Journal of Shoulder and Elbow Surgery

Cortical Button and Suture Anchor Fixation for Distal Biceps Tendon Repair Provide Similar Clinical Outcomes and Complication Profiles: A Systematic Review

2026-08-13

Distal biceps tendon ruptures in active adults are repaired surgically, with cortical button and suture anchor fixation among the most frequently used implants. This study aimed to systematically review and compare functional outcomes and complication profiles of cortical button versus suture anchor fixation in distal biceps tendon repair.

Evaluation of Acid Production as a Metabolic Phenotype in Cutibacterium acnes Shoulder Periprosthetic Joint Infections

2026-08-13

Cutibacterium acnes (C. acnes) is the most frequently isolated organism in shoulder periprosthetic joint infection (PJI), yet distinguishing contamination from infection remains challenging. Current diagnostic frameworks rely on culture positivity and consensus criteria but provide limited insight into bacterial metabolic activity. Since C. acnes produces short-chain fatty acids influencing host inflammation, acid production may represent a relevant metabolic phenotype beyond simple biomass.

Posterior Translation of the Humeral Head after Arthroscopic Bankart Repair: A Quantitative Analysis of Preoperative and Postoperative Axial MRI

Sang-Pil So, Hyun-Gyu Seok, In-Ho Jeon — 2026-08-13

Anterior shoulder instability leads to anterior humeral head translation on static axial imaging. While arthroscopic Bankart repair restores stability, its quantitative impact on static humeral head translation remains unclear. This study aimed to compare static anteroposterior translation of the humeral head on axial magnetic resonance imaging (MRI) before and after arthroscopic Bankart repair and identify independent factors influencing these translations and their magnitude of change.

Metabolic Bone Disease Care Practice Patterns and the Correlation Between Computed Tomography and Fracture Risk Assessment Tool Score in Patients Undergoing Total Shoulder Arthroplasty

Zhaorui Wang, Jesse King, Anthony Prentice, William Aibinder — 2026-08-12

Periprosthetic fracture following total shoulder arthroplasty (TSA) is a devastating complication. Metabolic bone disease has been shown to increase the incidence of fracture. However, the state of metabolic bone care in this population is poorly studied. The purpose of this study is to elucidate the state of metabolic bone care in patients undergoing TSA. We also aim to study the association between computed tomography (CT) derived Hounsfield unit (HU) measurements and Fracture Risk Assessment Tool (FRAX) scores in this population.

Anatomic Total Shoulder Arthroplasty with the Tornier Perform Posterior Augmented Glenoid versus Reverse Total Shoulder Arthroplasty for the Treatment of Walch B2 and B3 Glenoids: A Propensity Score Matched Analysis

2026-08-12

Addressing posterior glenoid deficiency in glenohumeral osteoarthritis (GHOA) with an intact rotator cuff remains contentious among shoulder surgeons. Both reverse total shoulder arthroplasty (rTSA) and anatomic total shoulder arthroplasty (aTSA) with an all-polyethylene posterior augmented glenoid (PAG) are viable options for GHOA with eccentric posterior wear, but aTSA with a PAG has not been directly compared to rTSA in this population. This study compares clinical outcomes of aTSA with a PAG to rTSA in patients with GHOA and Walch B2 or B3 glenoids.

Locking Plate Fixation with Cemented Screws versus Delta Xtend Reverse Shoulder Arthroplasty for Complex Proximal Humerus Fractures in the Elderly: A Matched-Pair Comparative Study

2026-08-12

Due to the high complication rates associated with open reduction and internal fixation using locking plates (ORIF-LP) for complex proximal humerus fractures (PHFs) in elderly patients, many authors consider reverse shoulder arthroplasty (rTSA)the treatment of choice. However, the use of cemented screws in locked plating (ORIF-LPc) has been suggested to reduce implant-related complications. The aim of this matched-pair study was to compare clinical and radiographic outcomes, complication and revision surgery rates in patients older than 65 years with complex PHFs treated with cement-augmented locking plate fixation or reverse shoulder arthroplasty.

Spin in Systematic Reviews on Patch-Augmented Rotator Cuff Repair: Prevalence, Predictors, and Methodological Implications

2026-08-12

Rotator cuff tears are a major cause of shoulder pain and dysfunction, and surgical repair is often complicated by the risk of retear, especially in patients with large, massive, revision tears and high-risk patients. Biologic or synthetic patch augmentation has emerged to reinforce repair and potentially reduce retears. Despite many systematic reviews and meta-analyses on patch-augmented versus non-augmented repair, concerns remain regarding study heterogeneity, outcome variability, and spin in interpretation and reporting, particularly in abstracts.

Risk Factors for instability and dislocation after reverse total shoulder arthroplasty: a systematic review

Noa Ulenberg, Stephanie Herbstreit, Marcel Dudda, Carsten Vogel, Bastian Mester — 2026-08-07

The number of reverse total shoulder arthroplasties has increased due to demographic changes, leading to more revision surgeries. Postoperative instability or dislocation is a frequent and challenging complication that impairs clinical outcomes. This study aimed to identify risk factors for instability following reverse total shoulder arthroplasty and to evaluate the underlying mechanisms described by Abdelfattah et al.

Modified Partial Radial to Axillary Nerve Transfer as the Index Procedure for Isolated Axillary Nerve Injury

2026-08-07

In patients with an isolated axillary nerve injury, when an appropriate donor radial nerve branch can be identified, partial radial-to-axillary nerve transfer as the index treatment procedure offers the possibility of significantly improving shoulder motion and functional strength, without detectable donor-site morbidity. Furthermore, the opportunity for meaningful functional improvement was observed even in patients treated with surgery beyond 6 months from the time of nerve injury and correlated with the observed persistence of deltoid MEPs at later time points.

Gärtner Type and Outcomes After US PAL Versus Arthroscopic Debridement for Calcific Tendinitis: A Retrospective Cohort Study

Yunfeng Mi, Bo Jiang, Shaowei Pan, Xuewen Jia, Yinfeng Hu — 2026-08-06

To compare the efficacy of US-PAL and AD for calcific tendinitis stratified by Gärtner type, addressing whether calcification morphology influences treatment response—a question prior randomized trials were not designed to answer.

RADIOLOGICAL AND CLINICAL OUTCOMES OF TWO DESIGNS (ANATOMIC RADIAL HEAD SYSTEM® AND ALIGN®) OF PRESS-FIT ANATOMIC RADIAL HEAD ARTHROPLASTY FOR ACUTE ELBOW TRAUMA

2026-08-06

Risk of Shoulder/Elbow Injuries and Imaging Abnormalities in Female Collegiate Baseball and Softball Players

Yuka Tsukahara, Erika Jyoto, Rie Sato — 2026-08-06

Shoulder and elbow injuries are common in overhead-throwing players; however, limited data exist regarding injury prevalence and imaging abnormalities among female collegiate baseball and softball players, particularly in relation to early sport participation.

The biomechanics of the sternoclavicular joint: an experimental and computational study

Talal Bin Irshad, Giulia Pascoletti, Elisabetta M. Zanetti — 2026-08-06

This study aims to thoroughly investigate the biomechanics of the sternoclavicular joint (SCJ), a key component of the shoulder complex.

Clinical impact of scapular stress fracture after reverse total shoulder arthroplasty: a single-center propensity score–matched analysis

By Chul-Hyun Cho, Hyuk-Joon Sohn, Du-Han Kim — 2026-08-06

Scapular stress fracture (SSF) is a recognized complication after reverse total shoulder arthroplasty (rTSA), yet its clinical impact remains controversial. This study aimed to determine the incidence of SSF after rTSA, compare outcomes with a 1:3 propensity score-matched control group, and evaluate the influence of fracture location, treatment modality, and radiographic union on clinical outcomes.

The impact of glenoid polyethylene type, humeral head size and composition on revision risk following primary anatomic total shoulder arthroplasty for osteoarthritis

David R.J. Gill, Sophia Corfield, Madeline McCau, William G. Blakeney — 2026-08-06

Glenoid loosening and polyethylene wear remain leading causes of failure after anatomic total shoulder arthroplasty (aTSA). The introduction of highly cross-linked polyethylene (XLPE) aims to reduce wear and improve implant longevity. Humeral head size and its composition (metal or ceramic) may influence glenoid wear patterns, yet its interaction with polyethylene type (XLPE vs non-XLPE) on revision risk has not been well defined. The study aim was to determine the effect of humeral head size and composition on revision risk in primary aTSA and to assess whether this relationship differs by polyethylene type.

Outcomes of Implant Removal After Failed Radial Head Arthroplasty:An Average 7-Year Follow-up Study

2026-08-05

Failure of radial head implants secondary to loosening, painful capitellar wear and other reasons is not uncommon. When radial head implants fail, the relative indications for implanting a new radial head implant versus implant removal with or without soft-tissue interposition remain unclear. Removal theoretically reduces the risk of radiocapitellar pain, however, little is known about the outcomes following removal of failed radial head replacements. The purpose of this study was to evaluate the outcomes, complications, and rates of proximal radioulnar impingement pain following removal of failed radial head implants.

Introduction of a Journal of Shoulder and Elbow Surgery manuscript processing fee

John E. (Jed) Kuhn, William J. Mallon — 2026-08-01

The American Shoulder and Elbow Surgeons (ASES) published the inaugural issue of the Journal of Shoulder and Elbow Surgery (JSES) in January 1992. Over the past 34 years, research in shoulder and elbow surgery has expanded dramatically, reflecting the rapid growth and maturation of our specialty. As the field has evolved, so too has JSES, which has grown from a single journal into a family of five publications: JSES, JSES International, Journal of Shoulder and Elbow Arthroplasty, JSES Reviews, Reports, and Techniques, and the newly launched JSES Sports Performance Rehabilitation & Therapy.

Superior Internal Rotation after Anatomic vs. Reverse Shoulder Arthroplasty Performed with Lesser Tuberosity Osteotomy

2026-07-31

Recent studies report superior internal rotation (IR) and lower anterior shoulder pain after anatomic total shoulder arthroplasty (aTSA) compared to reverse total shoulder arthroplasty (rTSA) for cuff-intact osteoarthritis. However, these differences may reflect variations in subscapularis management rather than implant design, as lesser tuberosity osteotomy (LTO) is routinely performed during aTSA but less commonly during rTSA. This is an important distinction given the higher healing rates after LTO and impact of subscapularis healing on IR after rTSA.

Infraspinatus Advancement via Remplissage Improves Dynamic Anterior Stability but Reduces External Rotation Moment Arm: A Computational Study

2026-07-30

The addition of remplissage to arthroscopic Bankart repair has demonstrated meaningful decreases in recurrent instability. Mechanisms for its effectiveness have been proposed but not validated. Similarly, hypothetical concerns surrounding overconstraint of the shoulder with limitations of external rotation have not been demonstrated on a large scale. This computational study sought to quantify the change in force vector of the infraspinatus if incorporated into remplissage fixation, and the subsequent effect of that on anterior stability and external rotation.

Assessing the Usefulness of Diagnostic Shoulder Arthroscopy in Evaluating Painful Shoulder Replacement: A Retrospective Case Series

Joseph T. Lazzara, Benjamin A. Nwadike, Aaron G. Ofori-Kuragu, Randall J. Otto — 2026-07-30

Persistent pain after total shoulder arthroplasty or reverse shoulder arthroplasty is challenging to evaluate when conventional imaging, laboratory testing, and joint aspiration are inconclusive. The purpose of this study was to evaluate the diagnostic utility of shoulder arthroscopy in identifying infectious and mechanical causes of pain and to assess its impact on subsequent management decisions.

Short Term Results of Structural Bone Grafting of Glenoid Defects in Reverse Total Shoulder Arthroplasty: A Systematic Review/Meta-analysis of Implant Design and Graft Characteristics

2026-07-30

Severe glenoid bone defects can compromise stable baseplate fixation in reverse total shoulder arthroplasty (rTSA). Although structural bone grafts are advocated, reported results are mixed and raise concerns. The purpose of this systematic review was to compare structural bone graft types and glenoid baseplate designs for glenoid reconstruction in primary and revision rTSA to better understand which grafts and designs lead to better outcomes in terms of graft incorporation, glenoid baseplate loosening and reoperation.

Total Shoulder Arthroplasty and Scapulohumeral Rhythm: The clinical impact of achieving native shoulder mechanics

2026-07-30

Scapulohumeral rhythm (SHR) is a foundational metric of shoulder biomechanics and represents the ratio of humeral to scapular contributions during shoulder motion. SHR has been studied across physiologic, pathologic, and postoperative states, including following total shoulder arthroplasty (TSA). The clinical relevance of scapular contribution remains incompletely defined. Patient reported outcome measures (PROMs), including visual analogue scale (VAS), single assessment numeric evaluation (SANE), and American Shoulder and Elbow Surgeon (ASES) scores, provide valuable insight for clinical decision making, treatment comparisons, and optimization of patient care.

Shoulder Injury and Surgery Patterns Among Astronauts Across Spaceflight Phases and Mission Operations: An Analysis of 677 Injuries from 1981 to 2024

2026-07-29

Shoulder injuries are the most frequently reported musculoskeletal condition among astronauts, occurring across all spaceflight mission phases. With rising extravehicular activity (EVA) demands, a detailed understanding of injury patterns is critical. Prior studies have linked prolonged microgravity exposure to post-flight shoulder pathology but have not comprehensively characterized large-scale epidemiologic trends, phase-specific timing, or the influence of cumulative training exposures. Therefore, this study aimed to: (1) characterize overall prevalence, identify the top 20 diagnoses, and report the 5 most common surgical procedures; (2) compare injury distributions across spaceflight phases, including a post-flight sub-analysis stratified by <6 versus ≥6 months of microgravity exposure; and (3) determine associations between Neutral Buoyancy Laboratory (NBL) and EVA exposure durations and injury timing.

Quality and Rate of Recovery after Simpliciti Anatomic Total Shoulder Arthroplasty and Tornier Pyrocarbon Hemiarthroplasty: A Propensity Score-Matched Comparative Study

2026-07-28

Simpliciti anatomic total shoulder arthroplasty (aTSA) and Tornier Pyrocarbon hemiarthroplasty (PyroC-HA) have been utilized with predictable benefit for the treatment of glenohumeral osteoarthritis (GHOA). The purpose of this study was to compare the rate of recovery and 2-year clinical outcomes in a matched group of patients undergoing these procedures.

Proximal Humerus Fractures Treated with Single or Dual-Plate Constructs: A Comparison of Clinical Outcomes

2026-07-27

Proximal humerus fractures (PHF) are common injuries in the adult population. Open reduction internal fixation (ORIF) still represents the most common treatment for reconstructable injuries. Despite the continued prevalence of ORIF, studies have demonstrated fixation failure ranging from 11% to 18% and a reoperation rate of up to 27%.1 Dual plating is an emerging technique that has been noted to enhance fracture fixation. There is only one comparative study examining the outcomes of isolated locked plating versus dual plating.

Can Total Elbow Arthroplasty Effectively Treat Post-traumatic Sequelae After Proximal Ulna or Radius Fracture and Fracture-Dislocations?

2026-07-27

In the United States, more than 50% of total elbow arthroplasties (TEA) are performed for acute trauma or post-traumatic sequelae. Outcomes of TEA performed for distal humerus fracture or nonunion have been well-documented; however less is known regarding outcomes of TEA for sequelae of complex proximal ulna or radius fractures. This study aimed to (1) identify operative considerations and outcomes and (2) determine TEA survivorship when performed for post-traumatic sequalae after proximal ulna or radius fracture or fracture-dislocation.

Lower Postoperative Geriatric Nutritional Risk Index Is Associated with Increased Complications and Reoperations Following Shoulder Arthroplasty

2026-07-26

Nutritional status influences postoperative recovery and complication risk across orthopedic procedures, yet its role in shoulder arthroplasty remains poorly defined. The purpose of this study was to evaluate whether postoperative Geriatric Nutritional Risk Index (GNRI) is associated with complications and outcomes following total shoulder arthroplasty (TSA).

Does Teres Minor Trophicity Affect Outcomes After Arthroscopically-Assisted Lower Trapezius Tendon Transfer in Irreparable Posterosuperior Rotator Cuff Tears?

Chang Hee Baek, Bo Taek Kim, Jung Gon Kim, Chaemoon Lim, Seung Jin Kim — 2026-07-26

The influence of teres minor (Tm) trophicity on outcomes after arthroscopically-assisted lower trapezius tendon (LTT) transfer for irreparable posterosuperior rotator cuff tears (PSRCTs) remains unclear. This study evaluated whether preoperative Tm trophicity affects postoperative pain, function, and range of motion (ROM).

Region-specific evaluation of Hounsfield units on elbow computed tomography as a predictor of osteoporosis in patients at risk

2026-07-26

Assessment of osteoporosis is crucial for favorable outcomes after trauma surgery, but a formal dual energy X-ray absorptiometry (DXA) scan may not be available preoperatively. The aim of the present study was to assess standardized measurements of Hounsfield units (HU) on computed tomography (CT) images of the elbow as a predictor for the presence of osteoporosis.

Response to Cromer and Alkabbani regarding: “GLP-1 agonist use increases the incidence of adhesive capsulitis and odds of requiring operative management in type 2 diabetes patients: a matched propensity score analysis”

2026-07-17

We thank the authors for their thoughtful comments regarding our study and for highlighting important principles in pharmacoepidemiologic research. We agree that target-trial emulation, clearly defined cohort entry, new-user designs, and active comparators are valuable methods when the objective is to estimate the causal effect of initiating one medication vs. another.

Dynamic analysis of nerves around the elbow using magnetic resonance imaging-derived three-dimensional modeling

Takenori Saeki, Yukimi Murakami, Hiroaki Iwase, Michiro Yamamoto — 2026-07-16

We are developing an elbow arthroscopy system that overlays three-dimensional (3-D) nerve and bone information in real time by means of augmented reality technology. The aims of this study were: (1) to extract 3-D bone and nerve data from elbow magnetic resonance imaging (MRI) scans obtained in multiple volunteers, (2) to generate an averaged 3-D model of perielbow nerves, and (3) to analyze nerve kinematics during flexion and extension.

Effect of Combined Tendon Remnant Preservation and Bone Marrow Stimulation on Rotator Cuff Healing: A Propensity Score–Matched Study

2026-07-16

Arthroscopic rotator cuff repair provides satisfactory functional results. However, imaging studies show a high healing failure rate. Recent studies on animal models evaluated the effect of preserving the tendon remnant of the rotator cuff on tendon healing, showing a positive impact by combining tendon remnant preservation and small bone vents on the greater tuberosity. The study aimed to evaluate the efficacy of a combined biologic augmentation technique consisting of tendon remnant preservation on the rotator cuff footprint and bone marrow stimulation of the greater tuberosity.

Development of convolutional neural networks for classification and characterization of proximal humerus fractures on computed tomography

2026-07-16

Agreement between surgeons on classification, characterization and choice of treatment for proximal humerus fractures (PHFs) is poor, leading to subjective surgical decision-making and poor intersurgeon reliability. Machine learning for classification and characterization of PHFs on radiographs performed insufficiently. More detailed three-dimensional configuration of PHFs on computed tomography (CT) scans may improve performance. This study aimed to 1) develop and internally validate a convolutional neural network on CT scans, 2) externally validate the model, and 3) compare characterization performance with orthopedic surgeons.

Methodological considerations in pharmacoepidemiologic analyses of real-world data

Sara J. Cromer, Wajd Alkabbani — 2026-07-16

We read with interest the article by Dr. Bergstein et al regarding the association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and adhesive capsulitis.2 The authors reported that GLP-1RA use was associated with higher odds of operative management for adhesive capsulitis compared with non-use (odds ratio [OR] 1.18), including higher odds of manipulation under anesthesia (OR 1.20), while no significant association was observed for capsular release (OR 0.68). However, several methodological concerns warrant caution in the interpretation of these findings.

Multiplanar CT-based characterization of offset and positional change in reverse shoulder arthroplasty and validation of radiographic metrics

Alexander J. Vervaecke, Olivier Verborgt, Jean-David Werthel — 2026-07-15

Accurate quantification of lateralization and distalization in reverse total shoulder arthroplasty (rTSA) is essential for optimizing planning and outcomes. Angular radiographic parameters such as the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are widely used and distance-based ratios, including the lateralization index (LI) and distalization index (DI) have recently been introduced. However, the validity of radiographic metrics reflecting implant position and pre- to postoperative positional changes remains unclear.

Evaluation of spin bias in systematic reviews and meta-analyses comparing Bankart repair with remplissage versus the Latarjet procedure

2026-07-15

Anterior shoulder instability is common in young, active patients and, when managed surgically, is typically treated with either Bankart repair with remplissage or a bony procedure such as Latarjet. Both procedures have demonstrated favorable clinical outcomes, but differences in recurrent instability, complications, functional outcomes, and return-to-sport rates continue to be debated. In the setting of ongoing clinical equipoise and heterogeneous evidence, systematic reviews and meta-analyses may help guide treatment decisions.

Early electromyography-based low supraspinatus activity exercises after arthroscopic repair of medium-sized rotator cuff tears: a randomized controlled trial

Gamze Kuş, Derya Çelik, Ata Can Atalar — 2026-07-15

Post-operative rehabilitation after arthroscopic rotator cuff repair remains controversial because early mobilization may compromise tendon healing and increase re-tear risk, leading many clinicians to prefer prolonged immobilization. Exercises associated with low supraspinatus muscle activity may enable earlier rehabilitation while minimizing stress on the repaired tendon. The aim of this study to investigate the effects of an electromyography (EMG) based early rehabilitation program consisting of low supraspinatus muscle activity exercises compared with a 4-week immobilization protocol following arthroscopic repair of full-thickness, medium-sized rotator cuff tears.

Triceps-sparing approach results in a better elbow function than a triceps-detaching approach in total elbow arthroplasty: a multicenter prospective cohort study

2026-07-15

New surgical approaches have been developed to optimize functional outcomes after total elbow arthroplasty (TEA). Historically, the triceps-detaching approach was predominantly used, involving partial release of the triceps tendon to improve surgical exposure, at the cost of a higher risk of post-operative extensor weakness. More recently, there has been a shift toward triceps-sparing techniques, in which the triceps tendon is preserved at the cost of limited articular visibility, possibly risking component malalignment.

Higher body weight and current smoking are associated with lower concentrations of perioperative antibiotic prophylaxis in the synovial fluid of the shoulder joint

2026-07-15

Surgical site infections are a clinically relevant complication in orthopedic surgery, and administration of perioperative antibiotic prophylaxis has been shown to reduce infection rates. This study aimed to identify influencing factors on the concentration of unbound cefazolin in shoulder synovial fluid, following the perioperative antibiotic prophylaxis administration of 2 g of cefazolin during shoulder surgery.

Clinical outcomes following arthroscopic pectoralis minor release

2026-07-15

Pectoralis minor syndrome (PMS) may produce scapulothoracic abnormal motion and associated neurogenic thoracic outlet syndrome (nTOS) which are under-recognized causes of shoulder dysfunction. The etiologies of these conditions have been attributed to congenital shortening or abnormal anatomy, acquired shortening and fibrosis, or muscular hyperactivity of the pectoralis minor (PMi). Our hypothesis is that arthroscopic PMi release for PMS and nTOS is safe and effective. Our secondary hypothesis is that anomalous PMi insertional anatomy is higher in this patient cohort.

Computerized branching logic systems significantly improve the accuracy of ASES scores for patients with bilateral shoulder pain undergoing shoulder arthroplasty

Maria Bozoghlian, Joseph Galvin, Edward Rojas, Brendan M. Patterson — 2026-07-14

The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score is widely used to determine functional outcome following shoulder arthroplasty. There is, however, limited guidance on efficient and accurate collection methods of the ASES score for patients with bilateral shoulder pathology. We developed a branching logic system to improve ASES score collection accuracy. The purpose of this study was to analyze ASES scores for patients who had undergone shoulder arthroplasty and subsequently presented with contralateral shoulder pain within 1 year after surgery, before and after the implementation of a branching logic system.

Antibiotic Elution from PMMA Over 60 Days: an in vitro Study of 21 antibiotic combinations against C. acnes and Coagulase Negative Staph. (CNS)

Matthew J. DiPaola, Michael Carinha, Umar Masood, John Crane — 2026-07-14

Periprosthetic Joint Infection (PJI) of the shoulder differs from that of other joints due a prevalence of C. acnes and Coagulase Negative Staph. The ideal antibiotic combination for 2-stage revision is not fully known. The purpose of this study was to evaluate numerous different antibiotic eluates over a 60 day period against multiple strains of common pathogens found in shoulder PJI.

Quantitative assessment of ulnohumeral instability after K-NOW unlinked total elbow arthroplasty using the helical axis: a pilot study

2026-07-14

Unlinked total elbow arthroplasty (TEA) is designed to mimic physiological kinematics and reduce stress at the bone-implant interface, yet postoperative instability remains a significant concern. The helical axis (HA) represents three-dimensional joint motion (rotation and translation) as a single axis, offering a potential tool to quantify joint laxity. This study aimed to evaluate and compare the kinematics of healthy elbows and those following unlinked TEA (K-NOW prosthesis) using the HA to quantify postoperative instability.

In silico biomechanical performance of inlay vs. onlay glenoid implants in total shoulder arthroplasty: a finite element study

Sushil Chapai, Utpal Dhar, Derek Francis Papp, Chi-Tay Tsai, Anthony Miniaci — 2026-07-14

While total shoulder arthroplasty (TSA) provides long-lasting relief for many patients, glenoid loosening remains one of the most common reasons for TSA failure and can lead to revision surgery in the mid- to long-term. Some studies show better biomechanical performance of inlay glenoid components over onlay glenoid components, indicating that onlay glenoid components have a higher chance of loosening. Clinical studies suggest better longevity of inlay implants vs. onlay glenoid designs when considering both concentric and eccentric glenoid bone loss situations.

Evaluation of radiograph parameters used to assess prosthetic overlengthening in radial head arthroplasty

2026-07-04

Radiographic landmarks, such as the lateral ulnohumeral joint space (LUHJ) and the proximal edge of the lesser sigmoid notch (SN), are intra-operative parameters used to evaluate radial head prosthetic overlengthening. This study aims to evaluate the reliability of the LUHJ and SN as radiographic parameters to assess radial head prosthetic overlengthening. We hypothesize that the SN is a more reliable radiographic landmark compared with the LUHJ for diagnosing prosthetic radial head overlengthening.

Prediction of acromial and scapular spine fractures after reverse total shoulder arthroplasty using machine learning: a retrospective cohort study

2026-07-03

Acromial and scapular spine fractures (ASSF) are an uncommon but significant complication following reverse total shoulder arthroplasty (rTSA). The study aims were to (1) determine the incidence and type of ASSF captured within a local shoulder arthroplasty registry, (2) develop a novel, interpretable machine learning model to predict individual risk of fracture after rTSA, and (3) assess model performance variation based on implant design.

Simultaneous versus staged bilateral shoulder replacement: a matched cohort study

Gabriel Pina, Juan David Lacouture, Brendan Y. Shi, Pascal Boileau — 2026-07-03

The safety and value of performing simultaneous bilateral shoulder arthroplasty (SimBA) remains unclear. In this retrospective single-center matched-cohort study, we investigated the safety and clinical outcomes after simultaneous versus staged bilateral shoulder arthroplasty.

The Humeral Bone Loss (HUMBL) classification identifies patterns of humeral bone loss associated with various revision, instability, and humeral loosening rates in primary and revision shoulder arthroplasty

2026-07-03

Humeral Bone Loss (HUMBL) is commonly encountered in primary and revision shoulder arthroplasty and can lead to complications including humeral loosening or instability. The HUMBL classification categorizes bone loss into 5 major patterns of increasing severity: 1) Intact/No substantial bone loss (including bone compromised by prior implants/hardware or abnormal bone quality) 2) isolated greater tuberosity loss or compromise (including acute fracture, nonunion and malunion) 3) segmental bone loss (bone loss distal to the surgical neck) 4) ectatic bone loss (expansion of the cortex compared to an intact segment) and 5) humeral discontinuity (separation of the humeral shaft from a prior implant or where a new implant would be placed).

Response to Chen and Wang: Clarifying patient follow-up in a cohort study of testosterone levels and adhesive capsulitis

Zina Smadi, Joseph A. Abboud — 2026-07-03

We appreciate the opportunity to respond to the letter by Drs Chen and Wang regarding our article, “Testosterone Levels and Risk of Adhesive Capsulitis: A 1:1 Propensity-Matched Analysis”.1 We thank the authors for their interest in our work and for their efforts to replicate our methodology. We have added the follow-up as a “visit at minimum of 5 years post the lab draw.”

Assistant experience enhances the learning curve in reverse total shoulder arthroplasty: a comparative cumulative sum analysis of 3 surgeons

2026-07-02

Reverse total shoulder arthroplasty (rTSA) is an established treatment for cuff tear arthropathy, irreparable rotator cuff tears, and advanced glenohumeral osteoarthritis. However, despite advances in implant design and preoperative planning, rTSA remains technically demanding during early experience, and the influence of assistant experience on learning curves is unclear.

Factors associated with poor outcomes for female patients undergoing total shoulder arthroplasty

2026-06-25

Numerous studies have demonstrated gender disparities in outcomes following total shoulder arthroplasty (TSA), with female patients typically having inferior outcomes. However, the current literature has yet to elucidate exactly why female patients have inferior outcomes. The aim of this study was to determine demographic and clinical differences between women with better and worse outcomes following TSA.

Letter to the Editor regarding Torrens et al: “Three-week immobilization vs. no immobilization in primary reverse total shoulder arthroplasty: a randomized controlled trial”

Kunal Mohan, Mohamed A. Imam, Ali A. Narvani — 2026-06-25

We would like to congratulate the authors1 on their prospective randomized controlled trial evaluating 3-week immobilization vs. no immobilization following primary reverse total shoulder arthroplasty (rTSA) for cuff-deficient shoulders. This study contributes valuable evidence to the discussion on optimal postoperative management. Their overall study methodology was robust, standardizing implant selection and follow-up across both study groups following appropriate patient randomization. Pain was assessed using the visual analog scale (VAS) across multiple early and late time points, and functional outcomes were measured using the Constant score at 12 and 24 months.

Response to Mohan et al regarding: “Three-week immobilization vs. no immobilization in primary reverse total shoulder arthroplasty: a randomized controlled trial”

Carlos Torrens, Claudia González-García, Marta Díez-Izquierdo, Fernando Santana — 2026-06-24

On behalf of the coauthors, I have the privilege to respond this letter to the Editor.

Is there a long-term benefit to use patient-specific guides for glenoid implant positioning in anatomic total shoulder arthroplasty? A comparative study at minimum 10 years

2026-06-23

The efficacy of patient-specific guides (PSGs) in improving accuracy and reducing the number of outliers in glenoid implant positioning in anatomic total shoulder arthroplasty (aTSA) has been clearly shown. However, long-term clinical benefit in terms of outcomes, revision rates, and patient satisfaction remains unproven. Our purpose was to compare the long-term clinical and radiographic outcomes of 2 aTSA groups, with or without the use of a PSG, for glenoid implant positioning.

Morphologic analysis of the scapula in healthy and osteoarthritic subjects

2026-06-23

While glenoid morphology in primary glenohumeral osteoarthritis (OA) has been extensively studied, less is known about differences in global scapular morphology. The purpose of this study was to identify three-dimensional morphologic differences of the scapula between healthy shoulders and shoulders with primary OA, and between Walch type A and type B glenoids.

Impact of severity of allergy to β-lactam antibiotics on the perioperative use of cephalosporins and revision rates following total shoulder arthroplasty

Dario Fucich, Swara Kalva, Tej Joshi, Arthur Perry, Jie J. Yao, Mandeep S. Virk — 2026-06-23

Prosthetic joint infection (PJI) after total shoulder arthroplasty (TSA) is a devastating complication. Cephalosporins are considered the standard of care for antibiotic prophylaxis during TSA procedures; however, reported β-lactam allergies may result in the use of less effective alternatives that are associated with higher infection and complication rates. The aim of this study is to evaluate the relationship between reported β-lactam allergies, antibiotic choice, and revision rates in TSA.

“Am I too old for a shoulder replacement?” The association between age and comorbidities on the outcomes following reverse shoulder arthroplasty

Olivia O'Malley, Andrew Davies, Amar Rangan, Sanjeeve Sabharwal, Peter Reilly — 2026-06-23

Reverse shoulder arthroplasty (rTSA) is increasingly performed in elderly patients; however, the influence of advancing age and comorbidity on revision, medical complications, and mortality remains poorly defined. This study aims to use population reflective data in the National Joint Registry to assess the outcomes of those ≥80 year old having an rTSA.

Incidence of lower extremity deep vein thrombosis following arthroscopic rotator cuff repair

2026-06-23

Lower extremity deep vein thrombosis (DVT) is one of the primary causes of pulmonary embolism, a serious postoperative complication of orthopedic surgery. The true incidence of venous thromboembolism, including asymptomatic DVT, after arthroscopic rotator cuff repair (ARCR) remains unclear. This prospective study aimed to investigate the incidence of lower extremity DVT after ARCR, evaluate perioperative D-dimer changes, and identify DVT risk factors.

The global glenoid component inclination: why scapulothoracic orientation should be considered when defining glenoid component inclination in reverse total shoulder arthroplasty

2026-06-23

In reverse total shoulder arthroplasty (rTSA), glenoid component inclination critically influences complications and implant performance. Current literature predominantly advocates for neutral or 0° inclination referenced to the supraspinatus fossa in order to avoid superior tilt which may lead to loosening. However, the influence of resting scapular rotation (RSR) on the effectively obtained inclination relative to the global reference system (gravity) remains poorly defined. This study aims to address this gap by evaluating the impact of RSR on global glenoid component inclination following rTSA.

Thirty-six months of experience and 30° of hip internal rotation as critical thresholds for capitellar osteochondritis dissecans in youth baseball players

Toshiki Kamiya, Makoto Nagasawa, Tomomi Oota, Takuya Tajima, Naosuke Kamei — 2026-06-22

Capitellar osteochondritis dissecans (OCD) is a serious throwing injury that can lead to long-term elbow dysfunction. While a longer duration of competitive play is a suspected risk factor, no specific cutoff value has been established to identify players at high risk.

Influence of age-related bone density changes on primary stability in stemless shoulder arthroplasty: a multi-implant finite element study

2026-06-18

Stemless implants were introduced to prevent some of the stem-related complications associated with the total shoulder arthroplasty. Although general requirements for receiving these implants include good bone quality conditions, little knowledge exists about how bone quality affects implant performance. The goal of this study was to evaluate the influence of age-induced changes in bone density, as a metric of bone quality, in the primary stability of five anatomic stemless shoulder implants using three-dimensional finite element (FE) models.

Evaluation of new normal after shoulder arthroplasty: comparison of anatomic vs. reverse total shoulder arthroplasty

Casey M. Beleckas, Daniel F. Schodlbauer, Albert D. Mousad, Jonathan C. Levy — 2026-06-18

Reports of equivalent patient-reported outcomes between anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) have contributed to a continued preference of rTSA. Although many surgeons believe that the best aTSA outcome can outperform the best rTSA outcome, this has not yet been demonstrated in the literature. The purpose of this study is to investigate the outcome characteristics of aTSA and rTSA patients who perceive that their shoulder is close to normal, with the hypothesis that aTSA patients will outperform rTSA patients.

Acromial stress fractures and reactions after reverse total shoulder arthroplasty: a case-control study

Feoline Wiemer, Jennifer A. Coghlan, Simon N. Bell — 2026-06-17

Acromial stress fractures can occur after reverse total shoulder arthroplasty (rTSA). We performed this study to assess the incidence, risk factors, characteristics, and outcome of acromial stress fractures and reactions after rTSA.

Stemless anatomic and reverse shoulder arthroplasty in patients under 55 years of age with primary glenohumeral osteoarthritis: an analysis of the Australian Orthopedic Association National Joint Replacement Registry at 5 years

2026-06-17

Primary glenohumeral osteoarthritis in young patients poses challenging treatment decisions. Arthroplasty options have different failure profiles and implant survivorship patterns. This registry study aims to analyze the cumulative per cent revision (CPR) rate of different types of arthroplasties conducted for primary osteoarthritis in patients below 55 years of age.

Long-term outcomes of reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humerus fractures in elderly patients: results from a prior randomized clinical trial

2026-06-17

Proximal humerus fractures (PHFs) are among the most common fractures in elderly patients, yet there is insufficient evidence from randomized controlled trials (RCTs) to determine the most appropriate interventions for their management. This study presents the long-term results of the first prospective RCT comparing surgical treatment with reverse shoulder arthroplasty (RSA) versus nonoperative treatment in displaced PHFs in elderly patients.

B2 and B3 glenoid osteoarthirtis: outcomes of corrective and concentric (C2) reaming of the glenoid combined with pyrocarbon hemiarthroplasty

Riccardo Ranieri, Caroline Cointat, Juan-David Lacouture-Suarez, Pascal Boileau — 2026-06-17

Posterior humeral subluxation (PHS) in B2 and B3 glenoid is a cause of asymmetric long-term stress on the glenoid and the potential reason for glenoid loosening in anatomic total shoulder arthroplasty and painful glenoid erosion in hemiarthroplasty with metallic heads. We hypothesized that corrective and concentric (C2) reaming of the glenoid associated with pyrocarbon hemiarthroplasty (HA-PYC) could improve the centering of the humeral head and decrease the risk of persistent painful glenoid erosion in young and active patients with B2 and B3 glenoid.

Long-term (minimum 10 years) survival and outcomes of pyrocarbon interposition shoulder arthroplasty

2026-06-17

There are some major controversies surrounding the use and longevity of pyrocarbon interposition shoulder arthroplasty (PISA). The objective of this study was to investigate the long-term survival and outcomes (minimum 10-year) following PISA for osteoarthritis (OA) in young and active patients.

Adjunctive hybrid telerehabilitation is associated with comparable clinical outcomes to in-person physical therapy after shoulder arthroplasty and arthroscopic rotator cuff repair: a cohort study

2026-06-16

We hypothesized that hybrid telerehabilitation, delivered as an adjunct to standard in-person physical therapy (PT), would demonstrate similar improvements in functional scores, pain, and range of motion compared with traditional PT, while reducing PT utilization in patients undergoing shoulder arthroplasty and arthroscopic rotator cuff repair (RCR).

Effect of an atelocollagen-loaded hyaluronic acid-based porous scaffold on healing in a rabbit model of chronic rotator cuff tear

2026-06-16

High re-tear rates following rotator cuff repair are largely due to poor tendon-to-bone healing and fibrotic tissue formation. Hyaluronic acid (HA) and atelocollagen have demonstrated potential for improving tendon healing, but their injectable forms suffer from rapid diffusion and limited retention at the repair site. We hypothesized that an atelocollagen-loaded HA porous scaffold would demonstrate excellent structural, mechanical, and biological properties in vitro and promote superior tendon healing in a rabbit model of chronic rotator cuff tear.

Preclinical safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell medicinal product for rotator cuff repair: a two-phase experimental study

2026-06-16

Cell therapy with adipose-derived mesenchymal stem cells (ASCs) is a promising biological augmentation strategy for rotator cuff repair; however, before clinical translation, regulatory frameworks mandate rigorous preclinical characterization of safety. We report the complete preclinical program evaluating both the safety of an allogeneic ASC-based cell therapy medicinal product (CTMP) and its efficacy in a chronic rotator cuff tear model.

Inconsistencies in terminology used to describe reverse shoulder arthroplasty: a systematic review

Jean-David Werthel, Jules Descamps, Elyette Lugo, Howard Routman — 2026-06-15

Reverse total shoulder arthroplasty (rTSA) implant design has evolved substantially over the past decades, with numerous modifications affecting medialization, lateralization, and center of rotation (COR) geometry. Although these parameters are frequently discussed in the literature, the terminology used to describe rTSA design and configuration remains heterogeneous and inconsistently defined, limiting comparability across studies.

Propensity matched professional baseball pitchers with early trunk rotation demonstrate increased shoulder and elbow distractive forces with equivalent ball velocity

2026-06-11

Prior mixed cohort pitching biomechanic analyses have noted favorable pitching biomechanics and decreased throwing arm kinetics in pitchers with delayed trunk rotation.

Is there still room for conservative treatment of distal biceps tendon ruptures? What patients (and surgeons) should know? A case series with a mean 4-year follow-up

2026-06-11

Distal biceps tendon (DBT) ruptures are uncommon injuries that typically require surgical repair in patients with high functional demands. Nonoperative treatment is usually reserved for sedentary patients. Only a small number of studies with limited samples have investigated the outcomes of conservative treatment after DBT ruptures, and none have specifically assessed fatigue and pain. The aim of this study was to further characterize the mid-term outcomes of conservative treatment and quantify fatigue and pain at mid-term follow-up.

Clarifying patient follow-up in a cohort study of testosterone levels and adhesive capsulitis

Po-Yuan Chen, Joshua Wang — 2026-06-09

We enjoyed reading Smadi et al’s4 recently published TriNetX-based study which found an association between normal-high testosterone levels and an increased risk of adhesive capsulitis when compared to patients with low testosterone levels. While we commend the authors' innovative research question and their methodological transparency, we are concerned that there are issues related to patient follow-up which may bias the study's conclusions. According to the authors, patients were only included in the study if they had “a minimum of 5 years of follow-up after their labdraw”.

Toward a common definition of frozen shoulder: a scoping review of randomized controlled trials

2026-06-09

Frozen shoulder (FS) is a common condition characterized by pain and restricted range of motion (ROM); however, its definition varies widely across randomized controlled trials (RCTs). This variability in eligibility criteria may compromise comparability across studies and hinder evidence synthesis. In this scoping review, we aimed to systematically map how FS has been defined in RCTs and identify key elements requiring standardization.

All-suture anchors exhibit less perianchor fluid formation independent of healing quality compared with polyetheretherketone anchors in arthroscopic rotator cuff repair: a propensity score–matched comparative study

2026-06-09

Perianchor fluid collection may differ according to anchor material following arthroscopic rotator cuff repair (ARCR), but its relationship with tendon healing remains unclear. This study aimed to compare perianchor fluid collection between all-suture anchors (ASAs) and polyetheretherketone (PEEK) anchors following ARCR and to evaluate its relationship with tendon healing at mid-term follow-up.

Shoulder muscle adiposity can predict the efficacy of corticosteroid injections in treating adhesive capsulitis after rotator cuff repair surgery

2026-06-08

Shoulder stiffness is a common complication after rotator cuff repair (RCR) that may progress to adhesive capsulitis, impeding functional recovery. Although corticosteroid injections are frequently used, treatment response varies substantially across patients. This study investigated whether pre-operative fatty infiltration into shoulder musculature predicts corticosteroid injection efficacy in managing post-RCR adhesive capsulitis.

WITHDRAWN: Letter to Editor for “Clarifying patient follow-up in a cohort study of testosterone levels and adhesive capsulitis”

Zina Smadi, Joseph A. Abboud — 2026-06-06

This article has been withdrawn at the request of the author(s) and/or editor due to an error in the publishing process. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies-and-standards/article-withdrawal

Shoulder arthroplasty outcomes in hypertensive patients: a propensity score-matched comparison of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors

2026-06-04

Hypertension is a highly prevalent comorbidity among patients undergoing total shoulder arthroplasty (TSA), and angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are among the most commonly prescribed antihypertensive medications. Emerging evidence suggests that ARBs may confer musculoskeletal benefits, including improved bone quality and reduced fracture risk, compared with ACEIs. The purpose of this study was to evaluate the association between ARB vs. ACEI use and the risk of periprosthetic complications in hypertensive patients undergoing TSA.

Non-opioid pain management in younger patients undergoing arthroscopic glenoid labrum surgery: a randomized controlled trial

2026-06-04

Opioids are traditionally prescribed for postoperative pain management following arthroscopic glenoid labrum repair in young patients. Injudicious use has contributed to rising rates of dependence and overdose, and subsequent interest in opioid-sparing strategies. This study compared the efficacy of multimodal non-opioid to opioid-containing regimens for postoperative pain control in young patients undergoing arthroscopic labral repair.

Image-based quantitative osteotomy planning for congenital proximal radioulnar synostosis: plan–execution discrepancy and postoperative radiographic outcomes

2026-06-04

Proximal radioulnar synostosis is a rare congenital anomaly that restricts forearm rotation and significantly impairs daily function. Surgical correction typically involves radial osteotomy with shortening and derotation; however, planning of osteotomy level, bone shortening, and rotational correction remains largely subjective and relies heavily on surgeon experience. This study retrospectively evaluated an image-based quantitative planning framework designed to provide objective geometric parameters for osteotomy in congenital proximal radioulnar synostosis.

Stepwise loss of shoulder stabilizers induces humeral head migration and progression of cuff tear arthropathy in a rat model

2026-06-03

Cuff tear arthropathy (CTA) is a distinctive form of shoulder osteoarthritis characterized by superior migration of the humeral head, cartilage degeneration, synovitis, and subchondral bone collapse. Although deficiencies of the rotator cuff (RC), superior capsule, and long head of the biceps (LHB) tendon are clinically implicated in CTA, the relative contribution of each structure and the quantitative relationship between humeral head migration and joint degeneration remain unclear.

Operative timing predicts postoperative complications after staged reverse total shoulder arthroplasty

2026-06-03

The optimal timing between staged bilateral reverse total shoulder arthroplasty (rTSA) is unknown. Here we sought to identify the association between interprocedural time and risk of surgical complications.

Monocyte chemoattractant protein-1 exacerbates diabetic rotator cuff tears by driving synovial inflammation via the mitogen-activated protein kinase/extracellular signal-regulated kinase-mediated macrophage polarization

Yingming Wang, Xianzhe Gu, Jun Tu, Bin Xu — 2026-06-03

Patients with diabetes exhibit a higher incidence and more severe manifestations of rotator cuff tears (RCTs), yet the etiopathogenesis remains poorly defined. This study investigates the pathological characteristics and mechanisms underlying diabetic rotator cuff pathology.

Open capsular shift with Achilles allograft augmentation for multidirectional shoulder instability: long-term outcomes and implications for patients with Ehlers-Danlos syndrome

2026-06-02

Multidirectional shoulder instability (MDI) remains a challenging clinical problem, particularly in patients with connective tissue disorders such as Ehlers-Danlos syndrome (EDS). While MDI may often be successfully treated nonoperatively, surgical intervention is indicated when conservative management fails. While open or arthroscopic capsular shift is often used, allograft tissue augmentation may be required for patients with recurrent instability and deficient capsular tissue. The purpose of this study was to evaluate long-term patient-reported outcomes following open capsular shift with Achilles allograft capsular augmentation in patients with MDI.

Management of massive rotator cuff tears involving irreparable subscapularis tear by arthroscopically assisted latissimus dorsi transfer: clinical results

2026-06-02

This study aims to evaluate the outcomes of arthroscopically assisted latissimus dorsi (LD) transfer for massive rotator cuff tears involving irreparable subscapularis tendon tears.

Snapping scapula syndrome: a systematic review of treatment options and outcomes

2026-06-01

Snapping scapula syndrome (SSS), or scapulothoracic bursitis, is an under-recognized disorder characterized by painful, audible, or palpable crepitus between the scapula and thoracic wall. While nonoperative management is the standard first-line treatment, surgical intervention is often considered for refractory cases.

Overweight and premorbid obesity status correlates with thromboembolism risk but not infection after total shoulder arthroplasty

2026-06-01

Total shoulder arthroplasty (TSA) is an effective treatment for shoulder arthritis. Although obesity is associated with complications after hip and knee arthroplasty, its association with TSA outcomes remains less defined. This study evaluated TSA outcomes stratified by body mass index (BMI).

Clinical and radiographic survival rates of the Arthrex Univers VaultLock uncemented central-peg all-polyethylene glenoid component in anatomic total shoulder arthroplasty at 2- and 5-years postoperatively

2026-06-01

To evaluate radiographic and functional outcomes at 2 and 5 years postoperatively for anatomic total shoulder arthroplasty (aTSA) performed with an uncemented central-peg all-polyethylene glenoid (Univers VaultLock; Arthrex, Inc., Naples, FL) designed for an uncemented central-peg fixation with peripheral cement and central osseous interdigitation.

How does a prior olecranon osteotomy impact the outcome of subsequent total elbow arthroplasty?

2026-06-01

Olecranon osteotomy is a common surgical exposure technique used for internal fixation of distal humerus fractures. Unfortunately, retained ulnar hardware and potential osteotomy complications (malunion, nonunion, or extensor mechanism insufficiency) may negatively impact subsequent total elbow arthroplasty (TEA) if needed. Although TEA is a reasonable option for management of failed distal humerus internal fixation or posttraumatic arthritis, little is known about how prior olecranon osteotomy influences TEA outcomes.

Morrey award 2025: cell count and differential of aspirated fluid in the diagnosis of periprosthetic joint infection of total elbow arthroplasty

2026-06-01

Periprosthetic joint infection (PJI) is a common method of failure following total elbow arthroplasty (TEA). Diagnosis is often guided by synovial fluid leukocyte counts and neutrophil percentages. Although cutoff values have been defined for hip and knee arthroplasty PJI, the elbow has a different microbiome and a higher rate of PJI. Currently, there are no data to guide determination of PJI following TEA. The purpose of this study was to identify cutoff values of synovial fluid leukocyte counts, neutrophil percentage, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to aid in the detection of periprosthetic total elbow infection.

Return to sport after ulnar collateral ligament repair and reconstruction

2026-05-29

Given the rising incidence of elbow ulnar collateral ligament (UCL) injury among young athletes in overhead sports, it is important to identify optimal treatments. The historic gold standard is UCL reconstruction. However, suture-augmented UCL repair techniques have become increasingly popular given their high rates of return to play in partial or full thickness avulsion UCL tears. The purpose of this study was to determine complications, clinical outcomes, and return to sport in UCL repair and reconstruction.

Early adopter surgeon experience with Mako robotic-assisted reverse shoulder arthroplasty: perceived utility, workload, and workflow reliability

2026-05-27

As robotic-assisted reverse total shoulder arthroplasty (rTSA) enters an early adoption phase, widespread implementation will be shaped as much by real-world usability and reliability as by the yet to be realized purported clinical benefits of accurate implant positioning. This study sought to characterize early adopter experience with the Mako robotic rTSA system (Stryker, Kalamazoo, MI) among surgeons participating in the platform's limited release.

Static and dynamic internal ulnar rotational stability in collegiate baseball pitchers

Jun Sakata, Kanta Matsuzawa, Toshiharu Tsutsui, Masaki Akeda, Tadahiro Sakai — 2026-05-26

The primary soft tissue stabilizer of valgus stress across the elbow is the anterior oblique ligament. The posterior oblique ligament (POL) is a stabilizer of internal rotational stress. This study aimed to identify whether POL morphologic changes affect the ulnar internal rotational laxity of the elbow, and whether the elbow flexors restrain it.

Has the internal joint stabilizer altered the need for a medial approach in triad injuries?

2026-05-26

Surgeons historically repair terrible triad injuries of the elbow with a laterally based approach, adding a secondary medial approach when adequate stability is not achieved with lateral repair alone. The internal joint stabilizer (IJS) (Skeletal Dynamics, Inc. Miami, Florida, USA) may improve joint stability from the standard lateral approach, potentially decreasing the need for a secondary medial approach or supplementary procedures. The purpose of this study was to determine the effect of the introduction of internal joint stabilization on the rate of supplemental medial approaches in the treatment of terrible triad injuries.

Postoperative infraspinatus contractility is independently associated with objective outcomes after arthroscopic rotator cuff repair

2026-05-25

Tendon integrity alone cannot fully explain recovery after arthroscopic rotator cuff repair (ARCR). Because the infraspinatus stabilizes the glenohumeral joint, we investigated whether postoperative infraspinatus contractility, measured using real-time tissue elastography (RTE), is related to objective recovery.

Pre-operative proton pump inhibitor use and risk of adverse outcomes after total elbow arthroplasty: a propensity-matched analysis

2026-05-25

Proton pump inhibitors (PPIs) are widely prescribed and commonly used in orthopedic patients, yet increasing evidence links chronic PPI exposure to infectious, skeletal, and thromboembolic complications. While associations have been reported following hip, knee, and spine surgery, the impact of PPI use on outcomes after total elbow arthroplasty (TEA) remains poorly characterized.

Age-related and sex-related differences in rotator cuff and deltoid muscle: a 3-dimensional segmentation analysis in healthy shoulders

2026-05-25

Muscle volume and fatty infiltration of the rotator cuff and deltoid may influence shoulder function and affect outcomes following rotator cuff repair and shoulder arthroplasty. However, age-specific and sex-specific changes and reference values for these parameters in healthy individuals remain limited. Establishing such benchmarks may help differentiate physiological muscle changes from pathological degeneration and improve surgical decision-making and outcome predictions. This study aimed to quantify age-related and sex-related differences in rotator cuff and deltoid muscle characteristics using quantitative 3-dimensional computed tomography–based muscle segmentation in healthy shoulders.

Subscapularis repair in reverse shoulder arthroplasty: a systematic review and meta-analysis with a sub-analysis by implant lateralization and repair techniques

2026-05-23

The debate about repairing the subscapularis in the setting of reverse shoulder arthroplasty (rTSA) is ongoing. Some reported benefits of the subscapularis repair are a reduced rate of instability, more internal rotation (IR) improvement, and better functional outcomes. However, with the popularization of lateralized implants, these benefits are becoming more limited. Therefore, this meta-analysis compared outcomes of rTSA depending on whether or not the subscapularis was repaired with a sub-analysis by rTSA design (lateralized vs.

Computed tomography analysis of osteophyte distribution in the throwing elbows of professional baseball players

Masaru Munemori, Akira Kodama, Yuichi Sumida, Nobuo Adachi — 2026-05-23

Posteromedial olecranon impingement is a common elbow disorder in professional baseball players that results from repetitive valgus extension overload during throwing. Osteophyte formation is a hallmark of this condition. However, its anatomical distribution and progression remain unclear. This study aimed to characterize the distribution of osteophytes in the elbows of professional baseball players using computed tomography (CT) and to evaluate the relationship between osteophyte location and player age.

Defining optimal synovial aspirate thresholds and utility of frozen sections in predicting bacterial presence at the time of revision shoulder arthroplasty

2026-05-22

The discriminatory utility of synovial aspirates and frozen sections in the evaluation of a failed shoulder arthroplasty is uncertain. We performed a multi-institutional study of consecutive revision shoulder arthroplasties to define the utility and optimal cutoffs of synovial aspirates and frozen sections to predict positive intraoperative cultures.

Statin therapy is not associated with inferior postoperative outcomes after arthroscopic rotator cuff repair: a systematic review and meta-analysis

2026-05-21

Despite historical concerns regarding muscle and tendon toxicity, preclinical studies suggest statins may exert anti-inflammatory and antifibrotic effects relevant to rotator cuff tendon–bone healing. Clinical studies of statin use after arthroscopic rotator cuff repair (ARCR) report mixed results with respect to tendon healing, revision surgery, and functional outcomes. This systematic review and meta-analysis evaluated postoperative healing and patient-reported outcomes between statin users and non-statin users following ARCR.

Associations of preoperative patient mental health status, sociodemographic and clinical characteristics with baseline pain, function and satisfaction in patients undergoing revision rotator cuff repairs

2026-05-21

This study aimed to investigate the associations of general patient and disease-specific factors with baseline patient-reported outcome measures (PROMs) in patients undergoing revision rotator cuff repair (RCR). Baseline characteristics were also compared to those of patients undergoing primary RCR.

Surgical treatment for posterior distal humeral shear fractures

Xiaoyong Xia, Yejun Zha, Xieyuan Jiang — 2026-05-21

Posterior shear fractures of the distal humerus are rare and have a complex, controversial injury mechanism. This study aims to investigate the morphological characteristics, injury mechanisms, and treatment outcomes of these fractures.

Feasibility of applying the Orthopaedic Data Evaluation Panel (ODEP) shoulder criteria for implants used in a United States–based integrated health care system

2026-05-21

Benchmarking allows for measurements and comparisons of prostheses using agreed-upon standards so that surgeons may be informed on performance for clinical decision making. We sought to apply the Orthopaedic Data Evaluation Panel (ODEP) for Shoulders methodology to benchmark prostheses used for shoulder arthroplasty in a US integrated health care system.

Donor site morbidity and patient satisfaction after arthroscopic superior capsule reconstruction using fascia lata autograft for irreparable rotator cuff tears

2026-05-20

Donor site morbidity—previously a major concern—remains a considerable issue in arthroscopic superior capsule reconstruction using a fascia lata autograft due to the limited scientific evidence. We aimed to evaluate donor site morbidity and patient satisfaction after arthroscopic superior capsule reconstruction using a fascia lata autograft for irreparable rotator cuff tears. We hypothesized that the procedure would result in certain donor site morbidities, would not have a significant impact on daily activities, and that improvements in shoulder function could compensate for donor site morbidity after superior capsule reconstruction.

Association between long head of the biceps tendon origin and rotator cuff tears: An Magnetic Resonance Imaging-based retrospective observational cohort study

2026-05-20

The long head of the biceps tendon (LHBT) plays an important role in glenohumeral stability and frequently coexists with rotator cuff (RC) pathology. Although anatomical variations in the glenoid origin of the LHBT have been described, their relationship with RC tears has not been fully elucidated. This study aimed to investigate the association between LHBT origin variations and the presence of full-thickness RC tears.

Neuromuscular signatures differentiating functional and impaired cases in full-thickness rotator cuff tears

2026-05-20

The relationship between structural damage and functional impairment in patients with full-thickness rotator cuff tears (FT-RCTs) remains inconsistent. While some patients maintain high function despite large tears, others experience profound disability, suggesting that compensatory neuromuscular mechanisms may be more closely associated with functional status than with anatomical integrity. This study aims to identify the clinical, structural, and neuromuscular factors that differentiate high-functioning from poor-functioning individuals with FT-RCTs.

Bone marrow stimulation and decortication compromise the biomechanical strength of all suture anchors in rotator cuff repair

Chien-An Shih, Kai-Lan Hsu, Yueh Chen, Fang-Hsien Lin, Wei-Ren Su, Fa-Chuan Kuan — 2026-05-19

Footprint preparation is considered an important factor influencing tendon–bone healing and fixation strength in arthroscopic rotator cuff repair. This study aimed to compare the biomechanical characteristics of all-suture anchors following 3 different footprint preparation techniques.

Patient portal messaging in shoulder and elbow surgery patients: a retrospective cohort study

2026-05-19

Patient portals have become a primary mechanism for patient-provider communication, offering convenience for patients while also creating an uncompensated workload burden for providers. This issue is underexplored in shoulder and elbow surgery, where pain, quality of life burden, and complex rehabilitation plans may drive frequent messaging. This study evaluated trends in portal messaging within a shoulder and elbow orthopedic cohort.

Preoperative anti-remodeling osteoporotic therapy is associated with increased periprosthetic humeral fracture risk

2026-05-19

Osteoporosis increases fracture risk and adversely affects outcomes after shoulder arthroplasty. Preoperative bisphosphonate use has been linked to higher rates of periprosthetic fracture after lower extremity total joint arthroplasty, but data in shoulder arthroplasty are limited. The purpose of this study was to evaluate whether anti-remodeling agents such as bisphosphonates or anabolic osteoporotic therapy influenced 1-year outcomes, including periprosthetic humeral fracture, acromial stress fracture, and all-cause revision, following anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).

A nonopioid multimodal pain protocol achieves equivalent pain control after total shoulder arthroplasty: a randomized controlled trial

2026-05-19

Amid efforts to reduce opioid use, identifying effective nonopioid pain protocols for orthopedic procedures is a priority. Shoulder arthroplasty is associated with significant postoperative pain and has traditionally relied on opioids, despite their side effects. This study evaluated the efficacy of a postoperative nonopioid, multimodal pain protocol compared to an opioid protocol for patients undergoing shoulder arthroplasty.

Elevated risk of medical complications in sickle cell disease patients after total shoulder arthroplasty

2026-05-19

Sickle cell disease (SCD) predisposes patients to vaso-occlusive and inflammatory complications that may be exacerbated by surgical stress. While SCD has been linked to adverse outcomes after lower-extremity arthroplasty, its effect on post-operative complications following total shoulder arthroplasty (TSA) is poorly understood, particularly independent of avascular necrosis. This study evaluates the association between SCD and post-operative outcomes after TSA using a national database.

Survival and clinical outcomes of the Eclipse stemless anatomic total shoulder arthroplasty: a comparative study of glenoid component designs and humeral head materials

Moritz Kraus, Henry Gebauer, Mara Warnhoff, Asimina Lazaridou, Markus Scheibel — 2026-05-15

Fixation of the glenoid component in anatomic total shoulder arthroplasty (aTSA) is critical for implant longevity. The aim of this study was to compare long-term implant survival and clinical outcomes between keeled and pegged glenoid components of the Eclipse stemless aTSA, and to evaluate the influence of humeral head material on revision rates and functional outcomes.

Evaluation of the International Consensus Meeting (ICM) diagnostic categories for shoulder periprosthetic joint infection: Cutibacterium acnes predominates even in definite infections

2026-05-13

Consensus-derived diagnostic criteria for shoulder periprosthetic joint infection (PJI) were established at the Second International Consensus Meeting (ICM) on Musculoskeletal Infection in 2018. Data are still limited, however, on the clinical presentation and distribution of shoulder PJI cases with regard to ICM diagnostic categories. The purpose of this study was to use data from a multicenter prospective cohort of revision shoulder arthroplasties to evaluate the frequency of cases meeting criteria for each ICM PJI category and to examine the distribution of demographic data, microbiology, and positive criteria in each category.

Impact of smoking on structural failure after arthroscopic rotator cuff repair: a systematic review and meta-analysis

Van Tam Nguyen, Yi-Jie Kuo, Lien-Chen Wu, Yu-Zhi Lian, Yu-Pin Chen — 2026-05-13

Rotator cuff tears cause significant shoulder pain and functional limitation. Arthroscopic rotator cuff repair improves symptoms, yet structural failure rates remain substantial. Smoking may impair tendon-to-bone healing, but clinical studies report mixed findings due to heterogeneous methodology. Therefore, a systematic synthesis of imaging-confirmed outcomes is needed to clarify the association between smoking and structural failure after arthroscopic rotator cuff repair.

Surgical options for the management of severe glenoid structural deficiencies in the setting of revision reverse shoulder arthroplasty: a systematic review

2026-05-12

Over the last decade, due to the increase in the number of shoulder arthroplasty procedures performed, revision to reverse total shoulder arthroplasty (rTSA) has increased by 392%. This rise has been associated with a greater incidence of complications, including implant loosening and bone loss requiring alternative strategies for management of failed arthroplasty with glenoid bone deficiency. The purpose of this article is to review the current literature and compare outcomes of different grafts and custom implants used to address severe glenoid defects for revision of failed shoulder arthroplasty.

The internal joint stabilizer in lateral ulnar collateral ligament injuries: a biomechanical study

2026-05-12

The internal joint stabilizer (IJS) effectively reduces varus angle deviations and mitigates maximum lateral ulnar collateral ligament (LUCL) strain during elbow flexion-extension, thereby improving elbow posterolateral rotatory stability.

Metal-associated undifferentiated pleomorphic sarcoma around a long-term elbow implant: a case report

Junghan Kim, Yongrae Kim, Jihun Park — 2026-05-12

Orthopedic implants are fundamental in fracture fixation and joint reconstruction and generally demonstrate excellent long-term biocompatibility and durability.2 However, metal-associated sarcomas, although extremely rare, represent a serious late complication.5,8 These malignancies often develop after a prolonged latency period and may present a diagnostic challenge because symptoms such as pain, swelling, and osteolysis can mimic chronic infection or aseptic loosening.5 Among the histologic subtypes reported in association with metallic implants, undifferentiated pleomorphic sarcoma is one of the most frequently described.

The Osborne-Cotterill lesion: a Radiographic analysis of morphology & clinical Impact

Louise S. Howse, Siddharth Virani, Labib Syed, Chan Khin, Joideep Phadnis — 2026-05-12

The Osborne-Cotterill lesion (OCL) is an osseoligamentous injury of the posterolateral capitellum associated with elbow instability. Its contribution to instability remains unclear, and evidence guiding management is limited. This study aimed to quantify the incidence and anatomy of OCLs and to correlate these findings with patterns of elbow instability, treatment, and outcome.

Efficacy and safety of elective primary total elbow arthroplasty in the last 25 years: a systematic review

2026-05-12

This systematic review evaluates the efficacy and safety of elective primary total elbow arthroplasty (TEA).

Age is not a contraindication: outcomes of distal biceps tendon repair in elderly patients

2026-05-12

Distal biceps tendon ruptures are increasingly common in the elderly, yet no studies have specifically examined surgical outcomes in patients aged more than 65 years. This represents a significant knowledge gap given the growing elderly population and increasing activity levels among older adults. The purpose of this study is to determine major and minor complication rates in patients aged 65 years andmore undergoing surgical repair of distal biceps tendon ruptures and to compare outcomes with a matched younger cohort.

Clinical outcomes following bursal acromial reconstruction using a dermal acellular graft for irreparable rotator cuff tears

Diego C. Villacis — 2026-05-12

Irreparable rotator cuff tears remain a challenge for orthopedic surgeons. Reverse shoulder arthroplasty (rTSA) has become an increasingly common option for these patients. However, in patients lacking arthritis and with a functionally balanced shoulder, alternative and less invasive surgical options have been pursued. In this study, we seek to investigate the outcome of arthroscopically placing an allograft on the undersurface of the acromion for pain relief.

The epidemiology of elbow dislocation in the United States 2014-2023

2026-05-12

Incurring elbow dislocations may have debilitating effects on patients' quality of life. The purpose of this study was to identify rates of elbow dislocation presenting to US emergency departments (EDs) from 2014-2023.

Postoperative outcomes of modified graft augmentation for large to massive rotator cuff tears

Satoru Ohta, Shusuke Masuda, Yoshiyuki Ueda, Osamu Komai — 2026-05-12

The re-tear rate after rotator cuff repair for large to massive tears remains high, and improving postoperative outcomes is a clinical challenge. This study aimed to evaluate the clinical and radiological outcomes of a modified graft augmentation (GA) technique using a double suture bridge configuration.

Pectoralis minor reattachment in Latarjet procedure: improvement of scapular stability in high-performance contact athletes— retrospective cohort comparison

2026-05-12

The Latarjet procedure is effective for recurrent anterior shoulder instability with glenoid bone loss; however, as a nonanatomic technique, it may lead to scapular dyskinesis, particularly in contact athletes. The necessity of reattaching the pectoralis minor remains a subject of debate. We hypothesized that pectoralis minor reattachment during the Latarjet procedure would be associated with a lower incidence of scapular dyskinesis and improved functional outcomes in high-performance contact athletes.

Factors associated with progression of symptomatic isolated supraspinatus tears 2 years after exercise therapy

2026-05-11

Although exercise therapy is an effective treatment for individuals with symptomatic rotator cuff tendon tears, tear size can increase. Understanding factors associated with tear progression will provide information that may be used to develop treatment plans and/or monitor tear size progression. Therefore, this study aims to identify factors associated with tear progression in persons with an isolated symptomatic supraspinatus tendon tear that underwent 12 weeks of personalized exercise therapy.

Do wound protectors reduce contamination in total shoulder arthroplasty? A randomized controlled trial

2026-05-11

Cutibacterium acnes is the most frequent cause of shoulder prosthetic joint infection with skin edges as a source of wound contamination. The primary purpose of this study was to determine if the use of a wound protector device decreases the deep wound bacterial colonization in primary shoulder arthroplasty. The secondary purpose was to assess the effect of device usage on deltopectoral muscle and cephalic vein injury.

An icariin-loaded Polycaprolactone (PCL) electrospun scaffold for enhanced tendon-bone healing in rotator cuff repair

Qi Zhu, Huang Zhai, Bangjun Cheng, Junwu Huang, Hanxing Mao, Zhenlong Bai — 2026-05-11

This study aimed to fabricate an icariin (ICA)-loaded polycaprolactone (PCL) electrospun scaffold and systematically evaluate its effects on tendon-bone healing in a rat rotator cuff injury model, with particular focus on its immunomodulatory, angiogenic, and fibrocartilaginous regeneration capabilities.

Radiographic findings following sequential transection of the medial collateral ligament and flexor–pronator mass

2026-05-06

Elbow valgus stability relies on both static and dynamic stabilizers. The medial collateral ligament, particularly the anterior bundle (AB), provides primary resistance to valgus stress, whereas the flexor–pronator mass (FPM) offers secondary, dynamic support. Combined disruption of these structures—especially following trauma—can result in significant elbow instability. This cadaveric study aimed to quantify radiographic changes in the medial ulnohumeral joint (UHJ) space and valgus alignment following sequential transection of the AB, posterior bundle (PB), and FPM.

Open repairs with biceps rerouting does not impact retears in large to massive rotator cuff tears compared to conventional open repair: a randomized clinical trial

2026-05-02

The treatment of large to massive rotator cuff tears leads to a high failure rate and several techniques have been proposed to improve these results. Rerouting the long head of the biceps tendon (LHBT) appears to be a biological reinforcement to increase tendon healing. Therefore, this study aimed to compare the clinical and radiological outcomes of open repair for large and massive rotator cuff tears reinforced with the LHBT to conventional open repair.

Assessment of virulence traits in Cutibacterium acnes from shoulder periprosthetic joint infections

2026-04-30

Cutibacterium acnes is the most common pathogen in shoulder periprosthetic joint infection (PJI) but remains difficult to distinguish from contamination due to its low virulence and presence as a skin commensal. Diagnostic ambiguity and variable antibiotic resistance further complicate management.

Factors associated with conversion of outpatient total shoulder arthroplasty to inpatient

2026-04-30

Outpatient total shoulder arthroplasty (TSA) is increasingly performed as perioperative pathways and value-based care models expand. However, a subset of patients scheduled for outpatient TSA require unexpected inpatient admission, which may indicate higher perioperative risk and increased resource use. We hypothesized that older age, greater comorbidity burden, and longer operative time would be associated with conversion from planned outpatient TSA to inpatient admission, and that conversion would be associated with worse short-term outcomes.

Nerve injury in revision total elbow arthroplasty: a systematic review and meta-analysis

Hamza Tareen, Michael Fox, Anna Panagitidou, Marco Sinisi, Ashley Simpson — 2026-04-30

Revision total elbow arthroplasty (TEA) is technically demanding and carries a substantial risk of postoperative neurological complications because of scarring, altered anatomy, implant removal, and repeated humeral and ulnar exposure. The incidence, nerve distribution, and recovery profile of nerve injury after revision TEA remain incompletely defined. This study aimed to systematically review the literature to define the incidence, recovery profile, and risk factors for nerve injury after revision TEA.

Do radiographic measurements of glenoid or humeral lateralization and distalization affect post-operative outcomes for reverse total shoulder arthroplasty?

2026-04-30

Optimizing patient outcomes in reverse total shoulder arthroplasty remains a subject of ongoing research. Newly described radiographic angles allow the determination of the glenoid and humeral component contributions to lateralization and distalization, which might play a role in patient outcomes. Thus, this study aims to explore the effect of radiographically measured glenoid vs. humeral lateralization and distalization on patient-reported outcomes and reoperation.

Risk factors for early revision following primary total shoulder arthroplasty in a single health system

2026-04-30

Shoulder arthroplasty has emerged as a reliable treatment for end-stage glenohumeral arthritis. However, as the volume of total shoulder arthroplasty (TSA) increases nationwide, revision procedures are expected to rise in parallel. These surgeries are already known to be technically challenging and associated with higher complication rates, longer recovery, and increased costs. Despite this growing demand, limited large-scale data exist to identify which patient factors predict early failure and adverse outcomes.

Comparison of truly anatomic coracoclavicular ligament reconstruction with vs. without acromioclavicular ligament reconstruction for acute Rockwood type V acromioclavicular joint dislocations: a prospective cohort study

2026-04-30

This study was designed to compare the 2-year clinical and radiologic results of the truly anatomic coracoclavicular ligament reconstruction (TACCR) vs. TACCR with additional acromioclavicular ligament reconstruction (TACCR-AC) for patients with acute Rockwood type V acromioclavicular (AC) joint dislocations.

Introducing posterior glenoid dysplasia with novel classification: comparison of proportion and morphology between young baseball players and other athletes

Sang-Hoon Lhee, Dongjun Jeon, Sungkuk Chae, Do Young Lee — 2026-04-30

Posterior glenoid dysplasia (PGD) has been described as an adaptive osseous change in young throwing athletes exposed to repetitive mechanical stress. However, prior studies have lacked consistent definitions, reliable classifications, or sport-specific analysis. This study aimed to analyze and classify PGD in young athletes across various sports and compare its proportion and severity between symptomatic baseball players and athletes from other sports.

Defining patient acceptable symptom state (PASS) following reverse total shoulder arthroplasty to treat proximal humeral fractures using the Advita Ortho database: a retrospective cohort study

2026-04-30

Proximal humeral fractures (PHFs) are common in the elderly population, and the use of reverse total shoulder arthroplasty (rTSA) as treatment has risen substantially in recent years. As opposed to statistical significance, clinical value has increasingly been used to evaluate outcomes; thus, this study aims to define patient acceptable symptom state (PASS) thresholds, Minimal Clinically Important Difference (MCID), and substantial clinical benefit (SCB) values for American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant-Murley score (CMS), and Shoulder Arthroplasty Smart (SAS) score in patients undergoing rTSA for PHFs.

Can standard preoperative serum laboratory tests predict bacterial presence at the time of revision shoulder arthroplasty?

2026-04-30

The utility and optimal threshold for serum laboratory tests taken prior to revision shoulder arthroplasty are unknown. We performed a multi-institutional study of consecutive revision shoulder arthroplasties to define the optimal thresholds of serum laboratory samples to predict bacterial presence in intraoperative cultures with and without definite periprosthetic joint infection (PJI).

Structural predictors of mechanical instability after posterolateral elbow dislocation: a magnetic resonance imaging–based threshold model

2026-04-30

Determining which posterolateral elbow dislocations require surgery is challenging as major ligament tears often occur regardless of clinical stability. This study aimed to identify specific magnetic resonance imaging patterns that represent the functional threshold for persistent mechanical instability.

The ABCs of shoulder measurements

Estelle M. Strangmark, C. Lucas Myerson, Joseph D. Zuckerman — 2026-04-30

This narrative review presents commonly used radiographic parameters in shoulder surgery. The review outlines the historical context, definitions, and evidence regarding diagnostic and prognostic utility of each measurement. Limitations such as variability in imaging technique and lack of standardized measurement protocols are discussed. Despite these constraints, these measurements remain central to evaluating imaging of the shoulder, guiding implant positioning, assessing pathology, and comparing outcomes across studies.

Partial tear at the musculotendinous junction of the teres major after anterior latissimus dorsi and teres major tendon transfer: associated factors and clinical impact in 256 patients

Chang Hee Baek, Chaemoon Lim, Jung Gon Kim, Bo Taek Kim, Seung Jin Kim — 2026-04-29

Anterior latissimus dorsi and teres major (aLDTM) tendon transfer is an established procedure for isolated irreparable subscapularis tendon tear and anterosuperior irreparable rotator cuff tears. However, partial tear at the musculotendinous junction (MTJ) of the teres major (TM) has been observed on post-operative magnetic resonance imaging (MRI). The associated factors and clinical significance of these lesions remain unclear. This study aimed to identify factors associated with these lesions and to evaluate their impact on clinical outcomes.

In reverse shoulder arthroplasty, selectively medializing the glenoid in higher-risk patients is associated with reduced risk of acromial stress fracture

2026-04-24

Reverse total shoulder arthroplasty has roughly a 4% risk of acromial stress fracture (ASF) and is associated with poor outcomes. Previous finite element analyses indicated that glenoid center of rotation lateralization significantly increased acromial strain; however, clinical studies have reported conflicting data with regards to implant position parameters on the incidence of ASFs. The purpose of this study was to evaluate whether medializing the glenoid component in patients at higher risk of ASF was associated with a lower incidence of ASF.

Revision reverse shoulder arthroplasty after failed shoulder arthroplasty: long-term survivorship and risk factors for failure

2026-04-24

Reverse shoulder arthroplasty (rTSA) is increasingly used as a revision option, but long-term survivorship and patient-reported outcomes (PROs) after revision rTSA remain poorly defined. We hypothesized that revision rTSA for failed rTSA would have inferior survivorship and PROs when compared to revision rTSA for failed anatomic total shoulder arthroplasty (aTSA) or failed hemiarthroplasty (HA). Moreover, we hypothesized that shoulders undergoing secondary revision would have a higher risk of failure when compared to those undergoing first-time revision surgery.

Cost analysis of different fixation techniques for distal biceps ruptures using time-driven activity-based costing

2026-04-24

Various fixation methods of distal biceps brachii tendon rupture (buttons, screws, and anchors) have been shown to have similar outcomes. However, the impact of these different implants on total day of surgery (DOS) costing has yet to be examined. The purpose of this study was to explore the DOS costs between different types of implants used for distal biceps repairs using time-driven activity-based costing.

Complete resection of the deltoid insertion is associated with post-operative dislocation of reverse total shoulder arthroplasty following proximal humerus oncological resection

Nong Lin, Liming Zheng, Weixu Li, Xin Huang, Xiaobo Yan, Meng Liu, Zhaoming Ye — 2026-04-24

Reconstruction of an oncologically resected proximal humerus poses a challenge to surgeons, and reverse total shoulder arthroplasty (rTSA) may provide greater functional improvement. However, the characteristics of patients suitable for rTSA remain unknown, owing to the lack of data in the literature regarding post-operative functional outcomes and complications. In this retrospective cohort study of patients who underwent rTSA for tumor-related proximal humerus resection, we aimed to identify the features related to improved outcomes and decreased complications.

Tendon stump tendinosis and combined subscapularis tear as risk factors for healing failure after medium-sized rotator cuff repair

2026-04-23

While age, tear size, and fatty infiltration are established prognostic indicators for arthroscopic rotator cuff repair (ARCR), little is known about the impact of tendon stump status and concomitant subscapularis tears on healing, especially in medium-sized tears. This study aimed to evaluate their impact on tendon healing following arthroscopic repair of medium-sized rotator cuff tears.

Increased decentralization of total shoulder arthroplasty procedures among surgeons in the United States: a nationwide market analysis

2026-04-23

Primary total shoulder arthroplasty (TSA) utilization has grown substantially in recent years. As procedure volume increases, understanding how operative volume is distributed across the surgeon workforce has become important, as concentration of cases among a limited number of high-volume surgeons vs. broader decentralization has implications for training exposure, care accessibility, and long-term workforce capacity. However, trends in surgeon-level case volume distribution for TSA over time remain unclear.

One-third of asymptomatic youth baseball players exhibit ulnar collateral ligament sub-apophyseal avulsions

2026-04-22

Ulnar collateral ligament sub-apophyseal avulsions are increasingly prevalent among youth baseball players, yet knowledge regarding avulsive changes in asymptomatic athletes is sparse. Ultrasound offers a minimal-risk method of assessing potential damage from repetitive valgus stress encountered during the throwing motion.

Effects of bone morphogenetic protein-7 and low-molecular-weight peptide solution on healing in a rotator cuff tear model: a histopathologic and biomechanical study in rats

2026-04-10

Rotator cuff tears are the most prevalent shoulder pathology requiring surgery, yet high retear rates necessitate additional biological adjuncts. This study evaluated the effects of bone morphogenetic protein-7 (BMP-7) and low-molecular-weight peptide solution (LMWPS) on early tendon-to-bone healing. We hypothesized that these 2 agents with different mechanisms of action would histopathologically and biomechanically enhance early rotator cuff repair.

Return to golf after shoulder arthroplasty: an American Shoulder and Elbow Surgeons multicenter study predicting performance after reverse total shoulder arthroplasty and anatomic total shoulder arthroplasty

ASES Multicenter Research Group — 2026-04-10

Return to sport (RTS), particularly golf, and athletic performance following reverse shoulder arthroplasty (rTSA) and anatomic shoulder arthroplasty (aTSA) remain largely understudied. Moreover, limited data exist on characteristics that predict successful RTS. This study aimed to evaluate return to golf after shoulder arthroplasty, as well as identify patient factors associated with optimal return to play.

Influence of repetitive batting on capitellar subchondral bone density distribution

2026-04-09

Osteochondritis dissecans of the capitellum occurs in adolescent baseball players, with repetitive throwing recognized as a major risk factor. Whether repetitive batting contributes to cumulative capitellar loading remains unclear. We hypothesized that repetitive batting would increase cumulative mechanical loading on the humeral capitellum, as assessed with computed tomography (CT) osteoabsorptiometry.

The effect of glenoid rotational malalignment on best-fit circles based on AI-generated mathematically true glenoid en face views

2026-04-09

The majority of studies that measure glenoid bone loss in the context of shoulder instability are based on a sagittal image, termed the en face view, with the aid of best-fit circles. However, the en face view has never been standardized. We created a mathematical en face view of the glenoid and demonstrated the effect that rotation of the glenoid has on best-fit circle size and position.

The impact of an intact rotator cuff on the outcomes of reverse shoulder arthroplasty: a meta-analysis of 20,924 patients

2026-04-09

While reverse shoulder arthroplasty (rTSA) is commonly utilized for rotator cuff tear arthropathy, indications have expanded to include, primary glenohumeral osteoarthritis (GHOA) with intact cuff. The presence of an intact cuff may influence outcomes after rTSA because preserved cuff musculature can contribute to shoulder stability and force which could potentially improve postoperative function and reduce complication rates. However, studies have reported contradictory results on whether or not an intact cuff would provide better outcomes in patients receiving an rTSA.

Cannabis use disorder is associated with increased early postoperative opioid use and pain but no long-term differences after arthroscopic rotator cuff repair: a retrospective cohort study using TriNetX

Tarun R. Sontam, Sri Tummala, Harmon S. Khela, Liane Miller, John D. Kelly — 2026-03-19

Cannabis use has become increasingly common in the general population, with cannabis use disorder (CUD) defined as clinically significant impairment and/or distress related to cannabis consumption. Prior studies have associated CUD with increased postoperative pain and opioid use, but its impact following arthroscopic rotator cuff repair (RCR) remains unclear. This study aimed to compare short- and long-term surgical outcomes following RCR between patients with and without CUD.

WITHDRAWN: Are glenoid retroversion, humeral subluxation and Walch classification associated with a muscle imbalance

2023-12-27

WITHDRAWN: Comparison of Glenoid Bone Grafting versus Augmented Glenoid Baseplates in Reverse Shoulder Arthroplasty: A Systematic Review

2022-03-25

WITHDRAWN: Midterm outcomes of a short cemented bipolar radial head arthroplasty, in a cohort of 56 cases with minimum 2-years follow-up

Marie Le Mapihan, Lior Amsallem, David Ing, Emmanuel H. Masmejean — 2021-03-04

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

WITHDRAWN: Fracture line morphology of greater tuberosity fragments of Neer 3 and 4 part proximal humerus fractures

2020-11-18

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