Clinics in Shoulder and Elbow最新文献

Background: This study used Statcast-derived metrics to evaluate return to play (RTP) and performance outcomes in Major League Baseball (MLB) position players following ulnar collateral ligament (UCL) surgery.

Methods: MLB position players undergoing UCL surgery between 2017 and 2024 were identified using the Tommy John List. A 1:1 age-matched control group of uninjured MLB position players was used for performance comparisons. Performance data from the two seasons before surgery and the two seasons following RTP were collected. The data included usage, offensive performance, batted ball metrics, and defensive performance.

Results: Twenty-five MLB position players were confirmed to have undergone UCL surgery (UCL reconstruction=18; UCL repair=7). Twenty-one players (84%) returned to MLB competition with a mean time to RTP of 9.4±3.8 months. Players who underwent UCL repair returned significantly faster than those who underwent reconstruction (7.3±1.6 vs. 10.4±4.2 months, P=0.049). No statistically significant differences were observed between pre- and post-surgery performance across any metric for the full cohort. However, catchers demonstrated statistically significant improvements in average exit velocity and hard-hit percentage compared to both preoperative performance (exit velocity: P=0.04; hard-hit percentage: P=0.03) and matched controls (exit velocity: P=0.05; hard-hit percentage: P=0.04).

Conclusions: MLB position players return to competition at a high rate following UCL surgery. Among those who return, Statcast-derived offensive and defensive metrics demonstrate that postoperative changes in performance are minimal and statistically insignificant. Interestingly, catchers demonstrated paradoxical improvements in both postoperative average exit velocity and hard-hit percentage. Level of evidence: III.

Background: We aimed to determine whether increased vertical displacement on upright clavicle radiographs (UCR) compared with supine clavicle radiographs (SCR) influenced the decision to operate.

Methods: Adult patients with clavicle fractures identified on initial SCR or computed tomography scans during primary evaluation at a level 1 trauma center from July 2021 to November 2023 were included. The patients also underwent UCR. Exclusion criteria were patients with chronic or pathologic fractures, inadequate imaging, or incomplete documentation. Increases in vertical displacement from SCR to UCR were measured, and we recorded how often these increases on UCR prompted surgical management.

Results: Overall, 160 patients (average age 47.0 years; 70% male) met the inclusion criteria. Most of the study population was managed nonoperatively (90%), with only 16 patients (10%) managed surgically. Only two of the 160 patients (1.3%) underwent surgical intervention based primarily on increased vertical displacement on UCR. With an average change of 4.5 mm (95% CI, 3.5-6.6 mm) between SCR and UCR for patients managed nonoperatively, and 5.1 mm (95% CI, 2.7-7.5 mm) for those managed operatively. There was no significant difference in management based on UCR (P=0.71). Subgroup analysis, stratifying patients by either ≥1 cm or <1 cm of displacement, found there was still no statistically significant change in SCR and UCR (P=0.44).

Conclusions: Inpatient UCR rarely alters the management of clavicle fractures at our institution, indicating that its use is best reserved for case-by-case consideration. Level of evidence: IV.

Background: Fixation of clavicular shaft fractures carries risks of nonunion, infection, and functional loss. Although superior and anteroinferior plating have widely been studied, the optimal approach remains debated. Previous literature has relied on indirect comparisons and been limited by early study cutoffs, high heterogeneity, and omission of key outcomes. This meta-analysis directly compared union, function, and complications between superior and anteroinferior plating.

Methods: This review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Eligible studies included randomized trials or prospective/retrospective cohort studies of adults. Outcomes of interest included the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; and complications (plate removal, infection, nonunion). Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions or Cochrane Risk of Bias 2.0 tool, and certainty of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Analyses were performed in Review Manager 5.4 (Cochrane).

Results: Twelve studies (n=980) were included. Constant-Murley scores did not differ significantly (mean difference [MD]=-1.19; 95% CI, -3.18 to 0.81; P=0.24). Beginning at 2 years, DASH scores showed no difference (MD=1.62; 95% CI, -0.46 to 3.70; P=0.13). Times-tounion (MD=0.41; 95% CI, -0.60 to 1.43; P=0.42) and rates of nonunion (odds ratio [OR]=2.42; 95% CI, 0.59-9.94; P=0.22) were comparable. Plate removal (OR=1.16; 95% CI, 0.82-1.65; P=0.41) and infection (OR=0.81; 95% CI, 0.32-2.06; P=0.66) also showed no significant differences. Heterogeneity was minimal (I2=0).

Conclusions: Superior and anteroinferior plating of midshaft clavicle fractures provide comparable union rates, functional outcomes, and complication rates. Selection of the surgical approach should depend on fracture morphology, surgeon preference, and patient-specific factors. Level of evidence: III.

Background: Patients with cardiac implantable electronic devices (CIEDs) increasingly present for elective orthopedic procedures. In this study we evaluate peri-operative complications associated with CIED presence using a large multicenter database.

Methods: Retrospective cohort analysis was performed using the TriNetX database. Adults undergoing primary total shoulder arthroplasty (TSA) between 2005 and 2025 were identified and stratified by CIED status. Four propensity score-matched (1:1) analyses were conducted: all TSA patients with versus without CIEDs, (2) patients with cardiac disease with CIED versus without CIEDs, and patients with recent device implantation (<6 months before TSA) versus patients with remote device implantation (>6 months before TSA). Matching balanced demographic factors and comorbidities. Outcomes included 90-day and 2-year complications. Relative risks, 95% CIs, and P-values were calculated using chi-square and t-tests; significance was set at P<0.05.

Results: After matching, 6,931 patients were included per cohort. CIED presence was associated with significantly higher 90-day rates of cardiac, renal, infectious, and neurologic complications, as well as increased mortality, readmissions, and emergency department visits. These associations persisted after controlling for underlying cardiac disease. Patients undergoing TSA within 6 months of device implantation experienced higher rates of complications. Revision rates were not significantly different between groups, and mechanical outcome associations were variable.

Conclusions: CIED presence was associated with increased systemic complications following TSA, particularly when surgery occurred within 6 months of device implantation. Mechanical outcome differences were less consistent. These findings indicate the necessity of multidisciplinary perioperative planning, thoughtful surgical timing, and prospective studies to better define underlying risk pathways. Level of evidence: III.

Parsonage-Turner syndrome (PTS) is an underdiagnosed condition that presents with debilitating symptoms in affected patients, with reported incidence rates varying between 1.64 and 3 per 100,000 individuals. Clinical presentation often includes acute shoulder pain associated with neurological deficits that do not follow a regular diagnostic pattern. The cause of this disease is not fully understood, but it is generally triggered by an upper respiratory infection a few weeks prior to presentation. Other associated risk factors include genetic predisposition, vaccines, and surgical intervention. Diagnosis often relies on clinical investigation, holistic physical exam, and appropriate diagnostic studies. Treatment is often conservative, in the form of physical rehabilitation and pain management to avoid muscular atrophy. The condition generally resolves over time, with a recovery rate of 65% at 10 months and a favorable prognosis for most cases. However, recurrences are noted, especially in patients with a genetic predisposition to the condition (75% in the hereditary form vs. 26% in the general form). Future research should explore the pathophysiological processes behind this disease to extrapolate strategies that can achieve an earlier diagnosis and more effective treatment.

Background: Concomitant repair of the subscapularis (SSC) tendon in reverse total shoulder arthroplasty (RTSA) with a lateralized design remains controversial. The present study aimed to evaluate the effect of SSC repair (repair at native insertion, repair at superiorly migrated position, and no repair) on the glenohumeral arc of motion following RTSA in a cadaveric biomechanical setting.

Methods: RTSA was performed on eight cadaveric shoulders under six testing conditions as follows: unrepaired SSC/intact teres minor (TM); intact SSC/intact TM; superiorly repaired SSC/intact TM; unrepaired SSC/deficient TM; intact SSC/deficient TM; and superiorly repaired SSC/deficient TM. Increasing load (2.5-N increments) was applied to the middle deltoid (anterior, posterior; 10 N each, middle; 10- 20 N). The resulting abduction and rotation positions were measured.

Results: Unrepaired SSC demonstrated greater abduction and reduced internal rotation (IR), whereas SSC repair increased IR, particularly in TM-deficient models. Superiorly repaired SSC had higher glenohumeral abduction and IR than original SSC repair. SSC repair caused excessive IR in the TM deficiency seen with massive rotator cuff tears.

Conclusions: Concomitant SSC repair in lateralized RTSA decreased glenohumeral abduction and increased IR. Concomitant SSC repair at the original and superiorly migrated footprints should be carefully considered following lateralized RTSA. Level of evidence: V.

Background: Tranexamic acid (TXA) is widely used to reduce bleeding and transfusion requirements during orthopedic procedures. The objective of this review was to evaluate the efficacy of TXA in the arthroscopic repair of rotator cuff tears.

Methods: This systematic review and meta-analysis focused exclusively on randomized controlled trials, sourcing data from Medline, Embase, Web of Science, Scopus, and Cochrane Central up to January 2025. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and evaluated parameters such as visualization in the surgical field, pain, function, total operation time, mean arterial pressure, amount of fluid lost, hospital stay, tear size, and complications.

Results: Initially, 298 records were identified. After a comprehensive screening process, 12 studies involving 967 patients were selected for inclusion. Most of the included studies used a saline solution as the control, and the most common route of TXA administration was intravenous, with a dose of 1,000 mg diluted in 100 mL of solution. In the parameters evaluated, no significant differences were found favoring the use of TXA. There was limited comparability of the results reported across the included studies.

Conclusions: This study finds a lack of clear evidence to support a clinical benefit of TXA in arthroscopic rotator cuff repair. Consequently, the routine use of TXA for this procedure should be reconsidered. Given its established safety profile, TXA might still have a role in specific, limited clinical situations in which its benefits could outweigh the current lack of evidence for its widespread application. Level of evidence: I.

Background: Lateral epicondylitis (LE), commonly known as tennis elbow, is a condition involving inflammation of the extensor carpi radialis brevis tendon at its attachment to the lateral epicondyle of the humerus. In recent years, platelet-rich plasma (PRP) therapy, an ortho- biologic treatment, has emerged as a promising option for the treatment of LE. Despite promising results in clinical trials, variability in PRP preparation and administration is a barrier to consistent outcomes. To address this, the Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were created in 2017 to establish a standardized approach for reporting findings in PRP-based studies. The objective of this study was to analyze and compare the rate of adherence of the MIBO guidelines in the use of PRP in treating LE.

Methods: This systematic review evaluates the adherence of studies on PRP for LE to MIBO guidelines using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Adherence was determined by calculating the total percentage of checklist items that each study adequately and clearly reported from the 46-point checklist.

Results: A total of 26 studies (954 patients) were included. Overall, only 52.2% of the 46-point MIBO checklist was reported per article on average with 0 articles displaying adherence rates of 100%. There was no significant difference in the mean adherence rates between studies prior to publication of the MIBO guidelines (45.2%) and after (53.7%).

Conclusions: This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. There was no difference in the adherence rates in studies published before and after the creation of MIBO guidelines in 2017.

Dynamic anterior stabilization (DAS) using the long head of the biceps tendon (LHB) is an arthroscopic option for recurrent anterior shoulder instability, especially with subcritical glenoid bone loss. This narrative review synthesizes biomechanical, technical, and clinical literature from PubMed/Medline, Embase, Cochrane (2014-2025), and Google Scholar. LHB-based DAS augments an arthroscopic Bankart repair by transferring the patient's LHB to the anterior glenoid, creating a dynamic "hammock-sling-bumper" effect that resists anterior translation in vulnerable positions. Contemporary techniques use minimally morbid arthroscopy with onlay or inlay fixation. Clinical series report low recurrence (0%-13%) at 1-5 years. Functional outcomes improve substantially: Rowe scores typically rise from 21-36 preoperatively to 90-95 postoperatively, American Shoulder and Elbow Surgeons scores exceed 90, and Western Ontario Shoulder Instability Index improves by roughly 959 points. Return-to-sport rates reach 85%-95%, with range of motion generally comparable to standard Bankart repairs. In patients with subcritical bone loss (10%-20% of glenoid width), DAS appears to enhance stability versus isolated soft-tissue repair while avoiding the complication profile of bone-block procedures (e.g., Latarjet). Suggested indications include recurrent instability with subcritical bone loss, failed prior soft-tissue repair, young high-demand athletes, and concomitant superior labrum anterior to posterior lesions. Contraindications and optimal thresholds for bone loss require clarification. Evidence remains limited by nonrandomized designs and short follow-up. Long-term outcomes beyond five years and high-quality comparative or randomized trials are needed to define durability, refine indications, and position LHB-based DAS within the broader algorithm for anterior shoulder instability management.