What's New — Elbow — September 2026¶

34 new articles published this month.

Themes: Epicondylitis Treatment and Tendon Care · UCL Injury in Baseball Pitchers · Total Elbow Arthroplasty Outcomes · Radial Head Arthroplasty and Fixation · Elbow Trauma and Instability · Triceps Repair and Sports Trauma

Digest generated 2026-10-04 16:05:21+00:00.

Highlights¶

Epicondylitis Treatment and Tendon Care¶

This month features a strong cluster on medial and lateral epicondylitis spanning conservative, minimally invasive, and surgical management. A double-blinded RCT of radial shockwave therapy found no benefit of therapeutic-dose over minimal-dose rESWT when combined with progressive home exercise [6]. Radiofrequency ablation shows promise in a systematic review of 311 elbows with pain improvement and no serious adverse events [26], while ultrasound-guided TenJet tenotomy improved 1-year outcomes for common flexor tendinopathy [34]. A large surgical series of 200 cases reported long-term results for common flexor and extensor tendon tears, including risk factors for failed nonoperative care [19]. Concerningly, prior glucocorticoid injection was associated with greater MRI-documented common extensor origin structural damage in chronic lateral epicondylitis [7].

UCL Injury in Baseball Pitchers¶

Several articles address ulnar collateral ligament (UCL) injury risk, prevention, and surgical outcomes in baseball. A covariate-matched survival analysis showed forearm flexor strains in MLB pitchers predict subsequent UCL surgery risk, with return timing and pitching characteristics influencing post-return outcomes [2]. Machine-learning analysis of game-level workload and mechanics identified discrete preinjury windows (7-49 days) that may enable targeted prevention of shoulder and elbow injuries [29]. Regarding treatment, suture tape-augmented UCL repair demonstrated favourable return-to-play rates and performance in MLB players [30], while revision UCL reconstruction yielded significantly lower return-to-play and return-to-level rates than primary reconstruction, with role-dependent performance changes [32]. Medial epicondyle morphology and stress ultrasound gapping in high school players further inform adolescent valgus injury assessment [23].

Total Elbow Arthroplasty Outcomes¶

Total elbow arthroplasty (TEA) is well represented, with studies clarifying indications, survivorship, and complications. A matched cohort found Parkinson disease did not clearly worsen midterm TEA survivorship or complication risk [11]. Single-institution data on 303 primary TEAs detailed modern reoperation patterns as indications shift toward trauma [22], and an NSQIP analysis compared short-term adverse events between primary and revision TEA [15]. Long-term series examined linked semiconstrained TEA in patients under 40 with unreconstructable distal humerus fracture sequelae [13] and compared primary versus secondary TEA after geriatric distal humerus fractures [14]. A cadaveric study of uncemented hemiarthroplasty with intramedullary screw fixation confirmed restoration of distal humeral valgus alignment [12].

Radial Head Arthroplasty and Fixation¶

Radial head arthroplasty (RHA) decision-making and implant performance received focused attention. A qualitative study of UK upper-limb surgeons revealed pragmatic heuristics for implant selection and fixation, with bone quality as the pivotal determinant [4]. A systematic review and meta-analysis stratified revision, loosening, and reoperation rates by stem fixation (loose-fit, press-fit, cemented) and polarity [16]. A Dutch registry study of 33 radiocapitellar arthroplasties reported 27% revision, most commonly radial component loosening, with post-traumatic osteoarthritis the leading indication [17]. A single-center series of 48 fracture RHAs analyzed the prosthesis removal subgroup at mid- to long-term follow-up [25].

Elbow Trauma and Instability¶

Traumatic elbow injury management was covered broadly, from dislocation patterns to fracture fixation and complications. A collaborative review described current trends in simple versus complex traumatic elbow dislocations and their management [31]. In terrible triad injuries, a retrospective comparison of 105 patients found outcomes differed by coronoid fixation and O'Driscoll subtype [28], and a level-I trauma centre cohort of 169 complex fracture-dislocations defined heterotopic ossification incidence, risk factors, and mid-term functional impact [18]. A cadaveric study validated the posterior ulna medial approach for anteromedial coronoid and posterior MCL exposure in posteromedial rotatory instability [27], while biomechanical testing evaluated the gravity varus test for posterolateral rotatory instability [24]. Suture tension band fixation reduced hardware complications in olecranon fractures [8].

Triceps Repair and Sports Trauma¶

Distal triceps rupture management and related athletic elbow trauma formed a smaller cluster. A technique report described transosseous double-row triceps repair in lateral decubitus positioning for a professional athlete, emphasizing a self-reinforcing construct with increased bone-tendon interface compression [1]. A comparative study evaluated complication rates and outcomes across various surgical techniques for acute distal triceps rupture repair [9]. Complementing these, an epidemiological analysis of emergency department data from 2010-2024 characterized sports- and recreation-related shoulder and elbow injuries in older adults, contextualizing athletic elbow trauma across age groups [21].

Articles by Theme¶

Epicondylitis Treatment and Tendon Care (5)¶

6. Wheeler PC, Tattersall C, Calver R. Radial extracorporeal shockwave therapy (rESWT) for patients with chronic lateral elbow tendinopathy (tennis elbow): A double-blinded randomised controlled trial. Shoulder & Elbow 2026. doi:10.1177/17585732261484894

In this double-blinded randomised controlled trial, 43 patients with chronic lateral elbow tendinopathy received three sessions of either 'therapeutic-dose' or 'minimal-dose' radial extracorporeal shockwave therapy alongside a structured home exercise program, with follow-up to six months. Both groups improved (average pain improved 27% at six weeks to 52% at six months), but no between-group differences emerged at any time point. The clinical implication is that therapeutic-dose rESWT offers no benefit over minimal dosing, questioning the value of standard-dose ESWT in this condition.

7. Henze A, Eckl L, Kadantsev P, et al. MRI severity of common extensor origin damage associated with prior glucocorticoid injection in chronic lateral epicondylitis: a retrospective multicenter analysis. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10450-7

This retrospective multicenter study of 147 patients with chronic lateral epicondylitis (symptoms ≥6 months) used MRI and the Walz classification to assess whether prior glucocorticoid injection was associated with greater structural damage of the common extensor origin. Roughly 43% had prior injections, and adjusted analyses linked injection history to more severe MRI-based tendon damage. The findings support caution in using glucocorticoid injections for lateral epicondylitis, given potential adverse structural effects on the tendon.

19. Herman ZJ, Mohr D, Arner JW, et al. Comprehensive Conservative Treatment and Surgical Management of Elbow Common Flexor Tendon and Common Extensor Tendon Tears, 200 Operative Cases with Average 9 Year Follow-up. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.08.025

This series of 200 operative cases of medial and lateral epicondylitis refractory to conservative care, with average 9-year follow-up, describes the senior author's surgical technique and reports long-term reoperation rates, symptom recurrence, return to activity, and factors predicting failure of nonoperative management. The findings guide operative decision-making and patient counseling, and help identify which patients are unlikely to respond to continued conservative treatment.

26. Ali M, Chandrashekhar MK, Kumar K, et al. The use of radiofrequency ablation for the treatment of lateral epicondylitis: a systematic review of the literature. Clinics in Shoulder and Elbow 2026. doi:10.5397/cise.2026.00416

This systematic review of 11 studies (including 4 RCTs) evaluated radiofrequency ablation for lateral epicondylitis, encompassing 311 treated elbows. Most patients experienced improved pain with no serious adverse events reported. The evidence supports radiofrequency ablation as a viable minimally invasive alternative for chronic lateral epicondylitis, offering significant pain relief and functional improvement with rapid recovery and low risk.

34. Dakkak M, Patel V, King D, et al. Ultrasound Guided Tenotomy with TenJet Improves Functional Outcomes at 1 Year for Common Flexor Tendinopathy: A Retrospective Review. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100884

This retrospective review assessed 1-year functional outcomes after ultrasound-guided tenotomy using the TenJet device for common flexor tendinopathy (medial epicondylitis). The authors report improved functional outcomes at 1 year post-procedure. The results support TenJet tenotomy as a minimally invasive treatment option for recalcitrant medial elbow tendinopathy.

UCL Injury in Baseball Pitchers (5)¶

2. Dillon MR, Mastroianni MA, Frappa N, et al. Forearm Flexor Strain and Subsequent Ulnar Collateral Ligament Surgery Risk in Major League Baseball Pitchers: A Covariate-Matched Survival Analysis. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261486103

This retrospective cohort study matched MLB pitchers with nonoperatively managed forearm flexor strains (2015-2024) to controls to quantify subsequent UCL surgery risk after return to play. The findings inform whether a forearm flexor strain should be regarded as a sentinel event for medial elbow risk. Clinically, results can guide monitoring, workload management, and counseling of pitchers returning from flexor strains.

23. Nishi R, Ogawa T, Kubota A, et al. Medial Epicondyle Morphology and Medial Elbow Gapping in High School Baseball Players: Implications for Throwing-Related Elbow Pain. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.08.029

Ultrasonographic assessment of 95 nationally competitive high school baseball players measured medial epicondyle morphology (protrusion, fragmentation, irregularity) and medial elbow gapping at rest and under valgus stress, relating these to temporally classified throwing-related elbow pain. The results clarify whether stress gapping better identifies laxity associated with pain, informing screening and prevention strategies for adolescent throwers.

29. Kang LS, Mavrommatis S, Ina JG, et al. Game-Level Temporal Patterns Identify Optimal Preinjury Windows for Shoulder and Elbow Injuries in Major League Baseball Pitchers. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261477532

This case-control study applied XGBoost machine-learning models to game-level workload and biomechanical data from MLB pitchers (2017-2025) to identify optimal preinjury windows for shoulder and elbow injuries across 3,970 pitcher-seasons. Changepoint analysis of cross-validated AUC identified discrete preinjury windows, with feature importance and dynamic analyses characterizing baseline risk and short-term variability. The results enable targeted, window-specific monitoring and workload interventions for injury prevention in professional pitchers.

30. Wardell W, Neumann D, Auerbach B. Return to Play Rate and Performance After Ulnar Collateral Ligament Repair with Suture Tape Augmentation in Major League Baseball Players. JSES International 2026. doi:10.1016/j.jseint.2026.101803

This study evaluated return-to-play rates and performance after ulnar collateral ligament repair with suture tape augmentation in Major League Baseball players. The findings quantify RTP outcomes and postoperative performance for this increasingly used alternative to reconstruction. Results inform expectations and decision-making for players, teams, and surgeons considering UCL repair with internal bracing.

32. Ma H, Chang W, Chen H, et al. Outcomes of Primary and Revision UCLR: Return to Play, Performance, and Role Adaptation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261484326

This cohort study compared 177 MLB pitchers undergoing primary versus revision ulnar collateral ligament reconstruction (2015-2021) across return-to-play, return-to-level, performance metrics, and role transitions over 3 postoperative years. Revision UCLR was associated with significantly lower RTP and RTL rates, with revision starters showing altered pitch usage and movement profiles. The findings support revised expectations and counseling regarding career outcomes after revision UCLR, particularly regarding return to prior performance level.

Total Elbow Arthroplasty Outcomes (6)¶

11. Anundson J, LeMaster E, Lee L, et al. Is Parkinson Disease a Risk Factor After Total Elbow Arthroplasty? Midterm Survivorship in a Matched Cohort. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101076

This retrospective matched-cohort study using the PearlDiver database compared midterm survivorship and complications of total elbow arthroplasty in patients with versus without Parkinson disease, matched 1:4 by age and sex. It clarifies whether the elevated periprosthetic fracture, infection, and loosening risks seen in hip and knee arthroplasty also apply to the elbow, guiding risk counseling and perioperative management for these patients.

12. Li J, Ibrahim JM, Darwiche SS, et al. Reproducing Valgus Angle in Uncemented Humeral Hemiarthroplasty. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101071

In six cadaveric specimens, investigators implanted an uncemented humeral hemiarthroplasty with intramedullary screw fixation and compared radiographic valgus alignment of the implant's flexion-extension axis with native distal humeral anatomy. The mean difference in articular spool valgus was 3.64°, indicating the implant reasonably but imperfectly reproduces native valgus alignment, which has implications for preoperative planning and implant design.

13. Bardellini G, Abate B, Celli A, et al. Total elbow arthroplasty for unreconstructible distal humerus fracture sequelae in patients less than 40 year old. Long-term outcomes. Journal of Shoulder and Elbow Arthroplasty 2026. doi:10.1016/j.jsea.2026.100028

This study reported long-term outcomes (minimum 10 years) of linked semiconstrained Coonrad-Morrey total elbow arthroplasty in 16 patients aged 40 years or younger with sequelae of unreconstructible distal humerus fractures. The findings challenge the assumption that TEA should be avoided in young patients, providing durability and satisfaction data to guide treatment of complex post-traumatic elbow arthritis in this population.

14. Deml O, Schenk P, Fritsche C, et al. Mid- and long-term results of primary vs. secondary total elbow arthroplasty after index intra-articular fracture of the distal humerus in the elderly. Journal of Shoulder and Elbow Arthroplasty 2026. doi:10.1016/j.jsea.2026.100027

This retrospective cohort with prospective follow-up compared mid- and long-term outcomes of primary versus secondary total elbow arthroplasty in 34 elderly patients treated for complex distal humerus fractures. The results help clarify whether performing TEA as the index procedure offers advantages over salvage arthroplasty after failed fracture fixation, informing surgical decision-making in geriatric fracture care.

15. Satalich JR, Smith MS, Sribhashyam S, et al. Primary vs. revision total elbow arthroplasty: an updated analysis of short-term complications and associated factors. Journal of Shoulder and Elbow Arthroplasty 2026. doi:10.1016/j.jsea.2026.100036

Using the ACS NSQIP database (2014-2023), this retrospective cohort of 583 primary and 179 revision total elbow arthroplasties analyzed short-term adverse events and associated risk factors. The updated comparative data on 30-day complications between primary and revision TEA support preoperative risk stratification and patient counseling.

22. Singh A, Fiandeiro M, Satalich J, et al. Medium Term Reoperation Rates after Primary Total Elbow Arthroplasty at a Single Institution: 303 Cases. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.08.030

A single-institution retrospective cohort of 303 primary total elbow arthroplasties performed between 2007 and 2025 evaluated indications, complications, and reoperation patterns at medium-term follow-up. As TEA indications shift from inflammatory to traumatic etiologies, these contemporary reoperation data inform surgeon and patient expectations regarding durability, infection, aseptic loosening, and mechanical failure.

Radial Head Arthroplasty and Fixation (4)¶

4. Beale H, Abouharb A, Reilly P, et al. Implant selection and fixation in radial head arthroplasty: A qualitative analysis of surgeon decision-making. Shoulder & Elbow 2026. doi:10.1177/17585732261487599

Qualitative interviews with 10 UK upper-limb/elbow consultant surgeons examined how they select implants and fixation strategies in radial head arthroplasty where trial evidence is sparse. Thematic analysis identified five themes, showing convergence on bone quality as the key determinant of fixation, use of modularity for anatomic variability, and functional over radiographic success criteria, with divergence on thresholds for 'unfixable' fractures and excision as a definitive option. The findings highlight reliance on heuristic decision-making and suggest targets for future comparative research and training.

16. Beale H, O'Malley O, Lam C, et al. Stem design in radial head arthroplasty: a systematic review and meta-analysis. Journal of Shoulder and Elbow Arthroplasty 2026. doi:10.1016/j.jsea.2026.100052

This systematic review and meta-analysis of 46 studies (4,467 elbows) compared revision, loosening, and reoperation rates after primary radial head arthroplasty stratified by stem fixation (loose-fit, press-fit, cemented) and polarity (monopolar vs. bipolar), using incidence-rate analysis to adjust for surveillance-time bias. The findings guide implant selection by clarifying which stem designs carry the lowest failure risk.

17. Prkić A, Macken A, van Steenbergen L, et al. Radiocapitellar elbow arthroplasty—a registry study on indications, types, and short-term survival in the Netherlands. Journal of Shoulder and Elbow Arthroplasty 2026. doi:10.1016/j.jsea.2026.100048

A Dutch Arthroplasty Register study of 33 radiocapitellar elbow arthroplasties (2014-2024, median 6.5-year follow-up) found a 27% revision rate, most often from radial component loosening within 3 years, with post-traumatic osteoarthritis the leading indication and an estimated 10-year survival of 60%. Although revision rates are high, radiocapitellar arthroplasty may retain a role in carefully selected patients within clinical trials using strict inclusion criteria.

25. Lopiz Y, Valentin E, Coderch J, et al. Radial Head Arthroplasty for Fracture: A Single-Center Series of 48 Patients with Analysis of the Prosthesis Removal Subgroup at Mid- to Long-Term Follow-Up. JSES International 2026. doi:10.1016/j.jseint.2026.101794

This single-center series reported mid- to long-term outcomes of 48 patients treated with radial head arthroplasty for fracture, with a focused analysis of the subgroup requiring prosthesis removal. The findings characterize implant survival and reasons for removal at extended follow-up. Clinically, the study informs patient counseling and decision-making regarding radial head arthroplasty and the management of failed implants.

Elbow Trauma and Instability (6)¶

8. Hussain ZB, Vazquez F, Dugarte AJ, et al. Suture tension band fixation reduces hardware complications in olecranon fractures: a comparative study. JSES International 2026. doi:10.1016/j.jseint.2026.101734

This comparative study evaluated a novel suture tension band technique for olecranon fractures using eyelet K-wires with suture, comparing surgical and functional outcomes against plate fixation and conventional tension band wiring. The hypothesis was noninferiority of the suture tape tension band construct. The key reported finding is that suture tension band fixation reduced hardware complications, supporting it as an alternative fixation strategy with fewer implant-related reoperations.

18. Jakobi T, Surgeon O, Schnetz M, et al. Heterotopic ossification after complex elbow fracture-dislocations - Mid-term outcome and risk factor analysis. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.08.020

A retrospective cohort of 169 surgically treated complex elbow fracture-dislocations at a level I trauma center (mean 4.6-year follow-up) classified heterotopic ossification by the Hastings and Graham system and used multivariable regression to identify independent risk factors while assessing ROM, MEPS, OES, and DASH outcomes. The study defines HO incidence/severity and predictors after complex fracture-dislocations, helping clinicians counsel patients and target prophylaxis for those at highest risk of stiffness and poorer function.

24. Bauer JA, Rajan R, Singh R, et al. Biomechanical Evaluation of the Gravity Varus Test in a Cadaveric Model of Posterolateral Rotatory Instability of the Elbow. JSES International 2026. doi:10.1016/j.jseint.2026.101792

A cadaveric biomechanical study evaluated the gravity varus test in a surgically created model of posterolateral rotatory instability of the elbow, quantifying its diagnostic performance for detecting this instability pattern. The findings define the test's utility in clinical examination, supporting or refining its use when evaluating patients for lateral ulnar collateral ligament insufficiency.

27. Qawasmi F, Yassin M, Watts AC. The posterior ulna medial approach to the elbow: a cadaveric anatomical study of exposure of the coronoid and posteromedial collateral ligament. Clinics in Shoulder and Elbow 2026. doi:10.5397/cise.2025.01375

This cadaveric study of six upper limbs described the posterior ulna medial approach (PUMA) for exposing the anteromedial coronoid facet and posterior bundle of the medial collateral ligament in posteromedial rotatory instability. The approach consistently allowed exposure and simulated repair of the pMCL and coronoid fixation without flexor-pronator detachment, anterior MCL violation, or ulnar nerve transposition. PUMA offers a reproducible surgical option for addressing key stabilizers in varus posteromedial rotatory instability of the elbow.

28. Babasiz T, Hockmann JP, Weber M, et al. The effects of coronoid fracture fixation on functional outcomes and complication rates following terrible triad injuries of the elbow. Clinics in Shoulder and Elbow 2026. doi:10.5397/cise.2026.00199

This retrospective study compared 105 terrible triad elbow injury patients managed with (n=46) versus without (n=59) coronoid fracture fixation, with stratified analyses by O'Driscoll subtype. Patients undergoing coronoid fixation, predominantly higher-grade (type 2/3) fractures, demonstrated better range of motion and functional scores (MEPS, QuickDASH, SES). The findings support coronoid fixation, particularly for anteromedial facet and basal fractures, to optimise functional outcomes in terrible triad injuries.

31. See A, Raval P, Boucher A, et al. Current Trends in Traumatic Elbow Dislocations: Simple or Complex and How are they managed?. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100885

This review summarized current trends in the classification and management of traumatic elbow dislocations, distinguishing simple from complex injury patterns. It outlined contemporary treatment strategies across the spectrum of dislocation severity. The work provides practical guidance for clinicians in selecting appropriate management for simple versus complex elbow dislocations.

Triceps Repair and Sports Trauma (3)¶

1. Fritsch L, Nocek M, Mitchell BC, et al. Transosseous Double‐Row Triceps Repair in a Professional Athlete. Arthroscopy Techniques 2026. doi:10.1002/atn2.70272

The authors describe a transosseous double-row repair for distal triceps rupture performed in the lateral decubitus position in a professional athlete. The technique combines a self-reinforcing construct with increased compressive loads at the bone-tendon interface during tendon loading. It offers a surgical option for high-demand patients where durable fixation and early rehabilitation are priorities.

9. Aloi NF, Weinberg JN, Feder NM, et al. Comparison of complication rates and outcomes for various surgical techniques for the repair of acute distal triceps ruptures. JSES International 2026. doi:10.1016/j.jseint.2026.101768

This study compared intraoperative and postoperative complications and functional outcomes of bone tunnels, suture anchors, and combined constructs for surgical repair of acute distal triceps ruptures. The findings inform surgeon selection among repair techniques by clarifying which approaches carry lower complication rates while maintaining comparable functional results.

21. Adio A, Boufadel P, Ilyas MH, et al. Epidemiology of Sports- and Recreation-Related Shoulder and Elbow Injuries in Older Adults Presenting to Emergency Departments in the United States between 2010 and 2024. Injury 2026. doi:10.1016/j.injury.2026.113636

Using national emergency department surveillance data from 2010 to 2024, the authors characterized the epidemiology of sports- and recreation-related shoulder and elbow injuries among older adults in the United States. The study defined injury patterns, trends, and demographic distributions of these injuries in the aging athletic population. The findings can guide clinicians in anticipating injury types in older athletes and inform targeted prevention and resource allocation efforts.

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