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Surgical Procedures

Elbow surgical options: arthroscopy, ligament reconstruction, arthroplasty, fracture fixation, and neurological structure considerations.

Overview

Treatment strategies for posterolateral rotatory instability of the elbow vary and should be performed based on surgeon experience and available evidence [1]. Most patients have good or excellent results after surgery for this condition [1]. However, up to 11% of patients may have complications after surgery for posterolateral rotatory instability of the elbow [1].

When used for appropriate indications, ankle arthroscopy appears to give good results [12]. Hip arthroscopy with labral preservation and capsular plication may offer a viable alternative to open surgery (PAO) for patients with borderline hip dysplasia [65]. Improved techniques for surface replacement of the hip with the Tharies system have extended indications to older patients [68]. Older patients undergoing surface replacement of the hip with the Tharies system appear to have fewer complications [68].

Clinical results of total knee arthroplasty using hinge joints generally depend on implant design, appropriate technical use, and adequate indications [16]. Silicone radial head prostheses have satisfactory clinical results and an acceptable complication rate when selecting a patient group in suitable condition for surgical indications [54]. Silicone radial head prostheses can be chosen as a potential surgical treatment method in current clinical practice [54].

Postoperative bracing is widely used for various surgical procedures, although much of the literature lacks adequate comparisons of brace types or specific indications [17]. Techniques and indications for pediatric elbow arthroscopy continue to evolve [61]. Definitive answers regarding whether minimally invasive approaches are better or should be generally adopted are not yet known [58]. Determining whether minimally invasive approaches are better or should be generally adopted will require many years of follow-up and large patient studies [58].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Understanding the static and dynamic anatomy of the lateral elbow is necessary to develop future treatment and preventive strategies [44]. Recent changes in elbow arthroplasty device design and implantation methods are driven by biomechanical and clinical outcome-based research to better reproduce elbow kinematics [45]. These biomechanical and clinical improvements in elbow arthroplasty result in more durable and long-lasting joint replacement procedures [45]. Biomechanical evidence suggests that elliptical humeral head implants yield glenohumeral kinematics that mimic the native joint [99]. Loading the long head and short head of the biceps has significant effects on glenohumeral kinematics and contact characteristics in the throwing shoulder [121].

Ligamentous Stability and Reconstruction

Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state [100]. Both proximal docking and single-point fixation hybrid reconstructions for elbow ulnar collateral ligament provided sufficient joint stability and strength compared to intact elbows, with the exception of the proximal docking method at low flexion angles [119]. While each coracoclavicular, acromioclavicular, or combined reconstruction technique was able to restore different elements of shoulder girdle kinematics, none completely restored the shoulder girdle to its pre-injured state [117].

Surgical Approaches and Instability Patterns

Both posterolateral and posteromedial rotatory instability directions must be addressed surgically to restore elbow stability [110]. The posterior (Boyd) approach allows better visualization of the lateral structures for repair and confers excellent stability to the elbow joint in terrible triad injuries [111]. Recognizing the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness in complex elbow instability [112]. Treatment strategies for posterolateral rotatory instability of the elbow should be based on surgeon experience and available evidence [1]. Up to 11% of patients with posterolateral rotatory instability may experience complications after surgery [1].

Arthroplasty and Revision Considerations

Cementing a nonanatomic hinge that does not rely on native elbow soft tissue support can result in a troubling biomechanical environment [101]. The most common mode of failure requiring total elbow arthroplasty revision is aseptic loosening, which may be a consequence of known biomechanical challenges inherent to elbow arthroplasty [109]. Combining an understanding of anatomy and biomechanics with surgical technique allows for the reconstruction of chronically dislocated joints to achieve functional and painless elbows [72].

Portal Safety and Intra-articular Procedures

Joint distention and positioning of the elbow in 90° of flexion provides an increased safety margin for proximal anterolateral portals in elbow arthroscopy relative to the radial nerve [108]. Intra-articular arthroscopic biceps tenodesis with interference screw resulted in no difference to the contralateral side in peak torque for both supination and elbow flexion on isokinetic tests [116].

Pediatric and Specific Pathologies

Improved, but not normal, elbow motion can be expected in many but not all cases following operative treatment of elbow contracture in patients twenty-one years of age or younger [113]. Lower trapezius muscle transfer for elbow extension in children with brachial plexus birth injury demonstrated significant improvements in elbow function and muscle strength without postoperative weakness in elbow flexion [114]. In patients treated surgically for snapping triceps syndrome, it is crucial to ensure full resolution of the snapping by examining all dislocating structures during passive elbow motion and/or myoelectrical stimulation [120].

Classification

Monteggia-like Lesions: Correct identification and classification of Monteggia-like lesions of the elbow using CT scans, followed by appropriate surgical treatment addressing all injury components, can achieve good to excellent mid-term results [11].

Medial Meniscus Ramp Tears: A surgically relevant classification system for medial meniscus ramp tears based on tear morphology allows for the evaluation of differing repair patterns and their effects on postoperative clinical outcomes [28].

Intraoperative Ulnar Nerve Instability: Agreement with a novel classification of intraoperative ulnar nerve instability increased when simplifying the classification to 2 categories, which may provide guidance to surgical decision making [35].

Tumor Endoprostheses Failure Modes: A suggested classification system for tumor endoprostheses failure modes should eliminate mechanical/nonmechanical categories, separate periprosthetic and prosthetic fractures, and include planned minor revisions as a failure type [47].

Cementless Femoral Stems: A new classification system for cementless femoral stems in total hip arthroplasty allows for the easy classification of all currently used stem types [52].

Lateral Discoid Meniscus Pathology: A novel classification system that comprehensively and descriptively characterizes the spectrum of lateral discoid meniscus pathology demonstrated moderate or substantial agreement in most diagnostic categories analyzed [59].

Degenerative Medial Meniscus Posterior Root Tears: A novel arthroscopic classification of degenerative medial meniscus posterior root tears based on tear gap demonstrates that higher tear types (increasing displacement of the tear gap) are associated with higher meniscal extrusion, severe chondral wear, and greater severity of arthritis [67].

Other Considerations: Surgical approaches are becoming better understood through large case series, and subtype-specific management is becoming increasingly central to patient care [8]. Complication rates after hip arthroscopy are in line with complication rates after open surgical dislocation when using the same classification system [53]. All reported complications after needle arthroscopy were classified as grade I according to the Clavien-Dindo-Sink classification [69]. The authors propose adding two new injury types to existing classifications to better describe complex patterns involving meniscal root tears, ramp lesions, and posterior medial tibial plateau [86].

Clinical Presentation

Accurate diagnosis is the cornerstone of successful surgical intervention across multiple orthopaedic subspecialties. For Morton’s interdigital neuroma, success relies on correct diagnosis with recognition of all problem elements and optimal surgical technique [4]. In trapezius muscle paralysis, an accurate diagnosis allows consideration of various treatment modalities reported to provide good outcomes for properly selected patients [31]. For borderline developmental dysplasia of the hip, preoperative patient characteristics and concomitant injuries must be considered when evaluating which surgical procedure will result in the most favorable outcomes [32]. Alternative viewpoints and combinations of questions can help uncover important aspects of the patient experience and surgical interventions that are not easily identifiable with traditional methods [34].

Clinical presentation varies by gender and timing in specific pathologies. Females exhibit more symptoms than males at 6 and 12 months after surgery for acute Achilles tendon rupture, a gender difference not found when the condition is treated non-surgically [30]. Early surgical intervention for femoroacetabular impingement syndrome (FAIS), defined as 3-6 months after symptom onset, is associated with superior outcomes compared to intervention beyond this timeframe [40]. In rotator cuff tears, a positive tangent sign predicts worse operative outcomes, resulting in equivalent improvements between surgical and nonsurgical treatment [38].

Specific anatomical lesions and chronic conditions present distinct diagnostic challenges. An unusual gastrocnemius muscle syndrome represents a definite clinical syndrome associated with a specific anatomical lesion amenable to surgical repair [39]. Recognition of pseudo-obstruction of the colon via thorough physical examination and early abdominal radiographs is essential to avoid operative intervention [29]. For missed Monteggia lesions in children, surgery for chronic anterior radial head dislocations should be considered regardless of patient age or time since trauma [41].

Surgical outcomes and failure definitions require precise clinical monitoring. Up to 11% of patients may experience complications after surgery for posterolateral rotatory instability of the elbow [1]. Clinical outcomes for subscapularis tear surgery improved at the first evaluation with a mean follow-up of 14.8 months [2]. Most patients return to full function after surgery for symptomatic enchondromas of the hand, where curettage remains the standard of care [26]. In knee cartilage restoration studies, revision surgery is the most common definition of failure, which should be defined using multiple outcomes including unplanned surgical procedures, patient-reported outcomes, and the ability to return to the desired level of function [7].

Revision and complex reconstructions demand specialized considerations. Revision surgery for cubital tunnel syndrome can be offered for persistent or recurrent symptoms unexplained by an alternative diagnosis, though patients should be counseled that complete resolution of symptoms is unlikely [27]. The incidence of subsequent shoulder surgery following isolated arthroscopic superior labrum anterior and posterior (SLAP) repairs is likely multifactorial, involving both surgeon and patient-related factors, with inherent difficulties in diagnosing and treating SLAP lesions contributing to these outcomes [36]. Megaprosthesis surgery for post-traumatic and periprosthetic large bone defects must be performed in specialized centres where knowledge and technologies are present [9]. Surgical approaches for musculoskeletal tumors are becoming better understood through large case series, with subtype-specific management becoming increasingly central to patient care [8].

Novel techniques and minimally invasive options show promise. A novel minimally invasive carpal tunnel release using a specialized surgical kit demonstrates promising clinical outcomes with shortened operative time, rapid symptom relief, and early functional recovery [37].

Investigations

Plain radiography: Careful evaluation of serial radiographs remains the cornerstone of diagnosing aseptic loosening in total hip arthroplasty [75]. Appropriate imaging is required for the early recognition of incomplete glenosphere seating to mitigate polyethylene damage and bone loss [82]. Preoperative radiological factors did not influence functional scores in medial patellofemoral ligament reconstruction [98]. No radiographic features on follow-up were associated with poorer patient recorded outcome measures in press-fit radial head arthroplasty for unconstructable radial head fractures with associated elbow injuries [94]. Radiological analysis is a main point of debate regarding proximal interphalangeal joint replacements with pyrolytic carbon implants in the hand [97].

MRI: MRI is essential for preoperative planning in endoscopic ganglionectomy of the elbow [33]. High-resolution MRI is recommended to ensure complete excision and decrease recurrence rates in glomus tumours of the elbow [57]. MRI provides valuable clues for the diagnosis of tenosynovial giant cell tumour and lipoma arborescens, but definitive diagnosis relies on histopathological confirmation [76]. MRI is an effective method of preoperative assessment for meniscal ramp lesions [88]. The presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis [88]. MRI at 1 year after surgery demonstrated residual tear evidence for all patients in the study evaluating meniscus tear repair healing [87]. At 1 year follow-up, residual abnormal MRI findings were more common in the traditional debridement group compared to the arthroscopic extensor carpi radialis brevis tenotomy and debridement group for refractory lateral epicondylitis [90].

CT: CT scans are used for the correct identification, classification, and understanding of Monteggia-like lesions of the elbow [11]. A computed tomography–based classification is used for arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow [89]. Stage III shows worse clinical and radiologic outcomes compared with stage I or II according to the CT-based classification for advanced-stage primary osteoarthritis of the elbow [89].

Other Considerations: Ultrasonography is an effective alternative to MRI for diagnosing musculoskeletal pathology, offering real-time imaging, excellent soft-tissue contrast, and high spatial resolution without radiation exposure [70]. The diagnosis of aseptic loosening in total hip arthroplasty involves a careful history, focused clinical exam, and thorough evaluation of imaging using several diagnostic modalities [75]. Preoperative and postoperative imaging examinations are necessary for special patients undergoing shoulder arthroscopy to avoid catastrophic consequences such as pneumothorax [80]. Before revision surgery for patellar redislocation after primary isolated medial patellofemoral ligament reconstruction, a focused clinical examination and adequate imaging including radiographs, MRI, standing full-leg radiographs, and torsional measurement are recommended to assess all relevant anatomic parameters [81]. In-office needle arthroscopy can evaluate meniscus tear repair healing as an alternative to magnetic resonance imaging [87]. Those with prior shoulder surgery had more diagnostic imaging and orthopaedic surgery in college [93].

Treatment

Non-Operative

Conservative management serves as the primary intervention for several distinct pathologies. For anterior ankle impingement and posterior ankle pathology, conservative treatment is the initial approach, with surgery indicated only when conservative measures are unsuccessful [49, 91]. Nonoperative management remains the first step in the early management of elbow osteoarthritis [84]. In patients with subacromial pain, non-operative treatment markedly reduced the need for surgery even after 10 years [79]. Non-operative treatment cannot correct hallux valgus deformity but can help control symptoms [78]. For skeletally immature patients with a first-time patellofemoral dislocation, non-operative management is a reasonable and safe option, although it appears to be associated with a high failure rate [102]. Conservative therapy is successful for younger patients with short-duration symptoms of plica syndrome of the knee [103].

Operative

Indications: Surgical intervention is generally reserved for cases where conservative measures fail or specific structural indications are met. Arthroscopic resection for synovial plica of the elbow is effective and safe if conservative treatment fails [43]. Surgery is recommended for symptomatic SLAP lesions in non-athletic patients only if conservative treatment for a reasonable period fails [83]. The main indication for hip arthroscopy is femoroacetabular impingement (FAI) [50]. Arthroscopy is a standardized procedure with numerous indications for posterior pathology when conservative measures fail [91]. For recurrent instability of the proximal part, stabilization by ligament reconstruction is effective if non-operative management is inappropriate [95]. Treatment options for entrapment neuropathy of the ulnar nerve range from nonsurgical methods to surgical release [96].

Surgical Approach / Technique: Surgical strategies should be performed based on surgeon experience and available evidence [1]. Key factors in the success of surgery for Morton’s interdigital neuroma are correct diagnosis with recognition of all elements of the problem and optimal surgical technique [4]. Thoracodorsal nerve transfer for elbow flexion reconstruction in infraclavicular brachial plexus injuries is considered a safe, reproducible, and effective surgical option [56]. Granuloma debridement and the use of an injectable calcium phosphate bone cement is a safe and effective technique with minimal morbidity for treating osteolysis in an uncemented total knee replacement [51]. This technique may be an appropriate treatment modality when more extensive revision surgery is not possible [51]. A 10-year survival rate higher than 90% can be expected for total joint replacement for osteoarthritis of the carpometacarpal joint of the thumb with a meticulous surgical technique [60]. Surgical treatment techniques for concomitant repair of double radial tears of the lateral meniscus and anterior cruciate ligament reconstruction have a low failure rate at short-term follow-up [63]. Failure of treatment of humeral non-unions is a lack of biology rather than a lack of stability [104].

Implant Selection: Clinical results for total knee arthroplasty using hinge joints generally depend on implant design, appropriate technical use, and adequate indications [16].

Alignment / Balancing Strategy: No specific alignment or balancing strategies are detailed in the provided evidence base.

Pain Management: Postoperative bracing is widely used for various surgical procedures, although much of the literature lacks adequate comparisons of brace types or specific indications [17].

Adjuncts: Both meniscus repair groups with and without bone marrow aspiration concentrate had improved outcomes at 1 year post-operatively with no difference in complication rate [21].

Revision: No specific revision principles are detailed in the provided evidence base.

Other Considerations: Arthroscopic surgery gives good results when used for appropriate indications [12]. Most patients have good or excellent results after surgery for posterolateral rotatory instability of the elbow [1]. Up to 11% of patients may have complications after surgery for posterolateral rotatory instability of the elbow [1]. Clinical outcomes for subscapularis tear repair or debridement improved at the first evaluation, with a mean follow-up of 14.8 months after surgery [2]. Expanded indications or changing surgical preferences may explain trends in the surgical treatment of cubital tunnel syndrome [3]. Arthroscopic surgery privileges should be granted by hospitals with input from committees, and surgeons must have appropriate training and experience [15]. Most patients achieved successful clinically meaningful outcomes after arthroscopic repair for circumferential labral tears at a mean follow-up of approximately 5 years [62]. Arthroscopic surgery had the highest rate of success and the best improvement in functional outcomes among the 3 approaches for lateral epicondylitis [64]. Most patients report symptomatic relief following surgery for entrapment neuropathy of the ulnar nerve [96]. Operative release yields excellent or good results in the majority of patients with plica syndrome of the knee [103].

Regarding cubital tunnel syndrome, no surgical treatment procedure has shown superiority over another [46]. Individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential [46]. The study on cubital tunnel syndrome performed detailed comparisons of clinical improvement, complications, and reoperation rates across different treatment methods [48].

Complications

General Incidence: Up to 11% of patients may have complications after surgical treatment for posterolateral rotatory instability of the elbow [1]. In early experiences, the complication rate for total elbow arthroplasty was very high, although most complications occurred during the early years of the study [124]. Perioperative complications are the most important factors affecting outcome after humeral head replacement for proximal humeral fractures, with prevalence varying substantially due to differences in definitions and follow-up duration [42].

Infection (PJI): Patients with multiple joint arthroplasties and a history of periprosthetic joint infection (PJI) are at higher risk for developing a second PJI, with metachronous rates ranging from 3% to 19% and synchronous rates from 1.3% to 6% [118].

Other Considerations: Some patients may develop late-onset low back pain, radicular pain, and may need additional surgery after microdecompression for lumbar synovial cysts [14]. The true rate of rerupture after distal biceps tendon repair may be higher than previously thought [115]. In patients with a history of trauma or previous surgery, arthroscopic elbow surgery might lead to higher complication rates in less experienced hands [92]. Multicenter studies with long-term follow-up are needed to validate the complication profiles of endoscopic-assisted ACDF for C2-C3 disc herniation [5].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or driving.

Full activity (months): Evidence does not provide specific month ranges for full activity or sport return.

Complete recovery / outcome plateau (months): Clinical outcomes for arthroscopic repair or debridement of subscapularis tears improved at the first evaluation, with a mean follow-up of 14.8 months [2]. Favorable short-term outcomes, including reduction of pain and increase in function, are maintained over long-term follow-up for arthroscopic treatment of lateral epicondylitis [10]. Long-term follow-up of bucket-handle meniscal tear repair demonstrates satisfactory clinical outcomes and failure rates [13]. Microdecompression for lumbar synovial cysts provides beneficial effects that persist long term, with outcome data available at an average of nearly ten years post-operative [14]. After a minimum five-year follow-up, over 84% of patients demonstrate successful repair with all-inside second-generation meniscal repair [18]. Patients undergoing hip arthroscopy with concomitant periacetabular osteotomy can achieve excellent long-term outcomes and high rates of survivorship at a minimum of 10 years post-operation [19]. Clinical and radiological outcomes for arthroscopic distal tibial allograft with endobutton fixation for anterior shoulder instability were excellent at 2 years, but this should be interpreted in the context of a high lost-to-follow-up rate [22]. Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up [25]. Clinical and radiological outcomes at 10-year follow-up for platelet-rich plasma in arthroscopic rotator cuff repair show substantial uniformity between groups, with clinical differences observed at 2 years disappearing at long term [127].

Rehabilitation protocol: Evidence does not provide specific details on PT phasing, immobilisation duration, weight-bearing progression, or sling/brace removal timing.

Functional milestones: Most patients achieve good or excellent results after surgery for posterolateral rotatory instability of the elbow, though up to 11% may experience complications [1]. Short-term outcomes for endoscopic-assisted ACDF for C2-C3 disc herniation are promising, but multicenter studies with long-term follow-up are needed to validate durability and complication profiles [5]. Some patients who undergo microdecompression for lumbar synovial cysts may develop late-onset low back pain, radicular pain, and may need additional surgery [14]. Additional long-term studies are needed to determine the operative success of all-inside versus inside-out meniscal repair with concurrent anterior cruciate ligament reconstruction over time [20]. The natural history of first-time shoulder dislocations in young patients is bound up with arthropathy [23]. Distal biceps short head tears present acutely, have a poor natural history akin to complete tears, and have good outcomes with acute and delayed reconstruction [24]. No differences in functional outcomes existed between groups at final follow-up for re-tear following rotator cuff repair [55]. In short-term follow-up, all conservative stems provided excellent survivorship for uncemented short stems in primary total hip arthroplasty [71]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity over time for autologous matrix-induced chondrogenesis treatment of focal cartilage defects in the knee [74]. A time interval of less than 12 months or greater than 12 months between staged bilateral hip arthroscopy procedures for femoroacetabular impingement syndrome did not affect clinical outcomes and revision rate [125]. There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus undergoing capsular release for adhesive capsulitis [126].

Other Considerations: Evidence does not provide specific predictors of return-to-work failure or patient-selection caveats for early ROM.

Key Evidence

  • [L4] Treatment strategies vary and should be performed based on surgeon experience and evidence available; most patients will have good or excellent results after surgery, however, up to 11% of patients may have complications. (10.1016/j.arthro.2014.02.029)
  • [L2] Clinical outcomes improved at the first evaluation (mean 14.8 months after surgery). (10.1016/j.jse.2013.07.006)
  • [L3] Possible reasons include expanded indications or changing surgical preferences. (10.1016/j.jhsa.2013.04.044)
  • [L5] Key factors in the success of surgery are correct diagnosis with recognition of all elements of the problem and optimal surgical technique. (10.1302/2058-5241.4.180025)
  • [Case_report] While short-term outcomes are promising, multicenter studies with long-term follow-up are needed to validate durability and complication profiles. (10.1186/s12891-025-09302-7)
  • [L1] The authors recommend using multiple outcomes, including unplanned surgical procedures, patient-reported outcomes, and the ability to return to the desired level of function, to define failure. (10.1016/j.asmr.2024.101044)
  • [L5] Surgical approaches are becoming better understood through large case series, and subtype-specific management is becoming increasingly central to patient care. (10.2106/jbjs.24.00945)
  • [Paper] This type of complex surgery must be performed in specialised centres where knowledge and technologies are present. (10.1016/j.injury.2014.10.032)
  • [L3] With correct identification, classification, and understanding using CT scans followed by appropriate surgical treatment that addresses all components of the injury, good to excellent mid-term results can be achieved. (10.1302/0301-620x.100b2.bjj-2017-0398.r2)
  • [L5] When used for the appropriate indications, ankle arthroscopy appears to give good results. (10.5435/00124635-199601000-00004)
  • [L3] Long-term follow-up of BHMT repair demonstrated satisfactory clinical outcomes and failure rates. (10.1177/23259671241296899)
  • [L3] This study provides outcome data at an average of nearly ten years post-operative, demonstrating that beneficial effects of surgical intervention persist long term, though some patients will develop late-onset low back pain, radicular pain, and may need additional surgery. (10.1186/1749-799x-2-5)
  • [L5] This statement outlines guidelines for arthroscopic surgery practice, emphasizing that privileges should be granted by hospitals with input from committees and that surgeons must have appropriate training and experience. (10.1016/s0749-8063(10)00768-1)
  • [L4] Clinical results generally depend on implant design, appropriate technical use, and adequate indications. (10.1302/2058-5241.4.180056)
  • [L4] Although much of the literature lacks adequate comparisons of brace types or specific indications, postoperative bracing is still widely used for various surgical procedures. (10.5435/jaaos-d-23-00498)
  • [L4] After minimum five year follow-up, over 84% of patients continue to demonstrate successful repair. (10.1177/2325967114s00068)
  • [L4] These patients can achieve excellent longterm outcomes and high rates of survivorship at minimum 10 years postoperation. (10.1177/2325967124s00150)
  • [L4] Additional long-term studies will be useful to determine the operative success of these repairs over time. (10.1177/0363546516642220)
  • [L3] Both groups had improved outcomes at 1 year post-operatively with no difference in complication rate. (10.1177/2325967119s00283)
  • [L3] Clinical and radiological outcomes were excellent at 2 years, but this should be interpreted in the context of a high lost to follow-up rate in this cohort. (10.1016/j.arthro.2024.11.028)
  • [Abstract] The natural history of the first time shoulder dislocations is bound up with arthropathy. (10.1016/j.jse.2007.02.100)
  • [L4] They present acutely, have a poor natural history akin to complete tears, and have good outcomes with acute and delayed reconstruction. (10.1016/j.jse.2020.04.038)
  • [L3] Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up. (10.1016/j.arth.2023.03.093)
  • [L4] Surgical management with curettage is the standard of care for symptomatic lesions, with most patients returning to full function after surgery. (10.5435/jaaos-d-15-00452)
  • [L3] Revision surgery can be offered in the setting of persistent or recurrent symptoms that are unexplained by an alternative diagnosis, but patients should be counseled that complete resolution of symptoms is unlikely. (10.1016/j.jhsa.2014.07.013)
  • [L4] This classification system allows for the ability to evaluate differing repair patterns and their effects on postoperative clinical outcomes. (10.1177/2325967125s00101)
  • [L4] Recognition by thorough physical examination and early abdominal radiographs is essential if operative intervention is to be avoided. (10.2106/00004623-198365060-00030)
  • [L2] Females have more symptoms compared to males after surgery both at 6 and 12 months but this difference is not found when treated non-surgically. (10.1177/2325967114s00055)
  • [L5] An accurate diagnosis allows consideration of various treatment modalities that have been reported to provide good outcomes for properly selected patients. (10.1016/j.xrrt.2024.03.014)
  • [L4] Preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes. (10.1177/23259671211007401)
  • [Paper] MRI is essential for preoperative planning. (10.1016/j.eats.2015.07.013)
  • [L5] Alternative viewpoints and combinations of questions can help uncover important aspects of the patient experience and of surgical interventions that are not easily identifiable with traditional methods. (10.1016/j.arthro.2024.10.047)
  • [L5] Agreement appeared to increase when simplifying the classification to 2 categories, which may provide guidance to surgical decision making. (10.1016/j.jse.2024.02.030)
  • [L3] The reasons for this are likely multifactorial and include both surgeon and patient-related factors and point to the inherent difficult in diagnosing and treating these lesions. (10.1016/j.jse.2016.07.066)
  • [L4] This novel minimally invasive technique demonstrates promising clinical outcomes with shortened operative time, rapid symptom relief, and early functional recovery. (10.1186/s12891-025-08612-0)
  • [L2] A positive tangent sign was predictive of worse operative outcomes, resulting in equivalent improvements between surgical and nonsurgical treatment. (10.1177/2325967119863010)
  • [L4] The case represents a definite clinical syndrome associated with a specific anatomical lesion that is amenable to surgical repair. (10.2106/00004623-197355060-00016)
  • [L3] In patients with FAIS, surgical intervention early after the onset of symptoms (3-6 months) is associated with superior outcomes when compared to patients who underwent surgical intervention beyond this time frame. (10.1177/2325967119s00321)
  • [L4] Surgery should be considered regardless of patient age or time since trauma. (10.1177/1758573219839225)
  • [L4] Perioperative complications are the most important factors affecting outcome, with prevalence varying substantially due to differences in definitions and follow-up duration. (10.2106/00004623-200501000-00031)
  • [L4] The arthroscopic resection is effective and safe if conservative treatment fails. (10.1302/2058-5241.5.200027)
  • [L4] Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies. (10.5397/cise.2023.01081)
  • [L5] Recent changes in device design and implantation methods are driven by biomechanical and clinical outcome-based research to better reproduce elbow kinematics, resulting in more durable and long-lasting joint replacement procedures. (10.1302/2058-5241.2.160064)
  • [L5] No surgical treatment procedure has shown superiority over another; however, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential. (10.5435/jaaos-d-20-01381)
  • [Commentary] The author recommends the suggested classification system for endoprosthetic failures but suggests eliminating the mechanical/nonmechanical categories, separating periprosthetic and prosthetic fractures, and including planned minor revisions as a failure type. (10.2106/jbjs.j.01779)
  • [L4] The study performed detailed comparisons of clinical improvement, complications, and reoperation rates across different treatment methods. (10.1016/j.jse.2022.11.025)
  • [L5] Conservative treatment is the first-line treatment, with surgery indicated only when conservative measures are unsuccessful. (10.1136/jisakos-2019-000282)
  • [L4] The main indication for hip arthroscopy today is FAI. (10.1177/2325967114s00133)
  • [L5] This is a safe and effective technique with minimal morbidity and may be an appropriate treatment modality when more extensive revision surgery is not possible. (10.1186/1749-799x-5-29)
  • [L5] The proposed system allows for the easy classification of all currently used stem types. (10.1016/j.arth.2022.09.014)
  • [L3] This rate of complications is in line with complication rates after open surgical dislocation using the same classification system. (10.1177/2325967113s00045)
  • [L4] Since SRHP have satisfactory clinical results and an acceptable complication rate when selecting a patient group in suitable condition for surgical indications, it is considered that SRHP can still be chosen as a potential surgical treatment method in current clinical practice. (10.5397/cise.2022.00990)
  • [L3] No differences in functional outcomes existed between at final follow-up. (10.1177/17585732241267222)
  • [L4] The authors consider it a safe, reproducible, and effective surgical option. (10.1016/j.jhsa.2014.04.043)
  • [Case_report] They recommend using high-resolution MRI and ensuring complete excision to decrease recurrence rates. (10.1111/sae.12041)
  • [L5] Definitive answers regarding whether minimally invasive approaches are better or should be generally adopted are not yet known and will require many years of follow-up and large patient studies. (10.2106/00004623-200311000-00001)
  • [L4] A novel classification system that more comprehensively and descriptively characterizes the spectrum of LDM pathology demonstrated moderate or substantial agreement in most diagnostic categories analyzed. (10.1177/2325967120s00244)
  • [L5] A 10-year survival rate higher than 90% can be expected with a meticulous surgical technique. (10.1530/eor-22-0027)
  • [L4] The techniques and indications continue to evolve. (10.1016/j.jse.2017.07.005)
  • [L4] Most patients achieved successful clinically meaningful outcomes after arthroscopic repair at a mean follow-up of approximately 5 years. (10.1177/23259671261418674)
  • [L4] The variety of surgical treatment techniques have a low failure rate at short-term follow-up, and patients tend to have good clinical outcomes with improvement in pain and overall function after surgically treating these injuries with simultaneous ACL reconstruction. (10.1016/j.asmr.2021.02.005)
  • [L4] Arthroscopic surgery had the highest rate of success and the best improvement in functional outcomes among the 3 approaches of LE surgery. (10.1177/23259671241230291)
  • [L3] For this select group, this procedure may offer a viable alternative to open surgery (PAO). (10.1177/2325967117s00414)
  • [L3] The classification system demonstrated that a higher tear type (increasing displacement of the tear gap in arthroscopic surgery) is associated with higher meniscal extrusion, severe chondral wear, and greater severity of arthritis. (10.1177/2325967119827945)
  • [L3] Improved techniques have extended indications to older patients, who appear to have fewer complications. (10.2106/00004623-198163070-00004)
  • [L4] All reported complications were classified as grade I according to the Clavien-Dindo-Sink classification. (10.1016/j.asmr.2025.101158)
  • [L5] Ultrasonography is an effective alternative to MRI for diagnosing musculoskeletal pathology, offering real-time imaging, excellent soft-tissue contrast, and high spatial resolution without radiation exposure, though its utility remains underutilized in orthopaedic surgery compared to other modalities. (10.5435/jaaos-d-16-00221)
  • [L4] In the short-term follow-up, all conservative stems provided excellent survivorship. (10.1302/2058-5241.3.170052)
  • [L4] By combining an understanding of anatomy and biomechanics with surgical technique, the authors could reconstruct chronically dislocated joints to achieve functional and painless elbows. (10.1016/j.jse.2006.09.003)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L5] The diagnosis of aseptic loosening involves a careful history, focused clinical exam, and thorough evaluation of imaging using several diagnostic modalities, with careful evaluation of serial radiographs remaining the cornerstone of diagnosis. (10.1016/j.arth.2022.02.060)
  • [L4] MRI provides valuable clues, but definitive diagnosis relies on histopathological confirmation. (10.1186/s12891-026-09563-w)
  • [L5] Non-operative treatment cannot correct the deformity but can help control symptoms. (10.1302/2058-5241.1.000005)
  • [L1] Even after 10 years non-operative treatment had markedly reduced the need for surgery in patients with subacromial pain. (10.1016/j.jse.2023.02.064)
  • [Case_report] It is necessary to carry out preoperative and postoperative imaging examinations for special patients, and orthopedic surgeons should initiate timely management to avoid catastrophic consequences. (10.1016/j.xrrt.2021.04.003)
  • [L4] Before revision surgery, a focused clinical examination and adequate imaging including radiographs, MRI, standing full-leg radiographs, and torsional measurement are recommended to assess all relevant anatomic parameters. (10.1177/2325967120926178)
  • [L4] Early recognition, appropriate imaging, and timely revision can mitigate polyethylene damage and bone loss, with good functional outcomes following revision surgery. (10.1016/j.xrrt.2026.100668)
  • [L2] Surgery is recommended only if conservative treatment for a reasonable period fails. (10.1016/j.jse.2014.11.030)
  • [L5] Nonoperative treatment remains the first step in the early management of elbow osteoarthritis. (10.2106/jbjs.e.00568)
  • [L4] The authors propose adding two new injury types to existing classifications to better describe these complex patterns. (10.1016/j.arthro.2024.06.011)
  • [L4] MRI at 1 year after surgery demonstrated residual tear evidence for all patients. (10.1016/j.asmr.2021.08.003)
  • [L4] MRI is an effective method of preoperative assessment, and the presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis. (10.1016/j.asmr.2020.03.003)
  • [L4] However, stage III shows worse clinical and radiologic outcomes compared with stage I or II according to CT-based classification. (10.1016/j.jse.2019.09.036)
  • [L3] At 1 year follow-up, there were no differences in outcome measures between groups, but residual abnormal MRI findings were more common in the traditional debridement group. (10.1177/23259671221092733)
  • [L5] It emphasizes that while conservative treatment is the initial approach, arthroscopy is a standardized procedure with numerous indications for posterior pathology when conservative measures fail. (10.1136/jisakos-2016-000082)
  • [L4] However, in patients with a history of trauma or previous surgery, the procedure is more challenging and might lead to higher complication rates in less experienced hands. (10.1016/j.jse.2013.01.032)
  • [L3] Those with prior shoulder surgery additionally had more diagnostic imaging and orthopaedic surgery in college. (10.1177/2325967115s00149)
  • [L4] No radiographic features on follow-up were associated with poorer patient recorded outcome measures. (10.1177/17585732241268904)
  • [L5] Treatment options range from nonsurgical methods to surgical release, with most patients reporting symptomatic relief following surgery. (10.5435/00124635-200711000-00006)
  • [L4] The main points of debate relate to surgical technique, radiological analysis, post-operative rehabilitation, and assessment of clinical results. (10.1302/2058-5241.2.160041)
  • [L4] Clinical factors, technical factors, and preoperative radiological factors did not influence functional scores. (10.1016/j.arthro.2017.08.056)
  • [L4] Biomechanical evidence suggests that an elliptical implant yields glenohumeral kinematics that mimic the native joint, and early clinical results are promising. (10.5435/jaaos-d-22-01084)
  • [L5] Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. (10.1177/0363546509350109)
  • [L5] Cementing a nonanatomic hinge that may not rely on the native elbow soft tissue support can result in a troubling biomechanical environment. (10.1016/j.jhsa.2018.11.020)
  • [L3] Non-operative management in skeletally immature patients with first-time patellofemoral dislocation remains a reasonable and safe option but appears to be associated with high failure rate. (10.1016/j.jisako.2023.03.308)
  • [L4] Conservative therapy is successful for younger patients with short-duration symptoms, while operative release yields excellent or good results in the majority of patients. (10.2106/00004623-198062020-00008)
  • [L4] Failure of treatment of humeral non-unions is a lack of biology rather than a lack of stability. (10.1016/j.injury.2005.07.041)
  • [L4] Joint distention and positioning of the elbow in 90° of flexion provides an increase in safety margin. (10.1136/jisakos-2018-000205)
  • [L4] The most common mode of failure requiring revision is aseptic loosening, which may be a consequence of the known biomechanical challenges inherent to elbow arthroplasty. (10.1016/j.jse.2025.05.024)
  • [L4] Both directions of instability must be addressed surgically to restore elbow stability. (10.1016/j.injury.2007.01.039)
  • [L4] The authors suggest that the approach allows better visualization of the lateral structures for repair and confers excellent stability to the elbow joint. (10.1016/j.jseint.2021.11.011)
  • [Paper] Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness. (10.1016/j.injury.2013.09.032)
  • [L4] Improved, but not normal, elbow motion can be expected in many but not all cases. (10.2106/00004623-200203000-00008)
  • [L4] The procedure demonstrated significant improvements in elbow function and muscle strength without postoperative weakness in elbow flexion. (10.1016/j.jse.2025.10.007)
  • [L4] Postoperative complication rates were similar to those found in prior studies, although the true rate of rerupture may be higher than previously thought. (10.1016/j.jse.2015.11.012)
  • [L4] Isokinetic tests revealed no difference to the contralateral side in peak torque for both supination and elbow flexion. (10.1016/j.jseint.2020.03.012)
  • [L5] While each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its pre-injured state. (10.1016/j.jse.2023.02.047)
  • [L4] Patients with multiple joint arthroplasties and a history of PJI are at higher risk for developing a second PJI, with metachronous rates ranging from 3% to 19% and synchronous rates from 1.3% to 6%. (10.5435/jaaos-d-23-00120)
  • [L5] Both the proximal docking and the single-point fixation hybrid reconstructions provided sufficient joint stability and strength compared to the intact elbows, with the exception of the proximal docking method at low flexion angles. (10.1016/j.jhsa.2014.07.040)
  • [L4] In patients treated with surgery, it is crucial to make sure full resolution of the snapping by examining all dislocating structures during passive elbow motion and/or myoelectrical stimulation to achieve excellent results. (10.1016/j.xrrt.2025.08.017)
  • [L4] Although the complication rate was very high, most complications occurred during the early years of the study. (10.2106/00004623-198163070-00002)
  • [L3] A time interval of less than 12 months or greater than 12 months between bilateral procedures did not affect clinical outcomes and revision rate. (10.1002/arj.70069)
  • [L3] There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus. (10.1016/j.jseint.2023.06.007)
  • [L1] The clinical and radiological outcomes at the 10-year follow-up show a substantial uniformity of results between the two groups, with clinical differences observed at 2 years disappearing at long term. (10.1177/2325967121s00245)

See Also

References

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