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Massive, irreparable rotator cuff tears, if left untreated, may result in cuff tear arthropathy, which causes shoulder disability and pain. The primary outcome of this systematic review was to evaluate differences in functional outcomes between the arthroscopic superior capsular reconstruction (SCR) and latissimus dorsi tendon transfer (LDTT) for the treatment of massive, irreparable posterosuperior rotator cuff tears without arthritis. The secondary outcome was to compare complication and reoperation rates between the two surgical procedures.The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched using keywords, and 20 studies were included in this review. Data extracted for quantitative analysis included the American Shoulder and Elbow Surgeons (ASES) score, the Constant-Murley score (CMS), the subjective shoulder value (SSV), the range of motion (ROM), the visual analog scale (VAS) for pain, numbers and types of complications and reoperation rate. The preoperative fatty degeneration of the muscles and the preoperative and follow-up acromio-humeral distance (AHD) and glenohumeral osteoarthritis according to the Hamada grading system were also reported.A total of 1112 patients were identified, among whom 407 and 399 underwent SCR and LDTT, respectively. The SCR group showed a higher mean age at the time of operation (64.5±7.8 vs. 62.1±8.9 years; p0.001). The SCR group showed a lower rate of previous surgical procedures on the shoulder (35 out of 407 vs. 111 out of 399; p0.001) and a shorter mean follow-up (30.4±7.5 vs. 36.3±10.3 months; p0.001). Patients who underwent SCR reported significantly better functionality and residual pain as measured by the CMS (75.5±11.2 vs. 65.6±22.8, p0.001), ASES (84.3±13 vs. 67.7±23, p0.001), SSV (79.4±13 vs. 64.4±23,p0.001), and VAS (1.4±2 vs. 2.8±3,p0.001) than patients who underwent LDTT. A greater AHD (5.8±2.5 vs. 7.6±2.7, p0.001) was found in the SCR group. The SCR group showed a significantly lower infection rate (0.2% vs. 2.8%., p=0.003), and an higher graft failure rate (12.3% vs. 6.8%, p=0.012). No differences in terms of reoperation for graft failure (1% vs. 2.3% for SCR and LDTT, respectively; p=0.172) or for conversion to reverse total shoulder arthroplasty (1.7% vs. 2% for SCR and LDTT, respectively; p=0.800) were found.Patients undergoing SCR report better functional outcomes and greater AHD than LDTT. The LDTT group shows a significantly higher infection rate, while the SCR group shows a significantly higher graft failure rate, but there are no differences in terms of reoperation between the two surgical procedures.

To evaluate the efficacy of selective interleukin (IL)-1 inhibitor therapy in the reduction of posttraumatic osteoarthritis (PTOA) progression following knee ligament or meniscal injury.A systematic review was conducted evaluating the disease-modifying efficacy of selective IL-1 inhibition in the setting of knee PTOA.The literature search identified 364 articles and 11 studies were included (n = 10 preclinical, n = 1 clinical). Drug delivery in preclinical studies was administered using IL-1Ra-encoded helper-dependent adenovirus particles (n = 3), synovial cells transfected with an IL-1Ra-encoded retroviral vector (n = 3), or varying chemical compositions of nonviral microcapsule gene carriers (n = 4). Intervention with selective IL-1 inhibitor therapy within 2 weeks of injury provided the greatest protective benefits in reducing the progression of PTOA regardless of drug delivery methodology in preclinical models. The majority of studies reported significantly better cartilage integrity and reduction in lesion size in animals treated with gene therapy with the greatest effects seen in those treated within 5 to 7 days of injury.Early intervention with selective IL-1 inhibitor therapy were effective in reducing proinflammatory IL-1β levels in the acute and subacute phases following traumatic knee injury in preclinical animal model studies, while significantly reducing cartilage damage, lesion size, and PTOA progression at short-term follow-up. However, it was found that the effect of these therapies diminished over time.Acute, intra-articular injection of selective IL-1 inhibitors may reduce PTOA progression, supporting the need for additional basic and clinical investigation.

Background This systematic review investigated the outcomes of revision surgery after periprosthetic ankle infection (PAI). Methods According to the PRISMA statement, 9 studies with 131 PAIs surgically treated and analyzed were included. Demographics and surgical techniques with eradication rates and complications were reported. Results Methicillin-sensitive Staphylococcus aureus (MSSA) (30.4%) and coagulase-negative Staphylococcus (CNS) (26.5%) were the most common microorganisms. The eradication rate was 91.7% with permanent antibiotic spacers (SPC), 84.4% with 2-stage, 79.4% with arthrodesis (AA), and 58.8% with debridement and implant retention (DAIR). DAIR showed a significantly lower eradication rate than 2-stage (p = 0.016) and SPC (p = 0.043). Amputations occurred in 25% of patients after SPC, 8.8% after AA and 3.9% after DAIR. SPC showed a significantly higher amputation rate than DAIR and 2-stage (p = 0.044, and p = 0.017, respectively). Conclusions SPC and 2-stage revision show the highest eradication rates, but 2-stage has a lower risk of amputation.

Meniscus root tears are increasingly being recognized and treated because of improved awareness and diagnostics. These injuries commonly occur in combination with knee ligament injuries. Untreated posterior meniscus root teats have been demonstrated to increase contact pressure and decrease contact area, ultimately leading to unfavorable joint loading and development of early osteoarthritis. Posterior lateral meniscus root tears (PLMRTs) also have been reported to increase anterior tibial translation and pivot shift in anterior cruciate ligament-deficient knees. Therefore, it is crucial to repair meniscal root tears when possible to restore knee joint loading and kinematics. Several techniques for repair of the PLMRT have been described. In this Technical Note, we describe our preferred technique for repair of PLMRT using an all-suture anchor. This technique is reproducible, does not need a tunnel, mitigates bungee effect of transtibial technique, and the anchor can easily be inserted on the footprint without a need for a guide.

Background Our purpose was to identify the 100 most cited articles in the shoulder surgery literature published in past decade and to compare them with the 100 most cited “classic” shoulder surgery articles to identify trends in the topics of shoulder research. Methods Using the term “shoulder,” we searched the Clarivate Analytics’ Web of Science Core Collection database for 2 periods: 2010 through 2019 (“contemporary group,” n = 12,394) and 1900 through 2009 (“classic group,” n = 8790). We used the database sort function to order articles by number of citations. Titles, abstracts, and, when necessary, full text were screened to determine relevance to orthopedic shoulder topics until the 100 most cited articles were determined for each group. We analyzed the following article characteristics: title, author(s), publication year, journal, geographic origin, article type (clinical vs basic research), study design, and level of evidence (for clinical articles). P Results The 3 journals with the most articles in the contemporary group were the American Journal of Sports Medicine (AJSM) (28%), the Journal of Shoulder and Elbow Surgery (JSES) (28%), and the Journal of Bone and Joint Surgery, American volume (JBJS Am) (23%). The top 3 journals in the classic group were JBJS Am (45%), AJSM (16%), and JSES (15%). The 3 most frequent topics in the contemporary group were rotator cuff tear (43%), instability (14%), and fractures (10%); those in the classic group were pathoanatomy (29%), rotator cuff (28%), and instability (17%). Compared with the classic group, the contemporary group had more articles on outcomes of common shoulder procedures, including rotator cuff repair (25% vs. 17%), arthroplasty (21% vs. 15%), arthroscopy (17% vs. 11%), reverse shoulder arthroplasty (13% vs. 7%), and the Latarjet procedure (7% vs. 2%). More articles reporting complications were found in the contemporary (9%) than in the classic (2%) group (P = .03). The contemporary group contained articles on topics not found in the classic group, such as platelet-rich plasma (8%), scaffolds (3%), infection (3%), Cutibacterium acnes (2%), stem cells (2%), superior capsular reconstruction (2%), bony increased offset reversed shoulder arthroplasty (2%), opioid issues (1%), and tendon transfer (1%). Conclusion The most cited studies from 1900 to 2009 and 2010 to 2019 reported on the rotator cuff and shoulder instability. The most cited articles from 2010 to 2019 reflect the development of shoulder arthroscopy, shoulder arthroplasty, treatment of surgical complications, and augmentation or biologic interventions for rotator cuff repair. Level of evidence Level IV; Review Article

To investigate associations between clinical and demographic parameters and Constant-Murley (CM) scores after subacromial balloon placement for massive, irreparable rotator cuff tears and to evaluate implant survival, shoulder function, and patient satisfaction.We prospectively analyzed patients with rotator cuff tears deemed irreparable on preoperative magnetic resonance imaging for whom nonoperative therapy was unsuccessful and who underwent balloon placement from 2014 to 2017 with minimum 1-year follow-up. Shoulder function was assessed using the CM score and the 12-Item Short Form Health Survey.The study included 51 patients (22 women and 29 men) with a mean age at surgery of 63 years (range, 50-78 years). The mean follow-up period was 36 months (range, 24-56 months). The postoperative acromiohumeral interval and total preoperative CM score predicted the postoperative CM score at final follow-up. The implant survival rates were 92% at 6 and 12 months, 90% at 2 years, and 87% at 3 and 4 years. Five patients underwent reverse total shoulder arthroplasty, and 1 underwent latissimus dorsi tendon transfer. Postoperatively, mean CM scores (± standard deviation) improved for range of motion (from 11 ± 5.4 to 34 ± 6.8) and strength (from 13 ± 5.4 to 28 ± 12) (P.01 for both). The total CM score improved from 27 ± 7.4 preoperatively to 77 ± 15 postoperatively (P.01). The physical and mental component summary scores on the 12-Item Short Form Health Survey improved from 27 ± 5.0 to 51 ± 6.5 (P = .02) and from 44 ± 15 to 56 ± 8.0, respectively (P.01). Thirty-eight patients reported excellent satisfaction, 8 were satisfied, and 5 were dissatisfied. Of the patients, 50 (98%) exceeded the minimal clinically important difference (≥10.4) and patient acceptable symptom state (≥44).At mean 3-year follow-up, subacromial balloon spacer placement for massive, irreparable rotator cuff tears was associated with a significant improvement in shoulder function, limited need for revision surgery, and high patient satisfaction. A greater postoperative acromiohumeral interval and lower preoperative CM score predicted a lower postoperative CM score at final follow-up.Level IV, retrospective cohort study and treatment study.

The aim of this study was to update the current evidence on functional outcomes, complications, and reoperation rates between cemented and cementless total knee arthroplasty (TKA) by evaluating comparative studies published over the past 15 years.The PubMed, MEDLINE, Scopus, and the Cochrane Central databases were used to search keywords and a total of 18 studies were included. Random and fixed effect models were used for the meta-analysis of pooled mean differences (MDs) and odds ratios (ORs).A total of 5,222 patients were identified with a mean age of 64.4 ± 9.4 and 63 ± 8.6 years for the cemented and cementless TKA groups, respectively. The mean follow-up was 107.9 ± 30 and 104.3 ± 10 months for the cemented and cementless TKA groups, respectively. Cemented TKA showed a significantly greater postoperative Knee Society Score (MD = -0.95, 95% CI [-1.57, 0.33], P = .003) and range of motion (MD = -1.09, 95% CI [-1.88, -0.29], P = .0007), but no differences in other outcome scores were found. The incidence of periprosthetic joint infection, radiolucent lines, instability, and polyethylene wear was also comparable. Cemented TKA showed less perioperative blood loss (SMD = -438.41, 95% CI [-541.69, -35.14], P.0001) but a higher rate of manipulation under anesthesia (OR = 3.39, 95% CI [1.64, 6.99], P = .001) and aseptic loosening (OR = 1.62, 95% CI [1.09, 2.41], P = .02) than cementless TKA. No differences were found in terms of the reoperation rate.When cemented and cementless fixations are compared in primary TKA, comparable functional outcomes and reoperation rates can be achieved. Cemented TKA showed less blood loss but a higher rate of manipulation under anesthesia and aseptic loosening.

As total shoulder arthroplasty has become more popular, the number of complications and failures are increasing. Surgeons performing the procedure and patients considering the surgery need to understand the factors that may determine success or failure. The most common predictors of failure are the indication for surgery (patient factors), the type of implant used (arthroplasty implant factors), and the skill of the surgeon (surgical factors). The aim of this review is to delineate the factors that may be associated with an increase in the risk of total shoulder arthroplasty failure.

One of the most serious complications after shoulder arthroplasty is periprosthetic joint infection. The reported incidence after primary procedures ranges from 0.7% to 4%, and the rates after revision surgery are even higher. Data on periprosthetic joint infection are derived in large part from the reported experience in managing infection at the sites of total knee and total hip arthroplasties; there is much less information available with which to guide decision making for the shoulder. This review focuses specifically on the current and future tools for diagnosing periprosthetic infections after shoulder arthroplasty.

Rotator cuff tear arthropathy is characterized by massive and irreparable rotator cuff tears associated with shoulder arthritis. Symptoms include varying degrees of pain, loss of motion, and loss of function, or "pseudo-paralysis" alone. Nonoperative modalities are the treatment mainstay for mildly symptomatic patients, and there are viable medical and surgical treatment options for those whose symptoms are not severe enough to warrant shoulder arthroplasty. The trend toward using reverse total shoulder arthroplasty as the only treatment for this highly variable patient group does not allow a cautious approach to this disease nor recognize the high potential complication rate of the reverse prosthesis.

Most studies and reviews on the treatment of rotator cuff abnormality as it relates to total shoulder arthroplasty have focused on subscapularis tendon tears before or after total shoulder arthroplasty. There is an increasing appreciation that rotator cuff dysfunction after total shoulder arthroplasty is more common than once believed and that the abnormality often involves the supraspinatus tendon. This review focuses specifically on the impact of tears of the supraspinatus tendon on preoperative planning for total shoulder arthroplasty and also on the evaluation and treatment of supraspinatus tears after total shoulder arthroplasty.