Orthopedic Reviews最新文献

There has been a recent trend towards outpatient arthroplasty since the Center for Medical Services removed the total knee and total hip arthroplasty from the inpatient only list. Arthroplasty in the ambulatory surgical center has been extensively studied, with research demonstrating better patient outcomes, better patient and surgeon satisfaction, and lower overall healthcare costs. Outpatient arthroplasty in the academic hospital setting has its own unique challenges associated with it. However there is a paucity of research pertaining to this particular setting. This review aims to evaluate the current literature and review of challenges particular to outpatient arthroplasty in the academic hospital setting. Throughout this review, evidence-based principles leading to the paradigm shift towards outpatient hip/knee arthroplasty within the hospital setting are elucidated. Additionally, practical methods for selecting appropriate candidates and optimizing perioperative care are discussed, as well as the implications of implementing outpatient arthroplasty within a university academic center.

Dislocations of the elbow are the second most common large joint dislocation, following shoulder dislocations. Most are closed reductions, especially posterior or posterolateral types, and do not require surgical intervention. When an elbow dislocation involves a vascular structure-usually the brachial artery-this injury becomes a rare and life-threatening emergency. Collateral circulation can maintain distal pulses, so these injuries can be underdiagnosed. Without rapid intervention, complications of limb ischemia, compartment syndrome, nerve injury, and even amputation can occur. This report describes a case of a 38-year-old female with complete transection of the brachial artery after elbow dislocation, emphasizing the importance of a thorough vascular assessment in the trauma setting. This case illustrates that a routine elbow injury can be catastrophic when there is a vascular injury. Given that the distal pulses can be maintained, an arterial injury should not be excluded based on pulse alone. Rapid surgery and a multidisciplinary approach were able to address the vascular repair and reduce the joint. This case also exemplifies the multiple complications that can occur with such injuries, including anterior interosseous nerve palsy. This case provides an example of a rare injury and treatment, which may aid in future patient care in the field of underrecognized and high-risk elbow trauma.

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.