Journal Of Orthopaedics And Traumatology[JOURNAL]
Sun
200 papers
Systematic review of 99 extremity bone malignancy survival prediction models.
Lai CY, Yen HK, Lin HC … +3 more , Groot OQ, Lin WH, Hsu HP
J Orthop Traumatol · 2025 Jan · PMID 39873938 · Full text
BACKGROUND: Various prediction models have been developed for extremity metastasis and sarcoma. This systematic review aims to evaluate extremity metastasis and sarcoma models using the utility prediction model (UPM) eva...
BACKGROUND: Various prediction models have been developed for extremity metastasis and sarcoma. This systematic review aims to evaluate extremity metastasis and sarcoma models using the utility prediction model (UPM) evaluation framework. METHODS: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and systematically searched PubMed, Embase, and Cochrane to identify articles presenting original prediction models with 1-year survival outcome for extremity metastasis and 5-year survival outcome for sarcoma. Identified models were assessed using the UPM score (0-16), categorized as excellent (12-16), good (7-11), fair (3-6), or poor (0-2). A total of 5 extremity metastasis and 94 sarcoma models met inclusion criteria and were analyzed for design, validation, and performance. RESULTS: We assessed 5 models for extremity metastasis and 94 models for sarcoma. Only 4 out of 99 (4%) models achieved excellence, 1 from extremity metastasis and 3 from sarcoma. The majority were rated good (62%; 61/99), followed by fair (31%, 31/99) and poor (3%, 3/99). CONCLUSIONS: Most predictive models for extremity metastasis and sarcoma fall short of UPM excellence. Suboptimal study design, limited external validation, and the infrequent availability of web-based calculators are main drawbacks. LEVEL OF EVIDENCE: This study is classified as Level 2a evidence according to the Oxford 2011 Levels of Evidence. Trial registration This study was registered in PROSEPRO (CRD42022373391, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=373391 ).
Masquelet's induced membrane technique in the upper limb: a systematic review of the current outcomes.
Pederiva D, De Luca L, Faldini C … +1 more , Vergano LB
J Orthop Traumatol · 2025 Jan · PMID 39869276 · Full text
BACKGROUND: The Masquelet induced membrane technique is a surgical procedure that allows the reconstruction of segmental bone defects using a relatively simple approach that requires minimal resources from both the healt...
BACKGROUND: The Masquelet induced membrane technique is a surgical procedure that allows the reconstruction of segmental bone defects using a relatively simple approach that requires minimal resources from both the healthcare facility and the patient. Historically applied to the lower limb, this technique is gaining increasing attention in the literature for its use in the upper limb. METHODS: A systematic review of the literature was conducted using the PubMed and Google Scholar databases to identify all studies reporting the outcomes of the Masquelet induced membrane technique in the long bones of the upper limb (humerus, radius, and ulna) with a sample size of at least 3 patients. The papers had to include the length of the bone defect, a description of the protocol used for treatment, the complications of each case, and the anatomical location of the defect. The studies that did not meet the above inclusion criteria were excluded. RESULTS: The search identified 1044 studies, of which 15 met the inclusion criteria. These studies described a total of 156 patients with a mean age of 42 years. The affected bone segments included the humerus in 22 cases and the forearm in 134 cases. In 108 cases, the bone defect was septic. The average defect length was 4.5 cm. PMMA was used as a spacer in all cases, with antibiotics added in 77% of them. The average time interval between the first and second phases of the procedure was 9.5 weeks, and bone union took an average of 5.5 months. The mean follow-up duration was 48 months, and the complication rate was 21%, ranging from 0% to 75%. CONCLUSIONS: The Masquelet induced membrane technique is a viable surgical option for managing segmental bone defects of the upper limb. However, the complication rate remains significant. Further research is needed to identify strategies to improve the outcomes of this technique. LEVEL OF EVIDENCE: Level 2.
Comparing the efficacy of 3D-printing-assisted surgery with traditional surgical treatment of fracture: an umbrella review.
Xiao L, Tang P, Yang S … +9 more , Su J, Ma W, Tan H, Zhu Y, Xiao W, Wen T, Li Y, Liu S, Deng Z
J Orthop Traumatol · 2025 Jan · PMID 39843654 · Full text
BACKGROUND: The objective of this review is to evaluate the methodological quality of meta-analyses and observe the consistency of the evidence they generated to provide comprehensive and reliable evidence for the clinic...
BACKGROUND: The objective of this review is to evaluate the methodological quality of meta-analyses and observe the consistency of the evidence they generated to provide comprehensive and reliable evidence for the clinical use of three-dimensional (3D) printing in surgical treatment of fracture. METHODS: We searched three databases (PubMed, Embase, and Web of Science) up until August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were adhered to in this review. The Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 was used to rate the quality and reliability of the meta-analyses (MAs), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to grade the outcomes. Furthermore, Graphical Representation of Overlap for Overviews (GROOVE) was employed to examine overlap, and the resulting evidence was categorized into four groups according to established criteria for evidence classification. RESULTS: Results from 14 meta-analyses were combined. AMSTAR 2 gave six meta-analyses a high rating, six MAs a moderate rating, and two MAs a low rating. Three-dimensional printing shows promising results in fracture surgical treatment, significantly reducing operation time and loss of blood for tibial plateau fracture. For acetabular fracture, apart from the positive effects on operation time (ratio of mean (ROM) = 0.74, 95% confidence interval (CI), 0.66-0.83, I = 93%) and blood loss (ROM = 0.71, 95% CI 0.63-0.81, I = 71%), 3D printing helps reduce postoperative complications (odds ratio (OR) = 0.42, 95% CI, 0.22-0.78, I = 9%). For proximal humerus fracture, 3D printing helps shorten operation time (weighted mean difference (WMD) = -19.49; 95% CI -26.95 to -12.03; p < 0.05; I = 91%), reduce blood loss (WMD = -46.49; 95% CI -76.01 to -16.97; p < 0.05; I = 98%), and get higher Neer score that includes evaluation of pain, function, range of motion, and anatomical positioning (WMD = 9.57; 95% CI 8.11 to 11.04; p < 0.05; I = 64%). Additionally, positive results are also indicated for other fractures, especially for operation time, blood loss, and postoperative complications. CONCLUSIONS: Compared with traditional fracture surgical treatment, 3D-printing-assisted surgery has significant advantages and great effectiveness in terms of operation time, loss of blood, and postoperative complications in the treatment of many different types of fractures, with less harm to patients.
Ipsilateral concomitant fractures of the clavicle and coracoid process of the scapula: incidence, characteristics, and outcomes.
Zhang N, Bai G, Kang X … +2 more , Zhu Y, Feng D
J Orthop Traumatol · 2025 Jan · PMID 39825975 · Full text
BACKGROUND: Clavicle fractures associated with ipsilateral coracoid process fractures are very rare, with limited literature reporting only a few cases. This study reports on 27 patients with ipsilateral concomitant frac...
BACKGROUND: Clavicle fractures associated with ipsilateral coracoid process fractures are very rare, with limited literature reporting only a few cases. This study reports on 27 patients with ipsilateral concomitant fractures of the clavicle and coracoid process who were followed for more than 12 months. MATERIAL AND METHODS: This retrospective study reviewed the charts of skeletally mature patients with traumatic ipsilateral clavicle and coracoid process fractures treated at the authors' institution. Each patient was regularly followed post-treatment. Radiographs assessed bone union and implant integrity, while clinical evaluations included the Constant-Murley score for shoulder function; disability of the arm, shoulder, and hand (DASH) questionnaire for upper limb function; and visual analog scale score for pain. Complications were also recorded. RESULTS: From October 2012 to February 2023, 40 patients were diagnosed with ipsilateral fractures of the clavicle and coracoid process of the scapula, accounting for 1.4% (40/2877) of all clavicle fractures and 5.2% (40/786) of all scapular fractures. This study included 27 patients with follow-up exceeding 12 months: 6 had medial-third clavicle fractures, 12 had middle-third fractures, and 9 had distal-third fractures. According to Eyres' classification, the coracoid fractures included two type I, five type II, eight type III, seven type IV, and five type V fractures. Twenty-two patients received operative treatment, with clavicle fractures fixed with internal plating and 11 coracoid fractures with internal fixation. Bone union was achieved in all patients. The mean Constant-Murley score was 91.2 ± 9.4 and the mean DASH score was 6.4 ± 7.6. Five patients reported mild shoulder pain and five patients developed complications. CONCLUSIONS: Ipsilateral concomitant fractures of the clavicle and coracoid process can occur at various clavicle locations, with shaft and medial fractures more common than previously thought. Displaced fractures can be effectively managed with operative treatment, and coracoid process fixation may not be necessary if satisfactory indirect reduction is achieved after clavicle fixation. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
Different patterns of neurogenic quadrilateral space syndrome: a case series of undefined posterior shoulder pain.
Porcellini G, Brigo A, Novi M … +7 more , De Santis E, Di Giacomo S, Giorgini A, Micheloni GM, Bonfatti R, Donà A, Tarallo L
J Orthop Traumatol · 2025 Jan · PMID 39747784 · Full text
BACKGROUND: Quadrilateral space syndrome is a painful disorder of the shoulder caused by static or dynamic entrapment of the axillary nerve and the posterior humeral circumflex artery. It was first described in 1983; how...
BACKGROUND: Quadrilateral space syndrome is a painful disorder of the shoulder caused by static or dynamic entrapment of the axillary nerve and the posterior humeral circumflex artery. It was first described in 1983; however, it is an uncommon syndrome that initially presents with nonspecific shoulder pain or selective deltoid atrophy, and diagnosis is often delayed owing to its rarity. Young athletes of overhead sports are more commonly affected by this syndrome. Symptoms of quadrilateral space syndrome include silent deltoid atrophy, persistent posterior shoulder pain, paresthesias, and tenderness over the quadrilateral space. Vascular symptoms may involve thrombosis and embolisms of the upper limb. Instrumental tests and imaging are not always conclusive, leading to frequent misdiagnosis of the syndrome. PATIENTS AND METHODS: The aim of this study is to present a case series of four patients diagnosed with neurogenic quadrilateral space syndrome, describe different clinical presentations, and suggest tips for diagnosing this syndrome. All patients underwent a detailed medical history collection, were interviewed about the sports and hobbies they engaged in, and received a comprehensive clinical examination of the neck and shoulder. Patients also underwent diagnostic exams such as magnetic resonance imaging (MRI) and electromyography. An ultrasound-guided injection of local anesthetic was performed into the quadrilateral space. RESULTS: All patients affected by neurogenic quadrilateral space syndrome underwent conservative treatment, which included a rehabilitation program. Only one out of four patients experienced complete resolution of symptoms and did not require surgical decompression. CONCLUSIONS: To properly treat this rare syndrome, we propose classifying it as either "dynamic" or "static," on the basis of the clinical history, MRI findings, and physical examination. The study includes a rehabilitation program that was effective for one patient, demonstrating that surgical decompression may be avoidable if the cases are promptly diagnosed and classified. Level of evidence IV according to "The Oxford 2011 Levels of Evidence".
MRI in the evaluation of plantar plate disease: diagnostic value of the "stress test".
Giuliani L, Ottonello C, Giuliani A … +5 more , Bondì L, Ronconi P, Tempesta V, Pacini P, Cantisani V
J Orthop Traumatol · 2024 Dec · PMID 39718683 · Full text
INTRODUCTION: The plantar plate, also called the plantar ligament, is a fibrocartilaginous structure found in the metatarsophalangeal (MTP) and interphalangeal (IP) joints. Our study aimed to evaluate the role of magneti...
INTRODUCTION: The plantar plate, also called the plantar ligament, is a fibrocartilaginous structure found in the metatarsophalangeal (MTP) and interphalangeal (IP) joints. Our study aimed to evaluate the role of magnetic resonance imaging (MRI) performed with the patient in the standard position or with joint hyperextension (the "stress test", ST) in the study of plantar plate (PP) disease that involves metatarsophalangeal joints. MATERIALS AND METHODS: All patients underwent forefoot MRI (Atroscan C, Esaote, Genoa, Italy), operating at 0.2 T. All patients first underwent a standard MRI examination (coronal T1 and T2 weighted image (WI) with fat suppression and axial and sagittal T2 WI); the examination was completed by performing a stress test (hyperextension of toes). The ST is an easy task to perform and is not time-consuming (requiring only one additional sagittal fast spin echo (FSE) T2-weighted MRI sequence; repetition time/ echo time (TR/TE): 3200/90 ms) for patients and operators. A 45°-dorsiflexion ST was performed for approximately 2.30 min, the time required to complete the sequence. No further diagnostic investigations were necessary; no patients underwent arthrography or arthro-MRI. The examinations were performed in a double-blind mode by two operators with proven experience in musculoskeletal radiology; no cases of intra-operator discordance were found. RESULTS: Twenty-five patients were recruited into our study over a 2-year period; 15 were positive for metatarsal pain and 10 were controls. Before treatment (surgery), all patients displaying symptoms underwent evaluation. As a result, the imaging features accurately represented the natural and actual conditions of the lesions. Among the symptomatic patients, 11 out of the 15 exhibited a PP tear or dysfunction in both the standard position and the ST. Additionally, two out of the 15 individuals displayed a tear in the ST alone, with no indication of it in the standard position. In contrast, two out of 15 patients showed no evidence of a PP tear in either the standard position or the ST. However, these two patients demonstrated dorsal subluxation during the ST, likely due to micro-instability resulting from PP failure. In the asymptomatic patients, nine out of the 10 individuals were found to be negative for PP dysfunction. Only one out of the 10 patients exhibited dorsal subluxation solely in the ST, indicative of plantar plate dysfunction, but no evidence of a tear in the PP. In the asymptomatic patients, standard MRI provided a specificity of 100% and a high negative predictive value (NPV) (90%), while the latter increased with the ST (specificity and NPV equal to 100%). In symptomatic patients, standard MRI gave a sensitivity of 75% when assessing a PP tear, which increased to 100% with the ST; the sensitivity of standard MRI the evaluation of MF subluxation was 60%, but it reached 100% with the ST. CONCLUSIONS: In our study, by introducing the ST, the sensitivity in both the diagnosis of a PP tear and the evaluation of MTP subluxation reached 100% (a surgical assessment was performed on all positive patients for confirmation). Ultrasound has the advantage of being a non-invasive method. However, comparing the results of our study with the data available in the literature, ultrasound has a lower sensitivity and a negative predictive value. Also, ultrasound does not allow for the assessment of possible bone marrow oedema or the degree of concomitant arthritis. If other studies in the literature confirm these results, it will be possible to consider incorporating the ST into diagnostic practice in the future.
Current trends in the medial side of the knee: not only medial collateral ligament (MCL).
Lucidi GA, Solaro L, Grassi A … +4 more , Alhalalmeh MI, Ratti S, Manzoli L, Zaffagnini S
J Orthop Traumatol · 2024 Dec · PMID 39704918 · Full text
The medial collateral ligament (MCL) is by far the most commonly injured ligament of the knee. The medial ligament complex covers a broad bony surface on the extraarticular portion of the femur and is highly vascularized...
The medial collateral ligament (MCL) is by far the most commonly injured ligament of the knee. The medial ligament complex covers a broad bony surface on the extraarticular portion of the femur and is highly vascularized, which allows for a high healing potential. For this reason, most MCL complex lesions were treated conservatively in the past. However, recent advancements regarding the MCL anatomy and kinematics highlighted the complex biomechanical behavior of the isolated and combined MCL lesion, and it is now fully appreciated that some MCL lesions warrant surgical treatment. The present review aims to provide the reader with an overview of the new evidence and advancement on the complex anatomy, biomechanics, and treatment of the MCL.
The ligamentum teres and its role in hip arthroscopy for femoroacetabular impingement: a systematic review.
Migliorini F, Cocconi F, Bardazzi T … +4 more , Masoni V, Gardino V, Pipino G, Maffulli N
J Orthop Traumatol · 2024 Dec · PMID 39704905 · Full text
BACKGROUND: The ligamentum teres (LT) has received attention in patients undergoing hip arthroscopy (HA) for femoroacetabular impingement (FAI). Indeed, a better understanding of the function of the LT and its implicatio...
BACKGROUND: The ligamentum teres (LT) has received attention in patients undergoing hip arthroscopy (HA) for femoroacetabular impingement (FAI). Indeed, a better understanding of the function of the LT and its implications for clinical outcomes in the presence of a torn LT is required. This systematic review analyses the patient-reported outcome measures (PROMs) and the complication rate when an intact or torn LT is encountered during HA for FAI. METHODS: Studies that compared patients with an intact to those with a torn LT managed with debridement during hip arthroscopy for FAI were identified from the Web of Science, PubMed, and Embase. The minimum follow-up for inclusion was 24 months. The Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias. Patient characteristics and PROMs were assessed at the baseline and last follow-up. RESULTS: The systematic review identified two studies comprising 611 patients. No statistically significant difference was found in pain, Harris Hip Score, and the activities of daily living and sports subscales of the Hip Outcome Score between patients with an intact LT and those with a torn LT treated with debridement, both of whom underwent HA for FAI. CONCLUSIONS: In patients undergoing arthroscopic management for FAI, an intact or torn ligamentum teres managed with debridement does not influence postoperative PROMs. Given the importance of the LT as a structure of the hip joint and the increasing interest in HA for FAI, further standardised studies will be a valuable source for surgeons encountering this pathology.
Differences in microorganism profile in periprosthetic joint infections of the hip in patients affected by chronic kidney disease.
Stimolo D, Budin M, De Mauro D … +3 more , Suero E, Gehrke T, Citak M
J Orthop Traumatol · 2024 Dec · PMID 39702802 · Full text
BACKGROUND: Patients affected by chronic kidney disease (CKD) are at increased risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA). This patient population has a higher risk of recurrent infec...
BACKGROUND: Patients affected by chronic kidney disease (CKD) are at increased risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA). This patient population has a higher risk of recurrent infections and hospitalization. The aim of this study is to compare the profile of microorganisms in patients with CKD and PJI of the hip versus controls and to individuate potentially unusual and drug-resistant microorganisms among the causative bacteria. MATERIALS AND METHODS: A total of 4261 patients affected by PJI of the hip were retrospectively studied. Patients affected by CKD in this population were identified and compared with a control group of patients with PJI but without CKD. Data on patient characteristics and comorbidities were collected. The microorganisms responsible for PJI were identified and compared between both groups. RESULTS: The CKD group included 409 patients, 54.3% male, mean age of 73.8 ± 8.9 years, a higher body mass index (BMI) than the general population (29.88 ± 5.90 kg/m), and higher age-adjusted CCI of 6.15 ± 2.35. Overall, 70 different isolates of microorganisms were identified, including 52 Gram-positive spp., 28 Gram-negative spp., 3 fungi, and 1 mycobacterium. Polymicrobial infections were more common in CKD group than controls (47.9% versus 30.9%; p < 0.0001). Staphylococcus spp. were the most common bacteria in both groups, followed by Gram-negative Enterobacteriaceae and Streptococcus spp. CKD group showed a higher risk of developing infections caused by Staphylococcus aureus (p = 0.003), Gram-negative bacteria, and Candida (p = 0.035). CONCLUSIONS: Renal failure exposes patients who undergo THA to PJI caused by microorganisms that are potentially more drug resistant, leading to a higher risk of treatment failure. Knowing in advance the different microorganism profiles could help to plan a different surgical strategy.
For many but not for all: the bikini incision direct anterior approach for total hip arthroplasty. A narrative review.
Faldini C, Traina F, Pilla F … +4 more , D'Agostino C, Brunello M, Morandi Guaitoli M, Di Martino A
J Orthop Traumatol · 2024 Dec · PMID 39694981 · Full text
Total hip arthroplasty (THA) has significantly improved the lives of patients with degenerative hip disorders. The direct anterior approach (DAA) is favored for its minimally invasive nature, leading to less postoperativ...
Total hip arthroplasty (THA) has significantly improved the lives of patients with degenerative hip disorders. The direct anterior approach (DAA) is favored for its minimally invasive nature, leading to less postoperative pain and a faster recovery. The bikini incision (BI) approach was developed to enhance aesthetic outcomes while maintaining the clinical and functional benefits of the DAA. Despite its advantages, the BI technique presents challenges, controversies persist regarding its efficacy and safety, and there is no consensus within the medical community about its overall benefits. Incisions aligned with Langer's lines, like the BI, promote better healing and minimal scarring. Studies indicate that BI patients report higher satisfaction with scar appearance and texture compared to traditional DAA patients. However, the BI carries a higher risk of lateral femoral cutaneous nerve (LFCN) injury, although most symptoms resolve within 6 months. For obese patients, the BI is associated with fewer complications, such as infections and delayed healing, compared to the conventional DAA, making it a safe and effective option. BI patients also experience better aesthetic outcomes and functional recovery, with reduced pain and itching. The BI technique in THA represents a significant advancement, offering improved aesthetic and wound-healing outcomes. The shift from the traditional DAA to the BI aligns with patient preferences for scars that are less visible and conspicuous. Despite the steep learning curve and risks, careful patient selection and refined surgical techniques can enhance the BI's benefits. Future research should focus on long-term outcomes and comparative studies to further establish the BI's efficacy and safety. As patient demand for aesthetically favorable surgeries grows, the BI is likely to become a preferred approach in THA.
Efficacy of platelet-rich plasma in meniscal repair surgery: a systematic review of randomized controlled trials.
Utrilla GS, Degano IR, D'Ambrosi R
J Orthop Traumatol · 2024 Dec · PMID 39694969 · Full text
PURPOSE: This study's primary objective was to evaluate the effectiveness of platelet-rich plasma (PRP) administration for meniscal injuries treated with meniscal repair procedures (sutures), using radiologic measures an...
PURPOSE: This study's primary objective was to evaluate the effectiveness of platelet-rich plasma (PRP) administration for meniscal injuries treated with meniscal repair procedures (sutures), using radiologic measures and clinical scales. The secondary objective was to identify potential bias-inducing elements in the analyzed studies. METHODS: In December 2023, a systematic search was conducted in PubMed, Cochrane, Embase, and Scopus for randomized controlled trials. This review compares PRP with placebo. Three studies were finally selected. The risk of bias was assessed using Cochrane's Risk of Bias Tool 2. Radiologic evaluation of meniscal healing was measured with magnetic resonance imaging (MRI) and arthroscopic studies, while clinical evaluation was performed using four scales [Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), International Knee Documentation Committee Subjective Knee Form (IKDC), and Western Ontario and McMaster Universities Index (WOMAC)] and by recording the incidence of complications. RESULTS: The three selected studies included 139 patients; of these, 76 (54.7%) were randomly assigned to the intervention group (PRP injection) and 63 (45.3%) to the control group (placebo). The mean age of the intervention group was 37.4 ± 7.5 years, while the mean age of the control group was 36.5 ± 9.2 years. There were 41 female patients (29.5%). The median follow-up duration was 27.58 ± 17.3 months. MRI evaluation did not show a significant improvement in the PRP group in any of the studies (p-value = 0.41-0.54). However, when assessed by the cumulative evaluation of MRI and arthroscopy, the cumulative failure rate was significantly better in the PRP group (p-value = 0.04-0.048). One study that evaluated isolated arthroscopy also showed significant improvement in the PRP group (p = 0.003). Regarding the VAS scale, no study demonstrated a significant difference, except for one study that showed significant improvement after 6 months and in the difference between the 3rd and 6th months. The KOOS scale yielded conflicting results; one study showed no significant difference, while the other two indicated significant improvement. The IKDC and WOMAC scales were evaluated in two studies, showing opposite results. All included studies reported no complications, and one study indicated no increased risk in the treatment group. CONCLUSIONS: The results of this review indicate the necessity for further studies to make a definitive statement about the effectiveness of PRP administration in meniscal repair processes. Level of evidence Systematic review and meta-analysis of articles of level 1.
Efficacy and safety of quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis.
Zhang XF, Liu P, Huang JW … +1 more , He YH
J Orthop Traumatol · 2024 Dec · PMID 39694948 · Full text
BACKGROUND: Quadriceps tendon (QT), bone-patellar tendon-bone (BPTB), and hamstring tendon (HT) autografts are widely used for anterior cruciate ligament reconstruction (ACLR), but the optimal autograft choice remains co...
BACKGROUND: Quadriceps tendon (QT), bone-patellar tendon-bone (BPTB), and hamstring tendon (HT) autografts are widely used for anterior cruciate ligament reconstruction (ACLR), but the optimal autograft choice remains controversial. This study assessed the treatment effects of QT versus BPTB and HT autografts for ACLR. METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies published from inception until July 2022. Effect estimates were presented as odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (CI) for categorical and continuous variables, respectively. All pooled analyses were performed using a random-effects model. RESULTS: Twenty-one studies (3 randomized controlled trials [RCTs], 3 prospective studies, and 15 retrospective studies) involving 2964 patients with ACLR were selected for meta-analysis. Compared with the HT autograft, the QT autograft was associated with a reduced risk of graft failure (OR: 0.46; 95% CI: 0.23-0.93; P = 0.031). Compared with the BPTB autograft, the QT autograft was associated with a reduced risk of donor site pain (OR: 0.16; 95% CI: 0.10-0.24; P < 0.001). Moreover, the QT autograft was associated with a lower side-to-side difference than that observed with the HT autograft (WMD: - 0.74; 95% CI: - 1.47 to - 0.01; P = 0.048). Finally, compared with the BPTB autograft, the QT autograft was associated with a reduced risk of moderate-to-severe kneecap symptoms during sports and work activities (OR: 0.14; 95% CI: 0.05-0.37; P < 0.001). CONCLUSIONS: The findings of this study suggest that the QT autograft can be defined as a safe and effective alternative choice for ACLR, but its superiority is yet to be proven by RCTs and prospective studies. Level of evidence Level III.
Postoperative femoral head cartilage injury after hip arthroscopic treatment for femoroacetabular impingement syndrome and labral tear.
Gao G, Zhu Y, Zhang S … +3 more , Ao Y, Wang J, Xu Y
J Orthop Traumatol · 2024 Dec · PMID 39694937 · Full text
BACKGROUND: Postoperative femoral head cartilage injury (FHCI) is a rare condition that can be observed in a certain proportion of patients undergoing hip arthroscopy. However, the prevalence and associated factors of FH...
BACKGROUND: Postoperative femoral head cartilage injury (FHCI) is a rare condition that can be observed in a certain proportion of patients undergoing hip arthroscopy. However, the prevalence and associated factors of FHCI, and the effect of this condition on clinical outcomes still remain unknown. PATIENTS AND METHODS: Consecutive patients who were diagnosed with femoroacetabular impingement syndrome (FAIS) and labral tear and underwent hip arthroscopic treatment in our institute between July 2020 and July 2021 were retrospectively evaluated. Supine anteroposterior hip radiographs, cross-table lateral radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) were obtained preoperatively. Postoperative MRI, at least 6 months after arthroscopy, was performed. Postoperative FHCI was evaluated by two surgeons through MRI. Preoperative patient-reported outcomes (PROs) including visual analog scale (VAS) for pain, and modified Harris Hip Score (mHHS) before surgery and at final followup were obtained. RESULTS: A total of 196 patients were included. Postoperative FHCI was identified in 21 (10.7%) patients. The intraobserver reliability of the observer A and B for detecting postoperative FHCI using 3.0-T MRI was high (k = 0.929, and k = 0.947, respectively). The interobserver reliability between the two observers for detecting FHCI using 3.0-T MRI was high (k = 0.919). There was no significant difference in preoperative and postoperative mHHS, VAS, and percentage of patients who surpassed minimal clinically important difference (MCID) and achieved patient acceptable symptom state (PASS) between patients with and without postoperative FHCI (P > 0.05). CONCLUSION: Although postoperative FHCI was observed in 10.7% of patients, which was associated with larger labrum, this condition did not result in inferior clinical outcomes. Level of evidence IV, retrospective case series. Trial registration The Chinese Clinical Trial Registry approved the registration (ChiCTR2200061166). The date of registration is 2022-06-15.
Biphasic cartilage repair implant versus microfracture in the treatment of focal chondral and osteochondral lesions of the knee: a prospective, multi-center, randomized clinical trial.
Tseng TH, Chen CP, Jiang CC … +4 more , Weng PW, Chan YS, Hsu HC, Chiang H
J Orthop Traumatol · 2024 Nov · PMID 39614986 · Full text
BACKGROUND: Autologous minced cartilage is a method for cartilage defect repair, and our study focuses on a newly developed biphasic cylindrical osteochondral construct designed for use in human knees. We aimed to compar...
BACKGROUND: Autologous minced cartilage is a method for cartilage defect repair, and our study focuses on a newly developed biphasic cylindrical osteochondral construct designed for use in human knees. We aimed to compare its clinical effectiveness and safety with microfracture, the commonly utilized reparative treatment for knee chondral or osteochondral defects. MATERIALS AND METHODS: Conducted as a prospective multicenter, randomized controlled, non-inferiority trial across nine hospitals, the study involved 92 patients with International Cartilage Repair Society (ICRS) grade 3 to 4 chondral or osteochondral lesions on femoral condyles. Patients were evenly randomized to receive either the biphasic cartilage-repair implant (BiCRI) or microfracture. Functional outcomes and safety assessments were conducted at postoperative intervals of 6 weeks and 3, 6, and 12 months. Primary and secondary endpoints included International Knee Documentation Committee (IKDC) 2000 Subjective Knee Evaluation Form score improvement, the grade distribution in the IKDC 2000 Knee Examination Form, and various assessments, such as the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scales (VASs) for pain, MRI findings, and arthroscopic findings at 12 months. RESULTS: Out of the initial participants, 47 in the BiCRI group and 45 in the microfracture group completed the follow-up. At 12 months, the mean change in IKDC total score was 25.56 ± 18.48 for BiCRI and 27.51 ± 23.65 for microfracture. The 95% confidence interval (CI) for the score difference (BiCRI minus microfracture) was - 6.95, exceeding the non-inferiority margin of - 12. Secondary endpoints indicated comparable functional outcomes, and arthroscopic findings demonstrated more fully regenerated cartilage in the BiCRI group. CONCLUSION: Based on the IKDC 2000 Subjective Knee Evaluation Form score, BiCRI proved non-inferior to microfracture at 12 months. Short-term functional outcomes were comparable to those with microfracture, while arthroscopic findings showed more complete cartilage regeneration in the BiCRI group. Consequently, BiCRI emerges as a viable alternative for treating chondral or osteochondral defects. LEVEL OF EVIDENCE: Level 2, multi-center, randomized clinical trial. TRIAL REGISTRATION: Name of the registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT01477008. Date of registration: 11/14/2011. URL of trial registry record: clinicaltrials.gov/study/NCT01477008.
Biomechanical evaluation of percutaneous compression plate and femoral neck system in Pauwels type III femoral neck fractures.
Xie X, Bi S, Song Q … +4 more , Zhang Q, Yan Z, Zhou X, Yu T
J Orthop Traumatol · 2024 Nov · PMID 39614019 · Full text
BACKGROUND: The optimal treatment for Pauwels type III femoral neck fractures remains contentious. We aim to compare the biomechanical properties of three inverted cannulated compression screw (ICCS), femoral neck system...
BACKGROUND: The optimal treatment for Pauwels type III femoral neck fractures remains contentious. We aim to compare the biomechanical properties of three inverted cannulated compression screw (ICCS), femoral neck system (FNS), and percutaneous compression plate (PCCP) to determine which offers superior stability for unstable femoral neck fractures. MATERIALS AND METHODS: Finite element analysis and artificial bone models were used to establish Pauwels III femoral neck fracture models. They were divided into ICCS, FNS, and PCCP groups based on respective internal fixation assemblies. The models were subjected to vertical axial loads (2100 N) and torsional forces (10 N × mm) along the femoral neck axis in the finite element analysis. The primary outcomes such as the Z axis fragmentary displacements, as well as displacements and the von Mises stress (VMS) distributions of internal fixations, were analyzed. Additionally, the artificial bones were subjected to progressively increasing vertical axial pressures and torsional moments at angles of 2°, 4°, and 6°, respectively. The vertical displacements of femoral heads and the required torque values were recorded. RESULTS: Finite element analysis revealed that under single-leg stance loading, the maximum Z-axis fragmentary displacements were 5.060 mm for ICCS, 4.028 mm for FNS, and 2.796 mm for PCCP. The maximum displacements of internal fixations were 4.545 mm for ICCS, 3.047 mm for FNS, and 2.559 mm for PCCP. Peak VMS values were 512.21 MPa for ICCS, 242.86 MPa for FNS, and 413.85 MPa for PCCP. Under increasing vertical loads applied to the artificial bones, the average vertical axial stiffness for the ICCS, FNS, and PCCP groups were 244.86 ± 2.84 N/mm, 415.03 ± 27.10 N/mm, and 529.98 ± 23.08 N/mm. For the torsional moment tests, the PCCP group demonstrated significantly higher torque values at 2°, 4°, and 6° compared with FNS and ICCS, with no significant difference between FNS and ICCS (P > 0.05). CONCLUSIONS: Finite element analysis and artificial bone models indicated that PCCP offers the best compressive and rotational stability for fixing Pauwels type III femoral neck fractures, followed by FNS and then ICCS. No significant difference in rotational resistance was observed between FNS and ICCS in synthetic bones. Level of Evidence Level 5.
Risk factors for proximal radial abnormalities in children with untreated chronic Monteggia fractures: a review of 142 cases.
Wang W, Mei Q, Liu H … +7 more , Guo Y, Mei H, Canavese F, Andreacchio A, Lyu H, Chen S, He S
J Orthop Traumatol · 2024 Nov · PMID 39614016 · Full text
BACKGROUND: The risk factors for proximal radial abnormalities (PRA) in paediatric patients with untreated chronic Monteggia fractures (CMFs) are unclear. This multicentre study aimed to evaluate the risk factors for PRA...
BACKGROUND: The risk factors for proximal radial abnormalities (PRA) in paediatric patients with untreated chronic Monteggia fractures (CMFs) are unclear. This multicentre study aimed to evaluate the risk factors for PRA in children with untreated CMFs. MATERIALS AND METHODS: The clinical data of 142 patients (mean age at the time of injury: 5.73 years) with untreated unilateral CMFs were retrospectively reviewed. The radial neck-shaft angle (RNS) and radial head size (RH) were measured on anteroposterior (AP) and lateral (L) radiographs, respectively. The RH size was the ratio of the widest width of the proximal radial metaphysis to the narrowest radial neck width. The En-RNS and En-RH were the ratios of the enlargement (En) of the RNS angle and RH size of the injured elbow to those of the uninjured elbow, respectively. Paired-sample t-tests, single-factor analyses and multiple linear regression analyses were performed to evaluate the correlation between the differences in these parameters between the injured and uninjured elbows and the assessed risk factors. These risk factors included institution, sex, laterality, age at injury, time from injury to diagnosis, direction of RH dislocation, distance of RH dislocation (DD-RH), presence of radial or median nerve injury, heterotopic ossification and immobilization of the elbow after injury. RESULTS: In children with untreated CMFs (mean time from injury to diagnosis: 14.6 months), Student's t-test revealed a significant difference in the RH size (P < 0.001) but not in the RNS angle (P = 0.075) between the injured and uninjured elbows. Pearson correlation analysis revealed a potential correlation between En-RH and age at the time of injury (P = 0.069), time from injury to diagnosis (P < 0.001) and DD-RH (P < 0.001), excluding other risk factors (P > 0.05). Multiple linear regression analysis revealed that age at the time of injury (P = 0.047), time from injury to diagnosis (P = 0.007) and DD-RH (P = 0.001) were risk factors for an increased En-RH in patients with untreated CMFs; the variability in En-RH among the other three risk factors was 21.4%. CONCLUSIONS: In paediatric patients with unilateral untreated CMFs, PRA of the injured elbow consisted mainly of RH enlargement or radial neck narrowing rather than valgus deformities of the proximal radius. Older age at injury, increased time from injury to diagnosis and DD-RH were risk factors for more severe PRA. LEVEL OF EVIDENCE: III.
The international Hip Outcome Tool 12 questionnaire (iHOT-12): an Italian language cross-cultural adaptation and validation.
Randelli F, Fioruzzi A, Clemente A … +29 more , Radaelli A, Menon A, Di Via D, Caria C, Mazzoleni MG, Buono C, Di Benedetto P, Paciotti M, Papalia R, Fiorentino G, Collarile M, Panasci M, Carulli C, Rosolani M, Rocca FD, Cerulli S, Potestio D, Conati M, Costantini A, Bisciotti GN, Aprato A, Perticarini L, Santori N, Loppini M, Solarino G, Vicenti G, Pavone V, Di Martino A, Rivera F
J Orthop Traumatol · 2024 Nov · PMID 39604661 · Full text
BACKGROUND: Patient-reported outcome (PRO) measures are essential for evaluating disease-related quality of life. The International Hip Outcome Tool 12 (iHOT12) assesses various aspects of hip-related symptoms, function,...
BACKGROUND: Patient-reported outcome (PRO) measures are essential for evaluating disease-related quality of life. The International Hip Outcome Tool 12 (iHOT12) assesses various aspects of hip-related symptoms, function, sports participation, and social limitations. This study aimed to adapt and validate an Italian version of the iHOT12 according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. MATERIALS AND METHODS: A multicenter observational cohort study was conducted to translate and validate the iHOT-12 into Italian (iHOT-12-ita) and assess its psychometric properties. Following international guidelines, we translated and culturally adapted the iHOT-12-ita. Patients with hip pain included in the study completed the iHOT-12-ita and mHHS-ita questionnaires at three timepoints: initial consultation (T0), 10-20 days later (T1), and at least 2 months after treatment (T2): hip injection, hip arthroscopy or total hip replacement. The evaluation of the iHOT-12-ita psychometric properties was conducted following the COSMIN checklist, assessing its reliability, responsiveness, interpretability, and acceptability. RESULTS: Between May 2019 to September 2022, 104 patients were included, from two tertiary hip surgery referral center clinics, they completed both questionnaires and were available for data analysis. The psychometric evaluations revealed robust test-retest reliability on 27 patients at T1, with a Lin coefficient of 0.709 [95% confidence interval (CI) 0.553-0.888] and a high Pearson correlation coefficient of 0.745. At T2 after treatment, there was significant responsiveness (p < 0.001, n = 72), with excellent correlation observed between the iHOT-12-Ita and mHHS-Ita questionnaires (pwcorr = 0.7971). All predefined hypotheses were confirmed. CONCLUSIONS: The Italian iHOT-12-ita proved reliable, valid, and responsive in assessing hip disease-related quality of life. Its implementation in routine clinical practice and research can enhance patient care and research quality in hip preservation surgery for the Italian orthopedic community. LEVEL OF EVIDENCE: II.
Comparison of survival, function and complication between intercalary frozen autograft versus massive allograft reconstruction after malignant bone tumors resection.
Li Z, Guo H, Deng Z … +3 more , Yang Y, Zhang Q, Liu W
J Orthop Traumatol · 2024 Nov · PMID 39581929 · Full text
PURPOSE: This study aims to compare the clinical outcomes of intercalary frozen autograft and allograft reconstruction for primary malignant bone tumors. METHODS: A retrospective study was conducted on 144 patients who u...
PURPOSE: This study aims to compare the clinical outcomes of intercalary frozen autograft and allograft reconstruction for primary malignant bone tumors. METHODS: A retrospective study was conducted on 144 patients who underwent intercalary biological reconstruction for primary malignant bone tumors at a single institution between January 2012 and July 2023. Seventy-two patients underwent intercalary liquid nitrogen-frozen autograft reconstruction, and 72 patients underwent intercalary allograft reconstruction in this study. A modified International Society of Limb Salvage classification system was used to evaluate the complications. RESULTS: The mean follow-up time was 60.2 ± 32.1 (range, 12-149) months. The mean union time was 9.6 months in the frozen autograft group and 15.9 months in the allograft group (p < 0.001). The 5-year overall survivorship was 86.8% in the frozen autograft group and 73.2% in the allograft group (p = 0.017). The average MSTS-93 score was comparable between the two groups (89.7% by autograft versus 87.6% by allograft, p > 0.05). Of the patients, 48.6% (70/144) had at least one complication. The most common complications were bone nonunion (20.8%, 30/144), followed by structural failure (17.4%, 25/144), tumor progression (10.4%, 15/144), infection (10.4%, 15/144), and soft tissue failures (5.6%, 8/144). Higher rates of bone nonunion (type 4B; p = 0.002) and structural failure (type 3B; p = 0.004) were obtained in the allograft group than in the frozen autograft group. CONCLUSIONS: The intercalary frozen autografts had shorter union time and lower complication rates than allograft reconstruction. Therefore, we recommend that frozen autograft reconstruction be considered when the tumor bone has not suffered severe osteolytic injury or pathological fracture. LEVEL OF EVIDENCE: level III, case-control study.
TikTok and frozen shoulder: a cross-sectional study of social media content quality.
D'Ambrosi R, Bellato E, Bullitta G … +9 more , Cecere AB, Corona K, De Crescenzo A, Fogliata V, Micheloni GM, Saccomanno MF, Vitullo F, Celli A, SICSeG (Italian Society of Shoulder, Elbow Surgery) Research Committee
J Orthop Traumatol · 2024 Nov · PMID 39581922 · Full text
PURPOSE: This study aimed to assess the validity and informational value of the material provided on TikTok regarding frozen shoulders. The hypothesis was that the video content on this platform would not provide adequat...
PURPOSE: This study aimed to assess the validity and informational value of the material provided on TikTok regarding frozen shoulders. The hypothesis was that the video content on this platform would not provide adequate and valid information. METHODS: The current study focused on frozen shoulder videos on the TikTok social media platform. The terms "frozen shoulder" and/or "adhesive capsulitis" were used as keywords for an extensive online search of video content on TikTok, and the first 100 videos were included. Out-of-topic, non-English, and duplicated videos were excluded from the analysis. The duration and numbers of likes, shares, and views were recorded for each video. Further, videos were categorized based on the source (physiotherapist/osteopath, medical doctor, or private user), type of information (physical therapy, etiopathogenesis, anatomy, clinical examination, patient experience, or symptoms), video content (rehabilitation, education, or patient experience/testimony), and the presence of music or a voice. The assessment of the video content's quality and reliability was performed by two experienced shoulder surgeons using the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS). RESULTS: A total of 100 videos were included in the analysis, of which 86 (86.0%) were published by physiotherapists/osteopaths. Most of the information and video content focused on physical therapy and rehabilitation (83.0% and 84.0%, respectively). Eighty-four (84.0%) videos included voice comments, while the remaining featured music. The mean number of views was 2,142,215.32 ± 6,148,794.63, while the mean numbers of likes, comments, and shares were 58,438.67 ± 201,863.54, 550.81 ± 1712.22, and 3327.43 ± 7320.81, respectively. The mean video duration was 110.20 ± 116.43 s. The mean DISCERN score, JAMA score, and GQS were 16.17 ± 2.36, 0.61 ± 0.51, and 1.18 ± 0.41, respectively. Videos posted by medical doctors or private users received higher scores than those posted by physiotherapists/osteopaths (p < 0.05). CONCLUSIONS: The educational value of videos published on TikTok was poor; videos posted by medical doctors exhibited better quality and educational value than those of physiotherapists or osteopaths. It is the responsibility of orthopedic surgeons to investigate the potential benefits, consequences, and implications of TikTok video content for the health of frozen shoulder patients and to propose necessary adjustments. Given the rapid growth of TikTok, further research is needed. LEVEL OF EVIDENCE: Level IV-cross-sectional study.
Magnesium degradation-induced variable fixation plates promote bone healing in rabbits.
Wen J, Zeng Y, Su S … +4 more , Song M, Wang Z, Chen X, Dong X
J Orthop Traumatol · 2024 Nov · PMID 39572420 · Full text
BACKGROUND: Both initial mechanical stability and subsequent axial interfragmentary micromotion at fracture ends play crucial roles in fracture healing. However, the conversion timing of variable fixation and its effect...
BACKGROUND: Both initial mechanical stability and subsequent axial interfragmentary micromotion at fracture ends play crucial roles in fracture healing. However, the conversion timing of variable fixation and its effect on and mechanism of fracture healing remain inadequately explored. METHODS: A magnesium degradation-induced variable fixation plate (MVFP) for femurs was designed, and its conversion timing was investigated both in vitro and in vivo. Then, locking plates and MVFPs with and without a magnesium shim were implanted in rabbit femur fracture models. X-ray photography and micro computed tomography (micro-CT) were performed to observe the healing of the fracture. Toluidine blue and Masson's trichrome staining were performed to observe new bone formation. The torsion test was used to determine the strength of the bone after healing. Finally, reverse transcription-polymerase chain reaction (RT-PCR) and western blotting were used to detect the expression of osteogenesis-related genes in the three groups. RESULTS: The MVFP with sample 3 magnesium shim showed greater axial displacement within 15 days in vitro, and its variable capability was likewise confirmed in vivo. X-ray photography and micro-CT indicated increased callus formation in the variable fixation group. Toluidine blue and Masson's trichrome staining revealed less callus formation on the rigid fixation side of the locking plate, whereas the variable fixation group presented more callus formation, more symmetrical intraosseous calli, and greater maturity. The torsion test indicated greater torsional resistance of the healed bone in the variable fixation group. RT-PCR and western blotting revealed that the expression levels of BMP2 and OPG increased during early fracture stages but decreased in late fracture stages, whereas RANKL expression showed the opposite trend in the variable fixation group. CONCLUSIONS: MVFP promoted faster and stronger bone healing in rabbits, potentially by accelerating the expression of BMP2 and modulating the OPG/RANKL/RANK signaling axis. This study offers valuable insights for the clinical application of variable fixation technology in bone plates and contributes to the advancement of both internal fixation technology and theory. LEVEL OF EVIDENCE: level V.
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