Search Results (39)

Background: Reverse shoulder arthroplasty (RSA) relies on secure baseplate fixation to the glenoid. This carries a risk of suprascapular nerve (SSN) injury during peripheral screw insertion. Although fixed safe zones have been described, it remains unclear whether these scale with scapular morphometry or whether common screw positions confer differential SSN risk. Methods: Twenty cadaveric shoulders (ten pairs) were dissected. The superior safe zone (distance from the supraglenoid tubercle to SSN at the suprascapular notch) and posterior safe zone (distance from the glenoid rim to SSN at the spinoglenoid notch) were measured. Scapular dimensions (height, spine length, width) were measured. In ten shoulders, simulated RSA baseplate fixation was performed with superior screws placed at 11, 12, or 1 o’clock and posterior screws at 8, 9, or 10 o’clock. Screw lengths were based on glenoid depth. Cortical breach and SSN proximity were recorded. Linear regression assessed relationships between scapular dimensions and safe zones. Results: The superior safe zone (mean 2.9 ± 0.5 cm) significantly correlated with scapular dimensions (r = 0.78–0.86; p < 0.0001). All superior screws remained intraosseous across configurations. The posterior safe zone (1.9 ± 0.6 cm) showed no correlation. Posterior cortical breach occurred in 50% of specimens across all tested positions and was associated with smaller scapular spine length (p = 0.027). No significant difference in SSN proximity was observed between posterior screw positions. Conclusions: Scapular dimensions predict the superior, but not posterior, safe zone. Scapulae with shorter spine lengths demonstrated increased risk of posterior cortical breach, independent of screw position. These findings establish anatomical scalability of the superior safe zone and suggest that scapular morphometry may inform preoperative RSA planning; however, prospective validation is needed before routine clinical implementation. Full article

This work presents a standardized 360-degree, clock-face ultrasonographic protocol for comprehensive static and dynamic assessment of the glenoid labrum. The protocol translates the arthroscopic clock-face orientation into ultrasound scanning windows, providing reproducible steps for each labral quadrant (12 to 12 o’clock) including patient positioning, transducer orientation, and dynamic maneuvers. By leveraging linear transducers with trapezoidal imaging and an optional convex transducer to bypass acoustic shadowing from the acromion and coracoid, all labral segments can be consistently visualized, while dynamic testing reveals subtle clefts, irregular margins, and medial displacement patterns. Clinically, this approach is particularly valuable for patients who cannot undergo MRI or MR arthrography (e.g., due to metallic implants, contrast allergy, claustrophobia or renal dysfunction) and in settings where MR/MRA is unavailable or impractical (sports medicine, urgent care, postoperative follow-up). The pictorial atlas and step-by-step checklists aim to support adoption in routine practice and to facilitate communication with surgeons through shared clock-face terminology. This protocol is not intended to replace MR arthrography for surgical planning; rather, when MRI/MRA cannot be performed or access is limited, it provides actionable, dynamic information that complements clinical decision-making. Full article

Background/Objectives: In reverse shoulder arthroplasty (RSA), precise K-wire positioning of the glenoid component is critical to prevent complications such as glenoid loosening or instability as well as premature implant failure. Optimal component placement must adhere to individualized preoperative plans to account for patient-specific anatomical conditions. Conventional methods often fail to achieve this level of accuracy, undermining the need for personalized medicine. Intraoperative navigation systems are growing in use to improve accuracy in orthopedic surgery. This study aimed to compare the accuracy of K-wire positioning in a 3D-printed model of the scapula using conventional versus navigated methods. Methods: We recruited 20 participants: 10 experienced surgeons and 10 inexperienced medical students. Each participant performed four K-wire drillings—two with conventional instruments and two with an intraoperative navigation system. A novel target system, BoneTrack3D, was used to measure accuracy. We assessed the absolute deviation of the entry and exit points as well as the three-dimensional drilling angle. Results: The navigated method was significantly more accurate for all measured parameters at a family-wise significance level of α = 0.05. The median absolute deviation for the entry point was 1.6 mm with navigation versus 3.0 mm with the conventional method (p < 0.001). Similarly, the exit point deviation was 1.8 mm with navigation versus 6.7 mm conventionally (p < 0.001). The drilling angle deviation also showed significant improvement with navigation, at 2.6° compared to 8.9° conventionally (p < 0.001). However, the navigated method took longer, with a median drilling time of 100.0 s compared to 55.0 s for the conventional method (p < 0.001). The navigated method provided consistent and superior results regardless of a participant’s surgical experience. Conclusions: Navigated techniques for K-wire positioning in RSA demonstrate enhanced accuracy in a 3D-printed model, effectively executing a precise, patient-specific preoperative plan. This could be a direct contribution to personalized medicine, ensuring the final implant alignment is tailored to the individual’s anatomy. Furthermore, intraoperative navigation may contribute to a flatter learning curve, thereby increasing accessibility for surgeons with varying levels of experience. Although navigation introduces additional costs and longer initial procedure times, these drawbacks could be offset by improved technical outcomes and a reduced risk of complications. Future studies, including randomized clinical trials and cost-effectiveness analyses, should seek to validate these results in clinical settings with longer follow-up periods and larger patient cohorts to define long-term value and utility of navigation systems in reverse shoulder arthroplasty. Full article

Background: The management of irreparable posterosuperior rotator cuff tears with an isolated loss of external rotation presents significant challenges. Latissimus dorsi tendon transfer in conjunction with medialized reverse total shoulder arthroplasty has been employed to rectify external rotation deficits; however, lateralized RTSA designs may yield similar outcomes with a reduced incidence of complications. The objective of this study was to compare the clinical outcomes of lateralized reverse total shoulder arthroplasty without latissimus dorsi tendon transfer against medialized RTSA with LDT in patients with ILER and a positive external rotation lag sign. Methods: This retrospective cohort study involved 34 patients diagnosed with CTA and severe external rotation deficiency, characterized by a positive ER lag sign and 0° active ER. The patients were treated with either lateralized reverse total shoulder arthroplasty (n = 21) or medialized RTSA with LDT (n = 13). Outcomes evaluated preoperatively and at the 24-month follow-up comprised range of motion, ER lag sign, Constant–Murley Score, SPADI, and radiographic offset parameters. Statistical analyses were adjusted for age, sex, and baseline values. Results: At follow-up, 70% of patients undergoing lateralized RTSA exhibited resolution of ER lag, compared to 23% in the LDT group (p < 0.05). Active external rotation improvement was more significant in the LDT group (34.6° compared to 18.5°, p < 0.05). However, both groups exhibited comparable final external rotation and functional scores (CMS: 63 ± 9 vs. 63 ± 16; SPADI: 73 ± 20 vs. 74 ± 22). Lateralized RTSA demonstrated superior preservation of internal rotation, as evidenced by a higher percentage of patients achieving a negative Apley scratch test (67% compared to 23%, p < 0.05). A greater glenoidal offset correlated with improved postoperative external rotation and resolution of external rotation lag. The influence of teres minor integrity was more significant in the LDT group. Conclusions: Lateralized reverse total shoulder arthroplasty without latissimus dorsi tendon transfer provides similar functional restoration of external rotation in irreparable posterosuperior rotator cuff tear patients, accompanied by reduced complications, shorter surgical durations, and improved preservation of internal rotation. LDT has the potential to provide enhanced ER gains from a low baseline; however, it is characterized by increased invasiveness and technical complexity. Prosthetic lateralization is a biomechanically effective method for restoring external rotation in patients with rotator cuff arthropathy and external rotation deficits. Full article

Background: Reverse total shoulder arthroplasty (RTSA) is increasingly used for managing cuff tear arthropathy, osteoarthritis, complex fractures, and revision procedures. As the demand for surgical precision and reproducibility grows, immersive technologies such as virtual reality (VR), augmented reality (AR), and metaverse-based platforms are being explored for surgical training, intraoperative guidance, and rehabilitation. While early data suggest potential benefits, a focused synthesis specific to RTSA is lacking. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, and Cochrane Library databases was performed through 30 May 2025. Eligible studies included those evaluating immersive technologies in the context of RTSA for skill acquisition or intraoperative guidance. Only peer-reviewed articles published in English were included. Data were synthesized narratively due to heterogeneity in study design and outcome metrics. Results: Out of 628 records screened, 21 studies met the inclusion criteria. Five studies evaluated immersive VR for surgical training: four randomized controlled trials and one retrospective case series. VR training improved procedural efficiency and showed non-inferiority to cadaveric training. Sixteen studies investigated intraoperative navigation or AR guidance. Clinical and cadaveric studies consistently reported improved accuracy in glenoid baseplate positioning with reduced angular and linear deviations in postoperative controls as compared to preoperative planning. Conclusions: Immersive technologies show promise in enhancing training, intraoperative accuracy, and procedural consistency in RTSA. VR and AR platforms may support standardized surgical education and precision-based practice, but their broad clinical impact remains limited by small sample sizes, heterogeneous methodologies, and limited long-term outcomes. Further multicenter trials with standardized endpoints and cost-effectiveness analyses are warranted. Postoperative rehabilitation using immersive technologies in RTSA remains underexplored and presents an opportunity for future research. Full article

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. Methods: From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. Results: The mean age at the time of surgery was 28.52 ± 8.0 (range: 19–45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6–35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21–37) % and Hill–Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16–40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30–100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0–20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. Conclusions: The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome. Full article

Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty. Full article

Purpose: This study aimed to determine the relationship between alpha angle (the angle between the screws and the glenoid) and thoracic diameters in patients undergoing the Latarjet procedure. Defining the relationship between thoracic morphology and alpha angle is aimed at filling the gap in the literature and improving surgical outcomes. Methods: This retrospective study analyzed 74 patients who underwent the Latarjet procedure for recurrent anterior shoulder instability between 2022 and 2024. All procedures were performed by the same surgeon using a standardized protocol to ensure consistency of surgical technique across cases. In postoperative chest CT scans, alpha angle, anteroposterior diameter of the thorax, transverse diameter of hemithorax, scapular inclination, and glenoid version were evaluated. Results: The study included predominantly male patients (90%) with a mean age of 26.4 ± 6.4 years who underwent Latarjet procedures predominantly on the right side (60%). Significant associations were observed between thoracic morphology and alpha angle on postoperative CT scans. There was a significant positive correlation between anterior-posterior/transverse diameter ratio (AP/T) and alpha angle (r = 0.407, p < 0.001), as well as correlations between scapular inclination, glenoid version, thoracoscapular angle, and alpha angle (r = 0.275, p = 0.018; r = 0.241, p = 0.039; r = −0.288, p = 0.013, respectively). Patients were divided based on an alpha angle threshold of 15 degrees, with results indicating worse outcomes for angles above this threshold. Additionally, the AP/T ratio demonstrated predictive value for poor outcomes (AUC = 0.660, p = 0.018) with a threshold of 1.2545. Conclusions: This study highlights the direct impact of thoracic morphology on the alpha angle observed on post-Latarjet chest CT scans. Specifically, patients with a higher ratio of anterior-posterior to transverse thoracic diameter (AP/T) show a proportional increase in alpha angle. When the AP/T ratio exceeds 1.25, surgeons may face challenges in achieving the target alpha angle. Full article

Background and Objectives: The aim of this study was to investigate the relationship between the position of the humeral head relative to the glenoid and the occurrence of iatrogenic surgical neck fractures of the humerus during anterior glenohumeral dislocation reductions. Materials and Methods: Patients with first-time anterior shoulder dislocations without generalized joint hyperlaxity were included. The humeral head displacement ratio was calculated as the distance between the medial border of the humeral head and the anterior glenoid rim divided by the diameter of the humeral head. Demographic data, concomitant tuberculum majus fractures, and the deltoid tuberosity index were recorded. Patients were divided into three groups: Group 1 (iatrogenic fracture development during closed reduction (CR)), Group 2 (failed CR), and Group 3 (successful reduction without iatrogenic fracture). Complicated dislocations were included in Groups 1 and 2, while uncomplicated dislocations were those in Group 3. Results: The study included 89 patients with a mean age of 46.44 ± 19.02 years (64 males, 25 females). Concomitant tuberculum majus fractures occurred in 37 (41.6%) cases. Iatrogenic surgical neck fractures occurred in 10 patients (Group 1), and CR was unsuccessful in 8 patients (Group 2), totaling 18 cases of complicated dislocations. Reduction without iatrogenic fracture was achieved in 71 cases (Group 3). The mean humeral head displacement ratio was higher in the complex dislocation group (92.91 ± 15.34 vs. 75.01 ± 13.80; p < 0.001). Complicated dislocations were more frequent in patients with tuberculum majus fractures (p = 0.031). Subgroup analysis showed higher humeral head displacement ratios in Groups 1 and 2 compared to Group 3 (p = 0.010 and p = 0.06, respectively). Tuberculum majus fractures were more frequent in Group 1 compared to Group 3 (p = 0.013), with no significant difference between Groups 2 and 3. Conclusions: In patients experiencing first-time traumatic anterior shoulder dislocations, a greater medial displacement of the humeral head relative to the glenoid rim significantly increases the risk of iatrogenic humeral fractures and the likelihood of unsuccessful closed reduction attempts. Full article

Background: The primary cause of medium- to long-term complications in reverse shoulder arthroplasty (RSA) is the failure of the glenoid component. The purpose of this study was to evaluate both the achievement of planning through computer-assisted navigation and the clinical outcomes at a minimum follow-up (FU) of 12 months. Methods: From December 2019 to December 2022, 57 Equinoxe RSAs with computer-assisted navigation were performed. The average age was 72.8 ± 6.6 years. Using the Orthoblue software, the version and inclination of the glenoid were evaluated from a preoperative CT scan, and planning was performed. Intraoperative navigation data were evaluated, and the clinical outcomes were assessed at a minimum follow-up of 12 months. Results: The average follow-up was 30.7 ± 13.5 months. The planning was reproduced in all implants. No errors in the computer-assisted navigation system were detected. No intraoperative or postoperative complications were recorded. At the final FU, the average active anterior elevation was 143° ± 36°, external rotation was 34° ± 5°, QuickDASH score was 19 ± 16 points, and constant score was 77 ± 18. Conclusions: Computer-assisted navigation is a reliable system for positioning prosthetic implants on challenging glenoids. A longer follow-up period is necessary to confirm the reduction in postoperative complications and the increase in survival compared to traditional RSA. Full article

Background: The midface plays an important role in the judgment of symmetry. However, studies on three-dimensional analyses of midface asymmetry are limited. This study investigated the characteristics of midface asymmetry in skeletal Class III malocclusion patients through three-dimensional analysis. Methods: Sixty-eight adult subjects with skeletal Class III malocclusion were included and divided into mandible symmetry and asymmetry groups. The prevalence of recognizable malar asymmetry and the deviation of anterior nasal spine (ANS) were examined. The relation between midface and mandible asymmetry were investigated with Spearman correlation. The difference in distance of landmarks to reference planes were compared between the two groups using Mann–Whitney U test (p < 0.05). Results: The overall prevalence of malar asymmetry was 7.35% and of ANS deviation was 38.24%. In subjects with chin deviated to the right, there was a moderate negative correlation between chin deviation and difference of zygion and zygomatic process to mid-sagittal plane. The absolute value of difference in the glenoid fossa was significantly greater in female asymmetry subjects. Conclusions: The prevalence of midface asymmetry is not low. The more severely the chin is shifted, the greater asymmetrical position of the zygoma and glenoid fossa was found. Therefore, pre-surgical case-by-case evaluation of the midface region is essential for understanding the midface skeletal characteristics of Class III patients with chin deviation, thereby providing patients with realistic expectations and optimizing surgical outcomes and patient satisfaction. Full article

Background and Objectives: Age estimation from skeletal remains and in living individuals is an important issue for human identification, and also plays a critical role in judicial proceedings for migrants. Forensic analysis of ossification centers is the main evaluation method for age estimation, and ossification degree can be determined using computed tomography analysis. The purpose of this study is to investigate the applicability of CT (computed tomography) in the analysis of left scapula ossification centers, for forensic age estimation in Turkish society. Materials and Methods: We analyzed six ossification centers of the left scapula and these ossification centers are the coracoid, subcoracoid, coracoid apex, acromial, glenoid, and inferior angle ossification centers. A pediatric radiologist analyzed these six ossification centers of the scapula by using a staging method defined by Schmeling et al. in 2004. Two months after the first assessment, 20 randomly selected cases was reanalyzed by the first observer and by another pediatric radiologist. Correlation between the age and ossification stage was assessed using Spearman’s nonparametric correlation test. Linear regression analysis was performed using a backwards model. Cohen’s kappa coefficient was used for evaluating interobserver and intraobserver variability. Results: In this retrospective study, 397 (248 male and 149 female) cases were evaluated. Ages ranged between 7.1 and 30.9. The mean age was 19.83 ± 6.49. We determined a positive significant correlation between the age and the ossification stages of ossification centers analyzed in both sexes. In each ossification center, except inferior angle, all of the stage 1 and 2 cases in both sexes were under 18 years old. Intraobserver and interobserver evaluations showed that reproducibility and consistency of the method was relatively good. Conclusions: The present study indicated that CT analysis of scapula ossification centers might be helpful in forensic age assessment of living individuals and dry bones. Full article

Reverse shoulder arthroplasty (RSA) has transformed the management of shoulder pathologies, including cuff tear arthropathy and osteoarthritis. The innovative design principles of RSA, such as the medialization and inferiorization of the joint center of rotation, distalization of the humerus, and a semi-constrained construct, enable effective deltoid compensation for rotator cuff deficiency. The Grammont-style RSA demonstrated excellent clinical outcomes. However, complications like instability and scapular notching prompted the exploration of lateralized designs. The radiographic evaluation of RSA is paramount for understanding the biomechanics of the implant and to foresee possible complications. Radiographic assessments encompass glenoid and humeral component positions, identifying features like scapular notching, radiolucent lines, heterotopic ossifications, bone adaptations, and humeral lengthening. Lateralized designs alter muscle moment arms and improve deltoid efficiency, influencing abduction and adduction mechanics. Despite the reduction in scapular notching, lateralized RSA introduces new challenges, such as increased risk of scapular spine and acromial fractures. Understanding the radiographic features and biomechanics of lateralized RSA is crucial for optimizing patient outcomes and mitigating potential complications. Full article

The arthroscopic Bankart–Latarjet procedure is used in the surgical management of anterior shoulder instability. This technique is mainly performed in referral centers due to its high technicity. This study aimed to evaluate surgical outcomes in a peripheral hospital center. This is a retrospective study of patients treated for recurrent anterior shoulder instability. The clinical scores (Walch–Duplay, Rowe, and Western Ontario Shoulder Instability Index (WOSI)) were assessed preoperatively and at 12 months after surgery. The consolidation and the position of the bone block were evaluated at 6 months using a CT scan. Between 2016 and 2020, 40 patients had been operated on (mean age: 28.5 ± 7.9 years). During a mean follow-up of 29.5 ± 11.6 months, we noted only one complication, a case of fracture of the callus of a consolidated bone block. No recurrence of instability was recorded. The Walch–Duplay score increased from 17.8 to 94.6, the Rowe score from 24.9 to 96.8, and the WOSI score decreased from 52.1% to 6.9%. The bone block was consolidated in 35 patients (87.5%), and a flush position with the anterior edge of the glenoid was noted for all patients. At one year, 67.0% of the patients practicing sport had returned to sports. The arthroscopic Bankart–Latarjet technique was a reliable procedure in the hands of an experienced shoulder surgeon, even in a peripheral hospital center. Full article

Introduction: The purpose of this study was to analyze the real range of motion (RoM) measured in patients operated on for reverse shoulder arthroplasty (RSA) and compare it to the virtual RoM provided by the preoperative planning software. Hypothesis: There was a difference between virtual and real RoM, which can be explained by different factors, specifically the scapula-thoracic (ST) joint. Methods: Twenty patients with RSA were assessed at a minimum follow-up of 18 months. Passive RoM in forward elevation abduction, without and with manually locking the ST joint, and in external rotation with arm at side were recorded. The humerus, scapula, and implants were manually segmented on post-operative CTs. Post-operative bony structures were registered to preoperative bony elements. From this registration, a post-operative plan corresponding to the real post-operative implant positioning was generated and the corresponding virtual RoM analysis was recorded. On the post-operative anteroposterior X-rays and 2D-CT coronal planning view, the glenoid horizontal line angle (GH), the metaphyseal horizontal line angle (MH), and the gleno-metaphyseal angle (GMA) were measured to assess the extrinsic glenoid inclination, as well as the relative position of the humeral and glenoid components. Results: There were some significant differences between virtual and post-operative passive abduction and forward elevation, with (55° and 50°, p < 0.0001) or without ST joint participation (15° and 27°, p < 0.002). For external rotation with arm at side, there was no significant difference between planning (24° ± 26°) and post-operative clinical observation (19° ± 12°) (p = 0.38). For the angle measurements, the GMA was significantly higher (42.8° ± 15.2° vs. 29.1°± 18.2°, p < 0.0001), and the GH angle, significantly lower on the virtual planning (85.2° ± 8.8° vs. 99.5° ± 12.5°, p < 0.0001), while the MH was not different (p = 0.33). Conclusions: The virtual RoM given by the planning software used in this study differs from the real post-operative passive RoM, except for external rotation. This can be explained by the lack of ST joint and soft tissues simulation. However, in focusing on the virtual GH participation, the simulation looks informative. Some modifications between the glenoid and humerus starting positions before running the motion analysis could be provided for making it more realistic and predictive of the RSA functional results. Level of evidence: III. Full article