JBJS Reviews最新文献

{"title":"Delaminated Rotator Cuff Tears.","authors":"Ruochen Li, Guangwei Wu, Yang Yu, Han Xue, Zheyue Zhu, Bowen Zeng, Yujia Shi, Yuquan Liu, Chen Zhang","doi":"10.2106/JBJS.RVW.25.00095","DOIUrl":"10.2106/JBJS.RVW.25.00095","url":null,"abstract":"<p><p>» Delaminated rotator cuff tears (DRCTs) represent a unique type of tear characterized by horizontal splits within the supraspinatus tendon, occurring in both partial-thickness and full-thickness tears, with or without retraction of the bursal or articular surfaces.» The pathogenesis of DRCTs lies in the anatomical layered architecture of the supraspinatus and infraspinatus tendons and the interlayer shear stress disparities. Furthermore, during shoulder abduction, hypovascular-driven degeneration and biomechanical strain gradients also contribute to this layered pathogenesis.» Accurate diagnosis of DRCTs mainly relies on imaging methods such as magnetic resonance imaging, magnetic resonance arthrography, and ultrasonography. Recent advances in shear wave elastography have enhanced diagnostic accuracy by delineating tear morphology and quantifying tendon stiffness.» Management of DRCTs requires individualized strategies based on tear size, muscle quality, and chronicity. Nonoperative approaches, including activity modification, nonsteroidal anti-inflammatory drugs, and targeted physiotherapy, may be considered for acute partial-thickness DRCTs. Surgical repair becomes necessary for chronic, severely retracted, or full-thickness DRCTs, as well as for cases where nonoperative treatments have failed to achieve satisfactory outcomes, using either en masse or dual-layer techniques.» Although en masse and dual-layer repairs show comparable clinical outcomes and retear rates, dual-layer repair demonstrates superior pain control and functional recovery, making it a preferred surgical approach.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 8","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859727","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":"Lateral Meniscus Oblique Radial Tears: A Review of Diagnostic Considerations, Biomechanical Impact, and Treatment Outcomes.","authors":"Jarod Karom, Clayton Peterson, Parker Cavendish, Eric Milliron, Robert Magnussen, Christopher Kaeding, David Flanigan","doi":"10.2106/JBJS.RVW.25.00102","DOIUrl":"10.2106/JBJS.RVW.25.00102","url":null,"abstract":"<p><p>» Lateral meniscus oblique radial tears (LMORTs) predominantly affect younger individuals younger than 30 years, especially men with a higher body mass index, presenting unique challenges in surgical management.» The diagnosis of LMORTs is challenging because of the variable sensitivity of magnetic resonance imaging (MRI), particularly in cases with concurrent anterior cruciate ligament (ACL) injuries, necessitating the integration of MRI findings with clinical and intraoperative evaluations for accurate diagnosis.» LMORTs significantly affect knee stability and joint mechanics, negatively influencing function and predisposing patients to subsequent joint degeneration.» Treatment strategies for LMORTs have evolved to favor meniscus preservation, with arthroscopic repair techniques such as transosseous pullout suture and side-by-side repair being recommended for more severe tear types.» Future research directions include advancing imaging techniques, conducting long-term outcome studies, exploring LMORTs in non-ACL injuries, performing biomechanical studies focused on healing outcomes, and emphasizing patient-reported outcomes to improve diagnostic accuracy and treatment effectiveness.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 8","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805055","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":"Predictors of Conversion Total Hip Arthroplasty After Surgically Managed Acetabulum Fractures: A Prognostic Factor Systematic Review and Meta-Analysis.","authors":"Geoffrey W Schemitsch, Darius L Lameire, Graeme Hoit, Manav Vyas, Amir Khoshbin, Rob Fowler, Aaron Nauth, Neill K J Adhikari","doi":"10.2106/JBJS.RVW.25.00086","DOIUrl":"10.2106/JBJS.RVW.25.00086","url":null,"abstract":"<p><strong>Background: </strong>Operative management of acetabular fractures can be complicated by the development of symptomatic post-traumatic arthritis, which may necessitate conversion total hip arthroplasty (THA). There is increased interest in treatment with THA for acute management, but optimal patient selection depends on identifying those at risk of later symptomatic post-traumatic arthritis requiring conversion THA.</p><p><strong>Methods: </strong>We systematically reviewed prognostic factors associated with conversion THA in adult patients with operatively managed acetabulum fractures. We searched MEDLINE and EMBASE from inception to September 27, 2024. Screening, data extraction, risk of bias assessment, and evidence grading were completed in duplicate. Data were pooled using a random-effects model to produce summary odds ratios (ORs), hazard ratios (HRs), and mean differences, with 95% confidence intervals (CIs). Risk of bias was assessed using the Quality in Prognosis Studies tool. Certainty of evidence was evaluated using the Grade of Recommendation, Assessment, Development, and Evaluation framework.</p><p><strong>Results: </strong>A total of 3,054 citations were screened, and 38 studies (6,931 fractures) met inclusion criteria. Eight factors were associated with conversion THA in unadjusted analyses: acetabular impaction (OR 2.08, 95% CI 1.60-2.70, moderate certainty), femoral head impaction (OR 2.70, 95% CI 1.80-4.06, moderate certainty), dislocation (OR 2.20, 95% CI 1.51-3.19, moderate certainty), nonanatomic reduction on radiography (OR 2.36, 95% CI 1.58-3.51, moderate certainty), nonanatomic reduction on computed tomography (OR 3.46, 95% CI 1.25-9.57, moderate certainty), associated fracture type (OR 1.76, 95% CI 1.29-2.41, moderate certainty), female sex (OR 1.48, 95% CI 1.15-1.88, moderate certainty), and posterior wall involvement (OR 1.82, 95% CI 1.18-2.80, moderate certainty). In multivariable analyses, age (adjusted OR 1.04, 95% CI 1.02-1.06, high certainty; adjusted HR 1.04, 95% CI 1.03-1.05, high certainty) and femoral head impaction (adjusted HR 3.19, 95% CI 1.16-8.75, moderate certainty) were associated with conversion THA. The weighted proportion of patients requiring THA conversion was 17.6% (95% CI 15.2%-20.4%, low certainty).</p><p><strong>Conclusion: </strong>Older age and femoral head impaction were the only factors associated with conversion to THA in univariable and multivariable analyses.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 8","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805056","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":"Balancing Risk and Reward in Hip Resurfacing for Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis.","authors":"Jean Shanaa, Ethan Bernstein, Natalie Shanaa, Maani Bahador, Theodor Di Pauli von Treuheim, Scott Marwin","doi":"10.2106/JBJS.RVW.25.00091","DOIUrl":"10.2106/JBJS.RVW.25.00091","url":null,"abstract":"<p><strong>Background: </strong>As interest in hip resurfacing arthroplasty (HRA) expands to complex pathologies, developmental dysplasia of the hip (DDH) has emerged as a challenging but increasingly considered indication. Although severe DDH often precludes resurfacing because of distorted anatomy, mild cases (Crowe I and II) may provide favorable conditions. This review evaluates outcomes of HRA in mild DDH, compares them with outcomes of total hip arthroplasty (THA) in DDH and HRA in primary osteoarthritis (OA) and assesses the potential of HRA to improve long-term function in this population.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, and Scopus identified studies reporting outcomes of HRA in DDH. Titles and abstracts were screened, followed by full-text review. Data on demographics, outcomes, and radiographic findings were extracted. Pooled complication and survivorship rates were calculated. A random-effects meta-analysis compared revision risk in HRA-treated patients with DDH vs. OA, and in patients with DDH treated with HRA vs. THA. Statistical significance was defined as a 95% confidence interval (CI) excluding 1. A separate meta-analysis compared mean postoperative flexion in patients with DDH treated with HRA vs. THA, with significance defined as a 95% CI excluding 0.</p><p><strong>Results: </strong>From 65 screened articles, 11 met inclusion criteria, totaling 895 patients and 1,006 hips with DDH. The mean age was 45.26 years, with an average follow-up of 7.06 years. The pooled survivorship was 93%, and the complication rate was 13%. No significant difference in revision risk was found between DDH and OA HRA cohorts, or between HRA and THA in DDH, although both trends favored OA and THA. Patients with HRA-treated DDH had significantly greater postoperative flexion (standardized mean difference -1.21, 95% CI -1.54 to -0.87).</p><p><strong>Conclusion: </strong>Despite anatomical challenges and a potential for higher revision or complication rates in patients with DDH, mid-term outcomes, including patient-reported outcome, were comparable with those in primary osteoarthritis and THA cohorts. This review supports the selective use of HRA in patients with Crowe I and II DDH, particularly when modern surgical techniques and DDH-specific implants are used.</p><p><strong>Level of evidence: </strong>Level III, systematic review of Level I, III, and IV studies. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664028","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 10-Year Systematic Review of Brucella Periprosthetic Joint Infections Following Total Knee Arthroplasty.","authors":"Klaudia Greer, Jonathan Brutti, Zachary Grand, Janae Rasmussen, Mikaela Rockwell, Taylor Davis, Joseph Song, Jaspreet Sidhu","doi":"10.2106/JBJS.RVW.25.00079","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00079","url":null,"abstract":"<p><strong>Background: </strong>Brucella species are zoonotic pathogens responsible for brucellosis, a systemic bacterial infection primarily transmitted through direct contact with infected animals or consumption of unpasteurized dairy products. While Brucella infections following total knee arthroplasty (TKA) are rare, they pose significant diagnostic and therapeutic challenges with limited reported cases.</p><p><strong>Methods: </strong>A systematic review, following the Preferred Reporting in Systematic Reviews and Meta-Analyses guidelines, was performed on February 22, 2025, using the databases PubMed and Google Scholar for Brucella TKA periprosthetic joint infections (PJIs) in patients older than 18 years. The search was further narrowed by excluding articles before 2015 to reflect the most current trends and practices. Our eligibility criteria were guided by the Population, Intervention, Comparison, and Outcome framework. We considered outcomes including, but not limited to, successful eradication of infection, complications, and functional outcomes following intervention.</p><p><strong>Results: </strong>Fifteen studies met inclusion criteria. Brucella PJIs in a TKA typically present late with nonspecific symptoms, often mimicking aseptic loosening or culture-negative PJIs. Most patients had identifiable risk factors, including travel to endemic regions, animal exposure, or consumption of unpasteurized dairy. Two-stage revision was used in 11 of 15 cases. Conservative management with implant retention was successful when no loosening was present in 3 out of the 15 cases. The most common antibiotic treatment was doxycycline plus rifampicin with duration ranging from 3 to 12 months, most commonly for a total of 6 months. Successful outcomes are possible with prolonged combination antibiotics and often require 2-stage revision arthroplasty, though diagnostic and treatment approaches vary widely.</p><p><strong>Conclusion: </strong>This is an updated systematic review of Brucella infections following TKA within the last 10 years. Given the insidious onset and potential for chronic infection, orthopaedic surgeons and infectious disease specialists must be aware of the possibility of Brucella PJIs in patients with the appropriate history and clinical examination.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664027","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":"Metal-Backed Tibial Components Offer Comparable Patient-Reported Outcome Measures With Lower Revision Rates Compared With All-Polyethylene Tibial Components in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Sina Hajiaghajani, Sadra Mohebbi, Keivan Asadi, Mohammad Poursalehian, Negin Ashoori, Amir Mehrvar","doi":"10.2106/JBJS.RVW.25.00061","DOIUrl":"10.2106/JBJS.RVW.25.00061","url":null,"abstract":"<p><strong>Background: </strong>Two tibial component designs are mainly used in fixed-bearing unicompartmental knee arthroplasty (UKA): metal-backed (MtB) and all-polyethylene (AP). While AP components allow for increased polyethylene thickness with minimal bone resection, MtB implants offer modularity for isolated bearing exchange and potentially superior stress distribution. However, controversy remains regarding their respective revision rates and patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered our protocol on International Prospective Register of Systematic Reviews (CRD42024604110). A comprehensive search was performed in PubMed, Web of Science, Embase, and Scopus up to December 10, 2024, without language restrictions. Studies comparing MtB and AP tibial components in medial fixed-bearing UKA were included, assessing revision rates, PROMs, and range of motion (ROM). Data were extracted independently by 2 reviewers, and statistical analysis was performed using a random-effect model. Odds ratios (ORs) were calculated for all-cause revision and aseptic tibial loosening rates, whereas mean differences were calculated for PROMs and ROM.</p><p><strong>Results: </strong>Sixteen studies involving 34,738 participants (34,998 knees) were included, with 21,097 knees receiving MtB prostheses and 13,836 receiving AP prostheses. The overall all-cause revision and aseptic tibial loosening rates were significantly lower in the MtB group: OR, 0.49; 95% confidence interval (CI), 0.31-0.79; p = 0.003 and OR, 0.29; 95% CI, 0.09-0.99; p = 0.048, respectively. However, PROMs-including Knee Society Score, Knee Society Function Score, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, Short Form-36, and ROM-were comparable between groups.</p><p><strong>Conclusion: </strong>MtB tibial components in medial fixed-bearing UKA offer comparable PROMs and ROM with significantly lower rates of both all-cause revision and revision because of aseptic tibial component loosening relative to AP designs.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664029","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":"Preoperative Patient Optimization for Lower Extremity Total Joint Arthroplasty Surgery.","authors":"Kristen Barton, Jason M Jennings, Douglas A Dennis, Antonia F Chen","doi":"10.2106/JBJS.RVW.25.00037","DOIUrl":"10.2106/JBJS.RVW.25.00037","url":null,"abstract":"<p><p>» Identifying medical comorbidities and optimizing modifiable risk factors (biological, social, and psychological) have been suggested as a strategy to improve the value of total joint arthroplasty (TJA) care, while reducing the risk of intraoperative and postoperative complications. Modifiable biological factors include weight management to reduce obesity, optimizing diabetic control, improving malnutrition, optimizing bone health, improving anemia, managing anticoagulants and bleeding risk, controlling inflammatory conditions, reducing methicillin-sensitive Staphylococcus aureus/methicillin-resistant S. aureus colonization, and reducing frailty. Modifiable social and psychological factors include tobacco and smoking cessation, reducing alcohol use, ceasing drug use/misuse, optimizing mental health (i.e., depression, anxiety), patient TJA education and managing expectations, and evaluating discharge determination and living status. This review comprehensively evaluates and summarizes preoperative patient optimization strategies for lower extremity TJA surgery, both in the primary and revision settings.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337151","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":"Split Posterior Tibialis Tendon Transfer and the Recurrence Rate of Equinovarus Deformity in Patients With Cerebral Palsy: A Systematic Review and Meta-Analysis.","authors":"Marc Daniel Bouchard, Cameron Pow, Mark Polemidiotis, David Slawaska-Eng, Mousa Saeed Alahmari, Waleed Kishta","doi":"10.2106/JBJS.RVW.25.00064","DOIUrl":"10.2106/JBJS.RVW.25.00064","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cerebral palsy (CP) is the most common motor disability of childhood, predominantly characterized by spasticity. A frequent complication of spastic CP is equinovarus deformity, resulting in pain, instability, and altered gait, significantly affecting ambulation. Surgical intervention, particularly the split posterior tibialis tendon transfer (SPOTT), is often required to correct deformity when conservative management fails. However, the variability in outcomes and recurrence rates across different patient subtypes and surgical techniques remains unclear. This systematic review aimed to evaluate the recurrence rate of equinovarus deformity in children with CP after SPOTT, with a focus on factors such as age, CP subtype, and functional status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of MEDLINE, Embase, and Emcare databases was performed to identify observational studies reporting recurrence rates after SPOTT in pediatric patients with CP (aged ≤18 years). Studies with short follow-up periods (&lt;12 months), non-English articles, conference abstracts, and those involving concomitant bony procedures were excluded. Statistical analyses used random-effects meta-analysis models to calculate pooled recurrence rates. All statistical analyses were performed, and forest plots were generated using R (version 4.3.2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nine studies (325 patients, 366 feet) met the inclusion criteria. The mean age at surgery was 10.35 years, with a mean follow-up duration of 76.18 months. The overall pooled recurrence rate of equinovarus deformity after SPOTT was 11.4% (95% confidence interval 5.0-17.8), with substantial heterogeneity (I2 = 71.9%). Subgroup analysis revealed higher failure rates among nonambulatory patients with quadriplegic CP (47.6%) compared with ambulatory hemiplegic patients (6.6%). The optimal age window for SPOTT seemed to be between 6 and 10 years as younger patients demonstrated increased risks of valgus deformity, whereas older patients had higher recurrence rates. Variations in surgical techniques, including interosseous membrane versus circumtibial routing, were identified as potential sources of heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;SPOTT seems to be an effective intervention for correcting equinovarus deformity in ambulatory patients with CP, particularly those with hemiplegia or diplegia. However, nonambulatory and quadriplegic patients are at higher risk of recurrence, warranting careful patient selection. These conclusions should be interpreted with caution because of substantial study heterogeneity and the variability in surgical techniques reported. Further high-quality studies with standardized reporting and direct comparisons between surgical techniques are necessary to optimize outcomes and inform clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Therapeutic Level IV, systematic review. See Instructions for Authors for a complete description of ","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337152","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":"Diagnosis and Management of Osteonecrosis of the Femoral Head in Young Patients.","authors":"Angel Xiao, Lisa Bonsignore-Opp, Victoria Koffi, Sarah Coufal, Ishaan Swarup","doi":"10.2106/JBJS.RVW.25.00046","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00046","url":null,"abstract":"<p><p>» Osteonecrosis of the femoral head (ONFH) in pediatric patients is a rare but significant cause of disability because of the risk of early-onset osteoarthritis. The pathophysiology is believed to be vascular in origin, stemming from the friable nature of the epiphyseal blood supply across an open physis. Etiologies of pediatric ONFH include idiopathic, traumatic, and atraumatic. The goal of treatment is to slow disease progression and prevent the sequelae after femoral head collapse. Early diagnosis is key using a combination of physical examination and imaging findings. The management of pediatric ONFH, however, is complicated by a limited body of evidence and a lack of consensus on prevention or treatment. Treatment consideration depends on the age of the patient, extent of femoral head involvement, and presence of femoral head collapse.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276259","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 Talar Morphology Between Patients With Clubfoot and Nonclubfoot Patients from Fetus to Adulthood: A Systematic Review.","authors":"Manon Pigeolet, Adam Nasreddine, Sion Yu Jang, Louise Atadja, Daniel Guss, Collin J May","doi":"10.2106/JBJS.RVW.25.00028","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00028","url":null,"abstract":"<p><strong>Background: </strong>The talus plays a central role in understanding the pathophysiology and natural history of clubfoot deformity. The morphology, severity, natural history, and functional implications of talar dysplasia in patients with clubfoot are poorly understood. Flat-top talus is a common finding in patients with a history of clubfoot that can lead to limited ankle dorsiflexion and painful anterior ankle impingement. The aim of this review was to assess the morphological differences between clubfoot and non-clubfoot tali.</p><p><strong>Methods: </strong>We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE/PubMed, Embase, and Scopus for articles reporting on talar morphology in patients with clubfoot. Our primary outcomes collected were demographic data of included patients and variables describing talar morphology.</p><p><strong>Results: </strong>The clubfoot talus is dysplastic in multiple dimensions. The prevalence of talar flattening appears to increase in early life and stabilizes during childhood. Differences in talar length and transverse talar neck angle between clubfoot and nonclubfoot tali virtually disappear by adolescence. The current literature suggests that differences in talar morphology in patients with clubfoot are both of an innate and an acquired nature. Despite the lack of longitudinal studies, some studies show a potential correlation between the presence or development of a flat-top talus and increased clubfoot severity.</p><p><strong>Conclusion: </strong>Talar dysplasia in patients with clubfoot, including flat-top talus, remains poorly understood, and further studies are necessary to inform treatment guidelines for flat-top talus.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276260","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}