Biological augmentation in revision surgery: effect of a bioinductive collagen patch (REGENETEN) in patients with rotator cuff retear and a previous arthroscopic rotator cuff repair.

Does physical activity provide additional benefit in individuals with rotator cuff related shoulder pain?

Rotator cuff repair vs. reverse arthroplasty for massive tears: A patient-centered outcome analysis.

Relationships between magnitude of handedness and bilateral asymmetry of shoulder muscle activation during a unilateral overhead fatiguing task in right-handed individuals.

Is the graft position critical for functional outcomes following arthroscopy-assisted lower trapezius tendon transfer for posterosuperior irreparable rotator cuff tears? A comparison of anterior vs. posterior position of graft.

Platelet-rich plasma enhances anti-apoptotic and paracrine effects of bone marrow mesenchymal stem cells through the PI3K/Akt pathway.

Overhead throwing sports, such as softball, impose significant biomechanical demands on the shoulder and elbow, yet chronic musculoskeletal adaptations in female softball players remain underexplored. This study aimed to investigate whether repetitive overhead throwing in collegiate female softball players leads to increased thickness of the supraspinatus, infraspinatus, and ulnar collateral ligament (UCL) in the throwing arm compared to the non-throwing arm. A cross-sectional study was conducted with 19 female collegiate softball players from an NCAA Division I team, excluding pitchers. Ultrasound imaging was used to measure the thickness of the supraspinatus, infraspinatus, and UCL with participants seated with arms relaxed for supraspinatus and infraspinatus imaging, and with the elbow flexed at 90° for UCL imaging. Paired t-tests were used to compare tissue thickness between arms. Mean thicknesses were similar across arms (supraspinatus: 1.93 (standard deviation [SD]=0.31) cm vs. 1.95 (SD=0.29) cm; infraspinatus: 2.26 (SD=0.35) cm vs. 2.18 (SD=0.34) cm; UCL: 0.58 (SD=0.05) cm vs. 0.56 (SD=0.06) cm). Paired t-tests revealed no significant differences between the throwing and non-throwing arms for supraspinatus thickness (P=0.401), infraspinatus thickness (P=0.236), or UCL thickness (P=0.171). We observed no between-arm differences in resting thickness of the supraspinatus, infraspinatus, or UCL; these data do not provide evidence for hypertrophic adaptation in these tissues among collegiate female softball players. This suggests that throwing may not provide sufficient stimulus to drive significant structural adaptation in these tissues. These findings highlight the need to explore additional adaptive mechanisms and position-specific demands to inform injury-prevention strategies better.

“Subacromial Impingement Syndrome (SAIS)” refers to conditions disrupting the balance between structural rigidity and soft tissue inflammation, leading to irritation in the subacromial space, primarily affecting the rotator cuff and bursa. High-Intensity Laser Therapy (HILT) is a non-invasive, painless treatment that increases mobility and stimulates deeper tissues. It can be used with antiinflammatory and analgesic effects. In the present case report, a 62-year-old woman reported with right shoulder pain and limited motion for four months. Clinical metrics included a Pain Disability Index (PDI) score of 36, a Shoulder Pain and Disability Index (SPADI) score of 69%, and a Shoulder Function Index (SFInX) of 40, suggesting impingement syndrome. A high-intensity laser was applied to the site. The exercise regimen included posture improvement, pectoral and trapezius stretching, shoulder Range of Motion (ROM) exercises, gentle stretches, and finger stair exercises over four weeks. At treatment's end, significant functional improvements were noted, including reduced pain, increased ROM, and enhanced muscle strength.

Background: Rotator cuff injuries are a leading cause of upper extremity dysfunction, particularly in populations with occupational strain, such as security guards. These injuries are associated with pain, restricted range of motion, and diminished functional independence. Objective: To investigate the association between previous rotator cuff injuries and upper limb dysfunction among security guards. Methodology: An analytical cross-sectional study was conducted among 138 male security guards aged 45 to 60 years with a documented history of rotator cuff injury. A non-probability convenience sampling technique was used to recruit participants. Participants were excluded if they had a history of fractures, active infections, neurological disorders affecting cognition, or recent overhead shoulder trauma. The Disabilities of the Arm, Shoulder, and Hand scale and the Western Ontario Rotator Cuff Index were used to assess upper limb disability and shoulder-related quality of life. Clinical assessment of rotator cuff integrity was performed using the Lift-Off and the Empty Can tests. Descriptive statistics were used to present categorical variables as frequencies and percentages. The Mann–Whitney U test and Kruskal–Wallis test were used to evaluate differences in functional outcomes, while the Chi-square test was applied to determine the association between rotator cuff injury and shoulder disability among security guards. A p-value of less than 0.05 was considered statistically significant. Results: A significant proportion of participants exhibited upper extremity dysfunction, with 66.7% and 61.6% testing positive on the Lift-Off and Empty Can tests, respectively. Pain and reduced range of motion, particularly in abduction and flexion, were strongly associated with diminished occupational performance. Participants with positive test results had higher symptom severity and lower functional scores. Participants showed the symptom score by Disabilities of the Arm, Shoulder, and Hand scale, Western Ontario Rotator Cuff Index, and Sports performance across both tests showed significant results (p>0.05), whereas Sports performance didn’t show significant results (p>0.05). Conclusion: Rotator cuff injuries substantially impact shoulder function and occupational performance in security guards. Rotator cuff injuries are a leading cause of upper limb dysfunction, particularly in high-risk occupational groups like security guards. Almost half of the population of security guards suffered from rotator cuff injury.

Efficacy of BMP-2 in rotator cuff repair: a randomized controlled trial based on radiological and clinical outcomes.

ABSTRACT Powerlifting, including the bench press, has shown an increasing participation rate, especially among women. While rotator cuff injuries are prevalent in lifters, there is limited knowledge on how biological sex impacts shoulder biomechanics during the bench press. This study evaluated the impact of biological sex and fatigue on subacromial space parameters, specifically the acromiohumeral distance and supraspinatus occupation ratio, during the bench press. We hypothesized that the occupation ratio would be higher in female lifters than males. Twenty-four competitive powerlifters (12 M, 12 F) underwent ultrasound imaging to measure supraspinatus tendon thickness and acromiohumeral distance in seated and bench press postures across three phases: pre-warmup, post-warmup and post-exercise. The fatiguing exercise protocol consisted of three sets of eight bench press repetitions at 73.9% 1RM. Females exhibited higher supraspinatus occupation ratios than males in the bench press position (p = 0.001). Female lifters had a significantly smaller acromiohumeral distance than males in the bench press position (p < 0.001). The study found females have a greater supraspinatus occupation ratio during the bench press, increasing their risk for shoulder impingement compared to males. Understanding these sex differences in shoulder biomechanics during the bench press can guide tailored injury prevention and training strategies for powerlifters.

Limited vascularization at the tendon-bone interface (TBI) hinders rotator cuff (RC) healing. Although cell sheet technology has shown promise for interfacial repair, prevascularization strategies remain underexplored. Twenty female New Zealand rabbits underwent bilateral infraspinatus tendon repair and were randomized to receive either bone marrow-derived mesenchymal stem cell (BMSC) sheets or prevascularized BMSC sheets generated by coculture with endothelial cells, implanted at the TBI. An age- and weight-matched uninjured group served as a control. Healing at 6 weeks was assessed by gross observation, histology, immunohistochemistry, gene expression, and biomechanical testing. Prevascularization of the BMSC sheets enhanced TBI vascularization, indicated by greater density of α-smooth muscle actin-positive vessels (16.16 ± 2.81 versus 10.63 ± 2.79/mm2, p = 0.0079). Immunohistochemistry demonstrated greater areas positive for collagen type II alpha 1 (86.96 ± 29.95 versus 40.25 ± 11.96 μm2, p = 0.0079) and interleukin 10 (14.93 ± 4.79 versus 7.43 ± 2.48 μm2, p = 0.0159). Biomechanically, prevascularization of the sheets yielded greater ultimate failure load (156.89 ± 51.92 versus 111.67 ± 27.51 N, p = 0.0364) and stiffness (37.27 ± 12.16 versus 27.16 ± 7.33 N/mm, p = 0.0486). Prevascularization of BMSC sheets was able to promote angiogenesis and improve structural and mechanical aspects of tendon-bone healing. Prevascularized BMSC sheets may represent a biologic adjunct to enhance tendon-bone healing in RC repair.

To quantitatively evaluate MRI-derived morphologic and bursal parameters in patients with calcific tendinopathy (CaT) of the shoulder and to determine imaging thresholds predictive of rotator cuff (RC) tears. In this retrospective, single-center study, 112 patients with calcific tendinopathy who met the inclusion criteria were included (January 2020 to April 2025). Patients with CaT confirmed by radiography or computed tomography were included. Exclusion criteria were prior shoulder surgery, incomplete MRI sequences, severe motion artifacts, or calcifications outside the RC tendons. MRI features recorded included tendon involvement, calcification morphology (solitary or multifocal), maximum deposit size, bursal thickness, and presence of bursitis. RC tear presence and severity were assessed in 3 planes on fluid-sensitive sequences. Receiver operating characteristic (ROC) analysis determined optimal thresholds for tear prediction. Of 134 eligible patients, 112 met inclusion criteria (84 females, 28 males; mean age: 50.3±10.5y). RC tears were identified in 42.9% of cases. Multifocal morphology was more frequent in patients with tears (79.2% vs. 25.0%, P<0.001). Mean deposit size was greater in the tear group (10.2±3.5 vs. 8.5±2.6mm, P=0.004); ROC analysis identified a ≥9mm cutoff (AUC=0.62). Bursal thickness was significantly higher in the tear group (5.1±2.1 vs. 2.8±1.9mm, P<0.001), with a ≥5mm threshold demonstrating good predictive value (AUC=0.81). Bursitis was more prevalent in tear cases (97.9% vs. 62.5%, P<0.001). MRI-derived multifocal calcification morphology, deposit size ≥9mm, and bursal thickness ≥5mm are significant predictors of RC tears in CaT. Quantitative assessment of these parameters can enhance MRI interpretation and may guide early management decisions.

Due to their potential to reduce occupational physical strain and enhance human performance, the development of exoskeletons has gained significant attention. This study presents a musculoskeletal simulation pipeline designed to evaluate the biomechanical effects of shoulder-supporting exoskeletons. The focus of the investigation is on the biomechanical tools obtained from musculoskeletal simulations for the evaluation of exoskeletons. Such tools result in many biomechanical values, such as joint kinematics, external joint torques, muscle activation and joint reaction forces. The pipeline was applied to a use case, where electromyography (EMG) signals were collected and compared with simulated muscle activations for validation. The simulated muscle activations had a relative root mean square error (RMSE) of 37% in the area under the curve (AUC) compared to the EMG muscle activation. Joint reaction force analysis revealed altered magnitude and direction of the tangential JRF in the glenohumeral joint during exoskeleton support. This work raises the question of whether the focus in the development of shoulder exoskeletons should be on reducing the load on the subacromial space. By analyzing joint reaction forces and muscle activations, the pipeline can help to identify design parameters that reduce the load on the rotator cuff in the subacromial space.

Clinical Outcome of Adding Middle Trapezius Transfer to Anterior Latissimus Dorsi and Teres Major Transfer in Anterosuperior Irreparable Rotator Cuff Tears with Narrow Acromiohumeral Distance: A Comparative Study

Hip osteoarthritis (OA) and rotator cuff lesions (RCL) are major musculoskeletal disorders that cause chronic pain, reduced mobility, and work incapacity. While certain occupational groups have been studied, limited data exist on other physically demanding professions typically performed by women, such as healthcare, childcare, and hairdressing. This study examines the prevalence and occupational risks of hip OA and RCL in Germany. A retrospective analysis was conducted using anonymized, large-scale, nationwide claims data (2016-2020). Individuals aged 18-65 years diagnosed with OA (International Classification of Diseases and Related Health Problems [ICD-10]: M16) or RCL (ICD-10: M75) were identified. Physically demanding occupational groups were classified according to the German Federal Employment Agency and compared to a propensity score-matched control group of office workers. Between 2016 and 2020, the prevalence of hip OA increased from 1.8% to 1.9%, and RCL from 4.4% to 4.6%. Higher prevalence rates for RCL were found in exposed occupations (4.9%). Increased risks were observed in elderly care (OA: odds ratio [OR] = 1.33, RCL: OR = 1.49) and in health and nursing care (OA: OR = 1.33, RCL: OR = 1.27) compared to office workers with lower physical exposure. Restricting the analysis to women yielded similar effect estimates. The findings highlight an elevated occupational risk for hip OA and RCL in physically demanding professions such as nursing. Targeted prevention, ergonomic interventions, and early screening are essential to reducing work disability and improving long-term health outcomes. Int J Occup Med Environ Health. 2026;39(1):68-78.

Rotator cuff (RC) tears are among the most common causes of shoulder dysfunction in sports medicine. Muscle atrophy and degeneration are important risk factors for RC tendon retearing and suboptimal recovery of shoulder function after tendon repair. Although blood flow restriction (BFR) can stimulate muscle regeneration after lower extremity trauma and anterior cruciate ligament reconstruction, the mechanisms that underlie BFR remain unknown, and its application to RC tears has not yet been explored. The authors hypothesized that BFR induces transfer of mitochondria from intramuscular fibro-adipogenic progenitors (FAPs) to myocytes, enhances muscle regeneration, and improves shoulder function after RC injury. Controlled laboratory study. To assess mitochondrial transfer after BFR, the authors used Prrx1-Cre/MitoTag reporter mice, in which FAP mitochondria are labeled. Mice underwent unilateral forelimb BFR, and supraspinatus (SS) muscles were collected at baseline and days 1, 2, 3, 5, and 7 for histology. To model massive RC tears, mice received unilateral SS and infraspinatus tendon transection with denervation (TT+DN) and then were randomized to a BFR (every 3 days) or control group. At 2 or 6 weeks after surgery, SS muscles were analyzed for mitochondrial transfer, fiber size, and fiber-type distribution. Additionally, forelimb gait and weightbearing were captured using the Blackbox system. BFR was associated with increased FAP-mediated mitochondrial transfer in healthy SS muscle as early as 1 day after BFR treatment and lasted for up to 3 days after BFR. The authors observed an enhanced effect of BFR-induced FAP mitochondrial transfer in SS muscle after RC injury, compared with the control, at both 2 and 6 weeks after TT+DN. BFR-treated mice had significantly reduced muscle atrophy, fatty infiltration, and fibrosis after RC injury. They also observed a significant improvement in forepaw weightbearing ratio and ipsilateral forepaw stride length at 6 weeks after injury in BFR-treated mice compared with controls. BFR significantly improves muscle quality and shoulder function after RC injury. These effects occur alongside increased mitochondrial transfer from FAPs to myocytes. Understanding the mechanism of BFR by which BFR enhances muscle regeneration could pave the way for its use as a novel rehabilitation strategy to improve recovery in patients with RC injuries and other muscle-related conditions.

The thrower's oblique rotator cuff (TORC) view was developed to more optimally visualize the commonly injured posterosuperior rotator cuff and capsulolabral structures in overhead athletes. The purpose is to evaluate whether the addition of the TORC view to standard MRI sequences improves the diagnostic evaluation of rotator cuff pathology and labral abnormalities in throwing athletes. Shoulder MRIs of MLB pitchers ordered by team physicians from 1/1/2019 to 12/31/2021 were retrospectively reviewed. The inclusion criteria were standard and TORC MRI sequences per individual player and players aged 18-35. The MRIs were read by a musculoskeletal radiologist and two orthopedic surgeons with and without the addition of the TORC plane. The TORC view resulted in minor redistribution of supraspinatus, infraspinatus, and labral classifications. Signal size measurements differed significantly between standard and TORC views at the individual reader level (p = 0.042, p = 0.003, and p < 0.001), with generally larger measurements on the TORC view; however, no significant difference was observed when measurements were pooled across readers (median 17.0mm; p = 0.197). Inter-reader reliability for signal size improved with the TORC view (ICC 0.47 → 0.73). Overall diagnostic confidence increased significantly for two of three readers with the TORC view (median paired increase, 1.0 point; p < 0.001), while no significant change was observed for the third reader. The addition of the TORC plane was associated with improved reader confidence and inter-reader reliability for quantitative signal size assessment without introducing systematic changes in categorical tendon or labral classification. These findings support the use of the TORC sequence as an adjunct to standard shoulder MRI protocols to enhance interpretive consistency and confidence, particularly in elite overhead throwing athletes.

Biceps tenodesis (BT) is performed to address symptomatic tendinopathy, partial tears, and instability of the long head of the biceps tendon to provide pain relief and improve function. Debate persists regarding which technique is optimal: arthroscopic suprapectoral BT (ASPBT) or open subpectoral BT (OSPBT). To systematically review the literature to evaluate clinical and patient-reported outcomes (PROs), complications, and reoperations after ASPBT versus OSPBT. Systematic review; Level of evidence, 4Methods:Studies published in the PubMed, Embase, and Cochrane Library databases reporting outcomes of OSPBT or ASPBT from inception to August 2025 were identified. Inclusion criteria included studies reporting patients undergoing BT with lesion cause, surgical technique, concomitant procedures, complications, reoperations, and any PROs. A total of 43 studies, consisting of 11,113 patients undergoing BT, with a weighted mean follow-up of 23.8 months (range, 0.7-133.20 months), were identified. The weighted mean patient age was 54.3 years (range, 16-91 years), and 66% of the patients were male. OSPBT was performed in 53.9% (5987/11,113) of patients, while 46.1% (5126/11,113) underwent ASPBT. A significantly higher percentage of superior labrum anterior to posterior (SLAP) lesions were reported in OSPBT patients (33.1%; 403/1217) (P < .001). Rotator cuff repair and subacromial decompression were the most common concomitant procedures. Fixation with interference screws was most common during OSPBT (69.9%; 2449/3503) and ASPBT (65.7%; 1548/2357), while suture anchor fixation was utilized in a higher percentage of ASPBT procedures (21.9% [517/2357] vs 11.6% [407/3503]; P < .001). Both techniques resulted in improvement in various PROs. Complications were reported in 5.6% (496/8784) of patients, with postoperative stiffness most frequent, occurring in a significantly greater proportion of ASPBT patients (2.5% [103/4048] vs 1.4% [66/4736]; P < .001). OSPBT was associated with a higher percentage of wound infections (1.1% [51/4736] vs 0.5% [22/4048]; P = .006) and nerve-related complications (1.1% [50/4736] vs 0.2% [7/4048]; P < .001). No significant differences were reported between groups in the incidence of "Popeye" deformities, implant failures, or overall complications. Reoperations were performed more frequently after ASPBT (1.9% [77/4048] vs 1.1% [52/4736]; P = .002). This systematic review of 43 studies found that both ASPBT and OSPBT were associated with improvement in a variety of PROs, while complication rates were comparable between techniques. While ASPBT is associated with a higher incidence of postoperative stiffness and a greater rate of reoperations, OSPBT was reported to lead to a higher incidence of wound infections and iatrogenic nerve injuries.

The "July effect" suggests increased patient morbidity and mortality during the early academic year due to new resident involvement. Evidence specific to orthopaedic sports medicine is limited. To evaluate the effect of resident and fellow involvement on postoperative complication rates, surgical time, and patient-reported outcomes (PROs) in anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR). Cohort study; Level of evidence, 3. Patients who underwent primary ACLR or RCR between 2014 and 2022 at a single institution with a minimum 2-year follow-up were analyzed. Outcomes included operative time, postoperative complications within 100 days, and PROs (International Knee Documentation Committee Subjective Knee Form, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, Patient-Reported Outcomes Measurement Information System [PROMIS]-Physical Function, PROMIS-Pain Interference, Marx Activity Rating Scale, and visual analog scale). Trainee involvement was defined by resident or fellow presence in the operating room. Statistical analyses included analysis of variance, t tests, chi-square tests, and linear mixed models (P < .05). Of the 3997 cases (2065 RCR, 1932 ACLR), trainees were involved in 1537 RCR and 1529 ACLR cases. ACLR demographic characteristics (age, sex, body mass index [BMI], and smoking status) were similar across all groups (P > .05), whereas RCR patients showed modest significant differences in sex (P = .011), BMI (P = .036), and smoking status (P = .012) but not age (P = .13). Postoperative complication rates were comparable with or without trainees (ACLR, 4.6%, P = .4; RCR, 3.6%, P = .4), although operative time was longer in cases with trainee involvement (ACLR, 97 minutes [no trainee] vs 110 minutes [fellow], 105 minutes [resident], and 112 minutes [both], P < .001; RCR, 91 minutes [no trainee] vs 106 minutes [fellow], 103 minutes [resident], and 117 minutes [both], P < .001). No significant differences in PROs were observed at 2 years. Trainee involvement in ACLR and RCR did not increase postoperative complication rates or worsen PROs, despite longer operative times and RCR demographic variations, supporting the safety of trainee participation in sports medicine surgeries.