Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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The Journal of the American Academy of Orthopaedic Surgeons
Clinical Outcomes and Safety Profile of Open and Arthroscopic Subtalar Joint Arthrodesis: A Systematic Review
BACKGROUND: Open and arthroscopic subtalar arthrodesis are safe and effective surgeries for patients with notable arthritis; however, not an established superiority among them has been found. This systematic review aims to present all of the available literature on studies directly comparing both surgeries. METHODS: Two independent authors completed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. In addition, the MINORS score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our search criteria included only studies that included both open and arthroscopic subtalar arthrodesis. RESULTS: A total of four studies including 125 open and 130 arthroscopic surgeries met the inclusion criteria for the current systematic review. The mean age and body mass index of patients in the open and arthroscopic groups were 50.0 ± 2.3 and 47.9 ± 1.4 years and 29.0 ± 3.7 and 29.5 ± 2.6 kg/m 2 , respectively. Patients in the open cohort and arthroscopic cohort were followed for a mean of 16.9 ± 6.5 and 15.8 ± 4.7 months, respectively. Union rate was 95.4% ± 4.6% vs. 93.6 ± 4.0%, and the time to fusion was 14 ± 1.6 vs. 10.5 ± 1.6 weeks. The overall complication rate among patients who underwent open arthrodesis was 44.0%, whereas the complication rate was 39% among patients who underwent arthroscopic arthrodesis. Patients stayed in the hospital for 2.2 ± 0.9 days following an open procedure versus 1.1 ± 0.5 days following minimally invasive procedures. CONCLUSION: The current systematic review found a high rate of union among both group of patients. Although trends suggested higher union rates and fewer complications in the arthroscopic cohort, no notable differences were found. Although limited, we hope that this systematic review may help to guide evidence-based decisions when planning the surgical management of patients with severe subtalar arthritis.
17 July 2026
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Loop versus anchor tenodesis of the long head of the biceps tendon: a prospective randomized controlled pilot study
BACKGROUND: The long head of the biceps tendon is a frequent source of anterior shoulder pain, often treated with tenodesis. While anchor tenodesis is well established, it carries risks of implant-related complications. This study evaluates an implant-free "loop tenodesis" technique as a potentially safer and cost-effective alternative. METHODS: In this prospective, double-blinded, randomized exploratory study, 48 patients undergoing arthroscopic biceps tenodesis were randomized to either loop (n = 24) or anchor (n = 24) tenodesis. Clinical outcomes were assessed using ASES, Constant, and DASH scores, as well as range of motion, supination strength, satisfaction, aesthetic appearance, and return-to-sport. Statistical analysis was performed using the Mann-Whitney U and Wilcoxon signed-rank tests to compare non-parametric data. RESULTS: Both groups showed significant improvements with similar gains in functional scores. Supination strength recovery was greater in the loop group (103% vs. 93%). There were no significant differences in range of motion or complications. Notably, only the anchor group showed cases of Popeye deformity (2 patients). Return to sport was achieved in 95.3% of patients, typically within 3 months. No revision or implant-related issues occurred. CONCLUSION: Loop tenodesis offers equivalent clinical outcomes to anchor-based techniques, with fewer aesthetic concerns and no implant-associated risks, making it a safe, reliable, and cost-effective alternative for biceps tenodesis.
25 May 2026
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