Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: This review aims to offer a foundational overview of Generative Artificial Intelligence (AI) for healthcare professionals without an engineering background. It seeks to aid their understanding of Generative AI's current capabilities, applications, and limitations within the medical field.

Recent findings: Generative AI models, distinct from discriminative models, are designed to create novel synthetic data. Key model families discussed include diffusion models for generating images and videos, Large Language Models (LLMs) for text, and Large Multimodal Models (LMMs) capable of processing multiple data types. Recent applications in healthcare are diverse, encompassing general uses like generating synthetic medical images, automating clinical documentation, and creating synthetic audio/video for training. More specialized applications include leveraging Generative AI models as backbones for diagnostic aids, enhancing information retrieval through Retrieval-Augmented Generation (RAG) pipelines, and coordinating multiple AI agents in complex workflows. Generative AI holds significant transformative potential in medicine, enhancing capabilities across imaging, documentation, education, and decision support. However, its integration faces substantial challenges, including models' knowledge limitations, the risk of generating incorrect or uncertain "hallucinated" outputs, inherent biases from training data, difficulty in interpreting model reasoning ("black box" nature), and navigating complex regulatory and ethical issues. This review offers a balanced perspective, acknowledging both the promise and the hurdles. While Generative AI is unlikely to fully replace physicians, understanding and leveraging these technologies will be crucial for medical professionals navigating the evolving healthcare landscape.

Purpose of review: Adolescent hip dysplasia represents a unique challenge for pediatric orthopaedic surgeons. The disease spectrum is broad and the complications of untreated disease can be severe. The purpose of this review is to provide a framework for understanding and treating adolescent hip dysplasia and when to consider nonoperative versus operative interventions.

Recent findings: Combined hip arthroscopy and periacetabular osteotomy may be considered for patients with concomitant symptomatic labral tears, which is often diagnosed by history and advanced imaging. Hip dysplasia in adolescent patients is an important diagnosis. There are various clinical and radiographic parameters and the most important ones are lateral center edge angle, Tonnis grade, and joint congruency. Management is based on symptoms and radiographic findings. Nonoperative management is typically recommended for patients with symptomatic borderline dysplasia. Surgical management includes periacetabular osteotomy for patients with symptomatic hip dysplasia that have failed nonoperative treatment. Concomitant hip arthroscopy may be considered for patients with symptomatic labral tear, but is generally not recommended in isolation if there is evidence of dysplasia. Outcomes are generally good after operative management of hip dysplasia in adolescent patients.

Purpose of review: Syndesmotic injuries are common football injuries. The unique demands of football athletes create large magnitude rotational moments about the ankle, even during low impact maneuvers. This review explores the structure and function of the syndesmosis, assesses recent data in football athletes at the professional and collegiate levels regarding epidemiology, describes available treatment options, and provides example cases from the authors' institution. The review concludes with clinical and surgical pearls for the evaluation and treatment of syndesmotic injury.

Recent findings: In general, flexible syndesmotic fixation has demonstrated similar clinical outcome scores as rigid fixation. Flexible fixation has demonstrated benefit over rigid fixation in terms of implant failure, hardware removal, and local irritation. Both flexible and rigid fixation remain viable options for treatment of syndesmotic injuries yet the indications for selecting a construct are often subjective. Certain cases of high-risk football players such as linemen may warrant careful consideration of rigid fixation options despite the clinical advantages of flexible fixation. During fixation, direct visualization techniques with open or arthroscopic assistance for reduction of the syndesmosis remain superior and enable diagnosis of chondral defects. Flexible and rigid syndesmotic fixation techniques are viable for treatment of unstable syndesmotic injuries in athletes. Recent literature favors flexible fixation. However, at-risk football athletes or those with length unstable fibula fractures may benefit from rigid or supplemental flexible fixation as opposed to traditional flexible fixation. We recommend direct visualization of reduction at the syndesmosis during surgical treatment of unstable ankle injuries.

Purpose of review: Since the introduction of videogames and augmented reality technology, injuries associated with e sports have garnered increased attention from researchers and healthcare professionals. This review articles examines the spectrum of injuries associated with videogames and augmented reality and describes the nuances of the diagnoses associated with gaming injuries.

Recent findings: Videogames changed architecture from a sedentary style of playing to a more interactive console with the introduction of technologies such as the Wii or Pokémon Go. This new style of gaming increased the range of musculoskeletal injuries to include lower energy injuries and more severe high energy trauma because of the introduction of mobility causing distraction and a neglect for safety. The previous sedentary nature of gaming lends itself to prolonged periods of static posture contributing to long-term effects and potential health implications in the future. This review article presents current literature on the specific injury types and increasing need for awareness of videogame-related injuries to further highlight preventative measures needed to mitigate injury risk and promote healthy gaming habits and ergonomic awareness.

Purpose of review: Anterior glenohumeral instability is a common injury among football players. The purpose of this review is to provide a summary of existing literature on the evaluation and management of anterior glenohumeral instability in football players.

Recent findings: The incidence and treatment of anterior glenohumeral instability varies by injury type, position, and time during the season. Shoulder instability represents a spectrum of pathologies. Important differences exist along this spectrum which affect treatment, rehabilitation, return to play, and outcomes. Current research demonstrates effective treatments and good return to play rates. There are currently no consensus guidelines for return to play after anterior glenohumeral instability for football. Successful RTP and future performance can be achieved with both non-operative and operative treatment.

Purpose of review: Anterior Cruciate Ligament (ACL) tears are one of the most common causes of lost playing time in American football athletes. Recently, there has been a push to get athletes back to sport faster. As such, numerous studies have evaluated management and rehabilitation protocols for return to play after ACL injury in football players. The purpose of this review is to synthesize information, both classic and new, to aid orthopedic surgeons in treatment of football players with ACL injuries.

Recent findings: Recent studies have demonstrated that not all ACL injuries are alike. Management should be a shared decision-making process between athlete and surgeon. Studies have demonstrated low failure rates when using bone-patellar tendon-bone (BTPB) autograft which is the most common graft utilized for elite football athletes. Outcomes are continually being evaluated by multicenter study groups such as the Multicenter Orthopaedic Outcome Network which has established a thorough rehabilitation protocol focusing on athlete milestones. ACL tears in the football athlete are common and challenging injuries. Treatment revolves around ACL reconstruction, most commonly with BTPB autograft. Post-operative rehabilitation is essential and should focus on objective criteria rather than time elapsed. Return to play criteria rely upon symptoms, athlete confidence, strength, and both functional and football specific testing. Return-to-play timelines are individualized for each football athlete but recent trends have highlighted a more delayed return of at least 7-9 months. Rate of returning to play varies from 63-82% and depends upon many factors including level of play and position.

Background: Purpose of review Agili-C® (CartiHeal, Smith & Nephew) is an off-the-shelf aragonite-based (inorganic calcium carbonate) scaffold approved for clinical use in 2022 to treat chondral and osteochondral lesions eventually also in the context of mild to moderate knee osteoarthritis (Kellgren-Lawrence 0-3). The successful preclinical studies justified the subsequent clinical trials which reported both clinical and radiological significant improvements over time as well as superiority over standard surgical techniques for cartilage lesions treatment (i.e. microfractures/debridement). The aim of the present review is to summarize the available preclinical and clinical evidence and to report the current indications, surgical techniques and outcomes of this novel and innovative osteochondral scaffold.

Recent findings: A total of six clinical reports, four single cohorts studies and a recent double arm randomized control trial followed by an analysis differentiating between femoral and trochlear lesions, have been published on Agili-C® safety and efficacy. Supported with an excellent safety profile, Agili-C® provided statistically significant clinical benefits at short and medium-term follow up in patients affected by knee joint surface lesions also when presenting in the context of mild to moderate knee osteoarthritis (Kellgren-Lawrence 0-3). Agili-C® (CartiHeal, Smith & Nephew) is an innovative aragonite-based osteochondral scaffold. It is an CE-marked and FDA approved off-the-shelf, cell-free, and cost-effective implant designed to treat knee joint surface lesions in the form of chondral and osteochondral defects. Its indications, supported by consistent clinical evidence, are single or multiple knee joint surface lesions (ICRS grade III or IV), with a total treatable area of 1-7cm², without severe knee OA (Kellgren-Lawrence grade 0-3).

Purpose of review: Reverse total shoulder arthroplasty has become an excellent surgical option for patients suffering from various shoulder pathologies including rotator cuff arthropathy, inflammatory arthritis and proximal humerus fractures. The goals of this operation are to reduce pain, restore function, and allow patients to be able to return to both work and sport. This article provides insight into the return to work and sport of patients who have undergone reverse total shoulder arthroplasty.

Recent findings: Recent literature has demonstrated that patients who have undergone reverse total shoulder arthroplasty demonstrate high rates of return to work and sport. Variations in patient age, sex, work intensity, type of sport and rehabilitation protocols can also play a factor in being able to return to work and sport. Patients who have undergone reverse total shoulder arthroplasty are able to return to work and sport in a timely manner. A structured rehabilitation protocol, appropriate patient selection and excellent communication between surgeon and patient is crucial to achieve a successful return to work and sport.

Purpose of review: The current landscape of treating anterior cruciate ligament (ACL) tears is rapidly evolving with the advent of the bridge-enhanced ACL restoration (BEAR). BEAR is a novel approach to restore the ACL in lieu of conventional reconstruction. BEAR has recently been approved for post-market use by all orthopaedic surgeons for midsubstance or proximal ACL tears. This article provides a review of the indications and outcomes of BEAR, graduating from the Trial 1 stage to the post-market stage, current operative techniques, and the postoperative rehabilitation protocol for BEAR.

Recent findings: Current research demonstrates similar postoperative patient-reported outcome measures and functional outcomes following BEAR compared to ACL reconstruction in clinical trials. Combining all three BEAR trials, there was an aggregate re-tear rate of 15%. Our post-market published BEAR data shows non-inferior short-term postoperative PROMs and functional outcomes as well as zero re-tears. The early- and mid-term results of BEAR show that it is a potential alternative to ACLR for specific patient groups.

Purpose of review: Cartilage injury does not heal spontaneously. The current cell-based cartilage treatments have either demonstrated poor clinical outcomes, require two surgeries, or are costly and logistically challenging. To overcome these challenges, our team has developed a one-stage, two cell-type surgical cell therapy for acute chondral defects. This procedure combines allogeneic mesenchymal stromal cells (MSCs) and autologous chondrons to harness MSCs as signaling cells to stimulate chondrons to promote tissue repair. This procedure has been investigated in clinical trials conducted in both Europe and the United States which are called IMPACT and RECLAIM, respectively. This article provides a review of our preclinical and clinical research which led to the development of this cell therapy.

Recent findings: The combination of allogeneic MSCs and autologous chondrons in preclinical studies have demonstrated to synergistically stimulate cartilage repair, and the combination of cells outperforms either cell-type alone. In clinical trials, the combined cell therapy was safe to use, improved knee function, and demonstrated durable pain reduction. Our single-stage, combined cell therapy of allogeneic MSCs and autologous chondrons is a viable cell therapy for acute articular cartilage defects. We anticipate this combined cell therapy may be a platform cell therapy for a wide range of musculoskeletal repair applications.