Journal of Orthopaedic Surgery最新文献

Background: Metatarsalgia is a frequent cause of forefoot pain, often linked to isolated gastrocnemius tightness, which increases forefoot pressure during gait. Gastrocnemius recession has been proposed as a surgical treatment to correct this biomechanical dysfunction. This systematic review aims to evaluate the clinical outcomes, complication rates, and quality of evidence regarding gastrocnemius recession performed exclusively for the treatment of isolated metatarsalgia. Materials and Methods: A systematic search of PubMed, MEDLINE, and the Cochrane Library was conducted in February 2025 following PRISMA guidelines. Studies were included if they reported outcomes of gastrocnemius release performed solely for isolated metatarsalgia. Data on surgical techniques, clinical outcomes, complications, and follow-up durations were extracted and analyzed. Results: Three studies met the inclusion criteria, encompassing a total of 86 operated feet with a mean follow-up of 37.5 months. Surgical techniques varied across studies, including proximal medial gastrocnemius release and musculotendinous junction recession. All studies reported significant improvements in Visual Analogue Scale (VAS) scores, along with high rates of patient satisfaction. Nevertheless, approximately 30% of patients required adjunctive forefoot procedures. The complication rate was low and predominantly involved minor nerve symptoms and transient bruising. Conclusion: Gastrocnemius recession appears to be an effective and safe surgical option for the management of isolated metatarsalgia, providing substantial pain relief and high patient satisfaction. However, the multifactorial nature of metatarsalgia often necessitates additional forefoot procedures. Standardization of surgical techniques, postoperative protocols, and outcome measures is essential to enhance clinical decision-making and future research quality.

BackgroundArtificial intelligence (AI) has rapidly gained momentum in the field of orthopaedics, with an increasing number of systematic reviews and meta-analyses providing synthesised evidence. However, most studies have focused on individual subspecialties or specific applications, and a comprehensive overview across the discipline is lacking.AimThe aim of this study is to chart publication trends and geographical distribution, classify clinical and anatomical focus, and map AI methodologies and applications in orthopaedic settings, thereby highlighting research opportunities in underexplored areas.MethodsWe conducted a scoping review of freely accessible systematic reviews with and without meta-analysis across PubMed, Web of Science and Scopus databases from year 2015 up to July 2025 that evaluated the use of AI in orthopaedics. Data were extracted on publication characteristics, geographical origin, orthopaedic subspecialty focus, anatomical region, AI methodologies, data modalities, and application types. The methodological quality of the included reviews was appraised using the A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2). Descriptive trends were summarised, and associations between variables were analysed using R software.ResultsWe identified 183 eligible systematic reviews published in the last 10 years, with an exponential increase in publications over the past 5 years. Most reviews concentrated on fractures, arthroplasty, and surgery-related studies, particularly in the spine, knee, and hip. Imaging datasets predominated, with deep learning most frequently applied to radiological tasks, while machine learning methods were more common in structured clinical data applications. Notable gaps remain in underrepresented anatomical regions and in underexplored applications such as prescriptive modelling.ConclusionOur review highlights that while there is rapid growth in AI research across orthopaedics, certain clinical domains remain underexplored. These gaps represent opportunities for future work to align AI methods with clinical needs. By addressing these areas, AI has the potential to effectively support orthopaedic care and improve patient outcomes.

Purpose: Titanium volar locking plates are widely used in distal radius fractures (DFRs) fixation, but their induction of radiographic shielding hinders fracture assessment. Carbon fiber-reinforced polyether ether ketone (CFR-PEEK) plates are radiolucent and biomechanically comparable to titanium, potentially improving intraoperative visualization and postoperative follow-up. This study aims to compare clinical and radiographic outcomes between CFR-PEEK and titanium plates.MethodsThis retrospective study included 39 patients with DRFs treated with either CFR-PEEK (n = 19) or titanium plates (n = 20) between August 2018 and June 2019. Intraoperative and postoperative parameters were compared between the two groups. The Wilcoxon rank sum test and Fisher's exact test were applied for statistical analysis.ResultsSatisfactory fracture reduction without implant-related complications was achieved in both groups. At 12 months, wrist range of motion and radiographic alignment did not significantly differ between the groups (both p > 0.05), and Disabilities of the Arm, Shoulder and Hand (DASH) scores were comparable between the groups (11.8 ± 7.0 vs 11.9 ± 4.6, p > 0.05). Notably, intraoperative CFR-PEEK plates significantly reduced the operative time compared with titanium plates (64.16 ± 15.24 min vs 78.4 ± 20.63 min, p = 0.0387). The implant removal rates did not differ between the groups.ConclusionCFR-PEEK volar locking plates demonstrated clinical and radiographic outcomes comparable to titanium plates, with added advantages of radiolucency and surgical efficiency, including a significantly shorter operative time. These findings identify CFR-PEEK plates as a safe and effective alternative in DRFs fixation.

PurposeACTIS and CORAIL are cementless titanium femoral stems with hydroxyapatite (HA) coating but differing macro-geometries: ACTIS features a variable triple-taper with a medial collar, whereas CORAIL is a straight double-tapered design available with or without a collar. We compared mid-term clinical and radiographic outcomes of these stems with a minimum 5-years follow-up.MethodsWe retrospectively reviewed 114 primary total hip arthroplasties using ACTIS (63 hips) or CORAIL (51 hips). Clinical outcomes and standardized radiographic parameters were assessed and compared between groups.ResultsThe canal-fill ratio (CFR) was significantly greater at the proximal, middle, and distal levels in the ACTIS group. Spot-weld formation was more frequent with ACTIS than with CORAIL (58.7% vs 35.3%). In logistic regression, proximal CFR significantly predicted spot-weld formation for ACTIS, with an optimal cutoff of 66.2% (sensitivity 91.9%, specificity 72.0%). Rates of subsidence, radiolucent lines, and pedestal formation did not differ significantly between groups. No severe stress shielding was observed with ACTIS, whereas three CORAIL hips demonstrated severe stress shielding (0% vs 5.9%). Clinical scores improved significantly in both groups, with no significant between-group differences at final follow-up.ConclusionsBoth stems yielded favorable radiographic and clinical mid-term outcomes. In ACTIS, greater proximal canal fill was associated with radiographic osseointegration, suggesting proximal CFR as a probabilistic radiographic marker of stem ingrowth.

BackgroundRotational alignment of the tibial component is critical for successful total knee arthroplasty (TKA). Akagi's line is a reliable anteroposterior reference, but its intraoperative applicability may be limited when the posterior cruciate ligament (PCL) is not visible after tibial resection. The extensor hallucis longus (EHL) tendon, as an extra-articular and consistently identifiable structure, may represent a practical distal landmark. This study evaluates the anatomical relationship between Akagi's line and the EHL tendon on computed tomography (CT) and analyzes its association with tibial morphometric parameters.MethodsA descriptive correlational study was conducted on CT scans of 100 anatomically normal tibiae. Akagi's line was defined as the line connecting the center of the PCL to the medial border of the patellar tendon. Its distal projection at the tibial plafond was compared with the center of the EHL tendon. Tibial length, morphology, posterior slope, sagittal distance, and the angle of Akagi's line relative to the femoral transepicondylar axis (TEA) were measured. Two independent observers performed all measurements. Associations were analyzed using Spearman's correlation coefficients with 95% confidence intervals.ResultsAkagi's line projected through the center of the EHL tendon in 60% of cases and medially in 40%, with no lateral deviations. The Akagi-EHL distance correlated strongly with tibial length (ρ = 0.71; p < 0.001) and sagittal distance (ρ = 0.70; p < 0.001), but showed no association with tibial slope. No significant correlation was observed between the Akagi-femoral TEA angle and morphometric parameters.ConclusionThe distal projection of Akagi's line consistently aligns with, or lies slightly medial to, the center of the EHL tendon. This predictable relationship supports the EHL as a reliable, extra-articular distal landmark for tibial rotational alignment in TKA when intra-articular references are obscured.Level of evidenceIV (Descriptive study).

IntroductionFirst metatarsophalangeal (MTP) joint arthrodesis is the gold-standard treatment for end-stage arthritis and hallux deformities. Successful fusion is improved by achieving adequate compression across the joint. Traditional plating systems provide single-point compression, whereas the Arthrex MTP valgus plate is designed for double compression, potentially improving stability and union rates. This study aimed to confirm double compression and compare two anchoring methods: K-wire and olive tip guide wire (BB-tack).MethodsTwelve cadaveric feet were randomised to plate fixation using either K-wire or BB-tack anchoring. Compression was measured with Tekscan sensors during three stages: after seating the first compression screw, after seating the second screw, and after reseating the second screw without the stabilising K-wire. Peak force and contact pressure were analysed using ANOVA and t-tests (α = 0.05).ResultsBoth techniques achieved measurable compression after the first screw, which increased significantly with the second screw (mean pressure: 0.55-0.62 MPa; peak force: 18.3-22.2 N). Removing the stabilising K-wire before reseating reduced peak force but maintained comparable pressure. No significant differences were found between anchoring methods (p > 0.05).ConclusionThe Arthrex MTP valgus plate achieves double compression, enhancing construct rigidity compared to single-compression systems. Further clinical studies are warranted to validate these biomechanical advantages.

BackgroundWhile obesity is an established risk factor for osteoarthritis (OA), the differential impacts of regional body composition is not well understood. This study aimed to examine the associations of whole-body and region-specific (arms, legs, and trunk) fat-to-muscle mass ratio (FMR) with OA prevalence, as well as the mediating effects of systemic inflammation in this relationship.MethodsData from adults aged ≥40 years were collected from the 1999-2006 & 2011-2018 cycles of National Health and Nutrition Examination Survey. Total and region-specific FMR was assessed using dual-energy X-ray absorptiometry, with OA status determined by self-report. Logistic regression was used to analyze the associations between total or regional FMR and OA prevalence. Mediation analysis was conducted to determine the mediating effect of the systemic immune-inflammation index (SII).ResultsAmong the 9,504 participants included, 953 (10.63%) had OA. The odds ratio (95% confidence intervals) for OA by arm, leg, trunk and total FMR were 1.122 (1.082-1.163), 1.156 (1.101-1.213), 1.142 (1.094-1.192), and 1.194 (1.131-1.260), respectively. Compared to the lowest quartile, the highest quartile of arm, leg, trunk, and total FMR had 75.4%, 115.7%, 113.6%, and 161.3% increased risk of OA, respectively. Restricted cubic spline curves indicated a linear relationship between leg, trunk and total FMR with OA. The discriminatory performances of FMR measures were modest (area under the curve 0.635-0.656). SII mediated 2.4%-2.6% of the association between FMR and OA.ConclusionA higher FMR in all body regions is associated with a higher risk of OA, which is partially mediated by systemic inflammation.

Study designNetwork Meta-Analysis.ObjectiveTo comprehensively compare the clinical efficacy and safety of anterior controllable antedisplacement and fusion (ACAF), anterior cervical corpectomy and fusion (ACCF), and laminoplasty (LP) for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL).MethodsPubMed, Cochrane Library, Embase, and Web of Science were systematically searched (inception to April 1, 2025) for clinical studies comparing at least two of ACAF, ACCF, or LP for multilevel (≥2 segments) cervical OPLL. Data on surgical parameters, neurological function (Japanese Orthopaedic Association [JOA] score, JOA recovery rate, Visual Analog Scale [VAS]), biomechanics (cervical curvature, Cobb angle, Range of Motion [ROM], Neck Disability Index [NDI]), and complications were extracted. A frequentist network meta-analysis using a multivariate random-effects model was performed. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA).ResultsThirty-one non-randomized studies involving 2616 patients were included (ACAF: 585; ACCF: 875; LP: 1156). NMA showed ACAF and ACCF achieved significantly better postoperative JOA scores and recovery rates than LP (p < 0.05). ACAF showed the highest probability of being the most effective treatment for postoperative VAS score (vs ACCF & LP, p < 0.05) and maintenance of cervical curvature/Cobb angle (vs ACCF & LP, p < 0.05). LP had the shortest operative time (p < 0.05). Regarding safety, ACAF was associated with the lowest probability of total complications (SUCRA 99.7%), with significantly lower risks of cerebrospinal fluid (CSF) leakage versus ACCF (p < 0.05), and C5 palsy and axial pain versus LP (p < 0.05). LP had the lowest risk of dysphagia (p < 0.05). Subgroup analysis suggested ACAF's benefits, particularly in neurological outcome, are more pronounced in patients with severe stenosis (occupying ratio ≥60%).ConclusionBased on current observational evidence, ACAF appears to be a promising option for multilevel cervical OPLL, particularly for patients with severe stenosis. ACCF provides effective neurological decompression but carries a higher CSF leak risk than ACAF. LP, while having shorter operative times, results in inferior neurological and biomechanical outcomes compared to anterior approaches. Surgical decisions require individualized assessment based on patient and OPLL characteristics.However, these findings should be interpreted with caution due to the predominance of non-randomized studies and potential selection bias.

BackgroundSuperior labrum anterior and posterior (SLAP) lesions are a common cause of shoulder pain and instability. Accurate diagnosis remains challenging in clinical practice. This study aims to develop and evaluate radiomics models and combined models integrating radiomics and clinical features for SLAP lesion detection.MethodsThis retrospective study included 149 patients who underwent shoulder arthroscopic surgery with preoperative shoulder magnetic resonance imaging (MRI) between 2019 and 2024. Regions of interest (ROIs) were manually delineated on MRI oblique coronal proton density-weighted fat-suppressed (PD FS) images, and radiomics features were subsequently extracted from these defined regions. Feature selection employed independent t-tests, Mann-Whitney U tests, Pearson correlation analysis, and least absolute shrinkage and selection operator (LASSO) regression. Common machine learning models including Support Vector Machine (SVM), Random Forest (RF), and Light Gradient Boosting Machine (LightGBM) were employed to construct diagnostic models based on radiomics features. A combined model integrating radiomics and clinical features was developed and visualized using nomograms.ResultsIn the test cohort, the LightGBM-based radiomics model achieved optimal performance with the Area Under the Curve (AUC) of 0.867, sensitivity of 0.952, and specificity of 0.625. The combined model demonstrated enhanced diagnostic capability with AUC of 0.899, sensitivity of 0.762, and specificity of 0.917. Manual diagnosis of SLAP injury using MRI achieved an accuracy of 50.3%, with a sensitivity of 27.7%, specificity of 78.8%, and AUC of 0.619.ConclusionMachine learning models based on MRI radiomics features demonstrated superior diagnostic accuracy compared to traditional radiologist assessment for SLAP lesions. The combined model incorporating both radiomics and clinical features provides effective risk prediction for SLAP lesions.

PurposePosterior medial meniscus root tears often cause persistent extrusion and altered joint mechanics despite repair. This study compared standard transtibial pull-out repair with repair plus a second-tunnel centralization, hypothesizing better patient-reported outcomes without major MRI extrusion changes.MethodsThis retrospective two-center cohort (2019-2024) included adults with MRI-confirmed root tears treated with anatomic repair alone or with an additional centralization tunnel. Propensity matching yielded 96 patients (54 vs 42). The primary endpoint was 24-months change in IKDC score. Secondary outcomes included KOOS subscales, Lysholm, visual analogue scale pain, and Tegner activity. Structural outcomes-medial meniscus extrusion and Meniscal Extrusion Index-were assessed on coronal MRI at 12 ± 4 months. Analyses used ANCOVA adjusted for baseline values, supported by inverse-probability weighting and mixed-effects checks.ResultsBaseline characteristics were balanced. Extrusion changes were small and similar; residual pathologic extrusion rates were comparable (65% vs 62%). Centralization showed greater IKDC improvement (+5.7 points; p = 0.008) and higher KOOS-Quality of Life. Knees with ≥3 varus demonstrated additional benefit (interaction p = 0.048). Complications were infrequent.ConclusionsSecond-tunnel centralization significantly increased the probability of achieving clinically meaningful functional improvement, despite unchanged static MRI extrusion. This suggests dynamic load-sharing benefits not captured by static imaging. Therefore, centralization is recommended as a selective adjunct, particularly in varus alignment, rather than a routine necessity.