--- title: 'Morning Brief — Tuesday, September 22, 2026' type: 'episode' url: 'https://doc.social/episodes/morning-brief-2026-09-22' show: 'doc social Morning Brief' show_url: 'https://doc.social/podcasts/morning-brief' published: '2026-09-22' audio: 'https://media.doc.social/podcasts/morning-brief/2026-09-22.mp3' --- # Morning Brief — Tuesday, September 22, 2026 JBJS: a Houston private practice audits three years of CPT 22-modifier claims — 71.7% approved, 7.7% more money, and up to 77% longer to get paid · ORTHOWORLD's 2026 spine market analysis: an $11B market growing ~3%, with Medtronic and Globus at a combined 43% and nobody else above 8% · Smith+Nephew brings the acquired Tendon Seam cuff system, a new knotless anchor and both-sides handheld… ## Summary 5 stories this morning, for surgeons and the people who support them. - **JBJS: a Houston private practice audits three years of CPT 22-modifier claims — 71.7% approved, 7.7% more money, and up to 77% longer to get paid** — Published online ahead of print September 21, 2026 in The Journal of Bone and Joint Surgery (American): Pfeil AN, Jennewine B, Sketchler B, Cusick MC, Hryc CF, Edwards TB, Patel AR, 'The CPT 22-Modifier at a Single Private-Practice Orthopaedic Institution: Success, Reimbursement, and Financial Burden,' DOI 10.2106/JBJS.26.00089, PMID 42766661. Fondren Orthopedic Research Institute, Texas Orthopedic Hospital, Houston. Three years of surgical claims across four subspecialties (adult reconstruction, hand, shoulder, sports medicine): 18,612 claims, of which 2,741 (14.7%) were amended with a 22-modifier. Overall approval 71.7%. By subspecialty: sports medicine 64.7%, adult reconstruction 72.8%, shoulder 73.8%, hand 76.3%. By payer: Workers' Compensation 62.9%, commercial 65.0%, government 78.0%. The modifier produced a 7.7% overall increase in reimbursement. Time to reimbursement increased 39.1% (hand) to 77.4% (shoulder) versus unmodified claims; claim denial produced a significantly higher rebilling rate in adult reconstruction. Level of evidence: Prognostic Level III. Authors' conclusion is that the financial gain may be offset by administrative and billing burden in some procedures or subspecialties. No external funding. [Source](https://pubmed.ncbi.nlm.nih.gov/42766661/) - **ORTHOWORLD's 2026 spine market analysis: an $11B market growing ~3%, with Medtronic and Globus at a combined 43% and nobody else above 8%** — Published September 20, 2026 on BONEZONE, authored by Mike Evers, Senior Market Analyst at ORTHOWORLD. Figures as published: worldwide spine revenue of $11 billion in 2025, 17% of orthopaedic sales, low-single-digit growth of roughly 3% in 2025, projected past $12 billion by 2028 and $12.5 billion by 2029. Medtronic and Globus Medical hold a combined 43% share, each above $2 billion in revenue; DePuy Synthes $883 million; ATEC $622 million; no other competitor above 8% share. Faster-growing second tier: Carlsmed +86% year over year, Centinel Spine +34.4% in 2025, SI-BONE past $200 million in 2025 on a 20% CAGR since 2018, ATEC on a 33% eight-year CAGR. Minimally invasive procedures are 20-30% of US spine cases. Spine's share of orthopaedic M&A fell from 30% of deals in 2016-2020 to 24% in 2021-2025, with capital shifting toward digital solutions and orthobiologics. Supporting demand data cited includes a Piper Sandler surgeon survey from early July 2026. This is secondary market analysis, not primary research; the DePuy Synthes figure is useful context for the reported Apollo Global Management talks covered in the September 15 episode (https://www.privateequitywire.co.uk/apollo-in-talks-to-acquire-jjs-depuy-synthes-for-around-20bn/). Aggregated the same day in Orthogate's briefing (https://www.orthogate.org/medtech-innovation/industry/84765-orthopaedic-industry-daily-briefing-2026-09-21). [Source](https://bonezonepub.com/2026/09/20/state-of-the-spine-market/) - **Smith+Nephew brings the acquired Tendon Seam cuff system, a new knotless anchor and both-sides handheld shoulder robotics to ICSES 2026 — contesting Zimmer Biomet's May 'first' claim** — Release dated September 21, 2026 ahead of the 16th International Congress of Shoulder and Elbow Surgery (ICSES 2026), Vancouver Convention Centre, September 22-25, 2026, hosted by ASES; Smith+Nephew holds an evening event September 22. Products: (1) TENDON SEAM Rotator Cuff Repair System, acquired with Integrity Orthopaedics in January 2026 for an initial $225 million cash plus up to $225 million in performance-based payments over five years (https://www.smith-nephew.com/en/news/2026/01/12/smithnephew-strengthens-shoulder-repair-portfolio-with-acquisition); design uses multiple 2x10 mm anchors with a continuous stitch perpendicular to the direction of load; company-reported biomechanical testing shows a 2x increase in repair strength and a 10x decrease in gap formation versus traditional techniques, with early clinical outcomes described as encouraging (bench data, not a clinical comparison). Smith+Nephew's own market framing at acquisition: roughly 500,000 US rotator cuff repairs annually, an estimated $875 million market, historical structural failure rates of 20-40%. (2) REGENETEN Bioinductive Implant, over 250,000 procedures globally since 2014, with a 2026 study reporting early recovery time halved after isolated use in partial-thickness tears versus traditional suture-anchor repair, and a four-star AAOS recommendation for bioinductive implants. (3) Q-FIX KNOTLESS 2.8 all-suture anchor, launching at ICSES. (4) CORI SHOULDER handheld robotic arthroplasty with the AETOS Shoulder System and CORIOGRAPH pre-op planning, supporting handheld robotic execution of both the humerus and the glenoid across anatomic and reverse procedures, on the CORI XT platform described as moving easily between rooms. Competitive timing: Zimmer Biomet's expanded ROSA Shoulder clearance came in May 2026 with a company claim of being the first robotic system supporting both glenoid and humeral preparation for anatomic and reverse techniques (https://www.massdevice.com/zimmer-biomet-expanded-fda-nod-rosa-shoulder/); Smith+Nephew announced its first CORI XT clinical cases across knee and shoulder arthroplasty in June 2026, including shoulder arthroplasty at Duke Health (Christopher Klifto) and the first ASC cases at North Valley Surgery Center in Scottsdale, Arizona (Bertrand Kaper) (https://www.smith-nephew.com/en/news/2026/06/08/first-clinical-cases-with-the-next-generation-cori-xt ; https://www.massdevice.com/smithnephew-first-cases-cori-xt-robot/). Smith+Nephew reported $6.2 billion in 2025 sales. No published head-to-head study compares robotic and conventional humeral preparation. [Source](https://www.globenewswire.com/news-release/2026/09/21/3365585/0/en/smith-nephew-to-showcase-leading-shoulder-technologies-for-joint-repair-and-reconstruction-at-icses-2026.html) - **ESSKA and the European Shoulder Associates publish their formal consensus on partial-thickness posterosuperior cuff tears: nonsurgical first, one Grade A recommendation, and Grade B support for PRP** — Published online ahead of print September 21, 2026 in Knee Surgery, Sports Traumatology, Arthroscopy: Kany J, Ruiz Iban M, Calvo E, Rosso C, Peach C, Dias CM, Metais P, Saccomanno MF, Boe B, Brilakis E, Bilsel K, Kovacic L, Raebroeckx AV, Gomes N, Martetschlager F, Beaufils P, Dyrna F, 'The 2026 ESSKA-ESA formal consensus on partial-thickness posterosuperior rotator cuff tears (Part 2): Treatment strategies, rehabilitation, return to sport and complications,' DOI 10.1002/ksa.70622, PMID 42766425. Method: ESSKA Formal Consensus Methodology; a 13-surgeon Steering Group developed 33 questions and statements from a standardized literature review with recommendation grades A-D, rated by an independent 20-surgeon Rating Group over three rounds. Results: 21 question-statement pairs reached strong agreement, generating 30 recommendations (1 Grade A, 6 Grade B, 10 Grade C, 13 Grade D). The single Grade A finding is an increased risk of postoperative stiffness after trans-tendon repair of articular-sided tears compared with tear completion. Grade B evidence supported conservative treatment for at least six months, platelet-rich plasma injections, and management of stiffness before surgery; trans-tendon/in-situ repair and tear-completion-and-repair showed similar return-to-sport rates, with slightly higher retear rates after tear completion. Most commonly reported outcome measures were ASES, Constant-Murley and VAS. Conclusion: individualize by activity level, symptoms, tear morphology and tissue quality; nonsurgical treatment is the preferred initial approach and no surgical technique has shown consistent superiority. Level of evidence: Level I, formal consensus. Contrast worth noting without conflating indications: the American College of Rheumatology's 2026 osteoarthritis guideline, covered in the September 15 episode, was strongly against PRP injections in knee and hip OA (https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/bltb3d12c34020da842/oa-guideline-summary-2026.pdf). [Source](https://pubmed.ncbi.nlm.nih.gov/42766425/) - **Five-year randomized subgroup from Lyon: 16.4% graft failure after isolated BPTB versus 4.8% for hamstring plus anterolateral ligament reconstruction in patients under 25** — Published online ahead of print September 21, 2026 in Knee Surgery, Sports Traumatology, Arthroscopy: Santamaria F, Carrozzo A, Pioger C, Vieira TD, Sonnery-Cottet V, Fayard JM, Thaunat M, Sonnery-Cottet B, 'Fourfold higher graft failure risk with isolated BPTB versus hamstring ACL reconstruction with ALL in patients under 25 years: A prespecified subgroup analysis of a randomized controlled trial,' DOI 10.1002/ksa.70617, PMID 42766437. Centre Orthopedique Santy, Hopital Prive Jean Mermoz, Lyon. Prespecified subgroup of patients younger than 25 from a prospective comparative study: 281 patients, 134 isolated bone-patellar tendon-bone ACL reconstruction versus 147 hamstring ACL reconstruction combined with anterolateral ligament reconstruction. Primary outcome graft failure at five years: 22 patients (16.4%) in the isolated BPTB group versus 7 patients (4.8%) in the HT+ALLR group, p = 0.0013; Kaplan-Meier log-rank p = 0.0008. Multivariate analysis: isolated BPTB independently associated with higher graft failure, odds ratio 4.2 (95% CI 1.8-11.3, p = 0.0007), hazard ratio 4.2 (95% CI 1.9-10.7, p = 0.0002). KOOS, IKDC, Lysholm and Tegner scores comparable between groups. Level of evidence: Level I, randomized controlled trial. Caveats to state on air: this is a prespecified subgroup rather than the trial's primary endpoint, it is single-centre, and the Santy group led by Bertrand Sonnery-Cottet has been the principal advocate of anterolateral ligament reconstruction. [Source](https://pubmed.ncbi.nlm.nih.gov/42766437/) ### Contribute to the Brief Faculty can send the show a note — a reaction to a paper, a correction, a read on a rule change — either written, which we shape for broadcast and read in the show's voice, or as a voice note under three minutes, which airs in your own voice. Send one from [Studio](https://next.doc.social/studio). Not on doc social yet? [Contribute a lecture or join the network](https://next.doc.social/contribute) — doc social is a clinical education platform for clinicians, and this show is one part of it. _Narration is synthesized. Reporting and editorial judgement are ours, and every story above links to its source._