Clinical and structural outcomes of arthroscopic rotator cuff repair augmented with biceps-based partial superior capsular reconstruction and distal tenotomy at two-year follow-up.

The Use of Diagnostic Ultrasound for the Assessment of Rotator Cuff Tendinopathy: A Systematic Review.

To evaluate ultrasound's diagnostic value for full-thickness supraspinatus tendon (SST) tears and correlate it with arthroscopy findings. In this retrospective study, patients with a clinical diagnosis of rotator cuff tears were included. The inclusion criteria were patients with shoulder joint pain and limited shoulder mobility. The exclusion criteria comprised patients who had undergone any previous shoulder surgery or those with shoulder fractures or dislocations. Ultrasound imaging features were observed and recorded, including measurements of the length and width of tears to reveal tear patterns. The chi-square test was used to compare the clinical characteristics of categorical variables, and the Wilcoxon test was used to assess the correlation between ultrasound and arthroscopy. From January 2023 to November 2023, 105 patients diagnosed with rotator cuff tears were included (50 males, 55 females, mean age 67.9 ± 14.2 years). Arthroscopy confirmed full-thickness SST tears in 82 patients (78.1%). Ultrasound demonstrated differential diagnostic performance across tear patterns: sensitivity/specificity 90.0%/95.8%(crescent), 93.1%/94.3% (U-shaped), 83.8%/98.0% (L-shaped), and 100%/98.6% (giant), with corresponding area under the ROC curves (AU-ROCs) of 0.789-0.882. Significant correlations were observed between ultrasound and arthroscopic measurements, particularly for crescent-type tear width (r = 0.949, p < 0.001). Ultrasound effectively distinguishes SST tear types, with high concordance to arthroscopy, supporting its use as a primary imaging tool for surgical planning in rotator cuff pathology. Ultrasound has significant application value in the diagnosis of full-thickness of SST tears. Ultrasound shows high consistency with arthroscopic findings and can effectively differentiate various tear patterns.

Return to Weightlifting Following Anatomic and Reverse Shoulder Arthroplasty.

Erratum: What's New in Shoulder and Elbow Surgery.

The suprascapular (SSN) and axillary (AXN) nerves are vital for shoulder mobility and are at notable risk for injury during glenohumeral surgeries due to their proximity to key anatomical landmarks. This systematic review evaluates their anatomical positioning relative to the glenohumeral joint and highlights the clinical significance of these relationships in shoulder procedures. A thorough literature search across PubMed, MEDLINE, and Google Scholar (2018-2025) yielded 424 studies. After applying inclusion criteria, 21 articles-including clinical, cadaveric, and systematic reviews-were selected to assess nerve pathways, anatomical variations, injury rates, and surgical relevance. The pooled incidence of SSN injury was 0.03 (95% CI: 0.00-0.08), indicating an extremely low occurrence across studies. In contrast, the pooled incidence of AXN injury was 0.07 (4%) [95% CI: 0.01-0.18], reflecting a higher but still uncommon risk. Meta-regression showed a significant association between longer follow-up duration and increased reporting of AXN injuries (p = 0.0005), whereas this relationship was not significant for SSN injuries (p = 0.3612). Significant publication bias was detected for both nerves (AXN: p = 0.0016; SSN: p < 0.0001). Overall, AXN injuries occurred in approximately 1% of cases-more frequent than SSN injuries, which were nearly absent in pooled analysis. Anatomical variability in the SSN and AXN significantly influences the likelihood of nerve injury during shoulder surgery. Utilizing preoperative imaging, tailoring surgical approaches to individual anatomy, and employing intraoperative nerve monitoring are essential strategies for minimising nerve damage. Enhanced anatomical education-through cadaveric dissection and surgical simulation-should be emphasised to reinforce knowledge. These findings support adopting nerve-sparing, patient-specific surgical techniques to improve safety and outcomes in shoulder procedures.

Enhancing anterior shoulder analgesia with a modified PECS II block during shoulder arthroscopy under regional anesthesia alone: a translational anatomical and clinical feasibility study.

A treatise on innovation in shoulder surgery.

The incidence of diaphragmatic-palsy following interscalene brachial plexus block (IBPB) is almost 100% where the drug volume plays a significant role. We compared the incidence of hemidiaphragmatic paresis and the success rate following IBPB using three different volumes of local anaesthetics. Ninety patients undergoing shoulder and arm surgeries under ultrasound-guided IBPB were randomly allocated into three groups: Group A (10ml), Group B (15ml), and Group C (20ml). The drug administered was 0.75% ropivacaine with 50 mcg dexmedetomidine. The diaphragm excursion was measured before and 30min after the block on the side of surgery. The incidence of diaphragmatic palsy and its severity were noted. The success rate following block, the onset of sensory blockade, duration of postoperative analgesia, and adverse effects were observed in all three groups. The statistical analysis was done using SPSS software. The demographic data, duration of surgery, and success rate following block were statistically insignificant. The hemidiaphragmatic paresis (< 25%, 25-75%, > 75%) in Group A (29,1,0), Group B (17,13,0), and Group C (15,8,7) was statistically significant (P value < 0.001). The onset of sensory blockade was Group A (7.06 ± 0.73min), Group B (6.23 ± 0.72min), and Group C (4.61 ± 0.63min) with a P value < 0.001. The duration of postoperative analgesia in Group A (440 ± 48.42min), Group B (429 ± 44.48min), and Group C (411 ± 51.37min) was statistically insignificant (P value-0.072). Five patients in Group C developed hoarseness of voice postoperatively, which was managed conservatively. Low volume ultrasound guided interscalene block (10ml) is associated with a lower incidence of hemidiaphragmatic paresis with a similar success rate and duration of postoperative analgesia. Higher volume of the drug yields a faster onset of the sensory blockade.

The purpose of this study was to assess the effect of combined preoperative benzoyl peroxide application and subcutaneous povidone-iodine (PV-I) disinfection, in addition to standard PV-I disinfection of the skin, on intraoperative cultures of Cutibacterium acnes. All patients undergoing arthroscopic or open shoulder surgery were eligible for inclusion. Patients were randomized into one of three groups: control (standard disinfection of the skin with PV-I), double prevention (disinfection of the skin and subcutaneous tissue with PV-I after incision for 60 seconds), and triple prevention (application of benzoyl peroxide during the three days before surgery, disinfection of the skin with PV-I, and disinfection of the subcutaneous tissue with PV-I after incision for 60 seconds). Cultures were taken of the tissue layers, equipment, and the surgeon's gloves. A sample size of 156 patients was calculated. Culture positivity was compared between the groups, with the intra-articular and deep muscular culture as the primary outcome. A total of 156 patients (median age 58 years (IQR 20 to 85), with 61 patients (39%) being female) were included. The intra-articular cultures were positive in 16 patients (32%) in the control group, 11 (21%) in the double prevention group, and five (10%) in the triple prevention group (p = 0.031). C. acnes presence in the muscular layer was 21 (42%) in the control group, 17 (33%) in the double prevention group, and seven (13%) in the triple prevention group (p = 0.0052). The median number of positive cultures was one in the control group (IQR 0 to 5), one in the double prevention group (IQR 0 to 3.75), and zero in the triple prevention group (IQR 0 to 2; p = 0.082). Combining disinfection of the subcutaneous tissue after incision with preoperative application of benzoyl peroxide reduced the presence of C. acnes during surgery. These results suggest that the triple prevention protocol may be effective in reducing C. acnes infections after both arthroscopic and open surgery.

Rotator cuff repair (RCR) failure and retear remain a persistent problem and concern in shoulder surgery. Successful healing is paramount for long-term functional results. Failure of rotator cuff healing can be broadly separated into biologic and structural complications. Biologic issues include poor host variables such as healing ability and blood flow. Structural problems include tendon thinning and loss as well as poor time-zero fixation. Recently, commercial grafts or "patches" designed for rotator cuff augmentation have increased dramatically. Various grafts aim to enhance biology, provide structure, or both. In addition, grafts are designed to be placed either on-lay, over an RCR, or interpositional, at the bone-tendon interface. Graft may be allograft, xenograft, or fully synthetic. This article discusses the current RCR augmentation graft types and representative products currently available.

Cutibacterium acnes, a component of normal skin flora and a common commensal Gram-positive bacterium, presents a diagnostic challenge for arthroplasty surgeons. While Cutibacterium acnes (C. acnes) as a source of infection has been well characterized in shoulder surgery, its presentation and clinical significance in total hip (THA) and total knee arthroplasty (TKA) remain less understood. A retrospective chart review identified patients with C. acnes culture positivity following THA or TKA. Demographics, laboratory values, and microbiologic data were collected. Statistical comparisons were performed using t-tests and chi-squared analysis. One-year outcomes were evaluated using the Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT) criteria among patients undergoing further surgical intervention. Twenty-nine patients with C. acnes-positive cultures were identified (21 THA, 8 TKA); 15 (52%) were polymicrobial. Ten THA patients (47.6%) and seven TKA patients (87.5%) met MSIS criteria for infection at the time of presentation. Mean time to culture positivity was similar between THA (6.8 days) and TKA (7.4 days; p = 0.57). Sonicated cultures were positive in 24% of THA and 12.5% of TKA cases. Mean ESR was 36.4 mm/h for THA and 51.5 mm/h for TKA (p = 0.21); mean C-reactive protein (CRP) was 35.2 and 36.8 mg/dL, respectively (p = 0.95). Mean synovial cell counts were 27,055 for THA and 22,194 for TKA, with polymorphonuclear cells (PMN) percentages of 68% and 73.9% (p = 0.72, 0.70). Monomicrobial infections demonstrated a mean cell count of 24,143 with 58.9% PMNs, compared to 25,903 and 78.8% in polymicrobial cases. At one year, 72% of patients undergoing subsequent surgery achieved successful outcomes. Higher ASA classification was the only significant predictor of failure (mean 3.0 vs. 2.75). C. acnes-associated THA and TKA infections often present with delayed culture growth, mild inflammatory markers, and frequent polymicrobial involvement. At one-year, patients with available follow-up who undergo surgical management experience favorable outcomes, with 72% achieving MSIS ORT success.

Academic productivity is an important factor in determining career success and institutional ranking. The Hirsch-index (h-index) is a validated measure that assesses both quantity and quality of research output. The aim was to explore factors associated with increased academic productivity among American Shoulder and Elbow Surgeons(ASES)-recognized fellowship programs and faculty. Shoulder and elbow surgery fellowship programs and affiliated faculty were identified via the ASES website, searched on December 6, 2023. Program-specific and faculty-specific characteristics were recorded. The h-index and total publication number were used as metrics and determined for each faculty member using the Scopus database. A total of 156 faculty members from 34 ASES fellowship programs were included, of which 96.2% were male, 77.6% academically affiliated, and 81.4% completed a shoulder and elbow surgery fellowship. The average years in practice was 18.3 years. The average h-index and total publications per fellowship program were 24.9(SD 12.5, IQR 16.6-33) and 520.3 (SD 458.8, IQR 181-649), respectively. Academic affiliation and faculty number were significant factors associated with increased h-index and total publications of a program. The average h-index and total publications per faculty member were 26.9 (SD 22.7, IQR 9.5-38.5) and 125.4(SD 145.4, IQR 26-169), respectively. Academic title of Professor, years in practice, and research staff were independent factors associated with faculty member productivity. ASES-recognized fellowship programs and affiliated faculty demonstrated a high level of academic productivity. This information can help shoulder and elbow surgeons benchmark and further improve their research output and academic influence.

The influence of prior shoulder surgery on implant survival and patient-reported outcomes of shoulder arthroplasty as analyzed by the Dutch Arthroplasty Register (LROI).

» Three-dimensional printing improves shoulder surgery by creating precise anatomical models for better planning and visualization.» Patient-specific guides and implants enhance accuracy, shorten surgery time, and lead to better functional outcomes in complex procedures.» Used effectively in fractures, instability, joint replacement, corrective bone surgery, and tumor reconstruction to support safer and more predictable surgery.» Challenges include high cost, time required for production, and limited long-term clinical evidence; future advancements include artificial intelligence and augmented reality to improve efficiency and personalization.

The Inconsistent Reporting and Effect of Resilience on Outcomes Following Shoulder Surgery

Rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA) are common treatments for shoulder osteoarthritis and rotator cuff tears. Although tobacco use is known to worsen surgical outcomes, the effect of nontobacco nicotine dependence (ND) remains unclear. The goal of this study was to evaluate the effects of nontobacco ND on postoperative complications in TSA, rTSA, and RCR. A retrospective cohort study using the TriNetX Research Network identified patients undergoing RCR, rTSA, or TSA. Patients with nontobacco ND were compared with those without ND. Propensity score matching balanced demographic factors with outcomes assessed at 1, 2, and 5 years. Prior nontobacco ND was associated with significantly higher rates of mortality, prosthesis dislocation, pneumonia, and sepsis across all surgical groups. The RCR and TSA nontobacco ND cohorts had a significantly higher risk of myocardial infarction than controls. At 2 and 5 years, the nontobacco ND cohorts had a notably higher mortality (up to 80% relative increase in risk) and incidence of mechanical complications than controls. Nontobacco ND is a notable risk factor for worse long-term outcomes after TSA, rTSA, and RCR. These findings highlight the need for preoperative counseling and management of ND in patients undergoing shoulder surgery.

Anterior shoulder dislocation is a common and functionally limiting injury in professional martial arts (MA) athletes. While arthroscopic Bankart repair is widely performed, data on long-term functional and sport-specific outcomes in elite-level MA athletes after a first-time dislocation remain scarce. To evaluate the 5-year clinical and functional outcomes of arthroscopic Bankart repair using bioabsorbable suture anchors in elite MA athletes who sustained a first-time traumatic anterior shoulder dislocation without bony Bankart lesions. Case series; Level of evidence: 4. A total of 27 elite international-level MA athletes who experienced a first-time anterior shoulder dislocation and underwent arthroscopic Bankart repair with bioabsorbable suture anchors were included. All surgeries were performed within 3 weeks after the injury. Patients with bony Bankart lesions and those who had undergone either remplissage for large Hill-Sachs lesion or previous shoulder surgery were excluded. Functional evaluation included pre- and postoperative assessments using Rowe, Athletic Shoulder Outcome Scoring System, Shoulder Sport Activity Score, forward flexion, and external rotation in adduction. Return to sport and return to preinjury competitive level were also recorded. Postoperative magnetic resonance imaging (MRI) at 6 months assessed anchor position, stability, and cartilage or bony lesions. Outcomes were compared between athletes who returned to their previous competition level and those who did not. The mean age was 24.3 years and the mean follow-up was 63.0 ± 2.5 months (range, 54-69 months). All athletes returned to sports, with 85.2% (n = 23) resuming competition at their preinjury level. Significant improvements were observed in all functional scores (P < .001 for all), while a slight postoperative decrease in range of motion parameters was noted. No significant differences were found in clinical scores between those who returned to their preinjury level and those who did not. Recurrent dislocation occurred in 2 athletes (7.4%) during competition. Radiological follow-up with postoperative MRI was available for all 27 athletes. At 6 months, all patients demonstrated proper anchor position and stability, with no evidence of displacement or loosening. No cartilaginous or bony lesions were detected. Arthroscopic Bankart repair with bioabsorbable suture anchors is a safe and effective treatment for first-time anterior shoulder dislocation in elite MA athletes. This approach results in excellent long-term functional outcomes and a high rate of return to elite-level competition, with a low risk of recurrence when patients are properly selected.

Background: Heterotopic ossification (HO) frequently occurs after treatments for acute acromioclavicular (AC) joint dislocations, and is often considered a complication. Hypothesis/Purpose: This study aimed to evaluate and compare HO severity and configuration after single-suture button (SSB) and double-suture button (DSB) stabilization, and nonoperative treatment. It was hypothesized that the extent of HO after Rockwood (RW) type V injuries is associated with increased vertical stability, without substantially impairing clinical results. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with acute RW type V dislocations treated with SSB (group 1), DSB (group 2), or nonoperatively (group 3) were analyzed with a 2-year follow-up. The exclusion criteria were previous shoulder surgery or concomitant fractures. HO was evaluated on anteroposterior stress radiographs in the conoid ligament area (CLA) and trapezoid ligament area (TLA), graded by severity and configuration. Radiographic parameters (coracoclavicular difference, RW classification, DPT, and osteoarthritis) and clinical outcomes (Constant Score, Subjective Shoulder Value, Taft score (TF), and Acromioclavicular Joint Instability score were assessed. Group differences were tested using the Kruskal-Wallis test, and associations between HO severity and outcomes were assessed using linear regression. Results: A total of 85 patients were included (group 1, n = 36; group 2, n = 28; and group 3, n = 21), with a mean age of 39.3 ± 11 and a mean follow-up of 44 ± 21.5 months. HO occurred in 71.3% of cases (CLA) and 58.7% of cases (TLA), with no group differences ( P = .390). Severity was predominantly mild across all groups, and the configuration was mostly clavicular. Severity showed no group difference (CLA, P = .703; TLA, P = .132). Configuration differed for the TLA ( P = .042), but not for the CLA ( P = .178). Severity of HO in the CLA correlated with higher TF scores (B = 0.902; P = .003), whereas TLA severity correlated negatively (B = −0.823; P = .034). Conclusion: When present, HO was mostly mild and clavicular, without relevant radiographic or clinical effects. Severity in the CLA correlated with a higher TF, whereas severity in the TLA correlated negatively. Given that the other radiographic and clinical parameters are unaffected, the term complication should be used with caution.

Innovations in Arthroscopic and Open Shoulder Stabilization Surgery