Annals of Joint最新文献

{"title":"Acromioclavicular and sternoclavicular joint injuries in contact sports: a narrative review of conservative and surgical treatments.","authors":"Andrew J Moyal, Robert J Burkhart, Jeremy M Adelstein, James E Voos, John M Apostolakos, Jacob G Calcei","doi":"10.21037/aoj-25-19","DOIUrl":"10.21037/aoj-25-19","url":null,"abstract":"<p><strong>Background and objective: </strong>Acromioclavicular (AC) joint sprain and sternoclavicular (SC) joint injuries commonly occur in contact athletes due to the direct-blow mechanism of injury. Despite the high prevalence in this patient population, a small degree of literature on AC and SC joint injuries specifically pertain to contact athletes. The goal of this narrative review is to analyze the literature pertaining to AC and SC joint injuries in both contact athletes and the general population and to provide treatment recommendations specifically for the contact athlete.</p><p><strong>Methods: </strong>A review of PubMed and MEDLINE was completed to identify articles reporting on the surgical and nonoperative treatment of AC and SC joint injuries in athletes. In this initial screen, the authors excluded general reviews, case reports, duplicate studies between databases and publications in languages other than English. The quality of included studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The authors then conducted a search for studies comparing non-operative to operative treatment of AC and SC joint injuries, in addition to studies comparing between operative technique.</p><p><strong>Key content and findings: </strong>Non-operative management of AC and SC joint injuries offer an acceptable return-to-play timeline. Despite persistent pathologic radiographic appearance in certain cases of non-operative management, clinical outcomes are generally equivalent between athletes treated non-operatively as compared to operatively. In cases of a failed course of nonoperative treatment, surgical management can achieve high return-to-sport rates, though is generally associated with longer recovery intervals. Despite mechanism of injury, rate of successful return to previous level does not appear to correlate with degree of contact in a sport, but instead with overhead demand of the sport.</p><p><strong>Conclusions: </strong>Contact athletes with AC and SC joint injuries should be trialed with a course of nonoperative management, even in higher grade injuries, with some exceptions. Athletes should be appropriately counseled, with particular attention paid to positions requiring increased overhead demand. When surgery is required, non-rigid anatomic fixation allows for a high rate of return to sport with less complications compared to rigid fixation.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"31"},"PeriodicalIF":0.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintaining natural knee asymmetry in total knee arthroplasty: short-term outcomes of a novel soft-tissue balancing technique (a retrospective cohort study).","authors":"Jian Wu, Feng Pan, Jun Zhang, Chao Yang, Yuan Gao, Desu Luo, Mao Liu","doi":"10.21037/aoj-25-43","DOIUrl":"10.21037/aoj-25-43","url":null,"abstract":"<p><strong>Background: </strong>The primary goal of total knee arthroplasty (TKA) is to relieve pain, improve function, and thereby enhance the quality of life. This study compares TKA using conventional mechanical alignment (MA) versus Intelligent Knee Planning and Alignment System (IKPAS) navigation-assisted soft tissue balancing that preserves key factors of knee natural asymmetry, evaluating differences in postoperative functional recovery and overall patient satisfaction.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 60 patients with American College of Rheumatology (ACR)-diagnosed, K-L grade III-IV knee osteoarthritis undergoing primary unilateral TKA at Guizhou Hospital of Beijing Jishuitan Hospital, between March 2024 and June 2024. According to the surgical methods, the patients were categorized into the study and control groups. Among them, 30 patients in the study group underwent unilateral TKA using the IKPAS navigation and a new method of soft tissue balancing technique to maintain the key factors of natural knee asymmetry. All surgeries were performed by a single senior surgeon. Simultaneously, the other 30 patients in the control group underwent unilateral TKA using the guided traditional MA and gap-tension equality balancing technique. The first ambulation time, hospital stay duration, and operative time were compared between the two groups. Knee Joint Clinical Score (KJCS), Knee Joint Functional Score (KJFS), knee extension-flexion range of motion (ROM), and Forgotten Joint Score (FJS) were assessed at the 1-, 3-, and 6-month postoperative follow-up visits.</p><p><strong>Results: </strong>All patients were followed for 1 to 9 months, with a mean follow up duration of 7±1.5 months. No surgical site complications (including infection or wound dehiscence) were reported in either group. Baseline characteristics, including age, sex, body mass index (BMI), preoperative KJCS, KJFS, and ROM, demonstrated no statistically significant differences between the kinematic alignment (KA) and MA groups (P>0.05). The study group demonstrated shorter first ground walking time and hospitalization time than the control group (P<0.05), with statistical significance. No statistically significant difference was noted between the two groups in terms of surgical time (P>0.05). At the 1-, 3-, and 6-month postoperative follow-ups, the study group exhibited higher KJCS, KJFS, knee extension-flexion ROM, and FJS than the control group (P<0.05), with statistical significance.</p><p><strong>Conclusions: </strong>The new method of soft tissue balancing in TKA by maintaining the natural knee asymmetry shows better clinical outcomes than the traditional gap-tension symmetric balancing TKA in a preliminary short-term follow-up study. The superior clinical outcomes of asymmetry-maintained TKA compared to traditional gap-tension equaled TKA implicated that the real balance of TKA is not simply defined as symmetry.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"25"},"PeriodicalIF":0.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment and validation of a screening and risk predication model for rotator cuff tear and shoulder stiffness.","authors":"Xiangyang Sun, Jiyuan Qi, Linyuan Zhang, Atiya Prajna Hooblal, Timoné Wagner, Zhi Yong Wong, Fusheng Wang, Weiguo Zhang, Kang Tian","doi":"10.21037/aoj-25-16","DOIUrl":"10.21037/aoj-25-16","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tears (RCTs) with shoulder stiffness have a high association rate; however, the mechanism and possible risk factors are unclear. This study aims to collect the factors that may affect RCT and shoulder stiffness, screen out the relevant risk factors through statistical analysis, and establish a simple model to predict the risk of RCT combined with shoulder stiffness.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 406 patients diagnosed with RCT through arthroscopic surgery at the Department of Joint and Sports Medicine, the First Affiliated Hospital of Dalian Medical University, from December 2019 to June 2023. The analysis comprised two groups: 213 patients with both RCT and shoulder stiffness, and 193 patients without shoulder stiffness. A total of 21 potential risk factors associated with RCT and shoulder stiffness were considered, and a prediction model was developed using single-focus logistic regression analysis and multifocal logistic regression analysis in the training set (N=284), which was presented as nomograms. The validation set (N=122) was used to assess the model's discrimination, calibration and clinical practicability. The proportion of patients with RCT combined with shoulder stiffness in both the training set and the validation set was 52.5%.</p><p><strong>Results: </strong>The study identified eight pertinent risk factors: gender, dominant side, smoking, hypothyroidism, depression, hyperlipidemia, type III acromion, and partial tear. Based on these factors, a clinical prediction model was developed. The model demonstrated excellent predictive performance with an area under the receiver operating characteristic curve (AUROC) of 0.856 [95% confidence interval (CI): 0.812-0.900] for the training set and 0.867 (95% CI: 0.807-0.928) for the validation set. Calibration curves exhibited strong agreement between the actual disease probabilities and predicted probabilities using the model in both datasets. Decision curve analysis (DCA) further confirmed the clinical utility of the model.</p><p><strong>Conclusions: </strong>Based on routine data, the prediction model offers clinicians a simple and reliable tool for predicting the combination of RCT and shoulder stiffness.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"24"},"PeriodicalIF":0.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotator cuff repair augmentation: a review of current techniques.","authors":"Doria L Weiss, Parth Kamdar, Carl M Cirino","doi":"10.21037/aoj-25-13","DOIUrl":"10.21037/aoj-25-13","url":null,"abstract":"<p><p>Rotator cuff tears are one of the most common orthopedic injuries, affecting nearly 40% of individuals over 60 years old. Surgical repair remains the gold standard following failed conservative treatment; however, retear rates remain a significant challenge, with some studies reporting recurrence in 40% to 94% of patients. In response to these high failure rates, various surgical augmentation techniques have been developed, offering the potential to enhance healing, improve repair integrity, and optimize long-term outcomes. A comprehensive literature review was conducted to assess the current methods of augmentation for rotator cuff repair (RCR) and to provide an updated analysis of augmentation techniques for RCR from 2010 to 2025. The review includes detailed descriptions of each augmentation technique, along with associated outcomes and available evidence supporting their use in clinical practice. Augmentation techniques for RCR have advanced, showing promising improvements in patient outcomes. This review highlights the growing popularity of dermal allografts and bioinductive collagen implants, alongside the emerging use of platelet-rich plasma (PRP), bone marrow aspirate concentration (BMAC) and fibrin clots. While these methods demonstrate potential, further high-quality randomized, prospective studies are needed to standardize protocols, establish clear indications, and address the variability in current evidence. Key areas requiring further investigation include the long-term durability of augmented repairs, optimal patient selection criteria, the comparative efficacy of different augmentation materials, and the cost-effectiveness of these techniques in routine clinical practice.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"28"},"PeriodicalIF":0.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved sexual activity and quality of life after anterior cruciate ligament reconstruction.","authors":"Riccardo D'Ambrosi, Federico Valli, Francesco D'Ambrosi, Nicola Ursino, Amit Meena","doi":"10.21037/aoj-25-17","DOIUrl":"10.21037/aoj-25-17","url":null,"abstract":"<p><strong>Background: </strong>Sexual activity profoundly influences one's overall quality of life. Sexual dysfunction can significantly adversely affect an individual's life. The aim of this investigation was to examine the impact of anterior cruciate ligament (ACL) reconstruction on sexual function and quality of life.</p><p><strong>Methods: </strong>Upon hospital (IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy) admission, each patient was asked to complete the New Sexual Satisfaction Scale-Short Form (NSSS-S) to evaluate their sexual behavior prior to the injury (preinjury) and at the time of admission (preoperative). Furthermore, patients were recontacted after a minimum follow-up period of 24 months (final follow-up). Quality of life was evaluated at hospital admission (preoperative) and at a minimum 24-month follow-up (final follow-up) using the Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QoL).</p><p><strong>Results: </strong>The study had 303 patients, including 233 males (76.9%) and 70 females (23.1%). The average age at surgery was 31.6±11.0 years, and the average follow-up duration was 63.3±20.1 months. A hamstring tendon autograft was used for 289 (95.4%) patients and a patellar tendon autograft was used for 14 (4.6%) of patients. At the final follow-up, sexual activity exhibited a significant difference compared to preoperative levels (P<0.001), although no difference was observed between preinjury and final follow-up values (P>0.99). Preinjury sexual activity exceeded preoperative activity (P<0.001). The quality of life at the last follow-up was significantly greater than the preoperative quality of life (P<0.001).</p><p><strong>Conclusions: </strong>ACL injury adversely affects sexual function scores alongside quality of life, while reconstructive surgery enhances these scores irrespective of age or sex.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"23"},"PeriodicalIF":0.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-wide association assessment between immune cells and osteoarthritis: a bidirectional Mendelian randomization study.","authors":"Jiayuan Zheng, Yujun Sun, Wenzhou Liu, Yanbo Chen, Taolve Zhou, Zhenxiang Zheng, Jiajie Li, Gang Zeng, Liangyan Wu, Weidong Song","doi":"10.21037/aoj-24-60","DOIUrl":"10.21037/aoj-24-60","url":null,"abstract":"<p><strong>Background: </strong>The synovial immune microenvironment plays a critical role in the onset and advancement of osteoarthritis (OA), but previous findings on some immune cells were inconsistent. This study seeks to comprehensively investigate the causal association between a multitude of immune cell traits and OA.</p><p><strong>Methods: </strong>We performed this bidirectional Mendelian randomization (MR) analysis between a genome-wide association studies (GWAS) summary statistics containing 407,746 European ancestry and the largest GWAS data on 731 immune phenotypes. A replication analysis was conducted on a dataset containing 63,556 participants for validating the positive results. The causal effects were primarily estimated through inverse variance weighted (IVW) method, with four other methods (MR Egger, weighted median, simple mode, weighted mode) to reinforce the strength of causal evidence. Multiple sensitivity analyses (MR Egger, IVW method, leave-one-out analysis) were applied to mitigate the impact of heterogeneity and horizontal pleiotropy. Additionally, we employed a bioinformatics analysis by xCell algorithm to examine the expression of these immune cell phenotypes in OA and normal synovial tissues.</p><p><strong>Results: </strong>After false discovery rate (FDR) correction test, thirteen immune cell traits exhibited significant causal relationships with OA. These immune cell phenotypes came from seven groups, including B cell (n=3), conventional dendritic cell (cDC) (n=3), monocyte (n=3), myeloid cell (n=1), T cell, B cell, natural killer (NK) cell (TBNK) (n=2), regulatory T cell (Treg) (n=1). The strongest effects on OA were found in \"CD64 on CD14^- CD16⁺ monocyte\" [odds ratio (OR): 1.044; 95% confidence interval (CI): 1.012-1.076; P_FDR=0.03] and \"CD16⁺ monocyte %monocyte\" (OR: 0.948; 95% CI: 0.916-0.980; P_FDR=0.009). Sensitivity analyses did not detect any evidence of heterogeneity and horizontal pleiotropy. We also identify five immune traits influenced by OA. Additionally, replication analysis reconfirmed the causal effect of \"CD64 on CD14^- CD16⁺ monocyte\" (OR: 1.102; 95% CI: 1.046-1.161; P_FDR<0.001) and \"HLA DR⁺ NK %NK\" (OR: 0.945; 95% CI: 0.908-0.983; P_FDR=0.03) on OA.</p><p><strong>Conclusions: </strong>Our findings reveal the causal relationships between specific immune cells and OA, offering genetic insights into the role of immune cells in OA pathogenesis and guiding the exploration of novel immunological treatments for OA.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"22"},"PeriodicalIF":0.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detriment of subchondral plate violation in antegrade osteochondral procedures-lessons and future direction.","authors":"Hayley Denwood, Tyler M Hauer, Megan Berube, Mary Grace Kelley, Abigail Cook, Hang Lin, Ting Cong","doi":"10.21037/aoj-24-69","DOIUrl":"10.21037/aoj-24-69","url":null,"abstract":"<p><p>The microfracture procedure, introduced in 1994 by Dr. Steadman, involves creating small perforations in the subchondral bone plate to stimulate cartilage regeneration through fibrocartilage formation. Early studies demonstrated its efficacy in improving patient-reported outcomes for small osteochondral defects, particularly in young, active patients. However, its popularity has declined due to poor long-term outcomes and limited indications. Emerging alternatives, such as autologous chondrocyte implantation (ACI) and osteochondral allograft/autograft transplantation (OAT), show superior long-term results. Antegrade procedures like microfracture and drilling aim to release marrow elements to facilitate cartilage repair, but evidence for their efficacy is limited. These techniques can damage subchondral structures, triggering inflammatory and mechanical changes, including subchondral cysts, osteophytes, and reduced bone mineral density. Retrograde drilling, which avoids subchondral plate violation, emerges as a potential solution, promoting revascularization while preserving structural integrity. Despite promising results in subchondral fracture fixation and avascular necrosis, clinical studies are needed to confirm its efficacy for cartilage repair. The key challenge lies in balancing sufficient marrow stimulation with subchondral plate preservation to maintain long-term joint functionality. Future research should focus on understanding the interplay between subchondral plate integrity and cartilage repair durability. Comparative clinical trials are essential to validate retrograde drilling and other evolving techniques as viable alternatives to traditional microfracture and drilling procedures.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"26"},"PeriodicalIF":0.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a predictive model for surgical site infection following joint surgery.","authors":"Zhi Li, Kun Li, Nan Li, Dingding Zhao, Jianqing Ma, Jinlong Li, Baoju Qin","doi":"10.21037/aoj-25-14","DOIUrl":"10.21037/aoj-25-14","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) are common complications after joint arthroplasty, leading to increased morbidity and healthcare costs. Traditional models, like the National Nosocomial Infections Surveillance (NNIS) system, have limitations in predicting SSI risk due to a lack of patient-specific factors. This study aimed to create and validate a predictive model focusing on hypoproteinemia to enhance SSI risk assessment in joint surgery patients.</p><p><strong>Methods: </strong>A retrospective cohort study of 726 patients undergoing joint arthroplasty between 2020 and 2022 was conducted. Data included demographics, laboratory values, and surgical details. Univariate and multivariate analyses identified key predictors, including hypoproteinemia, to develop a predictive nomogram. Model validation was performed using receiver operating characteristic curves, calibration, and decision curve analysis (DCA), comparing it to the NNIS model.</p><p><strong>Results: </strong>Hypoproteinemia was a significant independent predictor of SSI, with the new model outperforming the NNIS system (area under the curve: 0.829 <i>vs</i>. 0.534). Calibration analysis showed excellent agreement between predicted and observed probabilities, with a mean absolute error of 0.009. DCA further confirmed the model's clinical utility, showing a higher net benefit across various thresholds compared to traditional approaches.</p><p><strong>Conclusions: </strong>Hypoproteinemia is a critical risk factor for SSI in joint arthroplasty. The new predictive model offers improved risk stratification, supporting a more personalized approach to perioperative management in orthopedic surgery.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"21"},"PeriodicalIF":0.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subchondral bone contribution to osteochondral health and injury.","authors":"Svenja A Höger, Ting Cong, Arielle J Hall, Joseph Lane, Armin Runer","doi":"10.21037/aoj-25-12","DOIUrl":"10.21037/aoj-25-12","url":null,"abstract":"<p><p>Subchondral bone plays a critical yet often underappreciated role in osteochondral health, injury response, and the pathophysiology of osteoarthritis (OA). A limited understanding of subchondral bone behavior limits the accurate evaluation of cartilage repair outcomes. Alterations in the subchondral bone-such as changes in bone density and structure, subchondral cyst (SCC) formation, impairment of osseous microarchitecture, and overgrowth of the subchondral plate-can compromise the mechanical osteochondral unit's integrity, leading to compromised joint function and poor outcomes. Moreover, neuropathy and subchondral bone changes, both significant contributors to OA-related pain and progression, are rarely assessed in treatment strategies. A deeper understanding of subchondral bone dynamics could improve both the assessment of repair outcomes and the development of more effective therapeutic strategies for OA. In the context of cartilage procedures, clinical and translational studies revealed that up to one-third of patients undergoing microfracture or similar subchondral venting procedures exhibit clinically pathologic subchondral bone changes. These include cyst formation and upward migration of the bone plate, which negatively affect repair outcomes. Translational models further support these findings by elucidating the mechanisms of subchondral bone remodeling and its critical influence on cartilage health. This review focuses on recent translational research on the subchondral bone in both osteochondral health, injury, and OA, highlighting the need to preserve its integrity during cartilage repair and ensuring that subchondral bone is considered in OA therapy. Understanding subchondral bone alterations may guide repair strategies, including biologic therapies and biomaterial-based approaches aimed at restoring osteochondral function, paving the way for improved clinical outcomes.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"27"},"PeriodicalIF":0.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of proximal humeral bone loss: a narrative review.","authors":"Lauren Grobaty, Vahid Entezari, Jason C Ho, Eric T Ricchetti, Charles J Cogan","doi":"10.21037/aoj-24-70","DOIUrl":"10.21037/aoj-24-70","url":null,"abstract":"<p><strong>Background and objective: </strong>The optimal management of proximal humeral bone loss (PHBL) in shoulder arthroplasty is a debated topic. PHBL is a challenging problem for surgeons due to its effect on implant fixation and stability. Supplemental fixation options in the form of allograft-prosthetic composites (APCs) or reverse shoulder arthroplasty (RSA) endoprostheses are options to consider, each with its own benefits and complication profiles. This narrative review aims to evaluate current strategies for managing PHBL.</p><p><strong>Methods: </strong>A comprehensive literature search was performed using databases including PubMed, Cochrane Library, and Google Scholar using appropriate search terms. Studies published between 2013 and 2024 were included. All included studies were peer-reviewed and addressed PHBL in the setting of shoulder arthroplasty or proximal humerus resection.</p><p><strong>Key content and findings: </strong>A total of nineteen studies were included, comprising 7 retrospective case series, 4 prospective case series or cohort studies, 2 systematic reviews, 1 retrospective registry study, 3 descriptive papers of proposed classification systems, and 2 technique papers. Described classification systems categorize PHBL by integrity of the epiphysis, greater tuberosity, calcar, metaphysis, diaphysis, and cortices. Depending on the degree of bone loss, revision RSA without allograft, revision RSA with APC augmentation, and endoprosthesis are described as management options. In patients with greater than 5 cm of PHBL, use of APC or endoprosthesis has proven effective but with high complication profiles and revision rates. No paper directly compares endoprosthesis and APC outcomes.</p><p><strong>Conclusions: </strong>PHBL is a rare but important problem in the setting of tumor resection and revision shoulder arthroplasty. While small cohort studies have reported successful outcomes with both APC and endoprosthesis, systematic reviews have failed to demonstrate a clear benefit of one option over the other. Complication and reoperation rates can be high with both surgical options. With a focus on standardized classification and evaluation of patients with PHBL, we can hope to refine the surgical techniques and indications for optimal patient outcomes.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"30"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}