Arthroscope-Assisted Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft for Irreparable Rotator Cuff Tears Demonstrates Excellent Short-Term Outcomes in the Setting of Concomitant Subscapularis Repair.

Purpose: To quantify the improvement of patients undergoing scope-assisted lower trapezius tendon transfer (SALTT) for irreparable rotator cuff tears (IRCTs) and whether intraoperative subscapularis management affected these outcomes.

Methods: From 2015 to 2023, patients undergoing primary SALTT for IRCTs without osteoarthritis or brachial plexopathy with serial follow-up at 6 months and a minimum of 12 months postoperatively were identified. Subjective shoulder value (SSV) scores, active forward elevation (FE), external rotation (ER) lag, and cuff strength were recorded.

Perioperative Management, Complications, and Outcomes of Shoulder Arthroplasty in Patients with Diabetes Mellitus.

» Patients with diabetes mellitus (DM) undergoing shoulder arthroplasty (SA) have a unique risk profile, which must be considered by clinicians.» The presence of DM as a comorbidity is associated with longer length of stay following SA, greater likelihood of nonhome discharge, and a higher rate of 90-day readmission.» Though the incidence is low, patients with DM are at an increased risk of serious postoperative cardiovascular complications, such as pulmonary embolism, venous thromboembolism, and myocardial infarction.

Shoulder and elbow surgery fellowship applicants with greater research productivity during residency are ranked higher by fellowship programs.

Background: Shoulder and elbow surgery fellowships in the United States are recognized for their academic emphasis, yet the correlation between an applicant's research productivity and fellowship match results remains unclear. This study (1) analyzed temporal trends in research productivity among matched fellowship applicants, (2) evaluated the influence of quantity of publications and first authorships on match positions, and (3) investigated program variations in research productivity.

Methods: This is a retrospective analysis of data from the San Francisco Match Database for shoulder and elbow surgery applicants matched between 2017 and 2024.

The effect of reverse shoulder arthroplasty design and surgical indications on deltoid and rotator cuff muscle length.

Background: Advancements in surgical planning, technique, and prosthesis design have improved adaptation to patient anatomy in reverse total shoulder arthroplasty (rTSA). Postoperative changes in deltoid and rotator cuff muscle length are important and may vary based on preoperative indications and prosthesis selection. The purpose of this study is to demonstrate the changes in deltoid and rotator cuff muscle length for planned rTSA using the spectrum of prosthesis configurations in both glenohumeral arthritis (GHOA) and rotator cuff tear arthropathy (RCA).

Two-stage glenohumeral fusion for the paralytic shoulder.

Background: Shoulder fusion after nerve injury can improve overall arm function; however, high revision and low patient satisfaction rates have been described. The purpose of this study is to describe a 2-stage shoulder fusion, first pinning in a position of function and then converting to a shoulder fusion. Our hypothesis is that temporary pinning improves overall satisfaction after shoulder fusion in comparison to satisfaction reported in the literature.

Matching into shoulder and elbow surgery fellowships: do United States Medical License Exam scores and Alpha Omega Alpha status still matter?

Background: Despite the established importance of the United States Medical License Exam (USMLE) and Alpha Omega Alpha (AOA) status in orthopedic residency selection, their significance in the fellowship match remains unknown. This study evaluates the influence of USMLE scores and AOA status on interview invitation rates and match positions for shoulder and elbow surgery fellowship applicants.

Methods: This is a retrospective analysis of data from the San Francisco Match database from 2018 to 2023.

Clinically significant outcome thresholds and rates of achievement by shoulder arthroplasty type and preoperative diagnosis.

Background: Clinically significant outcome (CSO) benchmarks have been previously established for shoulder arthroplasty by assimilating preoperative diagnoses and arthroplasty types. The purpose of this study was to establish unique CSO thresholds and compare the time-to-achievement of these for reverse shoulder arthroplasty (RSA) for osteoarthritis (GHOA), RSA for rotator cuff arthropathy (RCA), and total shoulder arthroplasty (TSA) for GHOA.

Materials And Methods: Consecutive patients who underwent elective RSA for GHOA, TSA for GHOA, or RSA for RCA between February 2015 and May 2020, with 2-year minimum follow-up, were retrospectively identified from a prospectively maintained single surgeon registry.

Immediate Unprotected Weightbearing vs 2 Weeks Nonweightbearing After Open Reduction Internal Fixation of Ankle Fractures.

Background: Postoperative care protocols for ankle fracture surgery remain controversial with variability among care providers. This prospective controlled trial compared 12-week postoperative outcomes for immediate unprotected weightbearing (IMWB) vs nonweightbearing (NWB) for 2 weeks in a splint followed by weightbearing as tolerated (WBAT) in a boot after surgical fixation of selected low-energy ankle fractures without superior articular involvement.

Methods: Eighty-seven patients undergoing surgical fixation of ankle fractures at a single level 1 trauma center were recruited according to specific criteria and enrolled by presentation date.

Muscular Retraining and Rehabilitation after Shoulder Muscle Tendon Transfer.

Muscle tendon transfers around the shoulder involve transferring the tendon of a well-functioning muscle-tendon unit to the site of damaged muscle-tendon insertion. In turn, this restores function and strength of the injured shoulder muscle through dynamic muscular contraction and a tenodesis effect. Rehabilitation after shoulder muscle tendon transfers requires extensive and lengthy rehabilitation to achieve satisfactory clinical outcomes.

Outcomes of scapulothoracic fusion in patients with facioscapulohumeral dystrophy: a comparison of allograft versus autograft bone grafting.

Background: Scapulothoracic (ST) fusion for facioscapulohumeral muscular dystrophy (FSHD) is an established treatment that corrects scapular instability, although it has high reported complication rates. The purpose of our study was to characterize the outcomes of ST fusion for FSHD in a large patient cohort and compare the outcomes based on bone graft type and fixation technique. Our hypothesis was that union rates would not differ by bone graft type during ST fusion.

Serratus anterior dysfunction examination: wall push-up or shoulder flexion resistance test?

Background: Wall push-up is the most common examination used for the diagnosis of scapular winging secondary to serratus anterior dysfunction. The wall push-up test (WPUT) however may not be able to differentiate causes of scapulothoracic abnormal motion (STAM) or winging. We introduce a novel physical examination maneuver, the shoulder flexion resistance test (SFRT), and we propose that this test is more specific and accurate in determining serratus anterior dysfunction as the cause of STAM.

Radiographic Determination of the Distal Ulnar Diaphyseal Angle.

Purpose: Characterizing the distal ulnar diaphyseal angle (DUDA) may be important for anatomic recreation of the distal ulna during ulnar shortening osteotomy procedures using conventional straight plates. This study characterized the DUDA and determined side-to-side, age, and sex effects on DUDA magnitudes and locations.

Methods: Retrospective analyses of bilateral wrist radiographs were performed on 60 patients.

Novel Application of Immersive Virtual Reality Simulation Training: A Case Report.

Case: A percutaneous pinning of a slipped capital femoral epiphysis is described after the use of immersive virtual reality (iVR) training. This case report documents the first reported example of an immediate translation of surgical skill from iVR to the operating room.

Conclusion: There is increasing evidence for the use of iVR in orthopaedic education.

Mitigating Surgical Skill Decay in Orthopaedics Using Virtual Simulation Learning.

Background: The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeons and trainees. The concept of skill decay must be considered during inactivity of elective practice. The purpose of this study was to provide an evidence-based curriculum in association with immersive virtual reality (iVR) to prevent skill decay during periods of training cessation and beyond.

Immersive Virtual Reality for Surgical Training: A Systematic Review.

Background: Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons.

Virtual and augmented reality for surgical training and simulation in knee arthroplasty.

Background: Immersive virtual reality (IVR), augmented reality and mixed reality form a spectrum of extended reality technology integration that has gained popularity in orthopaedics recently. This review article examines the role of extended reality technologies in knee arthroplasty.

Methods: Existing literature on the applications of extended reality technologies in preoperative planning and intraoperative navigation were reviewed.

Shoulder surgeon perspective of surgical device representatives: a multinational survey.

Background: This study aimed to determine the working relationships of shoulder surgeons and surgical device representatives, and benefits or detractors to the operating environment.

Methods: An electronic survey was distributed to all members of the Codman Shoulder Society, an international group of fellowship-trained shoulder surgeons.

Results: The response rate was 44% (59 of 134).

Effectiveness of Immersive Virtual Reality on Orthopedic Surgical Skills and Knowledge Acquisition Among Senior Surgical Residents: A Randomized Clinical Trial.

Importance: Video learning prior to surgery is common practice for trainees and surgeons, and immersive virtual reality (IVR) simulators are of increasing interest for surgical training. The training effectiveness of IVR compared with video training in complex skill acquisition should be studied.

Objectives: To evaluate whether IVR improves learning effectiveness for surgical trainees and to validate a VR rating scale through correlation to real-world performance.

The evolution of virtual reality in shoulder and elbow surgery.

Virtual Reality (VR) in orthopedic surgery has significantly increased in popularity in the areas of preoperative planning, intraoperative usage, and for education and training; however, its utilization lags behind other surgical disciplines and industries. The use of VR in orthopedics is largely focused on education and is currently endorsed by North American and European training committees. The use of VR in shoulder and elbow surgery has varying levels of evidence, from I to IV, and typically involves educational randomized controlled trials.

Virtual reality in spinal endoscopy: a paradigm shift in education to support spine surgeons.

Background: Minimally invasive spine surgery (MISS) and endoscopic spine surgery have continually evolving indications in the cervical, thoracic, and lumbar spine. Endoscopic spine surgery entails treatment of disc disease, stenosis, spondylolisthesis, radiculopathy, and deformity. MISS involves complex motor skills in regions of variable anatomy.