Search Results (64)

Background: Artificial intelligence (AI) is progressively entering perioperative medicine; however, its role in preoperative anesthetic decision-making remains insufficiently characterized. We evaluated the concordance between anesthesiologist-selected anesthetic techniques and algorithm-generated recommendations in a cohort of adult patients undergoing non-cardiac surgery. Methods: This retrospective observational study included adult patients (≥18 years) undergoing elective non-cardiac surgery between January 2024 and January 2025 at two international centers (Mexico and Italy). Clinical, demographic, and surgical variables were extracted from electronic medical records. For each case, a structured anonymized vignette was submitted to ChatGPT (version 5.0, medical configuration) to obtain an independent recommendation regarding anesthetic technique. Concordance between AI-generated and clinician-selected techniques was assessed using agreement analysis and stratified by country and surgical specialty. Results: A total of 1965 patients were analyzed. Overall concordance between ChatGPT recommendations and anesthesiologist-selected techniques was 84.6%. Agreement remained stable across centers (Mexico 84.3%; Italy 88.7%). Disagreement rates varied by surgical specialty, with the highest values observed in vascular and proctologic surgery (28.6%), followed by urology (21.1%) and thoracic surgery (18.8%). Orthopedic procedures—particularly shoulder arthroscopy—accounted for a relevant proportion of divergences, where AI frequently favored regional techniques over general anesthesia. No specialty demonstrated discordance exceeding 30%. Conclusions: AI-generated anesthetic recommendations demonstrated substantial concordance with expert clinical decision-making across heterogeneous surgical settings. These findings support the potential integration of AI within a hybrid decision-making framework, complementing—rather than replacing—anesthesiologist expertise in contemporary perioperative care. Full article

Background/Objectives: Shoulder arthroscopies are commonly conducted in orthopedic practice. The interscalene brachial plexus block (ISB) is regarded as the “gold standard” for postoperative analgesia in shoulder surgeries. The serratus posterior superior intercostal plane block (SPSIPB) was introduced as an innovative treatment for addressing thoracic and shoulder discomfort. This study aims to examine the effects of SPSIPB and ISB techniques on postoperative pain levels, opioid intake, and respiratory function measures in patients having shoulder arthroscopy. Methods: Patients were divided into two groups. In the ISB group, 15 mL of fluid containing 0.25% bupivacaine was applied between interscalene muscles, while in the SPSIPB group, 30 mL of 0.25% bupivacaine was applied in the fascial plane between the serratus posterior superior muscle and the intercostal muscles. Results: There were no statistically significant differences in demographic characteristics (p > 0.05). VAS scores were statistically lower in the ISB group compared to the SPSIPB group at rest at 1, 2, 4, 8, 12, and 24 h postoperatively in the PACU (p < 0.05). VAS scores were also lower in the ISB group compared to the SPSIPB group during active movement at 1, 2, 4, 8, and 12 h postoperatively in the PACU (p < 0.05). Twenty-four-hour fentanyl consumption was lower in the ISB group compared to the SPSIPB group (407.50 ± 169.32 μg and 767.50 ± 178.00 μg, respectively, p < 0.001). The decrease in FEV₁ and FVC was higher in the ISB group compared to the SPSIPB group (p < 0.001). Conclusions: ISB effectively relieves pain during shoulder arthroscopic procedures; however, while SPSIPB is considered a more advantageous option in terms of respiratory safety, it may not provide adequate analgesia on its own. Full article

Arthroscopic treatment of acromioclavicular (AC) joint separations has evolved significantly over the past two decades. Modern anatomical repair methods frequently rely on suspensory fixation devices to reconstruct the coracoclavicular ligaments and, in some cases, to stabilize the AC joint itself. Background/Objectives: Arthroscopy offers a minimally invasive option that ensures excellent visualization of the joint, facilitates management of concomitant intra-articular injuries, and provides direct access to the undersurface of the coracoid process for implant placement. Methods: Over the past seven years, we have managed 30 AC separation cases using this arthroscopic approach. Results: The distinctive feature of our technique is the use of only two portals—one posterior and one anterosuperior—which proved adequate for optimal visualization and accurate implant positioning. Conclusions: In this article, we outline the benefits and limitations of the technique, identify current knowledge gaps, and propose avenues for future clinical research. Full article

(1) Background and aim: The benefit of surgical treatment compared to conservative management is unclear in degenerative cuff tears, and there is limited evidence regarding midterm functional outcomes. This study sought to compare the midterm functional outcomes of surgical versus conservative treatment for rotator cuff tears. (2) Methods: All patients on the waiting list for arthroscopy of cuff tears in a single center between 2013 and 2015 were analyzed. They were divided into two groups: those who underwent surgery (arthroscopy group) and those who declined the procedure (orthopedic group). The primary endpoint was shoulder functionality, evaluated with the CMS, SST, and SPADI-SP questionnaires. Inverse probability of treatment weighting (IPTW) was used to account for differences between the groups. (3) Results: Of 57 patients (67 (62–71) years old, 47% women), 32 were in the arthroscopy group and 25 in the orthopedic group. Functionality was assessed at a median of 7 (7–8) years after diagnosis. The patients in the arthroscopy group were younger (p = 0.023) and more frequently women (p = 0.074). No significant differences were observed in the type of tear (p = 0.205) or laterality (p = 0.164). Functional outcome analysis showed more favorable scores in the surgical group: constant (74.5 ± 16.6 vs. 58.4 ± 23, p = 0.016), SST (7.3 ± 3.1 vs. 4.9 ± 4.2, p = 0.016), and SPADI-SP (35.7 ± 26.6 vs. 56.1 ± 30.4, p = 0.006). (4) Conclusions: In this cohort of patients with cuff tears, arthroscopic repair was associated with better clinical and functional midterm results compared to conservative treatment, although the benefit was less evident in older patients and those with complete tears. Full article

Background: Optimal timing for surgery following acute rotator cuff tears remains unclear. This study examines how the timing of arthroscopic rotator cuff repair (RCR) affects retear rates and functional outcomes. Methods: This PROSPERO-registered review (CRD42024528249) followed PRISMA guidelines and included randomized trials, and cohort, studies on adults with imaging-confirmed full-thickness rotator cuff tears. Studies lacking timing data or key outcomes were excluded. Risk of bias was assessed using ROBINS-I. Meta-analysis of retear rates was performed comparing surgical timing. Qualitative analysis was conducted classifying results as early-beneficial, delayed-detrimental, or neutral. Results: Our review included 13 studies and 871 patients with an average age of 57.9. Meta-analysis of eight studies comparing retear rates between early and delayed RCR demonstrated a significant benefit associated with early intervention risk ratio 0.60 (95% CI: 0.38–0.96). Functional outcomes also favored early intervention with four studies demonstrating significantly greater postoperative functional improvements in the early intervention group. Conclusions: Early arthroscopic RCR decreased the rate of retear and improved functional outcomes. No study found early intervention to be detrimental or delayed intervention to be superior. These findings support consideration of early repair when clinically appropriate. Future studies should determine more finite timing guidelines. 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

Background: The opioid epidemic has highlighted the need for alternative pain management modalities in postoperative patients. Peripheral nerve blocks (PNBs) have been shown to reduce opioid consumption in the immediate postoperative period, but limited data exists on their impact on chronic opioid use. Objective: The present investigation focused on the use of preoperative PNB utilization in orthopedic surgeries and its association with chronic opioid use. Methods: A retrospective cohort study was conducted on 533 patients that had a total shoulder arthroplasty, reverse total shoulder arthroplasty, or knee arthroscopy between July 2021 and July 2024. Patients were grouped based on whether they received a preoperative PNB. Opioid prescription data were collected at 1-, 3-, and 6-month postoperative periods. In addition, a subset of patients completed a questionnaire to assess self-reported opioid consumption and other analgesic usage. Results: Patients who received a PNB were significantly less likely to report continued opioid use at one month postoperatively compared to those who did not (32.8% vs. 61.9%). Additionally, PNB recipients more often declined additional opioids due to a lack of need (p = 0.025), while those without a PNB cited other reasons, including fear of addiction or poor pain control (p = 0.033). Conclusions: The results of the present investigation suggest that preoperative PNBs may be associated with reduced chronic opioid use and have an important role in prescribing practices and pain management strategies following orthopedic surgery. Limitations: The limitations are as follows: retrospective design; potential recall and selection bias from questionnaire use; lack of data confirming actual opioid prescription fills; inclusion of patients with chronic pain comorbidities requiring long-term opioid use. Full article

Background/Objectives: This retrospective cohort study compared the outcomes (postoperative pain, morphine consumption, sleep disturbance, and function) of patients undergoing arthroscopic rotator cuff repair involving either continuous interscalene block (CISB group) or single-injection interscalene block with intravenous dexmedetomidine (SISB group) analgesia. Methods: This study included 61 patients, aged 59–71 years, who underwent elective arthroscopic rotator cuff repair and for whom complete electronic health records were available. Patients in the SISB group received a single-injection nerve block plus intraoperative intravenous dexmedetomidine and postoperative patient-controlled analgesia (PCA; morphine and dexmedetomidine; n = 33). Patients in the CISB group received continuous nerve block and morphine PCA (n = 28). Patient sleep disturbances, pain, total morphine consumption, and functional outcomes were evaluated postoperatively. Results: During the first 36 h postoperatively, there were no significant differences in the measured effects for patients in the two groups. Similarly, there were no significant differences in functional outcomes. However, patients in the SISB group had a significantly lower median morphine consumption total (18 mg) than those in the CISB group (24 mg; p < 0.001). Conclusions: Patients in the SISB group demonstrated significantly lower median morphine consumption than those in the CISB group; however, the postoperative pain, frequency of sleep disturbances, nausea, and functional outcomes did not show statistically significant differences. The reduced morphine consumption associated with the SISB group, compared with the CISB group, suggests that this analgesic protocol may result in fewer opioid-related effects following arthroscopic rotator cuff repair. Full article

Background: Shoulder arthroscopy is a common, minimally invasive surgery, but the resulting postoperative blood loss remains poorly understood. In this study, we quantified the intraoperative and postoperative blood loss, the hemoglobin (Hb) drop, and the effects of irrigation fluid retention, as well as the influence of solutions administered through infusions. Methods: A prospective observational study of 49 patients undergoing arthroscopic rotator cuff tear (RCT) repair was conducted. Their preoperative and postoperative Hb levels were measured, along with the intraoperative and postoperative blood loss. Irrigation fluid retention was analyzed, and multiple regression was used to assess the factors contributing to Hb drops. Results: The intraoperative blood loss amounted to 36.46 ± 20.34 mL, while the total blood loss reached 791.17 ± 280.96 mL, with 94.64% occurring postoperatively. The postoperative Hb drop (2.06 ± 0.74 g/dL) was significantly greater than the intraoperative Hb drop (0.11 ± 0.06 g/dL) (p < 0.001). An older age (p = 0.02) and male sex (p = 0.025) significantly predicted the postoperative Hb drop, while irrigation fluid retention and administration of crystalloids and colloids had no notable effects. Capsulotomy was associated with a small but significant increase in intraoperative blood loss (p < 0.01). Increased intraoperative blood loss correlated with greater irrigation fluid retention (r = 0.41, adjusted R2 = 0.152, p < 0.001). Conclusions: In shoulder arthroscopy, the postoperative blood loss and Hb drop are significantly greater than the intraoperative blood loss and Hb drop, as well as the fluid gain, emphasizing the need for careful monitoring, especially in high-risk patients. Future studies should investigate the potential impacts of low-molecular-weight heparin on postoperative bleeding after shoulder arthroscopy. Full article

Objectives: Metal anchors (MA), commonly used in the early stages of rotator cuff surgical treatment development, are associated with a high risk of complications, especially in osteoporotic bone. As an alternative to rigid anchors, all-suture anchors (ASA) have been introduced for the medial row, offering promising clinical outcomes and favorable biomechanical studies. We aimed to compare the clinical outcomes of MAs and ASAs in either single-row or in medial-row suture bridge techniques in arthroscopic rotator cuff repair. Our hypothesis was that in cases where ASA was used for at least 12 months of follow-up, more favorable results would be obtained as compared to rigid anchors, and intraoperative complications such as anchor pullout would be encountered less. Methods: In this retrospective cohort analysis, we reviewed patients who underwent arthroscopic rotator cuff repair between January 2020 and December 2022. Surgeries were performed by two senior surgeons in a single tertiary center. Patients who had undergone revision surgery, had a history of previous shoulder surgeries, had massive rotator cuff tears, and partial-thickness tears; or had concomitant subscapularis tears were excluded. Preoperative and postoperative scores, including Constant–Murley (CM), Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analog scale (VAS), were compared. The minimum follow-up period was 12 months. Clinical assessment of shoulder range of motion included forward flexion, abduction, internal rotation, and external rotation. Intraoperative anchor-related complications were compared. All patients underwent the same surgical technique and postoperative rehabilitation protocol. Results: A total of 142 patients (89 females, 53 males; mean age: 57.4 years) were included in the study, with 67 patients in the ASA group and 75 in the MA group. The sex distribution and mean age were similar between groups. The ASA group had 15 traumatic tears, while the MA group had 13 (p < 0.05). The mean follow-up period was 21.6 months (range 12–40 months). Preoperative CM scores were statistically better in the ASA group, but this difference was not clinically relevant (p < 0.046). The mean CM score was 75.64, the mean DASH score was 8.57, and the mean VAS was 1.38 at the postoperative period in the MA group. The mean CM score was 78.40, the mean DASH score was 9.75, and VAS was 1.59 at the postoperative period in the ASA group. Seven cases experienced anchor pullout in the MA group, and thread breakage occurred in one patient of each group (p = 0.014). The mean age of the patients with anchor pullout was significantly higher (p = 0.002). This finding was not hypothesized in the initial study design but emerged during post-hoc analysis and highlights the importance of considering bone quality in elderly patients. Conclusions: The clinical outcomes of rotator cuff repairs using all-suture anchors or metal anchors are comparable. However, ASA use may offer an advantage in elderly patients by reducing the risk of anchor pullout. Further studies assessing tendon integrity and bone quality and incorporating long-term follow-up periods are recommended to support and validate the present findings. Full article

Arthroscopic shoulder surgery has undergone significant advancements over the past decades, transitioning from a primarily diagnostic tool to a comprehensive therapeutic approach. Technological innovations and refined surgical techniques have expanded the indications for arthroscopy, allowing minimally invasive management of shoulder instability and rotator cuff pathology. Methods: This narrative review explores the historical evolution, current trends, and future perspectives in arthroscopic shoulder surgery. Results: Key advancements in shoulder instability management include the evolution of the arthroscopic Bankart repair, the introduction of the remplissage technique for Hill–Sachs lesions, and the development of arthroscopic Latarjet procedures. Additionally, novel techniques such as Dynamic Anterior Stabilization (DAS) and bone block procedures have emerged as promising solutions for complex instability cases. In rotator cuff repair, innovations such as the suture-bridge double-row technique, superior capsular reconstruction (SCR), and biological augmentation strategies, including dermal allografts and bioinductive patches, have contributed to improving tendon healing and functional outcomes. The role of biologic augmentation, including biceps tendon autografts and subacromial bursa augmentation, is also gaining traction in enhancing repair durability. Conclusions: As arthroscopic techniques continue to evolve, the integration of biologic solutions and patient-specific surgical planning will likely define the future of shoulder surgery. This review provides a comprehensive assessment of current state-of-the-art techniques and discusses their clinical implications, with a focus on optimizing patient outcomes and minimizing surgical failure rates. Full article

Visual clarity is crucial for shoulder arthroscopy, directly influencing surgical precision and outcomes. Despite advances in imaging technology, intraoperative bleeding remains a significant obstacle to optimal visibility, with subjective evaluation methods lacking consistency and standardization. This study proposes a novel image processing system to objectively quantify bleeding and assess surgical effectiveness. The system uses color recognition algorithms to calculate a bleeding score based on pixel ratios by incorporating multiple color spaces to enhance accuracy and minimize errors. Moreover, 200 three-second video clips from prior arthroscopic rotator cuff repairs were evaluated by three senior surgeons trained on the system’s color metrics and scoring process. Assessments were repeated two weeks later to test intraobserver reliability. The system’s scores were compared to the average score given by the surgeons. The average surgeon-assigned score was 5.10 (range: 1–9.66), while the system scored videos from 1 to 9.46, with an average of 5.08. The mean absolute error between system and surgeon scores was 0.56, with a standard deviation of 0.50, achieving agreement ranging from [0.96,0.98] with 96.7% confidence (ICC = 0.967). This system provides a standardized method to evaluate intraoperative bleeding, enabling the precise detection of blood variations and supporting advanced technologies like autonomous arthropumps to enhance arthroscopy and surgical outcomes. Full article

Introduction: Arthroscopic Bankart repair (ABR) is associated with an increased failure rate over time. The Recenter implant, a metal block, is designed to reinforce capsulolabral repair. The aim of this study was to evaluate whether the addition of the Recenter implant to ABR reduces the rate of recurrence in patients with glenohumeral anterior instability. Materials and Methods: This was a retrospective, multicentric case–control study focusing on patients surgically treated for anterior shoulder instability from February 2012 to November 2019. This study compared patients undergoing ABR augmented with the “Recenter” implant (augmented ABR group) against those receiving traditional ABR. Primary outcomes measured included recurrence rates. Secondary outcome measures included functional scores (Walch–Duplay and the subjective shoulder test [SST], the auto Rowe score, satisfaction, pain, and the presence or absence of subjective subluxation and apprehension), return to sports, the range of motion, as well as other complications. Results: Thirty-two patients with augmented ABR were compared to forty-eight patients in the traditional ABR group, with mean follow-up periods of 5.2 ± 1.3 years and 6.1 ± 1.5 years, respectively. Three patients (9.4%) experienced recurrence in the “Recenter” group, versus eight (16.7%) in the other group (p > 0.05). The Walch–Duplay score was 70.2 ± 8.2 in the “Recenter” group and 64.2 ± 8 in the control group (p > 0.05). The SST score out of 100 was, respectively, 84.6 ± 6 and 81.5 ± 5.5 (p = 0.05). There were no early complications in the implant group. No statistically significant differences were observed between the two groups for the other outcomes. Conclusions: ABR safely restores shoulder stability in selected patients with subcritical glenoid bone deficiency. However, the addition of the Recenter metal implant did not improve outcomes compared to traditional Bankart repair and introduced presumed significant surgical time, technical challenges, and additional costs. Full article

Background: Arthroscopic rotator cuff repair (RCR) is a common procedure, yet long-term patient-centered outcome studies remain limited. This study aims to evaluate the outcomes of arthroscopic RCR using a single-row metallic anchor technique over a 12-year follow-up, focusing on patient-reported outcomes and potential risk factors. Methods: A monocentric cohort study was conducted on patients who underwent complete arthroscopic RCR with a single-row metallic anchor technique from January 2007 to July 2011. A total of 628 patients completed three standardized questionnaires: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Simple Shoulder Test (SST). They were also asked for their overall satisfaction on the procedure with a single direct question. Outcomes were analyzed by gender, age at surgery, lesion pattern, and follow-up duration. Results: The mean follow-up period was 12.9 ± 1.3 years. Overall satisfaction was 96.5%. The mean scores for QuickDASH, ASES, and SST were 7.2 ± 15.7, 83.8 ± 23.9, and 89.9 ± 22.3, respectively. Female patients reported significantly lower QuickDASH (p < 0.001), ASES (p < 0.001), and SST (p = 0.004) than male patients, but overall satisfaction did not differ by gender. Age, number of tendons repaired, anterior tear, and follow-up length were not significantly associated with differences in outcome measures. Conclusions: Single-row arthroscopic RCR provides excellent long-term patient-reported outcomes and high patient satisfaction. Female gender may be associated with slightly lower functional scores, yet satisfaction remains unaffected. This study supports the single-row technique as a reliable, efficient, and cost-effective option for long-term success in RCR, challenging the need for more complex multi-anchor approaches. Full article

Background: Rotator cuff (RC) repair leads to less than optimal results when dealing with massive lesions, so the use of scaffolds as biological support has been proposed to improve RC repair site biology. The present study aims to evaluate the clinical and radiographical outcomes of a series of patients suffering from massive or irreparable RC tears treated with patch (porcine or human scaffolds) repair (augmentation or bridging). Methods: Twenty-three patients with a minimum follow-up of 24 months were subjectively, clinically, and radiographically assessed before and after surgery. Three different patient-related outcome measurements (PROMs) (American Shoulder and Elbow Surgeons score, Constant score, visual analog scale) were used for the subjective and clinical evaluation, while plain radiographs and magnetic resonance imaging where employed for radiographical follow-up. Results: Regardless of the technique (augmentation or bridging) or type of scaffold (porcine or human) employed, at follow-up, all patients experienced a statistically significant improvement in all PROMs and clinically. Conclusions: Patch repair represents a valid salvage procedure in massive or irreparable RC tears, improving the quality of life and eventually delaying the need for prosthetic replacement. Full article