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

EFORT Open Rev. 2025 Jun 2;10(6):345-351. doi: 10.1530/EOR-2025-0069.

ABSTRACT

Orthobiologics (OBs) have seen a constant increase in the number of available therapies and their clinical applications. Existing therapies can be categorized into blood-based (e.g., platelet-rich plasma (PRP)) and tissue/cell-based (e.g. mesenchymal stromal cells) approaches. While the popularity of OBs continues to grow, their diverse natures create unique challenges for the establishment of evidence-based guidelines. PRP has been reported by meta-analyses to increase patient-reported outcomes for conditions such as knee osteoarthritis (KOA), lateral epicondylitis and plantar fasciitis. However, the randomized controlled trials (RCTs) included often exhibit a high risk of bias due to the heterogeneity in the PRP preparation protocols and accompanying measures as well as inconsistent trial quality. The development pipeline of cell/tissue-based therapies is typically longer and more cost-intensive than that of blood-based therapies. Nevertheless, several products have demonstrated clinical safety. While some RCTs and meta-analyses on the outcome of cell/tissue-based therapies exist, their number is considerably lower than that of blood-based therapies and they focus mainly on KOA, with limited evidence on other orthopedic indications. Orthopedic societies such as ESSKA and AAOS have taken on the challenge of developing guidelines for OBs by combining high-level synthesized evidence with expert consensus. Patient stratification strategies represent a promising key to unlocking the full potential of OBs and are currently being investigated in ongoing studies. Further efforts to establish guidelines for the use of OBs should focus on developing frameworks for clinical trials and their reporting, alongside standardized protocols for the preparation, application and accompanying measures of OB therapies.

PMID:40459170 | PMC:PMC12139597 | DOI:10.1530/EOR-2025-0069

EFORT Open Rev. 2025 Jun 2;10(6):396-402. doi: 10.1530/EOR-2025-0052.

ABSTRACT

Shoulder arthroplasty is increasingly utilised among patients under 55 years of age due to rising incidences of traumatic injuries, inflammatory arthritis, avascular necrosis, degenerative joint diseases and heightened participation in demanding sports and occupational activities. Anatomic shoulder arthroplasty (ASA) remains the preferred surgical option for younger patients with intact rotator cuffs and minimal glenoid deformities, preserving natural biomechanics, strength and range of motion, and demonstrating high long-term implant survival rates at 10-15 years. Despite favourable outcomes, ASA carries potential long-term risks including implant wear, prosthetic loosening, glenoid erosion and progressive rotator cuff degeneration, particularly relevant for physically active younger patients. Reverse shoulder arthroplasty (RSA) offers a valuable alternative in complex clinical scenarios characterised by irreparable rotator cuff tears, extensive glenoid bone loss, severe anatomical disruption or previous surgical failures. RSA can be used as an alternative to ASR for primary osteoarthritis and an intact rotator cuff, with excellent clinical outcomes and survivorship in patients over 60. RSA is also being used successfully in patients under the age of 55 with excellent short-term results. There remain concerns regarding the longevity and reliability of RSA in younger, highly active individuals. ASA can be revised to RSA with good clinical outcomes, while failure of RSA is extremely challenging to address. If we accept that ASA will fail with time, then the primary ASA should allow for ease of revision to an RSA. Recent advances in modular prosthetic designs facilitate simpler revisions from ASA to RSA.

PMID:40459169 | PMC:PMC12139712 | DOI:10.1530/EOR-2025-0052

EFORT Open Rev. 2025 Jun 2;10(6):424-430. doi: 10.1530/EOR-2025-0055.

ABSTRACT

Crush injury arises from prolonged external force on soft tissues, resulting in muscle necrosis and systemic manifestations known as crush syndrome. Pathophysiology involves ischemia, reperfusion injury and the release of toxic metabolites, which lead to rhabdomyolysis, electrolyte imbalances, acute kidney injury and potential multi-organ failure. Early management emphasizes aggressive fluid resuscitation, urine alkalinization and electrolyte correction to avert life-threatening hyperkalemia and renal impairment. Controversies include the use of mannitol, indications for fasciotomy and optimal dialysis timing. Each must be individualized according to patient status and resource availability. Emerging therapies focus on addressing inflammation and oxidative stress, aiming to transition from largely supportive care to more causative interventions. Despite medical advances, prompt recognition, coordinated multidisciplinary care and proactive measures remain vital to reducing morbidity and mortality in crush syndrome, especially in disaster settings.

PMID:40459168 | PMC:PMC12139709 | DOI:10.1530/EOR-2025-0055

EFORT Open Rev. 2025 Jun 2;10(6):352-360. doi: 10.1530/EOR-2025-0058.

ABSTRACT

Surgical decompression of carpal tunnel syndrome is usually successful, and failure is rare. Diagnosis of persistent or recurrent carpal tunnel syndrome is based on thorough anamnesis and clinical examination, defining underlying comorbidities, nerve conduction studies and distinguish recurrent, persistent or new complaints. Management of failed carpal tunnel release may require revision surgery, which includes redo release of the transversal carpal ligament, external neurolysis and flaps. A hypothenar fat pad flap or other local, regional or distant flaps may be added to a redo release of the carpal tunnel. Currently, convincing evidence to superiority of additional flap surgery is lacking. Postoperative care is evolving toward early motion rather than immobilization, with nerve gliding exercises to prevent adhesions and promote nerve recovery. Virtual reality was recently added to postoperative protocol options.

PMID:40459165 | PMC:PMC12139599 | DOI:10.1530/EOR-2025-0058

EFORT Open Rev. 2025 Jun 2;10(6):431-438. doi: 10.1530/EOR-2025-0054.

ABSTRACT

Psychological consequences of trauma: Acute stress reactions and post-traumatic stress disorder are common psychological conditions that affect the healing process. Early interventions: Psychological first aid and psychoeducation are evidence-based approaches aimed at mitigating post-traumatic symptoms. Social support: It plays a central role in psychological stabilisation and promotion of functional recovery. Multidisciplinary approaches: Cooperation between orthopaedists, psychologists and social workers is crucial for optimal treatment results. Challenges in clinical practice: Limited time, stigmatisation of mental illness and inadequate resources are common barriers to effective care.

PMID:40459162 | PMC:PMC12139708 | DOI:10.1530/EOR-2025-0054

EFORT Open Rev. 2025 Jun 2;10(6):361-368. doi: 10.1530/EOR-2025-0053.

ABSTRACT

The French paradox cementing technique encompasses a canal filling highly polished stem with a thin (<1 mm) cement mantle. The technique has been developed by Pr Marcel Kerboull in the late 1960s after he observed the patterns of debonding of the original Charnley stem. The key point of the technique is based upon removal of the metaphyseal cancellous bone (with hollow reamers or aggressive broaches) especially at the supero-medial region. Only two stems have been validated with this technique: the Charnley-Kerboull (CK) and the Ceraver Osteal stem, both of which are collared. This technique is neither a taper slip (the stem does not subside at long-term follow-up) nor a composite beam (a highly polished stem is used). A 12% shortened stem CK has shown similar results to the standard-length stem, including the absence of stem subsidence. Combined with the Hueter anterior approach, this technique has demonstrated one of the lowest femoral PPF rate in elderly patients in the literature.

PMID:40459160 | PMC:PMC12139596 | DOI:10.1530/EOR-2025-0053

EFORT Open Rev. 2025 Jun 2;10(6):378-387. doi: 10.1530/EOR-2025-0051.

ABSTRACT

Patellar dislocations present predominantly during adolescence, with a higher incidence observed among female patients. Patellofemoral joint stability depends critically on both osseous anatomy and soft tissue structures. Patellofemoral pathology can be classified into three major groups: objective patellar instability OPI, potential patellar instability and painful patellar syndrome. Three primary risk factors predispose individuals to patellar dislocation: trochlear dysplasia, patella alta and increased tibial tuberosity-trochlear groove (TT-TG) distance. Three secondary risk factors should be considered: femoral and tibial rotational abnormalities and valgus deformity. MRI has become the imaging modality of choice, enabling precise quantification of OPI risk factors in a single imaging examination. The 'menu à la carte' approach guides the treatment of OPI by addressing the most relevant anatomical risk factors for each patient using statistical thresholds.

PMID:40459157 | PMC:PMC12139600 | DOI:10.1530/EOR-2025-0051

EFORT Open Rev. 2025 Jun 2;10(6):403-415. doi: 10.1530/EOR-2025-0070.

ABSTRACT

BACKGROUND: Despite the growing burden of degenerative cervical myelopathy (DCM), consensus on the optimal timing of surgical intervention remains lacking, especially for patients with mild symptoms or asymptomatic cord compression or in the context of recent trauma. Different scores, such as the mJOA, Nurick scale and NDI are commonly used to classify disease severity, but guidelines for managing these patients do not provide a clear framework for intervention timing.

MATERIALS AND METHODS: We conducted a narrative review of the literature on the optimal timing of surgical intervention for DCM, using PubMed to identify relevant studies. The search was focused on surgical and non-operative management, clinical and radiological assessments, biomarkers and emerging technologies. The selected papers were reviewed for relevance and quality, with guidance from a senior author.

RESULTS: The initial search identified 6,705 articles, which were narrowed down to 136 relevant studies after applying filters for study type and clinical focus. A final selection of 87 papers was categorized by topics and the findings were synthesized to highlight trends, challenges and knowledge gaps in surgical timing for DCM.

FOCUS OF THE STUDY: This review article examines strategies for determining the optimal timing for surgery in DCM. It explores how radiological signs, clinical indicators and other markers may help identify patients at risk of rapid neurological deterioration, particularly in the 'grey-zone' population (mild symptoms or asymptomatic disease), enabling clinicians to assess correctly different clinical scenarios and to indicate timely surgical intervention.

PMID:40459154 | PMC:PMC12139713 | DOI:10.1530/EOR-2025-0070

EFORT Open Rev. 2025 Jun 2;10(6):416-423. doi: 10.1530/EOR-2025-0037.

ABSTRACT

Posterolateral tibial plateau fractures are complex injuries requiring a thorough understanding of the anatomical structures involved, including the popliteus tendon, lateral collateral ligament and posterior horn of the lateral meniscus. Standard anterolateral or midline approaches provide limited access to the posterolateral corner, often necessitating specific surgical techniques to achieve optimal fracture reduction and joint stability. This review explores the main surgical approaches used for these fractures outlining their indications, advantages and limitations. Each section provides a step-by-step guide for an effective surgical technique, based on experience from a high-volume trauma center, to optimize exposure, reduction and fixation. Understanding the biomechanical and anatomical aspects of these fractures is crucial for selecting the most appropriate surgical strategy, minimizing complications and improving patient outcomes.

PMID:40459152 | PMC:PMC12139710 | DOI:10.1530/EOR-2025-0037

EFORT Open Rev. 2025 Jun 2;10(6):336-344. doi: 10.1530/EOR-2025-0050.

ABSTRACT

Current non-surgical managements of osteoarthritis (OA) do not change the clinical course or arrest the progression of the disease, while joint replacement is indicated for end-stage disease. Given these limitations, there is an unmet clinical demand for new treatment modalities that can improve the pain and quality of life of patients suffering from OA without surgery. The recent surge of interest in regenerative medicine (RM) for OA is based on these circumstances. Unlike traditional medicine, RM products may be accompanied by many uncertainties and long-term consequences. Considering that OA directly affects quality of life rather than life and death, the 'first do no harm' principle is more important when applying RM technology to the disease. Presently, culture-expanded mesenchymal stromal cells (MSCs) and orthobiologics, including bone marrow aspirate concentrate, stromal vascular fraction from adipose tissue and platelet-rich plasma have been applied to patients in clinical trials. Results of randomized clinical trials using MSCs have demonstrated that structural improvement and reversal of the pathologic process in OA are not definitely shown, while symptomatic relief is apparent. Orthobiologics seem to have efficiency comparable to those of culture-expanded MSCs. With the advantage of avoiding the approval process from regulation agencies, orthobiologics might provide a less expensive and handier option to culture-expanded MSCs. High-quality data from a large number of patients and head-to-head comparisons of several RM products will be necessary to define the place of culture-expanded MSCs or orthobiologics for OA treatment and resolve the reimbursement issue.

PMID:40459150 | PMC:PMC12139601 | DOI:10.1530/EOR-2025-0050

EFORT Open Rev. 2025 Jun 2;10(6):327-335. doi: 10.1530/EOR-2025-0057.

ABSTRACT

Charcot neuroarthropathy is the most severe complication of the diabetic foot. Its diagnosis is difficult and often overlooked, delaying management, with sometimes disastrous consequences. Its incidence is increasing due to the rapid global rise in the number of people with diabetes. Its pathophysiology remains unclear, although the activation of the RANK/RANK-L system appears to be involved, triggered either by neurotraumatic or neurovascular mechanisms, leading to the differentiation of monocytes into osteoclasts. Diagnosis relies on clinical and radiological arguments, particularly MRI. There are different types of Charcot foot depending on the evolution, according to Eichenholtz's classification and based on location according to Sanders and Brodsky's classifications. Treatment involves a multidisciplinary approach with diabetes management and addressing other general complications. Medical treatment is indicated as the first line, with offloading and immobilisation using a 'total contact cast'. In case of failure of this method, or if there is immediate deformity, surgical intervention is indicated, and techniques are evolving rapidly. Depending on the deformity, minimally invasive or arthroscopic procedures may be performed. In cases of significant deformity, foot reconstruction may be proposed, using the so-called 'super construct' technique if necessary. Infection will be treated concurrently or initially, depending on severity. Many complications are reported, but increasingly early and aggressive surgery improves patients' quality of life and reduces amputation rates.

PMID:40459148 | PMC:PMC12139603 | DOI:10.1530/EOR-2025-0057