Clinical guideline on the open arthrolysis for posttraumatic elbow stiffness in adult patients.

Background: Posttraumatic elbow stiffness poses significant clinical challenges for upper limb surgeons and severely impairs patients' ability to perform essential daily activities, including eating, dressing, and personal hygiene, thereby imposing substantial socioeconomic burdens. Open arthrolysis is widely employed when conservative therapies fail, yet current literatures demonstrate considerable heterogeneity in treatment concepts, surgical techniques, and perioperative management. This evidence-based clinical practice guideline aims to standardize treatment profiles and improve surgical outcomes for open arthrolysis of posttraumatic elbow stiffness in adult patients globally.

The Effect of Radial Collateral Ligament Plication on Varus Stability in a Sequential Injury Model of the Lateral Elbow: A Biomechanical Study.

Background: Insufficiency of the radial collateral ligament (RCL) can lead to symptomatic minor instability of the lateral elbow (SMILE). While RCL plication showed favorable clinical outcomes in treating SMILE, its biomechanical impact on varus stability remains unclear, particularly with regards to how effectively RCL plication can restore stability compared to an intact elbow across various degrees of lateral elbow injury. This study was to evaluate the impact of RCL plication on varus stability in a model of sequential lateral elbow injury under controlled varus load.

Determining the timing and extent of amputation in symmetrical peripheral gangrene: a report of three cases from Korea.

Symmetrical peripheral gangrene is a severe condition marked by symmetric acral necrosis without obstruction of the major blood vessels. This case report examines the critical decisions involved in choosing between early and delayed amputation, as well as determining the extent of the necessary amputation. We present three cases: one involving antiphospholipid syndrome, another with disseminated intravascular coagulation, and a third associated with diabetes mellitus.

Identifying clinically meaningful changes and predictors of improvement for patient-reported outcome measures in patients who undergo arthroscopic arthrolysis for post-traumatic elbow stiffness.

Background: Clinically meaningful outcome thresholds, including patient acceptable symptom state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB), have rarely been evaluated after arthroscopic arthrolysis for post-traumatic elbow stiffness. This study therefore aimed to determine PASS, MCID, and SCB values for the pain visual analog scale (pVAS), Single Assessment Numeric Evaluation (SANE), Mayo Elbow Performance Score (MEPS), and range of motion difference (ROMD) after arthroscopic elbow arthrolysis.

Methods: Sixty-five patients who underwent arthroscopic elbow arthrolysis were evaluated at a minimum of 1 year postoperatively using anchor-based methods for PASS and SCB, and a distribution-based method for MCID.

Evaluation of the Baseplate Position and Screws in Reverse Total Shoulder Arthroplasty Using 3D Printed Patient-Specific Instrumentation.

Patient-specific instrumentation (PSI) in shoulder arthroplasty has been used to translate preoperative surgical planning into precise implant positioning. However, screws for baseplate fixation using PSI have not been preoperatively planned or verified for proper location and length. This study aims to assess the reproducibility of the 3D-printed PSI system for baseplate and screw positioning in reverse total shoulder arthroplasty (rTSA) and the role of preoperative screw planning.

Arthroscopic Lateral Ulnar Collateral Ligament Plication/Reconstruction With Augmented Lateral Collateral Ligament Imbrication.

Posterolateral rotatory instability (PLRI) is a chronic condition resulting from damage to the lateral ulnar collateral ligament (LUCL) and related structures causing painful restrictions and instability in elbow movement. Conservative treatment often falls short, necessitating surgical intervention to restore elbow stability. Traditionally, open LUCL reconstruction with tendon grafting has been the standard of care but involves substantial tissue disruption and extended recovery.

Comparable Graft Failure Rates and Outcome in Superior Capsular Reconstruction Yet Faster Pain Relief Using Dermal Allograft and Faster Motion Recovery Using Tensor Fascia Lata Autograft.

Purpose: To directly compare clinical outcomes of superior capsular reconstruction (SCR) using dermal allografts (DAs) and tensor fascia latae (TFL) autografts and determine independent factors associated with patient satisfaction and graft failure.

Methods: This retrospective study was conducted between June 2013 and November 2021. Patients who underwent SCR using DA or TFL were included.

Superior capsular reconstruction after failed rotator cuff repair using a fascia lata autograft is associated with inferior outcomes compared to primary superior capsular reconstruction for irreparable massive rotator cuff tears.

Purpose: This study aimed to investigate the effect of failed rotator cuff repair (RCR) on surgical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft.

Methods: We included 79 patients with irreparable massive rotator cuff tears who underwent SCR using fascia lata autografts between 2018 and 2023, with a minimum follow-up of ≥  one year. Of them, 66 patients underwent primary SCR (primary SCR group) and 13 underwent SCR after structural failure of previous RCR (revision SCR group).

Advancements in the Management of Irreparable Rotator Cuff Tears.

Background: Rotator cuff tears (RTC) are a common cause of shoulder pain in adults, with massive and irreparable tears presenting significant treatment challenges. Addressing these tears effectively is crucial for improving patient outcomes. To review recent advancements in the surgical management of irreparable rotator cuff tears.

Indocyanine green fluorescence angiography-guided arthroscopic rotator cuff surgery: a randomized controlled trial.

Background: Indocyanine green (ICG) fluorescence angiography is used to evaluate tissue vascularity across various surgical fields. However, ICG has not been widely used in rotator cuff tendon surgery, which involves poorly vascularized tissue. In this study, we investigated the efficacy of ICG-guided arthroscopic rotator cuff repair (RCR) to evaluate the vasculature of the débridement margin and the tendon-bone interface and compared it with the conventional arthroscopic technique.

The Relationship Between Achieving the Minimal Clinically Important Difference and Patient-Reported Satisfaction After Arthroscopic Superior Capsular Reconstruction With a Fascia Lata Autograft for Irreparable Massive Rotator Cuff Tears.

Background: Surgeons used the minimal clinically important difference (MCID) to interrogate outcomes-using patient-reported outcomes-to determine whether a patient can achieve clinical benefit after orthopaedic surgery. However, it is proposed to be crucial to separate the idea of meeting a clinically established threshold of patient-reported outcome measures (PROMs), which could truly predict patient-reported satisfaction with that outcome.

Purpose: To investigate the association between achieving MCID and patient-reported satisfaction after arthroscopic superior capsular reconstruction with fascia lata autografts for irreparable massive rotator cuff tears.

Comparative clinical outcomes and patient satisfaction in primary vs. revision total elbow arthroplasty.

Background: Total elbow arthroplasty has become a common surgical procedure. However, a certain percentage of patients may require revision due to unsatisfactory outcomes or complications. This study aimed to compare the clinical outcomes and patient satisfaction between primary and revision total elbow arthroplasty (TEA), considering factors such as etiology and causes for revision.

Muscle-guided mapping of post-traumatic heterotopic ossification of the elbow: a novel computed tomography-based study.

Background: Heterotopic ossification (HO) involves abnormal bone formation in soft tissues near joints, commonly occurring after elbow trauma or surgery, leading to pain and functional limitations. Previous studies have primarily characterized HO distribution based on bony landmarks, lacking a detailed investigation into the characteristics of its distribution in periarticular soft tissue in post-traumatic elbows. This study aimed to (1) develop a muscle-guided classification system using computed tomography (CT) to map HO relative to elbow muscle-tendon units and (2) investigate correlations between HO location and severity.

Orthopedic surgeon level joint angle assessment with artificial intelligence based on photography: a pilot study.

Unlabelled: Accurate assessment of shoulder range of motion (ROM) is crucial for evaluating patient progress. Traditional manual goniometry often lacks precision and is subject to inter-observer variability, especially in measuring shoulder internal rotation (IR). This study introduces an artificial intelligence (AI)-based approach that uses clinical photography to improve the accuracy of ROM quantification.

Surgical Outcomes of Lateral Ulnar Collateral Ligament Reconstruction Versus Repair for Posterolateral Rotatory Instability of the Elbow: A Systematic Review and Meta-analysis.

Background: The aim of surgical treatment for posterolateral rotatory instability (PLRI) of the elbow is to restore the integrity of the lateral ulnar collateral ligament (LUCL), with ligamentous reconstruction being the preferred option for recurrent symptomatic PLRI. However, there is no clinical evidence demonstrating the superiority of reconstruction versus repair. Treatment options currently depend on the cause of the LUCL injury and surgeon preference.

Arthroscopic-Assisted Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Technical Note.

The lateral collateral ligament complex of the elbow is pivotal for maintaining the stability of the elbow joint. The open technique for reconstructing the lateral ulnar collateral ligament (LUCL) is a standard procedure to treat elbow instability caused by LUCL deficiency. Nevertheless, as arthroscopy procedures in the elbow have advanced, we describe an arthroscopic technique to reconstruct the LUCL with suture anchors and bone tunnel techniques.

Combined Superior Capsular Reconstruction Using Fascia Lata Autograft and Lower Trapezius Transfer Using Achilles Tendon Allograft Are Associated With Improved Surgical Outcomes in Patients With Chronic Posterosuperior Irreparable Massive Rotator Cuff Tears.

Purpose: To evaluate the minimum 12-month clinical and radiologic outcomes of combined superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) for posterosuperior irreparable massive rotator cuff tears (IMRCTs).

Methods: Patients with posterosuperior IMRCTs and severe fatty infiltration (Goutallier grade ≥3) of the infraspinatus who underwent combined SCR and LTT were retrospectively reviewed. A double-folded fascia lata autograft with 1 layer of polypropylene mesh inside was used for SCR, and an Achilles tendon allograft was used to connect the tendon of the lower trapezius to the greater tuberosity.

Surgical outcomes and complication rates of arthroscopic-assisted fixation versus open fixation for coronoid fractures: A systematic review and meta-analysis.

Background: Coronoid fractures often occur with complex elbow dislocations, accounting for 15% of elbow fractures. The effectiveness of open reduction internal fixation (ORIF) versus arthroscopic-assisted reduction internal fixation (ARIF) surgeries for coronoid fractures remains uncertain. This study aimed to compare the outcomes of these two surgical approaches in treating varus posteromedial injuries.

Osteoarthritis of Proximal Radioulnar Joint: Computed Tomography-Based Assessment and Associations with Clinical Findings.

Background: Although many studies have focused on the degenerative changes of the ulnohumeral and radiohumeral joints in osteoarthritis (OA) of the elbow, the proximal radioulnar joint (PRUJ), which facilitates the pronation and supination motions of the forearm, has not been comprehensively evaluated.

Purpose: To assess the prevalence of PRUJ OA in patients diagnosed with OA of the elbow using computed tomography (CT) images and to establish an association between the CT findings and clinical manifestations.

Study Design: Cross-sectional study; Level of evidence, 3.

Improved Acromiohumeral Distance Independently Predicts Better Outcomes After Arthroscopic Superior Capsular Reconstruction Graft Tears.

Purpose: To identify independent factors responsible for poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR).

Methods: Patients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. On the basis of the achievement of the minimal clinically important differences for clinical outcome measures at the final follow-up, patients were divided into the good outcome (GO) and poor outcome (PO) groups.

Clinical validation of enhanced CT imaging for distal radius fractures through conditional Generative Adversarial Networks (cGAN).

Background/purpose: Distal radius fractures (DRFs) account for approximately 18% of fractures in patients 65 years and older. While plain radiographs are standard, the value of high-resolution computed tomography (CT) for detailed imaging crucial for diagnosis, prognosis, and intervention planning, and increasingly recognized. High-definition 3D reconstructions from CT scans are vital for applications like 3D printing in orthopedics and for the utility of mobile C-arm CT in orthopedic diagnostics.

Basic to advanced elbow arthroscopy: the history, basic set up, and indications.

Elbow arthroscopy presents challenges; however, its indications and advantages over traditional open surgery are swiftly evolving. Despite being less widely performed than on other joints such as the knee, shoulder, ankle, and hip, arthroscopic management of the elbow has potential. The goals of this review are to describe and broaden the current applications of elbow arthroscopy.