What’s New in Orthopaedic Rehabilitation 2024

Topics of interest in orthopaedic rehabilitation, including platelet-rich plasma injections and novel minimally invasive techniques, are presented in the new JBJS Guest Editorial What’s New in Orthopaedic Rehabilitation. Here, we highlight the 5 most impactful studies, as selected by co-author Donald Kasitinon, MD, RMSK. 

Shoulder

Operative and nonoperative interventions for chronic calcific tendinitis of the rotator cuff were compared in a systematic review and meta-analysis of 27 randomized controlled trials. Patients who underwent surgery reported greater improvement in shoulder functional outcome scores than patients who received ultrasound-guided needling or radial extracorporeal shockwave therapy. All 3 intervention groups demonstrated improvement in pain scores following treatment. Complete radiographic resolution of calcium deposits was more common in the operative group according to 1 of the studies¹. 

Hand

A systematic review of 20 studies was performed to investigate the clinical effectiveness and safety of ultrasound-guided percutaneous carpal tunnel release. Although the included studies had very low levels of evidence, their findings indicated that this treatment for carpal tunnel syndrome is relatively safe and effective and has the potential for a short recovery time². 

Researchers assessed the outcomes of a novel minimally invasive technique for treating de Quervain tenosynovitis in a retrospective case series of 9 patients (10 wrists) with prior failed conservative management. The patients underwent complete percutaneous release of the first dorsal compartment with ultrasound guidance and had a mean follow-up of 23.1 months. Significant pain reduction (p < 0.001) and improvement in function (p = 0.03) were observed, indicating that the technique may be a safe and effective treatment option for patients for whom conservative management has failed³. 

Orthobiologics

Local injections of platelet-rich plasma (PRP) vs. corticosteroids for the treatment of lateral epicondylitis were compared in a systematic review and meta-analysis of 13 Level-I and II studies. The outcomes included Disabilities of the Arm, Shoulder and Hand questionnaire scores and visual analog scale for pain scores. PRP was not superior to corticosteroids within the first month of treatment but was superior at 3 and 6 months. This finding suggests that PRP offers greater long-term benefits⁴. 

The effect of PRP on range of motion, pain, and disability in patients with adhesive capsulitis was studied in a systematic review and meta-analysis of 14 studies (1,139 patients). The researchers found improved passive abduction and flexion at 1 and 3 months; improved passive external rotation at 3 months; reduced disability at 1, 3, and 6 months; and reduced pain at 3 and 6 months after the glenohumeral joint PRP injection. Therefore, PRP may be an effective treatment for adhesive capsulitis⁵. 

What’s New in Orthopaedic Rehabilitation is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

Recent OrthoBuzz posts include: What’s New in Shoulder and Elbow Surgery, What’s New in Hip Surgery, and What’s New in Osteoporosis. 

References 

1. Angileri HS, Gohal C, Comeau-Gauthier M, Owen MM, Shanmugaraj A, Terry MA, Tjong VK, Khan M. Chronic calcific tendonitis of the rotator cuff: a systematic review and meta-analysis of randomized controlled trials comparing operative and nonoperative interventions. J Shoulder Elbow Surg. 2023 Aug;32(8):1746-60. 
2. Chou RC, Robinson DM, Homer S. Ultrasound-guided percutaneous carpal tunnel release: a systematic review. PM R. 2023 Mar;15(3):363-79. 
3. Beidleman MB, Colberg RE, Beason DP, Fleisig GS. A retrospective case series study on a minimally invasive ultrasound-guided first dorsal compartment release technique for refractory De Quervain tenosynovitis. Am J Phys Med Rehabil. 2023 Mar 1;102(3):235-40. 
4. Hohmann E, Tetsworth K, Glatt V. Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet-rich plasma at 1 month but platelet-rich plasma is more effective at 6 months: an updated systematic review and meta-analysis of level 1 and 2 studies. J Shoulder Elbow Surg. 2023 Sep;32(9):1770-83. 
5. Lin HW, Tam KW, Liou TH, Rau CL, Huang SW, Hsu TH. Efficacy of platelet-rich plasma injection on range of motion, pain, and disability in patients with adhesive capsulitis: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2023 Dec;104(12):2109-22.