Risk Factors for New-Onset Anxiety and Depression after Arthroscopic Shoulder Stabilization Surgery

Background:Anterior glenohumeral instability is common in athletes and is often associated with an impaction fracture of the posterolateral humeral head, known as a Hill-Sachs lesion. As humeral bone loss increases, these lesions become more likely to engage anteriorly and require surgical intervention. With greater degrees of anterior glenoid bone loss, smaller Hill-Sachs lesions can be more clinically relevant, which can necessitate treatment of the posterior humerus in addition to addressing the anterior glenoid.Indications:Traditional anterior open approaches to Hill-Sachs lesions require detaching the subscapularis and dislocating the shoulder for access, which compromises anterior shoulder stabilizers and is limited by arthroscopy.Technique Description:This open posterior approach to the humeral head was previously described with a modified deltoid split. Beginning 1.5 cm medial and inferior to the posterolateral acromion, a 5-cm incision is made in line with the posterior deltoid fibers. Electrocautery is used to maintain hemostasis, and the deltoid fascia is split, carefully avoiding the axillary nerve and posterior humeral circumflex artery. Exposure of the infraspinatus and teres minor fascia is obtained with retractors. The fascia is split in line with the interval between the infraspinatus and teres minor, and the tissue plane between the posterior rotator cuff and posterior capsule is bluntly developed. Exposure of the capsule is obtained with placement of another retractor between the 2 muscles. The Hill-Sachs lesion is palpated, and a vertical capsulotomy overlying the defect is performed to visualize the lesion in preparation for humeral head allograft reconstruction.Results:An open posterior approach to the humerus allows for complete visualization of the Hill-Sachs lesion, facilitating allograft reconstruction while preserving the subscapularis anteriorly and without the need for surgical dislocation of the shoulder.Discussion/Conclusion:A previous study has demonstrated that the described approach exposes 100% of the Hill-Sachs lesion, with the benefits of subscapularis preservation, elimination of the need for shoulder dislocation or extreme external rotation, and a perpendicular approach for instrumenting the defect. The humeral head blood supply is also preserved, with no interaction anteriorly with the anterior humeral circumflex artery, and the posterior humeral circumflex artery is kept out of the dissection field.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Glenoid morphology and measurement techniques for bone loss in anterior shoulder instability have been the subject of much debate and multiple studies. We performed a retrospective comparison of computerised tomography (CT) and magnetic resonance imaging (MRI) scans, in order to assess if MRI can replace CT as the preferred imaging modality in these patients. A custom deep learning algorithm was trained and validated in automatically segmenting T1 fat-suppressed (39 patients) and Volumetric Interpolated Breath-hold Examination MRI arthrogram images (25 patients). The MRI segmentations were compared to manually derived CT segmentations of the same shoulder, using a Dice Similarity Coefficient (DICE) score. Other important glenoid parameters were also measured and compared. The DICE mean was more than 0.95 for all image comparisons, showing near-perfect accuracy of the automatically segmented MRI images. The Spearman correlation coefficient for all measured variables was more than 0.84. Despite the fact that CT is still considered by most authors to be a superior imaging modality when compared to MRI in glenoid anatomy, we have demonstrated that our automated MRI processing platform provides nearly identical anatomical definition when compared to CT, with the additional benefits of soft tissue visualisation and avoidance of ionising radiation.

Patients with a history of anterior shoulder instability (ASI) can develop glenohumeral arthritis, and often require total shoulder arthroplasty (TSA). The purpose of this study was to compare complications following TSA in patients with and without a history of ASI. The PearlDiver Mariner database was queried to identify all patients who underwent primary TSA with and without prior ASI from 2010 to 2020 using CPT codes for TSA and laterality-specific ICD-10 codes for ASI. After 1:1 propensity score matching was performed, postoperative mechanical complications, including periprosthetic fracture, prosthetic dislocation, prosthetic joint infection, mechanical loosening, superficial and deep surgical site infection, emergency department (ED) visits, readmissions, and revision surgery were evaluated within 30 days, 90 days and 1 year following TSA. Each cohort consisted of 594 patients after propensity matching. Patients with prior ASI had a statistically significant higher rate of ED visits within 30 days postoperatively. Within 90 days and at 1 year following TSA, patients with prior ASI had a statistically significant higher odds of prosthetic dislocation, revision surgery, and ED visits. Kaplan-Meier analysis demonstrated 1-year dislocation-free and revision-free survivorship rates of 96.5% and 95.8%, respectively, in patients with prior ASI surgery. Patients who underwent TSA with a history of prior ASI had a significantly increased risk of prosthetic dislocation and revision surgery within 90 days and at 1 year postoperatively. Awareness of this risk profile is essential for surgical planning, patient counseling, and optimizing postoperative management in this population. III.

Kinesiophobia, defined as the fear of reinjury and movement, is a risk factor for recurrent shoulder instability and remains unchanged unless specifically treated in clinical practice. Fear of reinjury is a reason for athletes not returning to sport after shoulder instability or stabilization surgery. Although physical rehabilitation is commonly used to address deficits in strength and range of motion after shoulder stabilization surgery, there are few documented clinical strategies to address kinesiophobia in athletes after shoulder stabilization surgery. This case report outlines the postoperative rehabilitation of a 23-year-old male who had undergone repeat Latarjet stabilization surgery, following previous failed Latarjet and arthroscopic stabilization surgeries and multiple episodes of instability. He presented with increased levels of kinesiophobia and decreased range of motion and strength following his Latarjet surgery. As an adjunct to his physical rehabilitation, graded exposure to fear-eliciting images was used to decrease kinesiophobia and was measured with the Tampa Scale of Kinesiophobia 11-item questionnaire. Usual physical rehabilitation included progressive range of motion and strength exercises. Kinesiophobia decreased with a change in Tampa Scale of Kinesiophobia-11 scores from 33/44 (moderate kinesiophobia) to 24/44 (low kinesiophobia) during his rehabilitation, which is greater than the minimal detectable change of the Tampa Scale of Kinesiophobia-11 (5.6-5.9). The secondary outcome of shoulder strength improved to within 5% of the opposite side below shoulder height, although strength deficits remained overhead. Range of movement also improved; specifically, external rotation in neutral increased from 5° to 40°. Motor imagery techniques such as graded exposure to fear eliciting images may be used in clinical practice as an adjunct to physical rehabilitation to decrease kinesiophobia in people with shoulder instability. Clinical rehabilitation could address the physical and psychological impact of shoulder instability using graded imagery. Future research could explore the use of fear-eliciting images on physiological and clinical outcomes.

Quantitative means of characterizing glenoid bone loss (GBL) remain a growing field of interest. Here, a 3D volumetric GBL estimation is compared against standard 2D methods for GBL computation to elucidate the effect of morphological differences in glenoid anatomy as a culprit for mis-estimating GBL. Twenty-two shoulder MRIs from healthy participants (19 ± 0.5 years) were segmented to isolate the glenoid. Anterior and posterior bone defects (5%-25%) were simulated according to established patterns of GBL in shoulder instability. Circle-of-best-fit and surface-based measurements of percent GBL were compared against the proposed 3D volumetric computation using Spearman correlations. Discrepancies in 2D measurements relative to 3D parameters were analyzed in the context of glenoid bony morphology derived from depth-based projection mapping. Very weak to moderate agreement was documented for both anterior and posterior defects. Direct comparison of 2D perfect-circle and surface-area methods against 3D measurements showed that 2D methods often over- or under-estimate percent GBL, which varies according to bone morphology. Greater variability in 3D volumetric GBL measurements was observed across all defects, suggesting greater morphological variability captured by the 3D-based computation. MRI-based volumetric analysis of 3D glenoid reconstruction may provide relevant insight for understanding the role of morphological differences in estimating critical bone loss toward improving clinical decision making for surgical management of shoulder instability.

Comprehensive Review of Shoulder Instability in the Female Athlete

Scapular (glenoid and acromion) osteotomies for the treatment of posterior shoulder instability: technique and preliminary results

Anterior shoulder instability represents one of the most common causes of shoulder dysfunction, particularly among young active individuals. Its prevalence is markedly elevated in the United States military, where incidence rates are up to 18 times higher than in the general population. Over the past 25 years, military orthopaedic surgeons have leveraged this unique population to advance the understanding, diagnosis, and treatment of shoulder instability through a systematic, translational research framework spanning epidemiology, biomechanics, imaging, and surgical innovation. Early studies identified the dramatically increased risk of recurrence after nonoperative management and established evidence-based guidelines for first-time dislocators, shifting global treatment paradigms toward early surgical intervention for high-risk patients. Subsequent investigations defined the critical and subcritical thresholds of glenoid bone loss, demonstrating that even modest loss (>13.5%) compromises outcomes after soft-tissue stabilization. Through extensive biomechanical and imaging research, this team validated the glenoid track concept, developed the Glenoid Track Instability Management Score (GTIMS), and demonstrated that bipolar bone loss involving both the glenoid and humeral head is additive and functionally significant. Advances in imaging led to the validation of three-dimensional MRI as a radiation-free alternative to CT for quantifying glenoid bone loss. To address the limitations of existing reconstructive options, the group developed the distal tibia allograft (DTA) as a novel osteochondral solution for glenoid bone loss, achieving comparable outcomes to the Latarjet with lower complication and revision rates. These clinical and translational advances were supported by the Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION). Collectively, this body of work has transformed the management of anterior shoulder instability, establishing new diagnostic standards, surgical techniques, and treatment algorithms that emphasize the right surgery for the right patient, done right the first time, benefiting both military service members and the broader orthopaedic community.

PURPOSE This study investigated the effects of combining the maximum abdominal contraction maneuver (MACM) with supine scapular punching (SSP) on abdominal and shoulder stabilizer muscle activity and upper trapezius (UT) muscle tone in healthy adult men.METHODS Twenty-one healthy men (aged 20-40 years) without shoulder dysfunction participated in a randomized crossover trial. The participants performed both SSP and SSP+MACM exercises in a randomized order. Surface electromyography was used to assess the muscle activity of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), serratus anterior (SA), and UT. UT muscle tone was measured using MyotonPRO. Data were analyzed using paired t-tests or Wilcoxon signed-rank tests, and one-way repeated-measures ANOVA or Friedman tests based on data normality (α = 0.05).RESULTS Compared with SSP alone, the SSP+MACM condition significantly increased the RA, EO, IO, and SA muscle activity (p < 0.05) and significantly reduced the UT activity (p < 0.05). Additionally, UT muscle tone was significantly decreased after SSP+MACM compared to both baseline and SSP (p < 0.001).CONCLUSIONS The combination of MACM and SSP effectively enhances abdominal and scapular stabilizer activation while reducing compensatory upper trapezius tension. This integrated approach may be a practical and efficient strategy for trunk and shoulder stabilization in rehabilitation and athletic training.

Posterior capsulolabral reconstruction results in good clinical and return to sport outcomes in tennis players with microtraumatic posterior shoulder instability.

Recurrent anterior traumatic shoulder instability is related to progressive bone loss on both the humeral and glenoid side. Recurrence of anterior shoulder instability after stabilization surgery is estimated to be around 35%. The severity of bone loss is known to be one of the principal prognostic factors for treatment success. Identification of risk factors of larger bone deficit may help to identify patients at risk. The purpose of this study is to identify modifiable risk factors that will help us counsel patients on habit modification and thus possibly help decrease recurrence of shoulder instability after stabilization surgery. Since 2010, all patients undergoing surgical treatment for recurrent shoulder instability are included in a vast inclusive prospective study cohort: the LUXE study. Patients were all recruited from Montreal's Sacred-Heart Hospital. All patients with complete demographic data and good quality computed tomography (CT) scans were included. Bone loss was measured using the validated Glenoid Track method, shoulder lesions being identified as “on-track” or “off-track” prior to arthroscopic surgery. Analysis of variance (ANOVA) and Pearson correlation statistical tests were used to correlate the Glenoid Track bone loss measurement method with multiple variables such as patient age, gender, BMI, the mean number of shoulder dislocations reported prior to surgery, alcohol and tobacco consumption, epilepsy, the Beighton score and the shoulder Instability Severity Index Score (ISIS). A total of 204 patients met inclusion criteria (161 male, 43 female) with a mean age of 29 years (range 16–52 years). The mean number of dislocations prior to surgery was 14 (range 2–150). Patient BMI was of 25 on average (range 16–41). A quarter (25%) of patients were smokers and a total of 47% reported alcohol consumption over the recommendations issued by Health Canada. Epilepsy was the cause of instability in 6% of patients. Off-track shoulder lesions were identified in 43% of shoulders and significant glenoid bone deficit, meaning 25% or more of the glenoid diameter, was seen in 19% of cases. Male gender, smoking, drinking alcohol, epilepsy, the number of dislocations and older age were all risk factors for greater bone loss at presentation. This study has shown us mutilple modifiable risk factors of increased bone loss in recurrent shoulder instability patients. Canadian shoulder surgeons should work closely with primary care physicians who are seeing patients with traumatic shoulder dislocations. Furthermore, patients should be educated on how smoking and drinking are related to worse outcomes to their shoulder anatomy. They should also be oriented younger and earlier than a mean of 14 shoulder dislocations for surgical stabilization to prevent progression of damage to their shoulder. Future studies with the LUXE cohort will possibly identify more patient risk factors and different measurement methods of glenoid and humeral bone loss that will help us better predict failure of surgical stabilization.

This review systematically maps the existing research on objective return to sport criteria for shoulder injuries, with a focus on clinical tests that inform decision-making. A scoping review was performed. The following databases were searched from inception up to July 2025: Cochrane Library, Embase, Medline, PEDRo, Cinahl and AMED. All studies, regardless of design, which assessed any kind of shoulder function with regard to return to sport decision-making in individuals participating in sports and presented with a shoulder injury were included. The result was qualitatively presented in free text, tables and figures. Eleven studies were identified that reported objective shoulder tests prior to return to sport in athletes after shoulder instability surgery. The tests evaluated various parameters, including range of motion, muscular strength, muscular endurance, power, plyometrics, movement quality and trunk control. The passing rates of isokinetic shoulder strength tests ranged from 40% to 70%, the isometric shoulder strength tests from 28% to 100%, for shoulder endurance tests from 70% to 81% and shoulder performance tests from 29% to 100%. These assessments were conducted within a time frame of 4-21 months following surgery. The rate of subsequent shoulder instability or re-dislocation ranged from 5% to 10% after returning to sport. Passing rates for objective shoulder tests, including muscular strength and endurance, as well as performance tests, varied widely, with re-dislocation rates between 5% and 10% after returning to sport. However, the predominance of case series limits the ability to draw definitive conclusions about the effectiveness of these tests in reducing the risk of subsequent shoulder instability. Level IV, scoping review of level III - level IV studies.

IntroductionThe Upper Quarter Y Balance Test (UQYBT) is a validated tool used to assess unilateral upper extremity function in a closed kinetic chain. It evaluates parameters such as mobility, stability, and injury risk, and can inform rehabilitation planning. Normative data have been well established for adolescent and active adult populations in the United States. This study aims to establish normative UQYBT values for healthy adults aged 18–36 years in the Indian subcontinent.MethodsA total of 190 healthy young adults (95 males and 95 females) aged 18–36 years who met the eligibility criteria were included. Baseline demographic data—age, height, weight, body mass index (BMI), and limb length—were collected. Participants performed the UQ-YBT by reaching in the inferolateral, medial, and superolateral directions using the three-reach box. Average reach distances were calculated for each limb, and composite scores (CS) were normalized using arm length.ResultsAge- and sex-specific reference values were established for both upper extremities and for average bilateral performance. Males demonstrated significantly greater reach distances than females; however, the difference decreased after normalization for limb length. Age-related variations were observed, with participants aged 26–30 years achieving the highest normalized reach scores (p < 0.05).ConclusionThe age- and sex-specific normative values obtained from this study can serve as benchmarks for assessing shoulder mobility and stability among healthy Indian adults aged 18–36 years.

Background: Arthroscopic Bankart repair (ABR) is one of the most common arthroscopic surgeries for recurrent dislocation of the shoulder. A few previous studies have reported anchor hole enlargement after ABR. All-soft suture anchors (ASSAs) and biodegradable anchors (BDAs) have been mainly used recently; however, to the authors’ knowledge, no reports are available that compare anchor hole enlargement between ASSAs and BDAs over a 2-year follow-up period. Purpose: To compare the changes in anchor hole diameter between ASSAs and BDAs. Study Design: Cohort study; Level of evidence, 3. Methods: The anchor holes of 61 patients who underwent ABR for anterior shoulder instability were analyzed. The changes in anchor hole diameters were evaluated by 3-dimensional computed tomography performed immediately after surgery and at 6, 12, and 24 months postoperatively. The diameter enlargement ratio was calculated by dividing the diameters at 6, 12, or 24 months by their counterparts immediately postoperatively and was classified into enlargement (ratio >1.5), mild enlargement (1.1-1.5), no change (0.9-1.1), or reduction (<0.9). Furthermore, all anchors were divided into 2 groups—ASSA group and BDA group—to evaluate the effect of the anchor types on the anchor hole diameter changes. The differences between preoperative and postoperative results were compared using paired t test, Mann-Whitney U test, or Fisher exact test. The differences in hole enlargements between the time points were analyzed using the Kruskal-Wallis test. Results: In total, 315 holes (232 ASSAs, 45 shoulders; 83 BDAs, 17 shoulders) were available for assessment. Among the overall holes, proportions of enlargement and mild enlargement at 6, 12, and 24 months were 8.3%, 8.0%, and 8.8% and 27.0%, 18.2%, and 16.9%, respectively. The anchor hole enlargement was observed in 35.4% of the ASSA group and 34.9% of the BDA group at 6 months compared with those immediately after surgery. The mildly enlarged anchor holes significantly decreased after 12 months in the ASSA group (26.3%, 15.3%, and 17.8% at 6, 12, and 24 months, respectively), whereas no significant decrease was observed in the BDA group (28.9%, 26.0%, and 17.4% at 6, 12, and 24 months, respectively). The enlarged anchor holes significantly decreased after 12 months compared with those immediately after surgery in the ASSA group (9.1%, 7.4%, and 6.7% at 6, 12, and 24 months, respectively) but did not decrease at 12 or 24 months in the BDA group (6.0%, 9.6%, and 10.9% at 6, 12, and 24 months, respectively). Conclusion: Enlarged anchor holes were decreased with ASSAs but not with BDAs. Enlarged anchor holes could be reduced over a longer observation.

Arthroscopic shoulder stabilisation surgery (ASSS) is a common procedure for treating anterior shoulder instability. Postoperative rehabilitation remains a crucial, but under-researched, aspect of patient recovery. Despite its importance, no comprehensive rehabilitation guideline based on robust clinical trials has emerged, leaving a gap in evidence-based practice.To address this, the British Elbow & Shoulder Society appointed the Allied Health Professional Clinical Guideline Group to review current practices and establish clinical guidance on rehabilitation. This evidence synthesis aims to provide a critical synthesis and discussion on rehabilitation following ASSS. The intended outcome is to highlight areas of uncertainty and make recommendations for clinical practice and further research.The development of this evidence synthesis followed a rigorous five-stage process: (1) systematic literature review, (2) UK national practice survey, (3) expert consensus (Delphi) study, (4) updated literature search and review and (5) synthesis of the previous four stages. Stages 1-3 have been published previously. This evidence synthesis comprised stages 4 and 5.10 key domains for postoperative rehabilitation from immediate postsurgery to return to normal function, including sports, were identified. This paper synthesises current knowledge and provides a platform for recommendations in clinical practice and future research. In particular, early shoulder movement was recommended during the 'immobilisation period', but confined to shoulder elevation up to 90°, anterior to the scapular plane, with neutral external rotation. Further high-quality primary research is needed to address uncertainties and expand the evidence base, thereby informing and challenging clinical practice.

The biceps brachii is an arm muscle which normally has two heads named as the long head and the short head. The incidence of an accessory head of biceps brachii was reported to be 8-20% in the literature. Variations in biceps brachii were found mostly in cadaver studies and also they were rarely found incidentally in clinical practice. We report a 38 years-old man who presented with right shoulder pain during routine daily activities. Shoulder impingement syndrome and rotator cuff tear were suspected during physical examination. MRI incidentally revealed bifurcation of the long head of the biceps tendon. Biceps tendon has an important role in shoulder stability. Variations in long head of biceps brachii are reported to cause compression syndromes at upper extremity. Moreover, being aware of this variation may provide clinical benefit in diagnosis or arthroscopic surgery. It is also clinically important to plan a treatment or follow up for a patient presenting with shoulder-arm pain.

Aims: This study aimed to investigate the relationships between various isokinetic strength ratios-including conventional concentric (CVRC) with separate velocities, conventional eccentric (CVRE), functional deceleration ratio (FDR), and mixed ratios (MR, MR_cross)-and two clinical performance measures; closed kinetic chain upper extremity stability test (CKCUEST) and Unilateral Seated Shot Put Test (USSPT). Methods: Thirty-two asymptomatic young adults (18-40 years) were assessed using an isokinetic dynamometer (Cybex NORM®, Humac, CA, USA). Seven isokinetic ratios were calculated from peak torque values. CKCUEST and USSPT were used to measure upper extremity stabilization and power, respectively. Normality was tested via Shapiro-Wilk and histogram analysis. Pearson correlation was applied for CKCUEST, and Spearman correlation for USSPT. Results: No isokinetic ratio was significantly correlated with CKCUEST. For USSPT, CVRC_240 showed the strongest negative correlation (p=-0.585, p&lt;0.001), followed by MR_cross (p=0.467, p=0.007), CVRC_120 (p=-0.422, p=0.016), and CVRC_60 (p=-0.378, p=0.033). Conclusion: CVRC_240 and MR cross ratios demonstrated moderate associations with segmental upper extremity power. These findings support their use as performance markers for ballistic functional tasks, while their lack of correlation with stabilization tests suggests different neuromechanical determinants.

Musculoskeletal (MSK) conditions affect over 20 million people in the UK. Follow-up appointments account for nearly two-thirds of all outpatient activity. Patient-initiated follow-up (PIFU) allows patients to request follow-up appointments based on clinical need, aiming to reduce unnecessary reviews and optimise service use. This study evaluated the impact and utilisation of PIFU in a secondary care Elective Upper Limb (Shoulder and Elbow) Clinic, focusing on patient engagement, re-presentation rates, and suitability across common upper limb conditions. A retrospective service evaluation was conducted over 18 months. Patients discharged under the PIFU pathway were included if they had at least six months' follow-up opportunity. Data collected included diagnosis, treatments received, re-presentation rates and outcomes. Descriptive analysis was used to assess patterns and clinical implications. Out of 353 consultations, 81 patients (23%) were discharged to PIFU. Among these, 62% were first-time referrals discharged at their initial appointment. Conditions most suitable were rotator cuff-related pain (33%), early glenohumeral arthritis (19%) and adhesive capsulitis (10%). Within six months, only 18% of PIFU patients re-accessed care - just 4.2% of the total cohort. One-third of returning patients required surgery, while the remainder were managed nonoperatively and re-entered the PIFU pathway. PIFU freed approximately 20% of follow-up slots. PIFU is a safe and effective follow-up model for stable or early-stage shoulder and elbow conditions, reducing outpatient burden, supporting patient autonomy and preserving clinic capacity without compromising care quality. Broader implementation, supported by patient education and structured feedback, may enhance sustainable delivery of orthopaedic services.

Ultrasound (US) is an accessible and non-invasive method for assessing pathology in the musculoskeletal system. Its application may include assessment of glenohumeral (GH) instability. Whereas GH instability is typically assessed in symptomatic patients, US measurements of anterior-posterior (AP) GH translation have shown good to excellent reliability in healthy populations. The aim of this study was to test the intra- and interrater reliability of measurements of AP GH translation in a clinical setting. Two clinicians performed measures of AP GH translation in patients with anterior shoulder instability. Measurements were conducted from both an anterior and a posterior view. The primary outcome was the intraclass correlation coefficient (ICC(2,1)). Twenty-three patients were included. The intrarater ICCs ranged from 0.70 to 0.76. The interrater ICCs ranged from 0.20 to 0.49. The most reliable test was a simulated "Load and Shift" test. The minimal detectable changes ranged from 2.16 to 3.42 mm for the same rater, and from 2.71 to 4.78 mm between raters. When performed in a clinical setting by raters with limited US experience, the US measurements of AP GH translation in patients with anterior shoulder instability demonstrated moderate to good intrarater reliability and poor interrater reliability. These findings suggest that while US may have potential for clinical use, its reliability may be limited when performed by novice raters. Amager and Hvidovre Hospitals Forskningspulje. gov (ID: NCT05250388).