Clinical outcomes validate the RAND/UCLA appropriateness criteria algorithm for anatomical total shoulder arthroplasty for streamlining the clinical decision-making process.

Aims: A recent study used the RAND Corporation at University of California, Los Angeles (RAND/UCLA) method to develop anatomical total shoulder arthroplasty (aTSA) appropriateness criteria. The purpose of our study was to determine how patient-reported outcome measures (PROMs) vary based on appropriateness.

Methods: Clinical data from a multicentre database identified patients who underwent primary aTSA from November 2004 to January 2023.

The biomechanical assessment of two stemless shoulder arthroplasty prostheses in uniformly poor-quality bone mineral density cadaveric specimens.

Background: Stemless shoulder arthroplasty offers several advantages, such as preserving bone stock and reducing periprosthetic fracture risk. However, implant motion can deter osteointegration and increase bone resorption, where micromotion less than 0.150 mm is crucial for bony ingrowth and vital to the success of the implant.

Return to Play at Preinjury Level After Anterior Cruciate Ligament Reconstruction in Divisions II and III National Collegiate Athletic Association Student-Athletes.

Background: The rates of return to play (RTP) after anterior cruciate ligament (ACL) reconstruction among professional and National Collegiate Athletic Association (NCAA) Division I athletes are well described in the orthopaedic literature. Less is known about these rates and risk factors for failure to RTP in Division II and III collegiate athletes.

Purpose: To determine the RTP rate after ACL reconstruction among Division II and III collegiate athletes and to explore the factors associated with RTP.

Costs and Timing of Surgery in the Management of Meniscal Tears.

Background: Treatment strategies for meniscal tears range from nonoperative management to surgical intervention. However, national trends in cost-related outcomes and patient factors related to the failure of nonoperative management remain poorly understood.

Purpose: To describe the costs associated with nonoperative versus operative management of meniscal tears in the 2 years after diagnosis and examine the relationship between patient characteristics and timing of surgery.

Editorial Commentary: Health Care Policies Must Ensure Equitable Access for All Patients.

It is critical to identify disparities in health care, including orthopaedic pathology, to ensure equitable care across all populations. Recent research shows that White, socially nondeprived, male patients with private insurance are more likely to undergo surgical procedures for rotator cuff disease after a minimum of 6 months of nonoperative management, and race and low income are associated with delays in access to health care and worse outcomes. Moreover, many practitioners and researchers do not record or report important socioeconomic factors.

Current Evidence Based Recommendations on Rehabilitation following Arthroscopic Shoulder Surgery: Rotator Cuff, Instability, Superior Labral Pathology, and Adhesive Capsulitis.

Purpose Of Review: Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis.

Nonoperative Treatment of Single-Tendon Proximal Hamstring Avulsions in Recreational Athletes.

The purpose of this study was to evaluate the patient-reported and objective functional outcomes of those patients who underwent nonoperative management of a single-tendon retracted proximal hamstring avulsion. A retrospective case series of consecutive patients with an MRI-confirmed diagnosis of single-tendon proximal hamstring avulsion treated nonoperatively with at least one year of follow-up was performed. Patient-reported outcome measures (PROMs) including SF-12v2, Lower Extremity Functional Score (LEFS), Hip Outcome Score-activities of daily living and sport subscale (HOS-ADL, HOS-SS) were prospectively collected.

Safety and Early Results for Off-Label Use of Intranasal Calcitonin for Treatment of Nondisplaced Acromial and Scapular Spine Stress Fractures After Reverse Total Shoulder Arthroplasty.

Immobilization for acromial and scapular spine stress AU4fractures (AF/SSF) after reverse total shoulder arthroplasty (RSA) is associated with patient dissatisfaction. Our study reports the effects and safety of intranasal calcitonin alongside sling immobilization on pain and function in the treatment of AF/SSF after RSA. The treatment was regimented calcitonin (salmon) 200 unit/actuation nasal spray (1 spray/day) for 6 weeks with sling immobilization for 4 weeks.

Higher complication rates following primary total shoulder arthroplasty in patients presenting from areas of higher social deprivation.

Aims: The aim of this study was to characterize the influence of social deprivation on the rate of complications, readmissions, and revisions following primary total shoulder arthroplasty (TSA), using the Social Deprivation Index (SDI). The SDI is a composite measurement, in percentages, of seven demographic characteristics: living in poverty, with < 12 years of education, single-parent households, living in rented or overcrowded housing, households without a car, and unemployed adults aged < 65 years.

Methods: Patients aged ≥ 40 years, who underwent primary TSA between 2011 and 2017, were identified using International Classification of Diseases (ICD)-9 Clinical Modification and ICD-10 procedure codes for TSA in the New York Statewide Planning and Research Cooperative System database.

Editorial Commentary: The Social Determinants of Health are Insufficiently Reported in the Orthopaedic Literature.

Socially and economically disadvantaged patients have delays in access to appropriate care, present more severely and to low-volume surgeons and facilities, and achieve lower clinical outcomes than socially advantaged patents. In the United States, 15% live in poverty based upon family income, and evaluation of social determinants of health (SDOH), such as race, ethnicity, employment status, insurance status, education level, and socioeconomic status, is important in helping identify patients at risk. Orthopaedic providers and researchers should collect and report SDOH as routine demographic data.

Scaffold- and graft-based biological augmentation of rotator cuff repair: an updated systematic review and meta-analysis of preclinical and clinical studies for 2010-2022.

Background: Despite advancements in the surgical techniques of rotator cuff repair (RCR), there remains a high retear rate. Biological augmentation of repairs with overlaying grafts and scaffolds may enhance healing and strengthen the repair construct. This study aimed to investigate the efficacy and safety of scaffold-based (nonstructural) and overlay graft-based (structural) biological augmentation in RCR (excluding superior capsule reconstruction and bridging techniques) in both preclinical and clinical studies.

Local Intraoperative Marrow-Derived Augmentation for Primary Rotator Cuff Repair: An Updated Systematic Review and Meta-analysis of Studies From 2010 to 2022.

Background: Recurrent tears of the rotator cuff pose a substantial problem despite advances in repair technique. Biologic augmentation via marrow stimulation or vented anchors may strengthen the suture-tendon junction and improve healing rates of native tissue, thereby enhancing outcomes of primary surgical repair.

Purpose: To provide a focused systematic review and meta-analysis of local, intraoperative marrow-derived augmentation techniques in clinical primary rotator cuff repair.

Incidence of primary anatomic and reverse total shoulder arthroplasty in patients less than 50 years of age and high early revision risk.

Background: Compared with the overall incidence of shoulder arthroplasty (SA), the relative risk and burden of revision may vary among patients specifically 40-50 years of age and less than 40 years of age. Our aim was to investigate the incidence of primary anatomic total SA and reverse SA, rate of revision within 1 year, and determine the associated economic burden in patients younger than 50 years.

Methods: A total of 509 patients less than 50 years old who underwent SA were included, using a national private insurance database.

Evidence for Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: A Systematic Review of Data From 2010 to 2022.

Background: Biologic healing after rotator cuff repair remains a significant challenge. Injectable biologic augmentation may improve tissue quality at the suture-tendon interface.

Purpose: To investigate the effect of injectable biologic supplementation in rotator cuff repair and to assess the quality and adherence to evolving reporting standards.

A novel comorbidity risk score for predicting postoperative 30-day complications in total shoulder arthroplasty and elucidation of potential racial disparities.

Background: Efficient and effective preoperative identification of those patients with elevated risk may allow for more cost-effective interventions, accurate bundled payment adjustments, and overall improved patient care. Few comorbidity indices have provided clinical utility and adequate discriminative ability in the setting of complications after shoulder arthroplasty (SA).

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for anatomic and/or reverse SA procedures between 2010 and 2019.

Relationship of Subtalar Joint Range of Motion to Ankle Injuries in NBA G League and Collegiate Basketball Players.

Background: This study sought to determine whether range of motion (ROM) of the ankle and subtalar joint complex (STJ) is correlated with ankle injuries in National Basketball Association (NBA) G-league and collegiate basketball players to identify an at-risk population that may benefit from participation in an ankle injury prevention program.

Methods: This prospective cohort study encompassed 103 player-seasons (68 collegiate, 35 NBA G-League). Patient demographics, passive ankle and STJ range of motion measurements, anterior drawer, and talar tilt tests were collected at preseason physicals along with plain radiographs.

Social determinants of health influence clinical outcomes of patients undergoing rotator cuff repair: a systematic review.

Background: Social determinants of health (SDOH) are the collection of environmental, institutional, and intrinsic conditions that may bias access to, and utilization of, health care across an individual's lifetime. The effects of SDOH are associated with disparities in patient-reported outcomes after hip and knee arthroplasty, but its impact on rotator cuff repair (RCR) is poorly understood. This study aimed to investigate the influences that SDOH have on accessing appropriate orthopedic treatment, as well as its effects on patient-reported outcomes following RCR.

Return to Sport After Anterior Cruciate Ligament Reconstruction Requires Evaluation of >2 Functional Tests, Psychological Readiness, Quadriceps/Hamstring Strength, and Time After Surgery of 8 Months.

Purpose: The purpose of this study was to examine the factors commonly used to determine readiness for return to sport (RTS) in the ACL reconstruction (ACL-R) patient population and assess which were most influential to successfully returning to sport and avoiding re-tear.

Methods: The PUBMED, EMBASE and Cochrane Library databases were queried for studies related to RTS in ACL-R. Inclusion and exclusion criteria were applied to identify studies with greater than 1-year outcomes detailing the rate of return and re-tear given a described RTS protocol.

Prevalence and Clinical Impact of Incidental Findings on Preoperative 3D Planning Computed Tomography for Total Shoulder Arthroplasty.

Introduction: 3D planning software for shoulder arthroplasty recently emerged for aiding in intraoperative determination of native glenoid. These protocols often require increased scan resolution, however, raising the question of an increased prevalence and clinical impact of incidental findings (IFs) from preoperative imaging.

Methods: A retrospective review of preoperative shoulder CT reports was conducted for 333 consecutive patients planning anatomic or reverse total shoulder arthroplasties.

Acute Proximal Hamstring Tears Can be Defined Using an Imaged-Based Classification.

Purpose: To develop a clinically meaningful proximal hamstring tear classification system and to present outcome data for defined subtypes.

Methods: Retrospective review was undertaken of patients diagnosed with proximal hamstring tears at a single institution from 2012 to 2019. Images were reviewed by an orthopedic surgeon and musculoskeletal radiologist.

Retro-sternal Goitre: an Overview.

Retro-sternal goitres are slow growing in nature. Dyspnoea on exertion is the most common presenting symptom due to the pressure effect of goitre on trachea. Due to the increased use of radiological investigations, retrosternal goitres are often diagnosed incidentally without any symptoms.

Editorial Commentary: Serum Cartilage Oligomeric Matrix Protein Appears to Be the Most Useful Biomarker for Tracking Early Osteoarthritis of the Knee in Anterior Cruciate Ligament Deficient Patients (But May Also Reflect Synovitis).

Owing to chondral or meniscal pathology sustained at the time of injury, patients who sustain anterior cruciate ligament injury are at risk of knee osteoarthritis (OA). Thus, recognition of early OA is critical. Detection of joint space narrowing on radiography has been described as outdated, and furthermore, the different descriptions of the Kellgren-Lawrence criteria have an impact on the classification of OA of the lowest grade (Kellgren-Lawrence grade ≥ 1).

A validated algorithm using current literature to judge the appropriateness of anatomic total shoulder arthroplasty utilizing the RAND/UCLA appropriateness method.

Background: Currently, appropriateness criteria evaluating when to perform total shoulder arthroplasty (TSA) is lacking. In the absence of society guidelines and limited quality evidence, the RAND/University California in Los Angeles (UCLA) method provides a suitable alternative to evaluate appropriateness and assist in clinical decision making. Given the rise in utilization, appropriateness criteria for TSA have the potential to be an extremely powerful tool for improving quality of care and controlling costs.

Clinical Outcomes After Reverse Total Shoulder Arthroplasty in Patients With Primary Glenohumeral Osteoarthritis Compared With Rotator Cuff Tear Arthropathy: Does Preoperative Diagnosis Make a Difference?

Introduction: The primary purpose of this study was to evaluate the clinical outcomes of patients who underwent reverse total shoulder arthroplasty performed for primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff compared with rotator cuff tear arthropathy (CTA).

Methods: This was a retrospective review of prospectively collected data including consecutive patients who underwent primary reverse total shoulder arthroplasty for GHOA or CTA with a minimum of 2-year follow-up. Baseline patient demographics and clinical outcomes including active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation, and visual analog scale for pain were collected.