Orthopedic Reviews最新文献

Platelet-rich plasma (PRP) therapy has emerged as a biologically based approach to enhance tendon healing and functional recovery in hand and other musculoskeletal injuries. PRP is an autologous concentrate of platelets and growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), insulin-like growth factor (IGF), and vascular endothelial growth factor (VEGF), which modulate inflammation, stimulate tenocyte proliferation, promote collagen synthesis, and support angiogenesis. Preclinical studies demonstrate that PRP improves extracellular matrix remodeling, collagen fiber alignment, and biomechanical strength in injured tendons, with effects influenced by PRP formulation, leukocyte content, activation method, and timing of application. Clinical evidence in hand tendon injuries-particularly flexor tendon repair, chronic tendinopathies, and stenosing tenosynovitis-suggests that PRP is generally safe and may enhance tendon morphology, range of motion, pain relief, and return to function. However, results are heterogeneous, with some randomized trials showing limited short-term functional improvements compared to conventional treatments such as corticosteroids, hyaluronic acid, or percutaneous needle tenotomy. The variability in outcomes reflects differences in PRP preparation, injection protocols, injury chronicity, and study design. Beyond the hand, PRP has been applied to rotator cuff, lateral epicondylitis, plantar fasciitis, ligament injuries, and spinal surgery, with mixed results and some evidence of tissue-specific limitations. Current challenges include standardizing PRP formulations, optimizing dosing and delivery, and identifying patient- and injury-specific factors influencing response. Future research should prioritize multicenter, well-powered randomized trials with uniform outcome measures, long-term follow-up, robust safety monitoring, and exploration of combination therapies to clarify the therapeutic role of PRP and support evidence-based integration into clinical practice.

Purpose: Hip arthroscopy is a minimally invasive procedure which has been increasingly used among athletes for several hip joint related pathologies as it allows for a faster recovery. However, objective return to sport criteria have not been described previously among this population.

Objective: To systematically review the literature to evaluate and describe the objective return-to-sport (RTS) criteria to release patients back to sport following hip arthroscopy.

Methods: We conducted a comprehensive literature search according to the PRISMA guidelines. Studies were included in the review if patients underwent a hip arthroscopy procedure and the study described criteria for their patients to RTS. Two independent reviewers selected studies for inclusion and extracted study characteristics and objective RTS criteria.

Results: Of the 306 that were a part of our original search, 6 studies fit our inclusion criteria. There were 250 athletes (average age: 26.1) and 263 hips which underwent hip arthroscopy surgery. Of these athletes, the cohort was on average 46.5% female and an average of 91.2% of athletes returned to sport about 6 months following surgery. The primary sports these athletes participated in were soccer, swimming, skiing/snowboarding, and hockey. The objective RTS measures that were generally described included sport specific tests, range-of-motion, hip strength, and performance-based criteria.

Conclusion: There are minimal studies who described objective RTS criteria to release patients back to sport following hip arthroscopy procedures. Sports specific tests, hip strength, and performance-based criteria were mentioned as objective criteria to release patients back to sport.

Background: Venous thromboembolism (VTE) remains a major source of morbidity after femoral fracture repair. We evaluated perioperative risk factors for 30-day deep vein thrombosis (DVT) and pulmonary embolism (PE) using a national clinical registry.

Methods: We conducted a retrospective cohort study of adults undergoing femoral fracture repair in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes were 30-day DVT and PE. Candidate predictors included demographics, comorbidities, functional status, preoperative laboratory values, American Society of Anesthesiologists (ASA) class, and operative time. Multivariable logistic regression models were fit separately for DVT and PE. Model performance was assessed with area under the receiver operating characteristic curve (AUC).

Results: Disseminated cancer and longer operative time were independent predictors of postoperative DVT. Disseminated cancer conferred higher odds of DVT (adjusted odds ratio [aOR] 1.65, 95% CI 1.15-2.36, p=0.0065), and each additional operative minute increased DVT odds by 0.32% (aOR 1.0032, 95% CI 1.0017-1.0047, p<0.001), approximating 19% higher odds per 60 minutes. Body mass index (BMI) showed a borderline association (aOR 1.014 per kg/m², 95% CI 0.999-1.027, p=0.056), while age, sex, diabetes, smoking, functional status, preoperative creatinine, platelets, dialysis, heart failure, and preoperative INR were not significant. The DVT model demonstrated modest discrimination (AUC 0.57).For PE, disseminated cancer (aOR 2.77, 95% CI 1.92-4.00, p<0.001), longer operative time (aOR 1.0025 per minute, 95% CI 1.0006-1.0044, p=0.012), and higher BMI (aOR 1.018 per kg/m², 95% CI 1.002-1.035, p=0.031) were independent risk factors, whereas higher preoperative INR was protective (aOR 0.43 per unit, 95% CI 0.23-0.80, p=0.008). The PE model AUC was 0.61.

Conclusions: Within 30 days of femoral fracture repair, disseminated cancer and prolonged operative time consistently increased VTE risk; BMI contributed modestly, and higher preoperative INR reduced PE risk. These findings support targeted prophylaxis and heightened surveillance in high-risk subgroups and highlight the need for enhanced, multifactorial prediction tools.

Background: Femoral intramedullary screw fixation is widely performed to stabilize femoral fractures. Although uncommon, postoperative acute kidney injury (AKI) and dialysis are serious complications associated with increased morbidity and mortality. This study aimed to identify predictors of AKI and postoperative dialysis following femoral intramedullary screw fixation.

Methods: We utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients undergoing femoral intramedullary screw fixation (CPT 27506) between 2018 and 2022. Predictors examined included demographic variables, comorbidities, preoperative laboratory values, ASA class, operative duration, and anesthesia type. Univariate analyses were performed, followed by multivariate logistic regression to determine independent risk factors for AKI and postoperative dialysis. Statistical significance was set at α = 0.05.

Results: A total of 63,734 patients were analyzed. Univariate predictors of AKI and postoperative dialysis included renal failure, elevated blood urea nitrogen, general anesthesia, hypertension, male sex, advanced age, decreased hematocrit, higher ASA class, diabetes, elevated BMI, and longer operative time. Multivariate logistic regression identified the following independent predictors: pre-existing renal insufficiency (p < 0.0001), elevated blood urea nitrogen (p < 0.0001), use of general anesthesia (p < 0.001), hypertension (p < 0.0001), male sex (p < 0.0001), older age (p < 0.001), decreased hematocrit (p < 0.001), ASA class III and IV (p = 0.0013, p = 0.0229), diabetes (p = 0.0038), and increased BMI (p = 0.0043).

Conclusion: This study identifies significant independent predictors of AKI and postoperative dialysis in patients undergoing femoral intramedullary screw fixation. Preoperative risk stratification incorporating these factors may improve perioperative planning and reduce adverse renal outcomes.

Lateral patellar dislocation (LPD) is a common knee joint sports injury in adolescents, with an incidence increasing year by year. Medial patellofemoral ligament reconstruction (MPFLR), as the mainstream surgical method for treating LPD, achieves favorable clinical efficacy and significantly reduces the redislocation rate. However, controversies remain regarding patients' return to sport (RTS) level, especially when combined with complex bony surgeries, where RTS outcomes are poorer. This review systematically evaluates the impact of different surgical strategies (isolated MPFLR and MPFLR combined with various bony surgeries) on RTS levels and explores the key role of psychological factors in RTS. It aims to provide references for optimizing clinical treatment strategies and formulating individualized RTS protocols.

Introduction: Busch-Hoffa fractures are rare, particularly in the pediatric population, with limited available literature. As it is an inherently unstable fracture and as the posterior femoral condyle is prone to non-union, correct and adequate treatment of the fracture is critical but challenging.

Objective: This study aims to (1) systematically review the literature on pediatric Busch-Hoffa fractures, and (2) present a rare case of a lateral Busch-Hoffa fracture with a bucket-handle lateral meniscus tear and popliteus tendon incarceration in a pediatric patient.

Methods: A systematic review was performed in February 2025 using PubMed/MEDLINE, identifying English-language articles on Busch-Hoffa fractures in patients aged ≤16 years. PRISMA guidelines and quality assessment tools were applied.

Results: A literature search identified 20 cases, predominantly occurring in males (66.7%) with an average age of 11.35 years. Falls and motor vehicle accidents were the most common mechanisms of injury. Open reduction and internal fixation was performed in 85% of cases, with generally favorable outcomes. Three cases presented with a concomitant osseous injury and two were associated with a soft tissue injury.

Conclusion: Although rare, pediatric Busch-Hoffa fractures must not be overlooked. Existing literature is sparse and consists primarily of case reports. Given the high risk of instability and non-union, surgical fixation remains the preferred treatment. Our case contributes to existing literature by presenting a unique combination of Busch-Hoffa fracture with significant soft tissue involvement, underscoring the role of arthroscopy in assessing and managing concomitant injuries.

With advancements in Left Ventricular Assist Devices (LVAD) technology, patients supported by LVAD are pursuing non-cardiac surgeries at a higher rate. This study is the largest retrospective case series to date to examine orthopedic surgery outcomes in this patient population. # Case Presentation From January 1, 2012, to December 31, 2022, there were 40 patients with LVAD who underwent 47 orthopedic surgeries at a Level II Trauma Center. The type of orthopedic procedure, time since LVAD implantation, length of hospital stays, blood loss, need for transfusion, postoperative thromboembolic events, and discharge destination were evaluated. # Management and Outcomes Orthopedic surgery in LVAD patients appears to have longer lengths of hospital stay, greater need for blood transfusion, higher emergency department visits, higher readmission rates, and a greater need for rehabilitation assistance. # Conclusion Orthopaedic surgery in patients with LVAD appears riskier, however, it is possible and may be necessary, optimization and collaborative inter-disciplinary care is paramount to success.

Aortic dissection is a life-threatening condition that deteriorates rapidly following onset. Factors such as uncontrolled hypertension, hyperlipidemia, and genetic factors contribute to the development of the condition. This case report covers the history, presentation, and treatment of a 66-year-old male with a Stanford Type A aortic dissection. This case highlights the urgency of the condition and the cruciality of teaching recognition and prompt treatment to maximize patient survival.

Chronic pain involving both the spine and visceral organs can present significant treatment challenges, especially in patients refractory to pharmacologic and interventional modalities. We report a case of a male in his late 50s with chronic axial lumbar pain due to degenerative disc disease and spondylosis, in combination with severe abdominal pain related to chronic pancreatitis. The patient failed multiple conservative treatments, including systemic medications and targeted nerve blocks. Ultimately, a spinal cord stimulator (SCS) was implanted with leads positioned at T5-T7 to capture both pain regions. The patient reported substantial improvement in both axial and abdominal pain, along with reduced opioid use. This case highlights the potential role of neuromodulation in managing complex, multifocal chronic pain syndromes.

Background: Post-traumatic elbow stiffness in adolescents is a complex challenge that requires individualized treatment approaches. While open arthrolysis remains the most commonly used technique, arthroscopic techniques have emerged as a promising alternative with potential advantages in this younger population. This narrative review aims to emphasize the advantages of arthroscopic arthrolysis over the open approach in the adolescent patient. In addition, we explore how differences in etiology, diagnostic evaluation, and treatment response between adolescents and adults influence decision-making and outcomes.

Methods: A narrative review of the current literature on post-traumatic elbow stiffness in adolescents was conducted. Clinical studies, previous reviews, and recent advancements were analyzed. Clinical examples from our center were also presented.

Results: Arthroscopic arthrolysis was associated with improved range of motion, faster recovery, and lower complication rates in selected patients. However, open arthrolysis remains superior in cases with severe deformity, heterotopic ossification, or prior surgical history. In our experience, the indications for arthroscopic arthrolysis can be expanded when performed by experienced surgeons.

Conclusion: Even though open arthrolysis remains the gold standard for complex elbow stiffness, arthroscopic approaches show promising outcomes in adolescents and could be used more widely in centers with sufficient expertise.