Orthopedic Reviews最新文献

Objective: To investigate the clinical effects of Leukocyte-poor-Platelet-Rich-Plasma (LpPRP) injections to treat chronic facet joint syndrome.

Methods: 78 patients suffering from chronic facet joint syndrome at the Center for Molecular Orthopedics (CMO) agreed to participate to this prospective controlled study to receiving a series of CT-guided PAT-injections (periarticular therapy) to lumbar facet joints. The patients were free to decide to receive either injections based on Platelet-Rich-Plasma (PRP) or local anesthetics (LA/bupivacaine). In this study leucocyte-poor PRP (LpPRP) was used for all patients of the verum group, namely autologous conditioned plasma (Arthrex ACP® / Arthrex Inc., Naples, FL, USA) as the verum group. 59 patients were treated 3-5 times in at least two levels of facet joints in the PRP group, 19 patients decided to join the LA group receiving local anesthetics (LA group) each in a weekly interval. All patients agreed to answer an automated email questionnaire for up to one year starting at baseline before receiving the first injections. The follow up protocol was based on a pain scale, and the Oswestry disability score. Data analysis was evaluated using the Excel analysis tools.

Results: Data analysis revealed that both, PRP and local anesthetics had a pain reducing effect initially at week 2 after receiving the first PAT, but from week six on up to one year post injection, PRP infiltrations were superior with a significantly reduced pain score compared to baseline up to one year (p<0.001). Oswestry score showed similar results with a significant improvement to about one half compared to baseline (p<0.001) up to six months, still being significantly better at one year (p<0.01). The comparison of the PRP group to the LA group showed a better pain relief and better values at the Oswestry disability score between three and six months and one year.

Conclusions: We show that a CT-guided injection therapy (PAT) based on LpPRP addressing the facet joint mediated low back pain syndrome leads to a significant long term pain reduction, and to a significant improvement in the Oswestry disability score for at least one year.

Orthopedic injuries are a common challenge in sports, often associated with inadequate postural patterns.

Objective: The aim of this study was to investigate the relationship between postural biomechanics and the incidence of orthopedic injuries in athletes from different sports.

Method: An exploratory and descriptive literature review was carried out, with a qualitative approach, based on the analysis of studies published between 2020 and 2024 in the following databases: PubMed, SciELO and BVS.

Results: Deficits in postural control significantly increase the risk of injuries, especially in sports that involve rapid changes of direction and repetitive landings. In addition, postural correction training and continuous biomechanical monitoring have proven to be effective strategies for preventing injuries.

Conclusion: Postural biomechanics directly influence the vulnerability of athletes to musculoskeletal trauma, and that the implementation of preventive interventions, such as muscle strengthening and regular postural analysis, is essential. However, there is a need for broader and longitudinal studies to deepen knowledge about the effectiveness of these approaches in reducing sports injuries.

Introduction: Noise exposure in orthopedic operating rooms (ORs), particularly from power tools, poses potential risks to surgical staff and patients, including noise-induced hearing loss (NIHL). This scoping review quantifies noise exposure related to orthopedic instrument use and explores recommended guidelines.

Methods: Using Covidence, PubMed was systematically searched for studies published between January 1990 and December 2023. Of 1671 initial studies, 13 met inclusion criteria. Data extracted included decibel measurements, instrument types, measurement distances, and noise exposure recommendations.

Results: Unweighted decibel measurements for oscillating and reciprocating saws ranged from 81 dB to 131 dB, drilling systems from 78.3 dB to 97 dB, and hammering from 92 dB to 103.4 dB. A-weighted measurements for saws ranged from 53 dB(A) to 100 dB(A), drilling systems from 74.6 dB(A) to 97 dB(A), rasping systems from 87 dB(A) to 110 dB(A), and acetabular reaming at 87 dB(A). Action value set by the UK Control of Noise at Work Regulations, begin at 80 dB(A), requiring information, training, and hearing protection, while the upper exposure action value is 85 dB(A), mandating noise reduction measures and enforce hearing protection use. Of the included studies, 61.5% (8 of 13) provided explicit noise mitigation recommendations, 23.1% (3 of 13) presented mixed recommendations, and 15.4% (2 of 13) found no significant risk.

Conclusion: Significant variation exists in reported exposure levels and recommendations, highlighting the need for standardized evaluation methodologies. Future research should focus on standardizing measurement parameters and comprehensively evaluating current instrumentation to develop evidence-based noise mitigation protocols for orthopedic ORs.

Some researchs have shown a positive correlation between hand grip strength and bone mineral density(BMD), but they lack comprehensiveness. In this study, we adjusted for body mass index and analyzed the association between relative grip strength index(RGSI) and trunk bone BMD (TBBMD). # Materials and methods Of 19,931 initial participants, 5,764 adults (aged ≥20 years) with complete TBBMD, grip strength, and BMI data were analyzed. Covariates included gender, age, weight, height, BMI, marital status, family income to poverty ratio (FIR), education level, alcohol, activity, total cholesterol, vitamin D, hypertension, diabetes, cancer, smoke, and sleep status. Missing values were imputed, and RGSI was calculated. Statistical analyses included baseline characteristics, regression, and nonlinear modeling. # Results Analysis of Participants (mean age 39.006 ± 11.545 years; 52.186% male) revealed a positive RGSI-TBBMD association. TBBMD increased across RGSI quartiles (Q1:0.864±0.102 vs. Q4:0.941±0.122, P<0.001). Multiple regression confirmed strong associations in unadjusted (β=0.033, 95% CI[0.029, 0.036], P<0.00001), gender and age adjusted (β=0.013, 95% CI[0.009, 0.017], P<0.00001), and fully adjusted models (β=0.035, 95%CI[0.030, 0.041], P<0.00001). The association was stronger in women (β=0.050) than men (β=0.032). Generalized additive models revealed inverted U-shaped relationships in total variable (inflection RGSI=4.935), males (4.999), females (3.088), age≤30 (4.975), and vitamin D Q4 (4.458), with negative associations above inflection points (all P<0.05). Participants >30 had an approximately linear positive associations. # Conclusion An elevated RGSI was significantly associated with higher TBBMD levels. Collectively, this study highlights the importance of RGSI in assessing TBBMD.

This bibliometric analysis investigates global research trends in anterior cruciate ligament (ACL) injury prevention and treatment by evaluating 4,086 articles indexed in the Web of Science Core Collection from 1985 to June 18, 2025. The top funding agencies of ACL research showed governmental-linked institutions from the United States, the People's Republic of China, and Japan supporting a substantial part of ACL literature. Keyword emphasis on surgical methods was evident in the indexed literature on ACL. Continued research towards improving surgical methods will prevent retear, assist in more efficient recovery, and better long-term outcomes for the patient.

Background: Massive irreparable rotator cuff tears are a significant challenge for shoulder function, with tendon transfers emerging as potential solutions.

Objective: This systematic review aims to comprehensively evaluate the current evidence on the outcomes of lower trapezius transfer for the treatment of massive rotator cuff tears.

Methods: This systematic review examines the use of trapezius transfer in managing these tears. Following PRISMA guidelines, a search of Medline, Embase, and Cochrane was conducted through March 2024 for studies on trapezius tendon transfer.

Results: The review analyzed data from 214 patients (161 males, 53 females) with an average age of 58 years (range: 31-73 years), focusing on surgical technique, complications, follow-up duration, and outcomes. Most procedures utilized an Achilles allograft, with reported complications including retear rates of 7.5% and surgical infections in 2.3% of cases. The average follow-up was 38.4 months, with 80% to 100% of patients returning to previous activity levels.

Conclusion: This review highlights the effectiveness of lower trapezius tendon transfer, particularly using an Achilles allograft, in enhancing pain relief, shoulder mobility, and overall function. Despite some complications, the high return-to-activity rate underscores the procedure's utility in restoring normalcy and productivity for patients with massive rotator cuff tears. Future research should aim to standardize operative and postoperative protocols to optimize outcomes and reduce complications.

Anterior cruciate ligament (ACL) is vital for knee joint stability, and its rupture is a common injury, especially among athletes in high-demand sports involving pivoting and jumping. ACL reconstruction using grafts-autografts or allografts-is the standard treatment to restore knee function. However, graft healing within the bone tunnel is complex, involving coordinated molecular and cellular events across inflammatory, proliferative, and remodeling phases. During the inflammatory phase, immune cells like neutrophils, macrophages, and lymphocytes infiltrate the injury site, releasing pro-inflammatory cytokines (IL-1β, TNF-α, IL-6) that initiate the healing cascade via pathways such as NF-κB. The proliferative phase features fibroblast and mesenchymal stem cell (MSC) activity, synthesizing extracellular matrix (ECM) components like type III collagen under the influence of growth factors (TGF-β, PDGF, bFGF) and promoting angiogenesis through VEGF. In the remodeling phase, tissue maturation occurs with the replacement of type III collagen by type I collagen, enhanced by matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), and alignment of collagen fibers facilitated by mechanotransduction pathways involving integrins and focal adhesion kinase (FAK). Early mechanical loading plays a critical role by activating mechanosensitive receptors, leading to the upregulation of anabolic growth factors (IGF-1, PGE2) and promoting cellular responses that enhance graft integration, collagen fiber alignment, and biomechanical properties. Understanding the optimal timing, intensity, and type of mechanical loading is essential for developing effective rehabilitation protocols. Personalized rehabilitation strategies that consider patient-specific factors-such as age, activity level, genetic predispositions (e.g., variations in COL1A1, COL5A1, IL-6, TNF-α genes), and graft type-can optimize healing outcomes. Integrating molecular biology insights with mechanical loading approaches holds promise for improving ACL reconstruction success rates, reducing recovery times, and minimizing complications. Future research should focus on identifying novel molecular targets and signaling pathways (e.g., Wnt/β-catenin) involved in graft healing. Combining mechanical loading with biological augmentations-such as growth factors, stem cells, or gene therapy-may lead to synergistic therapies that further enhance graft integration and functional recovery.

Background: There is relatively little literature into the cost of treating diaphyseal femur fractures in paediatric population. This study aims to determine the cost of managing paediatric diaphyseal femur fractures in a South African Academic Hospital.

Objective and methods: We conducted a retrospective study using prospectively collected data on paediatric diaphyseal femoral fracture treatment at our public academic hospital over a four-month duration. The study included patients who were between 2 years and 14 years of age and excluded those with femur fractures caused by pathological or atypical factors. The following costs were reviewed: emergency department, inpatient admission, anaesthesia and theatre, allied department, and radiology department.

Results: Data from 31 patients (80.6% males) with diaphyseal femoral fractures were included in the study; falls accounted for 64.5% of the injuries. The patients who underwent surgery had a mean hospital stay of 7.4 days (range:3 to 22 days), while the group that did not have surgery had a mean hospital stay of 24.1 days (range:17 to 34 days). The factors that had a greater impact on cost were the duration of the hospital stay, the cost of the implant, and the cost of the theatre. There was no statistically significant variation in the cost of emergency unit services among this group.

Conclusion: The data showed that orthopaedic surgeons need to be cognizant of the cost of treating paediatric diaphyseal femoral fractures in the current state of the economy.

Purpose: To systematically evaluate the effects of Tai Chi on bone mineral density (BMD) in lumbar spine, femoral greater trochanter, Ward's triangle, femoral neck, and calcaneus among middle-aged and older adults through a meta-analysis.

Methods: A comprehensive literature search was conducted across multiple databases, including CNKI, PubMed, Embase, Web of Science, and Cochrane Library, to identify randomized controlled trials (RCTs) investigating the impact of Tai Chi on BMD in middle-aged and older populations. The literature search covered the period from the establishment of each database to February 25, 2025. EndNote 20 was employed for literature management. The methodological quality of included studies was evaluated using the PEDro (Physiotherapy Evidence Database) scale. Heterogeneity analysis, bias assessment, and sensitivity analysis were performed on extracted data using RevMan 5.4 and Stata SE 15.0 software.

Results: 1. Seventeen randomized controlled trials (RCTs) with a total sample size of 1,253 participants (intervention group: n=675; control group: n=578) were included in the final analysis. The methodological quality of the included studies, as assessed by standardized evaluation criteria, demonstrated overall high robustness. The meta-analysis revealed statistically significant improvements in bone mineral density (BMD) at multiple skeletal sites following Tai Chi intervention: lumbar spine (WMD = 0.07, 95% CI: 0.04-0.11, p < 0.00001), greater trochanter (WMD = 0.04, 95% CI: 0.02-0.06, p < 0.00001), Ward's triangle (WMD = 0.03, 95% CI: 0.01-0.05, p = 0.007), femoral neck (WMD = 0.03, 95% CI: 0.02-0.05, p < 0.0001), and calcaneus (WMD = 5.52, 95% CI: 3.87-7.27, p < 0.00001).

Conclusion: Regular Tai Chi practice demonstrates significant improvements in bone mineral density (BMD) among middle-aged and older adults, particularly at the lumbar spine. Our meta-analysis suggests Tai Chi may serve as a viable non-pharmacological intervention for mitigating osteoporosis in aging populations. Notably, individuals aged ≥60 years exhibit more pronounced BMD enhancements when adhering to a structured regimen of ≥3 sessions/week over ≥6 months. However, rigorously designed randomized controlled trials (RCTs) are required to validate these observed benefits and systematically explore optimal Tai Chi exercise regimens for skeletal health promotion.