Title: 
Subsequent Total Shoulder Arthroplasty Following Common Shoulder Stabilization and Reconstructive Procedures

Background:
Shoulder stabilization and reconstructive surgeries are indicated based on a variety of pathologies including instability, impingement, and rotator cuff tears. Surgery to restore anatomic and biomechanical normalcy may reduce pain, restore function, or may slow the progression of osteoarthritis. This study analyzes common shoulder stabilization and reconstructive surgeries and compares their odds of future total shoulder arthroplasty (TSA) development.

Methods:
The TriNetX database patient data was queried from the period of May 2004 to May 2024 using ICD10 and CPT codes. Cohorts were built by including patients who underwent a procedure of interest, while the control group used a combination of patients from other procedural cohorts not undergoing the procedure of interest. Cohorts were then propensity matched for age, race, sex, and co-morbidities. Laterality was assessed separately to ensure ipsilateral index procedure and TSA. The primary outcome measured was TSA at 5 and 10 years postoperatively for 13 different shoulder procedures.


Results:
A total of 355,960 patients were divided into procedural cohorts and analyzed. The procedure with the highest rate of subsequent TSA was the Latarjet procedure (3.99% at 5 years; 4.23% at 10 years); whereas the procedure with the lowest rate was arthroscopic capsulorrhaphy (0.91% at 5 years; 0.95% at 10 years. Compared to propensity-matched controls, procedures associated with increased odds of subsequent TSA were the Latarjet procedure (OR 3.34, P<0.0001 at 5 years; OR 3.56, P<0.0001 at 10 years), arthroscopic capsulorrhaphy (OR 1.47, P=0.0042 at 5 years; OR 1.43, P=0.0066 at 10 years), open rotator cuff repair, chronic (OR 1.39, P=0.0005 at 5 years), arthroscopic extensive debridement (OR 1.31, P<0.0001 at 5 years; OR 1.26, P<0.0001 at 10 years), and open biceps tenodesis (OR 1.28, P=0.0003 at 5 years; OR 1.20, P=0.0053 at 10 years). Procedures associated with decreased odds of subsequent TSA were arthroscopic distal clavicle resection (OR 0.56, P<0.0001 at 5 years; OR 0.56, P<0.0001 at 10 years), arthroscopic subacromial decompression (OR 0.65, P<0.0001 at 5 years; OR 0.63, P<0.0001 at 10 years), arthroscopic rotator cuff repair (OR 0.78, P<0.0001 at 5 years; OR 74, P<0.0001 at 10 years), and arthroscopic biceps tenodesis (OR 0.78, P<0.0001 at 5 years; OR 0.76, P<0.0001 at 10 years).

Conclusion:
In general, arthroscopic procedures had decreased associated odds of subsequent TSA when compared to their open counterparts. However, arthroscopic capsulorrhaphy and arthroscopic extensive debridement had increased odds of subsequent TSA. The Latarjet procedure had the highest odds of all procedures for future TSA.

Subsequent Total Shoulder Arthroplasty Following Common Shoulder Stabilization and Reconstructive Procedures 


Background: As the most popular sport in the world, soccer has driven increased physical demands and higher levels of intensity, resulting in elevated levels of lower extremity injuries among players. Our study analyzed the effects of cleat stud patterns and models worn by players who sustained lower extremity injuries while playing in the English Premier League (EPL). 

Methods: Fifteen cleat models, 510 players, and 221 injuries were analyzed from the EPL 2021-22 season. The injured player cohort was established using Transfermarkt.com, while cleat attributes were obtained from footballbootsdb.com and were confirmed using product websites and online reviews. Odds ratios and confidence intervals were used to assess lower extremity injury risk. Stud patterns or cleat models were set as the experimental condition, with injury or no injury as the outcome.

Results: Our results suggest that very aggressive stud patterns have significantly higher injury odds when directly compared to mildly aggressive. In addition, the odds of players sustaining ankle or knee injuries were significant with very aggressive stud patterns, while the odds of players sustaining hamstring injuries were significant with both very aggressive and non-aggressive. Cleat models with significant total or specific lower extremity injury odds were Nike Mercurial, Adidas X, Nike Phantom GT, Adidas Predator, and Nike Tiempo.

Conclusion: EPL players who wear very aggressive stud patterns may be at higher risk for lower extremity injuries compared to those who wear mildly aggressive stud patterns. Players and clubs should evaluate their footwear choices to best mitigate their injury risk. 


Cleats Worn Versus Lower Extremity Injuries in the English Premier League

Orthopaedic Surgery (Clinical and Transitional Research)

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 Orthopaedic Surgery

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### Grand Prize Sponsor

AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on February 4, 2024 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

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Subsequent Total Shoulder Arthroplasty Following Common Shoulder Stabilization and Reconstructive Procedures

Cleats Worn Versus Lower Extremity Injuries in the English Premier League

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