Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: To evaluate the clinical outcomes of patients with on-track or non-engaging Hill-Sachs lesions (HSLs) undergoing Bankart repair (BR) versus BR with adjunctive remplissage (BR-R).

Recent findings: Three databases (MEDLINE, EMBASE, and PubMed) were searched on August 4th, 2025 for studies assessing outcomes following BR and BR-R. Nine studies involving 1006 patients (20.2% female, mean age 24.4 years, mean follow-up 33.5 months, 682 BR, 324 BR-R) were included. Compared with BR-R, the BR group demonstrated higher rates of recurrent instability (16.1% vs. 3.7%; RR = 3.39, 95% CI 1.96-5.89, p < 0.001, I² = 0%), re-dislocation (8.8% vs. 2.8%; RR = 2.36, 95% CI 1.13-4.95, p = 0.02, I² = 0%), and revision (9.4% vs. 2.8%; RR = 2.85, 95% CI 1.20-6.76, p = 0.02, I² = 0%). RTS was higher after BR-R (RB = 1.16, 95% CI 1.06-1.27, p < 0.001, I² = 0%). ROM was greater after BR in one of three studies. WOSI (MD=-1.77, 95% CI -3.54-0.01, p = 0.05, I² = 36%) and ROWE (MD=-4.86, 95% CI -8.09-1.62, p < 0.001, I² = 91%) scores favored BR-R, while ASES, SANE, VAS, and SSV were comparable. Apprehension was more common after BR (26.8% vs. 12.1%; RR = 2.42, 95% CI 1.45-4.04, p < 0.001, I² = 0%), and other complications were similar. Retrospective data suggests BR-R for on-track HSLs is associated with low risk of complications and offers significantly reduced risk of recurrent instability with similar outcomes compared to BR alone. Further research is needed to understand the indications for adjunctive remplissage in the setting of on-track/non-engaging HSLs.

Purpose of review: This study aims to systematically review the current literature on treatment strategies for ischiofemoral impingement (IFI), focusing on the outcomes of nonoperative, arthroscopic, and open surgical interventions.

Recent findings: IFI is an uncommon but increasingly recognized cause of posterior hip and deep gluteal pain, resulting from narrowing of the space between the ischial tuberosity and the lesser trochanter. Seven studies (level IV evidence) encompassing 101 patients (107 hips) were identified. Majority of patients were female (91%) with mean ages 26-47 years and follow-up ranging 18-48 months. Image-guided quadratus femoris injections provided short-term pain relief but limited long-term benefit. Arthroscopic lesser trochanter (LT) resection demonstrated consistent improvement in hip function and return to activity, with minimal complications and revision rates. One study on open derotation osteotomy reported significant improvements in range of motion, reduced impingement symptoms, and high patient satisfaction. Both conservative and surgical treatments improve symptoms of IFI, though surgical decompression reports sustained benefit. Arthroscopic LT resection shows promise as a safe and effective intervention. However, current evidence is limited to small, retrospective series without direct comparisons. Future prospective, comparative studies using standardized outcome measures are needed to define optimal management strategies for IFI.

Purpose of review: Ponte osteotomy (PO) is frequently used in corrective surgery, yet its specific effect on vertebral rotation correction remains unclear. This study systematically reviewed the literature to compare PO with alternative techniques in patients with idiopathic scoliosis. Following PRISMA methodology, MEDLINE, Embase, and Web of Science were searched for comparative studies assessing axial rotation outcomes in idiopathic scoliosis treated with or without PO. The primary outcome was vertebral rotation correction.

Recent findings: Six studies were included, encompassing a total of 439 patients with mean ages ranging from 13.5 ± 2.8 to 17.5 ± 3.7 years. Most study populations were predominantly female in four studies, predominantly male in one, and evenly distributed in one. Two studies showed a meaningful improvement in postoperative thoracic rotation in the PO group compared to inferior facetectomy (IF). Other studies found PO to be superior to IF and posterior spinal fusion (PSF), although these differences were not statistically significant, except for one study that reported a statistically significant advantage of PO over PSF. No meaningful superiority was observed when comparing PO with skip pedicle screw fixation. Overall, intraoperative and postoperative complication rates were similar between PO and non-PO groups, although one study reported a higher rate of intraoperative neuromonitoring changes and reoperations in the PO group. Most studies to date have found that PO is associated with superior vertebral rotation outcomes compared to IF and PSF, with only half showing statistical significance. PO is also linked to longer operative time and greater blood loss, warranting further high-quality studies to clarify its risk-benefit profile.

Purpose of review: This review examines existing literature on how orthopaedic education develops critical thinking and decision-making in medical students and residents.

Recent findings: Scopus, Web of Science, MEDLINE, and PubMed were searched for English-language studies published between 2015 and 2025. Twenty-eight studies met the inclusion criteria. Most involved residents (n = 19), fewer focused on medical students (n = 8), and one included both groups (n = 1). Five themes were identified: technology-enhanced learning, reflective and analytical practice, mentorship and professional development, curriculum design and integration, and assessment and feedback. Simulation and digital tools improved procedural reasoning and engagement. Reflection and mentorship supported analytical and diagnostic skills. Non-operative and outpatient decision-making were rarely explored. Orthopaedic education increasingly uses technology and active learning. However, structured development of critical thinking and decision-making remains limited, especially outside surgical settings and early training. Embedding reasoning, reflection, and mentorship in curricula may better connect classroom learning with clinical decision-making.

Purpose of review: To analyze the efficacy and efficiency of current large language models (LLMs), specifically GPT-5 in screening titles and abstracts for three review topics within different subspecialties in orthopedics.

Recent findings: Python scripts were developed to call on the GPT-5 model via OpenAIs application programming interface (API). Two human reviewers simultaneously performed screening based on the same inclusion and exclusion criteria. Performance metrics such as specificity, sensitivity, accuracy, positive predictive value (PPV), negative predictive values (NPV), and F1 scores for GPT-5 were calculated based on a gold-standard inclusion and exclusion list developed by a third human adjudicator. Efficiency metrics included total cost and time to completion for each task. The number of titles and abstracts to screen ranged between 668 and 1,131 amongst the three review topics. All performance metrics were above 92.3% amongst all three topics, with sensitivities ranging from 94.1%-100%. Time to completion ranged between 38.5-174.3 minutes. Cost ranged from $1.32-$3.73USD GPT-5 demonstrated exceptional accuracy, sensitivity, specificity, PPV, NPV, and F1 scores in automating title and abstract screening for three orthopedic systematic review topics in three different subspecialties. Results are similar to previous studies investigating the role of AI for screening, specifically increased accuracy and time-to-completion relative to humans. The average rate of screening ranged from 6.5-17.4 abstracts per minute and the average price ranged from $0.002-$0.0036USD per abstract, suggesting a high degree of efficiency compared to current standards.

Purpose of review: Tendinopathy is a common cause of musculoskeletal morbidity, resulting in frequent visits to primary care providers, orthopedists, and urgent care clinics. Six common regions of tendinopathy are discussed in this article, including up to date findings in their clinical history and exam findings, special testing, imaging, and treatment.

Recent findings: Point of care musculoskeletal ultrasound has gained popularity as a tool in the diagnosis of various tendinopathies. Advanced interventions, including extracorporeal shockwave therapy (ESWT) and injections modalities such as platelet rich plasma (PRP) are becoming more common in the treatment of tendinopathy; however, the evidence for these interventions is mixed with most providing some short-term relief in symptoms but no long-term improvement in outcomes.

Recent findings: Point of care musculoskeletal ultrasound has gained popularity as a tool in the diagnosis of various tendinopathies. Advanced interventions, including extracorporeal shockwave therapy (ESWT) and injections modalities such as platelet rich plasma (PRP) are becoming more common in the treatment of tendinopathy; however, the evidence for these interventions is mixed with most providing some short-term relief in symptoms but no long-term improvement in outcomes. The diagnosis of tendinopathy often remains a clinical diagnosis with the mainstay of treatment remaining activity modification, physical therapy, and anti-inflammatories for acute pain control. Recovery time is widely variable between patients and conditions.