Journal of orthopaedics and sports medicine最新文献

Musculoskeletal injuries are a leading cause of pain and disability, with many patients developing chronic pain. While traditional management focuses on physical treatments, psychological interventions have emerged as a complementary approach. This study examines the role of psychological treatments in pain management after musculoskeletal injury, their efficacy, and their integration with existing treatment strategies. A review of literature, including systematic reviews and meta-analyses, was conducted to assess the effectiveness of psychological treatments such as cognitive-behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and pain neuroscience education (PNE). Studies on the impact of psychological distress on pain perception, circulating inflammatory biomarkers, and neuromuscular exercises were analyzed. Research indicates that psychological elements, particularly pain catastrophizing, anxiety, and depression, play crucial roles in determining both pain intensity and disability levels. Short-term improvements in pain intensity, functional capacity, and psychological well-being have been documented with CBT, MBSR, and PNE interventions. The integration of psychological approaches with physiotherapy demonstrates enhanced patient outcomes. Biological markers of inflammation, specifically CRP and IL-6, show potential as indicators of pain severity and treatment effectiveness. Notably, neuromuscular exercises have shown pain-reducing effects comparable to pharmaceutical interventions, though long-term efficacy data for psychological treatments remains variable. The integration of psychological interventions represents a significant advancement in musculoskeletal pain management, particularly in addressing the mental and emotional dimensions of pain experience. While current research supports their immediate benefits, additional investigation is necessary to determine long-term effectiveness and refine treatment approaches. Future research should emphasize individualized treatment protocols, technological integration, and robust longitudinal studies to maximize therapeutic outcomes.

Open fractures are complex injuries that significantly increase the risk of infection and complications such as delayed healing, nonunion, and chronic osteomyelitis. Infections rates remain high, particularly in severe cases involving extensive soft tissue damage and contamination. This is due to a variety of factors involving the patient, environment and bacteria. This article critically reviewed the classification, common pathogens, and complications associated with open fractures, emphasizing the challenges posed by biofilms, antibiotic resistance, and host factors such as diabetes and immunosuppression. Current management strategies, including early antibiotic administration, surgical debridement, and wound care, are examined alongside emerging therapies such as continuous local antibiotic perfusion, antibiotic-coated implants, bacteriophage therapy, and bioelectric dressings. These approaches show promise in reducing infection rates, enhancing patient outcomes, and addressing the limitations of traditional treatments. However, there are gaps in understanding their long-term efficacy, especially in high-risk populations. Future research should focus on personalized protocols, combination therapies, and clinical trials to reduce the burden of infection-related complications in open fracture management.

Severe osteoarthritis (OA) is a debilitating condition that often necessitates surgical intervention when conservative treatments fail. We carefully reviewed the literature on the pros and cons of surgical options for severe OA, focusing on total joint arthroplasty (TJA) and other surgical techniques. Total joint arthroplasty, including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is the most established surgical option for severe OA, providing significant pain relief, functional restoration, and improved quality of life. The American College of Rheumatology and the American Association of Hip and Knee Surgeons recommend proceeding to TJA without delay in patients with symptomatic moderate-to-severe OA unresponsive to nonoperative therapy. Osteotomies and cartilage repair procedures are less commonly performed and have limited evidence supporting their long-term efficacy in reducing OA progression. Arthroscopic interventions, such as lavage and debridement, do not alter disease progression and are not recommended for routine treatment of OA. While TJA is highly effective, it is associated with risks such as postoperative complications, revisions, and reoperations. The cost-effectiveness of TJA is well-documented, making it a favorable option for managing end stage OA. However, patient selection is crucial, and factors such as age, comorbidities, and obesity must be considered to optimize outcomes. Total joint arthroplasty remains the gold standard for surgical management of severe OA, offering substantial benefits in pain relief and functional improvement. Other surgical options, such as osteotomies and arthroscopy, have limited roles and should be considered based on individual patient factors and disease severity. Evidence-based guidelines support the timely use of TJA to enhance patient outcomes and quality of life.

While clinical factors are traditionally considered central to orthopedic surgical outcomes, emerging literature highlights the significant impact of social determinants of health. Factors such as socioeconomic status, education, housing and community environment substantially influence patient recovery and post operative outcomes. This review evaluates three validated indices, the Social Vulnerability Index, Area Deprivation Index, Distressed Communities Index, and their association with orthopedic surgical results. Recent studies consistently demonstrate that higher scores in these indices correlate with increased postoperative complications, prolonged hospital stays, higher emergency department visits, elevated readmission rates, and greater mortality risk across orthopedic subspecialties including joint arthroplasty, trauma surgery, and spine surgery. Specifically, the social vulnerability index robustly predicts postoperative complications and increased healthcare resource utilization. Area deprivation index similarly forecasts extended hospitalization and institutional discharge rates, although its link to short-term complications varies. Distressed communities index reliably indicates higher healthcare resource use, though its predictive strength for specific surgical complications remains inconsistent. Despite these correlations, research limitations persist, notably retrospective study designs, inconsistent methodologies and difficulties integrating area level indices with individual patient data. Nevertheless, incorporating social risk assessments into clinical evaluations represents a crucial avenue to reduce disparities and enhance orthopedic patient care.

Spastic cerebral palsy (CP) frequently results in lower extremity musculoskeletal complications that cause disabling mobility loss and reduced quality of life. This review consolidates current understanding of these common complications, encompassing bony deformities (e.g., scoliosis, femoral anteversion, patella alta, ankle equinus), joint changes due to spasticity and contractures (e.g., hip subluxation, knee flexion contractures), spinal degeneration (e.g., cervical stenosis, lumbosacral spondylolisthesis), and neurologic dysfunction manifesting as pain and weakness. These pathologies are generally progressive, driven by impaired motor control, muscle spasticity, and shortened muscle-tendon units. By providing a comprehensive framework, this paper highlights the critical points facilitating a healthcare provider to recognize and understand these complications, ultimately improving patient care and outcomes.

Venous thromboembolism (VTE), a term encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a leading cause of mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Optimizing thromboprophylaxis, or the prevention of VTE after surgery, is becoming increasingly critical as the demand and frequency of total joint arthroplasty rises globally. This review covers the current literature on the risk factors, detection, and prevention of VTE in patients undergoing THA and TKA. It compares the efficacy and safety profiles of the most common pharmacological interventions including aspirin, low molecular weight heparin, rivaroxaban, apixaban, and warfarin. Mechanical methods, such as pneumatic compression devices, as well as intraoperative considerations, such as anesthesia modality, operative time, and tourniquet time, are also discussed. Furthermore, this review explores recent surgical advancements including minimally invasive approaches and robotic-assisted THA and TKA. Despite advancements and extensive research, the optimal thromboprophylaxis regimen remains debated, which highlights the need for individualized, patient-centered approaches to thromboprophylaxis.

Diabetes mellitus is known to impair tendon structure and function, yet the molecular mechanisms linking hyperglycemia to tendon degeneration remain poorly understood. This study investigated the expression of early growth response-1 (EGR1) and its association with toll-like receptor 4 (TLR4) and nuclear factor kappa B (NF-κB) signaling pathways in the rotator cuff tendons of hyperglycemic swine, a model chosen for its anatomical similarity to humans. Rotator cuff tendon tissues were collected from normal and hyperglycemic swine and analyzed using histology, qRT-PCR, Western blotting, and immunohistochemistry. Histological evaluation revealed altered tenocyte morphology and increased cellularity in hyperglycemic tendons. qRT-PCR results showed significant transcriptional upregulation of EGR1, TLR4, and NF-κB in hyperglycemic samples, suggesting activation of inflammatory and stress-response pathways. However, protein analysis revealed a non-significant decrease in EGR1 levels and modest increases in TLR4 and NF-κB, indicating possible post-transcriptional regulation. This discrepancy between mRNA and protein levels of EGR1 may be attributed to altered stress granule dynamics under hyperglycemic conditions. These findings elucidate a novel interplay among metabolic stress, innate immune signaling, and translational regulation in tendon tissue, proposing that targeting TLR4 signaling or stress granule formation may offer therapeutic potential for preserving tendon integrity in diabetic patients.

Achilles tendon defects represent a challenging reconstructive problem in both athletic and comorbid populations. The objective of this review was to evaluate the versatility, clinical utility, and patient-centered outcomes of Achilles tendon-based flaps and reconstructions across trauma, chronic rupture, sports medicine, diabetic foot, and salvage contexts. We performed a PubMed search (between 2015-2025), identified 223 studies that were limited to human subjects and English-language publications. Following application of inclusion and exclusion criteria, 71 full-text articles were assessed, of which 48 met criteria for qualitative synthesis. Eligible designs included randomized controlled trials, prospective and retrospective cohorts, systematic reviews, and case series with ≥10 patients. Data were extracted on study design, population, intervention, follow-up, and outcomes. Narrative synthesis was performed across predefined themes: preoperative assessment, intraoperative technique, postoperative management, functional outcomes, and limb salvage. Achilles tendon-based reconstructions demonstrated consistent adaptability across diverse clinical settings. In athletic and trauma cohorts, minimally invasive hamstring autografts, FHL transfers, and V-Y plasties produced significant improvements in functional scores and return-to-sport rates approaching 70-80%, with rerupture rates <5% in most series. In diabetic and salvage populations, regional flaps such as sural and peroneus brevis achieved durable wound coverage, while free anterolateral thigh flaps enabled composite tendon-skin reconstruction with limb salvage rates of 80-90%. Complications varied by context: venous congestion was most common in sural flaps, while infection rates exceeded 20% in uncontrolled diabetics. Across populations, success depended heavily on patient selection, vascular assessment, and compliance with staged rehabilitation. Achilles tendon flaps and grafts represent a versatile reconstructive strategy capable of restoring elite-level function in athletes while preserving limbs in high-risk diabetic and ischemic patients. Current evidence underscores that outcomes depend less on the specific technique than on appropriate patient selection and perioperative optimization. Future research should prioritize multicenter prospective studies, integration of quality-of-life outcomes, and cost-effectiveness analyses to refine the role of these techniques in lower extremity reconstruction.

Rotator cuff tears are among the most common musculoskeletal injuries worldwide, often requiring surgical intervention to restore shoulder function. Despite improvements in surgical techniques, rotator cuff re-injury remains a significant challenge, influenced by a combination of patient-related and procedural factors. The incidence of re-injury after surgery ranges from 15% to 21%, varying based on the severity of the initial injury and adherence to rehabilitation. In this article, we critically examine the risk factors, incidence, and management strategies associated with rotator cuff re-injury. Key risk factors include advanced age, larger tear size, poor tissue quality, high activity levels, and comorbid conditions like diabetes and hyperlipidemia. Age-related degenerative changes, muscle atrophy, and fatty infiltration impair tendon healing, increasing the risk of re-injury. Emerging geometric classifications of rotator cuff tears (Types 1-4) provide valuable insights into prognosis and guide surgical approaches. Management strategies for re-injury include both conservative approaches, such as physical therapy and activity modification, and surgical revisions, including tendon transfers and superior capsular reconstruction. Novel interventions like biological scaffolds, mesenchymal stem cell therapy, and machine learning-driven rehabilitation protocols are being explored to enhance tendon healing and reduce re-injury rates. However, gaps remain in understanding the biological mechanisms of tendon repair and optimizing personalized treatment strategies. Future research should focus on integrating biomolecular insights with clinical practice to improve outcomes and reduce the burden of rotator cuff re-injury.

This comprehensive review explores the latest advancements in the management of spinal disorders, including minimally invasive surgical techniques, treatment of complex deformities, disc replacement technologies, and non-surgical approaches. The review highlights the potential of innovations such as robotic-assisted surgeries, regenerative medicine, and artificial intelligence to enhance precision, reduce recovery times, and improve patient outcomes. It also discusses the integration of wearable technologies and personalized medicine in tailoring treatments. Challenges such as high costs, accessibility issues, and limited long-term data are critically analyzed, alongside gaps in research, including a lack of diversity in study populations and insufficient economic evaluations. Future directions emphasize the need for multidisciplinary collaboration to develop durable, accessible, and personalized solutions to address the global burden of spinal disorders.