Current Reviews in Musculoskeletal Medicine最新文献

Purpose of review: Limb alignment correction about the knee joint is crucial for the protection of the meniscus, particularly in the setting of meniscal root repairs and meniscal allograft transplantation. Distal femoral osteotomies and high tibial osteotomies have been described to restore the anatomic alignment to aid in meniscal preservation. This article provides a review of knee alignment and biomechanics, various surgical interventions to correct knee malalignment, and the effect of malalignment on the treatment of meniscal pathology.

Recent findings: Both distal femoral and high tibial corrective osteotomies have been shown to slow the progression of osteoarthritis in the postoperative period. Moreover, corrective osteotomies have resulted in high patient satisfaction and good survival rates at mid- to long-term follow-up in patients with prior varus/valgus malalignment. Ongoing research is aimed to determine the best utilization for concomitant osteotomies in the setting and treatment of meniscal pathology with hopes of decreasing the progression of early-onset osteoarthritis, and ultimately, the conversion to total knee arthroplasty.  Neutral alignment at the level of the knee joint results in optimal force distributions. Corrective valgus and varus osteotomies aim to restore neutral alignment with the goal of ligamentous and meniscal preservation, ideally slowing osteoarthritis progression.

Purpose of review: Atraumatic hip pain in children is one of the most common orthopaedic complaints in this population. This review details the important elements of the pediatric hip physical exam and provides an overview of pertinent clinical exam findings in specific diagnoses of common pediatric hip pathology.

Recent findings: A thorough physical exam is critical for the diagnosis of pediatric hip pathology, as many conditions have exam findings that are very commonly associated with the pathology, if not pathognomonic for the disorder. Additionally, pediatric hip pathology is strongly age-related, so an understanding of typical exam findings and common hip conditions by age can be invaluable in forming a correct diagnosis. Inspection, palpation, range of motion, gait analysis, and provocative tests provide clues about potential diagnoses. Together with history and risk factors, pediatric clinicians can make appropriate diagnosis of pediatric hip disorders.

Purpose of review: Fatty infiltration (FI) of the rotator cuff is a critical determinant of clinical outcomes following rotator cuff injuries and repairs. This review examines the natural history, pathophysiology, imaging evaluation, and treatment strategies for FI, highlighting recent insights into its cellular mechanisms and emerging therapeutic approaches.

Recent findings: Animal models demonstrate that FI begins shortly after tendon injury, progresses with muscle retraction and denervation, and is largely irreversible despite repair. Key cellular drivers include fibroadipogenic progenitor cells (FAPs), influenced by mechanical loading and inflammatory signaling pathways. Clinical studies show that FI is associated with advanced age, female sex, and full-thickness tears. Higher degrees of preoperative FI correlate with poorer functional outcomes and increased re-tear rates. Novel therapeutic targets, including pathways regulating FAP activity, TGF-β, and cell-based therapies, show promise in preclinical studies. Emerging strategies such as leukocyte-poor platelet-rich plasma (PRP) may mitigate FI progression in clinical settings. Fatty infiltration remains a significant barrier to successful rotator cuff repair and functional recovery. While surgical repair may slow FI progression, it is not consistently effective in reversing established muscle degeneration. Improved understanding of the molecular mechanisms driving FI has identified potential therapeutic targets, but their clinical applicability requires further validation. Future advances in regenerative medicine, including cell-based therapies and modulation of fibroadipogenic progenitors, offer hope for mitigating FI and improving long-term outcomes.

Purpose of review: The management of horizontal cleavage meniscus tears (HCT) has evolved in recent years. Historically, HCTs have been treated with partial meniscectomy, but multiple studies have shown the long-term risks of development of arthritic changes in the knee following meniscectomy. These findings have renewed interest in meniscal preservation whenever possible, even in older patients not previously considered for meniscus repair. This article provides an overview of current management of horizontal cleavage meniscus tears and describes modern surgical techniques for repair of HCTs.

Recent findings: Current research studies have continued to emphasize the benefits of meniscal preservation on long-term function. Recent data has demonstrated similar success rates following repair of HCTs compared to repair of other types of meniscus tears. Additionally, multiple recent studies have demonstrated the potential benefit of biologic augmentation in decreasing failure rate after meniscal repair. Modern surgical techniques and biologic augmentation have improved outcomes of meniscal repair. However, consideration of a patient's individual goals, activity level, and expectation are important to achieve a successful outcome regardless of treatment modality. While not every patient is a candidate for meniscal repair, current data has shown it should be considered for a growing number of patients.

Purpose of review: With the growing popularity and broadening indications for Reverse Shoulder Arthroplasty (RSA), increasing modularity in design and adjustments to each component can enhance postoperative range of motion (ROM), thus expanding treatment capabilities. This review outlines the advancements developed to optimize ROM through modifications in glenoid and humeral components and the integration of computational tools for surgical planning.

Recent findings: Enhancements in glenoid component design aim to mitigate complications like scapular notching and improve ROM, particularly in abduction and external rotation. Modifications to the humeral component, including adjustments in neck-shaft angle and lateralization, also contribute to ROM optimization. The integration of computational modeling and intraoperative navigation is advancing towards a more tailored approach to RSA to increase postoperative ROM. While RSA has evolved considerably since the introduction of the Grammont prosthesis, current research continues to improve upon implant design and positioning to overcome early design limitations. Modifications such as glenoid lateralization and inferior positioning and humeral neck-shaft angle and lateralization contribute to better postoperative ROM. The integration of these advancements in implant adjustments with computational modeling for surgical planning has the potential to enhance ROM and patient-specific outcomes. Translating these biomechanical improvements into clinical benefit remains a key area for future investigation.

Purpose of review: This review aims to analyze the impact of martial arts on youth, addressing the physical and psychosocial benefits, as well as the injury risks associated with increased participation.

Recent findings: Data from the National Federation of State High School Associations indicates a notable increase in youth participation in martial arts, with a rise of over 13,000 participants from 2018 to 2022. In addition to physical benefits, recent studies highlight that martial arts can significantly enhance mindfulness, reduce stress, and improve self-control, thus diminishing bullying behaviors in school-aged children. Additionally, the therapeutic application of martial arts techniques has been effective in managing pain in children with chronic diseases and in alleviating emotional distress in their siblings. However, the popularity of the sport brings concerns over a spectrum of injuries, especially more severe cases in competitive settings. Martial arts provide a dynamic platform for fostering robust physical health and psychological resilience among youth. While the benefits are substantial, they are accompanied by risks that require careful management through informed practices and supervision. This review underscores the importance of understanding the dual nature of martial arts - its capacity to empower and its potential to harm - to maximize its benefits and safeguard young athletes.

Purpose of review: For pediatric osteomyelitis and septic arthritis, 10-24% of cases occur in the upper extremity (UE). Due to delays in presentation and diagnosis, UE infections are often more complex and severe than infections of the lower extremity (LE). This review evaluates the literature from the past 6 years related to pediatric osteomyelitis and septic arthritis of the UE and provides a guide for professionals managing these conditions in children.

Recent findings: The shoulder and elbow are the most commonly affected joints, and the humerus is the most commonly affected bone. As with the LE, diagnosis of UE osteoarticular infections is based on clinical evidence, laboratory data, and diagnostic imaging. While Staphylococcus aureus is the primary bacteria identified in UE infections, there is an underappreciation of the burden from Kingella kingae as a causative organism in culture-negative patients where PCR is not performed. Septic joints should be treated with irrigation and debridement urgently, with subsequent antibiotic therapy for a minimum of 2-4 weeks. For acute osteomyelitis without abscess or concomitant septic joints, antibiotic therapy is standard of care. Methicillin-resistant Staphylococcus aureus is associated with more severe infection requiring more surgeries. Various strategies exist for managing segmental bone loss in chronic osteoarticular infections. Osteomyelitis and septic arthritis tend to occur less frequently in the UE than the LE but have a devastating impact on the health and quality of life of children around the world. Complete resolution of disease can be achieved through an individualized approach to antibiotic and operative management. Further study is needed to assess the efficacy of aspiration as a primary treatment strategy in UE joints.

Purpose of review: Anterior shoulder instability management within skeletally immature patients presents a unique challenge for providers. This systematic review examines the surgical management of traumatic anterior shoulder instability in skeletally immature patients, focusing on recurrence rate, pre-operative conditions, post-operative conditions, demographics, and risk factors for failure. Four full-length articles met the inclusion and exclusion criteria, consisting of two retrospective cohort studies and two case series. In total, 77 patients and 79 shoulders underwent surgical stabilization. Mean age at time of surgery ranged from 12 to 15.9 years with a male proportion ranging from 58 to 86%. The indication for surgery in these studies was recurrent anterior shoulder instability. The most used surgeries for stabilization were bone block procedures, such as the Latarjet, followed by the arthroscopic Bankart repair. This review found that surgically managed traumatic anterior shoulder instability in skeletally immature patients had low recurrence rates. The studies examined had recurrence rates of 8%, 4.4% and 0% after surgical stabilization and a singular study showed a return to sport rate of 75%. Subsequently, this study suggests that open bony procedures may be a safe and effective solution to recurrent anterior shoulder instability in the skeletally immature population, but further research is needed to determine the optimal surgical approach with a larger sample of different surgical approaches.

Level of evidence: Level IV.

Purpose of review: The physical health impacts of microplastics have received increasing attention in recent years. However, limited data impedes a full understanding of the internal exposure to microplastics, especially concerning the musculoskeletal system. The purpose of this review is to summarize the recent literature regarding the effects of microplastics on the musculoskeletal system.

Recent findings: Microplastics have been shown to cause abnormal endochondral ossification and disrupt the normal function of pre-osteoblasts, osteocyte-like cells, and pre-osteoclasts through gene mutations, endoplasmic reticulum stress induction, and reduced autophagosome formation in bone growth areas. Although there are few reports on their effects on muscle, it has been noted that microplastics inhibit energy and lipid metabolism, decrease type I muscle fiber density, impair muscle angiogenesis, cause muscle atrophy, and increase lipid deposition. Only a few recent studies have shown that microplastics interfere with the normal function of bone growth-related cells and reduce muscle mass and quality. This review underscores the need for further research into other parts of the musculoskeletal system and studies using human tissues at the disease level.