Pub Date : 2025-12-01Epub Date: 2025-10-01DOI: 10.1097/CORR.0000000000003688
Patrick J Cahill
{"title":"Reply to the Letter to the Editor: How Does Anterior Vertebral Body Tethering Compare to Posterior Spinal Fusion for Thoracic Idiopathic Scoliosis? A Nonrandomized Clinical Trial.","authors":"Patrick J Cahill","doi":"10.1097/CORR.0000000000003688","DOIUrl":"10.1097/CORR.0000000000003688","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2403-2405"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-07DOI: 10.1097/CORR.0000000000003723
Seth S Leopold
{"title":"Editorial: Fully Compromised, but Thanks All the Same to Our Peer Reviewers.","authors":"Seth S Leopold","doi":"10.1097/CORR.0000000000003723","DOIUrl":"10.1097/CORR.0000000000003723","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 12","pages":"2211-2213"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-21DOI: 10.1097/CORR.0000000000003684
Hannes Vermue, Nele Arnout, Thomas Tampere, Lenka Stroobant, Alexander Dereu, Jan Victor
{"title":"Reply to the Letter to the Editor: Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.","authors":"Hannes Vermue, Nele Arnout, Thomas Tampere, Lenka Stroobant, Alexander Dereu, Jan Victor","doi":"10.1097/CORR.0000000000003684","DOIUrl":"10.1097/CORR.0000000000003684","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2396-2397"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-09DOI: 10.1097/CORR.0000000000003644
Bo Zhang, Haijun Zhang
{"title":"Letter to the Editor: Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.","authors":"Bo Zhang, Haijun Zhang","doi":"10.1097/CORR.0000000000003644","DOIUrl":"10.1097/CORR.0000000000003644","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2394-2395"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Patients with developmental dysplasia of the hip (DDH) can also present with deformities of the patellofemoral joint, such as femoral trochlear dysplasia. Although previous studies have reported that trochlear dysplasia is clinically important in some patients with DDH, the association between DDH and trochlear dysplasia is still unclear.</p><p><strong>Questions/purposes: </strong>(1) Is trochlear dysplasia more common among lower limbs with bilateral DDH, with unilateral DDH, or without DDH (specifically, in the contralateral limb of patients with unilateral DDH)? (2) Is having more severe DDH (as measured by Hartofilakidis classification, Crowe classification, or according to angular measurements) associated with higher odds of having trochlear dysplasia?</p><p><strong>Methods: </strong>This was a single-center retrospective comparative study. Between November 2018 and February 2024, a total of 439 patients with DDH (of whom 56% [248 of 439] had bilateral DDH and the remainder had unilateral DDH) underwent THA in our center. Of those, we considered as potentially eligible patients who were between ages 18 and 50 years, with a history of DDH that did not undergo surgical treatment prior to the THA, and who had available demographic and radiographic data. We then excluded 31% of the patients because 62 of them had a history of hip or knee treatment, 8 had a history of trauma or infection in the hip or knee, 24 had severe knee osteoarthritis, 9 had a history of neuromuscular disease, and the data from 33 patients were incomplete, leaving 303 patients (of whom 50% [152 of 303] had bilateral DDH, while the remainder had unilateral DDH; 455 affected and 151 unaffected limbs, in total) for the analysis. From those, we formed three study groups: 33% (152) of limbs randomly selected from one of the limbs of each patient with bilateral DDH were assigned to the bilateral group, 33% (151) of limbs selected from the ipsilateral side of patients with unilateral DDH were assigned to the unilateral group, and 33% (151) of limbs selected from the contralateral limbs in patients with unilateral DDH were assigned to the contralateral group. There were no differences in demographics, such as sex, age, and BMI, between patients with bilateral DDH and unilateral DDH. All patients underwent CT as a standard component of the preoperative evaluation process for THA. To answer our first question about in which group trochlear dysplasia is more common, we measured anatomic parameters related to the patellofemoral joint by three-dimensional CT, diagnosed trochlear dysplasia using a sulcus angle of ≥ 145° or a femoral trochlear depth of ≤ 4 mm, and classified trochlear dysplasia according to the Dejour classification; the proportions of trochlear dysplasia among the three groups were compared totally or by sex. To answer the second question about whether more severe DDH is associated with a higher likelihood of trochlear dysplasia, Crowe cla
{"title":"Femoral Trochlear Dysplasia Is Common in Lower Limbs With Hartofilakidis C2 Hip Dysplasia.","authors":"Yijian Huang, Mingfeng Li, Fangxin Zhao, Cheng Wang, Jiafeng Yi, Xiangpeng Kong, Wei Chai","doi":"10.1097/CORR.0000000000003557","DOIUrl":"10.1097/CORR.0000000000003557","url":null,"abstract":"<p><strong>Background: </strong>Patients with developmental dysplasia of the hip (DDH) can also present with deformities of the patellofemoral joint, such as femoral trochlear dysplasia. Although previous studies have reported that trochlear dysplasia is clinically important in some patients with DDH, the association between DDH and trochlear dysplasia is still unclear.</p><p><strong>Questions/purposes: </strong>(1) Is trochlear dysplasia more common among lower limbs with bilateral DDH, with unilateral DDH, or without DDH (specifically, in the contralateral limb of patients with unilateral DDH)? (2) Is having more severe DDH (as measured by Hartofilakidis classification, Crowe classification, or according to angular measurements) associated with higher odds of having trochlear dysplasia?</p><p><strong>Methods: </strong>This was a single-center retrospective comparative study. Between November 2018 and February 2024, a total of 439 patients with DDH (of whom 56% [248 of 439] had bilateral DDH and the remainder had unilateral DDH) underwent THA in our center. Of those, we considered as potentially eligible patients who were between ages 18 and 50 years, with a history of DDH that did not undergo surgical treatment prior to the THA, and who had available demographic and radiographic data. We then excluded 31% of the patients because 62 of them had a history of hip or knee treatment, 8 had a history of trauma or infection in the hip or knee, 24 had severe knee osteoarthritis, 9 had a history of neuromuscular disease, and the data from 33 patients were incomplete, leaving 303 patients (of whom 50% [152 of 303] had bilateral DDH, while the remainder had unilateral DDH; 455 affected and 151 unaffected limbs, in total) for the analysis. From those, we formed three study groups: 33% (152) of limbs randomly selected from one of the limbs of each patient with bilateral DDH were assigned to the bilateral group, 33% (151) of limbs selected from the ipsilateral side of patients with unilateral DDH were assigned to the unilateral group, and 33% (151) of limbs selected from the contralateral limbs in patients with unilateral DDH were assigned to the contralateral group. There were no differences in demographics, such as sex, age, and BMI, between patients with bilateral DDH and unilateral DDH. All patients underwent CT as a standard component of the preoperative evaluation process for THA. To answer our first question about in which group trochlear dysplasia is more common, we measured anatomic parameters related to the patellofemoral joint by three-dimensional CT, diagnosed trochlear dysplasia using a sulcus angle of ≥ 145° or a femoral trochlear depth of ≤ 4 mm, and classified trochlear dysplasia according to the Dejour classification; the proportions of trochlear dysplasia among the three groups were compared totally or by sex. To answer the second question about whether more severe DDH is associated with a higher likelihood of trochlear dysplasia, Crowe cla","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2257-2268"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-05DOI: 10.1097/CORR.0000000000003565
Daishui Yang, Bernhard U Hoehl, Lukas Schönnagel, Lukas Mödl, Tianwei Zhang, Sihai Liu, Sandra Reitmaier, Lena Fleig, Matthias Pumberger, Hendrik Schmidt
<p><strong>Background: </strong>Low back pain (LBP) is a common health problem and a major contributor to disability. Modic changes, or vertebral marrow changes visible on MRI, are frequently observed in individuals with LBP. However, there is inconsistent evidence assessing the relationship between Modic changes and LBP, pain-related disability, and quality of life.</p><p><strong>Questions/purposes: </strong>(1) Are Modic change parameters, including their type, number, and extent, positively associated with the characteristics of LBP, particularly when classified into intermittent LBP and chronic LBP? (2) Are Modic change parameters associated with participant-reported longer duration and higher intensity of LBP? (3) Are Modic change parameters associated with worsened pain-related disability and poorer quality of life?</p><p><strong>Methods: </strong>This study was a Phase III, single-center, cross-sectional analysis drawing its data from the ongoing Berlin Back Study (research unit FOR5177). A total of 1218 participants who met the inclusion and exclusion criteria were recruited between January 2022 and January 2024. Of these, 18% (217 of 1218) were excluded because of the lack of results from orthopaedic clinical examination and MRI evaluation. After clinical examination and completion of questionnaires, another 24% (289 of 1218) were excluded because of pain in other locations or pain experienced in the past, leaving 58% (712 of 1218) of participants in our study. The individuals included in this study had a mean age of 42 ± 11 years, with 57% women and 43% men. Data on demographic characteristics, LBP features, pain-related disability, and quality of life were collected using structured questionnaires and clinical evaluations. Three independent evaluators, blinded to the participants' demographic information and health status, assessed the Modic change parameters, referring to signal alterations in the vertebrae's endplate. The relationship between Modic change parameters and individual health status was assessed using multiple regression analysis after adjustment for age, gender, BMI, smoking and alcohol consumption, disc herniation, facet joint degeneration, and spinal instability.</p><p><strong>Results: </strong>Among the common Modic change parameters, when Type I Modic changes were observed, we found higher odds of chronic LBP (OR 7.3 [95% confidence interval (CI) 3.1 to 17.0]; p < 0.001) and intermittent LBP (OR 4.9 [95% CI 1.7 to 14.0]; p = 0.003) after adjusting for potential confounders. However, when greater depth and area of Modic changes were observed, we found higher odds of chronic LBP (OR 3.1 [95% CI 1.3 to 7.3]; p = 0.01 and OR 1.3 [95% CI 1.0 to 1.7]; p = 0.03, respectively) but not of intermittent LBP (OR 1.2 [95% CI 0.4 to 4.1]; p = 0.72 and OR 1.0 [95% CI 0.7 to 1.3]; p = 0.86, respectively). In the chronic LBP subgroup, we found that Type I Modic changes were associated with slightly higher maximum pain intensity (β 1.
背景：腰痛（LBP）是一种常见的健康问题，也是导致残疾的主要原因。在腰痛患者中经常观察到轻微改变或MRI可见的椎髓改变。然而，评估Modic变化与LBP、疼痛相关残疾和生活质量之间关系的证据并不一致。问题/目的：(1)Modic change parameters，包括其类型、数量和程度，是否与LBP的特征呈正相关，特别是当分为间歇性LBP和慢性LBP时？(2) Modic变化参数是否与参与者报告的LBP持续时间更长和强度更高有关？(3) Modic改变参数是否与疼痛相关残疾恶化和生活质量下降相关？方法：本研究是一项III期、单中心、横断面分析，数据来自正在进行的柏林背部研究（研究单位FOR5177）。在2022年1月至2024年1月期间，总共招募了1218名符合纳入和排除标准的参与者。其中，18%（1218例中的217例）因缺乏骨科临床检查和MRI评估结果而被排除。在临床检查和完成问卷后，另外24%（1218人中的289人）因其他部位疼痛或过去经历过疼痛而被排除，剩下58%（1218人中的712人）的参与者留在我们的研究中。本研究纳入的个体平均年龄为42±11岁，其中57%为女性，43%为男性。通过结构化问卷调查和临床评估收集了人口统计学特征、腰痛特征、疼痛相关残疾和生活质量的数据。三名独立的评估者，不知道参与者的人口统计信息和健康状况，评估Modic变化参数，指的是椎体终板的信号改变。在调整年龄、性别、BMI、吸烟和饮酒、椎间盘突出、小关节退变和脊柱不稳定等因素后，采用多元回归分析评估Modic变化参数与个体健康状况的关系。结果：在常见的Modic改变参数中，当观察到I型Modic改变时，我们发现慢性腰痛的几率更高(OR 7.3[95%可信区间（CI） 3.1至17.0]；p < 0.001)和间歇性腰痛(OR 4.9 [95% CI 1.7 ~ 14.0]；P = 0.003)。然而，当观察到更大的深度和面积的Modic变化时，我们发现慢性腰痛的几率更高(OR 3.1 [95% CI 1.3至7.3]；p = 0.01， OR为1.3 [95% CI 1.0 ~ 1.7]；p = 0.03)，但间歇性腰痛不存在(OR为1.2 [95% CI为0.4 ~ 4.1]；p = 0.72, OR 1.0 [95% CI 0.7 ~ 1.3]；P = 0.86)。在慢性腰痛亚组中，我们发现I型Modic变化与最大疼痛强度略高相关(β 1.1 [95% CI 0.4至1.7]；p = 0.001)，多重Modic变化与慢性腰痛持续时间较长相关(β 5.1 [95% CI 1.2 - 9.0]；P = 0.01)。慢性LBP组的Modic变化深度和面积增加与疼痛强度升高有关，而间歇性LBP组则没有。此外，II型和单一Modic变化与疼痛相关功能障碍轻微恶化相关(β 1.1 [95% CI 0.1至2.0]；p = 0.03, β = 1.5 [95% CI 0.6 ~ 2.4]；P = 0.001)。Modic变化的存在也与稍差的生活质量有关，特别是在身体健康方面。结论：轻度改变与腰痛发生率增高、疼痛强度增大、疼痛相关残疾恶化和生活质量下降有关。I型和更大的Modic变化与慢性腰痛强度略高和身体功能略有下降相关。我们的研究将Modic变化与这些发现联系起来，但并不是为了证明两者之间存在因果关系。未来的研究将需要探索Modic变化与健康状况之间的因果关系，以及针对Modic变化是否可以提供缓解LBP的潜在方法。证据等级：III级，预后研究。
{"title":"Modic Changes Are Associated With Increased Pain Intensity, Greater Disability, and Reduced Quality of Life in Low Back Pain: A Cross-Sectional Study.","authors":"Daishui Yang, Bernhard U Hoehl, Lukas Schönnagel, Lukas Mödl, Tianwei Zhang, Sihai Liu, Sandra Reitmaier, Lena Fleig, Matthias Pumberger, Hendrik Schmidt","doi":"10.1097/CORR.0000000000003565","DOIUrl":"10.1097/CORR.0000000000003565","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a common health problem and a major contributor to disability. Modic changes, or vertebral marrow changes visible on MRI, are frequently observed in individuals with LBP. However, there is inconsistent evidence assessing the relationship between Modic changes and LBP, pain-related disability, and quality of life.</p><p><strong>Questions/purposes: </strong>(1) Are Modic change parameters, including their type, number, and extent, positively associated with the characteristics of LBP, particularly when classified into intermittent LBP and chronic LBP? (2) Are Modic change parameters associated with participant-reported longer duration and higher intensity of LBP? (3) Are Modic change parameters associated with worsened pain-related disability and poorer quality of life?</p><p><strong>Methods: </strong>This study was a Phase III, single-center, cross-sectional analysis drawing its data from the ongoing Berlin Back Study (research unit FOR5177). A total of 1218 participants who met the inclusion and exclusion criteria were recruited between January 2022 and January 2024. Of these, 18% (217 of 1218) were excluded because of the lack of results from orthopaedic clinical examination and MRI evaluation. After clinical examination and completion of questionnaires, another 24% (289 of 1218) were excluded because of pain in other locations or pain experienced in the past, leaving 58% (712 of 1218) of participants in our study. The individuals included in this study had a mean age of 42 ± 11 years, with 57% women and 43% men. Data on demographic characteristics, LBP features, pain-related disability, and quality of life were collected using structured questionnaires and clinical evaluations. Three independent evaluators, blinded to the participants' demographic information and health status, assessed the Modic change parameters, referring to signal alterations in the vertebrae's endplate. The relationship between Modic change parameters and individual health status was assessed using multiple regression analysis after adjustment for age, gender, BMI, smoking and alcohol consumption, disc herniation, facet joint degeneration, and spinal instability.</p><p><strong>Results: </strong>Among the common Modic change parameters, when Type I Modic changes were observed, we found higher odds of chronic LBP (OR 7.3 [95% confidence interval (CI) 3.1 to 17.0]; p < 0.001) and intermittent LBP (OR 4.9 [95% CI 1.7 to 14.0]; p = 0.003) after adjusting for potential confounders. However, when greater depth and area of Modic changes were observed, we found higher odds of chronic LBP (OR 3.1 [95% CI 1.3 to 7.3]; p = 0.01 and OR 1.3 [95% CI 1.0 to 1.7]; p = 0.03, respectively) but not of intermittent LBP (OR 1.2 [95% CI 0.4 to 4.1]; p = 0.72 and OR 1.0 [95% CI 0.7 to 1.3]; p = 0.86, respectively). In the chronic LBP subgroup, we found that Type I Modic changes were associated with slightly higher maximum pain intensity (β 1.","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2353-2363"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-05-28DOI: 10.1097/CORR.0000000000003566
Alec P Friswold, Arvind von Keudell, Clay Beagles, Devon Brameier, Mitchel B Harris, Christopher M Bono, David N Bernstein
<p><strong>Background: </strong>The largest value-based payment system in the United States is the Merit-based Incentive Payment System (MIPS), implemented by the Centers for Medicare & Medicaid Services (CMS). MIPS was designed to adjust physician reimbursement based on performance across several categories. However, concerns arose that MIPS may inadvertently penalize physicians caring for patients of high social risk. To address this concern, CMS introduced the Complex Patient Bonus (CPB), which provides a performance bonus for serving a greater proportion of dually eligible, or socially at-risk (as defined by CMS), patients. In orthopaedic surgery, there is a paucity of evidence assessing MIPS performance (such as scores and payment adjustments), the association between patient social risk and MIPS scores, and the relationship of the newly implemented CPB with performance scores.</p><p><strong>Questions/purposes: </strong>In this study, we asked: (1) How do orthopaedic surgeons fare in MIPS based on positive, negative, and bonus payment adjustments? (2) Do orthopaedic surgeons caring for more socially at-risk patients receive worse performance scores and payment adjustments than orthopaedic surgeons who treat fewer socially at-risk patients? (3) To what extent is the CPB associated with differences in MIPS scores and payment adjustments for orthopaedic surgeons caring for a greater proportion of socially at-risk patients?</p><p><strong>Methods: </strong>Orthopaedic surgeons participating in MIPS in 2021 were identified using publicly available, nationally representative, standardized CMS data sets, consistent with prior studies assessing clinician performance under MIPS. In keeping with prior studies and consistent with how CMS defines social risk for the purpose of adjusting MIPS performance and payments using the CPB, dual eligibility for Medicare and Medicaid was used as a proxy for social risk. Surgeons were stratified into quintiles based on the proportion of patients dually eligible for Medicare and Medicaid. To answer the first question about how orthopaedic surgeons, in aggregate, perform in MIPS, CMS MIPS outcome data were used to quantify the proportion of surgeons who received a positive or negative payment adjustment, an exceptional performance bonus, and a maximum payment penalty. To address the second question regarding the association between caring for socially at-risk patients and MIPS performance, MIPS scores and payment adjustments were compared between surgeons in the highest and lowest quintiles of patient social risk, as determined by the proportion of dually eligible patients in each surgeon's practice per CMS definition. To evaluate the extent to which the CPB is associated with differences in MIPS performance, multivariable regression was used to assess whether the proportion of socially at-risk patients in a surgeon's practice was associated with differences in MIPS scores, payment adjustments, and exceptional perform
{"title":"How Does CMS' Merit-based Incentive Payment System Penalize or Reward Orthopaedic Surgeons Caring for Socially At-risk Patients?","authors":"Alec P Friswold, Arvind von Keudell, Clay Beagles, Devon Brameier, Mitchel B Harris, Christopher M Bono, David N Bernstein","doi":"10.1097/CORR.0000000000003566","DOIUrl":"10.1097/CORR.0000000000003566","url":null,"abstract":"<p><strong>Background: </strong>The largest value-based payment system in the United States is the Merit-based Incentive Payment System (MIPS), implemented by the Centers for Medicare & Medicaid Services (CMS). MIPS was designed to adjust physician reimbursement based on performance across several categories. However, concerns arose that MIPS may inadvertently penalize physicians caring for patients of high social risk. To address this concern, CMS introduced the Complex Patient Bonus (CPB), which provides a performance bonus for serving a greater proportion of dually eligible, or socially at-risk (as defined by CMS), patients. In orthopaedic surgery, there is a paucity of evidence assessing MIPS performance (such as scores and payment adjustments), the association between patient social risk and MIPS scores, and the relationship of the newly implemented CPB with performance scores.</p><p><strong>Questions/purposes: </strong>In this study, we asked: (1) How do orthopaedic surgeons fare in MIPS based on positive, negative, and bonus payment adjustments? (2) Do orthopaedic surgeons caring for more socially at-risk patients receive worse performance scores and payment adjustments than orthopaedic surgeons who treat fewer socially at-risk patients? (3) To what extent is the CPB associated with differences in MIPS scores and payment adjustments for orthopaedic surgeons caring for a greater proportion of socially at-risk patients?</p><p><strong>Methods: </strong>Orthopaedic surgeons participating in MIPS in 2021 were identified using publicly available, nationally representative, standardized CMS data sets, consistent with prior studies assessing clinician performance under MIPS. In keeping with prior studies and consistent with how CMS defines social risk for the purpose of adjusting MIPS performance and payments using the CPB, dual eligibility for Medicare and Medicaid was used as a proxy for social risk. Surgeons were stratified into quintiles based on the proportion of patients dually eligible for Medicare and Medicaid. To answer the first question about how orthopaedic surgeons, in aggregate, perform in MIPS, CMS MIPS outcome data were used to quantify the proportion of surgeons who received a positive or negative payment adjustment, an exceptional performance bonus, and a maximum payment penalty. To address the second question regarding the association between caring for socially at-risk patients and MIPS performance, MIPS scores and payment adjustments were compared between surgeons in the highest and lowest quintiles of patient social risk, as determined by the proportion of dually eligible patients in each surgeon's practice per CMS definition. To evaluate the extent to which the CPB is associated with differences in MIPS performance, multivariable regression was used to assess whether the proportion of socially at-risk patients in a surgeon's practice was associated with differences in MIPS scores, payment adjustments, and exceptional perform","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2245-2254"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-13DOI: 10.1097/CORR.0000000000003585
Chao Fan Chen, Shi Yuan Qian, Tao Li, Lei Yao, Yang Xu, Li Wang, Jian Li
<p><strong>Background: </strong>In clinical practice, different surgical methods, including autografts, allografts, and artificial ligaments, have been used in reconstruction after ACL injuries. However, the available evidence is conflicting in terms of which approach has yielded better patient-reported outcomes, joint stability, and risk of graft reinjury. A network meta-analysis allows the comparison of approaches that have not been compared head-to-head in individual RCTs. Although several network meta-analyses have been performed on this topic, they are hampered by methodological limitations.</p><p><strong>Questions/purposes: </strong>We performed an updated network meta-analysis of RCTs to answer the following questions: Considering different grafts applied in ACL reconstruction, which graft is superior in terms of (1) patient-reported outcomes (International Knee Documentation Committee [IKDC] objective score, Lysholm score, and Tegner score), (2) knee stability results (Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference), and (3) risk of graft reinjury?</p><p><strong>Methods: </strong>We searched the PubMed, Embase, Cochrane Library, and Web of Science databases from January 2000 to November 2024 for completed studies. We reviewed 30,976 papers, and 27 met inclusion criteria, which were as follows: RCTs published in English, RCTs that involved ACL reconstruction with different grafts (autografts, allografts, and artificial ligaments) with fully described surgical techniques, RCTs that reported on at least one of the relevant outcome measures (preoperative and postoperative IKDC objective score, Lysholm score, Tegner score, Lachman test, pivot-shift test, KT-1000/2000 arthrometer side-to-side difference, and risk of graft reinjury), and RCTs that reported a minimum follow-up period of 12 months with at least 80% follow-up completeness. The Cochrane risk-of-bias tool (RoB 2.0) was used to assess the quality of the included studies, with 18 studies judged as being at a low risk of bias and 9 studies assessed as being at an unclear risk of bias. In total, 2572 patients were treated with 16 different types of grafts. The mean length of follow-up was 47 months. The mean age of the included patients was 28 years, and 71% of the patients were male. A Bayesian network meta-analysis was performed via the "gemtc" and "coda" packages of R Studio, version 4.2.1, and the "networkplot" command of Stata 15 software was used to plot network relationships for direct and indirect comparisons between different interventions. The surface under the cumulative ranking curve (SUCRA) was calculated to rank the intervention effects of different interventions. A SUCRA value approaching 1 (100%) indicates a greater probability that the corresponding treatment is superior in terms of efficacy or safety. The most common treatment comparisons were the single-bundle 4-strand semitendinosus with gracilis tendon autograft versus the bone-p
{"title":"Which Graft Is Associated With Better Outcomes in ACL Reconstruction? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.","authors":"Chao Fan Chen, Shi Yuan Qian, Tao Li, Lei Yao, Yang Xu, Li Wang, Jian Li","doi":"10.1097/CORR.0000000000003585","DOIUrl":"10.1097/CORR.0000000000003585","url":null,"abstract":"<p><strong>Background: </strong>In clinical practice, different surgical methods, including autografts, allografts, and artificial ligaments, have been used in reconstruction after ACL injuries. However, the available evidence is conflicting in terms of which approach has yielded better patient-reported outcomes, joint stability, and risk of graft reinjury. A network meta-analysis allows the comparison of approaches that have not been compared head-to-head in individual RCTs. Although several network meta-analyses have been performed on this topic, they are hampered by methodological limitations.</p><p><strong>Questions/purposes: </strong>We performed an updated network meta-analysis of RCTs to answer the following questions: Considering different grafts applied in ACL reconstruction, which graft is superior in terms of (1) patient-reported outcomes (International Knee Documentation Committee [IKDC] objective score, Lysholm score, and Tegner score), (2) knee stability results (Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference), and (3) risk of graft reinjury?</p><p><strong>Methods: </strong>We searched the PubMed, Embase, Cochrane Library, and Web of Science databases from January 2000 to November 2024 for completed studies. We reviewed 30,976 papers, and 27 met inclusion criteria, which were as follows: RCTs published in English, RCTs that involved ACL reconstruction with different grafts (autografts, allografts, and artificial ligaments) with fully described surgical techniques, RCTs that reported on at least one of the relevant outcome measures (preoperative and postoperative IKDC objective score, Lysholm score, Tegner score, Lachman test, pivot-shift test, KT-1000/2000 arthrometer side-to-side difference, and risk of graft reinjury), and RCTs that reported a minimum follow-up period of 12 months with at least 80% follow-up completeness. The Cochrane risk-of-bias tool (RoB 2.0) was used to assess the quality of the included studies, with 18 studies judged as being at a low risk of bias and 9 studies assessed as being at an unclear risk of bias. In total, 2572 patients were treated with 16 different types of grafts. The mean length of follow-up was 47 months. The mean age of the included patients was 28 years, and 71% of the patients were male. A Bayesian network meta-analysis was performed via the \"gemtc\" and \"coda\" packages of R Studio, version 4.2.1, and the \"networkplot\" command of Stata 15 software was used to plot network relationships for direct and indirect comparisons between different interventions. The surface under the cumulative ranking curve (SUCRA) was calculated to rank the intervention effects of different interventions. A SUCRA value approaching 1 (100%) indicates a greater probability that the corresponding treatment is superior in terms of efficacy or safety. The most common treatment comparisons were the single-bundle 4-strand semitendinosus with gracilis tendon autograft versus the bone-p","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2334-2349"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-05DOI: 10.1097/CORR.0000000000003627
David W Polly
{"title":"CORR Insights®: How Does Anterior Vertebral Body Tethering Compare to Posterior Spinal Fusion for Thoracic Idiopathic Scoliosis? A Nonrandomized Clinical Trial.","authors":"David W Polly","doi":"10.1097/CORR.0000000000003627","DOIUrl":"10.1097/CORR.0000000000003627","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2377-2378"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-30DOI: 10.1097/CORR.0000000000003739
Joseph Bernstein
{"title":"Not the Last Word: The Rational Calculus of Sports Injuries.","authors":"Joseph Bernstein","doi":"10.1097/CORR.0000000000003739","DOIUrl":"10.1097/CORR.0000000000003739","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 12","pages":"2230-2232"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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