Journal of Shoulder and Elbow Surgery

BACKGROUND: Revision shoulder arthroplasty continues to add an increasing burden on patients and the healthcare system. This study aimed to delineate long-term shoulder arthroplasty revision incidence, quantify associated Medicare spending, and identify relevant predictors of both revision and spending. METHODS: The complete 2016-2022(Q3) Medicare fee-for-service inpatient and outpatient claims data was analyzed. Patients receiving a primary total shoulder arthroplasty for osteoarthritis, rotator cuff pathology, or inflammatory arthropathy were included and subsequent ipsilateral revision surgeries were identified...

BACKGROUND: Stilting is a novel technique used in reverse shoulder arthroplasty (RSA) in patients with significant glenoid bone loss. This technique utilizes peripheral locking screws placed behind an unseated portion of the baseplate, to transmit forces from the baseplate to the cortical surface of the glenoid, without the need for bone grafting. The stilted screw, once locked, provides a fixed angle point of support for an unseated aspect of a baseplate. The primary advantages of this technique are reduced cost compared to a custom implant and reduced operative time compared to bone grafting...

BACKGROUND: For degenerative shoulder disease, reverse shoulder arthroplasty (RSA) has proven successful; however, problems such as scapular notching and instability still exist. These difficulties are intended to be addressed by recently improved prosthesis designs with reduced neck-shaft angles (NSA). Still, there are issues with complications, particularly with the humerus. In an effort to avoid these problems and maintain bone stock, a recently designed straight-short-stem humeral component was used; however, yet its clinical and radiological outcomes in RSA remain largely unexplored...

BACKGROUND: Mounting evidence suggests that mental health accounts for greater variation in levels of comfort and capability than pathophysiology severity across a range of musculoskeletal conditions. Using nationwide Dutch Arthroplasty Register (LROI) data, we tested the null hypothesis that none of the available mental, social, and pathophysiological factors are associated with variation in levels of comfort and capability among people with shoulder osteoarthritis prior to arthroplasty...

BACKGROUND: A failed prior Latarjet procedure can be a challenging situation for both patients and surgeons. The purpose of this study was to report on the techniques and outcomes of patients undergoing revision surgery for the treatment of recurrent anterior shoulder instability after a failed Latarjet procedure. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies which reported on surgical techniques for a failed Latarjet procedure with reporting of clinical outcomes...

BACKGROUND: Arthroscopic Latarjet using suture-button fixation has shown good clinical results and low recurrent instability in patients with significant glenoid bone loss (18). However, the presence of an associated Hill-Sachs lesion (HSL) is a risk factor for recurrent instability after isolated Latarjet (8,35,36). The aim of the study is to report clinical and radiological results following all-arthroscopic Latarjet combined with Hill-Sachs Remplissage (HSR). METHODS: Monocentric prospective study including 41 patients (mean age 28 ± 7 years) who underwent the combined procedure between 2014-2019 with minimum 2 years follow-up (mean 40 ± 13 months)...

BACKGROUND: Glenohumeral instability is a common pathology, particularly in young, active patients. METHODS: A narrative review was performed to describe the history of surgical treatments for anterior shoulder instability. RESULTS: Open surgical techniques were first described by Bankart in 1923. Techniques include both anatomic soft tissue repairs and nonanatomic procedures to provide constraint to motion and dislocation. Osseous techniques to address glenoid bone loss include both autograft techniques, such as the Latarjet procedure, or the use of various allografts...

BACKGROUND: Shoulder proprioception, in which the anterior glenohumeral capsule plays a major role, is critical to the functioning of the shoulder. Consequently, most surgeons either do not resect or reinsert the anterior capsule in shoulder stabilization surgery. In the original Open Latarjet Procedure (OLP), the anterior capsule is preserved. However, in the all-Arthroscopic Latarjet Procedure (ALP), complete anterior capsule resection is recommended for better view and access to the coracoid...

BACKGROUND: The posterosuperior humeral head contacts the glenoid during pitching. While magnetic resonance imaging (MRI) often detects abnormalities in the posterosuperior humeral head of baseball pitchers, ultrasonography may also be effective in identifying these abnormalities. However, studies on such abnormalities in asymptomatic players are limited. Thus, this study aimed to determine the prevalence of abnormal findings in the humeral head using ultrasonography in asymptomatic collegiate baseball pitchers...

OBJECTIVE: This retrospective, observational study aimed to assess the revision rates and survival curves in total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) patients, including a sub analysis to investigate the impact of pyrocarbon humeral head in revision rates. METHODS: Data from 92 primary HSA and 508 primary TSA patients performed by seven surgeons at a large private clinic, were analyzed. The study focused on revision rates and identified factors leading to revisions, including rotator cuff insufficiency, dislocation, aseptic loosening, implant material, and glenoid erosion...

BACKGROUND: Increased surgeon volume has been demonstrated to correlate with improved outcomes after orthopedic surgery. However, there is a lack of data demonstrating the effect of surgeon volume on outcomes after total shoulder arthroplasty. METHODS: The PearlDiver Mariner database was retrospectively queried from the years 2010-2022. Patients undergoing shoulder arthroplasty were selected using the CPT code 23472 (Total Shoulder Arthroplasty). Patients under 40 years of age, those undergoing revision arthroplasty and cases of bilateral arthroplasty were excluded...

BACKGROUND: To date, long-term results of the arthroscopic repair of glenoid rim fractures are missing. The aim of this study was, to evaluate clinical and radiographic results following arthroscopic repair of anteroinferior glenoid fractures using anchors or bioabsorbable compression screws after a mean follow-up period of ten years. METHODS: Clinical outcome measures included evaluation of recurrent instability, the Constant Score (CS), Subjective Shoulder Value (SSV), Rowe Score (RS), Western Ontario Shoulder Instability Score (WOSI) and Melbourne Instability Shoulder Score (MISS)...

BACKGROUND: Posterior shoulder dislocation frequently results in a centrally located impression fracture of the anterior humeral head, known as reverse Hill-Sachs lesion (RHSL). Depending on size and location of RHSL the RHSL can lead to engagement with the posterior glenoid rim and subsequently re-dislocation of the shoulder joint. The objective of this study was to present the clinical and radiological outcomes of anatomical reconstruction of the humeral articular surface using arthroscopically assisted disimpaction in patients with acute posterior shoulder dislocation and an engaging RHSL...

BACKGROUND: Brachial plexus birth injury (BPBI) is common and while most recover, 8-36% of patients experience permanent impairment. Typically, adolescents with untreated BPBI lack active and passive external shoulder rotation (ER) and overhead shoulder function. Limited shoulder function is due to 1) nonoperative BPBI 2) untreated BPBI or 3) unrecognized glenohumeral joint dysplasia. We describe a technique for achieving reanimation in adolescents who did not receive timely/effective BPBI care, a postoperative rehabilitation protocol, and results from a series of eight patients who underwent shoulder reanimation...

AIMS: Evaluate outcomes of arthroscopic capsulolabral repair in patients with structural dynamic posterior instability (Moroder classification B2), analyzing factors associated with inferior clinical outcomes or recurrence. The primary hypothesis is that this surgical approach in patients without static structural changes such as excessive glenoid retroversion or dysplastic glenoids will result in satisfactory clinical outcomes and low failure rates. METHODS: Observational retrospective analysis in patients diagnosed with posterior structural dynamic instability who underwent arthroscopic capsulolabral repair...

INTRODUCTION: The treatment of complex radial head fractures remains controversial with open reduction and internal fixation (ORIF), radial head arthroplasty, and radial head excision being the most common treatment options. While ORIF is the preferred treatment strategy for Mason type II fractures, the optimal treatment of Mason type III fractures is debated. PURPOSE: To report minimum 10-year outcomes after ORIF of Mason type II and type III radial head fractures...

BACKGROUND: In the past decade the prevalence of end stage inflammatory elbow arthritis has declined with consequential changes in indications and utilization of total elbow arthroplasty (TEA). Current literature lacks future projections for the utilization of TEA. This aim of this study is to review the trends in utilization of TEA in last two decades and determine the projections of utilization for TEA (primary and revision) through 2060. METHODS: This analysis utilized the publicly available 2000-2019 data from the CMS Medicare Part-B National Summary...

INTRODUCTION: Optimal management of retroversion in anatomic total shoulder arthroplasty (aTSA) remains controversial and limited attention has been directed to the impact of glenoid inclination. Prior biomechanical study suggest that residual glenoid inclination generates shear stresses that may lead to early glenoid loosening. Combined biplanar glenoid deformities may complicate anatomic glenoid reconstruction and affect outcomes. The goal of this matched-cohort analysis was to assess the relationship between biplanar deformities and mid-term radiographic loosening in aTSA...

BACKGROUND: Subscapularis tendon (SSc) dysfunction following total shoulder arthroplasty (TSA) results in poor functional outcomes. There have been numerous SSc repair constructs tested biomechanically and clinically, however, none has been demonstrated as superior. Newer techniques and implants have emerged, but have not been fully tested. HYPOTHESIS: We hypothesized that the unicortical button (UB) fixation will provide significantly improved restoration of the anatomic footprint and biomechanical properties when compared to transosseous (TO) repair of the SSc...

PURPOSE: To identify the potential role of humeral retrotorsion (HRT) and range of motion (ROM) as a risk factor for shoulder overuse injury in elite youth handball players. The hypothesis was that increased HRT is associated with an increased risk of shoulder overuse injury. METHODS: Over two seasons, 258 elite youth handball players (52% boys; age:14±0.8years) were included. Pre-season assessment included HRT and glenohumeral internal (IR) and external (ER) rotational ROM using ultrasound and a manual goniometer...