Current Reviews in Musculoskeletal Medicine最新文献

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.

Purpose of review: This review aims to provide a comprehensive analysis of the nonoperative management of Gartland Type II fractures in pediatric patients.

Recent findings: Supracondylar humeral fractures (SCF) are one of the most common traumatic fractures in pediatric populations, characterized as transverse fractures at the distal humerus between the medial and lateral columns. Early studies strongly opposed closed reduction and casting as an acceptable treatment modality for Gartland type II fractures as an early case series showed high rates of complications; however, more recent studies have suggested better outcomes. The optimal management of Gartland Type II supracondylar fractures has yet to be fully elucidated. This review highlights the indications, complications, and outcomes of nonoperative Gartland Type II supracondylar humeral fracture management. Additionally, it demonstrates the need for further research to inform guidelines on managing this condition.

Purpose of review: Adolescent idiopathic scoliosis (AIS) is a disabling spinal pathology, with a significant morbidity if left untreated. This review investigates the recent advances in the diagnosis and management of AIS.

Recent findings: Low radiation techniques have become a paramount focus in the management of patient's with AIS. The EOS system is growing in popularity due to lower radiation compared to conventional radiographs with the added advantage allowing 3D reconstruction. Bracing remains the standard treatment for curves amenable to this, however, due to the importance in compliance with brace wear there has been a recent push for more personalized brace construction using 3-dimensional printing. If curves are not amenable to bracing, then surgical intervention is generally recommended. Posterior spinal fusion (PSF) remains the gold standard; however, newer growth modulating techniques are in their infancy. Anterior vertebral body tethering (VBT) is a relatively novel method of treatment for AIS, that has seen promising early results. Due to its novelty and varying results VBT use remains limited and will need to be further investigated. AIS is a complex disease without a clear understanding of it's etiology. If identified earlier, then non-operative treatment may lead to prevention of curve progression and the need for surgical intervention. Newer technologies, such as the EOS system, allow 3D reconstruction of curves which can assist with pre-operative planning. PSF remains the gold standard surgical intervention for AIS, however, new developments in alternative techniques could have a promising future, especially for skeletally immature patients.

Purpose of the review: Anatomic and reverse endoprosthetic reconstruction are two common surgical options used after tumor resection of the proximal humerus. The purpose of this article is to provide an overview of the functional outcomes and complications of modern anatomic and reverse endoprostheses.

Recent findings: The anatomic endoprosthesis has traditionally been a successful reconstructive technique as it provided a stable platform upon which the hand and elbow could function. However, the reverse endoprosthesis has gradually replaced the anatomic endoprosthesis given that its semi-constrained design affords greater stability. Patients with reverse endoprostheses have improved motion, patient-reported outcome scores, and revision-free implant survivorship compared to those with anatomic endoprostheses. Shoulder function may be further improved with a reverse allograft prosthetic composite (APC) due to reconstruction of the rotator cuff tendons or by transferring the latissimus dorsi and teres major tendons to recreate the function of the posterosuperior rotator cuff muscles. The short-term functional improvement observed with the use of an allograft reconstruction, however, may diminish with longer follow-up due to delayed graft complications, such as resorption, nonunion, and fracture. In most patients undergoing oncologic resection of the proximal humerus, the reverse endoprosthesis or reverse APC is recommended due to improved functional outcomes and reduced postoperative complications compared to other reconstructive techniques.

Purpose of review: Provide a concise review of currently utilized functional metrics and patient reported outcomes measures (PROMs) determining appropriate return to sport following anterior cruciate ligament reconstruction (ACLR).

Recent findings: When determining return to sport following ACLR, a limb symmetry index (LSI) ≥ 90% when compared to the contralateral extremity is the most commonly reported functional metric. LSI is most commonly assessed using isokinetic quadriceps strength, followed by single-leg vertical hop and cross-over hop test. A minimum ACL-Return to Sport Index (ACL-RSI) score of 68.2 was reported, as well as a mean International Knee Documentation Committee (IKDC) score of 88.3%. A minimum Knee Injury and Osteoarthritis Outcome Score-Quality of Life (KOOS-QoL) of 62.5% was reported in a single investigation. There remains limited data on reported metrics guiding return to sport following ACLR. Evaluation of LSI when compared to the contralateral extremity is the most commonly reported functional measure, with ACL-RSI, IKDC and KOOS-QoL also being reported. Further investigations examining return to sport rate and the incidence of recurrent injury, factoring in differences in sex, competition level, and the presence or absence of concomitant meniscal injuries, based on functional metrics and PROMs is warranted to better understand which outcome measures are predictive of successful return to sport following ACLR.

Purpose of review: Femoroacetabular impingement (FAI) with labral tear is an increasingly recognized source of hip pain and lost playing time in elite athletes, yet data pertaining to professional American football athletes remains scarce. Prognostic recommendations are largely limited to single-institution cohort studies. To date, no large-scale literature review of surgical treatment of FAI in elite American football athletes has been performed. This review article reports the prevalence, return to play, performance outcomes, and career longevity following hip arthroscopy in professional American football athletes across all orthopedic literature between 2004-2024. We hypothesize high rates of return to sport (> 85%) to the same competition level and no differences in career longevity or postoperative performance.

Recent findings: In the last 20 years, 8 studies have reported outcomes following hip arthroscopy in NFL athletes; no outcomes have been reported since the 2017 season. Return to play ranged from 79-93% and time to return ranged between 6.0-7.4 months. Offensive lineman returned at the lowest rate among all position groups. There were no differences in postoperative performance or career length compared to age-matched controls. There is high rate of return to professional American football after hip arthroscopy for labral tear and/or FAI with no differences in performance or career longevity compared to control groups. Offensive lineman undergoing hip arthroscopy return to same-level competition at a lower rate compared to other football positions.

Purpose of review: Scaphoid fractures are commonly encountered injuries in the athletic population. Conservative management is pursued for incomplete fractures and those involving the distal pole. Operative management is indicated for displaced fractures, unstable fractures, and those involving the proximal pole. Complete non-displaced scaphoid waist fractures can be treated operatively or non-operatively based on patient and surgeon preference. The purpose of this article is to discuss the treatment, rehabilitation, and return to play guidelines for scaphoid injuries.

Recent findings: CT scan is critically important to determine fracture displacement (which influences treatment choices) and healing (which influences return to activity determination). Nondisplaced scaphoid waist fractures can be treated with casting with 99.4% healing rate. Surgical treatment can hasten return to activities; newer surgical constructs have been suggested including dual screw fixation, plating, and staples. Outcomes of scaphoid fractures are generally favorable, as long as the selected treatment achieves a united, well-aligned scaphoid. In the athletic population specifically, there are high return to play rates and functional performances seen after these injuries. Each athlete is unique with regard to chosen sport, level of play, fracture type, and timing of the injury. Treatment options and return-to-play must be determined in a case-by-case manner to ensure an optimal clinical outcome.

Purpose of review: This study aims to systematically review platelet dosage in platelet rich plasma (PRP) injections for common musculoskeletal conditions.

Recent findings: Notable heterogeneity exists in the literature regarding platelet dosage. Clinical studies indicate that a higher dosage may lead to improved outcomes concerning pain relief, functional improvement, and chondroprotection in knee osteoarthritis (OA). However, the impact of dosing on other musculoskeletal pathologies remains uncertain. Our investigation identifies a potential dose-response relationship between platelet dose and PRP effectiveness for knee OA treatment, pinpointing an optimal threshold of greater than 10 billion platelets for favorable clinical outcomes. Notably, this effect appears more pronounced for functional outcomes than for pain relief. For other conditions, a lower dosage may suffice, although the existing literature lacks clarity on this matter. PRP dosage may significantly influence treatmentoutcomes, particularly in knee OA. Further research is warranted to elucidate optimal dosages for varying conditions.