Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: The goal of this review is to discuss the current understanding of implantable shock absorbers (ISA) including mechanism of action, usage in patients, patient outcomes and the future of this technology.

Recent findings: Since the introduction of the ISA, it mainly has functioned as a surgical option for individuals with symptomatic medial compartment osteoarthritis who are too young, not indicated, or do not wish to proceed with arthroplasty. Biomechanically, ISA reduces peak medial compartment force by 32%. In a Food and Drug Administration (FDA) study, ISA was found superior to HTO, with significant reduction of pain and improvement of function. Survivorship and freedom to conversion to arthroplasty remains 85% at 5 years. Current randomized trial focuses on impact of continued non operative treatment of OA verses ISA. ISA is a reasonable surgical option for the treatment of medial compartment osteoarthritis without the need for disruption of the patient's native anatomy through osteotomy or arthroplasty.

Purpose of review: The purpose of this review is to compare beach chair (BC) and lateral decubitus (LD) positioning for arthroscopic shoulder stabilization, with an emphasis on the technical considerations, visualization and access, position-specific complications, and clinical outcomes.

Recent findings: Recent cohort studies, systematic reviews, and editorials consistently demonstrate that both beach chair (BC) and lateral decubitus (LD) positioning is safe and effective for arthroscopic shoulder stabilization procedures with comparable rates of recurrent instability, revision surgery, return to sports, and patient-reported outcomes. Reported differences between BC and LD positions are more consistently observed in intraoperative mechanics and workflow than in clinical outcomes. Though patient factors are often the most influential with respect to the outcome of surgery, it remains important to understand any available modifiable factors and how they can influence clinical outcomes. Patient position selection for arthroscopic shoulder stabilization procedures should be guided by surgeon experience, operative team familiarity, patient-specific factors, and the technical demands of the instability pattern being addressed. Future prospective and randomized studies are needed to more definitively evaluate whether surgical positioning independently influences outcomes.

Purpose: Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity of adolescence and disproportionately affects females, with outcomes strongly dependent on curve magnitude and timing of detection. Increasing evidence demonstrates that structural and systemic factors influence multiple stages of the AIS care continuum and may be the primary drivers of disparities in care amongst this population. This narrative review synthesizes contemporary evidence on sex- and race-based inequities in AIS, emphasizing structural drivers rather than biologic explanations for these disparities and highlighting priorities for future research.

Recent findings: Studies examining presentation severity show heterogeneous results, but intersectional analyses consistently identify compounded disadvantage among Black adolescents with public insurance. Delayed detection and loss to follow-up emerge as central mechanisms linking social context to higher surgical rates and greater economic burden. In contrast, disparities in short-term postoperative complications appear attenuated after adjustment in many cohorts. However, differences in length of stay, hospital charges, and the geographic distribution of care persist, primarily related to patient race and insurance coverage. Most variation in findings across settings reflects differences in screening policies, insurance structures, and the socioeconomic indices used to characterize disadvantage, as well as limitations inherent to administrative databases and registry attrition. The available evidence indicates that structural and systemic factors, rather than biological factors, have a direct impact on disparate care in AIS. This impact is most noticeable at the initial stages of care, such as screening and diagnosis, where sociocultural and socioeconomic differences can affect patients' access to timely non-operative care. However, it seems once the decision to treat with surgery has been made, the previously existing disparities do not affect surgical outcomes but can affect long-term follow-up.