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Anterior Shoulder Instability (ASI) is a common orthopedic condition often resulting in altered shoulder kinematics. Understanding the biomechanics of the unstable shoulder is critical to determine the most appropriate treatment. This study aims to conduct the first systematic review and meta-analysis of three-dimensional (3D) shoulder kinematic studies in ASI patients. A broad search was conducted within PubMed, Scopus, and Cochrane Library following the PRISMA guidelines. All cross-sectional or longitudinal studies with 3D motion analysis describing shoulder kinematics in patients with ASI were included. The quality of each study was assessed using the MINORS criteria. Qualitative and quantitative analyses were performed. Nine studies were included in the qualitative analysis and two in the meta-analysis. The qualitative review detected conflicting evidence for some parameters. The humeral head had a greater anterior translation in unstable shoulders in three of the studies analyzed, while the difference was not significant in one and another found higher variability for global humeral translation for instability patients. Two studies showed decreased rotation range of motion for unstable shoulders while one did not find significant differences. Conflicting results were also found regarding changes in scapulohumeral rhythm and scapular orientation. The meta-analysis indicated a greater scapulohumeral rhythm on the coronal plane for the instability group, suggesting a relatively greater contribution of motion at the glenohumeral joint compared with the scapulothoracic joint for arm abduction, and reduced glenohumeral peak angles for unstable shoulders. Identifying and quantifying kinematic changes associated with ASI are vital for refining treatment interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Objective  To biomechanically evaluate different fixation devices for the proximal biceps in the humerus of sheep, comparing their fixation strength to failure, tendon displacement, and failure site in each technique. Methods  A total of 27 humerus tests were performed on sheep, separating them into 3 groups: group A with tenodesis with metallic anchors ( n  = 11), group B with biocomposite knotless devices ( n  = 8) and group C with metallic interference screws ( n  = 8), performing tenodesis with the sheep's own biceps, maintaining its native distal insertion. The three methods were submitted to a universal tensile testing machine. Results  There was no statistically significant difference in the strength of fixation until failure and displacement between the tendons fixed by the different techniques. Regarding the pattern of ruptures, it was observed that most ruptures of the metallic anchors occurred at the level of the myotendinous junction, most of the bioabsorbable knotless anchors failed due to slippage of the wire-screw interface, and all interference screws failed via tendon slip. Conclusion  The three techniques with metal anchor, onlay bioabsorbable knotless anchors, and interference screws are largely resistant to tensile loads for long head of the biceps tenodesis in sheep. There was no statistical difference between the three groups. Cyclic load resistance studies can provide more valuable data for comparing groups., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses. Dr. Paulo Cesar Faiad Piluski relatou receber subsídios ou contratos da Implantcast Corporation como consultor. Dr. Osvandré Lech relatou receber subsídios ou contratos da Implantcast Corporation como palestrante; Revista Brasileira de Ortopedia e Traumatologia (RBO) como editor de artigo; pagamento de honorários de Hypera, BioLab, Marjan e Aché para redação do manuscrito; além de desempenhar a função de presidente da International Board of Shoulder and Elbow Surgery (IBSES)., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Rupture of the pectoralis major muscle is extremely rare in adolescents. The current literature contains only 5 reports of this condition in patients under 20 years old, with 2 reports in subjects under 16. In the present article, we report the case of a 15-year-old volleyball player who suffered a traumatic rupture of the pectoralis major in a match during the serve movement. After excluding endocrinological abnormalities as a cause of tendon weakening, the patient underwent surgical treatment due to muscle retraction, strength deficit, high demand, and esthetic concerns. Early diagnosis is crucial to successful outcomes, and the surgical intervention enabled early rehabilitation and a provided a higher likelihood of return to high-level competitive sports., Competing Interests: Conflito de Interesses Os autores não têm conflito de interesses a declarar., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Competing Interests: Conflito de Interesses Os autores não têm conflitos de interesse a declarar.

Background: Latissimus dorsi transfer is a surgical procedure that can be used for treating posterosuperior rotator cuff tears. The procedure leads to improved shoulder function via alterations in the force vector couple around the shoulder. However, there is still no consensus on the biomechanical changes resulting from latissimus dorsi transfer., Methods: We performed a systematic review of the literature on 3D motion analysis studies evaluating the effects of latissimus dorsi transfer on shoulder kinematics. The available data on segment and joint range of motion was extracted and subject to meta-analysis when consistent across the studies., Findings: Our meta-analysis of pre- and post-operative studies revealed a significant improvement in forward flexion and abduction following latissimus dorsi transfer. When comparing the latissimus transferred shoulder with an uninjured contralateral side the meta-analysis found no significant difference in flexion range of motion, while abduction and external rotation was significantly higher in the uninjured shoulders. The overall risk of bias was moderate to high. High heterogeneity was found in the reporting of data, which limited our ability to perform a meta-analysis across the studies for all interest outcomes., Interpretations: Our findings suggest that latissimus dorsi transfer for posterosuperior rotator cuff tears effectively improves shoulder flexion and abduction. External rotation is also expected to improve but at inferior levels as compared to the unaffected side. However, the heterogeneity of the reported data on 3D motion analysis studies highlights the need for better standardization in research and reporting as to conclude the impact of different joints., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: All-suture anchors and knotless anchors are increasingly used in the repair of anteroinferior labral tears in patients with shoulder instability. Optimal repair constructs may limit recurrent instability., Purpose: To perform a quantitative biomechanical comparison of 3 labral fixation devices for soft tissue Bankart lesions: knotless soft-body tensionable anchor (SB knotless), knotted soft-body anchor (SB knotted), and knotless hard-body PEEK (polyether ether ketone) interference anchor (HB knotless)., Study Design: Controlled laboratory study., Methods: A total of 21 glenoid specimens were randomized into 3 groups: SB knotless, SB knotted, and HB knotless. Artificial Bankart lesions were created at the anteroinferior labrum. Anchors were placed at the 3:30, 4:30, and 5:30 clockface positions, and sutures were passed through 1 cm of tissue. Anchors were tested simultaneously as one construct by pulling capsular tissue connected to the anteroinferior quadrant. Cyclic loading (5-25 N, 100 cycles) was followed by load-to-failure testing (15 mm/min). Biomechanical testing variables were collected, and failure mechanisms were recorded per individual anchor., Results: There were no differences in baseline specimen characteristics. There was no difference in elongation during cyclic loading ( P = .40). The ultimate load to failure between SB knotless (309.7 ± 125.6 N), SB knotted (226.4 ± 34.8 N), and HB knotless (256.5 ± 90.5 N) did not significantly differ ( P = .25). Failure mechanisms differed among groups ( P = .008); mechanisms included anchor pullout (SB knotless: 33.3%; SB knotted: 23.8%; HB knotless: 28.6%), suture pull-through (SB knotless: 66.7%; SB knotted: 38.1%; HB knotless: 33.3%), and anchor fixation method failure, defined as knot failure for knotted anchors or locking mechanism failure for knotless anchors (SB knotless: 0.0%; SB knotted: 38.1%; HB knotless: 38.1%).)., Conclusion: The SB knotless, SB knotted, and HB knotless labral fixation anchors studied exhibited comparable elongation during cyclic loading, stiffness, and ultimate loads to failure in a cadaveric model. However, the failure mechanisms significantly differed, as SB knotless anchors failed primarily from suture pull-through, while SB knotted and HB knotless anchors were subject to knot failure and locking mechanism failure, respectively., Clinical Relevance: These data support the benefit of SB knotless anchors for anteroinferior labral repair in limiting knot failure typically seen with knotted anchors, perhaps demonstrating that all-suture anchors may have better locking mechanism quality than their PEEK counterparts.

Background: Surgeon visual estimation of shoulder range of motion (ROM) is commonplace in the outpatient office setting and routinely reported in clinical research, but the reliability and accuracy of this practice remain unclear. The purpose of this study is to establish the reliability and accuracy of remote visual estimation of shoulder ROM in healthy volunteers and symptomatic patients among a large group of shoulder surgeons. Our hypothesis is that remote visual estimation would be reliable and accurate compared with the digital goniometer method., Methods: Fifty shoulder surgeon members of the PacWest Shoulder and Elbow Society independently determined the active shoulder forward flexion (FF), internal rotation at 90° abduction (IR90), external rotation at 90° abduction, external rotation at the side , and maximal spinal level reached with internal rotation (IR spine ) through visual estimation of video recordings taken from 10 healthy volunteers and 10 symptomatic patients. Variations in measurements were quantified using the interobserver reliability through calculation of the intraclass correlation coefficient. Accuracy was determined through comparison with digital goniometer measurements obtained with an on-screen protractor application using Bland-Altman mean differences and 95% limits of agreement., Results: The interobserver reliability among examiners showed moderate to excellent correlation, with intraclass correlation coefficient ranging from 0.768 to 0.928 for the healthy volunteers and 0.739 to 0.878 for the symptomatic patients. Accuracy was limited, with upper limits of agreement exceeding the established minimal clinically important differences (MCIDs) for FF (20° vs. MCID of 14°) and IR90 (25° vs. 18°) in the healthy volunteers and for FF (33° vs. 16°), external rotation at 90° abduction (21° vs. 18°), and IR90 (31° vs. 20°) in the symptomatic patients., Conclusion: Despite generally high intersurgeon reliability in the visual estimation of shoulder ROM, there was questionable accuracy when compared to digital goniometer measurements,with measurement errors often exceeding established MCID values. Given the potential implications for the clinical response to treatment and the significance of research findings, the adoption of validated instruments to measure ROM and the standardization of examination procedures should be considered., (© 2023 The Authors.)

Anterior shoulder instability can lead to anterior glenoid bone loss associated with humeral posterior deformity (bipolar bone loss). Latarjet procedure is a commonly used surgical option in such cases. However, the procedure is associated with complications in up 15% of the cases often associated with inadequate positioning of coracoid bone graft and screws. Considering that acknowledgment of patient anatomy and use of surgical planning intraoperatively can reduce such complications, we describe the use of 3D printing tools to obtain a 3D Patient-Specific Surgical Guide to aid in the Latarjet procedure. Such tools present advantages and limitations compared to other tools available, which are also discussed in this article., (© 2023 The Authors.)

Labral tears resulting in 270° near-circumferential pathology predispose patients to recurrent instability and are technically challenging to repair. Furthermore, when such lesions are associated with Hill-Sachs lesions, recurrent instability risk is significantly increased and can result in substantially lower clinical outcomes. When determining a surgical treatment algorithm for shoulder stabilization, it is important to consider both humeral- and glenoid-sided pathology because subtle defects can have significant influence on recurrence and patient reported outcomes. In this Technical Note and accompanying video, we discuss our surgical technique for knotless arthroscopic stabilization for a 270° labral tear with concurrent remplissage in the setting of recurrent shoulder instability., (© 2022 The Authors.)

Primary, isolated humeral head arthritis or focal chondral defects are uncommon and difficult to diagnose preoperatively. While these lesions have traditionally been treated with total shoulder arthroplasty, shoulder hemiarthroplasty is a viable option for patients with isolated humeral head disease and minimal degenerative changes in the glenoid. This approach can be performed in a minimally invasive fashion, which preserves bone stock and native biomechanics, and can be beneficial if conversion to total shoulder arthroplasty is required in the future and avoids risk of glenoid loosening or failure in younger and more active individuals. In this Technical Note and accompanying video, we describe our technique of humeral head resurfacing in a patient with isolated primary humeral osteoarthritis with a large focal chondral defect in the humeral head., (© 2022 The Authors.)

Objective  To outline the profile of self-citations from Revista Brasileira de Ortopedia (Rev Bras Ortop) and citations of this journal in other medical orthopaedic journals with general or specific content in a knowledge area of the specialty. Methods  This is an observational cross-sectional study of the frequency of self-citations and citations from Rev Bras Ortop in five other medical orthopaedic journals from different countries, all published in English. The last 15 articles published in 2020 in each of the six journals were analyzed. The references used in each of them were evaluated to identify the journal in which they were originally published. The frequency of distribution of the four main journals cited, their position, and the relative percentage to the total number of citations were observed and recorded in each of the six journals. The number of times that the Rev Bras Ortop was cited in each of the selected foreign journals was assessed using its absolute and relative frequencies. Results  The total number of citations evaluated in this study was 2,527 (ranging from 386 to 486 per magazine). Rev Bras Ortop showed a low rate of self-citation (2.6%), being the sixth journal cited in the journal itself (10 out of a total of 386 references). Moreover, Rev Bras Ortop was not mentioned in any of the other five medical journals included in the study (absolute frequency 0, relative frequency 0). Conclusion  Rev Bras Ortop has a low reference of itself, with a self-citation rate of 2.6% in the studied period, showing that the Brazilian orthopaedic surgeons do not mention the Brazilian orthopaedic surgeon who publishes in the journal. We suggest the elaboration and implementation of strong strategies to improve the journal's visibility in the world academic-scientific scenario. In addition, it is essential that Brazilian orthopaedic surgeons understand this reality and assist directly and effectively to change this scenario., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses, (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective  To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods  Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results  The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups ( p  < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion  Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)