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John Twomey-Kozak, Kwabena Adu-Kwarteng,* Kiera Lunn,* Damon Vernon Briggs, Eoghan Hurley, Oke A Anakwenze, Christopher S Klifto Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA*These authors contributed equally to this workCorrespondence: John Twomey-Kozak, Duke University Medical Center, Department of Orthopaedic Surgery, Durham, NC, USA, Email jnt25@duke.eduPurpose of Review: This narrative review comprehensively aims to analyze recent advancements in shoulder arthroplasty, focusing on implant systems and their impact on patient outcomes. The purpose is to provide a nuanced understanding of the evolving landscape in shoulder arthroplasty, incorporating scientific, regulatory, and ethical dimensions.Recent Findings: The review synthesizes recent literature on stemless implants, augmented glenoid components, inlay vs onlay configurations, convertible stems, and associated complications. Notable findings include improved patient-reported outcomes with stemless implants, variations in outcomes between inlay and onlay configurations, and the potential advantages of convertible stems. Additionally, the regulatory landscape, particularly the FDA’s 510(k) pathway, is explored alongside ethical considerations, emphasizing the need for standardized international regulations.Summary: Recent innovations in shoulder arthroplasty showcase promising advancements, with stemless implants demonstrating improved patient outcomes. The review underscores the necessity for ongoing research to address unresolved aspects and highlights the importance of a standardized regulatory framework to ensure patient safety globally. The synthesis of recent findings contributes to a comprehensive understanding of the current state of shoulder arthroplasty, guiding future research and clinical practices.Keywords: shoulder arthroplasty, rTSA, stemless implants, glenoid components, patient outcomes, innovations in arthroplasty

Background: The aim of this study was to systematically review the literature on concomitant repair of superior labral and rotator cuff tears, in light of the paucity of published clinical evidence., Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses compliant search of PubMed, Embase, and Cochrane Library databases was performed for clinical studies of patients undergoing combined repairs of the rotator cuff and superior labrum., Results: Ten studies comprising 241 shoulders were included, with a mean age of 52.6 years and mean follow-up of 29.0 months; 67.9% were male patients. Functional outcomes included the mean postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Score of 88.6, University of California at Los Angeles Shoulder Score of 30.6, constant score of 90.4, Simple Shoulder Test score of 8.6, and visual analog scale score of 1.1. Range of motion outcomes demonstrated mean postoperative forward flexion of 159°, external rotation of 68°, and internal rotation of 17°. The overall return-to-play rate was 76.8%, with 67.9% returning to preinjury level. The overall complication rate was 4.1% with an 18.9% rate of rotator cuff retear and 2.4% reoperation rate., Conclusion: Arthroscopic concomitant repair of superior labral and rotator cuff tears results in good functional outcomes and range of motion, along with a low reoperation rate. Among athletes, there are moderate rates of return but lower rates of return to the same level of play., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B168)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Recurrent instability remains a major source of morbidity following arthroscopic Bankart repair. Many risk factors and predictive tools have been described, but there remains a lack of consensus surrounding individual risk factors and their contribution to outcomes. The purpose of this study is to systematically review the literature to identify and quantify risk factors for recurrence following arthroscopic Bankart repair., Methods: A literature search was performed using the PubMed/MEDLINE databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were included if they evaluated risk factors for recurrent instability following arthroscopic Bankart repair., Results: Overall, 111 studies were included in the analysis, including a total of 19,307 patients and 2750 episodes of recurrent instability with 45 risk factors described. Age at operation was reported by 60 studies, with 35 finding increased risk at younger ages. Meta-analysis showed a 2-fold recurrence rate of 27.0% (171 of 634) for patients <20 years old compared with 13.3% (197 of 1485) for older patients (P < .001). Seventeen studies completed multivariable analysis, 13 of which were significant (odds ratio 1.3-14.0). Glenoid bone loss was evaluated by 39 studies, with 20 finding an increased risk. Multivariable analysis in 9 studies found odds ratios ranging from 0.7 to 35.1; 6 were significant. Off-track Hill-Sachs lesions were evaluated in 21 studies (13 significant), with 3 of 4 studies that conducted multivariable analysis finding a significant association with odds ratio of 2.9-8.9 of recurrence. The number of anchors used in repair was reported by 25 studies, with 4 finding increased risk with fewer anchors. Pooled analysis demonstrated a 25.0% (29 of 156) risk of recurrence with 2 anchors, compared with 18.1% (89 of 491) with 3 or more anchors (P = .06). Other frequently described risk factors included glenohumeral joint hyperlaxity (46% of studies reporting a significant association), number of preoperative dislocations (31%), contact sport participation (20%), competitive sport participation (46%), patient sex (7%), and concomitant superior labral anterior-posterior tear (0%)., Conclusion: Younger age, glenoid bone loss, and off-track Hill-Sachs lesions are established risk factors for recurrence following arthroscopic Bankart repair. Other commonly reported risk factors included contact and competitive sports participation, number of fixation devices, and patient sex., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Posterior shoulder instability makes up approximately 10% of all shoulder instability cases and its diagnosis and treatment is less well understood. Recently, however, there has been increased recognition of posterior instability and posterior stabilization. The purpose of this study was to systematically review the literature to ascertain the outcomes on arthroscopic stabilization of posterior shoulder instability., Methods: Two independent reviewers conducted a systematic literature search based on PRISMA guidelines, utilizing the MEDLINE database. Studies were eligible for inclusion if they reported postoperative outcomes for posterior shoulder instability following arthroscopic stabilization., Results: A total of 48 studies met inclusion criteria for review including 2307 shoulders. Majority of patients were male (83.3%), with an average age of 26.1 years and a mean follow-up of 46.8 months. The functional outcome score primarily utilized for postoperative assessment was the American Shoulder and Elbow Surgeons with an average of 84.77. Overall, 90.9% of patients reported being satisfied with their arthroscopic stabilization. Recurrent instability occurred in 7.4% of patients. The total revision rate was 5.2%. 16.6% of patients reported residual pain postoperatively. The rate of return to play was 86.4% with 68.0% of patients returning to play at the same or higher level of play., Conclusion: Arthroscopic stabilization of posterior shoulder instability resulted in good outcomes with high patient satisfaction and low rates of recurrent instability, revisions, and residual pain., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to compare the outcomes of primary reverse total shoulder arthroplasty (rTSA) using constrained liners (in a 145° onlay implant, Exactech, Equinoxe) with primary rTSA using standard liners with a minimum 1-year follow-up., Methods: A total of 836 primary rTSA patients were analyzed in this study. Patients treated with constrained liners (n=209) were cross-matched 1:3 for age, gender, glenosphere diameter, and follow-up duration, and compared with 627 patients who underwent primary rTSA with standard liners. Study endpoint was at one year. Outcomes were analyzed preoperatively and at the latest follow-up. Patient characteristics, postoperative range of motion (ROM), patient reported outcomes (PROs), complications and revisions were recorded., Results: There was no statistically significant changes in improvement in pain (-4.9 vs -5.1; p=0.356), ROM (abduction, 45.7° vs 47.9°; p=0.522) (forward elevation, 44.0 vs 50.8°; p=0.057) (internal rotation score 1.0 vs 1.1; p=0.709) (external rotation, 17.9° vs 16.7°; p=0.543), or PROs (American Shoulder and Elbow Surgeons Score, 44.5 vs 43.7; p=0.107) (Shoulder Arthroplasty Smart score, 27.5 vs 30.0; p=0.052) between the constrained and standard liner cohorts at minimum 1 year follow-up. However, the constrained liner rTSA cohort had a significantly higher rate of adverse events (6.2% vs. 2.7%; p=0.012), including a higher rate of scapular notching (15.6% vs. 8.8%; p=0.015)., Conclusion: The utilization of constrained liners in primary rTSA demonstrated no significant difference in the change in pain, abduction, forward elevation, ER and IR scores, ASES scores, and SAS scores at minimum 1-year follow-up. There was no significant difference in forward elevation or abduction compared to standard liners. However, we observed that the overall rate of adverse events, including scapular notching were significantly higher in the constrained liner cohort. Long-term clinical and radiographic follow-up is necessary to fully elucidate the durability of these results. At this time, it is unclear if constrained liners have any benefit in rTSA., (Copyright © 2024. Published by Elsevier Inc.)

Background: Reverse shoulder arthroplasty (RSA) is an established operative treatment for failed rotator cuff repair (RCR) that may not be amenable to revision repair. The purpose of this meta-analysis is to evaluate the clinical outcomes for patients undergoing RSA following prior failed RCR compared with patients without prior RCR undergoing primary RSA., Methods: A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to PRISMA guidelines. Comparative studies assessing outcomes of RSA after failed RCR versus primary RSA were included., Results: Seven studies with 2149 total patients were included; 760 patients had a prior RCR and 1389 patients did not have a prior RCR. Prior failed RCR resulted in significantly lower postoperative ASES scores (mean difference [MD], -8.31 95% confidence interval [CI] -10.96, -5.66), less forward flexion (MD, -6.71 95%CI -11.75, -1.67), and higher VAS pain scores (MD; 0.85, 95% CI 0.47, 1.22) when compared to primary RSA. There were no significant differences in external rotation, complications rate, or rate of revision., Conclusion: This study found that failed RCR prior to RSA was associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary RSA without prior RCR., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: The purpose of this study was to establish consensus statements via a modified Delphi process on the definition of shoulder pseudoparalysis and pseudoparesis., Methods: A consensus process on the definition of a diagnosis of pseudoparalysis utilizing a modified Delphi technique was conducted, and 26 shoulder/sports surgeons from 11 countries, selected based on their level of expertise in the field, participated in these consensus statements. Consensus was defined as achieving 80%-89% agreement, whereas strong consensus was defined as 90%-99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement., Results: Three statements regarding the diagnosis of pseudoparalysis reached strong (>89%) consensus: passive range of motion should be unaffected, the passive range of abduction should not be considered, and diagnosis should be excluded if lidocaine injection produces a substantial improvement in range of motion. Additionally, consensus (>79%) was reached that the active range of external rotation should not be considered for diagnosis, pain as a cause of restricted motion must be excluded, and that distinctions between restricted active flexion and external rotation should be made by range of motion rather than tear characteristics. No consensus could be reached on statements regarding the size, number of tendons or chronicity of cuff tears. Nor was there agreement on the active range of flexion permitted or on the difference between pseudoparalysis and pseudoparesis., Conclusion: A modified Delphi process was utilized to establish consensus on the definition of shoulder pseudoparalysis and pseudoparesis. Unfortunately, almost half of the statements did not reach consensus, and agreement could not be reached across all domains for a unifying definition for the diagnosis of pseudoparalysis in the setting of rotator cuff tears. Furthermore, it was not agreed how or whether pseudoparalysis should be differentiated from pseudoparesis. Based on the lack of a consensus for these terms, studies should report explicitly how these terms are defined when they are used., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Superior augment use may help avoid superior tilt while minimizing removal of inferior glenoid bone. Therefore, our goal was to compare superior augments vs. no-augment baseplates in reverse shoulder arthroplasty (RSA) for patients with rotator cuff dysfunction and no significant superior glenoid erosion., Methods: A multicenter retrospective analysis of 145 patients who underwent RSA with intraoperative navigation (Equinoxe GPS; Exactech) and 3-year follow-up (mean 32 months' follow-up, range 20-61 months) who had preoperative superior inclination less than 10° and retroversion less than 15°. Patient demographics, radiographic measurements, surgical characteristics, patient-reported outcomes at preoperative and postoperative visit closest to 3 years, and adverse events at final follow-up were obtained. Operative time, planned inclination, and planned version of the baseplate were obtained. χ 2 test was used to compare categorical variables, and Student t test was used to compare the augment and no-augment cohorts., Results: The study population consisted of 54 superior augment patients and 91 no-augment patients. The augment cohort had lower body mass index (27.2 vs. 29.4, P = .023) and higher native superior inclination (5.9° vs. 1.4°, P < .001). No difference between the augment and no-augment cohorts was found regarding age (P = .643), gender (P = .314), medical comorbidities (P > .05), surgical indication (P = .082), and native glenoid version (P = .564). The augment cohort had higher internal rotation score (4.6 vs. 3.9, P = .023), and all remaining range of motion (ROM) and patient-reported outcomes (PROs) preoperatively were not significantly different. At final follow-up, active ROM in all planes was not different between the cohorts. Regarding PROs, the postoperative Shoulder Arthroplasty Smart score was significantly higher (78.0 vs. 73.6, P = .042), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score trended toward higher (83.6 vs. 77.5, P = .063) in the augment cohort. The augment cohort had a significantly lower proportion of patients who planned to have superior baseplate tilt (1.9% vs. 14.3%, P = .012) and had greater mean inclination correction (6.3° vs. 1.3°, P < .001), compared with the no-augment cohort. Adverse events were rare, and there was no significant difference found between the augment and no-augment cohorts (5.6% vs. 3.3%, P = .509)., Discussion: Superior augmented baseplate in RSA with minimal superior glenoid erosion is associated with similar ROM and adverse events with somewhat improved postoperative PROs compared with nonaugmented baseplates at the 3-year follow-up. Additionally, superior augments resulted in a greater proportion of baseplates planned to avoid superior tilt, and trended toward shorter operative times. Further investigation of long-term glenoid baseplate loosening is imperative to fully understand the cost-effectiveness of superior augments in the setting of minimal glenoid deformity., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Bone marrow stimulation (BMS) has been proposed to augment healing at the time of arthroscopic rotator cuff repair (ARCR) by creating several bone marrow vents in the footprint of the rotator cuff, allowing mesenchymal stem cells, platelets, and growth factors to cover the area as a "crimson duvet.", Purpose: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes after BMS and a control for those undergoing ARCR., Study Design: Meta-analysis; Level of evidence, 1., Methods: A literature search of 3 databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RCTs comparing BMS and a control for ARCR were included. Clinical outcomes were compared, and a P value <.05 was considered to be statistically significant., Results: A total of 7 RCTs with 576 patients were included. Overall, 18.8% of patients treated with BMS and 21.0% of patients treated with a control had a retear ( I 2 = 43%; P = .61). With BMS, the mean Constant score was 88.2, and with the control, the mean Constant score was 86.7 ( P = .12). Additionally, there was no significant difference in the American Shoulder and Elbow Surgeons score (94.3 vs 93.2, respectively; P = .31) or visual analog scale score (0.9 vs 0.9, respectively; P = .89)., Conclusion: The level 1 evidence in the literature did not support BMS as a modality to improve retear rates or clinical outcomes after ARCR., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.M.D. has received support for education from SouthTech Orthopedics. L.M.J. has received support for education from Suvon Surgical, Gotham Surgical, and Arthrex and consulting fees from Flexion Therapeutics. R.M. has received consulting fees from Arthrex and compensation for services other than consulting from Empire Medical. J.F.D. has received support for education from SouthTech Orthopedics and Supreme Orthopedic Systems and compensation for services other than consulting from Arthrex. O.A. has received consulting fees from Exactech, Smith & Nephew, Medical Device Business Services, Bioventus, Lima, Responsive Arthroscopy, Encore Medical, and Stryker; support for education from Arthrex and SouthTech Orthopedics; and travel expenses from Wright Medical and Zimmer Biomet. C.K. has received consulting fees from Acumed, restor3d, and Smith & Nephew and holds stock or stock options in GE HealthCare, Johnson & Johnson, Merck, and Pfizer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: The majority of the current literature on arthroscopic Bankart repair is retrospective, and discrepancies exist regarding clinical outcomes including recurrent instability and return to play among studies of different levels of evidence., Purpose: The purpose of this study is to perform a systematic review of the literature to compare the outcomes of prospective and retrospective studies on arthroscopic Bankart repair., Methods: A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" was used, with all results being analyzed via strict inclusion and exclusion criteria. Three independent investigators extracted data and scored each included study based on the 10 criteria of the Modified Coleman Methodology Score out of 100. A χ 2 test was performed to assess if recurrent instability, revision, return to play, and complications are independent of prospective and retrospective studies., Results: A total of 193 studies were included in the analysis, with 53 prospective studies and 140 retrospective in design. These studies encompassed a total of 13,979 patients and 14,019 surgical procedures for Bankart repair for shoulder instability. The rate of redislocation in the prospective studies was 8.0% vs. 5.9% in retrospective studies (P < .001). The rate of recurrent subluxation in the prospective studies was 3.4% vs. 2.4% in retrospective studies (P = .004). The rate of revision was higher in retrospective studies at 4.9% vs. 3.9% in prospective studies (P = .013). There was no significant difference in terms of overall rate to return to play between prospective and retrospective studies (90% and 91%, respectively; P = .548). The overall rate of non-instability complications in the prospective cohort was 0.27% vs. 0.78% in the retrospective studies (P = .002)., Conclusions: The overall rates of recurrent dislocations-subluxations are higher in prospective studies than retrospective studies. However, rates of revision were reportedly higher in retrospective studies. Complications after arthroscopic Bankart repair are rare in both prospective and retrospective studies, and there was no difference in rates of return to play., (Copyright © 2024. Published by Elsevier Inc.)

Background: The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, range of motion (ROM), and complication and reoperation rates after revision reverse shoulder arthroplasty (RSA) for a failed primary total shoulder arthroplasty (TSA) or hemiarthroplasty (HA)., Methods: Two independent reviewers performed the literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies were included if they reported clinical outcomes for revision RSA for a failed primary TSA or HA., Results: Our review found 23 studies including 1041 shoulders (627 TSA and 414 HA) meeting our inclusion criteria. The majority of patients were female (66.1%), with an average age of 69.0 years (range: 39-93 years) and a mean follow-up of 46.3 months. American Shoulder and Elbow Surgeons and visual analog scale pain scores improved from 32.6 to 61.9 and 6.7 to 2.7, respectively. ROM results include forward flexion, abduction, and external rotation, which improved from 59.4° to 107.7°, 50.7° to 104.4°, and 19.8° to 26.3°, respectively. Only 1 of the 10 studies reporting internal rotation found a statistically significant difference, with the mean internal rotation improving from S1-S3 preoperatively to L4-L5 postoperatively for patients undergoing HA. The overall complication rate and reoperation rate were 23.4% and 12.5%, respectively. The most common complications were glenoid component loosening (6.0%), fracture (periprosthetic, intraoperative, or other scapula fractures) (n = 4.7%), and infection (n = 3.3%)., Conclusions: Revision RSA for a failed primary TSA and HA has been shown to result in excellent functional outcomes and improved ROM, suggesting that patients who have failed TSA or HA may benefit from a revision RSA., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Hypothesis: The purpose of this study was to systematically review complications arising from intramedullary nailing (IMN) of proximal and humeral shaft fractures. This study hypothesized that there would be a low rate of complications and revision among patients treated with IMN for humerus fractures., Methods: Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported on outcomes following the use of intramedullary nails for proximal humerus fractures or humeral shaft fractures. Variables that were collected included complications, Visual Analogue Scale (VAS) pain scores, and revision operations., Results: Overall, 179 studies met the inclusion criteria, with 7984 shoulders. The average age of patients in this study was 55.2 years and 60.7% of patients were female. The mean follow-up was 16.6 months. The overall complication rate for all fractures treated with intramedullary nails was 18.9%, and the overall revision rate was 6.8%. Among the complications were fracture complications (7.5%), hardware complications (7.2%), soft tissue complications (1.8%), neurovascular complications (1.6%), and infection (0.8%). 4-part proximal humerus fractures (52.9%) and open fractures (36.7%) had the highest rates of complication. Among the reasons for revision were hardware removal or replacement (5.0%), conversion to arthroplasty (0.6%), and other (1.2%). The mean VAS pain score at last follow-up was 1.6., Conclusion: Overall, there was a moderate rate of complications but low rate of revision following IMN of humerus fractures. Open fractures and 4-part proximal humerus fractures had the highest complication rates., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To systematically review the literature to evaluate the clinical studies on bioinductive collagen implant (BCI) for the treatment of rotator cuff tears., Methods: A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies reporting BCI for rotator cuff tears were included. Quantitive and qualitative data were evaluated., Results: A total of 21 studies were included. In patients with full-thickness tears, 7 of the 8 studies with pre- to postoperative American Shoulder and Elbow Surgeons (ASES) scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 75% to 100% of patients meeting the minimal clinically important difference. In those with partial-thickness tears, 7 of the 8 studies with pre- to postoperative ASES scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 54.4% to 100% of patients meeting the minimal clinically important difference. For studies that quantified percent increases in tendon thickness, the reported increases ranged from 13% to 44% in full-thickness tears and 14% to 60% in partial-thickness tears. Six studies evaluated rotator cuff retears after BCI treatment in the full-thickness cohort, with rates reported ranging from 0% to 9%. Five studies evaluated rotator cuff retears after BCI treatment in the partial-thickness cohort, with rates reported ranging from 0% to 18%. Two of the included studies found that BCI was cost-effective due to the increased tendon healing, with cost savings of $5,338 to $13,061 per healed rotator cuff tendon., Conclusions: The literature on rotator cuff tear augmentation with BCI has shown consistently reported good results. Additionally, there was evidence of low retear rates and consistently improved tendon thickness with BCI, with 2 randomized controlled trials showing improved tendon healing with BCI. However, there appears to be a higher rate of adhesive capsulitis reported., Level of Evidence: Level IV, systematic review of Level I, III, and IV studies., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Arthroscopic rotator cuff repair (ARCR) is one of the most common orthopedic procedures in the general population. Despite its prevalence, the price of ARCR varies significantly across regions, hospital models, and settings. The purpose of this study was to examine the effect of Geographic Region, Certificate of Need (CON) laws, and Medicaid expansion on ARCR pricing., Methods: This cross-sectional observational study used hospital payer-specific ARCR prices from the Turquoise Health Database using Current Procedural Terminology code 29827. These prices are negotiated rates or charges that hospitals establish with various payers, including insurance companies, Medicare, Medicaid, and self-pay patients, for medical services and treatments provided. Outliers below the 10th percentile and above the 90th percentile were excluded. State policies, including CON status and Medicaid expansion, were obtained from public sources, whereas additional socioeconomic and demographic data were sourced from the US Census. The state's region classification was determined based on 1 of 4 Geographic Regions defined by the US Census Bureau. A detailed analysis was also conducted for North Carolina, examining county-level data on urbanization and the Area Deprivation Index., Results: There were 57,270 ARCR prices from 2503 hospitals across the United States, with a median interquartile range listed price of $6428.17 (interquartile range: $2886.88). States with CON regulations had significantly lower ARCR prices than those without ($6500 vs. $8000, P < .0001). Multivariable analysis indicated that hospitals in the Northeast and West Regions listed significantly higher prices for ARCR than those in the Midwest Region (P < .0001). In contrast, hospitals in the South Region listed lower prices for ARCR than those in the Midwest Region (P < .0001). Medicaid expansion was associated with increased ARCR prices (P < .0001), whereas CON laws were linked to reduced prices (P < .0001). In North Carolina, Area Deprivation Index and urbanization status did not significantly affect ARCR prices., Conclusion: The prices listed for ARCR varied significantly depending on the Geographic Region where hospitals were located. In addition, CON laws were associated with reduced ARCR prices, whereas Medicaid expansion correlated with increased prices. These findings highlight the complex interplay between health care policy, regulatory frameworks, and socioeconomic factors in determining surgical prices., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Increased surgeon volume has been demonstrated to correlate with improved outcomes after orthopedic surgery. However, there is a lack of data demonstrating the effect of surgeon volume on outcomes after total shoulder arthroplasty., Methods: The PearlDiver Mariner database was retrospectively queried from the years 2010-2022. Patients undergoing shoulder arthroplasty were selected using the CPT code 23472 (Total Shoulder Arthroplasty). Patients under 40 years of age, those undergoing revision arthroplasty and cases of bilateral arthroplasty were excluded. Additionally, cases with a history of fracture, infection, or malignancy prior to surgery were excluded. Only surgeons who performed a minimum of 10 cases were selected and PearlDiver was queried using their provider ID codes. Primary outcome measures included 90 day, 1-year, and 2-year rates of complication and reoperation. A Bonferroni correction was utilized in which the significance threshold was set at p≤0.00082 RESULTS: A total of 155,560 patients met inclusion criteria and were retained for analysis. The 90 th percentile for surgeon volume was determined to be 112 cases during the study period. Surgeons above the 90 th percentile (n=340) operated on 68,531 patients whereas surgeons below the 90 th percentile (n=3,038) operated on 87,029 patients. Surgeons in the high-volume group were significantly more likely to have completed a Shoulder and Elbow fellowship (p<0.001) and less likely to have no fellowship training or fellowship training outside of Shoulder and Elbow or Sports Medicine (p<0.001). Low-volume surgeons operated on patients with higher baseline comorbidities (CCI: 2.01 vs 1.85, p<0.001). After adjusting for age, gender, CCI, obesity, and tobacco use, high-volume surgeons experienced lower rates of medical complications including renal failure (p<0.001), anemia (p<0.001), and UTI (p<0.001). All cause readmission (0.90, p<0.001), reoperation at 90 days (OR 0.75, p<0.001) and reoperation at 1 year (OR: 0.86, p<0.001) were significantly lower among high-volume surgeons. High-volume surgeons exhibited lower rates of various complications including prosthetic joint infection (90d: p<0.001; 1yr: p<0.001; 2yr: p<0.001), periprosthetic fracture (90d: p<0.001; 1yr: p<0.001; 2yr: p<0.001) and all complications (90d: p<0.001; 1yr: p<0.001)., Conclusion: Surgeons who perform a high volume of total shoulder arthroplasty are more likely to operate on healthier patients than surgeons who perform a lower volume of cases. When compared to low-volume surgeons, and after adjusting for age, gender, and CCI, high-volume surgeons have a significantly lower overall complication rate. Despite this lower complication rate, high-volume surgeons are responsible for a decreasing portion of shoulder arthroplasty since 2016., (Copyright © 2024. Published by Elsevier Inc.)

Opioid-limiting legislation has been enacted in response to the opioid epidemic in the United States. However, the impact of this legislation on perioperative opioid prescribing in elective shoulder surgery is not well understood. This is an observational review of 90-day perioperative opioid-prescription filling by patients undergoing shoulder surgery using a national insurance database (n = 231,634 patients) between 2010 and 2019. Statistics evaluated the impact of the year and opioid-limiting legislation on first prescription and cumulative 90-day opioid filling. Initial and cumulative opioid-prescription volume decreased significantly from 2010 to 2019 (49 to 44.4 initial oxycodone 5-mg equivalents, 132.8 to 72.3 cumulative oxycodone 5-mg equivalents; all p < 0.001). States with opioid-limiting legislation had larger reductions in initial and cumulative opioid-prescription filling over similar time frames (p < 0.001). Perioperative opioid prescribing has decreased significantly in shoulder surgery with time and state legislation. Individual prescribers and state and national legislators should continue to seek ways to reduce opioid overprescribing. (Journal of Surgical Orthopaedic Advances 33(3):152-157, 2024).

Since orthopedic surgery has been slower to acknowledge the rise of social media for distributing medical information, this study aims to evaluate TikTok videos' quality and educational value in relation to carpal tunnel syndrome treatment exercises. TikTok was searched using the hashtags "#carpaltunnelexercises", "#carpaltunnelremedies", "#carpaltunnelrehab", and "#physicaltherapyforcarpaltunnel". The engagement indicators were documented and the video content quality was assessed using the DISCERN, CTEES, JAMA, and GQS grading scales. There were 101 videos included, which accumulated 20,985,730 views. The videos received 1,460,953 likes, 15,723 comments, 243,245 favorites, and 159,923 shares. Healthcare professionals were responsible for 72% of the video uploads, whereas general users contributed 28%. More healthcare professionals' videos were graded as "poor" (79%) compared to general users (21%). General users received slightly more video grades of "very poor" (52%) than healthcare professionals (48%). For the DISCERN grading, the videos by healthcare professionals were significantly better than those by general users in terms of reliability, achieving aims, and relevancy. They were also superior in the overall composition of the health information derived from the total DISCERN score. However, no significant differences were found between the two groups when using the CTEES, JAMA, and GQS grading scales. Overall, despite the emergence of TikTok as a medical information tool, the quality and educational value of the carpal tunnel syndrome exercise videos were poor.

Purpose: To examine reported minimal clinically important difference (MCID) and patient-acceptable satisfactory state (PASS) values for patient-reported outcome measures (PROMs) after shoulder instability surgery and assess variability in published values depending on the surgery performed. Our secondary aims were to describe the methods used to derive MCID and PASS values in the published literature, including anchor-based, distribution-based, or other approaches, and to assess the frequency of MCID and PASS use in studies on shoulder instability surgery., Methods: A systematic review of MCID and PASS values after Bankart, Latarjet, and Remplissage procedures was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The Embase, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried from 1985 to 2023. Inclusion criteria included studies written in English and studies reporting use of MCID or PASS for patient-reported outcome measures (PROMS) after Latarjet, Bankart, and Remplissage approaches for shoulder instability surgery. Extracted data included study population characteristics, intervention characteristics, and outcomes of interest. Continuous data were described using medians and ranges. Categorical variables, including PROMs and MCID/PASS methods, were described using percentages. Because MCID is a patient-level rather than a group-level metric, the authors confirmed that all included studies reported proportions (%) of subjects who met or exceeded the MCID., Results: A total of 174 records were screened, and 8 studies were included in this review. MCID was the most widely used outcome threshold and was reported in all 8 studies, with only 2 studies reporting both the MCID and the PASS. The most widely studied PROMs were the American Shoulder and Elbow Surgeons (range 5.65-9.6 for distribution MCID, 8.5 anchor MCID, 86 anchor PASS); Single Assessment Numeric Evaluation (range 11.4-12.4 distribution MCID, 82.5-87.5 anchor PASS); visual analog scale (VAS) (range 1.1-1.7 distribution MCID, 1.5-2.5 PASS); Western Ontario Shoulder Instability Index (range 60.7-254.9 distribution MCID, 126.43 anchor MCID, 571-619.5 anchor PASS); and Rowe scores (range 5.6-8.4 distribution MCID, 9.7 anchor MCID). Notably, no studies reported on substantial clinical benefit or maximal outcome improvement., Conclusions: Despite the wide array of available PROMs for assessing shoulder instability surgery outcomes, the availability of clinically significant outcome thresholds such as MCID and PASS remains relatively limited. Although MCID has been the most frequently reported metric, there is considerable interstudy variability observed in their values., Clinical Relevance: Knowing the outcome thresholds such as MCID and PASS of the PROMs frequently used to evaluate the results of glenohumeral stabilization surgery is fundamental because they allow us to know what is a clinically significant improvement for the patient., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate clinical outcomes after tendon transfers in the setting of reverse total shoulder arthroplasty (RTSA)., Methods: PubMed and Embase were searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to find primary clinical studies of any type of tendon transfer in the setting of RTSA., Results: Overall, 17 studies (level of evidence [LOE] I: 1, LOE II: 0, LOE III: 3, LOE IV: 13) met inclusion criteria, with 300 shoulders. Most patients were female (56.7%), with an average age of 68.7 years (range 19 to 89) and a mean follow-up of 46.2 months (range 6 to 174). 11 studies reported outcomes after combined latissimus dorsi and teres major transfer (LDTM) while eight studies reported on latissimus dorsi transfer only (LD). Improvements in commonly reported subjective and functional outcome measures were as follows: external rotation +32° (LDTM) and +30° (LD), flexion +65° (LDTM) and +59° (LD), Visual Analog Score -5.4 (LDTM) and -4.5 (LD), subjective shoulder value +43.8% (LDTM) and +46.3% (LD), and overall Constant score +33.8 (LDTM) and +38.7 (LD). The overall complication rate was 11.3%, including tendon transfer ruptures (0.7%), instability (3.0%), infection (2.0%), and nerve injury (0.3%). The all-cause repeat operation rate was 7.3%, most commonly for arthroplasty revision (5.3%). Subgroup analysis revealed that lateralized implants with tendon transfer resulted in markedly greater improvements in Constant score, flexion, ER1, and ER2 while medialized implants with tendon transfer had markedly greater improvements in Visual Analog Score, subjective shoulder value, and abduction., Conclusion: Patients undergoing tendon transfer of either combined LDTM or latissimus dorsi alone in the setting of RTSA have markedly improved subjective and functional outcomes. A moderate incidence of complications (11.3%) was noted in this patient population., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following type V superior labrum anterior to posterior (SLAP) repair., Methods: Two independent reviewers performed a literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, utilizing the EMBASE, MEDLINE, and the Cochrane Library Databases. Studies were included if they had clinical outcomes on the patients undergoing type V SLAP repair. Statistical analysis was performed using SPSS (IBM, Armonk, NY, USA). A P value of <.05 was considered to be statistically significant., Results: Our review found 13 studies, including 451 shoulders meeting our inclusion criteria. The majority of patients were males (89.3%), with an average age of 25.9 years (range 15-58) and a mean follow-up of 53.8 months. The Rowe score was the most utilized functional outcome score, with a weighted mean of 88.5. Additionally, the mean Constant score was 91.0, the mean American Shoulder and Elbow Surgeons score was 88.3, the mean subjective shoulder value score was 85.5%, and the mean visual analog scale pain score was 1.2. The overall rate of return to play was 84.8%, with 80.2% returning to the same level of play. The overall reoperation rate was 6.1%, with a recurrent dislocation rate of 8.2%. In the studies comparing type V SLAP and isolated Bankart repair, there were statistically insignificant differences in visual analog scale pain scores (mean difference; 0.15, 95% confidence interval, -0.13 to 0.44, I 2  = 0%, P = .29) and recurrence rates (risk ratio; 1.38, 95% confidence interval, 0.88-2.15, I 2  = 0%, P = .16)., Conclusion: Arthroscopic repair of type V SLAP tears results in excellent functional outcomes, with high return to play rates in athletes. There are low rates of reoperations and recurrent dislocations. Additionally, in comparison to an isolated Bankart repair, SLAP repair does not increase recurrence rates or postoperative pain., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Regional anesthesia is a valuable component of multimodal pain control in total shoulder arthroplasty (TSA), and multiple interscalene block anesthetic options exist, including nonliposomal interscalene bupivacaine (NLIB) and liposomal interscalene bupivacaine (LIB). The purpose of this study was to compare pain control and opioid consumption within 48 hours postoperation in those undergoing TSA with either LIB or NLIB., Methods: This was a retrospective cohort study at a single academic medical center including consecutive patients undergoing inpatient (>23-hour hospitalization) primary anatomic or reverse TSA from 2016 to 2020 who received either LIB or an NLIB for perioperative pain control. Perioperative patient outcomes were collected including pain levels and opioid usage, as well as 30- and 90-day emergency department (ED) visits or readmissions. The primary outcome was postoperative pain and opioid use., Results: Overall, 489 patients were included in this study (316 LIB and 173 NLIB). Pain scores at 3, 6, 12, and 48 hours postoperatively were not statistically significantly different (P > .05 for all). However, the LIB group had improved pain scores at 24 and 36 hours postoperation (P < .05 all). There was no difference in the incidence of severe postoperative pain, defined as a 9 or 10 numeric rating scale-11 score, between the 2 anesthesia groups after adjusting for preoperative pain and baseline opioid use (odds ratio 1.25, 95% confidence interval 0.57-2.74; P = .57). Overall, 99 of 316 patients receiving LIB (31.3%) did not require any postoperative opioids compared with 38 of 173 receiving NLIB (22.0%); however, this difference was not statistically significant after adjusting for prior opioid use and preoperative pain (P = .33). No statistically significant differences in postoperative total morphine equivalents or mean daily morphine equivalents consumed between the groups were found during their hospital stays (P > .05 for both). Finally, no significant differences were found in 30- and 90-day ED visits or readmission rates (all P > .05)., Conclusion: LIB and NLIB demonstrated differences in patient-reported pain scores at 24 and 36 hours postoperation, although these did not reach clinical significance. There were no statistically significant differences in opioid consumption during the hospital stay, including opioid use, total morphine equivalents, and daily mean morphine equivalents consumed during the hospital stay. Additionally, no differences were observed in 30- and 90-day ED visits or readmission rates., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the extent to which experienced reviewers can accurately discern between artificial intelligence (AI)-generated and original research abstracts published in the field of shoulder and elbow surgery and compare this with the performance of an AI detection tool., Methods: Twenty-five shoulder- and elbow-related articles published in high-impact journals in 2023 were randomly selected. ChatGPT was prompted with only the abstract title to create an AI-generated version of each abstract. The resulting 50 abstracts were randomly distributed to and evaluated by 8 blinded peer reviewers with at least 5 years of experience. Reviewers were tasked with distinguishing between original and AI-generated text. A Likert scale assessed reviewer confidence for each interpretation, and the primary reason guiding assessment of generated text was collected. AI output detector (0%-100%) and plagiarism (0%-100%) scores were evaluated using GPTZero., Results: Reviewers correctly identified 62% of AI-generated abstracts and misclassified 38% of original abstracts as being AI generated. GPTZero reported a significantly higher probability of AI output among generated abstracts (median, 56%; interquartile range [IQR], 51%-77%) compared with original abstracts (median, 10%; IQR, 4%-37%; P < .01). Generated abstracts scored significantly lower on the plagiarism detector (median, 7%; IQR, 5%-14%) relative to original abstracts (median, 82%; IQR, 72%-92%; P < .01). Correct identification of AI-generated abstracts was predominately attributed to the presence of unrealistic data/values. The primary reason for misidentifying original abstracts as AI was attributed to writing style., Conclusions: Experienced reviewers faced difficulties in distinguishing between human and AI-generated research content within shoulder and elbow surgery. The presence of unrealistic data facilitated correct identification of AI abstracts, whereas misidentification of original abstracts was often ascribed to writing style., Clinical Relevance: With rapidly increasing AI advancements, it is paramount that ethical standards of scientific reporting are upheld. It is therefore helpful to understand the ability of reviewers to identify AI-generated content., Competing Interests: Disclosures All authors (R.D.S., S.Y.S., M.A.M., P.J.D., X.A.D., G.E.G., C.S.K., J.C.L., S.N., J.S-S., M.E.M.) 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 © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study is to assess the current trends in fellowship training, career satisfaction, practice characteristics, and surgical case volume among shoulder and elbow surgeons., Methods: A web-based, anonymous 25-item survey was sent to the membership of the American Shoulder and Elbow Surgeons (ASES) in October of 2022. Questions posed included respondent demographics, fellowship training, career satisfaction, practice characteristics, and surgical case characteristics. Descriptive statistics were performed to report demographic information, assess job and training satisfaction rates, and evaluate practice characteristics. Chi-squared and independent samples t-tests were performed to analyze satisfaction rates, job applications, and surgical case volume with regard to years in practice and practice setting., Results: Twenty percent (243/1248) of ASES members satisfactorily completed the survey. Of the 243 ASES member respondents, 97% (236/243) stated that they would pursue their fellowship training again. Ninety-eight percent (239/243) of respondents were satisfied with their specialty choice. One-hundred percent (242/243) were satisfied with their training in shoulder. Seventy-two percent (176/243) were satisfied with their training in elbow. Seventy-four percent (179/243) were satisfied with their job availability and 85% (207/243) were satisfied with their job location. The mean total number of orthopedic surgical cases per year was 393 ± 171. The mean total number of shoulder cases per year was 253 ± 149. The mean total number of elbow cases per year was 41 ± 41. Physicians who have been in practice for 11 years or more were comparatively more satisfied (90% vs. 80%) with their job location (P value = .008) and job availability (81% vs. 64%, P value < .001). Additionally, senior surgeons completed more orthopedic (431 vs. 347, P value < .001) and shoulder (279 vs. 220, P value = .002) cases annually than surgeons earlier in their careers. Satisfaction rates, job applications, and surgical case volume did not associate with practice setting., Conclusions: The majority of ASES member shoulder and elbow surgeons are satisfied with their training, their case volume and complexity, and their specialty choice. Fewer surgeons are satisfied with their elbow training and overall elbow case volume remains low among shoulder and elbow surgeons. Shoulder and elbow surgeons earlier in their careers perform fewer surgical cases, are less satisfied with their job availability and location, and completed more job applications for their first job after fellowship when compared to more senior surgeons., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA., Methods: A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded., Results: The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma., Conclusions: Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA., Type of Study/level of Evidence: Therapeutic II., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly or indirectly to the subject of this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to systematically review the evidence in the literature to determine the clinical outcomes following glenohumeral arthrodesis., Methods: Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they reported on outcomes following shoulder arthrodesis from the years of 2000-2022. Functional outcomes that were collected included the Subjective Shoulder Value, American Shoulder and Elbow Surgeons shoulder index score, visual analog scale pain score, and Oxford Shoulder Score. Range-of-motion data were also collected., Results: This review included 17 studies, with a total of 316 patients, that met the inclusion criteria. The majority of the patients were male (67.4%), and the average age was 38.4 years (range, 7-82 years). The overall fusion rate was 88.7%, and the time to fusion was on average, 3.9 months (range, 2-8 months). Shoulder arthrodesis resulted in improvement in each of the functional outcomes assessed: Subjective Shoulder Value (preoperatively, 18.8; postoperatively, 43.9; and percent change, 132.8%), American Shoulder and Elbow Surgeons shoulder index score (postoperatively, 62.1), visual analog scale pain score (preoperatively, 8.5; postoperatively, 3.03; and percent change, 62.4%), and Oxford Shoulder Score (preoperatively, 9.4; postoperatively, 30.9; and percent change, 328.7%). The abduction, forward flexion, external rotation, and internal rotation range-of-motion measurements postoperatively were 57°, 64°, 3°, and 48°, respectively. Complications were reported in 33.6% of patients, with fractures (20.9%) and infections (18.6%) being the most common sources of complication., Conclusion: Shoulder arthrodesis provides improvement in functional outcomes for end-stage glenohumeral injuries; however, it is also associated with high rates of complications., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Anterior shoulder instability is a complex spectrum of pathology characterized by excessive translation of the humeral head across the glenoid, leading to apprehension, subluxation, and dislocation. Diagnosis and classification require a thorough clinical history, physical examination, and imaging to appropriately determine the severity of instability. Depending on the individual patient anatomy and severity of instability, there exist many management options that are well-positioned to successfully treat this pathology and allow patients to return to prior functional levels. Treatment options available are conservative management, arthroscopic or open Bankart repair, remplissage, open or arthroscopic Latarjet, and glenoid bone grafting. Each of these options provides unique advantages for the surgeon in treating a subset of patients along the spectrum of disease. Selection of treatment modality depends upon the number of instability events, appropriate quantification, classification bone loss, presence of associated soft tissue injuries, and patient-specific goals regarding return of function. The purpose of this review was to present an evidence-based approach to the investigation, treatment selection, and follow-up of anterior shoulder instability. Individualized patient care is required to optimally address intra-articular pathology, restore stability and function, and preserve joint health for all., Competing Interests: Oke Anakwenze receives research support and consultant payments from Exactech, LIMA, Responsive Arthroscopy, Suture Tech, and Smith & Nephew. Christopher S. Klifto receives research support and consultant payments from Acumed, LLC, Restore3d, GE Healthcare, J&J, Merck, Pfizer, and Smith & Nephew. Yaw Boachie-Adjei has partnerships with DJO/Enovis Medical and restor3D. Johnathan Dickens has relationships with Asante, Blue Bio, Quadvantage, restor3D, Revbio, Sparta Biomedical, and Sparta Biopharma. None of these relationships are directly related to or may have added bias to this article. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article., (© 2024 The Authors.)

Purpose: To establish consensus statements on the diagnosis, nonoperative management, and labral repair for posterior shoulder instability., Methods: A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating on the basis of their level of expertise in the field. Experts were assigned to 1 of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement., Results: Unanimous agreement was reached on the indications for nonoperative management and labral repair, which include whether patients had primary or recurrent instability, with symptoms/functional limitations, and whether there was other underlying pathology, or patient's preference to avoid or delay surgery. In addition, there was unanimous agreement that recurrence rates can be diminished by attention to detail, appropriate indication and assessment of risk factors, recognition of abnormalities in glenohumeral morphology, careful capsulolabral debridement and reattachment, small anchors with inferior placement and multiple fixation points that create a bumper with the labrum, treatment of concomitant pathologies, and a well-defined rehabilitation protocol with strict postoperative immobilization., Conclusions: The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. The statements that achieved unanimous consensus were the relative indications for nonoperative management, and the relative indications for labral repair, as well as the steps to minimize complications for labral repair. There was no consensus on whether an arthrogram is needed when performing advanced imaging, the role of corticosteroids/orthobiologics in nonoperative management, whether a posteroinferior portal is required., Level of Evidence: Level V, expert opinion., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.T.P. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Society of Military Orthopaedic Surgeons, Society of Military Orthopaedic Surgeons, Arthrex, and SLACK Inc; editorial or governing board for Arthroscopy, Knee, and San Diego Shoulder Institute; IP royalties; paid consultant; research support for Arthrex; IP royalties from Arthrosurface; Publishing royalties, financial or material support from Elsevier; paid consultant Joint Restoration Foundation (AlloSource): and publishing royalties, financial, or material support from SLACK Inc. B.W. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association of North America; other financial or material support and paid presenter or speaker from Arthrex; editorial or governing board, publishing royalties, and financial or material support from Arthroscopy; publishing royalties and financial or material support from Elsevier; paid consultant for FH Ortho: stock or stock options and unpaid consultant for Kaliber AI; other financial or material support from the Musculoskeletal Transplant Foundation and Smith & Nephew; paid presenter or speaker; stock or stock options; unpaid consultant for Sparta; paid presenter or speaker for Vericel; editorial or governing board for Video Journal of Sports Medicine; and stock or stock options from Vivorte. B.E. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, and American Shoulder and Elbow Surgeons; paid consultant for and research support from Arthrex; and research support from DePuy, A Johnson & Johnson Company, Linvatec, Smith & Nephew, and Stryker. C.K. reports paid consultant for Acumed, Restore3d, and Smith & Nephew; and stock or stock options from GE Healthcare, Johnson & Johnson, Merck, and Pfizer. A.I. reports board or committee member for AGA, DGOOC, DGOU, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS); editorial or governing board for AOSSM, Archives of Orthopaedic and Trauma Surgery, Arthroscopy, Arthroskopie Springer, Journal of Shoulder and Elbow Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, Knee Surgery, Sports Traumatology, Arthroscopy, and OOTR; IP royalties and research support from Arthrex; IP royalties from Arthrosurface: paid consultant for Arthrosurface, medi Bayreuth; and publishing royalties, financial or material support Saunders/Mosby-Elsevier and Springer, Thieme. B.O. reports editorial or governing board for Orthopedics and Orthopedics Today; editorial or governing board and publishing royalties, financial or material support from American Journal of Sports Medicine; board or committee member of the American Orthopaedic Society for Sports Medicine; research support from Arthrex; IP royalties and paid consultant for CONMED Linvatec; paid consultant and research support from Mitek; research support from Musculoskeletal Transplant Foundation; publishing royalties and financial or material support from Saunders/Mosby-Elsevier, SLACK Inc, and Springer; paid consultant for Vericel; and stock or stock options from Vivorte. D.T. reports board or committee member for American Orthopaedic Society for Sports Medicine; editorial or governing board of OJSM; IP royalties from DePuy, A Johnson & Johnson Company; research support from Smith & Nephew; and other financial or material support from Arthrex, Breg, DJOrtho, Mitek, and Smith & Nephew. A.T. reports board or committee member for American Orthopaedic Society for Sports Medicine; and other financial or material support from Arthrex, Breg, Mitek, Smith & Nephew, and Stryker. F.C. reports board or committee member for American Shoulder and Elbow Surgeons; IP royalties from and paid consultant for Arthrex; and publishing royalties, financial or material support from Saunders/Mosby-Elsevier and Wolters Kluwer Health - Lippincott Williams & Wilkins. P.M. reports IP royalties from, research support from, and paid consultant for Arthrex; research support from Canon, DJ Orthopaedics, Icarus Medical, Ossur, Siemens, Smith & Nephew, Stryker, SubioMed, and Wright Medical Technology; and stock or stock Options from VuMedi. B.M. reports board or committee member for Arthroscopy Association of North America; paid consultant for Arthrex; and paid presenter or speaker for Pendopharm. O.A. reports paid consultant for Exactech, LIMA, Responsive Arthroscopy, and Smith & Nephew and stock or stock options from Suture Tech. H.M. reports paid presenter or speaker for CONMED Linvatec and DJ Orthopaedics; and board or committee member for the Irish Orthopaedic Association. J.S-S. reports paid consultant for Acumed; board or committee member for American Shoulder and Elbow Surgeons; publishing royalties and financial or material support from Elsevier; paid consultant for Exactech; editorial or governing board and publishing royalties, financial or material support from the Journal of Shoulder and Elbow Surgery; publishing royalties and financial or material support from Oxford University Press; stock or stock options from Orthobullets, Precision OS, and posterior shoulder instability: Stock or stock Options; and IP royalties, paid presenter or speaker, research support from Stryker. P.D. reports board or committee member for American Shoulder and Elbow Surgeons and Arthroscopy Association of North America; IP royalties; paid consultant; paid presenter or speaker; research support for Arthrex; stock or stock options for Kaliber Labs and PT Genie; and editorial or governing board of Orthopedics Today. I.W. reports research support from Aesculap/B.Braun and Arthrex; editorial or governing board of the American Journal of Sports Medicine (AJSM) and Arthroscopy; board or committee member for the American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Canadian Orthopaedic Association, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and International Society of Orthopaedic Surgery and Traumatology (Société Internationale de Chirurgie Orthopédique et de Traumatologie, SICOT); paid presenter or speaker for Bioventus and DePuy, A Johnson & Johnson Company; paid presenter or speaker and research support from Linvatec and Smith & Nephew. T.L. reports research support from Arthrex; other financial or material support from Lima; paid consultant for Stryker; and research support from Wright Medical Technology. R.M.F. reports board or committee member of AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association of North America, International Cartilage Restoration Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; editorial or governing board of the Journal of Shoulder and Elbow Surgery and Orthopedics Today; paid consultant; paid presenter or speaker for AlloSource and JRF; paid consultant, paid presenter or speaker, and research support from Arthrex; publishing royalties, financial or material support from Elsevier; paid presenter or speaker for Ossur, and research support from Smith & Nephew. G.A. reports board or committee member of American Shoulder and Elbow Surgeons; IP royalties from CONMED Linvatec, Exactech, and Wright Medical Technology; editorial or governing board of the Journal of Shoulder and Elbow Surgery; stock or stock options from Parvizi Surgical Innovation, PrecisionOS, and Reach Orthopedics; and IP royalties, paid consultant, and research support from Stryker. S.R. reports stock or stock options from Ortho RTI and paid consultant for Teladoc. J.Y.B. reports board or committee member of AAOS, Mid-American Orthopaedic Association, and Ohio Orthopaedic Society; research support from Arthrex; paid consultant for CONMED Linvatec and Stryker; and paid consultant for and Research support from Smith & Nephew. R.H.B. reports board or committee member of AAOS and American Orthopaedic Association; and editorial or governing board of the American Journal of Sports Medicine and Journal of the American Academy of Orthopaedic Surgeons. E.C. reports board or committee member of the European Society for Surgery of the Shoulder and Elbow and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid presenter or speaker for DePuy, A Johnson & Johnson Company, and Smith & Nephew; paid consultant for Johnson & Johnson; editorial or governing board of the Journal of Shoulder and Elbow Surgery; and paid presenter or speaker and research support from Stryker. C.C. reports paid consultant for Arthrex; research support from Major League Baseball; and publishing royalties and financial or material support from Springer. P.N.C. reports IP royalties, paid consultant, and paid presenter or speaker for DePuy, A Johnson & Johnson Company; paid consultant for DJ Orthopaedics; IP royalties from and paid consultant for Exactech; publishing royalties and financial or material support from the Journal of Shoulder and Elbow Surgery; IP royalties from Responsive Arthroscopy; paid consultant for Smith & Nephew; and stock or stock options for TitinKM Biomedical. R.A.D. reports unpaid consultant for Akunah; other financial or material support from Arthrex GmbH, Lynch Medical Supplies (Arthrex distributor), and Tekno Surgical (Stryker distributor); stock or stock options from Beemed; board or committee member of the Irish Shoulder and Elbow Society and Société Européenne pour la Chirurgie de l’Epaule et du Coude (SECEC); editorial or governing board of the Journal of the American Academy of Orthopaedic Surgeons; paid consultant for Precision OS; paid presenter or speaker for Smith & Nephew; and paid consultant and paid presenter or speaker for Stryker. X.A.D. reports board or committee member of the American Shoulder and Elbow Surgeons and Association of Bone and Joint Surgeons; editorial or governing board of Clinical Orthopaedics and Related Research; and paid presenter or speaker for Smith & Nephew; S.J.F. reports paid presenter or speaker for Anika Therapeutics; and paid consultant for Zimmer. M.T.F. reports board or committee member of the AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid consultant for Biorez; research support and unpaid consultant for CONMED Linvatec; research support from Major League Baseball, National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases and Eunice Kennedy Shriver National Institute of Child Health and Human Development), and Regeneration Technologies; IP royalties, paid consultant, paid presenter or speaker, and research support from Smith & Nephew; stock or stock options and unpaid consultant for Sparta; and paid consultant for Tornier. D.E.G. reports IP royalties from Pattern Health. P.R.H. reports board or committee member of the AGA-German speaking Arthroscopy Association. G.H. reports research support from Arthrex; paid consultant and research support from DePuy, A Johnson & Johnson Company: editorial or governing board of the Journal of Science and Medicine in Sport and Shoulder and Elbow (Wiley): research support from Medartis; and board or committee member of the Shoulder Elbow Society of Australia. E.I. reports editorial or governing board of the American Journal of Sports Medicine and Journal of Shoulder and Elbow Surgery. B.C.L. reports board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; research support from Arthrex and Wright Medical Technology; and paid consultant for DePuy, A Johnson & Johnson Company, and Miach. R.M. reports stock or stock Options from Alignmed; and paid presenter or speaker for Arthrex. L.E.L. reports editorial or governing board of the American Journal of Sports Medicine and Arthroscopy, and Video Journal of Sports Medicine; and board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America. W.N.L. reports IP royalties from and unpaid consultant for Zimmer. E.C.M. reports board or committee member of the American Orthopaedic Society for Sports Medicine and research support from Arthrex. M.E.M. reports board or committee member of the American Shoulder and Elbow Surgeons and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; IP royalties from and paid consultant for Biomet: paid consultant for Bioventus; research support for Breg, DJ Orthopaedics, Mitek, Ossur, and Smith & Nephew; publishing royalties, and financial or material support from Elsevier; editorial or governing board of Orthopedics Today and Orthopedics American Journal of Sports Medicine; and IP royalties from Zimmer. P.M. reports IP royalties and stock or stock options from Alyve Medical: IP royalties, paid presenter or speaker, and research support from Arthrex; and IP royalties from Medacta. L.N. reports paid consultant from; Arthrex board or committee member of the European Society for Shoulder and Elbow Surgery; stock or stock options from Sparta Biopharma and Statera; and IP royalties from and Paid consultant for Stryker. G.N. reports board or committee member of the American Shoulder and Elbow Surgeons and editorial or governing board of Obere Extremität/Springer; IP royalties from Anika and Innomed; paid presenter or speaker for Arthrosurface; paid consultant for AzurMed; IP royalties from and paid consultant for Stryker; and research support form Tornier. M.J.O. reports stock or stock options from Aevumed; board or committee member for the American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, and the Southern Orthopaedic Association; paid consultant for Exactech and Wright Medical Technology; and paid consultant for and research support from Smith & Nephew. S.A.P. reports board or committee member for the AAOS and American Shoulder and Elbow Surgeons; paid consultant for Arthrex and paid consultant for and research support from Exactech. J.P.S. reports editorial or governing board of Arthroscopy. N.A.T. reports paid presenter or speaker for DJ Orthopaedics. E.R.W. reports paid consultant for Acumed, Biomet, Osteoremedies, and Stryker and research support from Konica Minolta. J.R.W. reports board or committee member for the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; paid presenter or speaker for Arthrex and Vericel; paid consultant for Geistlich and ogy; editorial or governing board for Ortho Info; and stock or stock options for Viewfi. J.S.H. reports board or committee member for the American Shoulder and Elbow Surgeons and IP royalties and paid consultant for DJ Orthopaedics. L.M.J. reports research support from Arthrex, Mitek, and Smith & Nephew; editorial or governing board for the Bulletin for the Hospital for Joint Diseases and JBJS Reviews; stock or stock options from Lazurite: and publishing royalties, financial or material support from Wolters Kluwer Health - Lippincott Williams & Wilkins. A.L. reports paid consultant; paid presenter or speaker for Arthrex; stock or stock options from BeeMed and Follow Health; paid consultant; paid presenter or speaker; research support; stock or stock options from Medacta: board or committee member of the Société Francaise d'Arthroscopie; and IP royalties; paid consultant; paid presenter or speaker for Wright Medical Technology. G.E.G. reports stock or stock options from Aevumed, CultivateMD, Genesys, Patient IQ, ROM 3, and Sparta Biopharma; IP royalties; other financial or material support; paid consultant; paid presenter or speaker for DJ Orthopaedics: publishing royalties, financial or material support from Elsevier; paid consultant for Mitek; paid consultant; stock or stock options from Restor3d: and IP royalties from and paid consultant for Tornier. J.F.D. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Society of Military Orthopaedic Surgeons; and editorial or governing board for American Journal of Sports Medicine. S.N. reports paid consultant for ACI Clinical and Synthes; IP royalties; stock or stock options from Aevumed and MediFlix; board or committee member of American Shoulder and Elbow Surgeons and Philadelphia Orthopaedic Society; IP royalties; paid consultant; paid presenter or speaker for Biederman Motech; stock or stock options from CLEU Diagnostics, Coracoid Solutions, HealthExl, Parvizi Surgical Innovations, and SurgiWipe; IP royalties; paid consultant; paid presenter or speaker; research support from Enovis; editorial or governing board of the Journal of Bone and Joint Surgery - American and Shoulder & Elbow; publishing royalties, financial or material support from Saunders/Mosby-Elsevier, SLACK Inc, and Wolters Kluwer Health - Lippincott Williams & Wilkins: research support from Roche, Arthrex, DePuy, A Johnson & Johnson Company, Smith & Nephew, Stryker, and Zimmer; and IP royalties from Tigon. C.S.K. reports paid consultant for Acumed, Restore3d, and Smith & Nephew and stock or stock options from GE Healthcare, Johnson & Johnson, Merck, and Pfizer. O.A. reports paid consultant for Exactech, LIMA, Responsive Arthroscopy, and Smith & Nephew and stock or stock options from Suture Tech. Y.B-A. reports paid presenter or speaker from DJ Orthopaedics and stock or stock options from K2M. J.M.L. reports stock or stock options from Stryker and Zimmer. All other authors (E.T.H., Z.S.A., T.R.D., L.P., D.B.W., K.E.B., N.M.C., T.D., J.R.W., M.R., B.W.H., K.G.K., L.A.R., N.P., L.E., T.C., R.M.D., T.B.G.) 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 © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To establish consensus statements on glenoid bone grafting, glenoid osteotomy, rehabilitation, return to play, and follow-up for posterior shoulder instability., Methods: A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating on the basis of their level of expertise in the field. Experts were assigned to 1 of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement., Results: All of the statements relating to rehabilitation, return to play, and follow-up achieved consensus. There was unanimous consensus that the following criteria should be considered: restoration of strength, range of motion, proprioception, and sport-specific skills, with a lack of symptoms. There is no minimum time point required to return to play. Collision athletes and military athletes may take longer to return because of their greater risk for recurrent instability, and more caution should be exercised in clearing them to return to play, with elite athletes potentially having different considerations in returning to play. The relative indications for revision surgery are symptomatic apprehension, multiple recurrent instability episodes, further intra-articular pathologies, hardware failure, and pain., Conclusions: The study group achieved strong or unanimous consensus on 59% of statements. Unanimous consensus was reached regarding the criteria for return to play, collision/elite athletes having different considerations in return to play, indications for revision surgery, and imaging only required as routine for those with glenoid bone grafting/osteotomies at subsequent follow-ups. There was no consensus on optimal fixation method for a glenoid bone block, the relative indications for glenoid osteotomy, whether fluoroscopy is required or if the labrum should be concomitantly repaired., Level of Evidence: Level V, expert opinion., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.T.P. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Society of Military Orthopaedic Surgeons, Society of Military Orthopaedic Surgeons, Arthrex, and SLACK Inc; editorial or governing board for Arthroscopy, Knee, and San Diego Shoulder Institute; IP royalties; paid consultant; research support for Arthrex; IP royalties from Arthrosurface; Publishing royalties, financial or material support from Elsevier; paid consultant Joint Restoration Foundation (AlloSource): and publishing royalties, financial, or material support from SLACK Inc. B.W. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association of North America; other financial or material support and paid presenter or speaker from Arthrex; editorial or governing board, publishing royalties, and financial or material support from Arthroscopy; publishing royalties and financial or material support from Elsevier; paid consultant for FH Ortho: stock or stock options and unpaid consultant for Kaliber AI; other financial or material support from the Musculoskeletal Transplant Foundation and Smith & Nephew; paid presenter or speaker; stock or stock options; unpaid consultant for Sparta; paid presenter or speaker for Vericel; editorial or governing board for Video Journal of Sports Medicine; and stock or stock options from Vivorte. B.E. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, and American Shoulder and Elbow Surgeons; paid consultant for and research support from Arthrex; and research support from DePuy, A Johnson & Johnson Company, Linvatec, Smith & Nephew, and Stryker. C.K. reports paid consultant for Acumed, Restore3d, and Smith & Nephew; and stock or stock options from GE Healthcare, Johnson & Johnson, Merck, and Pfizer. A.I. reports board or committee member for AGA, DGOOC, DGOU, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS); editorial or governing board for AOSSM, Archives of Orthopaedic and Trauma Surgery, Arthroscopy, Arthroskopie Springer, Journal of Shoulder and Elbow Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, Knee Surgery, Sports Traumatology, Arthroscopy, and OOTR; IP royalties and research support from Arthrex; IP royalties from Arthrosurface: paid consultant for Arthrosurface, medi Bayreuth; and publishing royalties, financial or material support Saunders/Mosby-Elsevier and Springer, Thieme. B.O. reports editorial or governing board for Orthopedics and Orthopedics Today; editorial or governing board and publishing royalties, financial or material support from American Journal of Sports Medicine; board or committee member of the American Orthopaedic Society for Sports Medicine; research support from Arthrex; IP royalties and paid consultant for CONMED Linvatec; paid consultant and research support from Mitek; research support from Musculoskeletal Transplant Foundation; publishing royalties and financial or material support from Saunders/Mosby-Elsevier, SLACK Inc, and Springer; paid consultant for Vericel; and stock or stock options from Vivorte. D.T. reports board or committee member for American Orthopaedic Society for Sports Medicine; editorial or governing board of OJSM; IP royalties from DePuy, A Johnson & Johnson Company; research support from Smith & Nephew; and other financial or material support from Arthrex, Breg, DJOrtho, Mitek, and Smith & Nephew. A.T. reports board or committee member for American Orthopaedic Society for Sports Medicine; and other financial or material support from Arthrex, Breg, Mitek, Smith & Nephew, and Stryker. F.C. reports board or committee member for American Shoulder and Elbow Surgeons; IP royalties from and paid consultant for Arthrex; and publishing royalties, financial or material support from Saunders/Mosby-Elsevier and Wolters Kluwer Health - Lippincott Williams & Wilkins. P.M. reports IP royalties from, research support from, and paid consultant for Arthrex; research support from Canon, DJ Orthopaedics, Icarus Medical, Ossur, Siemens, Smith & Nephew, Stryker, SubioMed, and Wright Medical Technology; and stock or stock Options from VuMedi. B.M. reports board or committee member for Arthroscopy Association of North America; paid consultant for Arthrex; and paid presenter or speaker for Pendopharm. O.A. reports paid consultant for Exactech, LIMA, Responsive Arthroscopy, and Smith & Nephew and stock or stock options from Suture Tech. H.M. reports paid presenter or speaker for CONMED Linvatec and DJ Orthopaedics; and board or committee member for the Irish Orthopaedic Association. J.S-S. reports paid consultant for Acumed; board or committee member for American Shoulder and Elbow Surgeons; publishing royalties and financial or material support from Elsevier; paid consultant for Exactech; editorial or governing board and publishing royalties, financial or material support from the Journal of Shoulder and Elbow Surgery; publishing royalties and financial or material support from Oxford University Press; stock or stock options from Orthobullets, Precision OS, and PSI: Stock or stock Options; and IP royalties, paid presenter or speaker, research support from Stryker. P.D. reports board or committee member for American Shoulder and Elbow Surgeons and Arthroscopy Association of North America; IP royalties; paid consultant; paid presenter or speaker; research support for Arthrex; stock or stock options for Kaliber Labs and PT Genie; and editorial or governing board of Orthopedics Today. I.W. reports research support from Aesculap/B.Braun and Arthrex; editorial or governing board of the American Journal of Sports Medicine (AJSM) and Arthroscopy; board or committee member for the American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Canadian Orthopaedic Association, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and International Society of Orthopaedic Surgery and Traumatology (Société Internationale de Chirurgie Orthopédique et de Traumatologie, SICOT); paid presenter or speaker for Bioventus and DePuy, A Johnson & Johnson Company; paid presenter or speaker and research support from Linvatec and Smith & Nephew. T.L. reports research support from Arthrex; other financial or material support from Lima; paid consultant for Stryker; and research support from Wright Medical Technology. R.M.F. reports board or committee member of AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association of North America, International Cartilage Restoration Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; editorial or governing board of the Journal of Shoulder and Elbow Surgery and Orthopedics Today; paid consultant; paid presenter or speaker for AlloSource and JRF; paid consultant, paid presenter or speaker, and research support from Arthrex; publishing royalties, financial or material support from Elsevier; paid presenter or speaker for Ossur, and research support from Smith & Nephew. G.A. reports board or committee member of American Shoulder and Elbow Surgeons; IP royalties from CONMED Linvatec, Exactech, and Wright Medical Technology; editorial or governing board of the Journal of Shoulder and Elbow Surgery; stock or stock options from Parvizi Surgical Innovation, PrecisionOS, and Reach Orthopedics; and IP royalties, paid consultant, and research support from Stryker. S.R. reports stock or stock options from Ortho RTI and paid consultant for Teladoc. J.Y.B. reports board or committee member of AAOS, Mid-American Orthopaedic Association, and Ohio Orthopaedic Society; research support from Arthrex; paid consultant for CONMED Linvatec and Stryker; and paid consultant for and Research support from Smith & Nephew. R.H.B. reports board or committee member of AAOS and American Orthopaedic Association; and editorial or governing board of the American Journal of Sports Medicine and Journal of the American Academy of Orthopaedic Surgeons. E.C. reports board or committee member of the European Society for Surgery of the Shoulder and Elbow and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid presenter or speaker for DePuy, A Johnson & Johnson Company, and Smith & Nephew; paid consultant for Johnson & Johnson; editorial or governing board of the Journal of Shoulder and Elbow Surgery; and paid presenter or speaker and research support from Stryker. C.C. reports paid consultant for Arthrex; research support from Major League Baseball; and publishing royalties and financial or material support from Springer. P.N.C. reports IP royalties, paid consultant, and paid presenter or speaker for DePuy, A Johnson & Johnson Company; paid consultant for DJ Orthopaedics; IP royalties from and paid consultant for Exactech; publishing royalties and financial or material support from the Journal of Shoulder and Elbow Surgery; IP royalties from Responsive Arthroscopy; paid consultant for Smith & Nephew; and stock or stock options for TitinKM Biomedical. R.A.D. reports unpaid consultant for Akunah; other financial or material support from Arthrex GmbH, Lynch Medical Supplies (Arthrex distributor), and Tekno Surgical (Stryker distributor); stock or stock options from Beemed; board or committee member of the Irish Shoulder and Elbow Society and Société Européenne pour la Chirurgie de l’Epaule et du Coude (SECEC); editorial or governing board of the Journal of the American Academy of Orthopaedic Surgeons; paid consultant for Precision OS; paid presenter or speaker for Smith & Nephew; and paid consultant and paid presenter or speaker for Stryker. X.A.D. reports board or committee member of the American Shoulder and Elbow Surgeons and Association of Bone and Joint Surgeons; editorial or governing board of Clinical Orthopaedics and Related Research; and paid presenter or speaker for Smith & Nephew; S.J.F. reports paid presenter or speaker for Anika Therapeutics; and paid consultant for Zimmer. M.T.F. reports board or committee member of the AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid consultant for Biorez; research support and unpaid consultant for CONMED Linvatec; research support from Major League Baseball, National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases and Eunice Kennedy Shriver National Institute of Child Health and Human Development), and Regeneration Technologies; IP royalties, paid consultant, paid presenter or speaker, and research support from Smith & Nephew; stock or stock options and unpaid consultant for Sparta; and paid consultant for Tornier. D.E.G. reports IP royalties from Pattern Health. P.R.H. reports board or committee member of the AGA-German speaking Arthroscopy Association. G.H. reports research support from Arthrex; paid consultant and research support from DePuy, A Johnson & Johnson Company: editorial or governing board of the Journal of Science and Medicine in Sport and Shoulder and Elbow (Wiley): research support from Medartis; and board or committee member of the Shoulder Elbow Society of Australia. E.I. reports editorial or governing board of the American Journal of Sports Medicine and Journal of Shoulder and Elbow Surgery. B.C.L. reports board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; research support from Arthrex and Wright Medical Technology; and paid consultant for DePuy, A Johnson & Johnson Company, and Miach. R.M. reports stock or stock Options from Alignmed; and paid presenter or speaker for Arthrex. L.E.L. reports editorial or governing board of the American Journal of Sports Medicine and Arthroscopy, and Video Journal of Sports Medicine; and board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America. W.N.L. reports IP royalties from and unpaid consultant for Zimmer. E.C.M. reports board or committee member of the American Orthopaedic Society for Sports Medicine and research support from Arthrex. M.E.M. reports board or committee member of the American Shoulder and Elbow Surgeons and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; IP royalties from and paid consultant for Biomet: paid consultant for Bioventus; research support for Breg, DJ Orthopaedics, Mitek, Ossur, and Smith & Nephew; publishing royalties, and financial or material support from Elsevier; editorial or governing board of Orthopedics Today and Orthopedics American Journal of Sports Medicine; and IP royalties from Zimmer. P.M. reports IP royalties and stock or stock options from Alyve Medical: IP royalties, paid presenter or speaker, and research support from Arthrex; and IP royalties from Medacta. L.N. reports paid consultant from; Arthrex board or committee member of the European Society for Shoulder and Elbow Surgery; stock or stock options from Sparta Biopharma and Statera; and IP royalties from and Paid consultant for Stryker. G.N. reports board or committee member of the American Shoulder and Elbow Surgeons and editorial or governing board of Obere Extremität/Springer; IP royalties from Anika and Innomed; paid presenter or speaker for Arthrosurface; paid consultant for AzurMed; IP royalties from and paid consultant for Stryker; and research support form Tornier. M.J.O. reports stock or stock options from Aevumed; board or committee member for the American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, and the Southern Orthopaedic Association; paid consultant for Exactech and Wright Medical Technology; and paid consultant for and research support from Smith & Nephew. S.A.P. reports board or committee member for the AAOS and American Shoulder and Elbow Surgeons; paid consultant for Arthrex and paid consultant for and research support from Exactech. J.P.S. reports editorial or governing board of Arthroscopy. N.A.T. reports paid presenter or speaker for DJ Orthopaedics. E.R.W. reports paid consultant for Acumed, Biomet, Osteoremedies, and Stryker and research support from Konica Minolta. J.R.W. reports board or committee member for the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; paid presenter or speaker for Arthrex and Vericel; paid consultant for Geistlich and ogy; editorial or governing board for Ortho Info; and stock or stock options for Viewfi. J.S.H. reports board or committee member for the American Shoulder and Elbow Surgeons and IP royalties and paid consultant for DJ Orthopaedics. L.M.J. reports research support from Arthrex, Mitek, and Smith & Nephew; editorial or governing board for the Bulletin for the Hospital for Joint Diseases and JBJS Reviews; stock or stock options from Lazurite: and publishing royalties, financial or material support from Wolters Kluwer Health - Lippincott Williams & Wilkins. A.L. reports paid consultant; paid presenter or speaker for Arthrex; stock or stock options from BeeMed and Follow Health; paid consultant; paid presenter or speaker; research support; stock or stock options from Medacta: board or committee member of the Société Francaise d'Arthroscopie; and IP royalties; paid consultant; paid presenter or speaker for Wright Medical Technology. G.E.G. reports stock or stock options from Aevumed, CultivateMD, Genesys, Patient IQ, ROM 3, and Sparta Biopharma; IP royalties; other financial or material support; paid consultant; paid presenter or speaker for DJ Orthopaedics: publishing royalties, financial or material support from Elsevier; paid consultant for Mitek; paid consultant; stock or stock options from Restor3d: and IP royalties from and paid consultant for Tornier. J.F.D. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Society of Military Orthopaedic Surgeons; and editorial or governing board for American Journal of Sports Medicine. S.N. reports paid consultant for ACI Clinical and Synthes; IP royalties; stock or stock options from Aevumed and MediFlix; board or committee member of American Shoulder and Elbow Surgeons and Philadelphia Orthopaedic Society; IP royalties; paid consultant; paid presenter or speaker for Biederman Motech; stock or stock options from CLEU Diagnostics, Coracoid Solutions, HealthExl, Parvizi Surgical Innovations, and SurgiWipe; IP royalties; paid consultant; paid presenter or speaker; research support from Enovis; editorial or governing board of the Journal of Bone and Joint Surgery - American and Shoulder & Elbow; publishing royalties, financial or material support from Saunders/Mosby-Elsevier, SLACK Inc, and Wolters Kluwer Health - Lippincott Williams & Wilkins: research support from Roche, Arthrex, DePuy, A Johnson & Johnson Company, Smith & Nephew, Stryker, and Zimmer; and IP royalties from Tigon. C.S.K. reports paid consultant for Acumed, Restore3d, and Smith & Nephew and stock or stock options from GE Healthcare, Johnson & Johnson, Merck, and Pfizer. O.A.A. reports paid consultant for Exactech, LIMA, Responsive Arthroscopy, and Smith & Nephew and stock or stock options from Suture Tech. Y.B-A. reports paid presenter or speaker from DJ Orthopaedics and stock or stock options from K2M. J.M.L. reports stock or stock options from Stryker and Zimmer. All other authors (E.T.H., Z.S.A., T.R.D., L.P., D.B.W., K.E.B., N.M.C., T.D., J.R.W., M.R., B.W.H., K.G.K., L.A.R., N.P., L.E., T.C., R.M.D., T.B.G.) 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 © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Arthroscopic rotator cuff repair (ARCR) is one of the most commonly performed orthopaedic procedures; however, it is unclear how to manage patients with symptomatic retears., Purpose: To perform a systematic review to evaluate the outcomes of revision ARCR in the literature., Study Design: Systematic review; Level of evidence, 4., Methods: A systematic literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed utilizing the Embase, MEDLINE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on revision rotator cuff repair. Clinical outcomes were recorded., Results: The 17 included studies were composed of 888 shoulders in 885 patients. The mean age of the 885 patients was 58.6 ± 9.1 years, with a mean follow-up of 28.1 ± 22.1 months. The mean visual analog scale score was 2.1 ± 1.8, the mean American Shoulder and Elbow Surgeons score was 75.0 ± 18.3, and the mean Constant score was 67.4 ± 16.6. The overall rate of retears after revision was 25.3%, with an 8.0% reoperation rate including 2.7% undergoing reverse shoulder arthroplasty and 2.0% undergoing subsequent rotator cuff repair. Finally, the complication rate was 8.6%., Conclusion: Revision ARCR improved patient-reported outcomes, with 92% of patients free from reoperations at a mean follow-up of 2 years. Overall, 78.4% of patients were satisfied at final follow-up; however, the rate of retears was found to be higher than after primary ARCR., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.L. has received support for education from SouthTech Orthopedics. O.A.A. has received consulting fees from Exactech, Smith & Nephew, Encore Medical, Medical Device Business Services, Stryker, and Lima USA; support for education from SouthTech Orthopedics and Arthrex; and hospitality payments from Wright Medical Technology and Zimmer Biomet. C.S.K. has received consulting fees from Acumed, restor3d, and Smith & Nephew and owns stock or stock options in Acumed, GE HealthCare, Johnson & Johnson, Merck, and Pfizer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Effective nerve coaptation entails tensionless repair of healthy fascicles with intact fascicular architecture and a well-vascularized environment, supportive of the regenerative cellular behaviors of neurons, immune cells, and Schwann cells. Suture coaptations have historically been used to ensure that these criteria are met for end-to-end repair, nerve transfers, and allograft or autograft reconstructions; however, unfortunately, overall restoration of function remains poor. As optimal coaptation is required for return of sensorimotor function, adjunct biomaterials are increasingly being enlisted attempting to optimize these suture-based coaptations. The purpose of this review was to discuss the biological, preclinical, and clinical data for the use of fibrin glue and nerve wraps made of type 1 collagen, porcine small intestine submucosa, chitosan, and human amniotic membrane. This study provides available data on each material's ability to optimize the regenerative potential of nerve repair as well as available outcomes data. Although each biomaterial discussed has benefits to nerve regeneration, at large, data remain heterogeneous, and continued investigation is required to fully understand the specific mechanisms involved and the long-term potential clinical impacts each can provide for improvement of sensorimotor outcomes., Competing Interests: No benefits in any form have been received or will be received related directly to this article., (© 2024 The Authors.)

Purpose: To evaluate return to play (RTP), clinical outcomes, and recurrence rates in collision athletes 20 years of age and younger who underwent open Latarjet for anterior shoulder instability., Methods: A retrospective review of collision athletes 20 years of age and younger, who underwent an open Latarjet procedure by a single surgeon between the years of 2010-2020 was carried out. Inclusion criteria were 1) collision athlete, 2) underwent open Latarjet procedure, 3) 16-20 years old, and 4) minimum 24-month follow-up. Exclusion criteria were 1) other pathology of the ipsilateral shoulder and 2) noncollision athlete. Rate of RTP, time to RTP, rate of return to preinjury level, the Shoulder Instability Return to Sport after Injury score (SIRSI) score, Subjective Shoulder Value (SSV), visual analogue scale (VAS) scores, and recurrence events were recorded. Quantitative statistical analysis was carried out., Results: The study included 105 male collision athletes with a mean age of 18.6 ± 1.0 years (range: 17-20). The mean follow-up for patients was 36 ± 26.2 months. A total of 93 (88.6%) RTP at a mean time of 6.3 ± 2.2 months, with 73 (69.5%) returning to their preinjury level of participation. The mean SIRSI score was 69.2 ± 21.8, the mean VAS score was 2.3 ± 2.1, and the mean SSV score was 84.1 ± 16.8. Five patients (4.8%) redislocated their shoulder, with 4 of these requiring a further surgery (3.8%). Two patients (1.9%) reported incidents of subluxation., Conclusions: The open Latarjet procedure in young collision athletes results in high rates of RTP, excellent functional outcomes and low recurrence rates at mid-term follow-up. Additionally, complication rates are low in this cohort., Level of Evidence: Level IV, case series., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Acromioclavicular (AC) joint dislocation is a common clinical problem among young and athletic populations. Surgical management is widely used for high-grade dislocations (Rockwood III-VI) and in high-demand athletes at high risk of recurrence., Purpose: To systematically review the evidence in the literature to ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after surgical treatment for AC joint dislocation., Study Design: Systematic review; Level of evidence, 4., Methods: A systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in the PubMed database. Clinical studies were eligible for inclusion if they reported on RTP after surgical treatment for AC joint dislocation. Statistical analysis was performed with SPSS., Results: We found 120 studies including 4327 cases meeting our inclusion criteria. The majority of patients were male (80.2%), with a mean age of 37.2 years (range, 15-85) and a mean follow-up of 34.5 months. Most were recreational athletes (79%), and the most common sport was cycling. The overall rate of RTP was 91.5%, with 85.6% returning to the same level of play. Among collision athletes, the rate of RTP was 97.3%, with 97.2% returning to the same level of play. In overhead athletes, the rate of RTP was 97.1%, with 79.2% returning to the same level of play. The mean time to RTP was 5.7 months (range, 1.5-15). Specific RTP criteria were reported in the majority of the studies (83.3%); time to return to play was the most commonly reported item (83.3%). Type III Rockwood injuries had the highest RTP rate at 98.7% and the earliest RTP at 4.9 months. Among the different surgical techniques, Kirschner wire fixation had the highest rate of RTP at 98.5%, while isolated graft reconstruction had the earliest RTP at 3.6 months., Conclusion: The overall rate of RTP was reportedly high after surgical treatment for AC joint dislocation, with the majority of patients returning to their preinjury levels of sport. There is a lack of consensus in the literature for what constitutes a safe RTP, with further focus on this topic required in future studies., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: O.A. has received consulting fees from Exactech Inc, Smith & Nephew, Encore Medical, Medical Device Business Services, Stryker Corp, and Lima USA; support for education from SouthTech Orthopedics and Arthrex; and hospitality payments from Wright Medical Technology and Zimmer Biomet Holdings. C.S.K. has received consulting fees from Acumed, Restore3D, and Smith & Nephew and holds stock or stock options in GE Heathcare, Johnson & Johnson, Merck, and Pfizer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Importance: As reverse total shoulder arthroplasty (RTSA) has become an increasingly common procedure, rates of post-operative complications leading to potential hospital readmission are of greater importance. No previous systematic reviews have focused exclusively on post-operative complications and mortality rates at 90 days post RTSA., Objectives: The purpose of this study was to review complication, readmission, and mortality rates within 90 days post RTSA., Evidence Review: Two independent reviewers performed a literature search using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using PubMed, Embase, and Web of Science databases. Only studies reporting on outcomes of RTSA at 90-days follow-up specifically were considered for inclusion., Findings: Our search included 79,037 shoulders (62.1 ​% female) from a total of 15 studies with an average age of 72.4 ​± ​5.8 years. The overall 90-day re-admission rates were reported in nine studies as 6.1 ​% (4205/69,127) following RTSA. Additionally, a total of five studies reported the overall 90-day mortality rate as 1.1 ​% (19/1733). The overall pooled rate of medical complications was 3.9 ​% (2998/77,826) as reported in 13 studies, at 90-days post-RTSA, with the occurrence of anaemia being the most commonly reported outcomes as 2.9 ​% (1013/34,385) in six studies. The overall rate of surgical complications was 1.1 ​% reported in 13 studies (1327/77,826), with the pooled rate of surgical revisions of 1.5 ​% (607/40,563) at 90-days follow-up. A total of 8, 5, and 3 studies reported rates of dislocation, requirement for closed reduction and glenoid loosening as 0.9 ​% (344/37,995), 0.6 ​% (7/1180), and 0.3 ​% (30/9115) respectively at 90-days following RTSA., Conclusions and Relevance: This study established that the overall rates of mortality and medical and surgical complications are low in the short-term following RTSA, with only 6 ​% of patients requiring re-admission in the first 90 days., Level of Evidence: IV - Systematic Review of all levels of evidence., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Distal radius fractures (DRFs) are common upper extremity fractures and often require surgical fixation when they are intraarticular. Preoperative computed tomography (CT) has emerged as a surgical planning tool to evaluate intraarticular DRFs. Although CT affords additional details, patients receive higher radiation doses than standard radiographs. We aim to develop a low-dose CT (LDCT) protocol, relative to the institutional standard-dose CT wrist for intraarticular DRFs although providing adequate detail for surgical decision-making., Methods: A single-institution prospective study was conducted on patients with intraarticular DRFs who underwent closed reduction and below-elbow splinting who otherwise would undergo wrist CT. Observations were defined as total measurements taken, with each view undergoing 44 measurements. Patients underwent 2 scans with a standard dose and a 10× dose reduction. Articular step and gap measurements were recorded in the sagittal and coronal images., Results: A total of 11 patients were enrolled (7 women and 4 men). The mean age was 55 years (SD = 20.1). There were a total of 4 reviewers: 1 attending surgeon, 2 resident physicians, and 1 student. When comparing LDCT and conventional-dose CT (CDCT), there were no significant differences in step and gap measurements across all reviewers., Conclusion: This study demonstrated that LDCT provides comparable imaging quality for surgical planning as a CDCT without significant diagnostic decay in the setting of DRFs. This comes with the added benefit of a 10-fold reduction in radiation exposure. These results suggest that LDCT is an opportunity to reduce effective radiation in patients although providing beneficial preoperative imaging., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.S.K. is a paid consultant for Acumed LLC, a paid consult with stock options for Restore3d, and a paid consultant for Smith and Nephew. All other authors declare that they have no conflict of interest.

Purpose: To analyze the quality and readability of information regarding shoulder stabilization surgery available using an online AI software (ChatGPT), using standardized scoring systems, as well as to report on the given answers by the AI., Methods: An open AI model (ChatGPT) was used to answer 23 commonly asked questions from patients on shoulder stabilization surgery. These answers were evaluated for medical accuracy, quality, and readability using The JAMA Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score (FRES) & Grade Level (FKGL)., Results: The JAMA Benchmark criteria score was 0, which is the lowest score, indicating no reliable resources cited. The DISCERN score was 60, which is considered a good score. The areas that open AI model did not achieve full marks were also related to the lack of available source material used to compile the answers, and finally some shortcomings with information not fully supported by the literature. The FRES was 26.2, and the FKGL was considered to be that of a college graduate., Conclusions: There was generally high quality in the answers given on questions relating to shoulder stabilization surgery, but there was a high reading level required to comprehend the information presented. However, it is unclear where the answers came from with no source material cited. It is important to note that the ChatGPT software repeatedly references the need to discuss these questions with an orthopaedic surgeon and the importance of shared discussion making, as well as compliance with surgeon treatment recommendations., Clinical Relevance: As shoulder instability is an injury that predominantly affects younger individuals who may use the Internet for information, this study shows what information patients may be getting online., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of arthroscopic rotator cuff repair (ARCR) with and without acellular collagen matrix patch (ACMP) augmentation., Methods: A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing ACMP augmentation and a control for ARCR were included. Clinical outcomes were compared using Revman, and a P value < .05 was considered to be statistically significant., Results: Five RCTs with 307 patients were included. Overall, 11% of patients treated with ACMP augmentation and 34% of patients in the control group had a re-tear (P = .0006). The mean Constant score was 90.1 with ACMP augmentation, and 87.3 in controls (P = .02). Additionally, there was a significant higher American Shoulder and Elbow Surgeons score with ACMP augmentation (87.7 vs 82.1, P = .01)., Conclusions: The RCTs in the literature support the use of ACMP augment as a modality to reduce re-tear rates and improve outcomes after ARCR., Level of Evidence: Level II, Meta-Analysis of Level II Studies meta-analysis of Level II studies., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the quality and level of evidence of studies reporting on Bankart repair for anterior shoulder instability., Methods: A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" with all results were analyzed via strict inclusion and exclusion criteria. Two independent investigators scored each included study based on the 10 criteria of the Modified Coleman Methodology Score (CMS) out of 100 and gave each study a score out of 25 based on the Anterior Shoulder Instability (ASI) Methodology criteria., Results: Two hundred sixty-six studies were included in the analysis and encompassed a total of 19,156 patients and 19,317 surgical procedures for Bankart repair for shoulder instability. Overall, 81.6% of studies were Level III or IV evidence. The mean CMS score for the studies was 55.3 out of 100, and the mean ASI Methodology score for the studies was 12.1 out of 25. Weaknesses in the studies were identified in sample size, description of preoperative investigations and diagnoses, reporting of mean glenoid bone loss, nonsubjective clinical outcome reporting, and description of associated pathologies., Conclusions: A large proportion of studies reporting the clinical outcomes of Bankart repair for anterior shoulder instability are of low methodological quality and have a low level of evidence., Clinical Relevance: This study emphasizes need for greater reporting of many variables such as body mass index, mean glenoid bone loss, and patient-reported outcomes and provides a framework for future studies reporting., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Rotator cuff arthropathy is a spectrum of disease states secondary to full-thickness cuff tears classified by rotator cuff insufficiency and degenerative disease within the shoulder joint. Diagnosis can be made through standard physical exam and radiographic films demonstrating varying levels of weakness, along with acetabularization, femoralization, and superior migration of the humeral head. Severity of disease is classified through both the Hamada and Seebauer grading systems, which are used clinically to determine the appropriate treatment algorithm. Treatment exists along the spectrum from conservative therapy with physical therapy to a definitive treatment with total joint replacement. Depending on a patient's progression and other comorbidities, arthroscopic treatments may additionally be used in specific circumstances as joint-sparing techniques. In recent years, reverse total shoulder arthroplasty has produced increasingly favorable outcomes with improvements in pain and function while simultaneously diminishing complication rates, making it generally accepted as standard of care. This disease limits quality of life for a large population of patients and efforts toward optimization of the treatment regimen is critical. This review provides an overview on the diagnostic criteria, classification, pathoanatomic changes, biomechanics, treatment options, outcomes, and complications of rotator cuff arthropathy., Competing Interests: No benefits in any form have been received or will be received related directly to this article., (© 2024 The Authors.)

Background: Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures, but stiffness is a reported complication. The introduction of intramedullary (IM) nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the soft tissue. The goal of this study was to compare the surgical outcomes of IM nail and percutaneous pin fixation in isolated proximal phalanx fractures., Methods: A retrospective review was performed at our institution between the years 2018 and 2022 for patients treated for proximal phalanx fractures. Patients that underwent fixation with IM nails or percutaneous fixation for isolated extraarticular proximal phalanx fractures were included. Patients were excluded if they had concomitant hand fractures, tendon injury, or intraarticular extension., Results: A total of 50 patients were included in this study. Twenty-eight patients received percutaneous pin fixation, and 22 patients underwent IM nail or screw fixation. There was no significant difference in injury patterns or demographics between these two groups. Patients that underwent IM nail fixation had a significantly quicker return to active motion, shorter duration of orthosis treatment, and fewer occupational therapy visits. In addition, patients in the IM fixation group had significantly improved range of motion (ROM) at 6 weeks postoperatively., Conclusions: This study demonstrates that patients receiving percutaneous pin or IM nail fixation have equivocal union and complication rates. The IM nail fixation group was able to have quicker return to mobilization, fewer required occupational therapy visits, and improved early ROM., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: D.S.R. has received royalties from Acumed and Zimmer and serves as a consultant for Acumed and Depuy Synthes. M.J.R. has received royalties from Acumed and Field Orthopaedics and serves as a consultant to Acumed, DJO Global, restor3d, and Zimmer Biomet. All other authors have no conflicts of interest.

Background: Several randomized controlled trials (RCTs) have been conducted to assess the use of tranexamic acid (TXA) in the setting of arthroscopic rotator cuff repair (ARCR). However, these studies have shown mixed results, with some showing improved intraoperative visualization, subsequent operative times, and pain levels, and others finding no difference., Purpose: To perform a systematic review of the RCTs in the literature to evaluate the use of TXA on ARCR., Study Design: Meta-analysis; Level of evidence, 1., Methods: Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing TXA with a control in ARCR were included. Visualization, postoperative pain, operative time, pump pressures, and shoulder swelling were evaluated. A P value < .05 was deemed statistically significant., Results: Six RCTs with 450 patients were included in this review. Overall, 5 studies evaluated intraoperative visualization, with 3 studies finding a significant difference in favor of TXA. With TXA, patients had a lower mean postoperative visual analog scale (VAS) score of 3.3, and with the control, patients had a mean VAS score of 4.1, which was statistically significant ( P = .001). With TXA, the mean weighted operation time was 79.3 minutes, and with the control, the mean operation time was 88.8 minutes, which was statistically significant ( P = .001). No study found any difference in intraoperative pump pressures or swelling., Conclusion: TXA improved visualization, operative time, and subsequent postoperative pain levels in patients undergoing ARCR., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.L. has received support for education from TriCoast Surgical Solutions and SouthTech Orthopedics. O.A. has received consulting fees from Exactech Inc, Smith & Nephew, Medical Device Business Services, Biomentus, Lima USA, Responsive Arthroscopy, Encore Medical, and Stryker; support for education from Arthrex and SouthTech Orthopedics; and travel expenses from Wright Medical Technology and Zimmer Biomet Holdings. M.J.A. has received consulting fees from BodyCad, JRF Ortho, and Mitek; research support from Orcosa Inc; support for education from Suvon Surgical, Arthrex, and Gotham Surgical Solutions & Devices; and publishing royalties from Springer. C.K. has received consulting fees from Acumed, restore3d, and Smith & Nephew and holds stock or stock options in GE Healthcare, Johnson & Johnson, Merck, and Pfizer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: The incidence of proximal humerus fractures (PHFs) continues to increase with an aging population, and intramedullary nailing (IMN) and locking plate fixation are two commonly employed techniques for the surgical management of PHF. However, the optimal fixation method can be a source of ongoing controversy. Some influencing factors include the extent of humeral head involvement, fracture complexity, patient age, and surgeon preference. There are many studies that provide a mix of data either when comparing the two techniques or analyzing them in isolation. The aim of this review is to further elucidate the indications and technical considerations involved specifically in IMN vs. locking plate fixation for PHF to further aid orthopedic surgeons when choosing surgical management., Methods: A narrative approach was chosen for this review allowing for a comprehensive review of literature, including recent findings pertaining to the comparison of management options for PHF. A comprehensive literature search was conducted using the PubMed, Embase, and Cochrane Library databases. The inclusion criteria involved studies that discussed "proximal humerus fracture" and either "intramedullary nail" or "locking plate fixation.", Results: Complications such as avascular necrosis, hardware failure, additional surgical interventions, infection, fracture redisplacement, rotator cuff rupture, and nonunion did not show significant differences between the two groups. Newer generation humeral nails have minimized early complications. As both techniques undergo further refinement and utilization when specifically indicated, functional outcomes, potential complications, and postoperative pain continue to be improved., Conclusion: The available evidence suggests that both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method. The choice of technique should be tailored to patient factors such as fracture type, age, bone quality, and functional expectations. Surgeon experience also plays a role. While certain presentations may exhibit trends that favor one fixation, no specific technique can be universally recommended. Both IMN and LP have shown comparable and satisfactory outcomes, and the final fixation method chosen should take into account the unique characteristics of each patient., (© 2024 The Authors.)

Background: The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability., Methods: A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure., Results: There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play., Discussion: Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: To systematically review the literature to evaluate the outcomes following an open Latarjet (OL) procedure at a minimum 15-year follow-up., Methods: Two independent reviewers performed a literature search using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using 3 databases. Only studies reporting outcomes of OL procedure with a minimum of 15 years of follow-up were included., Results: Nine studies composed of 326 shoulders (78.2% males) in 313 patients were included (average age 26.9 ± 3.2 years (15-58)), with a mean follow-up of 271.9 ± 69.2 months (180-420) At a minimum 15-year follow-up, 93.5% (286 of 306) patients reported being satisfied with their OL procedure, whilst 86.8% (177 of 204) reported good/excellent outcomes at final follow-up. All nine of the included studies reported an overall rate of recurrent instability was 7.7%, with re-dislocations and subluxation at 3.4% and 5.8%, respectively. The rate of surgical revision was 5.15%; 3.5% of cases were revised for recurrent instability. Instability arthropathy was reported across all included studies as 41.0%., Conclusion: The OL procedure results in satisfactory clinical outcomes, low rates of recurrent instability and surgical revision at a minimum 15-year follow-up. Although high levels of radiological instability arthropathy and residual pain are found over the same period, these appear stable from a minimum of 10-year follow-up data., Level of Evidence: IV; a systematic review of all levels of evidence., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Complications are rare after arthroscopic Bankart repair, and as a result, there is a lack of guidance over rates of complications that can be used to consent patients. The purpose of this study is to systematically review the literature to assess the complications after arthroscopic Bankart repair, other than recurrent instability., Methods: A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies reporting on the complications after arthroscopic Bankart repair were included., Results: A total of 194 studies were included in the analysis, with 13,979 patients and 14,019 shoulders undergoing arthroscopic Bankart repair. The overall complication rate was 0.67%, with frozen shoulder being the most common complication occurring in 0.32%. Persistent pain occurred in 0.17%. The rates of nerve, hardware, and wound complications were 0.07%, 0.05%, and 0.03%, respectively., Conclusion: The arthroscopic Bankart repair has a very low rate of complications. Frozen shoulder and persistent pain are the most frequently encountered complications., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To systematically review the current evidence in the literature to compare return to play following arthroscopic Bankart repair versus open Latarjet procedure for the treatment of anterior shoulder instability., Methods: A literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative studies reporting return to play following arthroscopic Bankart repair versus open Latarjet procedure were included. Return to play was compared, with all statistical analysis performed using Review Manager, Version 5.3., Results: Nine studies with 1,242 patients (mean age: 15-30 years) were included. The rate of return to play was 61% to 94.1% among those undergoing arthroscopic Bankart repair and 72% to 96.8% in those undergoing an open Latarjet procedure. Two studies (Bessiere et al. and Zimmerman et al.) found a significant difference in favor of the Latarjet procedure (P < .05 for both, I 2  = 37%). The rate of return to play at preinjury level was 9% to 83.8% among those undergoing arthroscopic Bankart repair and 19.4% to 80.6% in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I 2  = 0%). The mean time of return to play was 5.4 to 7.3 months among those undergoing arthroscopic Bankart repair and 5.5 to 6.2 months in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I 2  = 39%)., Conclusions: Overall, the majority of studies showed no significant difference in rates of return to play or timing following arthroscopic Bankart repair or open Latarjet procedure. Furthermore, no study has found a significant difference in rate of return to play at pre-injury level, or rate of return to play among collision athletes., Level of Evidence: Level III, systematic review of Level I-III studies., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study is to systematically review the comparative studies in the literature to ascertain if biceps tenodesis or superior-labrum anterior to posterior (SLAP) repair results in superior clinical outcomes in the treatment of type II SLAP tears in patients under 40., Methods: A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to the PRISMA guidelines. Cohort studies comparing biceps tenodesis to repair in type II SLAP tears in patients under 40 were included. Clinical outcomes were extracted including return to play, reoperations, ASES, and VAS for pain. All statistical analysis was performed using Review Manager. A p-value of <0.05 was considered to be statistically significant., Results: Five studies were included. Biceps tenodesis resulted in comparable rates of return to play compared to SLAP repair (78.5% vs 67.7%, p ​= ​0.33), and there was no significant difference in return to play in overhead athletes (83.6% vs 74%, p ​= ​0.82). There was no significant difference in ASES score (87.2 vs 86.2, p ​= ​0.27) or VAS score for pain (1.8 vs 2.1, p ​= ​0.48). There was no significant difference in re-operation rates (2.9% vs 10.8%, p ​= ​0.22)., Conclusion: This study found that biceps tenodesis has no significant difference in rates of return to play in athletes, as well as in functional outcome scores and rates of revision surgery in younger patients compared to SLAP repair., Level of Evidence: Level III, Systematic review of Level III studies., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Maintaining premorbid proximal humeral positioning is an essential consideration of anatomic total shoulder arthroplasty (aTSA), as malposition of the prosthetic humeral head can result in poor clinical outcomes. Stemless aTSA prosthetic heads are usually concentric, while stemmed aTSA prosthetic heads are typically eccentric in nature. Therefore, the purpose of this study was to compare the ability to restore native humeral head position between stemmed (eccentric) vs. stemless (concentric) aTSA., Materials and Methods: Postoperative anteroposterior radiographs of 52 stemmed and 46 stemless aTSAs were analyzed. A best-fit circle was created using previously published and validated techniques to represent the premorbid humeral head position and axis of rotation. This circle was juxtaposed with another circle following the arc of the implant head. Next, the offset in center of rotation (COR), radius of curvature (RoC), and humeral head height above the greater tuberosity (HHH) were measured. Additionally, based on prior studies, an offset of >3 mm at any point between the implant head surface and premorbid best-fit circle was considered significant and further classified as overstuffed or understuffed., Results: RoC deviation was significantly greater in the stemmed cohort than the stemless cohort (1.19 ± 1.37 mm vs. 0.65 ± 1.17 mm, P = .025). There was no statistically significant difference in deviation from premorbid humeral head between the stemmed and stemless cohorts for COR (3.20 ± 2.28 mm vs. 3.23 ± 2.09 mm, P = .800) or HHH (1.12 ± 3.27 mm vs. 0.92 ± 2.70 mm, P = .677). When comparing overstuffed implants to appropriately placed implants, there was a significant difference in overall COR deviation in stemmed implants (3.93 ± 2.51 mm vs. 1.92 ± 1.05 mm, P < .001). Superoinferior COR deviation (stemmed: 2.38 ± 3.01 mm vs. -0.61 ± 1.59 mm, P < .001; stemless: 2.70 ± 1.75 mm vs. -0.16 ± 1.87 mm, P < .001), mediolateral COR deviation (stemmed: 0.79 ± 2.65 mm vs. -0.62 ± 1.27 mm, P = .020; stemless: 0.40 ± 1.41 mm vs. -1.13 ± 1.96 mm, P = .020), and HHH (stemmed: 3.61 ± 2.73 mm vs. 0.50 ± 1.31 mm, P < .001; stemless: 3.98 ± 1.18 mm vs. 0.53 ± 1.41 mm, P < .001) were significantly different between overstuffed implants and appropriate implants in both the stemmed and stemless cohorts., Discussion: Stemless and stemmed aTSA implants have similar rates of reproducing satisfactory postoperative humeral head COR with both producing COR deviation most commonly in the superomedial direction. Deviation in HHH contributes to overstuffing in both stemmed and stemless implants, COR deviation contributes to overstuffing in stemmed implants, while RoC (humeral head size) is not associated with overstuffing. Based on this study, it appears that neither eccentric nor concentric prosthetic heads are superior in recreating premorbid humeral head position., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)