Indian Journal of Orthopaedics最新文献

[This corrects the article DOI: 10.1007/s43465-025-01405-6.].

Persistent rotational instability, reported in 15-35% of isolated anterior cruciate ligament (ACL) reconstruction remains a significant cause of graft failure and impaired return to sports. This has led to an increased interest in supplementing ACL reconstruction with anterolateral ligament (ALL) reconstruction to address residual rotational laxity. ALL reconstruction may better restore rotational stability compared to traditional lateral extra-articular procedures. The patient is positioned supine with the knee flexed at 90°, and standard landmarks are identified. Semitendinosus and gracilis tendons are harvested via a small incision. A quadrupled semitendinosus graft reconstructs the ACL, while the gracilis tendon reconstructs the ALL. Femoral tunnels for ACL and ALL reconstruction share a common anatomical entry point proximal and posterior to the lateral epicondyle. Tibial tunnels for the ALL are created below Gerdy's tubercle. Graft fixation is achieved with a suture disc on both femoral and tibial sides, ensuring physiological tension in extension. Patients begin immediate weight-bearing and range-of-motion exercises within controlled limits. A progressive rehabilitation protocol facilitates return to sports, allowing pivoting activities after six months. Combined ACL and ALL reconstruction using autologous hamstring grafts offers a reproducible surgical option for addressing rotational knee instability. Anatomical graft placement and minimally invasive techniques may offer the potential for improved clinical outcomes, decreased graft failure rates, and enhanced patient return to pre-injury activity levels.

Purpose: Peroneus longus (PL) graft harvest has recently gained popularity for various ligament reconstruction surgeries. A recent systematic review shows it is a safe and reproducible technique with low morbidity of donor sites (1). The method for PL harvest routinely involves tenodesis of the PL stump to the peroneus brevis (PB); however, recent work has shown no impact on ankle functional outcomes with or without tenodesis. Harvesting of the PL should theoretically lead to a hypertrophy of the PB to compensate for its function. The purpose of the present study was to assess the effect of PL harvest on the PB.

Methods: Institutional ethics approval was obtained from the institutional ethics review board (January 2024). A total of 40 consecutive patients from January 2024 to February 2024 were included in the study: 20 patients in the no tenodesis group and 20 patients in the tenodesis group. Demographic variables (age, gender, and level of play) were recorded. Pre-operative American Orthopedic Foot and Ankle Society Score (AOFAS) and Functional Ankle Disability Index (FADI) scores were calculated for both groups and compared with post-operative scores at six weeks, three months, six months, and one-year follow-up. Ultrasound scan of bilateral ankle to assess PL and PB diameters was performed pre-operatively and tracked at three months, six months, and one year post-surgery.

Results: For the entire study population (n = 40), we found that AOFAS and FADI scores showed no significant difference at any interval. Age, gender, and level of play had no impact on ankle functional outcomes. Harvesting the PL did not significantly increase ipsilateral PB or contralateral PL diameter post-surgery. There was no significant difference between the tenodesis and no tenodesis groups regarding either PL or PB diameter at any time.

Conclusion: Tenodesis of the PL to the PB has been the standard procedure for harvesting PL grafts for various ligament surgeries. Recent work has shown that tenodesis or no tenodesis does not impact ankle functional outcomes. The present ultrasound-based study indicates that the PB does not hypertrophy to compensate for a harvested PL. Further, tenodesis or no tenodesis has no impact on either PB or PL diameters.

Introduction: Arthroscopic ACL reconstruction, a cornerstone in modern orthopedics, aims to restore knee stability while minimizing complications. Bibliometric analysis provides insights into research trends, influential contributors, and advancements in this field.

Materials and methods: A systematic analysis of 104 eligible articles on ACL reconstruction complications was conducted using the Web of Science database. Data, including titles, authors, and journals, were extracted. Bibliometric insights were generated using R software, while VOS viewer visualized bibliographic coupling, co-authorship networks, and keyword co-occurrence through interactive mapping techniques.

Results: Annual publications peaked in 2022, with the U.S. contributing 73 studies and fostering global collaborations. Arthroscopy: The Journal of Arthroscopic and Related Surgery emerged as the leading journal, with the highest H-index and G-index. Dr. Brian Forsythe was identified as the most prolific author. Key articles addressed complications such as infections. Co-citation and co-authorship analyses highlighted collaborative efforts among institutions, while keyword analysis revealed prominent research themes, including ACL reconstruction techniques, complication management, and outcomes.

Conclusion: This 20-year bibliometric review underscores global research trends in arthroscopic ACL reconstruction, with the U.S. leading in both publication volume and impact. Journals like Arthroscopy set benchmarks in the field, while emerging research focuses on improving outcomes, addressing complications, and refining patellar tendon graft techniques.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01543-x.

Purpose: The optimal autograft for restoring knee strength and expediting return-to-sport following anterior cruciate ligament reconstruction (ACLR) remains debated. This systematic review and meta-analysis compared isokinetic strength and patient-reported outcomes after ACLR using quadriceps tendon (QT), hamstring tendon (HT), or bone-patellar tendon-bone (BTB) autografts to determine graft-specific recovery patterns.

Methods: PubMed, Cochrane Library, EMBASE, and Google Scholar were systematically searched for comparative studies evaluating isokinetic strength following primary ACLR using QT, HT, or BTB autografts. Non-English, unavailable full-text, animal/cadaveric, and physeal-sparing studies were excluded. MINORS and Detsky evaluated bias risk. Key findings were quantified, and subgroup meta-analyses were performed on limb symmetry index (LSI) values (significance: p < 0.05).

Results: Seventeen studies (1,705 patients: QT = 765, HT = 725, BTB = 215) with follow-ups through 48 months were included. Due to data heterogeneity, four to six studies qualified for each meta-analysis. Among 13 QT vs. HT studies, QT grafts demonstrated weaker extensor strength in nine (56.3%) and greater flexor strength in six (37.5%). No differences were reported in extensor or flexor strength in four (25.0%) and seven (43.8%) studies, respectively. For QT vs. BTB, two studies (12.5%) showed similar extensor strength, whereas two reported conflicting results. QT had greater flexor strength in one (6.3%) and similar strength in three (18.8%) studies. Postoperative pain was comparable between QT and HT.

Conclusions: QT autografts resulted in stronger flexion and weaker extension than HT autografts after ACLR. Tailored rehabilitation targeting graft-specific deficits may accelerate recovery. Further research is required to clarify outcomes between QT and BTB autografts.Level of evidence: IV.

Purpose: This study aimed to explore the bibliometric characteristics of pediatric fracture research from its inception until 2024, specifically focusing on high-cited publications (HCPs) defined as those with 100 or more citations. Key indicators evaluated include publication frequency, citation counts, and collaboration metrics.

Methodology: The Scopus database was utilized to identify global publications related to pediatric fractures. The top HCPs were retrieved for detailed analysis, employing bibliometric and network analyses with VOSviewer and Biblioshiny software to uncover key contributors, including organizations, authors, and journals, along with their collaborative interactions and significant keyword co-occurrences.

Results: 262 HCPs in pediatric fracture research were identified and indexed in Scopus from 1929 to 2024 (95 years), accumulating a cumulative citation count of 42,675 and an average of 162.9 citations per publication. This body of work involved 931 authors from 160 organizations across 31 countries, with external funding at 9.16% and international collaboration at 7.25%. The United States of America was the leading contributor with 145 publications (55.34%), followed by the United Kingdom (11.83%) and Canada (11.45%). The Children's Hospital of Philadelphia emerged as the most productive organization, while the Journal of Pediatric Orthopaedics published the highest number of HCPs (n = 59). The journal 'Bone' exhibited the highest citation impact per paper, averaging 271.33 citations.

Conclusion: This study elucidates research trends and influential contributions in pediatric fracture research, offering valuable insights into past, present, and future research priorities in this domain.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01551-x.

Background: The Hoffa-Kastert syndrome was first described at the beginning of the twentieth century (Hoffa in Deutsche Medizinische Wochenschrift 30:337-338, 1904). The assumption of an independent disease of Hoffa's fat pad was extended by Kastert in the midtwentieth century with the finding that another pathology in the knee must be the cause for the inflammatory change ("Hoffaitis") (Kastert in Chirurg 24:390-394, 1953).

Case report: The fat pad can increase in size as a result of repeated trauma and lead to entrapment as described here.

Conclusion: Complete removal of the circumscribed tumour could eliminate the joint blockage.

Aims: To evaluate the prognostic role of serum albumin level in the radiological progression of gonarthrosis.

Methods: Two hundered and fifty patients with gonarthrosis (Group1: early stage gonarthrosis, Group 2: late-stage gonarthrosis), and 125 patients as a control group (Group 3) were included in this retrospective cross-sectional study. Age, gender, the Kellgren-Lawrence (KL) stage, serum albumin level, C-reactive protein (CRP)/albumin, platelet/lymphocyte, neutrophil/lymphocyte, lymphocyte/monocyte, lymphocyte/CRP, The Aggregate Index of Systemic Inflammation, Systemic Inflammatory Response Index, Systemic Immune Inflammation Index, Prognostic Nutritional Index (PNI), Modified Systemic Inflammation Score (mSIS) were recorded.

Results: Albumin and PNI were lower compared to the Group 3 in the Group 1 and Group 2, and compared to the Group 1 in the Group 2 (for all p ≤ 0.001). mSIS was higher in the Group 1 and Group 2 compared to the Group 3 (p < 0.001 for both), and in the Group 2 compared to the Group 1 (p = 0.01). CRP/albumin was higher in Group 2 compared to Group 1 (p = 0.004). KL stage was moderately negatively correlated with albumin (r = -0.45 p < 0,001) and PNI (r = -0.40 p < 0.001). Albumin and PNI values ​have diagnostic value in predicting early-stage (the cut-off value for albumin: 40.05 g/L, for PNI: 52.28) and late-stage (the cut-off value for albumin: 39.35 g/L, for PNI: 51.03) gonarthrosis in patients without gonarthrosis and late-stage gonarthrosis in patients with early-stage gonarthrosis (the cut-off value for albumin level: 38.55 g/L, for PNI: 49.73).

Conclusions: Serum albumin level has a prognostic role in the radiological progression of gonarthrosis.

Background: Lumbar stress fractures are very common lesions in young athletes participating in sport and are generally now diagnosed on MRI scanning. An ability to assess cortical thickness would help understand risk for future injury. This paper aims to establish a method for quantifying cortical thickness in the posterolateral vertebral arch of the lumbar spine on MRI scans.

Methods: Methods for measuring the cortical thickness of the pars, pedicle, and lamina of the lumbar vertebra were developed from existing methods in other bones and expert opinion. MRI images of elite cricket pace bowlers were retrospectively reviewed in a development phase (n = 13 MRI, 30 measurement sites per MRI) and a reliability testing phase (inter-rater reliability n = 33 MRI, intra-rater reliability n-12 MRI).

Results: Intra-rater reliability was overall excellent (intra-class correlation coefficient (ICC) 0.740-0.992). Inter-rater reliability ranged from fair to excellent (ICC 0.515-0.954), with lower reliability for the total pedicle cortex. Lower reliability was attributable to challenges of identifying the pedicle cortex and the more oblique orientation of the L5 vertebrae as the lumbar spine becomes more lordotic.

Conclusion: This paper establishes a new manual method to quantify cortical thickness in the posterolateral vertebral arch of the lumbar spine on MRI scans. This work supports future advancements by providing a reference standard for potential automation using artificial intelligence and to understand how cortical thickness may be related to adaptation and injury in athletes at high risk of lumbar bone stress injury.