A large rotator cuff tear is when a tendon in the rotator cuff muscle group breaks or falls offaround the shoulder joint. At least one of the tendons is involved. Common large rotator cufftears involve tendons in the rotator cuff muscle group， including supraspinatus， infraspinatus， teres minor， and subscapularis tendons. Large rotator cufftear has a great impact on patients'daily life. It weakens the stability of the shoulder joint， which increases the risk of shoulder dislocation. In recent years， the arthroscopic repair technique in the treatment of rotator cufftears has received more and more attention from doctors and patients. Among them，the arthroscopic modified load-sharing rip-stop technique （mLSRS） and the double-row suture bridge technique are two commonly used methods for the treatment of large rotator cufftears. mLSRS technology is a repair method that combines arthroscopy and traditional surgery. Through arthroscopic joint surface preparation， the torn edge of the rotator cuffcan be cleaned up， which can reduce surgical trauma and postoperative pain and help promote the early functional recovery of the shoulder joint. The double-row suture bridge technique crosses the suture lines in the tendons on both sides of the rotator cufftear to form a stable structure similar to a "bridge"， thus achieving the repair of the rotator cufftear. The advantage of this technique is that it can provide a more stable repair and reduce the risk of retearing after surgery. However， the efficacy of the two kinds of surgery is still controversial in the academic circle， and the research reports on the treatment mechanism of the two kinds of surgery are rarely studied.
Objective
To investigate the effect of modified barrier line tension （mLSRS） and double-row suture bridge under arthroscopy in treating large rotator cuff tears and to analyze its prognosis.
Methods
A total of 84 patients with large rotator cuff tears diagnosed and treated in our hospital from January 2019 to December 2021. According to the different treatment methods， 41 cases were divided into the mLSRS group， and the double-row suture bridge group （43 cases）. The mLSRS group was treated with the arthroscopic mLSRS technique， while the double-row suture bridge group was treated with the double-row suture bridge technique. The VAS score， Constant Murley score， UCLA score， ASES score， shoulder range of motion， prognosis， and complications were compared between the two groups before and 1 year after surgery.
Results
One year after surgery， the VAS scores in both groups were decreased compared with those before surgery （P＜0.05）， and the Constant-Murley score， UCLA score， and ASES score in both groups were increased compared with those before surgery （P＜0.05）. However， the VAS score， Constant-Murley score， UCLA score， and ASES score in the mLSRS group were compared with those in the double-row suture bridge group， and there was no statistical significance （P＞0.05）. One year after surgery， the lateral pronation decreased in both groups compared with that before surgery （P＜0.05）. The anterior flexion， abduction，and lateral pronation increased in both groups than before surgery （P＜0.05）. Still， there was no statistical significance in the ranges of anterior flexion， abduction， lateral pronation， and lateral pronation in the mLSRS group compared with those in the double-row suture bridge group （P＞0.05）.The healing rate in the mLSRS group was 95.12%， which was significantly higher than that in the double-row suture bridge group （79.07%）（P＜0.05）. The retear rate in the mLSRS group was 4.88%， which was significantly lower than that in the double-row suture bridge group （20.93%） （P＜0.05）. The incidence of complications in the mLSRS group was 9.76%， which was not statistically significant compared with 6.98% in the double-row suture bridge group （P＞0.05）.
Conclusion
The arthroscopic mLSRS and double-row suture bridge techniques in treating large rotator cufftears can effectively relieve pain and improve shoulder function and motion with high safety. However， the arthroscopic mLSRS technique can improve the healing rate of the rotator cuffmore effectively， reduce the retear rate， and improve the prognosis.
The prevalence rate of rotator cuff disease ranges from 0.5% to 7.4%，accounting for 85% of patients with shoulder joint pain， including rotator cuff tendon tear， tendinitis， calcific tendinitis， and subacromial bursitis. Some studies have pointed out that the overall incidence of rotator cufftendon tears is about 5% to 40%， and total tear is 5% to 17%， especially for older people over 60. This proportion is higher. The rotator cufftear's etiology can be divided into chronic degenerative， acute traumatic， and mixed tears.With the extension of population life expectancy， the proportion of patients with degenerative rotator cufftears is increasing， which brings a specific economic burden to families and society. Currently， the treatment of rotator cufftears is mainly conservative and surgical， but there is no consistent recommendation on the two methods. The literature has reported that the short-term effect of surgical treatment is better than that of conservative treatment.However， the difference in this effect becomes smaller over time， which still needs to be proved by many clinical data.
Objective
There is still controversy about the treatment of degenerative rotator cufftears. This article compares the clinical effect of conservative and surgical treatment of medium—and small-sized degenerative rotator cufftears.
Methods
Our unit treated one hundred thirty-seven patients with medium and small-sized degenerative rotator cuff tears from January 2022 to December 2022 were selected. The rotator cuff tear was divided into small tears （＜ 1 cm） and medium tears （1-3 cm） based on the size of the rotator cufftear， and then divided into a conservative treatment group and operation group （shoulder arthroscopy was used for surgery）according to the treatment methods. The visual analog scale（VAS） pain score， shoulder flexion， and abduction motion were used for the treatment effect. The Constant-Murley score （CMS） and UCLA shoulder score were added before treatment and at the last follow-up. All patients were followed up at 1， 3， 6， and 12 months after treatment.
Results
Patients with minor rotator cuff tears had significant differences in VAS pain score and shoulder flexion and abduction motion between the two groups at 1-month follow-up after treatment， with statistical significance （P＜0.001） and no statistical significance （P＞0.05） at 3 months， 6 months and 12 months follow-up.Patients with medium rotator cufftear had significant differences in VAS scores and shoulder flexion and abduction motion between the two groups at 1 month and 3 months after treatment， with statistical significance （P＜0.001）.In the medium- and long-term follow-up after treatment， the difference between the two groups was statistically significant only in VAS pain scores （P＜0.001）. At the last follow-up， the CMS score and UCLA score of the two kinds of tears were significantly different than those before treatment （P＜0.001）， but the difference between them was not significant （P＞0.05）.
Conclusion
Conservative and surgical treatment for mid- and small-sized degenerative rotator cufftears has proven clinical efficacy. Compared with the short-term postoperative curative effect， the effect of surgical treatment was significantly better than that of conservative treatment， and the mediumand long-term curative effect was not significantly different between the two treatment schemes.
Rotator cuff tear （RCT） is a common shoulder disease that causes shoulder pain and mobility impairment. The long head of the biceps tendon （LHBT） is an essential part of the shoulder joint， which is involved in the activities of the shoulder and elbow joint， limiting the humeral head movement and stabilizing the shoulder joint. The tendon lesions may cause pain and functional decline of the shoulder joint. Neer et al. reported that 95% of the injuries of the biceps long tendon developed from the rotator cuffinjury. Lu Yi et al. proposed that the rotator cufftear size was a significant risk factor for rotator cufftendon disease. Candela et al. pointed out in a retrospective study that the more serious the rotator cuffinjury， the more serious the rotator cuffinjury was. The higher the injury probability of long head tendon of biceps combined. Chen et al. divided rotator cuffinjury combined with long head biceps tendinopathy into six types and proposed treatment suggestions for different injuries. Currently， the injury of the biceps long head tendon is widely regarded as one of the common causes of shoulder joint pain， so some scholars advocate biceps long tendon amputation in rotator cuffrepair surgery. However， recent literature has pointed out that there is no significant difference in the postoperative pain and function of patients with rotator cuffinjury after amputation， retention， or fixation of the biceps long head tendon. However， in the shoulder arthroscopic treatment of rotator cuff injury， there is no consensus on treating the affected biceps long head tendon.
Objective
To compare the effect of biceps long head tendon amputation and retention on the outcome of medium and small-sized degenerative rotator cuffrepair in middle-aged and elderly patients.
Methods
A total of 78 middle-aged and elderly patients （59.03±66.86） years who underwent rotator cuffrepair with complete follow-up data were retrospectively analyzed. According to the treatment of the long head tendon of the biceps， the tendon amputation group was divided into a tendon amputation group （n=41） and a simple cleaning group （n=37）. According to the injuries of the long head tendon of the biceps during the operation，the tendon amputation group was divided into hyperemia edema-amputation group A （n=21） and partial tearamputation group B （n=20）. The simple cleaning group was split into hyperemia edema-retention group C（n=19） and partial tear-retention group D（n=18）. The incidence of postoperative complications， visual analogue scale （VAS） scores， ASES scores， Constant-Murley scores， UCLA scores and shoulder-humeral distance （AHD） before surgery and 1 year after surgery were collected before surgery， 6 weeks after surgery， 3 months after surgery， 6 months after surgery and 12 months after surgery.
Resutls
None of the 78 patients had adverse complications such as Popeye sign deformity and biceps spasm pain. The repaired rotator cufftissue had healed in all patients at the last follow-up. VAS scores in the last follow-up were significantly improved compared with those before surgery， and VAS scores in the resection group were significantly better than those in the clean-up group at 6 weeks after surgery， with statistical significance （P＜0.05）. The VAS score of the 6-week postoperative follow-up in the hyperemia and edema group was significantly better than that in the hyperemia and edema group， the difference was statistically significant （P＜0.05）. There was no significant difference between the other groups （P＞0.05）. The ASES scores， Constant-Murley scores and UCLA scores of the two groups at 3， 6 and 12 months after surgery were significantly improved compared with those before surgery， and there was no statistical significance between the groups （P＞0.05）. There was no significant difference in the scapulohumeral distance between the two groups before and after surgery（P＞0.05）.
Conclusion
For middle-aged and elderly patients with medium and small-sized degenerative rotator cuffinjuries， whether the biceps long head tendon is severed during rotator cuffrepair does not affect the ultimate shoulder pain and function.
Proximal humerus fractures are common， accounting for about 4%of total fractures. However， proximal humerus fractures combined with humeral head dislocations are uncommon， especially those with posterior dislocations of the humeral head， accounting for about 0.9%of shoulder fractures and dislocations. The causes of dislocations after proximal humeral fractures mainly include fall injury， traffic injury， electric shock injury， etc. The surgical effect of proximal humeral fracture combined with the posterior dislocation of the humeral head is rarely reported in the literature， and the choice of surgical approach and surgical method is still controversial.
Objective
To retrospectively analyze the cases of proximal humeral fracture combined with the posterior dislocation of the humeral head treated through the single anterior approach， explore the clinical results， and summarize the surgical treatment experience.
Methods
A retrospective analysis was performed on 26 patients （29 shoulders）with proximal humeral fractures combined with the posterior dislocations of the humeral head treated by open reduction and internal fixation via the single anterior approach between January 2013 and December 2023. Information such as gender， age， cause of injury， type of injury， time from injury to operation， amount of operative blood loss， fracture morphology， and other information were collected. Postoperative followups included shoulder joint X-ray film， shoulder joint function UCLA score， Constant score， pain VAS score，and incidence of complications.
Results
Twenty-three patients （26 shoulders） were followed up for an average of 43.1±11.0 （11-72） months. Twenty-six shoulder fractures and dislocations were all well reduced，and no further dislocation was reported. All fractures were clinically healed with a mean healing time of 12.4±3.2 （8-16） weeks. The Constant score， UCLA score， VAS score， and ranges of shoulder flexion，abduction， and rotation were significantly improved in the 1st month after surgery and the last followup. Compared with the fresh injury group， the ranges of flexion and abduction in the aged damage were worse after the operation， and there were statistical differences between the two groups. There was no significant difference in postoperative evaluation results of sex， age， and fracture types. There were 2 cases of humeral head necrosis， and no complications such as postoperative infection， failure of internal fixation， and iatrogenic nerve or vascular injury.
Conclusion
Open reduction and internal fixation through the single anterior approach can achieve better clinical results in treating proximal humeral fracture combined with the posterior dislocation of the humeral head. The aged-damage cases have worse shoulder flexion and abduction function than the fresh cases. Surgery should be performed as soon as possible to avoid the missed diagnosis. During the operation， the diseased part should be fully exposed to ensure the reduction and fixation of the joint and fracture under direct vision， and the blood flow of the humeral head should be protected to improve the therapeutic effect.
Shoulder pain is the third most common musculoskeletal disorder， and the most common diagnosis is subacromial pain syndrome （SAPS）， also known as “shoulder impingement syndrome （SIS）.” A decrease acromiohumeral distance （AHD） resulting in subacromial structure impingement below the acromion is generally considered a significant cause of SAPS. Both surgical and nonsurgical treatments were designed to increase AHD in patients with SAPS. However， previous studies have produced conflicting results regarding the link between AHD and symptoms. In addition， there is no consensus on the mechanism of SAPS. Whether preoperative AHD is reduced in patients undergoing shoulder surgery compared to nonsurgical patients has not been thoroughly studied.
Objective
To reevaluate the role of AHD in diagnosis and treatment decision-making in patients with SAPS by comparing the differences in AHD and Constant-Murley shoulder function score （CMS） and rotator cufftear （RCT）between surgical and nonsurgical patients.
Methods
A retrospective case-control study included patients in our hospital from 2019 to 2023， divided into surgical treatment group （n=93） and nonsurgical treatment groups （n=116）. The AHD， CMS， and RCT tear degree data were measured and statistically analyzed. The two groups were comparable in age， sex， and location of shoulder pain.
Results
The difference in AHD in the operation group was smaller than that in the non-operation group， but the difference was not statistically significant （P＞0.05）. CMS in the surgical group was significantly lower than in the nonsurgical group（P＜0.001）. The degree of RCT tear in the surgical group was significantly higher than in the nonsurgical group （P＜0.001）. The Pearson correlation analysis between AHD and CMS showed weak or no correlation（P＞0.05）. Spearman correlation analysis showed a significant correlation between CMS and RCT tear degree （P＜0.001）. There was no significant difference in the degree of tear between AHD and RCT（P=0.797）.
Conclusion
Our findings suggest that there is no statistical difference in preoperative AHD between non-operative and operative SAPS patients and that there is no linear relationship between AHD and shoulder function and rotator cufftear in adult SAPS patients， which does not support the theory of reduced subacromial space as an etiological mechanism of SAPS. Surgical or nonsurgical treatment of RCT patients should focus on shoulder function and the extent of rotator cufftear， with minimal potential value for AHD reduction in the subacromial space.
Acromioclavicular dislocation is a common shoulder injury in orthopedics.The surgical treatment of acromioclavicular dislocation is varied and controversial. In past clinical practice，rigid fixation schemes， such as clavicular hook plate surgery， were mainly used， but with the deepening of people's understanding of acromioclavicular joints， elastic fixation schemes have gradually been recognized by people. A double-Endobutton plate in an elastic fixation scheme has become the primary surgical method for treating acromioclavicular dislocation. However， some scholars believe that double-Endobutton plate surgery only focuses on the reconstruction of the coracoclavicular ligament， ignoring the repair of the acromioclavicular ligament， resulting in an increase in the incidence of postoperative complications such as shoulder instability. Therefore， exploring the excellent clinical effect of different surgical methods in treating acromioclavicular dislocation has become one of the current research hotspots.
Objective
To evaluate the efficacy of different methods in treating acromioclavicular dislocation and to discuss the necessity of repairing the acromioclavicular ligament in treating acromioclavicular dislocation with the double-Endobutton plate.
Methods
PubMed， Embase， Cochrane Library， CNKI， WF， VIP， and Sinomed were searched for published Chinese and English literature at home and abroad， and the literature was screened according to inclusion and exclusion criteria. The retrieval period was from May 15， 2024. The mesh metaanalysis was performed using RevMan 5.3 and Stata 16 software.
Results
A total of 24 pieces of literature were included， including 11 randomized controlled trials and 13 case-control studies involving 1 496 patients. The results of mesh meta-analysis showed that compared with CHP， both double-Endobutton and double-Endobutton combined with acromioclavicular ligament repair could reduce the incidence of postoperative complications， enhance postoperative shoulder joint function， and improve postoperative pain， and the differences were statistically significant. The cumulative probability ranking results showed that：operation time：CHP ＞ double-Endobutton ＞ double-Endobutton combined with acromioclavicular ligament repair； Intraoperative blood loss：double-Endobutton ＞ CHP ＞ double-Endobutton combined with acromioclavicular ligament repair； Postoperative complication rate， CM score， and Karlsson score were as follows：double Endobutton combined with acromioclavicular ligament repair ＞ double Endobutton ＞CHP； VAS score：double-Endobutton ＞ double-Endobutton combined acromioclavicular ligament repair ＞CHP.
Conclusion
Overall， double-Endobutton alone and its combination with acromioclavicular ligament repair are superior to CHP surgery in reducing postoperative complication rates， improving postoperative shoulder joint function， and alleviating postoperative pain. The reduction in postoperative complication rates is even more significant when using double-Endobutton in combination with ACJL repairs than when using it alone. Other outcome indicators show similar effects between these two procedures. However， more highquality， large-sample， and multi-center randomized controlled trials are still needed to confirm further the effectiveness of double-Endobutton in combination with ACJL repairs.
The glenohumeral joint is the most flexible joint with the most extensive range of motion in the human body， capable of completing internal rotation， external rotation， abduction and adduction， etc. However， its anatomical structure also leads to poor stability， increasing the risk of joint instability and dislocation. The stability of the shoulder joint is maintained by static structures such as the glenoid， glenoid lip， and ligaments， as well as dynamic stable structures such as the supraspinatus，infraspinatus， and subscapular muscles. Disruption of static or dynamic stability can cause the humerus head to move beyond its normal range relative to the glenoid， resulting in symptoms of joint instability， such as shoulder pain and weakness. The incidence of shoulder joint instability is the highest among all human joints，of which the anterior instability accounts for more than 95%. Epidemiological studies have shown that the incidence of anterior shoulder instability （ASI） in the general population is about 0.08‰， and the incidence in young high-risk men can be as high as 3%. Shoulder instability can lead to chronic pain， impaired mobility，and glenohumeral arthritis， so restoring joint stability is critical. When shoulder joint anterior dislocation occurs， it often leads to anterior and inferior glenoid labial tear （Bankart injury）， which may be accompanied by glenoid bone loss （GBL）， thus increasing the risk of recurrent dislocation and the difficulty of surgical treatment. Bankart prosthetics are widely used in the treatment of ASI， but long-term clinical follow-up has shown a high recurrence rate， especially in patients with GBL and Hill-Sachs lesions. Therefore， Latarjet，free bone block （FBB）transplantation ， and other procedures have gradually been widely used in the clinic.These surgical methods have different advantages and disadvantages， so comparing their clinical efficacy in treating ASI with GBL is necessary. Although previous studies used mesh meta-analysis to compare various surgical procedures for ASI， patients with GBL could not be compared due to limited research literature.
Objective
To compare the clinical efficacy and safety of various surgical approaches for treating ASI with GBL to provide valuable insights for clinical practice.
Methods
Randomized controlled trials， case-control studies， and cohort studies related to ASI surgery were searched in PubMed， Scopus，Embase， Cochrane Library， and Web of Science databases. The literature was screened according to inclusion criteria and exclusion criteria and finally included arthroscopic Bankart repair （AB）， Arthroscopic Latarjet AL， open Latarjet OL， AB combined with Remplissage and FBB transplantation were used in 5 surgical procedures. Frequency school mesh meta-analysis was performed using Stata 17.0 software to compare the clinical efficacy of different surgical methods for ASI with GBL.
Results
Twenty-two clinical studies （including 2 073 patients） were included for systematic review and mesh meta-analysis. Regarding recurrence rate， the AL group （OR=0.24， 95% CI：0.08-0.71） and OL group （OR=0.30， 95% CI：0.16-0.59）had significantly lower recurrence rates than the AB group. The recurrence rate in the OL group （OR=0.22，95% CI：0.08-0.63） was also significantly lower than that in the AB group for ≥15% GBL. Regarding the reoperation rate， the AL group （OR=0.13， 95% CI：0.02-0.92） and the OL group （OR=0.16， 95% CI：0.04-0.63） had significantly lower reoperation rates than the AB group. Regarding Rowe's score， surgical treatment of ≥15% GBL had a significantly higher Rowe score in the FBB group compared with the AB， OL， and AL groups. Regarding complications， the FBB group （OR=4.31， 95% CI：1.19-15.58） had a significantly higher complication rate than the ABR group. The overall consistency and publication bias tests showed that the results were stable.
Conclusion
AL and OL are both effective surgical treatment options for ASI with GBL， but OL has a lower recurrence rate and reoperation rate when ≥15% GBL. FBB for ASI with GBL had the best joint function score and complication rate.
