Pub Date : 2025-12-11DOI: 10.1016/j.jseint.2025.101410
Farah Selman MD , Esteban Ongini MSc , Nicholas Peter James Perry MD , Michel Meisterhans MD , Maximilian Gressl , Karl Wieser MD
Background and Hypothesis
Nonbiodegradable metal screws used for fixation in the Latarjet procedure can cause complications, including irritation from prominent hardware and the need for revision surgery. Magnesium-based, bioabsorbable screws may address these concerns. This study compared the biomechanical performance of magnesium screws to titanium screws with the hypothesis that there is no statistically significant difference between both groups.
Methods
Fourteen fresh-frozen cadaveric shoulders were matched by age and sex. Seven shoulders underwent a standard Latarjet procedure using two 5 mm cannulated partially threaded magnesium screws (average age 70.6 ± 9.4 years). The other 7 were fixed with two 4.5 mm cannulated partially threaded titanium screws (average age 71.4 ± 14). All shoulders underwent biomechanical testing with direct pressure on the graft: cyclic loading (100 cycles 10 N- 100 N) was performed to assess displacement, stiffness and load-to-failure. Those were measured using force-displacement data obtained through a mechanical testing system.
Results
Maximum cyclic displacement was 1.2 ± 0.6 mm for magnesium and 1.4 ± 1.1 mm for titanium screws (P = .643). Cyclical stiffness was 329 ± 147 N/mm (magnesium) vs. 402 ± 220 N/mm (titanium, P = .489). Construct stiffness was 327 ± 141 N/mm vs. 408 ± 207 N/mm (P = .425), and ultimate load to failure was 414 ± 128 N vs. 475 ± 271 N (P = .605). Bone block failure with screw bending was the most common failure mode in both groups.
Conclusion
No statistically significant differences in biomechanical performance were found between magnesium and titanium screws in this time-zero biomechanical study. Magnesium screws may offer a viable bioabsorbable alternative that reduces complications from permanent hardware.
{"title":"Comparable biomechanical performance of magnesium-based and titanium screws for the Latarjet procedure in a cadaveric study","authors":"Farah Selman MD , Esteban Ongini MSc , Nicholas Peter James Perry MD , Michel Meisterhans MD , Maximilian Gressl , Karl Wieser MD","doi":"10.1016/j.jseint.2025.101410","DOIUrl":"10.1016/j.jseint.2025.101410","url":null,"abstract":"<div><h3>Background and Hypothesis</h3><div>Nonbiodegradable metal screws used for fixation in the Latarjet procedure can cause complications, including irritation from prominent hardware and the need for revision surgery. Magnesium-based, bioabsorbable screws may address these concerns. This study compared the biomechanical performance of magnesium screws to titanium screws with the hypothesis that there is no statistically significant difference between both groups.</div></div><div><h3>Methods</h3><div>Fourteen fresh-frozen cadaveric shoulders were matched by age and sex. Seven shoulders underwent a standard Latarjet procedure using two 5 mm cannulated partially threaded magnesium screws (average age 70.6 ± 9.4 years). The other 7 were fixed with two 4.5 mm cannulated partially threaded titanium screws (average age 71.4 ± 14). All shoulders underwent biomechanical testing with direct pressure on the graft: cyclic loading (100 cycles 10 N- 100 N) was performed to assess displacement, stiffness and load-to-failure. Those were measured using force-displacement data obtained through a mechanical testing system.</div></div><div><h3>Results</h3><div>Maximum cyclic displacement was 1.2 ± 0.6 mm for magnesium and 1.4 ± 1.1 mm for titanium screws (<em>P</em> = .643). Cyclical stiffness was 329 ± 147 N/mm (magnesium) vs. 402 ± 220 N/mm (titanium, <em>P</em> = .489). Construct stiffness was 327 ± 141 N/mm vs. 408 ± 207 N/mm (<em>P</em> = .425), and ultimate load to failure was 414 ± 128 N vs. 475 ± 271 N (<em>P</em> = .605). Bone block failure with screw bending was the most common failure mode in both groups.</div></div><div><h3>Conclusion</h3><div>No statistically significant differences in biomechanical performance were found between magnesium and titanium screws in this time-zero biomechanical study. Magnesium screws may offer a viable bioabsorbable alternative that reduces complications from permanent hardware.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101410"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188554","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}
Pub Date : 2025-12-09DOI: 10.1016/j.jseint.2025.101429
Ayham Jaber MD , Tyler J. Uppstrom MD , Marilee P. Horan MPH , Christopher J. Hawryluk MBS , Yazan Jaber MD , Matthew T. Provencher MD, MBA , Peter J. Millett MD, MSc
Hypothesis
End-stage multidirectional recurrent shoulder instability (RSI) that is unresponsive to nonoperative treatment is a puzzling pathology, with no consensus on standard of care. The purpose is to report and compare outcomes of glenohumeral arthrodesis (GHA) and reverse total shoulder arthroplasty (rTSA). We hypothesized that both treatment options would be acceptable, but rTSA patients would have better function and higher patient satisfaction.
Methods
Patients who underwent primary GHA or rTSA for isolated RSI by a single surgeon were included. Failure was defined as a conversion surgery or major component exchange. Patient-reported outcome measures (American Shoulder and Elbow Surgeons, Single Assessment Numerical Evaluation, Quick Disabilities of the Arm, Shoulder and Hand, 12-item Short Form) were assessed preoperatively and postoperatively. Persistent instability and patient satisfaction were reported.
Results
Thirteen shoulders in 11 patients with end-stage RSI underwent either GHA (n = 8) or rTSA (n = 5) with a mean age was 29.7 ± 11.8 years. Ehlers-Danlos syndrome was present in 5 patients. Follow-up rate was 93% (12/13). One GHA patient required conversion to rTSA. One GHA patient underwent hardware removal and a varus-producing osteotomy for scapular pain. No persistent instability was reported. No significant differences were found in demographics or preoperative patient-reported outcomes. American Shoulder and Elbow Surgeons (GHA: 64.4 ± 15.4; rTSA: 89.6 ± 12.6, P = .016) and Single Assessment Numerical Evaluation (GHA: 60 ± 24; rTSA: 85.2 ± 20.9, P = .040) scores were higher at follow-up in the rTSA group. Quick Disabilities of the Arm, Shoulder and Hand scores were significantly lower (P = .026) in the rTSA group, indicating less disability. Both groups reported high median satisfaction on a 1–10 scale [GHA: 8 (range: 3–10), rTSA: 10 (range: 5–10), P = .156].
Conclusion
rTSA and GHA are viable options in treating end-stage RSI. rTSA resulted in better function and lower revision surgery rates, suggesting rTSA provides better shoulder mobility while maintaining stability.
{"title":"A comparison of reverse shoulder arthroplasty and glenohumeral arthrodesis for end-stage shoulder instability","authors":"Ayham Jaber MD , Tyler J. Uppstrom MD , Marilee P. Horan MPH , Christopher J. Hawryluk MBS , Yazan Jaber MD , Matthew T. Provencher MD, MBA , Peter J. Millett MD, MSc","doi":"10.1016/j.jseint.2025.101429","DOIUrl":"10.1016/j.jseint.2025.101429","url":null,"abstract":"<div><h3>Hypothesis</h3><div>End-stage multidirectional recurrent shoulder instability (RSI) that is unresponsive to nonoperative treatment is a puzzling pathology, with no consensus on standard of care. The purpose is to report and compare outcomes of glenohumeral arthrodesis (GHA) and reverse total shoulder arthroplasty (rTSA). We hypothesized that both treatment options would be acceptable, but rTSA patients would have better function and higher patient satisfaction.</div></div><div><h3>Methods</h3><div>Patients who underwent primary GHA or rTSA for isolated RSI by a single surgeon were included. Failure was defined as a conversion surgery or major component exchange. Patient-reported outcome measures (American Shoulder and Elbow Surgeons, Single Assessment Numerical Evaluation, Quick Disabilities of the Arm, Shoulder and Hand, 12-item Short Form) were assessed preoperatively and postoperatively. Persistent instability and patient satisfaction were reported.</div></div><div><h3>Results</h3><div>Thirteen shoulders in 11 patients with end-stage RSI underwent either GHA (n = 8) or rTSA (n = 5) with a mean age was 29.7 ± 11.8 years. Ehlers-Danlos syndrome was present in 5 patients. Follow-up rate was 93% (12/13). One GHA patient required conversion to rTSA. One GHA patient underwent hardware removal and a varus-producing osteotomy for scapular pain. No persistent instability was reported. No significant differences were found in demographics or preoperative patient-reported outcomes. American Shoulder and Elbow Surgeons (GHA: 64.4 ± 15.4; rTSA: 89.6 ± 12.6, <em>P</em> = .016) and Single Assessment Numerical Evaluation (GHA: 60 ± 24; rTSA: 85.2 ± 20.9, <em>P</em> = .040) scores were higher at follow-up in the rTSA group. Quick Disabilities of the Arm, Shoulder and Hand scores were significantly lower (<em>P</em> = .026) in the rTSA group, indicating less disability. Both groups reported high median satisfaction on a 1–10 scale [GHA: 8 (range: 3–10), rTSA: 10 (range: 5–10), <em>P</em> = .156].</div></div><div><h3>Conclusion</h3><div>rTSA and GHA are viable options in treating end-stage RSI. rTSA resulted in better function and lower revision surgery rates, suggesting rTSA provides better shoulder mobility while maintaining stability.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101429"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079042","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}
Pub Date : 2025-12-02DOI: 10.1016/j.jseint.2025.101415
Aghdas Movassaghi BS , Elizabeth W. Chan BS , Justin T. Childers MS , Benjamin T. Lack BS , Garrett R. Jackson MD , Clyde Fomunung MD , Roya Osswald , Vani J. Sabesan MD
Background
As surgical technologies, such as three-dimensional preoperative planning, computer navigation, and augmented reality, become increasingly utilized in shoulder arthroplasty, questions remain about their value from the patient's perspective. While education and patient interest have driven demand and technology adoption in hip and knee arthroplasty, their role in shoulder procedures remains unclear. This study aimed to evaluate patient perceptions of innovative technologies in shoulder arthroplasty and assess whether preoperative education influences confidence, satisfaction, and expectations.
Methods
In this prospective observational study, 87 patients scheduled to undergo shoulder arthroplasty at a single institution completed a preoperative survey assessing demographics, baseline familiarity with surgical technologies, and perceptions of surgeon use of innovative tools prior to seeing their provider. Following this, patients then viewed a standardized educational video on the role of technology in shoulder arthroplasty. Postvideo responses measured changes in confidence, satisfaction, and outcome expectations. Statistical analysis included paired t-tests and analysis of variance to evaluate prepost changes and demographic associations.
Results
Over half of patients (56.3%) were unfamiliar with innovative technologies at baseline, yet 60.9% reported increased confidence in surgeons using it. Most patients (66.7%) preferred the use of advanced planning technologies, though only 41.5% would choose a low-volume surgeon using these tools over a high-volume surgeon using conventional techniques. Improvements in confidence were significantly correlated with higher education and income levels (r = 0.31, P = .003). After viewing an educational video, patient confidence in their surgeon increased (P = .03), and expectations for improved outcomes (P < .001), fewer complications (P < .001), less pain (P < .001), and faster recovery (P < .001) significantly rose. Despite favorable perceptions, 62.1% of patients were unwilling to pay more, travel further, or wait longer to receive care involving innovative technologies.
Conclusion
Targeted preoperative education on surgical technology may improve patient confidence, strengthen perceptions of surgeon competency, and elevate expectations of care. While enthusiasm for advanced tools was observed following education, broader adoption may still be influenced by cost and accessibility. These findings support the role of brief, technology-focused education in enhancing the overall patient experience in shoulder arthroplasty.
{"title":"Do patients trust the tech? Exploring perception, confidence, and knowledge of innovations in shoulder arthroplasty","authors":"Aghdas Movassaghi BS , Elizabeth W. Chan BS , Justin T. Childers MS , Benjamin T. Lack BS , Garrett R. Jackson MD , Clyde Fomunung MD , Roya Osswald , Vani J. Sabesan MD","doi":"10.1016/j.jseint.2025.101415","DOIUrl":"10.1016/j.jseint.2025.101415","url":null,"abstract":"<div><h3>Background</h3><div>As surgical technologies, such as three-dimensional preoperative planning, computer navigation, and augmented reality, become increasingly utilized in shoulder arthroplasty, questions remain about their value from the patient's perspective. While education and patient interest have driven demand and technology adoption in hip and knee arthroplasty, their role in shoulder procedures remains unclear. This study aimed to evaluate patient perceptions of innovative technologies in shoulder arthroplasty and assess whether preoperative education influences confidence, satisfaction, and expectations.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 87 patients scheduled to undergo shoulder arthroplasty at a single institution completed a preoperative survey assessing demographics, baseline familiarity with surgical technologies, and perceptions of surgeon use of innovative tools prior to seeing their provider. Following this, patients then viewed a standardized educational video on the role of technology in shoulder arthroplasty. Postvideo responses measured changes in confidence, satisfaction, and outcome expectations. Statistical analysis included paired t-tests and analysis of variance to evaluate prepost changes and demographic associations.</div></div><div><h3>Results</h3><div>Over half of patients (56.3%) were unfamiliar with innovative technologies at baseline, yet 60.9% reported increased confidence in surgeons using it. Most patients (66.7%) preferred the use of advanced planning technologies, though only 41.5% would choose a low-volume surgeon using these tools over a high-volume surgeon using conventional techniques. Improvements in confidence were significantly correlated with higher education and income levels (r = 0.31, <em>P</em> = .003). After viewing an educational video, patient confidence in their surgeon increased (<em>P</em> = .03), and expectations for improved outcomes (<em>P</em> < .001), fewer complications (<em>P</em> < .001), less pain (<em>P</em> < .001), and faster recovery (<em>P</em> < .001) significantly rose. Despite favorable perceptions, 62.1% of patients were unwilling to pay more, travel further, or wait longer to receive care involving innovative technologies.</div></div><div><h3>Conclusion</h3><div>Targeted preoperative education on surgical technology may improve patient confidence, strengthen perceptions of surgeon competency, and elevate expectations of care. While enthusiasm for advanced tools was observed following education, broader adoption may still be influenced by cost and accessibility. These findings support the role of brief, technology-focused education in enhancing the overall patient experience in shoulder arthroplasty.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101415"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941283","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}
Pub Date : 2025-12-02DOI: 10.1016/j.jseint.2025.101426
Kyle K. Obana MD, Mark Ren MD, Andrew J. Luzzi MD, Matthew R. LeVasseur MD, Hasani W. Swindell MD, William N. Levine MD
Background
Artificial intelligence is becoming increasingly utilized as a source of convenient, efficient, and cost-effective information. Considering the potential utility of ChatGPT as an adjuvant in clinical decision making, the current study evaluates (1) the accuracy of ChatGPT-5 at evaluating shoulder x-rays containing either normal or proximal humerus fracture (PHFx) diagnoses and (2) interrater reliability between ChatGPT and orthopedic surgeons at different levels of training.
Methods
The Stanford University Musculoskeletal Radiographs publicly accessible dataset was utilized, and 70 x-rays (35 PHFx, 35 normal) were analyzed after inclusion and exclusion criteria were applied. X-rays were reviewed independently by an orthopedic surgery junior resident, senior resident, shoulder/elbow fellow, and shoulder/elbow fellowship-trained attending. X-rays for each patient were uploaded to ChatGPT-5 and questions were asked using a response-based algorithm.
Results
ChatGPT-5 demonstrated a sensitivity of 61.8%, specificity of 74.3%, and an overall accuracy of 67.1% for PHFx x-rays. ChatGPT incorrectly diagnosed 25.7% of normal x-rays with a fracture or dislocation. ChatGPT incorrectly diagnosed 23.5% of isolated PHFx x-rays as normal, 8.8% with an isolated glenohumeral dislocation without fracture, and 5.7% with a PHFx dislocation. Inter-rater reliability for ChatGPT was slight for displaced parts and poor for fractured part, Neer parts, and located glenohumeral joint. Junior and senior residents had moderate to substantial agreement with the attending reads (fractured part, displaced parts, Neer parts), while the fellow had substantial to almost perfect agreement.
Conclusion
This study demonstrates that ChatGPT-5 is highly inaccurate at identifying PHFx on shoulder x-rays, characterizing the fracture patterns, and providing accurate interpretations of shoulder x-rays. Over-reliance on generative artificial intelligence to guide clinical decisions risks harm to the patients and should be approached with limited credence.
{"title":"Bot vs. doc—who is better at reading proximal humerus fracture x-rays?","authors":"Kyle K. Obana MD, Mark Ren MD, Andrew J. Luzzi MD, Matthew R. LeVasseur MD, Hasani W. Swindell MD, William N. Levine MD","doi":"10.1016/j.jseint.2025.101426","DOIUrl":"10.1016/j.jseint.2025.101426","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence is becoming increasingly utilized as a source of convenient, efficient, and cost-effective information. Considering the potential utility of ChatGPT as an adjuvant in clinical decision making, the current study evaluates (1) the accuracy of ChatGPT-5 at evaluating shoulder x-rays containing either normal or proximal humerus fracture (PHFx) diagnoses and (2) interrater reliability between ChatGPT and orthopedic surgeons at different levels of training.</div></div><div><h3>Methods</h3><div>The Stanford University Musculoskeletal Radiographs publicly accessible dataset was utilized, and 70 x-rays (35 PHFx, 35 normal) were analyzed after inclusion and exclusion criteria were applied. X-rays were reviewed independently by an orthopedic surgery junior resident, senior resident, shoulder/elbow fellow, and shoulder/elbow fellowship-trained attending. X-rays for each patient were uploaded to ChatGPT-5 and questions were asked using a response-based algorithm.</div></div><div><h3>Results</h3><div>ChatGPT-5 demonstrated a sensitivity of 61.8%, specificity of 74.3%, and an overall accuracy of 67.1% for PHFx x-rays. ChatGPT incorrectly diagnosed 25.7% of normal x-rays with a fracture or dislocation. ChatGPT incorrectly diagnosed 23.5% of isolated PHFx x-rays as normal, 8.8% with an isolated glenohumeral dislocation without fracture, and 5.7% with a PHFx dislocation. Inter-rater reliability for ChatGPT was slight for displaced parts and poor for fractured part, Neer parts, and located glenohumeral joint. Junior and senior residents had moderate to substantial agreement with the attending reads (fractured part, displaced parts, Neer parts), while the fellow had substantial to almost perfect agreement.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that ChatGPT-5 is highly inaccurate at identifying PHFx on shoulder x-rays, characterizing the fracture patterns, and providing accurate interpretations of shoulder x-rays. Over-reliance on generative artificial intelligence to guide clinical decisions risks harm to the patients and should be approached with limited credence.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101426"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078875","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}
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).
Methods
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 t-test.
Results
The MDI group showed significantly greater humeral head deviation, wider amplitude of deviation, and faster deviation velocity than the control group (P = .008 for anterior deviation, P = .009 for posterior deviation). The deviation amplitude exceeded 35% of the glenoid width in MDI shoulders, surpassing established clinical thresholds.
Conclusion
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).
{"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 , Takashi Tachibana PT , Katsuya Nobuhara MD, PhD , 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}
Pub Date : 2025-12-02DOI: 10.1016/j.jseint.2025.101423
Yiwen Tan MD , Zhao Tan MD , Hu Zhang PhD , Fangfang Mou MD
Background
The internal fixation of Ogawa type I coracoid fractures is relatively difficult, and there is no consensus on the fixation method, which is also prone to screw cutout. This study aims to evaluate the biomechanical properties of 5 different screw internal fixation methods for Ogawa type I coracoid process base fracture through biomechanical experiments.
Hypothesis
The biomechanical effects of the 5 fixation methods are different.
Methods
Fifteen fresh adult scapula specimens were randomly selected to create models of Ogawa type I coracoid process base fracture. Five fixation methods were used: single hollow screw fixation entirely within the bone (M1), single hollow screw fixation partially exiting below the vertical part of the coracoid process (M2), single hollow screw fixation partially exiting above the vertical part of the coracoid process and extending to the scapular spine (M3), dual hollow screw fixation entirely within the bone (M4), and dual hollow screw fixation combining M1+M3 (M5). All specimens were randomly divided into 5 groups of 3, each corresponding to a fixation method. Biomechanical experiments of compression, tension, and rotation were conducted to assess the stability of each fixation method.
Results
There was no significant difference in bone mineral density among the groups (P = .873). At the compression end point, M2 sustained the lowest force and M4 the highest, with the ranking M2 < M3 < M1 < M5 < M4; the intergroup difference was statistically significant (P = .022). At the tension end point, M3 sustained the lowest force and M5 the highest, with the ranking M3 < M2 < M1 < M4 < M5; the intergroup difference was statistically significant (P = .019). At the torsion end point, M2 showed the lowest torque and M5 the highest, with the ranking M2 < M3 < M1 < M4 < M5; the intergroup difference was statistically significant (P = .032).
Conclusion
The dual-screw fixation methods (M4 and M5) demonstrated the best stability in treating Ogawa type I coracoid process base fracture, with no significant difference between M5 and M4. For single-screw fixation, the entirely intraosseous method (M1) was more stable than the “in-out-in” methods, and the mode with partial downward exit (M2) should be avoided.
{"title":"Biomechanical evaluation of different screw fixation methods for Ogawa type I coracoid process base fracture","authors":"Yiwen Tan MD , Zhao Tan MD , Hu Zhang PhD , Fangfang Mou MD","doi":"10.1016/j.jseint.2025.101423","DOIUrl":"10.1016/j.jseint.2025.101423","url":null,"abstract":"<div><h3>Background</h3><div>The internal fixation of Ogawa type I coracoid fractures is relatively difficult, and there is no consensus on the fixation method, which is also prone to screw cutout. This study aims to evaluate the biomechanical properties of 5 different screw internal fixation methods for Ogawa type I coracoid process base fracture through biomechanical experiments.</div></div><div><h3>Hypothesis</h3><div>The biomechanical effects of the 5 fixation methods are different.</div></div><div><h3>Methods</h3><div>Fifteen fresh adult scapula specimens were randomly selected to create models of Ogawa type I coracoid process base fracture. Five fixation methods were used: single hollow screw fixation entirely within the bone (M1), single hollow screw fixation partially exiting below the vertical part of the coracoid process (M2), single hollow screw fixation partially exiting above the vertical part of the coracoid process and extending to the scapular spine (M3), dual hollow screw fixation entirely within the bone (M4), and dual hollow screw fixation combining M1+M3 (M5). All specimens were randomly divided into 5 groups of 3, each corresponding to a fixation method. Biomechanical experiments of compression, tension, and rotation were conducted to assess the stability of each fixation method.</div></div><div><h3>Results</h3><div>There was no significant difference in bone mineral density among the groups (<em>P</em> = .873). At the compression end point, M2 sustained the lowest force and M4 the highest, with the ranking M2 < M3 < M1 < M5 < M4; the intergroup difference was statistically significant (<em>P</em> = .022). At the tension end point, M3 sustained the lowest force and M5 the highest, with the ranking M3 < M2 < M1 < M4 < M5; the intergroup difference was statistically significant (<em>P</em> = .019). At the torsion end point, M2 showed the lowest torque and M5 the highest, with the ranking M2 < M3 < M1 < M4 < M5; the intergroup difference was statistically significant (<em>P</em> = .032).</div></div><div><h3>Conclusion</h3><div>The dual-screw fixation methods (M4 and M5) demonstrated the best stability in treating Ogawa type I coracoid process base fracture, with no significant difference between M5 and M4. For single-screw fixation, the entirely intraosseous method (M1) was more stable than the “in-out-in” methods, and the mode with partial downward exit (M2) should be avoided.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101423"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188556","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}
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.
Methods
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 P < .05.
Results
Biomechanical results showed no significant differences in failure load between TR and SR at any time point (P = .423, P = .423, P = .631). However, at 12 weeks, the stiffness of TR was significantly higher than SR (P = .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 (P = .006), vascularity (P = .002), and Modified Watson tendon maturation score (P = .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.
Discussion
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.
Conclusion
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.
背景：肩袖撕裂是肩痛的主要原因，尽管手术技术进步，但其再破裂率很高。肌腱到骨愈合失败通常归因于修复部位纤维软骨再生不足。隧道内修复（TR）被认为是一种通过增加肌腱-骨接触和暴露于骨髓来源的干细胞来增强愈合的替代方法。然而，其治疗慢性肩袖撕裂的有效性尚不清楚。本研究旨在比较兔TR和表面修复（SR）模型的生物力学和组织学结果。我们假设与SR相比，TR可能在肌腱-骨愈合方面具有优势，特别是通过增加接触面积和骨髓暴露。方法以36只新西兰大白兔为实验动物，采用肩胛下肌腱断裂术并阻止其自愈8周，建立慢性肩袖撕裂模型。右肩接受TR，左肩接受sr。在修复后4周、8周和12周进行生物力学和组织学评估。生物力学测试评估失效载荷、刚度和伸长率。组织学评估包括胶原纤维组织、纤维软骨形成、血管分布和使用改良沃森肌腱成熟评分的肌腱成熟。采用非参数检验进行统计学分析，显著性水平为P <； 0.05。结果生物力学结果显示，各时间点TR和SR的失效负荷无显著差异（P = .423, P = .423, P = .631）。然而，在12周时，TR的僵硬度显著高于SR （P = 0.005）。早期组织学结果显示两组肌腱成熟、胶原排列和血管分布相似。到12周时，与TR相比，SR组的胶原组织（P = 0.006）、血管密度（P = 0.002）和改良沃森肌腱成熟评分（P = 0.004）明显更好。12周时，所有SR样本中都观察到潮汐线，这是纤维软骨发育的关键指标，但大多数TR样本中没有。与我们的假设相反，与sr相比，TR没有表现出更好的愈合结果。虽然TR提供了相似的生物力学特性，但随着时间的推移，其组织学结果较差。我们推测，隧道内炎症反应和肌腱微运动的增加可能导致了TR组中观察到的较差的组织学愈合。结论在治疗慢性肩袖撕裂时，TR并不比SR有明显的优势。需要进一步的研究来优化骨隧道内的愈合策略。
{"title":"Optimizing tendon-to-bone healing: a comparative study of intratunnel and anatomical repairs in rotator cuff tears","authors":"Muzaffer Agir MD , Koray Sahin MD , Anil Pulatkan MD , Mehmet Kapicioglu MD , Fatih Yamak PhD , Ergun Bozdağ PhD , Ayse Nur Toksoz Yildirim MD , 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> < .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}
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.
Methods
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.
Results
Active flexion and external rotation ROM showed statistically significant improvement (P = .039 and P = .006, respectively). CMS pain, strength, and total showed statistically significant improvement (P = .039 and P = .006, respectively). All the patients showed a nonstatistically significant difference of the SHR along the entire ROM between pre- and postoperative evaluation. The P value in flexion and abduction was >.05; the only statistically significant value was on tilt at 60° in flexion (P = .044)
Conclusion
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.
{"title":"Persistent scapular dyskinesis after arthroscopic rotator cuff repair: a prospective study","authors":"Michele Mercurio MD , Erminia Cofano MD , Claudia Mancuso MD , Lorena Paola MD , Alessandro Imbrogno PhD Student , Matteo Mantovani MSc , Filippo Familiari MD , Giorgio Gasparini MD , 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 >.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}
Pub Date : 2025-12-02DOI: 10.1016/j.jseint.2025.101424
Masataka Minami PhD, MD , Yoshikazu Kida PhD, MD , Masamitsu Kido PhD, MD , Ausberto R. Velasquez Garcia MD , Jesse B. O'Driscoll BS , James S. Fitzsimmons BSc , Kenji Takahashi PhD, MD , Shawn W. O'Driscoll PhD, MD
Background
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.
Methods
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.
Results
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.
Conclusion
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.
{"title":"Proxy for the surgery for elbow osteochondritis dissecans in adolescent baseball players","authors":"Masataka Minami PhD, MD , Yoshikazu Kida PhD, MD , Masamitsu Kido PhD, MD , Ausberto R. Velasquez Garcia MD , Jesse B. O'Driscoll BS , James S. Fitzsimmons BSc , Kenji Takahashi PhD, MD , 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}
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.
Methods
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.
Results
Of 181 patients enrolled, 20 (11%) had retears and 161 (89%) had no retears. The retear group was significantly older (P = .037) and had more large or massive tears (P = .044), larger tear sizes on magnetic resonance imaging (coronal plane: 29.9 ± 14.9 mm vs. 21.6 ± 12 mm, P = .005; sagittal plane: 23.7 ± 12.1 mm vs. 17.9 ± 9.4 mm, P = .013), and greater fatty infiltration (P < .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 [P = .004] and 81.2 ± 11.1 point vs. 86.3 ± 9.6 point at 24 months [P = .032]; UCLA score: 25 ± 2.6 point vs. 27.3 ± 3.5 point at 6 months [P = .005], 28.7 ± 4.6 point vs. 30.9 ± 3.7 point at 24 months [P = .018]) and higher visual analog scale scores at 24 months (21.5 ± 12 vs. 7.8 ± 7.7, P = .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°, P = .032, 35 ± 28.3° vs. 53 ± 9°, P = .038) and tended to show inferior outcomes overall.
Conclusion
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.
背景：在关节镜下肩袖修复（ARCR）中，三排（TR）技术增强了肌腱与骨的接触和修复的完整性。然而，有限的研究已经评估了这种技术的临床结果和风险因素。本研究的目的是比较使用TR技术进行ARCR后复发组和非复发组的临床结果，并确定复发的危险因素。方法采用TR技术行ARCR且随访至少24个月的患者入组，分为复发组和非复发组。临床结果包括术后3、6和24个月的活动范围、疼痛视觉模拟量表、恒肩（CS）和加州大学洛杉矶分校（UCLA）评分。随访3个月、6个月和24个月时，采用磁共振成像技术评估患者的再撕率和肌腱完整性，并分析再撕的危险因素。结果入组的181例患者中，20例（11%）有流泪，161例（89%）无流泪。撕裂组明显年龄大（P = 0.037），撕裂较大或块状（P = 0.044），磁共振成像撕裂尺寸较大（冠状面：29.9±14.9 mm vs. 21.6±12 mm, P = 0.005；矢状面：23.7±12.1 mm vs. 17.9±9.4 mm, P = 0.013），脂肪浸润较大（P < 0.001）。两组取得了良好的临床结果,但retear组显示显著降低CS和加州大学洛杉矶分校的分数在6到24个月(CS得分:72.4±9点和78.6±8.6点在6个月(P = 04)和81.2±11.1点和86.3±9.6点在24个月(P = .032),加州大学洛杉矶分校得分:25±2.6点和27.3±3.5点在6个月[P = .005], 28.7±4.6点和30.9±3.7点24个月[P = .018])和更高的视觉模拟量表得分在24个月(12和21.5±7.8±7.7,P = .021)。冈下肌脂肪浸润被认为是复发的独立危险因素。Goutallier分级≥3的患者在3个月和6个月时外旋明显较差（26±25.1°对44.7±11.4°，P = 0.032, 35±28.3°对53±9°，P = 0.038），总体结果较差。结论应用TR技术的arcr具有良好的临床效果，即使在有裂孔的病例中也是如此。然而，裂口患者，特别是那些大到大块的裂口或严重的冈下脂肪浸润的患者，其预后较差。
{"title":"Risk factors for retear of arthroscopic rotator cuff repair using triple-row technique","authors":"Ryosuke Takahashi MD , Ryosuke Sagami MD , Yohei Harada MD, PhD , 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> < .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}
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