HSS studies highlight nonoperative success for orthopedic conditions

Two studies presented by the Hospital for Special Surgery (HSS) at the 2026 American Academy of Orthopedic Surgeons annual meeting may influence how surgeons counsel families of children with severe orthopedic conditions.¹

The first of these studies highlights rest, bracing, and physical therapy as effective treatment for acute spondylolysis in 95% of adolescent athletes. According to investigators, this indicates patients can be treated with a conservative, nonoperative method, reserving surgery as a last resort.¹

“These results are important because when we sit with families to discuss treatment options, we can confidently tell them that the vast majority of patients do have resolution of their pain and are able to return to sports without having to undergo surgery,” said Jessica H. Heyer, MD, senior study author and spine surgeon at HHS.¹

Conservative treatment success

There were 179 children and teenagers with spondylolysis, defined as a stress injury or fracture of the pars leading to lower back pain, included in the analysis. These patients were diagnosed between February 2016 and August 2024, and 95% of them were pain free and able to return to normal activities after 3 months of rest, bracing, and physical therapy.¹

The remaining 5% of these patients required surgery, which involved either a direct repair of the pars or a fusion around the injury. According to Heyer, this was an excellent rate of pain resolution and return to activity. Heyer also noted that there are nationwide variations in the protocols for nonoperative management of spondylolysis.¹

Rather than an acute injury, spondylolysis is caused by repetitive stress.² It is most common in children and teenagers participating in organized sports, though symptoms may not present until adulthood.

The HSS recommends activity restriction for a full 3 months, with physical therapy beginning after 4 to 6 weeks of rest.¹ Restricting activity for this duration allows pain to improve and for healing to occur before deciding whether surgery is necessary.

Growth hormone therapy associated with physeal fractures

HSS researchers also presented a study showing a significant association between growth hormone (GH) therapy and increased odds of physeal fractures, defined as a pediatric growth injury impacting growth plates near the ends of long bones. These include fingers, wrists, and lower legs.¹

Fifteen percent to 30% of all childhood fractures are physeal fractures, with an increased prevalence reported among adolescents who are active in sports. Emily Dodwell, MD, MPH, senior study author and pediatric orthopedic surgeon at HSS, highlighted the significance of GH therapy being linked to greater rates of these fractures in upper and lower extremities.¹

“These findings are important because they provide more data to consider as we help families weigh the risks and benefits of GH therapy,” said Dodwell.¹

Resolving contradictory data

Before this study, data about the impact of GH therapy toward physeal fracture risk was contradictory. According to Dodwell, this led the HSS investigators to conduct their research, identifying pediatric physeal fractures in children with vs without GH exposure from a nationwide insurance claims database.¹

The database included patients aged 4 to 18 years with at least 1 month of GH therapy exposure between 2010 and 2022. This population was followed for at least 2 years. During this time, a significant association was reported between GH therapy and the risk of physeal fractures. Fractures were identified in the following locations¹:

• Proximal humerus
• Proximal radius
• Distal radius
• Distal ulna
• Distal femur
• Proximal tibia
• Distal tibia

“This retrospective study was not designed to determine whether GH actually causes these fractures,” said Dodwell. “Physicians should bear that in mind when counseling patients regarding the risks and benefits of GH therapy.”¹

References

1. HSS presents new findings impacting pediatric orthopedic care recommendations at AAOS annual meeting. News release. Hospital for Special Surgery. March 3, 2026. Accessed March 5, 2026. https://www.businesswire.com/news/home/20260303979806/en/HSS-Presents-New-Findings-Impacting-Pediatric-Orthopedic-Care-Recommendations-at-AAOS-Annual-Meeting
2. Spondylolysis (pars fracture). HHS. Accessed March 5, 2026. https://www.hss.edu/health-library/conditions-and-treatments/list/spondylolysis-pars-fracture