Current Reviews in Musculoskeletal Medicine最新文献

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.

Purpose of review: Football players are at an increased risk for posterior shoulder instability compared to other sports due to certain sport-specific motions that involve posteriorly directed force on the shoulder in a vulnerable position. Management of posterior instability, both nonoperative and operative, is aimed at preventing recurrent instability. Regardless of treatment, timing of return to play revolves around avoiding reinjury and prioritizing player safety. This article provides a review of the current treatment modalities of posterior shoulder instability and the return to play criteria that must be met prior to releasing the player to competition.

Recent findings: Posterior shoulder instability was traditionally thought to occur predominately in offensive linemen. However, recent literature suggests it can also commonly be found in other players, including defensive linemen and quarterbacks. Current research reports high return to play rates for athletes that undergo arthroscopic posterior capsulolabral repair. Whereas, there is limited literature regarding return to play rates after posterior bony augmentation and management of reverse Hill-Sachs lesions. Rehabilitation and return to play protocols have been recommended but are nonspecific to American football. Posterior shoulder instability has the potential to sideline young athletes for an extended time and presents a complex challenge to both the athlete and the treating physician. Although the ultimate goal is to facilitate return to play, the physician must balance this with minimizing the risk of re-injury.

Purpose of review: Artificial intelligence (AI) has rapidly proliferated though medicine with many novel applications to improve patient care and optimize healthcare delivery. This review investigates recent literature surrounding the influence of AI imaging technologies on spine surgical practice and diagnosis.

Recent findings: Robotic-assisted pedicle screw placement has been shown to increase the rate of clinically acceptable screw placement while increasing operative time. AI technologies have also shown promise in creating 3D spine imaging while reducing patient radiation exposure. Several models using various imaging modalities have been shown to reliably identify vertebral osteoporotic fractures, stenosis and spine cancers. Complex spinal anatomy and pathology as well as integration of robotics make spine surgery a promising field for the deployment of AI-based imaging technologies. Imaging-based AI projects show potential to enhance diagnostic and surgical efficiency, facilitate trainee learning and improve operative outcomes.

Purpose of review: The global rise in obesity and type 2 diabetes mellitus (T2DM) presents significant challenges in musculoskeletal care, contributing to increased perioperative complications, impaired bone health, and compromised muscle function. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), initially developed for glycemic control in T2DM, have demonstrated substantial benefits in weight reduction and metabolic regulation. The purpose of this review is to understand the musculoskeletal biologic and clinical implications of GLP-1RAs.

Recent findings: Evidence suggests that GLP-1RAs may impact musculoskeletal health through anti-inflammatory effects, bone metabolism modulation, and alterations in muscle composition. GLP-1RAs may promote osteoblastogenesis while dampening osteoclast activity to maintain bone mineral density. The result on fracture risk is unclear. Additionally, while GLP-1RAs cause lean mass loss, GLP-1RAs appear to preserve skeletal muscle, reduce fatty infiltration, and enhance fiber formation and function. Further, GLP-1Rs are present in synovial tissue and cartilage, demonstrating downregulation of inflammatory molecules and chondrocyte apoptotic pathways, though clinical studies show variable effects in the setting of osteoarthritis. Overall, the heterogeneity in findings underscores the need for further research to delineate the long-term musculoskeletal effects of GLP-1RAs. Understanding the musculoskeletal impact of GLP-1RAs is critical for optimizing their integration into orthopedic practice. This review explores the orthopedic implications of GLP-1RAs, highlighting their biologic mechanisms and clinical effects on obesity-related joint inflammation and arthropathy, bone mineral density and fracture risk, and skeletal muscle preservation.

Purpose of review: The main purpose of this review was to summarize the current evidence on treatment and outcomes of sports injuries requiring surgical intervention in female and non-binary athletes and identify key gaps in the related literature concerning sports injuries requiring surgical intervention to guide future research.

Recent findings: Of the 59 included studies, all focused on biological sex or sex-based differences, while none of the studies discussed gender or the inclusion of non-binary and transgender individuals. Most of the studies (47/59, 80%) focused on ACL reconstruction (37%), hip arthroscopy (27%) or rotator cuff repair (15%). Important sex-based differences were seen with these injuries including differences in fears regarding recovery after ACL injury and pre- and post-operative pain scores following rotator cuff injury. Despite increasing recognition of the role of biologic sex in the treatment and outcomes of sports injuries, very little is known about the impact of gender in sports injuries. Previous sociological literature suggests that gender may play an important role in one's athletic experience, and thus their injury experience. With most of the included studies focused on only three injury types, the experiences of female and non-binary athletes with all other sports injuries are poorly characterized. The lack of gender-inclusive sports injuries research means that the complete experiences of female, non-binary and transgender athletes are not comprehensively captured in the current literature. Future research should aim to characterize the effect of gender on the treatment and outcomes on all sport-related injuries, with the goal of providing inclusive surgical care for all athletes.