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Optimal glenosphere positioning in a lateralized reverse shoulder arthroplasty (RSA) to maximize functional outcomes has yet to be clearly defined. Center of rotation (COR) measurements have largely relied on anteroposterior radiographs, which allow assessment of lateralization and inferior position, but ignore scapular Y radiographs, which may provide an assessment of the posterior and inferior position relative to the acromion. The purpose of this study was to evaluate the COR in the sagittal plane and assess the effect of glenosphere positioning with functional outcomes using a 135° inlay stem with a lateralized glenoid. A retrospective review was performed on a prospectively maintained multicenter database on patients who underwent primary RSA from 2015 to 2021 with a 135° inlay stem. The COR was measured on minimum 2-year postoperative sagittal plain radiographs using a best-fit circle fit method. A best-fit circle was made on the glenosphere and the center was marked. From there, 4 measurements were made: (1) center to the inner cortex of the coracoid, (2) center to the inner cortex of the anterior acromion, (3) center to the inner cortex of the middle acromion, and (4) center to the inner cortex of the posterior acromion. Regression analysis was performed to evaluate any association between the position of the COR relative to bony landmarks with functional outcomes. A total of 136 RSAs met the study criteria. There was no relation with any of the distances with outcome scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale). In regard to range of motion (ROM), each distance had an effect on at least 1 parameter. The COR to coracoid distance had the broadest association with ROM, with improvements in forward flexion (FF), external rotation (ER0), and internal rotation with the arm at 90° (IR90) (P <.001, P =.031, and P <.001, respectively). The COR to coracoid distance was also the only distance to affect the final FF and IR90. For every 1-mm increase in this distance, there was a 1.8° increase in FF and 1.5° increase in IR90 (β = 1.78, 95% confidence interval [CI] 0.85-2.72, P <.001, and β = 1.53, 95% CI 0.65-2.41, P <.001; respectively). Evaluation of the COR following RSA in the sagittal plane suggests that a posteroinferior glenosphere position may improve ROM when using a 135° inlay humeral component and a lateralized glenoid. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to describe outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) using a patient-specific, custom glenoid component to address severe glenoid deficiency. Methods: Retrospective chart review identified patients at a single institution undergoing rTSA using the glenoid vault reconstruction system (VRS) between 2017 and 2022. Radiographic evaluation, range of motion and patient-reported outcome (PRO) measures, complications, and re-operations were assessed. Results: Fourteen shoulders were included. There was 100% implant survivorship of the glenoid baseplate at mean follow-up of 26.6 months. Mean range of motion improved in forward elevation (62–106 degrees), abduction (41–100 degrees), and external rotation (11–36 degrees). In 7 of 13 patients available for PRO collection, the mean final Visual Analog Pain Scale (VAS) score was 1.29, Single Assessment Numeric Evaluation (SANE) score was 72.14, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score was 77.14, and Penn Shoulder score was 72.26. Conclusions: Use of this custom glenoid resulted in encouraging clinical and radiographic outcomes, with no failures in implant survivorship seen at early follow-up. Larger prospective studies with longer-term follow-up should be undertaken in order to better determine the efficacy and longevity of this implant. Study Design: Retrospective case series; Level of evidence, 4. [ABSTRACT FROM AUTHOR]

Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. It is unclear if seasonal timing of surgery affects outcomes. Patients who underwent TSA between 2015 and 2021 and were enrolled in a multicenter registry were eligible for inclusion. Date of surgery was recorded and was divided up into winter, spring, summer, and fall. Demographic data and Walch classification were recorded. Baseline strength, range of motion (ROM), and patient-reported outcomes were recorded. Patient-reported outcomes and ROM at 2 years of follow-up were assessed and compared between TSA groups for each season. Overall, 506 patients were included in the analysis. Breakdown by season was winter (N = 124), spring (N = 118), summer (N = 120), and fall (N = 144). There were no differences in baseline demographics between patients based on season of surgery or Walch classification. No difference existed in baseline ROM, clinical outcomes, or strength between seasonal groups. There were no differences in 2-year clinical outcomes, ROM, or strength between groups. There is no difference in clinical outcomes based on seasonal timing for patients who undergo TSA. Patients should feel confident that their outcomes will not vary based on the season in which they undergo TSA. [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty (TSA) remains the treatment of choice for primary glenohumeral osteoarthritis with an intact rotator cuff (PGHOA). However, reverse total shoulder arthroplasty (RSA) has gained popularity as a primary procedure in selected patients who may be at risk for postoperative rotator cuff dysfunction or glenoid loosening. The purpose of this study was to compare short-term outcomes between TSA and RSA in patients with PGHOA and limited preoperative forward flexion (FF). A retrospective review was performed on a multi-institutional registry of patients to identify patients aged less than 80 years undergoing TSA or RSA for PGHOA with preoperative FF ≤ 90°. Forty-five TSAs were identified and matched by age and sex to 45 patients undergoing RSA. A subset of 22 TSAs and 24 RSAs with severely limited preoperative FF of ≤ 70° was also analyzed. Range of motion including FF, external rotation and internal rotation, strength, and patient-reported outcomes including visual analog scale pain score, Western Ontario Osteoarthritis of the Shoulder index score, Veterans RAND 12 mental score, American Shoulder and Elbow Surgeons score, and Constant-Murley score were evaluated at a minimum of 2 years postoperative. No significant differences were observed in postoperative FF, external rotation, or strength measurements between groups. The limited FF TSA group achieved significantly improved internal rotation compared to the RSA group (L2 vs. L4, P <.002). No significant differences were observed between TSA and RSA in American Shoulder and Elbow Surgeons, visual analog scale, Constant, or Single Assessment Numeric Evaluation scores (P >.05) for both the overall comparison and subset of patients with FF of ≤ 70°. However, patients in the RSA cohort showed a significantly higher return to normal sporting activities than the TSA group. Patients aged less than 80 years with PGHOA and limited preoperative FF achieve similar postoperative range of motion and patient-reported outcomes whether treated with TSA or RSA. Therefore, limited preoperative FF does not appear to be a major determinant of outcomes for PGHOA. [ABSTRACT FROM AUTHOR]

Background: A patient-specific, 3-dimensional-printed, custom glenoid baseplate can be utilized to address severe glenoid deficiency in reverse total shoulder arthroplasty (rTSA). Indications: A 73-year-old woman with right shoulder pain, weakness, and decreased range of motion in the setting of glenohumeral arthritis with severe glenoid bone loss. Additionally, this implant system was used in a 77-year-old man undergoing conversion to rTSA in the setting of glenoid erosion following prior failed total shoulder arthroplasty. Technique Description: A standard deltopectoral approach is utilized. In the revision setting, prior components are removed. Adequate glenoid exposure is obtained to allow for positioning and implantation of the custom glenoid baseplate. The glenoid is prepared utilizing patient-specific guides and trials before the custom glenoid component is seated within the glenoid vault and fixated with locking screws. Compatible glenosphere and humeral components are utilized for the remainder of the surgical procedure, as performed standardly. Results: There were no immediate complications following surgery. Surgical management led to improvement in the patient's pain and shoulder function. Discussion/Conclusion: Patient-specific, 3-dimensional-printed, custom glenoid baseplates may be used to manage severe glenoid deformity and bone loss in patients indicated for primary or revision rTSA. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Dislocation of the sternoclavicular joint is a rare injury and typically requires high-energy forces applied through the joint. Initial treatment is dependent on the direction of dislocation, with acute reduction indicated for posterior dislocations presenting with signs of tracheal, esophageal, or neurovascular compression. Although most patients do well with conservative treatment after the initial trauma, some can have persistent pain and scapular dyskinesia due to instability or locked dislocation of the sternoclavicular joint. Stabilization of the sternoclavicular joint with reconstruction may be indicated for those with persistent symptoms despite a trial of steroid injections and physical therapy. In this report and video, we present a figure-of-8 reconstruction technique to reduce and stabilize a posterior dislocation of the sternoclavicular joint using a gracilis autograft. Ultimately, this reconstruction technique can be performed in a safe, efficient, and reliable manner when appropriate surgical steps are followed.