搜索结果：Current reviews in musculoskeletal medicine

Tendinopathy is a common cause of musculoskeletal morbidity, resulting in frequent visits to primary care providers, orthopedists, and urgent care clinics. Six common regions of tendinopathy are discussed in this article, including up to date findings in their clinical history and exam findings, special testing, imaging, and treatment. Point of care musculoskeletal ultrasound has gained popularity as a tool in the diagnosis of various tendinopathies. Advanced interventions, including extracorporeal shockwave therapy (ESWT) and injections modalities such as platelet rich plasma (PRP) are becoming more common in the treatment of tendinopathy; however, the evidence for these interventions is mixed with most providing some short-term relief in symptoms but no long-term improvement in outcomes. Point of care musculoskeletal ultrasound has gained popularity as a tool in the diagnosis of various tendinopathies. Advanced interventions, including extracorporeal shockwave therapy (ESWT) and injections modalities such as platelet rich plasma (PRP) are becoming more common in the treatment of tendinopathy; however, the evidence for these interventions is mixed with most providing some short-term relief in symptoms but no long-term improvement in outcomes. The diagnosis of tendinopathy often remains a clinical diagnosis with the mainstay of treatment remaining activity modification, physical therapy, and anti-inflammatories for acute pain control. Recovery time is widely variable between patients and conditions.

Artificial intelligence (AI) has emerged as a useful tool across the field of orthopedic surgery. This review highlights recent literature on AI’s role in surgical outcome prediction, musculoskeletal imaging, economic and ethical considerations, with a focus on its integration in sports medicine workflow and procedures. Machine learning AI models have demonstrated superior accuracy in predicting orthopedic related patient-reported outcomes, surgical complications, and the utilization of healthcare compared to traditional, non-AI methods. Within imaging, AI applications now produce automated measurements for clinical and presurgical planning with precision equivalent to expert-level measurements. Large language AI models are increasingly used for clinical documentation, research workflows, and administrative support for healthcare delivery and effectiveness. Despite increasing integration of AI into orthopedics and its subspecialties, challenges in validation, accessibility due to cost, and ethical considerations remain. Orthopedic surgery and sports medicine are particularly well suited for AI applications due to their well-defined, measurable clinical outcomes. Emerging AI tools and models show promise in enhancing patient outcomes, surgical planning, and healthcare efficiency. Continued AI research must prioritize external validation, ethical implementation, and educational integration to ensure responsible, effective, and reproducible use.

This scoping review aims to evaluate the molecular mechanisms, therapeutic potential, and safety concerns of Body Protective Compound-157 (BPC-157) in the context of musculoskeletal healing. Given the compound’s increasing availability, popularity, and its regulatory controversies, we sought to assess the breadth and quality of preclinical and clinical data supporting its use in musculoskeletal medicine. BPC-157 is a synthetic pentadecapeptide originally isolated from gastric juice and has demonstrated regenerative properties across numerous animal models. It activates several overlapping pathways, notably VEGFR2 and nitric oxide synthesis via the Akt-eNOS axis, promoting angiogenesis, fibroblast activity, and neuromuscular stabilization. It also engages ERK1/2 signaling, facilitates endothelial and muscle repair, and exerts anti-inflammatory effects. These effects promote angiogenesis, fibroblast activity, and neuromuscular stabilization, particularly in poorly vascularized tissues such as tendons and myotendinous junctions. Despite broad preclinical support, human data are extremely limited. Only three pilot studies have examined BPC-157 in humans, including its use for intraarticular knee pain, interstitial cystitis, and intravenous safety/pharmacokinetics. No adverse effects were reported, but rigorous, large-scale trials are lacking. BPC-157 demonstrates robust regenerative and cytoprotective effects in preclinical studies, positioning it as a potentially valuable tool in musculoskeletal medicine. Despite its growing popularity among athletes and its wide availability through non-regulated sources, there is minimal human data available. Until well-designed clinical trials are conducted, BPC-157 should be considered investigational, and its use approached with caution. This review highlights that given the robust preclinical evidence and high public interest, there is a critical need for well-designed human trials to assess the safety, efficacy, and clinical utility of BPC-157 in musculoskeletal medicine.

Lateral patellar instability is one of the most common knee conditions among adolescents, with an estimated incidence of approximately 43 per 100,000 individuals. Trochlear dysplasia has been identified as the most common anatomic risk factor for patellar instability and may be present in up to 90% of patients with lateral patellar instability. It presents across a spectrum of severity ranging from mild to severe. While multiple surgical treatment algorithms exist for managing patellar instability, trochleoplasty remains the only procedure that directly addresses the underlying trochlear pathology and restores normal patellar tracking. The purpose of this review is to highlight the critical role of trochlear dysplasia in patellar instability and to review the indications, surgical technique, and contemporary role of trochleoplasty in the management of this condition. Recent studies report favorable short, mid and long term clinical outcomes following trochleoplasty in patients with lateral patellar instability associated with trochlear dysplasia. In parallel, emerging biomechanical and radiographic evidence has further clarified the role of trochlear dysplasia in increasing patellofemoral contact pressures and altering patellar tracking, while also demonstrating favorable radiographic outcomes following trochleoplasty. Together, these findings reinforce the importance of addressing the primary trochlear pathology in patients with lateral patellar instability, particularly in the setting of moderate- to high-grade trochlear dysplasia, and support a treatment paradigm that prioritizes correction of the underlying anatomic abnormality. Recent findings Lateral patellar instability is a multifactorial condition in which trochlear dysplasia represents a primary anatomic contributor to recurrent instability and altered patellofemoral biomechanics. Recent biomechanical, radiographic, and clinical evidence supports a pathology-driven approach to management, emphasizing the importance of directly addressing trochlear morphology in appropriately selected patients. Although the procedure is technically demanding, careful patient selection and surgeon expertise can result in good to excellent clinical outcomes and potential long-term preservation of patellofemoral cartilage.

Meniscus repair has become an important tool for managing meniscal tears due to the essential role each meniscus plays in load distribution, shock absorption, and joint stability. Repair is now favored whenever tissue quality and tear morphology are appropriate and this is supported by strong evidence highlighting the long-term adverse consequences of meniscectomy. Different meniscus repair techniques are available including all-inside, inside-out, and outside in. The purpose of this review is to outline the current clinical role of the outside-in meniscus repair technique, emphasizing its indications and technical considerations. Recent literature demonstrates a pronounced shift toward preservation-based management of meniscal tears, supported by robust biomechanical evidence indicating that even limited disruptions of circumferential fibers or meniscal root integrity markedly elevate tibiofemoral contact pressures and potentiate degenerative cartilage changes. Clinical outcomes studies consistently report increased utilization of meniscal repair and a corresponding decline in partial meniscectomy. Moreover, Systematic reviews have confirmed the superior long-term cost-effectiveness and functional outcomes associated with repair. Within this framework of expanding repair indications, advancement in suture-passing instrumentation has enhanced the precision, reproducibility, and efficiency of meniscus repair in general as well as the outside-in technique. The outside-in technique provides reliable access to anterior horn and body meniscus tears and affords secure fixation during meniscal allograft transplantation, thereby establishing it as an essential component of contemporary meniscal preservation techniques. The outside-in technique remains a valuable and cost-effective option, particularly for tears involving the anterior horn and mid-body of the meniscus, where access with all-inside devices may be limited. This method provides reliable fixation and accommodates a range of tear configurations. Although technically demanding for less-experienced surgeons and necessitating an additional skin incision, clinical outcomes remain favorable, with recent reports demonstrates low failure rates and significant functional improvement. As surgeon experience and technical refinement continue to progress, the outside-in technique further established its role as a fundamental tool in comprehensive meniscal preservation strategies.

This scoping review examines learner-reported preferences and experiences with remote learning, observership, and visiting-surgeon exchange models in low-resource settings. We outline potential benefits, limitations, equity considerations, and evidence gaps that can inform ethical and sustainable global orthopaedic education partnerships. Recent literature on global orthopaedic education has largely focused on training exchanges involving high-income country (HIC) trainees in low- and middle-income countries (LMICs), with reported benefits including skills transfer and professional development alongside challenges related to continuity of care, resource burden, and limited reciprocity. However, despite growing consensus around equity and reciprocity, the perspectives of orthopaedic trainees and practicing surgeons in low-resource settings remain underrepresented in the current literature. Learners in low-resource settings valued international exchanges that provided structured teaching, subspecialty exposure, and access to higher-volume clinical environments. Virtual and simulation-based education demonstrated consistent improvements in knowledge and surgical skills despite technical and cost-related barriers. In-person and hybrid programs were associated with meaningful capacity-building benefits but required substantial resources, infrastructure, and long-term institutional commitment. Across all models, challenges related to infrastructure, cost, equity, and reciprocity remained. Notably, none of the included studies examined LMIC learner perspectives on bidirectional exchange with higher-resource settings, despite growing emphasis on reciprocity in contemporary partnership frameworks. These findings underscore the need for locally driven, sustainable global orthopaedic education partnerships with stronger outcome evaluation and greater LMIC leadership.

Track and field is one of the most widely played sports worldwide, encompassing a variety of events across different age groups. Injury is extremely common, with data suggesting that up to 2/3 of track and field athletes will sustain an injury in any given season. In this review, we provide an overview of common track and field injuries, including their incidence, workup, management considerations, and return-to-play protocols. Track and field athletes experience a wide range of injuries, depending on the event in which they participate, as well as predisposing demographic factors. Such injuries range from catastrophic cervical and head injuries experienced by pole vaulters to shoulder and elbow injuries seen in javelin throwers, and stress fractures and lower extremity muscle strain seen in sprinters and jumpers. The workup of any patient with a suspected injury begins with an appropriate physical examination, followed by advanced imaging, with MRI commonly used to assess for stress fractures and muscle strains. Treatment is individualized based on the patient, with appropriate treatments ranging from non-operative care, including physical therapy and mitigation of baseline factors, to operative intervention for severe injuries. Return-to-play decisions are multifactorial, involving input from athletes, coaches, trainers, and orthopedic surgeons. They commonly utilize functional testing, strength measurements, and imaging evidence of interval healing, with a gradual return to play as tolerated. As track and field continues to evolve with increased year-round performance and higher stress placed on athletes, it is of paramount importance for athletes to undergo appropriate workups and optimization. By understanding the epidemiology, workup, prognostication, and treatment of common track and field injuries, sports medicine physicians may optimize outcomes and improve performance for their athletes.

Persistent pain after total hip arthroplasty (THA) is a common complication requiring extensive diagnostic effort and is often associated with potentially invasive and morbid treatment options. With THA volume expected to steadily increase there is a similarly growing need for creative and effective diagnostic and therapeutic options for these clinically challenging patients. Hip arthroscopy has emerged as a promising tool in the setting of persistent pain after THA with expanding indications and promising outcomes. The purpose of this article was to provide a review of the current state of literature regarding arthroscopic and endoscopic solutions for common causes of persistent pain after THA with a focus on patient selection, indications, surgical considerations, outcomes, and complications. The most common indication for hip arthroscopy after THA is iliopsoas tendinopathy, showing excellent outcomes with symptom resolution in greater than 90% of patients after arthroscopic iliopsoas release or lengthening. The second most common indication is diagnostic arthroscopy in the setting of otherwise negative extensive work-up, which has shown diagnostic value for occult implant loosening, capsular fibrosis, and metal hypersensitivity. Endoscopic decompression for the treatment of ischiofemoral impingement and sciatic nerve decompression has also shown consistent improvements in pain and function. In addition to these well described indications, future utilization of hip arthroscopy for loose body removal, capsular plication for instability, and management of prosthetic joint infection are potentially emerging indications. Hip arthroscopy after THA is a safe and effective tool for the management of common causes of persistent pain after THA with robust support for iliopsoas pathology and emerging evidence and outcomes for less common indications. Future research will both expand and narrow these indications as diagnostic criteria, patient selection, and surgical techniques are refined.

This paper aims to provide an overview on current recommendations for perioperative pain control for pediatric spine surgery. Managing pediatric pain is important to decrease postoperative morbidity, improve early mobilization, and decrease narcotic analgesic use. We aimed to summarize the data on preoperative pain management, intraoperative pain management, and postoperative pain management pathways for pediatric spine surgery. Pre-operative mental health conditions have been shown to be associated with increased post-operative pain. Intravenous ketorolac and oral gabapentin use postoperatively can improve postoperative pain control and decrease opioid use. While patient-controlled anesthesia is currently widespread after pediatric spine surgery, there is increasing research on regional modalities for pain control, including erector spinae plane blocks, liposomal bupivacaine, epidural analgesia, and intrathecal morphine injections, which are associated with earlier mobilization and decreased narcotic use, with maintained or decreased pain scores. Multimodal pain control, as outlined in Enhanced Recovery After Surgery protocols, is necessary to achieve adequate pain control while decreasing narcotic usage and the associated side effects. Psychosocial factors can impact pain through anxiety and pain catastrophizing. There is increased emphasis on regional and neuraxial anesthesia modalities for pain control. Further research is needed directly comparing the effectiveness of these modalities and further exploring the effect of psychosocial factors on pain and methods to address this.

Arthrogenic muscle inhibition (AMI) is a key neurophysiological mechanism that impairs voluntary quadriceps activation following total knee arthroplasty (TKA), potentially limiting functional recovery despite technically successful surgery. This review aims to synthesize current evidence on the neurophysiological mechanisms underlying AMI and to propose a mechanism-based rehabilitation framework targeting these inhibitory processes. Emerging evidence indicates that AMI is mediated by altered afferent input from the joint, leading to changes in spinal reflex excitability and supraspinal motor control. Mechanisms such as presynaptic inhibition, reduced α-motoneuron excitability, and impaired γ-loop function contribute to diminished quadriceps activation. In addition, recent studies suggest that AMI may manifest at the level of motor unit recruitment and firing behavior, reflecting persistent neuromuscular adaptations. These inhibitory processes are further influenced by joint effusion, pain, and pre-existing neuromotor deficits in patients with knee osteoarthritis. AMI represents a multilevel sensorimotor dysfunction that may act as a major limiting factor in postoperative recovery after TKA. A targeted rehabilitation approach addressing peripheral, spinal, and supraspinal mechanisms-including effusion control, neuromuscular electrical stimulation, blood flow restriction training, and sensorimotor retraining-may improve quadriceps activation and functional outcomes. Integrating neurophysiological principles into rehabilitation strategies may enhance recovery trajectories and should be a focus of future clinical research.

There has been an expanding role of artificial intelligence (AI) and machine learning (ML) in spine surgery, particularly in operative planning, intraoperative navigation, and postoperative management. With a focus on patient-specific surgical strategies, AI technologies offer new possibilities for improving surgical accuracy, reducing risks, and enhancing patient outcomes in spine care. AI models have shown strong accuracy in preoperative planning, with neural networks outperforming traditional algorithms in patient selection and outcome prediction. Advances in 3D modeling, supported by machine learning, enable efficient, patient-specific anatomical reconstructions, reducing manual segmentation time from hours to seconds. In intraoperative navigation, AI-driven virtual and augmented reality systems enhance screw placement precision and reduce radiation exposure by up to 90%, improving workflow and safety. Additionally, real-time AI-based decision support has decreased operative time and postoperative risks, while postoperative AI applications now support mortality risk stratification and discharge planning, yielding significant predictive accuracy for adverse events and extended stays. AI technologies are transforming spine surgery by increasing surgical precision, optimizing clinical workflows, and personalizing patient care. While challenges remain regarding data diversity and ethical considerations, ongoing innovations indicate that AI will continue to refine spine surgery through personalized and efficient care solutions.

Meniscus allograft transplantation (MAT) is associated with good clinical outcomes even though biological mechanical and technical challenges persist. These include early graft shrinkage, extrusion, reoperation due to reoccurrence of pain or mechanical symptoms and progression of osteoarthritis (OA). The purpose of this review is to evaluate the influence of MAT surgical techniques, and novel cell therapies on graft extrusion and tibial femoral contact stresses and how these can be optimized to improve clinical outcomes. Of the 27 articles that met the inclusion and exclusion criteria, 16 (clinical and cadaveric) focused on the impact of surgical fixation techniques on extrusion, joint loading mechanics and clinical outcomes. These studies demonstrated that bony fixation techniques were superior to soft tissue and transossesous suture fixation for restoring joint mechanics and minimizing extrusion. However, clinical outcomes were not significantly impacted by these biomechanical findings. The remaining 11 studies investigated novel cell therapies for meniscus regeneration and improving MAT procedures. Intrameniscal injections into frozen meniscus allografts demonstrated the potential for cell therapy to improve allograft tissue properties. Intraarticular injections and cell sheet transplantation led to tissue regeneration and chondroprotection following a hemi-meniscectomy in preclinical models. Although short-term clinical outcomes and PROMs are not significantly affected by fixation techniques, cadaveric and clinical studies have suggested that suture-only fixation with a traditional transosseous fixation may lead to worsened extrusion and joint mechanics compared to bony fixation methods. However, the implications of these findings on long-term clinical outcomes have not been evaluated. Cell therapy could further improve allograft tissue properties, chondroprotection and graft healing working together with current surgical techniques to restore joint functioning.

Frugal innovations prioritize low-cost interventions, while keeping in mind efficacy, accessibility and scalability. Despite a scientific culture that often celebrates major financial investment and cutting-edge technologies, frugal innovations can be just as important in both low-income countries where resources are scarce as they are high income countries where the health needs of aging populations may be outpacing economic growth. We sought to comprehensively review the current state of frugal innovations in orthopaedic surgery, as well as to identify next steps as the importance of these low-cost interventions continues to grow. Frugal innovation is particularly relevant in orthopaedic care as musculoskeletal interventions such as prosthetics, orthotics and surgery demand significant materials, skilled labor, and frequent follow-up. There have been numerous innovations in the recent years, including the development of low-cost intramedullary nails, bioabsorbable implants, negative-pressure wound therapy systems made from aquarium pumps, repurposed Foley catheters and nasogastric tubes for use in surgeries, among many more. Frugal innovations in orthopaedic surgery are becoming more relevant and rapidly evolving in all health-care settings as a tool to deliver value-based care to the growing needs of the population. Though many of these projects are performed on a local scale, when considered collectively, they demonstrate powerful efforts to move the needle in enhancing access to high-quality orthopaedic surgical care and reduce the burden of global musculoskeletal disability. Frugal innovations offer immense promise in reducing costs and closing the gap of access to high-quality orthopaedic care worldwide.

While social determinants of health are known to contribute to disparities in orthopaedic care, associations between social deprivation and total joint arthroplasty (TJA) outcomes remain unclear. This review assessed the relationship between social deprivation and multiple aspects of total joint arthroplasty, including access to care, early postoperative outcomes, resource utilization, and patient-reported functional recovery. Recent studies have increasingly used composite deprivation indices including the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), Social Deprivation Index (SDI), and Distressed Communities Index (DCI) to examine disparities in TJA care. Higher levels of social deprivation were consistently associated with reduced arthroplasty utilization, increased early postoperative complications, longer hospital stays, higher costs, and greater likelihood of non-home discharge. Associations with emergency department use were frequent, whereas findings related to readmissions were mixed. Relationships between deprivation and patient-reported outcomes were less consistent. Across multiple studies, deprivation was not uniformly associated with failure to achieve clinically meaningful improvement but was more frequently linked to failure to achieve patient-acceptable symptom states and challenges in sustaining functional recovery. Social deprivation is an important determinant of access, perioperative outcomes, and healthcare utilization following TJA, with ADI demonstrating the most consistent association. Although socially deprived patients generally achieve meaningful postoperative improvement, they are less likely to reach optimal recovery thresholds. Incorporating deprivation measures into perioperative planning may help identify patients who would benefit from targeted interventions. Future studies should standardize index use and evaluate strategies to reduce socioeconomic disparities in arthroplasty outcomes.

Residual acetabular dysplasia (RAD) is a common condition where the acetabulum remains shallow or underdeveloped even after treatment for developmental dysplasia of the hip (DDH). Proper management of RAD is crucial in reducing the risk of hip instability and premature arthritis. This review summarizes the most recent evidence related to the diagnosis and management of RAD in patients during their first decade of life, with an emphasis on data that may inform clinical decision-making and highlight areas in need of further investigation. Recent studies have shown that rigid abduction bracing significantly improves RAD in patients over six months of age compared to observation only and has minimal treatment complications. Furthermore, bracing has been shown to have a dose-dependent relationship with improvement in acetabular index (AI). Surgical treatment of RAD with pelvic osteotomy significantly improves AI compared to all other treatment approaches, though several studies indicate a reduced effect among older patients. The exact timing and indications for surgical intervention remain controversial. The management of RAD remains an active area of research, particularly regarding the timing and indications for surgical intervention. Recent studies have demonstrated the effectiveness of rigid abduction bracing for patients with RAD over the age of six months to assist in acetabular remodeling, with a low complication rate. Pelvic osteotomy provides the most significant improvement in AI compared to all other approaches, with some evidence suggesting that these procedures become less effective as patients get older. However, as the timeline for surgical intervention remains unclear, there is a need for shared decision-making when managing RAD, along with additional long-term prospective studies.

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity of adolescence and disproportionately affects females, with outcomes strongly dependent on curve magnitude and timing of detection. Increasing evidence demonstrates that structural and systemic factors influence multiple stages of the AIS care continuum and may be the primary drivers of disparities in care amongst this population. This narrative review synthesizes contemporary evidence on sex- and race-based inequities in AIS, emphasizing structural drivers rather than biologic explanations for these disparities and highlighting priorities for future research. Studies examining presentation severity show heterogeneous results, but intersectional analyses consistently identify compounded disadvantage among Black adolescents with public insurance. Delayed detection and loss to follow-up emerge as central mechanisms linking social context to higher surgical rates and greater economic burden. In contrast, disparities in short-term postoperative complications appear attenuated after adjustment in many cohorts. However, differences in length of stay, hospital charges, and the geographic distribution of care persist, primarily related to patient race and insurance coverage. Most variation in findings across settings reflects differences in screening policies, insurance structures, and the socioeconomic indices used to characterize disadvantage, as well as limitations inherent to administrative databases and registry attrition. The available evidence indicates that structural and systemic factors, rather than biological factors, have a direct impact on disparate care in AIS. This impact is most noticeable at the initial stages of care, such as screening and diagnosis, where sociocultural and socioeconomic differences can affect patients' access to timely non-operative care. However, it seems once the decision to treat with surgery has been made, the previously existing disparities do not affect surgical outcomes but can affect long-term follow-up.

Reverse total shoulder arthroplasty (rTSA) is a commonly utilized procedure for rotator cuff arthropathy, irreparable rotator cuff tears, and complex proximal humerus fractures. Although rTSA significantly improves long-term pain and function, postoperative pain remains common and is closely associated with increased opioid consumption, prolonged hospitalization, delayed recovery, and reduced patient satisfaction. Within the modern context of the opioid epidemic, optimizing pain control while minimizing narcotic usage is essential. This review summarizes recent evidence on pain management strategies for rTSAs, with emphasis on regional anesthesia techniques, multimodal analgesia, periarticular injections, Enhanced Recovery After Surgery (ERAS) protocols, and patient-specific factors influencing pain outcomes. Recent studies demonstrate that interscalene nerve blocks provide effective early postoperative analgesia and reduce opioid requirements, though complications such as phrenic nerve paralysis and rebound pain persist. Alternative regional techniques, including combined suprascapular and axillary nerve blocks, could offer comparable analgesia with reduced adverse risks in select patients. Multimodal analgesia protocols consistently decrease opioid consumption, improve early pain scores, and shorten hospital length of stay, although outcomes vary based on regimen composition. Periarticular injections further enhance analgesia when used alone or as adjuncts to regional anesthesia. ERAS protocols are associated with improved postoperative outcomes in hip and knee arthroplasty, but evidence of their application remains limited in rTSA. Patient-level factors, including preoperative opioid use, mental health conditions, and comorbidity burden, strongly predict postoperative pain and prolonged opioid dependence. Postoperative pain management after rTSA has evolved toward a multimodal, patient-centered approach integrating approaches such as regional anesthesia, non-opioid multimodal analgesia, and periarticular injections. Despite recent advances, optimal regional anesthetic techniques and the implementation of standardized ERAS protocols in rTSA remain areas of necessary future investigation.

Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) are high-cost procedures that disproportionately burden patients and healthcare systems. While disparities in primary total joint arthroplasty (TJA) are well documented, inequities specific to revision TJA remain less clearly characterized and are inconsistently interpreted. This scoping review synthesizes studies published from January 2019 onward to examine racial, sex-based, and geographic disparities in revision total hip or knee arthroplasty. Twenty-six studies met the inclusion criteria. Racial disparities were the most consistently documented, with multiple large database and registry studies demonstrating higher aseptic revision risk following primary TKA among Black patients compared with White patients. These disparities persisted after adjusting for patient, surgeon, and hospital characteristics. In contrast, racial disparities in revision THA were less consistent. Sex-based differences in revision TJA were smaller in magnitude and more heterogeneous, often reflecting biologic and biomechanical variation rather than access-related inequities. Geographic disparities highlighted substantial regional variation in revision TJA utilization and the influence of community-level social determinants of health on revision TJA risk and access. Disparities in revision TJA are multifactorial and reflect the interaction of differential revision TJA risk, unequal access to revision TJA care, and cumulative exposure to social determinants of health across the arthroplasty care continuum. Advancing revision TJA equity will require integrating measures of revision TJA risk and revision TJA access, incorporating social vulnerability into risk stratification, and designing policy interventions that address structural determinants of surgical care.

Osteochondral autograft transplantation (OATS) and osteochondral allograft transplantation (OCA) are established cartilage restoration procedures for symptomatic chondral and osteochondral defects of the knee in athletes. Postoperative rehabilitation is central to graft healing and incorporation, functional recovery, and safe return to play (RTP). This review synthesizes contemporary evidence on rehabilitation after OATS and OCA, including weight-bearing progression, bracing, range of motion, blood flow restriction training, and RTP criteria. Systematic reviews and survey studies report substantial variability in rehabilitation protocols, including weight-bearing timelines, bracing duration, continuous passive motion utilization, and RTP criteria. Few published protocols incorporate objective functional testing to guide RTP. Criteria-based frameworks that individualize progression by graft type, lesion location, and functional milestones are increasingly advocated, although supporting evidence remains limited. Blood flow restriction training may help preserve strength early after surgery, but data specific to OATS and OCA remain sparse. Return to play is commonly reported after both procedures, with earlier timelines more frequently reported after OATS than OCA. Rehabilitation after OATS and OCA requires balancing early graft protection with progressive restoration of motion, strength, and sport-specific capacity. Current evidence demonstrates wide protocol heterogeneity and continued reliance on time-based milestones, with underuse of objective RTP criteria. Standardized, criteria-driven pathways and multidisciplinary decision-making may improve consistency and optimize outcomes in athletic populations.