Guyton GP, Harrast JJ, Martin DF
… +12 more, Armstrong AD, Azar FM, Garvin KL, Jeray KJ, McComis GP, Mencio GA, Nelson CL, Sebastianelli WJ, Taitsman LA, Van Heest AE, Wolf BR,
on behalf of the American Board of Orthopaedic Surgery (ABOS)
J Bone Joint Surg Am
· 2026 Jul · PMID 42154851
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➢ The American Board of Orthopaedic Surgery (ABOS) collects sequential Current Procedural Terminology (CPT)-coded surgical case lists both from Candidates for initial certification and from Diplomates participating in Ma...➢ The American Board of Orthopaedic Surgery (ABOS) collects sequential Current Procedural Terminology (CPT)-coded surgical case lists both from Candidates for initial certification and from Diplomates participating in Maintenance of Certification (MOC). Collectively, these case lists represent a unique and extensive sampling of orthopaedic surgical practices across the United States. ➢ Because revisions or additions to the CPT system often take many years to reflect changes in surgical practice, in 2022 the ABOS began adding special questions for recorded cases in which the CPT codes alone do not identify potentially new or controversial surgical choices. ➢ The responses are used primarily for the ABOS internal case selection process for oral examination, but the ABOS recognizes that these previously unreported data are also of broad interest to the orthopaedic community. ➢ The data from the ABOS CPT-specific special questions from 2022 to 2024 were collected and analyzed. Responses from both early-career Candidates for initial certification and mid-career MOC Diplomates are compared in this report. They provide insight into both established orthopaedic practices across the United States and evolving trends in surgical choices and education across multiple subspecialties.
J Bone Joint Surg Am
· 2026 May · PMID 42154836
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The rapid migration of total joint arthroplasty from hospitals to ambulatory surgery centers (ASCs) represents one of the most consequential structural changes in contemporary orthopaedics in the United States. In parall...The rapid migration of total joint arthroplasty from hospitals to ambulatory surgery centers (ASCs) represents one of the most consequential structural changes in contemporary orthopaedics in the United States. In parallel, surgeon equity ownership in ASCs has expanded, aligning clinical decision-making with financial participation. Although surgeon ownership is legal, common, and often associated with efficiency and innovation, it introduces complex questions regarding transparency, case selection, and public trust. As higher-risk patients remain hospital-based while lower-risk patients migrate to ASCs, outcome comparisons may become distorted, and incentives may be less visible. Current disclosure practices and benchmarking frameworks have not evolved to reflect these structural shifts. This article argues that surgeon ownership in the ASC era necessitates updated safeguards, including standardized ownership disclosure, risk-adjusted site-of-service reporting, independent case review mechanisms, and transparent equity life-cycle planning. Proactive governance, rather than reactionary regulation, is essential to preserve professionalism and patient trust as ambulatory arthroplasty continues to expand.
Wang B, Ye T, Xie X
… +5 more, Zhang B, Wang Y, Sun L, Luo C, Zhu Y
J Bone Joint Surg Am
· 2026 May · PMID 42154832
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BACKGROUND: Posterior cruciate ligament tibial avulsion fracture (PCLAF) is relatively rare. This fracture may be accompanied by soft tissue injuries, most commonly involving the medial collateral ligament (MCL). The pre...BACKGROUND: Posterior cruciate ligament tibial avulsion fracture (PCLAF) is relatively rare. This fracture may be accompanied by soft tissue injuries, most commonly involving the medial collateral ligament (MCL). The present study aimed to determine the rate of MCL injury and its association with fracture characteristics in patients with PCLAF. METHODS: Patients with PCLAF were identified with computed tomography, and associated ligamentous and meniscal injuries were evaluated with magnetic resonance imaging. Fracture morphology was assessed via heat maps and quantitative measurements. Receiver operating characteristic (ROC) curves and logistic regression analyses were utilized to identify predictors of MCL injury. RESULTS: A total of 148 ethnic Chinese patients with PCLAF were included (mean age, 48.1 ± 12.9 years; 33.1% female), and 28.4% had concomitant MCL injuries. MCL injuries were significantly associated with posterior horn tears of the medial meniscus (p < 0.001). Patients with MCL injuries exhibited a larger fracture distribution area on heat maps. Consistent with that finding, quantitative analysis showed that these patients had a significantly smaller fracture medial border (p < 0.001) and a significantly larger fracture anteroposterior diameter percentage (p < 0.001). Multivariable analysis identified a fracture anteroposterior diameter percentage of ≥50.2% as an independent predictor of MCL injury (odds ratio, 13.74; 95% confidence interval, 4.85 to 38.95; p < 0.001). CONCLUSIONS: MCL injury is relatively common in patients with PCLAF and tends to occur concomitantly with a larger avulsed fragment. The fracture anteroposterior diameter percentage may serve as a valuable predictor for identifying concomitant MCL injury. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Lopas LA, Jang Y, Liu Z
… +7 more, Slaven JE, Arnold JC, Haller JM, Marchand LS, Mau M, Kacena MA, Natoli RM
J Bone Joint Surg Am
· 2026 May · PMID 42149746
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BACKGROUND: Fracture nonunion remains a major clinical challenge. Although radiographic scores such as RUST (Radiographic Union Score for Tibial fractures) and mRUST (the modified version) are widely used to assess heali...BACKGROUND: Fracture nonunion remains a major clinical challenge. Although radiographic scores such as RUST (Radiographic Union Score for Tibial fractures) and mRUST (the modified version) are widely used to assess healing, there has been limited investigation into their longitudinal use. This study evaluated whether a log-logistic statistical model of radiographic healing scores over time could quantify differences between fractures that healed and those that went on to nonunion. METHODS: This retrospective cohort analysis added serial radiographs of 49 femoral shaft nonunions to radiographs from previous cohorts. Tibiae and femora were scored with RUST and mRUST, respectively. Scores were plotted over time and fitted to a log-logistic curve to generate a healing ("position") equation. Model-derived parameters (Yinf [ultimate score], k [a curve shape parameter], and thalf [time to half of the score change]) were compared between fractures that did and did not unite. Secondarily, first and second derivatives were used to describe the fracture healing "velocity" and "acceleration" for each group. RESULTS: A total of 613 fractures were analyzed: 234 tibial (196 healed, 38 nonunion) and 379 femoral (330 healed, 49 nonunion). In femoral fractures, Yinf, k, and thalf all differed significantly (p < 0.008) between healed and nonunion cases. In tibial fractures, Yinf and k differed (both p < 0.008), whereas thalf did not (p = 0.30). The first and second derivatives at the population level suggest early differences in healing kinematics between fractures that heal and those that go on to nonunion. CONCLUSIONS: This proof-of-concept study demonstrates that log-logistic modeling of radiographic scores can quantify differences in radiographic healing between femoral and tibial shaft fractures treated with intramedullary nails that will go on to union versus nonunion. Differences in healing velocity and acceleration may emerge early, supporting the potential of the longitudinal framework for earlier identification of fractures at risk for nonunion. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
J Bone Joint Surg Am
· 2026 May · PMID 42133722
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BACKGROUND: Arthroscopically assisted latissimus dorsi tendon transfer (LDT) offers a joint-preserving option for irreparable posterosuperior rotator cuff tears, but long-term efficacy remains uncertain. We report outcom...BACKGROUND: Arthroscopically assisted latissimus dorsi tendon transfer (LDT) offers a joint-preserving option for irreparable posterosuperior rotator cuff tears, but long-term efficacy remains uncertain. We report outcomes after a minimum of 10 years. METHODS: We retrospectively analyzed 33 shoulders in 33 patients (mean age, 62.2 years; 58% male; all ethnic Korean) after arthroscopically assisted LDT. Clinical assessment included range of motion and Constant-Murley, American Shoulder and Elbow Surgeons (ASES), and VAS pain scores. Osteoarthritis progression was assessed radiographically using the Hamada classification. Complications and reoperations, including reverse total shoulder arthroplasty (rTSA), were recorded. RESULTS: The Constant-Murley score increased from 48.2 to 62.7, the ASES score increased from 49.5 to 68.7, and VAS pain decreased from 5.0 to 2.3 (all p < 0.001). Forward elevation increased from 115° to 143° and external rotation at 90° of abduction increased from 22° to 51° (both p < 0.001). The mean Hamada grade increased from 1.2 to 2.4, but clinical scores and range of motion were similar in the 12 shoulders (36%) that progressed to grade 3 or higher. On magnetic resonance imaging at the final follow-up (mean, 134 months postoperatively), 19 transfers (58%) remained intact (Sugaya types I to III) and 14 (42%) had a full-thickness retear (Sugaya types IV and V). Outcomes were similar between patients with and without osteoarthritis progression, but patients with intact transfers had better forward elevation, external rotation at 90°, and ADLER (activities of daily living that require active external rotation) scores. Late subscapularis tears occurred in 10 shoulders (30%) and were associated with preoperative grade-2 fatty infiltration (p = 0.002). Three shoulders (9%) required conversion to rTSA. CONCLUSIONS: Arthroscopically assisted LDT improved pain and function for most patients with irreparable posterosuperior rotator cuff tears. Despite frequent radiographic osteoarthritis progression, clinical outcomes remained favorable, and most shoulders retained the native joint. LDT may serve as an option to delay rTSA in appropriately selected younger patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Li J, Rubin LE, Krishnan R
… +10 more, Blessing M, Townsend D, Tung WS, Zhao X, Treggiari M, He Z, Dai F, Lin HM, Leslie MP,
the Yale GENBA-THA study group
J Bone Joint Surg Am
· 2026 May · PMID 42127167
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BACKGROUND: The purpose of this study was to compare an anterior quadratus lumborum block (aQLB) plus a lateral femoral cutaneous nerve block (LFCNB) with periarticular and local infiltration analgesia (PALIA) in total h...BACKGROUND: The purpose of this study was to compare an anterior quadratus lumborum block (aQLB) plus a lateral femoral cutaneous nerve block (LFCNB) with periarticular and local infiltration analgesia (PALIA) in total hip arthroplasty (THA), with both modalities using dual glucocorticoids: hydrophilic dexamethasone sodium phosphate (DEX) and lipophilic methylprednisolone acetate (MPA). METHODS: A total of 192 patients were randomized to either PALIA or aQLB+LFCNB and received 60 mL of 0.2% ropivacaine, 10 mg of DEX, and 80 mg of MPA. The mean age of the 188 included patients was 61 years, 46% were male, 96% were non-Hispanic, and 82% were White. The primary outcome was opioid consumption, measured as oral morphine milligram equivalents (oMME), on postoperative day (POD) 1. Secondary outcomes included opioid consumption on POD 2, fasting serum glucose, white blood-cell count, Brief Pain Inventory (BPI) pain severity and interference, and functional recovery measures, including Activity Measure for Post-Acute Care (AMPAC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, from POD 0 to 1 year. RESULTS: Ninety-three patients in the aQLB+LFCNB group and 95 patients in the PALIA group were included in the final analysis. There was no significant difference in the primary outcome, oMME on POD 1, between the aQLB+LFCNB group (median, 29.84 [interquartile range (IQR): 17.72, 38.75]) and the PALIA group (median, 30.50 [IQR: 18.00, 42.00]) (p = 0.57). Except for fasting serum glucose on POD 1, which was lower in the aQLB+LFCNB group (median, 141.50 [IQR: 124.50, 163.50] mg/dL) than in the PALIA group (median, 153.00 [IQR 139.00, 180.00] mg/dL) (p = 0.003), no significant differences were observed in any of the other secondary outcomes. CONCLUSIONS: Patients who received aQLB+LFCNB with dual glucocorticoids and those who received PALIA with dual glucocorticoids demonstrated no significant differences in daily opioid consumption, pain score, or functional recovery following THA. LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
Hoy G, Burrows K, McBride A
… +3 more, Ross M, Davis K, Warby S
J Bone Joint Surg Am
· 2026 May · PMID 42127166
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BACKGROUND: Pyrocarbon hemiarthroplasty (HA) is a recent option for younger patients with end-stage glenohumeral joint (GHJ) arthritis. Early results are promising but limited by study bias. The aim of this study was to...BACKGROUND: Pyrocarbon hemiarthroplasty (HA) is a recent option for younger patients with end-stage glenohumeral joint (GHJ) arthritis. Early results are promising but limited by study bias. The aim of this study was to evaluate medium-term clinical and radiographic outcomes following PyroTITAN pyrocarbon HA. METHODS: One hundred and nineteen shoulders with GHJ arthritis in 115 patients (mean age, 56.5 years; 92 shoulders were in male patients) underwent PyroTITAN pyrocarbon HA. Primary patient-reported outcome measures (PROMs) included the Western Ontario Osteoarthritis of the Shoulder Index and American Shoulder and Elbow Surgeons score. Clinicians assessed shoulder range of motion and abduction strength. PROMs and clinician evaluations were recorded preoperatively and at 6, 12, and 24 months and 5 years postoperatively. Postoperative complications were recorded, and radiographs were evaluated for glenoid erosion. Implant survival was calculated over the 5-year follow-up period. Data were analyzed on an intention-to-treat basis using linear mixed models for continuous data and Friedman analysis of variance for ordinal data. Kaplan-Meier analysis assessed revision-free survival. Significance was set at p < 0.05. RESULTS: There was significant improvement in all PROMs and ranges of motion at 6, 12, and 24 months and 5 years postoperatively. Abduction strength was significantly improved at 24 months. Seven complications (5.9%) were recorded: ongoing pain (n = 2), stiffness (n = 2), pain and stiffness (n = 2), and implant fracture (n = 1). There were 3 revisions (2.5%) and thus a 97.5% five-year survival rate. Glenoid erosion increased slightly but not significantly over time. CONCLUSIONS: The findings in our patient series support the PyroTITAN HA implant as a viable option for GHJ arthritis across a broad age range, including younger patients. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Ima M, Kabata T, Inoue D
… +6 more, Yanagi Y, Iyobe T, Fujimaru N, Tokoro M, Nojima T, Demura S
J Bone Joint Surg Am
· 2026 May · PMID 42118847
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BACKGROUND: Povidone-iodine (PVI) irrigation is widely used to reduce surgical site infection risk; however, the appropriate concentration and timing remain uncertain. We evaluated how the PVI concentration and irrigatio...BACKGROUND: Povidone-iodine (PVI) irrigation is widely used to reduce surgical site infection risk; however, the appropriate concentration and timing remain uncertain. We evaluated how the PVI concentration and irrigation interval influence the early bacterial burden and tissue response in a rat model of implant-related infection. METHODS: Female rats received a stainless steel plate contaminated with methicillin-susceptible Staphylococcus aureus . The rats were randomized to receive 0.13% PVI, 0.35% PVI, or normal saline solution irrigation every 30 or 60 minutes during a 60-minute procedure. Irrigation consisted of a 3-minute exposure followed by a saline solution rinse. Outcomes included the bacterial count after sonication, soft-tissue infection score, peri-implant bone mineral density (BMD) on microcomputed tomography (µCT), histological inflammation grading, and body weight trajectory. RESULTS: Higher PVI concentrations and a shorter irrigation interval were associated with reduced recoverable bacterial burden. Among the 30-minute interval groups, no culturable bacteria were recovered in the 0.35% PVI group (i.e., the values were below the assay detection limit); in contrast, culturable bacteria were detectable in all of the 60-minute interval groups. PVI-treated rats demonstrated lower macroscopic infection scores and a trend toward more rapid body weight recovery compared with saline solution controls. For both irrigation intervals, µCT showed higher peri-implant BMD in the PVI-treated groups than in the saline solution controls. Histology showed less inflammation and fewer abscesses in the PVI-treated groups compared with controls, with the least inflammation observed in the group that received 0.35% PVI at 30-minute intervals. CONCLUSIONS: In this rat model, PVI concentration and irrigation interval were associated with early differences in bacterial recovery and peri-implant tissue and bone responses. These findings are hypothesis-generating and should be interpreted as mechanistic, preclinical signals rather than as guidance for clinical practice. Further translational and clinical studies are needed to determine the relevance of these signals in humans. CLINICAL RELEVANCE: Current practice typically involves a single 3-minute 0.35% PVI soak before wound closure. This study provides preclinical mechanistic data on how PVI concentration and irrigation timing influence early bacterial recovery in an implant-related infection model. The findings do not support changes to clinical protocols, but highlight the need for careful evaluation of cytotoxicity and safety.
J Bone Joint Surg Am
· 2026 Jun · PMID 42096528
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➢ The sternoclavicular joint (SCJ) serves as the only osseous connection between the axial skeleton and the upper limb and is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartila...➢ The sternoclavicular joint (SCJ) serves as the only osseous connection between the axial skeleton and the upper limb and is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartilaginous disc. ➢ The brachiocephalic veins and other mediastinal structures are at risk from injury or surgery about the SCJ. ➢ SCJ injuries are best imaged with computed tomography (CT). CT angiography is warranted when a vascular injury is suspected, and magnetic resonance imaging (MRI) is useful to define soft-tissue injuries. ➢ Acute posterior SCJ dislocations in active, healthy individuals can result in considerable disability if unreduced and an aggressive treatment approach is warranted. ➢ Chronic locked posterior dislocations are more challenging to treat, making prompt recognition and referral (if appropriate) important. ➢ Reliable surgical techniques including ligament reconstruction and open reduction and internal fixation for SCJ injuries have been well supported in the current orthopaedic literature. ➢ Vascular injury is a rare but catastrophic concern when dealing with SCJ pathology and should be considered when determining the venue for planned intervention, as should collaboration with a thoracic or vascular surgeon.