Journal of Shoulder and Elbow Surgery最新文献

{"title":"Fulfillment of patients’ expectations for reverse total shoulder arthroplasty for the treatment of rotator cuff tear arthropathy using the Exactech Equinoxe Platform","authors":"Vincent A. Lizzio MD,&nbsp;Chrystina L. James MD,&nbsp;Johnny K. Kasto MD,&nbsp;Ryan Y. Sanii MD,&nbsp;Stephanie J. Muh MD","doi":"10.1016/j.jse.2025.07.004","DOIUrl":"10.1016/j.jse.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Despite the increasing use of reverse total shoulder arthroplasty (rTSA), there remain limited data regarding perioperative expectations and fulfillment of expectations for patients undergoing rTSA for rotator cuff tear arthropathy (CTA). Thus, the purpose of this study was to determine the proportion of expectations that are fulfilled following rTSA and to determine which patient characteristics are associated with fulfillment of expectations at 2-year follow-up.</div></div><div><h3>Methods</h3><div>Preoperatively, patients completed the Hospital for Special Surgery’s Shoulder Surgery Expectation Survey, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS) for pain, and a Single Assessment Numeric Evaluation (SANE) score for the affected shoulder. At 2-year follow-up, patients were asked to what extent each of their corresponding preoperative expectations that they had previously cited as “very important” were now fulfilled, and again completed the patient-reported outcomes. Demographic and range of motion (ROM) data were also collected.</div></div><div><h3>Results</h3><div>Seventy-seven patients met all inclusion criteria and were included in this study. The expectations most frequently cited as being “very fulfilled” postoperatively were improvement in self-care (75%), improvement in ability to drive and put on seatbelt (77%), and relief of daytime pain (73%). Eighty-one percent of patients cited improvement in shoulder ROM as an important expectation preoperatively, but only 53% reported that this expectation was “very fulfilled” postoperatively. Patients with better postoperative ASES scores (<em>P</em> &lt; .001), better VAS scores (<em>P</em> &lt; .001), and better SANE scores (<em>P</em> &lt; .001) compared with the average patient had a greater proportion of expectations fulfilled.</div></div><div><h3>Conclusions</h3><div>Patients undergoing rTSA for CTA had greatest fulfillment of expectations for improvement in self-care, ability to drive, and relief of daytime pain at 2-year follow-up. Relatively few patients reported fulfillment of expectations for shoulder ROM. Better postoperative ASES, VAS, and SANE scores correlated with greater fulfillment of expectations. It is important to understand traditional objective metrics considered for success to surgeons may not be the same as a patient’s perspective. Using this information, surgeons can better tailor their preoperative discussions with patients to appropriately manage expectations.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 713-718"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of glenohumeral rotational asymmetries on the risk of shoulder pain in volleyball players: a cross-sectional study","authors":"Catarina T. Sá MD ,&nbsp;Daniel M. Dias MD ,&nbsp;João B. Nunes MD ,&nbsp;Manuel A. Gutierres MD, PhD","doi":"10.1016/j.jse.2025.07.020","DOIUrl":"10.1016/j.jse.2025.07.020","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder rotational imbalances are common adaptations in volleyball players due to repetitive overhead movements. This study investigates the relationship between shoulder rotational asymmetries and the risk of shoulder pain in professional and semi-professional volleyball players.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted on 84 volleyball players, divided into groups with and without a history of shoulder pain (n = 29 and n = 55, respectively). Shoulder internal rotation and external rotation were measured using a goniometer. Glenohumeral internal rotation deficit (GIRD), external rotation gain, total range of motion (TROM), and TROM asymmetry were calculated. Multivariable logistic regression was used to determine independent risk factors, and receiver operating characteristic curve analysis was performed to define pathological thresholds.</div></div><div><h3>Results</h3><div>The pain group exhibited significantly higher GIRD (median: 18° vs. 10°, <em>P</em> &lt; .001) and greater TROM asymmetry (median: 8° vs. 4°, <em>P</em> = .033) compared to the no pain group. No significant differences were observed in external rotation gain. Logistic regression identified a weak but statistically significant association between GIRD (odds ratio = 1.100, <em>P</em> = .011) and shoulder pain and a stronger association with playing position (attackers: odds ratio = 11.101, <em>P</em> = .005). Receiver operating characteristic analysis determined cutoff values of 17° for pathological GIRD and 5° for pathological TROM asymmetry.</div></div><div><h3>Conclusion</h3><div>Increased GIRD and TROM asymmetry were statistically associated with shoulder pain in volleyball players. Despite the weak associations, these measures may signal early dysfunction in high-demand athletes. Attackers appear particularly at risk due to repetitive overhead movements. These findings support monitoring rotational imbalances and exploring preventive strategies in future prospective studies.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 907-916"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-wide transcriptional analysis of tendon tissue-related genes and pathways in the torn rotator cuff of diabetes patients","authors":"Ning Fan MD ,&nbsp;Aobo Wang MD ,&nbsp;Tianyi Wang MD,&nbsp;Shuo Yuan MD,&nbsp;Peng Du MM,&nbsp;Lei Zang MD","doi":"10.1016/j.jse.2025.07.012","DOIUrl":"10.1016/j.jse.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Diabetes is a major factor affecting rotator cuff tear (RCT) progression and healing. However, the underlying molecular mechanisms linking diabetes to RCT remain unclear. We aimed to investigate these mechanisms for developing targeted therapeutic strategies to improve tendon healing in diabetes patients.</div></div><div><h3>Methods</h3><div>Microarray analysis was used to profile differentially expressed mRNAs in RCT samples between 3 diabetes and 3 nondiabetes patients. Subsequently, Gene Ontology database, Kyoto Encyclopedia of Genes and Genomes pathway, and interaction networks for the differentially expressed genes (DEGs) were analyzed using Search Tool for the Retrieval of Interacting Genes, Cytoscape, and packages of the R computing language. All the hub genes were verified by quantitative real-time polymerase chain reaction.</div></div><div><h3>Results</h3><div>In total, 660 DEGs were identified, including 337 upregulated genes and 323 downregulated genes. Gene Ontology annotation analysis revealed that these DEGs were mainly associated with negative regulation of growth and cellular response to zinc ion in the biological process, heparin binding and cysteine-type endopeptidase activity in the molecular function, and extracellular space and plasma membrane in the cellular component. Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that these DEGs were mainly involved in the <em>Staphylococcus aureus</em> infection, mineral absorption, phagosome, asthma and influenza A. The interaction network analysis indicated that 10 hub genes, including <em>MT1H</em>, <em>MT1G</em>, <em>MT1X</em>, <em>MT1M</em>, <em>LOX</em>, <em>P4HA1</em>, <em>EGLN3</em>, <em>FMOD</em>, <em>SLC2A1</em>, and <em>COMP</em>, which are functionally involved in oxidative stress response and extracellular matrix organization. The quantitative real-time polymerase chain reaction data verified that <em>MT1H</em>, <em>MT1G</em>, <em>MT1X</em>, <em>MT1M</em>, <em>LOX</em>, <em>EGLN3</em>, <em>FMOD</em>, and <em>COMP</em> were consistent with the microarray results.</div></div><div><h3>Conclusions</h3><div>This study preliminarily identified different gene expression patterns between diabetes and nondiabetes patients with RCT. Bioinformatic analyses suggested several altered molecular processes, including oxidative stress response and extracellular matrix organization, may contribute to tendon degeneration and impaired healing in diabetes patients. However, further studies are required to provide direct biological evidence for these associations.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages e479-e489"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a first time anterior shoulder dislocation: the decision-making process of a surgeon","authors":"Liselore Quintens MD ,&nbsp;Filip Verhaegen MD, PhD ,&nbsp;Philippe Debeer MD, PhD","doi":"10.1016/j.jse.2025.07.018","DOIUrl":"10.1016/j.jse.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Management of a first-time anterior shoulder dislocation in young and active patients remains a topic of ongoing debate. This study aims to use choice-based conjoint analysis to identify the factors influencing a surgeon’s decision-making process and explore potential heterogeneity in the identified decision patterns.</div></div><div><h3>Methods</h3><div>A discrete choice experiment was conducted among all 94 members of the Belgian Elbow and Shoulder Society. Surgeons completed 15 choice tasks, each involving 3 instability cases, and were asked to select the most appropriate indication for surgery. Each case included 6 patient characteristics: gender, age, type and level of sports played, glenoid bone loss, and presence/absence of a Hill-Sachs lesion. The relative importance of each characteristic was quantified using two-level Bayesian hierarchical modeling. Latent class analysis was employed to assess heterogeneity in choice patterns. Subgroup analyses examined how experience and subspecialty of a surgeon influenced their decision-making. Two-way interactions were tested using the Chi-squared test.</div></div><div><h3>Results</h3><div>Fifty-five surgeons completed the survey. Of these, 31% had less than 5 years of experience, 38% had 5-20 years of experience, and 31% had more than 20 years of experience. All respondents regularly treated shoulder pathologies, with the majority managing a diverse patient population, including both sports-related and degenerative lesions. Only 27% primarily treated degenerative lesions. Glenoid bone loss had the highest relative importance on decision-making (24.6%), followed by the type of sports played (22.1%) and the presence of a Hill-Sachs lesion (21.2%). Heterogeneity in decision patterns was primarily attributed to differing views on the importance of off-track Hill-Sachs lesions. Subgroup analysis revealed that younger surgeons were more likely to prioritize the glenoid track concept in their decision-making. Additionally, an interaction between glenoid bone loss and Hill-Sachs lesions resulted in a 118% increase in effect among younger surgeons. The surgeon’s focus on sports pathology in their practice did not significantly affect their decision-making process.</div></div><div><h3>Conclusions</h3><div>Our findings highlight the significant role of bony lesions, including glenoid bone loss and Hill-Sachs lesions, in shaping surgical treatment decisions. Younger surgeons are more likely to incorporate the glenoid track concept into their decision-making compared to their older counterparts. However, most surgeons adopt a comprehensive approach, considering not only bony pathology but also the type and level of sports played, as well as the patient’s age. This reflects a growing trend toward individualized treatment strategies for first-time anterior shoulder dislocations, tailored to the specific clinical and functional needs of the patient.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 786-797"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rates and implications of prior authorizations for advanced shoulder imaging","authors":"Haley N. Tornberg MD ,&nbsp;Aine M. Gallahue MD, MEng ,&nbsp;Alison M. Blumstein BS ,&nbsp;Mohammasadegh Mikaeili PhD ,&nbsp;Hajar Sakai MS ,&nbsp;Joshua Bosire MS ,&nbsp;Catherine J. Fedorka MD","doi":"10.1016/j.jse.2025.07.003","DOIUrl":"10.1016/j.jse.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder pain is common across all ages and socioeconomic groups. Magnetic resonance imaging (MRI) is vital for diagnosing shoulder pathology, but prior authorizations (PAs) create significant barriers to access. Initially implemented by insurers to control costs, PAs increase administrative burdens on providers, leading to higher costs and delays. While the negative effects of PAs on patient care are documented, their specific impact on shoulder MRI access remains unclear. This study examines trends in PAs for shoulder MRIs and explores associations between PA denials and insurance type, patient demographics, diagnosis, or provider type.</div></div><div><h3>Methods</h3><div>Shoulder MRIs ordered at our institution between December 2021 and September 2023 that required a PA were retrospectively reviewed. Demographics, ordering diagnosis, provider specialty, insurance carrier, insurance type, and third-party authorizing company were collected. Chi-square test and logistic regression analysis using odds ratios were conducted to analyze the relationship between the independent variables and likelihood of PA denial.</div></div><div><h3>Results</h3><div>Of the 3,532 shoulder MRIs that were ordered, 3,191 (90.1%) required PA. After applying exclusion criteria, 2,499 patients were included, of which 5.8% were denied. Orthopedic surgeons ordered 75.7% of the MRIs, while orders by other providers were 4.38 times more likely to be denied (<em>P</em> = .00). African American patients were 1.62 times more likely to face denials compared to White patients (<em>P</em> = .03), with Hispanic patients also experiencing higher denial rates (<em>P</em> = .05). MRI orders were more likely to be denied by commercial insurance, followed by Medicaid plans, and then managed Medicare plans compared to Medicare D plans (<em>P</em> = .01, .02, and .02). There was a statistically significant difference in denial rates between the 4 different third-party authorization (TPA) companies (<em>P</em> &lt; .001) and 9 different primary payors (<em>P</em> &lt; .001).</div></div><div><h3>Discussion and Conclusion</h3><div>The results of this study suggest that multiple factors impact MRI denial rates, including race, provider specialty, TPA service, insurance plan, coverage type, and primary payor. Notably, denial rates were more dependent on insurance carriers or TPA companies than on insurance type (eg, Medicaid vs. commercial). Across the board, certain payors make access to care more difficult, regardless of plan type, tier, or category. Our findings question the utility of PAs for shoulder imaging, with only 5.8% of the PAs resulting in a denial. PAs can delay intervention and place additional cost and time burdens on the health-care system at large.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 864-871"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical guideline on the open arthrolysis for post-traumatic elbow stiffness in adult patients","authors":"Ziyang Sun MD ,&nbsp;Juehong Li PhD, MD ,&nbsp;Roger van Riet PhD, MD ,&nbsp;Pak-Cheong Ho PhD, MD ,&nbsp;Kevin A. Hildebrand PhD, MD ,&nbsp;Ken Lee Puah MD ,&nbsp;Jui-Tien Shih MD ,&nbsp;Zhongyu Li MD ,&nbsp;Cholawish Chanlalit MD ,&nbsp;Aashay L. Kekatpure MD ,&nbsp;Kun Zhang MD ,&nbsp;Shen Liu MD ,&nbsp;Maoqi Gong MD ,&nbsp;Fuguo Huang MD ,&nbsp;Hede Yan PhD, MD ,&nbsp;Jingyi Mi PhD, MD ,&nbsp;Jiuzhou Lu PhD, MD ,&nbsp;Yejun Zha MD ,&nbsp;Zhou Xiang MD ,&nbsp;Ming Xiang MD ,&nbsp;Cunyi Fan PhD, MD","doi":"10.1016/j.jse.2025.07.015","DOIUrl":"10.1016/j.jse.2025.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic elbow stiffness poses significant clinical challenges for upper limb surgeons and severely impairs patients’ ability to perform essential daily activities, including eating, dressing, and personal hygiene, thereby imposing substantial socioeconomic burdens. Open arthrolysis is widely employed when conservative therapies fail, yet current literatures demonstrate considerable heterogeneity in treatment concepts, surgical techniques, and perioperative management. This evidence-based clinical practice guideline aims to standardize treatment profiles and improve surgical outcomes for open arthrolysis of post-traumatic elbow stiffness in adult patients globally.</div></div><div><h3>Methods</h3><div>The Chinese National Center for Orthopaedics (Shanghai and Beijing, China) and Asan Medical Center (Seoul, Korea) initiate, sponsor, and organize a collaboration among worldwide experts in the field of elbow to develop this guideline, adhering to the Reporting Items for Practice Guidelines in Healthcare. Evidence searches focus on meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control studies, and case series studies. The Grading of Recommendations Assessment, Development and Evaluation system and Delphi method process are used to assess the level of evidence and strength of recommendations.</div></div><div><h3>Results</h3><div>Finally, a total of 28 evidence-based recommendations for open arthrolysis in adult post-traumatic elbow stiffness are formulated in response to 13 most concerned important clinical questions. On the whole, recommendations span 4 domains: (1) Indications/Timing; Q1-Q2, 2 recommendations; (2) Surgical Techniques; Q3-Q8, 15 recommendations; (3) Perioperative Care; Q9-Q11, 8 recommendations; and (4) Complication Prevention; Q12-Q13, 3 recommendations.</div></div><div><h3>Conclusion</h3><div>This multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult post-traumatic elbow stiffness. The recommendations provided herein are grounded in a comprehensive review of existing literatures, and they establish actionable standards for preoperative decision-making, intraoperative techniques, and postoperative care, ultimately hoping to enhance patients’ functional recovery and quality of life.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 811-825"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do patients benefit from a home exercise program with or without functional electromyostimulation initiated 1 year after reverse shoulder arthroplasty? A prospective randomized controlled trial","authors":"Thomas Wittmann MD ,&nbsp;Sandra Krawczyk MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Patric Raiss MD","doi":"10.1016/j.jse.2025.07.005","DOIUrl":"10.1016/j.jse.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative rehabilitation of deltoid function is crucial for optimizing outcomes after reverse shoulder arthroplasty (rTSA). Prior studies have shown that the maximal functional gains after rTSA occur 1 year after surgery. Adjunct therapies such as functional electromyostimulation (FES) may enhance muscle activation and improve shoulder function after the previous reported plateau time point. The aim of this study was to investigate the efficacy of therapy with FES augmentation for rTSA patients initiated 1 year after surgery. We hypothesized that FES yield superior improvements in Constant Score compared to a control group treated without FES.</div></div><div><h3>Materials and Methods</h3><div>Thirty four patients who underwent rTSA (Ascend Flex, Stryker Inc.) in one specialized shoulder center with a minimum follow-up of one year were included in this prospective, randomized controlled study and randomly assigned equally to the intervention or control group. A 6-week home exercise program using FES with progressive exercises aimed at enhancing shoulder mobility and deltoid strength was used in both groups. However, the FES device was only activated in the intervention group. Shoulder function was assessed pre- and postrehabilitation with the Constant Score, Subjective Shoulder Value, deltoid strength, abduction range of motion (ROM) and flexion ROM by clinical examination and automated measurement using ShowMotion software. This trial was conducted and reported in accordance with the CONSORT guidelines.</div></div><div><h3>Results</h3><div>Thirty-four patients were randomized into the intervention group (n = 17) and control group (n = 17) with similar demographics and baseline shoulder function (<em>P</em> &gt; .05). A total of n = 28 patient completed the study protocol (n = 14 intervention group; n = 14 control group). Significant improvements in Constant Score (65.7 to 79.5, <em>P</em> &lt; .001), Subjective Shoulder Value (from 70.1% to 91.1%, <em>P</em> &lt; .001), and abduction ROM (from 106° to 120°, <em>P</em> = .041) were observed in the intervention group. However, the control group showed no significant changes compared to baseline (<em>P</em> &gt; .104). Patients treated with FES achieved a significantly higher mean Constant Score (Control: 65.7 ± 13.2 Points vs Intervention: 79.5 ± 7.9 points, <em>P</em> = .003) and abduction ROM (Control: 94 ± 30° vs Intervention: 121 ± 32°; <em>P</em> = .038) compared to the control group. No significant differences were found in strength and flexion ROM.</div></div><div><h3>Conclusion</h3><div>Self-directed functional FES improves rTSA function when initiated one year after primary surgery. FES may be a beneficial adjuvant to rTSA rehabilitation due to its low adverse event rate and its availability for home-based training. Further research is needed to examine if the results remain advantageous at mid-to-long-term follow-up.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 899-906"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography for preoperative shoulder arthroplasty planning: lifetime malignancy risk","authors":"Westin Mace MS ,&nbsp;Amritpal S. Randhawa BS ,&nbsp;Shannon Tse BMBS ,&nbsp;Cassandra A. Lee MD ,&nbsp;Christopher O. Bayne MD ,&nbsp;Ryan D. Freshman MD ,&nbsp;Mariano E. Menendez MD","doi":"10.1016/j.jse.2025.07.024","DOIUrl":"10.1016/j.jse.2025.07.024","url":null,"abstract":"<div><h3>Background</h3><div>Computed tomography (CT) is routinely used for preoperative planning in shoulder arthroplasty. However, this practice exposes patients to ionizing radiation. This study evaluates the potential lifetime cancer risks of conventional and low-dose shoulder CT protocols.</div></div><div><h3>Methods</h3><div>Effective dose, a metric accounting for absorbed radiation, organ sensitivity, and radiation type, was used to evaluate conventional (8.0 mSv) and low-dose (1.4 mSv) shoulder CT protocols. Effective dose was determined using institutional records and literature. The Biological Effects of Ionizing Radiation VII report was used to calculate lifetime attributable risk (LAR) of cancer and number needed to harm (NNH) based on age and sex.</div></div><div><h3>Results</h3><div>The LAR of malignancy for a shoulder CT of a 50-year-old man was 0.0405% (NNH = 2,472) and 0.0071% (NNH = 14,124) for conventional and low-dose protocols, respectively. By age 80 in men, the NNH was 5,640 and 32,237 for conventional and low-dose protocols, respectively. The LAR of malignancy for a shoulder CT of a 50-year-old woman was 0.0541% (NNH = 1,849) and 0.0095% (NNH = 10,567) for conventional and low-dose protocols, respectively. By age 80 in women, NNH was 5,128 and 29,308 for conventional and low-dose protocols, respectively. There was a positive relationship between patient age and NNH.</div></div><div><h3>Conclusion</h3><div>The current reliance on preoperative shoulder CT for arthroplasty planning needs to be weighed against the potential lifetime cancer risks, especially among younger women. Risk-reduction strategies such as the widespread adoption of low-dose CT protocols should be considered.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 683-688"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative surgical screening clinics provide a safe alternative to primary care physician screening prior to total shoulder arthroplasty","authors":"Zachary T. Grace MD ,&nbsp;Jake Laverdiere BS ,&nbsp;Robert Carrier DO ,&nbsp;Alexander J. Rondon MD ,&nbsp;Matthew J. Grosso MD","doi":"10.1016/j.jse.2025.07.011","DOIUrl":"10.1016/j.jse.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative medical evaluation prior to total shoulder arthroplasty (TSA) allows for the mitigation of risk factors to optimize surgical outcomes. Dedicated preoperative surgical clearance clinics, through streamlined protocols and interdisciplinary management, may allow for increased optimization prior to TSA. This study compares 90-day surgical complication and cancellation rates between TSA patients who received a preoperative evaluation from a primary care physician (PCP) and those who received a preoperative evaluation from a Pre-Assessment Surgical Screening (PASS) clinic.</div></div><div><h3>Methods</h3><div>A retrospective review of a single-center acute care hospital was conducted for patients who underwent TSA between 2017 through 2024. Variables of interest included patient demographic information, medical comorbidities, surgical cancellation rate, and 90-day complications. Outcomes were compared between patients who underwent PCP vs. PASS preoperative clearance using univariate and logistic regression analyses.</div></div><div><h3>Results</h3><div>1,319 patients met inclusion criteria that comprised 696 (52.8%) and 606 (45.9%) patients evaluated preoperatively by a PCP and PASS clinic, respectively. Comparing PCP and PASS preoperative clinical pathways, there were no differences in patient demographics, medical comorbidities, surgical cancellations, or 90-day complication rates including prosthetic joint infection. In addition, there were no differences in the previous variables of interest among a subgroup analysis between anatomic and reverse TSA patients.</div></div><div><h3>Discussion</h3><div>We saw no differences in 90-day complications between preoperative evaluation from a PCP and a specialized screening clinic. Preoperative clinics may provide a safe, multidisciplinary, and streamlined approach for preoperative TSA patients, especially those who face challenges when scheduling an appointment with a PCP. However, the decision to receive preoperative evaluation for TSA from a PCP or a preoperative clinic may be influenced more by patient preference and convenience than by differences in clinical outcomes.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 697-703"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical evaluation of rTSA baseplate designs: implant stability with and without glenoid bone loss","authors":"Miguel A. Diaz MS ,&nbsp;Mitch Daniel BS ,&nbsp;Pablo Sanchez-Urgelles MD ,&nbsp;Mark A. Frankle MD","doi":"10.1016/j.jse.2025.07.009","DOIUrl":"10.1016/j.jse.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Baseplate fixation is a crucial step in reverse shoulder arthroplasty and presents a challenge when faced with deformities or glenoid bone loss. Utilization of newer baseplates that are augmented to account for bone loss may provide equivalent stability to standard baseplates without bone loss. The purpose of this biomechanical study was to compare modern designs by evaluating 3 baseplates: (1) a one-piece monoblock design (RSP), (2) a two-piece nonlocking baseplate (neutral) without bone loss and (3) a two-piece nonlocking design with a wedge augment (wedge) with asymmetric bone loss.</div></div><div><h3>Methods</h3><div>Polyurethane foam block cylinders (n = 6 per group) with a density of 0.48 g/cm³ were utilized. The 6 foam cylinders for the wedge baseplate were modified to stimulate 50% bone loss and the remaining 12 were left without modification, representing zero bone loss. Samples were mounted into a swing arm attached to the torque motor of a servo-electric test frame equipped with a 5 kN load cell. Samples were cycled through a 55° (from neutral, ±27.5°) arc of motion at 0.5 Hz for 10,000 cycles, while the test frame's actuator applied a constant 750 N compressive. Micromotion (μm) was measured throughout testing.</div></div><div><h3>Results</h3><div>All samples survived 10,000 cycles of loading without catastrophic failure. None of the constructs exhibited micromotion above the 150 μm threshold. The baseplate micromotions at baseline were observed to be significantly different from one another (<em>P</em> = .001). After 10,000 cycles of loading, similar outcomes were observed where the Neutral had the lowest measured baseplate micromotion compared to RSP and the Wedge. The Wedge baseplate had significantly more micromotion compared to the RSP (<em>P</em> = .0167).</div></div><div><h3>Conclusion</h3><div>The neutral design was found to be the most stable, followed by the RSP and then the wedge design. All designs evaluated remained below the 150-micron threshold. The two-piece nonlocking wedge baseplate design is a viable option for reverse shoulder arthroplasty when dealing with bone loss.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 841-848"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}