EFORT Open Rev. 2025 Aug 4;10(8):636-645. doi: 10.1530/EOR-2024-0135.

ABSTRACT

Hamstring injuries are a significant concern in high-speed running and kicking sports, contributing to a high incidence and recurrence rate among athletes. Anatomical and biomechanical properties of the hamstrings, especially the biceps femoris long head, make them susceptible to strain, contributing to the high injury rate observed in athletes. Key risk factors, including prior injury history, neuromuscular deficiencies, excessive load, and muscle-tendon architecture, have been identified as contributors to injury prevalence. Eccentric strengthening exercises, particularly the Nordic hamstring exercise, are highlighted for their effectiveness in reducing the incidence of hamstring injuries. Stretching protocols, when combined with strengthening exercises, have shown potential in enhancing muscle flexibility and reducing injury risk, although their standalone effectiveness remains a subject of ongoing research.

PMID:40757809 | PMC:PMC12326974 | DOI:10.1530/EOR-2024-0135

EFORT Open Rev. 2025 Aug 4;10(8):611-622. doi: 10.1530/EOR-2024-0119.

ABSTRACT

The main goal of a successful total knee arthroplasty is to relieve pain and restore function. While mechanical alignment provides excellent long-term implant survivorship, clinical and functional outcomes remain less than ideal. As a result, the focus has gradually shifted to a more personalized surgical approach based on the patient's specific characteristics. There is a pressing need for agreement on definitions of key terms to standardize limb alignment measurements and improve understanding and communication within the field. This work aims to clarify the concept of native limb alignment, outline how it is measured, and propose a standardized terminology to describe it.

PMID:40757805 | PMC:PMC12326966 | DOI:10.1530/EOR-2024-0119

EFORT Open Rev. 2025 Aug 4;10(8):600-610. doi: 10.1530/EOR-2024-0128.

ABSTRACT

PURPOSE: Meniscal extrusion (ME) can have detrimental effects. The aim of this study was to analyze the evidence about the reliability, potential of standing and dynamic evaluations, and influencing factors identified by using ultrasound (US) to evaluate knee ME.

METHODS: A systematic review of the literature was performed in February 2024 on PubMed, Scopus, and the Cochrane Library databases to select all articles, dealing with the US evaluation of ME. Relevant data of the involved articles, including study type, number of patients, age, sex, US technique, and data comparison with other radiological examinations, were extracted and collected for the study analysis.

RESULTS: Sixty studies on 4,742 patients were included: 38 cross-sectional, ten longitudinal, two case-control, and ten biomechanical studies. A strong correlation was found between MRI and US, with good US sensitivity (96%) and specificity (82%), and moderate to excellent interrater and intrarater reliability. US examinations in the standing position with weight-bearing or more complex dynamic conditions reported a significant influence of weight-bearing on MME. US was able to identify a relationship between meniscus posterior root tear and MME, as well as between ME and both pain and early osteoarthritis.

CONCLUSIONS: US is a valuable tool for the study of ME and the identification of the association between ME and various conditions. US in dynamic and weight-bearing evaluations is useful to characterize this anatomical abnormality in different pathologies, including OA, meniscal lesions, and in the follow-up of surgical procedures, providing important data to choose the best treatment to address patients affected by ME.

PMID:40757803 | PMC:PMC12326973 | DOI:10.1530/EOR-2024-0128

EFORT Open Rev. 2025 Jun 30;10(7):572-573. doi: 10.1530/EOR-2025-0029.

NO ABSTRACT

PMID:40591688 | PMC:PMC12226823 | DOI:10.1530/EOR-2025-0029

EFORT Open Rev. 2025 Jun 30;10(7):562-569. doi: 10.1530/EOR-2024-0147.

ABSTRACT

PURPOSE: This scoping review examines the epidemiology and incidence of complications associated with incorrect screw length in orthopaedic trauma surgeries, aiming to underscore its impact on clinical outcomes and healthcare costs.

METHODS: Guided by Arksey and O'Malley's framework and PRISMA guidelines, a thorough search was conducted across PubMed, Web of Science, Cochrane, and Google Scholar up to April 2024. Studies included must be human-based orthopaedic procedures involving screw length, published in peer-reviewed journals with full text available, and report complications from incorrect screw length; studies excluded were systematic reviews/meta-analyses. Paper characteristics and data on incident rates of complications due to screw protrusion were extracted and presented in a supplementary table using Microsoft Excel.

RESULTS: Of 2,285 studies identified, 31 met the inclusion criteria. Incorrect screw length led to severe complications, including neurovascular damage (7 studies), avascular necrosis (4 studies), delayed union or pseudoarthrosis (9), tendinitis/tendon rupture (12 studies), and pain (10 studies). Notably, improperly sized screws increased neurovascular and avascular necrosis complications, especially in weight-bearing joints. In addition, incorrect screw length was linked to higher hardware removal rates, contributing to increased healthcare costs. Limitations include the inability of some studies to definitively attribute complications to screw protrusion and the exclusion of cases involving joint collapse or solely mechanical complications.

CONCLUSION: This review underscores the importance of precise screw length selection to prevent complications and improve surgical outcomes. It calls for further research on the medico-legal and economic impacts of screw length errors and the need for better surgical practices.

PMID:40591687 | PMC:PMC12229280 | DOI:10.1530/EOR-2024-0147

EFORT Open Rev. 2025 Jul 1;10(7):510-519. doi: 10.1530/EOR-2024-0069.

ABSTRACT

PURPOSE: Dexmedetomidine is a widely employed adjunct in nerve block anesthesia for shoulder arthroscopy. This study aimed to assess the analgesic efficacy of dexmedetomidine as a nerve block adjuvant in patients undergoing shoulder arthroscopy.

METHODS: A thorough search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify randomized-controlled trials comparing the effects of dexmedetomidine-enhanced shoulder arthroscopy nerve blocks against those without dexmedetomidine. This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane-recommended risk of bias tool was employed for quality and bias assessment. Statistical analysis, utilizing Review Manager 5.4 with a significance level of P < 0.05, focused on primary outcomes: duration of analgesia and postoperative 24 h morphine consumption, and secondary outcomes: motor and sensory block duration, visual analog scale pain scores and adverse events.

RESULTS: Out of 307 articles retrieved, ten randomized-controlled trials involving 672 patients were included. Dexmedetomidine supplementation significantly prolonged the duration of analgesia (MD = 3.58, 95% CI: 2.53- 4.63, P < 0.00001, I 2 = 77%) and decreased postoperative morphine consumption (MD = -11.88, 95% CI: -17.25 to -6.52, P < 0.0001, I 2 = 41%). In addition, the dexmedetomidine group exhibited lower VAS pain scores at 1, 12 and 24 h postoperatively. No significant differences were observed in motor block duration, bradycardia (P = 0.18), hypotension (P = 0.50) and nausea and vomiting (P = 0.76). Sensitivity analyses validated the robustness of these findings.

CONCLUSIONS: This meta-analysis supports dexmedetomidine as an effective adjuvant in nerve blocks for shoulder arthroscopy. It enhances postoperative analgesia without increasing adverse events such as bradycardia, hypotension and nausea and vomiting.

PMID:40591683 | DOI:10.1530/EOR-2024-0069

EFORT Open Rev. 2025 Jun 30;10(7):570-571. doi: 10.1530/EOR-2024-0140.

NO ABSTRACT

PMID:40591682 | PMC:PMC12226824 | DOI:10.1530/EOR-2024-0140

EFORT Open Rev. 2025 Jul 1;10(7):439-444. doi: 10.1530/EOR-2025-0126.

NO ABSTRACT

PMID:40591679 | DOI:10.1530/EOR-2025-0126

EFORT Open Rev. 2025 Jul 1;10(7):475-486. doi: 10.1530/EOR-2024-0093.

ABSTRACT

While conventional structural magnetic resonance imaging (MRI) can detect cruciate ligament anatomy and injuries, it has inherent limitations. Recently, novel MRI technologies such as quantitative MRI and artificial intelligence (AI) have emerged to mitigate these shortcomings, providing critical quantitative insights beyond gross morphological imaging and poised to expand current knowledge in assessing cruciate ligament injuries and to facilitate clinical decision making. Quantitative MRI serves as a noninvasive histological and quantification tool, which significantly improves the evaluation of degeneration and repair processes. AI plays a crucial role in automating radiological estimations and enabling data-driven predictions of future events. Despite the transformative impact of advanced MRI techniques on the analytical and diagnostic algorithms related to cruciate ligament disorders, future efforts are warranted to address challenges such as economic burdens and ethical considerations.

PMID:40591678 | DOI:10.1530/EOR-2024-0093

EFORT Open Rev. 2025 Jun 30;10(7):534-542. doi: 10.1530/EOR-2024-0053.

ABSTRACT

Occurring in 0.5-3% of cases, periprosthetic humerus fractures pose a challenge, necessitating effective management strategies. A comprehensive review was conducted using PubMed. Used terms included 'Periprosthetic humerus fractures; complications; periprosthetic fractures shoulder arthroplasty; periprosthetic humeral fracture treatment; nerve palsy humeral revision arthroplasty; infections after shoulder arthroplasty; postoperative complications AND open reduction AND humeral fractures; allograft AND long humeral stem'. Studies were excluded if they did not meet the actual topic, included more than primary shoulder arthroplasty and/or were in non-English or non-German language. Thirty-eight papers with evidence levels ranging from two to three were selected for this review. Various classification systems have been implemented; their validation though was based on studies with only a limited number of patients. Risk factors include osteopenia/osteoporosis, rheumatoid arthritis, age, age-related lifestyle and gender. Treatment options range from conservative approaches to plate osteosynthesis or revision to a longer stem. Nevertheless, there is a lack of biomechanic studies and randomized-controlled clinical studies; hence, the evidence is low. Complications in revision arthroplasty encompass infections, nonunions, and nerve palsies, highlighting the importance of individualized treatment planning. The management of periprosthetic humeral fractures requires careful consideration of risk factors and tailored treatment plans. Existing literature relies on small case series and expert opinions, highlighting the need for further research to establish optimal treatment strategies for these challenging fractures.

PMID:40591677 | DOI:10.1530/EOR-2024-0053

EFORT Open Rev. 2025 Jul 1;10(7):466-474. doi: 10.1530/EOR-2024-0167.

ABSTRACT

PURPOSE: To evaluate the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of osteonecrosis of the femoral head (ONFH).

METHODS: Search for term systems related to ONFH and HBOT in PubMed, Cochrane Library, Embase and Web of Science databases. The risk ratio (RR) was used as the effective index for dichotomous variables while mean difference (MD) and 95% confidence interval (CI) were used as the effective index for continuous variables, with a two-sided P < 0.05 considered statistically significant. I2 statistic and Q test were used to evaluate the statistical heterogeneity of the included studies.

RESULTS: Ten studies were included, involving 568 participants. Pre-post meta-analyses to show the visual analog scale after HBOT (MD = -2.94, 95% CI: -4.27, -1.60, P < 0.0001), short form 12 physical component summary scale (SF12 PCS) (MD = 17.28, 95% CI: 8.26, 26.31, P = 0.0002), short form 12 mental component summary scale (SF12 MCS) (MD = 4.26, 95% CI: 2.56, 5.95, P < 0.00001), Harris hip score (HHS) (MD = 26.91, 95% CI: 0.35, 53.46, P = 0.05), modified Harris hip score (mHHS) (MD = 44.31, 95% CI: 13.75, 74.87, P = 0.004) were significantly different from those before treatment. The results of SF12 PCS (MD = -0.39, 95% CI: -7.85, 7.06, P = 0.92) and SF12 MCS (MD = 0.76, 95% CI: -7.02, 8.52, P = 0.85), patients' improved events (RR = 1.83, 95% CI: 0.37, 9.09, P = 0.46) showed no significant difference between the HBO and non-HBO groups.

CONCLUSION: The results of this study indicate that HBOT cannot be regarded as an effective measure for the treatment of early-stage necrosis of the femoral head and more large-scale randomized controlled trials are needed for further verification.

PMID:40591670 | DOI:10.1530/EOR-2024-0167

EFORT Open Rev. 2025 Jun 30;10(7):520-533. doi: 10.1530/EOR-2024-0078.

ABSTRACT

PURPOSE: Various conservative and surgical treatments was clinically applied in rotator cuff calcific tendinitis (RCCT), the evaluation of distinction among all available intervention is still lacking. This study aims to systematically compare the efficacy and safety of these interventions and provide guidance for RCCT treatment.

METHODS: The study utilized four electronic databases for literature retrieval and is registered in PROSPERO. Network meta-analyses (NMA) were conducted for continuous outcomes such as functional improvement and pain relief. For the outcome of calcification deposit resolution, due to discrepancies in statistical methods and insufficient data for pooling, a systematic review was conducted. The Cochrane Risk of Bias 2 tool was used to assess the risk of bias.

RESULTS: A total of 33 randomized-controlled trials (RCTs) covering 26 treatment methods were included. In nonsurgical treatments, comprehensive physical therapy (PT) methods (ranked 1st in Surface Under the Cumulative Ranking (SUCRA)) showed the best performance in terms of functional improvement, followed by high-energy extracorporeal shock wave therapy (ESWT-H) + PT, which ranked 2nd. For pain relief, radial shock wave therapy (RSWT) + PT (ranked 1st) was most effective. In surgical treatments, arthroscopic bursectomy debridement of rotator cuff (ABD) + arthroscopic subacromial decompression (ASD) showed similar effects to ABD alone for functional improvement (SMD: -0.01, 95% CI: -0.54 to 0.57) and pain relief (SMD: -0.02, 95% CI: -0.51 to 0.43), with no significant differences observed. For calcification resolution, ultrasound-guided needling (UGN) + subacromial corticosteroid injection (SAI) demonstrated promising therapeutic potential.

CONCLUSION: Comprehensive PT demonstrates superior efficacy in improving functional outcomes, while RSWT + PT significantly alleviates pain. In terms of surgical interventions, ABD alone demonstrated similar clinical effects to ABD + ASD in both functional improvement and pain relief. However, there is currently no direct data to compare the effectiveness of operative versus nonoperative treatments for RCCT.

TRIAL REGISTRATION: PROSPERO CRD42023476423.

PMID:40591667 | DOI:10.1530/EOR-2024-0078

EFORT Open Rev. 2025 Jul 1;10(7):487-495. doi: 10.1530/EOR-2024-0189.

ABSTRACT

PURPOSE: This scoping review aimed to map the literature on the effects of growth plate violation with intramedullary locking nail (IMN) at the knee in skeletally immature patients. It focused on assessing clinical and experimental outcomes, with particular attention to complications such as growth arrest and deformities.

METHODS: This scoping review followed the PRISMA extension for scoping reviews, with registered protocol at the Open Science Framework. A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus was performed for studies involving pediatric patients with open growth plates treated with IMNs at the knee and animal studies assessing physeal violations.

RESULTS: Ten studies were included, comprising six clinical, three animal studies, and one review. The clinical studies included 89 pediatric patients treated either with retrograde femoral or antegrade tibial nailing. The youngest patient was a 7-years-old female, and there were no reported cases of growth arrest following IMN. Animal studies demonstrated that up to 7% of physeal violation did not result in significant growth disturbances, but exceeding this threshold led to growth inhibition. In addition, implant removal showed mixed results, with early bone bridge formation noted in few cases.

CONCLUSIONS: Limited physeal violations by IMN may not cause significant growth disturbances, while exceeding certain thresholds could result in adverse outcomes. The current evidence is insufficient to make recommendations on the use of IMN at the knee in skeletally immature patients, particularly to make recommendations regarding age, femur/tibia and sex. Further research is needed to establish long-term outcomes and optimal guidelines for safe physeal instrumentation.

LEVEL OF EVIDENCE: 4.

PMID:40591666 | DOI:10.1530/EOR-2024-0189

EFORT Open Rev. 2025 Jun 30;10(7):543-550. doi: 10.1530/EOR-2024-0160.

ABSTRACT

PURPOSE: Our study aims to compare different perioperative treatments to reduce C. acnes, the most common causative agent of surgical site infections following shoulder surgery.

METHODS: A systematic search was performed in MEDLINE (PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and the Web of Science for studies published up to October 20, 2022. We included randomized-controlled trails investigating the efficacy of different dermal preparation in reducing the C. acnes colonising the skin surface. The studies examined positive bacterial cultures before and after skin treatment. The included trials were able to compare seven different skin treatment methods. We performed a frequentist network meta-analysis and calculated pooled risk ratios (RRs) with 95% confidence interval (CI).

RESULTS: Our study could include comparisons of 946 different patients. The use of 5% benzoyl peroxide (BPO) and its combination with the antibiotic clindamycin was found to be the most effective in reducing C. acnes colonization on the skin (BPO 5% RR = 0.25, CI: 0.08-0.72, BPO with clindamycin RR = 0.25, CI: 0.04-1.50). Based on the rank plot, 5% BPO (P score: 0.808) was the most effective treatment, followed by BPO 5% with clindamycin (P score: 0.749). We could not perform a network meta-analysis regarding the efficacy of different dermal preparation in reducing C. acnes colonization on the dermis and in the joint.

CONCLUSION: Cutibacterium colonization of the skin flora can be effectively reduced on the skin surface by the use of 5% BPO.

PMID:40591665 | DOI:10.1530/EOR-2024-0160

EFORT Open Rev. 2025 Jul 1;10(7):496-509. doi: 10.1530/EOR-2025-0006.

ABSTRACT

Developmental dysplasia of the hip (DDH) is a common neonatal musculoskeletal condition characterized by hip instability and inadequate acetabular coverage. If untreated, it can lead to osteoarthritis, chronic pain, and eventual hip replacement. Animal models, including dogs, pigs, sheep, rabbits, rodents, and chickens, are essential tools for studying DDH pathogenesis and testing therapeutic strategies. Larger species closely resemble human anatomy, while smaller species facilitate cost-effective, high-throughput studies and advanced genetic manipulation. Key modeling strategies include surgical interventions (e.g. joint dislocation, femoral or pelvic osteotomy), external fixation, and genetic modifications (e.g. gene knockout or lentiviral transduction) to simulate various aspects of DDH and reflect its multifactorial etiology. Evaluation techniques such as radiography, microcomputed tomography, MRI, and ultrasound are employed to image bony and cartilaginous structures. Histological and immunohistochemical analyses provide insights into cellular and extracellular matrix changes, while gait assessments evaluate functional deficits and pain-related behaviors. Selecting an appropriate animal model requires careful consideration of research objectives, ethical standards, and translational potential. Advances in gene editing technologies (e.g. CRISPR), three-dimensional-printed implants, and in vivo imaging are enhancing model fidelity and accelerating the discovery of novel therapies. Ongoing innovations in DDH research are expected to bridge gaps in understanding the disease's etiology and improve long-term outcomes for affected patients through optimized therapeutic interventions.

PMID:40591661 | DOI:10.1530/EOR-2025-0006

EFORT Open Rev. 2025 Jul 1;10(7):445-453. doi: 10.1530/EOR-2024-0154.

ABSTRACT

Enabling our patients to recover back to their pre-injury state or beyond is at the core of every treatment in orthopedic trauma surgery. Current methods of assessing functional recovery after extremity trauma largely focus on individual segments of complex, compound activities, or are created for a specific purpose and for specific populations. Such assessment instruments cannot readily account for the effect of limitations in adjacent segments. Equally, the segment-specific instruments use limited domains to assess complex actions and aptitudes. Most traditional functional assessment tools do not accommodate the individual nature of function and only assess function in larger increments during follow-up clinic visits. Recent developments of both commercial and medical-grade wearable systems and associated digital technologies can overcome most of the challenges associated with traditional outcome measures. In this review, we introduce the main technologies and their potential to track patient functional recovery in relation to the treatment phase, both before and after an injury.

PMID:40591659 | DOI:10.1530/EOR-2024-0154

EFORT Open Rev. 2025 Jul 1;10(7):454-465. doi: 10.1530/EOR-2024-0152.

ABSTRACT

PURPOSE: To compare the efficacy and safety of topical tranexamic acid (TXA) to systemic administration (intravenous and oral) and placebo in hip and knee surgeries.

METHODS: This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was conducted in PubMed and Scopus to compare the bleeding, hospitality, and morbidity between topical tranexamic acid with systemic administration of TXA and placebo. Random-effect models and meta-regressions were used to generate pooled estimates and assess heterogeneity.

RESULTS: Eighty RCTs with 13,969 patients were identified reporting on the outcomes of using topical tranexamic acid in hip fracture surgery, hip arthroplasty and knee arthroplasty compared with intravenous, oral, and placebo. Overall, topical TXA acid decreased total blood loss (-353 mL (95% CI: -395, -311), P < 0.001), drainage volume (-239.802 mL (95% CI: -298.744, -180.859), P < 0.001), intraoperative blood loss (-14.994 mL (95% CI: -34.370, 4.382), P < 0.001), hidden blood loss (-123.711 mL (95% CI: -153.703, -93.719), P < 0.001), total hemoglobin loss (-0.970 gr/dL (95% CI: -1.289, -0.651), P < 0.001), total hematocrit loss (-0.937 (95% CI: -1.289, -0.584), P < 0.001), and blood transfusion rate (RR diff.: 0.480 (95% CI: 0.386, 0.597), P < 0.001) compared to placebo. No significant differences were observed between topical TXA and systemic routes (intravenous or oral) in total blood loss, transfusion rates, and hemoglobin levels.

CONCLUSION: Topical TXA (intra-articular, peri-articular, or wound irrigation) significantly reduced blood loss, drain volume, hemoglobin loss, and transfusion need compared to placebo. Subgroup analysis showed that topical TXA outperformed placebo and was similar to intravenous and oral routes.

PMID:40591647 | DOI:10.1530/EOR-2024-0152

EFORT Open Rev. 2025 Jun 30;10(7):551-561. doi: 10.1530/EOR-2024-0061.

ABSTRACT

Radiography is of importance in the diagnosis of atlantoaxial dislocation (AAD), and it is the basic imaging technique. However, it should not be the sole diagnostic modality, especially in complex or unclear cases. Conventional X-ray includes an open-mouth odontoid view and a cross-table lateral view, and careful study of radiological findings is crucial to give an early diagnosis of AAD. Lateral flexion-extension dynamic views are only used as an additional supplement in some special cases. Although X-ray images are enough to diagnose AAD in most cases, some patients suspected with AAD should be evaluated with the readily available and quick CT scan. If patients with AAD have symptoms of spinal cord and medullary compression, apart from conventional radiographs, a combination of high-quality CT and MRI of cervical spine are necessary for the diagnosis and choice of treatment. For patients with AAD, both the thin slice CT scanning with coronal, sagittal and three-dimensional reconstruction images and MRI of cervical spine are fundamental to surgical planning. Clinical classifications of AAD associated with imaging are useful in determining treatment strategies. The present study reviews publications on imaging and clinical classification of AAD to aid the clinician in the evaluation and management of these dislocations.

PMID:40591637 | DOI:10.1530/EOR-2024-0061