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Degenerative Conditions

Glenohumeral osteoarthritis and cuff tear arthropathy: radiographic classification, management of primary vs secondary disease, and surgical indications.

Overview

Lumbar degenerative disease and low back pain are highly prevalent, with asymptomatic degeneration being common [1]. Evaluation requires distinguishing spinal causes from extraspinal causes [1]. Management strategies for thoracolumbar conditions must address the degenerative cascade [2]. Total disk replacement shows short-term success for thoracolumbar degenerative conditions but requires further investigation into long-term effects [2]. Nearly all elderly patients requiring surgery for degenerative diseases of the lumbar spine and lower extremities had advanced locomotive syndrome (LS stage 2) [3].

Surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease [4]. Patients with degenerative rotator cuff tears demonstrate clinically relevant differences in pain and functional outcomes with surgical intervention compared to nonoperative treatment [4]. Clinical outcomes after reverse total shoulder arthroplasty (RTSA) vary by indication, with the best results observed in patients with degenerative diseases [7]. RTSA outcomes are lowest in patients undergoing secondary interventions [7].

Pedicle-screw-based dynamic systems (Isobar TTL) provide significant and stable symptom relief for degenerative lumbar diseases [8]. Isobar TTL systems show an absence of implant-related complications and no revision surgery in the studied cohort [8]. Isobar TTL systems result in few adjacent segment degenerative changes [8]. Isobar hybrid dynamic stabilization with posterolateral fusion has clinical efficacy equivalent to titanium rod fusion surgery [12]. Isobar hybrid dynamic stabilization with posterolateral fusion is an alternative treatment for individuals with mild and moderate lumbar degenerative disease [12]. Arthroscopic intervention improves functional outcomes at short-term and midterm for patients with symptomatic femoroacetabular impingement (FAI) without significant existing degenerative changes [9].

The role of lumbar fusion for degenerative disorders is controversial [18]. Lumbar arthrodesis is indicated as an adjunct to decompression for patients with spinal stenosis associated with degenerative or iatrogenic spondylolisthesis [18]. Lumbar arthrodesis is indicated for the treatment of progressive degenerative lumbar scoliosis [18]. Lumbar fusion has a poor success rate when used to treat back pain associated with multilevel disk degeneration [18]. Arthrodesis is considered the best surgical treatment for persistently painful degenerative back conditions [24]. Arthrodesis for degenerative back conditions increases morbidity and mortality rates [24]. Arthrodesis for degenerative back conditions carries a risk of non-union [24]. Proximal-row carpectomy should be considered for proximal row diseases after conservative measures fail [23]. Mild degenerative arthritis is not a contraindication for proximal-row carpectomy [23]. Progressive degenerative arthritis of the radial capitate articulation did not occur after proximal-row carpectomy [23].

Anatomy & Pathophysiology

Classification and Predictive Factors

Frozen Shoulder Classification: Aims to obtain input from shoulder specialists to facilitate acceptance and use of the proposed classification [25]. The pathophysiology associated with primary (idiopathic) frozen shoulder involves specific tissue pathophysiology [89]. Furthermore, the pathophysiology of frozen shoulder differs between the upper and lower parts of the joint capsule [67].

Predictive Variables: Critical shoulder angle and age are easily assessable variables that adequately predict different shoulder pathologies in patients with shoulder complaints [92].

Biomechanics and Kinematics

Biomechanical Modeling: The biomechanical shoulder model is consistent with clinical observations regarding glenoid inclination and acromion index effects on humeral head translation and glenoid articular cartilage strain [33]. Asymptomatic rotator cuff pathology is associated with a plausible mechanical progression of kinematic and strength changes [43].

Functional Impact: Glenohumeral arthritis is associated with substantial loss of shoulder motion during overhead reach tasks, leading to compensatory increases in cervical, lumbar, pelvic, and elbow kinematics [66]. Osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function [85].

Comparative Pathophysiology

Osteonecrosis: Different biomechanical properties between the hip and shoulder joints likely cause epidemiological differences between osteonecrosis of the humeral head (ONHH) and osteonecrosis of the femoral head (ONFH) [40].

High-Level Activity: High-level rock climbing for 30 years does not result in restriction in shoulder function [74].

Classification

Post-operative Knee Fibrosis: Standardized, accepted criteria are required for the diagnosis, classification, and grading of severity to facilitate clinical trial inclusion and guideline development [21].

Frozen Shoulder: A consensus definition was developed using a consensus approach to obtain input from shoulder specialists, aiming for a classification that would be more readily accepted and used [25].

Hemophilic Arthropathy: A new four-category, 7-point classification system demonstrated interobserver reproducibility and correlation with joint function equivalent to the Pettersson et al. system [45]. This system was easier to apply and more sensitive in discriminating advanced arthropathy than the Arnold and Hilgartner system [45].

Gluteal Fatty Degeneration: Both the Goutallier classification system and the new Quartile system performed equally well in assessing fatty degeneration of the gluteus muscles, showing excellent levels of interrater and intrarater agreement [48].

Hip Osteoarthritis with Spinal Malalignment: The novel HiSS categorization supports the use of pelvic tilt to improve the ability to discern HiSS types/pathologies in patients with hip osteoarthritis and spinal sagittal malalignment [51].

Anterior Inferior Iliac Spine Morphology: The current radiographic classification scheme for the morphological distribution of the anterior inferior iliac spine should not be used exclusively for clinical decision making [53].

Cartilage Lesions: A universal and definitive grading system is necessary, and measurement devices are needed for objective cartilage grading in questionable cases [54].

Osteonecrosis of the Femoral Head (ONFH): A staging system has been developed to revise the 1994 ARCO classification for ONFH by an expert panel-based Delphi survey [58].

Hip Osteoarthritis (Tönnis): The Tönnis classification is widely utilized but has conflicting data regarding its reliability, with interobserver agreement ranging from slight to substantial depending on the study population and observer expertise [60].

Haemodialysis-Related Amyloidosis of the Shoulder (HDS): A new concise MRI classification of HDS was proposed [61].

Other Considerations: The classification of post-operative fibrosis of the knee requires standardized, accepted criteria for diagnosis, classification, and grading of severity to facilitate clinical trial inclusion and guideline development [21]. A universal and definitive grading system for cartilage lesions is necessary, and measurement devices are needed for objective cartilage grading in questionable cases [54].

Clinical Presentation

Lumbar degenerative disease and low back pain exhibit a high prevalence of asymptomatic degeneration [1]. Distinguishing spinal causes from extraspinal etiologies is critical during evaluation [1]. In the elderly population requiring surgery for lumbar degenerative diseases or lower extremity conditions, nearly all patients present with advanced conditions (LS stage 2) [3]. Cervical degenerative disorders are common and manifest with axial neck pain, radiculopathy, or myelopathy, presenting with signs ranging from mild neck pain to severe spinal cord and nerve root injury [10, 11].

Charcot arthropathy of the spine is a progressive disorder involving a destructive process of anatomical elements providing spinal stability, often characterized by delayed clinical recognition [5]. The presence of bone and cartilage debris ground into the synovial membrane is a significant pathological finding indicative of early neuropathic joints, often appearing before clinical or roentgenographic evidence is demonstrable [34]. However, this finding is not absolutely specific, as it can also occur in advanced degenerative arthritis [34].

Degenerative cervical conditions and rotator cuff pathology demonstrate distinct clinical trajectories. Surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease, with patients demonstrating clinically relevant differences in pain and functional outcomes compared to nonoperative treatment [4]. Clinical outcomes after reverse total shoulder replacement vary according to the underlying indication, with the best results observed in patients with degenerative diseases [7].

Hip pathology presents with variable symptomatic profiles. Osteoarthritis patients exhibit a broad range of symptoms, with 33% being asymptomatic [19]. Few asymptomatic hips with normal initial radiographs are at risk for pain or radiographic abnormalities in patients with non-traumatic osteonecrosis [13]. When disease develops in these asymptomatic hips, deterioration is slow and operative intervention is rarely indicated [13]. Rapidly destructive osteoarthritis of the hip joint represents an uncommon subset requiring regular clinical and radiological review to assess the speed of progression [17]. In adolescent athletes, while the majority with cam deformities and limited hip range of motion remain asymptomatic, those with features of femoroacetabular impingement have radiographic findings consistent with early osteoarthritis [16].

Shoulder and wrist degeneration show specific diagnostic challenges. Thirty-two percent of patients with painful acromioclavicular joints have a normal X-ray [19]. Degeneration of the articular disc in the human triangular fibrocartilage complex increases with age [14]. MRI serves as a noninvasive tool that overcomes the shortcomings of radiography by detecting preclinical disease and subtle early abnormalities in articular cartilage [15].

Systemic and post-surgical presentations require specific monitoring. Secondary degenerative changes in adjacent joints were not evident radiographically during a follow-up period ranging from 2.5 to seven years after tibiotalocalcaneal arthrodesis for arthritis and deformity of the hind part of the foot [6]. The final diagnosis of palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [35]. Although many OA-related biomarkers are currently available, none can be considered as a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time [36].

Investigations

Plain radiography: Asymptomatic degeneration is highly prevalent, necessitating the distinction between spinal and extraspinal causes of low back pain [1]. Degenerative cervical conditions commonly present with axial neck pain, radiculopathy, or myelopathy [11]. In osteoarthritis patients, 33% are asymptomatic, and 32% of patients with painful acromioclavicular joints have normal X-rays [19]. While radiographic changes of degenerative joint disease may progress, inflammatory disease changes are arrested in approximately 67% of knees following synovectomy in rheumatoid patients [27]. Secondary degenerative changes in adjacent joints were not evident radiographically during follow-up periods ranging from 2.5 to seven years following tibiotalocalcaneal arthrodesis [6]. Few asymptomatic hips with normal initial radiographs are at risk for pain or radiographic abnormalities, and disease deterioration is slow with operative intervention rarely indicated [13]. Features of femoroacetabular impingement, including cam deformities and limited hip range of motion, are associated with radiographic findings consistent with early osteoarthritis in adolescent athletes, even though the majority remain asymptomatic [16]. Pre-existing L5-S1 degeneration does not affect clinical and radiographical outcomes after isolated L4-5 fusion for spondylolisthesis [72]. Progressive radiographic osteoarthritic changes following arthroscopic debridement of massive irreparable rotator cuff tears do not negatively influence clinical results [81].

MRI: MRI serves as a noninvasive tool that overcomes the shortcomings of radiography by detecting preclinical disease and subtle early abnormalities in articular cartilage [15]. MRI features of facet joint degeneration and spinal stenosis do not show relevant correlation with reported pain relief after facet joint infiltration in the degenerate lumbar spine [56]. MRI is essential for detecting the pre-radiographic stage of osteonecrosis of the femoral head, although less than half of these cases progress to stage 2 or higher [68]. Conventional MRI is not reliable for detecting isolated cartilage lesions, but the presence of subchondral oedema should raise suspicion [69]. Magnetic resonance imaging should be part of the evaluation for patients with severe and progressive hip pain, as it can document complete resolution in cases of transient osteoporosis [71]. Clinical features are not very reliable for diagnosing acetabular labrum tears in sports patients with groin pain; magnetic resonance arthrography and hip arthroscopy should be utilized more [75].

Other Considerations: Charcot arthropathy of the spine is a progressive disorder involving destructive processes of spinal stability elements, often with delayed clinical recognition [5]. Rapidly destructive osteoarthritis of the hip is an uncommon subset requiring regular clinical and radiological review to assess progression speed and prevent rapid bone stock loss [17]. Rapidly destructive arthrosis of the shoulder joints presents with unique radiographic features, MRI findings, and a clinical course characterized by rapid humeral head collapse [63]. Routine screening for osteonecrosis is not necessary, but patients with persistent hip or knee pain after cardiac transplantation should be assessed with MRI [77].

Treatment

Non-Operative Management

Conservative treatment is effective in 77% of patients with a degenerative supraspinatus tear [38]. For degenerative hip abductor lesions, particularly partial tears, nonoperative management is a valid long-term option due to low risks of clinically relevant progression or muscle fatty infiltration, yielding clinical outcomes similar to those of operatively treated lesions [82]. Current non-surgical interventions for osteoarthritis do not alter the clinical course or arrest disease progression [39]. Nonoperative treatment is the standard initial approach for primary and posttraumatic elbow arthritis, with surgery reserved for cases refractory to conservative care [55]. In early-stage atraumatic osteonecrosis of the humeral head, nonoperative management is preferred to potentially prevent progression, though surgical intervention remains necessary in some instances [76]. Physical therapy for osteochondritis dissecans encompasses a full spectrum of conservative, nonoperative, and postoperative care [65].

Operative Management

Shoulder

Surgical intervention can alter the early natural history of degenerative rotator cuff disease, providing clinically relevant improvements in pain and functional outcomes compared to nonoperative treatment [4]. At 1 year, while functional outcomes show no significant difference between surgical and conservative groups, pain and disability metrics favor surgical treatment [44]. To ensure immediate and durable improvement in shoulder function, surgical treatment of degenerative rotator cuff tears should be performed before irreversible degenerative changes occur [49]. However, current surgical treatments cannot reverse fatty degeneration in massive rotator cuff tears and are associated with poor functional outcomes in these specific patients [46]. Clinical outcomes following reverse total shoulder replacement (RTSA) vary by indication, with the best results observed in patients with degenerative diseases [7].

Hip

Total hip arthroplasty (THA) is indicated for end-stage osteoarthritis [39]. Indication criteria for THA and total knee arthroplasty (TKA) are based on limited evidence [47]. THA in adolescents should be reserved for carefully selected patients for whom alternative procedures are contraindicated or unacceptable [50]. Bipolar hemiarthroplasty is not recommended as the primary operative treatment for degenerative arthritis of the hip [52].

Spine

Arthrodesis is indicated as an adjunct to decompression for spinal stenosis associated with degenerative or iatrogenic spondylolisthesis [18]. It is also indicated for the treatment of progressive degenerative lumbar scoliosis [18]. Arthrodesis is considered the best surgical treatment for persistently painful degenerative back pain, although it increases morbidity and mortality rates and carries a risk of non-union [24]. The role of lumbar fusion for degenerative disorders of the lumbar spine remains controversial [18]. Lumbar fusion demonstrates a poor success rate when used to treat back pain associated with multilevel disk degeneration [18]. Isobar hybrid dynamic stabilization with posterolateral fusion offers general clinical efficacy equivalent to titanium rod fusion surgery, presenting an alternative for individuals with mild and moderate lumbar degenerative disease [12]. Surgical options such as total disk replacement show short-term success but require further investigation into long-term effects [2].

Ankle

Arthroscopic ankle arthrodesis is an effective operation for treating degenerative ankle disease, resulting in good or excellent functional outcomes at a mean of 86 months post-operatively in nearly three-quarters of the patient cohort [37].

Wrist

Proximal-row carpectomy should be considered after conservative measures fail for diseases of the proximal row. Mild degenerative arthritis is not a contraindication, and progressive degenerative arthritis of the radial capitate articulation did not occur in the studied population [23].

Knee and Other Joints

Arthroscopic intervention results in improvements in functional outcomes at both short-term and midterm intervals for patients with symptomatic femoroacetabular impingement (FAI) in the absence of significant existing degenerative changes [9]. Non-operative and operative treatments for dislocation show similar osteoarthritis (OA) proportions at any point of follow-up [64]. Proper indication for autologous osteochondral grafting relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints [42].

Complications

Charcot Arthropathy: Charcot arthropathy of the spine is a progressive disorder involving a destructive process of the anatomical elements which provide spinal stability, often with delayed clinical recognition [5].

Instability: Long-term instability has a detrimental effect on the knee, causing proliferative and degenerative changes and persistent pain [20].

Adjacent Segment Degeneration: Secondary degenerative changes in the adjacent joints were not evident radiographically during a period of follow-up that ranged from 2.5 to seven years following tibiotalocalcaneal arthrodesis for arthritis and deformity of the hind part of the foot [6]. Pedicle-screw-based dynamic systems with Isobar TTL demonstrated absence of implant-related complications, no revision surgery, and few adjacent segment degenerative changes [8].

Rotator Cuff Re-tear: A follow-up of at least 2 years is necessary to determine short-term outcomes, especially in patients with severe preoperative fatty degeneration, as the re-tear rate of Sugaya III tendons between 1 and 2 years postoperatively after arthroscopic rotator cuff repair is over 30% [22].

Aseptic Loosening / Wear: Longer-term follow-up is registered concerning wear and loosening for cementless modular centroid reconstruction cups in young adults with congenital dysplasia of the hip [26].

Other Considerations: Patients with associated endocrine disease have symptoms develop at a younger age, have a significantly more protracted natural history, and more frequently undergo surgical treatment than patients with no associated endocrine disease [94].

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the available evidence. However, adhesive capsulitis exhibits a natural history of gradual resolution over 1 to 3 years [31].

Full activity (months): Specific timelines for full activity are not defined in the available evidence. Long-term instability causes proliferative and degenerative changes and persistent pain in the knee [20].

Complete recovery / outcome plateau (months): For adhesive capsulitis, 59% of patients achieve normal or near-normal shoulder function in the long term, while 41% report ongoing symptoms [62]. Persistent limitation occurs in 50% to 60% of patients with this condition [31]. In patients with femoroacetabular impingement (FAI) without surgical intervention, 14% develop symptomatic osteoarthritis and 4% undergo total hip arthroplasty (THA) at a mean follow-up of 24.7 years [28].

Rehabilitation protocol: Specific rehabilitation protocols are not detailed in the available evidence. However, a follow-up of at least 2 years is necessary to determine short-term outcomes, particularly in patients with severe preoperative fatty degeneration, as re-tear rates of Sugaya III tendons between 1 and 2 years postoperatively after arthroscopic rotator cuff repair exceed 30% [22].

Functional milestones: Surgical intervention for degenerative rotator cuff disease alters the early natural history, yielding clinically relevant differences in pain and functional outcomes compared to nonoperative treatment [4]. Degenerative rotator cuff disease demonstrates a progressive nature [32]. In the absence of significant existing degenerative changes, arthroscopic intervention improves functional outcomes at both short-term and midterm intervals for symptomatic FAI [9]. In the absence of joint degeneration, patients older than 40 years experience predictable and durable relief following arthroscopic management of FAI syndrome [95]. Patients with a history of lumbosacral pathology achieve significantly lower short-term meaningful clinical outcomes after hip arthroscopy for FAI syndrome compared to those without spine pathology [30]. Nearly all elderly patients requiring surgery for degenerative diseases of the lumbar spine and lower extremities present with advanced conditions (LS stage 2) [3].

Other Considerations: Charcot arthropathy of the spine is a progressive disorder involving a destructive process of the anatomical elements providing spinal stability, often with delayed clinical recognition [5]. Secondary degenerative changes in adjacent joints were not evident radiographically during follow-up ranging from 2.5 to seven years following tibiotalocalcaneal arthrodesis for hindfoot arthritis and deformity [6]. While radiographic changes of degenerative joint disease may progress, inflammatory disease changes are arrested in approximately 67% of knees following synovectomy in rheumatoid patients [27]. Humeral head replacement (HHR) remains successful for osteoarthritis at long-term follow-up, based on a report of 44 arthroplasties with a minimum 10-year follow-up [29]. There was no evidence of progression of intrinsic rotator cuff pathologic conditions at a mean follow-up of 4.5 years for partial-thickness rotator cuff tears treated with acromioplasty without repair [96]. Further long-term follow-up is warranted to confirm the clinical effectiveness of endoscopic repair of gluteus medius tendon tears of the hip [70]. Longer-term durability of total knee arthroplasty (TKA) in patients with systemic lupus erythematosus and osteonecrosis requires further study [73]. Longer-term follow-up is also registered concerning wear and loosening for cementless modular centroid reconstruction cups in young adults with congenital dysplasia of the hip [26].

Key Evidence

  • [L3] Nearly all elderly patients requiring surgeries for degenerative diseases of the lumbar spine and lower extremities had advanced conditions (LS stage 2). (10.1186/s12891-020-03547-0)
  • [L2] Surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease, with patients demonstrating clinically relevant differences in pain and functional outcomes compared to nonoperative treatment. (10.1016/j.jse.2024.05.056)
  • [L5] Charcot arthropathy of the spine is a progressive disorder involving a destructive process of the anatomical elements which provide spinal stability, often with delayed clinical recognition. (10.5435/jaaos-d-22-00212)
  • [L4] Secondary degenerative changes in the adjacent joints were not evident radiographically during a period of follow-up that ranged from 2.5 to seven years. (10.2106/00004623-198870090-00004)
  • [L4] Clinical outcomes after RTSA varied according to the underlying indication, with the best results observed in patients with degenerative diseases and the lowest in patients undergoing secondary interventions. (10.1186/s12891-025-09329-w)
  • [L4] The findings outline significant and stable symptoms relief, absence of implant-related complications, no revision surgery, and few adjacent segment degenerative changes. (10.1155/2013/183702)
  • [L4] Arthroscopic intervention results in improvements in functional outcomes at both the short-term and midterm for patients with symptomatic FAI in the absence of significant existing degenerative changes. (10.1016/j.arthro.2015.10.010)
  • [L3] The general clinical efficacy is equivalent to titanium rod fusion surgery, presenting an alternative treatment for individuals with mild and moderate lumbar degenerative disease. (10.1186/s12891-023-06329-6)
  • [L3] Few asymptomatic hips with normal findings on initial radiographs are at risk for pain or radiographic abnormalities; when disease does develop, deterioration is slow and operative intervention is rarely indicated. (10.2106/00004623-199703000-00006)
  • [L5] The degeneration of the articular disc increases with age and emphasizes its important mechanical function. (10.1007/s00402-021-03795-2)
  • [L5] MRI is evolving as a complete answer to cartilage-imaging requirements for lesion description, treatment planning, and outcome measurement, serving as a noninvasive tool that overcomes the shortcomings of radiography by detecting preclinical disease and subtle early abnormalities. (10.2106/jbjs.rvw.15.00093)
  • [L2] Although the majority of these participants remained asymptomatic, those with features of femoroacetabular impingement had radiographic findings consistent with early osteoarthritis. (10.1177/0363546517719460)
  • [L4] The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. (10.1186/1749-799x-3-3)
  • [L4] The role of lumbar fusion for treatment of degenerative disorders of the lumbar spine is controversial; arthrodesis is indicated as an adjunct to decompression for patients with spinal stenosis associated with degenerative or iatrogenic spondylolisthesis and in the treatment of progressive degenerative lumbar scoliosis, but has a poor success rate when used to treat back pain associated with multilevel disk degeneration. (10.5435/00124635-199505000-00002)
  • [L3] Osteoarthritis patients had a broad range of symptoms with 33% being asymptomatic, and 32% of patients with painful AC joints had a normal X-ray. (10.1016/j.jse.2021.03.086)
  • [L4] A follow-up of at least 2 years is necessary to determine short-term outcomes, especially in patients with severe preoperative fatty degeneration. (10.1016/j.arthro.2024.12.029)
  • [L4] It should be considered after conservative measures fail, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur. (10.2106/00004623-197759040-00004)
  • [L5] Arthrodesis is at present the best surgical treatment for the persistently painful degenerative back, though it increases morbidity and mortality rates and carries a risk of non-union. (10.2106/00004623-196345070-00016)
  • [L5] However, our goal in using this consensus approach was to obtain the valuable input of shoulder specialists so that the classification proposed would be more readily accepted and used. (10.1016/j.jse.2010.07.008)
  • [L3] Longer-term follow-up is registered concerning wear and loosening. (10.1016/j.arth.2007.01.003)
  • [L3] While radiographic changes of degenerative joint disease may progress, inflammatory disease changes are arrested in about 67 per cent of the knees. (10.2106/00004623-198668020-00004)
  • [L3] At mean follow-up of 24.7 years, 14% of hips had symptomatic OA and 4% underwent THA. (10.1177/0363546520949179)
  • [L4] HHR remains a successful operation for osteoarthritis at long-term follow-up. (10.1016/j.jse.2017.10.017)
  • [L3] Patients with a history of lumbosacral pathology achieved significantly lower short-term meaningful clinical outcomes after undergoing hip arthroscopy for FAIS when compared with patients without spine pathology. (10.1177/0363546519892916)
  • [L2] This study demonstrates the progressive nature of degenerative rotator cuff disease. (10.2106/jbjs.n.00099)
  • [L5] The biomechanical shoulder model is consistent with clinical observations. (10.1016/j.jse.2016.05.031)
  • [L4] The presence of bone and cartilage debris ground into the synovial membrane is a significant pathological finding indicative of early neuropathic joints, often appearing before clinical or roentgenographic evidence is demonstrable, though it is not absolutely specific as it can occur in advanced degenerative arthritis. (10.2106/00004623-194830030-00006)
  • [L5] Although many OA-related biomarkers are currently available, none can be considered as a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time. (10.1186/1471-2474-16-s1-s2)
  • [L4] Arthroscopic ankle arthrodesis is an effective operation for treating degenerative ankle disease, resulting in good/excellent functional outcomes at a mean of 86 months post-operatively in nearly three-quarters of the patient cohort. (10.1016/j.arthro.2016.03.077)
  • [L2] Conservative treatment was effective in 77% of patients with a degenerative supraspinatus tear. (10.1302/0301-620x.107b12.bjj-2025-0742.r2)
  • [L5] Current non-surgical managements for osteoarthritis do not change the clinical course or arrest disease progression, while joint replacement is indicated for end-stage disease. (10.1530/eor-2025-0050)
  • [L3] Despite anatomical similarities, different biomechanical properties between the hip and shoulder joints likely cause epidemiological differences between ONHH and ONFH. (10.1186/s12891-023-07022-4)
  • [Paper] Proper indication relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints. (10.1016/j.injury.2008.01.041)
  • [L3] Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology. (10.1016/j.jse.2016.11.048)
  • [L2] In this population of patients with degenerative rotator cuff tears, no significant difference in functional outcome was observed between surgical and conservative treatment at 1 year; however, significant differences in pain and disability favored surgical treatment. (10.1016/j.jse.2015.05.040)
  • [L4] The new four-category, 7-point classification system demonstrated interobserver reproducibility and correlation with joint function equivalent to the Pettersson et al. system, while being easier to apply and more sensitive in discriminating advanced arthropathy than the Arnold and Hilgartner system. (10.2106/00004623-198971020-00010)
  • [L5] Current surgical treatments are unable to alter or reverse the progression of fatty degeneration and are associated with poor functional outcomes in these patients. (10.1016/j.jse.2011.11.017)
  • [L2] The indication criteria for THA/TKA are based on limited evidence. (10.1186/s12891-016-1325-z)
  • [L4] Both the Goutallier classification system and the new Quartile system performed equally well in assessing fatty degeneration of the gluteus muscles, showing excellent levels of interrater and intrarater agreement. (10.1016/j.arth.2013.04.045)
  • [L4] Immediate and durable improvement of shoulder function can be expected, though surgical treatment should be performed before irreversible degenerative changes occur. (10.1016/j.jse.2008.12.003)
  • [L3] The findings suggest that total hip arthroplasty in adolescents should be reserved for carefully selected patients for whom alternative procedures are contraindicated or unacceptable. (10.2106/00004623-199607000-00003)
  • [L3] The novel HiSS categorization supported the use of pelvic tilt to potentially improve the ability to discern HiSS types/pathologies in a subset of patients with hip osteoarthritis and spinal sagittal malalignment. (10.5435/jaaos-d-18-00295)
  • [L4] The authors do not recommend bipolar hemiarthroplasty as the primary operative treatment for degenerative arthritis of the hip. (10.2106/jbjs.01879.pp)
  • [L3] The current radiographic classification scheme should not be used exclusively for clinical decision making. (10.1177/0363546516682230)
  • [L4] A universal and definitive grading system for lesions is necessary, and measurement devices are needed for objective cartilage grading in questionable cases. (10.1007/s00402-009-0868-y)
  • [L5] Nonoperative treatment is almost always initiated although surgical treatment may be indicated in cases refractory to conservative management. (10.1155/2013/473259)
  • [L4] MRI features of facet joint degeneration and spinal stenosis did not show any relevant correlation with reported pain relief after facet joint infiltration. (10.1186/s13018-017-0685-x)
  • [L5] A staging system has been developed to revise the 1994 ARCO classification for ONFH by an expert panel-based Delphi survey. (10.1016/j.arth.2019.11.029)
  • [L5] The Tönnis classification is widely utilized but has conflicting data regarding its reliability, with interobserver agreement ranging from slight to substantial depending on the study population and observer expertise. (10.1097/01.blo.0000534679.75870.5f)
  • [L3] A new concise MRI classification of HDS was proposed. (10.1007/s00167-016-4033-1)
  • [L3] In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. (10.1016/j.jse.2007.05.009)
  • [L4] Rapidly destructive arthrosis presents with unique radiographic features, MRI findings, and a specific clinical course characterized by rapid humeral head collapse. (10.1016/j.jse.2014.10.020)
  • [L1] Non-operative and operative treatments show similar OA proportions at any point of follow-up. (10.1007/s00167-020-06263-3)
  • [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. (10.1016/j.csm.2014.01.001)
  • [L4] Glenohumeral arthritis is associated with substantial loss of shoulder motion during an overhead reach task that mimics daily activities, which leads to compensatory increases in cervical, lumbar, pelvic, and elbow kinematics. (10.1016/j.jse.2026.02.019)
  • [L5] The pathophysiology of frozen shoulder differs between the upper and lower parts of the joint capsule. (10.1016/j.jse.2018.03.010)
  • [L3] Although MRI is essential for detecting pre-radiographic stage ONFH, less than half of preradiographic ONFH cases progress to stage 2 or higher. (10.1016/j.arth.2025.05.089)
  • [L4] Conventional MRI is not reliable for detecting isolated cartilage lesions, but the presence of subchondral oedema should raise such suspicion. (10.1186/1749-799x-1-4)
  • [L4] Further long-term follow-up is warranted to confirm the clinical effectiveness of this procedure. (10.1177/0363546508328412)
  • [Case_report] The authors document complete resolution of the affected hip and emphasize that magnetic resonance imaging should become part of the evaluation of patients who have severe and progressive pain in the hip. (10.2106/00004623-199274040-00021)
  • [L3] Pre-existing L5-S1 degeneration does not affect clinical and radiographical outcomes after isolated L4-5 fusion. (10.1186/s13018-015-0186-8)
  • [L3] Longer-term durability of TKA in these patients requires further study. (10.1016/j.arth.2026.03.073)
  • [L3] However, it is not related to any restriction in shoulder function. (10.1016/j.jse.2020.12.017)
  • [L4] Clinical features are not very reliable for diagnosis, and magnetic resonance arthrography and hip arthroscopy should be utilized more. (10.1007/s00167-003-0390-7)
  • [L5] Nonoperative treatment is the preferred option in early-stage disease, and it may prevent disease progression, though surgical treatment is required in some cases. (10.1016/j.xrrt.2022.02.005)
  • [L3] Routine screening is not necessary, but patients with persistent hip or knee pain should be assessed with MRI. (10.1016/j.arth.2007.01.006)
  • [L4] Although progressive radiographic osteoarthritic changes occur, they do not negatively influence clinical results. (10.1016/j.arthro.2008.03.007)
  • [L4] Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle fatty infiltration and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions. (10.1177/03635465221135759)
  • [L4] Osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. (10.1016/j.jht.2022.06.008)
  • [L1] This systematic review presents a summary of what is currently known about the tissue pathophysiology of primary frozen shoulder. (10.1186/s12891-016-1190-9)
  • [L3] The present study showed that critical shoulder angle and age, two easily assessable variables, adequately predict different shoulder pathologies in patients with shoulder complaints. (10.1186/s12891-017-1559-4)
  • [L3] Patients with associated endocrine disease have symptoms develop at a younger age, have a significantly more protracted natural history, and more frequently undergo surgical treatment than patients with no associated endocrine disease. (10.1016/j.jse.2006.06.007)
  • [L5] In the absence of joint degeneration, patients older than the age of 40 years experience predictable and durable relief following arthroscopic management of femoroacetabular impingement syndrome. (10.1016/j.arthro.2024.02.009)
  • [L4] There was no evidence of progression of intrinsic rotator cuff pathologic conditions at a mean follow-up of 4.5 years. (10.1177/03635465020300021801)

See Also

References

[1] Chapter 18 Lumbar Degenerative Disease and Low Back Pain. 2019.

[2] Chapter 49 Thoracolumbar Conditions. 2020.

[3] Improvement of locomotive syndrome with surgical treatment in patients with degenerative diseases in the lumbar spine and lower extremities: a prospective cohort study. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03547-0

[4] Does surgical intervention alter the natural history of degenerative rotator cuff tears? Comparative analysis from a prospective longitudinal study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.056

[5] Charcot Arthropathy of the Spine. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-22-00212

[6] Tibiotalocalcaneal arthrodesis for arthritis and deformity of the hind part of the foot.. The Journal of Bone & Joint Surgery. 1988. DOI: 10.2106/00004623-198870090-00004

[7] Retrospective, single-centre analysis comparing clinical outcomes of reverse total shoulder replacement for fracture, degenerative changes and revision procedure. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09329-w

[8] Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL. ISRN Orthopedics. 2013. DOI: 10.1155/2013/183702

[9] Arthroscopy Up to Date: Hip Femoroacetabular Impingement. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2015.10.010

[10] Chapter 48 Cervical Degenerative Conditions. 2020.

[11] Chapter 17 Degenerative Conditions of the Cervical Spine. 2019.

[12] Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06329-6

[13] The Natural History of Untreated Asymptomatic Hips in Patients Who Have Non-Traumatic Osteonecrosis. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199703000-00006

[14] Degeneration of the articular disc in the human triangular fibrocartilage complex. Archives of Orthopaedic and Trauma Surgery. 2021. DOI: 10.1007/s00402-021-03795-2

[15] Magnetic Resonance Imaging of Articular Cartilage. JBJS Reviews. 2016. DOI: 10.2106/jbjs.rvw.15.00093

[16] Cam Deformities and Limited Hip Range of Motion Are Associated With Early Osteoarthritic Changes in Adolescent Athletes: A Prospective Matched Cohort Study. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517719460

[17] Rapidly destructive osteoarthritis of the hip joint: a case series. Journal of Orthopaedic Surgery and Research. 2008. DOI: 10.1186/1749-799x-3-3

[18] Lumbar Spine Fusion in the Treatment of Degenerative Conditions: Current Indications and Recommendations. Journal of the American Academy of Orthopaedic Surgeons. 1995. DOI: 10.5435/00124635-199505000-00002

[19] Degenerative Status of Acromio-Clavicular Joint and Correlation Study Between Clinical Condition and X-Ray in Patients with Supra-Spinatus Tear. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.086

[20] Instability of the Knee: A LONG-TERM EXPERIMENTAL STUDY IN DOGS.. The Journal of Bone and Joint Surgery. American Volume. 1971.

[21] D. A. Mann, D. J. Deehan, for the Knee Joint Fibrosis Working Group. 2016.

[22] Re-tear Rate of Sugaya III Tendons Between 1 and 2 Years Postoperatively After Arthroscopic Rotator Cuff Repair Is Over 30% and Associated With Higher Tear Size and Fatty Degeneration. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2024.12.029

[23] Proximal-row carpectomy for diseases of the proximal row. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759040-00004

[24] Surgical Treatment of Degenerative Disease of the Back. The Journal of Bone & Joint Surgery. 1963. DOI: 10.2106/00004623-196345070-00016

[25] Frozen shoulder: a consensus definition. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.07.008

[26] Cementless Modular Centroid Reconstruction Cup in Young Adults With Congenital Dysplasia of the Hip. The Journal of Arthroplasty. 2008. DOI: 10.1016/j.arth.2007.01.003

[27] Long-term results of synovectomy in rheumatoid patients.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668020-00004

[28] Risk Factors for Long-term Hip Osteoarthritis in Patients With Femoroacetabular Impingement Without Surgical Intervention. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520949179

[29] Long-term outcomes of humeral head replacement for the treatment of osteoarthritis; a report of 44 arthroplasties with minimum 10-year follow-up. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.10.017

[30] The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: A Nested Case-Control Analysis. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519892916

[31] Chapter 74 Adhesive Capsulitis. 2019.

[32] A Prospective Evaluation of Survivorship of Asymptomatic Degenerative Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.00099

[33] Effects of glenoid inclination and acromion index on humeral head translation and glenoid articular cartilage strain. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.05.031

[34] BONE AND CARTILAGE DEBRIS IN THE SYNOVIAL MEMBRANE. The Journal of Bone & Joint Surgery. 1948. DOI: 10.2106/00004623-194830030-00006

[35] Palindromic Rheumatism: An Unusual Cause of the Inflammatory Joint: TWO CASE REPORTS AND A REVIEW.. The Journal of Bone and Joint Surgery. American Volume. 1974.

[36] Biomarkers of prognosis and efficacy of treatment in OA. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/1471-2474-16-s1-s2

[37] Arthroscopic Ankle Arthrodesis: A Long‐Term Follow‐up Study. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.077

[38] Factors associated with failed conservative treatment in patients with degenerative full-thickness supraspinatus tears. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b12.bjj-2025-0742.r2

[39] Considerations in modern regenerative medicine for osteoarthritis. EFORT Open Reviews. 2025. DOI: 10.1530/eor-2025-0050

[40] Comparison between osteonecrosis of the humeral and femoral heads - epidemiological analysis of the surgical trend using the nationwide claims database of the republic of Korea. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-07022-4

[42] Autologous osteochondral grafting—Technique and long-term results. Injury. 2008. DOI: 10.1016/j.injury.2008.01.041

[43] Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.11.048

[44] Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.040

[45] Roentgenographic classifications of hemophilic arthropathy. Comparison of three systems and correlation with clinical parameters.. The Journal of Bone & Joint Surgery. 1989. DOI: 10.2106/00004623-198971020-00010

[46] Mechanisms of fatty degeneration in massive rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.017

[47] Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1325-z

[48] Assessment of Fatty Degeneration of the Gluteal Muscles in Patients With THA Using MRI: Reliability and Accuracy of the Goutallier and Quartile Classification Systems. The Journal of Arthroplasty. 2014. DOI: 10.1016/j.arth.2013.04.045

[49] Arthroscopic treatment of synovial chondromatosis of the shoulder: Report of three patients. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.12.003

[50] Total Hip Arthroplasty with Cement in Patients Less Than Twenty Years Old. Long-Term Results. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199607000-00003

[51] Radiographic Categorization of the Hip-spine Syndrome in the Setting of Hip Osteoarthritis and Sagittal Spinal Malalignment. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00295

[52] Minimum Ten-Year Results of Primary Bipolar Hip Arthroplasty for Degenerative Arthritis of the Hip. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.01879.pp

[53] Morphological Distribution of the Anterior Inferior Iliac Spine in Patients With and Without Hip Impingement: Reliability, Validity, and Relationship to the Intraoperative Assessment. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546516682230

[54] How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-0868-y

[55] Primary and Posttraumatic Arthritis of the Elbow. Arthritis. 2013. DOI: 10.1155/2013/473259

[56] Predictability of the effects of facet joint infiltration in the degenerate lumbar spine when assessing MRI scans. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0685-x

[58] The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2019.11.029

[60] Classifications in Brief: Tönnis Classification of Hip Osteoarthritis. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/01.blo.0000534679.75870.5f

[61] Magnetic resonance imaging classification of haemodialysis-related amyloidosis of the shoulder: risk factors and arthroscopic treatment. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4033-1

[62] Long-term outcome of frozen shoulder. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.05.009

[63] Rapidly destructive arthrosis of the shoulder joints: radiographic, magnetic resonance imaging, and histopathologic findings. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.10.020

[64] Treatment type may influence degree of post‐dislocation shoulder osteoarthritis: a systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06263-3

[65] Physical Therapy Management of Patients with Osteochondritis Dissecans. Clinics in Sports Medicine. 2014. DOI: 10.1016/j.csm.2014.01.001

[66] Glenohumeral Arthritis Impairs Shoulder Mobility and Promotes Dynamic Compensatory Strategies During Overhead Reach. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.019

[67] Comparative proteome analysis of the capsule from patients with frozen shoulder. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.03.010

[68] Radiographic Progression in the Pre-Radiographic Stage of Osteonecrosis of the Femoral Head. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.089

[69] The importance of early arthroscopy in athletes with painful cartilage lesions of the ankle: a prospective study of 61 consecutive cases. Journal of Orthopaedic Surgery and Research. 2006. DOI: 10.1186/1749-799x-1-4

[70] Endoscopic Repair of Gluteus Medius Tendon Tears of the Hip. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546508328412

[71] Magnetic resonance imaging of transient osteoporosis of the hip. A case report.. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274040-00021

[72] Does pre-existing L5-S1 degeneration affect outcomes after isolated L4-5 fusion for spondylolisthesis?. Journal of Orthopaedic Surgery and Research. 2015. DOI: 10.1186/s13018-015-0186-8

[73] The Presence of Osteonecrosis in Patients Who Have Systemic Lupus Erythematosus Undergoing Total Knee Arthroplasty is Not Associated with Worse Outcomes. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.073

[74] Impact of 30 years’ high-level rock climbing on the shoulder: an magnetic resonance imaging study of 31 climbers. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.12.017

[75] A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0390-7

[76] Atraumatic osteonecrosis of the humeral head: pathophysiology and current concepts of evaluation and treatment. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.02.005

[77] Symptomatic Osteonecrosis of the Hip and Knee After Cardiac Transplantation. The Journal of Arthroplasty. 2008. DOI: 10.1016/j.arth.2007.01.006

[81] Arthroscopic Debridement of Massive Irreparable Rotator Cuff Tears. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.03.007

[82] Natural History of Degenerative Hip Abductor Tendon Lesions. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221135759

[85] Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2022.06.008

[89] The pathophysiology associated with primary (idiopathic) frozen shoulder: A systematic review. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1190-9

[92] Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1559-4

[94] Calcific tendinitis: Natural history and association with endocrine disorders. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.007

[95] Editorial Commentary: Older Patients Without Degenerative Joint Disease Can Have Excellent Outcomes After Hip Arthroscopy. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.02.009

[96] The Partial-Thickness Rotator Cuff Tear: Is Acromioplasty without Repair Sufficient?. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300021801

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