EFORT Open Rev. 2025 Sep 4;10(9):679-685. doi: 10.1530/EOR-2024-0040.

ABSTRACT

The normal functioning of the shoulder is characterized by the harmonious coordination between the glenohumeral joint and the scapulothoracic complex, a phenomenon commonly referred to as scapulohumeral rhythm (SHR). Reverse total shoulder arthroplasty (rTSA) shoulders exhibit distinct kinematics compared to normal shoulders. Reduced scapulohumeral rhythm (SHR) in rTSA shoulders implies a greater reliance on scapulothoracic motion over glenohumeral motion for arm elevation. Dynamic analyses suggest heightened scapulothoracic movement after rTSA, implying alterations in rotational movements across various planes. Utilization of reliable tools to measure preoperative scapulothoracic motion and forecast postoperative SHR in rTSA may improve functional results. Posture types and scapulothoracic orientation play an important role in optimal implant configuration and positioning, as well as clinical outcome, and should therefore be considered during patient selection, preoperative planning, and implantation of an rTSA. Recognizing the static position and kinematic changes of the scapulothoracic joint is vital for postoperative rehabilitation and optimizing outcomes in rTSA patients.

PMID:40905937 | PMC:PMC12412366 | DOI:10.1530/EOR-2024-0040

EFORT Open Rev. 2025 Sep 4;10(9):686-694. doi: 10.1530/EOR-2024-0218.

ABSTRACT

The results of our survey conducted among the members of the European Society for Surgery of the Shoulder and the Elbow is presented in this article. The two most important features of frozen shoulder are movement restriction and pain. Frozen shoulder is considered secondary if it occurs after surgery or trauma. Corticosteroid injections are recommended as the first choice of pharmacological therapy. Patient education and physical therapy are the first choice of non-surgical therapy. The rate of remaining symptoms was observed in less than 20% of patients.

PMID:40905931 | PMC:PMC12412373 | DOI:10.1530/EOR-2024-0218

EFORT Open Rev. 2025 Sep 4;10(9):660-670. doi: 10.1530/EOR-2024-0139.

ABSTRACT

Rotator cuff tears are prevalent, affecting 20% of the general population, with massive tears accounting for 40% of these cases. Massive tears, those larger than 5 cm or involving several tendons, pose substantial clinical problems, including poorer surgical outcomes and increased recurrence rates. Multiple classification systems offer varied definitions, complicating treatment strategies. The irreparability of these tears, exacerbated by conditions such as tendon atrophy and advanced imaging abnormalities, can further complicate management. Surgical options include superior capsular reconstruction (SCR) and tendon transfers. SCR, which involves attaching a graft to the superior glenoid and greater tuberosity, has shown promise in individuals with intact subscapularis tendons and minimal arthritis. Graft alternatives include fascia lata (FL) autografts, human dermal allografts, and long head of the biceps tendon (LHBT) autografts. Each graft type has distinct advantages and disadvantages, with FL autografts providing greater results despite donor site morbidity. Tendon transfers, such as latissimus dorsi and lower trapezius transfers, offer alternative treatments, especially for younger, more active individuals. This review thoroughly reviews different therapeutic options, emphasizing the most recent evidence and clinical outcomes to help guide the best management of massive posterosuperior irreparable rotator cuff injuries.

PMID:40905927 | PMC:PMC12412289 | DOI:10.1530/EOR-2024-0139

EFORT Open Rev. 2025 Sep 4;10(9):718-725. doi: 10.1530/EOR-2024-0191.

ABSTRACT

PURPOSE: While the incidence of acetabular fractures keeps rising among our older patient population, age-specific rehabilitation guidelines are lacking. Post-surgery weight-bearing is often restricted for 8-12 weeks to avoid secondary fixation failure. However, non- or restricted weight-bearing commonly results in atrophy, and older patients are at additional risk of long-term mobility and functionality loss. Therefore, if the risk of secondary fracture failure proves to be lower than currently believed, early or permissive weight-bearing might actually be the preferred treatment choice to advance fracture healing and decrease recovery time. This study aims to review the current literature on early weight-bearing outcomes of acetabular fractures in older adults.

METHODS: A systematic search of two databases was conducted following PRISMA guidelines. Eligible studies reported on early weight-bearing outcomes of older patients after surgical management. Data were showed in tables alongside a narrative synthesis. Critical appraisal and risk-of-bias tools assessed the study quality.

RESULTS: Six studies were included with a retrospective or observational design, with a total of 147 patients averaging 64 years old. The majority of studies discussed early weight-bearing protocols after percutaneous fixation (PF), with heterogeneity in terminology across protocols.

CONCLUSIONS: Albeit limited and low in evidence, the included studies suggest that early weight-bearing might be a possible alternative for non- or minimally displaced fractures and displaced fractures after PF and open reduction internal fixation, respectively. When risk assessments and functional outcomes are appropriately investigated, early weight-bearing may help patients, especially older adults, avoid suffering and prolonged rehabilitation periods.

PMID:40905923 | PMC:PMC12412364 | DOI:10.1530/EOR-2024-0191

EFORT Open Rev. 2025 Sep 4;10(9):709-717. doi: 10.1530/EOR-2024-0164.

ABSTRACT

PURPOSE: This study investigates the 1-year mortality of fragility fractures of the pelvis (FFP) in patients categorized under this system and treated with surgery or conservative methods, aiming to assess the algorithm's effectiveness.

METHODS: We systematically searched PubMed, Embase, Scopus, and Web of Science for English studies on the 1-year mortality of FFP, with no publication date restrictions. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled 1-year mortality rates were calculated using random-effects models. In addition, if applicable, odds ratios with 95% confidence intervals were employed. PRISMA guidelines were followed for reporting, and the study was registered with PROSPERO.

RESULTS: Analysis of 22 studies encompassing 3,265 patients with FFP revealed a concerning overall 1-year mortality rate of 15.5%. Mortality varied by fracture type, with FFP IV having the lowest rate (7.5%) and FFP III having the highest (17.0%). All studies concurred on conservative treatment for FFP I. For other fracture types, mortality rates differed between conservative and surgical approaches. Conservative treatment resulted in rates of 14.9, 21.8, and 5.1% for FFP II, III, and IV, respectively. Conversely, surgical treatment yielded mortality rates of 16.8, 19.5, and 24.2% for FFP II, III, and IV, respectively.

CONCLUSION: Fragility fractures of the pelvis have high mortality, especially in FFP III. Conservative treatment may be suitable for FFP I, while surgery might be better for FFP III. The rarity of FFP IV fractures limits conclusions, and FFP II fractures lack a clear treatment consensus. Further research is needed to optimize management for these fracture types.

PMID:40905922 | PMC:PMC12412362 | DOI:10.1530/EOR-2024-0164

EFORT Open Rev. 2025 Sep 4;10(9):695-708. doi: 10.1530/EOR-2024-0216.

ABSTRACT

PURPOSE: This systematic review and meta-analysis assesses the comparative effectiveness of home-based and supervised rehabilitation protocols following anterior cruciate ligament reconstruction, with a focus on functional recovery and muscle strength.

METHODS: Registered in PROSPERO (CRD42024585478) and following PRISMA guidelines, we searched Web of Science, PubMed, Ovid MEDLINE, and Cochrane. For the quality assessment, the Cochrane Collaboration risk of bias (RoB) tool was used. Review Manager v5.4 was used for the analysis.

RESULTS: Twelve studies were included qualitatively, and seven quantitatively. Outcomes included subjective knee scores (Lysholm, Tegner, IKDC) and quadriceps/hamstring strength measures. Our findings indicated a 19% improvement in subjective knee scores for home-based protocols in some studies. However, for hamstring strength measures, the supervised protocol was superior (SMD = -0.48, P = 0.02).

CONCLUSION: Overall, home-based rehabilitation outcomes were comparable to supervised programs in functional recovery. However, supervised approaches slightly enhanced muscle strength. Supervised rehabilitation is recommended to optimize strength, especially for athletes, though further research is needed to assess its impact on return to sport.

PMID:40905919 | PMC:PMC12412367 | DOI:10.1530/EOR-2024-0216

EFORT Open Rev. 2025 Sep 4;10(9):671-678. doi: 10.1530/EOR-2024-0067.

ABSTRACT

PURPOSE: To conduct a meta-analysis of clinical studies evaluating the efficacy and safety of arthroscopic and open surgery for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocation using a suture button.

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted the literature searches based on preferred reporting items from systematic reviews and meta-analyses. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies comparing arthroscopic and open surgery for the treatment of acute high-grade ACJ dislocation using a suture button. Constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, operation time, and occurrence of complications were analyzed.

RESULTS: Five studies comprising a total of 198 patients were included in this study. The findings revealed that, in comparison to open fixation, arthroscopic fixation resulted in longer surgical durations. However, there were no significant differences between the two techniques in terms of constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, or the occurrence of complications.

CONCLUSIONS: Based on current evidence, arthroscopic fixation demonstrates comparable postoperative outcomes to open fixation, albeit with longer surgical durations. With ongoing technological advancements and refinement of surgical techniques, the efficiency and accessibility of arthroscopy are expected to improve, potentially solidifying its role as a superior choice in the future.

PMID:40905916 | PMC:PMC12412284 | DOI:10.1530/EOR-2024-0067

EFORT Open Rev. 2025 Sep 4;10(9):646-659. doi: 10.1530/EOR-2025-0071.

ABSTRACT

PURPOSE: This study aimed to comprehensively review the current research status and trends of joint replacement for arthritis patients worldwide.

METHODS: Literature related to joint replacement for arthritis patients from 2004 to 2024 was extracted from the Web of Science Core Collection (WoSCC) database. A systematic qualitative and quantitative analysis of these publications was conducted. Visualization of results was achieved using CiteSpace and VOSviewer software.

RESULTS: In total, 14,349 publications met the inclusion and exclusion criteria and were selected for further research. Keyword analysis revealed a clinical emphasis on optimizing surgical outcomes through advancements in total knee arthroplasty, total hip arthroplasty, and patient-centered metrics. Emerging research hotspots since 2020 included precision techniques such as robotic-assisted surgery, strategies to address periprosthetic joint infection, and the role of psychological factors such as depression and patient satisfaction. Temporal trends highlighted evolving priorities, including personalized alignment protocols, where the burst intensities of kinematic alignment and mechanical alignment were 16.33 and 13.79, respectively, as well as functional recovery and complication prevention. Historical dominance of rheumatoid arthritis research has transitioned to broader exploration of osteoarthritis management and technological innovations in surgical precision.

CONCLUSION: This study revealed a marked transition from rheumatoid arthritis-focused studies to innovations in osteoarthritis management and precision surgical techniques. Clinically, these findings emphasize the need to integrate technological advancements with multidisciplinary frameworks to standardize infection control, optimize implant durability, and enhance rehabilitation outcomes. Future efforts should prioritize personalized alignment strategies, evidence-based infection control protocols, and multidisciplinary rehabilitation frameworks to improve long-term functional outcomes.

PMID:40905904 | PMC:PMC12412288 | DOI:10.1530/EOR-2025-0071

EFORT Open Rev. 2025 Aug 4;10(8):589-599. doi: 10.1530/EOR-2024-0105.

ABSTRACT

PURPOSE: The objective of this study was to assess the benefits of the PENG block on pain control and functional recovery.

METHODS: Randomized controlled trials in PubMed, Web of Science, Embase, and the Cochrane Library were selected, and data were meta-analyzed using a random-effects model to estimate mean difference (MD) or standardized mean differences (SMD).

RESULTS: Eleven trials involving 1,135 patients were included. The PENG block was associated with significantly lower total opioid consumption than sham/no block (MD: -25.23, 95% CI: -27.01 to -23.45, I 2 = 0%), as well as better functional recovery. The PENG block was noninferior to the suprainguinal fascia iliaca block regarding postoperative pain scores and functional recovery and had a significant reduction in total opioid consumption (MD: -8.25, 95% CI: -16.48 to -0.02, I 2 = 68%). The PENG block was associated with similar total opioid consumption and functional recovery as the periarticular anesthetic infiltration (PAI), but worse static pain scores at 12 h (SMD: 0.41, 95% CI: 0.08-0.75, I 2 = 51%) and dynamic pain scores at 48 h after surgery (SMD: 0.36, 95% CI: 0.08-0.64, I 2 = 0%).

CONCLUSIONS: While current evidence supports the PENG block as a viable alternative to other types of peripheral analgesia in THA, existing data remain insufficient to conclude that the PENG block outperforms other peripheral analgesia when it comes to pain control or functional recovery. More well-designed randomized controlled trials are needed in the future to thoroughly explore whether the PENG block has superiority over other analgesic techniques.

PMID:40757814 | PMC:PMC12326972 | DOI:10.1530/EOR-2024-0105

EFORT Open Rev. 2025 Aug 4;10(8):574-588. doi: 10.1530/EOR-2024-0049.

ABSTRACT

PURPOSE: Diagnosing osteomyelitis in the foot/ankle region is challenging primarily due to anatomical constraints. While bone biopsy is the gold standard, non-invasive methods such as SPECT (single photon emission computed tomography) and MRI are sensitive but lack specificity. This study aims to evaluate SPECT/CT's potential, integrating functional and structural imaging, to improve osteomyelitis diagnosis in this region.

METHODS: A systematic review following PRISMA guidelines and the Cochrane Handbook was conducted, including comprehensive research across major databases (inception to October 2022). Diagnostic studies using SPECT/CT for suspected foot/ankle bone lesions or inflammation were included. We carried out descriptive analysis, SROC curve generation, and calculated mean sensitivities and specificities. Subgroup analyses were conducted for various tracers, CT resolutions, and evaluation strategies. Sensitivity and heterogeneity analyses, bias risk, and publication bias were assessed.

RESULTS: Eleven diagnostic studies (463 patients) were reviewed, with seven focusing on diabetic patients. Tracers included labeled leukocytes (WBC), antigranulocyte antibodies, phosphonates (BS), and gallium citrate. Clinical follow-up was the primary reference standard. Mean sensitivity of SPECT/CT for osteomyelitis diagnosis was 93.8% (95% CI: 89.7-96.4%), and specificity was 84.6% (95% CI: 65.1-94.2%). WBC SPECT/CT was more specific (79.4%) but less sensitive (89.2%) than BS SPECT/CT (specificity 46.5%, sensitivity 93.1%). Combined tracers yielded the highest mean specificity (96.4%).

CONCLUSION: SPECT/CT shows promising diagnostic performance for osteomyelitis in the foot/ankle region, especially when applying combined tracer methods. It is particularly advantageous in chronic, postoperative, and post-traumatic cases, offering added value compared to MRI.

PMID:40757813 | PMC:PMC12326970 | DOI:10.1530/EOR-2024-0049

EFORT Open Rev. 2025 Aug 4;10(8):623-635. doi: 10.1530/EOR-2024-0120.

ABSTRACT

Total knee arthroplasty is a highly effective intervention for end-stage osteoarthritis, yet nearly 20% of patients report dissatisfaction with clinical outcomes. This dissatisfaction is often linked to intraoperative parameters, particularly whole-leg alignment and component positioning, which might play a role in ensuring both satisfaction and long-term implant survival. Over the past two decades, alignment techniques have progressed from systematic, two-dimensional methods focused on the frontal plane to more personalized, three-dimensional approaches. This evolution has introduced inconsistencies and confusion among surgeons regarding alignment techniques, terminology, and application, underscoring the need for standardized definitions that can be universally adopted. This work provides standardized definitions for six main knee alignment techniques to enhance communication within the scientific community, particularly in clinical research. While not an exhaustive analysis of each method, this effort focuses on the foundational principles of these techniques, organized using a standardized framework to facilitate comparison and improve clarity in the field.

PMID:40757810 | PMC:PMC12326975 | DOI:10.1530/EOR-2024-0120

EFORT Open Rev. 2025 Aug 4;10(8):636-645. doi: 10.1530/EOR-2024-0135.

ABSTRACT

Hamstring injuries are a significant concern in high-speed running and kicking sports, contributing to a high incidence and recurrence rate among athletes. Anatomical and biomechanical properties of the hamstrings, especially the biceps femoris long head, make them susceptible to strain, contributing to the high injury rate observed in athletes. Key risk factors, including prior injury history, neuromuscular deficiencies, excessive load, and muscle-tendon architecture, have been identified as contributors to injury prevalence. Eccentric strengthening exercises, particularly the Nordic hamstring exercise, are highlighted for their effectiveness in reducing the incidence of hamstring injuries. Stretching protocols, when combined with strengthening exercises, have shown potential in enhancing muscle flexibility and reducing injury risk, although their standalone effectiveness remains a subject of ongoing research.

PMID:40757809 | PMC:PMC12326974 | DOI:10.1530/EOR-2024-0135

EFORT Open Rev. 2025 Aug 4;10(8):611-622. doi: 10.1530/EOR-2024-0119.

ABSTRACT

The main goal of a successful total knee arthroplasty is to relieve pain and restore function. While mechanical alignment provides excellent long-term implant survivorship, clinical and functional outcomes remain less than ideal. As a result, the focus has gradually shifted to a more personalized surgical approach based on the patient's specific characteristics. There is a pressing need for agreement on definitions of key terms to standardize limb alignment measurements and improve understanding and communication within the field. This work aims to clarify the concept of native limb alignment, outline how it is measured, and propose a standardized terminology to describe it.

PMID:40757805 | PMC:PMC12326966 | DOI:10.1530/EOR-2024-0119

EFORT Open Rev. 2025 Aug 4;10(8):600-610. doi: 10.1530/EOR-2024-0128.

ABSTRACT

PURPOSE: Meniscal extrusion (ME) can have detrimental effects. The aim of this study was to analyze the evidence about the reliability, potential of standing and dynamic evaluations, and influencing factors identified by using ultrasound (US) to evaluate knee ME.

METHODS: A systematic review of the literature was performed in February 2024 on PubMed, Scopus, and the Cochrane Library databases to select all articles, dealing with the US evaluation of ME. Relevant data of the involved articles, including study type, number of patients, age, sex, US technique, and data comparison with other radiological examinations, were extracted and collected for the study analysis.

RESULTS: Sixty studies on 4,742 patients were included: 38 cross-sectional, ten longitudinal, two case-control, and ten biomechanical studies. A strong correlation was found between MRI and US, with good US sensitivity (96%) and specificity (82%), and moderate to excellent interrater and intrarater reliability. US examinations in the standing position with weight-bearing or more complex dynamic conditions reported a significant influence of weight-bearing on MME. US was able to identify a relationship between meniscus posterior root tear and MME, as well as between ME and both pain and early osteoarthritis.

CONCLUSIONS: US is a valuable tool for the study of ME and the identification of the association between ME and various conditions. US in dynamic and weight-bearing evaluations is useful to characterize this anatomical abnormality in different pathologies, including OA, meniscal lesions, and in the follow-up of surgical procedures, providing important data to choose the best treatment to address patients affected by ME.

PMID:40757803 | PMC:PMC12326973 | DOI:10.1530/EOR-2024-0128

EFORT Open Rev. 2025 Jun 30;10(7):572-573. doi: 10.1530/EOR-2025-0029.

NO ABSTRACT

PMID:40591688 | PMC:PMC12226823 | DOI:10.1530/EOR-2025-0029

EFORT Open Rev. 2025 Jun 30;10(7):562-569. doi: 10.1530/EOR-2024-0147.

ABSTRACT

PURPOSE: This scoping review examines the epidemiology and incidence of complications associated with incorrect screw length in orthopaedic trauma surgeries, aiming to underscore its impact on clinical outcomes and healthcare costs.

METHODS: Guided by Arksey and O'Malley's framework and PRISMA guidelines, a thorough search was conducted across PubMed, Web of Science, Cochrane, and Google Scholar up to April 2024. Studies included must be human-based orthopaedic procedures involving screw length, published in peer-reviewed journals with full text available, and report complications from incorrect screw length; studies excluded were systematic reviews/meta-analyses. Paper characteristics and data on incident rates of complications due to screw protrusion were extracted and presented in a supplementary table using Microsoft Excel.

RESULTS: Of 2,285 studies identified, 31 met the inclusion criteria. Incorrect screw length led to severe complications, including neurovascular damage (7 studies), avascular necrosis (4 studies), delayed union or pseudoarthrosis (9), tendinitis/tendon rupture (12 studies), and pain (10 studies). Notably, improperly sized screws increased neurovascular and avascular necrosis complications, especially in weight-bearing joints. In addition, incorrect screw length was linked to higher hardware removal rates, contributing to increased healthcare costs. Limitations include the inability of some studies to definitively attribute complications to screw protrusion and the exclusion of cases involving joint collapse or solely mechanical complications.

CONCLUSION: This review underscores the importance of precise screw length selection to prevent complications and improve surgical outcomes. It calls for further research on the medico-legal and economic impacts of screw length errors and the need for better surgical practices.

PMID:40591687 | PMC:PMC12229280 | DOI:10.1530/EOR-2024-0147

EFORT Open Rev. 2025 Jul 1;10(7):510-519. doi: 10.1530/EOR-2024-0069.

ABSTRACT

PURPOSE: Dexmedetomidine is a widely employed adjunct in nerve block anesthesia for shoulder arthroscopy. This study aimed to assess the analgesic efficacy of dexmedetomidine as a nerve block adjuvant in patients undergoing shoulder arthroscopy.

METHODS: A thorough search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify randomized-controlled trials comparing the effects of dexmedetomidine-enhanced shoulder arthroscopy nerve blocks against those without dexmedetomidine. This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane-recommended risk of bias tool was employed for quality and bias assessment. Statistical analysis, utilizing Review Manager 5.4 with a significance level of P < 0.05, focused on primary outcomes: duration of analgesia and postoperative 24 h morphine consumption, and secondary outcomes: motor and sensory block duration, visual analog scale pain scores and adverse events.

RESULTS: Out of 307 articles retrieved, ten randomized-controlled trials involving 672 patients were included. Dexmedetomidine supplementation significantly prolonged the duration of analgesia (MD = 3.58, 95% CI: 2.53- 4.63, P < 0.00001, I 2 = 77%) and decreased postoperative morphine consumption (MD = -11.88, 95% CI: -17.25 to -6.52, P < 0.0001, I 2 = 41%). In addition, the dexmedetomidine group exhibited lower VAS pain scores at 1, 12 and 24 h postoperatively. No significant differences were observed in motor block duration, bradycardia (P = 0.18), hypotension (P = 0.50) and nausea and vomiting (P = 0.76). Sensitivity analyses validated the robustness of these findings.

CONCLUSIONS: This meta-analysis supports dexmedetomidine as an effective adjuvant in nerve blocks for shoulder arthroscopy. It enhances postoperative analgesia without increasing adverse events such as bradycardia, hypotension and nausea and vomiting.

PMID:40591683 | DOI:10.1530/EOR-2024-0069

EFORT Open Rev. 2025 Jun 30;10(7):570-571. doi: 10.1530/EOR-2024-0140.

NO ABSTRACT

PMID:40591682 | PMC:PMC12226824 | DOI:10.1530/EOR-2024-0140

EFORT Open Rev. 2025 Jul 1;10(7):439-444. doi: 10.1530/EOR-2025-0126.

NO ABSTRACT

PMID:40591679 | DOI:10.1530/EOR-2025-0126

EFORT Open Rev. 2025 Jul 1;10(7):475-486. doi: 10.1530/EOR-2024-0093.

ABSTRACT

While conventional structural magnetic resonance imaging (MRI) can detect cruciate ligament anatomy and injuries, it has inherent limitations. Recently, novel MRI technologies such as quantitative MRI and artificial intelligence (AI) have emerged to mitigate these shortcomings, providing critical quantitative insights beyond gross morphological imaging and poised to expand current knowledge in assessing cruciate ligament injuries and to facilitate clinical decision making. Quantitative MRI serves as a noninvasive histological and quantification tool, which significantly improves the evaluation of degeneration and repair processes. AI plays a crucial role in automating radiological estimations and enabling data-driven predictions of future events. Despite the transformative impact of advanced MRI techniques on the analytical and diagnostic algorithms related to cruciate ligament disorders, future efforts are warranted to address challenges such as economic burdens and ethical considerations.

PMID:40591678 | DOI:10.1530/EOR-2024-0093