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.
