Current Reviews in Musculoskeletal Medicine最新文献

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.

Purpose of review: Sudden cardiac arrest (SCA) in a young athlete is a profoundly impactful and potentially tragic event. This review summarizes the epidemiology of SCA in athletes, evolving methods of carrying out the cardiac preparticipation evaluation (cPPE), and the appropriate identification and follow up care of athletes with positive cPPE screens. It also guides clinicians on decision making after a positive cPPE screen, provides an overview of shared decision-making following a new cardiac diagnosis, and emphasizes the importance of the emergency action plan (EAP).

Recent findings: SCA is more common than historical estimates, and survival rates may be improving. cPPE strategies based on the history and physical exam alone have significant limitations. The resting electrocardiogram (ECG) is endorsed as an important component of the cPPE by some societies and leagues and is the most statistically powerful tool to achieve the goal of early detection of cardiac conditions. A comprehensive evaluation, inclusive of expert consultation and shared decision making, is recommended to determine participation status following a new cardiac diagnosis. Long-term follow up studies suggest athletic competition with a known cardiac diagnosis may be safe in some cases. The optimal method of conducting the cPPE remains an area of intense debate. Regardless of method utilized, sports medicine clinicians should be able to accurately identify a positive screen based and understand the appropriate next steps based on modern ECG interpretation criteria and expert guidelines. No screening method is perfect, and the EAP will always remain a critical component of any safe athletic venture.

Purpose of review: We aim to summarize the validation of patient reported outcome measures (PROMs) used in orthopaedic conditions, particularly for non-English languages. We also identify completed translations and areas of ongoing need to support the expansion and broader adoption of PROMs in orthopaedic surgery.

Recent findings: Recent translations and cross-cultural adaptations of PROMs used in orthopaedic surgery continue to employ robust methods for validation. Many PROMs have undergone extensive translations since their initial development. There has also been a large volume of recent work to translate PROMs used in orthopaedic surgery, with more than 45 studies. While some PROMs are available in a wide range of different languages, some PROMs have undergone fewer translations. Additionally, while there has been ongoing work to translate tools and surveys used in orthopaedic surgery, a small proportion of these translated PROMs reflect that of the American Academy of Orthopaedic Surgeons-preferred list of PROMs.

Purpose of review: This review examines variability in failure and recurrence rates following split posterior tibial tendon transfer (SPOTT) for spastic equinovarus deformity (SED) in children with cerebral palsy (CP). It evaluates patient-specific and surgical risk factors contributing to poor outcomes and assesses the inconsistent definitions of failure across the literature.

Recent findings: Across the seven included studies, failure was more common in patients under the age of 8, non-ambulatory individuals, and those with quadriplegic CP. Surgical contributors included poor tendon tensioning, residual spasticity, over- or under-correction, and untreated bony deformities. Although modified techniques demonstrated improved outcomes, the risk of recurrence was not completely eliminated. All studies consistently lacked standardized definitions of surgical failure and recurrence, limiting cross-study comparability. Postoperative management strategies-particularly structured bracing protocols and delaying surgery until after age 8-were associated with more favorable outcomes. SPOTT remains a viable surgical option for dynamic SED in children with CP, but long-term success is highly dependent on careful patient selection, surgical expertise, and consistent postoperative care. Inconsistent definitions of recurrence and failure remain a major barrier to improving clinical outcomes and conducting meaningful comparative research. To enhance clinical decision-making and guide future studies, a standardized grading system should be urgently developed and adopted in the field.

Purpose of review: Joint hypermobility can increase complications in surgical management of musculoskeletal conditions. The purpose of this review is to 1) summarize clinical outcomes in patients undergoing various Orthopedic sports medicine surgical procedures by joint, and 2) compare outcomes in patients with and without hypermobility.

Recent findings: A total of 38 studies consisting of 144,609 patients and 144,860 joints were included (140,625 shoulders, 2,043 hips, 1,499 knees, 689 ankles, and four elbows). Notable heterogeneity exists within the literature regarding outcomes in hypermobile patients undergoing Orthopedic sports medicine procedures. In general, outcomes for hypermobile patients undergoing procedures of the shoulder, elbow, hip, and knee demonstrated similar or slightly worse outcomes across various patient reported outcomes measures (PROMs) and in terms of recurrent instability or dislocation. There were consistently worse outcomes (e.g. higher rates of post-operative recurrent instability, PROMs) in studies evaluating hypermobile patients undergoing surgery for chronic lateral ankle instability (CLAI) compared to non-hypermobile controls. Patients with joint hypermobility tend to have similar or worse outcomes following Orthopedic sports medicine procedures related to the shoulder, knee, hip, and elbow, and consistently worse outcomes for the ankle. Future studies are encouraged to focus on the effect of hypermobility on elbow and wrist sports pathologies.

Purpose of review: To establish the state-of-the-art in applied artificial intelligence (A.I) related to value-based musculoskeletal health care. We performed a literature review of A.I applications in orthopaedics and contextualized these studies based on their alignment with allocative value, technical value, and personal value. We synthesized our findings using descriptive analysis and the Gartner Hype Cycle.

Recent findings: 82% of research activity involving A.I and its applications in musculoskeletal care is dominantly focused on technical value, which can be divided into three main sub-groups: imaging and diagnostics, prognostic outcomes and risk factors, and A.I integration within medical devices and care pathways. A.I advancing personal value (18% of studies) is rapidly gaining traction. Relatively few studies (< 1%) focused on allocative value. Emerging applications of A.I in orthopaedics providing 'technical value' include machine learning algorithms for predicting risk and prognosis, diagnostic computer vision algorithms, models advancing surgical robotics; 'personal value' include ambient listening technology, A.I scribes, triage of clinical messages, patient engagement via LLM chatbots, pre-charting applications; and emotional intelligence. Application of these technologies to Gartner's Hype Cycle suggests big data analytics and robotic surgery applications are approaching the plateau of productivity while multiagent / autonomous systems, emotional intelligence, and AI-enabled decision intelligence serve as innovation triggers but are in their infancy. A.I offers the opportunity to improve medical diagnosis, processes, practices and patient experiences and outcomes within musculoskeletal care delivery. While applications enhancing technical value and personal value are being actively researched and rapidly developed in the digital health industry, studies on how A.I provides value through equitable and fair allocation of resources at a population level should be promoted.

Purpose of review: Virtual reality (VR) simulation in orthopedic education has gained recent interest in the literature. VR simulation provides a virtual space to practice surgical steps accurately, creating a user-controlled environment for novice surgical trainee skill development. Despite the reported benefits, VR is not routinely incorporated into orthopedic residency core curriculum. This study reviews and synthesizes contemporary data assessing the efficacy of VR simulation in orthopedic surgical training.

Recent findings: Twenty-three studies across six subspecialty areas were included. Seven hundred and forty-eight participants trained on over nine different VR simulators. Control groups included no additional training, surgical technique guides, surgical videos, and benchtop simulators. Outcome measurements included procedure-specific checklists, objective grading scales, time-to-task completion, and accuracy of implant placement, among others. No outcomes directly focused on patient safety or involved live patients. Across disciplines, VR simulation training improved outcomes when compared to controls, conferring quicker procedure times, higher correct step completion, and more accurate implant placement, although not always statistically significant. Virtual reality is a tool employed by various industries that offers immersive, interactive, and realistic learning experiences. In orthopedics, VR has the potential to enhance skills, improve safety, and increase trainee confidence. In most of the included studies, trainees performed better in the VR simulation groups when compared to control education modalities, and participants readily embraced VR. However, there is mixed evidence on its use, and future studies are needed involving longitudinal VR education to better assess the actual impact on trainee skills, as well as performance in the operating room and its impact on patient outcomes.