Outgoing JSES editor-in-chief Bill Mallon surveys the most consequential developments in shoulder and elbow surgery across his 16-year tenure (2008–2024). He identifies which advances genuinely changed patient care and which areas remain incompletely understood. This is a narrative editorial, not a primary study — its value is as a curated map of how the field moved.
Several thresholds and technique choices in this editorial map directly to clinical decisions you face today.
For shoulder instability with any bone loss: the Latarjet threshold has shifted. The Shaha et al. Data cited here place "subcritical" bone loss as low as 13.5% of glenoid diameter — if your patient has measurable bone loss on CT, Latarjet (open or arthroscopic) is now supported at lower thresholds than older teaching suggests.
For every shoulder arthroplasty patient: benzoyl peroxide skin prep in the days before surgery is a low-cost, low-risk intervention backed by multiple confirmatory studies. The Sabetta/Sethi paper established it; subsequent literature has reinforced it. Make it part of your preoperative protocol.
For overhead throwing athletes needing UCL reconstruction: counsel patients that the traditional 18–24 month timeline may shorten with internal brace augmentation, but the evidence base is still evolving across 13 described technique variants.
The honest takeaway on biologics: PRP and stem cells show in-vivo healing signal but no consistent clinical outcome benefit. Until preparation and dosing are standardized, interpret positive rotator cuff biologic studies cautiously.
Outgoing JSES editor-in-chief Bill Mallon surveys the most consequential developments in shoulder and elbow surgery across his 16-year tenure (2008–2024). He identifies which advances genuinely changed patient care and which areas remain incompletely understood. This is a narrative editorial, not a primary study — its value is as a curated map of how the field moved.
Several thresholds and technique choices in this editorial map directly to clinical decisions you face today.
For shoulder instability with any bone loss: the Latarjet threshold has shifted. The Shaha et al. Data cited here place "subcritical" bone loss as low as 13.5% of glenoid diameter — if your patient has measurable bone loss on CT, Latarjet (open or arthroscopic) is now supported at lower thresholds than older teaching suggests.
For every shoulder arthroplasty patient: benzoyl peroxide skin prep in the days before surgery is a low-cost, low-risk intervention backed by multiple confirmatory studies. The Sabetta/Sethi paper established it; subsequent literature has reinforced it. Make it part of your preoperative protocol.
For overhead throwing athletes needing UCL reconstruction: counsel patients that the traditional 18–24 month timeline may shorten with internal brace augmentation, but the evidence base is still evolving across 13 described technique variants.
The honest takeaway on biologics: PRP and stem cells show in-vivo healing signal but no consistent clinical outcome benefit. Until preparation and dosing are standardized, interpret positive rotator cuff biologic studies cautiously.