Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: To analyze the efficacy and efficiency of current large language models (LLMs), specifically GPT-5 in screening titles and abstracts for three review topics within different subspecialties in orthopedics.

Recent findings: Python scripts were developed to call on the GPT-5 model via OpenAIs application programming interface (API). Two human reviewers simultaneously performed screening based on the same inclusion and exclusion criteria. Performance metrics such as specificity, sensitivity, accuracy, positive predictive value (PPV), negative predictive values (NPV), and F1 scores for GPT-5 were calculated based on a gold-standard inclusion and exclusion list developed by a third human adjudicator. Efficiency metrics included total cost and time to completion for each task. The number of titles and abstracts to screen ranged between 668 and 1,131 amongst the three review topics. All performance metrics were above 92.3% amongst all three topics, with sensitivities ranging from 94.1%-100%. Time to completion ranged between 38.5-174.3 minutes. Cost ranged from $1.32-$3.73USD GPT-5 demonstrated exceptional accuracy, sensitivity, specificity, PPV, NPV, and F1 scores in automating title and abstract screening for three orthopedic systematic review topics in three different subspecialties. Results are similar to previous studies investigating the role of AI for screening, specifically increased accuracy and time-to-completion relative to humans. The average rate of screening ranged from 6.5-17.4 abstracts per minute and the average price ranged from $0.002-$0.0036USD per abstract, suggesting a high degree of efficiency compared to current standards.

Purpose of review: Tendinopathy is a common cause of musculoskeletal morbidity, resulting in frequent visits to primary care providers, orthopedists, and urgent care clinics. Six common regions of tendinopathy are discussed in this article, including up to date findings in their clinical history and exam findings, special testing, imaging, and treatment.

Recent findings: Point of care musculoskeletal ultrasound has gained popularity as a tool in the diagnosis of various tendinopathies. Advanced interventions, including extracorporeal shockwave therapy (ESWT) and injections modalities such as platelet rich plasma (PRP) are becoming more common in the treatment of tendinopathy; however, the evidence for these interventions is mixed with most providing some short-term relief in symptoms but no long-term improvement in outcomes.

Recent findings: Point of care musculoskeletal ultrasound has gained popularity as a tool in the diagnosis of various tendinopathies. Advanced interventions, including extracorporeal shockwave therapy (ESWT) and injections modalities such as platelet rich plasma (PRP) are becoming more common in the treatment of tendinopathy; however, the evidence for these interventions is mixed with most providing some short-term relief in symptoms but no long-term improvement in outcomes. The diagnosis of tendinopathy often remains a clinical diagnosis with the mainstay of treatment remaining activity modification, physical therapy, and anti-inflammatories for acute pain control. Recovery time is widely variable between patients and conditions.

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.