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Grit is not associated with opioid consumption patterns in patients that undergo arthroscopic rotator cuff repair 在接受关节镜下肩袖修复的患者中，砂砾与阿片类药物消费模式无关

Q2 Medicine

JSES International

Pub Date : 2026-01-01 DOI: 10.1016/j.jseint.2025.08.012

Rebekah M. Kleinsmith MD , Fernando A. Huyke-Hernandez MD , Megan Reams MA, OTR/L , Michael Obermeier MSEd, ATC , Bradley J. Nelson MD , Jonathan P. Braman MD , Michael R. Walsh MD

Background

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).

Methods

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).

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.

Results

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 (P ≥ .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], P = .206), preoperative PCS (r = −0.01, [-0.20, 0.17], P = .882), or postoperative VAS score (r = −0.01, [-0.19, 0.17], P = .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 (P = .464).

Conclusion

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.

本研究的目的是确定患者砂砾是否与原发性关节镜下肩袖修复（ARCR）术后阿片类药物消耗和疼痛/功能结果相关。方法本研究是一项前瞻性的纵向研究，在一个大城市地区的单一流动外科中心进行。从2019年12月开始招募18岁或以上接受原发性ARCR的患者，目标样本量为N = 120。患者被排除在慢性阿片类药物使用、工人补偿和伴随手术的基础上，包括以下任何手术：Bankart修复、上唇前后修复、后下唇修复和切开复位内固定。所有患者均接受相同的术后疼痛方案：1-2片羟考酮5mg每4小时，3片布洛芬200mg每8小时，2片对乙酰氨基酚500mg每8小时（均根据需要）。主要结果是术后前两周内吗啡毫克当量（MMEs）的消耗。次要结局包括术前和术后12项Grit评分（Grit-12）、简短恢复力评分（BRS）、疼痛灾难化量表（PCS）、疼痛量表和视觉模拟量表（VAS）疼痛评分。对Grit-12评分与(1)MMEs评分、(2)BRS评分、(3)PCS评分和(4)受累肩部VAS疼痛评分进行双变量Pearson和Spearman相关性分析。结果在142例入组患者中，共有120例患者（84.5%）完成了研究方案。术后2周时，Grit-12评分与MME无关（r = 0.06），高粒度（高于中位MME）和低粒度（低于中位MME）患者在任何时间点消耗的MME均无统计学差异（P≥0.172）。此外，术前Grit-12与术前BRS （r = - 0.12, [-0.29, 0.06], P = .206）、术前PCS （r = - 0.01, [-0.20, 0.17], P = .882）、术后VAS评分（r = - 0.01, [-0.19, 0.17], P = .903）无显著相关性。该队列以男性为主（62.7%），平均年龄为62.2±7.8岁。服用阿片类止痛药的患者在24小时、48小时、72小时和2周的总MME模式分别为45、30、15和52.5 MME。大约17.0%的患者需要羟考酮补剂，高剂量和低剂量患者之间没有差异（P = .464）。结论：尽管毅力和弹性与更好的逆境处理能力有关，但在ARCR后的前两周内，患者的毅力或弹性评分与阿片类药物消耗之间似乎没有关联。

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引用次数: 0

Q2 Medicine

JSES International

Pub Date : 2026-01-01

引用次数: 0

Q2 Medicine

JSES International

Pub Date : 2026-01-01

引用次数: 0

Q2 Medicine

JSES International

Pub Date : 2026-01-01

引用次数: 0

Q2 Medicine

JSES International

Pub Date : 2026-01-01

引用次数: 0

Q2 Medicine

JSES International

Pub Date : 2026-01-01

引用次数: 0

Q2 Medicine

JSES International

Pub Date : 2026-01-01

引用次数: 0

Age does not affect reliability of the Radiographic Union Score for HUmeral fractures score 年龄不影响肱骨骨折放射联合评分的可靠性

Q2 Medicine

JSES International

Pub Date : 2025-12-29 DOI: 10.1016/j.jseint.2025.101615

David Karimi MD , Peter Bremholm MD , Kasper Eriksen MD , Line Houkjær MD , Martin Hochheim MD , Kristoffer Hare MD, PhD , Joakim Jensen MD , Bjarke Viberg MD, PhD , Dennis Karimi MD PhD

Background

A key challenge of humeral shaft fracture management is nonunion after nonsurgical treatment. The Radiographic Union Score for HUmeral fractures (RUSHU) assesses early fracture healing; however, the effect of patient age on its reliability remains unclear.

Methods

In this validation study, 143 adult patients with nonsurgically managed humeral shaft fracture were included (nonelderly 18-64 years, n = 71; elderly ≥65 years, n = 72). Six raters with varying experience (medical students, residents, consultants) independently scored 6-week radiographs using RUSHU. Intra-rater and inter-rater reliability were evaluated for total scores, a binary RUSHU (<8 vs. ≥ 8), and individual cortices using weighted Cohen's kappa, Fleiss' kappa, and intraclass correlation coefficients.

Results

Mean RUSHU scores were similar between nonelderly (6.9 ± 2.0) and elderly patients (7.0 ± 1.9; P = .95). Intra-rater reliability was excellent for total RUSHU scores (κ = 0.92, 95% confidence interval (CI): 0.88-0.95) and moderate to excellent for the binary RUSHU (κ = 0.82, 95% CI: 0.72-0.91), with no age-related differences. Inter-rater reliability for total RUSHU was fair by Fleiss' kappa (κ = 0.24, 95% CI: 0.22-0.26) and moderate to good by intraclass correlation coefficient (0.69, 95% CI: 0.52-0.77). Binary scoring improved agreement (κ = 0.59-0.61). Inter-rater reliability also increased significantly with Cohen's kappa across rater pairs (κ = 0.45-0.82), experience levels (κ = 0.66-0.81), and within individual cortices (κ = 0.33-0.54). No significant differences were observed between age groups by experience level or individual cortices.

Conclusion

Age did not influence RUSHU reliability. Intra-rater reliability was moderate to excellent, and inter-rater reliability was fair to excellent depending on the statistical method utilized. Agreement improved with binary RUSHU and stratifying raters by experience and pairs. This indicated that RUSHU had measurable reliability. Reliabilities were consistent across age groups, cortices, and levels of clinical experience.

背景：非手术治疗后肱骨骨折不愈合是肱骨骨折治疗的一个关键挑战。肱骨骨折放射联合评分（RUSHU）评估骨折早期愈合；然而，患者年龄对其可靠性的影响尚不清楚。方法本研究纳入143例非手术治疗肱骨干骨折的成人患者（非老年18-64岁，n = 71；老年人≥65岁，n = 72）。六位具有不同经验的评分者（医学生、住院医生、顾问）使用RUSHU对6周的x线片进行独立评分。使用加权的Cohen’s kappa、Fleiss’kappa和类内相关系数来评估评分者内和评分者间的信度，包括总分、二元RUSHU （<8 vs.≥8）和单个皮质。结果非老年患者的平均RUSHU评分为（6.9±2.0）分，老年患者为（7.0±1.9）分，P = 0.95。总体RUSHU评分的评分内信度为优秀（κ = 0.92, 95%可信区间（CI）： 0.88-0.95），二元RUSHU评分的评分内信度为中等至优秀（κ = 0.82, 95% CI: 0.72-0.91），无年龄相关差异。通过Fleiss' kappa测试，总RUSHU的信度为一般（κ = 0.24, 95% CI: 0.22-0.26），通过类内相关系数测试，其信度为中等至良好（0.69,95% CI: 0.52-0.77）。二值评分提高了一致性（κ = 0.59-0.61）。评分者之间的信度也随着评分者对（κ = 0.45-0.82）、经验水平（κ = 0.66-0.81）和单个皮质（κ = 0.33-0.54）的Cohen's kappa而显著增加。不同年龄层之间的经验水平或个体皮质间无显著差异。结论年龄对汝书信度无影响。根据采用的统计方法，评分者内信度为中等至优秀，评分者间信度为一般至优秀。用经验法和配对法提高了二元茹数法和分层评分法的一致性。这表明如书具有可测量的信度。可靠性在不同年龄组、大脑皮层和临床经验水平上是一致的。

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引用次数: 0

Midterm outcomes of revision biceps tendon augmentation without tear completion for high-grade partial articular-sided supraspinatus retear 未完成撕裂的二头肌肌腱增强翻修术治疗高级别部分关节侧棘上肌后撕伤的中期结果

Q2 Medicine

JSES International

Pub Date : 2025-12-29 DOI: 10.1016/j.jseint.2025.101612

Young Jun Kim MD , Jin-Kyu Kang MD , Hwang-Young Yoo MD , Bo-Sung Kim MD , Jong-Hun Ji MD

Background

To evaluate the midterm clinical and radiological outcomes of revision biceps tendon augmentation without tear completion for high-grade partial articular-sided supraspinatus retear (PASR) lesions, which present challenges due to poor tendon quality.

Methods

From January 2014 to May 2023, a total of 22 patients (mean age: 57.2 ± 13.6 years, 8 males and 14 females) who underwent revision cuff repair with biceps tendon augmentation without tear completion for PASR lesions following arthroscopic rotator cuff repair were enrolled in our study. Clinical and radiological outcomes, including tendon integrity (Sugaya classification), were evaluated at the last follow-up.

Results

Previous rotator cuff tears included 10 full-thickness rotator cuff tears and 12 partial-thickness rotator cuff tears. The mean interval between the primary and revision surgeries was 5.9 ± 6.0 years (range, 0.4-14 years). Significant improvements were observed in all clinical outcome scores at the final follow-up. The mean visual analog scale for pain improved from 3.8 preoperatively to 0.6 postoperatively. American Shoulder and Elbow Surgeons scores improved from 64 to 94, University of California, Los Angeles shoulder scores from 22 to 33, Simple Shoulder Test scores from 7 to 11, and Korean Shoulder Scoring System scores from 71 to 94 (all P values <.001). Follow-up magnetic resonance imaging demonstrated good tendon integrity, with Sugaya type I in 6 cases, type II in 15 cases, and type IV in 1 case. Mean tendon thickness increased from 4.6 mm to 7.4 mm. There were no retears, and no progression of fatty infiltration or muscle atrophy was observed.

Conclusion

High-grade PASR lesions following arthroscopic rotator cuff repair are uncommon and challenging due to poor tendon quality. Revision biceps tendon augmentation without tear completion appears to be a reliable surgical option for PASR lesions, yielding favorable midterm functional and radiological outcomes.

背景：评估未完成撕裂的翻修二头肌肌腱增强术治疗高级别部分关节侧棘上肌后撕（PASR）病变的中期临床和影像学结果，该病变由于肌腱质量差而面临挑战。方法2014年1月至2023年5月，22例患者（平均年龄：57.2±13.6岁，男8例，女14例）在关节镜下肩袖修复术后行肱二头肌肌腱增强翻修修复术治疗PASR病变。在最后一次随访时评估临床和影像学结果，包括肌腱完整性（Sugaya分类）。结果10例肩袖全层撕裂，12例肩袖部分撕裂。初次手术和翻修手术之间的平均间隔为5.9±6.0年（范围0.4-14年）。在最后随访时，所有临床结果评分均有显著改善。疼痛的平均视觉模拟评分从术前的3.8分提高到术后的0.6分。美国肩部和肘部外科医生的评分从64分提高到94分，加州大学洛杉矶分校肩部评分从22分提高到33分，简单肩部测试评分从7分提高到11分，韩国肩部评分系统评分从71分提高到94分（P值均为0.001）。后续磁共振成像显示肌腱完整性良好，Sugaya I型6例，II型15例，IV型1例。肌腱平均厚度从4.6 mm增加到7.4 mm。未见复发，未见脂肪浸润或肌肉萎缩进展。结论关节镜下肩袖修复术后出现高级别PASR病变并不常见，且由于肌腱质量较差而具有挑战性。没有撕裂完成的肱二头肌肌腱增强翻修术似乎是PASR病变的可靠手术选择，具有良好的中期功能和放射学结果。

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引用次数: 0

Diagnostics of shoulder periprosthetic joint infections: a global survey 肩关节假体周围感染的诊断：一项全球调查

Q2 Medicine

JSES International

Pub Date : 2025-12-26 DOI: 10.1016/j.jseint.2025.101608

Oscar Dorrestijn MD, PhD , Nick Smeitink BSc , Eoghan T. Hurley MD , Emilio Calvo MD, PhD, MBA , Jeppe Rasmussen MD, PhD , Hanna Björnsson MD, PhD , Robert Hudek MD, PhD

Background

Diagnosing shoulder periprosthetic joint infections is challenging. Several diagnostic tests are available, but their predictive value varies and is often poor. The aims of this study were to assess internationally how shoulder surgeons diagnose periprosthetic joint infections, and to investigate if there are intercollegiate and intercontinental differences.

Methods

An online survey was designed for shoulder surgeons, incorporating questions regarding their utilization of various diagnostic tests and their level of professional experience. The survey was sent digitally to all members of the European Society for Surgery of the Shoulder and the Elbow, all European National Delegates, and 10 other Shoulder and Elbow societies worldwide.

Results

Two hundred thirty-nine surveys were included in this study. The majority of the respondents (≥65%) routinely use at least 9 of different diagnostic tests as a workup for a shoulder periprosthetic joint infections: blood testing (C-reactive protein, white blood cell count, and erythrocyte sedimentation rate), pre-revision synovial fluid aspiration (culture, white blood cell count and neutrophil percentage), intraoperative synovial fluid aspiration (culture), pre-revision tissue biopsy for culture, and tissue biopsy for culture during revision surgery. Significantly more cultures were taken by respondents who perform fewer revisions (P = .008). These surgeons are also less likely to rely solely on cultures to diagnose an infection of the periprosthetic joint of the shoulder. Respondents outside Europe use frozen section and sonication significantly less often (P < .001), and more often erythrocyte sedimentation rate (P = .001) and Metal Artifact Reduction Sequence magnetic resonance imaging (P = .01)), compared to respondents in Europe.

Conclusion

The majority of those who responded to the survey use at least 9 different tests to diagnose shoulder periprosthetic joint infections. Respondents who perform fewer revisions take more cultures, and are less likely to rely solely on these results, compared to surgeons who perform more revisions. There are several intercontinental differences in the use of diagnostic tests (within Europe and beyond).

诊断肩关节假体周围感染是一个挑战。有几种可用的诊断测试，但它们的预测价值各不相同，而且往往很差。本研究的目的是评估国际上肩关节外科医生如何诊断假体周围关节感染，并调查是否存在大学间和洲际差异。方法针对肩部外科医生设计一项在线调查，包括他们对各种诊断测试的使用情况和他们的专业经验水平。该调查以数字方式发送给欧洲肩关节外科学会的所有成员、所有欧洲国家代表以及全球其他10个肩关节学会。结果本研究共纳入问卷239份。大多数应答者（≥65%）常规使用至少9种不同的诊断测试作为肩部假体周围关节感染的检查：血液检查（c反应蛋白、白细胞计数和红细胞沉降率）、修复前滑膜液抽吸（培养、白细胞计数和中性粒细胞百分比）、术中滑膜液抽吸（培养）、修复前组织活检培养、修复手术期间组织活检培养。显着的是，执行较少修订的受访者采用了更多的文化（P = 0.008）。这些外科医生也不太可能仅仅依靠培养来诊断肩关节假体周围的感染。与欧洲的受访者相比，欧洲以外的受访者使用冷冻切片和超声的频率明显较低（P < .001），而红细胞沉降率（P = .001）和金属伪影还原序列磁共振成像（P = .01）的频率更高。结论大多数接受调查的患者使用至少9种不同的检查来诊断肩关节周围感染。与进行更多手术的外科医生相比，进行较少手术的受访者需要更多的培养，并且不太可能仅仅依赖于这些结果。在诊断测试的使用上存在一些洲际差异（在欧洲内部和欧洲以外）。

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