Despite the quadriceps being a large muscle group with distinct heads, no study has compared motor unit discharge rates (MUDRs) of the three superficial portions in the same participants. Further, day-to-day variability of quadriceps MUDRs and the influence of limb dominance have not been evaluated. Thus, during submaximal contractions, we assessed MUDRs of the vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) of the dominant and non-dominant limbs on two separate days. We hypothesized that MUDRs of the RF would be faster than VM and VL but not different between the VM and VL. Additionally, MUDRs would not be different between limbs, or days. During two identical sessions (≥72h apart), 16 healthy, young adults (8 females, 27±7y) performed repeated (7-14 per limb) 15-s isometric contractions at 25% of maximal knee extensor force. Motor unit trains (≥24 per muscle) were recorded from concentric needle electrodes inserted separately into the VL, RF, and VM, and analyzed using decomposition-based quantitative electromyography software. Muscle order was pseudorandomized, though consistent for each limb within a participant. A total of 5391 motor unit trains were included for analysis (26.9±5.5 per muscle per participant). Independent of limb dominance and day (main effects and interactions all P≥0.115), the mean MUDR for RF (12.6±1.8Hz) was faster than VL (10.2±1.5Hz) and VM (10.9±1.7Hz), and VM was faster than VL (all P≤0.001). The results indicate the three superficial quadriceps muscles have unique motor unit rate modulation, possibly reflecting different relative contributions to knee extension force production.

Five Medicare Administrative Contractors (MACs)-CGS, Palmetto GBA, Wellpoint Federal (formerly National Government Services), Wisconsin Physicians Service, and Noridian-participated in a collaborative policy-development process addressing peripheral nerve injections and related procedures for chronic pain. Novitas Solutions and First Coast Service Options did not participate. The September 2025 draft policies would have limited coverage principally to radiofrequency neurolysis for trigeminal neuralgia and corticosteroid injections for carpal tunnel syndrome and Morton neuroma, with lifetime caps on the latter procedures. After public comment and further evidence review, four contractors published materially identical final LCDs, with a notice period from September 10 through October 24, 2026, and an effective date of October 25, 2026. The final policies restored limited, criteria-based coverage for sympathetic blocks in complex regional pain syndrome, genicular nerve blocks and ablation for selected patients with knee osteoarthritis, greater occipital nerve blocks for occipital neuralgia, and selected suprascapular nerve blocks. They also removed the lifetime caps on median-nerve and Morton-neuroma injections. Pudendal, intercostal, ganglion impar, ulnar, and unspecified other peripheral-nerve procedures remain noncovered when performed for chronic pain. This health-policy analysis compares the draft and final policies, distinguishes Noridian's participation in the collaborative process from publication of a final LCD, summarizes coding and documentation requirements, and examines the access and health-equity implications of geographically discordant Medicare coverage.

Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs) involving multiple organs. However, delayed-onset, multisystem irAEs after treatment discontinuation are uncommon. Here, we present a rare case of a man in his 50s with microsatellite instability-high colon cancer who developed multisystem irAEs following treatment with nivolumab plus ipilimumab. The patient developed adrenocorticotropic hormone deficiency after four cycles of combination therapy, which improved with hydrocortisone supplementation. Following eight cycles of nivolumab monotherapy, treatment was discontinued because no cancerous lesions were detected. Six months after the final nivolumab administration, the patient presented with bilateral knee arthritis and elevated hepatobiliary and pancreatic enzyme levels. No evidence of infectious, autoimmune, or IgG4-related disease was found. Liver biopsy revealed portal lymphocytic infiltration with a predominance of CD8-positive cells. The patient was diagnosed with delayed ICI-related arthritis, accompanied by asymptomatic cholangitis and pancreatitis. These irAEs improved rapidly after prednisolone administration. This case demonstrates that irAEs can occur in a delayed and multisystem manner, even after the cessation of ICIs. Thus, clinicians should consider irAEs in the differential diagnosis when new symptoms or unexplained laboratory abnormalities occur in patients with prior ICI exposure.

Public information-seeking is an underused indicator of the diffusion of robotic-assisted surgery, yet no study has compared it jointly across the three highest-volume orthopedic domains or projected it toward the coming decade. Using Google Trends relative search volume (RSV: a term's share of all searches in a given month, rescaled 0-100 against the highest month of the study window, and not a count of searches) retrieved programmatically (Health category, worldwide, January 2014-June 2026; 150 monthly observations per term), we quantified and forecast public search interest in robotic knee, hip, and spine surgery. Mann-Kendall and Theil-Sen statistics confirmed significant monotonic growth in all three domains (P < 0.001). Knee interest rose from a mean RSV of 3.0 to 77.0 and hip interest emerged from below the reporting threshold to 15.1, while spine interest rose from a censored baseline to 18.8 and showed the steepest recent monthly growth of the three domains (3.7% versus 2.5% for knee and 2.2% for hip) over the final three years; because the hip and spine baselines lay at or below the platform's censoring threshold, fold-changes are baseline-dependent and are not used here as primary effect measures. Seasonal decomposition revealed consistent February and early-summer peaks and December troughs across all domains. Seasonal ARIMA models, selected by Akaike information criterion, project further three- to four-fold increases in arthroplasty-domain interest by 2030 (knee approximately 283; hip approximately 49), while spine forecasts remained conservative (approximately 21) owing to early censoring, with sensitivity analyses suggesting a plausible range up to approximately 112. Lay terminology outnumbered technical terminology roughly 10:1, though technical-term searching has recently accelerated; aggregate search data cannot identify who issues a query, so this shift is not attributed to any particular group of searchers. These findings indicate that English-language public search interest in robotic orthopedic surgery is rising rapidly and most steeply for spine surgery, and that infodemiological signals, being transparent, freely available, and continuously updated, can complement clinical evidence and institutional capacity metrics to inform technology investment, patient counseling, and research prioritization through 2030. Search interest reflects information-seeking behavior; its conversion into clinical demand was not measured and should not be assumed.

Robot-assisted unicompartmental knee arthroplasty (RA-UKA) has received increasing attention, but its overall research landscape and evolving priorities remain incompletely characterized. This study systematically analyzed the global literature on RA-UKA to identify research trends, major contributors, knowledge structures, and emerging topics. Publications indexed in the Web of Science Core Collection through August 20, 2026 were retrieved and analyzed using Bibliometrix/Biblioshiny and VOSviewer. A total of 238 publications from 73 journals involving 952 authors were included. Publication output increased markedly after 2018. The United States contributed the largest number of publications, while several European countries showed strong international collaboration. Knee Surgery, Sports Traumatology, Arthroscopy, The Journal of Arthroplasty, and The Bone & Joint Journal were major publication and citation sources. Early influential studies focused primarily on robotic systems, surgical accuracy, and implant positioning. More recent research has increasingly addressed clinical outcomes, survivorship, revision, complications, patient-reported outcomes, patient satisfaction, and personalized knee arthroplasty. Overall, RA-UKA research has shifted from establishing technical accuracy toward determining whether these technical advantages translate into durable and clinically meaningful benefits. Further multicenter and long-term comparative studies are needed to clarify its effectiveness across different patients, robotic platforms, and clinical settings.

BackgroundSpinal manual therapy is frequently employed to alleviate pain and improve function. Although traditionally applied to spinal disorders, its use for lower extremity isolated pain has been reported, within the framework of regional interdependence. However, the clinical rationale for selecting specific techniques remains insufficiently explored.ObjectiveOur scoping review aimed to systematically investigate and summarize the types of lower extremity conditions addressed using spinal manual therapy applied to the lumbo-pelvic area, the types of interventions used (manipulation, mobilization, soft-tissue techniques and others), and the clinical assessments and outcomes reported.MethodsA comprehensive search of PubMed/MEDLINE, Scopus, ProQuest, PEDro and SPORTDiscus was conducted, covering all study designs. The modified 11-item Consensus on Exercise Reporting Template checklist was used to evaluate the replicability and reporting of spinal manual therapy techniques. Data were systematically categorized, and frequency analyses were performed to identify trends in intervention types and assessment methods.ResultsFifty-one studies were included. Knee-related conditions were the most frequently addressed (62.7%), and manipulation was the most commonly reported spinal manual therapy (SMT) technique (82.4%). Pain, muscle strength and function were among the most frequently assessed outcomes. None of the studies met all modified Consensus on Exercise Reporting Template (mCERT) reporting criteria.ConclusionThe review identified various techniques, particularly for knee-related conditions. However, intervention descriptions were often insufficient to ensure reproducibility. Future research should provide replicable descriptions of spinal manual therapy techniques applied to the lumbo-pelvic area and investigate their effects on clinically relevant outcomes in specific lower extremity conditions.

Patellofemoral instability remains one of the most complex conditions in knee surgery because recurrent instability is rarely attributable to a single anatomical abnormality. Modern treatment has evolved from isolated soft-tissue reconstruction to an individualized "à la carte" approach. As surgical decision-making increasingly relies on quantitative imaging parameters-including patellar height, trochlear morphology, and tibial tubercle position-the reliability and clinical relevance of these measurements become critical. Commonly used patellar height indices and their measurement reliability influence clinical decision-making in the context of personalized patellofemoral stabilization surgery.