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Background: 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 rate (CPR) of different types of arthroplasties conducted for primary osteoarthritis in patients under 55 years of age., Methods: This comparative observational national registry study included all shoulder arthroplasty for osteoarthritis in patients under 55 years of age undertaken between January 1 st , 2005, and December 31 st , 2022. Partial hemi resurfacing and hemi stemless procedures were excluded. The cumulative percentage of revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for gender. Reasons for revision of each type of arthroplasty and cumulative incidence of revision diagnoses were analyzed., Results: 2111 primary shoulder arthroplasties were compared. Glenoid erosion is the predominant cause of revision for humeral resurfacing (29.8%) and hemiarthroplasty (35.5%). Instability is the predominant cause of revision for stemmed anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA), while loosening is the predominant cause of revision for stemless ATSA. The 6-year CPR is 12.8% for humeral resurfacing (HRA), 14.1% for hemiarthroplasty (HA), 12.4% for stemmed (ATSA), 7.0% for stemless ATSA, and 6.5% for (RTSA). Stemmed ATSA had a higher revision rate than RTSA (entire period HR=2.04 (95% confidence interval (CI) 1.16, 3.57), p=0.012). In contrast, the revision rate of stemless ATSA was not different from RTSA (HR =1.05 (95% CI 0.51, 2.19), p=0.889). Males outnumber females for all shoulder arthroplasty categories., Discussion: RTSA and stemless ATSA are viable options in young patients with primary osteoarthritis. Their short-to medium-term revision rates are comparable to those of older patients and lower than those associated with HRA, HA, and stemmed ATSA., Conclusion: In the predominantly male patient population under the age of 55, reverse shoulder arthroplasty and stemless ATSA have a lower short-term revision risk than stemmed ATSA., (Copyright © 2024. Published by Elsevier Inc.)

Background: Surgically repairing rotator cuff tears with a higher extent of fatty infiltration (FI) is controversial. Current evidence supports performing rotator cuff repair in patients exhibiting Goutallier stage 3-4 FI. However, the presence of retraction complicates accurate assessment using the Goutallier Classification, particularly on the lateral Y-view. A shift toward classifying FI in more medial regions may enhance the precision of tissue quality quantification. The objective of this study was to analyze the uniformity of FI within the entire supraspinatus muscle using the Goutallier Classification across 3 scapular Y-view sections and to examine the association between Goutallier grade, tangent sign, and modified Patte stage., Methods: A retrospective evaluation was conducted on preoperative magnetic resonance imaging scans from a consecutive series of 97 patients who had previously undergone arthroscopic rotator cuff repairs. Three supraspinatus sections on the magnetic resonance imaging sagittal plane were identified: the lateral Y-view (section 1), a medial section at the suprascapular notch anatomical landmark (section 2), and a section 3 cm medial from the suprascapular notch Medial Scapular Body (section 3). Goutallier grade, tangent sign, and modified Patte stage were used to evaluate FI, muscle atrophy, and tendon retraction, respectively., Results: Section 1 had the highest Goutallier grade, while section 3 had the lowest. Intraobserver rest retest reliability analysis showed excellent consistency in all sections with section 2 (intraclass correlation coefficient [ICC] = 0.920, 95% confidence interval [CI]), section 2 (ICC = 0.917, 95% CI), and section 3 (ICC = 0.923, 95% CI) for Goutallier grade. Interobserver reliability analysis also revealed excellent consistency in section 1 (ICC = 0.951, 95% CI), section 2 (ICC = 0.949, 95% CI), and section 3 (ICC = 0.922, 95% CI) for Goutallier grade. A strong correlation was observed between Goutallier grade and modified Patte stage (τb = 0.43-0.56, P = .001), and between Goutallier grade and tangent sign (τb = 0.43-0.54, P = .001) across all sections., Conclusion: The severity of FI within the supraspinatus muscle belly is inconsistent, with the lateral portion being the most severe and the medial portion the least severe. Goutallier grade demonstrates a strong correlation with tangent sign and modified Patte stage. This suggests that tendon retraction results in a potential overestimation in the amount of FI defining some tears unjustly irreparable when measuring at the traditionally described lateral Y-view position compared with 3 cm medial., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The degree of atrophy and fatty infiltration of rotator cuff muscle belly is a key predictor for cuff repairability. Traditionally, Goutallier grading of fatty infiltration is assessed at sagittal scapular Y-view. Massive rotator cuff tears are associated with tendon retraction and medial retraction of cuff musculature, resulting in medialization of the muscle bulk. Thus, standard Y-view can misrepresent the region of interest and may misguide clinicians when assessing repairability. It is hypothesized that by assessing the muscle belly with multiple medial sagittal magnetic resonance imaging (MRI) sections at the medial scapular body, the Medial Scapular Body-Goutallier Classification (MSB-GC) will improve reliability and repeatability, giving a more representative approximation to the degree of fatty infiltration, as compared with the original Y-view., Methods: Fatty infiltration of the rotator cuff muscles were classified based on the Goutallier grade (0-4) at 3 defined sections: section 1, original Y-view; section 2, level of suprascapular notch; and section 3, 3 cm medial to the suprascapular notch on MRI scans. Six subspecialist fellowship-trained shoulder surgeons and 3 musculoskeletal radiologists independently evaluated deidentified MRI scans of included patients., Results: Of 80 scans, 78% (n = 62) were massive cuff tears involving the supraspinatus, infraspinatus, and subscapularis tendons. Interobserver reliability (consistency between observers) for Goutallier grade was excellent for all 3 predefined sections (range: 0.87-0.95). Intraobserver reliability (repeatability) for Goutallier grade was excellent for all 3 sections and 4 rotator cuff muscles (range: 0.83-0.97). There was a moderate to strong positive correlation of Goutallier grades between sections 1 and 3 and between sections 2 and 3 and these were statistically significant (P < .001). There was a reduction in the severity of fatty infiltration on the Goutallier classification from sections 1 to 3 across all muscles: 42.5% of both supraspinatus and infraspinatus were downgraded by 1, 20% of supraspinatus and 3.8% of infraspinatus were downgraded by 2, and 2.5% of supraspinatus were downgraded by 3., Conclusion: This study found that applying the Goutallier classification to more medial MRI sections (MSB-GC) resulted in assignment of lower grades for all rotator cuff muscles. Additionally, this method demonstrated excellent test-retest reliability and repeatability. Inclusion of a more medial view or whole scapula on MRI, especially in advanced levels of tear retraction, could be more reliable and representative for assessment of the degree of fatty infiltration within the muscle bulk that could help predict tear repairability and therefore improve clinical decision making, which should be studied further in clinical studies., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Hypothesis: This study determined the response shift in patients undergoing rotator cuff repair using the Western Ontario Rotator Cuff index (WORC), a disease-specific quality of life questionnaire. We hypothesized there would be a response shift with a positive recalibration (overestimated their preoperative disability) on the WORC and increases over time., Methods: The study prospectively included 36 patients undergoing arthroscopic rotator cuff repair. At baseline, 3 months (T1), and 1 year (T2) after surgery the WORC, EuroQol (EQ)-5D-3L, and the patient's level of satisfaction after surgery were scored. To evaluate the response shift, patients also completed the WORC at 3 months (Pre-T1) and 1 year (Pre-T2) as how they perceived themselves to have been before surgery., Results: The result on Pre-T1 and Pre-T2 results revealed that patients retrospectively rated their overall WORC score comparable with the baseline WORC score (Pre-T0; T0 = 40.5 ± 18.4, Pre-T1 = 45.0 ± 22.7, Pre-T2 = 34.3 ± 21.3). No response shift was observed on all domains except a negative recalibrated response shift for emotional disability on T1 (P = .04)., Conclusions: No significant group-level response shift was observed using the WORC, except for the subdomain emotional disability at 3 months after arthroscopic rotator cuff repair. With the absence of any shift in patient's perception on the self-administered quality of life-related WORC questionnaire, this study suggests one could retrospectively reliably conduct group-level preoperative baseline information on quality of life up to 1 year after surgery., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)