Annals of Joint最新文献

Background: Blood flow restriction therapy (BFRT) has gained recognition in recent years as an adjunct to rehabilitation to maximize results for patients with poor strength and endurance. However, literature on the effects of BFRT for conditions afflicting the upper extremity is limited. The purpose of this study was to analyze the available literature regarding the role of BFRT in upper extremity conditions and evaluate its influence on functional and patient reported outcomes.

Methods: PubMed, Embase, and Cochrane Trials were searched in July 2024. Only randomized controlled trials (RCTs) with upper-extremity BFRT were included. Several variables were extracted, including number of patients per study, patient demographics, type of pathology, and functional outcomes. The risk of bias for each eligible RCT was evaluated using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Standard descriptive statistics were used to report outcomes for all the included study findings. BFRT protocols were reviewed and presented in a narrative manner.

Results: The systematic literature search yielded 605 articles, of which four RCTs involving 133 patients met the inclusion criteria. The conditions evaluated included distal radius fractures, osteoarthritis of the hand, and lateral elbow tendinopathy. The evidence for all studies was deemed low risk of bias. Overall, patients who received BFRT demonstrated marginally greater strength, improved pain control, and improved patient-reported outcome measures (PROMs) when compared to a non-BFRT counterpart.

Conclusions: A comprehensive review of the literature examining BFRT as an adjunct treatment for upper extremity conditions was conducted. Patients treated with BFRT may experience greater strength, improved pain control, and improved PROMs when compared to a non-BFRT counterpart. Future, large-scale studies are necessary to further define the benefits of BFRT in orthopaedic conditions of the upper extremity.

Background and objective: The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation (PTT) and injury typically occurs during knee flexion when an external force to the tibia causes PTT. PCL injuries are often overlooked and require a comprehensive exam including a thorough history, physical examination, and imaging. This narrative review aims to review the literature on objective assessments and management of PCL tears.

Methods: A narrative review of PubMed and SCOPUS-indexed relevant literature (no date restrictions, English only, up to October 2025). Studies including reference to the PCL, PCL reconstruction, PCL imaging, and current PCL management were included.

Key content and findings: Within the literature there are multiple reported physical examination tests with varying sensitivities and specificities that aid in the diagnosis of PCL tears such as the posterior drawer, posterior sag, and quadriceps activation tests. PCL stress radiography accompanies the physical exam to provide an objective assessment of PTT while magnetic resonance imaging (MRI) is the gold standard for visualizing acute PCL tears. Nonoperative management with dynamic bracing can promote physiologic healing in grade I, isolated partial PCL tears while grade II, complete PCL tears have demonstrated improved outcomes with both non-operative and operative management. Surgical intervention is typically recommended for grade III, combined PCL injuries and the double-bundle PCL reconstruction technique has demonstrated significantly improved objective stability when compared to the single-bundle reconstruction technique.

Conclusions: Both isolated and combined PCL tears may be difficult to diagnose from other ligamentous knee injuries due to overlapping symptoms and similar physical exam findings. This may lead to misdiagnosis and the sequalae of long-term functional disabilities and future osteoarthritis. The diagnosis and determination of proper PCL tear management requires a comprehensive history, multiple physical examination tests with concomitant imaging such as PCL stress radiographs and MRI. Surgical intervention is often recommended when a grade II or higher PCL injury is demonstrated during the physical examination, or ≥8 mm of PTT (grade II) is visualized when evaluating the side-to-side differences through PCL stress radiography.

Background: Non-union of femoral and tibial shaft fractures remains a challenging complication following surgical fixation. Magnetic intramedullary nails (mIMNs) allow controlled compression and distraction, offering a potential alternative to traditional exchange nailing or external fixation. However, limited clinical data exist regarding their efficacy and complications in treating long bone non-unions. This case series presents early outcomes and technical considerations of compressive magnetic intramedullary nailing for femoral and tibial shaft non-unions.

Case description: We conducted a retrospective case series at a level 1 trauma center in adult patients undergoing compressive magnetic intramedullary nailing of their femoral (n=5) or tibia (n=3) non-unions between 2017 and 2022. Eight patients were included with a mean age at surgery of 38±16 years and a mean follow-up of 16.1±8.7 months. All patients had at least one prior surgical procedure before mIMN. Five patients (62.5%) sustained initial open fractures. Six of eight patients (75%) achieved radiographic union at a mean of 6±2.6 months. Two patients did not achieve union for distinct reasons: one patient required an above-knee amputation due to deep infection, while the other, who had a persistent distal docking site non-union following bone transport with a magnetic nail, refused the recommended secondary surgery for bone grafting at the site.

Conclusions: mIMNs are a potential solution for complex tibial and femoral shaft non-unions, providing stable fixation while enabling controlled bone transport without the need for external fixation. Early results demonstrate satisfactory union rates. However, comparative studies are required to clarify optimal indications, timing of compression, and long-term outcomes.

Anterior cruciate ligament (ACL) tear is a common injury in high-level athletes and has a significant impact on a professional career. Precision management is necessary for successful return to sports (RTS) and return to a competitive level, referred to as return to play (RTP). ACL reconstruction (ACLR) is considered the gold standard and restores anteroposterior and rotatory knee stability to facilitate a successful comeback in the elite athlete's sport. Despite an overall high RTS and RTP rate in elite athletes, performance and career longevity can be significantly impacted. Management of ACL injury in an elite athlete should be individualized to address the demands of the sport and the athlete's expectations. Optimal treatment includes the proper graft choice, detailed sport-specific rehabilitation, and metrics for psychological readiness to RTS and RTP. Hamstring tendon (HT), quadriceps tendon (QT), and bone-patellar tendon-bone (BPTB) autograft for ACLR are the most widely used grafts in athletes. Each graft has a specific profile of characteristics, with BPTB and QT autografts showing the lowest failure rates compared to HT autografts. Graft-specific complications represent anterior knee pain in BPTB, functional weakness of the extensor mechanism of the knee when using QT autografts, and a higher failure rate in HT autografts. Concomitant injuries are common, with meniscus, chondral, and medial collateral ligament lesions being most frequent. Meniscus injuries should be repaired, and early timing plays a crucial role, considering good outcomes after meniscus repair in combined ACLR. Rehabilitation in high-level athletes is recommended to be based on functional criteria rather than purely on a timeline. Successful rehabilitation with the goal of RTP should include prevention of re-injury, progressive muscle strengthening, neuromuscular training, and sport-specific functional exercises.

Background: AI and machine learning (ML) have diverse applications in orthopedic surgery, such as for diagnosis of disease, surgical assistance, and outcome prediction. When used as adjuncts, AI has a potential to reduce clinical workload, improve workflow and aid in clinical decision making. The objective of this systematic review is to evaluate current literature on artificial intelligence (AI) to assess effectiveness in developing responses to inquiries related to orthopaedic upper extremity pathologies.

Methods: Three databases (PubMed, MEDLINE, EMBASE) were searched for studies involving AI and questions in shoulder and elbow orthopedics. Inclusion criteria included papers related to shoulder and elbow, human studies, use of AI models, published in English language and at any level of evidence. Data on response accuracy, reliability and quality, as well as area under the curve (AUC) of the given AI algorithm, were recorded. Meta-analyses were conducted on both the accuracy and AUC of AI algorithms on relevant studies. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

Results: A total of 16 studies were included in this review. Nine studies used a version of ChatGPT, one study used GoogleBard, and the remaining seven studies used a variety of AI learning models. The overall pooled accuracy of responses developed by AI models was 78%, and the pooled mean AUC of included AI algorithms was 86%. AI algorithms performed inferiorly compared to experts. The overall quality and readability of AI responses were poor.

Conclusions: AI algorithms assessed in our study demonstrated a promising degree of accuracy and performance. However, AI responses were found to be inferior to experts and had poor readability, quality, and value to the patient. In its current state of technology, AI is a powerful tool that can be used in conjunction with experts to augment patient education, however, it should not be utilized independently.

Background: Orthopaedic Fellowship Directors (FDs) and Division Chiefs (DCs) have a profound impact on trainee development. The purpose of this study was to identify and evaluate common demographic and academic characteristics among both FDs and DCs within orthopaedic arthroplasty divisions in the United States.

Methods: Adult reconstruction fellowship and residency programs were identified through the AAHKS Fellowship Match Program list and AMA's FREIDA database. Data on FDs and DCs were collected from program websites and verified through AAHKS listings. Demographic, academic, and professional information, including sex, race/ethnicity, education, fellowship training, academic rank, leadership roles, institutional tenure, and patient satisfaction, were obtained from publicly available sources such as online curricula vitae, Doximity, and LinkedIn. Research productivity metrics, including h-index, total publications, and ResearchGate (RG) scores, were extracted from Scopus and RG databases.

Results: One hundred and sixteen FDs and 77 DCs from 137 orthopaedic arthroplasty programs were included. 98.2% of surgeons were males. Racial demographics were comprised of 83.4% Caucasian, 11.2% Asian, 3.6% Hispanic, and 1.8% African Americans. The mean age was 52.7 years, with an average of 18.1 years since fellowship completion, 13.8 years at the current institution, and 9.7 years in respective leadership role. Thirty leaders (17.8%) held additional graduate degrees, and 68 (40.2%) occupied other leadership positions within their departments or hospitals. The average h-index was 16.9. In terms of academic rank, 29.9% of surgeons were Full Professors, while 26.6% and 23.1% were Associate and Assistant professors, respectively. There was a moderate positive correlation between academic rank and h-index (r=0.46). Fellowship programs that graduated the most FDs and DCs were Massachusetts General Hospital [17], Hospital for Special Surgery [17] and Mayo Clinic [13].

Conclusions: The majority of orthopaedic arthroplasty FDs and DCs are male and Caucasian, many hold additional leadership roles, and a small number of fellowship programs produce a disproportionately high number of current leaders. These findings highlight the need for targeted efforts to increase gender diversity and mentorship to strengthen the future of academic arthroplasty and improve training and patient care.

Background: Patients with aggressive and malignant tumors of the proximal fibula may require en bloc resection to reduce the recurrence rate. We aimed to analyze the clinical curative effect of the surgical treatment of proximal fibula tumors, and the relationship between a new classification system and functional evaluation of the knee and ankle joint.

Methods: Between July 2010 and February 2022, 30 patients with proximal fibula tumors were treated, of which 27 had primary tumors and three had recurrent tumors. The histologic diagnoses were aggressive osteoblastoma (three patients), 'active' osteochondroma (five patients), giant cell tumor of the bone (11 patients), chondrosarcoma (four patients), osteosarcoma (six patients), and metastatic carcinoma (one patient). The surgical methods were divided into four types according to two important anatomical structures-the deep peroneal nerve (DPN) and proximal tibiofibular joint (PTFJ). Brief descriptions of the removal methods are as follows. Type I includes intra-articular resection of the PTFJ and preservation of the DPN. Type II includes the resection of the DPN and intra-articular resection of the PTFJ. Type III includes extra-articular PTFJ resection and preservation of the DPN. Type IV includes extra-articular PTFJ resection and resection of the DPN.

Results: The 30 patients with proximal fibula tumor underwent successful operation. Those who underwent type I and type III procedures had normal ankle function because the DPN was preserved; however, in those who underwent type II and type IV procedures with resection of the DPN, ankle foot orthosis was needed to stabilize the ankle joint because of the resulting drop foot. In those who underwent type I and type II procedures with intra-articular PTFJ resection, the preservation of the lateral collateral ligament, biceps tendon, and popliteal tendon partly protected the structure of the knee joint, leading to postoperative knee joint stability. In those who underwent type III and type IV procedures with extra-articular PTFJ resection, gait abnormalities and knee instability occurred.

Conclusions: The peroneal nerve and PTFJ are adjacent to each other, and resection of proximal fibular tumors is challenging for orthopedic surgeons. The DPN and PTFJ classification can lead to better surgical planning and postoperative functional evaluation. It provides useful information for the standardized treatment of proximal peroneal tumors based on regional anatomy.