Recent orthopedic RCTs

Every randomized controlled trial the weekly pipeline has surfaced, appraised from the full text and ranked by rigour and impact — the shortlist for a journal club that wants Level I evidence.

3 papers· updated weekly · ranked by rigour & impact

British Journal of Sports Medicine · IF 15.5 · Jul 21, 2026 · LoE I

HEAT

Effectiveness of an individualised swimming and education programme for chronic low back pain (EduSwim): a randomised controlled trial

This Australian RCT randomized 76 adults with chronic non-specific low back pain to either an individualized 8-week swimming program plus education (delivered via four telehealth physiotherapy sessions) or education alone (up to two sessions). At 8 weeks, the swimming group had significantly less disability on the Roland Morris Disability Questionnaire than the education-only group (mean difference -2.5 points, 95% CI -4.5 to -0.5), but this advantage shrank over time and was no longer statistically significant by 52 weeks; pain intensity showed only a small, possibly non-meaningful benefit, and the swimming group had more adverse events (56% vs 30%), almost all non-serious.

AI summary · from the full text

Why it mattersSwimming is widely recommended by clinicians for chronic low back pain despite almost no trial evidence, and this is the first RCT to test it directly as the primary intervention, giving learners a concrete example of how weak evidence can underlie common practice recommendations.

RCTSpinen = 76DOI ↗

Rigor

Impact

Effect exceeds the MCID on Roland Morris Disability Questionnaire (RMDQ) and patient-important outcome.

Presenting this at rounds? Start here

?The swimming group received four telehealth sessions versus up to two in the education-only arm, so the intervention was not attention-matched; how much of the short-term benefit might reflect extra clinician contact and health-coaching rather than swimming itself?
?Given that the benefit was present mainly at 8 weeks and largely dissipated by 26-52 weeks alongside declining swimming adherence, how would you counsel a patient about whether to start a swimming program and how to sustain it long term?

Arthritis & Rheumatology · IF 11.4 · Jul 20, 2026 · LoE I

HEAT

Deucravacitinib in Active Psoriatic Arthritis: Efficacy and Safety up to 52 Weeks From the Randomized, Double‐Blind, Phase 3 POETYK PsA‐2 Trial

This phase 3 randomized controlled trial (POETYK PsA-2) tested deucravacitinib, a first-in-class oral selective TYK2 inhibitor, against placebo (with apremilast included only as a safety reference) in 729 adults with active psoriatic arthritis who were biologic-naive or had limited prior TNF inhibitor exposure. By week 16, significantly more patients on deucravacitinib achieved an ACR20 response than those on placebo (54.2% vs 39.4%, p=0.0002), and improvements in joint disease, skin disease (PASI75), physical function (HAQ-DI), and quality of life were sustained through 52 weeks with a stable, well-tolerated safety profile and no new safety signals.

AI summary · from the full text

Why it mattersDeucravacitinib offers an oral, non-biologic option with a novel mechanism (TYK2 regulatory-domain inhibition) and durable 1-year efficacy and safety data for psoriatic arthritis, a disease frequently co-managed by rheumatology and orthopaedic/joint specialists.

RCTGeneral🇨🇦 Canadian authorsn = 624DOI ↗

Rigor

Impact

Patient-important outcome and adequately powered, offset by more patients lost than the result can absorb and industry funded with author conflicts.

Presenting this at rounds? Start here

?The prespecified hierarchical (fixed-sequence) testing broke at enthesitis resolution, which did not reach significance at week 16, meaning all subsequent 'secondary' endpoints (dactylitis, DAS28-CRP, FACIT-Fatigue) are only reported as nominal, unadjusted p-values; how much weight should readers give these downstream results?
?Since apremilast was included only as a safety reference with no formal efficacy comparison to deucravacitinib, what can clinicians actually conclude about how this drug should be positioned relative to apremilast or biologics already in use for psoriatic arthritis?

Shoulder & Elbow · IF 1.5 · Jul 21, 2026 · LoE II

HEAT

Restoring the anatomic tension relationship of the long head of the biceps during tenodesis: A prospective, randomized controlled trial

This RCT of 160 patients undergoing arthroscopic shoulder surgery with biceps tenodesis compared a standard landmark-based tenodesis technique to a newer patient-specific method for restoring the biceps tendon's natural length-tension relationship. At final follow-up (mean 19.6 months), ASES functional scores, pain scores, and range of motion were statistically similar between groups (e.g., ASES mean difference only 2.0 points, p=.604), though the patient-specific group had modestly higher ASES scores at 6 weeks (mean difference 9.1, p=.048) that did not persist.

AI summary · from the full text

Why it mattersSince biceps tenodesis tensioning technique has never had a defined gold standard, this trial helps reassure surgeons that meticulous anatomic tensioning is not required for good long-term outcomes.

RCTShoulder & Elbown = 81DOI ↗

Rigor

Impact

Patient-important outcome and 4% loss to follow-up, offset by effect below the MCID on ASES and per-protocol analysis only.

Presenting this at rounds? Start here

?The study tested outcomes at six time points without any stated correction for multiple comparisons, and only two of those twelve tests (ASES at 6 weeks and at 12 months, favoring opposite groups) reached significance; how much should we trust these isolated findings given the multiplicity problem and lack of blinded outcome assessment?
?Given that final-outcome scores were statistically and clinically similar between techniques, does the added technical complexity of intraoperative patient-specific tensioning (leaving arthroscopic cannulas in place, precise marking, avoiding limb repositioning) offer enough practical benefit to justify routine adoption over the simpler landmark-based approach?