Weekly Digest

Key Takeaway: Self-directed CBT for chronic pain produced a mean 0.98-point greater reduction in BPI-I pain interference scores versus clinician-delivered CBT at 4 months, with superiority sustained through 12 months.

Key Takeaway: In osteoporotic patients undergoing single-level lumbar interbody fusion, 3D-printed porous titanium cages reduced subsidence rate from 58.3% to 12.5% compared to PEEK, with a T-score cut-off of -2.4 (AUC 0.865) identifying patients at elevated PEEK subsidence risk.

Key Takeaway: IO TXA (20 mg/kg) is noninferior to IV and topical TXA for hemoglobin reduction across POD 0–3, with exploratory data showing lower calculated total blood loss in the IO group on DOS and POD1 (P=0.005 and P=0.016).

Key Takeaway: Quadriceps tendon autograft achieves equivalent KT-1000 stability and IKDC/Lysholm outcomes versus both BPTB and hamstring autograft at 12–24 months, with high-certainty evidence of substantially lower donor-site morbidity compared to BPTB across 15 RCTs.

Key Takeaway: A J-shaped incision (distal limb lateralized 3 cm at the tibial tuberosity) reduced anterior knee numbness area by 54% at 2 months (3.5 vs. 7.6 cm²) and 60% at 6 months (2.1 vs. 5.3 cm²) compared to standard midline incision in primary TKA.

Key Takeaway: Lumbar decompression reduced mediolateral center-of-pressure sway by 24% (2.24 to 1.70 cm) and improved ODI by 16.8 points at 3 months, with Cone of Economy metrics capturing postural recovery not reflected by PROMs alone.

Key Takeaway: Scapular-focused rehabilitation after PHILOS fixation improved Constant-Murley scores at 1 month (46.1 vs. 41.5, P=0.039) and 3 months (63.4 vs. 57.2, P=0.018) but showed no difference at 12 months (P=0.325).

Key Takeaway: Each increase in Child Opportunity Index quintile was associated with a 9% higher risk of surgically treated supracondylar humerus fracture (p<0.001), with Black patients in high-COI neighborhoods bearing disproportionately elevated rates.

Key Takeaway: Lower extremity DVT occurred in 5.3% of patients after arthroscopic rotator cuff repair, all asymptomatic and distal, with age ≥65 years (OR 8.7) and female sex (OR 6.0) as independent risk factors.

Key Takeaway: A systematic HRSN screening initiative in a pediatric orthopaedic clinic increased screening completion from 38% to 65% and successful enrollment in social services from 25% to 61%.

Key Takeaway: A 45-year-old male undergoing THA accrues 25 lifetime JALYs under base-case assumptions, and this benefit does not fall below the 6-JALY benchmark set by 85-year-old patients unless the revision penalty exceeds 25 JALYs—an implausibly large threshold.

Key Takeaway: In 331 adults with CP, 24.5% had hip subluxation (MP>30%), with GMFCS IV/V showing the highest displacement (PE=16.29 and 14.20 respectively), but 21.6% of GMFCS I/II adults were MCHCS grade 4 or higher.

Key Takeaway: Stacked-cone constructs in complex primary and revision TKA achieved 91.7% 5-year survivorship free from aseptic loosening, but only 56.5% survivorship free from all-cause reoperation.

Key Takeaway: Os acromiale (incidence 9.7%) does not adversely affect functional outcomes or complication rates after rTSA, with no significant differences in any ASES, SST, Constant, or ROM measure versus matched controls at minimum 2-year follow-up.

Key Takeaway: Adding LET to primary ACL-R produced no difference in KOOS4 scores at 1 or 2 years (79.9 vs 80.7 at 2 years, P>0.5) and identical 2-year clinical failure rates (25.5% vs 25.6%).

Key Takeaway: Each 1-point increase in RAI-rev independently raised 30-day mortality odds by 5% (OR 1.05), and RAI-rev outperformed mFI-5 for mortality discrimination (C-statistic 0.73 vs. 0.57) in patients undergoing prophylactic femoral fixation for metastatic disease.

Key Takeaway: At mean 8.2-year follow-up after ACL reconstruction with concomitant meniscal injury, high-inflammation phenotype patients achieved MCID for VAS pain at nearly 3.3× the rate of low-inflammation patients (57.6% vs 17.6%), despite similar final PROM scores between groups.

Key Takeaway: Female patients have a significantly narrower glenoid rim (neck-to-face ratio, p<0.001) and lower anteroinferior quadrant bone density (272.5 vs. 303.0 HU, p=0.009) compared to males, independent of instability status.

Key Takeaway: In ACL reconstruction with concomitant nonoperatively treated MCL injury, hamstring autograft carries a 2.4× higher revision risk compared to BPTB autograft (HR 2.4, p=0.001) across 35,139 reconstructions.

Key Takeaway: THA after prior hip arthroscopy yields significantly lower FJS, mHHS, and HOOS-Pain scores at mean 6.6 years versus matched primary THA controls, with a 10% vs. 2% all-cause reoperation rate (P=.01).

Key Takeaway: Arthroplasty fellowship-trained surgeons achieved a 2.5% two-year UKA-to-TKA conversion rate versus 5.7% for non-fellowship-trained surgeons (P=0.049), despite operating on older, more comorbid patients with less robotic assistance.

Key Takeaway: Resurfaced osteoarticular allograft (ROA) achieved 58% 5-year allograft survival versus 19% for osteoarticular allograft (OA) in pediatric proximal tibial tumor reconstruction, though the difference did not reach statistical significance (P=0.236).

Key Takeaway: Between 2017–2022, 224,456 ED visits occurred for periprosthetic hip and knee fractures, with annual surgical volumes projected to reach up to 31,400 knee and 29,017 hip procedures by 2035 at costs up to $81,194 per case.

Key Takeaway: In 297 patients undergoing knee arthroscopy for meniscal injury, 9 of 10 synovial fluid biomarkers differed significantly between smoking cohorts, with RANTES negatively associated with pack-years (β = -0.5115) and IL-6 positively associated with time since cessation (β = 0.3842).

Key Takeaway: After excluding ultra-low-volume surgeons (<10 cases/year), mean annual TJA volume among standard-volume surgeons increased from 79.1 to 90.7 cases between 2016 and 2023, and the typical TJA patient was treated by a surgeon performing ~192 cases/year.

Key Takeaway: Among 409 women undergoing TSA, only 64.5% achieved PASS (SANE >75) at 2 years, with rTSA (OR 0.38), prior ipsilateral surgery (OR 0.53), and smoking independently predicting failure to reach this threshold.

Key Takeaway: High-cost-sharing patients undergo TKA disproportionately in Q4 (35.7%) versus Q1 (19.9%), with an inverse correlation between out-of-pocket payment and surgical volume (Pearson r = -0.42, p<0.001) across 450,125 knee OA patients.

Key Takeaway: ACL repair carries a 15.5% failure rate versus 4.2% for reconstruction at mean 6.3-year follow-up, with the excess risk concentrated in patients under 40 and those with preoperative pivot shift.

Key Takeaway: The knee-to-hip revision burden ratio increased significantly across three of four national registries at 3.63 percentage points per year (R²=0.876), driven by declining hip RBR and rising knee RBR, with infection now the predominant TKA failure mechanism.

Key Takeaway: At minimum 10-year follow-up, PSG-assisted glenoid implantation in aTSA showed no difference in revision rate (1/27 vs 1/20), functional scores, or component migration (19% vs 20%) compared to conventional technique.

Key Takeaway: Prior hip arthroscopy is associated with a 49% increased hazard of 5-year THA revision (HR=1.49; 4.9% vs. 3.3%) in patients aged 40–65 undergoing primary THA for osteoarthritis.

Key Takeaway: Despite targeting 0° glenoid inclination with PSI, global glenoid inclination averaged -18±10° (range 1° to -53°) due to resting scapular rotation variability, with SRA strongly correlated to GGI (r=0.77).

Key Takeaway: RAI outperformed mFI-5 in predicting 30-day mortality (AUC 0.69 vs 0.53) and non-home discharge (AUC 0.71 vs 0.57) in 824 patients undergoing periprosthetic femoral fracture surgery.

Key Takeaway: In 619 shoulders, all measured scapular morphologic parameters differed significantly between healthy and osteoarthritic shoulders, with CSA, SAT, PAC, PAH, glenoid version, and humeral subluxation showing graded differences across healthy, Walch type A, and type B groups (all p<0.001).

Key Takeaway: QT autograft produced less donor-site pain, numbness, and kneeling pain than BPTB but caused more quadriceps wasting/atrophy, with female QT patients showing significantly worse atrophy (estimate -2.90, p<0.0001) and a higher ipsilateral reoperation rate (26% vs 10%, p=0.016).

Key Takeaway: Intraoperative cephalosporin prophylaxis was associated with a 53% reduction in all-cause revision odds (OR 0.47) in TSA, with cephalosporin use dropping from 90% to 44% as β-lactam allergy severity increased.

Key Takeaway: In borderline dysplasia hips (LCEA 18–25°), central acetabular osteophytes were associated with microinstability (β=0.027, P<0.001), ligamentum teres tears (β=0.010, P=0.001), and increased combined anteversion (β=1.343, P=0.029) on logistic regression (R²=0.542).

Key Takeaway: In 6,988 patients aged ≥80 undergoing elective rTSA, 9-year revision rate was only 3.35%, but 30-day medical complications reached 16.4% and 1-year mortality reached 8.2% in the ≥90 cohort.

Key Takeaway: Remplissage utilization increased 4.5-fold from 2012 to 2024 (7.7% to 34.7%), with ~75% of remplissage cases performed on near-track or on-track Hill-Sachs lesions.

Key Takeaway: Upright-supine imaging (USI) detected instability in significantly more DLS segments than flexion-extension radiographs, and a ΔRT_USI threshold of 7.9% predicted worse outcomes after decompression-only while thresholds of 5.3–5.7% predicted better outcomes after fusion.

Key Takeaway: Type II and III periprosthetic patellar fractures carry dramatically higher revision risk than Type I, with 10-year revision-free survivorship of 60% for Type II versus 80% for Type I and hazard ratios of 8.4 and 17.0 for Types II and IIIA, respectively.

Key Takeaway: Arthroscopic suprascapular nerve decompression achieved return to duty or sport in 17 of 20 patients (85%) at a median 13 weeks, with VAS improving from 6 to 1 in the pain cohort and motor grade improving from 3.3–4.0 to 4.3–5.0 in the weakness cohort.

Key Takeaway: Cementless TKA utilization grew from 1.6% to 19.0% between 2012 and 2024, with a modestly higher adjusted one-year revision risk versus cemented fixation (aOR 1.12; 95% CI 1.00–1.25), driven primarily by aseptic loosening (aOR 2.37) and instability (aOR 1.64).

Key Takeaway: Preoperative ACL-injured limbs show a 20% isometric knee extension strength deficit and 10% quadriceps volume deficit versus the contralateral limb, with moderate-to-strong correlations between individual quadriceps muscle volume and extension strength (r=0.43–0.84).

Key Takeaway: ACLR + LEAP carries a 1.78× higher adjusted risk of arthrofibrosis requiring MUA or lysis of adhesions compared to isolated ACLR (3.3% vs 1.8% at 2 years, HR 1.78, 95% CI 1.16–2.71).

Key Takeaway: 6.5% of cervical OPLL patients undergoing posterior decompression required anterior revision surgery, with K-line(-) status and high canal occupancy ratio independently predicting earlier time to revision on Cox analysis.

Key Takeaway: In 98 GMFCS I-III spastic diplegic CP patients, improved knee range of motion after rectus femoris transfer did not translate to improved FAQ walking ability (IG: -0.08 vs UG: +0.79, no significant difference).

Key Takeaway: Anchor-based SCB thresholds for KOOS Pain, PS, and JR after primary TKA are 33, 16, and 23 points respectively, yet only 59% of patients achieved these thresholds at 1 year.

Key Takeaway: GTA reduces ROGT frequency in Herring B and C LCPD, but LP C patients maintain high residual ROGT rates despite equivalent absolute trochanteric growth inhibition to LP B patients.

Key Takeaway: Confirmed separation on MRI at 2–3 weeks post-surgery was associated with a 2.63-fold reduced mortality risk and median survival of 13.31 vs. 6.02 months compared to non-separation.

Key Takeaway: Experienced hip arthroscopy surgeons (late-phase cases) achieved 31.77 minutes shorter operative time and a 90% reduction in THA conversion rate (OR 0.10) compared to early-phase cases across 2,624 procedures.

Key Takeaway: Subtalar facet penetration occurred in 35% of lateral lengthening calcaneal osteotomies yet produced no significant difference in AOFAS scores, FFI, or MRI cartilage degeneration at minimum 5-year follow-up.

Key Takeaway: In functionally aligned robotic-assisted TKA, femoral component internal rotation >2° relative to the surgical TEA (present in 12% of cases) produced no statistically or clinically significant difference in Forgotten Joint Score or flexion ROM at 1 year.

Key Takeaway: EOS-derived sarcopenia (11.3% prevalence in ASD patients) independently associates with greater SVA (β=13.17), thoracic kyphosis (β=6.87), and cervical lordosis (β=5.84), reflecting a shift toward distal compensatory mechanisms.

Key Takeaway: Proximal tibia vara (MPTA <85°) yields significantly lower OKS (p=0.005), KSS (p=0.036), and FJS-12 (p=0.006) after medial UKA, with tibial component overhang independently worsening all three outcome scores.

Key Takeaway: DAIR for lower leg fracture-related infection achieved only 57% treatment success (implant retention + infection eradication + fracture healing + limb preservation), with no significant association between time to DAIR and outcome up to 9 weeks (HR 1.01, 95%CI 1.00–1.03, p=0.059).

Key Takeaway: Preoperative antipsychotic medication exposure is associated with 45% more opioid prescriptions (9.9 vs. 6.9 mean prescriptions) and higher rates of readmission, VTE, dysphagia, and subsequent cervical surgery within two years of ACDF.

Key Takeaway: In surgically treated geriatric tibial plateau fractures (≥70 years), overall complication rate was 24.3%, with Schatzker VI fractures reaching 44.2%, and prolonged operative time plus external fixator use—not classic comorbidities—were the significant predictors of complications.

Key Takeaway: Preoperative fall history in TKA patients ≥65 years is associated with nearly double the 2-year revision rate (2.8% vs. 1.8%), 1.8× higher PJI rate (2.8% vs. 1.7%), and 82% higher postoperative fall rate (15.3% vs. 8.4%) compared to propensity-matched controls.

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

Key Takeaway: Combined HTO with medial meniscus posterior root repair achieved complete healing in 12.5–64.9% of cases versus 5.9–50.0% with isolated HTO, but meniscal extrusion remained unchanged (3.1–5.5 mm) in both groups.

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

Key Takeaway: Tibial suspensory fixation produces 1.61–2.40 mm less tibial tunnel widening than interference screw in hamstring autograft ACL reconstruction, with equivalent functional scores and knee laxity at 24–40 months.

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

Key Takeaway: In combined coronoid and radial head fractures, 46% of radial head fractures involve both the anterolateral and anteromedial quadrants (31% as a single fragment, 15% as two fragments), and radial head fracture pattern does not correlate with O'Driscoll coronoid fracture type.

Key Takeaway: Decreased combined femoral-acetabular version (FV+AV) was independently associated with failure to achieve MCID for mHHS after hip arthroscopy, with an odds ratio of 6.38, despite overall significant PRO improvements across all version groups.

Key Takeaway: All 13 adolescent athletes with isolated first rib fractures (8 traumatic, 5 stress) achieved full symptom-free return to activity with conservative management, though mean time to presentation for stress fractures was 128 days versus 21.9 days for traumatic fractures.

Key Takeaway: Orthoplastic protocol implementation reduces time to skeletal stabilization and soft tissue coverage, decreases infection risk, improves functional outcomes, and lowers cost compared to non-protocol care.

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

Key Takeaway: In 352 knees undergoing robotic-assisted TKA with functional alignment, 73.6% demonstrated a stable coronal phenotype across ROM, with valgus knees (CPAK groups) showing the lowest stability and apex direction independently reducing odds of stability by 72-77% (OR 0.23-0.28).

Key Takeaway: Yoda1 (Piezo1 agonist) at low concentration improved tendon-to-bone failure load and stiffness versus controls at both 4 and 8 weeks (P<.001) while shifting macrophage polarization toward M2 phenotype at 4 weeks in a rat rotator cuff repair model.

Key Takeaway: A 3×3 laxity phenotype classification identifies nine distinct TKA gap patterns, with only 2 of 9 phenotypes (Types 4 and 5) meeting currently accepted balanced-gap criteria in both extension and flexion.

Key Takeaway: Autologous osteoperiosteal composite graft achieved >75% defect depth fill at 12 weeks with a histological score of 26.20 ± 1.48, significantly outperforming microfracture (21.80 ± 2.68, P=.0280) in a rabbit osteochondral defect model.

Key Takeaway: A three-round modified Delphi among 65 South African orthopaedic clinicians reached consensus on 12 prioritisation factors (6 patient-specific, 6 injury-specific) and 2 automatic red-flag overrides (acute compartment syndrome and threatened vascular status) for scheduling elective operative orthopaedic trauma in resource-constrained public hospitals.

Key Takeaway: The SAVE classification (Stability, Anatomical location, Viability, Environment) is proposed as a treatment-oriented framework for periprosthetic fractures after hip resurfacing arthroplasty, a failure mode not adequately addressed by existing systems such as the Vancouver classification.