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Background: For degenerative shoulder disease, reverse shoulder arthroplasty (RSA) has proven successful; however, problems such as scapular notching and instability still exist. These difficulties are intended to be addressed by recently improved prosthesis designs with reduced neck-shaft angles (NSA). Still, there are issues with complications, particularly with the humerus. In an effort to avoid these problems and maintain bone stock, a recently designed straight-short-stem humeral component was used; however, yet its clinical and radiological outcomes in RSA remain largely unexplored., Material and Methods: Using a 55 mm straight short stem (Comprehensive Reverse Shoulder System; Zimmer Biomet), a retrospective analysis of 93 patients undergoing primary RSA was carried out. Clinical assessments, including scores and range of motion, were conducted both before and after surgery. Complications, bone adaptation, and stem alignment were all evaluated radiographically. Significant correlations between postoperative shoulder movements and function were linked with angles of prosthesis lateralization and distalization., Results: Patients demonstrated significant improvements in clinical scores at 35-month follow-up on average: Constant-Murley (76.4 ± 13.4), American Shoulder and Elbow Surgeons (84.8 ± 16.5), Disabilities of Arm, Shoulder, the Hand (17.1 ± 15.8), and University of California and Los Angeles (7.1 ± 1.5). Radiographic assessments showed no stem loosening and stable implant attachment. There was no scapular notching, and there were noticeable improvements in shoulder range of motion and function., Discussion and Conclusion: This study validates the efficacy of a straight short stem for acceptable clinical outcomes and implant stability in RSA. Notably, it demonstrates specific angle ranges crucial for optimal postsurgical shoulder function. The findings suggest this stem design presents potential benefits in RSA, highlighting its safety and effectiveness while providing insights for future clinical strategies. The study contributes valuable data toward understanding and enhancing patient outcomes in shoulder arthroplasty procedures., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: The purposes of this study were to assess clinical and radiographic outcomes following plate-assisted bone segment transport (PABST) in large bone defects of the lower extremities., Design: Retrospective study of prospectively collected data., Setting: Level-1 trauma center located in Germany., Patient Selection Criteria: Patients who underwent PABST and were at least 1 year postoperatively were included., Outcome Measures and Comparisons: Demographic data were collected. Radiographic apparent bone gap (RABG), time to consolidation, time to full weight-bearing, and consolidation index were calculated. Numeric rating scale, lower extremity functional scale (LEFS), and complications were assessed., Results: Fifteen patients [13 male; mean age 51 years (range, 20-75)] underwent PABST and had follow-up at a mean of 29.1 months. The tibia was affected in 8 and the femur in 7 patients. Preoperative RABG was 60 mm [interquartile range (IQR): 40-125], and bone defects were caused by septic nonunions in 73% of patients. Fourteen patients (93%) demonstrated consolidated transport callus at 7.3 months [95% confidence interval (95% CI), 6-8.5], and 9 patients (60%) demonstrated complete consolidation of both docking site and transport callus at 11.5 months (95% CI, 7.3-15.3). Postoperative RABG was 0.1 mm (IQR: 0-0.8), and consolidation index was 1.9 months/cm (95% CI, 1.3-2.5). All patients achieved full weight-bearing at 8.7 months (IQR: 6.5-10.3). LEFS was 42 (95% CI, 34-50), and numeric rating scale was 3 (95% CI, 2-4). Patients treated for tibial defects had a significantly higher consolidation rate compared with patients treated for femoral defects ( P = 0.040)., Conclusions: PABST demonstrated high consolidation of transport callus with few complications. Although full weight-bearing was achieved in all patients, complete consolidation of the docking site was only present in 60% of cases., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Glenoid defects can be addressed traditionally by asymmetric reaming or by bone-preserving correction to a more lateral joint line by bone or metal augmented baseplates in reverse shoulder arthroplasties. While there is more evidence in literature regarding the outcome and complications of Bony Increased Offset Reversed Shoulder Arthroplasty (BIO-RSA), there is minimal reported experience with the outcome after metal glenoid augments. The aim of this study was to determine whether a metal augment can correct the glenoid deformity in an anatomic manner., Methods: Glenoid morphology and deformity were determined in 50 patients with Walch type B1, B2, D and Favard type E0-E3 glenoid defects using preoperative radiographic and computed tomography (CT) analysis. All patients received a preoperative planning CT with 3D planning, and measurements of glenoid inclination (in 3 planes proximal, middle, distal), reversed shoulder arthroplasty angle (RSA) and glenoid version were obtained. All patients had a pathologic inclination in the coronal or frontal planes of > 10°. Above the threshold of 10° pathological glenoid version or inclination metal hemi-augments of 10°, 20°, or 30° were used which allow an individual 360° augment positioning according to the patient glenoid deformity., Results: The mean preoperative numbers of the glenoid version demonstrate that most glenoids were in retroversion and superior inclination. In total 2410° wedges, 1820° wedges and 8 30° wedges were used. In the majority of cases, the wedge was positioned posteriorly and/or cranially between 10:00 and 12:00 o'clock, which allows a correction in a 3D manner of the glenoid inclination and version. The mean RSA angle could be corrected from 22.76 ± 6.06 to 0.19° ± 2.7 (p < 0.0001). The highest retroversion of the glenoid is evidenced in the proximal section and it could be corrected from - 23.32° ± 4.56 to - 6.74° ± 7.75 (p < 0.0001) and in the middle section from - 18.93° ± 3.35 to - 7.66° ± 5.28 (p < 0.0001). A mean sphere bone overhang distance (SBOD) of 5.70 ± 2.04 mm was found in order to avoid or minimize relevant scapular notching., Conclusion: By using a new 360° metal-augmented baseplate, the preoperative pathological inclination and retroversion can be corrected without medialization of the joint line. Future clinical results will show whether this bone-preserving procedure improves also the clinical outcomes as compared to asymmetric medialized reaming or wedged BIO-RSA., Level of Evidence: Level IV, Case series., (© 2023. The Author(s).)

Introduction: The interval slide procedure (IS) has been introduced to improve mobility in massive, retracted rotator cuff tears. As clinical studies showed controversial results, the benefit of the IS is still widely discussed., Aim: Aim of this study was to analyze the effect of IS procedure on tendon mobility in a fresh porcine cadaver model., Materials and Methods: In 30 fresh porcine cadaver shoulders with artificial supraspinatus defect tendon mobility was tested by measuring the load (in N) during tendon reduction to the footprint at the greater tubercle using a sensor enhanced arthroscopic grasper (t1). In intervention group (N = 15) anterior IS (t2), posterior IS (t3) and intraarticular capsule release (t4) were successively performed, each followed by tendon mobility assessment. Tendon mobility of the control group (N = 15) was measured in same time schedule without intervention., Results: Mobility did not differ between groups for native tendons (CG 28.0 ± 11.2 N vs. IG 26.6 ± 11.6 N; P = 0.75). IS procedure significantly improves mobility at about 25.2% (t1 26.6 ± 11.6 N vs. t4 19.9 ± 12.3 N; P < 0.001) compared to the native tendon and 34.1% compared to CG (CG 30.2 ± 13.7 N vs. 19.9 ± 12.3 N; P = 0.026). In posthoc analyzes, anterior IS (P < 0.001) and capsule release (P = 0.005) significantly increased mobility, whereas the posterior IS did not (P = 0.778)., Conclusion: The IS procedure results in increased supraspinatus tendon mobility in fresh porcine cadaver shoulders. However, performing the posterior IS subsequent to the anterior IS no significant improvement of mobility has been observed., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The treatment of non-unions is often complicated by segmental bone defects and bacterial colonization. Because of the limited availability of autologous bone grafts, tissue engineering focuses on antibiotic-loaded bone graft substitutes. HACaS+G is a resorbable calcium sulphate-hydroxyapatite loaded with gentamicin. The osteoinductive, osteoconductive, and anti-infective effect of HACaS+G has already been demonstrated in clinical studies on patients with chronic osteomyelitis. However, especially for the treatment of infected non-unions with segmental bone defects by HACaS+G, reliable clinical testing is difficult and sufficient experimental data are lacking. We used an already established sequential animal model in infected and non-infected rat femora to investigate the osteoinductive, osteoconductive, and anti-infective efficacy of HACaS+G for the treatment of infected non-unions. In biomechanical testing, bone consolidation could not be observed under infected and non-infected conditions. Only a prophylactic effect against infections, but no eradication, could be verified in the microbiological analysis. Using µ-CT scans and histology, osteoinduction was detected in both the infected and non-infected bone, whereas osteoconduction occurred only in the non-infected setting. Our data showed that HACaS+G is osteoinductive, but does not have added benefits in infected non-unions in terms of osteoconduction and mechanical bone stability, especially in those with segmental bone defects.

(1) Many biomechanical studies are performed using fresh frozen cadavers or embalmed specimens, although the biomechanical characteristics do not match the characteristics of in vivo tendons. Therefore, a fresh in vivo-like cadaver model has been introduced recently. As a limitation for studies with fresh cadavers, rigor mortis must be considered. The aim of this study was to evaluate the impact of the biomechanical properties and time of occurrence of rigor mortis in a fresh cadaver model. (2) For this study, 15 fresh porcine cadaver shoulders were used in an established biomechanical in vitro model to evaluate the onset of rigor mortis . Measurements took place at ten points of time (t1-t10) beginning 103 min post mortem (pm). The mobility of the supraspinatus tendon was measured in Newton (N) with a modified sensor-enhanced arthroscopic grasper. (3) The mean load measured at the time point t1 was 28.0 ± 11.2 N. The first significant decrease of mobility occurred 151 min post mortem (t4) at a mean load of 30.2 ± 13.7 N. From 227 min pm to 317 min pm, there was no further significant increase. (4) Tendon mobility decreases significantly within the first three hours after the killing. Therefore, reliable results can be obtained within 150 min post mortem before the onset of rigor mortis alters the biomechanical properties.

Background: This study aimed to evaluate clinical, cosmetic, and strength midterm outcomes in arthroscopic biceps tenotomy and subpectoral biceps tenodesis using bicortical endobutton and interference screw., Methods: In this retrospective study, inclusion criteria were long head of the biceps (LHB) pathologies treated either with tenotomy or an additional tenodesis. Postoperative assessment included Long Head of Biceps Score (LHBS), age-adjusted Constant-Murley Score, and Subjective Shoulder Value. Elbow flexion and forearm supination strength were measured. The presence of Popeye sign, cramps, and tenderness over the bicipital grove was evaluated. Statistical analysis of continuous variables without normal distribution was performed using Mann-Whitney U test. Grouped analysis was performed using 2-way analysis of variance. Binominal data were analyzed using chi-square test., Results: A total of 73 patients with a mean age of 63.1 ± 9.6 years and a mean follow-up of 4.2 ± 0.5 years were included. Tenotomy was performed in 34 and tenodesis in 39 patients. Tenodesis group displayed a significantly higher LHB score ( P  = .0006), but no significant differences were detected for the age-adjusted Constant-Murley Score and Subjective Shoulder Value. Tenodesis group showed a significantly lower rate of Popeye deformities ( P  = .0007) and tenderness over the bicipital groove ( P  = .004). Patients from the tenotomy group with biceps deformity showed a significantly higher mean contralateral supination strength ( P  = .002) but no significant difference in contralateral elbow flexion compared with patients without biceps deformity. There was one (1.4%) complication in the tenotomy group (postoperative shoulder stiffness)., Conclusion: Both techniques resulted in comparable outcome scores on preselected patients, with tenodesis leading to better LHB function. Tenodesis did not improve elbow flexion and forearm supination strength beyond the tenotomy; however, it reduced the frequency of biceps deformities and tenderness over the bicipital groove. Patients with a strong contralateral forearm supination strength could be at risk of developing a biceps deformity after tenotomy., (© 2022 The Authors.)

The treatment of infected and non-infected non-unions remains a major challenge in trauma surgery. Due to the limited availability of autologous bone grafts and the need for local anti-infective treatment, bone substitutes have been the focus of tissue engineering for years. In this context, bioactive glasses are promising, especially regarding their anti-infective potential, which could reduce the need for local and systemic treatment with conventional antibiotics. The aim of this study was to investigate the osteoinductive and osteoconductive effects, as well as the anti-infectious potential, of S53P4 using a standardized non-union model, which had not been investigated previously. Using an already established sequential animal model in infected and non-infected rat femora, we were able to investigate bioactive glass S53P4 under realistic non-union conditions regarding its osteoinductive, osteoconductive and anti-infective potential with the use of µCT scans, biomechanical testing and histological, as well as microbiological, analysis. Although S53P4 did not lead to a stable union in the non-infected or the infected setting, µCT analysis revealed an osteoinductive effect of S53P4 under non-infected conditions, which was diminished under infected conditions. The osteoconductive effect of S53P4 remained almost negligible in histological analysis, even 8 weeks after treatment. Additionally, the expected anti-infective effect could not be demonstrated. Our data suggested that S53P4 should not be used in infected non-unions, especially in those with large bone defects.

Background: The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial., Purpose: The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon., Study Design: Controlled laboratory study., Methods: A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t 1 ) was evaluated. In the intervention group, AIS (t 2 ), PIS (t 3 ), and CR (t 4 ) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention., Results: A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t 1 vs t 4 : 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t 1 vs t 2 : 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t 2 vs t 3 : 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t 3 vs t 4 : 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t 4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001)., Conclusion: The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally., Clinical Relevance: These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

To compare outcomes, complications, revisions, and rates of implant removal of superior compared to anteroinferior plating in displaced midshaft clavicle fractures at mid-term follow-up. We retrospectively reviewed 79 patients who underwent operative treatment for displaced midshaft clavicle fractures (Group A: 28 patients with superior plating; Group B: 51 patients with anteroinferior plating) that were at least 2 years postoperatively. Adjusted Constant Score (aCS), Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score were compared. Bone union, implant removal, complications and revision surgeries were assessed. Group A had a significantly higher aCS compared to group B (90, IQR: 85.0-91.0 vs. 91, IQR: 90.0-93.0; P = 0.037). No significant differences between groups were seen in VAS (P = 0.283) and QuickDASH (P = 0.384). Bone union was achieved in 76 patients (96.2%) with no significant differences between groups (Group A: 96.4% vs. Group B: 96.1%; P > 0.999). There were no significant differences in implant removal rates (Group A: 60.7% vs. Group B: 66.7%; P = 0.630), complications (Group A: 46.4% vs. Group B: 31.4%; P = 0.226) and revisions (Group A: 25% vs. Group B: 9.8%; P = 0.102). Superior and anteroinferior plating result in high bone union rates and good clinical outcomes with similar rates of plate removal., (© 2021. The Author(s).)