This study compared the clinical and radiological outcomes of Onlay and Inlay Lower Trapezius Tendon (LTT) transfer techniques in managing posterosuperior Functional Irreparable Rotator Cuff Tears (FIRCTs). This retrospective comparative study included patients who underwent Onlay and Inlay LTT transfer. The inclusion criteria were FIRCTs defined by tendon retraction to the glenoid, fatty infiltration > 2 grade according to Goutallier, and with a positive External Rotation (ER) lag sign. Patients with irreparable subscapularis, dysfunctional deltoid, advanced glenohumeral osteoarthritis, cuff tear arthropathy, and revision surgeries were excluded. Outcomes measures included the active Range Of Motion (ROM), Acromiohumeral Distance (AHD), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score and Constant score. The study included 39 patients (21 Onlay and 18 Inlay LTT) with at least 2-year follow-up. Both groups achieved significant improvement in active forward elevation from 118.6 ± 57.6° to 145.7 ± 18° in the Onlay group (p = 0.046) and 112.2 ± 49.2° to 140.6 ± 30.6° in the Inlay group (p = 0.046). The ER improved from 31 ± 21.2°to 44.3 ± 16° in the Onlay (p = 0.027) and 29.4 ± 27.1° to 45 ± 16.9° in the Inlay group (p = 0.046). The postoperative AHD was better in the Onlay group (7.3 ± 2.5 vs. 4.8 ± 3.2 mm, p = 0.001). The ASES, SANE, and Constant scores all improved significantly at final follow-up (all p < 0.001) in both groups and reached the Minimal Clinically Important Difference. Both the onlay and Inlay techniques of LTT transfer effectively improved shoulder function in patients with irreparable posterosuperior rotator cuff tears. The Onlay technique resulted in better AHD at final follow-up.

2025 Neer Award Part 2: the PMADS trial: personality, motivation, and attitude determinants of success with rehabilitation for reverse total shoulder arthroplasty.

Biological augmentation in revision surgery: effect of a bioinductive collagen patch (REGENETEN) in patients with rotator cuff retear and a previous arthroscopic rotator cuff repair.

Arthroscopic Posterior Labral Repair of the Shoulder in Active-Duty Military Patients Shows Improvements in Patient-Reported Outcomes and High Return to Sports and Military Duty at a Minimum 10 Years Follow-Up.

Recent evidence has demonstrated short-term superiority of biceps tenodesis compared to superior labrum anterior-posterior (SLAP) repair for the management of symptomatic type 2 SLAP tears. Long-term comparative patient-reported outcomes and revision rates remain poorly described. To compare minimum 10-year outcomes of arthroscopic SLAP repair with those of mini-open subpectoral biceps tenodesis for type 2 SLAP tears in active-duty military patients younger than 35 years of age. Cohort study; Level of evidence, 3. Consecutive active-duty military servicemembers younger than 35 years of age at the time of surgery who underwent arthroscopic SLAP repair or mini-open subpectoral biceps tenodesis for type 2 SLAP tears between January 2010 and December 2015 with at least 10 years of follow-up were included. SLAP repair was performed if preoperative biceps testing did not elicit pain and, intraoperatively, the tendon appeared clinically normal. All other patients underwent biceps tenodesis. Patient characteristics, patient-reported outcome measures, range of motion, complications, and return to military duty were assessed. In total, 25 patients who underwent arthroscopic SLAP repair and 23 who underwent biceps tenodesis were included (mean follow-up, 146.5 ± 18.7 months). Ten patients (40%) for whom SLAP repair failed were analyzed separately from those who did not experience failure. Pain visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons scores improved significantly in the successful SLAP repair, failed SLAP repair, and tenodesis subgroups (P < .0188), with greater improvements in the successful SLAP repair and tenodesis groups. When compared to successful SLAP repair, patients undergoing tenodesis were significantly more likely to achieve substantial clinical benefit (SCB) for VAS scores (100.0% vs 33.3%; P < .0001) and Patient Acceptable Symptom State (PASS) and SCB for SANE scores (95.7% vs 53.3% [P = .0032] and 100.0% vs 13.3% [P < .0001], respectively). All patients for whom SLAP repair failed were revised to tenodesis at a mean of 68.7 ± 48.9 months, while none of the patients initially treated with tenodesis required revision (P = .0007). At the minimum 10-year follow-up, 40% of the military cohort younger than 35 years of age treated with SLAP repair experienced treatment failure and underwent subsequent revision to biceps tenodesis, compared with no revisions in patients who underwent biceps tenodesis as the index procedure. Furthermore, even with successful SLAP repair, patient-reported outcomes were inferior to those after biceps tenodesis. Overall, this study suggests that biceps tenodesis is superior to SLAP repair for the treatment of type 2 SLAP tears in active-duty military patients younger than 35 years of age.

The purpose of this study was to describe a novel, simple, and implant-free arthroscopic soft-tissue tenodesis technique of the long head of the biceps tendon (LHBT) to the rotator cuff using an absorbable monofilament suture and to evaluate its clinical and functional outcomes at a minimum 1-year follow-up. A retrospective case series of 23 patients (mean age 58.0 ± 7.8years) who underwent arthroscopic rotator cuff repair with concomitant LHBT soft-tissue tenodesis between June 2021 and June 2023 was analyzed. Functional outcomes were assessed using Constant-Murley Score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and the Long Head of Biceps (LHB) score. Supination strength was measured with a handheld dynamometer and compared with the contralateral side. Incidence of Popeye deformity and tenderness over the bicipital groove were recorded. Objective Popeye deformity was observed in 13% of patients, with subjective concern reported by only 4.3%. Supination strength and LHB scores were similar to the contralateral side (means of 104.65 versus 104.64 N; LHB 93.7 versus 94.6 points). The mean CMS and ASES scores were 90.3 ± 12.4 and 89.6 ± 15.9 points, respectively. The SANE score averaged 87.4 ± 20.9, and the VAS for pain was low (1.65 ± 2.59cm). This implant-free, arthroscopic LHBT soft-tissue tenodesis technique is technically simple, cost-effective, and yields excellent clinical and functional outcomes with minimal cosmetic concerns. It represents a reliable option for patients undergoing rotator cuff repair with concurrent LHBT pathology. Level IV.

A comparison of reverse shoulder arthroplasty and glenohumeral arthrodesis for end-stage shoulder instability.

End-stage glenohumeral joint arthritis in young patients is difficult to manage due to increased physical demands and the need for prolonged implant longevity. Because of this, many surgeons prefer hemiarthroplasty (HA) over traditional anatomic total shoulder arthroplasty (TSA). This study aimed to compare the implant survivorship and patient-reported outcomes of HA versus TSA performed in patients under 40 years old. This study was a retrospective analysis of patients at a single institution who underwent HA or TSA at age 40 or younger with at least 5-year follow-up from their index surgery or until documented implant failure. Preoperative data collected included demographic variables, number of prior surgeries, and indication for shoulder arthroplasty. Postoperative data collected included implant survivorship, range of motion, pain visual analoge scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores. The final analysis included 18 patients who underwent HA and 45 patients who underwent TSA. The average follow-up period was 7.8 ± 2.8 years among HA patients versus 9.6 ± 3.9 among TSA patients. Post-traumatic arthritis was the most common indication for both HA (39%) and TSA groups (47%). Five (21.7%) HA patients underwent revision, most commonly for glenoid wear. Thirteen (28.9%) TSA patients were revised, most commonly for rotator cuff failure. Among revision cases, the mean time to revision was 6.2 ± 5.5 years for HA patients and 8.6 ± 6.0 years for TSA patients (p = 0.521). There were no significant differences between the cohorts for revision rate (p = 0.577) and the 5-year Kaplan-Meier survival rate (88.9% for HA vs. 93.3% for TSA, p = 0.364). There were no significant differences in postoperative ASES, SANE, and VAS between the two cohorts (p > 0.05). HA and TSA yielded comparable implant survivorship and patient outcomes in patients under the age of 40 at 5-year follow-up. Although glenoid arthrosis remains a concern, HA should not be excluded as a surgical choice for younger patients and should be considered on a case-by-case basis. Level III-Retrospective Cohort Study.

Outcomes of arthroscopic management of bony Bankart (BB) lesions may result in higher reinjury rates, revision surgeries, and return-to-sport outcomes compared with adolescent patients with no bony Bankart (NBB) lesions. Adolescent patients undergoing arthroscopic stabilization (2010 to 2023) with a minimum of 2 years follow-up were categorized into BB and NBB cohorts based on MRI and intraoperative findings. Preinjury glenoid diameter was estimated using a best-fit circle technique. Data collected included demographics, injury details, surgical techniques, and surgical outcomes. Patient-reported outcomes were assessed using single assessment numeric evaluation (SANE), pediatric/adolescent shoulder survey (PASS), and quick Disabilities of the Arm Shoulder and Hand (qDASH) scores. Fifty patients were analyzed (25 BB, 25 NBB), with mean age 16.9±0.9 years (BB) and 16.6±1.0 years (NBB) ( P =0.32), and overall mean follow-up 4.2 years. BB was associated with males ( P =0.02) and collision mechanisms of injury ( P =0.02). BB utilized more suture anchors (6.0±1.2 vs. 4.9±1.4) ( P =0.005). Preinjury glenoid diameter was larger in the BB (29.9±2.6 vs. 26.2±2.3mm) ( P <0.001). Mean sagittal width of the BB fragment measured 5.7±1.5mm (range: 3 to 10mm) and represented a mean glenoid bone loss of 18.9%±4.5%. Surgery failure rates (32% BB vs. 32% NBB), revision surgery rates (12% BB vs. 4% NBB), and return to sport rates (88% BB vs. 80% NBB) were not significantly different. SANE scores were higher with BB (91.2±9.9 vs. 85.2±12.8) ( P =0.03), yet no differences were found in PASS and qDASH outcomes. BB was associated with larger glenoid diameters, male sex, and collision injuries, but outcomes did not appear to vary when compared with NBB shoulders, refuting the hypothesis that bony Bankart shoulders would have poorer short-term to mid-term outcomes over time compared with those with only soft-tissue injury. Recurrent instability and revision surgery rates remain high in this youthful population regardless of the presence of a bony Bankart-associated anterior instability.

Evaluating the efficacy of intra-articular human amniotic suspension allografts for knee osteoarthritis management: A systematic review and meta-analysis.

In 2023, the first North American Hip Arthroscopy Registry was released: the Hip Surgical Treatment Registry (HipSTR). HipSTR is a prospective web-based data collection registry designed to gather baseline patient information, procedural data, and surgical outcomes. To present the initial demographic and surgical overview data for patients enrolled in 2023. Cohort study; Level of evidence, 3. Beta testing of HipSTR occurred between February 2023 and July 23, 2023, by 7 surgeons on >400 patients. Starting July 23, 2023, HipSTR was made available for enrollment by North American orthopaedic surgeons. HipSTR is a free, digitally administered registry integrated with cloud-based (Patient IQ) outcome database capturing preoperative demographics, patient-reported outcome (PRO) measures, and intraoperative surgical data. As of December 31, 2023, 14 surgical sites with 21 participating surgeons were enrolling hip arthroscopy patients, totaling 1098 patients in the calendar year 2023. The registry included 65% female patients and 34% male patients, with a mean age of 36.6 ± 14 years. Baseline compliance was 90%. Mean preoperative PRO measures (the 12-item International Hip Outcome Tool, EuroQol 5 Dimension 5 Level Visual Analog Scale, and Hip Single Assessment Numeric Evaluation scores) were 39.7 ± 19.0, 69.6 ± 19.6 and 39.1 ± 21.7, respectively, indicating the significant impact of their hip pain. In total, 315 patients described themselves as an athlete. Surgical findings revealed a variety of hip pathology, including 45% CAM lesions, 43% labral tears, 38% acetabular chondral lesions, 26% pincer morphology. Among patients with CAM and pincer/anterior inferior iliac spine morphology, 98% and 75% underwent femoral osteoplasty and acetabuloplasty, respectively. Additionally, 56% of all patients with acetabular cartilage injury underwent acetabular chondroplasty and 9% underwent microfracture. Notably, 16% of patients had prior surgery on their affected hip. Formal capsulotomies were performed in 68.3% of patients and of these, 83% had their capsulotomy fully repaired. These findings provide initial insights into the demographics and clinical profiles of North American patients undergoing hip arthroscopy as well as the types of procedures performed. These data, along with future contributions as the registry expands, will enhance understanding of the pathologies managed with hip arthroscopy, evaluate PRO measures to assess procedural efficacy, and guide efforts in the prevention and management of hip pain.

Cold therapy devices (CTDs) have been shown to provide analgesia, reduce swelling, and improve outcomes following orthopedic procedures. However, comparative data on postoperative narcotic use and pain control between CTDs and traditional ice packs remain limited. This study evaluates patient satisfaction and opioid use among those using CTDs after carpometacarpal (CMC) arthroplasty or distal radius open reduction internal fixation (ORIF). A prospective analysis was conducted on 124 patients who underwent hand surgery by a single fellowship-trained surgeon between June 2023 and February 2025. A total of 92 patients who underwent CMC arthroplasty or distal radius ORIF were included. Patient-reported outcomes on pain relief, cryotherapy use adherence, and opioid usage were compared between CTD users and those using traditional ice packs. In CMC arthroplasty patients, CTD users reported significantly higher pain relief scores (9.56/10 vs 3.42/10, P < .001) and greater adherence (>3 sessions/day: 94.4% vs 36.8%, P < .001) than ice pack users. Similar patterns were observed in distal radius ORIF patients, with higher CTD usage at both 3 and 7 days postoperatively (96% vs 11% and 88% vs 11%, respectively; P < .001). In distal radius ORIF patients, CTD users demonstrated a significant increase in 6-week Single Assessment Numeric Evaluation (SANE) score. No significant difference in oxycodone consumption was observed between groups for either procedure. CTD use following CMC arthroplasty and distal radius ORIF is associated with improved pain relief and adherence with cryotherapy. Although opioid use did not differ significantly, CTDs show promise as an adjunct for postoperative pain management in hand and wrist surgery.

Short-term follow-up of arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring autograft with suture tape reinforcement as an internal brace.

Superior Capsular Reconstruction With Acellular Dermal Allograft Improves Midterm Clinical Outcomes but Is Associated With High Rates of Graft Failure and Progression of Cuff Tear Arthropathy.

Proximal tibiofibular joint (PTFJ) instability is a relatively rare clinical condition, and the establishment of an evidence-based standard of care remains an ongoing challenge because of its low incidence in the literature. Current reports in the literature focus on isolated PTFJ reconstruction, and there remains to be any report on outcomes of PTFJ reconstruction performed concurrently with procedures for associated knee injuries, such as lateral collateral ligament (LCL) insufficiency coupled with tibiofibular instability. To assess subjective and clinical outcomes after combined reconstruction of the LCL and PTFJ utilizing a semitendinosus allograft in the setting of anterior PTFJ instability and concomitant knee injuries requiring additional procedures. Case series; Level of evidence, 4. A retrospective review was conducted on consecutive patients who underwent anatomic PTFJ reconstruction utilizing a semitendinosus allograft from 2016 to 2021, with a ≥2-year follow-up. Exclusion criteria included ipsilateral concomitant lower extremity fracture, prior knee surgery, previous diagnosis of connective tissue disorder, and postoperative follow-up <2 years. Clinical outcomes were measured by PROs (return to function, return to play, International Knee Documentation Committee [IKDC], Single Assessment Numeric Evaluation score, Lysholm score, 12-item Short Form Health Survey, and range of motion), radiographic parameters, and subjective outcome measures obtained through a retrospective chart review, as well as a patient outcomes questionnaire. Between August 2016 and November 2021, 29 patients underwent combined PTFJ and LCL reconstruction by the senior author. Of these, 25 patients (86%) met inclusion criteria and had a mean follow-up of 4.3 ± 2.1 years. Concomitant procedures were performed in 20 patients (80%), including anterior cruciate ligament reconstruction (48%), PCL reconstruction or repair (12%), and meniscal procedures (52%). Significant improvements were observed in patient-reported outcome measures, including the Lysholm score (preoperatively: median, 49 [IQR, 30-56]; follow-up: median, 95 [IQR, 76-95]; P < .001), IKDC (preoperatively: median, 34 [IQR, 18-54]; follow-up: median, 83 [IQR, 72-95]; P < .001), and Western Ontario and McMaster Universities Osteoarthritis Index total score (preoperatively: median, 36 [IQR, 21-49]; follow-up: median, 2 [IQR, 0-7]; P < .001). No patients required revision surgery related to the combined reconstruction. Sporting activity level remained high at follow-up (Tegner Activity Scale: median, 6.0 [IQR, 3.0-7.0]). Favorable outcomes can be expected after combined LCL and PTFJ reconstruction utilizing a semitendinosus allograft, even when performed alongside other procedures for concomitant injuries.

Standard vs. the alternative centerline technique for baseplate fixation in reverse shoulder arthroplasty: a comparison of anterior shoulder pain.

Preoperative patient expectation was found to be a significant predictor of post-operative outcomes and satisfaction in elective orthopedic surgery, including Rotator cuff repair (RCR). Given their knowledge and clinical expertise, surgeons are thought to be better at predicting patient outcomes than patients themselves. Thus, surgeon prediction of surgical outcomes could be used to set realistic patient expectations ahead of surgery to optimize outcomes. The purpose of the study was to determine the surgeon's and patient's accuracy in predicting patient's outcome one year following RCR. Data was collected in a healthcare registry as standard of care for all patients undergoing RCR from January 1 to December 31, 2022 at a single surgical center. The primary outcome was the SANE (Single-Assessment Numeric Evaluation) score where patients rate their shoulder function out of 100%, preoperatively and at one-year postoperatively. The surgeon was asked to predict the 1-year SANE score immediately following completion of the surgery. A repeated-measures ANOVA compared surgeon-predicted, patient-predicted, and actual mean 1-year post-operative SANE scores. The differences between actual and surgeon-predicted SANE scores, and actual and patient-predicted SANE scores were calculated. An “accurate prediction” was defined a priori as a difference being within +/−5% of the patient's achieved SANE. Sixty-nine patients were included in this study with a mean age of 60.9 (SD=6.9) years and of which 77% (N=53) were male. Mean surgeon-predicted 1-year postoperative SANE score was 77.6% (range 60–95%, SD= 6.8%), mean patient-predicted SANE was 88.7% (range 50–100%, SD=11.1%), and mean achieved SANE was 80.6% (range 8–100%, SD=19%) (p mean surgeon-predicted (p no statistical difference between mean surgeon-predicted and mean actual postoperative SANE. When assessing the distribution of the patient and surgeon predictions of outcomes, 24 patients and 14 surgeons predicted a SANE score that was higher than the patient's achieved SANE score. On the other hand, 31 surgeons and nine patients predicted a SANE score that was lower than the patient's achieved SANE score. The findings of this study demonstrate discrepancy between surgeon prediction and patient expectation of the one-year outcome following RCR. Surgeons on average were better than patients at predicting outcomes of RCR surgery. Additionally, surgeons tended to underestimate outcome while patients tended to overestimate outcome. This raises the importance of preoperative patient counselling to set more realistic expectations that could potentially improve their outcomes after RCR. This could be achieved using the surgeon's prediction of outcome as a benchmark.

Scaphoid non-union is associated with significant morbidity, and up to a 56% risk of post-traumatic arthritis if untreated. Thus, surgical intervention of a scaphoid non-united fracture (SNUF) is important to improve healing and subsequent function. Optimal treatment is still debated and is dependent on various factors including fracture morphology, patient factors, and time since injury. In the context of minimally displaced waist fractures, scaphoid non-union in-situ fixation (SNIF) is a viable treatment modality, and some studies have shown union rates of 89–100%. However, current literature consists of small sample sizes of healthy patients with restrictive inclusion criteria (minimally displaced fractures, no humpback deformity or cystic change at the fracture site, patients treated within 6 months of injury), limiting its relevance to the real-world population. The purpose of our study was to report on the outcomes of SNIF in an inclusive patient population. This is a multi-centre retrospective cohort study investigating in-situ screw fixation of SNUFs treated at tertiary referral hospital. Patients were followed until at least union was achieved or non-union was confirmed. Data on patient demographics, comorbidities, operative details and preoperative radiographic data were collected. Our primary outcomes were rate of union and time to union. Secondary outcomes included wrist range of motion, patient reported outcome measures (PROMs) including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient Related Wrist Evaluation (PRWE), and Single Assessment Numerical Evaluation (SANE) scores, as well as the rates of complications and revisions. 20 patients age 34±16yrs, 92% male, met the inclusion criteria with mean follow-up of 12.6±8.3 months. Five patients (25%) were smokers, one (5%) was diabetic. Average time from injury to surgery was 11.9±7.4mo. Dorsal approach was used in 75% of cases. All patients had fixation with a single 3.5mm headless compression screw. Two patients had concomitant bone grafting in-situ through the screw hole. Seven were proximal pole fractures and 13 (63%) were waist fractures. Humpback deformity as measured by height-length ratio (HLR) on sagittal 3D computed tomography imaging was 0.82±0.12 preoperatively and 0.72±0.16 postoperatively. As per Slade and Dodds classification, 17% had grade 3 and 83% had grade 4 cystic changes at the nonunion site. Twelve patients (67%) achieved &gt;50% union at 6 weeks, 14 (82%) by 12 weeks, and 16 (89%) by one year. Four patients (11%) went on to non-union. There were no other post-operative complications, and no patients required revision surgery. Wrist extension (pre-op 50±11 o, post-op 63±13o) and flexion (pre-op 66±18o, post-op 72±15o) improved post-operatively, but as expected, there was no significant change in supination (pre-op 73±12o, post-op 80±10o) or pronation (pre-op 75±11o, post-op 76±7o). Mean post-op PROMs were QuickDASH of 9±7, PRWE 16±11, and SANE 78±19. SNIF is an effective treatment for SNUF with a high rate of union and low complication rate in appropriately selected patients with minimally displaced scaphoid waist non-unions.

To compare the postoperative side-to-side laxity and short-term clinical outcomes of patients who received primary anterior cruciate ligament (ACL) repair with suture tape augmentation, acute anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation performed within eight weeks of injury (ACLRacute), or ACLR beyond eight weeks of injury. After institutional review board approval was obtained, 100 patients were enrolled in this prospective trial: 34 primary ACL repair with suture tape augmentation, 33 ACLRs performed within eight weeks of injury (ACLRacute), and 33 ACLRs. Patients were allocated to ACL repair if a proximal avulsion was present with good tissue quality (Sherman type 1), confirmed by intraoperative diagnostic arthroscopy. Preoperative side-to-side anteroposterior knee laxity was assessed with KT-1000 arthrometer, and patient-reported outcomes (PROs) including the visual analog scale, Marx activity scale, Veterans RAND 12-item health survey (VR-12 physical &amp; mental), Single Assessment Numeric Evaluation, Knee Injury and Osteoarthritis Outcome Score survey subscales, and range of motion were collected. These objective and subjective measures were repeated at regular intervals postoperatively through 2 years. Minimal clinically important difference calculations were performed assessing postoperative PRO changes at 2 years compared with preoperative. The average time from injury to surgery was 5.03 ± 1.2 weeks for the ACL repair group, 5.09 ± 0.74 weeks for the ACLRacute, and 43.22 ± 33.5 weeks for the ACLR group. Postoperatively, the KT-1000 side-to-side laxity difference for 30 lbs was determined to be 0.1 ± 0.37 (95% confidence interval [CI] –0.7 to 0.8) for ACL repair versus ACLR (P &lt; .0001), –0.8 ± 0.35 (95% CI –1.5 to –0.1) for ACLRacute versus ACLR (P &lt; .0001), and 0.8 ± 0.40 (95% CI 0.0–1.6) for ACL repair versus ACLRacute (P &lt; .0001). The data reveal ACL repair and ACLRacute are noninferior to ACLR at 2-year follow-up. The postoperative difference from baseline for all PROs demonstrated improvement for all PROs. Magnetic resonance imaging at one year revealed tissue healing for the three ACL injury treatment groups. Patients who underwent ACL repair of proximal tears with suture tape augmentation or ACL reconstruction within eight weeks from injury resulted in noninferior side-to-side knee laxity, comparable PROs, and similar range of motion at 2-year follow-up compared with ACLR.

The long-term clinical and radiographic outcomes for smooth stem metallic radial head replacements (RHR) used for acute radial head fractures are currently unknown. Short to medium term outcomes (mean 8 years) have been published on this population cohort (1–3). This is an updated study reporting the long-term clinical and radiographic outcomes. A retrospective review was performed of patients who underwent a smooth stem RHR for acute fractures (&lt; 4 weeks from fracture date) at a single upper extremity referral center. Patients returned for assessment and outcome measures including patient-rated elbow evaluation (PREE), Mayo elbow performance index (MEPI), single assessment numeric evaluation (SANE), disabilities of the arm, shoulder and hand (DASH), short-form 12 (SF-12), physical examination and radiographic evaluation. Elbow and forearm motion and grip strength were measured where possible. Thirty-one patients with 32 RHR participated in the study. The mean follow up was 17±4years. The mean age at injury was 51±13 and at follow up was 69±10. Twenty-two (71%) patients were female. Eight elbows (25%) had an isolated radial head injury with replacement. Conversely 24 (75%) elbows had an associated injury with 7 (32%), 11 (34%), 16 (50%) and 1(3%) having an elbow dislocation, coronoid fracture, lateral collateral ligament repair (LCL) and LCL plus medial collateral ligament repair, respectively. One RHR was excised for infection. The mean PREE score, MEPI, SANE and DASH scores were 10/100, 92/100, 93/100 and 11/100, respectively. Regarding the MEPI score, 19 (59%), 10 (31%) and 3 (9%) elbows had excellent, good and poor results. Mean elbow extension was 8±10°, flexion was 133±10°, pronation was 87±8° and supination was 76±16°. The mean grip strength of the affected side was 91% compared to the unaffected side. The mean pinch strength of the affected side was 95% compared to the unaffected side. Radiographic changes were mild when assessing for osteopenia, ulnohumeral arthritis, periprosthetic lucency and heterotopic ossification. Three patients (9%) had complications. One patient (3%) required surgery with removal of the RHR due to infection. This patient required further surgery for contracture release and ulnar nerve decompression. One patient had delayed ulnar neuropathy and another patient had complex regional pain syndrome, both patient's symptoms resolved without surgery. The long-term outcomes of acute radial head fractures managed with a smooth stem metallic radial head replacement were good to excellent in a high percentage of patients. Patients returned to and maintained high function in terms of PROMs, range of motion, and strength. Complications and post-traumatic arthritis did occur, however, at a low frequency.