Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Predicting Proximal Humerus Fracture Mechanical Complications: Are Computed Tomography Hounsfield Units the Answer?","authors":"Nina D Fisher, Andrew S Bi, Kenneth A Egol","doi":"10.5435/JAAOS-D-24-00594","DOIUrl":"10.5435/JAAOS-D-24-00594","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose was to determine whether computed tomography (CT) Hounsfield units (HU) as a proxy for bone quality can predict postoperative complications following surgical treatment of proximal humerus fractures.</p><p><strong>Methods: </strong>Sixty-six patients with 2-, 3-, or 4-part proximal humerus fractures who underwent surgical fixation at single institution and had complete radiographic data available were included. Radiographic measurements included the deltoid tuberosity index (DTI) on preoperative anterior-posterior shoulder radiographs, and the HU value from the surgical proximal humerus was determined by measuring the humeral head at the midaxial/coronal/sagittal CT image using a circle-type region of interest (≥35 mm 2 ). Postoperative complications recorded were implant failure, development of osteonecrosis, nonunion, and acute periprosthetic fracture. Patients with and without complications were statistically compared, and binary logistic regression was performed to determine whether preoperative proximal humerus CT HU were predictive of complications.</p><p><strong>Results: </strong>Eight patients (12.1%) developed 11 overall complications, with three patients experiencing multiple complications each. Complications included osteonecrosis (4), implant failure (5), nonunion (1), and acute periprosthetic fracture (1). No difference was observed in demographics or Neer or AO/OTA classification between those with and without complications. Patients with complications had markedly lower DTI and overall HU as well as HU in the coronal and sagittal planes. Regression analysis for average DTI demonstrated a higher DTI and had a 10 times decreased risk of complication ( P = 0.040, odds ratio = -10.5, 95% confidence interval, 0.000 to 0.616). Regression analysis for average total HU also found a higher HU associated with a decreased risk of complications ( P = 0.034, odds ratio = -0.020, 95% confidence interval, 0.980 to 0.962). Logistic regression analysis, including age, age-adjusted Charlson Comorbidity Index, mean DTI, and mean total HU, only found mean total HU to be notable within the model.</p><p><strong>Discussion: </strong>CT HU may identify patients with poorer bone quality and thus help predict postoperative complications.</p><p><strong>Level of evidence: </strong>Diagnostic Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"150-155"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523630","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":"Navigating the Orthopaedic Maze as a New Patient: A National Mystery Caller Study on Medicaid Coverage and Access to Specialized Surgeons.","authors":"Nicholas A Felan, Elizabeth Garcia-Creighton, Ankit Hirpara, Isabella Narváez, Adam Miller, Alexis J Batiste, Daniel J Stokes, Ryan Tseng, Alessandra Santiago, Anthony Smyth, Nicholas R Pulciano, Benjamin R Wharton, Eric C McCarty, Tyler M Muffly","doi":"10.5435/JAAOS-D-24-00668","DOIUrl":"10.5435/JAAOS-D-24-00668","url":null,"abstract":"<p><strong>Introduction: </strong>Medicaid coverage is associated with longer appointment wait times, decreased access to care, and poorer health outcomes compared with private insurance across medical subspecialties. The purpose of this study was to evaluate new patient appointment wait times for subspecialty Orthopaedic care based on insurance type and to identify factors influencing these wait times.</p><p><strong>Methods: </strong>Orthopaedic physicians were identified using the American Academy of Orthopaedic Surgeons patient-facing database in the fields of Adult Reconstruction, Foot and Ankle, Hand, Sports Medicine, Spine, Pediatric, and General Orthopaedic surgery. Mystery callers, posing as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance, contacted physicians to request the next available new patient appointment. The business days until the first available new patient appointment were recorded and analyzed using a linear mixed Poisson model.</p><p><strong>Results: </strong>A total of 1,002 phone calls were made to 501 unique physicians in 47 states. Among the 349 physicians meeting inclusion criteria, 37% (n = 130) did not accept Medicaid. Medicaid patients experienced a 10% longer wait for a new patient appointment compared with patients with BCBS (incidence rate ratio: 1.10; CI: 1.05 to 1.15; P < 0.01) with mean wait times of 24.9 business days (SD ± 24) and 19.6 business days (SD ± 23), respectively. Increased waiting times were also associated with academic institutions ( P < 0.01), prolonged call times ( P < 0.01), and specific geographic regions ( P < 0.05). Our model achieved an R-squared value of 0.94, demonstrating strong explanatory power.</p><p><strong>Conclusion: </strong>Patients with Medicaid experience longer wait times and decreased access to care when scheduling an appointment with an Orthopaedic surgeon compared with patients with private insurance. This may be due to reimbursement structures in Medicaid that do not cover the full cost of treatment. Aside from advocating for higher reimbursement rates, telehealth initiatives may help bridge this gap to ensure accessibility to orthopaedic surgery for all patients.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e181-e190"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787461","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":"Medicaid and the Children's Health Insurance Program: Understanding These Programs to Promote Advancements.","authors":"David M Kalainov, Ken Yamaguchi","doi":"10.5435/JAAOS-D-23-00735","DOIUrl":"10.5435/JAAOS-D-23-00735","url":null,"abstract":"<p><p>Medicaid and the Children's Health Insurance Program together represent the largest healthcare coverage programs in the United States, providing benefits for approximately one in four residents and more than half of all children. Both programs are funded by a combination of federal and state dollars with more than 70% of beneficiaries enrolled in managed care plans. The size and scope of these programs underpin the importance of a working knowledge to understand healthcare delivery in the United States. This primer provides an overview of several interrelated topics for an improved understanding of the Medicaid and Children's Health Insurance Program programs for orthopaedic surgeons, other clinicians, healthcare administrators, policy makers, and business leaders.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":"33 3","pages":"117-126"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Data-Driven Preoperative Hemoglobin Strata That Predict the Likelihood of Blood Transfusion and the Risk of Major Complications and Prosthetic Joint Infection After Total Hip Arthroplasty.","authors":"Mark Haft, Amil R Agarwal, Eliza R Brufsky, Zachary C Pearson, Alex Gu, Andrew Harris, Savyasachi Thakkar, Gregory J Golladay","doi":"10.5435/JAAOS-D-24-00435","DOIUrl":"10.5435/JAAOS-D-24-00435","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative anemia is an independent risk factor of complications after primary total hip arthroplasty (THA). Currently used hemoglobin thresholds are not developed for risk stratification of arthroplasty patients and do not provide surgery-specific information on postoperative complication risk. Thus, we aimed to calculate THA-specific preoperative hemoglobin strata that observe the likelihood of 90-day blood transfusion and determine whether these strata are associated with increased risk of 90-day complications and 2-year prosthetic joint infection (PJI).</p><p><strong>Methods: </strong>A retrospective cohort analysis identified 56,101 patients who underwent primary THA from 2013 to 2022. Using the lowest hemoglobin value for each patient one month before THA, stratum-specific likelihood ratio (SSLR) analysis calculated sex-based hemoglobin strata associated with the likelihood of 90-day postoperative blood transfusion. Propensity score matching was performed. Incidence rates and risk of 90-day major complications and 2-year PJI were observed for each identified preoperative hemoglobin stratum.</p><p><strong>Results: </strong>SSLR analysis identified five male (strata, likelihood ratio [<10.4 g/dL, 12.5; 10.5 to 11.4 g/dL, 8.0; 11.5 to 12.4 g/dL, 2.4; 12.5 to 13.4 g/dL, 1.3; 13.5 to 13.9 g/dL, 0.5]) and five female (<8.9 g/dL, 10.7; 9.0 to 10.9 g/dL, 4.0; 11.0 to 11.4 g/dL, 2.0; 12.0 to 12.9 g/dL, 1.0; 13.0 to 13.4 g/dL, 0.6) preoperative hemoglobin strata associated with varying likelihoods of 90-day blood transfusion after THA. After matching in both male and female cohorts, as the calculated preoperative hemoglobin strata decreased, the relative risk of overall 90-day major complications and 2-year PJI increased incrementally (all P < 0.05).</p><p><strong>Conclusion: </strong>SSLR analysis established THA-specific sex-based preoperative hemoglobin strata that observe the likelihood of 90-day blood transfusion and predict the risk of 90-day medical complications and 2-year PJI. These strata are a first of their kind in THA research. While preoperatively optimizing patients, we recommend using these hemoglobin thresholds to help guide decisions on presurgery anemia optimization and to reduce the need for postoperative blood transfusion.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"127-134"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538918","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":"Recent Advances in Minimally Invasive Local Cancer Control and Skeletal Stabilization of Periacetabular Osteolytic Metastases Under C-Arm Imaging Guidance.","authors":"Jungo Imanishi, Rui Yang, Hirotaka Kawano, Francis Y Lee","doi":"10.5435/JAAOS-D-24-00077","DOIUrl":"10.5435/JAAOS-D-24-00077","url":null,"abstract":"<p><p>Cancers are chronic manageable diseases in the era of the second phase of the Cancer Moonshot program by the US government. Patients with cancer suffer from various forms of orthopaedic morbidities, namely locomotive syndrome in cancer patients ( Cancer Locomo ). Type I encompasses orthopaedic conditions directly caused by cancers such as pathological fractures. Type II includes conditions caused by cancer treatments in cases of osteopenia, bone necrosis, insufficiency fractures, nonunions, and postsurgical complications. Type III defines coexisting conditions such as arthritis. The fundamental philosophy is that orthopaedic surgeons facilitate lifesaving ambulatory anticancer drug therapies by preventing and improving Cancer Locomo . Skeletal metastasis-specific procedures are evolving currently. Recently emerging percutaneous ambulatory minimally invasive procedures address skeletal reinforcement and local cancer control while avoiding many complications and drawbacks from extensive open surgical reconstructive procedures. Three-dimensional imaging techniques are useful but are not always available for acetabular procedures in all healthcare facilities. In this review, the techniques of percutaneous guidewire and antegrade cannulated screw placement under standard C-arm fluoroscopy are described in detail. In addition, cancer-induced bone loss, biomechanical data of percutaneous skeletal reinforcement, and clinical outcomes of minimally invasive procedures were reviewed.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e136-e150"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512550","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":"Identifying a Reliable Intra-articular Landmark to Avoid Vascular Injury During Transacetabular Screw Fixation: A 3D Computed Tomography Study.","authors":"Hansel E Ihn, Brian C Chung, Luke Lovro, Xiao T Chen, Douglass Tucker, Eric White, Darryl Hwang, Joseph T Patterson, Alexander B Christ, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00483","DOIUrl":"10.5435/JAAOS-D-24-00483","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular injury during acetabular screw fixation is a life-threatening complication of total hip arthroplasty. This study uses three-dimensional computed tomography to (1) measure absolute distance from the external iliac artery (EIA) to the acetabulum, (2) determine available bone stock along the EIA path, and (3) create a novel acetabular vascular risk map.</p><p><strong>Methods: </strong>A retrospective radiographic study was conducted using three-dimensional CT. Placement of four 6.5-mm screws in a radial projection from the acetabulum toward the EIA was simulated. The initial screw (Sc1) was placed anteriorly at the center of the anterior labral sulcus. The terminal screw (Sc4) was placed such that any screw placed further posteriorly would not be in contact with the EIA. The shortest distance to the EIA (AD) and acetabular bone depth (BD) were measured.</p><p><strong>Results: </strong>Fifty patients (100 hips) were included with an average age of 61.9 ± 15.4 years and average body mass index (BMI) of 27.5 ± 5.3 kg/m 2 . The mean AD at Sc1 was 25.1 ± 2.3 mm (range: 15.4 to 34.9), increasing to 71.5 ± 7.8 mm (range: 21.0 to 144.9) at Sc4. Mean BD at Sc1 was 4.6 ± 0.8 mm (range: 1.4 to 32.0), increasing to 20.1 ± 5.5 mm (range: 2.1 to 36.3) at Sc4. On univariate analysis, male patients demonstrated greater AD and BD at all screw positions. Multiple linear regression revealed an inverse correlation between age and AD and a direct correlation between weight and AD ( P value <0.005).</p><p><strong>Conclusion: </strong>This study identifies the tip of the cotyloid fossa as a reliable intra-articular landmark during total hip arthroplasty. Surgeons should remain wary of potential vascular injury during transacetabular screw fixation, particularly when operating on elderly, female patients.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":"33 3","pages":"e172-e180"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015758","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":"Ultracongruent Versus Posterior-Stabilized Polyethylene: No Difference in Anterior Knee Pain but Decreased Noise Generation.","authors":"Juan D Lizcano, Ilda B Molloy, Meera Kohli, Ramakanth R Yakkanti, Saad Tarabichi, Matthew S Austin","doi":"10.5435/JAAOS-D-24-00379","DOIUrl":"10.5435/JAAOS-D-24-00379","url":null,"abstract":"<p><strong>Background: </strong>Noise generation and anterior knee pain can occur after primary total knee arthroplasty (TKA) and may affect patient satisfaction. Polyethylene design in cruciate-sacrificing implants could be a variable influencing these complications. The purpose of this study was to analyze the effect of polyethylene design on noise generation and anterior knee pain.</p><p><strong>Methods: </strong>We prospectively reviewed a cohort of patients who underwent primary TKA between 2014 and 2022 by a single surgeon using either a posterior-stabilized (PS) or ultracongruent (UC) polyethylene of the same implant design. The primary outcomes were measured through a noise generation questionnaire and the Knee Injury and Osteoarthritis Outcome Score-Patellofemoral score.</p><p><strong>Results: </strong>A total of 409 TKA procedures were included, 153 (37.4%) PS and 256 (62.6%) UC. No difference was noted in the Knee Injury and Osteoarthritis Outcome Score-Patellofemoral score between PS and UC designs (71.7 ± 26 versus 74.2 ± 23.2, P = 0.313). A higher percentage of patients in the PS cohort reported hearing (32.7% versus 22.3%, P = 0.020) or feeling noise (28.8 versus 20.3, P = 0.051) coming from their implant. No notable difference was observed in noise-related satisfaction rates. Independent risk factors of noise generation were age (OR, 0.96; P = 0.006) and PS polyethylene (OR, 1.61; P = 0.043). Noise generation was associated with decreased patient-reported outcome measure scores ( P < 0.001).</p><p><strong>Conclusion: </strong>While there was no difference in anterior knee pain between PS and UC polyethylene designs, PS inserts exhibit higher rates of noise generation compared with UC. Noise generation had comparable satisfaction but was associated with decreased patient-reported outcome measure scores.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"135-144"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635606","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":"Intraoperative Complications in Medial Opening Wedge High Tibial Osteotomy.","authors":"Xuetao Xie, Yi Zhu, Philipp Lobenhoffer, Congfeng Luo","doi":"10.5435/JAAOS-D-23-01114","DOIUrl":"10.5435/JAAOS-D-23-01114","url":null,"abstract":"<p><p>Medial opening wedge high tibial osteotomy has been established for treatment of medial symptomatic knee arthrosis with varus malalignment in young and elderly but active patients. To obtain satisfactory results, it is essential for surgeons performing osteotomy to identify, prevent, and treat potential intraoperative adverse events. Lateral hinge fracture (LHF) is the most common intraoperative complication while popliteus artery injury is rare but limb-threatening. Computed tomography is the benchmark to detect LHF, the risk of which increased markedly with the opening gap larger than 11 mm. Setting the lateral hinge in a safe zone is the most important preventive measure. Medial long locking plate fixation may allow patients even with unstable hinge fractures to start early full weight bearing. Additional fixation of LHF is optional, and bone void filling is not routinely used. For protection of popliteus artery injury, flexing the knee joint is unreliable. It is paramount to place a protective retractor just behind the posterior tibial cortex toward the proximal tibiofibular joint before osteotomy, particularly in case of aberrant artery. A repertoire of surgical pearls is described in detail in this review to identify, prevent, and manage those intraoperative complications.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"101-107"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142086412","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":"Reconstruction of Internal Hemipelvectomy Defects After Oncologic Resection.","authors":"Max Vaynrub, John H Healey, Carol D Morris, Farooq Shahzad","doi":"10.5435/JAAOS-D-23-00502","DOIUrl":"10.5435/JAAOS-D-23-00502","url":null,"abstract":"<p><p>Internal hemipelvectomy is preferred to hindquarter amputation for pelvic tumor resection if a functional lower extremity can be obtained without compromising oncologic principles; multidisciplinary advances in orthopaedic and plastic surgery reconstruction have made this possible. The goals of skeletal reconstruction are restoration of pelvic and spinopelvic skeletal continuity, maintenance of limb length, and creation of a functional hip joint. The goals of soft-tissue reconstruction are stable coverage of skeletal, prosthetic, and neurovascular structures, elimination of dead space, and prevention of herniation. Pelvic resections are divided into four types: type I (ilium), type II (acetabulum), type III (ischiopubic rami), and type IV (sacrum). Type I and IV resections resulting in pelvic discontinuity are often reconstructed with vascularized bone flaps and instrumentation. Type II resections, which traditionally result in the greatest functional morbidity, are often reconstructed with hip transposition, allograft, prosthesis, and allograft-prosthetic composites. Type III resections require soft-tissue repair, sometimes with flaps and mesh, but generally no skeletal reconstruction. Extension of resection into the sacrum can result in additional skeletal instability, neurologic deficit, and soft-tissue insufficiency, necessitating a robust reconstructive strategy. Internal hemipelvectomy creates complex deficits that often require advanced multidisciplinary reconstructions to optimize outcomes and minimize complications.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e124-e135"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar Spine Injuries in Recreational Athletes: A Review.","authors":"Wellington Hsu, Robby Turk, Leo Spector","doi":"10.5435/JAAOS-D-24-00979","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00979","url":null,"abstract":"<p><p>Back pain that is associated with lumbar spine pathology is a growing issue in the athlete population. As an aging population continues to remain active, it is essential for primary care physicians, general orthopaedic surgeons, and spine surgeons alike to understand the nuances of diagnosis and management in the recreational athlete population. This is a unique population due to the increased importance placed on returning to high levels of activity, but, by definition, they enjoy less resources and financial incentive to optimize their rehabilitation and return to sport compared with professional athletes. Lumbar disk herniation, spondylolysis, and disk degeneration are common pathologies in this population. Most the time, these pathologies in recreational athletes can be managed nonsurgically with excellent outcomes. In recreational athletes who have failed nonsurgical treatment and/or have risk of neurological injury, surgical treatment is a viable option with good outcomes. Evidence suggests that most athletes can return to sport after both nonsurgical or surgical management. A rapidly expanding number of easily accessible, minimally invasive, surgical options continue to gain popularity and may gain further indication in this population. Future studies focused on the return to activity for the unique population of recreational athletes is warranted.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069059","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}