JSES International最新文献

{"title":"Anatomical ligament reconstruction for Neer type IIB distal clavicular fractures using suture buttons without acromioclavicular joint fixation","authors":"Satoshi Oki MD, PhD,&nbsp;Ryogo Furuhata MD, PhD,&nbsp;Ryosuke Tsujisaka MD,&nbsp;Tomoki Kasahara MD,&nbsp;Shohei Iwabu MD, PhD","doi":"10.1016/j.jseint.2025.06.013","DOIUrl":"10.1016/j.jseint.2025.06.013","url":null,"abstract":"<div><h3>Background</h3><div>Coracoclavicular (CC) ligament reconstruction has been reported as an option for distal clavicle fractures with ligament injuries. However, most of the reported techniques use single-bundle reconstruction which is not fully anatomical and sometimes associated with complications such as nonunion, coracoid fractures, or discomfort on the clavicle due to large-diameter drill holes and bulky implants. We therefore developed an anatomical double-bundle reconstruction of the CC ligaments for distal clavicle fractures. The conoid ligament is reconstructed using a suture button, while the trapezoid ligament is reconstructed using either a suture button or transosseous suturing. We used ankle syndesmosis suture-button, which requires smaller drill holes than suture buttons for acromioclavicular joint reduction. No temporary fixation of the acromioclavicular joint was performed. The purpose of our study was to describe this surgical technique and evaluate clinical and radiographic outcomes of double-ligament reconstruction without temporary wire fixation.</div></div><div><h3>Methods</h3><div>Twenty-three patients with distal clavicle fractures who underwent surgery at our institution were retrospectively enrolled. Twelve patients were treated with double suture buttons for CC ligament reconstruction (double-button group) and 11 were treated with a single suture button (for the conoid ligament) plus transosseous suturing of the trapezoid ligament fragment (single-button group). Sequential radiographs were taken over a 1-year postoperative period to evaluate time to bone union and displacement of the CC distance. These parameters were compared between the single- and double-button groups. Clinical outcomes were assessed using the Constant-Murley score at 1 year postoperatively.</div></div><div><h3>Results</h3><div>Clinical scores were satisfactory in both groups (single-button group: 97.0 ± 2.2; double-button group: 95.4 ± 2.9; <em>P</em> = .18). All patients except 1 in double-button group achieved bone union. One patient in the double-button group experienced suture-button pull-out from the coracoid process. Radiographs showed a slight increase in CC displacement from 1 to 3 months postoperatively in both groups. At 1 year, the average displacement relative to the intact side was 2.4 ± 2.8 mm in the single-button group and 4.4 ± 2.7 mm in the double-button group, with no significant difference (<em>P</em> = .11). No patients required implant removal or additional surgery.</div></div><div><h3>Conclusion</h3><div>Double-bundle reconstruction of the CC ligaments for distal clavicle fractures resulted in satisfactory outcomes. Transosseous suturing of the trapezoid ligament fragment provided comparable outcomes to suture-button fixation.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 1922-1928"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468699","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":"Erratum to ‘Diabetes mellitus as a risk factor for postoperative complications following arthroscopic rotator cuff repair’ [JSES International Volume 7 Issue 6 (2023) 2361-2366]","authors":"Patricia E. Cerri-Droz BS ,&nbsp;Kenny Ling MD ,&nbsp;Samuel Akhnoukh MD ,&nbsp;David E. Komatsu PhD ,&nbsp;Edward D. Wang MD","doi":"10.1016/j.jseint.2025.07.001","DOIUrl":"10.1016/j.jseint.2025.07.001","url":null,"abstract":"","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Page 2192"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468894","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":"Humeral head and distal tibia osteochondral allograft for bipolar bone loss in the setting of anterior shoulder instability from seizure disorder","authors":"Kier M. Blevins MD ,&nbsp;Sameer R. Khawaja MD ,&nbsp;Frank L. Vazquez BS ,&nbsp;Joanne Y. Zhou MD ,&nbsp;Hayden L. Cooke BS ,&nbsp;Zaamin B. Hussain MD, MEd ,&nbsp;Michael B. Gottschalk MD ,&nbsp;Eric R. Wagner MD, MS","doi":"10.1016/j.jseint.2025.06.019","DOIUrl":"10.1016/j.jseint.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Bipolar bone loss in patients with recurrent anterior shoulder instability secondary to epileptic seizures is a complex problem. There is no consensus on the preferred surgical management strategy in these patients. The purpose of our study is to describe an allograft-based reconstruction technique for bipolar bone loss using a distal tibia osteochondral allograft for reconstructing anterior glenoid bone loss and a humeral head osteochondral allograft to reconstruct posterior humeral head bone loss in patients with shoulder instability and seizures.</div></div><div><h3>Methods</h3><div>A total of 3 patients (4 shoulders) with a history of recurrent shoulder instability relating to seizure disorder with bipolar bone loss were included from the years 2021 to 2024. Patients were treated surgically with osteochondral allograft including distal tibia allograft for anterior glenoid bone loss and humeral head for the large Hill-Sachs lesion to restore shoulder stability. Postoperative outcomes included patient-reported outcome measures, range of motion, dynamic digital radiography, complications, and failures.</div></div><div><h3>Results</h3><div>Patient ages ranged from 25 to 34 year old with mean follow-up time of 32.7 months. The mean instability severity index score was 4.5 and with &gt;30% bipolar bone defects. At follow-up all patients reported a resting visual analog score of zero, a subjective shoulder value of 93.8% (range: 90%-100%), a mean American Shoulder Elbow Surgeons score of 97.5 (range: 94-100). There were no repeat dislocations, episodes of postoperative instability, postoperative complications (neurological deficits or infection), or graft failures.</div></div><div><h3>Conclusion</h3><div>Humeral head and distal tibia osteochondral allograft use in combination for reconstructing bipolar bone loss of the shoulder in patients with epilepsy is a promising treatment strategy with excellent patient outcomes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 1938-1946"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468984","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":"Scapular (glenoid and acromion) osteotomies for the treatment of posterior shoulder instability: technique and preliminary results","authors":"Christian Gerber MD, PhD, FRCS ,&nbsp;Bastian Sigrist MSc ,&nbsp;Bettina Hochreiter MD","doi":"10.1016/j.jseint.2025.06.018","DOIUrl":"10.1016/j.jseint.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Static and dynamic posterior shoulder instability (PSI) are associated with a higher, more horizontal acromion providing poor posterior humeral head (HH) coverage. The current surgical treatment yields unsatisfactory long-term outcomes with high recurrence rates in dynamic and failure to restore joint concentricity in static PSI. We hypothesized that restoring physiological acromio–glenoid relations would prevent recurrence of dynamic and positively influence static PSI.</div></div><div><h3>Methods</h3><div>This study reports the outcome after a “scapular (acromion and glenoid) corrective osteotomy for posterior escape procedure in 9 consecutive patients at a minimum 2-year follow-up. One patient had static, 2 had dynamic and 6 had combined PSI. Osteotomies to restore normal scapular bony anatomy were three-dimensionally planned and executed with three-dimensional printed cutting and reduction guides. Preoperatively and postoperatively the absolute Constant Scores (CS), relative CS, subjective shoulder value and glenohumeral subluxation indices (GHSIs) and scapulohumeral subluxation indices (SHSIs) were measured.</div></div><div><h3>Results</h3><div>The mean age at surgery was 37 years (±9.3; 23-47) and mean follow-up was 29 months (±8). In 6 patients, the operation was a revision. In 1 case, we operatively failed to achieve the planned correction resulting in clinical failure, persistent subluxation, and osteoarthritis progression. For the other 8 patients, the median subjective shoulder value increased by 42.5%, absolute CS by 18 points, relative CS by 18%, pain score by 3.5 points. The SHSI was ≥61% in 7/7 patients, GHSI was ≥55% in 4/7 patients. In 5/7 patients with pathological SHSI, the HH was recentered; in 2/7, it was improved but remained ≥61%. In 2/4 patients with the pathological GHSI, the HH was recentered, and improved but remained ≥55% in the other 2. All patients had subjectively stable shoulders.</div></div><div><h3>Conclusion</h3><div>At a minimum of 2 years successful correction of scapular anatomy can improve static subluxation and restore subjective and objective shoulder stability.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 1929-1937"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468693","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":"Two-year follow-up of arthroscopic bone block technique with iliac crest autograft and remplissage in patients with anterior shoulder instability and glenoid bone loss","authors":"Pablo Cañete San Pastor MD, PhD,&nbsp;Juan Manuel Antequera Cano MD,&nbsp;Inmaculada Prósper Ramos MD,&nbsp;Alberto Garcia Roig MD,&nbsp;Joan Andreu Safont MD","doi":"10.1016/j.jseint.2025.06.021","DOIUrl":"10.1016/j.jseint.2025.06.021","url":null,"abstract":"<div><h3>Background</h3><div>To retrospectively evaluate patients undergoing arthroscopic bone-block surgery combined with remplissage for anterior shoulder instability with glenoid bone loss, with a minimum follow-up of 2 years. The study assessed graft positioning, osteointegration, resorption, and functional outcomes.</div></div><div><h3>Methods</h3><div>Patients treated between 2019 and 2023 were retrospectively analyzed. Inclusion criteria included: unidirectional anterior shoulder instability, glenoid bone loss between 10% and 30%, and minimum 2-year follow-up. Exclusion criteria were posterior or multidirectional instability, prior bone-block surgery, or glenoid dysplasia. Preoperative computed tomography scans measured glenoid defects and Hill-Sachs lesions. Postoperative and follow-up computed tomography assessed graft positioning, glenoid index, and resorption. Functional outcomes were measured with pre- and postoperative Constant and Western Ontario Shoulder Instability Index scores.</div></div><div><h3>Results</h3><div>Thirty-two patients (34 shoulders) met inclusion criteria. All underwent arthroscopic iliac crest bone-block fixation and remplissage. Immediate postoperative glenoid width increased from 22.6 ± 1.8 mm to 33.5 ± 1.91 mm (<em>P</em> &lt; .05), stabilizing at 27.9 ± 2.97 mm at 2 years. The glenoid index improved from 0.76 to 1.13 postoperatively, then stabilized at 0.94. Mean graft resorption was 50.51% ± 22.64%; consolidation was achieved in 96.42%. Functional scores significantly improved: Constant score increased from 63.2 ± 9.1 to 87.74 ± 6.3; Western Ontario Shoulder Instability Index score from 1,220.4 ± 380.7 to 394.28 ± 314.5 (81.21%). One patient had recurrence requiring revision. All returned to sports, including the revision case.</div></div><div><h3>Conclusion</h3><div>Arthroscopic bone-block with iliac crest autograft and remplissage is effective for treating anterior shoulder instability with glenoid bone loss. It provides high consolidation rates, significant functional improvement, and low recurrence. Graft resorption does not appear to impair outcomes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 1947-1952"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468885","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":"Is premorbid scapulohumeral rhythm restored with anatomic or reverse shoulder arthroplasty for cuff-intact osteoarthritis? An in-vivo dynamic radiography study","authors":"Zaamin B. Hussain MD, EdM ,&nbsp;Sameer R. Khawaja MD ,&nbsp;Musab Gulzar BS ,&nbsp;Jaden C. Hardrick BS ,&nbsp;Krishna N. Chopra MA ,&nbsp;Anna Gorsky BS ,&nbsp;Victoria A. Conn BS ,&nbsp;Michael B. Gottschalk MD ,&nbsp;Eric R. Wagner MD, MS","doi":"10.1016/j.jseint.2025.06.008","DOIUrl":"10.1016/j.jseint.2025.06.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are both treatment options for advanced glenohumeral osteoarthritis with an intact rotator cuff; however, decision making is controversial, especially among younger active patients. Restoring native shoulder kinematics may be an important consideration for implant longevity and ultimate shoulder function, but &lt;em&gt;in-vivo&lt;/em&gt; assessment and comparisons have been historically difficult. The purpose of this study was to compare scapulohumeral rhythm (SHR) between aTSA and rTSA when performed for patients with cuff-intact osteoarthritis and compare these with preoperative values and normal controls.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective analysis was performed on 71 shoulders that underwent arthroplasty for cuff-intact osteoarthritis, aTSA (n = 28) and rTSA (n = 43), who had dynamic digital radiography performed more than 6 months postoperatively and compared these to 32 normal controls. SHR was calculated by dividing the change in glenohumeral abduction (ΔH) by the change in scapular upward elevation (ΔS) using the formula SHR = ΔH/ΔS, across the total range of abduction below 120° and between the 0°-30°, 30°-60°, 60°-90°, and 90°-120° abduction intervals. A paired subgroup analysis was performed on 14 aTSA and 14 rTSA shoulders with both pre- and postoperative dynamic digital radiography. Descriptive statistics were used to summarize data and differences between groups were analyzed using unpaired Student's &lt;em&gt;t&lt;/em&gt;-tests for continuous variables, and a paired &lt;em&gt;t&lt;/em&gt;-test for subgroup analyses, as well as a Bonferroni correction for multiple statistical tests. Interclass correlation of measurements was used to calculate the inter-rater reliability between the two measurers. All analyses were carried out using R v. 3.6.1. (R Foundation for Statistical Computing, Vienna, Austria). A &lt;em&gt;P&lt;/em&gt; value of less than .05 was considered statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The aTSA cohort had a similar median rest–120° SHR of 2.00 compared to 1.95 for the rTSA cohort (&lt;em&gt;P&lt;/em&gt; = .948), but both were lower than normal controls with a SHR of 2.38 (&lt;em&gt;P&lt;/em&gt; &lt; .001). Preoperative vs. postoperative analyses of the aTSA and rTSA cohorts show significant improvements in preoperative to postoperative median rest–120° SHR from 1.36 to 2.10 (&lt;em&gt;P&lt;/em&gt; = .0002) and 1.34 to 2.04 (&lt;em&gt;P&lt;/em&gt; = .002), respectively. The inter-rater reliability was 0.99.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Patients who underwent aTSA and rTSA for rotator cuff–intact glenohumeral osteoarthritis are associated with lower SHRs than normal asymptomatic patients; however, SHRs significantly improved from preoperative levels. There was no difference between postoperative SHRs for rTSA and aTSA. aTSA and rTSA both partially restore coordination between the glenohumeral and scapulothoracic joints, although not to the ex","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2053-2061"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468895","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":"Investigating the effectiveness of stretching interventions on post-traumatic elbow stiffness: a systematic review","authors":"Georgina Wistow MSc ,&nbsp;Meredith Newman MSc ,&nbsp;Erin Hannink PhD ,&nbsp;Karen L. Barker PhD","doi":"10.1016/j.jseint.2025.06.015","DOIUrl":"10.1016/j.jseint.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic elbow stiffness is a significant complication following traumatic elbow injury, with incidence up to 56%. A loss of 50% of elbow range-of-movement represents a total loss of 80% of upper limb function, a challenge for both patients and clinicians. There are no established guidelines for the physiotherapy management of elbow stiffness following traumatic injury. Understanding the best treatment for nonarthritic elbow stiffness and most effective rehabilitation for prevention of stiffness following trauma or surgery are two of the top 10 James Lind Alliance priorities for elbow conditions. The study investigates the effectiveness of clinical stretching interventions, either via hold-relax manual techniques or bracing, on post-traumatic elbow stiffness in previously healthy elbow joints.</div></div><div><h3>Methods</h3><div>A systematic search of five databases was performed until July 2024. Search terms related to the condition and interventions were used, without limits on date, language, or design. Adults aged ≥18 years with post-traumatic elbow stiffness, investigating any clinical stretch intervention, were eligible. Chronic or overuse elbow injuries and studies assessing alternative conservative interventions were excluded. Outcomes studied were elbow range-of-movement, function, and pain. Two reviewers screened articles and independently rated the evidence using the Cochrane Risk of Bias and Joanna Briggs Institute critical appraisal tools. Data were extracted, tabulated, and narratively synthesized.</div></div><div><h3>Results</h3><div>Nine studies were included, involving a total 312 participants. Three small randomized controlled trials investigated manual stretches using hold-relax stretch-reflex techniques in early post-traumatic elbow stiffness, with no adverse events reported. One randomized controlled trial and five retrospective case series studies investigated brace interventions in persistent post-traumatic elbow stiffness. Clinically important improvements were reported in elbow flexion and extension range-of-movement following both intervention types (hold-relax and bracing). Bracing interventions had more adverse events. Insufficient information was available regarding adherence to protocols. Heterogeneity and incomplete reporting prevented meta-analysis.</div></div><div><h3>Conclusion</h3><div>Hold-relax interventions may be used for early post-traumatic elbow stiffness, with weaker evidence supporting bracing in persistent elbow stiffness. Limitations included the study risk of bias and number of participants, with larger, multicenter studies warranted to confirm and quantify the effect size.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2146-2155"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468983","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":"Short-term complications of open reduction and internal fixation of olecranon fractures: a national database study","authors":"Grayson M. Talaski BSE ,&nbsp;Shahabeddin Yazdanpanah MS ,&nbsp;Matthew S. Smith MD ,&nbsp;Benjamin P. Cassidy MD ,&nbsp;James R. Satalich MD ,&nbsp;Jennifer L. Vanderbeck MD","doi":"10.1016/j.jseint.2025.06.017","DOIUrl":"10.1016/j.jseint.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Olecranon fractures comprise ∼10% of upper extremity fractures, often managed with open reduction and internal fixation (ORIF). Despite generally favorable outcomes, short-term complications remain challenging and uncharacterized. This retrospective study aims to address this gap by evaluating short-term complications of olecranon ORIF using a large, nationwide database to determine complication rates and identify associated risk factors.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Program database (2010-2023) was queried for patients undergoing olecranon ORIF (Current Procedural Terminology Code 24685). Demographic, comorbidities, operative variables, and postoperative complications within 30 days were analyzed. Descriptive statistics and multivariate logistic regression were used to identify significant predictors (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>A total of 8,524 patients (average age 59.4 ± 19.3; 62.3% female) were included. Surgical site infection was amongst the most common singular complications at a rate of 1.8%, with any adverse event reported at a rate of 7.2%. Risk factors included increased age (odds ratio [OR] = 1.03; <em>P</em> &lt; .001), operative time (OR = 1.02; <em>P</em> &lt; .001), blood transfusion (OR = 3.16; <em>P</em> = .001), ascites, and smoking history. Surgical site infection was associated with smoking (OR = 1.66; <em>P</em> = .01) and ascites (OR = 11.38; <em>P</em> = .03).</div></div><div><h3>Conclusion</h3><div>ORIF for olecranon fractures demonstrates low short-term complication rates; however, specific comorbidities such as smoking and ascites were associated with increased risk. These findings highlight opportunities for improving care through providing smoking cessation efforts and tailored perioperative management for high-risk patients.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2156-2160"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468985","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":"Radiomic analysis of the deltoid and scapula: identification of computed tomography-image based measurements predictive of pain, motion, and function before and after shoulder arthroplasty","authors":"Hamidreza Rajabzadeh-Oghaz PhD ,&nbsp;Josie Elwell PhD ,&nbsp;Bradley Schoch MD ,&nbsp;William Aibinder MD ,&nbsp;Bruno Gobbato MD ,&nbsp;Daniel Wessell MD, PhD ,&nbsp;Vikas Kumar PhD ,&nbsp;Christopher P. Roche MSE, MBA","doi":"10.1016/j.jseint.2025.06.014","DOIUrl":"10.1016/j.jseint.2025.06.014","url":null,"abstract":"<div><h3>Background</h3><div>The goal of this study is to analyze a registry of preoperative computed tomography (CT) images of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients, quantify the radiomics of the deltoid muscle and scapular bone, and identify the radiomic features that are most predictive of pain, motion, and function before and after aTSA/rTSA.</div></div><div><h3>Methods</h3><div>Preoperative CT images and clinical data from 4,009 primary shoulder arthroplasty patients were retrospectively analyzed. Next, three-dimensional masks of the deltoid (n = 2,597) and scapula (n = 3,358) were auto-segmented from CT images, and radiomic features were extracted using Py-Radiomics. These radiomics features were then used to train machine-learning regression models to predict pain, motion, and function before and after aTSA/rTSA. Finally, a clustering analysis was performed using the most predictive radiomic features to identify unique deltoid and scapula morphological groups/classes relevant to clinical outcomes before and after aTSA/rTSA.</div></div><div><h3>Results</h3><div>Incorporating radiomic features into the machine-learning models improved the accuracy of 70.5% of deltoid model outcome predictions and 67.3% of scapular model outcome predictions. Analysis of feature importance data demonstrated that the most predictive radiomic features were numerical representations of deltoid and scapula shape and size. Notably, most shape-based radiomic features were more predictive of aTSA/rTSA outcomes than any patient demographic data (except age), comorbidity data, implant data, or diagnosis data. Finally, a radiomic-based clustering analysis identified several deltoid muscle and scapula bone morphologies associated with differences in clinical outcomes before and after aTSA/rTSA.</div></div><div><h3>Conclusion</h3><div>This analysis of &gt;4,000 preoperative CT scans identified numerous radiomic features of the deltoid and scapula that were highly predictive of pain, motion, and function before and after aTSA/rTSA. These most predictive radiomic features were aggregated into unique morphological clusters of deltoids and scapula that were associated with differences in clinical outcomes before and after aTSA/rTSA. Shape-based radiomic features were more predictive than first-order and second-order radiomic features, suggesting that these more interpretable measurements are more clinically relevant and could be more readily incorporated into future radiomic-based clinical decision support tools. Future work is required to further validate these radiomic findings and refine the proposed clustering analysis.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2087-2097"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468647","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":"Trustworthy deep learning for the automated quantification of the fatty infiltration of the rotator cuff muscles using magnetic resonance imaging","authors":"Asma Salhi PhD ,&nbsp;Kristine Italia MD, FPOA ,&nbsp;Ignacio Viedma PhD ,&nbsp;Katreese Samsuya MD, FPOA ,&nbsp;Roberto Pareyon MD ,&nbsp;Freek Hollman MD, PhD ,&nbsp;Mohammad Jomaa MD ,&nbsp;Helen Ingoe MBBS, FRCS Eng ,&nbsp;Jashint Maharaj MBBS, FRSPH ,&nbsp;Kenneth Cutbush MBBS, FRACS, FAOrthoA ,&nbsp;Ashish Gupta MBBS, MSc, FRACS, FAOrthoA","doi":"10.1016/j.jseint.2025.06.020","DOIUrl":"10.1016/j.jseint.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div>The current method of classifying fatty infiltration is highly subjective and has low reliability, which may impact the decision-making for the management of rotator cuff tears. The purpose of this study was to present and evaluate a new deep-learning (DL) approach to automatically and objectively classify fatty infiltration of rotator cuff muscles on magnetic resonance imaging (MRI).</div></div><div><h3>Methods</h3><div>A validated dataset of 1,149 images of segmented rotator cuff muscles, derived from 383 patients, were classified using a simplified grading system (normal, mild, severe) proposed based on the original Goutallier classification. These images and their classifications were used to train the artificial intelligence models. A novel DL pipeline comprising key components of in-domain transfer learning, feature fusion, and machine learning classifiers was proposed for automatic fatty infiltration classification. Pretrained DL models Xception, InceptionV3, and MobileNetV2 were trained separately. Then, K-Nearest Neighbor, Support Vector Machines, and Naive Bayes classifiers were trained using fused features extracted by 3 DL models from the delineated rotator cuff muscle areas. Performance metrics, including accuracy, precision, recall, F1-score, and Gradient-Weighted Class Activation Mapping visualizations, were used to evaluate the model's performance.</div></div><div><h3>Results</h3><div>Among the individual models, MobileNetV2 demonstrated the highest overall performance, with accuracy of 89.5%, specificity of 94.7%, recall of 89.5%, precision of 90.5%, and F1-score of 90.0%. After feature fusion, K-Nearest Neighbour achieved the highest performance, with accuracy of 91.1%, specificity of 95.5%, recall of 91.1%, precision of 93.1%, and F1-score of 92.1%. Overall, the performance metrics of the feature fusion were higher compared to the individual models and approached the consistency of clinical experts (intraclass correlation coefficient 0.91).</div></div><div><h3>Conclusion</h3><div>This study provides evidence for the effective utilization of artificial intelligence advancements in the automated classification of fatty infiltration of rotator cuff muscles on MRI using in-domain transfer learning, feature fusion, and machine learning classifiers. By combining the power of these 3 components, the proposed approach has excellent potential to achieve accurate, robust, and enhanced classification, with a level of consistency in line with expert agreement. As such, this approach offers a promising solution for automating the classification of fatty infiltration on MRI which may have potential benefit for daily clinical practice.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 1999-2007"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468786","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}