Introduction:Elbow epicondylitis is a common tendinopathy in adults, and infiltration is frequently used when initial conservative treatment fails. Hyaluronic acid and corticosteroids are among the most widely used injectable agents, but their comparative effectiveness remains uncertain. Methods:We performed an evidence-based review of randomized controlled trials and systematic reviews comparing hyaluronic acid with corticosteroid injections for adult elbow epicondylitis. PubMed, Embase, the Cochrane Library, and BVS were searched through August 2025. Main outcomes were pain and elbow function; risk of bias and certainty of evidence were assessed using Cochrane and GRADE approaches. Results:Of 94 records, three studies met the eligibility criteria (one systematic review and two randomized trials), all focused on lateral epicondylitis. Very low-quality evidence suggests that hyaluronic acid provides greater improvement in pain and function than corticosteroids from 8 weeks to 6 months in acute cases, whereas in chronic lateral epicondylitis, corticosteroid injections appear more effective than hyaluronic acid for pain relief and functional recovery up to 6 weeks. Conclusions:Current evidence, though very limited and at high risk of bias, supports preferential use of corticosteroids for short-term symptom control and hyaluronic acid for medium- to long-term pain and functional improvement in adult lateral epicondylitis. Level of evidence II; Systematic review.
ABSTRACT Introduction: Large (≥ 3 cm) rotator cuff tears have a poorer prognosis, and the optimal arthroscopic repair configuration (single-row vs double-row) remains controversial. Methods: We performed an evidence-based review of systematic reviews and randomized controlled trials comparing arthroscopic double-row and single-row repair for tears ≥ 3 cm. PubMed, Embase, the Cochrane Library, and BVS were searched through May 2025. Only studies reporting size-stratified outcomes were included. Methodological quality was assessed, and the certainty of evidence was graded using the GRADE approach. Results: Two high-quality systematic reviews and five randomized trials provided separate data for tears ≥ 3 cm. Double-row repair showed better functional outcomes than single-row repair, with improved ASES (MD −3.09; 95% CI −6.19 to 0.02) and UCLA scores (MD −1.47; 95% CI −2.21 to −0.72) (moderate-quality evidence). Limited randomized data suggested higher healing rates with double-row repair (OR 3.44; 95% CI 1.09–10.88; low-quality evidence). Pain alone did not differ meaningfully beyond the immediate postoperative period. Conclusions: For rotator cuff tears ≥ 3 cm, arthroscopic double-row repair provides superior functional outcomes and likely higher structural healing versus single-row repair, supporting its preferential use in large and massive tears, with decisions individualized to patient and lesion characteristics. Level of evidence II; Systematic review.
ABSTRACT Introduction: Rotator cuff tendinopathy is a common cause of shoulder pain and disability, and the optimal nonoperative strategy remains debated. Physiotherapy is the mainstay of initial management, whereas hyaluronic acid injection has been proposed as an alternative or adjunct; their comparative effectiveness is uncertain. Methods: An evidence-based systematic review was conducted in PubMed, Embase, Cochrane Library, and the Regional Portal of the Virtual Health Library (BVS) up to February 2026. Randomized controlled trials comparing hyaluronic acid injection with physiotherapy in adults with rotator cuff tendinopathy were included. Outcomes were pain, function, range of motion, and quality of life. Certainty of evidence was assessed with the GRADE approach. Results: Two randomized controlled trials (130 participants) met the eligibility criteria. Hyaluronic acid injection was associated with greater short-term improvement in pain, range of motion, and quality of life than physiotherapy, particularly within the first three months. Functional outcomes were inconsistent: one trial reported comparable improvement between groups, whereas the other favored hyaluronic acid. Certainty of evidence was very low because of small sample sizes, risk of bias, and imprecision. Conclusion: Very low-quality evidence suggests that hyaluronic acid injection may provide superior short-term benefits over physiotherapy for rotator cuff tendinopathy, mainly up to three months. The available evidence remains limited and at high risk of bias; further high-quality studies are required. Level of evidence II; Systematic review.
ABSTRACT Introduction: Despite advances in arthroscopic techniques and tendon fixation methods, structural failure after rotator cuff repair remains a relevant clinical challenge, particularly in extensive and massive tears, poor tendon quality, and repairs performed under tension. In this context, tendon-bone healing is recognized as a key determinant of surgical success, driving interest in strategies to optimize the biological environment of the repair, such as bioinductive collagen implants (patches). Methods: A systematic review was conducted in PubMed, Embase, Cochrane Library, and the Virtual Health Library (VHL) up to March 2026, to evaluate whether rotator cuff repair augmented with a bioinductive implant (patch) is more effective than conventional rotator cuff repair for the treatment of rotator cuff tears. The certainty of evidence was assessed with the GRADE approach. Results: Four randomized controlled trials (288 participants) were included, with assessment of the re-tear rate and shoulder function. The results favored bioinductive implant augmentation, mainly through a lower re-tear rate and earlier functional recovery. Conclusion: To date, there is very low-quality evidence that rotator cuff repair augmented with a bioinductive implant (patch) is more effective than conventional repair for the treatment of rotator cuff tears (including complete and massive tears), with respect to the outcomes of re-tear and function. Level of evidence II; Systematic review.
Introduction:Complex (Neer 3- or 4-part) proximal humeral fractures in elderly patients are associated with high complication and failure rates after open reduction and internal fixation with locking plates (ORIF-LP). Reverse shoulder arthroplasty (RSA) has emerged as an alternative, but its comparative effectiveness remains debated. Methods:We conducted an evidence-based review of systematic reviews and randomized controlled trials including elderly patients with Neer 3- or 4-part fractures, identified through PubMed, Embase, Cochrane Library, and BVS (search to August 2025). High-quality systematic reviews were prioritized, and individual RCTs were added when necessary. Risk of bias and certainty of evidence were assessed using Cochrane methods and the GRADE approach. Results:Four systematic reviews and three RCTs met the inclusion criteria. Across network meta-analyses and direct comparisons, RSA provided superior shoulder function, with higher Constant and Oxford scores at 2 and 5 years than ORIF-LP. RSA also tended to reduce complication and reoperation rates, although event numbers were small and confidence intervals were wide. Overall certainty was low for function and very low for complications and reoperations. Conclusions:In elderly patients with complex proximal humeral fractures requiring surgery, RSA appears to yield better functional outcomes and fewer reoperations than ORIF-LP, supporting its use as the preferred surgical option, while acknowledging the low certainty of evidence. Level of evidence II; Systematic review.
ABSTRACT Introduction: Anterior shoulder instability is a common condition that mainly affects young adults. It is most often traumatic and is frequently associated with a Bankart lesion, characterized by detachment of the anteroinferior glenoid labrum. When conservative treatment fails, surgical repair is usually indicated. Biomechanical studies suggest that a greater number of anchors may increase the contact area and provide greater stability between the labrum and the glenoid, promoting a more stable reconstruction of the capsulolabral complex. Methods: A systematic review was conducted in PubMed, Embase, Cochrane Library, and the Virtual Health Library (VHL) up to March 2026 to evaluate whether the use of more than two anchors is more effective than the use of up to two anchors for the arthroscopic treatment of anterior shoulder instability in adults. The certainty of the evidence was assessed with the GRADE approach. Results: One randomized controlled trial and two cohort studies were included. For function and complications, there was no evidence showing that the use of three or more anchors was more effective than the use of two anchors. For recurrence, there was evidence, although the certainty of the evidence was very low, that the use of three or more anchors was more effective than the use of up to two anchors. Conclusion: The surgeon should individually assess patient- and disease-related characteristics to make the best treatment decision. Regarding recurrence, the SBCOC Consensus Project suggests a preference for three or more anchors, given a trend toward a lower recurrence rate. Level of evidence II; Systematic review.
ABSTRACT Introduction: Traumatic rotator cuff tears are acute structural injuries to one or more rotator cuff tendons caused by an identifiable trauma, generally associated with the abrupt onset of pain, weakness, and shoulder dysfunction. They must be distinguished from chronic degenerative tears and from acute injuries superimposed on previously degenerated tendons. The optimal timing of surgical repair remains debated. Methods: A systematic review was conducted in PubMed, Embase, Cochrane Library, and the Virtual Health Library (VHL) up to March 2026 to evaluate whether early repair is more effective than late repair for the treatment of traumatic rotator cuff tears, with respect to clinical and functional outcomes, retear, and return to pre-injury activities. The certainty of evidence was assessed with the GRADE approach. Results: Three cohort studies were included. The definition of "early" repair is not standardized in the literature – some authors consider it up to 3 weeks and others up to 6 months – so studies defining "early" as up to 3–4 months were included, which represents a potential source of bias. Functional outcomes were similar between early and late repair, whereas early repair was associated with and a lower likelihood of requiring tendon grafting in larger tears. The certainty of evidence was very low. Conclusion: The surgeon should individually assess patient- and disease-related characteristics to make the best treatment decision. Given the risk of irreparability and longer rehabilitation, the project recommends that, after a traumatic tear, repair be performed as early as possible. Level of evidence II; Systematic review.
Introduction:Anatomic total shoulder arthroplasty (ATSA) has long been indicated for the treatment of degenerative joint diseases in patients with an intact rotator cuff. However, age-related rotator cuff degeneration may negatively impact outcomes. Reverse total shoulder arthroplasty (RTSA), initially indicated for cuff tear arthropathy, has progressively expanded its indications, including elderly patients with an intact rotator cuff. Methods:A systematic review of the literature was conducted in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases up to November 2025, with the aim of comparing ATSA and RTSA regarding functional outcomes, complication rates, and the need for reoperation in patients aged 70 years or older with primary shoulder osteoarthritis and an intact rotator cuff. Results:Only one systematic review met the inclusion criteria, encompassing four observational studies, with a total of 2.731 arthroplasties. RTSA showed a lower reoperation rate compared with ATSA. Functional outcomes favored ATSA, although based on limited data. No statistically significant differences were observed between the techniques regarding complication rates. The overall quality of evidence was classified as very low. Conclusions:In patients aged 70 years or older with primary glenohumeral osteoarthritis and an intact rotator cuff, RTSA is associated with a lower revision rate, whereas ATSA demonstrates superior functional outcomes, with similar complication rates between the two techniques. Level of evidence II; Systematic review.
Introduction:Shoulder osteoarthritis is an inflammatory and degenerative condition affecting the joint between the humeral head and the glenoid. It is estimated to affect up to 20% of patients aged 60 or older. In our setting, the use of hyaluronic acid is becoming increasingly employed for the treatment of shoulder osteoarthritis. Therefore, this consensus aims to review the current literature to determine whether treatment with hyaluronic acid infiltration is more effective than corticosteroid infiltration in terms of pain outcome for the treatment of shoulder osteoarthritis in adults. Methods:A systematic review of the literature was conducted in the Pubmed, Embase, Cochrane Library and BVS databases up to November 2025, aiming to evaluate whether intra-articular injection with hyaluronic acid is more effective than with corticosteroids for the treatment of shoulder osteoarthritis in adults. Results:The systematic review concluded that hyaluronic acid infiltration is more effective than corticosteroid infiltration for pain and function outcomes, mainly after six months post-infiltration. Conclusion:There is evidence, albeit of very low quality, demonstrating that hyaluronic acid injections are more effective than corticosteroid injections for the treatment of shoulder osteoarthritis, with the best results for both treatment modalities occurring in mild to moderate cases of shoulder osteoarthritis. Level of evidence II; Systematic Review.
ABSTRACT Introduction: Recurrent anterior glenohumeral instability with "on-track" Hill-Sachs lesions and subcritical glenoid bone loss remains a therapeutic challenge, with considerable failure rates following isolated arthroscopic Bankart repair (BR). The addition of the Remplissage procedure (BR-R) has been proposed to improve stability and shoulder function, however, its effectiveness in "on-track" lesions remains uncertain. Methods: An evidence-based review was conducted in PubMed, Embase, Cochrane Library, and BVS (search up to August 2025), including comparative clinical studies that evaluated BR-R versus isolated BR in patients with anterior instability, on-track Hill-Sachs lesions, and partial glenoid bone loss. Primary outcomes were recurrence of dislocation and shoulder function; secondary outcomes included residual apprehension, reoperation, and return to sport. Results: Four studies met the inclusion criteria (one systematic review of six cohort studies and three additional cohort studies; 537 patients in total). Across studies, BR-R showed lower recurrence rates (0–7.7% vs. 3.5–30%) and better functional scores (WOSI, SSV, SANE, ASES, ROWE), higher return-to-sport rates at preinjury level in athletes, and less residual apprehension, without clear increase in complications. Overall certainty of evidence was very low. Conclusions: Very low-quality evidence suggests that the addition of Remplissage to arthroscopic Bankart repair may improve stability and functional outcomes compared with isolated Bankart repair in patients with on-track bone loss. Level of evidence II; Systematic review.
Introduction:Bone cementation is fundamental for orthopedic stability, and different techniques have been proposed to optimize the bone-cement interface. Objective:To evaluate whether adapted second-generation cementation improves osteointegration compared with the first-generation technique. Methods:Bone defects created in the femora and tibiae of goats were filled with polymethylmethacrylate using either the first-generation technique (Group 1) or an adaptation of the second-generation technique (Group 2). Cementation quality and the bone-cement interface were assessed by radiography, CT, and photographic analysis, evaluated by orthopedic examiners. Statistical analyses employed the chi-square and Mann-Whitney U tests. Results:No statistical differences were observed between the groups regarding cementation quality (radiography and CT) or osteointegration (photographic analysis) (p > 0.05). On CT, the mean number of bubbles was higher in the second-generation (6.05 vs. 3.95), whereas the proportion of samples with ≥5 bubbles was higher in the first-generation (50% vs. 30%). Photographic analysis showed that the second-generation group had a higher mean number of interdigitations (2.4 vs. 1.6) and a greater frequency of rough interfaces (50% vs. 25%). However, the first-generation group presented greater interdigitation depth (0.40 mm vs. 0.35 mm). Conclusion:Adapted second-generation cementation showed no clear advantage over the first-generation technique. Level of evidence II; Investigation of treatment outcomes in an animal model.
ABSTRACT Objective: To identify and analyze economic studies in orthopedics conducted in Brazil, classifying them according to the type and completeness of the analysis. Methods: Scoping review conducted according to PRISMA-ScR guidelines. Searches were performed in PubMed and BVS, including LILACS, using descriptors related to economic evaluation, orthopedics, and Brazil. Studies conducted exclusively in Brazil were included, with no year restriction. Results: Ninety-five records were identified, and 13 studies remained after application of the eligibility criteria. Of these, nine were complete economic evaluations and four were incomplete analyses. Conclusion: There is a scarcity of complete economic evaluations in orthopedics in Brazil. Level of Evidence III; Review article.
ABSTRACT Objective: This study aimed to map the scientific production of the National Institute of Traumatology and Orthopedics (INTO) over its 50 years of history. Methods: We conducted a descriptive bibliometric study in the PubMed, Scopus, and BVS databases, retrieving 522 articles published between 2007 and 2024. We identified the co-citation networks of INTO-affiliated authors, the keyword networks with the main topics addressed in the publications, and the institution's interaction network with other research and teaching entities. Results: There was a progressive growth in publications linked to INTO. In the last six years (2019–2024), the annual average number of publications increased by 44.83% compared with the previous period. The keywords with the highest co-occurrence were related to applied research, mainly with an epidemiological profile, but also to different study designs in basic and translational research. Conclusions: The analysis revealed a higher frequency of collaboration with public universities (UFRJ, UFF, UERJ, and USP). The institution's scientific production presented a well-articulated scientific collaboration network. Part of INTO's mission was evidenced through its work in public health research for health promotion in orthopedics and its contribution to the production of data for the formulation of public policies. Level of Evidence V; Descriptive Studies with Qualitative Approach.
ABSTRACT Objective: To report a case series of distal triceps tendon rupture associated with olecranon osteophyte avulsion, a rare condition with few reports in the literature. Methods: This study analyzed patients who underwent surgical treatment between 2011 and 2022 for distal triceps tendon rupture associated with olecranon osteophyte avulsion. Clinical and radiographic characteristics, pain levels, and functional outcomes were assessed using the Q-DASH and MEPS scores. Results: There was a significant reduction in pain between the 1st and 12th weeks (mean VAS from 5.8 to 0.8; p<0.001). The mean Q-DASH score improved from 1.9 to 0.2 between the 6th and 12th months (p=0.003). The MEPS remained high throughout the follow-up period (final mean: 100). Patients operated on within 7 days from trauma had less residual pain (p=0.02). Smokers had worse functional scores at 6 months (p=0.04). Previous elbow pain was associated with worse pain score in the first week post op (p=0.048), but no difference in final outcomes. Conclusion: Surgery for triceps tendon rupture with olecranon osteophyte avulsion led to significant improvements in pain and function. Factors such as time to treatment, smoking, and age influence recovery. Level of Evidence IV; Case Series.
ABSTRACT Objective: To investigate the epidemiological profile of births of children with congenital foot abnormalities and their associated factors within the Unified Health System (SUS). Methods: This study adopts a quantitative, descriptive, and cross-sectional approach, using secondary data from the Live Birth Information System (SINASC), provided by the SUS Department of Informatics (DATASUS). Data from the years 2014 to 2022, related to the State of Bahia, were analyzed. Births with congenital foot malformations were identified through specific ICD-10 codes designating the main diagnosis. Results: During the period from 2014 to 2022, Bahia recorded a total of 13,347 cases of congenital anomalies, of which 1,364 were related to congenital foot deformities, among a total of 1,765,439 births, representing a rate of 0.77 cases per 1,000 live births. Conclusion: The presented results indicate that male live births, children of mothers with less than 8 years of education, with a gestational age between 22 and 27 weeks, born by cesarean section, and with Apgar scores of less than 6 in the 1st and 5th minutes, are significantly associated with congenital foot malformations. Level of evidence II; Retrospective study.
ABSTRACT Objectives: To analyze the profile of deaths from malignant neoplasms of bones and articular cartilage in the pediatric population of Minas Gerais (2015–2024), considering sociodemographic, clinical, epidemiological, and regional aspects. Methods: Epidemiological, documentary, descriptive, and retrospective study with a census design, including deaths of individuals aged 0–19 years residing in Minas Gerais (ICD-10 C40–C41) registered in SIM/DATASUS. Variables analyzed included sex, age, race/color, municipality, place of death, length of hospital stay, and hospital costs. Descriptive statistics were used with frequencies, percentages, and mortality rates. Results: There were 3,883 hospitalizations and 79 deaths, predominating male patients (57.7% of hospitalizations; 59.5% of deaths), adolescents aged 10–19 years, and individuals of mixed race/color (pardo). Belo Horizonte accounted for most hospitalizations and deaths, while Juiz de Fora had high hospitalization rates but low mortality. Longer hospital stays were observed in female patients and those under 1 year; the highest costs were among adolescents aged 10–14 years. Hospitalizations decreased over time, but mortality remained stable. Conclusions: Findings highlight the need for early detection, access to specialized therapies, and reduction of regional inequalities to improve clinical outcomes and equity in pediatric oncology care. Level of Evidence IV; Retrospective cohort study.
ABSTRACT Objective: To compare short-term clinical and functional outcomes (0–6 months) of Anterior Cruciate Ligament (ACL) reconstruction using rectus femoris autograft versus established graft options. Methods: Prospective cohort study (Level II) including 35 patients who underwent ACL reconstruction between 2024 and 2025. Pain, Lysholm score, and range of motion (ROM) were assessed preoperatively, on postoperative day (POD) 1, POD 15, and at six months. Statistical analysis included ANOVA, Kruskal-Wallis tests, and linear mixed-effects models (α = 0.05). Results: The sample (15 hamstring, 11 rectus femoris, and 9 patellar tendon grafts) was homogeneous (p < 0.05). Significant improvements over time were observed in Lysholm scores (p < 0.001) and knee flexion ROM (p < 0.001), with no influence of graft type (p = 0.167 and p = 0.177, respectively). On POD 1, pain scores were similar among groups (p = 0.701), with mean Visual Analog Scale (VAS) values of 2.20 (hamstrings), 2.18 (rectus femoris), and 1.78 (patellar tendon). On POD 15, mean pain scores were 1.27, 1.73, and 3.00, respectively, remaining statistically comparable (p = 0.149). Conclusion: ACL reconstruction using the rectus femoris autograft demonstrates clinical and functional outcomes equivalent to patellar tendon and hamstring grafts within the first six months postoperatively. Level of Evidence II; Prospective cohort study.
ABSTRACT Objective: This study aimed to investigate the effects of Repetitive Peripheral Magnetic Stimulation (rPMS) treatment on postoperative pain control after foot and ankle surgeries. Methods: A controlled, randomized clinical trial conducted at a tertiary hospital. 67 patients who underwent foot and ankle surgeries were randomized into two groups: a control group (CG) – placebo stimulation; and an experimental group (EG) – rPMS for 10 minutes using an intermittent stimulation protocol (10 cycles/5 seconds; 100 Hz; 55 seconds of rest). Stimulation was received for 5 consecutive days in the immediate postoperative period. Neuropathic Pain Score 4 (DN4), Visual Analog Scale (VAS), Brief Pain Inventory (BPI), and American Orthopedic Foot and Ankle Score (AOFAS) were administered on days D0, D5, D14, D30, and D90. Postoperative opioid consumption was compared between the groups. Results: The most prevalent surgeries were in the forefoot (n=25). On DN4, the predominant pain was nociceptive (3.40 ± 1.54). Regarding pain, the VAS, BPI, and AOFAS scores demonstrated superior improvement in pain perception in the EG compared to the CG, with statistical significance. rPMS reduced postoperative opioid consumption. Conclusion: rPMS contributes to the control and reduction of pain perception and opioid consumption in the postoperative period of foot and ankle surgeries. Level of Evidence I; Randomized Clinical Trial.
ABSTRACT Introduction: Trigger finger (stenosing tenosynovitis of the flexors) is a common hand condition, causing pain and functional limitation. With the increasing use of social media as a source of information, especially Instagram, it becomes necessary to evaluate the quality and reliability of content related to the topic made available to the public. Objective: To evaluate the quality and reliability of information about trigger finger published on Instagram, using the validated instruments modified DISCERN and Global Quality Score (GQS). Methods: Observational, cross-sectional study based on the analysis of the hashtags #triggerfinger and #stenosingtenosynovitis. 118 eligible posts were analyzed. Two independent evaluators (orthopedic residents in hand surgery) classified the content. Results: There was excellent inter-rater agreement, and a positive correlation was observed between longer content duration and better quality. There was a significant difference between professionals: hand surgeons presented higher quality scores. Conclusion: The quality of the information is very low to moderate. Content produced by hand surgeons presents greater technical rigor, and the Reels format offers better informational quality. Level of evidence V; Descriptive observational study.
