JSES International最新文献

{"title":"Recurrence rates and outcomes of shoulder stabilization surgery in patients with seizures","authors":"Louis W. Barry BS,&nbsp;Benjamin Brej BS,&nbsp;Erryk S. Katayama BA,&nbsp;Kyle S. Huntley MD,&nbsp;Collin Todd BS,&nbsp;Brent Henderson BA,&nbsp;George Matta BS,&nbsp;Grant L. Jones MD,&nbsp;Ryan C. Rauck MD,&nbsp;Gregory L. Cvetanovich MD,&nbsp;Julie Y. Bishop MD","doi":"10.1016/j.jseint.2025.08.013","DOIUrl":"10.1016/j.jseint.2025.08.013","url":null,"abstract":"<div><h3>Background</h3><div>Patients with seizure disorders face a heightened risk of shoulder instability, often presenting with complex pathology and greater bone loss than nonseizure patients. We hypothesize that seizure patients experience a higher rate of recurrent instability after primary shoulder stabilization as compared to nonseizure patients.</div></div><div><h3>Methods</h3><div>This single-institution retrospective study (2009-2023) compares patients with recurrent shoulder instability with and without a seizure history undergoing shoulder stabilization surgery. Procedures included Bankart repair, remplissage, Hill-Sachs bone grafting, Latarjet procedure, and distal tibia allograft.</div></div><div><h3>Results</h3><div>Among 573 patients, 83 had seizures (46 epileptic, 37 nonepileptic). The seizure group was significantly older (29.1 vs. 24.9 years; <em>P</em> &lt; .001), had higher body mass index (28.5 vs. 26.8; <em>P</em> = .010), greater comorbidities (Charlson-Deyo Comorbidity Index, American Society of Anesthesiologists scores, smoking, and depression; <em>P</em> &lt; .001), and more glenoid bone loss (19% vs. 13%; <em>P</em> = .002). The direction of instability in the seizure group was anterior in 78% of patients (vs. 72%). Seizure patients had a significantly lower range of motion preoperatively and postoperatively. Seizure patients had worse postoperative visual analog scale (3.3 vs. 1.6; <em>P</em> = .001), Single Assessment Numeric Evaluation (75 vs. 86; <em>P</em> = .002), American Shoulder and Elbow Surgeons (69 vs. 87; <em>P</em> &lt; .001), and Shoulder Instability-Return to Sport after Injury (42 vs. 71; <em>P</em> = .007) scores. Recurrent instability was significantly higher in seizure patients (28% vs. 17%; <em>P</em> = .022). In seizure patients, arthroscopic soft tissue repair had a high recurrence rate (48%), significantly worse than open bone augmentation (13%; <em>P</em> = .004). Nonseizure patients had similar recurrence rates for soft tissue repair (19%) and bone augmentation (15%; <em>P</em> = .33). Recurrence rates were comparable between seizure and nonseizure groups after bone augmentation (<em>P</em> = .833) but significantly higher in seizure patients undergoing soft tissue repair (<em>P</em> &lt; .001). Instability-free survival at 2, 5, and 10 years was lower in seizure patients (<em>P</em> = .039) and lower for soft tissue repair vs. bone augmentation within the seizure group (<em>P</em> = .0016).</div></div><div><h3>Conclusion</h3><div>Seizure patients with shoulder instability have more comorbidities, worse clinical outcomes, and greater bone loss than nonseizure patients. Soft tissue repair in seizure patients has a high recurrence rate (48%), while bone augmentation procedures show lower recurrence, even after postoperative seizures. Bone augmentation should be strongly considered for these patients.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101376"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the fragility and robustness of randomized controlled trials in proximal humerus fracture management","authors":"Matthew T. McKinley MBA ,&nbsp;Aghdas Movassaghi BS ,&nbsp;Chase Burzynski BS ,&nbsp;Lana Smith ,&nbsp;Guoli Zhou MPH, MD, PhD ,&nbsp;Justin T. Childers MS ,&nbsp;Jocelyn Lubert MD ,&nbsp;Garrett R. Jackson MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1016/j.jseint.2025.09.002","DOIUrl":"10.1016/j.jseint.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Despite multiple surgical techniques for proximal humerus fractures (PHFs), no method has demonstrated superiority, and randomized controlled trials (RCTs) on PHF treatments have yielded conflicting results. The purpose of this study is to analyze the fragility indices for treatment of PHF by calculating fragility index (FI) and continuous fragility index (CFI) for PHF trials outcomes.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses to evaluate PHF RCTs. RCTs reporting at least one statistically significant dichotomous outcome published between 2000 and 2024 were included. The FI and CFI for continuous outcomes were calculated for each trial.</div></div><div><h3>Results</h3><div>Seventeen RCTs were included in FI analysis. The FI was 1 across 21 outcomes, meaning it would take 1 patient reversal to alter significance (FI: 1, interquartile range 0-2.5). Ten RCTs were included in the CFI analysis, which had a median of 4, indicating that across these 10 RCTs, changing 4 points on patient outcomes could nullify statistical significance (CFI: 4, interquartile range 0-8.0). After adjustment, the reported <em>P</em> value remained an independent predictor of fragility, with an effect size of β = −166.7 (standard error = 51.6, <em>P</em> = .0103) for CFI.</div></div><div><h3>Conclusion</h3><div>The observed median FI and CFI suggest significant findings of PHF RCTs could be modified with a single patient switching groups or patient-reported outcomes by changing just 4 points. Surgeons need to be skeptical of the results and conclusions drawn from high-level studies and consider the fragility and significant loss of follow-up impacting conclusions.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101380"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of socioeconomic deprivation on total shoulder arthroplasty outcomes","authors":"Jason Howard BS ,&nbsp;Thomas Stanila BS ,&nbsp;Andrew L. Chen MD ,&nbsp;Samuel E. Mircoff BS ,&nbsp;Hassan Farooq MD ,&nbsp;Dane H. Salazar MD, MBA ,&nbsp;Nickolas G. Garbis MD","doi":"10.1016/j.jseint.2025.08.010","DOIUrl":"10.1016/j.jseint.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is a highly effective surgical intervention to alleviate pain and restore function in various shoulder joint pathologies. As the demand for TSA continues to rise, it is important to understand patient factors that affect clinical outcomes. The Area Deprivation Index (ADI) quantifies socioeconomic deprivation, accounting for multiple variables including income, education, employment, and housing quality. The purpose of this study is to examine the effects of socioeconomic deprivation on patient outcomes after TSA.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed on patients who received TSA from January 2007 to December 2022. Records were reviewed for demographic factors including age, sex, race, body mass index, and Charlson Comorbidity Index. Postoperative outcomes included active forward flexion and active external rotation along with visual analog scale pain scores and American Shoulder and Elbow Surgeons (ASES) scores. Socioeconomic deprivation was evaluated through ADI scores from the Neighborhood Atlas. Chi-squared and analysis of variance tests were performed for analysis.</div></div><div><h3>Results</h3><div>In this study, 955 patients were included, with 426 receiving anatomic TSA (aTSA) and 529 receiving reverse TSA (rTSA) cohort. Among aTSA patients, 32% were least, 52% intermediate, and 16% most deprived. For rTSA, 27% of patients were least, 59% intermediate, and 13% most. The aTSA cohort saw significant differences among socioeconomic groups in postoperative active external rotation at 6 months (most deprived [47.0°] &gt;&gt; intermediate [44.6°], least [43.9°]), and postoperative ASES at the most recent follow-up (most deprived [76.5] &lt;&lt; least [89.4], intermediate [80.4]). There were also differences in mean pain scores at 3 months (most deprived [2.9] &gt;&gt; least [1.4], intermediate [1.7]), 1 year (most deprived [3.1] &gt;&gt; least [1.3], intermediate [1.7]), and the most recent follow-up (most deprived [2.9] &gt;&gt; intermediate [2.0] &gt;&gt; least [1.2]). The rTSA cohort saw significant differences among socioeconomic groups in preoperative ASES (most deprived [24.3] &lt;&lt; intermediate [32.0], least [35.8]). Differences in mean pain score were also significant at preoperative (most deprived [6.6] &gt;&gt; intermediate [5.6] &gt;&gt; least [4.7]) and 1 year time points (most deprived [2.6] &gt;&gt; intermediate [1.6], least [1.4]).</div></div><div><h3>Conclusion</h3><div>Some interval postoperative disparities highlight the impact of socioeconomic deprivation, with most deprived patients having worse outcomes in TSA cohorts. While outcomes were generally similar at the most recent follow-up, prospective studies are needed to more accurately elucidate differences. Nevertheless, incorporating ADI metrics care could maximize optimal outcomes in shoulder arthroplasty.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101373"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the rate of revision vary in primary total stemmed anatomic shoulder arthroplasty with short or conventional humeral stems?","authors":"David R.J. Gill MB, ChB, FRACS, FAOrthA ,&nbsp;Sophia Corfield PhD(Hons) ,&nbsp;Peiyao Du B Biostat ,&nbsp;Desmond J. Bokor MBBS, MHEd(Med), FRACS, FAOrthA","doi":"10.1016/j.jseint.2025.08.015","DOIUrl":"10.1016/j.jseint.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Primary total stemmed anatomic shoulder arthroplasty (aTSA) with either short (&lt;10 cm) or conventional length (≥10 cm) humeral stems undertaken for osteoarthritis were compared to determine the rates of all cause revision.</div></div><div><h3>Methods</h3><div>Between December 1, 2006, and December 31, 2023, all short or conventional humeral stemmed aTSAs were compared from a large national arthroplasty registry by Kaplan–Meier estimates of survivorship and hazard ratios from Cox proportional hazard models adjusted for age, gender, humeral head size, humeral fixation, glenoid component type, glenoid augmentation, polyethylene type, and surgeon volume. Possible interactions were examined.</div></div><div><h3>Results</h3><div>The cumulative percent revision at 13 years was 19.4% (95% confidence interval; 17.0-22.1) for short total shoulder arthroplasty (n = 4,550), 13% (95% confidence interval; 9.6-17.4) for long aTSA (n = 2,447). Long aTSA had a higher rate of revision compared to short aTSA (1.5 years+: <em>P</em> &lt; .001) with a multivariable adjustment. There was a strong interaction between humeral stem length and polyethylene type (Entire Period: <em>P</em> = .006), with a better predictive model of revision risk (Akaike Information Criterion 9,824.3) than main effects (Akaike Information Criterion 9,829.4). Non–highly cross-linked glenoids in combination with long aTSA had higher rates of revision than short aTSA (1.5 years+: <em>P</em> &lt; .001). In contrast, there was an early increase in revision rate of short aTSA with highly cross-linked glenoids compared to long aTSA (0-1.5 years: <em>P</em> = .006).</div></div><div><h3>Conclusion</h3><div>Modern primary aTSA outcome for osteoarthritis is affected by the humeral stem length and glenoid polyethylene. Technical challenges may explain the relative underperformance of short stem components in the short term rather than intrinsic characteristics.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101378"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Pathomechanics of glenohumeral capsule and scapula in idiopathic frozen shoulder: a study using a three-dimensional finite element model” [JSES: International Volume 9, Issue 5 (2025) 1474-1480]","authors":"Prince Shanavas Khan D'Ortho, MS Ortho ,&nbsp;Yon-Sik Yoo MD, PhD ,&nbsp;Ayyappan V. Nair D'Ortho, DNB Ortho ,&nbsp;Seong-Wook Jang MS ,&nbsp;Aebel Raju MRCS ,&nbsp;Sreehari C K MS Ortho","doi":"10.1016/j.jseint.2025.09.004","DOIUrl":"10.1016/j.jseint.2025.09.004","url":null,"abstract":"","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101382"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2025 Acknowlgement of Reviewers","authors":"","doi":"10.1016/j.jseint.2026.101616","DOIUrl":"10.1016/j.jseint.2026.101616","url":null,"abstract":"","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101616"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"While the bony glenoid is superiorly inclined, the glenoid surface is not","authors":"Maximilian Modelhart MD ,&nbsp;Eva C. Herbst PhD ,&nbsp;Alexander M.H. Kunde MD ,&nbsp;Abdelkader Shekhbihi MD ,&nbsp;Thomas Hoffelner MD ,&nbsp;Markus Scheibel MD ,&nbsp;Philipp Moroder MD","doi":"10.1016/j.jseint.2025.08.014","DOIUrl":"10.1016/j.jseint.2025.08.014","url":null,"abstract":"<div><h3>Background</h3><div>The labral complex plays a crucial role in shaping the glenoid fossa morphology, thereby enhancing passive joint stability. This study aimed to investigate the influence of the labrum on glenoid inclination, a key determinant for load distribution within the joint. In addition, the labral influence on glenoid concavity depth and radius of curvature in the supero-inferior plane was evaluated.</div></div><div><h3>Methods</h3><div>Forty-three patients (mean age: 42 years [range 21-64 years]; 35 males, 8 females) with acromioclavicular (AC)-joint dislocation and no glenohumeral pathologies, who received a full series of magnetic resonance imaging or magnetic resonance arthrography, were retrospectively included. For each patient, the glenoid surface inclination, concavity depth, and radius of curvature was measured and compared to their respective values of the bony glenoid. In addition, the bony humeral head radius was measured to evaluate the influence of the labrum on joint congruency. Paired t-tests were used to assess the differences between bony and glenoid surface inclination and concavity depth. Repeated measures analysis of variance and pairwise comparisons were made to compare radius of curvature measurements. The correlation between the bony glenoid inclination and its difference to glenoid surface inclination, as well as between the bony glenoid radius and its difference to glenoid surface radius, was analyzed.</div></div><div><h3>Results</h3><div>The bony glenoid inclination measured 7.1° ( ± 4.1° standard deviation [SD]), the glenoid surface inclination 1.6° ( ± 3.2° SD); the bony glenoid concavity depth measured 4.0 mm ( ± 0.8 mm SD), the glenoid surface concavity depth 7.1 mm ( ± 0.9 mm SD). The bony glenoid radius of curvature measured 33.4 mm ( ± 3.3 mm SD), the glenoid surface radius 25 mm ( ± 2.1 mm SD) and the humeral head radius 24.1 mm ( ± 1.7 mm SD). The labrum significantly decreased the glenoid fossa inclination by 5.5° (<em>P</em> &lt; .001), significantly decreased the glenoid fossa radius by 8.4 mm (<em>P</em> &lt; .001) and significantly increased the concavity depth by 3.2 mm (<em>P</em> &lt; .001). There was a positive correlation between the bony glenoid inclination and its respective difference to the glenoid surface inclination (r = 0.71, <em>P</em> &lt; .001). Also, there was a positive correlation between bony glenoid radius of curvature and its respective difference to the glenoid surface radius (r = 0.77, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>The labral complex decreases glenoid inclination and increases joint concavity and congruency in the supero-inferior plane. Differences between bony and surface glenoid measures were higher in individuals with increased superior bony inclination and larger bony radii, suggesting a compensatory role to the labrum for the underlying bony morphology.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101377"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse total shoulder arthroplasty is safe and effective in patients ≥90 Years old","authors":"Kyle K. Obana MD,&nbsp;Doria L. Weiss BS,&nbsp;Andrew J. Luzzi MD,&nbsp;Matthew R. LeVasseur MD,&nbsp;Michael L. Knudsen MD,&nbsp;Charles M. Jobin MD,&nbsp;William N. Levine MD","doi":"10.1016/j.jseint.2025.08.011","DOIUrl":"10.1016/j.jseint.2025.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Surgeons may be hesitant to perform reverse total shoulder arthroplasty (rTSA) in elderly patients due to medical complexity, frailty, and possibility of higher rates of complications and mortality. Credence is given to this notion by reports from the hip and knee arthroplasty literature, which show higher rates of postoperative complications and mortality in elderly patients. As such, the purpose of the current study is to analyze outcomes and complications following rTSA in patients ≥90 years old.</div></div><div><h3>Methods</h3><div>All patients ≥90 years old who underwent primary rTSA from 2010 to 2024 were retrospectively identified. Patient demographics and perioperative data were recorded. Range of motion was assessed preoperatively and at 3, 6, and 12 months postoperatively. Postoperative and radiographic complications were identified. Paired student's t-tests were used to compare preoperative to postoperative outcomes.</div></div><div><h3>Results</h3><div>Thirteen patients (38.5% males) age 92.2 ± 1.7 years old were included. Average follow-up was 11.9 ± 11.0 months. Seven (53.9%) patients lived alone and 6 (46.1%) lived with family. Ten (76.9%) patients required no assistive device and 3 (23.1%) patients used a walker. Seven (53.8%) had cuff tear arthropathy and 6 (42.9%) had proximal humerus fractures. Seven (53.8%) patients had a heart condition and/or prior heart surgery. Eleven patients (84.6%) had an American Society of Anesthesiolgists score ≥3. Average operative time was 85.2 ± 20.3 minutes. Average estimated blood loss was 163.0 cc. Three (23.1%) patients achieved same day discharge. Average inpatient stay was 4.3 days. Six (46.1%) patients were discharged home, 6 (46.1%) to a subacute rehabilitation facility, and 1 (7.7%) to an acute rehabilitation facility. All patients ultimately returned to their preoperative living arrangements. From preoperatively to 1 year follow-up there were improvements in forward flexion from 35.4° to 144.3° (<em>P</em> &lt; .05), external rotation at the side from 3.1° to 37.1° (<em>P</em> &lt; .05), external rotation at 90° shoulder abduction from 10.0° to 85.0° (<em>P</em> &lt; .05), and internal rotation from S1 to L2 (<em>P</em> &lt; .05). Two (15.4%) inpatients experienced acute kidney injuries that resolved and 1 (7.7%) patient had an axillary motor nerve palsy during follow-up that resolved. No patients required a blood transfusion.</div></div><div><h3>Conclusion</h3><div>Performing rTSA is safe and effective in patients ≥90 years old. Various preoperative and intraoperative measures can be taken to decrease the risk of complications. Regardless of preoperative independence level, patients and family members should be prepared for the likelihood of rehabilitation and inpatient stay following surgery.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101374"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grit is not associated with opioid consumption patterns in patients that undergo arthroscopic rotator cuff repair","authors":"Rebekah M. Kleinsmith MD ,&nbsp;Fernando A. Huyke-Hernandez MD ,&nbsp;Megan Reams MA, OTR/L ,&nbsp;Michael Obermeier MSEd, ATC ,&nbsp;Bradley J. Nelson MD ,&nbsp;Jonathan P. Braman MD ,&nbsp;Michael R. Walsh MD","doi":"10.1016/j.jseint.2025.08.012","DOIUrl":"10.1016/j.jseint.2025.08.012","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to determine whether patient grit is associated with postoperative opioid consumption and pain/functional outcomes following primary arthroscopic rotator cuff repair (ARCR).</div></div><div><h3>Methods</h3><div>This is a prospective longitudinal study set in a single ambulatory surgical center in a large metropolitan area. Patients aged 18 or older undergoing primary ARCR were enrolled starting December 2019 with a target sample size of N = 120. Patients were excluded on the basis of chronic opioid use, worker's compensation, and concomitant operation including any of the following procedures: Bankart repair, superior labrum anterior to posterior repair, posterior–inferior labral repair, and open reduction internal fixation. All patients received the same postoperative pain protocol: 1-2 pills of oxycodone 5 mg every 4 hours, 3 pills of ibuprofen 200 mg every 8 hours, and 2 pills of acetaminophen 500 mg every 8 hours (all as needed).</div><div>The primary outcome was morphine milligram equivalents (MMEs) consumed within the first 2 weeks after surgery. Secondary outcomes included preoperative and postoperative 12-item Grit score (Grit-12), Brief Resilience Score (BRS), Pain Catastrophizing Scale (PCS), pain scale, and visual analog scale (VAS) pain score. Bivariate Pearson and Spearman correlations were conducted between Grit-12 score and (1) MMEs, (2) BRS, (3) PCS, and (4) VAS pain score for the affected shoulder.</div></div><div><h3>Results</h3><div>Of the 142 enrolled patients, a total of 120 patients (84.5%) completed the study protocol. Grit-12 score was not associated with MMEs at 2 weeks postoperative (r = 0.06), and there was no statistical difference (<em>P</em> ≥ .172) in MMEs consumed at any time point between high-grit (above the median MME) and low-grit patients (below the median MME). Furthermore, there was no significant correlation between preoperative Grit-12 and preoperative BRS (r = −0.12, [-0.29, 0.06], <em>P</em> = .206), preoperative PCS (r = −0.01, [-0.20, 0.17], <em>P</em> = .882), or postoperative VAS score (r = −0.01, [-0.19, 0.17], <em>P</em> = .903). The cohort was mostly male (62.7%) with an average age of 62.2 ± 7.8. Overall mode of MME for patients that took opioid pain medication at 24 hours, 48 hours, 72 hours, and 2 weeks was 45, 30, 15, and 52.5 MME, respectively. Approximately 17.0% of patients required oxycodone refills with no difference between high- and low-grit patients (<em>P</em> = .464).</div></div><div><h3>Conclusion</h3><div>Although perseverance and resiliency have been associated with better ability to handle adversity, there seems to be no association between patient grit or resiliency scores and opioid consumption during the first 2 weeks following ARCR.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101375"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and structural outcomes of arthroscopic rotator cuff repair augmented with biceps-based partial superior capsular reconstruction and distal tenotomy at two-year follow-up","authors":"Chang Hee Baek MD ,&nbsp;Bo Taek Kim MD ,&nbsp;Gustavo A. Gil Noriega MD ,&nbsp;Jung Gon Kim MD ,&nbsp;Chaemoon Lim MD ,&nbsp;Paulo José Llinás Hernández MD","doi":"10.1016/j.jseint.2025.101433","DOIUrl":"10.1016/j.jseint.2025.101433","url":null,"abstract":"<div><h3>Background</h3><div>Repair of medium to large rotator cuff tears (RCTs) presents ongoing challenges, as the procedure may result in tendon retear and inadequate healing. Partial superior capsular reconstruction (pSCR) using the long head of the biceps tendon (LHBT) has emerged as a biomechanically robust and biologically advantageous technique for augmenting rotator cuff repairs. This study aims to evaluate the clinical and structural outcomes of arthroscopic rotator cuff repair augmented with pSCR using the LHBT combined with distal tenotomy in patients with medium to large reparable RCTs at two years postoperatively.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on patients who underwent arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy between January 2014 and June 2017. Surgical indications were reparable supraspinatus tears, with or without infraspinatus involvement, accompanied by tendon retraction, high-grade fatty infiltration, and an intact or less than 50% partial tear of the LHBT. Exclusion criteria included prior shoulder surgery, shoulder infection, irreparable subscapularis tear, or incomplete follow-up. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and range of motion, while structural integrity was evaluated via ultrasonography at the 2-year follow-up.</div></div><div><h3>Results</h3><div>After excluding 10 patients, 45 patients (mean age: 67.2 ± 6.3 years) were included in the analysis. The VAS score improved significantly from 6.1 ± 1.3 to 1.7 ± 1.1, and the ASES score increased from 31.0 ± 7.9 to 77.2 ± 7.7 (both <em>P</em> &lt; .001). Forward elevation improved from 95° to 156°, abduction from 78° to 142°, and external rotation from 33° to 50° (all <em>P</em> &lt; .001). All patients met the minimal clinically important difference for both VAS and ASES scores. Ultrasonography at the 2-year follow-up demonstrated complete healing of the repair with the pSCR construct in 86.7% of patients, partial healing in 6.6%, and complete retear in 6.6%. No patients reported postoperative anterior shoulder pain. Subgroup analysis showed comparable outcomes between single-row repair with pSCR for medium-sized RCTs and double-row repair with pSCR for large-sized RCTs.</div></div><div><h3>Conclusion</h3><div>Arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy resulted in significant improvements in pain and range of motion at the 2-year follow-up in patients with medium to large reparable RCTs. A high healing rate was observed with the pSCR construct, and no significant complications were reported.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101433"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}