Citations

Abstract Methods that map genetic risk to cells do not directly test whether spatially organized ligand–receptor (LR) gene annotations carry conditional heritability association. Here we introduce EdgeMap, which scores each gene by the spatial activity of its LR contexts in spatial transcriptomics data, maps these scores alongside cell-intrinsic annotations to SNP-level LD scores, and tests both jointly against GWAS summary statistics. Across 17 traits and five human tissues, edge z -scores are systematically higher in biologically matched tissues: all 15 traits with both matched and unmatched tissue classes show this ordering (median Δ z = 1.51 ; sign P = 3.1 × 10 −5 ), and 11 of 13 nominal-positive associations concentrate in the biologically matched set ( P = 1 × 10 −4 ). The pattern survives broad LR-gene-class and cell-type composition controls. Donor-level cross-section summaries, independent GWAS replication for LDL and CAD, and cell-segmented Visium HD liver data provide convergent support. A secondary analysis prioritizes constituent genes within active LR contexts; sixteen of 31 prioritized genes are absent from standard gene-level methods. These results establish spatially weighted LR-gene annotations as a complementary layer for interpreting complex-trait genetic architecture.

Objective: To evaluate the current literature on the role of collagen peptide supplementation in bone health, focusing on changes in bone turnover markers (BTMs) and bone mineral density (BMD). Data Sources: A search was conducted following PRISMA guidelines in the databases Academic Search Premier, APA PsychInfo, CINAHL Plus, GreenFILE, MEDLINE, and SPORTDiscus. Keywords included “collagen supplementation,” “bone turnover,” and “bone structure.” Studies published between January 2000 and March 2024 were included if they involved human subjects, oral collagen supplementation, and skeletal-related outcomes (BTMs or BMD). Risk of bias was assessed using the modified Physiotherapy Evidence Database (PEDro) scale. Main Results: Fifteen studies met the inclusion criteria. Collagen supplementation was associated with improvements in BTMs such as procollagen type I N-terminal propeptide and C-terminal telopeptide of type I collagen, as well as increases in BMD at whole body, femoral neck, and lumbar spine sites, particularly in postmenopausal women. However, neutral findings and substantial heterogeneity in study design, population characteristics, and dosing protocols were also observed. Conclusions: Collagen supplementation shows promise for supporting bone health, particularly in postmenopausal women, but the evidence remains inconsistent. Future research should address these gaps by focusing on premenopausal populations, standardizing dosing protocols, and exploring broader orthopedic applications, such as reducing stress fractures and enhancing recovery from musculoskeletal injuries.

Fetal repair of myelomeningocele remains an effective intervention to decrease hindbrain herniation and reduce the need for postnatal CSF shunting. Effectiveness depends on a watertight closure; however, there are challenges to achieving such. Often, a separate, watertight dural closure is difficult due to the thinness and fragility of the dural membrane. This video demonstrates the approach utilizing a previously described myofascial rotation of the bilateral paraspinal muscles to construct a robust closure even without the need for a separate dural closure or patch reinforcement. This method has been associated with improved primary closure rates and fewer postnatal procedures. The video can be found here: https://stream.cadmore.media/r10.3171/2026.1.FOCVID25235

OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is commonly performed in both inpatient and outpatient settings. In this study, the authors evaluate the influence of surgical setting on patient-reported outcome measures (PROMs), satisfaction, dysphagia, and complications following ACDF. METHODS A prospectively collected, multi-institutional quality improvement registry was retrospectively reviewed. Patients eligible for study inclusion were those who underwent ACDF without corpectomy or arthroplasty between 2016 and 2023. The patients were stratified by surgery setting, with same-day discharge indicating outpatients and an overnight stay indicating inpatients. PROMs were collected preoperatively and at 3 and 12 months postoperatively. Patient satisfaction was measured using the North American Spine Society (NASS) outcome assessment questionnaire, and dysphagia was measured using the 10-item Eating Assessment Tool (EAT-10). Propensity score overlap weighting (average treatment effect in the overlap population) was used to balance baseline covariates. RESULTS Of the 1514 patients who underwent ACDF, 462 were inpatients and 1052 were outpatients. The outpatient cohort was younger (55.1 ± 10.7 vs 60.5 ± 11.0 years, p < 0.001), had higher rates of private insurance (73% vs 52%, p < 0.001), had a lower mean American Society of Anesthesiologists (ASA) physical status (2.3 ± 0.6 vs 2.6 ± 0.6, p < 0.001), and underwent more single-level surgeries (53% vs 33%, p < 0.001). Propensity weighting resulted in comparable mean ages (58.9, p > 0.9) and ASA classes (2.5, p = 0.8) as well as private insurance rates (56%, p > 0.9) between the cohorts. After weighting, the inpatient cohort had a higher share of single-level fusions (46% vs 37%, p = 0.007). An outpatient status was associated with significantly better 12-month numeric rating scale (NRS) scores for neck pain (2.4 ± 2.7 vs 3.1 ± 3.0, p = 0.006), NRS scores for arm pain (1.7 ± 2.6 vs 2.2 ± 3.0, p = 0.047), and Neck Disability Index (NDI; 7.7 ± 7.8 vs 9.8 ± 9.4, p = 0.004) and greater improvement from baseline to 12 months on the NDI (−12.5 ± 9.7 vs −10.8 ± 10.5, p = 0.017), EQ-5D (0.242 ± 0.220 vs 0.209 ± 0.226, p = 0.047), and EQ visual analog scale (10.6 ± 21.6 vs 7.1 ± 20.8, p = 0.012). Fewer outpatients reported dysphagia at 3 months postoperatively (31% vs 40%, p = 0.010). No differences were observed in readmissions or revision procedures, although fewer outpatients experienced new neurological deficits (1.0% vs 2.6%, p = 0.032) and pneumonia (< 0.1% vs 0.9%, p < 0.001). In terms of the 12-month NASS outcome assessment, a smaller proportion of the outpatient cohort reported the lowest satisfaction score (3.9% vs 8.0%, p = 0.019). CONCLUSIONS Outpatient setting was associated with better PROMs at the 12-month follow-up when patients were weighted by baseline health status. These findings support the efficacy of outpatient ACDF in appropriately selected patients.

Background Current literature has shown benefit of radial pressure wave (RPW) and focused shockwave (FSW) for management of proximal hamstring tendinopathy (PHT), although there remains a lack of consensus on treatment parameters and optimal patient positioning. Purpose The purpose of this narrative review and clinical commentary is to report what has been described for patient positioning during treatment of PHT with RPW or FSW and propose an alternative side lying approach. Methods A search was conducted of MEDLINE/PubMed and EMBASE electronic databases for studies published from January 2005 to January 2026. Key search terms included proximal hamstring tendinopathy, shockwave therapy, extracorporeal shockwave treatment, radial pressure wave, hamstring tendinosis, hamstring tendinitis, and hamstring pain. Studies were included if they evaluated RPW or FSW for the treatment of PHT. Results Six manuscripts were identified for inclusion, two randomized controlled trials (RCT), two retrospective reviews, and two case reports; a total of 217 patients (145 female, 72 male) with PHT were treated with RPW and/or FSW. One RCT provided an in-depth description of patient positioning during shockwave treatment with the patient supine, with the hip and knee flexed, compared to other manuscripts detailing clinical focusing techniques only. One case report involving a para swimmer included a figure of treatment with the patient in a prone position. Improvement in patient reported outcomes with RPW and/or FSW was noted, with one RCT showing no differences between physiotherapy compared to RPW and FSW treatment. Conclusion RPW and FSW have some evidence regarding their benefits for treatment of PHT but controlled studies are limited and no consensus on treatment protocols or patient positioning during treatment have been determined. The authors’ preferred approach in treating PHT involves having the patient side lying with the hip and knee flexed to allow patient and clinician comfort while also creating compression of the proximal hamstring about the ischial tuberosity. It remains unclear how variance in patient positioning affects patient-reported outcomes. Future studies using RPW and FSW should include documentation of patient positioning when evaluating RPW and FSW efficacy. Level of Evidence 5

Aims Total knee arthroplasty (TKA) for end-stage osteonecrosis has historically been associated with concerns regarding aseptic loosening, and long-term data are limited. The purpose of this study was to update and expand our previous series with long-term follow-up, with specific emphasis on implant survivorship, risk factors for failure, complications, and clinical outcomes in a consecutive cohort of TKAs performed for primary and secondary osteonecrosis. Methods We retrospectively identified 295 consecutive TKAs in 266 patients for osteonecrosis performed at a single tertiary care academic institution from January 2002 to July 2022. Of these, 207 TKAs (70%) were performed for primary osteonecrosis, and 88 (30%) for secondary osteonecrosis. The predominant cause of secondary osteonecrosis was steroid use (59%; n = 52), followed by post-traumatic (25%; n = 22), radiation-induced (9%; n = 8), and alcohol-induced (7%; n = 6) osteonecrosis. Implant survivorship was analyzed as a time-to-event outcome using Kaplan-Meier estimation. The mean age was 61 years (18 to 93), with 67% being female (n = 197). The mean follow-up was nine years (2 to 20). Results The 15-year survivorship free of any revision for the entire cohort was 92% (95% CI 87 to 97), with similar rates between primary and secondary osteonecrosis (92% (95% CI 87 to 98) vs 93% (95% CI 87 to 100), respectively; p = 0.459). Varus-valgus constraint implant designs (HR 10.8 (95% CI 2.7 to 43.4); p < 0.001) and tibial stem use (HR 12.0 (95% CI 4.1 to 35.1); p < 0.001) were associated with an increased risk of any revision. The 15-year survivorship free of aseptic loosening was 97% (95% CI 93 to 100) for the entire cohort. Age under 65 years (HR 2.7 (95% CI 1.4 to 5.4); p = 0.005) and secondary osteonecrosis (HR 1.9 (95% CI 1.0 to 3.4); p = 0.044) were associated with an increased risk of any reoperation at 15 years. Conclusion TKA is a durable and reliable option for primary osteonecrosis at long-term follow-up. However, TKAs performed for secondary osteonecrosis carry a higher reoperation risk. Cite this article: Bone Joint J 2026;108-B(4):455–462.

Aims A type III internal hemipelvectomy includes resection of the pubic rami. Although bony reconstruction is not necessary, the integrity of the abdominal wall is deficient following resection. The aim of this study was to report the outcome of soft-tissue reconstruction following these resections. Methods We retrospectively reviewed all isolated type III internal hemipelvectomies which were undertaken at the Mayo Clinic (Rochester, USA) between January 2002 and December 2022. The group included 25 patients, of whom 14 (56%) were male. Their median age was 45 years (IQR 61 to 31) at the time of surgery. Most patients (n = 18; 72%) underwent resection for a sarcoma. Soft-tissue flaps were used in 21 patients (84%) and nine also had a mesh reconstruction. Results The five-year disease-specific survival was 65% following surgery, with significantly worse survival in patients with locally advanced tumour (35% (95% CI 12 to 100) vs 76% (95% CI 59 to 99); p = 0.036). Complications were common, with 21 patients (84%) having at least one complication, and 12 (48%) having several complications. Most commonly, this included seroma or haematoma (44%), wound dehiscence (40%), and infection (40%). The use of a soft-tissue flap did not significantly reduce the risk of infection (hazard ratio (HR) 0.68 (95% CI 0.14 to 3.28); p = 0.638) or seroma or haematoma (HR 0.31 (95% CI 0.30 to 4.14); p = 0.088), but patients who did not have a soft-tissue flap were significantly more likely to develop a hernia (odds ratio 9.0 (95% CI 1.14 to 71.03); p = 0.027). A total of three of 21 patients (14%) whose reconstruction involved a flap had donor site complications. Conclusion Soft-tissue reconstruction following a type III internal hemipelvectomy reduces the risk of postoperative hernia formation, with a low rate of donor site complications. This additional procedure should be considered for all patients undergoing this type of resection. Cite this article: Bone Joint J 2026;108-B(4):561–566.

ABSTRACT Behavioral and social factors (BSFs) substantially influence the risk, onset, and progression of Alzheimer’s disease and related dementias (ADRD), yet BSF-related knowledge remains scattered across heterogeneous sources, posing critical challenges for data harmonization and evidence synthesis. To address this gap, we present the B ehavioral S ocial Data and Knowledge O ntology for AD RD (BSO-AD), a FAIR-compliant semantic resource for representing and harmonizing BSFs and ADRD-related knowledge. BSO-AD was developed following established ontology design principles with reuse of existing ontologies and controlled terminologies, including the Social Determinants of Health Ontology, Drug Repurposing-Oriented Alzheimer’s Disease Ontology, AD-Onto, ICD-9-CM, and ICD-10-CM. Relationships between BSFs and ADRD were derived through literature mining. BSO-AD contains 1,690 classes, 152 object properties, 49 data properties, and 40 annotation properties. Ontology evaluation through Hootation-based domain expert review and a scalable LLM-assisted ontology assessment framework demonstrated high domain coverage and strong semantic coherence. BSO-AD provides a semantic foundation for data harmonization and knowledge integration in BSF-related ADRD research, while the LLM-assisted evaluation framework supports scalable and automated ontology assessment.