Current Reviews in Musculoskeletal Medicine最新文献

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.

Purpose of review: Patient-reported outcome measures (PROMs) represent a valuable means of assessing the impact of spine surgery on various aspects of patient function and quality of life. This review highlights the most common and contemporary PROMs used in degenerative cervical and lumbar spine conditions, adolescent idiopathic scoliosis, and adult spinal deformity.

Recent findings: Available PROMs differ in their comprehensiveness, flexibility, and ease of use, as well as their ability to provide prognostic information. Condition-specific PROMs such as the Scoliosis Research Society-22 and Modified Japanese Orthopedic Association offer the benefit of prompts tailored to capture the unique considerations for a particular disease state, while more generalized metrics such as the Short-Form 36 facilitate widespread PROM standardization permitting comparison between disease states and interventions. Newer PROMS such as the Patient Reported Outcomes Measurement Information System and the Patient Generated Index offer benefits due to their generalizable yet adaptable format, conferring them the potential to capture condition-specific factors while still permitting comparison between diseases. However, these instruments require further adaptations and validation prior to widespread implementation to fully realize these advantages. Many PROMs are available for use in the spine surgery population, each with unique benefits and drawbacks, necessitating careful evaluation when selecting PROMs for research use.

Purpose of review: This scoping review aimed to identify the indications, techniques, outcomes, and knowledge gaps related to managing postoperative native hip instability. Specifically, it examined how capsular repair and reconstruction strategies address iatrogenic capsular insufficiency following hip preservation procedures, with the goal of clarifying optimal surgical decision-making and guiding future research.

Recent findings: Arthroscopic reconstruction emerged as the most commonly described technique for post-arthroscopic hip instability, frequently involving the use of dermal allografts, iliotibial band, or Achilles tendon grafts. Arthroscopic repair methods (i.e., capsular plication) were also widely reported, showing improved patient-reported outcomes in case series and retrospective cohorts. Open reconstruction and repair approaches were less common but demonstrated comparable potential for restoring hip stability in select patients. Postoperative protocols emphasized restricted weight-bearing, bracing, and controlled rehabilitation to prevent excessive capsular strain. Despite promising clinical improvements, published data were predominantly case reports, technical notes, and small retrospective studies. Instability should be carefully considered and properly assessed in patients experiencing persistent pain and sensations of abnormal hip "looseness" or locking following hip arthroscopy. Capsular repair and reconstruction are viable interventions for addressing hip capsular deficiency and alleviating symptoms of iatrogenic instability. In the absence of high-quality comparative trials, no definitive consensus exists on optimal graft selection or surgical technique, although dermal allografts and iliotibial band constructs have both shown positive outcomes. Larger, prospective and/or comparative studies are needed to refine patient selection, establish standardized protocols, and evaluate long-term efficacy.

Purpose of review: The demand for AI-driven solutions in musculoskeletal (MSK) imaging has risen alongside the surge in orthopedic imaging studies, reflecting the need for tools that enhance diagnostic accuracy, reduce healthcare costs, and alleviate physician workload. This review explores recent applications of AI-particularly computer vision and deep learning (DL)-in MSK imaging, from trauma and surgery to specialized and point-of-care technologies. The review also highlights existing challenges and limitations hindering the integration of these tools into clinical practice.

Recent findings: AI applications are abundant in MSK imaging, with DL models showing remarkable versatility and success across multiple use cases. These include but are not limited to fracture detection, segmentation for preoperative planning, surgical navigation and tracking, tumor detection and classification, pediatric bone age estimation, and bone density measurement. Specialized use cases also target injury detection in sports medicine, and AI has been integrated into point-of-care technologies, such as motion-monitoring systems, underscoring AI's broad potential to improve diagnostic accuracy, reduce interpretation times, and increase efficiency. AI has shown promise in transforming MSK imaging, suggesting improvements in diagnostic performance, speed, and cost-efficiency. Despite research advances, challenges remain in deploying AI in real-world clinical settings, where model generalizability, data quality, and high computational demands pose obstacles. However, recent developments in AI, including the rise of adaptable foundation models and advancements in model efficiency, offer promising solutions that may accelerate the integration of AI into clinical workflows, bringing the field closer to realizing the full potential of AI in patient care.

Purpose of review: The goal of this review is to explore the role of acetabular and femoral osteotomies in the treatment of hip dysplasia and femoroacetabular impingement (FAI). We aim to answer key questions regarding the indications and outcomes associated with these procedures in managing both conditions. Hip dysplasia and FAI are often interrelated, with joint malalignment contributing to the development of pain, dysfunction, and early osteoarthritis. Acetabular and femoral osteotomies have been shown to restore proper alignment, alleviate symptoms, and delay the need for joint replacement.

Recent findings: Acetabular osteotomy is effective for improving patient symptomatology secondary to hip dysplasia by improving coverage and reducing instability. Further, it can delay or obviate the need for hip replacement. Femoral osteotomy, on the other hand, addresses excessive femoral anteversion in instability or retroversion in FAI. Both procedures are most effective when performed early in the disease process, prior to the onset of cartilage degeneration. Major takeaways include the importance of precise preoperative imaging, careful patient selection, and significant surgical expertise. Additionally, while both osteotomies can significantly improve function and delay arthritic progression, concomitant procedures like hip arthroscopy and osteochondral autograft and allograft transplantation are still being evaluated, underscoring the need for continued research in this area.