Orthop Clin North Am
· 2026 Apr · PMID 41856744
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Gluteal tendon tears are an increasingly recognized source of laterally based hip pain. These tendon tears are typically degenerative in nature and require careful history, physical examination, and imaging interpretatio...Gluteal tendon tears are an increasingly recognized source of laterally based hip pain. These tendon tears are typically degenerative in nature and require careful history, physical examination, and imaging interpretation for accurate diagnosis. After a trial of nonoperative management, open or endoscopic repair can predictably improve pain, though expected functional improvement is correlated to the degree of preoperative muscle atrophy. The authors advocate for an open double-row suture technique to reliably visualize the full extent of the tear, restore the anatomic footprint of the avulsed tendons, and achieve stable fixation.
Orthop Clin North Am
· 2026 Jan · PMID 41242828
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The management of mangled extremities has long produced contention among the orthopedic surgery community due to the complexity of injuries and difficulty predicting postoperative outcomes for limb reconstruction and amp...The management of mangled extremities has long produced contention among the orthopedic surgery community due to the complexity of injuries and difficulty predicting postoperative outcomes for limb reconstruction and amputation. This review discusses reliable prognostic indicators as well as socioeconomic factors that can drastically alter the feasibility and burden of various treatments for mangled lower extremity patients and treating surgeons. This review emphasizes an integrated, multidisciplinary approach to mangled extremity management, allowing for efficient utilization of resources and prompt stabilization and fixation for patients. The guidelines detailed in this review may expedite clinical decision-making and improve outcomes for future patients.
Orthop Clin North Am
· 2026 Jan · PMID 41242827
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The management of mangled extremities has long produced contention among the orthopaedic surgery community due to injury complexity and difficulty predicting postoperative outcomes for limb reconstruction and amputation....The management of mangled extremities has long produced contention among the orthopaedic surgery community due to injury complexity and difficulty predicting postoperative outcomes for limb reconstruction and amputation. This review discusses a series of reliable prognostic indicators and socioeconomic factors that can drastically alter the feasibility and burden of various treatments for mangled lower extremity patients and treating surgeons. This review emphasizes an integrated, multidisciplinary approach to mangled extremity management, allowing for efficient utilization of resources and prompt stabilization and fixation for patients. The guidelines detailed in thie review may expedite clinical decision-making and improve outcomes for future patients.
Orthop Clin North Am
· 2026 Jan · PMID 41242826
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Return to sport (RTS) after shoulder stabilization surgery is a critical milestone for athletes. However, emerging evidence supports a shift toward objective, individualized assessments. This article reviews evidence-bas...Return to sport (RTS) after shoulder stabilization surgery is a critical milestone for athletes. However, emerging evidence supports a shift toward objective, individualized assessments. This article reviews evidence-based RTS criteria, emphasizing the role of range of motion, strength, stability, and power metrics in optimizing recovery and minimizing reinjury risk. Functional testing using dynamometry, force plates, and velocity tracking provides measurable benchmarks to assess readiness. Despite advancements, no universal RTS guidelines exist, and variability persists across institutions. By integrating sport-specific functional testing with biologic healing considerations, clinicians can enhance decision-making, ensuring athletes return to play safely and effectively.
Orthop Clin North Am
· 2026 Jan · PMID 41242825
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Proximal humerus fractures occur frequently, especially in the aging population, and require a tailored approach considering patient-specific factors like age, activity level, and comorbidities. While nonoperative treatm...Proximal humerus fractures occur frequently, especially in the aging population, and require a tailored approach considering patient-specific factors like age, activity level, and comorbidities. While nonoperative treatment is common, surgical options such as open reduction internal fixation, reverse total shoulder arthroplasty (rTSA), and hemiarthroplasty are available based on fracture complexity and patient needs. Recent studies highlight the potential benefits of acute rTSA over delayed procedures, emphasizing improved outcomes in range of motion and reduced complications. Treatment choice should align with the patient's functional goals and lifestyle, ensuring optimal recovery and satisfaction.
Orthop Clin North Am
· 2026 Jan · PMID 41242824
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Although many hand and wrist complaints during pregnancy improve with non-operative treatment, these conditions can significantly alter quality of life and may benefit from surgery if unable to be managed conservatively....Although many hand and wrist complaints during pregnancy improve with non-operative treatment, these conditions can significantly alter quality of life and may benefit from surgery if unable to be managed conservatively. However, as there is a theoretically higher risk of teratogenic effects in the first trimester, it is recommended that non urgent or elective surgery be delayed until the second trimester. Orthopedic surgeons should be aware of dosages of local anesthetics, especially when combined with vasoconstrictors, such as epinephrine. Patients with pregnancy-related comorbidities may be more prone to experience side effects with these medications at even standard dosages.
Orthop Clin North Am
· 2026 Jan · PMID 41242823
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Developmental dysplasia of the hip remains a significant cause of hip pain, hip joint dysfunction, and premature hip osteoarthritis worldwide. The typical deformity involves anatomic acetabular insufficiency, with decrea...Developmental dysplasia of the hip remains a significant cause of hip pain, hip joint dysfunction, and premature hip osteoarthritis worldwide. The typical deformity involves anatomic acetabular insufficiency, with decreased acetabular contact area and subsequent overload of the acetabular rim. Bernese periacetabular osteotomy, a complex and powerful acetabular redirectional surgery, first described by Ganz and colleagues in 1988, remains a reliable option to manage the skeletally mature dysplastic hips with excellent outcomes precluding the need for a hip joint arthroplasty at an early age.
Brooks JT, Glover B, Weldon E
… +2 more, Sample K, Hariharan A
Orthop Clin North Am
· 2026 Jan · PMID 41242822
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Vertebral body tethering (VBT) is a growth-modulating, motion-preserving surgical alternative to posterior spinal fusion for select patients with adolescent idiopathic scoliosis. This review critically appraises the curr...Vertebral body tethering (VBT) is a growth-modulating, motion-preserving surgical alternative to posterior spinal fusion for select patients with adolescent idiopathic scoliosis. This review critically appraises the current evidence surrounding VBT, including surgical indications, technical considerations, radiographic and functional outcomes, and comparative data versus fusion and emphasizes patient selection based on skeletal maturity. The article also explores emerging applications in skeletally mature and non-idiopathic populations and highlights ongoing innovations in implant design and predictive modeling. Standardization in reporting and the need for long-term outcome data are identified as key areas for future development to define VBT's role in modern scoliosis care.
Orthop Clin North Am
· 2026 Jan · PMID 41242821
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Proximal humerus fractures are common among elderly patients and in some cases require operative intervention. Appropriate management of complex fracture patterns remains controversial. Non-operative management and locke...Proximal humerus fractures are common among elderly patients and in some cases require operative intervention. Appropriate management of complex fracture patterns remains controversial. Non-operative management and locked plating have been mainstays of treatment in recent decades. Arthroplasty is gaining popularity as a treatment option; however, indications are not well-defined. Individual patient factors, such as pre-injury functionality, expectations, and local bone quality, should be considered when deciding on a treatment plan.
Orthop Clin North Am
· 2026 Jan · PMID 41242820
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With the rates of total knee arthroplasty continuing to rise in the coming decades, large efforts have been made to provide a more reliable result. Pre-operative optimization of patients undergoing total knee arthroplast...With the rates of total knee arthroplasty continuing to rise in the coming decades, large efforts have been made to provide a more reliable result. Pre-operative optimization of patients undergoing total knee arthroplasty is beneficial in decreasing complications. Understanding common factors that put patients at increased risk, as well as some absolute contraindications to total knee arthroplasty, is important in patient selection and planning during the peri-operative period. While concrete guidelines on these factors are not universally utilized, understanding the risks associated with each and how to best treat them can allow surgeons to make a safer pre-operative plan.
Khury F, Ruff G, Sarfraz A
… +1 more, Schwarzkopf R
Orthop Clin North Am
· 2026 Jan · PMID 41242819
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The rise in solid organ transplantations (SOTs) has led to increased long-term survival and also a higher incidence of joint degenerative diseases, necessitating more total joint arthroplasties (TJAs). SOT recipients fac...The rise in solid organ transplantations (SOTs) has led to increased long-term survival and also a higher incidence of joint degenerative diseases, necessitating more total joint arthroplasties (TJAs). SOT recipients face unique challenges, including immunosuppression, infection risks, and altered bone metabolism, requiring meticulous perioperative management. Despite higher complication rates, TJAs in SOT patients provide significant pain relief and functional improvement. Preoperative evaluation, tailored antibiotic prophylaxis, and careful implant selection are crucial. Multidisciplinary collaboration is essential to optimize outcomes, reduce complications, and improve quality of life for this high-risk population.
Sheridan GA, Keogh CJ, Howard LC
… +3 more, Neufeld ME, Garbuz DS, Masri BA
Orthop Clin North Am
· 2026 Jan · PMID 41242818
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Although current complication rates of total hip arthroplasty, including instability, are exceedingly low, this was not always the case. The journey to low rates of prosthetic hip instability had humble beginnings. We de...Although current complication rates of total hip arthroplasty, including instability, are exceedingly low, this was not always the case. The journey to low rates of prosthetic hip instability had humble beginnings. We describe the evidence behind some of the major advances that have improved the rates of postoperative total hip arthroplasty instability over the last number of decades.
Holbrook HS, Wideman M, Hunter MC
… +6 more, Watkins A, Hoyer RW, Thompson NB, Calandruccio JH, Kaplan FTD, Weller WJ
Orthop Clin North Am
· 2025 Oct · PMID 41101925
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While the antegrade intramedullary pin remains a simple, inexpensive, and accessible technique with consistently favorable outcomes, retrograde headless compression screws offer a faster operative solution, with excellen...While the antegrade intramedullary pin remains a simple, inexpensive, and accessible technique with consistently favorable outcomes, retrograde headless compression screws offer a faster operative solution, with excellent radiographic alignment and low complication rates. The decision between these two implants should be individualized based on fracture pattern, implant availability, patient needs, and surgeon experience.
Orthop Clin North Am
· 2025 Oct · PMID 41101924
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Superior labrum anterior to posterior (SLAP) tears are highly prevalent in overhead athletes and heavy laborers. Biomechanical adaptations as well as anatomic factors make the area prone to injury with a diminished heali...Superior labrum anterior to posterior (SLAP) tears are highly prevalent in overhead athletes and heavy laborers. Biomechanical adaptations as well as anatomic factors make the area prone to injury with a diminished healing potential. Previously, SLAP tears were repaired frequently with often poor postoperative function secondary to increased stiffness. Recently, the trend has shifted toward addressing the bicep anchor with a bicep tenodesis. Return to sports is multifactorial and depends on type of activity; however, about 79.5% of athletes are able to return to sport after an isolated SLAP repair. The rate of return is lowest in professional pitchers.
White N, Ghisa C, Tran A
… +4 more, Haffner MR, Shybut TB, Getelman MH, Delman CM
Orthop Clin North Am
· 2025 Oct · PMID 41101923
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Posterior shoulder instability has emerged as an increasingly prominent concern for surgeons treating shoulder pathology. Previously estimated to account for only 5% to 10% of cases in the general population, it is now r...Posterior shoulder instability has emerged as an increasingly prominent concern for surgeons treating shoulder pathology. Previously estimated to account for only 5% to 10% of cases in the general population, it is now recognized that the true incidence is likely underestimated. This growing recognition highlights the need for tailored treatment strategies. Surgical patients without osseous involvement can achieve successful outcomes with arthroscopic labral repair, while those with glenoid bone loss exceeding 13.5% may benefit from procedures designed to restore glenoid bone width.
Orthop Clin North Am
· 2025 Oct · PMID 41101922
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Rotator cuff repair is a prevalent orthopedic procedure; however, it is associated with high retear rates in large, retracted, chronic, or revision cases. Augmentation techniques have been developed to enhance tendon hea...Rotator cuff repair is a prevalent orthopedic procedure; however, it is associated with high retear rates in large, retracted, chronic, or revision cases. Augmentation techniques have been developed to enhance tendon healing and improve clinical outcomes. A comprehensive literature review was performed using PubMed, Scopus, and Embase databases for studies related to augmentation in rotator cuff repair. Inclusion criteria were clinical studies, meta-analyses, and biomechanical investigations focusing on graft augmentation, biologics, and synthetic materials in tendon repair. Augmentation techniques have the ability to enhance tendon healing and reduce retear rates when indicated. Biological and synthetic materials offer advantages and limitations.
Orthop Clin North Am
· 2025 Oct · PMID 41101921
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Mild traumatic brain injury (mTBI) in children, commonly known as concussion, presents a significant public health concern, with sports-related concussions accounting for a substantial proportion of cases. Pediatric mTBI...Mild traumatic brain injury (mTBI) in children, commonly known as concussion, presents a significant public health concern, with sports-related concussions accounting for a substantial proportion of cases. Pediatric mTBI often results in diverse symptoms, from cognitive difficulties to emotional disturbances, affecting daily functioning, school attendance, and physical activity. Proper initial assessment, sideline evaluation, and multidisciplinary management, including use of standardized tools, are essential in promoting recovery. While most pediatric mTBIs resolve within weeks, emerging diagnostic and therapeutic strategies aim to enhance recovery and mitigate risks associated with prolonged symptoms or repeat concussions, ensuring a safe return to activities and sports.
McPhail CB, Rogers LJ, Reichle CE
… +1 more, Gibson A
Orthop Clin North Am
· 2025 Oct · PMID 41101920
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With the high rate of youth participation in sports, it is important for those responsible for maintaining the safety of athletes to be proficient in diagnosis and intervention of both catastrophic sports-related diagnos...With the high rate of youth participation in sports, it is important for those responsible for maintaining the safety of athletes to be proficient in diagnosis and intervention of both catastrophic sports-related diagnoses and other common sport-related injuries. The purpose of this article is to discuss current evidence for sideline management, diagnosis, and aftercare of concussion; exertional heat illness; sudden cardiac arrest; exertional sickling; and other sports-related injuries in adolescents.