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What's New — Elbow — July 2026

18 new articles published this month.

Themes: Total Elbow Arthroplasty Outcomes · Elbow Trauma and Fracture Classification · Lateral Elbow Tendinopathy and Rehabilitation · Surgical Techniques and Imaging Technology

Digest generated 2026-08-04 16:02:39+00:00.

Highlights

Total Elbow Arthroplasty Outcomes

Recent literature critically evaluates surgical approaches and indications for total elbow arthroplasty (TEA). A multicenter prospective study demonstrates that the triceps-sparing approach yields superior functional outcomes compared to the traditional triceps-detaching technique, despite potential visibility challenges [15]. In the revision setting, custom ulna megaprostheses offer a viable solution for complex bone loss, though evidence remains limited to institutional experiences [11]. Furthermore, TEA effectively addresses post-traumatic sequelae from proximal ulna or radius fractures, with acceptable survivorship and functional results over long-term follow-up [17]. Additionally, advanced kinematic analysis using helical axes reveals quantifiable instability patterns in unlinked TEA implants, highlighting the need for precise component positioning to mimic physiological motion [14].

Elbow Trauma and Fracture Classification

Several studies focus on the diagnostic and classification challenges associated with acute elbow trauma. The novel Munich Elbow Soft Tissue (MEST) classification provides a reliable MRI-based system for grading musculoligamentous injury severity in simple elbow dislocations [5]. For proximal ulna fracture-dislocations, the Mayo coronoid-centric classification demonstrates good external validity in an independent cohort, aiding in the identification of affected structures [10]. Anatomical research identifies the base of the coronoid as a reliable reference for the elbow axis of rotation, improving CT reconstruction accuracy [8]. Additionally, morphological analysis of isolated small coronoid fractures reveals that these injuries often involve significant soft tissue damage and occult instability, challenging the notion that they are benign [9].

Lateral Elbow Tendinopathy and Rehabilitation

Current discourse on lateral elbow tendinopathy (LET) highlights gaps in clinical assessment and rehabilitation protocols. A systematic review of 208 randomized controlled trials reveals that inadequate cervicothoracic screening is nearly universal in LET studies, despite evidence linking spinal involvement to forearm symptoms [6]. Methodological concerns have been raised regarding the interpretation of outcome measure utilization in international surveys of physiotherapy practice, prompting a detailed response from the original authors to clarify threshold definitions [2, 4]. Beyond conservative care, novel return-to-sport criteria are being developed; new neurocognitive reactive variations of upper extremity functional performance tests show promising test-retest reliability, addressing the lack of cognitive assessment in current return-to-play decision-making [3].

Surgical Techniques and Imaging Technology

Innovations in surgical technique and imaging are enhancing elbow arthroscopy and preoperative planning. An anatomical feasibility study supports the safety and efficacy of endoscopic release of the lacertus fibrosus using a dedicated centerline system, showing complete release without neurovascular injury in cadaveric models [1]. In the realm of augmented reality, dynamic 3-D modeling of peri-elbow nerves derived from MRI scans allows for the analysis of nerve kinematics during flexion, supporting the development of real-time overlay systems for arthroscopy [16]. Additionally, radiographic evaluation of radial head arthroplasty suggests that the proximal edge of the lesser sigmoid notch is a more reliable landmark than the lateral ulnohumeral joint space for detecting prosthetic overlengthening [13]. Finally, region-specific Hounsfield unit measurements on elbow CT scans show potential as a predictor for osteoporosis, offering a convenient preoperative assessment tool when DXA scans are unavailable [18].

Articles by Theme

Total Elbow Arthroplasty Outcomes (4)

11. Raval P, Raja H, Asaad O, et al. Custom ulna megaprosthesis use in revision total elbow replacement. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.11.022

This study reviewed institutional experiences with custom ulna megaprostheses (CUMP) for revision total elbow arthroplasty in patients with significant bone loss. It evaluated outcomes including range of motion, patient-reported scores, and radiographic stability to address the lack of evidence for CUMP use in nontumor indications. The findings provide data on the viability of CUMP as a solution for complex revision scenarios where other options are limited.

14. Sugiura Y, Iwamoto T, Matsumoto Y, et al. Quantitative Assessment of Ulnohumeral Instability After K-NOW Unlinked Total Elbow Arthroplasty Using the Helical Axis: A Pilot Study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.06.034

This pilot study used helical axis analysis to quantify ulnohumeral instability in elbows following unlinked total elbow arthroplasty compared to healthy controls. The TEA group exhibited significantly greater translational magnitude along the helical axis, indicating increased joint laxity. This quantitative method offers a potential tool for assessing postoperative instability and understanding the kinematic differences introduced by unlinked implants.

15. Meijering D, Boerboom AL, Gerritsma CL, et al. Triceps-sparing approach results in better elbow function compared to triceps-detaching approach in total elbow arthroplasty: A multicenter prospective cohort study.. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.06.032

This multicenter prospective cohort study compared functional outcomes of triceps-sparing versus triceps-detaching approaches in total elbow arthroplasty. The triceps-sparing approach resulted in better elbow function, specifically regarding fixed flexion deformity, compared to the triceps-detaching method. These findings support the shift toward triceps-sparing techniques to optimize postoperative extensor function and reduce complications.

17. You DZ, Rudisill SS, Fossum BW, et al. Can Total Elbow Arthroplasty Effectively Treat Post-traumatic Sequelae After Proximal Ulna or Radius Fracture and Fracture-Dislocations?. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.008

This study evaluated the operative considerations, outcomes, and survivorship of total elbow arthroplasty (TEA) performed for post-traumatic sequelae following complex proximal ulna or radius fractures. The findings indicate that TEA provides effective treatment for these specific injuries, demonstrating acceptable functional outcomes and survivorship despite the complexity of the underlying pathology. Clinically, this supports the use of TEA as a viable salvage option for patients with severe post-traumatic elbow dysfunction resulting from proximal forearm fractures.

Elbow Trauma and Fracture Classification (4)

5. Wackerle AM, Vieider RP, Kadantsev P, et al. The New Munich Elbow Soft Tissue (MEST) classification is a reliable MRI‐based injury severity grading system for acute simple elbow dislocations. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70505

This study evaluated the inter- and intrarater reliability of the novel Munich Elbow Soft Tissue (MEST) classification for grading soft tissue injuries in acute simple elbow dislocations using MRI. The analysis of 30 patients demonstrated good reliability for the classification system. The MEST classification is thus validated as a reliable tool for assessing injury severity in this clinical context.

8. Iribarren-Baró S, Martinez-Catalan N, Sanchez-Urgelles P, et al. The base of the coronoid as a reliable anatomical reference for elbow axis of rotation: evidence from a cadaveric study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.11.019

This cadaveric study investigated whether the base of the coronoid axis (BCA) serves as a reliable reference for the elbow's axis of rotation and CT imaging. The BCA was found to be parallel to the humeral interepicondylar axis, supporting its use as a surrogate for the flexion-extension axis. This anatomical reference can improve the accuracy of coronoid fracture measurements and surgical planning.

9. Chang A, Jeong SM, Choi W, et al. What injury makes an isolated small coronoid fracture? Morphological analysis using three-dimensional computed tomography reconstruction. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.11.003

This study utilized 3D CT modeling to analyze the morphology and injury mechanisms of isolated small coronoid fractures, finding that posteromedial rotatory instability was the most common diagnosis. The findings suggest that these fractures, often underestimated on plain radiographs, are frequently associated with significant soft tissue injuries and occult elbow instability. Clinicians should maintain a high index of suspicion for instability when evaluating these seemingly minor fractures to prevent missed diagnoses.

10. Martínez EF, Holc F, Victorica PB, et al. Inter- and intraobserver reliability of the Mayo coronoid-centric classification for proximal ulna fracture-dislocations. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.11.027

Researchers assessed the inter- and intraobserver reliability of the Mayo coronoid-centric classification for proximal ulna fracture-dislocations using an independent cohort of 79 patients. The study aimed to validate the external validity of this classification system, which centers on the continuity of the coronoid process with major ulnar fragments. Accurate application of this classification is essential for guiding treatment in these complex injuries with variable instability patterns.

Lateral Elbow Tendinopathy and Rehabilitation (4)

2. Rana E. Concerns regarding interpretation of outcome measure utilization in ‘Physiotherapists’ Use of Outcome Measures in the Assessment of Lateral Elbow Tendinopathy: An International Online Survey’. Shoulder & Elbow 2026. doi:10.1177/17585732261470034

This letter critiques the methodological and interpretational aspects of a recent survey on physiotherapists' use of outcome measures for lateral elbow tendinopathy. The author argues that specific issues may influence the validity of the study's conclusions regarding clinical practice patterns. The commentary highlights the need for careful interpretation of survey data in musculoskeletal rehabilitation research.

3. Stoddard SM, Lewis K, Riemann BL, et al. Effects of neurocognitive reactive activities on upper extremity closed kinetic chain functional performance testing. Shoulder & Elbow 2026. doi:10.1177/17585732261469815

The study established the test-retest reliability of two neurocognitive reactive variations of an upper extremity functional performance test in healthy adults. Results showed moderate to good reliability for both tests, with significant differences in performance metrics between the single-light and multi-light variations. These findings suggest these tests are reliable tools for assessing neurocognitive contributions to upper extremity function in return-to-sport decisions.

4. Heales L, Bisset L, Vicenzino B, et al. Response to: Concerns regarding interpretation of outcome measure utilisation in “Physiotherapists’ Use of Outcome Measures in the Assessment of Lateral Elbow Tendinopathy: An International Online Survey”. Shoulder & Elbow 2026. doi:10.1177/17585732261470036

This study evaluated the inter- and intrarater reliability of the novel Munich Elbow Soft Tissue (MEST) classification for grading soft tissue injuries in acute simple elbow dislocations using MRI. The analysis of 30 patients demonstrated good reliability for the classification system. The MEST classification is thus validated as a reliable tool for assessing injury severity in this clinical context.

6. Schumacher MR, Bakken EK, Reynolds KP, et al. Inadequate cervicothoracic assessment is nearly universal for screening participants with lateral elbow tendinopathy: A systematic review of 208 randomized controlled trials. Shoulder & Elbow 2026. doi:10.1177/17585732261467932

This systematic review of 208 randomized controlled trials found that nearly all studies on lateral elbow tendinopathy failed to adequately screen for cervicothoracic involvement. Only 1.9% of trials reported thorough screening, while 95.2% reported no screening at all. This highlights a significant gap in current research methodology, suggesting that cervicothoracic factors are often overlooked in clinical trials for this condition.

Surgical Techniques and Imaging Technology (4)

1. Vernet P, Maximen J. Endoscopic release of the lacertus fibrosus at the elbow: an anatomical feasibility study. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261473387

The authors evaluated the anatomical feasibility of endoscopically releasing the lacertus fibrosus using a specific system in four cadaveric specimens. The technique demonstrated complete release with perfect visualization and no neurovascular injury, confirming its safety and feasibility. This supports the potential clinical adoption of this minimally invasive approach for relevant elbow pathologies.

13. Welsch J, Bollepalli H, Choudhury A, et al. Evaluation of Radiograph Parameters Used to Assess Prosthetic Overlengthening in Radial Head Arthroplasty. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.06.024

This study evaluated the reliability of the proximal edge of the lesser sigmoid notch (SN) versus the lateral ulnohumeral joint space (LUHJ) for assessing radial head prosthetic overlengthening using cadaveric models. Results demonstrated that the SN had superior inter- and intra-rater reliability compared to the LUHJ. The proximal edge of the lesser sigmoid notch is recommended as a more reliable radiographic landmark for surgeons during radial head arthroplasty.

16. Saeki T, Murakami Y, Iwase H, et al. Dynamic analysis of nerves around the elbow using MRI-derived 3-D modeling. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.006

This study developed 3-D models of peri-elbow nerves from MRI scans to analyze nerve kinematics during flexion and extension for augmented reality surgical planning. The researchers generated averaged nerve models and assessed optimal angles for standard arthroscopic portals. The resulting data supports the development of real-time augmented reality systems to enhance safety and precision in elbow arthroscopy.

18. Klingler F, Schmid C, Mühlenfeld N, et al. Region-specific evaluation of Hounsfield units on elbow CT as a predictor of osteoporosis in patients at risk. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.007

Researchers assessed whether standardized Hounsfield unit (HU) measurements on elbow CT scans could predict osteoporosis by correlating them with dual-energy X-ray absorptiometry (DXA) results. The study found significant correlations between HU values in specific regions of the humerus, ulna, and radius and DXA T-scores, establishing the discriminatory capacity of these measurements. This suggests that elbow CT scans can serve as a practical, readily available tool for identifying osteoporosis in patients undergoing trauma surgery when formal DXA scans are not immediately accessible.

7. Yanai T, Onuma K. Weakening of the Active Muscle Restraint Against Valgus Loading During Repeated Baseball Pitching: Direct Evidence of Fatigue in Dynamic Valgus Stabilizers of the Elbow Joint in Collegiate Baseball Pitchers. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261460711

The study measured muscular varus strength and elbow valgus load in collegiate baseball pitchers over seven innings to assess dynamic stabilizer fatigue. Results showed that muscular varus strength weakened significantly as pitch count accumulated, becoming insufficient to counteract valgus loads in later innings. This provides direct evidence that fatigue compromises dynamic elbow stability, increasing reliance on the ulnar collateral ligament.

12. Mallon WJ, Kuhn JE“. A new JSES journal reveal. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.04.005

This editorial announces the acquisition of the Journal of Shoulder and Elbow Arthroplasty (JSEA) to consolidate arthroplasty manuscripts within the JSES family. The move aims to increase the visibility and accessibility of arthroplasty research through improved indexing and open access. Authors are encouraged to submit arthroplasty-related work to JSEA for greater public reach.

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