Weekly Digest

Key Takeaway: Physiotherapist-led care reduced emergency department length of stay by 1.0 hour (95% CI -1.2 to -0.8) compared to physician/nurse practitioner-led care for uncomplicated musculoskeletal conditions, with 98.1% probability of cost-effectiveness.

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

Key Takeaway: Double-row repair reduces retear risk by nearly half compared to single-row (OR 1.88) for tears ≥30 mm, but provides no functional or structural advantage for tears <30 mm.

Key Takeaway: Temporary in situ pinning followed by delayed modified Dunn yielded equivalent AVN rates (17% vs. 12%, P=0.99) and Merle d'Aubigné scores compared to primary modified Dunn in moderate-to-severe SCFE.

Key Takeaway: Adding meniscal centralization to medial meniscus posterior root repair produces only 0.6 mm greater extrusion reduction versus isolated repair (3.3 vs. 3.8 mm post-op), with no significant difference in Lysholm, IKDC, or VAS pain scores.

Key Takeaway: A postoperative rise in P1NP (ΔP1NP +38.5 vs -16.9 ng/mL, p=0.013) independently predicts one-year pseudarthrosis after ACDF, occurring in 30% of this cohort.

Key Takeaway: At 12 months post-ACLR, 76% of patients meeting the KOOS Sport PASS threshold (≥75) had concurrent quadriceps LSI below 90%, with near-zero agreement between PASS achievement and isokinetic symmetry (κ = 0.060 for KOOS Sport, κ = 0.030 for KOOS QoL).

Key Takeaway: Baseline AOS >63 and instability etiology (OR 5.1) independently predicted clinically meaningful improvement (≥28-point AOS gain) after primary TAR, with the model achieving AUC 0.76 in 631 patients.

Key Takeaway: Adding BBAT to PSSE improved trunk repositioning error at 15° and 30° and NLP test scores (all p<0.05) over 16 weeks, but no between-group difference exceeded the MDC95 threshold, and Cobb angle and ATR were unchanged.

Key Takeaway: MIS-PCF versus ACDF for cervical radiculopathy yields equivalent functional outcomes (NDI, EQ-5D) and revision rates, but MIS-PCF reduces operative time by 14.72 minutes, hospital stay by 0.99 days, and cost by $9,131.93.

Key Takeaway: After propensity score matching, DRF patients had a 2.58 vs. 2.00 subsequent hip fractures per 100 person-years compared to upper-limb contusion controls, with only 17.6% initiating osteoporosis treatment within 1 year post-injury.

Key Takeaway: In selected low-comorbidity patients undergoing predominantly low-complexity revision procedures, outpatient rTKA and rTHA achieved PJI rates of 9.0% vs 13.0% (p<0.001) and transfusion rates of 6.2% vs 21.9% (p<0.001) compared to inpatient cohorts.

Key Takeaway: Male donors have significantly greater distal radius coronal ROC (26.5 vs 23.5 mm), sagittal ROC (12.6 vs 11.1 mm), and BMD than female donors, and patients under 30 have higher BMD than those over 30, informing allograft selection for glenoid reconstruction.

Key Takeaway: After stratifying by modified Oxford bone score, obesity does not independently alter proximal femoral morphology, suggesting the elevated SCFE risk in obese children is driven by mechanical load or obesity-related physiology rather than anatomy.

Key Takeaway: Arthroscopic bone grafting for unstable scaphoid nonunion achieved union in 93.6% (autograft) vs. 88.9% (allograft) with no significant difference in union rate, healing time, or functional outcomes at mean 20 months follow-up.

Key Takeaway: Hyperlipidemia increases 5-year repeat rotator cuff repair rate from 7.0% to 9.8% (OR 1.440), but statin therapy does not reduce and may worsen reoperation risk.

Key Takeaway: PAO reduced femoral head decentration distance from 4 mm to 3 mm and radial extension from 90° to 53°, but complete resolution occurred in only 9 of 29 affected hips (31%), with persistent decentration associated with femoral anteversion >22° and dGEMRIC index of 436 vs. 606 msec in resolved hips.

Key Takeaway: Pectoralis major tendon transfer after rTSA yielded significantly higher ADLIR scores (28.1 vs 24.9, p=0.006), zero PM retears versus 31% SSC retear rate, and a 5.73-fold adjusted odds of return to work compared to subscapularis repair.

Key Takeaway: The SLIC system achieved an AUC of 0.968 and F1 of 0.78 in pediatric subaxial cervical spine injuries, but over-recommended surgery in children under 10, with 4 of 11 SLIC>4 patients successfully managed nonoperatively—all under age 10.

Key Takeaway: Preoperative hemoglobin below 12 g/dL in men and below 10 g/dL in women confers up to 4.94-fold increased 2-year PJI risk and 3.71-fold increased 90-day wound infection risk following TSA.

Key Takeaway: Fixed-bearing lateral UKA achieved 87% implant survivorship at 20 years with a mean OKS improvement of 19.75 points at 5 years in 113 knees.

Key Takeaway: Revision surgery after failed distal clavicle excision improved ASES scores by 29.8 points and VAS pain by 4.2 points, but 22.2% of patients remained dissatisfied and persistent subjective instability carried a 7-fold odds of dissatisfaction (OR 7.0, p=0.02).

Key Takeaway: Intramedullary lengthening produces the most pronounced postoperative weight loss, reaching a nadir of approximately 2% below baseline at 45 days before recovering, with early weight loss consistently associated with higher Bone Healing Index/External Fixation Index across all three lengthening cohorts.

Key Takeaway: Perioperative IV TXA was not independently associated with calculated total blood loss (β = 32.5 mL; 95% CI, -123.2 to 188.2; p = 0.682) following posterior approach acetabular fracture fixation in 591 patients.

Key Takeaway: Osteopenia confers a graded, intermediate reoperation risk after primary THA (4.4%) and TKA (1.7%) compared to normal BMD (0.4% and 0.3%) and osteoporosis (6.8% and 3.5%), with adjusted models confirming independent association for both BMD categories.

Key Takeaway: Meniscal repair performed with PCL reconstruction carries a 2-year failure rate of 4.1% versus 8.4% for isolated repair (adjusted HR 0.41), an effect size comparable to concomitant ACL reconstruction.

Key Takeaway: Collared uncemented stems reduced periprosthetic femoral fracture revision risk by 92% versus collarless stems (0.1% vs 0.6%; aOR 0.08) in women ≥70 years undergoing THA.

Key Takeaway: After transtibial pullout MMPR repair, varus thrust (5.2° ± 2.0) and midstance knee adduction angle remain statistically indistinguishable from unrepaired tears and significantly worse than controls (3.3° ± 0.9, P < .01), despite PASS achievement rates of 71–81%.

Key Takeaway: In 2,639 hip fracture arthroplasty patients, LMWH initiation delayed ≥19 hours from admission increased screen-detected in-hospital VTE risk by 22.8% (aHR 1.228, 95% CI 1.036–1.456), with each additional hour of delay conferring a 0.3% incremental VTE risk increase.

Key Takeaway: Serial casting in early-onset scoliosis carries a pooled complication rate of 17% (95% CI 9–24%), with dermatological complications predominating and significantly fewer complications than growth rods (1/27 vs 12/27).

Key Takeaway: Dementia carries an adjusted OR of 6.47 for postoperative delirium after TKA in patients ≥75 years, with a POD incidence of 20.7% vs. 2.6% in non-demented patients.

Key Takeaway: BMI ≥30 independently doubles mechanical failure risk after TAA (HR 2.27) regardless of whether a stemmed or keeled tibial component was used.

Key Takeaway: Primary TJA in patients with a prior surgically treated PJI in another joint carries a 1.5% one-year PJI incidence, statistically equivalent to controls (P=0.25), though prior exchange arthroplasty (vs. DAIR) confers higher risk (2.2% vs. 0%).

Key Takeaway: Iliac fixation in multilevel lumbosacral fusion (>4 levels) reduced long-term all-cause reoperation risk by 37% (HR 0.63) and nonunion-related reoperation by 70% (HR 0.30) over a mean 6.3-year follow-up.

Key Takeaway: In hip-spine syndrome patients undergoing both lumbar fusion and THA, spine-first sequencing was an independent predictor of greater 1-year HOOS improvement (β: 8.04, p=0.039) compared to hip-first sequencing.

Key Takeaway: Seiza sitting after THA produces a mean maximum hip flexion of only 74.9° with no liner-to-neck or bone-to-bone contact observed in 74 hips, suggesting kinematic feasibility in selected patients.

Key Takeaway: Over 25 years and 24,947 knee osteotomies in England, 90-day reoperation rate was 2.27% and serious adverse event rate was 1.95%, with 1-year conversion to arthroplasty of only 0.38%.

Key Takeaway: Primary THA in Down syndrome patients achieves 94.6% revision-free survival at 10 years, statistically equivalent to propensity-matched controls (RR 0.92, P=0.84).

Key Takeaway: Concomitant calcaneal displacement osteotomy at the time of primary TAA confers a 9.75-fold increased odds of PJI (95% CI 2.5–52.4), with an overall TAA infection rate of 2.7% in this 1,008-case series.

Key Takeaway: At 3 months post-THA, greater quadriceps strength (B=11.05, p=0.002), greater hip ROM (B=0.09, p=0.026), and lower pain scores (B=-2.90, p<0.001) independently predicted higher FJS-12 at 12 months (mean 73.4±22.2), while perceived leg-length discrepancy did not.

Key Takeaway: After ulnar tunnel foveal TFCC repair, pain improves by 12 weeks but full functional recovery (PROMIS upper extremity and physical function) requires 6 months, with 77% returning to full activity at mean 32-month follow-up.

Key Takeaway: Preoperative HbA1c ≥8.0 confers nearly double the odds of arthrofibrosis requiring MUA or aLOA within 3 months of TKA compared to non-diabetic controls (OR 1.91, 95% CI 1.35–2.71), with risk increasing in a dose-dependent fashion across glycemic strata.

Key Takeaway: Among 5 experienced hand surgeons reviewing 43 wrist arthroscopy cases, interobserver agreement for TFCC tear presence was only fair (Fleiss' kappa not specified numerically), classification agreement was slight-to-fair, and treatment decision agreement was low, with central tears showing higher presence/absence agreement (94.3%) than peripheral tears (80.0–85.0%).

Key Takeaway: Tourniquet use independently predicts early quadriceps inhibition after primary TKA with an OR of 6.25, and each additional unit of tourniquet duration increases inhibition risk by 65% (OR=1.65).

Key Takeaway: In obese patients undergoing lumbar interbody fusion, anterolateral approaches reduced transfusion risk (8.89% vs. 14.09%, RR=0.88) and unplanned revision (2.46% vs. 3.56%, RR=0.70) versus posterior approaches, but were associated with worse VAS-Back and ODI scores at 12 months that did not reach MCID.

Key Takeaway: AS patients undergoing THA had significantly higher 30-day stroke, MI, transfusion, and ICU rates versus matched controls, and day-of-surgery thiazide diuretics, ACE inhibitors, and beta blockers each independently increased 30-day stroke hazard within the AS cohort.

Key Takeaway: GLP-1RA exposure shows procedure-specific rather than class-wide effects on cervical fusion outcomes, with ACDF pseudarthrosis ORs ranging from 0.52 to 0.86 (inconclusive) while a semaglutide-specific posterior cervical fusion cohort showed OR 4.79 for 2-year pseudarthrosis.

Key Takeaway: Medicare Advantage patients undergoing elective hip and knee arthroplasty had a significantly longer mean LOS than Traditional Medicare patients (1.58 vs. 1.37 days, P=0.0104), with discharge disposition as the dominant modifier of this relationship.

Key Takeaway: Four proximal screws achieved equivalent Constant-Murley Scores (78 vs. 73, p=0.23) and screw perforation rates (8.6% vs. 10.6%, p=0.72) compared to five or more screws in locking plate fixation of proximal humerus fractures.

Key Takeaway: Fourth column thoracic fractures (concomitant sternal fracture) represent 1.8% of thoracic vertebral fractures but carry a PCCL ≥3 comorbidity burden of 59.3% vs. 11.7% in the general thoracic fracture cohort, with in-hospital mortality reaching 2.89% in patients ≥75 years.

Key Takeaway: After multivariable adjustment, nighttime intramedullary nailing of femoral fractures was not associated with increased complications compared to daytime surgery (aOR 0.45, 95% CI 0.15–1.38).

Key Takeaway: Across 1,868 patients and three surgical strategies for massive/irreparable rotator cuff tears, functional outcomes and forward flexion improved equivalently whether or not AHI increased significantly (range of AHI change: -3.2 to +5.3 mm).

Key Takeaway: Among 51 women with post-THA pregnancies, 61% delivered vaginally without reported implant complications, and 48% reported improved sexual satisfaction after THA.

Key Takeaway: Dermal allograft patch augmentation with mini-open triple-row repair for large-to-massive rotator cuff tears yielded a 12.8% retear rate at mean 32.5 months with no graft-related adverse events.

Key Takeaway: Among 30 MSTS orthopaedic oncologists, interrater agreement on pathologic fracture diagnosis from imaging was only moderate (Fleiss κ=0.54–0.64), with greatest disagreement on cortical perforation with soft tissue extension, severely compromised cortex without clear discontinuity, and incomplete fracture lines.

Key Takeaway: In rTSA patients with preoperative ER lag signs, preoperative active ER1 >25°, ER2 >40°, and ER2 lag <25° predicted functional ER recovery with AUC 0.74–0.76, while implant lateralization/distalization angles showed no independent correlation with ER outcomes.

Key Takeaway: A landmark-based suprapubic screw safe corridor in THA extends 15° superiorly and 9° inferiorly in the sagittal plane, with a safe entry point 1.5 cm posterior to the anterior acetabular rim and a 31° posterior corridor in the axial plane.

Key Takeaway: After simple elbow dislocation, MRI demonstrates collateral ligament injury in over 90% of cases (MCL 90.6%, LCL 94.3%) and acute osteochondral injury in 57.2%, but prognostic significance of these findings remains unestablished.

Key Takeaway: Orthopaedic surgeons can reduce falls, fragility fractures, and hospitalizations in older adults by prescribing muscle-strengthening/balance training, screening for malnutrition, and optimizing bone health within existing surgical care workflows.

Key Takeaway: Endoscopic management of greater trochanteric pain syndrome, iliopsoas tendinopathy, extra-articular impingement, and gluteal and hamstring tears yields reduced morbidity and faster recovery compared to open surgery, though outcome data remain largely level III-IV.

Key Takeaway: Expert consensus guidelines recommend UIV selection of C2 for poor bone health or 3-column osteotomies, and LIV extension to T1–T3 for poor cervical sagittal alignment in adult cervical deformity surgery.

Key Takeaway: Lateral femoral condyle distalisation of +4.5 mm increases patellofemoral reaction force by 36% during passive flexion (55.98 N to 76.30 N, p=0.006) in a dose-dependent manner.

Key Takeaway: Horizontal plate fixation for isolated greater tuberosity fractures achieved 100% union and a mean UCLA score of 30 in all 11 patients at minimum 24-month follow-up.

Key Takeaway: A 159-surgeon international survey established UC-AOSIS operative thresholds: scores ≤3 favor nonoperative management, scores ≥5 favor surgery, and score 4 represents an equipoise zone without consensus.

Key Takeaway: Lateral femoral joint-line distalization of ≥4 mm increases LCL strain to 6.0%, approaching microstructural injury thresholds and suggesting a critical biomechanical threshold between 2 and 4 mm.

Key Takeaway: In a cadaveric PMMR repair model, combining all 3 centralization sutures reduced contact pressures at 0°, 30°, and 60° flexion and extrusion at 90° flexion, while a single MCL-border suture alone restored pressures only at full extension.

Key Takeaway: In a finite element model of anterior shoulder instability with 13.5–25% glenoid bone loss, labral augmentation restored humeral head displacement to control levels (8.10 ± 0.58 mm vs. 7.61 ± 0.46 mm, P=.18), outperforming isolated Bankart repair and Bankart plus remplissage.

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

Key Takeaway: Outpatient unilateral biportal endoscopic lumbar decompression succeeded in 73% of patients aged ≥75 years, with ODI improving 21.5 points and radicular VAS improving 5.2 points at 3 months.

Key Takeaway: GPT-5 correctly identified the intended upper-extremity diagnosis in 92% of 180 structured vignettes, with accuracy unaffected by patient self-diagnosis but reduced for vague symptom descriptions and de Quervain tendinopathy specifically.

Key Takeaway: Current evidence does not demonstrate increased implant-related complications with return to sport after primary TKA, supporting individualized activity resumption including selected high-impact sports.

Key Takeaway: Inconsistent mobilization after hip fracture surgery stems from three identifiable structural barriers—interprofessional cultural conflict, organizational resource constraints, and non-therapeutic physical environments—rather than clinician ignorance of guidelines.

Key Takeaway: Complete detachment of the ATFL superior fascicle increases internal rotation displacement by 2.9° at 30° plantarflexion, while partial detachment produces no significant kinematic change.

Key Takeaway: Suture button plus AITFL augmentation (either nonanatomic tails or anatomic reconstruction) reduced external rotation by ~2.3° versus the fully sectioned state, but neither construct fully restored native rotational stability, and adding deltoid repair further reduced external rotation by 0.69–0.93°.

Key Takeaway: THA patients with documented SDOH-related Z-codes had 75% higher 2-year PJI rates (4.55% vs. 2.60%, RR 1.75) and 67% higher revision rates (3.66% vs. 2.20%, RR 1.67) compared to matched controls.