Background: The severity of fatty infiltration (FI) predicts the treatment outcome of rotator cuff tears. The purpose of this investigation was to quantitatively analyze supraspinatus (SSP) muscle FI and volume at the initial presentation and after a 3-month minimum of conservative management. We hypothesized that progression of FI could be predicted with initial tear size, FI, and muscle volume. Methods: Seventy-nine shoulders with rotator cuff tears were prospectively enrolled, and 2 magnetic resonance imaging (MRI) scans with 6-point Dixon sequences were acquired. The fat fraction within the SSP muscle was measured on 3 sagittal slices, and the arithmetic mean was calculated (FI^SSP). Advanced FI^SSP was defined as ≥8%, pathological FI^SSP was defined as ≥13.5%, and relevant progression was defined as a ≥4.5% increase in FI^SSP. Furthermore, muscle volume, tear location, size, and Goutallier grade were evaluated. Results: Fifty-seven shoulders (72.2%) had normal FI^SSP, 13 (16.5%) had advanced FI^SSP, and 9 (11.4%) had pathological FI^SSP at the initial MRI scan. Eleven shoulders (13.9%) showed a ≥4.5% increase in FI^SSP at 19.5 ± 14.7 months, and 17 shoulders (21.5%) showed a ≥5-mm³ loss of volume at 17.8 ± 15.3 months. Five tears (7.1%) with initially normal or advanced FI^SSP turned pathological. These tears, compared with tears that were not pathological, had significantly higher initial mediolateral tear size (24.8 compared with 14.3 mm; p = 0.05), less volume (23.5 compared with 34.2 mm³; p = 0.024), more FI^SSP (9.6% compared with 5.6%; p = 0.026), and increased progression of FI^SSP (8.6% compared with 0.5%; p < 0.001). An initial mediolateral tear size of ≥20 mm yielded a relevant FI^SSP progression rate of 81.8% (odds ratio [OR], 19.0; p < 0.001). Progression rates of 72.7% were found for both initial FI^SSP of ≥9.9% (OR, 17.5; p < 0.001) and an initial anteroposterior tear size of ≥17 mm (OR, 8.0; p = 0.003). Combining these parameters in a logistic regression analysis led to an area under the receiver operating characteristic curve (AUC) of 0.913. The correlation between FI^SSP progression and the time between MRI scans was weak positive (ρ = 0.31). Conclusions: Three risk factors for relevant FI progression, quantifiable on the initial MRI, were identified: ≥20-mm mediolateral tear size, ≥9.9% FI^SSP, and ≥17-mm anteroposterior tear size. These thresholds were associated with a higher risk of tear progression: 19 times higher for ≥20-mm mediolateral tear size, 17.5 times higher for ≥9.9% FI^SSP, and 8 times higher for ≥17-mm anteroposterior tear size. The presence of all 3 yielded a 91% chance of ≥4.5% progression of FI^SSP within a mean of 19.5 months. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Previous studies have found varied outcomes for elderly patients following reverse total shoulder arthroplasty (rTSA). Results for very old patients are rare. The purpose of this study was to analyze functional and radiographic outcomes after rTSA in patients aged 85 years and older and to compare them to a younger population. Of 1460 patients treated with rTSA from 2005 to 2020, 5% (n = 74) were ≥85 years. 32 patients were excluded due to travel difficulties, death, refuse to participate and lost to follow-up. 42 patients with a minimum follow-up of 2 years were included and matched for sex, body mass index, American Society of Anesthesiologists Score, surgical indication, smoking, alcohol consume, and follow-up time to a younger population with a mean age of 69.5 ± 9 years. Statistical analysis was performed based on preoperative and postoperative range of motion (ROM), pain scores and patient satisfaction. Postoperative X-rays were evaluated for notching, radiolucency, bone formation and resorption, implant migration and periprosthetic fractures. 42 cases with a mean age of 87 ± 2 years were included, 71% female. Indications for rTSA were rotator cuff (RC) tear with arthritis (36%), RC arthropathy (17%), RC tear without arthritis (17%), primary arthritis (17%), proximal humeral fracture (10%), failed osteosynthesis (7%), and instability (2%). Mean follow-up was 47 ± 22 months. Except for age, there were no significant differences in the matching cohort. In the elderly cohort, relative Constant-Murley Score (CMS) improved postoperative significantly from 41 ± 20 to 83 ± 11 and subjective shoulder value from 38 ± 20 to 80 ± 19. All aspects of ROM, except for external rotation, improved significantly. Abduction force and pain improved as well. Radiolucency around the glenoid (21%), bone formation (4.9%) and implant migration (4.9%) were significantly associated with poorer outcome in the absolute CMS (P = .013, P = .002 and P = .008). One patient (1/42, 2.4%) suffered multiple shoulder dislocations and needed a revision. No other reoperations were performed. Comparison between patients over 85 years and the younger matched control group showed no significant differences in relative CMS, subjective shoulder value, and ROM at final follow-up. Patients aged 85 years and older can expect significant improvement in shoulder function and significant reduction of pain after rTSA. Overall clinical outcome is comparable to a younger population. Complication and revision rates are low. Age should not be a limiting factor when considering rTSA.

Diagnosing simple valgus instability of the elbow currently involves time and cost-intensive imaging modalities such as MRI or MRA. Previous studies have demonstrated that stress radiography represents an alternative diagnostic tool for such conditions. The aim of this study was to investigate if standardized valgus stress radiography can identify soft-tissue lesions of the medial elbow. A telos stress device (telos GAIII/E; telos Arzt- und Krankenhausbedarf GmbH; Woelfersheim-Bernstadt; Germany) was used to apply 50 N of valgus stress to six cadaveric elbows during static radiographic imaging. Forearm flexor and extensor tendons were loaded with 25 N and 20 N respectively. Ulnohumeral joint spaces [mm] were measured with the joint in the intact state (M1), after transection of the medial collateral ligament (M2) and after release of the common flexor tendon (M3). Imaging was repeated in 0°, 30° and 60° flexion with the forearm in neutral rotation, supination and pronation in each position. Mean joint gapping was increased in all groups representing ligament- and/or tendon-deficient joint conditions compared to the intact (stressed) state (group M1). The absolute difference in ulnohumeral joint gapping after common flexor tendon transection compared to the uninjured state was statistically significant (p<0.05) in all positions but not in 30° flexion and supination. Medial joint laxity was greater in 60° than 0° or 30° flexion. Joint spaces were greater in pronation and neutral rotation compared to supination. Telos stress radiographic imaging can be used to detect large ligamentous injuries at the medial elbow. Dynamic joint stabilization might affect the detection of MCL injuries. Stress radiographic imaging at the elbow should involve examination of the joint at flexion angles of 60°.

Background: Lipoprotein(a) [Lp(a)] has emerged as a key mediator of calcific aortic valve disease and is strongly linked to the development and progression of aortic stenosis (AS). Whether elevated Lp(a) influences disease severity, long-term prognosis, or both in patients undergoing transcatheter aortic valve implantation (TAVI) remains uncertain. Methods: This multicenter study included 213 patients with severe symptomatic AS undergoing TAVI between 2016 and 2018. Pre-procedural Lp(a) concentrations were measured using a standardized immunoturbidimetric assay. Associations with long-term all-cause mortality were evaluated using Kaplan–Meier analyses and Cox proportional hazards models. The relationship between Lp(a) and AS severity was assessed using correlation analyses, multivariable linear regression models, and restricted cubic spline analyses. Anatomical and hemodynamic measures included aortic valve calcium score (AVCS), peak aortic jet velocity (AV Vmax), and transvalvular pressure gradients. Results: During a median follow-up of 7.58 years (IQR 4.33–8.66 years), Lp(a) was not associated with all-cause mortality, irrespective of whether it was analyzed as a continuous variable, according to established clinical thresholds, or across quartiles. In contrast, higher Lp(a) concentrations were associated with greater valvular calcification and more severe hemodynamic obstruction. These associations remained significant after adjustment for age, sex, diabetes mellitus, and renal function. Restricted cubic spline analyses suggested predominantly linear associations without evidence of significant non-linearity. Conclusions: Elevated Lp(a) concentrations were associated with greater anatomical and hemodynamic severity of AS but not with long-term mortality after TAVI. These findings suggest that elevated Lp(a) is associated with greater anatomical and hemodynamic severity of calcific aortic valve disease but was not linked to long-term mortality after TAVI.

Nonbiodegradable metal screws used for fixation in the Latarjet procedure can cause complications, including irritation from prominent hardware and the need for revision surgery. Magnesium-based, bioabsorbable screws may address these concerns. This study compared the biomechanical performance of magnesium screws to titanium screws with the hypothesis that there is no statistically significant difference between both groups. Fourteen fresh-frozen cadaveric shoulders were matched by age and sex. Seven shoulders underwent a standard Latarjet procedure using two 5 mm cannulated partially threaded magnesium screws (average age 70.6 ± 9.4 years). The other 7 were fixed with two 4.5 mm cannulated partially threaded titanium screws (average age 71.4 ± 14). All shoulders underwent biomechanical testing with direct pressure on the graft: cyclic loading (100 cycles 10 N- 100 N) was performed to assess displacement, stiffness and load-to-failure. Those were measured using force-displacement data obtained through a mechanical testing system. Maximum cyclic displacement was 1.2 ± 0.6 mm for magnesium and 1.4 ± 1.1 mm for titanium screws (P = .643). Cyclical stiffness was 329 ± 147 N/mm (magnesium) vs. 402 ± 220 N/mm (titanium, P = .489). Construct stiffness was 327 ± 141 N/mm vs. 408 ± 207 N/mm (P = .425), and ultimate load to failure was 414 ± 128 N vs. 475 ± 271 N (P = .605). Bone block failure with screw bending was the most common failure mode in both groups. No statistically significant differences in biomechanical performance were found between magnesium and titanium screws in this time-zero biomechanical study. Magnesium screws may offer a viable bioabsorbable alternative that reduces complications from permanent hardware.