搜索结果：The Journal of the American Academy of Orthopaedic Surgeons

Early, controlled weight-bearing using an antigravity treadmill may improve outcomes following definitive fixation of lower extremity periarticular fractures. We hypothesized that patients randomized to 10 weeks of antigravity treadmill therapy would report better 6-month joint-specific patient-reported function compared with standard of care. This prospective, multicenter, randomized trial included patients 18 to 55 years of age with fractures of the knee and distal tibia randomly assigned to either 10 weeks of antigravity treadmill therapy (intervention) or standard of care (control). The primary outcome was 6-month patient-reported function (Knee injury Osteoarthritis Outcome Score) for patients with knee fractures and Ankle Osteoarthritis Scale for patients with distal tibia fractures. Secondary outcomes included 6-month Patient-Reported Outcomes Measurement Information Systems Physical Function scores, 12-month fracture healing and complications, and 6-week, 3- and 6-month satisfaction with therapy. Of 80 randomized patients, 78 were included in the final analysis (intervention n = 38; control n = 40). Their mean age was 37 years; 55 (71%) had knee fracture and 23 (29%) had distal tibia fracture. The average Knee injury Osteoarthritis Outcome Score were 54 and 61 in the intervention and control groups, respectively (adjusted difference: -6.1; 95% confidence interval, -18.4, 6.2; P = 0.32). The average Ankle Osteoarthritis Scale scores were 28 and 50 for the intervention and control groups, respectively (adjusted difference: -19.5; 95% confidence interval, -39.3, 0.30; P = 0.05). No difference was found between treatment groups in Patient-Reported Outcomes Measurement Information Systems Physical Function, fracture healing, or complications. Patients in the intervention group reported higher satisfaction with their therapy at 6 weeks (9.5 vs. 8.5; P = 0.01) and 3 months (9.5 vs. 8.6; P = 0.04). This study suggests that antigravity treadmill therapy may be beneficial for patients with distal tibia fractures. Moreover, the study demonstrates that a 10-week antigravity treadmill therapy program is safe and feasible with high patient satisfaction, providing foundation for future effectiveness trials for patients with periarticular injuries.

Socioeconomic disparities are a critical risk factor for poor health outcomes yet remain under investigated in the context of developmental dysplasia of the hip (DDH). Childhood Opportunity Index (COI) 3.0 is a composite index of socioeconomic resources available to a child. Few studies have leveraged COI to investigate social determinants of health and outcomes of DDH. A retrospective review of patients younger than 9 months who presented with ultrasonographic evidence of DDH and treated with a Pavlik harness from January 1, 2016, to July 1, 2023, at a single tertiary care orthopaedic hospital was conducted. Participants were stratified by high and low opportunity using nationally normed COI 3.0 quintiles. Demographic data, clinical presentation, and treatment outcomes were compared. Two hundred eighty-seven patients with DDH treated with Pavlik harness were included; 194 and 93 patients were included in the high-COI and low-COI groups, respectively. Age at Pavlik harness initiation was not different between the low-COI (29.2 days ± 35.0) and high-COI groups (31.2 days ± 36.0, P = 0.66), nor was the proportion of patients presenting with bilateral DDH (63% versus 57%, respectively, P = 0.37). Per hip analysis demonstrated no difference in alpha angle at presentation between the low-COI (54.1° ± 6.7) and high-COI groups (53.6° ± 8.2, P = 0.54) or the percentage of dislocated hips (8% per group, P = > 0.99). The proportion of patients requiring rigid abduction orthosis after harness treatment was not different between the low-COI (18%) and high-COI groups (21%, P = 0.64) nor was the proportion of patients requiring surgical intervention (10% and 9%, respectively). At a tertiary care, urban orthopaedic hospital, lower childhood opportunity index (COI) was not associated with age or severity of DDH at presentation, nor success in Pavlik harness treatment, aligning with our current understanding of DDH and COI. Despite racial and ethnic differences between high-COI and low-COI groups, individual patient outcomes remained similar.

Ethnic, racial, and socioeconomic disparities are well-documented in orthopaedics, including pediatric scoliosis. Spanish-speaking patients face compounding disparities in accessing linguistically and culturally concordant physician-patient interactions and patient resources. This study contributes to existing literature by providing an updated and extended analysis of the quality, credibility, and readability of online Spanish-language patient educational materials on pediatric scoliosis. A search for the top 50 results of "escoliosis en los ni&#xf1;os" (scoliosis in children) was conducted across search engines. Spanish-speaking patients are likely to interact with Google, Yahoo, and Bing. Duplicates were removed, primary review assessed inclusion and exclusion criteria, and secondary review evaluated relevance. Each source was assessed independently by two reviewers for the following: categorization, Journal of American Medical Association Benchmark Criteria, Brief DISCERN questionnaire, and the Fern&#xe1;ndez-Huerta Index for credibility, quality, and readability, respectively. Scores were compared using Wilcoxon rank-sum tests. Of the 61 sources, most were categorized as Physician/Community Hospital, Industry, and News. The median readability score aligned with an eighth-grade to ninth-grade reading level. No websites achieved the recommended reading level (<6th grade) for patient educational materials. The median Journal of American Medical Association Benchmark score was 2 (interquartile range, 1 to 3), with only four websites meeting all criteria. The median Brief DISCERN score was 14 (interquartile range, 11 to 18), with only 36% meeting the >16 threshold for adequate quality. No statistical differences were observed in quality, credibility, or readability between the two most common categories: Physician/Community Hospital and Industry. These findings revealed an insufficient standard of resources on pediatric scoliosis that Spanish-speaking patients are likely to access through online search engines. Given disparities in orthopaedic care for Spanish-speaking patients, this highlights a need for increased awareness among healthcare professionals and institutions to create accessible, credible, transparent, and readable resources on pediatric scoliosis in Spanish.

Degenerative lumbar spine disease represents a leading global source of disability, with spondylolisthesis contributing substantially to the burden of low back pain and impaired function. Lumbar fusion remains a commonly performed surgical strategy for degenerative spondylolisthesis, although decompression alone versus decompression with fusion continues to be an area of active debate, particularly in select low-grade cases. This study aimed to compare inpatient complications, discharge disposition, mortality, and costs between anterior lumbar interbody fusion (ALIF) and posterolateral fusion (PLF) for degenerative lumbar spondylolisthesis. The National Inpatient Sample was queried from 2016 to 2022 for elective admissions of adults with a primary diagnosis of lumbar spondylolisthesis undergoing ALIF or PLF. Encounters with both approaches or additional interbody techniques were excluded. Outcomes included perioperative complications, in-hospital mortality, discharge disposition, length of stay, and inflation-adjusted costs. Survey-weighted logistic regression and generalized linear models adjusted for demographics, comorbidities, and hospital factors. Significance was set at the P < 0.05 level. We identified 57,475 weighted admissions: 12,410 ALIF and 45,065 PLF. In adjusted models, PLF was associated with higher odds of transfusion (OR, 2.60; P < 0.001), acute posthemorrhagic anemia (OR, 1.47; P < 0.001), cerebrospinal fluid leak/dural tear (OR, 3.57; P < 0.001), and the adverse-events composite (OR, 1.68; P < 0.001). PLF also demonstrated greater odds of nonroutine discharge (OR, 1.19; P = 0.002). In-hospital mortality was exceedingly rare and not meaningfully different. ALIF was associated with higher mean costs ($43,000 vs. $31,500; P < 0.001) despite shorter length of stay (2.81 vs. 3.31 days; P < 0.001). ALIF for degenerative spondylolisthesis was associated with fewer perioperative complications and lower odds of nonroutine discharge than PLF, though at substantially higher inpatient costs. These findings highlight a clinical-economic tradeoff between anterior and PLF strategies at the national level. III.

As the use of artificial intelligence (AI) and large language models (LLMs) is increasingly adopted into scientific writing, it is important to understand AI's ability to produce clear and accurate content that is on par with human-authored content in the field of orthopaedics, including orthopaedic oncology. The aim of this study was to compare a series of editorials written by orthopaedic oncologists with those written by a single LLM (ChatGPT 4.0) using a variety of quality metrics. Volunteer orthopaedic oncologists submitted a 3- to 4-paragraph persuasive editorial on a topic of their choice in the field of musculoskeletal oncology. ChatGPT 4.0 was then prompted to write a corresponding editorial for each topic. Each editorial was evaluated by two blinded peer reviewers and graded using a 25-point scale on the following quality metrics: content, clarity, grammar, persuasiveness, and creativity. The evaluators were also asked to indicate whether they believed the editorials were written by humans or by AI. A total of 20 editorials were submitted by human authors and matched with 20 prompted AI editorials. No notable difference in average total quality score for human versus AI submissions was observed. AI-generated articles scored markedly higher in grammar, but there were no notable differences in any other quality metric. Reviewers correctly identified author type 59% of the time. LLMs such as ChatGPT can generate editorial content in orthopaedic oncology that matches human-written quality, suggesting a potential supportive role for AI in scientific communication, with implications for authorship standards, editorial practices, and peer review.

Forefoot fractures are among some of the most common orthopaedic injuries. Treatment of zone 2 fifth metatarsal or Jones fractures is controversial and many times dependent on surgeon preference. Management of these injuries remains without clear guidelines. Accordingly, the goal of the current systematic review is to compare the clinical outcomes and complications for both surgical fixation and conservative treatment. Two independent authors completed a systematic review using the PubMed, EMBASE, and Cochrane Library databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and Cochrane Handbook guidelines were followed. In addition, the Methodological Index for Non-Randomized Studies score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our criteria included only studies that reported on both conservative and surgical treatment of Jones fractures. Ten studies including 998 patients met our criteria for inclusion. A total of 787 patients underwent conservative management while 211 patients underwent surgical fixation. The surgical cohort had a significantly lower rate of total complications (18/211 (8.5%)) in comparison with the conservative cohort (123/787 (15.6%; P = 0.02). Similarly, those who underwent surgery had a lower rate of nonunion (7/211 (3.3%) versus 91/787 (11.6%; P = 0.04)). Patient-reported outcome scores, including American Orthopaedic Foot and Ankle Society scores were significantly better at final follow-up in the surgical group (96.5) in comparison with the conservative group (84.1; P = 0.005). This systematic review found markedly fewer total complications, a lower nonunion rate, and higher mean American Orthopaedic Foot and Ankle Society scores in patients who underwent surgical management for Jones fractures in comparison with those who were treated nonoperatively. Although, conservative treatment is also a successful method of treatment, our findings support surgical treatment of Jones fractures.

Racial disparities in total joint arthroplasty (TJA) utilization are persistent and well-characterized. Improving surgeon workforce diversity may attract patients from diverse backgrounds. We sought to determine whether the recent hiring of an arthroplasty surgeon of underrepresented minority (URM) background in a predominantly non-URM arthroplasty practice was associated with increased patient diversity. We retrospectively reviewed all primary and revision elective TJAs by six arthroplasty surgeons at our institution from September 2022 to September 2023. Primary outcomes included patient age, sex, and race/ethnicity. Secondary outcomes included patient-reported outcome measures (PROMs) at preoperative and 3-month postoperative follow-up. Comparison cohorts included the following: (1) a recently hired URM attending surgeon; (2) a recently hired non-URM attending surgeon; and (3) four senior non-URM attending surgeons. Unpaired t-tests were used to compare means for continuous variables and chi-squared tests for qualitative variables. Overall, 2,101 patients were included, and 168 patients were included in group 1 (URM surgeon), 75 in group 2 (non-URM surgeon); and 1,858 in group 3 (non-URM senior surgeons). Compared with groups 2 and 3, patients within group 1 comprised a markedly greater proportion of female, Black, and Hispanic/Latino patients (64.8%, 33.3% and 59.7%, respectively, P < 0.01). Racial and ethnic demographic differences persisted when examining patients treated by the non-URM division in the year before the hiring of the URM surgeon. Subgroup analysis of URM patients showed markedly improved SF-12 mental scores for URM patients treated by the URM surgeon compared with those treated by senior surgeons (P < 0.05). Compared with an experience-matched non-URM surgeon and non-URM senior surgeons in the same division, the URM surgeon saw a markedly greater proportion of minority patients in their first year of practice. Hiring diverse orthopaedic faculty may represent a viable strategy for improving health care utilization for minority patients in arthroplasty practices.

Although os acromiale is often noted on preoperative imaging in patients undergoing reverse total shoulder arthroplasty (rTSA), its clinical significance is ill-defined. The purpose of this study was to compare the clinical outcomes in shoulders with an os acromiale undergoing rTSA with a matched control group. We conducted a retrospective review of a prospectively collected shoulder arthroplasty database for patients who underwent primary rTSA with a minimum 2-year clinical follow-up. Preoperative imaging studies taken within 6 months of surgery were assessed for an os acromiale. Sixty-four shoulders with os acromiale were identified and were matched in a ratio of 1:5 to a control group (n = 320) based on age (within 3 years), sex (exact), preoperative diagnosis, preoperative forward elevation (within 5&#xb0;) and American Shoulder and Elbow Surgeons score (within five points). Clinical outcome scores, shoulder strength, and active range of motion assessed preoperatively and at latest follow-up as well as the incidence of complications were compared between cohorts. Outcomes of meso- and meta-acromion were grouped and compared with preacromion shoulders. The incidence of os acromiale was 9.7% (64/663) in our institution. Of these, 55% (n = 34) were preacromion, 38% (n = 24) were mesoacromion, and 8% (n = 5) were meta-acromion. No statistically significant differences were found in any outcome score, shoulder strength, or range of motion measures between shoulders with os acromiale and matched controls. Similar proportions of each cohort achieved a clinically significant benefit (minimal clinically important difference/substantial clinical benefit) for the Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, constant score, abduction, forward flexion, external rotation, and internal rotation. Shoulders with os acromiale had a similar overall complication rate compared with matched controls (14% vs. 12%; P = 0.658). No statistical difference in outcomes were observed between the pre- and meso-/meta-acromion shoulders. Patients with os acromiale undergoing rTSA have similar postoperative functional outcomes and pain relief compared with matched controls. &#x2162;, Retrospective Matched Cohort Study.

Chemotherapy regimens in high-grade osteosarcoma have markedly improved survival rates, currently reaching approximately 70%. Concerns persist regarding a long-term effect on fertility. Despite the systematic application of many fertility preservation techniques, few studies specifically address fertility in survivors. Our goal was to assess fertility in patients treated for pediatric and young adult osteosarcoma in a long-term follow-up period. This study was retrospective analysis of osteosarcoma survivors treated at our center from 1980 to 2005. All followed a standardized chemotherapy protocol. In cases where contact could not be established at the time of the follow-up for their osteosarcoma, telephone interviews were conducted, querying about pregnancy desires and difficulties. In case of difficulties, we further investigated about the possible reasons behind them. Of 116 consecutive patients initially enrolled, 104 were contacted; 67 (36 women, 31 men) desired pregnancy. Mean age at the beginning of treatment was 16.9 (4 to 33) years. The mean age at the end of follow-up was 46.8 (31 to 64) years, with an average follow-up period of 359 (156 to 480) months. Among the 36 women desiring pregnancy, only 1 (2.7%) faced fertility challenges due to chemotherapy. Of the 31 men desiring pregnancy, 4 (12.9%) experienced difficulties due to azoospermia secondary to chemotherapy and in two cases, the cause is unknown because no fertility studies were conducted for the couple. No discernible chemotherapy dosage differences were found between patients with fertility issues and those without. Survivors of pediatric and young adult osteosarcoma exhibit a high success rate in achieving normal conception and childbirth, aligning with the general population. To inform pediatric and adolescent patients with osteosarcoma, as well as their parents, about the high success rate associated with achieving a normal conception and childbirth should be the standard.

Mid-shaft clavicle fractures in the adult and postpubescent adolescent population are a common injury treated by orthopaedic surgeons. This injury has a notable burden of disease due to its prevalence, effect on the patient, and effect on the society through cost of treatment and time lost from social activity. Determining surgical and nonsurgical care for a clavicle fracture can represent a clinical challenge. To assist clinicians with this treatment decision, the American Academy of Orthopaedic Surgeons has developed and adopted an appropriate use criteria to recommend nonsurgical and surgical treatment based on a variety of patient and injury characteristics. These criteria are available online and through phone-based applications. This article aims to illustrate how the criteria may be applied in clinical practice.

Large language models (LLMs) can generate plausible diagnoses from patient symptom descriptions and convey complex medical information in conversational, empathetic language. Given that LLMs may struggle with the vague symptom descriptions characteristic of less healthy mindsets, discordance between LLM and clinician diagnoses might signal misinterpretation of sensations. Among new musculoskeletal outpatients, we studied factors associated with (1) diagnostic discordance between an LLM and a clinician and (2) patient rating of experience interacting with the LLM. One hundred forty English-speaking patients described their symptoms to an LLM prompted to provide a single most likely diagnosis. Clinician diagnoses were recorded after the visit. Patients completed a survey assessing perceptions of the LLM interaction, demographics, and psychosocial factors-including measures of unhelpful thoughts and distress (eg, catastrophic thinking, misperception of pain as necessarily signifying injury, rumination about pain, and fear of losing cherished roles). Linear regression sought associations between personal factors, diagnostic concordance, and experience with the LLM. Discordance between clinician and LLM diagnoses was common 45% (67 of 140), but was not associated with any factors. Discordance often reflected diagnostic ambiguity (eg, knee osteoarthritis and meniscal tear) or clinician use of specific diagnoses for nonspecific symptoms (eg, myofascial pain syndrome, complex regional pain syndrome, and piriformis syndrome). Hispanic ethnicity, unmarried status, lower educational attainment, and lower annual income were associated with more favorable patient-rated experience with the LLM. Clinician use of speculative and ambiguous diagnostic labels may limit the usefulness of LLM-clinician discordance as a signal of patient unhelpful thinking and distress. LLMs may support personal health agency, particularly in the setting of social disadvantage.

Bicruciate-retaining (BCR) total knee arthroplasty (TKA) was developed to better replicate native knee biomechanics by preserving both cruciate ligaments. First-generation BCR implants were notorious for technical challenges and suboptimal survivorship. However, advancements in implant design and surgical techniques have renewed interest in second-generation BCR TKA systems. This study aimed to evaluate the overall survivorship of contemporary (second-generation) BCR primary TKA implants. A systematic review of PubMed, Scopus, Embase, Web of Science, and Cochrane databases was conducted from inception to January 3, 2025. Inclusion criteria were studies that reported the number of revisions following second-generation BCR TKA. We excluded case reports, review articles, and studies that evaluated first-generation BCR TKA. A total of 1046 articles were retrieved; ultimately, 13 were included. Events per person-years pooled analysis was performed to estimate the incidence of all-cause revision, adjusting for duration of follow-up. Heterogeneity was measured using I2 test. A p-value&#x2009;<&#x2009;0.05 was considered statistically significant. A total of 1,087 BCR TKA implants among 13 studies were analyzed. The mean follow-up was 2.6 years. A total of 62 (5.7%) knees were revised. The overall pooled rate of all-cause revision was 1.6 per 100 person-years (95% confidence interval [CI] 0.009-0.023) Heterogeneity among the analyzed studies was significant (I2&#x2009;=&#x2009;75.5%, p&#x2009;<&#x2009;0.001). Contemporary BCR TKA implants showed improved survivorship compared to historical reports, with a low pooled all-cause revision rate of 1.6 per 100 person-years, corresponding to a 1.6% chance of revision per year of follow-up. Despite the associated heterogeneity, these findings suggest that modern BCR designs offer durable outcomes and support their continued use. Further long-term comparative data are needed to better define their role relative to modern knee implants.

There is a paucity of literature on the short-term clinical significance and patient-reported outcome measures (PROMs) after arthroscopic stabilization for anterior shoulder instability. (1) To define the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for arthroscopic anterior shoulder stabilization at a minimum 2-year follow-up. (2) To investigate predictive factors, including preoperative, demographic, and intraoperative variables, for achieving MCID and PASS. Case-control study. Patients who underwent primary arthroscopic stabilization for anterior-inferior labral tears from March 2018 to December 2021 with a minimum of 2-year follow-up were retrospectively identified through a prospectively maintained institutional database. MCID thresholds were determined by a distribution-based method, while PASS thresholds were established using an anchor-based method. The PROMs analyzed included the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE), Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE), and the Veterans Rand-12 (VR-12) score. Multivariate logistic regression was performed to identify factors associated with achieving MCID and PASS. A total of 65 patients were included. The thresholds for MCID achievement and achievement rates were as follows: WOSI, 12.8 (84.6%); SANE, 14.4 (81.5%); PROMIS UE 4.4 (90.8%); VR-12 Physical, 3.9 (76.9%). The thresholds for PASS achievement and achievement rates were as follows: WOSI, 40.2 (80%); SANE, 74.9 (86.2%); PROMIS UE 40.5 (84.8%); VR-12 Physical, 49.9 (83.1%). Symptom duration >6 months was predictive of failing to achieve MCID for the WOSI and PASS for the WOSI and SANE. Preoperative hyperlaxity was predictive of failing to achieve PASS for the WOSI and PROMIS UE. A lower body mass index (BMI) was predictive of achieving PASS for the WOSI, PROMIS UE, and VR-12. The presence of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion was predictive of failing to achieve PASS for the WOSI and failing to achieve MCID and PASS for the WOSI, PROMIS UE, and VR-12 simultaneously. This study defines thresholds for MCID and PASS achievement at a minimum 2-year follow-up for patients undergoing arthroscopic anterior shoulder stabilization. Factors including symptom duration, hyperlaxity, BMI, and ALPSA lesions were found to be predictive of MCID and PASS achievement on multiple PROMs at short-term follow-up.

Postcapsulorrhaphy arthropathy (PCA) may result as a long-term sequela of instability surgery, eventually necessitating shoulder arthroplasty. Alterations to the soft tissue and bony anatomy during the index surgery may lead to unique wear patterns of the glenohumeral joint compared with what is observed in primary glenohumeral osteoarthritis (GHOA). We sought to characterize the three-dimensional glenoid morphology of patients with PCA to understand whether arthritic wear patterns are distinct from those observed in GHOA. Patients diagnosed with GHOA or PCA were retrospectively propensity matched in a 4:1 ratio by age and sex. Radiographic measurements-including glenoid inclination, version, humeral head subluxation, glenoid vault loss, and maximum erosion depth-were assessed using Materialise Surgicase Preoperative Planner. The presence of biplanar glenoid deformity, defined as glenoid inclination and version &#x2265;10&#xb0; was assessed. The PCA cohort was further stratified by capsulorrhaphy technique (open vs. arthroscopic). Univariate analysis was conducted to compare glenoid morphology between cohorts and subcohorts. After matching, the GHOA and PCA cohorts consisted of 264 and 67 patients, respectively, with no notable differences in age (GHOA 64.9 &#xb1; 7.0 years vs. PCA 63.6 &#xb1; 8.1 years; P = 0.236) or sex (85.0% male GHOA vs. 82.1% male PCA; P = 0.714). The PCA cohort demonstrated a markedly greater degree of superior inclination compared with the GHOA cohort (7.5 &#xb1; 5.4 vs. 4.3 &#xb1; 5.7; P = <0.001), although this is not likely clinically relevant. No other notable differences in any of the other radiographic measurements or parameters between GHOA and PCA cohorts were found. The arthroscopic and open PCA subcohorts consisted of 34 and 25 patients, respectively, with no notable differences in radiographic parameters observed between the open and arthroscopic cohorts (P > 0.05). Arthritic glenoid wear patterns in patients with PCA and GHOA demonstrate no notable differences despite the altered soft tissue and bony anatomy inherent to instability surgery. Subcohort analysis of open versus arthroscopic capsulorrhaphy revealed no notable differences in glenoid morphology. Although PCA presents unique surgical challenges, these may be more closely tied to soft-tissue alterations than to variations in glenoid morphology. Level III; Retrospective Comparative Study.

Our collective understanding of the pathogenesis, risk factors, and management of adjacent segment disease (ASD) following lumbar fusion has expanded markedly in recent years, necessitating an updated and comprehensive review. ASD is now recognized as a multifactorial process in which postoperative biomechanical changes accelerate degeneration, further amplified by predisposing genetic factors. Key risk factors have been identified and linked to increased rates of ASD, including elevated body mass index, preexisting degeneration at adjacent levels, and inadequate restoration of sagittal alignment, particularly pelvic incidence-lumbar lordosis mismatch. Innovative surgical techniques, including minimally invasive approaches and robotic-assisted instrumentation, have been increasingly used and researched over the past decade with the goal of reducing the incidence and progression of ASD, although long-term evidence remains mixed. Although these advancements are promising, it is important to evaluate their efficacy, limitations, indications, and contraindications using the most current available evidence. Finally, advances in diagnostic imaging and emerging biologic therapies represent a potential paradigm shift in our understanding of the pathogenesis and preventability of ASD.

Poor nutritional status is a modifiable risk factor that has been shown to have adverse outcomes in spine surgery, including higher rates of complications, poorer functional outcomes, longer hospital stays, and increased healthcare costs. As such, interest has emerged in clinical practice regarding the use of tools and important nutrient profiles that can be used to assess nutritional status both pre- and postoperatively. The purpose of this review is to synthesize the current evidence surrounding the clinical utility of various nutritional screening tools, as well as to evaluate the importance of targeted interventions. These strategies include protein and amino acid supplementation, vitamin D optimization, and preoperative carbohydrate loading; prior studies have associated these interventions with improved fusion rates, lower infection risk, and accelerated recovery. Furthermore, economic analyses in the setting of nutritional optimization are explored. Despite these benefits, substantial barriers like inconsistent protocols and patient nonadherence remain. In addition, reliance on single markers like albumin may be misleading due to inflammatory confounding, highlighting the need for multifactorial assessment that incorporates surrogates of bone quality and baseline health status. As the spine surgical population ages and procedures grow more complex, preoperative nutritional optimization represents a low-risk strategy with potential for substantial advancements in patient recovery. This review advocates for the standardization of multidisciplinary nutritional protocols as a key component of comprehensive perioperative spine care.

The purpose of this study was to assess whether patients can accurately predict and perceive their pain using an objective test. The authors hypothesized that sports medicine patients would demonstrate the ability to predict their pain tolerance. Two hundred two patients receiving care from a single surgeon at an academic medical center consented to participate in this study. Exclusion criteria included non-English speaking subjects and those younger than 18 years. Subjects were administered a survey and a pain tolerance threshold test using the "OUCH Test" by a research assistant in an examination room during their clinical encounter. The "OUCH Test" is an instrument for predictive pain tolerance, with higher levels indicating higher pain tolerance. One hundred ninety patients (94%) reached the highest level of the "OUCH Test." One hundred sixteen patients (57%) reported that they had reached a higher level on the device than they initially predicted. The correlation between actual and predicted level reached on the "OUCH Test" device was significant (r = 0.344 confidence interval, 0.217-0.461; P < 0.001). No notable differences were observed in "OUCH Test" results when comparing male and female patients, smokers and nonsmokers, Worker's Compensation patients, or patients who used pain medication in the 24 hours before their clinic visit. This study demonstrates that sports medicine patients can predict and perceive their pain tolerance with relative accuracy, offering a valuable tool for optimizing clinical decision making. II-Prospective Cohort Study.

Limited range of motion (ROM) and arthrofibrosis are complications that affect approximately 1 to 13% of patients after primary total knee arthroplasty (TKA). Manipulation under anesthesia (MUA) is the preferred treatment when failure to achieve adequate ROM in the early postoperative period occurs. This study aims to identify predictors for MUA that may guide surgeons in preoperative risk stratification. The Premier Healthcare Database was queried to identify patients aged 18 years or older who underwent elective total knee arthroplasty. Patients who underwent manipulation under anesthesia within 90 days of index surgery were compared with patients who did not. Demographics, comorbidities, and medication usage were compared between cohorts using chi-squared and t-tests. Akaike information criterion and Bayesian information criterion minimization was done to create an optimal mixed-effects model to identify risk factors. In total, 975,235 TKAs performed between 2015 and 2021 were identified. Of these, 1.55% (15,139) of patients required MUA. Patients in the MUA group were younger (62.47 &#xb1; 9.19 vs. 67.03 &#xb1; 9.24, P < 0.001) and more likely to be Black (15.91% vs. 8.29%, P < 0.001). Mixed-effects analysis revealed a decreased risk of MUA associated with perioperative dexamethasone (adjusted odds ratio [aOR] 0.925, 95% CI, 0.889-0.962, P < 0.001), daily prednisone usage (aOR 0.433, 95% CI, 0.347-0.542, P < 0.001), and angiotensin II receptor blockers (ARBs) (aOR 0.882, 95% CI, 0.840-0.927, P < 0.001). Younger age, female sex, and Black race were associated with an increased risk of MUA after TKA, while perioperative dexamethasone, daily steroids, and ARB use were protective. These findings may serve to aid surgeons in preoperative risk stratification.

The aim of this study was to evaluate the contemporary prevalence, demographics, treatment trends, and common comorbidities associated with trigger finger (TF). The TriNetX Research Network was queried for patients diagnosed with TF from January 1, 2015, to January 1, 2023, resulting in 465,763 patients. TF prevalence was assessed in the general population and in a cohort with diabetes mellitus. Demographics, comorbidities, and TF treatments were recorded. A secondary analysis examined rates of repeat injection and surgery after initial steroid injection. Comparative analyses were conducted using TriNetX's platform tools. The data demonstrated a TF prevalence of 2.0% in the general population and 5.8% in the diabetic population. Those with TF were older (60.6 vs. 39.5 years) and more likely female (63.0% vs. 54.3%) compared with those without TF. The most affected digits were the thumb (35.2%), middle finger (34.1%), and ring finger (26.0%). Approximately 13.5% and 16.6% of patients with TF underwent surgical release within 1 and 3 years, respectively. Among patients who received an initial injection, 25.9% and 36.0% received an additional injection and 13.4% and 20.1% required surgery within 1 and 3 years, respectively. After adjusting for demographic confounders, the TF cohort had nearly four times higher prevalence of carpal tunnel syndrome. TF affects 2% of the general population and nearly 6% of diabetic patients. The thumb, middle, and ring fingers are the most commonly affected, with an overall rate of surgery of 16.6% within 3 years. These data can help inform treatment decisions and guide future research.