{"title":"Corrigendum to ‘Glenohumeral bone lesions occurring during the first episode of shoulder dislocation do not influence function at an average of 2 years’ [Journal of Shoulder and Elbow Surgery, Volume 34, Issue 6 (2025) 1417-1425]","authors":"Cynthia Abane MD , Pierre-Sylvain Marcheix MD, PhD , Ludovic Labattut MD , Damien Delgrandre MD , Maxime Antoni MD , Franck Dordain MD , Anselme Billaud MD , Geoffroy Nourissat MD, PhD , SOFEC, Guillaume Villatte MD, PhD","doi":"10.1016/j.jse.2025.09.001","DOIUrl":"10.1016/j.jse.2025.09.001","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Page e521"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349573","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}
The posterior interosseous nerve (PIN) is at significant risk during proximal radius exposure. This study investigates the risk of PIN traction injury by comparing PIN strain between the Kocher and Kaplan approaches during simulated plate fixation of radial head fractures using upper limb cadaveric models.
Methods
Fourteen fresh-frozen upper extremity specimens were dissected with Kaplan (n = 7) and Kocher (n = 7) approaches, and the PIN was exposed at the anterior elbow with a separate incision. A Microminiature Displacement sensor (M-DVRT-9; LORD MicroStrain, Williston, VT) was positioned on the PIN at its origin from the radial nerve and just proximal to the supinator muscle. PIN displacement was recorded, and PIN length (distance between 2 sensors) was measured using a vernier caliper. PIN strain (%) was calculated by dividing the excursion of the PIN by its length. Strains were compared between the Kaplan and Kocher approaches in neutral, supination, and pronation at 90° elbow flexion. Both standard and extensile versions were tested under scenarios with and without lateral ulnar collateral ligament (LUCL) insufficiency, employing a custom K-wire jig to standardize traction forces.
Results
The standard and extensile Kaplan approaches exhibited significantly higher strains compared to the Kocher approach. The standard Kaplan approach resulted in median PIN strains of 3.87% in neutral, 4.51% in supination, and 4.41% in pronation—markedly higher than the Kocher approach, which maintained strains below 0.1% in all conditions. Strain values nearly doubled with the extensile Kaplan approach, although the increase was not statistically significant. When LUCL insufficiency was combined with the extensile Kaplan approach, significant variability in PIN strain was observed, with levels ranging from 0.01% to 46.80%. One specimen exhibited particularly high strain values of 39.04% in neutral, 46.80% in supination, and 33.62% in pronation. No significant difference in nerve strain was observed between forearm positions within any approach.
Conclusion
The Kaplan approach significantly increases PIN strain during exposure for internal fixation of radial head and neck fractures, thereby highlighting the potential risk of PIN traction injuries. In contrast, the Kocher approach is more effective in minimizing PIN traction injury. Even when utilizing an extensile approach to improve exposure, the strain on the PIN remains minimal. Caution is advised when using the Kaplan approach, particularly in cases of gross elbow instability, as dislocation of the radial head or deficiency of the LUCL can increase the risk of PIN injury from excessive traction.
{"title":"Comparative evaluation of posterior interosseous nerve strain in lateral approach to radial head fixation: a cadaveric study","authors":"Kittipich Sangkamard MD , Roongsak Limthongthang MD , Panai Laohaprasitiporn MD , Torpon Vathana MD , Yuwarat Monteerarat MD, PhD","doi":"10.1016/j.jse.2025.06.028","DOIUrl":"10.1016/j.jse.2025.06.028","url":null,"abstract":"<div><h3>Background</h3><div>The posterior interosseous nerve (PIN) is at significant risk during proximal radius exposure. This study investigates the risk of PIN traction injury by comparing PIN strain between the Kocher and Kaplan approaches during simulated plate fixation of radial head fractures using upper limb cadaveric models.</div></div><div><h3>Methods</h3><div>Fourteen fresh-frozen upper extremity specimens were dissected with Kaplan (n = 7) and Kocher (n = 7) approaches, and the PIN was exposed at the anterior elbow with a separate incision. A Microminiature Displacement sensor (M-DVRT-9; LORD MicroStrain, Williston, VT) was positioned on the PIN at its origin from the radial nerve and just proximal to the supinator muscle. PIN displacement was recorded, and PIN length (distance between 2 sensors) was measured using a vernier caliper. PIN strain (%) was calculated by dividing the excursion of the PIN by its length. Strains were compared between the Kaplan and Kocher approaches in neutral, supination, and pronation at 90° elbow flexion. Both standard and extensile versions were tested under scenarios with and without lateral ulnar collateral ligament (LUCL) insufficiency, employing a custom K-wire jig to standardize traction forces.</div></div><div><h3>Results</h3><div>The standard and extensile Kaplan approaches exhibited significantly higher strains compared to the Kocher approach. The standard Kaplan approach resulted in median PIN strains of 3.87% in neutral, 4.51% in supination, and 4.41% in pronation—markedly higher than the Kocher approach, which maintained strains below 0.1% in all conditions. Strain values nearly doubled with the extensile Kaplan approach, although the increase was not statistically significant. When LUCL insufficiency was combined with the extensile Kaplan approach, significant variability in PIN strain was observed, with levels ranging from 0.01% to 46.80%. One specimen exhibited particularly high strain values of 39.04% in neutral, 46.80% in supination, and 33.62% in pronation. No significant difference in nerve strain was observed between forearm positions within any approach.</div></div><div><h3>Conclusion</h3><div>The Kaplan approach significantly increases PIN strain during exposure for internal fixation of radial head and neck fractures, thereby highlighting the potential risk of PIN traction injuries. In contrast, the Kocher approach is more effective in minimizing PIN traction injury. Even when utilizing an extensile approach to improve exposure, the strain on the PIN remains minimal. Caution is advised when using the Kaplan approach, particularly in cases of gross elbow instability, as dislocation of the radial head or deficiency of the LUCL can increase the risk of PIN injury from excessive traction.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages e505-e512"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862633","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}
Pub Date : 2026-02-26DOI: 10.1016/j.jse.2026.02.015
Declan R Diestel, Suleiman Sudah, Nick Veale, Regan Arnold, Jason Corban, Jacob M Kirsch, Adam Bowler, Evan A Glass, Shannon E Gray, Miranda McDonald-Stahl, Calista S Stevens, Richard Puzzitiello, Michael A Moverman, Kiet Le, Warren Dunn, Andrew Jawa
<p><strong>Hypothesis and background: </strong>Return to sport (RTS) and sport-specific performance following shoulder arthroplasty are not well-characterized, particularly in strength-based activities such as weightlifting. This study evaluates return-to-weightlifting rates, exercise-specific performance, and patient-reported outcomes following reverse shoulder arthroplasty (rTSA) and anatomic shoulder arthroplasty (aTSA).</p><p><strong>Methods: </strong>We conducted a multicenter analysis of patients from 24 American Shoulder Elbow Society (ASES) surgeons across 17 institutions who underwent rTSA or aTSA and completed sport-specific RTS questionnaires. Study parameters were defined by the Delphi method, requiring 75% agreement for consensus. Data collected included pre- and postoperative participation, timing of return, and patient-reported outcomes on performance, frequency, enjoyment, and satisfaction relative to preoperative status. Specific weightlifting abilities (bench press, bicep curl, overhead press, deltoid raise, and pushups) were assessed. Subgroup analyses included age- and sex-matched comparisons of rTSA and aTSA for glenohumeral osteoarthritis (GHOA), and rTSA for GHOA vs rotator cuff arthropathy (RCA). Statistical analyses included t-tests, chi-square or Fisher's exact test, and multivariable logistic regression. Statistical significance was set at P < 0.05.</p><p><strong>Results: </strong>Among 175 weightlifters (mean follow-up of 23.3 ± 7.6 months), 93.1% returned to weightlifting and 79.4% reported maintained or improved performance. Most returned by 3-6 months (39.3%), with an additional 29.5% returning by 7-12 months. Propensity-matched analysis of 54 rTSA patients and 54 aTSA patients for GHOA found similar return rates (rTSA: 98.1% vs. aTSA: 96.3%, P > 0.999) and likelihood of improved or maintained performance (rTSA: 90.7% vs. aTSA: 79.6%, P = 0.176). However, rTSA patients were more likely to maintain or increase weightlifting frequency (90.7% vs. 72.2%, P = 0.026) and had higher improvement in deltoid raise ability (82.6% vs. 50.0%, P = 0.020). No significant differences were found in bench press, overhead press, biceps curls, or pushups. Within the rTSA cohort, GHOA patients reported greater postoperative enjoyment (95.6% vs 76.0%, p = 0.021) and percent who improved or maintained frequency (86.7% vs 60.0%, p = 0.025) compared to RCA patients. Multivariate regression found no significant predictors of worse postoperative performance (all P > 0.05).</p><p><strong>Conclusion: </strong>Most patients resume weightlifting after shoulder arthroplasty, often maintaining or improving performance. Although outcomes are comparable by arthroplasty type, rTSA may afford better deltoid function and increased participation frequency. Additionally, preoperative diagnosis appears to influence enjoyment and engagement following rTSA, despite similar improvements across specific exercises. These findings highlight the complex nature of
假设和背景：肩关节置换术后的运动恢复（RTS）和运动特异性表现并没有很好的特征，特别是在举重等力量活动中。本研究评估了逆行肩关节置换术（rTSA）和解剖肩关节置换术（aTSA）后的恢复举重率、运动特异性表现和患者报告的结果。方法：我们对来自17个机构的24名美国肩肘协会（ASES）外科医生的患者进行了多中心分析，这些患者接受了rTSA或aTSA，并完成了运动特异性RTS问卷。研究参数采用德尔菲法确定，一致性要求达到75%。收集的数据包括术前和术后参与情况、返回时间、患者报告的表现、频率、享受和相对于术前状态的满意度。具体的举重能力（卧推、二头肌弯曲、头顶按压、三角肌抬高和俯卧撑）被评估。亚组分析包括rTSA和aTSA治疗肩关节骨关节炎（GHOA）的年龄和性别匹配比较，以及rTSA治疗肩关节骨关节炎（GHOA）与肩袖关节病（RCA）的比较。统计分析包括t检验、卡方检验或Fisher精确检验和多变量逻辑回归。差异有统计学意义，P < 0.05。结果：175名举重运动员（平均随访23.3±7.6个月）中，93.1%恢复举重，79.4%保持或改善举重成绩。大多数人在3-6个月后返回（39.3%），另有29.5%的人在7-12个月后返回。对54例rTSA患者和54例aTSA患者的GHOA进行倾向匹配分析，发现相似的治愈率（rTSA: 98.1% vs. aTSA: 96.3%, P = 0.999）和改善或维持表现的可能性（rTSA: 90.7% vs. aTSA: 79.6%, P = 0.176）。然而，rTSA患者更有可能维持或增加举重频率（90.7%比72.2%,P = 0.026），三角肌提升能力改善更高（82.6%比50.0%,P = 0.020）。在卧推、顶推、二头肌卷曲或俯卧撑中没有发现显著差异。在rTSA队列中，与RCA患者相比，GHOA患者报告了更高的术后享受（95.6%对76.0%,p = 0.021），并且有百分之九十的患者改善或维持了频率（86.7%对60.0%,p = 0.025）。多因素回归分析未发现术后表现较差的显著预测因素（均P < 0.05）。结论：大多数患者在肩关节置换术后恢复举重，通常能维持或提高举重能力。虽然不同关节置换类型的结果是相似的，但rTSA可以提供更好的三角肌功能和更高的参与频率。此外，术前诊断似乎影响rTSA后的享受和参与，尽管在特定练习中有类似的改善。这些发现突出了康复的复杂性和个性化术前咨询的价值。
{"title":"Return to Weightlifting After Shoulder Arthroplasty: An ASES Multicenter Study Predicting Performance after Reverse Shoulder Arthroplasty (rTSA) and Anatomic Shoulder Arthroplasty (aTSA).","authors":"Declan R Diestel, Suleiman Sudah, Nick Veale, Regan Arnold, Jason Corban, Jacob M Kirsch, Adam Bowler, Evan A Glass, Shannon E Gray, Miranda McDonald-Stahl, Calista S Stevens, Richard Puzzitiello, Michael A Moverman, Kiet Le, Warren Dunn, Andrew Jawa","doi":"10.1016/j.jse.2026.02.015","DOIUrl":"10.1016/j.jse.2026.02.015","url":null,"abstract":"<p><strong>Hypothesis and background: </strong>Return to sport (RTS) and sport-specific performance following shoulder arthroplasty are not well-characterized, particularly in strength-based activities such as weightlifting. This study evaluates return-to-weightlifting rates, exercise-specific performance, and patient-reported outcomes following reverse shoulder arthroplasty (rTSA) and anatomic shoulder arthroplasty (aTSA).</p><p><strong>Methods: </strong>We conducted a multicenter analysis of patients from 24 American Shoulder Elbow Society (ASES) surgeons across 17 institutions who underwent rTSA or aTSA and completed sport-specific RTS questionnaires. Study parameters were defined by the Delphi method, requiring 75% agreement for consensus. Data collected included pre- and postoperative participation, timing of return, and patient-reported outcomes on performance, frequency, enjoyment, and satisfaction relative to preoperative status. Specific weightlifting abilities (bench press, bicep curl, overhead press, deltoid raise, and pushups) were assessed. Subgroup analyses included age- and sex-matched comparisons of rTSA and aTSA for glenohumeral osteoarthritis (GHOA), and rTSA for GHOA vs rotator cuff arthropathy (RCA). Statistical analyses included t-tests, chi-square or Fisher's exact test, and multivariable logistic regression. Statistical significance was set at P < 0.05.</p><p><strong>Results: </strong>Among 175 weightlifters (mean follow-up of 23.3 ± 7.6 months), 93.1% returned to weightlifting and 79.4% reported maintained or improved performance. Most returned by 3-6 months (39.3%), with an additional 29.5% returning by 7-12 months. Propensity-matched analysis of 54 rTSA patients and 54 aTSA patients for GHOA found similar return rates (rTSA: 98.1% vs. aTSA: 96.3%, P > 0.999) and likelihood of improved or maintained performance (rTSA: 90.7% vs. aTSA: 79.6%, P = 0.176). However, rTSA patients were more likely to maintain or increase weightlifting frequency (90.7% vs. 72.2%, P = 0.026) and had higher improvement in deltoid raise ability (82.6% vs. 50.0%, P = 0.020). No significant differences were found in bench press, overhead press, biceps curls, or pushups. Within the rTSA cohort, GHOA patients reported greater postoperative enjoyment (95.6% vs 76.0%, p = 0.021) and percent who improved or maintained frequency (86.7% vs 60.0%, p = 0.025) compared to RCA patients. Multivariate regression found no significant predictors of worse postoperative performance (all P > 0.05).</p><p><strong>Conclusion: </strong>Most patients resume weightlifting after shoulder arthroplasty, often maintaining or improving performance. Although outcomes are comparable by arthroplasty type, rTSA may afford better deltoid function and increased participation frequency. Additionally, preoperative diagnosis appears to influence enjoyment and engagement following rTSA, despite similar improvements across specific exercises. These findings highlight the complex nature of","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322291","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}
Pub Date : 2026-02-25DOI: 10.1016/j.jse.2026.02.013
Samuel W Rice, Michael G Flood, Gregory Iovanel, Harlene Kaur, Samhitha Satish Kumar, Saoirse Connolly, John McDonald, Matthew DeFazio, Scott Pascal, Lydia Parzych, Christine Decker Bub
<p><strong>Hypothesis/background: </strong>Distal humerus fractures (DHFs) in older adults can have significant clinical consequences. Prior mortality estimates are broad and confounded by concomitant injuries. The purpose of this study was to characterize 1- and 2-year mortality after isolated DHFs in older adults and identify predictors of survival, including comorbidity burden, operative status, and preinjury ambulation ability. We hypothesized that mortality would parallel that of other upper extremity fractures and be primarily influenced by baseline health and functional independence.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a Level I trauma center. Patients aged ≥55 years with OTA/AO 13A, 13B, or 13C DHFs from 2017-2024 were included for analysis.</p><p><strong>Exclusions: </strong>periprosthetic and pathologic fractures, non-index presentation, and all concomitant upper and lower-extremity or clinically significant spinal fractures. Demographics, comorbidities, baseline ambulation status, fracture characteristics, and treatment method were collected. Mortality at 1 and 2 years was assessed with Kaplan-Meier methods. Cox proportional hazards regression models adjusted for Charlson Comorbidity Index (CCI). Fragility index (FI) and fragility quotient (FQ) were calculated for operative status and ambulation comparisons.</p><p><strong>Results: </strong>Eighty-two patients met inclusion criteria. Kaplan-Meier-adjusted mortality was 13.4% at 1 year and 19.5% at 2 years. Patients who underwent operative intervention had lower 2-year mortality than nonoperative patients (9.3% vs 30.8%), but operative status was not independently associated with mortality after CCI adjustment. Preinjury ambulation ability was strongly associated with survival. Community ambulators had significantly lower mortality at 1 year (2.2% vs 27.0%) and 2 years (4.4% vs 32.4%) compared with non-community ambulators, and ambulation remained protective in adjusted models. CCI independently predicted mortality across all analyses. Fragility analysis showed operative versus nonoperative outcomes were statistically fragile (FI 1), while preinjury ambulation status was robust (FI 4-7).</p><p><strong>Discussion/conclusion: </strong>In older adults with isolated distal humerus fractures, mortality at 1 and 2 years is substantial. Comorbidity burden and preinjury ambulation are strong predictors of mortality. Operative treatment was not independently associated with mortality and likely reflects surgeon selection bias for healthier patients. Ambulation status remaining significant on adjusted models highlights that it captures aspects of physiologic reserve not reflected in CCI. Incorporating ambulation status into treatment planning may improve risk stratification and counseling. Further prospective studies could determine whether operative intervention mitigates the physiologic consequences of immobilization in functionally dependent patients.</p
假设/背景：老年人肱骨远端骨折（dhf）可能具有显著的临床后果。先前的死亡率估计是广泛的，并混淆了伴随伤害。本研究的目的是描述老年人孤立dhf后1年和2年的死亡率，并确定生存的预测因素，包括合并症负担、手术状态和伤前行走能力。我们假设死亡率与其他上肢骨折相似，主要受基线健康和功能独立性的影响。方法：我们在一家一级创伤中心进行回顾性队列研究。2017-2024年年龄≥55岁的OTA/AO 13A、13B或13C dhf患者纳入分析。排除：假体周围和病理性骨折，非指数表现，以及所有伴随的上肢和下肢或临床显著的脊柱骨折。统计数据、合并症、基线活动状况、骨折特征和治疗方法。用Kaplan-Meier方法评估1年和2年的死亡率。Cox比例风险回归模型校正了Charlson共病指数（CCI）。计算脆性指数（FI）和脆性商数（FQ），比较手术状态和走动情况。结果：82例患者符合纳入标准。kaplan - meier调整后1年死亡率为13.4%，2年死亡率为19.5%。接受手术干预的患者2年死亡率低于非手术患者（9.3% vs 30.8%），但CCI调整后手术状态与死亡率无独立相关性。损伤前行走能力与存活率密切相关。与非社区救护车相比，社区救护车的1年死亡率（2.2%对27.0%）和2年死亡率（4.4%对32.4%）显著降低，并且在调整后的模型中，社区救护车仍然具有保护作用。CCI独立预测了所有分析的死亡率。脆弱性分析显示，手术和非手术结果在统计学上是脆弱的（FI 1），而损伤前的活动状态是稳健的（FI 4-7）。讨论/结论：在孤立性肱骨远端骨折的老年人中，1年和2年的死亡率是可观的。合并症负担和伤前活动是死亡率的有力预测因子。手术治疗与死亡率没有独立关联，可能反映了对健康患者的外科医生选择偏差。在调整后的模型中，活动状态仍然显着，这表明它捕获了CCI中未反映的生理储备方面。将活动状况纳入治疗计划可以改善风险分层和咨询。进一步的前瞻性研究可以确定手术干预是否可以减轻功能依赖患者固定的生理后果。
{"title":"Predictors of Mortality After Isolated Distal Humerus Fractures in Older Adults.","authors":"Samuel W Rice, Michael G Flood, Gregory Iovanel, Harlene Kaur, Samhitha Satish Kumar, Saoirse Connolly, John McDonald, Matthew DeFazio, Scott Pascal, Lydia Parzych, Christine Decker Bub","doi":"10.1016/j.jse.2026.02.013","DOIUrl":"https://doi.org/10.1016/j.jse.2026.02.013","url":null,"abstract":"<p><strong>Hypothesis/background: </strong>Distal humerus fractures (DHFs) in older adults can have significant clinical consequences. Prior mortality estimates are broad and confounded by concomitant injuries. The purpose of this study was to characterize 1- and 2-year mortality after isolated DHFs in older adults and identify predictors of survival, including comorbidity burden, operative status, and preinjury ambulation ability. We hypothesized that mortality would parallel that of other upper extremity fractures and be primarily influenced by baseline health and functional independence.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a Level I trauma center. Patients aged ≥55 years with OTA/AO 13A, 13B, or 13C DHFs from 2017-2024 were included for analysis.</p><p><strong>Exclusions: </strong>periprosthetic and pathologic fractures, non-index presentation, and all concomitant upper and lower-extremity or clinically significant spinal fractures. Demographics, comorbidities, baseline ambulation status, fracture characteristics, and treatment method were collected. Mortality at 1 and 2 years was assessed with Kaplan-Meier methods. Cox proportional hazards regression models adjusted for Charlson Comorbidity Index (CCI). Fragility index (FI) and fragility quotient (FQ) were calculated for operative status and ambulation comparisons.</p><p><strong>Results: </strong>Eighty-two patients met inclusion criteria. Kaplan-Meier-adjusted mortality was 13.4% at 1 year and 19.5% at 2 years. Patients who underwent operative intervention had lower 2-year mortality than nonoperative patients (9.3% vs 30.8%), but operative status was not independently associated with mortality after CCI adjustment. Preinjury ambulation ability was strongly associated with survival. Community ambulators had significantly lower mortality at 1 year (2.2% vs 27.0%) and 2 years (4.4% vs 32.4%) compared with non-community ambulators, and ambulation remained protective in adjusted models. CCI independently predicted mortality across all analyses. Fragility analysis showed operative versus nonoperative outcomes were statistically fragile (FI 1), while preinjury ambulation status was robust (FI 4-7).</p><p><strong>Discussion/conclusion: </strong>In older adults with isolated distal humerus fractures, mortality at 1 and 2 years is substantial. Comorbidity burden and preinjury ambulation are strong predictors of mortality. Operative treatment was not independently associated with mortality and likely reflects surgeon selection bias for healthier patients. Ambulation status remaining significant on adjusted models highlights that it captures aspects of physiologic reserve not reflected in CCI. Incorporating ambulation status into treatment planning may improve risk stratification and counseling. Further prospective studies could determine whether operative intervention mitigates the physiologic consequences of immobilization in functionally dependent patients.</p","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318851","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}
Pub Date : 2026-02-25DOI: 10.1016/j.jse.2026.02.018
Quinn Dunivan, Michael Allen, Brian E Caplan, Brian J Cole
<p><strong>Background: </strong>Rotator cuff repair (RCR) is one of the most common orthopedic procedures, yet 20-40% of repairs fail structurally within two years, leading to pain, functional decline, and costly revision surgery. Platelet-rich plasma (PRP) has been proposed to enhance tendon-bone healing, but prior reviews frequently pooled heterogeneous formulations as a homogeneous intervention, producing conflicting conclusions. This review aimed to clarify formulation-specific effects within the PRP literature and, where benefit is observed, examine the biological rationale and practical economic implications for surgical adoption.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed and Embase were searched through July 2025 for comparative clinical studies of intraoperative PRP augmentation during arthroscopic RCR with imaging-confirmed retear outcomes. Risk of bias was assessed using ROB2 (RCTs) and ROBINS-I (nonrandomized studies). Random-effects models (REML; Hartung-Knapp) pooled risk ratios (RRs) for structural failure and, secondarily, mean differences in patient-reported outcomes (PROMs). Prespecified subgroups included PRP formulation, tear size, and follow-up duration; sensitivity analyses excluded high-risk and atypical studies. Publication bias was evaluated with Egger's regression and trim-and-fill. A pragmatic U.S. payer-perspective cost-consequence model estimated revision-related economic impact using pooled absolute risk reduction (ARR), number needed to treat (NNT), amortized per-case PRP setup costs, and reported reoperation rates after RCR.</p><p><strong>Results: </strong>Twenty-one studies (1,279 patients) were synthesized. PRP reduced retear risk with moderate heterogeneity (RR 0.74, 95% CI 0.55-0.99; I<sup>2</sup> ≈ 29%). Across formulations, LP-PRP demonstrated the clearest reduction; inclusion of one critically biased trial increased heterogeneity (I<sup>2</sup> = 53.3%), whereas its exclusion yielded a precise, homogeneous estimate (RR 0.37, 95% CI 0.19-0.73; I<sup>2</sup> = 0%). Benefit was most evident in medium-sized tears (RR 0.68, 95% CI 0.48-0.96). PROMs did not improve consistently. Publication-bias diagnostics suggested small-study effects (Egger p = 0.017); trim-and-fill (k<sub>0</sub> = 8) yielded an exploratory adjusted RR of 0.91 (95% CI 0.69-1.19). Using an ARR of 11.8% (NNT 9) for LP-PRP, economic modeling projected substantial reductions in structural failures, with cost neutrality or net savings achievable under low-cost preparation strategies when scaled by reported revision probabilities.</p><p><strong>Conclusion: </strong>Leukocyte-poor PRP augmentation during arthroscopic RCR is associated with reduced structural retear rates, with the most consistent benefit observed in medium-sized tears and no reliable improvement in PROMs. The economic value of LP-PRP is conditional rather than uniform and depends on revision p
背景：肩袖修复（RCR）是最常见的骨科手术之一，但20-40%的修复在两年内结构性失败，导致疼痛、功能下降和昂贵的翻修手术。富血小板血浆（PRP）已被提出用于促进肌腱-骨愈合，但先前的综述经常将异质制剂作为同质干预，从而产生相互矛盾的结论。本综述旨在澄清PRP文献中配方特异性效应，并在观察到益处的情况下，检查手术采用的生物学原理和实际经济意义。方法：根据PRISMA 2020指南进行系统评价和荟萃分析。PubMed和Embase检索了截至2025年7月的关节镜RCR术中PRP增强与影像学证实的复位结果的比较临床研究。采用ROB2 （rct）和ROBINS-I（非随机研究）评估偏倚风险。随机效应模型（REML; Hartung-Knapp）汇总了结构衰竭的风险比（rr），其次是患者报告结果（PROMs）的平均差异。预先指定的亚组包括PRP配方、泪液大小和随访时间；敏感性分析排除了高风险和非典型研究。采用Egger’s回归和补齐法评价发表偏倚。实用的美国支付者视角的成本-后果模型使用汇总绝对风险降低（ARR）、所需治疗数量（NNT）、平摊每例PRP设置成本和RCR后报告的再手术率来估计修订相关的经济影响。结果：共合成21项研究（1279例患者）。PRP降低了复发风险，具有中等异质性（RR 0.74, 95% CI 0.55-0.99; I2≈29%）。在所有配方中，LP-PRP表现出最明显的减少；纳入一项严重偏倚试验增加了异质性（I2 = 53.3%），而将其排除则产生了精确、均匀的估计（RR 0.37, 95% CI 0.19-0.73; I2 = 0%）。在中等大小的泪液中获益最为明显（RR 0.68, 95% CI 0.48-0.96）。逍遥音乐会并没有持续改善。发表偏倚诊断提示小研究效应（Egger p = 0.017）；修整填充（k0 = 8）的探索性调整RR为0.91 （95% CI 0.69-1.19）。利用LP-PRP的ARR为11.8% (NNT 9)，经济模型预测了结构故障的大幅减少，当按报告的修正概率进行缩放时，在低成本准备策略下可以实现成本中立或净节约。结论：关节镜下RCR期间白细胞缺乏的PRP增强与结构撕裂率降低有关，在中等撕裂中观察到最一致的益处，而在PROMs中没有可靠的改善。LP-PRP的经济价值是有条件的而不是统一的，取决于修改概率和制备成本。当使用低成本制备方法时，LP-PRP可以实现成本中立或适度节约，支持选择性采用作为结构保障而不是症状调节剂。
{"title":"Leukocyte-Poor Platelet-Rich Plasma Reduces Retear Risk After Arthroscopic Rotator Cuff Repair: A Meta-Analysis with Mechanistic and Economic Evaluation.","authors":"Quinn Dunivan, Michael Allen, Brian E Caplan, Brian J Cole","doi":"10.1016/j.jse.2026.02.018","DOIUrl":"https://doi.org/10.1016/j.jse.2026.02.018","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff repair (RCR) is one of the most common orthopedic procedures, yet 20-40% of repairs fail structurally within two years, leading to pain, functional decline, and costly revision surgery. Platelet-rich plasma (PRP) has been proposed to enhance tendon-bone healing, but prior reviews frequently pooled heterogeneous formulations as a homogeneous intervention, producing conflicting conclusions. This review aimed to clarify formulation-specific effects within the PRP literature and, where benefit is observed, examine the biological rationale and practical economic implications for surgical adoption.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed and Embase were searched through July 2025 for comparative clinical studies of intraoperative PRP augmentation during arthroscopic RCR with imaging-confirmed retear outcomes. Risk of bias was assessed using ROB2 (RCTs) and ROBINS-I (nonrandomized studies). Random-effects models (REML; Hartung-Knapp) pooled risk ratios (RRs) for structural failure and, secondarily, mean differences in patient-reported outcomes (PROMs). Prespecified subgroups included PRP formulation, tear size, and follow-up duration; sensitivity analyses excluded high-risk and atypical studies. Publication bias was evaluated with Egger's regression and trim-and-fill. A pragmatic U.S. payer-perspective cost-consequence model estimated revision-related economic impact using pooled absolute risk reduction (ARR), number needed to treat (NNT), amortized per-case PRP setup costs, and reported reoperation rates after RCR.</p><p><strong>Results: </strong>Twenty-one studies (1,279 patients) were synthesized. PRP reduced retear risk with moderate heterogeneity (RR 0.74, 95% CI 0.55-0.99; I<sup>2</sup> ≈ 29%). Across formulations, LP-PRP demonstrated the clearest reduction; inclusion of one critically biased trial increased heterogeneity (I<sup>2</sup> = 53.3%), whereas its exclusion yielded a precise, homogeneous estimate (RR 0.37, 95% CI 0.19-0.73; I<sup>2</sup> = 0%). Benefit was most evident in medium-sized tears (RR 0.68, 95% CI 0.48-0.96). PROMs did not improve consistently. Publication-bias diagnostics suggested small-study effects (Egger p = 0.017); trim-and-fill (k<sub>0</sub> = 8) yielded an exploratory adjusted RR of 0.91 (95% CI 0.69-1.19). Using an ARR of 11.8% (NNT 9) for LP-PRP, economic modeling projected substantial reductions in structural failures, with cost neutrality or net savings achievable under low-cost preparation strategies when scaled by reported revision probabilities.</p><p><strong>Conclusion: </strong>Leukocyte-poor PRP augmentation during arthroscopic RCR is associated with reduced structural retear rates, with the most consistent benefit observed in medium-sized tears and no reliable improvement in PROMs. The economic value of LP-PRP is conditional rather than uniform and depends on revision p","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318824","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}
Pub Date : 2026-02-25DOI: 10.1016/j.jse.2026.02.016
Malik Takreem Ahmad, Gaayen Ravii Sahga, Hamza Tareen, Bilaal Dar, Reubeen Ahmad, Rauhaan Tahir, Jonathan Joy Angelo, Mr Burhan Mirza, Mr Peter Domos
Background: Proximal humerus fractures (PHFs) are becoming more common, especially among older adults and often require surgical management. Two widely used surgical techniques are intramedullary nailing (IMN) and locking plate fixation (ORIF), yet there is ongoing debate regarding their comparative effectiveness. This study aims to systematically evaluate and compare functional, clinical, and complication-related outcomes of IMN and plating for adult patients with displaced PHFs.
Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines (PROSPERO registration: CRD42023434897). We searched the databases PubMed, Embase (OVID), and SCOPUS up to January 2025. Randomised controlled trials and cohort studies comparing IMN and plating with a minimum of 6 months' follow-up were included. The outcomes assessed were functional scores (DASH, ASES, Constant-Murley), pain (VAS), range of motion (external rotation and forward flexion), complications, and reoperation rates. We used a random-effects model to account for inter-study heterogeneity, and risk of bias was assessed using Cochrane RoB 2 and MINORS tools.
Results: After screening, twelve studies (n=1039 participants; mean age 65.6 years) were included. Amongst these, we found no statistically significant differences between IMN and plating in DASH, ASES, or Constant-Murley scores at 6 months. VAS pain scores, range of motion, complication rates, and reoperation rates were also comparable. Subgroup analysis for 2-part, 3-part fractures, and at 12 months follow up also revealed no significant outcome differences between techniques. While some individual studies showed small short-term advantages favouring one method, these did not exceed thresholds for clinical relevance. Evidence quality was moderate overall, with some heterogeneity in study design, outcome reporting, and follow-up duration.
Conclusion: We found that intramedullary nailing and plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults. We suggest therefore that IMN may represent a reasonable alternative to plating, given its reduced operative time, less soft tissue disruption, and lower overall cost. However, further research is needed to determine whether specific patient subgroups benefit more from one technique.
背景：肱骨近端骨折（phf）越来越常见，尤其是在老年人中，通常需要手术治疗。两种广泛使用的手术技术是髓内钉（IMN）和锁定钢板固定（ORIF），但关于它们的相对有效性仍存在争议。本研究旨在系统地评估和比较IMN和电镀治疗成人移位性phf的功能、临床和并发症相关结果。方法：根据PRISMA 2020指南（PROSPERO注册号：CRD42023434897）进行系统评价和荟萃分析。我们检索了截止到2025年1月的PubMed、Embase （OVID）和SCOPUS数据库。包括比较IMN和电镀至少6个月随访的随机对照试验和队列研究。评估的结果包括功能评分（DASH、ASES、Constant-Murley）、疼痛（VAS）、活动范围（外旋和前屈）、并发症和再手术率。我们使用随机效应模型来解释研究间的异质性，并使用Cochrane RoB 2和未成年人工具评估偏倚风险。结果：筛选后，纳入了12项研究（n=1039名参与者，平均年龄65.6岁）。其中，我们发现在6个月时，IMN和镀皿在DASH、ASES或Constant-Murley评分方面没有统计学上的显著差异。VAS疼痛评分、活动范围、并发症发生率和再手术率也具有可比性。2部分骨折、3部分骨折和12个月随访的亚组分析也显示两种技术之间没有显著的结果差异。虽然一些单独的研究显示了一种方法的短期优势，但这些并没有超过临床相关性的阈值。证据质量总体上是中等的，在研究设计、结果报告和随访时间上存在一定的异质性。结论：我们发现髓内钉和钢板在成人肱骨近端移位骨折的手术治疗中具有相同的临床效果。因此，我们认为IMN可能是一种合理的替代电镀，因为它减少了手术时间，更少的软组织破坏和更低的总成本。然而，需要进一步的研究来确定特定的患者亚组是否从一种技术中获益更多。
{"title":"Effectiveness of Intramedullary Nailing vs Locked Plating (ORIF) in Adult Displaced Proximal Humerus Fractures: A Systematic Review and Meta-Analysis.","authors":"Malik Takreem Ahmad, Gaayen Ravii Sahga, Hamza Tareen, Bilaal Dar, Reubeen Ahmad, Rauhaan Tahir, Jonathan Joy Angelo, Mr Burhan Mirza, Mr Peter Domos","doi":"10.1016/j.jse.2026.02.016","DOIUrl":"https://doi.org/10.1016/j.jse.2026.02.016","url":null,"abstract":"<p><strong>Background: </strong>Proximal humerus fractures (PHFs) are becoming more common, especially among older adults and often require surgical management. Two widely used surgical techniques are intramedullary nailing (IMN) and locking plate fixation (ORIF), yet there is ongoing debate regarding their comparative effectiveness. This study aims to systematically evaluate and compare functional, clinical, and complication-related outcomes of IMN and plating for adult patients with displaced PHFs.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines (PROSPERO registration: CRD42023434897). We searched the databases PubMed, Embase (OVID), and SCOPUS up to January 2025. Randomised controlled trials and cohort studies comparing IMN and plating with a minimum of 6 months' follow-up were included. The outcomes assessed were functional scores (DASH, ASES, Constant-Murley), pain (VAS), range of motion (external rotation and forward flexion), complications, and reoperation rates. We used a random-effects model to account for inter-study heterogeneity, and risk of bias was assessed using Cochrane RoB 2 and MINORS tools.</p><p><strong>Results: </strong>After screening, twelve studies (n=1039 participants; mean age 65.6 years) were included. Amongst these, we found no statistically significant differences between IMN and plating in DASH, ASES, or Constant-Murley scores at 6 months. VAS pain scores, range of motion, complication rates, and reoperation rates were also comparable. Subgroup analysis for 2-part, 3-part fractures, and at 12 months follow up also revealed no significant outcome differences between techniques. While some individual studies showed small short-term advantages favouring one method, these did not exceed thresholds for clinical relevance. Evidence quality was moderate overall, with some heterogeneity in study design, outcome reporting, and follow-up duration.</p><p><strong>Conclusion: </strong>We found that intramedullary nailing and plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults. We suggest therefore that IMN may represent a reasonable alternative to plating, given its reduced operative time, less soft tissue disruption, and lower overall cost. However, further research is needed to determine whether specific patient subgroups benefit more from one technique.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318891","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}
Pub Date : 2026-02-25DOI: 10.1016/j.jse.2026.02.014
Tobias P Bayer, Anna-Katharina Nolte, Benjamin Panzram, Patric Raiss, Kilian Wegmann, J Philippe Kretzer, Matthias Bülhoff, Sebastian Jaeger
Background: Metal-free fixation methods, such as the all-suture cerclage technique, for the Latarjet procedure aim to minimize implant-related complications. Clinical studies suggest equivalent clinical results while reducing implant related complications. However, recent studies have shown increased rates of graft migration and failure due to cortical cut-through. Revision strategies following such failures remain poorly described. The aim of this study is to evaluate the primary stability of revision Latarjet surgery using two conventional malleolar screws after failure of all-suture cerclage fixation compared to primary screw fixation. It is hypothesized that fixation of the coracoid graft using two malleolar screws in revision cases is equal or higher than primary screw fixation.
Methods: Twelve fresh-frozen cadaveric shoulder specimens (six matched pairs) were previously tested in a study comparing suture cerclage and malleolar screw fixation. Following failure due to cortical bone cut-through, revision surgery was performed on the cerclage specimens using two malleolar screws. Bone graft displacement under cyclic loading in six load levels (up to 300 N) and static conjoint tendon tension (10 N) was measured using a three dimensional optical marker system. Outcomes were compared to those from primary screw fixations.
Results: No statistically significant differences in graft displacement under cyclic loading between the revision and primary groups at any load level (p > 0.05) could be found. The revision group showed slightly higher displacement at low load levels but demonstrated superior stability at higher loads compared to primary screw fixation. One intraoperative graft fracture was observed during revision but did not affect the primary stability of the tested specimen.
Discussion and conclusion: Revision Latarjet surgery using malleolar screw fixation after failed all-suture cerclage provides non-inferior biomechanical primary stability compared to primary screw fixation. This technique appears to be a viable salvage option for addressing instability following failure of metal-free Latarjet constructs. Clinical studies need to be conducted in order to confirm the results of this biomechanical study.
{"title":"Biomechanical Evaluation of Primary Stability in Revision Latarjet Surgery Using Malleolar Screws Following Failure of All-Suture Cerclage Fixation.","authors":"Tobias P Bayer, Anna-Katharina Nolte, Benjamin Panzram, Patric Raiss, Kilian Wegmann, J Philippe Kretzer, Matthias Bülhoff, Sebastian Jaeger","doi":"10.1016/j.jse.2026.02.014","DOIUrl":"https://doi.org/10.1016/j.jse.2026.02.014","url":null,"abstract":"<p><strong>Background: </strong>Metal-free fixation methods, such as the all-suture cerclage technique, for the Latarjet procedure aim to minimize implant-related complications. Clinical studies suggest equivalent clinical results while reducing implant related complications. However, recent studies have shown increased rates of graft migration and failure due to cortical cut-through. Revision strategies following such failures remain poorly described. The aim of this study is to evaluate the primary stability of revision Latarjet surgery using two conventional malleolar screws after failure of all-suture cerclage fixation compared to primary screw fixation. It is hypothesized that fixation of the coracoid graft using two malleolar screws in revision cases is equal or higher than primary screw fixation.</p><p><strong>Methods: </strong>Twelve fresh-frozen cadaveric shoulder specimens (six matched pairs) were previously tested in a study comparing suture cerclage and malleolar screw fixation. Following failure due to cortical bone cut-through, revision surgery was performed on the cerclage specimens using two malleolar screws. Bone graft displacement under cyclic loading in six load levels (up to 300 N) and static conjoint tendon tension (10 N) was measured using a three dimensional optical marker system. Outcomes were compared to those from primary screw fixations.</p><p><strong>Results: </strong>No statistically significant differences in graft displacement under cyclic loading between the revision and primary groups at any load level (p > 0.05) could be found. The revision group showed slightly higher displacement at low load levels but demonstrated superior stability at higher loads compared to primary screw fixation. One intraoperative graft fracture was observed during revision but did not affect the primary stability of the tested specimen.</p><p><strong>Discussion and conclusion: </strong>Revision Latarjet surgery using malleolar screw fixation after failed all-suture cerclage provides non-inferior biomechanical primary stability compared to primary screw fixation. This technique appears to be a viable salvage option for addressing instability following failure of metal-free Latarjet constructs. Clinical studies need to be conducted in order to confirm the results of this biomechanical study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318921","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}
Pub Date : 2026-02-24DOI: 10.1016/j.jse.2026.02.017
Philipp Kriechling, Martina Scherer, Bettina Hochreiter, Felix Düppers, Eliane Willemsen, Samy Bouaicha, Karl Wieser
Introduction: Long-term data at 15 years following implantation of reverse total shoulder arthroplasty (rTSA) is very limited. It was the aim of this study to analyze patients at a minimum of 15 years following rTSA implantation.
Methods: A prospectively followed database of rTSAs performed at a tertiary referral center was analyzed at a minimum follow-up of 15 years. Kaplan-Meier survival curves were used to estimate time to complication and reoperation/revision rates and to calculate predictive factors. Clinical outcomes included the absolute and relative Constant-Murley score (CSa and CSr), Subjective Shoulder Value (SSV), range of motion including CS internal rotation (CS IR) and CS pain. The radiographic measurement included analysis of notching, radiolucent lines, heterotopic ossification, stress shielding and tuberosity resorption.
Results: A total of 258 shoulders (249 patients, median age 72 [75% IQR, 66 to 78] years, 62% female) underwent rTSA implantation in the specified period. Kaplan-Meier Survival analysis revealed a complication-free rate of 80% (IQR, 78% to 83%) and 76% (IQR, 70% to 81%) and a reoperation-free rate of 84% (IQR, 80% to 89%) at 10 and 15 years, respectively. Risk factors for complications were younger age (Hazard ratio (HR) 0.97), female gender (HR 2.04), and revision surgery as indication (HR 2.08). Of those 258 shoulders, 52 rTSAs (52 patients, median age 64 (IQR, 59 to 70) years, 46% female) were available for complete clinical and radiographic analysis at a minimum follow-up of 15 years (median 15.1 (IQR, 14.9 to 16,6) years). The initial improvements observed for most clinical parameters could be maintained from 2-years to mid-term and long-term follow-up at 10 and 15 years, respectively, including a CSa of 64 (IQR, 46 to 71), CSr of 79% (IQR, 60% to 86%), SSV of 80% (IQR, 60% to 93%), CS pain of 15.0 (IQR, 10.0 to 15.0), abduction of 120° (IQR, 88° to 145°), external rotation of 20° (IQR, 10° to 40°), and CS IR of 4.0 (IQR, 2.0 to 8.0), as well as strength of 2.13 (IQR, 0.00 to 3.45) kg at 15 years follow-up. Only flexion showed worsening over time from 130° (IQR, 100° to 150°) at 2 years to 115° (IQR, 94° to 130°) at 15 years postoperatively. All radiographic parameters progressed from preoperatively to 10 years postoperatively with no further progression.
Conclusion: RTSA provides a stable clinical and radiographic outcome at long-term follow-up of at least 15 years. However, complication and revision rates are still high.
{"title":"Long Term clinical and radiological outcomes of primary reverse total shoulder arthroplasty at a minimum follow-up of 15 years.","authors":"Philipp Kriechling, Martina Scherer, Bettina Hochreiter, Felix Düppers, Eliane Willemsen, Samy Bouaicha, Karl Wieser","doi":"10.1016/j.jse.2026.02.017","DOIUrl":"https://doi.org/10.1016/j.jse.2026.02.017","url":null,"abstract":"<p><strong>Introduction: </strong>Long-term data at 15 years following implantation of reverse total shoulder arthroplasty (rTSA) is very limited. It was the aim of this study to analyze patients at a minimum of 15 years following rTSA implantation.</p><p><strong>Methods: </strong>A prospectively followed database of rTSAs performed at a tertiary referral center was analyzed at a minimum follow-up of 15 years. Kaplan-Meier survival curves were used to estimate time to complication and reoperation/revision rates and to calculate predictive factors. Clinical outcomes included the absolute and relative Constant-Murley score (CSa and CSr), Subjective Shoulder Value (SSV), range of motion including CS internal rotation (CS IR) and CS pain. The radiographic measurement included analysis of notching, radiolucent lines, heterotopic ossification, stress shielding and tuberosity resorption.</p><p><strong>Results: </strong>A total of 258 shoulders (249 patients, median age 72 [75% IQR, 66 to 78] years, 62% female) underwent rTSA implantation in the specified period. Kaplan-Meier Survival analysis revealed a complication-free rate of 80% (IQR, 78% to 83%) and 76% (IQR, 70% to 81%) and a reoperation-free rate of 84% (IQR, 80% to 89%) at 10 and 15 years, respectively. Risk factors for complications were younger age (Hazard ratio (HR) 0.97), female gender (HR 2.04), and revision surgery as indication (HR 2.08). Of those 258 shoulders, 52 rTSAs (52 patients, median age 64 (IQR, 59 to 70) years, 46% female) were available for complete clinical and radiographic analysis at a minimum follow-up of 15 years (median 15.1 (IQR, 14.9 to 16,6) years). The initial improvements observed for most clinical parameters could be maintained from 2-years to mid-term and long-term follow-up at 10 and 15 years, respectively, including a CSa of 64 (IQR, 46 to 71), CSr of 79% (IQR, 60% to 86%), SSV of 80% (IQR, 60% to 93%), CS pain of 15.0 (IQR, 10.0 to 15.0), abduction of 120° (IQR, 88° to 145°), external rotation of 20° (IQR, 10° to 40°), and CS IR of 4.0 (IQR, 2.0 to 8.0), as well as strength of 2.13 (IQR, 0.00 to 3.45) kg at 15 years follow-up. Only flexion showed worsening over time from 130° (IQR, 100° to 150°) at 2 years to 115° (IQR, 94° to 130°) at 15 years postoperatively. All radiographic parameters progressed from preoperatively to 10 years postoperatively with no further progression.</p><p><strong>Conclusion: </strong>RTSA provides a stable clinical and radiographic outcome at long-term follow-up of at least 15 years. However, complication and revision rates are still high.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147312134","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}
Pub Date : 2026-02-19DOI: 10.1016/j.jse.2026.01.019
Alex B Boyle, Chris Frampton, Peter C Poon, Simon B M MacLean
Aims: Common indications for total elbow arthroplasty include fracture, osteoarthritis, and rheumatoid arthritis. Total elbow arthroplasty is increasingly being performed for fracture in the context of an ageing population, improved medical management of rheumatoid arthritis, and improving surgical technologies. This study aimed to investigate survivorship of total elbow arthroplasty implants by indication using data from the New Zealand Joint Registry.
Methods: Prospectively collected data from the New Zealand Joint Registry, a national database with capture >95%, were used to compare the survivorship rates and Oxford Scores of total elbow arthroplasty by indication for all procedures performed between January 2000 and December 2022. Underlying diagnoses, reason for revision and patient demographics were all recorded. Statistical analysis included survivorship analysis using Kaplan-Meier curves and comparison between groups using independent t tests.
Results: Over the 22 year study period, 601 total elbow arthroplasty procedures were performed representing 4875 component years. 185 total elbow arthroplasty procedures were performed for fracture, 318 for rheumatoid arthritis and 98 for osteoarthritis. The number of revisions per 100 component-years for total elbow arthroplasty was 0.40 for fracture, 0.98 for rheumatoid arthritis, and 1.86 for osteoarthritis. The adjusted revision rate for total elbow arthroplasty performed for fracture was lower than when performed for osteoarthritis (p=0.020) and equivalent to when performed for rheumatoid arthritis (p=0.240). Mean Oxford Scores 6 months post-operatively were 33.0 for total elbow arthroplasty procedures performed for fracture, 37.8 for total elbow arthroplasty performed for osteoarthritis and 39.0 for total elbow arthroplasty performed for rheumatoid arthritis. These differences were statistically significant (p<0.001).
Conclusions: In the context of a higher proportion of total elbow arthroplasty being performed for complex distal humeral fractures and their post-traumatic sequelae, survivorship and functional outcomes appear to be favourable or comparable to traditional indications such as rheumatoid arthritis and osteoarthritis.
{"title":"A comparison of survivorship and functional outcomes for total elbow arthroplasty performed for distal humerus fracture, rheumatoid arthritis and osteoarthritis, a New Zealand Joint Registry Study.","authors":"Alex B Boyle, Chris Frampton, Peter C Poon, Simon B M MacLean","doi":"10.1016/j.jse.2026.01.019","DOIUrl":"https://doi.org/10.1016/j.jse.2026.01.019","url":null,"abstract":"<p><strong>Aims: </strong>Common indications for total elbow arthroplasty include fracture, osteoarthritis, and rheumatoid arthritis. Total elbow arthroplasty is increasingly being performed for fracture in the context of an ageing population, improved medical management of rheumatoid arthritis, and improving surgical technologies. This study aimed to investigate survivorship of total elbow arthroplasty implants by indication using data from the New Zealand Joint Registry.</p><p><strong>Methods: </strong>Prospectively collected data from the New Zealand Joint Registry, a national database with capture >95%, were used to compare the survivorship rates and Oxford Scores of total elbow arthroplasty by indication for all procedures performed between January 2000 and December 2022. Underlying diagnoses, reason for revision and patient demographics were all recorded. Statistical analysis included survivorship analysis using Kaplan-Meier curves and comparison between groups using independent t tests.</p><p><strong>Results: </strong>Over the 22 year study period, 601 total elbow arthroplasty procedures were performed representing 4875 component years. 185 total elbow arthroplasty procedures were performed for fracture, 318 for rheumatoid arthritis and 98 for osteoarthritis. The number of revisions per 100 component-years for total elbow arthroplasty was 0.40 for fracture, 0.98 for rheumatoid arthritis, and 1.86 for osteoarthritis. The adjusted revision rate for total elbow arthroplasty performed for fracture was lower than when performed for osteoarthritis (p=0.020) and equivalent to when performed for rheumatoid arthritis (p=0.240). Mean Oxford Scores 6 months post-operatively were 33.0 for total elbow arthroplasty procedures performed for fracture, 37.8 for total elbow arthroplasty performed for osteoarthritis and 39.0 for total elbow arthroplasty performed for rheumatoid arthritis. These differences were statistically significant (p<0.001).</p><p><strong>Conclusions: </strong>In the context of a higher proportion of total elbow arthroplasty being performed for complex distal humeral fractures and their post-traumatic sequelae, survivorship and functional outcomes appear to be favourable or comparable to traditional indications such as rheumatoid arthritis and osteoarthritis.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146777124","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}
Background: There are no reports addressing the treatment and outcomes of kissing osteochondritis dissecans (OCD) of the radiocapitellar joint. This study aimed to retrospectively investigate the outcomes of the surgical treatment for kissing OCD of the radiocapitellar joint.
Materials and methods: Of the 220 patients who underwent surgery for capitellar OCD, we selected those with an additional diagnosis of concomitant OCD in the radial head. Only five patients (2.3%) met the inclusion criteria. All of the patients were boys belonging to sports clubs: four played baseball and one did gymnastics. Their primary complaint was elbow pain. The mean range of motion of the elbow was -22 degrees of extension and 129 degrees of flexion. Three-dimensional computed tomography revealed a mean maximum width of 14.4 mm for the capitellar lesion and 9.8 mm for the radial head lesion. Three patients had multiple loose fragments. Five patients underwent surgery at a mean age of 12.8 years. Cases 1 and 2 underwent osteochondral autologous transplantation (OAT) for the capitellum, and the stable radial head lesions were left in place. Case 3 underwent arthroscopic fragment removal (AR) alone. Case 4 underwent OAT for the capitellum and AR for the radial head. Case 5 underwent OAT for both kissing lesions. The donor site was the nonweight-bearing articular surface of the lateral femoral condyle. The mean observation period was 5.2 years. We examined the outcomes retrospectively.
Results: Defect enlargement in the radiocapitellar joint was observed in two patients (cases 3 and 4) who did not undergo OAT for both osteochondral defects following fragment removal. These two patients required salvage OAT for both osteochondral lesions. All five patients, including the aforementioned two, returned to competitive sports. At the final follow-up, the mean postoperative self-assessment scores were six points for the DASH Sports questionnaire and nine points for the PREE. The mean range of motion of the elbow was -12 degrees of extension and 132 degrees of flexion. The mean grip strength ratio of the affected hand compared to the unaffected hand was 93.9%.
Discussion: Kissing osteochondral defects may tend to enlarge. This series suggests that articular reconstruction of both the capitellum and radial head is an effective treatment for kissing osteochondral defects, but more work would be needed. This is the first report addressing the treatment and outcomes of kissing OCD of the radiocapitellar joint.
{"title":"Concomitant osteochondritis dissecans of the capitellum and radial head: kissing osteochondritis dissecans of the radiocapitellar joint.","authors":"Satoru Shiraishi, Masatoshi Takahara, Ryo Mitachi, Junichiro Shibuya, Tomohiro Uno, Hiroshi Satake, Michiaki Takagi","doi":"10.1016/j.jse.2026.02.006","DOIUrl":"https://doi.org/10.1016/j.jse.2026.02.006","url":null,"abstract":"<p><strong>Background: </strong>There are no reports addressing the treatment and outcomes of kissing osteochondritis dissecans (OCD) of the radiocapitellar joint. This study aimed to retrospectively investigate the outcomes of the surgical treatment for kissing OCD of the radiocapitellar joint.</p><p><strong>Materials and methods: </strong>Of the 220 patients who underwent surgery for capitellar OCD, we selected those with an additional diagnosis of concomitant OCD in the radial head. Only five patients (2.3%) met the inclusion criteria. All of the patients were boys belonging to sports clubs: four played baseball and one did gymnastics. Their primary complaint was elbow pain. The mean range of motion of the elbow was -22 degrees of extension and 129 degrees of flexion. Three-dimensional computed tomography revealed a mean maximum width of 14.4 mm for the capitellar lesion and 9.8 mm for the radial head lesion. Three patients had multiple loose fragments. Five patients underwent surgery at a mean age of 12.8 years. Cases 1 and 2 underwent osteochondral autologous transplantation (OAT) for the capitellum, and the stable radial head lesions were left in place. Case 3 underwent arthroscopic fragment removal (AR) alone. Case 4 underwent OAT for the capitellum and AR for the radial head. Case 5 underwent OAT for both kissing lesions. The donor site was the nonweight-bearing articular surface of the lateral femoral condyle. The mean observation period was 5.2 years. We examined the outcomes retrospectively.</p><p><strong>Results: </strong>Defect enlargement in the radiocapitellar joint was observed in two patients (cases 3 and 4) who did not undergo OAT for both osteochondral defects following fragment removal. These two patients required salvage OAT for both osteochondral lesions. All five patients, including the aforementioned two, returned to competitive sports. At the final follow-up, the mean postoperative self-assessment scores were six points for the DASH Sports questionnaire and nine points for the PREE. The mean range of motion of the elbow was -12 degrees of extension and 132 degrees of flexion. The mean grip strength ratio of the affected hand compared to the unaffected hand was 93.9%.</p><p><strong>Discussion: </strong>Kissing osteochondral defects may tend to enlarge. This series suggests that articular reconstruction of both the capitellum and radial head is an effective treatment for kissing osteochondral defects, but more work would be needed. This is the first report addressing the treatment and outcomes of kissing OCD of the radiocapitellar joint.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146777134","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}
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