EFORT Open Rev. 2025 May 5;10(5):316-326. doi: 10.1530/EOR-2024-0184.

ABSTRACT

PURPOSE: We conducted a systematic review of all proposed classifications of tibial plateau fractures (TPFs) to facilitate comparison and identify the most effective reduction methods.

METHODS: PubMed, Scopus, Embase, Web of Science and Cochrane Library databases were searched for all the articles involving the suggestion of a new method of TPF classification. The descriptions of classifications, along with their suggested management strategies, were recorded.

RESULTS: Out of the 2,712 identified records, 69 were included in the study. Schatzker's and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications were the most frequently mentioned in the literature. The concept of a 'column' and posterior column fractures were introduced in 2010. Following this, posterior plateau fractures were further divided into posteromedial and posterolateral fractures. Proposed treatment approaches in most studies were based on the involved region and degree of displacement, while others considered fracture plane, deformity direction and type of fracture. The latest developments include the subclassification of the posterolateral column and consideration of associated injuries to the fibular head, eminentia, extensor mechanism and mechanical derangements along with the concept of the main deformity direction.

CONCLUSION: The understanding of TPF patterns, associated injuries, surgical approaches and fixation methods has evolved in a compelling stepwise manner. Currently, there is no gold standard classification that addresses fracture configuration, soft-tissue injuries, principal direction of deformity, central eminence avulsions, extensor mechanism disruptions and mechanical derangements, while maintaining a simple and reliable categorization. Therefore, employing individualized classification systems remains the most logical approach at present. This study offers invaluable assistance in this regard.

PMID:40326555 | PMC:PMC12061015 | DOI:10.1530/EOR-2024-0184

EFORT Open Rev. 2025 May 5;10(5):237-249. doi: 10.1530/EOR-2024-0156.

ABSTRACT

This review highlights the role of existing spasticity treatment methods in reducing muscle tone and improving function. The surgical methods today mainly include selective dorsal rhizotomy, selective neurotomy, intrathecal baclofen treatment (ITB), etc. These techniques (except ITB) can lower patients' muscular tone in the long term and improve function to some extent. The young procedures, contralateral C7 nerve transfer and T1 neurotomy, are still under research. ITB and nonsurgical treatment methods, botulinum toxin A (BoNT-A) and extracorporeal shockwave therapy (ESWT), can reduce muscle tone in the short term, but the long-term efficacy is unsatisfactory. In addition, the effects of improving function are relatively controversial. The economic cost of these treatment methods is also heavy for patients. In addition, some studies have reported that some kinds of electrical/magnetic stimulation can improve the patients' function. They can potentially be used as an adjunctive treatment for spasticity. According to current studies and our own experience, surgery methods (except ITB) are still recommended for patients, whose spasticity has a major detrimental influence on their everyday lives, taking into account patient benefits and cost-effectiveness. There are also some problems in the current research on spasticity treatment, such as incomplete guidelines and a relative lack of high-quality studies, which is what the doctors need to strive for. Further exploration is needed to find the treatment methods that can reduce muscle tone while improving patients' function to better benefit patients.

PMID:40326554 | PMC:PMC12061021 | DOI:10.1530/EOR-2024-0156

EFORT Open Rev. 2025 May 5;10(5):258-266. doi: 10.1530/EOR-2024-0133.

ABSTRACT

PURPOSE: Controversy exists on whether a drug holiday is necessary for patients on antiresorptive medication for osteoporosis or bone metastasis and undergoing dental procedures to lower the risk of medication-related osteonecrosis of the jaw (MRONJ). This study evaluated the effects of discontinuing different antiresorptive regimens on MRONJ in these patients.

METHODS: Publications from PubMed, EMBASE, Cochrane Library and EBSCO Open Dissertations were searched from inception to September 2023 following PRISMA guidelines, and the review was registered in PROSPERO. Eligibility criteria included clinical studies on the effects of continued and discontinued antiresorptive medications for osteoporosis or bone metastasis in patients undergoing dental procedures. The involved antiresorptive agents were oral bisphosphonates (BPs), intravenous (IV) BPs and denosumab (Dmab). Relative risk (RR) with 95% confidence interval (CI) was estimated using a random-effects model.

RESULTS: Of the 2,590 records identified, six studies (n = 717) were included. Discontinued use of oral BPs had a lower MRONJ risk than discontinuation of IV BPs (RR = 0.05; 95% CI: 0.00-0.83) and continuation of IV BPs (RR = 0.03; 95% CI: 0.00-0.46). Continuing oral BPs also resulted in a lower MRONJ risk compared to both discontinuation and continuation of IV BPs, with RR = 0.04 (95% CI: 0.00-0.67) and RR = 0.03 (95% CI: 0.00-0.37), respectively. No significant difference was found between continuation and discontinuation of oral BPs, along with other comparisons.

CONCLUSIONS: A drug holiday may not be necessary before dental procedures for oral BPs. Temporary discontinuation of IV BPs or Dmab is also unlikely to reduce MRONJ risk compared to continued medication.

PMID:40326547 | PMC:PMC12061011 | DOI:10.1530/EOR-2024-0133

EFORT Open Rev. 2025 May 5;10(5):297-308. doi: 10.1530/EOR-2024-0122.

ABSTRACT

The long head of the biceps tendon (LHBT) has recently emerged as a therapeutic option for various shoulder pathologies. Synthetic materials and allografts have not shown sufficient resistance or favorable outcomes to restore rotator cuff native tissue properties, leading to consideration of using LHBT as biological augmentation. LHBT mimics adjacent structures, such as the rotator cuff, is easily accessible during surgery, and is a good source of live autologous cells for regenerative augmentation in rotator cuff repair, as a superior capsular reconstruction in irreparable cuff tears, in subscapularis augmentation in shoulder replacement and as a stabilizer in anterior shoulder instability. This narrative review aims to collect, synthesize and critically evaluate the literature on the use of the LHBT and its current applications in the field of shoulder surgery, improving the understanding of the terminology and consolidating the concepts related to the various procedures in shoulder surgery.

PMID:40326542 | PMC:PMC12061019 | DOI:10.1530/EOR-2024-0122

EFORT Open Rev. 2025 May 5;10(5):224-236. doi: 10.1530/EOR-2024-0116.

ABSTRACT

Clinicians, scientists and regulators do not use a common set of definitions and terminology to classify and code periprosthetic tissue reactions to wear debris of arthroplasty implants and a limited granularity is present to allow early identification of associated adverse events. Adverse local tissue reactions (ALTRs) is an umbrella term, which has been used in particular for periprosthetic tissue reactions to metal wear debris. In this review, it has been extended to all implant materials and adverse reaction to metallic debris as a subset of ALTR caused by or associated with metallic particulate debris. The high variability in the terminology of ALTRs used by national arthroplasty registries, various coding systems and clinicians impedes their accurate reporting and interpretation, crucial for evaluating the reasons for implant failure and revision arthroplasty. Histopathological examination of periprosthetic soft tissue and bone uses standardized criteria for the diagnoses of reactions to wear particles, significantly contributing to their understanding and refining their interdisciplinary terminology. This review critically analyzes the current gap in coding ALTRs due to arthroplasty implants' wear in national registries and classification systems of adverse events and the use of key terms. A comprehensive unified lexicon and classification system grounded on evidence-based histopathological analyses is proposed, implementing the following findings. (a) Pseudotumor is a descriptive term for ALTR, which cannot be used for codification. (b) Metallosis is a term lacking quantitative and qualitative determination and thus not a codifiable term for ALTR. (c) Aseptic lymphocyte dominant vasculitis-associated lesion (ALVAL) should not be used due to absence of histological findings diagnostic of vasculitis. (d) Metal delayed hypersensitivity and metal allergy should be codified as separate categories of adverse events. (e) ALTR is to be classified in due consideration of definition of predominant lymphocytic or predominant macrophage infiltrate. (f) Granulomatous reaction should be reserved to sarcoid-like, immune granulomas separated from the macrophage infiltrate with/without foreign body giant cell reaction. (g) Macrophage infiltrate containing particulate wear debris with or without lymphocytic component associated with macrophage induced osteolysis/aseptic loosening should be considered as a type of ALTR.

PMID:40326541 | PMC:PMC12061016 | DOI:10.1530/EOR-2024-0116

EFORT Open Rev. 2025 May 5;10(5):250-257. doi: 10.1530/EOR-2024-0085.

ABSTRACT

A comprehensive overview of current Asian joint arthroplasty registries, highlighting their strengths and weaknesses and providing a case for establishing registries nationwide, is given. Pertinent information required for the future establishment and improvement of Asian joint arthroplasty registries is given. Six registries in Asia were identified, with three, Indian Joint Registry, Japanese Orthopaedic Association National Registry and Pakistan National Joint Registry having developed official websites and published annual reports. The majority of both hip and knee surgeries in India and Pakistan were carried out on men, in contrary to Japan, where the majority of knee surgeries were conducted in women. Osteoarthritis was the primary indication for knee surgery, whereas osteonecrosis was the main indication for hip surgery in India and Pakistan, compared to osteoarthritis in Japan. Many countries in Asia have attempted to report data on joint arthroplasties, though little information on nationwide registries is available, with three countries - Japan, India and Pakistan - having made their joint registry data available to the public.

PMID:40326532 | PMC:PMC12061010 | DOI:10.1530/EOR-2024-0085

EFORT Open Rev. 2025 May 5;10(5):277-285. doi: 10.1530/EOR-2024-0020.

ABSTRACT

PURPOSE: The objective was to investigate the consistency in cumulative revision rates (CRRs) for a selection of total hip arthroplasty cups and stems across national/regional hip arthroplasty registries worldwide.

METHODS: Ten cups and ten stems from total hip systems were randomly selected. Two frequently used implants across registries were added, totalling 11 cups and 11 stems. CRRs and 95% CIs were extracted from the latest annual registry reports using these implants. CRRs were pooled for each cup or stem, and differences between cup-stem combinations and between registries were investigated.

RESULTS: CRRs were available for ten cups and eight stems from eight registries, totalling 552,148 cups and 727,447 stems. Follow-up was 1-20 years. The 5-year CRR pooled for all cups was 2.9% (95% CI: 2.3-3.6) and for all stems, 3.0% (95% CI: 2.4-3.8). Homogeneous (consistent) CRRs with respect to both associated implant and country were observed for two cups and three stems. Significant differences in CRR were identified in one cup by associated implant only, in one cup by registry only, and in two cups and four stems for both. Sparse data prevented evaluation of four cups and one stem.

CONCLUSION: Registries' annual reports provide a large amount of publicly available information on CRRs of specific implants. These CRRs can be synthesised to improve the assessment of implant performance over time. Our CRR analysis represents a promising approach to detect implants with a consistent low- or high-risk pattern across registries.

PMID:40326530 | PMC:PMC12061013 | DOI:10.1530/EOR-2024-0020

EFORT Open Rev. 2025 May 5;10(5):213-223. doi: 10.1530/EOR-2023-0100.

ABSTRACT

Arthroscopic ankle arthrodesis (AAA) has been performed for 40 years for end-stage ankle osteoarthritis. Along with open ankle arthrodesis (OAA) and total ankle replacement (TAR), it forms one arm of the triumvirate of commonly performed procedures for this condition. The aim of this article is to review the state of the art for AAA and compare outcomes with OAA and TAR. This narrative review of the literature traces the development of this technique through case series and systematic reviews. Traditional OAA techniques carry a nonunion rate of 11%, necessitating revision surgery in most cases. As individual and communal experience of AAA has grown, the range of pathology and deformity successfully corrected by this technique has developed. There is evidence that AAA offers greater and more rapid union rates, with reduced hospital stay and better long-term outcomes. However, the technique requires mature surgical skills and still carries a significant complication rate. No single procedure is suitable for all patients. AAA can be seen as the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity, either within the talocrural joint or hindfoot or patients with systemic and/or local comorbidities that would benefit from minimal disturbance to the soft-tissue envelope. However, in older patients, the presence of concomitant hindfoot osteoarthritis or significant deformity, TAR and OAA remain valuable procedures in the foot and ankle surgeon's armamentarium.

PMID:40326529 | PMC:PMC12061018 | DOI:10.1530/EOR-2023-0100

EFORT Open Rev. 2025 May 5;10(5):286-296. doi: 10.1530/EOR-2023-0184.

ABSTRACT

The piriformis muscle (PM) is important for posture and preventing falls. It is a key landmark for hip surgery. The PM function is reported to be increasingly important for improving total hip arthroplasty (THA) outcomes and reducing complications. This scoping review aims to map and summarize the literature on the anatomy and function of the PM and the outcomes of clinical studies on THA preserving the PM to improve readers' understanding and identify areas for further research. A scoping review following the PRISMA guidelines was conducted using PubMed and Scopus from their inception until June 2023. We used the search term 'piriformis' or 'PM' to include all PM-related studies. Two independent reviewers screened abstracts and full texts to select key aspects of PM anatomy and function and the main clinical THA studies reporting outcomes on PM preservation. Fifty-seven studies published between 1980 and 2023 met our inclusion criteria. During hip surgery, the PM anatomy, including its origin and insertion, muscle belly, and relation to other short hip rotators and the sciatic nerve, can vary greatly, making it difficult to recognize. The current literature on PM-preserving THA and hemiarthroplasty clinical studies is limited. It suggests potential benefits in terms of hip stability, dislocation risk, and functional outcomes compared to no PM preservation in short-term follow-up. Identifying and preserving the PM during hip surgery may be difficult due to its variable anatomy and its relation to surrounding structures. Although the literature supporting PM preservation potentially indicates better outcomes, further high-level research studies are needed.

PMID:40326528 | PMC:PMC12061017 | DOI:10.1530/EOR-2023-0184

EFORT Open Rev. 2025 May 5;10(5):309-315. doi: 10.1530/EOR-2024-0142.

ABSTRACT

OBJECTIVE: To investigate the efficacy of autologous bone marrow mesenchymal stem cell (BMSC) transplantation in patients with spinal cord injury (SCI) using meta-analysis, aiming to provide evidence-based guidance for clinical practice.

METHODS: Electronic databases such as PubMed, Web of Science, Cochrane Library and Embase were searched. Studies comparing the therapeutic effects of autologous BMSC transplantation and rehabilitation therapy on patients with SCI were included. The pooled effect size of autologous BMSC transplantation on the American Spinal Injury Association (ASIA) scores was calculated using the random- or fixed-effects model.

RESULTS: A total of seven eligible studies involving 288 patients with SCI were included in this study. The meta-analysis results showed that autologous BMSC transplantation significantly improved ASIA sensory scores (mean difference (MD): 8.80; 95% confidence interval (CI): 5.93, 11.67), ASIA motor scores (MD: 7.94; 95% CI: 2.05, 13.83), ASIA grade improvement (odds ratio (OR): 4.88; 95% CI: 2.48, 9.61) and somatosensory evoked potential improvement (OR: 3.34; 95% CI: 1.54, 7.25). This study did not find a statistically significant positive effect of autologous BMSC transplantation on bladder function and adverse events.

CONCLUSION: The therapeutic efficacy of autologous BMSC transplantation is encouraging, but further multicentre, large-sample, prospective studies are still needed.

PMID:40326527 | PMC:PMC12061012 | DOI:10.1530/EOR-2024-0142

EFORT Open Rev. 2025 Apr 1;10(4):203-212. doi: 10.1530/EOR-2024-0083.

ABSTRACT

Focal cartilage lesions refer to localized damage or defects in the cartilage covering joint surfaces, often resulting from trauma, wear and tear or underlying joint conditions. These lesions can lead to pain, impaired joint function and, if left untreated, may contribute to the development of degenerative joint diseases. Challenges in treatment of focal cartilage lesion are mainly due to limited intrinsic healing capacity, difficulty in early detection of lesions and variability in symptoms make timely intervention tricky. Conservative treatments varies from addressing symptoms using physical therapy, corticosteroid injections and viscosupplementation, to regenerative attempts such as in platelet-rich plasma and mesenchymal stem cells therapy. These modalities provide a limited duration of improvement and are commonly used to delay more aggressive treatment. Traditional surgery options are mainly summed up by microfractures (MFX) for smaller lesions, osteochondral autograft transfer, osteochondral allograft transfer (OCA) and autologous matrix-induced chondrogenesis for moderate-to-large lesions. Cellular approaches encompass autologous chondrocyte implantation (ACI), which involve targeted transplantation of chondrocytes. Current research is concentrating on cell-based surgical approaches utilizing advanced biomaterials for both scaffold and scaffold-free implants. While gene therapy and tissue engineering approaches aim to optimize chondrocyte proliferation and differentiation for improved quality of the transplanted biomaterial and patient's outcomes.

PMID:40167465 | DOI:10.1530/EOR-2024-0083

EFORT Open Rev. 2025 Apr 1;10(4):172-185. doi: 10.1530/EOR-2024-0088.

ABSTRACT

PURPOSE: This systematic review and meta-analysis investigated validity and test-retest reliability of inertial measurement units (IMUs) in gait metrics, static balance and functional mobility performance in community-dwelling older adults.

METHODS: Spatiotemporal/biomechanical outcomes were meta-analyzed using intraclass correlation coefficients (ICCs) or Pearson correlation coefficients (r) for validity and reliability, respectively.

RESULTS: In our systematic review of 56 articles and meta-analysis of 38 articles, the included studies varied in quality from low-to-moderate. During validity analysis, IMU-derived metrics, including walking speed, cadence, step/stride time, step time variability, step/stride length and duration of sit-to-stand (STS) test/timed up, and go test (TUGT) exhibited excellent (ICCs) or good-to-excellent (r values) agreement with gold standards. In terms of reliability, excellent test-retest consistency was found for walking speed, cadence, step/stride time, stance/swing time, step/stride length during gait, individual STS duration, TUGT duration and walking speed during the 6-min walk test.

CONCLUSIONS: Due to consistently high levels of validity and reliability, the present study supported the use of IMUs for measuring gait spatiotemporal outcomes. However, caution was advised when applying spatiotemporal variability and symmetry metrics. In addition, characterized by moderate-to-good validity and reliability, current review provides evidence of a neutral nature regarding the utilization of IMUs for static balance and functional mobility performance.

PMID:40167464 | DOI:10.1530/EOR-2024-0088

EFORT Open Rev. 2025 Apr 1;10(4):193-202. doi: 10.1530/EOR-24-0097. Print 2025 Apr 1.

ABSTRACT

PURPOSE: To provide a comprehensive, systematic review on the relationship and effects of smoking on clinical outcomes after meniscus surgery.

METHODS: The following combination of keywords was entered into the electronic search engines: meniscus, meniscus repairs, meniscectomy, meniscal tear, meniscus excision AND (smoke OR smoking OR nicotine OR tobacco). The year of the study, country, type of study, number of subjects, medial/lateral/both menisci, body mass index, smoking status, mean age, gender, follow-up, type/pattern of injury, surgical implications and clinical outcomes were recorded.

RESULTS: A total of 23 studies published in 2013-2024 were included in the analysis. In ten studies, the meniscus injury was associated with an anterior cruciate ligament (ACL) tear. In four studies, the effect of smoking on meniscal allograft transplantation (MAT) was investigated. The neutral effect of smoking on meniscus surgery was revealed in nine studies, and only one of them focused on isolated meniscus pathology and surgery. The negative effect of smoking on meniscus surgery was shown in ten papers, with four papers focused on isolated meniscus tears and six papers presenting data with concurrent ACL reconstructions.

CONCLUSIONS: This systematic review found that the results regarding the impact of smoking on meniscus repair outcomes were conflicting. Nevertheless, MAT and meniscus repair performed in the presence of concurrent ligamentous injury, both being demanding surgical procedures, require reduction of factors that may contribute to failure. Therefore, cessation of smoking in patients undergoing these procedures is highly advised.

PMID:40167455 | DOI:10.1530/EOR-24-0097

EFORT Open Rev. 2025 Apr 1;10(4):186-192. doi: 10.1530/EOR-2024-0126.

ABSTRACT

Trauma induced by surgery stimulates a neuroendocrine stress response, substantially increasing cortisol levels in the post-surgical setting. This has substantial effects on metabolism, water and electrolyte balance as well as on the cardiovascular, nervous and immune systems. While there are valid data on cortisol level courses in a variety of specific pathologies, such as septic shock, acute respiratory distress syndrome, bacterial meningitis, cardiac arrest, community-acquired pneumonia and influenza, there is a persisting lack of data on the cortisol stress response after musculoskeletal surgery. The present review provides an overview of the current state of research regarding trauma-induced cortisol response after musculoskeletal interventions, including both elective orthopedic surgery and trauma surgery. Trauma induced by musculoskeletal surgery triggers a cortisol response, which varies significantly depending on the type of surgery and its invasiveness. Notably, elective orthopedic procedures demonstrate a smaller range of cortisol levels compared to musculoskeletal trauma and surgery. In the future, high-quality prospective trials need to analyze the factors that may modulate the adequate adrenal response to stress, such as preoperative long-term treatments with glucocorticoids, as well as the potential impact of low cortisol levels and perioperative cortisol substitution therapy on pain management, blood requirements, catecholamine dependency, delirium and mortality after musculoskeletal surgery.

PMID:40167425 | DOI:10.1530/EOR-2024-0126

EFORT Open Rev. 2025 Feb 3;10(2):95-103. doi: 10.1530/EOR-24-0100. Print 2025 Feb 1.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) in patients who underwent previous knee surgeries can be a challenging procedure both technically and for the complication rate. Conversion TKA is affected by a higher risk of infection compared to primary TKA. The aims of this meta-analysis are i) to compare the infectious risk among patients undergoing TKA after a prior hardware implantation, evaluating removal vs maintenance of the hardware, and ii) within the removal group, to compare staged vs concurrent procedure.

METHODS: In accordance with the PRISMA guidelines, a systematic literature review was conducted up to January 2024. The review was registered in the PROSPERO database: CRD42024510444. The inclusion criteria comprised the following: i) patients aged 18 years or older, ii) individuals who had undergone total knee replacement and iii) those with a history of prior nonabsorbable hardware implantation. The pooled incidence of periprosthetic joint infections (PJI) was reported using odds ratios with corresponding 95% confidence intervals (CIs).

RESULTS: The investigation of database and references identified 284 studies. PJI risks differed significantly among groups, with a higher risk in the removal group (z = 3.5630, P = 0.0004). Furthermore, within the removal group, the risk of PJI was lower in cases of staged removal compared to concurrent removal (z = 2.0931, P = 0.0363).

CONCLUSIONS: TKA following a previous knee hardware implantation indicates a higher PJI risk when the hardware is removed compared to leaving it in place. If hardware removal is necessary, staged removal is recommended. The presence of minor hardware is the only scenario where, if removal is necessary, one-stage approach is preferred.

PMID:40071998 | PMC:PMC11825155 | DOI:10.1530/EOR-24-0100

EFORT Open Rev. 2025 Mar 3;10(3):125-140. doi: 10.1530/EOR-2024-0129.

ABSTRACT

This review focuses on the anatomic and radiographic characteristics of the pediatric proximal femur and the advantages and disadvantages of different protocols for the management of pediatric femoral neck fractures (PFNFs) in terms of fracture classification, reduction methods, reduction quality and fixation methods, with the goal of proposing an optimal treatment protocol for PFNFs to reduce the incidence of postoperative complications. The anatomic and radiographic characteristics of the pediatric proximal femur, including the presence of an active growth plate, an immature femoral calcar, greater trabecular density and plasticity and a relatively immature blood supply are very different from those of the adult proximal femur. Treatment protocols for PFNFs must differ from those for adult femoral neck fractures. PFNFs with posterior translation, and those with comminuted medial-posterior columns, are associated with a higher postoperative complication rate. This review suggests that the degree of damage to the nutrient vessels along the posterior femoral neck and the stability of the medial-posterior column of the femoral neck should be well assessed in patients with PFNFs for both classification and treatment purposes. Anatomic reduction through an anterior approach, placement of a small number of implants in the mid-inferior part of the femoral neck and additional external support are effective in reducing postoperative complications in patients with PFNFs.

PMID:40071987 | PMC:PMC11896687 | DOI:10.1530/EOR-2024-0129

EFORT Open Rev. 2025 Feb 3;10(2):82-94. doi: 10.1530/EOR-24-0002. Print 2025 Feb 1.

ABSTRACT

Wounds in orthopaedic surgery differ from wounds in other surgical fields in various ways. Tissues that are highly affected due to the trauma itself, the presence of an orthopaedic implant and the performance of prosthetic surgery in patients with many comorbidities make these wounds need special consideration. Complications of the surgical wound in orthopaedic surgery are not unusual, being the main cause of medical care and readmission in the first 90 days. There is no consensus on the best way to perform closure in orthopaedic surgery. The national 'Adequate Wound Management in Orthopaedic Surgery' survey has shown interindividual variability in wound closure and soft tissue management in orthopaedic surgery at the local level. This consensus document, generated by a group of experts in soft tissue management in orthopaedic surgery, proposes recommendations based on evidence (using the GRADE methodology) to promote best practices in this field. This document considers recommendations for surgical wound closure, dressing management and haemostasis. In addition, some of the 32 questions in the national survey, plus others relevant to the subject, were taken as a starting point for developing the contents.

PMID:40071985 | PMC:PMC11825138 | DOI:10.1530/EOR-24-0002

EFORT Open Rev. 2025 Feb 3;10(2):66-74. doi: 10.1530/EOR-22-0088. Print 2025 Feb 1.

ABSTRACT

PURPOSE: Evolving evidence demonstrates the role of epigenetics in the pathogenesis of osteoarthritis (OA), whereas in terms of mechanism, DNA methylation has received the highest attention thus far. This systematic review summarizes the current knowledge of DNA methylation and its influence on the pathogenesis of OA.

METHODS: A protocol in alignment with the PRISMA guidelines was employed to systematically review eight bibliographic databases between 1 January 2015 and 31 January 2021, to identify associations between DNA methylation and articular chondrocytes in OA.

RESULTS: We identified 23 gene-specific studies and 28 genome-wide methylation analyses. Gene-specific studies focused on pro-inflammatory markers in OA, demonstrating that DNA hypomethylation in the promoter region results in overexpression and hypermethylation is linked to gene silencing. Others reported on the association between OA risk genes and DNA methylation. Genome-wide methylation studies reported on differentially methylated regions (DMRs) comparing OA and non-OA chondrocytes. DMRs were seen in hip OA and knee OA chondrocytes.

CONCLUSION: The current body of literature demonstrates the potential and crucial role of DNA methylation in the pathogenesis and progression of OA. This knowledge contributes to the understanding of the pathomechanisms behind OA at gene-specific and genome-wide levels. The observed differences in DNA methylation between healthy and diseased tissues indicate the occurrence of changes in DNA methylation. Based on this, future research in this field that explores the characteristics of potentially reversible changes in DNA methylation may lead to opportunities for causative treatment options for OA.

PMID:40071982 | PMC:PMC11825139 | DOI:10.1530/EOR-22-0088

EFORT Open Rev. 2025 Mar 3;10(3):151-155. doi: 10.1530/EOR-24-0137. Print 2025 Mar 1.

ABSTRACT

Foraminal and extraforaminal lumbar disc herniations are common sources of pain and disability. Classic surgical treatments, such as open approach through Witsel technique, often involve resection of the superior articular process to decompress the foraminal space. Unilateral biportal endoscopy (UBE) has emerged as a minimally invasive alternative, providing enhanced visualization and precision while minimizing soft tissue damage. The extraforaminal approach using UBE offers a more effective solution for extraforaminal herniations, requiring less bone resection, reducing the risk of pars fracture and enhancing visualization. This article presents a comprehensive methodology for the extraforaminal approach, supported by an illustrated guide, surgical tips and highlights of UBE's advantages over traditional techniques.

PMID:40071975 | PMC:PMC11896681 | DOI:10.1530/EOR-24-0137

EFORT Open Rev. 2025 Mar 3;10(3):156-165. doi: 10.1530/EOR-24-0087. Print 2025 Mar 1.

ABSTRACT

Neurogenic bladder (NB) is a group of bladder and/or urethral dysfunctions caused by neurological lesions, commonly seen in patients with lumbar spine diseases, manifesting as urinary storage and voiding dysfunction, significantly affecting patients' quality of life. Degenerative changes or trauma to the lumbar spine can lead to narrowing of the dural sac, compressing the sacral nerve roots, cauda equina or blood vessels, causing bladder dysfunction and leading to NB. Diagnostic methods for NB include history taking, physical examination and noninvasive and invasive tests, such as urodynamic testing and cystoscopy. The treatment goals for NB are to protect upper urinary tract function, restore or partially restore lower urinary tract function, improve urinary control, reduce residual urine volume, prevent urinary tract infections and improve patients' quality of life. Treatment methods include conservative treatment, pharmacological treatment, catheterization, neuromodulation and surgical treatment, which should be sequentially administered based on the patient's specific condition.

PMID:40071973 | PMC:PMC11896685 | DOI:10.1530/EOR-24-0087