Journal of orthopaedics and sports medicine最新文献

Rotator cuff tendinopathy is a common cause of shoulder pain and dysfunction, presenting in two primary forms: calcific and non-calcific. These subtypes differ significantly in their pathophysiology, clinical manifestations, and natural history, necessitating tailored diagnostic and therapeutic approaches. This review delineates the clinical presentations of calcific rotator cuff tendinopathy (RCCT), characterized by distinct pre-calcific, calcific, and post-calcific stages, and contrasts them with the more insidious, degenerative course of non-calcific rotator cuff tendinopathy. Diagnostic imaging, particularly musculoskeletal ultrasound, plays a pivotal role in differentiating these conditions, offering advantages in cost, accessibility, and dynamic, real-time assessment over MRI. Treatment strategies range from conservative management with NSAIDs and physical therapy to interventional techniques including ultrasound-guided barbotage, extracorporeal shockwave therapy, corticosteroid injections, and emerging regenerative therapies such as platelet-rich plasma and prolotherapy. Despite advances, further high-quality studies are needed to optimize individualized care per rotator cuff tendinopathy classification and to clarify long-term outcomes. This review highlights current evidence and clinical decision-making considerations to improve the diagnosis and management of rotator cuff calcific and non-calcific tendinopathies.

Osteoarthritis (OA) is a degenerative joint disease that affects millions of individuals worldwide, causing pain, disability, and a significant burden on public health. Preclinical research using animal models is essential to our understanding of the underlying pathogenesis of OA and developing therapeutic strategies. Rodent models, in particular, have become indispensable in studying OA due to their ability to mimic various features of human disease. This review provides an overview of commonly used rodent models of OA, including surgical induction (e.g., destabilization of the medial meniscus and anterior cruciate ligament transection), chemical induction (e.g., monoiodoacetate-induced cartilage degeneration), and genetically modified models. Additionally, age-related OA models that naturally develop OA-like symptoms in aged rodents are also discussed. Despite their utility, rodent models face limitations in fully recapitulating the complexity of human OA. Emerging trends in OA research, including the use of 3D imaging for joint analysis, molecular profiling for deeper insights into disease mechanisms, and advancements in biomarkers for early detection and treatment, are highlighted. These innovations provide new opportunities to refine existing models and enhance the translation of findings to clinical therapies. This critical review provides comprehensive information for researchers working in OA and related fields, promoting a better understanding of the available rodent models and their applications in OA research.

In the United States, limb amputation affects around 2.3 million people, with projected numbers rising due to the higher levels of diabetes and peripheral vascular disease. Amputee patients not only encounter mobility loss but also residual limb pain, psychological stress, and disparities in access to healthcare. This article presents a critical review of the current literature on functional outcomes and pain management for patients who underwent limb amputation. In terms of pharmacological therapies, gabapentinoids and antidepressants provide minimal relief for post amputation pain, whereas surgical techniques including targeted muscle reinnervation and regenerative peripheral nerve interfaces have resulted in much larger improvements in decreasing neuroma-related and phantom limb pain. The non-pharmacological therapies, including mirror therapy, graded motor imagery, and virtual reality are some of the most effective interventions for reduction of phantom limb pain. Functional improvement can be optimized through microprocessor-controlled prosthetics, osseointegration, and early rehabilitation with an emphasis on resistance training, mobility, and psychological support. Newer techniques including neuromodulation and artificial intelligence-enhanced prosthetic control also play a part in rehabilitation; however, evidence is limited due to their novel introduction to the rehabilitation space. Overall, a multidisciplinary and individualized multimodal approach to rehabilitation remains the gold standard to improve pain control, quality of life, and functional restoration.

Rotator cuff injuries are a common cause of shoulder dysfunction, with diabetes mellitus and hyperlipidemia contributing to increased tendon vulnerability and impaired healing. In this article, a critical evaluation is presented on the comparative outcomes of open versus arthroscopic rotator cuff repair (RCR) in patients with these metabolic conditions. Findings suggest that arthroscopic RCR compared to open RCR offers advantages such as reduced tissue disruption, shorter recovery times, and lower infection rates, making it a preferred choice for metabolically compromised patients. However, open RCR provides superior visualization and structural support, as well as better function, benefiting patients with extensive tendon damage. In diabetics there was higher retear and infection rates than non-diabetics, particularly with open RCR, while those with hyperlipidemia exhibited impaired tendon healing and increased postoperative complications, with mixed effects from statin therapy. Despite these findings, existing research lacks large-scale, controlled studies directly comparing surgical outcomes in these high-risk populations. Given the chronic inflammatory and metabolic impairments associated with diabetes mellitus and hyperlipidemia, surgical decisions should be tailored to patient-specific factors, including lipid and glycemic control, tendon integrity, and tear severity. Arthroscopy appears to be the preferable option due to minimizing surgical trauma, lower retear rates and faster return-to-work times; meanwhile, open repair remains valuable in cases requiring extensive intervention.

Osteoarthritis is a complex and painful condition marked by joint destruction and remodeling, often resulting from overuse, aging, or genetic predisposition. Surgical arthroplasty is a widely used treatment to replace degenerated joints, relieve pain, and restore function, often caused by osteoarthritis. Artificial intelligence, including its subsets such as machine learning and deep learning, has emerged as a tool to enhance knee arthroplasty by improving diagnostic accuracy, surgical efficiency and patient outcomes. This article addresses the diverse applications of artificial intelligence across the preoperative, perioperative, and postoperative stages of knee arthroplasty, categorizing studies by their focus on patient education, surgical assistance, and outcome assessment.

There is mounting evidence to suggest that exogenous electromagnetic fields (EMF) may play a significant role in various biological processes that are crucial to therapeutic interventions. EMFs have been identified as a non-invasive, safe, and effective therapy that appears to have no apparent side effects. Numerous studies have demonstrated that pulsed EMFs (PEMFs) have the potential to become a stand-alone or adjunctive treatment modality for managing musculoskeletal disorders. However, several questions remain unresolved. Before their widespread clinical application, further research from well-designed, high-quality studies is required to standardize treatment parameters and determine the optimal protocol for healthcare decision-making. This article provides a comprehensive overview of the impact of musculoskeletal diseases on overall well-being, the limitations of conventional treatments, and the need to explore alternative therapeutic modalities such as electromagnetic field (EMF) therapy. EMF therapy uses low-frequency electromagnetic waves to stimulate tissue repair, reduce inflammation, and modulate pain signals, making it a safe and convenient alternative to conventional treatments. The article also discusses the historical perspective of EMF therapy in medicine. The article highlights the potential of EMF therapy as a personalized and comprehensive care option for musculoskeletal diseases, either alone or in conjunction with other therapies. It emphasizes the imperative for further research in this field and presents a compelling case for the use of EMF therapy in managing musculoskeletal diseases. Overall, the available findings on the underlying cellular and molecular biology support the use of EMF therapy as a viable option for the management of musculoskeletal disorders and stresses the need for continued research in this area.

Rotator cuff injuries are the most common injuries among active and training astronauts. According to the CDC, 1 in 4 adults in the U.S. experience rotator cuff injuries, particularly affecting the supraspinatus muscle. Hypercholesterolemia, a condition characterized by high levels of LDL cholesterol, is prevalent in approximately 2 in 5 adults in the US and is a risk factor for worsened outcomes in shoulder inflammation and rotator cuff injury repairs. Chronic inflammation, a prolonged low-grade inflammatory state, can arise from conditions like hypercholesterolemia and contribute to muscle atrophy. Skeletal muscle atrophy can be caused by factors such as disuse, aging, malnutrition, and microgravity, and currently lacks approved drug therapies. Thus, gaining a comprehensive understanding of the associations between hypercholesterolemia, chronic inflammation, and skeletal muscle atrophy is imperative for developing effective strategies to manage this condition. We conducted an animal study in Yucatan miniswine to investigate the impact of a high-cholesterol diet on rotator cuff muscle. The results suggested the presence of chronic inflammation in rotator cuff muscle hypercholesterolemic swine, associated with elevated pro-inflammatory cytokines and intramuscular adipocytes, and skeletal muscle atrophy. The results also revealed upregulation of the FOXO3/TRIM63/Titin axis in a hyperlipidemic state. These findings open new perspectives for developing better treatment strategies by targeting the FOXO3/TRIM63/Titin axis to manage rotator cuff muscle atrophy in the context of hypercholesterolemia.

Orthopedic diseases often present with dermatological symptoms that require prompt identification for appropriate treatment. Understanding these dermatologic presentations is crucial for accurate diagnosis and effective management. This article critically reviewed the dermatological manifestations observed in general and regional pathologies, followed by treatment-related manifestations. An extensive literature search was performed and limited to manifestations in orthopedic disease, excluding those pertaining to infection or syndromes. Case reports and case series documenting unusual and rare dermatologic presentations of orthopedic conditions were examined, providing novel perspectives on both prevalent and uncommon illnesses. The identified pathologies are discussed in detail, including their clinical features and diagnosis, while treatment approach varies depending on the severity of the condition, ranging from self-care to surgical intervention. The findings emphasize the need for interdisciplinary collaboration and highlight the importance of careful diagnosis and appropriate management to eliminate unnecessary approaches and ensure optimal outcomes for patients with orthopedic diseases and dermatologic symptoms.

Anterior Cruciate Ligament (ACL) injuries are a prevalent concern in athletic population, particularly among female athletes who are disproportionately affected. The increased incidence of ACL injuries in females is attributed to a combination of anatomical, physiological, and biomechanical factors that influence knee stability. This review comprehensively explores these contributing factors, highlighting gender-specific anatomical differences such as wider pelvis, increased quadriceps (Q) angle, and steeper tibial slopes, all of which predispose females to greater knee valgus during dynamic activities. Furthermore, hormonal influences and greater ligament laxity are discussed as physiological contributors to increased ACL injury risk. Biomechanical factors such as reduced knee flexion, increased knee valgus, and altered muscle activation patterns further amplify the risk of ACL tears in female athletes. Despite extensive research, gaps remain in the understanding of how these factors interact and influence injury susceptibility. This article is focussed on the critical points in the current literature, analyzing key risk factors, and identifying future research directions that can inform more effective prevention strategies. A better understanding of these factors will ultimately contribute to reducing the incidence of ACL injuries among female athletes and improving long-term strength and stability of knee joint.

Anterior Rotator cuff tears are one of the most common surgically addressed disorders, as the tears in the tendon can affect anyone regardless of risk factors or activity level. The rotator cuff is responsible for most of the shoulder motion, hence the tendon-bone interface experiences immense stress making it incredibly prone to failure. Rotator cuff tendon tears can either occur due to trauma or natural degeneration of the rotator cuff. To help mitigate effects of high stress on the rotator cuff tendon-bone interface, the rotator cuff is intrinsically designed to redistribute stress through protective mechanisms, such as the rotator crescent or coronal-transverse force. But when the tear goes through the intrinsic protective mechanisms, the glenohumeral joint is left unstable and thus is no longer capable of its normal range of motion. Location, size, and type of rotator cuff tendon tears are the strongest indicators for interventional therapy. Surgical therapies demonstrate low success rates, as seen by the significantly high recurrence rate of rotator cuff reinjury following initial repair. This is due to extrinsically healing of rotator cuff tendons, instead of the more intrinsic healing, which causes rotator cuff tendons to not undergo the necessary biomechanical remodeling to prevent reinjury leading to a mechanically and functionally inferior healed tendon. In this article, we thoroughly discussed the underlying pathophysiology of rotator cuff tears from onset to repair to healing, demonstrating that rotator cuff tendon healing is an intrinsically flawed process, irrespective of the risk factors, occurrence of rotator cuff tears, or surgical treatment. Rotator cuff healing can only be successful if rotator cuff tendon repair surgery is augmented with biologics to promote a successful intrinsic healing environment.