International Orthopaedics最新文献

Purpose: This study aimed to assess the presence of spin in abstracts of systematic reviews and meta-analyses comparing biceps tenodesis and tenotomy outcomes and to explore associations between spin and specific study characteristics.

Methods: Using Web of Science and PubMed databases, systematic reviews and meta-analyses comparing outcomes of biceps tenodesis and tenotomy were identified. Abstracts were evaluated for the nine most severe types of spin as described by Yavchitz et al. and appraised using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Study characteristics were extracted, including adherence to PRISMA guidelines,funding status, and impact metrics such as journal impact factor, total number of citations, and average annual citations.

Results: A total of 16 studies were included, with spin detected in 81.3% of the abstracts. Type three spin was the most frequent (56.3%), followed by types six (43.8%), five (37.5%), nine (25.0%), two (12.5%), and four (6.3%). Spin types one, seven, and eight were not observed. AMSTAR 2 appraised 75% of the studies as 'low' quality, and 25% as 'critically low' quality. All studies had at least one critical flaw, with item 15 (investigation of publication bias) being the most frequent (93.8%). A strong positive correlation was found between AMSTAR 2 scores and citation counts (r = 0.821, p < 0.001). Studies with a higher number of spin incidents were significantly more likely to have an associated letter to the editor (p = 0.0043).

Conclusion: Severe types of spin were prevalent in the abstracts of systematic reviews and meta-analyses comparing biceps tenodesis and tenotomy. Data analysis suggests that abstracts with a higher incidence of spin tend to attract more scrutiny from the academic community. These findings highlight the need to enhance reporting standards.

Purpose: Athletes face a higher risk of upper limb nerve entrapment due to repetitive stress, trauma, and biomechanics. Diagnosis is challenging, and delayed treatment can impair performance. When conservative care fails, surgery may be needed to restore function and enable return to play (RTP).

Methods: This systematic review adhered to PRISMA guidelines and evaluated surgical outcomes, RTP rates, and complications in athletes with upper limb nerve entrapment. A comprehensive search was conducted using MeSH terms and keywords for surgical interventions, nerve entrapment syndromes, and sports. Eligible studies included case series, cohort studies, and comparative studies that reported postoperative outcomes in athletes. Data extraction included nerve involvement, surgical techniques, clinical outcomes, and RTP rates.

Results: Thirty-one studies, comprising 1,297 athletes across 23 sports, were included. The most common nerve entrapments involved the ulnar nerve (50.1%), brachial plexus (39.2%), and suprascapular nerve (9.5%). Surgical interventions included ulnar nerve decompression/transposition, first rib resection with scalenectomy for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. RTP rates ranged from 62 to 100%, with an average of 87%. Suprascapular nerve decompression had the highest RTP success (100%), while TOS demonstrated greater variability (62.5-97%). Functional improvements included pain reduction, increased grip strength, and enhanced patient-reported outcomes. The overall complication rate was low, but TOS procedures had the highest reoperation rates (3.8-27%).

Conclusion: Surgical treatment of upper limb nerve entrapment in athletes yields high RTP rates and functional recovery. Ulnar and suprascapular nerve decompressions show consistent success, while TOS surgery outcomes vary.

Purpose: To compare the efficacy of an internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability (CLAI).

Methods: The clinical data of 71 patients who were diagnosed with chronic lateral ankle instability between May 2020 and May 2022 were retrospectively analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) scale, Foot and Ankle Ability Measure (FAAM), and Visual Analogue Scale (VAS) were used to assess clinical outcomes.

Results: A total of 59 patients were followed up for a mean of 21 months (range, 16-24 months). Thirty-seven patients underwent the modified Broström-Gould (IB) procedure, and twenty-two patients underwent the arthroscopic Broström-Gould (ABG) procedure. The mean postoperative VAS score (P = 0.790), AOFAS score (P = 0.252), FAAM daily activity score (P = 0.983), and FAAM for sports activity score (P = 0.379) were not significantly different between the ABG and IB groups at the final follow-up. However, the FAAM sports score was better in the internal brace group than in the arthroscopy group at the 1-year postoperative follow-up (P = 0.025).

Conclusion: Patients treated with an internal brace recovered faster than those who underwent the arthroscopic ABG procedure. However, no other significant differences were observed between the two methods.

Level of evidence: Level IV, retrospective case series.

Purpose: The spine research within India has seen significant advancement, yet detailed examinations of its impact and evolution still need to be made sparse. To conduct a comprehensive scientometric review of the most frequently cited papers in Indian spine research from 1995 to 2024, aiming to map the field's evolution and its global impact.

Methods: Utilizing the Scopus database, a search was performed with keywords related to spine research, identifying 105 highly cited papers. This study focused on trends in publications, document types, affiliations, collaboration networks, and citation patterns.

Results: The period between 2005 and 2014 saw a significant increase in publications, with a notable emphasis on international collaborations, especially with the United States and Canada. Clinical research, particularly on the lumbar spine and surgical advancements, emerged as the primary focus. The average citations per document stood at 102.37, with original research articles constituting 73.33% of the total. Collaboration spanned across 31 countries, with the United States being the foremost partner. Indian institutions like Ganga Hospital, Coimbatore, and the All India Institute of Medical Science, New Delhi, were among the top contributors. Indian authors, notably with S. Rajasekaran leading, followed by AK Jain.

Conclusion: The findings highlght the pivotal role of Indian spine research in contributing to the global knowledge base, highlighting significant areas of strength and opportunities for future research. The study offers valuable insights for researchers, policymakers, and healthcare planners, aiming to enhance spinal health care in India and internationally.

Purpose: No previous studies have reported the presence of sleep disturbances or their association with baseline factors in elderly patients with distal radius fracture (DRF). This study aimed to describe the proportion of patients with sleep disturbances and analyze their association with baseline factors in patients older than 60 years with conservatively treated DRFs.

Methods: This prospective observational study included 220 patients with extra-articular DRFs who completed the Pittsburgh Sleep Quality Index at two time points: two weeks after cast removal and at the one year follow-up. Sociodemographic, anthropometric, clinical, radiological, and patient-reported outcome measures were analyzed as baseline predictors, with measurements performed two weeks after cast removal.

Results: At two weeks after cast removal, 166 (75.5%) patients had sleep disturbances. Sleep disturbances were associated with the affected dominant hand (β = 1.6; p = 0.04), high-energy injury (β = 3.8; p < 0.001), extra-articular comminuted metaphyseal DRFs (β = 2.3; p < 0.001), higher Tampa Scale of Kinesiophobia scores (β = 2.4; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.4; p < 0.001), higher Pain Anxiety Symptoms Scale-20 scores (β = 2.1; p < 0.001), and higher visual analogue scale scores (β = 4.1; p < 0.001). At the one year follow-up, 85 (38.6%) patients had sleep disturbances, which were associated with higher Tampa Scale of Kinesiophobia scores (β = 2.6; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.5; p < 0.001), and higher Pain Anxiety Symptoms Scale-20 scores (β = 1.8; p = 0.02).

Conclusions: A high proportion of elderly patients with DRF experienced sleep disturbances. Expanding our understanding of the interplay between sleep disturbances and baseline risk factors may lead to improved care and clinical outcomes for these patients. Future studies should incorporate the clinical management of sleep disturbances in patients with DRFs.

Purpose: This study reports the relationship between posterior cruciate ligament (PCL) retention vs resection and soft tissue laxity and balance throughout flexion using a robotically controlled ligament tensioner.

Methods: 55 robotic-assisted TKAs (Total knee arthroplasty) were retrospectively reviewe. The robotic ligament tensioner collected laxity data both before and after PCL resection. Medial and lateral coronal laxity were compared before and after PCL resection at 10°, 45°, and 90° flexion. Gap opening was compared between pre-operative coronal hip-knee-ankle groups.

Results: Lateral laxity was greater after PCL resection at 60° (12.7 ± 2 vs 11.5 ± 3 mm), 75° (13.2 ± 2 vs 11.8 ± 3 mm), and 90° (13.7 ± 2 vs 12.1 ± 3 mm). Medial laxity was significantly greater after PCL resection at 90° (10.1 ± 2 vs 9 ± 2 mm). After PCL resection, laxity in valgus knees increased more compared to neutral/varus knees laterally at 30° (1.2 ± 1 vs 0.3 ± 1 mm), 45° (1.6 ± 1 vs 0.6 ± 1 mm), and 60° (2.1 ± 2 vs 1 ± 1 mm). A similar, but non-significant trend was observed at 90° (2.7 ± 2 vs 1.5 ± 1 mm, p = 0.09).

Conclusion: PCL resection increases flexion laxity laterally by up to 1.6 mm and medially by 1.1 mm on average, with valgus knees increasing more than neutral/varus knees. The findings emphasize that surgeons should consider the interplay between PCL resection and coronal deformity when planning and executing TKA procedures.

Purpose: Debridement, Antibiotic Treatment, and Implant Retention (DAIR) is considered the first-line treatment for early acute Prosthetic Joint Infection (PJI). This study aims to evaluate the five year success rates of early acute PJI managed with DAIR taking into consideration the time from the index surgery.

Materials and methods: A retrospective analysis of medical charts for 291 consecutive patients with acute PJI occurring within the first three months after primary or revision arthroplasty was conducted. Patients were stratified into two groups based on DAIR timing: Group (A) patients who underwent DAIR within the first four weeks post-arthroplasty; Group (B) patients who underwent DAIR between five and 12 weeks post- arthroplasty. Success rate was defined as implant in place, without signs of infection and not under suppressive antibiotic treatment.

Results: The overall five year success rate for the entire cohort at five years was 62.2%. The mortality rate during the study period was 8.2%. The five year success rate was 64.4% (141 of 219) for Group A and 55.6% (40 of 72) for Group B (p = 0.21). Including deceased patients without signs of infection and retained implants as successful cases, the five year success rates increased to 69.9% for Group A (153 out of 219) and 69.4% for Group B (50 out of 72). The implant survival rate at five years was 73% for Group A and 71% for Group B.

Conclusion: Our findings indicate that there are no significant differences between patients who undergo a DAIR procedure within four weeks from those performed between week five and 12. Importantly, the overall success rate decreased from 75.6 to 62.2% in the last three years of follow-up.

Purpose: Previous studies have shown that subtrochanteric femoral fractures treated with intramedullary nails might lead to varus-procurvatum malalignment. Similar results have been reported when using antegrade intramedullary lengthening nails (ILNs). The purpose of our study is to examine if antegrade telescoping intramedullary lengthening nails lead to varus-procurvatum malalignment of the proximal femur and what are possible predictors of that shift.

Methods: In this retrospective, single centre study, five surgeons performed 537 femoral ILN. 347 antegrade PRECICE nails were selected after applying exclusion criteria. The following exclusion criteria were applied, intentional angular deformity correction, retrograde femoral lengthening and concomitant tibial lengthening. After further exclusion criteria were applied, we retrospectively inspected 201 PRECICE nails inserted in 158 paediatric and adult patients (average age 19.9 years) that underwent IM nail limb lengthening. Follow-up was at least one year by which time all osteotomies were healed.

Results: Mean lengthening was 4.7 cm per lengthening surgery with some patients needing multiple lengthening for large discrepancies. Of the 201 nails, trochanteric entry was used in 127 procedures and piriformis entry was used in 74 of them. With pre-op Osteotomy Level Coefficient (OLC) of 0.3. The preoperative neck shaft angle (NSA) was significantly reduced from 130.6 to 127.4 degrees at the end of lengthening (P < 0.05). There was no discernible correlation between the OLC and change in NSA. The trochanteric entry point was associated with a greater tendency to reduce the NSA (Mdif = -4.1, SD = 6.5) as compared to the piriformis entry point (Mdif = -3, SD 6.4) (P < 0.05). No significant change in anatomic medial proximal femoral angle (aMPFA) was noted between pre- and postoperative time points, nor between trochanteric and piriformis entry groups.

Conclusion: Our study investigated the risk of iatrogenic varus deformity of the proximal femur following intramedullary limb lengthening procedures. We identified the osteotomy site as the most significant risk factor for developing iatrogenic varus, while the nail insertion point did not significantly predict this complication, showing comparable results for both trochanteric and piriformis entry points. Additionally, our study is the first to identify a correlation between the level of osteotomy and coxa-valga correction. We hypothesize that a higher osteotomy level might be beneficial for patients undergoing limb lengthening who also present with coxa-valga deformity.

Level of evidence: IV.

Purpose: Cutibacterium is commonly isolated from deep tissue samples taken at the time of revision shoulder arthroplasty, but the significance of these positive cultures is debated, and the impact of increasing bacterial loads on clinical outcomes is unclear. The objectives of this study were to (1) identify factors independently associated with high bacterial loads, and (2) compare patient-reported outcomes (PROs) and revision rates in patients found to have high Cutibacterium loads.

Materials and methods: Male patients undergoing single stage exchange with a minimum 2-year follow-up were included. Culture data were semi-quantitatively scored with the total Cutibacterium score (TShCuS). Two groups were compared: patients with a High Cutibacterium Load (HCL) group and those with Low Cutibacterium Load (LCL) group. PROs and revision rates were compared, and a multivariable analysis was conducted.

Results: Of 68 male patients that underwent revision shoulder arthroplasty, 29 (42.6%) met the inclusion criteria for the HCL group, while 27 patients (39.7%) were in the LCL group. Mean follow-up was 4.7 ± 3 years. Patients with intraoperative humeral loosening had an 18.4 times increased risk of having high Cutibacterium loads (95% CI 2.1-154.4, p < 0.001). There were no significant differences in PROs or re-revision rates between the HCL and LCL groups.

Conclusions: Intraoperative humeral loosening was independently associated with high Cutibacterium loads found at the time of revision shoulder arthroplasty. Male patients with high bacterial loads treated with complete single stage exchange and antibiotics had patient-reported outcomes similar to those of patients with minimal to no load.

Level of evidence: III.

Purpose: This is a preliminary study with short-term follow up to determine the safety and efficacy of the S-design osteotomy and internal fixation for acute varus and rotational correction technique in infantile Blount's disease.

Methods: We performed a retrospective series in our institutional hospital. An S-design osteotomy for multiplanar, acute correction followed by internal fixation was performed for Blount's disease patients. Effectiveness was measured by comparing pre-and post-operative tibiofemoral angle (TFA) and metaphyseal-diaphyseal angle (MDA). Safety was determined by the number of neurological deficits and compartment syndromes occurred post operatively. Functional outcome was assessed using the Lower Extremity Functional Scale (LEFS). All patients underwent a one-year follow-up after surgery.

Results: Nineteen patients (total of 31 extremities) were included in this study and classified into TFA less than 40 degree (group A) and more than 40 degree (group B). No neurological deficits nor compartment syndrome occured in either group. Regardless the severity of pre-operative deformity, both groups achieved significant corrections. Post operatively there was no significant difference in TFA in Group A and Group B (1.70 and 3.00 respectively, with p value of 0.147) and MDA (4,60 and 6,0 respectively, with p value of 0.327). This indicated there was no correlation between preoperative deformity and postoperative results. LEFS score of group A (73.85 ± 2.73) and Group B (73.85 ± 2.73) showed equally good results in both groups (p = 0.293).

Conclusion: This preliminary study with short-term follow up suggested that the S-design osteotomy effectively corrected internal rotation and varus while aiding limb length. The correction of internal rotation is accomodated by performing box osteotomy between the two horizontal (proximal and distal) lines of osteotomy, with safe and effective results. Acute correction is a safe and effective strategy for severe Blount's disease. Longer-term follow-up is awaited.

Level of evidence: V.