Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: There has been an expanding role of artificial intelligence (AI) and machine learning (ML) in spine surgery, particularly in operative planning, intraoperative navigation, and postoperative management. With a focus on patient-specific surgical strategies, AI technologies offer new possibilities for improving surgical accuracy, reducing risks, and enhancing patient outcomes in spine care.

Recent findings: AI models have shown strong accuracy in preoperative planning, with neural networks outperforming traditional algorithms in patient selection and outcome prediction. Advances in 3D modeling, supported by machine learning, enable efficient, patient-specific anatomical reconstructions, reducing manual segmentation time from hours to seconds. In intraoperative navigation, AI-driven virtual and augmented reality systems enhance screw placement precision and reduce radiation exposure by up to 90%, improving workflow and safety. Additionally, real-time AI-based decision support has decreased operative time and postoperative risks, while postoperative AI applications now support mortality risk stratification and discharge planning, yielding significant predictive accuracy for adverse events and extended stays. AI technologies are transforming spine surgery by increasing surgical precision, optimizing clinical workflows, and personalizing patient care. While challenges remain regarding data diversity and ethical considerations, ongoing innovations indicate that AI will continue to refine spine surgery through personalized and efficient care solutions.

Purpose of review: Hip arthroscopy is an effective surgical procedure to treat intra-articular hip pathology including femoroacetabular impingement (FAI) and labral tears. This review aims to synthesize current evidence on sex-based differences in the pathology, presentation, surgical management, and outcomes of femoroacetabular impingement (FAI) and hip arthroscopy.

Recent findings: Emerging evidence indicates distinct morphological and clinical patterns of FAI between sexes. Cam-type morphology is more prevalent in males, whereas females more frequently present with pincer morphology and generalized joint hypermobility. Sex-specific differences in acetabular and femoral version, pelvic anatomy, and ligamentous laxity may contribute to variable symptomatology and diagnostic challenges. Postoperative outcomes following hip arthroscopy also appear to vary, with some studies reporting inferior outcome scores in females while others report no differences based on patient sex. Sex-based anatomical and biomechanical differences in FAI are clinically significant and may impact diagnosis, treatment strategy, and surgical outcomes. Recognizing and addressing these distinctions can optimize outcomes for both male and female patients. Continued research is needed to refine our understanding sex-specific etiology, pathology, and management approaches to ultimately improve long-term hip preservation.

Purpose of review: Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure among general orthopedists, and is a logged procedure required for graduation from accredited orthopaedic residency programs.

Recent findings: ACL reconstruction surgery has a number of critical steps, and intraoperative errors can significantly impact the success rate and morbidity of this operation. Technical errors are frequently cited as some of the most common reasons for ACL reconstruction failure. This narrative review provides low-volume surgeons and trainees with an overview of the common errors that can be made during the critical steps of an ACL reconstruction procedure. We suggest technical points for avoiding commonly-encountered errors and provide a description of evidence-supported error recovery techniques to address these errors if they occur intraoperatively. These key steps include femoral tunnel creation, tibial tunnel creation, graft harvest and preparation, and graft fixation within the tunnels. We discuss a number of primary and backup fixation strategies as well as all commonly used autografts (bone-patellar tendon-bone, hamstring, and quadriceps tendon). Additionally, we provide a brief overview on address intra-operative graft contamination citing currently available evidence.

Purpose of review: Management of first-time anterior shoulder instability (ASI) is an extensively studied yet controversial topic. Successful treatment requires incorporation of a wide range of factors including patient demographics, varying presenting pathology, functional demands, and sport specific considerations. The purpose of this review is to provide an up-to-date summary of the current literature and trends regarding management of first time ASI events.

Recent findings: For non-operative treatment of first-time ASI events, shorter times for immobilization and consideration of positioning in external rotation may be more beneficial. Operative intervention may be favored for patients at high risk of recurrence (young, male, collision sports, and/or overhead athlete). Historically, open soft tissue stabilization was a primary treatment option for ASI. More recently, there has been an increased emphasis on arthroscopic Bankart repair (ABR) especially in the United States. The remplissage has become a useful adjunct to ABR to manage cases with Hill-Sachs lesions or sub-critical bone loss. Latarjet (coracoid transfer) remains a well-studied and common option for cases of critical glenoid bone loss. When directly compared both ABR with Remplissage and Latarjet improve outcomes and reduce the risk of recurrence in athletes with first-time ASI. Currently, there is no uniform approach to managing first-time ASI events. Therefore, an individualized approach is required with consideration of the individuals demographic, presence of bone loss, functional demands, and sport specific considerations. In young, male, collision athletes early surgical intervention may be beneficial to prevent recurrence. When faced with minimal (< 13.5%) or subcritical bone loss (13.5% to 20%), ABR with Remplissage may reduce rates of instability compared to ABR alone.

Purpose of review: To summarize the history of titanium implants in spine fusion surgery and its evolution over time.

Recent findings: Titanium interbody cages used in spine fusion surgery have evolved from solid metal blocks to porous structures with varying shapes and sizes in order to provide stability while minimizing adverse side effects. Advancements in technology, especially 3D printing, have allowed for the creation of highly customizable spinal implants to fit patient specific needs. Recent evidence suggests that customizing shape and density of the implants may improve patient outcomes compared to current industry standards. Future work is warranted to determine the practical feasibility and long-term clinical outcomes of patients using 3D printed spine fusion implants. Outcomes in spine fusion surgery have improved greatly due to technological advancements. 3D printed spinal implants, in particular, may improve outcomes in patients undergoing spine fusion surgery when compared to current industry standards. Long term follow up and direct comparison between implant characteristics is required for the adoption of 3D printed implants as the standard of care.

Purpose of review: Outcomes after anterior cruciate ligament reconstruction (ACLR) are generally favorable, yet the timing and extent of return to sport vary widely and are influenced by numerous factors. This review examines the principal pre-operative, intra-operative, and post-operative considerations that influence return to sport following ACLR.

Recent findings: Successful return to sport depends on many crucial elements during the pre-operative, intra-operative, and post-operative periods. Recent developments for adjunctive rehabilitation modalities-such as blood flow restriction, hyperbaric oxygen therapy, cryotherapy, and photo-biomodulation-may further enhance recovery for some patients. Additionally, psychological readiness has emerged and continues to grow as a key predictor of both the timing and success of return to sport. A criteria-based strategy that integrates physical performance, sport-specific skills, and psychological preparedness offers the most reliable framework for tailoring rehabilitation and maximizing retorn-to-sport outcomes following ACL reconstruction.

Purpose of review: Frugal innovations prioritize low-cost interventions, while keeping in mind efficacy, accessibility and scalability. Despite a scientific culture that often celebrates major financial investment and cutting-edge technologies, frugal innovations can be just as important in both low-income countries where resources are scarce as they are high income countries where the health needs of aging populations may be outpacing economic growth. We sought to comprehensively review the current state of frugal innovations in orthopaedic surgery, as well as to identify next steps as the importance of these low-cost interventions continues to grow.

Recent findings: Frugal innovation is particularly relevant in orthopaedic care as musculoskeletal interventions such as prosthetics, orthotics and surgery demand significant materials, skilled labor, and frequent follow-up. There have been numerous innovations in the recent years, including the development of low-cost intramedullary nails, bioabsorbable implants, negative-pressure wound therapy systems made from aquarium pumps, repurposed Foley catheters and nasogastric tubes for use in surgeries, among many more. Frugal innovations in orthopaedic surgery are becoming more relevant and rapidly evolving in all health-care settings as a tool to deliver value-based care to the growing needs of the population. Though many of these projects are performed on a local scale, when considered collectively, they demonstrate powerful efforts to move the needle in enhancing access to high-quality orthopaedic surgical care and reduce the burden of global musculoskeletal disability. Frugal innovations offer immense promise in reducing costs and closing the gap of access to high-quality orthopaedic care worldwide.