Current Reviews in Musculoskeletal Medicine最新文献

{"title":"Adolescent Idiopathic Scoliosis: Advances in Diagnosis and Management.","authors":"Alexander H Jinnah, Kyle A Lynch, Taylor R Wood, Michael S Hughes","doi":"10.1007/s12178-024-09939-2","DOIUrl":"https://doi.org/10.1007/s12178-024-09939-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>Adolescent idiopathic scoliosis (AIS) is a disabling spinal pathology, with a significant morbidity if left untreated. This review investigates the recent advances in the diagnosis and management of AIS.</p><p><strong>Recent findings: </strong>Low radiation techniques have become a paramount focus in the management of patient's with AIS. The EOS system is growing in popularity due to lower radiation compared to conventional radiographs with the added advantage allowing 3D reconstruction. Bracing remains the standard treatment for curves amenable to this, however, due to the importance in compliance with brace wear there has been a recent push for more personalized brace construction using 3-dimensional printing. If curves are not amenable to bracing, then surgical intervention is generally recommended. Posterior spinal fusion (PSF) remains the gold standard; however, newer growth modulating techniques are in their infancy. Anterior vertebral body tethering (VBT) is a relatively novel method of treatment for AIS, that has seen promising early results. Due to its novelty and varying results VBT use remains limited and will need to be further investigated. AIS is a complex disease without a clear understanding of it's etiology. If identified earlier, then non-operative treatment may lead to prevention of curve progression and the need for surgical intervention. Newer technologies, such as the EOS system, allow 3D reconstruction of curves which can assist with pre-operative planning. PSF remains the gold standard surgical intervention for AIS, however, new developments in alternative techniques could have a promising future, especially for skeletally immature patients.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909388","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":"Management of Horizontal Cleavage Meniscus Tears.","authors":"Zachary R Burnett, David C Flanigan","doi":"10.1007/s12178-024-09940-9","DOIUrl":"https://doi.org/10.1007/s12178-024-09940-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>The management of horizontal cleavage meniscus tears (HCT) has evolved in recent years. Historically, HCTs have been treated with partial meniscectomy, but multiple studies have shown the long-term risks of development of arthritic changes in the knee following meniscectomy. These findings have renewed interest in meniscal preservation whenever possible, even in older patients not previously considered for meniscus repair. This article provides an overview of current management of horizontal cleavage meniscus tears and describes modern surgical techniques for repair of HCTs.</p><p><strong>Recent findings: </strong>Current research studies have continued to emphasize the benefits of meniscal preservation on long-term function. Recent data has demonstrated similar success rates following repair of HCTs compared to repair of other types of meniscus tears. Additionally, multiple recent studies have demonstrated the potential benefit of biologic augmentation in decreasing failure rate after meniscal repair. Modern surgical techniques and biologic augmentation have improved outcomes of meniscal repair. However, consideration of a patient's individual goals, activity level, and expectation are important to achieve a successful outcome regardless of treatment modality. While not every patient is a candidate for meniscal repair, current data has shown it should be considered for a growing number of patients.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892506","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":"Osteomyelitis and Septic Arthritis of the Upper Extremity in Pediatric Patients.","authors":"Nnaoma M Oji, Coleen S Sabatini","doi":"10.1007/s12178-024-09938-3","DOIUrl":"https://doi.org/10.1007/s12178-024-09938-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>For pediatric osteomyelitis and septic arthritis, 10-24% of cases occur in the upper extremity (UE). Due to delays in presentation and diagnosis, UE infections are often more complex and severe than infections of the lower extremity (LE). This review evaluates the literature from the past 6 years related to pediatric osteomyelitis and septic arthritis of the UE and provides a guide for professionals managing these conditions in children.</p><p><strong>Recent findings: </strong>The shoulder and elbow are the most commonly affected joints, and the humerus is the most commonly affected bone. As with the LE, diagnosis of UE osteoarticular infections is based on clinical evidence, laboratory data, and diagnostic imaging. While Staphylococcus aureus is the primary bacteria identified in UE infections, there is an underappreciation of the burden from Kingella kingae as a causative organism in culture-negative patients where PCR is not performed. Septic joints should be treated with irrigation and debridement urgently, with subsequent antibiotic therapy for a minimum of 2-4 weeks. For acute osteomyelitis without abscess or concomitant septic joints, antibiotic therapy is standard of care. Methicillin-resistant Staphylococcus aureus is associated with more severe infection requiring more surgeries. Various strategies exist for managing segmental bone loss in chronic osteoarticular infections. Osteomyelitis and septic arthritis tend to occur less frequently in the UE than the LE but have a devastating impact on the health and quality of life of children around the world. Complete resolution of disease can be achieved through an individualized approach to antibiotic and operative management. Further study is needed to assess the efficacy of aspiration as a primary treatment strategy in UE joints.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881715","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":"Treatment Options, Return to Play, and Functional Performance after Operatively and Non-operatively Managed Acute Scaphoid Fractures.","authors":"Mark L Dunleavy, Nicholas Pilla, Michael Darowish","doi":"10.1007/s12178-024-09935-6","DOIUrl":"https://doi.org/10.1007/s12178-024-09935-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Scaphoid fractures are commonly encountered injuries in the athletic population. Conservative management is pursued for incomplete fractures and those involving the distal pole. Operative management is indicated for displaced fractures, unstable fractures, and those involving the proximal pole. Complete non-displaced scaphoid waist fractures can be treated operatively or non-operatively based on patient and surgeon preference. The purpose of this article is to discuss the treatment, rehabilitation, and return to play guidelines for scaphoid injuries.</p><p><strong>Recent findings: </strong>CT scan is critically important to determine fracture displacement (which influences treatment choices) and healing (which influences return to activity determination). Nondisplaced scaphoid waist fractures can be treated with casting with 99.4% healing rate. Surgical treatment can hasten return to activities; newer surgical constructs have been suggested including dual screw fixation, plating, and staples. Outcomes of scaphoid fractures are generally favorable, as long as the selected treatment achieves a united, well-aligned scaphoid. In the athletic population specifically, there are high return to play rates and functional performances seen after these injuries. Each athlete is unique with regard to chosen sport, level of play, fracture type, and timing of the injury. Treatment options and return-to-play must be determined in a case-by-case manner to ensure an optimal clinical outcome.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784430","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":"Endoprosthetic Reconstruction for Proximal Humerus Tumors.","authors":"Favian Su, Edgar Garcia-Lopez, Rosanna Wustrack, Drew A Lansdown","doi":"10.1007/s12178-024-09933-8","DOIUrl":"https://doi.org/10.1007/s12178-024-09933-8","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Anatomic and reverse endoprosthetic reconstruction are two common surgical options used after tumor resection of the proximal humerus. The purpose of this article is to provide an overview of the functional outcomes and complications of modern anatomic and reverse endoprostheses.</p><p><strong>Recent findings: </strong>The anatomic endoprosthesis has traditionally been a successful reconstructive technique as it provided a stable platform upon which the hand and elbow could function. However, the reverse endoprosthesis has gradually replaced the anatomic endoprosthesis given that its semi-constrained design affords greater stability. Patients with reverse endoprostheses have improved motion, patient-reported outcome scores, and revision-free implant survivorship compared to those with anatomic endoprostheses. Shoulder function may be further improved with a reverse allograft prosthetic composite (APC) due to reconstruction of the rotator cuff tendons or by transferring the latissimus dorsi and teres major tendons to recreate the function of the posterosuperior rotator cuff muscles. The short-term functional improvement observed with the use of an allograft reconstruction, however, may diminish with longer follow-up due to delayed graft complications, such as resorption, nonunion, and fracture. In most patients undergoing oncologic resection of the proximal humerus, the reverse endoprosthesis or reverse APC is recommended due to improved functional outcomes and reduced postoperative complications compared to other reconstructive techniques.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767272","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":"The Effect of Platelet Dose on Outcomes after Platelet Rich Plasma Injections for Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.","authors":"William Berrigan, Frances Tao, Joel Kopcow, Anna L Park, Isabel Allen, Peggy Tahir, Aakash Reddy, Zachary Bailowitz","doi":"10.1007/s12178-024-09922-x","DOIUrl":"10.1007/s12178-024-09922-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>This study aims to systematically review platelet dosage in platelet rich plasma (PRP) injections for common musculoskeletal conditions.</p><p><strong>Recent findings: </strong>Notable heterogeneity exists in the literature regarding platelet dosage. Clinical studies indicate that a higher dosage may lead to improved outcomes concerning pain relief, functional improvement, and chondroprotection in knee osteoarthritis (OA). However, the impact of dosing on other musculoskeletal pathologies remains uncertain. Our investigation identifies a potential dose-response relationship between platelet dose and PRP effectiveness for knee OA treatment, pinpointing an optimal threshold of greater than 10 billion platelets for favorable clinical outcomes. Notably, this effect appears more pronounced for functional outcomes than for pain relief. For other conditions, a lower dosage may suffice, although the existing literature lacks clarity on this matter. PRP dosage may significantly influence treatmentoutcomes, particularly in knee OA. Further research is warranted to elucidate optimal dosages for varying conditions.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":"570-588"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoporosis Management for Shoulder Surgeons.","authors":"Kelsey M Healy, Jacob Ritter, Emily Barr, Jessica L Churchill, Nicholas A Trasolini, Brian R Waterman, Alan W Reynolds","doi":"10.1007/s12178-024-09927-6","DOIUrl":"10.1007/s12178-024-09927-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this review is to aggregate currently available literature as it pertains to treating surgical shoulder pathology in patients with osteoporosis.</p><p><strong>Recent findings: </strong>Emerging data surrounding perioperative use of anti-osteoporosis medications for patients undergoing shoulder surgery have not shown definitively favorable or unfavorable outcomes. Similar evaluations in animal studies have shown promising results as a biologic augment to tendon and bone healing, especially with newer, anabolic agents. The mainstay of bone health management remains pre-operative evaluation, using opportunistic radiographic and CT based validated measurements, along with optimization of risk factors. Surgical techniques continue to incorporate implants that perform well in osteopenic bone. Promising pre-clinical studies have identified anabolic anti-osteoporosis medications as viable biologic augments to shoulder surgery, which has not been borne out in any clinical studies at this time.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":"559-569"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy?","authors":"Erin S Wilson, Kyle R Wagner, Andrea M Spiker","doi":"10.1007/s12178-024-09928-5","DOIUrl":"10.1007/s12178-024-09928-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia.</p><p><strong>Recent findings: </strong>Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":"538-547"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humeral Stem Design in Reverse Total Shoulder Arthroplasty.","authors":"Andrew C Lehman, Favian Su, Brian T Feeley","doi":"10.1007/s12178-024-09931-w","DOIUrl":"10.1007/s12178-024-09931-w","url":null,"abstract":"<p><strong>Purpose of the review: </strong>There have been tremendous modifications to the humeral component since Paul Grammont first introduced the reverse total shoulder arthroplasty in 1985. The purpose of this article is to review historical design features and their drawbacks and to summarize the clinical outcomes of modern designs.</p><p><strong>Recent findings: </strong>Decreasing the neck-shaft angle and increasing humeral lateralization have helped address problems of scapular notching and limited internal and external rotation that were common with traditional designs. Advancements in proximal porous coatings have also facilitated the development of short-stem and stemless implants, which decreases the need for cement fixation and allows preservation of bone stock. Moreover, a reduction in stem length with smaller metaphyseal and diaphyseal filling ratios may limit stress shielding. Current humeral implants have an aseptic loosening rate less than 1%. Despite promising results, many of these new humeral design features do not have long-term data and continued surveillance of their performance is necessary. The humeral stem design significantly influences clinical and radiographic outcomes. Surgeons should be mindful of these design variables to increase impingement-free range of motion, minimize scapular notching, reduce stress shielding, and improve implant survivorship.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":"616-624"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Non-Operative Interventions for Anterior Knee Pain.","authors":"Nicole B Katz, Nicholas Tsitsilianos, Andrew S Nowak, Stephanie R Douglas, Adam S Tenforde, Joanne Borg-Stein","doi":"10.1007/s12178-024-09930-x","DOIUrl":"10.1007/s12178-024-09930-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review presents evidence for advanced non-operative interventions, including extracorporeal shockwave therapy (ESWT), prolotherapy, platelet-rich plasma (PRP), adipose tissue-derived cells, bone marrow aspirate concentrate, various additional non-corticosteroid injectates, and needle-based interventions for common causes of anterior knee pain in the adult population. These etiologies include osteoarthritis of the knee, patellofemoral pain syndrome, chondromalacia patella, Hoffa fat pad impingement syndrome, patellar/quadriceps tendinopathy, and prepatellar bursitis. This review discusses patient care options using a case-based understanding of interventions by condition while recognizing strength of evidence.</p><p><strong>Recent findings: </strong>ESWT and PRP are the most robustly studied and have greatest evidence for treating tibiofemoral osteoarthritis and for long-term benefit in treating patellar tendinopathy. PRP may have evidence for treatment of chondromalacia and prolotherapy for management of tibiofemoral arthritis; both have limited evidence. Botulinum neurotoxin type A has strong evidence to support use in treating patellofemoral pain syndrome. There is limited evidence to support the use of viscosupplementation, percutaneous needle tenotomy, and medicinal signaling cell-based therapies beyond platelet-rich plasma for anterior knee pain. There is limited research on the management of quadriceps tendinopathy, prepatellar bursitis, patellofemoral osteoarthritis, and Hoffa's fat pad impingement syndrome. Further research and standardization of protocols are necessary to fully assess these treatments' efficacy. ESWT, cell-based, and needle-based interventions, may serve as effective treatment options for patients with anterior knee pain. Selection of each intervention requires understanding the evidence, level of risk, and appropriate application based on a patient's level of activity to enable clinicians to enhance patient outcomes and quality of life.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":" ","pages":"589-615"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}