EFORT Open Rev. 2025 Dec 5;10(12):894-902. doi: 10.1530/EOR-2025-0020.

ABSTRACT

PURPOSE: Telemedicine has emerged as a valuable tool in spinal surgery, enabling remote consultations, preoperative assessments, and postoperative care. This systematic review evaluates its impact on clinical outcomes, patient satisfaction, and healthcare resource use from 2020 to 2024, highlighting key benefits, challenges, and future research directions.

METHODS: A systematic search of PubMed/MedLine, Scopus, Web of Science, and Embase identified studies assessing telemedicine in patients undergoing spinal surgery. Covidence (Covidence, Melbourne, Australia) was used for screening and selection. Risk of bias was evaluated, and a qualitative synthesis was conducted following SWiM guidelines due to study heterogeneity. Data were standardised to one decimal place, except for reported P-values.

RESULTS: In total, 37 studies comprising 91,139 patients met inclusion criteria. Telemedicine demonstrated high diagnostic accuracy, with concordance rates exceeding 90% in most studies. Patient satisfaction remained consistently high (86.9-96.4%). It improved treatment adherence, pain management, and functional outcomes. Key advantages included cost-effectiveness and increased accessibility, though challenges such as bias and technological limitations persist.

CONCLUSION: Telemedicine plays a significant role in spinal surgery, offering high diagnostic accuracy, patient satisfaction, and improved clinical outcomes, including reduced pain and disability. It enhances compliance, reduces costs, and improves access to care. However, technological barriers, regulatory concerns, and study heterogeneity underscore the need for further research. Telemedicine holds promise for transforming spinal surgery care.

PMID:41347774 | DOI:10.1530/EOR-2025-0020

EFORT Open Rev. 2025 Dec 5;10(12):882-893. doi: 10.1530/EOR-2025-0021.

ABSTRACT

Malignant bone tumors, including primary bone tumors, such as osteosarcoma (OS), Ewing's sarcoma (ES), and multiple myeloma, and secondary bone tumors from prostate and breast cancers, pose significant mortality risks. Osteoblasts (OBs) and their derivatives play critical roles in the development, recurrence, and metastasis of these tumors. OBs promote metastasis-related events, including osteoclast differentiation and proliferation. Their derivatives, including extracellular vesicles and cytokines, modulate bone remodeling and tumor development through various signaling pathways. Recent in vivo and in vitro studies highlight the involvement of OBs in tumor progression, recurrence, and metastasis. Emerging therapies targeting OBs and their derivatives show promise in improving patient outcomes. The review emphasizes the importance of understanding the specific roles of OBs and their derivatives in malignant bone tumors. This knowledge can lead to the development of new therapeutic strategies aimed at improving patient survival rates and quality of life. Key findings include the regulatory effects of OBs on tumor dormancy, the vicious cycle of bone metastasis, and the potential for targeted therapies to disrupt these processes. Future research should focus on developing experimental models that more closely mimic the human tumor microenvironment and integrating multiple signaling pathways to create comprehensive treatment strategies.

PMID:41347773 | DOI:10.1530/EOR-2025-0021

EFORT Open Rev. 2025 Dec 5;10(12):865-881. doi: 10.1530/EOR-2024-0204.

ABSTRACT

PURPOSE: The purpose of this systematic review and meta-analysis was to synthesise available evidence on functional outcomes, knee stability, and complications between quadriceps tendon with patellar bone block (B-QT) and quadriceps soft-tissue (S-QT) autografts for primary anterior cruciate ligament reconstructions (ACLR).

METHODS: A systematic search (PROSPERO ID: CRD42023472220) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was performed on PubMed/MEDLINE, EMBASE, and WoS. The data concerning functional outcomes, knee stability, and complications were analysed.

RESULTS: There were 5,898 B-QT patients (67.5% male) and 1,849 S-QT patients (51.5% male) included, with a mean age of 27.4 ± 9.3 and 24.7 ± 9.2 years and mean follow-up of 28.9 months (5.3-123.6 months) and 25.3 months (6.0-69.9 months), respectively. In a meta-analysis, the B-QT had higher KOOS subscales scores: activity-of-daily-living 95.98 (95% CI: 94.09-97.88) vs 93.88 (95% CI: 93.66-94.11), P = 0.028; pain 91.99 (95% CI: 89.48-94.49) vs 88.51 (95% CI: 88.21-88.81), P = 0.005; sports & recreation 84.26 (95% CI: 79.20-89.31) vs 79.21 (95% CI: 78.69-79.73), P = 0.041; symptoms 87.82 (95% CI: 84.75-90.90) vs 81.26 (95% CI: 80.71-81.82), P < 0.001; quality-of-life 78.28 (95% CI: 73.68-82.89) vs 65.37 (95% CI: 60.59-70.15), P < 0.001; and a higher Marx score: 11.90 (95% CI: 10.92-12.87) vs 9.65 (95% CI: 8.21-11.09), P = 0.006. B-QT had higher side-to-side difference in anteroposterior tibial translation: 1.55 mm (95% CI: 1.33-1.77) vs 1.15 mm (95% CI: 0.85-1.33 mm), P = 0.026.

CONCLUSION: A QT autograft, with or without a bone block, provides satisfactory functional outcomes, knee stability, and few complications in primary ACLR. B-QT may result in higher patient-reported outcomes, while S-QT may potentially result in slightly improved knee stability.

PMID:41347769 | DOI:10.1530/EOR-2024-0204

EFORT Open Rev. 2025 Jun 2;10(6):388-395. doi: 10.1530/EOR-2025-0062.

ABSTRACT

The orthoplastic approach refers to an integrated evaluation of the surgical approach, the preoperative planning of surgical margins of resection, the loss of healthy tissue, the size of the resultant tissue defect, the functional defect, the impact of neoadjuvant therapies on local tissue, the patient's comorbidities, and predicted survival in order to decide the most favorable reconstruction option for the individual patient with a sarcoma. Microsurgical techniques are an essential component of the tissue reconstruction ladder. The vascularity of the flap used for reconstruction does not compromise the oncological outcomes, nor does it increase local recurrence or reduce overall survival. Free-vascularized fibula grafts are the most common osseous flaps used for bone defect reconstruction. Adequate fixation is necessary to provide mechanical stability and to increase the rate of primary bone union. Soft tissue wound closure under tension results in wound failure, especially when preoperative radiation therapy is used. Flap reconstruction decreases the rate of wound healing complications, allowing for continuation of adjuvant therapies. Soft-tissue local flaps are frequently used to treat tissue defects with a low complication rate. Plastic reconstruction should be tailored to the specific needs of patients.

PMID:41231048 | PMC:PMC12139711 | DOI:10.1530/EOR-2025-0062

EFORT Open Rev. 2025 Jun 2;10(6):369-377. doi: 10.1530/EOR-2025-0056.

ABSTRACT

Scepticism is still the most common attitude of orthopaedic surgeons toward short stems, despite the excellent survival rate reported in the International Registry, together with an acceptable complication risk. In surgical centres where these types of implants are commonly utilised, they account for a significant percentage of procedures (up to 50% of total hip replacements performed). Potential benefits of bone preservation were evident from the very early phase of introduction. Some complications have been experienced, especially with modular short stems. Some limitations and weak points during the evolution from early designs to modern short stems have been identified. With few exceptions, clinical results and survivorship were very good, despite widened indications (age- and pathology-related), giving an overall retrospective evaluation of our experience with short stems similar to primary hip implants. Failure of short stems is mostly related to the validity of bone preservation in terms of revision strategy. Standard surgical revision was generally performed with two-stage revisions in PJI and stem revision in periprosthetic fracture.

PMID:41223040 | PMC:PMC12139602 | DOI:10.1530/EOR-2025-0056

EFORT Open Rev. 2025 Nov 3;10(11):851-864. doi: 10.1530/EOR-2024-0183.

ABSTRACT

The subacromial bursa is located below the acromion, coracoacromial ligament, and deltoid deep fascia, above the rotator cuff and greater tuberosity of the humerus, and plays a crucial role in physiological processes such as exercise and pathological processes of rotator cuff diseases. The subacromial bursa is associated with inflammatory pain in patients with rotator cuff disease. Removing the bursa during surgery and intra-articular drug injection can both relieve this pain to some degree. Resection of the subacromial bursa improves intraoperative visualization and may loosen an already stiff shoulder joint; however, excessive resection appears to result in more severe adhesion. Current evidence suggests that the subacromial bursa is a source of reparative cytokines and mesenchymal stem cells that may contribute to and enhance the healing of the injured rotator cuff and improve prognosis. Research studies related to the utilization of the subacromial bursa for bioaugmentation is ongoing and shows potential to promote patient recovery. Preservation or bioaugmentation with the subacromial bursa during rotator cuff surgery might lead to a better prognosis, but there is not yet sufficient evidence to prove this.

PMID:41223039 | PMC:PMC12587034 | DOI:10.1530/EOR-2024-0183

EFORT Open Rev. 2025 May 5;10(5):267-276. doi: 10.1530/EOR-2024-0026.

ABSTRACT

PURPOSE: Total hip arthroplasty (THA) is performed commonly for various end-stage diseases of the hip joint. However, the likelihood of a subsequent contralateral THA (cTHA) after primary unilateral index THA (iTHA) remains insufficiently defined, with reported rates of 13-29.1% after 5 years and 8.7-54% after 10 years of follow-up. This review aims to determine the long-term likelihood over time of cTHA after iTHA.

METHODS: Systematic review of the literature with meta-analysis, including any clinical study published until July 2022, evaluating or documenting the likelihood over time of cTHA after iTHA, independently of the etiology. Excluded were cTHA within 12 months. A total of 21 studies, including 1,456,071 patients, who subsequently received 249,117 cTHA, were analyzed. Kaplan-Meier analysis was performed, weighting data on sample size, considering death as competing risk.

RESULTS: At 5 years after iTHA, likelihood of cTHA was 17.8% (95% confidence interval 12.3-23.3%). At 10 years, this likelihood increased to 22.7% (16.1-29.4%), with a marginal subsequent increase. The likelihood increased slightly considering death as competing risk.

CONCLUSION: Nearly every fourth THA patient will require cTHA within 10 years. The likelihood of cTHA in this review appears to fall within the lower third of previously published ranges. However, most cTHA are required within the first years. Our findings suggest that the likelihood of requiring cTHA within the initial 10 years is approximately twice as high as the likelihood of requiring revision of the iTHA.

PMID:41223035 | PMC:PMC12061014 | DOI:10.1530/EOR-2024-0026

EFORT Open Rev. 2025 Oct 1;10(10):796-805. doi: 10.1530/EOR-2024-0188.

ABSTRACT

PURPOSE: To evaluate the time taken to recover from arthroscopic rotator cuff repair (ARCR) in terms of pain and function, and to determine if there is an association with the size of the tear.

METHODS: PubMed and EMBASE were searched according to preferred reporting items for systematic reviews and meta-analyses guidelines. The recovery pattern of clinical outcomes and range of motion (ROM) was reported narratively. The percentage of the total improvement at 3 months, 6 months, and 1 year was defined as the recovery rate (%) at each time point. The 2-year score was considered 100% recovery. Subgroup analysis based on tear size was performed.

RESULTS: In total, 28 studies were included in this systematic review. Visual analog scale (VAS) pain score showed over 50% recovery at 3 months, while other clinical scores reached this threshold by 6 months. At 1 year, all clinical scores showed approximately 85% recovery. ROM worsened or showed minimal improvement at 3 months and significant improvement by 6 months or 1 year after ARCR. Tear size did not significantly affect clinical scores at any follow-up period (all P > 0.05).

CONCLUSION: All clinical scores including VAS pain score showed significant improvement at 3 or 6 months after ARCR. Especially, recovery of VAS pain score was faster compared to other clinical scores up to 6 months. ROM recovery slowly started at 6 months after ARCR. Recovery pattern was not different according to the tear size. It can give patients a better understanding of recovery after the operation.

PMID:41223034 | PMC:PMC12495555 | DOI:10.1530/EOR-2024-0188

EFORT Open Rev. 2025 Nov 3;10(11):842-850. doi: 10.1530/EOR-2024-0131.

ABSTRACT

BACKGROUND: Metastatic disease frequently causes pathological fractures, particularly in the proximal femur, significantly impacting patient prognosis and quality of life. With the advancements in cancer treatment leading to longer survival, there is a pressing need to evaluate the outcomes of surgical interventions aimed at managing proximal femoral metastases. This study compares the outcomes of internal fixation (IF) versus prosthesis (P) in the treatment of proximal femoral metastases, focusing on survival times, complication rates, functional outcomes, and reoperation rates.

METHOD: A systematic review and meta-analysis were conducted, searching PubMed, Embase, and Cochrane databases for studies published up to December 31, 2023. The PRISMA guidelines were followed. Studies comparing IF and P for proximal femoral metastases were included. Data on survival times, blood loss, reoperation rates, and functional scores were extracted and analyzed using the forest plot technique and inverse variance method. The quality of included studies was assessed using the Newcastle-Ottawa scale.

RESULTS: In total, 19 studies (16 retrospective and three prospective) involving 4,126 patients were included. The P group demonstrated significantly longer survival times compared with the IF group, with no significant difference in complication and reoperation rates between the two methods. However, IF was associated with shorter operative times and less blood loss.

CONCLUSION: P may provide superior long-term functional outcomes and extended survival compared with IF, with similar rates of complications and reoperations. However, selection bias - where healthier patients with better baseline physiology are more likely to undergo prosthetic reconstruction - significantly impacts the interpretation of these findings, underscoring the need for further prospective studies.

PMID:41223022 | PMC:PMC12587033 | DOI:10.1530/EOR-2024-0131

EFORT Open Rev. 2025 Nov 3;10(11):829-841. doi: 10.1530/EOR-2025-0100.

ABSTRACT

PURPOSE: Phosphaturic mesenchymal tumors (PMTs) are rare neoplasms causing tumor-induced osteomalacia (TIO), usually through fibroblast growth factor 23 (FGF-23) secretion. They arise in bone or soft tissue and present with non-specific symptoms, often leading to delayed diagnosis. This study evaluates tumor characteristics, the role of surgical therapy, and its impact on outcomes while highlighting key aspects of PMT management.

METHODS: A systematic review was conducted according to PRISMA guidelines, including 188 studies and 584 PMT cases, focusing on clinical presentation, treatment modalities, and outcomes. In addition, we retrospectively analyzed four patients treated at our institution.

RESULTS: The mean patient age was 49 ± 15 years, with a slight male predominance (56%). Tumors were evenly distributed between bone and soft tissue, most commonly affecting the lower extremities. Frequent symptoms included pain (90%) and pathological fractures (69%). Elevated FGF-23 levels were detected preoperatively in over 90% of cases. Complete remission was achieved in 66.2% of surgically treated patients compared to 29.4% of non-operatively managed patients (P < 0.001). Complete resection was associated with significantly higher remission rates (55.7 vs 6.6%, P = 0.001), particularly in bone-localized PMT. In our case series, all patients undergoing complete resection showed no evidence of disease and relief of TIO-associated symptoms.

CONCLUSIONS: PMTs often lead to diagnostic delays due to non-specific symptoms. Complete surgical resection is the strongest predictor of favorable outcomes, especially for bone-localized tumors. An interdisciplinary approach is critical for early diagnosis, optimal treatment, and maximizing favorable clinical outcomes.

PMID:41182108 | PMC:PMC12587032 | DOI:10.1530/EOR-2025-0100

EFORT Open Rev. 2025 Oct 1;10(10):733-744. doi: 10.1530/EOR-2023-0179.

ABSTRACT

Hip pain can be caused by extra-articular conditions such as subspine impingement, iliopsoas impingement, and ischiofemoral impingement. These syndromes are frequently secondary to underlying pathologies involving the hip joint or lumbar spine. While most cases are managed conservatively through activity modification and physiotherapy, surgical intervention is considered for refractory cases. Imaging, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) is crucial for diagnosing these conditions, as clinical symptoms can be nonspecific. CT scans help identify predisposing factors such as acetabular morphology, femoral version, and acetabular version, while MRI is useful for ruling out other conditions and detecting soft tissue pathology. Although positive treatment outcomes are generally observed, there are variations in results and procedures, and long-term follow-up studies are lacking. Complications of the treatments are a concern, but most reported complications are minor in nature.

PMID:41031635 | PMC:PMC12494060 | DOI:10.1530/EOR-2023-0179

EFORT Open Rev. 2025 Oct 1;10(10):771-781. doi: 10.1530/EOR-2025-0027.

ABSTRACT

PURPOSE: This study aimed to systematically evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in total knee arthroplasty (TKA).

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. Data extraction and quality assessment were performed independently by two investigators. The primary outcomes were hemoglobin (Hb) decrease and blood loss, while secondary outcomes included transfusion rate, operation time, hospital stay, and complications. The analysis used random-effects models and assessed heterogeneity with I 2 values.

RESULTS: Nine studies were included in the meta-analysis, comprising a total of 1,227 participants. Across the included studies, oral TXA was most commonly administered as 1.95-2 g given 1-2 h before surgery, with some regimens including postoperative doses. Intravenous TXA was typically given as 1 g before surgery, sometimes with additional doses before wound closure or after surgery. The results showed no significant difference between oral and intravenous TXA in terms of Hb decrease and transfusion rates. Similarly, there was no significant difference in complications, operation time, and length of hospital stay. Comparable findings were observed in both RCTs and non-RCTs. Sensitivity analysis demonstrated that the overall results remained robust, with no single study exerting a substantial influence on the pooled estimates.

CONCLUSIONS: Based on available evidence, there is no significant difference observed between oral and intravenous TXA in patients undergoing TKA. However, the wide confidence intervals for several outcomes indicate important uncertainty, and further high-quality studies are needed to confirm the comparative effectiveness and safety.

PMID:41031630 | PMC:PMC12495541 | DOI:10.1530/EOR-2025-0027

EFORT Open Rev. 2025 Oct 1;10(10):815-828. doi: 10.1530/EOR-2025-0041.

ABSTRACT

OBJECTIVE: Primary spondylodiscitis poses significant diagnostic and therapeutic challenges, with delayed diagnosis or improper treatment potentially resulting in severe complications. This systematic review aimed to summarize the latest diagnostic and therapeutic approaches for primary spondylodiscitis.

METHODS: Adhering to PRISMA 2020 guidelines, we conducted a systematic literature review. PubMed was comprehensively searched for English-language original studies from January 1, 1990, to October 31, 2024. Structured queries combined keywords and MeSH terms relevant to spondylodiscitis, vertebral osteomyelitis, spinal infection, and associated treatments. Two reviewers independently screened titles, abstracts, and full texts, with manual bibliography searches as a supplement. A total of 147 articles were finally included.

RESULTS: The literature indicates that diagnosis can be based on clinical suspicion, using serological, radiological, and microbiological tests. Newer methods such as metagenomics next-generation sequencing (mNGS) and positron emission tomography-computed tomography (PET-CT) can enhance diagnostic sensitivity and specificity. For confirmed cases, appropriate antibiotic therapy is crucial. Surgical treatment can benefit patients with neurological deficits, sepsis, spinal instability/deformity, epidural abscesses, or failed conservative treatment, accelerating recovery and reducing complications. Minimally invasive surgical approaches may also serve as an alternative to open surgery for select patients.

CONCLUSION: Although new technologies have improved diagnostic accuracy and treatment success rates for primary spondylodiscitis, establishing a robust staging system is vital to ensure patients receive effective, evidence-based treatment options.

PMID:41031628 | PMC:PMC12495883 | DOI:10.1530/EOR-2025-0041

EFORT Open Rev. 2025 Oct 1;10(10):756-762. doi: 10.1530/EOR-2024-0179.

ABSTRACT

PURPOSE: The surgical reconstruction of the medial patellofemoral ligament (MPFL) is a commonly used treatment for recurrent patellar dislocations. A surgical method which is frequently used is the dynamic reconstruction of the MPFL (dMPFLr), which involves attaching the released end of a hamstring muscle to the medial patella using a pulley. The aim of this systematic review and meta-analysis is to evaluate the evidence of this method in terms of patient-reported outcomes, the rate of recurrent instabilities, and other complications.

METHODS: MEDLINE® and Web of Science™ were used to identify eligible studies. We used a random-effects meta-analysis to estimate the pooled rates of the Kujala scores, rates of recurrent instabilities, and complication rates.

RESULTS: A total of 1,087 studies were screened for eligibility. Six studies, comprising a total of 267 treated knees, met the inclusion criteria and were included. All the publications included were retrospective analyses (level of evidence III). The random-effects model showed an overall mean postoperative Kujala score of 86.74 (95% CI: 79.37-94.11; heterogeneity: I 2 = 94%), a recurrent instability rate of 13% (95% CI: 9-18%; heterogeneity: I 2 = 0%), and additional complications mentioned at a rate of 9% (95% CI: 5-16%; heterogeneity: I 2 = 0%).

CONCLUSION: Although good results are achieved with regard to the patient-reported outcomes and complication rates, there is a high rate of recurrent instabilities. Despite these results, dMPFLr can be considered an option for the treatment of skeletally immature patients, as it avoids the need for intraoperative fluoroscopy and the risk of epiphyseal joint injury due to femoral fixation.

PMID:41031627 | PMC:PMC12494057 | DOI:10.1530/EOR-2024-0179

EFORT Open Rev. 2025 Oct 1;10(10):782-795. doi: 10.1530/EOR-2025-0022.

ABSTRACT

PURPOSE: To quantify the response to intra-articular saline administration in terms of pain, function, and quality of life, with a focus on the evolution of placebo response over time and the identification of influencing factors on the placebo response to knee osteoarthritis injections.

METHODS: After registration on PROSPERO, a systematic review was conducted following PRISMA guidelines to identify double-blind, placebo-controlled randomised clinical trials on intra-articular knee injections for knee osteoarthritis. The placebo response was evaluated through meta-analyses of VAS pain, WOMAC, KOOS, and responder rates at 1-, 3-, 6-, and 12-months on placebo arms of included trials. The evolution of placebo response over time was assessed, and meta-regression was conducted. Risk of bias and quality of evidence were assessed following Cochrane guidelines.

RESULTS: From the initial 2,746 records, 73 articles on 5,895 patients were included. The meta-analysis demonstrated statistically and clinically significant improvements at the 1-, 3-, and 6-month follow-ups. At the 12-month follow-up, placebo response declined and was no longer clinically significant for some sub-scores. Responder rates exceeded 50% at 1-, 3-, and 6-months. The placebo response was stronger in studies with a higher proportion of female participants and in more recently published trials.

CONCLUSIONS: Placebo response to intra-articular injections is statistically and clinically significant in knee osteoarthritis for pain, function improvement, and patients' quality of life, with responses peaking at 4-8 months but evidence up to 12 months. Among influencing factors, female sex and recent publications seem to present stronger placebo responses, emphasising the importance of placebo-controlled trials to evaluate knee osteoarthritis treatments.

PMID:41031623 | PMC:PMC12495556 | DOI:10.1530/EOR-2025-0022

EFORT Open Rev. 2025 Oct 1;10(10):806-814. doi: 10.1530/EOR-2025-0010.

ABSTRACT

Teardrop fractures of the cervical spine are characterized by a triangular-shaped fragment located in the anteroinferior corner of the vertebral body. Flexion-type teardrop fractures are highly unstable injuries resulting from a flexion-compression mechanism. A notable feature of these injuries is retrolisthesis of the vertebral body, which is often associated with a high risk of neurological compromise. The anterior approach is the most commonly used surgical treatment for flexion-type teardrop fractures. In contrast, extension-type teardrop fractures primarily affect the axis vertebral body and are generally stable injuries that can be treated nonoperatively.

PMID:41031621 | DOI:10.1530/EOR-2025-0010

EFORT Open Rev. 2025 Oct 1;10(10):745-755. doi: 10.1530/EOR-2024-0155.

ABSTRACT

This review presents a standardized, stepwise method for biplanar radiographic analysis of knee alignment, integrating both coronal and sagittal measurements for use in arthritic and non-arthritic knees. It critically compares leading classification systems, including the coronal plane alignment of the knee (CPAK) and the functional knee phenotype classifications. While CPAK provides a simplified 2D coronal model, the functional phenotype system offers a more granular, 3D approach that includes segmental deformities and has recently been expanded to incorporate laxity parameters. Sagittal plane parameters - including posterior tibial slope and femoral component flexion/extension - are essential for comprehensive alignment assessment. These factors influence implant positioning, knee kinematics, and postoperative function. The review outlines preferred measurement techniques, highlighting the value of long-leg weight-bearing radiographs and discussing the limitations and variability of 2D versus 3D imaging approaches. Incorporating both alignment and soft tissue behavior provides a more individualized approach to total knee arthroplasty planning and may lead to improved outcomes by better replicating native knee biomechanics.

PMID:41031620 | PMC:PMC12494059 | DOI:10.1530/EOR-2024-0155

EFORT Open Rev. 2025 Oct 1;10(10):726-732. doi: 10.1530/EOR-2024-0056.

ABSTRACT

PURPOSE: To synthesize and critically appraise the literature on long-term outcomes of proximal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years.

METHODS: This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of proximal osteotomies of the M1 for non-inflammatory and non-degenerative HV at a minimum follow-up of 5 years were included. We found four eligible studies comprising four datasets, and all assessed proximal osteotomies with a mean follow-up that ranged from 8 to 18 years.

RESULTS: The systematic search returned 7,918 records, of which 2,693 were duplicates, leaving 5,225 for screening. Of these, four studies were included, covering a total of 158 feet with a mean follow-up that ranged from 8 to 18 years. The pooled HVA following proximal osteotomies was 20.4° (CI: 11.3°-29.4°; I 2 = 95%), pooled IMA was 8.8° (CI: 3.3°-14.2°; I 2 = 98%), and pooled AOFAS was 82.1 (CI: 62.4-101.8; I 2 = 97%).

CONCLUSIONS: At a minimum follow-up of 8 years following proximal osteotomies of M1, the HVA was 20.4° and the IMA was 8.8°. Furthermore, the recurrence rates considering the various thresholds of HVA were 12% having >30°, 73% having >20°, and 13% if recurrence is a >10° increase in HVA.

LEVEL OF EVIDENCE: Meta-analysis, level IV.

PMID:41031617 | PMC:PMC12493268 | DOI:10.1530/EOR-2024-0056

EFORT Open Rev. 2025 Oct 1;10(10):763-770. doi: 10.1530/EOR-2024-0213.

ABSTRACT

In patients with knee osteoarthritis, tibial stress fractures are mostly associated with osteoporosis and lower limb malalignment. Nonoperative management may lead to knee stiffness (due to prolonged immobilization), persistence of pain (due to the underlying knee osteoarthritis), and fracture nonunion. Acute unstable tibial stress fractures can be managed with long-stem total knee arthroplasty. Exposing the fracture site should be avoided as much as possible because it may be associated with skin necrosis and delayed union. In irreducible cases or fractures with persistent gaps, fibular osteotomy, by increasing the mobility and compression across the fracture site, may help with fracture reduction and decrease the rate of nonunion.

PMID:41031615 | PMC:PMC12494058 | DOI:10.1530/EOR-2024-0213

EFORT Open Rev. 2025 Sep 4;10(9):679-685. doi: 10.1530/EOR-2024-0040.

ABSTRACT

The normal functioning of the shoulder is characterized by the harmonious coordination between the glenohumeral joint and the scapulothoracic complex, a phenomenon commonly referred to as scapulohumeral rhythm (SHR). Reverse total shoulder arthroplasty (rTSA) shoulders exhibit distinct kinematics compared to normal shoulders. Reduced scapulohumeral rhythm (SHR) in rTSA shoulders implies a greater reliance on scapulothoracic motion over glenohumeral motion for arm elevation. Dynamic analyses suggest heightened scapulothoracic movement after rTSA, implying alterations in rotational movements across various planes. Utilization of reliable tools to measure preoperative scapulothoracic motion and forecast postoperative SHR in rTSA may improve functional results. Posture types and scapulothoracic orientation play an important role in optimal implant configuration and positioning, as well as clinical outcome, and should therefore be considered during patient selection, preoperative planning, and implantation of an rTSA. Recognizing the static position and kinematic changes of the scapulothoracic joint is vital for postoperative rehabilitation and optimizing outcomes in rTSA patients.

PMID:40905937 | PMC:PMC12412366 | DOI:10.1530/EOR-2024-0040