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":"2026-05-01","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 : 2026-05-01Epub 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":"2026-05-01","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}
Pub Date : 2026-05-01Epub Date: 2025-12-13DOI: 10.1016/j.xrrt.2025.100608
Guilherme Augusto Stirma PhD, Paulo Santoro Belangero PhD, Paulo Henrique Schmidt Lara PhD, Carlos Vicente Andreoli PhD, Alberto de Castro Pochini PhD, Benno Ejnisman PhD
Background
This study aimed to investigate the biomechanical differences between natural coracoid (NC) and modified coracoid (MC) grafts (with a flattened surface to optimize contact with the glenoid cavity), focusing on their impact on contact area, contact volume, and stress distribution in scenarios of glenoid bone loss. The objective was to determine how graft configuration influences biomechanical stability and force distribution under varying conditions of bone loss.
Methods
Three-dimensional models of the glenoid cavity and coracoid process were developed using population-based anatomical averages. Two graft configurations were analyzed: NC and MC. Simulations incorporated progressive glenoid bone loss (0%-20%). Biomechanical analyses evaluated contact area, contact volume, stress distribution, and deformation under a compressive force of 700 N using finite element analysis.
Results
NC grafts demonstrated superior adaptation and a larger contact area in anatomically intact glenoid (0% bone loss). However, as bone loss increased beyond 2%, MC grafts provided more consistent contact areas, better stress distribution, and reduced stress concentration. The flattened surface of MC grafts optimized the biomechanical interaction, particularly under conditions of advanced bone loss, ensuring enhanced stability and reduced risk of localized deformation.
Conclusion
The findings highlight the importance of graft configuration in addressing glenoid bone loss. While NC grafts are preferable for intact or minimally compromised glenoids, MC grafts are more effective in scenarios with bone loss, providing improved biomechanical stability and optimized force distribution. This study underscores the need for tailored surgical strategies to achieve optimal outcomes based on individual anatomical and clinical conditions.
{"title":"Evaluating coracoid graft geometry for glenoid bone loss: a comparative study of stress distribution and contact mechanics","authors":"Guilherme Augusto Stirma PhD, Paulo Santoro Belangero PhD, Paulo Henrique Schmidt Lara PhD, Carlos Vicente Andreoli PhD, Alberto de Castro Pochini PhD, Benno Ejnisman PhD","doi":"10.1016/j.xrrt.2025.100608","DOIUrl":"10.1016/j.xrrt.2025.100608","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate the biomechanical differences between natural coracoid (NC) and modified coracoid (MC) grafts (with a flattened surface to optimize contact with the glenoid cavity), focusing on their impact on contact area, contact volume, and stress distribution in scenarios of glenoid bone loss. The objective was to determine how graft configuration influences biomechanical stability and force distribution under varying conditions of bone loss.</div></div><div><h3>Methods</h3><div>Three-dimensional models of the glenoid cavity and coracoid process were developed using population-based anatomical averages. Two graft configurations were analyzed: NC and MC. Simulations incorporated progressive glenoid bone loss (0%-20%). Biomechanical analyses evaluated contact area, contact volume, stress distribution, and deformation under a compressive force of 700 N using finite element analysis.</div></div><div><h3>Results</h3><div>NC grafts demonstrated superior adaptation and a larger contact area in anatomically intact glenoid (0% bone loss). However, as bone loss increased beyond 2%, MC grafts provided more consistent contact areas, better stress distribution, and reduced stress concentration. The flattened surface of MC grafts optimized the biomechanical interaction, particularly under conditions of advanced bone loss, ensuring enhanced stability and reduced risk of localized deformation.</div></div><div><h3>Conclusion</h3><div>The findings highlight the importance of graft configuration in addressing glenoid bone loss. While NC grafts are preferable for intact or minimally compromised glenoids, MC grafts are more effective in scenarios with bone loss, providing improved biomechanical stability and optimized force distribution. This study underscores the need for tailored surgical strategies to achieve optimal outcomes based on individual anatomical and clinical conditions.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100608"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078555","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 : 2026-05-01Epub 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":"2026-05-01","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}
There is limited data on the relationship between recovery metrics, including psychological factors, and shoulder function in rugby players after arthroscopic Bankart repair. The purpose of this study was to investigate return to play (RTP) in rugby players who underwent shoulder stabilization for anterior shoulder instability and to assess the relationship between postoperative ranges of motion (ROMs) and various recovery metrics, including performance, pain, and psychological conditions.
Methods
We retrospectively investigated subjects who underwent arthroscopic shoulder stabilization at our institute from January 2012 to April 2022. Inclusion criteria were as follows: (1) rugby players with traumatic anterior shoulder instability and (2) arthroscopic Bankart repair with rotator interval closure and Hill–Sachs remplissage. Exclusion criteria were as follows: (1) revision surgery and (2) incomplete questionnaire at the final follow-up. A questionnaire at the final follow-up was used to evaluate the recovery metrics as a visual analog scale (VAS), including athletic performance, pain, and fear of contact. Regression analyses were performed to assess the relationship between the VAS scores and ROMs.
Results
Ninety-one shoulders in 82 patients met the inclusion criteria, and 32 shoulders were excluded due to revision surgery, one shoulder; incomplete questionnaire, 31 shoulders. The remaining 59 shoulders in 50 patients were included in this study. The patients consisted of 48 males and 2 females, with a mean age at surgery of 19 years (range, 14-36). The mean follow-up was 31 months (range, 13-56). The mean time to start contact practice was 7 ± 5 months (range, 3-36), and the mean time to RTP was 8 ± 5 months (range, 4-36). Forty-nine patients (98%) returned to their preinjury sports level. The median of VAS values were as follows: 91 for athletic performance (range, 25-100), 100 for pain (range, 10-100), and 70 for fear of contact (range, 10-100). ROM data were available in 52 shoulders. Multiple regression analyses showed significant relationships between total VAS scores and ROMs at postoperative three months (anterior elevation, P = .015; external rotation at the side, P = .002).
Conclusion
Arthroscopic shoulder stabilization resulted in a 98% RTP rate in rugby players. The VAS score for fear of contact was relatively low, even in patients with complete return. The total VAS value was correlated with ROMs at three months postoperatively. A rehabilitation protocol that simultaneously addresses psychological and physical aspects may be required for better RTP.
{"title":"Return to play and recovery metrics after arthroscopic Bankart repair with augmentations in rugby players","authors":"Yuki Miyasaka RPT, Med , Shota Hoshika MD, PhD , Keisuke Matsuki MD, PhD , Takashi Takamura RPT, MD , Hideki Kamijo MD, PhD , Tomoyuki Matsuba MD, PhD , Tomoshige Tamaki MS , Norimasa Takahashi MD, PhD , Hiroyuki Sugaya MD, PhD","doi":"10.1016/j.xrrt.2025.100649","DOIUrl":"10.1016/j.xrrt.2025.100649","url":null,"abstract":"<div><h3>Background</h3><div>There is limited data on the relationship between recovery metrics, including psychological factors, and shoulder function in rugby players after arthroscopic Bankart repair. The purpose of this study was to investigate return to play (RTP) in rugby players who underwent shoulder stabilization for anterior shoulder instability and to assess the relationship between postoperative ranges of motion (ROMs) and various recovery metrics, including performance, pain, and psychological conditions.</div></div><div><h3>Methods</h3><div>We retrospectively investigated subjects who underwent arthroscopic shoulder stabilization at our institute from January 2012 to April 2022. Inclusion criteria were as follows: (1) rugby players with traumatic anterior shoulder instability and (2) arthroscopic Bankart repair with rotator interval closure and Hill–Sachs remplissage. Exclusion criteria were as follows: (1) revision surgery and (2) incomplete questionnaire at the final follow-up. A questionnaire at the final follow-up was used to evaluate the recovery metrics as a visual analog scale (VAS), including athletic performance, pain, and fear of contact. Regression analyses were performed to assess the relationship between the VAS scores and ROMs.</div></div><div><h3>Results</h3><div>Ninety-one shoulders in 82 patients met the inclusion criteria, and 32 shoulders were excluded due to revision surgery, one shoulder; incomplete questionnaire, 31 shoulders. The remaining 59 shoulders in 50 patients were included in this study. The patients consisted of 48 males and 2 females, with a mean age at surgery of 19 years (range, 14-36). The mean follow-up was 31 months (range, 13-56). The mean time to start contact practice was 7 ± 5 months (range, 3-36), and the mean time to RTP was 8 ± 5 months (range, 4-36). Forty-nine patients (98%) returned to their preinjury sports level. The median of VAS values were as follows: 91 for athletic performance (range, 25-100), 100 for pain (range, 10-100), and 70 for fear of contact (range, 10-100). ROM data were available in 52 shoulders. Multiple regression analyses showed significant relationships between total VAS scores and ROMs at postoperative three months (anterior elevation, <em>P</em> = .015; external rotation at the side, <em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>Arthroscopic shoulder stabilization resulted in a 98% RTP rate in rugby players. The VAS score for fear of contact was relatively low, even in patients with complete return. The total VAS value was correlated with ROMs at three months postoperatively. A rehabilitation protocol that simultaneously addresses psychological and physical aspects may be required for better RTP.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100649"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078556","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 : 2026-05-01Epub Date: 2025-12-24DOI: 10.1016/j.xrrt.2025.100646
Roya Khorram MD , Areeb Ahmad BS , Reza Vafadar MD , Ronald Joseph Shamus BA , Surena Namdari MD , G. Russell Huffman MD, MPH, FAAOS , Amir R. Kachooei MD, PhD
Background
Post-traumatic elbow stiffness (PTES) has been reported in up to 21% of pediatric patients following elbow fractures and can profoundly compromise a child's function, and independence. The primary surgical approaches include open and arthroscopic arthrolysis, both of which have demonstrated improvements in range of motion (ROM) and functional scores. This systematic review and meta-analysis aims to compare the effectiveness, ROM, and complication rates between open and arthroscopic release in pediatric patients with PTES.
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized to conduct a systematic review and meta-analysis on surgical treatment for PTES. Comprehensive search was conducted in PubMed, Web of Science, Medline, and Scopus from their inception to May 10, 2025. A total of 3,660 records were screened, of which 11 studies were included using open or arthroscopic pediatric PTES elbow arthrolysis. Outcome variables were changes in the ROM and complication rates. Surgical techniques were grouped as arthroscopic vs. open arthrolysis.
Results
Our findings showed that open arthrolysis resulted in greater ROM compared to arthroscopic arthrolysis (open arthrolysis (standardized mean difference: 58°, 95% confidence interval (CI): 46-69; P < .001), arthroscopic arthrolysis: (standardized mean difference: 33°, 95% CI: 26-39; P = .9)). Regarding the postoperative complications, there was no statistically significant difference between open and arthroscopic arthrolysis (open arthrolysis: [rate: 14%; 95% CI: 9%-22%], arthroscopic arthrolysis: [rate: 7%; 95% CI: 2%-25%].
Conclusion
Open arthrolysis significantly improves ROM in pediatric PTES, outperforming arthroscopic procedures, which showed nonsignificant gains. Complication rates were low and comparable, supporting the safety of both techniques. These findings favor open arthrolysis in severe cases and highlight the need for larger prospective studies to refine arthroscopic indications.
据报道，创伤后肘部僵硬（PTES）在肘部骨折后的儿科患者中高达21%，并且会严重损害儿童的功能和独立性。主要的手术方法包括开放和关节镜下关节松解术，这两种方法都能改善活动范围（ROM）和功能评分。本系统综述和荟萃分析旨在比较开放性和关节镜下释放对小儿PTES患者的疗效、ROM和并发症发生率。方法采用系统评价和荟萃分析指南首选报告项目对PTES手术治疗进行系统评价和荟萃分析。综合检索PubMed、Web of Science、Medline和Scopus，从它们成立到2025年5月10日。总共筛选了3,660份记录，其中11项研究包括使用开放或关节镜下的儿科PTES肘关节松解术。结果变量是ROM的变化和并发症发生率。手术技术分为关节镜和开放式关节松解。结果我们的研究结果显示，与关节镜下关节松解术相比，开放式关节松解术导致更大的ROM(标准化平均差：58°，95%可信区间（CI）： 46-69；P < .001)，关节镜下关节松解（标准化平均差：33°，95% CI: 26-39; P = .9）)。术后并发症方面，开放关节松解术与关节镜下关节松解术（开放关节松解术[发生率：14%；95% CI: 9%-22%]，关节镜下关节松解术[发生率：7%；95% CI: 2%-25%]）无统计学差异。结论：开放性关节松解术可显著改善儿童PTES患者的ROM，优于关节镜手术，但疗效不显著。并发症发生率低且具有可比性，支持两种技术的安全性。这些发现有利于严重病例的开放关节松解，并强调需要更大的前瞻性研究来完善关节镜适应症。
{"title":"Surgical treatment of post-traumatic elbow stiffness in pediatric patients: a systematic review and meta-analysis","authors":"Roya Khorram MD , Areeb Ahmad BS , Reza Vafadar MD , Ronald Joseph Shamus BA , Surena Namdari MD , G. Russell Huffman MD, MPH, FAAOS , Amir R. Kachooei MD, PhD","doi":"10.1016/j.xrrt.2025.100646","DOIUrl":"10.1016/j.xrrt.2025.100646","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic elbow stiffness (PTES) has been reported in up to 21% of pediatric patients following elbow fractures and can profoundly compromise a child's function, and independence. The primary surgical approaches include open and arthroscopic arthrolysis, both of which have demonstrated improvements in range of motion (ROM) and functional scores. This systematic review and meta-analysis aims to compare the effectiveness, ROM, and complication rates between open and arthroscopic release in pediatric patients with PTES.</div></div><div><h3>Methods</h3><div>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized to conduct a systematic review and meta-analysis on surgical treatment for PTES. Comprehensive search was conducted in PubMed, Web of Science, Medline, and Scopus from their inception to May 10, 2025. A total of 3,660 records were screened, of which 11 studies were included using open or arthroscopic pediatric PTES elbow arthrolysis. Outcome variables were changes in the ROM and complication rates. Surgical techniques were grouped as arthroscopic vs. open arthrolysis.</div></div><div><h3>Results</h3><div>Our findings showed that open arthrolysis resulted in greater ROM compared to arthroscopic arthrolysis (open arthrolysis (standardized mean difference: 58°, 95% confidence interval (CI): 46-69; <em>P</em> < .001), arthroscopic arthrolysis: (standardized mean difference: 33°, 95% CI: 26-39; <em>P</em> = .9)). Regarding the postoperative complications, there was no statistically significant difference between open and arthroscopic arthrolysis (open arthrolysis: [rate: 14%; 95% CI: 9%-22%], arthroscopic arthrolysis: [rate: 7%; 95% CI: 2%-25%].</div></div><div><h3>Conclusion</h3><div>Open arthrolysis significantly improves ROM in pediatric PTES, outperforming arthroscopic procedures, which showed nonsignificant gains. Complication rates were low and comparable, supporting the safety of both techniques. These findings favor open arthrolysis in severe cases and highlight the need for larger prospective studies to refine arthroscopic indications.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100646"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078595","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 : 2026-05-01Epub Date: 2025-12-01DOI: 10.1016/j.xrrt.2025.100631
Paul-Hugo Arcand BA , Simbarashe J. Peresuh MD , Joseph Confessore BS , Edward J. Testa MD , Matthew Quinn MD , Manjot Singh BS , Gabriella J. Avellino MD , Alan H. Daniels MD , Michel A. Arcand MD
Background
Anabolic androgenic steroid supraphysiologic dose use is linked to an increased risk of tendon rupture. Testosterone replacement therapy (TRT) is used to treat hypogonadism and is associated with increased bone mineral density. However, its relationship with fracture risk, particularly proximal humerus fractures (PHF), remains uncertain. This study evaluates the association between TRT and the incidence of PHFs using a large national database. We hypothesized that TRT use would be associated with a difference in the incidence of PHFs compared to a control group due to testosterone's role in maintaining bone mineral density.
Methods
This retrospective study with one-to-one matching queried the PearlDiver Mariner165 dataset to obtain a random sample of 500,000 patients aged 35 to 75 who received TRT continuously for at least 3 months and a random control sample of 500,000 different patients. Of the targeted 1,000,000 patients, 335,753 pairs of patients were matched based on age, tobacco use, diabetes history, and the Charlson Comorbidity Index. Incidence of PHF was assessed over a 2-year follow-up using the International Classification of Diseases codes, with comparisons made across the different cohorts. Multivariable logistic regression was conducted to identify the association between TRT use with PHF in men. An alpha level of 0.01 was prespecified to reduce the risk of type I error and ensure statistical rigor.
Results
In this matched-cohort study of 335,753 paired TRT and control patients, the mean age was 53.82 ± 10.58 years. Patients administered TRT demonstrated a higher incidence of PHF compared to the control cohort (0.029% vs. 0.005%, P < .001). Logistic regression analysis demonstrated that TRT was associated with a significantly increased risk of PHF (adjusted odds ratio 3.14; 95% confidence interval: 1.84-5.59; P < .001).
Conclusions
In this retrospective matched-cohort study, TRT patients demonstrated an increase in 2-year incidence rates of PHF in men. These findings underscore the need for tailored patient management and provide actionable insights for orthopedic practice. Future studies of prospective design are needed to better address confounding factors, establish causation, and evaluate surgical outcomes in TRT patients.
{"title":"The relationship between testosterone replacement therapy and incidence of proximal humerus fractures in men: a matched retrospective analysis","authors":"Paul-Hugo Arcand BA , Simbarashe J. Peresuh MD , Joseph Confessore BS , Edward J. Testa MD , Matthew Quinn MD , Manjot Singh BS , Gabriella J. Avellino MD , Alan H. Daniels MD , Michel A. Arcand MD","doi":"10.1016/j.xrrt.2025.100631","DOIUrl":"10.1016/j.xrrt.2025.100631","url":null,"abstract":"<div><h3>Background</h3><div>Anabolic androgenic steroid supraphysiologic dose use is linked to an increased risk of tendon rupture. Testosterone replacement therapy (TRT) is used to treat hypogonadism and is associated with increased bone mineral density. However, its relationship with fracture risk, particularly proximal humerus fractures (PHF), remains uncertain. This study evaluates the association between TRT and the incidence of PHFs using a large national database. We hypothesized that TRT use would be associated with a difference in the incidence of PHFs compared to a control group due to testosterone's role in maintaining bone mineral density.</div></div><div><h3>Methods</h3><div>This retrospective study with one-to-one matching queried the PearlDiver Mariner165 dataset to obtain a random sample of 500,000 patients aged 35 to 75 who received TRT continuously for at least 3 months and a random control sample of 500,000 different patients. Of the targeted 1,000,000 patients, 335,753 pairs of patients were matched based on age, tobacco use, diabetes history, and the Charlson Comorbidity Index. Incidence of PHF was assessed over a 2-year follow-up using the International Classification of Diseases codes, with comparisons made across the different cohorts. Multivariable logistic regression was conducted to identify the association between TRT use with PHF in men. An alpha level of 0.01 was prespecified to reduce the risk of type I error and ensure statistical rigor.</div></div><div><h3>Results</h3><div>In this matched-cohort study of 335,753 paired TRT and control patients, the mean age was 53.82 ± 10.58 years. Patients administered TRT demonstrated a higher incidence of PHF compared to the control cohort (0.029% vs. 0.005%, <em>P</em> < .001). Logistic regression analysis demonstrated that TRT was associated with a significantly increased risk of PHF (adjusted odds ratio 3.14; 95% confidence interval: 1.84-5.59; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>In this retrospective matched-cohort study, TRT patients demonstrated an increase in 2-year incidence rates of PHF in men. These findings underscore the need for tailored patient management and provide actionable insights for orthopedic practice. Future studies of prospective design are needed to better address confounding factors, establish causation, and evaluate surgical outcomes in TRT patients.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100631"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145898155","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 : 2026-02-01Epub Date: 2025-10-23DOI: 10.1016/j.xrrt.2025.100598
David Sylvester BS, Kassem Ghayyad MD, Daniel Goltz MD, G. Russell Huffman MD, MPH, FAAOS
{"title":"Glenoid grafting in the first stage of 2-stage revision shoulder arthroplasty in the setting of infection: a technical note","authors":"David Sylvester BS, Kassem Ghayyad MD, Daniel Goltz MD, G. Russell Huffman MD, MPH, FAAOS","doi":"10.1016/j.xrrt.2025.100598","DOIUrl":"10.1016/j.xrrt.2025.100598","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100598"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736686","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 : 2026-02-01Epub Date: 2025-10-28DOI: 10.1016/j.xrrt.2025.100603
Ankur Khanna BS, Christopher M. Hart MD, Tristan B. Weir MD, Micah Nieboer MD, Larry J. Prokop MLIS, Jonathan D. Barlow MD, Jennifer Tangtiphaiboontana MD, Joaquin Sanchez-Sotelo MD, Mark E. Morrey MD
Background
Periprosthetic joint infection after total elbow arthroplasty (TEA) is associated with substantial morbidity and the need for revision surgery. The aim of this systematic review and meta-analysis was to summarize studies on 2-stage exchange and débridement, antibiotics, and implant retention (DAIR) to determine differences in rates of recurrent infection, risk factors for recurrent infection, noninfectious complications, and functional outcomes.
Methods
A systematic search was conducted of the MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases in March 2024 to identify studies on infected TEAs treated with either 2-stage revision surgery or DAIR. Exclusion criteria included duplicate publications, review articles, and studies with a mean follow-up of less than 1 year. Fourteen studies were included in the final analysis. Data abstracted included demographics, treatment modalities, bacterial speciation, rates of recurrent infection, and functional outcomes (range of motion data and Mayo Elbow Performance Score.
Results
Two hundred ninety infected TEAs were included across all 14 studies, 131 treated with DAIR and 159 treated with 2-stage exchange. The overall pooled random-effects rate of recurrent infection was 34% (95% confidence interval: 21%-47%). The rate of recurrent infection was significantly lower following 2-stage exchange compared to DAIR (18% vs. 51%, P = .004). The overall pooled rate of noninfectious complications was 34% (95% confidence interval: 22%-46%). With the numbers available, the rate of noninfectious complications between 2-stage exchange and DAIR was smaller for 2-stage exchange, although the difference did not achieve statistical significance (27% vs. 43%, P = .244). Patients infected with coagulase-negative Staphylococci experienced a higher rate of recurrent infection than those infected with other species (44% vs. 14%), although again this difference did not reach statistical significance (P = .060). In patients undergoing 2-stage exchange, incomplete cement removal was associated with a significantly higher rate of recurrent infection than complete removal (56% vs. 19%, P = .001), but intentional retention of 1 component was not significantly associated with a higher rate of recurrent infection (37% vs. 20%, P = .315).
Discussion
The results of this systematic review and meta-analysis of the outcomes associated with the treatment of TEA periprosthetic joint infection with either DAIR or 2-stage reimplantation, 2-stage exchange was associated with a lower rate of recurrent infection. Incomplete cement removal was a risk factor for recurrent infection. Although it did not reach significance, it appeared that infection with coagulase-negative Staphylococci could also be a risk factor for failure of infection eradication.
背景：全肘关节置换术（TEA）后假体周围关节感染与大量发病率和翻修手术的需要相关。本系统综述和荟萃分析的目的是总结关于2期换药和体外移植术、抗生素和植入物保留（DAIR）的研究，以确定复发感染率、复发感染的危险因素、非感染性并发症和功能结局的差异。方法于2024年3月对MEDLINE、EMBASE、Cochrane、Scopus和Web of Science数据库进行系统检索，确定两期翻修手术或DAIR治疗感染tea的研究。排除标准包括重复出版物、综述文章和平均随访时间少于1年的研究。最终的分析包括14项研究。提取的数据包括人口统计学、治疗方式、细菌种类、复发感染率和功能结果（活动范围数据和梅奥肘部表现评分）。结果14项研究共纳入290例感染tea，其中131例采用DAIR治疗，159例采用2期交换治疗。复发感染的总随机效应发生率为34%（95%可信区间：21%-47%）。与DAIR相比，2期换药后复发感染率显著降低（18% vs. 51%, P = 0.004）。非感染性并发症的总合并率为34%（95%可信区间：22%-46%）。根据现有数据，两期置换与DAIR的非感染性并发症发生率较低，但差异无统计学意义（27% vs 43%, P = 0.244）。凝固酶阴性葡萄球菌感染的患者复发率高于其他种类葡萄球菌感染的患者（44%比14%），尽管这种差异也没有达到统计学意义（P = 0.060）。在接受2期骨置换的患者中，不完全骨水泥移除与复发感染的比例明显高于完全移除（56% vs. 19%, P = .001），但故意保留一个骨水泥组件与复发感染的比例没有显著相关性（37% vs. 20%, P = .315）。本系统综述和荟萃分析的结果与DAIR或2期再植入术治疗TEA假体周围关节感染相关的结果，2期置换与较低的复发感染率相关。骨水泥去除不完全是复发性感染的危险因素。虽然没有达到显著性，但凝固酶阴性葡萄球菌感染也可能是感染根除失败的危险因素。
{"title":"Débridement, antibiotics, and implant retention versus 2-stage revision for infected total elbow arthroplasty: a systematic review and meta-analysis","authors":"Ankur Khanna BS, Christopher M. Hart MD, Tristan B. Weir MD, Micah Nieboer MD, Larry J. Prokop MLIS, Jonathan D. Barlow MD, Jennifer Tangtiphaiboontana MD, Joaquin Sanchez-Sotelo MD, Mark E. Morrey MD","doi":"10.1016/j.xrrt.2025.100603","DOIUrl":"10.1016/j.xrrt.2025.100603","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection after total elbow arthroplasty (TEA) is associated with substantial morbidity and the need for revision surgery. The aim of this systematic review and meta-analysis was to summarize studies on 2-stage exchange and débridement, antibiotics, and implant retention (DAIR) to determine differences in rates of recurrent infection, risk factors for recurrent infection, noninfectious complications, and functional outcomes.</div></div><div><h3>Methods</h3><div>A systematic search was conducted of the MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases in March 2024 to identify studies on infected TEAs treated with either 2-stage revision surgery or DAIR. Exclusion criteria included duplicate publications, review articles, and studies with a mean follow-up of less than 1 year. Fourteen studies were included in the final analysis. Data abstracted included demographics, treatment modalities, bacterial speciation, rates of recurrent infection, and functional outcomes (range of motion data and Mayo Elbow Performance Score.</div></div><div><h3>Results</h3><div>Two hundred ninety infected TEAs were included across all 14 studies, 131 treated with DAIR and 159 treated with 2-stage exchange. The overall pooled random-effects rate of recurrent infection was 34% (95% confidence interval: 21%-47%). The rate of recurrent infection was significantly lower following 2-stage exchange compared to DAIR (18% vs. 51%, <em>P</em> = .004). The overall pooled rate of noninfectious complications was 34% (95% confidence interval: 22%-46%). With the numbers available, the rate of noninfectious complications between 2-stage exchange and DAIR was smaller for 2-stage exchange, although the difference did not achieve statistical significance (27% vs. 43%, <em>P</em> = .244). Patients infected with coagulase-negative <em>Staphylococci</em> experienced a higher rate of recurrent infection than those infected with other species (44% vs. 14%), although again this difference did not reach statistical significance (<em>P</em> = .060). In patients undergoing 2-stage exchange, incomplete cement removal was associated with a significantly higher rate of recurrent infection than complete removal (56% vs. 19%, <em>P</em> = .001), but intentional retention of 1 component was not significantly associated with a higher rate of recurrent infection (37% vs. 20%, <em>P</em> = .315).</div></div><div><h3>Discussion</h3><div>The results of this systematic review and meta-analysis of the outcomes associated with the treatment of TEA periprosthetic joint infection with either DAIR or 2-stage reimplantation, 2-stage exchange was associated with a lower rate of recurrent infection. Incomplete cement removal was a risk factor for recurrent infection. Although it did not reach significance, it appeared that infection with coagulase-negative <em>Staphylococci</em> could also be a risk factor for failure of infection eradication.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100603"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736726","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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