J Bone Joint Surg Am. 2025 Aug 4. doi: 10.2106/JBJS.24.01404. Online ahead of print.

ABSTRACT

BACKGROUND: This study was performed to determine if the Patient-Reported Outcomes Measurement Information System (PROMIS), the 9-item Oswestry Disability Index (ODI-9), and back pain intensity predict abnormal magnetic resonance imaging (MRI) findings in pediatric patients with back pain.

METHODS: We performed a retrospective review from April 2021 to June 2023 of 300 children (200 girls and 100 boys) aged 5 to 18 years with caregiver-reported back pain who underwent MRI of the spine and had completed the PROMIS Pediatric computerized adaptive testing measures for Pain Interference, Mobility, and Anxiety and the ODI-9, and had rated back pain intensity on a scale ranging from 0 to 5. Patients were excluded if they had neuromuscular or syndromic scoliosis, a history of previous spinal surgeries, or isolated neck pain. MRI findings were grouped as non-spinal and spinal findings, and then categorized into subgroups as incidental, correlative, and causative findings. Incidental findings were considered those in children with normal MRI findings. Patient-reported outcome measures (PROMs) were compared between children with normal and abnormal MRI findings (defined by the presence of correlative and/or causative findings) with use of Mann-Whitney U tests and logistic regression analysis.

RESULTS: Of the 300 children, 126 (42%) had abnormal MRI findings and 174 (58%) had normal MRI findings. Lower PROMIS Mobility scores (39.2 versus 42.8, p = 0.001) and higher ODI-9 percentages (27.4 versus 23.3, p = 0.015) were associated with abnormal MRI findings. A PROMIS Mobility threshold of 40.5 and an ODI percentage threshold of 21.1 were optimal for predicting abnormal MRI findings. We did not find an association between PROMIS Anxiety, PROMIS Pain Interference, or pain intensity with abnormal MRI findings.

CONCLUSIONS: Lower PROMIS Mobility scores and higher ODI-9 scores, which reflect worsening functional disability, were associated with abnormal MRI findings in pediatric patients with back pain. Additionally, the minimum clinically important difference was met for the PROMIS Mobility score between those with normal and abnormal MRI.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40758775 | DOI:10.2106/JBJS.24.01404

J Bone Joint Surg Am. 2025 Jul 31. doi: 10.2106/JBJS.24.01197. Online ahead of print.

ABSTRACT

As orthopaedic surgeons, we embrace a lifestyle and career defined by action, seeking to improve not only our patients' lives but also our profession. One critical area where we can improve lies in diversity, equity, and inclusion (DEI). Despite mounting evidence of the profound value that diverse teams bring to innovation, problem-solving, and patient care, orthopaedics has lagged behind most medical specialties in achieving a representative workforce. Addressing this disparity is important in advancing our profession and improving the equitable treatment of our patients. Recognizing this imperative, the American Orthopaedic Association (AOA) hosted a DEI symposium in June 2024, in conjunction with its annual meeting, that brought together orthopaedic surgeons, researchers, and educators to build upon the importance of creating inclusive spaces in order to ensure that diverse voices are present and are actively contributing to the future of the profession of orthopaedics. A standout feature of the 2024 symposium was a fireside chat format that was accompanied by dynamic audience participation, offering valuable insights and actionable strategies drawn from both the business world and medical oncology. These fields have made substantial strides in promoting diversity and inclusivity, providing a model for orthopaedics in overcoming similar challenges. The discussions illuminated the critical concept of allyship and examined the tangible steps that individuals and institutions can take. Allyship, as emphasized during the forum, requires deliberate, sustained effort. It is an active commitment to understanding and supporting underrepresented individuals and groups within the orthopaedic community. This means listening to their experiences, challenging biases, and working collaboratively to dismantle structural barriers. For institutions, it involves cultivating policies, mentorship opportunities, and recruitment strategies that prioritize equity and that reflect the diverse patient populations that we serve. By embracing allyship and adopting lessons from other fields, this symposium demonstrated opportunities to transform our profession and the lives of those who depend on our care, ensuring that our actions align with the ideals that we strive to uphold.

PMID:40743367 | DOI:10.2106/JBJS.24.01197

J Bone Joint Surg Am. 2025 Jul 31. doi: 10.2106/JBJS.24.01530. Online ahead of print.

ABSTRACT

BACKGROUND: Meniscal ramp lesions can impact knee stability, particularly when associated with anterior cruciate ligament (ACL) injuries. Although magnetic resonance imaging (MRI) is the primary diagnostic tool, its diagnostic accuracy remains suboptimal. We aimed to determine whether deep learning technology could enhance MRI-based ramp lesion detection.

METHODS: We reviewed the records of 236 patients who underwent arthroscopic procedures documenting ACL injuries and the status of the medial meniscal posterior horn. A deep learning model was developed using MRI data for ramp lesion detection. Ramp lesion risk factors among patients who underwent ACL reconstruction were analyzed using logistic regression, extreme gradient boosting (XGBoost), and random forest models and were integrated into a final prediction model using Swin Transformer Large architecture.

RESULTS: The deep learning model using MRI data demonstrated superior overall diagnostic performance to the clinicians' assessment (accuracy of 73.3% compared with 68.1%, specificity of 78.0% compared with 62.9%, and sensitivity of 64.7% compared with 76.4%). Incorporating risk factors (age, posteromedial tibial bone marrow edema, and lateral meniscal tears) improved the model's accuracy to 80.7%, with a sensitivity of 81.8% and a specificity of 80.9%.

CONCLUSIONS: Integrating deep learning with MRI data and risk factors significantly enhanced diagnostic accuracy for ramp lesions, surpassing that of the model using MRI alone and that of clinicians. This study highlights the potential of artificial intelligence to provide clinicians with more accurate diagnostic tools for detecting ramp lesions, potentially enhancing treatment and patient outcomes.

LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40743295 | DOI:10.2106/JBJS.24.01530

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00471. Online ahead of print.

ABSTRACT

BACKGROUND: We revaluated the radiographic results of a 2004 landmark, multicenter prospective study of patients with Legg-Calvé-Perthes disease (LCP). In the current study, we developed a new classification to evaluate the femoral head, acetabulum, and greater trochanter in the hips of patients with LCP, to address what we found to be deficiencies in the Stulberg rating system, which is based mainly on femoral head shape.

METHODS: We digitized and analyzed approximately 5,000 radiographs and related data sheets of 337 patients (345 hips) with LCP from the 2004 study. We found many unexpected abnormalities, including serious lesions of the femoral head, that had not been noted in that study. To record our findings in the femoral head, acetabulum, and greater trochanter, we developed a classification system that we termed the HAT (Head, Acetabulum, Trochanter) classification, which assigns the femoral head 1 to 5 points, the acetabulum 1 point if dysplastic, and the greater trochanter 1 point if elevated to or above the femoral head. The sum is the HAT score, which we compared with the Stulberg score, other predictive factors, and the Nonarthritic Hip Score (NAHS) from two 20-year follow-up studies of a number of patients from the 2004 study.

RESULTS: The intraclass correlation coefficient (ICC) of the HAT score was 0.93 (95% confidence interval [CI]: 0.90 to 0.95), and the total HAT score correlated strongly with the NAHS. Forty-nine percent of all hips had acetabular dysplasia, which correlated with a worse NAHS. A HAT of ≤3 was considered a good result. The odds of a patient developing acetabular dysplasia at skeletal maturity were lower after surgical treatment than after nonoperative treatment. In addition, surgically treated patients had better HAT scores than nonoperatively treated patients, especially if their skeletal age was ≥6 years at LCP onset. Better outcomes were also associated with a favorable lateral pillar classification, a younger skeletal at onset, and male sex.

CONCLUSIONS: The HAT classification is reproducible and allows a more comprehensive analysis of the radiographic outcomes of LCP. The system is flexible and would allow for different measures of its 3 components in future studies.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729461 | DOI:10.2106/JBJS.24.00471

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00835. Online ahead of print.

ABSTRACT

BACKGROUND: Aseptic loosening remains a main complication following total knee arthroplasty (TKA), requiring revision surgery. Radiostereometric analysis (RSA) can assess the risk of aseptic loosening. This study evaluated the migration and segmental motion of cemented and uncemented femoral and asymmetrical tibial Persona components (Zimmer Biomet) with model-based RSA.

METHODS: We conducted a randomized controlled trial with 63 patients (22 male patients and 41 female patients, with a mean age of 62 years) and compared patients who underwent TKA with cemented and uncemented Persona components. The primary outcome measure was the maximal total point motion (MTPM) after 2 years. The Mann-Whitney U test was used to compare groups. Migration was visualized by plotting the mean and 95% confidence interval (CI).

RESULTS: After 3 months, femoral components demonstrated an MTPM of 0.41 mm (95% CI, 0.35 to 0.48 mm) in the cemented group and 0.65 mm (95% CI, 0.50 to 0.80 mm) in the uncemented group. Subsequently, a stabilization occurred, and the MTPM after 24 months was 0.51 mm (95% CI, 0.41 to 0.61 mm) in the cemented group and 0.83 mm (95% CI, 0.65 to 1.02 mm) in the uncemented group. There was a significant difference between fixation types at 3 months (p = 0.04), 6 months (p = 0.03), 12 months (p = 0.02), and 24 months (p = 0.02). At 3 months postoperatively, the tibial component demonstrated an MTPM of 0.70 mm (95% CI, 0.53 to 0.88 mm) in the cemented group and 0.76 mm (95% CI, 0.61 to 0.91 mm) in the uncemented group. A stabilization was then observed, and migration after 24 months was 0.72 mm (95% CI, 0.55 to 0.89 mm) for cemented components and 0.78 mm (95% CI, 0.64 to 0.92) for uncemented components.

CONCLUSIONS: TKA with cemented and uncemented Persona components showed migration values within acceptable ranges, suggesting successful long-term fixation; however, significant differences in mean MTPM between cemented and uncemented femoral components were found.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729455 | DOI:10.2106/JBJS.24.00835

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.01205. Online ahead of print.

ABSTRACT

BACKGROUND: Lumbar spinal fusion (LSF) is a common surgical procedure for treating lumbar degenerative conditions. The use of osteobiologics to enhance fusion has emerged as a promising alternative to address the limitations of autologous iliac crest bone graft (AICBG), but their comparative efficacy and safety remain unclear. This systematic review and network meta-analysis (NMA) aimed to assess the fusion rates, safety profiles, and clinical outcomes of the use of osteobiologics in LSF.

METHODS: PubMed/MEDLINE and Scopus databases were searched for randomized controlled trials (RCTs) comparing different osteobiologics to AICBG in LSF. Data on fusion rates, complications, pain, disability, blood loss, operative time, and length of stay (LOS) were extracted. The risk of bias was evaluated using the Cochrane Risk of Bias-2 tool, and the certainty of evidence was assessed using the GRADE framework. The NMA was performed using a frequentist random-effects model to compare the efficacy and safety of various osteobiologics, along with associated perioperative and clinical outcomes.

RESULTS: Forty-three RCTs including a total of 3,823 patients were identified. The use of rhBMP-2 (recombinant human bone morphogenetic protein-2) significantly improved fusion rates (odds ratio [OR]: 3.71; 95% confidence interval [CI]: 2.59 to 5.32; p < 0.0001) and reduced complications (OR: 0.30; 95% CI: 0.13 to 0.68; p < 0.0001) compared with AICBG, with moderate certainty of the evidence. Other osteobiologics, including ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) and allograft, demonstrated reduced complication rates, although the quality of the evidence was low to very low. No significant differences were observed for pain, disability, or LOS. The use of rhBMP-2, autologous local bone, and silicate-substituted calcium phosphate was associated with decreased operative time, with rhBMP-2 additionally associated with lower intraoperative blood loss.

CONCLUSIONS: Use of rhBMP-2 was associated with significantly higher fusion and lower complication rates compared with AICBG, as well as decreased operative time and blood loss. Other osteobiologics may also offer benefits, but the supporting evidence is low-quality and limited by the notable underrepresentation of these materials in the published literature.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729448 | DOI:10.2106/JBJS.24.01205

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00792. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior cruciate ligament tears are a common injury that is often treated with arthroscopic anterior cruciate ligament reconstruction (ACLR). This meta-analysis investigates the impact of tourniquet use on ACLR and the outcomes of this procedure.

METHODS: Searches were conducted across 4 databases: Embase, PubMed, Scopus, and the Web of Science. The quality of the included studies was assessed using the Consolidated Standards Of Reporting Trials (CONSORT) 2010 checklist. A meta-analysis was performed to compare the outcomes between patients who underwent ACLR with versus without a tourniquet.

RESULTS: Eight studies were eligible for systematic review; of these, 6 were eligible for meta-analysis. The CONSORT scores for the studies ranged from 22 to 37. No significant differences were found between the groups in terms of intraoperative blood loss (standardized mean difference, with versus without a tourniquet [SMD], -2.15; 95% confidence interval [CI]: -5.87, 1.58; I2 = 99%), surgery time (SMD, -0.57; 95% CI: -1.32, 0.18; I2 = 94%), or Lysholm knee scores after 1 year (SMD, -0.06; 95% CI: -0.33, 0.21; I2 = 0%). The quality of the arthroscopic visual field varied across the studies. Postoperative pain levels were significantly higher in the tourniquet group (SMD6-hour follow-up, 1.77; 95% CI: 0.07, 3.47; I2 = 93%), although morphine consumption did not differ significantly between the groups (SMD, 0.25; 95% CI: -0.83, 1.33; I2 = 93%). The no-tourniquet group had significantly greater thigh (SMD, -0.46; 95% CI: -0.79, -0.14; I2 = 36%) and calf (SMD, -0.26; 95% CI: -0.49, -0.03; I2 = 70%) circumferences postoperatively.

CONCLUSIONS: Tourniquet use during ACLR did not significantly impact intraoperative blood loss, hemoglobin levels, or surgery time but was associated with increased postoperative pain. The use of epinephrine solution may be a viable alternative to the use of a tourniquet to improve visualization.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729445 | DOI:10.2106/JBJS.24.00792

J Bone Joint Surg Am. 2025 Jul 28. doi: 10.2106/JBJS.25.00532. Online ahead of print.

NO ABSTRACT

PMID:40720550 | DOI:10.2106/JBJS.25.00532

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.25.00574. Online ahead of print.

NO ABSTRACT

PMID:40712043 | DOI:10.2106/JBJS.25.00574

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.24.01520. Online ahead of print.

ABSTRACT

BACKGROUND: Achieving and maintaining global spinal balance is a crucial goal in posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Despite its substantial impact on operative success, there is a noticeable gap in the literature regarding a systematic evaluation of the trajectory and durability of this critical parameter. With this study, we aimed to characterize the evolution of global balance after posterior spinal fusion for AIS.

METHODS: A prospective, multicenter spinal deformity database was retrospectively queried for patients with AIS undergoing posterior spinal fusion. Standing, 2-view radiographs (anteroposterior and lateral) were obtained at the first-erect visit, 6 months, 1 year, 2 years, and 5 years, with a subset of patients having radiographs at the 10-year mark. Coronal balance was defined as the difference, in centimeters, between the C7 plumb line and the central sacral vertical line (CSVL). The sagittal vertical axis (SVA) measured sagittal balance, calculated as the difference, in centimeters, between the C7 plumb line and the posterosuperior corner of the superior end plate of S1.

RESULTS: The study included 477 patients with 5 years of follow-up and 84 patients with a decade of follow-up. The mean patient age was 14.1 years, 67.9% of the patients were White, and 81.6% of the patients were female. Preoperative assessment revealed that 50.7% of the patients demonstrated optimal global balance. The initial postoperative evaluation showed essentially no improvement, with only 55.6% achieving optimal balance (Coronal and Sagittal Harmony [CASH] A0) at the first-erect visit. Subsequent follow-up demonstrated steady improvement, with 81.8% reaching optimal balance at 5 years and 87.7% at the 10-year mark.

CONCLUSIONS: This study offers a comprehensive analysis of global spinal alignment and traces the balance trajectory (in both the coronal and sagittal planes) after posterior spinal fusion in AIS. To our knowledge, it is the largest and longest follow-up study of its kind. The findings highlight a profound and steady postoperative improvement in global balance over time, advancing our understanding of postoperative spinal balance in AIS. The novel CASH classification introduced here serves as a possible tool for evaluating overall alignment and balance in patients with AIS.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40712001 | DOI:10.2106/JBJS.24.01520

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.25.00086. Online ahead of print.

ABSTRACT

BACKGROUND: The U.S. Food and Drug Administration has approved a bupivacaine and meloxicam extended-release (ER) intra-articular injection for pain during total knee arthroplasty (TKA). However, the real-world evidence with regard to analgesic efficacy of that medication has been limited. This randomized clinical trial investigated the efficacy of this new medication compared with our standard periarticular injection for postoperative analgesia after primary TKA.

METHODS: Eligible patients undergoing primary, unilateral TKA for osteoarthritis at our academic center were enrolled. Patients were blinded and were randomized 1:1 to the bupivacaine-meloxicam ER (ZYNRELEF) injection group or the standard injection (ropivacaine, ketorolac, epinephrine) control group. A standardized, multimodal analgesic pathway was implemented. Numeric Rating Scale (NRS) pain scores and tallies of opioid consumption were collected. The primary outcome was the area under the curve (AUC) for NRS pain, adjusted for opioid consumption, over 72 hours. The minimal clinically important difference was considered to be 30%. Power analysis determined a minimum of 44 patients per group. The final groups included 53 patients in the experimental group and 48 patients in the control group.

RESULTS: Similar postoperative analgesia was observed, with an AUC for the adjusted NRS pain score up to 72 hours of 331 in the experimental group and 373 in the control group (p = 0.09). The mean maximum NRS pain scores were similar and reflected good, but not complete, analgesia. Scores were 3 to 5 on the day of the surgery, 4 to 6 on postoperative day (POD) 1, 5 to 6 on POD 2, and 4 to 5 on POD 3 (p > 0.05). One patient in the experimental group and 2 patients in the control group had early postoperative complications, none of which was deemed to be related to the analgesic choice.

CONCLUSIONS: This randomized clinical trial demonstrated similar analgesia with a bupivacaine-meloxicam ER solution and a standard periarticular injection up to 72 hours after primary TKA. Cost, reimbursement, and convenience may ultimately prove to be more important than analgesic differences when choosing between these 2 effective options for managing postoperative pain.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40711999 | DOI:10.2106/JBJS.25.00086

J Bone Joint Surg Am. 2025 Jul 21. doi: 10.2106/JBJS.24.01191. Online ahead of print.

ABSTRACT

BACKGROUND: Cement augmentation using vertebroplasty (VP) or kyphoplasty (KP) can be employed to manage vertebral compression fractures (VCFs). Randomized controlled trials (RCTs) have disagreed about the superiority of one technique over the other. Therefore, a meta-analysis of RCTs is warranted.

METHODS: PubMed, Cochrane, Embase, and Google Scholar were searched for articles from database inception to July 15, 2024. The inclusion criteria consisted of English and non-English-language RCTs comparing KP to VP in the management of VCFs. The studied outcomes were the risks of cement leakage and adjacent vertebral fractures (AVFs), operative time, the postoperative local kyphotic angle, and postoperative back pain.

RESULTS: A total of 11 RCTs were included, comprising 1,190 patients, of whom 600 (50.4%) underwent KP and 590 (49.6%) underwent VP. We found no difference in the risk of cement leakage (risk ratio [RR], 1.07; 95% confidence interval [CI], 0.68 to 1.69; p = 0.78) or AVFs (RR, 0.60; 95% CI, 0.29 to 1.23; p = 0.16) between the 2 groups. With the inclusion of additional trials, the KP group had a lower risk of AVFs (RR, 0.58; 95% CI, 0.34 to 0.98; p = 0.04). We found no difference in operative time (mean difference, 4.75 minutes; 95% CI, -7.34 to 16.84; p = 0.44) or postoperative pain (mean difference, -0.48; 95% CI, -1.91 to 0.95; p = 0.51) between the 2 groups. A lower postoperative kyphotic angle was observed in the KP group (standardized mean difference, -2.97; 95% CI, -5.62 to -0.32; p = 0.03).

CONCLUSIONS: This meta-analysis revealed that KP was associated with a better postoperative local kyphotic angle and a lower risk of AVFs, with no difference in postoperative pain or cement leakage, compared with VP.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40690559 | DOI:10.2106/JBJS.24.01191

J Bone Joint Surg Am. 2025 Jul 18. doi: 10.2106/JBJS.24.00996. Online ahead of print.

ABSTRACT

BACKGROUND: Workers' Compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures. The purpose of this study was to determine the impact of WC on the long-term outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) and labral tears and to compare these findings with those of a propensity-matched control group.

METHODS: A retrospective analysis was conducted that included patients with a WC claim who underwent hip arthroscopy for FAI and labral tears between 2008 and 2013. Included patients had complete preoperative and minimum 10-year postoperative questionnaires for patient-reported outcomes (PROs) or a documented end point. Patients were propensity-matched to a control group without a WC claim in a 1:3 ratio on the basis of age at the time of surgery, sex, body mass index, acetabular Outerbridge grade, and capsular treatment. Clinically meaningful thresholds, complications, survivorship, work type, and return-to-work rates were analyzed.

RESULTS: A total of 280 patients (WC group, 70; control group, 210) were included in the study. The WC group had a mean follow-up time of 123.9 ± 22.6 months. Compared with the matched control group, the WC group had worse preoperative PRO scores but a greater magnitude of improvement. The groups had similar (p > 0.05) rates of reaching the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values for the modified Harris hip score (MCID: 93.0% [WC group], 79.2% [control group]; PASS: 83.7% [WC], 77.8% [control]), the Non-Arthritic Hip Score (MCID: 90.7% [WC], 77.8% [control]; PASS: 74.4% [WC], 63.2% [control]), and the Hip Outcome Score Sport-Specific Subscale (MCID: 87.5% [WC], 72.3% [control]; PASS: 72.7% [WC], 55.6% [control]). In the WC group, 82.9% of patients returned to work, with a mean time to return to work of 8.0 ± 7.4 months. The WC group had a higher rate of revision hip arthroscopy than the control group, with a threefold relative risk (95% confidence interval, 1.6 to 5.7; p < 0.001) and a mean time to revision of 28.3 ± 37.1 months.

CONCLUSIONS: Hip arthroscopy for the treatment of FAI and labral tears in patients with a WC claim was associated with favorable outcomes and a high return-to-work rate at a minimum 10-year follow-up. These results were comparable with those of a benchmark control group. However, the WC group had a significantly higher rate of revision hip arthroscopy than the control group.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40680109 | DOI:10.2106/JBJS.24.00996

J Bone Joint Surg Am. 2025 Jul 16;107(14):e75. doi: 10.2106/JBJS.25.00221.

NO ABSTRACT

PMID:40668210 | DOI:10.2106/JBJS.25.00221

J Bone Joint Surg Am. 2025 Jul 16;107(14):e78. doi: 10.2106/JBJS.ER.24.00224.

NO ABSTRACT

PMID:40668200 | DOI:10.2106/JBJS.ER.24.00224

J Bone Joint Surg Am. 2025 Jul 16;107(14):e77. doi: 10.2106/JBJS.25.00333.

NO ABSTRACT

PMID:40668199 | DOI:10.2106/JBJS.25.00333

J Bone Joint Surg Am. 2025 Jul 16;107(14):e76. doi: 10.2106/JBJS.25.00234.

NO ABSTRACT

PMID:40668193 | DOI:10.2106/JBJS.25.00234

J Bone Joint Surg Am. 2025 Jul 11. doi: 10.2106/JBJS.24.01461. Online ahead of print.

ABSTRACT

BACKGROUND: We conducted a randomized controlled trial to compare the outcomes of tension band wiring and precontoured plate fixation for the treatment of 2-part and multifragmented isolated, displaced olecranon fractures.

METHODS: We recruited 200 patients, 18 to 75 years of age, who had isolated, displaced olecranon fractures and randomly allocated them to tension band wiring (n = 100) or plate fixation (n = 100). The patients were followed at 6 weeks, 12 weeks, 12 months, and 24 months. The study was designed as a noninferiority trial. The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 12 months.

RESULTS: More patients in the tension band wiring group were classified as ASA (American Society of Anesthesiologists) grade I; otherwise, the randomization groups were similar. Two patients in the tension band wiring group and 3 in the plate fixation group did not receive the allocated treatment. The duration of the surgical procedure was 64 and 88 minutes in the tension band wiring and plate fixation groups, respectively (p < 0.01). After 12 months, the median QuickDASH score was 5 for both groups, and the median of the differences was 0 (95% 1-sided confidence interval [CI], 2.3). There were no clinically relevant differences between the groups at any time point. In addition, there were no differences in outcomes in subgroup analyses of 2-part and multifragmented olecranon fractures. Complications and secondary surgical procedures were analyzed on the basis of the treatment received (tension band wiring = 101 patients, plate fixation = 99 patients). Sixty-four complications were recorded in 52 patients (tension band wiring, 30 patients; plate fixation, 22 patients; relative risk [RR], 1.20 [95% CI, 0.88 to 1.58]; p = 0.23). In the tension band wiring and plate fixation groups, 49 and 34 patients (RR, 1.33 [95% CI, 1.01 to 1.74]; p = 0.04) required at least 1 additional surgical procedure, respectively. Hardware-related irritation was the most reported indication of secondary surgery.

CONCLUSIONS: When treating isolated, displaced 2-part and multifragmented olecranon fractures, tension band wiring was noninferior compared with plate fixation. The surgical procedure was quicker for tension band wiring, but the frequency of secondary surgical procedures was higher. The majority of secondary surgical procedures were removal of symptomatic hardware.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40644505 | DOI:10.2106/JBJS.24.01461

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01106. Online ahead of print.

ABSTRACT

BACKGROUND: Hypermobile Ehlers-Danlos syndrome (hEDS) is a collagen disorder affecting multiple organ systems, including the musculoskeletal system. We sought to determine the type and severity of orthopaedic manifestations experienced by these patients. The purpose of this study was to identify the most common orthopaedic manifestations in patients with hEDS and to examine the patient-reported helpfulness of treatments. Of note, collagen disorders such as hEDS may affect the success rates of orthopaedic interventions. The success or failure of treatment is not currently fully understood for this patient population.

METHODS: A total of 1,999 patients who were enrolled in an international EDS registry were contacted to complete a 260-question survey regarding their experience with nonoperative and operative treatments for musculoskeletal instability and/or pain. Participants reported their demographic characteristics, hEDS diagnosis characteristics, symptomatic joints, nonoperative and operative treatments, and satisfaction with each treatment.

RESULTS: Over a 30-day period, 1,075 responses were received. Participants were predominately female (95.3%) and had a median age of 40.0 years (interquartile range width, 17.0 years). The majority (60.8%) of respondents reported a mental health burden every day, with the remainder reporting a mental health burden weekly (24.4%), monthly (11.0%), or never (3.80%). Compared with those who underwent standard physical therapy (n = 378), individuals who underwent physical therapy tailored to EDS (n = 602) more frequently reported improved posture (78.6% versus 43.1%; p < 0.001), greater helpfulness (p < 0.001), and a longer duration of attending therapy (p < 0.001). A total of 1,120 primary and 261 revision operations for joint or spine instability and/or pain were reported. The reported complication rates were 35.7% and 42.9% for joint and spine surgeries, respectively. Physical therapy was the only nonoperative treatment for which the median reported helpfulness sometimes equaled or exceeded that of a joint or spine surgery.

CONCLUSIONS: This study offers insights into the demographics and management of hEDS. The high rate of surgical complications reported by patients indicates the need for a better understanding of surgical indications and treatment options. These findings should guide physicians in managing hEDS and highlight the importance of incorporating this knowledge into clinical practice to improve the management of orthopaedic manifestations in patients with hEDS.

LEVEL OF EVIDENCE: Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638721 | DOI:10.2106/JBJS.24.01106

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01304. Online ahead of print.

ABSTRACT

BACKGROUND: Researchers employ murine fracture models to study bone healing, but the temporal relationship between mouse and human fracture healing is poorly understood. The hypothesis of this study was that it was possible to quantify specific post-fracture time frames corresponding to the stages of endochondral ossification in both mice and humans.

METHODS: Radiographs of mice and human femoral fractures treated with intramedullary stabilization were reviewed. The study included 330 human femoral fractures (OTA/AO 32A, B, or C injuries) that ultimately healed without complications in patients aged 18 to 55 years and 309 surgically created midshaft femoral fractures in 3-month-old C57BL6/J mice. Multiple orthopaedic surgeons assessed the radiographs using the Modified Radiographic Union Score for Tibia (mRUST). A 4-parameter log-logistic curve was fit to describe fracture healing over time, with 3 parameters allowed to vary: Y∞ (mRUST score at time = ∞), k (healing rate in [1/log(time)]), and X0.5 (time to half-healing).

RESULTS: The values (and 95% confidence interval) for the mice were Y∞ = 14.70 (14.54 to 14.87), k = 4.54/log(days) (4.30 to 4.77), and X0.5 = 11.77 days (11.56 to 11.98). For the humans, the values were Y∞ = 16.78 (16.21 to 17.36), k = 1.37/log(days) (1.28 to 1.45), and X0.5 = 91 days (83 to 99). All parameters differed significantly between the mice and humans (p < 0.05).

CONCLUSIONS: Using mRUST scoring and mathematical modeling, we were able to quantify and compare the temporal progression of fracture healing in mice and humans.

CLINICAL RELEVANCE: These data are relevant for designing and/or interpreting fracture healing studies of mice and humans to promote rational translation of fracture research between species.

PMID:40638717 | DOI:10.2106/JBJS.24.01304