Pub Date : 2025-12-01Epub Date: 2025-10-09DOI: 10.1097/CORR.0000000000003636
Chia-Hao Hsu
{"title":"Letter to the Editor: Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.","authors":"Chia-Hao Hsu","doi":"10.1097/CORR.0000000000003636","DOIUrl":"10.1097/CORR.0000000000003636","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2392-2393"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Patients with massive rotator cuff tears can present with shoulder pain with preserved ROM, yet the compensatory mechanisms remain poorly understood. Identifying these mechanisms, particularly the role of periscapular muscles, could guide nonsurgical therapeutic strategies.</p><p><strong>Questions/purposes: </strong>(1) In patients with massive rotator cuff tears who achieved acceptable active ROM with physical therapy, which periscapular muscles provide compensatory motor activity? (2) What is the correlation between muscle metabolic activity and fatty infiltration and atrophy?</p><p><strong>Methods: </strong>Between January 2019 and April 2019, we evaluated 39 consecutive patients who presented to our outpatient clinic and were diagnosed with massive rotator cuff tears through sonographic screening. Of these, 41% (16) were excluded because of concomitant diseases. Of the remaining 59% (23) of patients who met the inclusion criteria and began the rehabilitation program, 13% (5) discontinued because of partial adherence or conversion to surgery. Ultimately, 46% (18) of patients completed the rehabilitation program and were included in the final analysis, comprising 8 with anterosuperior tears (median [IQR] age 56 years [54 to 61]) and 10 with posterosuperior tears (median [IQR] age 59 years [58 to 64]). Additionally, four nuclear medicine technicians without a history of shoulder injury or pain were recruited as the control group (median [IQR] age 54 years [52 to 56]). To address our first research question-identifying the muscles responsible for compensatory motor activity after a massive rotator cuff tear-participants underwent positron emission tomography/CT with fluorodeoxyglucose (FDG-PET/CT) imaging after performing a scaption exercise to assess muscle metabolic activity. Standardized uptake values (SUVs), reflecting glucose-based metabolic activity, were calculated for the periscapular, rotator cuff, and deltoid muscles using FDG-PET/CT and compared among groups using Kruskal-Wallis tests. To address the second research question-examining the correlation between muscle metabolic activity and fatty infiltration or atrophy-MRI was used to assess the Goutallier classification and occupation ratio, and Spearman correlation analysis was performed to evaluate their relationship with SUVs. Continuous variables were expressed as median and IQR.</p><p><strong>Results: </strong>In patients with posterosuperior rotator cuff tears who regained acceptable active ROM, several periscapular muscles exhibited increased activity after shoulder abduction exercises compared with controls. This pattern was not observed in those with anterosuperior tears. SUVs were significantly higher in the posterosuperior group than in controls for the levator scapulae (0.75 [95% confidence interval (95% CI) 0.73 to 0.81] versus 0.65 [95% CI 0.60 to 0.71], mean rank difference 9.33; p = 0.04), rhomboids (0.80 [95% CI 0.70 to 0.85] versus 0.65
背景：大量肩袖撕裂的患者可表现为保留ROM的肩痛，但代偿机制尚不清楚。确定这些机制，特别是肩胛周围肌肉的作用，可以指导非手术治疗策略。问题/目的：(1)在通过物理治疗获得可接受的活动性ROM的大量肩袖撕裂患者中，哪些肩胛周围肌肉提供代偿性运动活动？(2)肌肉代谢活动与脂肪浸润、萎缩有何关系？方法：在2019年1月至2019年4月期间，我们评估了39例连续到我们门诊就诊并通过超声筛查诊断为大量肩袖撕裂的患者。其中41%（16例）因合并疾病而被排除。在其余59%（23）名符合纳入标准并开始康复计划的患者中，13%(5)名因部分坚持或转为手术而停止治疗。最终，46%（18）例患者完成了康复计划并纳入最终分析，其中8例为上前撕裂（中位[IQR]年龄56岁[54 ~ 61岁]），10例为上后撕裂（中位[IQR]年龄59岁[58 ~ 64岁]）。此外，招募4名无肩伤或疼痛史的核医学技术人员作为对照组（中位[IQR]年龄54岁[52至56岁]）。为了解决我们的第一个研究问题——确定大规模肩袖撕裂后负责代偿性运动活动的肌肉，参与者在进行截肢运动以评估肌肉代谢活动后接受了含氟脱氧葡萄糖的正电子发射断层扫描/CT （FDG-PET/CT）成像。使用FDG-PET/CT计算肩胛周围肌、肩袖肌和三角肌的标准化摄取值（SUVs），反映基于葡萄糖的代谢活动，并使用Kruskal-Wallis测试比较各组之间的差异。为了解决第二个研究问题-检查肌肉代谢活动与脂肪浸润或萎缩之间的相关性-使用mri评估Goutallier分类和职业比，并使用Spearman相关分析评估它们与suv的关系。连续变量用中位数和IQR表示。结果：与对照组相比，肩外展锻炼后，后上肩袖撕裂患者恢复可接受的活动ROM，几个肩胛周围肌肉的活动增加。这种模式在前上撕裂的患者中没有观察到。肩胛提肌的suv在后优组显著高于对照组(0.75[95%可信区间（95% CI） 0.73 ~ 0.81]对0.65 [95% CI 0.60 ~ 0.71]，平均等级差9.33；p = 0.04)，菱形体(0.80 [95% CI 0.70 ~ 0.85]对0.65 [95% CI 0.62 ~ 0.68]，平均等级差9.58；p = 0.03)，胸大肌(0.54 [95% CI 0.49 ~ 0.55] vs . 0.47 [95% CI 0.40 ~ 0.51]，平均等级差6.58；p = 0.04)，大圆肌(0.62 [95% CI 0.55 ~ 0.75]对0.51 [95% CI 0.47 ~ 0.55]，平均等级差9.28；P = 0.03)。在前优组，仅大圆肌的SUV显著高于对照组(0.63 [95% CI 0.55 ~ 0.69]对0.51 [95% CI 0.47 ~ 0.55]，平均等级差8.69；P = 0.04)。在大量肩袖撕裂恢复可接受的活动ROM的患者中，更大的脂肪浸润和更低的占比-反映更严重的肌肉萎缩-与肌肉激活减少有关。脂肪浸润与SUV呈正相关(ρ = -0.531 [95% CI -0.805 ~ -0.071]；p = 0.02)，职业比例与SUV之间(ρ = 0.493 [95% CI 0.018 ~ 0.786]；P = 0.04)在冈上肌，但在其他肩袖肌中没有。结论：大量肩袖撕裂患者经物理治疗后外展ROM恢复，可观察到肩胛周围肌的代偿性激活。肩胛骨提升器和偏心肱骨头减压器的代谢活动增加表明它们可能有助于这种功能适应。临床相关性：基于这些发现，未来的研究可能会探索特异性针对肩胛周围肌激活的物理治疗方案是否可以提高非手术治疗的大量肩袖撕裂患者的功能结局。
{"title":"Compensatory Activation of Periscapular Muscles Aids Active Abduction in Patients With Massive Rotator Cuff Tears.","authors":"Hao-Chun Chuang, Nan-Tsing Chiu, Zhao-Wei Liu, Chih-Kai Hong, Kai-Lan Hsu, Fa-Chuan Kuan, Yueh Chen, Joe-Zhi Yen, Wei-Ren Su","doi":"10.1097/CORR.0000000000003556","DOIUrl":"10.1097/CORR.0000000000003556","url":null,"abstract":"<p><strong>Background: </strong>Patients with massive rotator cuff tears can present with shoulder pain with preserved ROM, yet the compensatory mechanisms remain poorly understood. Identifying these mechanisms, particularly the role of periscapular muscles, could guide nonsurgical therapeutic strategies.</p><p><strong>Questions/purposes: </strong>(1) In patients with massive rotator cuff tears who achieved acceptable active ROM with physical therapy, which periscapular muscles provide compensatory motor activity? (2) What is the correlation between muscle metabolic activity and fatty infiltration and atrophy?</p><p><strong>Methods: </strong>Between January 2019 and April 2019, we evaluated 39 consecutive patients who presented to our outpatient clinic and were diagnosed with massive rotator cuff tears through sonographic screening. Of these, 41% (16) were excluded because of concomitant diseases. Of the remaining 59% (23) of patients who met the inclusion criteria and began the rehabilitation program, 13% (5) discontinued because of partial adherence or conversion to surgery. Ultimately, 46% (18) of patients completed the rehabilitation program and were included in the final analysis, comprising 8 with anterosuperior tears (median [IQR] age 56 years [54 to 61]) and 10 with posterosuperior tears (median [IQR] age 59 years [58 to 64]). Additionally, four nuclear medicine technicians without a history of shoulder injury or pain were recruited as the control group (median [IQR] age 54 years [52 to 56]). To address our first research question-identifying the muscles responsible for compensatory motor activity after a massive rotator cuff tear-participants underwent positron emission tomography/CT with fluorodeoxyglucose (FDG-PET/CT) imaging after performing a scaption exercise to assess muscle metabolic activity. Standardized uptake values (SUVs), reflecting glucose-based metabolic activity, were calculated for the periscapular, rotator cuff, and deltoid muscles using FDG-PET/CT and compared among groups using Kruskal-Wallis tests. To address the second research question-examining the correlation between muscle metabolic activity and fatty infiltration or atrophy-MRI was used to assess the Goutallier classification and occupation ratio, and Spearman correlation analysis was performed to evaluate their relationship with SUVs. Continuous variables were expressed as median and IQR.</p><p><strong>Results: </strong>In patients with posterosuperior rotator cuff tears who regained acceptable active ROM, several periscapular muscles exhibited increased activity after shoulder abduction exercises compared with controls. This pattern was not observed in those with anterosuperior tears. SUVs were significantly higher in the posterosuperior group than in controls for the levator scapulae (0.75 [95% confidence interval (95% CI) 0.73 to 0.81] versus 0.65 [95% CI 0.60 to 0.71], mean rank difference 9.33; p = 0.04), rhomboids (0.80 [95% CI 0.70 to 0.85] versus 0.65 ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2295-2305"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-21DOI: 10.1097/CORR.0000000000003662
Erik R Nakken, Kempland C Walley, Carol A Janney, Davin C Gong, Vandan D Patel, David M Walton, Paul G Talusan, James R Holmes
<p><strong>Background: </strong>Lower extremity splints are commonly used for the treatment of foot and ankle injuries and carry the risk of posterior heel pressure injury. Assessing heel contact pressures in a splint may guide clinicians toward specific splint designs that are associated with lower contact pressures.</p><p><strong>Questions/purposes: </strong>This biomechanical study tested multiple splint characteristics to answer: (1) Which combination of heel position, padding thickness, and padding type (brand) minimizes posterior heel contact pressure? (2) Are there factors while making a splint that are associated with higher contact pressures?</p><p><strong>Methods: </strong>Twenty legs in 10 volunteer participants (mean ± SD age 30 ± 14 years) without current foot or ankle injury were recruited for this biomechanical study. Three of 10 volunteers were female. A pressure transducer was used over the posterior heel to measure contact pressure in a short leg splint. To answer our first research question about the effects of different splint characteristics, we measured contact pressures with 0, 2, 4, 6, 8, and 10 layers of two undercast padding brands, with both resting the heel down and floating the heel freely by placing the leg on a pillow to keep the splinted heel free of contact. Pressures were compared with a threshold of 32 mm Hg, the pressure of dermal arteriolar capillary collapse. To answer our second research question about factors associated with higher contact pressures, we recorded measurements of abnormal pressure spikes and observed the effect of improperly bunched or folded padding behind the heel.</p><p><strong>Results: </strong>Mean contact pressure remained above 32 mm Hg when resting the heel down, independent of padding thickness or brand. Floating the heel, by resting the leg on a pillow, with 6, 8, and 10 layers of thicker undercast padding or 8 and 10 layers of thinner padding reduced pressure below the threshold of 32 mm Hg. The mean contact pressure between 8 and 10 layers of padding was not different (10 layers reduced contact pressure by 4 mm Hg more than 8 layers [95% confidence interval -3 to 11]; p = 0.22). Improperly bunched undercast padding behind the heel increased mean contact pressure roughly threefold compared with evenly applied padding (median 270% increase [range 187% to 575%]).</p><p><strong>Conclusion: </strong>In this study, the best splint configuration consisted of 8 or 10 evenly applied layers of thicker undercast padding when floating the heel. Lower extremity positioning with the heel floating freely appears to be an important modifiable factor to reduce heel dermal pressures. We contend that attention to these details of splint application might reduce the likelihood of pressure ulcers in patients, but future clinical studies of patients with various injuries or other indications for splinting are warranted.</p><p><strong>Clinical relevance: </strong>These findings may be relevant to orthop
背景：下肢夹板常用于足部和踝关节损伤的治疗，但存在后脚跟压迫损伤的风险。评估夹板中的后跟接触压力可以指导临床医生设计与较低接触压力相关的特定夹板。问题/目的：这项生物力学研究测试了多种夹板特性，以回答：(1)哪种鞋跟位置、填充物厚度和填充物类型（品牌）的组合能最大限度地减少后跟接触压力？(2)在制作夹板时，是否存在与较高接触压力相关的因素？方法：10名没有当前足部或踝关节损伤的志愿者（平均±SD年龄30±14岁）的20条腿被招募参加这项生物力学研究。10名志愿者中有3名是女性。在短腿夹板后脚跟处使用压力传感器来测量接触压力。为了回答我们的第一个研究问题，即不同夹板特性的影响，我们测量了两种衬垫品牌的0、2、4、6、8和10层的接触压力，同时将脚后跟放下，并通过将腿放在枕头上自由浮动脚跟，以保持夹板后跟不接触。比较压力阈值为32 mm Hg时，皮肤小动脉毛细血管塌陷的压力。为了回答我们的第二个研究问题，即与较高的接触压力相关的因素，我们记录了异常压力峰值的测量结果，并观察了不正确地束在脚跟后面或折叠垫的影响。结果：当足跟向下放置时，平均接触压力保持在32毫米汞柱以上，与填充物厚度或品牌无关。通过将腿放在枕头上，使足跟漂浮，6层、8层、10层较厚的衬垫或8层、10层较薄的衬垫将压力降低到32 mm Hg以下。8层和10层衬垫之间的平均接触压力没有差异（10层衬垫比8层衬垫减少了4 mm Hg[95%置信区间-3至11]；p = 0.22）。与均匀使用填充物相比，不适当地束在脚跟后面的衬垫使平均接触压力增加了大约三倍（中位数增加了270%[范围为187%至575%]）。结论：在本研究中，最好的夹板配置是在浮跟时均匀地应用8或10层较厚的下垫。下肢定位与脚跟自由浮动似乎是一个重要的修改因素，以减少脚跟皮肤压力。我们认为，关注夹板应用的这些细节可能会减少患者发生压疮的可能性，但未来对各种损伤或其他适应症夹板患者的临床研究是有必要的。临床意义：这些发现可能与骨科医生、急诊科和初级保健提供者以及石膏技术人员有关，他们都在减轻足部和踝关节损伤患者医源性后脚跟压疮的机械因素方面发挥作用。
{"title":"Can Simple Changes in Splinting Technique Reduce Posterior Heel Contact Pressure?","authors":"Erik R Nakken, Kempland C Walley, Carol A Janney, Davin C Gong, Vandan D Patel, David M Walton, Paul G Talusan, James R Holmes","doi":"10.1097/CORR.0000000000003662","DOIUrl":"10.1097/CORR.0000000000003662","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity splints are commonly used for the treatment of foot and ankle injuries and carry the risk of posterior heel pressure injury. Assessing heel contact pressures in a splint may guide clinicians toward specific splint designs that are associated with lower contact pressures.</p><p><strong>Questions/purposes: </strong>This biomechanical study tested multiple splint characteristics to answer: (1) Which combination of heel position, padding thickness, and padding type (brand) minimizes posterior heel contact pressure? (2) Are there factors while making a splint that are associated with higher contact pressures?</p><p><strong>Methods: </strong>Twenty legs in 10 volunteer participants (mean ± SD age 30 ± 14 years) without current foot or ankle injury were recruited for this biomechanical study. Three of 10 volunteers were female. A pressure transducer was used over the posterior heel to measure contact pressure in a short leg splint. To answer our first research question about the effects of different splint characteristics, we measured contact pressures with 0, 2, 4, 6, 8, and 10 layers of two undercast padding brands, with both resting the heel down and floating the heel freely by placing the leg on a pillow to keep the splinted heel free of contact. Pressures were compared with a threshold of 32 mm Hg, the pressure of dermal arteriolar capillary collapse. To answer our second research question about factors associated with higher contact pressures, we recorded measurements of abnormal pressure spikes and observed the effect of improperly bunched or folded padding behind the heel.</p><p><strong>Results: </strong>Mean contact pressure remained above 32 mm Hg when resting the heel down, independent of padding thickness or brand. Floating the heel, by resting the leg on a pillow, with 6, 8, and 10 layers of thicker undercast padding or 8 and 10 layers of thinner padding reduced pressure below the threshold of 32 mm Hg. The mean contact pressure between 8 and 10 layers of padding was not different (10 layers reduced contact pressure by 4 mm Hg more than 8 layers [95% confidence interval -3 to 11]; p = 0.22). Improperly bunched undercast padding behind the heel increased mean contact pressure roughly threefold compared with evenly applied padding (median 270% increase [range 187% to 575%]).</p><p><strong>Conclusion: </strong>In this study, the best splint configuration consisted of 8 or 10 evenly applied layers of thicker undercast padding when floating the heel. Lower extremity positioning with the heel floating freely appears to be an important modifiable factor to reduce heel dermal pressures. We contend that attention to these details of splint application might reduce the likelihood of pressure ulcers in patients, but future clinical studies of patients with various injuries or other indications for splinting are warranted.</p><p><strong>Clinical relevance: </strong>These findings may be relevant to orthop","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"2218-2226"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-07DOI: 10.1097/CORR.0000000000003723
Seth S Leopold
{"title":"Editorial: Fully Compromised, but Thanks All the Same to Our Peer Reviewers.","authors":"Seth S Leopold","doi":"10.1097/CORR.0000000000003723","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003723","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 12","pages":"2211-2213"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653041","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 : 2025-11-26DOI: 10.1097/corr.0000000000003784
Nicholas J Giori
{"title":"CORR Insights®: Does the Use of a Robotic Gap-tensioning System Improve Functional Outcomes After TKA? A Randomized Clinical Trial.","authors":"Nicholas J Giori","doi":"10.1097/corr.0000000000003784","DOIUrl":"https://doi.org/10.1097/corr.0000000000003784","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"25 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645100","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 : 2025-11-26DOI: 10.1097/CORR.0000000000003781
Julia Blackburn
{"title":"CORR Insights®: Which Analgesic Should We Use to Relieve Pain After Knee or Hip Arthroplasty? A Systematic Review and Network Meta-analysis of RCTs.","authors":"Julia Blackburn","doi":"10.1097/CORR.0000000000003781","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003781","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647520","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 : 2025-11-25DOI: 10.1097/corr.0000000000003754
Roberto Scanferla,Sreeraj Rajan,Federico Scolari,Luigi Maccauro,Francesco Muratori,Guido Scoccianti,Giovanni Beltrami,Domenico Andrea Campanacci
BACKGROUNDAllograft-prosthesis composite reconstruction after periacetabular resections allows for bony union and internal repair, restoring bone stock for further revisions; the allograft-prosthesis composite can be shaped according to the pelvic resection to reconstruct the complex bone anatomy. Recently, endoprosthetic reconstruction has become one of the most frequently used options to restore large periacetabular bone defects. However, a prosthetic reconstruction impairs pelvic bone stock preservation and often takes a long time to manufacture. Allograft reconstructions, on the other hand, allow for bony union and internal repair, and they restore bone stock for further revisions. In addition, allografts are usually readily available and can be shaped according to the pelvic resection, fully restoring the complex bone anatomy. Pelvic biological reconstructions may have still a role, and to our knowledge, there are few long-term results of allograft-prosthesis composite reconstruction of the pelvis after periacetabular resections for bone tumors.QUESTIONS/PURPOSES(1) What is the cumulative incidence percentage of patients who experienced complications after reconstruction with allograft-prosthesis composites after resection of periacetabular tumors? (2) What was the functional result after surgical treatment as assessed by the Musculoskeletal Tumor Society (MSTS) score at a minimum of 2 years? (3) What was the survivorship of these reconstructions free from revision and graft removal at 15 years?METHODSBetween February 1994 and April 2023, a total of 174 patients were treated at the university hospital of Florence for primary and secondary malignant or aggressive benign bone tumors of the pelvis with en bloc resection. Of treated patients, 51 underwent periacetabular resection and allograft-prosthesis composite reconstruction. We included in the study only patients with at least 24 months of follow-up or those who had complications earlier; thus 96% (49 of 51) of the patients had the required minimum follow-up and were included. Among the included patients, 88% (43 of 49) were available for a minimum follow-up of 24 months, whereas 12% (6) had < 24 months of follow-up but had complications earlier; thus, they were included for the analysis of complication-free survivorship. Seventy-eight percent (38) of patients were treated with a pelvic allograft combined with an acetabular cage, 16% (8) of patients received only a cemented cup, and 6% (3) of patients received a stemmed cementless cup. The mean ± SD follow-up time was 100 ± 77 months. The mean ± SD age at the time of reconstruction was 47 ± 17 years; 37% (18 of 49) of patients were female and 63% (31) were male. According to the Enneking and Dunham classification of pelvic resections, 39% (19) of patients had a Type I-II resection, 24% (12) had a Type II, 22% (11) had a Type II-III, 8% (4) had a Type I-II-III, 4% (2) had a Type I-II-IV, and 2% (1) had a Type I-II-III-IV. All patients had pr
{"title":"Periacetabular Resection for Bone Tumors: Is There Still a Role for Massive Allograft-prosthesis Composite Reconstructions?","authors":"Roberto Scanferla,Sreeraj Rajan,Federico Scolari,Luigi Maccauro,Francesco Muratori,Guido Scoccianti,Giovanni Beltrami,Domenico Andrea Campanacci","doi":"10.1097/corr.0000000000003754","DOIUrl":"https://doi.org/10.1097/corr.0000000000003754","url":null,"abstract":"BACKGROUNDAllograft-prosthesis composite reconstruction after periacetabular resections allows for bony union and internal repair, restoring bone stock for further revisions; the allograft-prosthesis composite can be shaped according to the pelvic resection to reconstruct the complex bone anatomy. Recently, endoprosthetic reconstruction has become one of the most frequently used options to restore large periacetabular bone defects. However, a prosthetic reconstruction impairs pelvic bone stock preservation and often takes a long time to manufacture. Allograft reconstructions, on the other hand, allow for bony union and internal repair, and they restore bone stock for further revisions. In addition, allografts are usually readily available and can be shaped according to the pelvic resection, fully restoring the complex bone anatomy. Pelvic biological reconstructions may have still a role, and to our knowledge, there are few long-term results of allograft-prosthesis composite reconstruction of the pelvis after periacetabular resections for bone tumors.QUESTIONS/PURPOSES(1) What is the cumulative incidence percentage of patients who experienced complications after reconstruction with allograft-prosthesis composites after resection of periacetabular tumors? (2) What was the functional result after surgical treatment as assessed by the Musculoskeletal Tumor Society (MSTS) score at a minimum of 2 years? (3) What was the survivorship of these reconstructions free from revision and graft removal at 15 years?METHODSBetween February 1994 and April 2023, a total of 174 patients were treated at the university hospital of Florence for primary and secondary malignant or aggressive benign bone tumors of the pelvis with en bloc resection. Of treated patients, 51 underwent periacetabular resection and allograft-prosthesis composite reconstruction. We included in the study only patients with at least 24 months of follow-up or those who had complications earlier; thus 96% (49 of 51) of the patients had the required minimum follow-up and were included. Among the included patients, 88% (43 of 49) were available for a minimum follow-up of 24 months, whereas 12% (6) had < 24 months of follow-up but had complications earlier; thus, they were included for the analysis of complication-free survivorship. Seventy-eight percent (38) of patients were treated with a pelvic allograft combined with an acetabular cage, 16% (8) of patients received only a cemented cup, and 6% (3) of patients received a stemmed cementless cup. The mean ± SD follow-up time was 100 ± 77 months. The mean ± SD age at the time of reconstruction was 47 ± 17 years; 37% (18 of 49) of patients were female and 63% (31) were male. According to the Enneking and Dunham classification of pelvic resections, 39% (19) of patients had a Type I-II resection, 24% (12) had a Type II, 22% (11) had a Type II-III, 8% (4) had a Type I-II-III, 4% (2) had a Type I-II-IV, and 2% (1) had a Type I-II-III-IV. All patients had pr","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"6 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599758","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 : 2025-11-25DOI: 10.1097/CORR.0000000000003778
Kacy Peek
{"title":"CORR Insights®: Only Nine Percent of Orthopaedic Clinical Trials Report and One Percent Analyze a Social Determinant of Health: A Systematic Review.","authors":"Kacy Peek","doi":"10.1097/CORR.0000000000003778","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003778","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602617","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 : 2025-11-24DOI: 10.1097/corr.0000000000003767
Motahareh Karimijashni,Marie Westby,Paul E Beaulé,Tim Ramsay,Stéphane Poitras
BACKGROUNDAlthough there has been increasing focus on patient-centered approaches in outcome evaluation, there is limited information on how well the existing patient-reported outcome measures (PROMs) used to assess function for hip or knee arthroplasty align with patients' perspectives.QUESTIONS/PURPOSES(1) To what extent do currently used functional PROMs for hip or knee arthroplasty cover the functional activities that are important to patients at 2, 6, 13, and 26 weeks after surgery? (2) Which functional activities important to patients are either not covered or inadequately covered by PROMs? (3) Which activities not important to patients are covered by PROMs?METHODSWe assessed functional key activity coverage and coverage gaps of 47 PROMs at four points. This analysis was based on 22 key activities identified by 953 patients who underwent primary elective hip or knee arthroplasty performed by eight surgeons. These patients were recruited from the Orthopedic Division at The Ottawa Hospital in Ottawa, Ontario, Canada, an academic-affiliated institution in an urban setting. From November 2023 to March 2024 and September 2024 to January 2025, a total of 615 patients who underwent hip arthroplasty and 555 who underwent knee arthroplasty were approached, and 503 and 450, respectively, completed the questionnaire. Patients who underwent hip arthroplasty had a mean ± SD age of 65 ± 11 years; 51.1% (257 of 503) were female, and the mean BMI was 28.3 ± 5.6 kg/m2. Patients who underwent knee arthroplasty had a mean age of 68 ± 9 years; 51.3% (231 of 450) were female, and the mean BMI was 31.1 ± 6.4 kg/m2. A functional activity was defined as key if at least 75% of patients rated it as important and at least 15% had difficulty doing it.RESULTSNo PROM adequately addressed all key activities. Within the first 2 weeks after surgery, knee-specific, hip-specific, and combined hip and knee PROMs addressed 86%, 85%, and 79% of key activities, respectively, but this coverage declined for hip and knee PROMs at subsequent follow-up points to fewer than one-half by 26 weeks. The most commonly covered activities were going up and down stairs, rising from a chair, and putting on footwear. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) demonstrated the widest coverage among knee and hip PROMs, respectively, while the WOMAC provided the widest coverage for combined hip and knee PROMs. Several key functional activities were either inadequately covered or not covered by PROMs. Inadequate coverage often resulted from combining multiple activities into a single item, with the most frequent key activities inadequately addressed being "going up and down stairs" and "doing housework." Five key activities, including washing lower body parts, putting on clothes, taking off clothes, carrying objects, and placing objects on the floor, were not covered by any PROMs. Furthermore, all PROMs included at least on
{"title":"Do Functional Patient-reported Outcome Measures Reflect the Activities That Matter Most to Patients After Hip or Knee Arthroplasty?","authors":"Motahareh Karimijashni,Marie Westby,Paul E Beaulé,Tim Ramsay,Stéphane Poitras","doi":"10.1097/corr.0000000000003767","DOIUrl":"https://doi.org/10.1097/corr.0000000000003767","url":null,"abstract":"BACKGROUNDAlthough there has been increasing focus on patient-centered approaches in outcome evaluation, there is limited information on how well the existing patient-reported outcome measures (PROMs) used to assess function for hip or knee arthroplasty align with patients' perspectives.QUESTIONS/PURPOSES(1) To what extent do currently used functional PROMs for hip or knee arthroplasty cover the functional activities that are important to patients at 2, 6, 13, and 26 weeks after surgery? (2) Which functional activities important to patients are either not covered or inadequately covered by PROMs? (3) Which activities not important to patients are covered by PROMs?METHODSWe assessed functional key activity coverage and coverage gaps of 47 PROMs at four points. This analysis was based on 22 key activities identified by 953 patients who underwent primary elective hip or knee arthroplasty performed by eight surgeons. These patients were recruited from the Orthopedic Division at The Ottawa Hospital in Ottawa, Ontario, Canada, an academic-affiliated institution in an urban setting. From November 2023 to March 2024 and September 2024 to January 2025, a total of 615 patients who underwent hip arthroplasty and 555 who underwent knee arthroplasty were approached, and 503 and 450, respectively, completed the questionnaire. Patients who underwent hip arthroplasty had a mean ± SD age of 65 ± 11 years; 51.1% (257 of 503) were female, and the mean BMI was 28.3 ± 5.6 kg/m2. Patients who underwent knee arthroplasty had a mean age of 68 ± 9 years; 51.3% (231 of 450) were female, and the mean BMI was 31.1 ± 6.4 kg/m2. A functional activity was defined as key if at least 75% of patients rated it as important and at least 15% had difficulty doing it.RESULTSNo PROM adequately addressed all key activities. Within the first 2 weeks after surgery, knee-specific, hip-specific, and combined hip and knee PROMs addressed 86%, 85%, and 79% of key activities, respectively, but this coverage declined for hip and knee PROMs at subsequent follow-up points to fewer than one-half by 26 weeks. The most commonly covered activities were going up and down stairs, rising from a chair, and putting on footwear. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) demonstrated the widest coverage among knee and hip PROMs, respectively, while the WOMAC provided the widest coverage for combined hip and knee PROMs. Several key functional activities were either inadequately covered or not covered by PROMs. Inadequate coverage often resulted from combining multiple activities into a single item, with the most frequent key activities inadequately addressed being \"going up and down stairs\" and \"doing housework.\" Five key activities, including washing lower body parts, putting on clothes, taking off clothes, carrying objects, and placing objects on the floor, were not covered by any PROMs. Furthermore, all PROMs included at least on","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"1 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599759","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 : 2025-11-24DOI: 10.1097/corr.0000000000003744
Olivia M Jochl,Zachary A Trotzky,Giulia Beltrame,Brian T Muffly,Ernest L Sink
BACKGROUNDAlthough periacetabular osteotomy (PAO) is a commonly used procedure with generally good intermediate and long-term outcomes, complications such as stress fractures of the ischium or pubis have been reported. A limited number of studies have investigated stress fracture after PAO, but the results lack consensus and do not thoroughly explore lifestyle factors or patient-reported outcome measures (PROMs).QUESTIONS/PURPOSESAmong patients treated with PAO: (1) What percentage of patients and hips developed a stress fracture after PAO? (2) What preoperative and intraoperative factors were associated with stress fractures? (3) Did PROMs or the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) achievement differ between patients with stress fractures and patients without at most recent follow-up?METHODSSix hundred seventy-five hips (546 patients) were treated with PAO with or without hip arthroscopy for symptomatic acetabular dysplasia between February 2016 and October 2024 by one surgeon in a mature hip preservation practice. Patients were excluded if the index procedure for those who had bilateral PAOs occurred before the study period. Patients who underwent concomitant femoral osteotomy, surgical hip dislocation, or relative neck lengthening were also excluded, yielding 90% (608 of 675) of hips from 487 patients as potentially eligible for analysis. Ninety-four percent (574 of 608) of PAOs were performed in women, and 65% (396 of 608) were performed without concomitant hip arthroscopy. The mean ± SD age was 26 ± 8 years, and the mean BMI was 23.2 ± 3.9 kg/m2. All hips had 6-week, 3-month, and 6-month postoperative radiographs available for review. Two patients with stress fractures and one without converted to THA, leaving 81% (393 of 484) of patients with available minimum 1-year PROMs after their most recent PAO surgery. Stress fracture diagnoses were tallied by hip and by patient to establish the percentages. Exploratory analyses included age, BMI, preoperative vitamin D levels, magnitude of lateral center-edge angle (LCEA) correction, magnitude of anterior center-edge angle correction, Tönnis grade, sex, marijuana use, nicotine use, screw type, prior ipsilateral surgery, PAO with or without concomitant hip arthroscopy, initial PAO versus subsequent contralateral PAO, and diagnoses of Ehlers-Danlos syndrome (EDS) or hypermobility. Factors with p < 0.1 were considered in the multivariate analysis. To determine the association between stress fractures and postoperative outcomes, univariate regression was performed with the presence of stress fractures as the independent variable. Multivariate regressions were performed to determine whether stress fractures were associated with modified Harris hip score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) improvement after controlling for factors identified in the previous analysis. Similarly, regression models were used to determine whether st
背景：虽然髋臼周围截骨术（PAO）是一种常用的手术，通常具有良好的中期和长期疗效，但也有报道称其并发症，如坐骨或耻骨应力性骨折。有限数量的研究调查了PAO后的应力性骨折，但结果缺乏共识，并且没有彻底探索生活方式因素或患者报告的结果测量（PROMs）。问题/目的在接受PAO治疗的患者中：(1)PAO后发生应力性骨折的患者和髋关节的百分比是多少？(2)哪些术前和术中因素与应力性骨折相关？(3)应力性骨折患者与非应力性骨折患者的PROMs或最小临床重要差异（MCID）和患者可接受症状状态（PASS）成就是否存在差异？方法在2016年2月至2024年10月期间，一名外科医生在成熟的髋关节保存实践中对675例髋关节（546例患者）进行PAO治疗，伴有或不伴有髋关节镜检查。如果双侧PAOs患者的指标手术在研究期间之前发生，则排除患者。同时行股骨截骨术、手术髋关节脱位或相对颈部延长术的患者也被排除在外，487例患者中有90%（675例中有608例）的髋关节可能符合分析条件。94%（574 / 608）的PAOs是在女性中进行的，65%（396 / 608）的PAOs没有同时进行髋关节镜检查。平均±SD年龄为26±8岁，平均BMI为23.2±3.9 kg/m2。所有髋部术后6周、3个月和6个月的x线片可供回顾。2例患者发生应力性骨折，1例未转为THA，在最近一次PAO手术后，有81%（484例中的393例）的患者可获得至少1年的prom。应力性骨折诊断按髋部和患者进行统计，以确定百分比。探索性分析包括年龄、BMI、术前维生素D水平、外侧中心棱角（LCEA）矫正幅度、前中心棱角矫正幅度、Tönnis分级、性别、大麻使用、尼古丁使用、螺钉类型、既往同侧手术、PAO伴或不伴髋关节镜检查、初始PAO与后续对侧PAO、ehers - danlos综合征（EDS）或活动过度的诊断。多因素分析考虑p < 0.1的因素。为了确定应力性骨折与术后预后之间的关系，以应力性骨折为自变量进行单变量回归。在控制先前分析中确定的因素后，进行多变量回归以确定应力性骨折是否与改良Harris髋关节评分（mHHS）和国际髋关节预后工具-12 （iHOT-12）改善相关。同样，回归模型用于确定应力裂缝是否与MCID和PASS的实现相关。结果应力性骨折发生率为8%（487例中37例），髋部发生率为7%（608例中40例）。在接受双侧PAOs的患者中，11%（121例中的13例）在第二次手术后发生应力性骨折。121例患者中有3例（2%）发生双侧应力性骨折。在控制了潜在的混杂变量，如年龄、BMI、LCEA矫正、药物使用、EDS或过度活动后，我们发现有几个因素与发生应力性骨折有关。年龄越大，应力性骨折的几率越高（OR 1.05[95%可信区间（CI） 1.01 ~ 1.09]）；P = 0.03)。BMI越高，应力性骨折的几率越大（BMI每增加kg/m2， OR为1.09 [95% CI 1.002 ~ 1.19]; p = 0.046）。LCEA矫正幅度越大，应力性骨折的发生率越高（每一矫正程度的OR为1.05 [95% CI 1.01至1.10];p = 0.02）。与不吸食大麻的人相比，目前吸食大麻的人发生应力性骨折的几率更高（OR为3.06 [95% CI 1.2至8.0];p = 0.02），目前吸食尼古丁的人发生应力性骨折的几率也更高（OR为6.41 [95% CI 1.2至34]；p = 0.03）。诊断为EDS或活动过度的患者发生应力性骨折的几率也较高（or 2.88 [95% CI 1.3 ~ 6.0]; p = 0.01）。虽然比例更高，但在双侧手术的患者中，第一次PAO和第二次PAO后应力性骨折的发生率没有差异（OR 2 [95% CI 1 ~ 4]; p = 0.07）。在控制了与应力性骨折、术前PROM评分和最近一次PAO后的时间相关的因素后，发现应力性骨折与术前和术后mHHS和iHOT-12评分的改善程度较低有关，同时也与iHOT-12达到PASS和mHHS达到MCID的几率降低有关。有应力性骨折的患者在mHHS方面的改善比无应力性骨折的患者平均少6个点（95% CI -11）。 6 ~ -0.84；P = 0.02)。应力性骨折患者iHOT-12评分的改善比无应力性骨折患者平均少12分（95% CI -20.6 ~ -2.45; p = 0.01）。应力性骨折患者达到iHOT-12 PASS的几率较低（OR 0.36 [95% CI 0.15至0.86];p = 0.02），达到mHHS MCID的几率较低（OR 0.33 [95% CI 0.13至0.83];p = 0.02）。应力性骨折与mHHS的PASS （OR 0.52 [95% CI 0.18至1.53],p = 0.24）或iHOT-12的MCID （OR 0.86 [95% CI 0.33至2.24],p = 0.76）无关。结论：年龄增加、BMI升高、LCEA矫正程度加大、大麻使用、尼古丁使用、EDS或活动过度与有症状的髋臼发育不良PAO术后应力性骨折发生风险增加相关。在至少1年的随访中，应力骨折与mHHS和iHOT-12的改善较小相关，并且达到iHOT-12的PASS和mHHS的MCID的几率较低。这些因素不是手术的障碍，而是可以指导外科医生与患者讨论，提供个性化的咨询和康复，包括关于潜在药物停用的指导，延长非负重期的使用，以及对早期功能获得的现实期望。随着更多的应力性骨折样本，可能通过多中心登记，未来的研究应旨在建立具有临床意义的相关因素阈值，并评估应力性骨折与PROMs之间的长期关系，包括骨折愈合和骨折位置的影响。证据等级：III级，治疗性研究。
{"title":"What Factors and Patient-reported Outcome Measures Are Associated With Stress Fracture After Periacetabular Osteotomy?","authors":"Olivia M Jochl,Zachary A Trotzky,Giulia Beltrame,Brian T Muffly,Ernest L Sink","doi":"10.1097/corr.0000000000003744","DOIUrl":"https://doi.org/10.1097/corr.0000000000003744","url":null,"abstract":"BACKGROUNDAlthough periacetabular osteotomy (PAO) is a commonly used procedure with generally good intermediate and long-term outcomes, complications such as stress fractures of the ischium or pubis have been reported. A limited number of studies have investigated stress fracture after PAO, but the results lack consensus and do not thoroughly explore lifestyle factors or patient-reported outcome measures (PROMs).QUESTIONS/PURPOSESAmong patients treated with PAO: (1) What percentage of patients and hips developed a stress fracture after PAO? (2) What preoperative and intraoperative factors were associated with stress fractures? (3) Did PROMs or the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) achievement differ between patients with stress fractures and patients without at most recent follow-up?METHODSSix hundred seventy-five hips (546 patients) were treated with PAO with or without hip arthroscopy for symptomatic acetabular dysplasia between February 2016 and October 2024 by one surgeon in a mature hip preservation practice. Patients were excluded if the index procedure for those who had bilateral PAOs occurred before the study period. Patients who underwent concomitant femoral osteotomy, surgical hip dislocation, or relative neck lengthening were also excluded, yielding 90% (608 of 675) of hips from 487 patients as potentially eligible for analysis. Ninety-four percent (574 of 608) of PAOs were performed in women, and 65% (396 of 608) were performed without concomitant hip arthroscopy. The mean ± SD age was 26 ± 8 years, and the mean BMI was 23.2 ± 3.9 kg/m2. All hips had 6-week, 3-month, and 6-month postoperative radiographs available for review. Two patients with stress fractures and one without converted to THA, leaving 81% (393 of 484) of patients with available minimum 1-year PROMs after their most recent PAO surgery. Stress fracture diagnoses were tallied by hip and by patient to establish the percentages. Exploratory analyses included age, BMI, preoperative vitamin D levels, magnitude of lateral center-edge angle (LCEA) correction, magnitude of anterior center-edge angle correction, Tönnis grade, sex, marijuana use, nicotine use, screw type, prior ipsilateral surgery, PAO with or without concomitant hip arthroscopy, initial PAO versus subsequent contralateral PAO, and diagnoses of Ehlers-Danlos syndrome (EDS) or hypermobility. Factors with p < 0.1 were considered in the multivariate analysis. To determine the association between stress fractures and postoperative outcomes, univariate regression was performed with the presence of stress fractures as the independent variable. Multivariate regressions were performed to determine whether stress fractures were associated with modified Harris hip score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) improvement after controlling for factors identified in the previous analysis. Similarly, regression models were used to determine whether st","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599760","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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