Journal of Bone and Joint Surgery, American Volume最新文献

Background: The integration of artificial intelligence (AI) in orthopaedics and sports medicine (OSM) has transformed clinical practice and scientific inquiry. However, the increasing reliance on AI raises critical concerns regarding transparency, ethical considerations, and reproducibility. The aim of this study was to systematically evaluate the editorial policies of leading OSM journals concerning AI usage and the endorsement of AI-specific reporting guidelines (RGs).

Methods: A cross-sectional review was conducted in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. The top 100 peer-reviewed OSM journals were identified using the 2023 SCImago Journal Rank (SJR). Data extraction included journal characteristics, AI-related policies within Instructions for Authors, and references to AI-specific RGs. Data were collected in a masked, duplicate fashion, with discrepancies resolved through consensus.

Results: Of the 100 journals analyzed, 94% referenced AI in their editorial policies, all of which explicitly prohibited AI authorship and required the disclosure of AI use in manuscript preparation. AI-generated content was permitted in 82% of journals. AI-assisted image generation was permitted by 60% of journals and explicitly prohibited by 34%. Despite these policies, only 1% of journals referenced AI-specific RGs, with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) being the sole guideline mentioned.

Conclusions: While most of the OSM journals had established policies on AI usage, there was a notable lack of standardization, particularly with respect to AI-generated images. Additionally, the absence of AI-specific RG endorsements highlights a gap in methodological guidance. Standardizing AI policies and encouraging the adoption of RGs could enhance the transparency, reproducibility, and ethical integrity of AI-driven research in OSM.

➢ Patient comprehension in orthopaedic surgery is frequently limited, with substantial gaps between perceived and actual understanding of conditions, procedures, and recovery timelines.➢ Expectation management is a central communication challenge, as patients often anticipate surgery or outcomes in ways that are unrealistic, directly affecting satisfaction and informed consent.➢ The EXPLAIN framework provides a structured, orthopaedic-specific approach to improve communication through 7 components: Educate, eXample, Purpose, Language/Learn, Analogy/Articulate, Illustrate, and Navigate.➢ Evidence supports the use of strategies such as plain language, teach-back, anatomical models, 3-dimensional aids, and structured navigation programs to improve comprehension, reduce anxiety, and lower readmissions.➢ Implementing EXPLAIN can enhance shared decision-making, reduce communication-related malpractice risk, and improve both patient satisfaction and outcomes.

Background: Osteochondritis dissecans (OCD) healing can be unpredictably slow, incomplete, or absent after surgical treatment. This frustrates patients, families, and the medical team. We aimed to develop an algorithm to predict the speed of OCD radiographic ossification based on patient demographic, physical, surgical, and imaging data.

Methods: We studied a prospective cohort of patients with knee OCD lesions in a multicenter database. We included patients who were diagnosed with knee OCD lesions of the lateral or medial femoral condyle and were treated operatively at a single center. We collected patient information from medical records and imaging studies. Radiographic healing was defined on the basis of the percentage of the original OCD lesion that had a normal bone density (ossification) compared with the surrounding condyle, rated on a continuous scale from 0 to 100. An OCD lesion that achieved ≥90% of the normal surrounding bone density at 6 months following surgery was defined as fast healing. Follow-up was conducted with radiographs only. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed.

Results: This study included 79 OCD lesions in 72 individuals. The mean patient age was 13.79 ± 2.71 years (range, 8.56 to 22.98 years), and 45 (62.5%) of the 72 patients were male. A total of 56 patients (77.8%) were White, and 69 patients (95.8%) were of non-Hispanic ethnicity. In all, 23 lesions (29.1%) fit the of fast healing. A multivariable regression analysis revealed that high preoperative bone density within the OCD lesion (p < 0.001) was the only feature that had an association with fast healing. A preoperative lesion density rating of ≥70% predicted fast ossification with a sensitivity of 87% and a specificity of 66.1%.

Conclusions: A preoperative OCD density rating that was ≥70% of that of the normal surrounding bone was found to be the only independent predictor of fast ossification following surgery.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background: Transthyretin (TTR) amyloid deposition in the tenosynovium in carpal tunnel syndrome (CTS) is a potential early manifestation of systemic amyloidosis. However, its effects on tenosynovial fibroblasts in CTS remain unclear. We aimed to clarify how wild-type and Val30Met mutant TTR amyloids affect tenosynovial fibroblasts in CTS.

Methods: Synovial tissue from 20 patients undergoing carpal tunnel release surgery was evaluated for TTR amyloid. Expression of genes related to fibrosis, inflammation, and oxidative stress was compared between TTR-positive and TTR-negative groups. Fibroblasts isolated from TTR-negative patients were treated in vitro with wild-type or Val30Met mutant recombinant TTR. Analyses included quantitative RT-PCR (reverse transcription-polymerase chain reaction), Picrosirius Red staining, MTT assays evaluating cell proliferation, reactive oxygen species (ROS) activity measurements, and senescence-related gene expression.

Results: In TTR-positive tissue, fibrosis-related genes (COL1A1, COL3A1, TGFB1, and ACTA2), the inflammatory mediator NFKB1, and oxidative-stress-related genes (KEAP1, NQO1, and SOD1) were significantly upregulated, whereas SOD2 was downregulated. With in vitro treatment in the TTR-negative group, both wild-type and Val30Met TTR increased COL3A1, IL6, and CXCL8 expression, whereas Val30Met TTR further enhanced IL1B expression. Picrosirius Red staining confirmed increased collagen deposition. MTT assays revealed increased cell viability, indicating enhanced fibroblast proliferation, in both groups. The senescence-related genes CDKN2D and GADD45A were downregulated, suggesting enhanced proliferative activity. ROS activity did not differ significantly between groups.

Conclusions: TTR amyloid was found to promote expression of fibrosis, inflammation, and oxidative-stress-related genes; inhibit senescence pathways; and enhance collagen deposition and fibroblast proliferation in fibroblasts from patients with CTS.

Clinical relevance: CTS with TTR deposition may reflect more than a localized neuropathy, as TTR potentially plays a pathogenic role in CTS development. This finding provides novel insights into the underlying mechanisms of CTS.

Malalignment after femoral fracture repair remains common, with up to one-third of patients experiencing malrotations. Manual femoral fracture reduction remains physically demanding and fluoroscopy-dependent. Surgeons must apply traction forces to overcome forces generated by the surrounding muscles during the reduction process. Current orthopaedic robots, designed primarily for arthroplasty or spine procedures, generally cannot deliver the high traction or torque required for long-bone manipulation. To address the need for controlled high-force manipulation during femoral fracture reduction and to reduce reliance on fluoroscopy for assessing alignment, we developed a novel surgical robotic system. The system combines a 6-degrees-of-freedom (6-DOF) parallel mechanism with a high load capacity, an optical tracking system that provides continuous pose feedback, and a gauge-based graphical interface that displays translational and angular offsets between bone fragments and the target alignment. The system is intended to provide controlled application of clinically relevant traction and torque during femoral fracture reduction. These capabilities reduce reliance on sustained manual traction and support reduction maneuvers that are more repeatable, potentially improving intraoperative alignment consistency and procedural workflow. Future work will focus on hardware and software updates to improve operating-room integration and to expand the usable workspace. It will evaluate the use of artificial intelligence (AI)-assisted registration and 3D visualization to support alignment assessment and automated alignment workflows.

Background: The role of an elevated critical shoulder angle (CSA) in rotator cuff healing following rotator cuff repair (RCR) remains a subject of clinical controversy. The present study aimed to investigate the effect of increased CSA on tendon-bone interface healing following RCR.

Methods: A bilateral chronic rotator cuff tear model was established in 48 Sprague-Dawley rats. Acromion lateralization (Acr) surgery was performed unilaterally to increase CSA. After 4 weeks, bilateral RCR was performed. Micro-computed tomography was utilized to measure CSA. Tendon-bone interface healing was assessed at 3, 6, and 9 weeks post-RCR with use of magnetic resonance imaging (MRI), biomechanical testing, gait analysis, and histological evaluation.

Results: The mean CSA in the Acr group was significantly greater than that in the RCR-only group (37.2° ± 2.6° versus 29.7° ± 3.1°; p < 0.001). At 6 and 9 weeks postoperatively, the Acr group demonstrated significantly poorer outcomes on MRI (i.e., higher signal-to-noise quotient), biomechanical strength (i.e., lower ultimate failure load and stiffness), and gait parameters compared with the RCR-only group (p < 0.05). Histological analysis revealed inferior tendon-bone interface integration in the Acr group (p < 0.01), including reduced fibrocartilage formation, disorganized collagen fibers, and a lower collagen I/III ratio. Immunohistochemistry showed significantly higher Piezo1 expression in the Acr group (p < 0.001), suggesting a mechanobiological response to increased mechanical stress.

Conclusions: An increased CSA impaired tendon-bone interface healing following RCR in a rat model. Although these findings were preclinical, they provide experimental evidence that an increased CSA may influence rotator cuff healing, supporting the potential role of CSA modification (e.g., with acromioplasty) in reducing the risk of retear.

Clinical relevance: The present study provides experimental evidence to support the consideration of CSA reduction in selected high-risk patients undergoing RCR to promote rotator cuff healing and potentially reduce retear rates.

Background: Several studies have assessed the impact of perioperative denosumab on local recurrence (LR) after surgical management of giant cell tumor (GCT), with conflicting results. This meta-analysis evaluates the association between LR in patients undergoing surgical management of GCT and perioperative denosumab, accounting for the type of surgery, number of denosumab doses, and timing of denosumab administration.

Methods: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar were searched until December 5, 2024. The extracted outcomes consisted of LR and denosumab-related complications.

Results: Sixteen studies from 15 cohorts were included in the meta-analysis. The number of patients totaled 1,551: 310 (20%) in the denosumab group (mean age, 32 years; mean follow-up, 40 months) and 1,241 (80%) in the control group (mean age, 32 years; mean follow-up, 62 months). Patients in the denosumab group had a significantly higher rate of LR compared with patients in the control group (odds ratio = 1.82; p = 0.03), and this remained true even when looking at studies using curettage as the only surgical management (odds ratio = 2.75; p < 0.001). In a subgroup analysis by the timing of denosumab administration, a significantly higher rate of LR was only found among patients receiving denosumab both preoperatively and postoperatively (odds ratio for recurrence relative to control = 5.57; p < 0.001). Overall, the reported incidence of denosumab-related complications was 6.5%.

Conclusions: In this meta-analysis, patients receiving denosumab only preoperatively did not have a significantly increased rate of LR compared with controls. Increased recurrence was observed primarily in patients being treated with both preoperative and postoperative denosumab.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.