This Week in Orthopedics — May 28, 2026

Welcome to This Week in Orthopedics. This week we're covering 9 notable papers spanning spine surgery outcomes, perioperative risk management, and sports medicine advances. Let's dive in.

First up, a significant focus on spine surgery this week, with four papers offering new insights into cervical and pediatric procedures. Two studies from the journal *Spine* look at outcomes in patients with degenerative cervical myelopathy, or DCM.

One study asks whether the duration of symptoms before surgery affects outcomes after an ACDF [8]. Investigators compared patients with symptoms for less than a year to those with symptoms for a year or more. The group with a longer duration of symptoms did have worse absolute outcomes in terms of postoperative pain and disability scores. However, rates of achieving a clinically meaningful improvement were similar between the groups, and there was no difference in neurologic recovery based on the mJOA score. The key takeaway is that while earlier intervention may lead to a better absolute result, delayed presentation does not prevent patients from experiencing meaningful improvement from surgery.

Also in *Spine*, a prospective multicenter study focused on a specific and often troubling symptom of DCM: neurogenic bladder dysfunction [7]. Among patients with preoperative bladder issues, about 71% achieved complete recovery of bladder function within two years of surgery. The two factors that predicted persistent bladder problems were older age at the time of surgery and more severe bladder dysfunction at baseline. This highlights that bladder function recovery can follow a different path than motor and sensory recovery, and these findings are crucial for counseling patients preoperatively about their expected outcomes.

Staying with the cervical spine, another study in *Spine* provides important data for the ongoing debate between anterior cervical discectomy and fusion, or ACDF, and cervical disc arthroplasty, or CDA [3]. In a retrospective review of over 300 single-level cases, the authors found distinct patient selection patterns, with CDA patients being younger and healthier. The key finding relates to long-term complications. CDA was associated with a significantly higher rate of revision surgery at the index level—over 5% compared to less than half a percent for ACDF. In fact, regression analysis showed CDA carried a more than 12-fold increased risk of revision. Conversely, ACDF was associated with a higher risk of developing adjacent segment disease requiring further surgery. This study quantifies the central trade-off: ACDF is more durable at the index level but may accelerate disease next door, while CDA preserves motion but has a higher failure rate of the implant itself.

Finally in spine, a major trial from *The New England Journal of Medicine* addresses a key question in pediatric neurosurgery: for children with a Chiari I malformation and syringomyelia, is it better to perform a posterior fossa decompression with duraplasty, or PFD-D, versus decompression alone [1]? In this cluster-randomized trial, the primary outcome was the rate of surgical complications within six months. Complications occurred in 14% of the duraplasty group and 6% of the decompression-alone group. While this risk was more than doubled in the duraplasty group, the difference was not statistically significant. Looking at secondary outcomes at two years, the duraplasty group had better syrinx reduction and a lower rate of repeat decompression, at 3% versus 14%. However, quality of life changes were similar. The authors conclude that larger trials are needed, but this study suggests that while duraplasty may offer better long-term structural results, it may come at the cost of more early complications.

Next, we turn to two large database studies examining common strategies to reduce perioperative complications.

From the journal *Arthroscopy*, a population-based cohort study from Austria looks at VTE prophylaxis after knee arthroscopy [4]. Using national insurance data for nearly 100,000 patients, investigators compared those who received prophylactic enoxaparin to those who did not. The group receiving enoxaparin had a significantly lower rate of symptomatic VTE within 90 days: 0.57% versus 0.89% in the no-prophylaxis group. This represents a 36% relative risk reduction. The number needed to treat to prevent one symptomatic VTE was 310, and rates of bleeding complications were rare in both groups. This large-scale evidence supports considering chemoprophylaxis after knee arthroscopy, while also contextualizing the absolute benefit.

And in *The Journal of Bone and Joint Surgery*, a multicenter retrospective study evaluates the utility of preoperative Staphylococcus aureus nasal screening to prevent surgical site infections in elective orthopaedic surgery [2]. In a propensity-matched analysis of over 50,000 patients, nasal screening was associated with a significant benefit, nearly halving the odds of a deep surgical site infection and reducing the odds of a superficial infection. However, the authors offer a crucial piece of nuance. The overall incidence of deep infection was low, and among the patients who did develop a deep SSI after being screened, only about 6% had tested positive for MRSA. This suggests that while screening and decolonization works, its overall impact may be limited by the low baseline rate of MRSA-driven infections. The authors conclude that a targeted screening approach in higher-risk populations may be more valuable than a universal screening policy.

In sports medicine, two papers this week address outcomes after major knee injury and the role of artificial intelligence in diagnosing shoulder instability.

First, from *The American Journal of Sports Medicine*, a reader study explores whether AI can help clinicians diagnose Bankart and reverse Bankart lesions on shoulder MRI and MR arthrography [5]. Four orthopaedic clinicians reviewed over 100 cases, once on their own and once with AI assistance. The results were striking. For Bankart lesions, the clinicians’ average sensitivity jumped from 38% unaided to over 78% with AI assistance. For reverse Bankart lesions, sensitivity improved from 31% to 50%. Overall, the AI assistance corrected more than half of the labral tears that were initially missed by the human readers, all while maintaining high specificity. Clinician confidence in their diagnosis also increased significantly. This study provides strong evidence that AI can serve as a powerful tool to augment, not replace, clinical expertise, directly improving diagnostic accuracy for a common and challenging problem.

Also in *The American Journal of Sports Medicine*, a study offers reassuring news for elite athletes with combined ACL and MCL injuries [9]. Researchers followed professional soccer and rugby players who underwent ACL reconstruction for a combined ligamentous injury, comparing their career longevity to matched, uninjured control players. The return-to-play rate was high, at over 90%. More importantly, there was no significant difference in career length. At five years after surgery, about 62% of the injured players were still competing, nearly identical to the 63% of uninjured controls. This held true whether the MCL was managed operatively or non-operatively. The findings suggest that for professional athletes, a combined ACL/MCL tear is not a career-ending injury, and with appropriate treatment, they can expect a career trajectory similar to their uninjured peers.

And a quick note on research methodology from *The Journal of Bone and Joint Surgery*. An article outlines the rationale for the Musculoskeletal Adaptive Platform Trial, or MAPT design [6]. This is a framework for more rapidly and efficiently comparing multiple treatments to find what works best for patients. It's a look at the future of how we generate evidence in our field.

If you only have time for one paper this week, make it the study on AI-assisted MRI interpretation in *The American Journal of Sports Medicine* [5]. It shows that AI support can more than double a clinician's sensitivity for detecting Bankart lesions without sacrificing specificity, dramatically improving our diagnostic power for a common and challenging problem.

Here are the key takeaways from this week in Orthopedics.

First: In degenerative cervical myelopathy, surgery provides meaningful improvement even if symptoms have been present for over a year, but counsel patients that bladder recovery is variable and depends on age and baseline function [7, 8].

Second: For single-level cervical disc disease, cervical disc arthroplasty carries a higher risk of index-level revision, while ACDF has a higher risk of adjacent segment disease, a trade-off that should guide shared decision-making [3].

Third: Routine VTE prophylaxis with enoxaparin after knee arthroscopy reduces the rate of symptomatic VTE, though a large number of patients—310—must be treated to prevent one event [4].

Fourth: Preoperative S. aureus screening is associated with lower SSI rates after elective surgery, but its low yield for MRSA in deep infections suggests a targeted, rather than universal, screening strategy may be more valuable [2].

And finally: In elite athletes with combined ACL and MCL injuries, expect a high rate of return to play and a career longevity comparable to uninjured peers, regardless of whether the MCL is treated operatively or non-operatively [9].

That's your roundup for This Week in Orthopedics. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.