The Journal of Bone & Joint Surgery最新文献

{"title":"Orthopaedic Care in Norway: Organization, Research, and Quality Improvement","authors":"Lene Bergendal Solberg,Jan-Erik Gjertsen,Eivind Inderhaug,Frede Frihagen","doi":"10.2106/jbjs.26.01026","DOIUrl":"https://doi.org/10.2106/jbjs.26.01026","url":null,"abstract":"➢ Norway has a universal, publicly funded orthopaedic health-care system through a network of public hospitals serving a geographically dispersed population of 5.6 million inhabitants. ➢ Orthopaedic care is characterized by salaried surgeons, close collaboration between hospitals, standardized treatment pathways, and equitable access to specialist services. ➢ National orthopaedic quality registries and high-quality clinical research are integrated into clinical practice, enabling continuous outcome monitoring, benchmarking, and rapid implementation of evidence-based improvements. ➢ Orthopaedic leadership has been central to several national quality improvement initiatives, including the development of secondary fracture prevention programs and national clinical guidelines, demonstrating how clinician-led collaboration can translate research into improvements in patient care. ➢ The Norwegian model demonstrates how universal health care, national collaboration, orthopaedic quality registries, and clinician-led innovation can be integrated to support high-quality orthopaedic care and continuous improvement.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What’s New in Osteoporosis and Fragility Fractures","authors":"Ronald Man Yeung Wong,Minghui Yang,Matthew L. Costa,Xinbao Wu,Seung Beom Han,Anna Noel Miller,Peter V. Giannoudis,Chunpeng Zhao,Ting Li,Yu Wang,Chun Sing Chui,Takeshi Sawaguchi,Gustavo Duque,Irewin Tabu,Joon Kiong Lee,Chaoran Liu,Jing Zhang,Xinyi Zhang,Sheung Wai Law,Wing Hoi Cheung,Maoyi Tian","doi":"10.2106/jbjs.26.00579","DOIUrl":"https://doi.org/10.2106/jbjs.26.00579","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma and Orthopaedic Surgery in Colombia","authors":"Rodrigo Pesantez,Camilo A. Delgadillo,Carlos Mario Olarte,Julian Salavarrieta,Eduardo Jose Burgos","doi":"10.2106/jbjs.26.00817","DOIUrl":"https://doi.org/10.2106/jbjs.26.00817","url":null,"abstract":"➢ The Colombian health-care system ensures universal health-care coverage, but access to timely orthopaedic and trauma care remains fragmented and unevenly distributed. ➢ The country faces a high burden of musculoskeletal injuries resulting from interpersonal violence and traffic accidents, the latter of which primarily involve motorcycles ➢ The main high-complexity hospitals and subspecialty services are centralized in major urban centers, which generates persistent inequities tied to geographic factors. ➢ Colombia has a well-established orthopaedic community, university residency programs, subspecialty societies, international academic partnerships, and a growing educational infrastructure. ➢ Future priorities include tiered referral pathways with defined transfer criteria, regional workforce distribution, national orthopaedic injury registries, digital integration, and locally led international collaboration.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Good Quality of Life 3 Decades After Rotationplasty","authors":"Gitte G.J. Krebbekx,Mylène J.C. Duivenvoorden,Inger N. Sierevelt,Niels F.J. Waterval,S. John Ham,Gerard R. Schaap,Jos A.M. Bramer,Gino M.M.J. Kerkhoffs,Floortje G.M. Verspoor","doi":"10.2106/jbjs.25.01227","DOIUrl":"https://doi.org/10.2106/jbjs.25.01227","url":null,"abstract":"Background: Long-term quality of life (QoL) after rotationplasty is important because prolonged patient survival has become more common. This study assessed QoL decades after rotationplasty. Methods: This cross-sectional study included surviving patients who had been treated for lower-extremity tumors, primaily sarcoma, between 1980 and 2002 at 2 Dutch centers. Patient-reported outcomes were assessed using the Short Form (SF)-36 Physical and Mental Component Summary (PCS and MCS) scores, Toronto Extremity Salvage Score (TESS), and Prosthesis Evaluation Questionnaire (PEQ). Functional status was assessed using the Musculoskeletal Tumor Society (MSTS) score. Results were compared with reference data from the general population and sarcoma survivors, and factors associated with better QoL outcomes were explored. Results: Thirty-three patients (mean age, 48.1 ± 8.9 years; mean follow-up, 32.8 ± 4.7 years) were included. Eighteen participants (54.5%) were female. The mean SF-36 PCS and MCS were 47.1 ± 10.4 and 52.2 ± 9.1, respectively. The mean TESS and MSTS were 88.2 ± 10.3 and 24.4 ± 5.4, respectively. Compared with a reference population with a history of lower-extremity sarcoma, patients who had been treated with rotationplasty scored higher on the PCS (p < 0.01) and TESS (p = 0.01). Only physical functioning was lower than in a general population (p = 0.01). Employment, relationship status, higher MSTS and TESS scores, greater satisfaction with prosthesis-related aspects of function and use on the PEQ, and greater overall satisfaction with rotationplasty were associated with higher PCS or MCS scores (p < 0.05). Conclusions: Rotationplasty appears to offer good long-term QoL outcomes and therefore remains a viable treatment option. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proportional Harmony or Radiographic Precision? Interpreting the Role of T4-L1 Pelvic Angle Normalization in Long-Segment Adult Spinal Deformity Fusion","authors":"Anas Al Abdallat","doi":"10.2106/jbjs.26.00295","DOIUrl":"https://doi.org/10.2106/jbjs.26.00295","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What’s New in Musculoskeletal Tumor Surgery","authors":"Pietro Ruggieri,Anna Breda,Andrea Angelini","doi":"10.2106/jbjs.26.01114","DOIUrl":"https://doi.org/10.2106/jbjs.26.01114","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Macrophage Activation Is Reduced by CCR2 Knockout in a Murine Subacromial Impingement Model","authors":"Matthew R. Covello,Camila B. Carballo,Krishna Pedaprolu,Vincent J. H. Yao,Sidharth Ranga,Alexander Piacentini,Yuki Suzuki,Yuki Okazaki,Edward Bowen,John W. Babich,James M. Kelly,Scott A. Rodeo,Claire D. Eliasberg","doi":"10.2106/jbjs.26.00704","DOIUrl":"https://doi.org/10.2106/jbjs.26.00704","url":null,"abstract":"Background: Rotator cuff (RC) tendinopathy is a prevalent cause of shoulder pain and disability, yet its underlying molecular drivers remain poorly defined. Increasing evidence highlights the role of early inflammation and macrophage activation in symptom development and disease progression. C-C chemokine receptor 2 (CCR2) regulates monocyte recruitment and pro-inflammatory macrophage signaling in tendinopathy. This study characterizes the temporal inflammatory profile of RC tendinopathy and evaluates the impact of CCR2 knockout in a murine subacromial impingement (SAI) model. Methods: Sixty mice (40 C57BL/6J wild type [WT SAI] and 20 CCR2 knockout [CCR2KO]) underwent bilateral placement of a subacromial surgical clip to induce RC impingement. Four additional C57BL/6J mice underwent sham surgery (WT sham controls). Animals were assessed through 42 days. Macrophage activation was quantified using microPET/CT (micro-positron emission tomography/computed tomography) and gallium-68-labeled folate receptor ligand. Selected WT SAI mice were killed at early and intermediate time points for temporal gene expression profiling. The remaining mice were killed on day 42 for histological, biomechanical, or gene expression analyses. Results: WT SAI mice demonstrated a reproducible pattern of early macrophage activation, peaking on postoperative days 3 and 7. CCR2KO mice exhibited significantly reduced macrophage activation at these time points. Gene expression analysis of WT SAI supraspinatus tendons revealed early upregulation of inflammatory and M1 macrophage-related genes, followed by later increases in anti-inflammatory mediators and M2 macrophage-related markers. CCR2KO tendons demonstrated fewer tendinopathic changes on histology but did not exhibit superior biomechanical properties compared with WT SAI tendons. Conclusions: RC tendinopathy exhibits a distinct early inflammatory phase characterized by macrophage activation and M1 macrophage-dominant signaling. CCR2KO reduces early inflammatory activity and may attenuate tendon degeneration. Clinical Relevance: Defining the inflammatory progression of RC disease may help to refine treatment strategies—particularly the use and timing of nonsteroidal anti-inflammatory drugs, corticosteroid injections, and emerging biologic therapies. CCR2 represents a potential therapeutic target for modulating early inflammation and improving tendon healing.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Denying and Delaying Indicated Care: The True Cost","authors":"Maximillian Y. Lee,Aditya S. Mazmudar,Rohit Rajput,Shreya Kurup,Dipankar Yettapu,Daniel K. Park,Kern Singh","doi":"10.2106/jbjs.26.01049","DOIUrl":"https://doi.org/10.2106/jbjs.26.01049","url":null,"abstract":"Cost in health care is not simply the dollar amount of a transaction. When a claim for indicated surgery is denied or delayed, savings are not guaranteed and patient outcomes likely worsen. Delays resulting from prior authorization create an administrative burden, and patients bear the burden of prolonged conservative care, lost workforce participation, and added psychological toll. Delaying or denying indicated surgery does not reduce cost; it simply redistributes it.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microstructural Vulnerability of the Tibial Tubercle Apophysis During Growth Hormone Therapy","authors":"Peter D. Fabricant,Samuel A. Beber,Camilo Perdomo-Luna,Katherine D. Groff,Sarah Lu,Ola Kvist,Sogol Mostoufi-Moab,Daniel W. Green,Diego Jaramillo","doi":"10.2106/jbjs.26.00599","DOIUrl":"https://doi.org/10.2106/jbjs.26.00599","url":null,"abstract":"Background: Tibial tubercle avulsion fractures occur in pediatric patients during periods of physeal vulnerability and have been associated with exposure to growth hormone therapy (rhGH). Diffusion tensor imaging-magnetic resonance imaging (DTI-MRI) can detect alterations in physeal microarchitecture by characterizing water diffusion along the organized cartilaginous columns of the physis. This study leveraged DTI-MRI to evaluate whether initiation of rhGH therapy is associated with temporally distinct changes in tibial tubercle physeal microstructure, which could potentially predispose children and adolescents to tibial tubercle avulsion fractures. Methods: Patients were recruited as part of a multicenter prospective cohort study. Skeletally immature patients aged ≥6 years scheduled to initiate rhGH therapy underwent DTI-MRI before rhGH administration and 4, 8, and 12 months after therapy initiation. Linear mixed-effects models were used to assess the effect of time on DTI metrics, with Dunnett-adjusted post hoc comparisons. Baseline skeletal age was included as a covariate. Results: Fifty-three patients were enrolled; 68% were male, 83% were White, and the mean skeletal age at therapy initiation was 10 ± 3 years. The apparent diffusion coefficient (ADC) in the tibial tubercle increased in 71% of patients after rhGH administration, with the maximum increase at 8 months. In adjusted mixed-effects models, ADC was significantly higher at 8 months compared with baseline (1.61 × 10 −3 [95% confidence interval (CI): 1.55 to 1.68 × 10 −3 ] versus 1.52 × 10 −3 [95% CI: 1.46 to 1.58 × 10 −3 ] mm 2 /sec, p = 0.041). Greater skeletal age was independently associated with lower ADC (β = −3.17 × 10 −5 , p < 0.001), higher fractional anisotropy (β = 0.011, p < 0.001), and higher tract volume (β = 0.106, p = 0.015). Conclusions: DTI-MRI identified temporally distinct microstructural changes at the tibial tubercle following rhGH initiation. The increase in ADC suggests transient physeal expansion and remodeling within at least the first 8 months of treatment, during a time in which ADC would typically be decreasing with normal skeletal maturation. This study therefore provides mechanistic insight into the reported association between rhGH therapy and tibial tubercle avulsion fractures. Adjusting impact sports and activities during this vulnerable time should be strongly considered. Level of Evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149092043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopaedic Surgery Should Consider a Change in Name","authors":"Mohammad Diab","doi":"10.2106/jbjs.26.00747","DOIUrl":"https://doi.org/10.2106/jbjs.26.00747","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}