Weekly Digest

Key Takeaway: Deltoid ligament repair in Weber C (OTA 44C) fractures produced superior talar tilt at 3 months (gravity stress: 0.6° vs 3.4°; p=0.001) but this difference resolved by 12 months with equivalent MCS and FAAM scores between groups.

Key Takeaway: FAI surgery (arthroscopy or surgical dislocation) achieved 90.6% THA-free survivorship at mean 10.4 years, with femoral head chondromalacia, obesity (BMI ≥30), older age, and male sex as independent predictors of conversion.

Key Takeaway: In 574 TKA patients ≥60 years, preoperative MMSE ≤25 (OR 0.771) and elevated PHQ-15 somatic symptom score (OR 1.187) were independent predictors of postoperative delirium, which occurred in 4.2% of the cohort.

Key Takeaway: Bioactive glass-ceramic cages produced equivalent NDI improvement (between-group difference -0.98 points, 95% CI -9.17 to 7.21) and C2-7 lordosis change (-0.19°) compared to allograft at mean 53.5 months after single- or two-level ACDF.

Key Takeaway: In nondisplaced scaphoid fractures, surgical treatment yields fewer nonunions overall, but for proximal pole fractures specifically, nonunion rates are similarly high regardless of treatment modality across 29 included studies.

Key Takeaway: Dual mobility constructs used for revision THA due to ARMD carry a 25% subsequent dislocation rate, compared to 3.1% in primary THA and 5.7–6.5% in other revision indications.

Key Takeaway: Pyrocarbon hemiarthroplasty achieved a Composite Clinical Success rate of 82.7% at mean 24.4 months, significantly outperforming a propensity-matched cobalt-chromium HA cohort at 66.8% (p<0.001).

Key Takeaway: Conversion megaprosthesis after failed osteoarticular allograft achieves 15-year revision-free survivorship of 37% versus 49% for primary megaprosthesis (p=0.61), with non-inferior MSTS-93 scores (23 vs. 25) and extensor lag outcomes.

Key Takeaway: THA in patients ≤30 years (n=4,416; 0.4% of 1,017,320 primary THAs) carries a reintervention rate of 8.4% versus 6.3% in the general THA population over a mean 5.8-year follow-up, with aseptic loosening accounting for 4.9% of reinterventions.

Key Takeaway: Despite a 6.5-percentage-point rise in fusion utilization for lumbar facet cysts from 2010 to 2022, 5-year reoperation-free survival was statistically equivalent between decompression alone (91.5%) and decompression plus fusion (90.6%).

Key Takeaway: Hemiarthroplasty performed by non-arthroplasty-trained surgeons carries significantly higher rates of periprosthetic fracture at 90 days, 1 year, and 2 years, and higher aseptic revision rates at 1 and 2 years compared to arthroplasty-fellowship-trained surgeons in a propensity-score-matched cohort of 21,612 patients.

Key Takeaway: Primary lumbar fusion volume stabilized (CAGR -0.77%) from 2016–2022, but aggregate costs rose (CAGR +1.41%), driven by a shift toward anterolateral interbody fusion (CAGR +5.78%) and $8.2 billion in revision costs representing a 15.1% revision burden.

Key Takeaway: Revision TKA for aseptic failure after two-stage exchange for PJI carries a 43% reoperation rate and 20% reinfection rate at 5 years, with 9% ultimately requiring amputation.

Key Takeaway: In 2845 patients undergoing both primary and revision ACLR, cartilage lesion prevalence, size, and severity increased across all compartments over a median 2.4-year interval, with each additional month from initial injury to revision surgery associated with a 0.7% increase in odds of cartilage damage.

Key Takeaway: A straight cementless femoral stem achieved 91.6% survival free of aseptic loosening and 79.2% all-cause survival at 33-year mean follow-up in 348 primary THAs.

Key Takeaway: Each 1° increase in radiographic posterior tibial slope raises the odds of MAT failure by 65.4% (OR 1.654) and reoperation by 12.6% (OR 1.126).

Key Takeaway: Non-articulating spacers carry an 8.9-fold higher odds of true patella baja versus articulating spacers during two-stage revision for chronic knee PJI, with patella baja associated with 23° less knee flexion at final follow-up.

Key Takeaway: Adding a genicular nerve block to ACB/IPACK for primary TKA produced no clinically meaningful improvement in pain scores, opioid consumption, time to PT clearance, or 90-day opioid refill rates in a propensity score-matched cohort of 7,810 patients.

Key Takeaway: Biologic DMARD use—particularly IL-6 inhibitors (7.9% PJI) and anti-TNF agents (3.7%)—was associated with significantly higher PJI rates after primary THA compared to conventional DMARD users (2.1%) and non-DMARD controls (2.6%).

Key Takeaway: T1DM confers a 5.81-fold increased odds of any 90-day adverse event and a 9.4% vs 6.4% 5-year THA conversion rate following hip arthroscopy for FAI syndrome.

Key Takeaway: In 4,698 TKAs, preoperative HKA strongly predicted postoperative GP and GT ankle alignment angles (P<0.001), and residual ankle alignment differences persisted even when neutral postoperative HKA was achieved.

Key Takeaway: Growth-stimulating minimal acetabuloplasty combined with open reduction achieved Severin 1 or 2 outcomes in 98.2% of 167 hips at up to 16 years follow-up, with only 3.6% requiring subsequent pelvic osteotomy for residual dysplasia.

Key Takeaway: DDA grade 4 cases had significantly longer operative times than grade 1 cases (P=0.011), with the classification effect most pronounced during the learning curve phase.

Key Takeaway: Combined SCR + lower trapezius transfer reduced graft tear rates to 13.3% versus 47.6% for isolated SCR in irreparable massive rotator cuff tears with Goutallier grade 3-4 infraspinatus infiltration.

Key Takeaway: Total femoral offset >48 mm is associated with an 83% increased risk of revision for aseptic femoral loosening (HR 1.83) and 20% increased all-cause revision risk in cementless THA, with collared stems reducing revision risk by 50%.

Key Takeaway: TEAM participant and non-participant hospitals had statistically equivalent 30-day complication rates (inpatient composite 28.2%, outpatient 10.4%), with ~94% of outcome variance attributable to patient-level rather than institutional factors.

Key Takeaway: 79.1% of patients receiving a triple-tapered collared cementless stem in primary THA demonstrated calcar resorption, with mean calcar width decreasing from 5.9 mm to 3.3 mm at mean 2.3-year follow-up.

Key Takeaway: Among 217 children admitted for overnight observation with isolated tibial diaphyseal fractures, PACS developed in only 2.8%, with older age (14.0 vs. 10.1 years) and lower sagittal angulation (2.2 vs. 6.3 degrees) as significant risk factors.

Key Takeaway: Customized individually made TKA implants produced equivalent MCID-based PROM improvement and complication rates compared to off-the-shelf implants across all four outcome measures at two years in a propensity-matched cohort of 1,032 patients.

Key Takeaway: A symptom duration cutoff of 3.0 weeks (AUC 0.775) predicts progressive-stage lumbar spondylolysis at diagnosis in adolescents, with progressive-stage lesions presenting at a median 5.7 weeks versus 1.1 weeks for very early stage.

Key Takeaway: Preoperative varus ≥10° did not reduce 10-year Hintegra survivorship free from metal revision (94.2% vs 93.7%, p=0.88), but varus ankles developed asymmetric polyethylene wear at 2.5× the rate of neutral ankles (42% vs 17%, p<0.001).

Key Takeaway: A dynamic slip ≥3 mm comparing upright and supine positions (DSUS-positive, 17.6% of cohort) independently predicted reoperation after lumbar decompression, with ROC AUC of 0.90 for the 3.0 mm threshold.

Key Takeaway: Patient-individual TKA with customized trochlear design achieved superior 12-month Kujala scores (79.5 vs. 59.7, p=0.001) and FJS (52.5 vs. 36.0) compared to robotic-assisted off-the-shelf TKA in valgus knees with LDFA <85°.

Key Takeaway: Preoperative ESI within 90 days of CDR is associated with a 3.5-fold higher 2-year revision rate (7.8% vs. 2.4%) and 5.3-fold higher 90-day readmission rate compared to matched controls.

Key Takeaway: In young females aged 14–25, HT and BPTB autografts yield equivalent 5-year revision rates (7.0% vs. 7.5%; HR 1.05, 95% CI 0.75–1.49), with HT showing a small but persistent Sport & Recreation KOOS advantage that lacks clear clinical significance.

Key Takeaway: In 202 ASD patients, cranial lordotic apex shift (occurring in 71% of apex-change cases) was associated with 6.3° less L4-S1 lordosis and greater 2-year back pain, while a preoperative inflection point outside T12/L1 increased spinopelvic complication risk by OR 2.04 (inverse of OR=0.49).

Key Takeaway: A novel MRI index combining tibial slope and lateral meniscal posterior horn displacement (TMSI >0.6) predicted residual pivot-shift instability after ACLR with AUC 0.80, sensitivity 86%, and specificity 82%.

Key Takeaway: Navigation (NAV) dominates freehand (FH) at a $50,000 willingness-to-pay threshold (ICUR: -$108,831/QALY) and saves payers an estimated $45 million over seven years for idiopathic scoliosis posterior fusion.

Key Takeaway: Joint effusion (OR=8.97) and bucket-handle meniscal tears (OR=5.24) are the strongest preoperative predictors of AMI before ACLR, while lateral femorotibial cartilage lesions (OR=8.63), female sex (OR=2.98), and preoperative AMI (OR=3.56) independently predict postoperative AMI at 90 days.

Key Takeaway: In neuromuscular scoliosis, curves ≥80° require 4× more adjunctive surgical techniques and 80 minutes more OR time yet leave residual curves twice as large (44.7° vs 22.6°) compared to curves <80°.

Key Takeaway: Posterolateral tibial plateau fractures were present in 66% of primary ACL reconstructions and were significantly associated with Kaplan fiber, anterolateral complex, and both meniscal injuries (all p<0.01), but did not increase quantitative pivot-shift anterior tibial lateral translation.

Key Takeaway: DBM fiber allograft augmentation in fourth-generation percutaneous hallux valgus correction improved radiographic union scores at 3 and 6 months (P=.005–.027) but produced no clinically meaningful difference in PROMs at a cost of $1,780 per procedure.

Key Takeaway: TOPIC grafting for medial OLT maintained significant pain reduction at 5 years, with VAS pain scores improving from 6.8 to 2.1 (mean improvement 4.7 points) and 80% of patients reporting satisfaction.

Key Takeaway: Single-stage press-fit femoral osseointegrated limb replacement achieved 93.0% implant survival at 5 years but carried a 40.3% revision surgery rate, with significant functional improvements in 2MWT, 6MWT, and PROMIS scores.

Key Takeaway: ORIF for Vancouver B2 periprosthetic femoral fractures achieved comparable HHS (73.56 vs 75.27) and radiographic success (91.3% vs 92%) to stem revision with significantly lower complication rates (21.7% vs 36%) at mean 63-month follow-up.

Key Takeaway: Non-optimal postoperative HKA alignment after MOWHTO does not worsen patient-reported outcomes in retained knees but causes significantly earlier conversion to TKA (log-rank χ²=29.11, p<0.001) at mean 11.5-year follow-up.

Key Takeaway: Robotic-assisted UKA and TKA demonstrated equivalent 5-year revision-free survivorship (97.6% vs. 96.2%, p=0.866) with similar 90-day ED visit and readmission rates in a single-center cohort with minimum 5-year follow-up.

Key Takeaway: Deltoid ligament release during TAA for varus deformity achieves an additional 4.95° of coronal correction versus TAA alone, with equivalent postoperative alignment (2.07° vs 2.84°) maintained through two-year follow-up.

Key Takeaway: At median 8-year follow-up after PAO, 22% of hips converted to THA, with age ≥30 years (HR 4.0) and smoking (HR 7.8) as independent predictors of conversion in multivariable analysis.

Key Takeaway: Robotic-assisted TKA reduced coronal outliers (>3° from target) from 21.3% to 6.7% and rotational outliers from 24.0% to 8.7% compared with conventional technique, without changing mean HKA alignment.

Key Takeaway: CT-based navigation achieved 100% cup placement within Lewinnek's safe zone versus 49% with manual technique, yet 10-year implant survival was equivalent (98.2% vs. 100%) and HHS improvement did not exceed the MCID.

Key Takeaway: In 223 elite rugby and soccer players undergoing ACL reconstruction with routine LET augmentation, graft rerupture rates were 2.4% (BPTB) and 5.2% (HT) with no statistically significant difference, and RTP exceeded 94% for both grafts at mean 5.6-year follow-up.

Key Takeaway: In 47 pediatric flexion-type supracondylar humerus fractures, translational deformity was the sole independent predictor of requiring open reduction (P=0.017), yet open reduction itself did not worsen functional outcomes (QuickDASH, P=0.173).

Key Takeaway: Cemented dual mobility liner within a highly porous tantalum shell achieved 0% dislocation rate and 95% overall implant survivorship at mean 48 months in 33 Paprosky 3A/3B and pelvic discontinuity reconstructions.

Key Takeaway: Among 37 patients with significant IONM alerts during spinal deformity surgery, 91.7% of those with initial neurological deficits achieved favorable outcomes at 24 months, with waveform recovery pattern predicting both deficit severity and recovery trajectory.

Key Takeaway: Dual-core dual-thread screws and cement augmentation through cannulated fenestrated screws provide superior biomechanical fixation compared to conventional constructs, with convergent trajectory and undertapping optimizing pullout strength in osteoporotic bone.

Key Takeaway: Early single-stage reconstruction is increasingly supported for selected MLKI patients, with contemporary evidence emphasizing that untreated posteromedial corner, posterolateral corner, and meniscal injuries directly compromise cruciate graft survival.

Key Takeaway: AS/DISH patients undergoing elective spinal fusion had 6× higher odds of 30-day readmission (OR 6.04, 95% CI 1.84–23.38) despite achieving superior or equivalent functional PROMs compared to matched controls.

Key Takeaway: A novel 6-DOF parallel robotic system with optical tracking was developed to address femoral fracture reduction, targeting the reported up-to-one-third malrotation rate after conventional repair.

Key Takeaway: Fresh osteochondral allograft transplantation of the femoral head yields a pooled THA conversion rate of 26.7% (95% CI 20.1–34.7%) at mean follow-up of 17–79 months across 145 hips.

Key Takeaway: A hybrid open fracture management course in Rwanda increased self-reported confidence from 3.83 to 4.69 out of 5 (p<0.001) among 160 learners, with 96.5% reporting anticipated practice change.

Key Takeaway: In mild DCM patients undergoing surgery, 60.9% had persistent upper extremity sensory impairment at 2 years, and angular-edged spinal cord deformity on axial MRI independently predicted this residual deficit (OR 4.264).

Key Takeaway: Each incremental extension of craniocervical junction fusion exponentially increases subaxial facet joint forces—up to 24,722% above baseline in occiput-C5 constructs—and annulus fibrosus stress up to 1,833% above baseline.

Key Takeaway: In a rat model, obesity combined with delayed rotator cuff repair produced ~6-fold increase in FABP4 and ~12-fold increase in perilipin 2 lipid infiltration markers versus early repair in healthy animals, with the worst structural, functional, and biomechanical outcomes of all four groups.

Key Takeaway: Preoperative CSI scores ≥40 and abnormal QST findings consistently predict worse postoperative pain, disability, and quality of life after spinal surgery, with CS prevalence of 10–20% in elective spine surgical populations.

Key Takeaway: A rat pull-out repair model for MMPRT demonstrates significantly lower meniscal extrusion ratio versus unrepaired controls at all time points, with tensile load-to-failure equivalent to the contralateral healthy limb by 4 weeks, but healing proceeds via fibrovascular indirect insertion rather than direct fibrocartilaginous regeneration at 12 weeks.

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

Key Takeaway: Summary unavailable from AI response.

Key Takeaway: Summary unavailable from AI response.

Key Takeaway: Summary unavailable from AI response.

Key Takeaway: Pretapping reduced insertion torque by 55% (1.30 vs 2.91 Nm, P=0.025) but did not alter maximum bending force to failure (103.9 vs 98.1 Nm, P=0.321) or pedicle fracture patterns, while pedicle fill was the only significant predictor of fixation strength (β=222.29 Nm, P=0.035).

Key Takeaway: Ultrasound-guided CTR (both standard and thread-based) achieves comparable decompression to open and endoscopic techniques with faster recovery, though cost and operator-dependence remain barriers to widespread adoption.

Key Takeaway: Naringin accelerates induced membrane technique bone defect repair in rats by directly binding JAK1 to promote M2 macrophage polarization via the JAK1/STAT6 pathway, with si-JAK1 knockdown reversing this osteogenic effect.

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

Key Takeaway: Minimally invasive techniques—including arthroscopic foveal TFCC repair, suture-button suspension, and distal oblique bundle reinforcement—are supplanting open reconstruction for DRUJ instability, with growing evidence supporting early mobilization in stable repairs.