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Pectoralis major transfer over vs. under the conjoint tendon for the treatment of irreparable subscapularis rupture: a systematic review comparing clinical outcomes, complications, and failure rates 胸大肌转移治疗不可修复肩胛下肌断裂:一项比较临床结果、并发症和失败率的系统综述
Q4 Medicine Pub Date : 2025-10-24 DOI: 10.1016/j.xrrt.2025.100600
Ross Clarke ScM , Lema Abuoqab BS , Brian S. Tao BA , Paul Sherban MA , Mohammad Abdelaal MD, PhD , Kevin A. Hao MD , Joseph W. Galvin DO , Jeffrey Bortman MD , Brian R. Waterman MD , Josef K. Eichinger MD , Xinning Li MD

Background

Transfer of the pectoralis major muscle tendon unit has proven to be an effective solution for reconstituting the force couple after rotator cuff tears involving an irreparable subscapularis tendon. The tendon can be routed over or under the conjoint tendon; however, it is unclear if tendon routing influences postoperative outcomes. The purpose of this study was to compare the complication rates and clinical outcome measures between pectoralis major transfer performed with a subcoracoid vs. supracoracoid tendon routing.

Methods

We performed a systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, querying MEDLINE (PubMed) and EMBASE databases for studies reporting outcomes and complications following pectoralis major transfer with a minimum of 1-year follow-up. We assessed the methodological quality of each study using the methodological index for nonrandomized studies score and extracted patient demographic, surgical, and outcome data.

Results

Seven studies involving 179 shoulders (174 patients) were included. The mean patient age was 57.6 years with a follow-up of 71.5 months. Tendon routing over (n = 76 shoulders) or under (n = 103 shoulders) the conjoint tendon showed similar improvements in Constant Score (+20.4 vs. +28.6, P = .08). Graft failure rates were also comparable when the pectoralis major tendon was routed over vs. under the conjoint tendon (14% vs. 9%, P = .46). However, graft failure varied by tendon type, with the sternal head having significantly higher failure rate (27%) compared to transfers using the clavicular head (7%) and entire tendon (5%) (P = .02). Complication rates, additional ipsilateral shoulder surgery, and rates of patient satisfaction were similar with respect to tendon placement above or below the conjoint tendon and graft type.

Conclusion

The complication rate, incidence of subsequent surgery, and Constant–Murley Score did not differ based on whether the pectoralis major tendon was placed over or under the conjoint tendon during transfers. However, graft failure rates were greater in cohorts using only the sternocostal head of the pectoralis major tendon, while all other outcomes were similar.
背景:胸大肌肌腱单元的转移已被证明是在肩胛下肌腱不可修复的肩袖撕裂后重建力偶的有效解决方案。肌腱可以穿过或穿过联合肌腱;然而,肌腱移位是否影响术后结果尚不清楚。本研究的目的是比较用喙下肌腱和冠上肌腱进行胸大肌转移的并发症发生率和临床结果。方法:我们使用首选报告项目进行系统评价和荟萃分析指南,查询MEDLINE (PubMed)和EMBASE数据库,报告胸大肌转移后的结果和并发症,随访至少1年。我们使用非随机研究的方法学指数评分来评估每项研究的方法学质量,并提取患者人口统计学、手术和结局数据。结果纳入7项研究,涉及179个肩部(174例患者)。患者平均年龄57.6岁,随访71.5个月。肌腱穿过(n = 76肩)或穿过(n = 103肩)关节肌腱在Constant Score中表现出相似的改善(+20.4 vs +28.6, P = 0.08)。当胸大肌肌腱在联合肌腱上和在联合肌腱下敷设时,移植物失败率也相当(14%对9%,P = 0.46)。然而,移植失败因肌腱类型而异,胸骨头移植失败率(27%)明显高于锁骨头移植(7%)和全肌腱移植(5%)(P = 0.02)。并发症发生率、额外的同侧肩关节手术和患者满意度在关节肌腱上方或下方和移植物类型的肌腱放置方面相似。结论转移时胸大肌肌腱位于联合肌腱上方或下方,其并发症发生率、后续手术发生率及Constant-Murley评分均无差异。然而,仅使用胸大肌肌腱胸肋头的移植失败率更高,而所有其他结果相似。
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引用次数: 0
Glenoid grafting in the first stage of 2-stage revision shoulder arthroplasty in the setting of infection: a technical note 感染情况下2期翻修肩关节置换术第一期关节盂移植术的技术要点
Q4 Medicine Pub Date : 2025-10-23 DOI: 10.1016/j.xrrt.2025.100598
David Sylvester BS, Kassem Ghayyad MD, Daniel Goltz MD, G. Russell Huffman MD, MPH, FAAOS
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引用次数: 0
Olecranon bursal repair for chronic traumatic bursitis: a surgical technique 鹰嘴滑囊修复慢性外伤性滑囊炎:一种外科技术
Q4 Medicine Pub Date : 2025-10-16 DOI: 10.1016/j.xrrt.2025.100597
Álvaro Javier Muratore MD , Nadia Gabotto Loredo MD , Gonzalo Martín Viollaz MD , Denise Hammoe MD , Gómez Rodriguez Gustavo MD , Diego José Gómez MD , Alejandro Tedeschi MD , Gustavo Teruya MD , Rafael Duran MD
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引用次数: 0
Correction of major humeral deformity from acquired ricket using a 3D personalized osteotomy guide 三维个体化截骨导具矫正获得性佝偻病肱骨主要畸形
Q4 Medicine Pub Date : 2025-10-15 DOI: 10.1016/j.xrrt.2025.100594
Mamoun Belkebir Mrani MD, Romain Carlat MD, Bruno Vincent MD, Faouzi Abou-Messaoud MD, Serge Ayong MD, Julien Coquay MD
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引用次数: 0
The cruciate double rip-stop technique: an all-suture distal triceps tendon repair technique combining a pulley mechanism and racking hitch knots 十字双撕裂停止技术:一种全缝合的三头肌腱远端修复技术,结合滑轮机构和拉结结
Q4 Medicine Pub Date : 2025-10-15 DOI: 10.1016/j.xrrt.2025.100595
Christian S. Rosenow MD , Parag Raval MBBS BSc (Hons), MRCS (Eng) FRCS (Tr & Orth) , Joaquin Sanchez-Sotelo MD, PhD , Mark E. Morrey MD, MS
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引用次数: 0
Salter-Harris type III fracture-dislocation of the glenoid: a case report Salter-Harris型关节盂骨折脱位1例
Q4 Medicine Pub Date : 2025-10-15 DOI: 10.1016/j.xrrt.2025.100596
Brandon L. Ziegenfuss BSc (Hons), MPH , Tristan Shuker BSc (Hons) , Kenneth Cutbush MBBS, FRACS, FAOrthA
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引用次数: 0
Exploring the level of association between rotator cuff tears and acromiohumeral distance: a systematic review 探讨肩袖撕裂与肩肱骨距离之间的关系:一项系统综述
Q4 Medicine Pub Date : 2025-10-14 DOI: 10.1016/j.xrrt.2025.100593
Saria Alharairi MSc (in Rehabilitation Sciences), Joshua Vincent PhD (in Rehabilitation Sciences)

Background

Rotator cuff tears (RCTs) are a prevalent cause of shoulder pain and dysfunction, often associated with narrowing of the acromiohumeral distance (AHD). AHD is commonly used as a valuable marker of rotator cuff integrity, yet its diagnostic and prognostic value remains debated. This systematic review aims to explore the relationship between AHD and RCTs, with consideration of tear type, imaging modality, and tendon involvement.

Methods

A systematic search of PubMed, EMBASE, CINAHL, and Web of Science was conducted to identify comparative studies published between 2000 and 2024. Eligible studies included adults (≥18 years) with chronic or acute RCTs (partial or full-thickness) and healthy controls. Studies were required to report AHD measurements using magnetic resonance imaging, radiographs, or ultrasound in an upright, neutral shoulder position. Risk of bias was assessed using the Hoy et al tool. Eight studies met the inclusion criteria.

Results

Across studies, AHD was consistently defined as the shortest distance between the acromion and humeral head. Imaging modalities varied, with magnetic resonance imaging most commonly used. While several studies reported significantly reduced AHD in RCTs, particularly full-thickness and multi-tendon tears, others found no significant differences compared to controls. Mean AHD values ranged from ∼5.9 mm in massive or multi-tendon tears to ∼9.7 mm in healthy controls. Multi-tendon involvement was consistently associated with greater AHD reduction than single-tendon tears. The reliability of AHD measurement was high across modalities. However, heterogeneity in sample size, imaging tools, and lack of control for confounding factors (eg, body mass index, activity level, muscle atrophy) limited comparability.

Conclusion

AHD tends to decrease with increasing RCT severity, particularly in multi-tendon involvement, supporting its relevance in clinical assessment. However, inconsistencies across studies highlight the need for standardized imaging protocols and consideration of confounders. While AHD shows promise as a diagnostic and prognostic marker, it should not be used in isolation. Future longitudinal and dynamic imaging studies are recommended to better understand its clinical utility.
背景:肩袖撕裂(rct)是导致肩部疼痛和功能障碍的常见原因,通常与肩肱距离(AHD)变窄有关。AHD通常被用作有价值的肩袖完整性标记物,但其诊断和预后价值仍存在争议。本系统综述旨在探讨AHD与rct之间的关系,并考虑撕裂类型、成像方式和肌腱受累。方法系统检索PubMed、EMBASE、CINAHL和Web of Science,筛选2000 - 2024年间发表的比较研究。符合条件的研究包括慢性或急性随机对照试验(部分或全层)的成人(≥18岁)和健康对照。研究报告AHD测量使用磁共振成像,x线片,或超声在直立,中立的肩膀位置。使用Hoy等工具评估偏倚风险。8项研究符合纳入标准。结果所有研究一致将AHD定义为肩胛骨和肱骨头之间的最短距离。成像方式多种多样,最常用的是磁共振成像。虽然一些研究报告了rct中AHD的显著降低,特别是全层和多肌腱撕裂,但其他研究发现与对照组相比没有显著差异。平均AHD值从大块或多肌腱撕裂的5.9 mm到健康对照组的9.7 mm不等。多肌腱受累与单肌腱撕裂相比,AHD的减少程度更大。AHD测量的可靠性在各种模式下都很高。然而,样本量、成像工具的异质性以及缺乏对混杂因素(如体重指数、活动水平、肌肉萎缩)的控制,限制了可比性。结论ahd倾向于随着RCT严重程度的增加而降低,特别是在多肌腱受累时,支持其在临床评估中的相关性。然而,研究之间的不一致性突出了标准化成像方案和考虑混杂因素的必要性。虽然adhd有望作为诊断和预后指标,但它不应单独使用。未来的纵向和动态影像研究建议,以更好地了解其临床应用。
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引用次数: 0
Comparison between allograft and autograft in lower trapezius tendon transfer in irreparable rotator cuff tears: a systematic review 同种异体和自体斜方肌下肌腱移植治疗不可修复肩袖撕裂的比较:系统综述
Q4 Medicine Pub Date : 2025-10-09 DOI: 10.1016/j.xrrt.2025.100588
Chang Hee Baek MD, Chaemoon Lim MD, Jung Gon Kim MD, Bo Taek Kim MD

Background

Recently, lower trapezius tendon transfer (LTT) has gained attention as an effective treatment option for irreparable rotator cuff tears. Although the use of interpositional graft is an inevitable process in LTT, there was no study to compare the allograft and autograft as an interpositional graft in LTT. The purpose of this systematic review is to compare the clinical outcome, graft retear and complications according to the interpositional graft using allograft and autograft in LTT.

Methods

This systematic review was prepared with the guidelines of the preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The inclusion criteria of this systematic review were a full-length article written in English, peer-reviewed articles, level of evidence IV or higher articles, and articles reporting the clinical outcome of LTT. A comprehensive search was performed in PubMed, Cochrane Library, and Ovid-Embase. The quality of selected articles was assessed with Methodological Index for Non-Randomized studies score. The postoperative range of motion, patient-reported clinical outcome scores, graft retear, complications, and reoperations were systematically analyzed.

Results

A total of 299 patients of 12 articles were included in this systematic review. Among them, 230 patients of 8 articles reported the results of allograft, and 69 patients of 4 articles reported the results of autograft. The mean Methodological Index for Non-Randomized studies score of 3 comparative studies and 9 case series were 17.3 ± 0.6 (72.1% of total score) and 10.6 ± 0.9 (66.3% of total score), respectively. Both allograft group and autograft group had a tendency of improvement in range of motion, and patients-reported clinical outcomes. Total graft retear rate was reported in 20 of 214 (9.3%) patients from 6 articles with a range from 4.3% to 10.5%. Total complication rate was reported in 33 of 299 (11.0%) patients from 12 articles with range from 8.6% to 26.8%. For allograft group and autograft group, the graft retear rate was 13 of 169 (7.7%) from 4 articles and 3 of 45 (6.7%) from 2 articles, respectively. The complication rate was 27 of 230 (11.7%) from 8 articles in allograft group and 6 of 69 (8.7%) from 4 articles in auto graft group.

Conclusion

LTT may lead to significant improvement in clinical outcomes in patients with irreparable rotator cuff tears, regardless of whether allograft or autograft is used for interpositional grafts. Although the graft retear rate was slightly higher in the allograft group, the difference of graft retear rate between allograft and autograft was not significant. However, other complications, and reoperations were higher in allograft group.
最近,下斜方肌腱转移(LTT)作为一种治疗不可修复的肩袖撕裂的有效选择而受到关注。虽然在LTT中使用间位移植物是一个不可避免的过程,但目前还没有研究比较同种异体移植物和自体移植物作为LTT的间位移植物。本系统综述的目的是比较同种异体移植物和自体移植物间位移植在LTT中的临床疗效、移植失败率和并发症。方法本系统评价以系统评价首选报告项目和meta分析声明为指导。本系统评价的纳入标准为英文全文、同行评议文章、证据水平为IV级或更高的文章,以及报道LTT临床结果的文章。在PubMed、Cochrane Library和Ovid-Embase中进行了全面的搜索。所选文章的质量用非随机研究的方法学指数评分进行评估。系统分析术后活动范围、患者报告的临床结果评分、移植物回收、并发症和再手术。结果本系统综述共纳入12篇文献299例患者。其中230例8篇报道同种异体移植结果,69例4篇报道自体移植结果。3项比较研究和9个病例系列的非随机研究方法学指数(Methodological Index for Non-Randomized studies)平均得分分别为17.3±0.6(占总分的72.1%)和10.6±0.9(占总分的66.3%)。同种异体移植物组和自体移植物组在活动范围和患者报告的临床结果方面都有改善的趋势。6篇文章报道了214例患者中有20例(9.3%)的总移植物再入率,范围从4.3%到10.5%。12篇文章中299例患者中有33例(11.0%)报告了总并发症发生率,范围从8.6%到26.8%。同种异体移植组和自体移植组4篇169例中有13例(7.7%),2篇45例中有3例(6.7%)。同种异体移植组8条230例中有27例(11.7%)出现并发症,自体移植组4条69例中有6例(8.7%)出现并发症。结论无论采用同种异体或自体间位移植,ltt均可显著改善不可修复的肩袖撕裂患者的临床预后。虽然同种异体移植组的移植失败率略高,但同种异体移植与自体移植的移植失败率差异不显著。同种异体移植组其他并发症和再手术发生率较高。
{"title":"Comparison between allograft and autograft in lower trapezius tendon transfer in irreparable rotator cuff tears: a systematic review","authors":"Chang Hee Baek MD,&nbsp;Chaemoon Lim MD,&nbsp;Jung Gon Kim MD,&nbsp;Bo Taek Kim MD","doi":"10.1016/j.xrrt.2025.100588","DOIUrl":"10.1016/j.xrrt.2025.100588","url":null,"abstract":"<div><h3>Background</h3><div>Recently, lower trapezius tendon transfer (LTT) has gained attention as an effective treatment option for irreparable rotator cuff tears. Although the use of interpositional graft is an inevitable process in LTT, there was no study to compare the allograft and autograft as an interpositional graft in LTT. The purpose of this systematic review is to compare the clinical outcome, graft retear and complications according to the interpositional graft using allograft and autograft in LTT.</div></div><div><h3>Methods</h3><div>This systematic review was prepared with the guidelines of the preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The inclusion criteria of this systematic review were a full-length article written in English, peer-reviewed articles, level of evidence IV or higher articles, and articles reporting the clinical outcome of LTT. A comprehensive search was performed in PubMed, Cochrane Library, and Ovid-Embase. The quality of selected articles was assessed with Methodological Index for Non-Randomized studies score. The postoperative range of motion, patient-reported clinical outcome scores, graft retear, complications, and reoperations were systematically analyzed.</div></div><div><h3>Results</h3><div>A total of 299 patients of 12 articles were included in this systematic review. Among them, 230 patients of 8 articles reported the results of allograft, and 69 patients of 4 articles reported the results of autograft. The mean Methodological Index for Non-Randomized studies score of 3 comparative studies and 9 case series were 17.3 ± 0.6 (72.1% of total score) and 10.6 ± 0.9 (66.3% of total score), respectively. Both allograft group and autograft group had a tendency of improvement in range of motion, and patients-reported clinical outcomes. Total graft retear rate was reported in 20 of 214 (9.3%) patients from 6 articles with a range from 4.3% to 10.5%. Total complication rate was reported in 33 of 299 (11.0%) patients from 12 articles with range from 8.6% to 26.8%. For allograft group and autograft group, the graft retear rate was 13 of 169 (7.7%) from 4 articles and 3 of 45 (6.7%) from 2 articles, respectively. The complication rate was 27 of 230 (11.7%) from 8 articles in allograft group and 6 of 69 (8.7%) from 4 articles in auto graft group.</div></div><div><h3>Conclusion</h3><div>LTT may lead to significant improvement in clinical outcomes in patients with irreparable rotator cuff tears, regardless of whether allograft or autograft is used for interpositional grafts. Although the graft retear rate was slightly higher in the allograft group, the difference of graft retear rate between allograft and autograft was not significant. However, other complications, and reoperations were higher in allograft group.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100588"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467940","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}
引用次数: 0
Acromiohumeral center edge angle for predicting degenerative rotator cuff tear in aging patients: a retrospective study 肩肱中心边缘角预测老年患者退行性肩袖撕裂:一项回顾性研究
Q4 Medicine Pub Date : 2025-10-09 DOI: 10.1016/j.xrrt.2025.100590
Nithi Pakmanee MD , Nuttawut Chanalithichai MD , Siravich Suvithayasiri MD , Tanadul Jarrusrojwuttikul MD , Sasikarn Wanitchakorn MD , Sittan Aimprasittichai MD

Background

The etiology of degenerative rotator cuff tears (DRCTs) is unclear, although certain distinct acromion morphologies may correlate with degenerative processes. Numerous radiographic measurements attempting to describe acromion morphology have been described previously. This study aimed to validate and study the relationship between the acromiohumeral center edge angle (ACEA) and DRCTs. We also aimed to compare the predictive value of ACEA to more widely studied parameters, including acromion index (AI), lateral acromion angle (LAA), and critical shoulder angle (CSA). We hypothesize that ACEA is a valid and reliable method for predicting DRCTs. Patients who have higher ACEA are more likely to experience DRCTs.

Methods

We conducted a retrospective review of 204 shoulder radiographs obtained from patients aged ≥ 40 years. The study population was divided into 2 groups based on rotator cuff status as identified by magnetic resonance imaging. We compared various radiologic parameters in 108 patients with partial and full-thickness DRCTs to 96 patients with intact rotator cuffs. Two independent authors measured the ACEA, AI, LAA, and CSA values on a standardized anteroposterior shoulder radiograph.

Results

The mean ACEA was significantly higher in the DRCT group than in the intact group (33.11° vs. 24.56°, P < .001). The ACEA has excellent reliability (intraclass correlation coefficient, 0.99). The cutoff value was determined to be > 29.88° (sensitivity, 0.69; specificity, 0.78). ACEA had the best predictive value (area under the curve: 0.76) and reliability compared with AI, LAA, and CSA.

Conclusion

Our study shows that ACEA is an effective predictor of DRCTs. Patients with an ACEA > 29.88° on plain radiography were more likely to have DRCTs.
背景退行性肩袖撕裂(drct)的病因尚不清楚,尽管某些独特的肩峰形态可能与退行性过程有关。许多试图描述肩峰形态的放射测量先前已经描述过。本研究旨在验证和研究肩肱骨中心边缘角(ACEA)与drct的关系。我们还旨在将ACEA的预测价值与更广泛研究的参数进行比较,包括肩峰指数(AI)、侧肩峰角(LAA)和临界肩角(CSA)。我们假设ACEA是预测drct的有效和可靠的方法。ACEA较高的患者更有可能经历drct。方法回顾性分析年龄≥40岁患者的204张肩部x线片。研究人群根据磁共振成像确定的肩袖状态分为两组。我们比较了108例部分和全层drct患者和96例完整肩袖患者的各种放射学参数。两位独立作者测量了标准化肩关节正位x线片上的ACEA、AI、LAA和CSA值。结果DRCT组的平均ACEA明显高于完整组(33.11°vs. 24.56°,P < 0.001)。ACEA具有优良的信度(类内相关系数为0.99)。截止值为29.88°(敏感性0.69,特异性0.78)。与AI、LAA和CSA相比,ACEA具有最佳的预测价值(曲线下面积:0.76)和可靠性。结论本研究表明,ACEA是预测drct的有效指标。x平片上ACEA≥29.88°的患者更有可能发生drct。
{"title":"Acromiohumeral center edge angle for predicting degenerative rotator cuff tear in aging patients: a retrospective study","authors":"Nithi Pakmanee MD ,&nbsp;Nuttawut Chanalithichai MD ,&nbsp;Siravich Suvithayasiri MD ,&nbsp;Tanadul Jarrusrojwuttikul MD ,&nbsp;Sasikarn Wanitchakorn MD ,&nbsp;Sittan Aimprasittichai MD","doi":"10.1016/j.xrrt.2025.100590","DOIUrl":"10.1016/j.xrrt.2025.100590","url":null,"abstract":"<div><h3>Background</h3><div>The etiology of degenerative rotator cuff tears (DRCTs) is unclear, although certain distinct acromion morphologies may correlate with degenerative processes. Numerous radiographic measurements attempting to describe acromion morphology have been described previously. This study aimed to validate and study the relationship between the acromiohumeral center edge angle (ACEA) and DRCTs. We also aimed to compare the predictive value of ACEA to more widely studied parameters, including acromion index (AI), lateral acromion angle (LAA), and critical shoulder angle (CSA). We hypothesize that ACEA is a valid and reliable method for predicting DRCTs. Patients who have higher ACEA are more likely to experience DRCTs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 204 shoulder radiographs obtained from patients aged ≥ 40 years. The study population was divided into 2 groups based on rotator cuff status as identified by magnetic resonance imaging. We compared various radiologic parameters in 108 patients with partial and full-thickness DRCTs to 96 patients with intact rotator cuffs. Two independent authors measured the ACEA, AI, LAA, and CSA values on a standardized anteroposterior shoulder radiograph.</div></div><div><h3>Results</h3><div>The mean ACEA was significantly higher in the DRCT group than in the intact group (33.11° vs. 24.56°, <em>P</em> &lt; .001). The ACEA has excellent reliability (intraclass correlation coefficient, 0.99). The cutoff value was determined to be &gt; 29.88° (sensitivity, 0.69; specificity, 0.78). ACEA had the best predictive value (area under the curve: 0.76) and reliability compared with AI, LAA, and CSA.</div></div><div><h3>Conclusion</h3><div>Our study shows that ACEA is an effective predictor of DRCTs. Patients with an ACEA &gt; 29.88° on plain radiography were more likely to have DRCTs.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466809","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}
引用次数: 0
Outpatient total elbow arthroplasty—outcomes and complications: a systematic review and meta-analysis 门诊全肘关节置换术-结果和并发症:系统回顾和荟萃分析
Q4 Medicine Pub Date : 2025-10-09 DOI: 10.1016/j.xrrt.2025.100592
Vishwajeet Singh MBBS, MRCS , Naadir Nazar MBChB, BSc, PGCertMEd , Lowilius Wiyono MD , Axler Jean Paul MD , Joideep Phadnis MD, FRCS (Tr&Orth)

Background

Total elbow arthroplasty (TEA) is a surgical procedure used in the management of arthritis and fractures. Outpatient total elbow arthroplasty (OTEA) could be a valid option to reduce workforce burden and cost, provided it can be proven to be equally safe and effective as inpatient TEA. This meta-analysis was conducted to evaluate the efficacy and safety of OTEA.

Methods

A literature search was performed in PubMed, Embase, Scopus, and Google Scholar using DistillerSR, with predetermined keywords based on the Patient/Problem, Intervention, Control, and Outcome criteria. Studies characterizing OTEA and/or inpatient TEA were included. Total readmissions, revision rates, cost difference, and functional outcome scores were assessed for outpatient vs. inpatient TEA. Risk of bias assessment was performed using the Risk of Bias in Nonrandomized Studies of Interventions tool.

Results

Five studies fulfilled the inclusion criteria. Seven hundred twenty-five patients in the outpatient group and 1,461 patients in the inpatient group (control). Incidence of complications was significantly higher in the inpatient cohort compared to the outpatient TEAs (inpatient n = 121 (%) vs. outpatient n = 51 (%), P = .037) Readmissions occurred in 84/1,166 cases (7%). There was no significant difference in the readmission rate between the inpatient (57/745, 7%) and the outpatient (27/421, 6%). The cost of OTEA was lower than inpatient TEA, with a mean of 26, 817 USD in the inpatient group when compared to 18,412 USD for OTEA.

Discussion

Clinical results of outpatient vs. inpatient TEA were similar with respect to overall complications, readmissions, and functional scores, and outpatient TEA was more cost effective. Our review indicates that outpatient TEA can be considered by individual care providers after development of appropriate local pathways. This review highlights the need for further high-quality studies in this niche but clinically important field.
背景:全肘关节置换术是一种用于治疗关节炎和骨折的外科手术。门诊全肘关节置换术(OTEA)可能是减少劳动力负担和成本的有效选择,前提是它能被证明与住院全肘关节置换术同样安全有效。本荟萃分析旨在评估OTEA的有效性和安全性。方法使用DistillerSR软件在PubMed、Embase、Scopus和谷歌Scholar中进行文献检索,并根据患者/问题、干预、控制和结局标准预先确定关键词。研究纳入了OTEA和/或住院患者TEA的特征。对门诊患者和住院患者的总再入院率、翻修率、成本差异和功能结局评分进行评估。使用非随机干预研究的偏倚风险评估工具进行偏倚风险评估。结果5项研究符合纳入标准。门诊组725例,住院组1461例(对照组)。住院患者的并发症发生率明显高于门诊患者(住院患者n = 121(%)对门诊患者n = 51 (%), P = 0.037),再入院发生率为84/ 1166例(7%)。住院患者再入院率(57/745,7%)与门诊患者再入院率(27/421,6%)无统计学差异。OTEA的费用低于住院组,住院组的平均费用为26,817美元,而OTEA的平均费用为18,412美元。门诊TEA与住院TEA的临床结果在总体并发症、再入院率和功能评分方面相似,门诊TEA更具成本效益。我们的回顾表明,在制定适当的局部途径后,个别护理提供者可以考虑门诊TEA。这篇综述强调了在这一利基但临床上重要的领域进一步开展高质量研究的必要性。
{"title":"Outpatient total elbow arthroplasty—outcomes and complications: a systematic review and meta-analysis","authors":"Vishwajeet Singh MBBS, MRCS ,&nbsp;Naadir Nazar MBChB, BSc, PGCertMEd ,&nbsp;Lowilius Wiyono MD ,&nbsp;Axler Jean Paul MD ,&nbsp;Joideep Phadnis MD, FRCS (Tr&Orth)","doi":"10.1016/j.xrrt.2025.100592","DOIUrl":"10.1016/j.xrrt.2025.100592","url":null,"abstract":"<div><h3>Background</h3><div>Total elbow arthroplasty (TEA) is a surgical procedure used in the management of arthritis and fractures. Outpatient total elbow arthroplasty (OTEA) could be a valid option to reduce workforce burden and cost, provided it can be proven to be equally safe and effective as inpatient TEA. This meta-analysis was conducted to evaluate the efficacy and safety of OTEA.</div></div><div><h3>Methods</h3><div>A literature search was performed in PubMed, Embase, Scopus, and Google Scholar using DistillerSR, with predetermined keywords based on the Patient/Problem, Intervention, Control, and Outcome criteria. Studies characterizing OTEA and/or inpatient TEA were included. Total readmissions, revision rates, cost difference, and functional outcome scores were assessed for outpatient vs. inpatient TEA. Risk of bias assessment was performed using the Risk of Bias in Nonrandomized Studies of Interventions tool.</div></div><div><h3>Results</h3><div>Five studies fulfilled the inclusion criteria. Seven hundred twenty-five patients in the outpatient group and 1,461 patients in the inpatient group (control). Incidence of complications was significantly higher in the inpatient cohort compared to the outpatient TEAs (inpatient n = 121 (%) vs. outpatient n = 51 (%), <em>P</em> = .037) Readmissions occurred in 84/1,166 cases (7%). There was no significant difference in the readmission rate between the inpatient (57/745, 7%) and the outpatient (27/421, 6%). The cost of OTEA was lower than inpatient TEA, with a mean of 26, 817 USD in the inpatient group when compared to 18,412 USD for OTEA.</div></div><div><h3>Discussion</h3><div>Clinical results of outpatient vs. inpatient TEA were similar with respect to overall complications, readmissions, and functional scores, and outpatient TEA was more cost effective. Our review indicates that outpatient TEA can be considered by individual care providers after development of appropriate local pathways. This review highlights the need for further high-quality studies in this niche but clinically important field.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100592"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520576","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}
引用次数: 0
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