shoulder elbow
RCT
LOE I
n = 79 enrolled, 76 completed 2-year follow-up (38 per group)
Minimum 2 years; radiographic assessment at 6, 12, and 24 months.
Rius X, Gonzalez-Morgado D · … · Hachem AI
Key Takeaway: The 155°-distalized stem configuration produced a 4-fold lower risk of greater tuberosity nonhealing compared to the 135°-lateralized stem (8% vs. 32%, RR 4.0, 95% CI 1.23–13.05) in reverse TSA for proximal humerus fractures.
pediatrics
prospective cohort
LOE II
n = 156 (UE n=64, LEAA n=52, AF n=40)
N/A
Kim S, Zotter SF · … · Schillinger A
Key Takeaway: Pediatric lower extremity above-ankle fractures present with mean serum 25-OH vitamin D of 18.9 ng/mL versus 25.7 ng/mL in upper extremity fractures, with 58% meeting deficiency criteria (<20 ng/mL) compared to 30% in upper extremity and ankle/foot groups.
shoulder elbow
prospective cohort
LOE II
n = 80 (40 per group)
Mean 68.9 months (OBICS) and 70.5 months (IABR); minimum 60 months.
Bitar IJ, Nores CA · … · Rivera Bacile JV
Key Takeaway: Open Bankart plus inferior capsular shift reduced recurrence to 2.5% versus 17.5% with isolated arthroscopic Bankart repair in collision athletes after a first dislocation (p=0.031), with equivalent functional scores, ROM, and return-to-sport rates at 5 years.
pediatrics
retrospective cohort
LOE II
n = 164
Until skeletal maturity (Risser 4+), curve ≥45°, or spinal fusion; specific duration not reported.
Taylor TN, Ratnasamy PP · … · Smith BG
Key Takeaway: A PHOS-based prognostic model predicts surgical curve progression in unbraced AIS patients with a c-statistic of 0.89 and NPV of 0.94, performing equivalently to a Risser-based model.
spine
prospective cohort
LOE II
n = 211 enrolled; n=98 completed 12-year PRO and radiographic follow-up
Median 12 years (range 9–15 years)
Rodrigues Fernandes R · … · Bailey C
Key Takeaway: At 12-year follow-up after lumbar stenosis surgery, 26% of patients required revision, and the revision cohort demonstrated clinically worse PI-LL mismatch (16° vs 10°) and lumbar lordosis (41° vs 47°) compared to non-revision patients.
shoulder elbow
biomechanical
LOE II
n = 5 fixation constructs (experimental arm) + 12 studies in NMA
N/A
Lin WH, Lai PC · … · Shih CA
Key Takeaway: In a combined biomechanical study and NMA, the 2-divergent-lateral-plus-1-medial-pin configuration (L2DM1) ranked highest across varus stiffness (SUCRA 99.7%), valgus stiffness (92.9%), and torsional failure torque (SUCRA 100%) for pediatric supracondylar humerus fracture fixation.
hand
database study
LOE II
n = 2,685,041 DRF patients; matched cohort n=26,186
N/A (retrospective database, 2010-2022 capture period)
Mungalpara NK, Reiser WK · … · Gonzalez MH
Key Takeaway: Among 2,685,041 DRF patients, preexisting upper-limb nerve injury carries the highest CRPS risk (OR 3.20), while overall CRPS incidence was only 0.18%.
hand
prospective cohort
LOE II
n = 1407 (BPTB n=1145, HT n=262)
5 years (assessments at 6 months, 1, 2, and 5 years)
McAleese T, Keane N · … · Devitt BM
Key Takeaway: BPTB autograft produces higher anterior knee pain prevalence at 6 months (26% vs. 6%) but this pain is mild, resolves by 1 year, and does not translate into differences in KOOS, WOMAC, IKDC, Marx scores, or return-to-play rates at 5 years.
arthroplasty
systematic review
LOE III
n = 35 studies (117 records screened)
Variable by included study; 90-day outcomes most commonly reported.
Strickler I, Jensen A · … · Bicos J
Key Takeaway: Across 35 studies, preoperative GLP-1 RA use was associated with similar or lower 90-day complications in arthroplasty—including reduced PJI rates—while spine surgery showed mixed signals including increased pneumonia, AKI, and pseudarthrosis with prolonged semaglutide exposure.
pediatrics
case-control
LOE III
n = 200 (100 cases, 100 controls)
N/A
Bram JT, Beber SA · … · Fabricant PD
Key Takeaway: Pediatric ACL tear patients demonstrated significantly greater valgus alignment than matched controls, with each 1° increase in HKA valgus increasing ACL tear odds by 14% (OR 1.14, 95% CI 1.02–1.27).
hand
retrospective cohort
LOE III
n = 767 patients, 790 fractures
30-day and long-term (up to 20-year institutional database, May 2000–May 2020)
Martinez FA, Shin AY · … · Pulos N
Key Takeaway: ACS-NSQIP predicted a 1.85% 'any' complication rate for distal radius ORIF, but observed long-term hand-related complications reached 27.72%—a 15-fold underestimation.
arthroplasty
retrospective cohort
LOE III
n = 99
Median 18 months (IQR 8–43); 90-day outcomes primary endpoint.
van Schalkwijk LHM, van der Zee JM · … · van der Heijden L
Key Takeaway: After national centralization of pediatric bone sarcoma surgery in the Netherlands, R0 margins were achieved in 94% of 99 patients, with 22% experiencing a 30-day complication and only 7% experiencing chemotherapy delay beyond 28 days.
pediatrics
retrospective cohort
LOE III
n = 58 (MIPO n=25, ESIN n=33)
Not explicitly reported as mean follow-up duration; union and return-to-sport endpoints captured at 10.6 and 13.3 weeks respectively for MIPO.
Leonetti D, Giuca G · … · Sanzarello I
Key Takeaway: In complex pediatric tibial fractures (AO 42B-C and 43A2-A3), MIPO achieved radiographic union 5.2 weeks faster than ESIN (10.6 vs. 15.8 weeks, P<0.001) and eliminated unplanned reoperations (0% vs. 24%).
shoulder elbow
retrospective cohort
LOE III
n = 113
Minimum 2 years.
Lee H, King JJ · … · Wright TW
Key Takeaway: In revision reverse TSA, short cementless stems achieved Constant score improvement of 23.5 points versus 3.5 points for long stems (P=.018), with a 0% humeral stem re-revision rate at minimum 2-year follow-up.
arthroplasty
database study
LOE III
n = 272,258
September 1999 to December 2022 (up to 23 years registry follow-up); mean not reported.
Wallace DT, Whitehouse SL · … · Crawford RW
Key Takeaway: 36-mm femoral heads carry a 14% higher all-cause revision hazard versus 32-mm heads (HR 1.14, 95% CI 1.08–1.20) in primary THA, driven by increased fracture (HR 1.30) and loosening (HR 1.21) revisions that outweigh the dislocation benefit.
shoulder elbow
retrospective cohort
LOE III
n = 194
Mean 4.2 years (range 2–9.3 years)
Klein A · … · Gunst S
Key Takeaway: Aseptic glenoid baseplate loosening occurred in 5.7% of Aramis rTSA cases at mean 4.2 years, independently predicted by intraoperative glenoid fracture (OR 15) and excessive lateral component positioning (OR 1.07 per degree).
arthroplasty
retrospective cohort
LOE III
n = 1,012 (69 DM, 943 fixed-bearing)
Mean 6.0 years (range 2.0–17.2)
Rudisill SS, Wu M · … · Trousdale RT
Key Takeaway: In morbidly obese patients (BMI >40) undergoing primary THA, dual mobility implants achieved 100% five-year survivorship free from revision versus 96.8% for fixed-bearing constructs, with instability rates of 1.4% versus 0.6%.
spine
retrospective cohort
LOE III
n = 115,570 (7,537 navigation; 108,033 non-navigation)
30 days (NSQIP capture window)
Rajkovic C, Koltenyuk V · … · Kinon MD
Key Takeaway: Stereotactic navigation in posterior thoracic/lumbar fusion and PLIF was independently associated with higher odds of superficial SSI and overall postoperative infection at 30 days after controlling for operative time, frailty, and revision status in 115,570 patients.
shoulder elbow
retrospective cohort
LOE III
n = 961 (537 sport participants, 656 sport participations)
Mean 24.0 ± 8.1 months
Corban J, Kirsch JM · … · ASES Multicenter Research Group
Key Takeaway: 89.2% of shoulder arthroplasty patients returned to sport with 80.2% reporting maintained or improved performance, and rTSA demonstrated superior sport performance stability versus aTSA in matched GHOA patients (87.9% vs 78.9%, P=0.039).
arthroplasty
meta-analysis
LOE III
n = 18 studies, 51,375 stems (12,969 anatomic; 17,115 single-taper; 19,326 single-wedge; 1,965 taper wedge)
N/A (not uniformly reported across included studies)
De C, Tahir M · … · Patel N
Key Takeaway: Anatomic femoral stems carry the highest overall revision rate (3.9%) in primary THA, while single-wedge stems demonstrate the lowest relative revision risk (RR 0.31) and periprosthetic fracture risk (RR 0.21) compared to anatomic designs.
shoulder elbow
retrospective cohort
LOE III
n = 5,049 (83 failures vs. 4,966 controls) across 15 institutions
Median 72 weeks to failure; minimum 3-month follow-up required for inclusion.
ASES Complications of RSA Research Group, Bowler A · … · Jawa A
Key Takeaway: Baseplate failure occurred in 1.6% of 5,049 rTSA cases, with revision surgery (OR 4.57), bone graft use (OR 2.81), and increased lateral offset (OR 1.08 per mm) as independent predictors, while central screw fixation was protective (OR 0.55).
arthroplasty
retrospective cohort
LOE III
n = 119 (cemented n=63, cementless n=56)
Minimum 2 years; Kaplan-Meier analysis reported at 50 months.
Schweizer C, Krug T · … · Waldstein W
Key Takeaway: At 50 months, cementless medial mobile-bearing UKA for osteonecrosis achieved 97.7% survival free from aseptic loosening versus 100% for cemented fixation, with no statistically significant difference (P=0.35).
shoulder elbow
retrospective cohort
LOE III
n = 449
Minimum 3 months radiographic follow-up; mean not reported.
Lazaro JS, Nanavati R · … · DeBernardis D
Key Takeaway: LTO nonunion occurred in 33.4% of aTSA patients, with younger age as the only significant predictor (OR 0.98 per year, p=0.037), yet only 2.7% of nonunions required revision surgery.
arthroplasty
retrospective cohort
LOE III
n = 176 (PIVR n=84, SRS Grade 2 alone n=92)
Median 27–28 months (IQR 27–28 months)
Chen Z, Zhang J · … · Ge Z
Key Takeaway: Adding convex posterior intervertebral release (PIVR) to SRS Grade 2 osteotomy achieved 14% greater coronal curve correction (70% vs. 56%) and tripled the odds of reaching MCID for self-image (OR 3.0) in severe rigid adult idiopathic scoliosis without increasing operative time or blood loss.
shoulder elbow
retrospective cohort
LOE III
n = 112 (anterior n=44, posterior n=68)
Minimum 2 years.
Baek CH, Elhassan BT · … · Kim SJ
Key Takeaway: Anterior graft placement (supraspinatus footprint) in arthroscopy-assisted lower trapezius transfer yielded significantly greater postoperative forward elevation (160.2° vs. 150.4°), forward elevation strength (27.4 vs. 24.4 N·m), and AHD MCID achievement (68.2% vs. 45.6%) compared to posterior placement.
arthroplasty
retrospective cohort
LOE III
n = 75 hips
N/A if not reported.
Riley JW, Aparicio HA · … · Montgomery SJ
Key Takeaway: Prior heterotopic ossification after index fixation confers a 3x increased risk of HO after conversion THA, with an overall HO incidence of 33.3% in this cohort.
spine
retrospective cohort
LOE III
n = 85 patients, 204 operated levels
2 years (with interim assessment at 6 months)
Choi JU, Hwang CJ · … · Lee DH
Key Takeaway: Facet resection ≥50% during posterior cervical foraminotomy produced equivalent VAS and NDI improvements to <50% resection at 2 years, though bone bridge formation was significantly higher (66.7% vs 26.3%, p=0.002).
shoulder elbow
retrospective cohort
LOE III
n = 71
N/A
Zhang H, Hu D · … · Zhong X
Key Takeaway: Preoperative shear wave elastography Δ shear modulus of the LHBT proximal to the bicipital groove correlates strongly with arthroscopic lesion severity (ρ = 0.750), with a diagnostic threshold >14 distinguishing normal from frayed tendon.
spine
retrospective cohort
LOE III
n = 213
Minimum 2 years postoperatively (exact mean not reported).
Fang T, Xue Z · … · Liu H
Key Takeaway: Multifidus atrophy and fat infiltration are independent risk factors for postoperative sagittal imbalance after multilevel PLIF, while psoas and erector spinae metrics are not, in a cohort of 213 patients with minimum 2-year follow-up.
arthroplasty
database study
LOE III
n = 50,556 (25,278 matched pairs)
Minimum 5 years
Forlenza EM, Burnett RA · … · Della Valle CJ
Key Takeaway: Adult reconstruction fellowship-trained surgeons performing UKA had a 31% lower 5-year revision-to-TKA rate (OR 0.69) and 61% lower implant failure rate (OR 0.52) compared to non-fellowship-trained surgeons.
sports
retrospective cohort
LOE III
n = 2033
N/A
Nickelberry C, Laxson S · … · Brady JM
Key Takeaway: Delayed ACL reconstruction (>120 days post-injury) increases odds of medial meniscus tears by 80% (aOR 1.80) and combined medial+lateral tears by 47% (aOR 1.47) across all age groups.
pediatrics
retrospective cohort
LOE III
n = 477 radiographs (320 for segmentation training, 157 paired AP/lateral for ulnar fracture classifier)
N/A
Chakladar S, Pereira DE · … · Hosseinzadeh P
Key Takeaway: A two-step deep learning pipeline detected radial head dislocation in pediatric Monteggia fractures with 95–97.5% accuracy and ulnar fracture detection AUC of 0.923, exceeding reported expert interpretation performance.
shoulder elbow
retrospective cohort
LOE III
n = 113
Mean 6.7 years (±2.3 years)
Collins AP, Sheth MM · … · Hsu JE
Key Takeaway: Glenoid wear after ream-and-run arthroplasty averages 0.3 mm/year and plateaus after 4 years, with 81% of patients experiencing ≤5 mm medialization at mean 6.7-year follow-up.
pediatrics
retrospective cohort
LOE III
n = 31 knees (30 patients)
Mean 5.7 years (TTO) and 4.8 years (non-TTO).
Grewal RS, Berger GK · … · Edmonds EW
Key Takeaway: In adolescents with TT-TG ≥20 mm, adding TTO to MPFL reconstruction produced no difference in recurrent instability, Kujala scores (91.4 vs. 88.5), or SANE scores (84.3 vs. 86.8) at mean 5.7-year follow-up.
spine
retrospective cohort
LOE III
n = 288
Registry data 2006–2019; follow-up duration not explicitly reported as a mean value.
Tsuchiya R · … · Kawai A
Key Takeaway: Primary malignant spine tumors carry a 5-year disease-specific survival of 47.5%, with advanced TNM stage (IVA+IVB) conferring a 7.6-fold increased hazard of death compared to localized disease.
arthroplasty
prospective cohort
LOE III
n = 116
Mean 11.1 years
Montagna A, Marescalchi M · … · Rossi SMP
Key Takeaway: The Persona PS Knee System achieved 95.7% implant survival at mean 11.1-year follow-up with a mean FJS-12 of 69.52, indicating substantial but incomplete joint awareness reduction.
basic science
retrospective cohort
LOE III
n = 224
N/A if not reported.
Cho JW · … · Hyunchul Jo C
Key Takeaway: A novel bilateral shoulder DXA protocol in 224 rotator cuff repair patients identifies a proximal humerus osteoporosis threshold of 0.478 g/cm² (corresponding to femoral neck T-score of -2.17), with significant BMD reduction in the medial humeral head (R2, p<0.001) that progresses from periarticular to diffuse with advancing fatty infiltration grade.
hand
retrospective cohort
LOE III
n = 22,968 (7,656 per matched cohort)
12 months post-injury
Ratnasamy PP · … · Luo X
Key Takeaway: DRF patients undergoing ORIF with same-day carpal tunnel release had a 1-year CRPS incidence of 1.44% and 4.60-fold higher odds versus non-operative management, compared to 1.84-fold for ORIF alone.
arthroplasty
database study
LOE III
n = 562,001
Maximum 9 years (Kaplan–Meier analysis); mean not reported.
Beckers G, Simon D · … · Holzapfel BM
Key Takeaway: Extra-long (≥XL) femoral heads in primary THA are associated with a 7.2% vs. 4.5% cumulative 9-year revision rate compared to standard heads, with use inversely correlated with hospital volume (5.4% low-volume vs. 3.0% high-volume centers).
arthroplasty
retrospective cohort
LOE III
n = 1,690 (845 matched pairs from 108,352 non-obese TSA patients)
Minimum 1 year; outcomes assessed at 90 days and 1 year.
White AE, Khilnani T · … · Taylor SA
Key Takeaway: Preoperative GLP-1 RA use in non-obese TSA patients (n=845 matched pairs) was not associated with increased 90-day or 1-year medical or surgical complications compared to controls.
arthroplasty
retrospective cohort
LOE III
n = 62
Median 2 years.
Le Baron M, Cipolla A · … · SOFCOT
Key Takeaway: In patients aged 81 years with loose implants (SOFCOT type 2/3 periprosthetic knee fractures), ORIF alone yielded a 2-year survival of 88.9% and re-revision rate of 22.2%, not significantly different from revision arthroplasty (88.9% survival, 15.9% re-revision; p=0.64).
arthroplasty
retrospective cohort
LOE III
n = 67 (EF n=34, RSA n=33)
Not explicitly reported as a mean duration; described as 'final follow-up' without a specific timepoint stated.
Vadalà A, Benelli C · … · Maffulli N
Key Takeaway: External fixation and RSA yield equivalent Constant-Murley Scores (58.4 vs. 55.2, p=0.42) for Neer 2- and 3-part proximal humerus fractures in patients aged 65-80, but EF produces superior external rotation (60.9° vs. 46.5°, p<0.01) with shorter operative time (48.2 vs. 92.4 min) and zero transfusion requirement.
pediatrics
case-control
LOE III
n = 34 (17 matched pairs)
Mean 7 ± 3 years
Tripon M, Bougard M · … · Hulet C
Key Takeaway: Septic arthritis after ACLR treated with arthroscopic lavage and graft retention yields equivalent 7-year functional scores to uncomplicated ACLR (Lysholm 89.1 vs 92.1, p=0.32), but delays return to sport by 2.1 months (10.2 vs 8.1 months, p=0.01).
arthroplasty
retrospective cohort
LOE IV
n = 49
Mean 100 months (±77 months); minimum 24 months.
Scanferla R, Rajan S · … · Campanacci DA
Key Takeaway: Periacetabular allograft-prosthesis composite reconstruction achieved 88% graft retention at 15 years with a mean MSTS score of 23/30 at mean 10-year follow-up in 49 patients with primary or secondary pelvic bone tumors.
pediatrics
retrospective cohort
LOE IV
n = 103
Not explicitly reported as a mean follow-up duration; outcomes measured to union and rotational recovery endpoints.
Levitt W, Stoddart M · … · Thomas S
Key Takeaway: Pre-bending flexible nails prior to ESIN of pediatric both-bone forearm fractures produced no significant difference in radial bow magnitude (4.9% vs. 5.3%), time to union (44 vs. 42 days), or forearm rotation recovery (100 vs. 81 days) compared to unbent nails.
shoulder elbow
retrospective cohort
LOE IV
n = 43
Mean 28 months (minimum 12 months).
Lopiz Y, Sanchez Del Saz J · … · Marco F
Key Takeaway: Surgical management of complex proximal ulna fractures yielded mean MEPI of 100 and QuickDASH of 6.8 at mean 28 months, but 37% developed radiographic arthrosis and patients with concomitant coronoid or radial head fractures had significantly worse outcomes.
arthroplasty
retrospective cohort
LOE IV
n = 200 rTKAs, 241 cones
Mean 3 years (range 2–4.5 years)
Meding LK, Meneghini RM · … · Meding JB
Key Takeaway: Third-generation flexible metaphyseal cones in revision TKA achieved 100% survivorship free from aseptic loosening at mean 3-year follow-up with a 0.5% cone-related intraoperative fracture rate across 241 cones.
basic science
retrospective cohort
LOE IV
n = 40
Mean 32 ± 15 months (minimum 12 months).
Goker B · … · Masrouha KZ
Key Takeaway: Calcium phosphate/calcium sulfate bone substitute achieved complete graft resorption in 88% of pediatric benign bone tumor patients by 1 year, with a 13% local recurrence rate at mean 32-month follow-up.
arthroplasty
retrospective cohort
LOE IV
n = 29 (31 enrolled, 29 available for follow-up)
Mean 57.0 months (range 2–208 months)
Hetto P · … · Lehner B
Key Takeaway: Two-stage knee arthrodesis using a modular intramedullary system achieved 87.2% Kaplan-Meier survival at 17.3 years with 100% limb salvage but a 19% reinfection rate across 29 patients.
pediatrics
case series
LOE IV
n = 42
Mean 41 months (range 24–66 months).
Pauletti F · … · Masquijo JJ
Key Takeaway: ACL-R + LET in high-risk adolescents (n=42) yielded 0% graft rupture and 89.7% return to preinjury or higher sport level at mean 41-month follow-up.
arthroplasty
retrospective cohort
LOE IV
n = 89 (66 with wear analysis)
20-year minimum (index procedures 1999–2003)
Thandoni A, Andreini DE · … · Sotereanos NG
Key Takeaway: Electron beam-radiated, melt-annealed HXLPE in THA demonstrates 93.5% all-cause survivorship and 98.6% osteolysis-free survivorship at 20 years, with a mean linear wear rate of 0.06 mm/year.
pediatrics
retrospective cohort
LOE IV
n = 27
Minimum 12 months.
Martínez-Álvarez S, Galán-Olleros M · … · Palazón-Quevedo Á
Key Takeaway: In 27 pediatric neglected Monteggia fractures, a preoperative maximum ulnar bow ≥3.45 mm predicted the need for ulnar osteotomy, and delayed surgery (median 73 days, range 51–220.5) did not worsen outcomes, with 22/27 patients achieving excellent MEPI scores.
shoulder elbow
prospective cohort
LOE IV
n = 21
Median 25.9 months (range 24–34 months); MRI assessment at 12 months.
Delgado C, Rodríguez G · … · Calvo E
Key Takeaway: Revision rotator cuff repair augmented with a bioinductive collagen patch (REGENETEN) achieved a 71.4% structural integrity rate at 12 months MRI (Sugaya I–III) with significant functional improvement (Constant score 44→63, ASES 20→59.2) in 21 patients.
pediatrics
case series
LOE IV
n = 24 patients (30 knees)
Mean 46.7 months (range 12–118 months).
Masquijo JJ, Carabajal Mattar M
Key Takeaway: Combined tibial tubercle periosteal sleeve transfer with MPFC reconstruction achieved Pedi-IKDC 90.9, Lysholm 96.9, and Kujala 92.7 at mean 46.7-month follow-up with one physeal arrest in 30 skeletally immature knees.
shoulder elbow
prospective cohort
LOE IV
n = 16
Minimum 1 year post-rTSA (cross-sectional assessment at single time point).
Ven L · … · Verhaegen F
Key Takeaway: In 16 rTSA patients, pectoralis major, teres minor, and latissimus dorsi overactivation negatively correlated with functional internal rotation (hand-to-back), while posterior deltoid, upper/lower trapezius, and teres major activation characterized high-fIR performers.
pediatrics
retrospective cohort
LOE IV
n = 101
Mean 5.1 years (±2.9)
Walls HR, Chung PJ · … · Pennock AT
Key Takeaway: Arthroscopic shoulder stabilization in skeletally immature patients yields a 34.7% recurrence rate and 10% revision rate at mean 5.1-year follow-up, with younger age as the primary risk factor.
arthroplasty
retrospective cohort
LOE IV
n = 24
Minimum 12 months; union endpoint mean 14.3 weeks.
Lee JW, Cho JH · … · Lim S
Key Takeaway: Suprapatellar rigid intramedullary nailing in skeletally immature adolescents (mean age 15.9 years) achieved union in all 24 patients at mean 14.3 weeks with zero cases of physeal growth disturbance or angular deformity at final follow-up.
pediatrics
case series
LOE IV
n = 19 hips, 16 patients
Median 23 months
Sarassa C, Aristizabal S · … · Herrera AM
Key Takeaway: Ligamentum teres intraosseous ligamentodesis ('Teretization') as an adjunct to open reduction in IHDI grade ≥III DDH achieved 0% redislocation and 10.5% asymptomatic AVN at median 23-month follow-up in 19 hips.
arthroplasty
retrospective cohort
LOE IV
n = 497 (8 fracture, 489 stemmed revision controls)
N/A (retrieval analysis; implantation time not significantly different between groups, p=0.10)
Kurtz MA, Gilbert JL · … · Kurtz SM
Key Takeaway: Insufficient metaphyseal fixation at or near the modular junction—not patient weight or implant duration—is the primary driver of metal fatigue fracture in revision TKA, identified in 8 fractured components versus 489 stemmed controls.
hand
case series
LOE IV
n = 21
Minimum 90 days; mean not reported.
Stoltz MJ, Smith N · … · Robinson LP
Key Takeaway: CT detected volar plate impingement in 76% of patients (16/21) after volar locking plate fixation of scaphoid waist nonunion, while plain radiographs identified only 2 of those 16 cases.
sports
cadaveric
LOE V
n = 9 cadaveric shoulders
N/A
Bauer J, Rajan R · … · Edgar C
Key Takeaway: A 30° angled distal tibial allograft restored glenohumeral contact forces to 86.6% of intact (62.17 N vs. 71.81 N) and distraction forces to 98.5% of intact, significantly outperforming flat graft placement in a 20% anterior glenoid defect model.
shoulder elbow
biomechanical
LOE V
n = N/A (manufacturer data across all commercially available U.S. rTSA polyethylene liner systems)
N/A
Misioura D, Chandra S · … · Salazar DH
Key Takeaway: Standard rTSA polyethylene liners vary in constraint ratio from 40% to 62% across U.S. manufacturers, with retentive liners ranging from 47% to 71%, demonstrating no consistent definition of either category.
sports
biomechanical
LOE V
n = 70 mice (56 experimental, 14 control)
8 weeks (harvest at 2, 4, 6, 8 weeks)
Yu S, Wei K · … · Nie M
Key Takeaway: Subacromial microclip impingement in mice peaks tenocyte apoptosis at 4 weeks (TUNEL index 16.72%), driven by concurrent mitochondrial cristae loss and rough ER cisternae expansion.
arthroplasty
survey
LOE V
n = 104 (48.1% response rate from 216 surveyed)
N/A
Ganz MP · … · Scuderi GR
Key Takeaway: Among 104 Knee Society members, cemented fixation dominates at 72.9% average use, while patellar resurfacing rates vary from 0–100% with no consensus, and 40% of surgeons changed their resurfacing indications within the past 5 years.
shoulder elbow
biomechanical
LOE V
n = 77 rats (71 wild-type Sprague-Dawley + 6 ScxGFP transgenic)
3 and 6 weeks postoperative
Tanimura S, Tokunaga T · … · Miyamoto T
Key Takeaway: SAB-preserved rotator cuff repair achieved 2.1× higher ultimate load to failure at 3 weeks compared to SAB-resected repair (6.8 N vs. 3.3 N, P=.0004) in a rat supraspinatus transection model.
hand
cadaveric
LOE IV
n = 16 shoulders (11 donors)
N/A
Giovannetti de Sanctis E, Monin B · … · Gauci MO
Key Takeaway: The Neviaser portal allows third-generation IMN insertion through the supraspinatus muscular portion in 100% of specimens, with nail entry point 4 mm from the myotendinous junction and 39 mm from the RC footprint.
arthroplasty
cadaveric
LOE V
n = 36 humeral specimens (18 matched pairs across 3 implant cohorts)
N/A
Greif DN, Castle P · … · Voloshin I
Key Takeaway: Stemless humeral components showed significantly greater micromotion at 820 N and reduced torsional stability versus stemmed implants (p<0.001), but lesser tuberosity osteotomy did not increase micromotion regardless of implant type; BMD was the dominant predictor of instability across all constructs.
arthroplasty
prospective cohort
LOE IV
n = 60
3 months
Duval G, Emery A · … · Hulet C
Key Takeaway: The Knee+ AR navigation device achieved mean coronal plane errors of 1.23° (LDFA) and 1.22° (MPTA), but tibial slope error averaged 2.15° with 21% of cases exceeding 3° error in the sagittal plane.
spine
biomechanical
LOE V
n = 35 rats (plus in vitro MSC experiments)
4 weeks (primary fusion endpoint); day 2 and day 4 cytokine timepoints
Ng MK, Koerner JD · … · Kepler CK
Key Takeaway: A single low-dose local TNF-α application (20 µL of 50 ng/mL) at the fusion site reduced posterolateral fusion rates from 4/5 to 0/5 by manual palpation at 4 weeks in a rat model.
basic science
cadaveric
LOE V
n = 12 cadaveric limbs
N/A
Sandriesser S, Pätzold R · … · Augat P
Key Takeaway: FE-based preoperative planning for Schatzker IV tibial plateau fractures doubled load to failure (1050 N vs. 442 N, p=0.041) and cycles to failure (10,100 vs. 4,100, p=0.046) compared to conventional CT planning, though significance was lost after anatomical variation adjustment.
hand
biomechanical
LOE V
n = 48 cadaveric scaphoids
N/A
Surke C, Del Rosario PA · … · Ackland D
Key Takeaway: Double screw fixation requires 78.3 N more force to achieve 2.0 mm displacement in bending and generates 60.6–65.6 N·mm greater maximum torque than single screw plus bone graft constructs in an unstable scaphoid waist fracture model.
arthroplasty
case series
LOE IV
n = 26 (28 enrolled, 26 available for bacterial testing)
N/A
Diot R, Goetti P · … · Wegrzyn J
Key Takeaway: Sonication of cerclage wires exchanged at second-stage revision THA for PJI revealed bacterial contamination in only 1 of 26 cases (3.8%) and zero cases of true bacterial colonization.
hand
survey
LOE V
n = 162 surgeons, 7 fracture scenarios each
N/A
Razi A, Brinkman N · … · Science of Variation Group
Key Takeaway: Surgeon likelihood of recommending volar plate fixation decreased and cast/K-wire fixation increased when patients reported financial insecurity, independent of fracture pattern in 162 surveyed surgeons.
hand
systematic review
LOE V
n = N/A
N/A
Schweizer A · … · Honigmann P
Key Takeaway: 3D virtual planning integrating kinematic analysis, ligament tension modeling, and patient-specific instrumentation improves precision of forearm deformity correction beyond what standard anatomic reduction alone achieves, though no comparative outcome numbers are reported.
spine
systematic review
LOE V
n = 4 studies reviewed
N/A
Camino-Willhuber G, Dandurand C · … · AO Spine Knowledge Forum Trauma & Infection
Key Takeaway: AO Spine recommends CT/MRI as gold standard for subaxial cervical fracture workup, conditional surgical treatment for floating lateral mass or large fragment unilateral facet fractures, posterior augmentation for stand-alone ACDF when PLL is injured or bilateral facet dislocation is present, and anterior fixation for unilateral facet injuries without cord injury.