Background Failure is widely reported in randomised controlled trials assessing rotator cuff repair (RCR), yet the term lacks a consensus definition and reported rates vary widely. This systematic review characterised how RCR failure is defined and reported in Level I and II studies and proposes a reporting standard. Methods MEDLINE, Embase and Cochrane were searched for English-language Level of Evidence I and II studies published between January 2003 and April 2025 reporting on failure following RCR. Data on definitions, parameters and etiologies of failure were extracted and summarised through descriptive statistics. Results Twenty-two studies met the inclusion criteria. Ten (45.5%) provided a formal definition of failure; the remainder described specific etiologies. Imaging-based assessment of tendon integrity was the most common parameter among formal definitions (7 of 10), and re-tear was the most common etiology among studies without one (9 of 12). Reported failure rates tracked closely with the parameter used, exceeding 50% under imaging-based definitions and reaching 0% under a patient-reported outcome measure (PROM)-based definition. Discussion RCR trials lack a uniform definition of failure. We propose a multi-domain reporting standard incorporating structural, patient-reported and clinical outcomes, with thresholds to be established through expert consensus.
Background Due to limitations of the original Grammont reverse shoulder arthroplasty (RSA) design, there has been a shift towards more anatomical implants with greater lateralization and distalization. The lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) were introduced as standardized measurements of these parameters. However, their prognostic value remains controversial. This study evaluates whether LSA and DSA are correlated with range of motion (ROM), clinical outcome scores, and complications following RSA. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. PubMed, Embase, and Scopus were searched from inception to April 29, 2024. Studies reporting association between LSA and/or DSA, and post-RSA ROM and/or clinical outcomes were included. Risk of bias was assessed using QUIPS and quality of evidence using GRADE framework. Results Twelve studies comprising 2303 subjects (mean age 71.7 years, 62.6% females) were included. LSA and DSA were significantly correlated with acromial stress, scapular spine fractures, and deltoid stiffness. Neither parameter was significantly associated with ROM or clinical outcome scores. Quality of evidence ranged from “low” to “very low.” Conclusion Although LSA and DSA are simple and reproducible measures, their prognostic value for post-RSA ROM and clinical outcomes remains inconsistent.
Background The next-generation anatomic total shoulder arthroplasty with hybrid glenoid fixation (AHG) is designed to reduce the incidence of glenoid component loosening. The primary aim is to assess the survival of AHG implant. Methods Retrospective review of prospectively collected data on AHG between 2010 and 2020, including Clinical data, radiographs, Oxford Shoulder (OSS) and Constant Shoulder scores, which were collected and analysed using GraphPad Prism. Results A total of 51 AHGs in 46 patients were identified with median 6.0 years follow-up (IQR 4.8–7.0 years). Only one case required revision for aseptic loosening of the glenoid component at 3 years. Overall survivorship of AHG was 97.6% at 7 years. OSS at 1 year improved significantly (median: 42, IQR 35–48 vs. median: 20, IQR 15–26.5; p < .05). All range of movement at 1 year significantly improved ( p < .05): flexion (median 132.5, IQR 105–150 vs. 90, IQR 70–97.5); abduction (median 130, IQR 100–150 vs. 60, IQR 50–90); external rotation (mean 50.9 vs. 22.8 degrees, SD ± 19.1) and non-parametric improvement in internal rotation. These improvements were maintained at the latest follow-up. Discussion AHG implants demonstrate a high survivorship rate whilst maintaining excellent range of movement and patient-reported outcome scores to support its continued use.
Background The optimal postoperative rehabilitation protocol after shoulder arthroplasty remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare the effectiveness of different rehabilitation interventions. Methods Two reviewers independently screened studies, extracted data, and assessed risk of bias using the PEDro scale and RoB 2 tool. Meta-analysis was performed with a random-effects model. Results Nine RCTs (793 patients) were included; PEDro scores ranged from 5 to 8. In reverse total shoulder arthroplasty (rTSA), home-based rehabilitation was non-inferior to outpatient physical therapy for range of motion, patient-reported outcomes, and pain at 1 year. Early mobilization improved forward flexion at 3 months, but this difference was no longer evident at 6 months; in one anatomic TSA trial, it was associated with a trend toward lower lesser tuberosity healing. Subscapularis-specific training did not confer additional benefits. Discussion Home-based or telerehabilitation is a safe, potentially cost-effective alternative after rTSA; limited evidence for anatomic TSA suggests similar trends. Early mobilization offers transient functional gains, and current evidence is insufficient to recommend subscapularis-specific training. These findings highlight the need for further high-quality trials, especially in anatomic TSA.
Isolated injuries to the short head of the biceps (SHB) are uncommon, and the existing literature mainly includes case reports documenting tears at the muscle belly or myotendinous junction. This case report presents the first reported SHB tendon injury at the coracoid insertion in a 34-year-old healthy male patient after trauma while playing with his daughter. The injury occurred with the arm forced into hyperextension, abduction, and external rotation, with the elbow fully extended. Diagnosis was confirmed by MRI, showing an isolated insertional tear of the SHB tendon with intact coracobrachialis, long head of biceps, and rotator cuff. Surgical intervention was performed using an extended deltopectoral approach and tendon-to-bone repair to the coracoid. At 6 months the patient had resumed normal daily and sports activities, with no residual anatomical deformity and no clinically evident strength deficit, showing that surgery is an option to restore arm function.
