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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 exhibit a high prevalence of asymptomatic degeneration [1]. Evaluation requires distinguishing spinal from extraspinal causes of low back pain [1]. Management strategies for thoracolumbar conditions must address the degenerative cascade [2]. Total disk replacement shows short-term success in managing 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 disease 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 yields the lowest clinical outcomes in patients undergoing secondary interventions [7].

Pedicle-screw-based dynamic systems (Isobar TTL) provide significant and stable symptom relief in degenerative lumbar diseases [8]. Isobar TTL is associated with an absence of implant-related complications and no revision surgery in degenerative lumbar diseases [8]. Isobar TTL is associated with few adjacent segment degenerative changes in degenerative lumbar diseases [8]. Isobar hybrid dynamic stabilization with posterolateral fusion has general clinical efficacy equivalent to titanium rod fusion surgery [12]. Isobar hybrid dynamic stabilization with posterolateral fusion presents an alternative treatment for individuals with mild and moderate lumbar degenerative disease [12].

Lumbar fusion is indicated as an adjunct to decompression for patients with spinal stenosis associated with degenerative or iatrogenic spondylolisthesis [18]. Lumbar fusion 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 [24]. Arthrodesis for degenerative back increases morbidity and mortality rates [24]. Arthrodesis for degenerative back carries a risk of non-union [24].

Anatomy & Pathophysiology

Classification and Assessment

Frozen shoulder classification aims to obtain input from shoulder specialists to ensure broader acceptance and use of the proposed definition [25]. The tissue pathophysiology of primary (idiopathic) frozen shoulder is summarized in systematic reviews [89]. Shoulder stiffness involves specific causes, clinical presentations, and treatments supported by current literature [83]. The pathophysiology of frozen shoulder differs between the upper and lower parts of the joint capsule [67]. An appropriate and directed shoulder physical examination allows clinicians to focus on further diagnostic strategies and treatment options [93]. 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 shoulder models are consistent with clinical observations regarding glenoid inclination and acromion index effects on humeral head translation and glenoid articular cartilage strain [33]. Glenohumeral arthritis causes 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]. Asymptomatic rotator cuff pathology is associated with a plausible mechanical progression of kinematic and strength changes [43]. Shoulder activity level is not related to the risk of rotator cuff tear progression [84]. High-level rock climbing over 30 years does not result in restriction in shoulder function despite structural changes [74].

Osteonecrosis and Joint Pathology

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]. Measurement of humeral subluxation in primary glenohumeral osteoarthritis may be more accurate in the glenoid hull plane than in the scapular plane [88].

Surgical and Functional Outcomes

Measures of adult shoulder function performance vary across different patient populations and settings [59]. Restoration of glenohumeral alignment is highly associated with superior clinical outcomes in the treatment of inflammatory arthritis via shoulder arthroplasty [86]. Nonlateralized reverse total shoulder arthroplasty designs minimize shear forces, while lateralized designs decrease impingement and scapular notching [80]. Both open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement significantly improve shoulder function and are relatively safe [79].

Classification

LS Stage: Nearly all elderly patients requiring surgeries for degenerative diseases of the lumbar spine and lower extremities had advanced locomotive syndrome conditions (LS stage 2) [3].

TFCC Disc Degeneration: The degeneration of the articular disc in the triangular fibrocartilage complex increases with age [14].

Post-operative Knee Fibrosis: Standardized, accepted criteria for the diagnosis, classification, and grading of the severity of post-operative fibrosis of the knee facilitate the identification of patients for inclusion in clinical trials [21]. These criteria also facilitate the development of clinical guidelines [21] and help to inform the management of this condition [21].

Frozen Shoulder: A consensus classification for frozen shoulder was proposed to obtain input from shoulder specialists so that the classification would be more readily accepted and used [25].

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

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

HiSS: The novel HiSS categorization supports the use of pelvic tilt to potentially 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 for cartilage lesions is necessary [54]. Measurement devices are needed for objective cartilage grading in questionable cases [54].

ARCO Staging of Osteonecrosis: The 2019 Revised Version of the Association Research Circulation Osseous (ARCO) Staging System of Osteonecrosis of the Femoral Head was developed to revise the 1994 ARCO classification [58]. The 2019 Revised Version of the ARCO Staging System was developed by an expert panel-based Delphi survey [58].

Tönnis Classification: The Tönnis classification of hip osteoarthritis is widely utilized [60]. Interobserver agreement for the Tönnis classification ranges 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 haemodialysis-related amyloidosis of the shoulder (HDS) was proposed [61].

Other Considerations: Standardized criteria for post-operative knee fibrosis facilitate trial inclusion, guideline development, and management [21].

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 elderly populations requiring surgical intervention for lumbar degenerative diseases or lower extremity conditions, nearly all patients present with advanced disease stages (LS stage 2) [3].

Cervical degenerative disorders are common and manifest with axial neck pain, radiculopathy, or myelopathy, ranging from mild symptoms to severe spinal cord and nerve root injury [10], [11]. Charcot arthropathy of the spine is a progressive disorder characterized by a destructive process of anatomical elements providing spinal stability, often with delayed clinical recognition [5].

Shoulder presentations vary by pathology. 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]. Clinical outcomes after reverse total shoulder replacement depend on the underlying indication, with the best results observed in patients with degenerative diseases [7].

Hip and knee presentations include a broad symptom range, with 33% of osteoarthritis patients being asymptomatic [19]. Few asymptomatic hips with normal initial radiographs are at risk for pain or radiographic abnormalities; when disease develops, deterioration is slow and operative intervention is rarely indicated [13]. Rapidly destructive osteoarthritis of the hip is an uncommon subset requiring regular clinical and radiological review to assess progression speed [17].

In the foot and ankle, 32% of patients with painful acromioclavicular (AC) joints have normal X-rays [19]. Secondary degenerative changes in adjacent joints were not evident radiographically during follow-up ranging from 2.5 to seven years after tibiotalocalcaneal arthrodesis for hindfoot arthritis and deformity [6].

Diagnostic imaging and pathology reveal specific early signs. MRI detects preclinical disease and subtle early abnormalities in articular cartilage, overcoming radiographic shortcomings [15]. Degeneration of the articular disc in the triangular fibrocartilage complex increases with age [14]. The presence of bone and cartilage debris ground into the synovial membrane indicates 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].

In adolescent athletes, while most with cam deformities and limited hip range of motion remain asymptomatic, those with features of femoroacetabular impingement show radiographic findings consistent with early osteoarthritis [16]. Palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course for final diagnosis [35]. Currently, no osteoarthritis-related biomarkers serve as surrogate markers for clinical and imaging features for diagnosis or prognosis [36].

Investigations

Plain radiography: Asymptomatic degeneration is highly prevalent in lumbar degenerative disease [1]. In the hip, few asymptomatic hips with normal initial radiographs are at risk for pain or radiographic abnormalities, and when disease develops, deterioration is slow with operative intervention rarely indicated [13]. For the shoulder, 32% of patients with painful acromioclavicular joints had normal X-rays [19]. In the knee, while radiographic changes of degenerative joint disease may progress, inflammatory disease changes are arrested in about 67% of knees following synovectomy in rheumatoid patients [27]. Progressive radiographic osteoarthritic changes after arthroscopic debridement of massive irreparable rotator cuff tears do not negatively influence clinical results [81]. Secondary degenerative changes in adjacent joints were not evident radiographically during follow-up ranging from 2.5 to seven years after tibiotalocalcaneal arthrodesis for hindfoot arthritis and deformity [6].

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]. It is essential for detecting pre-radiographic stage osteonecrosis of the femoral head, but 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 transient osteoporosis of the hip [71]. MRI features of facet joint degeneration and spinal stenosis did not show any relevant correlation with reported pain relief after facet joint infiltration in the degenerate lumbar spine [56].

Other Considerations: Distinguishing spinal causes from extraspinal causes is important in the evaluation of low back pain [1]. Degenerative cervical conditions commonly present with axial neck pain, radiculopathy, or myelopathy [11]. Charcot arthropathy of the spine is a progressive disorder involving a destructive process of anatomical elements providing spinal stability, often with delayed clinical recognition [5]. Participants with features of femoroacetabular impingement had radiographic findings consistent with early osteoarthritis, although the majority remained asymptomatic [16]. Rapidly destructive osteoarthritis of the hip is an uncommon subset requiring regular clinical and radiological review to assess progression speed and prevent rapid loss of bone stock [17]. In osteoarthritis patients, 33% were asymptomatic [19]. Rapidly destructive arthrosis of the shoulder joints presents with unique radiographic features, MRI findings, and a specific 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]. Clinical features are not very reliable for diagnosing acetabular labrum tears in sports patients with groin pain, and magnetic resonance arthrography and hip arthroscopy should be utilized more [75]. Pre-existing L5-S1 degeneration does not affect clinical and radiographical outcomes after isolated L4-5 fusion for spondylolisthesis [72].

Treatment

Non-Operative

Conservative management is effective for 77% of patients with degenerative supraspinatus tears [38]. For degenerative hip abductor lesions, particularly partial tears, nonoperative treatment offers a valid long-term option with low progression risk and clinical outcomes comparable to operative care [82]. In early-stage atraumatic osteonecrosis of the humeral head, nonoperative treatment is preferred to potentially prevent disease progression, though surgery remains necessary in some cases [76]. Conservative therapy is the standard initial approach for primary and posttraumatic elbow arthritis, with surgery reserved for refractory cases [55]. Physical therapy for osteochondritis dissecans encompasses a full spectrum of conservative, nonoperative, and postoperative care [65]. However, current non-surgical interventions for osteoarthritis do not alter the clinical course or arrest disease progression [39].

Operative

Shoulder: Surgical intervention can alter the early natural history of degenerative rotator cuff disease, yielding clinically relevant improvements in pain and function compared to nonoperative treatment [4]. At one year, while functional outcomes are similar between surgical and conservative groups, pain and disability significantly favor surgery [44]. Reverse total shoulder replacement (RTSA) outcomes vary by indication, with the best results observed in degenerative diseases [7]. Surgical treatment of shoulder synovial chondromatosis provides immediate, durable functional improvement if performed before irreversible degenerative changes occur [49]. Conversely, current surgical treatments cannot reverse fatty degeneration in massive rotator cuff tears and are associated with poor functional outcomes in these patients [46].

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 where alternative procedures are contraindicated or unacceptable [50]. Bipolar hemiarthroplasty is not recommended as primary operative treatment for degenerative hip arthritis [52].

Spine: Management of thoracolumbar conditions must address the degenerative cascade; total disk replacement shows short-term success but requires further long-term investigation [2]. Isobar hybrid dynamic stabilization with posterolateral fusion offers clinical efficacy equivalent to titanium rod fusion for mild to moderate lumbar degenerative disease [12]. Arthrodesis is indicated as an adjunct to decompression for spinal stenosis with degenerative or iatrogenic spondylolisthesis and for progressive degenerative lumbar scoliosis [18]. However, lumbar fusion has a poor success rate for back pain associated with multilevel disk degeneration [18]. While arthrodesis is considered the best surgical treatment for persistently painful degenerative back, it increases morbidity and mortality rates and carries a non-union risk [24].

Ankle: Arthroscopic ankle arthrodesis is effective for degenerative ankle disease, yielding good/excellent functional outcomes at a mean of 86 months post-operatively in nearly three-quarters of patients [37].

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

General/Other: Arthroscopic intervention improves short- and midterm functional outcomes for symptomatic femoroacetabular impingement (FAI) in the absence of significant existing degenerative changes [9]. Non-operative and operative treatments for dislocation show similar osteoarthritis proportions at any follow-up point [64]. Chronic non-orthopedic conditions are significantly more prevalent in patients with less severe degenerative changes at surgery, and these patients report significantly higher dissatisfaction with their operation [41].

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 re-tear rates of Sugaya III tendons between 1 and 2 years postoperatively after arthroscopic rotator cuff repair are over 30% [22].

Stiffness / Arthrofibrosis: Adhesive capsulitis has a natural history of gradual resolution over 1 to 3 years, though persistent limitation occurs in 50% to 60% of patients [31]. 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): Evidence does not provide specific week ranges for light activity or return to desk work. However, patients with a history of lumbosacral pathology achieve significantly lower short-term meaningful clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared with those without spine pathology [30].

Full activity (months): Evidence does not provide specific month ranges for full activity or sport return. Arthroscopic intervention improves functional outcomes at short-term and midterm intervals for patients with symptomatic femoroacetabular impingement (FAI) in the absence of significant existing degenerative changes [9]. In the absence of joint degeneration, patients older than 40 years experience predictable and durable relief following arthroscopic management of FAIS [95].

Complete recovery / outcome plateau (months): 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]. For adhesive capsulitis, the natural history involves gradual resolution over 1 to 3 years, though persistent limitation occurs in 50% to 60% of patients [31]. In the long term, 59% of patients with frozen shoulder have normal or near-normal shoulders, while 41% report ongoing symptoms [62].

Rehabilitation protocol: Evidence does not specify rehabilitation protocols, immobilisation durations, or weight-bearing progressions.

Functional milestones: Nearly all elderly patients requiring surgeries for degenerative diseases of the lumbar spine and lower extremities present with advanced conditions (LS stage 2) [3]. Surgical intervention alters the early natural history of degenerative rotator cuff disease, yielding clinically relevant differences in pain and functional outcomes compared to nonoperative treatment [4]. Degenerative rotator cuff disease demonstrates a progressive nature [32].

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]. Long-term instability detrimentally affects the knee, causing proliferative and degenerative changes and persistent pain [20]. While radiographic changes of degenerative joint disease may progress, inflammatory disease changes are arrested in about 67% of knees following synovectomy in rheumatoid patients [27]. At a mean follow-up of 24.7 years, 14% of hips with femoroacetabular impingement without surgical intervention developed symptomatic osteoarthritis (OA) and 4% underwent total hip arthroplasty (THA) [28]. Humeral head replacement (HHR) remains a successful operation for osteoarthritis at long-term follow-up [29]. There was no evidence of progression of intrinsic rotator cuff pathologic conditions at a mean follow-up of 4.5 years following acromioplasty without repair for partial-thickness rotator cuff tears [96]. 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]. 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].

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)
  • [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)
  • [L3] This updated review summarizes the available information about how nine measures of adult shoulder function perform for different patient populations in different settings. (10.1002/acr.24230)
  • [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)
  • [L3] Both techniques significantly improved shoulder function and are relatively safe procedures. (10.1016/j.jse.2019.09.035)
  • [L4] The review summarizes biomechanical concepts and clinical outcomes, noting that nonlateralized designs minimize shear forces while lateralized designs decrease impingement and scapular notching. (10.1177/1758573220937412)
  • [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)
  • [L5] This review examines the causes, clinical presentation, and treatment of patients with shoulder stiffness, providing a guide for treatment supported by data from the current literature. (10.1016/j.arthro.2008.03.014)
  • [L2] Shoulder activity level is not related to tear progression risks. (10.1016/j.jse.2017.05.023)
  • [L4] Osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. (10.1016/j.jht.2022.06.008)
  • [L3] Restoration of glenohumeral alignment is highly associated with superior clinical outcomes. (10.2106/00004623-200411000-00020)
  • [L4] Elbow stiffness is a challenging problem with no ideal management solution; however, functional improvements can be achieved with both nonsurgical and surgical strategies, and recent advancements in biology and pathology may lead to future breakthroughs in prevention and treatment. (10.1016/j.jhsa.2013.06.007)
  • [L4] Measurement in the glenoid hull plane may be more accurate than in the scapular plane. (10.1016/j.jse.2017.01.027)
  • [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)
  • [L5] An appropriate and directed shoulder physical examination allows the clinician to focus on further diagnostic strategies and treatment options for the patient. (10.1016/j.jhsa.2014.04.024)
  • [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

[41] Chronic_Non-Orthopedic_Conditions_More_Common_in_Patients_with_Less_Severe_Degen_S0883540315000753. n.d..

[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

[59] Measures of Adult Shoulder Function. Arthritis Care & Research. 2020. DOI: 10.1002/acr.24230

[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

[79] Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.035

[80] Lateralized versus nonlateralized reverse total shoulder arthroplasty. Shoulder & Elbow. 2020. DOI: 10.1177/1758573220937412

[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

[83] Shoulder Stiffness. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.03.014

[84] Shoulder activity level and progression of degenerative cuff disease. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.05.023

[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

[86] Shoulder Arthroplasty for the Treatment of Inflammatory Arthritis. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00020

[87] Prevention and Treatment of Elbow Stiffness: A 5-Year Update. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.06.007

[88] Interest in the glenoid hull method for analyzing humeral subluxation in primary glenohumeral osteoarthritis. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.01.027

[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

[93] Physical Examination of the Shoulder. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.024

[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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a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.