Pub Date : 2025-12-12DOI: 10.1016/j.xrrt.2025.100635
Allen A. Champagne MD, PhD , Winthrop C. Lockwood MD , Matthew Brown MD , George Puneky MD , Joshua Helmkamp MD , Alexandra Paul MD , Armodios M. Hatzidakis MD , Christian Péan MD , Malcolm R. DeBaun MD , Christopher Klifto MD
Background
To date, limited methods exist for intraoperative assessment of humeral rotation during intramedullary nailing. Here, we propose a standardized fluoroscopic sequence that relies on humeral bony anatomy and known retroversion between the proximal humerus, relative to the transepicondylar axis of the elbow.
Methods
Eight paired cadaveric specimens (4/4 M/F, N = 16) were mounted to simulate intraoperative positioning. Fluoroscopic images were acquired using a standardized sequence that includes a Grashey view of the proximal humerus and a lateral of the elbow. Rolling angles for each view were recorded and a corrective index was computed by calculating the difference in angulation between the Grashey view and lateral of the elbow. To test the proposed method, a transverse fracture of the proximal humerus was induced, and rotation was set during intramedullary fixation using the proposed sequence.
Results
Paired T-test comparing contralateral corrective indices showed no statistical difference across the paired sides (P = .190). Moreover, Pearson correlation among sides showed contralateral agreement (rho = 0.957, P = .0002) with absolute differences ranging from 1° to 8° suggesting that contralateral extremity can serve as a template for rotational profiling using this method.
Conclusion
The proposed fluoroscopic sequence provides a standardized method to restore native rotation of the humerus during intramedullary fixation, whereby the contralateral extremity can be used as a reference.
迄今为止，在髓内钉术中评估肱骨旋转的方法有限。在这里，我们提出了一个标准化的透视序列，该序列依赖于肱骨解剖和肱骨近端相对于肘关节经髁轴之间已知的后倾。方法8具配对尸体标本（4/4 M/F, N = 16）放置，模拟术中定位。采用标准化序列获得透视图像，包括肱骨近端和肘关节外侧的Grashey视图。记录每个视图的滚动角度，并通过计算Grashey视图与肘关节外侧角度之间的角度差异来计算校正指数。为了验证所提出的方法，我们诱导肱骨近端横向骨折，并在髓内固定过程中按照所提出的顺序进行旋转。结果西班牙t检验比较对侧矫正指标，两组间差异无统计学意义（P = 0.190）。此外，两侧之间的Pearson相关性显示对侧一致性（rho = 0.957, P = 0.0002），绝对差异范围为1°至8°，表明对侧肢体可以作为使用该方法进行旋转剖面的模板。结论所提出的透视序列提供了一种在髓内固定过程中恢复肱骨自然旋转的标准化方法，对侧肢体可作为参考。
{"title":"A standardized fluoroscopic method for profiling humeral rotational alignment during intramedullary nailing","authors":"Allen A. Champagne MD, PhD , Winthrop C. Lockwood MD , Matthew Brown MD , George Puneky MD , Joshua Helmkamp MD , Alexandra Paul MD , Armodios M. Hatzidakis MD , Christian Péan MD , Malcolm R. DeBaun MD , Christopher Klifto MD","doi":"10.1016/j.xrrt.2025.100635","DOIUrl":"10.1016/j.xrrt.2025.100635","url":null,"abstract":"<div><h3>Background</h3><div>To date, limited methods exist for intraoperative assessment of humeral rotation during intramedullary nailing. Here, we propose a standardized fluoroscopic sequence that relies on humeral bony anatomy and known retroversion between the proximal humerus, relative to the transepicondylar axis of the elbow.</div></div><div><h3>Methods</h3><div>Eight paired cadaveric specimens (4/4 M/F, N = 16) were mounted to simulate intraoperative positioning. Fluoroscopic images were acquired using a standardized sequence that includes a Grashey view of the proximal humerus and a lateral of the elbow. Rolling angles for each view were recorded and a corrective index was computed by calculating the difference in angulation between the Grashey view and lateral of the elbow. To test the proposed method, a transverse fracture of the proximal humerus was induced, and rotation was set during intramedullary fixation using the proposed sequence.</div></div><div><h3>Results</h3><div>Paired <em>T</em>-test comparing contralateral corrective indices showed no statistical difference across the paired sides (<em>P</em> = .190). Moreover, Pearson correlation among sides showed contralateral agreement (rho = 0.957, <em>P</em> = .0002) with absolute differences ranging from 1° to 8° suggesting that contralateral extremity can serve as a template for rotational profiling using this method.</div></div><div><h3>Conclusion</h3><div>The proposed fluoroscopic sequence provides a standardized method to restore native rotation of the humerus during intramedullary fixation, whereby the contralateral extremity can be used as a reference.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100635"},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xrrt.2025.100638
Areeb Ahmad BS , Kassem Ghayyad MD , Alaina Mitchell BS , Daryl C. Osbahr MD , G. Russell Huffman MD, MPH , Luke S. Oh MD, MS , Amir R. Kachooei MD, PhD , Rothman Florida Elbow Experts (ROFLEX) Group
Background
Traumatic elbow instability can be managed with hinged external fixator (HEF) or internal joint stabilizer (IJS). While prior studies report device-related complications with both devices, a comprehensive analysis comparing range of motion (ROM), patient-reported outcome measures, and surgical complications is limited. This study aims to evaluate these outcomes to guide treatment decisions for complex elbow instability.
Methods
This systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was performed in Google Scholar and PubMed from January 1, 2000, to February 20, 2025. Level I-IV studies were included if they reported on postoperative ROM, patient-reported outcome measure, or surgical complications as outcome measures in patients treated with HEF or IJS for elbow instability.
Results
Of the 2,041 articles identified, 38 studies met inclusion criteria for quantitative synthesis, including 27 of moderate quality and 11 of high quality based on the Newcastle–Ottawa Scale classification. Across the 29 retrospective studies, 8 prospective studies, and 1 randomized control trial, 500 patients underwent treatment with HEF, while 263 patients were treated with IJS. Disabilities of the Arm, Shoulder, and Hand scores were significantly better in the HEF group compared to IJS (9.8 vs. 23; P < .001). No significant differences were found between HEF and IJS in postoperative ROM, Mayo Elbow Performance Index, visual analog scale for pain, heterotopic ossification, or nerve injury rates.
Conclusion
HEF and IJS showed comparable rates of postoperative ROM, Mayo Elbow Performance Index, visual analog scale, heterotopic ossification, and nerve injury. However, Disabilities of the Arm, Shoulder, and Hand scores were 13.2 points lower in the HEF group, exceeding the minimal clinically important difference of 10.8 and indicating a clinically meaningful functional advantage of the upper extremity. This difference may be influenced by the less invasive nature of hardware removal with HEF compared to IJS. These findings should be interpreted with caution, given the overall lower level of evidence and heterogeneity across studies. Future prospective investigations with standardized rehabilitation protocols, longer follow-up, and stratification by injury chronicity, limb dominance, and preoperative motion are needed to better define optimal indications for each technique.
{"title":"External hinged fixation vs. internal joint stabilization for elbow instability: a systematic review and meta-analysis of functional outcomes and surgical complications","authors":"Areeb Ahmad BS , Kassem Ghayyad MD , Alaina Mitchell BS , Daryl C. Osbahr MD , G. Russell Huffman MD, MPH , Luke S. Oh MD, MS , Amir R. Kachooei MD, PhD , Rothman Florida Elbow Experts (ROFLEX) Group","doi":"10.1016/j.xrrt.2025.100638","DOIUrl":"10.1016/j.xrrt.2025.100638","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic elbow instability can be managed with hinged external fixator (HEF) or internal joint stabilizer (IJS). While prior studies report device-related complications with both devices, a comprehensive analysis comparing range of motion (ROM), patient-reported outcome measures, and surgical complications is limited. This study aims to evaluate these outcomes to guide treatment decisions for complex elbow instability.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was performed in Google Scholar and PubMed from January 1, 2000, to February 20, 2025. Level I-IV studies were included if they reported on postoperative ROM, patient-reported outcome measure, or surgical complications as outcome measures in patients treated with HEF or IJS for elbow instability.</div></div><div><h3>Results</h3><div>Of the 2,041 articles identified, 38 studies met inclusion criteria for quantitative synthesis, including 27 of moderate quality and 11 of high quality based on the Newcastle–Ottawa Scale classification. Across the 29 retrospective studies, 8 prospective studies, and 1 randomized control trial, 500 patients underwent treatment with HEF, while 263 patients were treated with IJS. Disabilities of the Arm, Shoulder, and Hand scores were significantly better in the HEF group compared to IJS (9.8 vs. 23; <em>P</em> < .001). No significant differences were found between HEF and IJS in postoperative ROM, Mayo Elbow Performance Index, visual analog scale for pain, heterotopic ossification, or nerve injury rates.</div></div><div><h3>Conclusion</h3><div>HEF and IJS showed comparable rates of postoperative ROM, Mayo Elbow Performance Index, visual analog scale, heterotopic ossification, and nerve injury. However, Disabilities of the Arm, Shoulder, and Hand scores were 13.2 points lower in the HEF group, exceeding the minimal clinically important difference of 10.8 and indicating a clinically meaningful functional advantage of the upper extremity. This difference may be influenced by the less invasive nature of hardware removal with HEF compared to IJS. These findings should be interpreted with caution, given the overall lower level of evidence and heterogeneity across studies. Future prospective investigations with standardized rehabilitation protocols, longer follow-up, and stratification by injury chronicity, limb dominance, and preoperative motion are needed to better define optimal indications for each technique.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100638"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xrrt.2025.100637
Rajpal S. Narulla MBBS, MS , Ryan Ting MBBS , Stone Sima , Ashish D. Diwan MBBS, MS (Ortho), DipNB, MNAMS, FRACS, FAOrthA, PhD , Geoffrey C.S. Smith MBBS, MS, FAOrthA, PhD
Background
Shoulder infections are an unfortunate and serious complication of surgery. The prevention strategy for infections is multimodal, with a strong reliance on surgical preparation solutions. There is great variability in the use of and effectiveness of surgical preparation solutions; this review aims to identify the most effective methods of shoulder surgical site preparation in the literature.
Methods
A systematic review and meta-analysis was conducted by 2 independent reviewers in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) framework. Articles were screened by title, then abstract, and finally by full text by each clinician independently. A third orthopedic clinician adjudicated any disagreement on the application of the inclusion criteria. Studies included were human clinical studies utilizing skin preparation methods for the shoulder in a simulated or real primary surgery setting. English language databases from 1980 until the first of January 2025 were accessed. The terms searched included “shoulder,” combined with each of the terms “skin,” “wound,” “antibiotic,” “decolonization,” “topical,” “eradication,” “preparation,” and “sterilization.” The results were pooled and then analyzed in subgroups according to the timing of skin preparation, the solution used, and the area of sampling.
Results
The search found 13,154 articles, of which 31 studies were included in the final study and captured a total of 2,115 patients who were cultured for organisms. The lowest rates of culture positivity at the time of surgery were associated with the use of benzoyl peroxide (27.1% culture positive) and prior-to-day-of-surgery preparation solution administration (30.5% culture positive). Patients who received preparation solutions with alcohol numbered 1,551, of which 577 (37.2%) had positive cultures. Patients who received preparation solutions without alcohol numbered 564, with 140 (24.8%) culture positive, P < .0001, chi-square = 28.285. Patients who had shoulder preparation only on the day of surgery numbered 2,067 with a total of 703 (34%) with positive cultures. The patients who did not have day-of-surgery preparation were numbered at 39, with 9 (23%) positive cultures, P = .027, chi-square = 4.89.
Conclusion
There is a wide range of available surgical preparation solutions to attempt to prevent day-of-surgery culture positivity. However, even the most robust regiments still have a substantially high culture positivity rate at the time of surgery. Further trials are warranted to unify protocols for the management of perioperative shoulder preparation.
肩部感染是手术中一种不幸且严重的并发症。感染的预防策略是多模式的，强烈依赖于手术准备解决方案。手术准备溶液的使用和有效性存在很大差异；本综述旨在找出文献中最有效的肩部手术部位准备方法。方法由2名独立审稿人按照PRISMA （Preferred Reporting Items for systematic review and meta-analysis）框架进行系统评价和meta分析。文章按标题筛选，然后是摘要，最后由每位临床医生独立筛选全文。第三位骨科临床医生裁决了对纳入标准应用的任何分歧。研究包括在模拟或真实的初级手术环境中使用肩部皮肤准备方法的人类临床研究。从1980年到2025年1月1日的英语数据库被访问。搜索的关键词包括“肩膀”，再加上“皮肤”、“伤口”、“抗生素”、“去殖民化”、“局部”、“根除”、“准备”和“消毒”。将结果汇总，然后根据皮肤准备时间、使用的溶液和采样面积分亚组进行分析。结果检索到13154篇文章，其中31篇研究被纳入最终研究，并捕获了2115名培养微生物的患者。手术时最低的培养阳性率与使用过氧化苯甲酰（27.1%培养阳性）和术前制剂溶液管理（30.5%培养阳性）有关。接受含酒精制剂溶液的患者1551例，其中577例（37.2%）培养阳性。接受不含酒精配制液的患者564例，培养阳性140例（24.8%），P < 0.0001，卡方= 28.285。仅在手术当天进行肩部准备的患者共有2067人，其中703人（34%）培养阳性。未做术前准备的患者39例，培养阳性9例（23%），P = 0.027，卡方= 4.89。结论有多种可行的手术准备方案可以防止术中培养阳性。然而，即使是最强大的军团在手术时仍然有相当高的培养阳性率。需要进一步的试验来统一围手术期肩关节准备的处理方案。
{"title":"Shoulder surgery preparation: a systematic review and meta-analysis","authors":"Rajpal S. Narulla MBBS, MS , Ryan Ting MBBS , Stone Sima , Ashish D. Diwan MBBS, MS (Ortho), DipNB, MNAMS, FRACS, FAOrthA, PhD , Geoffrey C.S. Smith MBBS, MS, FAOrthA, PhD","doi":"10.1016/j.xrrt.2025.100637","DOIUrl":"10.1016/j.xrrt.2025.100637","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder infections are an unfortunate and serious complication of surgery. The prevention strategy for infections is multimodal, with a strong reliance on surgical preparation solutions. There is great variability in the use of and effectiveness of surgical preparation solutions; this review aims to identify the most effective methods of shoulder surgical site preparation in the literature.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted by 2 independent reviewers in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) framework. Articles were screened by title, then abstract, and finally by full text by each clinician independently. A third orthopedic clinician adjudicated any disagreement on the application of the inclusion criteria. Studies included were human clinical studies utilizing skin preparation methods for the shoulder in a simulated or real primary surgery setting. English language databases from 1980 until the first of January 2025 were accessed. The terms searched included “shoulder,” combined with each of the terms “skin,” “wound,” “antibiotic,” “decolonization,” “topical,” “eradication,” “preparation,” and “sterilization.” The results were pooled and then analyzed in subgroups according to the timing of skin preparation, the solution used, and the area of sampling.</div></div><div><h3>Results</h3><div>The search found 13,154 articles, of which 31 studies were included in the final study and captured a total of 2,115 patients who were cultured for organisms. The lowest rates of culture positivity at the time of surgery were associated with the use of benzoyl peroxide (27.1% culture positive) and prior-to-day-of-surgery preparation solution administration (30.5% culture positive). Patients who received preparation solutions with alcohol numbered 1,551, of which 577 (37.2%) had positive cultures. Patients who received preparation solutions without alcohol numbered 564, with 140 (24.8%) culture positive, <em>P</em> < .0001, chi-square = 28.285. Patients who had shoulder preparation only on the day of surgery numbered 2,067 with a total of 703 (34%) with positive cultures. The patients who did not have day-of-surgery preparation were numbered at 39, with 9 (23%) positive cultures, <em>P</em> = .027, chi-square = 4.89.</div></div><div><h3>Conclusion</h3><div>There is a wide range of available surgical preparation solutions to attempt to prevent day-of-surgery culture positivity. However, even the most robust regiments still have a substantially high culture positivity rate at the time of surgery. Further trials are warranted to unify protocols for the management of perioperative shoulder preparation.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100637"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xrrt.2025.100636
Diego Gonzalez-Morgado MD, PhD , Kevin A. Hao MD , Barret Halgas MD , Farbod Malek MD , Spencer Falcon MD , Jordan Carter MD , Jorge L. Orbay MD , Ramesh C. Srinivasan MD
{"title":"Distal humerus allograft and double internal joint stabilizer reconstruction for chronic lateral humerus condyle nonunion with posterolateral instability: a case report","authors":"Diego Gonzalez-Morgado MD, PhD , Kevin A. Hao MD , Barret Halgas MD , Farbod Malek MD , Spencer Falcon MD , Jordan Carter MD , Jorge L. Orbay MD , Ramesh C. Srinivasan MD","doi":"10.1016/j.xrrt.2025.100636","DOIUrl":"10.1016/j.xrrt.2025.100636","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100636"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xrrt.2025.100639
Anna E. Crawford MD , Eric A. Mussell MD, MS, MBA , Matthew P. Ithurburn PT, DPT, PhD , Brook Ostrander BS , David Brockington BS , Cristian Arceo BS , Glenn S. Fleisig PhD , Marcus A. Rothermich MD , Michael K. Ryan MD , Benton A. Emblom MD , Jeffrey R. Dugas MD , E. Lyle Cain MD
Background
Use of all-suture soft anchors in arthroscopic rotator cuff repair (RCR) has been shown to provide both biomechanical and functional advantages. However, predictors of clinical outcomes following RCR using all-suture anchors have not been well established. This study aimed to examine predictors of clinical outcomes following double-row suture bridge RCR using either all-suture or solid medial row anchors.
Methods
We retrospectively identified patients at our institution who underwent arthroscopic RCR. Patients were eligible for inclusion if they underwent primary arthroscopic RCR using a double-row suture-bridge technique with either all-suture or solid medial row anchors, were between the ages of 18 and 85, and were at least 2 years postoperative. We collected demographic, clinical, and intraoperative data via electronic health record review. Patient-reported outcomes were evaluated at follow-up using the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment and visual analog scale (VAS). Proportions meeting Patient Acceptable Symptomatic State (PASS) thresholds for each were calculated. Within either anchor group, we used univariable linear and logistic regression to examine predictors of scores and meeting PASS thresholds at follow-up, respectively.
Results
In total, 352 patients completed follow-up (mean age = 60.3 ± 10.0 years; 61% male; mean follow-up time = 3.0 ± 0.8 years). Within the all-suture anchor group (n = 280), male sex (P = .04) and longer follow-up time (P < .01) were associated with improved ASES scores, higher odds of meeting the PASS cutoff for the ASES (P < .01), improved VAS scores (P = .01), and higher odds of meeting the PASS cutoff for the VAS (P = .02). Within the solid anchor group (n = 72), large tears were associated with worse ASES scores (P < .01), lower odds of meeting the PASS cutoff for the ASES (P = .02), and worse VAS scores (P < .01. Longer follow-up time was associated with higher odds of meeting the PASS cutoff for the VAS (P = .04).
Conclusion
Following arthroscopic double-row suture-bridge RCR, longer follow-up time was associated with better patient-reported outcomes (PROs) in both anchor type groups. However, smaller tear size was associated with better PROs only within the solid anchor group, whereas male sex was associated with better PROs only within the all-suture anchor group.
{"title":"Predictors of outcomes following double-row rotator cuff repair: an assessment of all-suture or solid medial row anchor utilization at a single high-volume institution","authors":"Anna E. Crawford MD , Eric A. Mussell MD, MS, MBA , Matthew P. Ithurburn PT, DPT, PhD , Brook Ostrander BS , David Brockington BS , Cristian Arceo BS , Glenn S. Fleisig PhD , Marcus A. Rothermich MD , Michael K. Ryan MD , Benton A. Emblom MD , Jeffrey R. Dugas MD , E. Lyle Cain MD","doi":"10.1016/j.xrrt.2025.100639","DOIUrl":"10.1016/j.xrrt.2025.100639","url":null,"abstract":"<div><h3>Background</h3><div>Use of all-suture soft anchors in arthroscopic rotator cuff repair (RCR) has been shown to provide both biomechanical and functional advantages. However, predictors of clinical outcomes following RCR using all-suture anchors have not been well established. This study aimed to examine predictors of clinical outcomes following double-row suture bridge RCR using either all-suture or solid medial row anchors.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients at our institution who underwent arthroscopic RCR. Patients were eligible for inclusion if they underwent primary arthroscopic RCR using a double-row suture-bridge technique with either all-suture or solid medial row anchors, were between the ages of 18 and 85, and were at least 2 years postoperative. We collected demographic, clinical, and intraoperative data via electronic health record review. Patient-reported outcomes were evaluated at follow-up using the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment and visual analog scale (VAS). Proportions meeting Patient Acceptable Symptomatic State (PASS) thresholds for each were calculated. Within either anchor group, we used univariable linear and logistic regression to examine predictors of scores and meeting PASS thresholds at follow-up, respectively.</div></div><div><h3>Results</h3><div>In total, 352 patients completed follow-up (mean age = 60.3 ± 10.0 years; 61% male; mean follow-up time = 3.0 ± 0.8 years). Within the all-suture anchor group (n = 280), male sex (<em>P</em> = .04) and longer follow-up time (<em>P</em> < .01) were associated with improved ASES scores, higher odds of meeting the PASS cutoff for the ASES (<em>P</em> < .01), improved VAS scores (<em>P</em> = .01), and higher odds of meeting the PASS cutoff for the VAS (<em>P</em> = .02). Within the solid anchor group (n = 72), large tears were associated with worse ASES scores (<em>P</em> < .01), lower odds of meeting the PASS cutoff for the ASES (<em>P</em> = .02), and worse VAS scores (<em>P</em> < .01. Longer follow-up time was associated with higher odds of meeting the PASS cutoff for the VAS (<em>P</em> = .04).</div></div><div><h3>Conclusion</h3><div>Following arthroscopic double-row suture-bridge RCR, longer follow-up time was associated with better patient-reported outcomes (PROs) in both anchor type groups. However, smaller tear size was associated with better PROs only within the solid anchor group, whereas male sex was associated with better PROs only within the all-suture anchor group.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100639"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While arthroscopic irrigation and débridement are commonly used to treat septic arthritis of the shoulder because of their minimally invasive nature and favorable clinical outcomes, reinfection remains a concern. Povidone-iodine has demonstrated broad-spectrum antimicrobial activity and is increasingly used for surgical site irrigation. However, its efficacy and safety in the arthroscopic management of septic shoulder arthritis have not been well established.
Methods
We retrospectively reviewed 15 shoulders in 15 patients with septic arthritis of the shoulder who underwent arthroscopic irrigation and débridement using a 0.35% povidone-iodine solution. Functional outcomes, reoperation rates for reinfection, and radiographic changes were assessed after a minimum postoperative follow-up period of 6 months.
Results
Although the reoperation rate for reinfection was 0%, 1 patient (6.7%, 1 of 15) experienced reinfection, which was managed nonoperatively. No adverse effects attributable to povidone-iodine were observed. Radiographic progression of glenohumeral arthritis was noted in 4 patients (26.7%). Functional outcomes were significantly worse in patients with progressive arthritic changes compared to those without progression.
Conclusion
Arthroscopic débridement combined with irrigation using diluted 0.35% povidone-iodine was associated with a low reoperation rate for reinfection in septic arthritis of the shoulder, without significant adverse effects. Further controlled studies are required to confirm the safety and efficacy of this approach.
{"title":"Low reoperation rate following arthroscopic débridement using diluted povidone-iodine irrigation for septic shoulder arthritis","authors":"Terufumi Shibata MD, PhD , Satoshi Miyake MD, PhD , Kotaro Miyazaki MD, PhD , Kei Matsunaga MD , Naofumi Hata MD , Masahiko Sakai MD , So Minokawa MD, PhD , Yozo Shibata MD, PhD , Teruaki Izaki MD, PhD , Takuaki Yamamoto MD, PhD","doi":"10.1016/j.xrrt.2025.100643","DOIUrl":"10.1016/j.xrrt.2025.100643","url":null,"abstract":"<div><h3>Background</h3><div>While arthroscopic irrigation and débridement are commonly used to treat septic arthritis of the shoulder because of their minimally invasive nature and favorable clinical outcomes, reinfection remains a concern. Povidone-iodine has demonstrated broad-spectrum antimicrobial activity and is increasingly used for surgical site irrigation. However, its efficacy and safety in the arthroscopic management of septic shoulder arthritis have not been well established.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 15 shoulders in 15 patients with septic arthritis of the shoulder who underwent arthroscopic irrigation and débridement using a 0.35% povidone-iodine solution. Functional outcomes, reoperation rates for reinfection, and radiographic changes were assessed after a minimum postoperative follow-up period of 6 months.</div></div><div><h3>Results</h3><div>Although the reoperation rate for reinfection was 0%, 1 patient (6.7%, 1 of 15) experienced reinfection, which was managed nonoperatively. No adverse effects attributable to povidone-iodine were observed. Radiographic progression of glenohumeral arthritis was noted in 4 patients (26.7%). Functional outcomes were significantly worse in patients with progressive arthritic changes compared to those without progression.</div></div><div><h3>Conclusion</h3><div>Arthroscopic débridement combined with irrigation using diluted 0.35% povidone-iodine was associated with a low reoperation rate for reinfection in septic arthritis of the shoulder, without significant adverse effects. Further controlled studies are required to confirm the safety and efficacy of this approach.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100643"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xrrt.2025.100642
Brittany Percin BS , Jennifer C. Wang MD , Christopher C. Joyce MD , Corrine Welt MD , Robert Z. Tashjian MD , Peter N. Chalmers MD
Background
Although rotator cuff tears are one the most common musculoskeletal sources of disability, healing after rotator cuff repair (RCR) fails in >25% of cases. Existing data suggest that estradiol deficiency may be associated with worse postoperative outcomes following RCR. Thus, the purpose of this study was to determine whether estradiol supplementation among postmenopausal women is associated with better outcomes after RCR and we hypothesized that such an association would exist.
Methods
A retrospective review of all patients who underwent RCR by the lead author was done to identify those who were female and ≥50 years old, thus presumed to be postmenopausal. For all patients, all medications were recorded the day of surgery by the anesthesiologist in the preanesthesia note. These notes were reviewed to determine which patients were taking hormone replacement therapy (ie. “HRT”) and those who were not (i.e. “non-HRT) at the time of surgery. All patients were contacted at 2 years postoperatively. Subjective Shoulder Value (SSV), visual analog scale (VAS) for pain, and American Shoulder and Elbow Surgeons (ASES) score were collected, in addition to satisfaction and need for further reoperation.
Results
Overall, 254 women underwent RCR, of whom 2-year outcomes were obtained in 184 (74%) of which 42 (23%) were on estradiol supplementation at the time of surgery. There were no differences between groups in preoperative SSV (43 ± 21 non-HRT vs. 38 ± 22 HRT, P = .209), VAS (5.6 ± 2.3 vs. 5.7 ± 2.3, P = .770), or ASES scores (46 ± 20 vs. 44 ± 19, P = .738). However, HRT postmenopausal patients had significantly better VAS (1.2 ± 2.1 vs. 0.3 ± 0.8, P < .001) and SSV scores (87 ± 16 vs. 95 ± 10, P = .003) at 2-years postoperatively when compared to non-HRT postmenopausal patients. There were no significant differences in satisfaction (96.3% vs. 90.3%, P = .605), ASES scores (87 ± 17 vs. 94 ± 11, P = .146), or reoperation rates (7.9% vs. 14.8%, P = .297).
Conclusion
Estradiol supplementation was associated with better outcomes in postmenopausal women undergoing RCR; however, these differences in VAS and SSV did not meet the minimal clinically important threshold. Future prospective randomized studies could be considered before prescribing estradiol to postmenopausal patients in the setting of RCR.
背景：虽然肩袖撕裂是最常见的肌肉骨骼致残原因之一，但有25%的病例在肩袖修复（RCR）后无法愈合。现有数据表明，雌二醇缺乏可能与RCR术后较差的预后有关。因此，本研究的目的是确定绝经后妇女补充雌二醇是否与RCR后更好的预后相关，我们假设存在这种关联。方法对第一作者进行的所有RCR患者进行回顾性分析，以确定那些年龄≥50岁的女性，因此推定为绝经后。所有患者的所有药物均由麻醉师在手术当日的麻醉前记录中记录。审查这些记录以确定哪些患者正在接受激素替代疗法(即：“HRT”)和那些在手术时没有（即“非HRT”）的人。所有患者在术后2年联系。收集主观肩值（SSV）、疼痛视觉模拟评分（VAS）、美国肩肘外科医生（ASES）评分，以及满意度和进一步手术的需要。结果总共有254名妇女接受了RCR，其中184名（74%）获得了2年的预后，其中42名（23%）在手术时补充雌二醇。术前SSV（非HRT 43±21 vs. HRT 38±22,P = .209）、VAS（5.6±2.3 vs. 5.7±2.3,P = .770）、as评分（46±20 vs. 44±19,P = .738）组间无差异。然而，与非HRT绝经后患者相比，HRT绝经后患者术后2年的VAS（1.2±2.1比0.3±0.8,P < 0.001）和SSV评分（87±16比95±10，P = 0.003）明显更好。两组患者满意度（96.3%比90.3%,P = 0.605）、asa评分（87±17比94±11，P = 0.146）、再手术率（7.9%比14.8%,P = 0.297）差异均无统计学意义。结论补充雌二醇可改善绝经后RCR患者的预后；然而，VAS和SSV的这些差异没有达到最低临床重要阈值。在RCR的背景下，在给绝经后患者开雌二醇处方之前，可以考虑未来的前瞻性随机研究。
{"title":"Does estradiol supplementation improve rotator cuff repair outcomes in postmenopausal women?","authors":"Brittany Percin BS , Jennifer C. Wang MD , Christopher C. Joyce MD , Corrine Welt MD , Robert Z. Tashjian MD , Peter N. Chalmers MD","doi":"10.1016/j.xrrt.2025.100642","DOIUrl":"10.1016/j.xrrt.2025.100642","url":null,"abstract":"<div><h3>Background</h3><div>Although rotator cuff tears are one the most common musculoskeletal sources of disability, healing after rotator cuff repair (RCR) fails in >25% of cases. Existing data suggest that estradiol deficiency may be associated with worse postoperative outcomes following RCR. Thus, the purpose of this study was to determine whether estradiol supplementation among postmenopausal women is associated with better outcomes after RCR and we hypothesized that such an association would exist.</div></div><div><h3>Methods</h3><div>A retrospective review of all patients who underwent RCR by the lead author was done to identify those who were female and ≥50 years old, thus presumed to be postmenopausal. For all patients, all medications were recorded the day of surgery by the anesthesiologist in the preanesthesia note. These notes were reviewed to determine which patients were taking hormone replacement therapy (ie. “HRT”) and those who were not (i.e. “non-HRT) at the time of surgery. All patients were contacted at 2 years postoperatively. Subjective Shoulder Value (SSV), visual analog scale (VAS) for pain, and American Shoulder and Elbow Surgeons (ASES) score were collected, in addition to satisfaction and need for further reoperation.</div></div><div><h3>Results</h3><div>Overall, 254 women underwent RCR, of whom 2-year outcomes were obtained in 184 (74%) of which 42 (23%) were on estradiol supplementation at the time of surgery. There were no differences between groups in preoperative SSV (43 ± 21 non-HRT vs. 38 ± 22 HRT, <em>P</em> = .209), VAS (5.6 ± 2.3 vs. 5.7 ± 2.3, <em>P</em> = .770), or ASES scores (46 ± 20 vs. 44 ± 19, <em>P</em> = .738). However, HRT postmenopausal patients had significantly better VAS (1.2 ± 2.1 vs. 0.3 ± 0.8, <em>P</em> < .001) and SSV scores (87 ± 16 vs. 95 ± 10, <em>P</em> = .003) at 2-years postoperatively when compared to non-HRT postmenopausal patients. There were no significant differences in satisfaction (96.3% vs. 90.3%, <em>P</em> = .605), ASES scores (87 ± 17 vs. 94 ± 11, <em>P</em> = .146), or reoperation rates (7.9% vs. 14.8%, <em>P</em> = .297).</div></div><div><h3>Conclusion</h3><div>Estradiol supplementation was associated with better outcomes in postmenopausal women undergoing RCR; however, these differences in VAS and SSV did not meet the minimal clinically important threshold. Future prospective randomized studies could be considered before prescribing estradiol to postmenopausal patients in the setting of RCR.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100642"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1016/j.xrrt.2025.100634
Chang Hee Baek MD , Bo Taek Kim MD , Mohammed Bensaka MD , Jose Alberto Llamas Martinez MD , Gyuna Baek MS , Jean Kany MD
Background
Arthroscopically assisted posterior latissimus dorsi (LD) tendon transfer has shown promise in patients with posterior superior rotator cuff tears (PSRCTs). Body mass index (BMI), a modifiable patient factor, may influence outcomes in rotator cuff surgeries. However, its impact on outcomes following arthroscopically assisted LD transfer remains underexplored. This study aims to assess the relationship between BMI and clinical outcomes in patients undergoing LD transfer for PSRCTs.
Methods
A retrospective review of patients who underwent arthroscopically assisted posterior LD transfer with a minimum of 5 years of follow-up was conducted. Clinical outcomes, including pain (visual analog scale), patient-reported outcome measures, and range of motion (ROM), were assessed preoperatively and at final follow-up. Patients were divided into 2 groups based on BMI (≥26.2 and <26.2). Also, univariable and multivariable regression models were used to evaluate associations between BMI and clinical outcomes.
Results
A total of 57 patients were included, with a mean follow-up of 76.7 ± 7.2 months (range, 69-92), and a mean age of 63.2 ± 8.6 years (range, 43-80). The average BMI was 26.2. Significant improvements were observed in all clinical measures, including pain; patient-reported outcome measures including Simple Shoulder Test, Subjective Shoulder Value, Activities of Daily Living External Rotation score, and the American Shoulder and Elbow Surgeons score; and ROM, all P < .001. No significant differences were found in clinical outcomes between the above-average and below-average BMI groups. Furthermore, BMI was not significantly correlated with the magnitude of clinical improvement.
Conclusion
Arthroscopically assisted posterior LD tendon transfer for PSRCTs leads to substantial improvements in pain, function, and ROM. No significant differences were observed between above-average and below-average BMI groups, and BMI was not correlated with clinical improvements. These findings suggest that BMI may not influence the effectiveness of posterior LD transfer.
{"title":"Body mass index does not affect clinical outcomes following arthroscopically assisted posterior latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears: a minimum 5-year follow-up study","authors":"Chang Hee Baek MD , Bo Taek Kim MD , Mohammed Bensaka MD , Jose Alberto Llamas Martinez MD , Gyuna Baek MS , Jean Kany MD","doi":"10.1016/j.xrrt.2025.100634","DOIUrl":"10.1016/j.xrrt.2025.100634","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopically assisted posterior latissimus dorsi (LD) tendon transfer has shown promise in patients with posterior superior rotator cuff tears (PSRCTs). Body mass index (BMI), a modifiable patient factor, may influence outcomes in rotator cuff surgeries. However, its impact on outcomes following arthroscopically assisted LD transfer remains underexplored. This study aims to assess the relationship between BMI and clinical outcomes in patients undergoing LD transfer for PSRCTs.</div></div><div><h3>Methods</h3><div>A retrospective review of patients who underwent arthroscopically assisted posterior LD transfer with a minimum of 5 years of follow-up was conducted. Clinical outcomes, including pain (visual analog scale), patient-reported outcome measures, and range of motion (ROM), were assessed preoperatively and at final follow-up. Patients were divided into 2 groups based on BMI (≥26.2 and <26.2). Also, univariable and multivariable regression models were used to evaluate associations between BMI and clinical outcomes.</div></div><div><h3>Results</h3><div>A total of 57 patients were included, with a mean follow-up of 76.7 ± 7.2 months (range, 69-92), and a mean age of 63.2 ± 8.6 years (range, 43-80). The average BMI was 26.2. Significant improvements were observed in all clinical measures, including pain; patient-reported outcome measures including Simple Shoulder Test, Subjective Shoulder Value, Activities of Daily Living External Rotation score, and the American Shoulder and Elbow Surgeons score; and ROM, all <em>P</em> < .001. No significant differences were found in clinical outcomes between the above-average and below-average BMI groups. Furthermore, BMI was not significantly correlated with the magnitude of clinical improvement.</div></div><div><h3>Conclusion</h3><div>Arthroscopically assisted posterior LD tendon transfer for PSRCTs leads to substantial improvements in pain, function, and ROM. No significant differences were observed between above-average and below-average BMI groups, and BMI was not correlated with clinical improvements. These findings suggest that BMI may not influence the effectiveness of posterior LD transfer.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100634"},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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