Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon’s point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO’s condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making.

Background: Infected nonunion of the tibia represents a challenging complication for orthopedic surgeons and poses a major financial burden to healthcare systems. The situation is even more compounded when the nonunion involves the metaphyseal region of long bones, a rare yet demanding complication due to the poor healing potential of infected cancellous bone; this is in addition to the increased likelihood of contamination of adjacent joints. The purpose of this study was to determine the extent and level of evidence in relation to (1) available treatment options for the management of septic tibial metaphyseal nonunions; (2) success rates and bone healing following treatment application; and (3) functional results after intervention. Methods: We searched the MEDLINE, Embase, and CENTRAL databases for prospective and retrospective studies through to 25 January 2021. Human-only studies exploring the efficacy of various treatment options and their results in the setting of septic, quiescent, and metaphyseal (distal or proximal) tibia nonunions in the adult population were included. For infection diagnosis, we accepted definitions provided by the authors of source studies. Of note, clinical heterogeneity rendered data pooling inappropriate. Results: In terms of the species implicated in septic tibial nonunions, staphylococcus aureus was found to be the most commonly isolated microorganism. Many authors implemented the Ilizarov external fixation device with a mean duration of treatment greater than one year. Exceptional or good bone and functional results were recorded in over 80% of patients, although the literature is scarce and possible losses of the follow-up were not recorded. Conclusion: A demanding orthopedic condition that is scarcely studied is infected metaphyseal tibial nonunion. External fixation seems promising, but further research is needed. Systematic Review Registration: PROSPERO No. CRD42020205781.

Background: The management of infected metaphyseal nonunion of the tibia is devastating, especially when associated with significant bone loss, poor soft tissues, draining sinuses, axial deformity, knee or ankle joint stiffness, limb discrepancy, and multiresisted pathogens. A systematic review, performed recently by the primary investigators but not yet published, yielded the lack of studies in the field and the huge heterogeneity of the presented results. We found several bias and controversies such as no clear definition of the exact part of the tibia where the nonunion was located, the pathogen causing the fracture-related infection, the number of previous interventions and time to presentation, and the exact type of treatment methods including the use of muscle flaps or bone grafting. Time to final union as a functional score is another important but missing data. Objective: The proposed study is designed to evaluate a sufficient number of patients with infected metaphyseal tibial nonunions using various general health, functional, and bone scores. Methods: This prospective clinical trial study, with a minimum follow-up period of 36 months, focuses on the effectiveness of the Ilizarov method after radical nonunion debridement and targeted antibiotic therapy in patients with infected metaphyseal tibial nonunions. The primary outcomes would be the definite healing of nonunion and infection-free results. Secondary outcomes would be limb alignment and discrepancy, alteration in the patient’s quality of life, and functional results. A power analysis calculated a minimum of 11 patients to obtain statistical power, but we aim to include at least 25 patients. Limb discrepancy, clinical validation of infection eradication and fracture healing, radiographic validation, and patient-reported outcome measures will be highlighted and correlated. Statistical analysis of the results will offer data missing from the literature so far. Measurements are scheduled at specific times for each patient: preoperatively, 3 and 6 months postoperatively, 1 month after Ilizarov frame removal, and once per semester afterward until the end of the follow-up period (minimum 36 months). Laboratory evaluation will be assessed once per month. Any complication will be reported and treated when it occurs. Results: The trial has already started. It was funded in June 2020. As of May 2022, 19 participants have been recruited and no major complications have been noticed yet. Data analysis will be performed after data collection ends, and results will be published afterward. Conclusions: An infected metaphyseal tibial nonunion is a rare condition with limited treatment options and many controversies. There is no consensus in the literature about the best treatment strategy, and this lack of evidence should be fulfilled. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 30905788; https://www.isrctn.com/ISRCTN30905788 International Registered Report Identifier (IRRID): DERR1-10.2196/39319

Posterolateral rotatory instability (PLRI) of the elbow is commonly treated with open lateral collateral ligament (LCL) reconstruction techniques. This cohort study evaluates the efficacy of a less invasive arthroscopic LCL imbrication technique for reducing grade I or II PLRI. Forty-three patients with stage 1 or 2 PLRI, unresponsive to conservative therapy, were included. Diagnoses were based on chronic post-traumatic pain (11 patients), chronic atraumatic lateral elbow pain (20), and previous open tennis elbow surgery (12). Following clinical and arthroscopic diagnosis confirmation, the LCL imbrication technique was performed. The Mayo Elbow Performance Score and range of motion (ROM) were assessed preoperatively and postoperatively using the Shapiro-Wilk test and Wilcoxon signed rank test, respectively, with a minimum 12-month follow-up (range 12-48 months). The Mayo Elbow Performance Score increased significantly from a median of 45 points preoperatively to 90 (range 80-100) at 3 months and 95 (range 80-100) at 12 months follow-up (P < .001). Postoperative median flexion reached 140°, and extension was 0°. At 12 months, 2 patients experienced a 10° extension deficit; 95.3% (41 of 43) achieved full ROM. Knot irritation occurred in 4 patients (out of the first 10 of this cohort, 9.3%), 3 of them requiring knot removal. Switching to a polydioxanone 1 suture eliminated this complication. One patient underwent arthroscopic arthrolysis for adhesions after 14 months. Arthroscopic LCL imbrication offers favorable outcomes for grade I or II PLRI from the third postoperative month with minimal complications. A slight restriction in ROM and transient knot discomfort were the main issues, the latter resolved by switching to a thinner polydioxanone suture.

Objective: Recent evidence has suggested that sialendoscopy should be the first-line treatment for chronic sialadenitis. This study aimed to assess the efficacy of steroid irrigation during sialendoscopy in non-lithiasic chronic sialadenitis. Methods: We conducted a systematic search of the databases of PubMed, Scopus, and Web of Science up to the 3rd of November 2024 for completed studies investigating the efficacy of steroid irrigation during sialendoscopy for chronic non-lithiasic sialadenitis. Primary outcomes were the number of patients with recurrence of sialadenitis symptoms and the number of patients who required a revision sialendoscopy. Secondary outcomes included the assessment of major complications of the procedure. Random-effect meta-analysis of proportion was conducted using Open Meta-Analyst software. Additionally, separate subgroup analyses linked to the underlying salivary gland disease were carried out. The quality of the included studies was evaluated utilizing the Moga tool and the ROBINS-I tool. Results: Thirty studies qualified for inclusion in the present systematic review. The weighted pooled proportion of recurrence after sialendoscopy by patient was 27.49% (95% CI: 21.04–34.45), whereas the revision rate was 10.64% (95% CI: 7.74–13.93). In every subgroup, the proposed intervention exhibited adequate efficacy for the symptomatic relief of patients, with similar rates of revision and repetition. The rate of major complications per patient was 0.77%. Conclusions: This study demonstrates that interventional sialendoscopy with intraductal steroid irrigation may yield therapeutic benefit for patients with chronic non-lithiasic sialadenitis and could be considered a safe treatment.