Orthopedic Center

Intramuscular adipose tissue (IMAT) has been proposed to directly contribute to myofiber dysfunction through paracrine signaling. The impacts of this signaling beyond contributing to myofiber insulin resistance are largely unknown. This study aims to explore the human IMAT transcriptome, with a focus on its potential role in myoblast fusion deficits in advanced muscle pathology. Using a within-subjects design, we compared IMAT to subcutaneous (SQ) fat in individuals with and without diabetes undergoing below-knee amputation. We hypothesized that IMAT from the diabetic group would exhibit a pro-inflammatory profile, similar to diabetic SQ, and that inflammatory secreted factors from IMAT progenitors would impair cultured myoblast fusion. Instead, we found that the IMAT transcriptome from the diabetic group exhibited reduced enrichment of inflammatory pathways compared with SQ and less transcriptional evidence for immune cell infiltration. While IMAT featured a mostly anti-myogenic transcriptional profile for secreted cytokines, media conditioned by IMAT progenitors did not uniquely impair fusion of cultured myoblasts compared with SQ. Surprisingly, the diabetic status of the myoblast donor predicted myoblast fusion, with reduced fusion rates in diabetic myoblasts exposed to conditioned media from all adipose sources. This suggests that IMAT-myoblast signaling may be detrimental to regeneration in diabetes, but that the effect is driven in part by an intrinsic difference in diabetic myoblasts' sensitivity to IMAT secreted factors. This emphasizes the insight that can be gained from disease-state matched and mismatched culture models and highlights the need to better understand how diabetes impacts myoblasts and their interaction with the disease environment.

IntroductionPrior studies reporting the utilization of anterior cruciate ligament reconstruction (ACLR) was limited to pediatric populations or lacked accounting for the impact of the COVID-19 pandemic. In this study, the authors sought to compare the annual incidence of primary ACLR following the COVID-19 pandemic shutdown to see if utilization has rebounded to pre-pandemic levels.MethodsThe number of ACLRs performed per year from 2017 through 2023 was identified from the authors’ health care system’s ACLR interregional registry, and average membership per year was identified from membership records. Incidence rates per 100,000 members were calculated for each year. Poisson regression was used to evaluate year-to-year trends overall and across graft selection, age, and gender. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) are presented.ResultsIn total, 23,082 ACLRs were performed from 2017 to 2023. Pre-pandemic, annual ACLR incidence increased from 47.0 per 100,000 in 2017 to 50.2 in 2019. During the pandemic (2020), this dropped by 33.9% to 33.2 per 100,000 (IRR, 0.66; 95% CI, 0.63–0.70). Post-pandemic, annual incidence increased from 38.6 to 42.3 per 100,000 from 2021 to 2023, respectively (2020 to 2021: IRR, 1.16; 95% CI, 1.10 –1.23; 2021 to 2022: IRR, 1.11; 95% CI, 1.06–1.16). However, this was still lower than the pre-pandemic incidence. In both genders, patients in the pediatric age groups had the biggest declines during the shutdown (drop off of 57% in the 10- to 14-year-old group and 40% in the 15- to 19-year-old group).DiscussionThe COVID-19 pandemic shutdown of elective orthopedic procedures led to a sharp drop in the numbers of ACLRs performed, and the United States is still in the recovery period.

Magnesium sulfate is commonly used intraoperatively to reduce postoperative pain in spinal surgery patients, but its effects when administered postoperatively are not well established. This study specifically aimed to assess the effect of magnesium sulfate on a postoperative basis on the incidence of postoperative pain in lumbar spinal surgery patients. This systematic review focuses on assessing the practicality of postoperative magnesium sulfate in the mitigation of pain after lumbar surgery. A comprehensive search was conducted across multiple databases, focusing on studies published between January 2000 and December 2023. The findings emphasize the significant role of magnesium in postoperative analgesia for adult patients undergoing lumbar spinal surgeries, with various administration routes explored, such as infusion, intravenous, or intramuscular. All in all, magnesium sulfate shows potential as an analgesic additive in lumbar surgery, aiding in postoperative pain reduction and decreased opioid use. However, its efficacy assessment is hindered by external variables. Standardized research is crucial to establish its optimal clinical applications and address knowledge gaps.

PurposeSurgical invasiveness indices have been used in adult spine surgery to characterize the invasiveness of complex procedures and for risk stratification. This has not been studied in the pediatric population. The purpose of this study was to develop and validate a surgical invasiveness index for pediatric spinal deformity surgery. MethodsThe National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried between the years 2016–2022. Patients were included if they were <18 years of age, received posterior or anterior-posterior spinal fusion surgery, and had a diagnosis of spinal deformity. The study cohort was divided into a derivation cohort and a validation cohort. A multivariable linear regression analysis was performed to identify surgical components associated with operative time. Surgical components of interest included number of posterior fusion levels, number of anterior fusion levels, pelvic instrumentation, posterior column osteotomies, three-column osteotomies, and prior spinal deformity surgery. Statistically significant variables were used to establish a pediatric spinal deformity surgical invasiveness index. The score was assessed and validated using linear and logistic regression analysis and receiver operating characteristic curve analysis on operative time and allogeneic transfusion. ResultsThere were 37,658 patients included (Derivation cohort: 26,372; Validation cohort: 11,286). In the linear regression analysis, more posterior fusion levels (7–12 levels: 0.54, p<0.001;>12 levels: 1.40, p<0.001), anterior fusion 1–3 levels (2.42, p<0.001), anterior fusion ≥4 levels (2.93, p<0.001), pelvic instrumentation (0.79, p<0.001), and previous spinal deformity surgery (0.44, p<0.001) were associated with longer operative time. Each level of posterior column osteotomy (0.13, p<0.001) and three-column osteotomy (0.61, p<0.001) were associated with increased operative time. Points were assigned to each surgical component: 7–12 posterior fusion levels (4 pts), >12 posterior fusion levels (11 pts), anterior fusion 1-3 levels (19 pts), anterior fusion ≥4 levels (23 pts), pelvic instrumentation (6 pts), previous spinal deformity surgery (3 pts), posterior column osteotomy (1 pt per level), and three-column osteotomy (5 pts per level). In the derivation cohort, each point was associated with an increase in operative time by 0.13 hours (R2=0.16, p<0.001). In the validation cohort, each point was associated with an increase in operative time by 0.12 hours (R2=0.15, p<0.001). In the derivation cohort, the area under the curve (AUC) for operative time ≥8 hours and allogeneic transfusion were 0.74 and 0.71, respectively. In the validation cohort, the AUC for operative time ≥8 hours and allogeneic transfusion were 0.74 and 0.70, respectively. ConclusionA pediatric spinal deformity surgical invasiveness index was created and predictive of prolonged operative time and allogeneic transfusion. This is the first quantitative tool to measure the extent of surgical interventions in pediatric spine surgery.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43390-025-01106-y.

Plantar plate (PP) tears often necessitate surgical intervention to address concerns of progressive toe deformity and impaired function, particularly in the case of fullthickness PP tears or when conservative treatment fails.There is currently a lack of level 1 or 2 evidence regarding the efficacy of surgical versus non-surgical approaches to guide the management of plantar plate tears, especially for older individuals.This case presents a successful conservative management of a 63year-old male recreational athlete/competitive skier with a full-thickness PP tear.The patient presented with a history of worsening pain around the left second metatarsophalangeal (MTP) joint, accompanied by a visible medial toe deviation and loss of toe purchase.Based on the history, physical exam, and MRI findings, the diagnosis of a subacute, full-thickness PP tear at the phalangeal attachment of the second MTP joint was made.During the surgical consultation, the patient was presented with both surgical and conservative treatment options and opted for conservative management.Conservative treatment consisted of avoiding activities requiring toe extension, carbon fiber insoles, a metatarsal pad, and sling taping of the toe for walking and other activities.He also performed daily toe plantarflexion stretches and used night splint taping with the second toe in 10-20 degrees of plantarflexion.At the 7-month follow-up, the patient was pain-free and had a notable reduction in toe deformity.The serial MRI findings revealed evolving scarring, with complete scar formation evident on the 19-month follow-up MRI.At the most recent follow-up, the patient remained physically active and pain-free 4 years after initiating treatment.

Background: The rehabilitation team, consisting of physiatrists, physical and occupational therapists, and speech pathologists, faces heightened risk of COVID-19 exposure because of treatment practices in rehabilitation settings.Aim: The study aimed to assess the knowledge, practices and attitudes of rehabilitation professionals in treating COVID-19 patients and to determine potential associations with respondents’ demographic factors (e.g., age, gender, type of profession).Setting: The study was conducted in the Philippines.Methods: This cross-sectional study was conducted from June 2021 to July 2021. Researchers employed snowballing and purposive homogenous convenient sampling methods. Participants completed a 31-item online questionnaire via Google Forms.Results: A total of 410 rehabilitation professionals participated in the study. The total mean scores for knowledge, practices and attitudes are 41.14 ± 3.16, 104.54 ± 33.65 and 37.13 ± 3.55, respectively which were considered adequate. However, only 9.8% (n = 40) professional was actively treating COVID-19 patients with analysis of variance indicated that age, type of profession and gender did not significantly impact COVID-19 knowledge. However, age (p = 0.005) and type of profession (p = 0.004) were found to influence COVID-19 practices, with physiatrists exhibiting higher adherence. There was a strong positive correlation between age and positive COVID-19 attitudes (p 0.000).Conclusion: Filipino rehabilitation professionals have positive attitude, adequate knowledge and skills about COVID-19.Contribution: The study provides information to modify training courses and curricula to further improve the knowledge and practices related to COVID-19.

A general decline in the osteogenic differentiation capacity of human bone marrow mesenchymal stem cells (hBMSCs) in the elderly is a clinical consensus, with diverse opinions on the mechanisms. Many studies have demonstrated that metformin (MF) significantly protects against osteoporosis and reduces fracture risk. However, the exact mechanism of this effect remains unclear. In this study, we found that the decreased miR-181a-5p expression triggered by MF treatment plays a critical role in recovering the osteogenic ability of aging hBMSCs (derived from elderly individuals). Notably, the miR-181a-5p expression in hBMSCs was significantly decreased with prolonged MF (1000 μM) treatment. Further investigation revealed that miR-181a-5p overexpression markedly impairs the osteogenic ability of hBMSCs, while miR-181a-5p inhibition reveals the opposite result. We also found that miR-181a-5p could suppress the protein translation process of plasminogen activator inhibitor-1 (PAI-1), as evidenced by luciferase assays and Western blots. Additionally, low PAI-1 levels were associated with diminished osteogenic ability, whereas high levels promoted it. These findings were further validated in human umbilical cord mesenchymal stem cells (hUCMSCs). Finally, our in vivo experiment with a bone defects rat model confirmed that the agomiR-181a-5p (long-lasting miR-181a-5p mimic) undermined bone defects recovery, while the antagomiR-181a-5p (long-lasting miR-181a-5p inhibitor) significantly promoted the bone defects recovery. In conclusion, we found that MF promotes bone tissue regeneration through the miR-181a-5p/PAI-1 axis by affecting MSC osteogenic ability, providing new strategies for the treatment of age-related bone regeneration disorders.