Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: Adolescent idiopathic scoliosis (AIS) is a disabling spinal pathology, with a significant morbidity if left untreated. This review investigates the recent advances in the diagnosis and management of AIS.

Recent findings: Low radiation techniques have become a paramount focus in the management of patient's with AIS. The EOS system is growing in popularity due to lower radiation compared to conventional radiographs with the added advantage allowing 3D reconstruction. Bracing remains the standard treatment for curves amenable to this, however, due to the importance in compliance with brace wear there has been a recent push for more personalized brace construction using 3-dimensional printing. If curves are not amenable to bracing, then surgical intervention is generally recommended. Posterior spinal fusion (PSF) remains the gold standard; however, newer growth modulating techniques are in their infancy. Anterior vertebral body tethering (VBT) is a relatively novel method of treatment for AIS, that has seen promising early results. Due to its novelty and varying results VBT use remains limited and will need to be further investigated. AIS is a complex disease without a clear understanding of it's etiology. If identified earlier, then non-operative treatment may lead to prevention of curve progression and the need for surgical intervention. Newer technologies, such as the EOS system, allow 3D reconstruction of curves which can assist with pre-operative planning. PSF remains the gold standard surgical intervention for AIS, however, new developments in alternative techniques could have a promising future, especially for skeletally immature patients.

Purpose of review: This review aims to provide a comprehensive analysis of the nonoperative management of Gartland Type II fractures in pediatric patients.

Recent findings: Supracondylar humeral fractures (SCF) are one of the most common traumatic fractures in pediatric populations, characterized as transverse fractures at the distal humerus between the medial and lateral columns. Early studies strongly opposed closed reduction and casting as an acceptable treatment modality for Gartland type II fractures as an early case series showed high rates of complications; however, more recent studies have suggested better outcomes. The optimal management of Gartland Type II supracondylar fractures has yet to be fully elucidated. This review highlights the indications, complications, and outcomes of nonoperative Gartland Type II supracondylar humeral fracture management. Additionally, it demonstrates the need for further research to inform guidelines on managing this condition.

Purpose of review: Meniscectomy alters knee function and known to be associated with an increased incidence of knee arthritis. Several methods and materials have been tried to replicate the function of a meniscus. One is a polycarbonate-urethane synthetic medial meniscus implant labeled as NUsurface. It is a non-anchored implant that is meant to replace the native meniscus. This article is intended to give an overview of the NUsurface implant and the experience to date.

Recent findings: The NUsurface implant is not intended to be a substitute for arthroplasty but has indications similar to meniscal allografts. It has had both prospective double armed and single armed prospective studies. Follow up at the 2-year mark has shown the implant can be successful in decreasing patients' pain and improving function. However, the reoperation rate has been high with a little over a 1/3 requiring an additional procedure and 30% requiring implant exchanged. With improved surgical technique and knowledge of contributing anatomic variables, the reoperation rate has been decreased by half. The synthetic medial meniscus implant NUsurface is able to improve the quality of life in select patients that are symptomatic after meniscectomy. The reoperation rate is of concern but it is decreasing as we refine the variables contributing to the high rate.

Purpose of review: Atraumatic hip pain in children is one of the most common orthopaedic complaints in this population. This review details the important elements of the pediatric hip physical exam and provides an overview of pertinent clinical exam findings in specific diagnoses of common pediatric hip pathology.

Recent findings: A thorough physical exam is critical for the diagnosis of pediatric hip pathology, as many conditions have exam findings that are very commonly associated with the pathology, if not pathognomonic for the disorder. Additionally, pediatric hip pathology is strongly age-related, so an understanding of typical exam findings and common hip conditions by age can be invaluable in forming a correct diagnosis. Inspection, palpation, range of motion, gait analysis, and provocative tests provide clues about potential diagnoses. Together with history and risk factors, pediatric clinicians can make appropriate diagnosis of pediatric hip disorders.

Purpose of review: This review aims to analyze the impact of martial arts on youth, addressing the physical and psychosocial benefits, as well as the injury risks associated with increased participation.

Recent findings: Data from the National Federation of State High School Associations indicates a notable increase in youth participation in martial arts, with a rise of over 13,000 participants from 2018 to 2022. In addition to physical benefits, recent studies highlight that martial arts can significantly enhance mindfulness, reduce stress, and improve self-control, thus diminishing bullying behaviors in school-aged children. Additionally, the therapeutic application of martial arts techniques has been effective in managing pain in children with chronic diseases and in alleviating emotional distress in their siblings. However, the popularity of the sport brings concerns over a spectrum of injuries, especially more severe cases in competitive settings. Martial arts provide a dynamic platform for fostering robust physical health and psychological resilience among youth. While the benefits are substantial, they are accompanied by risks that require careful management through informed practices and supervision. This review underscores the importance of understanding the dual nature of martial arts - its capacity to empower and its potential to harm - to maximize its benefits and safeguard young athletes.

Purpose of review: With the growing popularity and broadening indications for Reverse Shoulder Arthroplasty (RSA), increasing modularity in design and adjustments to each component can enhance postoperative range of motion (ROM), thus expanding treatment capabilities. This review outlines the advancements developed to optimize ROM through modifications in glenoid and humeral components and the integration of computational tools for surgical planning.

Recent findings: Enhancements in glenoid component design aim to mitigate complications like scapular notching and improve ROM, particularly in abduction and external rotation. Modifications to the humeral component, including adjustments in neck-shaft angle and lateralization, also contribute to ROM optimization. The integration of computational modeling and intraoperative navigation is advancing towards a more tailored approach to RSA to increase postoperative ROM. While RSA has evolved considerably since the introduction of the Grammont prosthesis, current research continues to improve upon implant design and positioning to overcome early design limitations. Modifications such as glenoid lateralization and inferior positioning and humeral neck-shaft angle and lateralization contribute to better postoperative ROM. The integration of these advancements in implant adjustments with computational modeling for surgical planning has the potential to enhance ROM and patient-specific outcomes. Translating these biomechanical improvements into clinical benefit remains a key area for future investigation.

Purpose of the review: Anatomic and reverse endoprosthetic reconstruction are two common surgical options used after tumor resection of the proximal humerus. The purpose of this article is to provide an overview of the functional outcomes and complications of modern anatomic and reverse endoprostheses.

Recent findings: The anatomic endoprosthesis has traditionally been a successful reconstructive technique as it provided a stable platform upon which the hand and elbow could function. However, the reverse endoprosthesis has gradually replaced the anatomic endoprosthesis given that its semi-constrained design affords greater stability. Patients with reverse endoprostheses have improved motion, patient-reported outcome scores, and revision-free implant survivorship compared to those with anatomic endoprostheses. Shoulder function may be further improved with a reverse allograft prosthetic composite (APC) due to reconstruction of the rotator cuff tendons or by transferring the latissimus dorsi and teres major tendons to recreate the function of the posterosuperior rotator cuff muscles. The short-term functional improvement observed with the use of an allograft reconstruction, however, may diminish with longer follow-up due to delayed graft complications, such as resorption, nonunion, and fracture. In most patients undergoing oncologic resection of the proximal humerus, the reverse endoprosthesis or reverse APC is recommended due to improved functional outcomes and reduced postoperative complications compared to other reconstructive techniques.

Purpose of review: Provide a concise review of currently utilized functional metrics and patient reported outcomes measures (PROMs) determining appropriate return to sport following anterior cruciate ligament reconstruction (ACLR).

Recent findings: When determining return to sport following ACLR, a limb symmetry index (LSI) ≥ 90% when compared to the contralateral extremity is the most commonly reported functional metric. LSI is most commonly assessed using isokinetic quadriceps strength, followed by single-leg vertical hop and cross-over hop test. A minimum ACL-Return to Sport Index (ACL-RSI) score of 68.2 was reported, as well as a mean International Knee Documentation Committee (IKDC) score of 88.3%. A minimum Knee Injury and Osteoarthritis Outcome Score-Quality of Life (KOOS-QoL) of 62.5% was reported in a single investigation. There remains limited data on reported metrics guiding return to sport following ACLR. Evaluation of LSI when compared to the contralateral extremity is the most commonly reported functional measure, with ACL-RSI, IKDC and KOOS-QoL also being reported. Further investigations examining return to sport rate and the incidence of recurrent injury, factoring in differences in sex, competition level, and the presence or absence of concomitant meniscal injuries, based on functional metrics and PROMs is warranted to better understand which outcome measures are predictive of successful return to sport following ACLR.

Purpose of review: Femoroacetabular impingement (FAI) with labral tear is an increasingly recognized source of hip pain and lost playing time in elite athletes, yet data pertaining to professional American football athletes remains scarce. Prognostic recommendations are largely limited to single-institution cohort studies. To date, no large-scale literature review of surgical treatment of FAI in elite American football athletes has been performed. This review article reports the prevalence, return to play, performance outcomes, and career longevity following hip arthroscopy in professional American football athletes across all orthopedic literature between 2004-2024. We hypothesize high rates of return to sport (> 85%) to the same competition level and no differences in career longevity or postoperative performance.

Recent findings: In the last 20 years, 8 studies have reported outcomes following hip arthroscopy in NFL athletes; no outcomes have been reported since the 2017 season. Return to play ranged from 79-93% and time to return ranged between 6.0-7.4 months. Offensive lineman returned at the lowest rate among all position groups. There were no differences in postoperative performance or career length compared to age-matched controls. There is high rate of return to professional American football after hip arthroscopy for labral tear and/or FAI with no differences in performance or career longevity compared to control groups. Offensive lineman undergoing hip arthroscopy return to same-level competition at a lower rate compared to other football positions.

Purpose of review: Scaphoid fractures are commonly encountered injuries in the athletic population. Conservative management is pursued for incomplete fractures and those involving the distal pole. Operative management is indicated for displaced fractures, unstable fractures, and those involving the proximal pole. Complete non-displaced scaphoid waist fractures can be treated operatively or non-operatively based on patient and surgeon preference. The purpose of this article is to discuss the treatment, rehabilitation, and return to play guidelines for scaphoid injuries.

Recent findings: CT scan is critically important to determine fracture displacement (which influences treatment choices) and healing (which influences return to activity determination). Nondisplaced scaphoid waist fractures can be treated with casting with 99.4% healing rate. Surgical treatment can hasten return to activities; newer surgical constructs have been suggested including dual screw fixation, plating, and staples. Outcomes of scaphoid fractures are generally favorable, as long as the selected treatment achieves a united, well-aligned scaphoid. In the athletic population specifically, there are high return to play rates and functional performances seen after these injuries. Each athlete is unique with regard to chosen sport, level of play, fracture type, and timing of the injury. Treatment options and return-to-play must be determined in a case-by-case manner to ensure an optimal clinical outcome.