Background/Objectives: Spinal fusion surgery is an accepted form of management for select patients who suffer from degenerative lumbar disease. The need for cost-effective durable techniques is paramount as our population ages. This study compares the radiographic and clinical outcomes of PEEK and 3D-printed titanium interbody cages. Methods: This study compared two cohorts which underwent either PEEK or 3D-printed titanium (3DPT) interbody fusion at a single institution between 2013 and 2022. The PEEK cohort was a retrospective analysis of a prospectively collected registry. The 3DPT data were prospectively collected. The inclusion criteria were adults >18 years who underwent 1 or 2 level lumbar interbody fusion for degenerative spine disease with at least 6 months follow-up. Patient demographics, radiographs, and PROMs were collected. The cohorts were compared using ANOVA for continuous variables and Fisher’s exact test for categorical variables, with significance set to 0.05. Results: The final study included 91 patients, 49 PEEK and 42 3DPT. The 3DPT patients were older (p = 0.047) with increased incidence of hypertension (p < 0.001). The 3DPT patients had less bone morphogenetic protein (BMP) usage (80.9% vs. 54.8%; p = 0.012), but more cellular allograft (p < 0.001). Fusion rate was high for both cohorts, with PEEK at 95.9% and 3DPT at 97.6%. There was no significant difference in reoperation rate. Both the PEEK and 3DPT cohorts demonstrated an improvement in the Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D) at 1 and 2 years compared to preoperative baseline. More patients in the 3DPT group met the MCID for EQ-5D at 1 and 2 years compared to PEEK; however, this was not significant (p = 0.350; p = 1.000). Conclusions: The 3DPT interbody provided comparable if not superior fusion properties to the PEEK interbody given the decreased use of BMP. Both cohorts demonstrated similar improvements in ODI and EQ-5D compared to preoperative baseline. These results suggest that 3DPT cages may be a cost-effective alternative in spinal fusion. Further studies utilizing a larger population with higher follow-up rates are indicated to determine the economic and clinical benefits of 3DPT compared to PEEK cages in lumbar fusion surgery.

The Enhanced Games (EG) represents a controversial shift in competitive athletics by removing anti-doping regulations and allowing the sanctioned use of performance-enhancing drugs (PEDs) in pursuit of maximum performance. This unprecedented model may fundamentally alter sports culture, competition standards, and the medical landscape in which athletes train and compete. Of particular concern are the potential consequences for orthopedic and musculoskeletal health, as PED use, particularly anabolic agents and growth factors, can both enhance and compromise musculoskeletal function. Potential benefits include increased muscle mass or bone density. However, these must be weighed against heightened risks of tendon rupture, altered joint biomechanics, delayed fracture healing, and increased susceptibility to overuse or catastrophic injuries. Given the likelihood of more extreme physical demands and higher injury rates in EG participants, proactive preparation from the orthopedic and sports medicine community is essential. This narrative review focuses on the potential influences of EG on musculoskeletal care, gathering evidence on anticipated injury patterns, surgical and rehabilitative considerations, and long-term health outcomes. The goal is to provide insight for policymakers and care providers tasked with protecting athletes who choose to compete in these environments. Cite this article as: Eftekhari M, Ryali R, Luk J, et al. Enhanced games and performance-optimized athletes: anticipating the orthopedic challenges, a narrative review. Acta Orthop Traumatol Turc. 2026; 60(4), 0824, doi: 10.5152/j.aott.2026.25824.

We introduce a novel quantitative electromyography technique, stimulation-free concentric needle-based motor unit number estimation, which could potentially aid surgical planning in the management of peripheral nerve injury. The ability to apply this technique to any muscle as part of a standard electromyography protocol without imposing additional time burden suggests this technique may represent a practical and feasible approach to optimize surgical outcomes.

Background: Diabetic peripheral neuropathy (DPN) affects nearly 50% of patients with diabetes mellitus, leading to impaired balance and falls. Vibrotactile stimulation during walking is shown to improve gait performance, although the effects of targeted stimulations in the swing phase of gait are unexplored. This study investigated the effects of swing-phase vibrotactile stimulation on gait parameters in DPN. Methods: We conducted a prospective controlled study with the DPN group (DG) aged 18-75 years diagnosed with DPN and the control group (CG) with no diagnosis of diabetes. Participants completed 3-minute walk and Timed Up and Go tests with and without vibrotactile stimulation provided by smart shoes. The shoes measured gait parameters, including stride length, velocity, strike angle, heel clearance, swing-stance ratio, stride duration, and distance. Analysis included the Mann-Whitney U test, with a significance threshold set at P <.05. Results: A total of 28 individuals were analyzed (CG n = 18; DG: n = 10). DG participants were of higher age and BMI compared with controls ( P < .01). At baseline, the DG demonstrated shorter stride length, smaller normalized stride length, lower walking velocity, reduced strike angle, and shorter distance covered in the 3-minute walk ( P < .01). Between-group comparisons revealed increased heel clearance in controls ( P = .03), which was attenuated after adjusting for age and BMI ( P = .17). Conclusion: Our findings did not reveal an immediate effect of swing-phase stimulation on gait parameters in DPN patients. However, temporal gait parameters may require more demanding tasks or longer exposure to yield measurable benefits. Larger, age-matched trials using variability data are warranted to determine efficacy and identify responders in DPN. Level of Evidence: Level II, prospective comparative study.

Background: Syndesmotic malreduction is a well-documented complication impacting ankle fracture outcomes. Although syndesmotic screw fixation remains the most common method for stabilization, optimal screw height placement has not been rigorously evaluated in terms of its impact on reduction accuracy. This cadaveric study aimed to assess the influence of screw height placement on syndesmotic alignment in a simulated pronation–external rotation (PER) ankle fracture model. Methods: Ten knee disarticulated cadaveric specimens underwent simulated PER injuries. Quad-cortical syndesmotic screws were incrementally placed at different levels at 0.6-cm intervals, ranging from 1.5 to 6.3 cm above the plafond. At each level, the syndesmosis was manually open reduced, stabilized, and imaged using computed tomography. Syndesmotic alignment was assessed using standard axial 2-D measurements and 3-D volumetric analysis. For each screw height placement, radiographic parameters were compared to the intact state. Results: Screw height placement significantly influenced syndesmotic alignment across all measured parameters. Fibular rotation and translation both varied significantly with screw level ( P < .01), as did anterior, mid, and posterior diastasis (all P < .01). Three-dimensional volumetric analysis also showed a significant difference between screw levels ( P < .01). A screw placed 2.7 cm above the tibial plafond resulted in alignment measurements closest to native across 2-D and 3-D measurements. With the numbers available, no correlation could be detected between surgeon variability, incisural morphology, and malreduction. Conclusion: This study suggests that screw height placement can influence the quality of syndesmotic reduction in a simulated PER ankle fracture model. A screw placed 2.7 cm above the tibial plafond most closely approximated native syndesmotic alignment and may minimize the risk of malreduction. Clinical Relevance: Given the reported incidence of syndesmotic malreduction and its association with worse outcomes, understanding whether screw height placement is a modifiable risk factor may inform intraoperative technique during syndesmotic fixation.