Journal of Bone and Joint Surgery, American Volume最新文献

{"title":"Medial Collateral Ligament Injury in Posterior Cruciate Ligament Tibial Avulsion Fractures: An Underrecognized Finding.","authors":"Binghao Wang, Teng Ye, Xuetao Xie, Binbin Zhang, Yukai Wang, Luhao Sun, Congfeng Luo, Yi Zhu","doi":"10.2106/JBJS.25.00826","DOIUrl":"10.2106/JBJS.25.00826","url":null,"abstract":"<p><strong>Background: </strong>Posterior cruciate ligament tibial avulsion fracture (PCLAF) is relatively rare. This fracture may be accompanied by soft tissue injuries, most commonly involving the medial collateral ligament (MCL). The present study aimed to determine the rate of MCL injury and its association with fracture characteristics in patients with PCLAF.</p><p><strong>Methods: </strong>Patients with PCLAF were identified with computed tomography, and associated ligamentous and meniscal injuries were evaluated with magnetic resonance imaging. Fracture morphology was assessed via heat maps and quantitative measurements. Receiver operating characteristic (ROC) curves and logistic regression analyses were utilized to identify predictors of MCL injury.</p><p><strong>Results: </strong>A total of 148 ethnic Chinese patients with PCLAF were included (mean age, 48.1 ± 12.9 years; 33.1% female), and 28.4% had concomitant MCL injuries. MCL injuries were significantly associated with posterior horn tears of the medial meniscus (p < 0.001). Patients with MCL injuries exhibited a larger fracture distribution area on heat maps. Consistent with that finding, quantitative analysis showed that these patients had a significantly smaller fracture medial border (p < 0.001) and a significantly larger fracture anteroposterior diameter percentage (p < 0.001). Multivariable analysis identified a fracture anteroposterior diameter percentage of ≥50.2% as an independent predictor of MCL injury (odds ratio, 13.74; 95% confidence interval, 4.85 to 38.95; p < 0.001).</p><p><strong>Conclusions: </strong>MCL injury is relatively common in patients with PCLAF and tends to occur concomitantly with a larger avulsed fragment. The fracture anteroposterior diameter percentage may serve as a valuable predictor for identifying concomitant MCL injury.</p><p><strong>Level of evidence: </strong>Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1453-1460"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance with the CONSORT AI Extension in Orthopaedic Randomized Controlled Trials.","authors":"Thomas Strasser, Christopher Baker, Jenna Cheminant, Blake Han, Sallie Canumay, John Schlechter","doi":"10.2106/JBJS.25.01439","DOIUrl":"10.2106/JBJS.25.01439","url":null,"abstract":"<p><strong>Background: </strong>The utilization of artificial intelligence (AI), such as machine learning, in health care has risen exponentially, underscoring the necessity of transparency and traceability in the reporting of AI in randomized controlled trials (RCTs) that involve AI. In 2020, a CONSORT (Consolidated Standards of Reporting Trials) AI extension was published that included 14 additional items that should be reported when AI is used in RCTs. This study aimed to evaluate compliance with these additional guidelines.</p><p><strong>Methods: </strong>A systematic approach was used to identify all RCTs in orthopaedics that involved AI since the extension was published. Three databases were searched (PubMed, Embase, Cochrane) using the search terms ([orthopaedic] OR [orthopedic]) AND ([artificial intelligence] OR [AI] OR [machine learning] OR [deep learning]).</p><p><strong>Results: </strong>One hundred and seventy-four articles were identified, and 11 articles satisfied the inclusion and exclusion criteria and were assessed for compliance. The average number of CONSORT AI-extension items met per study was 11.4 ± 1.6 (81.2% ± 12.1%). Eight items (1a [i], 1b [ii], 2a [i], 4a [i], 5 [ii], 5 [v], 5 [vi], 19) that were related to standard reporting of AI utilization were reported in all articles. The items with the lowest reporting rates were related to data transparency and included 4a (ii), 5 (iii), and 25, with only 9.1%, 36.4%, and 45.5% of all studies complying, respectively.</p><p><strong>Conclusions: </strong>Orthopaedic RCTs involving AI showed high compliance with respect to standard trial reporting and broad AI descriptors but low compliance with respect to detailed data transparency, data-quality handling, and code accessibility. Addressing these weaker areas is essential to improve reproducibility, reduce bias, and strengthen trust in AI-driven clinical research.</p><p><strong>Clinical relevance: </strong>Improved compliance with CONSORT-AI reporting standards may help orthopaedic clinicians to critically evaluate AI-based randomized trials, reproduce findings, and determine whether AI interventions are reliable and safe for clinical use.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1440-1444"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin-Loaded Mesh Reduces Staphylococcal Infection in a Murine Extensor Mechanism Reconstruction Model.","authors":"Tsung-Li Lin, Nicholas A Bedard, Melissa J Karau, Sebastian C Herren, Robin Patel, Matthew P Abdel","doi":"10.2106/JBJS.26.00619","DOIUrl":"https://doi.org/10.2106/JBJS.26.00619","url":null,"abstract":"<p><strong>Background: </strong>Infection following extensor mechanism reconstruction (EMR) with Marlex mesh (C.R. Bard) is devastating and limb-threatening. The purpose of this study was to evaluate whether vancomycin-loaded mesh reduces staphylococcal infection in a murine EMR model.</p><p><strong>Methods: </strong>Mouse-sized, 8-layer mesh constructs were fabricated to simulate clinical reconstruction and soaked in a vancomycin solution (50 mg/mL) for in vitro and in vivo testing. Three methicillin-resistant clinical isolates from human periprosthetic Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus lugdunensis knee infections were evaluated. In vitro testing assessed vancomycin loading capacity, mechanical properties, antibacterial activity, and inhibition of biofilm formation. For in vivo experiments, plain or vancomycin-loaded mesh was implanted into C57BL/6 mouse extensor mechanisms, which were intraoperatively contaminated with 1 of the 3 study isolates (5 per group). Mesh and surrounding tissue were harvested for quantitative culture on postoperative day 9.</p><p><strong>Results: </strong>For all 3 isolates, vancomycin-loaded mesh produced zones of inhibition and exhibited antibacterial activity through at least 3 days in vitro (p < 0.0001). Mechanical testing revealed that loading mesh with vancomycin did not negatively impact tensile strength, hysteresis, or suture pull-through properties. In vitro testing of inhibition of biofilm formation demonstrated reduced colony-forming units 6 hours after inoculation, which remained low throughout the 9-day experimental period (p < 0.05 for all isolates). In vivo, vancomycin-loaded mesh reduced bacterial burden on mesh and in surrounding tissue by >3 log10 compared with plain mesh for all 3 isolates (p < 0.01 for both mesh and tissue).</p><p><strong>Conclusions: </strong>Vancomycin-loaded mesh provided in vitro antibacterial activity without compromising mesh mechanical properties and reduced staphylococcal infection in a murine EMR model. Further work is needed to evaluate translational potential and safety before clinical application.</p><p><strong>Clinical relevance: </strong>Mesh-associated infection after EMR is devastating and difficult to treat. These preclinical findings suggest that local vancomycin delivery may serve as an adjunct to systemic prophylaxis, warranting further study before clinical use.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Global Implementation Gap in Immediate Weight-Bearing After Hip Fracture Surgery: The WAIT-Free Consensus for Low-Adoption Regions.","authors":"Wei Mao, Jia Jiang, Zhong-Min Shi, Choon Chiet Hong, Ruqayyah Yahya Turabi, Mahmoud Abdel Karim, Falethu Sukati, Vincenzo Giordano, Marco Antonio Altamirano-Cruz, Alberto López Reyes, Yan Li, Vivek Trikha, Muhammad Asif Rasheed, Jirawat Saengsin, Cagatay Tekin, Lisa Grünberg, Nazrul Nashi, Khin Yee Sammy Loh, Yun-Feng Rui, Ke-Wei Tian, Zhen-Hai Wang, Tao Liu, Li Zhang, Ao-Lei Yang, Ming Chen, Sun-Jun Hu, Shou-Chao Du, Shi-Min Chang, Ivan Tjun Huat Chua, Wei-Tao Jia, Xin Ma","doi":"10.2106/JBJS.26.00980","DOIUrl":"https://doi.org/10.2106/JBJS.26.00980","url":null,"abstract":"<p><p>Postoperative care for hip fractures remains globally inequitable. Immediate weight-bearing as tolerated (WBAT) after surgery is widely recommended in North America and Europe, yet it is not routinely implemented across regions that collectively represent over half of the world's population, including the People's Republic of China, South Asia, Southeast Asia, the Middle East, Latin America, and Africa (hereafter referred to as low-adoption regions [LARs]). To address this gap, the WAIT-Free Consensus was developed to support the safe and sustainable implementation of immediate WBAT for older adults with a hip fracture in these settings. A multidisciplinary Consensus Development Group of 31 international experts from 15 countries reviewed the available evidence and used a structured, 3-round Delphi process with a consensus threshold of ≥2/3 to develop and refine recommendations. The final consensus statement comprised 13 recommendations organized around 4 domains: (1) shared decision-making with proportionate documentation of informed discussions about benefits and realistic risks, (2) mobility-based stratification that prioritizes immediate WBAT for patients who were independently ambulatory before the fracture, (3) structured fall prevention and multidisciplinary perioperative optimization, and (4) postoperative stability-related triage to individualize weight-bearing protocols after internal fixation versus arthroplasty. In addition, a pragmatic supportive-factor checklist is provided to guide phased implementation. This consensus statement provides a structured, evidence-informed pathway for LARs to adopt immediate WBAT after hip fracture surgery in older adults. The recommendations can be adapted to local resource constraints, with implementation audited using context-specific indicators and refined iteratively as capacity and evidence evolve.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cement Brand and Mixing Sequence Determine Vancomycin Elution from High-Dose PMMA Spacers: An in Vitro Comparative Study.","authors":"Mohammed Hammad, Christina A Chao, Mathias P Bostrom, Alberto V Carli","doi":"10.2106/JBJS.25.00745","DOIUrl":"https://doi.org/10.2106/JBJS.25.00745","url":null,"abstract":"<p><strong>Background: </strong>High-dose vancomycin is routinely mixed into polymethylmethacrylate (PMMA) spacers for chronic periprosthetic joint infection (PJI). The precise manner by which to maximize elution remains unknown, and the impact of PMMA-antibiotic mixing sequences remains unexplored.</p><p><strong>Methods: </strong>Sixty PMMA discs (5 formulations consisting of 2 PMMA brands, 2 viscosities, presence or absence of premixed gentamicin) were mixed with 4 g of vancomycin using either a polymer-first or monomer-first sequence. Vancomycin elution was quantified over 28 days, antimicrobial activity against methicillin-sensitive Staphylococcus aureus was tested, and micro-computed tomography scans were performed to assess porosity. Elution amounts were compared with Holm-corrected t tests and are reported as the mean ± standard error.</p><p><strong>Results: </strong>Vancomycin retained bactericidal activity across all formulations. Monomer-first mixing of Palacos MV (medium-viscosity) yielded the greatest cumulative elution (2,897 ± 64 µg/mL), 120% greater than monomer-first mixing of Simplex P. A monomer-first sequence increased vancomycin elution from medium-viscosity Palacos MV by 57% compared with high-viscosity Palacos R. Polymer-first mixing of Simplex P yielded the greatest immediate elution over the first hour (415 ± 33 µg/mL), as well as a 52% greater cumulative elution amount over 28 days versus its monomer-first sequence. Premixed gentamicin only increased vancomycin elution for high-viscosity formulations. No significant differences were seen in porosity.</p><p><strong>Conclusions: </strong>The cement brand and mixing sequence significantly influenced elution of high-dose vancomycin from PMMA. Palacos MV mixed monomer-first produced the greatest cumulative antibiotic delivery, whereas polymer-first Simplex P maximized initial release. The mixing methods did not deleteriously affect PMMA integrity or antimicrobial activity.</p><p><strong>Clinical relevance: </strong>Clinicians should consider their choice of PMMA brand, viscosity, and mixing sequence when preparing high-dose spacers in revision arthroplasty for PJI. Maximizing cumulative elution may be a clinically favorable strategy to improve PJI eradication.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification of Forearm Involvement in Multiple Hereditary Exostoses: Consensus from the CoULD Study Group.","authors":"Carley Vuillermin, Maria F Canizares, Patricia E Miller, Lindley B Wall, Suzanne E Steinman, Ann Van Heest","doi":"10.2106/JBJS.25.01593","DOIUrl":"https://doi.org/10.2106/JBJS.25.01593","url":null,"abstract":"<p><strong>Background: </strong>Existing classifications for forearm deformity in multiple hereditary exostoses (MHE) have demonstrated low interrater reliability and limited clinical applicability. Our primary research question was whether a Delphi consensus process could generate a more reliable and clinically useful classification for longitudinal surveillance of MHE-related forearm deformities.</p><p><strong>Methods: </strong>Fifteen pediatric hand surgeons from the Congenital Upper Limb Difference (CoULD) Study Group participated in 7 rounds of online Delphi surveys (June 2022 to September 2023). An investigator team facilitated the process with anonymized feedback. Round 1 identified key clinical and radiographic features. Subsequent rounds refined these features, determined categorical structure, and piloted the system with representative radiographs. Consensus was defined as ≥70% agreement. After final consensus, interrater reliability was tested by 4 independent surgeons who classified 101 radiographs from 67 patients with forearm MHE. Reliability was assessed with kappa and concordance coefficients and compared with the Masada, Gottschalk, and Jo classifications.</p><p><strong>Results: </strong>The Delphi process identified radiographic predictors that included ulnar variance, the radial articular angle (RAA), radial head alignment, and osteochondroma size. Consensus favored a 3-tier classification: Type 1, mild; Type 2, moderate; and Type 3, severe. Closing consensus was achieved, with 93% agreement. Reliability testing showed moderate agreement on the first reading (kappa = 0.55), significantly higher than for the Masada (kappa = 0.21 [original classification], kappa = 0.35 [modified version]), Gottschalk (kappa = 0.43), and Jo (kappa = 0.43) classifications. After refinement that incorporated osteochondroma size and the radial head subtypes (3A, subluxation, and 3B, dislocation), agreement improved to substantial (kappa = 0.64) (p < 0.001), with high concordance (0.82).</p><p><strong>Conclusions: </strong>The CoULD MHE Classification, developed through expert consensus, integrates validated radiographic predictors with defined thresholds. It demonstrated significantly improved reliability over prior systems and provides a practical framework for longitudinal monitoring of forearm deformities in patients with MHE.</p><p><strong>Level of evidence: </strong>Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision Risk Following Primary Anatomic and Reverse TSA with an Exactech Equinoxe Compared with Other Devices: A U.S.-Based Cohort Study.","authors":"Heather A Prentice, Richard N Chang, Edward Yian, Ronald A Navarro, Anshuman Singh, Danny P Chan, David Ding, Josie A Elwell, Jessica Degrasse, Chris Roche, Elizabeth W Paxton","doi":"10.2106/JBJS.25.01594","DOIUrl":"https://doi.org/10.2106/JBJS.25.01594","url":null,"abstract":"<p><strong>Background: </strong>In 2024, Exactech issued a voluntary recall of Equinoxe devices after finding that some devices had been packaged in bags that were non-conforming because a secondary oxygen barrier layer of ethylene vinyl alcohol was missing. We sought to evaluate the revision risk following shoulder arthroplasty using an Exactech Equinoxe device compared with other eligible devices.</p><p><strong>Methods: </strong>We conducted a cohort study using data from a U.S. health-care system's shoulder arthroplasty registry. The study included 13,901 adult patients who had undergone primary elective anatomic total shoulder arthroplasty (ATSA), elective reverse total shoulder arthroplasty (RTSA), or RTSA for fracture (2005 to 2023). The mean age for the ATSA cohort (N = 8,707) was 68 years, 53.3% were male, and 84.7% were White. Corresponding values for the elective RTSA cohort (N = 4,374) were 74 years, 41.2% male, and 79.9% White, and those for the RTSA for fracture cohort (N = 820) were 73 years, 16.3% male, and 78.4% White. Multivariable Cox regression with covariate adjustment was used to evaluate all-cause revision risk for Equinoxe devices compared with other devices.</p><p><strong>Results: </strong>In adjusted analyses, a higher revision risk was observed for ATSAs with Equinoxe versus other devices (hazard ratio [HR] = 1.87, 95% confidence interval [CI] = 1.33 to 2.62). The higher revision risk was also observed in a subanalysis restricted to ATSAs with Equinoxe devices packaged in non-conforming bags (HR = 1.91, 95% CI = 1.34 to 2.72). No differences were observed in elective RTSAs (HR = 0.71, 95% CI = 0.33 to 1.49) or RTSAs for fracture (HR = 2.30, 95% CI = 0.84 to 6.28) with Equinoxe compared with other devices.</p><p><strong>Conclusions: </strong>We observed a higher revision risk with the use of Equinoxe devices in ATSA, but no difference for Equinoxe devices in elective RTSA compared with other devices. While all Equinoxe devices packaged in non-conforming bags were recalled worldwide in 2024, clinicians should be mindful of these findings when a patient had previously received an Equinoxe ATSA device.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Arthroplasty in Context: Balancing Evidence and Innovation in Joint Replacement.","authors":"Andrew Fraval, Ashok Rajgopal, Kevin J Bozic, Mohit Bhandari, Javad Parvizi","doi":"10.2106/JBJS.26.00706","DOIUrl":"https://doi.org/10.2106/JBJS.26.00706","url":null,"abstract":"<p><p>➢ This review examines the contemporary evidence surrounding robotic-assisted joint replacement, including its effects on surgical precision, clinical outcomes, and implant survivorship, and the broader implications for innovation in arthroplasty.➢ Current evidence consistently demonstrates that robotic-assisted arthroplasty improves the precision and reproducibility of component positioning. However, systematic reviews, meta-analyses, randomized trials, and national registry data have not demonstrated consistent improvements in patient-reported outcomes, complication rates, or implant survivorship.➢ The existing literature is limited by statistical fragility, heterogeneity among robotic platforms, and a disconnect between scientific evidence and public enthusiasm.➢ Future value may lie in the integration of robotics with large-scale data acquisition and data-driven personalization, although these concepts remain largely unproven.➢ The experience of robotic-assisted arthroplasty highlights the need for a more rigorous evidence-based framework for innovation in orthopaedic surgery, with adoption guided by demonstrable improvements in patient outcomes and health-care value rather than technical precision alone.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's New in Musculoskeletal Basic Science.","authors":"Stuart B Goodman, Jaimo Ahn, Edward Ebramzadeh","doi":"10.2106/JBJS.26.00996","DOIUrl":"https://doi.org/10.2106/JBJS.26.00996","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Self-Rehabilitation With Versus Without Sling Immobilization After Open Latarjet Procedures for Recurrent Anterior Shoulder Instability: A Randomized Controlled Trial.","authors":"Patrick Goetti, Hugo Bothorel, Tiago Martinho, Antoine Seurot, Jeanni Zbinden, Philippe Collin, Alexandre Lädermann","doi":"10.2106/JBJS.25.00560","DOIUrl":"https://doi.org/10.2106/JBJS.25.00560","url":null,"abstract":"<p><strong>Background: </strong>Recent research has highlighted the adverse effects of immobilization in shoulder rehabilitation. The present study aimed to compare the efficacy of immediate self-rehabilitation with and without sling immobilization following an open Latarjet procedure for recurrent anterior shoulder instability.</p><p><strong>Methods: </strong>This monocentric randomized controlled trial included 86 patients (median age, 26; 92% male) divided into 2 groups: sling immobilization for 3 weeks postoperatively and no sling immobilization. Patients were evaluated with use of patient-reported outcome measures (PROMs), motion-capture analysis, and computed tomography scans before and 6 months after surgery. An additional questionnaire was administered at 2 years postoperatively to update PROMs. The primary outcome was the Rowe score. Secondary outcomes included visual analogue pain scale scores, single assessment numeric evaluation (SANE) scores for instability, patient satisfaction, range of motion, return to work and sport activities, graft union, and osteolysis. Patient acceptable symptom states were calculated and utilized to interpret PROMs. Multivariable linear and modified Poisson regressions were utilized to evaluate the effect of sling immobilization on different outcomes, independent of age, sex, preoperative PROMs, and range of motion.</p><p><strong>Results: </strong>Both groups had comparable PROMs, range of motion, and radiographic outcomes at 6 months postoperatively, with no statistically significant differences observed between groups. At 2 years postoperatively, the no-sling group reported greater Rowe and SANE instability scores by 12.5 points (p = 0.005) and 7.9 points (p = 0.001), respectively. The no-sling treatment was more likely to achieve very high patient satisfaction (relative risk [RR], 1.53; p = 0.015), Rowe patient acceptable symptom state (RR, 1.47; p = 0.012), and SANE instability scores (RR, 1.55; p = 0.001). Two recurrent shoulder dislocations occurred in the sling group (5%).</p><p><strong>Conclusions: </strong>Immediate self-rehabilitation without sling immobilization yielded superior functional scores at 2 years after a Latarjet procedure. Both approaches resulted in excellent early functional outcomes and a high return-to-sport rate, suggesting that sling avoidance did not negatively impact patient recovery. As a result, the practice of sling immobilization following open Latarjet procedures may be reconsidered. Further investigation into optimal postoperative rehabilitation strategies is warranted.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}