JSES International最新文献

{"title":"Humeral head deviation and velocity in multidirectional instability of the glenohumeral joint: a cine magnetic resonance imaging study","authors":"Kazuhisa Matsui PT, PhD, MSc ,&nbsp;Takashi Tachibana PT ,&nbsp;Katsuya Nobuhara MD, PhD ,&nbsp;Yasushi Uchiyama PT, PhD","doi":"10.1016/j.jseint.2025.101419","DOIUrl":"10.1016/j.jseint.2025.101419","url":null,"abstract":"<div><h3>Background</h3><div>Manual clinical tests for shoulder instability rely heavily on subjective assessments of humeral head translation, making objective quantification challenging. This study hypothesized that patients with multidirectional glenohumeral instability (MDI) would demonstrate greater humeral head deviation and faster deviation velocity than healthy controls during active shoulder rotation, as assessed using cine magnetic resonance imaging (MRI).</div></div><div><h3>Methods</h3><div>Fourteen participants (eight shoulders with MDI and 20 healthy shoulders) underwent cine MRI while performing active shoulder rotation with the arm at the side. Humeral head deviation, deviation amplitude, and deviation velocity were calculated and compared between the groups using Welch's <em>t</em>-test.</div></div><div><h3>Results</h3><div>The MDI group showed significantly greater humeral head deviation, wider amplitude of deviation, and faster deviation velocity than the control group (<em>P</em> = .008 for anterior deviation, <em>P</em> = .009 for posterior deviation). The deviation amplitude exceeded 35% of the glenoid width in MDI shoulders, surpassing established clinical thresholds.</div></div><div><h3>Conclusion</h3><div>Patients with MDI demonstrated quantifiable dynamic instability on cine MRI. This modality may provide objective support for clinical findings. However, validation in larger cohorts is warranted to confirm these findings, given the limited number of MDI shoulders (n = 8).</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101419"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904065","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":"Optimizing tendon-to-bone healing: a comparative study of intratunnel and anatomical repairs in rotator cuff tears","authors":"Muzaffer Agir MD ,&nbsp;Koray Sahin MD ,&nbsp;Anil Pulatkan MD ,&nbsp;Mehmet Kapicioglu MD ,&nbsp;Fatih Yamak PhD ,&nbsp;Ergun Bozdağ PhD ,&nbsp;Ayse Nur Toksoz Yildirim MD ,&nbsp;Kerem Bilsel MD","doi":"10.1016/j.jseint.2025.101425","DOIUrl":"10.1016/j.jseint.2025.101425","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff tears are a leading cause of shoulder pain, with high rerupture rates despite advancements in surgical techniques. Tendon-to-bone healing failure is often attributed to insufficient fibrocartilage regeneration at the repair site. Intratunnel repair (TR) has been proposed as an alternative approach to enhance healing by increasing tendon-bone contact and exposure to marrow-derived stem cells. However, its effectiveness in chronic rotator cuff tears remains unclear. This study aims to compare the biomechanical and histological outcomes of TR and surface repair (SR) in a rabbit model. We hypothesized that TR might offer advantages in tendon-to-bone healing compared to SR, particularly through enhanced contact area and marrow exposure.</div></div><div><h3>Methods</h3><div>A chronic rotator cuff tear model was created in 36 New Zealand White rabbits by tenotomizing the subscapularis tendon and preventing spontaneous healing for 8 weeks. The right shoulders underwent TR, while the left shoulders received SR. Biomechanical and histological evaluations were performed at 4, 8, and 12 weeks postrepair. Biomechanical testing assessed failure load, stiffness, and elongation. Histological assessments included collagen fiber organization, fibrocartilage formation, vascularity, and tendon maturation using Modified Watson tendon maturation scoring. Statistical analyses were conducted using nonparametric tests with a significance level of <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>Biomechanical results showed no significant differences in failure load between TR and SR at any time point (<em>P</em> = .423, <em>P</em> = .423, <em>P</em> = .631). However, at 12 weeks, the stiffness of TR was significantly higher than SR (<em>P</em> = .005). Early histological findings showed similar tendon maturation, collagen alignment, and vascularity in both groups. By 12 weeks, the SR group exhibited significantly better collagen organization (<em>P</em> = .006), vascularity (<em>P</em> = .002), and Modified Watson tendon maturation score (<em>P</em> = .004) compared to TR. The tidemark line, a key indicator of fibrocartilage development, was observed in all SR samples at 12 weeks but was absent in most TR specimens.</div></div><div><h3>Discussion</h3><div>Contrary to our hypothesis, TR did not demonstrate superior healing outcomes compared to SR. While TR provided similar biomechanical properties, its histological outcomes were inferior over time. We speculate that increased inflammatory response and tendon micromotion within the tunnel may have contributed to the inferior histological healing observed in the TR group.</div></div><div><h3>Conclusion</h3><div>These findings suggest that TR does not offer significant advantages over SR in chronic rotator cuff tears. Further studies are needed to optimize healing strategies within the bone tunnel.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101425"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078871","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":"Persistent scapular dyskinesis after arthroscopic rotator cuff repair: a prospective study","authors":"Michele Mercurio MD ,&nbsp;Erminia Cofano MD ,&nbsp;Claudia Mancuso MD ,&nbsp;Lorena Paola MD ,&nbsp;Alessandro Imbrogno PhD Student ,&nbsp;Matteo Mantovani MSc ,&nbsp;Filippo Familiari MD ,&nbsp;Giorgio Gasparini MD ,&nbsp;Olimpio Galasso MD","doi":"10.1016/j.jseint.2025.101420","DOIUrl":"10.1016/j.jseint.2025.101420","url":null,"abstract":"<div><h3>Background</h3><div>The supraspinatus plays a critical role in stabilizing the glenohumeral joint and facilitating arm elevation. The biomechanical disruption caused by supraspinatus tears changes the normal force couple balance between the deltoid and rotator cuff muscles, often resulting in superior migration of the humeral head and altered scapulohumeral rhythm (SHR). This study aims to prospectively compare the shoulder kinematics of patients preoperatively and after arthroscopic rotator cuff repair using magnetic inertial measurement units with a motion analysis system.</div></div><div><h3>Methods</h3><div>A prospective study was conducted with data collection on 21 patients who underwent shoulder arthroscopy for rotator cuff tear repair. Preoperatively and at a minimum 12-month follow-up, each patient was evaluated using the range of motion (ROM) assessment and the Constant–Murley Score (CMS). Patients were examined using the ShowMotion 3D kinematic tracking system (NCS Lab, Modena, Italy), which uses wireless wearable noninvasive magnetic and inertial measurement units sensors to assess the three-dimensional kinematics of the shoulder. For each plane of elevation (ie, flexion and abduction), the SHR was described by 3 scapulothoracic rotations (ie, protraction–retraction, mediolateral rotation, and posterior–anterior tilting) as a function of humeral anteflexion or humeral abduction.</div></div><div><h3>Results</h3><div>Active flexion and external rotation ROM showed statistically significant improvement (<em>P</em> = .039 and <em>P</em> = .006, respectively). CMS pain, strength, and total showed statistically significant improvement (<em>P</em> = .039 and <em>P</em> = .006, respectively). All the patients showed a nonstatistically significant difference of the SHR along the entire ROM between pre- and postoperative evaluation. The <em>P</em> value in flexion and abduction was &gt;.05; the only statistically significant value was on tilt at 60° in flexion (<em>P</em> = .044)</div></div><div><h3>Conclusion</h3><div>A persistent scapular dyskinesis was observed after arthroscopic rotator cuff repair. Despite a statistically significant improvement reported for active flexion, active external rotation, and for the total CMS, scapular dyskinesis is not resolved with surgery and may contribute to worse long-term outcomes. Further biomechanical and clinical research studies are needed to define specific rehabilitation programs, to maximize outcomes, and to prevent possible cause of reinjury of the rotator cuff repaired.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101420"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941281","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":"Proxy for the surgery for elbow osteochondritis dissecans in adolescent baseball players","authors":"Masataka Minami PhD, MD ,&nbsp;Yoshikazu Kida PhD, MD ,&nbsp;Masamitsu Kido PhD, MD ,&nbsp;Ausberto R. Velasquez Garcia MD ,&nbsp;Jesse B. O'Driscoll BS ,&nbsp;James S. Fitzsimmons BSc ,&nbsp;Kenji Takahashi PhD, MD ,&nbsp;Shawn W. O'Driscoll PhD, MD","doi":"10.1016/j.jseint.2025.101424","DOIUrl":"10.1016/j.jseint.2025.101424","url":null,"abstract":"<div><h3>Background</h3><div>Capitellar osteochondritis dissecans (OCD) is a disorder frequently affecting adolescent athletes and can lead to chronic disability or surgery. While preventive measures have been advocated, there is no established method to monitor the prevalence of OCD. This study aimed to validate the use of surgical codes from the Japanese national database as proxies for OCD.</div></div><div><h3>Methods</h3><div>A retrospective epidemiological analysis was conducted using the Japanese national claims database from 2014 to 2022. Surgical procedures potentially linked to OCD, including drilling, bone débridement, synovectomy, and loose-body removal were analyzed by age, sex, and geographic distribution. Bibliometric data on OCD-related publications were extracted to assess their correlation with regional surgical incidence. Statistical analyses were performed to evaluate the validity of these surgical codes as proxies for OCD.</div></div><div><h3>Results</h3><div>Loose-body removal was the most strongly associated with OCD, with 97% of procedures performed on males and 64% on patients under 20 years of age. Significant regional variation was observed, with Tokushima Prefecture showing the highest incidence of loose-body removal, mirroring its strong publication record on this topic. In contrast, drilling and bone débridement showed weaker demographic alignment with OCD and no significant correlation with publication activity. Synovectomy demonstrated moderate regional alignment but lacked demographic specificity for OCD.</div></div><div><h3>Conclusion</h3><div>This study highlights the utility of surgical codes from the national database in approximating OCD epidemiology, with loose-body removal serving as a reliable proxy. These findings establish a foundation for future studies to assess preventive strategies and guide resource allocation for OCD management in youth athletes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101424"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078860","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":"Risk factors for retear of arthroscopic rotator cuff repair using triple-row technique","authors":"Ryosuke Takahashi MD ,&nbsp;Ryosuke Sagami MD ,&nbsp;Yohei Harada MD, PhD ,&nbsp;Yukihiro Kajita MD, PhD","doi":"10.1016/j.jseint.2025.101412","DOIUrl":"10.1016/j.jseint.2025.101412","url":null,"abstract":"<div><h3>Background</h3><div>The triple-row (TR) technique enhances tendon-to-bone contact and repair integrity in arthroscopic rotator cuff repair (ARCR). However, limited studies have evaluated the clinical outcomes and risk factors for retears following this technique. This study aimed to compare clinical outcomes between retear and nonretear groups after ARCR using the TR technique and identify risk factors for retear.</div></div><div><h3>Methods</h3><div>Patients who underwent ARCR using the TR technique with at least 24 months follow-up were enrolled and categorized into retear and nonretear groups. Clinical outcomes, including range of motion, visual analog scale for pain, Constant Shoulder (CS), and University of California Los Angeles (UCLA) score, were evaluated at 3, 6, and 24 months postoperatively. The retear rate and tendon integrity were assessed at 3, 6, and 24 months follow-up using magnetic resonance imaging, and risk factors for retear were analyzed.</div></div><div><h3>Results</h3><div>Of 181 patients enrolled, 20 (11%) had retears and 161 (89%) had no retears. The retear group was significantly older (<em>P</em> = .037) and had more large or massive tears (<em>P</em> = .044), larger tear sizes on magnetic resonance imaging (coronal plane: 29.9 ± 14.9 mm vs. 21.6 ± 12 mm, <em>P</em> = .005; sagittal plane: 23.7 ± 12.1 mm vs. 17.9 ± 9.4 mm, <em>P</em> = .013), and greater fatty infiltration (<em>P</em> &lt; .001). Both groups achieved good clinical outcomes, but the retear group showed significantly lower CS and UCLA scores at 6 and 24 months (CS score: 72.4 ± 9 point vs. 78.6 ± 8.6 point at 6 months [<em>P</em> = .004] and 81.2 ± 11.1 point vs. 86.3 ± 9.6 point at 24 months [<em>P</em> = .032]; UCLA score: 25 ± 2.6 point vs. 27.3 ± 3.5 point at 6 months [<em>P</em> = .005], 28.7 ± 4.6 point vs. 30.9 ± 3.7 point at 24 months [<em>P</em> = .018]) and higher visual analog scale scores at 24 months (21.5 ± 12 vs. 7.8 ± 7.7, <em>P</em> = .021). Fatty infiltration of the infraspinatus was identified as an independent risk factor for retears. Patients with Goutallier grade ≥3 had significantly inferior external rotation at 3 and 6 months (26 ± 25.1° vs. 44.7 ± 11.4°, <em>P</em> = .032, 35 ± 28.3° vs. 53 ± 9°, <em>P</em> = .038) and tended to show inferior outcomes overall.</div></div><div><h3>Conclusion</h3><div>ARCR using the TR technique provides favorable clinical outcomes, even in cases with retears. However, patients with retears—especially those with large-to-massive tears or severe infraspinatus fatty infiltration—showed inferior outcomes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101412"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079046","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":"Subcutaneous tissue disinfection is more effective than the use of electrocautery in reducing Cutibacterium acnes burden in open shoulder surgery","authors":"Nicolas Gallusser MD ,&nbsp;Bertrand Léger PhD ,&nbsp;Caroline Passaplan MD ,&nbsp;Stéphane Emonet MD ,&nbsp;Beat Kaspar Moor PD","doi":"10.1016/j.jseint.2025.101408","DOIUrl":"10.1016/j.jseint.2025.101408","url":null,"abstract":"<div><h3>Background</h3><div><em>Cutibacterium acnes</em> (<em>C</em>. <em>acnes</em>) is a pathogen linked to infections following shoulder surgery. Exposure can occur during surgical dissection and spread in the surgical field through the surgeon's gloves and instruments. Disinfection of the subcutaneous tissue has been shown to reduce its contamination. No evidence has been provided for a decrease in the transmission rate when the dissection is performed with an electrocautery. The aim of this study was to ascertain whether disinfection of subcutaneous tissue can reduce the <em>C</em>. <em>acnes</em> rate in primary open shoulder surgery in comparison with dissection performed with electrocautery. We also wanted to compare the contamination rate of the operating field after electrocautery dissection with those found in the literature.</div></div><div><h3>Methods</h3><div>All patients who qualified for primary open shoulder surgery via a deltopectoral approach were prospectively included in our single-blinded, two-arm randomized clinical trial. For every patient, a skin swab from the surgical area was taken before the standard preparation of the skin. In the disinfection group, the subcutaneous layer was treated with povidone iodine solution after exposure of the deltoid fascia. The cautery group underwent subcutaneous tissue dissection using an electrocautery. After fully exposing the proximal humerus, 5 swabs were collected from various locations for microbiological analysis, following a rigorous protocol. All cultures were incubated for 14 days under both aerobic and anaerobic conditions.</div></div><div><h3>Results</h3><div>Between February 2020 and July 2021, 210 shoulders were enrolled in 2 groups (140 disinfection vs. 70 cautery). The 2 groups showed no significant differences in terms of sex, age, body mass index, or diabetes prevalence. The subcutaneous disinfection protocol led to a significant decrease in the overall positive culture rate of the operating field for all bacteria (<em>P</em> = .001) and specifically for <em>C</em>. <em>acnes</em> (<em>P</em> = .021). The reduction of positive swabs for <em>C</em>. <em>acnes</em> was significant for both the surgeon's gloves (<em>P</em> = .004) and for the subcutaneous tissue (<em>P</em> = .009). <em>C</em>. <em>acnes</em> contamination rate was noted in 26% of patients in the electrocautery group and 13% in the disinfection group after exclusion of the outside scalpel blade sample, which was removed from the scrub nurse's instrument table and therefore no longer used during the procedure.</div></div><div><h3>Conclusion</h3><div>Disinfection of the subcutaneous tissue reduces the contamination rate of <em>C</em>. <em>acnes</em> by a factor of 2 during open shoulder surgery compared with an approach performed with electrocautery and could limit the contamination of the operating field.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101408"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904067","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":"Mitochondria dysfunction and increased expression of WNT5A and BNIP3 in tenocytes obtained from patients with tendinopathy","authors":"Yusuke Nakagawa MD, PhD ,&nbsp;Yuki Okazaki MD, PhD ,&nbsp;Camila B. Carballo PT, PhD ,&nbsp;Susumu Wada MD, PhD ,&nbsp;Daniel Nemirov MD ,&nbsp;Elizabeth R. Selvaggio MD ,&nbsp;Amir H. Lebaschi MD ,&nbsp;Xiang-Hua Deng MD ,&nbsp;Miguel Otero PhD ,&nbsp;Michelle L. Delco DVM, PhD ,&nbsp;Lisa A. Fortier DVM, PhD ,&nbsp;Scott A. Rodeo MD","doi":"10.1016/j.jseint.2025.101417","DOIUrl":"10.1016/j.jseint.2025.101417","url":null,"abstract":"<div><h3>Background</h3><div>Tendinopathy is a significant source of pain and functional impairment, with contributions from various extrinsic and intrinsic factors. Prior studies have demonstrated the role of mitochondria (MT) dysfunction in a murine model of supraspinatus tendinopathy, with improvement in tendon structure following treatment with the mitochondrial protectant agent Szeto-Schiller-31 (elamipretide). However, there is very little information available on mitochondrial function in human tendinopathy. The purpose of this study is to compare MT function in human tenocytes obtained from pathologic tendons of patients with tendinopathy and normal tendons and to identify potential target genes for the treatment of tendinopathy.</div></div><div><h3>Methods</h3><div>Samples of degenerative tendons from the upper extremity (biceps tendon [n = 7], rotator cuff [n = 4], and extensor carpi radialis brevis tendon [n = 2]; total n = 13) and normal tendons from the lower extremity (hamstring [n = 4], patellar [n = 3], and quadriceps [n = 2]; total n = 9) were collected during surgeries. Cell viability, ultrastructural morphology (using transmission electron microscopy), differentiation potential (adipogenesis and osteogenesis), MT membrane polarity, production of reactive oxygen species, and gene expression profile (using NanoString and quantitative real-time polymerase chain reaction (qRTPCR)) were analyzed.</div></div><div><h3>Results</h3><div>Tenocytes from normal tendons exhibited higher colony formation potential (<em>P</em> = .026) and cell viability (<em>P</em> = .017) compared to those from the degenerative group. Transmission electron microscopy revealed degeneration of MT in degenerative tenocytes, with ingestion by phagosomes. The degenerative group showed higher adipogenic potential than the normal group (<em>P</em> = .025). MT membrane potential was significantly decreased in the degenerative group (<em>P</em> &lt; .0001). No gene reached statistical significance when an adjusted <em>P</em> value &lt;.05 was used as the threshold in the NanoString analysis. However, several genes showed upregulation in the degenerative group compared with the normal group (listed in order of smallest <em>P</em> value with log2 fold change, log2FC): IDH2 (<em>P</em> = .0014, log2FC = 0.69), vascular endothelial growth factor (<em>P</em> = .0017, log2FC = 0.63), BNIP3 (BCL2/adenovirus E1B 19 kDa protein-interacting protein 3) (<em>P</em> = .0021, log2FC = 0.70), FGF2 (<em>P</em> = .0026, log2FC = 0.99),WNT5A (Wingless-type MMTV integration site family member 5A) (<em>P</em> = .0027, log2FC = 2.2). WNT5A and BNIP3 upregulation was also confirmed by qRT-PCR.</div></div><div><h3>Conclusion</h3><div>Our results confirm MT dysfunction in the degenerative group, as reported in previous studies. The upregulation of the WNT5A and BNIP3 expression was confirmed by both Nanostring and qRT-PCR.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101417"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904068","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":"Risk factors for new-onset anxiety and depression after arthroscopic shoulder stabilization surgery","authors":"David C. Lutati BS,&nbsp;Jane C. Brennan MS,&nbsp;Andrea H. Johnson MSN, CRNP,&nbsp;Matthew A. Peterman DO,&nbsp;Daniel E. Redziniak MD,&nbsp;Cyrus J. Lashgari MD,&nbsp;Justin J. Turcotte PhD, MBA","doi":"10.1016/j.jseint.2025.101413","DOIUrl":"10.1016/j.jseint.2025.101413","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder instability is a common shoulder pathology, especially in young athletes involved in contact sports, sometimes requiring surgical intervention. In this retrospective database study, we aimed to identify the incidence of new-onset anxiety or depression (NOAD) after arthroscopic shoulder stabilization surgery, identify risk factors for the development of NOAD, evaluate the effect of NOAD on postoperative complications, and examine whether psychiatric interventions have a protective effect against adverse outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the PearlDiver national database was completed. Included patients had no prior diagnosis of depression/anxiety or prior utilization of antidepressant medication before shoulder stabilization surgery and had at least 1 year of postoperative follow-up. The primary outcome was the development of NOAD within 1 year postoperatively. Multivariate logistic regression was used to assess predictors of NOAD. Postoperative outcomes were compared between patients who did and did not develop NOAD after propensity score matching. A subgroup comparison of outcomes across various NOAD treatments was performed.</div></div><div><h3>Results</h3><div>Of the 38,388 patients, 1,950 (5.1%) were diagnosed with NOAD within 1 year postoperatively. Increased age (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.98-0.98; <em>P</em> &lt; .001), increased Charlson Comorbidity Index score (OR: 1.07, 95% CI: 1.01-1.12; <em>P</em> = .012), female sex (OR: 1.72, 95% CI: 1.56-1.89; <em>P</em> &lt; .001), hypermobility (OR: 2.17, 95% CI: 1.33-3.38; <em>P</em> = .001), headaches/migraines (OR: 1.33, 95% CI: 1.20-1.47; <em>P</em> &lt; .001), obesity (OR: 1.49; 95% CI: 1.31-1.70; <em>P</em> &lt; .001), preoperative opioid use (OR: 3.68, 95% CI: 3.34-4.05; <em>P</em> &lt; .001), tobacco use (OR: 2.25, 95% CI: 1.99-2.53; <em>P</em> &lt; .001), and alcohol disorders (OR: 2.13, 95% CI: 1.70-2.64; <em>P</em> &lt; .001) were all associated with a higher risk of developing NOAD. Postoperatively, the NOAD group had a 9.52 times increased risk of 90-day readmission (<em>P</em> &lt; .001), a 1.58-times increased risk of prolonged opioid use (<em>P</em> &lt; .001) at 1 year, increased total cost ($11,107 ± 12,317 vs. $7,695 ± 8,840; <em>P</em> &lt; .001), and a 1.48-times increased risk of revision at 2 years (<em>P</em> &lt; .001). Patients with NOAD undergoing psychotherapy had lower rates of postoperative opioid use.</div></div><div><h3>Conclusion</h3><div>The postoperative development of NOAD is an understudied but relatively common complication of arthroscopic shoulder stabilization surgery, occurring in approximately 5% of patients. The current study highlights a variety of risk factors that may be used to identify at-risk patient populations. Further work is needed to identify interventions that can mitigate the adverse outcomes associated with NOAD.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101413"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078872","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":"Longitudinal analysis of rotator cuff repair: joint kinematics and clinical outcomes","authors":"Sujata Khandare PhD ,&nbsp;Rebekah L. Lawrence PT, PhD ,&nbsp;Alena Jalics MS ,&nbsp;Roger Zauel MS ,&nbsp;Vasilios Moutzouros MD ,&nbsp;Eric C. Makhni MD, MBA ,&nbsp;Stephanie Muh MD ,&nbsp;Michael J. Bey PhD","doi":"10.1016/j.jseint.2025.101421","DOIUrl":"10.1016/j.jseint.2025.101421","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff repair is a common surgical procedure, but postoperative outcomes can be highly variable, and postoperative repair tissue healing remains a significant clinical challenge. Furthermore, the biomechanical effects of rotator cuff repair are not fully understood.</div></div><div><h3>Methods</h3><div>Twenty-two participants scheduled for arthroscopic rotator cuff repair were evaluated preoperatively and at 3, 12, and 24 months postsurgery. The following data were recorded at each time point: glenohumeral and scapulothoracic kinematics, shoulder strength, and patient-reported measures of pain and function. Postoperative repair integrity was assessed via magnetic resonance imaging at 3 months and 24 months postsurgery.</div></div><div><h3>Results</h3><div>At 3 months postsurgery, 5 of 20 patients were identified as having a recurrent tear. An additional 4 patients had a recurrent tear at 24 months postsurgery. The center of contact of the humerus on the glenoid gradually shifted superiorly on the glenoid during the 24 month follow-up period (<em>P</em> &lt; .01). There were subtle changes in scapulothoracic upward rotation at 3 months postsurgery compared to presurgery (<em>P</em> ≤ .01), but these differences did not persist at 12 or 24 months postsurgery. Compared to presurgery, there were significant increases in flexion and internal rotation strength at 12 months postsurgery (<em>P</em> &lt; .01) and significant increases in flexion, abduction, external rotation, and internal rotation strength at 24 months postsurgery (<em>P</em> &lt; .01). Patient-reported measures of pain and function improved significantly over the 24 month follow-up period (<em>P</em> &lt; .01).</div></div><div><h3>Conclusion</h3><div>Surgical rotator cuff repair was associated with decreased pain and improved subjective assessments of function within the first 3 months after surgery, and increased shoulder strength over 12- 24 months postsurgery. The study also found subtle changes over time in glenohumeral joint and scapulothoracic motion.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101421"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941284","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":"Total resection and reconstruction of collateral ligaments in severe elbow stiffness induced by heterotopic ossification: a novel approach and review of the literature","authors":"Mehmet Fatih Güven MD ,&nbsp;Muhammed Yusuf Afacan MD, FEBOT, PhD ,&nbsp;Erdem Şahin MD ,&nbsp;Göker Utku Değer MD","doi":"10.1016/j.jseint.2025.101418","DOIUrl":"10.1016/j.jseint.2025.101418","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic elbow stiffness poses a complex challenge, often attributed to intrinsic and extrinsic factors. Heterotopic ossification (HO) is a significant extrinsic contributor, leading to contracture and entrapment syndromes. This study explores the pioneering strategy of total resection and reconstruction of the ossified and contracted collateral ligament in managing extensive HO-induced elbow stiffness. Our goal was to show that complete collateral ligament excision and reconstruction result in a wide range of motion and no long-term HO or elbow instability.</div></div><div><h3>Methods</h3><div>Six patients with severe elbow stiffness underwent HO resection and extensive soft tissue release. Two of them underwent a single fraction of radiotherapy, receiving a dose of 7 gray within the 24 hours preceding the surgery. Five patients with extensive medial HO underwent medial collateral ligament reconstruction using palmaris longus autografts in four of them and tensor fascia lata autograft in one of them, and one patient underwent lateral collateral ligament reconstruction with palmaris longus autograft after lateral collateral ligament sacrifice. Anterior transposition of the ulnar nerve was carried out for all patients to prevent postoperative ulnar nerve symptoms. Evaluations included preoperative and postoperative elbow flexion/extension arcs and Mayo Elbow Performance Score.</div></div><div><h3>Results</h3><div>The study included six patients with stiff elbows (five males, 1 female), aged 17- 45 years (mean age: 30 years). Injury patterns included three nonvehicle traffic accidents and three trauma-related injuries. The trauma-to-surgery interval ranged from 6 to 288 months, with a mean of 79.17. Three patients required intensive care unit stays before surgery, while the other three did not, suggesting varying causes of HO development. After an average follow-up of 3 years, patients exhibited improved flexion/extension arcs (122.5°) from a mean preoperative 20°. The mean Mayo Elbow Performance Score improved from 21.67 preoperatively to 98.33 postoperatively. None of the patients reported varus or valgus instability.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that excision and reconstruction of the ligament with HO can be a viable and reliable solution for elbow joint stiffness, particularly when the wide HO involves collateral ligaments and loosening procedures are deemed insufficient. Our approach proves cost-effectiveness compared to alternatives involving suture anchors or external fixators, with the added advantage of facilitating more flexion and extension postoperatively to preserve the achieved range of motion.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101418"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941282","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}