PURPOSE:To compare 3 antiseptics and to identify factors associated with suture contamination during arthroscopic rotator cuff repair. METHODS:One hundred fifty male patients scheduled for rotator cuff repair between July 2021 and October 2022 were enrolled. Patients were randomly assigned to 1 of 3 antiseptics groups: povidone-iodine (P), alcohol-containing povidone-iodine (AP), and olanexidine gluconate (O). To minimize variability in surgical duration, surgeons were categorized into 3 groups (A, shortest; B, intermediate; C, longest) based on their preliminary average surgical time, and 1 of 3 antiseptics was randomly assigned to each group. Sutures cut after the last medial knot tying were cultured for a maximum of 3 weeks. The positive rates of Cutibacterium acnes and miscellaneous bacteria were compared between antiseptics and surgeon groups. Repair integrity was evaluated via postoperative magnetic resonance imaging, and its relation with contamination was assessed. RESULTS:C. acnes was detected in 92 shoulders (61%) and miscellaneous bacteria in 34 shoulders (23%), with coagulase-negative Staphylococcus predominating. There were no significant differences in the C. acnes-positive rates between the antiseptics groups. The contamination rate for any bacteria was significantly lower in AP than in O. Logistic regression analysis showed that O had a higher risk of any bacterial contamination than AP (odds ratio, 3.82; P = .013). Shorter surgical and suture exposure times were associated with lower contamination rates. No relation was found between contamination and retear. CONCLUSIONS:C. acnes was the most commonly detected bacterium in suture contamination during arthroscopic rotator cuff repairs. There was no difference in the efficacy of the 3 disinfectants in preventing C. acnes contamination; however, the overall bacterial contamination rate was significantly higher in olanexidine compared with alcohol-containing povidone-iodine. Shorter surgical and suture exposure times were associated with a lower incidence of suture contamination. LEVEL OF EVIDENCE:Level I, prospective randomized study.

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

[This corrects the article DOI: 10.1016/j.jseint.2025.05.006.].

Background:Rotator cuff tears (RCTs) are highly prevalent and increase with age. Although suprascapular neuropathy associated with RCTs has been increasingly reported, the prevalence of other neuropathies, including cervical radiculopathy and brachial plexopathy, remains unclear. Furthermore, the relationship among neuropathy, tear size, and shoulder pseudoparalysis remains incompletely understood. This study aimed to determine the prevalence of neuropathies associated with RCTs using needle electromyography (EMG) and examine their relationship with tear size and pseudoparalysis. Methods:A total of 659 patients with surgically treated magnetic resonance imaging-confirmed RCTs between 2012 and 2014 were included in the study. All patients underwent pre-operative needle EMG. Neuropathy was classified as suprascapular neuropathy, axillary nerve palsy, or proximal neuropathy (cervical radiculopathy or brachial plexopathy). Tear size was categorized as subscapularis, partial thickness, small, medium, large, or massive. Pseudoparalysis was defined as active shoulder elevation ≤90°. Statistical analyses included one-way analysis of variance and chi-square tests with post-hoc residual analyses. Statistical significance was set at P < .05. Results:Of the 659 patients, 105 (15.9%) had abnormal EMG findings, including 48 (7.3%) with suprascapular neuropathy, 3 (0.5%) with axillary nerve palsy, and 54 (8.2%) with proximal neuropathy. The prevalence of neuropathy increased with tear size and was the highest in the massive tear group, where proximal neuropathy was present in 40.4% of cases. Nerve status was significantly associated with tear size (P < .001), with suprascapular and proximal neuropathy being significantly over-represented in massive tears. Patients with proximal neuropathy were significantly older than those without proximal neuropathy (P = .0001). Shoulder pseudoparalysis occurred in 91 patients (13.8%). Among these, proximal neuropathy was the most common abnormality, identified in 42.9%. The prevalence of pseudoparalysis increased with tear size and was the highest in the massive tear group. A significant association was observed between neuropathy and pseudoparalysis (P < .05). Conclusion:Neuropathy, particularly proximal neuropathy, was strongly associated with larger RCTs and shoulder pseudoparalysis. These findings suggest that neurological involvement is not incidental but may contribute to disease severity, functional impairment, and the progression of fatty infiltration through the combined effects of disuse and neuropathy. Needle EMG is a valuable tool for detecting neuropathies and may improve diagnostic accuracy and treatment planning. Therefore, EMG should be considered selectively, particularly in patients with large-to-massive tears, severe muscle atrophy, or pseudoparalysis rather than being routinely performed in all cases.

Objective: First rib stress fractures are a relatively rare cause of shoulder pain in baseball players, which are sometimes overlooked. Although several case reports have been published, there have been limited studies on their clinical characteristics and distinction from other causes of shoulder pain. Additionally, the accuracy of diagnosing a first rib stress fracture with plain radiographs is unclear. The purpose of this study was to compare clinical features of first rib stress fractures with those of baseball players presenting with shoulder pain without fracture, and to evaluate how accurately they can be diagnosed on initial radiographs. We hypothesized that first rib stress fractures present with distinct patterns, particularly posterior scapular pain during batting, and that they are often underdiagnosed despite being visible on radiographs. Methods: We retrospectively collected baseball players who visited our institute complaining of shoulder or scapular pain between 2013 and 2019. Patients without radiographs were excluded. All available imaging studies, including initial and follow-up radiographs and CT when performed, were retrospectively evaluated. All confirmed first rib stress fractures were assigned to the fracture group, while controls were randomly selected patients with baseball players with shoulder or scapula pain without fracture. Clinical variables included age, sex, affected side, playing position, pain location, and pain-inducing activity. Pain location was determined from medical records. 'Shoulder pain' was defined as pain localized around the proximal humerus, and 'scapular pain' as pain in the posterior scapular region. Diagnostic timing was categorized as fracture identified at the initial visit, diagnosed at follow-up, or missed. Imaging modalities (radiographs, CT, or follow-up radiographs) were also documented. Two orthopaedic surgeons independently reviewed all initial radiographs. Diagnostic accuracy was evaluated in terms of sensitivity, specificity, PPV, NPV, and overall accuracy. Interobserver agreement was calculated with Cohen's κ. Statistical analysis: Group comparisons used Fisher's exact test with Bonferroni correction where appropriate. Significance was set at p < 0.05. Results: Epidemiology: From 2013 to 2019, 2,285 baseball players with shoulder or scapular pain were reviewed. After excluding 190 without radiographs, 2,095 shoulders were analyzed (mean age 17 ± 7 years; 2,030 males, 65 females). Thirty-two shoulders (1.5%, all male, mean age 16 ± 2 years) were diagnosed with first rib stress fractures, while 51 shoulders without fracture (all male, mean age 17 ± 6 years) were randomly selected from the remaining non-fracture cases and served as controls. There were no significant differences in baseline characteristics between groups (Figure 1 and 2).Pain location: Posterior scapular pain predominated in fractures (26/32, 81%), whereas shoulder pain was uncommon (2/32, 6%). In contrast, controls most often presented with anterior-only or combined anterior-posterior shoulder pain (45/51, 88%). Posterior scapular pain was strongly associated with fractures (p < 0.001), yielding a sensitivity of 81% and specificity of 88% (PPV 79%, NPV 83%) (Figure 3).Pain-inducing activity: Batting was the most frequent activity in fractures (13/32, 41%), followed by pitching (5/32, 16%), whereas pitching predominated in controls (31/51, 61%, p < 0.001). Nearly half of fractures occurred during batting, reflecting rib cage stress distinct from pitching-related shoulder disorders. Diagnostic accuracy in clinical practice: Of 32 fracture cases, 15 (47%) were diagnosed at the initial visit (12 by radiographs, 3 by CT), 4 (12%) at follow-up, and 13 (41%) were missed. Retrospective review showed 29 of 32 fractures (91%) were visible on initial radiographs, while 2 cases (6%) required CT and 1 (3%) follow-up radiographs, suggesting most were overlooked rather than radiographically occult. This finding highlights the supplementary role of CT in selected cases (Figure 4). Radiograph performance against reference standard: Examiner 1 demonstrated a sensitivity of 91%, specificity of 94%, PPV of 91%, NPV of 94%, and accuracy of 93%. Examiner 2 showed a sensitivity of 91%, specificity of 98%, PPV of 97%, NPV of 94%, and accuracy of 95%. Interobserver agreement was excellent (κ = 0.90). Conclusions: First rib stress fractures accounted for 1.5% of baseball players with shoulder pain, occurring exclusively in adolescent males. Posterior scapular pain, particularly posterior-only, was highly characteristic and demonstrated strong specificity, whereas anterior pain predominated in baseball shoulder. Batting was the leading mechanism of injury, emphasizing the load transmitted to the rib cage during swing motion. Although nearly half of fractures were initially missed, careful review of radiographs detected most cases with high accuracy and excellent interobserver reliability. CT may be considered in selected cases with persistent suspicion despite negative or equivocal radiographs. Recognition of these patterns may improve diagnostic precision, reduce misclassification, and support timely management for safe return to play in young athletes.

Background:The accuracy of two-dimensional (2D) scapulohumeral rhythm (SHR) measurements in comparison to the precise three-dimensional (3D) SHR measurements in shoulders with reverse total shoulder arthroplasty (rTSA) has not been fully validated. The primary aim of this basic science study was to assess the validity of the mean SHR, calculated from the arm at the side to maximum abduction using 2D measurements derived from 2 radiographic images, in comparison to 3D measurements obtained through 3D to 2D model-image registration in shoulders with rTSA. Methods:The study included 35 shoulders from 34 patients who underwent rTSA at a single institution. Each shoulder underwent computed tomography and single-plane fluoroscopy at an average of 14 (range, 12-27) months post-operatively. Fluoroscopic images were acquired during scapular plane abduction and 2 fluoroscopic images taken with the arm at the side and at maximum abduction were used for the mean SHR measurement from the arm at the side to maximum abduction. For 3D measurement using model-image registration techniques, the poses of 3D models were iteratively adjusted to match the silhouettes in the fluoroscopic images. For 2D measurement, a line drawn along the lateral side of the humeral stem, a line connecting the top and bottom edges of the backside of the glenosphere, and a vertical thoracic reference line were used. SHR was defined as (ΔH-ΔS)/ΔS, where ΔH is the increment in humeral abduction angle and ΔS is the increment in scapular upward rotation angle. The agreement between 3D and 2D measurements was assessed using Bland-Altman plots. Pearson's correlation coefficient was used to evaluate the correlation between the mean SHR of 2 methods. Results:The Bland-Altman plot of mean SHR from 3D and 2D measurements showed 1 of 35 shoulders was outside the limits of agreement (2.9%). The mean SHR using 3D methods was significantly higher than those using 2D measurements (1.40 ± 0.74 vs. 1.05 ± 0.50, P < .001). In addition, regression analysis showed a significant difference between the methodologies (P < .001). A significantly strong positive correlation was observed between the mean SHR using 3D methods and using 2D measurements (r = 0.870, P < .001). Conclusion:This study demonstrated a significantly strong positive correlation between 2 measures of SHR. However, both fixed bias and proportional bias were observed. Consequently, while a 2D measurement of SHR may offer some clinical utility, it is crucial to recognize its tendency to underestimate the mean SHR compared to 3D measurement.

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: Osteochondral autograft transplantation (OAT) is widely performed for capitellar osteochondritis dissecans (OCD). However, preoperative predictors of suboptimal postoperative outcomes remain unclear. Purpose/Hypothesis: The authors aimed to evaluate clinical outcomes after OAT for capitellar OCD and identify preoperative risk factors associated with suboptimal outcomes. They hypothesized that radiographic indicators of disease severity, including preoperative proximal migration of the radial head, lesion size, and lateral wall disruption, would be associated with suboptimal postoperative clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: The records of adolescent athletes who underwent OAT for capitellar OCD with a minimum 2-year follow-up were retrospectively reviewed. Clinical outcomes included elbow range of motion (ROM) and Timmerman-Andrews (T-A) score. A suboptimal outcome was defined as a postoperative T-A score <160. Preoperative radiographs were used to measure proximal migration of the radial head relative to the coronoid process, hypertrophy of the radial head, OCD lesion area, and a 5-grade lateral wall disruption classification; measurement reliability was assessed. Multivariate logistic regression analysis was performed to identify independent predictors of a suboptimal outcome, and receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value for proximal migration. Results: A total of 69 elbows (mean age, 13.6 years; mean follow-up, 48 months) were included. ROM and T-A scores improved significantly after OAT, and all athletes returned to any sports. Of these, 50 elbows (72%) achieved good outcomes, whereas 19 (28%) had suboptimal outcomes. Preoperative proximal migration was significantly greater in the suboptimal outcome group compared with the good outcome group (mean, 2.1 ± 2.3 vs 0.5 ± 1.7 mm; P = .002), as were lesion area (mean, 70 ± 16 vs 58 ± 20 mm 2 ; P = .02) and lateral wall disruption grade (median, 5 vs 3; P = .01). On multivariate analysis, proximal migration of the radial head was the only independent predictor of a suboptimal outcome (adjusted OR, 1.47 per 1-mm increase; 95% CI, 1.03-2.09; P = .033). ROC analysis showed an area under the curve of 0.72 with an optimal cutoff of 2.2 mm (sensitivity, 56%; specificity, 84%). Conclusion: OAT resulted in significant clinical improvement in adolescents with capitellar OCD; however, 28% of patients were classified as having suboptimal outcomes. Preoperative proximal migration of the radial head is an independent predictor of a suboptimal postoperative outcome. A value >2.2 mm may indicate advanced radiocapitellar incongruity, a condition in which OAT may be less effective.

Background:Shoulder instability is one of the most common problems in judo. Some studies have examined outcomes of shoulder stabilization in judo athletes. While open procedures yield acceptable results, arthroscopic stabilization has yielded poor outcomes or involved small sample sizes. For >20 years, the authors have treated competitive judo athletes with soft tissue Bankart repair and soft tissue augmentation, such as rotator interval closure. Purpose:To present the results of a treatment algorithm for arthroscopic soft tissue stabilization with selective augmentation in competitive judo athletes, with special emphasis on the risk of recurrence, range of motion restrictions, and return-to-sport outcomes. Study Design:Case series; Level of evidence, 4. Methods:Competitive judo athletes who underwent arthroscopic soft tissue shoulder stabilization for recurrent traumatic anterior shoulder instability between August 2004 and December 2015 were included. Patients with <2 years of follow-up were excluded. All procedures were performed according to the treatment algorithm. Outcomes assessed included recurrence, return to sport, range of motion, Rowe score, and Subjective Shoulder Value for sports (SSV-sports). Results:A total of 84 shoulders in 78 competitive judo athletes (58 male, 20 female; mean age at surgery, 19 years) were included. Among them, 6 athletes (4 male, 2 female) underwent bilateral surgery, resulting in 62 shoulders from male athletes and 22 shoulders from female athletes. The mean follow-up was 65 months (range, 24-166 months). All procedures were performed according to the treatment algorithm. The overall recurrence rate was 4.8% (4/84 shoulders), and all recurrences occurred in the tsurite group. The mean loss in abduction-external rotation was observed but did not affect return to sport. Among the 74 patients without recurrence, 69 (93%) returned to the same or higher preinjury competition level. The Rowe and SSV-sports scores were significantly improved postoperatively. Conclusion:The treatment algorithm for arthroscopic soft tissue shoulder stabilization in competitive judo athletes resulted in good clinical outcomes, with low recurrence rates and a high rate of return to preinjury levels in tsurite- as well as hikite-side shoulders.

Background:It has been proven that superior capsule reconstruction (SCR) improves the superior translation of the humeral head through cadaveric studies. However, there has been limited information on in vivo glenohumeral kinematics of shoulders with SCR. The purpose of this study was to compare pre- and postoperative glenohumeral kinematics in shoulders that underwent arthroscopic SCR using model-image registration techniques. Methods:Patients who were planned for arthroscopic SCR using the fascia lata autograft due to irreparable massive rotator cuff tears were recruited for this study. The exclusion criteria were (1) preoperative active abduction <60°, (2) massive graft failure on postoperative magnetic resonance imaging, and (3) low image quality. Fluoroscopic images were recorded during active scaption pre- and postoperatively. Computed tomography was performed to create three-dimensional models of the humerus and scapula. Using these fluoroscopic images and three-dimensional models, three-dimensional shoulder kinematics were measured using model-image registration techniques. Pre- and postoperative glenohumeral kinematics and scapulohumeral rhythm were statistically compared. Shoulder ranges of motion and the American Shoulder and Elbow Surgeons scores were also compared. Results:Twenty-five shoulders were included in this study, and 10 shoulders were excluded: graft failure, 4 shoulders; insufficient shoulder elevation, 5 shoulders; low image quality, 1 shoulder. The subjects of this study were 15 shoulders (9 males and 6 females) with a mean age of 63 years (range, 53-70). Flexion and the American Shoulder and Elbow Surgeons score significantly improved after surgery (P = .03 and < .001, respectively). There were no significant postoperative changes in glenohumeral rotations and scapulohumeral rhythm. The superior/inferior position of the humeral head from 10° to 90° of humeral abduction also showed no significant postoperative change; however, the change in humeral position from 30° was significantly smaller after surgery than before surgery (P = .03). Conclusion:No significant changes were observed in glenohumeral rotations and scapulohumeral rhythm after arthroscopic SCR. The superior/inferior humeral translation at humeral abduction greater than 30° was significantly smaller after surgery. These findings suggest that SCR stabilizes the humeral superior/inferior translation without alteration of glenohumeral rotation kinematics.

Background:Postoperative shoulder stiffness (POSS) is one of the most common complications of arthroscopic rotator cuff repair (ARCR). Although adduction restriction is commonly observed in the early postoperative period, it remains unclear whether a prolonged duration of this restriction impacts the development of POSS. The aim of this study was to investigate whether early postoperative adduction restriction is associated with the occurrence of POSS 1 year after ARCR. Methods:This retrospective cohort study included patients who underwent ARCR at a single institution between April 2017 and June 2018. A total of 96 shoulders were analyzed. Active and passive range of motion were assessed preoperatively and at 12 months postoperatively. Adduction restriction was evaluated in two positions: the droop position and the intermediate position. Adduction restriction was defined as resolved when the medial side of the arm made contact with the side of the body. Based on these evaluations, the duration of persistent postoperative adduction restriction was evaluated. POSS was defined as passive external rotation at the side of less than 30° at 12 months after surgery according to the previous studies. Patients were assigned to one of two groups: Group N, without POSS group, or Group S, with POSS group. Propensity score matching was used to ensure comparability between groups. The duration of persistent postoperative adduction restriction was compared between the groups. Results:After propensity score matching, 38 shoulders were analyzed (19 in Group N and 19 in Group S). While no significant difference in the duration of persistent postoperative adduction restriction in the droop position between the groups was observed, the duration in the intermediate position was significantly shorter in Group N compared to Group S (7 ± 3 weeks vs. 10 ± 4 weeks, P = .007). Conclusion:The duration of persistent adduction restriction in the intermediate position was significantly longer in shoulders with POSS at 12 months after ARCR compared to those without POSS. Prolonged early postoperative adduction restriction may associate with the occurrence of POSS 12 months after ARCR.

BackgroundThe management of ulnar collateral ligament (UCL) injuries widely varies among surgeons. Although various treatment options have been proposed including surgical and conservative treatments, no golden standard treatment strategy has been established of yet. The American survey reported an overall experienced and well-trained cohort of surgeons often reached consensus opinions on how to approach UCL injury. However, the consensus among Japanese surgeons on the treatment of UCL injuries remains unclear. The purpose of this study was to survey current trends among Japanese orthopaedic surgeons in the treatment of UCL injuries in baseball players.MethodsAn online survey was distributed to the active members of the Japanese doctor's network for baseball injury prevention, which was formed by partial members of the medical committee in the Japan Baseball Council. The survey was composed of three sections: demographics of the surveyees, preferred operative and nonoperative management of UCL injuries, and five fictional clinical case scenarios of baseball players with a UCL injury.ResultsThe 131 e-mailed invitations to society members yielded 78 completed online surveys with a participation rate of 60%. Sixty-four respondents (82%) reported >15 years of clinical experience. Sixty-five respondents (83%) performed ≤5 UCL reconstructions per year. As nonsurgical management of UCL injuries, seventy-four surgeons (95%) preferred physiotherapy followed by intraarticular injection (46%). For surgical management, seventy-three surgeons (93%) preferred UCL reconstruction. Of the five case scenarios, a consensus was reached in three cases: to perform surgery on the patient with full-thickness UCL tear. When operative management was the preferred option, a consensus was reached to perform UCL reconstruction.ConclusionJapanese doctors involved in the treatment of baseball injuries reached a consensus to indicate high-level athletes with a full-thickness UCL tear for surgery. When operative management was the preferred option, a consensus was reached to perform UCL reconstruction. These results may contribute to the decision-making for managing UCL injuries.

Background:There is limited data on the relationship between recovery metrics, including psychological factors, and shoulder function in rugby players after arthroscopic Bankart repair. The purpose of this study was to investigate return to play (RTP) in rugby players who underwent shoulder stabilization for anterior shoulder instability and to assess the relationship between postoperative ranges of motion (ROMs) and various recovery metrics, including performance, pain, and psychological conditions. Methods:We retrospectively investigated subjects who underwent arthroscopic shoulder stabilization at our institute from January 2012 to April 2022. Inclusion criteria were as follows: (1) rugby players with traumatic anterior shoulder instability and (2) arthroscopic Bankart repair with rotator interval closure and Hill-Sachs remplissage. Exclusion criteria were as follows: (1) revision surgery and (2) incomplete questionnaire at the final follow-up. A questionnaire at the final follow-up was used to evaluate the recovery metrics as a visual analog scale (VAS), including athletic performance, pain, and fear of contact. Regression analyses were performed to assess the relationship between the VAS scores and ROMs. Results:Ninety-one shoulders in 82 patients met the inclusion criteria, and 32 shoulders were excluded due to revision surgery, one shoulder; incomplete questionnaire, 31 shoulders. The remaining 59 shoulders in 50 patients were included in this study. The patients consisted of 48 males and 2 females, with a mean age at surgery of 19 years (range, 14-36). The mean follow-up was 31 months (range, 13-56). The mean time to start contact practice was 7 ± 5 months (range, 3-36), and the mean time to RTP was 8 ± 5 months (range, 4-36). Forty-nine patients (98%) returned to their preinjury sports level. The median of VAS values were as follows: 91 for athletic performance (range, 25-100), 100 for pain (range, 10-100), and 70 for fear of contact (range, 10-100). ROM data were available in 52 shoulders. Multiple regression analyses showed significant relationships between total VAS scores and ROMs at postoperative three months (anterior elevation, P = .015; external rotation at the side, P = .002). Conclusion:Arthroscopic shoulder stabilization resulted in a 98% RTP rate in rugby players. The VAS score for fear of contact was relatively low, even in patients with complete return. The total VAS value was correlated with ROMs at three months postoperatively. A rehabilitation protocol that simultaneously addresses psychological and physical aspects may be required for better RTP.

Background: The purpose of this study was to measure the distance between the scapular neck and the humeral polyethylene insert in shoulders with a 145° neck-shaft-angle (NSA) semi-inlay reverse total shoulder arthroplasty (rTSA) during active external rotation and to compare it with the distance in shoulders with a 155° NSA inlay rTSA. Methods: Twenty shoulders with 145° NSA semi-inlay rTSA and 18 shoulders with 155° NSA inlay rTSA were analyzed. Each shoulder underwent computed tomography and fluoroscopy. Fluoroscopic images were acquired during the activity, starting from internal rotation at the side and progressing to maximum external rotation, while keeping the shoulder adducted. Using model-image registration techniques, the poses of 3-dimensional models were iteratively adjusted to match their silhouettes with those in the fluoroscopic images. Based on the 3-dimensional kinematics of the implants, the closest distance between the scapular neck and polyethylene insert was computed. The data from 10° internal rotation to 50° external rotation were used for analysis. It was also evaluated whether the distance approached within 1 mm, as it was considered that impingement occurred between the scapular neck and polyethylene insert at this proximity. Results: The distance between the scapular neck and the polyethylene insert significantly decreased as the shoulder externally rotated (P < .001). This distance was significantly larger in shoulders with semi-inlay rTSA compared to those with inlay rTSA (P < .001). The rate of shoulders that approached within 1 mm of distance during activity was significantly lower in the semi-inlay rTSA group than in the inlay rTSA group [20.0% (4/20) vs. 83.3% (15/18), respectively, P < .001]. Conclusions: The distance between the scapular neck and the polyethylene insert during active external rotation was greater in a 145° NSA semi-inlay rTSA compared to a 155° NSA inlay rTSA. This study supports the notion that a 145° NSA semi-inlay rTSA significantly reduces scapular notching compared to a 155° NSA inlay rTSA. However, scapular notching, especially caused by maximum external rotation, should still be considered in shoulders with a 145° NSA semi-inlay rTSA as well, as the distance significantly decreases during external rotation.

Background: Conservative treatment such as physiotherapy is a treatment option for ulnar collateral ligament (UCL) injuries in baseball pitchers, with 46%-66% of patients returning to their previous performance levels. However, a standardized conservative treatment algorithm for UCL injuries has yet to be established. While extracorporeal shock wave therapy (ESWT) is widely used for sports-related musculoskeletal disorders, there have been limited data on its effectiveness for suspected UCL-related symptoms in baseball pitchers specifically. The purpose of this study was to retrospectively evaluate the effectiveness of ESWT for suspected UCL-related symptoms by comparing the clinical outcomes between patients treated by physiotherapy with or without ESWT. We hypothesized that physiotherapy with ESWT for suspected UCL-related symptoms would result in superior clinical outcomes, including better sports return and a shorter time to resume throwing. Methods: The study subjects were skeletally mature baseball pitchers who (1) were diagnosed with an isolated UCL injury of the throwing-side elbow, (2) were treated with physiotherapy with or without ESWT, (3) underwent magnetic resonance imaging (MRI) of the elbow, and (4) played at the competitive sports level or practiced more than twice a week. The diagnosis of UCL injury was based on symptoms and physical examination, with MRI as a reference. ESWT was proposed for patients with residual elbow pain after two months of physiotherapy and applied to those who consented. Elbows with previous surgical treatment, prior platelet-rich plasma treatment, or traumatic UCL injuries were excluded. The patients were divided into 2 groups: group E, physiotherapy with ESWT; group P, physiotherapy alone. Return-to-play rates and the time to resume throwing were compared between the groups. Results: Sixty-three baseball pitchers with a mean age of 17 years (range, 15-23) were included in this study. Group E and P included 36 and 27 patients, respectively. Most elbows showed lower-grade injuries on MRI, and there were no complete tears. In group E, 31 (86%) elbows successfully returned to sports, while 16 (59%) elbows returned in group P. The difference in the return rates was significant (P = .03). The median time to start throwing was 4 (range, 2-15) and 5 weeks (range, 1-12) in groups E and P, respectively, and the difference was significant (P = .01). Conclusion: Physiotherapy with ESWT for suspected UCL-related symptoms in baseball pitchers yielded better clinical outcomes than physiotherapy alone in terms of a higher return rate and earlier start of throwing. ESWT can be an alternative treatment option for baseball pitchers with suspected UCL-related symptoms.

Background Biomechanical differences between reverse shoulder arthroplasty (RSA) designs, specifically those with larger neck-shaft angles like the Grammont-type prosthesis and those with smaller neck-shaft angles such as lateralized humerus RSAs, have been analyzed in ex vivo studies. However, there are limited data on the differences in in vivo shoulder kinematics between these designs. The purpose of this study was to analyze in vivo kinematics of lateralized humerus RSA during active scaption and external rotation at the side, and to compare them to previously reported data for Grammont-type RSA. Methods Twenty shoulders that underwent RSA using a lateralized onlay prosthesis were included in this study. They consisted of 10 males and 5 females with a mean age of 76 years (range: 69-83). Patients underwent fluoroscopy during active scaption and external rotation at the side at or after postoperative 1 year; additionally, computed tomography was performed to create three-dimensional scapular implant models. Using these fluoroscopic images and three-dimensional models, three-dimensional shoulder kinematics were computed using model-image registration techniques. Scaption kinematics and scapular-neck distance were compared with data from previous studies on Grammont-type RSA, which were analyzed using the same techniques as in this study. Results There were no significant differences in scaption kinematics between lateralized humerus and Grammont-type RSA. However, the scapular neck-insert distance during active external rotation at the side was significantly greater in lateralized humerus RSA (3.2-5 mm) than in Grammont-type RSA (approximately 1 mm, P < .001), despite the glenohumeral abduction angles being significantly smaller (P = .03). Conclusion Lateralized humerus RSA showed similar scaption kinematics to Grammont-type RSA; however, the scapular neck-insert distance during active external rotation at the side was significantly greater in lateralized humerus RSA than in Grammont-type RSA. The greater neck-insert distance may contribute to a lower incidence of scapular notching. (c) 2025 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background Conservative treatment such as physiotherapy is a treatment option for ulnar collateral ligament (UCL) injuries in baseball pitchers, with 46–66% of patients returning to their previous performance levels. However, a standardized conservative treatment algorithm for UCL injuries has yet to be established. While extracorporeal shock wave therapy (ESWT) is widely used for sports-related musculoskeletal disorders, there has been limited data on its effectiveness for suspected UCL-related symptoms in baseball pitchers specifically. Purpose/hypothesis The purpose of this study was to retrospectively evaluate the effectiveness of ESWT for suspected UCL-related symptoms by comparing the clinical outcomes between patients treated by physiotherapy with or without ESWT. We hypothesized that physiotherapy with ESWT for suspected UCL-related symptoms would result in superior clinical outcomes, including better sports return and a shorter time to resume throwing. Methods The study subjects were skeletally mature baseball pitchers who 1) were diagnosed with an isolated UCL injury of the throwing-side elbow, 2) were treated with physiotherapy with or without ESWT, 3) underwent MRI of the elbow, and 4) played at the competitive sports level or practiced more than twice a week. The diagnosis of UCL injury was based on symptoms and physical examination, with MRI as a reference. ESWT was proposed for patients with residual elbow pain after two months of physiotherapy and applied to those who consented. Elbows with previous surgical treatment, prior platelet-rich plasma treatment, or traumatic UCL injuries were excluded. The patients were divided into two groups: Group E, physiotherapy with ESWT; Group P, physiotherapy alone. Return-to-play rates and the time to resume throwing were compared between the groups. Results Sixty-three baseball pitchers with a mean age of 17 years (range, 15–23) were included in this study Group E and P included 36 and 27 patients, respectively. Most elbows showed lower-grade injuries on MRI, and there were no complete tears. In Group E, 31 (86%) elbows successfully returned to sports, while 16 (59%) elbows returned in Group P. The difference in the return rates was significant (P = .03). The median time to start throwing was 4 (range, 2-15) and 5 weeks (range, 1-12) in Groups E and P, respectively, and the difference was significant (P = .01). Conclusion Physiotherapy with ESWT for suspected UCL-related symptoms in baseball pitchers yielded better clinical outcomes than physiotherapy alone in terms of a higher return rate and earlier start of throwing. ESWT can be an alternative treatment option for baseball pitchers with suspected UCL-related symptoms. Level of evidence Level III; Retrospective Cohort Comparison; Treatment Study

Background:Panner disease is a condition characterized by osteochondrosis of the humeral capitellum. Because of its rarity, clinical outcomes, including return to sports, have not been well described in previous studies. Purpose:To investigate the clinical and radiographic outcomes after nonoperative treatment of elbows affected by Panner disease. Study Design:Case series; Level of evidence, 4. Methods:The inclusion criteria for this study were as follows: (1) elbows diagnosed with Panner disease between January 2007 and March 2021, and (2) elbows in patients who were followed until clinical and radiographic healing was confirmed. Patient background (sports participation, familial smoking, steroid use, and bone age), symptoms, radiographic findings, and outcomes after nonoperative treatment were analyzed. Results:Seven elbows in 7 patients (5 boys and 2 girls; 4 gymnasts and 3 baseball players) were included. The mean age at the initial examination was 10 years (range, 7-11 years), and bone age was younger than the chronological age in 3 patients (43%). All patients were treated nonoperatively with a mean follow-up of 37 months (range, 14-109 months). At the initial examination, all patients experienced elbow pain, and a limited range of motion was observed in 4 patients (57%). Familial smoking was reported in 2 patients (29%), and steroid use in 1 patient (14%). After a mean of 7 months (range, 2-15 months) of overhead motion restriction and cessation of upper extremity loading, all patients returned to sports at a mean of 15 months (range, 10-24 months). Complete healing of the epiphyseal nucleus of the capitellum was observed at a mean of 12 months (range, 10-18 months). Conclusion:Nonoperative treatment for Panner disease resulted in favorable outcomes in 7 patients. All patients fully returned to sports with well-remodeled capitella.

BACKGROUND:Shoulders capable of achieving active abduction greater than 90° following reverse total shoulder arthroplasty (rTSA) have been reported to exhibit better scapulohumeral rhythm (SHR) compared to those limited to less than 90 degrees of active abduction. This study aimed to calculate SHR in shoulders following semi-inlay rTSA and to investigate whether improved SHR is associated with better postoperative patient-reported outcome measures in shoulders achieving active abduction greater than 90°. METHODS:Twenty shoulders of 19 patients who underwent semi-inlay rTSA were analyzed. Each shoulder underwent computed tomography and fluoroscopy. Fluoroscopic images were acquired during scapular plane abduction. Using model-image registration techniques, the poses of 3-dimensional models were iteratively adjusted to match the silhouettes in the fluoroscopic images. SHR was defined as (ΔH-ΔS)/ΔS, where ΔH is the increment in humeral elevation angle and ΔS is the increment in scapular upward rotation angle. The mean postoperative SHR assessed from 20° to 90° of humeral abduction was used to divide the shoulders into 2 groups: SHR <2 or SHR ≥2. American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score was evaluated preoperatively and 1 year after surgery. RESULTS:The mean postoperative SHR was 1.7. Fourteen shoulders had SHR <2, while 6 shoulders had SHR ≥2. There were no significant differences in demographic data, preoperative active range of motion, or preoperative ASES scores between the groups. Although no significant differences in postoperative range of motion were observed, shoulders with SHR ≥2 had significantly higher postoperative ASES scores (94.3 ± 4.6) compared to those with SHR <2 (82.1 ± 9.4, P = .007). A significant positive correlation was observed between the postoperative ASES scores and both the mean SHR (r = 0.452, P = .045) and the overall SHR measured from arm at side to maximum abduction (r = 0.478, P = .033) across all shoulders. CONCLUSIONS:Shoulders following semi-inlay rTSA with SHR ≥2 exhibited significantly higher postoperative ASES scores compared to those with SHR <2. A significant positive correlation was also observed between the mean SHR and postoperative ASES scores across all shoulders, highlighting the positive impact of improved SHR on achieving superior postoperative patient-reported outcome measures.

Background:The coracoid process transfer, such as the Bristow or Latarjet procedure, is standard procedure for cases of anterior shoulder instability with large bone defects. However, the revision surgery for failed coracoid transfer was challenging. The purpose of this study was to retrospectively assess the clinical outcomes after arthroscopic soft-tissue stabilization for failed coracoid transfer. Methods:This retrospective study assessed patients who underwent arthroscopic soft-tissue shoulder stabilization for failed coracoid transfer at our institute between January 2008 and December 2021 with at least 2 years of follow-up. Patients' demographics, radiographic findings, intraoperative findings, clinical outcomes (Rowe scores, Subjective Shoulder Value, and the visual analog scale for pain), and return to play sports were investigated. Results:This study included fifteen shoulders in fifteen patients (14 males and 1 female) with a mean age of 30 years (range, 18-51 years). Fourteen (93%) patients participated in sports activities. The average time between the initial and revision surgeries was 107 months (range, 24-360 months) with a follow-up of 46 months (range, 24-120 months). Preoperative computed tomographic showed graft nonunion in nine (60%) shoulders, graft malposition in five (33%) shoulders, and hardware complications in five (33%) shoulders. Intraoperative findings demonstrated an unrepaired Bankart lesion in 14 (93%) patients and a capsular tear in one (7%) patient. Rowe score, Subjective Shoulder Value, and pain visual analog scale significantly improved postoperatively (P < .001 for each). Twelve of 14 patients (86%) returned to sports activity at a complete or near-preinjury level. One (7%) patient experienced redislocation that required revision surgery and two (13%) experienced axial nerve palsy. Conclusion:All shoulders with failed coracoid transfer had an unrepaired Bankart lesion except one shoulder with a capsular tear. Arthroscopic soft-tissue stabilization combined with selective augmentations yielded good clinical outcomes, demonstrated by a low recurrence rate, high return to play sports rate, and good shoulder function.