Dave Osinachukwu Duru

Background: Degenerative rotator cuff (RC) tears have poor healing potential. The molecular determinants and milieu underpinning RC failure remain indeterminate across small, methodologically heterogeneous human studies. Hypothesis: RC tears demonstrate a stage-dependent transcriptional profile, with patient comorbidities amplifying adverse pathways and poor healing. Study Design: Systematic review, Level 4. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the Medline, Embase, and Cochrane databases were systematically searched up to September 2025 and included studies reporting gene-expression profiles from RC tissue. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Results: A total of 60 human intraoperative studies met the inclusion criteria. Despite heterogeneity, convergent degenerative processes emerged with increasing tear severity: (1) amplification of innate inflammatory mediators and matrix-remodeling; (2) activation of adipogenic and profibrotic pathways; and (3) progressive loss of growth-factor and tendon/muscle structural transcripts. Partial-thickness tears showed modest perturbation, whereas large/massive tears demonstrated suppression of TGF-β/BMP signaling alongside extracellular matrix (ECM) disarray and fatty degeneration signatures. Clinical modifiers—including diabetes, smoking, and vitamin D deficiency—consistently magnified proinflammatory, proteolytic, and adipogenic responses. Conclusion: Human intraoperative transcriptomics of RC disease converge with chronic inflammation, ECM remodeling, and adipogenesis, which intensify depending on tear size and patient factors. These signals nominate modifiable targets—macrophage polarization, cellular senescence, and metabolic optimization—and support a translational pathway of molecular stratification and RC debridement/repair augmented with M2-skewing biologics. These data support molecular stratification of tears at the time of surgery and rational development of biologic adjuncts targeting macrophage polarization, senescence, and metabolic optimization to enhance personalized healing.

Context: Testosterone influences connective tissue biology, neuromuscular performance, and postoperative recovery. However, its clinical impact on anterior cruciate ligament (ACL) injury risk and outcomes after ACL reconstruction (ACLR) remains unclear. Objective: To evaluate the association between testosterone replacement therapy (TRT) or endogenous testosterone levels and ACL tear incidence, ACLR revision, patient-reported outcome measures (PROMs), strength, and complications. Data Sources: Embase, Ovid MEDLINE, and PubMed were searched from inception to March 14, 2026. Study Selection: Studies evaluating TRT use or endogenous testosterone levels in relation to ACL tear incidence or outcomes after ACLR were included. Systematic reviews, narrative reviews, scoping reviews, letters, editorials, technical notes, conference abstracts without full-text publication, animal studies, cadaveric studies, case reports, and non-English studies were excluded. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: Two reviewers independently extracted study characteristics, testosterone exposure, ACL tear incidence, ACLR revision, PROMs, strength outcomes, and complications. Random-effects meta-analyses pooled odds ratios for ACL tear incidence and ACLR revision. Study quality was assessed using the Methodological Index for Non-Randomized Studies and Cochrane Risk of Bias 2.0, and certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. Results: Seven studies were eligible, comprising 1,178,891 patients, of whom 589,436 were TRT users. TRT use was associated with a significantly increased risk of primary ACL tear within 2 years (odds ratio [OR], 2.83; 95% CI, 1.74-4.62; I ² = 95.4%), with consistent findings across sex-specific analyses. In contrast, there was no difference in ACLR revision rates at 2 years (OR 1.04; 95% CI 0.84-1.29; I ² = 0%). One randomized trial demonstrated increased early postoperative lean mass with TRT, without differences in strength or PROMs. Increased ACL rupture risk was associated with higher testosterone levels in men, and lower levels in women. Higher testosterone levels did not adversely affect PROMs or complication rates after ACLR. Conclusion: TRT is associated with increased ACL tear risk at 2 years after initiation but does not appear to affect 2-year ACLR revision rates. Higher endogenous testosterone levels may influence ACL injury susceptibility in a sex-dependent manner, without impairing ACLR recovery.

Background: Hip arthroscopy is increasingly performed in paediatric and adolescent patients, however, data on mid- to long-term survivorship remain limited. The purpose of this systematic review was to evaluate survivorship and patient-reported outcomes (PROMs) following hip arthroscopy at minimum 5-year follow-up. Methods: MEDLINE, Embase, and CENTRAL were searched from inception to 12 June 2026. Studies reporting outcomes at a mean minimum 5-year follow-up in patients aged ≤ 18 years undergoing primary hip arthroscopy were included. A random-effects meta-analysis was performed for revision rate. Weighted means were calculated for PROMs. Results: Six studies comprising 260 hips were included. Mean age was 16.5 years (range, 12.0–17.7 years) and mean follow-up was 10.2 years (range, 6.7–12.0 years). The most common indication was femoroacetabular impingement syndrome. The pooled revision hip arthroscopy rate was 9.3% (95% CI 5.8%–13.5%; I2 = 0.0%). Individual study revision rates ranged from 0% to 9.5% at 5–10 years and 10.0% to 13.8% beyond 10 years. No study reported conversion to total hip arthroplasty. Weighted mean postoperative scores were 87.2 for the modified Harris Hip Score (mHHS), 92.2 for the Hip Outcome Score-Activities of Daily Living, and 86.6 for the Hip Outcome Score-Sports Specific Subscale (HOS-SSS), representing significant improvement from baseline. Minimal clinically important difference achievement ranged from 75.9% to 90.0% for mHHS and 84.5% to 93.7% for HOS-SSS. Conclusion: Hip arthroscopy in paediatric and adolescent patients demonstrates durable mid- to long-term outcomes, with a pooled revision rate of 9.3%, no reported conversions to total hip arthroplasty, and sustained clinically meaningful improvements in PROMs.

Background: Bilateral medial compartment knee osteoarthritis with varus alignment may be treated with staged or simultaneous medial opening wedge high tibial osteotomy (MOWHTO). Simultaneous bilateral MOWHTO may reduce the overall rehabilitation burden, but concerns remain regarding complications, early mobility, and return to work. This study evaluated adverse events, radiographic correction, functional recovery, and return to work after simultaneous bilateral MOWHTO with early weight bearing. Methods: A retrospective case series was performed of 15 patients who underwent simultaneous bilateral MOWHTO between January 2002 and December 2023 at a single specialist sports medicine centre. Demographic, operative, radiographic, complication, mobility, return-to-work, hardware removal, and conversion-to-total-knee-arthroplasty data were extracted from medical records and imaging. Adverse events were classified using the Martin et al. framework (Class I–III). Results: Fifteen patients underwent 30 osteotomies. Mean age was 50 years, and minimum follow-up was 18 months. Mean operative time was 107 min, mean hospital stay was 4.5 days, and mean osteotomy opening was 12.0 mm. Mean hip-knee-ankle angle improved from 169.8° pre-operatively to 180.9° post-operatively. Radiographic union was confirmed at the 6 month radiograph in 28 knees and at the 9 month radiograph in 2 knees. Three undisplaced lateral hinge fractures and 2 delayed unions occurred, all resolving without surgical intervention. Two superficial infections resolved with oral antibiotics and local wound care. There were no Class III adverse events, deep infections, thromboembolic events, cardiac events, hardware failures, losses of correction, or reoperations. All patients discontinued mobility aids by 12 weeks. Among 9 patients employed pre-operatively, 8 returned to work at a mean of 165.1 days. Conclusions: Simultaneous bilateral MOWHTO with early weight bearing was associated with low serious adverse event rates, reliable radiographic union, early functional recovery, and high return to work. These findings support simultaneous bilateral MOWHTO as an effective option for patients seeking a single operative and rehabilitation episode.

Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for type 2 diabetes mellitus and obesity. Their metabolic, anti-inflammatory, and osteogenic effects raise important questions regarding their influence on spinal fusion. To date, no systematic review has specifically investigated how GLP-1RAs influence outcomes following the common anterior cervical discectomy and fusion (ACDF). This study aimed to evaluate the association between perioperative GLP-1RA use and outcomes following ACDF. Methods: Following PRISMA guidelines, MEDLINE, Embase, PubMed, and the Cochrane Library were searched from inception to February 2026 for studies evaluating GLP-1RA exposure in the context of ACDF. Eligible studies included human observational cohort studies. Data were extracted independently by two reviewers. Results: Eight retrospective cohort studies analysing 311,402 ACDF patients were included, of whom 8,182 were GLP-1RA users matched to non-users. Random-effects meta-analysis demonstrated significantly lower odds of pseudarthrosis among GLP-1RA users at 6 months (OR = 0.60, 95% CI: 0.52 to 0.71; I² = 16.6%), 12 months (OR = 0.62, 95% CI: 0.53 to 0.73; I² = 39.1%), and 24 months (OR = 0.67, 95% CI: 0.57 to 0.79; I² = 34.9%). Findings for reoperation, dysphagia, deep vein thrombosis, and readmission were heterogeneous and inconsistent across studies. Conclusion: Perioperative GLP-1RA use was associated with lower odds of pseudarthrosis. However, evidence regarding other postoperative complications remains inconclusive. Future prospective studies are required to further elucidate the impact of GLP-1RA use on ACDF outcomes. Level of evidence: Level III, therapeutic study.