Journal of Shoulder and Elbow Surgery

INTRODUCTION: Machine Learning (ML) based clinical decision support tools (CDST) make personalized predictions for different treatments; by comparing predictions of multiple treatments, these tools can be used to optimize decision making for a particular patient. However, CDST prediction accuracy varies for different patients and also for different treatment options. If these differences are sufficient large and consistent for a particular subcohort of patients, then that bias may result in those patients not receiving a particular treatment...

BACKGROUND: Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older. METHODS: A literature search of Embase, PubMed, Medline, and Cochrane databases was performed according to PRISMA guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis...

INTRODUCTION: Patients are increasingly undergoing bilateral total shoulder arthroplasty (TSA). At present, it is unknown whether success after the 1st TSA is predictive of success after contralateral TSA. We aimed to determine whether exceeding clinically important thresholds of success after primary TSA predicts similar outcomes for subsequent contralateral TSA. METHODS: We performed a retrospective review of a prospectively-collected shoulder arthroplasty database for patients undergoing bilateral primary anatomic (aTSA) or reverse (rTSA) total shoulder arthroplasty since January 2000 with preoperative and 2- or 3-year clinical follow-up...

BACKGROUND: Large to massive rotator cuff tears (RCTs) affect shoulder functions profoundly with unmanageable disability without intervention. The retear rates with arthroscopic rotator cuff repair (ARCR) in these patients are abysmal. Patch augmentation has been credited for preventing retears, improving functions by increasing the strength and acting as a bio-conductive scaffold. This study attempted to assess the retear rates, clinical and radiological outcomes between the ARCR with and without acellular human dermal allograft (HDA) augmentation...

INTRODUCTION: Up to 59% of undisplaced greater tuberosity (GT) fractures are missed on initial evaluation. Timely diagnosis of these injuries can avoid undue morbidity, but a clinical sign to accurately identify them has not previously been described. Magnetic Resonance Imaging (MRI) remains the gold standard for their assessment, but may not be routinely available, or difficult to organize urgently. We aimed to evaluate the diagnostic efficacy of a new clinical sign (the anterior bruise sign [ABS]), in diagnosing radiologically-occult GT fractures...

BACKGROUND: Total elbow replacement (TER) is an accepted treatment for complex intra-articular distal humerus fractures in elderly patients. Distal humeral hemiarthroplasty (HA) is also a potential surgical option for unreconstructable fractures and avoids the concerns regarding mechanical wear and functional restrictions associated with TER. In the current literature, there are limited data available to compare the revision rates of HA and TER for the treatment of fracture. We used data from a large national arthroplasty registry to compare the outcome of HA and TER undertaken for fracture/dislocation and to assess the impact of demographics and implant choice on revision rates...

BACKGROUND: Current methods available for assessment of radiolucency and in between fin growth of a glenoid component have not undergone interobserver reliability testing for an all-polyethylene fluted central peg glenoid (FCP). The purpose of this study was to evaluate anteroposterior radiographs of an FCP glenoid component at ≥ 48 months comparing commonly used scales to a new method adapted to the FCP. Our hypothesis was that the new method would result in acceptable intra- and interobserver agreement and a more accurate description of radiographic findings...

BACKGROUND: Overloading of the elbow joint prosthesis following total elbow arthroplasty can lead to implant failure. Joint moments during daily activities are not well-contextualized for a prosthesis' failure limits and the effect of the current postoperative instruction on elbow joint loading is unclear. This study investigates the difference in elbow joint moments between simulated daily tasks and between flexion-extension, pronation-supination, varus-valgus movement directions. Additionally, the effect of the current postoperative instruction on elbow joint load is examined...

BACKGROUND: Failure to achieve fixation of the glenoid baseplate will lead to clinical failure. The fixation of the baseplate to the scapula must be able to withstand sufficient shear forces to allow bony ingrowth. The importance of compression to neutralize the forces at the baseplate-bone interface has been assumed to be critical in limiting excessive micromotion. The purpose of this study is to determine the effect of compression on implant stability with different baseplate designs...

BACKGROUND AND HYPOTHESIS: A double cortical button technique for ulnar collateral ligament reconstruction (UCLR) has advantages including significant control over graft tensioning, less concern about graft length and minimized risk of bone tunnel fracture compared to traditional UCLR techniques. This double cortical button technique was recently found to be non-inferior in mechanical performance compared to the traditional docking technique regarding joint strength, joint stiffness, and graft strain...

BACKGROUND: Anatomic and reverse total shoulder arthroplasty (aTSA, rTSA) are well-established treatments for patients with primary osteoarthritis and an intact cuff. However, it is unclear whether aTSA or rTSA provide superior outcomes in patients with preoperative external rotation (ER) weakness. METHODS: A retrospective review of a prospectively collected shoulder arthroplasty database was performed between 2007-2020. Patients were excluded for preoperative diagnoses of nerve injury, infection, tumor, or fracture...

BACKGROUND: The pathogenesis of SIRVA is incompletely understood, but it is postulated to be an immune-mediated inflammatory response to a vaccine antigen, leading to shoulder pain and dysfunction. The purpose of this investigation is to systematically review the literature related to SIRVA specifically after the COVID-19 vaccination by describing the diagnostic and clinical characteristics, diagnoses associated with SIRVA, and incidence between vaccine types. METHODS: A systematic review was performed to identify level I to IV studies and case descriptions of shoulder pain occurring after COVID-19 vaccination...

INTRODUCTION: The purpose of this study was to create a model to simulate treatment of unreconstructable distal humerus fractures with hemiarthroplasty. Stability was restored with a new plate-system that simultaneously tensions medial and lateral collateral ligament grafts. MATERIALS AND METHODS: Static varus and valgus elbow stability was tested in 11 cadaver elbows with intact ligaments and capsule at five flexion angles (0, 30, 60, 90, 120 degrees). The elbows were then destabilized via release of all ligaments and capsular attachments...

INTRODUCTION: The purpose of this study is to examine and compare trends in the treatment of proximal humerus fractures (PHF) (nonoperative versus operative; different surgical treatments) across different age groups over the last decade (2010-2020). METHODS: The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried using ICD and CPT codes to identify all patients presenting with or undergoing surgery for PHF between 2010-2020...

BACKGROUND: Although short-term results are promising, there are limited data for long-term results of arthroscopic SSC repair. The purpose of this study is to report minimum ten-year outcomes of primary arthroscopic repair of isolated partial or full-thickness tears of the upper third of the subscapularis (SSC) tendon. METHODS: Patients who underwent arthroscopic repair of isolated upper third SSC tears, Lafosse type I (>50% of tendon thickness) or type II were included...

BACKGROUND: Evidence continues to mount for the deleterious effects of preoperative opioid use in the setting of total shoulder arthroplasty (TSA). Tramadol, a synthetic opioid with concomitant neurotransmitter effects, has become a popular alternative to traditional opioids, but it has not been well studied in the preoperative setting of TSA. The purpose of this study is to evaluate postsurgical outcomes in TSA for patients with preoperative tramadol use compared to patients using traditional opioids and those who were opioid naïve...

INTRODUCTION: Clinical studies are often at risk of spin, a form of bias where beneficial claims are overstated while negative findings are minimized or dismissed. Spin is often more problematic in abstracts given their brevity and can result in the misrepresentation of a study's actual findings. The goal of this study is to aggregate primary and secondary studies reporting the clinical outcomes of the use of sub-acromial balloon spacers in the treatment of massive, irreparable rotator cuff tears (MIRCTs) to identify the incidence of spin and find any significant association with study design parameters...

Throwing with high velocity requires extremes of glenohumeral external rotation of the abducted arm where particularly high forces in the shoulder and elbow are endured. Repeated throwing leads to dominant-arm bony remodeling of the humerus, glenoid, and elbow, and multiple soft tissue changes that would be considered abnormal. Many of these features are thought to be adaptive and protective. The purpose of this work is to: 1.) define the concept of adaptive pathology, 2.) review the mechanics of the throwing motion, 3...

BACKGROUND: To reduce hardware-related complications in coracoid graft fixation to the anterior aspect of the glenoid, a metal-free Latarjet technique was recently introduced. The aim of this study was to compare the primary stability of a classic Latarjet procedure with two metal screws to a novel metal-free, all-suture cerclage method. It is hypothesized that fixation of the coracoid graft with two malleolar screws provides higher primary stability compared to an all-suture cerclage technique...

BACKGROUND: The popularity of team handball is increasing with over 10 million children playing this overhead, throwing and collision sport with highest demands on the shoulder joint. Due to the risk for recurrent instability, the Latarjet-Patte (LP) procedure has been recommended to treat young competitive players. This is the first LP outcome study in professional handball. METHODS: We included 20 shoulders retrospectively (18 players/17 males/mean age 22.9 years, range 17-35 years; minimum/mean follow-up: 2/6...