Weekly Digest

Key Takeaway: At 2 years post-Latarjet, eliminating sling immobilization yielded Rowe scores 12.5 points higher and SANE instability scores 7.9 points higher than 3-week sling immobilization, with 1.53× greater likelihood of very high patient satisfaction.

Key Takeaway: Long-acting injectable cabotegravir-rilpivirine every 8 weeks was superior to daily oral TLD for maintaining virological suppression in HIV-positive adolescents, with confirmed virologic failure in 0.9% vs 6.4% at 96 weeks (p=0.0013).

Key Takeaway: At mean 63-month follow-up, VBT achieved a final instrumented Cobb angle of 25.7° from a preoperative mean of 47.9°, but 66% of patients had suspected tether breakage and 21.6% required unplanned return to the OR.

Key Takeaway: An 8-week smartphone-based digital therapeutic combining exercise and CBT reduced usual knee pain by 12.5 mm VAS (95% CI -17.1 to -7.8) versus education-plus-exercise-instruction in chronic PFP.

Key Takeaway: MIS-TLIF achieved noninferior ODI reduction vs open TLIF at 3 months (mean difference 0.4 points, 90% CI -5.7 to 6.5) but cost 10.5% more despite a 1.5-day shorter hospital stay.

Key Takeaway: The ROCK consortium enrolled >1,900 patients across 25 centers and demonstrated comparable functional outcomes between transarticular and retroarticular drilling in a landmark RCT, while validating reliable classification systems across radiograph, MRI, and arthroscopic modalities.

Key Takeaway: After rTSA, shoulder internal rotation remains reduced at 6 months (22.92° vs 29.63° preoperative), yet functional hand-behind-back task performance returns to baseline through a 58% increase in compensatory trunk rotation (10.21° vs 6.44°).

Key Takeaway: Preseason isokinetic H/Q ratio was the only significant predictor of noncontact lower extremity injury (aOR 0.78 per unit increase), but no isokinetic parameter independently predicted ACL, ankle, or non-ACL knee injuries in elite female footballers over 5 seasons.

Key Takeaway: In 4,540 handball-related ACL injuries, 55% were non-contact and 80% occurred during ball possession, with feinting (32%) and shooting (30%) as the dominant mechanisms.

Key Takeaway: Exactech Equinoxe ATSA carries an 87% higher all-cause revision risk versus other devices (HR 1.87, 95% CI 1.33–2.62), while elective RTSA with Equinoxe shows no significant difference.

Key Takeaway: In 115 spine fusion patients with intraoperative IONM alerts, degree of alert resolution (full, partial, or none) did not predict the rate, timing, or reversibility of postoperative motor deficits.

Key Takeaway: Labral repair and reconstruction achieve comparable PRO improvements (MCID and PASS >70% in both groups) at 2–5.8 years, but repair yields lower THA conversion rates while reconstruction shows lower failure rates in patients ≥40 years.

Key Takeaway: AIS prevalence rose by 110 cases per 100,000 patients from 2016 to 2023, with PSF occurring in 5,990 per 100,000 AIS patients in 2023 and projected to reach 10,230 per 100,000 by 2030.

Key Takeaway: ACL tears with Segond fractures carry a 13.6× higher odds of residual pivot-shift positivity at 2 years versus ACL tears without Segond fractures (50.0% vs 6.1%), driven by a 78.7% rate of lateral meniscus oblique radial tears.

Key Takeaway: High preoperative Pfirrmann grade (III–IV) at adjacent segments independently predicts a 0.16 decrease in postoperative-to-preoperative disk height ratio and 3.9× greater odds of worse disk height score at 1–2 years after ACDF, though 5-year revision rates for ASD were equivalent between groups.

Key Takeaway: Each 10% increase in postoperative supraspinatus muscle volume independently reduces retear odds by 51% (OR 0.49, 95% CI 0.30–0.80) and correlates with superior Constant scores and abduction strength at mean 38.9 months after rotator cuff repair.

Key Takeaway: OSA patients undergoing ACDF face significantly higher rates of respiratory failure, mechanical ventilation, dysphagia, and persistent opioid use, but pseudarthrosis, implant failure, and revision surgery rates are equivalent to non-OSA patients at 5-year follow-up.

Key Takeaway: Preoperative sepsis within 3 months of TSA carries an OR of 3.89 for postoperative sepsis and OR of 5.98 for PJI at 2 years when the causative organism is Staphylococcal.

Key Takeaway: Prior THA before lumbar spinal fusion carries a 32.5% spinal fusion revision rate at 2 years, compared to 10.6% in patients with no prior arthroplasty.

Key Takeaway: Among 463 THA patients with a 93.5% same-day discharge rate, later-day discharge was independently predicted by lower modified RAPT score (aOR 0.71), later OR exit time (aOR 1.35 per hour after 8 AM), and longer operative duration (aOR 1.03).

Key Takeaway: Discharge to SNF/IRF after elective lumbar fusion independently predicts 2.24 times higher odds of 90-day readmission compared to home discharge, even after multivariate adjustment.

Key Takeaway: Pediatric discectomy patients present with worse baseline PROMIS Mobility (32.7 vs. 37) and Pain Interference (62 vs. 57) than non-operative patients, yet achieve equivalent final scores with greater magnitude of mobility improvement (+9.1 vs. +4.2 points).

Key Takeaway: Early fixation of open ankle fractures involving the medial malleolus carries a 22% infection rate versus 9% with delayed fixation, reaching statistical significance (p=0.049) in bimalleolar and trimalleolar subgroups.

Key Takeaway: Prophylactic intramedullary nailing at external fixator removal eliminated regenerate fractures (0% vs. 25%) after tibial lengthening in fibular hemimelia patients.

Key Takeaway: At 2-year follow-up after ACLR, patients lacking knee confidence had significantly lower Marx Activity Rating Scale scores (4.7 vs 8.9) and KOOS Sport/Rec scores (58.1 vs 85.7) compared to confident patients, with MCID achievement rates of 70.6% vs 91.2%.

Key Takeaway: Robotic-assisted navigation achieved 97% screw placement success across 710 attempted screws in EOS patients, but robotic technical challenges occurred in 34% of cases.

Key Takeaway: Hip arthroscopy with capsular plication for surgically identified microinstability achieves MCID in 70.6–84.8% of patients, with revision and arthroplasty conversion rates of 1.65%/year and 0.27%/year respectively, comparable to propensity-matched FAI controls.

Key Takeaway: Adding open reduction to VDRO plus pelvic osteotomy for CP hip dysplasia (preoperative MP ≥60%) increased 90-day medical complications (47% vs. 22%) and secondary surgery rates (17% vs. 1%) without improving final migration percentage (21% vs. 15%, P=0.187).

Key Takeaway: Hip arthroscopy for global acetabular overcoverage (LCEA ≥40° plus coxa profunda) achieves significant 5-year PRO improvements but carries a 2-fold increased relative risk of revision hip arthroscopy (15.69% vs 7.84%) compared to matched controls.

Key Takeaway: Revision TKA for stiffness produced similar 90-day opioid consumption (total MME 695 vs. 785, P=0.7) and pain scores compared to revision for aseptic loosening or instability, despite a significantly higher rate of preoperative opioid use in the stiffness cohort (15.4% vs. 5.7%, P=0.003).

Key Takeaway: Postmenopausal women with medial meniscus posterior root tears have significantly lower 10-year arthroplasty-free survival compared to age- and BMI-matched men (53.5% vs. 78.4%, P=.02).

Key Takeaway: In 524,119 cementless THAs, periprosthetic femoral fracture risk increases significantly beyond age 71 in women and 72 in men, with 80-year-olds carrying 26% and 18% higher risk than those at the respective thresholds.

Key Takeaway: At minimum 10-year follow-up after BMS for OLT, patients >45 years achieved QoL MCID in only 52.8% versus 96.7% in those <30 years, with symptom duration >25.5 months and bone marrow edema depth >10.5 mm predicting failure in the older cohort.

Key Takeaway: Biological age acceleration predicted perioperative complications after TKA with an AUC of 0.77 (OR 1.20 per year, p<0.001), while chronological age showed no association (p=0.34).

Key Takeaway: Pediatric patients with lateral femoral condyle OCD have a significantly more horizontal ACL posterolateral bundle insertion (mean relative height 0.36 vs. 0.43 in both control groups, p<0.001), suggesting a mechanical contribution to LFC OCD pathogenesis.

Key Takeaway: PAD patients undergoing primary THA face a 3.68-fold increased hazard of lower extremity amputation and 39% higher 3-year revision rates compared to propensity-matched controls.

Key Takeaway: A preoperative L5 SAP-E angle <92.13° predicted postoperative contralateral symptoms after unilateral open L4/5 TLIF with 100% sensitivity and 89.3% specificity (AUC 0.961) in a cohort of 296 DLS patients.

Key Takeaway: Custom UKA carried a 2-year revision rate of 8.9% versus 3.8% for OTS implants (P=0.010), driven by a 6-fold higher aseptic loosening rate (4.8% vs 0.8%, P=0.006), with no PROM advantage.

Key Takeaway: Placing the most inferior Bankart anchor at the 6 o'clock position reduces recurrence from 26.3% to 10.1% (OR 2.89) compared to non-6 o'clock anchor placement.

Key Takeaway: In Masquelet stage-2 culture-positive patients, antibiotic-impregnated composite bone grafts reduced infection recurrence from 75% to 0% (p=0.01) compared to standard autologous cancellous graft.

Key Takeaway: Multiligament injury (OR=8.2), hyperextension bone bruise pattern (OR=8.1), and medial meniscus tear (OR=6.9) are the strongest independent predictors of proximal PCL tear location on MRI in acute complete PCL injuries.

Key Takeaway: 3D-printed patient-specific guide plates for autologous osteoperiosteal transplantation reduced cyst recurrence from 47% to 8% and shortened operative time by 0.74 hours compared to conventional technique in large cystic medial OLTs.

Key Takeaway: An AI-based planning system (OAPS) completed OWHTO preoperative alignment measurements in 9.27 seconds versus 4.30 minutes for manual planning, with mean absolute HKA error of 0.47° compared to attending surgeons.

Key Takeaway: Preoperative lateral compartment cartilage changes on MRI were not associated with increased revision risk after medial UKR at mean 9.6-year follow-up (sHR 0.40, p=0.40), with 10-year cumulative revision incidence of 3.0% in the MRI-abnormal group versus 9.1% in those without lateral changes.

Key Takeaway: Arthroscopic rotator cuff repair within 6 months of MI carries a 7.55-fold increased odds of postoperative MI compared to controls, with no significant risk elevation beyond that window.

Key Takeaway: Prior ipsilateral hip arthroscopy does not compromise post-THA functional outcomes, with comparable HOOS subscales at mean 52.6 months except QoL (HA-THA 75.7 vs THA 82.9, p=0.009).

Key Takeaway: After 1:1 matching by open fracture status, TTC nailing and ORIF for AO/OTA 43C pilon fractures showed no significant difference in FRI (25.7% vs 13.7% unmatched, equalized post-match), reoperation, nonunion, or amputation rates despite TTC patients carrying higher ISS (15.8 vs 11.4) and polytrauma burden (42.9% vs 20.0%).

Key Takeaway: Medial posterior tibial slope independently predicts increasing ATT side-to-side difference after ACLR, with a correlation rising from r=0.2 at 1 year to r=0.3 at 2 years, while LET reduces 2-year ATT SSD by 1.2 mm (6.1 vs. 7.3 mm).

Key Takeaway: Patellofemoral OCA transplantation yields statistically significant functional improvements across all 7 included studies, but long-term failure rates range from 0% to 25% with conversion to arthroplasty as the primary failure endpoint.

Key Takeaway: Lateral first metatarsal hemiepiphysiodesis for juvenile hallux valgus yields only 6° HVA improvement with 80% residual deformity and 30% reoperation rate at mean 57 months.

Key Takeaway: Hip arthroscopy for FAI in patients ≥40 years yields durable mHHS improvement (baseline 40.5–73 improving to 72.9–96 at 5–10 years) with THA conversion rates of 2.9–13.2% across studies.

Key Takeaway: Two-stage revision for PJI in revision TKA yields only 34.9% 10-year survivorship free from all-cause reoperation, with 8.1% requiring above-knee amputation.

Key Takeaway: Spinal fusion in Prader-Willi syndrome achieves 55.8% major Cobb angle correction (76.8° to 35.4°) with a 21.7% complication rate and 17.4% unplanned return to OR, with higher BMI independently associated with more complications (P=0.03).

Key Takeaway: RSA for proximal humerus fractures achieves durable pain relief by one year (VAS 1.4), with only 3.1–23.4% of patients achieving MCID in any outcome measure between one and two years.

Key Takeaway: Surgical fixation of pediatric bicondylar fracture-dislocation of the elbow (BiCFDE) yielded excellent or good outcomes in 100% of 12 patients at mean 50.5 months, with all fractures consolidating by mean 5.7 weeks.

Key Takeaway: ORIF of acute clavicle fractures in professional jockeys achieves return to riding at a mean of 7 weeks with a mean 12-month DASH score of 1.

Key Takeaway: Arthroscopic single-row suture anchor fixation of bony Bankart lesions achieves a 3.1% redislocation rate and 90.6% patient satisfaction at a mean 18.3-year follow-up.

Key Takeaway: Knee arthroscopy in pediatric OI patients carries a 48.3% complication rate and 35% revision surgery rate, yet 85% return to full baseline activity at a mean of 182 days.

Key Takeaway: At 5-year follow-up after ACL reconstruction, RTP rate was 83% regardless of chondral lesion severity, with no significant difference between ICRS grade 1–2 and grade 3–4 lesions in medial (85% vs 77.4%, P=.179) or lateral (85.1% vs 86.6%, P=.850) compartments.

Key Takeaway: Modified Woodward procedure with clavicle morcellation improved Cavendish grade in 25/27 shoulders and yielded mean shoulder abduction gains of 34° and forward flexion gains of 39° at mean 8.1-year follow-up.

Key Takeaway: Vertebral and pelvic fragility fractures carry significant mortality and morbidity, yet remain underdiagnosed and undertreated, with surgical intervention reserved for intractable pain, functional decline, neurologic deficit, or radiographic deterioration.

Key Takeaway: Only 61.1% of spine surgeons globally screen with DXA before instrumented fusion, with North America highest at 89.5% and Africa lowest at 36.6%.

Key Takeaway: Monomer-first mixing of medium-viscosity Palacos MV yields 2,897 ± 64 µg/mL cumulative vancomycin elution over 28 days—120% greater than monomer-first Simplex P—demonstrating that cement brand and mixing sequence are independent determinants of antibiotic delivery from high-dose PMMA spacers.

Key Takeaway: At mean 9.7-year follow-up after medial UKA, 98.1% of previously sport-active knees returned to sport, and prearthritic Tegner score independently predicted final Tegner score (regression coefficient 0.531, p<0.001).

Key Takeaway: The CoULD MHE Classification achieved substantial interrater reliability (kappa=0.64) on refined testing, significantly outperforming the Masada original (kappa=0.21), Masada modified (kappa=0.35), Gottschalk (kappa=0.43), and Jo (kappa=0.43) classifications for forearm deformity in multiple hereditary exostoses.

Key Takeaway: Transfibular trabecular metal TAA achieved 98.6% implant survivorship at mean 11-year follow-up, with only 1 metal component revision (periprosthetic infection requiring BKA) among 71 ankles.

Key Takeaway: A 31-expert, 15-country Delphi consensus (≥2/3 threshold, 3 rounds) produced 13 recommendations across 4 domains to guide immediate WBAT implementation after hip fracture surgery in low-adoption regions representing >50% of the world's population.

Key Takeaway: After ACL graft failure following combined ACL-ALL reconstruction, ALL graft continuity was preserved on MRI in 100% of cases, and median ATT was reduced by 2 mm and pivot-shift grade by 1 grade compared to pre-index values.

Key Takeaway: Robotic-assisted arthroplasty consistently improves component positioning precision but has not demonstrated improvements in patient-reported outcomes, complication rates, or implant survivorship across systematic reviews, meta-analyses, RCTs, and national registry data.

Key Takeaway: An international Delphi panel of 32 pediatric orthopaedic surgeons from 12 countries reached consensus on 15 of 20 statements, establishing open anterior arthrotomy as the preferred approach and antibiotic duration ≤4 weeks for isolated septic hip arthritis in prewalking children.

Key Takeaway: A Ti6Al4V mini-prosthesis with nano-multilayer film coating and 3D-printed porous stem (NMF@3D-Ti) achieved superior osseointegration and opposing-cartilage protection versus CoCr and microfracture at 24 weeks in a porcine focal cartilage lesion model.

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

Key Takeaway: A 106-expert multidisciplinary consensus across ESSKA/EKA, EHS, and APAS produced 63 statements on fast-track TKA/THA perioperative care, with 56 achieving strong agreement (mean scores 7.7–8.9 on a 1–9 Likert scale) and 39 graded A or B evidence.

Key Takeaway: The dMCL is the primary restraint to external tibial rotation at low flexion angles and is the key driver of anteromedial rotatory instability (AMRI), a diagnosis requiring combined valgus stress at 20°, anteromedial drawer at 20°, and anterior tibial translation at 90° with tibia in neutral and external rotation.

Key Takeaway: Among 47 consensus statements on rTSA, revision, and rehabilitation for rotator cuff tears, 33 achieved strong consensus (90–99% agreement) and 3 failed to reach any consensus level across 97 international shoulder surgeons.