Annals of Joint最新文献

Rotator cuff tears are one of the most common orthopedic injuries, affecting nearly 40% of individuals over 60 years old. Surgical repair remains the gold standard following failed conservative treatment; however, retear rates remain a significant challenge, with some studies reporting recurrence in 40% to 94% of patients. In response to these high failure rates, various surgical augmentation techniques have been developed, offering the potential to enhance healing, improve repair integrity, and optimize long-term outcomes. A comprehensive literature review was conducted to assess the current methods of augmentation for rotator cuff repair (RCR) and to provide an updated analysis of augmentation techniques for RCR from 2010 to 2025. The review includes detailed descriptions of each augmentation technique, along with associated outcomes and available evidence supporting their use in clinical practice. Augmentation techniques for RCR have advanced, showing promising improvements in patient outcomes. This review highlights the growing popularity of dermal allografts and bioinductive collagen implants, alongside the emerging use of platelet-rich plasma (PRP), bone marrow aspirate concentration (BMAC) and fibrin clots. While these methods demonstrate potential, further high-quality randomized, prospective studies are needed to standardize protocols, establish clear indications, and address the variability in current evidence. Key areas requiring further investigation include the long-term durability of augmented repairs, optimal patient selection criteria, the comparative efficacy of different augmentation materials, and the cost-effectiveness of these techniques in routine clinical practice.

Background: Sexual activity profoundly influences one's overall quality of life. Sexual dysfunction can significantly adversely affect an individual's life. The aim of this investigation was to examine the impact of anterior cruciate ligament (ACL) reconstruction on sexual function and quality of life.

Methods: Upon hospital (IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy) admission, each patient was asked to complete the New Sexual Satisfaction Scale-Short Form (NSSS-S) to evaluate their sexual behavior prior to the injury (preinjury) and at the time of admission (preoperative). Furthermore, patients were recontacted after a minimum follow-up period of 24 months (final follow-up). Quality of life was evaluated at hospital admission (preoperative) and at a minimum 24-month follow-up (final follow-up) using the Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QoL).

Results: The study had 303 patients, including 233 males (76.9%) and 70 females (23.1%). The average age at surgery was 31.6±11.0 years, and the average follow-up duration was 63.3±20.1 months. A hamstring tendon autograft was used for 289 (95.4%) patients and a patellar tendon autograft was used for 14 (4.6%) of patients. At the final follow-up, sexual activity exhibited a significant difference compared to preoperative levels (P<0.001), although no difference was observed between preinjury and final follow-up values (P>0.99). Preinjury sexual activity exceeded preoperative activity (P<0.001). The quality of life at the last follow-up was significantly greater than the preoperative quality of life (P<0.001).

Conclusions: ACL injury adversely affects sexual function scores alongside quality of life, while reconstructive surgery enhances these scores irrespective of age or sex.

Background: The synovial immune microenvironment plays a critical role in the onset and advancement of osteoarthritis (OA), but previous findings on some immune cells were inconsistent. This study seeks to comprehensively investigate the causal association between a multitude of immune cell traits and OA.

Methods: We performed this bidirectional Mendelian randomization (MR) analysis between a genome-wide association studies (GWAS) summary statistics containing 407,746 European ancestry and the largest GWAS data on 731 immune phenotypes. A replication analysis was conducted on a dataset containing 63,556 participants for validating the positive results. The causal effects were primarily estimated through inverse variance weighted (IVW) method, with four other methods (MR Egger, weighted median, simple mode, weighted mode) to reinforce the strength of causal evidence. Multiple sensitivity analyses (MR Egger, IVW method, leave-one-out analysis) were applied to mitigate the impact of heterogeneity and horizontal pleiotropy. Additionally, we employed a bioinformatics analysis by xCell algorithm to examine the expression of these immune cell phenotypes in OA and normal synovial tissues.

Results: After false discovery rate (FDR) correction test, thirteen immune cell traits exhibited significant causal relationships with OA. These immune cell phenotypes came from seven groups, including B cell (n=3), conventional dendritic cell (cDC) (n=3), monocyte (n=3), myeloid cell (n=1), T cell, B cell, natural killer (NK) cell (TBNK) (n=2), regulatory T cell (Treg) (n=1). The strongest effects on OA were found in "CD64 on CD14^- CD16⁺ monocyte" [odds ratio (OR): 1.044; 95% confidence interval (CI): 1.012-1.076; P_FDR=0.03] and "CD16⁺ monocyte %monocyte" (OR: 0.948; 95% CI: 0.916-0.980; P_FDR=0.009). Sensitivity analyses did not detect any evidence of heterogeneity and horizontal pleiotropy. We also identify five immune traits influenced by OA. Additionally, replication analysis reconfirmed the causal effect of "CD64 on CD14^- CD16⁺ monocyte" (OR: 1.102; 95% CI: 1.046-1.161; P_FDR<0.001) and "HLA DR⁺ NK %NK" (OR: 0.945; 95% CI: 0.908-0.983; P_FDR=0.03) on OA.

Conclusions: Our findings reveal the causal relationships between specific immune cells and OA, offering genetic insights into the role of immune cells in OA pathogenesis and guiding the exploration of novel immunological treatments for OA.

The microfracture procedure, introduced in 1994 by Dr. Steadman, involves creating small perforations in the subchondral bone plate to stimulate cartilage regeneration through fibrocartilage formation. Early studies demonstrated its efficacy in improving patient-reported outcomes for small osteochondral defects, particularly in young, active patients. However, its popularity has declined due to poor long-term outcomes and limited indications. Emerging alternatives, such as autologous chondrocyte implantation (ACI) and osteochondral allograft/autograft transplantation (OAT), show superior long-term results. Antegrade procedures like microfracture and drilling aim to release marrow elements to facilitate cartilage repair, but evidence for their efficacy is limited. These techniques can damage subchondral structures, triggering inflammatory and mechanical changes, including subchondral cysts, osteophytes, and reduced bone mineral density. Retrograde drilling, which avoids subchondral plate violation, emerges as a potential solution, promoting revascularization while preserving structural integrity. Despite promising results in subchondral fracture fixation and avascular necrosis, clinical studies are needed to confirm its efficacy for cartilage repair. The key challenge lies in balancing sufficient marrow stimulation with subchondral plate preservation to maintain long-term joint functionality. Future research should focus on understanding the interplay between subchondral plate integrity and cartilage repair durability. Comparative clinical trials are essential to validate retrograde drilling and other evolving techniques as viable alternatives to traditional microfracture and drilling procedures.

Background: Surgical site infections (SSIs) are common complications after joint arthroplasty, leading to increased morbidity and healthcare costs. Traditional models, like the National Nosocomial Infections Surveillance (NNIS) system, have limitations in predicting SSI risk due to a lack of patient-specific factors. This study aimed to create and validate a predictive model focusing on hypoproteinemia to enhance SSI risk assessment in joint surgery patients.

Methods: A retrospective cohort study of 726 patients undergoing joint arthroplasty between 2020 and 2022 was conducted. Data included demographics, laboratory values, and surgical details. Univariate and multivariate analyses identified key predictors, including hypoproteinemia, to develop a predictive nomogram. Model validation was performed using receiver operating characteristic curves, calibration, and decision curve analysis (DCA), comparing it to the NNIS model.

Results: Hypoproteinemia was a significant independent predictor of SSI, with the new model outperforming the NNIS system (area under the curve: 0.829 vs. 0.534). Calibration analysis showed excellent agreement between predicted and observed probabilities, with a mean absolute error of 0.009. DCA further confirmed the model's clinical utility, showing a higher net benefit across various thresholds compared to traditional approaches.

Conclusions: Hypoproteinemia is a critical risk factor for SSI in joint arthroplasty. The new predictive model offers improved risk stratification, supporting a more personalized approach to perioperative management in orthopedic surgery.

Subchondral bone plays a critical yet often underappreciated role in osteochondral health, injury response, and the pathophysiology of osteoarthritis (OA). A limited understanding of subchondral bone behavior limits the accurate evaluation of cartilage repair outcomes. Alterations in the subchondral bone-such as changes in bone density and structure, subchondral cyst (SCC) formation, impairment of osseous microarchitecture, and overgrowth of the subchondral plate-can compromise the mechanical osteochondral unit's integrity, leading to compromised joint function and poor outcomes. Moreover, neuropathy and subchondral bone changes, both significant contributors to OA-related pain and progression, are rarely assessed in treatment strategies. A deeper understanding of subchondral bone dynamics could improve both the assessment of repair outcomes and the development of more effective therapeutic strategies for OA. In the context of cartilage procedures, clinical and translational studies revealed that up to one-third of patients undergoing microfracture or similar subchondral venting procedures exhibit clinically pathologic subchondral bone changes. These include cyst formation and upward migration of the bone plate, which negatively affect repair outcomes. Translational models further support these findings by elucidating the mechanisms of subchondral bone remodeling and its critical influence on cartilage health. This review focuses on recent translational research on the subchondral bone in both osteochondral health, injury, and OA, highlighting the need to preserve its integrity during cartilage repair and ensuring that subchondral bone is considered in OA therapy. Understanding subchondral bone alterations may guide repair strategies, including biologic therapies and biomaterial-based approaches aimed at restoring osteochondral function, paving the way for improved clinical outcomes.

Background and objective: The optimal management of proximal humeral bone loss (PHBL) in shoulder arthroplasty is a debated topic. PHBL is a challenging problem for surgeons due to its effect on implant fixation and stability. Supplemental fixation options in the form of allograft-prosthetic composites (APCs) or reverse shoulder arthroplasty (RSA) endoprostheses are options to consider, each with its own benefits and complication profiles. This narrative review aims to evaluate current strategies for managing PHBL.

Methods: A comprehensive literature search was performed using databases including PubMed, Cochrane Library, and Google Scholar using appropriate search terms. Studies published between 2013 and 2024 were included. All included studies were peer-reviewed and addressed PHBL in the setting of shoulder arthroplasty or proximal humerus resection.

Key content and findings: A total of nineteen studies were included, comprising 7 retrospective case series, 4 prospective case series or cohort studies, 2 systematic reviews, 1 retrospective registry study, 3 descriptive papers of proposed classification systems, and 2 technique papers. Described classification systems categorize PHBL by integrity of the epiphysis, greater tuberosity, calcar, metaphysis, diaphysis, and cortices. Depending on the degree of bone loss, revision RSA without allograft, revision RSA with APC augmentation, and endoprosthesis are described as management options. In patients with greater than 5 cm of PHBL, use of APC or endoprosthesis has proven effective but with high complication profiles and revision rates. No paper directly compares endoprosthesis and APC outcomes.

Conclusions: PHBL is a rare but important problem in the setting of tumor resection and revision shoulder arthroplasty. While small cohort studies have reported successful outcomes with both APC and endoprosthesis, systematic reviews have failed to demonstrate a clear benefit of one option over the other. Complication and reoperation rates can be high with both surgical options. With a focus on standardized classification and evaluation of patients with PHBL, we can hope to refine the surgical techniques and indications for optimal patient outcomes.

Background and objective: Perioperative pain management is of considerable interest in shoulder surgery due to its association with severe postoperative pain. Over time, regional anesthesia has become widely utilized in postoperative pain control. Because poor pain management after orthopedic surgery remains an issue, optimal utilization of regional anesthesia should continue to be a focus for shoulder surgeons. This review seeks to summarize the most commonly used regional anesthesia techniques in shoulder surgery while highlighting key innovations in these areas. Furthermore, it will appraise the available high-quality evidence on these topics, providing a snapshot of the most current practices and conclusions.

Methods: PubMed was queried for studies published within the previous 20 years on topics of regional anesthesia procedures for shoulder surgery. The most recent high-quality studies-systematic reviews, meta-analyses, and randomized controlled trials-were prioritized for selection. Additional references were identified from the reference lists of these articles.

Key content and findings: The interscalene brachial plexus block (ISB), the supraclavicular brachial plexus block (SCB), and the suprascapular nerve block (SSNB) are at the forefront of regional anesthesia for shoulder surgery. ISB remains the gold standard, offering the most complete anesthesia. SCB and SSNB have important roles as well, having a lower risk of complications but the additional requirement of general anesthesia (GA). Continuous catheter infusion (CCI), while effective in extending analgesia, has fallen out of favor due to its safety concerns, such as catheter migration. Adjuvant medications have become more popular in recent years and have been shown to prolong nerve blockade, with intravenous dexamethasone and dexmedetomidine gaining significant traction. Liposomal bupivacaine (LB), a newer advancement, increases nerve block duration but has shown mixed evidence in improving patient outcomes.

Conclusions: Regional anesthesia plays a major role in postoperative pain management and has changed the landscape of how patients can recover from shoulder surgery. ISB, SCB, and SSNB techniques all have their place, each offering unique advantages and disadvantages. CCI and adjuvant medications have shown benefit, while LB requires further investigation. Future research should aim to refine regional anesthesia techniques to further improve outcomes.

Background and objective: Quadriceps tendon ruptures can occur in both the native knee and in knees which have undergone prior total knee arthroplasty (TKA). Complete ruptures require surgical treatment to optimize patient function. Debate exists surrounding the ideal repair technique for native ruptures, and there is little consensus regarding the optimal surgical treatment option for post-TKA ruptures. The objective of this narrative review is to provide an overview of quadriceps tendon ruptures occurring in both native knees and in the setting of TKA, with a focus on contemporary treatment options and their results.

Methods: A narrative review of the relevant literature was performed in November 2024. English language articles published up to November 2024 which related to quadriceps tendon ruptures, involving both the native knee and the post-TKA knee, were reviewed. All types of published articles were considered.

Key content and findings: Quadriceps tendon ruptures almost always occur in patients with antecedent tendon pathology. Primary repair of acute native quadriceps ruptures is supported by a large body of literature, and most patients have reasonable outcomes. The clinical outcomes of transosseous and suture anchor repair techniques seem to be comparable in this setting. Quadriceps ruptures, which occur in the setting of TKA, are much more difficult to treat. In this setting, the complication rates of primary repair, repair with augmentation, and reconstruction are high. Even with improvements in the contemporary reconstructive options, including allograft and synthetic mesh, outcomes remain suboptimal. More work is needed to improve outcomes for patients with post-TKA quadriceps tendon ruptures.

Conclusions: Generally reliable results can be achieved when treating native quadriceps tendon ruptures with contemporary techniques. Quadriceps ruptures, which occur in the setting of TKA, on the other hand, are much more challenging to treat. Various surgical techniques have been explored and developed in an effort to improve outcomes. While modest improvements have been realized, these injuries remain problematic, with very high complication and failure rates, regardless of technique.

Background and objective: Kabaddi is an athletic contact sport that involves power, aggression, fine mind-body balance, agility, and swift reflexes. Since Kabaddi is a contact sport, athletes face a higher risk of injuries during competition and training. There is a paucity of literature regarding sports injuries during this game. This review article lays down a plinth-stone for global recognition of this game and associated sports injuries, intending to improve awareness in the sports medicine fraternity and boost further research related to this topic.

Methods: A comprehensive synthesis of the relevant literature was conducted to provide insights for clinicians, trainers, and players to enhance injury prevention and rehabilitation strategies.

Key content and findings: Kabaddi, a traditional Indian sport, is gaining popularity worldwide. Its physically demanding nature poses a significant risk for sports injuries among players. Anterior cruciate ligament (ACL) ruptures with concurrent meniscal injuries are the most common soft tissue injuries in Kabaddi. However, due to the sport's aggressive and physical nature, nearly all types of injuries are possible.

Conclusions: This review article highlights the mechanisms of injury and common injuries associated with Kabaddi. It also offers a comprehensive overview of the sport's origin, regulations, and etiquette. This review concludes that a multidisciplinary approach involving physiotherapists, sports orthopaedic specialists, and medical teams is crucial for conditioning players and minimizing injury risk.