Steven M Garcia, Justin Lau, Aboubacar Wague, Sankalp Sharma, Kevin C Wang, Miguel Lizarraga, Cristhian Montenegro, Xuhui Liu, Grace O'Connell, Stephanie E Wong, Brian T Feeley
Background: Sex-based disparities remain a major challenge in musculoskeletal medicine. Women and men experience different anterior cruciate ligament (ACL) injury rates and severity, but the causes remain unclear. We hypothesized that cellular differences in human progenitor cells contribute to the higher ACL tear risk observed in females.
Methods: ACL samples were collected from 4 male and 5 female patients undergoing ACL reconstruction surgery. Live cells were collected through flow cytometry and sent for single-cell RNA sequencing. Significantly greater expression in either sex relative to the other was defined as a >25% increase in expression level (log2 fold change > 0.32) and p < 0.05). Subpopulation characterization was performed with immunofluorescence on tissue sections.
Results: We discovered sex-based differences in all of the native cell types within the ACL. In particular, fibroblast progenitor-like (TPPP3+) cells from female patients expressed genes associated with dysregulation and degradation of collagen more highly than progenitor cells from male patients.
Conclusions: These results highlight a ligament progenitor population with a sex-dependent gene expression profile. This work suggests that sex-based differences in stem cell populations may drive differential injury rates and outcomes between male and female patients with musculoskeletal injuries.
Clinical relevance: The differential gene expression among TPPP3+ progenitor-like cells provides a possible target population for studying ligamentous injury and regeneration. Differential expression of collagen and extracellular matrix-related genes provides evidence of specific genes that could be therapeutically targeted to strengthen the ACL and reduce the risk of rupture, particularly in female athletes.
{"title":"Sex-Based Differences in Cell Types and Gene Expression within the Anterior Cruciate Ligament.","authors":"Steven M Garcia, Justin Lau, Aboubacar Wague, Sankalp Sharma, Kevin C Wang, Miguel Lizarraga, Cristhian Montenegro, Xuhui Liu, Grace O'Connell, Stephanie E Wong, Brian T Feeley","doi":"10.2106/JBJS.25.00860","DOIUrl":"https://doi.org/10.2106/JBJS.25.00860","url":null,"abstract":"<p><strong>Background: </strong>Sex-based disparities remain a major challenge in musculoskeletal medicine. Women and men experience different anterior cruciate ligament (ACL) injury rates and severity, but the causes remain unclear. We hypothesized that cellular differences in human progenitor cells contribute to the higher ACL tear risk observed in females.</p><p><strong>Methods: </strong>ACL samples were collected from 4 male and 5 female patients undergoing ACL reconstruction surgery. Live cells were collected through flow cytometry and sent for single-cell RNA sequencing. Significantly greater expression in either sex relative to the other was defined as a >25% increase in expression level (log2 fold change > 0.32) and p < 0.05). Subpopulation characterization was performed with immunofluorescence on tissue sections.</p><p><strong>Results: </strong>We discovered sex-based differences in all of the native cell types within the ACL. In particular, fibroblast progenitor-like (TPPP3+) cells from female patients expressed genes associated with dysregulation and degradation of collagen more highly than progenitor cells from male patients.</p><p><strong>Conclusions: </strong>These results highlight a ligament progenitor population with a sex-dependent gene expression profile. This work suggests that sex-based differences in stem cell populations may drive differential injury rates and outcomes between male and female patients with musculoskeletal injuries.</p><p><strong>Clinical relevance: </strong>The differential gene expression among TPPP3+ progenitor-like cells provides a possible target population for studying ligamentous injury and regeneration. Differential expression of collagen and extracellular matrix-related genes provides evidence of specific genes that could be therapeutically targeted to strengthen the ACL and reduce the risk of rupture, particularly in female athletes.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph F Levy, Robert V O'Toole, Deborah M Stein, Elliott R Haut, Katherine P Frey, Renan C Castillo, Nathan N O'Hara
Background: Although clinical guidelines endorse enoxaparin for the prevention of venous thromboembolism in patients with orthopaedic trauma, recent evidence from a large clinical trial has demonstrated that aspirin provides comparable protection against death and pulmonary embolism. This study evaluated the cost-effectiveness of thromboprophylaxis with enoxaparin compared with that with aspirin in patients with orthopaedic trauma from the perspective of the U.S. health-care system.
Methods: The study modeled a hypothetical cohort of adult patients with an operatively treated extremity, pelvic, or acetabular fracture based on data from a recent clinical trial and national databases. We used a decision analysis model to compare 30 mg of enoxaparin with 81 mg of aspirin, administered twice daily in-hospital and prescribed for 21 days after discharge. Health-care costs and quality-adjusted life-years (QALYs) within 1 year after the injury derived from published research and publicly available cost data were based on potential disease states, including death or a combination of pulmonary embolism, proximal deep vein thrombosis, distal deep vein thrombosis, or a bleeding complication. We assessed cost-effectiveness compared with a willingness-to-pay threshold of $150,000 per QALY.
Results: Our model estimated that the 1-year health-care costs among patients prescribed enoxaparin were $35,301, producing 0.6705 QALYs. Aspirin was associated with $35,067 in 1-year health-care costs and 0.6701 QALYs. The overall health-care costs were $234 higher with enoxaparin but yielded only a 0.0004 improvement in QALYs, for an incremental cost-effectiveness ratio for enoxaparin of $635,340 per QALY, indicating that enoxaparin is not cost-effective compared with aspirin. In a sensitivity analysis, the probability of enoxaparin thromboprophylaxis being cost-effective compared with aspirin was 9.8% in 10,000 iterations.
Conclusions: The findings suggest that enoxaparin is not cost-effective relative to aspirin for thromboprophylaxis in patients with orthopaedic trauma. The results support consideration of aspirin as a preferred agent in future guidelines, especially given the consistent patient preference for its oral administration.
Level of evidence: Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Cost-Effectiveness of Enoxaparin Compared with Aspirin for Thromboprophylaxis in Patients with Orthopaedic Trauma.","authors":"Joseph F Levy, Robert V O'Toole, Deborah M Stein, Elliott R Haut, Katherine P Frey, Renan C Castillo, Nathan N O'Hara","doi":"10.2106/JBJS.25.00681","DOIUrl":"https://doi.org/10.2106/JBJS.25.00681","url":null,"abstract":"<p><strong>Background: </strong>Although clinical guidelines endorse enoxaparin for the prevention of venous thromboembolism in patients with orthopaedic trauma, recent evidence from a large clinical trial has demonstrated that aspirin provides comparable protection against death and pulmonary embolism. This study evaluated the cost-effectiveness of thromboprophylaxis with enoxaparin compared with that with aspirin in patients with orthopaedic trauma from the perspective of the U.S. health-care system.</p><p><strong>Methods: </strong>The study modeled a hypothetical cohort of adult patients with an operatively treated extremity, pelvic, or acetabular fracture based on data from a recent clinical trial and national databases. We used a decision analysis model to compare 30 mg of enoxaparin with 81 mg of aspirin, administered twice daily in-hospital and prescribed for 21 days after discharge. Health-care costs and quality-adjusted life-years (QALYs) within 1 year after the injury derived from published research and publicly available cost data were based on potential disease states, including death or a combination of pulmonary embolism, proximal deep vein thrombosis, distal deep vein thrombosis, or a bleeding complication. We assessed cost-effectiveness compared with a willingness-to-pay threshold of $150,000 per QALY.</p><p><strong>Results: </strong>Our model estimated that the 1-year health-care costs among patients prescribed enoxaparin were $35,301, producing 0.6705 QALYs. Aspirin was associated with $35,067 in 1-year health-care costs and 0.6701 QALYs. The overall health-care costs were $234 higher with enoxaparin but yielded only a 0.0004 improvement in QALYs, for an incremental cost-effectiveness ratio for enoxaparin of $635,340 per QALY, indicating that enoxaparin is not cost-effective compared with aspirin. In a sensitivity analysis, the probability of enoxaparin thromboprophylaxis being cost-effective compared with aspirin was 9.8% in 10,000 iterations.</p><p><strong>Conclusions: </strong>The findings suggest that enoxaparin is not cost-effective relative to aspirin for thromboprophylaxis in patients with orthopaedic trauma. The results support consideration of aspirin as a preferred agent in future guidelines, especially given the consistent patient preference for its oral administration.</p><p><strong>Level of evidence: </strong>Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21Epub Date: 2025-11-24DOI: 10.2106/JBJS.25.00443
Laura Robbins, Mathias Bostrom, Adolfo Llinás
{"title":"Global Orthopaedics Education: Doing More with Less.","authors":"Laura Robbins, Mathias Bostrom, Adolfo Llinás","doi":"10.2106/JBJS.25.00443","DOIUrl":"10.2106/JBJS.25.00443","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"100-102"},"PeriodicalIF":4.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21Epub Date: 2025-12-01DOI: 10.2106/JBJS.25.01212
T David Luo, Sebastian B Braun, Brent A Lanting
{"title":"What's New in Adult Reconstructive Knee Surgery.","authors":"T David Luo, Sebastian B Braun, Brent A Lanting","doi":"10.2106/JBJS.25.01212","DOIUrl":"https://doi.org/10.2106/JBJS.25.01212","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"108 2","pages":"83-91"},"PeriodicalIF":4.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21Epub Date: 2025-11-13DOI: 10.2106/JBJS.25.00494
Dipit Sahu
{"title":"Disconfirmation Bias May Exist in All of Us, But Being Aware Is the First Step Toward Critical Thinking.","authors":"Dipit Sahu","doi":"10.2106/JBJS.25.00494","DOIUrl":"10.2106/JBJS.25.00494","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"98-99"},"PeriodicalIF":4.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21Epub Date: 2025-11-13DOI: 10.2106/JBJS.25.00364
Benjamin A Nelson
{"title":"Pause, and Appreciate.","authors":"Benjamin A Nelson","doi":"10.2106/JBJS.25.00364","DOIUrl":"10.2106/JBJS.25.00364","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"103"},"PeriodicalIF":4.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21Epub Date: 2025-11-24DOI: 10.2106/JBJS.25.00474
Jason Zarahi Amaral, Jay Moran, Rioke M Diejomaoh, Stuart D Ferrell, Basel M Touban, Jessica A McGraw-Heinrich, Scott D McKay
<p><strong>Background: </strong>Monteggia fracture-dislocations are uncommon pediatric injuries that often require surgical stabilization. Concomitant ipsilateral upper-extremity fractures are rare, are poorly characterized, and may be missed during initial evaluation. In this study, we aimed to evaluate the incidence, characteristics, and management of acute pediatric Monteggia fracture-dislocations with concomitant ipsilateral upper-extremity fractures.</p><p><strong>Methods: </strong>A retrospective review was conducted at a single tertiary academic center from 2011 to 2024. Patients ≤18 years of age with acute Monteggia or Monteggia-equivalent fracture-dislocations were identified and categorized using the Bado classification. Patients with concomitant ipsilateral upper-extremity fractures were identified and reported descriptively. The rates of formal operative reduction and ulnar fracture fixation were compared between patients with and without concomitant fractures.</p><p><strong>Results: </strong>In total, 468 pediatric patients with Monteggia fracture-dislocations (mean age, 6.3 ± 2.5 years; 49% female; 48% White, 39% Hispanic, 8% Asian, 3% Black, and 2% not specified) were included. Of these, 32 (7%) had ≥1 concomitant ipsilateral upper-extremity fracture. Bado I was most common among patients with concomitant fractures (59%). Concomitant fracture types included distal radial fractures in 59%, supracondylar humeral fractures in 34%, distal ulnar fractures in 25%, medial epicondylar fractures of the humerus in 9%, and lateral condylar fractures of the humerus in 6%. The observed fracture combinations, in decreasing order, were Monteggia fracture-dislocation with distal radial fracture (34%), with supracondylar humeral fracture (25%), and with combined distal radial and distal ulnar fractures (16%). Additional patterns included Monteggia fracture-dislocation with combined supracondylar humeral, distal radial, and distal ulnar fractures (9%); with medial epicondylar fracture of the humerus (9%); and with lateral condylar fracture of the humerus (6%). Patients with concomitant fractures more frequently underwent formal operative reduction (78% versus 48%; p = 0.001) and ulnar fracture fixation (66% versus 37%; p = 0.001) compared with those with isolated Monteggia fracture-dislocations.</p><p><strong>Conclusions: </strong>Concomitant ipsilateral upper-extremity fractures were identified in 7% of acute pediatric Monteggia fracture-dislocations, most frequently involving the distal radius (59%) and the supracondylar region of the humerus (34%). Patients with concomitant fractures more commonly underwent formal operative reduction and ulnar fracture fixation compared with those without concomitant fractures. Given the 7% incidence, surgeons should maintain a high index of suspicion for subtle secondary injuries and ensure appropriate imaging during initial evaluation. Further research is needed to guide management and rehabilitation in these c
{"title":"Incidence, Characteristics, and Management of Concomitant Ipsilateral Upper-Extremity Fractures in Pediatric Monteggia Fracture-Dislocations: A 13-Year Single-Institution Case Series.","authors":"Jason Zarahi Amaral, Jay Moran, Rioke M Diejomaoh, Stuart D Ferrell, Basel M Touban, Jessica A McGraw-Heinrich, Scott D McKay","doi":"10.2106/JBJS.25.00474","DOIUrl":"10.2106/JBJS.25.00474","url":null,"abstract":"<p><strong>Background: </strong>Monteggia fracture-dislocations are uncommon pediatric injuries that often require surgical stabilization. Concomitant ipsilateral upper-extremity fractures are rare, are poorly characterized, and may be missed during initial evaluation. In this study, we aimed to evaluate the incidence, characteristics, and management of acute pediatric Monteggia fracture-dislocations with concomitant ipsilateral upper-extremity fractures.</p><p><strong>Methods: </strong>A retrospective review was conducted at a single tertiary academic center from 2011 to 2024. Patients ≤18 years of age with acute Monteggia or Monteggia-equivalent fracture-dislocations were identified and categorized using the Bado classification. Patients with concomitant ipsilateral upper-extremity fractures were identified and reported descriptively. The rates of formal operative reduction and ulnar fracture fixation were compared between patients with and without concomitant fractures.</p><p><strong>Results: </strong>In total, 468 pediatric patients with Monteggia fracture-dislocations (mean age, 6.3 ± 2.5 years; 49% female; 48% White, 39% Hispanic, 8% Asian, 3% Black, and 2% not specified) were included. Of these, 32 (7%) had ≥1 concomitant ipsilateral upper-extremity fracture. Bado I was most common among patients with concomitant fractures (59%). Concomitant fracture types included distal radial fractures in 59%, supracondylar humeral fractures in 34%, distal ulnar fractures in 25%, medial epicondylar fractures of the humerus in 9%, and lateral condylar fractures of the humerus in 6%. The observed fracture combinations, in decreasing order, were Monteggia fracture-dislocation with distal radial fracture (34%), with supracondylar humeral fracture (25%), and with combined distal radial and distal ulnar fractures (16%). Additional patterns included Monteggia fracture-dislocation with combined supracondylar humeral, distal radial, and distal ulnar fractures (9%); with medial epicondylar fracture of the humerus (9%); and with lateral condylar fracture of the humerus (6%). Patients with concomitant fractures more frequently underwent formal operative reduction (78% versus 48%; p = 0.001) and ulnar fracture fixation (66% versus 37%; p = 0.001) compared with those with isolated Monteggia fracture-dislocations.</p><p><strong>Conclusions: </strong>Concomitant ipsilateral upper-extremity fractures were identified in 7% of acute pediatric Monteggia fracture-dislocations, most frequently involving the distal radius (59%) and the supracondylar region of the humerus (34%). Patients with concomitant fractures more commonly underwent formal operative reduction and ulnar fracture fixation compared with those without concomitant fractures. Given the 7% incidence, surgeons should maintain a high index of suspicion for subtle secondary injuries and ensure appropriate imaging during initial evaluation. Further research is needed to guide management and rehabilitation in these c","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"134-141"},"PeriodicalIF":4.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21Epub Date: 2025-11-17DOI: 10.2106/JBJS.25.00263
Carol Zhao Xiaoshu
{"title":"Through Their Eyes: Doctors or Monsters?","authors":"Carol Zhao Xiaoshu","doi":"10.2106/JBJS.25.00263","DOIUrl":"https://doi.org/10.2106/JBJS.25.00263","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"108 2","pages":"104-106"},"PeriodicalIF":4.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21Epub Date: 2025-11-20DOI: 10.2106/JBJS.25.00506
Joseph Bernstein
{"title":"Am I That Guy?","authors":"Joseph Bernstein","doi":"10.2106/JBJS.25.00506","DOIUrl":"10.2106/JBJS.25.00506","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"96-97"},"PeriodicalIF":4.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Podagra.","authors":"Kiana C Allen","doi":"10.2106/JBJS.25.01513","DOIUrl":"https://doi.org/10.2106/JBJS.25.01513","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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