JBJS Reviews最新文献

» Anterior cruciate ligament (ACL) tears are one of the most common severe injuries in sports medicine, with notable differences in incidence and outcomes between male and female athletes.» While anatomical, biomechanical, and hormonal sex-specific factors such as quadriceps angle, posterior tibial slope, and cyclic hormonal variation have been extensively evaluated, the influence of psychological and societal factors, including fear of reinjury, access to training, and disparities in access to care, remains less well understood.» This review aims to provide a comprehensive overview of intrinsic (anatomic, biomechanical, and hormonal) and extrinsic (psychological, social, and environmental) factors contributing to sex-based differences in ACL injury risk. In doing so, we seek to highlight both the breadth of current understanding and the relative lack of research addressing external, sex-based influences on injury incidence and recovery.» Recognizing sex-based differences in ACL injury risk, treatment, and recovery should guide the development of individualized prevention and rehabilitation strategies to optimize outcomes for all athletes.

» Based on the available evidence, there are numerous strategies that may reduce infection risk in primary shoulder arthroplasty. Preoperatively, optimization of iron deficiency anemia and smoking cessation are associated with lower rates of periprosthetic joint infection and perioperative complications. In addition, risk of infection may be mitigated by deferring shoulder arthroplasty for at least three months following a corticosteroid injection. Management of biologic and targeted immunosuppressive therapies should be coordinated with medical specialists and tailored to the specific agent's pharmacokinetics and surgical risk.» Preoperative skin preparation with agents such as benzoyl peroxide or chlorhexidine gluconate may decrease bacterial colonization. Antibiotic prophylaxis with a single preoperative dose of cefazolin administered within one hour of incision reduces infection risk, and in patients with true beta-lactam allergy, fully infused vancomycin prior to incision is an effective alternative. Intraoperatively, measures such as dilute betadine lavage, vancomycin powder, chlorhexidine wash, and antibiotic irrigation can reduce bacterial contamination. Additional intraoperative techniques including electrocautery after skin incision may further decrease bacterial burden, although higher level evidence for these latter interventions remains limited or conflicting.

Background: Fibrosis is a prevalent impediment to musculoskeletal healing, which contributes to poor outcomes across orthopaedic procedures and remains largely underaddressed in orthopaedic care.

Purpose: To review the effects of losartan on fibrosis across musculoskeletal tissues, and to evaluate its mechanistic rationale, preclinical outcomes, delivery strategies, and translational potential in orthopaedic practice.

Content summary: Losartan inhibits transforming growth factor beta 1 signaling by antagonizing the angiotensin II type 1 receptor, thereby reducing myofibroblast activity, limiting extracellular matrix deposition, and preserving regenerative cell populations across musculoskeletal tissues. Preclinical models demonstrate histological and mechanical improvements in models of cartilage injury, joint capsule fibrosis, tendon-bone healing, and skeletal muscle regeneration. Therapeutic efficacy is strongly influenced by timing, delivery route, and the microenvironment of the injury. Biomaterial innovations such as nanofiber scaffolds and injectable angiotensin II receptor blocker (ARB) hydrogels may enhance delivery. Further studies stratifying outcomes by age and sex are warranted. Ongoing clinical trials are evaluating losartan for arthrofibrosis, skeletal muscle disorders, and comparative antifibrotic efficacy among ARBs.

Conclusion: Losartan offers a mechanistically targeted, clinically familiar antifibrotic therapy with strong potential to improve surgical and rehabilitative outcomes in orthopaedics.

Background: Administering recombinant human growth hormone (rHGH) in a medically directed fashion has emerged as an investigational therapeutic intervention in clinical research to improve orthopaedic and sports medicine-related outcomes. Literature suggests that rHGH administration may improve athletic performance and influence osteoporosis and hip fracture outcomes. The purpose of this systematic review is to examine dosage regimens, identify adverse events, and summarize published peer-reviewed data of clinical outcomes where rHGH has been used in orthopaedic surgery human clinical studies to identify potential patient population targets, gaps in knowledge, and risks of use.

Methods: Three databases (Embase, PubMed, and MEDLINE) were searched using search terms including but not limited to "human growth hormone," "muscle strength," and "bone healing." Duplicate studies were removed and were subsequently screened first by title and abstract, followed by full-text. The reference lists of included studies were also evaluated with title screen. Data were abstracted and underwent pooled analysis, including meta-analysis where possible.

Results: The initial search produced 2,047 unique studies. A total of 22 studies with moderate methodological quality were included, which comprised 1,157 total patients, with a mean age of 54.3 years and a mean daily rHGH dose of 1.49 mg/d. Administration of rHGH led to a dose-dependent increase in serum insulin-like growth factor 1 (mean increase +133.2%). Lean body mass increased in 15 of the 23 studies (mean difference of +3.63% vs. placebo). Leg extension strength increased for rHGH administration vs. placebo (mean difference +3.17%). The most common adverse events in GH patients were peripheral edema (odds ratio [OR] = 3.03), carpal tunnel symptoms (OR = 3.85), and arthralgias (OR = 2.94).

Conclusion: rHGH administration led to improvements in clinical outcomes; however, the noteworthy side effects should also be taken into consideration when designing a treatment regimen for orthopaedic-related pathologies.

Level of evidence: Therapeutic Level II, systematic review of Level I and II studies. See Instructions for Authors for a complete description of levels of evidence.

» Ramp lesions occur in up to 40% of anterior cruciate ligament (ACL) injuries and are easily missed without systematic posteromedial inspection.» Magnetic resonance imaging has 70% sensitivity; arthroscopic probing using the posteromedial portal remains the diagnostic gold standard.» Unstable ramp lesions require repair; stable lesions may heal spontaneously with ACL reconstruction.» Repair restores knee stability and yields excellent outcomes comparable with isolated ACL reconstruction.» Return-to-sport rates exceed 80%, with rehabilitation mirroring standard ACL reconstruction protocols.

Background: The management of periprosthetic femoral fractures (PFFs) around polished taper-slip (PTS) cemented femoral stems in total hip arthroplasty has seen a recent shift in practice from revision to open reduction and internal fixation (ORIF). While ORIF is the accepted standard for stable uncemented stems, evidence guiding optimal management of PFF around cemented stems remains inconclusive. This metanalysis aimed to compare the outcomes of ORIF vs. revision in patients with Vancouver B2 PFFs around cemented PTS femoral stems.

Methods: We systematically searched MEDLINE, Embase, CENTRAL, Scopus, and ClinicalTrials.gov from inception to May 2025, for studies comparing ORIF with revision arthroplasty in adults with Vancouver type B2 PFFs around cemented PTS stem. None of the included studies were randomized control trials (RCTs). The outcomes were 5-year implant survival, 2-year reoperation rate, 1-year mortality, infection, aseptic loosening, nonunion, and operative time.

Results: Eight studies involving 675 patients (318 ORIF, 357 revision) met eligibility criteria. The mean age was 82.2 years, and the mean follow-up was 2.8 years. Two-year reoperation was significantly lower with ORIF (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.14-0.53, p < 0.001). Operative time was significantly shorter in the ORIF group (mean difference -42.28 minutes, 95% CI -71.27 to -13.29; p < 0.001). No significant differences were observed in 5-year implant survival (OR 0.64, 95% CI 0.26-1.60) or 1-year mortality (OR 2.05, 95% CI 0.71-5.89). Postoperative infection, aseptic loosening, and nonunion rates were also similar. Risk of bias was moderate overall.

Conclusion: For patients with Vancouver B2 PFFs around cemented PTS femoral stems, ORIF was associated with a significantly lower 2-year reoperation rate and shorter operative time compared with revision, while other outcomes were similar. These findings indicate comparable overall performance between ORIF and revision; however, given the heterogeneity and potential selection bias, uncertainty remains high, supporting the need for an RCT to evaluate both options.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

» Cervical disc arthroplasty (CDA) offers a potential alternative for patients with degenerative disc disease, improving long-term outcomes such as preserved range of motion, decreased incidence of adjacent segment degeneration, and lower morbidity.» CDA offers potential advantages over anterior cervical discectomy and fusion in regard to length of stay, cost, and routine discharge, but the motion-preserving design may introduce novel complications and failure modalities that are poorly understood.» Complications of CDA may include heterotopic ossification, decreased range of motion, persistent or worsening pain, unintended fusion, and permanent neurologic deficit.» Preventing CDA failures begins with careful recognition of contraindications such as cervical instability, osteoporosis or osteopenia, previous surgery at the surgical level(s), and extensive facet joint arthropathy.» Complication profiles associated with CDAs vary in accord with device characteristics, highlighting a potential need for matching prosthesis design with patient-specific factors.

» Pediatric syndesmotic ankle injuries are uncommon but increasingly recognized, particularly among youth athletes participating in pivoting and contact sports such as football, soccer, and skiing.» The most sensitive and specific modalities for diagnosis are advanced imaging techniques such as magnetic resonance imaging and computed tomography; standard radiographic parameters (tibiofibular overlap, medial clear space) are less reliable in children.» An evidence-based approach to management distinguishes stable injuries, amenable to nonoperative care with immobilization and rehabilitation, from unstable injuries that may require surgical fixation.» Surgical techniques-including syndesmotic screw and suture-button fixation-must account for skeletally immature anatomy; the decision to remove hardware is controversial.» There is a substantial gap in pediatric-specific literature regarding standard radiographic imaging parameters, optimal fixation methods, and long-term outcomes, highlighting the need for further prospective studies in skeletally immature athletes.

» Most evidence in low back pain (LBP): Evidence supports spinal manipulation therapy (SMT) as a conservative option for acute, subacute, and chronic LBP, especially when used as part of multimodal care.» Limited role beyond LBP: SMT shows insufficient or conflicting evidence for neck pain, headaches, extremity disorders, and is not recommended for nonmusculoskeletal conditions.» Risk profile: Serious adverse events are rare and may be underreported; minor, transient soreness is more common. Careful screening for contraindications (e.g., trauma, connective tissue disease, vascular disorders) is critical.» Ongoing gaps: Variability in practice standards, inconsistent informed consent, and poor adverse event reporting limit clarity on true effectiveness and safety.

» Skin adhesives are increasingly used in orthopaedic surgery because they provide secure incision closure, limit postoperative drainage, support wound integrity, and may reduce operative time. However, allergic contact dermatitis (ACD) remains an important consideration with their use. ACD is a hypersensitivity skin reaction seen in some patients exposed to surgical adhesives, particularly the 2-octyl cyanoacrylate ingredient. It can be difficult to distinguish ACD from cellulitis or surgical site infections due to overlapping clinical features. Timely recognition is critical, as early management can minimize wound complications and optimize outcomes. Management options include removal of the adhesive, topical corticosteroids, oral antihistamines, and antibiotics with concomitant infection. This review highlights the role of surgical adhesives across several orthopaedic surgery subspecialties, emphasizing the incidence, recognition, and management of surgical adhesive-related ACD.