(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

Background: A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes. Methods: Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size. Results: 289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher (p = 0.007 and p = 0.004) and lower (p = 0.029 and p = 0.028) in Group A, both in the Small-and Medium-size subgroups. No complications were outlined. The mediolateral width of the acromion was reduced, according to the preoperatively calculated measure. Conclusion: Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°–35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions. Level of evidence: II.

Background: The optimal treatment for complex proximal humerus fractures (PHFs) lacks consensus, with reverse total shoulder arthroplasty (RTSA) often being a final resort rather than a primary approach. This study aimed to compare outcomes and satisfaction rates of primary RTSA for PHFs versus salvage RTSA for previously unsuccessful treatments. We hypothesized that primary RTSA would yield superior clinical outcomes, functional scores, and patient satisfaction. Methods: A retrospective analysis of RSA procedures between 2011 and 2021 was conducted, focusing on primary RTSA for PHFs or salvage RTSA for failed osteosynthesis. Patients meeting inclusion criteria underwent clinical and radiological follow-up for at least two years. Demographic characteristics, outcomes scores, and range of motion (ROM) were assessed. Results: Of 63 patients, 42 underwent primary RTSA and 21 underwent salvage RTSA. The median follow-up was 50 months. Statistically significant differences favored primary RTSA in forward flexion, abduction, internal rotation, and Constant shoulder score. Patient satisfaction levels did not significantly differ between groups. Complications occurred in 7.15% of primary RTSA cases and 14.28% of salvage RTSA cases. Conclusions: Primary RTSA may yield slightly better outcomes and lower complication rates compared to salvage RTSA. Further prospective studies are necessary to validate these findings.

Background: Reverse shoulder arthroplasty (RSA) is increasingly employed for managing complex three- and four-part proximal humeral fractures (PHFs) in elderly patients. Tuberosity healing and implant stability remain critical challenges, particularly in uncemented RSA. We describe a novel surgical technique—the “Hug Technique” for uncemented RSA in acute three- and four-part PHFs, designed to preserve metaphyseal bone stock, avoid tuberosity osteotomy, and optimize tuberosity healing. Additionally, we evaluated the functional outcomes of our novel surgical technique. Methods: A single-center retrospective cohort study was conducted on patients treated with the “Hug Technique” between January 2023 and January 2025. Inclusion criteria were acute displaced three- or four-part PHFs, age > 65 years, intact deltoid function, and ≥12 months of follow-up. All procedures were performed by a single surgeon using a standardized reverse shoulder implant. Clinical outcomes, functional scores, radiographic findings, complications, and implant survivorship were assessed. Results: A total of 14 patients were included, with a mean age of 74.8 years and a mean follow-up of 14.2 months. At final follow-up, the mean postoperative Constant score was 68.4, and the mean ASES score was 81.6. Mean active forward flexion reached 132°, external rotation 28°, and internal rotation reached the L3 vertebral level in most patients. Anatomical or consolidated tuberosity healing was observed in 78.5% of cases. No cases of stem loosening were observed. Complications occurred in 2 patients, including one case of deep periprosthetic infection and one case of anterior dislocation. Conclusions: The “Hug Technique” represents a feasible surgical strategy for cementless RSA in complex PHFs. Preliminary clinical and radiographic results appear promising. Further prospective comparative studies are required.

Background: Reverse total shoulder arthroplasty (RSA) significantly impacts deltoid length, tension, and structure. Studies have extensively investigated various modifications in deltoid characteristics, such as perfusion, elasticity, caliber, histological changes, and strength post-RSA. However, to date, there is a notable absence of research evaluating changes in bone mineral density (BMD) at the deltoid muscle origin after the RSA procedure. Methods: A retrospective analysis of a consecutive series of RSAs performed between May 2011 and May 2022 was conducted. Inclusion criteria comprised primary RSAs with both preoperative and last follow-up shoulder CT scans and a minimum follow-up of 12 months. Trabecular attenuation measured in Hounsfield units (HU) was calculated using a rapid region-of-interest (ROI) method. BMD analysis involved segmenting three ROIs in both pre- and postoperative CT scans of each patient: the acromion, clavicle, and spine of the scapula. Results: A total of 44 RSAs in 43 patients, comprising 29 women and 14 men, were included in this study. The mean follow-up duration was 49 ± 22.64 months. Significant differences were observed between preoperative and postoperative HU values in all analyzed regions. Specifically, BMD increased in the acromion and spine, while it decreased in the clavicle (p-values 0.0019, <0.0001, and 0.0088, respectively). Conclusions: The modifications in shoulder biomechanics and, consequently, deltoid tension post-implantation result in discernible variations in bone quality within the analyzed regions. This study underscores the importance of thorough preoperative patient planning. By utilizing CT images routinely obtained before reverse shoulder replacement surgery, patients at high risk for fractures of the acromion, clavicle, and scapular spine can be identified.

Background: In revision total knee arthroplasty (rTKA), clinical focus is mainly on the femoral and tibial components, while patellar complications are often underemphasized. However, patellar bone deficiency is a significant issue that can negatively affect surgical outcomes, especially in septic revisions. Objective: This review provides an overview of contemporary approaches to the evaluation and treatment of patellar bone loss in rTKA, emphasizing preoperative planning, classification frameworks, and treatment options. Methods: A narrative review of the literature was conducted. Studies published between 2000 and 2024 addressing preoperative assessment, surgical techniques, and outcomes in the management of patellar bone loss in rTKA were screened. Discussion: A recent consensus has addressed the evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA), providing specific recommendations for the management of patellar bone loss and extensor mechanism involvement in cases of severe bone deficiency. In this review, the principal surgical strategies described in the literature are summarized, including patellar component retention or revision, the use of biconvex inlay and trabecular metal implants, bone grafting, various augmentation techniques, resection arthroplasty, gull-wing osteotomy, and patellectomy. Conclusions: Despite various surgical strategies, no consensus exists on a universally superior approach. Ongoing research is essential to establishing standardized, evidence-based protocols for effective management of patellar bone loss in rTKA.