Musculoskeletal infection (MSKI) remains a major problem after trauma and elective orthopedic surgery. Chronic MSKI is related to the formation of biofilm, which impairs diagnosis and effective treatments. Therefore, to understand and communicate global standards and best practices, the 2025 International Consensus Meeting (ICM) on MSKI created a Biofilm Section to address crucial aspects of biofilm biology pertaining to its mechanisms of drug resistance and immune evasion, and potential approaches to overcome them. This featured a 2-year process, with final voting and discussion on May 8-10, 2025, in Istanbul, Turkey. This Consensus Article is the effort of the Biofilm Basic Mechanisms Workgroup, which interpreted the results on ICM questions related to (1) the infectious microenvironment; (2) appropriate inocula in preclinical research; (3) biofilm behavior in infected tissues; and (4) synergy within biofilms and with other comorbidities. Collectively, we find that this field has the necessary research tools to discover the pathophysiology of orthopedic implant-associated biofilm development and maturation, perform clinically relevant studies in animal models, and elucidate mechanisms that allow opportunistic infections in compromised tissues and patients with other health issues.
Musculoskeletal infection (MSKI) is a leading cause of implant failure following orthopedic surgery for trauma or elective procedures and it is associated with catastrophic outcomes for patients and healthcare systems worldwide. International Consensus Meetings (ICM) aim to define state-of-the-art, influencing clinical standards of care and accelerating discoveries by setting research priorities. The 3rd ICM was held on May 8-10, 2025 in Istanbul (Turkey) and included a 2-year-long Delphi process that culminated with in-person voting by 1205 delegates on 102 General and 30 Biofilm-specific MSKI questions. Consistent with prior ICMs, a Research Priorities Workgroup was established after the voting to interpret the results and summarize the most important future directions. Here, the group reports on several critical research priorities that emerged, which should be addressed to advance the field. These include: (1) improving diagnostics through standardized patient sampling, advanced non-invasive imaging technologies, and biofilm-specific biomarkers; (2) developing clinically relevant in-vitro and in-vivo models to rigorously and reproducibly test antibiofilm strategies; (3) identifying high priority immunological research areas, including deciphering the role of T-cell immunity in biofilm persistence, and if T cell targeting therapies can be harnessed to disrupt chronic biofilm-associated infection; (4) clinically evaluating novel anti-biofilm technologies on larger cohorts of patients; and (5) addressing translational barriers through the use of multi-center data collection and large-scale data tools to accelerate clinical application. These research priorities aim to enhance the prevention, diagnosis, and treatment of biofilm-associated MSKI.
BACKGROUND:Meniscal preservation has been demonstrated to contribute to long-term knee health and has been a successful intervention in isolation and in patients with anterior cruciate ligament reconstruction (ACLR). The long-term results of meniscal repair in the setting of revision ACLR have yet to be documented. PURPOSE:To report the incidence of meniscal repair failures at the 6-year follow-up in a cohort of patients who underwent concurrent revision ACLR and primary meniscal repair. STUDY DESIGN:Prospective cohort study; Level of evidence, 2. METHODS:All revision ACLRs with concomitant primary meniscal repair cases from a multicenter group between 2006 and 2011 were selected. Six-year follow-up was obtained to determine whether any subsequent surgery had occurred since their initial revision ACLR. If so, operative reports were obtained, whenever possible, to verify pathological condition and treatment. RESULTS:In total, 221 patients from 1234 revision ACLRs underwent concurrent primary meniscal repairs (18% of the cohort). There were 238 repairs performed: 173 medial and 65 lateral. The majority of these repairs (n = 181; 76%) were performed with an all-inside technique. Six-year surgical follow-up was obtained in 77% (171/221) of the cohort, or 189 of 238 (79%) of the repairs (136 medial, 53 lateral). The meniscal repair failure rate, defined as reoperation, was 16% (31/189) at 6 years. Of the 31 failures, 28 were medial (24 all-inside, 4 inside-out; 28/136 = 20.6% failure rate) and 3 were lateral (2 all-inside, 1 inside-out; 3/53 = 5.7% failure rate). Three medial failures were treated in conjunction with a subsequent repeat revision ACLR. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears (20.6% vs 5.7%; P = .01) and had a significantly shorter survival time compared with lateral tears (P = .02). No difference was found between the failure and nonfailure groups when it came to tear type, tear length, repair technique utilized, suture/implant type, or number of sutures used between the 2 groups. CONCLUSION:Meniscal repair in the revision ACLR setting has a 16% failure rate at 6 years. Failure rates for medial tears (20.6%) were found to be higher than that for lateral tears (5.7%), which aligns with previous studies in both the revision and primary ACLR setting.
Background Precise and accurate glenoid preparation is important for the success of shoulder arthroplasty. Despite advancements in preoperative planning software and enabling technologies, most surgeons execute the procedure manually. Patient-specific instrumentation (PSI) facilitates accurate glenoid guide pin placement for cannulated reaming; however, few commercially available systems offer depth of reaming control. Robotic arm-assisted bone preparation has gained popularity in knee and hip arthroplasty, but at the present time there is limited information available on the use of robotics for shoulder arthroplasty. The purpose of this study was to compare glenoid preparation and final implant position using 3 techniques: manual, manual assisted with PSI, and robotic arm-assisted bone preparation. Methods Six shoulder surgeons participated in this study using 3 preparation techniques: (1) manual reaming, (2) manual reaming over a pin inserted using PSI, and (3) preparation using a robotic arm assist with an end-effector burr and haptic boundaries. Each surgeon randomly conducted each technique on 2 separate Bone Matrix glenoid models, for a total of 36 glenoid models tested. To compare the techniques, the final prepared Bone Matrix models underwent a computed tomographic scan with 3D virtual model generation. The prepared 3D virtual glenoid models were then compared to the preoperatively planned models. Parameters compared included deviations in version, inclination, anterior-posterior (AP) translation, superior-inferior (SI) translation, and depth of reaming. Results Regarding glenoid version with values reported as mean deviations from the preoperative plan, the robotic-assisted technique (1 degrees) was significantly better than manual (9 degrees, P < .001) and PSI (4 degrees, P < .001) techniques at executing the preoperative plan. Regarding inclination, the robotic-assisted technique (2 degrees) was significantly better than manual (9 degrees, P = .003) but not significantly different than PSI (3 degrees, P = .211). The robotic arm technique, with AP translation, resulted in significantly lower mean displacements (0.3 mm) than the manual technique (2 mm, P = .001) and the PSI technique (2 mm, P = .002). With SI translation, the robotic arm-assisted technique (0.7 mm) resulted in significantly lower mean displacements as compared to the manual (2 mm, P = .007) and PSI (1 mm, P = .011). The robotic arm-assisted technique (0.4 mm) did not result in significantly lower mean depth of reaming displacements compared to the manual technique (0.8 mm, P = .051) but did when compared to PSI (0.8 mm, P = .036). Conclusions Glenoid preparation using a robotic arm with an end-effector burr and haptic boundaries was significantly better in its ability to execute a preoperatively planned implant position than manual preparation in 4 of the 5 glenoid metrics examined and was significantly better than PSI in 4 of the 5 glenoid metrics. (c) 2025 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
OBJECTIVES:To compare hemiarthroplasty (HA) outcomes for low-energy femoral neck fracture (FNF) among a direct anterior approach (DAA), direct lateral approach (DLA), and posterior approach (PA). METHODS: DESIGN:Retrospective review. SETTING:Nine level-1 tertiary academic centers. PATIENT SELECTION CRITERIA:All patients from January 2010 through December 2019 undergoing HA for a low-energy FNF (AO/OTA 31B1-3). Exclusion criteria were pathologic fractures, concomitant acetabular fractures, and high-energy mechanisms. OUTCOME MEASURE AND COMPARISONS:Multivariable regression models were constructed for outcomes among DAA and DLA compared with PA including mortality, revision, and infection. It was hypothesized that anterior approaches would be independently associated with fewer postoperative complications including infection, dislocation, and mortality. RESULTS:A total of 956 consecutive patients with FNF treated with HA using DAA (n = 71; 7.4%; mean (SD) age 82.6 (8.5) years), DLA [n = 252; 26.4%; mean (SD) age 81.3 (10.8) years] or PA [n = 633; 66.2%; mean (SD) age 79.2 (10.9) years] were included. There were no differences in sex among groups ( P = 0.83). The DAA was independently associated with higher periprosthetic joint infection rates at 90 days [Odd's Ratio (OR), 7.295; 95% confidence interval (CI), 2.35‒22.61; P < 0.001] and 1-year (OR, 5.769; 95% CI, 1.93‒17.22; P = 0.002), as was the DLA at 90 days (OR, 2.952; 95% CI, 1.29‒6.74; P = 0.010) and 1-year (OR, 3.047; 95% CI, 1.43‒6.50; P = 0.004). The DLA was associated with lower 90-day dislocation (OR, 0.129; 95% CI, 0.03‒0.60; P = 0.009), 1-year dislocation (OR, 0.175; 95% CI, 0.05‒0.63; P = 0.008), and greater independent ambulation at discharge (OR, 3.273; 95% CI, 2.00‒5.37; P < 0.001). CONCLUSIONS:Among HA for low-energy femoral neck fracture, the lateral approach was associated with decreased dislocation postoperatively and greater independent ambulation at discharge, but with decreased ambulatory distance compared to a posterior approach. Furthermore, the anterior and lateral approaches were associated with increased infection versus a posterior approach. LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
