Journal of orthopaedics and sports medicine最新文献

{"title":"Digital Telerehabilitation After Total Knee Arthroplasty: A Narrative Review of Clinical Outcomes, Patient Experience, Safety, and Resource Use.","authors":"Rohan Reddy, Nicholas Lam, Mihali Dieguez, Marcel P Fraix, Devendra K Agrawal","doi":"10.26502/josm.511500276","DOIUrl":"10.26502/josm.511500276","url":null,"abstract":"<p><strong>Purpose: </strong>Digital telerehabilitation has become an increasingly employed form of rehabilitation therapy to support patients who have undergone total knee arthroplasty (TKA). However, various platforms differ in content, monitoring, feedback, and clinician involvement. This review summarizes recent evidence on smartphone-based and digitally mediated telerehabilitation. Functional recovery was emphasized as the primary outcome.</p><p><strong>Recent findings: </strong>A search across PubMed, EMBASE, and CINAHL Complete was conducted from January 1^st, 2019, to April 30^th, 2026, resulting in eighteen postoperative TKA studies being included in the synthesis. Digital telerehabilitation generally produced functional recovery comparable to conventional physical therapy or usual care, with reported study specific advantages in range of motion, gait, strength, activity, or patient-reported function. Despite adherence and patient-experience findings often being favorable, the measures were inconsistent across studies. Additionally, pain outcomes were heterogeneous, and safety, including complications and readmissions, were limited due to incomplete reporting and low event counts. No included study provided a full economic evaluation. However, several studies reported reduced travel burden, out-of-pocket costs, or rehabilitation costs.</p><p><strong>Summary: </strong>This review integrates evidence across functional recovery, adherence, pain, satisfaction and engagement, complications and readmissions, while treating cost and resource-use findings as contextual evidence. Digital telerehabilitation appears to be a feasible adjunct or alternative for selected patients after TKA, with the clearest support for comparable functional recovery and less standardized evidence across secondary and contextual outcomes.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"8 3","pages":"228-238"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889631","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":"Effective Interventions in Restoring Mobility and Relieving Pain After Lower Limb Amputation.","authors":"Suyeon Su Kim, Grace Kim, Dominick Shoha, Marcel P Fraix, Devendra K Agrawal","doi":"10.26502/josm.511500282","DOIUrl":"10.26502/josm.511500282","url":null,"abstract":"<p><p>Lower-limb amputation is associated with substantial functional impairment, chronic pain, and reduced quality of life, posing significant challenges for long-term rehabilitation and community reintegration. Despite advances in surgical techniques and prosthetic technologies, many individuals continue to experience limitations in mobility and persistent pain after amputation. This narrative review synthesizes current evidence on the functional consequences of limb loss and the most effective strategies for restoring mobility and managing pain following lower-limb amputation. Key approaches to rehabilitation include structured physical therapy, prosthetic optimization, and multidisciplinary care models that address biomechanical and psychosocial factors, including recovery. Pharmacologic regimens, neuromodulation, mirror therapy, and emerging surgical interventions, such as targeted muscle reinnervation, have demonstrated promising outcomes in reducing phantom limb pain and improving functional control. In addition, innovations in neuroprosthetics, wearable sensors, and data-driven rehabilitation are expanding opportunities for personalized treatments and improved prosthetic integration. However, disparities in access to rehabilitation services and advanced prosthetic technologies remain significant barriers to many patients. Continued research emphasizing standardized outcome measures, long-term clinical trials, and multidisciplinary care frameworks will be essential to improving functional outcomes and quality of life for individuals living with limb loss.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"8 3","pages":"273-289"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076098","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":"Evaluating the Benefits of Neuromuscular vs. Strength-Only Training in Athletes for ACL Re-Injury Prevention.","authors":"Akshay Bharadwaj, Marcel P Fraix, Devendra K Agrawal","doi":"10.26502/josm.511500267","DOIUrl":"10.26502/josm.511500267","url":null,"abstract":"<p><p>Anterior cruciate ligament (ACL) injuries are one of the most prevalent injuries occurring in athletes. These injuries are highly prevalent in cutting sports such as basketball, football, and soccer. Additionally, there is a significant risk of re-injury for athletes who return to their sports without proper rehabilitation. Neuromuscular training, or NMT, is a more comprehensive form of rehabilitation focused on aspects such as plyometrics, agility training, and balance. The goal of this study is to compare the efficacy of NMT- focused rehabilitation to strength-only rehabilitation. This study was executed as a narrative review gathering various published research articles from Google Scholar and PubMed. The studies showed that NMT is strongly linked to lower re-injury rates compared to conventional rehabilitation programs. Arundale et al. (2018) reports a re-injury rate of 2.5% following an NMT-focused prevention program, while Paterno et al. (2014) reports a 29.5% re-injury rate following a strength-focused program. Additionally, specific improvements in biomechanical outcomes were noted, such as reduced knee abduction movement and improved hop test symmetry. The studies also highlighted predictors of risk of re-injury, such as younger age, female sex, and time-based return to sport as opposed to criteria-based return to sport. Overall, the conclusion is that NMT should be incorporated alongside a strength training program to produce the most optimal outcomes in athletes returning to their sport following an ACL injury.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"8 2","pages":"164-169"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145698","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":"Integrating Mechanical Diagnosis and Therapy Within Multidisciplinary Biopsychosocial Care for Chronic Musculoskeletal Pain.","authors":"Manas Aavula, David Parvizi, Sugeeth Kandikattu, Devendra K Agrawal","doi":"10.26502/josm.511500253","DOIUrl":"10.26502/josm.511500253","url":null,"abstract":"<p><p>Chronic musculoskeletal conditions such as osteoarthritis and fibromyalgia make up a major portion of the disability population worldwide. An interplay among biological, psychological, and social factors influences the symptoms of these disorders. Treating these disorders requires a multidisciplinary approach, as a unimodal approach fails to produce long-term functional improvement. This review studies the role of biopsychosocial care in chronic pain management with an emphasis on the indications and limitations of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). MDT was compared with the effectiveness of physical therapy, occupational therapy, medication management, and psychological interventions, and its effectiveness was also examined when integrated into a multidisciplinary rehabilitation model. MDT has a limited role in centrally mediated conditions such as fibromyalgia, but it is superior in situations controlled by mechanism. MDT increases self-management, lowers disability, and reduces one's dependence on passive therapies. MDT is best seen as a mechanism-specific, patient-centered intervention integrated into a biopsychosocial framework. Ideal long-term outcomes in chronic musculoskeletal pain involve the integration of progressive exercise, occupational therapy, psychological intervention, targeted mechanical therapy, and medication management.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"8 1","pages":"49-57"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635274","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":"Long-term Performance and Durability of Biomaterials and Implant Designs in Total Joint Arthroplasty and Spinal Fusion.","authors":"David Parvizi, Artin Allahverdian, Gregory Ayzenberg, Sugeeth Kandikattu, Ramtin Sahafi, Devendra K Agrawal","doi":"10.26502/josm.511500256","DOIUrl":"10.26502/josm.511500256","url":null,"abstract":"<p><p>Advancements in biomaterials and implant design has created a lasting impact on orthopedic surgery. Changes such as implant longevity, biocompatibility, and patient satisfaction have been attained with the use of new biomaterials. Contemporary implants have been able to balance mechanical strength, corrosion resistance, wear characteristics, and biological integration all while decreasing complications including infection and periprosthetic fractures. Metallic biomaterials include titanium alloys, cobalt-chromium alloys, and stainless steel. These materials excel in durability and have favorable strength-to-weight ratios. Although, there are challenges when introducing new biomaterials in orthopedic surgery. Stress shielding and wear-induced osteolysis and stress shielding. This has prompted improvements to implant geometry, surface modifications, and material compositions. Polymeric components such as ultra-high molecular weight polyethylene has undergone significant refinement over the last several years leading to a reduction in oxidative degradation and debris formation. Newer technologic advancements in porous coatings, bioactive surface treatments, additive manufacturing, and patient-specific implant design have shown to further enhance osseointegration and biomechanics compatibility. The interplay between material science, biomechanics, and host biology is essential for ideal implant optimization and reducing the number of revisions. Continued research integrating materials engineering and clinical outcomes will drive the next generation of durable, biologically integrated orthopedic implants.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"8 1","pages":"74-97"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13056366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640661","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":"Comparing Regenerative Biologics and Standard Pharmacotherapy for Chronic Rotator Cuff Tendinopathy: A Study of PRP, Cell-Based, and Peptide Interventions.","authors":"Andre Aabedi, Devendra K Agrawal","doi":"10.26502/josm.511500247","DOIUrl":"10.26502/josm.511500247","url":null,"abstract":"<p><p>Chronic rotator cuff tendinopathy is a degenerative condition characterized by persistent shoulder pain, weakness, and functional limitation. Conventional pharmacologic therapies-including nonsteroidal anti-inflammatory drugs and corticosteroid injections-are commonly used but provide only short-term symptom relief without addressing underlying tendon degeneration, and may negatively affect tendon integrity. These limitations have prompted increasing interest in regenerative therapies aimed at promoting tissue repair and durable clinical improvement. This literature review evaluates and compares the clinical outcomes, safety profiles, and practical considerations of regenerative therapies-specifically platelet-rich plasma, mesenchymal stem cell-based interventions, and peptide-based therapies-relative to traditional pharmacologic management for chronic rotator cuff tendinopathy. A comprehensive review of randomized controlled trials, systematic reviews, meta-analyses, and consensus guidelines was conducted to assess pain relief, functional outcomes, tendon structural integrity, safety, and clinical applicability of pharmacologic versus regenerative treatment strategies. Pharmacologic treatments, particularly NSAIDs and corticosteroid injections, demonstrate limited efficacy beyond short-term pain reduction and do not promote tendon healing; repeated corticosteroid use is associated with tendon weakening and inferior long-term outcomes. In contrast, PRP consistently provides superior intermediate- and long-term improvements in pain and function compared with corticosteroids, with favorable safety profiles. Mesenchymal stem cell therapies show promising regenerative potential, including structural tendon improvement and sustained symptom relief, though evidence is limited by heterogeneity, cost, and regulatory constraints. Peptide-based therapies represent an emerging modality with encouraging preclinical and early clinical data but remain insufficiently validated for routine use. Regenerative therapies-particularly platelet-rich plasma and mesenchymal stem cell-based interventions-offer safer and more durable alternatives to conventional pharmacologic management for select patients with chronic rotator cuff tendinopathy who have failed conservative care. However, widespread clinical adoption is limited by variability in protocols, regulatory barriers, and a lack of large-scale, high-quality randomized trials. Further research is required to standardize treatment approaches, refine patient selection, and establish long-term efficacy.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"8 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286416","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":"Geriatric Total Hip Arthroplasty: Fixation Strategies, Approaches and Outcomes.","authors":"Bahram Saber, Devendra K Agrawal","doi":"10.26502/josm.511500255","DOIUrl":"10.26502/josm.511500255","url":null,"abstract":"<p><p>Total hip arthroplasty (THA) is a cornerstone of geriatric medicine, yet the selection of optimal fixation strategies and surgical approaches remains a subject of intense clinical debate. As global demographics shift toward an aging population, the demand for THA is projected to rise exponentially, necessitating a thorough evaluation of perioperative outcomes and long-term survivorship. This review critically analyzes recent 2024-2025 evidence regarding the biomechanical stability and clinical efficacy of cemented versus cementless fixation in patients aged 70 years or older. Current literature suggests that while cementless technology dominates younger cohorts, cemented fixation provides superior initial rotational stability in the osteoporotic environment, significantly reducing the risk of intraoperative periprosthetic fractures. Furthermore, this report examines the impact of the Direct Anterior Approach (DAA) compared to the Posterior Approach (PA) within the framework of Enhanced Recovery After Surgery (ERAS), highlighting the DAA's benefits in minimizing soft-tissue trauma and reducing hospital length of stay. Finally, we synthesize modifiable and non-modifiable risk factors for periprosthetic joint infection (PJI) and fracture progression. Understanding these multifaceted factors is essential for tailoring personalized surgical interventions and improving functional recovery in the geriatric population.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"8 1","pages":"68-73"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13056365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640581","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":"Psychological Treatment in the Management of Pain following Musculoskeletal Injury.","authors":"Andre Aabedi, Vera Wang, Marcel P Fraix, Devendra K Agrawal","doi":"10.26502/josm.511500191","DOIUrl":"https://doi.org/10.26502/josm.511500191","url":null,"abstract":"<p><p>Musculoskeletal injuries are a leading cause of pain and disability, with many patients developing chronic pain. While traditional management focuses on physical treatments, psychological interventions have emerged as a complementary approach. This study examines the role of psychological treatments in pain management after musculoskeletal injury, their efficacy, and their integration with existing treatment strategies. A review of literature, including systematic reviews and meta-analyses, was conducted to assess the effectiveness of psychological treatments such as cognitive-behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and pain neuroscience education (PNE). Studies on the impact of psychological distress on pain perception, circulating inflammatory biomarkers, and neuromuscular exercises were analyzed. Research indicates that psychological elements, particularly pain catastrophizing, anxiety, and depression, play crucial roles in determining both pain intensity and disability levels. Short-term improvements in pain intensity, functional capacity, and psychological well-being have been documented with CBT, MBSR, and PNE interventions. The integration of psychological approaches with physiotherapy demonstrates enhanced patient outcomes. Biological markers of inflammation, specifically CRP and IL-6, show potential as indicators of pain severity and treatment effectiveness. Notably, neuromuscular exercises have shown pain-reducing effects comparable to pharmaceutical interventions, though long-term efficacy data for psychological treatments remains variable. The integration of psychological interventions represents a significant advancement in musculoskeletal pain management, particularly in addressing the mental and emotional dimensions of pain experience. While current research supports their immediate benefits, additional investigation is necessary to determine long-term effectiveness and refine treatment approaches. Future research should emphasize individualized treatment protocols, technological integration, and robust longitudinal studies to maximize therapeutic outcomes.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"7 1","pages":"162-168"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059144","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":"Current Strategies in the Prevention and Management of Infection in Open Fractures.","authors":"Laura Roberts, Mohamed Radwan Ahmed, Devendra K Agrawal","doi":"10.26502/josm.511500198","DOIUrl":"10.26502/josm.511500198","url":null,"abstract":"<p><p>Open fractures are complex injuries that significantly increase the risk of infection and complications such as delayed healing, nonunion, and chronic osteomyelitis. Infections rates remain high, particularly in severe cases involving extensive soft tissue damage and contamination. This is due to a variety of factors involving the patient, environment and bacteria. This article critically reviewed the classification, common pathogens, and complications associated with open fractures, emphasizing the challenges posed by biofilms, antibiotic resistance, and host factors such as diabetes and immunosuppression. Current management strategies, including early antibiotic administration, surgical debridement, and wound care, are examined alongside emerging therapies such as continuous local antibiotic perfusion, antibiotic-coated implants, bacteriophage therapy, and bioelectric dressings. These approaches show promise in reducing infection rates, enhancing patient outcomes, and addressing the limitations of traditional treatments. However, there are gaps in understanding their long-term efficacy, especially in high-risk populations. Future research should focus on personalized protocols, combination therapies, and clinical trials to reduce the burden of infection-related complications in open fracture management.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"7 2","pages":"218-229"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303862","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":"Merits and Limitations of Robotic-assisted Surgery in Improving Precision, Accuracy, and Patient Outcomes in Orthopedic Procedures.","authors":"David Parvizi, Blake Han, Artin Allahverdian, Devendra K Agrawal","doi":"10.26502/josm.511500243","DOIUrl":"10.26502/josm.511500243","url":null,"abstract":"<p><p>Since the 1980s, research in robotic-assisted orthopedic surgery has shown to improve precision and accuracy in implant positioning and alignment, specifically for knee and hip arthroplasty. The current meta-analyses and randomized controlled trials have shown that robotic systems are able to consistently reduce alignment outliers and lead to improved radiological outcomes. Some evidence has also concluded small, yet significant, improvements for short-term, patient-reported postoperative pain. Although modest improvements have been demonstrated in the shortterm, long-term technical improvements have not been established. Patient satisfaction, functional outcomes, and rates of revision and complications are still under investigation in terms of long-term outcomes. Moreover, clinical impact is also variable between different robotic platforms, surgeon experience, and healthcare setting. High costs, steep learning curves, and increased operative costs are major limitations to the implementation of widespread use of robotic systems. Altogether, robotic-assisted orthopedic surgery may improve technical accuracy and precision, however, its limitations such as inconsistent clinical benefit, increased operating time, and high cost begs the question whether these systems will be implemented in hospital systems. Further long-term studies must be done to conclude whether robotic assistance plays a significant role in improving clinical outcomes.</p>","PeriodicalId":73881,"journal":{"name":"Journal of orthopaedics and sports medicine","volume":"7 4","pages":"569-578"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328325","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}