Weekly Digest

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% had radiographic tether breakage and 21.6% required unplanned return to the OR.

Key Takeaway: Combined iPACK + ACB reduced 48-hour opioid consumption by 3.2 mg MME versus two-level lumbar-sacral ESPB (9.7 vs 12.9 mg MME; p=0.035) in elderly TKA patients.

Key Takeaway: Among 157 children with distal radius buckle fractures, formal activity restrictions produced significantly worse QuickDASH scores (20.3 vs. 9.1) and greater parental anxiety without any difference in healing or complication rates compared to self-limited activity.

Key Takeaway: 72.4% of TKA patients achieved MCID on KOOS JR by 12 months, but 9.9% were delayed achievers (by 24 months) and 11.0% failed to maintain early MCID gains.

Key Takeaway: Children with Sprengel's deformity demonstrate mean shoulder abduction of 113° and forward elevation of 120°—significantly below normal—with PODCI Upper Extremity, Sports, and Global Function scores all reduced versus norms, regardless of bilateral or syndromic presentation.

Key Takeaway: Serial MRI at 3 and 8 months post-IFN showed peroneal tendon thickness equivalent to healthy controls (brevis 2.9 vs 2.8 mm, longus 3.4 vs 3.4 mm; TOST p<0.001) with zero MRI-detectable pathology across 102 patients.

Key Takeaway: In geriatric patients undergoing THA or TKA, median Geriatric Depression Scale scores declined from 8.5 to 4 at 3 months in those with elevated baseline symptoms (GDS 6–15), with most improvement occurring in the early postoperative period.

Key Takeaway: Pooled pelvic insufficiency fracture incidence after pelvic radiotherapy is 17% (95% CI: 15–20%) across 11,272 female patients, with sacral/SI joint involvement in 71% of cases and definitive RT carrying a 25% fracture rate versus 6% with adjuvant RT.

Key Takeaway: MRI-measured median nerve CSA at the carpal tunnel inlet (cutoff 11.3 mm²) achieves only poor-to-fair diagnostic accuracy for CTS (AUC 0.67, sensitivity 74%, specificity 60%), limiting its utility as a standalone diagnostic tool.

Key Takeaway: LLM-based extraction of THA operative note data outperformed rules-based NLP for bearing surface identification by 15 percentage points (89% vs. 74%) and correctly inferred bearing surface in 80% of ambiguous notes.

Key Takeaway: Late sarcoma specialist consultation (>2 months) after unplanned excision independently increased the odds of 5-year metastasis 7.1-fold (OR=7.11) and mortality 11.3-fold (OR=11.29) compared to consultation within 2 months.

Key Takeaway: Adding lower trapezius transfer to LHBT-based superior capsular reconstruction improves postoperative external rotation by 14.7° (35.3° vs 20.6°, p<0.001) and reduces infraspinatus retear rate from 27.8% to 5.6% (OR=0.11) in massive posterosuperior irreparable rotator cuff tears with Goutallier ≥3 fatty infiltration.

Key Takeaway: In 369 healthy scapulae, 6–13% exceeded published pathological morphological thresholds for posterior instability, anterior instability, and glenohumeral OA, with younger subjects (<60 years) paradoxically displaying more pathology-resembling geometry than older subjects.

Key Takeaway: Dual mobility THA reduced 5-year dislocation incidence from 4.8% to 0.5% compared to conventional THA in femoral neck fracture patients without increasing overall revision rates.

Key Takeaway: CMS-proposed SCB thresholds of 22 points (HOOS JR) and 20 points (KOOS JR) are externally validated, with Youden-optimal thresholds of 24–26 points for THA and 21–24 points for TKA across satisfaction anchors, and 20% of patients failed to meet CMS benchmarks.

Key Takeaway: Spinal opioid and epidural analgesia reduce total opioid consumption by more than 50% compared to PCA (1.7 and 1.9 vs. 4.1 OME/kg) after posterior spinal fusion for AIS, without improving pain scores, complication rates, or length of stay.

Key Takeaway: All three patella-related complications (including two reoperations) in 932 RA-TKA cases occurred exclusively in the valgus-internal rotation femoral component cohort (Val-IR, 15% of cases), despite no significant difference in KOOS JR or PROMIS scores at one year across alignment groups.

Key Takeaway: A six-variable nomogram predicts recurrent LDH after PELD with AUC 0.755 (training) and 0.831 (external validation), identifying Modic type II changes (OR 5.755) as the strongest independent predictor.

Key Takeaway: Early dislocation within 90 days of primary THA carries a 29.0% rate of recurrent dislocation or aseptic revision by 2 years versus 1.3% in controls, with HR 22.6 for all-cause revision.

Key Takeaway: TSA incidence grew 248% from 2015–2025 (13.1 to 45.6 per 100,000) and is projected to increase by 73–397% by 2040, representing the highest proportional annual growth rate (12.4%/year by Poisson modeling) of any major arthroplasty.

Key Takeaway: Iliopsoas tunnel deepening achieved 78.8% resolution of painful internal snapping at minimum 2-year follow-up, equivalent to the 81.8% resolution seen with fractional lengthening (P=.76).

Key Takeaway: Ischiopubic synchondrosis fusion before age 5 years is associated with an 82.9% rate of residual acetabular dysplasia after closed reduction for DDH, versus 63.2% in those fusing at age 5 or older.

Key Takeaway: Excessive femoral anteversion (>25°) is associated with significantly worse 2-year PROMs after hip arthroscopy for FAIS, including iHOT12 scores of 79.1 vs 95.1, and a 75% vs 29.4% prevalence of anteroinferior labral tears.

Key Takeaway: High-risk TJA patients (Elixhauser Index ≥95th percentile) are concentrated at teaching hospitals at a significantly higher rate than non-teaching hospitals (7.39% vs. 6.16%, p<0.001), with teaching hospital comorbidity burden increasing while non-teaching hospitals decreased by 0.2 EI points from 2016–2023.

Key Takeaway: Fassier-Duval telescopic rodding carries a 36.7% revision rate at median 64-month follow-up, with age ≤30 months at surgery (HR 0.986 per additional month, p<0.001) and OI type IV (p=0.034) as independent predictors of earlier revision.

Key Takeaway: PJI patients presenting with concomitant sepsis had 81.4% all-cause mortality during follow-up versus 50.6% in non-septic PJI patients, with hip sepsis patients reaching only 42% one-year survival.

Key Takeaway: Surgical reconstruction of cleft foot in 101 feet reduced forefoot splay angle from 36.14° to 21.39° (P<0.001) with an 8% revision rate over mean 3.7-year follow-up.

Key Takeaway: Osteoporotic UKA patients had significantly lower KSS functional scores and FJS than normal-BMD patients at mean 32-month follow-up, and within the osteoporotic cohort, mobile-bearing prostheses outperformed fixed-bearing on KSS functional score (P=0.007) and FJS (P=0.026).

Key Takeaway: DTI metrics in the distal tibial physis correlate strongly with physeal bar size, with ADC showing the strongest inverse correlation (ρ=-0.77) and radial diffusivity the strongest overall (ρ=-0.80), suggesting DTI can quantify residual physeal integrity beyond conventional MRI.

Key Takeaway: Gravity varus stress CT reduced the false-negative rate for detecting instability in isolated coronoid fractures from 82% (static CT) to 11% (p<0.001).

Key Takeaway: Patients with the highest preoperative anxiety/depression scores achieved MCID on iHOT-12 at significantly lower rates than those without (47% vs 63%, P=.031) after hip arthroscopy for FAI syndrome.

Key Takeaway: The Talar Index identifies residual clubfoot equinus with 95.9% sensitivity and 90.5% specificity (AUC 0.929) against the lateral tibiocalcaneal angle as reference standard.

Key Takeaway: PsA patients undergoing THA carry a 4.7-fold increased odds of 90-day sepsis and 2.9-fold increased odds of deep SSI compared to controls, while PsC patients show a 2.3-fold increased superficial SSI risk and 2.8-fold sepsis risk.

Key Takeaway: In propensity-matched elderly patients with acetabular fractures, ORIF carries a 69% higher relative risk of revision arthroplasty at 2 years compared to acute THA (10.4% vs 6.1%), but acute THA has significantly higher early infection (7.1% vs 4.5%) and dislocation (5.7% vs 4.3%) rates.

Key Takeaway: In 161,326 patients with concomitant lumbar fusion and THA, operative order (SAHA vs. HASA) produced no significant difference in hip dislocation, mechanical loosening, periprosthetic fracture, DVT, infection, or revision rates (3.6% vs. 2.6%, P=0.5).

Key Takeaway: CMT cavovarus demonstrates forefoot adduction 3× greater than controls and a significantly lower transverse arch plantar angle (94.2°) versus idiopathic cavus (100.5°) and controls (102.7°), confirming quantifiable multiplanar morphologic distinctions on WBCT.

Key Takeaway: Patient-specific CT-derived finite element models predict TLIF cage subsidence with AUC=0.809 (average trabecular intermediate strain), outperforming cage length (AUC=0.797), cage width (AUC=0.750), and cage height (AUC=0.698).

Key Takeaway: AOPT for large cystic OLTs yields equivalent FAOS improvement (~35 points) and MOCART 2.0 scores (~73) regardless of lesion laterality at mean 84.6 months follow-up.

Key Takeaway: Outpatient single-level ALIF/LLIF demonstrated higher 5-year revision-free survival (log-rank P=0.007) and 40% lower median 90-day global reimbursements ($5,169 vs. $6,779) compared to matched inpatient controls.

Key Takeaway: CFL injury on preoperative MRI independently predicts recurrent instability after arthroscopic ATFL repair with an OR of 9.00 (95% CI 1.95–56.22), with thin-type CFL morphology carrying a 31.5% recurrence rate.

Key Takeaway: Primary displacement ≥3 mm carries a 6.7-fold increased odds of complications in pediatric proximal radius fractures, with surgical treatment itself associated with 5.0-fold greater odds of unfavorable functional outcome.

Key Takeaway: Soft bandage management of pediatric distal radius torus fractures reduced total societal cost by 33–47% compared to short and long arm splints ($23.46 vs $34.82 vs $44.06), with a projected $7,773 combined saving over the study period.

Key Takeaway: WNT7B is the most strongly upregulated gene in fracture and PTOA synovium, with WNT pathway activation significantly broader in PTOA than in nontraumatic OA, supporting a molecularly distinct PTOA subtype.

Key Takeaway: Stem subsidence (≥5 mm) occurred in 13.2% of RSA press-fit short stems, with metaphyseal filling ratio <70% (OR 0.90) and osteoporosis (OR 3.2) as independent predictors.

Key Takeaway: Despite statistically significant reductions in preoperative EQ-5D-5L scores during COVID-19, the adjusted mean difference was ≤0.03 points—not clinically meaningful—while THA and TKA patient satisfaction paradoxically increased by approximately 5 percentage points during the pandemic.

Key Takeaway: EOS and lateral pelvic radiographs agreed on only 9 of 24 total high-risk patients identified (37.5% overlap), with a mean sit-to-stand sacral slope discrepancy of 7.2° between modalities.

Key Takeaway: The overall incidence rate of pediatric extremity fractures in Denmark was 3,164 per 100,000 persons/year over 20 years, with forearm fractures most common and upper/lower leg fractures the only anatomical sites showing a declining trend.

Key Takeaway: MIS and open talonavicular arthrodesis produced equivalent AOFAS gains (36.2 vs. 30.9 points) at mean 361-day follow-up with no significant difference in operative time (59.2 vs. 69.6 min).

Key Takeaway: Custom uncemented distal humeral megaprosthesis with locked flange achieved functional improvement and an 18% reoperation rate at mean 32 months in 11 revision TEA patients with severe bone loss.

Key Takeaway: Bipolar patellofemoral OCA transplantation had a 25% structural graft failure rate versus 0% for unipolar, but cumulative lesion area—not bipolarity per se—was the independent predictor of failure (OR 1.005 per mm²).

Key Takeaway: Cementing a polyethylene liner into Harris-Galante II shells yielded 77% survivorship free from acetabular cup revision at 15 years with a 39% overall complication rate.

Key Takeaway: Quadriceps tendon autograft ACLR demonstrates graft failure rates of 0–24% and anterior knee pain rates of 0–5% at 5–23 year follow-up across 662 reconstructions.

Key Takeaway: Hip arthroscopy in acetabular dysplasia yields durable PRO improvements at mean 9.6–12 years follow-up, with THA conversion rates of 2.6–23.7% and revision rates of 2.6–15.2%, comparable to nondysplastic cohorts across all 4 comparative studies.

Key Takeaway: Arthroscopic posterior labral repair in active-duty military patients yields 92.3% return to full military duty and 87.2% return to sport at mean 11.7 years, with ASES improving from 46.7 to 87.8.

Key Takeaway: MRI-based synthetic CT techniques (ZTE, UTE, 3D-GRE, and deep learning-based sCT) demonstrate high agreement with conventional CT across multiple anatomical sites, with deep learning models showing the strongest improvement trajectory despite limited training datasets.

Key Takeaway: Open supracondylar humerus fractures represent 1.1% of all pediatric SCH fractures and carry a 20.6% nerve injury rate and 26.5% reoperation rate.

Key Takeaway: PJI after TAA occurred at 1.3% (12/955 patients, 5.4 per 1000 person-years), with only 50% overall implant retention and 2 of 5 chronic PJI patients ultimately requiring below-knee amputation.

Key Takeaway: Among 24 cohort studies, standing AP radiographs with block/lift correction tests were the most reliable discriminators of limb-origin versus spine-origin pelvic obliquity, though mixed-etiology cases remain diagnostically unresolved.

Key Takeaway: Anterior harvest deltoid osteomuscular transfer (DOT) from the distal clavicle significantly suppressed humeral head superior translation versus massive irreparable rotator cuff tear (MRCT) alone at 0° and 30° of glenohumeral elevation across all applied force conditions (0–30 N).

Key Takeaway: Robotic-assisted rTSA requires an absolute risk reduction in early revision of 6.55% (1 revision prevented per 15 cases) to break even, which exceeds the observed baseline early revision rate of 2.1%, making routine economic justification impossible under current conditions.

Key Takeaway: Both tibia-based suture anchor and capsular-based side-to-side repair of type 3 lateral meniscal oblique radial tears restored lateral compartment contact mechanics, meniscal extrusion, and anterior root forces to intact-state values, while debridement failed to do so across all four flexion angles tested.

Key Takeaway: A biomimetic hematoma scaffold delivering 42 µg rhBMP-2 achieved superior predicted torsional strength (highest pMOI, p<0.0001) in a 2.5 cm goat tibial defect compared to ACS delivering 50-fold higher dose (2.1 mg rhBMP-2).

Key Takeaway: All three LET fixation methods (suture anchor, interference screw, metallic staple) restored rotational stability to near-native levels after 2000 cycles of 5 N·m internal rotation, though suture anchors showed significantly greater change in internal rotation from pre- to post-cyclic loading versus screw fixation (7.2% ± 2.3% vs -1.3% ± 2.6%, P = .011).

Key Takeaway: In a rat ACLT model, detectable macroscopic joint changes and peak M1 macrophage infiltration occur by day 7, with osteoclast activity elevated from day 3, establishing a PTOA intervention window within 1 week of injury.

Key Takeaway: Inferior leaflet resection of medial meniscus HCTs significantly decreases contact area and percent meniscal loading (8%–60% of gait) and increases peak contact stress during midstance (19%–30% of gait), while HCT repair restores mechanics equivalent to the intact meniscus.

Key Takeaway: Lateral UKA via medial parapatellar approach achieved 97.2% 7-year survivorship with 99.0% of patients meeting KSS-Knee PASS thresholds at mean 47.6 months in 108 patients.

Key Takeaway: Modified Broström using absorbable sutures alone achieved mean AOFAS improvement of 21.4 points (66.84→88.20) with 6.3% recurrence and 1.2% reoperation rate at mean follow-up not specified.

Key Takeaway: Basicervical hip fractures (AO/OTA 31B3) show comparable long-term outcomes to intertrochanteric and valgus femoral neck fractures but carry significantly higher rates of minor in-hospital complications even after multivariate adjustment, with no significant difference in outcomes across fixation constructs within the basicervical cohort.

Key Takeaway: Preoperative anxiety (APAIS >11) in ACL reconstruction patients was associated with a 2.5-fold increase in level 2 analgesic use and a 7-fold increase in locoregional anesthesia requirement in the recovery room, but did not predict flexion contracture at 3 weeks.

Key Takeaway: A rat femur fracture model inoculated with biofilm-derived S. aureus (10⁴–10⁵ CFU/mL) and stabilized with stainless-steel hardware produced >10⁶ CFU/mL on both bone and implant at 3 weeks despite surgical debridement and cefazolin, with no significant difference in bacterial burden between compartments.

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

Key Takeaway: Protective plating with screw overlap (short or long) beyond the innermost nail interlocking screws significantly reduces interimplant femoral strains versus no-overlap or no-plate configurations under 200 N axial load in osteoporotic synthetic bone.

Key Takeaway: The Next-AR intraoperative navigation platform achieved implant alignment within a mean bias ≤1.5° of target across all six alignment parameters in cadaveric medially-stabilized TKA, with RMSE ≤2.3°.

Key Takeaway: Hyperselective neurectomy and tendon lengthening each address upper limb spasticity tone management through distinct mechanisms, but no high-level evidence currently establishes superiority of one over the other in functional or non-functional hands.