Introduction Postoperative shoulder stiffness (POSS) is one of the most common complications following arthroscopic rotator cuff repair (ARCR) and is thought to be caused by pathological changes in the anterosuperior soft-tissue structures of the glenohumeral joint. The aim of this study was to determine whether objective ultrasonographic evaluation can predict the occurrence of POSS at one year after surgery and to investigate the reliability of a newly developed ultrasonographic measurement method. Methods This retrospective cohort study included patients who underwent ARCR at a single institution between April 2017 and June 2018. Ultrasonographic external rotation (UER) and the subscapularis (SSC) sliding rate, representing anterosuperior soft-tissue sliding mobility assessed by ultrasonography, were evaluated at 1 and 3 months postoperatively. POSS was defined as passive external rotation <30° and forward elevation <120° at 12 months. Patients were assigned to one of the two groups: Group N (without POSS) or Group S (with POSS). Propensity score matching was performed to minimize baseline differences between groups. UER and SSC sliding rate were compared between the groups. Receiver operating characteristic (ROC) curve analysis was also used to determine predictive thresholds values for POSS at 12 months after surgery, and intra- and inter-rater reliability were assessed using intraclass correlation coefficients (ICCs). Results After propensity score matching, 40 shoulders (20 per group) were analyzed. The SSC sliding rate at 1 and 3 months and UER at 3 months were significantly greater in Group N than in Group S. The greatest between-group difference was observed for the SSC sliding rate at 1 month postoperatively. Regarding ROC curve analysis, the thresholds for POSS at one year postoperatively were 48% for the SSC sliding rate at 1 month after surgery, 38% for the SSC sliding rate at 3 months postoperatively, and 7° for UER at 3 months postoperatively. Reliability analysis showed substantial to almost perfect intra- and inter-rater reliability for both SSC sliding rate and UER. Conclusion Early postoperative ultrasonographic evaluation is useful for predicting the development of POSS at one year after ARCR. Reduced SSC sliding rate and limited UER in the early postoperative period were significantly associated with subsequent POSS. Level of Evidence Level III, Retrospective Cohort Design, Prognosis Study
Background As the use of artificial intelligence (AI) expands into orthopaedic surgery, the potential to use AI for review and summation of literature leaves researchers and clinicians questioning the quality of AI-driven literature reviews. This study aims to compare AI-generated literature reviews to those done by orthopaedic surgery trainees. Methods ChatGPT-4o and The-Literature, a directed AI platform, were asked to produce a literature review on 5 shoulder and elbow related research topics. The primary output produced by ChatGPT-4, The-Literature, a fourth-year medical student, a third-year orthopaedic surgery resident, and an orthopaedic surgery sports medicine fellow were blinded then graded on a 1-5 Likert Scale for evidence and analysis, conclusion, references, and overall quality by two fellowship-trained orthopaedic shoulder and elbow surgeons. Results The average overall Likert ratings were 2.90 ± 0.88 for the medical student, 3.90 ± 0.74 for the resident, 3.50 ± 0.53 for the fellow, 2.30 ± 1.16 for ChatGPT-4 and 3.40 ± 0.84 for The-Literature. The resident and fellow reviews were significantly better than ChatGPT-4 (P=0.0004, P=0.0209), while the medical student review was not (P=0.5092). None of the trainee reviews were significantly better than The-Literature. The-Literature’s reviews were significantly better than ChatGPT-4 (P=0.0412). The majority (58.8%) of ChatGPT-4’s references were fabricated. Conclusion A limited and directed AI search program was comparable to orthopaedic surgery trainees and performed better than an open AI Large Language Model. ChatGPT-4 had poor overall utility stemming mainly from its tendency to fabricate references.
Background: Humeral torsion is an important factor for reverse total shoulder arthroplasty planning, yet its measurement requires elbow imaging frequently absent from clinical computed tomography (CT) scans. We hypothesized that a deep learning approach could accurately predict humeral torsion from proximal humerus morphology alone. Methods: CT-based segmentations from 581 shoulders were used to train and evaluate a deep learning model within the nnU-Net framework. The transepicondylar axis was represented as a full 3-dimensional plane extending throughout the imaging volume. The model was trained on 478 cases and tested on 103, with ground-truth torsion derived from elbow segmentations. Robustness to osteophytes and reduced fields of view was assessed. Results: The model achieved a mean absolute torsion prediction error of 5.35° ± 3.96° and a strong linear correlation with ground-truth measurements (R = 0.85), outperforming prior proximal landmark-based approaches (R = 0.33–0.42). Performance was robust to osteophytes (mean error: 6.19° ± 3.95°) and was maintained with proximal field of view reductions down to 25% of humeral length, beyond which accuracy progressively declined. Conclusion: Deep learning can predict humeral torsion directly from proximal humerus morphology with clinically relevant accuracy, reducing the need for distal elbow imaging. These findings support the hypothesis that torsional alignment is largely encoded in the proximal epiphysis and offers a practical solution for reverse total shoulder arthroplasty planning when full-length CT is unavailable.
Background Subacromial pain is associated with substantial individual burden and healthcare costs. Exercise rehabilitation can be delivered either at home or under physiotherapist supervision. This study investigated whether home-based exercise rehabilitation was associated with increased long-term secondary healthcare utilisation compared with supervised exercise rehabilitation. Methods A total of 208 participants were randomised to home-based, group-based supervised, or individually supervised exercise rehabilitation. For this secondary analysis, the two supervised groups were pooled and compared with the home-based group. The outcomes were shoulder-related secondary healthcare contacts and shoulder surgery during the 5-year follow-up. Associations were analysed using logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results During the 5-year follow-up, 22/71 participants (31%) in the home-based group and 45/137 (33%) in the supervised group had a shoulder-related secondary healthcare contact (adjusted OR 0.91; 95% CI 0.52–1.61). Shoulder surgery was recorded in 14/71 participants (20%) in the home-based group and 24/137 (18%) in the supervised group (adjusted OR 1.16; 95% CI 0.42–3.22). Conclusion In this 5-year register-based follow-up of a randomized controlled trial, we found no evidence of increased shoulder-related secondary healthcare contacts or surgery following home-based compared with supervised exercise rehabilitation for subacromial pain. However, the estimates were imprecise and should be interpreted with caution. These findings support home-based exercise as a potentially scalable rehabilitation strategy, although larger studies are needed to confirm long-term healthcare utilisation outcomes. Level of Evidence Level II, Randomized Controlled Trial, Treatment Study
BACKGROUND Utilization of radial head arthroplasty (RHA) has increased in recent years, but national age-specific trends in ambulatory RHA use in the United States have not been described. The purpose of this study was to evaluate national trends in ambulatory RHA by age. METHODS The Nationwide Ambulatory Surgery Sample (2016–2022) was used to identify adults (≥20 years) undergoing ambulatory RHA for isolated acute radial head or neck fractures. Patients were stratified by age (20–39, 40–59, and ≥60 years). Descriptive statistics and sample-weighted regression models were used to assess temporal trends and factors associated with younger age at surgery. Age- and sex-adjusted national incidence rates were calculated using negative binomial regression. RESULTS A weighted total of 13,453 patients were identified, of which 20.3% were young (20–39 years), 35.9% middle-aged (40–59 years), and 43.9% elderly (≥60 years). Annual ambulatory RHA volume increased from 1,657 cases in 2016 to 2,289 cases in 2022 (+38.1%). The greatest relative increase occurred in young patients (+58.2%), compared with elderly (+47.0%) and middle-aged (+19.5%) patients. Age- and sex-adjusted incidence increased significantly in young patients (0.45 to 0.54 per 100,000; IRR 1.21, 95% CI 1.05-1.39; p=0.009) but stayed stable in elderly patients. Young patients undergoing RHA were more likely to be male (female OR 0.32, 95% CI 0.28-0.35; p<0.001), have lower household income (highest vs lowest quartile OR 0.54, 95% CI 0.45-0.64; p<0.001), and be treated at urban teaching hospitals (OR 1.49, 95% CI 1.29-1.72; p<0.001) and in the Western region (OR 1.28, 95% CI 1.09-1.49; p=0.003). CONCLUSIONS Overall ambulatory RHA utilization in the United States increased from 2016 to 2022, most significantly in young adults. These findings demonstrate increasing ambulatory utilization of RHA among young adults and highlight the need for longitudinal studies evaluating implant durability, revision risk, and functional outcomes in this population. Whether this trend reflects changes in treatment patterns, referral practices, outpatient migration, or other factors also warrants further investigation. Level of Evidence Level IV, Descriptive Epidemiology Study
Background Postoperative pain following arthroscopic rotator cuff repair (ARCR) is highly variable. While some patients require strong analgesia, including opioids, others report minimal discomfort. Identifying predictors of low pain early after surgery may help tailor analgesic strategies and anticipate functional outcomes. Purpose To identify independent predictors of low pain at one month after ARCR and to evaluate whether early low pain predicts a more favorable clinical course during the first postoperative year. Methods A retrospective single-center, single-surgeon study included 178 patients who underwent primary ARCR between 2022 and 2023. Patients with partial or revision repairs, patch augmentation, tendon transfers, or isolated subscapularis tears were excluded. Low pain was defined as a visual analog scale (VAS) ≤3 at one month without analgesic use. Multivariate logistic regression identified predictors of low pain. Clinical outcomes (Constant score, ASES, SSV, ROM, strength, VAS), return to work/sport, complications, and revisions were compared between patients with and without low pain. Propensity score matching (1:1) was performed to reduce confounding. Results Three independent predictors of low pain at one month were identified: absence of subscapularis tendon involvement (p=0.03), absence of preoperative analgesic use (p=0.001), and lower baseline VAS pain score (p=0.049). Patients with low pain at one month (n=58; 32.6%) had significantly higher Constant, ASES, and SSV scores, as well as lower VAS pain at all postoperative time points up to one year (p<0.05 for all). At one year, between-group differences exceeded the minimal clinically important difference for all PROMs. No differences were observed in return-to-work, return-to-sport, complication, or revision rates. Conclusion Low pain at one month after ARCR was independently associated with absence of subscapularis involvement, absence of preoperative analgesic use, and lower baseline pain. Patients experiencing early low pain follow a consistently more favorable clinical trajectory, achieving superior functional outcomes throughout the first postoperative year.
Background Ultrasound-guided interscalene block (ISB) is a common anesthesia technique for shoulder surgery. However, its effective area remains unclear. Therefore, this study aimed to evaluate the specific area in the proximal aspect of the shoulder affected by ultrasound-guided ISB. Methods A total of 100 consecutive patients who underwent arthroscopic rotator cuff repair under ultrasound-guided ISB in a single institution were included in this study. The effective area of the block was investigated using a pinprick test after surgery along seven uniquely preset lines: line A extended from the anterolateral corner of the acromion proximally to the proximal edge of the clavicle, line B extended from the coracoid proximally and parallel to line A, line C extended from the coracoid inferiorly and vertically to line B, line D was the bisector of lines B and C, line E extended from the posterolateral corner of the acromion proximally along the scapular spine, line F extended from the posterolateral corner of the acromion inferiorly and vertically to line E, and line G was the bisector of lines E and F. The ratio of the effective range to the distance between the anterolateral corner of the acromion and the proximal edge of the clavicle (A-P distance) was calculated to standardize the physical differences among patients. Results Of the 100 patients, 3 demonstrated ineffective supraclavicular nerve block, and 59 required local anesthesia on the portal sites in addition to ISB. The average measurements and ratios of the remaining 38 patients were 129.2 ± 36.2 mm and 0.69 ± 0.18 in line A, 106.8 ± 25.5 mm and 0.57 ± 0.13 in line B, 62.4 ± 15.1 mm and 0.34 ± 0.09 in line C, 80.8 ± 22.3 mm and 0.44 ± 0.12 in line D, 65.8 ± 19.3 mm and 0.36 ± 0.11 in line E, 58.2 ± 14.7 mm and 0.31 ± 0.08 in line F, and 58.7 ± 16.1 mm and 0.32 ± 0.09 in line G, respectively. The variability of the ratio was significantly higher in lines A, B, and D than in lines C, E, F, and G. Conclusion This study demonstrated the effective area in the proximal aspect of the shoulder induced by ultrasound-guided ISB. The effective range in the supraclavicular nerve area is highly variable. These findings can help surgeons determine the range of skin incisions and portal sites for arthroscopic shoulder surgery. Level of evidence Level IV, Case Series, Treatment Study
Background:Osteochondritis dissecans (OCD) of the capitellum is a cartilage and subchondral bone disorder predominantly affecting young, physically active individuals. While established surgical techniques such as microfracturing and osteochondral autograft transfer offer acceptable outcomes, limitations in cartilage quality or procedural invasiveness remain. Autologous chondrocyte implantation (ACI) has been proposed as a less invasive, biologically restorative alternative, though clinical data on its use in the elbow are not available. Therefore, the aim of this pilot study was to evaluate the feasibility of ACI for the treatment of elbow OCD in a case series. Methods:In this prospective observational study, 6 male patients (20.5 ± 5.2 years) with centralized International Cartilage Research Society grade IV OCD lesions of the capitellum were included and treated with ACI. Clinical evaluations were performed at 6 months (T1), 12 months (T2), and 34.8 ± 7.9 months (T3) post-operatively, including assessment of range of motion, subjective elbow value, visual analog scale for pain, Mayo Elbow Performance Score, Kerlan-Jobe Orthopaedic Clinic score, and return to sport. Magnetic resonance imaging was conducted at T2 and T3, and cartilage repair tissue was analyzed using the magnetic resonance observation of cartilage repair tissue 2.0 Ankle Score. Results:Improvements were observed across all clinical outcome measures. Subjective elbow value increased from 59 ± 18.5% pre-operatively to 91.2 ± 4.2% at final follow-up, while visual analog scale under load decreased from 6.5 ± 1.6 to 0.8 ± 0.7. Mayo Elbow Performance Score and Kerlan-Jobe Orthopaedic Clinic improved from 70.6 ± 17.7 to 97.5 ± 6 and from 38.3 ± 10 to 88.5 ± 8.4, respectively. Magnetic resonance imaging demonstrated defect filling and integration in all individuals, as assessed by the magnetic resonance observation of cartilage repair tissue score, which showed no deterioration between T2 and T3. The mean return to sport time was 6.8 ± 3 months. No complications or need for revision surgery were recorded. Conclusion:This pilot feasibility study provides preliminary insights into the treatment of centralized capitellar OCD lesion with ACI in a case series of young, active patients, with clinical and radiological findings at a mean 3-year follow-up (range, 25-42 months). These exploratory findings suggest that ACI may warrant further investigation for focal, symptomatic elbow defects with minimal or limited involvement of the subchondral bone. Larger controlled studies are needed to define the role of ACI relative to established treatment options.
Background Corrective osteotomies for malunions after proximal humerus fractures (PHFs) are reserved for selected cases. These procedures are technically demanding and surgical planning based on two-dimensional imaging, with free-hand operative correction, may lead to surgical inaccuracy. Three-dimensional (3D) preoperative planning combined with patient-specific surgical guides and surgical simulation can overcome this issue. This study introduces 3D patient-specific guides for corrective osteotomies in proximal humeral malunions and determines the accuracy of achieved correction in human cadaveric shoulders with two innovative surgical techniques. Methods Seven reversed corrective osteotomies were planned and performed on four Thiel embalmed human specimens using seven different respective 3D patient-specific cutting and reduction guides. Computed tomography-scans were used to create 3D segmentations of all specimens. Subsequently, virtual surgical plans of osteotomies were created, and 3D-printed patient-specific cutting- and reposition guides were designed and produced. Three humeri underwent an ‘extracapsular’ corrective osteotomy and four humeri underwent correction using a novel ‘humeral head-tuberosity separation’ technique. Accuracy was assessed for valgus angulation and rotation by comparing preoperative planning with postoperative results quantified with CT-scans. Results The overall median difference between preoperative planning and postoperative results for rotation was 5.2° (min-max; 2.9° – 8.5°) and 3.4° (min-max; 2.4° – 5.8°) for valgus angulation. For the ‘extracapsular’ method, median difference in rotation was 5.2° (min-max; 2.9° – 7.0°) and 3.9° (min-max; 3.2° – 5.8°) for valgus angulation. The median differences in rotation and valgus angulation for the ‘humeral head-tuberosity separation’ corrections were 6.3° (min-max; 3.6° - 8.5°) and 3.1° (min-max; 2.4° - 3.6°), respectively. Conclusion The application of 3D surgical planning and patient-specific guides is feasible for corrective osteotomies of malunited proximal humerus and resulted in reconstructions with less than 10 degrees deviation from preoperative planning, demonstrating acceptable technical accuracy and supporting the potential of this approach for future clinical application. The extracapsular osteotomy technique may serve as a solution for malunions with an intact anatomical relationship between the humeral head and greater tuberosity, whereas the novel osteotomy may be a solution for severe malunions with disrupted anatomy between the humeral head, greater tuberosity, and surgical neck. Future studies need to evaluate the proposed techniques in patients with actual proximal humeral malunions. Level of evidence Basic Science Study, Surgical Techniques
Background Rotator cuff retears following arthroscopic rotator cuff repair (ARCR) remain a critical clinical challenge, influenced by patient, tear, and rehabilitation factors. Conventional assessment methods struggle to capture this multifactorial complexity, limiting accurate retear prediction and personalized management. The purpose of this study was to develop a machine learning-based predictive model to stratify the risk of structural retear at 6 months postoperatively. Methods This study analyzed 1,428 patients with complete datasets from an initial cohort of 3,090 patients who underwent ARCR between January 2011 and May 2024 across four centers. A total of 79 clinical variables were collected, including patient demographics, tear size, range of motion, muscle strength, and pain and functional scores at baseline and at 2–4 months postoperatively. Retear was defined as Sugaya classification type IV or V on standardized 6-month postoperative MRI. Five machine learning models (Logistic Regression, k-Nearest Neighbors, Support Vector Machine, Convolutional Neural Network, and Multi-Layer Perceptron) were evaluated for retear prediction. Model performance was evaluated using accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUROC). Results The Multi-Layer Perceptron (MLP) model showed the most favorable numerical performance among the evaluated models, with a retear-class F1-score of 0.76 and precision of 0.92 under a random 80:20 split, and the largest AUROC among the models tested. However, under temporal validation the retear-class F1-score fell to 0.30, indicating limited generalizability over time. Conclusions The MLP model demonstrated potential for stratifying the risk of MRI-defined 6-month structural retear after ARCR and may serve as an adjunctive tool for early postoperative risk stratification. Because it relies on postoperative predictors and has been evaluated only within a single hospital network, external validation is required before clinical use. Level of Evidence Level II; Prognostic Study
Background Humeral torsion is an important factor for reverse total shoulder arthroplasty (rTSA) planning, yet its measurement requires elbow imaging frequently absent from clinical CT scans. We hypothesized that a deep learning approach could accurately predict humeral torsion from proximal humerus morphology alone. Methods CT-based segmentations from 581 shoulders were used to train and evaluate a deep learning model within the nnU-Net framework. The transepicondylar axis was represented as a full 3D plane extending throughout the imaging volume. The model was trained on 478 cases and tested on 103, with ground-truth torsion derived from elbow segmentations. Robustness to osteophytes and reduced fields of view was assessed. Results The model achieved a mean absolute torsion prediction error of 5.35° ± 3.96° and a strong linear correlation with ground-truth measurements (R = 0.85), outperforming prior proximal landmark-based approaches (R = 0.33–0.42). Performance was robust to osteophytes (mean error: 6.19° ± 3.95°) and was maintained with proximal field-of-view reductions down to 25% of humeral length, beyond which accuracy progressively declined.
Background Diagnosing shoulder periprosthetic joint infection (PJI) remains challenging, particularly in the setting of indolent organisms. Broad-range 16S rRNA gene PCR with sequencing has been proposed as an adjunct to culture; however, its diagnostic performance in revision shoulder arthroplasty using periprosthetic tissue remains incompletely defined. Methods Single center retrospective study of revision shoulder arthroplasty cases in which both intraoperative periprosthetic tissue cultures and broad-range 16S rRNA gene PCR with sequencing were obtained which is routine at the study center. Five deep periprosthetic tissue specimens from the glenoid and/or humeral bone–implant interfaces were cultured aerobically and anaerobically for a minimum of 14 days. For molecular testing, five tissue specimens were pooled and homogenized prior to automated DNA extraction, real-time PCR amplification, sequencing, and organism identification using SmartGene IDNS. The microbiologic reference standard for infection was defined as classified by the 2018 International Consensus Meeting. Diagnostic performance of 16S PCR was calculated relative to this reference. Agreement between 16S PCR and culture was assessed using Cohen’s κ. Results Fifty-nine revision cases were included; 18 met the 2018 International Consensus Meeting (ICM) criteria for infection and 41 were classified as not infected. Relative to the ICM-confirmed causative organism, 16S PCR yielded 0 true positives, 18 false negatives, 6 false positives, and 35 true negatives. Sensitivity was 0.0%, specificity was 85.4%, PPV was not calculable (no true positives identified), NPV was 66.0%; and overall accuracy was 59.3%. Overall agreement was 66.1% with only slight chance-corrected agreement (Cohen’s κ = 0.087). Conclusions In this shoulder-specific cohort, 16S rRNA gene PCR demonstrated low observed sensitivity, poor organism-level concordance with tissue culture, and limited clinical utility. Routine use of 16S PCR in revision shoulder arthroplasty cannot be supported based on the findings of the present study. Its role may be limited to select cases with high clinical suspicion and negative bacterial cultures, though further prospective study is needed. Level of Evidence Level III; Retrospective Design; Diagnostic Study
Background Due to the complex load transmission across the elbow and the limited systems available for total elbow arthroplasty (TEA), optimal implant positioning, which is crucial for achieving satisfactory functional outcomes and longstanding implant survival, remains challenging. Technological advancements in orthopedic surgery are rapidly evolving, with some of the main goals including improving implant positioning. In contrast to more common arthroplasties, these techniques are rarely described for TEA. The purpose of this review is to assess the current technologies available for TEA and investigate whether these are beneficial for surgical accuracy, functional outcomes, and implant survival. Methods A systematic search using Embase, Medline, Web-of-Science, Cochrane, and Google Scholar was used to identify articles investigating the use of novel technologies in surgical planning for TEA. Results A total of 16 articles, published between 2007 and 2022, were included in this systematic review. Augmented reality, robotic tracking systems, patient-specific instrumentation, and three-dimensional planning or printing were investigated in a total of 89 patients and 55 cadaver elbows. Compared to conventional methods, implant positioning was significantly improved using these novel technologies with similar short-term functional outcomes. Conclusion Despite being sparsely investigated, several novel technologies are nowadays available for TEA. These technologies show improved implant positioning following TEA when compared to conventional planning methods. Although superior implant positioning did not directly translate into significantly better clinical outcomes, further investigation of the effect on long term outcomes and implant survival is needed to assess the potential benefit of these techniques in future TEA. Level of Evidence Level IV; Systematic Review
Background Quantification of anterior and posterior bony containment of the glenoid roof provides a reproducible radiographic framework for characterizing direction-specific shoulder instability on standard radiographs. However, simple and reproducible radiographic parameters integrating anterior and posterior roof morphology have not been systematically defined. The aim of this study was to compare posterior acromial coverage (PAC), anterior coracoid coverage (ACC), and glenoid roof coverage (GRC), defined as the sum of ACC and PAC, among shoulders with neutral alignment, static posterior subluxation (Walch B), and chronic anterior instability before Latarjet surgery. We hypothesized that posterior acromial coverage would be reduced in static posterior subluxation (Walch B), whereas anterior coracoid coverage would be reduced in chronic anterior instability compared with neutral shoulders. Methods A prospectively maintained institutional shoulder registry was retrospectively reviewed to identify 150 standardized preoperative Neer lateral Y-view radiographs, including 50 clinically stable arthritic shoulders with neutral glenoid alignment (Neutral), 50 shoulders with static posterior subluxation (Walch B), and 50 shoulders with chronic anterior instability treated with a Latarjet procedure (Latarjet). PAC and ACC were measured independently by two observers using predefined radiographic landmarks. Between-group comparisons were performed using Mann–Whitney U tests. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, and associations with group allocation were explored using logistic regression. Interobserver reliability was evaluated using intraclass correlation coefficients (ICC). Results PAC was lower in Walch B than in Neutral (63.2° [55.3-68.9] vs 70.0° [65.9-77.9]; p<0.001) and discriminated Walch B from Neutral (AUC 0.76; 95% CI 0.66-0.85). ACC was lower in Latarjet than in Neutral (70.1° [61.2-77.1] vs 75.6° [69.6-83.7]; p=0.001) and moderately discriminated Latarjet from Neutral (AUC 0.70; 95% CI 0.59-0.79). GRC was highest in Neutral and reduced in Walch B (p=0.006) and Latarjet (p<0.001). Interobserver reliability was excellent for all parameters (ICC ≥0.85). Conclusion PAC and ACC quantify direction-specific alterations of superior glenoid roof morphology and provide a reproducible radiographic framework for identifying reduced anterior or posterior humeral head coverage on standardized Y-view radiographs. Level of Evidence Level III, Retrospective Cohort Comparison using Registry Data, Prognosis Study
Background Partial-thickness rotator cuff tears are a common cause of shoulder pain and disability. There are few large prospective cohort studies evaluating outcomes following arthroscopic repair and reported structural failure rates vary widely across techniques. Purpose To (1) evaluate the structural and clinical outcomes of an arthroscopic undersurface knotless inverted mattress repair for partial-thickness rotator cuff tears, (2) assess the effect of surgical experience on outcomes, and (3) place these outcomes in the context of published series of alternative techniques Methods A prospectively collected cohort of 1000 consecutive patients with articular- or bursal-sided partial-thickness supraspinatus tears >50% thickness underwent arthroscopic repair using the Opus knotless system (Smith & Nephew) with an undersurface knotless inverted mattress technique. Structural integrity was assessed using ultrasound at a minimum of 6 months. Pain, range of motion, and strength were assessed preoperatively and at 6 weeks, 12 weeks, and 6 months. Results The cohort comprised 570 males and 430 females with a mean (± SD) age of 56 ± 11 years (range 18–87). Tear area was 1.5 ± 1.0 cm2 and median anchor number was one (range one to five). Repairs were intact in 986 patients 6 months, with retear rate of 1.4% (95% CI 0.8–2.3%). Seven patients (0.7%) underwent revision rotator cuff repair, and no patients required reoperation for infection or postoperative stiffness. Significant improvements were observed across pain, range of motion, strength, and functional outcomes (p<0.01). A learning curve was identified, with retear rates peaking at 5% between cases 100–200 and declining to ≤1% after approximately 200 cases. Conclusion Arthroscopic undersurface knotless inverted mattress repair of partial-thickness rotator cuff tears achieved a retear rate of 1.4%, with no reoperations for infection or postoperative stiffness and consistent improvements across all clinical outcome measures. Retear rates declined after approximately 200 cases, a pattern consistent with a learning-curve effect, although this descriptive moving-average analysis is exploratory and was not subjected to formal change-point modelling. The favourable structural outcomes and short operative time observed with this technique may relate, in part, to minimal disruption of the remaining tendon and subacromial bursa, and the direct intra-articular visualisation afforded by this undersurface approach. Level of evidence Level IV, Case Series, Treatment Study
Background Scapulohumeral rhythm (SHR) after reverse total shoulder arthroplasty (rTSA) is typically reduced, with shoulder elevation relying predominantly on scapulothoracic motion. Previous studies have shown that higher postoperative SHR is associated with improved shoulder elevation and superior patient-reported outcome measures (PROMs). Therefore, despite the non-anatomic design of rTSA, achieving a favorable SHR is desirable. Although implant positioning is believed to influence postoperative shoulder kinematics, the specific implant-related factors contributing to improved SHR remain unclear. This study aimed to investigate the relationship between postoperative SHR and changes in humeral lateralization or distalization, as well as medialization or distalization of the center of rotation (COR). Methods Forty-six shoulders from 45 patients who underwent rTSA at a single institution and achieved more than 90° of humeral abduction were included. The cohort comprised 27 men and 18 women with a mean age of 75 years. Three implant configurations were used: medialized glenoid–medialized humerus (MGMH), medialized glenoid–lateralized humerus (MGLH+), and medialized glenoid–mildly lateralized humerus (MGLH). At a mean of 14 months postoperatively, computed tomography and fluoroscopy were performed during active scapular plane abduction. Three-dimensional implant and scapular motions were analyzed using model–image registration. SHR was calculated from 20° to 90° of humeral abduction. Implant positioning parameters were measured from postoperative radiographs, and changes from preoperative values were calculated. Correlations between SHR and each parameter were assessed using Pearson’s correlation coefficient. Results The mean SHR was 1.39 ± 0.64. A significant positive correlation was identified between postoperative SHR and the change in humeral distalization (r = 0.321, P = 0.030). No significant correlations were observed between SHR and other implant positioning parameters. Conclusion The increase in humeral distalization from the preoperative to the postoperative state following rTSA showed a significant but weak positive correlation with postoperative SHR, whereas no other implant positioning parameters were significantly correlated with postoperative SHR.
Background:Downhill skiing and snowboarding are popular winter sports, yet limited data describe outcomes after surgical fixation of proximal humerus fractures in these patients. The purpose of this study was to evaluate clinical outcomes and return to sport (RTS) after surgical fixation of proximal humerus fractures sustained while skiing or snowboarding, and to determine the influence of age, sex, sport, injury severity (Neer classification), and fixation type (open reduction internal fixation vs. closed reduction percutaneous pinning) on these outcomes. Methods:A retrospective cohort study of patients who underwent surgical fixation of proximal humerus fractures sustained while skiing or snowboarding between 2005 and 2022 by a fellowship-trained surgeon (P.J.M) was performed. Inclusion criteria were age ≥18 years, acute fracture sustained during downhill snow sports, and ≥12 months of follow-up. Exclusion criteria included prior fixation, pathologic fracture, polytrauma, arthroplasty, or incomplete records. Patient-reported outcome measures (PROMs) included 12-Item Short-Form Physical Component Summary (SF-12 PCS)/12-Item Short-Form Mental Component Summary, American Shoulder and Elbow Surgeons, Quick Disabilities of the Arm, Shoulder and Hand, Single Assessment Numeric Evaluation, visual analog scale pain, satisfaction, and RTS. Sub-group analyses compared outcomes by age (<65 vs. ≥ 65 years), sex, sport (skiing vs. snowboarding), Neer classification (2- vs. 3-4-part), and fixation type (open reduction and internal fixation vs. closed reduction and percutaneous pinning). Results:Forty-eight patients (26 females, 22 males; median age 55.8 years; 38 skiing, 10 snowboarding) were analyzed at a mean 83.9-month follow-up (minimum 12 months). Neer classification included 17 (35%) 2-part and 31 (65%) 3-4-part fractures. Median PROMs were SF-12 PCS (55.5), 12-Item Short-Form Mental Component Summary (56.0), American Shoulder and Elbow Surgeons (94.9), Quick Disabilities of the Arm, Shoulder and Hand (4.5), Single Assessment Numeric Evaluation (95.0), and visual analog scale pain (0.0). Overall, 77% (37/48) returned to sport, with 55% returning at or near preinjury level; median satisfaction was 10/10, and the revision rate was 4%. Younger patients (<65 years) had higher SF-12 PCS scores (P = .004), and snowboarders were younger (P = .003) and reported higher satisfaction (P = .048) than skiers; no other significant differences in PROMs or RTS were observed by age, sex, sport, fracture severity, or fixation type. Conclusion:Operative fixation of proximal humerus fractures sustained during skiing or snowboarding yields excellent long-term clinical outcomes, with 77% (37/48) of patients returning to sport at a mean follow-up of 83.9 months, high patient satisfaction (median 10/10), and a low revision rate (4%, 2/50 operative cases). Clinical outcomes were largely comparable across age, sex, sport, fracture severity, and fixation type, underscoring the reliability of surgical management for proximal humerus fractures in active snow sport populations.
Background:The role of horizontal acromioclavicular (AC) stabilization in chronic AC dislocation reconstructions remains uncertain. While commonly used techniques focus on coracoclavicular (CC) ligament reconstruction, the potential benefit of adding horizontal AC stabilization has not been clearly established. The aim of this study was to evaluate whether horizontal AC stabilization in chronic AC dislocations treated with CC ligament reconstruction improves clinical outcomes, reduces failure, complications, or revisions, and enhances radiographic reduction. Methods:A retrospective multicenter study included 209 patients (mean age 44.5 ± 14.1 years, 90.9% male) who underwent CC ligament reconstruction (Weaver-Dunn, anatomic biologic reconstruction, or synthetic ligament) between 2006 and 2024. Patients were stratified according to the addition of horizontal AC stabilization. Primary outcome was the Constant score at final follow-up. Secondary outcomes included Subjective Shoulder Value, visual analog scale pain, radiographic AC distance, failures, complications, and revisions. Multivariate linear regression and 1:1 propensity score matching were performed. Results:Horizontal AC stabilization was not associated with higher Constant scores (β = -1.2, P = .62), Subjective Shoulder Value (β = -5.77, P = .09), or lower visual analog scale pain (β = -0.28, P = .37). Failure (15% vs. 15%, P > .99) and revision rates (5% vs. 12.5%, P = .43) were comparable between groups. However, horizontal stabilization was associated with fewer complications (12.5% vs. 45%, P = .003) and improved radiographic reduction, with lower AC distance at last follow-up (β = -4.99, P = .029). Conclusion:Horizontal AC stabilization in chronic AC dislocations treated with CC ligament reconstruction does not significantly improve clinical outcomes or reduce failures, but it appears to lower complication rates and provide superior radiographic reduction. These results suggest a potential stabilizing benefit of horizontal AC fixation, although further prospective studies are needed to validate its clinical relevance.
Background Rotator cuff repair (RCR) is a common orthopedic procedure, with patient benefit often assessed using the American Shoulder and Elbow Surgeons (ASES) score. However, because ASES scores are not consistently collected across patient populations or care settings, they may be impractical for broad policy evaluation. The objective of this study was to assess whether the number of shoulder-related encounters a patient has during a Recovery Period after standard follow-up care (here 181-365 days post-RCR) can serve as a proxy benefit measure for 12-month ASES scores following RCR. Methods Adult patients (18 years or older) who underwent a primary RCR between 2017 and 2022 and had complete post-operative ASES surveys at 12 months were included in this study. Health-care encounters with shoulder-related diagnoses were counted during the Recovery Period. Linear regression was used to contrast outcome models as a function of baseline covariates for Recovery Period shoulder-related encounter and 12-month ASES score benefit measures and to estimate the association between these measures. Results Of an initial sample of 683 patients who underwent primary RCR and provided a baseline ASES score, 513 (75%) had complete 12-month ASES scores. Outcome models showed consistent relationships between patient baseline covariates and the 12-month ASES scores and Recovery Period shoulder-related encounters. Furthermore, regression showed a strong association between the number of Recovery Period shoulder-related encounters and ASES scores at 12 months (P < .001). Additional shoulder-related encounters during the Recovery Period were associated with 4.7-point reduction 12-month ASES scores (P < .01). Patients with 3 or more shoulder-related encounters during the Recovery Period had predicted lower 12-month ASES scores within the range of the published Minimal Clinically Important Difference results for rotator cuff. Conclusion Additional shoulder-related encounters during the Recovery Period were associated with clinically important lower 12-month ASES scores. Encounter-based measures should not replace patient-reported outcome measures for clinically focused research and individual clinical decision-making but may provide useful proxy measures of patient benefit for population-level orthopedic outcomes research when patient-reported outcome measure data are incomplete or unavailable.
