Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Triceps-Splitting Versus Triceps-Reflecting in United States Total Elbow Arthroplasty: A 20-Year Systematic Review of Complications and Outcomes.","authors":"Laura C M Ndjonko, Mahir A Siddiqui, Jeanette T Nguyen, Melanie G Vasquez, Corey J Schiffman, Nicholas Hernandez","doi":"10.5435/JAAOS-D-24-01354","DOIUrl":"10.5435/JAAOS-D-24-01354","url":null,"abstract":"<p><strong>Background: </strong>Total elbow arthroplasty (TEA) is indicated for patients with elbow arthritis that have exhausted nonsurgical management and can be performed through multiple surgical approaches. However, it is not clear if and which approach is superior. The objective of this systematic review is to evaluate recent TEA literature in the United States to compare the clinical outcomes for the triceps-splitting and triceps-reflecting approaches.</p><p><strong>Methods: </strong>Querying PubMed, Embase, Web of Science, and CINAHL, a systematic review was conducted on total elbow arthroplasty and its outcomes for the triceps-splitting and triceps-reflecting approaches. Inclusion criteria were studies published from 2004 to 2024 that addressed clinical outcomes for triceps approaches. Studies were excluded if duplicates, from non-United States, published beyond the past 20 years, lacking TEA approaches, lacking clinical outcomes, cadaver or animal studies, or unavailable in English full texts.</p><p><strong>Results: </strong>A total of 25 studies involving 2,393 elbows across 2,382 patients were included in this systematic review. The triceps-splitting approach was used in 777 elbows across 11 studies, whereas the triceps-reflecting approach was applied to 1,618 elbows in 14 studies. The triceps-reflecting approach demonstrated a greater change in Mayo Elbow Performance Scores, from a mean of 34.9 preoperatively to 78.2 postoperatively (triceps-splitting: 48.8-79). Both approaches showed notable improvement in all metrics of range of motion (ROM), but higher-quality studies showed trends of favoring the triceps-reflecting approach for greater increases in ROM. Furthermore, the complication rate was higher in the triceps-splitting group (31.2%) compared with the triceps-reflecting group (17.7%).</p><p><strong>Conclusion: </strong>The triceps-reflecting approach of TEA suggests notable improvements in Mayo Elbow Performance Scores and ROM, with potentially lower complication rates than the triceps-splitting approach. More quality research is also needed on other triceps approaches.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level II to IV studies.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"1151-1158"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acromioclavicular Separations: Complications and How to Avoid Them.","authors":"Emmanuel Nnamdi Osadebey, Stephan G Pill, Geoff D Abrams, James M Gregory","doi":"10.5435/JAAOS-D-24-00696","DOIUrl":"10.5435/JAAOS-D-24-00696","url":null,"abstract":"<p><p>Management of acromioclavicular separations remains controversial. A variety of surgical techniques have been described, but no clear consensus has formed regarding optimal treatment. As these techniques have evolved, so have the complication profiles. This review aims provide a review of the complications following management of acromioclavicular joint injections based on the chosen surgical technique. Complications of nonsurgical treatment will also be highlighted. Evidence-based strategies for minimizing complications are provided to allow surgeons to optimize both their preoperative patient discussion and intraoperative decision making.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"1130-1140"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Internal Rotation-Dependent Activities of Daily Living Performance and Favorable Satisfaction Despite Loss of Objective Internal Rotation After Reverse Shoulder Arthroplasty.","authors":"Robert J Cueto, Kevin A Hao, Rachel L Janke, Timothy R Buchanan, Keegan M Hones, Lacie M Turnbull, Jonathan O Wright, Thomas W Wright, Kevin W Farmer, Aimee M Struk, Bradley S Schoch, Joseph J King","doi":"10.5435/JAAOS-D-24-00267","DOIUrl":"10.5435/JAAOS-D-24-00267","url":null,"abstract":"<p><strong>Introduction: </strong>Previous research has determined that objective and subjective internal rotation (IR) may be discordant. The purpose of this study was to identify predictors of patient-reported ability to perform IR-dependent activities of daily living (IRADLs) and favorable patient satisfaction after reverse shoulder arthroplasty (RSA) despite the loss of objective IR.</p><p><strong>Methods: </strong>A single, institutional, shoulder arthroplasty database was queried for patients undergoing primary RSA with a minimum 2-year follow-up. Patients who were wheelchair bound or had a preoperative diagnosis of infection, fracture, or tumor were excluded. We first identified patients in the overall cohort that lost objective IR from pre- to postoperative assessment, defined as a one-point reduction in the eight-point Flurin scale. In this cohort, we identified patient characteristics that were predictive of patient-reported ability to perform IRADLs and overall patient satisfaction and thresholds in postoperative objective IR.</p><p><strong>Results: </strong>Out of 599 RSAs initially identified, 107 RSAs lost objective IR (45% female, mean age 70 years). On average, patients lost 1.7 IR score points pre- to postoperatively. Greater preoperative IR and lesser loss of objective IR pre- to postoperatively were associated with greater patient-reported ability to perform all 4 IRADLs (odds ratio 1.54 to 2.5), whereas female sex was associated with worse patient-reported ability to perform 3 IRADLs (odds ratio 0.26 to 0.36). We identified that patients with postoperative IR below the sacrum were unlikely to be able to perform IRADLs and those with postoperative IR at or above L4-L5 were likely to be satisfied.</p><p><strong>Conclusion: </strong>Despite losing objectively assessed IR after RSA, many patients are still able to perform IRADLs and report favorable satisfaction as long as objective IR reaches L4/5. Female sex and postoperative IR below the sacrum were associated with the inability to perform IRADLs, whereas postoperative IR to or above L4-L5 was associated with subjective ratings of satisfaction.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"1141-1150"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Year Functional and Radiographic Outcomes Following Large Lesser Tuberosity Osteotomy in Stemless Anatomic Total Shoulder Arthroplasty: A Case Series.","authors":"Eleanor H Sato, Samuel K Simister, Garrett V Christensen, Amy M Cizik, Michael A Moverman, Christopher D Joyce, Peter N Chalmers, Robert Z Tashjian","doi":"10.5435/JAAOS-D-23-01090","DOIUrl":"10.5435/JAAOS-D-23-01090","url":null,"abstract":"<p><strong>Background: </strong>Despite debate over the optimal surgical management of the subscapularis in anatomic total shoulder arthroplasty (aTSA), no prior studies have reported 2-year functional and radiographic outcomes in patients undergoing stemless aTSA with a large lesser tuberosity osteotomy.</p><p><strong>Methods: </strong>Retrospective review of all patients who underwent stemless aTSA with a large lesser tuberosity osteotomy at a single institution with minimum 2-year follow-up was done. Patient demographics and outcomes were recorded, including active range of motion standardized subscapularis strength testing, and complication rates. Outcomes included the visual analog scale (VAS) pain score and the American Shoulder and Elbow Surgeons (ASES) score. Radiographic outcomes included evidence of lesser tuberosity osteotomy healing and implant loosening.</p><p><strong>Results: </strong>Overall, 54 patients were included, 44 (83.0%) of which with minimum 2-year follow-up. At 2 years postoperatively, active forward elevation, external rotation, VAS pain, and ASES scores markedly improved compared with preoperatively ( P < 0.001). Internal rotation strength testing was comparable to the contralateral limb (13.8 vs. 15.2 lbs, P = 0.38). Complete radiographic lesser tuberosity osteotomy healing was identified in 38 of 41 patients (93%), and none had a displaced osteotomy. Eighty-one percent (33 of 41) of patients had a Churchill grade of 0 of the humeral components. Revision surgeries occurred only for cerclage wire removal (13.6%, n = 6). The average ASES and VAS pain scores after cerclage wire removal were 85 (range 63-100, SD, 14.0) and 1.0 (range 0-4, SD 1.7), respectively.</p><p><strong>Conclusion: </strong>Patients undergoing stemless aTSA with a large lesser tuberosity osteotomy repaired with cerclage wires demonstrate excellent functional and radiographic outcomes, with a 93% complete healing rate, no cases of osteotomy displacement, and internal rotation strength equal to the contralateral limb. Despite 13% of patients requiring subsequent wire removal, outcomes were comparable to patients not requiring removal.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1205-e1214"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Nutritionally at Risk and Proinflammatory States in Patients Undergoing Elective Shoulder Surgery.","authors":"Robert C Juniewicz, E Fumina Kobayashi, Terence L Thomas, Adam A Rizk, Surena Namdari","doi":"10.5435/JAAOS-D-25-00629","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00629","url":null,"abstract":"<p><strong>Background: </strong>The effect of malnutrition on patients undergoing orthopaedic surgery has been a recent topic of interest. The purpose of this study was to describe the prevalence and risk factors of patients who are nutritionally at risk (NAR) of becoming malnourished and its relationship with proinflammatory states (PIS), demographic risk factors, and comorbid conditions in patients undergoing shoulder surgery.</p><p><strong>Methods: </strong>This study was a single-institution retrospective study of 42 patients with nutrition and inflammatory labs obtained before elective shoulder surgery from September 2023 to April 2024. Patients were considered NAR if they had at least one abnormal level of the following: albumin, prealbumin, or vitamin D. Patients were considered as having a PIS if they had at least one abnormal level of the following: CRP, transferrin, or platelet:lymphocyte ratio. Unpaired t-test and odds ratio (OR) were used to assess associations between demographics, laboratory abnormalities, and comorbid conditions with NAR and PIS.</p><p><strong>Results: </strong>Of the 42 patients, five (11.9%) were NAR, whereas 26 (61.9%) had proinflammatory labs. NAR patients had significantly elevated BMI (37.0 vs 29.0, P = 0.009, OR: 1.75 [1.08 to 2.83]). Patients who were NAR had greater odds of having a greater number of total laboratory abnormalities (1.46 vs 3.60, P = 0.069, OR: 2.56 [1.18 to 5.54]). The patients who met criteria for PIS were significantly more likely to have a greater number of total abnormal labs drawn from the standard preoperative laboratory set (0.69 vs 2.35, P < 0.001, OR: 3.67 [1.51 to 8.94]). No significant differences in comorbidities, alcohol use, or smoking status were found between any group.</p><p><strong>Conclusion: </strong>Our findings show a greater overall prevalence of NAR state in shoulder surgery patients than previously described rates of malnutrition. Risk factors for being NAR include elevated BMI and greater overall number of abnormal nutrition and inflammatory labs.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":"33 20","pages":"e1236-e1247"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allograft Prosthetic Composites in Complex Primary and Revision Shoulder and Elbow Arthroplasty.","authors":"Jacob J Triplet, Joaquin Sanchez-Sotelo, Adnan N Cheema, Matthew T Houdek, Mark E Morrey","doi":"10.5435/JAAOS-D-24-01475","DOIUrl":"10.5435/JAAOS-D-24-01475","url":null,"abstract":"<p><p>Substantial bone loss at the time of complex primary and revision shoulder or elbow arthroplasty is challenging. Large bone defects compromise component support and important muscle-tendon units. Megaprosthesis, osteoarticular allografts, vascularized bone transfers, fusions, and allograft prosthetic composites (APCs) have all been described for reconstruction in these difficult situations. APCs increase bone stock and provide a better opportunity for soft-tissue reconstruction; however, they are prone to other complications, including graft resorption, nonunion, and fracture. This article provides a comprehensive understanding and review of the benefits and disadvantages of APC utilization in shoulder and elbow arthroplasty. Technical considerations are discussed to maximize functional outcomes. Moreover, advances in templating and three-dimensional printing offer a promising future for planning, precise preparation, and surgical efficiency of APC use in upper extremity arthroplasty.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1179-e1190"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long Head of the Biceps Tendon Pathology: From Etiology to Management.","authors":"John P Scanaliato, Benjamin Kerzner, Bernard R Bach, Grant E Garrigues","doi":"10.5435/JAAOS-D-24-00723","DOIUrl":"10.5435/JAAOS-D-24-00723","url":null,"abstract":"<p><p>An improved understanding of the complex biomechanics of the static and dynamic stabilizers of the shoulder has allowed for the evolution in diagnosing and treating shoulder pathology. The long head of the biceps brachii tendon (long head of the biceps tendon [LHBT]) is associated with various shoulder pathologies, including superior labrum from anterior to posterior tears, rotator cuff pathology, or even isolated biceps instability. Injuries to the LHBT can occur in both athlete and nonathlete populations. Recent evidence has highlighted the complex interplay between the superior labrum and the proximal aspect of the LHBT. It is becoming increasingly clear that these two anatomic structures do not exist in isolation. In this review article, we provide a comprehensive overview of the pathoanatomy, patient presentation, diagnosis and treatment options for patients who present with pathology affecting the LHBT.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1191-e1204"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Greater Distress Is Associated With a Larger Area Marked on a Shoulder Pain Diagram.","authors":"Amin Razi, Grant McHorse, Petar Golijanin, David Ring, Sina Ramtin","doi":"10.5435/JAAOS-D-25-00213","DOIUrl":"10.5435/JAAOS-D-25-00213","url":null,"abstract":"<p><strong>Introduction: </strong>In the hand and low back, the area and distribution marked on a pain diagram correlates with feelings of distress and misconceptions about sensations. Shoulder pain diagrams could help identify unhelpful thoughts and feelings that are targets for improved shoulder health. This study aimed to answer (1) What factors are associated with greater area of pain marked on a shoulder pain diagram? (2) What factors are associated with a larger proportion of total pain area in the posterior shoulder? and (3) What factors are associated with levels of upper extremity (UE)-specific capability and pain intensity?</p><p><strong>Methods: </strong>One hundred thirty-nine patients (51% men; 71/139) consulting a musculoskeletal specialist (58% new patients; 80/139) for shoulder pain were invited to participate. Patients marked a shoulder pain diagram and completed a survey including levels of unhelpful thinking, feelings of distress regarding symptoms, UE-specific capability (measured using the Patient-Reported Outcome Measurement Information System UE computer adaptive test; Patient-Reported Outcome Measurement Information System UE computer adaptive test), and levels of discomfort. Bivariate and multivariable analyses identified factors associated with the total area and relative location of shoulder pain (defined as the ratio of anterior marked area divided by total posterior plus anterior area) and levels of comfort and capability.</p><p><strong>Results: </strong>The total area marked on a pain diagram was associated with greater feelings of distress regarding symptoms. The ratio of marked posterior to total pain area was not associated with any factors in bivariate analysis. Greater levels of incapability were associated with greater feelings of distress regarding symptoms, women, older age, and less education. Greater pain intensity was associated with greater levels of distress and low income.</p><p><strong>Conclusion: </strong>The observation that greater distress is associated with a larger marked area on the shoulder pain diagram and higher levels of discomfort and incapability suggests that such markings could be useful to help identify modifiable mindset factors that contribute to shoulder health.</p><p><strong>Level of evidence: </strong>Level IIIb, Cross Sectional Observational Study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"1168-1175"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conversion of Failed Anatomic Total Shoulder Arthroplasty to Reverse Shoulder Arthroplasty Yields Similar Pain and Functional Outcomes to Primary Reverse Shoulder Arthroplasty But has a Higher Baseplate Failure Rate: A Matched Cohort Study.","authors":"Kevin A Hao, Trevor G Simcox, Keegan M Hones, Jonathan O Wright, Thomas W Wright, Tyler LaMonica, Bradley S Schoch, Joseph J King","doi":"10.5435/JAAOS-D-24-01296","DOIUrl":"10.5435/JAAOS-D-24-01296","url":null,"abstract":"<p><strong>Background: </strong>To investigate whether patients who initially underwent anatomic total shoulder arthroplasty (aTSA) for glenohumeral osteoarthritis and were subsequently revised to reverse TSA (rTSA) due to rotator cuff failure or glenoid loosening ultimately attained a similar clinical outcome compared with those who underwent primary rTSA and identify predictors of poor outcomes in the former population.</p><p><strong>Methods: </strong>We did a single-center retrospective review of 63 shoulders who underwent revision rTSA after primary aTSA that failed due to glenoid component loosening (n = 32), rotator cuff failure (n = 24), or recurrent instability (n = 7). Pain and functional outcomes at minimum 2-year follow-up were compared between patients undergoing revision rTSA (n = 45) and a matched control group of primary rTSAs performed for primary osteoarthritis with an intact rotator cuff. Predictors of a poor American Shoulder and Elbow Surgeons score and baseplate loosening in the former cohort were identified.</p><p><strong>Results: </strong>After revision rTSA, patients demonstrated statistically significant ( P < 0.05) improvement in overhead motion, functional outcome scores, and pain but no improvement in external or internal rotation. A 35% complication rate was observed, most commonly baseplate loosening (21%). The implant survivorship following revision rTSA was 97% after 2 years and 75% after 5 years. No notable differences in any outcome scores, range of motion, shoulder strength, or pain measures were found between revision rTSAs and matched primary rTSA controls at a mean of 8 years since index surgery. Humeral stem retention was independently associated with poorer postoperative American Shoulder and Elbow Surgeons scores, whereas a lesser interval between index and revision surgery and use of a structural bone graft were associated with a higher risk of baseplate loosening.</p><p><strong>Conclusion: </strong>Patients who undergo aseptic revision rTSA after failed primary aTSA for cuff-intact glenohumeral osteoarthritis attain similar pain and functional outcomes compared with those who underwent primary rTSA when matched by time since index surgery.</p><p><strong>Level of evidence: </strong>Level III, Case-Control Study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1215-e1225"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Split Anconeus Fascia Transfer for Posterolateral Rotatory Instability of the Elbow.","authors":"Brett D Haislup, Linda L Zhang, Caroline Chebli, Anand M Murthi","doi":"10.5435/JAAOS-D-24-01507","DOIUrl":"10.5435/JAAOS-D-24-01507","url":null,"abstract":"<p><p>Posterolateral rotatory instability (PLRI) of the elbow occurs from chronic lateral ulnar collateral ligament (LUCL) injury leading to subluxation of the ulnohumeral joint and radial head. Patients with failed or untreated LUCL injury can go on to have chronic elbow instability and difficulty with activities that require an axial load on the elbow. Free grafts such as semitendinosus, Achilles, or palmaris longus require fixation on both the humerus and ulna, or may not represent the native LUCL kinematics as a native tendon such as anconeus. Split anconeus fascia transfer is a surgical treatment option for PLRI that does not require ulnar drilling or graft site morbidity. This surgical technique paper describes evaluation, management, and treatment of PLRI with accompanying video and description of the split anconeus fascia transfer technique.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"1123-1129"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}