Current Reviews in Musculoskeletal Medicine最新文献

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.

Purpose of review: The Layer Concept is a widely used model that provides an excellent anatomic framework with which to systematically diagnose and treat non-arthritic hip pain. More recently, there is a growing body of evidence highlighting the significant impact that psychosocial factors can have on both the presentation of various hip disorders and clinical outcomes following hip preservation surgery (HPS). Herein we propose the Layer + Model as a simple modification to help clinicians better diagnose and treat patients presenting with non-arthritic hip pain.

Recent findings: Building on the original four layers (osseous, inert, contractile, neuromechanical), the Layer + Model adds in a fifth layer, the psychosocial layer, to contextualize the numerous non-mechanical factors that influence perceived pain and patient-reported outcomes. Such psychosocial variables can include everything from pain level and chronicity to quality of life, mental health, social and family health, cultural contributions and many more factors that we are just learning about. This systematic review summarizes the existing evidence supporting the inclusion of a psychosocial layer. Additionally, we highlight early multidisciplinary efforts aimed at addressing each of these factors around the time of HPS. For patients presenting with non-arthritic hip pain, a complete understanding of all five layers is essential to make an accurate diagnosis and subsequently customize therapeutic recommendations to each patient's unique needs. By recognizing the importance of such psychosocial factors, the Layer + model may also help to support the continued research and development of multidisciplinary strategies to screen for (and treat) psychosocial risk factors around the time of HPS.

Purpose of review: The purpose of this review was to critically appraise the literature and establish an evidence-based clinical guideline for the use of non-steroidal anti-inflammatory drugs (NSAIDs) in a fracture setting.

Recent findings: With few exceptions, studies in animals suggest that NSAIDs impair fracture healing. It is unclear if nonselective or cyclooxygenase-(COX)2-selective NSAIDs pose differing effects on fracture healing. Human studies show NSAID use to be a consistent risk factor for fracture non-union in skeletally mature populations across the literature and indicates that indomethacin in particular poses a significant risk for non-union of adult acetabular fractures. Current evidence appears to suggest no harm in using ketorolac or ibuprofen in a pediatric fracture population, while indomethacin poses a significant risk for non-union in adult acetabular fracture patients when used for six weeks. Despite the majority of available clinical studies showing NSAID use as a recurring risk factor for fracture non-union in adult populations, a lack of standardization amongst studies makes it difficult to determine any clinical recommendations about timing, dosage, duration, or type of agent administered. More high-quality prospective studies are needed.

Purpose of review: Osteotomies around the knee are well-established techniques used to correct lower-extremity malalignment. While osteotomies of the proximal tibia and distal femur have traditionally been performed free-hand, the advent of Patient-Specific Instrumentation (PSI) in the form of custom 3D printed cutting guides and implants offers surgeons a greater ability to individualize surgical corrections to a patient's unique bony anatomy. This review aims to investigate the current state of the literature surrounding the use and outcomes of PSI for knee osteotomies and the benefits and drawbacks of PSI compared to traditional techniques.

Recent findings: Recent studies have demonstrated the potential benefits of PSI in knee osteotomy, including improvements in the accuracy of planned corrections, reductions in operative time and fluoroscopy exposure, and similar patient-reported outcomes. While increased costs and lead time represent drawbacks to the use of PSI, the technology continues to evolve such that these areas may improve over time. For osteotomy of the distal femur and proximal tibia, PSI offers surgeons an opportunity to improve surgical precision intra-operatively, with similar outcomes and complication rates as compared to traditional osteotomy techniques.

Purpose of review: The discoid lateral meniscus is an abnormal variant that can lead to pain and mechanical symptoms. This review aims to summarize the clinical outcomes after surgical management of the discoid lateral meniscus. Procedures included saucerization/meniscectomies, repair, or meniscus allograft transplantation.

Recent findings: A total of 52 articles were included, consisting of 4,503 patients (4,784 knees). Weighted preoperative and postoperative Lysholm scores were 57.8 and 88.6, respectively, with 100% of studies (27/27) finding a significant improvement in scores postoperatively. Weighted preoperative and postoperative IKDC scores were 59.6 and 87.3, respectively, with 88.9% of studies (8/9) finding a statistically significant improvement in scores. Weighted preoperative and postoperative Tegner scores were 4.8 and 7.3, respectively, with 100% of studies (5/5) finding a statistically significant improvement in scores postoperatively. Weighted preoperative and postoperative VAS scores were 5.3 and 3.2, respectively, with 100% of studies (5/5) finding a statistically improvement in scores postoperatively. Amongst patients with reported values, 209 (6.6%; range 0-23.7%) suffered retears, while there were 290 reoperations (6.0%; range: 0-36.7%). Complications included persistent pain, mechanical symptoms, or swelling (n = 115; 2-4%). Studies to date have reported good outcomes overall following surgical management of the discoid lateral meniscus, with significant improvements in PROMs. However, retear and reoperation rates within the literature have been reported to be as high as 23.7% and 36.7%, respectively.