Background: Metastatic bone disease (MBD) presents significant challenges in patient management, leading to skeletal-related events (SREs), compromised health-related quality of life, and heightened pain experiences. Denosumab (Dmab) and zoledronic acid (ZA) are bone-modifying agents (BMAs) commonly employed to mitigate the sequelae of MBD. Previous meta-analyses have assessed primary outcomes such as overall survival, pathological fractures, radiation to bone, and the time to SREs within studies. However, a single comprehensive analysis comparing their efficacy across multiple primary and secondary outcomes, as well as cost-effectiveness in specific cancer types, has not yet been conducted. Methods: A literature search identified relevant randomized controlled trials (RCTs), and the primary outcomes included overall survival, pathologic fractures, radiation to bone, and the time to SREs within studies. Secondary outcomes included adverse events, pain, analgesia usage, quality of life, and cost. Results: Meta-analysis revealed that Dmab effectively reduced the need for bone-targeted radiation therapy and was superior to ZA in delaying the time to SREs, except in multiple myeloma. Dmab also reduced pathological fracture incidences in breast cancer patients by 39%. Conclusions: Our analysis suggests that while both agents similarly impact overall survival and disease progression, Dmab offers advantages in SRE reduction and improved HRQoL and pain outcomes with lower rates of opioid usage, albeit with higher risks of hypocalcemia and osteonecrosis in some subgroups. The consensus on cost-effectiveness is mixed and varies based on the cancer type and healthcare system, with some studies favoring Dmab’s superior efficacy and safety, while others find ZA more cost-effective due to its lower cost. This study underscores the potential of Dmab as a preferred BMA for MBD management, especially for high-risk skeletal complications, while highlighting cancer-specific safety considerations. Further research is warranted to refine cancer-specific BMA use and optimize MBD management strategies.

The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee, with most patients undergoing surgical reconstruction. Of these patients, 6.5-27.6% require a second operation to treat loss of motion, which can cause substantial delays in patient recovery and return to sport. Currently, there is a paucity of comprehensive data regarding loss of motion following anterior cruciate ligament reconstruction (ACLR) surgery, resulting in variable measures of incidence and uncertainty about risk factors. The primary objective of this study is to identify the incidence and risk factors for repeat surgical intervention for loss of motion following primary ACLR. Two independent reviewers conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, MEDLINE, and PubMed databases were searched, along with the reference lists of included articles and related systematic reviews. Studies were included if they met the following criteria: (1) included adult patients with primary ACL ruptures treated surgically, (2) had a follow-up period of at least 3 months postoperative, (3) provided an objective definition of stiffness, arthrofibrosis, or cyclops lesions, and (4) reported the incidence and/or risk factors for loss of motion. A random-effects meta-analysis was conducted to estimate the pooled incidence of loss of motion across studies. A total of 48 studies were included in the final analysis. Of these studies, 46 reported the incidence of loss of motion requiring surgery, with a mean pooled incidence of 4% (95% CI: 3-5 ​%). The incidence decreased over time from 10% (95% CI: 7-13%) in 1991-1999 to 4% (95% CI: 3-5%) in 2000-2023. There were 29 studies that reported statistically significant risk factors for loss of motion requiring surgery. The most common risk factors were female sex, acute repair, concomitant meniscus repair, delayed postoperative range of motion, and preoperative range of motion deficit. The incidence of loss of motion requiring surgery after ACLR is 4%, with a variety of risk factors related to the patient, injury, surgery, and recovery. The incidence has decreased over time, but arthrofibrosis remains a devastating surgical complication that is important to discuss with patients. III.

Objective: To evaluate the impact of vestibular rehabilitation (VR) on patient-reported outcome measures in adults with vestibular migraine (VM). Databases reviewed: Medline, Embase, and Scopus were reviewed from database inception to May 2025. Additional citation searches were performed. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were used. Primary studies assessing VR in adults with VM diagnosed using ICHD-3 or equivalent criteria were included. The primary outcome was the change in the Dizziness Handicap Inventory (DHI) and the Activity-Specific Balance Confidence Scale (ABC). Mixed-effects modeling was used for the meta-analysis. Results: Seven studies comprising 272 participants were included. All studies demonstrated improvement in DHI following VR, with individual study treatment effects ranging from −10.57 to −44.7 points reduction. Meta-analysis showed a clinically significant pooled DHI reduction of −23.97 (95% CI: −33.31 to −14.62; P <0.0001). Heterogeneity was high ( I ² =96%), potentially due to patient selection, duration of disease, duration of VR, adjunctive therapies, timing of outcomes assessment, and VR protocol differences. Funnel plot asymmetry suggested small-study effect. Improvements in the ABC were reported but did not meet clinically significant thresholds. Conclusion: On the basis of the included studies, VR is associated with clinically meaningful reductions in DHI among VM patients; however, effects on balance may not be clinically significant. Heterogeneity, limited data, as well as moderate and low quality of evidence for the available outcomes, highlight the importance of future large prospective studies with standardized VR protocols and outcomes.

Background/Objectives: Metastatic bone disease (MBD) of the pelvis is commonly managed with open reconstruction despite substantial morbidity and high complication rates ranging from 16–32%. Percutaneous fixation techniques have emerged as a lower morbidity alternative; however, robust evaluations of outcomes remain limited. Therefore, the primary aim of this systematic review was to evaluate changes in pain and function following percutaneous fixation for pelvic MBD, and to determine the complication and reoperation rates of these procedures. Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, Scopus, and Cochrane Library databases were searched from inception through 15 May 2025. Studies evaluating percutaneous fixation for pelvic MBD in adults were included. Pooled estimates of visual analog scale (VAS) pain scores, Eastern Cooperative Oncology Group (ECOG) performance status scores, complication rates, and reoperation rates were generated using meta-analysis techniques. Results: Twenty-five studies were included in the final analysis. VAS pain scores were reported in 15 studies, with an average decrease of 5.0 points (95% CI: 3.9–6.1) from pre- to postoperative. ECOG performance status scores were reported in 8 studies, with an average improvement of 1.1 points (95% CI: 0.7–1.5) from pre- to postoperative. Complications were reported in 24 studies, with a pooled complication rate of 8% (95% CI: 6–12%) and reoperation rate of 4% (95% CI: 2–7%). Conclusions: Percutaneous fixation for pelvic MBD provides meaningful improvements in pain and function with relatively low complication rates. However, substantial study heterogeneity exists in the patient population, surgical techniques, and implant selection, reflecting the novelty of this treatment strategy and the absence of standardized guidelines.