The shoulder joint is the most flexible in the human body and has an extensive range of motion, so the human shoulder joint is easy to be injured. The stability of the shoulder joint is mainly maintained through the dynamic and static structures of the shoulder joint, and the maintenance of the two structures keeps the shoulder joint in a fixed position. Dynamic parts include the muscles and tendons around the shoulder joint, including the rotator cuff, allowing the shoulder joint to move in different directions. The static structure consists of the inherent anatomy of the shoulder joint, the surrounding ligaments, and the glenoid lip of the shoulder joint. The glenoid lip of the shoulder is a fibrocartilaginous tissue that surrounds the edge of the glenoid and helps stabilize the humeral head during displacement. Shoulder dislocation is common, primarily anterior dislocation, which often occurs in young people with a lot of exercise. High-energy trauma can cause the failure of the anterior static structure, and most of them are traumatic dislocations. Frequent dislocation will develop into recurrent dislocation, often leading to shoulder glenoid labial tear (Bankart injury) , the most common cause of recurrent shoulder dislocation. With the improvement of living standards and sports demand, the incidence of Bankart injury increases. If treatment is delayed or improper, the recurrence rate is high, so the treatment of Bankart has significant clinical value. Shoulder dislocation combined with glenoid defect and surgical method selection are challenging, and arthroscopic iliac bone grafting has a long learning curve and requires doctors with rich experience, so it is difficult to carry out in all sports medicine disciplines.

To investigate the diagnosis and treatment of shoulder Bankart injury and to study the technique and early clinical results of treating recurrent shoulder dislocation combined with glenoid defect using double loops autogenous bone grafting (Eden-Hybbinette procedure) under arthroscopy.

A literature review summarized the diagnosis and treatment of Bankart injury. Ten patients with anterior shoulder instability combined with severe glenoid defect underwent the Eden-Hybbinette procedure with arthroscopic navigation and double loop fixation between January 2021 and October 2022. All patients were followed up for at least 18 months after surgery. The improvement of shoulder joint function was evaluated by comparing patients' ASES scores and Rowe scores before surgery. A protractor measured the range of motion of the shoulder joint, and the three-dimensional model of the shoulder joint was reconstructed by Mimics software through postoperative CT data. The healing, position, and bone resorption of autogenous iliac bone grafts were evaluated.

All patients were followed up. Before surgery, 6 months after surgery, 12 months after surgery, and 18 months after surgery, ASES scores were 60.6, 82.2, 89.4, and 90.8, respectively. Rowe's scores were 35.5, 85.5, 87, and 90, respectively. From the beginning of 6 months to the last follow-up of 18 months, the ASES score and Rowe score were significantly improved, and the difference was statistically significant with a P<0.05. Postoperative CT showed that the bone mass was firmly fixed, and although there was some bone resorption, the bone mass, and glenoid had healed, the fracture line disappeared, and the overall shape of the bone mass was good. No clinical complications, such as unstable bone mass fixation and joint space narrowing, occurred in all patients, and the overall treatment effect was satisfactory.

The Eden-Hybbinette procedure with double loop fixation under arthroscopic guidance has good early clinical results in treating anterior shoulder instability combined with severe glenoid bone defect.

Since the mid-1980s, Professor Grammont's design and promotion of reverse shoulder arthroplasty (RSA) has initiated a new area in shoulder joint surgery. Following the FDA approval of RSA in the United States in 2003, its adoption has experienced explosive growth, and RSA has now become an indispensable option for treating various shoulder pathologies. Although initially developed for cuff tear arthropathy (CTA) due to the inability of conventional shoulder arthroplasty to effectively restore stability and function in such cases, its clinical success has expanded its applications to other shoulder conditions. These include massive rotator cuff tears (MRCT) , glenohumeral arthritis with intact rotator cuff, acute proximal humeral fractures, sequelae of proximal humeral fractures, proximal humeral tumors, inflammatory arthropathies, and revision surgeries following failed anatomic total shoulder arthroplasty or hemiarthroplasty. With the increasing utilization of RSA, complication rates have concurrently risen, reported to range between 15%-50%. However, given that RSA is frequently employed for clinically challenging conditions—many representing salvage procedures—the relatively high complication rates are not unexpected. Significant variations in reported complication rates exist across studies due to differing definitions of complications and prosthesis heterogeneity. Improvements in RSA concepts, designs, and surgical techniques have led to evolving complication profiles. For instance, early prosthesis designs were associated with higher rates of scapular notching, while contemporary designs have substantially reduced this complication. Consequently, modern prostheses and surgical techniques demonstrate significantly lower revision rates than earlier generations. Therefore, monitoring complication patterns and incidence remains crucial as RSA indications continue to expand and surgical techniques progress. Compared to international experience, RSA adoption in China began later, with limited complication-related research reported. Exceptionally constrained by single-center case volumes, there remains a paucity of domestic studies analyzing complications in cohorts exceeding 100 cases, highlighting the necessity for further investigation in this field.

To analyze and explore the occurrence of single-center reverse shoulder arthroplasty complications in China.

A review was conducted on 164 cases of RSA performed by a single surgeon in our hospital. The average age of the patients was (70.2±7.98) years (ranging from 24 to 85 years) , and the average follow-up period was 18.6 months (ranging from 1 to 96 months) . The incidence of surgery-related complications was evaluated.

There were a total of 25 cases of total complications, with an incidence rate of (15.2%) . Among them, there were 13 cases (7.9%) of significant complications, including 2 cases (1.2%) of glenoid fractures during the operation, 4 cases (2.4%) of proximal humeral fractures, 1 case (0.6%) of humeral shaft fractures, and 6 cases (3.6%) of prosthesis dislocation after the operation. Among them, 3 cases underwent revision surgery. It included 2 cases of secondary periprosthetic joint infection. Secondary complications included numbness in fingers or wrists in 8 cases (4.9%) after the operation, pain around the incision in 2 cases (1.2%) after the operation, and poor incision healing in 2 cases (1.2%) after the operation. Among the 13 major complications, nine occurred during the operations of the first 80 cases.

These results prove that the complications of reverse shoulder joint replacement surgery are controllable in domestic applications. The core of its successful implementation lies in the solid theoretical foundation of the shoulder joint, strict management of the learning curve, and precise control of technical details, providing an important evidence-based basis for the standardized development of this surgical method in China.

The stability of the acromioclavicular joint depends on a three-level anatomical defense system: Bony interlocking structure (the acromioclavicular joint surface forms a concave-convex matching shape) , static stability system (the four-dimensional tension network of the acromioclavicular ligament bears 82% of the initial anti-displacement load, and the coracoclavicular ligament complex provides vertical suspension function) , and dynamic stability system (the trape-deltoid muscle fascia generates dynamic compressive force Reaching 2.1 times the body weight during outreach. A pathological dislocation occurs when high-energy trauma interrupts ligament continuity (MRI shows that the Angle of conical ligament rupture is >25°) . There are significant differences in the stepwise treatment strategies based on the Rockwood classification: In types I-II, conservative treatment (dynamic brace fixation combined with biofeedback training) is adopted chiefly, while in cases of types IV-VI, surgical intervention is mainly required. For controversial type III dislocation, the failure rate of conservative treatment for manual workers reached 41.2%, prompting 56.3% of cases to choose early surgical intervention. Although the traditional clavicle hook plate technique can shorten the braking period through rigid fixation, it causes characteristic complications: unhooking, shoulder joint stiffness, intractable shoulder joint pain, acromial impact, subacromial osteolysis, etc. Persistent shoulder joint dysfunction (CMS<65) occurred in a few cases. In contrast, the single-incision double Endobutton loop plate technique achieved anatomical reconstruction. Its elastic fixation characteristic increased the CMS score to 84.7±1.8 three months after the operation (19.3% higher than the hook plate group, P=0.004) and reduced the incidence of complications such as acromial impact. However, the data of this group showed that the failure rate of the internal fixation device was 8%. A comparative study of 46 cases of Rockwood type III-IV (2020-2023) revealed the core contradiction: The Endobutton technique sacrifices the initial fixation strength while reducing mechanical complications. This discovery suggests that a new hybrid fixation system needs to be developed to enhance the fixation strength of the Endobutton.

This study conducted a retrospective cohort analysis to systematically compare the differences between the two surgical methods regarding surgical parameters, functional recovery, and complications.

This article aims to evaluate the clinical data of 46 patients with Rockwood type III and type IV acromioclavicular joint dislocation admitted to the Department of Orthopedics and Traumatology of Zibo Central Hospital from January 2020 to June 2023. We conducted a retrospective study on these patients. The same surgical team performed all surgeries. According to different surgical methods, 46 patients with acromioclavicular joint dislocation were divided into 23 cases in the single-incision double Endobutton loop plate internal fixation group, 12 in Rockwood type III, and 11 in Rockwood type IV. In the clavicle hook plate internal fixation group, there were 23 cases, including 13 of Rockwood type III and 10 of Rockwood type IV. The two groups' operation duration, incision length, and intraoperative blood loss were compared. The acromioclavicular distance (ACD) and coracoclavicular distance (CCD) before the operation, 1 month, 3 months, and 6 months after the operation distance, and the visual analogue scores (VAS) of the double-Endobutton plate internal fixation group and the clavicle hook plate internal fixation group at 1 month, 3 months and 6 months after the operation scale, VAS and Constant-murley functional score (CMS) were compared. The complications in the two groups were compared one year after the operation.

Both groups of surgeries were completed, and the follow-up time obtained was more than one year for both. The operation duration (49.00±3.84) min and incision length (45.29±8.16) mm in the double Endobutton loop plate internal fixation group were both shorter than those in the clavicle hook plate internal fixation group [ (67.63±5.14) min and (69.87±5.41) mm] , and the differences were comparable (P<0.05) . The intraoperative blood loss in the clavicle hook plate internal fixation group (81.65±5.05) ml was more than that in the double Endobutton loop plate internal fixation group (61.12±2.80) ml, and the difference was comparable (P<0.05) . At 1, 3, and 6 months after the operation, The VAS double Endobutton loop plate internal fixation groups [ (2.98±0.41) points, (2.37±0.29) points, (1.44±0.23) points] were all lower than those in the clavicle hook plate internal fixation groups [ (4.00±0.52) points, (2.80±0.42) points, (1.67±0.14) points] . The differences were comparable (P<0.05) . The Constant-Murley scores in the double Endobutton loop plate internal fixation group [ (73.43±1.83) points, (84.71±1.81) points, (88.24±1.58) points] were all higher than those in the clavicular hook plate internal fixation group [ (65.71±2.27) points, (79.30±1.99) points, (81.69±1.93) points There was a significant difference in , and the differences were comparable (P<0.05) . Different complications occurred in both the double Endobutton loop plate internal fixation group and the clavicle hook plate internal fixation group after the operation, with significant differences that were comparable (P<0.05) .

The dual Endobutton system achieves anatomical reconstruction through the dual mechanism of "suspension-tension band" and its dynamic fixation characteristics are more in line with the physiological kinematics of the acromioclavicular joint. Compared with the rigid fixation of the hook steel plate, the stress shielding effect is reduced. From the perspective of complications, the complications in the experimental group were mainly related to material properties (metal fatigue, interfacial frets) , while the complications in the control group were caused mainly by mechanical compression (acromial impingement syndrome) . Therefore, a type-oriented complication prevention system should be established. Due to the effect of the clavicle hook plate on local force application, we speculate that Endobutton should be given priority for patients with osteoporosis, and for those with high activity requirements, it is recommended to combine with enhanced suture techniques. The double Endobutton surgical method shows significant advantages in minimally invasive and functional recovery. Future research should focus on developing intelligent navigation systems to optimize the positioning accuracy of tunnels and improve the configuration design of steel plates through finite element analysis.

Rotator cuff injury (RCI) can lead to severe chronic shoulder joint pain. The prevalence of RCI in the general population is approximately 20%, with an incidence rate ranging from 10% to 50%, affecting millions worldwide. Patients with RCI often have sleep disorders and anxiety simultaneously. Currently, the etiology of RCI remains unclear, and a promising treatment strategy is crucial for patients with RCI. Many studies have shown that shoulder arthroscopic surgery is ideal for treating RCI. Arthroscopic surgery has the advantages of being minimally invasive, safe, and precise. With the continuous development of equipment and surgical techniques, arthroscopy has become the primary treatment method for many shoulder joint diseases. Compared with open surgery, arthroscopic surgery can adopt smaller surgical incisions, reduce surgical injuries, improve intra-articular visualization, have more precise surgical operations, and achieve faster postoperative recovery. Therefore, the use of arthroscopy for the treatment of shoulder joint diseases is gradually gaining favor among surgeons and patients. Arthroscopic surgery applies to various shoulder joint surgeries, including rotator cuff tears, shoulder joint instability, and shoulder joint stiffness. Although arthroscopic surgery causes less trauma, the postoperative pain is still very severe, which will aggravate complications such as anxiety and insomnia in patients during the perioperative period. In recent years, the concept of perioperative pain management has gradually received attention. Through preemptive analgesia, multimodal analgesia, and personalized analgesia regimens, the perioperative pain management of patients has been significantly improved. However, the management of perioperative anxiety and insomnia is still insufficient. Appropriate sleep and anxiety management may optimize postoperative recovery, alleviate patient pain, reduce anxiety, increase patient satisfaction, and improve surgical prognosis. Therefore, adequate perioperative sleep and anxiety management are key factors for recovery after arthroscopic shoulder surgery.

To evaluate the clinical efficacy of the perioperative sleep-anxiety management program (alprazolam combined with olanzapine) combined with conventional multimodal analgesia in patients undergoing arthroscopic rotator cuff repair of the shoulder.

A prospective randomized controlled study was conducted from January 2023 to December 2023. Sixty patients scheduled for arthroscopic giant rotator cuff repair were randomly divided into two groups: The study group adopted the conventional multimodal analgesia combined with the sleep-anxiety management program during the perioperative period (oral administration of alprazolam 0.8 mg every night before sleep from 2 days before the operation to 7 days after the operation; if insomnia or anxiety symptoms persisted, olanzapine 5 mg was added orally before sleep) . The control group only received conventional analgesic regimens (oral celecoxib, nerve block, and, when necessary, oxycodone hydrochloride sustained-release tablets and postoperative patient-controlled analgesic pumps) . The leading observation indicators were sleep quality pittsburgh sleep quality index (PSQI) , anxiety state self-rating anxiety scale (SAS) , and resting pain intensity visual analogue scale (VAS) on the 1st, 3rd, and 5th days after the operation. The secondary outcomes included the total dosage of olanzapine, the number of compressions by the analgesic pump, and the Constant-Murley, ASES, and UCLA shoulder joint function scores 6 months and 12 months after the operation.

The sleep quality and anxiety scores of the patients in the study group at each time point during the perioperative period were significantly better than those in the control group (P<0.05) , and the early postoperative resting VAS pain score and the usage of analgesic pumps were lower. Six months after the operation, the shoulder joint function score of the study group was significantly better than that of the control group. However, at 12 months, there was no statistically significant difference between the two groups, suggesting that the sleep-anxiety management program is helpful to improve the early clinical outcome.

The sleep-anxiety management program of alprazolam (0.8 mg) combined with olanzapine (5 mg) when necessary during the perioperative period, combined with conventional analgesic strategies, can significantly improve the sleep quality of patients after arthroscopic rotator cuff repair of the shoulder, relieve anxiety and pain, and promote early functional recovery. Although the early postoperative benefits were significant, there was no intergroup difference in the long-term functional outcome at 12 months, suggesting that the main advantage of this plan was concentrated in the early postoperative recovery stage.