Abdulmalik A. Alduraibi

Background: Pediatric scoliosis with restrictive respiratory physiology represents a high-risk clinical setting in which pulmonary impairment functions both as a marker of perioperative risk and a target for optimization. The respiratory burden varies by phenotype, particularly in early-onset scoliosis/thoracic insufficiency syndrome (EOS/TIS), neuromuscular scoliosis, and scoliosis associated with intrinsic parenchymal lung disease, and these differences have important implications for perioperative planning and surgical strategy. Objectives: To synthesize current evidence on phenotype-driven perioperative respiratory assessment, preoperative optimization, surgical decision-making, and expected outcomes in children and adolescents with scoliosis and restrictive respiratory physiology. Methods: This narrative review was structured according to the SANRA framework. PubMed/MEDLINE and Google Scholar were searched through February 2026 using terms related to scoliosis, restrictive lung disease, thoracic insufficiency syndrome, early-onset scoliosis, neuromuscular scoliosis, pulmonary function testing, noninvasive ventilation, perioperative management, and postoperative pulmonary complications. English-language and English-translated publications from 2010 to 2026 were considered, with older landmark studies retained when essential for foundational concepts. Evidence was synthesized thematically, with emphasis on respiratory risk stratification, predictors of adverse outcomes, phenotype-specific operative strategies, prehabilitation, postoperative respiratory care, and outcome patterns. Results: Across phenotypes, baseline physiologic reserve appeared more informative than curve magnitude alone when estimating perioperative risk. Forced vital capacity, cough effectiveness, nocturnal ventilatory failure, nutritional status, and comorbidity burden were the most clinically relevant markers for identifying children at increased risk of postoperative ventilation, intensive care needs, and pulmonary complications. In EOS/TIS, growth-friendly constructs aim to preserve thoracic and spinal growth while delaying definitive fusion when feasible. In neuromuscular scoliosis, surgical goals are more closely linked to function, sitting balance, caregiver ease, and quality of life, whereas respiratory outcomes are often better understood as stabilization rather than normalization. Evidence for intrinsic parenchymal lung disease remains limited and supports cautious, individualized planning within a multidisciplinary framework. Conclusion: Management of pediatric scoliosis with restrictive respiratory physiology should be phenotype-driven and multidisciplinary. Structured assessment of respiratory reserve, ventilatory failure, cough effectiveness, and comorbidity can guide perioperative optimization, align surgical strategy with physiologic risk, and support safer postoperative respiratory care.

Objectives: Distraction osteogenesis (DO) is an established technique for bone regeneration but is associated with prolonged consolidation time and extended external fixation. Biophysical and biologic adjuncts have been proposed to accelerate regenerative maturation. This systematic review aimed to comparatively evaluate the available clinical evidence regarding low-intensity pulsed ultrasound (LIPUS) and biologic augmentation strategies in distraction osteogenesis. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251125456). MEDLINE, Embase, Scopus, and Google Scholar were searched from inception to October 2025. Randomized controlled trials and cohort studies evaluating LIPUS, platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), culture-expanded mesenchymal stem cells, or hyperbaric oxygen therapy in distraction osteogenesis were included. Risk of bias was assessed using RoB 2 for randomized trials and structured domain-based criteria for observational studies. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Results: Nine studies involving 304 participants met the inclusion criteria, including randomized controlled trials and cohort studies across multiple anatomical sites and fixation techniques. Randomized trials evaluating LIPUS demonstrated inconsistent reductions in healing index and consolidation time, with no consistent effect on complication rates. Biologic adjuncts such as PRP, BMAC, and cell-based therapies showed signals of improved consolidation parameters in selected studies; however, evidence was limited by small sample sizes and methodological heterogeneity. Hyperbaric oxygen therapy lacked sufficient high-quality evidence to support routine use. Overall, the certainty of evidence was constrained by variability in study design, outcome definitions, and risk of bias. Conclusions: Although both biophysical and biologic adjuncts demonstrate compelling biological rationale, current clinical evidence in distraction osteogenesis remains heterogeneous and inconclusive. Biologic strategies may offer theoretical advantages through direct cellular and growth factor supplementation, whereas LIPUS provides non-invasive mechanotransductive stimulation; however, neither approach can currently be recommended for routine clinical use. High-quality, adequately powered trials with standardized outcome reporting are required to define their true clinical role. Level of Evidence: Level III (Systematic review of Level I–III studies).

Background: Varus malalignment accelerates medial compartment knee osteoarthritis, for which high tibial osteotomy (HTO) is the standard joint-preserving treatment but involves implants and delayed rehabilitation. Proximal fibular osteotomy (PFO) has emerged as a less invasive, implant-free alternative, yet comparative evidence between the 2 procedures remains limited. Purpose: This study aimed to clarify how PFO compares with HTO for managing varus medial knee osteoarthritis. We sought to determine whether PFO offers comparable pain relief, functional recovery, radiographic correction, and safety at short-term follow-up. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we systematically searched major databases through April 2025. We included randomized and observational comparative studies evaluating adults undergoing PFO versus HTO. Data were synthesized using random-effects models, with risk of bias appraised using RoB 2 and Methodological Index for Non-Randomized Studies, and evidence certainty graded through GRADE methodology. Results: Eleven studies encompassing 550 knees (266 PFO, 284 HTO) met the inclusion criteria. At the most consistent follow-up point of approximately 12 months, pain outcomes were nearly identical (MD 0.01; 95% confidence interval −0.35 to 0.37), and improvements in functional scores did not differ in a clinically meaningful way. Radiographic alignment changes varied across studies without demonstrating a clear advantage for either procedure. Overall complication rates were similar, although transient peroneal irritation occurred only after PFO and hardware-related symptoms only after HTO. Conclusion: Current short-term evidence analyzed in this systematic review and meta-analysis suggests that PFO and HTO achieve broadly comparable improvements in symptoms and function for varus medial knee osteoarthritis, while PFO offers a simpler, implant-free alternative with immediate weight-bearing. Level of Evidence: Level III: Systematic review and meta-analysis of level-I to Level-III studies.

Background/Objectives: Sacral giant cell tumor of bone (GCTB) is a rare, mostly benign but locally aggressive neoplasm that carries significant diagnostic and treatment challenges due to its anatomic complexity, proximity to sacral nerve roots as well as the blood vessels, and potential impact on bowel, bladder, sexual, and lumbopelvic function and stability. This narrative review aimed to synthesize current evidence on the epidemiology, clinical presentation, diagnostic evaluation, classification, management strategies, outcomes, and surveillance of sacral GCTB. Methods: A focused literature search of PubMed/MEDLINE and Google Scholar was conducted for studies published between January 2000 and January 2026, with additional manual review of reference lists. Given the rarity of the tumor and the observed heterogeneity in study designs, treatment strategies, and outcomes, the evidence was synthesized narratively. Results: Sacral GCTB mainly affects young adults with an indolent nature, often presenting late with progressive low back or buttock pain, radiculopathy, or neurological deficits. Magnetic resonance imaging is the preferred modality for determining local extent, whereas histopathologic biopsy and molecular testing remain essential for definitive diagnosis. Conventional grading systems, such as Enneking and Campanacci, have limited value in sacral disease, as anatomical extent and anticipated neurological morbidity are more relevant for treatment planning. Surgery remains the cornerstone for resectable disease, yet management plans should balance local tumor control against preservation of sacral nerve roots and mechanical stability. Denosumab, selective arterial embolization, and radiotherapy may play important roles in selected unresectable or high-morbidity cases. Local recurrence remains a major concern, and long-term surveillance is recommended because tumor relapse, treatment-related morbidity, and distant metastasis may occur late. Conclusions: Current evidence supports a multidisciplinary, individualized approach to sacral GCTB, guided by tumor extent, expected neurological morbidity, and patient-centered functional outcomes. Prospective multicenter studies are needed to refine treatment algorithms and improve risk stratification.

Background/Objectives: An accurate understanding of anterior cruciate ligament (ACL) morphology is essential for individualized surgical planning in ACL reconstruction. Morphometric parameters of the knee, including the femoral notch width and surrounding soft tissue characteristics, may influence native ACL dimensions and potentially assist in preoperative graft sizing. Methods: This retrospective case–control study analyzed medical records, radiographs, and knee magnetic resonance imaging (MRI) performed at a tertiary academic medical center. Variables collected included femoral notch width, thigh thickness, and ACL attachment dimensions at the femoral and tibial insertions. Comparisons between patients with ACL tears and those with intact ACLs were also performed. Correlation analyses were performed to evaluate associations between morphometric parameters and ACL attachment size. Multivariable linear regression models were constructed to identify independent predictors after adjusting for age, sex, body mass index (BMI), limb side (left or right leg), and ACL status. Results: A total of 600 participants were included. The mean femoral notch width was 21.55 ± 6.15 mm, and the mean thigh thickness was 53.05 ± 11.66 mm. The mean ACL femoral and tibial attachment sizes were 8.12 ± 2.57 mm and 11.79 ± 3.89 mm, respectively. Thigh thickness demonstrated weak but significant positive correlations with both ACL femoral (r = 0.168, p = 0.001) and tibial attachment sizes (r = 0.236, p < 0.001). Femoral notch width showed a borderline association with ACL femoral attachment size (r = 0.092, p = 0.068) and a weak but significant correlation with ACL tibial attachment size (r = 0.095, p = 0.039). ACL tear group exhibited smaller thigh thickness measurements compared with controls (49.80 ± 12.00 mm vs. 55.65 ± 14.80 mm, p < 0.001) and smaller femoral notch width measurements compared with controls (21.20 ± 3.40 mm vs. 22.50 ± 3.18 mm, p = 0.001). Moreover, further analysis demonstrated that ACL tear status was associated with smaller measured ACL attachment sizes (p < 0.001). Conclusions: Thigh thickness and femoral notch width demonstrate measurable association with ACL attachment dimensions and differ between patients with ACL tears and those with intact ligaments. These findings indicate that both osseous and soft-tissue morphometric characteristics may influence ACL morphology and susceptibility to injury. Comprehensive preoperative imaging assessment of these anatomical parameters may help to optimize individualized surgical planning in ACL reconstruction.

Introduction: Smoking tobacco negatively affects fracture healing, increasing the risk of delayed union, malunion, and nonunion, as well as healthcare expenses. Although smoking is common in Saudi Arabia, the literature on public awareness of the negative impact of smoking on fractures is...