Indications for Reverse Shoulder Arthroplasty (RSA) have been extended over the last 25 years, and RSA has become the most frequently implanted shoulder arthroplasty worldwide. The initial Grammont design with medialization of the joint center of rotation (JCOR), placement of the JCOR at the bone–implant interface, distalization and semi-constrained configuration has been associated with drawbacks such as reduced rotation and range of motion (ROM), notching, instability and loss of shoulder contour. This review summarizes new strategies to overcome these drawbacks and analyzes the use of glenoid-sided, humeral-sided or global bipolar lateralization, which are applied differently by surgeons and current implant manufacturers. Advantages and drawbacks are discussed. There is evidence that lateralization addresses the initial drawbacks of the Grammont design, improving stability, rates of notching, ROM and shoulder contour, but the ideal extent of lateralization of the glenoid and humerus remains unclear, as well as the maximal acceptable joint reaction force after reduction. Overstuffing and spine of scapula fractures are potential risks. CT-based 3D planning as well as artificial intelligence will help surgeons with planning and execution of appropriate lateralization in RSA. Long-term follow-up of lateralization with new implant designs and implantation strategies is needed.

Partial thickness supraspinatus tears and tendonosis can be managed either nonoperatively or by various arthroscopic techniques. New biologic treatment approaches are currently being investigated. MRI is commonly used for objective imaging outcome evaluation but there is a lack of reliability studies. We propose a novel MRI classification of partial supraspinatus tears and tendonosis and evaluate its inter-observer and intra-observer reliability. Digital MRI scans (3 Tesla) of 65 patients investigated for assessment of supraspinatus pathology or subacromial impingement were evaluated by three independent and experienced musculoskeletal (MSK) radiologists. Tendonosis (absent, focal, generalized), partial thickness (PT) tears (absent, 0%–25% PT, 25%–50% PT, 50%–100% PT, and full thickness tears), and anteroposterior extent of tears (less than 5 mm, 5–10 mm, greater than 10 mm) were scored by each radiologist on two separate occasions (t1, t2), 2 months apart. The inter-observer and intra-observer agreement and weighted kappa values for each parameter were calculated. The range of weighted intra-observer kappa (IAK) was 0.84–0.93 for evaluation of tendonosis; 0.84 (all raters) for depth of partial thickness, 0.74–0.84 for AP tear size, and 0.83–0.85 for the total score. The range of weighted inter-observer kappa (IEK) over two time points (t1, t2) was 0.55–0.74 for tendonosis, 0.69–0.84 for depth for partial thickness tears, 0.57–0.80 for AP tear size, and 0.63–0.80 for the total score. A comprehensive MRI grading protocol is proposed and is reliable for the evaluation of supraspinatus tendonosis and partial thickness tears with good to excellent kappa values. This rotator cuff MRI protocol can be applied to evaluate morphological tendon outcomes after different treatment modalities.

Tendinopathy and small partial-thickness tears of the rotator cuff tendon are common presentations in sports medicine. No promising treatment has yet been established. Corticosteroid injections may improve symptoms in the short term but do not primarily treat the tendon pathology. Ultrasound-guided autologous tenocyte implantation (ATI) is a novel bioengineered treatment approach for treating tendinopathy. We report the first clinical case of ATI in a 20-year-old elite gymnast with a rotator cuff tendon injury. The patient presented with 12 months of increasing pain during gymnastics being unable to perform most skills. At 1 year after ATI the patient reported substantial improvement of clinical symptoms. Pretreatment and follow-up MRIs were reported and scored independently by two experienced musculoskeletal radiologists. Tendinopathy was improved and the partial-thickness tear healed on 3 T MRI. The patient was able to return to national-level competition.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed at comparing resurfacing hip arthroplasty (RHA) and total hip arthroplasty (THA) in terms of rate of complications, revisions, functional outcomes, blood loss, operative time and metal ions levels. The search was conducted on three databases (PubMed, Cochrane and Web of Science) updated until 13 October 2022. The inclusion criteria were RCTs) written in the English language, with no time limitation, comparing RHA and THA. Among the retrieved 4748 articles, 18 RCTs were eligible for a total of 776 patients (mean age 53.1 ± 5.0). A meta-analysis was performed. RHA reported significantly lower blood loss compared to THA (p < 0.001) but with longer operative time (p < 0.001). No statistically significant difference was found between RHA and THA in terms of complications (12.08% and 16.24%, respectively) and revisions (6.32% and 6.14%, respectively). Both RHA and THA provide excellent clinical results in a population of young and active patients. Functional outcomes were not significantly different between the groups. Moreover, no significant difference in metal ion levels was found. These findings provide evidence concerning the safety and clinical effectiveness of RHA. Because of its bone-preserving properties, the lack of drawbacks and good outcomes, RHA appears to be a valid alternative to THA in young and active patients.

We report the case of a 74-year-old woman who sustained a scapular spine (SS) fracture after a fall 4 weeks after reverse shoulder arthroplasty (RSA). Open reduction and internal fixation (ORIF) with locked 90°-double plating resulted in union of the SS fracture with a good outcome (subjective shoulder value: 80%; Constant score 67; 1 year) despite of an adjacent lateral acromion fracture 3 weeks after ORIF. This is the second description in the literature of a successful double plate ORIF with union of an SS fracture after RSA. SS fractures are known to lead to poor RSA outcomes with a high mal-union rate and non-union rate. We describe the positioning of the plates and technical steps for successful ORIF to avoid complications, discuss the aftercare and report the outcome.