Current Reviews in Musculoskeletal Medicine最新文献

Purpose: Meniscus repair is preferred over meniscectomy when possible due to its ability to preserve meniscal tissue and reduce long-term joint degeneration. However, meniscus repair has a risk of failure, resulting in an increasing number of patients presenting with symptoms following a failed repair. Revision meniscus repair remains an option for symptomatic patients, yet guidance on indications, surgical techniques, and expected outcomes is limited. The purpose of this review is to summarize indications, surgical approaches, and outcomes associated with revision meniscus repair.

Recent findings: Patient-specific factors such as age, activity level, and modifiable risk factors influence revision repair success. Younger, highly active individuals may be at higher risk of retear due to increased mechanical stress. Tissue quality and vascularity are critical, as degenerative changes and poor perfusion increase failure rates. The gold-standard inside-out technique is often favored for revision repairs due to its superior biomechanical stability. However, all-inside and outside-in techniques remain viable options in specific cases. Biological augmentation, including platelet-rich plasma (PRP) and marrow venting, may enhance healing potential but requires further investigation. Revision meniscus repair demonstrates comparable failure rates and functional outcomes to primary repair, with reported failure rates ranging from 21-33% at mid-term follow-up. Many patients successfully return to high levels of activity following revision repair. Although younger age and high activity levels may predispose to failure, revision meniscus repair remains a viable option for preserving meniscal integrity and optimizing long-term joint health.

Purpose of review: This review aims to summarize the epidemiology, associated pathology, and treatment options for rotator cuff tears following shoulder dislocations and to provide a treatment algorithm for these complex injuries.

Recent findings: Rotator cuff tears after shoulder dislocations most often occur in patients older than 40 and may be more prevalent in women. Up to 50% of these patients may have concomitant Bankart lesions. Patients treated nonoperatively generally have worse functional outcomes and higher pain scores than those who undergo rotator cuff repair. However, further studies are needed to elucidate when the rotator cuff can be repaired in isolation versus in combination with capsulolabral stabilization. Reverse total shoulder arthroplasty is a viable treatment option for elderly patients with irreparable cuff tears after dislocation or post-instability arthropathy. Patients who sustain a shoulder dislocation should be evaluated for a rotator cuff tear, particularly if older than 40. Those with post-instability full-thickness rotator cuff tears benefit from surgical treatment. Further research is needed to clarify when additional stabilization procedures should be performed alongside rotator cuff repair.

Purpose of review: The purpose of this review is to synthesize current science on meniscus anatomy and biomechanics and repair techniques to create an empirical foundation for postoperative rehabilitation precautions and guidelines, including timelines, clinical and performance-based criteria for return to activity, to maximize both meniscal healing potential and patient recovery.

Recent findings: Recent literature has focused on meniscus repair rather than debridement, and rehabilitation protocols should be designed to optimize healing. Complex, unstable tears, like root and radial tears, disrupt hoop stress and warrant a more conservative protocol including 6 weeks of non-weightbearing; however, more stable tears, like ramp and vertical tears, can often weight bear immediately after surgery. All protocols should emphasize early protected joint motion. Return to activity guidelines remain ill-defined but this review explores evidence-based recommendations for timelines, strength and performance testing. Patients typically should wait ≥ 4 months for a return to activity and the presence of joint line tenderness or effusion could be a sign of delayed/failed healing. It is essential for therapists to know the size, type, and location of a meniscus repair to optimize patient outcomes. Guidelines for weight bearing, range of motion, strength training, and return to activity should vary per tear type and repair technique and recovery should be both time- and criteria-based. Return to activity should align with healing time, objective clinical and performance testing, and clinical and imaging exam findings. Future research should aim to optimize repair techniques and rehabilitation protocols, specifically further study on the timing to initiate weightbearing, early motion, and return to activity.

Purpose of review: Meniscus repair plays a critical role in preserving knee function and delaying degenerative changes after a meniscus tear. Despite advancements in surgical techniques, there remains significant variability in how outcomes are defined and reported. This review examines the evolving interplay between traditional metrics of success such as reoperation rates, radiographic healing, etc., and the more subjective patient reported outcome measures (PROMs).

Recent findings: Recent findings highlight the discrepancies between radiographic healing, symptomatic relief, and functional improvement. While reoperation rates remain a widely used failure criterion, they do not account for patients who avoid revision surgery despite persistent symptoms. MRI assessments can detect incomplete healing, but imaging abnormalities do not always correlate with clinical dysfunction. PROMs and return-to-sport (RTS) rates offer valuable insight into functional recovery, yet they vary across studies and may not always reflect anatomical failure. Emerging consensus supports a dual model: anatomical failure, which reflects structural compromise seen on imaging or second-look arthroscopy, and clinical failure, which includes persistent symptoms, limited function, or poor patient-reported outcomes regardless of imaging results. Meniscus repair failure should be assessed using a multidimensional approach, incorporating structural integrity, symptom persistence, functional performance, and patient satisfaction. Standardizing failure definitions will improve data comparability, enhance treatment strategies, and guide patient expectations. Future research should refine composite failure models and integrate meniscus-specific PROMs to optimize long-term outcomes. By redefining failure, clinicians can improve surgical success rates and provide more personalized, evidence-based care.

Takeaway: Not all healed menisci function well, and not all unhealed ones fail. By redefining failure, we can reframe success-and better serve patients.

Purpose of review: Treatment of meniscus injuries can have a substantial effect on the intra-articular biomechanics and long-term function of the knee. Meniscus repair has become a more favorable treatment option as prior studies have demonstrated a strong correlation between meniscal preservation and restoration of intra-articular contact pressure and decreased progression of arthritis. The goal of meniscus repair is to provide a stable load bearing construct to allow for meniscal healing. Repair constructs vary by tear pattern, tear location, and repair technique. The purpose of this review is to highlight the biomechanical strength of meniscus repair techniques for frequently encountered meniscus tears.

Recent findings: Recent literature reports that meniscus tear type and location influence which repair technique would provide the most stable construct. Prior studies report that inside-out meniscus repair is the gold standard for longitudinal tears, but more recent literature on modern all-inside repair devices suggest improvements with all-inside devices. Radial tears repaired with vertical mattress rip stop sutures added to horizontal mattress repair sutures have less suture cut-out and improved stability. Root tears repaired with a locking suture configuration result in biomechanical strength similar to a native meniscus and addition of a centralization suture may further improve this construct. No single repair technique is superior to others across meniscus repair types. Surgeons need to thoroughly understand various tear patterns and be familiar with a variety of repair techniques in order to provide the most stable construct for meniscus repair.

Purpose of review: The rapid evolution of virtual technology and artificial intelligence (AI), combined with physical distancing limitations imparted by the COVID- 19 pandemic, has hastened the shift of healthcare toward digitally enabled practitioners. As physical therapy embraces virtual care, its impact is far-reaching across stakeholders, affecting patients, providers, and payors. This article seeks to explore the role of virtual physical therapy (VPT) in managing patients with musculoskeletal (MSK) conditions and its impact on healthcare and patient outcomes.

Recent findings: While research on VPT is growing, high-quality studies remain limited due to challenges in conducting blinded, randomized controlled trials, sponsor bias, and the diversity of digital solutions that complicate comparative studies. Nevertheless, general literature trends show that VPT, particularly when guided by a physical therapist, can yield improvements in pain and function comparable to in-person therapy. VPT demonstrates fair to excellent reliability and validity across key assessment areas, successfully identifying MSK diagnoses and delivering outcomes similar to conventional treatment for pain, function, and quality of life across multiple MSK disorders. Additionally, VPT addresses adherence issues by reducing travel, costs, and exposure risks, while technology enhancements foster patient engagement and communication with therapists. By increasing access and adherence to PT, VPT has the potential to optimize outcomes and curb long-term healthcare costs by preventing progression to more expensive interventions. Virtual care harnesses technology to advance musculoskeletal care by improving access, enhancing patient-provider communication and connection, and optimizing patient engagement and outcomes. VPT moves beyond replication of the in-person experience to an enhanced patient journey. This journey taps into technological advancements to deliver a more integrated experience that engages and supports the patient. VPT offers a sophisticated model of care from the therapist, emphasizing evidence-based practice and critical thinking.

Purpose of review: Shoulder arthroplasty (SA) is an effective surgical procedure to treat advanced degenerative conditions of the shoulder as well as tumors or fractures of the proximal humerus. Utilization of SA is increasing in the United States as indications have expanded, however, health care disparities around utilization and clinical outcomes following SA also exist. This review examines current literature on patient related health care disparities in SA.

Recent findings: Within SA, patient related health care disparities are highly influenced by race, ethnicity, socioeconomic status, geography, and patient sex. Short term clinical outcomes show that Non-White patients experience lower utilization of SA, longer hospital stays, higher complications, and increased readmissions. Sex related disparities demonstrate that female patients have a longer interval between initial consultation and surgery. Additionally, females experience lower functional scores and higher rates of perioperative fractures than males. In the current era of value-based care, wide disparities in early postoperative outcomes increase the cost of healthcare to both patients and health systems. Disparities in SA remain underexplored compared to other health topics. Existing literature highlights suboptimal outcomes in racially, ethnically, or socially disadvantaged groups. Active awareness and recognition of healthcare disparities are required to renew and strengthen initiatives to deliver more equitable care after SA.

Purpose of review: Meniscus tears are some of the most commonly managed orthopedic injuries that affect a wide variety of patient populations. Traditionally, meniscus tears were treated either conservatively or with partial meniscectomy. However, recent technological innovations have generated a rapid evolution in the modern evaluation and treatment of meniscus tears. The primary objective of this review is to provide a detailed overview of long-term results of meniscus repair after greater than five to ten years follow up, highlighting modern surgical techniques, clinical and radiologic outcomes, rates of failure and revision surgery, as well as emerging insights and future directions.

Recent findings: Advancements in arthroscopic implants and techniques helped establish meniscus repair as the preferred approach for treating many meniscal tears due to its ability to preserve native knee kinematics and decrease the risk of osteoarthritic progression. In properly indicated patients, long-term clinical data supports performing meniscus repair over traditional treatments, such as partial meniscectomy, to preserve overall knee function and longevity. The impact of tear morphology on healing rates, potential for biologic augmentation, and optimal postoperative rehabilitation are substantial areas of active research. Undertaking a comprehensive, individualized approach evaluating careful patient selection, sound surgical technique, and ideal rehabilitation strategies is critical to guiding treatment decisions and achieving long-term successful outcomes.

Purpose of review: This review aims to synthesize current knowledge on humeral avulsion of the glenohumeral ligament (HAGL) lesions, emphasizing clinical presentation, operative indications, and surgical outcomes.

Recent findings: HAGL lesions play an important role in shoulder instability, occurring in 7.5%-9.4% of surgically treated cases, with a high propensity to cause recurrent instability if left untreated. The sensitivity of magnetic resonance imaging for detecting HAGL lesions remains imperfect (50%- 83%), making arthroscopy the diagnostic gold-standard. Primary instability is the most common surgical indication (up to 82% of cases). Surgical repair, whether open or arthroscopic, yields excellent outcomes, with return to sport (RTS) rates of 81%- 100% and recurrent instability rates as low as 0%- 5.6%. Athletes may not always RTS at the same level (44%- 80%), however, and recurrent instability rates are higher in collision athletes (up to 21%). Limited data suggest a high incidence of recurrent instability in nonoperatively managed cases (up to 90%), although data on ideal indications for nonoperative management are lacking. HAGL lesions are an important yet often under-recognized cause of shoulder instability. Surgery is indicated in most cases due to its positive results, though comparative data between arthroscopic and open approaches are limited. Future research should refine imaging accuracy, directly compare arthroscopic versus open approaches, and enhance rehabilitation to improve pre-injury RTS rates.

Purpose of review: Treatment of anterior shoulder instability (ASI) is complex with many factors contributing to surgical decision making. The remplissage is an adjunct surgical technique that can be added at the time of arthroscopic labral repair or glenoid bone block reconstruction to decrease the recurrence rate of ASI post-operatively. The purpose of this review is to highlight the history, indications, and outcomes of remplissage when used for anterior shoulder instability.

Recent findings: Prior studies have demonstrated that remplissage, when used in addition to an arthroscopic labral repair, can significantly reduce the rate of recurrent instability in patients with both off-track and near-track Hill Sachs lesions. There remains concern that addition of remplissage will negatively affect post-operative range of motion (ROM). However, recent literature suggests no difference observed in ROM when comparing remplissage plus arthroscopic labral repair to arthroscopic labral repair alone. While the addition of a remplissage has promising rates of return to sport, these results are less favorable when a remplissage is performed in an overhead athlete. The remplissage is a powerful surgical tool to utilize in addition to an arthroscopic labral repair or glenoid bone block reconstruction in patients with anterior instability. An understanding of appropriate indications and its influence on post-operative outcomes can assist the surgeon with providing the best possible outcome for each individual patient.