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

113 citationsUpdated Aug 2026

Overview

Surgical management of conditions such as posterolateral rotatory instability of the elbow varies based on surgeon experience and available evidence [1]. Most patients achieve good or excellent results following surgery for this instability [1]. However, up to 11% of patients may experience complications [1]. For cubital tunnel syndrome, trends in surgical treatment may reflect expanded indications or changing preferences [3].

Arthroscopic interventions show specific outcome profiles across joints. Ankle arthroscopy yields good results when used for appropriate indications [12]. In knee cartilage restoration, failure is most commonly defined as revision surgery, though multiple outcomes including unplanned procedures, patient-reported outcomes, and return to function should define failure [7]. Hip arthroscopy with labral preservation and capsular plication may offer a viable alternative to open surgery (PAO) for patients with borderline hip dysplasia [65].

Implant and technique considerations also shape overview decisions. Silicone radial head prostheses provide satisfactory clinical results and an acceptable complication rate in suitable patient groups, serving as a potential treatment method [53]. For the Tharies system, improved techniques have extended surface replacement indications to older patients, who appear to have fewer complications [69]. Pediatric elbow arthroscopy techniques and indications continue to evolve [61]. Definitive answers on whether minimally invasive approaches are superior or should be generally adopted remain unknown and require long-term follow-up and large studies [58].

Operational standards require that hospital privileges for arthroscopic surgery be granted with committee input, ensuring surgeons have appropriate training and experience [15]. Postoperative bracing is widely used, though literature often lacks adequate comparisons of brace types or specific indications [16]. Proper patient selection, surgical technique, and postoperative management are critical to mitigate risks such as nerve injuries in the arthroscopic treatment of stiff elbow [68].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Elbow Arthroplasty: Recent changes in device design and implantation methods are driven by biomechanical and clinical outcome-based research to better reproduce elbow kinematics [44]. Biomechanical evidence suggests that elliptical humeral head implants yield glenohumeral kinematics that mimic the native joint [100]. However, cementing a nonanatomic hinge that may not rely on native elbow soft tissue support can result in a troubling biomechanical environment [102]. 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 [110]. Anatomical and biomechanical understanding combined with surgical technique can reconstruct chronically dislocated elbows to achieve functional and painless joints [73].

Shoulder Kinematics: Loading the long head and short head of the biceps brachii has significant effects on glenohumeral kinematics and contact characteristics in the throwing shoulder [122]. While each coracoclavicular, acromioclavicular, or combined reconstruction technique was able to restore different elements of joint kinematics, none of the strategies completely restored the shoulder girdle to its pre-injured state [118].

Ligamentous and Soft Tissue Stability

Ulnar Collateral Ligament (UCL): Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state [101]. Both proximal docking and single-point fixation hybrid reconstructions for elbow UCL provided sufficient joint stability and strength compared to intact elbows, with the exception of the proximal docking method at low flexion angles [120].

Posterolateral Rotatory Instability (PLRI): Treatment strategies for posterolateral rotatory instability of the elbow should be based on surgeon experience and available evidence [1]. Both posterolateral and posteromedial rotatory instability directions must be addressed surgically to restore elbow stability [111]. Up to 11% of patients with posterolateral rotatory instability of the elbow may have complications after surgery [1]. Further understanding of the static and dynamic anatomy of the lateral part of the elbow is needed to develop future treatment and preventive strategies [43].

Other Soft Tissue Pathologies: In patients treated with surgery 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 [121]. Isokinetic tests for intra-articular arthroscopic biceps tenodesis with interference screw revealed no difference to the contralateral side in peak torque for both supination and elbow flexion [117].

Surgical Approaches and Technical Considerations

Approaches: The posterior (Boyd) approach to terrible triad injuries allows better visualization of the lateral structures for repair and confers excellent stability to the elbow joint [112]. Joint distention and positioning of the elbow in 90° of flexion provides an increase in safety margin for proximal anterolateral portals in elbow arthroscopy relative to the radial nerve [109].

Pediatric and Developmental Considerations: 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 [115]. Improved, but not normal, elbow motion can be expected in many but not all cases of operative treatment for elbow contracture in patients twenty-one years of age or younger [114].

Clinical Outcomes and Functional Goals

Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness in complex instability of the elbow [113]. The goal of treatment for posttraumatic elbow stiffness is to restore a functional range of elbow motion (≥30° to 130°) [107].

Classification

Monteggia-like lesions: Correct identification and classification of these elbow injuries, followed by appropriate surgical treatment addressing all injury components, achieves good to excellent mid-term results [11].

Medial meniscus ramp tears: A surgically relevant classification system based on tear morphology allows for the evaluation of differing repair patterns and their effects on postoperative clinical outcomes [27].

Intraoperative ulnar nerve instability: Simplifying a novel classification of this instability to 2 categories may increase agreement and provide guidance to surgical decision making [34].

Tumor endoprostheses failure modes: A suggested classification system should eliminate mechanical/nonmechanical categories, separate periprosthetic and prosthetic fractures, and include planned minor revisions as a failure type [46].

Cementless femoral stems: A new classification system for total hip arthroplasty stems allows for the easy classification of all currently used stem types [51].

Lateral discoid meniscus: A comprehensive classification system demonstrated moderate or substantial agreement in most diagnostic categories analyzed [59].

Degenerative medial meniscus posterior root tears: A novel arthroscopic classification based on tear gap shows that higher tear types (increasing displacement) 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 [52]. All reported complications after needle arthroscopy were classified as grade I according to the Clavien-Dindo-Sink classification [70]. Two new injury types should be added to existing classifications to better describe complex patterns involving meniscal root tears, ramp lesions, and posterior medial tibial plateau [87]. The type and incidence of open shoulder surgery procedures continue to change [86].

Clinical Presentation

Complication and Failure Profiles: Complications occur in up to 11% of patients undergoing surgery for posterolateral rotatory instability of the elbow [1]. In knee cartilage restoration, failure is most commonly defined by the need for revision surgery [7]. However, failure 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].

Diagnostic Accuracy and Surgical Indications: Success in Morton’s interdigital neuroma surgery depends on correct diagnosis with recognition of all elements of the problem and optimal surgical technique [4]. A positive tangent sign is predictive of worse operative outcomes in rotator cuff tears, resulting in equivalent improvements between surgical and nonsurgical treatment [37]. Preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes for borderline developmental dysplasia of the hip [31].

Timing and Technique Considerations: Early surgical intervention for femoroacetabular impingement syndrome (3-6 months after symptom onset) is associated with superior outcomes compared to intervention beyond this timeframe [39]. A novel minimally invasive carpal tunnel release technique demonstrates shortened operative time, rapid symptom relief, and early functional recovery [36]. Surgical management with curettage is the standard of care for symptomatic enchondromas of the hand, with most patients returning to full function after surgery [25].

Postoperative Outcomes and Symptom Reporting: Clinical outcomes for subscapularis tears improved at the first evaluation, with a mean follow-up of 14.8 months after surgery [2]. Revision surgery for cubital tunnel syndrome can be offered for persistent or recurrent symptoms unexplained by an alternative diagnosis, but complete resolution of symptoms is unlikely [26]. Females report more symptoms than males at 6 and 12 months after surgery for acute Achilles tendon rupture, a difference not observed in non-surgically treated patients [29].

Investigations

Plain radiography: Careful evaluation of serial radiographs remains the cornerstone of diagnosing aseptic loosening in total hip arthroplasty [76]. Appropriate imaging is required for the early recognition of incomplete glenosphere seating to mitigate polyethylene damage and bone loss [83]. 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 [95]. Preoperative radiological factors did not influence functional scores in medial patellofemoral ligament reconstruction [99]. Radiological analysis is a main point of debate in proximal interphalangeal joint replacements with pyrolytic carbon implants in the hand [98].

MRI: MRI is essential for preoperative planning in endoscopic ganglionectomy of the elbow [32]. 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 [77]. MRI is an effective method of preoperative assessment for meniscal ramp lesions [89]. The presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis [89]. Residual abnormal MRI findings were more common in the traditional debridement group compared to the extensor carpi radialis brevis tenotomy and debridement group for refractory lateral epicondylitis, despite no differences in outcome measures [91]. MRI at 1 year after surgery demonstrated residual tear evidence for all patients in the study on in-office needle arthroscopy [88].

CT: CT scans are used for the correct identification and classification 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 [90]. Stage III shows worse clinical and radiologic outcomes compared with stage I or II according to the CT-based classification for elbow osteoarthritis [90].

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 [71]. Ultrasonography's utility remains underutilized in orthopaedic surgery compared to other modalities [71]. 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 [76]. Preoperative and postoperative imaging examinations are necessary for special patients undergoing shoulder arthroscopy to avoid catastrophic consequences such as pneumothorax [81]. 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 [82]. In-office needle arthroscopy can evaluate meniscus tear repair healing as an alternative to magnetic resonance imaging [88]. Those with prior shoulder surgery had more diagnostic imaging and orthopaedic surgery in college [94].

Treatment

Non-Operative

Conservative management serves as the primary intervention for several pathologies. For anterior ankle impingement and posterior ankle pathology, conservative treatment is the first-line approach, with surgery indicated only when these measures fail [48, 92]. Similarly, nonoperative management is the initial step in early elbow osteoarthritis [85], and conservative therapy is successful for younger patients with short-duration plica syndrome symptoms [104]. In skeletally immature patients with first-time patellofemoral dislocation, non-operative management is a reasonable and safe option, though it carries a high failure rate [103]. For hallux valgus, non-operative treatment cannot correct the deformity but helps control symptoms [79]. Physiotherapy with specific exercises significantly reduces the need for surgery in subacromial pain patients, even after 10 years [80]. For symptomatic SLAP lesions in non-athletic patients, surgery is recommended only if conservative treatment fails for a reasonable period [84].

Operative

Indications: Surgical intervention is reserved for cases where conservative measures are unsuccessful or inappropriate. For recalcitrant cubital tunnel syndrome, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential, as no single procedure has shown superiority over another [45]. Arthroscopic resection of the elbow synovial plica is effective and safe if conservative treatment fails [42]. For recurrent instability of the proximal part, stabilization by ligament reconstruction is effective if non-operative management is inappropriate [96]. Surgery for anterior ankle impingement is indicated only when conservative measures are unsuccessful [48]. Posterior ankle arthroscopy is indicated for posterior pathology when conservative measures fail [92]. Total joint replacement for carpometacarpal joint osteoarthritis is considered based on the high survival rate with meticulous technique [60].

Surgical Approach / Technique: Surgical strategies for posterolateral rotatory instability should be based on surgeon experience and available evidence, with most patients achieving good or excellent results [1]. Arthroscopic surgery for lateral epicondylitis demonstrates the highest success rate and best functional improvement among three approaches [64]. Arthroscopic repair of circumferential labral tears yields successful clinically meaningful outcomes at a mean follow-up of approximately 5 years [62]. Surgical techniques for concomitant double radial tears of the lateral meniscus and anterior cruciate ligament reconstruction have a low failure rate at short-term follow-up, with patients tending to have good clinical outcomes and improved pain and function [63]. Operative release for plica syndrome yields excellent or good results in the majority of patients [104]. Ligament reconstruction for recurrent instability preserves fibular physiology and avoids complications associated with arthrodesis or resection [96]. Thoracodorsal nerve transfer for elbow flexion reconstruction in infraclavicular brachial plexus injuries is a safe, reproducible, and effective option [56]. Granuloma debridement with injectable calcium phosphate bone cement is a safe and effective technique with minimal morbidity for osteolysis in uncemented total knee replacements, particularly when extensive revision is not possible [50].

Implant Selection: Clinical results of total knee arthroplasty using hinge joints depend on implant design, appropriate technical use, and adequate indications [54].

Adjuncts: Meniscus repair outcomes improved at 1 year post-operatively in both groups with and without bone marrow aspiration concentrate, with no difference in complication rates between the two groups [20].

Other Considerations: The success of surgery for Morton’s interdigital neuroma depends on correct diagnosis with recognition of all elements of the problem and optimal surgical technique [4]. Ankle arthroscopy provides good results when used for appropriate indications [12]. Up to 11% of patients with posterolateral rotatory instability may experience complications after surgery [1]. Most patients report symptomatic relief following surgery for entrapment neuropathy of the ulnar nerve, with treatment options ranging from nonsurgical methods to surgical release [97]. Failure of treatment of humeral non-unions is attributed to a lack of biology rather than a lack of stability [105]. Trends in the surgical treatment of cubital tunnel syndrome may be driven by expanded indications or changing surgical preferences [3]. A study on cubital tunnel syndrome performed detailed comparisons of clinical improvement, complications, and reoperation rates across different treatment methods [47]. Arthroscopic surgery privileges should be granted by hospitals with input from committees, requiring surgeons to have appropriate training and experience [15].

Complications

General Incidence: Up to 11% of patients may have complications after surgical treatment for posterolateral rotatory instability of the elbow [1]. In patients with a history of trauma or previous surgery, arthroscopic elbow surgery might lead to higher complication rates in less experienced hands [93]. 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 [41].

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% [119].

Other Considerations: Postoperative complication rates for distal biceps tendon repair were similar to those found in prior studies, although the true rate of rerupture may be higher than previously thought [116]. The complication rate for total elbow arthroplasty was very high in a five-year experience at the Mayo Clinic, although most complications occurred during the early years of the study [125]. Some patients who undergo microdecompression for lumbar synovial cysts will develop late-onset low back pain, radicular pain, and may need additional surgery [14]. 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 desk work return.

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

Complete recovery / outcome plateau (months): 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]. Clinical and radiological outcomes for arthroscopic distal tibial allograft with endobutton fixation for anterior shoulder instability were excellent at 2 years [21]. Clinical and radiological outcomes at the 10-year follow-up for platelet rich plasma in arthroscopic rotator cuff repair show a substantial uniformity of results between groups, with clinical differences observed at 2 years disappearing at long term [128].

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

Functional milestones: 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 demonstrated satisfactory clinical outcomes and failure rates [13]. Beneficial effects of microdecompression for lumbar synovial cysts persist long term, with outcome data available at an average of nearly ten years post-operative [14]. Over 84% of patients continue to demonstrate successful repair after a minimum five-year follow-up for all-inside second generation meniscal repair [17]. Patients undergoing hip arthroscopy with concomitant periacetabular osteotomy can achieve excellent long-term outcomes and high rates of survivorship at minimum 10 years postoperation [18]. No differences in functional outcomes existed between groups at final follow-up for re-tear following rotator cuff repair [55]. In the short-term follow-up, all conservative stems provided excellent survivorship for uncemented short stems in primary total hip arthroplasty [72]. 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 [126]. 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 [127].

Other Considerations: Multicenter studies with long-term follow-up are needed to validate durability and complication profiles for endoscopic-assisted ACDF for C2-C3 disc herniation [5]. Additional long-term studies are useful to determine the operative success of all-inside versus inside-out meniscal repair with concurrent anterior cruciate ligament reconstruction over time [19]. Further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time for autologous matrix-induced chondrogenesis treatment of focal cartilage defects in the knee [75]. The natural history of first-time shoulder dislocations is bound up with arthropathy [22]. 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 [23]. Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up [24]. Some patients may develop late-onset low back pain, radicular pain, and may need additional surgery after microdecompression for lumbar synovial cysts [14]. 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 in this cohort [21].

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. [1] (10.1016/j.arthro.2014.02.029)
• [L2] Clinical outcomes improved at the first evaluation (mean 14.8 months after surgery). [2] (10.1016/j.jse.2013.07.006)
• [L3] Possible reasons include expanded indications or changing surgical preferences. [3] (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. [4] (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. [5] (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. [7] (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. [8] (10.2106/jbjs.24.00945)
• [L4] Favorable short-term outcomes such as reduction of pain and increase in function are maintained over a long-term follow-up. [10] (10.1197/j.jht.2008.04.007)
• [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. [11] (10.1302/0301-620x.100b2.bjj-2017-0398.r2)
• [L5] When used for the appropriate indications, ankle arthroscopy appears to give good results. [12] (10.5435/00124635-199601000-00004)
• [L3] Long-term follow-up of BHMT repair demonstrated satisfactory clinical outcomes and failure rates. [13] (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. [14] (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. [15] (10.1016/s0749-8063(10)00768-1)
• [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. [16] (10.5435/jaaos-d-23-00498)
• [L4] After minimum five year follow-up, over 84% of patients continue to demonstrate successful repair. [17] (10.1177/2325967114s00068)
• [L4] These patients can achieve excellent longterm outcomes and high rates of survivorship at minimum 10 years postoperation. [18] (10.1177/2325967124s00150)
• [L4] Additional long-term studies will be useful to determine the operative success of these repairs over time. [19] (10.1177/0363546516642220)
• [L3] Both groups had improved outcomes at 1 year post-operatively with no difference in complication rate. [20] (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. [21] (10.1016/j.arthro.2024.11.028)
• [Abstract] The natural history of the first time shoulder dislocations is bound up with arthropathy. [22] (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. [23] (10.1016/j.jse.2020.04.038)
• [L3] Contemporary revision acetabular components have dramatically improved upon historical results at available follow-up. [24] (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. [25] (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. [26] (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. [27] (10.1177/2325967125s00101)
• [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. [29] (10.1177/2325967114s00055)
• [L4] Preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes. [31] (10.1177/23259671211007401)
• [Paper] MRI is essential for preoperative planning. [32] (10.1016/j.eats.2015.07.013)
• [L5] Agreement appeared to increase when simplifying the classification to 2 categories, which may provide guidance to surgical decision making. [34] (10.1016/j.jse.2024.02.030)
• [L4] This novel minimally invasive technique demonstrates promising clinical outcomes with shortened operative time, rapid symptom relief, and early functional recovery. [36] (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. [37] (10.1177/2325967119863010)
• [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. [39] (10.1177/2325967119s00321)
• [L4] Perioperative complications are the most important factors affecting outcome, with prevalence varying substantially due to differences in definitions and follow-up duration. [41] (10.2106/00004623-200501000-00031)
• [L4] The arthroscopic resection is effective and safe if conservative treatment fails. [42] (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. [43] (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. [44] (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. [45] (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. [46] (10.2106/jbjs.j.01779)
• [L4] The study performed detailed comparisons of clinical improvement, complications, and reoperation rates across different treatment methods. [47] (10.1016/j.jse.2022.11.025)
• [L5] Conservative treatment is the first-line treatment, with surgery indicated only when conservative measures are unsuccessful. [48] (10.1136/jisakos-2019-000282)
• [L4] The main indication for hip arthroscopy today is FAI. [49] (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. [50] (10.1186/1749-799x-5-29)
• [L5] The proposed system allows for the easy classification of all currently used stem types. [51] (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. [52] (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. [53] (10.5397/cise.2022.00990)
• [L4] Clinical results generally depend on implant design, appropriate technical use, and adequate indications. [54] (10.1302/2058-5241.4.180056)
• [L3] No differences in functional outcomes existed between at final follow-up. [55] (10.1177/17585732241267222)
• [L4] The authors consider it a safe, reproducible, and effective surgical option. [56] (10.1016/j.jhsa.2014.04.043)
• [Case_report] They recommend using high-resolution MRI and ensuring complete excision to decrease recurrence rates. [57] (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. [58] (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. [59] (10.1177/2325967120s00244)
• [L5] A 10-year survival rate higher than 90% can be expected with a meticulous surgical technique. [60] (10.1530/eor-22-0027)
• [L4] The techniques and indications continue to evolve. [61] (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. [62] (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. [63] (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. [64] (10.1177/23259671241230291)
• [L3] For this select group, this procedure may offer a viable alternative to open surgery (PAO). [65] (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. [67] (10.1177/2325967119827945)
• [L4] The authors discuss the importance of proper patient selection, surgical technique, and postoperative management to mitigate risks such as nerve injuries. [68] (10.5402/2011/378135)
• [L3] Improved techniques have extended indications to older patients, who appear to have fewer complications. [69] (10.2106/00004623-198163070-00004)
• [L4] All reported complications were classified as grade I according to the Clavien-Dindo-Sink classification. [70] (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. [71] (10.5435/jaaos-d-16-00221)
• [L4] In the short-term follow-up, all conservative stems provided excellent survivorship. [72] (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. [73] (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. [75] (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. [76] (10.1016/j.arth.2022.02.060)
• [L4] MRI provides valuable clues, but definitive diagnosis relies on histopathological confirmation. [77] (10.1186/s12891-026-09563-w)
• [L5] Non-operative treatment cannot correct the deformity but can help control symptoms. [79] (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. [80] (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. [81] (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. [82] (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. [83] (10.1016/j.xrrt.2026.100668)
• [L2] Surgery is recommended only if conservative treatment for a reasonable period fails. [84] (10.1016/j.jse.2014.11.030)
• [L5] Nonoperative treatment remains the first step in the early management of elbow osteoarthritis. [85] (10.2106/jbjs.e.00568)
• [L3] The type and incidence of open shoulder surgery procedures continues to change. [86] (10.1016/j.jse.2020.01.075)
• [L4] The authors propose adding two new injury types to existing classifications to better describe these complex patterns. [87] (10.1016/j.arthro.2024.06.011)
• [L4] MRI at 1 year after surgery demonstrated residual tear evidence for all patients. [88] (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. [89] (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. [90] (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. [91] (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. [92] (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. [93] (10.1016/j.jse.2013.01.032)
• [L3] Those with prior shoulder surgery additionally had more diagnostic imaging and orthopaedic surgery in college. [94] (10.1177/2325967115s00149)
• [L4] No radiographic features on follow-up were associated with poorer patient recorded outcome measures. [95] (10.1177/17585732241268904)
• [L5] Treatment options range from nonsurgical methods to surgical release, with most patients reporting symptomatic relief following surgery. [97] (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. [98] (10.1302/2058-5241.2.160041)
• [L4] Clinical factors, technical factors, and preoperative radiological factors did not influence functional scores. [99] (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. [100] (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. [101] (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. [102] (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. [103] (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. [104] (10.2106/00004623-198062020-00008)
• [L4] Failure of treatment of humeral non-unions is a lack of biology rather than a lack of stability. [105] (10.1016/j.injury.2005.07.041)
• [L5] The goal of treatment is to restore a functional range of elbow motion (≥30° to 130°). [107] (10.5435/00124635-200203000-00006)
• [L4] Joint distention and positioning of the elbow in 90° of flexion provides an increase in safety margin. [109] (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. [110] (10.1016/j.jse.2025.05.024)
• [L4] Both directions of instability must be addressed surgically to restore elbow stability. [111] (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. [112] (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. [113] (10.1016/j.injury.2013.09.032)
• [L4] Improved, but not normal, elbow motion can be expected in many but not all cases. [114] (10.2106/00004623-200203000-00008)
• [L4] The procedure demonstrated significant improvements in elbow function and muscle strength without postoperative weakness in elbow flexion. [115] (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. [116] (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. [117] (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. [118] (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%. [119] (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. [120] (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. [121] (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. [125] (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. [126] (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. [127] (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. [128] (10.1177/2325967121s00245)

See Also

• Cubital Tunnel Syndrome
• Elbow Arthroplasty
• Elbow Osteoarthritis

References

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