Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

{"title":"Surgical Approach and Microbiologic Trends in Hip Periprosthetic Joint Infection: A Retrospective Comparison of Anterior and Posterior THA.","authors":"John R Tyler, Daniel Schmitt, William J Long, Samantha Bialek, Dana H Tran, Nicholas M Brown","doi":"10.5435/JAAOSGlobal-D-26-00023","DOIUrl":"10.5435/JAAOSGlobal-D-26-00023","url":null,"abstract":"<p><strong>Introduction: </strong>Periprosthetic joint infection (PJI) is a serious complication after total hip arthroplasty (THA). Previous work has explored risk factors of infection, but few studies have evaluated whether surgical approach influences the microbiologic profile of THA PJIs.</p><p><strong>Methods: </strong>A retrospective review identified patients who developed PJI after primary THA between January 2007 and January 2024. The surgical approach (direct anterior vs. posterior) was determined from surgical reports. Infecting organisms were categorized as gram-positive, gram-negative, polymicrobial, or culture-negative. Clinical and microbiologic variables were compared between approaches. Among culture-positive, microbiologically homogeneous infections, multivariable logistic regression assessed the association between approach and gram-negative infection.</p><p><strong>Results: </strong>Eighty-three patients met inclusion criteria: 22 with anterior and 61 with posterior THAs. No significant differences were observed in age, sex, body mass index, Charlson Comorbidity Index, or SIRS score between cohorts (P > 0.05). Organism profiles were broadly similar across groups, with no statistically significant differences in specific pathogens or microbiologic categories, including gram-positive, gram-negative, or culture-negative PJIs. Although not statistically significant, polymicrobial infections were more common in the posterior cohort (13.1 vs. 4.5%, P = 0.433) and gram-negative organisms in the anterior cohort (18.2 vs. 4.9%, P = 0.076). On multivariable analysis, the surgical approach trend toward gram-negative infections remained but was not statistically significant (OR, 3.79; 95% CI, 0.74 to 19.34; P = 0.110).</p><p><strong>Conclusion: </strong>The surgical approach was not associated with significant differences in the infecting organism profile after THA PJI. However, the observed trend toward more gram-negative infections with the anterior approach warrants additional investigation.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 4","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634723","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":"Accuracy of Diagnosis and Anticipation of Future Treatment in Pediatric Peripelvic Infections: The Role of Multisurgeon Review and Implications for Future Machine Learning Algorithms.","authors":"Tyler M Staten, Jarrett Warden, Pamela J Lang, Joel Turtle, Kenneth J Noonan, Laura L Bellaire","doi":"10.5435/JAAOSGlobal-D-26-00001","DOIUrl":"10.5435/JAAOSGlobal-D-26-00001","url":null,"abstract":"<p><strong>Introduction: </strong>MRI is commonly used to evaluate pelvic musculoskeletal infections. Limited \"quick\" MRI protocols enable timely imaging without intravenous contrast or sedation. This study examines the consistency of interpretation among pediatric orthopaedic surgeons when using quick versus full, contrast-enhanced MRI scans in cases of peripelvic musculoskeletal infection and explores these findings to inform future development and design of machine learning algorithms.</p><p><strong>Methods: </strong>Twenty-nine pediatric patients with full pelvis MRI with and without contrast and culture-positive peripelvic infection were retrospectively identified. Two deidentified files were created for each patient: one including all sequences and the other containing only the limited sequences included in our institution's quick MRI protocol. Three pediatric orthopaedic surgeons independently and sequentially evaluated the images, followed by group discussion to reach consensus on the primary diagnosis and management. Fleiss' Kappa (FK) statistic was calculated for each outcome.</p><p><strong>Results: </strong>Moderate agreement in primary diagnosis was observed among reviewers using quick MRI sequences (Kappa = 0.488), and substantial agreement was seen with full sequences (0.684; P = 0.003). Inter-rater agreement on treatment recommendations was poor with both quick (0.09) and full (0.233) MRI (P = 0.046). No difference was found in team consensus diagnosis and final diagnosis between quick (0.523) and full (0.569) MRI (P = 0.662). Poor agreement was found between team treatment recommendations and actual treatment for both quick (0.182) and full (0.07) MRI (P = 0.254).</p><p><strong>Conclusion: </strong>Independent evaluation of limited, quick MRI sequences by pediatric orthopaedic surgeons showed more variability in diagnosis and treatment compared with full MRI review. When reviewed collaboratively, the diagnostic accuracy of quick MRI approached that of full MRI. Future artificial intelligence-based imaging interpretation platforms will benefit from multi-institutional collaboration to improve training data quality; use of ensemble learning techniques to reflect the diversity of multispecialist approaches; and incorporation of relevant clinical data to properly identify, triage, and direct treatment of complex pediatric musculoskeletal conditions.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475811","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":"Using Three-Dimensional Quantitative CT Models to Compare Density Patterns Across Pelvic Fractures.","authors":"Sanjana D Kanumuri, Conor P Kleweno, Jonah Hebert-Davies, Scott Telfer","doi":"10.5435/JAAOSGlobal-D-26-00020","DOIUrl":"10.5435/JAAOSGlobal-D-26-00020","url":null,"abstract":"<p><strong>Background: </strong>Between 1990 and 2007, the population-adjusted incidence of pelvic ring fractures increased from 27.24 to 34.30 per 100 000 capita. Measuring bone density would aid in surgical planning for patient-specific treatment after traumatic pelvic injuries to decrease the need for repeat surgery. Opportunistic quantitative CT has recently been used to provide bone density data without the need for an additional measurement through dual-energy radiograph absorptiometry, in addition to providing more detailed information about the density distribution. The purpose of this study was to determine whether locations of pelvic fractures correlated with differences in bone density across the fracture and low-density regions.</p><p><strong>Method: </strong>After retrospective study of clinical CT scans for trauma patients taken on a calibrated CT scanner, 24 scans were included. Medical image processing software, three-dimensional Slicer, was used to segment the innominate bone while accounting for displacement. Density data analysis done through Python 3.10 compared proximal and distal segments and density by region of the innominate bone.</p><p><strong>Results: </strong>Of these 47 fractures, 43 (91.5%) occurred in low-density regions. Along with this, we found an absolute mean difference of 16.29 mg/mL (P < 0.005) between proximal and distal segments of the fracture.</p><p><strong>Conclusion: </strong>With this being one of the first studies using quantitative CT to measure bone density across fractures, these data indicate that studying fractures using three-dimensional quantitative models is a useful method to analyze risk factors for pelvic fractures, both in trauma and osteoporotic fragility fractures.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475847","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":"Patient Perceptions of Artificial Intelligence in Orthopaedic Surgery: Identifying Potential Barriers to Acceptance and Disparities With Implementation.","authors":"Nicole J Newman-Hung, Charlotte F Wahle, Yifan V Mao, Kameel Khabaz, Kodi K Azari, Prosper Benhaim, Alexander B Christ, Alexandra I Stavrakis, Nicholas M Bernthal, Lauren E Wessel","doi":"10.5435/JAAOSGlobal-D-25-00081","DOIUrl":"10.5435/JAAOSGlobal-D-25-00081","url":null,"abstract":"<p><strong>Introduction: </strong>Despite growing enthusiasm for artificial intelligence (AI) implementation in orthopaedic care, patient attitudes toward AI adoption remain unexplored. This study assesses patient perceptions of AI integration in diagnosis, treatment, and patient communication in orthopaedic surgery.</p><p><strong>Methods: </strong>A 28-question survey was administered to patients in hand surgery, orthopaedic oncology, and joint replacement surgery clinics. The survey queried patients' baseline comfort with AI and its perceived strengths, weaknesses, risks, and benefits.</p><p><strong>Results: </strong>Among 300 patients, the median age was 59 years. Most (55.2%) were comfortable with AI-assisted radiologic diagnosis, 58.3% with robot-assisted surgery, and 34.7% with AI-driven communication tools. Higher education and income correlated with greater AI acceptance (P < 0.001). Patients with lower education levels perceived fewer benefits in daily AI use and a less positive impact of surgical outcomes (P = 0.03, P = 0.05). Common concerns included loss of patient-surgeon relationships (70.0%), surgeon overreliance on AI (56.9%), and lack of individualized care (51.5%). Men were more accepting of AI use in diagnosis and surgery (P < 0.03), whereas women were more concerned about AI perpetuating biases (P = 0.05). Older patients were less comfortable with using AI for diagnostics (P < 0.001).</p><p><strong>Conclusion: </strong>As AI implementation in orthopaedic care expands, women, older patients, and patients with lower education and household income levels may feel less comfortable with AI integration, threatening their quality of clinical care. Universal concerns about AI implementation include AI potentially weakening the patient-surgeon relationship. Targeted patient education efforts to address common concerns about AI adoption will enable orthopaedic surgeons to responsibly integrate these tools into practice.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475788","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":"Association Between Depression and Increased Odds of Inpatient Mortality Following Hip Fracture Repair.","authors":"Georgia R Sullivan, Sufyan Ibrahim, Jack M Haglin, Callie M Davies, Mohamad Bydon, Kostas J Economopoulos","doi":"10.5435/JAAOSGlobal-D-25-00292","DOIUrl":"10.5435/JAAOSGlobal-D-25-00292","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures are a common source of disability in older adults. Depression, which is also prevalent in the elderly, has been correlated with negative surgical outcomes in other fields. The purpose of this study was to determine how hip fracture postoperative morbidity and mortality differ in older adults with depression compared with those without depression.</p><p><strong>Methods: </strong>The National Inpatient Sample was queried from 2016 to 2021 for patients aged 65 years and older who were treated surgically for a hip fracture. Outcomes for patients with depression were compared with those without depression using univariate and multivariable regression models after accounting for demographic variables and comorbidities. The primary outcome was inpatient mortality. Secondary outcomes include deep vein thrombosis or pulmonary embolism (DVT/PE), myocardial infarction, infection, discharge disposition, length of stay, and total charges.</p><p><strong>Results: </strong>A total of 307,377 patients were identified as having a hip fracture surgically repaired from 2016 to 2021 of whom 48,556 (15.8%) were depressed. Patients with depression were more likely to be female (76.3% and 68.6%, P < 0.01) and White (90.5% and 86.1%, P < 0.01). On multivariable regression analysis, patients with depression were more likely to experience inpatient mortality (odds ratio [OR]: 1.13 to 1.33, P < 0.01), DVT/PE (OR: 1.03 to 1.23, P = 0.01), and myocardial infarction (OR: 1.02 to 1.19, P = 0.02) than patients without depression. Patients with depression were also less likely to experience a routine discharge (OR: 0.62 to 0.66, P < 0.01) and were more likely to experience a longer length of stay (β coefficient 95% confidence interval, 0.46 to 0.54, P < 0.01) and greater total charges (β coefficient 95% confidence interval, 2,511 to 3,716, P < 0.01) than patients without depression.</p><p><strong>Conclusions: </strong>Patients with depression experienced increased odds of adverse events during their hospitalization including inpatient mortality, DVT/PE, and myocardial infarction. The lower odds of routine discharge and longer length of stay in depressed patients suggest that they may face a more difficult recovery process after surgery. Additional research is warranted to determine how long-term surgical outcomes are affected by depression and how interventions can influence these outcomes.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469391","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":"Suggestive Association Between Tryptophan-indole Metabolic Pathway and Total Joint Arthroplasty Early Revision for Heterogeneous Failure Modes in Patients With Primary Osteoarthritis: A Meta-analysis of Metabolomics.","authors":"Ming Liu, Robert Gill, Rajiv Gandhi, Jingyi Huang, Andrew Furey, Anthony Perruccio, Raja Rampersaud, Nizar N Mahomed, Proton Rahman, Mohit Kapoor, Guangju Zhai","doi":"10.5435/JAAOSGlobal-D-25-00285","DOIUrl":"10.5435/JAAOSGlobal-D-25-00285","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify metabolic biomarkers and pathways that might be associated with total joint arthroplasty (TJA) early revision for heterogeneous failure modes using an individual data meta-analysis of metabolomics.</p><p><strong>Methods: </strong>Two independent osteoarthritis (OA) cohorts were included. Revision records of patients with primary knee and hip OA were extracted at an average of 11.1 and 7.8 years after primary TJA, respectively. Preoperative fasting plasma was metabolomically profiled. Concentrations of metabolites/metabolism indicators were natural log-transformed, and their associations with early revision for all reasons in each individual cohort were assessed using logistic regression; the summary statistics from each cohort were then subjected to random-effects meta-analysis modelling.</p><p><strong>Results: </strong>Five hundred seventy-two patients with primary OA in The Newfoundland Osteoarthritis Study and 368 in the Longitudinal Evaluation in the Arthritis Program: Osteoarthritis Study were included. The revision rates were 4% and 6%, and mean times to revision were 1.7 and 2.1 years, respectively. No metabolite reached the prespecified significance threshold for multiple testing correction. However, 119 metabolites including choline, tryptophan betaine, indole, ornithine, three acylcarnitines, four cholesteryl esters, two lysophosphatidylcholines, five long-chain diglycerides, and 101 unsaturated (very) long-chain triglycerides were nominally significant with P < 0.05, suggesting potential links between these metabolites and early revision. Among these, indole and one acylcarnitine were positively associated with revision (odds ratio ≥1.73), while all others were negatively associated (odds ratio ≤0.73).</p><p><strong>Conclusion: </strong>Overactivation of the tryptophan-indole metabolic pathway may be associated with early revision after primary TJA. However, the findings were suggestive and represented a composite signal from heterogeneous failure modes.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391362","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":"Effect of Posterolateral Mini-incision Hip Hemiarthroplasty on Pain Scores and Hip Function in Elderly Patients With Hip Fractures.","authors":"Zhentao Dai, Zhuwen Ye","doi":"10.5435/JAAOSGlobal-D-25-00206","DOIUrl":"10.5435/JAAOSGlobal-D-25-00206","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the effect of posterolateral mini-incision hip hemiarthroplasty (HHA) on pain and hip function in elderly patients with hip fractures.</p><p><strong>Methods: </strong>Sixty hip fracture patients treated at our hospital between January 2023 and January 2024 were randomly assigned to two groups, with 30 patients in each group. The control group underwent traditional posterolateral approach HHA, while the observation group received HHA using the posterolateral mini-incision approach. General data were collected from both groups. Surgical indicators, including surgical time, time to ambulation, and length of hospital stay, were compared between the two groups. Adverse reactions and postoperative complications were recorded. Postoperative pain was assessed using the Visual Analog Scale (VAS) 24 hours after surgery. Treatment efficacy was evaluated with the Harris Hip Score (HHS), and balance ability was assessed using the Berg Balance Scale.</p><p><strong>Results: </strong>No significant differences were observed in baseline characteristics between the two groups (P > 0.05). The observation group demonstrated better surgical outcomes, with shorter operation and recovery times, as well as fewer adverse reactions and complications (P < 0.05). Postoperative VAS scores were significantly lower, and both HHS and Berg Balance Scale scores were higher in the observation group compared with the control group (P < 0.05).</p><p><strong>Conclusion: </strong>The posterolateral mini-incision approach for HHA in elderly patients with hip fractures can optimize surgical outcomes, reduce postoperative pain and complications, improve hip joint function, and promote better postoperative recovery, resulting in overall superior effects.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445501","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":"Risk Factors for Development of New-onset Anxiety and Depression After Sports Medicine Surgeries in Patients 25 Years of Age or Younger.","authors":"Andrea H Johnson, Jane C Brennan, James J York, Daniel E Redziniak, Benjamin M Petre, Justin J Turcotte","doi":"10.5435/JAAOSGlobal-D-25-00465","DOIUrl":"10.5435/JAAOSGlobal-D-25-00465","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to evaluate the incidence of new-onset anxiety and depression (NOAD) in younger patients undergoing common sports medicine procedures, determine risk factors associated with NOAD, and identify which treatments are used.</p><p><strong>Methods: </strong>A retrospective review of the PearlDiver national database was done. All patients included had no diagnosis of depression or anxiety before undergoing the following surgical procedures: anterior cruciate ligament reconstruction (ACLR), meniscus repair, hip arthroscopy (HA), shoulder instability repair, rotator cuff repair, or Achilles tendon repair. All patients were 25 years or younger and had ≥1-year follow-up. The primary outcome was development of NOAD within 1 year postoperatively. Multivariate regression was used to assess risk factors for NOAD.</p><p><strong>Results: </strong>A total of 178,759 patients were included in this study. Overall, 8,900 (5.0%) of patients developed NOAD within 1 year postoperatively; HA patients had the highest rate of NOAD (8.43%). Logistic regression identified age (P < 0.001), female sex (P < 0.001), Charlson Comorbidity Index score (P < 0.001), alcohol disorders (P < 0.001), headaches/migraines (P < 0.001), obesity (P < 0.001), and tobacco use (P < 0.001) as predictors of NOAD. Compared with ALCR, HA patients (OR, 1.81; P < 0.001) had the greatest risk of developing NOAD.</p><p><strong>Conclusion: </strong>The incidence of NOAD in the first year after common sports medicine procedures was 5% for patients aged 25 years or younger. Increased age, substance use, comorbidities, and HA were identified as risk factors for NOAD. Additional study of both mental health and functional outcomes, prevention, and treatment strategies is required to elucidate the risk of NOAD.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379110","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":"Radiographic Measurement of Graft Bending Angle in Failed Anterior Cruciate Ligament Reconstructions: A Matched Control Analysis.","authors":"Doria L Weiss, Emma L Tomlinson, Christian K Law, Kyle K Obana, Dana P Piasecki, Bryan M Saltzman, David P Trofa","doi":"10.5435/JAAOSGlobal-D-25-00470","DOIUrl":"10.5435/JAAOSGlobal-D-25-00470","url":null,"abstract":"<p><strong>Background: </strong>As anterior cruciate ligament (ACL) reconstruction failures rise, there is increasing recognition of the graft bending angle (GBA) as a potential risk factor for graft failure.</p><p><strong>Purpose: </strong>This study aims to investigate the association between steeper GBA and the need for a revision ACL reconstruction. In addition, this study proposes a standardized protocol for GBA measurement using more readily accessible radiograph imaging.</p><p><strong>Methods: </strong>A retrospective analysis of ACL reconstruction revisions performed at a single institution from January 1, 2017, to July 30, 2024, was conducted. Patients were included if they had available radiographic imaging between the primary ACL reconstruction and revision. Measurements of coronal GBA, femoral tunnel incline, and tibial tunnel incline were recorded from radiographs before ACL revision. Surgical data, including graft types and femoral tunnel drilling technique, were collected. Revision patients were compared with a matched control group who did not require revision.</p><p><strong>Results: </strong>A total of 81 patients who underwent ACL revision surgery were included. The average coronal GBA was 155.4° ± 12.30°, femoral tunnel incline was 47.9° ± 14.14°, and tibial tunnel incline was 67.2° ± 7.60. Coronal GBA varied by drilling technique, with notable differences between retroreaming (RR) (147.71° ± 11.43°) and transtibial (164.96 ± 11.82°; P = 0.019). A notable difference between the coronal GBA of cases (153.43° ± 12.52°) and controls (158.35° ± 8.50°) was found (P = 0.030).</p><p><strong>Conclusion: </strong>In this retrospective analysis, we found that RR femoral tunnel results in the most acute GBA in the coronal plane and that GBAs were more acute in cases of failed ACL reconstructions, by 5°, compared with matched controls. Our findings underscore the utility of two-dimensional radiographic imaging for measuring GBA in patients undergoing ACL revision surgery and consideration for limiting the obliquity of the femoral tunnel during primary ACL reconstruction.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356868","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":"Nociplastic Pain and Central Sensitization in Hip and Knee Arthroplasty: A Practical Primer for Arthroplasty Surgeons.","authors":"Christopher N Carender, Michael M Kheir, Elizabeth A Dailey, Daniel J Clauw","doi":"10.5435/JAAOSGlobal-D-25-00471","DOIUrl":"10.5435/JAAOSGlobal-D-25-00471","url":null,"abstract":"<p><p>Nociplastic pain is a type of pain distinct from nociceptive pain (pain from damage to tissues) and neuropathic pain (pain from damage to nerves). Mechanistically, nociplastic pain is incompletely understood but is thought to be secondary to altered pain sensory pathways peripherally and in the central nervous system. Nociplastic pain has been identified in more than one-third of patients presenting for evaluation of hip and knee arthritis. Importantly, many of these patients may not carry a formal diagnosis of fibromyalgia or other nociplastic pain syndrome. Patients with nociplastic pain undergoing arthroplasty surgery experience less pain relief and functional improvement, and exhibit increased opioid use after surgery. With an increasing emphasis being placed on preoperative to postoperative change in patient-reported outcome measures for measures of surgical quality and physician reimbursement, recognition of nociplastic pain by the arthroplasty surgeon before surgery is of critical importance.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}