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Background: Determining the presence of bacteria in the shoulder prior to shoulder arthroplasty can be challenging especially in the case of revision arthroplasty. An open biopsy provides an opportunity to obtain tissue samples with minimal patient morbidity. The purpose of this study was to characterize the diagnostic utility of an open shoulder biopsy. Methods: A retrospective cohort study was performed at an academic medical center. All patients that underwent an open shoulder biopsy using a small proximal deltopectoral incision between 2008 and 2021 were included. Demographics, surgical history, culture results, and development of subsequent infection were recorded. Subsequent infection was defined as the development of a sinus tract, purulent drainage, or revision surgery with greater than or equal to two tissues specimens with growth of the same bacterial species. Sensitivity and negative predictive value (NPV) of an open biopsy were calculated based on the development of subsequent infection. As culture positive patients were treated for their infection, positive predictive value and specificity could not be determined. Results: We identified 55 patients that underwent 75 open biopsies. Most patients had a shoulder arthroplasty in place at the time of biopsy (69.1%), while 23.6% had an antibiotic spacer, and 7.3% had a native shoulder. Patients with a history of infection were more likely to have a spacer in place at the time of biopsy (65% vs. 0%; P

The utilization of free bone grafts to reconstruct large anterior glenoid defects has increased. Distal tibia allograft is commonly used due to its lack of donor site morbidity, ability to restore large bony defects, and near anatomic osteoarticular restoration. However, the intact coracoid and conjoint tendon often impair adequate visualization and access to perform an anatomic reconstruction during open free bone graft reconstruction and often requires violation of the subscapularis tendon to gain exposure. We present a surgical technique wherein we perform a coracoid osteotomy and subsequent repair to improve visualization when performing an open free glenoid bone graft in the setting when a patient has not undergone a prior coracoid transfer that does not require violation of the subscapularis tendon. This technique demonstrates excellent functional outcomes as well as radiographic healing of the coracoid osteotomy without pain or prominent hardware at the coracoid.

Background: To perform an analysis of intraoperative costs associated with arthroscopic rotator cuff repair (RCR) acellular dermal allograft patch augmentation and interposition. Methods: This was a matched cohort retrospective cost identification analysis. We identified patients who underwent arthroscopic RCR with acellular dermal allograft patch augmentation or interposition between 2014 and 2023 at a single academic center. These were matched based on age and tear size to a cohort of patients who underwent arthroscopic RCR without a patch. Patients without preoperative MRI data were excluded. Via chart review, we collected demographics, medical comorbidities, tear characteristics, and intraoperative repair characteristics. Patch and control patients were compared with paired t tests. Differences in costs between patch and control patients were assessed using multivariable regression controlling for observable covariates. Results: One hundred and thirty-two (132) total patients were included: 66 patch patients and 66 control patients. The patch group demonstrated more tear retraction and utilized single row medial repair more frequently. Multivariable analysis revealed that there was a $4930 total direct cost increase with the utilization of a patch (P