OrthoEvidence

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@bmj_latest Citation: Kortekangas, Tero et al. “Cast immobilisation versus surgery for unstable lateral malleolus fractures (SUPER-FIN): randomised non-inferiority clinical trial.” BMJ (Clinical research ed.) vol. 392 e085295. 14 Jan. 2026

ACE Report: https://t.co/EVOanQD7bm

[OrthoEvidence @OrthoEvidence]

The SUPER-FIN Trial (in the @bmj_latest)
Should we be operating on unstable ankle fractures?

Ankle fractures, particularly those that are Weber B grade, are increasingly managed surgically when deemed unstable.

But the evidence to support this practice is weak at best. A randomized trial was desperately needed.

In large randomized trial comparing cast vs plate fixation, Finnish researchers found:

- No difference in function
- No difference in pain, quality of life, or range of motion
- No difference in ankle osteoarthritis progression
- Less treatment-related harms with casting

Overall, it appears that below the knee casting can adequately stabilize unstable ankle fractures. And may even have some advantages

Does a result like this change your practice?

[OrthoEvidence @OrthoEvidence]

Citation: Kalske, Roope, et al. "Arthroscopic Partial Meniscectomy for Degenerative Tear—10-Year Outcomes." New England Journal of Medicine 394.17 (2026): 1757-1759.

ACE Report: https://t.co/GCWkhsG0Jj

[OrthoEvidence @OrthoEvidence]

Arthroscopic Partial Meniscectomy for Degenerative Meniscal Tears: 10 Years Later
Published in @NEJM

The FIDELITY Trial challenged the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscal tears by finding it to be no better than sham after 1 year.

But how do things shape up 10 years later?

Fortunately, the results are in.

Among 133 patients who completed 10-year follow up:

No evidence of a benefit of arthroscopic partial meniscectomy vs. sham.

And even some signal suggesting that it may lead to worse function and symptoms.

Its a strong finding which could potentially be practice changing.

[OrthoEvidence @OrthoEvidence]

Preventing Infection in High-Risk Total Joint Arthroplasty
Published in @JArthroplasty

Periprosthetic joint infection (PJI) is rare but devastating. Minimizing the risk of PJI, particularly in high-risk patients, is imperative. But what's the best protocol to do so?

METHODS
1,901 total joint arthroplasty patients at high risk for PJI were randomized across 17 different sites in the USA to receive either:

1) Vancomycin powder
2) Dilute povidone iodine
3) Both vancomycin and povidone-iodine
4) Saline

The primary outcomes of interest include PJI, wound complications, emergency department visits, readmissions, and serious adverse events.

RESULTS
821 patients received total hip arthroplasty and 1,080 received total knee arthroplasty.

There were no differences between study groups in the incidence of:

- wound drainage or dehiscence
- cellulitis or abscess formation
- 3-month infection rates
- aseptic revision rate
- emergency department visits
- readmissions
- wound complications
- PJI or other surgical outcomes

BOTTOM LINE
In high-risk patients, the use of prophylactic measures like vancomycin powder, povidone-iodine, or both did not result in any marked reduction on infection rate vs. saline -- particularly in circumstances where surgeons are using a range of sterile and antibiotic techniques that are now standard of care.

[OrthoEvidence @OrthoEvidence]

https://t.co/2jBfCbynNh

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Haliburton Out With Achilles Injury in Game 7 Loss

Two injuries are universally feared among elite athletes, regardless of the sport -- Achilles tendon ruptures and anterior cruciate ligament (ACL) ruptures.

Last night, in Game 7 of the NBA Playoffs, Pacers star Tyrese Haliburton left the game early after suffering a supposed Achilles tendon rupture.

This has been a major talking point this playoffs, with both Jayson Tatum & Damian Lillard suffering similar injuries.

In our OE Original, Maximum Performance, Maximum Risk: ACL and Achilles Ruptures in Elite Athletes, we discuss the treatment options available for Haliburton going forward.

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Citation: Bailey et al. (2020). Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months. New England Journal of Medicine 382, 1093–1102.

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To Operate or Not To Operate: Persistent Sciatica
Published in the @NEJM

Methods
➡️ 128 patients with sciatica symptoms lasting 4-12 months
➡️ Randomized to receive either microdiscectomy surgery or 6 months of conservative therapy
➡️ Primary outcome of interest: pain at 6 months follow-up

Results
✅ Pain at 6 months was significantly lower in the surgery group
✅ Leg and back pain lower in the surgery group at 12 months as well
✅ Superior quality of life and function scores in surgery group
✅ Higher rate of satisfaction and higher employment rate at 12 months

🏁Takeaway
For patients with persistent sciatica, surgical intervention appears to provide substantial advantages over conservative treatment!

[OrthoEvidence @OrthoEvidence]

@jbjs Read the full ACE Report here!
https://t.co/4ffJG7J0Dj

[OrthoEvidence @OrthoEvidence]

Total Hip Arthroplasty vs. Hemiarthroplasty for Displaced Femoral Neck Fracture: An SR & MA
Published in @jbjs

Methods
➡️ 16 randomized trials (3,084 patients)
➡️ Total hip arthroplasty (THA) vs. hemiarthroplasty
➡️ Outcomes including revision, function, quality of life, mortality, dislocation, peri-prosthetic fracture, and operative time
➡️ Meta-analyses performed

Results
✅ Small advantage in quality of life for the total hip arthroplasty group (below minimum important difference)
✅ No difference in the rate of revision up to 5 years follow-up
✅ No difference in function up to 3 years follow-up
✅ No difference in rate of dislocation or peri-prosthetic fracture
✅ 22 mins shorter operative time in the hemiarthroplasty group

Takeaway
🏁 THA and HA provide similar clinical outcomes -- THA might provide a small benefit in quality of life, while HA is slightly faster to perform!

[OrthoEvidence @OrthoEvidence]

@jbjs Citation: Ekhtiari et al. (2020) Total Hip Arthroplasty Versus Hemiarthroplasty for Displaced Femoral Neck Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Bone and Joint Surgery 102(18):p 1638-1645.

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Want to read the full ACE Report?

https://t.co/xMNQg3nrCW

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Epidural Analgesia After Lumbar Decompression Surgery
Published in #Spine Journal

Research Question
In patients undergoing lumbar decompression surgery, does an epidural injection of 0.25% bupivacaine significantly reduce post-operative pain severity compared to placebo?

Results
Pain Severity
Pain scores in the 48 hours post-operation were significantly lower in the epidural group compared to the placebo group, particularly in the immediate post-operative period (first 8 hours).

Opioid Use, Quality of Life, and Recovery
No difference in opioid use, quality of life, or recovery scores were observed between the two groups.

Complications
Two complications were reported, both in the control group. No differences in the rate of complications were observed between the two groups.

Takeaway
An epidural injection with 5mL of 0.25% bupivacaine after lumbar decompression surgery significantly reduced immediate post-operative pain scores, with no increase in opioid consumption!

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Citation: Hermans, Sem M M et al. “A Randomized Controlled Trial Using Epidural Analgesia for Pain Relief After Lumbar Interlaminar Decompressive Spine Surgery: The RAPID trial.” Spine vol. 49,7 (2024): 456-462.

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Read the full ACE Report here👇

https://t.co/Dv3qptBqIk

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Adjuvant PRP in Arthroscopic Rotator Cuff Repair: A Double-Blind RCT
Published in AJSM @aossmjournals

Research Question
Does adjuvant leukocyte-poor PRP injection, applied after arthroscopic rotator cuff repair, decrease the risk of re-tear in patients with rotator cuff tears, up to 1 year post-op?

Results
Retear Rate
The rate of re-tear was substantially lower in the patients who received PRP injection compared to the control group (15.2% vs. 34.1%, p=0.037).

Patient Improvement
Patients who received PRP injection reported higher improvement scores compared to those who received surgery only at both 6 and 12 months (p<0.05 for both).

Patient Reported Outcomes
Pain, function, and sleep quality were similar between the two groups up to 12 months post-operation.

Takeaway
Leukocyte-poor PRP as an adjuvant to arthroscopic rotator cuff repair significantly reduced the risk of re-tear and improved the patient's perception of improvement!

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Citation: Rossi, Luciano Andres et al. “Leukocyte-Poor Platelet-Rich Plasma as an Adjuvant to Arthroscopic Rotator Cuff Repair Reduces the Retear Rate But Does Not Improve Functional Outcomes: A Double-Blind Randomized Controlled Trial.” The American journal of sports medicine vol. 52,6 (2024): 1403-1410.

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Read the full OE Original here:

https://t.co/qSaji3SqqZ

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Current Treatments for Femoroacetabular Impingement Syndrome
An OE Original

We looked at the recent literature comparing hip arthroscopy and physical therapy for the treatment of FAI.

Non-Operative Treatment
Physical therapy programs, particularly active and supervised types, have demonstrated effectiveness in improving function.

There is also evidence suggesting that injection therapies, like HA or corticosteroids, can provide some symptomatic relief.

Surgical Intervention
Hip arthroscopy has emerged as the best available surgical intervention for FAI, providing superior clinical outcomes compared to open surgery.

Advantages include:
- less invasive
- shorter hospitalization
- faster rehab
- ability for bilateral performance
- better survivorship

However, nerve palsy-related complications have been reported.

Physical Therapy vs. Hip Arthroscopy
We ran a meta-analysis of RCTs that compared quality of life scores between the two treatments:

Quality of Life at 6 Months
No significant difference between groups, but trending in favour of hip arthroscopy (p=0.15).

Quality of Life at 12 Months
Significantly better in the hip arthroscopy group (p<0.001).

Range of Motion
The FAIT trial (Palmer, 2019) found that hip arthroscopy led to significantly better hip flexion range of motion. A previous systematic review also came to similar conclusions (Diamond, 2015)

Takeaway
FAI can be effectively managed with hip arthroscopy, with superior quality of life and functional outcomes being observed compared to non-operative treatment based on the existing literature!

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Citation: S Mahmoud, R Rambani, OrthoEvidence. Current concepts of treatment of Femoroacetabular Impingement Syndrome.. OE Original. 2024;8(7):1.