Weekly Digest

Key Takeaway: Preoperative pain sensitivity (PSQ) was a significant negative predictor of FJS and OKS at 2 years, while coronal alignment strategy was not; among low-sensitivity patients, functional alignment produced a 13-point higher FJS than mechanical alignment (74.9 vs 61.9, P=0.03).

Key Takeaway: In patients under 25, isolated BPTB-ACLR carries a 16.4% 5-year graft failure rate versus 4.8% with HT-ACLR + ALLR, yielding an odds ratio of 4.2 for failure with BPTB alone.

Key Takeaway: Across 78 RCTs and 8,515 TKA patients, multimodal periarticular injection consistently reduced pain and opioid consumption versus placebo, but no single cocktail formulation proved superior to others, and liposomal bupivacaine showed equivalence—not superiority—to standard cocktails in most trials.

Key Takeaway: Template-guided CBT and freehand traditional pedicle screw trajectory produced equivalent ODI and pain outcomes at 24 months, but CBT had a higher rate of upper endplate perforation (5 vs. 0 screws) and longer instrumentation time (25 vs. 18 min).

Key Takeaway: Complete sciatic nerve involvement on MRI (circumferential edema) was independently associated with 12.2 additional days to return-to-sport (33.7 vs 21.5 days) compared to no involvement after controlling for BAMIC grade.

Key Takeaway: A novel palmaris longus-FDP-anchor construct for pediatric 2-stage flexor tendon reconstruction achieved a mean ultimate failure load of only 24.55 N with anchor pullout as the predominant failure mode in 7 of 9 specimens.

Key Takeaway: Anterior labral tears in high-impact athletes are associated with accelerated cartilage loss over 2.1 years (aIRR 1.46; 95% CI 1.01–2.09), though the effect size is modest.

Key Takeaway: IONM alerts occurred in 5% of 5,206 AIS fusion patients, with Lenke Type-4 curves carrying the highest alert risk (8%, RR=1.61) and major Cobb angle as the leading independent predictor; permanent neurologic deficits occurred in fewer than 0.04% of all patients.

Key Takeaway: Bilateral hip arthroscopy (staged or simultaneous) for FAI yields mHHS, NAHS, iHOT-12, and reoperation rates statistically comparable to unilateral surgery at minimum 2-year follow-up across 1,124 bilateral and 3,118 unilateral patients.

Key Takeaway: A combined CNN and random forest model predicted fellowship-trained hand surgeon operative recommendations for distal radial fractures with 87% accuracy, 97% sensitivity, and AUC 0.96 on pre-reduction radiographs.

Key Takeaway: DAIR for fungal PJI yields 60–68% lower odds of treatment success versus one-stage (OR 0.32) and two-stage revision (OR 0.40), supporting its contraindication in this setting.

Key Takeaway: Among patients meeting 2 Kocher criteria, SA and OM each accounted for 39.4% of diagnoses, and no significant difference in Kocher score distribution existed between SA and OM cohorts (P=0.874), demonstrating the criteria cannot differentiate these two conditions.

Key Takeaway: Nonhamstring grafts yielded 7.89 points higher IKDC scores than hamstring grafts after ACL reconstruction, but MCL injury status did not significantly modify this association (interaction term β = -7.02, P = .095).

Key Takeaway: MILD procedure achieved 0% SedSign reversal and no measurable anatomical decompression on postoperative MRI, versus 100% SedSign reversal and >90% ligamentum flavum removal with open decompression.

Key Takeaway: Neuraxial anesthesia for hip arthroscopy reduces intraoperative and PACU narcotic consumption but produces equivalent 2-year PROs and revision rates (3.8%) compared to general anesthesia.

Key Takeaway: Early surgery (≤2 days) for periprosthetic proximal femur fracture does not reduce 30-day (2.4 vs. 2.5%), 90-day (4.8 vs. 4.4%), or 1-year (7.7 vs. 7.9%) mortality compared to delayed surgery, but is associated with higher 30-day transfusion rates (19.7 vs. 16.4%).

Key Takeaway: Staging interval (<1 year vs. ≥1 year) for bilateral hip arthroscopy did not affect 2-year mHHS, NAHS, revision arthroscopy rate (7.0% vs. 12.1%), or THA conversion rate (4.7% vs. 3.0%) in 76 patients with FAI syndrome.

Key Takeaway: In 100 ACL reconstruction patients followed 5–10 years, increasing age independently predicted lower preoperative synovial TIMP-1 (β = -0.0775, P = .014) and worse PROs, with age-dependent interactions modifying the prognostic value of TIMP-1, TIMP-2, and MIP-1β.

Key Takeaway: Ceftriaxone monotherapy produced equivalent FRI rates compared to cefazolin plus gentamicin for Gustilo-Anderson Type III open lower extremity fractures (12.8% vs 18.3%, adjusted HR=1.26, p=0.545), while IIIB/C severity (HR=3.05) and time-to-antibiotics >60 minutes (HR=2.56) were the dominant independent predictors of infection.

Key Takeaway: Adding hypoalbuminemia (<3.5 g/dL) to the mFI-5 improves 30-day mortality discrimination from AUC 0.687 to 0.757 in revision THA, with severe hypoalbuminemia (<2.5 g/dL) conferring up to 8.98-fold higher odds of adverse outcomes.

Key Takeaway: Cerclage use during lateral locked plating of Vancouver B1/C periprosthetic femur fractures was not associated with nonunion (aOR 0.3, 95% CI 0.1–1.8), with nonunion rates of 4% vs. 10% in cerclage vs. no-cerclage groups.

Key Takeaway: The FNF-ON8 scoring system predicted posttraumatic osteonecrosis after femoral neck fixation with an AUC of 0.80, outperforming the Garden classification (AUC 0.70), with ONFH rates of 4% in low-risk versus 42% in high-risk patients.

Key Takeaway: 74.6% of adolescents presenting with anterior shoulder instability had bone loss on MRI, with 34.3% demonstrating bipolar bone loss and 7.2% off-track lesions, suggesting isolated Bankart repair is insufficient for a substantial proportion of this population.

Key Takeaway: Standard screening criteria (abnormal neuro exam, left-sided curve, thoracic hyperkyphosis) collectively missed 34% of patients with confirmed Chiari I malformation and/or syrinx in operative pediatric scoliosis, yielding a combined sensitivity of only 66%.

Key Takeaway: Preoperative MPTA did not influence OKS improvement at 2 years following mobile-bearing medial UKA across three MPTA strata (≤83°, 84–86°, ≥87°), though varus tibial component alignment produced significantly greater OKS gains in the ≤83° MPTA subgroup.

Key Takeaway: PAO with concurrent femoral head-neck osteochondroplasty reduced 10-year reoperation rate from 33% to 8% (P=.005) compared to PAO alone, driven by elimination of secondary FAI procedures.

Key Takeaway: In chronically anticoagulated patients undergoing primary THA, postoperative COX-2 inhibitor use was not associated with increased bleeding or renal complications and reduced 30-day opioid utilization by 43% (RR 0.567, P<0.001).

Key Takeaway: In high-risk ACL patients undergoing ACLR with concomitant LET, graft failure rates were statistically similar between those with PTS ≥12° (24%) and PTS <12° (18%), with PTS conferring no independent hazard on Cox analysis (HR 1.07/degree, 95% CI 0.95–1.19).

Key Takeaway: Co-occurring low back pain and depression reduced odds of achieving MCID on Oxford Knee Score by 53% (OR=0.47) at 6 months post-primary TKA, with the greatest functional deficit concentrated in the lowest-improving quartile (25th-percentile β=-3.11).

Key Takeaway: At 1 year post-PAO, only 53% of patients achieve SCB on mHHS, rising to 85% at 10 years, with prior ipsilateral surgery, psychiatric diagnosis, and bilateral surgery each independently delaying threshold achievement.

Key Takeaway: Each categorical increase in preoperative anxiety/depression severity raised the odds of dissatisfaction at one year by 51% after TKA (OR 1.51) and 45% after THA (OR 1.45) in an Australian cohort of 1,462 patients.

Key Takeaway: TT-PCL distance increases by approximately 1.3 mm from proximal to distal slice selection, and normalization to tibial width reduces variability while yielding only moderate discrimination for patellar instability (AUC 0.69 at best).

Key Takeaway: Perioperative cefazolin prophylaxis reduces PJI risk by 50% (HR 0.5) compared to non-cefazolin alternatives in aseptic revision TKA and THA.

Key Takeaway: EDS patients undergoing combined HA+PAO achieve >80% satisfaction at 2 years but only 43% reach absolute PROMIS-PF PASS at 1 year versus 78% of non-EDS controls.

Key Takeaway: Hospital site, not Area Deprivation Index, drove neuraxial anesthesia utilization in primary TKA (p<0.0001 vs p=0.53), while neuraxial anesthesia independently reduced 90-day ED visits from 13.7% to 5.0%.

Key Takeaway: After Bernese PAO, 83% of patients achieved MCID on at least one PROM, but symptom duration >2 years (OR 0.3) and femoral antetorsion >25° (OR 0.2) independently reduced odds of reaching PASS.

Key Takeaway: ASC-based TJA in patients ≥75 years showed no significant difference in 90-day readmission (3.6% vs 1.8%, P=0.15) or major complications versus inpatient surgery after propensity score matching.

Key Takeaway: For multilevel CSM (≥3 levels), ACDF, PCDF, and laminoplasty yield equivalent JOA score improvement, but ACDF reduces axial pain (OR 0.21) and C5 palsy (OR 0.27) at the cost of a 5.88-fold higher dysphagia rate versus laminoplasty.

Key Takeaway: In 30,246 primary THAs over 25 years, 10-year dislocation-free survivorship was 96% posterior, 98% anterolateral, and 99% direct anterior, with bearing surface choice significantly modifying dislocation risk only in posterior and anterolateral approaches.

Key Takeaway: In 506 AIS patients with major thoracic curves, PI correlates with proximal lumbar lordosis (r=0.470) but not distal lumbar lordosis (r=0.007), meaning PI-driven LL variation is entirely a proximal lumbar phenomenon.

Key Takeaway: Revision THA for periprosthetic fracture and PJI carries 3–4× higher 90-day mortality versus aseptic loosening (HR 3.96 and 2.95, respectively), with 30-day SMRs of 3.67 and 3.18 compared to the general population.

Key Takeaway: After multivariable adjustment, ACL tear location (modified Sherman classification) does not independently predict anterior tibial translation side-to-side difference (ATT-SSD), but injury chronicity does (B = -0.205, p = 0.032), with acute injuries showing 0.6 mm greater ATT-SSD than chronic injuries (4.6 vs. 4.0 mm).

Key Takeaway: PFA carries significantly higher rates of subsequent arthroscopy at 2 years (7.3% vs 2.9%) and 5 years (10.4% vs 5.5%) compared to UKA, though 10-year implant survivorship and conversion to TKA rates are equivalent.

Key Takeaway: Primary lateral PATS (OR 1.166) and lateral tibial slope (OR 1.193) independently predict ACL reconstruction graft failure, with moderate discriminative ability (AUC 0.682 and 0.668 respectively).

Key Takeaway: Across 5,880 California hospital-year-procedure observations from 2015–2024, TKA carried 38% lower SSI risk than THA (IRR 0.62), while hospital volume, public reporting policy epochs, and the COVID-19 pandemic had no significant association with SSI incidence.

Key Takeaway: Surgical reconstruction of scapular neck and body malunions and nonunions produced a mean 30.7-point improvement in DASH score (p<0.001), with 100% radiographic union and no intraoperative complications in 45 patients.

Key Takeaway: Among TJA patients (mean age 70), daily smartphone use was high in both age groups (80% in ≥65 vs. 85% in <65), but patients ≥65 showed significantly lower proficiency on complex multi-step tasks such as calendar entry (44% vs. 77%, P<0.001).

Key Takeaway: Meniscal allograft transplantation in athletes achieves 81.0% overall return to sport and 62.7% return to the same or higher level, with graft survivorship declining from ~90% at 2 years to ~70% at 12 years and a 25.0% complication rate.

Key Takeaway: Pediatric septic shoulder results in permanent radiologic sequelae in 82.6% of cases, with physeal arrest or bar formation (Type III) being the most common pattern at 47.8% over a mean 6.2-year follow-up.

Key Takeaway: When a posterior wall fragment is positioned medial to the femoral head before closed reduction, 100% of fragments that subsequently displaced intra-articularly shared this position, and medial position was associated with non-concentric reduction in 74.2% of cases (OR 6.5).

Key Takeaway: A positive SST-1 response (comfortable at rest) at 3 months post-ream-and-run confers 15.7 times increased odds of 2-year satisfaction, and a positive SST-2 response (comfortable sleeping) at 6 months confers 6.2 times increased odds.

Key Takeaway: PF OA radiographically progressed in 55.4% of knees after open-wedge HTO, yet KOOS-PF and HSS patella scores were identical between progressors and non-progressors at mean 12.2-year follow-up.

Key Takeaway: Sarcopenia is highly prevalent among Chinese fragility fracture patients, and acute THA or combined hip procedures are emerging as a treatment paradigm for acetabular fragility fractures in this population.

Key Takeaway: Early partial weight-bearing (≤4 weeks) after medial meniscus posterior root repair yields incomplete healing rates of 31.3–39.2% and postoperative IKDC scores of only 46.4–70.4, remaining below satisfactory thresholds in several cohorts.

Key Takeaway: Periprosthetic femoral fractures after THA carry mortality rivaling native hip fragility fractures, with reoperation rates and implant survival after fixation substantially compromised, demanding prevention as a core component of arthroplasty care.

Key Takeaway: Knot-dependent proximal biceps tenodesis constructs demonstrated significantly greater ultimate failure load than knotless constructs by a weighted mean difference of only 28.2 N (95% CI: 0.22–56.17 N, P=.05), while inlay vs. onlay, all-suture vs. other materials, and single vs. double-anchor configurations showed no significant differences across 245 cadaveric specimens.

Key Takeaway: Spine surgery missions in low-resource settings require sustained institutional partnerships and ethical patient selection frameworks, drawn from experience across 2 Jamaican hospital systems under the Back to Healing initiative.

Key Takeaway: In 101 patients undergoing combined MPFL reconstruction and deepening trochleoplasty for Dejour B–D dysplasia, higher preoperative sagittal TT-TG distance independently predicted better BPII 2.0 scores (β=0.91, p=0.037), lower pain, and superior function at mean 32.3-month follow-up.

Key Takeaway: Asia bears a disproportionate absolute share of the global sarcoma burden while facing systemic resource constraints that have driven indigenous limb-salvage prosthesis development and procedural innovation.

Key Takeaway: In staged bilateral hip arthroscopy for FAI, contralateral labral height at the 3:00 position decreased significantly from 4.0 to 3.7 mm and tear classification worsened over a mean 49.6-month inter-stage interval, yet neither change correlated with postoperative PROs.

Key Takeaway: Abstract not available — see the original article for details.

Key Takeaway: In skeletally immature knees, lateral OCD lesions have a mean lesion base-to-physis distance of only 13.4 mm versus 20.0 mm for medial lesions, and a 16 mm drill or screw length provides complete lesion penetration with a minimum 3 mm physeal safe zone.

Key Takeaway: Abstract not available — see the original article for details.

Key Takeaway: Ulnar osteotomy with external fixation and gradual closed reduction achieved 0% recurrent radial head dislocation at median 21.6-month follow-up in 14 pediatric chronic Monteggia fractures.

Key Takeaway: Abstract not available — see the original article for details.

Key Takeaway: Modified MacIntosh ITB technique with gracilis augmentation yielded a 4.9% graft re-rupture rate at mean 84.3 months, with 91.6% overall return to sport.

Key Takeaway: Combined cable reconstruction with biologic tuberoplasty restored muscle forces to near-intact levels (P > .05) in an irreparable rotator cuff tear model, whereas isolated biologic tuberoplasty failed to normalize forces across both motion planes.

Key Takeaway: In a cadaveric model, a +10° increase in lateral PTS significantly increased anterior tibial translation (P=.012), while a +10° delta PTS (lateral minus medial) produced 7.6° more internal rotation (P=.015), demonstrating that lateral and medial slopes have mechanistically distinct kinematic effects.

Key Takeaway: Among 48 consensus statements on subscapularis repair, augmentation, and tendon transfer, only 32 reached consensus (≥80% agreement), with all subscapularis repair statements achieving strong consensus (≥90%) but most augmentation/SCR statements failing to reach any consensus level.

Key Takeaway: No single radiographic technique demonstrates clear superiority for acetabular anteversion measurement, and CT-based assessment requires whole-pelvis imaging to establish an accurate pelvic reference plane.

Key Takeaway: Among 97 international shoulder surgeons, 30 of 50 consensus statements on posterosuperior rotator cuff tear diagnosis, nonoperative management, and repair achieved strong consensus (≥90% agreement), while 3 failed to reach any consensus level.

Key Takeaway: The 2015 Knee Society Radiographic Evaluation System's use of the native patella midpoint as the reference landmark systematically overestimates lateral patellar translation in both unresurfaced patellae and medialized patellar prostheses.

Key Takeaway: The AMKI classification introduces a three-letter grading system for anteromedial knee instability that stratifies medial and anteromedial laxity into Grades A (isolated dMCL), B (combined dMCL+sMCL ± ACL), and C (complete medial stabilizer disruption) to guide individualized treatment.

Key Takeaway: A modular intramedullary temporary stabilisation system with PMMA spacer achieved axial stiffness of 90 N/mm and bending stiffness of 1.2 N/mm in a 50-mm femoral defect model, exceeding plate (60 N/mm axial, 1.0 N/mm bending) but comparable to external fixation (80 N/mm axial, 0.6 N/mm bending).

Key Takeaway: Trans-tendon repair of articular-sided partial-thickness posterosuperior rotator cuff tears carries a Grade A evidence-supported increased risk of postoperative stiffness compared with tear-completion-and-repair, while both techniques yield similar return-to-sport rates.