Clinics in Shoulder and Elbow最新文献

Background: Isolated infraspinatus tears are rare and traditional arthroscopic repairs often result in unsatisfactory outcomes. This study evaluates the clinical and radiological outcomes of arthroscopically-assisted lower trapezius tendon (aLTT) transfer in patients with isolated irreparable infraspinatus tears.

Methods: This single-center retrospective study reviewed patients who underwent aLTT transfer for irreparable infraspinatus tears with no advanced glenohumeral arthritis. Clinical assessment included visual analog scale (VAS), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE). Shoulder range of motion was also evaluated. Radiographic evaluation included postoperative magnetic resonance imaging used to evaluate tendon integrity at final follow-up. Two patients were excluded due to loss to follow-up or incomplete data.

Results: Six patients were included, with a mean age of 60.7±4.1 years and a mean follow-up duration of 36.7±19.8 months (range, 24-75 months). At the final follow-up, VAS pain scores had improved from 6.0±1.4 to 1.7±0.8 (P<0.05). Functional scores had also improved: Constant score, from 51.5±5.6 to 72.0±6.4; ASES, from 60.5±4.5 to 82.0±6.3; and SANE, from 48.0±6.7 to 79.1±8.0 (P<0.05). Range of motion (ROM) improved in forward elevation (115°±12° to 170°±9°), abduction (95°±15° to 143°±16°), and external rotation at side (22°±11° to 51°±11°) (P<0.05). No progression of glenohumeral arthritis or tendon retears were seen on final follow-up.

Conclusions: aLTT transfer significantly reduces pain, improves shoulder function, and restores ROM in patients with isolated irreparable infraspinatus tears. These findings suggest that aLTT transfer is an effective treatment option for this challenging condition. Level of evidence: IV.

Background: Elbow dysfunction can impair daily activities and reduce health-related quality of life (HRQoL). This study used the EuroQol five dimensions instrument (EQ-5D) alongside functional scores and treatment priorities to assess HRQoL in patients awaiting elective elbow surgery.

Methods: In this prospective study, patients scheduled for elbow surgery from December 2024 onward were enrolled and categorized as having osteoarthritis, stiffness, or instability. HRQoL was measured using the EQ-5D. Multivariable regression was performed with EQ-5D as the dependent variable and waiting time, age, sex, and diagnosis as predictors. Functional outcomes were assessed with the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (qDASH). Patients also indicated whether they prioritized pain relief or improved mobility.

Results: Overall, 102 patients were included. The mean waiting time was 204±115 days, and the overall EQ-5D index was 0.67±0.06. Patients with osteoarthritis had the lowest EQ-5D index (0.60±0.29), highest pain levels (2.32±0.48), and greatest depression scores (1.97±0.75). They also showed the lowest MEPS and highest qDASH, with MEPS significantly lower than in patients with instability (P=0.016). The multivariable regression suggested non-significant trends toward lower EQ-5D with longer waiting times (β=-0.0001, P=0.663) and older age (β=0.002, P=0.306). Osteoarthritis patients prioritized pain relief (P=0.026), and stiffness patients prioritized mobility (P=0.021).

Conclusions: Although longer waiting times and older age showed non-significant trends toward lower HRQoL, osteoarthritis patients were most affected, with the lowest EQ-5D (0.60) and significantly worse MEPS (P=0.016) than in the other groups. Future studies should test whether preoperative pain or psychological support can mitigate HRQoL decline. Level of evidence: II.

Background: We aimed to review all published evidence on the surgical management of internal impingement and associated conditions in athletes of overhead sports.

Methods: Our search included studies reporting outcomes of any surgical intervention on shoulder internal impingement and its sequelae in overhead athletes. The primary outcome was return to sport at pre-injury level or higher in the main text (RTS+). Secondary outcomes included return to sport at any level (RTS), shoulder function, and complications. No quantitative analyses were possible due to the nature of the evidence included.

Results: Forty-two observational studies were eligible. They included 1,420 overhead athletes with a mean age of 27.3 years. RTS+ across all surgical procedures ranged from 25% to 94%. In patients treated with debridement of articular-sided partial-thickness rotator cuff tears, the RTS+ ranged from 50% to 85%, and in those who underwent posterior glenoidplasty for glenoid spurs, it ranged from 55% to 63.6%. Comparative studies for superior labrum anterior to posterior (SLAP) tears demonstrated similar RTS+ after open subpectoral tenodesis and arthroscopic SLAP repair. RTS+ after the two procedures in all observational studies ranged from 35% to 100% and 54.2% to 100%, respectively. RTS+ after capsulorrhaphy, when performed concomitantly with other procedures, ranged from 25% to 93%.

Conclusions: Outcomes associated with the surgical management of internal impingement are variable. Surgical decision-making should prioritize patient-specific factors following unsuccessful conservative management. We provide surgical recommendations and considerations.

Background: This study aimed to determine the effectiveness of electromyography (EMG) biofeedback training on scapular kinematics and/or muscle activation in patients with scapular dyskinesis (SD) associated with subacromial impingement syndrome (SIS).

Methods: An electronic search was conducted in the Medline, Embase, Scopus, Web of Science, CINAHL, SPORTDiscus, LILACS, CENTRAL, and PEDro databases. Eligibility criteria comprised randomized clinical trials investigating the effects of adding EMG biofeedback training to scapular-focused exercises on scapular kinematics and/or muscle activation in patients with SD associated with SIS. Data were pooled using a Hartung-Knapp-Sidik-Jonkman random-effects method or Mantel-Haenszel fixed-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results: Four trials met the eligibility criteria. The mean difference (MD) for upward rotation was 1.13° (P=0.07), and that for downward rotation was 1.2° (P=0.08). The MDs for muscle activation of the lower trapezius during scapular plane elevation and descending movements were 7.22% (P=0.010) and 2.26% (P<0.001), respectively. The MDs for the muscle balance ratios of the upper/lower trapezius and upper trapezius/serratus anterior were 0.11% (P=0.95) and 0.15% (P=0.04), respectively. All differences favored the EMG biofeedback plus scapular-focused exercises group.

Conclusions: In the short-term, adding EMG biofeedback training to scapular-focused exercises resulted in significant differences only in lower trapezius activity. Conversely, the results were inconclusive regarding improvements in scapular kinematics and changes in the activation of other scapular muscles. The quality of evidence ranged from very low to high according to GRADE rating, suggesting that the effect of EMG biofeedback might not be captured in this study. Level of evidence: I.

Background: The incidence of ulnar collateral ligament (UCL) repair continues to increase, so evaluating the accuracy and readability of information about this procedure that is produced by artificial intelligence (AI) models is important. This study assesses AI-generated responses to common patient questions about UCL repair.

Methods: Twenty patient questions frequently encountered in clinical practice were submitted to ChatGPT, Gemini, and Grok. Three fellowship- trained orthopedic surgeons independently rated answer accuracy using the ChatGPT Response Rating System (CRRS) and AI Response Metric (AIRM), which assign scores from 1-5, with lower scores indicating better accuracy. Responses with CRRS >2 were classified as requiring more than minimal clarification. Readability was evaluated using the Flesch-Kincaid Reading Ease (FKRE) and Grade Level (FKGL) metrics. Responses with an FKGL >6 exceeded the American Medical Association (AMA) and National Institutes of Health (NIH) recommended 6th grade reading level for patient education materials.

Results: More than minimal clarification was required for 15% (3/20) of ChatGPT, 5% (1/20) of Gemini, and 40% (8/20) of Grok responses. Gemini (CRRS, 1.5±0.5; AIRM, 1.6±0.5) demonstrated significantly better accuracy than ChatGPT (CRRS, 2.0±0.4; P=0.0002; AIRM, 2.2±0.5; P=0.0001) and Grok (CRRS, 2.1±0.7; P=0.005; AIRM, 2.4±0.8; P=0.002). All responses exceeded the AMA/NIH 6th grade reading level threshold (FKGL >6). Gemini produced the highest FKGL (16.2±2.2), significantly higher than ChatGPT (14.4±1.6, P=0.005) and Grok (14.6±1.7, P=0.017). FKRE did not differ significantly among models (P=0.14).

Conclusions: AI models generated generally accurate information about UCL repair but at reading levels far above the AMA/NIH recommendations. In this study, Gemini was the most accurate model and produced the least readable content. Level of evidence: III.

Background: Existing research on the influence of symptom duration on the outcomes of ultrasound-guided shoulder hydrodilatation for frozen shoulder remains limited. This prospective analytical study aims to investigate the associations between symptom duration and other potential factors and shoulder function following ultrasound-guided shoulder hydrodilatation.

Methods: This study was conducted at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, and involved patients with frozen shoulder who underwent ultrasound-guided shoulder hydrodilatation. Using convenience sampling, 72 participants were recruited, and 36 were classified into the early hydrodilatation group and 36 into the late hydrodilatation group. Outcome measures were the Oxford Shoulder Score (OSS), visual analog scale (VAS), and shoulder range of motion (ROM), which were assessed both before and 6 weeks after the hydrodilatation procedure.

Results: Duration of symptoms, age, sex, history of diabetes mellitus, physiotherapy, and baseline shoulder ROM did not exhibit any association with OSS changes. However, a high VAS score at baseline was associated significantly with improved shoulder function following ultrasound- guided shoulder hydrodilatation (P=0.006).

Conclusions: There was no association between the duration of symptoms and enhanced shoulder function after ultrasound-guided shoulder hydrodilatation in short-term assessments. Patients with higher baseline shoulder pain severity tended to experience greater improvements in shoulder function compared to those with milder pain levels. Level of evidence: III.

Background: Total elbow arthroplasty (TEA) is increasingly performed for complex elbow pathology, yet revision procedures remain challenging due to high complication rates and limited bone stalk. While TEA may produce satisfactory functional outcomes for select patients, it is often burdened by high complication rates, necessitating revision TEA, often with extensive bone loss. Among available reconstructive strategies, allograft-prosthesis composite (APC) reconstruction has emerged as a possible technique; however, reported outcomes remain heterogeneous. This systematic review aims to characterize the use and outcomes of APC reconstruction in revision TEA for patients with significant bone loss.

Methods: We searched the PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify clinical studies of revision TEA performed with an APC published between inception of each database and 2023. Outcomes of interest were patient-reported outcome measures (PROMs), range of motion (ROM), radiographic outcomes, and complications.

Results: We included five studies that reported on 85 elbows with APC TEA revisions for extensive bone loss. PROMs and ROM were reported for 70 elbows, yielding a mean postoperative Mayo Elbow Performance Score of 64 points and an active elbow arc of 24°-120°. The complication rate across 85 elbows was 38.8% (33 elbows). The graft-host junction non-union rates of humeral and ulnar allografts were 40% (20 elbows) and 16% (5 elbows), respectively.

Conclusions: APC provides a salvage option in revision TEA with severe bone loss but is associated with high complication and non-union rates.

Background: This study evaluates the biomechanical effects of acellular dermal matrix (ADM) patch augmentation in a rotator cuff repair model and determines the effect of medial knot tying on time-zero stability.

Methods: A biomechanical study was conducted using a porcine flexor digitorum profundus tendon model. Eighteen specimens were assigned to three groups: non-patched repair with medial row knot tying (n=5), patch-augmented repair without medial row knot tying (n=4), and patch-augmented repair with medial row knot tying (n=4). All repairs were performed using a standardized double-row suture bridge technique. Biomechanical testing assessed elongation, strain, load to failure, and construct stiffness at time zero.

Results: Patch augmentation without medial row knot tying resulted in significantly greater tendon elongation (12.9±6.5 mm) than nonpatched repairs (5.0±5.3 mm, P=0.016) and patch-augmented repairs with medial row knot tying (4.4±4.4 mm, P=0.027). Similarly, strain was significantly higher in the patch-augmented group without medial knot tying (75.8%±42.9%) than in the non-patched repair (35.2%±38.9%, P=0.028) and patch-augmented repair with medial knot tying groups (29.1%±28.9%, P=0.052). However, load to failure did not differ significantly among the groups (P>0.05).

Conclusions: ADM patch augmentation did not enhance time-zero mechanical strength in the tested conditions, though biomechanical advantages might emerge after integration to the tendon. In addition, patch augmentation without medial row knot tying showed the highest elongation and strain among groups, potentially reducing the stability of the repair. Level of evidence: V, controlled laboratory study.

Background: Acromioplasty is frequently performed during arthroscopic rotator cuff repair (ARCR) to address subacromial impingement, though its clinical value remains debated. This meta-analysis examines whether acromioplasty improves functional outcomes, pain relief, or re-tear rates in patients undergoing ARCR for full-thickness rotator cuff tears.

Methods: A systematic search of PubMed, Embase, Cochrane Library, and Scopus was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify randomized controlled trials (RCTs) from 2011 to 2023. Six RCTs comparing ARCR with and without acromioplasty were included. Primary outcomes included functional scores of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff Index, University of California, Los Angeles scores, pain levels (visual analog scale [VAS]), and re-tear rates. Data were pooled using a random-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Across 574 patients, both groups demonstrated improvement in functional outcomes. The acromioplasty group showed a modest advantage (e.g., ASES score: mean difference, 2.93), but these gains did not exceed the minimal clinically important difference. There were no significant differences in pain relief (as measured by VAS) or re-tear rates between groups. The risk of bias was moderate in some trials due to a lack of blinding. GRADE assessment rated evidence as high for ASES scores and moderate for other outcomes.

Conclusions: Acromioplasty offers statistically modest improvements in shoulder function but does not meaningfully enhance pain relief or reduce re-tear rates. Given these findings, the routine use of acromioplasty in ARCR is not supported; however, select patients may benefit based on individual anatomical or clinical factors. Level of evidence: I.

Background: The role of manipulation under anesthesia (MUA) without arthroscopic capsular release in patients with preoperative stiffness undergoing arthroscopic rotator cuff repair (ARCR) remains unclear. Additionally, the association between shoulder stiffness and tendon healing after ARCR is still controversial. This study aimed to compare the clinical outcomes and retear rates between patients with preoperative stiffness treated by MUA alone and those without stiffness.

Methods: This retrospective study included 322 patients who underwent ARCR for full-thickness tears between January 2012 and May 2022 with a minimum 2 years of follow-up. Clinical outcomes-including passive range of motion (ROM); the Japanese Orthopedic Association (JOA) score; and the University of California, Los Angeles (UCLA) score-were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients were divided into the stiffness group (MUA completed) and the non-stiffness group. Retears were evaluated using magnetic resonance imaging at 6 months postoperatively, and retear rates were analyzed by tear size (medium vs. large/massive).

Results: Eighty-eight patients with stiffness and 234 without stiffness met the study inclusion criteria. Preoperative ROM, JOA, and UCLA scores were significantly lower in the stiffness group. Both groups showed significant improvements at final follow-up, with greater gains in the stiffness group. Final outcomes were comparable, except for external rotation. In medium-sized tears, the retear rate was significantly lower in the stiffness group (1.9%) than in the non-stiffness group (10.8%) (P=0.042). No significant difference was observed for large/massive tears.

Conclusions: Patients with preoperative stiffness treated with MUA alone achieved comparable outcomes to those without stiffness, with improved tendon healing in medium-sized tears. Level of evidence: III.