Search

Background: Different joint-preserving techniques for treatment of preosteoarthritic, constitutional static (type C1) posterior shoulder instability (PSI) have been proposed, including posterior glenoid open wedge osteotomy and bone graft augmentation. However, the techniques are demanding, the reported complication and reoperation rates are high, and posterior decentering cannot reliably be reversed. Purpose: To assess the clinical and radiological longitudinal outcomes of patients with type C1 PSI after arthroscopic posterior articular coverage and shift (PACS) surgery. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective analysis of a prospective database with longitudinal follow-up including 14 shoulders in 13 patients who underwent an arthroscopic PACS procedure for symptomatic preosteoarthritic constitutional static posterior instability (type C1) with previous failed nonoperative treatment. Patients were clinically evaluated before surgery and at 3, 6, 12, and 24 months postoperatively in terms of satisfaction and pain levels as well as standardized physical examination, Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability Index (WOSI) score, Constant score, and Rowe score. Preoperative, postoperative, and follow-up magnetic resonance imaging scans were obtained in all patients. A paired 2-sample t test was used to compare changes in continuous variable parameters over time. Correlation analyses were performed using the Pearson correlation coefficient. Results: All outcome scores and the pain level improved significantly from preoperatively to postoperatively, and the improvement was sustained over the follow-up period of 2 years (pain level, 6.4 preoperatively vs 3.3 at 2 years, P < .001; SSV, 40 vs 70, P = .001; WOSI, 33 vs 56, P = .001; Constant, 70 vs 79, P = .049; Rowe, 52 vs 76, P < .001). The mean glenohumeral and scapulohumeral subluxation indices were significantly lower in the early postoperative period compared with preoperative measurements (glenohumeral, 52% ± 6% vs 58% ± 10%, P = .02; scapulohumeral, 70% ± 8%; vs 77% ± 9%, P = .002, respectively); however, they returned to baseline values at follow-up (57% ± 7% vs 58% ± 10%, P = .7; 75% ± 6% vs 77% ± 9%, P = .4, respectively). A high scapulohumeral subluxation index, excessive glenoid retroversion, and increased posterior positioning of the humeral head in relation to scapular blade axis and older age were correlated with worse clinical outcomes. Conclusion: Over the follow-up period of 2 years, the PACS procedure significantly improved outcome scores in patients who had preosteoarthritic constitutional static posterior shoulder instability, especially in younger patients with less severe glenoid retroversion and posterior decentering of the humeral head. However, similar to other techniques, the PACS procedure needs to be considered a symptomatic therapy that does not reverse the underlying cause or stop the progressive pathology.

Rotator cuff lesions are a common shoulder pathology mainly affecting patients aged50 years. This condition is accompanied by not only pain and loss of function but also impaired quality of life and psychological stress. A frequently employed treatment option is arthroscopic repair. But expectations regarding the outcome after surgery might differ between patients and surgeons and therefore lead to dissatisfaction on both sides. The aim of this study was to document patient expectations of a planned arthroscopic rotator cuff repair and compare the results with the assessment of shoulder surgeons.A total of 303 patients and 25 surgeons were involved in this study. Patients with partial- or full-thickness tear of the rotator cuff scheduled for arthroscopic repair were included in this study. Preoperatively, they were asked to fill out questionnaires inquiring sociodemographic data, scores of the underlying pathology, as well as expectations regarding the operation with regard to pain relief, gain of range of motion and strength, as well as the effect on activities of daily life, work, and sports. Furthermore, 25 surgeons were surveyed on what they think their patients expected using the same standardized questions.Among the patients, 43.9% considered gain of range of motion to be the most important goal after rotator cuff repair, followed by pain relief (30.6%) and gain of force (13.7%). Among the surgeons, 72% believed pain relief to be the most important for their patient followed by movement (20%) and strength (8%). When asked which parameter was the most important to achieve after operation, for patients, movement was on first place, pain second, and strength third. For shoulder specialists, the ranking was pain, movement, and strength. Surgeons significantly overrated pain relief when ranking against movement compared with their patients.The expectations of patients regarding their operation differ from the surgeon's assessment. Whereas gaining range of motion was more important for patients, surgeons clearly voted for pain relief. Different expectations should therefore be discussed within the pretreatment interview and taken into account when planning the right therapy. This might lead to better satisfaction on both sides.

BACKGROUND: Metallic humeral and glenoid lateralized implants have been developed to prevent common problems that can emerge using Grammont’s concept (ie, medialization of center of rotation, decreased humeral offset, scapular notching) in reverse shoulder arthroplasty. The purpose of this study was to evaluate the clinical and radiological results of metallic humeral and glenoid lateralized implants for cuff tear arthropathy (CTA) and primary osteoarthritis (OA). METHODS: In this prospective study, patients with CTA or OA who underwent reverse shoulder arthroplasty using augmented base plates for glenoid lateralization and a “curved stem” design for the humeral side were included. The Constant-Murley score and Subjective Shoulder Value were documented at 1- and 2-year follow-ups. Radiographs were reviewed for scapular notching, instability, loosening, osteolysis, ossification, bone resorption, or fractures. Lateralization and distalization shoulder angles were evaluated at the final follow-up. RESULTS: There were 23 patients with CTA and 19 patients with OA (27 women; mean age, 76 years; range, 59-85) available for examination at 2 years. Both groups increased significantly in all outcome measures compared with baseline (P

Background Scapulothoracic orientation, especially scapular internal rotation (SIR) may influence range of motion in reverse total shoulder arthroplasty (RTSA) and is subjected to body posture. Clinical measurements of SIR rely on apical bony landmarks, which depend on changes in scapulothoracic orientation, while radiographic measurements are often limited by the restricted field of view (FOV) in CT scans. Therefore, the goal of this study was (1) to determine whether the use of CT scans with a limited FOV to measure SIR is reliable and (2) if a clinical measurement could be a valuable alternative. Methods This anatomical study analyzed the whole-body CT scans of 100 shoulders in 50 patients (32 male and 18 female) with a mean age of 61.2 ± 20.1 years (range 18; 91). (1) CT scans were rendered into 3D models and SIR was determined as previously described. Results were compared to measurements taken in 2D CT scans with a limited FOV. (2) Three apical bony landmarks were defined: (the angulus acromii (AA), the midpoint between the AA and the coracoid process tip (C) and the acromioclavicular (AC) joint. The scapular axis was determined connecting the trigonum scapulae with these landmarks and referenced to the glenoid center. The measurements were repeated with 0°, 10°, 20°, 30° and 40° anterior scapular tilt. Results Mean SIR was 44.8° ± 5.9° and 45.6° ± 6.6° in the 3D and 2D model, respectively (p p = 0.203) as did the AC-joint at 10° anterior scapular tilt (p = 0.949). All other points showed a significant difference from the scapular axis at all degrees of tilt. Conclusion 2D CT scans are reliable to determine SIR, even if the spine is not depicted. Clinical measurements using apical superficial scapula landmarks are a possible alternative; however, anterior tilt influenced by posture alters measured SIR.

Zusammenfassung Hintergrund Irreparable Rotatorenmanschettenmassenrupturen (RMM-Rupturen) haben einen Anteil von bis zu 40 % an allen Rotatorenmanschettenrupturen (RM-Ruptur). Das klinische Beschwerdebild variiert ebenso wie die Verletzungsmorphologie. Entsprechend wird in der Studie der Einfluss der Rupturmorphologie auf die aktive Schulterbeweglichkeit untersucht. Material und Methoden Im Rahmen einer multizentrisch angelegten Studie wurden retrospektiv 178 Patientenfälle untersucht. Die Rupturmorphologie wurde anhand eines MRT ermittelt und in anterosuperiore sowie posterosuperiore 2‑ bzw. 3‑Sehnen-Rupturen unterteilt. Weiterhin wurde die muskulotendinöse Läsion hinsichtlich der Sehnenretraktion, Rupturausdehnung und fettigen Muskeldegeneration beschrieben. Die aktive Schulterbeweglichkeit wurde klinisch ermittelt. Ergebnisse Die 3‑Sehnen-Rupturen gehen mit einer größeren Einschränkung der Abduktionsbeweglichkeit und in einem geringeren Umfang auch der Anteversionsbeweglichkeit einher als 2‑Sehnen-Rupturen. Eine signifikante Rolle spielen dabei insbesondere posterosuperiore 3‑Sehnen-Rupturen, welche alleine eine Beteiligung der Teres-minor-Sehne inkludieren. Die Innenrotationsfähigkeit wird v. a. durch anteriore Verletzungsmuster mit Beteiligung der Subscapularissehne beeinflusst. Bei 2‑Sehnen-Rupturen ist dieser Einfluss signifikant. Die Außenrotationsfähigkeit zeigt keinen klinisch relevanten Zusammenhang mit der Rupturmorphologie. Schlussfolgerung Die Abduktionsfähigkeit hängt mit der Zahl der betroffenen Sehnen zusammen. Hierbei zeigen posterosuperiore 3‑Sehnen-Verletzungen mit Beteiligung der Teres-minor-Sehne einen signifikanten reduzierenden Einfluss. Die Innenrotationsfähigkeit wird wesentlich durch anteriore Verletzungsmuster mit Beteiligung der Subscapularissehne beeinträchtigt. Die RM-Qualität (Muskel- und Sehnenstatus) der betroffenen Rupturanteile zeigte sich dagegen weniger relevant für die aktive Schulterbeweglichkeit.

Component selection and placement in reverse total shoulder arthroplasty (RTSA) is still being debated. Recently, scapulothoracic orientation and posture have emerged as relevant factors when planning an RTSA. However, the degree to which those parameters may influence ROM and whether modifiable elements of implant configuration may be helpful in improving ROM among patients with different postures have not been thoroughly studied, and modeling them may be instructive.Using a dedicated expansion of a conventional preoperative planning software, we asked: (1) How is patient posture likely to influence simulated ROM after virtual RTSA implantation? (2) Do changes in implant configuration, such as humeral component inclination and retrotorsion, or glenoid component size and centricity improve the simulated ROM after virtual RTSA implantation in patients with different posture types?In a computer laboratory study, available whole-torso CT scans of 30 patients (20 males and 10 females with a mean age of 65 ± 17 years) were analyzed to determine the posture type (Type A, upright posture, retracted scapulae; Type B, intermediate; Type C, kyphotic posture with protracted scapulae) based on the measured scapula internal rotation as previously described. The measurement of scapular internal rotation, which defines these posture types, was found to have a high intraclass correlation coefficient (0.87) in a previous study, suggesting reliability of the employed classification. Three shoulder surgeons each independently virtually implanted a short, curved, metaphyseal impaction stem RTSA in each patient using three-dimensional (3D) preoperative surgical planning software. Modifications based on the original component positioning were automatically generated, including different humeral component retrotorsion (0°, 20°, and 40° of anatomic and scapular internal rotation) and neck-shaft angle (135°, 145°, and 155°) as well as glenoid component configuration (36-mm concentric, 36-mm eccentric, and 42-mm concentric), resulting in 3720 different RTSA configurations. For each configuration, the maximum potential ROM in different planes was determined by the software, and the effect of different posture types was analyzed by comparing subgroups.Irrespective of the RTSA implant configuration, the posture types had a strong effect on the calculated ROM in all planes of motion, except for flexion. In particular, simulated ROM in patients with Type C compared with Type A posture demonstrated inferior adduction (median 5° [interquartile range -7° to 20°] versus 15° [IQR 7° to 22°]; p0.01), abduction (63° [IQR 48° to 78°] versus 72° [IQR 63° to 82°]; p0.01), extension (4° [IQR -8° to 12°] versus 19° [IQR 8° to 27°]; p0.01), and external rotation (7° [IQR -5° to 22°] versus 28° [IQR 13° to 39°]; p0.01). Lower retrotorsion and a higher neck-shaft angle of the humeral component as well as a small concentric glenosphere resulted in worse overall ROM in patients with Type C posture, with severe restriction of motion in adduction, extension, and external rotation to below 0°.Different posture types affect the ROM after simulated RTSA implantation, regardless of implant configuration. An individualized choice of component configuration based on scapulothoracic orientation seems to attenuate the negative effects of posture Type B and C. Future studies on ROM after RTSA should consider patient posture and scapulothoracic orientation.In patients with Type C posture, higher retrotorsion, a lower neck-shaft angle, and a larger or inferior eccentric glenosphere seem to be advantageous.

Background Scapulothoracic orientation, especially scapular internal rotation (SIR) may influence range of motion in reverse total shoulder arthroplasty (RTSA) and is subjected to body posture. Clinical measurements of SIR rely on apical bony landmarks which are subjected to changes in scapulothoracic orientation, while radiographic measurements are often limited by the restricted field of view (FOV) in CT scans. Therefore, the goal of this study was (1) to determine whether the use of CT scans with a limited FOV to measure SIR is reliable and (2) if a clinical measurement could be a valuable alternative. Methods This anatomical study analyzed the whole-body CT-scans of 100 shoulders in 50 patients (32 male and 18 female) with a mean age of 61.2 ± 20.1 years (range 18; 91). (1) CT-scans were rendered into 3D models and SIR was determined as previously described. Results were compared to measurements taken in 2D CT-scans with a limited FOV. (2) Three apical bony landmarks were defined: (the angulus acromii (AA), the midpoint between the AA and the coracoid process tip (C) and the acromioclavicular (AC) joint. The scapular axis was determined connecting the trigonum scapulae with these landmarks and referenced to the glenoid center. The measurements were repeated with 0°, 10°, 20°, 30° and 40° anterior scapular tilt. Results Mean SIR was 44.8° ± 5.9° and 45.6° ± 6.6° in the 3D and 2D model, respectively (p

(1) To determine applied patellar drilling techniques for medial patellofemoral ligament (MPFL) reconstruction among members of the International Patellofemoral Study Group (IPSG) and (2) to evaluate the risk of patellar fracture for various patellar bone tunnel locations based on a finite element analysis (FEA) model. In the first part of the study, an online survey on current MPFL reconstruction techniques was conducted among members of the IPSG. In the second part of the study, a three-dimensional FEA model of a healthy knee joint was created using a computed tomography scan. Patient-specific bone density was integrated into the patella, and cartilage of 3 mm thickness was modeled for the patellofemoral joint. According to the survey’s results, two different types of patellar bone tunnels (bone socket and transpatellar bone tunnel) were simulated. The risk of patellar fracture was evaluated based on the fracture risk volume (FRV) obtained from the FEA. Finite element analysis revealed that subchondral bone socket tunnel placement is associated with the lowest FRV but increased with an anterior offset (1–5 mm). Transpatellar bone tunnels violating the lateral or anterior cortex showed a higher FRV compared to bone socket, with the highest values observed when the anterior cortex was penetrated. Violation of the anterior or lateral patellar cortex using transpatellar bone tunnels increased FRV compared to a subchondral patellar bone socket tunnel. In MPFL reconstruction, subchondral patellar bone socket tunnels should be considered for patellar graft fixation to avoid the risk of postoperative patellar fracture. Survey; Descriptive laboratory study/Level V.

Static posterior subluxation of the humeral head is a pre-osteoarthritic deformity preceding posterior erosion in young patients. Its etiology remains unknown. The aim of this study was to analyze the differences in scapular morphology between young patients with pre-osteoarthritic static posterior subluxation of the humeral head and healthy controls with a centered humeral head.We performed a retrospective analysis of all patients with pre-osteoarthritic static posterior subluxation of the humeral head who were treated in our institution between January 2018 and November 2019. Fourteen shoulders in 12 patients were included in this study and then matched according their age, sex, and affected side with controls. Computed tomography images of both groups were compared in the standardized axial imaging plane for differences in scapular morphology. The following parameters were measured: glenoid version relative to the Friedman line and scapular blade axis, scapulohumeral and glenohumeral subluxation index, and neck angle, as well as glenoid and humeral offset.The patients in the subluxation group showed significantly higher scapulohumeral and glenohumeral subluxation indexes than controls (0.76 vs. 0.55 [P.0001] and 0.58 vs. 0.51 [P = .016], respectively). The mean measurements of glenoid version according to the Friedman line and relative to the scapular blade axis were significantly higher in the subluxation group than in controls (19° vs. 4° [P.0001]and 14° vs. 2° [P = .0002], respectively). The glenoid vault was significantly more anteriorly positioned with respect to the scapular blade axis in the subluxation group than in controls (neck angle, 166° vs. 173° [P = .0003]; glenoid offset, 9.2 mm vs. 4.6 mm [P = .0005]). The midpoint of the humeral head showed a posterior offset with respect to the scapular blade axis in the subluxation group, whereas controls had an anteriorly placed midpoint of the humeral head (-2 mm vs. 3.1 mm, P = .01). A higher scapulohumeral subluxation index showed significant correlations with an increased anterior offset of the glenoid vault (increased glenoid offset: r = 0.493, P = .008 and decreased neck angle: r = -0.554, P = .002), a posterior humeral offset (r = -0.775, P.0001), and excessive glenoid retroversion measured by both methods (Friedman line: r = 0.852, P.0001; scapular blade axis: r = 0.803, P.0001). A higher glenohumeral subluxation index also correlated significantly with an increased anterior offset of the glenoid vault (increased glenoid offset: r = 0.403, P = .034; decreased neck angle: r = -0.406, P = .032) and posterior humeral offset (r = -0.502, P = .006).Young patients with pre-osteoarthritic static posterior subluxation of the humeral head have significant constitutional differences in scapular morphology in terms of an increased anterior glenoid offset, excessive glenoid retroversion, and increased posterior humeral offset in relation to the scapular blade compared with healthy matched controls.

Two-stage revision arthroplasty using cement spacers is a well-established treatment strategy for periprosthetic shoulder infection (PSI). As antibiotic-loaded cement spacers lose their efficacy to release local antibiotics over time, they can be colonized, resulting in persisting infection. This study aimed to investigate the prevalence of positive cultures in two-stage revision surgery for PSI and evaluate whether a longer period of spacer implantation is a risk factor for persistence of infection. Patients scheduled for two-stage revision surgery for PSI were enrolled in this prospective cohort study. Periprosthetic tissues samples were colected for microbiological and histopathologic analysis. Sonication analysis of the retrieved implants and spacers was performed at the first- and second-stage sugery, as well as multiplex PCR analysis of the sonication fluid of the cement spacers. Between December 2017 and December 2019, 16 patients (n = 11 female, n = 5 male; mean age 68.1 ± 7.4 years) were included. Mean interval between primary arthroplasty and revision surgery was 41 ± 21 months. PSI was identified in 12 patients (75%). Coagulase-negative staphylococci were the most common isolated pathogens in 11 patients, followed by Cutibacterium acnes in 5 patients. The mean interval between first-and second-stage surgery was 50 ± 21 (range 6–77) days. In 5 patients a more than two-stage procedure was necessary. Microbiological analysis of sonication fluid derived from the retrieved cement spacers was positive in 4 cases (33%) among infected patients, which was independent of the duration of spacer implantation. Microorganisms can be found on cement spacers in two- or more-stage revision surgeries for PSI. The interval between revision surgeries in patients with a positive microbiological result of the retrieved cement spacer was comparable to patients with a sterile cement spacer.

Depending on their size, all glenoid defects lead to a certain amount of loss of glenohumeral stability and therefore may represent a risk factor for the recurrence of instability after soft tissue stabilization procedures. The degree of loss of stability depends not only on the extent of the defect but also on differences in individual constitutional shape, which need to be analyzed in a three-dimensional context. Additionally, patient-specific factors such as age and activity level have a significant influence on the clinical effect of glenoid bone loss. Therefore, when treating a patient with glenoid bone loss, a bony glenoid reconstruction surgery in the form of a free bone graft transfer or Latarjet should be considered based on the extent of the defect, native glenoid shape, age, and activity level. Furthermore, in the presence of a relevant Hill–Sachs defect, the addition of a remplissage to a Bankart procedure should be considered or the use of a bony glenoid augmentation procedure instead.

Subcapital fractures of the 5th metacarpal bone (MCV) represent a common injury. Volar angulation measurement is essential for treatment decision-making and therefore needs a reliable and valid method. The purpose of the present study was to investigate a new technique for volar angulation measurement, called the "Trigonometric Technique" (TT), and to compare the TT with the reference standard based on computed tomography (CT).Quantifying volar angulation in MCV neck fractures with the TT shows no difference compared to the angle measured on CT scans.Fifteen patients (14 men and 1 woman) with a mean age of 37±16years (range, from 16 to 72 years) who suffered MCV neck fracture and met the inclusion and exclusion criteria were selected for this prospective cohort study. Radiologic investigation included simple dorsopalmar (DP) radiographs and CT scans from the injured hand. Volar angulation measurements were performed by three observers at two time points comparing the TT to measurements obtained on CT scans. Intraclass correlation coefficients (ICC) were determined to assess inter- and intra-observer reliability.The TT showed a mean volar angulation of 39±5 degrees (range, from 26 to 46 degrees) compared to 41±7 degrees (range, from 28 to 54 degrees) on CT measurement, which revealed a significant correlation between the two measurement techniques (R=0.922, p0.001). Overall, the inter-rater (R=0.977; 95% CI 0.945-0.992) as well as intra-rater (R=0.857; 95% CI 0.739-0.941) reliability for the volar angulation using the TT was excellent.The TT presented in this study uses plain radiography and trigonometric identities to precisely determine volar angulation in MCV neck fractures. The TT correlates excellently with the obtained volar angulation angles measured on CT scans. We recommend the TT for volar angulation measurement in boxer's fracture as a reliable alternative to the conventional techniques. However, rotational abnormalities may remain undetected and should therefore be ruled out during clinical examination.II, study of diagnostic test.

Introduction While the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality. In this case report, we present a method for non-operative reduction and stabilization of a high-grade AC joint injury. Case A 31-year-old male orthopaedic resident sustained a Rockwood type V injury during a snowboarding accident. His AC joint was reduced and stabilized with an AC joint brace for six weeks. The brace provided active clavicle depression and humeral elevation. After removal of the brace the AC joint showed a nearly anatomic reduction. Six-month follow-up weighted X-ray views showed an AC joint which had healed in a Rockwood type II position and the patient returned to full pre-injury function with a satisfying cosmetic appearance. Conclusion Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. A “closed reduction and external fixation” approach with the aid of a dedicated AC joint brace can reduce the AC joint and keep it in place until ligamentous consolidation occurs, thus improving AC joint stability and cosmetic appearance without surgical intervention.

Background The effect of patient age on functional improvement after arthroscopic rotator cuff repair (ARCR) is still a matter of debate. The purpose of this study was to evaluate the clinical midterm results after ARCR in patients who were 75 years or older at the time of surgery. Methods A total of 31 shoulders in 30 patients older than 75 years at the time of surgery underwent ARCR for a degenerative full-thickness rotator cuff tear (RCT) between 2010 and 2016. Among those, 23 shoulders in 22 patients (74%) with a mean age at time of surgery of 77 ± 2 years (range, 75-82 years) were followed up after a mean of 7 ± 2 years (range, 3-9 years). Clinical assessment included the Western Ontario Rotator Cuff (WORC) index as well as patient satisfaction, the Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score. Results Overall, patient satisfaction was excellent, as everybody stated to be very satisfied with the surgery. Neither any complication nor revision surgery occurred during the study period. At final follow-up, the mean WORC index was 88% ± 15%. The mean SSV was comparable between the affected shoulder (90% ± 15%) and the contralateral side (87% ± 15%) (P = .235). The mean SST score was 10 ± 2 points and the mean ASES score was 89 ± 17 points. Conclusion ARCR for symptomatic RCTs without advanced muscle degeneration in patients older than 75 years at the time of surgery provided good clinical results and high patient satisfaction at midterm follow-up.

Background: Pathological muscle activation patterns of the external rotators and periscapular muscles can result in posterior positional functional shoulder instability (PP-FSI). In several patients, physical therapy and surgical treatment are not successful. Purpose: The shoulder-pacemaker treatment concept was evaluated prospectively in patients with PP-FSI and previously failed conventional therapy attempt. Study Design: Case series; Level of evidence, 4. Methods: A negative selection of 24 consecutive cases of noncontrollable PP-FSI in 16 patients with previously failed conventional therapy were included in this prospective study. The shoulder-pacemaker treatment consisted of an electrical muscle stimulation–based therapy protocol with 9 to 18 one-hour treatment sessions. Two patients were excluded because of nonadherence to the training schedule, leaving a final study cohort of 21 cases in 14 patients. Follow-up included assessment of clinical function, impairment during daily activities and sports, satisfaction, Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value at 0 weeks, 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and 24 months after intervention. Results: WOSI, Subjective Shoulder Value, and Rowe score showed a highly significant improvement at all time points of follow-up ( P < .001). Young age ( P = .005), low weight ( P = .019), shoulder activity level ( P = .003), unilateral affliction ( P = .046), and higher baseline WOSI score ( P = .04) were associated with a better treatment effect. Cases with increased glenoid retroversion, posterior scapulohumeral decentering, and dysplastic bony glenoid shape showed a trend toward shorter treatment effect duration. No complications during the intervention or follow-up period were observed. Conclusion: The shoulder-pacemaker therapy concept is an effective treatment with rapid improvement and sustained outcome over the course of 2 years in patients with noncontrollable PP-FSI with previously failed conventional treatment. Young and more athletic patients with lower weight and unilateral pathology respond best to the treatment.

Background The aim of this study was to investigate the validity of implant sonication fluid cultures in the diagnosis of shoulder periprosthetic joint infection (PJI) compared with tissue culture. Methods This was a retrospective case-control study analyzing all patients who underwent a revision surgery for any kind of suspected septic or aseptic event due to failed shoulder arthroplasty at our institution between July 2014 and December 2018. The diagnostic validity of implant sonication was analyzed on the basis of the last proposed definition criteria of the International Consensus Meeting and compared with standard tissue cultures. Results Of the 72 patients, a total of 28 (38.9%) were classified as infected. Of the 28 infected patients, 20 (71.4%) had an identified organism by tissue cultures, and Cutibacterium acnes was the most commonly isolated pathogen. The sensitivities of sonicate fluid (≥50 CFU/mL) and periprosthetic tissue culture for the diagnosis of periprosthetic shoulder infection were 36% and 61% (P = .016), and the specificities were 97.7% and 100% (P > .99), respectively. If no cutoff value was used in sonication culture, the sensitivity increased to 75% whereas the specificity dropped to 82%. Although there was no significant difference in sensitivity between tissue culture and the no-cutoff sonication fluid culture (61% vs. 75%, P = .125), the specificity of tissue culture was significantly higher (100% vs. 82%, P = .01). Conclusion Tissue culture showed a higher sensitivity and specificity than implant sonication in the diagnosis of shoulder PJI and should remain the gold standard for microbiological diagnosis of shoulder PJI.

Background: Arthroscopic rotator cuff repair (RCR) with suture anchor–based fixation techniques has replaced former open and mini-open approaches. Nevertheless, long-term studies are scarce, and lack of knowledge exists about whether single-row (SR) or double-row (DR) methods are superior in clinical and anatomic results. Purpose: To analyze long-term results after arthroscopic RCR in patients with symptomatic rotator cuff tears and to compare functional and radiographic outcomes between SR and DR repair techniques at least 10 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2005 and 2006, 40 patients with a symptomatic full-thickness rotator cuff tear (supraspinatus tendon tear with or without a tear of the infraspinatus tendon) underwent arthroscopic RCR with either an SR repair with a modified Mason-Allen suture–grasping technique (n = 20) or a DR repair with a suture bridge fixation technique (n = 20). All patients were enrolled in a long-term clinical evaluation, with the Constant score (CS) as the primary outcome measure. Furthermore, an ultrasound examination was performed to assess tendon integrity and conventional radiographs to evaluate secondary glenohumeral osteoarthritis. Results: A total of 27 patients, of whom 16 were treated with an SR repair and 11 with a DR repair, were followed up after a mean ± SD period of 12 ± 1 years (range, 11-14 years). Five patients underwent revision surgery on the affected shoulder during follow-up period, which led to 22 patients being included. The overall CS remained stable at final follow-up when compared with short-term follow-up (81 ± 8 vs 83 ± 19 points; P = .600). An increasing number of full-thickness retears were found: 6 of 22 (27%) at 2 years and 9 of 20 (45%) at 12 years after surgery. While repair failure negatively affected clinical results as shown by the CS ( P < .05), no significant difference was found between the fixation techniques ( P = .456). In general, progressive osteoarthritic changes were observed, with tendon integrity as a key determinant. Conclusion: Arthroscopic RCR with either an SR or a DR fixation technique provided good clinical long-term results. Repair failure was high, with negative effects on clinical results and the progression of secondary glenohumeral osteoarthritis. While DR repair slightly enhanced tendon integrity at long-term follow-up, no clinical superiority to SR repair was found.

Purpose To investigate the clinical and radiologic mid- to long-term results of arthroscopic iliac crest bone-grafting for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability. Methods Seventeen patients were evaluated after a minimum follow-up of 5 years. Clinical [range of motion, subscapularis tests, apprehension sign, Subjective Shoulder Value (SSV), Constant Score (CS), Rowe Score (RS), Walch Duplay Score (WD), Western Ontario Shoulder Instability Index (WOSI)], and radiologic [X-ray (true a.p., Bernageau and axillary views) and computed tomography (CT)] outcome parameters were assessed. Results Fourteen patients [mean age 31.1 (range 18–50) years] were available after a follow-up period of 78.7 (range 60–110) months. The SSV averaged 87 (range 65–100) %, CS 94 (range 83–100) points, RS 89 (range 30–100) points, WD 87 (range 25–100) points, and WOSI 70 (range 47–87) %. The apprehension sign was positive in two patients (14%). One patient required an arthroscopic capsular plication due to a persisting feeling of instability, while the second patient experienced recurrent dislocations after a trauma, but refused revision surgery. CT imaging showed a significant increase of the glenoid index from preoperative 0.8 ± 0.04 (range 0.7–0.8) to 1.0 ± 0.11 (range 0.8–1.2) at the final follow-up (p Conclusion Arthroscopic reconstruction of anteroinferior glenoid defects using an autologous iliac crest bone-grafting technique yields satisfying clinical and radiologic results after a mid- to long-term follow-up period. Postoperative re-dislocation was experienced in one (7.1%) of the patients due to a trauma and an anatomic reconstruction of the pear-shaped glenoid configuration was observed. Level of evidence IV.

Irreparable rotator cuff tears are challenging to treat. Especially in younger patients without concomitant osteoarthritic changes, joint-preserving procedures are warranted. To date, no treatment guideline exists because none of the available techniques has shown superiority over the others, and long-term survivorship data are missing. The aim of the “Strings” is to provide an arthroscopic solution to anatomically reconstruct presumably irreparable rotator cuff tears by bridging the gap with multiple string-like tendon interposition autografts.

Background: Isolated soft tissue injuries of the posterior capsulolabral complex can be addressed arthroscopically, with various anchor systems available for repair. Purpose: To evaluate clinical and patient-reported outcomes after arthroscopic capsulolabral repair in patients with posterior shoulder instability (PSI) and to compare differences in outcomes between patients treated with a suture-first technique (PushLock anchor) and an anchor-first technique (FiberTak all-suture anchor). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 32 patients with dynamic structural PSI (type B2 according to the ABC classification) treated with an arthroscopic posterior capsulolabral repair. After a mean follow-up time of 4.8 ± 3.4 years (range, 2-11) patients were evaluated clinically, and standardized outcome scores were obtained for the Subjective Shoulder Value (SSV), the Western Ontario Shoulder Instability Index (WOSI), Rowe, Kerlan-Jobe Orthopaedic Clinic (KJOC), patient satisfaction (0-5 [best]), and pain on a visual analog scale (VAS; 0-10 [worst]). Results: The overall satisfaction level with the outcome of the surgery was 4.6 ± 0.5 (range, 4-5). No patient suffered from instability events. The mean VAS level for pain was 0.4 ± 0.9 (range, 0-4) at rest and 1.9 ± 2.0 (range, 0-6) during motion. The mean SSV was 80 ± 17 (range, 30-100), the mean postoperative WOSI score 75% ± 19% (range, 18-98), the mean Rowe score 78 ± 20 (range, 10-100), and the mean KJOC score was 81 ± 18 (range, 40-100) for the entire cohort. There was no significant difference between the techniques with regard to range of motion, strength, or clinical outcome scores. Conclusion: Arthroscopic posterior capsulolabral repair was a satisfactory method to treat structural PSI type B2 with regard to stability, pain relief, and functional restoration. The majority of patients had good outcomes. No differences in outcomes were observed between the anchor-first and suture-first techniques.

This study evaluated the reliability and comprehensiveness of the Unified classification system (UCPF), Wright & Cofield, Worland and Kirchhoff classifications and related treatment recommendations for periprosthetic shoulder fractures (PPSFx). Two shoulder arthroplasty specialists (experts) and two orthopaedic residents (non-experts) assessed 20 humeral-sided and five scapula-sided cases of PPSFx. We used the unweighted Cohen’s Kappa (κ) for measuring the intra-observer reliability and Krippendorff’s alpha (α) for measuring the inter-observer reliability. The inter-rater reliabilities for the Wright & Cofield and Worland classifications were substantial for all groups. The expert and non-expert groups for UCPF also showed substantial inter-rater agreement. The all-rater group for the UCPF and the expert and non-expert group for the Kirchhoff classification revealed moderate inter-rater reliability. For the Kirchhoff classification, only fair inter-rater reliability was found for the non-expert group. Almost perfect intra-rater reliability was measured for all groups of the Wright & Cofield classification and the all-rater and expert groups of the UCPF. All groups of the Kirchhoff and Worland classifications and the group of non-experts for the UCPF had substantial intra-rater reliabilities. Regarding treatment recommendations, substantial inter-rater and moderate intra-rater reliabilities were found. Simple classification systems for PPSFx (Wright & Cofield, Worland) show the highest inter- and intra-observer reliability but lack comprehensiveness as they fail to describe scapula-sided fractures. The complex Kirchhoff classification shows limited reliability. The UCPF seems to offer an acceptable combination of comprehensiveness and reliability.

A displaced anterior glenoid rim fracture, the so-called bony Bankart lesion, occurs after a traumatic shoulder dislocation resulting from a high energy trauma and is associated with recurrent shoulder instability. Different surgical techniques have been described in the literature to address this pathology, including open reduction and fixation, as well as arthroscopic transosseous, and single-row or double-row approaches with the use of suture anchors. However, there is currently no gold standard of treatment and the stability of fixation and the healing of the bony fragment are still a concern. The purpose of this report was to introduce an arthroscopic independent double-row (IDR) bony Bankart repair technique for fixation of large glenoid fractures.Eine dislozierte vordere Glenoidrandfraktur, die sogenannte knöcherne Bankart-Läsion, tritt nach einer traumatischen Schulterluxation als Folge eines energiereichen Traumas auf und ist mit einer rezidivierenden Schulterinstabilität verbunden. In der Literatur werden verschiedene Operationstechniken zur Behandlung dieser Pathologie beschrieben, darunter die offene Reposition und Fixation sowie arthroskopische transossäre, ein- oder zweireihige Rekonstruktionen mit Verwendung von Nahtankern. Allerdings gibt es derzeit keinen Goldstandard für die Behandlung, und die Stabilität der Fixierung und die Heilung des Knochenfragments sind nach wie vor problematisch. Ziel dieses Berichts war es, eine arthroskopische unabhängige zweireihige knöcherne Bankart-Rekonstruktionstechnik zur Fixierung großer Glenoidfrakturen vorzustellen.

Distal radius fractures are common and account for approximately 14% to 18% of all adult extremity injuries. On rare occasions, ipsilateral elbow dislocation can be observed additionally. However, this can be missed without careful examination, especially in patients experiencing altered mental status. The aim of this study was to analyze the mechanism, level of injury, demographics, and associated injuries in distal radius fracture with ipsilateral elbow dislocation. Between 2012 and 2019, we searched our trauma database for distal radius fracture with ipsilateral elbow dislocation. All patients older than 18 years old were included. Data on demographics, mechanism of injury, level of energy, and subsequent treatment were collected. A total of seven patients were identified. The mean age in this cohort was 68.7 +/- 13.3 years old, and the left side was involved in 71.4% of the patients. Females were affected in 85.7% (n = 6/7) of cases, all of whom suffered from low-energy monotrauma at a mean age of 71.5 +/- 12.3 years old. One male patient suffered from high-energy trauma (52 years old). Mainly, posterior elbow dislocations were observed (66.7%; n = 4/6). Distal radius fracture patterns, in accordance with the AO classification, included two C2-, two C3-, one C1-, and one B1-type fractures. In the patient suffering from high-energy trauma, the closed distal radius fracture was classified as type C3. Associated injures included open elbow dislocation, ulnar artery rupture, and damage to the flexor digitorum superficialis. Although distal radius fracture with ipsilateral elbow dislocation is thought to be from high-energy trauma, this study shows that most patients were elderly females suffering from low-energy mechanisms. It is important for clinicians to maintain a high level of suspicion for any concomitant injury in this population.

The indication for surgical treatment of lateral snapping elbow syndrome is recurrent joint blockage in combination with pain of the affected elbow joint. Different parts of the lateral synovial capsule sleeve complex, including the annular ligament itself, a hypertrophic synovial fold, or meniscus-like soft tissue interposition can lead to painful entrapment. Surgical treatment options can include an arthroscopic or open procedure. The aim of this technical note is to provide a step-by-step illustration of the authorsʼ preferred arthroscopic approach with a comprehensive review of literature on clinical outcome.

The indication for surgical treatment of lateral snapping elbow syndrome is recurrent joint blockage in combination with pain of the affected elbow joint. Different parts of the lateral synovial capsule sleeve complex, including the annular ligament itself, a hypertrophic synovial fold, or meniscus-like soft tissue interposition can lead to painful entrapment. Surgical treatment options can include an arthroscopic or open procedure. The aim of this technical note is to provide a step-by-step illustration of the authors' preferred arthroscopic approach with a comprehensive review of literature on clinical outcome.Rezidivierende Gelenkblockaden in Kombination mit Schmerzen und Schnappen im Bereich des lateralen Ellenbogengelenkes können häufig mit einem sogenannten „Snapping annular ligament“ assoziiert werden. Ursächlich hierfür ist eine Interposition des Ligamentum annulare bzw. eine hypertrophierte Plica posterolateralis in das humeroradiale Gelenkkompartiment. Operative Therapieoptionen beinhalten ein arthroskopisches oder offenes Vorgehen. Die nachfolgende Technical note thematisiert das arthroskopische Vorgehen sowie die aktuellste Literatur.

Chronic locked posterior shoulder dislocations are challenging to treat and often warrant total shoulder arthroplasty. While joint preserving treatment is preferable in young patients, surgical techniques to treat this pathology have rarely been described in the literature. This technical note presents the treatment of a 30-year-old male patient with a chronic locked posterior shoulder dislocation by means of combined humeral allograft reconstruction and posterior glenoid autograft augmentation. Restoration of the spheric humeral head surface was obtained using a fresh-frozen femoral allograft fixed with two reabsorbable screws. Due to the intraoperatively persistent posterior instability after humeral reconstruction, the posterior glenoid was augmented with a tricortical iliac crest autograft, which was fixed with two metal screws. This treatment strategy resulted in a full range of motion and a centered stable shoulder joint at one-year follow-up. Therefore, the procedure of segmental reconstruction of the humeral head with a fresh-frozen allograft combined with a posterior glenoid augmentation with an iliac crest bone autograft is a joint-preserving treatment alternative to shoulder arthroplasty in young patients when humeral head reconstruction alone does not suffice.Chronisch verhakte hintere Schulterluxationen erfordern häufig einen endoprothetischen Gelenkersatz. Vor allem bei jungen Patienten ist jedoch ein gelenkserhaltender Therapieansatz zu bevorzugen. In diesem Fallbeispiel berichten wir über die Behandlung eines 30-jährigen Patienten mit chronisch verhakter hinteren Schulterluxation mittels kombiniertem humeralen Aufbau und glenoidaler Augmentation. Zur Rekonstruktion der Konvexität des Humeruskopfes erfolgte der Aufbau mit einem fresh-frozen Femur-Allograft, fixiert mit 2 absorbierbaren Magnesiumschrauben. Bei intraoperativ fortbestehender Instabilität wurde zusätzlich das posteriore Glenoid durch einen trikortikalen Beckenkammspan augmentiert. Durch dieses Vorgehen bestand 1-Jahr postoperativ eine freie Beweglichkeit bei zentriertem und stabilem Gelenk. Radiologisch stellt sich das Gelenk zentriert dar, humeral kam es zur partiellen Resorption des Allografts. Deshalb stellt die kombinierte anatomische Rekonstruktion des humeralen Defektes mittels fresh-frozen Femur-Allograft mit zusätzlicher Augmentation des hintern Glenoides mit einem autologen Beckenkammspan eine gelenkserhaltende Therapiealternative bei jungen Patienten mit chronisch verhakter hinterer Schulterluxation dar.

In the treatment of anterior shoulder instability with glenoid bone loss, free bone graft transfers have proven to be a viable anatomic alternative to the commonly performed, nonanatomic Latarjet procedure. Implant-free fixation of the free bone grafts, in particular, has rendered excellent short- and long-term results. However, a drawback remains the source of the graft. We describe an arthroscopic bone block cerclage technique using a tricortical scapular spine autograft, which provides an anatomic arthroscopic glenoid reconstruction with the combined benefit of sparing the subscapularis, metal-free fixation, and intraregional donor site for autograft harvesting.

Purpose Purpose of this study was to evaluate the mid- to long-term outcome after conservatively treated first-time posterior shoulder dislocations and to determine structural defects associated with failure. Methods In this multi-centric retrospective study, 29 shoulders in 28 patients with first-time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross-sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow-up of 8.3 ± 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed. Results Redislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 ± 12.5% vs. 50.6 ± 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8° ± 7.2°, vs. 93.3° ± 9.7°). The adapted gamma angle was higher than 90° in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV: r = 0.543, p = 0.02; ROWE: r = 0.418, p = 0.035 and WOSI: r = 0.478, p = 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI (r = − 0.59, p = 0.02) and follow-up posterior glenohumeral decentring (r = 0.68, p = 0.007). The gamma angle (r = 0.396, p = 0.039) and depth of the reverse Hill–Sachs lesion (r = 0.437, p = 0.023) correlated significantly with the grade of osteoarthritis at follow-up. Conclusion Conservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid- and long-term follow-up especially in patients with centred joint, low gamma angle, and middle or old age. Level of evidence IV.

Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI.In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared.Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P.001, daily activities: P = .001, sports activities: P.001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed.FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.

MicroRNAs (miRNAs) have emerged as key regulators orchestrating a wide range of inflammatory and fibrotic diseases. However, the role of miRNAs in degenerative shoulder joint disorders is poorly understood. The aim of this explorative case‐control study was to identify pathology‐related, circulating miRNAs in patients with chronic rotator cuff tendinopathy and degenerative rotator cuff tears (RCT). In 2017, 15 patients were prospectively enrolled and assigned to three groups based on the diagnosed pathology: (i) no shoulder pathology, (ii) chronic rotator cuff tendinopathy, and (iii) degenerative RCTs. In total, 14 patients were included. Venous blood samples (“liquid biopsies”) were collected from each patient and serum levels of 187 miRNAs were determined. Subsequently, the change in expression of nine candidate miRNAs was verified in tendon biopsy samples, collected from patients who underwent arthroscopic shoulder surgery between 2015 and 2018. Overall, we identified several miRNAs to be progressively deregulated in sera from patients with either chronic rotator cuff tendinopathy or degenerative RCTs. Importantly, for the several of these miRNAs candidates repression was also evident in tendon biopsies harvested from patients who were treated for a supraspinatus tendon tear. As similar expression profiles were determined for tendon samples, the newly identified systemic miRNA signature has potential as novel diagnostic or prognostic biomarkers for degenerative rotator cuff pathologies. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. Inc. J Orthop Res 38:202–211, 2020

Introduction Aberrant muscle activation patterns of periscapular and shoulder muscles can result in severe functional posterior shoulder instability (FPSI) without demonstrating underlying structural defects. Conventional physiotherapy as well as surgical interventions are often unsuccessful in the treatment of FPSI. Case presentation We report a 13-year-old girl with rare, tic-like non-positional FPSI. 3 months of conventional conservative therapy failed and a rapid progression of the pathology resulted in an extremely limited shoulder function including repetitive posterior subluxations, chronic pain and stigmatization. The application of electric muscle stimulation (“EMS”) immediately achieved a dislocation-free shoulder motion. After 6 weeks of treatment using an EMS therapy concept, the patient regained a stable shoulder motion for all retrained shoulder movements and a persistent effect of the treatment was observed at the 12 months’ follow-up. However, rapid and uncoordinated shoulder movements still cause involuntary subluxations. Conclusion Electric muscle stimulation (“EMS”) is able to successfully re-establish glenohumeral stability even in patients with rare, tic-like non-positional FPSI. A sustained therapeutic effect that allows for a stable shoulder motion can be achieved after only a few therapeutic sessions.

Head-split fractures account for less than 5% of proximal humerus fractures and occur when the humeral head cleaves as it impacts against the narrow “anvil” of the glenoid into two or more large fragments, generally associated with fractures of the tuberosities or surgical neck. The articular surface is fragmented into disconnected pieces, frequently these fractures often very challenging and demanding in terms of initial diagnosis and treatment options. They often need surgical intervention because of their articular fracture pattern and their high risk of malunion with the development of premature glenohumeral arthritis. Moreover, head-split fractures are often misdiagnosed on initial plain radiographs, which can delay and complicate appropriate treatment. The purpose of this article is to provide an overview of the diagnosis, classification, and treatment of head-split fractures.

Instability arthropathy (IA) is a major long-term concern in patients with anterior shoulder instability. This study investigated the association of glenoid morphology with the development of IA.The study included 118 patients with unilateral anterior shoulder instability and available bilateral computed tomography scans. Instability-specific information was obtained from all patients. The glenoid morphology of the affected shoulder was compared with the nonaffected contralateral side resembling the constitutional preinjury glenoid shape. Both shoulders were evaluated independently by 3 observers to assess the grade of IA according to a Comprehensive Arthropathy Rating (CAR) system. Associations between IA and the glenoid morphology parameters were investigated.The average glenoid retroversion (P .001), glenoid depth (P .001), glenoid diameter (P .001), and the bony shoulder stability ratio (P .001) of the affected shoulder were significantly reduced compared with the contralateral side due to bony defects in 79.6% of the patients. The CAR of the affected side was significantly higher (P .001), with more osteophytes (P = .001) and more sclerosis and cysts (P .001). Differences in CAR (Δ-CAR) correlated positively with the age at the time of the computed tomography scan (P .001), age at the initial dislocation (P = .001), size of the glenoid defect (P = .005), and the contralateral glenoid depth (P = .011), glenoid diameter (P = .016), and bony shoulder stability (P = .029), and negatively with glenoid retroversion of the affected side (P = .027).Development of IA arthropathy is associated not only with the age of the patients but also with morphologic parameters of the glenoid, including glenoid defect size and the constitutional glenoid concavity shape.

Background The purpose of this study was to evaluate the long-term clinical and radiologic results after arthroscopic transosseous rotator cuff repair (TORCR). Methods A total of 69 patients with full-thickness supraspinatus tendon tears with or without infraspinatus tendon tears treated with arthroscopic TORCR by a single surgeon between 1998 and 2003 were included. Among them, 56 patients (81%) with a mean age of 58 ± 5 years (range, 42-70 years) were available for final follow-up examination after an average of 15 ± 2 years (range, 12-18 years). The Subjective Shoulder Value, Constant score (CS), University of California at Los Angeles score, and American Shoulder and Elbow Surgeons score were recorded. Magnetic resonance imaging (MRI) was performed to visualize tendon integrity in 66% of patients. Results At final follow-up, the mean CS was 84 ± 8 points; mean University of California at Los Angeles score, 33 ± 2 points; mean American Shoulder and Elbow Surgeons score, 92 ± 10 points; and mean Subjective Shoulder Value, 89% ± 17%. MRI revealed asymptomatic repair failure in 9 patients (27%). Moreover, 4 patients (7%) underwent revision surgery because of a symptomatic rerupture, resulting in an overall retear rate of 33%. Patients with intact repairs at final follow-up showed a significantly higher CS (P = .019) and abduction strength (P = .016) than patients with retears. Conclusion Arthroscopic TORCR for the treatment of full-thickness rotator cuff tears provided good clinical results 12 to 18 years after surgery. Cuff integrity on follow-up MRI scans had a positive effect on the clinical outcome.

Shoulder pathologies are often accompanied by rotator interval synovitis. This phenomenon is poorly described in the literature so far. The aim of the study was to analyze the occurrence of macroscopically visible synovial reaction in the rotator interval in patients with chronic shoulder pathologies and to perform a histopathological evaluation. In this prospective cohort study, 167 consecutive patients undergoing arthroscopic shoulder surgery for chronic shoulder pathology were included (♀ = 45, ♂ = 122; $$\emptyset ~$$ 54.5 years ± 12.8). Included patients were divided into subgroups according to the encountered chronic shoulder pathology: (1) impingement syndrome with or without bursal sided partial rotator cuff tear (RCT); (2) articular sided partial RCT; (3) full-thickness RCT; (4) RCT that involves at least two tendons; (5) shoulder instability; and (6) cartilage damage. Standardized soft tissue biopsies from the rotator interval were taken. The synovitis score of Krenn/Morawietz was used for histopathological examination. Extraarticular pathology (group 1) showed significantly decreased synovitis scores compared to all the other groups. Increased size of rotator cuff tears (group 4), as well as cartilage damage (group 6) showed significantly higher synovitis scores than group 3 (p

Background Since phase III trials for the most prominent vaccines excluded immunocompromised or immunosuppressed patients, data on safety and efficacy of SARS‐CoV‐2 vaccines for recipients of solid organ transplantations are scarce. Aims Our study offers a synthesis of expert opinions aligned with available data addressing key questions of the clinical management of SARS‐CoV‐2 vaccinations for transplant patients. Method An online research was performed retrieving available recommendations by national and international transplantation organizations and state institutions on SARS‐CoV2 vaccination management for transplant recipients. Results Eleven key statements were identified from recommendations by 18 national and international societies, and consensus for the individual statements was evaluated by means of the Society Recommendation Consensus score. The highest consensus level (SRC A) was found for prioritized access to vaccination for transplant patients despite anticipation of a weakened immune response. All currently authorized vaccines can be considered safe for transplant patients (SRC A). The handling of immunosuppressive medication, the timely management of vaccines, and other aspects were aligned with available expert opinions. Conclusion Expert consensus can be determined for crucial aspects of the implementation of SARS‐CoV‐2 vaccination programs. We hereby offer a tool for immediate decision‐making until empirical data becomes available.

Background Rotator cuff fatty infiltration (FI) is one of the most important parameters to predict the outcome of certain shoulder conditions. The primary objective of this study was to define a new computed tomography (CT)–based quantitative 3-dimensional (3D) measure of muscle loss (3DML) based on the rationale of the 2-dimensional (2D) qualitative Goutallier score. The secondary objective of this study was to compare this new measurement method to traditional 2D qualitative assessment of FI according to Goutallier et al and to a 3D quantitative measurement of fatty infiltration (3DFI). Materials and methods 102 CT scans from healthy shoulders (46) and shoulders with cuff tear arthropathy (21), irreparable rotator cuff tears (18), and primary osteoarthritis (17) were analyzed by 3 experienced shoulder surgeons for subjective grading of fatty infiltration according to Goutallier, and their rotator cuff muscles were manually segmented. Quantitative 3D measurements of fatty infiltration (3DFI) were completed. The volume of muscle fibers without intramuscular fat was then calculated for each rotator cuff muscle and normalized to the patient’s scapular volume to account for the effect of body size (NVfibers). 3D muscle mass (3DMM) was calculated by dividing the NVfibers value of a given muscle by the mean expected volume in healthy shoulders. 3D muscle loss (3DML) was defined as 1 – (3DMM). The correlation between Goutallier grading, 3DFI, and 3DML was compared using a Spearman rank correlation. Results Interobserver reliability for the traditional 2D Goutallier grading was moderate for the infraspinatus (ISP, 0.42) and fair for the supraspinatus (SSP, 0.38), subscapularis (SSC, 0.27) and teres minor (TM, 0.27). 2D Goutallier grading was found to be significantly and highly correlated with 3DFI (SSP, 0.79; ISP, 0.83; SSC, 0.69; TM, 0.45) and 3DML (SSP, 0.87; ISP, 0.85; SSC, 0.69; TM, 0.46) for all 4 rotator cuff muscles (P Conclusion The Goutallier score has been helping surgeons by using 2D CT scan slices. However, this grading is associated with suboptimal interobserver agreement. The new measures we propose provide a more consistent assessment that correlates well with Goutallier’s principles. As 3DML measurements incorporate atrophy and fatty infiltration, they could become a very reliable index for assessing shoulder muscle function. Future algorithms capable of automatically calculating the 3DML of the cuff could help in the decision process for cuff repair and the choice of anatomic or reverse shoulder arthroplasty.