This Week in Orthopedics — Sep 24, 2026

This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.

Welcome to This Week in Orthopedics. This week we're covering 10 notable papers spanning shoulder surgery — from international consensus on rotator cuff tears to bone loss in adolescent instability — plus risk prediction and counselling in hip and knee reconstruction, and a cluster of spine and trauma studies. Let's dive in.

We start with the shoulder, where Arthroscopy has published a two-part international consensus exercise on rotator cuff tears involving 97 shoulder and sports surgeons from 15 countries. In the first part, Hurley and colleagues report 50 statements covering diagnosis, nonoperative management, and repair of posterosuperior tears, and the striking finding is how much agreement there is at the front end of care [1]. Every diagnostic domain reached strong consensus — that evaluation should emphasise mechanism of injury, tissue quality and activity level, and that tears should be classified by size, tendons involved, thickness, fatty infiltration and retraction. The panel supported an initial trial of rehabilitation and activity modification for most partial or chronic full-thickness tears, and endorsed nonoperative treatment for older, low-demand or medically unfit patients even with traumatic tears. They agreed corticosteroid injections have a role, but that surgery should be delayed several weeks afterwards. Only three of the fifty statements failed to reach any consensus. The second part is where the picture fractures [2]. Of 48 statements on subscapularis repair, augmentation, and tendon transfer, 16 reached no consensus at all. Subscapularis repair itself was uncontroversial — every statement reached strong agreement on approach, anchor number, and tension-free repair with adequate mobilisation. But graft and patch augmentation and superior capsular reconstruction were the opposite: no agreement on optimal graft type, augmentation configuration, or indications for balloons, tuberoplasty, or acromial patching. For tendon transfer, the panel did converge on indications — younger active patients with irreparable tears, preserved passive motion, minimal arthritis, and an intact deltoid — and preferred lower trapezius over latissimus dorsi for posterosuperior tears, while pectoralis major transfer for irreparable subscapularis tears reached no consensus. Both papers are Level V expert opinion, so they map where the field agrees rather than settling anything; the value is in seeing precisely which questions remain genuinely open.

Staying with the shoulder but moving to the American Journal of Sports Medicine, Arvesen and colleagues challenge how we think about adolescent instability [6]. In a retrospective cohort of 181 patients aged 10 to 19 with anterior shoulder instability at a single tertiary centre, bone loss on magnetic resonance imaging was present in about three quarters of patients, and roughly a third had bipolar bone loss at the very first evaluation. Around four in ten had a distance to dislocation under 10 millimetres. Even among first-time dislocators, close to seven in ten patients had bone loss. Male sex and having five or more prior dislocations were independent predictors — male sex raised the odds of bipolar bone loss more than tenfold. This is Level III evidence from one referral centre, so referral bias is a real consideration, but the authors conclude that isolated arthroscopic Bankart repair may be insufficient for many adolescents, which runs against the reflex assumption that young patients have pristine bone.

Turning to reconstruction, two papers address the quality of what we tell patients before surgery. In Clinical Orthopaedics and Related Research, Trotzky and colleagues followed 665 patients after periacetabular osteotomy for acetabular dysplasia, and modelled how the probability of achieving meaningful improvement accumulates over a decade [9]. Using the modified Harris hip score, about six in ten patients had reached the minimum clinically important difference at one year, rising to roughly nine in ten by ten years. Substantial clinical benefit lagged behind — just over half of patients at one year, about 85 percent at ten years. Prior ipsilateral hip surgery was associated with a substantially longer time to every threshold, and a psychiatric diagnosis, present in over a third of this cohort, with a longer time to reach the minimum clinically important difference. This is single-institution observational data, but it quantifies something that matters for preoperative conversations: after periacetabular osteotomy, benefit keeps accruing for years rather than declaring itself at twelve months. Alongside that sits a risk-prediction study, also in Clinical Orthopaedics and Related Research, from Bian and colleagues [3]. Across three centres in China, 1,012 patients aged 18 to 65 with femoral neck fractures treated with three cannulated screws were analysed, and about one in five developed osteonecrosis of the femoral head. Five preoperative variables — age 45 or older, displaced fracture, comminution, and superior or inferior subcapital fracture lines — were assembled into an eight-point score. Displacement carried by far the most weight, associated with roughly eightfold higher odds. The score discriminated better than the Garden classification, and at the low threshold the negative predictive value was about 96 percent, meaning a low score reasonably rules osteonecrosis out. The positive predictive value at the high threshold was only about 42 percent, so this is better at reassurance than at prediction of failure, and it is retrospective and not yet externally validated.

Two arthroplasty-adjacent papers deal with implants over the long haul. In Acta Orthopaedica, Kinoshita and colleagues report the 10-year follow-up of a randomised radiostereometric trial comparing bicruciate-retaining with cruciate-retaining total knee arthroplasty, with 25 patients in each arm [4]. Tibial component migration at ten years did not differ significantly between groups, and neither did the Oxford Knee Score or Forgotten Joint Score trajectories. The bicruciate-retaining group had two revisions; the cruciate-retaining group had none. So the theoretical kinematic advantage of preserving both cruciates did not translate into better fixation or better patient-reported outcomes here, and complications were more frequent — though with 50 patients total this trial is far too small to settle revision risk. Complementing that, a review in the Journal of Bone and Joint Surgery by Lamb and Whitehouse frames periprosthetic femoral fracture after total hip arthroplasty as an impending epidemic [8]. Registry projections indicate the absolute number will rise substantially as primary arthroplasty volumes grow and implanted populations age, and the authors emphasise that mortality after these fractures rivals that after hip fragility fractures, with high reoperation rates and compromised implant survival after fixation. It is a narrative review rather than new data, but it makes the case that prevention belongs within arthroplasty care rather than downstream of it.

Finally, spine and trauma. In Spine, Jasti and colleagues pooled twelve comparative studies and 1,129 patients undergoing surgery for multilevel cervical spondylotic myelopathy, comparing anterior cervical discectomy and fusion, posterior cervical decompression and fusion, and laminoplasty [5]. Neurological recovery, measured by improvement in the Japanese Orthopaedic Association score, did not differ significantly between any of the three approaches. What differed was everything else: the anterior approach was associated with less neck pain and shorter hospital stay than laminoplasty, and lower rates of axial pain and C5 palsy, but roughly a sixfold higher odds of dysphagia. Surgical site infection was more frequent after posterior fusion than laminoplasty. The evidence base is observational and heterogeneous, so the authors frame approach selection as driven by alignment and patient-specific concerns rather than by any expectation of superior neurological recovery. In the Journal of Bone and Joint Surgery, CreveCoeur and colleagues analysed intraoperative neuromonitoring in 5,206 patients undergoing fusion for adolescent idiopathic scoliosis [7]. Alerts occurred in 5 percent of patients, and the leading independent risk factor was a larger preoperative major Cobb angle — alert patients averaged about 67 degrees versus 56. Lenke type 4 curves carried the highest alert rate and type 5 the lowest. Hypotension was the most common trigger, at about a quarter of alerts, and raising blood pressure the most common response. Crucially, fewer than one percent of the whole cohort sustained any neurologic deficit and only two patients had a permanent one, and at two years curve correction was equivalent whether or not an alert had occurred — around 72 percent in both groups. That last point is reassuring: responding to an alert did not come at the cost of correction. And in a smaller series, also in the Journal of Bone and Joint Surgery, Cole and colleagues report 45 patients with symptomatic extra-articular malunion or nonunion of the scapular body and neck treated by deformity correction [10]. All achieved union, and disability scores improved by about 31 points on average, with gains in forward flexion and abduction range and strength, though external rotation did not improve significantly. A quarter of patients returned to theatre, mostly for symptomatic implant removal. This is a Level IV single-surgeon case series with no comparison group, so it establishes feasibility rather than superiority over continued nonoperative care.

If you only have time for one paper this week, make it the adolescent shoulder instability study in the American Journal of Sports Medicine [6]. It reopens a question many assumed was settled — whether a young first-time dislocator can be treated with isolated Bankart repair — by showing that bone loss is already present in most of these shoulders at presentation.

Here is what this week's evidence adds up to in Orthopedics. First, international expert opinion on rotator cuff tears is firm on diagnosis, nonoperative trials, and both posterosuperior and subscapularis repair, but genuinely unsettled on augmentation, superior capsular reconstruction, and pectoralis major transfer — meaning the graft and patch literature has not yet produced agreement among surgeons who do this work. Second, two large observational datasets improve the precision of preoperative counselling rather than changing technique: an eight-point score outperforms the Garden classification for ruling out osteonecrosis risk after femoral neck fixation in patients under 65, and periacetabular osteotomy outcomes continue to accrue for years after the first postoperative year. Third, for multilevel cervical myelopathy, pooled comparative data show neurological recovery is similar across all three common approaches, and the meaningful differences lie in motion preservation, length of stay, and distinct complication profiles. Fourth, in adolescent idiopathic scoliosis, neuromonitoring alerts are uncommon, driven mainly by curve magnitude, and responding to them did not appear to compromise two-year correction. And finally, ten-year randomised radiostereometric data give no signal that bicruciate-retaining knee arthroplasty improves fixation or patient-reported outcomes over cruciate-retaining designs, though the trial is small and revision counts are too few to be conclusive.

That's your roundup for This Week in Orthopedics. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.