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Background: The management of massive posterosuperior rotator cuff tears is controversial, with no gold standard. Two recently developed techniques that have shown promising initial results include arthroscopic superior capsular reconstruction (SCR) and tendon transfers (latissimus or lower trapezius). However, there remains a scarcity of studies examining each procedure's early postoperative clinical outcomes individually or in comparison to each other. The purpose of this study is to compare the early postoperative recovery outcomes of tendon transfers (TTs) to SCR., Methods: Using the surgical outcomes system global database (Arthrex Inc.), we assessed the postoperative recovery outcomes for all patients who had outcomes recorded at least 6 months after SCR or TT. The time points analyzed included preoperative and postoperative (2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years). The outcomes analyzed included pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, VR-12 physical, and Single Assessment Numeric Evaluation (SANE)., Results: Overall, 163 patients underwent SCR and 24 arthroscopically assisted TT. The mean age for SCR and TT was 60 and 56 years, respectively. Postoperative recovery curves demonstrate that both procedures produced improved outcomes at each postoperative time point compared to preoperative. The pain and functional outcomes measures, including VAS, ASES, SANE, and VR-12 physical, were comparable for TT and SCRs, with similar recovery curves between the 2 techniques. Ultimately at 2 years postoperatively, there were no significant differences between the 2 techniques., Conclusions: Analysis of the early outcomes associated with arthroscopic treatment of massive posterosuperior rotator cuff tears demonstrated that the arthroscopically assisted tendon transfers and arthroscopic superior capsular reconstruction had similar pain and functional outcomes throughout the 2-year postoperative recovery period. Overall, the process of recovery appears equivalent between the 2 techniques. Future studies are needed to assess the outcomes of each technique and specific indications in an attempt to delineate an algorithm for the treatment of irreparable rotator cuff tears., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Bone grafting during primary reverse shoulder arthroplasty (RSA) is a technique used to restore poor glenoid bone, increase lateralization, and restore abnormal inclination or version. The purpose of this article is to analyze early outcomes of bone grafting during RSA, assessing the influence of technical and patient considerations., Methods: In a 4.5-year time period, 137 RSAs with glenoid bone grafting were performed with a minimum 3 months' follow-up. The mean follow-up was 17 months (range, 3-38). The mean age was 71 years (range, 45-89), and body mass index was 28 (range, 19-44). The source of the autografts were humeral head (n = 113) and iliac crest autograft (ICBG; n = 24). The humeral components included 84 onlay and 53 inlay designs., Results: Overall, there were 16 complications (12%), of which 6 were major (5%) (3 graft nonunions and 3 infections) and 10 minor (8%) (1 carpal tunnel syndrome and 9 transient axillary neuropraxias). Of the 9 axillary neuropraxias, 8 resolved by the most recent follow-up, whereas 1 patient was lost to follow-up. There were 4 reoperations (3%): 2 for glenoid baseplate loosening, 1 for severe notching associated with severe glenoid bone loss, and 1 for deep periprosthetic infection. One additional patient had a baseplate failure and is undergoing further treatment. There was no difference in the occurrence of graft nonunions, revision surgery, or glenoid component loosening when comparing type of graft or humeral component used. There was an association of revision surgery (P = .02) with ICBG and older age at the time of surgery (P = .02) and an association of transient neuroapraxia with onlay humeral components (P = .01) and workers' compensation cases (P = .04)., Conclusions: There is a high union rate and low complication rate after bone grafting of the glenoid performed with RSA. Transient neuropraxias are the most frequent complication, but the majority resolve within the first postoperative year. These early findings can serve as the basis for future long-term, comprehensive analysis of complications and outcomes after bone grafting during RSA., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: There remains a paucity of studies examining the impact of workers' compensation (WC) on a variety of outcomes after biceps tenodesis. The purpose of this study was to compare the postoperative recovery curves after biceps tenodesis in patients with and without WC claims., Methods: Using the Surgical Outcomes System database, we assessed the postoperative recovery outcomes of all patients who had outcomes recorded at least 6 months after isolated biceps tenodesis for the treatment of a diagnosis of biceps tendinitis, stratified by WC status. The outcomes analyzed included visual analog scale, American Shoulder and Elbow Surgeons, VR-12 (Veterans RAND 12 Item Health Survey) mental and physical, Simple Shoulder Test, and Single Assessment Numeric Evaluation scores., Results: Overall, 139 patients with WC claims underwent isolated biceps tenodesis vs. 786 patients without WC claims. Demographic characteristics and comorbidities were similar in the 2 groups. Patients without WC claims had significantly improved visual analog scale, VR-12, American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and Simple Shoulder Test scores at all times points after 3 months and 1 year compared with patients with WC claims., Conclusions: On analysis of patients' recovery after isolated biceps tenodesis, WC claims led to significantly worse pain and functional outcomes at every time point of analysis (3, 6, 12, and 24 months). Furthermore, patients with WC claims had worse preoperative-to-postoperative improvements in most outcomes. This information can be used to educate surgeons and patients on postoperative expectations, as well as to perform analyses focused on health economics, value, and policy., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Superior capsule reconstruction (SCR) has shown promising outcomes in its initial description, but lacks additional reports analyzing outcomes. This study analyzes early outcomes of SCRs in patients with massive irreparable rotator cuff tears., Methods: A retrospective analysis of all SCRs at our institution from January 1, 2015, to August 31, 2017, was performed with a minimum 6-months follow-up. A total of 34 patients were included with a mean age of 60 years. SCR was performed by 1 of 6 fellowship trained surgeons., Results: At an average follow-up of 12 months, 22 patients were identified as failures after modified Neer classification. Furthermore, 8 of these patients have undergone a reoperation, whereas an additional 14 patients were considered clinical failures experiencing continued pain and a lack of shoulder function. Of note, 2 of the 3 patients with a subscapularis tear had a failure. In addition, revision cases, female gender, increased fatty infiltration in the infraspinatus and low surgeon volume were associated with a higher rate of failure. There was no significant improvement in range of motion or functional scores., Conclusion: SCR performed for large-to-massive irreparable rotator cuff tears has a high rate of persistent pain and poor function leading to clinical failure in 65% of patients. Risk factors predicting clinical failure included revision cases, female gender, increased Goutallier fatty infiltration of the infraspinatus, and low surgeon volume (n ≤ 10)., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Since the approval of reverse shoulder arthroplasty (RSA) in 2004, the use of shoulder arthroplasty increased dramatically. Although the success of RSA in the revision setting has been demonstrated, there remains a paucity of studies examining the epidemiology of RSA in revision arthroplasty. This study describes trends of revision arthroplasty during the "era of the reverse," from 2005 through 2016., Methods: In a multicenter retrospective analysis, we analyzed 274 revision shoulder arthroplasties converted to a RSA (n = 182), anatomic total shoulder arthroplasty (TSA, n = 68), or hemiarthroplasty (n = 24) from 2005 to 2016. Demographics, surgical indications, and types of prosthesis were analyzed., Results: The number of revision arthroplasties increased over 12 years. From 2005 to 2010, TSA (33%) or hemiarthroplasty (16%) were used in similar rates as RSA (51%). From 2011 to 2016, there was a much higher incidence of revision arthroplasty with RSA (78%) compared with TSA (19%) or hemiarthroplasty (3%). Specifically, the number of RSAs increased in 2011 to 2016 compared with 2005 to 2010 in patients aged younger than 60 years, obese patients, patients with indications of glenoid loosening, and those with a diagnosis of diabetes mellitus or rheumatoid arthritis., Conclusions: The use of RSA for revision arthroplasty increased over the "era of the reverse" and became the majority by 2016. The reverse prosthesis has had expanding indications regarding both patient demographics and pathology. This study demonstrates the reverse prosthesis has had a similar and even more profound effect on revision shoulder arthroplasty than what has previously been well documented in the primary setting., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Neurologic dysfunction is a known complication after the open Latarjet procedure. Although the reported clinical incidence is variable, a prior neuromonitoring study demonstrated a significant incidence of nerve dysfunction during surgery, presumably from nerve stretch. We aimed to determine whether a nerve stretch-reduction protocol reduced the incidence of neurologic injury after the open Latarjet procedure., Methods: In a nonrandomized study, 38 patients (group 1) who underwent surgery before our neuromonitoring study were compared with 48 patients (group 2) who underwent surgery after this study. Follow-up was at least 3 months or until documented resolution of nerve dysfunction., Results: There were no significant demographic differences between the groups. In group 1, there were 7 nerve injuries, of which all but 2 recovered. In group 2, there were 3 nerve injuries, of which all but 1 recovered. The overall incidence of nerve injury was 18.4% (group 1) vs. 6.3% (group 2); however, the incidence of permanent motor dysfunction was 5.3% (group 1) vs. 2.1% (group 2). These differences were not significant, likely due to the small number of patients included., Conclusions: We observed a reduction of nerve injury with the implementation of a nerve stretch-reduction protocol during the Latarjet procedure; however, we could not demonstrate statistical significance. This trend represents an important finding that modification of surgical technique can reduce the incidence of nerve injury with the Latarjet procedure., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)