Management of anterior shoulder instability in patients aged 40 or above: a systematic review

Management of anterior shoulder instability in patients aged 40 and older: a systematic review

Outcomes of primary reverse total shoulder arthroplasty in patients younger than 65 years: A systematic review.

Background Reverse total shoulder arthroplasty (RTSA) is increasingly performed in younger patients, yet prior studies frequently include heterogeneous cohorts and revision cases. This systematic review evaluated outcomes of primary RTSA in patients <65 years. Methods Embase, PubMed, and CENTRAL were queried through October 2025. Methodological quality was assessed using the Newcastle-Ottawa Scale (level III) and NIH Quality Assessment Tool for Case Series (level IV). Random-effects meta-analysis generated pooled estimates for range-of-motion (ROM), patient-reported outcome measures (PROMs), and complication/revision rates. Results Thirteen studies (nine level III, four level IV; fair-to-good quality) were included. Weighted mean age was 55.4 years (60.9% female; follow-up 2-7.8 years). Forward flexion = 133.2° (95% CI 126-140.4); external rotation = 38.1° (95% CI 32-44.2); abduction = 118.2° (95% CI 111.2-125.2); internal rotation = 3.7 (95% CI 2.7-4.7, 0-7 scale). ASES = 69.5 (95% CI 64.7-74.4); VAS = 2.6 (95% CI 1.3-3.9); Constant-Murley = 62.9 (95% CI 60.3-65.5); SST = 7.5 (95% CI 5.9-9.1); SPADI = 38 (95% CI 33.3-42.7); UCLA = 27.9 (95% CI 26.9-28.8). Complication rate was 13% (95% CI 6%-23%) and revision rate 8% (95% CI 5%-14%), most commonly for instability. Sensitivity analyses demonstrated significant pre-to-postoperative improvements in forward flexion (+46.6°; 95% CI 34.9-58.3) and external rotation (+16.6°; 95% CI 13.6-19.5). Discussion Primary RTSA in patients <65 years improves ROM and PROMs. Although complication/revision risk increases over time, these findings support RTSA in appropriately selected younger patients and provide benchmarks for outcome counseling.

DO ALL FIRST-TIME TRAUMATIC ANTERIOR SHOULDER DISLOCATIONS REQUIRE SURGERY? A RETROSPECTIVE COHORT STUDY

The optimal management following first time traumatic anterior shoulder dislocation in young adults remains uncertain. This study is to evaluate whether surgical intervention should be considered following first time traumatic anterior shoulder dislocation, with focus on patients aged 25 years or younger. We retrospectively reviewed all patients presenting with a first-time shoulder dislocation to our unit between January 2022 and December 2023. Data were collected from clinical and radiological records. Patients were stratified into three age groups ≤25, 25–40, and >40 years. The primary outcome was re-dislocation following non-operative management with two years follow up. Total of 140 patients were included (mean age 52 years, range 14–95), with 65% male and 34% female. Nerve injuries occurred in 16% of patients, predominantly affecting the axillary nerve, and resolved spontaneously. Only two cases (1.5%) required urgent open reduction. Nineteen patients (14%) required surgical intervention: Rotator cuff repair 7, open laterjet 4, arthroscopic stabilisation 3, ORIF greater tuberosity 4, ORIF glenoid 1. Re-dislocation rates within two years varied by age, with the highest rate observed in patients aged ≤25 years (7/30, 23%), compared with 20% in those aged 25–40 years and 7% in patients over 40 years. The observed re-dislocation rate of 23% was substantially lower than the commonly cited 70% for this young age group and was more consistent with finding from recent studies. Indirect comparison with recent literature suggests a number needed to treat of six to prevent one re dislocation in high-risk younger patients. This supports early surgical intervention, although its cost effectiveness remains uncertain.

Risk Factors for instability and dislocation after reverse total shoulder arthroplasty: a systematic review.

BACKGROUND The number of reverse total shoulder arthroplasties has increased due to demographic changes, leading to more revision surgeries. Postoperative instability or dislocation is a frequent and challenging complication that impairs clinical outcomes. This study aimed to identify risk factors for instability following reverse total shoulder arthroplasty and to evaluate the underlying mechanisms described by Abdelfattah et al. METHODS: A systematic literature review was conducted using PubMed and Google Scholar with MeSH terms and keywords including "shoulder replacement," "shoulder arthroplasty," "joint instability," "risk factors," and "odds ratio." The search was completed on February 21, 2025. Instability mechanisms were classified according to the Frankle classification by Abdelfattah et al.. A meta-analysis of odds ratios was performed for risk factors reported in multiple studies. RESULTS Ten retrospective studies (six cohort studies, four case series) were included. Eleven significant risk factors were identified: male sex, younger age, opioid use disorder, depressive disorder, revision surgery, nonunion, rotator cuff disease, prior postoperative subluxation, absence of subscapularis repair, cemented humeral stem, and a expanded/ lateralized glenosphere >9mm. Additional less conclusive factors included high body-mass index, malunion, hypertension, electrolyte disorders, prior ipsilateral shoulder surgery, acute fractures, and glenosphere-related factors (size, positioning, neck-shaft angle). The most common mechanism of instability was loss of compression, followed by impingement. CONCLUSION Both established and novel risk factors for instability were identified, including younger age, opioid use disorder, depressive disorder, nonunion, and lack of bony lateralization. Loss of compression was the predominant mechanism. These findings may improve preoperative risk assessment and support individualized surgical planning. However, due to the retrospective nature of the available evidence and potential confounding by indication, particularly for implant-related factors, these findings should be considered hypothesis-generating rather than causal. Future studies should link risk factors to instability mechanisms to enable targeted treatments and develop a validated risk score. LEVEL OF EVIDENCE Level IV, Systematic Review.

MEDIAL PATELLOFEMORAL LIGAMENT SURGERY IN THE PEDIATRIC POPULATION: A LITERATURE REVIEW ON THE CURRENT STATE OF THE ART

Early outcomes of reverse shoulder arthroplasty for degenerative shoulder conditions

Background: Reverse shoulder arthroplasty (RSA) is widely used for the treatment of degenerative shoulder conditions, particularly in the presence of rotator cuff deficiency. This study aimed to evaluate short-term clinical and functional outcomes following RSA.Methods: A prospective cohort study including 32 patients with cuff tear arthropathy or primary glenohumeral osteoarthritis was conducted. Patients were evaluated preoperatively and at a minimum of 12 months postoperatively using the Bulgarian versions of the Simple Shoulder Test (BSST) and the American Shoulder and Elbow Surgeons (BASES) score. Range of motion and complications were also assessed. Subgroup and correlation analyses were performed.Results: Significant improvements were observed in both BSST and BASES scores (mean increase 56.4 and 56.7 points, respectively; p < 0.001). Range of motion improved significantly in all planes, particularly in forward flexion and abduction (p < 0.01). The complication rate was 15.6%, including aseptic loosening, infection, and component dissociation. No significant differences were found across subgroups, and no correlations were identified between demographic factors and outcomes.Conclusion: RSA provides significant short-term improvements in pain, function, and shoulder mobility in patients with degenerative conditions, with consistent outcomes across patient subgroups. Further studies are required to evaluate long-term durability.