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Understanding Sex-Based Differences in Anterior Cruciate Ligament Injury Risk and Management. 了解前交叉韧带损伤风险和处理的性别差异。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-26 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00174
Hanna H Sorensen, Kiera Little, Mitchell J Christiansen, Mary K Mulcahey

» 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.

前交叉韧带(ACL)撕裂是运动医学中最常见的严重损伤之一,在男女运动员的发病率和结局上存在显著差异。虽然解剖学、生物力学和激素性别特异性因素,如股四头肌角度、胫骨后斜度和周期激素变化已被广泛评估,但心理和社会因素的影响,包括对再损伤的恐惧、接受训练的机会和获得护理的差异,仍然知之甚少。»本综述旨在全面概述导致ACL损伤风险性别差异的内在因素(解剖学、生物力学和激素)和外在因素(心理、社会和环境)。在此过程中,我们试图强调当前理解的广度和相对缺乏的研究,解决外部的,基于性别的影响伤害发生率和恢复。认识到ACL损伤风险、治疗和恢复的性别差异,应该指导个性化预防和康复策略的发展,以优化所有运动员的结果。
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引用次数: 0
Optimizing Infection Prevention in Primary Shoulder Arthroplasty: Evidence-Based Strategies and Best Practices. 优化原发性肩关节置换术中的感染预防:循证策略和最佳实践。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-26 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00139
C Lucas Myerson, Brian O Molokwu, Jacquelyn J Xu, Sophia M Jacobi, Dennis A DeBernardis, Mandeep S Virk

» 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.

根据现有的证据,有许多策略可以降低原发性肩关节置换术的感染风险。术前,优化缺铁性贫血和戒烟可降低假体周围关节感染和围手术期并发症的发生率。此外,在注射皮质类固醇后推迟至少三个月的肩关节置换术可以减轻感染的风险。生物和靶向免疫抑制治疗的管理应与医学专家协调,并根据具体药物的药代动力学和手术风险量身定制。术前皮肤准备剂如过氧化苯甲酰或葡萄糖酸氯己定可减少细菌定植。术前在切口一小时内给予单剂量头孢唑林的抗生素预防可降低感染风险,对于真正的β -内酰胺过敏的患者,切口前完全输注万古霉素是一种有效的替代方法。术中,稀倍他定灌洗、万古霉素粉剂、氯己定冲洗、抗生素冲洗等措施可减少细菌污染。其他术中技术,包括皮肤切口后的电灼,可能会进一步减少细菌负担,尽管后一种干预措施的高水平证据仍然有限或相互矛盾。
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引用次数: 0
Effects of Losartan on Musculoskeletal Tissues : Basic Science and Clinical Applications. 氯沙坦对肌肉骨骼组织的影响:基础科学和临床应用。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00156
Alan D Villegas Meza, Michael Nocek, Ioanna K Bolia, Alyson Speshock, Marc J Philippon, Johnny Huard

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.

背景:纤维化是肌肉骨骼愈合的普遍障碍,导致骨科手术预后不良,在骨科护理中仍未得到充分重视。目的:回顾氯沙坦对肌肉骨骼组织纤维化的影响,并评估其机制原理、临床前结果、输送策略和在骨科实践中的转化潜力。内容概述:氯沙坦通过拮抗血管紧张素II型1受体抑制转化生长因子β 1信号,从而降低肌成纤维细胞活性,限制细胞外基质沉积,并保持肌肉骨骼组织的再生细胞群。临床前模型显示软骨损伤、关节囊纤维化、肌腱-骨愈合和骨骼肌再生模型的组织学和力学改善。治疗效果受时间、递送途径和损伤微环境的强烈影响。生物材料的创新,如纳米纤维支架和可注射血管紧张素II受体阻滞剂(ARB)水凝胶可能会提高递送。根据年龄和性别对结果进行分层的进一步研究是有必要的。正在进行的临床试验正在评估氯沙坦治疗关节纤维化、骨骼肌疾病和arb的比较抗纤维化疗效。结论:氯沙坦提供了一种机械靶向、临床熟悉的抗纤维化治疗方法,具有改善骨科手术和康复效果的强大潜力。
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引用次数: 0
Human Growth Hormone as a Therapeutic Treatment Option in Orthopaedics: A Systematic Review of Dosing, Side Effects, and Clinical Outcomes. 人类生长激素作为矫形外科的治疗选择:剂量、副作用和临床结果的系统回顾。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-20 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00194
Ajay Shah, Nikhil Aman Patel, Rishab Udiaver, Bheeshma Ravi, Cari Whyne, David Wasserstein

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.

背景:在医学指导下使用重组人生长激素(rHGH)已经成为临床研究中的一种研究性治疗干预措施,以改善骨科和运动医学相关的结果。文献表明,rHGH可以改善运动表现,影响骨质疏松症和髋部骨折的结果。本系统综述的目的是检查剂量方案,确定不良事件,并总结已发表的同行评审的临床结果数据,其中rHGH已用于骨科外科人类临床研究,以确定潜在的患者人群目标,知识差距和使用风险。方法:检索三个数据库(Embase、PubMed和MEDLINE),检索词包括但不限于“人类生长激素”、“肌肉力量”和“骨愈合”。重复的研究被删除,然后首先通过标题和摘要进行筛选,然后是全文。纳入研究的参考文献列表也用标题屏幕进行评估。对数据进行抽象和汇总分析,并在可能的情况下进行meta分析。结果:最初的搜索产生了2047个独特的研究。共纳入22项方法学质量中等的研究,共纳入1157例患者,平均年龄54.3岁,平均每日rHGH剂量为1.49 mg/d。rHGH的使用导致血清胰岛素样生长因子1的剂量依赖性增加(平均增加133.2%)。23项研究中有15项的瘦体重增加(与安慰剂相比平均差异为+3.63%)。与安慰剂相比,rHGH组腿部伸展力量增加(平均差值+3.17%)。GH患者最常见的不良事件是外周水肿(优势比[OR] = 3.03)、腕管症状(OR = 3.85)和关节痛(OR = 2.94)。结论:rHGH可改善临床预后;然而,在设计骨科相关病理的治疗方案时,也应考虑到值得注意的副作用。证据水平:治疗性II级,对I级和II级研究进行系统评价。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Medial Meniscal Ramp Lesions: Current Concepts in Diagnosis and Treatment. 内侧半月板斜坡病变:当前诊断和治疗的概念。
IF 2.4 Q2 SURGERY Pub Date : 2026-01-13 eCollection Date: 2026-01-01 DOI: 10.2106/JBJS.RVW.25.00220
Abdulhamit Misir, Ali Yuce

» 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.

斜坡病变发生在高达40%的前交叉韧带(ACL)损伤中,如果没有系统的后内侧检查,很容易被遗漏。»磁共振成像灵敏度70%;使用后内侧门静脉的关节镜探查仍然是诊断的金标准。不稳定斜坡病变需要修复;稳定的病变可以通过前交叉韧带重建自行愈合。修复可恢复膝关节稳定性,并产生与孤立前交叉韧带重建相当的优异结果。恢复率超过80%,康复与标准ACL重建方案一致。
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引用次数: 0
Fixation vs. Revision of Vancouver B2 Periprosthetic Fractures Around Polished Tapered Cemented Femoral Stems: A Meta-Analysis of Outcomes. 磨光锥形骨水泥股骨柄周围的Vancouver B2假体周围骨折的固定与翻修:结果的荟萃分析
IF 2.4 Q2 SURGERY Pub Date : 2025-12-26 eCollection Date: 2025-12-01 DOI: 10.2106/JBJS.RVW.25.00215
Zain Choudhary, Sachin Singal, Amr Selim, Abdelrahman Ibrahim, Ronald Hang Kin Nam, Abdul-Basit Rafi, Siddharth Govilkar, Geraint Thomas

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.

背景:在全髋关节置换术中,围绕磨光锥形滑移(PTS)骨水泥股骨柄的假体周围股骨骨折(pff)的治疗最近从翻修转向切开复位内固定(ORIF)。虽然ORIF是稳定非骨水泥茎的公认标准,但指导骨水泥茎周围PFF最佳管理的证据仍然没有定论。本荟萃分析的目的是比较ORIF与翻修术对温哥华B2 pff患者骨水泥PTS股骨干周围的疗效。方法:我们系统地检索了MEDLINE、Embase、CENTRAL、Scopus和ClinicalTrials.gov从成立到2025年5月的研究,比较ORIF和翻修性关节置换术在成人温哥华B2型pff骨水泥PTS周围的疗效。纳入的研究均非随机对照试验(RCTs)。结果为5年种植体存活率、2年再手术率、1年死亡率、感染、无菌性松动、不愈合和手术时间。结果:8项研究涉及675例患者(318例ORIF, 357例修订)符合入选标准。平均年龄82.2岁,平均随访2.8年。ORIF组2年再手术率显著降低(优势比[OR] 0.28, 95%可信区间[CI] 0.14-0.53, p < 0.001)。ORIF组的手术时间明显缩短(平均差异为-42.28分钟,95% CI为-71.27 ~ -13.29;p < 0.001)。5年种植体存活率(OR 0.64, 95% CI 0.26-1.60)和1年死亡率(OR 2.05, 95% CI 0.71-5.89)无显著差异。术后感染、无菌性松动和不愈合率也相似。偏倚风险总体为中等。结论:对于骨水泥PTS股骨干周围的Vancouver B2 pff患者,与翻修术相比,ORIF可显著降低2年再手术率,缩短手术时间,其他结果相似。这些发现表明ORIF和修正之间的总体表现相当;然而,考虑到异质性和潜在的选择偏倚,不确定性仍然很高,因此需要随机对照试验来评估这两种选择。证据等级:治疗性III级。有关证据水平的完整描述,请参见作者说明。
{"title":"Fixation vs. Revision of Vancouver B2 Periprosthetic Fractures Around Polished Tapered Cemented Femoral Stems: A Meta-Analysis of Outcomes.","authors":"Zain Choudhary, Sachin Singal, Amr Selim, Abdelrahman Ibrahim, Ronald Hang Kin Nam, Abdul-Basit Rafi, Siddharth Govilkar, Geraint Thomas","doi":"10.2106/JBJS.RVW.25.00215","DOIUrl":"10.2106/JBJS.RVW.25.00215","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Failures in Cervical Disc Arthroplasty: A Narrative Review of Failure Modes and Clinical Implications. 颈椎间盘置换术的失败:失败模式和临床意义的叙述回顾。
IF 2.4 Q2 SURGERY Pub Date : 2025-12-26 eCollection Date: 2025-12-01 DOI: 10.2106/JBJS.RVW.25.00208
James G Lyman, Kaitlyn L Hurka, Jake A Morales, Connor P McCloskey, Arun K Movva, Daniel E Herrera, Cody Goedderz, Theodore A Joaquin, Vadim Goz, Srikanth N Divi, Alpesh A Patel

» 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.

颈椎椎间盘置换术(CDA)为退行性椎间盘疾病患者提供了一种潜在的替代方案,改善了长期预后,如保持了活动范围,降低了邻近节段退变的发生率,降低了发病率。与前路颈椎间盘切除术和融合术相比,CDA在住院时间、费用和常规出院方面具有潜在优势,但保留运动的设计可能会引入新的并发症和失败模式,目前尚不清楚。CDA的并发症可能包括异位骨化、活动范围减小、疼痛持续或加重、意外融合和永久性神经功能缺损。预防CDA失败首先要仔细识别禁忌症,如颈椎不稳定、骨质疏松或骨质减少、既往手术和广泛的小关节关节病变。与cda相关的并发症随器械的特点而变化,强调了将假体设计与患者特定因素相匹配的潜在需求。
{"title":"Failures in Cervical Disc Arthroplasty: A Narrative Review of Failure Modes and Clinical Implications.","authors":"James G Lyman, Kaitlyn L Hurka, Jake A Morales, Connor P McCloskey, Arun K Movva, Daniel E Herrera, Cody Goedderz, Theodore A Joaquin, Vadim Goz, Srikanth N Divi, Alpesh A Patel","doi":"10.2106/JBJS.RVW.25.00208","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00208","url":null,"abstract":"<p><p>» 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.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnosis and Management of Pediatric Syndesmosis Ankle Injuries. 小儿踝关节联合损伤的诊断与治疗。
IF 2.4 Q2 SURGERY Pub Date : 2025-12-22 eCollection Date: 2025-12-01 DOI: 10.2106/JBJS.RVW.25.00209
Harjot Uppal, John Tis

» 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.

儿童关节联合损伤并不常见,但越来越多的人认识到,特别是在参加旋转和身体接触运动(如足球、足球和滑雪)的青少年运动员中。*最敏感和特殊的诊断方式是先进的成像技术,如磁共振成像和计算机断层扫描;标准x线参数(胫腓骨重叠,内侧间隙)在儿童中不太可靠。»以证据为基础的治疗方法区分稳定型损伤和不稳定型损伤,稳定型损伤可通过非手术治疗进行固定和康复,不稳定型损伤可能需要手术固定。*手术技术-包括联合螺钉和缝合-按钮固定-必须考虑到骨骼未成熟的解剖结构;移除硬件的决定是有争议的。关于标准放射成像参数、最佳固定方法和长期结果的儿科文献存在大量空白,强调需要对骨骼发育不成熟的运动员进行进一步的前瞻性研究。
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引用次数: 0
Chiropractic Care and Spinal Manipulation: Evidence, Risks, and Referral Considerations for Spine Surgeons. 脊椎治疗和脊柱操作:脊柱外科医生的证据、风险和转诊考虑。
IF 2.4 Q2 SURGERY Pub Date : 2025-12-16 eCollection Date: 2025-12-01 DOI: 10.2106/JBJS.RVW.25.00196
Bryce A Basques, Shaoyang Ma, Puru Sadh, Alan H Daniels, Alejandro Perez-Albela

» 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.

»大多数关于腰痛(LBP)的证据:证据支持脊柱推拿疗法(SMT)作为急性、亚急性和慢性腰痛的保守选择,特别是当作为多模式治疗的一部分时。※作用有限:SMT治疗颈部疼痛、头痛、肢体疾病的证据不足或相互矛盾,不推荐用于非肌肉骨骼疾病。»风险概况:严重不良事件罕见,可能被低估;轻微的、短暂的疼痛更为常见。仔细筛查禁忌症(如创伤、结缔组织疾病、血管疾病)至关重要。持续的差距:实践标准的差异,不一致的知情同意,不良事件报告不足限制了对真实有效性和安全性的明确。
{"title":"Chiropractic Care and Spinal Manipulation: Evidence, Risks, and Referral Considerations for Spine Surgeons.","authors":"Bryce A Basques, Shaoyang Ma, Puru Sadh, Alan H Daniels, Alejandro Perez-Albela","doi":"10.2106/JBJS.RVW.25.00196","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00196","url":null,"abstract":"<p><p>» 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.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hypersensitivity Reactions to Liquid Skin Adhesives in Orthopaedic Surgery: A Review of the Literature. 骨科手术中对液体皮肤粘接剂的过敏反应:文献综述。
IF 2.4 Q2 SURGERY Pub Date : 2025-12-16 eCollection Date: 2025-12-01 DOI: 10.2106/JBJS.RVW.25.00178
Matthew T Geiselmann, George Economou, Constantina Economou, Edwin Sun, Randy M Cohn, James A Germano

» 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.

皮肤粘接剂在骨科手术中的应用越来越多,因为它们提供安全的切口闭合,限制术后引流,支持伤口完整性,并可能减少手术时间。然而,过敏性接触性皮炎(ACD)仍然是一个重要的考虑与他们的使用。ACD是一种过敏性皮肤反应,见于一些接触外科粘合剂的患者,特别是2-辛基氰基丙烯酸酯成分。由于临床特征重叠,很难将ACD与蜂窝织炎或手术部位感染区分开来。及时识别是至关重要的,因为早期处理可以减少伤口并发症并优化结果。治疗方案包括去除黏合剂,外用皮质类固醇,口服抗组胺药和抗生素并伴有感染。这篇综述强调了外科粘接剂在几个骨科亚专科中的作用,强调了外科粘接剂相关ACD的发生率、识别和处理。
{"title":"Hypersensitivity Reactions to Liquid Skin Adhesives in Orthopaedic Surgery: A Review of the Literature.","authors":"Matthew T Geiselmann, George Economou, Constantina Economou, Edwin Sun, Randy M Cohn, James A Germano","doi":"10.2106/JBJS.RVW.25.00178","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00178","url":null,"abstract":"<p><p>» 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.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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