Journal of Orthopaedic Surgery and Research最新文献

Background: Managing ARCO stage III osteonecrosis of the femoral head (ONFH) is controversial, as surgeons choose between joint preservation and arthroplasty. While MRI provides superior assessment of lesion geometry compared with radiographs and may theoretically allow more precise targeting for debridement, it remains unclear whether preoperative MRI-based trajectory planning improves hip survival after core decompression in ARCO Stage III disease compared with pure fluoroscopic guidance. Obtaining an additional MRI solely to determine the three-dimensional location of the lesion prior to core decompression may impose financial and time burdens without adding significant value to treatment. This study aimed to determine whether the absence of timely three-dimensional imaging has an impact on the prognosis of patients with ARCO Stage III disease undergoing core decompression.

Methods: This study retrospectively analyzed patients with ARCO stage III ONFH who underwent core decompression between 2010 and 2023 at a single institution. The hips were categorized into MRI-guided group and X-ray-guided group based on the availability of preoperative MRI. The primary outcome was the rate of conversion total hip arthroplasty at one, two and five years. Secondary outcomes included visual analogue scale (VAS) and Harris Hip Score (HHS).

Results: A total of 241 hips in 207 patients were included in the analysis and were categorized into MRI-guided group (114 hips) and X-ray-guided group (127 hips). Overall survival at one, two, and five years was 70.5%, 57.3%, and 46.5%, respectively. Among stage IIIa hips, five-year survival was higher in the X-ray-guided group than in the MRI-guided group (62.8% vs. 41.9%, P = 0.036). In stage IIIb, outcomes were poor and comparable between groups (34.7% vs. 37.5%).There was no difference in conversion-free-survival between MRI-guided and X-ray-guided group at last follow-up. Postoperative VAS and HHS improved significantly in both groups, with no intergroup differences.

Conclusion: Preoperative MRI availability did not significantly influence survival following core decompression, THA conversion, or functional outcomes in ARCO stage III ONFH. X-ray-guided core decompression may be a feasible treatment option for stage III ONFH when radiographic diagnosis is evident, particularly in settings with limited MRI accessibility.

Level of evidence: Level III, retrospective cohort study.

Background: Intertrochanteric femoral fractures are common in the elderly population and are associated with substantial mortality. While fracture reduction quality is known to influence mechanical outcomes, its relative impact on mortality compared with patient-related comorbidities remains unclear. The objective of this study was to evaluate the impact of fracture reduction quality on survival in patients with intertrochanteric hip fractures, relative to the effect of comorbid diseases.

Methods: This retrospective cohort study included 297 elderly patients who underwent surgical treatment with a cephalomedullary nail for intertrochanteric femoral fractures at a tertiary care center between 2011 and 2022. Fractures were classified according to the AO/OTA system. Reduction quality was assessed using tip-apex distance, modified Baumgaertner criteria, Cleveland-Bosworth quadrant position, and neck-shaft angle. Mortality at 6, 12, and 24 months was recorded using data obtained from the national death notification system. The associations between mortality, reduction parameters, comorbid conditions, and ASA score were analyzed.

Results: Heart failure and dementia were identified as independent predictors of 6-month mortality. Heart failure remained significantly associated with 12- and 24-month mortality, while male sex was additionally associated with increased mortality at 24 months. Higher ASA scores (3-4) were consistently associated with increased mortality at all follow-up intervals. In contrast, AO/OTA fracture type and fracture reduction parameters were not significantly associated with mortality.

Conclusion: Mortality following intertrochanteric femoral fractures is largely determined by patient-related systemic factors, particularly heart failure and dementia, rather than fracture type or reduction quality. While optimal reduction remains essential for mechanical stability, improving survival outcomes in this patient population requires a focus on perioperative medical optimization and comprehensive management of comorbidities.

Introduction: This study compared the clinical outcomes of the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations for the management of acute midsubstance Achilles tendon ruptures (AMATR).

Methods: A retrospective analysis was conducted on 63 AMATR patients (54 men and 9 women, with a mean age of 39.84 ± 10.40 years (range, 21-62 years). All patients underwent Achilles tendon repair using the modified Bunnell suture configuration using the all-inside endoscopic repair (n = 31) or a minimally invasive repair (n = 32). The primary endpoint was postoperative functional outcome, assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS) at 6, 12, and 24 months. Secondary endpoints included perioperative and short-term recovery parameters, including operative time, incision length, postoperative pain assessed by the Visual Analog Scale (VAS) on postoperative days 1 and 3, wound complications, and time to return to work and sports activities.

Results: There were no intraoperative complications, and all patients in the endoscopic group achieved primary wound healing. At the 6-, 12-, and 24-month follow-up, both groups demonstrated significant improvement in AOFAS and ATRS scores over time, with no significant differences between groups. Regarding secondary endpoints, the all-inside endoscopic group had a significantly longer operative time but a significantly shorter incision length compared with the minimally invasive group (p < 0.05). VAS pain scores on postoperative days 1 and 3 were significantly lower in the endoscopic group (p < 0.05). No wound infections occurred in the endoscopic group, whereas three superficial infections were observed in the minimally invasive group; however, the difference was not statistically significant. Patients in the endoscopic group returned to work one week earlier (p < 0.05), while the time to return to sports was comparable between groups.

Conclusion: Both the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations provide reliable repair for AMATR and support a successful return to occupational and athletic activity. While the all-inside endoscopic procedure was associated with a longer operative time, it offered advantages in terms of reduced early postoperative pain, smaller incisions, and earlier return to work, without compromising functional recovery at the 2-year follow-up.

Aneurysmal bone cysts (ABCs) and simple bone cysts (SBCs) are benign osseous lesions predominantly affecting children and adolescents, typically presenting with pain, deformity, or pathologic fracture. Despite their frequency, optimal management remains debated. This review synthesizes current evidence on therapeutic strategies, efficacy, recurrence, and safety. For ABCs, intralesional curettage remains the standard surgical approach, though recurrence rates vary and are reduced with adjuvants such as high-speed burring, cryotherapy, or cementation. En bloc resection offers the lowest recurrence; however, it is restricted by procedural morbidity and poor functional outcomes. Minimally invasive modalities, including sclerotherapy, selective arterial embolization, endoscopic curettage, and image-guided ablation, consistently achieve high rates of healing, pain relief, and functional recovery, often with fewer complications. Management of SBCs ranges from observation to intervention in symptomatic or unstable lesions. Elastic stable intramedullary nailing (ESIN) provides both decompression and structural stability, with high healing rates. Overall, advances in minimally invasive and biologic therapies are reshaping treatment paradigms, yet standardized outcome measures and head-to-head comparative trials remain needed.

Background: To our knowledge, this is the first clinical outcome study of the arthroscopic dual-reduction fixation technique combining transosseous and U-shaped half-cerclage suspensory constructs for acromioclavicular joint dislocation(ACJ). This study evaluates the clinical outcomes of an arthroscopic dual-reduction fixation technique for the treatment of ACJ dislocation and compares it with the traditional single bundle coracoclavicular (CC) ligament reconstruction.

Methods: This retrospective study included 30 patients with acute acromioclavicular joint dislocation, divided into an arthroscopic dual-reduction fixation group (Group 1, n = 12) and a traditional suture-button reconstruction with a looped clavicular plate group (Group 2, n = 18). All patients were followed up postoperatively for at least 6 months. Postoperative evaluations were performed using patient-reported outcome measures (PROMs) to assess shoulder joint function and pain relief. Changes in shoulder joint range of motion (ROM) were recorded and compared between the two groups. Additionally, X-ray imaging was used to measure the coracoclavicular distance (CCD) and the extent of the clavicular bone tunnel widening (CBTW) in both groups, assessing the reduction and stability of the ACJ. Postoperative complications were also recorded and analyzed for both groups.

Results: The body mass index (BMI) and surgical duration in Group 1 were significantly higher than those in Group 2, while the follow-up period in Group 2 was significantly longer than in Group 1. In terms of functional scores, no significant differences were found between the two groups at any follow-up time point. However, the VAS score at 3 months postoperatively was significantly lower in Group 1 than in Group 2 (P < 0.05). Regarding shoulder joint ROM recovery, Group 1 demonstrated more significant improvement at 3 months postoperatively compared to Group 2 (P < 0.05). Radiographic findings showed that the CCD at 6 months postoperatively was significantly smaller in Group 1 compared to Group 2 (P < 0.05), and the degree of bone tunnel enlargement was notably smaller. In terms of complications, Group 1 had only one case of complication, while Group 2 had nine cases of recurrence of instability, AC arthritis, and implant sinking or migration.

Conclusion: Arthroscopic dual-reduction fixation was associated with the combined use of transosseous passage and a U-shaped half-cerclage suspensory construct fixation, with improved maintenance of reduction, less clavicular tunnel enlargement, and fewer complications compared with traditional single-bundle reconstruction in the early postoperative period.

Background: Tibial spine avulsion fractures (TSFs) are the pediatric equivalent of anterior cruciate ligament (ACL) injuries. The optimal management of type II fractures remains debated, and both conservative and surgical strategies have been described. This systematic review compares outcomes of nonsurgical and surgical treatments in type II TSFs and evaluates different surgical fixation techniques.

Methods: A PRISMA-guided search identified studies reporting clinical and radiographic outcomes of pediatric TSFs. Data were pooled for patient demographics, treatment, complications, and functional results. Comparative analyses were performed for conservative versus surgical management in type II fractures and for suture versus screw fixation across all surgical cases.

Results: Thirty-eight studies (1,070 patients) were included. In type II fractures (371 knees), surgical treatment achieved lower rates of clinical instability (0.7% vs. 13.2%, p < 0.0001) and residual laxity (10.2% vs. 23.2%, p < 0.01) compared with conservative care, although with a higher incidence of range of motion deficits and arthrofibrosis. Lysholm scores were significantly higher after surgery (95.7 vs. 87.9, p < 0.001). Across surgical techniques (699 patients), suture fixation showed reduced residual laxity (7.1% vs. 15.7%, p < 0.0003), fewer hardware removals (1.1% vs. 17.5%, p < 0.0001), and better motion preservation compared with screw fixation with no clinically relevant differences in functional scores.

Conclusions: Surgical treatment should be considered the preferred option for type II TSFs in active children and adolescents as it provides better stability and function. Suture fixation appears advantageous over screws and minimizes laxity, motion loss, and secondary procedures. High-quality randomized studies are needed to refine treatment algorithms.

Purpose: Restoration of medial soft-tissue restraint is essential in the surgical treatment of lateral patellofemoral instability. While anatomic medial patellofemoral ligament reconstruction (MPFLR) has become the preferred technique, non-anatomic procedures such as vastus medialis advancement (VMA) are still used in selected clinical scenarios. However, controlled biomechanical data comparing these techniques remain limited. This study aimed to evaluate and compare the tensile behavior of VMA and MPFL reconstruction using a cadaveric biomechanical model.

Methods: Ten fresh-frozen human cadaveric knees were mounted in a custom-designed biomechanical testing apparatus that simulated physiological quadriceps loading. Progressive lateral force was applied to reproduce patellar dislocation, and the failure load of the native medial patellofemoral ligament was recorded. Specimens were then randomized into two groups: MPFL reconstruction (n = 5) and vastus medialis advancement (n = 5). Tensile testing was repeated following each procedure, and the forces required to produce 10, 20, 30 and 40 mm of lateral patellar displacement were measured and analyzed.

Results: Following reconstruction, the MPFLR group demonstrated numerically higher tensile force values at 10, 20, and 30 mm of lateral patellar displacement compared with the native condition, whereas the VMA group exhibited lower tensile force values across this physiologically relevant displacement range. At 40 mm displacement, which exceeds physiological patellar translation and reflects failure behavior rather than functional stability, a reduction in tensile force was observed in both groups. Overall, mean tensile force values tended to be higher in the MPFLR group than in the VMA group; however, no statistically significant differences were observed between the two techniques in either the medial soft-tissue injury induction test or the post-reconstruction tensile rupture test (p > 0.05 for all comparisons).

Conclusion: In this cadaveric biomechanical study, medial patellofemoral ligament reconstruction and vastus medialis advancement demonstrated different construct behavior patterns, with no statistically significant differences in the tensile force required to achieve lateral patellar displacement.