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Study Type: Multicentre RCT (Level I evidence)

Key Question: Does robotic closed reduction improve reduction quality and reduce radiation exposure compared with manual closed reduction in displaced pelvic fractures?

Key Findings:

• Robotic reduction achieved excellent/good reduction (Matta criteria) in 96% vs 48% with manual technique (RR 2.00, 95% CI 1.47–2.72; p<0.001)
• Intraoperative surgeon fluoroscopic exposures were significantly lower with robotic reduction (median 0 vs 38; p<0.001)
• No significant difference in 12-week Majeed functional scores (69 vs 71; mean difference −3, 95% CI −11 to 6; p=0.55)

Clinical Relevance: Robotic reduction offers substantially improved anatomical outcomes and reduced radiation burden for pelvic ring fractures, relevant to UK major trauma centres considering robotic platform investment.

Limitations: Short follow-up (12 weeks) limits conclusions on functional recovery, and the study was conducted in Chinese tertiary centres, limiting generalisability to NHS trauma systems without cost-effectiveness data.

Study Type: Decision analysis (Markov state-transition model)

Key Question: Are age-based thresholds that restrict THA in younger patients logically consistent with its routine use in patients aged 85 and over?

Key Findings:

• 45-year-old males are projected to accrue ~25 JALYs (joint-adequate life years) under base-case assumptions, far exceeding the 6-JALY benchmark derived from 85-year-old recipients
• The 45-year-old cohort's expected benefit only falls below this threshold if revision carries a penalty exceeding 25 JALYs — an implausibly high value
• Findings were robust across sensitivity analyses varying prosthetic survival, satisfaction rates, failure rates, and discount rates

Clinical Relevance: UK orthopaedic clinicians and commissioners who apply informal age-floor thresholds for THA should recognise these may lack logical basis; younger patients with disabling hip disease stand to gain substantially more lifetime benefit than older patients routinely offered the procedure.

Limitations: The model uses US life tables and theoretical constructs (JALYs) not validated against patient-reported outcome data, limiting direct clinical translation.

Study Type: Retrospective case series (Level III)

Key Question: What are the clinical presentation patterns and outcomes of arthroscopic suprascapular nerve decompression in young, active patients without rotator cuff tear or space-occupying lesion?

Key Findings:

• Two distinct presentations identified: pain-predominant (n=10, normal MRI/EMG) and weakness-predominant (n=10, all with MRI muscle oedema/atrophy and EMG denervation changes)
• Pain-predominant group: median VAS improved from 6 to 1 (p=0.009); weakness-predominant group: abduction and external rotation motor grades improved significantly (both p<0.01)
• 17/20 patients (85%) returned to military duty or sport at median 13 weeks, sustained beyond one year

Clinical Relevance: Suprascapular neuropathy is likely under-diagnosed in active patients with unexplained shoulder pain or weakness; this series supports a structured diagnostic algorithm and arthroscopic decompression as an effective intervention.

Limitations: Small single-centre series (n=20) in a predominantly young military male population limits generalisability to typical NHS shoulder caseloads.

Study Type: Retrospective comparative cohort study (single institution, Level III prognostic)

Key Question: Do social determinants of health (SDOH) disparities — including race, insurance type, transportation access, living alone, and neighbourhood deprivation indices — affect PROMs completion rates following total joint arthroplasty?

Key Findings:

• Across 12,842 TJA patients, no clinically important differences (defined as ≥15% change) in PROM completion were identified based on race, transportation access, living alone, or insurance type at any timepoint.
• Neighbourhood-level deprivation scores (ADI and SVI) showed statistically significant but clinically negligible differences between completers and non-completers.
• Statistically significant p-values were present throughout but did not meet the pre-specified threshold for clinical importance.

Clinical Relevance: As NHS England expands PROM requirements for elective arthroplasty, these findings suggest common SDOH factors may not substantially drive completion gaps, though generalisability beyond a US urban academic centre requires caution.

Limitations: Single-institution US dataset with a predominantly White cohort (86%) limits generalisability to diverse NHS patient populations.

Study Type: Retrospective cohort analysis (Level III)

Key Question: What are the SCB thresholds for KOOS subscales after primary TKA, and which patient factors predict failure to achieve them?

Key Findings:

• SCB thresholds were 33/100 (KOOS Pain), 16/100 (KOOS PS), and 23/100 (KOOS JR); only 59% of patients achieved these at one year
• Non-White race was consistently the strongest predictor of SCB non-attainment across all subscales (OR ~1.7–1.8), alongside older age, higher comorbidity burden, and lower education level
• AUC values (0.69–0.72) indicate moderate discriminative ability of these anchor-based thresholds

Clinical Relevance: Although US CMS reimbursement policy drives this study, NHS England's increasing use of PROMs for TKA quality benchmarking makes understanding SCB thresholds and equity-related outcome disparities directly relevant to UK arthroplasty services.

Limitations: Single-institution US registry data with ~21% loss to follow-up may limit generalisability to NHS populations with differing demographics and healthcare structures.

Study Type: Retrospective multicentre descriptive study (secondary data analysis; Level IV)

Key Question: In combined coronoid and radial head fractures, what radial head fracture patterns predominate, and do they correlate with coronoid fracture type?

Key Findings:

• The commonest radial head fracture pattern was a single fragment spanning both anterolateral and anteromedial quadrants (31%; 51/167), with most fractures comprising a single fragment overall (49%)
• No statistically significant association was found between radial head fracture pattern and O'Driscoll coronoid fracture type
• Interrater reliability was substantial for both quadrant mapping (κ=0.715) and O'Driscoll classification (κ=0.658)

Clinical Relevance: These findings support treating radial head and coronoid fractures as independent injury components during preoperative CT planning and intraoperative assessment, rather than inferring one from the other — relevant to surgical approach selection in terrible triad and complex elbow instability cases.

Limitations: Retrospective Level IV design from two tertiary trauma centres limits generalisability and introduces selection bias.

Study Type: Cross-sectional study

Key Question: Does cerebellar activation differ between patients with chronic ankle instability (CAI) and controls across visual conditions, and does this relate to neuromuscular deficits?

Key Findings:

• CAI patients showed significantly reduced cerebellar activation (lobule VI, vermis VI, crus I) when transitioning from eyes-open to eyes-closed during ankle movement tasks (group mean differences ranging −21.7 to −26.6 voxels, all p<0.001)
• Reduced cerebellar and fusiform gyrus activation correlated moderately with delayed peroneal reaction time (eyes-open: r=−0.38; eyes-closed: r=−0.40, both p<0.05) and worse self-reported function (CAIT, ALR-RSI)
• No association was found between cerebellar activation and static postural stability (Romberg ratio)

Clinical Relevance: Central sensorimotor deficits, not purely peripheral, underpin CAI — suggesting rehabilitation programmes should incorporate vision-manipulation and cerebellar-targeted tasks rather than focusing solely on peripheral proprioception.

Limitations: Small sample size (n=35) limits generalisability and statistical power for subgroup analyses.

Study Type: Randomised Controlled Trial (Level 1 evidence)

Key Question: Does accelerated rehabilitation (full weightbearing, no bracing) produce equivalent outcomes to conservative rehabilitation (6-week bracing, restricted weightbearing) following surgical repair of acute proximal hamstring avulsion involving ≥2 tendons?

Key Findings:

• Accelerated rehabilitation showed better SF-12 physical scores at 3 months (p=0.039) and lower hamstring pain severity at 3 and 12 months (p=0.034; p=0.010), but no significant differences in strength or hop test outcomes at any timepoint
• Isokinetic strength and single-leg hop performance improved significantly in both groups across 24 months (all p<0.001)
• Overall rerupture rate was 7% (4/57), evenly distributed between groups

Clinical Relevance: This supports omitting post-operative bracing and early full weightbearing following proximal hamstring repair, which has practical implications for patient comfort and NHS rehabilitation resource utilisation.

Limitations: The trial was underpowered to detect meaningful differences in rerupture rates between protocols.