• Arthroplasty
• Categories
• Constant
• Fracture
• Outcome
• Shoulder

• Constant Score
• Correlation
• Oxford Shoulder Score
• QuickDASH
• conversion
• outcome measures
• proximal humerus fracture

• Arthroscopy
• Lateral acromion angle
• Rotator cuff repair

• Humans
• Male
• Female
• Middle Aged
• Rotator Cuff Injuries/diagnostic imaging
• Rotator Cuff Injuries/surgery
• Acromion/diagnostic imaging
• Acromion/surgery
• Retrospective Studies
• Rotator Cuff/diagnostic imaging
• Rotator Cuff/surgery
• Shoulder
• Arthroscopy/methods
• Magnetic Resonance Imaging
• Treatment Outcome

• arthroscopic surgery
• biodegradable
• meta-analysis
• nonbiodegradable
• rotator cuff tear
• suture anchors
• systematic review

• biomechanics
• magneto-inertial measurement units
• scapula
• scapular kinematics
• shoulder
• wearable systems

• Humans
• Biomechanical Phenomena
• Scapula
• Shoulder
• Shoulder Joint
• Range of Motion, Articular
• Wearable Electronic Devices

• Arthroplasty
• Instability
• PROMs
• Patient reported outcome measures
• Rotator cuff
• Shoulder surgery

• kinematics
• range of motions
• rotator cuff tears
• scapula
• scapular dyskinesis

• ASES
• Agreement
• OSS
• crosswalk
• registry
• shoulder

Numerous interventions are advised for the surgical management of distal clavicle fractures. Hook plate (HP) and distal locking plate (DLP) are among the commonly used techniques; nonetheless, no single procedure is deemed to be the benchmark treatment. Thus, the aim of the study is to conduct a comparative analysis, hopefully, to recommend the superior method between the two operations.

PubMed, Embase via Ovid and Web of science were electronically searched between January 2000 and to date for studies directly comparing HP to DLP. Comparative retrospective/prospective and randomized studies were incorporated. Constant-Murley score “CMS” at a minimum of 12 months, pain visual analogue scale “VAS”, coracoclavicular distance “CCD” and reported complications were analysed. Review manager software was used for the statistical analyses.

The total number of patients was 523; 274 (52.3%) with HP and 249 (47.6%) with DLP, 81 of which were associated with CC reconstruction. The mean follow up was 38.7 and 37.03 months for HP and DLP, respectively. CMS leaned towards the DLP group with no statistically significant difference (P=0.06). VAS was in favour of the DLP with again no statistically significant difference (P=0.12). In terms of CCD, the comparison favoured the HP with a lesser CCD postoperatively and a statistically significant difference (P<0.05). Complications were significantly higher in the HP group (P<0.0001).

Contrary to our hypothesis, though HP did show a better radiological outcome; nonetheless, DLP did demonstrate a better functional result with a lesser rate of complications and the ability to retain the implant avoiding a second surgery.

• AVN
• Fracture dislocation
• ORIF
• complications
• outcomes
• reoperation

• Elderly
• Functional results
• Humeral tuberosities
• Proximal humerus fractures
• Reverse prosthesis
• Trauma surgery

• Tenodesis
• rotator cuff
• subpectoral
• suprapectoral

Proximal humerus fractures are the seventh most frequent fracture in adults, and the third in patients over 65 years old, 5.7% of whole diagnosed fractures. Most of these fractures can be treated conservatively and achieve good results. However, more and more frequently we are confronted with dislocated and multifragmentary fractures, and with elderly and high functional demanding patients. In patients with osteoporosis and poor general conditions external fixation can be performed as rapid and mininvasive procedure with good outcome and low complication rates. The authors investigated the use of external fixation in the treatment of proximal humerus fractures. The objective is to demonstrate the effectiveness of this method as a valid alternative to other surgical techniques.

A multicentre study was conducted at 7 hospitals in Italy from 2014 through 2018. We recruited all proximal humeral fractures (as classified with the Neer system) that are surgically treated with the same external fixator DOS, for a total of 110 patients, evaluated later with Oxford Shoulder Scale (OSS) and disability of the arm, shoulder and hand score (DASH) at 1, 2 and 6 months.

The patients have passed from a score of 75,37 in the first month to a score of 29,47in the sixth month at the DASH and from 47,02 to 27,71 at the OSS. The data further confirm the increased incidence of these fractures in women and in a mean age of about 65.

Although it does not represent the golden standard in the treatment of fractures of the proximal humerus, in our experience the minimal osteosynthesis with external fixator turned out to be a very valid help especially for the simplicity and speed of the method, as well as for the exciting functional results. sometimes superior to other methods. The preliminary results from the different centers have confirmed this hypothesis. We hope this will be a good starting point for further in-depth studies. (www.actabiomedica.it)

• humeral fracture
• external fixation
• multicentric
• shoulder
• osteoporosis
• dos

Different studies on reverse shoulder arthroplasty (RSA) have proposed changes to the humeral design to lateralise the humeral centre of rotation (COR), with humeral inclination to 135 or 145 from 155 degrees or to switch to onlay humeral trays from inlay design; with both having also been used in combination. There have been many studies and systematic reviews to show the difference in outcomes and complications to the variations in glenoid design but to date, there have been no systematic studies to compare different humeral inclinations for RSA implants.

Searches using keywords were used in common medical search engines in a systematic fashion. The article was reviewed for the class of evidence and bias, summarised and compared in meta-analysis. Inclusion criteria included studies on adults with RSA that compared lateralised humeral implants to medialised.

The search produced 349 articles; of these, we identified nine studies that met the inclusion criteria. Our review identified a total of 562 patients who had been included in studies directly comparing lateralised humerus to a more medial design. Meta-analysis showed a significantly reduced risk of scapular notching in lateralised humerus compared to the standard medialised component. The external rotation range of motion in the lateralised group was statistically significant.

The improvement in scapular notching and gain in the range of motion without any apparent downside in the form of reduced patient-reported outcome measures or complications suggest a lateralised humeral component is superior to the more medialised design in RSA. A large RCT with a longer-term follow-up is needed to confirm whether there is clinically significant benefit from the lateralisation of the humerus.

• 135
• 145
• 155
• ascend flex
• centre of rotation
• inlay
• lateralisation
• onlay
• reverse shoulder arthroplasty

Fracture reverse shoulder arthroplasty (fRSA) in geriatric, complex dislocated proximal humerus fractures is becoming the standard treatment next to conservative treatment. fRSA is a multifaceted, reasonably challenging procedure of which functional outcomes and complication rates are likely to depend on the experience of the surgeon. The goal of this study was to determine whether there is a learning curve for fRSA.

All patients with a dislocated multipart proximal humerus fracture that were treated with an fRSA between 2013 and 2019 in a specialized institution were included. The functional outcomes (Constant Shoulder Score, Oxford Shoulder Score, and range of motion), complications, and operation time of fRSA were assessed with linear regression plots and cumulative summation analysis to establish whether a learning curve was present.

In this cohort study, 50 patients were included. They had a mean age of 77.1 years and were treated with an fRSA by one trauma surgeon. Learning curves were distinguished for functional outcomes, complications, and operation time based on learning targets for daily activity and the mean complications and operation time. Results indicated that an optimal treatment is achieved after performing 20 fRSAs.

The results show that functional outcomes of PHFs treated with an fRSA improve with surgical experience. Also, outcomes are getting less variable after about 20 procedures. Surgeons starting this procedure should be aware of the learning curve and, therefore, should consider guidance from an experienced surgeon to swiftly optimize functional outcomes and prevent unnecessary complications.

• CUSUM analysis
• Fracture reverse shoulder arthroplasty
• Learning curve
• Proximal humerus fractures

• MCID
• PASS
• PROMIS
• SCB
• Shoulder
• reverse total shoulder arthroplasty

Postoperative pain and analgesic use after arthroscopic rotator cuff repair remain important issues that affect rehabilitation and overall outcomes.

To evaluate the pre- and intraoperative factors that may cause prolonged duration of postoperative pain and analgesic use.

Case-control study; Level of evidence, 3.

We included 443 patients who underwent arthroscopic rotator cuff repair and subacromial decompression. Visual analog scale (VAS) scores for pain were obtained preoperatively and at 30 and 90 days postoperatively. Patients were divided into a group who had prolonged postoperative pain (duration ≥1 and <3 months; n = 86 patients) and a group with nonprolonged pain (duration <1 month; n = 357 patients). The following factors were compared between groups: age, sex, body mass index, repair technique, tear size, retraction amount, repair tension, tendon degeneration, preoperative pseudoparesis, symptom duration, application of microfracture to the rotator cuff footprint for marrow stimulation, smoking, degree of fatty degeneration, preoperative narcotic analgesic use, diabetes, acromioclavicular joint degeneration, and preoperative Douleur Neuropathique 4 (DN4) and American Shoulder and Elbow Society (ASES) scores.

Significant differences were seen between the prolonged and nonprolonged groups regarding the median duration of pain (54 vs 27 days, respectively; P < .001) and analgesic use (42 vs 28 days, respectively; P < .001). Significant differences were noted between the groups for symptom duration (P = .007), smoking status (P = .001), degree of fatty degeneration (P = .009), preoperative narcotic analgesic use (P < .001), preoperative DN4 and ASES scores, 30-day VAS score (P < .001), duration of opioid and nonopioid analgesic use (P < .001), tear size (P = .026), and retraction stage (P = .032). Tear size (P = .009), retraction amount (P = .005), preoperative narcotic analgesic use (P < .001), degree of fatty degeneration (P < .001), and preoperative DN4 score (P = .024) were factors independently associated with prolonged postoperative pain and analgesic use.

Patients with larger size tears, retracted tendons, preoperative use of narcotic analgesics, higher tensioned tendon after repair, and Goutallier grade 3 or 4 fatty degeneration faced an increased risk of prolonged postoperative pain and analgesic use after arthroscopic rotator cuff repair. These factors might be mitigated by psychosocial support; gentle, controlled, and individualized postoperative rehabilitation approaches; detailed preoperative evaluation; and closer follow-up of patients who are treated operatively.

• analgesic
• postoperative
• predictor
• prolonged pain
• rotator cuff tear

• outcome measure
• patient reported outcomes
• patient-reported outcome measures
• shoulder arthroplasty

• Shoulder
• University of California Los Angeles Shoulder Score
• pain
• psychometrics
• rotator cuff tear

• ASES
• Constant score
• PROMIS
• adhesive capsulitis
• frozen shoulder
• outcome scores

The aim of this study was to determine the correlation between functional outcome scores and treatment success after arthroscopic rotator cuff repair.

We conducted a retrospective cohort study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2010 and 2015. University of California at Los Angeles Shoulder Score (UCLASS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) were measured before and at 6, 12, and 24 months after surgery. Patients were divided into 2 groups at each follow-up: (1) those with successful treatment and (2) those with unsuccessful treatment. Treatment success was defined as simultaneous fulfilment of 3 criteria: clinically significant improvement in pain, expectations for surgery met, and patient satisfied with surgery.

A total of 214 subjects met the inclusion criteria. UCLASS was a consistent significant predictor of treatment success at 6 months (odds ratio [OR] 1.192, P = .005, 95% confidence interval [CI] 1.054-1.348), 12 months (OR 1.274, P < .001, 95% CI 1.153-1.406), and 24 months (OR 1.266, P < .001, 95% CI 1.162-1.380). Lower preoperative CSS was significant in predicting treatment success at 6 months (OR 0.952, P = .001, 95% CI 0.926-0.979), while larger tear size was significant in predicting treatment success at 24 months (OR 1.773, P = .043, 95% CI 1.019-3.083).

UCLASS is a better tool for predicting treatment success than CSS and OSS in patients undergoing arthroscopic rotator cuff repair, up to a minimum of 24 months’ follow-up. A holistic assessment of shoulder function, taking into account both subjective and objective evaluation of function, as well as patient-reported satisfaction, is important in determining treatment success after arthroscopic rotator cuff repair.

III, retrospective comparative study.

• Bankart
• Latarjet
• maximal medical improvement
• minimal clinically important difference
• shoulder dislocation
• shoulder stabilization
• value

• patient-reported outcomes
• recall bias
• retrospective
• rotator cuff

The Oxford Shoulder Score (OSS) is a simple and reliable, joint-specific, self-reported outcome measure. It can be applied in patients with shoulder disease other than instability. The purpose of this study was to perform a translation, cultural adaptation of the Polish version of the OSS and to evaluate its selected psychometric properties in patients after arthroscopic rotator cuff repair.

Sixty-nine subjects participated in the study, with a mean age 55.5 (ranging from 40 to 65 years). The OSS has been translated using the widely accepted guidelines. All patients completed the Polish version of OSS (OSS-PL), the short version of the Disabilities of Arm, Shoulder and Hand Questionnaire (QuickDASH), the Short Form-36 v. 2.0 (SF-36) and the 7-point Global Rating of Change Scale (GRC).

High internal consistency of 0.96 was found using Cronbach’s alpha coefficient. Reliability of the OSS resulted in Intraclass Correlation Coefficient (ICC) = 0.99, Standard Error of Measurement (SEM) = 1.14 and Minimal Detectable Change (MDC) = 3.15. The validity analysis showed a moderate (General health r = 0.34) to high (Physical role functioning r = 0.82) correlation between the OSS-PL and SF-36 and a high correlation between the OSS-PL and the QuickDASH (r = − 0.92).

The Polish version of OSS is a reliable and valid, self-reported questionnaire, which can be applied in patients with a rotator cuff tear undergoing reconstruction surgery. The very good psychometric properties of the Polish version of the OSS indicate that it can be used in clinical practice and scientific research.

• Oxford shoulder score
• Patient-reported outcomes
• Reliability
• Rotator cuff
• Shoulder
• Validity

• equivalent Constant Shoulder Score
• equivalent Oxford Shoulder Score
• equivalent QuickDASH
• outcome scores
• shoulder

• Juvenile idiopathic arthritis
• juvenile rheumatoid arthritis
• resurfacing hemiarthroplasty
• shoulder arthroplasty
• shoulder replacement
• shoulder resurfacing

• Shoulder arthroplasty
• economically disadvantaged
• insurance
• low income
• medicaid
• socioeconomic

• American Orthopaedic Foot and Ankle Society
• Foot and Ankle Outcome Score
• health survey
• mobile phone
• musculoskeletal assessment questionnaires

To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.

Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD^® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score.

Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.

TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.

• Anatomical shoulder arthroplasty
• Stemless
• Omarthrosis
• Total shoulder replacement
• Joint geometry