What’s New in Shoulder and Elbow Surgery 2026

New research in shoulder and elbow surgery is presented in the latest JBJS Specialty Update, What’s New in Shoulder and Elbow Surgery. Here, we highlight the 5 most impactful studies, as selected by coauthor Allison J. Rao, MD. 

Rotator Cuff

Researchers investigated the effect of a single intraoperative dose of zoledronic acid on the outcomes of arthroscopic rotator cuff repair in a randomized controlled trial (RCT) involving 80 patients with no osteoporosis. The group that received zoledronic acid had a lower retear rate (15%) than the control group (35%) at 6 months postoperatively, as shown on magnetic resonance imaging¹. 

Two-year results were reported for an RCT comparing debridement with vs. without a subacromial balloon spacer for the treatment of irreparable rotator cuff tears. The Oxford Shoulder Score (the primary outcome) and complication rates did not differ between the groups, while the Patient Global Impression of Change and Western Ontario Rotator Cuff scores favored debridement alone². “These findings do not support routine use of the subacromial balloon spacer for this indication,” Specialty Update authors Drs. Rao et al. explain. 

Shoulder Instability and Labrum

A systematic review and meta-analysis evaluated whether operative or nonoperative treatment was more effective in managing instability following a first-time dislocation in adults <40 years of age and adolescents. Operative treatment was associated with lower recurrence rates. Additionally, no difference in instability recurrence was observed between arthroscopic and open Bankart repair³. 

Arthroplasty

An international, multicenter RCT compared total shoulder arthroplasty (TSA) and hemiarthroplasty in a cohort of 79 patients with glenohumeral osteoarthritis. The TSA group had better mean Constant-Murley scores than the hemiarthroplasty group at 5 years, with no differences in the adverse event rate or relative risk of revision⁴. These findings “[reinforce] the literature favoring glenoid resurfacing in appropriately selected patients,” Drs. Rao et al. write. 

Elbow

The SCIENCE trial, a multicenter RCT, compared surgical fixation and nonoperative care for treating acutely displaced medial epicondylar fractures in 335 pediatric patients. Surgical fixation showed no clinical benefit at 12 months and was not cost-effective compared with nonoperative care. The researchers concluded that nonoperative treatment should remain the default for these injuries⁵.  

What’s New in Shoulder and Elbow Surgery is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

Recent OrthoBuzz posts include: What’s New in Hip Surgery, What’s New in Orthopaedic Rehabilitation, and What’s New in Limb Lengthening and Deformity Correction. 

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References 

1. Schanda JE, Ullrich R, Boesmueller S, Mittermayr R, Bruell T, Hexel M, Heuberer PR, Woisetschlaeger G, Neuper OM, Redl H, Grillari J, Fialka C. Intraoperative zoledronic acid for arthroscopic rotator cuff repair: short-term results from a prospective, randomized, placebo-controlled phase II trial. Am J Sports Med. 2026 Feb;54(2):342-52. 
2. Haque A, Parsons H, Parsons N, Mason J, Khan I, Stallard N, Underwood M, Hutchinson C, Lawrence T, Drew S, Kearney R, Metcalfe A. Two-year follow-up of a group-sequential, multicenter randomized controlled trial of a Subacromial Balloon Spacer for Irreparable Rotator Cuff Tears of the Shoulder (START:REACTS). Am J Sports Med. 2025 May;53(6):1291-98. 
3. Jin H, Zhang G, Chen S, Tong Y, Shao W, Li T, Huang Y, Li J, Tang X. Surgical treatment is superior to conservative options in preventing recurrence of first-time anterior shoulder dislocation in adolescents and adults under 40 years of age: a systematic review and network meta-analysis. Arthroscopy. 2025 Dec;41(12):5364-77.e4. 
4. Südkamp N, Jaeger M, Adolfsson L, Berndt T, Blauth M, Joeris A, Lambert S. Total shoulder arthroplasty for glenohumeral osteoarthritis leads to better outcomes than hemiarthroplasty at a minimum 5 years: an intraoperative randomization-controlled trial of 79 patients. Acta Orthop. 2025 Dec 11;96:904-13. 
5. Perry DC, Achten J, Zimmermann A, Kandiyali R, Appelbe D, Wright JG, Ferguson D, Wang K, Wilson N, Moscrop A, Mason J, Kounali D, Costa ML; SCIENCE Study Collaborators. Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study): a multicentre, randomised controlled, superiority trial and economic evaluation. Lancet. 2026 Feb 7;407(10528):577-86.