Journal Of Orthopaedics And Traumatology[JOURNAL]
Sun
200 papers
Prevalence and patterns of adductor lesions on MRI in athletes with osteitis pubis.
Eraslan A, Kose O
J Orthop Traumatol · 2025 Sep · PMID 41026411 · Full text
PURPOSE: Adductor lesions (ALs) frequently coexist with osteitis pubis (OP) in athletes, yet the prevalence and clinical impact of different AL types have not been comprehensively evaluated. This study aimed to determine...
PURPOSE: Adductor lesions (ALs) frequently coexist with osteitis pubis (OP) in athletes, yet the prevalence and clinical impact of different AL types have not been comprehensively evaluated. This study aimed to determine the frequency of various AL types using magnetic resonance imaging (MRI) and to investigate their association with clinical outcomes in athletes with OP. MATERIALS AND METHODS: This retrospective cross-sectional study included male athletes aged 18-45 years with MRI-confirmed OP. ALs were classified into four types on the basis of MRI: type 1 (strain), type 2 (tendon avulsion), type 3 (tendinopathy), and type 4 (secondary cleft sign). Types 1-2 were considered acute, and types 3-4 chronic lesions. The relationships between AL types, age, symptom side, return to sport (RTS), and hip outcome score (HOS) were analyzed. RESULTS: Among 132 athletes with OP, 90% had concurrent AL, while 10% had isolated OP. Type 3 AL was the most frequent type (77.3%), followed by type 4 (23.5%), type 1 (15.9%), and type 2 (2.3%). Logistic regression revealed that type 3 was more likely to be found in younger athletes, while types 1 and 4 were found in older athletes. Although 95% of athletes had bilateral OP, 72% reported unilateral symptoms. The symptom side showed better consistency with the AL side than the OP side (Cohen's kappa = 0.489 versus 0.057). All athletes were treated conservatively, 50 chronic AL cases were applied also injection (31 corticosteroid-CS, 19 platelet reach plasma-PRP). Athletes with isolated OP achieved a higher RTS rate than those with AL (100% versus 75%, p = 0.033). RTS rates were higher in acute AL cases than in chronic cases (91% versus 72%) and in CS injections than in PRP injections (80% versus 63%), but without statistical significance. HOS scores were comparable across groups. CONCLUSIONS: Adductor lesions, particularly chronic types, are highly prevalent in athletes with OP. While age influences the type of AL, the symptom side is compatible with the AL side, regardless of the type. RTS rates are more satisfactory in isolated OP and acute AL cases, but chronic AL cases were less successful in RTS outcomes despite injection treatments. These findings underscore the importance of identifying and classifying ALs for prognosis and treatment strategy in athletic groin pain. LEVEL OF EVIDENCE: level IV, retrospective cohort study.
Exploring the role of hemiarthroplasty in revision shoulder arthroplasty: a systematic review.
Uccheddu G, Verona M, Dąbrowski F … +3 more , Mazurek T, Capone A, Marongiu G
J Orthop Traumatol · 2025 Sep · PMID 41003960 · Full text
BACKGROUND: Hemiarthroplasty (HA) is a salvage option in revision shoulder arthroplasty when reimplantation (aTSA/rTSA) or secure glenoid fixation is not feasible. This systematic review evaluates indications, clinical o...
BACKGROUND: Hemiarthroplasty (HA) is a salvage option in revision shoulder arthroplasty when reimplantation (aTSA/rTSA) or secure glenoid fixation is not feasible. This systematic review evaluates indications, clinical outcomes, and complications after conversion to HA using an indication- and implant-stratified synthesis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed/MEDLINE, Embase/Scopus, and Web of Science were queried to 15 March 2024. Studies reporting revision of any shoulder arthroplasty to HA with ≥ 12-month follow-up were included. Owing to heterogeneity in measures and implant types, a descriptive analysis stratified by initial implant × indication was performed; primary endpoints were postoperative functional scores, with complications and reoperations as secondary endpoints. RESULTS: Of 580 identified studies, 20 met inclusion criteria, totaling 268 patients. Glenoid component loosening was the most frequent indication (≈59%), followed by soft-tissue insufficiency (≈11%) and infection (≈9%). Postoperative function varied: ASES 48.2-66, constant 22-37, SANE 54-70. Complications occurred in 29%, and 15.7% underwent reoperation. Outcomes were indication-dependent: the highest scores were observed after humeral loosening (small subgroup), whereas glenoid loosening after aTSA or rTSA showed moderate, clinically meaningful improvements, particularly when bone loss could be reconstructed (e.g., grafting). Instability yielded modest gains, and infection was associated with the poorest results. Preoperative values were inconsistently reported, limiting Δ estimates. CONCLUSIONS: HA remains a salvage solution with indication-dependent effectiveness: best after humeral/glenoid loosening when reconstruction is feasible, modest in instability, and poor in infection. While HA can relieve pain and provide moderate functional improvement, it does not restore normal function. Selection should be deliberate and indication-specific, and future studies should adopt standardized reporting and prospective, indication-stratified designs.
Application of internal brace ligament augmentation technique in knee ligament injury: a systematic review.
Tang P, Tan X, Wen T … +4 more , Zhang J, Li Y, Zhang K, Xiao W
J Orthop Traumatol · 2025 Sep · PMID 41003959 · Full text
BACKGROUND: Anterior cruciate ligament (ACL) injuries are common and can lead to significant knee instability and an increased risk of long-term cartilage damage. Given the emerging role of internal brace ligament augmen...
BACKGROUND: Anterior cruciate ligament (ACL) injuries are common and can lead to significant knee instability and an increased risk of long-term cartilage damage. Given the emerging role of internal brace ligament augmentation (IBLA) in treating these injuries, this systematic review aimed to evaluate the collective evidence on the safety and effectiveness of IBLA in patients with anterior cruciate ligament injury. METHODS: We systematically searched the PubMed, Embase, Cochrane Library, and Web of Science databases until July 2025. The literature was screened according to the inclusion and exclusion criteria, and data were extracted. The extracted key data included the International Knee Documentation Committee score (IKDC), Tegner score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Arthritis Index score (WOMAC), Marx Activity Scale, visual analogue scale (VAS), and the Veterans RAND 12-Item Health Survey (VR-12). The quality of nonrandomized trials was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Systematic screening identified 11 studies (n = 676 patients) for analysis. Patient-reported outcomes demonstrated significant improvements post-intervention. Meta-analyses demonstrated statistically significant increases in KOOS (MD = 36.86, 95% CI: 32.51-41.20, p < 0.01), VR-12 (MD = 16.62, 95% CI:14.75-18.49, p < 0.01), and decreases in visual analog scale (VAS) (MD = -2.82, 95% CI: -3.40 to -2.25, p < 0.01). Lysholm (postoperative 89-94) and IKDC scores (postoperative 85-91) approached or exceeded pre-injury levels. Tegner scores remained stable near pre-injury levels (5.33-6.4). Marx activity scores showed a significant decrease (MD = -3.84, 95% CI: -6.19 to -1.49, p < 0.01), potentially indicating postoperative activity adaptation. Study heterogeneity was noted. All included studies demonstrated mild to high quality. CONCLUSIONS: IBLA appears to be a promising technique for improving functionality, stability, and pain management in anterior cruciate ligament injury. However, the current evidence is significantly constrained by small sample sizes, a predominance of low-quality studies, and a lack of long-term comparative data. Therefore, further rigorous, high-quality research is required to definitively establish the safety and long-term effectiveness of IBLA. LEVEL OF EVIDENCE: III.
Five-year radiographic and clinical outcomes after arthroscopic synovectomy of the ankle in rheumatoid arthritis: A clinical trial.
Zhang J, Wang C, Wang J … +4 more , Wu C, Yang F, Ma X, Shi Z
J Orthop Traumatol · 2025 Sep · PMID 41003952 · Full text
BACKGROUND: Rheumatoid arthritis (RA) affects ankle joints in up to one half of patients with established disease, causing inflammation and damage. Arthroscopic synovectomy removes inflamed tissue to improve joint functi...
BACKGROUND: Rheumatoid arthritis (RA) affects ankle joints in up to one half of patients with established disease, causing inflammation and damage. Arthroscopic synovectomy removes inflamed tissue to improve joint function, but long-term outcomes and the potential role of adjunctive therapies are limited. MATERIALS AND METHODS: A total of 176 patients who had a preoperative diagnosis of RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria, radiographic Larsen grade ≤ 3, and who underwent arthroscopic synovectomy from May 2013 to May 2019 were prospectively enrolled. Weight-bearing anteroposterior and lateral plain radiographs of the ankle were performed annually after initial surgery. The Larsen grade was used to evaluate the progression of ankle joint damage in RA, and patient-reported outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Scale and the Foot and Ankle Outcome Score [FAOS]) were collected annually. The primary outcome measure was 5-year AOFAS score. Baseline characteristics, including age, body mass index (BMI), duration of symptoms before surgery, Larsen grade before surgery, and other potentially related factors, including number of platelet-rich plasma (PRP) injections and change in BMI from baseline, were recorded. RESULTS: There were 138 patients included, all with minimum 5-year follow-up data. The overall reoperation rate was 13% (95% confidence interval [CI] 6.8-18.9%; 18 of 138). According to multivariable analysis, 5-year AOFAS scores were associated with number of PRP injections (correlation coefficient = 2.09 [95% CI 1.47-2.71]; P < 0.001), duration of symptoms before surgery (correlation coefficient = 0.42 [95% CI 0.14-0.70]; P = 0.01), Larsen grade before surgery (correlation coefficient = 0.28 [95% CI 0.06-0.49]; P = 0.034), and mean BMI change from baseline (correlation coefficient = -1.23 [95% CI -1.57 to -0.89]; P < 0.001). When comparing the number of PRP injections (0, 1-2, or ≥ 3), patients who had serial PRP injections (≥ 3) had diminished functional and radiographic deterioration over time. CONCLUSIONS: Arthroscopic synovectomy improves symptoms for ankle RA and appears to slow-but not halt-radiographic deterioration over 5 years. Serial PRP injections and reduction in BMI from baseline could be associated with better clinical outcomes and slower joint degeneration, which needs to be verified by randomized controlled trials. LEVEL OF EVIDENCE: Level II, prospective cohort study. Trial registration Research Registry, researchregistry10878. Registered 24 November 2024-retrospectively registered, http://researchregistry.knack.com/researchregistry10878.
Second revision of anterior cruciate ligament reconstruction using achilles tendon allograft: a case series of 20 patients at mid-term follow-up.
Pettinari F, Chirico M, Mazzon A … +4 more , Corti J, Di Muro A, Civinini R, Matassi F
J Orthop Traumatol · 2025 Sep · PMID 41003882 · Full text
PURPOSE: This study aimed to evaluate the clinical outcomes, failure rates, and complications associated with a second revision anterior cruciate ligament reconstruction using an Achilles tendon allograft in a mono-loop...
PURPOSE: This study aimed to evaluate the clinical outcomes, failure rates, and complications associated with a second revision anterior cruciate ligament reconstruction using an Achilles tendon allograft in a mono-loop fashion, which allows simultaneous reconstruction of the anterior cruciate ligament and the anterolateral ligament. The hypothesis was that this combined technique is safe and leads to satisfactory clinical outcomes at mid-term follow-up. METHODS: A retrospective analysis was conducted on 20 patients who underwent a second revision ACL reconstruction between January 2018 and December 2022. All patients received an Achilles tendon allograft with a bone plug, used in a mono-loop technique to reconstruct both ACL and ALL. Exclusion criteria included multi-ligament injuries, posterior tibial slope > 12°, or follow-up shorter than 24 months. Clinical evaluation included pre- and postoperative scores: Tegner, subjective IKDC, Lysholm, and KOOS, as well as physical examination and Rolimeter testing. Mean follow-up was 32.2 months. RESULTS: The mean patient age was 36.8 ± 6.3 years. All clinical scores improved postoperatively: Tegner (from 64.3 to 87), subjective IKDC (55.1 to 64.4), Lysholm (58.2 to 76.9), and KOOS (59.7 to 70.1). Anteroposterior laxity decreased from 7.2 ± 2.1 mm preoperatively to 1.2 ± 1.3 mm postoperatively. A total of 55% of patients returned to their desired sports level, 25% to a lower level, and only one patient (5%) did not return owing to residual laxity. No postoperative complications or re-revisions were reported. CONCLUSIONS: The mono-loop technique for simultaneous ACL and ALL reconstruction using an Achilles tendon allograft during a second revision procedure is safe and effective. It results in satisfactory mid-term outcomes, low failure rates, and no significant complications, providing a viable single-stage alternative for complex revision cases. STUDY DESIGN: Cohort study; Level of evidence, 3.
Soft tissue reconstruction of tumor-related proximal tibial hemiarthroplasty using synthetic mesh combined with a medial gastrocnemius flap.
Li Z, Zhao J, Fan D … +5 more , Deng Z, Yang Y, Niu X, Zhang Q, Liu W
J Orthop Traumatol · 2025 Sep · PMID 41003870 · Full text
PURPOSE: This study was to evaluate the efficacy of soft tissue reconstruction using synthetic mesh and a medial gastrocnemius flap in patients who underwent proximal tibial hemiarthroplasty after resection of proximal t...
PURPOSE: This study was to evaluate the efficacy of soft tissue reconstruction using synthetic mesh and a medial gastrocnemius flap in patients who underwent proximal tibial hemiarthroplasty after resection of proximal tibial bone sarcomas. METHODS: A retrospective cohort study was conducted on 102 skeletally immature children (58 males, 44 females) who underwent proximal tibial Hemiarthroplasty between January 2005 and December 2023. The most common diagnoses were osteosarcoma (95%), Ewing's sarcoma (4%), and chondrosarcoma (1%). The mean age was 11 years (7-14 years) and the mean follow-up was 85 months (12-233 months). We reported complications according to the modified Henderson classification. The functional outcomes were evaluated by Musculoskeletal Tumour Society Score (MSTS-93) and the Toronto Extremity Salvage Score (TESS). RESULTS: Patients in the combined reconstruction group had higher MSTS-93 and TESS scores (MSTS-93, 83% versus 72%, p = 0.023; TESS, 85% versus 74%, p = 0.041). The mean 2-year postoperative Insall-Salvati ratio (ISR), the Blackburne-Peel index (BPI), and the Caton-Deschamps index (CDI) for patients who underwent combined reconstruction were 1.18 ± 0.32, 0.98 ± 0.22, and 1.21 ± 0.28, respectively. While, The mean 2-year postoperative ISR, BPI, and CDI of patients without combined reconstruction were 1.42 ± 0.39, 1.25 ± 0.29, and 1.61 ± 0.41, respectively (p < 0.05). The combined reconstruction group had a lower mean extensor lag (4.3° versus 11.3°, p < 0.001). In total, 33 patients had at least one complication and 27 patients underwent surgical revision, including 13 infections, 8 local recurrences, 3 soft tissue failures, 2 aseptic loosening, and 1 implant failure. The combined reconstruction group had a lower rate of knee dislocation (2.7% versus 21.4%, p = 0.002). CONCLUSIONS: Soft tissue reconstruction of the proximal tibia using synthetic mesh combined with a medial gastrocnemius flap improves the postoperative efficacy of tumor-related proximal hemiarthroplasty and is expected to reduce the incidence of postoperative knee dislocation and periprosthetic infection. LEVEL OF EVIDENCE: Level III case control study.
The risk factors attributing to the avulsion fracture of anterior inferior tibiofibular ligament (AITFL) in surgically treated ankle fractures.
Wang SP, Wu YH, Hsu WE … +2 more , Tang SC, Chen KH
J Orthop Traumatol · 2025 Sep · PMID 41003860 · Full text
OBJECTIVE: Avulsion fracture of the anterior inferior tibiofibular ligament (AITFL) combined with ankle fracture compromises the integrity of the ankle and affects its outcome. This study aimed to determine the incidence...
OBJECTIVE: Avulsion fracture of the anterior inferior tibiofibular ligament (AITFL) combined with ankle fracture compromises the integrity of the ankle and affects its outcome. This study aimed to determine the incidence of AITFL fractures in surgically treated ankle fractures and to identify its related risk factors. METHODS: In this study, we enrolled a total of 156 patients with surgically treated ankle fractures. We extracted information from medical records on patients' demographic characteristics, body mass index, trauma mechanism, medical history, American Society of Anesthesiologists grade, and trauma mechanism. Ankle fractures were classified on X-ray images, and AITFL fractures according to the original or modified Wagstaffe classification based on radiographs and computed tomography (CT) images. The diagnostic capability of radiographs and risk factors for AITFL fractures were determined. RESULTS: Patients were divided into two groups: (1) with and (2) without AITFL avulsion fractures. Of the 156 cases, 77 (49.4%) anterior malleolar injuries were identified from CT images. Among these cases, 49 (63.6%) were solely Wagstaffe fractures, 18 (23.4%) were solely Chaput avulsion fractures, and 10 (13.0%) had both avulsion lesions. In 9 of the 10 cases with both avulsion fractures were supination-external rotation (SER) fractures. Moreover, there are 30 cases (39.0%) of AITFL avulsion fractures unidentifiable on the basis of plain radiographs. Age (OR 1.04, p < 0.001) and posterior Pilon fracture (OR 3.52, p = 0.002) were risk factors of AITFL avulsion fractures. CONCLUSIONS: AITFL injuries appeared more commonly in ankle fractures than previously thought, and were frequently overlooked clinically. Recognizing AITFL fractures associated with ankle fractures through CT imaging is imperative, and timely repair is crucial for optimizing functional outcomes. Our findings provide clinicians with insights on such injuries for better surgical management.
Comparison of treatment outcomes for patients with chronic lateral ankle instability with subtle cavus foot: Is calcaneal osteotomy an essential procedure?
Fu S, Wang C, Wang J … +2 more , Wu C, Shi Z
J Orthop Traumatol · 2025 Sep · PMID 41003856 · Full text
BACKGROUND: Chronic lateral ankle instability (CLAI), frequently resulting from ankle sprains, is often associated with undiagnosed hindfoot varus deformities, specifically subtle cavus foot (SCF). While ligament reconst...
BACKGROUND: Chronic lateral ankle instability (CLAI), frequently resulting from ankle sprains, is often associated with undiagnosed hindfoot varus deformities, specifically subtle cavus foot (SCF). While ligament reconstruction remains the standard treatment for CLAI with SCF, there is ongoing debate regarding the need for adjunctive calcaneal osteotomy to correct the underlying malalignment. Our study aims to evaluate the clinical efficacy and necessity of minimally invasive calcaneal osteotomy combined with arthroscopic modified Broström procedure in patients with CLAI with SCF. MATERIALS AND METHODS: A retrospective analysis of 102 patients with CLAI and SCF was conducted from November 2016 to November 2022. Patients undergoing arthroscopic modified Broström procedure were assigned to the control group, while those receiving arthroscopic modified Broström procedure with minimally invasive calcaneal osteotomy were placed in the experimental group. General data and complications were documented. Preoperative and postoperative imaging included calcaneal pitch angle, Meary's angle, arch height, and calcaneus valgus angle. Clinical outcomes were measured using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and visual analogue scale (VAS). RESULTS: A total of 81 patients with 2-year follow-up were included, with 46 in the experimental group and 35 in the control group. Significant differences in imaging indicators were observed in the experimental group at all follow-up points (P < 0.001), while no significant changes were noted in the control group (P > 0.05). Both groups demonstrated improvements in AOFAS and VAS scores (P < 0.001), with differences between 3- and 24-month follow-up (P < 0.001). Significant differences in imaging indicators and AOFAS scores were found between groups at both follow-up intervals (P< 0.01). The complication rate was 6.52% in the experimental group and 11.43% in the control group. CONCLUSIONS: For patients with CLAI with SCF, arthroscopic modified Broström procedure with minimally invasive calcaneal osteotomy is an effective treatment that minimizes bone and soft tissue damage. Our study suggests that it is necessary to correct hindfoot alignment while stabilizing the ankle joint to enhance function and reduce recurrence of chronic ankle instability. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
A study on the factors associated with the dimensions of the iliocapsularis muscle.
Gao G, Zhou X, Jiesisibieke D … +3 more , Zhang Z, Wang J, Xu Y
J Orthop Traumatol · 2025 Sep · PMID 40993457 · Full text
PURPOSE: To identify the correlation between the iliocapsularis muscle and other imaging parameters, with the aim of enhancing understanding of its function and primarily exploring the influence on hip stability and func...
PURPOSE: To identify the correlation between the iliocapsularis muscle and other imaging parameters, with the aim of enhancing understanding of its function and primarily exploring the influence on hip stability and function. METHODS: We retrospectively evaluated patients who attended the sports medicine clinic of our department and who underwent arthroscopic surgery for femoroacetabular impingement (FAI) between January 2019 and December 2020. Preoperative supine anteroposterior hip radiography, 45° Dunn view radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) were performed in all patients. The alpha angle and lateral center-edge angle, femoral and acetabular version, were measured on radiographs and CT. Cross-sectional area, thickness, width, and circumference of the iliocapsularis were measured on MRI. The thickness of the hip capsule was assessed in the midcoronal plane relative to the femoral head at three specific locations: at the level of the femoral head-neck junction, at a point midway between the midcapsule and the labrum), and at a point equidistant towards the greater trochanter. The Pearson correlation coefficient was used to test for the association between the imaging parameters and dimensions of the iliocapsularis muscle. RESULTS: A total of 120 patients (48 men and 72 women) were finally included in this study. There was a significant correlation between the dimensions of the iliocapsularis muscle and femoral version and Mckibbin index. Femoral version had a negative correlation between cross-sectional area (r = -0.28, P = 0.0045), thickness (r = -0.20, P = 0.043), width (r = -0.24, P = 0.012), and circumference (r = -0.27, P = 0.0052) of the iliocapsularis muscle. Mckibbin index also had negative correlation with cross-sectional area (r = -0.28, P = 0.0039), thickness (r = -0.27, P = 0.0054), width (r = -0.22, P = 0.025), and circumference (r = -0.26, P = 0.0075) of the iliocapsularis muscle. Besides, there was a significant correlation between the thickness of the iliocapsularis muscle and central acetabular version (r = -0.22, P = 0.025). No correlation was found between dimensions of the iliocapsularis muscle and alpha angle, lateral center-edge angle (LCEA), cranial acetabular version, and capsular thickness. CONCLUSIONS: Our study revealed a negative correlation between femoral version, the Mckibbin index, and various morphological parameters of the iliocapsularis muscle, including cross-sectional area, thickness, width, and circumference. Higher levels of femoral version and the Mckibbin index were associated with a potential reduction in the dimensions of the iliocapsularis muscle. These findings suggest a biomechanical relationship between hip morphology and the structural characteristics of the iliocapsularis muscle, highlighting the importance of considering these factors in the assessment of hip stability and function.
Comparative analysis of machine learning algorithms for predicting tibial intramedullary nail length from patient characteristics.
Hui Y, Hu H, Xiang J … +1 more , Du X
J Orthop Traumatol · 2025 Aug · PMID 40824601 · Full text
OBJECTIVE: This study aimed to evaluate the performance of five machine learning algorithms in predicting tibial intramedullary nail length using patient demographic data (gender, height, age, and weight), with the goal...
OBJECTIVE: This study aimed to evaluate the performance of five machine learning algorithms in predicting tibial intramedullary nail length using patient demographic data (gender, height, age, and weight), with the goal of developing a clinically relevant and accurate predictive model. METHODS: Retrospective data from 155 patients who underwent tibial intramedullary nailing at the Affiliated Jiangyin Hospital of Nantong University were analyzed. After data cleaning, outlier handling, and gender encoding, the dataset was divided into an 80% training set and 20% testing set. Models were trained and evaluated using root mean squared error (RMSE), mean absolute error (MAE), coefficient of determination (R), and correlation analysis. Key variables included height (cm), weight (kg), age (years), and gender. RESULTS: The XGBoost model demonstrated superior clinical precision, achieving the lowest testing RMSE (9.15 mm) and MAE (7.56 mm), with an R of 0.871, explaining 87.1% of variance in nail length. While the random forest model had the highest R (0.874) and correlation coefficient (r = 0.935), XGBoost outperformed all models in error metrics, critical for minimizing surgical complications. Variable importance analysis identified height as the most influential factor, followed by weight and age. All models achieved acceptable accuracy (≥ 86.21%) within a ± 15 mm error margin, compatible with intraoperative adjustments. CONCLUSIONS: Machine learning, particularly XGBoost, significantly improves preoperative prediction of tibial intramedullary nail length compared with traditional methods.
Comparison of extracorporeal shockwave therapy, ultrasound therapy, and corticosteroid injections for treatment of lateral epicondylitis: an umbrella review of meta-analyses.
Zhu P, Tang P, Su J … +7 more , Yang Y, Yang S, Zhang C, Xiao W, Zhou Y, Li Y, Deng Z
J Orthop Traumatol · 2025 Aug · PMID 40824407 · Full text
BACKGROUND: The purpose of this study was to assess the methodological quality of meta-analyses (MAs) and resolve evidence inconsistencies by quantifying overlap in primary studies, thereby providing enhanced evidence on...
BACKGROUND: The purpose of this study was to assess the methodological quality of meta-analyses (MAs) and resolve evidence inconsistencies by quantifying overlap in primary studies, thereby providing enhanced evidence on the efficacy of extracorporeal shockwave therapy (ESWT) versus placebo, ultrasound therapy, and corticosteroid injections for lateral epicondylitis. METHODS: We conducted searches in four databases: PubMed, Embase, Cochrane Library, and Web of Science, until August 2024. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) graded the quality and reliability of the MAs, and the quality of outcomes was graded by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Graphical Representation of Overlap for OVErviews (GROOVE) was applied to analyze overlap and classified the resulting evidence into four categories (I-IV) on the basis of evidence classification criteria. RESULTS: A total of nine MAs were included for analysis: five had a high AMSTAR 2 rating, three had a moderate AMSTAR 2 rating, and one had a low AMSTAR 2 rating. GROOVE analysis revealed substantial overlap, informing evidence classification. ESWT can effectively reduce the pain assessed by the visual analogue scale (VAS) compared with placebo (MD = -0.68; 95% CI -1.06, -0.3; P = 0.0004; I = 75%). Compared with ultrasound therapy, ESWT has a significantly large reduction in the level of pain after the treatment at 1-month follow-up (MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I = 92%) and 3-month follow-up (MD = -1.65; 95% CI -1.81, -1.49; P < 0.00001; I = 98%). ESWT is better than corticosteroid injection when calculating the pooled effect size of VAS (SMD = 1.13, 95% Cl 0.72, 1.55; P < 0.00001; I = 0). ESWT also has a significant difference in the rate of 50% reduction in pain (RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I = 41%). However, compared with placebo, it has no clinically important difference of grip strength (MD = 3.33; 95% CI 0.93, 5.73; P = 0.007; I = 30%), and the pain score of Thomsen test (MD = -3.22; 95% CI -14.06, 7.62; P = 0.56; I = 69%). CONCLUSIONS: ESWT has a significant difference in reducing pain evaluation and relief of pain symptoms, and the effect is better than ultrasound therapy and corticosteroid injections. THIS PROTOCOL HAS BEEN REGISTERED IN THE PROSPERO DATABASE: CRD42024586419.
High prevalence of borderline hip dysplasia in young patients with femoral head subchondral stress fractures.
Zhang Z, Jia H, Ren N … +6 more , Cheng H, Luo D, Li Y, Sun W, Fu J, Zhang H
J Orthop Traumatol · 2025 Aug · PMID 40810859 · Full text
BACKGROUND: Limited research exists on young patients with femoral head subchondral stress fractures (SSF), especially regarding how hip anatomy may contribute to this condition. Few studies have explored the potential c...
BACKGROUND: Limited research exists on young patients with femoral head subchondral stress fractures (SSF), especially regarding how hip anatomy may contribute to this condition. Few studies have explored the potential correlation between its pathogenesis and developmental dysplasia of the hip (DDH). We aimed to determine hip morphology in patients with femoral head SSF and analyze the distribution of various parameters reflecting hip coverage and stability. MATERIALS AND METHODS: Radiographic data of all patients with femoral head SSF who met the inclusion criteria between January 2019 and November 2023 were retrospectively reviewed. These data included the lateral center-edge angle (LCEA), Tönnis angle, anterior center-edge angle (ACEA), femoral head extrusion index, acetabular arc, femoral head lateralization, upsloping lateral sourcil, cliff sign, crossover sign, posterior wall sign, and ischial spine sign. We determined the proportion of borderline DDH (BDDH) and the distribution of each parameter on the affected side. Additionally, we compared differences between patients with LCEA < 25° and LCEA > 25°. RESULTS: In affected hips, 15 cases (57.7%) had BDDH, 3 cases (11.5%) had DDH, and only 8 cases (30.8%) had a normal LCEA. On the contralateral side, 8 cases (30.8%) had BDDH, 4 cases (15.4%) had DDH, and 14 cases (53.8%) had normal LCEA. Abnormalities were prominent in the extrusion index (50.0%), acetabular arc (65.4%), femoral head lateralization (46.2%), cliff sign (42.3%), and posterior wall sign (65.4%). Among patients with affected-side LCEA < 25°, more than 50% exhibited abnormalities in ACEA, extrusion index, acetabular arc, cliff sign, or posterior wall sign. Among patients with normal LCEA on the affected side, most had acetabular retroversion, with 75.0% showing a positive crossover sign and 75.0% showing a positive ischial spine sign. CONCLUSIONS: This study revealed a notably high prevalence of BDDH in young patients with femoral head SSF. The various abnormalities observed in parameters reflecting coverage and stability in BDDH may explain the potential association between BDDH and femoral head SSF. LEVEL OF EVIDENCE IV: Retrospective case series.
Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns.
Abualhaj S, Abualhaj MM, Dawod MS … +6 more , Alkhateeb M, Alqarqaz E, Jaber M, Al-Ebbini R, Alananzh M, Alshadfan L
J Orthop Traumatol · 2025 Aug · PMID 40794315 · Full text
BACKGROUND: The reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite...
BACKGROUND: The reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite its increasing use, comprehensive multicenter data on its survival outcomes and anatomical site-specific performance remain limited. METHODS: This retrospective multicenter case series included all patients who underwent RSAF for distal lower extremity defects between 2015 and 2024 across military, governmental, private, and academic institutions. Data on patient demographics, defect characteristics, surgical technique, and postoperative outcomes were collected and analyzed using Jamovi. Kaplan-Meier survival analysis was used to assess flap survival over time, with subgroup comparisons based on defect site. RESULTS: A total of 60 patients were included. The overall flap survival rate was 96.7%, with a mean wound healing time of 21.5 days. Venous congestion occurred in 83.3% of cases. Persistent venous congestion occurred in 10% of cases, leading to partial flap necrosis. Flap width, pedicle length, prolonged operative time, and patient-specific factors such as body mass index (BMI) and smoking status were significantly associated with adverse outcomes. Site-specific analysis revealed that RSAFs used for ankle and lower leg defects had a 100% survival rate at 60 months, while heel-based flaps showed a decline in survival to 70.8% at 60 months. CONCLUSIONS: RSAF is a highly successful and reliable option for lower extremity reconstruction, especially in resource-variable settings. However, anatomical site, flap design parameters, and modifiable patient risk factors significantly impact outcomes. Long-term surveillance highlights excellent durability in ankle and lower leg reconstructions, while heel-based reconstructions require closer follow-up. Level of Evidence Level III (Retrospective Comparative Study).
Writing for JOOT: raising standards in clinical research and evidence synthesis.
Migliorini F, Randelli F, Di Martino A … +1 more , Rivera F
J Orthop Traumatol · 2025 Aug · PMID 40760235 · Full text
This editorial aims to guide prospective authors in effectively preparing and structuring a manuscript for submission to JOOT. Despite the increasing scientific quality of many submissions, the Editorial Board frequently...
This editorial aims to guide prospective authors in effectively preparing and structuring a manuscript for submission to JOOT. Despite the increasing scientific quality of many submissions, the Editorial Board frequently receives manuscripts that fail to meet fundamental standards in structure, style or adherence to journal requirements, which may compromise their chances of acceptance. Scientific writing is a crucial skill, and tailoring a manuscript to the expectations and guidelines of the target journal is vital for successful publication. This article offers practical recommendations to enhance manuscript preparation, improve clarity and align submissions with the editorial standards of JOOT.
Minimally invasive plate osteosynthesis (MIPO) with mini-open technique versus open reduction and internal fixation (ORIF) in the treatment of displaced midclavicular fracture: a retrospective study.
Shakya S, Wen Y, Wen X … +1 more , Long C
J Orthop Traumatol · 2025 Aug · PMID 40751889 · Full text
INTRODUCTION: Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) for the treatment of different long bone fractures. This retrospective study ai...
INTRODUCTION: Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) for the treatment of different long bone fractures. This retrospective study aimed to compare MIPO with the mini-open technique versus conventional ORIF for the treatment of displaced midshaft clavicular fractures. We hypothesized that this technique would improve supraclavicular nerve (SCN) injury-related numbness, decrease surgical incision, blood loss, thick scar, and overall patient satisfaction. METHODS: We retrospectively reviewed 45 cases of displaced midclavicular fractures that were treated surgically at our hospital between December 2020 and June 2022. There were 20 (44.4%) patients using mini-open with MIPO and 25 (55.6%) patients using conventional ORIF treated with anatomical locking plate guided by C-arm X-ray machine. Comparison of surgical indices (operative time, blood loss, incision length, and fluoroscopy exposure times) and postoperative complications (anterior chest wall numbness, area of numbness, superficial infection, hardware irritation, and scar satisfaction) were compared between the two groups. In addition, Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Score (CMS), and overall surgical satisfaction were compared between the two groups. RESULTS: The mini-open MIPO group had statistically significant benefits on the basis of surgical length, blood loss, visual analog scale (VAS) score on the first and third postoperative days, and length of hospital stay. Major complications, such as SCN-related numbness, area of numbness, and thick scarring, were greatly reduced. The cosmetic and overall surgical satisfaction was greater in MIPO. Conversely, hardware irritation, surgical infection, and numbness were more frequent in the ORIF group. There were no significant differences in DASH and CMS scores between the groups at the 12-month follow-up. CONCLUSIONS: MIPO is a more effective and safer modern surgical method than ORIF for displaced midclavicle fractures. Improvements in operative indices, postoperative numbness owing to SCN injury, surgical incision, and cosmesis satisfaction were achieved. LEVEL OF EVIDENCE: Level III, retrospective case-control study.
Do weight and BMI predict the results of surgical treatment with ESIN in pediatric tibial shaft fractures?
Marsiolo M, Aulisa AG, Masci G … +4 more , Poggiaroni A, Giordano M, Calogero V, Falciglia F
J Orthop Traumatol · 2025 Jul · PMID 40705160 · Full text
BACKGROUND: Diaphyseal leg fractures are common in pediatric age, and the most used treatment is surgery using elastic stable intramedullary nailing (ESIN). In the past, a cutoff of 50 kg was the limit of weight indicati...
BACKGROUND: Diaphyseal leg fractures are common in pediatric age, and the most used treatment is surgery using elastic stable intramedullary nailing (ESIN). In the past, a cutoff of 50 kg was the limit of weight indication for the use of ESIN. In literature, the concept of BMI has recently been introduced to evaluate the results owing to an increase in the incidence of obesity in children; up to now, it has only been used in one study for the femur but never in the tibia, although more than one author suggests doing so. The objective of this study was to research a correlation between weight, BMI, and the results of ESIN treatment. MATERIALS AND METHODS: A total of 84 patients treated with ESIN from 2013 to 2021 were included; the inclusion criteria were clinical and radiographic data until complete healing and the presence of weight and height data collection; patients with an exposed fracture or neurovascular injury were excluded. The following were evaluated: clinical healing time in terms of load resumption (CHT), radiographic healing time (RHT), anteroposterior (APA) and lateral (LA) radiographic alignment, surgical time (CT), nonunion (NU), and delayed union (DC). Patients were divided into two weight groups (< 50; > 50). The statistical analysis was performed using STATA (Stata, College Station, TX, USA), and a p-value less than 0.05 was considered statistically significant. The Shapiro-Francia test was used to check the normality of each variable. Pearson's correlation coefficient was calculated for the correlation between variables. RESULTS: A total of 84 patients with an average weight of 41.53 kg (18-85 kg) were included. Patients were divided into two groups; 62 patients weighing < 50 kg (GR1) and 22 patients weighing > 50 kg (GR2). We found a statistically significant correlation between weight and CHT, RHT, and ST and between BMI and CHT, RHT, and ST. Average results: GR1: CHT 55.84 days; RHT 48.79 days; ST 61.68 min and GR2: CHT 63.27 days; RHT 55.77 days, ST 79.32. We found no significant difference in CHT and RHT between the two groups, while a significant difference for ST was observed. CONCLUSIONS: We confirm that ESIN nails can also be used in patients weighing > 50 kg affected by tibial shaft fractures; in fact, we found no statistical differences between the two groups' clinical and radiographic healing times. Moreover, we found no difference in results between weight and BMI for tibial shaft fracture. The statistical difference correlation in ST between GR1 and GR2 does not imply an important difference in clinical practice.
Tantalum versus titanium acetabular component in single-stage hip revision for periprosthetic joint infection: a comparative analysis of implant survivorship.
Xue Z, Guo W, Mu W … +2 more , Xu B, Cao L
J Orthop Traumatol · 2025 Jul · PMID 40699476 · Full text
BACKGROUND: The impact of tantalum (Ta) versus titanium (Ti) acetabular components on reinfection risk in periprosthetic joint infection (PJI) remains controversial. While prior studies have focused on two-stage revision...
BACKGROUND: The impact of tantalum (Ta) versus titanium (Ti) acetabular components on reinfection risk in periprosthetic joint infection (PJI) remains controversial. While prior studies have focused on two-stage revisions, this is the first comparative analysis of Ta versus Ti in single-stage revisions. This study aimed to compare all-cause rerevision and infection recurrence rates between Ta and Ti acetabular components in single-stage revision for chronic PJI. MATERIALS AND METHODS: In this study, all patients underwent single-stage revision combined with intra-articular (IA) antibiotic infusion, with 56 receiving Ta acetabular components and 79 receiving Ti components. Both the Ta and Ti groups utilized acetabular reconstruction methods (including cups with and without augments) and cementless prostheses for all femoral components. We compared implant survivorship between the two groups, using implant survivorship free from reinfection and all-cause revision as the endpoints. Multivariate logistic regression (MVLR) was used to determine the independent predictive factors for septic failure. RESULTS: The implant survivorship free from reinfection of the Ta group (92.9%; 95% confidence interval (CI) 85.7~98.2%) was comparable to that of the Ti group (88.6%; 95% CI 81.0~94.9%; P = 0.391; log-rank test). The implant survivorship free from all-cause rerevision of the Ta group (91.1%; 95% CI 84.1~100%) was comparable to that of the Ti group (87.3%; 95% CI 78.9~94.4%; P = 0.323; log-rank test). MVLR did not identify the Ta acetabular component (P = 0.414) as a protective factor against septic failure in acetabular reconstruction. However, previous revision (P = 0.048) was identified as a risk factor. CONCLUSIONS: Ta acetabular components exhibited a risk of all-cause rerevision comparable to Ti components in single-stage revision, with no significant protective effect against reinfection. These findings suggest that the notion of Ta components preventing infections should be viewed with caution.
Extraarticular distal humeral nonunion: systematic review of literature.
Vicenti G, Guerra E, Pesare E … +6 more , Colasuonno G, Minerba M, Loiodice M, Conte F, Sergi P, Solarino G
J Orthop Traumatol · 2025 Jul · PMID 40690057 · Full text
BACKGROUND: Distal humeral fractures accounted for ~1% of all fractures; however, they were prone to complications, including nonunion if left untreated or inadequately managed. Nonunion, which predominantly occurred at...
BACKGROUND: Distal humeral fractures accounted for ~1% of all fractures; however, they were prone to complications, including nonunion if left untreated or inadequately managed. Nonunion, which predominantly occurred at the supracondylar level, resulted in mechanical instability, functional impairment, and persistent discomfort. The most commonly employed surgical options included open reduction and internal fixation (ORIF), total elbow arthroplasty (TEA), and external fixation. This article provides a comprehensive assessment of these surgical procedures and shared clinical experiences related to these challenging cases. METHODS: A systematic review of literature was conducted using the PubMed database up to October 2024, with a focus on cases involving extraarticular distal humeral nonunions that were treated with ORIF, TEA, or Ilizarov techniques. RESULTS: A total of 25 studies involving 448 patients were encompassed in the review, with a mean patient age of 50 years and an average follow-up period of 48 months. Reported success rates for ORIF and TEA were 90% and 74%, respectively. A higher rate of fracture healing was demonstrated by ORIF, although functional outcomes were found to be comparable between the techniques. Complications such as infections and reduced range of motion (ROM) were documented. CONCLUSIONS: The highest success rate in treating aseptic nonunions was associated with ORIF, highlighting the importance of stable fixation, bone grafting, and meticulous preoperative planning. TEA was regarded as a viable option, particularly for patients with poor bone quality or complex, unreconstructible fractures. To optimize outcomes, surgical techniques were required to be customized on the basis of patient-specific factors and surgeon expertise. Further research is recommended to facilitate the comparison of long-term functional outcomes across different surgical approaches. LEVEL OF EVIDENCE: IV.
The effects of augmentation choices for locking plate fixation in proximal humerus fracture osteosynthesis: a systematic review and meta-analysis.
Cheng HY, Liang CW, Wang JH … +4 more , Kuo YR, Ko PY, Chuang CH, Wu PT
J Orthop Traumatol · 2025 Jul · PMID 40676439 · Full text
BACKGROUND: Various augmentation choices have been reported to improve outcomes following locking plate fixation for proximal humerus fracture, but their effectiveness and safety are still under investigation. This study...
BACKGROUND: Various augmentation choices have been reported to improve outcomes following locking plate fixation for proximal humerus fracture, but their effectiveness and safety are still under investigation. This study aims to investigate the effects of augmentation choices, including bone grafts, cement, and intramedullary plates, in locking plate fixation for proximal humerus fractures. METHODS: PubMed, Embase, and Cochrane Library were searched for studies up to April 2024. A random-effects meta-analysis was performed within a frequentist framework. RESULTS: A total of 35 studies, comprising 6 randomized controlled trials and 29 nonrandomized studies of intervention with a total of 37,494 patients, were included in this review. After adjusting for small-study bias, locking plate fixation with bone grafts or cement did not affect overall complication risk (risk ratio [RR]: 1.03, 95% confidence interval [CI] 0.74-1.45), the screw protrusion risk (RR: 0.74, 95% CI 0.45-1.13), and the avascular necrosis risk (RR: 0.98, 95% CI 0.73-1.32) compared with locking plates alone. Augmentation showed small-to-moderate effects on pain reduction and functional improvement and reduced changes in humeral head height and neck-shaft angle. In subgroup analyses, cement augmentation, while possibly inferior to bone grafts in pain relief and function, showed comparable effects on radiographic outcomes. No significant difference between strut fibular and non-fibular grafts was observed. CONCLUSIONS: Augmentation with bone grafts or cement does not convincingly reduce complication risks or screw protrusion compared with locking plate fixation alone. However, it improves pain, function, and radiographic outcomes in osteosynthesis of proximal humerus fractures. LEVEL OF EVIDENCE: II. REGISTRATION: CRD42024500403.
Letter to the Editor: is longer better? Rethinking clamping duration in TXA use for ACL reconstruction.
Yuncu M
J Orthop Traumatol · 2025 Jul · PMID 40663227 · Full text
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