Musab Gulzar

Background: The purpose of this study was to describe, and report the outcomes of, a surgical technique that combines reverse shoulder arthroplasty (RSA) using an allograft-prosthetic composite (APC) with a lower trapezius transfer (LTT) to the infraspinatus of the allograft extended with the inferior capsule. Methods: Between 2019 and 2023, 2 surgeons performed a total of 27 RSAs using an APC in conjunction with an LTT. Once the RSA APC reconstruction had been performed, cuff-capsule allograft tissue was passed posterior to the glenosphere and secured to the harvested lower trapezius. One shoulder was resected for periprosthetic joint infection; the remaining 26 shoulders were followed for a minimum of 2 years (mean, 2.7 years; range, 2 to 5 years). Results: The rate of revision or reoperation for humeral complications was 15% and included secondary bone grafting (2 shoulders), resection for infection (1 shoulder), and internal fixation of a periprosthetic fracture (1 shoulder). Other complications requiring surgery included hematoma treated with evacuation (2 shoulders), dislocation (1 shoulder), and glenosphere disassociation (1 shoulder). Preoperatively, 11 shoulders presented with pseudoparalysis, and the mean active elevation of the remaining 16 shoulders was 43°, with only 1 shoulder demonstrating >90° of active elevation. At the most recent follow-up, 3 shoulders were pseudoparalytic, 11 had 90° of active elevation, and 3 had active elevation to 90°. The overall mean active elevation of the 25 shoulders that could be assessed was 79°. Preoperatively, only 4 (15%) of the 27 shoulders demonstrated active external rotation past neutral; at the most recent follow-up, 80% of surviving shoulders had active external rotation past neutral. Conclusions: LTT at the time of RSA using an APC has the potential to restore active external rotation in shoulders with proximal humeral bone loss and posterosuperior cuff deficiency. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Scapholunate interosseous ligament (SLIL) injuries have traditionally been treated via open approaches. Recent arthroscopic techniques have improved the ability to access the SLIL while preserving local blood supply and ligaments. Here, we present a systematic review comparing outcomes after arthroscopic versus open SLIL repair.A systematic search of PubMed was conducted for primary research articles evaluating open or arthroscopic SLIL repair. Inclusion criteria were primary articles examining open or arthroscopic repair of SLIL injuries. Data extracted included surgical interventions and indications, time from injury to surgery, length of follow-up, range of motion (ROM), reoperations, patient-reported outcome measures (PROMs), radiographic results, and complications.Out of 226 studies screened, 15 met inclusion criteria, encompassing 982 SLIL repairs (827 arthroscopic, 155 open). The frequency-weighted mean follow-up was 41 months, with a mean age of 34 years (range 14–68). PROMs were significantly improved in arthroscopic compared with open repairs, with visual analog scale (VAS) scores of 1.13 versus 4.69 (p < 0.05), Disabilities of the Arm, Shoulder, and Hand (DASH) scores of 9.93 versus 21.93 (p < 0.05), and Mayo scores of 87.55 versus 80.28 (p < 0.05). Functional outcomes also revealed increased range of motion and strength in the arthroscopic group: flexion (67.04 degrees vs. 51.73 degrees), extension (72.56 versus vs. 51.97 degrees), and strength (41.94 kg vs. 34.59 kg; all p < 0.05). Radiographic outcomes demonstrated a significant albeit smaller postoperative scapholunate (SL) angle, with arthroscopic repairs at 54.08 degrees and open repairs at 59.10 degrees (p < 0.05).Arthroscopic SLIL repair is associated with improved pain, ROM, strength, and PROMs compared with open repair, along with a more favorable postoperative SL angle. These findings support the potential benefits of arthroscopic approaches in managing SLIL injuries and may inform future treatment algorithms.

Background: Reverse shoulder arthroplasty (RSA) with structural bone grafting of the glenoid utilizing an autograft from the resected humeral head is an effective strategy to address severe glenoid bone loss. Although learning curves have been established for RSA, RSA with bone grafting is more technically challenging, with relatively higher complication rates. The number of cases needed for proficiency and the optimal learning strategies have yet to be defined for RSA with bone grafting. Methods: All patients who underwent primary, single-stage RSA with bone grafting for severe glenoid bone loss at our institution between November 2018 and February 2022 were identified. Perioperative data, including imaging, operative time, complications, revisions, postoperative functional data, and patient-reported outcomes, were recorded and analyzed. The learning curve for a fellowship-trained shoulder and elbow surgeon was analyzed using linear regression and cumulative sum (CUSUM) analysis. CUSUM analysis objectively evaluated differences in operative time over the course of the surgeon’s practice and elucidated the completion of the learning curve. Results: A total of 32 patients (53% male and 47% female; mean age, 68 years) were included in the analysis. The mean follow-up was 28 months. The mean operative time was 127 minutes, and there was a linear decrease in operative time throughout the study. CUSUM analysis using operative times demonstrated that the surgeon’s learning curve was 14 patients. When comparing patients among the first 14 cases and the last 18 cases, there was no difference in shoulder range of motion, American Shoulder and Elbow Surgeons (ASES) scores, and Subjective Shoulder Value (SSV), while visual analog scale (VAS) pain scores at the time of final follow-up were better for patients in the surgeon’s proficiency phase compared with the learning phase. Conclusions: In this study, we found a significant linear decrease in operative time with the number of cases completed, without associated detriment to the postoperative outcome or complication rate. Our findings suggest that at least 14 cases may be required before proficiency is obtained with RSA using humeral head bone graft. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Case: A 46-year-old male patient presented with shoulder pain, limited range of motion, and loss of sensation for a year after undergoing hemiarthroplasty for a proximal humerus fracture. Workup demonstrated a greater tuberosity nonunion and deltoid paralysis secondary to upper trunk brachial plexopathy. The pectoralis major (PM) for deltoid transfer successfully restored shoulder function and resolved pain without requiring any subsequent intervention. Conclusion: A PM transfer for deltoid and rotator cuff insufficiency restored shoulder stability and improves biomechanics for shoulder abduction and flexion in this case. Dynamic radiography demonstrates enhanced fluidity of shoulder kinematics with improved scapulohumeral motion.