Weekly Digest

Key Takeaway: Adding intrawound tobramycin (1.2 g) to vancomycin (1.0 g) powder did not reduce deep SSI rates in high-risk periarticular tibial fractures (7.4% vs 6.6%; HR 1.11, 95% BCI 0.75–1.66).

Key Takeaway: Post-ACL reconstruction hinged bracing produced no clinically meaningful improvement in Lysholm scores, strength, ROM, reoperation, or rerupture rates (2.9% vs 3.6%, P=.79) across 6 RCTs and 384 patients, with only a 0.20 mm KT-1000 side-to-side difference favoring bracing.

Key Takeaway: Across 29 ACL reconstruction RCTs, the median fragility index was 2.0, meaning most statistically significant graft comparisons reverse with a change of just 2 events.

Key Takeaway: Intramedullary nailing achieves rotational correction within 6.6±4.9 degrees of planned derotation—noninferior to plate fixation by an intergroup difference of only 0.7 degrees—in adolescent femoral derotational osteotomy.

Key Takeaway: In 89 RCTs of rotator cuff tendinopathy, exercises plus percutaneous electrolysis produced the greatest pain reduction (SMD -1.58) and exercises plus trigger point dry needling the greatest functional improvement (SMD 3.10) versus no treatment, though evidence certainty was very low across all comparisons.

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.

Key Takeaway: Among 148 patients undergoing BPTB ACL reconstruction, patellar defect filling with autograft, calcium phosphate cement, or DBM produced no significant difference in anterior knee pain at 12 months (VAS p=0.598, Kujala p=0.878).

Key Takeaway: Anterior quadratus lumborum block plus lateral femoral cutaneous nerve block provided no reduction in POD 1 opioid consumption (median 29.84 vs 30.50 oMME, p=0.57) compared to periarticular infiltration analgesia when both techniques incorporated dual glucocorticoids in THA.

Key Takeaway: Wound protectors in primary TSA did not reduce deep C. acnes colonization (15% vs 21%, p=0.593) but significantly reduced deltoid and pectoralis major injury scores (p<0.001 for both).

Key Takeaway: Distal forearm fractures account for 48% of all pediatric long-bone fractures (n=45,355 of 94,347), with peak incidence at ages 10–12 and bimodal seasonal peaks in May–June and August–September.

Key Takeaway: C. acnes was the most common organism in both Definite (25%) and Non-Definite (27%) shoulder PJI categories using the 2018 ICM diagnostic framework across 490 revision arthroplasty cases.

Key Takeaway: At 20 years post-ACLr, the ipsilateral knee arthroplasty rate was 2.44% versus 0.88% in the contralateral knee, yielding an HR of 3.00 for isolated ACLr and 3.50 when concurrent meniscal surgery was performed.

Key Takeaway: Open access orthopaedic RCTs had significantly higher citations (36.8 vs 30.1), Altmetric Attention Scores (44.1 vs 17.2), and Mendeley readership (136.6 vs 113.4) compared to closed access articles across 1,223 RCTs.

Key Takeaway: Smoking increases imaging-confirmed structural failure after arthroscopic rotator cuff repair by 53% (RR 1.53, 95% CI 1.13–2.08) across 1,683 shoulders with low heterogeneity (I² = 24.7%).

Key Takeaway: Posterior lumbar fusion for isthmic spondylolisthesis carries 2.65x higher odds of 90-day revision surgery compared to anterior lumbar fusion, despite lower readmission and ileus rates.

Key Takeaway: Elective primary TEA achieves a weighted mean MEPS of 82 and long-term survivorship of 86.3% at ≥7 years, but carries a 16.8% all-cause reoperation rate that has not improved over 25 years.

Key Takeaway: 3-month mortality after geriatric hip fracture in New York State fell from 10.8% in 2010 to 8.6% in 2019, with Cox regression confirming significantly reduced hazard ratios from 2012–2019 versus 2010 across 142,540 patients.

Key Takeaway: In revision RSA with severe glenoid defects, custom implants achieved MCID in 100% of outcome measures versus bone graft constructs that failed MCID for external rotation (67%) and internal rotation (50%), though complication rates were 19% vs 28% respectively.

Key Takeaway: DAPT following primary THA/TKA was not associated with increased 90-day bleeding versus clopidogrel alone, but carried a 2.34x higher adjusted odds of stroke (95% CI 1.16–4.69).

Key Takeaway: Keeled cemented glenoid components in the Eclipse stemless aTSA achieved 102-month median survival and 13% revision rate versus 66–73 months and 53% revision rate for pegged cemented components, regardless of humeral head material.

Key Takeaway: Retrograde nail versus lateral locked plate for distal femur fractures showed no significant difference in all-cause revision (24% vs. 19%, P=0.2) or union-promoting revision (8.2% vs. 10%, P=0.5) at mean 16-month follow-up in a propensity-matched cohort of 490 fractures.

Key Takeaway: An AI pipeline analyzing 19 3D anatomic variables from standard MRI discriminated ACL-injured from control knees with 80% sensitivity, 70% specificity, and AUC-ROC of 0.81, identifying flatter articular surfaces and greater sagittal tibial inclination as the dominant risk features.

Key Takeaway: Lateralized RTSA achieved equivalent ROM and Constant score improvements regardless of infraspinatus fatty infiltration grade, though high-FI patients had significantly lower absolute ER strength at final follow-up (p=0.007).

Key Takeaway: ACLISS grade does not predict overall reoperation rate (grade 1: 10.2% vs grades 2–3: 10.9%, P=.832), but higher-grade injuries underwent reoperation earlier, with 69% of grade 2–3 reoperations occurring within 5–15 months versus 22% for grade 1.

Key Takeaway: Noncemented TKA patients required 35% more opioids inpatient (MME 101.4 vs 75.0, p<0.001) and were significantly less likely to forget their joint at 1 year (51% vs 75.3%, p=0.002) compared to matched cemented TKA patients.

Key Takeaway: Pediatric soccer players cleared for return-to-sport after ACLR demonstrate persistent biomechanical risk factors during on-field cutting, including 2.3° greater knee valgus and 22.2° greater peak hip flexion during unplanned tasks compared to matched controls.

Key Takeaway: Intraoperative nursing shift change independently predicted 2.04 days longer LOS and 53% lower odds of home discharge after cervical spinal fusion.

Key Takeaway: In 428 femoral neck fracture arthroplasties, BCIS grade I or II occurred in 70% of patients but was not associated with cement use; spinal anesthesia was the only independent predictor (OR 2.37, 95% CI 1.55–3.61).

Key Takeaway: META achieved significantly lower nonunion (2.6% vs. 14.3%), implant failure (0% vs. 10.4%), and recurrence (0% vs. 7.4%) rates compared to modified Lapidus, with greater improvements in PROMIS physical function and mobility scores.

Key Takeaway: Navigation- and robotic-assisted TKA achieved MCID on KOOS-JR 26–29% faster than conventional TKA (median 20–21 vs. 28 days by distribution-based threshold), with no difference in 1-year MCID attainment rates.

Key Takeaway: Immediate weight-bearing following ETO during revision THA achieved 86.8% bony union at a mean of 4.2 months with a 3.8% deep infection rate and significant HOOS JR improvement (16.4 to 3.5, p≤0.000001).

Key Takeaway: A triple-tapered collared femoral stem reduced early periprosthetic fracture incidence from 1.8% to 0.26% (p=0.038) in patients over 70 undergoing primary THA compared to a dual-tapered collarless stem.

Key Takeaway: Elderly patients (≥65 years) undergoing distal biceps repair had a major complication rate of 6.1% versus 6.7% in matched younger controls (p=0.822), with no significant difference in any individual complication.

Key Takeaway: Fully HA-coated, collared, triple-taper cementless stems achieved 98.1% two-year survivorship with zero aseptic femoral loosening across an unselected population aged 39–89.

Key Takeaway: The Osborne-Cotterill lesion is present in 66% of acute elbow instability cases (120/181), with posterior impaction morphology comprising 86.6% of lesions and avulsion subtype showing stronger association with instability requiring operative treatment.

Key Takeaway: Fellow involvement in primary TKA produced no significant difference in operative time (54.0 vs. 56.4 min, P=0.131), and a 9-minute THA time penalty during the first fellowship rotation resolved by the second rotation (78.3 vs. 75.4 min, P=0.149).

Key Takeaway: Fragment incarceration, present in 28% of operatively treated pediatric medial epicondyle fractures, was independently associated with lower MEPS and reduced ROM, while implant type (K-wire vs. cannulated lag screw) produced only a 3–4 point MEPS difference.

Key Takeaway: Swing-phase knee flexion (55–75% of gait cycle) at 3–12 months post-TKA significantly predicted all KOOS subscales except sports/recreation, while operated-limb kinematics stabilized by 3 months postoperatively.

Key Takeaway: Hip preservation via surgical hip dislocation in adolescents with residual LCPD improved mHHS from 58.6 to 72.1 and Gait Deviation Index at mean 2-year follow-up, without improvement in Sphericity Deviation Score.

Key Takeaway: Systematic Congo red staining of primary THA specimens identified amyloid in 4.2% of contemporary cases versus 0.06% historically, with ATTR subtype confirmed in 11 of 29 mass-spectrometry-subtyped cases.

Key Takeaway: Female patients using oral contraceptives at the time of ACLR+LET demonstrated significantly lower global graft SNQ on 7-month MRI (1.8 vs 3.7, P=.001), indicating superior graft maturation compared to non-OC users.

Key Takeaway: ML models predicting prolonged LOS and 30-day readmission after primary THA (n=180,762) demonstrated systematically lower fairness metrics—including predictive parity and statistical parity—for Hispanic/LatinX patients, women, and diabetic patients, and bias mitigation algorithms improved some metrics while worsening others.

Key Takeaway: PENG block reduced PACU stay by 28–60 minutes and lowered postoperative pain scores in 5 of 6 studies versus no block, but opioid reduction was inconsistent (0–2 mg morphine equivalents) across 11 studies totaling 386 patients.

Key Takeaway: Five CPAH morphotypes (2N, 5N, 5H, 6N, 8N) account for 82% of an osteoarthritic THA cohort, and short stems achieved the best anatomic fit across all nine morphotypes while anatomic stems mismatched in up to 80% of cases.

Key Takeaway: Pectoralis minor reattachment during Latarjet reduced positive scapular dyskinesis test rates across all five assessment tools (OR 0.007–0.095) and improved UCLA scores by 5 points (34 vs. 29) in high-performance contact athletes.

Key Takeaway: Percutaneous posterior fixation after ALIF/LLIF reduces EBL by 387 mL, OR time by 65 minutes, and LOS by 1.7 days versus open fixation, while open fixation achieves 12.9° greater lumbar lordosis correction in adult spinal deformity cases.

Key Takeaway: ITBAG achieved comparable return-to-sport rates to HT-LET (65.3% vs. 66.9%) but produced significantly better ACL-RSI scores (87.5 vs. 79.2) and lower overall complication rates, driven primarily by reduced cyclops syndrome in the HT-LET group.

Key Takeaway: Preoperative C2-7 Cobb angle was the only imaging predictor of C5 palsy (11.4° vs. 6.39°, p=0.001), yet its AUC of 0.636 renders both MRI and radiographic measurements clinically non-predictive.

Key Takeaway: Each 1-mm increase in KT-1000 side-to-side difference at 1 year post-ACLR carries an adjusted hazard ratio of 2.97 for graft re-rupture, with SSD >5 mm conferring an 8.85-fold increased risk versus SSD <3 mm.

Key Takeaway: DCM patients with symptom duration ≥1 year before surgical consultation had roughly half the odds of achieving MCID for NDI (OR=1.64), SF-12 PCS (OR=1.98), and EQ-5D (OR=2.08) compared to those symptomatic <1 year, despite equivalent neurological recovery.

Key Takeaway: At mean 90-month follow-up after aTSA with a fluted central peg glenoid, 28% developed central peg osteolysis and radiolucency progression was associated with 13% greater revision risk and significantly lower ASES and SANE score improvement.

Key Takeaway: Preoperative dehydration (BUN/Cr ≥20), present in 37.4% of single-level lumbar fusion patients, independently predicted blood transfusion requirement and 1-year spine reoperation on multivariate analysis.

Key Takeaway: Dome-shaped proximal tibial osteotomy above the tibial tubercle achieved significant WOMAC and pain score improvement (P<0.001) with high patient satisfaction in 28 knees with combined varus deformity >5° and external tibial torsion >30°.

Key Takeaway: Hip Axis Error (HAE) predicts mechanical failure after ASD surgery with OR=1.20 per degree (P<0.001), outperforming L1PA Error as a predictor regardless of fusion length.

Key Takeaway: At mean 134-month follow-up, arthroscopically assisted latissimus dorsi transfer improved Constant-Murley scores from 48.2 to 62.7 and ASES from 49.5 to 68.7, with only 9% requiring conversion to rTSA despite a 42% full-thickness retear rate.

Key Takeaway: Endoscopic discectomy reduced dural tear rate from 1.15% to 0.15% (OR 0.179) and SSI from 1.15% to 0.08% (OR 0.082) compared to open discectomy in a propensity-matched cohort of 2,618 patients.

Key Takeaway: PyroTITAN pyrocarbon hemiarthroplasty achieved 97.5% five-year implant survival with significant improvement in WOOS and ASES scores at all time points in patients with glenohumeral arthritis (mean age 56.5 years).

Key Takeaway: A Random Forest machine learning model predicted 1-year Failed Back Surgery Syndrome with AUROC 0.715 for lumbar decompression and 0.701 for lumbar fusion across 13,018 surgeries.

Key Takeaway: A novel 8-task Mobility Outcomes Testing Battery (MOTB) detected significant functional improvement at both 3 and 6 months post-TKA (p=0.001 and p=0.008), with stair descent remaining the most challenging task—only 50% of patients achieving optimal scores at 6 months.

Key Takeaway: Bursal acromial reconstruction for irreparable rotator cuff tears improved mean ASES by 46 points and VAS by 4.9 points at 2 years, with 3 of 22 patients (14%) requiring conversion to rTSA.

Key Takeaway: In contact athletes, Latarjet reduces recurrence vs. arthroscopic Bankart repair (7% vs. 15%, p=.014) but carries a 4-fold higher complication rate (8% vs. 2%, p<.0001), with no difference in revision rates, RTS rates, or functional scores.

Key Takeaway: Arthroscopic primary ACL repair in acute proximal tears (Sherman I-II) achieved 95.4% RTS and a 10% failure rate at mean 47.9 months, with failure concentrated in patients younger than 25 years.

Key Takeaway: Revision ACLR carries 1.6-fold higher odds of meniscal injury (OR 1.64) and 3.5-fold higher odds of chondral lesions (OR 3.53) compared to primary ACLR across 37,423 cases.

Key Takeaway: HO excision following THA achieved only 9% radiographic recurrence (one Brooker IV case) and a single reoperation in 45 patients with Brooker grade III/IV HO using contemporary prophylaxis.

Key Takeaway: Delayed MMPRT repair (≥90 days) carries 4.96-fold increased odds of medial tibiofemoral cartilage injury in patients under 19, with 45% of the cohort already demonstrating arthroscopic cartilage damage at time of surgery.

Key Takeaway: Cementless TKA with a highly porous tibial baseplate achieved 97.8% survivorship free of aseptic loosening at 12 years in morbidly obese patients (mean BMI 46.1), with only 2 tibial aseptic loosening events both occurring within 8 months of index surgery.

Key Takeaway: A modified graft augmentation technique using a double suture bridge configuration achieved 0% retear rate at minimum 2-year follow-up in 30 patients with large to massive rotator cuff tears.

Key Takeaway: A metaphor-based conceptual framework (key/door/puzzle) organizes fracture reduction strategy across anatomic regions, though no outcome data are reported.

Key Takeaway: Discharge timing concordant with patient preference reduced the rate of feeling prematurely discharged from 32.3% to 3.4% (P<0.001) after outpatient MI-TLIF or MI-laminectomy.

Key Takeaway: Retear rates of 5–50% after rotator cuff repair have driven rapid commercial expansion of augmentation grafts, which are categorized by material (allograft, xenograft, synthetic) and placement (onlay vs. interpositional) to address biologic or structural failure modes.

Key Takeaway: Weight-bearing 3D spatial HKA alignment correlates more strongly with joint space narrowing (r=0.52–0.61) and WOMAC scores (r=0.45–0.56) than conventional 2D HKA, with 89.1% of KL Grade 4 knees exhibiting a varus-flexion phenotype.

Key Takeaway: An icariin-loaded PCL electrospun scaffold promoted M2 macrophage polarization, increased CD31/EMCN angiogenic expression, and enhanced fibrocartilaginous interface regeneration with organized collagen I/II architecture at 8 weeks in a rat rotator cuff model.

Key Takeaway: Cementless patellar resurfacing in 323 primary TKAs yielded a 0.6% fracture rate and zero revisions at mean 36 months, with mean residual bone thickness of 13.5 mm and osteolysis in 3.4% of cases.

Key Takeaway: In a cadaveric SCR model, a 4.8 mm porcine xenograft restored superior humeral translation to near-intact levels at all abduction angles, while a 2.1 mm single-layer human dermal allograft showed persistently elevated translation at 0° and 20° (P < 0.05).

Key Takeaway: Ligamentum flavum is consistently absent at C0-C1 in all 12 cadaveric specimens, replaced by novel atlantodural and axiodural ligaments connecting C1-C2 posterior elements directly to the dura.