Clinical Orthopaedics and Related Research®最新文献

{"title":"Increasing Trends of Pediatric Thoracic and Lumbar Spine Fractures in the United States from 2004 to 2023: A 20-year National Injury Review Depicting Shifts in Mechanisms of Injury.","authors":"Patrick P Nian, Ithika S Senthilnathan, Isabella G Marsh, Christopher J Williams, Jessica H Heyer","doi":"10.1097/CORR.0000000000003421","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003421","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the thoracic and lumbar spine are uncommon injuries in children and adolescents, but they carry substantial morbidity and a real risk of death. Compared with the adult spine, the pediatric spine has unique anatomic and biomechanical properties that yield different fracture patterns than the adult population. The mechanisms of injury and degree of skeletal maturity constitute important predictors of the outcomes of pediatric thoracic and lumbar fractures; however, there remains a paucity of meaningful epidemiologic data with specific attention to the pediatric spine.</p><p><strong>Questions/purposes: </strong>(1) What are the overall incidence and trends of all-cause pediatric thoracic and lumbar fractures in the past 20 years, and how do these differ by age and sex? (2) What are the primary mechanisms of injury responsible for all-cause pediatric thoracic and lumbar fractures, and how do these differ by age and sex? (3) What are the sex-specific incidence risks of all-cause pediatric thoracic and lumbar fractures in the past 20 years? (4) What are the age-specific incidence risks of all-cause pediatric thoracic and lumbar fractures in the past 20 years?</p><p><strong>Methods: </strong>The National Electronic Injury Surveillance System (NEISS) is a publicly available database from a nationally representative sample of emergency departments that offers key details on mechanisms of injury and a statistically valid calculation method of national injury estimates. The NEISS was retrospectively queried for patients ages 0 to 18 years who presented with all-cause thoracic and lumbar fractures between 2004 and 2023. Thoracic and lumbar fractures were identified from upper trunk and lower trunk fracture NEISS diagnosis codes, filtering out nonpertinent diagnoses such as rib, hip, or pelvis fractures (72% [5853 of 8131]). From relevant thoracic and lumbar fractures, only acute fractures were included after narrative review; chronic or incidental fractures or spondylolysis (0.2% [5 of 2278]) and acute fractures that did not specify an affected thoracic or lumbar region (6% [136 of 2278]) were subsequently excluded. Collected variables included age, sex, hospitalization, primary mechanism of injury, fracture level(s), and fracture type. Each NEISS case record is assigned a statistical weight, representing an estimate of such injury occurring nationally. The aggregate of these weights in patients presenting with a thoracic or lumbar fracture provides a total national estimate of these injuries. Age was subsequently classified into children (younger than 14 years) and adolescents (ages 14 to 18 years). There were 1064 case records of thoracic fractures, 988 case records of lumbar fractures, and 85 case records of thoracic and lumbar fractures between 2004 and 2023, corresponding to a national estimate of 26,732 thoracic fractures, 29,274 lumbar fractures, and 2083 thoracic and lumbar fractures after computing the ag","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Among People Presenting for Musculoskeletal Specialty Care, Is There an Association of Accommodation of Aging and Other Mindset Factors With Levels of Comfort and Capability?","authors":"Jefferson Hunter, Juan Pablo Flanagan, Aydin Azarpey, Niels Brinkman, David Ring, Prakash Jayakumar, Amin Razi","doi":"10.1097/CORR.0000000000003427","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003427","url":null,"abstract":"<p><strong>Background: </strong>Many musculoskeletal symptoms arise from the natural decline of cells and tissues with age (senescence). Among patients seeking care for those conditions, symptom intensity often corresponds more with thoughts and feelings about bodily sensations than with the severity of any pathophysiology. Population studies suggest that a large percentage of people manage to live with (accommodate) symptoms from these conditions without seeking care, and that as people age, healthy attitudes toward sensations from musculoskeletal senescence may help them accommodate these kinds of symptoms; to our knowledge, however, this has not been specifically studied.</p><p><strong>Questions/purposes: </strong>In a cross-sectional study of patients presenting for musculoskeletal specialty care, we asked: (1) Are there factors associated with accommodation of aging, including mindsets measured as levels of unhelpful thoughts, feelings of distress, and intolerance of uncertainty? (2) Are there any factors associated with pain intensity, including comfort with aging and mindset measures? (3) Are there any factors associated with level of capability, including comfort with aging and mindset measures?</p><p><strong>Methods: </strong>One hundred fifty-six English-speaking adults (age 18 to 89 years) presenting for initial or return specialist evaluation of a musculoskeletal problem (largely an unselected sample of patients with common lower and upper extremity problems) in a single large urban city in the United States agreed to participate. Among the 98% (153) who completed the survey and were analyzed, 57% (87) were women, the mean age was 53 ± 17 years, 69% (105) were non-Hispanic White, and 47% (72) had private insurance. Participants completed an 11-point ordinal measure of pain intensity, a measure of level of capability (a person's perception of the level of difficulty of specific activities, distinct from objective impairment or incapacity), intolerance of uncertainty (that is, a negative regard for uncertainty), unhelpful thoughts (unhealthy misinterpretations) regarding sensations, feelings of distress (worry or despair) regarding sensations, and attitudes toward aging (quantified positive or negative regard for aging), all using instruments with evidence supporting their ability to measure these constructs. Factors associated with levels of accommodation of aging, pain intensity, and incapability were analyzed using multivariable regression models, limiting the models to a single mental health variable because of concerns about collinearity and selecting the best performing model based on the Akaike information criterion. To account for known and anticipated collinearity of the mental health measures, we also performed a k-means cluster analysis to identify statistical groupings of unhelpful thoughts regarding sensations, distress regarding sensations, and intolerance of uncertainty and tested for differences in attitudes toward aging","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bicruciate-stabilized TKA Does Not Result in Improved Patient-reported Outcomes Compared With Posterior-stabilized TKA: A Randomized Controlled Trial in Bilateral Simultaneous TKA.","authors":"Man Soo Kim, Keun Young Choi, Jae Won Na, Yong In","doi":"10.1097/CORR.0000000000003423","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003423","url":null,"abstract":"<p><strong>Background: </strong>Traditional posterior-stabilized implants use a cam-post mechanism as a substitute for the PCL, aiming to enhance stability and ROM. Bicruciate-stabilized TKA has been developed to mimic the function of both the ACL and PCL using a dual-cam mechanism. Despite these theoretical advantages, improvements in actual clinical and functional outcomes of bicruciate-stabilized implants compared with posterior-stabilized implants, if any, remain unproven.</p><p><strong>Questions/purposes: </strong>(1) Does bicruciate-stabilized TKA result in improved posterior offset ratio and patellar tendon angle (AP position and translation of the femur in relation to sagittal plane parameters) compared with posterior-stabilized TKA? (2) Are postoperative patient-reported outcomes (PROs) superior in knees treated with bicruciate-stabilized TKA than those treated with posterior-stabilized TKA?</p><p><strong>Methods: </strong>A prospective, single-center, patient-blinded, parallel-group randomized controlled trial was performed in 50 patients (100 knees) undergoing simultaneous bilateral TKA for primary osteoarthritis between November 2019 and April 2020. All patients underwent same-day bilateral TKAs using a bicruciate-stabilized implant (bicruciate-stabilized group) in one knee and a posterior-stabilized implant (posterior-stabilized group) in the other. Fifty patients were screened and enrolled, but two patients were lost to follow-up, so 48 patients (96 knees) were analyzed. The mean ± SD patient age was 75 ± 6 years, and 96% (46) of patients were women. Preoperatively, there were no between-group differences in terms of clinical parameters, including ROM, hip-knee-ankle angle, Knee Society Score (KSS), and WOMAC score. Radiographic measurements, including the posterior offset ratio, patellar tendon angle, joint line orientation angle, and static AP laxity, were obtained at 2 years postoperatively. Also at 2 years postoperatively, PROs were compared using the KSS, WOMAC score, and Forgotten Joint score (FJS); in addition, patients were asked which knee was their \"preferred\" knee. To address the challenge of evaluating PROs for a single patient with bilateral TKA, patients were instructed to independently evaluate each knee while performing daily activities, including distance walked and stair climbing, based on their subjective perception of comfort and functionality in each knee.</p><p><strong>Results: </strong>The radiographic results showed that at 2 years, knees treated with the bicruciate-stabilized device had greater patellar tendon angles than those treated with the posterior-stabilized device (patellar tendon angle: 15° ± 4° versus 9° ± 4°; mean difference -6° [95% confidence interval (CI) -7° to -5°]; p < 0.001). The knees treated with the bicruciate-stabilized device had a smaller posterior offset ratio than those treated with the posterior-stabilized device (5% ± 4% versus 18% ± 4%, mean difference 13% [95% CI 11% to 15%]; p ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Transhumeral Osseointegration After Amputation Improve Patient-reported Outcomes and Prosthesis Use?","authors":"Jonathan A Forsberg, Julio A Rivera, Ashley B Anderson, Jason M Souza, Benjamin K Potter","doi":"10.1097/CORR.0000000000003420","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003420","url":null,"abstract":"<p><strong>Background: </strong>Individuals who have undergone transhumeral amputation often have difficulty wearing conventional socket-based prostheses, leading to frequent dissatisfaction and abandonment of the prosthesis. Osseointegration surgery may alleviate or mitigate many of these issues by providing a firm, reliable attachment between the humerus and the prosthesis, potentially leading to better functionality and quality of life; however, it is unclear whether the risks inherent to transdermal bone-anchored implants outweigh the potential functional benefits.</p><p><strong>Questions/purposes: </strong>(1) Were there improvements in patient-reported outcome measures at 2 years among patients with transhumeral amputations undergoing osseointegration compared with presurgical function in those patients? (2) What was the frequency and severity of complications related to the osseointegration procedures?</p><p><strong>Methods: </strong>Between October 2016 and April 2021, we recruited 12 active duty service members, retirees, and healthcare beneficiaries to undergo transhumeral osseointegration surgery using the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in this prospective, observational study. The primary indication was difficulty wearing a traditional socket-based prosthesis after extended efforts to do so and a residual humerus of ≥ 10 cm, while the exclusion criteria were a residual humerus of<≤ 10 cm, BMI > 35 kg/m2, severe peripheral vascular disease including diabetes, taking immunosuppressant medications, pregnancy, and those unable to sign their own consent. A total of 24 people were screened, and 12 met the inclusion criteria. All 12 participants (all men with a mean ± SD age of 38 ± 12 years) completed the minimum follow-up time of 2 years for this analysis. The majority of the patients' mechanism of injury was blast (10 of 12) followed by motor vehicle collision (2 of 12). All 12 participants in this prospective FDA early feasibility study underwent both Stage 1 (fixture implantation into the humerus) and Stage 2 (muscle and skin fashioning) surgery, and none was lost to follow-up at a minimum of 2 years after April 2021. Participants were asked to complete the DASH questionnaire, the Defense and Veterans Pain Rating Scale (DVPRS), and items from three domains of the Patient-Reported Outcomes Measurement Information System (PROMIS) before surgery and at 3, 6, 12, and 24 months after the second stage of the procedure. They also reported their prosthetic use time in hours in a day and days in a week. We recorded the frequency of complications related to the procedure, including soft tissue, mechanical, and infectious complications.</p><p><strong>Results: </strong>Participants had improvements in mean ± SD DASH scores between baseline (36 ± 23) and a minimum of 2-year follow-up (19 ± 13) (mean difference 17 [95% confidence interval (CI) 1 to 33]; p = 0.04), and they had increases in days per","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leptin Enhances M1 Macrophage Polarization and Impairs Tendon-Bone Healing in Rotator Cuff Repair: A Rat Model.","authors":"Yinghao Li, Lei Yao, Yizhou Huang, Long Pang, Chunsen Zhang, Tao Li, Duan Wang, Kai Zhou, Jian Li, Xin Tang","doi":"10.1097/CORR.0000000000003428","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003428","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tears are common, affecting more than 60% of individuals older than 80 years, and they have been implicated in 70% of patients with shoulder pain. M1 polarization-related inflammation has been reported to be associated with poor healing outcomes of rotator cuff injury, and leptin, an adipokine, has been reported to be a potential activator of inflammation. However, whether leptin affects rotator cuff repair remains unknown.</p><p><strong>Questions/purposes: </strong>Using in vitro cell experiments and an in vivo rat rotator cuff tear model, we therefore asked: (1) Does leptin promote the M1 polarization of macrophages in vitro and in vivo? (2) Does leptin impair biomechanical strength, the histologic structure of the tendon-bone interface, bone mineral density (BMD), or gait in the rotator cuff tear scenario? (3) Does leptin promote M1 polarization by upregulating the tumor necrosis factor (TNF) pathway?</p><p><strong>Methods: </strong>The impact of leptin on M1 macrophage polarization in vitro was determined by reverse transcription-polymerase chain reaction (RT-PCR), the Western blot test, and immunofluorescence staining. The effect of leptin on tendon-bone healing was assessed in an in vivo rat rotator cuff tear model by comparing a leptin group with a suture group in terms of gait, biomechanical tensile strength, the histologic structure of the tendon-bone interface, and BMD. In the in vivo experiments, 8-week-old male Sprague Dawley rats were used, adapting a previously developed rat rotator cuff tear model. The supraspinatus tendon was resected from the greater tuberosity bilaterally, and then the tendon was secured to its anatomical footprint using the transosseous single-row technique. In total, 30 rats were randomized into two groups (suture, leptin) by drawing lots (15 rats in each group). They were assessed at 2, 4, and 8 weeks after the surgery. In the suture group, 100 µL of normal saline was injected into the subacromial space after the deltoid muscle was restitched to the original position. In the leptin group, 100 µL of leptin solution (200 ng/mL) was injected into the subacromial space after the deltoid muscle was restitched to the original position. Biomechanical properties including maximal failure load, stiffness, and tensile failure stress were determined to assess the biomechanical strength at 4 and 8 weeks after the surgery. Histologic staining was conducted to compare the structure of the tendon-bone interface between treatment groups. Micro-MRI and micro-CT assessments were conducted to compare the overall healing outcome and BMD between treatment groups. Gait analysis was conducted to compare the stride length and strength between treatment groups. M1 macrophage polarization in vivo at the tendon-bone interface was assessed by immunofluorescence staining. Finally, to explore the underlying mechanism of the effects of leptin, Necrostatin-1 (Nec-1) was used to block the TNF sign","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Medical and Recreational Marijuana State Laws Impact Trends in Postoperative Opioid Prescriptions Among Patients Who Have Undergone TJA?","authors":"Andrew Grant, Ruijia Niu, Anna Michalowski, Ayesha Abdeen, Eric L Smith","doi":"10.1097/CORR.0000000000003422","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003422","url":null,"abstract":"<p><strong>Background: </strong>Total joint arthroplasty (TJA) is a painful procedure frequently managed with opioid medication, which puts patients at risk for chronic opioid use. Marijuana is a pain modifier and may be an effector of opioid-use reduction. Recently, many states have legalized the use of medical and recreational marijuana, and these legalization events have correlated with reductions in opioid prescriptions. This trend has not yet been demonstrated in the context of orthopaedic surgery, and there is limited evidence overall investigating the effect of marijuana on perioperative opioid use in TJA.</p><p><strong>Question/purposes: </strong>(1) Is legalization of medical marijuana associated with changes in perioperative opioid use in patients who have undergone TJA? (2) Is legalization of recreational marijuana associated with changes in perioperative opioid use in patients who have undergone TJA? (3) Are these changes observed in any specific subpopulations of patients who have undergone TJA?</p><p><strong>Methods: </strong>The MarketScan Commercial and Medicare Supplemental Claims and Encounters Database was queried to assess the relative effect of marijuana legalization on perioperative opioid use in THA and TKA between May 1, 2017, and September 30, 2021, which was around and after the time that the opioid crisis was declared a public health emergency. We identified 129,132 inpatient TJA procedures (THA = 49,718, TKA = 79,414). The perioperative period was defined as 30 days before surgery and 90 days after surgery. We used the recreational and medical marijuana legalization effective dates in all 50 states and Washington, DC to conduct a difference-in-difference analysis to compare trends of outpatient opioid prescriptions among patients who underwent TJA in states with legalizations of medical or recreational marijuana with those among patients who underwent TJA in states without a change in marijuana legalization status.</p><p><strong>Results: </strong>We observed no impact of medical marijuana legalization on morphine milligram equivalent (MME)/day (difference-in-difference change 4.38 [95% confidence interval (CI) -4.49 to 13.22]). However, recreational marijuana legalization implementation was associated with an increase in MME/day (difference-in-difference change 8.83 [95% CI 0.22 to 17.43]). When we looked at specific patient groups, the implementations of medical and recreational marijuana laws were both associated with increases in perioperative opioid prescriptions in women, while recreational marijuana legalization was associated with increased opioid use in patients undergoing TKA and patients without prior use of opioids.</p><p><strong>Conclusion: </strong>We did not identify differences with respect to medical marijuana legalization implementation. However, we found that recreational marijuana legalization was associated with an increase in perioperative MME/day for TJA. This is important because surgeons in stat","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Proximal Femur Reconstruction With a Vascularized Fibula and Allograft Successful at Reconstructing a Tumor Resection in Children 6 Years of Age or Younger?","authors":"Luca Cevolani, Eric Lodewijk Staals, Tanya Fernández-Fernández, Anna Mammone, Marco Innocenti, Domenico Andrea Campanacci, Davide Maria Donati, Marco Manfrini, Laura Campanacci","doi":"10.1097/CORR.0000000000003414","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003414","url":null,"abstract":"<p><strong>Background: </strong>Treating bone sarcomas in young children, particularly in the proximal femur, is challenging because of the need to preserve growth potential, maintain joint function, and conserve bone for future revisions. In 1997, we introduced a new technique combining a vascularized fibula that preserved the proximal epiphysis to substitute for the femoral head and physis with a massive bone allograft aimed at providing a supportive scaffold for the autograft during growth. This approach initially showed promising results in both anatomic and functional restoration, but because it was a complex operation, we believed that longer term follow-up of this procedure would be helpful to judge its value as a potential reconstructive option.</p><p><strong>Questions/purposes: </strong>(1) What proportion of patients achieved allograft union; what proportion exhibited radiologic signs of vitality in the vascularized fibula, demonstrating bone growth and remodeling; what proportion avoided revision surgery; and what complications were observed with this technique? (2) What were the observed outcome scores using the Musculoskeletal Tumor Society (MSTS) score? (3) What was the status of the hip after treatment?</p><p><strong>Methods: </strong>Between 1997 and 2010, a total of 14 patients who were 6 years old or younger underwent resection of the proximal femur for a bone sarcoma in two sarcoma centers. Six patients were treated with a vascularized fibular autograft plus bulk allograft reconstruction. The median (range) length of the proximal femur resection was 13 (11 to 14) cm. During the period in question, we generally performed the vascularized fibular autograft plus bulk allograft when the acetabular diameter was < 36 mm. None of those who had the fibula autograft plus bulk allograft reconstruction were lost to follow-up before 2 years without meeting a study endpoint (revision, reoperation) or died prior to 2 years with implants intact. All six patients in the original group had either a follow-up of at least 14 years or had met a study endpoint (revision, reoperation) before that minimum surveillance duration; these patients were the focus of the current study. We noted that two patients had follow-up periods of 20 and 27 years but have not been seen in the last 5 years; they were included for survivorship analysis purposes, yet we emphasize that we cannot ascertain their current status. The median (range) follow-up was 17 (14 to 27) years.</p><p><strong>Results: </strong>Six of six patients achieved allograft union, while five of six underwent reoperations, and four of six had the graft removed as part of a revision procedure at a median (range) of 19 (7 to 40) months. Only one patient maintained the original reconstruction after 27 years, despite an epiphysiolysis that occurred 56 months after surgery, which was corrected surgically. The other five patients experienced a complication of the reconstruction at a median (range) onset","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Gabapentinoids Effective at Reducing Pain and Improving Sleep After Nerve Injury? A Systematic Review and Meta-analysis.","authors":"Ebubechi K Adindu, Nienke A Krijnen, Sierra N Short, Teun Teunis","doi":"10.1097/CORR.0000000000003415","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003415","url":null,"abstract":"<p><strong>Background: </strong>Gabapentinoids are increasingly prescribed off-label to reduce the intensity of peripheral nerve injury-related pain and improve sleep. However, randomized controlled trials (RCTs) comparing gabapentinoids to placebo show differing results, and the crossover design used in some of these trials carries a significant risk of unblinding. Considering that side effects of gabapentinoids are common and misuse is increasing, we pooled the blinded data to provide the best available evidence on the efficacy of gabapentinoids compared with placebo.</p><p><strong>Questions/purposes: </strong>In this meta-analysis of RCTs of patients with peripheral nerve injuries, we asked: Are gabapentinoids superior to placebo in terms of (1) pain reduction or (2) mitigating sleep disruption?</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane Library for RCTs from January 2000 up to January 2022. Only studies reporting on nerve injuries, measuring pain intensity with a VAS or numeric rating scale, were included. Our search yielded 1862 articles: 1218 from Embase, 559 from PubMed, and 85 from the Cochrane Library. We excluded 338 duplicate studies, leaving 1524 remaining studies. After an initial title and abstract screen, we excluded an additional 1512 studies. In all, 12 full texts were analyzed, and 4 studies were included in our meta-analysis, which involved 919 total patients: 402 were treated with either gabapentin or pregabalin, 394 with placebo, and 123 with both in two crossover trials. In the 3 of 4 studies wherein gender distribution of the patient populations was specified, women represented 57% (143 of 250) and 47% (118 of 250) of the patients in the treatment and placebo groups, respectively. The mean ± SD age was 52 ± 13 years for both the treatment and placebo groups. Risk of bias was assessed with the Cochrane Risk of Bias tool and was low for all included studies. We addressed the high risk of unblinding in the crossover trials by excluding the after crossover (unblinded) results. Certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate. All included studies lacked an objective consensus reference test to diagnose peripheral nerve injury, therefore leading to indirectness of available results.</p><p><strong>Results: </strong>Gabapentinoids did not reduce pain compared with placebo at 1 month (-0.21 [95% confidence interval (CI) -0.72 to 0.29]; p = 0.40) nor at 2 to 4 months (-0.38 [95% CI -0.76 to 0.00]; p = 0.05) after treatment. Additionally, gabapentinoids showed no clinically important difference in sleep interference compared with placebo at 2 to 4 months (-0.56 [95% CI -0.91 to -0.22]; p < 0.01), with a minimum clinically important difference of -1.5.</p><p><strong>Conclusion: </strong>The best available evidence, now consisting of four RCTs, suggests that gabapentinoids should not be used to reduce pain intensity or sleep di","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.","authors":"Charu Jain","doi":"10.1097/CORR.0000000000003418","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003418","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Are the Minimum Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptom State Thresholds for the Modified Harris Hip Score and International Hip Outcome Tool 12 Among Patients Who Undergo Periacetabular Osteotomy?","authors":"Zachary A Trotzky, Ryan G Smolarsky, Sophia J Madjarova, Olivia M Jochl, Benjamin F Ricciardi, Stephen Lyman, Catherine H MacLean, Benedict U Nwachukwu, Ernest L Sink","doi":"10.1097/CORR.0000000000003393","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003393","url":null,"abstract":"<p><strong>Background: </strong>The utility of patient-reported outcome measures (PROMs) has been well established, but their interpretation relies on population-specific definitions of meaningful improvement. As such, the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) thresholds have become prominent metrics in the orthopaedic evidence to ascribe clinical relevance to numeric PROM scores. Studies assessing outcomes of periacetabular osteotomy (PAO) relative to the MCID and PASS have previously evaluated patients against thresholds defined for hip arthroscopy for the treatment of femoroacetabular impingement or distribution-based MCID calculations. These scores may not accurately reflect the status or expectations of patients with a different symptom profile undergoing open hip preservation surgery.</p><p><strong>Questions/purposes: </strong>For patients treated with PAO, we sought to (1) define the MCID, SCB, and PASS threshold values for the mHHS (modified Harris hip score) and International Hip Outcome Tool 12 (iHOT-12) using anchor-based methods; (2) assess the validity of MCID and SCB estimates against minimal detectable change (MDC) values; and (3) determine the proportion of patients who achieved a clinically meaningful threshold.</p><p><strong>Methods: </strong>Between February 2011 and May 2023, a total of 690 patients underwent PAO for symptomatic acetabular dysplasia at one institution and were included in a longitudinally maintained hip preservation registry. The cohort used to define and validate MCID, SCB, and PASS threshold values consisted of those with a completed postoperative anchor questionnaire, which yielded 456 patients as potentially eligible. An additional 139 patients were excluded because of missing mHHS or iHOT-12 scores during the eligibility window (1 to 2 years postoperatively), leaving 70% (317 of 456) of patients to define and validate MCID, SCB, and PASS at a mean ± SD of 1.0 ± 0.3 years of follow-up. A minimum 1-year follow-up was chosen to reduce recall bias. The cohort for defining MCID, SCB, and PASS (94% [298 of 317] women, mean ± SD age at time of surgery 27 ± 8 years) included 21% (68 of 317) of patients with prior ipsilateral surgery. From those registry patients without complete anchor questionnaires, 37% (137 of 373) were identified with pre- and postoperative PROM scores at a mean ± SD of 1.0 ± 0.9 years of follow-up to form the sample for assessing the proportion of patients achieving a clinically meaningful threshold. The MCID, SCB, and PASS thresholds for the mHHS and iHOT-12 were calculated through an anchor-based approach, using area under the receiver operating curve to determine cut points that best identified positive responses, according to quality of life-based anchor questions. The MDC was calculated with confidence intervals (CIs) reflecting 80%, 90%, and 95% certainty to determine the smallest change in the PR","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}