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Hubert Laprus St Luke’s Hospital, Bielsko-Biala, Poland
Dworska Hospital, Kraków, Poland
Hospital in Proszowice, Poland

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Bartłomiej Juszczak University Children’s Hospital in Kraków, Poland

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Roman Brzóska St Luke’s Hospital, Bielsko-Biala, Poland

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Adrian Błasiak St Luke’s Hospital, Bielsko-Biala, Poland

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Ion-Andrei Popescu Romanian Shoulder Institute -ORTOPEDICUM, Bucharest, Romania

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Przemysław Lubiatowski Rehasport Clinic, Poznań, Poland

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  • Rotator cuff tears (RCT) and instability are the most common surgically treated shoulder pathologies.

  • The concept of augmentation using the long head of the biceps tendon (LHBT) autograft was created to improve the results of surgical treatment of these pathologies, especially in cases of chronic and massive injuries.

  • The popularity of using the LHBT for augmentation is evidenced by the significant number of publications on this topic published in the last 3 years; however, only one systematic review has been published regarding only LHBT augmentation for massive RCTs.

  • Several studies comparing partial repair with partial repair and additional LHBT augmentation for RCT showed superior clinical outcomes and lower re-tear rates when LHBT augmentation was performed.

  • There is a rising popularity of using LHBT as an autograft to perform superior capsule reconstruction (SCR) in case of irreparable rotator cuff tears.

  • In recent years, shoulder stabilization by arthroscopic Bankart repair with biceps augmentation has been promoted with very promising short-term results.

  • The evidence provided by studies appears to be sufficient to recommend the use of LHBT for augmentation whenever necessary; however, larger studies with long-term follow-up are needed.

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Ulas Can Kolac Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey

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Alp Paksoy Charité University Hospital, Center for Musculoskeletal Surgery, Berlin, Germany

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Doruk Akgün Charité University Hospital, Center for Musculoskeletal Surgery, Berlin, Germany

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  • Accurate component placement in shoulder arthroplasty is crucial for avoiding complications, achieving superior biomechanical performance and optimizing functional outcomes.

  • Shoulder and elbow surgeons have explored various methods to improve surgical understanding and precise execution including preoperative planning with 3D computed tomography (CT), patient-specific instrumentation (PSI), intraoperative navigation, and mixed reality (MR).

  • 3D preoperative planning facilitated by CT scans and advanced software, enhances surgical precision, influences decision-making for implant types and approaches, reduces errors in guide pin placement, and contributes to cost-effectiveness.

  • Navigation demonstrates benefits in reducing malpositioning, optimizing baseplate stability, improving humeral cut, and potentially conserving bone stock, although challenges such as varied operating times and costs warrant further investigation.

  • The personalized patient care and enhanced operational efficiency associated with PSI are not only attractive for achieving desired component positions but also hold promise for improved outcomes in complex cases involving glenoid bone loss.

  • Augmented reality (AR) and virtual reality (VR) technologies play a pivotal role in reshaping shoulder arthroplasty. They offer benefits in preoperative planning, intraoperative guidance, and interactive surgery. Studies demonstrate their effectiveness in AR-guided guidewire placement, providing real-time surgical advice during reverse total shoulder arthroplasty (RTSA). Additionally, these technologies show promise in orthopedic training, delivering superior realism and accelerating learning compared to conventional methods.

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Alp Paksoy Charité University Hospital, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, Germany

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Doruk Akgün Charité University Hospital, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, Germany

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Sebastian Lappen Schulthess Klinik, Lengghalde 2, Zurich, Switzerland

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Philipp Moroder Schulthess Klinik, Lengghalde 2, Zurich, Switzerland

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  • Posterior shoulder instability (PSI) is less common than anterior shoulder instability, accounting for 2–12% of total shoulder instability cases.

  • However, a much higher frequency of PSI has been recently indicated, suggesting that PSI accounts for up to 24% of all young and active patients who are surgically treated for shoulder instability.

  • This differentiation might be explained due to the frequent misinterpretation of vague symptoms, as PSI does not necessarily present as a recurrent posterior instability event, but often also as mere shoulder pain during exertion, limited range of motion, or even as yet asymptomatic concomitant finding.

  • In order to optimize current treatment, it is crucial to identify the various clinical presentations and often unspecific symptoms of PSI, ascertain the causal instability mechanism, and accurately diagnose the subgroup of PSI.

  • This review should guide the reader to correctly identify PSI, providing diagnostic criteria and treatment strategies.

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Anna E van der Windt Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands

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Lisette C Langenberg Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands

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Joost W Colaris Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands

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Denise Eygendaal Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands

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  • Despite the common occurrence of radial head fractures, there is still a lack of consensus on which radial head fractures should be treated surgically.

  • The radial head is an important secondary stabilizer in almost all directions. An insufficient radial head can lead to increased instability in varus–valgus and posterolateral rotatory directions, especially in a ligament-deficient elbow.

  • The decision to perform surgery is often not dictated by the fracture pattern alone but also by the presence of associated injury. Comminution of the radial head and complete loss of cortical contact of at least one fracture fragment are associated with a high occurrence of associated injuries.

  • Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. Displacement (>2 mm) of fragments in radial head fractures without a mechanical block to pronation/supination is not a clear indication for surgery.

  • Mechanical block to pronation/supination and comminution of the fracture are indications for surgery.

  • The following paper reviews the current literature and provides state-of-the-art guidance on which radial head fractures should be treated surgically.

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Hongfu Jin Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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Shide Jiang Department of Orthopaedics, The Central Hospital of Yongzhou, Yongzhou, Hunan, China

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Volotovski Pavel Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Belarus

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Djandan Tadum Arthur Vithran Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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Wenfeng Xiao Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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Yusheng Li Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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  • Reverse total shoulder arthroplasty (rTSA) has been demonstrated to be an effective intervention for various shoulder disorders. The number of rTSA-related studies performed has increased annually over the past three decades.

  • The Journal of Shoulder and Elbow Surgery had the highest number of publications and citations in the rTSA-related research domain and is therefore considered to be the most influential journal in this field.

  • The USA published the most publications and established a high degree of cooperation with many countries worldwide. The University of Florida, the Hospital for Special Surgery, and Rush University, Mayo Clinic were representative and active institutions in this field.

  • It is anticipated that advancements in prosthesis design, specifically with regards to lateralized design concepts, expanding indications for rTSA, a trend toward younger patient populations, and the management of postoperative complications will emerge as research hotspots in the following years.

  • The most valuable publications, influential journals, major researchers, and leading countries were analyzed. The findings of our study will help researchers gain insights into current research hotspots and frontiers and shape their research focus in the field of rTSA.

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Victor Housset Clinique de l'épaule, Clinique Maussins-Nollet, Paris, France

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Sean Wei Loong Ho Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore

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Alexandre Lädermann Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland
FORE (Foundation for Research and Teaching in Orthopedics, Sports Medicine, Trauma, and Imaging in the Musculoskeletal System), Meyrin, Switzerland
Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

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Sean Kean Ann Phua Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore

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Si Jian Hui Department of Orthopaedic Surgery, National University Health System, Singapore

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Geoffroy Nourissat Clinique de l'épaule, Clinique Maussins-Nollet, Paris, France

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Purpose

  • A variety of instabilities are grouped under multidirectional instability (MDI) of the shoulder. This makes understanding its diagnostic process, presentation and treatment difficult due to lack of evidence-based consensus. This review aims to propose a novel classification for subtypes of MDI.

Methods

  • A systematic search was performed on PubMed Medline and Embase. A combination of the following 'MeSH' and 'non-MesH' search terms were used: (1) Glenohumeral joint[tiab] OR Glenohumeral[tiab] OR Shoulder[tiab] OR Shoulder joint[tiab] OR Shoulder[MeSH] OR Shoulder joint[MeSH], (2) Multidirectional[tiab], (3) Instability[tiab] OR Joint instability[MeSH]. Sixty-eight publications which met our criteria were included.

Results

  • There was a high degree of heterogeneity in the definition of MDI. Thirty-one studies (46%) included a trauma etiology in the definition, while 23 studies (34%) did not. Twenty-five studies (37%) excluded patients with labral or bony injuries. Only 15 (22%) studies defined MDI as a global instability (instability in all directions), while 28 (41%) studies considered MDI to be instability in two directions, of which one had to include the inferior direction. Six (9%) studies included the presence of global ligamentous laxity as part of the definition. To improve scientific accuracy, the authors propose a novel AB classification which considers traumatic etiology and the presence of hyperlaxity when subdividing MDI.

Conclusion

  • MDI is defined as symptomatic instability of the shoulder joint in two or more directions. A comprehensive classification system that considers predisposing trauma and the presence of hyperlaxity can provide a more precise assessment of the various existing subtypes of MDI.

Level of Evidence

  • III

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Heri Suroto Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

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Benedictus Anindita Satmoko Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

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Tabita Prajasari Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

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Brigita De Vega Division of Surgery and Interventional Science, University College London, Royal Free Hospital Campus, United Kingdom

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Teddy Heri Wardhana Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

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Steven K Samijo Department of Orthopedic and Traumatology, Zuyderland Medisch Centrum, Heerlen, Netherlands

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Purpose

  • The use of non-biodegradable suture anchors (NBSA) in arthroscopic rotator cuff repair (RCR) has increased significantly. However, several complications such as migration, chondral damage, revision, and imaging difficulties have been reported. Meanwhile, the effectiveness of biodegradable suture anchors (BSA) in overcoming such complications and achieving functional outcomes requires further study. Thus, we aim to compare the clinical outcomes and complications of RCR using BSA and NBSA using direct comparison studies.

Methods

  • Two independent reviewers conducted systematic searches in PubMed, Embase, Cochrane Library, and Web of Science from conception to September 2022. Using the RoB 2 and ROBINS-I tools, we assessed the included studies for bias. We applied GRADE to appraise our evidence. Our PROSPERO registration number is CRD42022354347.

Results

  • Six studies (two randomized controlled trials, one retrospective cohort, and three case–control studies) involving 423 patients were included (211 patients received BSA and 212 patients received NBSA). BSA was comparable to NBSA in forward flexion, abduction, external rotation, Constant–Murley score, and perianchor cyst formation (P = 0.97, 0.81, 0.56, 0.29, and 0.56, respectively). Retear rates were slightly higher while tendon healing was reduced in BSA compared to NBSA, but the differences were not significant (P = 0.35 and 0.35, respectively).

Conclusion

  • BSA and NBSA appear to yield similar shoulder functions and complications in rotator cuff repairs.

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Pududu Archie Rachuene Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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Roopam Dey Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa

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Sudesh Sivarasu Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa

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Jean-Pierre du Plessis Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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Stephen Roche Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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Basil Vrettos Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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  • Structural glenoid defects are common during primary reverse shoulder arthroplasty (RSA) and are often associated with poor outcomes.

  • The lack of pre-operative imaging protocols for determining the depth and degree of glenoid wear hinders our ability to accurately plan and correct these defects.

  • Although bone grafting has been reported to be effective in reducing glenoid wear during RSA, there is limited information on when to utilise it and how to prepare the graft.

  • We conducted this review to assess the evidence for the management of glenoid defects, with an emphasis on bone grafts to treat structural glenoid bone loss in primary RSA patients.

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Maciej Otworowski Idea Ortopedia, Warsaw, Poland

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Dariusz Grzelecki Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Otwock, Poland

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Krzysztof Starszak Department of Human Anatomy, Medical University of Silesia, Katowice, Poland

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Andrzej Boszczyk Trauma and Orthopedics Department, Centre of Posgraduate Medical Education, Otwock, Poland

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Mateusz Piorunek Medical University of Warsaw, Warsaw, Poland

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Bartłomiej Kordasiewicz Idea Ortopedia, Warsaw, Poland
Trauma and Orthopedics Department, Centre of Posgraduate Medical Education, Otwock, Poland

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Purpose

  • The goal of this study was to review available literature on periprosthetic shoulder fractures to evaluate epidemiology, risk factors and support clinical decision-making regarding diagnostics, preoperative planning, and treatment options.

Methods

  • Two authors cross-checked the PubMed and Web of Science medical databases. The inclusion criteria were as follows: original human studies published in English, with the timeframe not limited, and the following keywords were used: ‘periprosthetic shoulder fracture,’ ‘total shoulder arthroplasty periprosthetic fractures,’ ‘total shoulder arthroplasty fracture,’ and ‘total shoulder replacement periprosthetic fracture.’ Seventy articles were included in the review. All articles were retrieved using the aforementioned criteria.

Results

  • The fracture rate associated with total shoulder arthroplasty varied between 0 and 47.6%. Risk factors for periprosthetic fractures were female gender, body mass index < 25 kg/m2, smoking, rheumatoid arthritis, and Parkinson’s disease. The most commonly used classification is the Wright and Coefield classification. Periprosthetic fractures can be treated both, conservatively and operatively.

Conclusion

  • Periprosthetic fracture frequency after shoulder arthroplasty ranges from 0 to 47.6%. The most common location of the fracture is the humerus and most commonly occurs intraoperatively. The most important factor influencing treatment is stem stability. Fractures with stem instability require revision arthroplasty with stem replacement. Fractures with a stable stem depending on the location, displacement and bone stock quality can be treated both conservatively and operatively. For internal fixation plates with cables and screws are most commonly used.

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Johannes Barth Clinique des Cèdres, 21 Avenue Albert Londres, 38130 Échirolles, France

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Jerôme Garret Clinique du parc, 155, Boulevard Stalingrad, Lyon, France

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Luca Nover ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Floris van Rooij ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Philippe Clavert Service de Chirurgie du Membre Supérieur, Haut Pierre 2, CHRU Strasbourg, avenue Molière, Strasbourg, France

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The Société Francophone d'Arthroscopie *
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The Société Francophone d'Arthroscopie

  • The aim of this study is to determine whether adjuvant Distal Clavicle Resection (DCR) improves outcomes of Rotator Cuff Repair (RCR) in terms of ROM, clinical scores as well as reducing complications and/or reoperations.

  • This systematic review conforms to the PRISMA guidelines. Studies were included if they compared outcomes of RCR with and without adjuvant DCR and reported on postoperative ROM, clinical scores, complications, and/or reoperations.

  • Seven studies that comprised 1572 shoulders which underwent RCR at a follow-up ranged 8-54 months: 398 with adjuvant DCR and 1174 without DCR. No significant differences were found between patients that had DCR versus those that did not have DCR, in terms of postoperative clinical scores (ASES, Constant, pVAS), postoperative ROM (AFE, external and internal rotation), retear rate and reoperation rate.

  • There were no significant differences in ROM, clinical scores, or rates of retears and reoperations between patients that underwent RCR with or without adjuvant DCR.

  • There is insufficient evidence to support routine DCR during RCR; the incidence of new or residual acromioclavicular joint (ACJ) pain after RCR with adjuvant DCR is higher than following isolated RCR, which could in fact induce iatrogenic morbidity and therefore does not justify the additional surgery time and costs of routine adjuvant DCR.

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