Purpose of Review: The global rise in obesity and type 2 diabetes mellitus (T2DM) presents significant challenges in musculoskeletal care, contributing to increased perioperative complications, impaired bone health, and compromised muscle function. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), initially developed for glycemic control in T2DM, have demonstrated substantial benefits in weight reduction and metabolic regulation. The purpose of this review is to understand the musculoskeletal biologic and clinical implications of GLP-1RAs. Recent Findings: Evidence suggests that GLP-1RAs may impact musculoskeletal health through anti-inflammatory effects, bone metabolism modulation, and alterations in muscle composition. GLP-1RAs may promote osteoblastogenesis while dampening osteoclast activity to maintain bone mineral density. The result on fracture risk is unclear. Additionally, while GLP-1RAs cause lean mass loss, GLP-1RAs appear to preserve skeletal muscle, reduce fatty infiltration, and enhance fiber formation and function. Further, GLP-1Rs are present in synovial tissue and cartilage, demonstrating downregulation of inflammatory molecules and chondrocyte apoptotic pathways, though clinical studies show variable effects in the setting of osteoarthritis. Overall, the heterogeneity in findings underscores the need for further research to delineate the long-term musculoskeletal effects of GLP-1RAs. Summary: Understanding the musculoskeletal impact of GLP-1RAs is critical for optimizing their integration into orthopedic practice. This review explores the orthopedic implications of GLP-1RAs, highlighting their biologic mechanisms and clinical effects on obesity-related joint inflammation and arthropathy, bone mineral density and fracture risk, and skeletal muscle preservation.

Background: Rotator cuff (RC) tears are among the most common causes of shoulder dysfunction in sports medicine. Muscle atrophy and degeneration are important risk factors for RC tendon retearing and suboptimal recovery of shoulder function after tendon repair. Although blood flow restriction (BFR) can stimulate muscle regeneration after lower extremity trauma and anterior cruciate ligament reconstruction, the mechanisms that underlie BFR remain unknown, and its application to RC tears has not yet been explored. Hypothesis: The authors hypothesized that BFR induces transfer of mitochondria from intramuscular fibro-adipogenic progenitors (FAPs) to myocytes, enhances muscle regeneration, and improves shoulder function after RC injury. Study Design: Controlled laboratory study. Methods: To assess mitochondrial transfer after BFR, the authors used Prrx1-Cre/MitoTag reporter mice, in which FAP mitochondria are labeled. Mice underwent unilateral forelimb BFR, and supraspinatus (SS) muscles were collected at baseline and days 1, 2, 3, 5, and 7 for histology. To model massive RC tears, mice received unilateral SS and infraspinatus tendon transection with denervation (TT+DN) and then were randomized to a BFR (every 3 days) or control group. At 2 or 6 weeks after surgery, SS muscles were analyzed for mitochondrial transfer, fiber size, and fiber-type distribution. Additionally, forelimb gait and weightbearing were captured using the Blackbox system. Results: BFR was associated with increased FAP-mediated mitochondrial transfer in healthy SS muscle as early as 1 day after BFR treatment and lasted for up to 3 days after BFR. The authors observed an enhanced effect of BFR-induced FAP mitochondrial transfer in SS muscle after RC injury, compared with the control, at both 2 and 6 weeks after TT+DN. BFR-treated mice had significantly reduced muscle atrophy, fatty infiltration, and fibrosis after RC injury. They also observed a significant improvement in forepaw weightbearing ratio and ipsilateral forepaw stride length at 6 weeks after injury in BFR-treated mice compared with controls. Conclusion: BFR significantly improves muscle quality and shoulder function after RC injury. These effects occur alongside increased mitochondrial transfer from FAPs to myocytes. Clinical Relevance: Understanding the mechanism of BFR by which BFR enhances muscle regeneration could pave the way for its use as a novel rehabilitation strategy to improve recovery in patients with RC injuries and other muscle-related conditions.

Background: Randomized controlled trials (RCTs) and clinical trials (CTs) are critical for evaluating treatment effectiveness, with abstracts serving as the primary source of the study that is read. Purpose: This study explored selective reporting of significant P values in the abstracts of RCTs and CTs on mesenchymal stromal cells (MSCs) for the treatment of knee osteoarthritis (OA). The purpose was to compare the rates of significant P values reported in the abstract compared with the main text of RCTs and CTs on MSCs for the treatment of knee OA. Study Design: Systematic review. Methods: PubMed (MEDLINE) and Embase searches were conducted using related terms and were filtered for RCTs and CTs. There were 2 reviewers who analyzed the abstract and main text independently and extracted study characteristics and every P value reported in the abstract and main text of each article. The distribution of significant P values between the abstract and main text was compared using a paired-samples t test and odds ratios. Significance was set at P < .05. Results: The initial search yielded 156 articles, with 61 meeting the inclusion criteria. Our analysis showed a significant discrepancy in the distribution of P values between the abstract and main text. In abstracts, 79.3% of P values were significant compared with 53.8% in main texts. The odds of significant P values being reported in the abstract over the main text were more than 3 times higher (odds ratio, 3.3). The paired-samples t test confirmed that abstracts were significantly more likely to report significant findings ( P = 7.5 × 10 ⁻⁸ ). Primary outcomes were reported in 90.2% of abstracts, with 18.0% being significant, 47.5% being not significant, and 34.4% being not applicable because of qualitative results. Functional and quality of life scores were the most common primary outcomes in 34 studies, followed by safety and adverse events in 25 studies, pain measurements in 20 studies, and imaging outcomes in 17 studies. Conclusion: Our study highlights a significant risk of reporting bias in RCTs and CTs of MSCs for the treatment of knee OA. With growing interest in the use of MSCs, it remains crucial for busy clinicians to recognize the possibility of selective reporting bias in abstracts, as this could potentially influence clinical decision making.

UNSTRUCTURED On November 20, 2022, an AI company introduced ChatGPT, a technological breakthrough with significant potential for public use. In this article, we will explore the role of ChatGPT in residency training and how it can benefit medical professionals in their pursuit of delivering quality patient care. By integrating ChatGPT into residency training programs, medical professionals can enhance their knowledge and practical skills, communication skills, empathy, and cultural competence. These are essential qualities for providing quality patient care and ensuring positive outcomes. To fully harness the capabilities of ChatGPT, medical professionals must acquire a profound understanding of the tool and its workings to prevent bias or errors resulting from improper usage. Nevertheless, it is essential to acknowledge that using ChatGPT raises ethical and performance concerns that must be addressed. Establishing professional ethics, user responsibility and transparency in the work routine is crucial to mitigate potential issues. In conclusion, ChatGPT presents a significant opportunity for residency education to enhance their skills and abilities. By integrating it into residency training programs and adopting a responsible approach, we can harness the potential of ChatGPT to provide better patient care and ultimately improve the healthcare system.