Orthopedic Surgery

Leukocyte-poor PRP reduces structural retears after arthroscopic rotator cuff repair

This PRISMA-compliant meta-analysis synthesized 21 comparative studies (1,279 patients) of intraoperative PRP during arthroscopic rotator cuff repair with imaging-confirmed retears. Overall, PRP reduced structural failure risk (RR 0.74, 95% CI 0.55-0.99) with moderate heterogeneity. Leukocyte-poor PRP showed the strongest effect; excluding a critically biased study yielded a homogeneous estimate (RR 0.37, 95% CI 0.19-0.73). Benefit appeared greatest for medium-sized tears, while patient-reported outcomes were not consistently improved. 1

Intramedullary nails and locking plates perform similarly in displaced proximal humerus fractures

This systematic review and meta-analysis included 12 studies (1,039 adults; mean age 65.6 years) with displaced proximal humerus fractures. DASH, ASES, and Constant-Murley scores at 6 months did not differ significantly between intramedullary nailing and locking plate fixation. Pain, range of motion, complication rates, and reoperation rates were also comparable, including at 12 months. Subgroup analyses for 2-part and 3-part fractures showed no clinically meaningful advantage of either technique. 2

Diacerein does not improve pain in effusion-synovitis knee osteoarthritis

This multicenter, randomized, double-blind, placebo-controlled trial enrolled 262 patients with symptomatic knee osteoarthritis and MRI effusion-synovitis. Participants received diacerein 50 mg once daily for 2 weeks, then 50 mg twice daily, or placebo, for 24 weeks. Change in VAS knee pain at 24 weeks was similar (−19.9 mm diacerein vs −18.6 mm placebo; between-group difference −1.3 mm; 95% CI −9.8 to 7.3). Gastrointestinal adverse events, particularly diarrhea, were more frequent with diacerein (41.7%) than placebo (25.4%). 3

First-in-human intradiscal linezolid shows promising pain relief for Modic type 1 low back pain

This double-blind, randomized, sham-controlled phase 1b trial tested intradiscal linezolid (PP353) in 40 patients with chronic low back pain and Modic type 1 or mixed Modic 1/2 changes. Participants were randomized 1:1 to two intradiscal PP353 doses or two sham procedures at a single lumbar level and followed for 12 months. PP353 and the intradiscal procedure were well tolerated, with no severe, life-threatening, or disabling adverse events and similar overall event rates to sham. At 12 months, PP353 achieved a statistically significant and clinically meaningful reduction in low back pain NRS compared with sham. 4