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Exploring the Endorsement and Implementation of Artificial Intelligence Guidelines in Leading Orthopaedic and Sports Medicine Journals: A Cross-Sectional Study

JBJS -

J Bone Joint Surg Am. 2026 Feb 18;108(4):313-319. doi: 10.2106/JBJS.25.00373. Epub 2025 Nov 26.

ABSTRACT

BACKGROUND: The integration of artificial intelligence (AI) in orthopaedics and sports medicine (OSM) has transformed clinical practice and scientific inquiry. However, the increasing reliance on AI raises critical concerns regarding transparency, ethical considerations, and reproducibility. The aim of this study was to systematically evaluate the editorial policies of leading OSM journals concerning AI usage and the endorsement of AI-specific reporting guidelines (RGs).

METHODS: A cross-sectional review was conducted in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. The top 100 peer-reviewed OSM journals were identified using the 2023 SCImago Journal Rank (SJR). Data extraction included journal characteristics, AI-related policies within Instructions for Authors, and references to AI-specific RGs. Data were collected in a masked, duplicate fashion, with discrepancies resolved through consensus.

RESULTS: Of the 100 journals analyzed, 94% referenced AI in their editorial policies, all of which explicitly prohibited AI authorship and required the disclosure of AI use in manuscript preparation. AI-generated content was permitted in 82% of journals. AI-assisted image generation was permitted by 60% of journals and explicitly prohibited by 34%. Despite these policies, only 1% of journals referenced AI-specific RGs, with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) being the sole guideline mentioned.

CONCLUSIONS: While most of the OSM journals had established policies on AI usage, there was a notable lack of standardization, particularly with respect to AI-generated images. Additionally, the absence of AI-specific RG endorsements highlights a gap in methodological guidance. Standardizing AI policies and encouraging the adoption of RGs could enhance the transparency, reproducibility, and ethical integrity of AI-driven research in OSM.

PMID:41706011 | DOI:10.2106/JBJS.25.00373

Minimizing Missed Diagnoses of Tibial Plateau Fractures: The Role of AI in Radiographic Evaluation

JBJS -

J Bone Joint Surg Am. 2026 Feb 18;108(4):303-312. doi: 10.2106/JBJS.24.00579. Epub 2025 Nov 26.

ABSTRACT

BACKGROUND: Tibial plateau fractures represent a diverse group of intra-articular injuries that can be difficult to detect and characterize on initial imaging. The aim of the present study was to develop an artificial intelligence (AI) diagnostic tool for identifying tibial plateau fractures on radiographs.

METHODS: In this retrospective study, we analyzed radiographs that had been made from January 2018 to December 2020 for 1,809 patients, with an equal distribution of male and female adults. A total of 3,821 anteroposterior and lateral knee radiographs were evaluated with use of the EfficientNet B3 AI model, with computed tomography (CT) images being used as the ground truth. Evaluation metrics focused on the area under the receiver operating characteristic curve (AUC) and positive predictive values across different subgroups.

RESULTS: Our AI model attained AUCs of 0.98 and 0.97 for detecting tibial plateau fractures in the test and external validation datasets, respectively. Subgroup analysis revealed diverse positive predictive values across different Schatzker types and 3-column classifications.

CONCLUSIONS: Our deep learning model exhibits newfound ability for identifying tibial plateau fractures. However, we encountered several limitations, such as imbalances among the sizes of various subgroups in the dataset and an inability to identify radiographs containing foreign objects or other defects.

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

PMID:41706010 | PMC:PMC12885574 | DOI:10.2106/JBJS.24.00579

Is there an association between distal femoral morphology and periprosthetic femoral fracture risk after Posterior-Stabilized Total Knee Arthroplasty?

International Orthopaedics -

Int Orthop. 2026 Feb 17. doi: 10.1007/s00264-026-06756-9. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to determine whether distal femoral morphology (DFM) constitutes a risk factor for periprosthetic femoral fractures (PPFs) in a cohort of patients who underwent posterior-stabilized total knee arthroplasty (PS-TKA).

MATERIALS AND METHODS: Retrospective study of patients who had undergone primary PS-TKA, with a follow-up of minimum two years. Citak's ratio was calculated, and patients were classified according to DFM. Univariate and multivariate statistical analysis was performed to identify PPFs risk factors. ROC analysis was performed to evaluate the ability of DFM to distinguish patients at risk for PPFs.

RESULTS: A total of 2452 patients 1644 female, 808 male were included in the analysis. The mean age of the participants was 70.2 years (SD = 6.4). PPFs were detected in 33 patients (1.35%). According to the Citak classification, patients were categorized as Group A (4/33, 12.1%), Group B (8/33, 24.2%), and Group C (21/33, 63.7%). DFM was significantly related to the PPFs rate (p = 0.001). The ROC curve analysis yielded an Area Under the Curve (AUC) of 0.669 (CI 95% 0.580-0.758) for the DFM.

CONCLUSIONS: Preoperative evaluation of distal femoral morphology and management of osteoporosis may reduce the risk of fractures after PS-TKA.

PMID:41699317 | DOI:10.1007/s00264-026-06756-9

Acetabular component positioning after pelvic osteotomy: a retrospective comparison between the anterior and posterolateral approaches

International Orthopaedics -

Int Orthop. 2026 Feb 16. doi: 10.1007/s00264-026-06755-w. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare the acetabular component positioning accuracy and clinical outcomes between the direct anterior approach (DAA) and the posterolateral approach (PLA) for total hip arthroplasty (THA) in patients with a history of pelvic osteotomy.

METHODS: This retrospective study included 37 hips from 35 patients who underwent THA following pelvic osteotomy between 2005 and 2023. The primary outcomes were acetabular component positioning accuracy within the target zones and Japanese Orthopaedic Association (JOA) scores. The component angles were measured using postoperative computed tomography.

RESULTS: The mean follow-up was 4.3 ± 3.0 years in the DAA group (short- to mid-term outcomes) and 11.2 ± 3.6 years in the PLA group (mid- to long-term outcomes). Significant improvement in JOA scores was observed in both groups, with no significant difference in final JOA scores. Mean inclination angles were similar with comparable variance. Although mean anteversion angles did not significantly differ, DAA demonstrated significantly lower variability. Optimal cup positioning within the target zones was significantly higher in the DAA group than in the PLA group. No dislocations occurred in the DAA group, whereas one did in the PLA group.

CONCLUSION: Both approaches demonstrated comparable clinical outcomes. Although the DAA showed higher rates of optimal cup placement and improved anteversion angle consistency, the overall clinical results were similar. The DAA and PLA are valid options for THA after pelvic osteotomy.

PMID:41697349 | DOI:10.1007/s00264-026-06755-w

Two-year outcomes of ultrasound-guided percutaneous tenotomy for long head of the biceps tendinopathy

International Orthopaedics -

Int Orthop. 2026 Feb 16. doi: 10.1007/s00264-026-06751-0. Online ahead of print.

ABSTRACT

BACKGROUND: The long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain, particularly in older adults, and may persist despite conservative treatment. Arthroscopic tenotomy is effective but requires an operating room, anaesthesia, and postoperative restrictions, which may be suboptimal in elderly or comorbid patients. Ultrasound-guided percutaneous LHBT tenotomy has emerged as a minimally invasive alternative, yet long-term clinical outcomes remain insufficiently reported. This study aimed to evaluate two-year pain, functional, and sleep-quality outcomes following ultrasound-guided percutaneous LHBT tenotomy in patients with isolated LHBT tendinopathy.

METHODS: This retrospective case series included 51 consecutive patients (mean age 61.8 ± 4.8 years) with MRI-confirmed isolated LHBT tendinopathy who underwent ultrasound-guided percutaneous tenotomy between 2022 and 2024. Pain (VAS), functional scores (ASES and Constant-Murley), and sleep quality (PSQI) were assessed at baseline and at three, six, 12, and 24 months. Repeated-measures ANOVA or Friedman tests were used for longitudinal analysis, with effect sizes reported as partial eta-squared. Complications and patient satisfaction were recorded at the final follow-up.

RESULTS: All outcome measures improved significantly at each postoperative time point compared with baseline (p < 0.001). Mean VAS decreased from 6.84 ± 1.29 to 2.16 ± 0.89 at 24 months (η2 = 0.71), with 92.1% achieving the minimal clinically important difference (MCID). Functional outcomes improved markedly (ASES: 35.7 → 85.1; Constant-Murley: 60.4 → 82.5), both with large effect sizes (η2 = 0.68 and 0.64). PSQI improved from 9.2 ± 3.1 to 4.8 ± 2.2 (η2 = 0.56), reducing clinically significant sleep disturbance from 78.4% to 29.4%. Four patients (7.8%) developed asymptomatic Popeye deformity; no major complications occurred. Patient satisfaction at 24 months was 88.2%.

CONCLUSIONS: Ultrasound-guided percutaneous LHBT tenotomy is a safe, minimally invasive, and effective procedure that provides durable improvements in pain, function, and sleep quality over two years, with a low complication rate. It represents a valuable alternative to arthroscopic tenotomy in appropriately selected patients.

PMID:41692907 | DOI:10.1007/s00264-026-06751-0

Outcomes of major trauma patients by hospital level of care in New Zealand

Injury -

Injury. 2026 Feb 6:113090. doi: 10.1016/j.injury.2026.113090. Online ahead of print.

ABSTRACT

BACKGROUND: Major trauma centres generally deliver better outcomes than non-specialist centres, but whether this association holds true in New Zealand, a country with challenging geography and a dispersed population, is uncertain.

AIMS: The aim of this study was to determine whether definitive care at a tertiary trauma hospital compared with a regional (non-tertiary) hospital was associated with improved survival in patients with major trauma in New Zealand. We also aimed to identify factors that predict transfer from a regional hospital to a tertiary centre.

METHODS: A registry-based cohort study of adults with major trauma was conducted using data from the New Zealand Trauma Registry. All patients who were in a tertiary hospital at any time during their hospitalisation were considered to have received definitive care in a tertiary centre. The primary outcome was in-hospital mortality during the index hospitalisation episode (including where a hospitalisation episode included care in multiple hospitals). Secondary outcomes were 30 and 90-day mortality, requirement for secondary transfer, and discharge destination. Multivariable logistic regression analysis was used to assess the association between definitive care hospital level and in-hospital mortality, and to identify factors associated with secondary transfer.

RESULTS: 10,001 major trauma patients were identified, with inpatient case fatality rate of 11.1% (regional hospitals 12.7%, tertiary hospitals 10.5%; P = 0.001). After risk adjustment, definitive care at a tertiary trauma hospital was associated with substantially lower odds of in-hospital death compared with regional hospitals (adjusted odds ratio 0.68 [95% CI, 0.57-0.82]; P < 0.001). Factors associated with secondary inter-hospital transfer included intubation, injury due to falls, Māori ethnicity, higher injury severity, and younger age.

CONCLUSION: Definitive care provided at a tertiary trauma hospital was associated with decreased odds of mortality in major trauma patients in New Zealand, indicating the importance of improving equity of access to specialised trauma care for patients suffering from serious injuries.

PMID:41690826 | DOI:10.1016/j.injury.2026.113090

Beyond acute care: A time-to-event analysis of injury-related readmissions after a transport-related injury

Injury -

Injury. 2026 Feb 6:113091. doi: 10.1016/j.injury.2026.113091. Online ahead of print.

ABSTRACT

INTRODUCTION: Injury-related readmissions related to an index injury admission impose significant burden on patients, families, and health systems. Understanding predictors of short-, medium-, and long-term injury-related readmissions can inform strategies to mitigate risk and guide early interventions. This study examines injury-related readmission patterns and predictors among transport-injured patients in Queensland, Australia.

METHODS: A population-based, epidemiological data-linkage study was conducted using hospital administrative records for transport-related injury admissions between 2011 and 2021. Index admissions were identified, and subsequent injury-related readmissions were classified using time- and diagnosis-based logic. Outcomes included three time frames for readmissions: within 31-days, 90-days, and 1-year post-discharge. Parametric survival analysis with a Gompertz distribution assessed predictors of injury-related readmission, and dominance analysis quantified the relative importance of these predictors. Predictors spanned six domains: sociodemographic factors, healthcare funder, hospital characteristics, injury-specific attributes, injury mechanism, and geographic factors.

RESULTS: Among 89,611 patients with transport-related injury admissions, 7.2% were readmitted for injury-related conditions within 31 days, 10.5% within 90 days, and 17.2% within one year. Mean time-to-readmission was 11, 25, and 92 days for the respective timeframes. Motor vehicle crashes were the most common transport-related injury mechanism, but had the lowest injury-related readmission rates compared to bicycle, motorcycle, and pedestrian injuries. Dominance analysis indicated that injury characteristics, particularly nature of injury, were the strongest predictors of injury-related readmission, with nature, body region and injury mechanism collectively explaining 67.5% to 83.2% of variation across timeframes.

CONCLUSION: Injury-related readmissions after transport-related injury occur most frequently within the first month post-discharge but persist up to one year. Injury characteristics dominate predictive influence, suggesting that interventions targeting these factors may reduce both short- and long-term injury-related readmission risk. These findings highlight opportunities for tailored discharge planning and early intervention strategies to alleviate patient and system burden.

PMID:41688229 | DOI:10.1016/j.injury.2026.113091

Epidemiology of injury-related bloodstream infections in Queensland, Australia: a population-based data linkage study

Injury -

Injury. 2026 Feb 7;57(4):113086. doi: 10.1016/j.injury.2026.113086. Online ahead of print.

ABSTRACT

INTRODUCTION: Bloodstream infections (BSIs) are an important complication among injured patients, yet existing studies have focused on selected populations or specific settings, limiting the generalisability of the findings. In this study, we conducted a population-based study to examine the incidence, demographic and clinical variation of injury-related BSIs.

METHODOLOGY: The study population consisted of all residents of Queensland, Australia, who developed an injury-related BSI identified between 1 January 2000 and 31 December 2019. The linked data used for this study consisted of three statewide databases of all public and private hospital admissions, public pathology data and deaths. ICD-10 AM codes for injuries (S00-T75 and T79) were used to identify hospitalisations for index injuries. Incidence rates were calculated by age, sex, geographic remoteness and socio-economic status using estimated residential population data and aggregated acute injury hospital episodes.

RESULTS: Across 20 years, a total of 3205 injury-related BSI episodes occurred among 3188 individuals. The median age of this cohort was 63 years, with males accounting for 65 % of the population. The overall 30-day case-fatality rate was 13 %. During the study period, age-standardised rates increased from 2.47 to 4.62 per 100,000 population, with males experiencing higher rates than females. Patients from remote areas in Queensland had significantly higher rates compared to those from other regions. Additionally, age-specific rates increased with advancing age. Approximately two-thirds of the injury-related BSI episodes were hospital-onset. The most commonly identified pathogens among these patients were Staphylococcus aureus and Escherichia coli.

CONCLUSION: This world-first population-based study on injury-related BSIs provides a comprehensive understanding of the incidence and variation by demographic and clinical characteristics. Injury-related BSIs differed across subgroups: males, remote area residents and older people had higher rates than females, urban/regional area residents and younger individuals. These findings provide a foundation for further work to target treatment and interventions to minimise the burden of injury-related BSIs.

PMID:41687278 | DOI:10.1016/j.injury.2026.113086

Ergonomic risks in healthcare workers in acute care; the POSTURE framework

Injury -

Injury. 2026 Feb 6;57(4):113085. doi: 10.1016/j.injury.2026.113085. Online ahead of print.

ABSTRACT

INTRODUCTION: Healthcare workers performing fluoroscopy-guided procedures are at an elevated risk for work-related musculoskeletal disorders (WMSD) due to prolonged, maladaptive postures, further aggravated by the physical burden of lead aprons. Despite growing awareness, few studies have continuously assessed posture risk with task-level contributors to poor ergonomics in surgical settings.

OBJECTIVES: To quantify the proportion of time that healthcare workers spend in medium-to high-risk postures during fluoroscopic procedures in Interventional Cardiology and Orthopaedic Trauma to identify WMSD risk. A secondary aim categorizes specific tasks through qualitative video analysis of the high-risk postures in Orthopaedic Trauma.

METHODS: A mixed-methods cohort study was conducted for 23 participants over 47 procedures (22 in Interventional Cardiology and 25 in Orthopaedic Trauma). Participants included nurses, physicians and trainees, all of whom wore standard lead aprons during procedures. Postures were continuously assessed using three inertial measurement units attached on the spine to derive real-time Rapid Upper Limb Assessment (RULA) scores. Medium-to high-risk postures were defined as RULA scores ≥5, known to contribute to WMSD risk. For Orthopaedic procedures, synchronized audiovisual data from an Operating Room Black Box® was analyzed using open and focused coding to identify task-related contributors to posture.

RESULTS: Healthcare workers spent more than 50% of procedural time in medium-to high-risk postures. Physicians in Orthopaedics demonstrated the highest risk activity, with 38.9% of time in RULA 6+ postures. Task-based contributions were categorized using the novel POSTURE framework: Pressure, Operations, Sight Technology, Uneven Demographics, Reaching and Exceptions. This framework revealed role-specific ergonomic risks that traditional RULA score alone could not differentiate.

CONCLUSIONS: This study highlights a concerning prevalence of high-risk postures among healthcare workers in fluoroscopy-dependent procedures. The integration of continuous IMU-based RULA monitoring with qualitative task analysis offers a scalable and clinically relevant approach to posture assessment. The POSTURE framework extends existing ergonomic tools by contextualizing task-specific risks, providing actionable insights to guide ergonomic interventions, institutional policy, and training aimed at reducing WMSDs in surgical environments.

PMID:41679115 | DOI:10.1016/j.injury.2026.113085

Enhancing Patient Comprehension in Orthopaedic Surgery: The EXPLAIN Framework for Surgeon-Patient Communication

JBJS -

J Bone Joint Surg Am. 2026 Feb 12. doi: 10.2106/JBJS.25.01047. Online ahead of print.

ABSTRACT

➢ Patient comprehension in orthopaedic surgery is frequently limited, with substantial gaps between perceived and actual understanding of conditions, procedures, and recovery timelines.➢ Expectation management is a central communication challenge, as patients often anticipate surgery or outcomes in ways that are unrealistic, directly affecting satisfaction and informed consent.➢ The EXPLAIN framework provides a structured, orthopaedic-specific approach to improve communication through 7 components: Educate, eXample, Purpose, Language/Learn, Analogy/Articulate, Illustrate, and Navigate.➢ Evidence supports the use of strategies such as plain language, teach-back, anatomical models, 3-dimensional aids, and structured navigation programs to improve comprehension, reduce anxiety, and lower readmissions.➢ Implementing EXPLAIN can enhance shared decision-making, reduce communication-related malpractice risk, and improve both patient satisfaction and outcomes.

PMID:41678671 | DOI:10.2106/JBJS.25.01047

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