Mid-term functional outcomes of arthroscopy-assisted lower trapezius transfer using doubled peroneus longus tendon.

Influence of teres minor trophicity on clinical outcomes after arthroscopically assisted posterior latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears.

Double-button fixation provides superior horizontal stability in acute acromioclavicular joint reconstruction: A comparative radiologic analysis.

Rotator cuff disease (RCD) constitutes the most common cause of shoulder pain, with partial-thickness rotator cuff tears (PT-RCTs) representing a substantial subset that may progress over time. Although both surgical and non-surgical interventions are employed in clinical practice, a consensus regarding the optimal management of symptomatic PT-RCTs is lacking, and a comprehensive synthesis of available evidence has not yet been conducted. A systematic review was conducted according to PRISMA guidelines using MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and WHO ICTRP. Studies on arthroscopic surgical and/or non-surgical treatments for PT-RCTs in patients ≥ 18 years were included. Clinical outcomes (Constant Score (CS), ASES Score, VAS for pain) were extracted. Random-effects meta-analysis and descriptive statistics were used to analyze outcomes and study characteristics. Of the 9,894 trials screened, 33 trials with a total of 1,818 patients met the inclusion criteria. Comparing pooled weighted mean outcomes across studies, surgical cohorts demonstrated higher scores than non-surgical cohorts in both the CS (p = 0.0095) and the ASES (p = 0.0060). However, no specific surgical technique proved superior, with neither Reconstruction versus Debridement (CS, p = 0.19; ASES, p = 0.06) nor Tear Completion versus Transtendon Repair (CS, p = 0.13; ASES, p = 0.65) reaching statistical significance. Although surgical treatment was statistically superior to non-surgical approaches, the observed differences remained below the minimal clinically important differences (MCID), indicating limited clinical relevance. Pooled analyses showed higher Constant and ASES scores in surgical cohorts. However, the magnitude of this difference does not exceed MCID, indicating limited clinical relevance. No surgical technique demonstrated significant superiority. These findings highlight the need for individualized treatment decisions, considering the limited clinical benefit of surgery over non-surgical approaches. The protocol was registered in PROSPERO with ID: CRD42023487714.

Survival and clinical outcomes of the Eclipse™ stemless anatomic total shoulder arthroplasty: a comparative study of glenoid component designs and humeral head materials.

Traditionally, revision of stemmed arthroplasty necessitated the use of longer stem. In young patients, preservation of bone stock is crucial for possible further operations and prevent stress shielding and further bone loss. To analyse the clinical and radiological outcomes of a series of patients who underwent revision shoulder arthroplasty, in whom the primary implant was stemmed total shoulder arthroplasty (TSA) and the implant for revision surgery was a stemless metaphyseal reverse TSA without a stem expanding to the humeral diaphysis. Between 2010 and 2020, 10 patients (6M; 4F) underwent revision arthroplasty from long stemmed to short metaphyseal stemless rTSA due to pain and disfunction, implant instability and dislocation, cases of loosening and infection. The mean age at surgery was 67 ± 12.2 years. The stemmed implants revised were from different design and manufacturers (Biomet, Lima, Zimmer and Exactech). Impaction with bone graft substitute was used in all cases to fill the void on the humeral side together with antibiotic impregnated Calcium sulfate (Stimulan) beads, in infection cases or in suspicion of low-grade infection. Patients were assessed clinically with the Constant score (CS), Subjective Shoulder Value (SSV), Satisfaction and Radiologic assessment at 3, 6 and 12 months post-operatively, and annually thereafter. The mean follow-up was 69 months (24-144). Mean CS improved from 16.2 (4-35) to 72.1 (67-85), age/sex adjusted CS from 20.4 to 98.5 (p < 0.005). The mean SSV increased from 0.5/10 pre-operatively to 9/10 in the last follow-up. All the patients showed improvements in pain Range of motion and function. Post revision the metaphyseal stemless implants showed solid fixation in the humerus without any lucent lines, loosening, subsidence or evidence of stress shielding, with good new bone formation and filling of the intramedullary canal. In two patients, an implant tilt with perforation of the lateral cortex occurred in the first three weeks post-operatively due to weak cortical bone. The implants settled and remained stable in its new tilted position with conservative treatment, with new bone that was formed around the implants with solid long-term fixation. Revision of a long-stemmed prosthesis with a stemless-metaphyseal one is feasible and a better option, if the metaphyseal cortical envelope is preserved on removal of the stemmed implant. Good outcome is achieved with good fixation of the stemless-metaphyseal implant and preservation of bone stock. However, implant design is pivotal in achieving immediate stability, resistance to torque and good stress distribution. The use of these implants in revision surgery enables surgeons to take 'a step back' in the patient's journey, preserve and 'create' more bone stock.

Surgical Options for the Management of Severe Glenoid Structural Deficiencies in the Setting of Revision Reverse Shoulder Arthroplasty: A Systematic Review.

Large to Massive Rotator Cuff Tears With Only Partial Repair Possible Treated With Human Dermal Allograft Results in Lower Retear Rates and Improved Function Compared With Matched Group Without Augmentation.

To explore the clinical effect of cannulated screw fixation for coracoid process fractures of the scapula assisted by robot navigation combined with O-arm imaging. A retrospective analysis was conducted of the clinical data from 19 patients with scapular coracoid process fractures who underwent surgical treatment at our center from January 2022 to July 2023. All the patients had their coracoid process fractures fixed with screws assisted by the robot navigation system combined with the O-arm imaging navigation system by experienced orthopedic surgeons. Three patients were excluded due to insufficient follow-up, and finally 16 patients were included in the study. The patients' surgical conditions (operation time, intraoperative blood loss) and fracture healing time were recorded. During the outpatient follow-up 12months after the operation, the Constant score was used to evaluate the function of the patients' shoulder joints, and the Visual Analogue Scale (VAS) pain score was applied to assess the residual pain of the patients' shoulder joints. All patients were followed for at least 12months, with an average of 14.2months (ranging 12 to 19months). The average operation time of the 16 patients was 75.8min (ranging from 52 to 98min), and the average intraoperative blood loss was 47.3ml (ranging from 28 to 75ml). All 16 fractures healed without nonunion or loss of reduction, and the average healing time was 10.2weeks (range, 8 to 14weeks). One year after the operation, the shoulder joint functions of all 16 patients were good. The average Constant score was 90.5 points (ranging from 82 to 97 points), and the average VAS score of the shoulder joints was 1.0 points (ranging from 0 to 4 points). No cases of blood vessel or nerve injury related to surgical operation were found in all patients during the perioperative period and follow-up period. In this retrospective case series, robot-assisted cannulated screw fixation with O-arm navigation for coracoid process fractures resulted in satisfactory fracture healing and shoulder function, with minimal blood loss and low perioperative complication rates. The proceduralized workflow may facilitate surgical standardization. Given the study's exploratory nature and low level of evidence, further controlled studies are needed to confirm comparative advantages.

This study evaluated the effect of bisphosphonate therapy on tendon healing and clinical outcomes after arthroscopic rotator cuff repair in patients with osteoporosis. PubMed, Scopus, and Ovid MEDLINE were searched from inception to January 2026 to identify comparative studies of osteoporotic patients treated with bisphosphonates versus no bisphosphonate therapy. Five studies met the inclusion criteria. Bisphosphonate therapy was associated with a significantly lower rate of structural tendon retear (odds ratio, 0.32; 95% confidence interval, 0.18-0.59; P =0.0002). No significant differences were observed between groups in postoperative American Shoulder and Elbow Surgeons scores, Constant scores, or reoperation rates. Patients receiving bisphosphonates demonstrated a modest but statistically significant improvement in postoperative forward flexion (mean difference, 8.28°; 95% confidence interval, 3.54-13.02). No serious bisphosphonate-related adverse events were reported.

The use of orthobiologic augmentation, including platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), has gained increasing attention in rotator cuff repair; however, evidence supporting their combined use remains limited and inconsistent. This prospective randomized controlled study evaluated the clinical efficacy of PRP and combined PRP with BMAC (BMAC + PRP) following arthroscopic repair of large full-thickness rotator cuff tears (3-5cm). A total of 93 patients were allocated into three groups: control (n = 33), PRP (n = 30), and BMAC + PRP (n = 30). Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score (primary outcome), visual analogue scale (VAS), and Constant score at baseline, 3 months, and 6 months. To address baseline imbalances, propensity score-based overlap weighting (ATO) and weighted ANCOVA were performed. All groups demonstrated significant improvement in pain and functional outcomes over time. In unadjusted analyses, early differences were observed at 3 months; however, after adjustment using overlap weighting and baseline covariates, no statistically significant differences were observed between groups at 6 months for ASES, VAS, or Constant scores. Exploratory age-stratified analyses suggested potential trends toward improved outcomes in patients aged > 55 years in the BMAC + PRP group, although these findings were attenuated after adjustment and should be interpreted cautiously. These findings indicate that, despite theoretical biological complementarity, the addition of BMAC to PRP does not confer clinically meaningful short-term benefit after repair of large rotator cuff tears. The results challenge the assumption of additive efficacy in combined orthobiologic strategies and underscore the need for biologically stratified trials to identify patient subsets that may derive benefit. Longer-term and mechanistically integrated studies are required to define the role of combined biologic augmentation in tendon regeneration.Trial registration: The patients were registered in the institutional board registry of Hallym University Medical Center (registry number 138-82-02667). The study was registered with the International Standard Randomized Controlled Trial Number (ISRCTN) 69,088,783.

Does clavicle shaft malunion with more than 20 mm shortening have a clinical and radiological effect on the shoulder joint?

Transtendon repair vs. tear completion in partial-thickness rotator cuff tears: systematic review and meta-analysis.

Post-operative pain following arthroscopic rotator cuff repair is challenging. Peripheral nerve blocks are commonly used, but debate remains over single-shot versus continuous interscalene catheters. This trial compared early post-operative pain and opioid use with a single-shot block versus a continuous interscalene catheter. In this prospective, double-blinded randomized controlled trial, 45 patients undergoing arthroscopic rotator cuff repair received an interscalene catheter with an initial single-shot block. They were randomized to either a patient-controlled infusion of normal saline (control, n = 22) or low-dose anesthetic (treatment, n = 23). Visual analogue scale for pain severity (VAS-S) and frequency (VAS-F) were assessed pre-operatively, daily for the first post-operative week, and at 2, 6, and 12 weeks. Opioid consumption was recorded for one week post-operatively. Functional outcomes were measured using the Constant and Western Ontario Rotator Cuff scores, and satisfaction with the surgery was assessed at 12 weeks. A significant interaction effect was found for VAS-S over the first week (P = .041), with the treatment group reporting significantly lower pain on day 1 (P = .011). Both groups showed significant improvement in clinical scores (P < .0001). The treatment group had a higher Constant score at 12 weeks (P = .040), though this did not reach the Minimally Clinically Important Difference. No significant difference in opioid consumption (P = .653) or satisfaction (treatment: 82%, control: 91%) was observed. Continuous interscalene catheters improved early post-operative pain without reducing opioid use. Despite these findings, careful consideration of patient needs, cost-effectiveness, and the potential complications associated with catheter use should be acknowledged in the individual patient's pain management strategy.

The purpose of arthroscopic rotator cuff repair (ARCR) is to achieve pain reduction and functional improvement for rotator cuff tears. We have adopted the net-like bridging ARCR, a double-row suture-bridge technique. The technique has demonstrated biomechanical superiority in terms of footprint coverage and contract pressure, thereby supporting clinical application. The purpose of this study is to investigate mid-term clinical outcomes and cuff integrity on magnetic resonance imaging after net-like bridging ARCR. Between 2013 and 2014, ARCR was performed on 44 patients with symptomatic full-thickness rotator cuff tears, specifically focusing on those with a maximum tear size of 20 mm or more. Of these patients, 22 patients who consented to participate and returned for follow-up evaluation at a minimum of five years post-operatively were included. The mean age at surgery was 65.8 years (range, 54.6-79.7 years). Active range of motion, clinical score, Cofield classification, and Sugaya classification were investigated. Retear was defined according to the Sugaya classification as types 4 and 5. A P value less than .05 was significant. Mean follow-up period was 71.3 months (range, 62.9-79.6 months). There were 20 males (91%) and 2 females. The Cofield classification was as follows: medium (6 cases), large (8 cases), and massive (8 cases). For active range of motion, flexion increased from pre-operative 131° ± 42° to final 159° ± 12° (P < .05). The Japanese Orthopedic Association score also improved from a pre-operative value of 62.1 ± 11.5 points to 93.9 ± 5.1 points at final follow-up (P < .01). The Constant score at final follow-up was 88.2 ± 11.9 points. Sugaya classification at 1 year and final follow-up are shown below, there was no significant difference: 1 year, type 1: 10; type 2: 3; type 3: 3; type 4: 5; type 5: 1; at final follow-up, type 1: 9; type 2: 3; type 3: 4; type 4: 2; type 5: 4. The retear rate was 27.3%, and no new retears occurred between 1 year post-operatively and the final follow-up. Net-like bridging ARCR for medium-sized or larger full-thickness rotator cuff tears (≥20 mm) results in a retear rate of 27.3%, with no new retears beyond 1 year at a mean follow-up of 71.3 months (minimum 5 years), and sustained muscle strength in patients without retear. Despite the low follow-up rate, two-time-point evaluation in large tears (≥20 mm) provides clinically relevant mid-term outcomes.

To date, no prior study has established procedure-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for anterior combined latissimus dorsi and teres major (LDTM) tendon transfer in irreparable anterosuperior rotator cuff tears (IASRCTs). This study aimed to establish these patient-centered benchmarks in a cohort with a minimum 5-year follow-up. We retrospectively reviewed 31 patients (33 shoulders) who underwent a single-stage anterior LDTM transfer for IASRCTs and completed a minimum 5-year follow-up. Patient-reported outcome measures (PROMs) included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, Constant score, and activities of daily living requiring internal rotation (ADLIR) score. The MCID was calculated as one-half of the standard deviation of the change score for each PROMs. PASS thresholds were derived from receiver operating characteristic analysis, using postoperative satisfaction as the external anchor. At a mean follow-up of 83.0 ± 7.4 months, all PROMs improved significantly (P < .001). Distribution-based MCID thresholds were 10.5 (ASES), 0.9 (VAS), 10.5 (Constant), and 8.6 (ADLIR). Corresponding MCID achievement rates were 77.4%, 87.1%, 74.2%, and 87.1%, respectively. Anchor-based PASS thresholds were ASES ≥75, VAS ≤2, Constant ≥60, and ADLIR ≥78; these were achieved by 64.5%, 80.6%, 77.4%, and 71.0% of patients, respectively. Age showed a significant negative correlation with ASES MCID (r_pb = -0.53, P = .002) and ADLIR MCID (r_pb = -0.41, P = .021). Male sex correlated positively with ASES PASS attainment (φ = 0.46, P = .010). No other baseline variables were significantly associated with MCID or PASS (all P > .05). This study is the first to establish clinically meaningful MCID and PASS thresholds for anterior LDTM transfer in patients with IASRCTs at a minimum 5-year follow-up. Most patients achieved substantial improvements that were deemed acceptable by the patients. These procedure-specific benchmarks provide practical targets for clinical assessment and patient counseling and serve as reference values for future outcome research.

Locking plate fixation is widely used for the treatment of displaced proximal humerus fractures; however, robust long-term data regarding its function and late complications remain limited. We report 6-year clinical and radiographic outcomes of locking plate fixation, including data regarding the relationship between avascular necrosis (AVN), post-traumatic osteoarthritis (PTA), and shoulder function. Between 2017 and 2019, 31 consecutive patients (21 women, 10 men; mean age, 63 years) with displaced proximal humerus fractures underwent fixation with a locking plate. Follow-up data were obtained at 3, 12, and 72 months. The fractures were classified using the Neer classification system (9 patients with 2-part fractures, 16 with 3-part fractures, and 6 with 4-part fractures). Functional outcomes were assessed using the Constant score. Radiographs were evaluated for AVN (y/n) and PTA (y/n). Reoperations and complications were also recorded. At 72 months, the mean Constant score was 66.2, with no improvement beyond 12 months. AVN occurred in 19% of patients and PTA in 34% of patients. Despite marked radiographic changes, the patients with AVN showed better shoulder function than those with PTA (P < .05). Reoperations were required in 32% of patients at a mean of 11 months and were most commonly implant removal with or without arthrolysis. Long-term function after locking plate fixation is moderate and plateaus after one year. Although radiographically severe, AVN does not necessarily impair shoulder function. In contrast, PTA is associated with progressive functional decline. These findings emphasize the importance of differentiating between necrotic and degenerative radiographic sequelae and of carefully tailoring the indication for locking plate fixation, particularly in complex fracture patterns.

Does prior rotator cuff surgery affect outcomes of posterior latissimus dorsi tendon transfer for irreparable posterosuperior tears?

Clinical outcomes and structural integrity after arthroscopic partial repair with patch augmentation for large to massive rotator cuff tears.

Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses.