Journal Of Orthopaedics And Traumatology[JOURNAL]
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200 papers
A study on the association between tibial plateau fractures and intra-articular soft-tissue injuries under valgus injury mechanisms.
Duan S, Wang S, Zhu T … +2 more , Li Q, Zhang M
J Orthop Traumatol · 2026 Apr · PMID 42033543 · Full text
BACKGROUND: While recent investigations have focused on injury mechanism classifications of tibial plateau fractures (TPFs), the association between valgus TPFs and concomitant soft-tissue damage involving menisci and li...
BACKGROUND: While recent investigations have focused on injury mechanism classifications of tibial plateau fractures (TPFs), the association between valgus TPFs and concomitant soft-tissue damage involving menisci and ligaments remains insufficiently elucidated. This study aimed to characterize intra-articular soft-tissue injuries associated with various valgus TPFs and assess the predictive value of lateral plateau depression (LPD) and widening (LPW). Additionally, the analysis extended to other injury mechanisms. MATERIALS AND METHODS: This study included adult patients with acute tibial plateau fractures who had complete imaging data, excluding patients with open fractures and multiple fractures throughout the body. Imaging examinations were used to assess the fracture mechanism and intra-articular soft-tissue damage. RESULTS: The study retrospectively analyzed the clinical data of 138 patients with valgus injury TPFs in our hospital. The study compared the incidence of TPFs with intra-articular soft-tissue damage under different injury mechanisms. The result demonstrated that the incidence of valgus hyperextension TPFs combined with medial collateral ligament injuries was relatively high (61.5%) compared with TPFs with other injury mechanism. Multivariable logistic regression and smooth curve fitting revealed significant dose-response relationships of LPD (odds ratio [OR] = 1.408; 95% confidence interval [CI] 1.217, 1.627) and LPW (OR = 1.782; 95% CI 1.387, 2.290) with the risk of lateral meniscus (LM) tears in valgus TPFs. Receiver operating characteristic curves showed the area under the curve (AUC) values and the optimal thresholds of LPD and LPW. For all valgus TPFs, the AUCs of LPD and LPW associated with LM tear were 0.804 (95% CI 0.728, 0.880) and 0.741 (95% CI 0.657, 0.825), respectively. And the optimal threshold for LPD to predict LM tears was 7.11 mm (sensitivity 0.80, specificity 0.74). Subgroup analysis by injury mechanism further demonstrated that, under the valgus extension injury mechanism, the optimal threshold was 8.45 mm (sensitivity 0.68, specificity 0.91). Under the valgus flexion injury mechanism, the optimal threshold was 7.18 mm (sensitivity 0.69, specificity 0.87). Further analyses revealed that varus flexion TPFs demonstrated elevated risks of anterior cruciate ligament injuries (82.5%), lateral collateral ligament injuries (65.0%), and meniscal tears (70.0%), whereas varus hyperextension TPFs showed higher posterior cruciate ligament injury prevalence (56.3%). CONCLUSIONS: LPD serves as a reliable predictor of fractures combined with LM tears. Specifically, under the overall valgus injury mechanism, the possibility of LM tears (particularly the posterior horn tears) should be guarded against when LPD exceeds 7.11 mm. For the valgus extension subtype, the possibility of LM tears (especially the anterior horn tears) should be highly suspected when LPD exceeds 8.45 mm. And for the valgus flexion subtype, an LPD exceeding 7.18 mm should prompt evaluation for LM tears, particularly those affecting the posterior horn. LEVEL OF EVIDENCE: Level 3.
The coronoid as the key fragment of trans-ulnar fracture-dislocations of the elbow: Insights from a retrospective cohort comparison using the coronoid-centric Mayo classification system.
Henssler L, Kerschbaum M, Zanklmaier M … +3 more , Wieczorek LA, Alt V, Klute L
J Orthop Traumatol · 2026 Apr · PMID 42014627 · Full text
BACKGROUND: Trans-ulnar fracture-dislocations of the elbow are rare injuries with complex fracture patterns and variable outcomes. Traditional classification systems offer limited prognostic value. A recently introduced...
BACKGROUND: Trans-ulnar fracture-dislocations of the elbow are rare injuries with complex fracture patterns and variable outcomes. Traditional classification systems offer limited prognostic value. A recently introduced coronoid-centric Mayo classification distinguishes injury subtypes based on coronoid attachment and identifies trans-ulnar basal coronoid (TUBC) fractures as a particularly challenging entity. This study evaluated outcomes across Mayo fracture types and explored factors associated with inferior results in TUBC injuries. MATERIALS AND METHODS: In this retrospective cohort study, surgically treated trans-ulnar elbow fracture-dislocations managed at a level I trauma center between 2010 and 2022 were identified and classified according to the Mayo system. Demographic data, injury characteristics, surgical management, radiographic outcomes, and complications were recorded. Functional outcomes were assessed after a minimum follow-up of 12 months using the Mayo Elbow Performance Score (MEPS); Oxford Elbow Score (OES); Quick Disabilities of Arm, Shoulder and Hand Questionnaire (QuickDASH); European Quality of Life Five-Dimension, Five-Level Version (EQ-5D-5L); and range-of-motion measurements. Radiographs were analyzed for union, instability, heterotopic ossification, and post-traumatic osteoarthritis (OA). RESULTS: A total of 52 patients were included (14 trans-olecranon, 28 TUBC, 10 Monteggia-variant). TUBC injuries were the most common subtype (53.8%). Post-traumatic OA was significantly more frequent in TUBC injuries than in fractures with coronoid attachment to a major fragment (88% versus 61%, P = 0.047). Higher-grade OA and persistent instability were associated with inferior functional outcomes. Although functional scores tended to be lower in TUBC injuries, differences compared with other subtypes were not consistently statistically significant. Within the TUBC group, poorer outcomes were observed when stable screw fixation of the basal coronoid fragment could not be achieved. CONCLUSIONS: TUBC fracture-dislocations represent a high-risk subgroup of trans-ulnar elbow injuries. Stable fixation of the coronoid base appears critical for achieving favorable outcomes. The Mayo classification provides clinically relevant stratification and prognostic insight for these complex injuries. LEVEL OF EVIDENCE: Level IV.
Feasibility study of a robot-assisted endoscopic technique for plate osteosyntheses of the acetabulum and anterior pelvic ring.
Hinz N, Althoff G, Thomaschewski M … +11 more , Bonke LA, Eberenz A, Münch M, Behrends L, Männel G, Kundrat D, Weyers I, Schulz AP, Keck T, Frosch KH, Hartel M
J Orthop Traumatol · 2026 Apr · PMID 41986773 · Full text
BACKGROUND: Minimally invasive stabilization of acetabular and pelvic ring fractures using endoscopic techniques has become increasingly important. The logical advancement of conventional endoscopic techniques is a robot...
BACKGROUND: Minimally invasive stabilization of acetabular and pelvic ring fractures using endoscopic techniques has become increasingly important. The logical advancement of conventional endoscopic techniques is a robot-assisted approach, which benefits from the advantages of robot-assistance systems (e.g., more degrees of freedom for instruments and improved visualization). The aim was therefore to investigate the feasibility of a robot-assisted endoscopic technique for plate osteosyntheses of the acetabulum and anterior pelvic ring. MATERIALS AND METHODS: In this two-part feasibility study, four different plate osteosyntheses were performed endoscopically using the Hugo™ robot-assisted surgery system, first on ten synthetic pelvic models and then on ten human cadavers. During robot-assisted dissection for the preperitoneal approach, identification of ten relevant anatomical landmarks was also assessed. In both parts, the success, number of drilling errors, and time for each plate were described as learning curves and analyzed using linear regression. RESULTS: The infrapectineal plate could be successfully performed in 100% of synthetic models, the posterior column plate in 100%, the suprapectineal plate in 90%, and the superior pubic ramus plate in 80%. Learning curves could be observed for the number of drilling errors per plate (e.g., 0.67 to 0, p = 0.009) and the time required, but they were mostly nonsignificant. In the ten human cadavers, all ten anatomical landmarks could be identified and all four plate osteosyntheses could be performed from the third attempt on (attempt 1: 6/10 landmarks, 3/4 plates; attempt 2: 7/10 landmarks, 3/4 plates). The time decreased for the superior pubic ramus plate (98 to 15 min, p = 0.002), suprapectineal plate (55 to 25 min, p = 0.013), infrapectineal plate (50 to 10 min, p = 0.004), and nonsignificantly for the posterior acetabular column plate (31 to 21 min). The average number of drilling errors per plate decreased nonsignificantly (1 to 0.5). CONCLUSIONS: Plate osteosynthesis for the acetabulum and anterior pelvis is feasible using a robot-assisted endoscopic technique but is more time-consuming than using a conventional endoscopic technique and is associated with technical challenges, such as screw angulation. With the development of specialized instruments for pelvic trauma surgery, endoscopic and robot-assisted techniques will likely play a significant role in the future. LEVEL OF EVIDENCE: Level 5.
Favorable subjective clinical outcomes after revision hip arthroscopy for femoroacetabular impingement syndrome despite a high rate of capsular defects and increased capsular thickness.
Cao Z, Gao G, Lin W … +4 more , Zhu Y, Zhou X, Wang J, Xu Y
J Orthop Traumatol · 2026 Apr · PMID 41984286 · Full text
BACKGROUND: The capsular healing status and capsular thickness changes in patients with femoroacetabular impingement syndrome (FAIS) following revision hip arthroscopy are poorly documented, and their relationship with s...
BACKGROUND: The capsular healing status and capsular thickness changes in patients with femoroacetabular impingement syndrome (FAIS) following revision hip arthroscopy are poorly documented, and their relationship with subjective clinical outcomes remains unclear. The purpose of this work is to evaluate the incidence of capsular defects and changes in capsular thickness using magnetic resonance imaging (MRI) following hip arthroscopy in patients with FAIS, and to compare the subjective clinical outcomes between patients with and without capsular healing after revision hip arthroscopy. PATIENTS AND METHODS: Consecutive patients with FAIS who underwent revision hip arthroscopy between 2013 and 2023 were included. Patients were categorized into two groups on the basis of capsular healing status after revision hip arthroscopy. Patient-reported outcomes (PROs) were collected preoperatively and at minimum 2-year follow-up, including the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activity of Daily Living Scale (HOS-ADL), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS). Achievements in minimal clinically important difference (MCID) and patient acceptable symptom state (PASS), patient satisfaction, and re-revision rates were evaluated and compared between groups. Capsular thickness was assessed by MRI pre-index, pre-revision, and at a minimum of 12-month post-revision time points in cases with healed capsule. Spearman rank correlation analysis was performed to assess the association between PROs and capsular thickness postoperatively. RESULTS: A total of 19 patients (20 hips) were included. Capsular defects were observed in six hips (30%) at minimum 1 year follow-up following revision hip arthroscopy. No significant differences were identified between the healed and unhealed groups in patient demographics, intraoperative findings, arthroscopic procedures, or preoperative PROs (P > 0.05). Postoperative PROs, MCID and PASS achievement rates, patient satisfaction, and re-revision rates were also comparable between groups (P > 0.05). The proximal (P = 0.015) and middle (P = 0.009) capsular thickness significantly increased at the final follow-up after revision hip arthroscopy compared to pre-revision surgery time point. No significant correlations were found between capsular thickness and PROs following revision hip arthroscopy (P > 0.05). CONCLUSIONS: Although the rate of capsular defects following revision hip arthroscopy was 30% at minimum 1 year follow-up, comparable improvements in subjective clinical outcomes were observed at minimum 2-year follow-up regardless of capsular healing status. Patients with healed capsules exhibited increased proximal and middle capsular thickness after revision hip arthroscopy, with no correlation observed between capsular thickness and PROs. LEVEL OF EVIDENCE: IV.
From bench to bedside: a novel suture-augmented prosthesis for greater trochanteric fixation in osteoporotic hip arthroplasty.
Yang M, Yang J, Wang X … +11 more , Wu Z, Bian S, Sheng R, Liao F, Qin K, Zhang C, Yuan H, Ding X, Xie C, Ma G, Chang J
J Orthop Traumatol · 2026 Apr · PMID 41964866 · Full text
BACKGROUND: Stable fixation of the greater trochanter during hip arthroplasty for unstable osteoporotic intertrochanteric fractures remains a significant challenge. Conventional techniques depend on securing the bone-imp...
BACKGROUND: Stable fixation of the greater trochanter during hip arthroplasty for unstable osteoporotic intertrochanteric fractures remains a significant challenge. Conventional techniques depend on securing the bone-implant interface, which is particularly compromised in osteoporotic bone. Here, we propose a novel conceptual approach that establishes a direct mechanical bridge from the abductor tendon to the prosthesis, thereby reducing reliance on the fragile bone-implant interface. METHODS: In this two-stage translational study, we progressed from biomechanical validation to clinical application. First, using a decalcified caprine femoral model simulating osteoporosis, three fixation constructs were compared: locking plate (LP), suture-augmented locking plate (LPSA), and Kirschner-wire tension band (KWTB). Ultimate load and construct stability were evaluated. Biomechanical testing confirmed the principle of suture-mediated load sharing and highlighted the intrinsic weakness of screw fixation in osteoporotic bone. Guided by these results, we designed a novel femoral prosthesis that eliminates screw fixation, employs sutures as the primary load-bearing element, and incorporates integrated suture anchor tunnels. This prosthesis was then assessed in a retrospective series of 15 consecutive elderly patients with osteoporotic intertrochanteric fractures. Clinical outcomes were evaluated using the Harris Hip Score (HHS). RESULTS: Biomechanically, the LPSA construct sustained a significantly higher ultimate load than the LP construct in decalcified bone (P < 0.001) and exhibited a greater load at 2-mm displacement than the KWTB construct (P < 0.001). Clinically, all patients achieved fracture union without prosthesis-related complications. The mean HHS at final follow-up was 88.27 ± 6.60, and 80% of patients regained independent ambulation. CONCLUSIONS: A prosthesis-anchored, suture-mediated "tendon-to-prosthesis" load pathway provides reliable stabilization of the greater trochanter in osteoporotic bone. Biomechanical validation and favorable early clinical outcomes support the potential of this novel fixation strategy.
Updating radiographic parameters for the healthy growing hip: are current parameters still valid?
Hütter K, Smolle MA, Butter S … +3 more , Schroedter R, Tschauner S, Kraus T
J Orthop Traumatol · 2026 Apr · PMID 41949745 · Full text
BACKGROUND: This study aimed to evaluate whether the acetabular angle (AA) by Tönnis and lateral center-edge angle (LCEA) by Wiberg-key radiographic parameters in pediatric hip assessment-have changed in a contemporary p...
BACKGROUND: This study aimed to evaluate whether the acetabular angle (AA) by Tönnis and lateral center-edge angle (LCEA) by Wiberg-key radiographic parameters in pediatric hip assessment-have changed in a contemporary pediatric population compared with historical reference values, considering trends in earlier skeletal maturation and body composition. MATERIALS AND METHODS: This retrospective diagnostic accuracy study assessed changes in AA and center-edge angle (CE) angles in a contemporary cohort. A total of 1774 anteroposterior pelvic radiographs (3548 hips) from patients aged 0-18 years without hip pathology were analyzed. Radiographs were obtained between 2006 and 2018 and measured using the Supervisely digital platform. Standardized anatomical landmarks were applied. Data were stratified by age and sex and compared with historical values using two-sample t-tests (p < 0.05). To minimize measurement bias, two independent observers conducted all assessments using standardized digital protocols. RESULTS: A total of 1774 patients aged 0-18 years (mean age, 8.30 ± 5.20 years; 666 females, 1108 males) were evaluated. AA values did not show statistically significant differences in 11 of 16 age groups compared with historical data (p > 0.05). In contrast, LCEAs were significantly higher in the contemporary cohort, especially in the 5-8, 9-12, and 12-16 age groups (all p < 0.01), indicating a trend toward earlier or increased acetabular ossification and femoral head coverage. CONCLUSIONS: LCEA values were significantly higher in the contemporary pediatric cohort compared with historical data, while AA values remained stable across most age groups. These findings suggest that current radiographic reference standards for LCEA may warrant reassessment to ensure accurate dysplasia assessment. LEVEL OF EVIDENCE: level 3 (diagnosis).
In-hospital deep vein thrombosis after tibial plateau fractures: incidence, laterality/anatomy, and risk factors in a multicenter retrospective cohort of 3366 patients.
Yang S, Li G, Li Y … +9 more , Long Y, Zhang J, Liu L, Zhao Z, Sun C, Liu L, Jin L, Wang T, Hou Z
J Orthop Traumatol · 2026 Mar · PMID 41886203 · Full text
BACKGROUND: We aimed to determine the cumulative in-hospital incidence, anatomic distribution, and predictors of duplex ultrasonography-detected lower-extremity deep vein thrombosis (DVT) in patients hospitalized with ti...
BACKGROUND: We aimed to determine the cumulative in-hospital incidence, anatomic distribution, and predictors of duplex ultrasonography-detected lower-extremity deep vein thrombosis (DVT) in patients hospitalized with tibial plateau fractures under routine thromboprophylaxis and protocolized surveillance. METHODS: We retrospectively analyzed consecutive adults (≥ 18 years) admitted to two level-I trauma centers (November 2014-January 2024). Bilateral duplex ultrasonography was performed on admission/preoperatively (as soon as feasible after arrival and prior to surgery) and repeated serially during hospitalization (approximately every 5-7 days and when clinically suspected). The primary outcome was cumulative in-hospital DVT from admission to discharge; isolated intermuscular calf-muscle vein thrombosis (soleal/gastrocnemius) was recorded descriptively but excluded from the primary endpoint. Multiple injuries (polytrauma) were defined as ≥ 1 additional acute traumatic lesion beyond the index tibial plateau fracture documented on admission. Pulmonary embolism (PE) was assessed only when clinically suspected and confirmed by computed tomography pulmonary angiography (CTPA). Multivariable logistic regression identified independent predictors; receiver operating characteristic (ROC) analysis evaluated discrimination for key continuous predictors. RESULTS: Among 3366 patients, 675 developed in-hospital DVT (20.0%). First detection occurred preoperatively in 432 (64.0%) patients and postoperatively in 243 (36.0%). Most events were distal (584/675, 86.5%) and ipsilateral (617/675, 91.4%); proximal DVT occurred in 91 patients (2.7% of the cohort). Independent predictors included age, multiple injuries, anemia, alcohol use, and inverse associations with activated partial thromboplastin time and serum sodium. ROC analysis of age showed modest discrimination (area under the curve [AUC] 0.593) with a cohort-derived Youden threshold of 42 years (age ≥ 42 years). Symptomatic PE occurred in five patients (0.15% of the cohort) and was confirmed by CTPA. CONCLUSIONS: Under protocolized inpatient duplex surveillance, patients with tibial plateau fracture had a substantial in-hospital burden of predominantly distal and ipsilateral DVT. Increasing age was independently associated with DVT; however, age alone showed limited discriminatory ability (AUC 0.593), with a cohort-derived Youden threshold of 42 years (age ≥ 42 years). Multiple injuries, anemia, alcohol use, shorter activated partial thromboplastin time (APTT), and lower serum sodium were independently associated with DVT, while the discrimination of age alone was modest. These findings may help inform risk stratification and the consideration of systematic or risk-adapted surveillance and individualized perioperative management; prospective studies are needed to determine whether risk-tailored strategies improve clinically meaningful outcomes.
Retained articulating spacers (1.5 stage) in chronic knee periprosthetic joint infections: an analysis of associate factors and outcomes in a single center cohort of patients.
Balato G, Ascione T, Festa E … +4 more , De Mauro D, Di Gennaro D, Rosa D, Mariconda M
J Orthop Traumatol · 2026 Mar · PMID 41879942 · Full text
BACKGROUND: Two-stage revision remains the gold standard for chronic periprosthetic joint infection (PJI), but it can significantly impact patients' quality of life and functional recovery. The 1.5-stage revision, involv...
BACKGROUND: Two-stage revision remains the gold standard for chronic periprosthetic joint infection (PJI), but it can significantly impact patients' quality of life and functional recovery. The 1.5-stage revision, involving indefinite spacer retention, has emerged as a potential alternative in selected high-risk patients. Our questions were: (1) What are the early functional outcomes, including their infection-free survival? (2) Which pre- and perioperative factors are associated with spacer retention? and (3) What is the mechanical survivorship of retained spacers? MATERIALS AND METHODS: This was a retrospective observational study including 108 consecutive patients with chronic PJI between 2016 and 2020 who were followed prospectively for clinical outcomes. Functional status and quality of life were assessed using the EuroQol-5-Dimension-5-Level (EQ-5D-5L), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Society Score (KSS) before spacer placement and prior to scheduled reimplantation. Infection-free status was defined as the absence of clinical, radiographic, and laboratory signs of infection recurrence over a 24-month follow-up. Univariate and multivariate logistic regression were used to identify factors associated with spacer retention. RESULTS: All patients initially underwent articulating spacer implantation as part of a planned two-stage protocol. Subsequently, after shared decision-making, the spacer was retained indefinitely ("retained articulating spacer," commonly referred to as "1.5-stage") in 43 patients (39.8%), while 65 patients proceeded to reimplantation (two-stage revision). The KSS, WOMAC, and quality of life (QoL) scores, before scheduling the revision, were better than preoperative ones (p < 0.001). An age over 75 years (odds ratio [OR] 4.216, p = 0.001), a lower postoperative WOMAC score (OR 0.972, p = 0.013), and a history of re-revision (OR 1.102, p = 0.027) were independently associated with 1.5-stage candidacy. Infection-free status was achieved in 91.7% of the overall cohort, with 87.6% success in the two-stage group and 97.7% in the 1.5-stage group. Kaplan-Meier survival analysis showed spacer survivorship of 100% at 24 months, 88.8% at 30 months, and 73.3% at 36 months. CONCLUSIONS: Older age, better early functional outcomes, and a history of multiple surgeries at the same site were associated with spacer retention. These associations may inform patient counseling and surgical decision-making. Level of evidence IV, retrospective cohort study.
Moderate leg length discrepancy: a long-term risk factor for hip osteoarthritis?
Aprato A, Donis A, Via RG … +5 more , Scandurra A, Tuè F, Audisio A, Fusini F, Massè A
J Orthop Traumatol · 2026 Mar · PMID 41872389 · Full text
BACKGROUND: Leg length discrepancy (LLD) has been implicated as a biomechanical factor contributing to hip osteoarthritis (OA), yet the extent of its influence remains unclear. This study examines the correlation between...
BACKGROUND: Leg length discrepancy (LLD) has been implicated as a biomechanical factor contributing to hip osteoarthritis (OA), yet the extent of its influence remains unclear. This study examines the correlation between moderate LLD (≥ 10 mm) and hip OA progression, focusing on asymmetrical OA distribution in patients over 65 years old. MATERIALS AND METHODS: A retrospective analysis was conducted from a database of 1672 full-length standing X-rays. Patients under 65 years, with deformities, unilateral limb issues, or prosthetics, were excluded; therefore, the study group was composed of 220 patients. Tibial and femoral lengths were measured bilaterally, and hip OA severity was assessed using the Tönnis classification. Statistical analyses included Pearson's Chi-squared test and linear regression to explore correlations between LLD and OA distribution. RESULTS: Among the sample, 18% showed an LLD ≥ 10 mm. A significant correlation was found between LLD and the asymmetrical distribution of hip OA (p = 0.002), with higher OA severity observed in the hypometric limb. Linear regression analysis suggested that each millimeter of LLD corresponded to a 0.74-unit change in OA severity difference between hips. CONCLUSIONS: This study highlights a significant association between moderate LLD and contralateral hip OA in the elderly, emphasizing the biomechanical impact of asymmetrical joint loading. Findings suggest the need for early identification and targeted management of LLD to mitigate OA progression. LEVEL OF EVIDENCE: III.
Authorship, titles and open access as drivers of citation performance in orthopaedics: a scientometric analysis.
Migliorini F, Vaishya R, Rivera F … +5 more , Eschweiler J, Kobbe P, Betsch M, Oliva F, Maffulli N
J Orthop Traumatol · 2026 Mar · PMID 41862779 · Full text
BACKGROUND: Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the fac...
BACKGROUND: Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses. METHODS: Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword 'orthopaedic'. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates. RESULTS: Larger author teams were associated with higher citation rates (β = 0.108 citations/year per additional author, 95% confidence interval [CI] 0.103-0.114, p < 0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p = 0.001). Title length in characters correlated positively with citation rate (β = 0.023 per character, p < 0.001), whereas title length in words showed a negative association (β = -0.183 per word, p < 0.001). The presence of a colon (+0.314 citations/year, p < 0.001) or dash (+0.187, p = 0.001) increased citation performance, while question marks (-0.476, p < 0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p < 0.0001). CONCLUSIONS: In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more critical than citation metrics.
Interpreting nonsignificant findings: Reassessing the safety of self-locking standalone cages in octogenarian patients undergoing ACDF.
Abudayeh A, Fishchenko I
J Orthop Traumatol · 2026 Mar · PMID 41854842 · Full text
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A novel, simple, and affordable technique for arthroscopic soft-tissue tenodesis of the long head of the biceps tendon.
Fossati C, Ioppoli A, Ravaglia R … +3 more , Vaja F, Menon A, Randelli PS
J Orthop Traumatol · 2026 Mar · PMID 41845135 · Full text
BACKGROUND: 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 mo...
BACKGROUND: 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. METHODS: A retrospective case series of 23 patients (mean age 58.0 ± 7.8 years) 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. RESULTS: 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 ± 2.59 cm). CONCLUSIONS: 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 OF EVIDENCE: Level IV.
ORIF of three- and four-part proximal humeral fractures: a retrospective study of long-term clinical and complication outcomes of two-plate fixation methods.
Conteduca J, Gasbarra E, Rausa I … +5 more , Casto A, Valentino L, Solarino G, Meccariello L, Rollo G
J Orthop Traumatol · 2026 Mar · PMID 41832917 · Full text
BACKGROUND: The aim of this study was to compare clinical outcomes and complication rates during long-term follow-up (≥ 6 years) after treatment for three- and four-part proximal humeral fractures using two different typ...
BACKGROUND: The aim of this study was to compare clinical outcomes and complication rates during long-term follow-up (≥ 6 years) after treatment for three- and four-part proximal humeral fractures using two different types of locking plates. MATERIALS AND METHODS: A total of 113 patients with three- and four-part proximal humeral fractures who underwent surgery between September 2012 and January 2019 were enrolled retrospectively. Data for 49 patients [ 9 males, 40 females; mean age [standard deviation] (SD ) 68.9 (5.8) years} treated with a PGR (intrauma) plate (group A) and 51 patients [10 males, 41 females; mean age (SD): 66.0 (7.5) years] treated with a PHILOS humeral plate (PHP, group B) were available at the last follow-up. The mean follow-up periods in groups A and B were 10.8 and 10.2 years, respectively, with a minimum follow-up of 6 years. At the final follow-up evaluation, functional outcomes were assessed using the Oxford Shoulder Scale (OSS), Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. X-ray evaluation was also performed, and complications were recorded. RESULTS: The mean OSS score in the PGR and PHP groups at follow-up was 42.9 and 39.1, respectively (p > 0.05). The SST score (PGR: 7.5 ± 2.0; PHP: 7.3 ± 4.0) and DASH score (PGR: 22.1 ± 5.5; PHP: 20.5 ± 4.0) were similar in both groups (p > 0.05). In our series, 6% of patients had complications; these included avascular necrosis of the humeral head (two cases in the PGR group and three in the PHF group) and one case of periplate fracture in the PGR group. CONCLUSIONS: Among patients with three- and four-part proximal humeral fractures, both PGR plate and PHP treatment achieved comparable functional outcomes and demonstrated similarly low complication profiles. These results reinforce the appropriate clinical utility of either implant for fixation in the treatment of this fracture pattern.
Incidence rates and treatment of the transcervical fracture of the neck of femur in Italy: is total hip arthroplasty an increasingly preferred approach? A population study on trends between 2001 and 2023 based on 1,120,770 hospital discharge records.
Ciminello E, Romanini E, Venosa M … +9 more , Cazzato G, Tucci G, Boniforti F, Carpanese L, Cuccu A, Falcone T, Ciccarelli P, Ceccarelli S, Torre M
J Orthop Traumatol · 2026 Mar · PMID 41831175 · Full text
INTRODUCTION: Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in the elderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments inc...
INTRODUCTION: Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in the elderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment. MATERIALS AND METHODS: Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: total arthroplasty, partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age. RESULTS: The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1 years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45-54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively. CONCLUSIONS: Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years. Level of evidence level 1, population-based study.
Does latissimus dorsi tendon transfer provide a normal scapular rhythm and external rotation strength in posterosuperior massive irreparable rotator cuff tears? A kinematic analysis in a retrospective cohort.
Calvo C, Fiumana G, Brigo A … +7 more , Ruggiero ED, Bonfatti R, Donà A, Micheloni GM, Giorgini A, Tarallo L, Porcellini G
J Orthop Traumatol · 2026 Mar · PMID 41779269 · Full text
BACKGROUND: Posterosuperior massive irreparable rotator cuff tears (PMIRT) are rare and disabling conditions. When conservative treatment fails, latissimus dorsi tendon transfer (LDTT) is a viable surgical option for sym...
BACKGROUND: Posterosuperior massive irreparable rotator cuff tears (PMIRT) are rare and disabling conditions. When conservative treatment fails, latissimus dorsi tendon transfer (LDTT) is a viable surgical option for symptom relief in carefully selected patients. However, its effectiveness in restoring glenohumeral function and its influence on scapulothoracic rhythm remain subjects of ongoing debate. PURPOSE: The purpose of this study was to evaluate the clinical outcomes of LDTT and assess its impact on scapulothoracic rhythm using kinematic and electromyographic analysis. MATERIAL AND METHODS: A total of 18 patients with PMIRT underwent LDTT. Functional scores consisted of Constant-Murley score (CMS), America Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Electromyography (EMG) activity of the latissimus dorsi muscle was evaluated in conjunction with three-dimensional (3D) kinematic tracking system. Differences in external rotation strength were compared with and without active adduction. RESULTS: The mean age was 55.9 years (range 40-69 years), with a mean follow-up of 20.4 months (range 6-39 months). At final follow-up, the mean CMS was 68.2 (95% CI 64.9-71.5), ASES was 76.9 (95% CI 66.1-87.6), and QuickDASH was 17.6 (95% CI 9.5-25.6). A significant difference in external rotation strength was observed with and without active adduction (p < .0005). EMG confirmed latissimus dorsi activation in all patients, with no significant differences between rotation conditions (p > .05). Kinematic analysis showed an overall normal scapulothoracic rhythm, with significant differences only in scapular tilting during elevation and external rotation with the shoulder in adduction (p = 0.044 and p = 0.023, respectively). CONCLUSIONS: LDTT provides satisfactory clinical outcomes in patients with PMIRT, enhancing external rotation strength when the latissimus dorsi is actively recruited and contributing to near-normal scapulothoracic rhythm restoration. A structured, targeted postoperative rehabilitation protocol is essential to optimize outcomes. LEVEL OF EVIDENCE: IV.
Is there a need for exploration in pulseless supracondylar fractures of the humerus? A systematic review and individual patient data meta-analysis.
Haoyang C, Chen JG, Lai H … +3 more , Lim AKS, Tan SHS, Hui JHP
J Orthop Traumatol · 2026 Feb · PMID 41689724 · Full text
BACKGROUND: Different approaches have been proposed to treat patients with pulseless supracondylar humeral fractures (SHF). We aim to analyze the current outcomes of patients who have undergone different treatment option...
BACKGROUND: Different approaches have been proposed to treat patients with pulseless supracondylar humeral fractures (SHF). We aim to analyze the current outcomes of patients who have undergone different treatment options for pulseless SHF, namely watchful waiting versus urgent surgical exploration. METHODS: Electronic databases including PubMed, Embase, and Cochrane Library were explored. Our study included patients from all age groups but only included English-language articles. Single case reports and case studies with adequate description of patient population, injury, and outcomes were included. An individual patient data meta-analysis was done to evaluate key outcomes of surgical exploration versus no surgical exploration in pulseless patients with SHF. RESULTS: Overall, the data for 1070 individual patients from a total of 48 studies were included. Patients with pulseless SHF with open fractures have a higher probability of requiring vascular intervention (p < 0.001) as they are more likely to have disrupted arteries (p = 0.050) and more likely to require vascular repairs (p < 0.001) than patients with closed fractures. Similarly, patients with pulseless SHF with pucker sign (p = 0.003) and ecchymosis (p = 0.002) were more likely to undergo surgical exploration. However, the neurological status had no relation to them undergoing surgical exploration (p = 0.382), and also does not affect complication outcomes (p = 0.326) nor the need for vascular intervention (p = 1.00). However, patients with pale pulseless SHFs were more likely to undergo surgical exploration (p < 0.001), were more likely to have disrupted arteries (p < 0.001), required more vascular intervention (p < 0.001), and had a higher likelihood of complications (p < 0.001). Notably, there is no significant difference in overall complications between those who underwent exploration of arteries and those who did not among patients with pink pulseless SHF (p = 0.230). CONCLUSIONS: Significant predictors for arterial injury requiring intervention include a pale pulseless limb, open fracture, pucker sign, and ecchymosis; expedient surgical exploration is recommended in these scenarios. However, for patients with pink pulseless SHF, watchful waiting is a viable strategy. Our meta-analysis found no significant difference in overall complication rates between patients with pink pulseless who underwent exploration and those who did not. LEVEL OF EVIDENCE: Level II. REGISTRATION: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines CRD.
Increasing complexity and plateauing outcomes in AO type C distal humerus fractures: a 50-year institutional case series.
Hönck K, Wenzelburger P, Eibinger N … +2 more , Sadoghi P, Puchwein P
J Orthop Traumatol · 2026 Feb · PMID 41670762 · Full text
BACKGROUND: Distal humerus fractures in adults are rare but complex injuries, particularly AO type C3 fractures, often involving comminution, instability, and osteoporotic bone. Demographic trends indicate rising inciden...
BACKGROUND: Distal humerus fractures in adults are rare but complex injuries, particularly AO type C3 fractures, often involving comminution, instability, and osteoporotic bone. Demographic trends indicate rising incidence, especially among elderly patients, with increasing functional demands challenging modern osteosynthesis. Open reduction and internal fixation (ORIF) with bicolumnar plating remains the preferred reconstructive approach, although complications remain substantial. This study aimed to evaluate trends in fracture complexity, patient demographics, and functional outcomes over five decades, focusing on the most recent cohort (2009-2018, series E) and comparing with historical cohorts (series A-D, 1969-2008). METHODS: This retrospective analysis included five consecutive 10-year institutional cohorts (series A: n = 43; B: n = 29; C: n = 47; D: n = 58) of 233 patients with 235 supradiacondylar distal humerus fractures (AO type C1-3) treated with ORIF. Functional outcome parameters (Jupiter and Cassebaum Scores) and demographic data were available for all cohorts; additional parameters (range of motion (ROM), QuickDASH Score) were available for series D and E, Mayo Elbow Performance Score (MEPS), Short Form (SF)-36, and strength were assessed specifically in series E (n = 56; follow-up n = 21). Cross-cohort comparisons of categorical variables used chi-square tests; continuous outcomes were summarized descriptively. Historical cohort means served as a basis for comparison, and analysis of variance (ANOVA) with Tukey Honestly Significant Difference (HSD) was applied for within-series analyses. RESULTS: Mean patient age increased to 62.6 (range 19-89, SD ± 18.1) years in series E. The proportion of AO type C3 fractures rose significantly from 11.6% (series A) to 71.4% (series E) (p ≤ 0.05). In series E (n = 56, follow-up n = 21), ORIF with bicolumnar plating was performed in 94.6% of cases and the overall complication rate was 16.4%, with mean hospitalization time of 11.1 (range 1-40, SD ± 10.1) days, mean extension deficit of 23° (range 0-90°, SD ± 26.4°), strength loss of 25.5 N (range 0-64.7 N, SD ± 19.1 N), QuickDASH Score of 23.3 (range 0-61.4, SD ± 21.2), and mean MEPS of 83.2 (range 45-100, SD ± 17.0). Good-to-excellent results were observed in 52.6% (Jupiter) and 73.7% (Cassebaum). Subjective satisfaction remained high. CONCLUSIONS: Over five decades, distal humerus fractures increasingly involved older patients and more complex AO type C3 patterns. While ORIF continues to provide satisfactory outcomes, persistent deficits in motion and plateauing functional scores indicate that reconstructive limits may be approached in this evolving patient population. LEVEL OF EVIDENCE: Level IV; Case series, treatment study.
Long-term outcomes of the modified Dunn procedure in moderate and severe slipped capital femoral epiphysis: a prospective case series with 7-year follow-up.
Fahmy M, Abdelazeem AH, Shawky MA
J Orthop Traumatol · 2026 Feb · PMID 41665709 · Full text
INTRODUCTION: Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents and may lead to femoroacetabular impingement, early osteoarthritis, and long-term functional disability if inadequatel...
INTRODUCTION: Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents and may lead to femoroacetabular impingement, early osteoarthritis, and long-term functional disability if inadequately treated. While in situ pinning remains the standard treatment for mild slips, it fails to correct the deformity in moderate and severe cases, potentially predisposing to degenerative changes. The modified Dunn procedure (MDP) was developed to restore proximal femoral anatomy through surgical hip dislocation while preserving vascular supply. The aim of the study is to evaluate the long-term radiological and functional outcomes of the MDP in patients with moderate (14 cases) and severe (10 cases) SCFE, and to assess the incidence of avascular necrosis (AVN), osteoarthritis, and other complications. METHODS: A prospective case series was conducted between August 2015 and January 2019 at a single tertiary institution. A total of 24 hips with moderate-to-severe SCFE and open physis were treated using the MDP via surgical hip dislocation. Mild and acute-only slips were excluded. MDP was used as a primary procedure, performed early in severe slips and in selected moderate slips after clinical assessment. Patients were followed clinically and radiologically for a mean duration of 84 ± 2.6 months (range 80-88 months). Functional outcomes were assessed using the Harris Hip Score (HHS) and Merle d'Aubigné and Postel score. Radiographic outcomes and complications, including AVN and secondary arthritis, were documented. Fixation was performed using Schanz screws, cannulated screws, or K-wires according to intraoperative findings. RESULTS: The mean preoperative slip angle (48.3° ± 7.2°) significantly improved postoperatively (11.4° ± 3.1°, p < 0.001). HHS improved from a preoperative mean of 70.4 ± 5.8 to 92.9 ± 4.2 at final follow-up (p < 0.001). The Merle d'Aubigné and Postel score improved from 13.8 ± 1.6 preoperatively to 17.5 ± 0.9 at final follow-up (p < 0.001). AVN developed in 4 out of 24 hips (16.7%). Arthritis developed in 2 out of 24 hips (8.3%, degenerative OA; no septic arthritis or chondrolysis), representing a total of 6 out of 24 hips (25%) with significant complications when combined with AVN. No cases of postoperative instability or wound infection occurred. Functional scores showed sustained improvement in the majority of patients. CONCLUSIONS: MDP offers favorable long-term anatomical correction and functional recovery in moderate-to-severe SCFE. However, the risk of AVN and arthritis, particularly in unstable or severe cases, warrants careful patient selection and technical precision. Extended follow-up is essential to detect late complications and evaluate procedural durability.
Magnetic resonance imaging-based fat infiltration grading improves reparability prediction in massive rotator cuff tears.
Hu Q, Zhang G, Wang D … +3 more , Tung TH, Ding J, Zhou X
J Orthop Traumatol · 2026 Feb · PMID 41632428 · Full text
PURPOSE: This study aims to investigate the extent of fat infiltration (FI) in the rotator cuff (RC) muscles in more medial slices from the Y-shaped view (Y-view) on shoulder magnetic resonance imaging (MRI) and assess w...
PURPOSE: This study aims to investigate the extent of fat infiltration (FI) in the rotator cuff (RC) muscles in more medial slices from the Y-shaped view (Y-view) on shoulder magnetic resonance imaging (MRI) and assess whether these slices provide a more accurate prediction of the repairability of massive RC tears (massive RCTs). METHODS: The retrospective study included 57 patients with massive RCTs who successfully underwent arthroscopic surgery between 1 January 2023 and 31 December 2023. Patients were categorized into two groups: the irreparable group and the reparable group. All patients underwent shoulder MRI covering the region from the acromion to the medial border of the scapula in oblique coronal and oblique sagittal orientations. The FI stage of the RC was assessed across three different views to determine which view most effectively predicts the repairability of patients with massive RCTs. RESULTS: The FI stage of the infraspinatus (IS) muscle across three distinct views demonstrated a significant correlation with the repairability of massive RCTs. The FI stage was more severe in the irreparable group. Receiver operating characteristic (ROC) analysis revealed that the area under the curve for the 1/2 scapula view (0.737) and the most severe view (0.745) exceeded that of the traditional Y-view (0.644). Paired-sample ROC curve analysis revealed a significant difference between the most severe view and the traditional Y-view. The number of slices from the Y-view to the 1/2 scapula view was 5.89 ± 1.2. The most severe view of the IS was defined as the slice indicating the most severe FI stage, which was observed in at least two slices (84% probability) or exclusively in a single slice (16% probability). CONCLUSIONS: This study's conclusions are based on the following findings: (1) Applying the Goutallier classification confirmed that FI in massive RCTs can extend medially to the Y-view, with the most severe FI not confined to a standard anatomical plane; (2) The concept of the "most severe view"-a nonstandardized, non-reproducible MR plane-reflects the area of peak FI. In predicting the reparability of massive RCTs, FI assessment of the IS muscle from this view demonstrates certain advantages over the traditional Y-view; however, its predictive value remains moderate. Future research should therefore focus on developing improved imaging strategies and clarifying the precise relationship between FI progression and clinical outcomes. LEVEL OF EVIDENCE: Level IV; case-control study.
Mid-term clinical and functional outcomes after reverse shoulder arthroplasty with latissimus dorsi transfer.
Colombini AG, Rab P, Macken AA … +7 more , Soares MN, Kimmeyer M, Shirinskiy IJ, Popescu IA, Lafosse L, Buijze GA, Lafosse T
J Orthop Traumatol · 2026 Jan · PMID 41612089 · Full text
BACKGROUND: Although reverse total shoulder arthroplasty (rTSA) with concomitant latissimus dorsi transfer (LDT) has been shown to effectively treat external rotation (ER) deficits, there are limited data regarding its o...
BACKGROUND: Although reverse total shoulder arthroplasty (rTSA) with concomitant latissimus dorsi transfer (LDT) has been shown to effectively treat external rotation (ER) deficits, there are limited data regarding its outcomes with modern implants and its impact on activities of daily living (ADLs) requiring ER. The purpose of this study was to assess the mid-term clinical and radiographic outcomes of rTSA with concomitant isolated LDT in patients with an ER lag sign and posterior rotator cuff deficiency. METHODS: This retrospective cohort study with prospective follow-up included consecutive patients who underwent rTSA with concomitant isolated LDT between 2010 and 2022 with a minimum follow-up of 2 years. Primary outcomes included the resolution of ER lag sign, active ER, and the Activities of Daily Living and External Rotation (ADLER) score. Secondary outcomes included the Auto-Constant Score (CS), Subjective Shoulder Value (SSV), activities of daily living requiring internal rotation (ADLIR) score, visual analog scale (VAS) for pain, and radiographic analysis of standardized radiographs. RESULTS: In total, 32 procedures in 32 patients were identified. Of these, 22 procedures in 22 patients (68% female, 72.9 ± 8.4 years at surgery) were available for follow-up at 4.8 ± 2.2 years postoperatively (response rate 73%). The ER lag sign resolved in 95.5% of patients, the active ER improved significantly from -13° (-20-0°) preoperatively to 10° (0-20°) postoperatively (p = 0.002). The ADLER score increased from 20 (18-21.5) to 30 (28-30, p < 0.001). The CS improved from 32 (25-52) to 71 (67-75, p < 0.001) and the SSV from 30 (28-40) to 80 (65-100, p = 0.002), and low pain levels were reported. Internal rotation (p = 1) and the ADLIR score (p = 0.56) did not improve or decrease. No revisions or complications were observed. CONCLUSIONS: rTSA with concomitant isolated LDT resulted in favorable clinical, functional, and radiographic mid-term outcomes, with a high rate of resolved external rotation lag sign and a significant improvement in activities of daily life that require ER. This procedure should be considered a viable treatment option in patients undergoing rTSA with posterior rotator cuff deficiency and an ER lag sign. LEVEL OF EVIDENCE: IV, retrospective case series.
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