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New Advances in Shoulder Surgery
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New Advances in Shoulder Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 29303

Special Issue Editor

Prof. Dr. Eugene T. Ek

E-Mail Website
Guest Editor
1. Department of Surgery, Monash University, Melbourne, VIC 3168, Australia
2. Melbourne Orthopaedic Group, Melbourne, VIC 3181, Australia
Interests: orthopaedic surgery; upper extremity reconstruction surgery; hand surgery; elbow surgery; shoulder surgery

Special Issue Information

Dear Colleagues,

Over the last decade, we have seen significant advances across the entire field of shoulder surgery, from advances in arthroscopic techniques, shoulder arthroplasty and revision surgery, rotator cuff repairs and biological augmentation, as well as in the treatment of proximal humerus and shoulder girdle trauma. Despite such progress, innovative and pioneering shoulder surgeons continue to push the boundaries and try to solve unanswered questions and clinical dilemmas and also advance the state of shoulder surgery techniques, with the overall goal of improving patient outcomes.

In this Special Issue, we aim to discuss various new advances in shoulder surgery, from technological advances in implants and prostheses, to innovation in surgical techniques and diagnosis, to the frontier of biological treatment options. We believe that this Special Issue will provide readers a glimpse of the ever-changing and advancing landscape of shoulder surgery. We invite you to contribute to this Special Issue.

Dr. Eugene T.H. Ek
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • shoulder surgery
  • arthroplasty
  • arthroscopy
  • biologics
  • augmented reality
  • patient specific instrumentation
  • virtual reality
  • advances
  • innovation

Published Papers (10 papers)

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Research

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13 pages, 6398 KiB  
Article
Development of a Cadaveric Shoulder Motion Simulator with Open-Loop Iterative Learning for Dynamic, Multiplanar Motion: A Preliminary Study
by David Timothy Axford, Robert Potra, Richard Appleyard, Janos Tomka, Antonio Arenas-Miquelez, Desmond Bokor, Louis Ferreira and Sumit Raniga
J. Clin. Med. 2023, 12(14), 4596; https://doi.org/10.3390/jcm12144596 - 10 Jul 2023
Viewed by 947
Abstract
Ex vivo shoulder motion simulators are commonly used to study shoulder biomechanics but are often limited to performing simple planar motions at quasi-static speeds using control architectures that do not allow muscles to be deactivated. The purpose of this study was to develop [...] Read more.
Ex vivo shoulder motion simulators are commonly used to study shoulder biomechanics but are often limited to performing simple planar motions at quasi-static speeds using control architectures that do not allow muscles to be deactivated. The purpose of this study was to develop an open-loop tendon excursion controller with iterative learning and independent muscle control to simulate complex multiplanar motion at functional speeds and allow for muscle deactivation. The simulator performed abduction/adduction, faceted circumduction, and abduction/adduction (subscapularis deactivation) using a cadaveric shoulder with an implanted reverse total shoulder prosthesis. Kinematic tracking accuracy and repeatability were assessed using maximum absolute error (MAE), root mean square error (RMSE), and average standard deviation (ASD). During abduction/adduction and faceted circumduction, the RMSE did not exceed 0.3, 0.7, and 0.8 degrees for elevation, plane of elevation, and axial rotation, respectively. During abduction/adduction, the ASD did not exceed 0.2 degrees. Abduction/adduction (subscapularis deactivation) resulted in a loss of internal rotation, which could not be restored at low elevation angles. This study presents a novel control architecture, which can accurately simulate complex glenohumeral motion. This simulator will be used as a testing platform to examine the effect of shoulder pathology, treatment, and rehabilitation on joint biomechanics during functional shoulder movements. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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10 pages, 1143 KiB  
Article
Acromial Morphology and Its Relation to the Glenoid Is Associated with Different Partial Rotator Cuff Tear Patterns
by Paul Borbas, Rebecca Hartmann, Christine Ehrmann, Lukas Ernstbrunner, Karl Wieser and Samy Bouaicha
J. Clin. Med. 2023, 12(1), 233; https://doi.org/10.3390/jcm12010233 - 28 Dec 2022
Cited by 4 | Viewed by 2583
Abstract
The pathogenesis of subacromial impingement syndrome is controversially discussed. Assuming that bursal sided partial tears of the supraspinatus tendons are rather the result of a direct subacromial impact, the question arises whether there is a morphological risk configuration of the acromion and its [...] Read more.
The pathogenesis of subacromial impingement syndrome is controversially discussed. Assuming that bursal sided partial tears of the supraspinatus tendons are rather the result of a direct subacromial impact, the question arises whether there is a morphological risk configuration of the acromion and its spatial relation to the glenoid. Patients who underwent arthroscopic repair of either a partial articular supraspinatus tendon avulsion (PASTA) or bursal-sided supraspinatus tear (BURSA) were retrospectively allocated to two groups. Various previously described and new omometric parameters on standard anteroposterior and axial shoulder radiographs were analyzed. We hypothesized that acromial shape and its spatial relation to the glenoid may predispose to a specific partial supraspinatus tendon tear pattern. The measurements included the critical shoulder angle (CSA), the acromion index (AI), Bigliani acromial type and the new short sclerotic line, acromioclavicular offset angle (ACOA), and AC offset. The ratio length/width of acromion and the medial acromial offset were measured on axial radiographs. A total of 73 patients were allocated to either PASTA (n = 45) or BURSA (n = 28). The short sclerotic line showed a statistically significant difference between PASTA and BURSA (16.2 mm versus 13.1 mm, p = 0.008). The ratio acromial width/length was statistically significant (p = 0.021), with BURSA having slightly greater acromial length (59 vs. 56 mm). The mean acromial offset was 42.9 mm for BURSA vs. 37.7 mm for PASTA (p = 0.021). ACOA and AC offset were both higher for BURSA, without reaching statistical significance. The CSA did not differ significantly between PASTA and BURSA (33.73° vs. 34.56°, p = 0.062). The results revealed an association between a narrow acromial morphology, increased medial offset of the acromion in relation to the glenoid, and the presence of a short sclerotic line in the anteroposterior radiograph in bursal-sided tears of the supraspinatus tendon. Assuming that bursal-sided tears are rather the result of a direct conflict of the tendon with the undersurface of the acromion, this small subgroup of patients presenting with impingement syndrome might benefit from removing a harming acromial spur. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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17 pages, 5236 KiB  
Article
Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution
by Kristine Italia, Marine Launay, Luke Gilliland, James Nielsen, Roberto Pareyon, Freek Hollman, Asma Salhi, Jashint Maharaj, Mohammad Jomaa, Kenneth Cutbush and Ashish Gupta
J. Clin. Med. 2022, 11(24), 7422; https://doi.org/10.3390/jcm11247422 - 14 Dec 2022
Cited by 3 | Viewed by 2524
Abstract
Revision shoulder arthroplasty is increasing with the number of primary shoulder replacements rising globally. Complex primary and revisions of shoulder arthroplasties pose specific challenges for the surgeon, which must be addressed preoperatively and intraoperatively. This article aimed to present strategies for the management [...] Read more.
Revision shoulder arthroplasty is increasing with the number of primary shoulder replacements rising globally. Complex primary and revisions of shoulder arthroplasties pose specific challenges for the surgeon, which must be addressed preoperatively and intraoperatively. This article aimed to present strategies for the management of revision of shoulder arthroplasties through a single-stage approach. Preoperatively, patient factors, such as age, comorbidities, and bone quality, should be considered. The use of planning software can aid in accurately evaluating implants in situ and predict bony anatomy that will remain after explantation during the revision surgery. The planning from such software can then be executed with the help of mixed reality technology to allow accurate implant placement. Single-stage revision is performed in two steps (debridement as first step, implantation and reconstruction as the second step), guided by the following principles: adequate debridement while preserving key soft tissue attachments (i.e., rotator cuff, pectoralis major, latissimus dorsi, deltoid), restoration of glenoid joint line using bone grafting, restoration of humeral length, reconstruction and/or reattachment of soft tissues, and strict compliance with the postoperative antibiotic regimen. Preliminary results of single-stage revision shoulder arthroplasty show improvement in patient outcomes (mean 1 year), successful treatment of infection for those diagnosed with periprosthetic joint infection, and improved cost–benefit parameters for the healthcare system. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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11 pages, 1349 KiB  
Article
Complications of Long Head of the Biceps Tenotomy in Association with Arthroscopic Rotator Cuff Repair: Risk Factors and Influence on Outcomes
by Riccardo Ranieri, Marko Nabergoj, Li Xu, Pierre Le Coz, Ahmad Farihan Mohd Don, Alexandre Lädermann and Philippe Collin
J. Clin. Med. 2022, 11(19), 5657; https://doi.org/10.3390/jcm11195657 - 26 Sep 2022
Cited by 2 | Viewed by 1652
Abstract
Background: This study aims to report the rate of biceps-related complications after LHB tenotomy, investigating related risk factors and their influence on the outcome. The hypothesis is that these complications have a limited clinical influence. Methods: A single-center prospective observational study was performed [...] Read more.
Background: This study aims to report the rate of biceps-related complications after LHB tenotomy, investigating related risk factors and their influence on the outcome. The hypothesis is that these complications have a limited clinical influence. Methods: A single-center prospective observational study was performed between 2015 and 2017 on consecutive patients who underwent RCR associated with LHB tenotomy. Patients were clinically and radiologically evaluated preoperatively, at six months and one year, and screened for postoperative popeye deformity, cramps, and bicipital discomfort. Each complication was analyzed for the following risk factors: age, sex, body mass index (BMI), dominant arm, manual work, tear patterns, and tendon healing. Finally, the clinical outcome was compared between patients with and without complications. Results: 207 patients were analyzed. Cramps, popeye deformity, and discomfort, were respectively, present in 16 (7.7%), 38 (18.4%) and 52 (25.1%) cases at six months and 17 (8.2%), 18 (8.7%) and 24 (11.6%) cases at one year. Cramps were associated with lower age (p = 0.0005), higher BMI (p = 0.0251), single tendon tear (p = 0.0168), manual work (p = 0.0086) at six months and manual work (p = 0.0345) at one year. Popeye deformity was associated with male sex at six months (p < 0.0001). Discomfort was associated with lower age (p = 0.0065), manual work (p = 0.0099), popeye deformity (p = 0.0240) at six months and manual work (p = 0.0200), single tendon tear (p = 0.0370), popeye deformity (p = 0.0033) at one year. Patients without complications showed a significant higher Constant score, pain and subjective shoulder value (SSV) (75.3 vs. 70.4, p = 0.00252; 0.9 vs. 1.9, p < 0.00001; 80.2 vs. 76.4; p = 0.00124) at six months and pain and SSV (0.6 vs. 2.0; p = 0.00044; 91.1 vs. 77.8; p ≤ 0.00001) at one year. Conclusions: Younger age, male sex, higher BMI, manual work, and single tendon tears are risk factors associated with the development of biceps-related symptoms during the first year after tenotomy in association with rotator cuff repair. Nevertheless, the clinical influence of these symptoms on shoulder outcomes is limited. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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9 pages, 970 KiB  
Article
Validation of a Novel Patient Specific CT-Morphometric Technique for Quantifying Bone Graft Resorption Following the Latarjet Procedure
by Fraser W. Francis-Pester, Manuel Waltenspül, Karl Wieser, Greg Hoy, Eugene T. Ek, David C. Ackland and Lukas Ernstbrunner
J. Clin. Med. 2022, 11(19), 5514; https://doi.org/10.3390/jcm11195514 - 20 Sep 2022
Viewed by 1133
Abstract
Bone graft resorption following the Latarjet procedure has received considerable concern. Current methods quantifying bone graft resorption rely on two-dimensional (2D) CT-scans or three-dimensional (3D) techniques, which do not represent the whole graft volume/resorption (i.e., 2D assessment) or expose patients to additional radiation [...] Read more.
Bone graft resorption following the Latarjet procedure has received considerable concern. Current methods quantifying bone graft resorption rely on two-dimensional (2D) CT-scans or three-dimensional (3D) techniques, which do not represent the whole graft volume/resorption (i.e., 2D assessment) or expose patients to additional radiation (i.e., 3D assessment) as this technique relies on early postoperative CT-scans. The aim of the present study was to develop and validate a patient-specific, CT-morphometric technique combining image registration with 3D CT-reconstruction to quantify bone graft resorption following the Latarjet procedure for recurrent anterior shoulder instability. Pre-operative and final follow-up CT-scans were segmented to digitally reconstruct 3D scapula geometries. A virtual Latarjet procedure was then conducted to model the timepoint-0 graft volume, which was compared with the final follow-up graft volume. Graft resorption at final follow-up was highly correlated to the 2D gold standard-technique by Zhu (Kendall tau coefficient = 0.73; p < 0.001). The new technique was also found to have excellent inter- and intra-rater reliability (ICC values, 0.931 and 0.991; both p < 0.001). The main finding of this study is that the technique presented is a valid and reliable method that provides the advantage of 3D-assessment of graft resorption at long-term follow-up without the need of an early postoperative CT-scan. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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8 pages, 525 KiB  
Article
A Comparison of Central Screw versus Post for Glenoid Baseplate Fixation in Reverse Shoulder Arthroplasty Using a Lateralized Glenoid Design
by Michael J. Bercik, Brian C. Werner, Benjamin W. Sears, Reuben Gobezie, Evan Lederman and Patrick J. Denard
J. Clin. Med. 2022, 11(13), 3763; https://doi.org/10.3390/jcm11133763 - 29 Jun 2022
Viewed by 1591
Abstract
The purpose of this study was to compare the short-term clinical and radiographic outcomes of a lateralized glenoid construct with either a central screw or post. Methods: A multicenter retrospective study was conducted of reverse shoulder arthroplasties (RSAs) with minimum 2-year clinical followup. [...] Read more.
The purpose of this study was to compare the short-term clinical and radiographic outcomes of a lateralized glenoid construct with either a central screw or post. Methods: A multicenter retrospective study was conducted of reverse shoulder arthroplasties (RSAs) with minimum 2-year clinical followup. All RSAs implanted had a 135° neck shaft angle (NSA) and a modular circular baseplate. The patients were divided into two cohorts based on the type of central fixation for their glenoid baseplates (central post (CP) vs. central screw (CS)). The clinical outcomes, rates of revisions, and available radiographs were evaluated. Results: In total, 212 patients met the study criteria. Postoperatively, both groups improved over their preoperative baseline. There were no significant differences between the cohorts in any PROs at 2 years postoperatively. No findings of gross loosening were identified in either cohort. Implant survival was 98.6% at 2 years. Conclusions: When using a lateralized glenoid implant with a 135° NSA inlay humeral component, both central post and central screw baseplate fixation provide good clinical outcomes, survivorship, and improvements in ROM at 2 years. There is no difference in loosening or revision rates between the types of baseplate fixation at a minimum of 2 years postoperatively. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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Review

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21 pages, 14073 KiB  
Review
Current Understanding and New Advances in the Surgical Management of Reparable Rotator Cuff Tears: A Scoping Review
by Franziska Eckers, Stefan Loske, Eugene T. Ek and Andreas M. Müller
J. Clin. Med. 2023, 12(5), 1713; https://doi.org/10.3390/jcm12051713 - 21 Feb 2023
Cited by 1 | Viewed by 2692
Abstract
Rotator cuff (RC) tears are among the most common musculoskeletal disorders and can be associated with pain, weakness, and shoulder dysfunction. In recent years, there have been significant advances with regard to the understanding of rotator cuff disease and its management. With technological [...] Read more.
Rotator cuff (RC) tears are among the most common musculoskeletal disorders and can be associated with pain, weakness, and shoulder dysfunction. In recent years, there have been significant advances with regard to the understanding of rotator cuff disease and its management. With technological improvements and advanced diagnostic modalities, there has been much progress as to improved understanding of the pathology. Similarly, with advanced implant designs and instrumentation, operative techniques have evolved. Furthermore, refinements in postoperative rehabilitation protocols have improved patient outcomes. In this scoping review, we aim to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight recent advances in its management. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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28 pages, 31242 KiB  
Review
Management of Proximal Humerus Fractures in Adults—A Scoping Review
by Hayden P. Baker, Joseph Gutbrod, Jason A. Strelzow, Nicholas H. Maassen and Lewis Shi
J. Clin. Med. 2022, 11(20), 6140; https://doi.org/10.3390/jcm11206140 - 18 Oct 2022
Cited by 16 | Viewed by 6449
Abstract
Proximal humerus fractures are the third most common fracture type in adults, with their incidence increasing over time. There are varied approaches to both the classification and treatment of proximal humerus fractures. Optimal treatments for this fracture type are still widely open to [...] Read more.
Proximal humerus fractures are the third most common fracture type in adults, with their incidence increasing over time. There are varied approaches to both the classification and treatment of proximal humerus fractures. Optimal treatments for this fracture type are still widely open to debate. This review summarizes the current and historical treatment modalities for proximal humerus fractures. In this paper, we provide updates on the advances and trends in the epidemiology, classification, and operative and nonoperative treatments of proximal humerus fractures. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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Other

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15 pages, 606 KiB  
Systematic Review
The Effect of PRP Augmentation of Arthroscopic Repairs of Shoulder Rotator Cuff Tears on Postoperative Clinical Scores and Retear Rates: A Systematic Review and Meta-Analysis
by Ioannis Angelos Trantos, Elias S. Vasiliadis, Filippos S. Giannoulis, Eleni Pappa, Fotios Kakridonis and Spyros G. Pneumaticos
J. Clin. Med. 2023, 12(2), 581; https://doi.org/10.3390/jcm12020581 - 11 Jan 2023
Cited by 4 | Viewed by 1963
Abstract
The aim of this review and meta-analysis is to assess recent clinical trials concerning the combination of operative treatment of rotator cuff tears and the administration of PRP and its effect on clinical scores and postoperative retear rates. The trials were used to [...] Read more.
The aim of this review and meta-analysis is to assess recent clinical trials concerning the combination of operative treatment of rotator cuff tears and the administration of PRP and its effect on clinical scores and postoperative retear rates. The trials were used to compare the combination of PRP treatment and arthroscopic rotator cuff repair to arthroscopy alone. Twenty-five clinical trials were reviewed. A risk-of-bias assessment was made for all randomized clinical trials included, using the Cochrane collaboration’s tool as well as a quality assessment for all non-randomized studies utilizing the Newcastle–Ottawa scale. The PRP-treated patients showed statistically significant improvement postoperatively compared to control groups concerning the Constant–Murley (mean difference 2.46, 95% CI 1.4–3.52, p < 0.00001), SST (mean difference 0.32, 95% CI 0.02–0.63, p = 0.04), and UCLA (mean difference 0.82, 95% CI 0.23–1.43, p = 0.07) scores. A statistically significant decrease of retear rates in the PRP-treated patients, with a risk ratio of 0.78 (95% CI 0.65–0.94, p = 0.01), was found. We believe that the results presented have positive aspects, especially concerning the retear risk, but are yet inconclusive concerning clinical results such as shoulder pain and function. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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21 pages, 2511 KiB  
Commentary
Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint
by Lyn Watson, Tania Pizzari, Simon Balster, Ross Lenssen and Sarah Ann Warby
J. Clin. Med. 2022, 11(17), 5140; https://doi.org/10.3390/jcm11175140 - 31 Aug 2022
Cited by 3 | Viewed by 6117
Abstract
Multidirectional instability (MDI) of the glenohumeral joint refers to symptomatic subluxations or dislocations in more than one direction. The aetiology of MDI is multifactorial, which makes the classification of this condition challenging. A shoulder rehabilitation program is the initial recommended treatment for MDI, [...] Read more.
Multidirectional instability (MDI) of the glenohumeral joint refers to symptomatic subluxations or dislocations in more than one direction. The aetiology of MDI is multifactorial, which makes the classification of this condition challenging. A shoulder rehabilitation program is the initial recommended treatment for MDI, however available rehabilitation programs have varying levels of evidence to support their effectiveness. In 2016, we published the details of an evidence-based program for MDI that has been evaluated for efficacy in two single-group studies and a randomised controlled trial. In 2017, we published a clinical commentary on the aetiology, classification, and treatment of this condition. The aim of this paper is to provide an update on the components of these publications with a particular focus on new advances in the non-operative management of this condition. Full article
(This article belongs to the Special Issue New Advances in Shoulder Surgery)
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