Weekly Digest

Key Takeaway: Single-shot epidural ropivacaine with opioid-free IV-PCA reduced postoperative fentanyl consumption by 1,345 µg (fusion) and 1,005 µg (decompression) versus conventional fentanyl IV-PCA without a clinically important difference in pain scores.

Key Takeaway: Trabecular Titanium acetabular cups demonstrated 17% higher periprosthetic metabolic activity (SUV) at 4 weeks post-THA compared to hydroxyapatite-coated cups, suggesting faster early osseointegration.

Key Takeaway: Glenohumeral arthritis reduces overhead flexion by 38° (84° vs. 122°) and drives compensatory lumbar rotation tripling (9° vs. 3°) and elbow flexion sextuplng (26° vs. 4°) compared to the contralateral asymptomatic shoulder.

Key Takeaway: At 9 years post-APM, patients with unstable chondral lesions left in situ had a 21.9% subsequent arthroplasty rate versus 2.0% in those without chondral lesions.

Key Takeaway: Wrist arthritis patients undergoing corrective surgery develop CTS at 26.4% versus 7.0% in conservatively managed controls at 1 year (OR 4.06), with CTR rates of 17.7% versus 2.3% (OR 8.25), and PRC carries the highest adjusted odds for both outcomes.

Key Takeaway: ABM/P-15 as bone graft extender in uninstrumented posterolateral fusion for degenerative spondylolisthesis reduced 10-year reoperation rate to 18% versus 43% with allograft (P=0.024), achieving cost dominance with 20% lower total healthcare costs.

Key Takeaway: K-wire infections occurred in 3.3% of 3,425 hand/wrist cases, with 20.4% of infected patients progressing to major complications predicted by initial purulence and need for a second antibiotic course.

Key Takeaway: A novel femoral extraction osteotome system achieved successful stem removal without osteotomy or fracture in 73% of osseointegrated cementless revision THA cases, but failed in 57% of fit-and-fill and fully HA-coated stems.

Key Takeaway: IMN for pathologic diaphyseal tibial fractures achieved 1-year survival of 48.7% and reduced median VAS pain scores from 38 to 6 at one month, with 73% achieving full weight-bearing by 3 months.

Key Takeaway: Severe cervical multifidus sarcopenia (Goutallier grade ≥2.5) is independently associated with worse postoperative cervical sagittal alignment and higher NDI and VAS neck pain scores following laminoplasty for OPLL in a cohort of 134 patients.

Key Takeaway: Non-academic centers had 31% higher odds of pseudoarthrosis or mechanical failure at one year (OR=1.314) and more than double the 30-day readmission rate (OR=2.211) compared to academic centers after long-segment posterior lumbar fusion.

Key Takeaway: 4-in-1 surgery reduced refracture rate to 11.8% versus 37.0% for combined tibial nailing/Ilizarov/bone graft in Crawford Type IV CPT, but at the cost of significantly worse Malhotra ankle valgus classification at final follow-up.

Key Takeaway: Elective transtibial amputation for CRPS/neuropathic pain produced greater VAS pain reduction (median ΔVAS -5) than nonneurogenic late amputation (median ΔVAS -3, p=0.02), with no difference in PROMIS pain interference scores (57 vs. 56, p=0.81) and 0% revision to higher amputation level at median 9-year follow-up.

Key Takeaway: Robotic-assisted navigation reduces intraoperative fluoroscopy dose 1.5-fold but increases total perioperative radiation 25-fold (12.5 vs. 0.5 mSv) compared to freehand technique in pediatric idiopathic scoliosis PSFI.

Key Takeaway: Nondominant-sided aTSA yielded significantly higher RTS rates than dominant-sided surgery in active patients ≤65 years (85.7% vs 69.5%, P=.015).

Key Takeaway: Arthroscopic saucerization with or without repair for pediatric discoid lateral meniscus achieves 97.2% return to full activity and 8.3% reoperation rate at median 8.08-year follow-up.

Key Takeaway: Dual mobility confers lower dislocation risk before 4.25 years (HR 0.52) but higher risk after 4.25 years (HR 8.26) compared to jumbo heads ≥40 mm, with no significant difference in revision rates for any indication.

Key Takeaway: A dedicated spine team (DST) reduced operative time by 67.7 minutes (138.5 vs. 206.2 min, p<0.001) and postoperative PCA morphine usage compared to a nondedicated team in posterior spinal fusion for idiopathic scoliosis.

Key Takeaway: Dual S1S2-iliac fixation achieved 64% major curve correction versus 53% with S2-iliac alone, but differences in pelvic obliquity correction and complication rates were statistically insignificant (P>0.4) in 77 neuromuscular/EOS patients.

Key Takeaway: Lumbar fusion after THA increases compensatory hip flexion by a mean of 13–14° in the flexed-seated position, with each additional fused level independently associated with greater PFA increase (standardized β = 0.39, R² = 0.43).

Key Takeaway: ORPP and CRPP for pediatric supracondylar humerus fractures produce equivalent postoperative pain scores (FLACC 2.5 vs. 2.7, p=0.613) and opioid use, with only 16.4% of all patients requiring any opioid.

Key Takeaway: Aspirin reduced VTE rates by 37.5% versus LMWH (1.0% vs 1.6%, aOR 0.6) and transfusion rates by 27% (6.0% vs 8.2%, aOR 0.8) following first-stage revision TKA for PJI.

Key Takeaway: Trainee involvement in ACLR and RCR did not increase 100-day complication rates (4.6% and 3.6%, respectively) or worsen 2-year PROs, though operative time increased by 13–26 minutes depending on trainee type.

Key Takeaway: EHR behavioral flag designation was associated with 5.57-fold higher odds of major postoperative complications and 4.06-fold higher odds of reoperation at 1 year after operative fracture fixation, with preoperative flags carrying the highest risk (OR 14.74).

Key Takeaway: Surgical treatment for lumbar spondylolisthesis and stenosis within 6 months of diagnosis reduced 3-year metabolic burden risk by 6–7% (RR 0.94) compared to nonoperative care, but surgery was associated with 19% higher risk of active opioid prescription at 3 years.

Key Takeaway: Periosteal entrapment was not an independent risk factor for growth disturbances in distal tibial Salter-Harris II fractures, with an overall growth disturbance incidence of 14.8% across 27 patients regardless of treatment method.

Key Takeaway: CDI outperforms both PTI and SPE in discriminating patellofemoral instability in pediatric patients (AUC 0.534–0.594 for MRI indices vs. CDI sensitivity/specificity >73%), while 40.5% of CDI-defined patella alta cases showed preserved engagement by SPE (>0.45).

Key Takeaway: 100% of children with symbrachydactyly reported sports participation, with 85.7% currently active, and injury incidence (34.3%) comparable to the general pediatric population, though greater limb deficiency was significantly associated with higher injury risk (P=0.03).

Key Takeaway: ChatGPT 5, Grok 3, and Claude 4.5 Sonnet achieved overall fracture diagnostic accuracies of only 26.8%, 18.8%, and 22.4%, respectively, across five common orthopaedic trauma fracture types.

Key Takeaway: Adding a lateral extra-articular procedure to revision ACL reconstruction in workers' compensation patients reduced graft re-rupture from 33.3% to 5.9% and shortened time to RTW by 124 days.

Key Takeaway: In arthroscopic transosseous TFCC foveal repair, knotless suture anchor fixation was an independent predictor of favorable outcomes (Modified Mayo Wrist Score ≥80) on multivariate regression, with greater postoperative wrist flexion arc compared to manual tie technique in 70 patients.

Key Takeaway: Suture tape-based SCR yields a lower re-tear rate than LHBT-based SCR (11.5% vs. 16.6%, p=0.04) with equivalent functional scores and greater acromiohumeral distance restoration in massive rotator cuff tear partial repair.

Key Takeaway: Revision lumbar fusion patients carry 3x higher opioid burden at 2 years postoperatively (1,550 vs. 497 MME, P<0.001) despite similar 30-day use, with revision status independently predicting greater MME consumption beginning at 1 year (β=964.4).

Key Takeaway: Intraoperative calcar fractures treated with double-loop cerclage wiring during short stem THA resulted in 0% revision rate at 2 years versus 2.03% in matched controls (p not significant), with no significant difference in subsidence, PFF, PJI, or dislocation.

Key Takeaway: UKA carries half the PJI revision risk of TKA (HR 0.53, p<0.001), but implant-retaining revision for PJI fails in approximately one-third of cases for both implant types.

Key Takeaway: High-volume UKA centers (≥80 procedures/year) had significantly lower revision rates, with loosening, OA progression, malalignment, and pain all less frequent compared to low-volume centers (≤24/year) across 48,029 procedures.

Key Takeaway: High ADI (socioeconomically disadvantaged) UKA patients showed no difference in 2-year all-cause revision (3.04% vs. 2.86%, OR 1.07) or PJI rates compared to low ADI patients, but incurred significantly higher day-of-surgery costs ($5,336 vs. $4,118).

Key Takeaway: Transverse foramen fractures (OR 3.42) and subluxation/dislocations (OR 4.41) are the cervical fracture patterns most strongly associated with blunt cerebrovascular injury, while isolated level-based fractures (C1, C2, C1-C3, C4-C7) show no statistically significant association.

Key Takeaway: In 11,113 patients across 43 studies, OSPBT carried higher rates of wound infection (1.1% vs 0.5%) and nerve injury (1.1% vs 0.2%), while ASPBT had more postoperative stiffness (2.5% vs 1.4%) and reoperations (1.9% vs 1.1%), with no difference in overall complication rates or Popeye deformity.

Key Takeaway: At median 6-year follow-up, SCR with acellular dermal allograft achieved ASES improvement from 48 to 83 (81% exceeding MCID) but demonstrated 66% major graft failure (Hasegawa V) and 63% progression to Hamada grade 4 cuff tear arthropathy.

Key Takeaway: OCAT was used in 80.2% of tibial plateau osteochondral lesion cases but carried a 30.1% failure rate, while OAT and microfracture each failed in only 6.3% of cases.

Key Takeaway: In the largest reported ES cohort (n=20), intraspinal anomalies were present in 50% (tethered cord in 40%), and VEPTR carried a 233% complication rate versus 33% for MCGR and 25% for PSF.

Key Takeaway: Arthroscopic partial repair with footprint medialization and HDA patch augmentation achieved a 7.5% retear rate and mean ASES improvement from 68.4 to 93.7 in retracted rotator cuff tears >2.5 cm with residual footprint exposure >1.5×1.5 cm.

Key Takeaway: After open Latarjet for <5% glenoid bone loss, coracoid graft consolidation occurred in 97% of cases at mean 8-year follow-up, with 3D CT demonstrating consistent superomedial resorption and a mean glenoid surface augmentation of 20.9%.

Key Takeaway: In elderly patients with anterior glenohumeral dislocation, glenoid fractures >25% of glenoid width with humeral subluxation warrant fixation, and reverse shoulder arthroplasty is the preferred salvage for recurrent instability with concurrent degenerative pathology.

Key Takeaway: Fluoroscopy plus needle arthroscopy guidance achieved 68% higher load to failure (1,784 vs. 1,063 N) compared to fluoroscopy alone for lateral tibial plateau fracture fixation in a cadaveric model.

Key Takeaway: Standalone A+LLIF achieved a 5-year cumulative revision rate of 2.2% vs 31.1% for circumferential L+PLIF in propensity-matched multilevel lumbosacral fusion patients (P<.001).

Key Takeaway: Kyphoplasty demonstrates lower adjacent vertebral fracture risk and greater kyphotic deformity correction compared to vertebroplasty, particularly in patients with severe preoperative kyphosis.

Key Takeaway: A combined nomogram incorporating the CT-derived screw trajectory-to-vertebral body HU ratio and MRI-based pedicle bone quality score predicted pedicle screw loosening with an optimism-corrected AUC of 0.883 at 12 months, with a 14.3% loosening rate in 313 patients.

Key Takeaway: First-TMT plantarflexion bone block arthrodesis with precontoured allograft wedge carries a 42.3% nonunion rate and 26.9% revision rate at mean 2-year follow-up.

Key Takeaway: Isolated lateral extra-articular procedures for persistent rotatory instability after intact-graft ACLR achieved a 5.4% pooled failure rate with significant improvement in pivot-shift grade and IKDC, Lysholm, and Tegner scores at mean 25.5 months.

Key Takeaway: Mechanically preconditioned BMSCS-encapsulated dTFBC scaffolds achieved a mean ultimate failure load of 203.9 N at 12 weeks, a 73% improvement over standard repair (118 N, P=.003) in a rabbit rotator cuff model.

Key Takeaway: Full-thickness quadriceps tendon grafts achieve 0–5.1% failure rates and KT-1000 side-to-side difference of 0.6–1.3 mm but cause 26–31% isokinetic quadriceps strength deficits, while partial-thickness grafts show only 2.3% failure with minimal strength loss across 13 studies and 427 patients.

Key Takeaway: In ACL-deficient knees with posterolateral tibial fractures ≤3 mm, ACLR with LET restored pivot-shift kinematics to native state at all flexion angles, while ACLR with PLTF repair produced significantly higher ATT than native at 15°–45° of flexion.

Key Takeaway: Posterior side-to-side suture healing after arthroscopy-assisted lower trapezius transfer yields a 6.5% graft retear rate versus 55.0% in the unhealed group, with teres minor fatty infiltration grade as the sole independent predictor of healing.

Key Takeaway: BFR stimulates FAP-to-myocyte mitochondrial transfer within 1 day in murine supraspinatus muscle and reduces fatty infiltration, fibrosis, and muscle atrophy at 6 weeks after massive rotator cuff tear with denervation.

Key Takeaway: Computer simulation of rigid intramedullary nailing in adolescents aged 10–13 shows proximal tibial physeal injury volumes of 2.26–5.15% across reamer sizes 9.75–12.0 mm, remaining below the classically described 7% threshold of concern.

Key Takeaway: Sequential transection of popliteomeniscal fascicles, meniscofibular ligament, and posterior meniscotibial ligament progressively increased lateral meniscus posterior horn anterior displacement from 6.3 mm (intact) to 11.4 mm, with internal rotation laxity rising from 32.6° to 40.2°.

Key Takeaway: Revision of failed Fitmore short-stem THA using a new short or standard primary stem achieved a 4.5% re-revision rate at mean 69 months follow-up, avoiding dedicated revision implants in 84% of cases.

Key Takeaway: Bone plug MAT showed greater improvement with peripheral stabilization in internal-external rotation laxity (P=.010) and contact area (P=.022), but both bone plug and soft tissue root fixation achieved generally similar time-zero biomechanical profiles when peripheral stabilization was added.

Key Takeaway: Isolated superior peroneal retinaculum repair without bony procedures achieved 0% recurrence and improved Karlsson-Peterson scores from 57.5 to 86.0 at mean 20.7 months across all retromalleolar groove morphologies.

Key Takeaway: ITB-augmented gluteus medius repairs achieved 98% greater ultimate load to failure (294.6 N vs. 149.0 N, P=.002) compared to nonaugmented double-row suture bridge repairs in a cadaveric model.

Key Takeaway: TTIF achieved mean 15° kyphosis correction and 12.2% ODI improvement at 1 year in 22 patients with thoracic proximal junctional failure, with 100% arthrodesis rate.

Key Takeaway: A contoured 3.5 mm T-plate achieved 100% union at mean 8.7 weeks for pediatric proximal femoral fractures (Delbet types II–V), with good functional outcomes in 64.9% of 37 patients.

Key Takeaway: A symmetric bicondylar talar component TAA reduced dorsiflexion by 4.0° and increased transverse-plane ankle ROM by only 1.9° during cadaveric gait simulation, with no significant subtalar kinematic changes.

Key Takeaway: Total joint arthroplasty (TJA) for thumb CMC arthrosis has evolved significantly but no implant system has demonstrated superiority over trapeziectomy-based resection arthroplasty in controlled comparisons.

Key Takeaway: Adolescents aged 14–18 carry the highest dislocation risk and recurrence rates sufficient to justify early arthroscopic stabilization, while children under 12 are best managed conservatively given ligamentous-to-bone strength ratios.

Key Takeaway: MOPS-N preserved nerve isografts combined with PEG-fusion achieved significantly higher sciatic functional index scores and near-baseline grip strength by week 4 compared to autografts without PEGf and Normosol-preserved grafts in an 8-mm rat sciatic nerve gap model.

Key Takeaway: Excessive posterior tibial slope causing flexion gap instability produced the highest reported serum cobalt and chromium levels in primary TKA literature, with systemic toxicity manifesting as cognitive impairment, neuropathy, and cardiac symptoms nearly a decade postoperatively.