Orthopedics [JOURNAL]
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200 papers
Cauda Equina Dural Sac Hernia Caused by the Drainage Tube After Lumbar Unilateral Biportal Endoscopy Surgery: A Case Report.
Fang X, Xu D, Lin C … +2 more , Zhu M, Teng H
Orthopedics · 2026 · PMID 41885512 · Publisher ↗
Previously reported cases of cauda equina herniation primarily involve compression of the spinal cord caused by fracture fragments intruding into the spinal canal following traumatic spinal burst fractures or by dural te...
Previously reported cases of cauda equina herniation primarily involve compression of the spinal cord caused by fracture fragments intruding into the spinal canal following traumatic spinal burst fractures or by dural tears occurring during spinal endoscopic surgery. Such cases can often be evaluated preoperatively or intraoperatively to facilitate the selection of an appropriate treatment plan. However, cauda equina herniation resulting from the use of a drainage tube following spinal endoscopic surgery has not yet been reported. In this article, we present a case of a 76-year-old male patient who experienced a dural tear resulting in cauda equina herniation due to the positioning of the drainage tube following an L4/5 lumbar unilateral biportal endoscopy procedure. This case highlights the importance of timely surgery following cauda equina herniation and provides guidance for intraoperative procedures and perioperative management of patients undergoing spinal endoscopic surgery.
Estrogen Replacement Therapy and Postoperative Complications After Distal Radius Open Reduction and Internal Fixation.
Alhankawi AR, Braithwaite CL, Holle AM … +3 more , Koschmeder KT, Lin E, Renfree KJ
Orthopedics · 2026 · PMID 41885511 · Publisher ↗
BACKGROUND: To our knowledge, there are no studies assessing associations between patients on preoperative estrogen replacement therapy (ERT) undergoing distal radius open reduction and internal fixation (DRORIF) and pos...
BACKGROUND: To our knowledge, there are no studies assessing associations between patients on preoperative estrogen replacement therapy (ERT) undergoing distal radius open reduction and internal fixation (DRORIF) and postoperative outcomes. Thus, the purpose of this study was to compare surgical and medical complications in patients on ERT undergoing DR-ORIF with a matched control cohort. MATERIALS AND METHODS: The PearlDiver Mariner database was searched for female patients who took ERT within 3 months of the index procedure. Patients were matched 1:4 with non-ERT controls using propensity score matching. Complications were assessed at 90 days, 2 years, and 5 years. Statistical analyses were conducted using odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was determined at a value of <.05. RESULTS: The ERT cohort consisted of 1,815 ERT users, and the control cohort consisted of 7,247 patients. At 2 years, the ERT cohort was associated with a slightly greater incidence of malunion/nonunion (OR, 1.57; 95% CI, 1.13-2.18) but with no increased risk of revision surgery (OR, 1.10; 95% CI, 0.50-2.10). Similarly, at 5 years, the ERT cohort was associated with a slightly higher likelihood of a malunion/nonunion diagnosis (OR, 1.69; 95% CI, 1.24-2.30). CONCLUSION: The current study suggests that patients on preoperative ERT had a slightly increased risk of malunion/nonunion at 2 years and 5 years after DR-ORIF. We did not find associations between increases in the risk of any other major or minor complications and the cohort of patients on preoperative ERT within 5 years postoperatively.
Capitellar Osteochondritis Dissecans Lesion Treated With Bioabsorbable Pin, Extracellular Matrix Cartilage Allograft, and Intraosseous Bioplasty: A Case Report.
Hutton JD, Ahmady AA, Riedel BB
Orthopedics · 2026 · PMID 41801125 · Publisher ↗
Capitellar osteochondritis dissecans (OCD) is a painful and debilitating condition, most often seen in adolescent overhead athletes and gymnasts. Treatment options for unstable capitellar OCD lesions include fragment fix...
Capitellar osteochondritis dissecans (OCD) is a painful and debilitating condition, most often seen in adolescent overhead athletes and gymnasts. Treatment options for unstable capitellar OCD lesions include fragment fixation, autologous chondrocyte implantation, osteochondral autograft, fragment debridement, and drilling of the lesion. While many current surgical techniques yield suboptimal outcomes, this case demonstrates a novel technique for treating an unstable capitellar OCD lesion with associated subchondral cyst in a 14-year-old female patient. This technique combines bioabsorbable pin fixation and allograft cartilage extracellular matrix with intraosseous bioplasty to restore the articular surface and subchondral support. A lateral approach to the elbow was used to create a reamed window in the capitellum, allowing access to the cystic defect. The osteochondral fragment was fixed with a poly-L-lactide acid pin, and the defect was backfilled using demineralized bone matrix mixed with bone marrow aspirate. The residual cartilage lesion was filled with extracellular matrix cartilage allograft. The graft was contained in the lateral window with fibrin glue. At 4-month follow-up, the patient displayed full elbow range of motion with no pain. At 6-year follow-up, magnetic resonance imaging showed a well-healed capitellum with normal contour and signal of the repaired cartilage. This case demonstrates a novel technique for treating OCD lesions of the capitellum with durable clinical and radiographic success.
Primary Total Ankle Replacement for Acute Comminuted Pilon Fractures in Older Adults: Proposed Indications and a Report of 29 Cases.
Kim J, Chun DI, Cho J … +3 more , Won SH, Lee SH, Yi Y
Orthopedics · 2026 · PMID 41801124 · Publisher ↗
BACKGROUND: Management of severe distal tibia pilon fractures (AO/OTA 43-C3) in older adults is exceptionally challenging. Open reduction and internal fixation is associated with a high incidence of posttraumatic arthrit...
BACKGROUND: Management of severe distal tibia pilon fractures (AO/OTA 43-C3) in older adults is exceptionally challenging. Open reduction and internal fixation is associated with a high incidence of posttraumatic arthritis, whereas primary arthrodesis results in significant functional limitations. We investigated primary total ankle replacement (TAR) as a definitive, single-stage, motion-preserving solution. MATERIALS AND METHODS: We retrospectively reviewed 29 older adult patients (age ≥60 years) treated with primary TAR since 2016 for comminuted pilon fractures. Inclusion required severe articular destruction (AO/OTA 43-C2/C3) but a reconstructable metaphyseal cortical shell. We evaluated surgical timing, adjunctive fixation, bone grafting, and clinical and radiographic outcomes. The primary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at ≥6 months. RESULTS: At 6 months post-surgery, the mean AOFAS score was 85.2 ± 7.5. Metaphyseal fracture union was achieved in all cases at an average of 17.4 ± 2.1 weeks. Postoperative alignment was excellent, with a mean medial distal tibial angle (MDTA) of 89.2° ± 1.8°. No deep infections, insert dislocations, or component overhang were observed. Three patients (10.3%) developed progressive valgus deformity, with MDTA increasing by an average of 3.4° at 1 year. CONCLUSION: In this retrospective level IV series with short-term follow-up, primary TAR may be a feasible option for carefully selected older adult patients with comminuted pilon fractures and a preserved metaphyseal cortical shell, demonstrating encouraging early functional outcomes. Longer term follow-up is required to determine implant survivorship and revision risk.
Pediatric Mycobacterium Tuberculosis Infection Involving the Ankle: A Case Report.
Chen H, Gao S, Li L … +2 more , Zhao X, Zhao G
Orthopedics · 2026 · PMID 41801123 · Publisher ↗
Extrapulmonary tuberculosis is relatively rare, and osteoarticular tuberculosis involving the ankle joint is particularly uncommon. We report a 10.5-year-old, previously healthy male patient who initially presented to th...
Extrapulmonary tuberculosis is relatively rare, and osteoarticular tuberculosis involving the ankle joint is particularly uncommon. We report a 10.5-year-old, previously healthy male patient who initially presented to the trauma surgery department with a 2-month history of swelling, pain, and limited mobility of the left ankle following minor trauma. Blood tests, including tests to determine blood cell counts, C-reactive protein level, and the erythrocyte sedimentation rate, bacterial and fungal cultures, and T-cell spot tests for tuberculosis (T-SPOT.TB) were performed. B-ultrasound-guided aspiration of the infected area was carried out, which included two surgeries for extensive irrigation, debridement, and drainage. A pus sample was sent for routine bacterial culture and an acid-fast bacillus test, and the bone and soft tissue samples were sent for pathological biopsy and the detection of by sequencing and rifampicin resistance analysis. The empirical antibiotic was administered for 1 week, followed by linezolid and rifampicin for anti-infection treatment. Ten days later, the T-SPOT.TB test result was positive. Gene sequencing detected the complex at "very low levels" with no detection of rifampicin resistance, and the pathological report revealed "chronic necrotizing granulomatous inflammation." After the diagnosis of infection was confirmed, the patient was started on appropriate antituberculosis therapy with the isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE) regimen, and the function of the ankle joint was followed up in the outpatient clinic. This case serves as a reminder for clinicians to consider infection in children presenting with atypical ankle swelling and pain.
Radiographic Features of Posttraumatic Knee Osteoarthritis More Than 10 Years After Anterior Cruciate Ligament Reconstruction: Osteophyte Enlargement With Preserved Joint Space.
Sugitani K, Kim Y, Kubota M … +10 more , Kawashima Y, Mihara N, Arita H, Tomura J, Shiozawa J, Hada S, Yoshida K, Kaneko H, Saita Y, Ishijima M
Orthopedics · 2026 · PMID 41774567 · Publisher ↗
BACKGROUND: Anterior cruciate ligament (ACL) injury is a major risk factor for knee osteoarthritis (OA). Although ACL reconstruction (ACLR) restores stability, it does not reliably prevent OA. This study investigated the...
BACKGROUND: Anterior cruciate ligament (ACL) injury is a major risk factor for knee osteoarthritis (OA). Although ACL reconstruction (ACLR) restores stability, it does not reliably prevent OA. This study investigated the radiographic features of patients with knee OA more than 10 years after ACLR. MATERIALS AND METHODS: Thirty patients (21 female and 9 male; mean age, 45.4 ± 12.0 years) who underwent ACLR more than 10 years ago (mean postoperative period, 14.5 ± 4.0 years) were included. Standing anteroposterior radiographs of ACLR and contralateral healthy knees were evaluated for Kellgren-Lawrence (KL) grade, osteophyte width at the medial and lateral tibial and femoral surfaces, and minimum joint space width (mJSW). Lower limb alignment was assessed using medial proximal tibial angle (MPTA) and joint line convergence angle (JLCA). Subgroup analyses were based on KL grade concordance and history of partial meniscectomy. RESULTS: KL grades were significantly higher in ACLR knees than in contralateral knees ( < .001). Osteophyte widths were greater in ACLR knees at medial tibia (2.1 ± 1.1 mm vs 0.5 ± 0.7 mm), lateral tibia (2.3 ± 2.3 mm vs 0.5 ± 0.7 mm), medial femur (2.0 ± 1.7 mm vs 0.1 ± 0.4 mm), and lateral femur (1.4 ± 2.3 mm vs 0.2 ± 0.5 mm); all < .001. No significant differences were observed in mJSW ( = .904), MPTA ( = .232), or JLCA ( = .681). Subgroup analyses showed similar findings. CONCLUSION: Enlarged osteophytes without joint space narrowing were observed in ACLR knees, suggesting a posttraumatic OA radiographic pattern distinct from that of primary OA.
Exceptional Massive Calcification of the Medial Collateral Ligament: A Case Linked to Underlying Lung Neoplasm.
Ta H, Yang J, Liu X … +1 more , Zhou F
Orthopedics · 2026 · PMID 41745902 · Publisher ↗
Calcific tendinitis of the medial collateral ligament (MCL) is an exceedingly rare cause of knee pain. We report an exceptional case of massive, refractory MCL calcific tendinitis, with a unique presentation potentially...
Calcific tendinitis of the medial collateral ligament (MCL) is an exceedingly rare cause of knee pain. We report an exceptional case of massive, refractory MCL calcific tendinitis, with a unique presentation potentially linked to an underlying malignancy. A 61-year-old female patient presented with a 3-month history of persistent left medial knee pain, unresponsive to conservative therapy. Physical examination revealed medial joint line tenderness and limited range of motion. Imaging-including radiography, 3-dimensional computed tomography, and magnetic resonance imaging-demonstrated an unusually voluminous, strip-like calcific deposit within the proximal MCL. Notably, a concurrent lesion was identified in the left lung during the diagnostic workup and was subsequently confirmed as invasive lung adenocarcinoma. Given the failure of nonoperative measures and the large size of the calcification, open surgical excision was performed, leading to rapid and complete resolution of symptoms. This case highlights that massive, refractory calcific tendinitis may be a marker of systemic calcium dysregulation. The coexistence of invasive lung adenocarcinoma warrants consideration of an underlying systemic process, including potential metabolic dysregulation or paraneoplastic mechanisms that may contribute to periarticular calcification. We suggest that clinicians should evaluate for underlying metabolic and/or oncological disorders when atypical or massive periarticular calcifications are encountered. In such complex scenarios, open excision remains an effective definitive treatment if conservative measures fail.
No Difference in Knee Pain Between Bone-patellar Tendon-bone and Hamstring Autograft at 2-year Follow-up.
Banfield NF, Kleinsmith RM, Puckett HD … +5 more , Doxey SA, Tompkins M, Fetzer G, Nelson BJ, Cunningham BP
Orthopedics · 2026 · PMID 41745646 · Publisher ↗
BACKGROUND: Previous literature has suggested that bone-patellar tendon-bone (BPTB) autograft can be associated with more postoperative anterior knee pain compared to other graft types during anterior cruciate ligament r...
BACKGROUND: Previous literature has suggested that bone-patellar tendon-bone (BPTB) autograft can be associated with more postoperative anterior knee pain compared to other graft types during anterior cruciate ligament reconstruction (ACLR). This study aimed to compare the differences between patients undergoing ACLR with either BPTB or hamstring (HT) autografts, focusing on 2-year follow-up patient-reported outcome measures (PROMs). MATERIALS AND METHODS: A retrospective cohort study of a prospectively collected PROMs database was conducted for 411 patients who underwent primary ACLR between 2009 and 2021. Outcomes collected included 2-year Knee Injury and Osteoarthritis Outcome Score (KOOS), the KOOS pain subscale, and a Single Assessment Numeric Evaluation. Statistical analysis consisted of descriptive analyses (eg, counts, means, ranges), independent-sample t tests, chi-squared tests, as well as analysis of variance. The level of statistical significance was set at ≤ .05. RESULTS: The 2-year improvement and final KOOS pain subscale from the preoperative baseline was not found to be significantly different between the groups (BPTB: 91.6 vs HT: 90.6; BPTB: 12.5 vs HT: 15.2, = .065, = .633, respectively). The baseline overall KOOS was higher in BPTB autograft cohort and the 2-year change in KOOS was higher in the HT autograft cohort when compared to other autograft cohort (68.2 vs 63.6, .001; 16.4 vs 19.7, = .040, respectively). Overall KOOS at final follow-up did not differ between autografts (84.6 vs 83.0, = .136, respectively). CONCLUSION: ACLR with BPTB autograft was not found to be associated with worse knee pain scores compared to HT autograft at 2-year follow-up.
Return to Driving After Anterior Total Hip Arthroplasty.
Masturov YA, Hogan WB, Regal S … +2 more , Sybert M, Hammarstedt JE
Orthopedics · 2026 · PMID 41636440 · Publisher ↗
BACKGROUND: Traditional guidance after posterior-approach total hip arthroplasty (THA) recommends return to driving at 6-8 weeks. Muscle-sparing direct anterior THA (A-THA) may enable earlier recovery. Our objective was...
BACKGROUND: Traditional guidance after posterior-approach total hip arthroplasty (THA) recommends return to driving at 6-8 weeks. Muscle-sparing direct anterior THA (A-THA) may enable earlier recovery. Our objective was to assess brake reaction time (BRT) before and after right and left A-THA. MATERIALS AND METHODS: This is a prospective cohort study of 32 patients who underwent an A-THA (21 right, 11 left). BRTs were recorded using Vericom's stationary reaction timer and response software at the patient's last preoperative visit and at 2 and 6 weeks postoperatively. Pain was assessed during each visit using the visual analog scale (VAS); an Oxford Hip Score (OHS) was filled out at the preoperative and 6-week visits. RESULTS: For patients undergoing right A-THA, mean BRT improved from 0.67 seconds (s) (±0.15) preoperatively to 0.60s (±0.05) at 2 weeks ( = .01) and 0.58s (±0.06) at 6 weeks ( = .03). Eighteen of 21 (85.7%) reached or surpassed baseline by 2 weeks. OHS improved from 36 to 19, and VAS improved from 2.9 to 0.24. Right-foot brakers undergoing left A-THA exhibited no significant BRT change: 0.63s (±0.13) preoperatively; 0.60s (±0.11) at 2 weeks, = .53; and 0.58s (±0.07) at 6 weeks, = .31. OHS improved from 37 to 20, and VAS did not change significantly. CONCLUSION: Our objective data support consideration of earlier return to driving after A-THA when patients are off narcotics and meet local/insurer requirements.
Effects of Physical Activity on Orthopedic Surgery Resident Quality of Life.
Taylor BC, Ryan GA, Melton B … +2 more , Biber DD, Anderson MS
Orthopedics · 2026 · PMID 41636439 · Publisher ↗
BACKGROUND: Although various factors have been investigated with the goal of improving orthopedic surgery residents' quality of life, there is limited information on the effect of exercise on this population. The primary...
BACKGROUND: Although various factors have been investigated with the goal of improving orthopedic surgery residents' quality of life, there is limited information on the effect of exercise on this population. The primary purpose of this study was to investigate the effects of physical activity on the quality of life of orthopedic surgery residents, with the secondary aim of comparing the differing effects of aerobic and resistance training in this population. Additionally, this study sought to examine the relationship between burnout and quality of life, with the goal of identifying potential associations that may inform targeted interventions to support resident well-being. MATERIALS AND METHODS: Sixty-seven orthopedic surgery residents from all postgraduate years were enrolled in this cross-sectional, survey-based quantitative study. Respondents completed the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP), the International Physical Activity Questionnaire (IPAQ), the World Health Organization Quality of Life questionnaire (WHOQOL-BREF), and the Muscle-Strengthening Exercise Questionnaire (MSEQ) via a secure online platform. RESULTS: Analysis revealed significant negative correlations between the psychological domain of the WHOQOL-BREF and the emotional exhaustion and depersonalization subscales of the MBI-HSS-MP (r = -0.496, < .001; r = -0.267, = .034, respectively). The strongest negative significant correlation was observed between the physical domain of the WHOQOLBREF and emotional exhaustion (r = -0.519, < .001). Physical activity demonstrated a moderate positive correlation with physical quality of life (r = 0.308, = .018) and a strong positive correlation with psychological quality of life (r = 0.450, < .001). CONCLUSION: The findings suggest that quality of life and burnout are significantly correlated in the orthopedic resident population. Both aerobic and resistance training showed the greatest association with the psychological domain of quality of life, followed by a notable relationship with the physical domain.
What Is the Fate of the Adjacent L3-L4 and L5-S1 Disk Angles Following a L4-L5 Decompression-only Surgery?
Sedwick JD, Bansal A, Fujii T … +8 more , Nguyen KT, Cherel M, Reynolds L, Lipson P, De Oliveira RG, Nemani VM, Leveque JC, Louie PK
Orthopedics · 2026 · PMID 41636438 · Publisher ↗
BACKGROUND: Although decompression without fusion is widely performed for lumbar stenosis, the segmental behavior of adjacent disks following decompression alone remains poorly defined. Most prior studies have focused on...
BACKGROUND: Although decompression without fusion is widely performed for lumbar stenosis, the segmental behavior of adjacent disks following decompression alone remains poorly defined. Most prior studies have focused on adjacent segment mechanics after fusion, yet it is unclear whether similar reciprocal changes occur when motion is preserved. This pilot study evaluated changes in sagittal alignment at adjacent segments and lower lumbar lordosis following single-level L4-L5 decompression for lumbar spinal stenosis. MATERIALS AND METHODS: A retrospective review of 46 patients (21 males, 25 females) undergoing L4-L5 laminectomy, diskectomy, or combined procedures was performed. Standing lumbar radiographs were obtained preoperatively and 6 months postoperatively. Measurements included L1-S1 lumbar lordosis (LL) and disk angles at L3-L4, L4-L5, and L5-S1. Univariate regression analysis identified predictors of cranial (L3-L4) and caudal (L5-S1) changes, including age, sex, body mass index, surgical approach, procedure type, and LL and L4-L5 changes. RESULTS: Among 46 patients (23 laminectomy, 15 diskectomy, 8 combined), mean LL change was 1.39° ( = .372) and the change in L4-L5 disk angle correlated significantly with change at L3-L4 (β = 0.241, P = .0407), but no predictors met criteria for multivariate inclusion. Subgroup analysis showed consistent L4-L5 to L3-L4 coupling across procedures, strongest for laminectomy (β = 0.236, R = 0.129, f2 = 0.148, power = 42.1%). CONCLUSION: L4-L5 laminectomy demonstrated the strongest association between operated and cranial segment motion, suggesting biomechanical coupling after decompression. Larger, prospective studies are warranted to validate these preliminary findings.
Hitting the Limb Length Target in Total Hip Arthroplasty Requires a Patient-specific Approach.
Chi R, Cao A, Nakla A … +1 more , Rajaee S
Orthopedics · 2026 · PMID 41636437 · Publisher ↗
BACKGROUND: Proper limb length restoration after primary total hip arthroplasty (THA) remains challenging. Current imaging and guidance tools do not account for patient-perceived or examination-based limb length differen...
BACKGROUND: Proper limb length restoration after primary total hip arthroplasty (THA) remains challenging. Current imaging and guidance tools do not account for patient-perceived or examination-based limb length differences. This study defined a three-pronged comprehensive approach to setting patient-specific limb length targets: 1) patient preoperative perception of limb length discrepancy (LLD), 2) surgeon objective examination of LLD, and 3) radiographic hip length measurements based on extent of cartilage and bone loss. MATERIALS AND METHODS: A total of 102 patients who had hip osteoarthritis undergoing primary direct anterior approach THA were included. Patient-perceived preoperative limb length was collected. Target hip length was then determined using a radiographic goal for lengthening, preoperative hip pathology, patient perception, and physical examination findings of LLD. The primary outcome was the presence of patient-perceived or surgeon-examined LLD at latest follow-up. Secondary outcomes included patient outcome scores. RESULTS: A total of 102 patients (54.90% female) were included, with mean age and body mass index of 66.68 ± 11.79 years and 27.51 ± 4.63 kg/m, respectively. Preoperatively, 32.35% of patients reported perceived LLD. Postoperatively, 99.02% reported no LLD symptoms. Mean Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores improved from 49.41 ± 15.16 preoperatively to 79.34 ± 16.32 at 1 year. CONCLUSION: Appropriate restoration of patient limb length remains an important target and a technical challenge. While different technologies can help surgeons achieve an LLD target, a three-pronged clinical approach to setting target LLD leads to over 99% patient satisfaction with their limb length at 1-year follow-up.
Radiolucent Lines Do Not Affect Short-term Outcomes of a Novel Fixed-bearing Cementless Total Knee Arthroplasty System.
Cabell GH, Leal J, Holmes JS … +3 more , Wellman SS, Jiranek WA, Ryan SP
Orthopedics · 2026 · PMID 41636436 · Publisher ↗
BACKGROUND: Cementless total knee arthroplasty (TKA) is becoming increasingly common, and new systems warrant continued investigation. In this study, early functional and patient-reported outcome measures (PROMs) were in...
BACKGROUND: Cementless total knee arthroplasty (TKA) is becoming increasingly common, and new systems warrant continued investigation. In this study, early functional and patient-reported outcome measures (PROMs) were investigated as they relate to the presence of radiolucent lines (RLL) in patients who underwent TKA using a novel cementless fixed-bearing system. MATERIALS AND METHODS: An institutional database was retrospectively reviewed from November 1, 2022, to April 1, 2024, for primary TKA patients using a novel cementless TKA system. Demographics, range of motion, alignment, PROMs, and radiographs were collected and summarized for the cohort. Postoperative bone length, anteroposterior, and lateral weight-bearing-calibrated radiographs were evaluated for the presence of RLL by two reviewers. Patients were subsequently stratified by presence of RLL, and their functional and PROMs were compared. RESULTS: A total of 262 TKAs were performed by a single surgeon during the study period. Of these, 36 (13.7%) patients met inclusion criteria. Median Patient-Reported Outcomes Measurement Information System pain interference, physical function, and depression scores, as well as Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, scores all improved 1 year postoperatively compared to preoperatively. Cohen's kappa was 0.34, indicating fair agreement between reviewers in radiographic analysis of RLL. Agreement was greatest for zones 1, 4, 10, 11, and 12. In total, there was at least one RLL detected by both reviewers in the same zone in 66.7% of knees, most commonly in zone 1. Lines were all <2 mm in depth, and no cases of aseptic loosening or revisions were noted. CONCLUSION: Our results showed that this novel cementless system is a viable option for cementless TKA. Although RLL were present in the majority of patients in our cohort, all lines were <2 mm in depth and there were no cases of loosening or needing revision surgery. As expected, all PROMs improved at 1 year postoperatively. Further research is needed to investigate the mid- and long-term outcomes of this implant.
Construction and Validation of a Nomogram for Predicting the Risk of New Vertebral Fracture After Percutaneous Kyphoplasty in Osteoporotic Lumbar Vertebral Compression Fracture Patients Based on Lumbar Paraspinal Muscle Degeneration.
Yang Y, Xu C, Sun J … +4 more , Huang J, Wang J, Wang X, Ni L
Orthopedics · 2026 · PMID 41636435 · Publisher ↗
BACKGROUND: Percutaneous kyphoplasty (PKP) has been widely used for the treatment of osteoporotic vertebral compression fractures (OVCFs). However, the risk factors for refracture are controversial. Many studies have eva...
BACKGROUND: Percutaneous kyphoplasty (PKP) has been widely used for the treatment of osteoporotic vertebral compression fractures (OVCFs). However, the risk factors for refracture are controversial. Many studies have evaluated various factors; paraspinal muscle degeneration is one of them. MATERIALS AND METHODS: This retrospective analysis was performed on 197 patients who underwent PKP for OLVCFs between July 2017 and December 2022. All patients were divided into the refracture group and the non-refracture group. Univariate logistic regression analysis was performed to determine whether there were differences in sex, age, body mass index (BMI), T-score, fatty infiltration (FI), relative cross-sectional area (rCSA), level of fracture vertebra, presence of lumbar spondylolisthesis, history of hypertension, or history of diabetes between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for new vertebral fracture after PKP for OLVCFs, and a nomogram was constructed and validated to predict the risk of refracture. RESULTS: The refracture rate was 21.8% (43/197). Univariate logistic regression analysis revealed statistically significant differences in age, BMI, T-score, and FI (all < .1). Multivariate logistic regression analysis showed that the independent risk factors for new vertebral fracture were FI and T-score (all < .05). The nomogram demonstrated favorable discriminative ability, with area under the curve values of 0.861 (95% CI: 0.793-0.928) in the training set and 0.796 (95% CI: 0.718-0.873) in the validation set ( < .05, respectively). The decision curve analysis indicated satisfactory clinical utility. CONCLUSION: A higher FI of the lumbar paraspinal muscle and a lower T-score of the lumbar spine are independent risk factors for new vertebral fracture after PKP for OLVCFs. The nomogram established based on the risk factors demonstrated favorable predictive performance for refracture.
The Anterolateral Ligament of the Knee: Anatomical, Biomechanical, and Clinical Perspectives With Implications for Injury Management.
Gunturu P, Rohl MR, Wetzel CN … +5 more , Owoeye AO, Boghdady AA, Korb I, Turnow MT, Taylor BC
Orthopedics · 2026 · PMID 41636434 · Publisher ↗
The anterolateral ligament is a distinct structure found in the anterolateral aspect of the knee that, in recent years, has garnered renewed attention among orthopedic and sports medicine specialists. This review aims to...
The anterolateral ligament is a distinct structure found in the anterolateral aspect of the knee that, in recent years, has garnered renewed attention among orthopedic and sports medicine specialists. This review aims to synthesize current anatomical, biomechanical, and clinical evidence to provide a comprehensive overview of the anterolateral ligament, characterize its relevance in knee stability, and optimize management strategies following injury. Injuries to the anterolateral ligament, often concomitant with anterior cruciate ligament tears, were found to exacerbate knee instability. The debate over the necessity and optimal technique for anterolateral ligament reconstruction remains ongoing.
Injury Reporting Frequency of the Anterolateral Ligament in Sport-related Anterior Cruciate Ligament Tears: A Retrospective Magnetic Resonance Imaging Review.
Vargas LA, Foremny GB, Moutafis AD … +9 more , Torres-Caiaffa CA, Cervantes JE, Callan CM, Schurhoff MR, Davis WA, Yagnik GP, Zvijac JE, Hechtman KS, Uribe JW
Orthopedics · 2026 · PMID 41636432 · Publisher ↗
BACKGROUND: The anterolateral ligament (ALL) has gained interest due to ongoing debates on its clinical significance. This retrospective study aimed to determine the ALL-injury reporting rate on primary magnetic resonanc...
BACKGROUND: The anterolateral ligament (ALL) has gained interest due to ongoing debates on its clinical significance. This retrospective study aimed to determine the ALL-injury reporting rate on primary magnetic resonance imaging (MRI) assessment compared to a secondary review by a fellowship-trained musculoskeletal radiologist. We hypothesized that ALL injuries were underreported on routine MRI assessments. MATERIALS AND METHODS: Inclusion criteria consisted of patients ≤25 years with sport-related anterior cruciate ligament (ACL) tears and concomitant injuries in the lateral compartment treated with primary ACL reconstructions from 2015 to 2019. ACL revisions and non-sport-related injuries were excluded. Secondary ALL visualization was defined as full, partial, or not visualized and characterized as Grade I (mild/intermediate sprain), II (severe sprain/partial tear), or III (complete tear/avulsion). Sample size was determined using chi-squared test of independence ( < .05). RESULTS: A total of 370 patients met the inclusion criteria and 200 were sequentially enrolled (average age: 21.1 ± 6.0 years, 34% women, 66% men). Injuries occurred during recreational (n = 86), high school (n = 83), college (n = 29), and professional sports (n = 2). The primary ALL-visualization rate was 0% (0/200) compared to 99.5% (199/200) during secondary review (133 fully, 66 partially). Of visualized ALLs, 67.5% (n = 135) demonstrated a concomitant injury that was missed on the initial MRI assessment: 41.5% Grade I, 44.4% Grade II, and 14.1% Grade III. CONCLUSION: Concomitant ALL injuries are frequently missed on routine MRI in young patients with primary sports-related ACL tears. Education and heightened awareness of the ALL may improve diagnostic accuracy on routine MRIs and provide guidance for surgical management.
Long-term Outcomes of 3-dimensional-printed Cutting Guides for Long Bone Sarcoma Resection and Intercalary Allograft Reconstruction: An Updated Case Series.
Butler ZR, Riley DJ, Gusho CA … +2 more , Blank AT, Gitelis SM
Orthopedics · 2026 · PMID 41636431 · Publisher ↗
BACKGROUND: The use of 3-dimensional (3D)-printed cutting guides for resection of long bone sarcoma may offer advantages over traditional free-hand or navigational osteotomy, including improved margin control and reconst...
BACKGROUND: The use of 3-dimensional (3D)-printed cutting guides for resection of long bone sarcoma may offer advantages over traditional free-hand or navigational osteotomy, including improved margin control and reconstruction accuracy. We evaluated long-term surgical and oncologic outcomes of limb salvage procedures using 3D-printed cutting guides, with updated follow-up from our previously published case series and the addition of new cases focusing on margin status, bony union, and local recurrence. MATERIALS AND METHODS: We retrospectively reviewed 9 patients from our surgical database who underwent limb salvage surgery for long bone sarcoma using patient-specific 3D-printed cutting guides. This included extended follow-up of 6 previously reported cases and 3 new patients. Clinicopathologic, surgical, and radiographic data were collected and analyzed. RESULTS: All 9 patients (100%) achieved negative surgical margins (mean, 7.7 mm) with no local recurrences at a mean follow-up of 4.1 years (range, 0.5-11.6 years). Bony union was achieved at 16 of 18 (89%) osteotomy sites, comparing favorably to reported intercalary allograft nonunion rates of 6% to 43%. Two patients (22%) required revision to modular oncology devices due to nonunion. At most recent follow-up, no local recurrences were observed, while 7 grafts (78%) remained. Eight patients (89%) are continuously disease free, and 1 (11%) is alive with metastatic disease. CONCLUSION: This expanded case series demonstrates excellent long-term oncologic and surgical outcomes using 3D-printed cutting guides for long bone sarcoma resection. Patient-specific guides achieved 100% negative margins with durable graft retention and no local recurrences at 4.1-year follow-up, supporting their continued use in complex limb salvage procedures.
Analysis of United States Federal Government Projections on Anticipated Shortages in the Orthopedic Surgeon Workforce.
Silvestre J, Kelly JD, Seeger S … +4 more , Kang JD, Reitman CA, Harris MB, Leddy LR
Orthopedics · 2026 · PMID 41636430 · Publisher ↗
BACKGROUND: There is a paucity of research on the supply and adequacy of the orthopedic surgeon workforce. This study assessed United States federal government projections on the supply and demand of orthopedic surgeons...
BACKGROUND: There is a paucity of research on the supply and adequacy of the orthopedic surgeon workforce. This study assessed United States federal government projections on the supply and demand of orthopedic surgeons to 2037. MATERIALS AND METHODS: This was a cross-sectional analysis of orthopedic surgeons using data from the Health Resources and Services Administration (2025 to 2037). Supply was defined as the number of full-time equivalent (FTE) physicians. Demand was defined as the number of FTE physicians needed to support health care needs. Adequacy was defined as the ratio of supply and demand. Trends were analyzed with linear regression and comparisons were made with chi-squared tests. RESULTS: From 2025 to 2037, the supply of orthopedic surgeons was projected to decrease from 31,980 to 30,620 (4.3% decrease, < .001), whereas demand was projected to increase from 33,690 to 35,850 (6.4% increase, < .001). Orthopedic surgeon adequacy was projected to decrease from 94.9% to 85.4% ( < .001). By 2037, non-metropolitan areas were expected to have less adequacy than metropolitan areas (45.1% vs 91.6%, < .001). The South (78.4%) had the lowest projected adequacy ( < .001). By 2037, the states with the lowest projected adequacy were West Virginia (54.5%), Arkansas (60.0%), and Delaware (61.5%). By 2037, orthopedic surgery ranked 9 out of 20 for physician adequacy relative to the 20 largest specialties by number of physicians. CONCLUSION: There are projected deficiencies in the supply of orthopedic surgeons, which are greatest in non-metropolitan areas, the South, and certain states like West Virginia. Future work is needed to increase the supply of orthopedic surgeons in identified areas.
Semaglutide Use Is Associated With Decreased Length of Stay and Hospital Costs in Patients Undergoing Anterior Lumbar Interbody Fusion: A Retrospective Cohort Study.
Ng MK, Mastrokostas PG, Tabbaa A … +9 more , Razi A, Johnson M, Said M, Mastrokostas LE, Dalton J, Vaccaro AR, Kepler CK, Monsef JB, Razi AE
Orthopedics · 2026 · PMID 41636429 · Publisher ↗
BACKGROUND: Anterior lumbar interbody fusion (ALIF) is frequently performed to treat degenerative spine disease. Outcomes, however, may be affected by obesity and diabetes. Semaglutide, a glucagon-like peptide-1 receptor...
BACKGROUND: Anterior lumbar interbody fusion (ALIF) is frequently performed to treat degenerative spine disease. Outcomes, however, may be affected by obesity and diabetes. Semaglutide, a glucagon-like peptide-1 receptor agonist, improves metabolic health and reduces inflammation, with emerging data suggesting it may aid postoperative recovery. Its specific impact on ALIF remains underexplored. This study evaluates the association between semaglutide use and postoperative complications, length of stay (LOS), and health care costs in ALIF patients. MATERIALS AND METHODS: We conducted a retrospective cohort study using the PearlDiver Mariner database from 2010 through 2022. Patients undergoing ALIF with active semaglutide prescriptions were propensity score-matched 1:5 to non-users based on age, sex, Elixhauser Comorbidity Index, obesity, tobacco use, and diabetes-related variables. Outcomes included 90-day complications, 2-year surgical complications, LOS, and total costs. Statistical analysis included chi-squared tests and multivariable logistic regression, with Bonferroni-adjusted significance set at < .003. RESULTS: A total of 2,939 patients were included in the final analysis (425 semaglutide users, 2,514 matched controls). No significant differences were observed in 90-day or 2-year complication rates between the groups. However, semaglutide users had a significantly shorter LOS by 0.6 days and incurred roughly $10,400 lower same-day surgical costs and about $9,700 lower 90-day postoperative costs ( < .001 for all comparisons). CONCLUSION: Semaglutide use was associated with reduced LOS and health care costs in ALIF patients without increasing complication rates. These findings suggest a potential role for semaglutide in optimizing perioperative outcomes and reducing resource use. Further research is warranted to assess long-term benefits.
Postoperative Syndesmotic Widening Following Ankle Fracture Fixation: A Retrospective Comparison of Fibular Nailing and Plating.
O'Brien AC, Puleo JM, Mener A … +2 more , Rosenbaum A, Chisena EN
Orthopedics · 2026 · PMID 41557498 · Publisher ↗
BACKGROUND: Disruption of the distal tibiofibular syndesmosis is a common complication of ankle fractures that can result in chronic instability and early osteoarthritis. This study aimed to compare syndesmotic widening...
BACKGROUND: Disruption of the distal tibiofibular syndesmosis is a common complication of ankle fractures that can result in chronic instability and early osteoarthritis. This study aimed to compare syndesmotic widening and complications after plate fixation versus intramedullary fibular nailing. We hypothesized that fibular nailing would be associated with more syndesmotic widening but fewer complications. MATERIALS AND METHODS: Patients treated with plate or nail fixation for ankle fractures at a level 1 trauma center were identified through query of the electronic medical record. Data included demographics, fracture characteristics, medial clear space (MCS), tibiofibular clear space (TFCS), and complications. Mortise radiographs were assessed preoperatively, intraoperatively, and postoperatively. Syndesmotic widening was defined as MCS >4 mm and TFCS >5 mm at final follow-up. RESULTS: A total of 143 ankles were included; 84 patients (58.7%) received plate fixation, and 59 patients (41.3%) received fibular nailing. Mean follow-up was 6.1 ± 4.1 months and 6.5 ± 5.3 months, respectively. With the number of patients available, no significant differences were found between cohorts in the change in MCS ( = .663) or TFCS ( = .912) from fluoroscopy to 6 months postoperatively. No significant difference was observed in the proportion of patients with MCS >4 mm ( = .163) or TFCS >5 mm ( = .087) at final follow-up. Complication rates did not significantly differ between cohorts (20.2% plate cohort vs 16.9% nail cohort; = .621). CONCLUSION: Syndesmotic widening after ankle fracture fixation is comparable between plating and fibular nailing, suggesting both methods effectively maintain syndesmotic reduction.
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