The Journal of Bone & Joint Surgery最新文献

{"title":"Minimized Medial Soft Tissue Release with Bone-Recut Adjustment Improves Short-Term Outcomes: Compared with Medial Release in Posterior-Stabilized Total Knee Arthroplasty.","authors":"Takashi Tsuda,Kazunori Hino,Tatsuhiko Kutsuna,Kunihiko Watamori,Tomofumi Kinoshita,Yusuke Horita,Masaki Takao","doi":"10.2106/jbjs.24.01098","DOIUrl":"https://doi.org/10.2106/jbjs.24.01098","url":null,"abstract":"BACKGROUNDManaging soft-tissue balance and selecting an appropriate alignment target are crucial factors in modern total knee arthroplasty (TKA). Medial soft-tissue release has been widely performed in posterior-stabilized (PS) TKA; however, recent approaches to medial structure management have been reconsidered. This retrospective study aimed to assess the effectiveness of minimizing medial structure invasion using personalized alignment (PA) with precise additional bone cutting in PS-TKA compared with conventional mechanically aligned (MA) PS-TKA.METHODSOverall, 188 patients who underwent PS-TKA were enrolled; propensity score matching on the basis of preoperative patient characteristics was used to ensure that the groups were similar. Additional medial soft-tissue release was performed if necessary in the MA group for inappropriate ligament balance. Adequate bone recutting, as an alternative to medial release, was performed in the PA group, permitting a maximum of 3° tibial varus alignment.RESULTSAdditional medial soft-tissue release was performed in 33 knees (35.1%) in the MA group, whereas bone recutting was performed in 37 knees (39.4%) in the PA group. The PA group had a significantly more varus postoperative medial proximal tibial angle than the MA group (mean ± standard deviation, 89.1° ± 1.2° versus 90.3° ± 1.8°; p < 0.0001). The postoperative patient satisfaction score of the 2011 New Knee Society Score (KSS) in the PA group was significantly higher than that in the MA group (mean, 29.4 ± 6.7 versus 27.5 ± 7.3; p = 0.04). Moreover, PA with bone recutting resulted in a significantly greater postoperative extension angle (mean, -1.5° ± 3.7° versus -3.0° ± 3.5°; p = 0.02) and higher KSS patient satisfaction (30.1 ± 7.7 versus 26.7 ± 7.2; p = 0.04) compared with MA with medial release.CONCLUSIONSThis novel surgical strategy achieved appropriate balance without excessive medial release and resulted in superior clinical outcomes in PS-TKA.LEVELS OF EVIDENCETherapeutic 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":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796940","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":"The Smallest Worthwhile Effect as a Promising Alternative to the MCID in Estimating PROMs for Adult Idiopathic Scoliosis.","authors":"Di Liu,Zhengye Zhao,Guozhuang Li,Xiangjie Yin,Yuanpeng Zhu,Ze Liu,Jialuo Han,Terry Jianguo Zhang,Nan Wu, ","doi":"10.2106/jbjs.24.01269","DOIUrl":"https://doi.org/10.2106/jbjs.24.01269","url":null,"abstract":"BACKGROUNDThe smallest worthwhile effect (SWE) enables patients to evaluate the expected value of a treatment by weighing its benefits, risks, and costs. It has emerged as an alternative to the minimal clinically important difference (MCID) for interpreting patient-reported outcome measures (PROMs). The purposes of this study were to determine the SWE estimates and MCID thresholds in patients undergoing surgery for adult idiopathic scoliosis (AdIS) and to verify whether meeting or exceeding the SWE estimates correlates with satisfaction at a minimum of 2 years postoperatively.METHODSPatients with postoperative satisfaction measured at a minimum of 2 years were prospectively recruited between July 2017 and August 2022. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was preoperatively administered to estimate the SWE thresholds using the benefit-harm trade-off method. The baseline SRS-22r and the SRS-30 at a minimum of 2 years postoperatively were recorded to determine the MCID estimates using the anchor-based approach, with questions 24 to 30 of the SRS-30 used as anchors. A construct validity assessment was performed to evaluate the association between meeting or exceeding the 50th percentile of the SWE (SWE50) threshold and postoperative satisfaction (defined as a score of ≥4 on both SRS-22r satisfaction questions). Race and ethnicity data were collected from the medical records.RESULTSA total of 119 Asian participants (19 male and 100 female) with a mean age of 26.5 ± 7.2 years were included. The absolute SWE50 estimates for the SRS-22r were 0.8 (interquartile range [IQR], 0.6 to 1.2) for self-image, 0.0 (IQR, 0.0 to 0.2) for function, 0.0 (IQR, 0.0 to 0.6) for pain, 0.4 (IQR, 0.0 to 0.6) for mental health, and 0.4 (IQR, 0.2 to 0.6) for the total score. The MCID thresholds for the corresponding domains or total score were 0.7, 0.1, 0.1, 0.3, and 0.3, respectively. Achieving or exceeding the absolute SWE50 threshold for the total score (p < 0.001) or the self-image (chi-square, 11.3; p < 0.001), function (chi-square, 6.3; p = 0.012), or pain (chi-square, 5.7; p = 0.017) domain was significantly correlated with postoperative satisfaction at a minimum of 2 years.CONCLUSIONSThe SWE could serve as an effective alternative to the MCID for interpreting PROMs at a minimum of 2 years postoperatively in patients with AdIS.LEVEL OF EVIDENCEPrognostic 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":"161 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787170","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":"Cement Mantle Screws in Periprosthetic Hip Fracture Fixation Near Well-Fixed Femoral Stems May Not Impact Short-Term Femoral Stem Survivorship.","authors":"James Shaw,Ruby Patel,Peter K Sculco,Joshua Wright-Chisem,Naomi E Gadinsky,Craig E Klinger,David L Helfet,Dean G Lorich,David S Wellman","doi":"10.2106/jbjs.24.00920","DOIUrl":"https://doi.org/10.2106/jbjs.24.00920","url":null,"abstract":"BACKGROUNDVancouver Type-B1 and C periprosthetic hip fractures have traditionally been treated using single- or double-plate fixation constructs. Concern exists regarding screws within the cement mantle due to the theoretical risk of cement fracture and eventual prosthetic loosening. The aim of this study was to assess femoral stem survivorship in patients with Vancouver Type-B1 or C fractures around a well-fixed cemented femoral component who were treated with a plate construct and screws into the cement mantle. The hypothesis was that screw fixation into the cement mantle would not compromise stem fixation.METHODSA retrospective review was performed of patients who were consecutively, surgically treated for a periprosthetic fracture around a femoral stem by 3 surgeons, as identified through a search of records from January 1, 2007, to January 1, 2023. A total of 112 consecutive patients with Vancouver Type-B1 or C periprosthetic femoral fractures treated at our institutions were reviewed. Patients who underwent fixation using plate constructs with ≥1 screw within the cement mantle around the stem were included. Patients were followed until union, revision due to plate construct failure, or stem revision. Other complications, including alignment loss, cemented stem subsidence, radiographic stem loosening, and new cement-mantle fractures, were assessed.RESULTSTwenty-eight patients (19 female; 27 White or Caucasian; 3 Hispanic or Latino; mean age, 81.4 ± 8.7 years) met the inclusion criteria. Radiographic union was achieved in 26 patients (92.9%). The study included 8 (28.6%) interprosthetic fractures between a total hip arthroplasty prosthesis and a total knee arthroplasty prosthesis. The mean union time was 8.0 ± 4.6 months (range, 2.2 to 25.6 weeks). The mean follow-up duration following the index procedure was 33.3 ± 24.0 months (range, 6.1 to 86.2 months). Two nonunions occurred (7.1%), both involving plate failure. Both patients required revision of the femoral prosthesis, which was not loose at the time of reoperation. No stem subsidence or cement mantle fractures occurred during follow-up, and no revisions were performed for stem loosening.CONCLUSIONSScrew fixation into cement around a well-fixed stem did not contribute to stem loosening at short-term follow-up. There were no isolated femoral component revisions for cement mantle issues.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787169","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":"Topical Versus Systemic Tranexamic Acid to Reduce Blood Loss After Total Knee and Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Maude Boucher,Juliette Tremblay,Théo Pelet,Julien Dartus,Etienne L Belzile,Stéphane Pelet","doi":"10.2106/jbjs.24.01511","DOIUrl":"https://doi.org/10.2106/jbjs.24.01511","url":null,"abstract":"BACKGROUNDTranexamic acid (TXA) has been shown to reduce blood loss during total knee arthroplasty (TKA) and total hip arthroplasty (THA), but the most effective administration method has yet to be determined. This systematic review and meta-analysis aimed to compare topical and systemic TXA administration to reduce operative blood loss.METHODSMEDLINE, Embase, and Cochrane CENTRAL were screened for randomized controlled trials comparing topical and systemic TXA for patients who underwent elective TKA and THA. The primary outcome was the total volume of operative blood loss, and the secondary outcomes were postoperative transfusion requirements, hemoglobin drop, hospital length of stay, and the frequencies of the main adverse events (infections and thromboembolic events). Data pooling was performed using RStudio. Subgroup analyses compared outcomes between TKA and THA.RESULTSFifty-nine randomized controlled trials with a total of 6,791 patients were included in this review. Data analysis showed no significant difference between topical and systemic TXA application in terms of total blood loss (Hedges g = 0.11; 95% confidence interval [CI], -0.04 to 0.26; I2 = 82.4%). There was also no significant difference between the 2 groups in hemoglobin drop, hospital length of stay, and transfusion requirements. Subgroup analysis showed that patients undergoing TKA who received topical TXA had a significant reduction in total blood loss (g = 0.19; 95% CI, 0.00 to 0.38; I2 = 85%; p = 0.046) compared with those who received systemic TXA.CONCLUSIONSTopical and systemic TXA were equally effective in reducing blood loss in the analysis in which THA and TKA were combined. However, in TKA, topical application significantly reduced blood loss compared with systemic administration, while the reverse was true in THA. Further research is still necessary to find the optimal TXA dosage and administration route.LEVEL OF EVIDENCETherapeutic Level I. 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":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787167","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":"Intraoperative Bone Perfusion Assessment Using Fluorescence Imaging in a Simulated Fracture Model: Effects of Osteotomy and Periosteal Disruption on Bone Perfusion During Amputation.","authors":"Yue Tang,Shudong Jiang,Jonathan Thomas Elliott,Xinyue Han,Xu Cao,Logan M Bateman,Lillian A Fisher,Jessica M Sin,Eric R Henderson,Ida Leah Gitajn","doi":"10.2106/jbjs.24.01436","DOIUrl":"https://doi.org/10.2106/jbjs.24.01436","url":null,"abstract":"BACKGROUNDAccurate debridement of poorly perfused bone and soft tissue is critical to reduce the risk of infection in open fracture or of recurrent fracture-related infection (FRI). However, accurate delineation of viable and nonviable tissue is difficult with current technology. The aim of this pilot study was to develop and evaluate an indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI) strategy to provide intraoperative, objective, real-time information on bone perfusion using an osteotomy model in patients undergoing lower-extremity amputation.METHODSFifteen patients who were ≥18 years of age and were undergoing lower-extremity amputation were included in this study. Perfusion-related kinetic parameters derived from DCE-FI, including maximum fluorescence intensity, ingress slope, and blood flow, were compared among 3 conditions reflecting sequentially increasing osseous damage: baseline, osteotomy (disruption of endosteal blood flow), and osteotomy plus periosteal stripping (disruption of endosteal and periosteal blood flow).RESULTSThere were significant decreases in median values from baseline to after osteotomy alone for maximum intensity (96.2 to 58.9 relative fluorescence units [RFUs]), ingress slope (3.2 to 2.0 RFU/second), and blood flow (6.7 to 4.9 mL/min/100 g). Following osteotomy plus periosteal stripping, there were also significant decreases in median values for maximum intensity (12.0 RFU), ingress slope (0.2 RFU/s), and blood flow (0.8 mL/min/100 g). The Mann-Whitney U test confirmed a significant perfusion reduction (p < 0.001) in the tibial diaphysis due to these injuries. The areas under the curve (AUC) in the receiver operating characteristic (ROC) analysis for identifying periosteal stripping (compared with only osteotomy or no osseous damage) were 0.89 to 0.90, which were higher than the AUCs for identifying any osseous damage (osteotomy with or without periosteal stripping) compared with no damage, 0.75 to 0.82.CONCLUSIONSThis clinical study utilizing DCE-FI for intraoperative bone perfusion assessment in orthopaedic surgery demonstrated that kinetic variables derived from DCE-FI can effectively characterize and classify degradation of bone perfusion due to osteotomy and osteotomy plus periosteal stripping.LEVEL OF EVIDENCEDiagnostic 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":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787432","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":"Development of a Spine Surgery Center of Excellence: Rationale, Design, Implementation, and Assessment of Outcomes.","authors":"Alan H Daniels,Manjot Singh,Joseph E Nassar,Christy Ciesla,Bassel G Diebo,Bryce Basques,Dominic Kleinhenz,Eren O Kuris","doi":"10.2106/jbjs.25.00031","DOIUrl":"https://doi.org/10.2106/jbjs.25.00031","url":null,"abstract":"➢ The growing prevalence and complexity of spinal pathologies have prompted hospital systems to establish dedicated spine centers to provide personalized, high-quality patient care.➢ The Joint Commission offers Advanced Certification in Spine Surgery to recognize programs that meet rigorous, evidence-based standards of care to their patient population.➢ Designing and implementing a spine center of excellence require the identification of key stakeholders, the development of a strategic plan, the generation of evidence-based clinical protocols, and routine evaluation of program metrics.➢ Spine centers of excellence offer standardized clinical pathways involving comprehensive preoperative optimization and coordinated postoperative care, thus leading to reduced complications and improved patient satisfaction with outcomes.➢ With recent advancements in minimally invasive techniques, robotic surgery, and value-based care models, a dedicated spine program should routinely evaluate the current best clinical practices to ensure compliance with the latest evidence-based care.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787168","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":"PROMIS and ODI Tools: Clinically Useful Markers of Abnormal MRI Findings in Pediatric Patients with Back Pain.","authors":"Devan Devkumar,Karina Zapata,Yuhan Ma,Chan-Hee Jo,Brandon Ramo","doi":"10.2106/jbjs.24.01404","DOIUrl":"https://doi.org/10.2106/jbjs.24.01404","url":null,"abstract":"BACKGROUNDThis study was performed to determine if the Patient-Reported Outcomes Measurement Information System (PROMIS), the 9-item Oswestry Disability Index (ODI-9), and back pain intensity predict abnormal magnetic resonance imaging (MRI) findings in pediatric patients with back pain.METHODSWe performed a retrospective review from April 2021 to June 2023 of 300 children (200 girls and 100 boys) aged 5 to 18 years with caregiver-reported back pain who underwent MRI of the spine and had completed the PROMIS Pediatric computerized adaptive testing measures for Pain Interference, Mobility, and Anxiety and the ODI-9, and had rated back pain intensity on a scale ranging from 0 to 5. Patients were excluded if they had neuromuscular or syndromic scoliosis, a history of previous spinal surgeries, or isolated neck pain. MRI findings were grouped as non-spinal and spinal findings, and then categorized into subgroups as incidental, correlative, and causative findings. Incidental findings were considered those in children with normal MRI findings. Patient-reported outcome measures (PROMs) were compared between children with normal and abnormal MRI findings (defined by the presence of correlative and/or causative findings) with use of Mann-Whitney U tests and logistic regression analysis.RESULTSOf the 300 children, 126 (42%) had abnormal MRI findings and 174 (58%) had normal MRI findings. Lower PROMIS Mobility scores (39.2 versus 42.8, p = 0.001) and higher ODI-9 percentages (27.4 versus 23.3, p = 0.015) were associated with abnormal MRI findings. A PROMIS Mobility threshold of 40.5 and an ODI percentage threshold of 21.1 were optimal for predicting abnormal MRI findings. We did not find an association between PROMIS Anxiety, PROMIS Pain Interference, or pain intensity with abnormal MRI findings.CONCLUSIONSLower PROMIS Mobility scores and higher ODI-9 scores, which reflect worsening functional disability, were associated with abnormal MRI findings in pediatric patients with back pain. Additionally, the minimum clinically important difference was met for the PROMIS Mobility score between those with normal and abnormal MRI.LEVEL OF EVIDENCEPrognostic 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":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777952","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":"From Asymptomatic Flatfoot to Progressive Collapsing Foot Deformity: Peritalar Subluxation Is the Main Driver of Symptoms.","authors":"Cesar de Cesar Netto,Nacime Salomão Barbachan Mansur,Grayson Talaski,Ryan P Jasper,Eli Schmidt,Kepler Alencar Mendes de Carvalho,Kevin Dibbern,Francois Lintz,Scott J Ellis,Donald Dean Anderson","doi":"10.2106/jbjs.24.01619","DOIUrl":"https://doi.org/10.2106/jbjs.24.01619","url":null,"abstract":"BACKGROUNDFlatfoot, or pes planus, is a common anatomical variation marked by a reduced or absent longitudinal arch. Although it is often considered benign, the condition can progress to progressive collapsing foot deformity (PCFD), a debilitating pathology. This study aimed to identify imaging biomarkers that distinguish asymptomatic flatfoot from PCFD by comparing 3D measurements among normally aligned feet, asymptomatic flatfeet, and feet with PCFD.METHODSA prospective, comparative, and controlled study was conducted on 561 feet in 475 subjects: 88 control subjects with 98 normally aligned feet, 66 control subjects with 132 asymptomatic flatfeet, and 321 patients with 331 feet with symptomatic PCFD. Bilateral weight-bearing computed tomography (WBCT) scans were performed, and various 3D measurements were analyzed, focusing on hindfoot valgus (Class A deformity), midfoot and/or forefoot abduction (Class B), arch collapse (Class C), and peritalar subluxation (PTS) (Class D). Statistical analysis, including multivariable nominal regression, was used to identify significant predictors of symptoms.RESULTSProgressive increases in Class A, B, and C deformity parameters were observed from normally aligned feet to asymptomatic flatfeet and finally to feet with PCFD. Significant differences in PTS (Class D deformity) were found only in the comparison between the feet with PCFD and the control groups, with reduced joint coverage and increased sinus tarsi coverage, indicating extra-articular impingement. Multivariable analysis identified the minimum sinus tarsi distance as the strongest predictor of symptoms, with a threshold of 1.9 mm best distinguishing symptomatic from asymptomatic feet.CONCLUSIONSThis study demonstrated that although hindfoot valgus, midfoot and/or forefoot abduction, and arch collapse deformities progressively increase from normal alignment to PCFD, significant subtalar joint subluxation and sinus tarsi impingement were unique to symptomatic PCFD. These findings suggest that PTS can serve as a crucial biomarker for diagnosing pathologic flatfoot (PCFD) and differentiating it from asymptomatic flatfoot. Future research should explore the predictive value of PTS biomarkers in identifying flatfoot at high risk for collapse and their impact on clinical management and surgical decision-making.LEVEL OF EVIDENCEPrognostic 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":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777951","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":"Enhanced Detection, Using Deep Learning Technology, of Medial Meniscal Posterior Horn Ramp Lesions in Patients with ACL Injury.","authors":"Hyung Jun Park,Sungwon Ham,Euddeum Shim,Dong Hun Suh,Jae Gyoon Kim","doi":"10.2106/jbjs.24.01530","DOIUrl":"https://doi.org/10.2106/jbjs.24.01530","url":null,"abstract":"BACKGROUNDMeniscal ramp lesions can impact knee stability, particularly when associated with anterior cruciate ligament (ACL) injuries. Although magnetic resonance imaging (MRI) is the primary diagnostic tool, its diagnostic accuracy remains suboptimal. We aimed to determine whether deep learning technology could enhance MRI-based ramp lesion detection.METHODSWe reviewed the records of 236 patients who underwent arthroscopic procedures documenting ACL injuries and the status of the medial meniscal posterior horn. A deep learning model was developed using MRI data for ramp lesion detection. Ramp lesion risk factors among patients who underwent ACL reconstruction were analyzed using logistic regression, extreme gradient boosting (XGBoost), and random forest models and were integrated into a final prediction model using Swin Transformer Large architecture.RESULTSThe deep learning model using MRI data demonstrated superior overall diagnostic performance to the clinicians' assessment (accuracy of 73.3% compared with 68.1%, specificity of 78.0% compared with 62.9%, and sensitivity of 64.7% compared with 76.4%). Incorporating risk factors (age, posteromedial tibial bone marrow edema, and lateral meniscal tears) improved the model's accuracy to 80.7%, with a sensitivity of 81.8% and a specificity of 80.9%.CONCLUSIONSIntegrating deep learning with MRI data and risk factors significantly enhanced diagnostic accuracy for ramp lesions, surpassing that of the model using MRI alone and that of clinicians. This study highlights the potential of artificial intelligence to provide clinicians with more accurate diagnostic tools for detecting ramp lesions, potentially enhancing treatment and patient outcomes.LEVEL OF EVIDENCEDiagnostic 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":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756228","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":"AOA Critical Issues Symposium: Allyship in Action.","authors":"Shian L Peterson,Aaron M Brandt,Bethany J Adams,Maria Quintos Baggstrom,Dane H Salazar,Sean A Tabaie","doi":"10.2106/jbjs.24.01197","DOIUrl":"https://doi.org/10.2106/jbjs.24.01197","url":null,"abstract":"As orthopaedic surgeons, we embrace a lifestyle and career defined by action, seeking to improve not only our patients' lives but also our profession. One critical area where we can improve lies in diversity, equity, and inclusion (DEI). Despite mounting evidence of the profound value that diverse teams bring to innovation, problem-solving, and patient care, orthopaedics has lagged behind most medical specialties in achieving a representative workforce. Addressing this disparity is important in advancing our profession and improving the equitable treatment of our patients. Recognizing this imperative, the American Orthopaedic Association (AOA) hosted a DEI symposium in June 2024, in conjunction with its annual meeting, that brought together orthopaedic surgeons, researchers, and educators to build upon the importance of creating inclusive spaces in order to ensure that diverse voices are present and are actively contributing to the future of the profession of orthopaedics. A standout feature of the 2024 symposium was a fireside chat format that was accompanied by dynamic audience participation, offering valuable insights and actionable strategies drawn from both the business world and medical oncology. These fields have made substantial strides in promoting diversity and inclusivity, providing a model for orthopaedics in overcoming similar challenges. The discussions illuminated the critical concept of allyship and examined the tangible steps that individuals and institutions can take. Allyship, as emphasized during the forum, requires deliberate, sustained effort. It is an active commitment to understanding and supporting underrepresented individuals and groups within the orthopaedic community. This means listening to their experiences, challenging biases, and working collaboratively to dismantle structural barriers. For institutions, it involves cultivating policies, mentorship opportunities, and recruitment strategies that prioritize equity and that reflect the diverse patient populations that we serve. By embracing allyship and adopting lessons from other fields, this symposium demonstrated opportunities to transform our profession and the lives of those who depend on our care, ensuring that our actions align with the ideals that we strive to uphold.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756131","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}