JBJS Reviews最新文献

{"title":"Surgeon Experience and Patient Outcomes in Spine Surgery: A Narrative Review of Tenure, Volume, and Performance.","authors":"Arun K Movva, Rishi Jain, Rohan Govind, Ashym A C Patel, Theodore A Joaquin, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi","doi":"10.2106/JBJS.RVW.25.00250","DOIUrl":"10.2106/JBJS.RVW.25.00250","url":null,"abstract":"<p><p>» Surgeon experience is a well-recognized determinant of patient outcomes, with greater experience associated with lower complication rates, improved efficiency, and better patient recovery.» Experience has variable definitions across studies, including total or annual case volume, years in practice, surgeon age, and fellowship completion.» Surgeon case volume reflects procedural repetition, and tenure encompasses judgment and decision-making that develops over time. Both independently contribute to patient outcomes.» It is unclear whether surgeon subspecialty or age has an impact on objective outcomes, suggesting that experience and case volume are more reliable indicators of performance.» Significant gaps remain in the literature, including inconsistent definitions, limited longitudinal data, a lack of statistically significant preliminary results, and an overrepresentation of complex academic cases.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Integration of 3-Dimensional Printing in Shoulder Surgery: Current Applications, Evidence, and Future Directions: A Narrative Review.","authors":"Nima Bagheri, Mohammadreza Guity, Omid Salkhori, Seyyed Hadi Kalantar, Seyyed Saeed Khabiri, Seyed Mohammadjavad Mortazavi, Behzad Nezhad Tabrizi, Hamed Naghizadeh","doi":"10.2106/JBJS.RVW.25.00230","DOIUrl":"10.2106/JBJS.RVW.25.00230","url":null,"abstract":"<p><p>» Three-dimensional printing improves shoulder surgery by creating precise anatomical models for better planning and visualization.» Patient-specific guides and implants enhance accuracy, shorten surgery time, and lead to better functional outcomes in complex procedures.» Used effectively in fractures, instability, joint replacement, corrective bone surgery, and tumor reconstruction to support safer and more predictable surgery.» Challenges include high cost, time required for production, and limited long-term clinical evidence; future advancements include artificial intelligence and augmented reality to improve efficiency and personalization.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Angina: An Often Overlooked Cause of Noncardiac Chest Pain.","authors":"Jonathan P Japa, Philip Zitser, Mark Ehioghae, Kevin Yoon, Linus Lee, Shankar Thiru, Addisu Mesfin","doi":"10.2106/JBJS.RVW.25.00238","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00238","url":null,"abstract":"<p><p>» Chest pain is the second most common chief complaint in the emergency department.» Cervical Angina is an important cause of non-cardiac chest pain, and is often overlooked.» Cervical angina is believed to be caused by cervical radiculopathy of the C6-C7 nerve roots.» Diagnosis involves a thorough history and physical, ruling out cardiac causes of chest pain.» Both operative and non-operative management options are effective.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of the Biomechanical and Clinical Outcomes of Tibial-Sided Fixation for Anterior Cruciate Ligament Reconstruction.","authors":"Garrett R Jackson, Rhett Wakefield, Clayton W Nuelle, Steven F DeFroda","doi":"10.2106/JBJS.RVW.25.00186","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00186","url":null,"abstract":"<p><p>» Tibial fixation remains the biomechanically weaker site in ACL reconstruction due to lower bone density and directional loading forces, making fixation choice critical for graft stability.» Interference screws provide aperture fixation close to the joint line but are limited by graft slippage, tunnel widening, and progressive loss of tension over time.» Suspensory devices engage cortical bone and reduce graft damage during insertion; when supplemented with backup fixation, such as knotless suture anchors, they demonstrate greater fixation strength and reduced graft micromotion.» Internal suture augmentation offers promising biomechanical and early clinical benefits by protecting the graft during the vulnerable early healing period, especially in young athletes and revision cases, though long-term effects remain under investigation.» Fixation strategy should be individualized, balancing graft choice, bone quality, and rehabilitation demands to optimize outcomes and reduce risk of failure.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Social and Behavioral Determinants on Utilization and Outcomes of Total Ankle Arthroplasty: A Systematic Review.","authors":"Alexander Tham, Megan Calton, Jared Rubin, Anaelie Mainville, Raymond Walls, Kevin A Schafer, Lew C Schon, John G Kennedy","doi":"10.2106/JBJS.RVW.25.00228","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00228","url":null,"abstract":"<p><strong>Background: </strong>Total ankle arthroplasty (TAA) provides pain relief and motion preservation for end-stage ankle arthritis, yet outcomes and utilization vary widely. Social determinants of health (SDOHs) such as socioeconomic, demographic, and behavioral factors may contribute to these disparities, but their influence on TAA has not been systematically evaluated.</p><p><strong>Methods: </strong>A systematic review was registered on PROSPERO (CRD420251156933) and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PROGRESS-Plus framework to identify studies examining the impact of SDOH on TAA utilization and outcomes. PubMed, Embase, and Scopus were searched through 2025. Study quality was assessed with the Risk Of Bias In Nonrandomized Studies of Interventions tool, and certainty of evidence for each domain was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Data were synthesized narratively with random-effects meta-analysis where feasible.</p><p><strong>Results: </strong>Forty-four studies including more than 200,000 patients were analyzed. Social determinants were found to influence both access to TAA and postoperative outcomes. Men demonstrated slightly better postoperative function, whereas women reported more pain and higher rates of nonhome discharge. Older patients experienced more perioperative complications but achieved similar long-term implant survival compared with younger cohorts. Patients from minority racial and ethnic groups had higher complication rates and were less likely to receive TAA compared with arthrodesis. Lower income, public insurance, and treatment in rural or lower-volume hospitals were consistently linked with reduced access to TAA, longer hospital stays, and greater healthcare costs. Behavioral factors such as smoking and preoperative opioid use were strongly associated with wound complications, prolonged hospitalization, and poorer recovery.</p><p><strong>Conclusion: </strong>SDOH significantly shape access to surgery, complication risk, and recovery after TAA. Recognition of these influences and targeted strategies such as preoperative optimization, equitable referral pathways, and improved access to rehabilitation may help reduce disparities and improve outcomes in ankle arthroplasty.</p><p><strong>Level of evidence: </strong>Level III, systematic review of predominantly Level III studies.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Diagnosing Tarsal Tunnel Syndrome Across the Literature: A Systematic Review and a Call for Standardization.","authors":"Nadine Boers, Melanie Haverkamp, Anne Merijn Eligh, Manuel Castro Cabezas, J Henk Coert, Willem D Rinkel","doi":"10.2106/JBJS.RVW.25.00222","DOIUrl":"10.2106/JBJS.RVW.25.00222","url":null,"abstract":"<p><strong>Background: </strong>The lack of a gold standard in tarsal tunnel syndrome (TTS) diagnosis leads to diagnostic inconsistencies and variation in patient selection for treatment. Therefore, the aim of this review is to summarize the diagnostic criteria used in current studies on TTS based upon this best-evidence synthesis.</p><p><strong>Methods: </strong>Three databases were searched to identify all studies on TTS. Studies were included when they included (1) diagnosis or treatment of TTS as the primary focus, (2) a description of the diagnosis of TTS, (3) an original data set of TTS cases, and (4) a minimum of 10 adult patients diagnosed with TTS. A best-evidence synthesis was used to summarize the results.</p><p><strong>Results: </strong>In total, 4,213 patients were represented in 82 included studies. Among the varying diagnostic methods employed, aside from clinical symptoms, provocative testing was most often used (in 94% of studies, mandatory for diagnosis in 41% of studies) with the Tinel sign being the most prevalent (used in 89% of studies). Sensitivities of provocative tests, electrodiagnostic, and ultrasound measurements showed significant variability.</p><p><strong>Conclusion: </strong>We provided an overview of the diagnostic tools and workups reported in the literature on TTS. Our findings show that the lack of a standardized diagnostic approach results in considerable variability in clinical practice. Alongside typical clinical symptoms, the Tinel sign is the most frequently used diagnostic test. The varying sensitivities reported in literature underscore the need for evidence-based diagnostic guidelines on TTS diagnosis.</p><p><strong>Level of evidence: </strong>Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150908","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":"Shoulder-to-Elbow Humeral Malunions: Current Concepts and Review of the Literature.","authors":"Jazmoné Kelly, Niaz Ahankoob, Emily Benson","doi":"10.2106/JBJS.RVW.25.00185","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00185","url":null,"abstract":"<p><p>» Proximal humeral malunions: Arthroscopic techniques are effective for mild malunions, osteotomy is suitable for more significant deformities, and shoulder arthroplasty is ideal for cases with severe damage or nonviable humeral heads.» Humeral shaft malunions: Rotational and angled deformities should be addressed with an osteotomy, though malunions are generally well tolerated and more likely to be cosmetic deformities.» Distal humerus malunions are complex, but corrective osteotomy or arthroplasty can improve function and pain, especially with 3-dimensional imaging enhancing surgical accuracy.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Sex-Based Differences in Anterior Cruciate Ligament Injury Risk and Management.","authors":"Hanna H Sorensen, Kiera Little, Mitchell J Christiansen, Mary K Mulcahey","doi":"10.2106/JBJS.RVW.25.00174","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00174","url":null,"abstract":"<p><p>» Anterior cruciate ligament (ACL) tears are one of the most common severe injuries in sports medicine, with notable differences in incidence and outcomes between male and female athletes.» While anatomical, biomechanical, and hormonal sex-specific factors such as quadriceps angle, posterior tibial slope, and cyclic hormonal variation have been extensively evaluated, the influence of psychological and societal factors, including fear of reinjury, access to training, and disparities in access to care, remains less well understood.» This review aims to provide a comprehensive overview of intrinsic (anatomic, biomechanical, and hormonal) and extrinsic (psychological, social, and environmental) factors contributing to sex-based differences in ACL injury risk. In doing so, we seek to highlight both the breadth of current understanding and the relative lack of research addressing external, sex-based influences on injury incidence and recovery.» Recognizing sex-based differences in ACL injury risk, treatment, and recovery should guide the development of individualized prevention and rehabilitation strategies to optimize outcomes for all athletes.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Infection Prevention in Primary Shoulder Arthroplasty: Evidence-Based Strategies and Best Practices.","authors":"C Lucas Myerson, Brian O Molokwu, Jacquelyn J Xu, Sophia M Jacobi, Dennis A DeBernardis, Mandeep S Virk","doi":"10.2106/JBJS.RVW.25.00139","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00139","url":null,"abstract":"<p><p>» Based on the available evidence, there are numerous strategies that may reduce infection risk in primary shoulder arthroplasty. Preoperatively, optimization of iron deficiency anemia and smoking cessation are associated with lower rates of periprosthetic joint infection and perioperative complications. In addition, risk of infection may be mitigated by deferring shoulder arthroplasty for at least three months following a corticosteroid injection. Management of biologic and targeted immunosuppressive therapies should be coordinated with medical specialists and tailored to the specific agent's pharmacokinetics and surgical risk.» Preoperative skin preparation with agents such as benzoyl peroxide or chlorhexidine gluconate may decrease bacterial colonization. Antibiotic prophylaxis with a single preoperative dose of cefazolin administered within one hour of incision reduces infection risk, and in patients with true beta-lactam allergy, fully infused vancomycin prior to incision is an effective alternative. Intraoperatively, measures such as dilute betadine lavage, vancomycin powder, chlorhexidine wash, and antibiotic irrigation can reduce bacterial contamination. Additional intraoperative techniques including electrocautery after skin incision may further decrease bacterial burden, although higher level evidence for these latter interventions remains limited or conflicting.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Losartan on Musculoskeletal Tissues : Basic Science and Clinical Applications.","authors":"Alan D Villegas Meza, Michael Nocek, Ioanna K Bolia, Alyson Speshock, Marc J Philippon, Johnny Huard","doi":"10.2106/JBJS.RVW.25.00156","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00156","url":null,"abstract":"<p><strong>Background: </strong>Fibrosis is a prevalent impediment to musculoskeletal healing, which contributes to poor outcomes across orthopaedic procedures and remains largely underaddressed in orthopaedic care.</p><p><strong>Purpose: </strong>To review the effects of losartan on fibrosis across musculoskeletal tissues, and to evaluate its mechanistic rationale, preclinical outcomes, delivery strategies, and translational potential in orthopaedic practice.</p><p><strong>Content summary: </strong>Losartan inhibits transforming growth factor beta 1 signaling by antagonizing the angiotensin II type 1 receptor, thereby reducing myofibroblast activity, limiting extracellular matrix deposition, and preserving regenerative cell populations across musculoskeletal tissues. Preclinical models demonstrate histological and mechanical improvements in models of cartilage injury, joint capsule fibrosis, tendon-bone healing, and skeletal muscle regeneration. Therapeutic efficacy is strongly influenced by timing, delivery route, and the microenvironment of the injury. Biomaterial innovations such as nanofiber scaffolds and injectable angiotensin II receptor blocker (ARB) hydrogels may enhance delivery. Further studies stratifying outcomes by age and sex are warranted. Ongoing clinical trials are evaluating losartan for arthrofibrosis, skeletal muscle disorders, and comparative antifibrotic efficacy among ARBs.</p><p><strong>Conclusion: </strong>Losartan offers a mechanistically targeted, clinically familiar antifibrotic therapy with strong potential to improve surgical and rehabilitative outcomes in orthopaedics.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012665","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}