JBJS

Long-Term Outcomes After Arthroscopically Assisted Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Rotator Cuff Tears: Assessment at a Minimum 10-Year Follow-up

J Bone Joint Surg Am. 2026 May 14. doi: 10.2106/JBJS.25.01135. Online ahead of print.

ABSTRACT

BACKGROUND: Arthroscopically assisted latissimus dorsi tendon transfer (LDT) offers a joint-preserving option for irreparable posterosuperior rotator cuff tears, but long-term efficacy remains uncertain. We report outcomes after a minimum of 10 years.

METHODS: We retrospectively analyzed 33 shoulders in 33 patients (mean age, 62.2 years; 58% male; all ethnic Korean) after arthroscopically assisted LDT. Clinical assessment included range of motion and Constant-Murley, American Shoulder and Elbow Surgeons (ASES), and VAS pain scores. Osteoarthritis progression was assessed radiographically using the Hamada classification. Complications and reoperations, including reverse total shoulder arthroplasty (rTSA), were recorded.

RESULTS: The Constant-Murley score increased from 48.2 to 62.7, the ASES score increased from 49.5 to 68.7, and VAS pain decreased from 5.0 to 2.3 (all p < 0.001). Forward elevation increased from 115° to 143° and external rotation at 90° of abduction increased from 22° to 51° (both p < 0.001). The mean Hamada grade increased from 1.2 to 2.4, but clinical scores and range of motion were similar in the 12 shoulders (36%) that progressed to grade 3 or higher. On magnetic resonance imaging at the final follow-up (mean, 134 months postoperatively), 19 transfers (58%) remained intact (Sugaya types I to III) and 14 (42%) had a full-thickness retear (Sugaya types IV and V). Outcomes were similar between patients with and without osteoarthritis progression, but patients with intact transfers had better forward elevation, external rotation at 90°, and ADLER (activities of daily living that require active external rotation) scores. Late subscapularis tears occurred in 10 shoulders (30%) and were associated with preoperative grade-2 fatty infiltration (p = 0.002). Three shoulders (9%) required conversion to rTSA.

CONCLUSIONS: Arthroscopically assisted LDT improved pain and function for most patients with irreparable posterosuperior rotator cuff tears. Despite frequent radiographic osteoarthritis progression, clinical outcomes remained favorable, and most shoulders retained the native joint. LDT may serve as an option to delay rTSA in appropriately selected younger patients.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:42133722 | DOI:10.2106/JBJS.25.01135

Glucocorticoid-Enhanced Fascial Plane and Peripheral Nerve Blocks Versus Periarticular and Local Infiltration Analgesia in Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

J Bone Joint Surg Am. 2026 May 13. doi: 10.2106/JBJS.25.01476. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to compare an anterior quadratus lumborum block (aQLB) plus a lateral femoral cutaneous nerve block (LFCNB) with periarticular and local infiltration analgesia (PALIA) in total hip arthroplasty (THA), with both modalities using dual glucocorticoids: hydrophilic dexamethasone sodium phosphate (DEX) and lipophilic methylprednisolone acetate (MPA).

METHODS: A total of 192 patients were randomized to either PALIA or aQLB+LFCNB and received 60 mL of 0.2% ropivacaine, 10 mg of DEX, and 80 mg of MPA. The mean age of the 188 included patients was 61 years, 46% were male, 96% were non-Hispanic, and 82% were White. The primary outcome was opioid consumption, measured as oral morphine milligram equivalents (oMME), on postoperative day (POD) 1. Secondary outcomes included opioid consumption on POD 2, fasting serum glucose, white blood-cell count, Brief Pain Inventory (BPI) pain severity and interference, and functional recovery measures, including Activity Measure for Post-Acute Care (AMPAC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, from POD 0 to 1 year.

RESULTS: Ninety-three patients in the aQLB+LFCNB group and 95 patients in the PALIA group were included in the final analysis. There was no significant difference in the primary outcome, oMME on POD 1, between the aQLB+LFCNB group (median, 29.84 [interquartile range (IQR): 17.72, 38.75]) and the PALIA group (median, 30.50 [IQR: 18.00, 42.00]) (p = 0.57). Except for fasting serum glucose on POD 1, which was lower in the aQLB+LFCNB group (median, 141.50 [IQR: 124.50, 163.50] mg/dL) than in the PALIA group (median, 153.00 [IQR 139.00, 180.00] mg/dL) (p = 0.003), no significant differences were observed in any of the other secondary outcomes.

CONCLUSIONS: Patients who received aQLB+LFCNB with dual glucocorticoids and those who received PALIA with dual glucocorticoids demonstrated no significant differences in daily opioid consumption, pain score, or functional recovery following THA.

LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

PMID:42127167 | DOI:10.2106/JBJS.25.01476

PyroTITAN Pyrocarbon Shoulder Hemiarthroplasty: Clinical and Radiographic Outcomes with Medium-Term Follow-up

J Bone Joint Surg Am. 2026 May 13. doi: 10.2106/JBJS.25.00779. Online ahead of print.

ABSTRACT

BACKGROUND: Pyrocarbon hemiarthroplasty (HA) is a recent option for younger patients with end-stage glenohumeral joint (GHJ) arthritis. Early results are promising but limited by study bias. The aim of this study was to evaluate medium-term clinical and radiographic outcomes following PyroTITAN pyrocarbon HA.

METHODS: One hundred and nineteen shoulders with GHJ arthritis in 115 patients (mean age, 56.5 years; 92 shoulders were in male patients) underwent PyroTITAN pyrocarbon HA. Primary patient-reported outcome measures (PROMs) included the Western Ontario Osteoarthritis of the Shoulder Index and American Shoulder and Elbow Surgeons score. Clinicians assessed shoulder range of motion and abduction strength. PROMs and clinician evaluations were recorded preoperatively and at 6, 12, and 24 months and 5 years postoperatively. Postoperative complications were recorded, and radiographs were evaluated for glenoid erosion. Implant survival was calculated over the 5-year follow-up period. Data were analyzed on an intention-to-treat basis using linear mixed models for continuous data and Friedman analysis of variance for ordinal data. Kaplan-Meier analysis assessed revision-free survival. Significance was set at p < 0.05.

RESULTS: There was significant improvement in all PROMs and ranges of motion at 6, 12, and 24 months and 5 years postoperatively. Abduction strength was significantly improved at 24 months. Seven complications (5.9%) were recorded: ongoing pain (n = 2), stiffness (n = 2), pain and stiffness (n = 2), and implant fracture (n = 1). There were 3 revisions (2.5%) and thus a 97.5% five-year survival rate. Glenoid erosion increased slightly but not significantly over time.

CONCLUSIONS: The findings in our patient series support the PyroTITAN HA implant as a viable option for GHJ arthritis across a broad age range, including younger patients.

LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

PMID:42127166 | DOI:10.2106/JBJS.25.00779

Diluted Povidone-Iodine Irrigation for Prevention of Implant-Related Infection: A Comparative Analysis of Concentration and Frequency in a Rat Model

J Bone Joint Surg Am. 2026 May 12. doi: 10.2106/JBJS.25.01235. Online ahead of print.

ABSTRACT

BACKGROUND: Povidone-iodine (PVI) irrigation is widely used to reduce surgical site infection risk; however, the appropriate concentration and timing remain uncertain. We evaluated how the PVI concentration and irrigation interval influence the early bacterial burden and tissue response in a rat model of implant-related infection.

METHODS: Female rats received a stainless steel plate contaminated with methicillin-susceptible Staphylococcus aureus . The rats were randomized to receive 0.13% PVI, 0.35% PVI, or normal saline solution irrigation every 30 or 60 minutes during a 60-minute procedure. Irrigation consisted of a 3-minute exposure followed by a saline solution rinse. Outcomes included the bacterial count after sonication, soft-tissue infection score, peri-implant bone mineral density (BMD) on microcomputed tomography (µCT), histological inflammation grading, and body weight trajectory.

RESULTS: Higher PVI concentrations and a shorter irrigation interval were associated with reduced recoverable bacterial burden. Among the 30-minute interval groups, no culturable bacteria were recovered in the 0.35% PVI group (i.e., the values were below the assay detection limit); in contrast, culturable bacteria were detectable in all of the 60-minute interval groups. PVI-treated rats demonstrated lower macroscopic infection scores and a trend toward more rapid body weight recovery compared with saline solution controls. For both irrigation intervals, µCT showed higher peri-implant BMD in the PVI-treated groups than in the saline solution controls. Histology showed less inflammation and fewer abscesses in the PVI-treated groups compared with controls, with the least inflammation observed in the group that received 0.35% PVI at 30-minute intervals.

CONCLUSIONS: In this rat model, PVI concentration and irrigation interval were associated with early differences in bacterial recovery and peri-implant tissue and bone responses. These findings are hypothesis-generating and should be interpreted as mechanistic, preclinical signals rather than as guidance for clinical practice. Further translational and clinical studies are needed to determine the relevance of these signals in humans.

CLINICAL RELEVANCE: Current practice typically involves a single 3-minute 0.35% PVI soak before wound closure. This study provides preclinical mechanistic data on how PVI concentration and irrigation timing influence early bacterial recovery in an implant-related infection model. The findings do not support changes to clinical protocols, but highlight the need for careful evaluation of cytotoxicity and safety.

PMID:42118847 | DOI:10.2106/JBJS.25.01235

Advances in the Management of Sternoclavicular Joint Injuries

J Bone Joint Surg Am. 2026 May 7. doi: 10.2106/JBJS.25.01025. Online ahead of print.

ABSTRACT

➢ The sternoclavicular joint (SCJ) serves as the only osseous connection between the axial skeleton and the upper limb and is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartilaginous disc.➢ The brachiocephalic veins and other mediastinal structures are at risk from injury or surgery about the SCJ.➢ SCJ injuries are best imaged with computed tomography (CT). CT angiography is warranted when a vascular injury is suspected, and magnetic resonance imaging (MRI) is useful to define soft-tissue injuries.➢ Acute posterior SCJ dislocations in active, healthy individuals can result in considerable disability if unreduced and an aggressive treatment approach is warranted.➢ Chronic locked posterior dislocations are more challenging to treat, making prompt recognition and referral (if appropriate) important.➢ Reliable surgical techniques including ligament reconstruction and open reduction and internal fixation for SCJ injuries have been well supported in the current orthopaedic literature.➢ Vascular injury is a rare but catastrophic concern when dealing with SCJ pathology and should be considered when determining the venue for planned intervention, as should collaboration with a thoracic or vascular surgeon.

PMID:42096528 | DOI:10.2106/JBJS.25.01025

The Prevalence of Pediatric Septic Arthritis of the Hip with Concomitant Osteomyelitis: A Retrospective Study of 58 Consecutive Cases Investigated Using MRI

J Bone Joint Surg Am. 2026 May 5. doi: 10.2106/JBJS.25.01422. Online ahead of print.

ABSTRACT

BACKGROUND: This observational study systematically used magnetic resonance imaging (MRI) to determine the prevalence of concomitant osteomyelitis and its influence on clinical outcomes in cases of pediatric septic arthritis (SA) of the hip.

METHODS: We retrospectively analyzed the demographic, clinical, microbiological, and radiographic data of 58 children treated for SA of the hip who underwent systematic MRI between 2000 and 2025. Patients were categorized into 2 groups: isolated septic arthritis and septic arthritis with concomitant osteomyelitis. The clinical and laboratory parameters, causative pathogens, and treatments were compared between the groups.

RESULTS: Concomitant osteomyelitis was identified with MRI in 43% (25) of the 58 patients, while radiographs detected it in only 16%. Demographic, clinical, and inflammatory parameters were statistically similar between the groups. Kingella kingae was the most commonly identified pathogen (37.9%), and Staphylococcus aureus and Streptococcus spp. were more frequently associated with repeat surgery. No significant differences in complication rates, treatment duration, or outcomes were found between the groups.

CONCLUSIONS: The systematic use of MRI revealed concomitant osteomyelitis in >40% of cases of pediatric SA. However, the presence of osteomyelitis was not associated with worse outcomes, suggesting that factors related to the microorganism profile or virulence must contribute substantially to disease severity. Nonetheless, MRI should be considered early in any diagnostic work-up of pediatric SA of the hip.

LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42085536 | DOI:10.2106/JBJS.25.01422

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