intrathecal baclofen (ITB) therapy is widely used to manage spasticity in cerebral palsy (CP), yet its relationship to scoliosis progression remains debated. This study examined whether ITB therapy accelerates curve progression or affects outcomes after spinal fusion in neuromuscular scoliosis. Material and Methods: We reviewed 64 patients with CP who underwent spinal fusion between 2018 and 2021, divided into ITB ( n= 19) and non-ITB ( n= 45) cohorts. For patients with a preexisting ITB pump, we additionally recorded age at time of pump implantation and mean age at implantation was 9.7 years ± 3.1. Cobb angle at the time of pump implantation and baclofen therapy dosage could not be compared due to incomplete and inconsistent data availability. Cobb angles were measured at two preoperative time points (mean interval 31.6 months) to determine annual curve progression. Postoperative outcomes included curve correction, percent correction, length of stay, operative time, and surgical site infection (SSI). Groups were compared using independent samples t-tests and Fisher's exact test. Results: Mean age was 13.1 years; 39 (62%) were female. Baseline characteristics were well matched. Annual curve progression was similar between cohorts (17.0° ± 15.6° vs. 15.8° ± 9.9°/year, p= 0.73). Postoperative correction did not differ significantly (−42.5° ± 19.0° vs. −48.4° ± 19.3°, p= 0.28), nor did percent correction (47.3% vs. 56.1%, p= 0.09), length of stay (9.5 vs. 11.5 days, p= 0.56), or operative time (6.96 vs. 7.28 hours, p= 0.44). SSI rates were low in both groups (5.3% vs. 8.9%, p= 1.0). Conclusion: No significant difference in scoliosis progression or worse surgical outcomes in this population was identified between patients with ITB therapy and without ITB therapy. However, given the limited sample size these findings should be considered preliminary.
