Asimina Lazaridou

Purpose: To explore factors associated with the occurrence of finger lacerations during arthroscopic and open knot‐tying techniques in shoulder surgery. Methods: This cross‐sectional survey was conducted at an international shoulder surgery course in March 2024. Attending shoulder surgeons performing arthroscopic and open shoulder surgeries were asked to participate in a survey on site using a structured questionnaire to explore factors associated with the occurrence and anatomical distribution of skin lacerations during arthroscopic and open knot‐tying techniques. Demographic, procedural, and intraoperative variables were collected and compared between techniques. Linear and logistic regression analyses were performed to identify predictors of laceration occurrence and severity. Results: A total of 100 surgeons were invited to participate, all of whom completed the survey (response rate: 100%). Eighty‐nine percent of respondents reported having experienced finger lacerations either currently or in the past, with 79% still affected at the time of the survey. The remaining 10% had adopted effective preventive measures: 3% modified their knot‐tying technique, 2% wrapped tape around the affected fingers, and 5% developed hyperkeratosis as a protective adaptation. Among those affected, lacerations were reported to occur always in 20%, often in 42%, sometimes in 22%, and rarely in 16% of arthroscopic cases. The distal interphalangeal joints of the index and little fingers were most commonly involved, with the index finger affected in 71%, the little finger in 30%, and 18% reporting lesions on both fingers. Rotator cuff reconstruction was the procedure most frequently associated with laceration occurrence; however, no significant correlation was found between laceration frequency and the number of reconstructions performed per year ( r = 0.091, P = .371). Similarly, no association was observed between handedness and the affected side, with 43% reporting bilateral involvement ( χ ² = 2.464, P = .292). Hyperkeratosis was observed in 54.4% of affected surgeons, suggesting a potential adaptive response to repetitive skin trauma. Conclusions: Finger lacerations are a common problem among shoulder surgeons. Seventy‐nine percent of respondents reported being regularly affected, particularly at the distal interphalangeal joint of the index and little fingers. Surgeons performing rotator cuff repairs showed a significantly higher incidence of finger lacerations at present. Clinical Relevance: Finger lacerations and glove microlesions during knot tying are common among shoulder surgeons and may compromise barrier integrity. The lack of widely effective preventive measures underscores the need for improved strategies to protect both surgeons and patients.

Background: Loss of reduction and persistent instability are among the most common complications following acromioclavicular (AC) stabilization using suture button devices. The effect of additional tendon allograft augmentation on radiographic and clinical outcomes in acute AC joint injuries with bidirectional instability has not been investigated. Purpose: To evaluate the impact of tendon graft augmentation on radiographic and clinical outcomes after acute AC joint dislocations. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study included patients with acute AC joint dislocation and bidirectional instability (Rockwood IIIb and V). All patients were treated with arthroscopically assisted double-button fixation and an AC cerclage. Patients were treated consecutively without graft augmentation between 2018 and 2021 and with augmentation between 2022 and 2024. Vertical and horizontal stability were assessed preoperatively and at the latest postoperative follow-up using bilateral Alexander and panoramic shoulder radiographs. The primary radiographic endpoints were the coracoclavicular displacement ratio (CCDR) and side-to-side difference (SSD) of the circles measurement at final follow-up. The secondary endpoint was the clinical outcome (Subjective Shoulder Value [SSV], EQ-5D-5L) at the latest follow-up (defined as 24 months when available or 12 months otherwise). Results: In total, 120 patients were included (51 graft, 69 no graft). Time to surgery was comparable (10.94 ± 10.86 vs 11.04 ± 4.95 days; P = .95). Final CCDR did not differ between groups (31.4% ± 37.7% vs 31.0% ± 34.9%; P = .95), and graft augmentation was not associated with final CCDR after adjustment for age and follow-up duration (β = −2.0; 95% CI, −16.1 to 12.2; P = .79). The SSD of the circles measurement was comparable (4.65 ± 4.68 vs 5.06 ± 4.82 mm; P = .69). No significant differences were observed in SSV (89.9 vs 92.6; P = .21) or EQ-5D-5L (0.952 vs 0.962; P = .48). Conclusion: In patients with acute, bidirectionally unstable high-grade AC joint injuries, tendon allograft augmentation added to arthroscopically assisted double-button fixation did not improve radiographic reduction maintenance or patient-reported outcomes. These findings suggest that routine tendon graft augmentation may not be necessary in acute bidirectionally unstable high-grade AC joint injuries when adequate coracoclavicular and AC stabilization is performed.

Introduction: Outcomes after rotator cuff repair are commonly evaluated in terms of structural healing and surgical technique. However, psychological factors may also influence patients’ experience of pain and functional recovery. Increasing attention has therefore been directed toward the potential role of preoperative psychological distress in shaping postoperative outcomes. To systematically review the available evidence examining whether psychological factors present before surgery are associated with postoperative pain and functional outcomes following rotator cuff repair. Methods: This systematic review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251132190; 28/08/2025). A structured literature review was performed using MEDLINE, Embase and PsycINFO, from database inception to March 6, 2026, for studies evaluating preoperative psychological variables in relation to postoperative pain and functional outcomes. Eligible study designs included randomized controlled trials, non-randomized trials, and observational cohort studies; however, only observational cohort studies met the final inclusion criteria. Risk of bias was assessed using the ROBINS-I tool, and methodological quality was appraised using the Newcastle-Ottawa Scale. Results: Ten observational studies were included. Across these studies, higher levels of depression, anxiety, pain catastrophizing, poorer emotional well-being, negative affect, and broader psychological distress were frequently associated with worse postoperative pain intensity and lower functional outcome scores. The reported associations were generally small-to-moderate strength and varied across cohorts. Some findings suggested potential interaction between psychological vulnerability and biological predisposition, including variation in Catechol-O-Methyltransferase (COMT) genotype. Importantly, elevated preoperative psychological distress did not preclude meaningful postoperative improvement, and several studies reported parallel improvements in psychological symptoms and physical recovery over time. Discussion: The available evidence indicates that recovery after rotator cuff repair cannot be explained solely by structural or surgical factors. Psychological health appears to influence how patients experience and report postoperative pain and function. However, the observed relationships are not uniform, and the evidence base is limited by observational design, methodological heterogeneity, and variability in outcome measurement. While preoperative psychological assessment may have clinical value, further prospective and interventional research is required to clarify its impact on surgical outcomes. Conclusions: Preoperative psychological distress is associated with postoperative pain and functional outcomes after rotator cuff repair, although it does not determine recovery in isolation. Psychological factors likely represent one component of a broader multifactorial recovery process. Future studies should explore whether targeted psychological interventions can improve postoperative pain trajectories and functional recovery.

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Purpose: Shoulder arthroplasty has evolved substantially in surgical technique, implant design, and indications. Careful coordination across the patient care pathway remains central to optimizing outcomes. Concurrently, rapid advances in digital health, wearable technologies, smart implants, and intraoperative innovations are being explored across orthopedics, with emerging applications in shoulder arthroplasty. Objective: This narrative review synthesizes current evidence on digital technologies relevant to shoulder arthroplasty, with particular attention to the strength and origin of the available data. Patients and Methods: A structured review of recent literature was performed, including primary studies in shoulder arthroplasty as well as relevant evidence extrapolated from hip and knee arthroplasty. Areas examined included CT-based 3D planning, navigation, patient-specific instrumentation, robotics, augmented/mixed reality, mobile health (mHealth) platforms, wearable devices, tele-rehabilitation, sensor-enabled implants, and artificial intelligence (AI). Results: In shoulder arthroplasty, digital planning tools, navigation systems, and patient-specific instrumentation have demonstrated improvements in implant positioning accuracy in selected studies; however, evidence linking these technologies to superior long-term clinical outcomes remains limited. Robotic systems and augmented reality applications are in early investigational phases. Postoperative digital health tools, including tele-rehabilitation and wearable monitoring, have shown non-inferior functional outcomes compared with conventional care in hip and knee arthroplasty, with only preliminary and pilot data currently available in shoulder populations. Sensor-enabled implants and AI-based predictive models represent emerging areas of research, but external validation, workflow integration, and cost-effectiveness analyses remain insufficient. Conclusion: Digital and smart health technologies in shoulder arthroplasty are evolving and largely investigational. While early findings and extrapolated evidence from other arthroplasty domains suggest potential benefits in planning accuracy, patient engagement, and outcome monitoring, robust shoulder-specific clinical validation is limited. Further prospective studies are required before widespread clinical adoption can be recommended. This narrative review synthesizes emerging evidence in this field, which is currently dominated by feasibility studies, technical reports, and early-phase clinical investigations, with limited high-level outcome data specific to shoulder arthroplasty.