Recent orthopedic systematic reviews

New systematic reviews from the weekly pipeline — hottest first.

Arthroscopy The Journal of Arthroscopic and Related Surgery IF 4.4 Aug 24 2026 LoE I Full text read

Double‐Row Repair Improves Outcomes for Large Rotator Cuff Tears but Offers No Advantage for Small‐to‐Medium Tears: A Systematic Review and Meta‐analysis of Randomized Controlled Trials

This meta-analysis pooled 18 randomized trials (1,308 patients) comparing single-row (SR) versus double-row (DR) arthroscopic rotator cuff repair. Overall, DR repair had a lower retear rate than SR (20.7% vs 11.9%, OR=1.88, 95% CI 1.33-2.66) and slightly better UCLA scores and forward flexion, but took longer to perform. When tears were stratified by size, DR's advantage in retear rate and functional scores (ASES, UCLA) was significant only for tears >30 mm, while for tears <30 mm there was no significant difference between techniques.

AI summary · from the full text

Why it mattersThis helps surgeons decide when the extra time and cost of double-row fixation is justified: reserving it for larger tears while using the faster single-row technique for small-to-medium tears.

Systematic reviewSportsn = 1,308DOI ↗

Rigor × clinical importance

Rigor88Clinical75Editorial49

Strong71

Bone & Joint Open IF 2.8 Jul 21 2026 LoE I Full text read

Comparative efficacy of analgesic techniques in total hip arthroplasty

This network meta-analysis pooled 112 randomized trials comparing 23 different regional analgesic techniques (nerve blocks, periarticular injection, intrathecal morphine, and combinations) against placebo in patients undergoing total hip arthroplasty. On the primary outcome, postoperative day 1 pain score, several techniques reached statistical significance versus placebo but none crossed the pre-defined MCID of 1.86 points on the VAS, meaning no technique produced a pain reduction patients would actually notice; secondary analyses found intrathecal morphine and iliopsoas block plus periarticular injection reduced opioid use, and intrathecal morphine and pericapsular nerve group (PENG) block shortened hospital stay.

AI summary · from the full text

Why it mattersThis challenges the assumption, embedded in current PROSPECT guidelines, that specific regional blocks meaningfully reduce pain after hip arthroplasty, and instead points clinicians toward opioid-sparing and discharge-related benefits rather than pain control itself.

Systematic reviewArthroplastyDOI ↗

Presenting this at rounds? Start here

?The primary outcome (POD1 pain) showed many statistically significant pairwise differences that were then judged clinically insignificant using an externally sourced MCID of 1.86; how robust is that threshold, and could it be masking real differences in some subgroups?
?If no block meaningfully reduces day-1 pain, should a surgeon still choose PENG or intrathecal morphine purely for their opioid-sparing and length-of-stay benefits, and what does that mean for patients who cannot receive intrathecal morphine (e.g., outpatient/no spinal anesthesia)?

Rigor × clinical importance

Rigor60Clinical80

Sound64

Journal of Orthopaedic Surgery and Research IF 2.8 Jul 30 2026 LoE II Full text read

Clinical translation of artificial intelligence in musculoskeletal care: a systematic review of current applications, evidence gaps, and implementation readiness

This systematic review searched for studies validating AI tools for musculoskeletal imaging between 2022 and 2025, screening 1,245 records down to 123 full-text papers. Using strict criteria for quantitative clinical validation, only three studies qualified, and all three were limited to MRI-based segmentation and biomarker extraction, with no studies validating AI on other imaging modalities or in multi-center, real-world settings.

AI summary · from the full text

Why it mattersOrthopedic surgeons increasingly encounter AI-assisted imaging tools, and this review shows the evidence supporting their clinical use remains extremely thin despite hype.

Systematic reviewGeneralDOI ↗

Rigor × clinical importance

Rigor43Clinical45

Limited32

Sports Medicine IF 9.2 Aug 28 2026 LoE III Full text read

Biomechanics of Rugby Tackle Techniques in Youth and Adult Players: A Systematic Review of Age-Specific Injury Risk and Performance Implications

This is a systematic review of 32 studies examining rugby tackle biomechanics and injury risk in youth versus adult players. It found that tackles with the tackler's head positioned in front of the ball carrier raised per-tackle concussion risk roughly five- to eight-fold and were more common in youth; tackling with the dominant shoulder produced lower peak head accelerations than non-dominant shoulder tackles (23.0 g vs 30.4 g in one study), though this advantage diminished with fatigue; and youth players showed lower tackle proficiency (less hip/knee flexion, less leg drive, more arm-only contact) than adults.

AI summary · from the full text

Why it mattersThese findings help clinicians and coaches understand which biomechanical tackle features drive concussion and cervical injury risk, informing age-appropriate coaching to reduce injury in a sport with very high concussion rates during tackling.

Systematic reviewSpineDOI ↗

Presenting this at rounds? Start here

?Should youth rugby coaching programs specifically emphasize correct head placement and dominant-shoulder engagement earlier in development, given that youth players show less proficient tackle mechanics than adults?
?How should coaches address the erosion of the 'dominant shoulder' safety advantage under match fatigue, and does this argue for conditioning-focused injury prevention strategies?

Rigor × clinical importance

Rigor40Clinical45Editorial48

Weak28

Arthroscopy The Journal of Arthroscopic and Related Surgery IF 4.4 Sep 6 2026 LoE III Full text read

Segmental and Circumferential Hip Labral Reconstructions Both Show Favorable Outcomes in Primary Hip Arthroscopy: A Systematic Review

This systematic review pooled 9 studies (13 cohorts, 371 hips) of primary hip labral reconstruction, comparing segmental (partial labral replacement) versus circumferential (full labral replacement) techniques for irreparable labral tears. Both techniques showed favorable patient-reported outcomes at midterm follow-up (postoperative modified Harris Hip Score 75.6-89.0 for segmental vs 83.6-87.8 for circumferential; iHOT-12 63.9-76.7 vs 73.6-79.5), with revision/THA conversion rates ranging 0-20% for segmental and 0-5.4% for circumferential cohorts, but only one study directly compared the two approaches head-to-head.

AI summary · from the full text

Why it mattersHip arthroscopists frequently must choose between segmental and circumferential labral reconstruction when a labrum is unsalvageable, and this review highlights that the choice currently rests on limited, non-comparative, low-level evidence rather than proven superiority of either technique.

Systematic reviewArthroplastyn = 192DOI ↗

Presenting this at rounds? Start here

?When a labrum is deemed irreparable intraoperatively, how should surgeons decide between preserving remaining healthy tissue with segmental reconstruction versus performing a full circumferential reconstruction?
?Given the higher failure rate seen with allograft segmental reconstruction in one cohort, should graft type (autograft vs allograft) influence the choice of segmental versus circumferential technique in individual patients?

Rigor × clinical importance

Rigor38Clinical46Editorial48

Weak26

Arthroscopy The Journal of Arthroscopic and Related Surgery IF 4.4 Aug 24 2026 LoE III Full text read

Isolated Hip Arthroscopy Provides Comparable Mid‐ to Long‐Term Outcomes in Borderline Hip Dysplasia and Normal Hips: A Systematic Review and Meta‐analysis

This systematic review and meta-analysis pooled four retrospective cohort studies (478 hips total: 157 with borderline hip dysplasia [BDH], 321 with normal acetabular coverage) undergoing isolated hip arthroscopy for FAIS, with follow-up of 5 to over 10 years. Pooled patient-reported outcomes (modified Harris Hip Score, HOS subscales, pain VAS) showed no statistically significant differences between BDH and control groups, and revision rates (14.0% vs 20.9%, OR 0.61, P=.07) and conversion to hip replacement (1.9% vs 4.7%, OR 0.45, P=.22) were also not significantly different, though the point estimates favored BDH patients numerically.

AI summary · from the full text

Why it mattersThis informs surgeons and patients whether borderline dysplastic hips can be safely treated arthroscopically without incurring worse durability compared to normally covered hips, which is a common intraoperative decision point in young active patients with FAIS.

Systematic reviewArthroplastyn = 478DOI ↗

Presenting this at rounds? Start here

?Given that revision and conversion-to-THA rates were numerically lower (though not statistically significant) in the BDH group, how should surgeons weigh capsular plication and labral preservation techniques when counseling BDH patients about arthroscopy versus periacetabular osteotomy?
?Should adjunct radiographic parameters like the FEAR index or femoral version be incorporated into preoperative decision-making for BDH patients even though none of the included studies reported them?

Rigor × clinical importance

Rigor40Clinical45Editorial48

Weak24