Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: Meniscus allograft transplantation (MAT) is associated with good clinical outcomes even though biological mechanical and technical challenges persist. These include early graft shrinkage, extrusion, reoperation due to reoccurrence of pain or mechanical symptoms and progression of osteoarthritis (OA). The purpose of this review is to evaluate the influence of MAT surgical techniques, and novel cell therapies on graft extrusion and tibial femoral contact stresses and how these can be optimized to improve clinical outcomes.

Recent findings: Of the 27 articles that met the inclusion and exclusion criteria, 16 (clinical and cadaveric) focused on the impact of surgical fixation techniques on extrusion, joint loading mechanics and clinical outcomes. These studies demonstrated that bony fixation techniques were superior to soft tissue and transossesous suture fixation for restoring joint mechanics and minimizing extrusion. However, clinical outcomes were not significantly impacted by these biomechanical findings. The remaining 11 studies investigated novel cell therapies for meniscus regeneration and improving MAT procedures. Intrameniscal injections into frozen meniscus allografts demonstrated the potential for cell therapy to improve allograft tissue properties. Intraarticular injections and cell sheet transplantation led to tissue regeneration and chondroprotection following a hemi-meniscectomy in preclinical models. Although short-term clinical outcomes and PROMs are not significantly affected by fixation techniques, cadaveric and clinical studies have suggested that suture-only fixation with a traditional transosseous fixation may lead to worsened extrusion and joint mechanics compared to bony fixation methods. However, the implications of these findings on long-term clinical outcomes have not been evaluated. Cell therapy could further improve allograft tissue properties, chondroprotection and graft healing working together with current surgical techniques to restore joint functioning.

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.