ABSTRACT Introduction: Rotator cuff tendinopathy is a common cause of shoulder pain and disability, and the optimal nonoperative strategy remains debated. Physiotherapy is the mainstay of initial management, whereas hyaluronic acid injection has been proposed as an alternative or adjunct; their comparative effectiveness is uncertain. Methods: An evidence-based systematic review was conducted in PubMed, Embase, Cochrane Library, and the Regional Portal of the Virtual Health Library (BVS) up to February 2026. Randomized controlled trials comparing hyaluronic acid injection with physiotherapy in adults with rotator cuff tendinopathy were included. Outcomes were pain, function, range of motion, and quality of life. Certainty of evidence was assessed with the GRADE approach. Results: Two randomized controlled trials (130 participants) met the eligibility criteria. Hyaluronic acid injection was associated with greater short-term improvement in pain, range of motion, and quality of life than physiotherapy, particularly within the first three months. Functional outcomes were inconsistent: one trial reported comparable improvement between groups, whereas the other favored hyaluronic acid. Certainty of evidence was very low because of small sample sizes, risk of bias, and imprecision. Conclusion: Very low-quality evidence suggests that hyaluronic acid injection may provide superior short-term benefits over physiotherapy for rotator cuff tendinopathy, mainly up to three months. The available evidence remains limited and at high risk of bias; further high-quality studies are required. Level of evidence II; Systematic review.
M. Fernandes, Leonardo Zanesco, J. Murachovsky et al.· Acta Ortopédica Brasileira· 0 citations
Introduction
Anatomic total shoulder arthroplasty (ATSA) has long been indicated for the treatment of degenerative joint diseases in patients with an intact rotator cuff. However, age-related rotator cuff degeneration may negatively impact outcomes. Reverse total shoulder arthroplasty (RTSA), initially indicated for cuff tear arthropathy, has progressively expanded its indications, including elderly patients with an intact rotator cuff.
Methods
A systematic review of the literature was conducted in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases up to November 2025, with the aim of comparing ATSA and RTSA regarding functional outcomes, complication rates, and the need for reoperation in patients aged 70 years or older with primary shoulder osteoarthritis and an intact rotator cuff.
Results
Only one systematic review met the inclusion criteria, encompassing four observational studies, with a total of 2.731 arthroplasties. RTSA showed a lower reoperation rate compared with ATSA. Functional outcomes favored ATSA, although based on limited data. No statistically significant differences were observed between the techniques regarding complication rates. The overall quality of evidence was classified as very low.
Conclusions
In patients aged 70 years or older with primary glenohumeral osteoarthritis and an intact rotator cuff, RTSA is associated with a lower revision rate, whereas ATSA demonstrates superior functional outcomes, with similar complication rates between the two techniques. Level of evidence II; Systematic review.
M. Fernandes, Leonardo Zanesco, J. Murachovsky et al.· Acta Ortopédica Brasileira· 0 citations
Abstract Background/Objective/Introduction Hip fractures in older patients are associated with substantial morbidity and in-hospital mortality. Despite the clinical importance of this condition, few tools specifically estimate in-hospital mortality or account for clinical deterioration during hospitalization, particularly in middle-income settings. This study aimed to develop a dynamic prognostic score to estimate the risk of in-hospital mortality among older patients undergoing surgical treatment for hip fractures. Materials and Methods A retrospective cohort study was conducted with 1,509 patients aged 60 years and older treated at a Brazilian trauma centre between 2013 and 2023. Demographic, clinical, orthopaedic, laboratory and in-hospital evolution variables were analysed. Independent predictors of mortality were identified using binary logistic regression. A prognostic score was constructed using weights derived from the magnitude of association (odds ratios) observed in the logistic regression. Model accuracy was assessed by the area under the ROC curve (AUC). Patients were stratified into four in-hospital death risk categories: low, moderate, high, and very high. Results The in-hospital mortality rate was 3.7%. Independent predictors included dementia, acute myocardial infarction, heart failure, and abnormalities in creatinine, potassium, and INR. In-hospital events including pulmonary thromboembolism, need for blood transfusion, and postoperative ICU admission were also strongly associated with death. The final score showed good discriminative performance with an AUC of 0.819. Predicted in-hospital mortality increased progressively across the risk groups, from 3%, among low-risk patients to > 20% among very-high-risk patients. Conclusions The In-Hospital Hip Fracture Mortality Score demonstrated good predictive ability for in-hospital mortality in older surgically treated patients with hip fractures. However, it should be considered a preliminary hospital-based tool, and external validation in independent cohorts is needed before routine clinical implementation
Erica Blenda da Silva, Fernanda Yuri Yuamoto, M. W. Perroud Junior et al.· Annals medicus· 0 citations
