Pub Date : 2025-12-10DOI: 10.1097/corr.0000000000003800
Dong Uk Jin,Ji Sup Hwang,Hyun Sik Gong
BACKGROUNDCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is more prevalent in patients with diabetes. However, the underlying mechanisms linking diabetes and CTS have not been fully elucidated. The advanced glycation end products (AGEs) and the receptor for AGEs (RAGE) are involved in chronic inflammation and diabetic complications, suggesting that this pathway may be relevant to the pathogenesis of CTS in patients with diabetes.QUESTIONS/PURPOSES(1) Is RAGE expressed in the flexor tendon synovium in patients with CTS, and if so, is it expressed more in patients with diabetes? (2) Is RAGE expression in the flexor tendon synovium associated with CTS severity?METHODSBetween February 2020 and March 2023, a total of 130 patients underwent open carpal tunnel release performed by a single highly experienced hand surgeon. Patients with peripheral neuropathies, cervical radiculopathy, diabetic polyneuropathy, systemic inflammatory diseases such as gout or rheumatoid arthritis, a history of wrist fracture, or previous wrist surgery were excluded. Patients who did not consent to tissue storage or whose consent was not documented were also excluded. As a result, flexor tendon synovium samples were available in the biobank for 72% (93 patients) of the initial cohort. Among these, 8% (7 of 93) of samples were excluded because of poor immunohistochemical staining quality, leaving 66% (86 patients) of the initial cohort for the final analysis. The mean ± SD age of the patients was 60 ± 12 years. Of the 86 patients, 81% (70) were female. CTS severity was classified according to the Bland scale as mild to moderate (Grades 1 to 3) or severe (Grades 4 to 6) based on electrophysiologic findings. In this cohort, 45% (39) had severe CTS and 21% (18) had diabetes. RAGE expression in the flexor tendon synovium was measured semiquantitatively by immunohistochemistry. The scoring method showed excellent interobserver reliability (intraclass correlation coefficient 0.92). RAGE expression was compared between patients with and without diabetes. Multivariable logistic regression analysis was performed to identify factors that were independently related to CTS severity.RESULTSHistopathologic analysis revealed that RAGE expression was predominantly observed in the vascular endothelial cells of the subsynovial connective tissue. Patients with diabetes had a greater RAGE staining index expression than those without diabetes (median [IQR] 8.5 [6.0 to 9.0] versus 8.0 [6.0 to 8.0], difference of medians 0.5; p = 0.03). For all patients, those with and without diabetes, RAGE staining index expression was not associated with CTS severity (OR 1.17 [95% confidence interval (CI) 0.94 to 1.44]; p = 0.16), BMI was not associated (OR 1.12 [95% CI 0.98 to 1.29]; p = 0.10), and only age was associated (OR 1.10 [95% CI 1.05 to 1.17]; p < 0.001). When stratified to only those patients with diabetes, after controlling for potentially confounding variables such as age
背景：腕管综合征（carpal tunnel syndrome， CTS）是最常见的压迫性神经病变，在糖尿病患者中更为常见。然而，将糖尿病和CTS联系起来的潜在机制尚未完全阐明。晚期糖基化终产物（AGEs）和AGEs受体（RAGE）参与慢性炎症和糖尿病并发症，提示该途径可能与糖尿病患者CTS的发病机制有关。(1) RAGE是否在CTS患者的屈肌腱滑膜中表达，如果有，是否在糖尿病患者中表达更多？(2)屈肌腱滑膜RAGE表达是否与CTS严重程度相关？方法：在2020年2月至2023年3月期间，共有130例患者接受了由一位经验丰富的手外科医生实施的开放式腕管松解术。排除有周围神经病变、颈神经根病、糖尿病多发性神经病变、全身炎性疾病如痛风或类风湿关节炎、腕部骨折史或既往腕部手术的患者。不同意组织储存或没有书面同意的患者也被排除在外。结果，初始队列中72%（93例）的屈肌腱滑膜样本在生物库中可用。其中，由于免疫组化染色质量差，有8%（93例中的7例）的样本被排除，留下66%（86例）的初始队列进行最终分析。患者平均±SD年龄为60±12岁。86例患者中，81%（70例）为女性。根据电生理结果，CTS的严重程度根据Bland量表分为轻度至中度（1至3级）或重度（4至6级）。在该队列中，45%（39人）患有严重CTS， 21%（18人）患有糖尿病。采用免疫组化半定量法检测RAGE在屈肌腱滑膜中的表达。评分方法具有良好的观察者间信度（类内相关系数0.92）。比较糖尿病患者和非糖尿病患者的RAGE表达。进行多变量logistic回归分析，以确定与CTS严重程度独立相关的因素。结果组织病理学分析显示RAGE主要表达于滑膜下结缔组织血管内皮细胞。糖尿病患者RAGE染色指数表达高于无糖尿病患者（中位数[IQR] 8.5[6.0 ~ 9.0]对8.0[6.0 ~ 8.0]，中位数差异0.5;p = 0.03）。对于所有患者，无论是否患有糖尿病，RAGE染色指数的表达与CTS严重程度无关(OR 1.17[95%可信区间（CI） 0.94至1.44]；p = 0.16)， BMI无关（OR 1.12 [95% CI 0.98 ~ 1.29]; p = 0.10），只有年龄相关（OR 1.10 [95% CI 1.05 ~ 1.17]; p < 0.001）。当只对糖尿病患者进行分层时，在控制了年龄、BMI等潜在的混杂变量后，在我们研究的变量中，只有RAGE染色指数表达与CTS相关（OR 3.40 [95% CI 1.10 ~ 10.53]; p = 0.03），这是本研究的关键发现。结论rage介导的机制可能参与糖尿病相关CTS的病理生理机制。需要进一步的研究来阐明RAGE相关的分子通路，并确定靶向RAGE是否可能成为影响疾病进展或手术结果的潜在治疗策略。证据等级：诊断性研究III级。
{"title":"Is RAGE Expression in Flexor Tendon Synovium Associated With Carpal Tunnel Syndrome in Patients With Diabetes?","authors":"Dong Uk Jin,Ji Sup Hwang,Hyun Sik Gong","doi":"10.1097/corr.0000000000003800","DOIUrl":"https://doi.org/10.1097/corr.0000000000003800","url":null,"abstract":"BACKGROUNDCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is more prevalent in patients with diabetes. However, the underlying mechanisms linking diabetes and CTS have not been fully elucidated. The advanced glycation end products (AGEs) and the receptor for AGEs (RAGE) are involved in chronic inflammation and diabetic complications, suggesting that this pathway may be relevant to the pathogenesis of CTS in patients with diabetes.QUESTIONS/PURPOSES(1) Is RAGE expressed in the flexor tendon synovium in patients with CTS, and if so, is it expressed more in patients with diabetes? (2) Is RAGE expression in the flexor tendon synovium associated with CTS severity?METHODSBetween February 2020 and March 2023, a total of 130 patients underwent open carpal tunnel release performed by a single highly experienced hand surgeon. Patients with peripheral neuropathies, cervical radiculopathy, diabetic polyneuropathy, systemic inflammatory diseases such as gout or rheumatoid arthritis, a history of wrist fracture, or previous wrist surgery were excluded. Patients who did not consent to tissue storage or whose consent was not documented were also excluded. As a result, flexor tendon synovium samples were available in the biobank for 72% (93 patients) of the initial cohort. Among these, 8% (7 of 93) of samples were excluded because of poor immunohistochemical staining quality, leaving 66% (86 patients) of the initial cohort for the final analysis. The mean ± SD age of the patients was 60 ± 12 years. Of the 86 patients, 81% (70) were female. CTS severity was classified according to the Bland scale as mild to moderate (Grades 1 to 3) or severe (Grades 4 to 6) based on electrophysiologic findings. In this cohort, 45% (39) had severe CTS and 21% (18) had diabetes. RAGE expression in the flexor tendon synovium was measured semiquantitatively by immunohistochemistry. The scoring method showed excellent interobserver reliability (intraclass correlation coefficient 0.92). RAGE expression was compared between patients with and without diabetes. Multivariable logistic regression analysis was performed to identify factors that were independently related to CTS severity.RESULTSHistopathologic analysis revealed that RAGE expression was predominantly observed in the vascular endothelial cells of the subsynovial connective tissue. Patients with diabetes had a greater RAGE staining index expression than those without diabetes (median [IQR] 8.5 [6.0 to 9.0] versus 8.0 [6.0 to 8.0], difference of medians 0.5; p = 0.03). For all patients, those with and without diabetes, RAGE staining index expression was not associated with CTS severity (OR 1.17 [95% confidence interval (CI) 0.94 to 1.44]; p = 0.16), BMI was not associated (OR 1.12 [95% CI 0.98 to 1.29]; p = 0.10), and only age was associated (OR 1.10 [95% CI 1.05 to 1.17]; p < 0.001). When stratified to only those patients with diabetes, after controlling for potentially confounding variables such as age ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"55 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1097/corr.0000000000003782
Lorenz H M van Schalkwijk,Jasper M van der Zee,Roelof van Ewijk,Johannes H M Merks,Jos A M Bramer,Hendrik W B Schreuder,Lianne M Haveman,Michiel A J van de Sande,Lizz van der Heijden
BACKGROUNDPediatric bone sarcomas are rare malignancies that are usually treated with specialized multimodal care to allow specialized oncologists to gain experience and provide expertise in treatment. In the Netherlands, oncologic care for all pediatric cancers, including pediatric bone sarcoma, has been centralized in one tertiary referral center for pediatric oncology since 2018. Surgical decision-making is not solely driven by whether limb salvage is oncologically feasible, but rather by a comprehensive shared decision-making process in which all surgical options are carefully weighed against one another. This includes not only oncologic safety, but also expected functional outcomes such as sports participation, the risk of complications, and the burden of additional surgeries that may be performed over time. By openly discussing these trade-offs with patients and families, we aim to reach a decision that best aligns with the family's values and expectations, and thereby with the child's long-term well-being and priorities. The objective of this study was to provide benchmark values for future comparisons of short-term perioperative and postoperative outcomes.QUESTIONS/PURPOSESWe evaluated results following the national centralization of pediatric bone sarcoma care in the Netherlands to determine: (1) What were the intraoperative complications and blood loss? (2) What was the proportion of patients who achieved R0 margins? (3) What were the 30- and 90-day complications after surgical treatment, and what proportion had a delay in resuming chemotherapy?METHODSBetween 2018 and 2024, a total of 157 children age 0 to 18 years underwent surgical resection for primary malignant bone sarcoma. We excluded 42 patients who had centralized systemic treatment but underwent surgery at referring adult sarcoma centers and 16 patients who had an axial localization. We included 99 patients who underwent surgery at the national pediatric oncology center for osteosarcoma (n = 69), Ewing sarcoma (n = 25), or other (n = 5); the extremities were involved in most patients (91% [90]). Of these, none were lost to follow-up; 1% (1) died within the first year from other causes. Seventy percent (69 of 99) had ≥ 1 year of follow-up. Ninety-day postoperative outcomes were evaluated to capture clinically relevant short-term treatment morbidity and care continuity. Tumor and treatment characteristics were retrospectively analyzed. The median (IQR) age was 13 years (9 to 15); 36% (36) were female. The median (IQR) follow-up time was 18 months (8 to 43). Among the 99 included patients, surgical procedures included limb-sparing surgery (68% [67]), amputation (15% [15]), rotationplasty (17% [17]), and other (1% [1]). Medical charts were reviewed for blood loss and surgical margins. Postoperative complications (using the Clavien-Dindo and the Henderson classifications) are reported from short-term (< 30 days) to midterm (< 90 days).RESULTSThree percent (3 of 99) of patients had s
{"title":"Preliminary Surgical Findings and Complications After National Centralization of Pediatric Bone Sarcoma Resections in the Netherlands: A Benchmarking Study.","authors":"Lorenz H M van Schalkwijk,Jasper M van der Zee,Roelof van Ewijk,Johannes H M Merks,Jos A M Bramer,Hendrik W B Schreuder,Lianne M Haveman,Michiel A J van de Sande,Lizz van der Heijden","doi":"10.1097/corr.0000000000003782","DOIUrl":"https://doi.org/10.1097/corr.0000000000003782","url":null,"abstract":"BACKGROUNDPediatric bone sarcomas are rare malignancies that are usually treated with specialized multimodal care to allow specialized oncologists to gain experience and provide expertise in treatment. In the Netherlands, oncologic care for all pediatric cancers, including pediatric bone sarcoma, has been centralized in one tertiary referral center for pediatric oncology since 2018. Surgical decision-making is not solely driven by whether limb salvage is oncologically feasible, but rather by a comprehensive shared decision-making process in which all surgical options are carefully weighed against one another. This includes not only oncologic safety, but also expected functional outcomes such as sports participation, the risk of complications, and the burden of additional surgeries that may be performed over time. By openly discussing these trade-offs with patients and families, we aim to reach a decision that best aligns with the family's values and expectations, and thereby with the child's long-term well-being and priorities. The objective of this study was to provide benchmark values for future comparisons of short-term perioperative and postoperative outcomes.QUESTIONS/PURPOSESWe evaluated results following the national centralization of pediatric bone sarcoma care in the Netherlands to determine: (1) What were the intraoperative complications and blood loss? (2) What was the proportion of patients who achieved R0 margins? (3) What were the 30- and 90-day complications after surgical treatment, and what proportion had a delay in resuming chemotherapy?METHODSBetween 2018 and 2024, a total of 157 children age 0 to 18 years underwent surgical resection for primary malignant bone sarcoma. We excluded 42 patients who had centralized systemic treatment but underwent surgery at referring adult sarcoma centers and 16 patients who had an axial localization. We included 99 patients who underwent surgery at the national pediatric oncology center for osteosarcoma (n = 69), Ewing sarcoma (n = 25), or other (n = 5); the extremities were involved in most patients (91% [90]). Of these, none were lost to follow-up; 1% (1) died within the first year from other causes. Seventy percent (69 of 99) had ≥ 1 year of follow-up. Ninety-day postoperative outcomes were evaluated to capture clinically relevant short-term treatment morbidity and care continuity. Tumor and treatment characteristics were retrospectively analyzed. The median (IQR) age was 13 years (9 to 15); 36% (36) were female. The median (IQR) follow-up time was 18 months (8 to 43). Among the 99 included patients, surgical procedures included limb-sparing surgery (68% [67]), amputation (15% [15]), rotationplasty (17% [17]), and other (1% [1]). Medical charts were reviewed for blood loss and surgical margins. Postoperative complications (using the Clavien-Dindo and the Henderson classifications) are reported from short-term (< 30 days) to midterm (< 90 days).RESULTSThree percent (3 of 99) of patients had s","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"6 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1097/CORR.0000000000003794
Lisa G M Friedman
{"title":"Residency Diary: Getting Stuck In.","authors":"Lisa G M Friedman","doi":"10.1097/CORR.0000000000003794","DOIUrl":"10.1097/CORR.0000000000003794","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1097/CORR.0000000000003801
Alexander S Rascoe
{"title":"CORR Insights®: Does Isolated Ankle Arthrodesis Affect Medial Column Alignment in Patients With Progressive Collapsing Foot Deformity and End-stage Ankle Osteoarthritis?","authors":"Alexander S Rascoe","doi":"10.1097/CORR.0000000000003801","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003801","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1097/corr.0000000000003797
Szu-An Jou,Chia-Hao Hsu
{"title":"Letter to the Editor: Factors That Increase the Risk of Prosthetic Joint Infection Within 90 Days After THA and TKA: A Nationwide Population-based Study.","authors":"Szu-An Jou,Chia-Hao Hsu","doi":"10.1097/corr.0000000000003797","DOIUrl":"https://doi.org/10.1097/corr.0000000000003797","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"50 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1097/corr.0000000000003759
Alicia R Jacobson
{"title":"CORR Insights®: Is There a Relationship Between Social Health and Musculoskeletal Discomfort and Incapability? A Systematic Review.","authors":"Alicia R Jacobson","doi":"10.1097/corr.0000000000003759","DOIUrl":"https://doi.org/10.1097/corr.0000000000003759","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"14 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1097/corr.0000000000003783
Tae Kyun Kim
{"title":"Beyond the Bone: From Healers to Enablers of Mobility.","authors":"Tae Kyun Kim","doi":"10.1097/corr.0000000000003783","DOIUrl":"https://doi.org/10.1097/corr.0000000000003783","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"4 1","pages":"20-22"},"PeriodicalIF":4.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145785829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1097/corr.0000000000003790
Ruby Lawson,Babar Kayani,John A Skinner
{"title":"CORR Synthesis: What Is the Role of Robotic Technology in THA?","authors":"Ruby Lawson,Babar Kayani,John A Skinner","doi":"10.1097/corr.0000000000003790","DOIUrl":"https://doi.org/10.1097/corr.0000000000003790","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"28 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1097/corr.0000000000003787
Safak Ekinci
{"title":"Letter to the Editor: A Conversation With … William Berloni, Broadway and Hollywood Animal Trainer, on the Differences Between Training and Education.","authors":"Safak Ekinci","doi":"10.1097/corr.0000000000003787","DOIUrl":"https://doi.org/10.1097/corr.0000000000003787","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"29 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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