Musculoskeletal Surgery[JOURNAL]
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200 papers
Correction: Co-design of a novel rehabilitation intervention for patients after ankle fracture surgery: establishing healthcare professional consensus.
Bretherton C, Al-Saadawi A, Sandhu H … +2 more , Baird J, Griffin X
Musculoskelet Surg · 2025 Dec · PMID 40257728 · Full text
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Role of titanium elastic nails in open forearm fractures in adults: a feasible alternative.
Harna B, Kaushik R, Arya S
Musculoskelet Surg · 2025 Dec · PMID 40246807 · Publisher ↗
INTRODUCTION: Traditional management of forearm fractures involves open reduction and internal fixation (ORIF) using plates and screws after wound healing. However, recent years have seen the emergence of minimally invas...
INTRODUCTION: Traditional management of forearm fractures involves open reduction and internal fixation (ORIF) using plates and screws after wound healing. However, recent years have seen the emergence of minimally invasive techniques like titanium elastic nailing (TENS) as potential alternatives. This retrospective study evaluates the role of TENS in managing open forearm fractures in adults. METHODOLOGY: A retrospective analysis was conducted over 5 years, including 18 adult patients with open forearm fractures without neurovascular or tendon injury, classified as Gustilo Anderson III A and IIIB. Surgical management involved TENS insertion following debridement with patients undergoing general anaesthesia or brachial block. Patients were positioned supine, and reduction was performed under fluoroscopy. TENS nails were inserted into the radius and ulna, with appropriate sizing and positioning. Plastic surgical interventions were performed as necessary. RESULTS: There were satisfactory outcomes in 14 patients, with four patients achieving excellent outcomes at 12-month follow-up. The radiological union was observed in 12 patients, while six required revision surgeries. Deep tissue infection occurred in two patients, managed with debridement and vacuum-assisted closure. No forearm shortening was observed, with average supination and pronation of 70° and 80°, respectively. No evidence of infection was noted at the last follow-up. CONCLUSION: The study underscores the feasibility of TENS as an alternative to external fixation or ORIF in managing open forearm fractures. TENS provides a viable option, particularly in combined orthopaedic and plastic surgery management, offering satisfactory outcomes and allowing for subsequent plating if needed. Ultimately, treatment decisions should be individualised, weighing various factors to optimise patient care and outcomes.
Co-design of a novel rehabilitation intervention for patients after ankle fracture surgery: the patient perspective.
Bretherton C, Al-Saadawi A, Sandhu H … +2 more , Baird J, Griffin X
Musculoskelet Surg · 2025 Dec · PMID 40172791 · Full text
PURPOSE: Effective rehabilitation following ankle fracture surgery is essential for optimal recovery and patient satisfaction. However, traditional rehabilitation strategies often lack personalisation, leading to subopti...
PURPOSE: Effective rehabilitation following ankle fracture surgery is essential for optimal recovery and patient satisfaction. However, traditional rehabilitation strategies often lack personalisation, leading to suboptimal outcomes. This study aimed to co-design a rehabilitation package, collaborating directly with patients, to understand their individual needs, using the Behaviour Change Wheel (BCW) framework. METHODS: Integrated within the larger weight-bearing in ankle fractures (WAX) trial, this study employed the BCW to understand behaviour, intervention options and content implementation. Nominal Group Technique was used to facilitate a workshop with 10 ankle fracture patients, and subsequent surveys were used to gather and prioritise rehabilitation needs and strategies. Participants were aged between 28 and 69, and nine (90%) were female, with representation from seven different NHS hospital trusts. Two experienced patient representatives facilitated the workshop. RESULTS: Rehabilitation strategies were developed focussing on interventions that included education, training, environmental restructuring, persuasion and enablement, delivered through an app or website. Survey results indicated high patient enthusiasm for structured, accessible rehabilitation support, including instructional videos, live chats with physiotherapists and peer support forums. Patients desired advice on returning to hobbies and life roles, and particularly returning to driving, bathing and work. CONCLUSION: The BCW framework facilitated the development of a patient-centred rehabilitation package, highlighting the importance of tailored, accessible interventions. Patients expressed strong support for the proposed strategies, suggesting potential for improved rehabilitation outcomes through personalised, digitally delivered support. These components will be used to co-design future rehabilitation interventions.
Modified percutaneous needle aponeurotomy for Dupuytren's disease: case series with functional outcome.
Bhat AK, Navaneeth PK, Pai GM
Musculoskelet Surg · 2025 Dec · PMID 40163285 · Full text
PURPOSE: Over the past three decades, percutaneous needle aponeurotomy (PNA) for Dupuytren's disease has become increasingly prevalent and offers numerous potential benefits. However, significant rates of recurrences are...
PURPOSE: Over the past three decades, percutaneous needle aponeurotomy (PNA) for Dupuytren's disease has become increasingly prevalent and offers numerous potential benefits. However, significant rates of recurrences are observed in literature. We aimed to evaluate the effectiveness of our technical modifications of percutaneous needle aponeurotomy that significantly separates the cord in the palm and digits, thereby minimizing recurrences. METHODS: We treated 23 consecutive patients with our modified technique. We use a larger-bore needle in the dorsovolar direction which involves a more controlled extensive disruption of the cord under local anesthesia. The mean total passive extension deficit (TPED) and the Dupuytren's contracture-specific Unité rhumatologique desaffections de la main (URAM) scores were calculated at final follow-up. RESULTS: Twenty-three patients underwent the procedure, involving 28 affected hands and 38 fingers, including 22 ring fingers, 6 little fingers, and 10 middle fingers. The average follow-up period was 22 months, ranging from 12 to 28 months. At presentation, the mean total passive extension deficit TPED was 50°. At the time of the final follow-up, the mean (TPED) was 10°, with a mean percent correction of 83% which was found to be statistically significant. This included 82% correction at the metacarpophalangeal joint and 81% at the proximal interphalangeal joint. Only four experienced recurrences, accounting for 14.2% of the total with a mean TPED of 30°. Lower URAM score indicated a significant short-term functional improvement. CONCLUSION: Our modified PNA technique enhances cord division in the palm and fingers, leading to improved contracture correction and lower recurrence rates. However, further studies with larger cohorts and control groups are needed to validate these findings.
Adhesive capsulitis: current concepts.
Fernandes MR
Musculoskelet Surg · 2026 Mar · PMID 40095380 · Publisher ↗
Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and progressive loss of shoulder motion. This condition typically affects individuals between 40 and 60 years of age and can se...
Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and progressive loss of shoulder motion. This condition typically affects individuals between 40 and 60 years of age and can severely impact daily functioning and quality of life. The etiology of adhesive capsulitis is multifactorial, with contributions from systemic conditions such as diabetes and thyroid disorders, as well as idiopathic factors. This review provides an overview of current concepts in the diagnosis and management of adhesive capsulitis, highlighting advancements in both conservative and surgical treatments. Conservative management remains the first-line approach, emphasizing pain relief and restoration of shoulder mobility through physical therapy, analgesics, and corticosteroid injections. Techniques such as the suprascapular nerve block have gained prominence for their effectiveness in reducing pain and facilitating rehabilitation. Recent studies underscore the importance of early intervention and individualized treatment plans tailored to the patient's needs. Surgical intervention, including arthroscopic capsular release, is considered when conservative measures fail to yield satisfactory results. While effective in restoring shoulder function, surgery carries risks and necessitates a comprehensive rehabilitation program to prevent recurrence of stiffness. This review also addresses potential complications associated with both conservative and surgical treatments, and the role of emerging techniques and technologies in improving patient outcomes. The integration of evidence-based practices and personalized care strategies is crucial for optimizing treatment efficacy and enhancing the quality of life for individuals affected by adhesive capsulitis.
Knee arthrodesis with intramedullary nail in end-stage periprosthetic joint infection with extensor mechanism failure: a retrospective outcome and reinfection rate analysis of a case series.
Benvenuti L, Digennaro V, Panciera A … +3 more , Ferri R, Cecchin D, Faldini C
Musculoskelet Surg · 2025 Dec · PMID 40072780 · Publisher ↗
BACKGROUND: Chronic periprosthetic knee infection is a highly debilitating complication. In case of failed R-TKA, with significant bone loss and extensor mechanism failure, re-revision procedures could not even be feasib...
BACKGROUND: Chronic periprosthetic knee infection is a highly debilitating complication. In case of failed R-TKA, with significant bone loss and extensor mechanism failure, re-revision procedures could not even be feasible. The most appropriate therapeutic strategy in these cases remains unclear. This study aims to evaluate the clinical and subjective outcomes, as well as the reinfection rate, in nine patients with extensor mechanism failure following chronic PJI treated with knee arthrodesis using a cemented intramedullary nail with a bridging technique. METHODS: The series included nine patients who underwent knee arthrodesis with a cemented intramedullary nail at our Institute between 2020 and 2024. All patients were treated by a single operator using a standardized two-stage revision procedure. Clinical scores (OKS and VAS), subjective scores (SF-36), postoperative limb length discrepancy, and the reinfection rate were evaluated for each patient. RESULTS: All patients achieved good clinical and subjective scores, indicating good functional recovery and pain reduction. No patient had clinically relevant limb length discrepancy. One patient (11.1%) experienced a recurrence of infection. Literature shows that re-revision surgery with extensor mechanism reconstruction has high complication and reinfection rates, while transfemoral amputation results in lower clinical and functional scores. Knee arthrodesis ensures good functionality and a low reinfection rate. CONCLUSIONS: Knee arthrodesis with a cemented intramedullary nail is a valid therapeutic alternative for patients with extensor mechanism failure following chronic periprosthetic infection. Patients in our study achieved good functional recovery and pain reduction. Further comparative studies with larger series are needed to confirm these results.
Mortality risk factor in centenarians with proximal femoral fractures.
Casadei R, Lughi M, Perini C … +4 more , Maraldi M, Di Cecco F, Pace A, Caldari E
Musculoskelet Surg · 2025 Dec · PMID 40048138 · Publisher ↗
BACKGROUND: Given the increased life expectancy, an increasing number of proximal femur fractures (PFFs) will occur in centenarian patients. In these patients, PFF has a serious impact on quality of life with high morbid...
BACKGROUND: Given the increased life expectancy, an increasing number of proximal femur fractures (PFFs) will occur in centenarian patients. In these patients, PFF has a serious impact on quality of life with high morbidity and mortality and an increase in total cost of care. Therefore, it is important to understand the surgical outcome for this group of patients defining preoperative risk factors. MATERIAL AND METHOD: From January 1, 2010, to December 31, 2020, 33 centenarian patients with PFF were treated with locked nail or hemiarthroplasty. Mortality risk factors were assessed. Several survival-related factors were evaluated using the log-rank test and univariate Cox regression statistical analysis for categorical and quantitative variables, respectively. Significative variables at the univariate analysis were included in the Cox multivariate model, using Backward Elimination technique. A P value of < 0.05 was considered statistically significant for all tests. Software STATA 17.0 was used for statistical analysis. RESULTS: Centenarians with femoral neck and pertrochanteric fracture were treated with hemiarthroplasty and locked nail, respectively. At the time of admission, only 21% had normal hemoglobin value. Postoperatively, a moderate anemia was observed in 45% of patients and a severe dementia was observed in 18%. In 85% of patients, Charlson Index was less than 3. At the time of admission, 30% of them were considered independent in walking and activity of daily living (ADL), but at discharge ambulation was worsened and none of them were independent in ADL at one month. Postoperative delirium was observed in 30% of patients preventing a complete rehabilitation program. One month after discharge 27% of patients were readmitted in hospital for complications. Mortality was 16%, 59%, and 66% at 1-6-12 months, respectively. At a multivariate evaluation, male, severe anemia and Functional Ambulation Categories (FAC) score < 3 at admission were the only variables statistically related to high risk of mortality. CONCLUSION: The anemia value was found to be related to mortality, and a quick restoration of these values is necessary. Geriatric and functional status scores, especially FAC score, are related to survival, providing an accurate prognosis. In our study, a high percentage of patients are unable to return to their pre-fracture level of independence. This suggests that the prognosis for centenarian patients with PFF may be as poor as previously thought.
Identification of potential genes associated with metastasis in osteosarcoma: an integrated bioinformatics analysis.
Wiratnaya IGE, Ismail MD, Hasan F
Musculoskelet Surg · 2025 Dec · PMID 40000579 · Publisher ↗
This study aims to identify the potential genes, pathways, and tumor immune microenvironment that might be involved in the metastasis process of osteosarcoma (OS). The GEO2R tool was deployed to screen two datasets obtai...
This study aims to identify the potential genes, pathways, and tumor immune microenvironment that might be involved in the metastasis process of osteosarcoma (OS). The GEO2R tool was deployed to screen two datasets obtained from the Gene Expression Omnibus (GEO) database (GSE87624 and GSE85537). Integrated bioinformatic analyses were then performed to investigate Gene Ontology, potential pathways, protein-protein network interaction, core hub genes, genetic alterations, and immune cell infiltration. The hub gene expression levels were validated utilizing another dataset (GSE14329) and patient prognosis was validated using the GDC-TARGET OS dataset. Our analysis identified 263 differentially expressed genes (DEGs), predominantly associated with the PI3K-AKT signaling pathway. Analysis using Cytoscape based on DEGs revealed five validated core hub genes including COL6A1, MMP2, POSTN, TAGLN, and THY1. Additionally, TAGLN and THY1 have a significant association (P = 0.008) (P = 0.03) with unfavorable outcomes in osteosarcoma patients. This study unveiled that TAGLN and THY1 were associated with metastasis and poor prognosis in OS.
Returning to running after total knee arthroplasty: a systematic review and a novel multimodal protocol.
Faldini C, Traina F, Digennaro V … +6 more , Berti L, Panciera A, Cecchin D, Ferri R, Benvenuti L, Calbucci L
Musculoskelet Surg · 2025 Jun · PMID 39987394 · Publisher ↗
Total knee arthroplasty (TKA) is the gold standard for advanced knee osteoarthritis and is increasingly performed on younger, active individuals. While low-impact sports are recommended after TKA, running remains controv...
Total knee arthroplasty (TKA) is the gold standard for advanced knee osteoarthritis and is increasingly performed on younger, active individuals. While low-impact sports are recommended after TKA, running remains controversial due to concerns about implant loosening. Cemented implants have durability issues at the bone-cement interface, while cementless designs seem to promote better osseointegration. Despite limited research, running after TKA is gaining acceptance. The purpose of this paper is to present a systematic review of the literature and present a novel and specific protocol to guide motivated patients in safely resuming running. We conducted a systematic review of PubMed studies regarding running after TKA and the PRISMA flow diagram shows the inclusion and exclusion criteria adopted. In addition, we present a novel protocol (FAST) specifically designed for TKA patients aiming to return to running which combines surgical techniques, perioperative analgesia, and physical therapy. It has been approved by the Ethics Board, the prospective trial is registered (NCT06383936), and we are currently enrolling participants. After screening according to inclusion and exclusion criteria, six studies were included in the analysis. The FAST protocol combines cementless CR-design implants, minimally invasive surgery, and personalized functional alignment. Local infiltration analgesia reduces pain and enables rehabilitation within 24 h. Rehabilitation progresses with range-of-motion exercises, muscle strengthening, and gradual return to running at 6-8 months. Monitoring activity carefully prevents inflammation, optimizing recovery. Running after TKA, once discouraged, now shows low complication rates. Preoperative fitness and patient-specific factors are key predictors of success. The FAST protocol integrates cementless implants, personalized alignment, and structured rehabilitation. Proper patient selection and communication are essential. Further research is required to validate long-term outcomes.
Outcome of total knee arthroplasty in patients with Blount disease or Blount-like deformity: a systematic review.
Akkawi I, Zmerly H, Draghetti M … +1 more , Felli L
Musculoskelet Surg · 2025 Dec · PMID 39987393 · Publisher ↗
Blount disease is a genetic disorder affecting the proximal tibial bone, resulting in a complex deformity of the knee. In the absence of timely treatment, the likelihood of developing degenerative arthritis increases. A...
Blount disease is a genetic disorder affecting the proximal tibial bone, resulting in a complex deformity of the knee. In the absence of timely treatment, the likelihood of developing degenerative arthritis increases. A total knee arthroplasty (TKA) is the conventional treatment for adult patients with Blount disease or Blount-like deformity with advanced degenerative changes. The aim of this systematic review is to evaluate the results of TKA in this particular cohort of patients. The present systematic review comprised a total of 5 articles. The 5 evaluated studies included data from 9 patients who undergone 12 TKAs. The patients were assessed throughout an average follow-up duration of 4 years. In all, there were three revisions of the prosthetic components. All studies achieved successful clinical scores at the last follow-up. A thorough exploration of PubMed, Embase, and Web of Science was conducted to identify research that documented the results of TKA in patients diagnosed with Blount disease or Blount-like deformity. TKA in patients with Blount disease or Blount-like deformities is intricate and demanding. Constrained implants can effectively mitigate the possible problem of persistent instability. Notwithstanding the unfavorable circumstances, TKA in this cohort of patients appears to yield satisfactory outcomes during the short- to medium-term period of observation. Other study is necessary to establish the enduring outcomes of TKA in this particular cohort of patients.
Outcome of hemiarthroplasty to total hip arthroplasty conversion: a systematic review.
Ansari S, Gupta T, Pranav J … +4 more , Gupta K, Raja BS, Biswas A, Kalia RB
Musculoskelet Surg · 2025 Dec · PMID 39979523 · Publisher ↗
PURPOSE: A systematic review of the literature was performed in order to synthesize the available data on the outcome of conversion total hip arthroplasty after failed hemiarthroplasty keeping in mind the higher complica...
PURPOSE: A systematic review of the literature was performed in order to synthesize the available data on the outcome of conversion total hip arthroplasty after failed hemiarthroplasty keeping in mind the higher complication rates of conversion as compared to a primary total hip arthroplasty. METHODS: Comprehensive search of literature was performed for the systematic review through online databases-PubMed, EMBASE, Scopus, and the Cochrane database. The abstracts were identified first by the above-mentioned search methods and were assessed for eligibility based on strict criteria. 15 studies regarding conversion hemiarthroplasty were finally included for the study. RESULTS: The 15 studies evaluating 3432 hips revealed that the main indication for conversion to arthroplasty was pain in the groin or thigh symptomatically and acetabular erosion with well-fixed femoral stem (455 cases; 13.25%) radiologically. Majority of the cases were revised in a single stage (292 cases) as compared to 25 cases revised in 2-stage surgery mostly owing to infection. The mean pre-conversion Harris Hip Score (HHS) improved from 45.74 to 84.03 in the post-conversion time. Majority of the conversions constituted cemented fixation for the femoral component and uncemented fixation for the acetabular component. Mean survivorship was found to be 97.21% at 5-6 years. The conversions were most commonly complicated by prosthetic joint infection most commonly which was managed by long-term antibiotics and/or debridement with or without exchange of implants. CONCLUSION: The conversion group had consistently higher odds of prosthetic joint dislocation, prosthetic joint infection, periprosthetic fracture, aseptic loosening and revision both at 1- and 2-year follow-ups. It was also noteworthy that the odds of developing these complications increased significantly from 1-year follow-up to the 2 years follow-up.
Artificial intelligence in orthopedic research assistance: a resident's perspective.
Perez RDA, Garcia RL
Musculoskelet Surg · 2025 Dec · PMID 39962035 · Full text
Artificial intelligence (AI) is transforming orthopedic research by optimizing academic workflows, improving evidence synthesis, and expanding access to advanced data analysis tools. Generative AI models such as ChatGPT...
Artificial intelligence (AI) is transforming orthopedic research by optimizing academic workflows, improving evidence synthesis, and expanding access to advanced data analysis tools. Generative AI models such as ChatGPT and GPT-4, alongside specialized platforms such as Consensus and SciSpace, empower researchers to refine search queries, enhance literature reviews, synthesize documents, and conduct advanced statistical analyses. These technologies enable the interpretation of large datasets, saving time and boosting efficiency. For orthopedic residents, AI is particularly impactful, revolutionizing their education and fostering greater independence in research. This review explores the key applications of AI as a research assistant in orthopedics, as well as its ethical considerations and challenges.
Inconsistencies in clinically significant outcome metrics for knee cartilage repair: a systematic review.
Mowers CC, Lack BT, Childers JT … +1 more , Jackson GR
Musculoskelet Surg · 2025 Dec · PMID 39955404 · Publisher ↗
To systematically review the variability of reporting of clinically significant outcomes (CSOs) including minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptom...
To systematically review the variability of reporting of clinically significant outcomes (CSOs) including minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptom state (PASS), and threshold calculation methods following surgical treatments for cartilage defects of the knee. A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A literature search was performed on August 12th, 2024, using the PubMed, Embase, and Scopus online databases for human clinical studies with publication dates ranging from 2010 to 2024 reporting on MCID, SCB, or PASS following surgical treatments for cartilage defects of the knee. Study demographics, patient-reported outcome measures (PROMs), CSO thresholds, and methods of CSO calculation were collected. A total of 19 studies (n = 3659 patients) with an average follow-up of 36.5 months were included. A total of 14 (93.3%) studies reported MCID, six (31.8%) studies reported SCB, and five (26.3%) studies reported PASS. Of the included studies, 16 (80%) referenced another study for calculating their CSO whereas three (20%) studies calculated their own CSO. A total of 16 different PROMs were reported among the included studies. Eight studies utilized the anchor-based method for CSO calculation, ten studies used both the anchor and the distribution-based methods for calculation, while only one study used the distribution-based method alone. There is considerable variation in the reporting and calculation methods of MCID, SCB, and PASS for different PROMs following surgical treatments for cartilage defects of the knee.Level of Evidence: IV, Systematic Review of Level I-IV studies.
Changes in spino-pelvis-lower extremity alignment in patients with knee osteoarthritis: a prospective radiographic study.
Singh R, Yadav P, Agarwal S … +2 more , Kaur S, Jain M
Musculoskelet Surg · 2025 Dec · PMID 39921806 · Publisher ↗
PURPOSE: Osteoarthritis (OA) is a prevalent, debilitating ailment among the elderly. Humans need a correct sagittal spino-pelvis-lower extremity alignment to stand upright. Pathology in trunk or lower extremity section m...
PURPOSE: Osteoarthritis (OA) is a prevalent, debilitating ailment among the elderly. Humans need a correct sagittal spino-pelvis-lower extremity alignment to stand upright. Pathology in trunk or lower extremity section might disrupt this harmony, causing compensatory alterations in other segments. The aim of the present study was to evaluate spino-pelvis-lower extremity alignment and association among the various spino-pelvic, knee, and ankle radiological angles in patients with knee osteoarthritis (OA). MATERIALS AND METHODS: This prospective study enrolled 70 adults over 50 years of age of either sex who complained of knee pain and met the American College of Rheumatology criteria for symptomatic OA of at least one knee. The radiological assessment comprised anteroposterior and lateral lower extremity full-length scans, as well as the Kellgren-Lawrence radiographic classification of OA. We measured hip, knee, ankle, and spino-pelvic angles using Horos software. We calculated descriptive statistics and linear correlation between continuous variables. RESULTS: There was a significant association (p < 0.05) between age and the majority of the spino-pelvic, knee, and ankle angles and between age and severity of OA. Significant variables linked with 'SFA' include HKAA (p = 0.008), mLDFA (p < 0.001), TJLA, FS-TS, Cond-Plateau, and femoral bowing (p = 0.007). We found significant associations between 'PFA' and mMPTA (p = 0.005), Cond-Plateau (p = 0.005), Tibial Bowing (p = 0.003), and 'LL' with HKAA, mLDFA, FS-TS, and Cond-Plate. SSA was significantly associated with mLDFA, mMPTA, TJLA, Cond-Plateau, and HKAA; while, FI' was significantly associated with FS-TS, femoral bowing, and tibial bowing (p < 0.001). The variables 'SS' was substantially linked with TTA (p = 0.008), TT (p = 0.004), PP (< 0.001), GP (p < 0.001), and GT (p = 0.010). 'PI' was substantially linked to TT (p = 0.001), GP (p = 0.005), and GT (p = 0.042), and 'PT' to TT (p < 0.001) and GT (p = 0.012). 'SFA' and 'PFA' only correlated with TT (p = 0.012 and 0.010). Lower limb angles were significantly associated with TT, PP, GP, GT, mLDFA, and mMPTA (p = 0.031, p = 0.026, p = 0.009, p = 0.009, TT, GP, GT, p < 0.001). GP was the sole significant association for 'TJLA' (p = 0.016). 'FS-TS' substantially correlated with PP (p = 0.015), GP (p < 0.001), and GT (p < 0.001). "Femoral Bowing" was significantly linked to PP (p = 0.017), GP (p = 0.007), and GT (p < 0.001), and "Cond-Plateau" was significantly linked to GP (p = 0.002) and GT. "Tibial Bowing" was significantly linked to TTA (p < 0.001), TAS (p = 0.003), LDTA (p = 0.002), TC (p < 0.001), GP (p = 0.007), and GT (p < 0.001). Age, gender, BMI, and the severity of knee OA significantly influenced the association among these various angles. CONCLUSION: Osteoarthritis of the knee disrupts the harmonious alignment of the spine and pelvis with the lower limbs, resulting in compensatory changes in the ankle and spine. The severity of knee osteoarthritis and the patient's gender, age, and BMI impact compensatory adaptations. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: CTRI/2021/08/036088 [Registered on: 31/08/2021] - Trial Registered Prospectively.
Comparative study of fitmore and CLS stems in total hip arthroplasty: midterm clinical and radiographic outcomes.
Evola FR, Caldaria A, Costarella L … +4 more , D'Amico AG, D'Agata V, Vecchio M, Sessa G
Musculoskelet Surg · 2025 Sep · PMID 39920536 · Publisher ↗
PURPOSE: Short-stem implants offer several advantages, including the preservation of bone stock and a physiological load transfer in the subtrochanteric area. The aim of this study was to compare the radiological and fun...
PURPOSE: Short-stem implants offer several advantages, including the preservation of bone stock and a physiological load transfer in the subtrochanteric area. The aim of this study was to compare the radiological and functional outcomes of short stem and traditional stem during midterm follow-up. MATERIALS AND METHODS: We conducted a retrospective analysis of a consecutive series of 50 patients with Fitmore and CLS stems. Clinical assessment was performed by Harris hip score; additionally, thigh pain was assessed at six months, one year, and the latest follow-up. The following radiological parameters were evaluated: stem alignment, presence of radiolucent lines and osteolysis around the stem, stem subsidence, cortical hypertrophy, femoral stress-shielding, pedestal formation at the tip of the stem, calcar resorption, heterotopic ossification, and implant loosening. RESULTS: The mean follow-up duration was 8.4 ± 2.1 years in the CLS group and 7.6 ± 2.2 years in the Fitmore group. The mean HHS improved from 43.0 ± 3.3 to 93.2 ± 2.5 for the CLS group and from 43.2 ± 4.4 to 93.6 ± 3.2 for the Fitmore group, without any statistical differences between the two groups. Thigh pain disappeared in all patients in the Fitmore group, while it persisted in 8% of the patients in the CLS group. There was a significant difference in the level of cortical hypertrophy between the two groups, with 28% in the Fitmore group compared to 12% in the CLS group. No statistically significant difference was observed for other radiological parameters. CONCLUSIONS: Both short stems and standard stems demonstrated stable fixation and satisfactory clinical and radiological outcomes.
Significance of tibial-tubercle trochlear groove distance and adjunctive radiological parameters in patients with recurrent patellar instability.
Lim W, Al-Dadah O
Musculoskelet Surg · 2025 Sep · PMID 39907984 · Publisher ↗
PURPOSE: Magnetic resonance imaging (MRI) is often used to evaluate patients with patellar dislocations to facilitate diagnosis and management strategies. Many radiological parameters have been described in the literatur...
PURPOSE: Magnetic resonance imaging (MRI) is often used to evaluate patients with patellar dislocations to facilitate diagnosis and management strategies. Many radiological parameters have been described in the literature. The aim of this study was to assess the significance of tibial-tubercle trochlear groove distance (TT-TG) distance and other MRI measurements in patients with and without patellar instability. METHODS: This case-control study included 41 patients with recurrent patellar instability and 50 patients with stable knees, all of whom underwent MRI scans. A total of 19 radiological parameters were measured in both groups. RESULTS: All measured MRI parameters had statistically significant differences between both groups (p < 0.05) apart from trochlear cartilage length. TT-TG distance. 20 mm had the strongest association with patellar instability (OR 53.3, p = 0.006, 95%CI [3.1- 927.4]) and the highest specificity (100%) but had the lowest sensitivity (34%) out of all the measured parameters. TT-TG. 13 mm had a higher sensitivity (68%) but lower specificity (72%) and weaker association with patellar instability (OR 5.5, p < 0.001, 95%CI [2.2. 13.7]). TT-TG/trochlear articular cartilage width ratio also had a strong association with patellar instability (OR 14.7, p < 0.001, 95%CI [4.5. 48.5]) with high specificity (92%) but lower sensitivity (56%). CONCLUSION: The cut-off values for TT-TG distance at 13 mm and 20 mm both had advantages and disadvantages which supports the concept of using patient-individualised ratios. Patellar instability is associated with many radiological abnormalities demonstrated on MRI scans. Selection of the most appropriate measurement is dependent on the philosophy and preference of the treating clinician.
Is routine Gram-negative antibiotic coverage required for optimum antibiotic prophylaxis in open reduction and internal fixation of fractures? A multicenter analysis of bacteria pathogens in fracture-related infections.
Shodipo OM, Arojuraye AS, Ramat AM … +7 more , Balogun MJ, Ajiboye LO, Ibrahim SS, Aremu WI, Alatishe KA, Akah CM, Lasebikan OA
Musculoskelet Surg · 2025 Sep · PMID 39891873 · Publisher ↗
PURPOSE: Measures directed at infection prevention, particularly perioperative systemic antibiotic prophylaxis, have received widespread implementation and are considered a standard of care for patients undergoing operat...
PURPOSE: Measures directed at infection prevention, particularly perioperative systemic antibiotic prophylaxis, have received widespread implementation and are considered a standard of care for patients undergoing operative management of fractures, especially with implant use. This study aimed to review the microbiology profile of patients with fracture-related infections (FRIs) in a sub-Saharan African country in order to establish the necessity or otherwise of Gram-negative cover in the selection of antibiotics for perioperative prophylaxis. METHODOLOGY: This study retrospectively reviewed records of adult patients (aged 18 years and above) diagnosed with FRI from January 2018 to December 2022 in ten tertiary hospitals in Nigeria. Data related to demographics, fracture and FRI classification as well as pathogenic bacteria were obtained while data were analyzed with SPSS version 23. RESULTS: Over the study period, 137 cases met the inclusion criteria and their data were obtained for analysis. Gram-positive and Gram-negative bacteria species accounted for 70 (51%) and 67 (49%), respectively, of the entire microorganisms identified by bacteriological culture. The most common organisms isolated from culture include Staphylococcus aureus (62, 45.3%), Escherichia coli (29, 21.2%), Klebsiella pneumonia (17, 12.4%) and Pseudomonas aeruginosa (11, 8.1%). The distribution of pathogenic bacteria isolated from positive cultures of infected closed and open fractures revealed a predominance of Gram-negative bacteria in closed fractures accounting for 45(55.6%) of the 81 organisms isolated; however, Gram-negative organisms accounted for only 22 (39.3%) of the 56 organisms isolated in open fractures (P = 0.061). CONCLUSION: The findings in this study suggest that Gram-negative cover may be necessary for optimal perioperative antibiotic coverage, particularly in the sub-Saharan Africa setting in patients undergoing internal fixation of fractures. We recommend that individual institutions should establish local prophylactic protocols that provide Gram-positive and Gram-negative pathogen coverage guided by local microbiological flora.
A combined anterior and posterior cuff transfer: a novel technique for massive irreparable rotator cuff tears.
Khanfar A, Alswerki MN, Alelaumi AF … +11 more , Al-Tamimi S, Saimeh TH, Keilani LZ, Keilani DZ, Altarawneh TA, Barakat M, Alelaumi OF, Almomani A, Hammad R, Theeb L, Al Qaroot B
Musculoskelet Surg · 2025 Sep · PMID 39891872 · Publisher ↗
INTRODUCTION: Irreparable rotator cuff tears (IRCTs) are large tears that can't be surgically repaired due to poor tissue quality, degeneration, or severe tendon retraction. These tears often involve multiple tendons and...
INTRODUCTION: Irreparable rotator cuff tears (IRCTs) are large tears that can't be surgically repaired due to poor tissue quality, degeneration, or severe tendon retraction. These tears often involve multiple tendons and lead to fatty infiltration, humeral head migration, and tendon retraction. Patients with IRCTs typically present with pseudoparalysis, muscle atrophy, or anterosuperior escape. While various surgical options exist, outcomes are often inconsistent. This case series presents a novel technique for managing massive IRCTs, showing excellent, consistent results and offering a promising advancement for treating these challenging cases. METHODOLOGY: Our case series involved 20 patients with massive irreparable rotator cuff tears, presenting clinically with pseudoparalysis and radiographically with signs of fatty infiltration, anterosuperior escape, and tendon retraction. The outcomes of interest included the Western Ontario Rotator Cuff Index (WORI), Oxford Shoulder Score (OSS), and range of motion arc (forward flexion and abduction), measured both preoperatively and postoperatively. RESULTS: The mean age of our patient cohort was 53.6 years, with a mean follow-up time of 40 months. The mean preoperative WORI score was 155.3, which improved to 54.2 postoperatively, showing an improvement of 101 points from the baseline. The mean preoperative OSS was 34.4, improving to 10.5 postoperatively, with a gain of 23.8 points. The mean preoperative range of motion for forward flexion was 67.0°, which improved to 164° postoperatively, resulting in a mean gain of 97°. The mean preoperative abduction was 57°, which improved to 166° postoperatively, with a mean gain of 109°. All these findings were statistically significant (p < 0.05). CONCLUSION: In our surgical technique, all patients demonstrated clinically and statistically significant improvements in both range of motion and patient-reported outcomes. This makes our approach a novel, robust, and reliable technique for managing massive irreparable tears, particularly in young adult patients. LEVEL OF EVIDENCE: Case Series, Level IV.
The efficacy of medial patellofemoral ligament reconstruction combined with distal femoral varus osteotomy in recurrent patellar dislocation and genu valgum.
Arias Pérez RD, Jaramillo Quiceno GA, Sarmiento Riveros PA
Musculoskelet Surg · 2025 Sep · PMID 39890771 · Publisher ↗
Medial patellofemoral ligament (MPFL) reconstruction is a widely recognized treatment for recurrent patellar dislocation. However, limited research addresses the outcomes of combining MPFL reconstruction with distal femo...
Medial patellofemoral ligament (MPFL) reconstruction is a widely recognized treatment for recurrent patellar dislocation. However, limited research addresses the outcomes of combining MPFL reconstruction with distal femoral varus osteotomy, particularly in patients with genu valgum. This study aims to evaluate the clinical outcomes of this combined surgical approach in individuals experiencing recurrent patellar dislocation associated with genu valgum. A systematic review followed PRISMA guidelines by searching the PubMed, Scopus, and Cochrane Library databases through July 1, 2024. Studies included patients whose MPFL reconstruction was combined with distal femoral varus osteotomy to treat recurrent patellar dislocation and genu valgum. A meta-analysis was performed to evaluate pain, clinical and functional outcomes, with data reported as mean difference (MD) and 95% confidence interval (CI). A total of three studies with 58 knees were included. Most of the patients were female 62.5%, with a mean patient age of 20.5 years and a mean follow-up of 26.4 months. The mean preoperative mechanical leg axis was 6.8° of valgus. After MPFL reconstruction with distal femoral varus osteotomy significant improvements were found in the Kujala score (MD, 33.64 [95% CI 31.3-35.99]), Lysholm score (MD, 34.89 [95% CI 23.27-46.51]), visual analog scale score for pain (MD, - 3.99 [95% CI - 5.66 to - 2.31]), and Tegner Activity Score (MD, 1.96 [95% CI 1.63-2.29]). No subluxation or redislocation occurred in any study during the follow-up period, and all reported radiological correction of genu valgum. Combined medial patellofemoral ligament reconstruction and distal femoral varus osteotomy in patients with recurrent patellar dislocation and genu valgum lead to significant improvements in clinical outcomes, such as pain relief and functional scores, as well as effective radiological correction of valgus deformity. However, further high-quality studies are needed to confirm these findings and establish stronger evidence for this combined approach. Systematic review and meta-analysis, level IV.
A bibliometric analysis of the 50 most cited articles on acromioclavicular joint reconstruction.
O'Dwyer L, Murphy B, Davey MS … +2 more , Morrissey D, Cassidy JT
Musculoskelet Surg · 2025 Sep · PMID 39883299 · Full text
The aim is to identify the 50 most cited papers and thus the most influential papers pertaining to ACJ reconstruction, and specifically, analysing the level of evidence (LOE), article content, journals occurring, and cou...
The aim is to identify the 50 most cited papers and thus the most influential papers pertaining to ACJ reconstruction, and specifically, analysing the level of evidence (LOE), article content, journals occurring, and countries represented within the 50 most cited. A search of the Web of Science database was carried out using the following terms: "Acromioclavicular joint" OR "AC joint" (Topic) AND Reconstruction OR Repair (Topic). The top 50 relevant articles were analysed in relation to citations, citation density, geographic origin of the article, year published, and article type. The articles were cited a total of 6053 times. The most cited article was cited 347 times. The highest citation density was 20.02, with a mean citation density of 7.71 ± 4.13. Seventy per cent of the articles involved clinical research, 74% of which involved level IV evidence. Fifty-two per cent of the articles were published in the American Journal of Sports Medicine (AJSM). Most authors originated from USA (n = 26 or 52%), followed by Germany (n = 14 or 28%). This study revealed a paucity of articles with higher LOE among the most cited. Eight of the top 10 are either theoretical or biomechanical studies, and one reports an examination technique. Only two of the top 10 reported outcomes following surgical intervention and can thus directly guide treatment. Future research in the area of ACJ reconstruction should focus on generating high-quality interventional studies capable of informing/impacting patient care. Publishing in journals such as AJSM or Arthroscopy may lead to more citations.
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