Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Analysis of Reasons for Medical Malpractice Litigation Following Arthroscopic Surgery.","authors":"Kai Nguyen, Ethan Vyhmeister, Zachary Brandt, Anthony Essilfie","doi":"10.5435/JAAOS-D-24-01487","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01487","url":null,"abstract":"<p><strong>Purpose: </strong>The primary aim of this study was to identify and characterize medical malpractice lawsuits following arthroscopic surgery.</p><p><strong>Methods: </strong>Two large medicolegal databases-Westlaw Edge and VerdictSearch-were queried using the term \"arthroscopy.\" Cases were reviewed and classified according to the nature of the plaintiff's complaint. Cases were only included if the primary basis of litigation rested on a malpractice claim related to arthroscopy. Data collected included reason for litigation, verdict ruling, location, monetary award, and joint involved. Pearson chi-squared test was used to assess associations between the variables.</p><p><strong>Results: </strong>After review of 11,006 cases, 271 were identified as malpractice claims following arthroscopy. The most common reasons for litigation were perioperative complications (n = 120), delayed or denied treatment (n = 70), poor postoperative management (n = 32), inadequate informed consent (n = 22), contraindicated procedure (n = 19), and gross negligence (n = 8). More than 90% of the identified cases involved arthroscopy of the knee or shoulder, with cases involving the shoulder significantly more likely to result in a plaintiff verdict or settlement than a defendant verdict compared with cases involving the knee (P = 0.013). Regarding the verdict ruling, 71.8% (n = 140) of cases ruled in favor of the defendant, 17.9% (n = 35) ruled in favor of the plaintiff, 0.5% (n = 1) resulted in a mixed ruling, and 9.8% (n = 19) resulted in an out-of-court settlement. An average payment of $842,834 ± $958,549 resulted from cases that resulted in either a plaintiff ruling or out-of-court settlement.</p><p><strong>Conclusion: </strong>This study describes several common reasons for malpractice lawsuits following arthroscopy. The study findings suggest that timeliness of diagnosis and surgical referral, coordination of care, and understanding of the indications versus limitations of conservative therapy are key factors frequently implicated in malpractice lawsuits following arthroscopic surgery.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AAOS Clinical Practice Guideline Summary Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures.","authors":"Charles P Hannon, Matthew J Grosso, Yale A Fillingham, Lauren L Patton","doi":"10.5435/JAAOS-D-25-00458","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00458","url":null,"abstract":"<p><p>The Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies examining the influence of dental care and procedures on outcomes after total joint arthroplasty (TJA) as well as strategies to mitigate potential risks associated with dental care and procedures in patients with a TJA. The scope of this guideline includes the role of dental screening, antibiotic prophylaxis, use of antimicrobial mouth rinses, and timing of dental procedures before and after TJA. The population was limited to patients with total hip arthroplasty (THA) or total knee arthroplasty because of a paucity of data on patients with other orthopaedic implants. Based on the best current available evidence, this guideline contains five options to assist all qualified clinicians, including orthopaedic surgeons and dental providers, considering the prevention of total hip arthroplasty and total knee arthroplasty periprosthetic joint infections in patients undergoing dental procedures. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in literature and informs areas for future research and quality measure development.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment and Prevention of Injuries in Skeletally Immature Throwing Athletes.","authors":"Jason Ina, David Soma, Christopher Camp, Nicholas Pulos","doi":"10.5435/JAAOS-D-25-00186","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00186","url":null,"abstract":"<p><p>Increased participation in youth sports has led to a corresponding increase in throwing-related injuries among skeletally immature athletes. These injuries often stem from overuse and can in part be attributed to sport specialization leading to year-round sport participation without adequate rest and an increase in volume of practices and games during the season. Injuries that occur in skeletally immature athletes can be unique to this population due to the vulnerability of the open growth plates. Common injuries include Little League shoulder (proximal humeral epiphysiolysis), internal impingement of the shoulder, Little League elbow, medial ulnar collateral ligament injuries, and capitellar osteochondral defects. Diagnosis and management of these injuries requires a high index of suspicion from the treating physician. In addition, prevention strategies and pitching guidelines have been introduced to decrease the burden of injury on this population. Proper treatment, appropriate intervention, and a thorough understanding of injury prevention guidelines can allow these young athletes to undergo a timely recovery and return to sport participation with minimal long-term effect.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Foot and Ankle Pain After Total Knee Arthroplasty and the Role of Subtalar Joint Motion Capacity.","authors":"Mirac Kadir Turhan, Tayfun Bacaksiz, Ihsan Akan, Mehmet Maden, Cem Ozcan, Cemal Kazimoglu","doi":"10.5435/JAAOS-D-25-00479","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00479","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee arthroplasty (TKA) restores the mechanical axis of the lower extremity, which is impaired due to gonarthrosis. Foot and ankle pain observed after TKA is not uncommon, and the exact cause has not been determined. This study aims to assess the role of the movement capacity of the subtalar joint and the clinical and radiological risk factors for foot and ankle pain after TKA.</p><p><strong>Methods: </strong>This study included 184 patients who underwent TKA due to primary varus gonarthrosis. Patients were evaluated clinically and radiologically before and after surgery. Lower extremity mechanical axis, talar-tilt angle, foot ground-talar dome angle, heel alignment ratio, heel alignment angle, heel alignment distance, and postoperative changes were the radiological angles measured. The Oxford Knee Score, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, visual analog scale score, and ankle and subtalar joint range of motion examinations were used clinically. Patients were grouped as those whose American Orthopaedic Foot and Ankle Society scores did not worsen after surgery (group 1) and those whose scores worsened (group 2).</p><p><strong>Results: </strong>The group 1 included 142 patients (77.2%) and group 2 included 42 patients (22.8%). The mean preoperative knee varus degree of group 1 was 11.49 ± 3.45, and that of group 2 was 14.26 ± 4.21 (P < 0.001). The mean body mass index was 26.67 ± 2.31 for group 1 and 29.47 ± 3.14 for group 2 (P < 0.001). Although no important difference was found between the groups in preoperative ankle motion capacity (P = 0.086), subtalar joint motion was found to be markedly limited in group 2 (P < 0.001).</p><p><strong>Conclusion: </strong>High preoperative knee varus degree and body mass index values, especially diminished preoperative subtalar joint motion capacity together with these values, are risk factors for postoperative foot and ankle pain after TKA.</p><p><strong>Level of evidence: </strong>Level III, Retrospective comparative study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide Analysis of Cardiopulmonary Outcomes After Multiple Long Bone Fracture Fixation.","authors":"Gable Moffitt, Laura Krech, Maxwell Phillips, Chelsea Fisk, Jessica Parker, Alistair J Chapman","doi":"10.5435/JAAOS-D-24-00347","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00347","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple long bone lower extremity fractures repaired with intramedullary nail (IMN) fixation have been associated with notable cardiopulmonary burden and may result in mortality. These patients are at an increased risk for fat embolism syndrome, pulmonary embolism, acute respiratory distress syndrome (ARDS), and pneumonia. Minimal data exist regarding the risk of simultaneous versus staged fixation of multiple long bone fractures that include both tibial and femoral injuries. We aimed to compare the cardiopulmonary outcomes after simultaneous versus staged IMN fixation.</p><p><strong>Methods: </strong>The American College of Surgeons' Trauma Quality Improvement Program database was queried to identify patients who sustained multiple long bone lower extremity fractures between January 2016 and December 2019. Patients were split into two cohorts: simultaneous fixation (fixation of all fractures in the same operation/calendar day) and staged fixation (two or more operations each >24 hours apart).</p><p><strong>Results: </strong>In total, 202,777 records of patients with tibial and/or femoral fractures were identified in the Trauma Quality Improvement Program database; 3,202 patients met the inclusion criteria. In total, 75.9% underwent simultaneous IMN fixation of two or more long bones, and 24.1% received staged fixation. The groups were similar across multiple variables; however, the staged fixation group was older (42 vs. 37, P < 0.0001) and had a significantly higher rate of ventilator associated pneumonia, ARDS, and acute kidney injury. The staged group had a longer time to surgery (16 vs. 39.5 hours, P < 0.0001) and hospital length of stay (17 vs. 11 days, P < 0.0001).</p><p><strong>Conclusion: </strong>After propensity score matching, simultaneous fixation of multiple long bone lower extremity fractures was not associated with increased cardiopulmonary events, including ARDS, ventilator associated pneumonia, and acute kidney injury. Given these findings, simultaneous IMN fixation should be considered because it was not associated with an increased risk of cardiopulmonary complications in the high-risk patient.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Novel Orthopaedic Surgery Summer Program for Medical Students.","authors":"Jhillika Patel, Jomar Aryee, Jason Yang, Thomas McPartland, Charles Gatt, Brian Katt","doi":"10.5435/JAAOS-D-25-00062","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00062","url":null,"abstract":"<p><strong>Introduction: </strong>Early exposure to surgical specialties markedly affects medical students' career interests and preparedness. This study evaluates the effectiveness of a novel Orthopaedic Surgery Summer Immersion Program in fostering interest, enhancing knowledge, and building mentorship connections among medical students.</p><p><strong>Methods: </strong>The program targeted rising 2nd-year medical students and provided surgical and clinical shadowing, academic lectures, hands-on workshops, and mentorship opportunities. A mixed-methods approach was used, including pre- and postprogram surveys analyzed for quantitative and qualitative data. Participants self-reported knowledge, skills, and career intentions using Likert scales. Changes in responses were assessed using paired t-tests, with significance set at P < 0.05.</p><p><strong>Results: </strong>Three years of programming were successfully completed, and survey results were provided for the later 2 programming years, including 2023 summer and 2024 summer. Among 20 survey participants' self-reported knowledge of musculoskeletal anatomy, physiology, and pathology increased from 4/10 pre-program to 8/10 postprogram (P < 0.001). Subjective confidence in reading radiographic images (4/10 to 9/10, P < 0.001) and performing basic orthopaedic physical examinations (3/10 to 7/10, P < 0.001) also improved. Students' self-reported operating room etiquette and fundamental surgical principles improved from 5/10 to 8/10 (P < 0.001). Interest in pursuing orthopaedic surgery rose from 50% preprogram to 95% postprogram. Participants rated program effectiveness as 10/10 and 85% reported connecting with at least one potential mentor.</p><p><strong>Conclusion: </strong>The Orthopaedic Surgery Summer Immersion Program markedly enhanced participants' self-reported knowledge, skills, and career intentions in orthopaedics. Statistically significant improvements in educational outcomes and mentorship highlight the program's value as a replicable model for introducing medical students to orthopaedic surgery and addressing gaps in early musculoskeletal education.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Different Surgical Methods for Campanacci Grade III and Recurrent Giant Cell Tumors of the Distal Radius.","authors":"Anqi Wang, Jinxin Hu, Tianqi Luo, Qinglian Tang, Jin Wang, Xiaojun Zhu","doi":"10.5435/JAAOS-D-25-00217","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00217","url":null,"abstract":"<p><strong>Background: </strong>Campanacci grade III and recurrent giant cell tumors (GCTs) of the distal radius are aggressive, but treatments are scare, and universally accepted surgical strategy has not been established. The purpose of this study was to compare the clinical outcomes of different surgical methods for these tumors.</p><p><strong>Methods: </strong>We retrospectively analyzed 26 patients with Campanacci grade III or recurrent GCT of the distal radius between 2017 and 2023 in this study. Patients were divided into intralesional curettage group (n = 12) and wide excision group (n = 14). According to the different reconstruction methods, the wide excision group was further divided into two subgroups, including the arthroplasty subgroup (n = 8) and the arthrodesis subgroup (n = 6). All patients underwentsurgeries, and perioperative denosumab was recommended. Pre- and postoperative active range of motion (ROM) of the wrist, grip strength, visual analog score, Mayo wrist score and Musculoskeletal Tumor Society score were assessed. Postoperative complications, denosumab application, and tumor recurrence were also evaluated.</p><p><strong>Results: </strong>The intralesional curettage group was superior to the wide excision group in reservation of ROM of the wrist but related to higher local recurrence rate (25% vs. 7.1%). Postoperative pain relief and satisfaction of the patients were more obvious in the wide excision group compared with the intralesional curettage group. Arthroplasty and arthrodesis following wide excision provided similar improvements in grip strength, visual analog score, Mayo wrist score, and Musculoskeletal Tumor Society scores after surgery. Arthroplasty better reserved ROM of the wrist but associated with more complications especially wrist instability and revision surgery than arthrodesis. Arthrodesis restricted flexion, extension, and radial and ulnar deviations of the wrist but related to few instability complications.</p><p><strong>Conclusion: </strong>Wide excision was the preferred choice for Campanacci grade III and recurrent GCT of the distal radius considering adequate local control, good pain relief, and satisfaction. Extended intralesional curettage with postoperative denosumab administration was also a reasonable alternative with better functional outcomes but increased risk of recurrence and possibility of wide excision revision surgery in the future. Arthroplasty following wide excision could reserve the motion of wrist but associated with frequent wrist instability and relatively high revision surgery rate. Arthrodesis could ensure a more stable wrist, and it is recommended for manual workers.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Comparison; Treatment Study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ipsilateral Preoperative Corticosteroid Injection and Timing Not Associated With Postoperative Deep Infection After Carpal Tunnel Release.","authors":"Annika N Hiredesai, Alejandro M Holle, Ammon Driggs, Eugenia Lin, Jens T Verhey, Cara H Lai, Shelley S Noland","doi":"10.5435/JAAOS-D-25-00317","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00317","url":null,"abstract":"<p><strong>Introduction: </strong>Previous literature reports an increased risk of postoperative infection with preoperative corticosteroid injection (CSI) before carpal tunnel release (CTR), although the temporal nature of this risk remains unclear. A large administrative claims database was used to answer the following: (1) Is CSI within 90 days before CTR associated with higher postoperative deep infection (PDI) rates? (2) When stratified by 0 to 30 days, 31 to 60 days, and 61 to 90 days before CTR, is CSI timing associated with higher PDI rates?</p><p><strong>Methods: </strong>Patients who underwent endoscopic or open CTR were identified in the PearlDiver M170 database. Exclusion criteria included concomitant hand procedure, age younger than 18 years, unspecified or bilateral carpal tunnel syndrome, and insufficient postoperative data. Patients who received ipsilateral CSI within 90 days before CTR or no CSI were matched by age, sex, Elixhauser Comorbidity Index, hypertension, diabetes, obesity, rheumatoid arthritis, thyroid disorders, and tobacco use. Patients with a preoperative CSI before CTR were further stratified into those who received CSI 0 to 30 days, 31 to 60 days, and 61 to 90 days. Demographic variables between matched cohorts were compared using chi-squared or Kruskal-Wallis tests. Chi-squared tests were used to determine association between CSI timing and 30-, 60-, and 90-day PDI requiring surgical intervention.</p><p><strong>Results: </strong>Each matched cohort included 17,125 patients. No notable increase in PDI risk was observed in the CSI cohort who relative to controls. Secondary analysis by preoperative CSI timing of 0 to 30, 31 to 60, or 61 to 90 days similarly did not reveal any notable increase in PDI risk relatives to controls.</p><p><strong>Conclusion: </strong>The reported findings suggest that preoperative CSI, at all studied timepoints, was not associated with increased risk of PDI, a divergence from existing literature. Surgeons should consider these findings when evaluating risks and benefits of nonsurgical and surgical treatments for carpal tunnel syndrome.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safety Profile and Outcomes of Tranexamic Acid for Total Ankle Arthroplasty: A Systematic Review.","authors":"Rodrigo Encinas, Sarah Hall Kiriluk, Jack Hardman, J Benjamin Jackson, Tyler Gonzalez","doi":"10.5435/JAAOS-D-25-00365","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00365","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) is frequently used in knee and hip arthroplasty because of its benefits. The literature is scarce on TXA and total ankle arthroplasty (TAA). The current systematic review aims to present the available literature on the subject.</p><p><strong>Methods: </strong>Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. The search criteria were based on TAA and TXA. The MINORS score criteria were used to evaluate the strength and quality of the selected studies.</p><p><strong>Results: </strong>A total of eight studies including 263 TAA were completed with the usage of TXA and 228 TAA were without TXA. The average blood loss and change in hemoglobin in the TXA group was 335.4 mL and 1.45 g/dL, respectively. In the non-TXA group, average blood loss and change in hemoglobin was 441.8 mL and 1.78 g/dL, respectively. The total number of complications and wound complications reported in all studies for the TXA group were 19% and 6.8%; in the non-TXA group, 33.3% and 16.7% were observed, respectively. The difference in wound complication rate was statistically significant (P = 0.014). Trends favoring the TXA group were found for lower transfusion, pulmonary embolism, deep vein thrombosis, and cerebrovascular accident.</p><p><strong>Conclusion: </strong>The utilization of TXA in TAA appears to be safe and effective. Wound complication rate was the only finding with a notable difference favoring the TXA group. The rest of the data from this systematic review demonstrate a trend toward lower in blood loss, hemoglobin decrease, and total complications when using TXA in TAA. Larger prospective studies and randomized controlled trials are needed to further guide evidence-based guidelines.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Failure After Lumbar Tubular Microdecompression Without Stabilization.","authors":"Ameen Barghi, Anirudh K Gowd, Edward Beck, Mark Glover, Christian Sangio, Hudson McKinney, Emily Barr, Marcel G Brown, Garrett Bullock, John Birkedal, Tadhg O'Gara","doi":"10.5435/JAAOS-D-24-00763","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00763","url":null,"abstract":"<p><strong>Objective: </strong>To identify radiographic and MRI imaging markers associated with failure after lumbar tubular microdecompression (LTM) without stabilization or fusion.</p><p><strong>Background: </strong>LTM is a minimally invasive option for treating lumbar spine pathology without instability. Stabilization procedures are considered but may be associated with increased blood loss, risk of future adjacent segment disease, and higher costs and should be used only when required.</p><p><strong>Methods: </strong>Four hundred sixty-eight patients undergoing LTM for central, lateral recess and foraminal/extraforaminal stenosis between 2014 and 2023, including unilateral laminotomy, unilateral laminotomy for bilateral decompressions, and far lateral decompression, were included. Preoperative imaging was reviewed for evidence of static and dynamic degenerative spondylolisthesis, facet effusions, and synovial cysts. The primary outcome was failure following LTM, which was defined as undergoing fusion, open laminectomy, or revision LTM at the same level of the index procedure for recurrent symptoms during the exposure period. Poisson regressions were done and controlled for age, sex, body mass index, and smoking status, with an offset for total follow-up time.</p><p><strong>Results: </strong>Static spondylolisthesis was not associated with failure (1.00 [95% CI, 0.97 to 1.03], P = 0.996), whereas increases in dynamic spondylolisthesis (1.13 [95% CI, 1.01 to 1.26], P = 0.034) and facet effusions (1.22 [95% CI, 1.01 to 1.48], P = 0.040) predicted increased risk for failure. Presence of spinal synovial cysts was not associated with failure (0.6 [95% CI, 0.1 to 2.4], P = 0.469).</p><p><strong>Discussion: </strong>The presence of dynamic spondylolisthesis and facet effusions suggest that decompression alone may result in a greater likelihood of failure, and the addition of stabilization procedures should be considered.</p><p><strong>Study design: </strong>Retrospective cohort study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}