Musculoskeletal pain presents a major global public health burden as it is a highly prevalent and disabling health condition. Non-pharmacologic treatments such as therapeutic exercise and dry needling are increasingly utilized in current practice although uncertainty remains regarding their comparative and combined effectiveness. This study aimed to systematically review contemporary evidence regarding the effectiveness of dry needling and exercise, alone and in combination, for the management of musculoskeletal pain. A systematic search adherent to PRISMA guidelines was conducted of PubMed, Web of Science, and Scopus databases for relevant studies from 2000-2023. After screening 642 records, 22 studies comprising a total of 1585 participants were analyzed. Seventeen studies (73.9%) found that dry needling provided no additional benefits over exercise alone for the reduction of musculoskeletal pain. Three studies demonstrated no improvements with either intervention alone. However, three studies showed greater improvements when dry needling was combined with exercise in knee osteoarthritis, trapezius myofascial pain, and low back pain. The most frequently utilized dry needling technique involved rapid in-and-out needling for 25 seconds to 15 minutes with 12-15 insertions per muscle, delivered over at least five weeks (twice weekly). Current evidence supports dry needling plus exercise as efficacious for musculoskeletal pain, although dry needling offers no additional benefit versus exercise alone. The heterogeneity of methods underscores the need for further high-quality comparative effectiveness trials across diverse populations and pain conditions to identify optimal protocols.

BackgroundAdductor canal block (ACB) catheters are an effective method of pain control for patients undergoing total knee arthroplasty (TKA). Despite their widespread use, there is limited research analyzing their impact on postoperative outcomes. Thus, this study compares 30 and 90 days postoperative outcomes in TKA patients stratified by the use of an ACB catheter.MethodsThis retrospective, propensity-matched cohort study utilized the TriNetX Research Network. The first cohort included patients who had an indwelling ACB catheter (continuous infusion) on the same day as their TKA (+ACB). The second cohort consisted of patients who did not have an ACB catheter on the same day as their TKA (-ACB). The study analyzed data collected between January 1, 2003, and January 1, 2023. To control for confounding variables, propensity score matching was employed based on common comorbidities. P < 0.01 was considered significant.ResultsA total of 27,813 patients were successfully matched in each cohort. Within 30 days following TKA, patients in the +ACB cohort exhibited a significantly increased rate of several complications including: transfusion (1.5% vs 0.5%; RR: 3.2), deep vein thrombosis (lower extremity) (2.5% vs 1.9%; RR: 1.3), periprosthetic joint infection (0.9% vs 0.6%; RR: 1.6), acute renal failure (2.1% vs 1.2%; RR: 1.8), acute posthemorrhagic anemia (8.1% vs 3.9%; RR: 2.1), and opioid use (98.6% vs 94.2%; RR: 1.046 [95% CI: 1.043-1.050]). The increased risk profile remained at 90-days follow-up. Notably, we found no significant difference in the risk of manipulation under anesthesia between the cohorts at 90-days follow-up (RR: 1.0).ConclusionOur study raises concern that the use of ACB catheters in TKA may increase morbidity following TKA. While ACB catheters may help with pain management, these results suggest an increased risk of many postoperative complications within 30- and 90-days post-TKA.

Simultaneous ruptures of the quadriceps tendon and contralateral patellar tendon are exceedingly rare, particularly in patients without serious comorbidities or other known predisposing factors. We present the case of an obese 31-year-old man without metabolic syndrome or any other known predisposing risk factors who suffered a right quadriceps tendon rupture and simultaneous left patellar tendon rupture, and tear of the anterior horn of the left lateral meniscus. These injuries occurred while walking downstairs and missing a step. He presented with bilateral knee pain, ecchymosis, and the inability to extend either leg. The diagnosis was confirmed by imaging, and he underwent surgical repairs of both tendons as well as the left lateral meniscus. Thereafter, the postoperative course was uncomplicated. By six months post-surgery, he was able to regain full range of motion in both knees with minimal pain and a normal gait. This case highlights the importance of early recognition, prompt surgical intervention, and structured rehabilitation in achieving optimal recovery in a complex and rare extensor mechanism injury.

Optimal frontal plane alignment of transtibial bone-anchored prostheses (BAPs) is essential to minimize knee joint loading asymmetries. This study examined whether bilateral whole-leg radiographic imaging could improve static alignment and reduce knee joint loading during gait in 23 unilateral transtibial BAP users with press-fit osseointegration implants with an experimental within subject study design. Static weight-bearing line (WBL) alignment and frontal plane knee moments during gait were assessed before and after the intervention. Pain levels were monitored one week before and one week after the intervention. Radiographic imaging significantly improved static WBL symmetry (p < 0.001). Thereby, it can be said with 90% confidence that asymmetries above 4.2 mm can be improved by alignment adjustments. The magnitude of these changes was significantly associated with changes in prosthetic-side peak knee adduction moment (p < 0.001), although no significant group-level improvement in dynamic knee adduction moment asymmetry was observed. Pain levels remained unchanged (p = 0.773), and 19 of 23 participants preferred the radiograph-based alignment over their original setup. These findings support radiographic imaging as an effective method for detecting and correcting static misalignments in transtibial BAP users, while highlighting the need for complementary dynamic gait evaluation.