JBJS Open Access最新文献

{"title":"The Use of 3D Printing as an Educational Tool in Orthopaedics.","authors":"Peter Joseph Mounsef, Pasquale Mulé, Mitchell Bernstein, Reggie Hamdy","doi":"10.2106/JBJS.OA.25.00062","DOIUrl":"10.2106/JBJS.OA.25.00062","url":null,"abstract":"<p><strong>Background: </strong>Three-dimensional (3D) printing has proven to be effective in orthopaedic surgery, improving both surgical planning and outcomes. Despite its increasing use in surgical programs, reviews evaluating its educational impact are sparse. Therefore, the aim of this review was to provide educators with evidence-based findings on 3D printing's potential in training junior surgeons, as well as discuss its benefits in enhancing patient communication.</p><p><strong>Methods: </strong>A comprehensive search using PubMed and Web of Science databases was performed to identify articles related to orthopaedics, 3D printing, and education. After removing duplicates, 2,160 articles were screened, 152 underwent full-text review, and 50 met inclusion criteria. Articles discussed the impact of 3D-printed models on comprehension or surgical performance. Data on publication details, sample size, teaching focus, learning outcomes, costs, and conclusions were extracted. Learning effects in the control (didactic) and experimental (3DP) groups were compared.</p><p><strong>Results: </strong>In fracture management training, studies demonstrated significantly improved fracture classification accuracy, surgical performance, and interobserver classification agreement with 3D models compared with didactic learning and traditional imaging modalities. These benefits were particularly evident in cases of complex fractures and junior trainees. In arthroscopy, 3D-printed simulators improved procedural accuracy and were more cost-effective than virtual reality simulators and cadaveric laboratory results. Three-dimensionally printed simulators were also assessed for skills related to spine surgery, in which trainees demonstrated clear learning curve improvements for pedicle screw placement and osteotomy techniques, as well as a better understanding of vital paraspinal structures. The application of 3D printing in patient education was equally promising, as it facilitated the process of informed consent, ultimately promoting shared decision making.</p><p><strong>Conclusion: </strong>The use of 3D-printed models offers effective and customizable methods for developing essential surgical skills. Future research should focus on larger, more diverse study populations and should include long-term follow-up to better assess the impact of 3D printing on education and patient outcomes.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181972","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":"<i>JBJS Open Access</i> 2024 Award Winners and Journal Update.","authors":"Eng Hin Lee, Robin Richards, George Sinclair Mitchell Dyer, Mohit Bhandari","doi":"10.2106/JBJS.OA.25.00055","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00055","url":null,"abstract":"","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181838","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":"Impact of Transitioning to a Level 1 Trauma Center on Orthopaedic Surgical Volume and Resident Education: Case Report in Orthopaedic Education.","authors":"Darlington Nwaudo, Solomon Egbe, Audrey Litvak, Jason Strelzow","doi":"10.2106/JBJS.OA.24.00208","DOIUrl":"10.2106/JBJS.OA.24.00208","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic residents are required to complete at least 1,000 surgical cases over their 5-year training, including specific procedural categories mandated by the Accreditation Council for Graduate Medical Education (ACGME). This study evaluates the effects of upgrading a major academic center to an adult Level 1 trauma center (L1TC) on orthopaedic case volume, complexity, and residents' training experience. In 2018, our institution transitioned from a Level 3 to a L1TC. We retrospectively analyzed surgical records and resident case logs spanning from 2013 to 2023.</p><p><strong>Methods: </strong>ACGME case logs and electronic medical records (EMRs) from a single urban institution were reviewed from July 2013 to June 2023. Data were divided into pre-L1TC (2013-2018) and post-L1TC (2018-2023) periods. Trauma cases were defined by ACGME Current Procedural Terminology (CPT) codes in the \"fracture/dislocation\" and \"manipulation\" categories and further identified by criteria such as treatment by orthopaedic trauma surgeons, emergent scheduling, or occurrence on weekends or holidays. All other cases were categorized as elective. Linear regression analyses assessed trends in case volumes over time.</p><p><strong>Results: </strong>Total ACGME cases logged ranged from 6,172 in 2015 to 10,541 in 2018, without a significant trend over time (p = 0.17). Trauma logs increased significantly post-L1TC (p < 0.001), with an average of 2,586 (31% of all cases) compared with 1,467 (22%) pre-L1TC. Trauma case volume saw a near 12-fold increase post-L1TC (p < 0.001). Elective cases remained stable (p = 0.48) but decreased significantly during the COVID-19 pandemic (p = 0.0035).</p><p><strong>Conclusions: </strong>The shift to L1TC status significantly boosted trauma case exposure for residents without an observed displacement of elective cases in favor of trauma cases. Elective cases declined during the pandemic, emphasizing the role of L1TC access in sustaining training. Future studies should investigate the impact of the L1TC experience on early career proficiency in orthopaedic practice. These findings underscore the value of trauma center access in resident training and support further exploration into optimizing orthopaedic education.</p><p><strong>Level of evidence: </strong>Level V, Case report. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129068","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":"Development of Explainable Machine Learning Models to Identify Patients at Risk for 1-Year Mortality and New Distant Metastases Postendoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Secondary Analysis of the PARITY Trial.","authors":"Jiawen Deng, Myron Moskalyk, Madhur Nayan, Ahmed Aoude, Michelle Ghert, Sahir Bhatnagar, Anthony Bozzo","doi":"10.2106/JBJS.OA.24.00213","DOIUrl":"10.2106/JBJS.OA.24.00213","url":null,"abstract":"<p><strong>Background: </strong>Accurate prediction of postoperative metastasis and mortality risks in patients undergoing lower-limb oncological resection and endoprosthetic reconstruction is essential for guiding adjuvant therapies and managing patient expectations. Current prediction methods are limited by variability in patient-specific factors. This study aims to develop and internally validate explainable machine learning (ML) models to predict the 1-year risk of new distant metastases and mortality in these patients.</p><p><strong>Methods: </strong>We performed a secondary analysis of data from the Prophylactic Antibiotic Regimens in Tumor Surgery trial, which included 604 patients. Candidate features were selected based on availability and clinical relevance and then narrowed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and Boruta algorithms. Six ML classification algorithms were tuned and calibrated: logistic regression, support vector machines, random forest, Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), and neural networks. Models were developed with and without including percent tumor necrosis due to its high missing data rate (>30%). Hyperparameters were tuned using Bayesian optimization. Internal validation was conducted using a 30% hold-out set. Model explainability was assessed using permutation-based feature importance and SHapley Additive exPlanations.</p><p><strong>Results: </strong>LightGBM was identified as the best-performing algorithm for both outcomes. For 1-year mortality prediction without percent necrosis, LightGBM achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.78 (95% confidence interval [CI] 0.70-0.86) during cross-validation and 0.72 on internal validation. For distant metastasis prediction, the LightGBM model without percent necrosis achieved an AUC-ROC of 0.77 (95% CI 0.71-0.84) during cross-validation and 0.77 on internal validation. Including percent necrosis did not significantly improve model performance. The top predictors identified were patient age, largest tumor dimension, and tumor stage.</p><p><strong>Conclusions: </strong>Explainable ML models can effectively predict the 1-year risk of mortality and new distant metastases in patients undergoing lower-limb oncological resection and endoprosthetic reconstruction. Further external validation and consideration of other data modalities are required before integrating these ML-driven risk assessments into routine clinical practice.</p><p><strong>Level of evidence: </strong>Level II, Prognostic Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129067","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 Value of Research in the Orthopaedic Surgery Residency Applicant: A Pilot Survey of Orthopaedic Surgery Residency Program Directors.","authors":"Ryan C White, Rithvik Vutukuri, Shreya M Saraf, Mia V Rumps, Mary K Mulcahey","doi":"10.2106/JBJS.OA.24.00216","DOIUrl":"10.2106/JBJS.OA.24.00216","url":null,"abstract":"<p><strong>Introduction: </strong>The role of research in the orthopaedic surgery residency application process has become increasingly important, particularly in the wake of the United States Medical Licensing Examination (USMLE) Step 1 examination transitioning to pass/fail. The purpose of this study was to determine the value that orthopaedic surgery residency program directors and other faculty place on various research elements included in residency applications.</p><p><strong>Methods: </strong>An anonymous cross-sectional survey was distributed to program directors and other faculty involved with the review of orthopaedic surgery residency applications within the Collaborative of Orthopaedic Education Research Group in February 2024. The survey asked questions related to the value placed on publication types, authorship position, dedicated research years, and the general importance of research.</p><p><strong>Results: </strong>Ten respondents, including 7 program directors, 2 assistant program directors, and 1 director of research, participated. Eight (80%) indicated that the number of publications is important, with 4 (40%) identifying a minimum number of publications of 2 to 3 to be considered competitive at their program. Respondents also identified the following components as important: journal impact factor (9; 90%), authorship position (5; 50%), and study type (7; 70%). Clinical research within orthopaedic surgery was most highly regarded (9; 90%), while case studies were deemed least valuable (9; 90%). Six respondents (60%) agreed that research is more important now that USMLE Step 1 is pass/fail.</p><p><strong>Conclusions: </strong>Since the transition of Step 1 to pass/fail, research has become an increasingly important part of an orthopaedic surgery resident's application. Residency programs value research productivity, particularly clinical research within orthopaedics. While the minimum number of publications varies, 2 to 3 are often considered competitive. Factors contributing to the perceived value of research include journal impact factor, authorship position, and study type. With this knowledge, applicants can align their research activities with the values of orthopaedic surgery residency programs.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129069","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":"Path to a Successful Match in Orthopaedic Surgery for International Medical Graduates.","authors":"Sukrit J Suresh, Krishna V Suresh, Diane Ghanem, Majd Marrache, Dawn LaPorte, Amiethab Aiyer","doi":"10.2106/JBJS.OA.24.00109","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00109","url":null,"abstract":"<p><p>International medical graduates (IMG) comprise many annual applications submitted for the orthopaedic surgery match but traditionally have a noticeably lower match rate compared with graduates from allopathic and osteopathic medical schools in the United States. Barriers for IMGs include (1) limited US clinical experience, (2) suboptimal networking and sponsorship opportunities, and (3) the extended time and financial investment required to build a strong application. This review article identifies important tips to circumvent these barriers, providing IMGs with a pathway to a successful match into orthopaedic surgery.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080517","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":"In Young Patients Undergoing Total Hip Arthroplasty, Is There a Correlation Between Activity Level and Wear of Highly Cross-Linked Polyethylene?","authors":"Sergio F Guarin Perez, Diego J Restrepo, Sheng-Hsun Lee, Michael B Stuart, Robert T Trousdale, Daniel J Berry, Rafael J Sierra","doi":"10.2106/JBJS.OA.24.00242","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00242","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) effectively restores mobility, reduces pain, and enhances the quality of life of patients of all ages. Despite its benefits, concerns regarding the long-term effects of high-impact activities and sports on implant longevity require further study. This study investigated the effect of activity level on long-term radiographic wear of highly cross-linked polyethylene (HXLPE) in young patients undergoing THA.</p><p><strong>Methods: </strong>Between 1999 and 2008, 785 patients (909 hips) aged ≤50 underwent primary THA using first-generation HXLPE liners from 4 different vendors with either metal or ceramic heads. Functional activity and participation questionnaires, including the Hip Injury and Osteoarthritis Outcome Score (HOOS Jr), University of California Los Angeles (UCLA) activity scale, and High-Activity Arthroplasty Score (HAAS), were surveyed in 2018 to 2019. The response rate was 44%. Radiographic linear wear rates were measured using the ROMAN software in patients who had completed questionnaires and had radiographs taken at least 10 years apart, leaving a final cohort of 249 patients (284 hips). Multivariate analyses were performed to determine the relationship between HXLPE wear rates and activity scores.</p><p><strong>Results: </strong>At the time of the survey, approximately 10% of the patients performed high-impact activities not-recommended by consensus guidelines. The HXLPE linear wear rate was 0.036 mm/year (SD: 0.026). Patients with higher activity levels, as measured on the continuous UCLA/HAAS activity scale, did not exhibit increased wear (β = -0.0009; p = 0.31). Stair climbing was correlated with increased wear rates (β = 0.0066; p = 0.004), whereas walking (β = 0.0005; p = 0.66) and running (β = 0.0017; p = 0.30) were not significantly correlated. Patients performing nonrecommended activities did not show increased wear rates compared with those performing recommended activities (β = 0.0063; p = 0.19).</p><p><strong>Conclusions: </strong>Linear wear rates of first-generation HXLPE were not related to functional activity or participation in high-impact activities. Future research should include longitudinal assessments of activity levels and data on other potential complications related to high-impact sports to provide robust evidence regarding recommended activity level postoperatively.</p><p><strong>Level of evidence: </strong>Level III, Retrospective Comparative Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080328","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":"Cow Hitch Cerclage Suture Fixation of the Greater Tuberosity in Reverse Total Shoulder Arthroplasty Performed for Proximal Humerus Fractures: A Retrospective Cohort Study With a Minimum Follow-up of 2 Years.","authors":"Zendeli Flamur, Philipp Kriechling, Bouaicha Samy, Sabine Wyss, Wieser Karl, Grubhofer Florian","doi":"10.2106/JBJS.OA.24.00152","DOIUrl":"10.2106/JBJS.OA.24.00152","url":null,"abstract":"<p><strong>Background: </strong>Reverse total shoulder arthroplasty (RTSA) is a well-established treatment option for complex proximal humeral fractures in older patients, with greater tuberosity (GT) healing being critical for achieving optimal clinical outcomes. We compared the clinical and radiological outcomes between 2 GT fixation techniques: the \"cow hitch\" (CH) cerclage suture fixation technique and conventional suture fixation technique.</p><p><strong>Methods: </strong>This retrospective cohort study compared 20 consecutive patients who underwent RTSA using the CH cerclage suture fixation technique (CH group) with 29 consecutive patients who underwent RTSA using the conventional suture fixation technique (control group). Radiological healing of the GT was defined as the primary outcome parameter and assessed using standard radiographs at the last follow-up visit. Clinical outcomes were assessed as secondary outcome parameters and measured using the absolute and relative Constant-Murley scores (aCS and rCS), Subjective Shoulder Value (SSV), range of motion (ROM), and patient-reported outcome satisfaction (PROS).</p><p><strong>Results: </strong>At a mean follow-up at 47 ± 30 (range, 24-120) months, the radiographic findings revealed a 95% healing rate of the GT in the CH group compared with a 66% healing rate in the control group (p = 0.03). No secondary displacement was observed in the CH group, whereas 5 cases (17%) were observed in the control group (p = 0.14). Overall, aCS, rCS, SSV, ROM (flexion, abduction, external rotation), and PROS were significantly higher in the CH group than in the control group (p-values: 0.03, 0.002, 0.004, 0.03, 0.01, 0.01, 0.047, respectively).</p><p><strong>Conclusion: </strong>Compared with the conventional suture GT fixation technique, the CH cerclage suture fixation technique in RTSA performed for complex proximal humerus fractures resulted in higher healing rates with no secondary displacement of the GT, improved clinical outcomes, and enhanced patient satisfaction.</p><p><strong>Level of evidence: </strong>Level III (Retrospective cohort study). See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080273","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":"Uneven Ground: Exploring the Impact of Geographical Region and Gender on Orthopaedic Surgery Resident Research Productivity.","authors":"Natasja Lessiohadi, Hayden Hartman, James Pai, William B Goodman, Mia V Rumps, Mary K Mulcahey","doi":"10.2106/JBJS.OA.24.00224","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00224","url":null,"abstract":"<p><strong>Introduction: </strong>Research plays a crucial role in orthopaedic surgery advancement, patient outcomes, and both residency and fellowship training. This study aimed to examine associations between research productivity of orthopaedic surgery residents, gender proportion of residents, and the geographical region of orthopaedic surgery residency programs.</p><p><strong>Methods: </strong>Using the Fellowship and Residency Electronic Interactive Database (FRIEDA) and the Doximity Residency Navigator, a list of the top 10 Accreditation Council for Graduate Medical Education (ACGME) orthopaedic surgery residency programs for each region (Northeast, South, Midwest, and West) were identified. FRIEDA, program websites, SCOPUS, PubMed, and ResearchGate were utilized to collect the following: residency program name, type, and location; and resident name, gender, H-index, and number of publications.</p><p><strong>Results: </strong>Forty orthopaedic surgery residency programs and 1,377 residents across 4 regions were evaluated. Of these, 29.6% (408/1,377) were female and 70.4% (969/1,377) were male. Northeast programs averaged the highest publications (11.6) per resident, while the South averaged the fewest publications (5.9, p < 0.0001). Similarly, residents in Northeast programs had the highest average H-index (2.9), and residents in the South had the lowest average H-index (1.6) (f-ratio = 11.19, p < 0.0001). Male residents averaged more publications (9.0 vs. 5.5, p < 0.05) and higher H-indices (2.3 vs. 1.8, p < 0.05) than female residents. These differences were greatest in the South (male:female publication ratio = 1.9, H-index ratio = 1.4) and lowest in the Midwest (male:female publication ratio = 1.3, H-index ratio = 1.1).</p><p><strong>Conclusion: </strong>At the top 10 orthopaedic surgery residency programs across all regions, female residents remain underrepresented in academic research compared with male residents, evidenced by a lower average number of publications H-indices, with the degrees of these discrepancies varying regionally. Further research is needed to identify the underlying factors influencing these differences. Program directors and orthopaedic surgery residents should be aware of these geographic and gender-based trends to improve their academic productivity and address the existing inequities within academic orthopaedics.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080530","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":"When is Growth the Greatest? Spine and Total Body Growth in Idiopathic Scoliosis Through Sanders Maturation Stages 2, 3A, 3B, and 4.","authors":"Yusuke Hori, Bryan Menapace, Norihiro Isogai, Sadettin Ciftci, Burak Kaymaz, Luiz Carlos Almeida da Silva, Kenneth J Rogers, Petya K Yorgova, Peter G Gabos, Suken A Shah","doi":"10.2106/JBJS.OA.24.00189","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00189","url":null,"abstract":"<p><strong>Background: </strong>Sanders maturation stages (SMS) 2 to 4 represent periods of rapid growth and are considered ideal candidates for growth modulation surgery, such as anterior vertebral body tethering. A detailed assessment of spine growth during these stages is essential but limited. This study aimed to clarify the differences in growth rates for spine and total body height across SMS 2, 3A, 3B, and 4, as well as to assess cumulative growth until skeletal maturity for these stages.</p><p><strong>Methods: </strong>This single-center, retrospective, case-control longitudinal study evaluated consecutive patients with idiopathic scoliosis staged SMS 2 to 4. T1-S1 spine height, total body height, and curve magnitude were measured at each visit. Monthly growth rates for spine and total body height were calculated between baseline and first follow-up visit (6-12 months). In a subset followed to skeletal maturity, cumulative spine and total body height gain were assessed. To account for height loss due to scoliosis, spine and total body height were adjusted for curve magnitude using validated formulas. Multivariate linear regression models were employed to evaluate the relationship between SMS and growth, adjusting for confounding factors.</p><p><strong>Results: </strong>A total of 517 patients (68% female) were included. Spine height growth was highest in patients at SMS 3A, approximately 1.4 times stage 2, 1.5 times stage 3B, and 1.8 times stage 4. Total body height growth rates were comparable between SMS 2 and 3A, both significantly exceeding SMS 3B and 4. Among 314 patients followed to skeletal maturity, cumulative growth in spine and total body height was greatest in patients at SMS 2.</p><p><strong>Conclusions: </strong>This study demonstrated that spinal growth was most pronounced in patients at SMS 3A, while total body height growth was greatest during SMS 2 and 3A. Less mature patients exhibited greater cumulative growth potential in both spine and total body height. These findings provide crucial insights for determining the optimal timing of growth modulation surgery.</p><p><strong>Level of evidence: </strong>Level III Case-control study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015462","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}