Current Reviews in Musculoskeletal Medicine最新文献

{"title":"Correction to: Hip Arthroscopy After Total Hip Arthroplasty: A Current Review of Indications, Techniques, and Outcomes.","authors":"Justin Harrington, Patrick Castle, Nicholas Morriss, Brian Giordano","doi":"10.1007/s12178-026-10050-x","DOIUrl":"10.1007/s12178-026-10050-x","url":null,"abstract":"","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374910","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":"Parsing Through the Data on Achilles Tendon Rupture Management, Rehab and Sports Return Criteria: a Current Literature Review.","authors":"Lambert T Li, Ansh Shah, Greta Wilker, Morgan W Rice, Shana Miskovsky","doi":"10.1007/s12178-026-10043-w","DOIUrl":"10.1007/s12178-026-10043-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate and discuss controversies that have arisen as management of acute and chronic Achilles tendon ruptures continues to evolve. Areas of debate include operative versus nonoperative treatment, best repair or reconstruction techniques, timing of post-op weightbearing protocols, and newer functional rehabilitation interventions. With the incidence of Achilles tendon ruptures increasing, the goal of this review is to provide a resource in determining best treatment options.</p><p><strong>Recent findings: </strong>Evidence demonstrates that operative and nonoperative management yield comparable long-term functional outcomes. However, surgical repairs offer lower rerupture rates and earlier return to activity. There is a trend towards minimally invasive techniques for primary repairs, favored due to reduced wound complications and faster recovery. Earlier surgical intervention after injury shows improved functional outcomes. For chronic ruptures, flexor hallucis longus tendon transfer is the workhorse of secondary reconstruction. Early functional rehabilitation has been shown to be safe and effective across treatment strategies. The management of Achilles tendon injuries remains a complex clinical challenge that demands a comprehensive understanding of the tendon biomechanics, and distinct pathophysiological differences between acute and chronic presentations. Selection between operative and non-operative management requires individualized consideration, while adhering to evidence-based rehabilitation protocols is paramount to successful functional outcomes. Navigating these patient specific treatment options for various patient populations promotes optimal recovery in the short and long term.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359895","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":"Perioperative Management of Patients Undergoing Periacetabular Osteotomy: An Evidence-Based Review.","authors":"Conor Dolson, Ira Zaltz, Alex L Gornitzky","doi":"10.1007/s12178-026-10049-4","DOIUrl":"10.1007/s12178-026-10049-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Periacetabular osteotomy (PAO) is an established and effective surgical treatment for symptomatic acetabular dysplasia in adolescents and young adults with healthy articular cartilage. While outcomes and technical surgical considerations are well described, perioperative management practices vary significantly across institutions. The purpose of this narrative review was to synthesize current literature on evidence-based best practices for perioperative management of patients undergoing PAO and to identify knowledge gaps for future investigation.</p><p><strong>Recent findings: </strong>A comprehensive review of the literature was performed focusing on perioperative care across four phases: preoperative, intraoperative, acute postoperative, and rehabilitation. Areas of emphasis included laboratory evaluation and nutritional optimization, mental health screening, patient education, blood loss mitigation strategies, pain control, venous thromboembolism and heterotopic ossification (HO) prophylaxis, and postoperative rehabilitation protocols. Strong evidence exists to support specific intraoperative practices such as tranexamic acid administration, controlled hypotension, and fascia iliacus blocks for pain control. Conversely, limited or heterogeneous evidence exists regarding preoperative laboratory testing, psychosocial interventions, standardized opioid prescribing, venous thromboembolism prophylaxis regimens, and rehabilitation protocols. Psychosocial health and preoperative educational interventions appear underutilized despite growing evidence of their impact on outcomes. Significant gaps remain, particularly regarding preoperative optimization and rehabilitation strategies. Continued high-quality research is needed to establish standardized, evidence-based perioperative care pathways to further improve outcomes following PAO.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337907","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":"Osteonecrosis of the Femoral Head: Evolution of Contemporary Management Strategies.","authors":"Tyler Sharp, Nathan Davies, Justin J Greiner","doi":"10.1007/s12178-026-10048-5","DOIUrl":"10.1007/s12178-026-10048-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Osteonecrosis of the femoral head (ONFH) is a progressive condition disproportionately affecting young adults and is a leading indication for total hip arthroplasty in young adults. This review aims to provide a contemporary overview of ONFH with emphasis on treatment strategies aimed to prevent femoral head collapse and disease progression as supported by recent clinical research from the past five years.</p><p><strong>Recent findings: </strong>The 2019 revised ARCO classification has emerged as the most clinically applicable staging system, guiding treatment selection based on lesion size, location, and collapse status. Core decompression remains the surgical mainstay for pre-collapse disease. Recent evidence supports the addition of hip arthroscopy to improve clinical outcomes and increase native hip survival rates. Augmentation strategies including bone marrow aspirate concentrate (BMAC), mesenchymal stem cells (MSCs), bone grafting, and hip arthroscopy have demonstrated the most promising results when combined with core decompression in early-stage disease. Pharmacologic agents, including bisphosphonates and denosumab, have shown meaningful benefit in slowing disease progression but remain adjunctive. Total hip arthroplasty continues to demonstrate excellent long-term outcomes for post-collapse stages, even in younger patient populations. Management to prevent collapse and disease progression of ONFH remains a challenge. Joint preservation through early surgical intervention with augmentation strategies, such as addition of hip arthroscopy, bone grafting, and biologic regenerative biologic therapies represent promising advancements in ONFH management. However, the existing literature remains limited by heterogeneous study designs, small sample sizes, and inconsistent outcome reporting.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337925","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":"To Trim or Not to Trim: Revisiting Acetabuloplasty During Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Overcoverage.","authors":"Jacob D Mikula, Rakan R Alshaibi, John J Kelly, Aaron J Krych, Mario Hevesi","doi":"10.1007/s12178-026-10045-8","DOIUrl":"10.1007/s12178-026-10045-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Acetabuloplasty is a common component of hip arthroscopy for pincer-type and mixed femoroacetabular impingement (FAI), yet the optimal degree of correction remains controversial. Historically, rim trimming has often been guided by radiographic normalization, particularly of the lateral center-edge angle (LCEA). The purpose of this review is to synthesize current evidence regarding acetabular morphology, radiographic assessment, clinical outcomes related to the degree of acetabular correction, and intraoperative strategies that support optimal correction during acetabuloplasty.</p><p><strong>Recent findings: </strong>Recent literature suggests that acetabular overcoverage should not be viewed as a uniform indication for [aggressive] rim resection. Although the LCEA remains a useful measure of acetabular coverage, it incompletely captures focal versus global overcoverage, acetabular version, and dynamic impingement. Mid-term studies have demonstrated favorable outcomes after hip arthroscopy for pincer morphology, with no consistent relationship between postoperative LCEA normalization and patient-reported outcomes. In addition, patients with residual postoperative overcoverage may achieve outcomes comparable to those with normalized coverage and may actually demonstrate lower rates of conversion to arthroplasty. At the same time, excessive rim resection risks iatrogenic undercoverage, instability, edge loading, and accelerated degeneration. Current evidence supports a patient specific rather than radiographically uniform approach to acetabuloplasty. Successful treatment appears to depend on restoring functional femoroacetabular clearance while preserving sufficient acetabular coverage for joint stability and load distribution. Incremental resection, dynamic intraoperative reassessment, labral preservation, and balanced correction of acetabular- and femoral-sided pathology are central to this strategy. Future studies should emphasize three-dimensional assessment, standardized reporting, and longer-term evaluation of joint preservation.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301247","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":"Hip Arthroscopy After Total Hip Arthroplasty: A Current Review of Indications, Techniques, and Outcomes.","authors":"Justin Harrington, Patrick Castle, Nicholas Morriss, Brian Giordano","doi":"10.1007/s12178-026-10039-6","DOIUrl":"10.1007/s12178-026-10039-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Persistent pain after total hip arthroplasty (THA) is a common complication requiring extensive diagnostic effort and is often associated with potentially invasive and morbid treatment options. With THA volume expected to steadily increase there is a similarly growing need for creative and effective diagnostic and therapeutic options for these clinically challenging patients. Hip arthroscopy has emerged as a promising tool in the setting of persistent pain after THA with expanding indications and promising outcomes. The purpose of this article was to provide a review of the current state of literature regarding arthroscopic and endoscopic solutions for common causes of persistent pain after THA with a focus on patient selection, indications, surgical considerations, outcomes, and complications.</p><p><strong>Recent findings: </strong>The most common indication for hip arthroscopy after THA is iliopsoas tendinopathy, showing excellent outcomes with symptom resolution in greater than 90% of patients after arthroscopic iliopsoas release or lengthening. The second most common indication is diagnostic arthroscopy in the setting of otherwise negative extensive work-up, which has shown diagnostic value for occult implant loosening, capsular fibrosis, and metal hypersensitivity. Endoscopic decompression for the treatment of ischiofemoral impingement and sciatic nerve decompression has also shown consistent improvements in pain and function. In addition to these well described indications, future utilization of hip arthroscopy for loose body removal, capsular plication for instability, and management of prosthetic joint infection are potentially emerging indications. Hip arthroscopy after THA is a safe and effective tool for the management of common causes of persistent pain after THA with robust support for iliopsoas pathology and emerging evidence and outcomes for less common indications. Future research will both expand and narrow these indications as diagnostic criteria, patient selection, and surgical techniques are refined.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301188","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":"The Management of Acetabular Labral Tears: A Contemporary Review.","authors":"Joseph C Brinkman, Kyle N Kunze, Ty L Monty, Chandler A Sparks, Philip Malloy, Jorge Chahla, Shane J Nho","doi":"10.1007/s12178-026-10035-w","DOIUrl":"10.1007/s12178-026-10035-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize contemporary evaluation and management of acetabular labral tears, particularly in the setting of femoroacetabular impingement syndrome (FAIS), including diagnosis, nonoperative care, surgical decision-making, and rehabilitation.</p><p><strong>Recent findings: </strong>The acetabular labrum is critical for maintaining hip stability, preserving the suction seal, and distributing load. Evaluation includes history, provocative examination, radiographs to assess CAM and Pincer morphology, and advanced imaging to confirm labral pathology and exclude alternative pain generators. Nonoperative treatment, including activity modification, targeted physical therapy, and selective intra-articular injections, is first-line. Appropriately selected patients often achieve significant pain relief and functional improvement with arthroscopic hip preservation surgery. Current surgical strategies prioritize labral preservation through repair when viable, reconstruction for irreparable tissue, correction of underlying osseous abnormalities, and meticulous capsular management. Acetabular labral tears are a common source of hip pain frequently associated with FAIS. A structured diagnostic approach and stepwise management encompassing nonoperative and appropriately indicated surgical intervention optimize outcomes. Individualized, phase-based rehabilitation with objective testing and sport-specific criteria supports return to activity and sport, with typical return occurring around 6-8 months but varying widely by sport and athlete demands.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301296","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":"Ossification of the Pediatric Elbow with a Focus on Radial Head Ossification Patterns.","authors":"Tina H Tran, Hannah Chi, Tiffany C Liu, Bamidele Kammen, Ishaan Swarup","doi":"10.1007/s12178-026-10047-6","DOIUrl":"10.1007/s12178-026-10047-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Accurate interpretation of pediatric elbow imaging depends on understanding the developmental relationship between the radial head and the capitellum. While the traditional sequence of pediatric elbow ossification centers provides a useful framework, it does not capture morphologic variability, asynchronous maturation, and eccentric ossification patterns that may mimic pathology. This review synthesizes current evidence on pediatric elbow ossification with particular emphasis on normal and variant radial head development. The following key questions are addressed: (1) How frequently does eccentric radial head ossification occur on MRI? (2) What is its magnitude and relationship to age and sex? (3) How should normal variants be distinguished from pathology?</p><p><strong>Recent findings: </strong>Recent findings reveal that the capitellum commonly ossifies eccentrically before centralizing with growth. In our cohort of 66 children, radial head ossification was eccentric in 68-71% of cases in both sagittal and coronal planes. Offsets were small (average magnitude < 3%), predominantly posterior and radial, and generally did not correlate with age except for progressive centralization in the coronal plane among males. The radiocapitellar line remained reliable on the lateral view but demonstrated expected lateral offset on AP views. Eccentric radial head ossification represents a common physiologic pattern that does not reliably centralize with age. Recognition of this variant can reduce misdiagnosis and unnecessary intervention, and has implications for fracture assessment, surgical planning, and longitudinal research. Future studies should include prospective MRI tracking across diverse populations to establish normative ranges and develop quantitative tools for clinical applications.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301136","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":"Management of Labral Tears Associated with Glenohumeral Instability in Athletes.","authors":"Mina Entessari, Azra N Dees, Sarah E Watson, Dyrian D Wandick, Brian R Waterman","doi":"10.1007/s12178-026-10044-9","DOIUrl":"10.1007/s12178-026-10044-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Glenoid labral tears account for more than 10% of surgically managed shoulder injuries and are classified and managed depending on location, mechanism, associated bone loss, and patient-specific risk factors. The purpose of this review is to examine the current literature on the evaluation and management of labral pathology with associated glenohumeral instability, with a focus on rehabilitation and return to sport.</p><p><strong>Recent findings: </strong>While the management of anterior labral tears has historically been emphasized, recent studies demonstrate that posterior and combined capsulolabral injuries are more common than previously recognized. Advances in management include reduced time to surgical treatment, lower thresholds of critical glenohumeral bone loss, evolving surgical techniques with both bony and soft tissue reconstruction, as well as personalized rehabilitation protocols with a focus on periscapular and rotator cuff strengthening. Operative stabilization demonstrates superior outcomes compared to nonoperative treatment, especially in high-risk patients (e.g young age, contact sport participation, hyperlaxity). However, recurrent instability remains a persistent problem, necessitating a comprehensive approach to management in order to optimize outcomes. Optimal functional outcomes in managing labral tears require a multifaceted, patient-specific approach. Treatment decisions, rehabilitation protocols, and return to sport testing should consider individual risk factors, account for combined pathology and bone loss, and consider psychological readiness to prevent recurrent instability and optimize long-term outcomes.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276412","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":"Social Deprivation as a Driver of Disparities in Arthroplasty: A Contemporary Review.","authors":"Rimel N Mwamba, Shannon Stover, Anna Lavernia, Rachel Bergman, Linda Suleiman","doi":"10.1007/s12178-026-10046-7","DOIUrl":"10.1007/s12178-026-10046-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>While social determinants of health are known to contribute to disparities in orthopaedic care, associations between social deprivation and total joint arthroplasty (TJA) outcomes remain unclear. This review assessed the relationship between social deprivation and multiple aspects of total joint arthroplasty, including access to care, early postoperative outcomes, resource utilization, and patient-reported functional recovery.</p><p><strong>Recent findings: </strong>Recent studies have increasingly used composite deprivation indices including the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), Social Deprivation Index (SDI), and Distressed Communities Index (DCI) to examine disparities in TJA care. Higher levels of social deprivation were consistently associated with reduced arthroplasty utilization, increased early postoperative complications, longer hospital stays, higher costs, and greater likelihood of non-home discharge. Associations with emergency department use were frequent, whereas findings related to readmissions were mixed. Relationships between deprivation and patient-reported outcomes were less consistent. Across multiple studies, deprivation was not uniformly associated with failure to achieve clinically meaningful improvement but was more frequently linked to failure to achieve patient-acceptable symptom states and challenges in sustaining functional recovery. Social deprivation is an important determinant of access, perioperative outcomes, and healthcare utilization following TJA, with ADI demonstrating the most consistent association. Although socially deprived patients generally achieve meaningful postoperative improvement, they are less likely to reach optimal recovery thresholds. Incorporating deprivation measures into perioperative planning may help identify patients who would benefit from targeted interventions. Future studies should standardize index use and evaluate strategies to reduce socioeconomic disparities in arthroplasty outcomes.</p>","PeriodicalId":10950,"journal":{"name":"Current Reviews in Musculoskeletal Medicine","volume":"19 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276332","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}