Journal of Shoulder and Elbow Surgery最新文献

Background: Glucagon-like peptide-1 agonists (GLP-1s) are increasingly prescribed for type 2 diabetes mellitus (T2DM) and obesity, with over 12% of the United States population reported to being using this medication. While GLP-1s have been associated with reduced complication rates in total hip and knee arthroplasty populations, their association with outcomes after shoulder surgery remains unclear. The purpose of the current study was to perform a systematic review and meta-analysis of studies comparing adverse events between GLP-1 users and non-users following shoulder surgery.

Methods: A PRISMA-compliant literature search of PubMed, Embase, and Scopus was performed in August 2025. Comparative studies (Level of Evidence I-III) assessing postoperative adverse events in GLP-1 and non-GLP-1 users undergoing total shoulder arthroplasty (TSA) or shoulder arthroscopic procedures were included. Data pertaining to 90-day and 2-year complication rates were extracted. Random effects meta-analyses were conducted independently for TSA studies and pooled odds ratios with confidence estimates were quantified. Outcomes of studies examining arthroscopic procedures were described narratively given limited data.

Results: Six studies encompassing outcomes of 43,415 patients were included. Four (66.7%) studies evaluated TSA, while one evaluated arthroscopic RCR and one manipulation under anesthesia/capsular release for adhesive capsulitis (AC). The overall pooled 90-day complication rate following TSA was 18.1% for GLP-1 users and 15.9% for non-users (OR = 0.86, 95% CI: 0.36-2.07, P = .74). The overall pooled 2-year complication rate following TSA was 3.8% in the GLP-1 group and 3.7% in the non-GLP-1 group (OR = 1.24, 95% CI: 0.73-2.00, P = .42). The RCR and AC studies reported significantly lower 90-day complication rates for GLP-1 users (11.0% vs. 27.4%) and (2.5% vs. 4.8%), respectively. A lower re-tear rate was observed in GLP-1 users compared with non-users by 2-years postoperatively (12.5% vs. 18.3%).

Conclusion: GLP-1 agonist use is not significantly associated with 90-day or 2-year adverse events following TSA. Based on this data, GLP-1 agonist use should not be a contraindication for proceeding with TSA. Lower complication rates were observed in both studies concerning arthroscopic intervention for non-arthritic shoulder conditions.

Background: Extraction of well-fixed humeral implants during revision shoulder arthroplasty is difficult and prone to complications, especially humeral fracture (up to 12% in anatomical stem revision and 30% in reversed stem revision). To prevent this complication, we perform a Vertical Incomplete Humerotomy (VIH) and use cerclages with suture loops and Nice Knots for fixation.

Purpose: To describe the VIH technique with suture cerclage fixation, report the perioperative complications, and evaluate the radiological and clinical results outcomes.

Methods: We performed a retrospective monocentric study of consecutive patients who underwent revision shoulder arthroplasty with a VIH at a single institution (2007-2022). A straight longitudinal humeral osteotomy was created posterior and parallel to the bicipital groove. This allows for extraction of the humeral stem and cement mantle. Osteotomy closure was performed with 2 to 6 cerclages with suture loops (Nice Loop, Tornier-Stryker, Kalamazoo, MI, USA) and a non-sliding knot ("Nice knot"). The primary outcome was assessment of intraoperative and postoperative complications. The secondary outcome was osteotomy healing at 6 months and clinical results at two years.

Results: A cohort of 47 patients (mean age of 67.34 years, range 33-86) with a mean follow-up was 37.9 months who underwent revision shoulder with VIH were analyzed. There were 21 Hemiarthroplasty (HA), 11 Total Shoulder Arthroplasty (TSA) and 15 Reversed Shoulder Arthroplasty (RSA). There were 5 revisions to TSA, 26 revisions to RSA, 3 humeral stem revision and 13 revisions to spacers secondary to periprosthetic joint infection (PJI). One intraoperative humeral fracture occurred during stem removal. No postoperative complication related to the humerotomy occurred and no patients required surgical revision secondary to the humerotomy. Primary osteotomy healing and callus formation were evident in all cases by 6 months. In 12 cases of PJI, a second stage revision was performed, there were 3 reinterventions (2 instability and 1 infection). At the last follow-up, 82% of patients were satisfied after the intervention; the mean Subjective Shoulder Value (SSV) was 58%, and the VAS score was 3.4/10.

Conclusion: (1) VIH facilitates extraction of well-fixed cemented or uncemented humeral components and prevents iatrogenic humeral fractures in revision shoulder arthroplasty, and (2) Suture fixation, using suture loops (Nice Loop; Tornier-Stryker, Kalamazoo, MI, USA) and a non-sliding knot ("Nice knot"), provides constant bone healing and is an alternative to wire for cerclage fixation of humerotomy.

Background: Scapular dyskinesis is an alteration in scapular position and movement that disrupts glenohumeral kinematics. Among its causes, pectoralis minor retraction induces scapular protraction and internal rotation, altering shoulder biomechanics. Often asymptomatic, scapular dyskinesis may also cause pain and reduced joint mobility, compromising function. Initial management relies on targeted rehabilitation, which generally ensures recovery. However, when conservative treatment fails, surgery may be considered. This study evaluates the clinical outcomes of arthroscopic pectoralis minor tenotomy in patients with painful shoulder and scapular dyskinesis due to pectoralis minor retraction.

Methods: A retrospective monocentric study included patients operated on between 2020 and 2024 for painful shoulder syndrome associated with scapular dyskinesis secondary to excessive pectoralis minor tension. Patients undergoing concomitant or subsequent surgery on the same shoulder were excluded. We conducted a longitudinal intrasubject study comparing preoperative and postoperative outcomes. Patients were assessed preoperatively and at their last follow-up for active range of motion, pain (visual analog scale), Constant score, and simple shoulder value. Complications were recorded.

Results: Thirty-seven patients met the entry criteria and were enrolled in the study with a mean follow-up of 19.9 months (range, 6 to 44). All patients were women (mean age 43.8), with 49% reporting trauma and 57% practicing sports. Among the 37 patients, information on preoperative corticosteroid injections was missing for 2 patients. Of the remaining 35, 34 (97%) received at least 1 injection. Functional scores and pain improved significantly postoperatively. The Constant score increased from 55.3 to 73.27 (P < .001), the visual analog scale decreased from 7.51 to 2.62 (P < .001), and the simple shoulder value rose from 46.75 to 74.73 (P < .001). Active elevation improved significantly from 128.38° to 143.9° (P = .013), while external and internal rotations showed no significant difference. Four cases of adhesive capsulitis were reported; three resolved with rehabilitation, while 1 patient retained stiffness in elevation at last follow-up.

Conclusion: When conservative treatment fails, arthroscopic tenotomy is an effective surgical option for patients with painful shoulder and scapular dyskinesis due to pectoralis minor contracture. This study demonstrates significant improvement in functional scores, pain, and anterior elevation range, while external and internal rotations remain unchanged. However, randomized studies with longer follow-up are needed to confirm result durability.

Background: Online physician review websites are being increasingly utilized by patients when choosing their surgeon. Although most reviews are positive, extremely negative reviews can significantly compromise a physician's online reputation. The purpose of this study was to analyze factors that contribute to negative reviews for orthopedic shoulder surgeons.

Methods: One hundred orthopedic shoulder surgeons were randomly selected from the "find a doctor" tool on the American Shoulder and Elbow Surgeons (ASES) website. A search was performed for all reviews listed under the selected surgeons on the following sources: Google Reviews, Healthgrades, Vitals, and Yelp. For each website, a surgeon's average rating, total number of reviews, and number of 1-star reviews was recorded. One-star reviews with comments were then reviewed to categorize the complaint(s), determine whether they referenced a clinical or non-clinical issue, and determine whether the complaint referenced a surgical or non-surgical episode of care. Categorical variables were analyzed using a chi-square test.

Results: A total of 7616 reviews were analyzed and 722 (9.5%) were identified as one-star. After application or exclusion criteria, 329 single-star reviews with 837 total complaints were included for analysis. Of the 329 single-star reviews, 237 (72.0%) were from non-surgical patients and 92 (28.0%) were from surgically treated patients. Non-surgical patients had a significantly higher rate of total complaints per each review than surgical patients (1.76 vs. 0.78, p=0.034). The most common complaints were regarding bedside manner (160 complaints), insufficient time with the provider (82 complaints), uncontrolled pain (73 complaints), and rude staff (72 complaints). Poor surgical outcomes were noted in terms of complication (66 complaints), reoperation (26 complaints) and readmissions (2 complaints).

Conclusion: For orthopedic shoulder surgeons, the most common complaints are non-clinical and include poor bedside manner, wait time, and insufficient time with the provider. Relatively few negative reviews referenced objective measures of healthcare quality such as complications or surgical outcomes. These results provide a deeper understanding of the reasons for patient dissatisfaction in shoulder surgery, which can be considered when striving to maintain a favorable online reputation.

Background: Dislocation of the sternoclavicular joint (SCJ) is the most common SCJ condition reported to be managed surgically. However, primary SCJ osteoarthritis (OA) is substantially more common. There are few reports in the literature on the outcome of surgical management of primary SCJ OA. We have successfully adopted sternal docking allograft reconstruction for SCJ instability and have now expanded the technique to patients with primary SCJ OA. This is our first report on the outcome of the sternal docking technique specifically for patients with primary SCJ OA.

Methods: Between 2012 and 2023, one fellowship trained shoulder surgeon consecutively performed surgical resection of the medial end of the clavicle and semitendinosus allograft ligament reconstruction using the sternal docking technique in 29 patients with SCJ OA. Seven patients were lost to follow-up (one declined participation, and 6 could not be contacted). The remaining 22 patients form the study cohort. There were 17 females and 5 males with a mean age of 49 ± 11 years at the time of surgery (range, 32-71 years). Their electronic medical records were reviewed to collect demographics, pain using a visual analog scale (VAS), complications and reoperations. Patients were also contacted at most recent follow-up to record VAS for pain, subjective shoulder value and American Shoulder and Elbow Surgeons shoulder score. The procedure was considered successful when patients experienced pain relief and did not develop any complications or required reoperation. The mean length of follow-up was 4 ± 3 (range, 1-12) years.

Results: SCJ reconstruction was associated with significantly improved pain relief and overall shoulder function. Preoperatively, the mean VAS was 6 ± 1.5 (range, 4-9) points. At the most recent follow-up, the mean pain score was 0.5 ± 1.5 (range, 0-6) points, with median scores of 90 (interquartile range: 60-98) for subjective shoulder value and 80 (interquartile range: 70-81) points for American Shoulder and Elbow Surgeons. Twenty-one of 22 patients reported high satisfaction rates with their postoperative outcomes, with one patient endorsing partial satisfaction due to limited shoulder range of motion. Persistent peri-incisional numbness was reported by one patient. There were no re-operations at the time of the most recent follow-up.

Conclusion: Medial clavicle resection and ligament reconstruction seems to be associated with good overall outcomes, a high degree of patient satisfaction, and a low reoperation rate in patients with primary SCJ OA.

Background: Frozen shoulder (FS) is a common fibroinflammatory disorder of the glenohumeral joint capsule, characterized by persistent pain and progressive restriction of range of motion. The fibroblast-to-myofibroblast transition is a central pathological event driving capsular fibrosis, yet the molecular regulators underlying this process remain poorly defined. Protein tyrosine phosphatase 1B (PTP1B) has emerged as a key regulator of fibrosis in multiple organs, but its role in musculoskeletal fibrosis, particularly in FS, has not been investigated.

Methods: In this prospective case-control study, glenohumeral capsular tissues were collected from 21 patients with idiopathic FS and 21 matched controls with rotator cuff tears during arthroscopic surgery. Tissue samples were evaluated using histology, immunofluorescence, and Western blotting. Clinical function was assessed preoperatively using the American Shoulder and Elbow Surgeons and Constant-Murley scores.

Results: FS patients exhibited significantly worse functional outcomes across all domains, including pain, range of motion, and activities of daily living. Histopathological analysis revealed pronounced fibroblast proliferation, dense collagen deposition, hypervascularity, and perivascular adipocyte accumulation in FS capsules compared to controls. Critically, PTP1B expression was significantly upregulated in FS tissues. PTP1B immunoreactivity was prominently localized to α-SMA⁺ myofibroblasts. Co-localization studies confirmed an enrichment of PTP1B within activated myofibroblasts, indicating its specific involvement in fibrotic transdifferentiation.

Conclusion: This study identified PTP1B as a novel biomarker that was upregulated in FS and was specifically associated with myofibroblast activation and capsular fibrosis. These findings position PTP1B as a promising therapeutic target for mitigating fibrosis and functional impairment in FS.

Background: Glenohumeral internal rotation deficit (GIRD) has been associated to shoulder injuries in overhead athletes. The glenohumeral posterior capsule stretching techniques, such as the sleeper stretch and cross-body stretch, are used to improve range of motion (ROM) and reduce pain. However, there are no studies comparing these techniques in symptomatic overhead athletes with GIRD. This study aimed to compare the effects of sleeper stretch and cross-body stretch on shoulder pain and shoulder ROM in overhead athletes with GIRD and shoulder pain.

Methods: This is a randomized, double-blind, controlled clinical trial. Overhead athletes aged 18 to 40 years who were actively engaged in their sport at a competitive level, with shoulder pain and GIRD were randomly allocated into 2 groups: the Cross-body Stretch Group (CBG), and the Sleeper Stretch Group (SSG). Both groups received interventions 3 times a week for four weeks. The primary outcomes were shoulder pain intensity and glenohumeral internal rotation range of motion. Secondary outcomes included affective response to interventions, adherence, and reported co-interventions.

Results: Thirty-five athletes participated in the study, with 17 allocated to the CBG and 18 to the SSG. No significant differences were observed between groups for shoulder pain and GIRD. SSG showed a decrease of -2.17 in pain intensity (95% CI = -3.13 to -1.21), while CBG reduced pain by -1.54 (95% CI = -2.53 to -0.55). Additionally, GIRD was attenuated in both treatment groups, with the SSG showing a reduction of -14.69 (95% CI = -19.48 to -9.89) and the CBG showing a reduction of -14.77 (95% CI = -19.70 to -9.84).

Discussion: The results of this study suggest that both the sleeper stretch and the cross-body stretch significantly reduced pain and improved glenohumeral internal rotation in overhead athletes with shoulder pain and GIRD after four weeks, with no significant difference between them. Affective responses, adherence, and the occurrence of co-interventions were similar, indicating good tolerance and safety of both techniques. These findings provide clinical support for the use of either strategy in the conservative management of these athletes. Future research should focus on the long-term effects and the investigation of multimodal treatment strategies.

Conclusion: Both sleeper stretch and cross-body stretch showed similar effects in reducing pain and glenohumeral internal rotation deficit.

Background: Stemless anatomic total shoulder arthroplasty (aTSA) has gained considerable traction as an alternative to traditional stemmed implants for the management of glenohumeral arthritis, particularly for patients where bone preservation is a priority. However, some surgeons remain cautious employing a lesser tuberosity osteotomy (LTO) when using stemless implants due to concerns of metaphyseal fixation and implant stability. This study evaluates clinical, radiographic, and functional outcomes of a novel transosseous suture-cable repair for LTO in stemless aTSA.

Methods: A retrospective review identified 55 stemless aTSAs performed in 52 patients by a single surgeon from September 2022 to September 2024. Patients aged ≥ 18years who underwent stemless aTSA with LTO were included, while revisions or patients with prior metal hardware were excluded. All patients underwent a transosseous suture-cable LTO repair anchored to the bicipital groove. Patient charts were reviewed to assess clinical, radiographic, and patient-reported outcomes. Radiographic LTO healing was classified as fully healed, partially healed, or not healed, and reoperation and implant-related complications were assessed. Functional outcomes included American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation scores. Pain was evaluated using the visual analog scale. Range of motion was measured for abduction, forward flexion, external rotation, and internal rotation (IR) preoperatively and at final follow-up.

Results: At the latest follow-up, 87.3% (n = 48) of LTOs demonstrated full bony healing, 10.9% (n = 6) were partially healed, and 1.8% (n = 1) did not heal. Follow-up time for this study was 26.7 ± 8.3months. No implant loosening or malposition was observed. There were no reoperations. Postoperatively, glenohumeral abduction improved from 58.6° ± 28.7° to 104.5° ± 49.8° (P < .001), forward flexion from 110.0° ± 27.0° to 149.3° ± 33.6° (P < .001), and external rotation from 17.8° ± 18.3° to 50.4° ± 16.4° (P < .001). Of the patients with "poor" IR, approximately 22% (7/32) improved to "acceptable" or "normal" IR (P = .027). Mean postoperative American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation scores were 94.0 ± 7.4 and 88.2 ± 9.2, respectively, with a mean visual analog scale pain score of 0.1 ± 0.6.

Conclusion: Transosseous suture-cable fixation for LTO in stemless aTSA achieves high healing rates, excellent functional outcomes, and minimal complications. Patients showed significant improvements in pain, motion, and IR, supporting the role of LTO in preserving subscapularis function.

Background: Lower trapezius transfer has been demonstrated to restore external rotation in patients with brachial plexus palsies. In certain cases of cuff tear arthropathy, patients exhibit preserved forward elevation but lack active external rotation. This study evaluates the clinical outcomes of lower trapezius transfer, augmented with a semitendinosus tendon autograft and anchored to the infraspinatus insertion using an arthroscopically assisted technique and, to determine whether pain relief and functional improvement are maintained at minimum 7.5-year follow-up compared to the 11-month follow-up.

Methods: Between March 2014 and February 2024, 23 patients (15 men, 8 women; mean age 55 years, range 32-75) underwent surgical reconstruction of irreparable posterosuperior rotator cuff tears involving the supraspinatus, infraspinatus, and non-functional teres minor. A 6 cm horizontal incision was made just inferior to the scapular spine to harvest the lower trapezius tendon, which was augmented with the semitendinosus tendon. The extended tendon was fixed laterally to the greater tuberosity at the infraspinatus insertion via arthroscopy. The proximal stump was fixed medially into the lower trapezius muscle belly with the arm in maximum external rotation. Clinical outcomes were assessed using the Constant-Murley score, Visual Analog Scale (VAS), active Range of Motion and, Subjective Shoulder Value (SSV).

Results: Twenty-three patients were included, with a first mean follow-up of 11 months (range: 5-19 months). Twelve patients had a second mean follow-up of nine years and four months (range: 92-128 months). At the first follow-up, the average increase in external rotation in adduction was 40°, and 70° at ninety degrees of abduction (p<.001). The Constant-Murley score improved from 46 to 82 points (p<.001), the SSV increased from 40% to 67% (p<.001), and VAS pain decreased from 5 to 1 (p<.001). Both the lag sign and Hornblower sign were negative post-transfer. The subgroup with a follow-up of at least 7.5 years showed slight improvements in functional outcomes, including active range of motion (aROM), Constant score, VAS, and SSV, but no statistically significant differences compared to the 11-month follow-up. Complications included two hematomas, only one requiring revision due to infection.

Conclusion: Lower trapezius transfer is an effective treatment for irreparable posterosuperior rotator cuff tears with external rotation deficiency. This procedure results in significant improvement in pain and active external rotation in adduction and at 90° of abduction. Functional results remain stable over a long-term follow-up of minimum 7.5 years.