Search Results (125)

The growing flexibility of load dispatching in modern smart grids has exposed critical limitations in conventional capacity pricing mechanisms, which calculate charges based solely on monthly maximum demand without distinguishing when peak demand occurs. This approach fails to reflect the temporal value of capacity and provides insufficient incentives for demand-side optimization. To address these challenges, this paper proposes a time-of-use (TOU) capacity pricing method that integrates user load characteristics to enable more equitable cost allocation and optimized electricity consumption patterns. The methodology employs K-means clustering analysis of user load profiles to partition pricing periods, accurately capturing differential capacity value across temporal intervals. We validate the clustering approach through the elbow method and silhouette analysis, confirming k = 3 as optimal and demonstrating K-means superiority over hierarchical and density-based alternatives. This data-driven approach ensures that period delineation reflects actual consumption patterns of commercial and industrial users. A capacity cost allocation model is established using the Shapley value method, incorporating maximum demand in each designated period while maintaining revenue neutrality for the grid operator. The 80% load simultaneity factor is empirically validated using 12 months of Shanghai industrial data (May 2023–April 2024). A Stackelberg game-based pricing model for TOU capacity tariffs is developed, incentivizing users to deploy energy storage systems and optimize charging strategies. We prove game convergence theoretically and demonstrate equilibrium achievement within 3–5 iterations across diverse initialization scenarios. Energy storage capacity is optimized by sector (3.5–6.5% of peak demand) rather than uniformly, and realistic battery self-discharge rates (0.006%/hour) are incorporated. Case study analysis using real operational data from 11 commercial and industrial sub-sectors in Shanghai demonstrates effectiveness. Extended to 12 months with seasonal analysis, results show the proposed strategy reduces the peak-to-valley difference ratio by 2.4% [95% CI: 1.9%, 2.9%], p < 0.001; increases the system load factor by 1.3% [95% CI: 0.9%, 1.7%], p < 0.001; and achieves reductions in users’ total capacity costs of 3.6% [95% CI: −4.2%, −3.0%], p < 0.001. Comparative analysis shows the proposed method significantly outperforms simple TOU (improvement +1.2 pp) and peak-responsibility pricing (improvement +0.6 pp). Monte Carlo robustness analysis (1000 scenarios) confirms performance stability under demand uncertainty. This research provides theoretical foundations and practical methodologies for capacity cost allocation, offering valuable insights for policymakers and utilities seeking to enhance demand-side response mechanisms and improve power resource allocation efficiency. Full article

Transparent heaters intended for skin-contacting applications must simultaneously satisfy optical transparency, mechanical compliance, thermal uniformity, and operational safety under biologically relevant temperature ranges. Here, we evaluate the applicability of a TiO₂/Ag/SiO₂ (TAS) dielectric–metal–dielectric transparent heater as a functional biomaterial platform for wearable and skin-integrated thermal systems. By systematically optimizing each layer thickness of the TAS structure, the heater achieves high visible-light transmittance (average of 86.6%) together with low sheet resistance on the order of 7.7 Ω/sq for low-voltage operation. The TAS heater demonstrates rapid and reproducible Joule-heating behavior, showing fast thermal response with short thermal time constants and spatially homogeneous temperature distributions without localized hot spots. Stable electrothermal performance is maintained under repeated on/off cycling and during cyclic mechanical bending down to small radii, confirming excellent mechanical stability under repeated bending relevant to wearable applications. Importantly, direct on-skin evaluations conducted by attaching the device to a human elbow reveal conformal contact, uniform heating at therapeutically relevant temperatures (50–70 °C), and stable operation under dynamic bending and extension. The absence of thermal inhomogeneity during motion highlights the intrinsic stability of the TAS architecture for skin-interfaced use. Given the high optical visibility, mechanical compliance, thermal uniformity, and electrothermal stability, the proposed TAS architecture represents a promising functional biomaterial platform for wearable thermotherapy, skin-mounted healthcare devices, and human-interactive thermal systems operating under continuous mechanical deformation and direct skin contact. Full article

Background: Spinal cord injury (SCI) is a leading cause of chronic disability. Loss of upper extremity (U.E.) function is central to limitations, in mobility, postural control, transfers, and self-care. The aim of this exploratory pilot study was to investigate whether self-reported UE function is associated with independence in activities of daily living (ADLs) in people with motor-incomplete tetraplegia. Methods: Eleven (n = 11) individuals with motor-incomplete tetraplegia (AIS C–D; neurological levels C4–T1; injury duration ≥ 1 year), recruited through convenience sampling from five specialist rehabilitation centres, participated in an exploratory cross-sectional pilot study designed to generate hypotheses rather than test them. U.E. function was assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, selected for its ability to capture pain and task-related functional difficulty in the elbow, wrist, and hand; its application in this neurological population is considered exploratory. Independence in ADLs was evaluated using the Spinal Cord Independence Measure III (SCIM III). Given the small sample, all analyses were primarily descriptive and along with bivariate associations (Spearman correlations). Regression findings are reported strictly for exploratory purposes. Results: The median age was 50 years (interquartile range [IQR] 43–55). A strong negative correlation was observed between PRTEE total score and SCIM III (r_s = −0.76). In an exploratory univariate analysis, each 1-point increase in PRTEE total score was associated with a 1.3-point lower SCIM III score (β = −1.3, 95% CI −2.34 to −0.26, p = 0.02). Age also showed a positive association (β = 1.31, 95% CI 0.04 to 2.58, p = 0.05) with SCIM III; however, this finding is highly likely to reflect a statistical artefact of the small and unrepresentative sample. Multivariable regression was not conducted as a primary analysis due to insufficient statistical power. All findings should be treated as strictly exploratory and hypothesis-generating. Conclusions: Self-reported U.E. function appears to be associated with ADL independence in motor-incomplete tetraplegia. U.E. capacity may contribute to functional tasks requiring postural stability and mobility-related activities, but no predictive inferences can be made from this underpowered, convenience sample. Future studies with larger cohorts and performance-based measures are needed to confirm these preliminary observations and clarify the role of U.E. function in rehabilitation planning. Full article

Background and Objectives: Surface electromyography (EMG) is widely used to assess muscle activation. However, direct interpretation of its functional biomechanical consequences remains challenging. This study aimed to develop and evaluate an EMG-driven musculoskeletal simulation framework for investigating how controlled modifications of muscle activation patterns influence joint-level biomechanics in the upper limb. The objective was not to reproduce specific clinical pathologies but to enable systematic virtual scenario analysis of activation-dependent movement alterations. Materials and Methods: Surface EMG signals were recorded from five healthy adults (3 males, 2 females; age 22 ± 1 years) during cyclic elbow flexion/extension tasks using a wireless system (sampling frequency: 2000 Hz). Processed and normalized EMG envelopes were directly applied as prescribed neural inputs in forward dynamic simulations implemented in OpenSim, without optimization-based muscle recruitment. Controlled virtual scenarios were generated through parametric modification of activation signals to represent reduced activation capacity, increased antagonist co-activation, spasticity-like activation modulation, and tremor-like oscillatory modulation. Joint kinematics, joint moments, and movement stability were evaluated. A Movement Quality Index (MQI) was introduced as a comparative research metric integrating biomechanical performance indicators. Simulations were deterministic and analyzed descriptively. Results: Distinct activation modifications produced characteristic kinematic and kinetic responses. Reduced activation capacity decreased simulated joint moment output, increased co-activation altered joint moment timing and mechanical stability, and tremor-like oscillatory modulation generated periodic fluctuations in joint kinematics and kinetics. The MQI enabled quantitative differentiation between simulated scenarios and severity levels within the controlled modelling framework. Conclusions: The proposed EMG-driven forward dynamic simulation framework provides a methodological platform for controlled virtual scenario analysis of activation-dependent biomechanical changes. The findings highlight the sensitivity of joint-level mechanics to altered muscle activation patterns, within the deterministic modelling environment. The framework is intended for research-oriented biomechanical investigation and hypothesis testing rather than direct clinical diagnosis of neuromuscular disorders. Full article

Shoulder pain and shoulder surgery are increasingly prevalent and encompass a broad spectrum of pathologies, including rotator cuff disease, glenohumeral osteoarthritis, and shoulder instability. Growing evidence suggests that gender-related factors influence disease presentation, patient-reported outcomes, and postoperative recovery; however, these effects remain inconsistently reported across the literature. This current concepts review synthesizes available evidence on the influence of gender on pre-operative characteristics, non-operative management, and postoperative outcomes following common shoulder procedures, including rotator cuff repair, anatomic and reverse shoulder arthroplasty, and surgical stabilization for instability. A comprehensive literature search of PubMed, the Cochrane Library, and Google Scholar was performed for studies published through October 2025, with outcomes assessed using validated instruments such as the Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons score, Constant–Murley score, Simple Shoulder Test, Visual Analog Scale, and Shoulder Pain and Disability Index. Across shoulder pathologies, female patients consistently demonstrated worse pre-operative functional scores, higher pain levels, and greater perceived disability despite similar structural disease severity. Postoperatively, both genders experienced meaningful clinical improvement; however, females often reported higher early postoperative pain and lower absolute functional outcomes, particularly following shoulder arthroplasty for glenohumeral osteoarthritis and surgical treatment of multidirectional instability. In contrast, outcomes following rotator cuff repair and anterior instability stabilization were largely comparable between genders. Recognition of these gender-related differences is essential for individualized patient counseling, expectation setting, and optimization of management strategies, and highlights the need for future studies with robust gender-disaggregated analyses. Full article

Background/Objectives: Complex elbow dislocations are rare but severe injuries. Optimal treatment is controversial, and few studies focus on return to sports. The aim of the study is to analyze functional outcomes and return-to-sport and return-to-work metrics in recreational athletes after complex elbow dislocation. Methods: A retrospective single-center study at a level I trauma center was performed from January 2008 to December 2019. Epidemiological data, associated injuries, and treatment of complex elbow dislocations were analyzed. Patients were followed up for at least two years after injury, and return-to-sports and return-to-work rates along with patient-reported outcome measures were investigated. Results: Fifty-six patients were included. The mean follow-up was 6.4 years (range, 2.0–12.5). The mean Subjective Elbow Value was 80.2 (95% CI, 74.7–85.8), the Mayo Elbow Performance Score was 83.8 (95% CI, 78.8–88.7), and Oxford Elbow Score was 37.8 (95% CI, 35.1–40.5). Of 41 recreational athletes, 37 returned to sports; however, only 31.7% fully returned to their pre-injury sport, 43.9% returned partially, and 24.4% switched sports. A total of 82% fully returned to work, 8.2% partially, and 10.2% did not return. Conclusions: Complex elbow dislocations remain severe injuries associated with relevant functional limitations. Nevertheless, good clinical outcomes and high overall return-to-sport and return-to-work rates can be achieved in recreational athletes. While the majority resume sporting activity, nearly 25% of patients do not return to their pre-injury sport. Full article

An injury to the elbow’s lateral ulnar collateral ligament (LUCL) is an orthopedic emergency that can impair joint stability and functional biomechanics throughout the upper extremity. The development and application of synthetic ligament substitutes, particularly short-chain-length and medium-chain-length polyhydroxyalkanoate (SCL-PHA and MCL-PHA) co-polymers, represent a promising innovation for lateral elbow stabilization. This experimental cadaveric study aimed to (1) compare biomechanical parameters of torque and angular rotation among control, damage, repair, and reconstruction groups and (2) compare stress and strain responses across the same groups. Twenty-four cadaveric elbows were allocated among six experimental conditions. The control group consisted of intact elbows (n = 4), while the damage group (n = 4) involved transection of the anterior capsule and extensor carpi radialis brevis (ECRB) to simulate ligament injury. The repair group (n = 4) underwent anterior capsular suturing. The reconstruction group (n = 12) was divided into three subgroups: palmaris longus (PL) autograft alone, PL with SCL-PHA co-polymer augmentation, and PL with MCL-PHA augmentation. Biomechanical testing measured maximum torque, angular displacement, shear stress, and strain, with statistical analysis conducted using descriptive statistics, one-way ANOVA, and post hoc multiple comparisons. The results demonstrated that maximum torque (F = 24.930, p < 0.001) and maximum shear stress (F = 8.130, p < 0.001) significantly differed among groups. The control group exhibited the highest mechanical performance (30.700 ± 9.368 Nm and 0.880 ± 0.216 MPa), whereas the damage group showed the lowest values (10.300 ± 2.904 Nm and 0.210 ± 0.073 MPa). The reconstruction group using palmaris longus with SCL-PHA co-polymer reinforcement (RC-PLSCL) demonstrated torque (29.550 ± 7.656 Nm) and shear stress (0.610 ± 0.206 MPa) comparable to those of the control group (p > 0.05), indicating near-physiological mechanical behavior. These findings suggest that SCL-PHA co-polymer augmentation offers superior biomechanical restoration relative to standard repair and other reconstruction strategies, highlighting its potential as an advanced biomaterial for ligament reconstruction in LUCL injuries. Full article

Background: To compare the biomechanical strength of three fixation techniques for the elbow anterior capsule and coronoid process using a synthetic ulna model. We hypothesize that a cortical suture button would be equivalent to the bone tunnel model but inferior to a screw-post construct. Methods: A biomechanical study was conducted using a composite ulna bone model to simulate coronoid process fixation with three techniques: traditional trans-osseous bone tunnel repair, suspensory fixation using a cortical button, and a screw-post construct using a 3.5 mm cortical screw. All constructs were assembled using high-strength suture. Each specimen underwent axial loading on an Instron machine until failure, defined as loss of fixation through the dorsal cortex. Peak ultimate strength was recorded. Statistical analysis was performed using one-way ANOVA and Tukey’s HSD test. Results: The suture button construct demonstrated the highest mean ultimate strength at 490.3 ± 125.2 N, significantly greater than both the bone tunnel (328.8 ± 86.4 N, p < 0.01) and screw-post constructs (273.4 ± 54.5 N, p < 0.001). While the bone tunnel construct exhibited a 20.3% higher strength than the screw-post construct, this difference was not statistically significant (p = 0.13). The screw-post construct showed the least variability in strength to failure but the lowest overall strength. The suture button demonstrated the greatest mechanical strength but also the most variability. Conclusions: Suspensory fixation using a titanium cortical suture button provides significantly greater mechanical strength compared to traditional bone tunnel and screw-post techniques in a synthetic ulna model. While variability was greatest with the suture button construct, its superior load-bearing capacity suggests potential advantages in stabilizing the elbow through anterior capsule and coronoid fracture repair. These findings support further clinical investigation of suture button fixation as a viable technique in complex elbow injuries. Full article

Due to the complex anatomical structure of the distal humerus, elbow joint, and the soft tissue mantle (the triceps brachii muscle, large nerves, and vessels), fractures of the distal humerus and humeral condyle are difficult to treat. In most cases, strong instrumentation is needed to stabilize the fractures. To improve exposure of the distal humerus and humeral condyle, we proposed a caudolateral approach that involves elevating the anconeus muscle and splitting the triceps brachii. This study presents the results of using this approach in 16 canine cadavers. After exposing the distal humerus and maximally flexing the elbow joint, photographs were taken of the condyle from the same distance before and after olecranon osteotomy. The visible surface area of the articular cartilage was then calculated in square pixels after calibrating the photographs. It was possible to reach the distal and middle humerus in all cases. The only vital structure that could be easily identified and protected in all cadavers was the radial nerve. The visible area of the articular surface of the humeral condyle increased after olecranon osteotomy. The A₀ (visible area before osteotomy) was significantly smaller than the A₁ (visible area after osteotomy) in all dogs (p < 0.001). The ratio of A₀ to A₁ ranged from 57% to 67% in 15 dogs (median: 64%, interquartile range (IQR): 61–66%), with a very high value of 85% observed in one dog. This experiment used cadavers with intact elbows. This could limit the study’s findings because the effectiveness of the proposed access in reducing T-Y fractures was not assessed. The caudolateral approach is a valuable alternative to other methods for treating T-Y humeral fractures in dogs. Olecranon osteotomy widens access to the condyle. Further studies are needed to evaluate the necessity of olecranon osteotomy in clinical cases. Full article

Background/Objectives: Biodegradable implants have emerged as a promising alternative to traditional metallic fixation devices in pediatric orthopedic surgery. Avoiding implant removal is especially advantageous in children, who would otherwise require a second operation with additional anesthetic and surgical risks. This study reviews the current use of poly(lactic-co-glycolic acid) (PLGA) implants in pediatric fracture fixation and evaluates how they address limitations associated with traditional hardware. Methods: A narrative review was conducted summarizing current evidence, clinical experience, and case examples involving PLGA-based devices used in pediatric trauma. Special emphasis was placed on the degradation mechanism of PLGA, its controlled hydrolysis profile, and the capacity of the material to provide temporary mechanical stability during bone healing before complete resorption. The review included studies of PLGA use in forearm, distal radius, ankle, and elbow fractures, comparing outcomes to those obtained with metallic implants. Results: Across multiple clinical reports and case series, PLGA implants demonstrated effective fracture healing, stable fixation, and complication rates comparable to traditional metallic devices. Patients treated with resorbable implants benefited from reduced postoperative morbidity, no requirement for implant removal, and improved imaging compatibility. Conclusions: PLGA-based bioabsorbable implants represent a safe and effective alternative to conventional metal fixation in children. Their favorable degradation kinetics and clinical performance support their growing use in pediatric trauma surgery, while ongoing advances in polymer design and bioresorbable alloys continue to expand future applications. Full article

This study analyzes long-term deterioration patterns in 1378 Maryland steel bridges using annual Bridge Health Index (BHI) records from 1995–2021. Missing observations were addressed through linear interpolation combined with forward/backward filling, after which feature-wise z-score standardization was applied to ensure comparability across annual trajectories. Euclidean K-means clustering (k-means++ initialization, 10 restarts) was implemented to identify deterioration archetypes, with K = 6 selected using the elbow method and the silhouette coefficient. Cluster-internal stability was evaluated using bridge-level Root Mean Squared Error (RMSE), and uncertainty in median deterioration profiles was quantified using 2000-iteration percentile-based bootstrap confidence intervals. To interpret structural and contextual drivers within each group, Principal Component Analysis (PCA) was performed on screened and standardized geometric, structural, and traffic-related attributes. Results revealed strong imbalance in cluster membership (757, 503, 35, 33, 44, and 6 bridges), reflecting substantial diversity in long-term BHI behavior. Cluster-median RMSE values ranged from 2.69 to 22.66, while wide confidence bands in smaller clusters highlighted elevated uncertainty due to limited sample size. PCA indicated that span length, deck width, truck percentage, and projected future ADT were the most influential differentiators of deteriorating clusters, while stable clusters were distinguished by consistently high BHI component values and limited geometric complexity. Missing rehabilitation records prevented definitive attribution of U-shaped or recovering trajectories to specific intervention events. Overall, this study establishes a scalable, statistically supported framework for deterioration-trajectory profiling and provides actionable insight for proactive inspection scheduling, rehabilitation prioritization, and long-term asset management planning for state-level bridge networks. Full article

Background/Objectives: Distal biceps tendon rupture is a disabling injury that compromises elbow flexion and forearm supination strength, particularly in high-performance athletes. Although several fixation techniques have been proposed, no single method has proven optimal in combining mechanical stability, anatomical restoration, and early functional recovery. This study aimed to evaluate the efficacy, safety, and reproducibility of a hybrid dual-fixation technique combining a Tightrope^® cortical button (Arthrex, Naples, FL, USA) with a PEEK interference screw for anatomic reinsertion of the distal biceps tendon in athletic individuals. Methods: A prospective observational study was conducted on 13 high-performance athletes who underwent distal biceps tendon repair using the hybrid Tightrope–PEEK construct between March 2024 and September 2025. Functional recovery, muscle strength, esthetic contour, and patient satisfaction were evaluated using the Visual Analog Scale (VAS), Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and a 5-point Likert scale over a 12-month follow-up. Descriptive statistical analysis was performed using IBM SPSS Statistics, version 29.0. Results: All patients achieved secure fixation with no intraoperative or postoperative complications, loss of reduction, or hardware failure. Early controlled mobilization began within the first postoperative week. At 6 months, flexion and supination strength were fully restored, and at 12 months, all patients achieved full range of motion and optimal functional scores (mean MEPS 100; QuickDASH 0). No “Popeye” deformities or contour irregularities were observed, and mean patient satisfaction was 5/5. Conclusions: The hybrid Tightrope–PEEK dual-fixation technique provides excellent mechanical stability, allowing early mobilization and rapid functional recovery with minimal complications. Its reproducibility and cosmetic advantages suggest that it represents a safe and effective option for distal biceps tendon reinsertion in high-demand athletes. Full article

Background: The radiocapitellar articulation of the elbow joint is particularly susceptible to subluxation and dislocation. Joint stability can be quantified using the stability ratio, a biomechanical parameter of joint stability defined as the ratio of the maximum dislocating force the joint can resist in relation to the joint compressive force. The purpose of this study was to biomechanically assess the stability of the radiocapitellar joint in the anterior and posterior direction across varying degrees of elbow flexion. Methods: Eight fresh-frozen cadaveric elbows, average age 68.9 years (range 61–73 years; 3 males and 5 females; 7 left and 1 right) were tested. The distal humerus and proximal radius were dissected of all soft tissues to isolate the radiocapitellar articulation. The radius and humerus were mounted on a custom jig that allows for positional adjustment and incorporates a material testing machine. Each specimen was mounted at neutral forearm position and tested at 30, 45, and 60 degrees of anatomical elbow flexion. All specimens were subjected to 10 mm of anterior–posterior displacement for 5 cycles at 20 mm per minute with 40 N of compressive load. Subluxation force, displacement at subluxation force, linear stiffness, stability ratio, and energy absorbed were calculated. Results: In all degrees of elbow flexion, the stability ratio in the posterior direction was significantly higher than the anterior direction by an average of 39.8 ± 32.6% (p < 0.025). Maximum subluxation force was also significantly higher in the posterior direction when compared to the anterior direction (p < 0.027). There was no significant difference in any other parameters. Conclusions: The stability ratio and maximum subluxation force of the radiocapitellar joint when positioned in neutral forearm rotation are significantly greater in the posterior direction when compared to the anterior direction. This finding provides quantitative insights and a biomechanical rationale for the propensity of anterior instability in the radiocapitellar joint. Full article

Background/Objectives: Vaccine elicitation of antibodies with high HIV-1 neutralization breadth is a long-standing goal. Recently, the induction of such antibodies has been achieved at the fusion peptide site of vulnerability. Questions remain, however, as to how much anti-fusion peptide antibodies can be improved and whether their neutralization breadth and potency are sufficient to prevent HIV-1 infection. Methods: Here, we use yeast display coupled with deep mutational screening and biochemical and structural analyses to study the improvement of the best fusion peptide-directed, vaccine-elicited antibody, DFPH_a.01, with an initial 59% breadth. Results: Yeast display identified both single and double mutations that improved recognition of HIV-1 envelope trimers. We characterized two paratope-distal light chain (LC) mutations, S10R and S59P, which together increased breadth to 63%. Biochemical analysis demonstrated DFPH-a.01_10R59P-LC, and its component mutations, to have increased affinity and stability. Cryo-EM structural analysis revealed elbow-angle influencing by S10R-LC and isosteric positioning by S59P-LC as explanations for enhanced breadth, affinity, and stability. Conclusions: These results, along with another antibody with enhanced performance (DFPH-a.01_1G10A56K-LC with 64% breadth), suggest that mutations improving DFPH_a.01 are plentiful, an important vaccine insight. Full article

Lateral elbow pain is a common condition often misattributed solely to tendinopathy, while subtle instability may represent a significant underlying cause. Traditional classifications of elbow instability primarily address traumatic or grossly unstable patterns, leaving minor forms underrecognized. Recent evidence has emphasized the role of the Radial-Lateral Collateral Ligament (R-LCL) in maintaining joint stability, and its elongation has been linked to Symptomatic Minor Instability of the Lateral Elbow (SMILE). This model describes a horizontal type of radiocapitellar instability, where ligamentous incompetence leads to compensatory overload of the extensor carpi radialis brevis, ultimately producing chronic pain. Advances in diagnostic tools—including dynamic ultrasound (HELP-US test), CT arthrography with the SMILE Index, and arthroscopic signs such as the Loose Collar Sign—have improved recognition of this condition. However, surgical controversies remain, particularly regarding the potential destabilizing role of lateral release in patients with unrecognized R-LCL pathology. Arthroscopic stabilization techniques, such as R-LCL plication or imbrication, have shown promising outcomes, offering pain relief and functional recovery with minimally invasive approaches. This review integrates anatomical, biomechanical, and clinical evidence into a structured diagnostic and therapeutic algorithm, aiming to reduce diagnostic uncertainty and guide tailored interventions. Recognition of microinstability, and, in particular, the SMILE model, is crucial to optimize management of patients with chronic lateral elbow pain refractory to conservative measures. Full article