JBJS Open Access最新文献

{"title":"Biologic Augmentation Improves Rotator Cuff Integrity But Not Clinically Significant Patient Outcomes: A Meta-Analysis of Randomized Controlled Trials.","authors":"Jake X Checketts, Stephen D Daniels, Corey J Schiffman, Frederick A Matsen, Jason E Hsu","doi":"10.2106/JBJS.OA.26.00248","DOIUrl":"10.2106/JBJS.OA.26.00248","url":null,"abstract":"<p><strong>Background: </strong>Biologic augmentation is increasingly used to enhance tendon healing after rotator cuff repair, with recent American Academy of Orthopaedic Surgeons guideline updates supporting certain implants. However, clinically significant benefits to the patient remain unclear. The primary objectives of this study were (1) to assess whether adding biologic augmentation to rotator cuff repair lowers retear rates and (2) to determine whether biologic augmentation yields superior patient-reported outcomes that exceed the minimal clinically important difference threshold for clinical significance.</p><p><strong>Methods: </strong>Systematic review and meta-analysis were carried out for Level I randomized controlled trials (RCTs) (PubMed, Embase, and CENTRAL) from inception to January 1, 2025, per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only RCTs reporting postoperative imaging and patient-reported outcomes of American Shoulder & Elbow Surgeons (ASES), Constant, Simple Shoulder Test (SST), and University of California Los Angeles (UCLA) were included. Random-effects models evaluated retear rates and functional scores; subgroup analyses examined platelet rich plasma (PRP), patch, and other biologics. Mixed-effects models and correlations assessed the relationship between retear and function.</p><p><strong>Results: </strong>Twenty RCTs (1,327 shoulders) were included. Biologic augmentation reduced the retear rate by approximately 12% (14.8% vs. 26.7%; RR 0.62, 95% CI 0.50-0.76, p < 0.0001; I² = 8%), with significant benefits for both PRP and patch augmentation. Intact repairs had clinically significantly higher ASES (+14.3, 95% CI 10.8-17.8) and Constant (+10.5, 95% CI 7.2-13.8) scores than retorn repairs. However, patient-reported outcomes were not clinically significantly better for augmented repairs (effect size ASES 0.9; Constant 2.18; SST 0.78; UCLA 1.01).</p><p><strong>Conclusion: </strong>In the included RCTs, biologic augmentation was associated with lower retear rates but not clinically significantly greater patient-reported outcomes after rotator cuff repair.</p><p><strong>Level of evidence: </strong>Level I, evidence-based systematic review. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Disparities in Surgical Treatment Choice for Displaced Femoral Neck Fractures.","authors":"Monica Guirgus, Yoyo Ocho, Brett Ewing, Carol Lin","doi":"10.2106/JBJS.OA.25.00040","DOIUrl":"10.2106/JBJS.OA.25.00040","url":null,"abstract":"<p><strong>Background: </strong>Femoral neck fractures (AO-OTA 31B) (FNFs) are prevalent among the elderly, and the choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) remains debated. Given previous evidence of treatment disparities in FNFs, we investigated racial differences in THA utilization.</p><p><strong>Methods: </strong>Using the National Inpatient Sample (NIS) database, a representative sample of inpatient admissions, we identified patients aged ≥65 years who underwent HA or THA for FNFs from 2000 to 2020. Records were extracted using ICD9/ICD10 codes for intracapsular FNFs, excluding basicervical and peritrochanteric fractures, and procedure codes for THA and HA were used to create the cohorts. The primary outcome was treatment with either HA or THA. Covariates include hospital characteristics, demographics, socioeconomic factors, and medical comorbidities. Logistic regression analysis evaluated the relationship between race and treatment with THA or HA.</p><p><strong>Results: </strong>Bivariate analyses showed similar rates of HA across races and no statistically significant differences (Hispanic 89.6%, Asian 89.4%, Black 89.4%, White 88.7%; p = 0.056). Patient factors, including age, sex, and insurance, influenced treatment choice (all p < 0.0001), as did hospital-related factors such as location, region, and bed size (all p < 0.0001). Statistically significant comorbidities included acquired immune deficiency syndrome (AIDS), solid tumor without metastasis, alcohol abuse, metastatic cancer, depression, diabetes, hypertension, chronic obstructive pulmonary disease (COPD), obesity, hypothyroidism, and peripheral vascular disease (all p < 0.05).When controlling for patient- and hospital-related variables and significant comorbidities in our multivariable logistic regression model predicting THA, Black (OR 0.83, 95% CI 0.75-0.93; p = 0.001) and Hispanic (OR 0.76, 95% CI 0.67-0.86; p < 0.001) patients had significantly lower odds of undergoing THA compared with patients, whereas differences for Asian/Pacific Islander patients were not statistically significant.</p><p><strong>Conclusion: </strong>Variations in patient age, insurance status, and hospital-related variables influenced HA versus THA treatment. Racial disparities persisted after controlling these factors, underscoring the need to closely evaluate potential inequities to ensure equitable access to appropriate care.</p><p><strong>Level of evidence: </strong>Level III, prognostic. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative Artificial Intelligence in Hip and Knee Arthroplasty: A Systematic Review of Emerging Clinical Applications in Patient Communication and Education, Documentation, and Decision Support.","authors":"Ivan A Garces, Andres G Wong, Jonathan A Brutti, Stefano A Bini, Andrew McDaid, Charles M Lawrie","doi":"10.2106/JBJS.OA.26.00077","DOIUrl":"10.2106/JBJS.OA.26.00077","url":null,"abstract":"<p><strong>Background: </strong>Generative artificial intelligence (AI), including large language models (LLMs), has been increasingly explored in orthopedic surgery; however, its application within total hip and knee arthroplasty (THA/TKA) has not been clearly characterized. Therefore, we performed a systematic review to further evaluate generative AI in THA/TKA across 3 clinical domains.</p><p><strong>Methods: </strong>A PubMed and Embase systematic literature review was performed on July 9, 2025, in accordance with the Preffered Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies evaluated generative AI use in THA/TKA and addressed 1 of our 3 domains. Excluded studies used nongenerative AI, involved populations not undergoing THA/TKA, or were non-English or non-peer-reviewed. Quality metrics that were assessed included blinded clinician ratings, readability scores, DISCERN scores, and diagnostic accuracy measures. The heterogeneity of the included studies led to a narrative synthesis, and no formal risk of bias was conducted.</p><p><strong>Results: </strong>Of the 91 articles retrieved, 23 met the inclusion criteria. ChatGPT versions 3.5 or 4 were assessed across all studies, and 3 studies included Google Gemini, Claude 3 Opus, and DeepSeek. Among studies in patient communication and education (n = 19), blinded clinician ratings showed that ChatGPT-generated responses to frequently asked questions (FAQ's) were as accurate, clear, and complete as surgeon-written responses. Regarding documentation (n = 2), LLMs demonstrated 97.5% to 100% accuracy in identifying operative report information and created patient consent documents with improved readability scores (grade level 12.6 vs. 16.8) and completeness (2.4/3 vs. 1.8/3). Among studies assessing decision support (n = 2), ChatGPT demonstrated high sensitivity when predicting surgical candidacy but low specificity when predicting surgical outcomes.</p><p><strong>Conclusion: </strong>LLMs performed well in several aspects of patient communication and education with support from high clinician ratings, accuracy, and readability scores. However, evidence for documentation and decision support remained limited. Moreover, proper implementation that considers clinical workflows could increase clinician efficiency and positively affect patient experience.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Orthopaedic Education Gap: Implementing a Fracture Conference Curriculum for Medical Students at Institutions Without Affiliated Residency Programs.","authors":"Lachlan F Anderson, Carl Berghult, Erica R Olfson, Joseph Mellberg, Mitchel Hawley, Anne M Boeckmann, David N Shau","doi":"10.2106/JBJS.OA.26.00152","DOIUrl":"10.2106/JBJS.OA.26.00152","url":null,"abstract":"<p><strong>Background: </strong>Access to orthopaedic education varies substantially across institutions, particularly at medical schools without affiliated residency programs. Faculty-supervised, peer-facilitated fracture conference curricula have emerged as a potential solution, yet evidence evaluating their impact remains limited. This study evaluated a structured, faculty-supervised fracture conference curriculum at medical schools without an affiliated orthopaedic department.</p><p><strong>Methods: </strong>A cross-sectional survey was administered to medical students who attended at least 1 session of a 13-module fracture conference curriculum between Fall 2022 and Spring 2026. The survey assessed pre- and postparticipation perceived familiarity across 7 orthopaedic skill domains, interest in orthopaedic surgery, agreement with 6 predefined statements evaluating educational value, and barriers to participation.</p><p><strong>Results: </strong>Forty-one respondents were included. Respondents reported consistent improvements in perceived familiarity across all 7 domains (all p < 0.001). Agreement with 6 predefined statements evaluating the program's educational value and impact had scores that were uniformly high, with respondents endorsing the low-stakes learning environment and the program's role in audition rotation preparedness. Among 10 respondents who completed an orthopaedic elective or away rotation, 90% rated the curriculum as \"Very\" or \"Extremely\" helpful.</p><p><strong>Conclusion: </strong>A structured, faculty-supervised fracture conference curriculum represents a potential approach to improving orthopaedic familiarity, specialty interest, and rotation preparedness among medical students at institutions without affiliated residency programs. This model may offer a low-resource, replicable framework for expanding orthopaedic exposure to students who currently lack access to specialty-specific education and warrants further evaluation through prospective, multi-institutional study.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Incidence of Bone Cement Implantation Syndrome Grade 3 in Hip and Knee Arthroplasty: A Retrospective Multicenter Case Series.","authors":"Karen E Brokke, Sjoerd Servaas, Inger N Sierevelt, Karel W J Klop, Sef J A van Bilsen, Laurens Kaas, Loes W A H van Beers, Erik H P A van Dongen, Rutger van Geenen, W Anton Visser, Iris Koenraadt-van Oost, Monique A H Steegers, Peter A Nolte","doi":"10.2106/JBJS.OA.26.00252","DOIUrl":"10.2106/JBJS.OA.26.00252","url":null,"abstract":"<p><strong>Background: </strong>Cardiac arrest during hip or knee arthroplasty (KA) represents the most severe manifestation of bone cement implantation syndrome (BCIS). However, true incidence rates remain uncertain, and data on clinical characteristics and outcomes are limited. The aim of this study was to determine the incidence of BCIS grade 3 in hip and KA and to describe associated clinical characteristics and mortality.</p><p><strong>Methods: </strong>This retrospective multicenter case series included all hip and KA procedures performed at 4 Dutch hospitals. Potential cases were identified through database queries. Medical records were manually reviewed to confirm BCIS grade 3, defined as cardiovascular collapse requiring cardiopulmonary resuscitation occurring from joint manipulation through skin closure.</p><p><strong>Results: </strong>No cases of BCIS grade 3 occurred during 25,914 knee arthroplasties. Among 39,237 hip procedures, 31 patients experienced BCIS grade 3 (0.08%), of which 27 cases occurred during hemiarthroplasty for femoral neck fracture (FNF). The mean age of patients with BCIS grade 3 was 86.2 ± 7.7 years; 71.0% were female, 93.5% underwent acute surgery for FNF, 87.1% involved cemented procedures, and perioperative mortality was 67.7%.</p><p><strong>Conclusion: </strong>BCIS grade 3 is rare but highly lethal, occurring predominantly during hemiarthroplasty for FNF in elderly patients. Individualized risk assessment and informed consent are essential when managing FNF in high-risk patients.</p><p><strong>Level of evidence: </strong>Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Functional Outcomes and Prognostic Factors After Corrective Valgus Osteotomy for Infantile Blount's Disease.","authors":"Tattaporn Kotcharaksa, Nath Adulkasem, Thanase Ariyawatkul, Perajit Eamsobhana, Chatupon Chotigavanichaya, Jidapa Wongcharoenwatana","doi":"10.2106/JBJS.OA.26.00125","DOIUrl":"10.2106/JBJS.OA.26.00125","url":null,"abstract":"<p><strong>Background: </strong>Long-term functional outcomes following corrective valgus osteotomy for infantile Blount's disease (IBD) remain insufficiently characterized, particularly using patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>This retrospective cohort study with prospective long-term follow-up included patients with IBD who underwent corrective valgus osteotomy between 2002 and 2019 and had a minimum follow-up of 5 years. Functional outcomes were assessed using the Pediatric International Knee Documentation Committee (Pedi-IKDC), with the Patient Acceptable Symptom State (PASS) threshold used to define satisfactory outcomes. Health-related quality of life was evaluated using Pediatric Quality of Life Inventory 4.0 (PedsQL). Univariable and multivariable logistic regression analyses were performed to identify prognostic factors.</p><p><strong>Results: </strong>Thirty-four patients (59 limbs) were evaluated at a mean follow-up of 13.1 ± 4.8 years (range, 5.8-22.6). The mean Pedi-IKDC score was 86.1 ± 17.1, with 81.4% achieving PASS. The mean PedsQL score was 84.3 ± 17.1, with 70.6% achieving PASS. Recurrence occurred in 27.1% of limbs and 23.7% required reoperation. Patients failing PASS had higher body mass index (BMI) and greater preoperative deformity. In multivariable analysis, preoperative femorotibial angle (FTA) varus ≥23° independently predicted unsatisfactory outcomes (odds ratio 0.03, p = 0.013), while BMI >33 kg/m² showed a nonsignificant trend.</p><p><strong>Conclusions: </strong>In the subset of patients available for long-term follow-up, corrective valgus osteotomy was associated with favorable functional outcomes in most patients. Greater preoperative varus deformity (FTA ≥23°) independently predicted unsatisfactory functional outcomes.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will the Knee Outlive the Patient? Kaplan-Meier Systematically Overstates the Lifetime Risk of Revision After Total Knee Arthroplasty.","authors":"Wayne Hoskins, Charles A Gusho, Kenrick Rosser","doi":"10.2106/JBJS.OA.26.00217","DOIUrl":"10.2106/JBJS.OA.26.00217","url":null,"abstract":"<p><strong>Background: </strong>Lifetime revision risk after total knee arthroplasty (TKA) is usually estimated from Kaplan-Meier survivorship, which treats death as noninformative censoring and overstates revision incidence when competing mortality is substantial. The bias increases with age. We quantified the discrepancy between Kaplan-Meier and competing-risk estimates and derived the age- and sex-specific probability of dying with the original TKA.</p><p><strong>Methods: </strong>We analyzed 2,920 primary TKAs from a 15-year multisurgeon single-institution database linked to the New Zealand Joint Registry. Revision and death were modelled as competing events using Aalen-Johansen cumulative incidence functions and Fine-Gray subdistribution hazards, with patient-level clustering for bilateral cases. Kaplan-Meier estimates censoring death served as the benchmark. Cohort mortality was compared with the New Zealand population using standardized mortality ratios (SMRs) from 2017 to 2019 life tables.</p><p><strong>Results: </strong>There were 155 revisions and 525 deaths (median follow-up 7.4 years). The 15-year revision estimate was 8.3% by Kaplan-Meier versus 7.4% by competing-risk estimation overall, and 5.6% versus 3.0% in patients aged 85 years or older (relative overestimation >80%). At 10 years, cumulative incidence of revision was 5.7% (95% CI 4.8-6.7) versus 19.9% (18.2-21.8) for death, diverging with age (85 years or older: 3.0% versus 67.6%). 97% of patients aged 75 years or older died with the original TKA. Each 10-year age increment lowered the revision hazard (sHR 0.76, 0.61-0.94) and raised mortality (HR 2.33, 2.02-2.68). Cohort mortality was lower than the general population (SMR 0.73, 0.66-0.79). Among Māori, this relative advantage (SMR 0.66) was absent against the total population (SMR 1.11).</p><p><strong>Conclusions: </strong>Kaplan-Meier systematically overstates absolute lifetime revision incidence after TKA, most in older patients for whom competing mortality dominates. Age- and sex-specific competing-risk estimates provide more accurate preoperative figures and should be reported alongside Kaplan-Meier when presenting long-term revision risk.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in Journal and Publisher Policies on Artificial Intelligence Use in Manuscript Preparation: An Orthopaedic Perspective.","authors":"Nicholas Kelly, Jillian Neuner, Sanjeev Sabharwal","doi":"10.2106/JBJS.OA.26.00221","DOIUrl":"10.2106/JBJS.OA.26.00221","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI)-generated text has been detected in nearly 90% of orthopaedic peer-reviewed publications, yet public disclosure of AI use remains extremely low. Whether journal and publisher policies for authors on AI use are present, sufficiently detailed, and internally consistent has not been systematically examined in orthopaedics. We characterized the prevalence, scope, and within-publisher consistency of AI policies across a structured sample of leading orthopaedic and biomedical journals.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of publicly available author instructions, editorial policies, and publisher guidance for 32 journals (6 core orthopaedic, 19 orthopaedic subspecialty, 7 general biomedical) across 12 biomedical publishers. Forty-one variables were extracted per journal between March and April 2026, including presence of policy for AI use for authors, disclosure requirements, and use of AI for data analysis, generating figures and references, and policies for peer reviewers. A second reviewer independently coded a 12-variable subset for 10 journals (31% calibration) to assess inter-rater reliability (Cohen's kappa = 0.90, 96% agreement).</p><p><strong>Results: </strong>Twenty-nine of 32 journals (91%) had an identifiable AI policy for authors; 3 subspecialty journals had none. All core orthopaedic (6/6) and general biomedical (7/7) journals had policies, versus 16 of 19 subspecialty journals (84%). Among journals with policies, 28 of 29 (97%) required disclosure of AI use by authors and 22 of 29 (76%) prohibited listing AI as an author. Coverage of other domains was less frequent: figures and images (66%), hallucinations or fabrication (62%), AI-generated references (48%), peer review (45%), and data analysis (41%).</p><p><strong>Conclusions: </strong>Domains that can directly impact scientific integrity and clinical practice, such as AI-assisted manipulation of data, statistical outputs, fabricated references, and undisclosed image alterations, are currently not consistently queried in detail at manuscript submission. With advances in software technology, biomedical journals can test and adopt AI-detection tools that are both sensitive and specific to screen all submissions before peer-review to maintain scientific integrity and transparency.</p><p><strong>Level of evidence: </strong>Level IV, Cross-Sectional Study.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Ankle Deformity Correction Following Transfibular Total Ankle Arthroplasty: A Comparative Cohort Analysis With Minimum 5-Year Follow-Up.","authors":"Lew C Schon, Jonathan Day, Morgan Motsay, Katherine Convery, Helen Zhang, Zijun Zhang, Kevin A Schafer","doi":"10.2106/JBJS.OA.26.00234","DOIUrl":"10.2106/JBJS.OA.26.00234","url":null,"abstract":"<p><strong>Background: </strong>There are limited results about total ankle arthroplasty (TAA) in the setting of severe malalignment. The aim of this study was to compare midterm patient-reported and radiographic outcomes in patients with severe varus or valgus tibiotalar deformity treated with primary transfibular TAA at a minimum of 5-year follow-up.</p><p><strong>Methods: </strong>Retrospective review was performed of all primary transfibular TAA by a single surgeon from October 2012 to January 2020 and grouped based on preoperative coronal talar tilt angle. Severe preoperative deformity included cases with ≥10° of varus (n = 36) or valgus (n = 33), while cases within 5° of neutral coronal alignment (n = 140) served as a control group. PROMs included 12-item Short-Form Health Survey physical and mental component scores, Ankle Osteoarthritis Scale, and Visual Analog Scale. Alignment and periprosthetic cysts (>2 mm) were assessed on postoperative radiographs. Adverse events and reoperations were reported using the Canadian Orthopaedic Foot and Ankle Society Reoperation Coding System.</p><p><strong>Results: </strong>Aside from age (Neutral vs. Valgus, 58.1 vs. 64.2 years; p = 0.01), there were no significant differences in demographics, preoperative, or postoperative PROMs among the 3 groups. The median preoperative talar tilt was -15.1° (interquartile range [IQR], -17.8° to -13.1°) in the Varus and 16.0° (IQR, 12.0° to 19.5°) in the Valgus groups; there were no significant differences in median tibiotalar alignment between the 3 groups postoperatively. In the Neutral group, 1 patient had postoperative varus, and 2 patients had postoperative valgus deformity. In the Varus group, 1 patient had recurrent varus, and 1 patient progressed to valgus. Seven ankles had periprosthetic cysts. Overall reoperation rates were similar (Neutral, 34%; Varus, 33%; Valgus, 36%) with no implant revisions.</p><p><strong>Conclusion: </strong>Transfibular TAA is capable of correcting severe coronal tibiotalar malalignment in the primary treatment of end-stage ankle arthritis. Patients with ≥10° varus or valgus deformity demonstrated postoperative patient-reported and radiographic outcomes similar to those with neutral ankle alignment at midterm follow-up, without an increased risk of reoperations.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Orthopaedic Resident Education Curriculum: Implementation of the Academy of Orthopaedic Surgeons Resident Orthopaedic Core Knowledge Platform.","authors":"Joshua T Bram, Mark F Megerian, Austin C Kaidi, Daniel W Green, Duretti T Fufa","doi":"10.2106/JBJS.OA.26.00047","DOIUrl":"10.2106/JBJS.OA.26.00047","url":null,"abstract":"<p><strong>Background: </strong>Traditional orthopaedic residency educational approaches rely on unstandardized lecture series and self-directed study, which can lead to inconsistencies in knowledge acquisition. The Residency Orthopaedic Core Knowledge (ROCK) curriculum, introduced by the American Academy of Orthopaedic Surgeons in 2022, is a structured, comprehensive framework designed to standardize orthopaedic education. This study evaluates resident satisfaction with implementation of the ROCK curriculum within a single orthopaedic residency program and its association with resident performance on the Orthopaedic In-Training Examination (OITE).</p><p><strong>Methods: </strong>A 2-year residency didactics curriculum was designed to incorporate the ROCK curriculum at a single, urban academic orthopaedic residency program with a wider breadth of topics starting in the 2023 to 2024 academic year. To assess pre-/post-implementation response to this change, a survey assessing resident attitudes toward lectures/study patterns was designed. This was administered at the end of the 2022-23 academic year (pre-ROCK), with responses also collected 1 (2023-24) and 2 (2024-25) years after implementation. The survey captured resident demographics, attendance patterns, content satisfaction, and study habits. Questionnaire answers and OITE scores were compared between the year 2022 to 2023 (pre-ROCK) and the years 2023 to 2025 (post-ROCK).</p><p><strong>Results: </strong>A total of 78 responses were recorded over the 3 years (63% male) out of a potential 135 respondents. The proportion of residents who agreed that conferences were high quality (93% vs. 70%, p = 0.013) and were satisfied with conferences (91% vs. 65%, p = 0.006) was greater with the ROCK curriculum. In addition, residents felt there was a more appropriate balance of case-/didactic-based lectures after implementation (86% vs. 57%, p = 0.006). With the new curriculum, program OITE percentile increased from 68th percentile in 2022 (pre-ROCK) to 79th percentile in both 2023 and 2024 to 83rd percentile in 2025.</p><p><strong>Conclusions: </strong>Integrating the ROCK curriculum into an orthopaedic residency didactics curriculum led to high resident satisfaction and an overall trend toward higher OITE scores. These results support the use of the ROCK curriculum to augment resident education. Orthopaedic program directors and education leaders alike can replicate or adapt our proposed lecture schedule.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}